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Clinical In ı989, Madjar D, Kusner W, Shifman A


wrote that labial endodontic access is an alternative to the conventional lingual endodontic access in permanent teeth. The labial approach facilitates visibility and provides direct access to the root apex. Current restorative procedures offer improved methods to overcome the aesthetic impairment from this approach. Labial access is especially beneficial for patients with limited mandibular opening. Other research – carried out in ı99ı by


Clements RE and Gilboe DB in Canada on access for root canal treatment for lower incisors – found that this approach facilitates the identification and instrumen- tation of two canals, if present, and makes complete obturation easier. More coronal tooth structure is preserved, enabling an optimum core design for bracing the root. As a result of my reading about alter-


native access, my clinical practice has changed dramatically and now all lower incisors are treated with labial access. Surprisingly, no patient has questioned why the tooth is accessed from the visible side and none had any aesthetic complaints after treatment. I believe this is because a wide selection of composite materials and


constantly developing techniques make the access cavity invisible. I recently reviewed a case treated a few


ABOUT THE AUTHOR


Having undergone extensive postgraduate training in endodontics, Dr Paradowski gained an MSc in endodontology at the University of Chester in 2012. Shortly after graduation in 1999 from Medical and Dental University in Szczecin and VT training in Poland, Marcin performed his first root canal treatment, using a Leica surgical microscope. He has used a surgical microscope for this procedure ever since and tested several brands of surgical microscope for his MSc dissertation. Marcin has trained in oral surgery for more than three years, including surgical endodontics in his native Poland. Hours spent in oral surgery, maxillofacial units and general surgery wards have seen him achieve success with difficult surgical treatments. Postgraduate courses in Germany increased his knowledge in restora- tive dentistry and, since moving to Scotland, he has become a VT trainer and runs study days for VTs at Glasgow Dental Hospital. Contact Marcin at paradowskim@icloud.com


years ago. Review X-rays showed excellent healing of a large apical lesion, thanks to good access to apical area during treat- ment. Labial access was most helpful here and I could only get this result due to the alternative modern approach. Use of the Zeiss microscope and rotary instruments from Dentsply were also useful (Figs ı-3). If we analyse the lower incisor anatomy


radiologically, we can see that labial access provides straight line access. And if we draw a line on the X-rays from apex to coronal part, it shows that access cavity projects labially in those teeth (Figs 4-6). Surprisingly, all new VTs that I meet


on my endodontic study days at Glasgow Dental Hospital’s Postgraduate Centre have never heard of labial access. However, most of them, after the study day and a short exercise on extracted teeth, are happy to give it a go. All say it is a lot simpler and they will be able to restore the access cavity with composite material. I hope this short article provides another


option to clinicians undertaking endo- dontic procedures.


Scottish Dental magazine 57


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