endo access Flashcards
objectives of access
gain access to pulpal space and maintain tooth strength
To Gain Access
to the pulpal
space for:
- Visualization
- Instrumentation
- Obturation
how to maintain strength of tooth w access
- Preserve Incisal Edge
- Conserve Marginal Ridges
- Maintain correct Shape, Size & Position
max CI outline
Triangular with the base of the triangle toward the incisal edge
max LI outline
follow the same form as CI but are narrower and less flared incisally
max C outline
also have the same general form but are closer to an oval
where is pulp usually found in regards to ant max teeth
Usually in the center mass of the root form.
man CI and LI outline
are very narrow and have 2 canals 40% of the time so the access is very narrow M-D and extends further incisally
man c outline
similar to max c
danger with Man incisors
BEWARE: Mandibular Incisors are VERY NARROW M-D
We must be AWARE of this to avoid ruining the tooth by
tipping our access bur to the mesial or distal and drilling
out the side of the tooth
We must VISUALIZE the angulation of the unseen root in
both M-D and B-L directions
what must be understood of tooth we are accessing
Crucial to have a visual and spatial understanding of the tooth/pulp you are attempting to access
Don’t ever look for the canals with?
Don’t expect to always feel?
You will find the ______ first
Don’t ever look for the canals with the bur
Don’t expect to always feel a “drop” into the
pulp chamber
You will find the roof of the pulp chamber first
what mark should be made on the bur?
7mm, if chamber not found by this deep call faculty
unroofing of the chamber can be done with?
round bur or endo Z
IF you don’t know for certain where you are:
STOP & TAKE A RADIOGRAPH
*Have someone else take a look
*Don’t become DISORIENTATED
too much removal of tooth structure for access will?
weaken tooth and increase risk of fracture
angles, caries, marg ridges, mm on alll sides
Access: Maxillary Central Incisor
*Triangular access (base of
triangle at incisal)
“Incisal compromise”
Total straight-line access on all anteriors would involve access from the facial and create a weakening of the incisal edge and an esthetic issue.***
ideal max CI access restoration
would
not require a crown and
could be adequately
restored with a
composite restoration.
bur,shape, root
Access: Maxillary Lateral Incisor
use 2 round bur
*Triangular/Oval Access
*Thinner root than central (narrower access M-D narrower pulp horns)
*“Incisal Compromise” on all anterior teeth
bur, shape, canals narrower in which plane, root/canal
Access: Maxillary Canine
Use #2 or #4 round bur
*Oval access
*Canal narrower M-D than F-L
*One root (larger and longer than lateral)
*USUALLY SINGLE CANAL (most max. anteriors)
Access: Mandibular Incisors bur
2 round
man incisors access
*Root wider which way?
*Very narrow which way?
*One canal/ Two canals?
*When two canals-mostly Type?
*Cervical access will miss?
*Root wider F-L than M-D
*Very narrow M-D (easy to perforate to side
of root)
*One canal 60% Two canals 40%
*When two canals-mostly Type II (See
Weine)
*Cervical access will miss Lingual canal
how often does a man LI have two canals
44%
common canal configurations
*Type I: one canal from pulp chamber to apex
*Type II: 2 canals from pulp chamber, join prior to apex
*Type III: 2 canals from pulp chamber to apex
*Type IV: one canal from pulp chamber divides prior to apex (most difficult to treat)
outline
Maxillary first premolars canals, MD width, bur,
Maxillary first premolars have a B. & a L. canal in at least 85% of cases. M-D width of the access is no wider than a #4 round bur and the opening usually
extends from near the tip of the buccal cusp lingually as a narrow oval.
canal(s), where canal located
Maxillary second premolars outline
contain a second canal in at least 35% of cases and the access form is very similar to the first PM. If there is a single canal, it is centrally located and wide from B to L.
PM easy to perf? how to combat?
All premolars are very easy to perforate to the mesial or distal! Use #2 bur and align carefully with root
angulatio