Tag Archives: endodontic access prep

An Unconventional Access.

Patient presented with #1.3 pulp necrosis and chronic apical abscess.  Due to missing #1.2, mesially tilted tooth #1.3 had been restored as #13-#1.4 splinted crowns in the place of  #1.2 and #1.3.  The clinical picture shows a ceramic interdental papilla which covers the root of tooth #1.3.

The key aspects in treating such a case are as follows:

  1. reviewing the risks of the procedure in detail with the patient (i.e. possible damage to the restorative work to the point of needing replacement, possible mishaps during the endodontic treatment [perforation, instrument fracture], etc.)
  2. through assessment of the tooth/root under the crown using a probe and by palpating the root
  3. good understanding of the root angulations in mesial-distal and buccal-lingual directions
  4. planning for initial access location
  5. good isolation with a stable clamp that can be placed over the root
  6. constantly aligning the bur with the long access of the root while drilling in the center of it
  7. and finally, Patience, Patience and more Patience!

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Office website: vanendo ,  FaceBook page: @endospecialists


Watch Out for the Twisted Ones!

If you attended my lecture at the Pacific Dental Conference last month, I mentioned “The Laws” that allow us to safely and predictably locate canals without being worried about mishaps (i.e. perforations, over-enlarged access cavities, etc.).  One of the scenarios that we have to always be prepared for is accessing through a crown that is placed on a rotated tooth.  One of the key elements discussed was the use of a probe to gain a better appreciation of the root outline at the CEJ level. The “Law of Concentricity” then allows us to start our access cavity preparation in the right direction.

The case below shows a rotated tooth #1-4 under a PFM crown. Preparing a typical access cavity in the Buccal-Lingual direction would definitely result in mishaps.  Understanding the orientation of the tooth prior to the start of root canal treatment can result in achieving a safe and a conservative access prep. Note that even the rubber dam clamp wings are not good  guides for the orientation of the chamber floor and for locating canals.

 

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Office website: vanendo ,  FaceBook page: @endospecialists


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