Podcast
Questions and Answers
What shape is the access cavity for a single-canal mandibular second molar?
What shape is the access cavity for a single-canal mandibular second molar?
What is the most commonly seen type of canal in a mandibular second molar?
What is the most commonly seen type of canal in a mandibular second molar?
What type of difficulties are created by poor access during root canal treatment?
What type of difficulties are created by poor access during root canal treatment?
What can debris falling into the canal orifices during root canal treatment cause?
What can debris falling into the canal orifices during root canal treatment cause?
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What can make the location of root canal orifices difficult during access cavity preparation?
What can make the location of root canal orifices difficult during access cavity preparation?
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What anatomical feature can complicate root canal treatment in mandibular molars?
What anatomical feature can complicate root canal treatment in mandibular molars?
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Which wall connects the mesiolingual and distolingual orifices in a mandibular second molar?
Which wall connects the mesiolingual and distolingual orifices in a mandibular second molar?
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What can inadequate caries removal during root canal treatment lead to?
What can inadequate caries removal during root canal treatment lead to?
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What is the shape of the pulp chamber in a mandibular second molar compared to a first molar?
What is the shape of the pulp chamber in a mandibular second molar compared to a first molar?
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What difficulties can be caused by labial perforation during root canal treatment?
What difficulties can be caused by labial perforation during root canal treatment?
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Study Notes
Size of Pulp Chamber
- In young patients, pulp chamber is larger in all three dimensions, requiring more extensive preparation.
- In older patients, pulp has receded, and pulp chamber is smaller in all three dimensions.
Shape of Pulp Chamber
- Incisors: Triangular shape
- Premolars: Ovoid bucco-lingually shape
- Molars: Triangular or Trapezoidal shape
Number, Position, and Curvature of Root Canals
- Cavity walls are extended to allow easy instrument approach to the apical foramen.
- Knowledge of internal anatomy of individual tooth is essential due to variations in canal anatomy.
Principles of Access Cavity Preparation
- Principle I: Preservation of Tooth Structure
- Principle II: Convenience Form
- Unobstructed access to canal orifice
- Direct access to apical foramen
- Principle III: Removal of Remaining Carious Dentin
- Eliminate mechanically as many bacteria as possible
- Eliminate discolored tooth structure
- Eliminate saliva leaking into the prepared cavity
- Principle IV: Cleansing of the Cavity
- Removal of calcified or metallic debris
- Removal of soft debris
- Prevention of bacterial population and crown staining
Laws of Access Cavity Preparation
- Radiographs help in knowing:
- Morphology of the tooth
- Anatomy of root canal system
- Number of canals
- Curvature of branching of the canal system
- Length of the canal
- Position and size of the pulp chamber and its distance from occlusal surface
- Position of apical foramen
- Calcification, resorption present if any
Classification of Access Cavity Preparation Instruments
- I. Initial Penetration
- Round and tapered tungsten carbide bur
- Round and tapered diamond points
- Endo access bur
- II. Unroofing the Pulp Chamber
- Endo access bur with a safe tip or non-cutting tip
- Round Bur
- Tapered fissure Bur
- III. Canal Orifice Flaring Instruments
- Gates-Glidden drill
- Peeso Reamer
- NiTi rotary file
- IV. Endodontic Pathfinders
- DG-16 Endodontic explorer
- Ultrasonic unit and tips
- NiTi pathfinder rotary file
- V. Vision, Magnification, and Illumination
- Fiber optic light source
- Methyline blue
- Surgical operating microscope
- Binocular loupes
- DG-16 endodontic explorer
Access Cavity Preparation for Different Teeth
- Maxillary Central Incisor
- Access cavity is oval or triangular in shape
- Removal of lingual shoulder is critical
- Mandibular Incisors
- Access cavity is long oval with greater dimension incisogingivally
- Complete removal of lingual shoulder is critical
- Mandibular Canine
- Access cavity is oval or slot-shaped
- One canal is present, but two canals could be present
- Maxillary Molars
- Bur entry is determined by the mesial boundary and oblique ridge
- Place bur in Central groove between Mesial and Distal boundary and direct it Palatally
- Feel drop and de-roof using round, tapered fissure or safe tip bur
- Shape and size of the chamber guide the cutting
- Locate canal orifice with Endo explorer, remove ledge or obstruction if present
- Smoothen cavity walls and merge with pulp chamber diverging occlusally
Difficulties Created by Poor Access
- Overzealous tooth preparation
- Inadequate caries removal
- Labial perforation
- Furcal perforation
- Root perforation due to misinterpretation of angulation
- Debris falling into the orifices such as old amalgam restorations and dentin debris
Difficulties During Access Opening and Trouble Shooting
- Calcifications
- Unusual anatomy
- C-shaped canal
- Bayonet-shaped canals
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Description
Test your knowledge on endodontic access cavity anatomy for maxillary and mandibular incisors. Learn about the importance of removing the lingual shoulder and achieving straight-line access for successful root canal treatments.
