endo access cavity preparation 5

8/11/2019 Endo Access Cavity Preparation 5

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ANATOMY


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74% - apical third

11% - middle third

15% - cervical third.


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All groups of teeth had at least one accessory

foramen.

The maxillary premolars had the most and the largest

accessory foramina(mean value, 53 m) and the most

complicated apical morphologic makeup. The

mandibular premolars had strikingly similarcharacteristics, a possible reason why root canal

therapy may fail in premolar teeth.


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Anatomy of the Apical Root

The space between the

major and minor

diameters has beendescribed as funnel

shaped or hyperbolic, or

as having the shape of a

morning glory.


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According to Weine

CANAL CONFIGURATIONS


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According to Vertucci

The only tooth that showed all eight possible

configurations was the maxillary second premolar.


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C-SHAPED CANALthat often occurs in

MANDIBULAR SECOND MOLAR


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C-shaped mandibular molars are so named because of

the cross-sectional morphology of their fused roots andtheir root canals.

Instead of having several discrete orifices, the pulp

chamber of a molar with a C-shaped root canal system is

a single, ribbon-shaped orifice with an arc of 180

degrees or more.


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Melton et al. in 1991 proposed the following classification of C-

shaped canals based on their cross-sectional shape. Fan et al. in

2004 modified Meltonsmethod


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Isthmus classifications described by Kim and colleagues.

Type I is an incomplete isthmus; it is a faint communication between twocanals.

Type II is characterized by two canals with a definite connection between them

(complete isthmus).

Type IIIis a very short, complete isthmus between two canals.

Type IV is a complete or incomplete isthmus between three or more canals.

Type V is marked by two or three canal openings without visible connections.


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Nine guidelines, or laws, of pulp chamber

anatomy to help clinicians determine the

number and location of orifices on thechamber floor:-


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Law of centrality: The floor of the pulp chamber is

always located in the center of the tooth at the level of

the CEJ.

Law of concentricity:The walls of the pulp chamber are

always concentric to the external surface of the tooth at

the level of the CEJ, that is, the external root surface

anatomy reflects the internal pulp chamber anatomy.


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Law of the CEJ:The distance from the external surfaceof the clinical crown to the wall of the pulp chamber is

the same throughout the circumference of the tooth at

the level of the CEJ, making the CEJ is the most

consistent repeatable landmark for locating the positionof the pulp chamber.


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First law of symmetry: Except for the maxillary molars,

canal orifices are equidistant from a line drawn in a

mesiodistal direction through the center of the pulp

chamber floor.

Second law of symmetry:Except for the maxillary molars,canal orifices lie on a line perpendicular to a line drawn in

a mesiodistal direction across the center of the pulp

chamber floor.


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Law of color change:The pulp chamber floor is always darker

in color than the walls.

First law of orifice location:The orifices of the root canals are

always located at the junction of the walls and the floor.

Second law of orifice location: The orifices of the root canals

are always located at the angles in the floorwall junction.

Third law of orifice location:The orifices of the root canals are

always located at the terminus of the roots developmental

fusion lines.


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Allowing sodium hypochlorite

(NaOCl) to remain in the pulp

chamber may help locate a

calcified root canal orifice. Tiny

bubbles may appear in the

solution, indicating the position of

the orifice.


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INSTRUMENTS USED IN

ACCESS CAVITY


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Access burs: #2

and #4 rounddiamond burs.


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Access burs

Safety-tip tapered

diamond bur (left);

Safety-tip tapered

carbide bur (right


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Access bur: round-end

cutting tapered diamondbur


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Access burs

A,Mueller bur

B,LN bur.


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Gates-Glidden burs, 1 through 6.


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Access instruments

DG-16endodontic explorer (top);

JW-17endodontic explorer (bottom).


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Itis the efficient uncovering the

roof of the pulp chamber &

providing the direct access to the

apical foramina by the way of

the pulpcanals

.

ACCESS OPENING


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According to R.E. Walton, the 3 main objectives of access

cavity preparation are :-

1. Straight line access : Helps in

a. Improved instrument control.

b. Improved obturation.

c. Decreased procedural errors.


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2. Conservation of tooth structure :-

a. Minimal weakening of tooth.

b. Prevention of perforation.

3. Un roofing of chamber and exposure of pulp

horns :-

a. Maximum visibility.

b. Location of canals.


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Principles of Endodontic Cavity

Preparation

Endodontic Coronal Cavity Preparation :-

I. Outline Form

II. Convenience Form

III. Removal of the remaining carious dentin and

defective restorations.

IV. Toilet of the cavity


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Principle I: Outline Form

The outline form of the endodontic cavity must be

correctly shaped and positioned.

Establish complete access for instrumentation, from

cavity margin to apical foramen.

External outline form = internal anatomy of pulp.


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Principle II: Convenience form

(1) Unobstructed access to the canal orifice.

(2) Direct access to the apical foramen.

(3) Cavity expansion to accommodate filling

techniques.

(4) Complete authority over the enlarging

instrument.


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Principle III: Removal of the Remaining Carious

Dentin and Defective Restorations

This according to Ingle, must be done for three reasons:-

(1) To eliminate mechanically as many bacteria as

possible from the interior of tooth

(2) To eliminate discoloration of tooth structure

(3) To eliminate the possibility of any bacteria- ladensaliva leakinginto the prepared cavity.


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Principle IV: Toilet of the Cavity

1. All of the caries, debris, and

necrotic material must be removed

before the radicular preparation isbegun.

2. 0bstruction, bacterial growth.

Pulp Canal Anatomy and Access Cavity Preparations


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Pulp Canal Anatomy and Access Cavity Preparations

Endodontic Cavity Preparation Maxillary Anterior Teeth


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Maxillary Central Incisor

Pulp chamber: -

Centrally located.Broad mesio-distally.

Broadest incisally3 pulp horns

Access opening:Triangle in shape.


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Maxillary Lateral incisor

Pulp chamber

Similar to central.

2 pulp horns

Access opening

Triangular /ovoid


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The root apex and the

apical foramen were

displaced distolingually.


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Radicular developmental palatogingival groove.

A, Radiograph show lesion resulting from bacterial access along groove.

B, Extracted tooth shows extent of groove.

The incidence of radicular grooves is 3.0%in lateral incisors

Maxillary Canine


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Maxillary Canine

Pulp chamber Largest among single

rooted teeth

Triangular(labiolingually)

Flame shaped(mesiodistally)

1 pulp horn

Access opening Ovoid


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Endodontic Cavity Preparation in Mandibular


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Endodontic Cavity Preparation in Mandibular

Anterior Teeth

Mandibular Central and Lateral Incisors


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Mandibular Central and Lateral Incisors

Pulp chamber

Smallest in the arch.

Flat (mesiodistally)

Ovoid

(labiolingually) 3 pulp horns

Access opening Long oval

(incisogingivally)


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MANDIBULAR LATERAL INCISOR

A cross section of the root is

ovoid or hourglass in shape due

to the developmentaldepressions on each side.


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Mandibular Canine


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Mandibular Canine

Pulp chamber

More wide

(labiolingually)


Anomalies Rarely more than 1

canal and 1 root.


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Endodontic Preparation of Maxillary


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Endodontic Preparation of Maxillary

Premolar Teeth

Maxillary First Premolar


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Maxillary First Premolar

Pulp chamber

Narrow(mesiodistally).

Wide(buccolingually)

2 pulp horns (Buccal& Palatal)

Root & root canal

2 roots (i.e. Buccal &Palatal)

Access opening

Ovoid(buccolingually).

Th mesial root on a it i i t d


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The mesial root concavity is more prominent and

extends onto the cervical third of the crown.

This results in a root that is broad buccolingually and

narrow mesiodistally with a kidney shape when viewed in

cross section at the cementoenamel junction.

These anatomical features have implications in

restorative dentistry and in periodontal treatment, and

are common areas for endodontic root perforations.


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Maxillary Second Premolar


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Maxillary Second Premolar

Pulp chamber

Similar to 1stpremolar

2 pulp horn.

Single canal orifice.

Root & root canal

Single rooted (90%)

Access opening

Ovoid (buccolingually)


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The cross-sectional root

anatomy of the maxillary

second premolar in the

midroot area is describedas oval- or kidney-shaped


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Endodontic Preparation of Mandibular


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p

Premolar Teeth

Mandibular First Premolar


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Mandibular First Premolar

Pulp chamber

Prominent buccal pulphorn.

30 lingual tilt of crown.

Root & root canal Narrow (mesiodistally)

Broad (buccolingually)


Upper 1/3rdlingualincline of buccal cusp.


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Mandibular Second Premolar


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Mandibular Second Premolar

Pulp chamber

Prominent lingual

pulp horn.

Root & root canal

Wider (mesiodistally)

Broad

(buccolingually)

Access opening

Ovoid


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Endodontic Preparation of Maxillary Molar Teeth


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p y

Maxillary First Molar


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Maxillary First Molar

Pulp chamber

Largest in dentalarch.

4 pulp horns.

Roof: rhomboidal

Root & root canal

3 roots and 3 canals

Access opening

Rhomboidal


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Of all the canals in the maxillary first molar, the MB2 can be the

most difficult to find and negotiate in a clinical situation.


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The mesiobuccal root is broad buccolingually and has


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The mesiobuccal root is broad buccolingually and has

prominent depressions or flutings on its mesial and distal

surfaces.

The internal canal morphology is highly variable, but the

majority of the mesiobuccal roots contain two canals.

The distobuccal root is generally rounded or ovoid in crosssection and usually contains a single canal.

The palatal root is more broad mesiodistally than

buccolingually and ovoidal in shape but normally contains onlya single canal. Although the palatal root generally appears

straight on radiographs, there is usually a buccal curvature in

the apical third.

Maxillary Second Molar


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Pulp chamber

Similar to 1stmolar.

Narrow

(mesiodistally)

Root & root canal 3 roots & 3 canals

Access opening

Similar to 1stmolarwith variations as

anatomy dictates.


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Endodontic Preparation of Mandibular Molar


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Teeth

Mandibular First Molar


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Pulp chamber

4 pulp horns. Roof: rectangular

Floor: rhomboidal

Root & root canals

Usually 2 roots & 3canals

Access opening

Trapezoidal orrhomboid


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Mandibular Second Molar


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Pulp chamber

Same as 1stmolar.

Root & root canals

Usually 2 roots & 3

canals

Access opening

Trapezoidal or

rhomboidal.


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4. Ledge : caused due to loss of instrument control.

5. Discoloration : incomplete removal of pulp debris.

6. Missed canals : due to small access cavity.

7. Broken Instruments : occurs in curved canals due to

failure in extending outline/internal prep.


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QUESTIONS


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2. Shown below in the photograph dark lines between

two canal orifice is :-

A. Dentinal Groove

B. Dentinal Map

C. Formed because of faulty

access opening

D. Dentinal shadow

3 Wh t % f l 1st l h 2 di t l l


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3. What % of lower 1stmolars show 2 distal canals

A. 10%

B. 30%

C. 60%

D. 75%


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4 Shown below tooth 43 is the case of :-


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4. Shown below tooth 43 is the case of :-

A. External root resorption

B. Internal root resorption

C. Lateral root perforation

D. Iatrogenic root perforation


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5. What should be the treatment for the above case:-

A. Extraction

B. Repair of the resorption

C. Do a follow up for 6 months

D. No treatment is required


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6. Shown below in the photograph is an example of:-


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A. Furcation perforation

B. Pulp stone

C. Dental pulp

D. Both A & B

7 Two canals are most often seen in the:


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7. Two canals are most often seen in the:-

A. Maxillary canine

B. Mandibular canine

C. Maxillary lateral incisors

D. Mandibular first premolar

[Ref. Grossman 11thEd Pg 166]


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Bifurcations and trifurcations are most common in

mandibular 1st premolar.

They present a challenge during cleaning, shaping and

obturation. Because, of this it is known as "Enigma to

endodontist".


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8 The fourth root canal if present in a maxillary 1st molar


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8. The fourth root canal if present in a maxillary 1st molar

is usually present in:

A. Mesiolingual root

B. Mesiobuccal

C. Palatal root

D. Distal root


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9. Cervical cross section of maxillary first premolar has:

A. A round shape

B. Elliptical shape

C. Oval shape

D. Square shape

The mesial root concavity is more prominent

d t d t th i l thi d f th


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and extends onto the cervical third of the crown.

This results in a root that is broad buccolingually

and narrow mesiodistally with a kidney shape

when viewed in cross section at the

cementoenamel junction.


restorative dentistry and in periodontal

treatment, and are common areas for

endodontic root perforations.


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10. Shown below in the photograph is?

A. Endodontic explorer

B. Spoon excavator

C. Periodontal probe

D. Gingival marginal trimmer


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11. Of the following permanent teeth, which is least

likely to have two roots?

A. Maxillary canine

B. Mandibular canine

C. Maxillary first premolar

D. Mandibular first premolar


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CASE

Patient report to a clinic and

complains of pain while biting

in his lower anterior teeth. He

gave history of root canaltreatment 5 years back with

his lower anterior teeth.


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12. What is the etiology for not healing of this lesion:-

A. Incomplete preparation & obturation

B. Missed canal

C. Lateral perforation

D. No reason


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13. Accessory canals are most frequently found in:

A. The cervical one third of the root

B. The middle one third of the root

C. The apical one third of the root

D. With equal frequency in all the above mentioned


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74% - apical third

11% - middle third

15% - cervical third.


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14. There are sharp demarcations between pulpal

chambers and pulp canals in which of the followingteeth ?

A. Mandibular second premolars

B. Maxillary first premolars

C. Maxillary Lateral incisors

D. Mandibular canines


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Ans. 'B' [Ref. Grossman 11thEd Pg 156]

The division between root canal and pulp chamber is

indistinct in single rooted teeth whereas in posterior teeth

this demarcation is sharp.

15 In the mandibular arch the greatest lingual


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15. In the mandibular arch, the greatest lingual

inclination of the crown from its root is seen in the

permanent:

A. Canine

B. Third molar

C. First premolar

D. Central incisor

Ans. C [Ref. Grossman 11th Ed Pg


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[ g

167]

Mandibular 1st premolar containsprominent buccal cusp and smaller

lingual cusp that give the crown a

lingual tilt of 30.

To compensate for the tilt and to

prevent perforations, the enamel is

penetrated at the upper 3rd of

lingual incline of facial cusp anddirected along long axis of root.


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16. Shown below in the photograph is :-

A. Periodontal ligament

B. Iatrogenic perforation

C. Extruded gutta-percha

D. B & C

17. The mesiolingual root canal of the mandibular 1st


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g

molar is found under the:

A. Mesio lingual cusp

B. Mesio buccal cusp

C. Central groove

D. Mesio lingual ridge.

Ans. C[Ref. Grossman 11thEd Pg 170]


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The mesiobuccal orifice is under the mesiobuccal cusp and is

usually difficult to find if enough tooth structure is not removed.

The mesiolingual orifice is present below the central groove.

The distal orifice has an elliptical shape and is usually present in

the centre of tooth buccolingually.

18. A divided pulp canal is most likely to occurin the:


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A. Root of a maxillary canine

B. Root of mandibular canine

C. Root of a maxillary central incisor

D. Lingual root of a maxillary first molar

Ans. B]


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The occlusal cross-section view of maxillary central


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incisor is triangular in shape; while the apex located

lingually and base of the triangle located facially.

Grossman/llthed/p-151

20. Considering the morphology of root and pulp canals, a


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root canal instrument should be placed in what

direction to gain access to the Mesiofacial root ofpermanent maxillary first molar:

A. From the mesiobuccal

B. From the distobuccal

C. From the mesiolingual

D. From the distolingual

Ans. D


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In case of MAXILLARY FIRST MOLAR

The orifice of mesiobuccal canal is gained access from distopalatal

direction.

The distobuccal root canal is gained access from mesiolingual

direction.

The palatal root is gained access from buccal direction.

For MANDIBULAR 1st MOLAR:

The mesiobuccal orifice is present under mesiobuccal cusp and is

explored from mesiobucco apical direction.

The mesiolingual orifice is present below the central groove and is

explored from disto buccal direction.

The distal orifice is explored from a mesial direction.

21. Mandibular 1st molar has:


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A. 2 roots and 2 canals

B. 2 roots and 3 canals

C. 3 roots and 3 canals

D. 3 roots and 4- canals

Ans. B [Ref. Grossman 11thEd Pg 170]


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22. In which single rooted tooth are bifurcated roots


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present:

A. Mandibular lateral incisor

B. Maxillary canine

C. Mandibular central incisor

D. Mandibular premolar


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23 S b l i i f l Wh t i


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23. Sown below is access opening of premolar. What iss

the error inaccess opening?

A. Outline form is incomplete

B. De-roofing is not done

C. Access cavity should be

mesio-distally wide

D. Both B and C


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24. Which root canal is most difficult to prepare in

maxillary molar?

A. Mesiobuccal

B. Distobuccal

C. Palatal

D. Both A and B


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Ans. A[Ref. Grossman 11thEd Pg 161]

Mesio buccal root has greatest distal curvature and is

narrowestof all the three canals.

h il f d h i h li h i l


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25. The most easily perforated tooth with a slight mesial

or distal angulation of bur after a mandibular central

incisor is:

A. Maxillary premolar

B. Maxillary molar

C. Mandibular premolar

D. Maxillary canine

The mesial root concavity is more prominent and



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restorative dentistry and in periodontal treatment,

and are common areas for endodontic rootperforations.


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The cross-sectional root

anatomy of the maxillary

second premolar in the

midroot area is described

as oval- or kidney-shaped

27 Th t l t lik l t h i l


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27. The root canals most likely to share a common apical

opening are:

A. Mesial and distal roots of mandibular premolars

B. Mesiobuccal and mesiolingual roots of mandibular firstmolars

C. Both "A & B

D. None of above

Ans. C[Ref. Grossman 11thEd Pg 167, 170]


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[ g , ]

The mesiobuccal and mesiolingual roots of mandibular

first molars are the root canals most likely to share acommon apical opening..

28 B hi f l l l i l t lik l i


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28. Branching of pulpal canals is least likely seen in:

A. Maxillary central incisor

B. Upper 1st premolar

C. Mand central incisor

D. Mand lateral incisor.

Ans. A[Ref. Grossman 11thEd Pg 151]


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[ g ]

29 The anterior tooth most likely to display two canals is:


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29. The anterior tooth most likely to display two canals is:

A. Maxillary central

B. Maxillary lateral

C. Mandibular central

D. Mandibular lateral


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30. The tooth which usually has the largest pulp chamber

in the mouth is the:


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in the mouth is the:

A. Maxillary central

B. Maxillary canine

C. Maxillary 1st molar

D. Mandibular 1st molar

Ans. C [Ref. Grossman 11th Ed Pg 160]


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Ans. C [Ref. Grossman 11 Ed Pg 160]

The pulp chamber of maxillary 1st molar is the

largest in the dental arch.

The pulp chamber of the maxillary canine(Option 'B') is the largest of any single rooted

teeth.

31. Incidence of 3rdroot in upper first premolar:


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A. 6%

B. 10%

C. 12%

D. 1%


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DIAGNOSIS

16. What is your diagnosis of this case?


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A. Drug induced discoloration

B. Amelogenesis imperfecta

C. Non-vital tooth

D. Staining due to systemic disease

17. What should be treatment of choice for this


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17. What should be treatment of choice for this

tooth?

A. Microabrasion

B. Night guard bleaching

C. Home applied technique

D. Walking bleach technique

BLEACHING

Themocatalytic or in-off ice


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Themocatalytic or in off ice

technique

(35% H2O2)

Nonvital Teeth

Walking bleach (Superoxol)

Power Bleach or in-off ice

technique(35% H2O2 & Heat or light)

Vital teeth

Ni ht Guard Bleach


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18 What are the choice of agent in this bleaching


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18. What are the choice of agent in this bleaching

technique?

A. Superoxol + sodium perborate

B. Carbamide peroxide

C. 18% hydrochloric acid

D. Superoxol


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Superoxol is heated directly within the pulp

chamber in the thermocatalytic bleach or mixed with

sodium perborate and sealed in the pulp chamber to

form the walking bleach.

19 What is the most important


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19. What is the most important

complication that can occur due touse of this agent?

A. Teeth become hypersensitive

B. External cervical resorption

C. Irritation of gingival papilla

D. Thinning of enamel

Studies found the incidence of cervical root


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resorption after bleaching ranged from 0 to 6.9 percent.

it could occur in as many as one of every 12 teethbleached.

Therefore, it appears that the age of the patient at the

time the tooth became pulpless and the presence of a

barrier may be as important as the type of bleachingagent and the use of heat during bleaching.

Upon successful bleaching of the tooth, rinse the

h b d fill it t ithi 2 f th f


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chamber and fill it to within 2 mm of the cavosurface

margin with a paste consisting of calcium hydroxidepowder in sterile saline.

Reseal the access opening with a temporary

restorative material in a manner previously described

and allow the calcium hydroxide material to remain

in the pulp chamber for 2 weeks.

20. What are the treatment modalities for repair of


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20. What are the treatment modalities for repair of

resorption?

A. Extraction

B. Calcium hydroxide

C. Forced orthodontic extrusion

D. All of the above

There are treatment options for repair of resorption:-


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1. Calcium hydroxide therapy.

2. Forced orthodontic extrusion.

3. Surgery.

4. Extraction.

Forced orthodontic extrusion


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By extruding the root, the resorptive defect can beelevated coronal to crestal bone.

Here it is accessible and can be included in a crownpreparation or repaired.

Specific orthodontic criteria must be met for success.

The crown/root ratio must be 1:1 and the root should

be non-tapering.

SURGERY

Th most ommon approa h t i i l d f t i


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The most common approach to repair cervical defects is

surgery.

The resorption usually starts proximally and often wraps

around toward the palatal.

Both a labial and palatal flap are necessary for access.

The lesion is cleaned, bony contouring accomplished, and

the defect repaired.

Esthetic concerns may arise due to bone loss and tissue

changes. The tooth is more susceptible to fracturing.

Case 5

A 24 years old female patient complains of severe


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A 24 years old female patient complains of severe

throbbing pain from last few days with respect to lowerright back region.

Pain increases on lying down and is relieved with

analgesics.

Also pain is spontaneous in nature.

On oral examination, mandibular right firstpermanent molar is found to be carious. The tooth is

sensitive to percussion.


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21. What is diagnosis of this case?


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A. Reversible pulpitis

B. Irreversible pulpitis

C. Symptomatic irreversible pulpitis

D. Hyperplastic pulpitis

Signs and Symptoms Pulpal Diagnosis Periapicaldiagnosis

Sharp pain from exposed dentin on application of

thermal or osmotic stimuli. No dental abnormality.

Normal

( dentin

Normal


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hypersensitivity)

Sharp pain from exposed dentin on application ofthermal or osmotic stimuli or both. Evidence of

dental caries, fractured restoration, cracked cusps

etc.

Reversible pulpitis Normal

Spontaneous, throbbing pain, sharp pain on

application of thermal stimuli that persists

following removal of stimulus.

Irreversible pulpitis Normal

Spontaneous, throbbing pain, sharp pain on

application of thermal stimuli that persists

following removal of stimulus.

Tender to bite or percussion or both. R/g widening

of PDL likely.

Irreversible pulpitis Acute apical

periodontitis

Spontaneous, throbbing pain. No response to

thermal stimuli. Tender to bite or percussion or

both. Localized or diffuse swelling may be there.

R/g may be inconclusive or lesion

Necrosis Acute

periradicular

abscess

22. Identify the area marked by circle X on radiograph?

A. Pulp stone


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p

B. Radiolucency due to carious involvement of tooth

C. Nomal pulp canal

D. Normal pulp chamber


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Increase the difficulty of negotiating the root canals.

The incidence of calcifications in the chamber or in the

canal may increase with periodontal disease, extensive

restorations, or aging.

23. What should be treatment in rendered in this


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case?

A. Restoration with amalgam

B. Endodontic therapy

C. Direct pulp capping

D. indirect pulp capping


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Direct pulp capping Indirect pulp capping

24. A tooth tested nonvital in vitality tests showing

periapical radiolucency shows the presence of


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periapical radiolucency shows the presence of

a sinus tract clinically. What should be the

treatment for the sinus tract?

A no treatment

B curettage of the sinus tract

C Cauterization

D Irrigation with sodium hypochlorite


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To trace the sinus tract, a size #25 gutta-percha cone is

threaded into the opening of the sinus tract.

25. In root fracture of the apical one - third of permanent

anterior teeth, the teeth usually:


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anterior teeth, the teeth usually:

A. Discolor rapidlyB. Remain in function and are vital

C. Undergo pulpal necroses and become ankylosed

D. Are indicated for extraction and prosthetic replacement

Apical 3rdFracture

Fracture with no mobility no displacement of the coronal


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segment and no symptoms- do not require any immediate

treatment.

Long term observation with periodic evaluation of pulp status.

If Considerable mobility- only splinting and periodic evaluation.

Healing is uneventful

Middle 3rdfractures

Most common site of occurrence.


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Presents with considerable amount of mobility and

/or dislocation of the coronal segment.

The treatment is aimed towards preserving thevitality and favor repair of the fracture.

Correct repositioning ( Reduction)

Splinting (Retention)

Coronal 3rdfractures


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If reattachment of the fractured segments is

not possible the coronal segment must be

extracted and the choice of whether to retain

the apical fragment becomes major

predicament.


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THANK YOU

endo access cavity preparation 5

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