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Endo II > Policies, Access & Working Length > Flashcards

Policies, Access & Working Length Flashcards

1
Q

What is the procedure for the outline part of access?

A
  • Create outline form just through enamel with number 2 round or 330 bur
    *bur is somewhat perpendicular to lingual surface of tooth
  • Stay shallow at this point. Just through enamel < 1mm.
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2
Q

What is the procedure for the penetration part of access?

A
  • Penetrate pulp chamber roof with bur angled approaching parallel to long axis of root in center of outline form.
  • You should reach the pulp in most cases by 7 mm.
  • Confirm Pulp canal entry with
    endodontic explorer
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3
Q

What is the procedure for the un-roofing part of access?

A
  • Un-roof Pulp Chamber with brushing out-strokes. Take care not to gouge axial walls.
  • Remove obstructions & smooth the walls
  • Irrigate well (NaOCl)
    – Vision
    – Remove Debris
    – Begin Disinfection
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4
Q

What is the procedure for the refining part of access?

A
  • Refine access prep with Safe ended diamond bur or Endo–Z bur to help provide straight-line access to mid-root.
  • The non-cutting tip is simply a pilot.
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5
Q

What is the next step after accessing a tooth?

A

determine the working length

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6
Q

The correct WL is: ___mm. SHORT of the CANAL EXIT

A

1.0

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7
Q

How do you find the canal exit in your hand?

A

Look at it
– Observe the canal exit
– Measure before you MOUNT tooth

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8
Q

How do you find the canal exit in the mouth?

A

Start w/ Average Length
– Chart
– Apex Locator (only in clinic setting)
– Radiograph (with #15 file in canal)

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9
Q

Where do you use an apex locator?

A

use on a patient in the clinic
- cannot use in lab

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10
Q

How do you use an apex locator?

A
  • Place a #15 hand file in the access and extend it in the canal to the estimated canal length
  • Take a radiograph and adjust until you determine the correct Working Length
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11
Q

Everything you do following an inaccurate working length is……..

A

WRONG!

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12
Q

The GOAL for the working length is 1mm.short of the…

A

canal exit

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13
Q

1.0mm short of canal exit places the working length in close proximity to the natural…

A

Apical Constriction

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14
Q

What happens if the working length is too short?

A

The canal is NOT well CLEANED

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15
Q

What happens if the working length is too long?

A

Even ¼ of a mm. long of the constriction – we have created a “BLOW-OUT” which guarantees incomplete compaction at the apex and an explosion of sealer in the PA tissues.

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16
Q

How do you measure the working length?

A

Select a solid, reproducible location on the tooth
* Tip of incisal edge (anteriors)
* Tip of cusp for which the canal is named (molars)

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17
Q

What is the first step after DX?

A

Access (Cleaning and Shaping)

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18
Q

Access to the Pulp Chamber FACILITATES:

A

– Locating the Canals
– Negotiating the Canals
– Gaining Patency
– Establishing Working Length
– Maintaining Apical Constriction
– A GOOD OUTCOME

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19
Q

Proper ______ is arguably the singlemost important requisite contributing to routine endodontic success

A

Access

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20
Q

Poor ACCESS yields PROBLEMS such as…

A
  • You will NOT have a predictable result
  • You will routinely miss canals
  • You will NOT be able to clean properly
  • You will NOT be able to shape completely
  • You will NOT be able to fill adequately
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21
Q

What should the shape be of an access?

A

– SMOOTH
– CONSTANTLY TAPERING
– RESPECTING THE SHAPE OF THE NATURAL CANAL
– CONSTRICTING NEAR THE TERMINUS OF THE ROOT

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22
Q

What is the “coke bottle” affect?

A

canal is bigger than the cervical access at some more apical point in the canal

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23
Q

What are the requirements of access?

A
  1. Visibility of pulp chamber and all canal orifices from a single vantage point
  2. Straight-line access to mid-root for instrument placement
  3. Complete removal of pulpal roof & pulp horns
  4. Avoidance of unnecessary weakening of tooth
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24
Q

What should you be able to see with access?

A

Visibility of pulp chamber and all canal orifices from a single vantage point

25
Q

Straight-line access to __________ is required for instruments & obturating materials

A

mid-root

26
Q

Cross-hatched area of secondary dentin should be _________ to create better access to mesial root (this is
also called a dentin triangle).

A

removed

27
Q

What are the three steps of access?

A
  1. Outline Form (2 dimensional surface shape)
  2. Coronal Access (Extending into pulp)
  3. Radicular Access (Adjustments to allow easy straight-line entry to mid-root of each canal)
28
Q

What is the outline form for access?

A

The 2 dimensional plan for the initial opening

29
Q

What is the function of coronal access?

A

To allow unobstructed visualization of the pulpal floor and ALL canal orifices from a single vantage point

30
Q

During coronal access you should reach the pulp at ___mm

A

7 mm or less

31
Q

Pulpal FLOOR should NOT be
touched by the…

A

access bur

32
Q

Walls of the coronal access should
DIVERGE to the occlusal because…

A
  1. better light
  2. better visualization
  3. Your temporary restoration which is placed between visits will not be easily dislodged to Leak & Contaminate
33
Q

What is the function of radicular access?

A

To allow straight-line access to midroot for all shaping instruments and obturation materials (observe canal path not long axis of tooth)

34
Q

What are the types of common canal configurations?

A

– 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)

35
Q

What is a type I canal?

A

one canal from pulp chamber to apex

36
Q

What is a type II canal?

A

2 canals from pulp chamber, join prior to apex

37
Q

What is a type III canal?

A

2 canals from pulp chamber to apex

38
Q

What is a type IV canal?

A

one canal from pulp chamber divides prior to apex (most difficult to treat)

39
Q

What shape is the access on maxillary central incisors?

A

Triangular

40
Q

What shape is the access on maxillary lateral incisors?

A

triangular/oval

41
Q

What shape is the access on maxillary canine?

A

triangular/oval

42
Q

What shape is the access on mandibular incisors?

A

oval

43
Q

What shape is the access on mandibular canine?

A

oval

44
Q

What shape is the access on maxillary 1st premolars?

A

thin oval access

45
Q

What shape is the access on maxillary 2nd premolar?

A

thin oval

46
Q

What shape is the access on mandibular 1st premolar?

A

thin oval

47
Q

What shape is the access on mandibular 2nd premolar?

A

thin oval

48
Q

What shape is the access on maxillary 1st molar?

A

triangle (apex to palatal)

49
Q

What shape is the access on maxillary 2nd molar?

A

triangle (apex to palatal)

50
Q

What shape is the access on mandibular 1st molar?

A

trapezoid

51
Q

What shape is the access on manidbular 2nd molar?

A

trapezoid/triangle

52
Q

What are some common errors during access?

A
  • access too large
  • access skewed to mesial or distal
  • pulp horns not cleaned
  • straight-line access to mid-root is inhibited
53
Q

How many canals in maxillary 1st premolar?

A
  • Two canals most prevalent
    – 85% two canals
    – 9% one canal
    – 6% three canals
54
Q

How many roots in maxillary 2nd premolar?

A
  • 2 roots (15 -25%)
  • 3 roots very rarely
55
Q

How many roots and canals does the mandibular 1st premolar have?

A
  • Usually one root, 1 canal (type I), 73.5 %
  • Type IV, 24 %
  • Three canals less than 1%
56
Q

How many roots and canals does the mandibular 2nd premolar have?

A
  • Usually one root, 1 canal (type I), 85.5 %
  • Type III, 11.5 %
  • Three canals less than 1%
57
Q

How many canals in maxillary 1st molar?

A

4 canals most of the time
5 canals 2.4%

58
Q

How many canals in mandibular 1st molar?

A

4 or 3 canals
- 64% 3 canals
- 29% 4 canals

59
Q

How many canals in mandibular 2nd molar?

A

3 canals 81%
4 canals 11%

Endo II (2 decks)

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