ACCESS CAVITY

PREPARATION
Anjali s nair
Definition
 Access cavity preparation is defined as
an endodontic coronal preparation
which enables unobstructed access to
the canal orifices , a straight line access
to apical foramen, complete control
over instrumentation and accomodate
obturation technique
Objectives of access cavity
preparation

 1- Straight line access to apical foramen

or to the initial curvature of the canal.
 2- To locate all root canal orifices.
 3- To conserve sound tooth structure
 4-complete deroofing of pulp chamber
 5-provide a positive support for
temporary filling
Principles of access cavity preparation

 1. Outline form.
 2. Convenience form.
 3. Removal of remaining carious dentin
and defective restorations.
 4. Toilet of the cavity.
1.Outline form:

 Established by mechanically projecting

the internal anatomy to the external
surface.
 Three factors regulating the outline
form:
 a. Size of pulp chamber:
 Young patients - extensive.
 Old patient -limited.
 b. Shape of pulp chamber:
 Anteriors -Triangular.
 Premolars - Oval or ovoid.
 Molars - Triangular.
 c. Number and direction of root canals.
2Convenience form
 It is the form given to the access cavity to
improve visibility, instrumentation and
obturation of the root canal by providing a
straight line access from occlusal surface to the
apical foramen.
 Benefits:
 1. Unobstructed access to the orifices.
 2. Direct access to the apical foramina.
 3. Complete authority over the instrument.
 4. Expansion to accommodate filling techniques.
3- Removal of remaining carious dentin and
defective restorations:
Reasons of removing caries and
defective restorations:
 1. Elimination of bacteria.
 2. Elimination of discolored tooth
structure.
 3. Elimination of the possibility of
coronal leakage.
4- Toilet of the cavity
 All caries, calcified debris and necrotic
material should be removed by
irrigation from the pulp chamber before
radicular preparation is begun to avoid
obstruction of the root canals.
Instruments

 Endodontic explorer
 DG16;
Deinged by Devid Green in1951 to identify canal
orifices and to determine canal angulation
 CK(Clark-Khademi)17; used to identify calcified
canals because of being thinner and stiffer in nature
 Endodontic spoon excavator ;it is double ended
excavator with long shank so as to reach deep into
the prepared cavity . It is used to excavate base of
pulp chamber
 Access opening burs
 Diomond round bur;
 nos.2 and 4 diamond
burs are used to gain entry into tooth
structure and restorative materials
 No2 is for anteriors and no.4 is for
posteriors
 Carbide round bur
 no 2 and 4 surgical length
round burs are used to reach pulp . These
have longer shank so give better visibility .
 Transmetal bur
 used for cutting any type of
metal .it has saw tooth blade configuration
which provide efficiency without vibration
,helpful for entering hot tooth
 Endo Z bur
 it is safe –ended taperd carbide bur .
Lateral cutting edge of endo Z bur are used to
flare flatten and refine the internal axial walls .
Its non cutting edge can be placed on the
pulpal floor without the risk of perforation
 Tapered diamond bur
 used in heigh speed to flatten
flare and finish axial walls of pulpal chamber
 X gates
 nos.1to 4 Gates – Glidden are used
in sequential manner to form a funnel
shaped access coronal surface .
 ultrasonic instruments
 used to create trough along
the grooves to expose hidden orifices
,remove pupl stone , negotiate calcified
canals and finish access preperation
Laws of the pulp chamber anatomy

 According to krasner and rankow

 1-Law of centrality: The floor of the pulp

chamber is always located in the center
of the tooth at the level of the CEJ.
 2-Location of CEJ: The distance from the
external surface of the clinical crown to
the wall of the pulp chamber is the
same throughout the circumference of
the tooth at the level of the CEJ, making
the CEJ is the most consistent
repeatable landmark for locating the
position of the pulp chamber.
 3-Firstlaw of symmetry: Except for the
maxillary molars, canal orifices are
equidistant from a line drawn in a
mesiodistal direction through the center of
the pulp chamber floor.
 4-Second law of symmetry: Except for the
maxillary molars, canal orifices lie on a line
perpendicular to a line drawn in a
mesiodistal direction across the center of
the pulp chamber floor.
 5-Law of color change: The pulp
chamber floor is always darker in color
than the walls.
 6-First law of orifice location: The
orifices of the root canals are always
located at the junction of the walls and
the floor.
 7-Second law of orifice location: The
orifices of the root canals are always
located at the angles in the floor–wall
junction.
 8-Third law of orifice location: The
orifices of the root canals are always
located at the terminus of the roots’
developmental fusion lines.
Guidelines for access cvity
preparation
 Check the depth of preparation and
position of pulp chamber by alinging the
bur and hand peice against the
radiograph
 Use round bur to penetrating into pupl
chamber .once “drop in “to the pulp
chamber is obtained , round bur is moved
inside to outside in brushing motion. By
this dentin overhangs are removed
 After this finishing and flaring of the
preparation is done using nonended cutting
bur . It creates smooth transition between
access cavity and walls of pulp chamber
and flaring of pulp chamber occlussally
 Diamond burs are prefferred over tungsten
carbide burs because they cut more
smoothly , produce lesser vibration and are
well tolerated by patients
 Walls of pulp chamber are flared and
tapered to form a gentle funnel shape with
large diameter towards occlusal surface
.shape of access cavity differ from
restorative dentistry . For access cavity one
should uncover the pulp by remooving the
roof of the pulp chamber
 Access cavity is prepared through occlusal
or lingual surface never through proximal or
gingival surface
 Size of pulp chamber ; wider in younger
patients
 Shape of chamber ; triangular in
anteriors ,ovoid buccolingually in premolars
and trapezoidal or triangular in molars
 Number position and curvature of canal ; it
can lead to modified access preparation
like shamrock preparation in maxillary
molar
Access cavity preparation in anterior teeth

 Outline form of central and lateral incisors are triangular

with the base of the triangle towards the incisal edge
and the apex towards the cingulum.

 Steps
 1-Entrance is gained through the middle of the middle
third of the palatal surface.

 2-Initial entrance Is prepared with a round bur at a high

speed operated at a right angle to the long axis of the
tooth. Only enamel is penetrated.
 3-The bur is positioned in a 45 degree to
the long axis of the tooth then advanced
to penetrate the pulp chamber.
 4-Removal of the pulp chamber
(deroofing)
 5 -Removal of lingual shoulder.
Maxillary central incisor
 Shape of access cavity is rounded
triangular with base facing the incisal
aspect
 Width of base depends upon the distance
between the mesial and distal pulp horns
 Shape may change from triangular to
slightly oval in mature teeth because less
prominence of mesial and distal pulp
horns
Maxillary laterals
 Almost same as that of centrals
 Smaller in size
 Shape is rounded triangular when pulp
horns are present
 Oval when pulp horns are missing
 Frequently a palatal or distal curvature
of apical third of root is found
Maxillary canine
 Oval with
 greater
 dimension
 Labio-
 palatally
Mandibular incisors
 Shape of access cavity of both central
and lateral is same and it differs from
maxillary in following aspects
 Smaller
 Long oval with greater dimension
directed incisolingually
Mandibular caninnes
 Simmiler to maxillary canine except that
 Its smaller
 Root canal outline is narroer in
mesiodistal dimension
 Two canals are often present in
mandibular canine
 Errors
 1- GOUGING of the labial wall caused by
failure to recognize the 29-degree
lingual-axial angulation of the tooth.
 2- Missed canal due to insufficient
convenience extension.
 3- PERFORATION at the labiocervical caused by
failure to complete convenience extension
toward the incisal, prior to the entrance of the
shaft of the bur.
 5- DISCOLORATION of the crown caused by
failure to remove pulp debris. The access cavity
is too far to the gingival with no incisal extension.
 6- LEDGE formation at the apical-distal curve
caused by using an uncurved instrument too
large for the canal. The cavity is adequate
Access cavity preparation for
premolars
 Inpremolars the pupl chamber is
located in the center of occlusal surface
between buccal and lingual cusp tips .
Two pulp horns are located within the
peaks of their cusps and orifices are
located within the horns so cavity
preparation can be done without
involving cusps .
 Initial penetration is made parallel to the long
axis of the tooth in the exact center of the
central groove
 1A no. 4 round bur is used to open into the pulp
chamber by directing paralell to the long axis.
The bur will be felt to “drop” when the pulp
chamber is reached.
 Removal of roof of pulp chamber using a round
bur tapered or nonend cutting bur alongside the
walls of pulp chamber working inside to out side
 Remove any remaining cervical bulges
or obstructions using safty tip bur or
Gates-Gliden drills and obtain a straigh
tline access to canal
 Final preparation is larger in
buccolingual dimension. Two canals are
often joined by a shallow groove located
at floor of pulp chamber
Maxillary first premolar
 Shape; ovoid where boundaries should
not exceed beyond half the lingual
incline of buccal cusps and half the
buccal incline of lingual cusps
Maxillary second premolar
 Similer to maxillary premolar . Weine
stated that second premolar has single
root with ovoid canal in60%of the
cases . Finding the single eccentric
orifice indictes presence of another
canal
Mandibular first premolar
 Diiferfrom maxillary premolar in
following aspects
 There is a 30° lingual inclination of the
crown to the root; hence the starting
point of bur penetration should be
halfway up the lingual incline of the
buccal cusps on a line connecting the
cusp tips
 Oval shape wider mesiodistally
Mandibular second premolar
 Similer to first premolar except that ;
 Enamel penetration is initiated in the central
groove because its crown has smaller lingual tilt
 Because of better developed lingual half , the
lingual boundary of access opening extends
halfway upto the lingual cusp incline ,making up
pulp chamber wider buccolingually
 Rootcanals are more often ovel than round
 Ovoid access opening is wider mesiodistally
 Errors
 Under extended access cavity
 Over extended access cavity
 PERFORATION at the cervical area caused by
failure to recognize that the premolar has tilted
to the distal.
 FAILURE to locate the third canal of the
maxillary first premolar (6% of the time).
Maxillary First Molar
 Shape of pulp chamber is rhomboid with
acute mesiobuccal angle ,obtuse
distobuccal angle and palatal right
angles
 Palatal canal orifice is located palatally .
Mesiobuccal canal orifice is located
under mesio buccal cusp . Distobuccal
canal orifice is located slighlty distal and
palatal to the mesiobuccal orifice
A line drawn to conncet all three orifices
foarms a triangle ,termed as molar
triangle .
 Almost always a second mesiobuccal
canal ,that is ,MB2 is presented in
maxillary first molars , which is located
palatal and mesial to MB1 . Though its
position can vary ,sometimes it can lie
in a line between MB1 and palatal
orifices
Shamrock preperation
 because of presence of MB2 ,the access
cavity acqiure a rhomboid shape with corners
corresponding to all canal orifice . Luebke
showed that an entire wall is not extended to
search and facilitating cleaning , shaping
and obturation of extra canal . He
recommended extension of only that portion
of the wall where extracanal is present and
this may result” cloverleaf appearance “ it
is reffered to as “shamrock preperation”
Maxillary second molar
 Basic technique is similar to maxillary molars
with following differences
 Three roots are found closer which may even
fuse to form single root
 MB2 is less likely to be present in secondmolar
 Three canals form a rounded triangle with base
towards buccal side
 Mesiobuccal orifice is located more towards
mesial and buccal than in first molar.
Mandibular first molar
 Mesiobuccal orifice is under
mesiobuccal cusp. Mesiolingual orifice is
located in a deepression formed by
mesial and lingual walls . Distal orifice
is oval in shape with largest diameter
buccolingually located distal to the
grooves
 Orifices of all the canals are located in
the mesial two third of the crown
 Casses have also been reported with an
extra mesial canal lying in the
developmental groove betweeen
mesiobucal and mesiolingual canals .
Distal root has also shown to have more
than one orifices,that is distobuccal
distolingual and middle distal . These
orifices are usually joined by the
developmental grooves .
 Shape of access cavity is usually
trapezoidal or rhomboidal irrespective
of the number of canals present
 The mesial wall is straight, the distal
wall is round . The buccal and lingual
walls converges to meet the mesial and
distal walls
Mandibular second molar
 Similar to that of first molar but
differes in the following aspects
 Pulp chamber is smaller in size
 One two or more canals may be
present
 3canals; more triangular and less
rhomboidal than first molar
 2canals ; rectangular, wider
mesiodistally and narrower
buccolingually
 Because of buccoaxial inclination
sometimes it is necessary to reduce a
large portion of the mesiobuccal cusps
to gain convenience form for
mesiobuccal canal
 Errors
 Under extended access cavity
 Over extended access cavity
 Perforation in the furcation area Failure
to locate all the canals
 Crown perforation Root perforatio
Clinical management of difficult
cases for access opening
 Good quality radiograph
 Magnification
 Knowledge of clinical anatomy
 Color of pulpal floor
 Extension of access cavity
 Management of cases with extensive restotations
 Tilted and angulated crowns
 Calcified canals
 Sclerosed canal
 Teeth with non or minimal crown
Access preparation of calcified
canals
 Access opening and identification of
canal orifice
 To locate canal orifice mentally visualize
and plan the normal facial relationship
of the pulp space on to a radiograph of
calcified tooth. Measure the distance
from occlusal surface to the pulp
chamber from preoperative radiograph
 Start with no. 2 or 4 round bur . Avoid
removing large amount of dentin. Small
round bur is used to find out a pathway
to the orifice
 Location of orifice ;
 DG16Vexplorer
“stick “ – no. 8 or 10 K file
 Cavity preparation without LA
Recent advances
 Minimal invasive endodontics
 Conservetive endodontic cavity (CEC) is
prepared to minimize the loss of tooth
structure ,preserve chamber roof and
pericervical dentin resulting improved
fracture resistance of teeth .
 Ninja preparation
Newer guidelines- Important
aspects
 Pericervical or pericingulum dentin –PCD
 Avoid GG drills and round burs
 Preserve tooth structure for 3D ferrule
 Cavosurface design – cala lilly preparation
 Posterior teeth
 banking /soffit /stepped access
 Anterior teeth
 traditional, new model by clark
Khademi (CKP)
 Thank you