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
CEJ
-Law of the CEJ: the CEJ is the most consistent, repeatable landmark for locating the position of the pulp.
5. Ultrasonics:
For refinement of access cavities it can be helpful to use piezoelectric ultrasonics as you can cut and see at the same time.
Reference:
JOE VOL. 30, NO.1, January 2004vAnatomy of the Pulp-Chamber Floor Paul Krasner, DDS, and Henry J. Rankow, DDS