endo access Flashcards by Caleb Houghton

objectives of access

gain access to pulpal space and maintain tooth strength

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To Gain Access
to the pulpal
space for:

Visualization
Instrumentation
Obturation

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how to maintain strength of tooth w access

Preserve Incisal Edge
Conserve Marginal Ridges
Maintain correct Shape, Size & Position

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max CI outline

Triangular with the base of the triangle toward the incisal edge

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max LI outline

follow the same form as CI but are narrower and less flared incisally

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max C outline

also have the same general form but are closer to an oval

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where is pulp usually found in regards to ant max teeth

Usually in the center mass of the root form.

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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

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man c outline

similar to max c

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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

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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

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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

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what mark should be made on the bur?

7mm, if chamber not found by this deep call faculty

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unroofing of the chamber can be done with?

round bur or endo Z

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IF you don’t know for certain where you are:

STOP & TAKE A RADIOGRAPH
*Have someone else take a look
*Don’t become DISORIENTATED

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too much removal of tooth structure for access will?

weaken tooth and increase risk of fracture

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angles, caries, marg ridges, mm on alll sides

Access: Maxillary Central Incisor

*Triangular access (base of
triangle at incisal)

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“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.***

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ideal max CI access restoration

would
not require a crown and
could be adequately
restored with a
composite restoration.

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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

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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)

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Access: Mandibular Incisors bur

2 round

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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

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how often does a man LI have two canals

44%

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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

Access on posteriors from the _______- surface always

***Access always gained through the occlusal approach on all posterior teeth.

# #canals %, where canal orfices located, width of root/access? Access: Maxillary 1st Premolar

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

most common error of the max pm

Not totally unroofed Most Common Error

max PM1 access bur? remove? finish with? no wider than?

Use a #2 round bur remove pulpal roof finish with ENDO-Z bur FINAL WIDTH OF ACCESS IS NO WIDER THAN #4 ROUND BUR

max PM2 has two canals ___% of the time

23%

Access: Maxillary Second Premolar width/shape? Slightly less_______extension than 1st Most often Type what canals? root number? If one canal found but not in center F-L this means? beware of what type of canals?

Access: Thin oval (width of #4) Slightly less F-L extension than 1st Most often Type I 1 root 1 canal (75-85%); Type II, III & 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, Beware Type IV, very hard to shape, clean and fill

Mandibular PMs also have a very narrow _______width and access extends from near the tip of the _______ cusp ________

Mandibular PMs also have a very narrow M-D width and access extends from near the tip of the buccal cusp lingually.

2 canals at PMs often?

rare and difficult

how to find 2nd PM canalswith radiographs

fast breaks

Access:Mandibular First Premolar Access shape Usually how many root/canal? Type III? Three canals ?

Access: thin oval Usually one root, 1 canal (type I), 73.5 % Type III, 19.5 %*** Three canals less than 1% Vertucci study

law of color change

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

law of centrality

law of concentricity

law of the CEJ

what tool should we use to find the canal entrance

endo explorer

M or PM access more difficult? why?

molars Attention to detail is much more complicated and compacted into a smaller area Many new opportunities to mess up are presented

worst error of access

perforation

# shape? why? first man molar access

common probability of 2 distal canals (30%), we feel the wisest plan is to use the TRAPEZOIDAL FORM with rounded angles as shown. The wider base of the form is to the Mesial (taking care to preserve the mesial marginal ridge) and extending only as far distally as to provide clear access to the distal canals or canal.

missed canal?

failed RCT

when can you tell if the 1st man molar has 3/4 canals

when you enter pulp

where would a singular D canal be on man M1

mid distal

symmetry rule

B/L canals will be equidistant from a line drawn MD

what can be seen at pulpal floor to lead to canal entry

dev black lines

# mostly seen at which M? c shaped and middle mesial canals at Man M's

2-8 % VARIABLE 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 and are extremely difficult to find and worse to instrument. These are largely seen in 2nd molars. Second molars in general are considerably more difficult than 1st molars which explains why Advanced Endo does all 2nd molars.

third molar RCTs?

rarele done, little reason

maxillary M canals, challenge?

4 canals most of the time (95%) MB2 is biggest challenge, hard to find and thin

max molars canal layout

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

Endo Z

law of sym does not apply to?

max molars

are max molar variation rare? what to do with them?

not rare, refer

Maxillary Molars are mechanically difficult why?

Maxillary Molars are mechanically difficult as the MB2 canal may require exceptional skill in locating and shaping. MB2 may require as much TIME as all 3 other canals in total !

max I mutiple canals?

rare

man incisors variations

Single root + 1 canal = 60% Single root +2canals = 40%

max canines variations

multi canals rare

man canine variations

Single canal = 78% 2 canals = 22%

max PM1 variations

2 Canals = 85% Single canal = 9% 3 Canals = 6%

max PM2 variations

Single canal = 50% 2 canals = 50%

Man PM1 variations

single canal = 74% 2 canals = 25% 3 canals = 1%

man PM2 variations

single Canal = 98% 2 canals = 2%

max M1 root and canals %

3 roots & 4 canals = 95% 3 roots & 3 canals = 5%

max M2 variations

3 roots 4 canals = 60% 3 roots & 3 canals = 40%

man M1 variations how many roots? hw many canals at each? rare case?

Usually 2 roots Mesial = 2 canals 98%, 1 canal = 2% Distal = 1 canal 70%, 2 canals 30% Rare = 3 roots + 4 canals

man M2 variations

2 roots + 3 canals = 81% 2 roots + 2 canals = 15% 1 root + 1 canal = 4%