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Four themes of the day (Our 5 learning areas today)

• Access Cavity – getting it right


I want you to experience (learning outcomes)

• The use and advantage of Piezon-Ultrasound • Identify and remove lips of peripheral pulpal roof • Know when you are in the pulp and colour of the

pulpal floor • Know where to look for the orifices of the root canals • Irrigate from the beginning

Clinical Tips on Endodontic Access

• Go for the biggest canal first in multi-rooted teeth • The access cavity should always be centred over the

canal(s) with the greatest distal curvature (mand molars: MB/L & max molars MB)

• This means you do not want files to be under stress (i.e. bending) when placed in the root canal

• Ideally a quarter and no more than a third of the overall width of the tooth (no more)

Practical application

Improve Access Cavity (commonest error is ‘lippping’!)

If the access cavity is wrong then many bacteria will be left behind to re-infect the

root canal! It will blight your preparation, irrigation

and obturation.


‘Lipping’ ‘Shelves’ of the roof of pulp around the access cavity –

beneath these shelves will be huge numbers of bacteria



Access and coronal third: Lets take a look at me accessing a simple maxillary canine (post trauma)


../Swansea Lecture March 2011/endodontic access and coronal preparation 2009.wmv


Access and coronal third: Lets take a look at me accessing a hot pulp of a dentist with a crack and pulp stone


../Swansea Lecture March 2011/endodontic access and coronal preparation 2009.wmv


How can we avoid creating pulpal floor perforations during access?

• Good X-ray - bitewings as good as any

• Measure the distance from the top of the tooth to the pulpal floor, or put the bur you are using against the radiograph

Practical knowledge


Measure and Look Practical knowledge


Digitally measure sclerosed canal Practical knowledge


Piezon Master 400 for Endo & Perio separate fluid bottle – approx £1,500

EMS miniPiezon – No separate bottle – approx £500 a good bit of kit for perio & endo


What we want you to do?

• Select a decent multi-rooted tooth with X-ray. • Check that the root apex is closed • Can you draw on the tooth your access outline on

tooth (with pencil) before you start • Work out how much of the bur will need to go into

the tooth to enter the pulp chamber • We have lots of burs.



Access: what we want you to do? • Select a fast bur • Make access into pulpal chamber • Clear away the roof of pulp to allow access to the

orifices of the root canals (with either fast or slow) • Be sure to remove lips of pulpal roof • Confirm darker colour of the dentine on the

furcational floor (brown in vivo / bluish with extracted teeth)

• Some will have secondary dentine deposits to remove



I want you to experience (learning outcomes)

• The use and advantage of Piezon-Ultrasound • Identify and remove lips of peripheral pulpal roof • Know when you are in the pulp and colour of the

pulpal floor • Know where to look for the orifices of the root canals • Irrigate from the beginning



Confront your worst fears


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