Modern Minimal Publication

How to Cite:
Jakhar, A., Dahiya, N., Jaiswal, H., Bagde, R., Sharma, D., & Sinha, A. (2022). Modern minimal
invasive access opening: Case report. International Journal of Health Sciences, 6(S1), 10832–10837.
https://doi.org/10.53730/ijhs.v6nS1.7600
Modern minimal invasive access opening-Case

report
Dr. Ashima Jakhar

Assistant professor, Department of Conservative Dentistry and Endodontics
Bharati Vidyapeeth Dental College and Hospital Navi Mumbai
Corresponding author email: [email protected]
Dr. Nitesh Dahiya

Email: [email protected]
Dr. Himmat Jaiswal

Dr. Reena Bagde

Dr. Deepak Sharma

Reader, Department of Conservative Dentistry and Endodontics Bharati
Vidyapeeth Dental College and Hospital Navi Mumbai
Dr. Anamika Sinha

Abstract---In summary, directed dentin and enamel conservation is

the best and only proven method to buttress the endodontically
treated molar. No man-made material or technique can compensate
for tooth structure lost in key areas of the PCD. The primary purpose
of the redesigned access is to avoid the fracturing potential of the
endodontically treated molar. Current case report presents a case of
an anterior tooth with conservative access opening according to clark
and khadami. Central to our philosophy should be balance needs to
International Journal of Health Sciences ISSN 2550-6978 E-ISSN 2550-696X © 2022.

Manuscript submitted: 27 March 2022, Manuscript revised: 18 April 2022, Accepted for publication: 9 May 2022
10832
10833
be restored to these 3 needs, which are almost always in conflict when

performing complete cusp-tip to root-tip treatment. Current case
report presents a case of an anterior tooth with conservative access
opening according to clark and khadami.
Keywords---Modern minimal, access opening, endodontically treated

molar.
Introduction
During patient treatment, the clinician needs to consider many factors that will
affect the ultimate outcome. In simple terms, these factors can be grouped into 3
categories:
1. The operator needs are the conditions the clinician needs to treat the tooth.
2. The restoration needs are the prep dimensions and tooth conditions for
optimal strength and longevity.
3. The tooth needs are the biologic and structural limitations for a treated
tooth to remain predict- ably functional. It has been noticed that failures of
endodontically treated teeth with beautiful root canal treatments have
occured not because of chronic or acute apical lesions but because of
structural compromises to the teeth that ultimately renders them useless.
Traditional endodontic access has been endodontic centric, primarily focused on

operator needs, and has been decoupled from the restorative needs and tooth
needs. Central to our philosophy should be balance needs to be restored to these
3 needs, which are almost always in conflict when performing complete cusp-tip
to root-tip treatment. Current case report presents a case of an anterior tooth
with conservative access opening according to clark and khadami.
Case report
A 43-year-old male patient was sent to the dept of conservative dentistry and
endodontics for intentional Root canal treatment from the dept of prosthodontics
with respect to 11. He had history of root canal treatment with 14,15. There was
no contributory medical history. Soft tissue examination was normal. No bleeding
on probing was seen. Pocket depth is within normal limits.
10834
Fig 1: Preoperative Radiograph
Fig 2: Preoperative Photograph
Fig 3: Access opening of 11

10835
Fig 4: Working Length determined
Fig 5: Mastercone Radiograph

10836
Fig 6: Post-operative Radiograph
Treatment Procedure
After administration of local anesthesia, an anterior Endodontic Access opening

was performed (preserving soffit) as shown in fig 3.Tooth was then isolated with a
rubber dam. One canal was located. After locating the canal pulp tissue located in
the chamber was removed using a small spoon excavator.The working length of
canal was estimated by means of an electronic apex locator (Root ZX; Morita,
Tokyo, Japan) as shown in fig 4 and then confirmed by a radiograph.Working
length was 19 mm.The canalwas initially instrumented with #10 & #15 K
File.Cleaning and shaping of the canal was done by using rotary nickel titanium
Protaper file system with a crown-down technique using 5% NaOCl and 17%
EDTA.Canals was dried using paper points. The canal was obturated with AH
plus resin sealer (Dentsply Maillefer, Ballaigues, Switzerland) and gutta-percha
points as shown in fig 6.The access cavity was then restored with composite
filling.
Discussion
Conventional access opening sacrificed more and more dentin (PCD) to create
direct pathway to the apices.Dentin acts as a trimodal composite, it can be of
great value to the tooth whether the undermined dentin occurs naturally, such as
the soffit, or from previous restorative/endodontic treatment.
10837
PCD is the dentin near the alveolar crest. Although the apex of the root can be
amputated, and the coronal third of the clinical crown removed and replaced
prosthetically, the dentin near the alveolar crest is irreplaceable.The research is
unequivocal; long-term retention of the tooth and resistance to fracturing are
directly related to the amount of residual tooth structure. So, more dentin is kept,
the longer the tooth is kept. Soffit was maintained in the above case by not
deroofing the pulp chamber completely.When the authors first began to maintain
a soffit, which is a small piece of roof around the entire coronal portion of the
pulp chamber, it seemed sloppy and contradicted the compulsive nature of
traditional dentistry that has made complete deroofing a mark of a thorough
clinician.
The pulp seemed difficult to remove under the tiny eve and the removal of sealer
and gutta percha was equally difficult. It just seemed wrong. Today, with the
advancement in endodontics it makes perfect sense. Attempting to remove the
pulp chamber roof does not accomplish any real endodontic objective, and
invariably gouges the walls that are responsible for long-term survival of the
tooth.
The primary reason to maintain the soffit is to avoid the collateral damage that
usually occurs, namely the gouging of the lateral walls. Research will certainly
need to be done to validate the strength attributes of the roof strut or soffit.
However, in the absence of a compelling reason to remove dentin, our default
position should always be conservative.
Conclusion
In summary, directed dentin and enamel conservation is the best and only proven
method to buttress the endodontically treated molar. No man-made material or
technique can compensate for tooth structure lost in key areas of the PCD. The
primary purpose of the redesigned access is to avoid the fracturing potential of
the endodontically treated molar. For expediency, molar fracturing can be
described as retrograde vertical root fracture; midroot vertical root fracturing;
oblique root/crown fracturing; and horizontal, oblique, and vertical coronal
fracturing.
References
1. Clarke J. Modern molar endodontic access and directed dentin conservation.

DCNA 2010, Apr;54(2):249-73.
2. Granados JM. Conservative Endodontic Access – Cone Beam Computed
Tomography (CBCT)- Guided Preparation and its Impact on Endodontic
Referrals. JSM Dent 2018,6(1): 1102

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How to Cite:

Modern minimal invasive access opening-Case

Dr. Ashima Jakhar

Dr. Nitesh Dahiya

Dr. Himmat Jaiswal

Dr. Reena Bagde

Dr. Deepak Sharma

Dr. Anamika Sinha

Abstract---In summary, directed dentin and enamel conservation is

International Journal of Health Sciences ISSN 2550-6978 E-ISSN 2550-696X © 2022.

be restored to these 3 needs, which are almost always in conflict when

Keywords---Modern minimal, access opening, endodontically treated

Traditional endodontic access has been endodontic centric, primarily focused on

Fig 1: Preoperative Radiograph

Fig 2: Preoperative Photograph

Fig 3: Access opening of 11

Fig 4: Working Length determined

Fig 5: Mastercone Radiograph

Fig 6: Post-operative Radiograph

After administration of local anesthesia, an anterior Endodontic Access opening

1. Clarke J. Modern molar endodontic access and directed dentin conservation.

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