ACCESS CAVITY

PREPARATION
Dr. Ahmed
Negm
Access is the first and most important phase of
root canal treatment. A well-designed access
preparation is essential for a good endodontic
result.
 Pulp space morphology

Pulp horn

Coronal pulp Pulp chamber

Orifice

Lateral canal
Radicular pulp
Root canal

Apical foramen
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
 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:

teriors Triangular.
molars Oval or ovoid.
lars Triangular.

Number and direction of root canals.

2. Convenience 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.
 Instrume
nts

Low speed contra High speed contra

 Round bur
DG 16 endodontic explorer size 2,3,4
Safe-end tapered ston

Endo Z bur Tapered stone with

Transmetal bur
round end
 Pulpout bur

Endo access bur

Ultrasonics
 Loupes
Surgical operating microscope
 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.

Incisal edge

Cervical line
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.

In canine the outline is oval
 Errors

1- GOUGING of the labial wall caused by

failure to recognize the 29-degree lingual-
axial angulation of the tooth.

2- GOUGING of the distal wall caused by

failure to recognize the 16-degree
mesial-axial inclination of the tooth.
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.

4- Missed canal due to insufficient convenience

extension.
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.
 Premola
Upper oval
rs Lower ovoid
Maxillary premolars

Buccal canal is located

under the buccal cusp
tip.
Palatal canal is located
at the base of the
palatal cusp.
 1
Initial penetration is made parallel to the long axis of
the tooth in the exact center of the central groove
 2
A round bur is used to open into the pulp chamber.
The bur will be felt to drop when the pulp chamber
is reached.
 3

An endodontic explorer is used to locate orifices.

 4

A round bur is used to deroof the pulp

chamber.
 5

Finishing and flaring of the cavity walls.

Upper Lower
 Errors
Under Over
extended extended
access access
cavity cavity
PERFORATION at the cervical FAILURE to locate the third
area caused by failure to canal of the maxillary first
recognize that the premolar premolar (6% of
has tilted to the distal. the time).
 Molars
Upper Lower

B
B

D M M D

L
P Trapezoid
 Upper

MB1
MB2
DB

Palatal

Point of
entry

s located under the buccal cusp tip.

s located mesial and palatal to MB1 (at the end of a comma tail)
located under the central fossa.
al is located at the junction of mesiopalatal cusp and oblique ridg
of entry is the center of the occlusal table.
 Lower

Point of entry

MB

Distal
ML

B is located under the mesiobuccal cusp tip.

L is located at the same line lingual to the central fissure.
stal is located distal to the central fossa.
int of entry is the central fossa.
Maxillary Molar Endo Access - Table Top Microscope.mp4
 Errors
Under extended Over extended
access cavity access cavity
Perforation in the furcation area Failure to locate all the canals
Crown perforation Root perforation
 Axioms of pulp anatomy

1- The two orifices of the

maxillary first premolars are
further to the buccal.

2- The orifices of the mesio-buccal

canals in molars are well up under the
mesio-buccal cusps and the outline form
should be widely extended into the
cusp.
3- The orifices of the palatal canal in
maxillary molars is not too far to the
lingual, but is actually in the center of
the mesial half of the tooth

4- The orifices of the disto-buccal

canal in maxillary molars is not too
far to the disto buccal, but it is almost
buccal to the palatal orifice.
5- The orifice of the distal canal in
mandibular molars is not too far to
the distal, but is actually in the
exact center of the tooth

6- The orifice of the mesio-lingual

canal in mandibular molars is not
too far to the mesio-lingual, but is
almost mesial to the distal orifice.
 Laws of the pulp chamber anatomy

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-First law 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.
M

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.

D
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 floorwall
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.
Thank you