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Endo I > Endodontic Access- Anterior and Molars > Flashcards

Endodontic Access- Anterior and Molars Flashcards

1
Q

what are the objectives of endo access

A
  • to gain access to the pulpal space
  • to maintain strength of the tooth
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2
Q

why would you want to gain access to the pulpal space

A
  • visualization
  • instrumentation
  • obturation
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3
Q

how would you maintain strength of the tooth

A
  • preserve incisal edge
  • conserve marginal ridges
  • maintain correct shape, size, and position
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4
Q

what is the outline form of maxillary central incisors

A

triangular with the base of the triangle toward the incisal edge

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5
Q

what is the outline form of the maxillary lateral incisors

A

follow the same form of maxillary central incisors but are narrower and less flared incisally

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6
Q

what is the outline form of maxillary canines

A

same general form of central incisors but are closer to an oval

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7
Q

what is the general outline form of maxillary anteriors

A

triangular to ovoid

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8
Q

what are penetration points

A

where you would generally expect to find the pulp
- usually in the center mass of the root form

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9
Q

describe the access in mandibular central and lateral incisors

A
  • very narrow M-D
  • 2 canals 40% of the time
  • extends further incisally
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10
Q

describe the outline form of mandibular canines

A

oval and similar to maxillary canine access

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11
Q

why must you be aware that mandibular incisors are very narrow M-D

A

avoid ruining the tooth by tipping our access bur to the mesial or distal and drilling out the side of the tooth

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12
Q

what visual and spatial understanding should you have for the tooth/pulp you are attempting to access

A
  • review dental anatomy and morphology
  • general size and shape of the tooth and the pulp
  • relationships of the pulpal space to the tooth structure
  • how many canals and variations
  • positioning of teeth in the mouth
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13
Q

dont ever look for the canals with:

A

the bur

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14
Q

dont expect to feel ______ into the pulp chamber

A

a drop

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15
Q

you will find the _____ of the pulp chamber first

A

roof

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16
Q

mark your access at _____

A

7 mm

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17
Q

if you dont know for certain where you are:

A
  • stop and take a radiograph
  • have someone else take a look
  • dont become disoriented
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18
Q

how do you access the maxillary central incisor

A
  • triangular access- base of triangle at incisal
  • angles of triangles are slightly rounded
  • M and D marginal ridges are not invaded or weakened
  • base of triangle parallels with incisal edge
  • pulp horns and chamber are free of tissue and caries
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19
Q

what is ideal access of maxillary central incisor

A
  • does not require a crown and could be adequately restored with a composite restoration
  • variations occur due to trauma, caries, existing restorations or just plain aberration that could create another situation
  • few patients present with a perfect tooth and ask for RCT to be performed
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20
Q

what is the ideal access for maxillary lateral incisor

A
  • use #2 round
  • triangular/oval access
  • thinner root than central ( narrower access M-D narrower pulp horns)
  • incisal compromise on all anterior teeth
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21
Q

what is the ideal access for maxillary canine

A
  • use #2 or #4 round bur
  • oval access
  • canal narrower M-D than F-L
  • one root
  • usually single canal - most maxillary anteriors
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22
Q

what is the ideal access for mandibular incisors

A
  • oval access
  • use #2 round bur
  • 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
  • cervical access will miss lingual canal
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23
Q

what is a type I canal configuration

A

one canal from pulp chamber to apex

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24
Q

what is a type II canal configuration

A

2 canals from pulp chamber, join prior to apex

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25
Q

what is a type III canal configuration

A

2 canals from pulp chamber to apex

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26
Q

what is a type IV canal configuration

A

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

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27
Q

what is the outline form of maxillary first premolars

A
  • have a Buccal and Lingual canal in at least 85% of cases
  • M-D width of the access is no wider than a #4 round bur
  • opening usually extends from near the tip of the buccal cusp lingually as a narrow oval
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28
Q

what is the outline of maxillary second premolars

A
  • contain a second canal in at least 35% of cases
  • 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
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29
Q

all premolars are very easy to perforate to the________

A

mesial or distal

30
Q

what bur should you use with premolars

A

2

31
Q

access on posterior teeth is always gained through:

A

the occlusal approach

32
Q

describe the ideal access of the maxillary 1st premoalr

A
  • thin oval access
  • width of #4
  • thin M-D root
  • two canals most prevalent: 85% two canals, 9% one canal, 6% three canals
  • canal orifices lie under respective cusp tips
  • finish with ENDO-Z bur
33
Q

what is the most common error in access to maxillary 1st premolar

A

not totally unroofed

34
Q

final width of ideal maxillary 1st premolar is no wider than:

A

width of round #4 bur

35
Q

what is the ideal access of the maxillary second premolar

A
  • access: thin oval - width of #4
  • slightly less F-L extension than 1st
  • most often type I root canal (75-85%); type II, III and IV less frequently
  • 2 roots (15-25%_
  • 3 roots very rarely
  • if one canal found but not in center F-L, there are probably 2 canals
36
Q

type IV are very hard to:

A

shape, clean and fill

37
Q

describe the outline form of mandibular premolars

A
  • very narrow M-D width and access extends from near the tip of the buccal cusp lingually
  • 2 canals in mandibular PMs are rare and very difficult
  • 2nd canals can occur in both mandibular canals
38
Q

what do 2nd canals in mandibular premolars appear as

A
  • look for 4 PDLs
  • “fast break” or “fuzzy” canal somewhere in the mid root
39
Q

what is the ideal access for the mandibular first premolar

A
  • access: thin oval
  • usually one root, 1 canal (type I), 73.5%
  • type III, 19.5%
  • three canals less than 1%
  • vertucci study
40
Q

what is the law of color change

A

the color of the pulp chamber is always darker than the surrounding walls

41
Q

what is the law of centrality

A

pulp chamber in the center of the tooth

42
Q

what is the law of concentricity

A

walls of the pulp chamber are always concentric to the external surface

43
Q

what is the law of CEJ

A

CEJ is the most consistent landmark for locating the position of the pulp chamber

44
Q

what is the worst error you can make at access

A

perforation

45
Q

what is the outline form of mandibular molars

A
  • trapezoidal form with rounded angles because of the probability of 2 distal canals (30%)
46
Q

where is the wider base of the form for mandibular first molar and why

A
  • to the mesial
  • to preserve the mesial marginal ridge
  • extends as far distally to provide clear access tot he distal canals or canal
47
Q

a missed canal is a:

A

failed RCT

48
Q

what shape access is for 3 canals

A

triangular

49
Q

what shape access is for 4 canals

A

trapezoidal

50
Q

how can you tell if there are 3 or 4 canals

A

when you enter the tooth

51
Q

if there is a singular distal canal in mandibular molars it will be:

A

generally in the center of the form and may be wide B-L

52
Q

what is the C shaped canal

A
  • in mandibular molars
  • tooth contains 3 or more canals associated by an irregular network of thread like canals and areas that are variable in size, shape and complexity
  • extremely difficult to find and instrument
  • mostly in 2nd molars
53
Q

which is more difficult: 2nd or 1st mandibular molars

A

2nd

54
Q

what percentage of mandibular molars are variably shaped canals and what are the variations

A
  • 2-8%
  • middle mesial canal
  • C-shaped canal
55
Q

what is the biggest challenge of maxillary molars

A

MB2 canal

56
Q

what percentage of maxillary molars have 4 canals

A

95%

57
Q

what does the endo Z bur do

A

used to define the walls as they meet the floor of the prep

58
Q

variations are ____

A

not rare

59
Q

MB2 may require as much time as _____

A

all 3 other canals in total

60
Q

what are the common variations of maxillary incisors

A

multiple canals- rare

61
Q

what are the common variations of mandibularincisor

A
  • single root +1 canal = 60%
  • single root + 2 canals = 40%
62
Q

what are the common variations of maxillary canine

A

multiple canals- rare

63
Q

what are the common variations of mandibular canine

A
  • single canal = 78%
  • 2 canals = 22%
64
Q

what are the common variations for maxillary first premolar

A
  • 2 canals = 85%
  • single canal = 9%
  • 3 canals = 6%
65
Q

what are the common variations for maxillary second premolar

A
  • single canal = 50%
  • 2 canals = 50%
66
Q

what are the common variations for mandibular first premolar

A
  • single canal = 74%
  • 2 canals = 25%
  • 3 canals = 1%
67
Q

what are the common variations for mandibular second premolar

A
  • single canal = 98%
  • 2 canls = 2%
68
Q

what are the common variations of maxillary first molar

A
  • 3 roots and 4 canals = 95%
  • 3 roots and 3 canals = 5%
69
Q

what are the common variations for maxillary second molars

A
  • 3 roots 4 canals = 60%
  • 3 roots and 3 canals - 40%
70
Q

what are the common variations for mandibular first molars

A
  • usualyl 2 roots
  • mesial= 2 canals 98%, 1 canal = 2%
  • distal = 1 canal 70%, 2 canals 30%
  • rare = 3 roots and 4 canals
71
Q

what are the common variations for mandibular second molars

A
  • 2 roots and 3 canals = 81%
  • 2 roots and 2 canals = 15%
  • 1 root and 1 canal = 4%
72
Q
A

Endo I (13 decks)

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