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    Access Cavity Preparation: Dr. Ahmed Negm

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    Santika Indahsari
    1. Access cavity preparation is the first and most important phase of root canal treatment, as it allows for location of all root canal orifices and straight line access to the canals. 2. Principles of access include establishing an outline form based on tooth anatomy and size of the pulp chamber, and a convenience form to improve visibility and instrumentation. 3. Factors such as remaining caries, defective restorations, and debris must be removed to eliminate bacteria and possibility of reinfection.

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    Access Cavity Preparation: Dr. Ahmed Negm

    Uploaded by

    Santika Indahsari
    113 views55 pages
    1. Access cavity preparation is the first and most important phase of root canal treatment, as it allows for location of all root canal orifices and straight line access to the canals. 2. Principles of access include establishing an outline form based on tooth anatomy and size of the pulp chamber, and a convenience form to improve visibility and instrumentation. 3. Factors such as remaining caries, defective restorations, and debris must be removed to eliminate bacteria and possibility of reinfection.

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    1. Access cavity preparation is the first and most important phase of root canal treatment, as it allows for location of all root canal orifices and straight line access to the canals. 2. Principles of access include establishing an outline form based on tooth anatomy and size of the pulp chamber, and a convenience form to improve visibility and instrumentation. 3. Factors such as remaining caries, defective restorations, and debris must be removed to eliminate bacteria and possibility of reinfection.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    113 views55 pages

    Access Cavity Preparation: Dr. Ahmed Negm

    Uploaded by

    Santika Indahsari
    1. Access cavity preparation is the first and most important phase of root canal treatment, as it allows for location of all root canal orifices and straight line access to the canals. 2. Principles of access include establishing an outline form based on tooth anatomy and size of the pulp chamber, and a convenience form to improve visibility and instrumentation. 3. Factors such as remaining caries, defective restorations, and debris must be removed to eliminate bacteria and possibility of reinfection.

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    ACCESS CAVITY

    PREPARATION
    Dr. Ahmed Negm
    Access is the first and most important phase of root canal
    treatment. A well-designed access preparation is essential for a
    good endodontic result.
    Pulp space morphology

    Pulp horn

    Coronal pulp Pulp chamber


    Orifice

    Lateral canal
    Radicular pulp
    Root canal

    Apical foramen
    Objectives of access cavity preparation:

    1- Straight line access to apical


    foramen or to the initial
    curvature of the canal.

    2- To locate all root canal


    orifices.

    3- To conserve sound tooth


    structure.
    Principles of access cavity preparation

    1. Outline form.

    2. Convenience form.

    3. Removal of remaining carious dentin and defective


    restorations.

    4. Toilet of the cavity.


    1.Outline form:
    Established by mechanically projecting the internal anatomy
    to the external surface.

    Three factors regulating the outline form:

    a. Size of pulp chamber:


    Young patients extensive.
    Old patient limited.
    b. Shape of pulp chamber:

    Anteriors Triangular.
    Premolars Oval or ovoid.
    Molars Triangular.

    c. Number and direction of root canals.


    2. Convenience form:

    It is the form given to the access cavity to improve visibility, instrumentation and
    obturation of the root canal by providing a straight line access from occlusal surface
    to the apical foramen.

    Benefits:

    1. Unobstructed access to the orifices.


    2. Direct access to the apical foramina.
    3. Complete authority over the instrument.
    4. Expansion to accommodate filling techniques.
    3- Removal of remaining carious dentin and
    defective restorations:

    Reasons of removing caries and defective restorations:

    1. Elimination of bacteria.
    2. Elimination of discolored tooth structure.
    3. Elimination of the possibility of coronal leakage.
    4- Toilet of the cavity:

    All caries, calcified debris and necrotic material should be removed by irrigation
    from the pulp chamber before radicular preparation is begun to avoid obstruction
    of the root canals.
    Instruments

    Low speed contra High speed contra


    Round bur size
    DG 16 endodontic explorer 2,3,4
    Safe-end tapered stone

    Endo Z bur Tapered stone with


    Transmetal bur
    round end
    Pulpout bur

    Endo access bur

    Ultrasonics
    Loupes
    Surgical operating microscope
    Access cavity preparation in anterior teeth

    Outline form of central and lateral incisors are triangular with the base of the triangle
    towards the incisal edge and the apex towards the cingulum.

    Incisal edge

    Cervical line
    Steps
    1
    Entrance is gained through the middle of the middle
    third of the palatal surface.
    2
    Initial entrance Is prepared with a round bur at a high speed
    operated at a right angle to the long axis of the tooth. Only
    enamel is penetrated.
    3

    The bur is positioned in a 45 degree to the long axis of the


    tooth then advanced to penetrate the pulp chamber.
    4
    Removal of the pulp chamber (deroofing)
    5

    Removal of lingual shoulder.


    In canine the outline is oval
    Errors

    1- GOUGING of the labial wall caused by failure to


    recognize the 29-degree lingual-axial angulation of the
    tooth.

    2- GOUGING of the distal wall caused by failure to


    recognize the 16-degree mesial-axial inclination of
    the tooth.
    3- PERFORATION at the labiocervical caused by failure to
    complete convenience extension toward the incisal, prior
    to the entrance of the shaft of the bur.

    4- Missed canal due to insufficient convenience extension.


    5- DISCOLORATION of the crown caused by failure to remove
    pulp debris. The access cavity is too far to the gingival with no
    incisal extension.

    6- LEDGE formation at the apical-distal curve caused by using


    an uncurved instrument too large for the canal. The cavity is
    adequate.
    Premolars
    Upper oval Lower ovoid
    Maxillary premolars

    Buccal canal is located under


    the buccal cusp tip.

    Palatal canal is located at the


    base of the palatal cusp.
    1
    Initial penetration is made parallel to the long axis of the tooth in
    the exact center of the central groove
    2
    A round bur is used to open into the pulp chamber. The bur will be
    felt to “drop” when the pulp chamber is reached.
    3

    An endodontic explorer is used to locate orifices.


    4

    A round bur is used to deroof the pulp chamber.


    5

    Finishing and flaring of the cavity walls.


    Upper Lower
    Errors
    Under extended Over extended
    access cavity access cavity
    PERFORATION at the cervical area FAILURE to locate the third canal of
    caused by failure to recognize that the maxillary first premolar (6% of
    the premolar has tilted to the distal. the time).
    Molars
    Upper Lower

    B
    B

    D M M D

    L
    P Trapezoid
    Upper

    MB1
    MB2
    DB

    Palatal

    Point of
    entry
    • MB1 is located under the buccal cusp tip.
    • MB2 is located mesial and palatal to MB1 (at the end of a comma tail).
    • DB is located under the central fossa.
    • Palatal is located at the junction of mesiopalatal cusp and oblique ridge.
    • Point of entry is the center of the occlusal table.
    Lower

    Point of entry

    MB

    Distal
    ML

    • MB is located under the mesiobuccal cusp tip.


    • ML is located at the same line lingual to the central fissure.
    • Distal is located distal to the central fossa.
    • Point of entry is the central fossa.
    Errors
    Under extended Over extended
    access cavity access cavity
    Perforation in the furcation area Failure to locate all the canals
    Crown perforation Root perforation
    Axioms of pulp anatomy

    1- The two orifices of the maxillary first


    premolars are further to the buccal.

    2- The orifices of the mesio-buccal canals in


    molars are well up under the mesio-buccal cusps
    and the outline form should be widely extended
    into the cusp.
    3- The orifices of the palatal canal in maxillary
    molars is not too far to the lingual, but is
    actually in the center of the mesial half of the
    tooth

    4- The orifices of the disto-buccal canal in


    maxillary molars is not too far to the disto
    buccal, but it is almost buccal to the palatal
    orifice.
    5- The orifice of the distal canal in
    mandibular molars is not too far to the
    distal, but is actually in the exact center of
    the tooth

    6- The orifice of the mesio-lingual canal in


    mandibular molars is not too far to the
    mesio-lingual, but is almost mesial to the
    distal orifice.
    Laws of 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-Location of 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.
    3-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.
    M

    4-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.

    D
    5-Law of color change: The pulp chamber floor is always darker in color than the walls.
    6-First law of orifice location: The orifices of the root canals are always located at the
    junction of the walls and the floor.

    7-Second law of orifice location: The orifices of the root canals are always located at
    the angles in the floor–wall junction.
    8-Third law of orifice location: The orifices of the root canals are always located at
    the terminus of the roots’ developmental fusion lines.
    Thank you

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