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You dont know how much you know until you know
cusp. The floor of the pulp chamber runs parallel to the roof and
the tooth, particularly dentin forming the furcation area. The canal
orifices are openings in the floor of the pulp chamber leading into
the root canals. The canal orifices are not separate structures, but
are continuous with both pulp chamber and root canals. The walls
access opening.
angles of a pulp chamber derive their names from the walls forming
The pulp cavity is the central cavity within a tooth and is entirely
enclosed by dentin except at the apical foramen (Fig. 1). The pulp
(Fig. 1)
chamber gradually merges into the root canal, and this division
The root canal is that portion of the pulp cavity from the canal
the number of canals can vary from one to four or more. The roof
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to the apex
ii.
(Fig. 4)
divides into two in the root; the two then merge to exit as one
canal (1-2-1)
divides short of the apex into two separate, distinct canals with
divides and then rejoins in the body of the root and finally re-
chamber and join short of the apex to form one canal (2-1)
i.
(Fig. 3)
iii.
(Fig. 5)
Thus, a clinician must be familiar with the various pathways the root
iv.
(Fig. 6)
structure
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(Fig. 7)
c. Orifice Enlargers
Fig. 7 DG 16
(Fig. 8)
d. Orifice Enlargers
i.
X Gates
(Fig. 13)
Fig. 13 X gates
i.
(Fig. 9)
ii.
iii.
(Fig. 14)
nation
(Fig. 15)
e. Patency files
i.
i.
ii.
(Fig. 11)
b. Ultrasonic Tips
i.
I. Maxillary Incisors
(Fig. 12)
region for penetration of the bur. This is usually just incisal to the
cingulum,
surface,
The bur head is then oriented parallel to the long axis to the
Fig. 12 Start X ultrasonic tips
tooth,
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(b)
with the base towards the incisal edge and apex towards the
cingulum.
(a)
(b)
(a)
(b)
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Key Rules:
12 oclock position
Better orientation
Key rules:
1. Ovoid / Round shaped access
(a)
(b)
Fig. 24 Maxillary first molar. The outline is trapezoidal in shape with the broader
base towards the buccal surface. The cavity is entirely within the mesial half of
the tooth and need not invade the transverse ridge but is extensive enough,
buccal to lingual, to allow positioning of instruments
Fig. 22
(a) Incomplete de-roofing of a maxillary
premolar access cavity preparation
(b) De-roofing allows access to the
isthmus area which contains pulp tissue
(c) Completed access opening allowing
straight line access to both the buccal
and palatal canals
Maxillary molars generally have three roots and can have as many
as three mesial canals, two distal canals, and two palatal canals.
The mesiobuccal root of the maxillary first molar has generated
more research and clinical investigation than any root in the mouth.
It generally has two canals and they are called mesiobuccal (MB-1)
(c)
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wall
ii. If Mesio-buccal canal is present near the buccal wall, trough for
MB-1 orifice.
Fig. 27 Quadrilateral outline form reflects the anatomy of the pulp chamber.
Both mesial and distal walls slope mesially. The cavity is primarily within
the mesial half of the tooth but is extensive enough to allow positioning of
instruments. Further exploration should determine whether a fourth canal can
be found in the distal. In that case, an orifice will be positioned at each angle
of the rhomboid.
Key Rules:
1. Quadrilateral / Trapezoidal shape access
2. Suspect for the fourth canal
Fig. 25 The two most common locations of the MB2 canal
Common variations:
1. Possibility of a 2nd distal canal which can be in the following
configuration
C shaped canals
2 distinct orifices
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Most important
Color is the
language of endodontics
STEP # 6
Establish straight
line access
Locating the Canal Orifices
STEP # 7
Eureka
Moment!!!
Fig. 30 Two distal canals Orifices next Fig. 31 Two distal canals Distinctly
to each other
separate orifices
STEP # 1
Reduce
4. Teeth having two canals in a straight line do not have any third
following reasons:
determination
STEP # 2
Fig. 32 Single mesial canal which is in line with the distal canal in a
mandibular second molar.
STEP # 3
Geography
STEP # 1
Reduce
STEP # 3
Know your
is the Fear of Perforation. This fear stems from the fact that many
Chase the caries
operators are not clear of the internal map / geography of the pulp
Know your
Geography
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ii. Law of Concentricity: The walls of the pulp chamber are always
CEJ, that is, the external root surface anatomy reflects the
iii. Law of the CEJ: The distance from the external surface of the
STEP # 4
Most important
39 (a)
39 (b)
sticking to it, you will gain access in a predictable way without the
concern of perforating the floor of the chamber.
Once we enter into the roof of the pulp chamber then the operator
has to change to a lateral cutting motion instead of proceeding
in an apical direction. Care must be taken to slowly completely
remove the roof over the pulp chamber.
39 (c)
39 (d)
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explorer. Once through the secondary dentin and pulp stones, the
Color is the
language of endodontics
Table 1: Color chart of endodontic access cavity preparation
Enamel
White
STEP # 6
Dentin
Yellow
line access
Gray
Pulp stone
Establish straight
Fig. 43 The probe pointing into the distal canal while straight line access is
not present for the mesial canals
Fig. 42 Note the dome shaped floor having a distinct gray color after the
partial removal of pulp stones
Law of color change: The color of the pulp chamber floor is always
STEP # 7
Moment!!!
Eureka
they do not fuse with the floor like secondary dentin does. For this
reason, they can often be picked away from the floor with a sharp
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Fig. 49 Representation of first and second laws of symmetry and first, second
and third laws of orifice location
Conclusion:
Cleaning and shaping constitutes the most important phase of
endodontics. However, it is the access cavity preparation that lays
the foundation for successful cleaning and shaping. In my opinion,
mastering the art of access cavity preparation is the single most
important operator variable that ultimately determines both the
prognosis and quality of the endodontic therapy
The following laws will help the clinician in locating the canal
orifices:
Law of symmetry 1: Except for maxillary molars, the orifices of the
canals are equidistant from a line drawn in a mesio-distal direction
through the pulp chamber floor.
Law of symmetry 2: Except for maxillary molars, the orifices of the
canals lie on a line perpendicular to a line drawn in a mesio-distal
direction across the center of the floor of the pulp chamber.
Law of orifices location 1: The orifices of the root canals are
always located at the junction of the walls and the floor.
Law of orifices location 2: The orifices of the root canals are
located at the angles in the floor-wall junction.
Law of orifices location 3: The orifices of the root canals are
located at the terminus of the root developmental fusion lines.
The above laws were found to occur in 95% of the teeth examined.
Five percent of mandibular second and third molars did not
conform to these laws because of the presence of C-shaped canal
anatomy.
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