Clinical
Labial access to lower incisors
Dr Marcin Paradowski presents a review of the literature and examples of clinical practice with regards to labial access during endodontic procedures
S
traight line access to root canals is one of the most important factors in modern endodontics (S Patel & J. Rhodes British Dental Journal
203). It prevents instruments from working under high stress and helps to avoid sepa- ration. It also prevents iatrogenic mistakes such as ledging, zipping perforations and separations of instruments. For most of the teeth, straight line access
is easily done, especially when working with magnification and under the rubber dam. For lower incisors, however, there are no clear guidelines on how to approach root canal treatment and lingual access is very popular. In my clinical practice over the past ı0
years, all root canal treatments are done with the use of a microscope. Initially, lower incisors were treated with lingual access, as I was taught in dental school. However, this provided poor visualisation of the root canal system and I was hardly able to find, and never able to clearly see, two canals. This was frustrating as I was not gaining much from using a microscope. This made me think that there must be
better way of doing root canal treatment in lower incisors and to visualise both canals, especially since about 40 per cent of lower incisors present two canals. Those are located in labial and lingual direction. Early articles that I found helped a great deal. First, in ı985, clinicians LaTurno SA, Zillich RM said: “A radiographic analysis of lower incisors conclude that a more labial orien- tation of the access opening would provide straight-line access to the canal more consistently than the ‘traditional’ lingual access opening. The more labial placement of the access opening on mandibular ante- rior teeth will make endodontic treatment more efficient and may, therefore, increase endodontic success rates in these teeth.”
56 Scottish Dental magazine
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