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Access cavity preparations

Access cavity preparations

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    • KENNEHT S. SEROTA, DDS, MMSC KENDO@ENDOSOLNS.COM VOLUME 6; ISSUE 1 WWW.ENDOSOLNS.COM VA R I A B I L I T Y O F CA N A L C O N F I G U R AT I O N JANUARY 2006 ACCESS DESIGN AND CREATION PROTOCOL1. Great White™ Ultra Bur, round, coarse gritRevelation diamond—(initial access) for penetra-tion through PFMs2. Tapered diamond, football diamond (accessextension)3. Pulp shaping bur/safe-ended bur (pulpal floorextension, dentin shelf removal) - by Brasseler4. Pear composite finishing bur (orifice identifica-tion, and peripheral wall extension at the orificelevel)5. Cone composite finishing bur (initial orificepenetration)Factor in the use of ultrasonic tips6. Routine endo sequence follows...... Caption describing picture or graphic. WHERE TO OBTAIN MATERIALS Great White™Ultra Bur—www.sswhiteburs.com Bur Revelation diamond—www.sswhiteburs.com di Tapered, football, safe ended diamonds This story can fit 75-125 words. keep the story focused. http://www.brasselerusa.com/ brasseler_flash_intro_1024.html Your headline is an important Examples of possible headlines part of the newsletter and include Product Wins Industry Composite Finishing Burs should be considered carefully. Award, New Product Can Save www.ultradent.com—under Finish Products icon You Time!, Membership Drive In a few words, it should accu- Exceeds Goals, and New Office rately represent the contents of Opens Near You. the story and draw readers into the story. Develop the headline before you write the story. This way, the headline will help you
    • Page 2FINDING THE MB2It is generally accepted that all maxillary first molars have a second canal in the MB root and in a small per-centage of cases there may be three. In almost 15% of the mesial roots of mandibular first molars an “isthmuscanal” can be detected. In neither case, can all these canals be routinely negotiated. As the maxillary molar isfar more prevalent, let’s examine the means by which predictable instrumentation can be achieved. The MB2 is very curved at the coronal limit of the canal. The shelf of dentin that grows over and obscures the minute orifice has the effect of moving the canal entrance distal to the true path (yellow arrow). When the exploratory file (.06/.08) is inserted, it immediately runs into a wall of dentin on the mesial aspect of the canal. The extremely nar- row confines of these typically small canals will not allow the file to negotiate the typically abrupt curvature. Excessive vertical work merely crumples the file tip and risks ledging the orifice. In order to create access, the file tip is worked to the point where resistance is met, pulling the file to the mesial to remove the overhanging dentin. When the file first engages, only 2 or 3 flutes of the file may engage. As these few flutes are worked, movement of the MB2 orifice to the mesial becomes evident. Once the operator gains experience, this mesial shift can done with ultrasonic troughing tips to provide a more developed mesial incline into the canal . Ultrasonics can be alternated with a small round burs (eg, LN-205 burs from Caulk—these tend to pro- vide a more burnished ap- pearance to the dentin); This makes the orifice more visible with magnifi-cation and illumination. It should be noted that a thin film of wateror alcohol enhances visibility at this point. When the initial accessglide path is sufficient, the file begins to increase its penetration ofthe canal space. This will coincide with an increasingly vertical fileorientation. A significant number of small files will be utilized forthis procedure as they will tend to buckle. You want to avoid a lotof work with the file tip early on, following the safer watch windingapproach to prevent ledging within the canal. Slow and incre-mental removal of the cervical ledge (blue arrow) obscuring thetrue path of the MB2 canal will enable accurate negotiation of thefull canal length with time and patience. VARIABILITY OF CANAL CONFIGURATION