Effect of access cavity location and design on degree and distribution of instrumented root canal surface in maxillary anterior teeth.
OBJECTIVE
The null hypothesis tested in this study was that in single-rooted anterior teeth with simple root canal anatomy, different access cavity designs ('lingual cingulum', 'lingual conventional', 'incisal straight-line') do not influence the ability of endodontic files to plane the walls of the root canals.


METHODS
Thirty extracted human maxillary anterior teeth were divided randomly into three groups for each access cavity. The access cavities were prepared according to predefined criteria and the roots embedded in individual polyvinyl-siloxane putty matrices. The matrices allowed these teeth to be split into buccal and palatal halves and to be reassembled. The split teeth enabled removal of pulpal remnants from the root canal system and the walls to be stained with an even layer of permanent black ink. Once dried, the split roots were reassembled in the putty matrices and a step-back filing technique was used to prepare the canals with water irrigation. The canal walls were examined for residual ink staining and scored by three independent assessors using an index devised for the purpose.


RESULTS
There was good agreement between the assessors. None of the access cavities allowed file contact with the entire root canal wall. The overall (palatal and buccal sections) scores showed significant differences (P < 0.01) between the access cavity groups in the extent to which the canal walls could be filed. The straight-line incisal access cavity had the greatest proportion of instrumented root canal surface. The lingual cingulum access cavity was the worst in this respect. The differences in residual ink scores between the access cavity types were significant for the buccal halves (P < 0.01) but not for the palatal halves (P > 0.05).


CONCLUSIONS
The null hypothesis was proven. Regardless of access cavity design, mechanical preparation did not allow instrumentation of the entire root canal wall. Straight-line access allowed the greatest proportion of the root canal wall to be instrumented and the lingual cingulum access the least.
Eastman Dental Institute for Oral Healthcare Sciences, University College London, UK.
G
G
Mannan
E R
ER
Smallwood
K
K
Gulabivala
D016009:Chi-Square Distribution; D004396:Coloring Agents; D003481:Cuspid / Q000033:anatomy & histology*; D003754:Dental High-Speed Equipment; D003786:Dental Pulp Cavity / Q000033:anatomy & histology*; D006801:Humans; D007180:Incisor / Q000033:anatomy & histology*; D007281:Ink; D008437:Maxilla; D011670:Pulpectomy; D018915:Root Canal Preparation / Q000145:classification* / Q000295:instrumentation
D004396:Coloring Agents