Access all areas
The following case clearly illustrates this point, especially when access is restricted in the posterior region of the mouth.
A lady in her mid-60s was referred to me for endodontic treatment of the LL7. She had a recently fitted porcelain bonded crown which had become symptomatic specifically to hot and cold. At her consultation we made a diagnosis of symptomatic irreversible pulpitis (fig 1) and she agreed to endodontic treatment which was completed in a single visit to retain the tooth. Whilst very keen to keep the tooth she was naturally slightly hesitant about her new crown so we opted to take a reasonably minimal approach to preserve as much of the tooth structure as possible.
The access cavity was prepared in a stepped-access fashion to minimise the impact of dentine removal underneath the crown and help to preserve the tooth structure, particularly in the pericervical area. Initial access was made with a 016 medium round bur and small tapered diamond bur to locate and partially de-roof the pulp chamber (fig 2).