Creating the perfect access can be difficult and time consuming—until now! My next two reviews give you an easy solution for pristine endodontic access.
One of the goals in root canal therapy is to remove the entire pulp complex from the pulp horns to the apex. I like to divide the pulp into two sections. The portion above the cementoenamel junction (CEJ) is the coronal pulp tissue and the portion below is the radicular pulp tissue. The radicular pulp tissue is removed with instruments and irrigants, while the coronal pulp tissue is removed with a bur.
To simplify the removal of the coronal pulp tissue, it’s important to review the literature to determine a few measurements and make this a safe procedure. According to Azhim et al. JOE 9/2014, his CBCT calculations noted the average distance from the furcation of the tooth to the floor of the pulp chamber is approximately 3 mm. The average pulpal height is 2 mm and the average distance from the pulpal ceiling to the cusp tip is 6 mm (regardless of maxillary or mandibular tooth). Therefore, we have an average of 8 mm before we start impinging on the pulpal floor of most molar teeth.
My suggestion is to take the Diamond Access bur from Lexicon, which comes in sizes 2, 4 and 6, and use a permanent marker 8 mm from the tip to gauge where you are in those challenging and not so challenging teeth to make sure you enter the pulp chamber safely. This simple hack will allow for a quick and easy penetration and enlargement of the pulp chamber. (Figure 1).
In part two of this review, I discuss how the Pulp Shaper bur can also help you achieve perfect access.
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