Access Opening

Objectives
Achieve maximum visibility of the canal Determine precise root canal location Allow for proper cleaning & shaping of the canal Remove causes of bacterial infection

Endodontic Cavity Preparation

Coronal cavity prep Access Opening

Radicular Cavity Prep Root Canal Preparation

Principles of Access Opening Removal of carious dentine & defective restorations Outline form Convenience form Toilet of the cavity

Removal of remaining carious dentine & defective restorations

Point to start opening access Eliminate the discolored tooth structure

Removal of remaining carious dentine & defective restorations

Eliminate as many micro-organisms as possible Eliminate the possibility of saliva leaking into the prepared cavity

Failure to remove caries or faulty restorations Reasons to remove restorations Evidence of leakage Caries beneath restorations Fracture uncovered during access preparation Tx-planned restoration replacement Convenience to work

Outline form
Evolves from internal anatomy - Size of pulp chamber - Shape of pulp chamber

Shape of Access Opening

Max insicor Max molar Mand molar

Shape of Access Opening

Mand incisor Max & mand canine Max & mand premolar

Outline form
Evolves from internal anatomy - Age of tooth - Number, position & curvature of canals

Convenience form
Unobstructed access to the canal orifice Direct access to the apical foramen

Convenience form
Expansion to accommodate filling techniques Complete authority over the instruments
ledge

Inadequate convenience form leads to:

1.ledging 2.instrument breakage 3.incorrect shape of complete canal 4.improper debridement

Toilet of cavity Remove all caries & debris from chamber before radicular prep is begun Endo spoon excavator is ideal for debris removal NaOCl is an excellent irrigation

Irrigating syringe

Access
1.No caries or defected restoration 2.No roof of pulp chamber 3.Straight line access

Access
4.
5. 6.

Front surface mouth mirror


Temporary

wall: Am, CR, GI, IRM

Orthodontic band Gingivectomy Crown lengthening

Procedures Step 1 Radiograph Step 2 Rubber dam application Step 3 Pencil Access Step 4 Cut through Center

Step 5 Establish outline form (round diamond or carbide bur with high speed handpiece)

Burs

Friction grip: taper fissure 010, 012

Step 6 Remove roof of pulp chamber (endo length round bur with low speed handpiece)

Check roof of pulp chamber:

Explorer No. 5

Step 7 Remove Li shoulder, dentine shelf (GG, safety tip diamond)

Burs
Safe-ended burs

Burs

Round: normal & extra long 010, 014, 018

Gates-glidden drills

Step 8 Locate canal orifice (endo explorer): reparative dentine is softer & lighter than normal dentine

Locate canal orifices:

Endodontic explorer

Irrigate often
TUG BACK in the area of canal orifice Step 9 Check straight line access (endo explorer or #10 file)

Shape of Access Opening

Max insicor Max molar Mand molar

Shape of Access Opening

Mand incisor Max & mand canine Max & mand premolar

Maxillary anterior teeth

Maxillary posterior teeth

Mandibular teeth

Access CEJ

Error in Access Preparation Underextended preparation Overextended preparation Gouging Perforation Disoriented () Failure to remove caries or faulty restorations

Underextended prep Missed canals Tooth discoloration

Underextended prep
Perforation or ledge caused by failure to complete convenience form Total loss of instrument control

Overextended preparation

Weakening coronal tooth structure: Coronal fracture

Gouging Accumulate debris Inconvenient to instrumentation

Perforation
Coronal to the pulp chamber

Perforation
Floor of the pulp chamber

Disoriented
Misinterpretation Faulty cavity has in full crown of angulation been preparing

- Missed

canal -Perforation