
Access Pulp Chamber
Begin access at the center of the occlusal surface with a #331 or #245
bur. Penetrate to the pulp chamber. Remove the entire chamber roof with a
lateral and upward motion. Thoroughly clean the pulp chamber with copious
irrigation, vigorous scraping (endo spoon excavator) and suction.
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Locate Canal Orifices*
Locate all canal orifices with an endodontic explorer. For highly
calcified canals use a small
K-file to locate the orifices. Instrument all canals to about mid-root
until a #10 K-file fits
loosely. Do not instrument beyond mid-root. Remove pulp tissue from
canals with barbed broaches.
*LightSpeed suggests loupes or microscope for enhanced visualization.
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Move Mesial Canal Orifices
With Hedstrom files sizes 15, 20, and 25 (in that sequence) move (transport) the mesial canal orifices and coronal third of the mesial canal walls away from the furcation (see arrows). This helps avoid furca perforations with rotary instruments used for coronal flaring (Step 4). The mesial canal orifices and the coronal third of the mesial canal walls are moved mesially. By forcefully directing the Hedstrom blade mesially, the dentin at the orifices and walls is cut away with a pulling motion. This mesially directed filing is called "anticurvature filing" because it removes the coronal curve of mesial canals. When this curvature is removed, instruments can enter parallel to the long axis of the tooth rather than from the distal. This minimizes furca perforations and instrument separation.
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Flare Coronally
The coronal 4 mm of the canal
is flared and cleaned with G-G's, sizes 2, 3, 4, in that order. Rotaries
are safe if the coronal curve has first been straightened with Hedstroms
(Step 3). Use a light pecking motion to advance G-G's about 4 mm into the
canal (blade length of #4 G-G). Using force may cause a ledge. Distal and
palatal canals of molars having oval shapes coronally can be cleaned with
G-G's directed back and forth, wiping and cleaning all walls of the oval.
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Complete the StraightLine Access
Remove any remaining projections of the chamber roof with a long, tapered,
high speed diamond, leaving smooth, continuous access walls from chamber
floor to top of
crown. Then, make a "path" from each mesial canal orifice to the top of
the crown. Do this by: a) placing the tip of the diamond (not rotating)
into the canal orifice, b) raising the tip just slightly above the
orifice, c) activating the hand piece and tilting the diamond vertically.
Do not move the tip. Use the diamond the same way for the distal (Man.)
and palatal canals (Max.)
except that the diamond is tilted parallel to the coronal part of the
canal rather than vertically. This completes a standard access
(Fig. 5). |
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Modify The Access for
Rotary Instruments
With all Ni-Ti rotaries, the most difficult canals to enter are the ML of
Mandibular and MB of Maxillary molars. To make
entry easier and reduce the possibility
of a separation during instrumentation,
the "path" to these difficult orifices must
be modified.
Position the hand piece at each orifice as described in Step 5, (a) and
(b). The modification to (c) of Step 5 entails
further tilting of the long tapered diamond beyond the vertical towards
the mesio- lingual line angle (see arrows). Modify the ML "path" by
tilting the diamond until the hand piece can be withdrawn without hitting
the upper teeth. For the MB "path" tilt the diamond until the hand piece
can be withdrawn without hitting the lower teeth. These new "paths" make
for better StraightLine access.
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Do |
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Do appreciate the importance of a good access. Access "paths" guide
instruments, gutta percha cones, etc., to
canal orifices
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Do understand that the entire chamber roof must be removed
to locate all canal orifices
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Do realize that the location of canal orifices dictate the shape
of the access (usually triangular, sometimes rectangular,
never round)
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Do make a good access by making a "path" from the occlusal
surface to each canal orifice
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Do move mesial canal orifices and their coronal canal walls away from
the furcation area to avoid a furca perforation or instrument separation
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Do perform early coronal flaring. We highly recommend it
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Do use a light pecking motion when using Gates-Glidden
drills to avoid ledging
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Do clean oval canals (coronally) with G-G drills using
a back and forth brushing motion. Move the G-G's in the direction of
the oval, milling the walls clean
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Do modify the access "path" to the mesio-lingual canal of mandibular
molars and the mesio-buccal canal of maxillary molars (Step 6)
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Do concentrate just on access and spend the time to get
it right
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Do Not |
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Do not make access as a small or large round hole. Neither
provides guidance into canals
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Do not use explorers or spoon excavators that are not
specifically designed for root canal treatment
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Do not rotate Hedstrom files for any reason. They cut very
effectively in a pull motion but may break when rotated
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Do not use excessive lateral forces with Gates-Glidden
drills. The smaller sizes may fail
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Do not go into curved canals more than about 4 mm with
Gates-Glidden drills
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Do not allow the tip of the diamond to touch the canal orifice
(Step 5 and Step 6). This may make a shelf. Instead, suspend the tip
slightly above the orifice
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Do not trivialize the importance of a good access. It's an
absolute must do. No compromising |
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