ACCESS CAVITY

PREPARATION
PREPARED BY : BATCH E
DEPARTMENT OF ENDODONTICS
AND CONSERVATIVE DENTISTRY
GUIDED BY : DR. VAISHALI MA’AM
DR. NIDHI MA’AM
Anatomy of Pulp Cavity and
Its Access Opening
PULP:
Pulp is soft tissue of mesenchymal origin
residing within the pulp cavity.
PULP CAVITY
Definition: pulp cavity is the central cavity
within a tooth and is entirely enclosed by
dentin except at apical foramen.

coronal portion: pulp chamber

radicular portion: root canal
 PULP CHAMBER
In Anterior Teeth: The pulp chamber gradually
merges into the root canal & this
this division become indistinct.
In Multirooted Teeth: The pulp cavity consists of a
single pulp chamber &usually
three root canal .

Roof Of Pulp Chamber: Consist of dentin covering

the pulp chamber occlusally or incisally,
• PULP HORN: It is an Accentuation of the roof
of the pulp chamber directly
under a cusp or developmental lobe.

• FLOOR OF PULP CHAMBER: Parallel to the

roof & consists of dentin bounding
the pulp chamber near the cervical
area of tooth.

• CANAL ORIFICES: Opening in the floor of pulp

chamber leading into the root canals.
 ROOT CANALS
Portion of the Pulp cavity from the canal
orifice to the apical foramen.

Consists of 3 sections:
coronal
middle
apical
 Apical Foramen
• It is the terminal end of the pulp space by
which it communicates with the periapical
region.

Minor Constriction: Narrowest portion at the

terminal end of the pulp space.it is said to
coincide with the cemento-dentinal
junction.
Accessory Foramen: Opening of accessory&
Lateral canal.
 Lateral canals & Accessory Foramina
• Lateral canal: An accessory canal that
branches to the lateral surface of the tooth.
• Accessory foramina:
Opening of accessory
& lateral canal in the root
surface.
Influence of Aging On Pulp cavity
 Objectives
• Well designed access preparation is essential
for good endodontic result. Without adequate
access, instruments and material become
difficult to handle properly in highly complex
and variable canal system.
• To achieve a straight or direct line staright to
access to apical foramen.
• To locate the root canal orifice.
• To conserve sound tooth structure.
ACCESS OPENING FOR
MAXILLARY TEETH
 Access Cavity Preparation for
Maxillary Central Incisor
• Average tooth length : 22.8 mm
• Pulp chamber – located on the
center of the crown
- Broad mesiodistally
• Root & Root canal – one root with
single root canal
• Outline form – Rounded triangular
shape with base facing the incisal
aspect
• Width of the base – depends upon
the distance b/w mesial and distal
pulp horns
 Access Cavity Preparation for
Maxillary Lateral Incisor
• Average tooth length : 22.4 mm
• Pulp chamber – similar but smaller
shape than central incisor
Has 2 pulp horns
• Root & Root canal : conical
configuration with finer diameter
Majority of roots have distal curve
• Shape of the cavity similar to maxillary
central incisor except :
- Smaller in size
- Rounded triangular shape when pulp
horns are present
- Oval shape when pulp horns are
missing
 Access Cavity Preparation for
Maxillary Canine
• Average tooth length: 26 mm
• Pulp chamber : Labiopalatally
triangular in shape with apex towards
cusp and broad base in cervical one
third of crown
Narrow mesiodistally resembling flame
Ovoid shaped in cross section
• Root & Root canal : Wider
labiopalatally , on reaching middle third
tapers gradually to an apical
constriction
• Anomalies : 2 roots in some cases
ACCESS OPENING
 Maxillary First Premolar
• Average Tooth length: 21.5
mm
• Pulp chamber: It is narrow
mesiodistaly,it is wide
buccopalataly,and bicameral
pulp horn is more prominent
than palatial.
• floor of the pulp chamber is
convex
• Roots and roots canal : it has two roots in 54 6%
of cases.In 21.9% double roots.
• Access opening:
• by measuring the shape,size & extension of pulp
chamber
• Using no.2 round carbide but in a high speed
contracts angle,one penetrate the enamel in
center of the occlusal surface between buccal &
lingual cusps.and used to penetrate into pulp
chamber.
• To remove roof of Pulp chamber,the wall of the
chamber & cut occlusally.
• Anomalies : in rare cases has three roots
canals.
 Maxillary second premolar

• Average Tooth length: 21.6 mm

• Pulp chamber : It has narrow
chamber mesiodistally.
One pulp horn superimposed
over another.
The roof of the pulp chamber is
similar to first premolar.
• Roots and roots canals:
It has a single roots in 90.3% of
patients
• Clinical significance :
• If one roots canal is present the orifices will be
indistinct.
• if two present,two distinct orifics
• The root of maxillary second premolar
situated closer to the maxillary sinus.
• Access opening: the access opening of
maxillary second premolar is basically
same as first premolar..
• varied only as dictated by anatomic
structures of the pulp chamber.
• Anomalies: The maxillary second
premolar in rare cases has three roots
canals
Access cavity preparation in maxillary
molar
• Determine shape and size of the access opening by
measuring boundaries of pulp chamber medially and
distally.
• Measial boundary is line joining the mesiobuccal and
mesiolingual cusp and distal boundary is the oblique ridge.
• Penitrate the enamel with no-4 round but in the central
groove directed palatally.
• Penitrate the but deep into dentin until the clinician feels
“drop” into pulp chamber
• Now remove the roof of pulp chamber using tapered
fissure,round bur and smoothen and finish the access
cavity walls.
 Maxillary first molar
• Average tooth length : 21.3
mm
• Pulp chamber :
• Largest pulp chamber in dental
arch with four pulp horn
• Rhomboidal shape
• The orifice of the root canals
are located in the three angle
of the floor
• The palatal orifice is the largest
round or ovale in shape and
easily accessible for exploration
• Roots and root canals :
• It has three roots with usually, three canal situates
mesiobuccally,distobuccally and palatally
• The distobuccal root is small and is more or less round
in shape
• The palatal root has the largest diameter and longest
root of maxillary first molar
• Access opening :
• The enamel is penetray with a high speed but by
positioning the instrument inthe central fossa and
angling it towards the palatal root
• After penetration into the enamel,one uses the but to
penetrate the dentin ,the bur is angled towards the
palatal root until the pulp chamber is reached
• Loose debris is removed by irrigation with 5.2%
solution of sodium hypochlorite
• Maxillary first molar lies under the maxillary sinus
• The fundus of alveolar socket containing the root
may protrude in to the sinus and may produce a
samll bony prominence in the floor of the sinus
• Anomalies :
• Maxillary first molar with single root and a single
canal
• Maxillary first molar with two distal canals
• Maxillary first molar with two palatal roots
 Maxillary second molar
• Average tooth length : 21.7 mm
• Pulp chamber :
• It is similar to max first molar
except narrower mesiodistally
• The roof chamber is more
rhomboidal in cross section,the
floor of pulp chamber is an
obtuse triangle in cross section
and mesiobuccal and distobuccal
canals are closer together and
may appear to have common
opening
• Roots and root canals
• Three roots which are closely grouped because of
close grouping buccal roots may fused
• If the buccal roots fuse to form one buccal root,
the tooth may have only two canals,one buccal
and one palatal.
• Access opening
• It is the same as max first molar
• Anomalies
• Maxillary second molar with five roots and five
canals
• Maxillary second molar with three mesiobuccal
canals
 Maxillary third molar
• Average tooth length : 17.1mm
• Pulp chamber :
• It’s anatomy resembles second molar
• But it may also have an oddly shaped chamber
with four or five root canal orifice or conical
chamber with only one root canal
• Roots and root canal :
• It may have three well developed roots that are
closely grouped may also have fused roots ,one
conical root or four or more indipendent roots
• Access opening :
• Similar to that for the maxillary second molar
with modification for variations in anatomic
structure
• Anomalies :
• It is tooth in which anomalies are common,not
exception.
ACCESS OPENING OF
MANDIBULAR TEETH
 CENTARAL INCISORS
•Average tooth length:- 20.8mm
•Pulp chamber :-
It is smallest tooth im the arch
The pulp chamber is small and flat
mesiodistally.
Three distinct pulp horns present
chamber is wide and ovoid
labiolingually and it tapers
inscisally
• ACCESS OPENING :
• Same as maxillary anterior teeth,with
variation that its smaller size demands
• The shape of access opening is long and oval
 Root and root canals
• It has one root which is flat and narrow
mesiodistally but wide labiolingually
• It may have a distolabial curvature
• canal is broad and cervical of middle third of
root in labiolingual aspect , tapers towards
apex
• Canal is ovoid in laiolingual direction in
cervical third of root
 LATERAL INCISOR
• Average tooth length :-22.6mm

• PULP CHAMBER :
Same as mandibukar central incisor but it has larger
dimension
• ROOT AND ROOT CANAL :
Larger than mandibular centaral incisor
Majority of root are straight
It may also have distally labially curved root as
central incisor but the distal curve is sharper
• ACCESS OPENING :
• Same as mandibular cantral incisor
• Anomalies- gemination and fusion
 CANINE
• Average tooth length:- 25mm
• PULP CHAMBER :
• Small and flat mesiodistally
• Only one pulp horn is present in
adult tooth
• No distinct demarcation
between pulp chamber and
canal
 ROOT AND ROOT CANAL

• It has one and sraight root (68%) may have

curved roots(20%)
• single canal in single apical foramen
• canal is broad and middle third and taper
towards apex
• Canal is ovoid in cross section in the cervical
third of root and round towards apex
• ACCESS OPENING :
• Same as maxillary canine with the variation of
smaller anatomic dimension
 FIRST PREMOLAR
• Average tooth length:-21.9mm
• PULP CHAMBER:-
• M-D narrow
• Buccolingually pulp chamber is wide
with prominent buccal pulp horn
• In cross section the chamber is
ovoid with greater diameter
buccolingually
• If single canal is present than there
is no distinct division between pulp
chamber and canal
• Buccal cusp and lingual cusp give
the crown a 30% lingal tilt
• ROOT AND ROOT CANAL :
• Short conical root ,usually straight 48% but
may be curved
• One canal ane one apical foramen 70%
• One canal and two foramen 24%
• Canal cone shaped and simple in outline
• Mesiodistally narrow and buccolingualky
broad and taper toward the apical third
• In cross section cervical and middlethird are
ovoid ane apical third is round
• ACCESS OPENING :
• Same as maxillary premolars
• Access cavity is ovoid and pulp chamber is
divergent occlusally
• The ovoid prepartion should extend buccally
and lingualky enough to allow the comllete
removal of the roof of the pulp chamber
• It permits exploration for bifurcation and
trifurcation in middle and apical third
• Anomalies-bifurcation and trifurcatin of the
root
 SECOND PREMOLAR
• Average tooth length :-
22.3mm

• PULP CHAMBER
• Similar to mandibular first
premolar except that
lingual pulp horn is more
prominent
• ROOT AND ROOT CANAL :
• Usually has a single root but rarely two or
three roots
• Root has a greatre girth and wider
bucoolingually
• Straight root (39%) curved root(40%)
• single canal and single apical foramen(97.5%)
• bifurcation seen in 2.5%
• ACCESS OPENING :
• Same as mandibular first premolar except that
the enamel penetration is initiated in the
central fossa,and the ovoid access opening is
wider mesiodistally
• Anomalies -two roots
 FIRST MOLAR
• Average tooth length -21.9mm
• PULP CHAMBER :
• Roof of pulp chamber is rectangualar shape
• Four pulp horns:misiobuccal
,mesiolingual,distobuccal,distolingual
• three orifices:mesiobuccal ,mesiolingualand
distal
• the mesiobuccal orifice is difficult to find .
To penetrate this orifice insert a long shank
explorer into the point anglecreated at
junction of mesial wall ,buccal wall abd
subpulpal floor of the pulp chamber
• Mesiolingual orifice is locate in a depression
formed by the mesial and lingual walls
• A groove usually connects mesiobuccal and
mesiolingual orifices
• The distal orifices is oval in shape with widest
diameter
• Can be explored by starting from mesial
direction
• The multiple orifices in the distal root are
usually found
• ROOT AND ROOT CANALS :
• Two roots :mesial and distal
• Third root may found5.3%
• Roots are wide and flate
• Mesial root has :2canals with 2
foramens(41%)
2 canals one foramen 28% in rare
case 3 canals and 3 foramina
present the third orifices is
referred as middle mesial canal
Distal root has:1 canal and 1
foramen (70%)
2 canal and 1 foramen (15%)
• ACCESS OPENING :
• It follows the antomy of pulp chamber
• Enamel and dentin are penetrated in the
central fossa with bur angled toward distal
root
• Remain all are same as maxillary molar
• it is usually trepazoidal with round corner
• Anomalies -radix entomolaris(3roots).
 SECOND MOLAR
• Average tooth length : 21.4 mm
• PULP CHAMBER :
• same as mandibular 1st molar
except smaller in dimention
• ROOTS AND ROOT CANAL :
• two roots(71%) one root (27%)
three roots(2%)
• most frequent variation is presence
of only two canals
• ACCESS OPENING :
• same as mandibular first
molar with the variation
that smaller in size
• because of the buccoaxial
inclination some time it is
necessary to reduce a
large portion of
mesiobucal cusp
• ANOMALIES : Third root
 THIRD MOLAR
• Average tooth length:-18.5mm
• PULP CHAMBER :
• same as mandibular first and second molar except
large and posseses many anomalous configuration such
as c shaped root canal orifices

• ROOT AND ROOT CANALS :

Usually has a two roots and two canals
the root canal are generally large and short
Occasionally one root and one canalor three root and
three canals seen
• ACCESS OPENING :
• Same as mandibular first and second molars
with the variation that anatomic structure
dictates
• ANOMALIES : complex anatomic structure
THANK YOU