Rational for the access cavity treatment

Fabio Gorni

The non surgical retreatment 

The disassembling is one of the most important step in nonsurgical retreatment. That's why in the video I want to show you the rationale for treatment and how is important the access cavity in this step.  The case that they want to show you today is a retreatment in the upper molar where the previous treatment failed. Success in endodontics is strictly connected to the rationale that we will apply during our treatment, valid in case of primary treatment and retreatment as well.  

Incorrect approach = big problems

This case is a typical example of what we are saying: an incorrect approach during the access has created a big problem missing part of the root canal system. The collegue tried to perform the access cavity not removing the distal crest margin and the decay below this area. The wrong approach have carried out the complete failure of the treatment.  The video will show however as a more rational approach allows us to reach the space below with a simple action maintaining optimal visibility during all the therapy.  The first and the very important reasone you have to do before the end the treatment is what type of restoration would be the best solution for these tooth. Is it possible to restore the tooth without losing that distal margin? Definitely no. Consequently, the first thing to do it will be remove part of the dental tissue in order to further. First the complete elimination of the decay. Second allow adequate consideration about periodontal problems. Third, allow the correct isolation with the positioning of the rubber dam. And last but not least, obtain an optimal visibility and access. It's not only a waste of time trying to keep part of the distal tissue non recoverable from a restoration point of view, but counterproductive from every point of view. For these reasons, we should quickly break down the distal margin crest and subsequently remove all the caries, improving the shape of our access cavity. After the cleaning of the cavity, we really evaluate if it's possible to perform the correct isolation without any kind of periodontal surgery and or without any pre-endodontic build-up.  Once established, the tooth can be successfully isolated. Thanks to the liquidy dam, we can obtain a good isolation for the next step of in the endodontic therapy. After completing the access cavity, we can proceed with shaping and cleaning the root canal system. All the procedure are extremely simple thanks to the condition created by the rational approach. Underestimating how important it can be to simplify and rationalize our procedures can not only complicate or at the same time compromise the current performance of our therapy, but also increase the chair time.  The therapy will be completed with a three dimensional obturation using warm gutta percha and vertical condensation technique by Herbert Schilder. Obtain a predictable result in endodontics is strictly connected to the seal of the too canalf system that we will have at the end of the treatment. Nowadays perform a technique is quite simple, especially using new device is extremely useful during the heating up of the gutta percha like Fast Pack from Eighteeth Company, thanks to innovative software, allow us to quickly heat the gutta percha.  Another best advantages using Fastpack is to control the temperature of the heating and choose from five different programs in function of our need and techniques. This option could be very useful if you want to change the gutta percha consistency or use different type of cements that can need different level of eating.  


After completing the filling we carefully clean the cavity and the pulpal floor from excess of cement before the post endodontic restoration. Comparing the cavity before and after the therapy would be easier to understand the difference between the two approaches. The key to success is strictly linked to simplify the procedure going straight to the target. Our goal is made the difficult fames simpler. 

One comment on “Rational for the access cavity treatment”

  1. Your article gave me a lot of inspiration, I hope you can explain your point of view in more detail, because I have some doubts, thank you.

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