** The access armamentarium should be simple, yet sufficiently versatile, to achieve the preparation goals. Every dentist who performs endodontic procedures has a preferred set of that are used for any given access procedure. Fortunately, only two, three, or four rotary cutting burs are typically required to create an optimal access cavity. Although it is normal for any given clinician to have a specific preference, generally most dentists can agree on a core set of burs. The following will provide a brief description of the Endo Access Kit (Dentsply Tulsa Dental Specialties; Tulsa, Oklahoma) that may be used to initiate, progressively open, and completely finish any access cavity within any tooth in the mouth .
• Diamond Round Bur: The #2 and #4 diamond round burs,
in conjunction with water, are utilized to brush-cut away
tooth-colored restoratives and to create a window through
materials such as porcelain . A #2 diamond
round bur is appropriately sized for bicuspid and anterior
teeth, whereas the #4 diamond round bur is generally the
right size for molar teeth.
• Transmetal Bur: The transmetal bur is specifically
designed for cutting any type of metal . This bur
has a saw-tooth blade configuration, which provides efficiency
while reducing unwanted vibration, especially
important when entering pulpitis or so-called “hot teeth.”
• Carbide Round Burs: The #2 and #4 surgical length
carbide round burs provide extended reach and improved
vision during the entry into the pulp chamber .
Fortuitously, longer shank burs move the bulky head of
the handpiece further away from the occlusal table, giving
the clinician a line of sight along the shaft of the bur.
These burs are used to remove variously encountered
restorative materials and dentin, including the overlying
roof of the pulp chamber. Again, the #2 round bur is
appropriately sized for bicuspid and anterior teeth, whereas
the #4 round bur is sized best for molar teeth.
• Endo Z Bur: The Endo Z bur is a tapered and safe-ended
carbide bur . This bur is popular in that its noncutting
end can be safely placed directly on the pulpal floor without a
risk of perforation. The Endo Z bur’s lateral
cutting edges are used to flare, flatten, and refine the
internal axial walls.
• Tapered Diamond Bur: A surgical length tapered diamond
bur may be utilized at high speeds to flare, flatten, and finish
the axial walls of the pulp chamber . A surgical
length tapered diamond bur is utilized to expand the
access preparation and to blend the axial walls so the
orifice(s) is just within this outline pattern. Strategically, a
surgical length, tapered, and end-cutting diamond bur can
be safely used at slow speeds of 500-750 rpm to safely,
selectively, and precisely sand away dentin, track along
grooves in search of hidden orifices, or when space is
available, to remove certain triangles of dentin.
• X-Gates: One X-Gates is comprised of four Gates Glidden
(GG) drills. Specifically, the heads of the GG 1-4 burs are
sequentially stacked on the active portion of a single
X-Gates to create a funnel-shaped form . The
X-Gates is rotated at a slow speed of 500-750 rpm and is used
like a brush to cut dentin with its lateral surfaces or
belly on the outstroke. The X-Gates may be used for three
strategic purposes: (1) to initially open, flare, and smoothly
blend the canal orifice(s) to the axial walls, (2) to remove
internal triangles of dentin, and importantly, (3) to intentionally
relocate the coronal-most portion of a canal away
from furcal danger. Together, the X-Gates and surgical
length diamond bur are the burs of choice for finishing the
preparation and providing easy access to the underlying
root canal space.
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