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The challenge of every dentist initiating endodontic treatment is to safely prepare the access cavity and to definitively identify the orifice(s). Featured in this show is access refinement with the SINE Ultrasonic Instruments.
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the terminal abutment of this three in a bridge is intimately involved notice the diffused lesions associated with the apices it's interesting as a side note to know that about 20% of all sinusitis is odontogenic in origin one final comment notice the club-shaped mb route a lot of colleagues would look down into this photographic image into the pulp chamber and say I'm ready to begin clean and shaping but to me the access cavity although it's a nice start it's still deficient by placing hand files into the orifices you can begin to interpret the entry angle of the canals as they enter into the pulp chamber here we're brushing with a gates glidden - now we're using a gates glidden 4 so we can use a series of gates as 1 through 4 to relocate or forces away from Furcal site concavities the bigger Gates's can be used to marry the orifices to the axial walls and we can progressively expand the coronal part of the canals to remove restrictive dentin so hand files stand up straight and tall this is a very very tight calcific env2 orifice by removing some of the restrictive dentin with ultrasonics you can notice there's more room to accommodate the 10 file notice the 10 file is still very tight as you can observe handle flutter rather than try to negotiate the full length of the canal it's important to stop and reevaluate do I have good access the answer is we could benefit from using a surgical length diamond and taking the entire mesial wall back at the expense of the mesial marginal Ridge this will tend to upright our hand files notice the change in the outline pattern from the occlusal view well we can use again ex gates or gee-gees to flare the orifice by removing restrictive dentin were able to irrigate better vacuum and irrigate notice without much more effort the instruments are probably close to the full working length and the instrument handles are observed to be standing up straight and tall if you observe the post-operative film again you can see that there's an MB 1 and 2 that have been cleaned shaped and packed it is interesting that about 93% of all maxillary molars have 2 systems in the mesial buccal root and about 40% of the 93% it's important to note that the two systems are separate over length and end in two or more separate apical portals of exit in this occlusal view notice how far mesial the mb2 orifices it has historically been said that the mb2 orifice is on an imaginary line from the mv-1 to the power rule you can see in most instances like this one this is just not the case color is another great indicator and road mapping method for finding second systems let's review how to find mb2 systems and maxillary molars it all starts by evaluating multiple horizontally angulated preoperative films check out your straight line access you either have it or you don't so if you're off axes that'll dictate the next move on the chessboard that is removing triangles of dentin ultrasonic techniques are very valuable by removing the bulky head of the handpiece to allow us to work precisely doing detailed work it is usual to alter the outline pattern to accommodate treating the mb2 system pre enlargement techniques allow our small sized hand files to work more easily towards the apical 1/3 so by managing the access cavity chamber like we've talked about you can begin to find and treat with great confidence in B
