Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
This document discusses root canal preparation techniques presented by Dr. Fasahath Ahmed Butt. It covers the objectives of root canal preparations, which are to completely remove pulp tissue and bacteria while maintaining the original root canal anatomy. The main types of preparations discussed are crown-down, step-back, and hybrid techniques. For each technique, the document outlines the basic process and advantages and disadvantages. It also briefly covers different filing techniques used in root canal preparations like watch winding, reaming, and balanced force.
The document discusses various endodontic mishaps that can occur during root canal treatment. It describes mishaps related to access preparation, instrumentation, and obturation. Access-related mishaps include treating the wrong tooth, missing canals, damaging existing restorations, perforating the access cavity, and crown fractures. Instrumentation mishaps include ledge formation, perforating the root, and separated instruments. Obturation mishaps include overfilling or underfilling the canal. The document provides details on the causes, recognition, correction, prevention and prognosis of several common endodontic mishaps.
The document discusses various techniques for root canal preparation and shaping. It describes the objectives of cleaning and shaping, which include removing infected tissue, providing space for disinfectants and filling materials, and retaining tooth structure. Several instrumentation techniques are covered, such as step-back preparation, which involves incrementally reducing the working length, and anticurvature filing, which shapes the canal away from thin root sections. The document also addresses other methods like standardized preparation and considerations for curved canals.
This document provides an overview of root canal anatomy, including the divisions of the pulp cavity, landmarks in the apical region, classifications of canal configurations, and detailed descriptions of canal morphology for different tooth types. Key points include:
- The pulp cavity is divided into the coronal pulp chamber and radicular root canals.
- Important apical landmarks include the apical constriction, foramen, cementodentinal junction, and accessory canals.
- Classification systems describe common canal morphologies, such as single versus multiple canals.
- Tooth-specific details are given for maxillary incisors, canines, premolars, and molars, including average canal numbers, lengths
Endodontic mishaps/PROCEDURAL ACCIDENTSNivedha Tina
The document discusses various endodontic mishaps that can occur during root canal treatment such as loss of working length, canal blockages, ledging, missed canals, instrument separation, perforations, and over/under filling. It describes the causes, signs, and management of each mishap. Prevention is key and includes proper access cavity preparation, using sequential file sizes with copious irrigation, verifying instrument position radiographically, and maintaining sterile conditions with a rubber dam. The document emphasizes informing patients about any procedural accidents and their treatment and prognosis implications.
The document discusses the anatomy and root canal morphology of maxillary central incisors. It notes that maxillary central incisors typically have:
- A single root with a single root canal system
- A triangular/ovoid root cross-section that tapers lingually
- Midroot and apical lateral canals that are common
- The root apex and apical foramen located distolabially on average
- A triangularly-shaped pulp chamber located in the center of the crown that follows the contours of the crown and has three pulp horns
The document discusses endodontic access cavity preparation. It defines access cavity preparation as creating an unobstructed opening to reach canal orifices and the apical foramen. There are principles for proper access, including establishing the correct outline form based on internal anatomy, providing direct access to canals and accommodation for instrumentation. Guidelines are provided for access preparation of different tooth types. Common errors include failing to identify all caries, establish proper access, or recognize tooth angulation. Proper access is the foundation for successful root canal treatment.
This document discusses the rationale for endodontic therapy and periradicular healing. It begins by explaining that the rationale for endodontic therapy is to completely debride and seal the root canal system through non-surgical or surgical means. This achieves a fluid-tight seal and removes the source of infection, allowing periradicular tissues to heal. Several theories are discussed relating to the spread of infection and zones of reaction in periradicular tissues. Complete elimination of irritants from the root canal through treatment is necessary for periradicular healing to occur over several months. Factors like technical quality of the root filling and ability to clean the entire root canal influence healing outcomes.
This document discusses root canal preparation techniques presented by Dr. Fasahath Ahmed Butt. It covers the objectives of root canal preparations, which are to completely remove pulp tissue and bacteria while maintaining the original root canal anatomy. The main types of preparations discussed are crown-down, step-back, and hybrid techniques. For each technique, the document outlines the basic process and advantages and disadvantages. It also briefly covers different filing techniques used in root canal preparations like watch winding, reaming, and balanced force.
The document discusses various endodontic mishaps that can occur during root canal treatment. It describes mishaps related to access preparation, instrumentation, and obturation. Access-related mishaps include treating the wrong tooth, missing canals, damaging existing restorations, perforating the access cavity, and crown fractures. Instrumentation mishaps include ledge formation, perforating the root, and separated instruments. Obturation mishaps include overfilling or underfilling the canal. The document provides details on the causes, recognition, correction, prevention and prognosis of several common endodontic mishaps.
The document discusses various techniques for root canal preparation and shaping. It describes the objectives of cleaning and shaping, which include removing infected tissue, providing space for disinfectants and filling materials, and retaining tooth structure. Several instrumentation techniques are covered, such as step-back preparation, which involves incrementally reducing the working length, and anticurvature filing, which shapes the canal away from thin root sections. The document also addresses other methods like standardized preparation and considerations for curved canals.
This document provides an overview of root canal anatomy, including the divisions of the pulp cavity, landmarks in the apical region, classifications of canal configurations, and detailed descriptions of canal morphology for different tooth types. Key points include:
- The pulp cavity is divided into the coronal pulp chamber and radicular root canals.
- Important apical landmarks include the apical constriction, foramen, cementodentinal junction, and accessory canals.
- Classification systems describe common canal morphologies, such as single versus multiple canals.
- Tooth-specific details are given for maxillary incisors, canines, premolars, and molars, including average canal numbers, lengths
Endodontic mishaps/PROCEDURAL ACCIDENTSNivedha Tina
The document discusses various endodontic mishaps that can occur during root canal treatment such as loss of working length, canal blockages, ledging, missed canals, instrument separation, perforations, and over/under filling. It describes the causes, signs, and management of each mishap. Prevention is key and includes proper access cavity preparation, using sequential file sizes with copious irrigation, verifying instrument position radiographically, and maintaining sterile conditions with a rubber dam. The document emphasizes informing patients about any procedural accidents and their treatment and prognosis implications.
The document discusses the anatomy and root canal morphology of maxillary central incisors. It notes that maxillary central incisors typically have:
- A single root with a single root canal system
- A triangular/ovoid root cross-section that tapers lingually
- Midroot and apical lateral canals that are common
- The root apex and apical foramen located distolabially on average
- A triangularly-shaped pulp chamber located in the center of the crown that follows the contours of the crown and has three pulp horns
The document discusses endodontic access cavity preparation. It defines access cavity preparation as creating an unobstructed opening to reach canal orifices and the apical foramen. There are principles for proper access, including establishing the correct outline form based on internal anatomy, providing direct access to canals and accommodation for instrumentation. Guidelines are provided for access preparation of different tooth types. Common errors include failing to identify all caries, establish proper access, or recognize tooth angulation. Proper access is the foundation for successful root canal treatment.
This document discusses the rationale for endodontic therapy and periradicular healing. It begins by explaining that the rationale for endodontic therapy is to completely debride and seal the root canal system through non-surgical or surgical means. This achieves a fluid-tight seal and removes the source of infection, allowing periradicular tissues to heal. Several theories are discussed relating to the spread of infection and zones of reaction in periradicular tissues. Complete elimination of irritants from the root canal through treatment is necessary for periradicular healing to occur over several months. Factors like technical quality of the root filling and ability to clean the entire root canal influence healing outcomes.
The document discusses the definitions, objectives, and techniques for cleaning and shaping the root canal system, including the use of various hand files, rotary instruments, and ultrasonic devices. It covers the phases of negotiation, coronal pre-enlargement, working length determination, and root canal shaping techniques. The goals are to remove debris and shape the canal to receive obturation while preserving the canal anatomy and preventing errors.
This document discusses various root canal preparation techniques including step-back, crown-down, and balanced force techniques. It provides details on each technique's procedures, advantages, and limitations. The step-back technique involves initial apical preparation followed by step-wise coronal preparation to create tapers. Crown-down starts with coronal flaring before apical instrumentation to minimize debris extrusion. Hybrid and balanced force techniques combine aspects of different methods.
This document discusses common errors that can occur during endodontic treatment and ways to prevent or manage them. It covers errors related to accessing the pulp space like treating the wrong tooth, incomplete caries removal, or perforating through a full coverage restoration. It also discusses errors during canal cleaning and shaping such as ledge formation, canal deviations, or instrument separation. Finally, it addresses procedural errors during obturation like underfilling or overfilling the canal with gutta percha. Throughout, it provides tips for preventing errors like using small instruments sequentially, maintaining canal patency, and taking pre-operative radiographs to understand anatomy.
This document discusses root canal morphology and access cavity preparation. It begins with an introduction discussing the objectives of root canal treatment and the importance of understanding root canal anatomy. It then covers topics like root canal classification systems, anatomy of the apical root, accessory canals, canal isthmuses, root canal curvatures, and guidelines for cavity preparation. The document provides detailed information on root canal anatomy and considerations for access cavity preparation.
One of the most dreaded nightmares of any clinician is broken instruments in the midst of an endodontic treatment. NiTi rotary instruments show a high incidence of instrument fracture despite their favourable qualities.
The document discusses working length determination in endodontics. It defines working length as the distance from a coronal reference point to the point where canal preparation and obturation should terminate. This is usually 1mm short of the apical foramen. Several methods of determining working length are discussed, including radiographic methods and the use of electronic apex locators, which provide objective measurements with high accuracy. Consequences of working length that is too long or too short are also outlined.
This document discusses common errors that can occur during root canal treatment and their prevention and management. Some key points include:
1) Missed canals are the most common error, which can be prevented by adequate access preparation, expecting extra canals, using magnification, and taking angled radiographs.
2) Perforations are also common and can be iatrogenic or pathological. Management includes regaining access, controlling hemorrhage, and sealing the perforation with materials like GIC or MTA.
3) Instrument separation is another error that can occur from overuse or excess pressure. Management depends on factors like retrieving or bypassing the separated instrument.
4) Sodium hypochlor
Apexification is a technique used to induce formation of a calcified barrier at the apex of a tooth with incomplete root development and non-vital pulp. It involves removal of pulp tissue, placement of calcium hydroxide or mineral trioxide aggregate (MTA) in the root canal to stimulate apical closure, and subsequent filling of the canal. The steps are accessing the canal, determining root length, cleaning and shaping, placing calcium hydroxide or MTA, and filling the canal once closure is achieved, usually within 6 months. Apexification aims to enable conventional root canal treatment in teeth that would otherwise be non-restorable due to open apices.
The document discusses various methods for endodontic diagnosis including obtaining a thorough medical and dental history, examining subjective symptoms, performing clinical observations and tests, and interpreting radiographs. A key part of diagnosis involves determining the cause of pain or pathology through differential diagnosis and comparing current symptoms to other potential conditions. The diagnostic process aims to identify both diseased and healthy teeth through indirect evaluation of a patient's response to various stimuli and tests.
The objectives of root canal preparation are to clean the root canal of organic remnants and shape it to receive a three-dimensional filling. The canal is cleaned primarily through irrigation and shaped primarily by instrumentation to develop a continuously tapering conical form. The preparation should make the canal narrower apically, with the narrowest diameter at the terminus, in multiple planes without transporting the foramen and keeping the apical foramen as small as possible. Sodium hypochlorite is recommended as an irrigant as it dissolves organic debris, has antibacterial properties, and lubricates instrumentation.
This document discusses endodontic perforations, including their causes, types, management, and prognosis. It describes coronal, lateral, furcation, and apical perforations. Immediate repair with MTA offers the best outcome, though prognosis depends on factors like location, size, timing of repair, and access. A case report demonstrates repair of a crestal perforation using biodentine after retrieving gutta-percha that had been condensed into the perforation during a previous root canal treatment. The perforation communicated with the oral cavity and had led to periodontal pocket formation over a year.
explained with Limited matter moreover I have included all the images. if you go through a standard textbook and referred to this PPT it will help you so much I hope It helps you. ask me for the books details.
Cleaning and shaping of the root canal systemHamza Tahir
My presentation is about Materials used for dressing , cleaning , irrigating the canals. Also include , irrigation techniques and instruments . Enjoy !!
This document provides information on root canal obturation including the purpose, materials, techniques, and potential causes of failure. It discusses criteria for obturation such as absence of symptoms. Common obturation materials include gutta-percha, resins, and silver points used with sealers like zinc oxide-eugenol, calcium hydroxide, and epoxy resin. Techniques covered are cold lateral condensation, warm lateral/vertical condensation, thermocompaction, and others. Potential causes of failure include inadequate apical, coronal, or lateral seals and over/under filling.
The document discusses common endodontic mistakes related to access, instrumentation, and obturation including treating the wrong tooth, ledge formation, perforations, separated instruments, and over/under filled canals. It provides details on causes, recognition, correction, and prevention of each mistake to help endodontists avoid errors and improve treatment outcomes. The document emphasizes the importance of careful diagnosis, conservative access preparation, adhering to principles of instrumentation, and optimizing obturation quality.
Procedural accidents in root canal treatment last oneammar905
- Immediately stop procedure
- Check throat and mouth of patient
- Monitor vital signs
- Call emergency services if needed
Dentist:
- Reassure patient
- Take appropriate radiographs
- Monitor patient and seek medical advice as needed
Prognosis depends on:
- Location and size of object
- Time elapsed before removal
- Patient's general health
The document discusses various techniques for cleaning and shaping the root canal system during endodontic treatment. It describes the objectives and basic principles of root canal preparation, including removing debris and maintaining the original shape of the canal. Several techniques are summarized, such as step-back, crown-down, balanced force, and ultrasonic instrumentation. For each technique, the document outlines the steps and discusses advantages and disadvantages.
Endodontic Root Perforation: Causes, Identification, and Management LectureIraqi Dental Academy
This lecture present to you the concept of root perforation and its complications in endodontic practice. Management of such situation is also presented briefly.
Iatrogenic Perforation- A guide to fixing the hole in your patient's toothTaseef Hasan Farook
An overview of the possible types of perforation that may occur during endodontic treatment with their management. This slide presentation covers multiple management possibilities of said perforation proposed by various clinicians from around the world which can aid the readers in their treatment plan for the repair of a tooth perforation
The document discusses access cavity preparation for endodontic treatment. It provides guidelines for preparing access cavities, including removing caries and restorations, locating all canal orifices, and achieving straight line access to the canals. Specific steps are outlined for preparing access cavities in anterior and posterior teeth, including maxillary and mandibular molars as well as maxillary central incisors. The goal of access cavity preparation is to allow for thorough cleaning, shaping, and filling of the root canal system.
This document provides guidance on accessing tooth canals during root canal treatment. It discusses locating all canals, removing pulp tissue while conserving tooth structure. Access openings should be made under rubber dam isolation using high-speed instruments with good illumination. Tooth anatomy and pre-operative x-rays are used to determine the number and location of canals. Care must be taken to locate extra canals which may be present, especially in teeth with complex anatomy.
The document discusses the definitions, objectives, and techniques for cleaning and shaping the root canal system, including the use of various hand files, rotary instruments, and ultrasonic devices. It covers the phases of negotiation, coronal pre-enlargement, working length determination, and root canal shaping techniques. The goals are to remove debris and shape the canal to receive obturation while preserving the canal anatomy and preventing errors.
This document discusses various root canal preparation techniques including step-back, crown-down, and balanced force techniques. It provides details on each technique's procedures, advantages, and limitations. The step-back technique involves initial apical preparation followed by step-wise coronal preparation to create tapers. Crown-down starts with coronal flaring before apical instrumentation to minimize debris extrusion. Hybrid and balanced force techniques combine aspects of different methods.
This document discusses common errors that can occur during endodontic treatment and ways to prevent or manage them. It covers errors related to accessing the pulp space like treating the wrong tooth, incomplete caries removal, or perforating through a full coverage restoration. It also discusses errors during canal cleaning and shaping such as ledge formation, canal deviations, or instrument separation. Finally, it addresses procedural errors during obturation like underfilling or overfilling the canal with gutta percha. Throughout, it provides tips for preventing errors like using small instruments sequentially, maintaining canal patency, and taking pre-operative radiographs to understand anatomy.
This document discusses root canal morphology and access cavity preparation. It begins with an introduction discussing the objectives of root canal treatment and the importance of understanding root canal anatomy. It then covers topics like root canal classification systems, anatomy of the apical root, accessory canals, canal isthmuses, root canal curvatures, and guidelines for cavity preparation. The document provides detailed information on root canal anatomy and considerations for access cavity preparation.
One of the most dreaded nightmares of any clinician is broken instruments in the midst of an endodontic treatment. NiTi rotary instruments show a high incidence of instrument fracture despite their favourable qualities.
The document discusses working length determination in endodontics. It defines working length as the distance from a coronal reference point to the point where canal preparation and obturation should terminate. This is usually 1mm short of the apical foramen. Several methods of determining working length are discussed, including radiographic methods and the use of electronic apex locators, which provide objective measurements with high accuracy. Consequences of working length that is too long or too short are also outlined.
This document discusses common errors that can occur during root canal treatment and their prevention and management. Some key points include:
1) Missed canals are the most common error, which can be prevented by adequate access preparation, expecting extra canals, using magnification, and taking angled radiographs.
2) Perforations are also common and can be iatrogenic or pathological. Management includes regaining access, controlling hemorrhage, and sealing the perforation with materials like GIC or MTA.
3) Instrument separation is another error that can occur from overuse or excess pressure. Management depends on factors like retrieving or bypassing the separated instrument.
4) Sodium hypochlor
Apexification is a technique used to induce formation of a calcified barrier at the apex of a tooth with incomplete root development and non-vital pulp. It involves removal of pulp tissue, placement of calcium hydroxide or mineral trioxide aggregate (MTA) in the root canal to stimulate apical closure, and subsequent filling of the canal. The steps are accessing the canal, determining root length, cleaning and shaping, placing calcium hydroxide or MTA, and filling the canal once closure is achieved, usually within 6 months. Apexification aims to enable conventional root canal treatment in teeth that would otherwise be non-restorable due to open apices.
The document discusses various methods for endodontic diagnosis including obtaining a thorough medical and dental history, examining subjective symptoms, performing clinical observations and tests, and interpreting radiographs. A key part of diagnosis involves determining the cause of pain or pathology through differential diagnosis and comparing current symptoms to other potential conditions. The diagnostic process aims to identify both diseased and healthy teeth through indirect evaluation of a patient's response to various stimuli and tests.
The objectives of root canal preparation are to clean the root canal of organic remnants and shape it to receive a three-dimensional filling. The canal is cleaned primarily through irrigation and shaped primarily by instrumentation to develop a continuously tapering conical form. The preparation should make the canal narrower apically, with the narrowest diameter at the terminus, in multiple planes without transporting the foramen and keeping the apical foramen as small as possible. Sodium hypochlorite is recommended as an irrigant as it dissolves organic debris, has antibacterial properties, and lubricates instrumentation.
This document discusses endodontic perforations, including their causes, types, management, and prognosis. It describes coronal, lateral, furcation, and apical perforations. Immediate repair with MTA offers the best outcome, though prognosis depends on factors like location, size, timing of repair, and access. A case report demonstrates repair of a crestal perforation using biodentine after retrieving gutta-percha that had been condensed into the perforation during a previous root canal treatment. The perforation communicated with the oral cavity and had led to periodontal pocket formation over a year.
explained with Limited matter moreover I have included all the images. if you go through a standard textbook and referred to this PPT it will help you so much I hope It helps you. ask me for the books details.
Cleaning and shaping of the root canal systemHamza Tahir
My presentation is about Materials used for dressing , cleaning , irrigating the canals. Also include , irrigation techniques and instruments . Enjoy !!
This document provides information on root canal obturation including the purpose, materials, techniques, and potential causes of failure. It discusses criteria for obturation such as absence of symptoms. Common obturation materials include gutta-percha, resins, and silver points used with sealers like zinc oxide-eugenol, calcium hydroxide, and epoxy resin. Techniques covered are cold lateral condensation, warm lateral/vertical condensation, thermocompaction, and others. Potential causes of failure include inadequate apical, coronal, or lateral seals and over/under filling.
The document discusses common endodontic mistakes related to access, instrumentation, and obturation including treating the wrong tooth, ledge formation, perforations, separated instruments, and over/under filled canals. It provides details on causes, recognition, correction, and prevention of each mistake to help endodontists avoid errors and improve treatment outcomes. The document emphasizes the importance of careful diagnosis, conservative access preparation, adhering to principles of instrumentation, and optimizing obturation quality.
Procedural accidents in root canal treatment last oneammar905
- Immediately stop procedure
- Check throat and mouth of patient
- Monitor vital signs
- Call emergency services if needed
Dentist:
- Reassure patient
- Take appropriate radiographs
- Monitor patient and seek medical advice as needed
Prognosis depends on:
- Location and size of object
- Time elapsed before removal
- Patient's general health
The document discusses various techniques for cleaning and shaping the root canal system during endodontic treatment. It describes the objectives and basic principles of root canal preparation, including removing debris and maintaining the original shape of the canal. Several techniques are summarized, such as step-back, crown-down, balanced force, and ultrasonic instrumentation. For each technique, the document outlines the steps and discusses advantages and disadvantages.
Endodontic Root Perforation: Causes, Identification, and Management LectureIraqi Dental Academy
This lecture present to you the concept of root perforation and its complications in endodontic practice. Management of such situation is also presented briefly.
Iatrogenic Perforation- A guide to fixing the hole in your patient's toothTaseef Hasan Farook
An overview of the possible types of perforation that may occur during endodontic treatment with their management. This slide presentation covers multiple management possibilities of said perforation proposed by various clinicians from around the world which can aid the readers in their treatment plan for the repair of a tooth perforation
The document discusses access cavity preparation for endodontic treatment. It provides guidelines for preparing access cavities, including removing caries and restorations, locating all canal orifices, and achieving straight line access to the canals. Specific steps are outlined for preparing access cavities in anterior and posterior teeth, including maxillary and mandibular molars as well as maxillary central incisors. The goal of access cavity preparation is to allow for thorough cleaning, shaping, and filling of the root canal system.
This document provides guidance on accessing tooth canals during root canal treatment. It discusses locating all canals, removing pulp tissue while conserving tooth structure. Access openings should be made under rubber dam isolation using high-speed instruments with good illumination. Tooth anatomy and pre-operative x-rays are used to determine the number and location of canals. Care must be taken to locate extra canals which may be present, especially in teeth with complex anatomy.
The document provides information on endodontic access cavity preparation for various types of teeth. It discusses the major objectives of straight-line access and conservation of tooth structure. It then describes the anatomy, root canal morphology, and preparation techniques for maxillary and mandibular anterior teeth, premolars, and molars. Common errors in cavity preparation are also highlighted, including inadequate removal of tooth structure, ledges, and perforations.
Endodontics deals with diseases of the dental pulp, which is made of loose connective tissue inside the root canals. The number of canals correlates to the number of tooth roots. The pulp provides nutrients, sensation, and forms secondary dentin for protection. Accessory canals can branch off from the main canal. Proper access cavity preparation is important to allow straight-line access to the canals and apical foramen. Irrigation serves to lubricate, dissolve pulp, wash out debris, and disinfect canals using solutions like sodium hypochlorite and EDTA. New technologies like EndoVac and EndoActivator improve irrigation.
1. Access cavity preparation is the first and most important phase of root canal treatment, with the goals of achieving straight line access to the apical foramen, locating all root canal orifices, and conserving sound tooth structure.
2. The principles of access cavity preparation include establishing an outline form based on pulp chamber size and shape and the number/direction of root canals, providing a convenience form for improved visibility and instrumentation, and removing caries/defective restorations and debris from the pulp chamber.
3. Key steps in access cavity preparation depend on the specific tooth but involve using burs and instruments to locate and prepare access to all root canal orifices while avoiding errors like
The document discusses the importance of proper access cavity preparation in endodontic therapy. It emphasizes that preoperative radiographs are essential to determine canal locations and angles. The clinician must understand tooth morphology and carefully study the radiograph before beginning preparation. Access cavities should be precisely cut to allow straight-line access to all canals without being too small, which can make treatment difficult, or too large, increasing risk of perforation. An ideal bur size is recommended based on tooth type and anatomy.
Principles of intra coronal and radicular preparationIAU Dent
This document discusses the principles of endodontic cavity preparation. It is divided into three phases: cleaning and shaping, disinfection, and obturation. The objectives of cleaning and shaping are to remove all contents from the root canal that could harbor microorganisms or lead to periapical issues. The root canal must be prepared to a continuously tapering shape that maintains the original anatomy and position of the foramen. Cavity preparation has coronal and radicular divisions, following Black's principles modified for endodontics. These include outline form to follow canal anatomy, convenience form for instrument access, and resistance form to prevent overfilling. Thorough cleaning is achieved through instrumentation and irrigation to eliminate debris and bacteria.
The document discusses principles of endodontic cavity preparation. It emphasizes that careful cavity preparation and debridement are essential for successful root canal therapy. The outline form of the cavity must provide complete access from the margins to the apical foramen. Factors like pulp chamber size and shape, and root canal anatomy influence the cavity design. Coronal and radicular preparations are described separately but must flow together.
Working length is the distance from a coronal reference point to the point where canal preparation and obturation should terminate. It is important to determine working length precisely using radiographs or electronic apex locators. The radiographic method involves measuring the total length of the tooth on preoperative radiographs, subtracting 1mm as a safety factor, and confirming length under radiograph after instrumentation. Electronic apex locators use electric current to detect the apical foramen. Tactile methods are unreliable due to risk of over-instrumentation or under-instrumentation.
This document discusses principles and guidelines for preparing access cavities for root canal treatment of posterior teeth. It begins with an introduction on the importance of proper access cavity preparation for thorough root canal treatment. It then discusses root canal anatomy and complexity, noting that multiple canals and complex morphologies are common. The key principles of access cavity preparation are outlined, including establishing the correct outline and convenience forms to provide straight-line access to all canals. Anatomical landmarks like the cementoenamel junction and external root surface are emphasized as guides. Proper removal of caries and debris is also covered.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Anthropology is the scientific study of humans and human behavior and societies. It is divided into two main categories: physical anthropology, which studies humans and human evolution from a biological and genetic perspective, and cultural anthropology, which looks at human cultures, societies, and behaviors. Key areas of physical anthropology include human genetics, paleontology, ethnology, anthropometry, and biometrics. Cultural anthropology's main areas are prehistoric archaeology and social anthropology. The evolution of humans from early primates to modern Homo sapiens is also examined.
Access cavity preparation for maxillary caninesKritika Sarkar
The document summarizes the anatomy and access cavity preparation for maxillary canines. It describes the anatomy of the root canal system and clinical significance. It then outlines the objectives and steps for access cavity preparation, including visualizing internal anatomy, outlining access with a pencil, cutting through the center and extending the opening, removing undercuts to achieve straight-line access to the apical foramen, and irrigating periodically. The maxillary canine has the longest root among human teeth and its complex anatomy requires careful access preparation.
This document discusses guidelines for preparing access cavities for root canal treatment. It emphasizes the importance of straight-line access to allow visualization and instrumentation of all root canals. Key principles include removing caries and defective restorations before starting treatment, and eliminating dentin overhangs to provide optimal access. Common canal morphologies are reviewed for different tooth types. Tips are provided to locate additional canals like second mesiobuccal canals in maxillary molars. Proper access cavity preparation is highlighted as essential for thorough root canal treatment.
This document discusses principles and guidelines for access cavity preparation in endodontic treatment. It outlines the basic principles established by G.V. Black, including outline form to establish complete access, convenience form to make procedures more convenient, and removal of remaining caries and defective restorations. Guidelines include centrality and concentricity of the pulp chamber floor, using the cementoenamel junction as a landmark, and symmetry of canal orifices. Specific access preparations are described for maxillary and mandibular molars and premolars. Considerations are provided for anatomical variations, extensive restorations, tilted/angled crowns, calcified canals, and teeth with minimal crowns.
Procedural errors in endodontics /certified fixed orthodontic courses by In...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Endodontic mishaps include procedural errors that can occur during root canal treatment such as ledge formation, canal perforation, separated instruments, and overfilling/underfilling of canals. It is important for practitioners to understand how to recognize, prevent, and treat these mishaps. Common causes include inadequate access, excessive force, or improper instrument use. Perforations require immediate sealing with materials like MTA to achieve the best prognosis. Separated instruments may be bypassed or retrieved, while ledges can sometimes be circumvented with smaller files. Overall, minimizing errors requires adherence to principles like conservative access, copious irrigation, and careful instrumentation.
This document provides an overview of principles of cavity preparation. It defines cavity preparation and discusses its history and objectives. Factors affecting cavity preparation and various classification systems are described, including those proposed by G.V. Black and G.J. Mount. Terminology related to cavity preparation such as tooth preparation walls, angles, and classifications of cavities are defined. The stages of cavity preparation including initial outline form and depth are outlined. Key principles for preserving cuspal strength and marginal ridge strength are discussed.
Determination of root canal working length /certified fixed orthodontic cours...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
This document provides guidelines for access cavity preparation for endodontic treatment. It discusses the objectives of access cavity preparation which are to achieve straight-line access to the root canal, locate all root canal orifices, and conserve sound tooth structure. It then describes the ideal access cavity shape and provides examples of common access preparations and cavity shapes for different types of teeth, including maxillary and mandibular incisors, canines, premolars, and molars.
Auxillary methods of retention in class ii dental amalgam restorationsIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
The document discusses guidelines for preparing access cavities for root canal treatment. It outlines principles such as outlining the cavity shape based on tooth anatomy, providing direct access to canals, and removing all caries and defective restorations. Specific guidelines covered include visualizing internal anatomy, evaluating landmarks like the cementoenamel junction, preparing through the lingual/occlusal surfaces, and locating all canals before placing the dental dam. The goal is to provide unobstructed access to canals for effective cleaning, shaping and filling.
The document discusses guidelines for preparing access cavities for root canal treatment. It outlines principles such as removing all caries and defective restorations, conserving tooth structure, and providing straight-line access to canal orifices. Specific guidelines covered include visualizing internal anatomy, evaluating anatomical landmarks, preparing cavities through lingual/occlusal surfaces, and locating all root canals before placing a dental dam. The goal is to efficiently locate and treat all canals following principles of access cavity design.
This document discusses BMPs (bone morphogenetic proteins), which are osteogenic proteins that form part of the TGF-beta family and are implicated in cell differentiation, tissue morphogenesis, regeneration and repair. Studies have shown that recombinant human BMP-2, BMP-4, and osteogenic protein 1 (OP-1) induce differentiation of adult pulp cells into odontoblasts and cause hard tissue formation when placed on exposed dental pulps in various animal studies. Commercially available recombinant human BMPs may be useful for experimentation and clinical trials of reparative dentinogenesis. The document also discusses the anatomy of root canals in primary teeth and guidelines for proper access preparation during endodontic procedures.
endodontic surgery and its current concepts boris saha
This document provides an overview of endodontic surgery and its concepts. It discusses the history and evolution of endodontic surgery techniques. It also covers indications for endodontic surgery, classifications of different surgical procedures, and considerations for pre-surgical treatment planning. Key surgical steps like flap design, osteotomy, and root-end resection are summarized.
Conse iv script-10-procedural-accidents-in-endodonticsTalal Al-Dham
This document discusses procedural accidents that can occur during endodontic treatment, including definitions, classifications, causes, prevention, and treatment. Some key accidents covered include access cavity perforations, ledge formation, artificial canal creation, root perforations, separated instruments, and irrigant extrusion. The importance of gaining proper straight line access is emphasized to help prevent many procedural errors. Treatment depends on the specific accident but may involve repair with materials like MTA, bypassing the area, or sometimes surgical intervention. Prognosis varies by case and factors like size, location and timing of the accident. Vigilance, proper technique, and knowledge of tooth anatomy are stressed to minimize endodontic mishaps.
The document discusses guidelines for preparing an access cavity for endodontic treatment. It describes the importance of the access cavity in allowing visualization and access to all root canals. Key steps in access preparation include complete removal of the pulp chamber roof, removal of dentinal shoulders, and preparation of cavity walls to allow straight-line access to the canals without obstruction. Examples of access cavity designs are provided for different types of teeth, focusing on locating canal orifices and achieving optimal access. The document emphasizes that a properly designed access cavity is essential for successful root canal treatment.
This document discusses special anatomic problems that can occur during canal cleaning and shaping, including curved canals, calcified canals, C-shaped canals, and S-shaped canals. It provides guidelines for managing each type of anatomic problem, such as using smaller files, pre-curving files, changing filing techniques, copious irrigation, and adjusting filing forces. Managing complex canal anatomies requires modified cleaning and shaping approaches to complete the endodontic procedure successfully.
In this presentation, we will see the different mishaps or errors that we can encounter during endodontic procedure and what can be the various treatment options for them.
This document provides information on the surgical procedure of apicoectomy. It begins by defining apicoectomy as the surgical resection and removal of the root tip along with pathological tissues. It then lists indications for the procedure such as teeth with active periapical inflammation despite satisfactory endodontic therapy. The document describes the surgical technique which includes flap design, exposing the apex, resection of the apex, and potentially retrograde filling. It provides details on instruments used and cautions to take such as ensuring the resection is at a right angle to reduce apical leakage.
Seminar on the topic of Access cavity preparation presented by Dr Aswin S, Jr Resident , Dept of Conservative dentistry and Endodontics. The fundamental aim of root canal treatment is to remove bacteria and to treat apical periodontitis using biomechanical preparation, infection control and complete obturation of the root canal system. In order to be able to effectively carry out any of the above technical stages, adequate access to the root canal system is required. As the key technical phase governing the success/ease of the subsequent treatment stages, it is of paramount importance. A poorly executed access cavity will compromise the remaining technical stages and result in an increased risk of procedural errors or failure to carry out a satisfactory treatment.
MAZEN DOUMANI Access cavity and morphologymazen doumani
This document discusses tooth morphology and root canal anatomy. It describes the components of the root canal system and various pulp canal configurations that can occur. It provides guidelines for access cavity preparation, including objectives, evaluation of tooth anatomy, use of magnification and burs, orifice location and flaring. Morphology and specific preparation techniques are outlined for individual tooth types from anterior to posterior in both arches. Care must be taken during access preparation to locate all canals and avoid perforations.
The document discusses methods for determining the working length in root canal treatment. It defines working length as the distance from a coronal reference point to the point where canal preparation and obturation should terminate. The key methods discussed are the radiographic method, using an electronic apex locator, and non-radiographic methods. Ingle's radiographic technique is described as the recommended method, which uses a preoperative radiograph and subtracts 1mm from the estimated working length to the radiographic apex. Terminating instrumentation between 0.5-1mm from the radiographic apex is advocated.
The document discusses the anatomy of root canals and classifications of root canal morphologies. It introduces several past classification systems from Weine, Vertucci, and others. However, it notes that these systems are unable to categorize all the diversity seen in root canal configurations based on more recent anatomical studies using micro-CT technology. A new simplified classification system is needed that can be adopted universally to better describe the complex variations in root and root canal anatomy.
This document discusses the complex anatomy of teeth, with a focus on the anatomy of the root apex. It provides background on early classification systems for tooth anatomy and describes various anatomical features of the root apex, including the apical constriction, apical foramen, types of apical constrictions, root apex shapes, canal morphologies, and root canal classifications. Understanding the detailed anatomy and variations of the root apex is important for effective endodontic treatment and procedures.
The department of Conservative Dentistry ^0 Endodontics👻 (2).pptxNavendusingh7
The document discusses guidelines for access cavity preparation in endodontics. It defines access cavity preparation as coronal preparation that provides unobstructed access to canal orifices and straight line access to the apex. It outlines principles of conservation of tooth structure, prevention of perforations, and maximum visibility. It describes factors that determine the outline form such as pulp chamber size, shape, and number/direction of canals. Common tools used for access cavity preparation are also listed. The document provides detailed descriptions of accessing different types of teeth based on their anatomy. It emphasizes removal of caries and defective restorations to eliminate bacteria and possibility of coronal leakage. Overall, the document provides a comprehensive overview of guidelines and procedures for access
This document provides an overview of access cavity preparation in endodontics. It discusses objectives of access cavity preparation including removing caries and pulp tissue while conserving tooth structure. Principles of access cavity preparation including penetration, enlargement, and finishing phases are outlined. Challenging access preparations involving teeth with minimal crowns, heavily restored teeth, and calcified canals are described. The importance of radiographs and different access designs are also reviewed. Newer concepts and techniques in access cavity preparation such as conservative access cavities and guided/navigated access are introduced.
Opportunity for Dentists (BDS/MDS )to relocate to United kingdom -Register as a DENTAL HYGIENIST/ DENTAL THERAPIST without Board exams and after approval you can register in GDC as a DH/DT and start working as a DH/DT Immediately and get paid.
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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This document discusses dental occlusion concepts and philosophies for complete dentures. It introduces key terms like physiologic occlusion and defines different occlusion schemes like balanced articulation and monoplane articulation. The document discusses advantages and disadvantages of using anatomic versus non-anatomic teeth for complete dentures. It also outlines requirements for maintaining denture stability, such as balanced occlusal contacts and control of horizontal forces. The goal of occlusion for complete dentures is to re-establish the homeostasis of the masticatory system disrupted by edentulism.
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This document discusses dental casting investment materials. It describes the three main types of investments - gypsum bonded, phosphate bonded, and ethyl silicate bonded investments. For gypsum bonded investments specifically, it details their classification, composition including the roles of gypsum, silica, and modifiers, setting time, normal and hygroscopic setting expansion, and thermal expansion. It provides information on how the properties of gypsum bonded investments are affected by their composition. The document serves as a comprehensive overview of dental casting investment materials.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
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GASTROINTESTINAL INFECTIONS AND GASTRITIS
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Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
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Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
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“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
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chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
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Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7
Access cavity prepn.
1. Access Cavity Preparation & Working Length
Determination
INTRODUCTION
Most of the endodontic literature published, specially the text books
have a tendency to concentrate or rather emphasize on the preparation of access
cavities in teeth with ideal anatomic crowns and root canal systems. It is
however, equally important for the clinician to be well versed with the practical
world of the canal morphologies and their complexities that exist.
Right from the early work of HESS to the recent studies which
demonstrate the anatomic complexities of the root canal system, it has been
shown that a root with gracefully tapering canal and a single apical foramen is
more of an exception rather than a rule. Investigators have shown multiple
foramina, deltas, accessory canals etc. in most of the teeth.
The success of root canal therapy, thus has been equally attributed to a
careful access cavity preparation as much as to the obturation. As Ingle rightly
states, the apical–moisture–proof seal, which is so very essential for the success
of non – surgical endodontic therapy is not possible unless the space to be filled
is carefully prepared to receive the restoration.
If mentioned as in relation to Operative Dentistry “The final restoration
is rarely better than the initial cavity preparation”.
1
2. Divisions of Cavity Preparation
For sake of descriptive convenience Ingle has divided endodontic cavity
preparation into
A. Coronal Preparation
2. Radicular Preparation
Principles of Endodontic Cavity Preparation
Any discussion of cavity preparation must ultimately revert back to the
basic principles of cavity preparation established by Dr. G.V. Black.
- By slightly altering these principles, a list of principles of Endodontic cavity
preparation is established. Thus as the preparation of coronal and radicular
portions was divided, similarly the principles, therefore we have :
Endodontic Coronal Cavity Preparation: - Principles
I. Outline Form
II. Convenience Form
III.Removal of Remaining Carious Dentin (and defective restoration)
IV.Toilet of the Cavity
I. Outline Form
In order to obtain complete access for instrumentation from the cavity
margins to the apical foramen the outline form of the endodontic cavity must
be correctly shaped and positioned. Moreso, the external outline form evolves
from the internal anatomy of the tooth established by the pulp. Due these
2
3. internal external relationships endodontic preparations are through necessity
done in a reverse manner i.e. from the inside of a tooth to the outside.
Thus to achieve an optional preparation with an ideal outline form, three
factors of internal anatomy must be considered.
i. The size of the pulp chamber
ii. Shape of the pulp chamber
iii. Number of individual root canals, their curvature and their
position.
i. Size of the pulp chamber in young patients the endodontic cavity
preparation is surely more extensive than in an older patient in whom the
pulp has receded and the chamber is small in all 3 dimensions.
ii. Shape of the pulp chamber for an ideal outline form, the finished outline
form should accurately reflect the shape of the pulp chamber. Eg., floor of
pulp chamber in molars is triangular.
iii. Number, position and curvature of root canals : As far as the outline form is
concerned. In order to accommodate extra canals (when present) into the
prepared cavity and to instrument each canal efficiently without
interference, the cavity walls have to be extended to allow an unstrained
instrument approach to the apical foramen. This could be regarded as a
change for convenience in preparation.Thus we could say that the
convenience form partly regulates the outline form.
3
4. II. Convenience Form:
- In operative dentistry the term convenience form was concieved by G.V.
Black as a modification of the cavity outline form to establish greater
convenience in the placement of intra coronal restorations. In endodontic
therapy however, convenience form makes more convenient (and accurate)
the preparation as well as filling of the root canal.
- Four important advantages / benefits are gained through this convenience
form :
i. Unobstructed access to canal orifice
ii. Direct access to apical foramen
iii. Cavity expansion to accommodate various filling techniques
iv. Complete authority even enlarging instrument
Thus it must remembered that a failure to properly modified the access
cavity outline by extending the convenience form will ultimately lead to failure
by either root perforation, “ledge” or “shelf” formation within the canal,
instrument breakage or the incorrect shape of the completed canal preparation
often as “zipping” or “apical transportation”.
III. Removal of Remaining Carious Dentin:
This, according to Ingle must be done for 3 reasons viz.
a. To eliminate mechanically as many bacteria as possible from the interior of
the tooth
4
5. b. To eliminate discolored tooth structure with may eventually cause staining
of the crown
c. To eliminate any possible bacteria laden saliva leaking into the prepared
cavity
- While performing this step if a perforation results, sealing the perforation
with a cement / adhesive composite from inside the cavity, preferably has
been stated.
- Another thought expressed by Ingle is that during removal of the defective
restoration or common teeth structure if the tooth is sufficiently weakened
and access cavity exposed to salivary contamination, restoration of the
missing walls could be postponed until completion of the radicular cavity
preparation, as this would allow greater access for instrumentation. The
cavity should however be isolated with proper radicular placement.
IV.Toilet of the Cavity:
This pertains to the removal of all of the caries, debris and necrotic
material from the chamber before the preparation is begun.
- Calcified or metallic debris carried into the canal may act as obstruction
during the canal enlargement. On the other hand, soft debris carried in from
the chamber would increase bacterial population in the canal. Thus is it
imperative to removal all debris.
- Instruments used for this purpose include, a slow speed round bur, long
blade endodontic spoon excavator and of course another good method is
copious irrigation with Sodium hypochlorite.
5
6. Access Cavity Preparation – For Individual Teeth.
For sake of simplicity we have grouped the teeth for access opening as
follows:
a. Maxillary anterior. Teeth d. Mandibular anterior
b. Maxillary Pre-molars e. Mandibular Pre-molars
c. Maxillary molars f. Mandibular molars
In addition we would be dealing with access openings along with the
following subheadings viz:
1. Average tooth length
2. Pulp chamber & Root Canal anatomies
3. Anatomic relations in situ
4. Access openings
5. Errors / Complecations
Access cavity preparation for maxillary anterior teeth:
General features: (for all anterior maxillary teeth)
1. The entrance is always made through the lingual surface in the middle 1/3
region.
2. Initial entrance / penetration is made with a round ended tapered fissure bur.
Only enamel is penetrated. The bur should not be forced but allowed to cut
it’s own way, because if it is forced it will act as a wedge and causes
enamel to “check” or “craze” and would therefore weaken the tooth.
6
7. 3. Along with initial penetration, comes the convenience extension where the
same bur with it’s tip in the middle is turned incisally so that the bur
parallels the long axis of the tooth and the enamel and dentin are beveled
incisally.
4. So the preliminary outline form which is triangular is ready with a short
incisal bevel and then the dentin “nest” which would receive the no. 2 or 4
round bur to penetrate into the pulp chamber.
5. Slow speed, contra-angle no. 2 or 4 round bur then used to penetrate into
the pulp chamber.
- High speed instruments, according to Ingle, must be avoided due to a
lack of tactile sensation with these.
6. Once penetrated, the round bur should be worked from inside to outside to
remove the lingual and labial walls of the pulp chamber.
7. Then a surgical length bur or a long tapering diamond point (accessory to
Ingle) or Gates Glidden drills (of size 4 usually) are used to eliminate the
lingual shoulder.
8. The no. 1 or 2 round bur maybe used laterally and incisally to eliminate
pulpal horn debris and bacteria. This step aids in preventing future
discoloration.
9. So the final preparation we have is mostly a triangular shaped opening,
which funnels down to the canal orifice.
7
8. A short note on:
Location of canal orifices (Messing & Stock)
Sometimes it is difficult to locate a canal orifice in the pulp chamber
floor, particularly in the posteriors. Therefore, for one, a thorough knowledge
of the number of canals likely to be present and their location is essential.
Usually, a good pre-operative radiograph or two from different angles is useful.
Other methods used to locate canals include :
a. a good access opening which allows a complete view of the pulp
chamber and the canal orifices.
b. (DG 16) canal explorer
c. Binocular loops – with a magnification of X2. These could be fitted
onto spectacles.
d. For the posteriors, one canal maybe located but it is not possible to
decide which one. Then an instrument is placed in the canal and
radiograph taken. Identification is made using the buccal object rule.
e. Transillumination of the tooth using a fiber optic, keeping the light at
a gingival level may reveal position of the canal orifices.
f. Dyes such as iodine maybe used which show the canal orifice as a
darker area.
g. As a last resort a bur maybe used.
8
9. - A hole 2mm deep is cut where the canal orifice is expected and parallel to
the long axis of the tooth. If the canal is not located then the bur should be
removed from the handpiece placed in the prepared hole and retained by
soft wax. A pencil line is drawn on the buccal surface of the tooth and a
radiograph taken. A, 2-D picture is obtained with helps to provide correct
allignment of the bur. Then further penetration into the root maybe carried
out.
I. Access cavity preparation for maxillary central incisor:
Before going in to the detail of the access opening, a short update on the
tooth anatomy and it’s relations are necessary.
A. Average tooth length 21. 8mm.
B. Pulp chamber - located in the centre of the crown
- broad mesio – distally
- broadest - incisally
- has 3 pulp horns – with correspond to the developmental
mamelons in a young tooth.
3. Root and Root canal –
- Single rooted
- Root canal – broad labio-lingually
- Ovoid in cross - section mesio – distally
- Conical in shape
- Statistics reveal that majority of roots are straight (75%), some curve
distally (8%), mesially (4%) palatally (4%) or labially (9%).
9
10. 4. anatomic relations in situ:
Labially – labial cortical plate maybe fused with the root, because of this
proximity fenestration’s and dehiscence maybe present and also abscesses may
perforate the cortical plates.
- Apex of the tooth is in relation with the floor of the nasal fossa.
E. Access opening:
- Is similar as mentioned before in general features.
- To summarize:
- Initial penetration – 2 schools of thought Grossman prefers a no. 4 round
bur with high speed and coolant, while Ingle suggests a round ended
tapering bur.
- Enamel is penetrated the middle 1/3 of lingual surface
- Then “drop” into chamber with a slow speed no. 4 carbide bur.
- Remove all debris
- Remove lingual shoulder using gates gladden drill, working inside out with
light strokes.
- Lingual shoulder is not an anatomic entity but a prominence of dentin
created when the lingual roof is removed.
- Therefore on removal of this shoulder and lingual root one gains direct
access to the apical area of the root canal.
10
11. - Thus the access cavity prepared in the maxillary central has a angular
shape, with it’s apex towards the cervical zone.
II. Access cavity preparation for maxillary lateral incisor:
A. Average tooth length – 23.1mm
B. Pulp chamber – similar to central
– has only two pulp hours
C. Root and Root canal – conical in shape
– has a finer diameter
– lateral canals are frequent (26%)
- Majority of the roots curve distally, and therefore the root tips maybe in the
centre of the cancellous bone pointing distally, thus giving an indication
why abscesses arising from the laterals usually drain palatally.
C. Access opening – similar to central, but is smaller and more ovoid in
shape.
- Technique for entry is same except that a smaller i.e. a no. 2 round bur may
be used instead of no. 4 as for central.
- Access cavity preparation in maxillary lateral need to be modified in certain
case such as in anomalies such as dens invaginatus, peg laterals and talon
cusps.
III. Access Cavity Preparation for Maxillary canines:
A. Average tooth length – 26mm
B. Pulp chamber – Largest amongst single rooted teeth
11
12. - Triangular labiolingually
- Flame shaped – mesio – distally
- Only one pulp horn present
C. Root canal – oval in shape, wider in labio palatal direction
D. Anatomic relations in situ – the canine root often called as the “canine
pillar” is positioned in the cancellous portion of the maxilla between the
nasal cavity and maxillary sinus.
- Because of it’s great size it causes the most prominent bulge in the maxilla
called alveolar or canine eminence.
- Abscesses from the maxillary canine usually perforate the labial cortical
plates below the insertion of the levator muscles of the upper lip and drains
into the buccal vestibule. (If perforation is below this insertion the abscess
drains into the canine pace and causes cellulitis).
E. Access Opening:
- Shape of the opening is ovoid, as dictated by the pulp chamber anatomy.
Maxillary Anterior Teeth: Errors in Cavity Preparation
1. Perforation – usually at the labratervical level caused by failure to complete
convenience extension at the incisal.
2. Gouging – of labial and distal walls due to failure to recognize 29° lingual
and 16° mesial inclination of teeth respectively.
12
13. 3. Pear Shaped preparation - due to failure to provide convenience extensions
– causes inadequate debridement and obturation – thus leads to failure.
4. Discoloration – of crown caused by a failure to remove pulpal debris
5. Ledge Formation and Perforation – caused by a very small cavity
preparation and thus reduced access in apically curved canals.
Access Cavity Preparation for Mandibular Anterior Teeth
General Features:
The basic principles followed in access preparation in mandibular
anterior are similar to those of maxillary anterior teeth. They are as follows:
1. The entrance / initial penetration is always begun at the middle 1/3 zone. A
common error here is to begin far too gingivally.
2. Initial penetration – of enamel only – is done with high speed tapered
fissure bur (701 U) with an air water coolant. Do not force the bur.
3. Convenience extension towards incisal continuous with the initial
penetration. Maintain point of bur in central cavity and rotate handpiece
towards incisal and mesio distal so that bur parallels long axis of the tooth.
Enamel and dentin are beveled toward incisal.
4. The preliminary cavity outline is thus formed with is roughly triangular in
shape with apex cervically.
5. Then penetrate into pulp chamber with slow speed no. 2 round bur.
13
14. 6. Once into the chamber, working from inside chamber to outside suing the
round bur remove lingual and labial walls of pulp chamber.
7. Then use a long surgical bur or Gates Glidden drill (No. 2) to remove the
lingual shoulder.
8. Occasionally a no.1 round bur maybe used laterally and incisally to
eliminate pulpal horn bebris and bacteria. This also prevents future
discoloration.
9. Final preparation shows a angular preparation which funnels down to the
orifice of the canal.
Mandibular central Incisor
1. Average tooth length 20.8 mm.
2. Pulp chamber smallest in the arch.
pulp chamber is flat mesio-distally, ovoid labio-
lingually
has 3 pulp horns when recently erupted which calcify
and disappear early because of constant masticatory stress.
3. Root and Root canal – flat – mesio - distally
– wide – labio – lingually
14
15. – has a ribbon – shaped configuration in middle 1/3
where bifurcation usually occur and perforates usually
can occur here.
4. Access Opening – same as mentioned with greatest dimension oriented
incisogingivally.
Mandibular Lateral Incisor
Average Tooth Length – 22.6
Pulp chamber same, but lateral tooth has larger dimensions
Anatomic relation maybe fused to labial cortical plate
Access same as central
Mandibular canine
Average tooth length – 25mm
Pulp chamber more wide labiolingually
single cusp
Anatomic Relation same as mandibular incisors
Opening same as maxillary cuspid with anatomy variations.
Access Cavity Preparation in Maxillary Premolars
General features:
1. As we know entrance to the pulp chamber in all posterior teeth always
gained to the occlusal surface for the pre-molars the initial
access/penetration is made II’l to the long axis of the tooth in exactly the
15
16. centre of the central groove. For this the 701U tapered fissure bur with high
speed and air-water coolant is recommended for use. This initial penetration
must be restricted to only the enamel surface.
2. Further penetration then into the pulp chamber is done using a slow speed
round bur until the characteristic “drop” of the bur is felt.
As Ingle states, if the chamber happens to be calcified and the drop is
not felt then the vertical penetration is made until the contrangle rests against
the occlusal surface. This depth is approx 9mm, the position of the floor of the
pulp chamber that lies at the cervical level.
Then while removing the bur the orifice is widened – buccolingually to
twice the width of the bur to allow exploration of the canals orifices.
3. The endodontic explorer can be used to locate the canal orifices.
4. Following this, the no. 2 or 4 round bur is used at low speed, working from
inside the pulp chamber to outside, to extent the cavity bucco-lingually by
removing the roof of the pulp chamber.
5. Then the bucco-lingual extension and final finishing of the access cavity is
accomplished using the 701U fissure bur at high speed.
6. The final bucco-lingual ovoid preparation reflects the anatomy of the pulp
chamber and position of buccal and lingual orifices.
Maxillary 1st
Pre Molar
Average tooth length – 21.5mm
16
17. Pulp chamber – narrow – mesio – distally
Wide – bucco- palatally
– 1 pulp horn under each cusp
– Roof of the pulp chamber is coronal to cervical line
– Floor of pulp chamber is usually convex lies deep in
the coronal third of the root below the cervical line.
3. Roots and Root canals –
– usually has 2 roots
– when roots are fused, a groove running in an occluso-
apical direction divides the root into buccal and palatal
portions.
- The palatal canal is generally the larger of the two and is directly under the
palatal cusp and it’s orifice can be traced by following palatal wall of the
pulp chamber
- The buccal canal is directly under the buccal cusp and it’s orifice can be
penetrated by following the buccal wall of the pulp chamber.
4.Anatomic relation – the maxillary first premolar lies below the maxillary
sinus and is separated from it by a thin layer of spongy and compact bone.
5. Access opening – additional points are to be noted are:
17
18. a) The walls of the access cavity are smoothened and sloped slightly
towards the occlusal surface. This occlusal divergence creates a positive
seat for the temp filling.
b) The borders of this ovoid access cavity should not extend beyond half
the lingual incline of the facial cusp and half the facial incline of the
palatal cusp.
The access cavity preparation for endodontic treatment of a premolar
differs from Black’s cavity preparation for an occlusal restoration (Class I). In
Black’s preparation the ovoid shape runs mesiodistally and ecompasses all pits
and fissures whereas endodontic preparation runs ovoid in a bucco-lingual
direction and permits direct access to the root canal.
Maxillary 2nd
premolar
Average tooth length – 21.6mm
Pulp chamber – similar to 1st
premolar, may have single orifice, but with 2 pulp
horns.
Root and Root canals – Usually single rooted (90.3%)
- (Grossman) roots maybe straight (37.4%), distal curve (33.9%) buccal
curve (15.6%), ‘S’ or bayonet curve (13%).
- Canals are usually ovoid in bucco-lingual direction
Anatomic Relation: roots are closer to the max sinus.
18
19. - The sinus may dip down and surround the tip of the root or roots forming
prominences in the sinus floor.
- The roots and sinus maybe separated by a thin layer of bone, or bone maybe
totally absent thus leaving only the periodontal membrane and the
schneiderian membrane of the sinus.
Access Opening – Same as Ist
Premolar
Errors in Cavity Preparation in Maxillary premolars (Ingle).
1. Under extended preparation – exposing only pulp horns
2. Overextended preparation – undermining of enamel walls while searching
for a receded pulp.
3. Perforation – when distoaxial inclination of tooth (10°) is neglected by
clinician.
4. Broken Instruments – seen when internal cavity preparation has not
completely exposed orifices.
Access Cavity Preparation for Mandibular P.M.
General features:
1. As in all posterior – initial penetration is performed through the occlusal
surface, more precisely at the centre of the central groove.
- This is done using a high speed, air-water coolant assisted no. 702U taper
fissure bur.
19
20. - At this juncture only the enamel is penetrated.
2. Once the enamel thickness has been penetrated a slow speed, no. 4 round
bur is used then to open the pulp chamber. If chamber is calcified
penetration is continued till contrangle rests on the occlusal surface.
Then while removing the bur, the occlusal opening is widened buccolingual
to twice width of the bur to allow room for exploration location of the
orifices. The cavity should be cut more on the buccal than on the lingual
cusps.
3. Using the endodontic explorer locate the canal(s).
4. Remove the roof of the chamber with the no. 2 or 4 round bur, working
inside out.
5. Finish the buccolingual extension and cavity walls with the 702U fissure
bur.
6. The finished bucco lingual ovoid outline reflects anatomy of the pulp
chamber and position of the centrally located canal.
Mandibular 1st
Pre Molar
1. Average Tooth Length – 21.9mm
2. Pulp chamber – The mandibular first premolar is the transitional tooth
between anterior and posterior teeth, and in anatomic structure resembles
both.
20
21. - It has a prominent buccal pulp horn.
- The prominent buccal cusp and smaller lingual cusp give the crown a
30° lingual tilt.
3. Root and Root canal – usually single rooted with a single canal which is
cone shaped and simple in outline. Narrow mesiodstally and broad
buccolingually.
4. Anatomic Relation – closely related to alveolar plates and sometimes also
to mental canal and foramen with maybe misdiagnosed for a peri apical
pathosis.
5. Access Opening – in addition to mentioned :
- To compensate for the 30° lingual tilt and to prevent perforations the
enamel is penetrated at the upper 1/3 of the lingual incline of the facial
cusp.
Mandibular 2nd
Pre Molar
Average tooth length – 22.3mm
Pulp chamber – lingual horn more prominent.
Roots and Root canal – usually single rooted
– greater overall girth of root canal
Anatomic relation – closer to mental foramen
Access Opening – ovoid opening is widen mesio-distally to the
wider pulp chamber.
21
22. Access cavity preparation for Maxillary Molar Teeth:
General Features:
1. As in all postures, the entrance to the pulp chamber is always gained
through the occlusal surface.
- The initial penetration is made at the exact centre of the mesial pit with the
bur directed slightly in a lingual direction .
- For this step, according to Ingle a high speed contrangle the 702 U tapering
fissure bur with a rounded end is ideal for penetrating enamel uptil the
dentin or even perforating cast gold restorations.
- Amalgam restorations maybe penetrated with a no. 4 or 6 round bur.
2. Once the enamel is penetrated, the no. 4 round bur is used to open up the
pulp chamber important to remember here is that the bur should be directed
towards the orifice of the palatal or mesiobuccal canal orifice, where the
greatest space in the chamber exists.
- The chamber “drop” is felt when a proper chamber exists or else if calcified
penetrate till c. angle restoration occlusal surface.
3. Then work the round bur inside out to remove roof of the pulp chamber and
allow location of orifices with endodontic explorer.
22
23. The canals usually are 3 viz: mesiobuccal, distobuccal and palatal.
Occassionally a fourth canal i.e. a second mesiobuccal canal maybe present in
the maxillary 1st
molars.
4. Once canals are well located, use the round bur working inside out again to
remove remaining roof (if any)
- The amount of extension required in the access cavity can be guessed
by the tension of the endodontic explorer against the walls of the
endodontic cavity prepared.
5. The final finish and funneling of the cavity is then completed using the 702
U fissure bur or tapered diamond points at accelerated speed.
6. The final outline form is angular in shape with the base of the angle directed
buccally.
Maxillary 1st
Molar:
Average Tooth Length: 21.3mm
Pulp chamber - largest in the dental arch
- 4 pulp horns – mesiobuccal, distobuccal mesiopalatal,
distopalatal.
- Therefore pulpal roof has a rhomboidal appearance
- However floor is angular in shape with apex at the
palatal orifice.
- Anatomic dark lines, mentioned in Orbans as the
“Dentinal Map” connect the orifices.
23
24. - The palatal orifice is the longest, round or oval and
easily accessible.
MB - Mesiobuccal - The MB orifice lies below the MB cusp, is long bucco-
palatally and may have a depression at the palatal end
where 4th
orifice i.e. second MB orifice maybe present.
- The distobuccal orifice is located slightly distal and
palatal to the MB orifice.
Root and Root Canals
- 3 roots – 3 canals – mesiobuccal mesiolingual Palatal
Mesiobuccal root - is broad in a bucco-lingual direction
- usually MB roots have a distal curve but may also be
straight or ‘S’ (bayonet) shaped.
- Lateral canals (1%) or two separate canals (14%)
maybe present.
Distobuccal root - Small and more less round in shape
- Usually straight (54%) but maybe distally curved or S
– shaped.
- Single canal, lateral canals are occasionally present
(36%) i.e. more than MB root.
Palatal Root - Largest diameter
- Longest of the 3
24
25. - May sometimes curve buccally in the apical zone –
important to pre-curve instruction or else would lead to
perforation.
Lateral canals are present not only in roots (45%) but may also be in the
trifurcation areas (18%).
Anatomic Relations of maxillary 1st
molar
- Lies under the maxillary sinus
- So the alveolar socket may protrude into the sinus thus a bony prominence
maybe produced in the sinus.
- The roots maybe separated from the sinus by a periodontal ligament and
mucopenosteal lining of the sinus.
- This close relation thus produces soreness in maxillary posteriors due to
sinusitis or infection of sinus due to pulpitis.
The divergence of the roots may :
1. Permit sinus to drop into trifurcation
2. Place root surfaces in close proximity to conrtical plates and palatal
root close to lateral area of the nasal floor.
Access Opening:
25
26. - The access opening as I’ve mentioned is angular with the round corners
extending towards, but not including the mesiobuccal cusp tip, marginal
ridge and oblique ridge.
- The angular permits direct access to the root canal orifices.
- Loose debris during the mentioned preparation can be removed with 5.25%
NaOCl.
Maxillary Second Molar:
1. Average Tooth Length – 21.7mm
2. Pulp Chamber - similar to first molar but
a. Narrower mesiodistally
b. Roof is more rhomboidal in appearance
c. Floor is obtuse L’ed angle
d. MB & DB canal orifices are very close and may appear
to have a common opening.
3. Root and Root Canals – 3 roots – closely grouped, maybe fused to form a
single conical root (46%)
4. Anatomic relations - More close to maxillary sinus than 1st
molar
5. Access opening - Same as for maxillary first molar with variations
as anatomy dictates.
Errors in Access Preparation for maxillary molars.
26
27. 1. Under extension – Only pulp horns are exposed
2. Over extension – gouging and weakening of tooth
3. Perforation – in function – by failing to realise depth of pulp chamber had
been reached.
4. Inadequate preparation – by not understanding the inclination of the tooth
(specially unopposed teeth)
Access Cavity preparation for Mandibular Molars.
Same as for maxillary molars.
5. When penetrating into pulp chamber with a no. 4 or 6 round bur, bur should
be directed towards orifice of mandibular or distal canal.
6. Final cavity is triangular or trapezoidal or rectangular in shape with base
directed mesially.
Mandibular 1st
Molar:
Average Tooth Length : 21.9mm
Pulp chamber : Has 4 pulp horns – mesiobuccal, mesiolingual,
distobuccal, distolingual.
: Roof is often rectangular in shape
: Floor is rhomboidal
: 3 orifices – MB. ML. Distal
MB orifice – Is under the mesiobuccal cusp tip
27
28. - (Grossman advocates use of Starlite D-11 explorer to locate
MB orifice.
ML orifice - Located in a depression formed by the mesial and lingual walls
Distal orifice - Widest buccolingually, oval in shape
- additional distal orifices maybe present
Anatomic Relation in situ
- Mesial root is in close proximity to buccal cortical plate while distal is
centrally located.
- Apex of roots maybe close to mandibular canal depending on length of
roots and height and body of mandible.
Access opening for mandibular 1st
molar:
- In additional to the mentioned features, the access opening should extend
towards the mesiobuccal cusp to expose the MB orifice, lingually slightly
beyond the centrol groove and distally slightly beyond the buccal groove.
Mandibular 2nd
Molar
Average Tooth Length – 22.4mm
Pulp chamber – Came as first molar but smaller in size and root canal orifices
are smaller and closer.
Relation in sites – same as 1st
molar except that mesial root is centrally located
and distal root is close to lingual cortical plate.
28
29. - May be more closer to mandibular canal.
Access Opening – same as mandibular first molar but smaller, greater amount
of MB cusp may have to be removed because of bucco-axial inclination of
tooth and thus access to MB canal.
Working Length Determination
Successful root canal treatment has been stated to be the performance of
a meticulous art.
If clinicians are to provide endodontic therapeutic procedures with a
high degree of success they must possess a complete understanding of the basic
principles of endodontics which include
1. Knowledge of internal anatomy of teeth and
2. Mechanisms of determining the tooth length and working length of root
canals.
The important of correct working length determination lies in the facts
that, an inaccurately determined root canal length may either lead to
I. Apical perforation and overfilling of the root canal with increased
incidence of post operative pain.
II. Incomplete instrumentation and under filling with subsequent
problems, among which notable would be persistent pain and
discomfort from inflamed shreds of retained pulp tissues.
29
30. - Thus to determine the precise working lengths many methods have been
proposed over the years.
- But lets first take a look at the requirements of these methods as stated by
Ingle : These are :
1. Method must be accurate
2. Should be easily and readily performed and
3. Easily confused.
Methods –
Many methods have been proposed to determine the working length of
root canals and also the length of teeth.
I. Grossman’s Method
- An instrument is placed into the canal extending to the apical construction
(as act by tactile sensation) and then a radiograph is taken
- A stopper is also placed at the incisal / occlusal margin to help know the
actual instruction length.
- The radiographic lengths of both the tooth and instrument are then
measured and also is the actual length of the instruments
- The actual length of the tooth is then measured using the mathematical
formula
Actual Length = Actual length Radiographic length
Of tooth of instrument of tooth
30
31. Radiographic length of instrment
II. Ingle’s Method
1. Measure the tooth on the pre-operative radiograph.
2. Substract at least 1.0mm for “safety allowance” such as for image distortion
or magnification.
3. Set the endo scale at this tentative W.L. and adjust the stop on the
instrument at that level.
4. Then place the instrument in the canal until the stop reaches point of
reference.
5. Expose and develop the radiograph.
6. On the radiograph measure the difference between end of the instrument
and end of the root (add or substract) this amount to the original measured
length.
7. Finally from this adjusted length subtract 1.0mm “safety factor” to confirm
the apical termination of the root canal at the C.D.J.
Coming now to a chronological order of how generally methods to this
day were developed or determination of the wave length :
31
32. 1. 1950 – Bregmen used 25mm length feat probes with steel blades fixed with
acrylic resins as a stop leaving a free 10mm for placement into the canal.
This probe is placed into the tooth until the metabolic end touches the
reference plane. The radiograph is then taken and following measured :
CAD - Apparent tooth length (as seen in the radiograph)
CRI - Real instrument length.
CAI - Apparent instrument length.
CRD - Real tooth length is measured using the formula.
CRD = CRI X CAD
CAI
2. 1960 – Best – determined the tooth length by fixing a steel pin – 10mm
long to the labial surface of a tooth with utility wax keeping the pin parallel
to the long axis of the tooth and a radiograph is obtained.
- This radiographs is then carried to a (BW) gauge which would indicate the
tooth length.
- Ortho wires also used
3. 1963 – Everett and Finot – designed a diagnostic X-ray grid system for
determine tooth length.
- This diagnostic x-ray grid system consists of lines 1mm apart running
lengthwise and crosswise.
- Every 5th
mm has a heavier line for easier reading.
32
33. - Actually, enamelled copper-wires were placed in a plexiglass and fixed to
the regular p.a. film. The grid has been of use to accurately determined
tooth length.
Coming next to recent advances :
1. Xeroradiography :
The new-radiography technique has potential use in endodontics.
The word Xeros is from a greek word meaning dry which differentiates
– Xeroradiography from the conventional photochem system in that it does not
need wet chemical processing or a dark room.
- Xeroradiography uses a rigid aluminium photoreception plate. This plate is
electrically charged, placed in a light proof plastic cassette positioned in the
mouth and exposed to x-rays.
- When exposed to x-rays, the charge on the photoreceptor is dissipated
according to the tissue density and a latent electrostatic image is formed.
- This latent image is transformed to a visible image by the deposition of
specially pigmented particles attracted to the photoreceptor plate.
- This Xeroradiography may be viewed by either reflected or transilluminated
light.
- It has a property of edge enhancement and endodontic studies concluded
that Xeroradiography provided better visualization of metallic instruments
tips and root apices allowing a more accurate length measurement.
33
34. - The radiation levels for Xeroradiography are also much lesser.
- Therefore it is valuable addition to the endodontists armamentarium.
Further developments in working length measurements led to develop of
some non-radiographic methods.
1982-Negm – Introduced a novel non-radiographic method
- The new instrument (Apex finder) is used to locate the apex as well as
measure the root length.
- The method is based on the insertion of a plastic fine tapered barb shaft
through a bevelled tube into the root canal.
- When resistance to withdrawal is felt with indicates that some barbs have
engaged the apical margin.
Electrical Root Length Determination:
- Was begun as early as 1962 when it was first demonstrated by Sunada.
- Sunada has found the resistance to passage of an electric current, when an
instrument introduced into the root canal, reaches the apical foramen to be
40 M.A.
- In this one electrode is attached to the patients cheek and the other gently
introduced into the root canal until the micro-ammeter indicates 40MA.
This length corresponds to the tooth length.
34
35. Sunada’s ideal was the followed by Inove and Saito and then these
systems were marketed :
Eg : FORMATRON IV – Formatron – Parkell USA.
- SONO-Explorer
- Dentometer
- Evident etc.
Also we have Endometer / Audiometer which indicate reaching apex by
needle deflection / beep 53-83% success.
Ushjama (1983) The modern apex locations mark by sending a mild A.C. into
the canals and then monitoring the p gradient along the canal with needle type
electrodes.
- The density of the constant current will be highest at the narrowest point
and the electric field will change at the apical foramen.
- Some of the early apex locations used DC which had to be used in canals
without vital pulp tissues, blood, tissue fluids or pus, electrocytes and
NaOcl, saline, EDTA or metallic restorations.
However todays AC locators only electrocytes and metal restorations
may show false readings.
- However of late SAITO has redesigned these AC-EAL which work even in
the presence of NaOcl – Eg: Endex Unit, Endo Hygiene Cater
35
36. Conclusion :
Thus to conclude these electronic units, the new generation electronic
apex locators have characterized notably improved clinical accuracy and ease
of operation which thus promise their acceptance for the future in endodontic
practice.
36