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Endodontic Access Cavities: Current Approaches to Design Principles and Clinical Outcomes

Year 2025, Volume: 28 Issue: 3, 452 - 461, 30.09.2025

Levent Akıncı , Nesibe Sena Mungan

https://doi.org/10.7126/cumudj.1667325

Abstract

The preparation of the access cavity plays a critical role in the success of endodontic treatment. This process is essential for effectively cleaning infected pulp tissue and properly shaping the root canal system. Traditional methods often result in significant loss of dental tissue due to the need for broad and straight-line access, whereas modern minimally invasive techniques aim to minimize this loss. However, as the size of the access cavity decreases, visualizing the pulp chamber, cleaning infected tissues, and locating, shaping, and filling the root canals become increasingly challenging. A small access opening can create serious obstacles in clinical practice due to the limited space; this situation can hinder a thorough examination of the pulp chamber, making it difficult to perform necessary interventions effectively. Particularly in anatomically complex dental structures, narrow access areas can lead to uncertainties in clinical decision-making processes, thereby adversely affecting treatment success. Consequently, the preparation of the access cavity is not merely a mechanical step but an essential strategic component that determines the long-term success of endodontic therapy. Minimally invasive techniques enhance treatment effectiveness while preserving the structural integrity of the tooth and significantly contribute to achieving safe and predictable clinical outcomes in modern endodontic practice. In clinical applications, the advantages and disadvantages of these techniques should be carefully considered, and clinicians must take into account patients’ individual circumstances and current conditions to determine which methods are most appropriate.

Keywords

Dental pulp cavity Endodontics access cavity preparation Preparation Root canal theraphy Root canal preparations

References

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Endodontik Giriş Kavitesi: Tasarım Prensipleri ve Klinik Sonuçlara Yönelik Güncel Yaklaşımlar

Year 2025, Volume: 28 Issue: 3, 452 - 461, 30.09.2025

Levent Akıncı , Nesibe Sena Mungan

https://doi.org/10.7126/cumudj.1667325

Abstract

Giriş kavitesi hazırlığı, endodontik tedavinin başarısında kritik bir role sahiptir. Bu süreç, enfekte pulpa dokusunun temizlenmesi ve kök kanal sisteminin etkili bir şekilde şekillendirilmesi için gereklidir. Geleneksel yöntemler genellikle geniş ve doğrusal erişim gereksinimleri nedeniyle diş dokusunda önemli kayıplara yol açabilirken, modern minimal invaziv teknikler bu kaybı en aza indirmeyi hedefler. Ancak, giriş kavitesinin boyutu ne kadar küçülürse, pulpa odasının görselleştirilmesi, enfekte dokuların temizlenmesi ve kök kanallarının bulunup şekillendirilmesi, temizlenmesi ve doldurulması o kadar zor hale gelir. Küçük bir erişim boşluğu, sınırlı alan nedeniyle klinik uygulamada ciddi zorluklar yaratabilir; bu durum, pulpa odasının detaylı incelenmesini engelleyerek, gerekli müdahalelerin etkin bir şekilde gerçekleştirilmesini zorlaştırabilir. Özellikle anatomik olarak karmaşık diş yapılarında, dar erişim alanları, klinik karar verme süreçlerinde belirsizliklere yol açarak tedavi sürecinin başarısını olumsuz etkileyebilir. Sonuç olarak, giriş kavitesi hazırlığı yalnızca mekanik bir aşama değil, aynı zamanda endodontik tedavinin uzun süreli başarısını belirleyen temel bir stratejik unsurdur. Minimal invaziv teknikler, dişin yapısal stabilitesini koruyarak tedavi etkinliğini artırmakta ve modern endodonti pratiğinde güvenli ve öngörülebilir klinik sonuçlar elde edilmesine önemli katkılar sağlamaktadır. Klinik uygulamalarda, bu tasarımların avantajları ve dezavantajları dikkate alınmalı ve klinisyenler, hangi tekniklerin en uygun olduğunu belirlemek için hastaların bireysel durumlarını ve mevcut koşulları göz önünde bulundurmalıdır.

Keywords

Diş pulpası kavitesi Endodontik giriş kavitesi hazırlama Kök kanalını hazırlama Kök kanal tedavisi

References

  • 1. Moore B, Verdelis K, Kishen A, Dao T, Friedman S. Impacts of Contracted Endodontic Cavities on Instrumentation Efficacy and Biomechanical Responses in Maxillary Molars. J Endod 2016;42:1779-1783.
  • 2. Patel S, Rhodes J. A practical guide to endodontic access cavity preparation in molar teeth. Br Dent J 2007;203:133-140.
  • 3. Watson A. Pulp space anatomy and access cavities. In: B. S. Chong (eds). Harty's Endodontics in Clinical Practice. Elsevier 2010:35.
  • 4. Mannan G, Smallwood E, Gulabivala K. Effect of access cavity location and design on degree and distribution of instrumented root canal surface in maxillary anterior teeth. Int Endod J 2001;34:176-183.
  • 5. Shabbir J, Zehra T, Najmi N, Hasan A, Naz M, Piasecki L, Azim A. Access Cavity Preparations: Classification and Literature Review of Traditional and Minimally Invasive Endodontic Access Cavity Designs. J Endod 2021;47:1229-1244.
  • 6. Lin CY, Lin D, He WH. Impacts of 3 Different Endodontic Access Cavity Designs on Dentin Removal and Point of Entry in 3-dimensional Digital Models. J Endod 2020;46(4):524-530.
  • 7. Schroeder KP, Walton RE, Rivera EM. Straight line access and coronal flaring: effect on canal length. J Endod 2002;28:474-476.
  • 8. Wang D, Wang W, Li YJ, Wang YR, Hong T, Bai SZ, Tian Y. The effects of endodontic access cavity design on dentine removal and effectiveness of canal instrumentation in maxillary molars. Int Endod J 2021;54:2290-2299.
  • 9. Clark D, Khademi JA. Case studies in modern molar endodontic access and directed dentin conservation. Dent Clin North Am 2010;54:275-289.
  • 10. Krishan R, Paque F, Ossareh A, Kishen A, Dao T, Friedman S. Impacts of conservative endodontic cavity on root canal instrumentation efficacy and resistance to fracture assessed in incisors, premolars, and molars. J Endod 2014;40:1160-1166.
  • 11. Alovisi M, Pasqualini D, Musso E, Bobbio E, Giuliano C, Mancino D, Scotti N, Berutti E. Influence of Contracted Endodontic Access on Root Canal Geometry: An In Vitro Study. J Endod 2018;44:614-620.
  • 12. Elnaghy AM, Elsaka SE. Evaluation of root canal transportation, centering ratio, and remaining dentin thickness associated with ProTaper Next instruments with and without glide path. J Endod 2014;40:2053-2056.
  • 13. Vieira GCS, Perez AR, Alves FRF, Provenzano JC, Mdala I, Siqueira JF, Jr., Roças IN., Impact of Contracted Endodontic Cavities on Root Canal Disinfection and Shaping. J Endod 2020;46:655-661.
  • 14. Shabbir J, Zehra T, Najmi N, Hasan A, Naz M, Piasecki L, Azim A. Access cavity preparations: classification and literature review of traditional and minimally invasive endodontic access cavity designs. J Endod 2021;47:1229-1244.
  • 15. Hülsmann M, Schäfer E. Preparation of the coronal and radicular spaces. In: Ingle JI, Chong BS, Baumgartner LG (eds). Ingle’s Endodontics. Quintessence 2019:557-633.
  • 16. Xu T, Tay FR, Gutmann JL, Fan B, Fan W, Huang Z, Sun Q. Micro–computed tomography assessment of apical accessory canal morphologies. J Endod 2016;42:798-802.
  • 17. Plotino G, Grande NM, Isufi A, Ioppolo P, Pedullà E, Bedini R, Gambarini G., Testarelli L. Fracture strength of endodontically treated teeth with different access cavity designs. J Endod 2017;43:995-1000.
  • 18. Krishan R, Paqué F, Ossareh A, Kishen A, Dao T, Friedman S. Impacts of conservative endodontic cavity on root canal instrumentation efficacy and resistance to fracture assessed in incisors, premolars, and molars. J Endod 2014;40:1160-1166.
  • 19. Moore B, Verdelis K, Kishen A, Dao T, Friedman S. Impacts of contracted endodontic cavities on instrumentation efficacy and biomechanical responses in maxillary molars. J Endod 2016;42:1779-1783.
  • 20. Silva EJNL, De‐Deus G, Souza EM, Belladonna FG, Cavalcante DM, Simões‐Carvalho M, Versiani M.A. Present status and future directions–Minimal endodontic access cavities. Int Endod J 2022;55:531-587.
  • 21. Bóveda C, Kishen A. Contracted endodontic cavities: the foundation for less invasive alternatives in the management of apical periodontitis. Endod Top 2015;33:169-186.
  • 22. Silva E, Pinto KP, Ferreira CM, Belladonna FG, De-Deus G, Dummer PMH, Versiani M.A. Current status on minimal access cavity preparations: a critical analysis and a proposal for a universal nomenclature. Int Endod J 2020;53:1618-1635.
  • 23. Gideon PAG, van Z, William PB, Christian W, Volker S. Introduction: Crack Distribution and Durability of SHCC. In: Van Zijl G, Slowik V. A Framework for Durability Design with Strain-Hardening Cement-Based Composites (SHCC). State-of-the-Art RILEM Rep. Springer. 2017;22:1-26.
  • 24. Chlup Z, Žižka R, Kania J, Přibyl M. Fracture behaviour of teeth with conventional and mini-invasive access cavity designs. J Eur Ceram Soc 2017;37:4423-4429.
  • 25. Lang T, Steiner I, Ditz A, Weich KW, Nguyen DQ-V, Gaengler P. Review of Endodontic Instrumentation via Different Access Cavities–from Randomized In-Vitro Studies to Clinical Applications. 2024.
  • 26. Neelakantan P, Khan K, Ng GPH, Yip CY, Zhang C, Cheung GSP. 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? J Endod 2018;44:274-279.
  • 27. Jiang Q, Huang Y, Tu X, Li Z, He Y, Yang X. Biomechanical properties of first maxillary molars with different endodontic cavities: a finite element analysis. J Endod 2018;44:1283-1288.
  • 28. Auswin MK, Ramesh S. Truss access new conservative approach on access opening of a lower molar: a case report. J Adv Pharm Ed Res 2017;7:345-348.
  • 29. Clark D, Khademi J. Modern molar endodontic access and directed dentin conservation. Dent Clin North Am 2010;54:249-273.
  • 30. Asundi A, Kishen A. Stress distribution in the dento-alveolar system using digital photoelasticity. Proc Inst Mech Eng H 2000;214:659-667.
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There are 80 citations in total.

Details

Primary Language English
Subjects Endodontics
Journal Section Review
Authors

Levent Akıncı 0000-0002-8043-0267

Nesibe Sena Mungan 0009-0002-4849-7776

Publication Date September 30, 2025
Submission Date March 28, 2025
Acceptance Date July 10, 2025
Published in Issue Year 2025 Volume: 28 Issue: 3

Cite

EndNote Akıncı L, Mungan NS (September 1, 2025) Endodontic Access Cavities: Current Approaches to Design Principles and Clinical Outcomes. Cumhuriyet Dental Journal 28 3 452–461.
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Cumhuriyet Dental Journal (Cumhuriyet Dent J, CDJ) is the official publication of Cumhuriyet University Faculty of Dentistry. CDJ is an international journal dedicated to the latest advancement of dentistry. The aim of this journal is to provide a platform for scientists and academicians all over the world to promote, share, and discuss various new issues and developments in different areas of dentistry. First issue of the Journal of Cumhuriyet University Faculty of Dentistry was published in 1998. In 2010, journal's name was changed as Cumhuriyet Dental Journal. Journal’s publication language is English.


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