Objectives

Access cavity preparation is the first and most important aspect of endodontic treatment. A well‐executed access cavity is essential for successful instrumentation and subsequent obturation of the root canal system. At the end of this chapter the reader should have an appreciation of the rationale and design principles of access cavity preparation.

Introduction

A 45‐year‐old male presents with pain associated in the upper left molar region.

Chief Complaint

The patient complains of a low‐grade intermittent ache when trying to chew on the UL7; the symptoms last for several minutes. The symptoms were also spontaneous, but the tooth was not temperature sensitive. The symptoms have been present for two months and are getting progressively worse.

Medical History

Patient has anxiety issues after losing his job and a recent divorce, both of which occurred within a few months of each other. He has been prescribed antidepressants by his doctor.

Dental History

Regular attender.

Clinical Examination

The dentition was minimally restored. The soft tissues were healthy and the periodontal probing depths were less than 2 mm.

The UL7 was tender to finger pressure. No other signs of endodontic or periodontal disease could be elicited from the neighbouring teeth. The UL5, UL6 and UL8 responded normally to sensibility testing, the UL7 did not respond to sensibility testing.

Diagnosis and Treatment Planning

The diagnosis for the UL7 was symptomatic periapical periodontitis associated with an infected necrotic root canal system.

The following treatment options were discussed with the patient:

• Root canal treatment, followed by cuspal coverage restoration.
• Extraction, including possible fixed and removable prosthodontic options.
• Leave alone.

The patient decided to go ahead with root canal treatment and subsequent restoration of the tooth.

Preparation of the Tooth for Root Canal Treatment

Once the patient has consented for root canal treatment, the first step of treatment is to determine the restorability of the tooth; that is, whether treatment is going to be viable.

The angulation and any rotation of the tooth should be appreciated, as these will influence the access cavity design. Anatomical landmarks, such as the cemento‐enamel junction and furcation, are useful landmarks indicating the level of the floor of the pulp chamber.