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Submitted To-:
Dr Anurag Singhal
Dr Anurag Gurtu
Dr Naveen Chhabra
Dr Raju Chauhan
Submitted By-:
Kapil adav!"#$
Shailendra Singh!%%$
Seminar &n-:Access Cavity Preparation
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CCESS C VITYCCESS C VITY
PREP R TION
REP R TION
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INTRODUCTIONINTRODUCTION
The major factor involved in the development ofthe apical periodontiti are lo of inte!rit" of
coronal tooth #$tance and the entr" of
microor!anim into the dentine and p#lp
pace%The chemo&mechanical removal of
microor!anim' their #$trate and prod#ct
form
the dentine and p#lp pace i primar" aim of root
canal treatment' (ith the econd $ein! the three
dimenional o$literation and ealin! of the p#lp
pace to prevent $acterial recontamination%
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A clear #ndertandin! of the anatom" of h#manteeth $ecome an eential prere)#iite for
achievin! the o$jective of acce' thro#!h
cleanin!' diinfection' and o$t#ration of the p#lp
pace%in thi eminar (e have tried to decri$e the
acce openin! of the teeth%
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* The acce cavit" preparation !enerall" refer to thepart of the cavit" from the occl#ion ta$le to the canalorifice% +accordin! to Stephen Cohen,
O-.ECTIVES
/ell dei!ned acce preparation i eential for a !oodendodontic re#lt% /itho#t ade)#ate acce' intr#ment
and material $ecome diffic#lt to handle properl" in the
hi!hl" comple0 and varia$le canal "tem%
* To achieve a trai!ht or direct line acce to the apical
foramen%* To locate all root canal orifice%
* To conerve o#nd tooth tr#ct#re%
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* /ell prepared and correct acce cavit" allo(complete irri!ation' hapin! 'cleanin! and)#alit" o$t#ration%
* Ideal acce re#lt in a trai!ht entr" into thecanal orifice' (ith the line an!le formin! af#nnel that drop moothl" into the canal%
1UIDE2INES
It i eential for the completion of ideal acce
preparation%
3% Vi#ali4ation of internal anatom" $eca#einternal anatom" dictate acce hape% Thire)#ire eval#ation of an!led peri&apicalradio!raph' e0amination of coronal andcervical tooth anatom"%
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5% Eval#ation of CE. and occl#al anatom"%traditionall"' acce cavit" i prepared in relation
to the occl#al anatom"% CE. i the mot
important anatomical landmar6 for determinin!the location of p#lp cham$er and root
canal orifice%
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Accordin! to 7raner and Ran6o(' five !#ideline
or la(' of p#lp cham$er anatom" to helpclinician determine the n#m$er and location of
orifice on the cham$er floor
8irt 2a( of S"mmetr"
It tate that e0cept for the ma0illar" molar' canalorifice are e)#iditant from a line dra(n in meio&ditaldirection thro#!h the p#lp cham$er floor%
Second 2a( of S"mmetr"
It tate that e0cept for the ma0illar" molar' canalorifice lie on line perpendic#lar to a line dra(n in ameio&dital direction acro the center of the p#lpcham$er floor
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8irt 2a( of Orifice 2ocation
It tate that the orifice of the root canal areal(a" located at the j#nction of the (all andthe floor%
Second 2a( of Orifice 2ocation
It tate that the orifice of the root canal areal(a" located at the an!le in the floor&(allj#nction%
Third 2a( of Orifice 2ocation
It tate that the orifice of the root canal areal(a" located at the termin# of the root9developmental f#ion line%
2a( of Color Chan!e
It tate that the p#lp cham$er floor i al(a"
dar6er in color than the (all%
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:% Preparation of the acce cavit" i thro#!hlin!#al in anterior teeth and on the poterior teeth
thro#!h occl#al #rface%
;% Removal of #n#pported tooth tr#ct#re%Thired#ce the tooth9 reitance to tre%
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=% 2ocation' flarin! and e0ploration
of all root canal orifice% Aharp endodontic e0plorer #edto locate the canal orifice and todetermine their an!le ofdepart#re from the p#lp cham$er%
>% ?a!nification and ill#mination%
Thee are important in root canal
therap"' epeciall" fordeterminin! the location of canal'c#rved and calcified canal and
de$ridin! and removin! ti#efrom the p#lp cham$er%
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@%Taperin! of cavit" (all and eval#ation of paceade)#ac" for a coronal eal% A proper acce
cavit" ha taperin! (all and i (idet at
occl#al #rface% At leat :%< mm of temporar"
fillin! material i needed to provide an ade)#atecoronal eal for a hort period%
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ANATO?Y O8 TE PU2P CAVITYANATO?Y O8 TE PU2P CAVITY
P#lp cavit" i the central cavit" (ithin the tooth
and i entirel"encloed $" dentin e0cept at theapical foramen%
P#lp cavit" ma" $e divided into a coronal portion'
p#lp cham$er' radic#lar portion and root canal% In anterior teeth the p#lp cham$er !rad#all"
mer!e into root canal%
In m#ltirooted teeth' the p#lp cavit" conit of ain!le p#lp cham$er and ##all" three root canal%
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A p#lp horn i an accent#ation of the roof of thep#lp cham$er directl" #nder a c#p ordevelopmental lo$e%
Orifice are contin#ation (ith $oth p#lp
cham$er and root canal% A root canal ma" $e divided into three ection
namel" coronal' middle' apical third%
Acceor" canal or lateral canal i a lateral$ranch of main root canal' !enerall" occ#r in the
apical third or f#rcation area of a root%
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In mot cae n#m$er of root canal depend#pon the n#m$er of root of the tooth%
In "o#n! a!e' apical foramen i f#nnel hapedin a incompletel" developed teeth%
/ith the development of the root' the apicalforamen $ecome narro(er%
The hape and i4e of p#lp cavit" i infl#enced$" a!e%
In "o#n! people' p#lp cham$er i lar!e and(ith increae of a!e' it !et maller%
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The root canal "tem i hi!hl" comple0 andcanal ma" $ranch' divide and rejoin%
Vert#cci et alidentified and claified ei!ht p#lp
pace confi!#ration (hich are follo(in! a &B
T"pe I B A in!le canal e0tend from the p#lpcham$er to the ape0%
T"pe II B T(o eprate canal leave the p#lpcham$er and join hort of the ape0 to form
canal%T"pe III B One canal leave the p#lp cham$er and
divide into t(o in the rootB the t(o then mer!eto e0it a one canal%
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T"pe IV B T(o eparate' ditinct canal e0tend from
the p#lp cham$er to the ape0%
T"pe V B One canal leave the p#lp cham$er and
divide and divide hort of the ape0 into t(o
eparate' ditinct canal (ith eparate apical
foramina% T"pe VI B T(o eparate canal leave the p#lp
cham$er' mer!e in the $od" of the root' and
redivide hort of the ape0 to e0it a t(o ditinct
canal%
T"pe VII B One canal leave the p#lp cham$er'
divide and then rejoin in the $od" of root' and
finall" redivide into t(o ditinct canal hort of
the ape0%
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T"pe VIII B Three eparate' ditinct canal
e0tend from the p#lp cham$er to the ape0%
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Acce Cavit" PreparationAcce Cavit" Preparation
Anterior acce cavit" preparation?an" of the ame tep are #ed in imilar tooth
t"pe to prepare an acce cavit"%
The follo(in! dic#ion o#tline the tep for
ma0illar" and mandi$#lar anterior teeth%
3% Removal of Carie and Permanent Retoration
Carie i t"picall" removed earl"' $efore the p#lpcham$er i entered%
Thi minimi4e the ri6 of contamination of thep#lp cham$er or root canal (ith $acteria%
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Removal of defective permanent retorationalo permit trai!ht line acce and preventthe retorative fra!ment from $ecomin!lod!ed in the root canal "tem%
If rec#rrent deca" i detected or #pected'the permanent retoration m#t $e removedentirel" to prevent coronal contamination ofp#lp cham$er%
5% Initial E0ternal O#tline 8orm
Once carie and retoration have addreed'the clinician create an initial e0ternal o#tlineopenin! on the lin!#al #rface of the anteriorteeth
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8or an intact tooth' the clinician ho#ld $e!inin the center of lin!#al #rface of anatomic
cro(n%
No 5 or ; ro#nd $#r or tapered fi#re $#r i
#ed to penetrate the enamel and li!htl" intothe dentine (ith a hi!h peed hand piece%
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The $#r i directed perpendic#lar to the lin!#al#rface a the e0ternal o#tline openin! icreated%
:% Penetration of the P#lp Cham$er Roof
Penetration of the p#lp cham$er roof icontin#in! (ith the ame ro#nd or taperedfi#re $#r' (e chan!e the an!le of the $#rfrom perpendic#lar to the lin!#al #rface toparallel to the lon! a0i of the tooth%
Penetration into the tooth i accomplihedalon! thi root lon! a0i #ntil the roof of thep#lp cham$er i penetrated' fre)#entl" a drop&in effect i felt (hen the penetration occ#r%
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Complete Roof Removal
Once the p#lp cham$er ha $een penetrated'the remainin! roof i removed $" catchin! theend of a ro#nd $#r #nder the lip of the dentin
roof and c#ttin! on the $#r removal tro6e% Each tooth ha a #ni)#e p#lp cham$eranatom"' (or6in! in thi manner allo( theinternal p#lp anatom" to dictate the e0ternalo#tline form of the acce openin!%
In vital cae p#lp ti#e hemorrha!e canimpair the clinician a$ilit" to ee the internalanatom"%
In #ch cae' a oon a eno#!h roof ha$een removed to allo( intr#ment acce'
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The coronal p#lp ho#ld $e amp#tated at theorifice level an endodontic poon or ro#nd $#r
and the cham$er irri!ated copio#l" (ith
odi#m h"po chlorite%
After hemorrha!e ha $een controlled' allo(in!vii$ilit"' all of the p#lp cham$er roof' (ith p#lp
horn' m#t $e removed and all internal (all
m#t $e flared to lin!#al #rface of the tooth%
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Identification of All Canal Orifice After the p#lp cham$er ha $een #nroofed' the canal
orifice are located (ith an endodontic e0plorer
Poitionin! the e0plorer in an orifice allo( the
clinician to chec6 the haft for clearance from the a0ial
(all an d determine the an!le at (hich a canal departthe main cham$er%
Removal of lin!#al ho#lder' orifice and coronal
flarin!
Once the orifice ha $een identified' the lin!#al ho#lderi removed%
2in!#al Sho#lder&B thi i the lin!#al helf of dentin that
e0tend from the cin!#l#m to a point appro0imatel"
5mm apical to the orifice%
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Strai!ht line acce determination
After the lin!#al ho#lder ha $een removed
and the orifice' the clinician m#t determine
(hether trai!ht line ha $een achieved%
Ideall"' an endodontic file can approach theapical foramen or the firt point of the canal
c#rvat#re%
Vi#al inpection of the acce cavit"
The clinician ho#ld inpect and eval#ate theacce cavit" #in! appropriate ma!nification
and ill#mination%
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Refinement and moothin! of retoratin!
mar!in
The final tep in the preparation of an acce
cavit" i to refine and mooth cavo#rface
mar!in% Ro#!h mar!in can ca#e of coronal lea6a!e%
Proper retorative mar!in are important
$eca#e anterior teeth ma" not re)#ire a
cro(n a a final retoration
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Poterior cce Cavit" Preparation
The proce of preparin! acce cavit" onpoterior teeth i imilar to that for anterior teeth'$#t eno#!h difference e0it to (arrant a
eparate dic#ion%Removal of carie and permanent retoration
Same a anterior teeth $#t in poterior teeth' theroot canal therap" re)#ire a t"picall" have $eenheavil" retored or cario# proce i e0tenive%
S#ch condition' alon! (ith the comple0 p#lpanatom" of the poterior teeth' can ma6e acceproce challen!in!%
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Initial e0ternal o#tline form
The p#lp cham$er of poterior teeth i
poitioned in the center of the tooth at the level
of CE.%
An acce tartin! location m#t $e determinedfor an intact tooth%
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In ma0illar" premolar thi point i on the central!roove $et(een the c#p tip%
In mandi$#lar 3tpremolar the tartin! locationi half (a" #p the lin!#al incline of the $#ccalc#p on the line connectin! the c#p tip%
In mandi$#lar 5ndpremolar the tartin! locationi one third the (a" #p lin!#al incline of the$#ccal c#p on a line connectin! the $#ccalc#p tip and lin!#al !roove $et(een the lin!#al
c#p% In ma0illar" and mandi$#lar molar the tartin!
location i limit (ith meial and dital $o#ndar"%
The meial $o#ndar" for $oth molar i a lineconnectin! the meial c#p tip%
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Penetration of p#lp cham$er roof
Contin#in! (ith a ame ro#nd or tapered fi#re
$#r and an!le of $#r i chan!ed ame a
anterior teeth%
In cae of premolar the direction of penetrationan!le i to(ard the meio&dital and $#cco&
lin!#al and in cae of molar it i to(ard the
lar!et canal $eca#e p#lp cham$er pace i
##all" lar!et j#t occl#al to the orifice of thicanal%
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Complete Roof Removal Ro#nd or tapered fi#re $#r i paed $et(een
the orifice alon! the a0ial (all to remove theroof of p#lp cham$er (ith p#lp horn and createthe deired e0ternal o#line hapeim#ltaneo#l"%
Identification of all Canal Orifice
Ideall" the orifice are located at the corner ofthe final preparation to facilitate the hapin!
and cleanin! proce%
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Removal of the Cervical Dentin $#l!e and
Orifice
and Coronal flarin!
The cervical dentine $#l!e are helve of dentin
that overhan! orifice in poterior teeth%Thee $#l!e can $e removed (ith car$ide $#r or
1ate&1lidden $#r%
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After thi the orifice and the coronal portion ofthe canal can $e flared (ith 1ate&1lidden $#r'
(hich are #ed in (eepin! #p(ard portion (ith
lateral pre#re a(a" from the f#rcation%
Strai!ht 2ine cce preparation It i paramo#nt to #ccef#l hapin!%
8ile m#t have #nimpeded acce to the apical
foramen or the firt point of canal c#rvat#re%
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Vi#al inpection of the p#lp cham$er floor
Same a anterior acce cavit" preparation%
Refinement and moothin! of the retorative
?ar!in
The retorative mar!in are refined and moothed
to minimi4e the potential of coronal lea6a!e%
?ORPO2O1Y AND ACCESS CAVITY?ORPO2O1Y AND ACCESS CAVITY
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?ORPO2O1Y AND ACCESS CAVITY?ORPO2O1Y AND ACCESS CAVITY
PREPARATION 8OR ?AI22ARYPREPARATION 8OR ?AI22ARY
CENTRA2 INCISORCENTRA2 INCISOR
Developmental and anatomic data
Avera!e time of er#ption&B >&@ Year
Avera!e a!e of calcification&B 3F Year
Avera!e tooth len!th&B 5:%
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P#lp cham$er It i located in the centre of cro(n e)#iditant
from the dentinal (all%
It i $road m&d' (ith it $roadet part inciall"%
It ha three p#lp horn that correpond to thedo#$le mammelon in a "o#n! tooth%
Root and root canal
It ha one root (ith one root canal%
Root canal i $road la$io&palatal"' conicalhape' and centrall" located%
In cro&ection' canal i ovoid m&d in cervicalthird' ro#nded in middle and apical third%
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INCIDENCE
Root
o Strai!ht B >
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Anatomic relationhip in it# 2a$ial #rface of the root lie #nder the la$ial
cortical plate of the ma0illa and ma" f#e (ithit%
It ha an avera!e of 5 de!ree of meio&a0ialinclination and 5H de!ree of palato&a0ialan!#lation in it alveol#%
Acce openin!
Shape' i4e and coronal e0tenion of p#lp
cham$er are etimated $" dia!noticradio!raph%
Enamel i penetrated in the centre of the lin!#al#rface at an an!le perpendic#lar to it' (ith a
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n#m$er ; ro#nd $#r in hi!h peed contra&an!le% After penetration of the enamel' a No ; car$ide
$#r in a lo( peed contra&an!le i directed
alon! the lon! a0i of the tooth #ntil the p#lp
cham$er i reached% A drop of the $#r into the cham$er ma" $e felt
if the cham$er i lar!e eno#!h%
The overhan!in! enamel and dentin lin!#al
#rface of the p#lp cham$er i removed (ith aNo ; ro#nd $#r in a lo( peed contra&an!le $"
(or6in! from inide to o#tide follo(in! internal
anatom"%
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Anatomic alteration in p#lp
The ##al anatomic tr#ct#re of the cham$er inthe root canal ma" $e altered in an" tooth d#e
to depoition of reparative or econdar" dentin% Thi alteration in anatom" ma" $e d#e to
tra#ma' carie' retorative proced#re' a!in!%
To ecape thi alteration (e can #e No 5 ro#nd
car$ide $#r% Enlar!e the enamel portion of the acce cavit"to an ovoid hape' (ith !reatet diameterincio!in!ivall"%
?ORPO2O1Y AND ACCESS CAVITY?ORPO2O1Y AND ACCESS CAVITY
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PREPARATION 8OR ?AI22ARYPREPARATION 8OR ?AI22ARY
2ATERA2 INCISOR2ATERA2 INCISOR
? I22 RY 2 TER 2 INCISOR
Developmental and anatomic data
Avera!e time of er#ption&B @&HYear
Avera!e a!e of calcification&B 33Year
Avera!e tooth len!th&B 55mm
Avera!e cro(n len!th&B Hmm
Avera!e root len!th&B 3:mm
?&D of cro(n&B =%
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P#lp cham$er The hape of the p#lp cham$er i imilar to the
ma0illar" central incior%
It onl" ha t(o p#lp horn' correpondin! to the
developmental mamelon%Root and root canal
Confi!#ration of the root canal i conical $#t itha a finer diameter than ma0illar" centralincior%
In cro&ection' the canal i ovoid la$io&palatal"in the cervical third and middle third' ro#nd inapical third%
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INCIDENCE
Root
o Strai!ht B :FG
o Ditall" c#rved B
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Anatomic relationhip in it#
It ha an avera!e of 3= de!ree of meio&a0ial inclination and
avera!e of 5H de!ree of palato a0ial an!#lation in it alveol#%
Acce openin!
It i imilar to that for a ma0illar" central incior' $#t i maller and
##all" more ovoid%
E0cept a No 5 ro#nd $#r ma" $e #ed intead of a No ;%
?ORPO2O1Y AND ACCESS CAVITY?ORPO2O1Y AND ACCESS CAVITY
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PREPARATION 8OR ?AI22ARYPREPARATION 8OR ?AI22ARY
CANINECANINE
Developmental and anatomic data
Avera!e time of er#ption&B 3F&35Year
Avera!e a!e of calcification&B 3:&3mm Avera!e cro(n len!th&B 3Fmm Avera!e root len!th&B 3>mm ?&D of cro(n&B >%
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P#lp cham$er It ha the lar!et p#lp cham$er than an" in!le
rooted tooth%
2a$io&palatall" trian!#lar in hape' ape0 i
to(ard the in!le c#p and $ae to(ard thecervical third of cro(n%
?eio&ditall" it i narro(er and ma" reem$leli6e flame%
In cro&ection it i ovoid in hape' (ith !reater
diameter la$io&palatall"% Onl" one p#lp horn i preent%
R t d t l
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Root and root canal
Sin!le root canal of ma0illar" c#pid i lar!er
than that of ma0illar" incior%
It i (ider la$io&palatall" than it meio&ditaldiameter' and on reachin! middle third' it taper
!rad#all" to an apical contriction%
In cro&ection' root canal i ovoid in the
cervical and middle third and !enerall" ro#nd inthe apical third
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INCIDENCE
Root
o Strai!ht B :HG
o Ditall" c#rved B :5G
o Palatall" c#rved B >G
o 2a$iall" c#rvedB 3:G
o S&haped or $a"onet c#rvedB >G
Apical foramen
o Centrall" located in anatomic ape0 B 3;G
o Apical delta B :G
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Anatomic relationhip in it#
The root of ma0illar" c#pid i poitioned in the
cancello# $one of the ma0illa $et(een the
naal cavit" and the ma0illar" in#' called the
canine pillar%
It ha an avera!e of = de!ree dito&a0ial
inclination and an avera!e of 53 de!ree palato&
a0ial an!#lation in it alveol#%
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Acce openin!
E0ternal acce o#tline form i oval or lothaped $eca#e no meial or dital p#lp horn
are preent ?eio&dital lope i determined $" the meio&
dital (idth of p#lp cham$er%
Incio&!in!ival diameter i determined viatrai!ht line acce factor and removal of the
lin!#al ho#lder%
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Incial e0tenion i approached (ith in 5&: mmof the incial ed!e to allo( for trai!ht line
acce%
All internal (all f#nnel to the orifice%
?ORPO2O1Y AND ACCESS CAVITY?ORPO2O1Y AND ACCESS CAVITYPREPARATION 8OR ?AI22ARY 3PREPARATION 8OR ?AI22ARY 3STST
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PREPARATION 8OR ?AI22ARY 3PREPARATION 8OR ?AI22ARY 3STST
PRE?O2ARPRE?O2AR
Developmental and anatomic data
Avera!e time of er#ption&B 3F&33Year
Avera!e a!e of calcification&B 35&3:YearAvera!e tooth len!th&B 55%
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P#lp cham$er
It i narro( ?&D' (ider $#cco&palatall"%
The $#ccal p#lp horn i more prominent than
the palatal in "o#n! tooth%
The floor of the p#lp cham$er i conve0 ##all"(ith t(o canal orifice (ith one $#ccal and
other palatal' it lie deep in the coronal third of
the root%
The roof of the p#lp cham$er i coronal to the
cervical line%
Root and root canal
It ma" have one' t(o' or three root and canal%
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It mot often ha t(o root namel" $#ccal andpalatal%
The root are conidera$l" horter and thinnerthan the canine%
The palatal orifice i li!htl" lar!er than $#ccalorifice%
In the cro&ection at the CE.' the palatalorifice i (ider $#cco&lin!#all" and 6idne"haped $eca#e of the meial concavit"%
Anatomic relationhip in it#
The tooth lie in the alveolar oc6et $elo( thema0illar" in# and i eparated from it $" a thinla"er of pon!" and compact $one%
It ha an avera!e of 3F de!ree of dito&a0ialinclination (ith avera!e of = de!ree of $#cco&
a0ial an!#lation in it alveol#
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INCIDENCE
Root+ Sin!le rooted,
o Strai!ht B :@%;G
o Ditall" c#rved B :=%@G
o -#ccall" c#rved B 3;%;G
o Palatall" c#rvedB 5%;G
o S&haped or $a"onet c#rvedB @G
Apical foramen
o Centrall" located in anatomic ape0 B 3;G
o Apical delta B :G
Do $le Rooted TeethDo#$le Rooted Teeth
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Do#$le Rooted TeethDo#$le Rooted Teeth
* -#ccal Rooto Strai!ht B 5>%@G
o Ditall" c#rved B 3;G
o -#ccall" c#rved B 3;G
o Palatall" c#rvedB :=%5Go S&haped or $a"onet
c#rvedB @G
Apical foramen
o Centrall" located in
anatomic ape0 B 35Go Apical delta B :%5G
* Palatal Rooto Strai!ht B ;;%;G
o Ditall" c#rved B 3;G
o -#ccall" c#rved B 5>%@G
o Palatall" c#rvedB @%:Go S&haped or $a"onet
c#rvedB
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Acce openin!
The dia!notic radio!raph i #ed for mea#rin!the hape and e0tenion of the p#lp cham$ermeiall"' ditall" and coronall"%
The acce preparation i oval or lot haped%
It i alo (ide $#cco&lin!#all"' narro( meio&ditall" and centered meio&ditall" $et(een thec#p tip%
Uin! a No 5 ro#nd $#r in a hi!h peed contraan!le one penetrate the enamel in the center of
the occl#al #rface and the $#r i directed intothe lon! a0i of the tooth%
Than a No 5 ro#nd car$ide $#r in a lo( peedcontra an!le' ali!n in the lon! a0i of the tooth i#ed to penetrate thro#!h the dentin into the
p#lp cham$er%
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Uin! the radio!raphic mea#rement' one
penetrate deep eno#!h to remove the roof of thep#lp cham$er (itho#t c#ttin! into the cham$erfloor%
To remove the roof of the p#lp cham$er' oneho#ld place the $#r alon! the ide of (all of thecham$er and c#t occl#all"%
A tapered c"linder' elf limitin! diamond in lo(peed contra an!le i #ed to remove theremainin! roof of the p#lp cham$er%
The (all of the cavit" are moothened andloped li!htl" to the occl#al #rface%
The diver!ence of the acce cavit" create apoitive eal for the temporar" fillin! #ch acavit"%
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The $order of the ovoid acce cavit" ho#ld not
e0ceed $e"ond half the lin!#al inclined of thefacial c#p and half the facial incline of thepalatal c#p%
An" looe de$ri i removed $" irri!atin! the
acce cavit" (ith
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Schematic representationof three canal access
preparation.
?ORPO2O1Y AND ACCESS CAVITY?ORPO2O1Y AND ACCESS CAVITYPREPARATION 8OR ?AI22ARY 5PREPARATION 8OR ?AI22ARY 5NDND
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PREPARATION 8OR ?AI22ARY 5PREPARATION 8OR ?AI22ARY 5NDND
PRE?O2ARPRE?O2ARDevelopmental and anatomic data
Avera!e time of er#ption&B 3F&35YearAvera!e a!e of calcification&B 35&3;YearAvera!e tooth len!th&B 55%
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P#lp cham$er
It i li6e ma0illar" 3t premolar It i (ider $#cco&lin!#all" than the ma0illar" 3t
pre molar and ho( t(o p#lp horn in thiprojection' a $#ccal and a palatal%
In cro&ection' the p#lp cham$er ha a narro(ovoid hape%
Root and root canal
Sin!le rooted tooth $#t ma" $e t(o or three rootand canal %
The majorit" of canal ma" $e c#rved%
The" ma" $e c#rved ditall"' $#ccall"' palatall"or $#cco&palatall"%
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INCIDENCE
Root +in!le root HF%:G,
o Strai!ht B :>%;G
o Ditall" c#rved B ::%HG
o -#ccall" c#rved B 3G
o Palatall" c#rvedB 5%;G
o S&haped or $a"onet c#rvedB 3:G
Apical foramen
o Centrall" located in anatomic ape0 B 35G
o Apical delta B :%5G
Onl" 5G have t(o (ell developed root%
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A in!le root i oval and (ider $#cco&lin!#all"
than m&d% The canal remain oval from the p#lp cham$er
floor and taper rapidl" to the ape0%
Acce cavit" preparation
Nearl" identical to 3tma0illar" premolar%
If three canal are preent' the e0ternal acce
o#tline form are trian!#lar in hape%
?ORPO2O1Y AND ACCESS CAVITY?ORPO2O1Y AND ACCESS CAVITYPREPARATION 8OR ?AI22ARY 3PREPARATION 8OR ?AI22ARY 3STST
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PREPARATION 8OR ?AI22ARY 3PREPARATION 8OR ?AI22ARY 3
?O2AR?O2AR
Developmental and anatomic data
Avera!e time of er#ption&B =&>Year
Avera!e a!e of calcification&B H&3FYear
Avera!e tooth len!th&B 5F%@mm
Avera!e cro(n len!th&B >%
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P#lp cham$er
It ha fo#r p#lp horn m&$' d&$' m&p' d&p' thearran!ement of the fo#r p#lp horn !ive thep#lpal roof of a rhom$oidal hape in cro&ection%
The fo#r (all formin! the roof conver!eto(ard the floor (here the lin!#al (all almotdiappear%
The floor of the p#lp cham$er th# ha atrian!#lar form in cro&ection%
The orifice of the root canal are located in thethree an!le of the floor%
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Root and root canal
It ha three root (ith ##all" : canal it#atedmeio&$#ccall"' dito&$#ccall"' palatall"%
?eio&$#ccal root
* It i $road in the $#cco&palatal direction%
* ?ajorit" of the m&$ root have a dital c#rve and
ome are haped or $a"onet haped%
* It ha one root and one canal' it i narro(et of
the : canal' flattened in a m&d direction in theorifice' $#t ro#nd in the apical third%
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Dito&$#ccal root
* It i mall and i more or le ro#nd in hape%* It ma" $e trai!ht +
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* ?eio&$#ccal Rooto Strai!ht B 53G
o Ditall" c#rved B >@G
o -#ccall" c#rved B 3;G
o S&haped or $a"onet
c#rvedB 3G
Apical foramen
o Centrall" located in
anatomic ape0 B 3;G
* Dito&$#ccal Rooto Strai!ht B
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* Palatal Rooto Strai!ht B ;FG
o Ditall" c#rved B 3G
o ?eial c#rved B ;G
o -#ccall" c#rvedB
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Acce openin! Radio!raph i #ed to determine the hape and
i4e a (ell a the e0tenion of the p#lpcham$er meiall"' ditall" and coronall"%
The enamel i penetrated (ith No ; ro#ndcar$ide $#r in a hi!h peed contra an!le $"poitionin! the intr#ment in the central foaand an!lin! it to(ard palatal root%
After penetration of the enamel No ; ro#nd
car$ide $#r in lo( peed i #ed in a lo(peed contra an!le to penetrate dentin%
The $#r i an!led to(ard the palatal root #ntilthe p#lp cham$er i reached%
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A drop of the $#r into the p#lp cham$er ma"$e felt if the cham$er $ecome lar!e%
The internal anatom" of the p#lp cham$er!#ide the occl#al c#ttin!%
A tapered c"linder elf limitin! diamond in alo( peed contra an!le i #ed to remove theremainin! roof of the p#lp cham$er%
The (all of the acce cavit" ho#ld $e in !oodconfl#ence (ith the (all of p#lp cham$er and
ho#ld $e li!htl" diver!ent to the occl#al#rface%
The acce openin! ho#ld $e trian!#lar forpermittin! direct acce to the root canalorifice%
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An" looe de$ri i removed $" irri!atin! theacce cavit" (ith
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87
PREPARATION 8OR ?AI22ARY 5
?O2AR?O2AR
Developmental and anatomic data
Avera!e time of er#ption&B 33&3:Year
Avera!e a!e of calcification&B 3;&3=Year Avera!e tooth len!th&B 3Hmm
Avera!e cro(n len!th&B >mm
Avera!e root len!th&B 33mm+$, 35mm+p,
?&D of cro(n&B Hmm ?&D of cro(n at cervi0&B >mm
2a$io&lin!#al diameter of cro(n&B 33mm
2a$io&lin!#al diameter at cervi0&B3Fmm
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P#lp cham$er Similar to ma0illar" 3tmolar' e0cept it i
narro(er m&d%
It i rhom$oidal in hape%
The roof of the p#lp cham$er i morerhom$oidal in cro&ection'
The floor of the p#lp cham$er i an o$t#etrian!le in cro&ection%
The meio&$#ccal and dito&$#ccal root canal
are cloer to!ether and appear to have acommon openin!%
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Root and root canal It ha ##all" one canal in each root ho(ever '
it ma" have t(o or three meio&$#ccal canal'one or t(o dito&$#ccal canal' or t(o palatalcanal%
The three main orifice + ?&-' D&-' P, ##all"form a flat trian!le and ometime a trai!htline%
The meio&$#ccal canal orifice i located to the
$#ccal and meial than 3t
molar% Dito&$#ccal orifice approache the mid point
$et(een the m&$ and palatal orifice
Palatal orifice ##all" located at the motpalatal apect of the root%
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8loor of the p#lp cham$er i conve0 (hich !ivethe canal orifice a li!ht f#nnel hape%
/hen fo#r canal are preent' acce cavit"preparation ha a rhom$oid hape' if threecanal are preent' it i a ro#nded trian!le (ith
the $ae placed $#ccall"% If t(o canal are preent the acce o#tline form
i oval and (idet $#cco&lin!#all"%
INCIDENCEINCIDENCE
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* ?eio&$#ccal Rooto Strai!ht B 55G
o Ditall" c#rved B ##all"
Apical foramen
o Centrall" located in
anatomic ape0 B 3=Go Apical delta B :G
Dital Rooto Strai!ht B ##all"
o ?eiall" c#rved B 3>G
Apical foramen
o Centrall" located inanatomic ape0 B 3=G
o Apical delta B :G
* Palatal Rooto Strai!ht B ##all"
o -#ccall" c#rved B :>G
Apical foramen
o Centrall" located in
anatomic ape0 B 3=Go Apical delta B :G
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Acce cavit" preparation Same a 3tmolar%
?ORPO2O1Y AND ACCESS CAVITY?ORPO2O1Y AND ACCESS CAVITYPREPARATION 8OR ?AI22ARY :PREPARATION 8OR ?AI22ARY :RDRD
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?O2AR?O2AR
Developmental and anatomic data
Avera!e time of er#ption&B 3>&55Year
Avera!e a!e of calcification&B 3@&5mm
Avera!e cro(n len!th&B =%
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It i conidered a a trate!ic a$#tment after lo
of ma0illar" 3tand 5nd molar%
P#lp cham$er
Anatomic reem$lance to ma0illar" 5nd molar%
It ma" alo have an odd haped p#lp cham$er(ith fo#r or five root canal orifice%
Conical cham$er (ith onl" one root canal%
Root and root canal
Three (ell developed root' f#ed root' oneconical root or fo#r or more independent root%
Root ma" $e trai!ht' c#rved or dilacerated%
One ma" find a C haped p#lp cham$er (ith a
C haped root canal%
?ORPO2O1Y AND ACCESS CAVITY?ORPO2O1Y AND ACCESS CAVITY
PREPARATION 8OR ?ANDI-U2ARPREPARATION 8OR ?ANDI-U2AR
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PREPARATION 8OR ?ANDI-U2ARPREPARATION 8OR ?ANDI-U2AR
CENTRA2 INCISORCENTRA2 INCISOR
Developmental and anatomic data
Avera!e time of er#ption&B =&>Year Avera!e a!e of calcification&B HYear
Avera!e tooth len!th&B 55mm Avera!e cro(n len!th&B H%
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P#lp cham$er
It i mall and flat m&d% Three ditinct p#lp horn preent%
P#lp cham$er i (ide and ovoid la$io&lin!#all"and it taper inciall"%
Root and root canal It ha one root (hich i flat and narro( meio&
ditall" $#t (ide la$io&lin!#all"%
It ma" have a dital la$ial c#rvat#re%
Canal i $road and cervical of middle third ofroot in la$io&lin!#al apect' taper to(ard ape0%
Canal i ovoid in la$io&lin!#al direction in thecervical third of root%
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INCIDENCE
Root
o Strai!ht B =FG
o Ditall" c#rved B 5:G
o 2a$iall" c#rvedB 3:G
Apical foramen
o Centrall" located in anatomic ape0 B 5
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It i ri$$on haped in la$io&lin!#al direction in
middle third and ro#nd in the apical third% Apical foramen i central in root in 5
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Mandibular lateral incisor
?ORPO2O1Y AND ACCESS CAVITY?ORPO2O1Y AND ACCESS CAVITY
PREPARATION 8OR ?ANDI-U2ARPREPARATION 8OR ?ANDI-U2AR
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PREPARATION 8OR ?ANDI-U2ARPREPARATION 8OR ?ANDI-U2AR
2ATERA2 INCISOR2ATERA2 INCISOR
Developmental and anatomic data
Avera!e time of er#ption&B >&@Year
Avera!e a!e of calcification&B 3FYear
Avera!e tooth len!th&B 5:%
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P#lp cham$er
Same a mandi$#lar central incior $#t it halar!er dimenion%
Root and root canal
2ar!er than mandi$#lar central incior% ?ajorit" of root are trai!ht%
It ma" alo have ditall" ' la$iall" c#rved root acentral incior $#t the dital c#rve i harper%
Anatomic relation in it# Avera!e 3> de!ree of meio&a0ial inclination of
5F de!ree of lin!#o&a0ial an!#lation of tooth init alveol#%
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INCIDENCE
Same a mandi$#lar central incior e0cept apical
foramen (hich i located centrall" in 5FG cae
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?ORPO2O1Y AND ACCESS CAVITY?ORPO2O1Y AND ACCESS CAVITY
PREPARATION 8OR ?ANDI-U2ARPREPARATION 8OR ?ANDI-U2AR
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PREPARATION 8OR ?ANDI-U2ARPREPARATION 8OR ?ANDI-U2AR
CANINECANINE
Developmental and anatomic data
Avera!e time of er#ption&B 33&35Year
Avera!e a!e of calcification&B 3:&3mmAvera!e cro(n len!th&B 3FmmAvera!e root len!th&B 3>mm
?&D of cro(n&B >%
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P#lp cham$er
It i mall and flat meio&ditall"%
Three ditinct p#lp horn are preent%
It i (ide and ovoid m&d and taperin! inciall"%
Root and root canal
It i ##all" in!le rooted%
It ha trai!ht root+=@G, ma" have c#rvedroot+5FG,
Sometime a S haped $a"onate haped c#rvei alo een%
It ##all" ha a in!le canal and apical foramen% Root canal i $road in middle third and taper to
contriction in the apical third in la$io&lin!#alvie(%
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INCIDENCE
Root
o ?eiall" c#rved B 3G
o Ditall" c#rved B 5FGo 2a$iall" c#rvedB >G
o S&haped or $a"onet c#rvedB 5G
Apical foramen
o Centrall" located in anatomic ape0 B :FGo Apical delta B @G
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In cro&ection it i ovoid in middle third and
ro#nd in apical third% 2ateral canal are preent in :FG cae
Anatomic relation in it#
Avera!e of 3: de!ree of meio&a0ial inclination
of avera!e of 3< de!ree of lin!#o&a0ialan!#lation of tooth in it alveol#%
Acce openin!
Similar to ma0illar" canine%
?ORPO2O1Y AND ACCESS CAVITY?ORPO2O1Y AND ACCESS CAVITY
PREPARATION 8OR ?ANDI-U2AR 3PREPARATION 8OR ?ANDI-U2AR 3tt
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111
PRE?O2ARPRE?O2AR
Developmental and anatomic data
Avera!e time of er#ption&B 3F&33Year
Avera!e a!e of calcification&B 35&3:Year
Avera!e tooth len!th&B 5;%
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P#lp cham$er
It i the tranition tooth $et(een anterior andpoterior%
The m&d (idth i narro(%
-#cco&lin!#all" the p#lp cham$er i (ide (ith
prominent $#ccal p#lp horn that e0tend #nder a(ell&developed $#ccal c#p%
In cro&ection the cham$er i ovoid (ith the!reater diameter $#cco lin!#all"%
Sin!le canal i preent%
In "o#n! tooth a mall lin!#al p#lp horn ipreent in the prominent $#ccal c#p andmaller lin!#al c#p !ive the cro(n an :Fde!ree lin!#al tilt%
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Root and root canal It ha a hort conical root (hich ma" divide in
the apical third into 5 or : root%
Root i ##all" trai!ht +;@G, $#t ma" $e c#rved
alo% One canal and and apical foramen i preent%
Canal i cone haped and imple in o#tline%
Root canal i m&d narro( and $&l $road and taperto(ard the apical third%
In cro&ection' the cervical and middle thirdare ovoid and apical third i conical%
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INCIDENCE
Root
o -#ccall" c#rved B 5G
o Ditall" c#rved B :G
o Strai!ht B ;@G
Apical forameno Centrall" located in anatomic ape0 B 3
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116
PRE?O2ARPRE?O2AR
Developmental and anatomic data
Avera!e time of er#ption&B 3F&35Year Avera!e a!e of calcification&B 35&3;Year
Avera!e tooth len!th&B 5;%
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P#lp cham$er
Same a mandi$#lar 3tpremolar%
2in!#al p#lp horn i more prominent #nder (ell
developed lin!#al c#p%
Root and root canal
Sin!le root $#t rarel" t(o or three root%
Root i (ider $#cco&lin!#all" than the co#nter
tooth%
It ma" c#rve ditall"H+;FG, and c#rve+:FG,%
Sin!le canal i preent%
2ateral canal in +;@%:G, cae%
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INCIDENCE
Root
o -#ccall" c#rved B 3FG
o Ditall" c#rved B ;FGo 2in!#all" c#rvedB :G
o S&haped or $a"onet c#rvedB >G
o Strai!ht B :HG
Apical forameno Centrall" located in anatomic ape0 B =F%3G
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Anatomic relation in it#
Similar to mandi$#lar 3tpremolar%
Avera!e 3F de!ree of dito&a0ial inclination of
root and avera!e of :; de!ree $#cco&a0ial
an!#lation of tooth in it alveol#%
Acce openin!
Same a mandi$#lar 3tpremolar%
Enamel penetration i initiated in the central
foa %
Ovoid acce cavit" i (ider m&d and dictated $"
the (ide p#lp cham$er%
?ORPO2O1Y AND ACCESS CAVITY?ORPO2O1Y AND ACCESS CAVITYPREPARATION 8OR ?ANDI-U2AR 3PREPARATION 8OR ?ANDI-U2AR 3STST
?O2AR?O2AR
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121
?O2AR?O2AR
Developmental and anatomic data
Avera!e time of er#ption&B =&>Year
Avera!e a!e of calcification&B H&3FYear
Avera!e tooth len!th&B 53%%
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122
P#lp cham$er Roof of the p#lp cham$er i often rectan!#lar%
The meial (all i trai!ht and dital (allconver!e ro#nd%
-#ccal and lin!#al (all conver!e to meetmeial and dital (all to form a rhom$oidalfloor%
The roof of the p#lp cham$er ha fo#r p#lphorn m&$' m&l' d&$ and d&l%
The fo#r p#lp horn re!re (ith a!e% The roof of the p#lp cham$er i located in
cervical third of cro(n j#t a$ove the cervi0
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8loor i located in the cervical third of the root% Three ditinct orifice are preent in the p#lpalfloor m&$' m&l and dital%
The m&$ orifice i located #nder the m&$ c#pand diffic#lt to find%
It can $e penetrated $" a lon! han6 e0plorer%
The meio$#ccal and the meio&lin!#al orificema" $e cloe #nder the meio&$#ccal c#p%
Dital orifice i oval in hape%
The m#ltiple orifice ma" $e preent in the ditalroot or are fo#nd in $#ccal and lin!#al portion ofovoid root canal%
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Root and root canal T(o root meial and dital%
The root are (ide and flat' (ith a depreion inthe middle of the root $&l%
Sometime third root i preent%
?eial root i c#rved ditall"%
Dital root i trai!ht%
Three canal are ##all" preent%
?eial root ma" have t(o canal and apicalforamina%
Dital root ha one canal%
In cro&ection three canal are ovoid incervical and middle third and ro#nd in apical
third
INCIDENCEINCIDENCE
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* ?eial Rooto Strai!ht B 3=G
o Ditall" c#rved B @;G
Apical foramen
o Centrall" located in
anatomic ape0 B 55Go Apical delta B 3FG
*
Dital Rooto Strai!ht B >;G
o Ditall" c#rved B 53G
o ?eiall" c#rved B
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Anatomic relation in it# On avera!e a
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?O2AR?O2AR
Developmental and anatomic data
Avera!e time of er#ption&B 33&3:Year
Avera!e a!e of calcification&B 3;&3mm
Avera!e root len!th&B 3:mm
?&D of cro(n&B 3Fmm
?&D of cro(n at cervi0&B @mm 2a$io&lin!#al diameter of cro(n&B 3Fmm
2a$io&lin!#al diameter at cervi0&BHmm
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P#lp cham$er It i maller than the mandi$#lar 3tmolar%
Root canal orifice are mall and cloe to eachother%
Root and root canal It ha meial and dital root%
Rarel" three rooted%
In the in!le rooted tooth root i trai!ht $#tma" c#rve ditall"' lin!#all" it i S haped or$a"o#t hape
In t(o rooted tooth meial root c#rve ditall"'trai!ht and S haped $#ccall"%
INCIDENCEINCIDENCE
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* ?eial Root
o Strai!ht B 5>G
o Ditall" c#rved B =3G
o -#ccall" c#rved B ;G
o S&hapedB >G
Apical foramen
o Centrall" located in anatomicape0 B 3HG
* Dital Root
o Strai!ht B
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Three root canal ma" $e preent%
The meial root ha one canal and foramina%
The dital root ha one canal and foramina%
In cro&ection all three root canal are mall
and ovoid in cervical and middle third and ro#ndin the apical third%
Anatomic relation in it#
On avera!e &
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?O2AR?O2AR
Developmental and anatomic data
Avera!e time of er#ption&B 3>&53Year
Avera!e a!e of calcification&B 3@&5mm
Avera!e root len!th&B 33mm
?&D of cro(n&B 3Fmm
?&D of cro(n at cervi0&B >%
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P#lp cham$er
It i imilar to mandi$#lar 3
t
and 5nd
molar% It i lar!e and ha an anatomic confi!#ration of
a c haped root canal orifice
Root and root canal
T(o root (ith t(o canal are preent% Three root (ith three canal are !enerall"
lar!e and hort%
Anatomic relation in it#
The alveolar oc6et ma" project to the lin!#alplate of mandi$le%
Ape0 of root i in cloe pro0imit" of the meio&dital canal
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Acce openin!
It i ame a the mandi$#lar 3tand 5ndmolar
Error in acce cavit" preparationError in acce cavit" preparation
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* Poor acce placement and inade)#ate meial
e0tenion ma" lead to #ncovered meial orifice%
* Inade)#ate e0tenion of the dital acce cavit"
ma" leave the d&$ canal #ne0poed%
* 1ro over e0tenion of the acce cavit"(ea6en the coronal tooth tr#ct#re and
compromie the final retoration%
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* 8ail#re to remove the roof of the p#lp cham$er
ma" lead to p#lp horn mita6en a canal
orifice%
* Over4ealo# tooth removal d#e to improper
an!#lation of $#r and fail#re to reco!ni4e the
lin!#al inclination of the tooth%
* Inade)#ate openin! ma" lead to &B3% -#r or file $rea6a!e
5% Coronal dicoloration
:% Root perforation;% Canal led!in!
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* 8#rcation perforation leadin! to the (ea6enin!
of the tooth and periodontal pro$lem%
* Common error in the teeth (ith f#ll cro(n i
perforation of the meial #rface d#e to the
fail#re to reco!ni4e that tooth i tipped or
reco!ni4e the ali!nment of $#r alon! the lon!
a0i of tooth%
* Enterin! the (ron! tooth i a ver" erio# error
and ma" lead to the medico le!al pro$lem%
* An" improper motion and e0ceive pre#re
ma" lead to $#r and file $rea6a!e' $ro6en
fra!ment ma" lead to e0ceive tooth removal%
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Concl#ionConcl#ion
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* The aim of the acce preparation i a !ood
endodontic re#lt and (ith retoration of
normal tr#ct#re and f#nction of the tooth%
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