5 Tips For Successful Endodontic Access
1. Pre operative analysis of a radiograph:
Use digital measurements for tentative WL, depth of penetration to reach the pulp chamber, shape of pulp chamber etc, look for root canal curvatures, presence of calcifications from a good quality PA radiograph, a BW radiograph if available can be helpful in identifying location of pulp chamber especially in relation to restoration margins/caries can offer handy clues
2. Useful instruments for access cavity preparation:
For isolation: a dental dam
A DG-16 endodontic probe
Burs for access : roundended taper bur for example endoZ, slow speed long neck burs
Dental loupes for Magnification and illumination
Access: after initial access always switch to a non-end cutting such as endo Z and then long neck or ‘goose-neck’ burs which allow better visibility
3. Removal of any defective restorations:
Or caries if present must be done during access cavity preparation.
4. Follow the Anatomical laws:
-Law of centrality: the floor of the pulp chamber is always located in the center of the tooth at the level of the CEJ.
-Law of concentricity: the walls of the pulp chamber are always concentric to the external surface of the tooth at the level of the
-Law of the CEJ: the CEJ is the most consistent, repeatable landmark for locating the position of the pulp.
For refinement of access cavities it can be helpful to use piezoelectric ultrasonics as you can cut and see at the same time.
JOE VOL. 30, NO.1, January 2004vAnatomy of the Pulp-Chamber Floor Paul Krasner, DDS, and Henry J. Rankow, DDS