Does the Orifice-directed Dentin Conservation Access Design Debride Pulp Chamber and Mesial Root Canal Systems of Mandibular Molars Similar to a Traditional Access Design?

By Neelakantan P, Khan K, Hei Ng GP, Yip CY, Zhang C, Pan Cheung GS. 

Date: 01/2018
Journal: J Endod


Purpose: to compare the effect of the 2 access cavity (orofice directed dentin conservation DDC and traditional endodontic access TEC)  designs on debridement of the pulp chamber and root canal system in the mesial canals of mandibular molars evaluated using a histologic approach

  •N= 32 Mandibular molars


1.Micro CT was used to scan all specimens initially.

2.Sample was divided randomly into 2 experimental groups (group 1: TEC and group 2: DDC) and histologic controls (n = 8).

3.Traditional access was performed as usual. In DDC, the slot and oval cavities were performed over the mesial and distal canal of the tooth, guided by the Micro CT images. (figure)

4.After instrumentation to a size 30/0.06 taper using 3% NaOCl as irrigant, specimens were processed for histologic evaluation

5.The remaining pulp tissue (RPT) was measured from the pulp chamber, root canal, and isthmus at all root thirds.

Most highlighted Results:

•RPT in both experimental groups at all points of evaluation was significantly lower than that of the control (P < .05).

•In the pulp chamber, the amount of RPT was significantly less in the TEC group compared with the DDC group.

•There was no significant difference in RPT between the TEC and DDC groups within the MB or ML root canal at any of the root thirds.

•The isthmus was filled with tissue and debris at all 3 levels of the canal in both groups, but there was no significant difference between the 2 groups.(P > .05)

Clinical significance:  

there was no significant difference between the orifice-directed access cavity and traditional access cavity in the per- centage of RPT in the root canals and isthmus at all root thirds. The pulp chamber retained a significantly higher percentage of remaining pulp tissue in teeth with the DDC access cavity.