Endodontic Access Cavity Preparation

PREPARED BY: DR. HAMED AL-HADDAD

1

Access Cavity Preparation MAJOR OBJECTIVES

1- Straight-Line Access
2- Conservation of Tooth Structure
3- Unroofing of Chamber and Exposure of Pulp Horns

Endodontic Preparation of Maxillary and mandibular Anterior Teeth

Incisor

Maxillary Central
All upper anterior teeth have one root and one canal.

Central incisor are large and on an average of 23 mm.

It has a single canal and a single apical foramen.

The canal form is usually Type I.

The pulp in young patients normally has 3 pulp horns.

The pulp chambers is noticeably wider in the faciolingual direction than in the mesiodistal. 4

Maxillary Lateral Incisor

It is shorter than central incisor. Average length of 21- 22 mm. It has a single canal and a single apical foramen. The canal form is usually Type I.

In young patients have two only pulp horn and is wider in labiopalatal dimension.
The canal is tapered and the apex is often curved generally in distal direction.
5

Maxillary Canine
It is the longest tooth (26.5 mm) Seldom has more than one canal
The pulp chamber is quite narrow M- D, and there is one pulp horn pointed to the incisal angle.

The pulp space is much wider labiopalatally and the pulp space follows this outline.
Oval Type I root canal. The root apex is often tapered and very thin. The canal is usually straight but may show a distal apical 6 curvature.

Mandibular Central and Lateral Incisors

Average length is 21 mm, but the central incisor may be shorter than the lateral.
The root canal morphology may be place into 1 or 3 configurations. Type I canal form is most prevalent, Types II and III are less prevalent.

CENTRAL

The pulp chamber is smaller replica of the upper incisors.

When the tooth has a single root canal it is normally straight but may curve to the distal.
7

LATERAL

Mandibular Canine
Smaller than the maxillary canine.
The average length is 22.5 mm. Type I canal form is most prevalent.
Rarely has 2 roots, but fewer of mandibular canine display the Type IV canal form with 2 separates apical formina.

Access cavity preparation

Endodontic Preparation of Maxillary Anterior Teeth

10

Endodontic Preparation of Maxillary Anterior Teeth

Adult tooth

11

Cavity Access. Canine

Extensive ovoid, funnel-shaped coronal preparation
12

Maxillary Anterior Teeth ERRORS in Cavity Preparation

13

Maxillary Anterior Teeth ERRORS in Cavity Preparation

14

Endodontic Preparation of Mandibular Anterior Teeth

15

Mandibular Anterior Teeth ERRORS in Cavity Preparation

16

Mandibular Anterior Teeth ERRORS in Cavity Preparation

17

18

19

Endodontic Preparation of Maxillary and mandibular Premolar Teeth

20

Maxillary First Generally has 2 root with 2 canals, but in the case of 1 root has 2 Premolar canals which open in a common apical
foramen. Many types of canal configurations. Average length 21.5 mm. The pulp chamber is wide B-P with 2 distinct pulp horn. M-D, the pulp chamber is much narrower.

Endodontic Preparation of Maxillary First premolar Teeth

Young tooth Adult tooth

22

Maxillary Second Premolar

The typical second premolar has one root and one canal and sometimes has an apical distal curvature. The Type I canal form is prevalent with a frequency of 48%, approximately the same as types II and IV-VII combined. The pulp chamber is wider B-P and narrower M-D and has 2 well define pulp horns.

The canal orifice is directly in the centre of the tooth. Average length: 21 mm.

Young tooth

Endodontic Preparation of Maxillary Second premolar Teeth

Adult tooth

24

Endodontic Preparation of Maxillary Premolar Teeth

25

Maxillary Premolar Teeth ERRORS in Cavity Preparation

26

Maxillary Premolar Teeth ERRORS in Cavity Preparation

27

Mandibular Premolars
Usually has a single delicate root with a mesial concavity, but occasionally present a division of the root in the apical half.

As a rule, both teeth have a single canal. The coronal pulp is wide B-L with a large buccal horn and a small lingual horn. The shape of the canal is similar in first and second premolars. Its buccolingual extension is broad until the middle third of the canal, but is very narrow in the apical third. Average Length: 22mm

Cavity Access
Because of the inclination of the crowns of mandibular teeth and the smaller lingual cusp, the access opening should be placed buccal to the central fissure. The preparation is made oval, corresponding to the shape of the root and canal.

Endodontic Preparation of Mandibular premolar Teeth

Young tooth Adult tooth

30

Endodontic Preparation of Mandibular Premolar Teeth

31

Mandibular Premolar Teeth ERRORS in Cavity Preparation

32

Mandibular Premolar Teeth ERRORS in Cavity Preparation

33

Endodontic Preparation of Maxillary and mandibular Molar Teeth

34

Maxillary First Molars

Generally three rooted with 3 canals. Additional canal is located in the MB root. Large pulp chamber, triangular in shape, with the base toward the buccal and the apex toward the lingual surface. Slightly curved buccal roots. DP curvature of the MB root. Apical-buccal curvature of the palatal root (55%)

Average Length:
MB: 20mm DB: 19.5mm P: 20.5mm

Maxillary First Molars

It has 3 or 4 pulp horn, the MB is the longest.

The floor of the pulp chamber is normally just apical to the cervix and is rounded and convex to the occlusal. The MB canal opening is closer to the buccal wall than is the DB orifice.
The DB canal is closer to the middle of the tooth than to the distal wall, and is the shorter and finest of the 3 canals.

Endodontic Preparation of Maxillary First molar Teeth

Young tooth Adult tooth

37

Maxillary Second Molar

It is similar of the first molar: Large pulp chamber. Mesiobuccal, distobuccal, and palatal roots, each with one canal. Gradual curvature of all three canals.
Flattened triangular outline form. The DB canal orifice is nearer the centre of the cavity floor.

Endodontic Preparation of Maxillary Second Molar Teeth

Young tooth Adult tooth

39

Endodontic Preparation of Maxillary Molar Teeth

40

Locate canal orifices & obtain Straight-Line Access

Probing the Canal Entrances After the roof of the pulp chamber has been penetrated and the access cavity prepared, the entrances to the pulp canals must be probed. A hooked explorer can be used to determine if enough dentin has been removed The canal entrances are found by feeling with a thin, stiff explorer. If the explorer sticks in a spot, a size 15 Hedstr6m file is used to verify that the spot is indeed the entrance to a root canal and not a perforation. Only then is the opening gently enlarged. Narrow root canals must first be enlarged coronally with a Hedstr6m file before the deep preparation with Gates-Glidden burs can be started.

42

Maxillary Molar Teeth ERRORS in Cavity Preparation

43

Maxillary Molar Teeth ERRORS in Cavity Preparation

44

Mandibular First Molar

Usually has 2 roots one mesial and one distal. The Distal root is smoller and vertical. Distal curvature of the mesial root (84% of the time) which has two canals. The distal canal is larger and more oval. The MB is the most difficult canal to instrument because its tortuous path.

Average Length: 21 mm The cavity is primarily within the mesial half of the tooth but is extensive enough to allow positioning of instruments and filling materials. Triangular outline form reflects the anatomy of the pulp chamber, with the base toward mesial and the apex toward the distal surface.

Mandibular Second Molar

It is smaller version of the first molar with an average length of 20mm. The mesial root has 2 canals and the distal one. The mesial canals tend to fuse in the apical third to give rise to one main apical foramen. Commonly has fused roots.

Endodontic Preparation of Mandibular Molar Teeth

Young tooth Adult tooth

48

Endodontic Preparation of Mandibular Molar Teeth

49

Mandibular Molar Teeth ERRORS in Cavity Preparation

50

Mandibular Molar Teeth ERRORS in Cavity Preparation

51

Thank you
52