Root Canal Anatomy: Implications in Biofilm Disinfection

Abstract

The primary goals of endodontic treatment are to disinfect and to seal the root canal system as effectively as possible, aiming to establish or maintain healthy periapical tissues. Treating complex and anomalous anatomy requires knowledge of the internal anatomy of all types of the teeth before undertaking endodontic therapy. Recently, three-dimensional imaging using micro-computed tomography has been used to reveal the internal anatomy of the teeth to the clinician, bringing new perspectives on the overall quality of the endodontic treatment and confirming the inability of shaping tools in acting within the anatomical complexity of the root canal. Furthermore, the disinfecting effects of instruments and irrigants may be additionally hampered in the presence of accessory canals, ramifications, intercanal connections, fins, isthmuses, and apical deltas, which can be ideal sites for microbial biofilm formation and cannot be properly assessed by conventional techniques. Apart from biofilms, these hard-to-reach areas may also be packed with dentin debris generated and pushed therein by endodontic instruments, interfering with disinfection by both preventing the irrigant flow into them and by neutralizing its efficacy. This chapter provides an overview of recent information on the complexity of root canal anatomy and discusses its relationship to the understanding of the principles and problems of microbial biofilm elimination.