ACCESS CAVITY

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Aims of Endodontic treatment Biologic aims a) To remove all the debris support to bacterial growth b) To destroy all micro--organisms from the root canal

Mechanical aims
c) Prepare root canal space for three dimensional filling d) To obturate prepared canal in order to completely seal from both apical (at the cemento-enamel junction) and coronal seal

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Steps in root canal therapy

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Patient selection Tooth selection Isolation Access cavity Canal irrigation Working length Canal preparation Trial filling Canal obturation Crown restoration
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Preparation of tooth
1 1. 2. 3 3. 4.

Remove carious dentine and bad restorations

Restore it with GIC Isolate the crown Disinfected the crown and immediate environment 5. Adhere to surgically clean technique

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Objectives of Access cavity

1. To remove the entire roof of the pulp chamber so that the pulp chamber can be irrigated and cleaned the canal entrance exposed. 2. To avoid damage to floor of the pulp chamber for located root canals orifices. Natural floor is having funnel shape orifice tends to guide an instrument in to the canal. 3. To achieve direct--line access to the apical third of the root canals for proper instrumentation, irrigation, shaping, cleaning, drying and obturation. 4. To enable a temporary seal to be placed. 5. To conserve as much sound tooth tissue as possible compatible with above.
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Guide lines for Access cavity preparation

1. Visualization of the internal anatomy 2. Evaluation of the cemento-enamal junction and occlusal anatomy 3. Removal of all defective restoration and caries 4. Removal of unsupported enamel 5. Creating direct line access to apical third

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Guide lines for Access cavity preparation

6. Delay of isolation until all the canal orifices located 7. Location, flaring and exploration of all the canal orifices 8. Inspection of the pulp chamber using magnification and adequate illumination 9. Tapering cavity walls and 10. evaluation of space adequacy for coronal seal
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Visualization of the internal anatomy

X-ray
Position of the pulp chamber Degree of calcification Number of roots Number of root canals Approximate canal length Examination coronal and cervical anatomy palpation along the attached gingiva for root location & direction Assessments choose the direction of the initial bur penitration
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Evaluation of the cemento--enamal junction and occlusal anatomy

Except maxillary molars, canal orifices are equidistant from line drawn in mesiodistal direction through the pulp chamber floor. Except maxillary molars, canal orifices lie on a line perpendicular to a line drawn a mesiodistal direction across the centre of the pulp chamber floor. the pulp chamber floor is always darker in color than the walls
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Evaluation of the cemento--enamal junction and occlusal anatomy

The orifices of the root canals are always located at the junction of the wall and the floor The orifices of the root canals are always located at the angles in the floor- wall junction The orifices of the root canals are always located at the terminus of the root developmental fusion lines Mandibular 2nd and 3rd molars are prone to have C shape canal
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 All defective restoration should be removed before entry into the pulp chamber
Open preparation is much easier to locate, irrigation, cleaning , shaping, drying and obturation. Restorative debris easily lodged in to the canals

Removal of all defective restoration and caries

All caries should be remove before entering to the pulp chamber

Prevent contamination of the canals Prevent contamination of the accidental perforations Prevent leaking of irrigating solutions
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Removal of unsupported enamel

Preparation of access cavity results weaker crown This will prone to fractures After finishing access cavity clinician should remove all unsupported enamel to assess restorability and to prevent tooth fracture

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Creating direct line access to apical third

Sufficient tooth structure should be removed from the pulp chamber wall to allow instruments to be placed easily into each canal orifices without interference from the canal walls Root canal walls should guide the files not the pulp chamber wall If not procedural error may formed like ledge formation, instrument separation, apical transportation
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Delay of isolation until all the canal orifices located

For crowded, rotated, fractured, calcified, heavily filed and crown and angled teeth should not isolate before locating canal orifices It is difficult to locate canal orifices for above mention teeth

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Location, flaring and exploration of all the canal orifices

With sharp endodontic explorer locate the canals With pre-curved small K file explore the canal Until working length is determined instrument should be operated within the confines of the canal system Always a lubricating agent should be used

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Inspection of the pulp chamber using magnification and adequate illumination

To see internal land mark and color changes magnification and light is essential Operating microscope is the best At least magnifying loupes should be used

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Tapering cavity walls and

Access cavity should have widest at occlusal surface Occlusal forces not push the temporary restoration into the cavity

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evaluation of space adequacy for coronal seal

At least 3.5mm thick temporary material is needed for proper coronal seal Glass ionomer and light cure composite restoration enhance the coronal seal

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Non-vital tooth

Initial access

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Cutting into the pulp

Removal pulp roof

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Use of Briault probe

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Extension of access cavity

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Completed access cavity.

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Use of barbed broach

Root canal irrigation

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Direct line access

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Prepare coronal part with gate bur

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Tooth length

Working length

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Non--vital posterior tooth

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Initial access

Access to the pulp

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Withdrawal action

Smoothening walls

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Orifice enlargement

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Remove interferences

Uses of gates bur

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Preparation of coronal two third

Number 3 Gates bur Number 2 Gates bur Number 1 Gates bur

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Direct line access

Anti-curvature filing

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Access cavity
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Average length 22.5mm Prepared canal

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Access cavity
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Average length 22.0mm

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Prepared canal
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Access cavity
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Average length 26.5mm

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Prepared canal
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Access cavity
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Average length 20.6mm

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Prepared canal
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Access cavity
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Average length 21.5mm

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Prepared canal
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Access cavity
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Average length 20.8mm

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Prepared canal
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Access cavity

Average length 20.0mm

Prepared canal

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Access cavity
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Average length 20.9mm

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Prepared canal
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Access cavity
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Average length 25.6mm

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Prepared canal
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Access cavity
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Average length 21.6mm

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Prepared canal
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Access cavity
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Average length 22.3mm

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Prepared canal
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Access cavity

Average length 21.0mm

Prepared canal

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Access cavity

Average length 19.8mm

Prepared canal

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Access cavity

Average length 22.5mm

Prepared canal

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