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?

Abstract

Introduction: Despite the increasing reports on mechanical aspects of contracted endodontic access cavities (CECs), we believe that the biological aspects (debridement) have not been adequately investigated. This study examined if 1 type of CEC (orifice-directed dentin conservation [DDC] access) was able to debride the pulp chamber, root canals, and isthmus of mesial roots of mandibular molars similar to a traditional endodontic access cavity (TEC).

Methods: Mandibular molars (N = 32) were selected and divided randomly into 2 experimental groups (n = 12) after micro-computed tomographic scanning (group 1: TEC and group 2: DDC) and histologic controls (n = 8). After instrumentation to a size 30/0.06 taper using 3% sodium hypochlorite as irrigant, specimens were processed for histologic evaluation, and the remaining pulp tissue (RPT) was measured from the pulp chamber, root canal, and isthmus at all root thirds. Data were analyzed using 1-way analysis of variance, Kruskal-Wallis, and appropriate post hoc tests (P = .05).

Results: The RPT in the pulp chamber was significantly higher in DDC compared with TEC (P < .05). Comparing the root thirds in each group, there was no significant difference in the RPT within the root canals or the isthmus (P > .05). The RPT within the root canals and isthmus was not significantly different between the 2 access cavity designs at any root third (P > .05).

Conclusions: Debridement of the pulp chamber was significantly compromised in DDC. The type of access cavity did not influence the amount of RPT in the root canals and isthmus.

Keywords: Access; contracted endodontic access; debridement; histology; modern endodontic access; orifice-directed access; traditional endodontic access.