Access Cavity Preparation

The objectives of access cavity preparation are

(1) to remove all caries,
(2) to conserve sound tooth structure,
(3) to completely unroof the pulp chamber,
(4) to remove all coronal pulp tissue (vital or necrotic),
(5) to locate all root canal orifices,
(6) to achieve straight- or direct-line access to the apical foramen or to the initial curvature of the
canal, and
(7) to establish restorative margins to minimize marginal leakage of the restored tooth.
Guidelines for the completion of an ideal access preparation.
(1) Visualization of the Likely Internal Anatomy
(2) Evaluation of the Cementoenamel Junction and Occlusal Anatomies
(3) Preparation of the Access Cavity Through the Lingual and Occlusal Surfaces
(4) Removal of All Defective Restorations and Caries Before Entry Into the Pulp Chamber
(5) Removal of Unsupported Tooth Structure
(6) Creation of Access Cavity Walls That Do Not Restrict Straight- or Direct-line Passage of
Instruments to the Apical Foramen or Initial Canal Curvature
(7) Delay of Dental Dam Placement Until Difficult Canals Have Been Located and Confirmed
(8) Location, Flaring, and Exploration of All Root Canal Orifices
(9) Inspection of the Pulp Chamber, Using Magnification and Adequate Illumination
(10) Tapering of Cavity Walls and Evaluation of Space Adequacy for a Coronal Seal
(1) Visualization of the Likely Internal
Anatomy
This visualization requires
(1) Evaluation of angled periapical radiographs
Diagnostic radiographs help the clinician estimate the position of the pulp chamber, the degree of
chamber calcification, the number of roots and canals, and the approximate canal length.

(2) Examination of tooth anatomy at the coronal, cervical, and root levels.
Palpation along the attached gingiva aids the determination of root location and direction.

The clinician uses the information

from these assessments to choose the direction of initial bur
penetration.
(2) Evaluation of the Cementoenamel
Junction and Occlusal Anatomies
Law related to the pulp chamber anatomy

(1) Law of centrality:

The floor of the pulp chamber is always located in the center of the tooth at the level of the CEJ.

(2) 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, that is, the external root surface anatomy reflects the internal pulp chamber anatomy.

(3) Law of the CEJ:

The distance from the external surface of the clinical crown to the wall of the pulp chamber is the
same throughout the circumference of the tooth at the level of the CEJ, making the CEJ is the most
consistent repeatable landmark for locating the position of the pulp chamber.
Law related to locate the orifice

(1) First law of symmetry:

Except for the maxillary molars, canal orifices are equidistant from a line drawn in a mesiodistal
direction through the center of the pulp chamber floor.

(2) Second law of symmetry:

Except for the maxillary molars, canal orifices lie on a line perpendicular to a line drawn in a
mesiodistal direction across the center of the pulp chamber floor.

(3) Law of color change:

The pulp chamber floor is always darker in color than the walls
Law related to locate the orifice

(4) First law of orifice location:

The orifices of the root canals are always located at the junction of the walls and the floor.

(5) Second law of orifice location:

The orifices of the root canals are always located at the angles in the floor–wall junction.

(6) Third law of orifice location: The orifices of the root canals are always located at the terminus of
the roots’ developmental fusion lines.
 (3) Preparation of the Access Cavity
Through the Lingual and Occlusal Surfaces
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 means of
achieving straight-line access and diminishing esthetic and restorative concerns
(4) Removal of All Defective Restorations
and Caries Before Entry Into the Pulp
Chamber
• All carious dentin must be removed during access preparation. This removal prevents irrigating
solutions from leaking past the rubber dam into the mouth and prevents carious dentin and its
bacteria from entering the root canal system
• more likely to miss fractures, caries, and marginal breakdown if restorations were not completely
removed. Working through restorations also allows restorative debris to become more easily
lodged in the canal system
(5) Removal of Unsupported Tooth
Structure
After completing the preparation, the clinician should remove all unsupported tooth structure to
assess restorability and to prevent tooth fracture.
(6) Creation of Access Cavity Walls That
Do Not Restrict Straight- or Direct-line
Passage of Instruments to the Apical
Foramen or Initial Canal Curvature
Sufficient tooth structure must be removed to allow instruments to be placed easily into each canal
orifice without interference from canal walls, particularly when a canal curves severely or leaves the
chamber floor at an obtuse angle
(7) Delay of Dental Dam Placement Until
Difficult Canals Have Been Located and
Confirmed
Difficulty can arise in gaining access into teeth that are crowded and rotated, fractured to the free
gingival margin, heavily restored and calcified, or part of a fixed prosthesis. In these situations the
clinician’s best course of action may be to prepare the initial part of the access cavity before placing
the dental dam so that the inclination of root eminences can be visualized
(8) Location, Flaring, and Exploration of
All Root Canal Orifices
• A sharp endodontic explorer is used to locate canal orifices and to determine their angle
of departure from the pulp
• All canal orifices and the coronal portion of the canals are flared to make instrument
placement easier
• The canals are then explored with small, precurved K-files (#6, #8, or #10)
(9) Inspection of the Pulp Chamber, Using
Magnification and Adequate Illumination
(10) Tapering of Cavity Walls and Evaluation
of Space Adequacy for a Coronal Seal
• A proper access cavity generally has tapering walls with its widest dimension at the
occlusal surface.
• At least 3.5 mm of temporary filling material (e.g., Cavit [3M, St. Paul, MN]) is needed to
provide an adequate coronal seal for a short time to prevent bacteria contamination.