The Study and Relevance of Pulp Chamber Anatomy in Endodontics – A Comprehensive Review

Abstract

With the ever-increasing understanding of tooth anatomy, there is a renewed focus on the pulp chamber as an important component of the root canal system. For example, the pulp chamber is of critical relevance during diagnostic procedures such as pulp sensibility tests, deep caries removal, vital pulp treatments, access cavity preparation, tooth whitening, tooth restoration as well as methods for examining the floor of the pulp chamber to aid the detection of root canal orifices or the presence of perforations and cracks. The more recent concept of minimal invasive endodontics has also created a need to understand better the anatomy of the pulp chamber. The purpose of this article is to discuss the research methods used to study pulp chamber anatomy and the significance of the pulp chamber in endodontic research and clinical practice. In addition, directions for future research are emphasised.

A Proposal to Develop a New Classification for Pulp Chamber Anatomy

“…The pulp chamber of each tooth type has characteristic anatomical features that must be understood before commencing root canal treatment ( 10 ). Anatomical variations of the pulp chamber (shape, size and floor) also occur in teeth with dental anomalies such dens invaginatus, dens evaginatus, C-shaped canals, taurodontism, tooth fusion and gemination ( 9 , 19 – 22 ). This is in addition to characteristic features for the pulp chamber of teeth with dentine disorders such as dentine dysplasia ( 23 ).…”

“…Calcified pulp chambers are likely to have a delayed response in teeth compared to those with larger pulp chambers that usually have prominent pulp horns ( 24 , 25 ). The pulp horns correspond to the incisal edge or major cusps in anterior and posterior teeth, respectively ( 9 ). The location of pulp horns will impact on the location where pulp sensibility tests (thermal and electric pulp testing) should be applied ( 24 , 26 – 28 ).…”

“…The pulp chamber is defined as the portion of the pulp space within (or extending just apical) the anatomic crown of the tooth that contains the coronal pulp tissue and consists of the pulp horn(s) and body leading to the orifice(s) of the root canal(s) ( 6 , 7 ). The shape, size and position of the chamber originally reflects the anatomy of the crown ( 8 ), but is particularly subject to morphological changes as a result of age and as a defensive mechanism against irritation ( 1 , 9 ) ( Fig. 1 ).…”