Endodontic Topics 2011, 19, 2232

All rights reserved

2011 r John Wiley & Sons A/S

ENDODONTIC TOPICS 2011
1601-1538

Disassembly techniques to gain

access to pulp chambers and root
canals during non-surgical root
canal re-treatment
JOHN S. RHODES
Received 26 October 2009; accepted 14 December 2010.

Introduction
Gaining access to root canals for non-surgical retreatment may involve the removal of existing restorations, posts, cores, and material from the orifices of the
root canals. All of these factors can make re-treatment
more complex and challenging. This paper discusses
the removal of restorations, crowns, bridges, posts, and
core material.

Intracoronal restorations: to remove

or not?
While completing the treatment planning exercise, it is
worth considering how the previous root treatment
may have failed. Are there obvious macroscopic signs of
coronal micro-leakage (1)? Is it likely that microorganisms were not removed during the previous
treatment, or have they gained access via a leaking
restoration, or both?
It has been shown that the quality of seal provided by
the root filling may be more important in the
prevention of periapical periodontitis than the coronal
restoration. The quality of the coronal seal is important; however, Tronstad et al. (2) reported that a
success rate of 81% was achievable when a good root
filling was combined with a good restoration as
opposed to 71% when a tooth with a good root filling
was restored with a poor restoration. It is well
documented that coronal leakage can occur, especially

22

when a poor coronal restoration is combined with a

poor root filling (3, 4). During root canal re-treatment,
the canals are often filled with a medicament between
visits and these may be vulnerable to recontamination if
the coronal restoration is leaking. Therefore, if there is
any doubt as to the integrity of seal, then a restoration
should be removed. It is imperative that the coronal
seal is maintained before, during, and after endodontic
treatment (Fig. 1).
Restorations that may be encountered during disassembly include crowns, bridges, posts, and cores.

Removing crowns
If a crown has defective margins or has been undermined by caries, it should be removed. Retaining such a
restoration may jeopardize successful root canal retreatment because of the risk of reinfection.
By removing a full coverage restoration, the condition and amount of remaining tooth substance can be
assessed (Fig. 2). It is important to preserve sound
remaining tooth substance in order to aid isolation
during treatment and enhance future restorations.
Visibility and achieving straight line access to the root
canals is improved (5) when a crown is removed. In
addition, difficulty locating the canal orifices in
situations where the prosthesis is morphologically or
anatomically different than the previous natural tooth
is avoided.

Disassembly techniques to gain access to pulp chambers and root canals

Fig. 1. The radiograph shows a poorly root-filled

maxillary first molar. The root canals are underprepared and under-filled. The attempt at root canal
treatment was carried out through the existing
restoration but there are obvious macroscopic signs of a
gap at the distal margin under an amalgam filling, which
in turn would allow micro-leakage. It would have been
better to remove the restoration prior to root canal
treatment.

technique may be required for isolation. If there is

insufficient tooth substance remaining onto which a
rubber dam clamp can be placed, or the margins are
deeply subgingival, then it is questionable whether the
tooth is restorable. Another management optionF
such as extraction and replacement with an implant,
bridge, or dentureFmay be more appropriate and offer
a more successful long-term solution.
If the crown is of good quality, i.e. both clinically and
radiographically there does not appear to be any
marginal deficiencies on a macroscopic scale, it may
be retained. If the restoration does not need to be
replaced as part of the overall treatment plan or has
only recently been fitted, root canal re-treatment can
normally be carried out through a conservative access
cavity, which will be sealed using adhesive restorative
materials following treatment. It is worth remembering that any restoration has the potential for microleakage and that the operator can only assess this on a
macroscopic scale by looking for evidence of staining,
caries, marginal gaps, loosening of a restoration, or
radiographic changes. In a laboratory study using
incisor teeth, Yu & Abbott (7) reported that cutting an
access cavity resulted in a 15% reduction in relative
strength, and 5% when amalgam was used to restore
the cavity to the level of the dentin. This increased
considerably when the amalgam was finished level with
the coping. Restoring a tooth with a plastic material
following access cavity preparation should not greatly
affect the survival of the restoration.

Methods for removing crowns

Fig. 2. Root canal re-treatment is being undertaken in
this tooth. Removal of the restoration has allowed better
visualization of the root canals and assessment of caries.

The various methods used for removing crowns are

listed in Table 1.
Table 1. Methods for removing full coverage restorations

It is essential to warn a patient that a restoration could

be damaged during access cavity preparation or may
need to be removed. Informing the patient before
embarking on disassembly generally results in the patient
being more likely to accept the potential additional cost
of a new restoration should it be required.
The remaining tooth substance can sometimes be
difficult to isolate with a rubber dam following removal
of the restoration. This may be overcome by carrying
out crown lengthening, building a simple core in a
dual-cure composite or recementing the existing
restoration with glass ionomer as a temporary measure
following caries removal (6). Alternatively, a split dam

Method

Observations

Sectioning

Destroys restoration but preserves tooth substance

Levering

Risk of tooth fracture; best used when restoration

is loose

Forceps

Risk of tooth fracture; easy to apply excessive force

Lifting
devices

Minimal damage to restoration; may be possible to

re-use. Requires sound core or tooth substance to
lever against

Ultrasonics

Unlikely to remove restoration but useful to

undermine margins and may reduce force required
to remove

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Fig. 3. The simplest means of removing a cast restoration

is to section it and elevate the pieces.

Sectioning
Probably the simplest way to remove a crown or bridge
abutment is by sectioning with a bur and then
separating the pieces (Fig. 3). This is particularly relevant
with ceramic restorations, which can be very difficult to
remove intact. This method also reduces the risk of
damage to the underlying tooth substance and core.
Metal restorations can easily be cut using a tungsten
carbide fissure bur such as a Jet Beaver bur (Beavers
Dental, Morrisburg, Ontario, Canada) (8). The crown
is partially sectioned by cutting a groove from the
gingival to the occlusal surface. A crown remover, flat
plastic, or Couplands chisel can be used to open up the
groove and flex the restoration, breaking the cement
lute. It is worth checking that the restoration is
completely severed at the gingival margin, otherwise
prising the crown apart is impossible. Some crowns, if
particularly well cemented, will need to be peeled off
the tooth (9).

Levering and tapping off

1. Chisel, flat plastic, and Couplands chisel
Careful placement of a chisel, flat plastic, or Couplands
at the gingival margin of a crown can be sufficient to
cause the cement lute to fail. Force should be applied
with a wedging (rotating) action so that the restoration
is encouraged to dislodge while fracture of the underlying tooth substance and core material is hopefully
avoided. The instrument should be held with a
forefinger near the tip so that if the instrument slips
there is no risk of injury to the patient. A small diamond

24

bur or an ultrasonic tip can be used to make a gap into

which the chisel blade can be inserted.
An access cavity can be cut in the occlusal surface and
the instrument inserted between underlying core material and the underside of the crown. By cutting an access
cavity, retention of the crown is significantly reduced and
should therefore make crown removal easier (10, 11). A
diamond bur is preferred for cutting porcelain and a
tungsten carbide bur is used to cut through metal.
2. Chisel and mallet
A straight chisel and mallet can be used to tap off the
crown. Obvious risks include slipping with the chisel,
fracture of the underlying tooth substance and/or
restoration. It is also not that pleasant for the patient!
3. Forceps
Special forceps for crown removal are available with
protective rubber beaks. When coated in carborundum
powder, they grip the crown. Surgical extraction
forceps can be used but great care must be exercised
to ensure that the instrument does not slip or that
excessive force is not placed on the tooth, thereby
damaging it. Generally, forceps are applied to the
crown that needs to be removed and a gentle
wiggling action used to loosen the restoration.
One must be careful not to damage adjacent or
opposing teeth. If there is a cast post present, the
restoration should not be rotated as this will increase
the risk of root fracture.

Lifting devices and techniques

1. The Richwell Crown and Bridge Remover
This consists of a water-soluble resin which is softened
in hot water and placed on the restoration that needs to
be removed. The patient bites down and compresses
the resin block to about two-thirds of the original
thickness. When the resin has cooled, the patient opens
their mouth quickly and hopefully lifts or loosens the
restoration. The restoration from an opposing tooth
can sometimes be removed!
2. Ultrasonics
It can be useful to loosen the cement from around the
margins of a poorly fitting crown using ultrasonics.
This could be a simple ultrasonic scaler tip vibrated at
high power with a water spray or a specialist tip such as
the CT4 (SybronEndo, Orange, CA, USA). The
technique is not recommended if a porcelain crown
needs to be removed with little damage as there is a
significant risk of fracture. Vibration of well-fitting

Disassembly techniques to gain access to pulp chambers and root canals

cemented cast restorations with ultrasound had little
effect on retention in a laboratory study (12).
However, the means by which the ultrasound is
generated may be important; Piezon handpieces can
generate higher forces than magnetostrictive units and
it is perhaps relevant to note that most crowns which
need to be removed during root canal re-treatment are
poorly fitting or have undergone some micro-leakage
and dissolution of the luting cement. It has been
reported that ultrasonic vibration for up to 12 min
could be an advantageous adjunct in reducing the
retention of cast crowns (13).
3. Crown removers
The basic crown remover consists of an attachment that
is inserted under the margin of the restoration to be
removed. This in turn is connected to a rod with either
a weight- or a spring-loaded device to apply a sudden
force, which breaks the cement lute. Well-fitting
restorations obviously present a problem as it is difficult
to find a margin under which the instrument can be
inserted.
Mechanized devices such as the KaVo Coronaflex
(KaVo Dental Ltd., Amersham, UK) work by delivering pneumatic force. Special forceps or bands are
provided which can be linked to either crowns or
bridges. The mechanized devices may be more
comfortable for the patient.
4. The Wamkey
There are three key-like instruments (Fig. 4) in the kit
(Dentsply, Weighbridge, UK). A small access is cut in
the buccal or lingual surface of the crown such that
space is made between the underside of the restoration
and any core material or sound tooth substance

Fig. 5. A small cavity has been cut in the buccal surface

of the restoration into which the Wamkey is inserted
and rotated. The underlying tooth substance is shown in
Fig. 2.

(Fig. 5). The key is then inserted and rotated,

separating the crown from the underlying core
material. The Wamkey device works best on metal
crowns and when there is solid core under the crown.
Removal in this way may allow the crown to be reused
as a temporary restoration. There is a risk of porcelain
fracture if the Wamkey is used to remove metal ceramic
restorations. When the core material is soft or there is
significant caries, the key may be ineffective.
5. Metalift
The Metalift (Baton Rouge, Los Angeles, CA, USA)
instrument consists of a self-tapping screw which is
inserted through a hole made in the occlusal surface of
the restoration. As the screw is rotated, it engages the
crown and presses on the underlying core material,
applying force between the two. It can be used to
remove metal restorations but requires solid core
material to work against it. Cotton wool can sometimes
be plugged through the hole to produce a firm base
when the core material is soft. Flexure of the
restoration can occur when the metal is thin, and
porcelain fracture can occur when removing a metal
ceramic restoration. Occasionally the screw taps into
the core material and is therefore ineffective.

Removing bridges

Fig. 4. The Wamkeys are a series of instruments that can

be inserted between the underside of a restoration and the
underlying core in order to break the cement lute.

The retainers of bridges can normally be treated as

individual crowns and access is often made in the
occlusal surface in the normal manner. A split dam
technique can be useful to achieve isolation and
caulking will be required to block out the area under
the pontics (6). A simple tip is to place caulking under

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Rhodes
the pontic area before placing the dam as this ensures a
good seal under the rubber sheet.
If a bridge is to be sectioned and removed, it is
important that the remaining portion, if cantilevered,
does not allow excessive force to be placed on the
abutment and so risk fracture. In the anterior region of
the mouth where esthetics are important, it may be
easier and beneficial to construct a temporary bridge
using an acrylic material. When glazed and polished, a
very good cosmetic result can be achieved. Alternatively, a temporary denture may be provided.

Removing posts
Post removal has been shown to be a predictable
procedure and, using appropriate techniques, rarely
results in root fracture (1420). In a survey of
Endodontic Specialists in Australia and New Zealand,
66% preferred to remove a post in order to complete
root canal re-treatment. Although 45% had witnessed a
root fracture during post removal, the incidence of root
fracture was less than 0.002% overall (21).
The various types of posts are described in Table 2.

Ultrasonics in post removal

The use of ultrasonics has been shown to be invaluable
for the removal of posts (Fig. 6). Dowel and core posts
cemented with zinc phosphate and vibrated with
ultrasound for 8 min required 26% less force in order
Table 2. Types of posts encountered during non-surgical
re-treatment
Type

Removal
Difficulty

Shape

Observations

Anatomical/
cylindrical

Ultrasonics and Moderate when

pulling devices well cemented
work well

Metal
Cast

Pre-formed Cylindical/
tapered

Ultrasonics and Simple

pulling devices
work well

Fiber

Cylindrical/
tapered

The post can

usually be
drilled out

Ceramic

Anatomical/
cylindical

Ultrasonics have Difficult when well

little effect on
cemented
hard ceramics

26

Simple/moderate

Fig. 6. Ultrasonic tips for use in Endodontics. ProUltra

tips (Dentsply Maillefer, Ballaigues, Switzerland) are
shown. Tip 3 is useful for undermining posts and
removing core material from the pulp floor. Tip 4 is
used to vibrate posts for removal.

to be displaced (22). Anatomic, cast, and pre-fabricated

posts cemented with glass ionomer and vibrated with
ultrasound for 3 min were significantly easier to remove
(23). Another laboratory study showed that 2 min of
ultrasonic vibration significantly reduced the forces
require to remove posts (24), while Paraposts cemented in premolar teeth were effectively removed in
16 min with ultrasound vibration (25). In contrast,
another laboratory experiment showed metal type,
cement type, and ultrasonic vibration did not influence
the force required for removal. These posts were
parallel-sided pre-fabricated posts cemented with zinc
phosphate, glass ionomer, and resin and vibrated with
ultrasound for 16 min (26). The bond strength of zinc
phosphate cement on nickel chromium alloy was
reduced after 1 min of ultrasonic vibration compared
with resin and glass ionomers, which required 5 min
(27). Vibration with ultrasound for 10 min reduced the
retentive force required to remove posts cemented with
zinc phosphate by 39% compared with 33% for glass
ionomer and had no effect on those cemented with
resin ex vivo (28).
Various ultrasonic units have been tested for their
performance: piezon units with specialist tips at high
power and with maximum audible sound seemed most
efficient (29). Both magnetostrictive and piezon units
have been shown to be useful in post removal but sonic
devices are not effective (30).
Running an ultrasonic post removal tip at high
power and without coolant waterspray will result in
generation of heat. Ex vivo, ultrasound applied to a

Disassembly techniques to gain access to pulp chambers and root canals

stainless-steel post for longer than 15 s generated high
temperature (31). Obviously in the clinical situation
this could potentially lead to damage of the periodontal
ligament and consequently the tips are usually used
with coolant, either directed through the tip or
intermittently via a 3 : 1 tip.
Histological investigation in dogs following ultrasonic post removal showed little evidence of harmful
influence on the periodontal tissue, excluding transient
and reversible inflammation (32).
Another potential problem that has been cited with
the use of ultrasonics in this way is crack formation in
the root substance. Prolonged application of ultrasonic
vibration to ceramic posts has been shown to increase
the incidence of root-face cracks (33). Cracking did not
appear to be a significant factor in the removal of
stainless-steel posts.
It would appear that the use of ultrasonic vibration is
a safe method in the removal of posts, and coolant will
reduce potential heat production. Well-cemented posts
are far more difficult to remove and ultrasound alone
may not be effective. Fortunately many posts that need
to be removed during root canal re-treatment will have
been subject to micro-leakage and the cement lute
weakened, therefore making removal in the clinical
environment potentially easier than that simulated in
laboratory studies.

Screw posts
The simplest means of removing a screw post is to use
the wrench provided by the manufacturer for insertion
to unthread it from the canal.
Core material is carefully removed from around the
head of the post using a bur and ultrasonic tips such as
the CT4, CPR 2 (Obtura-Spartan, Fenton, MO,
USA), BUC 1 (Obtura-Spartan, Fenton, MO, USA),
or Pro Ultra Endo tips 2 or 3 (Dentsply Maillefer,
Ballaigues, Switzerland). The head of the post is left
intact. Ultrasonic tips are used in a Piezon ultrasonic
unit and vibrated at reasonably high force with water
spray. It is generally useful to remove some of the
cement lute with ultrasonics prior to using a wrench.
The Dentatus (Dentatus AB, Hagersten, Sweden) or
Radix Anker (Dentsply, Weybridge, UK) are two types
of screw posts.
Radix Anker posts have grooves along the main shaft
into which luting cement can flow. Care should be
exercised when attempting to remove such a post as

they can become mechanically locked. The wrench

should never be forced.
Following isolation of the post and removal of core
material, a wrench is used to unscrew the post. If the
head of the post has been damaged so that a wrench no
longer fits, then a small piece of cotton wool can be
placed over the end of the post to provide a tighter fit.
Screw posts can sometimes be removed using
ultrasound. The ultrasonic tip is worked around the
post in an anti-clockwise direction to help loosen and
unscrew it. If it is sufficiently loose, the post may
actually unwind itself from the root canal.

Cast posts
Historically, cast metal posts were commonly used to
restore anterior teeth. More complex cast cores are
sometimes found on posterior teeth and can be
dismantled using similar methods. If a core in a
posterior tooth has posts in more than one canal, the
core material can be sectioned with tungsten carbide
and the pieces removed individually.
There are three phases to the removal of a cast post:
Removal of the coronal restoration Having decided
on the form of temporary restoration, the coronal
restoration covering the post and core is removed.
Uncovering the post It is helpful to undermine the
margins of the core to aid removal. This can be
achieved either with an ultrasonic tip or LN bur (B205
LN bur, Dentsply Maillefer, Ballaigues, Switzerland).
Extraction Ultrasonic force is applied, with water
spray in the long access of the tooth by cutting a notch
in the core. An ultrasonic scaler tip or CPR1 can be
used. If the post does not loosen following 10 to
15 min ultrasonic vibration, an alternative removal
method would be used and less force should subsequently be required to remove the post.

Post removal devices

There are several post removal devices available
including the Sword post puller (Carl Martin, Solingen, Germany), the Eggler post remover (Automaton
VertriebsGesellschaft, Stuttgart, Germany) (34), the
Gonon or Thomas post remover (FFDM Pneumat,
Bourges Cedex, France) (19), and the Ruddle post
removal system (SybronEndo, Orange, CA, USA).
Essentially all of these devices work on the principle of
exerting a force between the root face and the post such

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Fig. 7. The working head of a Ruddle post removing

instrument. The remover (arrow) is screwed onto the
remains of the post that has been milled with a special
trephine. The jaws of the extracting pliers are placed
between the head of the remover and rubber bungs that
protect the tooth substance. When the jaws open by
rotating a screw, force is exerted along the long axis of the
post to remove it (arrowhead).

that the cement lute can be broken. Once this has been
achieved, the post can be removed easily with Stieglitz
forceps. Although post removers have been shown to
be more efficient in removing posts (35), vibration
with ultrasound could significantly decrease the force
required for removal. Post removers should never be
used to try to remove screw-type posts as there is a risk
of root fracture.
1. The Ruddle Post Removal Kit
Before using this post remover, it is useful to check
that there is sufficient interproximal space between
the adjacent teeth for the jaws of the remover.
Core material is first reduced in size so that a trephine
drill from the kit can be used to mill the core
into a cylinder (Fig. 7). Several rubber bungs are
used to rest on the root surface and protect it. These
are fitted onto the shaft of the remover, which is
then screwed onto the milled core. The jaws
of the extracting pliers are placed between the
head of the remover and the rubber bungs. When
opened by rotating a screw, force is exerted along the
long axis of the post and causes the cement lute to fail.
Excessive force should not be applied so that the
remaining root structure does not fracture and rubber
bungs should always be used on the jaws to act as a
cushion.
2. The Sword Post Puller
This is effectively a mini post puller with jaws that grip
the head of the post and feet which fit on the shoulders

28

Fig. 8. The tip of a Masserann trephine. This is a useful

instrument for removing a conservative amount of material
from around a cylindrical object before vibrating with
ultrasound. It can also be used to remove posts.

of the root surface. It is sometimes difficult to obtain a

good purchase on the remaining post fragment and the
jaws may slip off in this instance.

Removal of a fractured metal post

There are three phases to the removal of fractured posts
from within the root canal system.
Make space space is required to allow removal of the
fractured piece of post. This provides an exit pathway.
Loosen the post fragment or post is normally
loosened using ultrasonics. This may take between
2 and 16 min. Irrigant spray will also break up and
remove luting cement from around the post.
Removal/retrieval if the post cannot be removed
using ultrasonics alone then it can usually be retrieved
using the Masserann kit.

The Masserann kit

Trephines The Masserann device (Micro-Mega,
Besancon, France) was designed for the removal of
metallic objects lodged in the root canal. The kit
consists of a series of fourteen color-coded trephines
ranging from 1.1 to 2.4 mm (Fig. 8). The trephines are

Disassembly techniques to gain access to pulp chambers and root canals

Fig. 9. (a) The crown on this tooth has been sectioned and the pieces have been elevated. Resin cement is retained on the
core material. (b) A ProUltra tip number 4 is used to remove cement and undermine the core. A notch has been cut in the
core, into which the ultrasonic post removing tip will fit. (c) A ProUltra tip number 3 is used to vibrate the core.
Unfortunately this does not loosen the post, but the gold core separated from the underlying metal post. (d) The core has
been removed following ultrasonic vibration, leaving the post cemented in the root canal. As the post was serrated and
likely to be cemented with resin cement, a post puller was not used in this instance. (e) A Masserann trephine was used to
conservatively remove material from around the post, which was then vibrated with an ultrasonic tip cooled with water
spray. (f) After about 5 min, the post was retrieved using a Masserann trephine.

designed for removing material from around a

fractured object, for gripping it, and for extracting
large-diameter objects such as posts (36). This device is
best used in the coronal aspect of the root canal where
access is good and remaining tooth tissue more
substantial.
Extractors Two extractors consisting of a rod and
tube can be used for removing smaller diameter objects
such as silver points and instrument fragments. There
are now more conservative methods available for
working within the confines of the root canal with
the aid of a microscope.
Gauges There are two sets of gauges that correspond to the trephines and can be used as measuring
devices.
Technique The Masserann kit is an excellent means
of removing fractured cylindrical post fragments from
the coronal part of the root canal (Fig. 9).
The trephines, which cut in an anti-clockwise
direction, can be used in a speed-reducing handpiece
or attached to a long handle that is rotated by hand. If
the post has a circular cross-section, a trephine is
selected that is slightly larger than the post diameter.
This is used to remove a small amount of dentin and
any cement lute from around the head of the fractured
post. An ultrasonic tip such as a CT4, CPR1, or scaler
tip (15) can then be used to vibrate the post fragment.
The unit is used at high power with irrigant spray to
prevent over-heating and to remove debris. A smaller

trephine is used to grip the fragment of post and

retrieve it.
Removal will probably be more difficult if resin
cements have been used to cement the post (37, 38).
In the clinical environment, micro-leakage will often
contribute to failure of the cement lute and subsequently
help reduce the time required for removal (39).

Fiber and ceramic posts

Fiber posts are constructed of carbon fiber, glass, or
quartz fibers in a composite matrix. They are normally
bonded into the root canal using dentin bonding
agents. This can sometimes make them difficult to
remove. Fortunately, most of the posts that will need to
be removed during root canal re-treatment will have
failed as a result of coronal micro-leakage and therefore
the bond interface has often failed. These can sometimes be removed using artery forceps or a post puller.
Fiber posts can be drilled out using special burs from
the corresponding post removal kit (40). These are used
to remove post material following the creation of a pilot
channel down the center of the post with a small round
swan neck bur (DT205 LN bur, Dentsply Maillefer,
Ballaigues, Switzerland). A laboratory study examining
the efficiency and effectiveness of various methods for
removing four different types of fiber post showed that
removal kits were significantly more efficient; diamonds
and ultrasonics took on average 10 min longer but were

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more effective (41). Fiber posts can also be removed
using Peezo drills or Gates-Glidden burs (42).
Titanium posts cemented with resin cement took
longer to remove than titanium posts cemented with
glass ionomer or fiber posts cemented with resin (43).
The fiber posts were removed by coring them out
internally while the metal posts were vibrated with
ultrasound. Little difference was demonstrated between three fiber post removal systems ex vivo (44) and
removal should therefore not be unduly complicated.
Ceramic posts, when well cemented, can be extremely difficult to remove. A Masserann trephine can
be used to effectively drill them out; however, care
must be taken to preserve as much root substance as
possible. Ultrasonics are not always effective in removing such posts, and there is a reported risk of inducing
root microfracture.

Removing plastic core material

Cores are generally constructed out of amalgam or
composite. The Nayyar core (45) is advocated as a
means of restoring posterior teeth without the need for
posts. The material is normally packed into the coronal
3 mm of the root canals. It is very important not to try
to remove this material using a bur as the risk of root
perforation is high.

Dismantling a Nayyar core

An estimate of the depth of material can be made from
a paralleling radiograph. Using magnification and
illumination, the coronal portion of the restoration is
removed either with a tungsten carbide or diamond
bur until the boundaries of the original access cavity
become evident. Core material is removed until the
pulp floor just becomes visible. An ultrasonic tip such as
a CT4, CPR2, BUC1, or Pro Ultra Endo tip 2 is then
used on medium to high power with irrigant spray to
carefully break up core material across the pulp floor.
Using the same instrument, material can be removed
conservatively from the coronal part of the root canal
without risking perforation (Fig. 10) (46). The CPR2,
BUC1, and ProUltra 2 tips are diamond coated and
effective at removing amalgam and composite.

Access cavity design

A well-designed access cavity permits:
! complete debridement of the pulp chamber;

30

Fig. 10. Using an ultrasonic tip to remove core material

from the pulp chamber floor in order to uncover the canal
orifices.

! visualization of the pulp floor;

! unimpeded placement of instruments into the root
canals; and
! conservation of tooth tissue.
Good access cavity design and preparation is imperative for quality treatment results, prevention of
iatrogenic problems, and to avoid technical failure in
endodontic treatment. Conservation of coronal tooth
structure should never preclude the proper design and
fulfillment of the purpose of the access opening (47).
Extraneous material, caries, and overhanging remnants
of the pulp roof all need to be removed.
The number of canals and their approximate positions
can be predicted from a sound knowledge of dentinogenesis and the nature of root formation. Magnification
and illumination with an operating microscope enhances
the detection of canal orifices (48).
To prevent damage to the floor of the pulp chamber,
non-endcutting burs or ultrasonic tips are used to
remove dentin.
Careful inspection of the pulp chamber floor will reveal
subtle changes in the color of the dentin that aid in the
identification of the canal orifices. Dark developmental
lines may be visible linking canal orifices, which will
appear as a small area of opaque dentin against a
background of yellow/gray secondary dentin. A canal
orifice will feel sticky when probed with a DG16
endodontic probe or Micro-Opener (Dentsply Maillefer,
Ballaigues, Switzerland). In extensively calcified canals,
transillumination or the use of dyes may provide some
guidance for canal orifice identification.
The pulp chamber is irrigated with sodium hypochlorite (NaOCl) during access cavity preparation to

Disassembly techniques to gain access to pulp chambers and root canals

clear debris. This will also reduce the inadvertent
inoculation of micro-organisms from the pulp chamber
into the root canal system.
Once the canal orifice(s) have been identified, it may
be necessary to refine or modify the outline of the
original access cavity to allow endodontic files unimpeded, straight-line access into the coronal third of the
root canal system. Straight-line access will reduce the
likelihood of iatrogenic problems such as zips, elbows,
and ledges being created.

13.

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