Access cavity

Pre-endodontic
reconstruction of teeth

Access cavity
Definition: a cavity placed on the coronal
part of the tooth that allow access,
cleaning, shaping and filling of the
entire root canal
Purposes of root canal treatment are:
1) cleaning
and
shaping
Impossible
2) disinfection
without
correct
3) three-dimensional obturation of the
access
cavity
root
canal system.

Initial radiograph
Morphology and
volume of the pulp
chamber
Distance from the
pulp chamber roof to
the occlusal face
Number and position
of the root canals
Morphology and
length of the root
canals

Requirement of the access cavity

1. Permit the removal of all pulp chamber
content
Good endodontic cleaning starts pulp chamber
roof of the pulp chamber removed
cleaned

pulp chamber + pulp horns

IF NOT

contamination or infection of the endodontic space that the

dentist is trying to clean.
discoloration of the endodontically-treated tooth (especially the
front teeth).

Control of the removal of the en

roof of the pulp chamber is
done by probing

No 17

Requirement of the access

cavity

2. Permit complete and direct

vision of the floor of the pulp
chamber and of the root canal
openings

Be able to visualize
the entire floor and the root
canal openings on one look
Pulp chamber floor - grayish
The floor frequently has
natural grooves, at the end of
which the canal orifices are
located

Requirement of the access

cavity
3.Facilitate the introduction of canal instruments in
the root canal openings
Floor + walls of pulp chamber => acute angle

Insertion of instruments in the canal sliding gently along the cavity walls

Check
the radiograph

Requirement of the access cavity

4.Provide access as direct as possible to
the apical third of the canal for
preparation and filling instruments

When working in the canal, they should move freely, particularly in the
apical one third
NOT BE IN CONTACT WITH THE WALLS OF THE PULP CHAMBER
work on the entire circumference of the canal
shaft frictions against
the coronal
obstructions narrow access cavity

work on only one wall of the canal,

while the other remains completely untouched
much the
working portion of the
against the
canal walls
Deformations of the apical foramen

force
ability to sense how
instrument is engaged

fracture

AVOID COMPLICATIONS ENLARGE THE ACCESS CAVITY

Requirement of the access cavity

5.Provide positive support for temporary fillings
FUNNEL SHAPED
Walls diverging towards occlusal
Including only the occlusal part of
the cavity
Form enlarged occlusal
projection
Of the contour of the pulp
chamber
floor on the occlusal face

Insufficient flaring- sinking of the filling

Fracture of the temporary filling

Requirement of the access

cavity
6. Always have four walls
The four walls of the access cavity serve several
purposes:
correct positioning of the rubber dam so that the clamp
is stable and the rubber dam isolates the field well
keeping the pulp chamber constantly flooded with as
much irrigating solution as possible
defining easily recognizable, stable reference points
for the rubber stops on the endodontic instruments
introducing the temporary medication without
affecting the interproximal papillae
If one ore more walls are missing restored

Pre-endodontic reconstruction
Teeth requiring endodontic treatment present
1.Carious lesions
2. Fractures
3. Improper restorations
First step of endodontic treatment = removal of
carious dentin or incorrect restorations
Tooth - big loss of tooth structure
Inconvenient for placing the rubber dam
Impossible to prepare a correct access cavity

Pre-endodontic reconstruction
Restorative: Glass ionomers, pin retained
amalgam buildup, composite resins
Prosthetic: copper bands, provisory crowns,
orthodontic bands
Technique:
1.Removal of infected dentine/restoration->
sound tooth structure
2.Placement of matrix system(circular) or copper
band
3.Placement of a cotton pallet in the pulp
chamber if the pulp chamber is exposed
4.Placement of the chosen material

Preparation of the access

cavity
Penetration
Finishing
Round diamond
cutting end
Air turbine

Enlargement
Round bur

Fissure with
non

Low speed handpiece

Air turbine

Action of the bur

applied on the way out

Upper maxillary incisor

Pulp chamber 2
pulp hornes (mesial
and distal)
One root
One root canal
ovoid in cross
section larger
diameter mesiodistal
Length - 23 mm

Upper maxillary incisors

2

The access cavity is initiated by

applying the bur occlusal to the
cingulum, almost

perpendicular to the palatal

surface
Removal of the triangle 1 enamel
round diamond
A slight mesiodistal movement must
be
imparted simultaneously to the bur,
so as to remove all of the roof
associated
with the pulp horns

3. Removal of triangle 2 dentin

Upper lateral incisor

Pulp chamber 2 horns
situated closely or one
central pulp horn
One root
One root canal cross
section ovoid long
diameter facio-lingually
Length 22,5mm
Access cavity performed
as for the CI
Difference shape - OVAL

Curvatures of the root canal:

Palatal - access cavity extended towards facial
Distal access cavity extended towards mesial

Upper canine
Pulp horn 1 central
One root
One root canal cross
section oval - long
diameter faciolingually
Length 27mm

Access cavity OVAL shape

long diameter occlusogingivaly
Start palatal face-
distance
Same rules as for incisors

1st upper premolar

Pulp chamber -2 horns facial and lingual
2 roots
2 root canals (may have 1 root canal situated
central or 3 root canals -2 facial and one palatal)
Length -21mm
Root canals are parallel or the palatal one is
slightly curved
Distally
Bayonet curvature

Upper premolars
The point of entry of the bur is the
middle of the central sulcus and
parallel to the long axis of the tooth .
As one penetrates with the round,
high-speed diamond bur, one
simultaneously applies a buccopalatal movement to the bur, so as to
begin to outline the future occlusal
contour of the access cavity
2 Once the chamber is penetrated, a
low-speed round bur is used on the
way out, to peel the undercuts of
dentin that remains after penetration
3. Then, with a non-cutting end, highspeed diamond bur, the cavity is
finished and flared.
The final shape of the access cavity is
ovoid

2nd upper premolar

One root and one root

canal located central
Cross section oval long
diameter facio-lingually
with a central
strangulation ( 8 shape)
Two root canals facial and
lingual
Length -21,5mm
Access cavity
= OVAL

1st Upper Molar

3 roots
3 or 4 root canals
palatal root curved buccaly

longest root, cross section round

- canal orifice under MP cusp

distobuccal root shorter
- cross section round
- - canal orifice under DB cusp
mesio buccal root 2 root canals
MB 1 placed under the MB cusp
- cross section oval - flat mesiodistally
MB2 groove between MB1
and P root canal
MB1 and MB2 2 distinct apex or
one apex

1st Upper Molar

Access cavity
quadrangular shape
following the shape of
the occlusal projection
of the pulp chamber
on cross section in the
cervical area

Preparation of the access cavity

3. Finishing
non-cutting end
1. Penetration
2. Enlargement long shafted bur
bur air turine
Round bur air turbine
Slow speed handpiece
Funnel shaped cavit
Penetration in the central fossa
Active on exiting the cavity

2nd Upper Molar

Pat
Anatomy resemble
to the anatomy of
the 1st molar
3 roots with 3 or 4
root canals
Disto-buccal canal
located more
palatal

Lower incisors
CI one root one root
canal or 2 root
canals(30%)
LI one root and 1 or 2
root canals(47%)
Canal is oval the
larger diameter is
facio-lingual
Length CI = 20,7mm
LI = 21,8
mm

Lower incisors

Because of the position of the

root canals the access cavity
has a ovoid shape
Performed at the biginning with
the round bur attached to the air
turbine followed by the removal
of the two triangles and the
carefull shaping of the access
cavity to allow the access to the
second oral root canal
Extension of the access cavity in
incisal direction permit
instrumentation of the lingual
root canal
Very difficult endodontic
treatment

Lower canine
One root
One root canal (curved
distally)
Oval on cross section
larger diameter faciolingual
One central pulp horn
Length = 25mm
Access cavity :palatal
oval
shape

1st Lower premolar

One root
One root canal with
complex anatomy
Cross section oval
long axe facio-lingual
Can divide in two or
more canals that
rejoin together at the
apex
Length = 21,5mm

Lower first premolar

Crown asymmetrical with a big

buccal cusp and a very small oral
cusp
The pulp chamber lies almost
entirely under the buccal cusp
Access cavity started in the
middle of the central groove
with the round bur attached to
the air turbine
The bur orientated towards
the buccal pulp horn
Root one or two root
canals(often)
Access cavity eliptical shape
Oral cusp preserved, buccal
cusp eliminated at the peak

2nd Lower premolar

One root
One root canal
oval cross section
Length = 21,5mm
Can show a
curvature towards
distal

1st Lower molar

Two roots mesial and distal

3 root canals - distal central,
large, straight or curved distally
- oval cross section
- 2 mesial MB + ML
4 root canals - 2 distal - DL + ML
- 2 mesial - MB + ML
If two distal canals are present smaller
, round on cross section

Distal root concavity on

the mesial face
Mesial root concavity on
the distal face

1st Lower molar

Access cavity
trapezoidal - 3 canals
Quadrangular - 4 canals
Access is started with a round
diamond air turbine entry
point central fossa
After penetrating the pulp
chamber
Round bur attached low speed
handpiece
The entire roof is removed
Funnel shape form is provided by
finishing the cavity with a non
cutting ended tapered fissure bur
or the Endo Z or Endo Access bur

1.Penetration

2. Enlargemen

3. Finishing

2nd Lower molar

Two roots mesial and distal

3 root canals - distal
central, large, straight or
curved distally
- oval
cross section
- 2 mesial
MB + ML
Access cavity trapezoidal

Golden rule
It should not be the dentist to
decide the shape of the access
cavity but rather the anatomy of
the pulp chamber floor
A.
Castelluci