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ePaper created 2018-03-06, 08:52:14 | version 1.38.0
| trends & applications Minimally invasive access cavity preparation in endodontics: When? How? Why? Dr Alfredo Iandolo, Italy, & Dr Dina Abdel Latif, Egypt Introduction Bacteria and their by-products are the main causative factors of infections in the pulp and the periapical area.1 The aim of modern endodontics is to eliminate or reduce the bacterial load to levels compatible with the healing process.2 This can be achieved by adequate root ca- nal shaping, appropriate 3-D cleaning and finally com- plete obturation of the complex root canal system with thermoplasticised gutta-percha.3, 4 The previously listed Figs. 1a–c: Cleaning the pulp horns with an ultrasonic tip for endodontic surgery. procedures can treat irreversible pulpitis or eliminate a periapical and/or lateral lesion of endodontic origin. However, even if carried out correctly, a short or long- term success cannot be guaranteed from the structural point of view. One of the major causes of postoperative root canal therapy failures, leading to extraction of the treated tooth, is tooth fracture due to insufficient remaining tooth struc- ture. For this reason, if correct and modern endodontic treatment is combined with a minimally invasive access design, which provides the room to explore and conserve as much of the tooth structure as possible, greater dura- bility will be assured for the treated tooth. The success of endodontic treatment depends on identifying, exploring and completely treating all of the complex root canal system. This goal can be accom- plished through possessing the requisite knowledge and exploring the anticipated canal system using the new- est technologies. Throughout the past few years, min- imal access cavity preparation and its disadvantages have been topics of much debate. The objective of this article is to discuss when it is possible to create conser- vative access cavities in endodontic treatment, how this should be done and why. When? A minimally invasive access cavity can be prepared only if the following considerations can be entirely re- alised: – direct visualisation of the entire floor of the pulp cham- ber and ability to fully explore the anatomy of the pulp chamber – ability to localise all of the anticipated canal orifices – complete removal of any present calcifications on the floor of the pulp chamber – ability to prepare the isthmuses in premolars with two root canals – likewise, ability to prepare the mesial isthmuses in Figs. 2a–d: Cleaning the pulp horns with an ultrasonic tip. mandibular molars 12 roots 1 2018