Remodeling a Ninja Access

Ninja accesses are one of the more discussing topic nowadays in dentistry, here a case where some mistakes has been done thanks to a wrong approach in the access

Ninja accesses are one of the more discussing topic nowadays in dentistry , here a case where some mistakes has been done thanks to a wrong approach in the access


The author will soon host a workshop:

Micro Endodontics Surgery

Micro Endodontics Surgery

An intense two days hands-on training to teach the rational and technical aspects of endodontic microsurgery

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Lesson transcript

 After removal of the temporary filling is clear the access missed part of the original anatomy , with the micro suction we are trying to understand what’s happened on the pulpal floor . 
In the middle of the access there is an area looks like a perforation , that’s why with a paper point we are checking for any bleeding . Probably it’s not a perforation , but now we have to increase the dimension of the access for a better vision removing the old infiltrated composite . 
 The situation is now clearer , large areas of necrotic tissue that visually occlude canal orifices . With the use of Ultrasonic device  we are improving the quality of the access , the ultrasonic tip remove the infiltrated tissue in a selective way . This action takes time but is really efficient in preserving health tissue . It’s important during this phase of the treatment to alternate the tip action with the irrigation of the cavity access activating the sodium hypochlorite with the same tip . 
Step by step the vision of the floor increase a lot , now is possibile to clearly see the palatal orifice , and the distal one . With the explorer we are checking the position of the mesial orifice and we need to better discover this area below the cusp that’s why we will increase the dimension of the access selectively removing tissue with the ultrasonic tip . 
With the new access the visibility is completely changed , the orifices are visible and we can interpret the tooth anatomy correctly . 
Now the access has been designed and we can remove the infiltrated tissue on the pulpal floor , this is a very important action because we have to eliminate all the bacterias and the necrotic tissue , all phase of treatment were performed using ACTEON - SATELEC P5 NEWTRON ULTRASONIC DEVICE   and ET 18 ULTRASONIC TIP 
 Irrigation and the following activation of the irrigant  allow us to  understand how is different the situation now , in term of visibility and cleaning , but the job is not finished yet . 
Procedures takes time , but step by step the situation has changed , more magnification we will use and more careful will be our action , we are working in the inner space that’s why we need control 
The quantity of infiltrated tissue is so important that we have to use a slow speed rotary bur to clean  pulpal floor completely , especially around the palatal orifice . 
Pulpal floor is clean , now we have to go forward in our treatment 
The pre-flaring using rotary instruments will complete the access moving the orifices away from the furcation in their final position , improving the cleaning  of coronal one third of the root canal system 
Using a step-down technique and taking advantage of instrument’s taper the blades will remove the last part of infiltrated tissue . Don’t forget to use a gentle action don’t push the files too much deeper in the canal and let the game come to you . 
The role of the cleaning is really important during all the treatment’s steps and the action of the irrigant will increase the visibility  allowing us to detect the entire anatomy including the mesio buccal canal . 
The refinement of the orifices using the ultrasonic tip design the final access where is possible see 4 orifices , palatal , distal , MB1 and MB2 , the difference between the original access and the new access is huge and show what’s important the access cavity in the Endodontics treatment . 

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Hussain Al-huwaizi

It is important to concentrate on performing an access opening that allows us to negotiate all the canals and get ood endodontic treatment rather concentrate on narrower access opening