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8/9/2019 Access Cavity
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Access cavity
Pre-endodontic
reconstruction of teeth
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Access cavity
Defnition: a cavity placed on the coronalpart o the tooth that allow access,cleaning, shaping and flling o the
entireroot canalPurposes o root canal treatment are:
1) cleaning and shaping
2) disinection3) threedimensional o!turation o the
root canal system"
Impossiblewithout correctaccess cavity
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#nitial radiograph
$orphology andvolume o the pulpcham!er
Distance rom the
pulp cham!er roo tothe occlusal ace
%um!er and positiono the root canals
$orphology andlength o the rootcanals
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Requirement of the access cavity
1. Permit the removal of all pulp chamber
content
&ood endodontic cleaning starts ' pulp cham!er
roo o the pulp cham!er ' removed
pulp cham!er ( pulp horns
' contamination or inection o the endodontic space that thedentist is trying to clean"
' discoloration o the endodonticallytreated tooth especially theront teeth)"
cleaned
#* %+
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-ontrol o the removal o the eroo o the pulp cham!er isdone !y pro!ing
%o 1.
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Requirement of the accesscavity
2. Permit complete and directvision of the oor of the pulpchamber and of the root canalopenings
/e a!le to visuali0e
the entire oor and the root
canal openings on one loo
Pulp cham!er oor grayish
he oor reuently hasnatural grooves, at the end o
which the canal orifces are
located
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Requirement of the accesscavity
3.Facilitate the introduction of canal instruments in
the root canal openings*loor ( walls o pulp cham!er 45 acute angle#nsertion o instruments in the canal ' sliding gently along the cavity walls
-hecthe radiograp
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Requirement of the access cavity.Provide access as direct as possible to
the apical third of the canal forpreparation and !lling instruments 6hen woring in the canal, they should move reely, particularly in the
apical one third
%+ /7 #% -+%A- 6#8 87 6A99 +* 87 P;9P -8A$/7ecting the interpro?imal papillae
# one ore more walls are missing ' restored
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Pre4endodontic reconstruction
eeth reuiring endodontic treatment present1"-arious lesions
2" *ractures
3" #mproper restorations
*irst step o endodontic treatment 4 removal ocarious dentin or incorrect restorations
ooth !ig loss o tooth structure
#nconvenient or placing the ru!!er dam #mpossi!le to prepare a correct access cavity
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Preendodontic reconstruction
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Preparation of the accesscavity
Penetration -nlargement
Finishing
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5pper ma6illary incisor
Pulp cham!er ' 2pulp hornes mesialand distal)
+ne root
+ne root canal 'ovoid in crosssection ' largerdiameter mesio
distal 9ength 23 mm
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5pper ma6illary incisors
he access cavity is initiated !yapplying the !ur occlusal to thecingulum, almost
perpendicularto the palatalsurace
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5pper lateral incisor
Pulp cham!er ' 2 hornssituated closely or onecentral pulp horn
+ne root
+ne root canal ' crosssection ovoid ' longdiameter aciolingually
9ength ' 22,Bmm
Access cavity ' perormed
as or the -#
Di>erence ' shape $#"(
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Curvatures of the root canal:
Palatal - access cavity extended towards facial
Distal access cavity extended towards mesial
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5pper canine
Pulp horn ' 1 central +ne root
+ne root canal ' crosssection ' oval long
diameter ' aciolingually
9ength ' 2.mm
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Access cavity +CA9 shape
long diameter ' occluso
gingivaly
tart ' palatal ace
distance
ame rules as or incisors
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1stupper premolar Pulp cham!er 2 horns ' acial and lingual
2 roots 2 root canals may have 1 root canal situated
central or 3 root canals 2 acial and one palatal)
9ength 21mm
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5pper premolars
he point o entry o the !ur is the
middle o the central sulcus andparallel to the long a?is o the tooth "As one penetrates with the round,highspeed diamond !ur, onesimultaneously applies a !uccopalatal movement to the !ur, so as to
!egin to outline the uture occlusalcontour o the access cavity
2 +nce the cham!er is penetrated, alowspeed round !ur is used on theway out, to EpeelF the undercuts o
dentin that remains ater penetration3" hen, with a noncutting end, highspeed diamond !ur, the cavity isfnished and ared"he fnal shape o the access cavity isovoid
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7ndupper premolar
+ne root and one root
canal located central -ross section ' oval long
diameter ' aciolinguallywith a centralstrangulation G shape)
wo root canals ' acial andlingual
9ength 21,Bmm
Access cavity
4 +CA9
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1st5pper 'olar
3 roots
3 or root canals
palatal root curved !uccaly
longest root, cross 'section round canal orifce ' under $P cusp
disto!uccal root 'shorter
cross section ' round
canal orifce ' under D/ cusp
mesio ' !uccal root ' 2 root canals
$/ 1 ' placed under the $/ cusp
cross section oval at mesiodistally
'87 , groove , between '81and P root canal
'81 and '87 7 distinct ape6 orone ape6
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1st;pper $olar
Access cavity 'uadrangular shapeollowing the shape othe occlusal proHectiono the pulp cham!er
on cross section in thecervical area
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Preparation o the access cavity
1" Penetration
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7nd5pper 'olar
Anatomy resem!leto the anatomy othe 1stmolar
3 roots with 3 or root canals
Disto!uccal canallocated morepalatal
Pat
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9ower incisors
-# one root one rootcanal or 2 rootcanals3IJ)
9# one root and 1 or 2root canals.J)
-anal is oval thelarger diameter isaciolingual
9ength -# 4 2I,.mm
9# 4 21,Gmm
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(ower incisors
/ecause o the position o theroot canals the access cavityhas a ovoid shape
Perormed at the !iginning withthe round !ur attached to the airtur!ine ollowed !y the removalo the two triangles and thecareull shaping o the accesscavity to allow the access to thesecond oral root canal
7?tension o the access cavity inincisal direction ' permitinstrumentation o the lingualroot canal
Cery di=cult endodontictreatment
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(ower canine
+ne root +ne root canal curved
distally)
+val on cross section 'larger diameter aciolingual
+ne central pulp horn
9ength 4 2Bmm
Access cavity :palataloval
shape
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1st(ower premolar
+ne root
+ne root canal ' withcomple? anatomy
-ross section 'ovallong a?e aciolingual
-an divide in two ormore canals that
reHoin together at theape?
9ength 4 21,Bmm
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(ower !rst premolar
-rown asymmetrical with a !ig!uccal cusp and a very small oralcusp
he pulp cham!er lies almostentirely under the !uccal cusp
Access cavity ' started in the
middle o the central groove 'with the round !ur attached tothe air tur!ine
he !ur ' orientated ' towardsthe !uccal pulp horn
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2nd9ower premolar
+ne root
+ne root canal 'oval cross section
9ength 4 21,Bmm -an show a
curvature towards
distal
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1st(ower molar
wo roots mesial and distal
3 root canals distal'central,large, straight or curved distally
oval cross section
7 mesial ' $/ ( $9
root canals 7 distal 4 %( 9 '(
4 7 mesial 4$/ ( $9# two distal canals are present ' smaller
, round on cross section
Distal root ' concavity onthe mesial ace
$esial root ' concavity onthe distal ace
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1st(ower molar
Access cavity
trape0oidal 3 canals
Kuadrangular canals
Access is started with a rounddiamond ' air tur!ine ' entrypoint ' central ossa
Ater penetrating the pulpcham!er
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1.Penetration
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7. -nlargeme
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3. Finishing
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7nd(ower molar wo roots mesial and distal
3 root canals distal'central, large, straight orcurved distally
ovalcross section
7 mesial '
$/ ( $9Access cavity ' trape0oidal
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&olden rule
It should not be the dentist todecide the shape of the accesscavity but rather the anatomy of
the pulp chamber oor
".&astelluci
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