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ePaper created 2018-03-06, 08:52:14 | version 1.38.0
trends & applications | Fig. 12a Fig. 12b Fig. 12c Fig. 12d Fig. 13 Figs. 12a–d: The four canals after obturation. P = palatal; MB2 = second mesiobuccal; MB = mesiobuccal; DB = distobuccal. Fig. 13: Post-op radiograph. third of the canal as illustrated in Figure 1b. Moreover, with the aid of pre-bent modern rotary files, which have super-elastic alloys even in their martensitic phase (rest phase), it is possible to enter root canals with difficult ac- cess without sustaining fractures. Only after we have visualised the actual anatomy of the pulp chamber is it possible to precede with root canal shaping, followed by the phases of 3-D cleaning and 3-D obturation. With modern protocols of irrigant activation, it is possible to guarantee a more accurate and thorough cleaning. Among these protocols are ultrasonic activa- tion, sonic activation, internal heating, laser and negative apical pressure. Why? Why complicate life? This is one of the most repeated questions when it comes to the conservative access. The answer is simple: because the suggested access design in the current article is not extreme, and when it is per- formed with experience and with the updated technolo- gies while respecting all of the previously discussed pa- rameters, iatrogenic errors can be avoided. Not only will the tooth be treated in a safe and healthy approach that will preserve valuable tooth structure, but the short- and long-term success will be improved as well. Figures 3–13 illustrate the preparation of a conservative access cavity and its clinical applications in clinical cases. Conclusion If through the conservative access cavity, it is possi- ble to eliminate the entire carious lesion, to visualise the whole floor of the pulp chamber, to explore all of the ca- nal orifices, to prepare and to clean the isthmuses, and to remove any calcifications present, then it is possible to obtain short- and long-term success. Above all, valuable sound tooth structure will be preserved in comparison with the conventional access design. Certainly, in order to prepare these conservative ac- cess cavities, it is necessary for the operator to have enough clinical experience. Equally important is the use of modern technologies, in particular the dental operating microscope, ultrasonic tips, modern rotary files and up- to-date protocols of 3-D cleaning. In conclusion, these modern technologies and this conservative access de- sign should be implemented by more endodontists in or- der to achieve higher rates of success and longevity of root canal therapies. Editorial note: A list of references is available from the publisher. contact Dr Alfredo Iandolo is a contract professor of Endodontics at the University of Naples Federico II in Italy. He can be contacted at iandoloalfredo@libero.it. Dr Dina Abdel Latif is an endodontist, clinical and pre-clin- ical instructor (Department of Conser- vative Dentistry) at Alexandria University in Egypt. She can be contacted at dinaabdellatif81@gmail.com. roots 1 2018 15