CDA Essentials 2016 • Volume 3 • Issue 1 - page 34

34 | Volume3 Issue1
Supporting Your Practice
Doyouhaveanyburningclinicalquestions related toyoureverydaypractice?Areyou facinga
challengingclinicalcaseandneedadvice?Sendyourqueries toOasisDiscussions forexpertguidance.The
followingquestionwassubmitted toOasisDiscussionsbyageneraldentist.Drs.MaryDabuleanu,Gevik
MalkhassianandSuhamAlexanderprovideda response.
Question
Response
Aremore conservative root canal preparations and smaller tapered files better in preserving tooth structure during
endodontic treatment? The trend seems to be shifting from large tapers (0.08 and 0.06) coronally plus large apical size files
(30, 35) to keeping canals narrow so that tooth structure is preserved and fractures are prevented. Please advise.
OasisDiscussions
AskYourColleagues
Examples in teeth37and46of a
conservativeendodonticaccess.
Figure 1
Endodontically treated teethareoftencompromised structurallyand fracture is
oneof themaincausesof failureof endodontically treated teeth. Theamount of
remaining sound tooth structureplays a significant role in the fracture resistanceof
these teeth.1
Preservationof healthy tooth structuremight beachievedby:
– Conservativeaccesspreparation
– Conservativedentin removal at thecemento-enamel junction (CEJ) level
– Conservativepreparationof apical root dentin
Conservative access preparation
Thiscanbeachievedby reducing the sizeof traditional accesscavitypreparationsor
modifying thepositionor shapeof theaccesscavitywithout compromisingproper
access to the root canal system.Newapproaches inpreparingaccesscavities focus
onpreservingmorecoronal tooth structure, to theextent that someclinicianseven
advocatecreatinganendodonticaccesswithout completely
unroofing thepulpchamber (Fig. 1).
Conservative dentin removal at theCEJ level
This canbeachievedby limited removal of peri-cervical dentin
(PCD),which isdefinedas thedentinat 4mmaboveand6mm
below theCEJ. 2 ThePCD is themost common siteof diagnosed
root fractures 2 (Fig. 2a and 2b).
ThePCD ispreservedbyminimizinguseof roundburs and
GatesGliddendrillswhenaccessing the teethandenlarging
orifices andminimizing thecoronal taper preparationof
the root canals. TheEndoGuide®bur system (SSWhite®,
Lakewood, NJ) is anexampleof a set of burs thatmay
beused for access andorificeenlargement inorder to
conservedentin.
Several new instrumentshavebeen introduced to improveflexibilityof the
nickel-titanium (NiTi) alloyandconservemore tooth structure in thecoronal