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Faculty of Dentistry
Laboratory endodontic manual Guide for practical steps:access opening for Anterior Teeth
During endodontic treatment. ANATOMY OF ANTERIOR TEETH Maxillary Central Incisor The maxillary central incisor has a roughly triangular shaped crown with its pulp chamber reflecting that same shape. mesial and distal. Describe the access outline and process for making access into all anterior teeth. 3. Cite the most common error in making endodontic access. Describe the two basic outline shapes of access and give the reason for their shapes. Maxillary centrals very rarely have multiple canals. usually to the buccal or lingual. all tissue must be removed from the pulp horns. 4. They often have accessory canals. The triangular shape of the pulp chamber creates two pulp horns. Accessory canals can often be visualized after obturation of the root by the presence of radiopaque sealer in the accessory canals. 2. If tissue is left behind in the pulp horn extensions. Discuss general principles in controlling the depth of access. Discuss the internal anatomy of all anterior teeth. Accessory canals may be implied on the radiograph of a tooth with necrotic pulp by the location of a radiolucency in the bone adjacent to an accessory canal – a radiolucency is usually centered on its source. 8.5mm. The average length of the maxillary central is 22. pigments from the breakdown of the tissue can cause discoloration of the tooth. . 5. 6.ACCESS OPENING Outcomes 1. though. which are not visible on a radiograph before endodontic treatment. Approximately 45% of maxillary centrals have the foramen located away from the anatomic terminus (apex) of the root. Discuss procedures to avoid making errors in endodontic access. Demonstrate proper processing of radiographs.ANTERIOR ANATOMY:. Explain the objectives of endodontic access. 7.
cutting with the top of the round bur. the access is usually oval. the chamber is unroofed with withdrawal strokes.5mm. The outline is made to be oval instead of triangular if the pulp chamber is found to be of average size. Mishandling of the apical curvature during instrumentation can result in failure of the endodontic treatment (the maxillary lateral incisor has one of the highest failure rates). After penetration is made.The coronal pulp is ovoid in cross-section and the access preparation reflects this shape. The shape of the pulp chamber in the lateral is triangular like the central. though. The preparation may be smoothed using the Endo-Z bur. Maxillary lateral incisors very often have a moderate to severe distal curvature in the apical 1/3 of the root with the foramen most often corresponding to the anatomic apex. The curve may also have a palatal aspect to it. Initial penetration into the pulp chamber is made with the bur at the cingulum area of the preparation. The maxillary lateral has a coronal shape similar to the central but with smaller dimensions. reflecting the triangular form of the pulp chamber.Access into the maxillary central is triangular in shape. The average length is 22mm. This is removed using a long shank #2 or #4 round bur or Gates-Glidden drills creating straight-line access into the canal. There may be a lingual overhang of dentin partially obstructing the orifice of the canal. Due to the smaller dimensions of the lateral. If the lateral incisor is larger. almost the same as the central. the outline may be triangular. Maxillary Lateral Incisor Maxillary Canine The maxillary canine is the longest tooth in the dental arch with an average length of 26. . It is made by first cutting the triangular outline into tooth structure to a depth of 2mm. The root may have mild to moderate apical curvature and the foramen is usually close to the anatomic apex. with a corresponding larger pulp chamber. Access is accomplished similarly to the maxillary central incisor.
though. keeping the outline oval in shape. Average length of mandibular incisors is 20. Access extends from the cingulum 2/3 the distance to the incisal edge or. A #2 round bur may be used to make the access preparation to prevent overextension. . may on occasion have two canals or two roots evidenced on the radiograph by an apparent termination of the visible canal somewhere at mid-root level. even to the incisal edge. It is very often obscured from view by an overhang of dentin that must be removed to make complete access. A mandibular incisor should usually be treated as if it has 2 canals. After obturation. However. ribbon shaped reflecting the same dimensional proportions as the exterior root surface. but if a view were taken from the proximal.7mm. the clinical radiographic view may not reveal much taper in the shape of the canal. two separate foramina occur less than 5% of the time. The oval shaped access preparation is made very carefully and is not expanded at all mesio-distally beyond the width of the #557 or #4 round bur. The second canal (or second lobe of the dumbbell shaped canal) is usually located toward the lingual after initial access is made. Where two canals are present. sometimes.Accessory canals occur less frequently than in maxillary incisors. similar to the maxillary canine. Access is made in a manner similar to the central and lateral. It is a fairly straightforward tooth with minimal complications. therefore. Two canals or a dumbbell shaped canal occur in 40% of mandibular incisors. The pulp space is. This access is easily restored with bonded composite.6mm. Mandibular Central and Lateral Incisor Mandibular Canine The mandibular canine has an average length of 25. The root apex may have a distolabial curvature. The incisal extension is about 2/3 of the distance to the cusp tip. Severely rotated mandibular incisors or those with lingually tipped crowns may require access on the labial surface. sparing the mesial and distal surfaces. The mandibular canine. a significant taper would be seen. Instrumentation is done in mandibular incisors at the expense of the facial and lingual surfaces of the canal. Mandibular incisors have their greatest cross-sectional dimension in the facial-lingual direction and are very narrow mesio-distally.
Nonetheless. If so. ASK FOR HELP!! . When in doubt. an instructor must be consulted. both must be located and treated. take at least 2 radiographs (at different angles) to help guide you along with faculty consultation. then go to this predetermined location. SUMMARY: The most common error made in accessing anterior teeth is perforation of the facial crown or root surface. Frequently the foramen exits to the buccal or mesial (35%-50%). If the canal is not easily encountered within the confines of the crown of the tooth. If you do not find the pulp chamber at this point. Always have an objective when you cut on a tooth.it is usually easier to gain access into one than the other. The access preparation is oval as in the maxillary canine. Remember to estimate the location of the pulp chamber and if you do not find it there take a radiograph and ask for help In order to minimize perforations you must evaluate the radiographs and estimate where the pulp chamber will be found and determine if you are comfortable with this search.
MAXILLARY CENTRAL INCISOR .
MAXILLARY LATERAL INCISOR .
MAXILLARY CANINE .
MANDIBULAR CENTRAL AND LATERAL INCISOR .
MANDIBULAR CANINE .
Get help if you have not found the pulp chamber at this point. Hold the bur perpendicular to the lingual surface and make an outline of the access preparation 2 mm into tooth structure. Make initial penetration into the pulp chamber. Mandibular incisors may extend all the way to the incisal edge. The preparation extends from the cingulum to 2/3 of the cusp height. ANTERIOR ACCESS . Locate the opening into the chamber with the DG16 endodontic explorer. sweep it incisally. Use a #2 F. unroofing the rest of the pulp chamber. then with the bur parallel to the long axis of the tooth.G. 2. Enter the pulp chamber with a round. A fissure bur such as the 557 may also be used for access.there is a risk of perforating the buccal surface. round bur for mandibular incisors or a #4 F.1. 3. Do not penetrate more than 4 mm from the lingual surface . 4. round bur for all other anterior teeth. Change the angle of the bur so it is parallel to the long axis of the tooth and place the tip of the bur in the most cervical part of the access outline (cingulum area).G. Do not remove tooth structure from the walls or floor of the pulp chamber unless specifically instructed to do so by an instructor.
6. remove the lingual overhang with Gates-Glidden drills.5. 7. Probe for the orifice(s) with a sharp endodontic explorer. If the canal is large. . Explore any remaining pulp horns with a DG16-explorer.
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