Maxillary Lateral Incisor: A Deep Dive into Dental Endomaster's Latest Challenge

This edition will explore last week’s Master Challenge topic: Maxillary Lateral Incisor.

The first screen shows the maxillary arch setup. The model used in Dental Endomaster is based on actual extracted teeth from patients. Additionally, the radiographic image was taken before the extraction, providing virtual training that closely mirrors reality. The positioning of the teeth in the dental arch is also based on CBCT images, ensuring real patient scenarios.

In Dental Endomaster, you first gain insights into the tooth's internal structure, including key landmarks such as the pulp horn and orifice. Understanding the internal anatomy of a tooth is essential for better endodontic treatment. Here, you can examine (1) the angulation of the tooth, (2) the location of the pulp horn and orifice, (3) the axis of the tooth(pulp), and (4) the relationship between the canal and the external shape of the tooth. This allows you to visualize information you may have learned but could not see directly.

Based on this information, you can determine (1) the entry point of the canal access cavity and (2) the direction of the cavity preparation. You then practice implementing this plan in the next phase.

Now, let's dive into the first stage of the simulation. We’ll compare the palatal approach taught in textbooks and the incisal edge approach. Let’s first look at the palatal approach(left side of the lower image). Approaching from the midpoint between the cingulum and the incisal edge creates the following setup.

The central blue dot represents the orifice, and the yellow triangle represents the pulp horn triangle. As you approach the incisal edge, the triangle’s size decreases(right side of the upper image), which implies that less dentin needs to be removed to properly clean the pulp chamber.

Once you’ve determined the entry point for access cavity preparation, it’s time to begin drilling toward the canal orifice. At this stage, you need to consider the direction of the root within the arch. The root of the maxillary lateral incisor is tilted disto-palatally, so you should adjust your drilling direction and depth accordingly.

You can now observe the results of the access cavity preparation. The pink area represents the cavity prepared, while the yellow triangle indicates the triangle formed by the horns. In a palatal approach, failing to adequately remove tissue from the hidden areas beneath the incisal edge and cingulum may lead to secondary infection in clinical situations.

The image from the lateral view shows the untreated parts after the access opening. The closer you approach the incisal edge, the more the pulp horns are removed as the cavity is formed.

What happens if you approach too labially from the palatal side? This is one of the common iatrogenic errors made by beginners. When the canal is calcified, unfortunate accidents can occur if you continue drilling without feeling the entry into the chamber. In this case, as shown on the right side of the lower image, the chamber’s shape is almost unrecognizable, often leading to errors. Cultivating the habit of regularly checking the drill's direction and the external shape of the tooth can help prevent such accidents.

Lastly, here’s a summary of the approach direction and the resulting cavity images. When preparing the cavity, design your approach based on the tooth’s condition and visualize the outcome before you proceed.

Conclusion:

Mastering the endodontic access and preparation technique requires a deep understanding of dental anatomy and meticulous practice. Dental Endomaster provides a realistic and educational simulation that bridges the gap between theoretical knowledge and practical application. By visualizing and practicing different approaches and techniques, you can significantly improve your endodontic skills, minimizing the risk of errors and optimizing patient outcomes. Whether you're a beginner or an experienced dentist, consistent practice using advanced tools like Dental Endomaster is key to achieving mastery in endodontics.