12. Chronic pulpitis. Pathological morphology, clinic, diagnostics. Exacerbation of chronic pulpitis. Pathological morphology, clinic, diagnostics. Methods of treatment of pulpitis. Choise of pulpitis treatment method due to nform, stage of pulpitis and general organism state.
Chronic fibrous pulpitis n(pulpitis chronica fibrosa)
A chronic fibrous pulpitis is a form of npulpitis which meets most often, which is the result of sharp pulpitis. For people nwith low reactivity of organism sometimes a chronic fibrous pulpitis can arise nup and without the previous clinically expressed sharp stage of inflammation.
Chronic fibrous pulpitis Photomicrograph X n80.
A patient produces complaints about pains from ntemperature and chemical irritants, which do not pass right after removal of nreason. Pain can arise up and from the sharp change of temperature. The patient nof complaints does not produce often enough, and a chronic fibrous pulpitis nappears at a review during sanation of cavity of mouth. It is explained that nlocalization of some carious cavities (for example, subgingival) is uaccessible to the irritants, and also by the presence of good drainage of nconnection with the cavity of tooth).
Complaints about ninvoluntary pain at the chronic forms of pulpitis are absent and arise up only nat acuteening of chronic process.
At a review a doctor finds out a deep carious cavity. The cavity of tooth is nexposed in one point probing of which sharply painfully. nIf a peccant tooth is under stopping, after the delete of the last it is nmore frequent succeeded to find out everything sickly connection with the ncavity of tooth. It is set that a point is exposed more frequent localized at the vestibular horn of pulp (63,5%), rarer nnear oral (24,09%) or between them.
On occasion after necrectomy the area of nlighter dense dentine appears with a barely noticeable point in a center, which ndoes not bleed, but sickly at probing. Consisting is given possibly of tooth nwhich before treats oneself odontogenic facilities as a medical gasket.
Probing on a dentino – enamel border, as a rule, painlessly, that is why nnecrectomy needs to be conducted, beginning from the walls of carious cavity.
A reaction on a cold is sickly and not at once passes after the removal nof reason. A tooth can be changed in a color n— more dark comparatively with intact teeth. Percussion of tooth is not nsickly, but sometimes comparative percussion helps to define a peccant tooth, nthat it is possible to explain a change in periodontium (on a sciagram they nappear in 30% cases).
A transitional fold is without pathology (aexception is made by children). ЕОD at a chronic fibrous pulpitis — 35 mcA, but from na intact hump can be within the limits of 17—20 mcA.
A chronic fibrous pulpitis must be ndifferentiated with a deep caries, sharp hearth pulpitis and chronic gangrenous npulpitis.
Differential ndiagnostics of chronic fibrous pulpitis and deep caries
General:
1. nPresence nof deep carious cavity;
2. Complaints are on pain from all types of irritants. n
Difference:
1. nat a nchronic fibrous pulpitis a pain reaction on an irritant disappears not right nafter removal of reason, but at a deep caries — in that moment;
2. nat a nchronic fibrous pulpitis there is connection with a pulp chamber probing of nwhich sharply painfully, and at a deep caries the bottom of carious cavity is ndense, probing is painfully even on all bottom and dentino-enamel border;
3. it is possible to find out from anamnesis, that at na chronic fibrous pulpitis a tooth was ill before, and at the deep caries of ninvoluntary or aching pains was not;
4. nindexes of nЕОD at a nchronic fibrous pulpitis — to 35—40 mcA, nand at a deep caries — to 12—18 mcA;
5. on a sciagram at a chronic fibrous pulpitis it is npossible to find out connection of pulp chamber with a carious cavity and sometimes expansion of periodontal crack ithe area of apex of root, what is not at a deep caries.
Differential ndiagnostics of chronic fibrous and chronic gangrenous pulpitis
General:
1. nwithout symptoms ran across on occasion;
2. pains are from temperature irritants;
3. presence of deep carious cavity which is reported nwith the cavity of tooth.
Difference consist in that at a chronic gangrenous pulpitis:
1. the crown of the tooth is darker, than at a chronic nfibrous pulpitis, connection with the cavity of tooth wider;
2. probing of bottom of carious cavity, perforatioopening and mouth of root channel painlessly or poorly sickly, pulp does not bleed;
3. a tooth reacts anymore ohot, what on cold, and at a chronic fibrous pulpitis — on cold;
4. indexes of ЕОD at a chronic gangrenous pulpitis — 60—100 mcA, nand at a chronic fibrous pulpitis — 35— 40 mcA.
Chronic fibrous pulpitis in the stage of acuteening
A patient produces complaints about ninvoluntary aching pains which increase from temperature and chemical nirritants. Pains are periodic, alternated incomplete “light” and more frequent arise up in evening and nightly ntime. Cold more frequent than other irritants causes the protracted paireaction. A characteristic irradiation of pain is for the step of branches of ntrigeminal nerve.
At a review a deep carious cavity or tooth nappears under stopping. The cavity of tooth is exposed in one point. Probing of npulp of sharply painfully. Pulp bleeds at probing. A reaction lasted on a cold, pain did not pass nafter the removal of reason. Percussion of tooth can be poorly sickly. A ntransitional fold is without pathology.
On a sciagram on occasion possibly expansioof periodontal crack in the area of apex of root, there is connection of ncarious cavity with the cavity of tooth. ЕОD = 35—45 mcA.
Chronic fibrous pulpitis in the stage of nacuteening it is necessary to differentiate with a sharp partial pulpitis, nsharp diffuse pulpitis, chronic gangrenous pulpitis in the stage of acuteening, nsharp apex periodontitis and chronic periodontitis in the stage of acuteening.
Differential ndiagnostics chronic nfibrous pulpitis in the stage of nacuteening and sharp partial pulpitis
General:
1. presence of deep carious cavity; the sickly probing nis in one point;
2. provocation of the protracted aching pain a cold;
3. ninvoluntary npain incomplete “light”.
Difference:
1. npresence nof pains, that irradiation, at a chronic fibrous npulpitis in the stage of acuteening, what is not at a sharp hearth npulpitis;
2. npresence nof involuntary or protracted aching pains from different irritants in the past, nand a sharp partial pulpitis exists not more than 1—2 days;
3. npresence nof sickly at probing connection of carious ncavity with the cavity of tooth, and at a nsharp partial pulpitis the cavity of tooth is not exposed (except for a ntraumatic pulpitis);
4. na sharp npartial pulpitis meets for persons with high reactivity of organism, that nrarely enough;
5. nat a sharp ninitial pulpitis never there are changes in periapical fabrics;
6. npercussioat a sharp initial pulpitis is never un sickly.
Differential ndiagnostics chronic fibrous pulpitis ithe stage of acuteening and sharp diffuse pulpitis
General:
1) ncomplaints nabout involuntary aching pain incomplete “light”, that irradiation for the step of branches of trigeminal nerve;
2) nthe nprotracted pain is provoked by chemical and temperature irritants;
3) npresence nof deep carious cavity, sickly at probing;
4) npercussion can be sickly.
Difference:
1) na presence nof involuntary pains is in the past at a chronic fibrous pulpitis in the stage of acuteening. A sharp diffuse npulpitis can exist not more than 2—14 days;
2) nprobing at na chronic fibrous pulpitis in the stage nof acuteening painfully in one point, the cavity of tooth is exposed.
At the sharp diffuse npulpitis of probing painfully on all bottom of carious cavity and there is nconnection with the cavity of tooth;
3) at a sharp diffuse npulpitis a cold can quiet pain, what is not observed at a chronic fibrous pulpitis in the stage of nacuteening.
At presence of in the ncavity of mouth of plenty of teeth with the complicated caries a doctor must be npredisposed to the diagnosis of chronic fibrous npulpitis in the stage of acuteening, as a sharp diffuse pulpitis meets nmore frequent for people with the low index of CSR.
Differential ndiagnostics of chronic fibrous pulpitis in the stage of acuteening and sharp or acuteening nof apex periodontitis
General:
1) nprotracted naching pains;
2) na tooth is nchanged in a color;
3) npresence nof deep carious cavity (or tooth under stopping);
4) npercussiois sickly.
Difference:
1. nat a pulpit necessarily presence of “light” without pains intervals, and at sharp forms periodontitis npain is permanent, increasing in time;
2. at a pulpitis pain arises up from temperature nirritants, what is not at periodontitis;
3. a reaction on percussion at acuteening of chronic fibrous pulpitis is expressed poorly, only ncomparatively with a row by costing healthy teeth, and at the sharp forms of periodontitis to the tooth very even to ntouch;
4. at a pulpitis a transitional fold at palpation is nsickly, and at the sharp forms of periodontitis nshe was swollen, hyperemia, sickly;
5. indexes of ЕОD at any periodontitis more than 100 mcA, that talks nabout complete death of pulp;
6. sciagraphies are given also nhelp correctly to diagnose, at periodontitis destructive changes appear iperiapical fabrics, except for sharp periodontitis nin the stage of intoxication.
Chronic ngangrenous pulpitis (pulpitis nchronica gangraenosa)
Complaints for a patient at this form of npulpitis absent more frequent in all, nhowever there can be pains which arise up from different irritants, more frequent in all from hot. Characteristic npains which appear at the change of temperatures (on leaving from a warm napartment on a cold and vice versa). Sometimes a patient is disturbed by aunpleasant smell from a tooth. It is possible to discover from anamnesis, that na tooth in was strongly ill the past, but then pains calmed down gradually. At na review a deep carious cavity appears more frequent in all. The color of tooth nhas a grey tint. Usually the cavity of tooth is exposed widely enough. At nlasted current process of probing painfully only in the deep layers of crowpulp or at back of channels of roots. Superficial layers of mash dirtily – grey ncolor, not bleeding. The action of temperature irritants (especially thermal) ncauses slow growth pains and its gradual fading. Percussion of tooth is not nsickly. On a sciagram in periapical fabrics often expansion of periodontal ncrack or resorption of bone appears with unclear contours (at deep necrosis of npulp). Electro-excitability of pulp is reduced 60-100 mcA.
A chronic gangrenous pulpitis must be ndifferentiated with a chronic fibrous pulpitis (look differential diagnostics nof chronic fibrous and chronic gangrenous pulpitis) and chronic apex periodontitis.
Differential ndiagnostics chronic gangrenous pulpitis and chronic apex periodontitis
General:
1) nwithout nsymptoms ran across sometimes (out nof acuteening);
2) ncomplaints nare about a putrid smell from a carious cavity;
3) nthe npainless probing of superficial layers is in the cavity of tooth;
4) nchanges nare on a sciagram in periapical fabrics.
Difference consist in that at chronic apex periodontitis:
1. nfrom nanamnesis it is possible to find out appearance of the slight swelling on gums nand pain at biting on a peccant tooth during acuteening;
2. a tooth is never irresponsive on temperature nirritants;
3. at the review of transitional fold it is possible nto find out fistula, scar from fistula or stagnant hyperemia;
4. probing is painlessly along the whole length of nchannel, except for those cases, when granulation from periodontium grows in a nchannel, but in this case on trailer appears brightly is red nblood, that not ncharacteristically for a gangrenous pulpitis;
5. granulation at probing is less sickly, than pulp nwhich was saved, in a channel at a gangrenous pulpitis;
6. indexes of ЕОD of more than 100 mcA.
Chronic ngangrenous pulpitis in the stage of exacerbation
A patient produces complaints about ninvoluntary aching pains incomplete “light” short. Sometimes paitakes undulating character, only a little calming down and again increasing. nHotter provokes pain, the cold of her calms for a short time. Pain can appear nat bite. It turns out from anamnesis that a tooth hurts not first time.
At a review: a tooth is changed in a color, nthere is a deep carious cavity which is reported widely enough with the cavity nof tooth. Probing of superficial layers of npulp painlessly, pulp does not bleeding, the color of her dirtily n- grey. A putrid smell appears. A nsickly reaction appears at probing of more deep layers of crown pulp or mouths nof channels of roots. A reaction on a cold can be painless. Percussion of tooth nis sickly. On a transitional fold hyperemia of mucus shell appears in the area nof peccant tooth. ЕОD — 60—100 mcA.
On a sciagram changes can appear as expansioof periodontal crack or resorption of bone fabric with unclear contours.
Chronic gangrenous pulpitis in the stage of nacuteening it is needed to differentiate with a chronic fibrous pulpitis in the nstage of acuteening (see differential diagnostics of chronic fibrous pulpitis), nby a sharp diffuse pulpitis, sharp apex periodontitis and chronic apex nperiodontitis in the stage of acuteening.
Differential ndiagnostics of nchronic gangrenous pulpitis in the stage of acuteening and sharp diffuse npulpitis
General:
1) na presence nof the protracted involuntary aching pains is almost without “light” nintervals;
2) nhotter nprovokes pain, cold calms her;
3) nsickly percussion.
Difference:
1. nat a nchronic gangrenous pulpitis in the stage of acuteening it turns out from nanamnesis, that this tooth was ill and before, and at the sharp diffuse npulpitis of involuntary pains in was not the past, as he exists not more thatwo weeks;
2. nat a gangrenous pulpitis there is connection of carious cavity with the ncavity of tooth, at sharp — the cavity of tooth is usually closed;
3. npresence nof changes in periapical fabrics on a sciagram at a gangrenous pulpitis, what is not at a sharp general pulpitis.
Differential ndiagnostics of nchronic gangrenous pulpitis in the stage of acuteening and sharp or acuteening of apex periodontitis
General:
1) npresence nof the protracted aching pains;
2) npain at nbiting, sickly percussion;
3) nthere is nconnection with the cavity of tooth superficial probing of which painlessly;
4) nthere is a nputrid smell from a tooth;
5) non a nsciagram changes appear in periapical fabrics.
Difference:
1) npains at a npulpitis take periodic character, and at the nsharp forms of apex periodontitis n— increasing, without “light” intervals;
2) nbiting on a tooth at this form of pulpit not such npainfully, as at the sharp forms of periodontitis, when to the tooth very even to touch, and palpation of transitional fold nis sharply sickly;
3) ndeep probing at gangrenous pulpitis npainfully, and at periodontitis — npainlessly;
4) na pain reaction is expressed on hot temperature irritants at a gangrenous pulpitis, nand at a periodontitis reaction is;
5) nindexes of nЕОD are at a npulpitis to 100 mcA, and at periodontitis — more than 100 mcA.
Chronic nhypertrophy pulpitis (pulpitis chronica hypertrophic)
A chronic hypertrophy pulpitis has two nclinical forms:
· that granulates (excrescence of granulation fabric nis from the cavity of tooth in a carious ncavity)
· a polypus of pulp is more nlate stage of motion of disease, nwhen fabric of pulp which overgrew is covered a mouth epithelium.
The cages of epitheliums are carried from ngums, cover all surface of bursting pulp and densely with her accustomed to ndrinking.
Chronic hypertrophy npulpitis
Photomicrograph X 200
A patient produces complaints about bleeding from na tooth at mastication, pain at a hit in the tooth of hard meal. Sometimes a npatient is disturbed by original appearance nof tooth from the carious cavity of which “something bursts”.
At a review a carious cavity is determined, npartly or fully filled fabric which overgrew. At a granulation form the color nof fabric is bright red, bleeding appears at the easy probing, moderate pain. nThe polypus of pulp has a pinky color (color of normal mucous), at probing nbleeding is absent, pain weak, consistency of polypus is dense. Abundant dental ndeposits appear on the side of peccant tooth, as a patient spares this side at nmastication. A reaction on temperature irritants is expressed poorly. On the nsciagram of changes in periapical fabrics, as a rule, does not appear.
A chronic hypertrophy pulpitis more frequent nmeets for children and teenagers.
A chronic hypertrophy pulpitis must be ndifferentiated with excrescence of gingival papilla and with granulation which novergrew, from the perforation of bottom of cavity of tooth.
Differential ndiagnostics of nchronic hypertrophy pulpitis and excrescence of gingival papilla
General
1. for these diseases there is original appearance of carious cavity, filled fabric which overgrew, probing of which causes nbleeding and weak pain (except for the polypus of pulp).
Difference:
1. na gingival npapilla which overgrew can be forced out an instrument or wadding marble from a ncarious cavity and to find out his connection with interdental gums, and nhypertrophy pulp overgrows from the perforation opening of roof of cavity of ntooth;
2. non a nsciagram at a pulpitis it is possible to see connection of carious cavity with nthe cavity of tooth.
Differential ndiagnostics of nchronic hypertrophy pulpitis and granulation that overgrew from the perforation of bottom nof cavity of tooth (bifurcation)
General:
1) na carious ncavity is filled granulation fabric;
2) nthere is nbleeding at probing of granulation.
Difference:
1) nprobing in the area of perforation less painfully (like a prick igums), what at a chronic hypertrophy pulpitis;
2) na level of nperforation more frequent in all is below thaeck of tooth, and at a nhypertrophy pulpitis — higher (at the level of roof of pulp chamber);
3) nat nexcrescence of granulation fabric from bifurcation nat presence of in this area of perforation, as a rule, the complicated form of ncaries appears on the different stages of treatment. At partial necrectomy the nmouths of channels appear before stopped or empty;
4) non a nsciagram connection of cavity of tooth is determined from periodontitis bifurcation and dilution of bone fabric ithis area, and at the hypertrophy pulpit of changes in periodontium does not nappear;
5) nindexes of nЕОD from nhumps at a pulpitis less, and at periodontitis more than 100 mcA.
State nafter complete or partial delete of pulp
Diagnosis the “state after the complete ndelete of pulp” belongs in case that a patient appealed to dentist nconcerning the fall of stopping in before devitalized tooth; a tooth does not ndisturb, air-tight channels nnot broken, percussioot sickly, transitional fold in the area of this tooth nwithout pathology, on the sciagram of changes in periodontium does not appear. nIf even one of the transferred signs doubtful (broken air-tight channels, weak pain at percussion, hyperemia of ntransitional fold), it is necessary to have a x-ray for clarification of the nstate of channels and periodontium, whereupon a diagnosis belongs on the state nperiapical fabrics of tooth.
Diagnosis “the state after the partial delete nof pulp” belongs in case if a tooth was treated the method of ncongratulatory amputation (for example in child’s age during forming of root) nand ЕОД is ngiven confirm viability of root pulp, on the sciagram nof changes in periapical fabrics is.
TREATMENT nOF PULPITIS
At treatment of pulpitis it is necessary to ndecide the followings problems:
1) nto remove na pain symptom;
2) nto nliquidate the hearth of inflammation in pulp;
3) nto guard fabrics of periodontium from a damage with the purpose of warning of ndevelopment of periodontium;
4) nto enable formed scold at treatment of pulpitis for a child;
5) nto pick up thread an anatomic form and function of tooth as to the norgan.
The existent methods of treatment of pulpitis ncan be divided on
· conservative
· surgical
· conservatively – surgical.
The biological (conservative) method of ntreatment of pulpitis is directed on the removal of inflammation in pulp by nmedicinal preparations and methods of physiotherapy without the subsequent ndelete of vascular-nervous bunch, or partial delete of pulp under anesthesia nwith the subsequent saving of its part which remained (methods of ncongratulatory and deep congratulatory amputation).
Surgical methods of treatment of pulpitis n(vital and devital extirpation) are the mashes directed on a delete under nanesthesia or after its devitalization.
Biological nmethods of treatment of pulpitis
A biological method of ntreatment of pulpitis is a method, directed on the complete saving of pulp ithe viable state. Saving viability of all pulp is possible at the circulating forms of its inflammation.
There are nindications for the choice of this method:
· nSharp npartial pulpitis.
· nThe casual nbaring of intact pulp is at preparing of carious cavity or tooth under a crown, nbreaking off of crown of the tooth nat a trauma. In last case it is necessary to be convinced from data of ЕОD, that nthe complete break of vascular-nervous bunch did not take place in the area of napex of root.
· nChronic nfibrous pulpitis at the indexes of ЕОD of not more than 25 mcA and in default of ianamnesis of information about acuteening of this form of pulpitis.
· nLow intensity of caries (not more than 7 and the constant of S — stopping predominates).
· nYoung age (to n30) and absence of heavy concomitant chronic diseases, and also sharp diseases nof respirators the day before and during treatment.
· nAbsence of nchanges is on a sciagram in the area of apex of root.
· nAbsence of nallergic reactions is on common medicinal preparations.
A tooth is not subject prosthetics.
Direct coverage of pulp is at a biological nmethod treatment of pulpitis (chart)
1 is pulp:
2 is a medical gasket;
3 is a dentine;
4 is a cement gasket;
5 —is stopping.
A carious cavity must not be localized in a ncervical area, as in this case inflammation of crown pulp can quickly pass to nthe root, and also it is very difficult technically to execute this method of ntreatment from the closeness of gingival edge and in relation to the small ndepth of carious cavity for imposition of multi-layered gaskets.
A biological method allows prevent inflammation in pulp, to stimulate forming of dentine, the same keeping a reliable biological barrier to penetratioof microorganisms in fabric of periodontium that keeps him intact.
Unsuccessful results nafter application of this method it is possible to explain the followings reasons:
· an error is in a diagnosis nat determination of the state of pulp;
· expansion of testimonies is nto application of biological method;
· violation in the technique nof implementation of method (failure to observe of rules of asepsis and antiseptics, ntraumatic interference, disparity of common preparations, careless imposition of gaskets and other).
Stages nof biological method of treatment (look lecture material)
Medical gaskets
A medical gasket is nimposed a thin layer (
Most doctors give nadvantage preparations on the basis of hydroxide of calcium, application of which is instrumental in formatioof reparative dentine and dentinal bridge. The lacks of these preparations is:
a) high рН n(to 12) on occasion can bring to necrosis of pulp;
b) calcification is possible in pulp, nformation of denticles, that will bring cavities over of tooth to obliteration.
Medical gaskets must owext properties
· to stimulate the reparative function of pulp;
· to own bactericidal and antiinflammation actions;
· to operate anaesthetizing;
· not to annoy pulp of tooth;
· to own good adhesion;
· to be plastic;
· to maintain pressure after hardening;
· to be adapted to modern composite materials.
Preparations which contaithe hydroxide of calcium: Dycal n(firm Dentsply); Calcipulpe (firm Septodont); Life (firm Kerr); Calcimol (firm nVoco); Reocap (firm Vivadent) and other
To pasture, that contain eugenol, also nodontogenic own and by antiinflammation actions.
Eugenol – containing npastes: biodent; zinc – eugenol npaste (not recommended for direct coverage of pulp); Cavitec (firm Kerr); nEugespad (firm SPAD).
Their failings are the followings moments:
· they are not adapted to modern composite materials, nthat is why during work with these medical gaskets it is necessary to avoid ntheir hit on the walls of carious cavity and carefully to insulate them from nthe permanent stopping indifferent insulating gaskets;
· an allergic reaction is possible from the side of npulp on eugenol.
Method of vital namputation
Saving of viable pulp nin the channels of roots after the delete of crown pulp is named “by the nmethod of vital amputation”. A method is based on the capacity of root npulp for reparative processes.
By shows to the method of vital amputation:
· nsharp npartial pulpitis;
· ncasual nbaring of pulp;
· a chronic fibrous pulpitis is at nelectro-excitability of pulp to 40 mcA
· a tooth is with the unformed root.
This method is used in the teeth of nmultiroots, where a border is expressly expressed between crown and by root npulp, at healthy periodontium and paradontium for healthy young people.
Stages of conducting nof method of vital amputation (look lecture material)
Surgical methods of treatment of pulpitis
Method of vital extirpation
The nmethod of vital extirpation is based on the delete of all pulp under nanaesthetizing without previous imposition of arsenic paste.
Advantages of method:
· absence of toxic action is non fabric of periodontium preparations of arsenic;
· treatment is conducted in one nsession;
· painlessness of nmanipulations is in a tooth.
Disadvantages of nmethod:
· a risk of complications is nduring conducting of anesthesia (unbearableness of anesthetic, action of vasoconstrictive preparations, inwardly nvascular introduction and other);
· bleeding from a channel, which can arise up during ntearing away of vascular-nervous bunch from fabrics of periodontium;
· absence of reaction is from the side of patient nunder time of endodontics manipulations;
· an origin of pains is at that which bite as a result nof education haematomas in periapical areas or destroying of stopping material nfor the apex of root.
A method is shown at all forms of pulpitis, nespecially at gangrenous and hypertrophy, nwhen to use arsenic paste it is contra-indicated.
Location of stopping materials at treatment nof pulpit by a surgical method
1 is paste;
2 is an artificial dentine;
3 is a cement gasket;
4 is the permanent stopping.
Choice nof anesthetic (look lecture material)
For stopping of channels nuse the followings materials:
1. to pasture, that contaieugenol: Endobtur, Endometpasone n(firm Septodont), zinc – eugenol paste;
2. to pasture with the nhydroxide of calcium: Biocalex (firm SPAD);
3. to pasture on the basis of nepoxides resins: АН-26, AH-Plus;
4. materials are on the basis nof formalin of resortsyn: resortsyn – nformalin paste, Forfenan (firm Septodont);
5. gutta-percha, thermafil n(firm Dentsply).
After stopping of channels it is necessary to ndo control sciagraphy, argued that channels nare sealed on all draught.
Method nof devital extirpation
Method nof devital extirpation is based on the delete of all pulp after its necrotization and conducted in two visits.
By shows to this method there are pulpitis which it nis impossible to nbring through vital methods on objective reasons (absence of shows and presence of against shows, for example, unbearableness of anesthetics, badly ncommunicating channels through their ramified, nlarge curvature and etc).
Imposition of devitalizing past (chart)
1 is pulp;
2 is devitalizing paste;
3 is a tampon with an anesthetic matter;
4 is an artificial dentine.
For necrotization of use preparations of narsenic anhydride and paraformaldehyde. In the first visits after necrectomy of ncarious cavity one of these preparations is imposed on the exposed horn of pulp nunder a bandage.
Stages of conducting nof method of devital amputation (look lecture material)
Combined method of ntreatment
Shows to application of this method is:
· sharp diffuse pulpitis
· chronic forms of pulpitis of teeth of multiroots nfrom heavily by clock-houses by the channels of roots and one accessible for treatment and stopping a nchannel.
At treatment of pulpitis in such teeth at nfirst conduct the partial delete of the softened and pigmented fabrics of ncarious cavity, section of cavity of tooth, imposition of devitalized pasts. Inext visits expose the cavity of tooth, delete crown pulp. After antiseptic ntreatment of cavity of tooth extend the mouths of channels of roots the spherical ndrill. Then from the palatal channel of molars of overhead jaw and distal nchannel of molars of lower jaw fully delete root pulp, and a root channel after nantiseptic treatment and drying is stopped some hardening paste to the apex nopening of root of tooth. Mash which was saved in impassable channels, 2 — 3 ntimes add impregnation, mummify resortsyn – formalin mixture with subsequent abandonment above the mouths of channels of resortsyn – formalin past or to nparacyn-cement.
Methods of obturation of nroot channel
Till recently the basic method of stopping of nchannels of roots was a method of filling one paste. Thus the very popular were pastes on the basis of noxide of zinc and eugenol, and also preparations which contain resortsyn and formaldehyde in the composition. nTechnique of stopping of root channel by paste simple enough and does not nrequire considerable temporal and financial charges.
However much the row of the substantial nfailings has stopping of channels one paste:
1. At this method nmaterial is fill a main channel only and the numerous forks of the system of nroot channel remain opened.
2. Very often paste nhatches for the apex of root, as there is not adequate control of filling of nroot channel material.
3. Paste fills a root nchannel unevenly, abandoning emptinesses and not providing the adequate npressurizing.
4. Pasturing all is ngiven contraction and resolve at a contact with a tissue liquid.
5. Most pastes own airritable action on periodontium.
