Endodontic Access cavity preparation principles in Anterior and premolar maxillary and mandibular teeth

1. Dr. Ghaliah Alsawah
Endodontist
DcSc, BDS
1st Step into
Successful RCT:
Access
Part I : Anterior + Premolars

2. Tooth isolation using the dental dam is
the standard of care; it is integral and
essential for any nonsurgical
endodontic treatment.
AAE Statement , 2017
Dr. Ghaliah Alsawah

3. 03
01 02
Table of contents
Introduction General Principles
Teeth Access
Dr. Ghaliah Alsawah

4. Introduction
01
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5. The major objectives of endodontic access are:
(1) Identifying canal orifices.
(2) Obtaining straight-line access to the apical third
of the root canal space
(3) Conserving tooth structure.
Dr. Ghaliah Alsawah

6. Access Cavity requirements
Permit the
removal of all
the chamber
contents
Direct Access as
possible to the
canal apical 1/3
Direct vision
Provide a positive
support for
temporary fillings
Facilitate the
introduction of
instruments into
the orifice
Always have four
walls
Dr. Ghaliah Alsawah

7. General Principles
02
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8. General Principles
1.Penetration
phase
breaking through the
roof with the bur.
3.Finishing
phase
smooth Access cavity
walls
2.Enlargement
phase
brushing motion so all the
overhangs of dentin left
behind are removed
Dr. Ghaliah Alsawah

9. Teeth Access
03
Anteriors & Premolars
Maxillary & Mandibular
Dr. Ghaliah Alsawah

10. Upper Anteriors
Starting point
Cingulum
Perpendicular to
Palatal Surface
1st Drill
Mesi-Distal
Enlargment
Deroofing
Parallel to Tooth for
straight line access
2nd Drill
The only difference the final shape of the cavity opening.
Dr. Ghaliah Alsawah

11. Upper 1st Premolar
Access Orientation
Bucco-Lingual
Middle penetrating to
central sulcus
1st Drill
BL direction under
cusps
Deroofing
Usually not involving the
cusps peaks
Finishing
Dr. Ghaliah Alsawah

12. Upper 2nd Premolar
The canal is approached and prepared as though there were two, unless there is definitely only one.
Dr. Ghaliah Alsawah

13. Lower Anteriors
Incisal Edge of cingulum is
Starting point
Cingulum
Perpendicular to
Lingual Surface
1st Drill
Completely remove the
triangular for straight
line access
Deroofing
Parallel to Tooth for
straight line access
2nd Drill
Dr. Ghaliah Alsawah

14. The lower central, as well as the lower lateral
incisor, is anything but easy to treat. The difficulties
posed by this tooth are related to its mesiodistal
thinness when compared to its buccolingual width
which makes it very difficult, if not impossible, to
widen the canal(s) completely in any direction.
Note
Dr. Ghaliah Alsawah

15. Lower Premolars
Starting point
Central groove
Inclination directed
toward the side of the
Buccal cusp
1st Drill
Finishing & flaring the
cavity
Deroofing Occlusal View
Lingual cusp preserved
Dr. Ghaliah Alsawah

16. Insta: dr.g_alsawah
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Thank You
Sources of clinical images :
1.Chapter 11. Access Cavity and Endodontic Anatomy By ARNALDO CASTELLUCCI.
2. My own cases.