Acces opening of anterior and premolar teeth(shadan)

instument,rules,complicated cases

1. Shadan sahib hameed Access opening in anterior and premolar teeth

2. Access cavity is defined as endodontic coronal preparation which is the first and most important phase of nonsurgical root canal treatment that is essential for a good endodontic result.

3. Objectives

4. Classification of Canal Morphology Weine's Classification of Root Canal

5. Vertucci's Classification

6. Laws for finding pulp canal orifices :

7. Law of Symmetry

8. PREOPERATIVE CLINICAL GUIDELINES

9. Instrument and armamentarium Magnification and illumination. Rubber dam. Headpieces. Burs . Endodontic explorer (DG-16, DE-17). Endodontic operative spoon . #17 Explorer . Ultrasonic unit and tips

10. Magnification and illumination Surgical telescopes ( loupes) Microscope(DOM)  

11. Headpieces.

12. Burs Round carbide burs #2,#4,#6 Round diamond burs

13. Fissure carbide bur diamond round end

14. Endo Z Bur

15. Transmetal Bur Extended-shank round burs Multi-purpose Bur

16. Gates glidden bur Orifiece opener

17. explorers Endodontic Explorer A #17 operative explorer DG16 CK17

18. Endodontic Spoon

19. Ultrasonic Unit and Tips Finding and Breaking Into Hidden Canals

20. Passive Ultrasonic Irrigation Obstruction Removal

21. Principle I Outline Form 1.Size of Pulp Chamber :

22. 2.Shape of Pulp Chamber

23. 3.Number, Position, and Curvature of Root Canal

24. Principle II Convenience Form 1.Unobstructed Access to the Canal Orifice .

25. 2.Direct Access to the Apical Foramen .

26. 3.Extension to Accommodate Filling Techniques

27. 4.Complete Authority over the Enlarging Instrument

28. Principle III Removal of the Remaining Carious Dentin and Defective Restorations 1 ) to eliminate mechanically as many bacteria as possible from the interior of the tooth . (2) to eliminate the discolored tooth structure , that may ultimately lead to staining of the crown . (3) to eliminate the possibility of any bacteria-laden saliva leaking into the prepared cavity

29. Principle IV; Toilet of the Cavity All of the caries, debris, and necrotic material must be removed from the chamber before the radicullar preparation is begun

30. Principle IV; Toilet of the Cavity

31. Endodontic Access Cavity Preparation of Anterior Teeth   Entrance through the lingual surface. Penetration into enamel with No. 2 or No. 4 in an accelerated-speed handpiece , at a right angle Convenience extension toward the incisal .

32. *cavity outline is funneled and fanned incisally with a fissure bur. Penetrate(drop) the pulp chamber with surgical-length No. 2 or 4 round bur in aslow -speed . *remove the lingual and labial walls of the pulp chamber. *the lingual “shoulder” is removed

33. Maxillary Central Incisor Average Length 23mm One canal 100% Lateral canals 23% Straight 75% Distal Curve 8%  Outline form : ovoid in adult Triangular in young

34. There are two situations in which one must necessarily involve the incisal margin: abraded or fractured teeth. .

35. Maxillary Lateral Incisor Average Length 22 .8 mm One canal 99.9% Lateral canals 10% Straight 30% Distal Curve 53% Outline form : ovoid Or triangular

36. Maxillary Canine Average Length 2 6 .0mm One canal 100% Lateral canals 24% Straight 39 % Distal Curve 32% Outline form:ovoid

37. incisor Mandibular Central Average Length 21.5 One canal 70% Two canals 23% Straight 60% Distal Curve 23% Outline form : triangular in young and ovoid in adult

38. mandibular Lateral Incisors Average Length 22.5 One canal 57% Two canals one foramen 14.7%% Two canals two foramina 29.5% Straight 60% % Distal Curve 23 Outline form : triangular in young and ovoid in adult

39. Mandibular Canine Average Length 25.2 mm One canal 94% Two canals 6 % Straight 68% Distal Curve 20%

40. ERRORS in Cavity Preparation of anterior teeth PERFORATION at the labiocervical GOUGING of the labial and distal walls

41. DISCOLORATION of the crown LEDGE formation and perforation at the apical-distal curve

42. PEAR-SHAPED PREPARATION of the apical canal

43. Access cavity preparation of premolar teeth * Entrance through the occlusal surface No. 4 round bur *Open(drop) into the pulp chamber . *Remove the roof of the pulp chamber *Outline form is buccolingual ovoid for adult and newly errupted

44. Maxillary First Premolar Average Length 21.8mm One canal 9% Two canals 72% Three cnals 6% Straight 38% Distal Curve 37% Outline form ovoid

45. Maxillary Second Premolar Average Length 21mm One canal 75% Two canals 24% Three cnals 1% Outline form ovoid

46. Access cavity preparation of mandibular premolars because of the lingual tilt of the mandibular premolars ,the access cavity should have extended on to the buccal cusp inclines ,in order to gain straight line access

47. Mandibular First Premolar Average Length 22.1mm One canal 73% Two canals 19% Three canals 0.5% Straight 48% Distal Curve 35% Outline form ovoid

48. Mandibular Second Premolar Average Length 21.4mm One canal 85% Two canals 11% Three canals 0.5% Outline form ovoid

49. ERRORS in Cavity Preparation of premolars UNDEREXTENDED preparation OVEREXTENDED preparation PERFORATION at the mesiocervical

50. BROKEN INSTRUMENT PERFORATION at the distogingival PERFORATION at the apical curvature INCOMPLETE preparation

51. CHALLENGING ACCESS PREPARATIONS Teeth with Minimal or No Clinical Crown 1.caries left un treated 2. Badly decayed teeth typically can fracture under occlusal function. 3.teeth with heavily restoration. 4.External trauma .

52. Heavily Restored Teeth (Including Those with Full Veneer Crowns

53. 3.Teeth with Calcified Canals Causes : Caries Truama aging

54. 4.Crowded Teeth