acess cavity preparation

7/21/2019 acess cavity preparation

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Submitted To-:

Dr Anurag Singhal

Dr Anurag Gurtu

Dr Naveen Chhabra

Dr Raju Chauhan

Submitted By-:

Kapil adav!"#$

Shailendra Singh!%%$

Seminar &n-:Access Cavity Preparation


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CCESS C VITYCCESS C VITY

PREP R TION

REP R TION


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INTRODUCTIONINTRODUCTION

The major factor involved in the development ofthe apical periodontiti are lo of inte!rit" of

coronal tooth #$tance and the entr" of

microor!anim into the dentine and p#lp

pace%The chemo&mechanical removal of

microor!anim' their #$trate and prod#ct

form

the dentine and p#lp pace i primar" aim of root

canal treatment' (ith the econd $ein! the three

dimenional o$literation and ealin! of the p#lp

pace to prevent $acterial recontamination%


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A clear #ndertandin! of the anatom" of h#manteeth $ecome an eential prere)#iite for

achievin! the o$jective of acce' thro#!h

cleanin!' diinfection' and o$t#ration of the p#lp

pace%in thi eminar (e have tried to decri$e the

acce openin! of the teeth%


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* The acce cavit" preparation !enerall" refer to thepart of the cavit" from the occl#ion ta$le to the canalorifice% +accordin! to Stephen Cohen,

O-.ECTIVES

/ell dei!ned acce preparation i eential for a !oodendodontic re#lt% /itho#t ade)#ate acce' intr#ment

and material $ecome diffic#lt to handle properl" in the

hi!hl" comple0 and varia$le canal "tem%

* To achieve a trai!ht or direct line acce to the apical

foramen%* To locate all root canal orifice%

* To conerve o#nd tooth tr#ct#re%


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* /ell prepared and correct acce cavit" allo(complete irri!ation' hapin! 'cleanin! and)#alit" o$t#ration%

* Ideal acce re#lt in a trai!ht entr" into thecanal orifice' (ith the line an!le formin! af#nnel that drop moothl" into the canal%

1UIDE2INES

It i eential for the completion of ideal acce

preparation%

3% Vi#ali4ation of internal anatom" $eca#einternal anatom" dictate acce hape% Thire)#ire eval#ation of an!led peri&apicalradio!raph' e0amination of coronal andcervical tooth anatom"%


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5% Eval#ation of CE. and occl#al anatom"%traditionall"' acce cavit" i prepared in relation

to the occl#al anatom"% CE. i the mot

important anatomical landmar6 for determinin!the location of p#lp cham$er and root

canal orifice%


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Accordin! to 7raner and Ran6o(' five !#ideline

or la(' of p#lp cham$er anatom" to helpclinician determine the n#m$er and location of

orifice on the cham$er floor

8irt 2a( of S"mmetr"

It tate that e0cept for the ma0illar" molar' canalorifice are e)#iditant from a line dra(n in meio&ditaldirection thro#!h the p#lp cham$er floor%

Second 2a( of S"mmetr"

It tate that e0cept for the ma0illar" molar' canalorifice lie on line perpendic#lar to a line dra(n in ameio&dital direction acro the center of the p#lpcham$er floor


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8irt 2a( of Orifice 2ocation

It tate that the orifice of the root canal areal(a" located at the j#nction of the (all andthe floor%

Second 2a( of Orifice 2ocation

It tate that the orifice of the root canal areal(a" located at the an!le in the floor&(allj#nction%

Third 2a( of Orifice 2ocation

It tate that the orifice of the root canal areal(a" located at the termin# of the root9developmental f#ion line%

2a( of Color Chan!e

It tate that the p#lp cham$er floor i al(a"

dar6er in color than the (all%


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:% Preparation of the acce cavit" i thro#!hlin!#al in anterior teeth and on the poterior teeth

thro#!h occl#al #rface%

;% Removal of #n#pported tooth tr#ct#re%Thired#ce the tooth9 reitance to tre%


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=% 2ocation' flarin! and e0ploration

of all root canal orifice% Aharp endodontic e0plorer #edto locate the canal orifice and todetermine their an!le ofdepart#re from the p#lp cham$er%

>% ?a!nification and ill#mination%

Thee are important in root canal

therap"' epeciall" fordeterminin! the location of canal'c#rved and calcified canal and

de$ridin! and removin! ti#efrom the p#lp cham$er%


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@%Taperin! of cavit" (all and eval#ation of paceade)#ac" for a coronal eal% A proper acce

cavit" ha taperin! (all and i (idet at

occl#al #rface% At leat :%< mm of temporar"

fillin! material i needed to provide an ade)#atecoronal eal for a hort period%


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ANATO?Y O8 TE PU2P CAVITYANATO?Y O8 TE PU2P CAVITY

P#lp cavit" i the central cavit" (ithin the tooth

and i entirel"encloed $" dentin e0cept at theapical foramen%

P#lp cavit" ma" $e divided into a coronal portion'

p#lp cham$er' radic#lar portion and root canal% In anterior teeth the p#lp cham$er !rad#all"

mer!e into root canal%

In m#ltirooted teeth' the p#lp cavit" conit of ain!le p#lp cham$er and ##all" three root canal%


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A p#lp horn i an accent#ation of the roof of thep#lp cham$er directl" #nder a c#p ordevelopmental lo$e%

Orifice are contin#ation (ith $oth p#lp

cham$er and root canal% A root canal ma" $e divided into three ection

namel" coronal' middle' apical third%

Acceor" canal or lateral canal i a lateral$ranch of main root canal' !enerall" occ#r in the

apical third or f#rcation area of a root%


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In mot cae n#m$er of root canal depend#pon the n#m$er of root of the tooth%

In "o#n! a!e' apical foramen i f#nnel hapedin a incompletel" developed teeth%

/ith the development of the root' the apicalforamen $ecome narro(er%

The hape and i4e of p#lp cavit" i infl#enced$" a!e%

In "o#n! people' p#lp cham$er i lar!e and(ith increae of a!e' it !et maller%


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The root canal "tem i hi!hl" comple0 andcanal ma" $ranch' divide and rejoin%

Vert#cci et alidentified and claified ei!ht p#lp

pace confi!#ration (hich are follo(in! a &B

T"pe I B A in!le canal e0tend from the p#lpcham$er to the ape0%

T"pe II B T(o eprate canal leave the p#lpcham$er and join hort of the ape0 to form

canal%T"pe III B One canal leave the p#lp cham$er and

divide into t(o in the rootB the t(o then mer!eto e0it a one canal%


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T"pe IV B T(o eparate' ditinct canal e0tend from

the p#lp cham$er to the ape0%

T"pe V B One canal leave the p#lp cham$er and

divide and divide hort of the ape0 into t(o

eparate' ditinct canal (ith eparate apical

foramina% T"pe VI B T(o eparate canal leave the p#lp

cham$er' mer!e in the $od" of the root' and

redivide hort of the ape0 to e0it a t(o ditinct

canal%

T"pe VII B One canal leave the p#lp cham$er'

divide and then rejoin in the $od" of root' and

finall" redivide into t(o ditinct canal hort of

the ape0%


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T"pe VIII B Three eparate' ditinct canal

e0tend from the p#lp cham$er to the ape0%


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Acce Cavit" PreparationAcce Cavit" Preparation

Anterior acce cavit" preparation?an" of the ame tep are #ed in imilar tooth

t"pe to prepare an acce cavit"%

The follo(in! dic#ion o#tline the tep for

ma0illar" and mandi$#lar anterior teeth%

3% Removal of Carie and Permanent Retoration

Carie i t"picall" removed earl"' $efore the p#lpcham$er i entered%

Thi minimi4e the ri6 of contamination of thep#lp cham$er or root canal (ith $acteria%


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Removal of defective permanent retorationalo permit trai!ht line acce and preventthe retorative fra!ment from $ecomin!lod!ed in the root canal "tem%

If rec#rrent deca" i detected or #pected'the permanent retoration m#t $e removedentirel" to prevent coronal contamination ofp#lp cham$er%

5% Initial E0ternal O#tline 8orm

Once carie and retoration have addreed'the clinician create an initial e0ternal o#tlineopenin! on the lin!#al #rface of the anteriorteeth


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8or an intact tooth' the clinician ho#ld $e!inin the center of lin!#al #rface of anatomic

cro(n%

No 5 or ; ro#nd $#r or tapered fi#re $#r i

#ed to penetrate the enamel and li!htl" intothe dentine (ith a hi!h peed hand piece%


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The $#r i directed perpendic#lar to the lin!#al#rface a the e0ternal o#tline openin! icreated%

:% Penetration of the P#lp Cham$er Roof

Penetration of the p#lp cham$er roof icontin#in! (ith the ame ro#nd or taperedfi#re $#r' (e chan!e the an!le of the $#rfrom perpendic#lar to the lin!#al #rface toparallel to the lon! a0i of the tooth%

Penetration into the tooth i accomplihedalon! thi root lon! a0i #ntil the roof of thep#lp cham$er i penetrated' fre)#entl" a drop&in effect i felt (hen the penetration occ#r%


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Complete Roof Removal

Once the p#lp cham$er ha $een penetrated'the remainin! roof i removed $" catchin! theend of a ro#nd $#r #nder the lip of the dentin

roof and c#ttin! on the $#r removal tro6e% Each tooth ha a #ni)#e p#lp cham$eranatom"' (or6in! in thi manner allo( theinternal p#lp anatom" to dictate the e0ternalo#tline form of the acce openin!%

In vital cae p#lp ti#e hemorrha!e canimpair the clinician a$ilit" to ee the internalanatom"%

In #ch cae' a oon a eno#!h roof ha$een removed to allo( intr#ment acce'


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The coronal p#lp ho#ld $e amp#tated at theorifice level an endodontic poon or ro#nd $#r

and the cham$er irri!ated copio#l" (ith

odi#m h"po chlorite%

After hemorrha!e ha $een controlled' allo(in!vii$ilit"' all of the p#lp cham$er roof' (ith p#lp

horn' m#t $e removed and all internal (all

m#t $e flared to lin!#al #rface of the tooth%


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Identification of All Canal Orifice After the p#lp cham$er ha $een #nroofed' the canal

orifice are located (ith an endodontic e0plorer

Poitionin! the e0plorer in an orifice allo( the

clinician to chec6 the haft for clearance from the a0ial

(all an d determine the an!le at (hich a canal departthe main cham$er%

Removal of lin!#al ho#lder' orifice and coronal

flarin!

Once the orifice ha $een identified' the lin!#al ho#lderi removed%

2in!#al Sho#lder&B thi i the lin!#al helf of dentin that

e0tend from the cin!#l#m to a point appro0imatel"

5mm apical to the orifice%


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Strai!ht line acce determination

After the lin!#al ho#lder ha $een removed

and the orifice' the clinician m#t determine

(hether trai!ht line ha $een achieved%

Ideall"' an endodontic file can approach theapical foramen or the firt point of the canal

c#rvat#re%

Vi#al inpection of the acce cavit"

The clinician ho#ld inpect and eval#ate theacce cavit" #in! appropriate ma!nification

and ill#mination%


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Refinement and moothin! of retoratin!

mar!in

The final tep in the preparation of an acce

cavit" i to refine and mooth cavo#rface

mar!in% Ro#!h mar!in can ca#e of coronal lea6a!e%

Proper retorative mar!in are important

$eca#e anterior teeth ma" not re)#ire a

cro(n a a final retoration


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Poterior cce Cavit" Preparation

The proce of preparin! acce cavit" onpoterior teeth i imilar to that for anterior teeth'$#t eno#!h difference e0it to (arrant a

eparate dic#ion%Removal of carie and permanent retoration

Same a anterior teeth $#t in poterior teeth' theroot canal therap" re)#ire a t"picall" have $eenheavil" retored or cario# proce i e0tenive%

S#ch condition' alon! (ith the comple0 p#lpanatom" of the poterior teeth' can ma6e acceproce challen!in!%


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Initial e0ternal o#tline form

The p#lp cham$er of poterior teeth i

poitioned in the center of the tooth at the level

of CE.%

An acce tartin! location m#t $e determinedfor an intact tooth%


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In ma0illar" premolar thi point i on the central!roove $et(een the c#p tip%

In mandi$#lar 3tpremolar the tartin! locationi half (a" #p the lin!#al incline of the $#ccalc#p on the line connectin! the c#p tip%

In mandi$#lar 5ndpremolar the tartin! locationi one third the (a" #p lin!#al incline of the$#ccal c#p on a line connectin! the $#ccalc#p tip and lin!#al !roove $et(een the lin!#al

c#p% In ma0illar" and mandi$#lar molar the tartin!

location i limit (ith meial and dital $o#ndar"%

The meial $o#ndar" for $oth molar i a lineconnectin! the meial c#p tip%


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Penetration of p#lp cham$er roof

Contin#in! (ith a ame ro#nd or tapered fi#re

$#r and an!le of $#r i chan!ed ame a

anterior teeth%

In cae of premolar the direction of penetrationan!le i to(ard the meio&dital and $#cco&

lin!#al and in cae of molar it i to(ard the

lar!et canal $eca#e p#lp cham$er pace i

##all" lar!et j#t occl#al to the orifice of thicanal%


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Complete Roof Removal Ro#nd or tapered fi#re $#r i paed $et(een

the orifice alon! the a0ial (all to remove theroof of p#lp cham$er (ith p#lp horn and createthe deired e0ternal o#line hapeim#ltaneo#l"%

Identification of all Canal Orifice

Ideall" the orifice are located at the corner ofthe final preparation to facilitate the hapin!

and cleanin! proce%


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Removal of the Cervical Dentin $#l!e and

Orifice

and Coronal flarin!

The cervical dentine $#l!e are helve of dentin

that overhan! orifice in poterior teeth%Thee $#l!e can $e removed (ith car$ide $#r or

1ate&1lidden $#r%


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After thi the orifice and the coronal portion ofthe canal can $e flared (ith 1ate&1lidden $#r'

(hich are #ed in (eepin! #p(ard portion (ith

lateral pre#re a(a" from the f#rcation%

Strai!ht 2ine cce preparation It i paramo#nt to #ccef#l hapin!%

8ile m#t have #nimpeded acce to the apical

foramen or the firt point of canal c#rvat#re%


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Vi#al inpection of the p#lp cham$er floor

Same a anterior acce cavit" preparation%

Refinement and moothin! of the retorative

?ar!in

The retorative mar!in are refined and moothed

to minimi4e the potential of coronal lea6a!e%

?ORPO2O1Y AND ACCESS CAVITY?ORPO2O1Y AND ACCESS CAVITY


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PREPARATION 8OR ?AI22ARYPREPARATION 8OR ?AI22ARY

CENTRA2 INCISORCENTRA2 INCISOR

Developmental and anatomic data

Avera!e time of er#ption&B >&@ Year

Avera!e a!e of calcification&B 3F Year

Avera!e tooth len!th&B 5:%


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P#lp cham$er It i located in the centre of cro(n e)#iditant

from the dentinal (all%

It i $road m&d' (ith it $roadet part inciall"%

It ha three p#lp horn that correpond to thedo#$le mammelon in a "o#n! tooth%

Root and root canal

It ha one root (ith one root canal%

Root canal i $road la$io&palatal"' conicalhape' and centrall" located%

In cro&ection' canal i ovoid m&d in cervicalthird' ro#nded in middle and apical third%


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INCIDENCE

Root

o Strai!ht B >


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Anatomic relationhip in it# 2a$ial #rface of the root lie #nder the la$ial

cortical plate of the ma0illa and ma" f#e (ithit%

It ha an avera!e of 5 de!ree of meio&a0ialinclination and 5H de!ree of palato&a0ialan!#lation in it alveol#%

Acce openin!

Shape' i4e and coronal e0tenion of p#lp

cham$er are etimated $" dia!noticradio!raph%

Enamel i penetrated in the centre of the lin!#al#rface at an an!le perpendic#lar to it' (ith a


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n#m$er ; ro#nd $#r in hi!h peed contra&an!le% After penetration of the enamel' a No ; car$ide

$#r in a lo( peed contra&an!le i directed

alon! the lon! a0i of the tooth #ntil the p#lp

cham$er i reached% A drop of the $#r into the cham$er ma" $e felt

if the cham$er i lar!e eno#!h%

The overhan!in! enamel and dentin lin!#al

#rface of the p#lp cham$er i removed (ith aNo ; ro#nd $#r in a lo( peed contra&an!le $"

(or6in! from inide to o#tide follo(in! internal

anatom"%


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Anatomic alteration in p#lp

The ##al anatomic tr#ct#re of the cham$er inthe root canal ma" $e altered in an" tooth d#e

to depoition of reparative or econdar" dentin% Thi alteration in anatom" ma" $e d#e to

tra#ma' carie' retorative proced#re' a!in!%

To ecape thi alteration (e can #e No 5 ro#nd

car$ide $#r% Enlar!e the enamel portion of the acce cavit"to an ovoid hape' (ith !reatet diameterincio!in!ivall"%



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2ATERA2 INCISOR2ATERA2 INCISOR

? I22 RY 2 TER 2 INCISOR


Avera!e time of er#ption&B @&HYear

Avera!e a!e of calcification&B 33Year

Avera!e tooth len!th&B 55mm

Avera!e cro(n len!th&B Hmm

Avera!e root len!th&B 3:mm

?&D of cro(n&B =%


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P#lp cham$er The hape of the p#lp cham$er i imilar to the

ma0illar" central incior%

It onl" ha t(o p#lp horn' correpondin! to the

developmental mamelon%Root and root canal

Confi!#ration of the root canal i conical $#t itha a finer diameter than ma0illar" centralincior%

In cro&ection' the canal i ovoid la$io&palatal"in the cervical third and middle third' ro#nd inapical third%


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INCIDENCE

Root

o Strai!ht B :FG

o Ditall" c#rved B


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Anatomic relationhip in it#

It ha an avera!e of 3= de!ree of meio&a0ial inclination and

avera!e of 5H de!ree of palato a0ial an!#lation in it alveol#%

Acce openin!

It i imilar to that for a ma0illar" central incior' $#t i maller and

##all" more ovoid%

E0cept a No 5 ro#nd $#r ma" $e #ed intead of a No ;%



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CANINECANINE


Avera!e time of er#ption&B 3F&35Year

Avera!e a!e of calcification&B 3:&3mm Avera!e cro(n len!th&B 3Fmm Avera!e root len!th&B 3>mm ?&D of cro(n&B >%


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P#lp cham$er It ha the lar!et p#lp cham$er than an" in!le

rooted tooth%

2a$io&palatall" trian!#lar in hape' ape0 i

to(ard the in!le c#p and $ae to(ard thecervical third of cro(n%

?eio&ditall" it i narro(er and ma" reem$leli6e flame%

In cro&ection it i ovoid in hape' (ith !reater

diameter la$io&palatall"% Onl" one p#lp horn i preent%

R t d t l


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Root and root canal

Sin!le root canal of ma0illar" c#pid i lar!er

than that of ma0illar" incior%

It i (ider la$io&palatall" than it meio&ditaldiameter' and on reachin! middle third' it taper

!rad#all" to an apical contriction%

In cro&ection' root canal i ovoid in the

cervical and middle third and !enerall" ro#nd inthe apical third


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INCIDENCE

Root

o Strai!ht B :HG

o Ditall" c#rved B :5G

o Palatall" c#rved B >G

o 2a$iall" c#rvedB 3:G

o S&haped or $a"onet c#rvedB >G

Apical foramen

o Centrall" located in anatomic ape0 B 3;G

o Apical delta B :G


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The root of ma0illar" c#pid i poitioned in the

cancello# $one of the ma0illa $et(een the

naal cavit" and the ma0illar" in#' called the

canine pillar%

It ha an avera!e of = de!ree dito&a0ial

inclination and an avera!e of 53 de!ree palato&

a0ial an!#lation in it alveol#%


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Acce openin!

E0ternal acce o#tline form i oval or lothaped $eca#e no meial or dital p#lp horn

are preent ?eio&dital lope i determined $" the meio&

dital (idth of p#lp cham$er%

Incio&!in!ival diameter i determined viatrai!ht line acce factor and removal of the

lin!#al ho#lder%


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Incial e0tenion i approached (ith in 5&: mmof the incial ed!e to allo( for trai!ht line

acce%

All internal (all f#nnel to the orifice%

?ORPO2O1Y AND ACCESS CAVITY?ORPO2O1Y AND ACCESS CAVITYPREPARATION 8OR ?AI22ARY 3PREPARATION 8OR ?AI22ARY 3STST


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PREPARATION 8OR ?AI22ARY 3PREPARATION 8OR ?AI22ARY 3STST

PRE?O2ARPRE?O2AR



Avera!e a!e of calcification&B 35&3:YearAvera!e tooth len!th&B 55%


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P#lp cham$er

It i narro( ?&D' (ider $#cco&palatall"%

The $#ccal p#lp horn i more prominent than

the palatal in "o#n! tooth%

The floor of the p#lp cham$er i conve0 ##all"(ith t(o canal orifice (ith one $#ccal and

other palatal' it lie deep in the coronal third of

the root%

The roof of the p#lp cham$er i coronal to the

cervical line%

Root and root canal

It ma" have one' t(o' or three root and canal%


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It mot often ha t(o root namel" $#ccal andpalatal%

The root are conidera$l" horter and thinnerthan the canine%

The palatal orifice i li!htl" lar!er than $#ccalorifice%

In the cro&ection at the CE.' the palatalorifice i (ider $#cco&lin!#all" and 6idne"haped $eca#e of the meial concavit"%


The tooth lie in the alveolar oc6et $elo( thema0illar" in# and i eparated from it $" a thinla"er of pon!" and compact $one%

It ha an avera!e of 3F de!ree of dito&a0ialinclination (ith avera!e of = de!ree of $#cco&

a0ial an!#lation in it alveol#


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INCIDENCE

Root+ Sin!le rooted,

o Strai!ht B :@%;G

o Ditall" c#rved B :=%@G

o -#ccall" c#rved B 3;%;G

o Palatall" c#rvedB 5%;G

o S&haped or $a"onet c#rvedB @G

Apical foramen

o Centrall" located in anatomic ape0 B 3;G

o Apical delta B :G

Do $le Rooted TeethDo#$le Rooted Teeth


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Do#$le Rooted TeethDo#$le Rooted Teeth

* -#ccal Rooto Strai!ht B 5>%@G

o Ditall" c#rved B 3;G

o -#ccall" c#rved B 3;G

o Palatall" c#rvedB :=%5Go S&haped or $a"onet

c#rvedB @G

Apical foramen

o Centrall" located in

anatomic ape0 B 35Go Apical delta B :%5G

* Palatal Rooto Strai!ht B ;;%;G

o Ditall" c#rved B 3;G

o -#ccall" c#rved B 5>%@G

o Palatall" c#rvedB @%:Go S&haped or $a"onet

c#rvedB


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Acce openin!

The dia!notic radio!raph i #ed for mea#rin!the hape and e0tenion of the p#lp cham$ermeiall"' ditall" and coronall"%

The acce preparation i oval or lot haped%

It i alo (ide $#cco&lin!#all"' narro( meio&ditall" and centered meio&ditall" $et(een thec#p tip%

Uin! a No 5 ro#nd $#r in a hi!h peed contraan!le one penetrate the enamel in the center of

the occl#al #rface and the $#r i directed intothe lon! a0i of the tooth%

Than a No 5 ro#nd car$ide $#r in a lo( peedcontra an!le' ali!n in the lon! a0i of the tooth i#ed to penetrate thro#!h the dentin into the

p#lp cham$er%


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68

Uin! the radio!raphic mea#rement' one

penetrate deep eno#!h to remove the roof of thep#lp cham$er (itho#t c#ttin! into the cham$erfloor%

To remove the roof of the p#lp cham$er' oneho#ld place the $#r alon! the ide of (all of thecham$er and c#t occl#all"%

A tapered c"linder' elf limitin! diamond in lo(peed contra an!le i #ed to remove theremainin! roof of the p#lp cham$er%

The (all of the cavit" are moothened andloped li!htl" to the occl#al #rface%

The diver!ence of the acce cavit" create apoitive eal for the temporar" fillin! #ch acavit"%


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69

The $order of the ovoid acce cavit" ho#ld not

e0ceed $e"ond half the lin!#al inclined of thefacial c#p and half the facial incline of thepalatal c#p%

An" looe de$ri i removed $" irri!atin! the

acce cavit" (ith


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70

Schematic representationof three canal access

preparation.

?ORPO2O1Y AND ACCESS CAVITY?ORPO2O1Y AND ACCESS CAVITYPREPARATION 8OR ?AI22ARY 5PREPARATION 8OR ?AI22ARY 5NDND


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71

PREPARATION 8OR ?AI22ARY 5PREPARATION 8OR ?AI22ARY 5NDND

PRE?O2ARPRE?O2ARDevelopmental and anatomic data

Avera!e time of er#ption&B 3F&35YearAvera!e a!e of calcification&B 35&3;YearAvera!e tooth len!th&B 55%


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P#lp cham$er

It i li6e ma0illar" 3t premolar It i (ider $#cco&lin!#all" than the ma0illar" 3t

pre molar and ho( t(o p#lp horn in thiprojection' a $#ccal and a palatal%

In cro&ection' the p#lp cham$er ha a narro(ovoid hape%

Root and root canal

Sin!le rooted tooth $#t ma" $e t(o or three rootand canal %

The majorit" of canal ma" $e c#rved%

The" ma" $e c#rved ditall"' $#ccall"' palatall"or $#cco&palatall"%


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INCIDENCE

Root +in!le root HF%:G,

o Strai!ht B :>%;G

o Ditall" c#rved B ::%HG

o -#ccall" c#rved B 3G

o Palatall" c#rvedB 5%;G

o S&haped or $a"onet c#rvedB 3:G

Apical foramen

o Centrall" located in anatomic ape0 B 35G

o Apical delta B :%5G

Onl" 5G have t(o (ell developed root%


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A in!le root i oval and (ider $#cco&lin!#all"

than m&d% The canal remain oval from the p#lp cham$er

floor and taper rapidl" to the ape0%

Acce cavit" preparation

Nearl" identical to 3tma0illar" premolar%

If three canal are preent' the e0ternal acce

o#tline form are trian!#lar in hape%

?ORPO2O1Y AND ACCESS CAVITY?ORPO2O1Y AND ACCESS CAVITYPREPARATION 8OR ?AI22ARY 3PREPARATION 8OR ?AI22ARY 3STST


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PREPARATION 8OR ?AI22ARY 3PREPARATION 8OR ?AI22ARY 3

?O2AR?O2AR


Avera!e time of er#ption&B =&>Year

Avera!e a!e of calcification&B H&3FYear

Avera!e tooth len!th&B 5F%@mm

Avera!e cro(n len!th&B >%


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76

P#lp cham$er

It ha fo#r p#lp horn m&$' d&$' m&p' d&p' thearran!ement of the fo#r p#lp horn !ive thep#lpal roof of a rhom$oidal hape in cro&ection%

The fo#r (all formin! the roof conver!eto(ard the floor (here the lin!#al (all almotdiappear%

The floor of the p#lp cham$er th# ha atrian!#lar form in cro&ection%

The orifice of the root canal are located in thethree an!le of the floor%


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Root and root canal

It ha three root (ith ##all" : canal it#atedmeio&$#ccall"' dito&$#ccall"' palatall"%

?eio&$#ccal root

* It i $road in the $#cco&palatal direction%

* ?ajorit" of the m&$ root have a dital c#rve and

ome are haped or $a"onet haped%

* It ha one root and one canal' it i narro(et of

the : canal' flattened in a m&d direction in theorifice' $#t ro#nd in the apical third%


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Dito&$#ccal root

* It i mall and i more or le ro#nd in hape%* It ma" $e trai!ht +


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81

* ?eio&$#ccal Rooto Strai!ht B 53G

o Ditall" c#rved B >@G

o -#ccall" c#rved B 3;G

o S&haped or $a"onet

c#rvedB 3G

Apical foramen


anatomic ape0 B 3;G

* Dito&$#ccal Rooto Strai!ht B


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* Palatal Rooto Strai!ht B ;FG

o Ditall" c#rved B 3G

o ?eial c#rved B ;G

o -#ccall" c#rvedB


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83

Acce openin! Radio!raph i #ed to determine the hape and

i4e a (ell a the e0tenion of the p#lpcham$er meiall"' ditall" and coronall"%

The enamel i penetrated (ith No ; ro#ndcar$ide $#r in a hi!h peed contra an!le $"poitionin! the intr#ment in the central foaand an!lin! it to(ard palatal root%

After penetration of the enamel No ; ro#nd

car$ide $#r in lo( peed i #ed in a lo(peed contra an!le to penetrate dentin%

The $#r i an!led to(ard the palatal root #ntilthe p#lp cham$er i reached%


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A drop of the $#r into the p#lp cham$er ma"$e felt if the cham$er $ecome lar!e%

The internal anatom" of the p#lp cham$er!#ide the occl#al c#ttin!%

A tapered c"linder elf limitin! diamond in alo( peed contra an!le i #ed to remove theremainin! roof of the p#lp cham$er%

The (all of the acce cavit" ho#ld $e in !oodconfl#ence (ith the (all of p#lp cham$er and

ho#ld $e li!htl" diver!ent to the occl#al#rface%

The acce openin! ho#ld $e trian!#lar forpermittin! direct acce to the root canalorifice%


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86

An" looe de$ri i removed $" irri!atin! theacce cavit" (ith


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87

PREPARATION 8OR ?AI22ARY 5

?O2AR?O2AR


Avera!e time of er#ption&B 33&3:Year

Avera!e a!e of calcification&B 3;&3=Year Avera!e tooth len!th&B 3Hmm

Avera!e cro(n len!th&B >mm

Avera!e root len!th&B 33mm+$, 35mm+p,

?&D of cro(n&B Hmm ?&D of cro(n at cervi0&B >mm

2a$io&lin!#al diameter of cro(n&B 33mm

2a$io&lin!#al diameter at cervi0&B3Fmm


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88


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P#lp cham$er Similar to ma0illar" 3tmolar' e0cept it i

narro(er m&d%

It i rhom$oidal in hape%

The roof of the p#lp cham$er i morerhom$oidal in cro&ection'

The floor of the p#lp cham$er i an o$t#etrian!le in cro&ection%

The meio&$#ccal and dito&$#ccal root canal

are cloer to!ether and appear to have acommon openin!%


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90

Root and root canal It ha ##all" one canal in each root ho(ever '

it ma" have t(o or three meio&$#ccal canal'one or t(o dito&$#ccal canal' or t(o palatalcanal%

The three main orifice + ?&-' D&-' P, ##all"form a flat trian!le and ometime a trai!htline%

The meio&$#ccal canal orifice i located to the

$#ccal and meial than 3t

molar% Dito&$#ccal orifice approache the mid point

$et(een the m&$ and palatal orifice

Palatal orifice ##all" located at the motpalatal apect of the root%


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91

8loor of the p#lp cham$er i conve0 (hich !ivethe canal orifice a li!ht f#nnel hape%

/hen fo#r canal are preent' acce cavit"preparation ha a rhom$oid hape' if threecanal are preent' it i a ro#nded trian!le (ith

the $ae placed $#ccall"% If t(o canal are preent the acce o#tline form

i oval and (idet $#cco&lin!#all"%

INCIDENCEINCIDENCE


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* ?eio&$#ccal Rooto Strai!ht B 55G

o Ditall" c#rved B ##all"

Apical foramen


anatomic ape0 B 3=Go Apical delta B :G

Dital Rooto Strai!ht B ##all"

o ?eiall" c#rved B 3>G

Apical foramen

o Centrall" located inanatomic ape0 B 3=G

o Apical delta B :G

* Palatal Rooto Strai!ht B ##all"

o -#ccall" c#rved B :>G

Apical foramen


anatomic ape0 B 3=Go Apical delta B :G


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Acce cavit" preparation Same a 3tmolar%

?ORPO2O1Y AND ACCESS CAVITY?ORPO2O1Y AND ACCESS CAVITYPREPARATION 8OR ?AI22ARY :PREPARATION 8OR ?AI22ARY :RDRD


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94

?O2AR?O2AR


Avera!e time of er#ption&B 3>&55Year

Avera!e a!e of calcification&B 3@&5mm

Avera!e cro(n len!th&B =%


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96

It i conidered a a trate!ic a$#tment after lo

of ma0illar" 3tand 5nd molar%

P#lp cham$er

Anatomic reem$lance to ma0illar" 5nd molar%

It ma" alo have an odd haped p#lp cham$er(ith fo#r or five root canal orifice%

Conical cham$er (ith onl" one root canal%

Root and root canal

Three (ell developed root' f#ed root' oneconical root or fo#r or more independent root%

Root ma" $e trai!ht' c#rved or dilacerated%

One ma" find a C haped p#lp cham$er (ith a

C haped root canal%


PREPARATION 8OR ?ANDI-U2ARPREPARATION 8OR ?ANDI-U2AR


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CENTRA2 INCISORCENTRA2 INCISOR


Avera!e time of er#ption&B =&>Year Avera!e a!e of calcification&B HYear

Avera!e tooth len!th&B 55mm Avera!e cro(n len!th&B H%


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P#lp cham$er

It i mall and flat m&d% Three ditinct p#lp horn preent%

P#lp cham$er i (ide and ovoid la$io&lin!#all"and it taper inciall"%

Root and root canal It ha one root (hich i flat and narro( meio&

ditall" $#t (ide la$io&lin!#all"%

It ma" have a dital la$ial c#rvat#re%

Canal i $road and cervical of middle third ofroot in la$io&lin!#al apect' taper to(ard ape0%

Canal i ovoid in la$io&lin!#al direction in thecervical third of root%


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99

INCIDENCE

Root

o Strai!ht B =FG

o Ditall" c#rved B 5:G

o 2a$iall" c#rvedB 3:G

Apical foramen

o Centrall" located in anatomic ape0 B 5


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100

It i ri$$on haped in la$io&lin!#al direction in

middle third and ro#nd in the apical third% Apical foramen i central in root in 5


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101

Mandibular lateral incisor




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102


2ATERA2 INCISOR2ATERA2 INCISOR


Avera!e time of er#ption&B >&@Year

Avera!e a!e of calcification&B 3FYear

Avera!e tooth len!th&B 5:%


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103

P#lp cham$er

Same a mandi$#lar central incior $#t it halar!er dimenion%

Root and root canal

2ar!er than mandi$#lar central incior% ?ajorit" of root are trai!ht%

It ma" alo have ditall" ' la$iall" c#rved root acentral incior $#t the dital c#rve i harper%

Anatomic relation in it# Avera!e 3> de!ree of meio&a0ial inclination of

5F de!ree of lin!#o&a0ial an!#lation of tooth init alveol#%


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104

INCIDENCE

Same a mandi$#lar central incior e0cept apical

foramen (hich i located centrall" in 5FG cae


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106


CANINECANINE


Avera!e time of er#ption&B 33&35Year

Avera!e a!e of calcification&B 3:&3mmAvera!e cro(n len!th&B 3FmmAvera!e root len!th&B 3>mm

?&D of cro(n&B >%


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107

P#lp cham$er

It i mall and flat meio&ditall"%

Three ditinct p#lp horn are preent%

It i (ide and ovoid m&d and taperin! inciall"%

Root and root canal

It i ##all" in!le rooted%

It ha trai!ht root+=@G, ma" have c#rvedroot+5FG,

Sometime a S haped $a"onate haped c#rvei alo een%

It ##all" ha a in!le canal and apical foramen% Root canal i $road in middle third and taper to

contriction in the apical third in la$io&lin!#alvie(%


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108

INCIDENCE

Root

o ?eiall" c#rved B 3G

o Ditall" c#rved B 5FGo 2a$iall" c#rvedB >G

o S&haped or $a"onet c#rvedB 5G

Apical foramen

o Centrall" located in anatomic ape0 B :FGo Apical delta B @G


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109


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110

In cro&ection it i ovoid in middle third and

ro#nd in apical third% 2ateral canal are preent in :FG cae

Anatomic relation in it#

Avera!e of 3: de!ree of meio&a0ial inclination

of avera!e of 3< de!ree of lin!#o&a0ialan!#lation of tooth in it alveol#%

Acce openin!

Similar to ma0illar" canine%


PREPARATION 8OR ?ANDI-U2AR 3PREPARATION 8OR ?ANDI-U2AR 3tt


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111

PRE?O2ARPRE?O2AR



Avera!e a!e of calcification&B 35&3:Year

Avera!e tooth len!th&B 5;%


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112

P#lp cham$er

It i the tranition tooth $et(een anterior andpoterior%

The m&d (idth i narro(%

-#cco&lin!#all" the p#lp cham$er i (ide (ith

prominent $#ccal p#lp horn that e0tend #nder a(ell&developed $#ccal c#p%

In cro&ection the cham$er i ovoid (ith the!reater diameter $#cco lin!#all"%

Sin!le canal i preent%

In "o#n! tooth a mall lin!#al p#lp horn ipreent in the prominent $#ccal c#p andmaller lin!#al c#p !ive the cro(n an :Fde!ree lin!#al tilt%


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113


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114

Root and root canal It ha a hort conical root (hich ma" divide in

the apical third into 5 or : root%

Root i ##all" trai!ht +;@G, $#t ma" $e c#rved

alo% One canal and and apical foramen i preent%

Canal i cone haped and imple in o#tline%

Root canal i m&d narro( and $&l $road and taperto(ard the apical third%

In cro&ection' the cervical and middle thirdare ovoid and apical third i conical%


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115

INCIDENCE

Root

o -#ccall" c#rved B 5G

o Ditall" c#rved B :G

o Strai!ht B ;@G

Apical forameno Centrall" located in anatomic ape0 B 3


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116

PRE?O2ARPRE?O2AR


Avera!e time of er#ption&B 3F&35Year Avera!e a!e of calcification&B 35&3;Year

Avera!e tooth len!th&B 5;%


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117

P#lp cham$er

Same a mandi$#lar 3tpremolar%

2in!#al p#lp horn i more prominent #nder (ell

developed lin!#al c#p%

Root and root canal

Sin!le root $#t rarel" t(o or three root%

Root i (ider $#cco&lin!#all" than the co#nter

tooth%

It ma" c#rve ditall"H+;FG, and c#rve+:FG,%

Sin!le canal i preent%

2ateral canal in +;@%:G, cae%


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118

INCIDENCE

Root

o -#ccall" c#rved B 3FG

o Ditall" c#rved B ;FGo 2in!#all" c#rvedB :G

o S&haped or $a"onet c#rvedB >G

o Strai!ht B :HG

Apical forameno Centrall" located in anatomic ape0 B =F%3G


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120


Similar to mandi$#lar 3tpremolar%

Avera!e 3F de!ree of dito&a0ial inclination of

root and avera!e of :; de!ree $#cco&a0ial

an!#lation of tooth in it alveol#%

Acce openin!

Same a mandi$#lar 3tpremolar%

Enamel penetration i initiated in the central

foa %

Ovoid acce cavit" i (ider m&d and dictated $"

the (ide p#lp cham$er%

?ORPO2O1Y AND ACCESS CAVITY?ORPO2O1Y AND ACCESS CAVITYPREPARATION 8OR ?ANDI-U2AR 3PREPARATION 8OR ?ANDI-U2AR 3STST

?O2AR?O2AR


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121

?O2AR?O2AR


Avera!e time of er#ption&B =&>Year

Avera!e a!e of calcification&B H&3FYear

Avera!e tooth len!th&B 53%%


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122

P#lp cham$er Roof of the p#lp cham$er i often rectan!#lar%

The meial (all i trai!ht and dital (allconver!e ro#nd%

-#ccal and lin!#al (all conver!e to meetmeial and dital (all to form a rhom$oidalfloor%

The roof of the p#lp cham$er ha fo#r p#lphorn m&$' m&l' d&$ and d&l%

The fo#r p#lp horn re!re (ith a!e% The roof of the p#lp cham$er i located in

cervical third of cro(n j#t a$ove the cervi0


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124

8loor i located in the cervical third of the root% Three ditinct orifice are preent in the p#lpalfloor m&$' m&l and dital%

The m&$ orifice i located #nder the m&$ c#pand diffic#lt to find%

It can $e penetrated $" a lon! han6 e0plorer%

The meio$#ccal and the meio&lin!#al orificema" $e cloe #nder the meio&$#ccal c#p%

Dital orifice i oval in hape%

The m#ltiple orifice ma" $e preent in the ditalroot or are fo#nd in $#ccal and lin!#al portion ofovoid root canal%


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125

Root and root canal T(o root meial and dital%

The root are (ide and flat' (ith a depreion inthe middle of the root $&l%

Sometime third root i preent%

?eial root i c#rved ditall"%

Dital root i trai!ht%

Three canal are ##all" preent%

?eial root ma" have t(o canal and apicalforamina%

Dital root ha one canal%

In cro&ection three canal are ovoid incervical and middle third and ro#nd in apical

third

INCIDENCEINCIDENCE


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126

* ?eial Rooto Strai!ht B 3=G

o Ditall" c#rved B @;G

Apical foramen


anatomic ape0 B 55Go Apical delta B 3FG

*

Dital Rooto Strai!ht B >;G

o Ditall" c#rved B 53G

o ?eiall" c#rved B


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127

Anatomic relation in it# On avera!e a


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128

?O2AR?O2AR


Avera!e time of er#ption&B 33&3:Year

Avera!e a!e of calcification&B 3;&3mm

Avera!e root len!th&B 3:mm

?&D of cro(n&B 3Fmm

?&D of cro(n at cervi0&B @mm 2a$io&lin!#al diameter of cro(n&B 3Fmm

2a$io&lin!#al diameter at cervi0&BHmm


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129


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130

P#lp cham$er It i maller than the mandi$#lar 3tmolar%

Root canal orifice are mall and cloe to eachother%

Root and root canal It ha meial and dital root%

Rarel" three rooted%

In the in!le rooted tooth root i trai!ht $#tma" c#rve ditall"' lin!#all" it i S haped or$a"o#t hape

In t(o rooted tooth meial root c#rve ditall"'trai!ht and S haped $#ccall"%

INCIDENCEINCIDENCE


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131

* ?eial Root

o Strai!ht B 5>G

o Ditall" c#rved B =3G

o -#ccall" c#rved B ;G

o S&hapedB >G

Apical foramen

o Centrall" located in anatomicape0 B 3HG

* Dital Root

o Strai!ht B


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132


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133

Three root canal ma" $e preent%

The meial root ha one canal and foramina%

The dital root ha one canal and foramina%

In cro&ection all three root canal are mall

and ovoid in cervical and middle third and ro#ndin the apical third%


On avera!e &


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134

?O2AR?O2AR


Avera!e time of er#ption&B 3>&53Year

Avera!e a!e of calcification&B 3@&5mm

Avera!e root len!th&B 33mm

?&D of cro(n&B 3Fmm

?&D of cro(n at cervi0&B >%


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135

P#lp cham$er

It i imilar to mandi$#lar 3

t

and 5nd

molar% It i lar!e and ha an anatomic confi!#ration of

a c haped root canal orifice

Root and root canal

T(o root (ith t(o canal are preent% Three root (ith three canal are !enerall"

lar!e and hort%


The alveolar oc6et ma" project to the lin!#alplate of mandi$le%

Ape0 of root i in cloe pro0imit" of the meio&dital canal


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136

Acce openin!

It i ame a the mandi$#lar 3tand 5ndmolar

Error in acce cavit" preparationError in acce cavit" preparation


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137

* Poor acce placement and inade)#ate meial

e0tenion ma" lead to #ncovered meial orifice%

* Inade)#ate e0tenion of the dital acce cavit"

ma" leave the d&$ canal #ne0poed%

* 1ro over e0tenion of the acce cavit"(ea6en the coronal tooth tr#ct#re and

compromie the final retoration%


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138


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139

* 8ail#re to remove the roof of the p#lp cham$er

ma" lead to p#lp horn mita6en a canal

orifice%

* Over4ealo# tooth removal d#e to improper

an!#lation of $#r and fail#re to reco!ni4e the

lin!#al inclination of the tooth%

* Inade)#ate openin! ma" lead to &B3% -#r or file $rea6a!e

5% Coronal dicoloration

:% Root perforation;% Canal led!in!


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140

* 8#rcation perforation leadin! to the (ea6enin!

of the tooth and periodontal pro$lem%

* Common error in the teeth (ith f#ll cro(n i

perforation of the meial #rface d#e to the

fail#re to reco!ni4e that tooth i tipped or

reco!ni4e the ali!nment of $#r alon! the lon!

a0i of tooth%

* Enterin! the (ron! tooth i a ver" erio# error

and ma" lead to the medico le!al pro$lem%

* An" improper motion and e0ceive pre#re

ma" lead to $#r and file $rea6a!e' $ro6en

fra!ment ma" lead to e0ceive tooth removal%


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Concl#ionConcl#ion


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142

* The aim of the acce preparation i a !ood

endodontic re#lt and (ith retoration of

normal tr#ct#re and f#nction of the tooth%


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Documents

acess cavity preparation