Endodontics | Treatment - Access Cavity | INBDE, NDEB, ADAT — Transcript

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1. 0:05hello everyone Dr shahad here and in
2. 0:07this video we're going to talk about
3. 0:09axis cavity
4. 0:10preparation as mentioned previously
5. 0:13there are three main steps of endodontic
6. 0:15treatment the first being axis cavity
7. 0:17preparation followed by cleaning and
8. 0:19shaping of the root canals and finally
9. 0:22obturation of the root canal system in
10. 0:25this video we're going to take a deeper
11. 0:26dive into the first step of axis cavity
12. 0:29preparation
13. 0:30all right let's get into it the main
14. 0:33objective of access preparation is to
15. 0:35give us access to the pulp Chambers and
16. 0:37the root canal system this is the most
17. 0:40important step of RCT since it sets the
18. 0:43stage for all of the subsequent clinical
19. 0:45steps now in order to have a successful
20. 0:48access prep not only do we have to find
21. 0:50the canal orifices but we have to create
22. 0:53straight line access to those orifices
23. 0:56to make the instrumentation steps more
24. 0:58efficient
25. 1:00and we can achieve all of this with the
26. 1:02help of our high-speed Burr we typically
27. 1:05start with a cylindrical Burr and
28. 1:07carbides are preferred here mainly due
29. 1:10to their cutting speed and their
30. 1:13effectiveness later on we can switch to
31. 1:15a round bur which will give us a bit
32. 1:18more control when trying to locate the
33. 1:20actual Canal
34. 1:23orifices now I have a few more points
35. 1:26that should be kept in mind during axis
36. 1:28cavity preparation the first concerns
37. 1:31the rubber Dam rcts should always be
38. 1:35done under a rubber Dam and it should be
39. 1:37placed before accessing the pulp chamber
40. 1:40because even though it's likely that
41. 1:42teeth requiring root canal treatment
42. 1:44have bacteria already present in the
43. 1:45pulp we don't want to introduce more
44. 1:48bacteria into the pulp and by not using
45. 1:51a rubber damp that's exactly what we
46. 1:52will be doing so don't be that guy or
47. 1:55gal that doesn't use a rubber d make me
48. 1:57proud use the D the second point is that
49. 2:01we must der roof the entire pop chamber
50. 2:03including the pp horns so that we can
51. 2:06adequately remove all remnants of the
52. 2:08pulp because we have to remember guys
53. 2:10the pulp at this point is infected and
54. 2:12so we want to remove all infected tissue
55. 2:15and maintaining straight line access to
56. 2:17our orifices really helps achieve this
57. 2:19goal but it's a fine
58. 2:22line you also want to conserve as much
59. 2:25tooth structure as possible so you can
60. 2:27imagine that obliterating and cutting
61. 2:29away the entire crown for example would
62. 2:31theoretically gain you straight line
63. 2:33access to the orifice but at what cost
64. 2:36the tooth wouldn't be restorable at that
65. 2:37point so you have to always be cognizant
66. 2:40to avoid over preparation especially in
67. 2:43the areas of cusp tips and marginal
68. 2:46ridges all right guys last thing I want
69. 2:48to discuss is the common shapes for axis
70. 2:51preps these shapes are extremely
71. 2:53important to keep in mind because they
72. 2:54guide us as to where to drill into the
73. 2:56tooth to find our Canal orifices okay so
74. 3:00let's start with the
75. 3:02incizors the AIS preparation shape for
76. 3:04incizors whether it be on the maxillary
77. 3:06or on the mandibular Ridge will be
78. 3:08triangular or ooid and remember these
79. 3:12will always be on the lingual aspect of
80. 3:14the incizors the K9 teeth also have an
81. 3:18ovoid axis prep shape irregardless of
82. 3:20the arch and again these will be on the
83. 3:22lingual aspect of the teeth since they
84. 3:24are part of the anterior teeth just like
85. 3:26the
86. 3:28enzers all right moving on to the
87. 3:30premolar which are our first posterior
88. 3:33teeth which means the axis prep location
89. 3:35will be on the accusal surface and in
90. 3:38this case guys the shape will be an ooid
91. 3:40but they are generally narrow in nature
92. 3:43especially when the premolar has more
93. 3:44than one
94. 3:46rout moving on to the max MERS and here
95. 3:49we have some variability guys since the
96. 3:51misio Bucko rout sometimes contains two
97. 3:54canals we have an MB canal and what we
98. 3:57call an mb2 canal in these these cases
99. 4:00the axis prep shape will be rhomboidal
100. 4:02in nature and we can clearly see that on
101. 4:03the
102. 4:04illustration conversely if the mb2 is
103. 4:07not present you can imagine that the
104. 4:09shape takes on a more triangular shape
105. 4:11as you can see with the molder on the
106. 4:13right in both cases though the apex of
107. 4:15the triangle or the narrow part of the
108. 4:17axis prep will always be towards the
109. 4:20petal since there is only one route in
110. 4:22this
111. 4:23location all right guys last but not
112. 4:26least we have our mandibular molers
113. 4:28which also have some variability
114. 4:30the three Canal variant is definitely
115. 4:32more common and these actually take on a
116. 4:34trapezoidal shape because the distal
117. 4:36Canal typically ends up being pretty
118. 4:38Broad and with the two canals in the
119. 4:40misal route it takes on the shape of a
120. 4:43trapezoid the four Canal variant on the
121. 4:45other hand occurs when there are two
122. 4:48canals in the distal route and in these
123. 4:49cases the shape becomes rectangular
124. 4:52super useful information to know not
125. 4:54only for your exam but also for clinical
126. 4:57practice all right guys now let's
127. 4:59reinforce everything we just learned
128. 5:00with a couple of practice
129. 5:02problems we have a 34-year-old male
130. 5:04Chief complained I have swollen gums and
131. 5:06my tooth hurts while eating we have no
132. 5:09relevant background and or patient
133. 5:10history and current findings indicate
134. 5:13that we have a localized fluctuant
135. 5:14swelling associated with the lower left
136. 5:17first Moler we have no response to
137. 5:19Thermal testing and it's very painful on
138. 5:22percussion so the question is what is
139. 5:24the shape of the axis cavity preparation
140. 5:26for the tooth requiring rot Canal
141. 5:28treatment positive video if you need and
142. 5:30the answer is
143. 5:33trapezoid remember guys the most common
144. 5:35axis cavity preparation shape for a
145. 5:37lower first Moler is trapezoidal because
146. 5:40we have that broad canal in the distal
147. 5:42route along with the two mesial canals
148. 5:45in the misal rout all right let's take
149. 5:48on another
150. 5:49question okay so we have the same
151. 5:51scenario same patient but the question
152. 5:53is when should the rubber Dand be placed
153. 5:55for treatment of the lower left for a
154. 5:57smaller pause the video if you need
155. 6:00and the answer is B before axis cavity
156. 6:05preparation so as I mentioned before you
157. 6:07want to place the rubber Dam before you
158. 6:09begin the access cavity preparation
159. 6:11because you don't want to further infect
160. 6:13the root canal system all right guys
161. 6:16that's it for this video thanks for
162. 6:17watching see you next
163. 6:19[Music]
164. 6:28time
165. 6:30[Music]