Access cavity of Premolar
Teeth
Dr\ Mohamed Samir
lecturer of Endodontics
Maxillary First Premolar
Maxillary First Premolar
In premolars, pulp chamber is located in the center
of occlusal surface between buccal and lingual cusp
tips.
access cavity can be prepared without involving the
cusps
Maxillary First Premolar
• The orientation of the access cavity must be
buccolingual, not mesiodistal, as with the cavity
created in restorative dentistry.
Maxillary First Premolar
• Penetration:
• Directing No. 4 round bur in the middle of the
central sulcus, parallel to the long axis of the
tooth .
• The bur is moved in buccolingual direction to
deroof the pulp chamber.
Maxillary First Premolar
• Once the “drop in” is felt, locate the canal orifices
with the help of sharp endodontic explorer.
Maxillary First Premolar
Deroofing:
Deroofing the pulp chamber using a round, tapered
fissure or non end cutting bur alongside the walls of
pulp chamber working from inside to outside to
“peel” the undercuts of dentin that remains after
penetration.
Maxillary First Premolar
Finishing and flaring:
Remove any remaining cervical bulges or
obstructions using safety tip burs or Gates-
Glidden drills so that the cavity is finished and
flared.
Maxillary First Premolar
The final shape of the access cavity is ovoid
with larger dimensions buccolingually, and it
usually does not involve the cusp peaks.
The boundaries of access cavity should not
exceed beyond half the lingual incline of buccal
cusp and half the buccal incline of lingual cusp.
Maxillary First Premolar
Two canals are often joined by a shallow
groove located at floor of pulp chamber
Maxillary second premolar
Maxillary second Premolar
Maxillary Second Premolar
It is similar to that of maxillary first premolar.
Weine stated that second premolar has single
root with ovoid canal in 60% of the cases.
Finding of single, eccentric canal orifice
indicates presence of another canal.
Mandibular first premolar
The buccal cusp is more pronounced while the lingual cusp is just
evident.
So, considered a canine with a large cingulum.
The pulp chamber, which is ovoid and directed buccolingually,
lies almost entirely below the buccal cusp;
thus, 90% of the access cavity must be created at the expense of
the buccal cusp.
The entry point of the bur is in the middle of
the central groove, the inclination directed
toward the side of the buccal cusp, which is
eliminated almost at the peak.
In contrast, the side of the lingual
cusp is almost completely
preserved.
It would be incorrect to orient the
bur parallel to the long axis of the
tooth, because this could easily lead
to a lingual perforation.
Mandibular First Premolar
Access cavity of mandibular first premolar
differs from maxillary premolar in following
aspects:
The 30° lingual inclination of the crown to the
root; hence the starting point of bur penetration
should be halfway up the lingual incline of the
buccal cusp on a line connecting the cusp tips.
Shape of access cavity is oval which is wider
mesiodistally, when compared to its maxillary
counterpart
Mandibular second
premolar
Mandibular Second Premolar
The access cavity preparation is
similar to mandibular first premolar
except that in mandibular second
premolar
Enamel penetration is initiated in
the central groove because its
crown has smaller lingual tilt
Mandibular Second
Premolar
Because of better developed lingual half,
the lingual boundary of access opening
extends halfway up to the lingual cusp
incline, making pulp chamber wider
Buccolingually
Ovoid access opening is wider
mesiodistally
Mandibular Second
Premolar
It can have 2 lingual cusps, if of equal size,
the prep. is centered mesiodistally in a line
connecting the buccal cusps and the lingual
groove between the lingual cusp tips, if not
of equal sizes, (ml larger) the lingual
extension of the oval outline is just distal to
the tip of ml cusp.
Errors of access cavity preparation of premolars
Coronal perforation due to under extension preparation
failure to recognize the inclination of the access cavity over extension preparation failure to explore and recognize the second canal
