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Endodontic Access: Straight-Line Access for Anterior Incisors

Learning Objectives:

As a result of watching this video, the viewer should:

  • Learn what a clinician must do to gain endodontic access to a maxillary central incisor tooth
  • Understand the steps, precautions, and instrumentation that need to be used to gain endodontic access to a tooth

The primary goal of access preparation is to allow instruments to be introduced into the canal without bending. This is referred to as straight-line access. Proper straight-line access is essential to successful endodontic treatment. By correctly accessing the root canal system, the clinician can reduce the possibility of instrument fracture and facilitate obturation.

After the outline form has been established, access should be initiated using high speed rotary instruments to remove the roof of the chamber. Once the roof of the chamber is removed, it is advisable to switch to slow speed rotary instruments. It is essential to avoid damage to the floor of the pulp chamber.

Since measurement control has not yet been established, this is an opportune time to determine if there is a need to reduce the occlusion as part of a pain preventative strategy. There are specific indicators that will help a clinician determine if occlusal reduction is necessary.

Appropriate occlusal reduction is an important component of a pain-preventive strategy which also includes: addressing the patient’s anxiety and preoperative Non-steroidal medication.

Related Reading:

  1. Abou-Rass, M., Frank AL, Glick DH: The anticurvature filing method to prepare the curved root canal. J. Am Dent Assoc. 101:792, 1980.
  2. Acosta Vigourox, Trugeda Bosaans,: Anatomy of the pulp chamber floor of the permanent maxillary first molar. J. Endod. 4:214, 1978.
  3. Baisden MK, Kulild JC, Weller RN: Root canal configuration of the mandibular first premolar. J. Endod. 18:505, 1992.
  4. Barnett F: Mandibular molar with C-shaped canal. Endod Dent Traumatol. 2:79, 1986.
  5. Beatty RG: A five-canal maxillary first molar. J Endod . 10:156, 1984.
  6. Mauger MJ, Waite RM, Alexander JB, Schindler WG: Ideal endodontic access in mandibular incisors. Endod. 25:206, 1999.
  7. Nosonowitz DM, Brenner MR: The major canals of the mesiobuccal root of the maxillary 1st and 2nd molars. NY J. Dent 43:12, 1973.
  8. Vertucci FJ: Root canal anatomy of the human permanent teeth. Oral Surg 58:589, 1984.
  9. Ruddle CJ: Microendodontics: identification and treatment of the MB2 system. J Calif Dent Assoc 25:313, 1997.
  10. Deveaux E: Maxillary second molar with two palatal roots. J. Endod 25:517, 1999.
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