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From: Terry Pannkuk
To: ROOTS
Sent: Friday, February 09, 2007 8:27 AM
Subject: [roots] Deep Bifurcation and the Necessity of Access
To have greater assurance that the root canal system is clean by
facilitating better wall contact with precurved files, you need
unimpeded access to each orifice. To insure control of more
complete obturation and deep penetration of heat carriers and
pluggers so that multiple waves deform gp without “shrink back
at the POE’s you need to have unimpeded access to each
canal orifice.
Flaring the access to the coronal portion of the crown in no way
cervically weakens a tooth which is an important issue, more so
than the occlusal surface outline. A constricted occlusal
outline means visibility is limited, irrigant flushing is limited,
precurved file contact is limited, the risk of file separation is
increased, obturation is compromised, and the endodontic result
may look good on the radiograph but isn’t as idealized as it
could be. A SEE access strategically removes the necessary tooth
structure to completely treat the tooth. The first rule is to
complete definitive endo. Only a gross lack of understanding and
anatomical ignorance, extending access to unimportant areas/walls
wrecks a tooth.
Poor restoration wrecks a tooth, not definitive endo.
Above is a case from this morning where I took some extra pictures
of the cleaning, shaping, and downpack sequence. Clearly there was
an apical bifurcation that was better visualized by flaring as much
as practical. There are fewer lateral canals, bifurcations and Hess
anatomical ramifications demonstrated with the rotary shapes created
through restricted access preparation. Small as practical means
Flared as Necessary. The first rule is to definitively complete
endodontic therapy. Improper restoration and failure to understand
anatomy by ditching and ledging cervical areas through a constricted
blind occlusal outline wrecks a tooth - Terry
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