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1. ACCESS CAVITY

2. WHAT IS ACCESS
CAVITY
COMPLETE DEROOFING OF
THE PULP CHAMBER

3. AIM OF ACCESS CAVITY
TO CREATE A STRAIGHT LINE PATH TO
THE CANAL ORIFICES AND THUS THE
APEX

4. ADVANTAGES
 Ease of removal all the pulp or necrotic
tissue (asepsis + discoloration)
 Facilitation in canal location (vision,
hemorrhagic points, canal location)
 Facilitation in irrigation and shaping
 Successful root canal is important than a
conservative approach

5. PROCEDURE
 A good preop radiograph is extremely
imp ( orientation + depth)
 Remove all the carious lesion first
 A round or tapering fissure carbide bur
 Round diamond bur is used to cut
through the Porcelain crown or carbide
bur through metal crown
 In sclerosed chamber, calculate the
depth of the chamber

6. PROCEDURE

7. PROCEDURE
 PENETRATION PHASE: Feel the dip
with a round tungsten carbide bur in high
speed hand piece
 ENLARGEMENT PHASE: Round bur in
slow hand piece is used next with a
pulling out action
 FINISHING AND FLARING PHASE:
tapering fissure bur may be used in
lateral cut / Endo Z burr has non cutting

8. PROCEDURE
 Check with probe,
the complete
deroofing
 Coronal pulp is
removed using a
long shank excavator
or a round burr in a
slow hand piece

10. WHAT IS THE IDEAL
SHAPE?
 Completely deroofed
pulp chamber and
having divergent
walls
 U will be able to
appreciate the
dentinal map on the
floor joining the
orifices

11. MAXILLARY ANTERIOR
 Rarely two canals / roots
 Ovoid or round triangular in shape on the
lingual surface
 It is placed slightly above the cingulum in
the centre
 A buccal approach if grossly carious tooth
 A straight approach in case of horizontal
fracture
 Max canine has more ovoidal shape

14. MAXILLARY ANTERIOR

15. MAXILLARY ANTERIOR

16. MAXILLARY ANTERIOR
 Access cavity for
max canine is oval
 May have two canals
or roots

17. MAXILLARY PREMOLARS
 4 has two canals and 5 may have one or
two
 preparation is ovoid (bucco lingually) and
directed through the middle of the
occlusal surface
 Cervical circumference is 2/3 rd the
coronal circumference
 Mesial concavity in max first premolar be
kept in mind

19. MAXILLARY MOLARS
 Three roots and three canals
 Usually a triangular cavity on the occlusal
surface
 Bur is placed in the centre directed
towards the palatal canal
 Mesio buccal, disto buccal and palatal
canals.
 Presence of fourth canal (MB 2) may
require a trapezoidal shape. Usually under
a ridge / shelf.

21. MANDIBULAR ANTERIOR
 Usually a single root and
canal. An oval cavity or
an hour glass shape
cavity.
 Mesio distal width is very
less
 More than 40% have two
roots
 Burr is placed in the
centre just above the
cingulum
 Buccal approach in
crowding or tooth loss
 Incisal approach in
fracture

22. MANDIBULAR ANTERIOR

23. MANDIBULAR ANTERIOR

24. MANDIBULAR
PREMOLARS
 Rarely two canals are
present
 Round or oval cavity
 Lingual inclination of the
occlusal table
 Burr not be
perpendicular to the
table
 If there is abrupt loss of
translucency than there
is a bifurcation

25. MANDIBULAR PREMOLARS

26. MANDIBULAR MOLARS
 Two roots and three canals. Mesio
buccal, mesio lingual and distal.
 Triangular cavity on the occlusal surface
 Burr is kept slightly to the mesial of the
centre and directed towards the biggest
canal
 Trapezoidal cavity if there are two distal
canals

28. MANDIBULAR MOLARS

29. PROBLEMS IN ACCESS
CAVITY
 Incomplete deroofing
 perforation

30. INCOMPLETE DEROOFING
 Inability to locate the canals
 Coronal pulp or necrotic tissue left behind
 Improper irrigation
 Improper cleaning and shaping

31. PERFORATION
 Supra gingival Crown Perforation : if
supra gingival restore it first.
 Sub gingival Crown Perforation :
gingivectomy to avoid impinging on the
biological width
 If perforation in the bifurcation area – GIC
or Floor raising with amalgam ( MTA may
be used)

34. I THANK U ALL