Description
Access opening is the first step in the root canal treatment procedure. In this process the carious portion of the tooth is excavated and access to the pulp . i.e. to the root canals is made by an airotor with a rotary bur. In this process of making an access to the opening of a root canal there might be an unintentional communication formed while cavity preparation. This communication between the root canal system to the soft tissues of the tooth or teeth is known as a perforation
Résumé
- Dental caries is prevalent in India, affecting a significant portion of the population and leading to numerous root canal treatments annually. While endodontic therapy has a generally high success rate, failure rates still exist, highlighting the importance of careful treatment planning and execution.
- Access cavity preparation is a crucial initial step in root canal therapy, impacting the success of both the endodontic treatment and subsequent restoration. It is critical to understand pulp chamber anatomy, including the roof and floor, to ensure complete deroofing without damaging the floor, where the canals are located.
- Key objectives in access cavity preparation include excavating all caries lesions to gain proper access and de-roofing the pulp chamber to achieve straight-line access to the canals. Using appropriate burs like endo access burs and ultrasonic instruments can aid in achieving these objectives effectively.
- Preoperative radiographs play a vital role, offering a "trailer" of what to expect during treatment, identifying potential challenges such as calcifications, open apices, or curved canals. They also help in managing patient expectations regarding treatment duration and complexity.
- When initiating the access cavity, it is advisable to start by drawing on the tooth and marking the bur to avoid over-instrumentation. After de-roofing the pulp chamber, examine the pulp floor to identify canal orifices using the dental map and exploring with a DG16 explorer.
- It's a misconception that smaller, conservative access cavities are beneficial. Research suggests that they do not strengthen the tooth and may lead to missed canals, instrument separation, and ultimately, treatment failure. Therefore, a well-prepared access cavity is crucial for successful root canal treatment.
- Crown perforations are a significant cause of root canal failure, but they can be repaired effectively. MTA has traditionally been used, but bio-dentine offers advantages such as a shorter setting time and comparable properties, allowing for single-visit repairs.
- Even in cases with perforations or significant bone loss, teeth can often be saved with appropriate endodontic treatment and repair. Complete the BMP before repairing a site of perforation in order to prevent the blockage of the canal. Having the proper technique allows clinicians to save the patient and do a service to endodontics.
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