Endodontic Access

Question 1

What must a tooth be free of before endodontic intervention?

Answer 1

caries

Question 2

Why must a tooth be caries free before commencing endodontic treatment?

Answer 2

• to assess restorability
• to allow treatment planning for the final restoration
• to expose anatomical landmarks
• to allow for dam isolation
  • safe use of irrigants

Question 3

How can safe use of irrigants be encouraged?

Answer 3

providing an access cavity with four walls

Question 4

When should dental dam be placed for root canal treatment?

Answer 4

• from the start of the procedure
• once pulp chamber penetrated
  • if need to see anatomy to aid access
  • cotton wool rolls and saliva ejector before

Question 5

What clamps can be used for anterior teeth?

Answer 5

• C
• E

Question 6

What clamps can be used for premolars?

Answer 6

• E
• EW

Question 7

What clamps can be used for molars?

Answer 7

• A
• AW
• FW
• K

Question 8

What can be used to aid dam seal?

Answer 8

• Oraseal caulking
• OpalDam

Question 9

How can the seal of a dental dam be checked?

Answer 9

chlorhexidine solution

Question 10

What measurements should be made on a pre-operative radiograph?

Answer 10

• estimated working length
  
  • length of each root
    
    • with anatomical reference point

Question 11

What can be measured to reduce the risk of perforation during access?

Answer 11

• DG16 with rubber stop
  
  • gauge depth of access cavity
  • if beyond ACJ stop

Question 12

Describe the process of accessing an anterior tooth

Answer 12

• open into dentine in centre of lingual surface
  
  • high speed diamond round/fissure
  • incisal to cingulum
• shank of bur parallel to long axis of tooth
  
  • ensure straight line access
• long shank latch grip bur can be used
  
  • if regular bur does not access pulp chamber
• opening should be funnelled
  
  • remove ledges on palatal aspect
  • remove pulp chamber roof
  • remove pulp horn remnants
• avoid hollowing out the natural crown
  
  • retain as much cingulum dentine as possible

Question 13

What shape should access cavities be for incisors?

Answer 13

• triangualr
  
  • base to incisal edge

Question 14

What shape should access cavities be for canines?

Answer 14

oval

Question 15

Describe the process of accessing a posterior tooth

Answer 15

• open into dentine
  
  • high speed diamond bur
• estimate depth of penetration necessary
  
  • aim for largest pulp horn
• open into pulp chamber
  
  • preferably slow speed
    
    • long shank round bur
  • do not let bur touch pulp chamber floor
• remove remainder of pulp chamber roof
  
  • endo Z bur
  • float bur at roof of the pulp chamber
  • do not let bur touch pulp chamber floor
• remove contents of pulp chamber with discoid excavator
• remove any overhanging edges of pulp chamber
  
  • endo Z bur