Access Cavity

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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Access Cavity