Access cavity Of Anterior

Teeth
Dr\ Mohamed Samir
lecturer of Endodontics
KEY STEPS TO CONSIDER IN
ACCESS PREPARATION

Two-dimensional, pre-operative diagnostic

radiographs help the clinician estimate:

• The position of the pulp chamber

• The degree of chamber calcification
• The number of roots and canals
• The approximate canal length
 Sufficient tooth structure must be removed to
allow instruments to be placed easily into
each canal orifice without interference from
canal walls,
Direct-Line Passage of
Instruments to the Apical access design depends not only on the orifice
Foramen or Initial Canal location, but also on the position and
curvature of the entire canal.
Curvature
Failure to follow this guideline results in
treatment errors, including root perforation,
ledge formation, instrument separation, or
apical transportation.
Removal of
unsupported tooth structure should be removed
Unsupported to prevent tooth fracture during or between
procedures.
Tooth
Structure
Penetration phase:

Access begins in the center of the lingual surface.

Access opening is initiated at occlusal to the

cingulum by using round bur almost perpendicular
to palatal surface.
A #2 or #4 round bur may be used to penetrate the
enamel and slightly into the dentin (about 1 mm)
perpendicular to the lingual surface of the tooth.
.
Preliminary outline form is developed half to three
quarters the projected final size of the access cavity.
Penetration of the Pulp
Chamber Roof
bur is redirected,
the angle of the bur is rotated from
perpendicular to the lingual/palatal surface to
parallel to the long axis of the root (or 45° to
the long axis of the tooth) until “a drop in” into
the pulp chamber is felt.
• E, Completion of removal of the pulp chamber roof; a
round carbide bur is used to engage the pulp horn, cutting
on a lingual withdrawal stroke.
 If no drop into the pulp chamber
Measuring the distance from the incisal edge to the roof of the pulp chamber
on a radiograph may serve as guide in limiting penetration and possibly
preventing a perforation.

If the drop-in effect is not felt at this depth, an endodontic explorer can be used
to probe the depth of the access.

Angled radiographs can be used to assess if angle should be realigned.

 Removal of the
Chamber Roof
Deroofing the pulp chamber;
a round carbide bur is used to engage the pulp horn
and the lip of the dentin roof , cutting on a lingual
withdrawal stroke.
this is confirmed with a #17 operative explorer if no
“catches” with the explorer tip is withdrawn from the
pulp chamber along the mesial, distal, and facial walls.

.
Deroofing
A slight mesiodistal movement must be
imparted simultaneously to the bur, so as to
remove all the roof associated with the pulp
horns.
Enlargement phase (Flaring):
all internal walls are flared to the lingual surface of the tooth.

it is still necessary to remove 2 obstacles:

“triangle # 1” and “triangle # 2” during the enlargement phase
as they interfere with the introduction of endodontic
instruments.

“Triangle # 1”, the more coronal one, essentially constituted of

enamel, is removed with the bur held more parallel to the long
axis of the tooth.
Enlargement phase (Flaring):
all internal walls are flared to the lingual surface of the tooth.

“Triangle # 1”, the more coronal one, essentially constituted of

enamel, is removed with the bur held more parallel to the long
axis of the tooth.
Enlargement phase (Flaring):
“Triangle # 2”, predominantly constituted of dentin, is
smoothed with a small, long-shafted round bur mounted
on a low-speed handpiece.

The bur applied to “peel” the small ledge little by little.

Finishing the cavity using self diamond bur.

Enlargement phase

Lingual shoulder removed.

The canal should be evident and easily
observed.
Removal of the Lingual Shoulder
and Coronal
Flaring of the Orifice
Lingual shoulder is a prominence of dentin
formed by removal of lingual roof which
extends from the cingulum to approximately 2
mm apical to the orifice.
Its removal improves straight-line access
Its removal from mandibular anterior teeth may
often expose an extra orifice and canal.
Removal of the Lingual Shoulder
and Coronal
Flaring of the Orifice

The contemporary approach to flaring the orifice involves

the use of rotary nickel-titanium (NiTi) orifice openers that
allow rapid, safe removal of the lingual shoulder or ledge.

Instead, using Gates-Glidden drills or safe tipped diamond

or carbide burs.
Removal of the Lingual
Shoulder and Coronal
Flaring of the Orifice
When a fine, safety-tip diamond bur is used, the
tip is placed approximately 2 mm apical to the
canal orifice and inclined to the lingual during
rotation to slope the lingual shoulder.

When Gates-Glidden are used, it can be placed

passively 2 mm apical to the orifice is used first.
During rotation, gentle pressure is applied on the
bur as it cuts against the lingual shoulder and then
is withdrawn. The size of these burs can be
increased sequentially.
Straight-Line Access
Determination

After removal of the lingual shoulder

and flaring of the orifice, straight-line
access must be determined.

Ideally, a small intracanal file can

reach the apical foramen or the first
point of canal curvature with no
deflections.

Unnecessary deflection of the file can

result in loss of instrument control.
Straight-Line Access
Determination
Deflected instruments function under more stress
than and are more susceptible to separation
during enlargement and shaping.

Without straight-line access, procedural errors

(e.g., ledging, transportation, and zipping) may
occur,

Deviated file forms a ledge

Maxillary Central Incisor
Outline form
Triangular shape
with the base incisally and
apex cervically

Shape may change from triangular to slightly oval in

mature tooth because of less prominence of mesial and
distal pulp horns.
In very abraded teeth or teeth with fractures of
the middle one third of the crown, the cavity is
prepared entirely on the incisal surface
In very abraded teeth or teeth with
fractures of the middle one third of the
crown, the cavity is prepared entirely on
the incisal surface
 Access cavity of
maxillary lateral incisor
 Shape of access cavity is almost similar to that
Maxillary of maxillary central incisor except that‰it is
smaller in size
Lateral The only difference is when pulp horns are
present, shape of access cavity is rounded
Incisor triangle, while if the pulp horns are missing,
shape is oval
Maxillary lateral Incisors
Outline form

Triangular Shaped

adult incisor with extensive secondary

dentin formation: Ovoid shaped.
Maxillary Canine
Outline form: oval with greater dimensions
labiopalatally.
Access cavity of mandibular
central incisor
Access cavity of
mandibular central incisor
The lower incisors, are anything but easy to treat.
In a graduated scale of difficulty, Weine places it
immediately after the molars and lower premolars
with more than one canal.
This is related to its mesiodistal thinness when
compared to its buccolingual width.
So, particular attention to preparing the access cavity
to avoid lateral perforations.
Halfway along the root, there is a concavity on both
sides; thus, excessive widening may cause stripping
of the root.
Access cavity of
mandibular central incisor

Mandibular Incisors
Access cavity of mandibular central and lateral
incisors is almost similar in steps and shape.

It is different from maxillary incisors in the

following aspects: Smaller in shape
Shape is long oval with greater dimensions
directed incisogingivally.
Access cavity of mandibular
central incisor

Sometimes, it is easier to identify the second canal after

the first has been prepared, which enhances the tactile
sensation from the entrance of the thin instrument into a
second thin canal, which has yet to be prepared.
LOWER LATERAL INCISOR

This tooth is identical to the central

incisor, the only difference being
that it is often slightly longer
 Access cavity of
mandibular canine
Access Cavity of Mandibular Canine

Outline form of mandibular canine is Oval in

shape
similar to maxillary canine except that
It is smaller in size
Two canals may be present in mandibular
canine
The access cavity must be extended
buccolingually enough to allow straight-line
access to the lingual canal or, in any case, the
lingual wall of the root canal.
Access cavity of mandibular anterior teeth
Errors of access cavity
preparation of anterior teeth

• A. Gouging due to neglection of 29°

lingual axial inclination of the tooth.

• B. Perforation due to improper

angulation of the bur.
Errors of access cavity
preparation of anterior teeth

• C. Missed canal due to underextention

of the access cavity.

• D. Discoloration due to failure to

remove the pulp tissue.
Errors of
access cavity
preparation of
anterior teeth
Errors of
access cavity
preparation of
anterior teeth
Straight line access Through
the Lingual and Occlusal Surfaces

Esthetics Vs. Conservatism

Access cavities on anterior teeth usually are prepared through the

lingual tooth surface, and those on posterior teeth are prepared
through the occlusal surface.
These approaches are the best for achieving straight-line access
while reducing esthetic and restorative concerns.

Some authors recommended that the traditional access for

mandibular incisors be moved from the lingual surface to the incisal
surface in lingually inclined or rotated;

this allows better access to the lingual canal and improves canal
debridement.
 Ethetics vs. conservation:
In very abraded teeth or teeth
with fractures of the middle
one third of the crown, the
cavity is prepared entirely on
the incisal surface
Note how far more tooth structure may be conserved with a labial access at the cost of
disrupting the labial esthetics.
 Straight-line access dilemma:
For a traditional cavity, straight-line access to the root canal is recommended, for
effective instrumentation and the prevention of iatrogenic errors.

Straight-line access to the orifices of the root canals is

recommended to facilitate disinfection and complete debridement
The removal of a large amount of dental tissue poses a risk to its
integrity and increases the probability of fracture.

To avoid these complications, contracted access cavity designs

have recently been suggested

Kapetanaki I, Dimopoulos F, Gogos C. Traditional and minimally invasive access cavities in

endodontics: a literature review. Restorative dentistry & endodontics. 2021 Aug;46(3).