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ACCESS CAVITY
PREPARATION
PRESENTED BY –
DR. SANKET HANS PANDEY
CONTENTS
Introduction
Traditional endodontic cavity
Need for newer modifications
Pericervical dentin
CT guided endodontic access cavity
Truss access
Limitations of Contracted Access Opening
Conclusion
TRADITIONAL ENDODONTIC CAVITY
Ingle JI. Endodontic cavity preparation. In: Ingle J, Tamber J, eds. Endodontics,
3rd ed. Philadelphia: Lea & Febiger; 1985:102–67
Consequent removal of tooth structure, coronal to the pulp chamber, along the
chamber walls, and around canal orifices, may undermine the resistance of the tooth
to fracture under functional loads.
Endod Top 2006;13:57–83.
TEC
CEC
PREMOLARS
MOLARS
Pericervical dentin (PCD)
J Endod. 2003;29:523-528
The emerging concept of conservative endodontic access is a shift to transform the
outline of the endodontic cavity from a traditional operator-centric design to a
scheme that focuses more on peri cervical dentin preservation.
Visual enhancers, such as loupes and clinical microscopes, increase the precision and efficacy of clinical
endodontics, providing detailed visualization of the tooth to be treated and allowing the clinician to conservatively
solve complex situation such as calcified teeth.
By knowing in advance the sizes and anatomical details of the tooth
to be treated, access cavities can even be diminished to the level
where a cuspal protection is not restoratively indicated, by
maintaining the occlusal isthmus not larger than one-third of the
intercuspal distance.
The endodontic cavity should be as small as possible while still
achieving the biological objectives of the root canal treatment and
as wide as the anatomy permits in a particular case.
• Generally, a contracted cavity is suggested to be slightly wider
than the coronal extension of the root canal. This permits the
maintenance of some of the roof (dentin soffit) around the entire
coronal portion of the pulp chamber.
ANGLES OF ENTRY TO VARIOUS CANALS
IN ABSENCE OF STRAIGHT LINE ACCESS
CT GUIDED ENDODONTIC ACCESS
OPENING
In these cases, preparing an adequate access and identifying the
canal orifice can be challenging and may create a massive loss of
tooth structure that Is associated with a higher risk of fracture
Et al. 2006) and a high failure rate (cvek et al.
Therefore, preoperative planning is highly recommended and 3D
imaging may be a useful tool.
Scans were matched with CBCT data by aligning the crowns of the teeth.
Finally, a virtual template was designed by applying a tool of the software.
Information on sleeve‘s position was considered in the planning.
Enamel should be removed in the area using a diamond bur until dentine is
exposed. Then, the specific bur is used to gain access to the root canal.
The final position was reached when the bur hit the mechanical stop of the sleeve.
Disadvantages of CT-GEA
High price
More time required for access cavity preparation.
More exposure to radiation because of use full mouth CBCT and
optical surface scan.
TRUSS ACCESS
The aim of this phase is to approach the pulp chamber through discontinuities
in the crown (caries, restorations, etc.)
Lesion-driven approach intended to take advantage of the already absent hard structures due to caries
in order to modify the approach as possible through this area and by limiting the restorative needs of
the treated tooth.
It is important to recognize the limiting factors in this approach, which may be beyond
the operator’s control. For instance tooth position, inclination, mouth-opening
capabilities of the patient, anatomical complexity, degree of calcification, and other
patient-related factors, all of which would result in increased time required for the
endodontic treatment.
This phase warrants considerable training and technical competency.
By limiting the removal of hard structures at the pericervical, radicular, and apical
zones of those teeth, long-term success should improve.
IRRIGATION ON A TOOTH WITH TRUSS ACCESS
FRACTURE RESISTANCE OF TEETH
PREPARED WITH TEC AND CEC
For incisors, the mean load at fracture did not differ significantly among the 3 groups
In premolars and molars, the mean load at fracture for CEC was significantly higher than for TEC and did not
differ significantly from intact teeth.
in the TEC group, the load at fracture in premolars and molars was significantly lower (P < .05) than in
intact controls
UNTOUCHED CANAL WALL
DUE TO CONTRACTED ENDODONTIC ACCESS
VOLUME OF DENTIN REMOVED
Small differences were observed between the CEC and TEC groups
in the mesial canals of molars and premolars; in incisors, the
difference was more substantial but not statistically significant.
CONCLUSION
The basis for the need of newer modification techniques for access opening derives from the
fact that an artificial restoration is of less biological and functional significance when
compared to the original healthy dentin tissue.