Access Cavity Access Cavity

Dr.K.M.Wijerathne Dr.K.M.Wijerathne
BDS (Sri Lanka), MPhil (Endodontics), CD (Japan) BDS (Sri Lanka), MPhil (Endodontics), CD (Japan)
Head, Department of Restorative Dentistry Head, Department of Restorative Dentistry
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Steps in root canal therapy Steps in root canal therapy Steps in root canal therapy Steps in root canal therapy
1. Patient selection
2. Tooth selection
3. Isolation
4 Access cavity 4. Access cavity
5. Canal irrigation
6 Working length 6. Working length
7. Canal preparation
8. Trial filling
9. Canal obturation
10. Crown restoration
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Rubber dam isolation Rubber dam isolation
1. Provide aseptic operating field
2 Facilitate use of strong medicaments 2. Facilitate use of strong medicaments
3. Prevent inhalation of debris, instruments, irrigants and
materials
4. Prevent ingestion of debris, instruments, irrigants and materi
5. Eliminate salivary (moisture) contamination
6 Eliminate micro organisms contamination 6. Eliminate micro-organisms contamination
7. Improve visibility (contrast)of operating area
8. Protect soft tissues
C tt l i l ti
9. Relaxes the patient
10. Eliminate conversation and rinsing the mouth
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Cotton role isolation
Preparation of tooth Preparation of tooth Preparation of tooth Preparation of tooth
1 Remove carious dentine and bad 1. Remove carious dentine and bad
restorations
2 Restore it with GIC 2. Restore it with GIC
3. Isolate the crown
4. Disinfected the crown and immediate
environment
5. Adhere to surgically clean technique
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Access cavity Access cavity Access cavity Access cavity
1. To remove the entire roof of the pulp chamber so that the
pulp chamber can be cleaned and canal entrance
exposed exposed.
2. To enable root canals to be located and instrumented by
providing direct-line access to the apical third of the root
canals.
3. To avoid damage to floor of the pulp chamber. Natural
floor tends to guide an instrument in to the canal orifice floor tends to guide an instrument in to the canal orifice.
4. To enable a temporary seal to be placed.
5. To conserve as much sound tooth tissue as possible
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p
compatible with above.
Negotiate - instruments of sufficient size to Negotiate instruments of sufficient size to
the apical part of the root canal without losing
patency patency
Shape the radicular access to a predefined
taper and sized to allowiirigant and filling taper and sized to allow iirigant and filling
materials to be delivered to the full extend of
the root canal systemin a controlled way the root canal system in a controlled way
Wider and larger radicular access may allow
b tt dili f h i l t th better dilivery of chemicals to the
uninstrumented surfaces.
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Methods Of Determining Anatomic Methods Of Determining Anatomic
C fi ti C fi ti Configuration Configuration
1. Reading radiograph under magnification
2. Diagnostic periapical radiograph(s)
3 Tube-shift diagnostic radiograph(s) 3. Tube-shift diagnostic radiograph(s)
4. Knowledge of root canal anatomy
5. Typical variations from normal.
6. Knowledge of variations that will not be visible on radiographs
7. Knowledge of ethnic characteristics and differences
8 Fiber optic illumination of access cavity 8. Fiber optic illumination of access cavity
9. Probing floor of pulp chamber with endodontic explorer
10. Digital perception with hand instrument in canal.
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g p p
Root canal irrigant Root canal irrigant
1. Dissolve organic debris
2. Flush out inorganic and organic g g
debris
3. Lubricate endodontic instruments
4 Eli i t i i 4. Eliminate micro-organisms
5. Bleaching of tooth to prevent
staining sta g
6. Be relatively non-toxic
7. Be relatively non-irritant
8. Be inexpensive
9. Long shelf life
10 Freely available
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10. Freely available
Methods Used To Reduce Endodontic Methods Used To Reduce Endodontic
Microbial Flora Microbial Flora
1. Proper patient with good oral hygiene
2. Aseptic treatment procedures - p p
3. Rubber dam isolation -
4. Debridement - remove caries, mechanical instrumentation,
drainage if required drainage if required.
5. Irrigation - with disinfecting agents (NaOCl).
6. Medication - with anti-microbial dressings g
7. Temporization - of teeth and access cavities.
8. Obturation - complete sealing prevent entry of pathogens
9 S t i tibi ti i di t d i ll b f 9. Systemic antibiotics - indicated in small number of cases.
10. Final restoration - long-term coronal seal of tooth.
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Root canal system Root canal system Root canal system Root canal system
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Apical anatomy Apical anatomy p y p y
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Lingual shoulder Lingual shoulder Lingual shoulder Lingual shoulder
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Dentine Triangle Dentine Triangle Dentine Triangle Dentine Triangle
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Canal configurations Canal configurations
T I T II T III T IV Type I Type II Type III Type IV
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Type V Type VI Type VII Type VIII
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Access cavity Average length Access cavity Average length 22.5mm Pulp volume 12.4mm 22.5mm Pulp volume 12.4mm
3 3
Prepared canal Prepared canal
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Access cavity Average length Access cavity Average length 22.0mm Pulp volume 11.4mm 22.0mm Pulp volume 11.4mm
33
Prepared canal Prepared canal
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Access cavity Access cavity Average length Average length 26.5mm Pulp volume 14.7mm 26.5mm Pulp volume 14.7mm
33
Prepared canal Prepared canal
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Access cavity Access cavity Average length Average length 20.6mm Pulp volume 18.2mm 20.6mm Pulp volume 18.2mm
33
Prepared canal Prepared canal
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Access cavity Access cavity Average length Average length 21.5mm Pulp volume 16.5mm 21.5mm Pulp volume 16.5mm
33
Prepared canal Prepared canal
Access cavity Access cavity Average length Average length 20 8mmPulp volume 68 2mm 20 8mmPulp volume 68 2mm
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Prepared canal Prepared canal
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Access cavity Access cavity Average length Average length 20.8mm Pulp volume 68.2mm 20.8mm Pulp volume 68.2mm
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Prepared canal Prepared canal
Access cavity Access cavity Average length Average length 20.0mmPulp volume 44.3mm 20.0mmPulp volume 44.3mm
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Prepared canal Prepared canal
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Access cavity Access cavity Average length Average length 20.0mm Pulp volume 44.3mm 20.0mm Pulp volume 44.3mm Prepared canal Prepared canal
Access cavity Access cavity Average length Average length 20 9mmPulp volume 6 6mm 20 9mmPulp volume 6 6mm
33
Prepared canal Prepared canal
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Access cavity Access cavity Average length Average length 20.9mm Pulp volume 6.6mm 20.9mm Pulp volume 6.6mm
3 3
Prepared canal Prepared canal
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Access cavity Access cavity Average length Average length 25.6mm Pulp volume 14.2mm 25.6mm Pulp volume 14.2mm
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Prepared canal Prepared canal
A i A i A l h A l h 21 6 P l l 14 9 21 6 P l l 14 9
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P d l P d l
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Access cavity Access cavity Average length Average length 21.6mm Pulp volume 14.9mm 21.6mm Pulp volume 14.9mm
33
Prepared canal Prepared canal
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Access cavity Access cavity Average length Average length 22.3mm Pulp volume 14.9mm 22.3mm Pulp volume 14.9mm
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Prepared canal Prepared canal
Access cavity Access cavity Average length Average length 21.0mm Pulp volume 52.5mm 21.0mm Pulp volume 52.5mm
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Prepared canal Prepared canal
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yy g g g g pp pp
Access cavity Access cavity Average length Average length 19.8mmPulp volume 32.9mm 19.8mmPulp volume 32.9mm
33
Prepared canal Prepared canal
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Access cavity Access cavity Average length Average length 19.8mm Pulp volume 32.9mm 19.8mm Pulp volume 32.9mm Prepared canal Prepared canal
Access cavity Access cavity Average length Average length 22.5mm Pulp volume 32.9mm 22.5mm Pulp volume 32.9mm
33
Prepared canal Prepared canal
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