1. Periodontitis of temporal teeth. Conformities to the law of clinical motion.
Diagnostics, differential diagnostics
2. Periodontitis of the second teeth. Conformities to the law of clinical motion.
Diagnostics, differential diagnostics
3. Roengenologic diagnostics of caries of teeth and his complications for
children in different age.
Features of development of periodontitis often it will be to meet.
Child’s dentistry from heavy complications of caries — sharp and chronic periodontitis. And than sanitation is worse organized, the inflammatory diseases of periodontium are more frequent diagnosed. Periodontium is disposed in space, limited from one side the cortical plate of small hole, and from other — by cement of root.
Child’s dentistry must know the features of periodontium of the unformed tooth, in what periodontium stretches from the neck of tooth to part of root of, which was formed, where meets with the area of growth and is in touch with mash of root channel. As far as forming of root the size of sprout area of the apical opening and contact diminish with mash, but length of periodontal crack is increased. Upon termination of development of apex of root yet forming of periodontium proceeds for a year. As far as rarefaction of root of baby tooth length of periodontal crack diminishes and the contact of periodontium is again increased with mash and spongy matter of bone.
Principal reason of periodontitu is an infection, when microbes, their toxins, biogenic amines, which act from the inflamed nekrotizo mash, spread on periodontium. Periodontium for a child presented more loose connecting fabric, contains plenty of cellular elements and blood vessels that does him more reactive at the action of unfavourable factors.
Second place among reasons which cause periodontitu in child’s age, the sharp trauma of tooth occupies (dislocation, break of root on that or other level). In this case speech goes mainly about frontal teeth. To put, when begin to walk, fall, struck a person, as a result there are different types of incomplete dislocations, in particular killed, such, that quite often accompanied the break of vascular-nervous bunch. In school age more frequent there is a trauma of the second unformed frontal teeth, when to put for help does not apply and gradually without the expressed clinical displays mash perishes and chronic periodontitu develops. Certain role in the origin of periodontitu a mechanical trauma can play during treatment of root channel by sharp instruments, needles, stopping material shown out for an apex.
In development of periodontitu for children drastic chemical and medical matters which get during treatment of pulpit play a certain role. On occasion inflammation of periodontium can develop gematogenic by a way at the sharp infectious diseases of children. The way of distribution of infection is possible on periodontium from the inflamed fabrics, located next door. Often periodontitis develops as a result of pulpit, if the methods of saving of mash (biological method, congratulatory amputation) apply without strict determination of certificates, with violation of conducting method, without the account of degree of indemnification of caries and state of child health.
At periodontitis both for adults and for children find out the different associations of microorganisms. Gram-positive cocci (mainly streptococci and staphylococci), and also fungi, laktobakterium, aktinomitsetium and other, prevail in composition mikroflora Among microorganisms which are more frequent all selected, on the first place aerobic and anaerobic forms of streptococci, then staphylococci. That clinical classification of periodontitu is utilized in child’s dentistry practice, which is accepted for adults.
For localizations distinguish apex (apical) and marginal periodontitis, down stream — sharp and chronic.
Classification of periodontitis.
For classifications of Т.F.Vinogradova (1976), periodontitis are divided:
on etiology :
– infectious,
– traumatic,
– medical;
for localizations:
– apical,
– marginal;
on clinical motion:
-sharp,
-chronic
-in the stage of sharpening;
on pathomorphological changes in fabrics:
– serenity
– festering,
– fibrosis,
– granulematous,
– granulating.
The features of periodontitis of baby teeth.
Frequent all meet chronic forms of periodontitu in the stage of sharpening in temporal teeth, however much it eliminates development of sharp forms of disease. General symptomatic of sharp apical periodontitis for children characterized active motion of inflammatory process in periodontium, rapid passing of the limited process to diffuse. The stage of inflammation usually did not last and passes to festering. At the uncompleted forming of root a process is complicated death of area of growth and stopping of development of tooth. The dynamics of clinic of sharp periodontitu is expressed in growth of pain reaction on Perkasie, increase of intensity of involuntary pain of permanent, aching character, increase of oedema and hyperaemia, gums at a causal tooth with bringing in of surrounding fabrics and regional lymphatic knots.
Sharp serous and festering periodontitis, being the separate stages of one process. At a festering form pain becomes strong and pulsating, goes down from cold, the general state is violated, appeared head pain and indisposition. Complication porosities and osteomielitis is especially often at the uncompleted forming of root, accompanied the sharp worsening of the general state of child with the increase of temperature of body to 38-39°С, increase of SHOE, and more heavy local picture (an enema is expressed, pain reaction of nearby with causal teeth). Especially difficultly sharp periodontitis flows for children with lowering of pressure of organism and after the carried diseases (fig. 1, 2).
fig. 1.
fig. 2.
A prognosis at diagnostics of periodontitu of temporal teeth depends and from as rezorbtion of root: even, uneven, mainly in the area of bifurcation of root. Yes, if at even rezorbtion of root the border of conservative treatment is rarefaction of 2/3 lengths, at bifurcation – extraction of tooth are shown regardless of the state of root.
The result of sharp periodontitu depends on the exit of exudation from periodontal of space:
– Through a root channel; on a periodontal crack by melting of circular ligament; – on spaces to the surface of jaw bone (subperiosteum and subgingival abscess, periostitis, sepsis);
– passing of sharp periodontitu to chronic is possible in default of treatment or at wrong medical tactic.
Chronic periodontitis can be the result of sharp inflammation of periodontium or develop as initially chronic process at the gangrene of mash, to complicate chronic pulpits, chronic trauma of tooth and wrong treatment of pulpits.
Fibrosis and granulematous periodontitis is possible only in the formed teeth. Taking into account importance of hearth of granulation at chronic inflammation of periodontium for medical tactic, it is possible to select two stages of this process:
1 – is expansion of periodontal crack due to thinning and hearth of compact plate by granulation without the expressed destructive process in a spongy bone;
2 – is distribution of hearth outside periodontal of space, origin of defect of bone due to rezorbtsii of compact and spongy matter round the apexes of root, which also can be resorped. A bone plate between a hearth and follicle is diminished, but stored. These stages of disease are subject treatment unlike granulating periostitis, which extraction of temporal tooth is shown at. At elektroodontodiagnostics teeth with absent mash react on the sizes of current of more than 100 mka. By the leading diagnostic signs of chronic inflammation in periodontium of baby tooth, that allow to define not only his presence but also character, degree of distribution, and also state of surrounding fabrics, there are roentgenologic changes.
Kinds and types of resorption of roots in baby teeth.
Physiological and pathological resorption of roots of baby teeth.
To distinguish them it is one from other possible thus: at presence of sprout area a periodontal crack has an even width at the formed part of root and here meets with the area of growth. Cortical a plate of interalveolaris partition is its continuation which limits the area of growth. A cortical plate disappears at death of area of growth; the hearth of dilution has different sizes and unclear scopes. In obedience to these histological researches (T.F. Vinogradova , 1967), resorption of roots of baby teeth from intact periodontium is carried out with participation of osteoklasts. Parallel there is a process of resorption. The source of again well-educated bone is cages of periodontium. Reparation processes take a place simultaneously with resorption which provides saving of structure of bone around resorptive roots.
Such type of rezorbtsii is observed at rezorbtsii of roots of intact of baby teeth, but possible also at rezorbtsii of carious and pulpless teeth at intact periodontitis. Physiology resorption develops unevenly, however takes all of surface of roots. Thus internal surface of roots, located nearer to the rudiment of the second teeth, resorp quick; these can explain physiology resorption on three types. On the late stages of physiology rezorbtsii mash of tooth takes part in a process, carrying out resorption of dentine from the side of cavity of tooth. The source of osteoklasts. Cages of mash.
Together with physiology resorption pathological resorption of roots can develop under act of row of reasons. More frequent all it arises up as a result of chronic inflammation in periodontium of baby teeth.
Pathological resorption of roots of baby teeth is carried out giant cages of foreign bodies and cages of inflammatory infiltrate. In relations with it at pathological rezorbtsii a leading roentgen logic sign is destruction and absence of bone fabric between the roots of baby teeth or round them. Pathological resorption does not submit the laws of physiology rezorbtsii. In this period substituted for natural fabric of periodontium granulation fabric of inflammatory infiltrate. Resorption of root goes shallow deep lacuna, which are filled the cages of inflammation. In fabric of inflammatory infiltrate often there are epitheliums which take large space and can germinate all of layer of fabric and to grow in the channels of root. As far as progress of pathological process scolded baby teeth and follicles of permanent ramification, while at physiological resorption they are drawn together. Rarefaction of unformed root of baby teeth, root, second teeth dissociated from a follicle can come at pathological rezorbtsii, and roots of nearby teeth. The process of pathological rezorbtsii can spread on the follicles of the second teeth, cause premature resorption of bone shell of follicle and dentition of the second teeth. Brings these phenomena over of І.О. Novak (1968) as illustration of speed-up resorption of roots of pulp less baby teeth. However much it follows to talk in parallel instances, at first, about resorption of roots of baby teeth, not simply deprived mash, but about resorption at chronic inflammation; secondly, not about speed-up, but about premature resorption, as a term a «speed-up» can be attributed to the physiology processes and conditioned acceleration. Term «premature» resorption already in itself testifies to pathology.
T.F. Vinogradova (1976) considers that in the clinic of child’s dentistry at presence of chronic proliferating inflammation which overcame a bone in the area of bifurcation of root of baby tooth, especially if a pathological process spread on the follicle of the second teeth or on the roots of nearby teeth, a term must be accepted «chronic granulating ». For chronic granulating porosities characteristically violation of conformities to the law of physiological resorption of roots. At him pathological resorption of roots of baby teeth. Under act of chronic granulating porosities there are serious changes in jaw bones, follicles and rudiments of the second teeth.
Yet Terner specified first, that crackpot development of permanent rudiments quite often was investigation of inflammation of periodontium of baby tooth. For Terner, such teeth more frequent meet on a lower jaw and there are mainly second premolars. Clinically these teeth are characterized undevelopment of crown on which an enamel cover absents and which has a brown color; in other cases these teeth have a form of crown and undevelopment of enamel as hypoplasia. Such teeth in a clinic name of Terner’s. F.І.Lepidus (1934), Т.І.Alban sky (1934), R.І.Smolyanova(1963) and other researchers described different supervisions as follicle cysts, hearth hypoplasia fabrics of the second teeth, change of the second teeth and etc, which arise up under act of chronic inflammatory processes which develop in periodontium of baby teeth.
At chronic granulating periostitis, when follicles and rudiments of the second teeth are involved in a pathological process, it is roentgenologic possible to select the followings complications:
– violation of the valuable forming of fabrics of permanent premolar, which clinically appears as hypoplasia;
– death of rudiment of the second teeth, which, growing into the infected foreign body, supports motion of chronic inflammation;
– Premature dentition of permanent premolar, in which firmness is reduced in a small hole and through the overload of inferior periodontium inflammation develops and to mash, periodontitis up to tearing away of rudiment;
– distribution of pathological process on fabrics of nearby teeth which stand, and on the follicle of first permanent molar;
– formation of radicularis cysts of suckling and follicle cysts of the second teeth;
– change of rudiments of the second teeth.
Histological a pathological hearth is presented the cages of inflammatory infiltrate with the different amount of germinating epithelium. Consider that it is an epithelium of enamel organ. Clinical supervisions allow asserting that exactly an epithelium hinders the regeneration of fabrics in the hearth of inflammation.
A large role in it belongs to the microbes which constantly enter hearth from resorptive roots and that support inflammation.
Chronic inflammation of periodontium is the protracted process which inflammation and death of mash was preceded. As a result of death of mash and pathological changes in the periodontitis processes of growth and forming of roots violated, pathological resorption of roots is possible. Terms of primary changes, equal as and character them, to take into account is not possible. Consequently, age of child at presence of chronic periodontitu caot specify a doctor on the state of roots.
Clinic of periodontitis of temporal teeth.
Сhronic motion of periodontitu or his sharpening is most widespread In temporal teeth. Chronic periodontitis of infectious origin in temporal teeth can develop as a chronic process without the previous stage of sharp inflammation. It relates with the аanatomic-morphological features of temporal teeth, in particular with absence for the children of stability of structure of periodontitu, and also with the features of functioning of the immune system for the children of junior age. Chronic granulating periodontitis appeared in temporal teeth far more frequent comparatively with other forms of chronic inflammation.
A child complains mainly in the presence of fistulas with a possible selection a pus, and also – carious cavities and change of color of tooth.
A tooth can have a carious cavity, filled mainly rarefaction, something by a second dentine, or to be sealed, changed in a color. Carious cavity at chronic granulematous periodontitis is localized mainly within the limits of interpulp dentine. However disposed it can be and in a cloak dentine. The cavity of tooth is more frequent closed. These features of clinical motion of chronic periodontitu are predefined rapid motion of caries and insufficiency of protective function of mash of temporal teeth (especially in the period of growth and rarefaction of roots) of, which results in infecting of periodontitu. The differences of anatomic structure of hard fabrics of temporal teeth are instrumental in distribution of infection also: more thin layers of enamel and dentine, less degree them mineralization, wide and short dentine canals.
Sounding of bottom of carious cavity at chronic granulematous periodontitis. A reaction absents on thermal irritants, the reaction of tooth on perccusion is painless. Such clinical symptomatic complicates differential diagnostics of chronic periodontitu and caries of temporal teeth substantially. Absence of pain during preparation of enamel-dentin connection testifies to death of mash and development of inflammatory process in periodontium. Sounding of bottom of carious cavity at periodontitis of temporal teeth is painless. Sometimes it cause by an insignificant sickliness and bleeding as a result of granulation fabric from periodontitu in root channels and cavity in tooth, especially in the period of growth or rarefaction of roots.
In most cases on the mucus shell of gums in the projection of apex roots or bifurcation of the staggered tooth fistules is determined with salient granulations and by selection pus (fig. 5, 6, 7). In default of fistulas the mucus shell of gums in the area of causal tooth, has a cianosis tint. The symptom of vasopressin of Locums is positive, namely: after pressure of spatula there is whitishness pressure on gums, which acquires the bright red colouring gradually. Granulating form of chronic periodontitu of temporal teeth for children more frequent than for adults, accompanied regional chronic lymphadenitis, and sometimes – by a chronic porosities reaction.
Roentgen logic in the area of bifurcation of molar and apical part of roots destruction of cortical plate of аalveolus and hearth of dilution of bone fabric is determined with unclear boards. Quite often there is pathological resorption of roots, and also destruction (perforation) of bottom of cavity of tooth in the area of bifurcation. At distribution of pathological process there is destruction of cortical plate of follicle on the rudiment of the second teeth.
Differential diagnostics of chronic granulating periodontitis of temporal teeth is conducted with next diseases.
1. by a chronic middle caries which is characterized with pain during preparing of enamel-dentin connection.
2. by a chronic fibrosis and gangrenous pulpit: between a carious cavity and cavity of tooth and beginning of root channels at a pulpit accompanied sharp pain.
3. by a pulpit which was complicated focal periodontitis: at sounding of the exposed horn mashes arise up great pain and moderate bleeding. The differentiating diagnostic signs of chronic granulematous periodontitis is presence of fistules with a selection a pus granulations on a background filling out of serous shell of gums in the projection of pathological process, destructive changes in the area of bifurcation and apexes of roots of the staggered tooth of, which are determined on a sciagram, and also absence of pain during preparation of enemal-dentin connection.
Chronic granulating periodontitis of temporal tooth can entail development of complications, the degree of weight of what depends on prevalence of inflammatory process and term of follicle of the second teeth.
1. Distribution of pathological process is on the rudiment of the second teeth on the stage of book-mark of enamel organ; differentiation of cages and formations of follicle to beginning of his mineralization can result in death of rudiment.
2. Infecting of follicle of the second teeth on the early stages of his mineralization can entail development of local hypoplasia enamel (forming of tooth of Turner) as a result of violation of function of Almelo- and odontoblasts (fig. 9). The crown of such tooth is underdeveloped, oblate, and yellow, sometimes there is aplasiya of enamel.
3. Distribution of inflammatory process on the rudiment of the second teeth in more late terms can be completed death of area of growth, what the subsequent forming of the second teeth is halted and takes a place his sekvestration.
4. The protracted motion of chronic periodontitu can result in the change of position of follicle of the second teeth in a jaw which clinically shows up the turn of the second teeth round (tortoanomaliya), by his oral or vestibular displacement.
5. Destruction of bone between the roots of temporal teeth and follicles permanent as a result of excrescence of granulation fabric can entail premature dentition of the second teeth with low cage of mineralization of enamel and by the high risk of development of caries.
6. Premature delete of temporal tooth concerning chronic granulating periodontitu, especially in the period of forming of roots and at the beginning of their stabilizing, can result in retention of permanent tooth.
7. Distribution of inflammation on fabrics which surround the rudiment of permanent tooth, in some cases can result in development of follicular cyst.
Fig. 5.
Fig. 6.
Fig. 7.
Chronic fibrosis periodontitis in temporal teeth almost not diagnosed.
Chronic granulematous periodontitis is also determined in temporal teeth very rarely. He more frequent develops in a period the stabilization roots of temporal tooth.
Sharpening of chronic periodontitu in temporal teeth occupies the second place on frequency.
Sharpening of chronic periodontitu of temporal teeth of characterize expressed clinical symptomatic and to the fasts of cages: a phase of inflammation is brief and for a day long outgrows in festering. The features of anatomic structure of jaws for children (low degree of mineralization of cortical layer and bone tissues, thin trabecules of spongy matter and large bone-cerebral intervals, wide folkman and gavers channels) are instrumental in spread of exudates under a periostium, to forming of abscess and phlegmon.
Clinical picture. Patients grumble about permanent aching pain which increases gradually, especially at pressing on a tooth. Renounce to put a meal. At development of festering inflammation and sharp periostitis reaction the general state of patients is quickly worsened in relations with the increase of temperature of body and appearance of signs of intoxication. The pallor of skin, weakness, languor, head pain, bad sleep and appetite, is marked.
During an objective inspection there is a carious cavity of different depth or stopping in the causal tooth. A cavity of tooth can be closed and opened. During its opening can festering exudation. A tooth is mobile due to the accumulation of exudation in periodontium. Touching to the tooth is sickly, comparative perccusion — sharply sickly. The reaction of tooth absents on thermal irritants. Mucus shell of gums in the area of the staggered tooth brightly red, filling out, sickly at palpation. In the case of development of periostal reaction of transitional fold is marked, what appear also nearby teeth. Sometimes on a background the changed mucus shell fistule can be determined with selection pus. Regional lymphatic knots are megascopic, dense, and sickly at palpation.
Roentgenologic at sharpening of chronic periodontitu of temporal teeth the signs of him are diagnosed mainly granulating forms. Sharpening of chronic periodontitu of temporal teeth it follows differentiate with a sharp diffuse pulpit which was complicated perifokal periodontitis: opening of cavity of tooth cause by sharp pain and bleeding.
For sharp motion of chronic periodontitu of temporal teeth the clinical (a dark color of tooth and appearance of fistula or scar is after it on a background filling out, brightly red, sickly at palpation mucus shell) have a diagnostic value and roentgenologic signs (destruction of cortical plate of alveolus and bone is in the area of bifurcation and apexes of roots of temporal teeth).
Sharp periodontitis in temporal teeth diagnosed rarely and has a mainly toxic, traumatic, rarer infectious origin.
Sharp toxic periodontitis of temporal teeth cause as a result of application of arsenium pasture for devitalisation or drastic antiseptics of group of phenol (phenol, kamforofenol, trikrezol, ferezol ) and aldehydes (formalin) for treatment of root channels, especially in periods of growth and rarefaction of roots.
Sharp traumatic periodontitis of temporal teeth can be investigation inflicted a blow or falling of child, and also mistakes, assumed a doctor during endodontic interference during treatment of pulpit (instrumental treatment and stopping of root channel).
Sharp periodontitis of infectious origin more frequent appear as a result of perifokal process in periodontium at the sharp pulpitis of temporal teeth (or festering).
Clinic of periodontitis of the second teeth.
Chronic periodontitis of infectious origin in the second teeth for children after frequency occupies the first place. Chronic inflammation in periodontium can arise up as a result of sharp, however in the second teeth with the uncompleted growth of roots more frequent there is development of process. By the most widespread form of chronic periodontitu of the second teeth for children, especially in the period of formation roots, granulating.
Clinical picture. Chronic granulating periodontitis of permanent teeth for children has run across more frequent.
During an objective inspection in a causal tooth find out stopping or carious cavity a depth of which can be different. Percussion of bottom of carious cavity painless. A reaction absents on thermal irritants. Reaction of tooth on percussion — painless. Between a carious cavity and cavity of tooth often appears connection sounding of which is painless. At chronic granulating periodontitis of the second teeth with the unformed roots often enough there is growing in of granulations in root channels. In such cases deep percussion poorly sickly and accompanied bleeding.
Children have fistulas the leading clinical sign of this form of chronic periodontitis of the second teeth.
Sometimes a scar which testifies to its temporal closing appears in place of fistulas. In default of fistulas near a pecan tooth there is cyanosis of mucus shell of gums. The symptom of vasoparesis of Lukomsky is positive. For children the granulating form of chronic periodontitu of the second teeth is accompanied regional lymphadenitis.
Development of chronic granulating periodontitu in the second teeth with the uncompleted growth of roots can be complicated areas of growth and stopping of the subsequent forming of roots. Roentgenologic chronic granulating periodontitis by characterize destruction of cortical plate of alveolus near a apex root, periodontal crack, and also by the hearth of rarefaction bone near the apexes of roots, which has unclear outlines. Dilution of bone fabric can be observed and in the area of bifurcation of permanent molars. Roentgenologic picture of chronic granulating periodontitis of the second teeth with the uncompleted forming of roots it is needed to distinguish from the area of growth in intact teeth. Safety of cortical plate of alveolus, which surrounds an unharmed sprout area, is it by a differential sign.
Chronic granulating periodontitis of the second teeth for children it is necessary to differentiate with chronic middle and deep caries, by a chronic fibrous and gangrenous pulpit, and also pulpitis, that focal periodontitis was complicated. The final diagnosis of chronic granulating periodontitu can be put on the basis of information of clinical inspection (fistula with salient granulation and by a selection a pus on a background filling out, stagnant hyperaemia of mucus shell of gums or scar after it, the color of tooth is changed) and results of roentgenologic research (destruction of cortical plate of alveolus, periodontal fissure and bones near the apexes of roots of the staggered teeth).
Chronic granulematous periodontitis arises up in permanent teeth for children mainly then, when their roots and periodontium is already formed fully. Development of granules on the first stages it is possible to see as a protective reaction of organism in reply to the receipt of infection of root channel to the periodontal crack. Limitation of pathological process due to formation of connective capsule is possible in the case of morphofunctional maturity of fabrics of periodontium. However digs up the protective function of granuloma only during time. Gradually its capsule germinates vessels, as a result barer between granuloma and by fabrics, that it is surrounded, violated, that granuloma begins to act part hearth of chroniosepsis.
Clinical picture. Chronic granulematous periodontitis of permanent teeth for children characterized mainly motion. Only in some cases patients grumble about the unpleasant feelings during pressing on a tooth, change of his color. A tooth can be intact (in the case of traumatic origin of periodontitu), sealed or to have a carious cavity, what connect with the cavity of tooth. Sounding of bottom of carious cavity, its connection with the cavity of tooth and beginning of root channels is painless. The reaction of tooth on percussion of tooth is painless. A reaction absents on thermal irritants. Palpation on a mucus shell alveolar sprout, thrusting out of bone wall can be determined in the area of pathological process./
The diagnosis of chronic periodontitu is determined on the basis of roentgenologic research: in the area of apexes of roots of the staggered tooth there is destruction of cortical plate of alveolus and periodontal crack and hearth of dilution of bone fabric of round or oval form with clear outlines, the diameter of which does not exceed
Differential diagnostics of chronic periodontitis must be conducted with next diseases.
1. By a chronic deep caries which is characterized appearance of pain during preparing of enamel-dentin connection, and also sensitiveness of tooth, to the action of thermal irritants.
2. By a chronic fibrous and gangrenous pulpit, that complicated by focal periodontitis, on the basis of origin of sharp pain during sounding of connection between a carious cavity and cavity of tooth and beginning of root channels.
3. Granulating and fibrous chronic periodontitis after helping information of roentgenologic research. Dilution of bone fabric at the granulating form of periodontitu does not have clear outlines. Fibrous form him characterized deformation of periodontal crack and saving of safety of cortical plate of alveolus.
4. Cystgranuloma and reticular cyst: the hearth of destruction of bone on a sciagram has a diameter more than 5 and 8 accordingly.
Chronic fibrous periodontitis of the second teeth for the children of diagnosis relatively rarely comparatively with other forms of chronic inflammation of periodontium. He is characterized education in apical part of roots of connecting fabric which changes by periodontium. Some authors interpret such changes in periodontium as his fibrous and does not examine this process as inflammatory.
Fibrous periodontium can develop in the second teeth with formed roots as a result of the carried sharp inflammation in anamnesis, mainly traumatic origin. Sometimes fibrous periodontitis is observed in teeth which before were curate concerning pulpitis, and also can arise up after effective treatment of other forms of chronic periodontitu (granulating).
Clinical picture. Fibrous periodontium complaints absented about pain.
Objective. Tooth of intact (in the case of traumatic origin) or sealed, rarer — carious. Percussion of tooth is painless. The mucus shell of gums is not changed. Diagnostics of fibrous changes in periodontium is conducted after helping of roentgenologic research. On a sciagram deformation of periodontal crack appears as uneven it expansion and narrowing — in the areas of hypercementosis. Roentgenologic of fibrous periodontium is very similar to the changes which appear on the sciagram of teeth with uncompleted growth of roots, namely — on the stage of the unclosed apical opening and unformed periodontium. For determination of final diagnosis is necessary to take into account age of child, and also to the period of growth and forming of roots in different teeth.
Sharp periodontitis of the second teeth for children more frequent all arises up as a result of blow or falling of child. A trauma also can cause errors at treatment of pulpit during endodontic treatment. Before development of sharp toxic periodontitu, especially in teeth with the uncompleted forming of roots, the use for devitalisation mash of pastes, which contain a arsenic anhydride, and also application for antiseptic treatment and stopping of root channels of facilities which are toxic characteristics, leads: groups of phenol (to the phenol, kamforphenol, trikrezol, ferezol, to ) and aldehide (to formalin). Sharp periodontitis of the second teeth of infective origin for children quite often accompanies motion of sharp or festering pulpitis that is a perifokal process.
Clinical picture of sharp periodontitis. There are patients that complain on protracted pain of aching character in a causal tooth, and та¬кож feeling, that a tooth “grew” as though.
Objective. At a traumatic origin sharp periodontitis tooth of intact or with traumatic of his crown part on a different level. In the case of sharp toxic periodontitu there are signs preparing of carious cavity, partial or full opening of cavity of tooth. At sharp periodontitis of infective origin a carious cavity which is not reported with the cavity of tooth appears in a tooth. In the case of death (to necrosis) of mash and development of focal process in periodontium of probing bottom of carious cavity painless. A reaction absents on thermal irritants. Vertical percussion of tooth is sickly. A tooth can be something mobile due to the accumulation of exudates in periodontium. The mucus shell of gums in the area of the staggered tooth is not changed or the masses insignificant signs of inflammation: pastosis, poorly hyperaemic, during palpation a bit sickly. Regional lymphatic knots sometimes can be megascopic in sizes, poorly sickly during palpation.
Clinical picture of sharp festering periodontitu characterize by permanent intensive pressuring pain. Even the insignificant touching to the tooth (by a language or tooth-antagonist) provokes sharp pain that is why patients hold mouth half-open salivation is possible. In the case of distribution of pus under a periostium pain diminishes. The general state of patients is worsened as a result of increase of temperature of body and development of intoxication. There are a general weakness, head pain, violation of sleep and appetite. A tooth can be intact, curate before or to have a carious cavity which is not reported with the cavity of tooth. A leading clinical sign is intensive pain during vertical and horizontal percussion. Diffuse distribution of process draws origin of pain during percussion research of the teeth located alongside. A causal tooth becomes mobile sharply.
Mucus shell of gums in the area of inflammation brightly hyperaemic, filling out, sickly during palpation. As a result of distribution of festering exudates under a periostium an abscess is formed, what characterized of smoothness of transitional fold in an area staggered and nearby teeth.
Asymmetry of person is marked due to the collateral edema of soft fabrics. Submandibular lymphatic knots are megascopic in sizes, dense, sickly during palpation. Changes on a sciagram at sharp periodontitis mainly absent. In some cases as a result of diffuse distribution of pus a clearness of picture of spongy matter of bone in the area of causal tooth can be lost.
It follows to differentiate sharp motion of periodontitu with next diseases.
1. By a sharp diffuse pulpit which was complicated perifokal periodontitis. Objective: sounding of carious cavity is sickly on all of bottom, opening of cavity of tooth is accompanied intensive pain and bleeding, the general state of patient is not broken.
2. Sharpening of chronic periodontitu – on the basis results of roentgenologic research (by the presence of destructive changes in periodontium).
3. By sharp odontogenic periostitis.
Objective: transitional fold in an area causal and the teeth located alongside smoothed out, filling out, hyperaemic, sickly during palpation.
4. Sharp odontogenic osteomielitis.
Objective: determinates mobile of patient and nearby teeth, smoothness transitional fold on either side of alveolar sprout, selection pus from gum pockets.
Sharpening of chronic periodontitis of the second teeth for children with the uncompleted growth of roots is diagnosed far more frequent than his sharp motion. The clinical picture of sharpening of chronic inflammatory process is very similar to sharp motion of periodontitu. In a clinic the differential signs of sharpening are a change of color of tooth, presence of fistula or scar after it, and also connection of carious cavity with the cavity of tooth, mainly in the second teeth with formed roots. In anamnesis can be determined previous sharpening of pathological process. The roentgenologic sharpening is distinguished by such signs: destruction of cortical plate of alveolus, deformation of periodontal crack and hearth of dilution of bone fabric with unclear edge near the apexes of roots. Differential diagnostics between sharpening and sharp motion of periodontitu is conducted taking into account absence or presence of the previous sharpening in anamnesis, fistula or scar after it, changes of color tooth.
Regional (marginal) periodontitis develops as a result of mechanical damage of gingival edge, penetration of infection, chemical matters (acid, meadow) or devitalisation to pasture. Sometimes reason of regional periodontitu is penetration of extraneous body, stopping is unskilled imposed.
Chronic marginal periodontitis develops as a result of the protracted action of mechanical or chemical irritant. A patient can complain on the insignificant pain feelings in the area of defeat. A clinical picture is characterized a moderate edema and stagnant hyperaemia of marginal part of gums. Horizontal percussion something sickly.
Clinical picture of sharp regional periodontitu. Complaints are about permanent pain in the area of the staggered tooth. Gingival edges fillings out, hyperaemic, sometimes covered ulcers, at the festering inflammatory process form sickly infiltrate up to development of subgingival abscess, from a gum pocket a pus is selected, there is a sickliness during horizontal percussion. On the sciagram of destructive changes in a bone is however possible it is to find out an extraneous body or unhigh-quality imposed filling. In the case of sharpening of chronic regional periodontitu a clinical picture is similar to described higher. On a sciagram there is expansion of periodontal crack in overhead third of periodontium and resorption of cortical plate of intracellular partition.
Roentgenologic diagnostics of caries of teeth and his complications for
children in different age
Roentgenologic picture of sharp periodontitu extremely informing and does not have a diagnostic value. There can be insignificant expansion of periodontal crack due to the accumulation of exudates, structure of spongy matter iear root fabrics due to infiltration and edema.
Chronic fibrous periodontitis roentgenologic appears expansion of periodontal crack. The change of its width is observed on the limited area or rarely on all of draught which depends on prevalence of process.
At chronic granulating periodontitis on a sciagram cortical plate not evidently on the limited area and in the same place there is not a characteristic spongy matter which testifies to dilution of bone. This area of dilution does not have clear scopes. Chronic granulematous periodontitis on a sciagram determined as dilution of bone fabric of the rounded or oval form, sometimes at his lateral surface. It is explained that channel or closed on the lateral surface of root, or before apex divided and opened a few mouths on the surface of root. During the perforation of root can be disposed in the places of perforation. Passing of line of periodontium is determined directly to the bone defect, caused granulema.
Radiological diagnosis of dental caries and its complications in children of all ages
Fig. Prykusna radiograph demonstrating a defect in medium size on the distal surface 84 of the tooth that are not defined clinically.
Fig. Prykusni radiographs are important for the diagnosis of occlusal caries surfaces ( a) On the clinical pictures shown fissur sealing tooth 85 , which was held ahead of a visit without prior production prykusnoyi radiographs . Notice the shadow under the sealant. ( B) In prykusnoy radiograph revealed a large cavity under koriozna sealant.
Fig. A series of radiographs of a child of school age who repeatedly performed restorative treatment. Photos are used to bite into dihnostyky new cavity or recurrence of caries. Vnutrishnorotovi shots milk molars help identify pathology that develops in the periodontium.
Fig. On radiographs of the patient shown residual caries.
Fig. In the X-ray determined thinning of bone tissue in the bifurcation 85 tooth restoration glass ionomer cement which proved ineffective . B) periodontal abscess on tooth 74 , which was filling with cement glassionomer posed no local anesthetic and an incomplete removal of tissue affected by caries .
Fig. On intraoral radiograph shows deep cavities in aproksymalnyh surfaces 74 and 75 teeth.
Fig. After welcoming the amputation of 75 teeth was made a series of control radiographs : ( a) before treatment , ( b ) immediately after treatment , (c) after 3 months , (d) after 12 months. From the bone tissue in the bifurcation undetectable changes, is the indication of successful treatment .
Fig. Baby teeth with signs of bone pathology in the separation of roots
Periodontal destruction in milk teeth are usually found in the area bitrifurkatsiyi unlike periapical pathology observed in permanent molars. This is because there are many tubules that provide connections pulp chamber with a bone in the separation of the roots of (b ). The figure shows such a remote point on the milk molars. Note the presence of granulation tissue sprouted in the region of bifurcation.
Pathological root resorption
Fig. Intraoral radiograph , which shows pathological root resorption due to chronic process in the region of tooth 74 with involvement in the pathological process of the follicle and germ permanent premolars in this case shows a tooth extraction.
Fig. A series of radiographs demonstrating the gradual regeneration of bone in the area after the bifurcation pulpektomiyi performed on tooth 75 (a) before treatment , ( b ) immediately after treatment , ( c) after 3 months ; (d) a year.
Errors in diagnosis and treatment of periodontitis
All errors and complications that arise in the treatment of periodontitis, can be grouped into 3 groups:
1 – error encountered during diagnosis of periodontitis ;
2 – Errors and complications that arise in the treatment of periodontitis ;
3 – complications arising after treatment of periodontitis.
Diagnostic errors often occur when application ¬ ing X-ray study. Thus, the X-ray upper jaw ¬ noyi frontal projection Sutura intermaxillaris fora ¬ men incisivum nasal openings and nasal septum may be mistakenly regarded as defects of bone in the region of 21,112 teeth. Often mistaken for foramen incisivum hranlematoznyy periodontitis.
Similar errors occur when the X-ray dos lidzhennya 765 567 teeth, maxillary sinuses when branching ( maxillary sinuses) mistaken for large bone defect ( kistohranulomy , cysts , etc. . ).
In the area of the shadow of the mandible foramen mentale, which pro ¬ ektuyetsya on the top 54 and 45 teeth, can induce an incorrect diagnosis – granulating or granulomatous periodontitis.
In some cases, the canalis mandibularis is so close to the teeth of his upper wall merges with compact plas ¬ morter alveoli of one of the molars. To ensure that the teeth are not in the channel , it is necessary to make additional photos in other projections.
Often dentists mistakenly set the diagnosis of exacerbations of chronic granulating periodontitis, when the shadow of a large, fuzzy alveolar bone defect piling on the adjacent teeth . These teeth appear to be affected by granulomas ¬ ted (or granulomatous ) periodontitis . To avoid diagnostic errors and related complications , it is necessary to conduct a comprehensive examination of the patient ¬ nd – clinical , radiological ( different projections ) , electrical odontodiahnostychne . The combination of all data will allow agencies ¬ you a proper diagnosis and to select and execute the right method of treatment of teeth affected by various forms of periodontitis.
1. Dissection cavity and disclosure ¬ nyny tooth cavity can be complicated by perforation of the wall or floor . This problem is a result of poor knowledge of the topography of the doctor in ¬ tooth cavity and the thickness of his hard tissues in various parts ¬ tries , especially in children and elderly patients .
Perforation of the bottom cavity of the tooth and its wall if it occurred to the neck of the tooth ( Fig. 8), remove the snap. It punched a hole pre- processed antiseptic and Zach dig ¬ glassionomer seal with cement. Sometimes, before sealing the hole closed with foil (pain usually subsides after that ) and continue to treat the tooth.
Fig.8 . Errors
revealing the cavity of the tooth :
A – perforation of the wall of the tooth due to
failure to comply with the axis of the tooth;
B – perforated floor of the tooth
in bifurcation
Ways to eliminate perforations :
· closure seal of skloinomernoho tsymentu ;
· closing foil;
· Use Pro Root ( ProRut ) ITA .
ProRut MTA ( Mineral Trioxide Aggregate ) – Water-based material for the restoration of root canal dentin .
Ingredients:
Calcium oxide 65%
Silicon oxide 21%
Iron oxide 5%
Aluminum oxide 4%
Calcium sulfate 2.5%
Magnesium Oxide 2%
Soda and other 0.05%
material for the restoration of root kanaliv.Material to restore root canal ProRut Em- Tee- hey – a powder consisting of fine hydrophilic particles that are curable in conjunction with water. When wet the powder turns into a gel , which then freezes creating an impenetrable barrier.
Indications:
1. Filling the root apex.
2. Repair of root canals as apical plugs in apeksatsii .
3. To repair the perforation of the root canal during endodontic treatment.
4. Once inside rezorbtsiyi.5 . For direct pulp capping .
Contraindications:
WARNING:
1. Bags of material for the restoration of root canal ProRut Em- Tee- hey should be stored tightly sealed in a dry place to prevent moisture penetration.
2. The material for the restoration of root canal ProRut Em- Tee- hey should be applied immediately after mixing with water to avoid dehydration during usadky.3 . Use material for the restoration of root canal ProRut Em- Tee- Hey root canal and / or pulp chamber , not higher , as this material is in the nature of its components can lead to tooth discoloration .
Instructions for use :
RECOVERY AFTER perforation resorption.
1. Putting Rubber Dam , clean the root canal of sawdust and product -life , using tools for treatment of root canals and canal irrigating solutions containing NaOCI .
2. Place a temporary filling , closing access to the cavity.
4. Dry the canal with paper pins and set the area of the defect root canal.
5. Spend obturation of all canals in the apical zone of the established area of the defect.
6. PREPARE MATERIAL PRORUT
7. Using the applied probe for applying, put material in the area of the defect. Seal material ProRut Em- Tee- Hey cavity using a small amalhamnym plunger and a cotton ball or paper pins.
Note: You can condense material , using a large ultrasonic nozzle without irrigation water on medium power.
8. Make sure you are correctly placed ProRut Em- Tee- hey , using renthenohrammoy . If adequate barrier have been created, wash material ProRut Em- Tee- Hey water from the area of the defect and repeat.
9. Place moistened cotton swab into the cavity and channel zaplombuyte temporary restorative materials for at least 4 hours.
10. After 4 hours , or during the next intake using Rubber Dam inspect material ProRut Em- Tee- Hey. The material should be solid. If not , clean it and repeat the application.
11. When the material ProRut Em- Tee- hardened Hey , obturuyut other channels . ProRut Em- Tee- hey should remain as a permanent part of the seal of the root canal.
RESTORATION perforation root canal.
1. Putting Rubber Dam , clean the root canal of sawdust and product -life , using tools for treatment of root canals and canal irrigating solutions containing NaOCI .
2. Dry the root canal system of paper pins and isolate the location of perforation.
3. Obturuyut all channels located on the apical perforation.
4. PREPARE MATERIAL PRORUT
5. Using the applied probe for applying, put material in the area of the defect. Seal material ProRut Em- Tee- Hey cavity using a small amalhamnym plunger and a cotton ball or paper pins.
Note: You can condense material , using a large ultrasonic nozzle without irrigation water on medium power.
6. Make sure you are correctly placed ProRut Em- Tee- hey , using renthenohrammoy . If adequate barrier have been created, wash material ProRut Em- Tee- Hey water from the area of the defect and repeat.
7. Place moistened cotton swab into the cavity and channel zaplombuyte temporary restorative materials for at least 4 hours.
8. After 4 hours , or during the next intake using Rubber Dam inspect material ProRut Em- Tee- Hey. The material should be solid. If not , clean it and repeat the application.
9. When the material ProRut Em- Tee- hardened Hey , obturuyut other channels . ProRut Em- Tee- hey should remain as a permanent part of the seal of the root canal.
APEKSFIKSATSIYA roots.
1. Putting Rubber Dam , clean the root canal of sawdust and product -life , using tools for treatment of root canals and canal irrigating solutions containing NaOCI .
2. Dry the root canal system of paper pins and Disinfection place calcium hydroxide paste in the feed per week.
4. PREPARE MATERIAL PRORUT
5. Using the applied probe for applying, put material in the area of the defect. Seal material ProRut Em- Tee- Hey cavity using a small amalhamnym plunger and a cotton ball or paper shtyftamy.Uvaha : You can condense material , using a large ultrasonic nozzle without irrigation water on medium power.
6. Make sure you are correctly placed ProRut Em- Tee- hey , using renthenohrammoy . If adequate barrier have been created, wash material ProRut Em- Tee- Hey water from the area of the defect and repeat.
7. Place moistened cotton swab into the cavity and channel zaplombuyte temporary restorative materials for at least 4 hours.
8. After 4 hours , or during the next intake using Rubber Dam inspect material ProRut Em- Tee- Hey. The material should be solid. If not , clean it and repeat the application.
9. When the material ProRut Em- Tee- hardened Hey , obturuyut other channels . ProRut Em- Tee- hey should remain as a permanent part of the seal of the root canal.
SEALING root apex.
1. Provide access to the root apex and rezurtsiruyte it using a surgical bur .
2. Using ultrasonic handpiece prepares cavity during class I at a depth of 3 to
3. Isolate work area . Dry root cavity with paper pins. Stop the bleeding hermetic sponge or other suitable material.
4. PREPARE MATERIAL PRORUT
5. Using the applied probe for applying, put material in the area of the defect. Seal material ProRut Em- Tee- Hey cavity using a small amalhamnym plunger and a cotton ball or paper pins.
6. Remove excess cement and clean the root surface moistened gauze.
7. Make sure you are correctly placed ProRut Em- Tee- hey , using renthenohrammoy . ProRut Em- Tee- hey should remain as a permanent part of the seal of the root canal.
Pulp capping .
1. Using Rubber Dam , end cavity preparation using burs at high speed with constant irrigation water.
3. Rinse the cavity and the surrounding area (s) 2.6 – 5 % solution NaOC1. Bleeding can be controlled with a cotton swab moistened with sterile saline solution.
4. PREPARE MATERIAL PRORUT
5. Using a small applicator with a ball on the end or a similar device, apply a small amount ProRuta Em- Tee- Hey on bare land.
6. Remove excess moisture in the working area using a cotton swab moistened .
7. Apply a small amount of material fluid cushioning material kompomernoho Dayrakt Flow ( or similar material glassionomer svetopolimerizuemoho pads) to cover ProRut Em- Tee- hey, zapolimeryzuyetsya it according to the manufacturer’s instructions.
8. Protruyity cavity surface were 34% -37% phosphoric acid gel for 15 seconds. Rinse .
9. Gently dry the cavity , leaving the dentin slightly moist but not wet. Apply Prime End Bond En- Those like him or adhesive. Zapolimeryzuyetsya instructed.
10. Complete restoration, composite material causing Spectrum Tee- Pee HSBC or similar composite material.11 him . When you next visit the patient evaluate the viability of the pulp. The vitality of the pulp should be checked every 3-6 months using radiographs .
Complications arising after treatment of periodontitis
1. At various times after treatment of periodontitis may asymptomatic progression of the pathological process in the periodontium , which can lead to chronic osteomyelitis, odontogenic cysts and others. Often this complication occurs in patients with reduced immunity , individual response to plombuval starting material or if dispersal endochannel seal.
This pathology detected radiographically. It needs immediate retreatment of the tooth. If quality perelikuvaty HVO ¬ ing tooth caot he be removed as fire hronio – septic state .
2. Quite a common complication of chronic periodontitis are odontogenic sinusitis . The cause of its destruction can be spongy substance of the alveolar process of patho -logical process, maxillary sinus infection , trauma it during root canal treatment tool 765 567 teeth, output seal binding material in the cavity so ¬ sinus. Exacerbations may occur after 1-2 months or 1 -2 years. In such cases, the causal tooth removed and carried ¬ dyat treating sinusitis .
Complications in the treatment of periodontitis
Complications may occur as in the treatment of periodontitis , and after filling the root canal. Root Canal Treatment potent drugs ( high concentration of formaldehyde , phenol, rezortsynformalyna and other substances ) can cause periodontal intoxication . Clinically, this translates blurred by pain at that nakushuye on the affected tooth. In these cases, the channels leaving any substance is not irritant periodontal ( эvhenol , clove oil diluted 1:5000 in furatsilin , hydrocortisone ), or spend electrophoresis iodide of potassium, proteolytic enzymes , anode – galvanization . As a result, the pain usually subsides in 2 to 3 teeth and visit the seal fails . Emerging after – resorcinol method formalynovoho pain abolished after 3-4 days without additional treatment.
Very often the treatment of chronic periodontitis have to use machining rozshyryalnymy root canal instruments. By processing channel drylborom hand , do not exert excessive force . When working of machine drylborom probable perforation of the wall of the channel or timer tool , so you should give the maximum number of turns.
When vidlami endodontic instrument channel should try to remove it. If the end of the rod protrudes from the mouth instrument channel, a small spherical bur drill dentin chips around , then pull vidlamok forceps or tweezers little eye .
Where the instrument oblomyvsya deep in the channel , the latter expand with EDTA. Then the pulpэkstraktor wound cotton turundas injected into the channel and rotational movements pulpэkstraktora trying to wrap wool lying freely vidlamok and take him out of the channel.
If you can not bring vidlamok then attempt to pass the channel to the apical foramen along with a broken tool. With the failure of the treatment was carried out rezortsynformalinovyy channel after electrophoresis of potassium iodide . Where the vidlamok tool closes the apical third of the channel should fill the upper part of the channel phosphate cement and resect the root apex.
Another complication that often occurs when processing channels drylboramy is punching walls of the root. This can be avoided , constantly controlling the direction of the needle, which should correspond to the longitudinal axis of the tooth. Be sure to control the direction of X-ray endodontic instrument channel both in the process of expanding and beyond. To do this, root canal throughout its length available root needle is introduced , which is fixed with a cotton swab and hold this position for X-ray of the tooth.
When the pain during root canal treatment is necessary to stop its expansion and check the position of the tool in the channel. Pain may occur as a result of collision with the tool near the top of periodontal tooth root or in the walls of the perforation . Perforation of root canal walls can significantly hinder its further expansion and particularly affect the quality stopping it. In addition, in accordance with section periodontal perforations then usually develops additional incendiary fire. If you find the channel wall perforation tooth it should seal zinc evhenolovoyu paste or phosphate cement. This should avoid withdrawal filling material through perforation hole in the periodontium . Sometimes severely curved root apex when canal to pass over all its not possible to make an artificial perforation close to the apical foramen of the root, so it spoluchalasya navkoloverhivkovym with abnormal cell. Then, through the course of fire navkoloverhivkove administered bioactive paste or filling material .
Often in the treatment of periodontitis can observe a condition where teeth do not maintain airtight closure. Such situation is explained by an incomplete root canal passage and retaining it in the collapse of the pulp. Typically, after instrumental treatment of the channel and its washing antiseptic enzymes or pain during superimposed airtight bandage is no longer there . However, in some cases, inflammation can worsen both during treatment and after root-canal . In the first case, the treatment is to create an outflow of fluid from the area of the apical periodontium through root canal (tooth left open ), the appointment of physical therapy (uhf – therapy mahnitoterapyya , flyuktuoryzatsyya , dyadynamoterapyya etc. .) And painkillers.
After filling the channel often occurs as a result of the aggravation of the pathological cell size disparity in periodontal number entered into it filling material. In order to prevent an aggravation of the inflammatory process once it is expedient to carry out the procedure electrophoresis potassium iodide or proteolytic enzymes. It greatly reduces the likelihood of exacerbations of chronic inflammation.
When the manifestation of aggravation relief it must begin with the appointment of physiotherapy and injections of hydrocortisone on transitional fold . When these tools are unable to arrest the inflammation and gum abscess occurs , it should be open. Cuts quickly lead to exacerbations .
Rarely , in the case of the withdrawal of a large number of filling material with little degradatioavkoloverhivkovyh tissues in patients with long remain pain on palpation of the gums and sometimes pain wheakusuvanni in sealed tooth. Often the gums in a tooth called fistulas move. To close the fistula electrophoresis effective overlay indifferent electrode on a transitional fold . In severe cases, the electrode can be used as copper or silver wire that is introduced in the course of fistulas . As a last resort in these cases it may be recommended to remove excess filling material with a small spoon kyuretazhnoy progress through fistulas or specially made gum incision in the apex of the root. This intervention is accompanied by significant pain, and therefore should be under anesthetic injection .
The most common cause of complications such as acute inflammation through a particular time after the treatment of periodontitis are incomplete filling of the root canal . To address the question of whether treatment of the tooth is needed radiograph on which determine the degree of filling of the root canal filling material and character .
Simply solve the problem by identifying the channel netverdnuchyh paste ( zinc- hlytserynova et al. ), The removal of which is not of great work. Much more difficult to remove from the channel rezortsynformalinovoyi hardened pastes and especially phosphate cement.
If the channel is sealed only in ⅓ of or even less , it often fails rozplombuvaty . If channels odnokornevyh teeth sealed with cement to 1 / s or 1/4 lengths better to resect the root apex of tooth replantation or do , if that is clinical or radiological screenings .
Bahatokorenevi teeth with narrow and crooked , poorly sealed root canals with the inability of their treatment by electrophoresis and frequent exacerbations of inflammation or hemisection be deleted.
Errors and complications
during endodontic treatment
During and after endodontic treatment of a variety of possible errors and the development of complications. Shareware can be divided into two groups.
1. Errors and complications associated with creating endodontic access:
• insufficient removal of arch tooth cavity ;
• perforation of the crown at the level of the cervix ;
• perforation of the walls of the cavity crowns ;
• perforation of the floor of the crown;
• perforation in the bifurcation ;
• timer or tongue vestibular wall of the tooth;
• painting crown devitalnyh teeth.
2. Errors and complications associated with hemomehanichnym preparation and obturation of the root canal : the mouth of the lack of a root canal , a space of possible root canal , formation of the ledge in the wall of the root canal , perforation of the wall of the root canal , the instrument timer in the root canal , a longitudinal fracture of the root , forming a channel in a ” hourglass ” , the formation of the lower curvature of the channel as a ” saw teeth ” pushing the decay products of the pulp through verhivkovyyotvir in peryapikalni tissue ;
• foreign material in tissues peryapikalnyh ;
• blockage of the root canal;
• apikalnaya perforation ;
• reaction to endodontic medicaments (materials );
• damage zone sprout emerging permanent tooth root ;
• injury to permanent tooth germ in the treatment of deciduous teeth ;
• perforation of the sinus walls verhnoschelepovoyi ;
• injury to the neurovascular bundle in the channel of the lower jaw;
• postendodontychna compressioeuropathy branches of the trigeminal nerve;
• poor sealing of the root canal :
– Incomplete filling of the root canal;
– Removal of filling material for apical opening;
• aspiration or ingestion of rod instruments;
• air embolism
• Establishment of subcutaneous emphysema face and neck ;
• postendodontychnyy pain;
• reinfection of the root canal ;
• perykorenevi persistent infection.
Consider some of the most difficult and ti.scho frequently encountered complications of endodontic treatment and ways to address them.
Perforation DENTAL
Perforation is defined as a man-made hole in the tooth or root , resulting in tooth cavity communicates with the periodontal tissues. There are following perforation teeth : lateral ( through the wall cavity crowns ) furkatsiyni (through its bottom ) wall of the root canal and apical foramen . Perforations occur as a result of poor targeting , reviews and crude preparation – excluding the provisions of the tooth and its working length.
Perforations should be seen as a significant factor that limits the ability of endodontic treatment. Perforation of the walls and floor of the crown observed often in poor knowledge of the topographical features of its structure and excessive expansion of the mouths of root canals , sometimes as a result of attempts to detect mouth sklerozovanoho channel. Diagnosis of perforation cavity bottom and sides of crown is not of great difficulty . Punched hole floor of the crown easily detect probing . Avoid perforation floor of the multi- tooth crown helps to display the mouths of root canals using dyes. Of course , it is important , as has been said , the knowledge of the topography of root canals and their mouths .
Perforation bottom and sides of crown cavity requires immediate action . Perforation should be removed immediately after its occurrence , as postponement can lead to perforation at the site of inflammation, which is difficult to treat and jeopardizing the ability to save the tooth.
Treatment of lateral perforation cavity crowns reduced exposure to cervical tooth surgically and stopping just treatment voids V class.
Furkatsiyni eliminate perforation through the cavity crowns using materials retrograde filling of the channel ( amalgam , glass ionomer tsementы , kompomery , calcium phosphate cements , osteoplastic materials). Classical perforation to seal the bottom of the cavity crowns are gold foil , over which is placed amalgam .
The success of treatment depends on the ability to fill the perforation without significant excess filling material in periodontal inflammation and prevention of infection in it.
Narrow by perforation obturuyut principles root canal . With a wide perforation wound on pre- imposed preparations based on calcium hydroxide .
Perforation of the wall of the root canal can result from careless use of endodontic instruments when the axis does not correspond to the direction of the root canal. In addition, the walls of the perforation can occur when you try preparing curved root canals. Depending on your location perforation root canals are divided into apical , middle and coronal . On the walls of the root canal perforation shows a sharp pain that suddenly appeared during manipulation in the cavity of the tooth , as well as an appearance in the lumen of the root canal blood. In this case, the desired radiographic studies when introduced into the root canal needle. Often perforuyetsya root of the tooth in its field curvature . Especially easy perforuyetsya rezorbovana wall of the root.
To prevent perforation of the wall of the root canal to avoid the forced passage narrow and obliteryrovanyh root canals and irrational use of machine tools. It is also advisable to resort to periodic radiographic control in the process of passing a root canal. May be useful to study the X-ray of the tooth root with a magnifying glass , revealing uzury wall of the root canal , which can upertysya tool and the rotation perforate the wall of the channel.
When perforation of the wall of the root canal treatment is carried instrumental channel , which is then fastened . Before sealing to eliminate inflammation in the lateral periodontal associated with perforation, useful vnutrishnokanalnyy electrophoresis tincture of iodine or potassium iodide .
If perforation occurred in the apical third of the root, it is usually by eliminating the root apex resection .
Perforation navkoloverhivkovyh tissues ( apical perforation) caused by the withdrawal of rod instruments for apical opening. In this case, the patient responds hurt . However , the pain often subsides quickly . Bred at the top of the root tool easily detected radiographically. Intact instrument usually easily removed from the root canal. After that, the lumen of the root canal can be detected blood or blood fluid. After drying the root canal lumen leave his dry q turundas . If the walls of the root canal had previously been treated sufficiently and no patient complained of , and in the lumen of the root canal is not detected moisture treatment complete tooth root canal .
Substandard root canal
In endodontic practice, there are cases where it is necessary to unsealing root canal before obturovanyh . Common causes of root canal retreatment as complaints of pain iakushuvanni (due to withdrawal of filling material at the tip of the root ) nedoplombuvannya channel , the presence of the X-ray signs of bone destruction , despite the fact that the channel is filled to the apical foramen , the need for partial unsealing channel under the pin or kultevuyu tab. Before perelikuvannya need to do X-ray , which will identify potential difficulties . Based on the X-ray data on the location and direction of the channels , as well as clinical indicators to determine the range of tooth tactics, methods, materials and tools. It should be borne in mind that any perelikuvannya root canal not only increases the deformation of the tooth , but also increases its fragility due to mechanical stress associated directly with dezobturatsiyeyu and re- preparation and obturation of canals.
When perelikuvanni root canal dentist is facing a number of issues. The first step is to define reality and rationality perelikuvannya saving the tooth. You then need to find the mouth of the channel , to determine their direction , type of material , which was sealed channel, and so on. Pay attention to the color of the material at the mouth of the channel, as well as the color of the material particles on the working of the tool, which examined the.
In dental practice for removing filling material from root canals using the following methods:
• Mechanical – using endodontic instruments;
• physical – with the use of ultrasound and heat ;
• Chemical – using different solvents;
The mechanical method of removing filling materials should be used with partial unsealing of the root canal during kultevuyu tab or pin when you need rozplombuvaty channel at a certain depth . Use both hand and machine endodontic instruments or alternate them. Apply endodontic instruments such as Largo, Peeso-Reamer, K-reamer. Some firms hold special tools for unsealing channels.
Substantial assistance to provide ultrasonic tools that allow vnutrishnokorenevi undermine or destroy material pins inside the root canal.
The opening of the channel in the first 2-
These drugs help remove filling materials containing eugenol (Endosolv E, “Septodont”), rezortsynvmisnu resin (Endosolv R), gutta-percha ( halothane, eucalyptol , xylene , chloroform ). They greatly facilitate the task of softening and removal of filling material from the channel. Also used drugs that can expand the lumen of the channel due to chelate action.
Before the removal of root fillings chemical way to delete the coronal seal. After removing the padding necessary to release the mouth of root canals , extend them and create a funnel deepen – the tank of solvent. After making the solvent at the mouth of the channel there is a softening layer of root fillings. With K-file solvent needed to push a little deeper into the mouth of a root canal.
The next step – removing the softened material from the wellhead of the root canal. Depending on the size of the mouth of the selected corresponding K-file. After making a fresh batch of solvent K-file corresponding diameter exercise movements as in watch winding slowly venturing into the channel. As you approach the top of the root is used K-file is smaller – according to the technique “crown down”. At the difficulties that arise in the process of unsealing soluble liquid can be placed in the mouth cavity or channel at part of his passes for a few days. Achieving the root apex is necessary to confirm radiographically or electrometry.
If root canal passed through the root to seal the root apex , you can begin to extract the wall material. With this easy to use tool with aggressive lateral surfaces – H-file. To remove the wall material H-file is introduced into the canal until it stops. Instrument pushing against the wall of the root canal , lateral sides vidskribayut filling material from the walls . Consistently changing the H-file for larger tools , conduct a complete removal of filling material .
The criterion for removal of filling material quality is the appearance of dentinal shavings.
In some cases, along with the stopping material must be removed or other metal in the middle koreneya retention structures – core pins and rods . They oholyayut careful drilling filling material around.
Cast instruments in root canals
Removal of fragments of root canal instruments are complex and demanding procedure that requires a doctor to experience and considerable patience.
One must consider a number of factors that caot always be fully and accurately assess:
• type of instrument;
• Tool length fragments ;
• extent of damage to the instrument in the root canal ;
• Chips position tool in relation to the axis of the channel;
• type of filling material that surrounds vidlomok ;
• anatomy of the root canal;
• technical means available to the physician ;
• prediction of treatment.
In addition, a significant importance and reasons for failure of the tool:
• lack of direct access to the root canal;
• violations of sequence 6ndodontychnoho use tools;
• insufficient monitoring of the instrument ;
• Significant efforts to the tool during dissection disturbances technology tool use ;
• Work in dry root canal ;
• haste at work.
Planning procedures for extracting chips should begin with an analysis of the localization and type of broken tools.
For example, the H- file that breaks when screwing in the root canal and gets stuck in its lumen , remove tougher than K-reamer, which when forced nadlomlyuyetsya injected into the root canal. Often prone to fractures and kanalonapovnyuvachi .
During the intervention requires repeated adjustment of measurement methods and technical means.
Tactics deletion fragments endodontic instrument is determined in each case individually.
Weather interference favorable if the tool broke in the upper third of the channel , because this area is enough space for approach and his passion for chips using tools that rotate. Vidlamok surrounded filling materials, and removal of this material leads to the simultaneous removal of chips tool.
If vidlamok located in the coronal canal or is the end of the cavity crowns , you must create the space around to grab it. It uses thin forests or forests – circular trepan . Straight boron may accidentally cut off the end of the tool sticking . Capture tool that opens, carried a thin krovozupynnym clamp or special devices .
When vidlamok occupies the middle part of the root canal , extracting it from the channel depends on the possibility of removal of filling material that surrounds it. The cavity approach to dissect chips should carefully without damaging or destroying of no chips, speaking from the mouth of the root canal. With K-reamer determine the position of the fragments and the ability to access it. After forming cavity access chips you can try to bypass using K-rearrier. Gradually vidlamok tool shaken and extracted the tool of larger diameter .
If vidlamok crashed into the wall of the root canal and stuck , then you can loosen or acting on his instrument of larger diameter , or using special tools ( extractor ) that allow you to hook vidlamok tool to grip it and withdraw from the canal.
Recently, a method was proposed mikrozvarky that is what drew vidlamok , pryvaryvshy it to vnutrishnokanalnoho tool using mikrorozryadu . Developed the following technologies . Two vnutrishnokanalni tools are used as electrodes. The first tool ( electrode) is seeking to enter between the chips and the channel wall . The second electrode is subsumed under careful visual control directly to the chips. After contact with the second electrode chips discharge occurs , in which the electrode is welded to the chips. Extraction is carried fragments pulling movements. When rotation welding strength is not enough to remove the chips.
This method is used when all other traditional methods are ineffective. The basic condition for using this method is to provide direct access to the chips.
If you can not pull vidlamok , the root canal and are expanding along with the chips.
The use of ultrasound devices is justified in the case vidlamok available and ultrasound can effectively influence upon him .
If vidlamok instrument is in the apical part of the canal, extracting its prognosis is much worse. You must avoid pushing chips beyond the apical foramen .
Exit foreign body in the root tip peryapikalnyy space hinders its extraction from the root canal. In cases where attempts to remove chips tool from root canal were unsuccessful shown apikalnaya surgery and autopsy apical part.
Often a compromise and the only real result of all of manipulation is to preserve fragments of its inclusion in the filling material of the root canal .
Reaching the partial treatment effect forced removal of chips can create new difficulties , reflected in additional breakage tools create ledges , perforations in reducing tooth root expansion physiological hole. Removing chips tool from root canal is a time consuming and complex process that often requires several hours and sometimes several visits .
Discoloration of tooth after ENDODONTYCHNOHOLIKUVANNYA
Discoloration often occurs due to incorrect endodontic treatment. Change the color ( dyskoloryt ) hard tissue endodontic treated tooth is the result of a number of reasons , among them :
• depulpuvannyazuba ;
• root-canal filling materials by changing the color of the tooth ( resorcinol – formalin , zinc and other evhenolovoyu paste );
• imposition of gaskets and sealing materials containing silver ;
• Pins base metal , chips endodontic instruments.
Often discoloration is caused by necrosis of the pulp when there is hemolysis of erythrocytes and hemolysis products penetrate the dentinal tubules , being essentially iron compounds . Last interact with hydrogen sulfide to form a black iron sulfide .
The degree of discoloration of the tooth is different – from a strong dark coloring to a small color changes. When restoring teeth that saved the full structure, but discolored , bleaching instead pokrytyya their crowns and veneers becomes a full treatment of choice.
If devitalnoho dyskoloryta whitens teeth by using professional whitening vnutrishnokoronkove and combined (a combination of external and vnutrishnokoronkovoho ). Professional whitening usually combined with the influence of physical factors – heat, ultrasound, ultraviolet , halogen and laser radiation.
There is a list of compositions for bleaching teeth devitalizovanyh : ether peroxide, perhidrol , sodium perborate , sodium peroxide , carbamide peroxide , sodium hipofosfat , patented drugs – Pyrozone (“Me Kesson & Robbins”), Superoxol (“Merk”), Endopezox (” Septodont “), Hi Lite (” Shofu “).
The use of bleaching compositions comprising peroxide compounds, gives very good cosmetic results with vnutrishnokoronkovomu bleaching .
Perekysnyye connection freely penetrate the enamel and dentin , due to low molecular weight oxidized pigments peroxide tooth and denaturation of protein compounds contained in the pigments.
Regardless of the technology used teeth whitening , fundamental factors are: the reason for the change of color, the original color of teeth bleaching product concentration , temperature, time, whitening , oral hygiene status .
It is necessary to evaluate the color of teeth whitening procedures that require , on a scale “Vita”.
You must know that the process of bleaching caot go indefinitely . Typically, you can really lighten your teeth by 1-2 tones on a scale “Vita”. Prodeduru whitening begins with a professional cleaning tooth surfaces. Before the procedure, you must remove the old restoration to improve the diffusion of the drug inside the tooth bleaching and maximize its contact with the enamel and dentin .
Whitening teeth with crowns changed color :
catalytic method;
gradual whitening method ;
method “night ” whitening Nightguard-vital-Bleaching.
POSTENDODONTYCHNAYA compressive neuropathy
BRANCHES trigeminal
By the grave and dangerous consequences of endodontic treatment should include branches of the trigeminal nerve neuropathy that occurs as a complication due to excessive withdrawal of instruments and filling material in peryapikalni tissue or adjacent anatomical areas ( mandibular canal , opening the chin, upper jaw sinus ).
Common cause of these complications are serious errors in the technique of preparation and filling of root canals :
• errors in determining the working length of the tooth;
• violations of apical dissection ;
• excessive disclosure apical stop or lack thereof ;
• breach of obturation technique of root canal ;
• neglect of diagnostic X-ray examination or false interpretation of the results ;
• use of medication and filling materials , which include toxic chemical components.
Clinical manifestations of neurological complications in the derivation of filling material beyond the root canal depends primarily on group membership affected teeth , due to the peculiarities of the anatomical and histological structure of the jaw bone and its innervation.
In the development of neurological complications in endodontic intervention is important initial state peryapikalnyh tissues. We caot take into account the damaging effect of filling material for healthy bone tissue. Excessive amounts of filling material that has mechanical , chemical, toxic , allergic effects , promotes inflammatory and destructive processes in bone.
Among the most common complications of acute compression and toxic neuropathy inferior alveolar nerve – a grave consequence of excessive output plombuvvlnoho material in peryapikalni tissue, lower channel \ pidborid jaw or holes .
Contact with filling material in cells of the spongy substance of bone of the upper jaw because of the compression- toxic effect leads to necrosis and, as a consequence – of pain .
When endodontic treatment premolyarov and molars of the upper jaw may hit filling material into the cavity of the upper jaw or surrounding tissue. Output filling material for root apex in the treatment of incisors and canines of the upper jaw leads to the development of neuropathy infraorbital nerve, which is also accompanied by severe autonomic response.
Treatment in such cases should begin as soon as possible with intensive therapy vidnosyachys to this disease as an urgent condition.
