ENDODONTIC CAVITY PREPARATION

By Dr.Mohamed khalefa Prof. Of endodontics Al-Azhar University.

ENDODONTIC CAVITY PREPARATION

Divided into:

* Intra-Coronal preparation.

* Intra-Radicular preparation.

Endodontic cavity preparation

Objectives:
1) Obtaining direct line access to both RC orifices & Apical foramen.

2) Conservation of tooth structure.

3) Reroofing of the Pulp chamber.

1) Intra-Coronal Cavity Preparation.

Principles of Intra-Coronal Cavity Preparation:

(I): Out line Form. (II): Convenience Form.

(III): Removal of Remaining Carious Dentin & Defective Restorations.

(IV): Toilet of the Cavity.

Principle I: Outline Form:

Endodontic cavity is correctly shaped & positioned to establish complete access for instrumentation from cavity margin to the apical foramen.

N.B.

External outline form is established by mechanically projecting the internal anatomy of the pulp into the external surface of the tooth.

Factors affecting Outline Form

1) Size of the pulp chamber. 2) Shape of the pulp chamber. 3) Number, Position & Curvature or Direction of each individual root canal 4) Age of the patient.

Principle II: Convenience Form:

I.e. Modification of the Cavity Outline Form to establish greater conven-ience in preparation as well as obturation of the root canals.

Benefits of Convenience Form:

1) Unobstructed access to the canal orifice & searching for extra canal.

2) Direct access to the apical foramen. 3) Complete authority over the enlarging instruments.
4) Cavity expansion to accommodate filling techniques

Principles III: Removal of the Remaining Carious Dentin & Defective Restorations:
I.e. All carious & loosed or fractured restorations must be removed & the cavity is sealed with hard restoration before Endodontic cavity preparation is established.

Benefits of Removal of Carious Dentin & Defective Restorations:

1) To eliminate mechanically as many micro-organisms as possible from the interior of the tooth. 2) To eliminate the discolored tooth structure. 3) To eliminate the possibility of micro-organisms coming with saliva leakage through defective restoration. 4) To avoid detached tooth or restoration particles from entering & closing the root canal.

Principle IV: Toilet of the cavity: (Irrigation of the Cavity)

All the detached carious dentin, debris & necrotic material must be removed from the pulp chamber before the Radicular preparation is begun because they may: 1) Obstruction of the canal during enlargement. 2) Increase bacterial possibilities in the canal (RCs infection). 3) Discoloration of the crown.

Access Cavity Preparation for Anterior Teeth (Step by Step)

Maxillary Incisors

Mandibular Incisors

Maxillary Cuspid (Canine)

Mandibular Cuspid (Canine)

 -Maxillary & Mandibular premolar : the outline

form prepared in the center of the occlusal surface as OVAL shape .

Maxillary molars

The access preparation on the occlusal surface as a triangular shape , with the base toward the buccal surface and the apex toward the palatal surface . The first penetration of enamel is made using round bur at the central groove midway between the mesial marginal ridge & the oblique ridge and the roof of the pulp chamber is removed completely . The access preparation is to be enlarged to accommodate the fourth canal in the MB root .

 Mandibular molars :
The access preparation on the occlusal surface as a triangular shape in case of 3 canals ,or rectangular shape in case of 4 canals . The base of the triangle is towared the mesial surface and the apex toward the distal .

Access Preparation
Access Opening

ENDO ACCESS BUR

(Dr Howard Martin)
Grain : Coarse Shank : FG

Orifice Loction :
Access Preparation
Access Opening Orifice Location

Pathfinder or endodontic explorer is used for Reaching, Feeling, and Digging at canal opening.

Errors in coronal cavity preparation of maxillary & mandibular anterior teeth :

1-discoloration of the crown which caused by failure to remove pulp debris . 2- failure to explore the second canal which caused by inadequate inciso-cervical extension of coronal cavity . 3-perforation at the labio-cervical caused by failure to complete extension towered incisally . 4- gouging of labial & distal wall caused by failure to correct angulations of bur during access cavity . 5- ledge formation at apico-distal curve caused by using incurved instruments .

Errors in cavity preparation of maxillary & Mandibular premolars

1- Under or over extended preparation . 2- perforation at mesio-cervical indentation . 3-failure to explore second or third canal .

1- Perforation into furcating region . 2- failure to detect fourth canal . 3-perforation at mesio-cervical caused by failure to orient bur with long axis of molar severely tipped to mesial .

Molar teeth