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ACCESS CAVITIES Dr Saidah Tootla
ACCESS CAVITIES
Dr Saidah Tootla
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Despite advances there is always a chance of error in endodontic

therapy, and diligence in the involved procedures is necessary.

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  • it is important that the access preparation be precise

  • Entering a tooth without an adequate radiograph is a “fool’s errand.”

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  • Preoperative radiographs are

essential because they tell us where

pulp chambers are located in relationship to coronal surfaces, and at what angles canals enter pulp chambers

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 Gaining access to root canals, wherein the root canal instruments can be slipped easily into
 Gaining access to root canals,
wherein the root canal instruments
can be slipped easily into the canals
to reach the apical portion, is the
most important starting point of the
root canal treatment. Before you lift
that hand piece to start access cavity
preparation, stop and think about the
following three points:
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 Have you refreshed the knowledge of the morphology and anatomy of the tooth you are
Have you refreshed the knowledge of the
morphology and anatomy of the tooth you
are going to treat?
Have you taken a good look at the tooth
in the oral cavity? Its shape, size, tilt and
morphology need careful consideration.
Have you spent sufficient time studying
the radiograph?
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When the access preparation is cut too small, it is often impossible to

find all the canals in the tooth.

Even if all the canals are located, it sets the stage for negotiation difficulties, file breakage, and unnecessary frustration during obturation procedures (Figure 1).

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Conversely, access cavities that are

cut too big are a betrayal of the

clinician’s first admonishment to do

no harm, increasing the short-term

possibility of perforation and the long-term probability of tooth and root fracture.

 Conversely, access cavities that are cut too big are a betrayal of the clinician’s first
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CHOOSE SAFE, EFFECTIVE

BURS

choosing the wrong bur can presage a poor access result

burs that are too large will inevitably increase the size of the final cavity preparation as well as significantly increase the potential for tooth perforation

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#2 round is ideal for anterior and premolar access a #4 is optimal for molar access

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As soon as the author drops into the chamber, the round bur has

accomplished its purpose and is replaced with a tapered diamond bur.

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In anterior and premolar teeth, the convenience form is afforded by

extending the preparation from buccal to lingual; the conservation form is accomplished by preserving tooth structure in the mesial to distal dimension

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Anterior - Triangular 16
Anterior - Triangular
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Canines - ovoid 17
Canines - ovoid
Canines - ovoid
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Premolar - Round
Premolar - Round
Premolar - Round 18
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In posterior teeth, the line-angle extensions are cut to the working

cusps and stop 1 mm to 2 mm short

of the idling cusps.

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In maxillary premolars and molars, the line angle extensions are taken

to the palatal cusps (working) and are short of the buccal cusps (idling)

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Molar - Rhomboid
Molar - Rhomboid
Molar - Rhomboid 21
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Conversely, in mandibular premolars and molars the line angle extensions

are taken to the buccal and are short

of the lingual cusps

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Straight-line access  Success in modern endodontic treatment may be dependent upon a well-designed access cavity
Straight-line access
 Success in modern endodontic
treatment may be dependent upon a
well-designed access cavity to permit
straight-line access to all the main
root canals
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Flexural stress will be increased if the instrument must negotiate past an overhang; arrow A indicates
Flexural stress will be increased if the instrument must negotiate past
an overhang; arrow A indicates overhang preventing continuous
straight line access; arrow B indicates point of greatest curvature on
outside wall of canal.
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Showing a canal opened to the apex to a No. 20 reamer or file; arrow indicates
Showing a canal opened to the apex to a No. 20 reamer or file; arrow
indicates the thickest, most engaged part of NiTi, most prone to fracture
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Questions??? 29
Questions???
Questions???
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