Escolar Documentos
Profissional Documentos
Cultura Documentos
Submitted To-:
Dr Anurag Singhal
Submitted By-:
Dr Anurag Gurtu
Kapil Yadav(25)
Dr Naveen Chhabra
Shailendra Singh(44)
Dr Raju Chauhan
ACCESS CAVITY
PREPARATION
INTRODUCTION
The major factor involved in the development of
the apical periodontitis are loss of integrity of
coronal tooth substance and the entry of
microorganisms into the dentine and pulp
space.
The chemo-mechanical removal of
microorganisms, their substrate and products
form
the dentine and pulp space is primary aim of root
canal treatment, with the second being the three
dimensional obliteration and sealing of the pulp
space to prevent bacterial recontamination.
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GUIDELINES
It is essential for the completion of ideal access
preparation.
1. Visualization of internal anatomy because
internal anatomy dictates access shape. This
require evaluation of angled peri-apical
radiograph, examination of coronal and
cervical tooth anatomy.
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2.
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Pulp chamber
It is located in the centre of crown equidistant
from the dentinal wall.
It is broad m-d, with its broadest part incisally.
It has three pulp horns that corresponds to the
double mammelons in a young tooth.
Root and root canal
It has one root with one root canal.
Root canal is broad labio-palataly, conical
shape, and centrally located.
In cross-section, canal is ovoid m-d in cervical
third, rounded in middle and apical third.
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INCIDENCE
Root
o Straight : 75%
o Distally curved : 8%
o Mesially and palatally curved : 4%
o Labially curved: 9%
Apical foramen
o Centrally located in anatomic apex : 12%
o Apical delta : 1%
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Pulp chamber
The shape of the pulp chamber is similar to the
maxillary central incisor.
It only has two pulp horn, corresponding to the
developmental mamelons.
Root and root canal
Configuration of the root canal is conical but it
has a finer diameter than maxillary central
incisor.
In cross-section, the canal is ovoid labio-palataly
in the cervical third and middle third, round in
apical third.
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INCIDENCE
Root
o Straight : 30%
o Distally curved : 53%
o Mesially and palatally curved : 3%
o Labial curved: 4%
o S-shaped or bayonet curved: 6%
Apical foramen
o Centrally located in anatomic apex : 22%
o Apical delta : 3%
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Access opening
It is similar to that for a maxillary central incisor, but is smaller and
usually more ovoid.
Except a No 2 round bur may be used instead of a No 4.
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Pulp chamber
It has the largest pulp chamber than any single
rooted tooth.
Labio-palatally triangular in shape, apex is
toward the single cusp and base toward the
cervical third of crown.
Mesio-distally it is narrower and may resemble
like flame.
In cross-section it is ovoid in shape, with greater
diameter labio-palatally.
Only one pulp horn is present.
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INCIDENCE
Root
o Straight : 39%
o Distally curved : 32%
o Palatally curved : 7%
o Labially curved: 13%
o S-shaped or bayonet curved: 7%
Apical foramen
o Centrally located in anatomic apex : 14%
o Apical delta : 3%
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Access opening
External access outline form is oval or slot
shaped because no mesial or distal pulp horn
are present
Mesio-distal slope is determined by the mesiodistal width of pulp chamber.
Inciso-gingival diameter is determined via
straight line access factor and removal of the
lingual shoulder.
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Pulp chamber
It is narrow M-D, wider bucco-palatally.
The buccal pulp horn is more prominent than
the palatal in young tooth.
The floor of the pulp chamber is convex usually
with two canal orifices with one buccal and
other palatal, it lies deep in the coronal third of
the root.
The roof of the pulp chamber is coronal to the
cervical line.
Root and root canal
It may have one, two, or three roots and canals.
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INCIDENCE
Root( Single rooted)
o Straight : 38.4%
o Distally curved : 36.8%
o Buccally curved : 14.4%
o Palatally curved: 2.4%
o S-shaped or bayonet curved: 8%
Apical foramen
o Centrally located in anatomic apex : 14%
o Apical delta : 3%
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Palatal Root
o
o
o
o
o
o
o
o
o
o
Straight : 27.8%
Distally curved : 14%
Buccally curved : 14%
Palatally curved: 36.2%
S-shaped or bayonet
curved: 8%
Apical foramen
o Centrally located in
anatomic apex : 12%
o Apical delta : 3.2%
Straight : 44.4%
Distally curved : 14%
Buccally curved : 27.8%
Palatally curved: 8.3%
S-shaped or bayonet
curved: 5.5%
Apical foramen
o Centrally located in
anatomic apex : 12%
o Apical delta : 3.2%
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Access opening
The diagnostic radiograph is used for measuring
the shape and extension of the pulp chamber
mesially, distally and coronally.
The access preparation is oval or slot shaped.
It is also wide bucco-lingually, narrow mesiodistally and centered mesio-distally between the
cusp tips.
Using a No 2 round bur in a high speed contra
angle one penetrates the enamel in the center of
the occlusal surface and the bur is directed into
the long axis of the tooth.
Than a No 2 round carbide bur in a slow speed
contra angle, align in the long axis of the tooth is
used to penetrate through the dentin into the
pulp chamber.
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Schematic representation
of three canal access
preparation.
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Pulp chamber
It is like maxillary 1st premolar
It is wider bucco-lingually than the maxillary 1st
pre molar and shows two pulp horn in this
projection, a buccal and a palatal.
In cross-section, the pulp chamber has a narrow
ovoid shape.
Root and root canal
Single rooted tooth but may be two or three root
and canal .
The majority of canal may be curved.
They may be curved distally, buccally, palatally
or bucco-palatally.
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INCIDENCE
Root (single root 90.3%)
o Straight : 37.4%
o Distally curved : 33.9%
o Buccally curved : 15.7%
o Palatally curved: 2.4%
o S-shaped or bayonet curved: 13%
Apical foramen
o Centrally located in anatomic apex : 12%
o Apical delta : 3.2%
Only 2% have two well developed root.
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Pulp chamber
It has four pulp horns m-b, d-b, m-p, d-p, the
arrangement of the four pulp horn gives the
pulpal roof of a rhomboidal shape in crosssection.
The four walls forming the roof converge
towards the floor where the lingual wall almost
disappear.
The floor of the pulp chamber thus has a
triangular form in cross-section.
The orifices of the root canal are located in the
three angles of the floor.
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Disto-buccal root
Palatal root
INCIDENCE
Mesio-buccal Root
Disto-buccal Root
o Straight : 21%
o Distally curved : 78%
o Buccally curved : 14%
o S-shaped or bayonet
curved: 1%
Apical foramen
o Centrally located in
anatomic apex : 14%
o
o
o
o
Straight : 54%
Distally curved : 17%
Mesial curved : 20%
S-shaped or bayonet
curved: 10%
Apical foramen
o Centrally located in
anatomic apex : 19%
o Apical delta : 2%
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Palatal Root
o Straight : 40%
o Distally curved : 1%
o Mesial curved : 4%
o Buccally curved: 55%
Apical foramen
o Centrally located in anatomic apex : 18%
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Access opening
Radiograph is used to determine the shape and
size as well as the extension of the pulp
chamber mesially, distally and coronally.
The enamel is penetrated with No 4 round
carbide bur in a high speed contra angle by
positioning the instrument in the central fossa
and angling it toward palatal root.
After penetration of the enamel No 4 round
carbide bur in slow speed is used in a slow
speed contra angle to penetrate dentin.
The bur is angled toward the palatal root until
the pulp chamber is reached.
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Pulp chamber
Similar to maxillary 1st molar, except it is
narrower m-d.
It is rhomboidal in shape.
The roof of the pulp chamber is more
rhomboidal in cross-section,
The floor of the pulp chamber is an obtuse
triangle in cross-section.
The mesio-buccal and disto-buccal root canal
are closer together and appear to have a
common opening.
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INCIDENCE
Mesio-buccal Root
o Straight : 22%
o Distally curved : usually
Apical foramen
o Centrally located in
anatomic apex : 16%
o Apical delta : 3%
Distal Root
Palatal Root
o Straight : usually
o Buccally curved : 37%
Apical foramen
o Centrally located in
anatomic apex : 16%
o Apical delta : 3%
o Straight : usually
o Mesially curved : 17%
Apical foramen
o Centrally located in
anatomic apex : 16%
o Apical delta : 3%
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Pulp chamber
Anatomic resemblance to maxillary 2nd molar.
It may also have an odd shaped pulp chamber
with four or five root canal orifice.
Conical chamber with only one root canal.
Roots and root canal
Three well developed roots, fused root, one
conical root or four or more independent roots.
Root may be straight, curved or dilacerated.
One may find a C shaped pulp chamber with a
C shaped root canal.
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Pulp chamber
It is small and flat m-d.
Three distinct pulp horns present.
Pulp chamber is wide and ovoid labio-lingually
and it tapers incisally.
Root and root canals
It has one root which is flat and narrow mesiodistally but wide labio-lingually.
It may have a distal labial curvature.
Canal is broad and cervical of middle third of
root in labio-lingual aspect, tapers toward apex.
Canal is ovoid in labio-lingual direction in the
cervical third of root.
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INCIDENCE
Root
o Straight : 60%
o Distally curved : 23%
o Labially curved: 13%
Apical foramen
o Centrally located in anatomic apex : 25%
o Apical delta : 5%
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Pulp chambers
Same as mandibular central incisor but it has
larger dimension.
Root and root canal
Larger than mandibular central incisor.
Majority of root are straight.
It may also have distally , labially curved root as
central incisor but the distal curve is sharper.
Anatomic relation in situ
Average 17 degree of mesio-axial inclination of
20 degree of linguo-axial angulations of tooth in
its alveolus.
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INCIDENCE
Same as mandibular central incisor except apical
foramen which is located centrally in 20% cases
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Access opening
Same as mandibular central incisor
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Pulp chamber
It is small and flat mesio-distally.
Three distinct pulp horn are present.
It is wide and ovoid m-d and tapering incisally.
Root and root canal
It is usually single rooted.
It has straight root(68%) may have curved
root(20%)
Sometimes a S shaped bayonate shaped curve
is also seen.
It usually has a single canal and apical foramen.
Root canal is broad in middle third and taper to
constriction in the apical third in labio-lingual
view.
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INCIDENCE
Root
o Mesially curved : 1%
o Distally curved : 20%
o Labially curved: 7%
o S-shaped or bayonet curved: 2%
Apical foramen
o Centrally located in anatomic apex : 30%
o Apical delta : 8%
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Pulp chamber
It is the transition tooth between anteriors and
posteriors.
The m-d width is narrow.
Bucco-lingually the pulp chamber is wide with
prominent buccal pulp horn that extend under a
well-developed buccal cusp.
In cross-section the chamber is ovoid with the
greater diameter bucco lingually.
Single canal is present.
In young tooth a small lingual pulp horn is
present in the prominent buccal cusp and
smaller lingual cusp give the crown an 30
degree lingual tilt.
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INCIDENCE
Root
o Buccally curved : 2%
o Distally curved : 35%
o Lingually curved: 7%
o S-shaped or bayonet curved: 7%
o Straight : 48%
Apical foramen
o Centrally located in anatomic apex : 15%
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Pulp chamber
Same as mandibular 1st premolar.
Lingual pulp horn is more prominent under well
developed lingual cusp.
Root and root canal
Single root but rarely two or three roots.
Root is wider bucco-lingually than the counter
tooth.
It may curve distally9(40%) and curve(30%).
Single canal is present.
Lateral canal in (48.3%) cases.
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INCIDENCE
Root
o Buccally curved : 10%
o Distally curved : 40%
o Lingually curved: 3%
o S-shaped or bayonet curved: 7%
o Straight : 39%
Apical foramen
o Centrally located in anatomic apex : 60.1%
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Pulp chamber
Roof of the pulp chamber is often rectangular.
The mesial wall is straight and distal wall
converge round.
Buccal and lingual walls converge to meet
mesial and distal wall to form a rhomboidal
floor.
The roof of the pulp chamber has four pulp
horns m-b, m-l, d-b and d-l.
The four pulp horns regress with age.
The roof of the pulp chamber is located in
cervical third of crown just above the cervix
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INCIDENCE
Mesial Root
o Straight : 16%
o Distally curved : 84%
Apical foramen
o Centrally located in
anatomic apex : 22%
o Apical delta : 10%
Distal Root
o Straight : 74%
o Distally curved : 21%
o Mesially curved : 5%
Apical foramen
o Centrally located in
anatomic apex : 20%
o Apical delta : 14%
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Pulp chamber
It is smaller than the mandibular 1st molar.
Root canal orifice are small and close to each
other.
Root and root canal
It has mesial and distal root.
Rarely three rooted.
In the single rooted tooth root is straight but
may curve distally, lingually it is S shaped or
bayout shape
In two rooted tooth mesial root curve distally,
straight and S shaped buccally.
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INCIDENCE
Mesial Root
o Straight : 27%
o Distally curved : 61%
o Buccally curved : 4%
o S-shaped: 7%
Apical foramen
o Centrally located in anatomic
apex : 19%
Distal Root
o Straight : 58%
o Distally curved : 18%
o Mesially curved : 10%
o Buccally curved: 4%
o S-shaped: 6%
Apical foramen
o Centrally located in anatomic
apex : 21%
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Pulp chamber
It is similar to mandibular 1st and 2nd molars.
It is large and has an anatomic configuration of
a c shaped root canal orifice
Root and root canal
Two roots with two canals are present.
Three roots with three canals are generally
large and short.
Anatomic relation in situ
The alveolar socket may project to the lingual
plate of mandible.
Apex of root is in close proximity of the mesiodistal canal
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Access opening
It is same as the mandibular 1st and 2nd molars
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Conclusion
The aim of the access preparation is a good
endodontic result and with restoration of
normal structure and function of the tooth.
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