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Introduction Definition of access cavity preparation Objectives Rules Principles of endodontic cavity preparation Anatomy of pulp-chamber floor Canal configurations Armamentarium Access preparation guide lines Individual tooth access-cavity preparations Errors in cavity preparations Aids in locating canals Clues in locating extra-canals Conclusion.
“It is the efficient uncovering the roof of the pulp chamber & providing the direct access to the apical foramina by the way of the pulp canals”. .
Decreased procedural errors. Improved obturation. b.According to R. Improved instrument control. Straight line access : Helps in a.E. c. the 3 main objectives of access cavity preparation are : 1. . Walton.
3. Conservation of tooth structure : Helps in a. Un roofing of chamber and exposure of horns : Help in pulp a. Maximum visibility.2. Location of canals. Minimal weakening of tooth. b. . Prevention of perforation. b.
. 3. 2.Rules for proper access preparation (Franklin S. Access cavity preparations operative occlusal preparations. The objective of entry is direct access to apical foramina. not merely to the canal orifices. Interior anatomy of the tooth. Weine) 1.
5.4. Endodontic entries are prepared through the occlusal or lingual surface – never through the proximal or gingival surface. . Unsupported cusps 6. Rubber dam – when canals difficult to find the rubber dam should not be placed until correct location has been confirmed.
Removal of the remaining carious dentin and defective restorations. Outline Form II. Toilet of the cavity .Principles of Endodontic Cavity Preparation Endodontic Coronal Cavity Preparation : I. IV. Convenience Form III.
.Principle I: Outline Form The outline form of the endodontic cavity must be correctly shaped and positioned Establish complete access for instrumentation. from cavity margin to apical foramen External outline form = internal anatomy of pulp Internal-external relationship.
(2) Shape of the pulp chamber. (3) Number of individual root canals. and their position. their curvature.Three factors of internal anatomy must be considered (1) Size of the pulp chamber. .
(3) Cavity expansion to accommodate filling techniques. . (2) Direct access to the apical foramen.Principle II: Convenience form: (1) Unobstructed access to the canal orifice. and (4) Complete authority over the enlarging instrument.
Principle III: Removal of the Remaining Carious Dentin and Defective Restorations This according to Ingle. . must be done for three reasons: (1) To eliminate mechanically as many bacteria as possible from the interior of tooth (2) To eliminate discoloration of tooth structure (3) To eliminate the possibility of any bacterialaden saliva leaking into the prepared cavity.
. bacterial growth.Principle IV: Toilet of the Cavity All of the caries. and necrotic material must be removed. before the radicular preparation is begun. debris. 0bstruction.
Anatomy of the pulp chamber floor JOE. 2.30. Vol. . Two Categories of anatomic patterns were observed: 1. Relationships of pulp chamber to the clinical crown Relationship of the orifices on the pulp chamber floor. Jan 2004.
The distance from the external surface of the clinical crown to the wall of the pulp chamber was the same throughout the circumference of the tooth at the level of the CEJ. .Relationships of pulp chamber to the clinical crown The following observations were noted: Pulp chamber was always in the center of the tooth at the level of CEJ The walls of the pulp chamber were always concentric to the external surface of the crown at the level of the CEJ.
These observations were consistent enough that several anatomic laws could be formulated: Law of centrality .the floor of the pulp chamber is always located in the center of the tooth at the level of CEJ. repeatable landmark for locating the position of the pulp chamber . Law of concentricity – the walls of the pulp chamber are always concentric to the external surface of the tooth at the level of the CEJ Law of CEJ – the CEJ is the most consistent.
The orifices of the root canals are located at the angles in the floor wall junction. The floor of the pulp chamber is always a darker color than the surrounding dentinal walls. The orifices of the root canal are always located at the junction of the walls and floor.Relationship on chamber floor: 1. 3. . 4. 2. This color difference creates a distinct junction where the walls and the floor of the pulp chamber meet. the pulp- The following observations were noted relative to all teeth.
The developmental root fusion lines are darker than the floor color. The orifices lay at the terminals of the developmental root fusion lines if present. . Reparative dentin or calcifications are lighter than the pulp chamber floor and often obscure it and the orifices.
These observations were consistent enough that several anatomic laws regarding the pulp chamber floor can now be proposed: Law of symmetry 1: Except for maxillary molars. the orifices of the canals lie on a line perpendicular to a line drawn in a mesial-distal direction across the center of the floor of the pulp chamber. Law of symmetry 2: Except for the maxillary molars. . the orifices of the canals are equidistant from a line drawn in a mesial distal direction through the pulp chamber floor.
Law of Color change: the color of the pulp chamber floor is always darker than the walls. Law of orifice location 1: the orifices of the root canals are always located at the junction of the walls and the floor. Law of orifice location 3: the orifices of the root canals are located at the terminus of the root development fusion lines. . Law of orifice location 2: the orifices of the root canals are located at the angles in the floor wall junction.
CANAL CONFIGURATIONS According to Weine .
According to Vertucci .
12. 3. 6. 8. 4. 9. Cotton pliers Broaches Glass slab Files & reamers Burs Rubber dam kit . 10. Front surface mirror Endodontic explorer Endodontic excavator Plastic instrument Irrigating solutions Spatula 7. 2.Armamentarium for Access Preparation 1. 5. 11.
2 – Mandibular anterior teeth – Maxillary premolar (narrow chambers & canals) – Incisal pulp horn area (Maxillary anterior teeth) No.Round bur No. 4 – – – – Maxillary anterior teeth Mandibular premolar teeth Maxillary premolar teeth Maxillary and mandibular molars .
Long shank. 1 – Used in the floor of pulp chamber to seek additional canal orifice. No. Taurodontism No. full crown and inlay . 6 – Only in large pulp chamber of molars i. No. 701 or 558: – Round or safe tipped tapered fissure bur – 702U: Access cavity through restoration.e..
initial access be prepared without a rubber dam in place. In difficult situation .Access Preparation Guidelines I) First step .Diagnostic radiograph visualization of the location of the pulp space. . Buccolingual angulations and coronal anatomy are judged visually.
A 1mm to 2mm of occlusal adjustment of teeth may be done.II) Restorative material impinging on the straight-line access should be removed before pulp chamber is accessed to prevent lodging of debris in the canals. Caries is removed to prevent irrigating solutions from leaking past the rubber dam into the mouth and to prevent bacterial contamination of the canal system with saliva. . Place an interim restoration.
.III) The roof of the pulp chamber is best perforated with a round bur. The bur is best directed toward largest part of pulp chamber. multi-rooted teeth. In calcified. For teeth with porcelain crowns.. A no.2 bur ( anterior and premolar teeth) A no. 4 bur should be used in molar teeth. it is better to direct the access toward the largest canal.
the round bur is used to remove the roof of the pulp chamber from underneath. This should establish an initial outline form. The pulp chamber should be frequently flushed with sodium hypochlorite solution to remove debris and bacteria.IV) Once the pulp chamber is located (with light upward pressure). . the “belly” of the bur should be used to cut on the outstroke.
and the careful examination of internal dentin color. Once the canals are located. . a no. In heavily calcified teeth . Tooth length may be determined at this point. 15 type of file is introduced into the canal to determine patency.10 or no.V) A sharp DG 16 double ended explorer is used to locate canal orifices.transillumination.
tapered.VI) Final outline form is established with a round tip. diamond bur after the canals have been located and the initial opening has been completed. This important outline form is dictated by the internal anatomy and modified to improve visibility. establish convenience form and conserve critical tooth structure. .
Pulp Canal Anatomy and Access Cavity Preparations Endodontic Cavity Preparation Maxillary Anterior Teeth .
Maxillary Central Incisor Pulp chamber: – Centrally located. – Broad mesiodistally. . – Broadest incisally – 3 pulp horns Root & Root canal Access opening: – Triangle in shape.
– 2 pulp horns Root & root canal Access opening – Triangular / ovoid .Maxillary Lateral incisor Pulp chamber – Similar to central.
Maxillary Canine Pulp chamber – Largest among single rooted teeth – Triangular (labiolingually) – Flame shaped (mesiodistally) – 1 pulp horn Root & root canal Access opening – Ovoid Anomalies – Rarely 2 roots may be present. .
Endodontic Cavity Preparation in Mandibular Anterior Teeth .
– Flat (mesiodistally) – Ovoid (labiolingually) – 3 pulp horns Root & root canal Access opening – Long oval (incisogingivally) .Mandibular Central and Lateral Incisors Pulp chamber – Smallest in the arch.
– More wide (labiolingually)
Root & root canal Access opening
– Rarely more than 1 canal and 1 root.
Endodontic Preparation of Maxillary Premolar Teeth
Maxillary First Premolar
– Narrow (mesiodistally). – Wide (buccolingually) – 2 pulp horns (Buccal & Palatal) – Roof: – Floor:
Root & root canal
– 2 roots (i.e. Buccal & Palatal)
– – – – Ovoid (buccolingually). Slight occlusal divergence Border. Differ from (Class I)
– Rarely 3 root canals
Maxillary Second Premolar Pulp chamber – Similar to 1st premolar – 2 pulp horn. – Single canal orifice. Root & root canal – Single rooted (90%) Access opening – Ovoid (buccolingually) Anomalies – Very rarely 3 root canals may be present .
Endodontic Preparation of Mandibular Premolar Teeth .
Mandibular First Premolar Pulp chamber – Transitional tooth. Root & root canal – Narrow (mesiodistally) – Broad (buccolingually) Access opening – Ovoid – Upper 1/3rd lingual incline of buccal cusp. . – 30° lingual tilt of crown. – Prominent buccal pulp horn.
Mandibular Second Premolar Pulp chamber – Prominent lingual pulp horn. Root & root canal – Wider (mesiodistally) – Broad (buccolingually) Access opening – Ovoid – Widen (mesiodistally) to the wider pulp chamber .
Endodontic Preparation of Maxillary Molar Teeth .
Maxillary First Molar Pulp chamber – Largest in dental arch. – Roof: rhomboidal Root & root canal – 3 roots and 3 canals Access opening – Rhomboidal . – 4 pulp horns.
. – Narrow (mesiodistally) Root & root canal – 3 roots & 3 canals Access opening – Similar to 1st molar with variations as anatomy dictates.Maxillary Second Molar Pulp chamber – Similar to 1st molar.
Endodontic Preparation of Mandibular Molar Teeth .
Mandibular First Molar Pulp chamber – 4 pulp horns. . – Roof: rectangular – Floor: rhomboidal Root & root canals – Usually 2 roots & 3 canals Access opening – Trapezoidal or rectangular (if 2nd distal canal present).
. Root & root canals – Usually 2 roots & 3 canals Access opening Trapezoidal or rectangular (if 2nd distal canal present).Mandibular Second Molar Pulp chamber – Same as 1st molar.
depth of pulp chamber.ERRORS IN CAVITY PREPARATION : 1. Gouging . unsuccessful search for canals or receded pulp. Under extension : Entire roof of pulp chamber not removed. overextension : caused due to failure to recognize inclinations. 3. . lingual shoulder not removed leading to curved access. Perforations : caused due to failure to recognize inclinations. 2. assuming canal is straight.
5. Missed canals : due to small access cavity. Ledge : caused due to loss of instrument control.4. 6. Broken Instruments : occurs in curved canals due to failure in extending outline/internal prep. . 7. Discoloration : incomplete removal of pulp debris.
Magnification and illumination .Aids in locating canals Presence of dark lines on the floor of the pulp chamber(dentinal map). either directly or indirectly. A drop of iodine on the floor of the pulp chamber. Use of fiber optic on buccal or lingual surface.
4. .Clues in locating extra canals RADIOGRAPHICALLY: 1. Short bulky roots. Unclear outline or unusual contour of any root. 3. 2. Sharp change in radiographic density of root canal space. Dark shadow running nearly parallel to a file in a root canal space.
Clues in locating extra root canals – Clinically .
conclusion .An Access A foundation to success.
THANK YOU .
Methods of locating calcified canals Preoperative radiograph Chronic inflammatory processes All canals must be cleaned and shaped. Serious errors with inappropriate attempts (root wall and canal perforations) can occur No rapid technique Safety approach .
Access Through Full Veneer Crowns Properly made crowns are constructed with the occlusal relationship of the opposing tooth as a primary consideration Preoperative radiograph Achieving access through crowns should be done with coolants because frictional heat .
Once penetration of metal accomplished can change to a sharp. . Metal filings and debris from the access cavity should be removed. round bur and move toward the central pulp chamber.
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