ACCESS CAVITY

PREPARATION
 A well designed access cavity is essential
for quality endodontic result.
Ideal Access:
1. The objective of entry.
2. Access cavity preparations  operative
occlusal preparations.
3. Interior anatomy.
4. Rubber dam.
5. Endodontic entries are prepared through the
occlusal or lingual surface – never through
the proximal or gingival surface.
6. Unsupported cusps.
Principles of Endodontic Cavity Preparation
According to Ingle, Endodontics follows the basic principles by G.V.
Black with slight modifications to explain principles of endodontic
cavity preparation.
Endodontic coronal cavity preparation
Outline form
Size of pulp chamber
Shape of pulp chamber
Number , position and curvature of root canals
Convenience form
Unobstructed access to the canal orifice.
Direct access to the apical foramen
Cavity expansion to accommodate filling technique
Complete authority over the enlarging instrument.
Outline Form Convenience Form
 Removal of the remaining carious dentin and
defective restoration
Toilet of the cavity
Endodontic radicular cavity preparation
Outline form
Retention form
Resistance form
Extension for prevention
Common canal configurations
Types of configurations:
Type 1: Single canal from the pulp chamber to the
apex.
Type 2: Two separate canals leaving the chamber but
merging short of the apex to form only one canal.
Type 3: Two separate canals leaving the chamber
and exiting the root in separate apical foramina.
Type 4: One canal leaving the pulp chamber but
dividing short of the apex into two separate and
distinct canals with separate apical foramina.
According to Weine
According to Vertucci
The following term have been used to indicate
the frequency of occurrence.
Most frequent – present in more than 55%
of cases.
Less frequent – present in less than 45% but
more than 25% of cases.
Least frequent – Present in less than 25%
but more than 2% cases.
Rare – Occurring in less than 2% of cases
but still present occasionally.
Armamentarium for Access
Preparation

1. Front surface mirror 7. Cotton pliers

2. Endodontic explorer 8. Broaches
3. Endodontic excavator 9. Glass slab
4. Plastic instrument 10. Cotton pellets
5. Amalgam plugger 11. Burs
6. Spatula 12. Rubber dam kit
Round bur
No. 2
Mandibular anterior teeth
Maxillary premolar (narrow chambers & canals)
Incisal pulp horn area (Maxillary anterior teeth)
No. 4
Maxillary anterior teeth
Mandibular premolar teeth
Maxillary premolar teeth
Maxillary and mandibular molars
No. 6
Only in large pulp chamber of molars i.e.,
Taurodontism
No. 1
Used in the floor of pulp chamber to seek additional
canal orifice.
Long shank, No. 701 or 558:
Round or safe tipped tapered fissure bur
702U: Access cavity through restoration, full crown
and inlay
Preparation of Area for Treatment
1. Preparation of the site of treatment.
2. To ensure patient comfort the tooth must
be correctly anaesthetized.
3. The tooth to be treated must be able to
accommodate a rubber dam.
4. Need for local anaesthesia during
endodontic treatment.
5. Types of anaesthetic solutions used in
endodontics
Lidocaine (Xylocaine)
Mepivacaine (Carbocaine)

Injections needed for removal of vital pulp

tissue:
Special comments about mandibular block injections –
Administer correct amount of solution
Use of the short needle
Use care when giving a IAN block with a short needle.

Intraligamentary anaesthesia
Application of rubber dam for severely broken down teeth.
Use of bands
Access when a deep gingival caries is present.
Aid for a leaky rubber dam
Access Preparation Guidelines
I)
First step - visualization of the location of the pulp
space.
Buccolingual angulations and coronal anatomy are
judged visually.
Cervical anatomy can be judged.
Palpation along the attached gingiva.
Diagnostic radiograph.
In difficult situation - initial access be prepared without
a rubber dam in place.
Endodontic Preparation of Maxillary Molar
Teeth
II)
Restorative material impinging on the
straight line access - this is especially
important in mandibular teeth.
Caries is removed to prevent irrigating
solutions from leaking past the rubber
dam into the mouth and to prevent
bacterial contamination of the canal
system with saliva.
Place an interim restoration.
A 1mm to 2mm of occlusal adjustment
of teeth may be done.
III)
The roof of the pulp chamber is best
perforated with a round bur.
A no.2 bur should be used in anterior and
premolar teeth.
A no. 4 bur should be used in molar teeth.
For teeth with porcelain crowns.
The bur is best directed toward largest part
of pulp chamber.
In calcified, multirooted teeth, it is better to
direct the access toward the largest canal..
IV)
Once the pulp chamber is located (with light upward
pressure), the round bur is used to remove the roof of the
pulp chamber from underneath; the “belly” of the bur
should be used to cut on the outstroke.
This should establish an initial outline form.
The pulp chamber should be frequently flushed with sodium
hypochlorite solution to remove debris and bacteria.
V)
DG 16 double ended explorer.
In heavily calcified teeth -
transillumination, and the careful
examination of internal dentin color.
Fiber-optic light.
VI)
Once the canals are located, a no.10 or no. 15 type of file is
introduced into the canal to determine patency.
If the canal is narrow - K-type or Hedstroem files to provide space
for the use of Gates-Glidden drills.
Hedstroem files used with lateral pressure.
Tooth length may be determined at this point.
Care must be taken to keep the files within the canal.
A lubrication agent, such as RC-Prep, which is water based
preparation that will not congeal vital pulp tissue, may be
introduced. Congealed pulp tissue can potentially form a collagen
plug at the apex that could block the apex from cleaning and shaping
VII)
The radicular access initiated by two methods.
The traditional and most popular method is to
use a Gates-Glidden drill in a step-back
fashion.
The no. 1, no. 2 and no. 3 Gates-Glidden drills
are used for radicular step back.
The no. 4, no. 5 and no. 6 are used coronal to
canal orifice to create a funnel shape to
facilitate the ease of file introduction.
This procedure will establish a convenience
form that creates a more straight line
access into the canal.
Convenience form is established by using
the Gates Glidden drill in a sweeping
upward motion, with lateral pressure away
from the furcation.
An alternative method is to use an 0.08 to
0.12 tapered engine driven nickel and
titanium file.
VIII)
Final outline form is established with a round
tip, tapered, diamond bur after the canals have
been located and the initial opening has been
completed.
This important outline form is dictated by the
internal anatomy and modified to improve
visibility, establish convenience form and
conserve critical tooth structure.
Use pathfinder for locating canal orifices
 Pulp Canal Anatomy and Access Cavity Preparations
Endodontic Cavity Preparation Maxillary Anterior Teeth
Maxillary Central and Lateral Incisors
Maxillary Canine
Endodontic Cavity Preparation in Mandibular
Anterior Teeth
Mandibular Central and Lateral Incisors
Mandibular Canine
Endodontic Preparation of Maxillary
Premolar Teeth
Maxillary First Premolar
Maxillary Second Premolar
Endodontic Preparation of Mandibular
Premolar Teeth
Mandibular First Premolar
Mandibular Second Premolar
Endodontic Preparation of Maxillary Molar
Teeth
Maxillary First Molar
Maxillary Second Molar
Endodontic Preparation of Mandibular Molar
Teeth
Lower Molar
Mandibular First Molar
Mandibular Second Molar
C-shaped molar
Errors in Cavity Preparation
Errors in Cavity Preparation
Mandibular teeth
Errors in Cavity Preparation
Maxillary premolar teeth
Errors in Cavity Preparation
Mandibular Premolar Teeth
Errors in Cavity Preparation
Maxillary Molar Teeth
Errors in Cavity Preparation
Mandibular Molar Teeth
General Shape of Walls in Access
Preparations

Removal of obstructions to the apex

Need for divergent walls
Access for badly worn or fractured anterior
teeth.
Access Through Full Veneer Crowns

Properly made crowns are constructed with the

occlusal relationship of the opposing tooth as a
primary consideration.
Preoperative radiograph.
Achieving access through crowns should be
done with coolants and rubber dam..
Once penetration of metal is accomplished,
the clinician can change to a sharp, round
bur and move to the central pulp chamber.
Metal filings and debris from the access
cavity should be removed.
Search margins and internal spaces for
leaks.
Search for signs of fracture or perforation.
Caries removal if possible.
Methods of locating calcified canals
Preoperative radiograph
All canals must be cleaned and shaped.
Serious errors (root wall and canal
perforations) – repair.
No rapid technique.
Achieving access through complex
restorations
Extensive caries / extensive coronal tooth loss /
subgingival caries.
Achieving access.
Coronal access.
Straight line access (calcified canals /malposed
teeth).
Inclined teeth.
Ideal access (removal of all rest. mat.).
Gold crowns and PFM crowns – potential risks.
Periodontal and Endodontic situations

Complications of aging
Problems of bone loss, chronic inflammation.
Closure of internal spaces.
Height of the pulp space.
Perforations.
Position of the bur tip and proper angle.
Caries on exposed root surfaces (Pdl pts).
Access related mishaps &
management
Missed canals
Mesial root of maxillary molar (MB-2)
Distal root of mandibular molar
Access cavity perforations (Undesirable communication)
Bur right angles to tooth
Mesially drifted molars
• Recognition
• Correction
Crown fractures
Fracture due to tooth weakened additionally by an access preparation
Small fracture fragment
Fracture extensive
Existing permanent restoration
Small restoration on occlusal surface
Class II amalgam or inlay
Defective restoration
Access through full crown
Carious leakage under crown margins / periodontal status
Undermined natural crown rotated or misaligned with normal tooth position and
arch configuration
Visibility is limited
Porcelain to metal crowns fractures on craze lines
Large metallic deposits in pulp chambers
Treating the wrong tooth
Inattention by dentist
Mark the tooth before rubber dam application
Developmental anomalies
Dens invaginatus (dens in dente)
Extra root or canal
Enamel defect above cingulum
Palatal groove
Dens evaginatus
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