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| technique access cavities 26 roots 4 2016 we could “just suck the pulp out, without cutting any toothstructure.”Aswetalked,Icametobetterunder- stand the structural imperative of saving teeth in the long term, setting me on a quest for tools and meth- ods that would allow us to achieve the same consis- tently ideal endodontic outcomes, through smaller access openings and coronal canal shapes. Ultimately, it was the inspiration for my invention of the Maximum Flute Diameter (MFD) limitations on GT and GTX rotary files (DENTSPLY Tulsa Dental Spe- cialties), the LAX (line angle extension) GuidedAccess Diamond Burs by SybronEndo, as well as obturation methods using flexible condensation devices, such as System-B Continuous Wave electric heat pluggers (SybronEndo)andGT/GTXObturators(DENTSPLYTulsa Dental Specialties). The Itty Bitty Access Committee Since that initial awakening in the ’80s, it has felt like being a lone voice in the wilderness until the past 10 years, when a new generation of dentists and en- dodontists,steepedinthenewrealityofimplantden- tistry as an alternative to RCT, have taken up the cry for longer-term outcomes through improved struc- tural preservation, ultimately becoming what I jok- ingly call The Itty Bitty Access Committee (IABC). Assooftenhappens,somebodyoutsideofourspe- cialty,ageneraldentistnamedDrDavidClark,started lecturing on the access elephant in the endodontic livingroom.HegotmybuddyDrJohnKhademiturned on to the possibilities that more conservative access cavities could offer the specialty,4 and one by one a groupofyoungendodontistsjoinedthegameofwho candoaperfectRCTthroughthesmallestaccesscav- ity. This ad hoc group of talent began the IBAC club. The cases shown in Figures 4 through 10—mostly done by IBAC members—make me very happy and afraidatthesametime.Whattheheckaretheydoing? Little, tiny entries, leaving pulp chamber roofs intact, lateral pulp horns unroofed as well, or just total RCT through previously cut restorative cavities! After getting over my initial shock at what they wereaccomplishing,Icametounderstandthatthefu- ture of endo is very good in these extremely talented hands, and I saw that the procedure I was developing for endodontic surgery—CT-guided endodontic sur- gery (CT-GES)—could be applied to conventional treatment as well (Figs. 11a–12d). Andmorningbreaksoverthefieldofendodontics._ Editorialnote:ThisarticlewasfirstpublishedintheClinical Masters magazine, Vol. 1, 1/2015. A complete list of refer- encesisavailablefromthepublisher. author DrL.StephenBuchanan,DDS,FACD,FICD,isadiplomateofthe AmericanBoardofEndodontics,afellowoftheAmericanand InternationalCollegesofDentistsandservesaspart-timefaculty totheUCLAandUSCgraduateendodonticprograms.Heholdspatents ontheEndobenderPlier(SybronEndo),System-BandContinuousWave obturationtoolsandmethods(SybronEndo), GTandGTXfilesystems(DENTSPLYTulsaDentalSpecialties), LAAxxessBurs(SybronEndo),andBucultrasonictips(Spartan/Obtura). BuchananlivesinSantaBarbara,CA,whereheenjoysapracticelimited toconventionalandmicrosurgicalendodonticsanddentalimplantsurgery.Heisthefounderof DentalEducationLaboratories,ahands-ontrainingfacilityinSantaBarbarathathehasdirected for28years. Figs.11a–c: From left:Virtual treatment planning for CT-guided endodontic access (CT-GEA).The tooth to be treated is segmented from the CT volume,ideal access entry paths are plotted through the occlusal surface of the tooth,and a CT-GEA drill guide is 3-D printed. Figs.12a–d: From left:Author’s root-fractured #18; that tooth set in a stone model after extraction,with the printed CT-GEA drill guide mounted and the first drill in place; the two small access entry holes cut using the drill guide; and a post-exercise radiograph showing cones fit in canals after they were negotiated and shaped. Fig.11a Fig.12a Fig.12b Fig.12c Fig.12d Fig.11b Fig.11c 42016