endodontics access

objective of access prparetion

1- locating all the canals
2- un-impeded straight line access to apical third or first canal
curvature
3- de roofing of pulp chamber and removal of coronal pulp
4- conservation of pulp chamber
general princiable
access outline form is a projection of the internal tooth anatomy
into the external tooth surface
caries removal is essential before preparing access
general considreation
- before beginning the access a preopreative radiograph should be
asessed
- in difficuilt cases access can be prepared without rubber dam
- when canal is located a small file (#1! is used to explore canals
and determine patency
- access mustn"t be under-prepared
- when preparing access throught restortive material most or all of it
should be removed
- access can be prepared through existing metal or porcilin crown
aids in canal location include :-
1- #nowladge of pulp anatomy
2- preopretive radiograph
3- illumination and fibrooptic handpieces $ handpiece with light$
4- magnification %- loupes amd microscopy
access openning for individual teeth

maxillary incisors &&&&&&< trianguliar outline form
- pulp horns should be eliminated to avoid discoloration
- lingual dentin shelf should be removed
maxillary canine &&&&&&< ovoid in middle third lingual surface
maxillary premoalr &&&&&&&< ovoid in the center of the crown
$buccolingual$
maxillary moalr &&&&&&< outiline is triangular in the mesial part of the
tooth
base to the facial and apec to lingual '' obli(ue ridge is left mostly
intact
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mandibular incisors &&&&&< triangular with base incisally and apec
cervicaly

if 2 canal are present labial canal is easier to locate
mandibular canine =====< ovoid outline form
mandibular premoalr =====< ovoid access in a buccolingual
direction
access is positioned buccal to central groove for first premolar , and
centrally for the second premolar
mandibular molar ======< rectangulair or trapezoid access
positioned in the mesiobuccal portion of the crown
mb canal is located slightly distal to MB cusp tip , ML in the central
groove area
errors in access
1- inad(uate preparation
result in
decrease access and visability which prevent locating the canal
limited ability to remove pulp tissue and obturating material
inad(uate straight line access which lead to deflection of the file by
coronal interferance and procedurcal errors $leadge formation$
2- excessive removal of tooth strcture
irreversable and can result in wea#ing of tooth and subse(uent
coronal fracture