A new approach to endodontic access in anterior teeth - a pilot study

The coronal opening is essential, during endodontic treatment, for direct access to the root canals. Usually, in the anterior teeth, endodontic access is achieved on the palatal/lingual surface, more specifically in the cingulum region. However, the lack of observation for dental positioning can lead to some accidents and complications, such as buccal perforations, causing esthetic damage and compromising the treatment.

Objective

To evaluate the applicability of a new approach for performing coronal opening in anterior teeth, regarding the wear caused on the tooth crown, and to evaluate the ease of performing the new technique to minimize the risk of perforation.

Material and method

Ten students (n=10) from the Improvement in Endodontics program participated in the present study. Twenty artificial teeth were used, which were upper, central incisors. Each participant performed two coronal openings. First, with no guidance (Group A - Conventional Technique) and afterward, a new opening, but with guidance with the spherical diamond tip placed parallel to the long axis of the tooth (Group B - Modified Technique).

Result

The results showed that 90% of the participants considered the Modified Technique as having lower risk of accidents, as well as being easier for locating the pulp chamber. There was a statistical difference both in the measurement of the total area of wear and in the width, while there was no statistical difference in the height.

Conclusion

Preliminary data collected with the survey were satisfactory for the Modified Technique. Statistically, it showed a favorable difference in relation to the area of wear and the width. However, in height there was no statistical difference.

Descriptors:
Coronal opening; conservative access; endodontics

Participant	Response
1	“In the modified technique, it was easier to locate the pulp chamber, with greater preservation of the dental structure.”
2	“Angle of the drill bit.”
3	“The modified technique,allows greater preservation of the dental structure and there is less risk of perforation and anatomical accidents.”
4	“Ease of reaching the pulp with minimal wear.”
5	“Ease of directing the drill bit.”
6	“The angle of the drill bit in the conventional technique I believe is easier to have a deviation of the bit, or even a perforation of the tooth.”
7	“The risk of too much wear with the modified technique appears to be less.”
8	“Guiding the direction of the drill bit.”
9	“In the modified technique, locating the pulp chamber is easier, it seems that the drill bit goes directly to the right place.”
10	“The modified technique had direct access to the pulp chamber and access to the canals.”

GROUPS		A	B
AREA	$\bar{X} \bar{X}$ 1	9.611^a	5.234^b
	SD 2	3.017	2.265
	SE 3	1.067	0.801
WIDTH	$\bar{X} \bar{X}$ 1	2.824^a	2.192^b
	SD 2	0.2505	0.4639
	SE 3	0.0886	0.164
HEIGHT	$\bar{X} \bar{X}$ 1	3.975^a	3.602 ^a
	SD 2	0.907	1.247
	SE 3	0.321	0.441

GROUPS		A
AREA	(t)=	3.217
	DF 1	7.000
	(p) unilateral =	0.007^*
	(p) bilateral =	0.015^*
WIDTH	(t)=	3.8851
	DF 1	7
	(p) unilateral =	0.003*
	(p) bilateral =	0.006^*
HEIGHT	(t)=	0.7819
	DF 1	7
	(p) unilateral =	0.2299^§
	(p) bilateral =	0.4599§

Universidade Estadual Paulista Júlio de Mesquita Filho Rua Humaitá, 1680 - Caixa Postal 331, 14801-903 Araraquara,São Paulo,SP, Tel.: (55 16) 3301-6376, Fax: (55 16) 3301-6433 - Araraquara - SP - Brazil
E-mail: adriana@foar.unesp.br

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[1] CONFLICTS OF INTERESTS

The authors declare no conflicts of interest.