Method of saving of pulp (biological): ground, testimony to the use

13. Method of preserving the  pulp (biological): indications for the use. Method of treatment. Medication, their prescriptions. Effectivnes of the use, possible complications.

 

A biological method is directed on treatment of all of pulp. He has for a purpose if not to bring through pulp, then save its main functions: protective, plastic, and nourishing. The special value has saving of protective properties of pulp relatively to pericementum as a prophylaxis of apex periodontitis.

Testimony. The initial stages of sharp pulpitis are subject treatment a conservative method:

– hyperemia of pulp

– sharp limited pulpitis

– traumatic pulpitis

– a chronic fibrose pulpitis is without the clinical and roentgenological displays of periodontitis.

 

A method is shown at presence of such terms:

– age of patient to 30

– central localization of carious cavity

– absence of internal diseases and pathological changes is in pericementum

– insignificant duration of inflammatory process

 

Contra-indication: sharply positive reaction from the side of pericementum, signs of general periodontitis, decline of threshold of electro-excitability of pulp of over 40 mkA, rentgenological changes in apex tissues. In addition, teeth, which will be used as base under prosthesis constructions, inflammations of pulp for patients with the clinical displays of chronic dental intoxication, pulpitis for persons by age over 45 – 50 years, and also teeth, are not subject treatment this method with a carious cavity in the area of neck or root. At a safety method treatment of pulpitis use different medications: antibiotics and their combinations, combination of sulfamid preparations with antibiotics, corticosteroids, calcareous facilities, enzymic, nitrofuranovy preparations, glucosaminglucane and other

 

Corticosteroids preparations correct a contra inflammation action, take off pain, but reduce the reactive state of pulp and hinder forming of granulation fabric which is instrumental in the regeneration of pulp. Of short duration operating of corticosteroids on pulp (4 – 6 days) does not cause side changes in it. However expediently as a bandage, to limit to application of corticosteroids the term 3 – 5 days, with subsequent replacement their facilities which stimulate creating of dentin. Forming of dentin bridge in pulp make faster combination of corticosteroids with the calciumhydroxid.

 

In the different samples of writing operates the calciumhydroxid on pulp more better than other facilities. Normalizing acid-basic balance of the inflamed pulp, these preparations correct contra inflammatory and exsiccation operate, stimulate formation of the second dentine and mineralization of the light, softened dentine. Pastes which contain the calciumhydroxid, antibiotics, sulfanilamid preparations, corticosteroids, are presently widespread That is why, and also preparations are ready on the basis of calciumhydroxid: Cavital, Calcipulpa, Actical, Dycal, Hydrex.

 

Promote efficiency of treatment of pulpitis also glucosaminoglucal (luronit, khoksurid, geparin) and nitrofuran. These preparations make faster repair processes in pulp due to the biological properties. Yes, luronit is preparation, which contains gualuron acid which plays an important role in the protect processes of pulp of tooth. Geparin in the case of sharp inflammation of pulp represses, diminishes vascular permeability, reduces pressure in pulp. In addition, glucosaminoglucan is instrumental in the compression of fibred formations of pulp, and to the end of 6 -8 week – calcinosis them. Medicines of nitrofurans have a wide spectrum of antimicrobial action, repress activity of antibiotic resistant cultures of microorganisms.

 

Calcium materials of the chemical hardening are for direct and indirect coverage of pulp

 

 

Table 2

Calcium materials for coverage of pulp of tooth with the light hardening

 

 

Application of enzymes is grounded their property to melt dead fabrics, blood , improve the outflow of fluid, reduce contra antibiotic resistant of microbes. Coming from it, use of proteolitic enzymes for treatment of inflammation of pulp it is enough effective.

Enzim therapy with antibiotic therapy results in the removal of inflammatory process in pulp, diminishing of pressure in the cavity of tooth, creation of terms for a regeneration in pulp, and clinically – to the removal of pain.

 

Methods of treatment.

First visit. After careful antiseptic treatment of oral cavity and anaesthetizing a sick tooth is insulated by rubberdam or sterile cotton wool. Surface staggered and two nearby teeth process 2 % by the tincture of iodine, 1 % by solution of hlorhexidinum and other Then carefully prepare a carious cavity. The special attention during preparing is turned on being of over pulp dentine in the day of carious cavity – success of biological method of treatment depends mostly from it. A dentine as source of infection, intoxication and sensibilization of pulp is pathologically changed it is needed maximally to delete in the process of opening and forming of carious cavity: the products of his disintegration can in activate operate antibiotics and other preparations. A testimony to baring of horn of pulp are cases of inflammation on a background chronic motion of cariosity with formation of layer of removal dentine. At that rate opening of horn creates timely decompression, terms for the outflow of fluid and influencing of medical preparations on the inflamed pulp. If sharp motion of cariosity is preceded a pulpitis, exposing the cavity of tooth does not cost, as outflow of fluid that diffusion of medicinal matters in pulp take a place through the thin layer of the softened non mineral dentine on the day of cavity. Thus, influence of medications on the inflamed pulp can be lines and unlines

 

To create optimum terms for the outflow of fluid from the cavity of tooth after its opening, on the first session of treatment recommend to abandon medications in a cavity on a marble from cotton wool, because paste hinders the outflow of fluid from pulp. After tooling of carious cavity the amount of fluid can be increased, strengthening pain, that is why it does not cost after such treatment at once to impose the permanent stopping. If the cavity of tooth is exposed, imposing paste follows very carefully, without pressure.

Second visit. For some patients after the first visit pain does not disappear. Even insignificant pain, a reaction is promoted on thermal irritants, percussion and increase of electro-excitability of pulp or presence even one of the transferred symptoms is a testimony to the reiteration of session of treatment. A carious cavity is in second times irrigated solution of enzyme with an antibiotic or other anti inflammatory medicine, again abandon a tampon with medications on 24 – 48 hour. If for this time pain and reaction disappeared on thermal irritants, a carious cavity is irrigated and impose paste on the basis of calcium of hydroxide, the alkaline reaction of which stimulates making of removal dentine of odontoblasts. Then make filling. If during 5 – 7 days of complications does not arise up, impose the permanent filling.

If results are unsatisfactory, the process of inflammation grows, it follows to substitute conservative therapy by the surgical method of treatment

Radiograph showing extensive decay into the pulp.

 

 

PREPARATIONS FOR TREATMENT OF PULPITIS

BIOLOGICAL METHOD

 

For saving of viability pulp more frequent all apply preparations on the basis of calcium of hydroxide. Wide application of medical pastes, made on the basis of calcium of hydroxide, is explained them antibacterial, anti inflammatory action. To the calcium of hydroxide for treatment of pulpitis with a biological method use in a clean kind and in combination with the oxide of magnesium, hydrocabonatis , bromide of potassium, evgenol.

A lot of firms produce the prepared preparations which contain a hydroxide calcium in different combinations.

 

Kal’metsin contains in the composition, except for a hydroxide calcium, oxide of zinc, dry plasma of blood. As basis is used solution of cellulose of methyl. Paste which hardens through 2-3 min appears at mixing of powder and liquid.

 

Calcipulpe. In his composition enter a hydroxide calcium and sulfate of barium. Used for treatment of pulpitis for a biological method.

Produced in a syringe, 2,5 g to pasture, that contains. Hardens through 30 s. Made a firm «Septodont».

 

Septocalcine of ultra is selfhardening preparation on the basis of hydroxide calcium, used for saving of pulp. Produced a firm «Septodont» in two tubes – But also In, mixture from which in equal parts is mixed during 15 from and hardens through 2 min.

 

Calcicur is less contrast paste which has pH – 12,0. Contains 45 % of the hydroxide calcium. Proceeds in viability of pulp of tooth, instrumental in formation of the second dentine, and also owns a bactericidal action. Calcicur inflict layer to the desired thickness.

Produced a firm «VOCO» in a syringe, 2 ml to pasture, that contains.

Calcimol is medical X-ray contrast paste on the basis of calcium of hydroxide. Apply treatment of pulpitis for a biological method. Contains in the composition 26 % to the hydroxide calcium. Paste – paste is the system (base and catalyst). Involve in even amounts (in a proportion 1 : 1) during 10 s. At a room temperature time of hardening – 2 min. Produced a firm «VOCO».

Calcimol LC – light sensitive, X-ray sensitive material of the prolonged action, used for saving of viability of pulp. Contains 5 % to the hydroxide calcium. It is recommended to impose the even layer of material in thick 1 mm and to light up him with a lamp during 20-30 s. If a thickness is needed more than 1 mm, it follows to impose preparation in two stages. Calcimol LC incompatible with materials which contain eugenol. Packing of material consists of two tubas to on 5 Produced a firm «VOCO».

 

Together with the pastes which contain a hydroxide calcium listed above, exist et al: Dycal, Kerr Life, Procal, Hypocal, Calxyl, Reogan.

During many years in stomatology for treatment of pulp apply antibiotics a biological method. At the use of antibiotics for saving of the inflamed pulp take into account the sensitiveness of its microbes to these preparations.

 

Introduction of glucocorticosteroids in the complement of pastes at treatment of pulpitis by a biological method conditioned by their anti pests properties. They repress activity of gialuronidase, stabilize permeability of capillaries and the same reduce intensity of processes of ecsudation in the inflamed pulp. However, giving a anti inflammatory action, glucocorticosteroids oppress regenerator properties of pulp. That is why it is expedient to conduct treatment of pulpitis in two stages: on the first stage, during 3- 5 days, apply paste with antibiotics and corticosteroids; on the second stage, in 3-5 days, this medical paste is replaced paste which contains a hydroxide calcium (for stimulation of development of dentine).

Pulpomixine is medical mixture, used for saving of viability of pulp. Gives anti inflammatory and bacterial resistant operate. Two antibiotics (sulfate of framitsetini and sulfate of polymiksini B) of wide spectrum of action for local application and corticosteroids (acetate of deksametazonum) which gives a anti inflammation effect enter in the complement of Pulpomixine.

Pulpomixine is using for direct and indirect coverage of pulp with the purpose of saving of its viability at treatment of sharp hearth, chronic fibrosis pulpitis, and also at the casual section of pulp. Produced in tubes to on 5.

 

SURGICAL METHODS OF TREATMENT PULPITIS

 

The surgical methods of treatment of pulpitis consist in the partial (amputation of pulp) or complete (pulpectomy, or extirpation of pulp) delete of the destructively changed pulp. Under congratulatory methods understand the partial or complete delete of pulp under certain anaesthesia. For conducting of non vital methods, pulp at first making dead, applying different facilities, for example arsenic anhydride, paroform and others like that. More progressive surgical method is treatment of pulpitis under anaesthesia (local or general) which allows painlessly to conduct interference on pulp, and also to make off treatment for one session and at certain testimonies to save root pulp. Application of onesession method not only saves time but also prevents the disease of pericementum.

 

VITAL AMPUTATION OF PULP.

 

Essence of amputation of pulp under anaesthesia consists in the onesession delete of area of focal inflammation of crown pulp with next medicinal treatment of pulp , imposition of medical paste and permanent stopping.

 

Testimony:

– hyperemia of pulp

– sharp limited pulpitis

– chronic fibrosis

– chronic hypertrophy pulpitis

– a sharp and chronic pulpitis of temporal teeth is in a period resorbtion of roots and second teeth with unfinished growth of roots.

 

Amputation is shown also for patients with years in the case of constriction of cavity of tooth and root channels, and also in the case of curvature of root. For the choice of amputation method an important value has age and general state of patient. All of therapeutic measures must head for creation of terms which prevent development of infection in pulp and promote repair processes in it. For the correct diagnosing of separate forms of pulpitis it is necessary to use all of methods of research a doctor, because the positive result of amputation depends from it.

 

Method of treatment

After the rest room of cavity of mouth and effective anaesthetizing conduct the first stage preparing of carious cavity. Carefully delete a carious dentine. A carious cavity is widely exposed for creation of direct transition of its walls in the walls of cavity of tooth. Before opening of cavity of tooth a carious cavity is irrigated solution of enzyme with an antibiotic, by solution of furacilini or hlorheksidini and others like that.

Second stage: resection of vault of cavity of tooth, its opening. This manipulation is carried out the sterile fissural coniferous forest. Quality of opening of cavity of tooth determines success of treatment of pulpitis mostly. If the cavity of tooth is not enough exposed, ofteear the horn of pulp there is a dead dentine which is the source of its infecting and intoxication. In such cases amputation of pulp is carried out only partly. In subsequent the infected is left crown pulp can become reason of development of remaining pulpitis of root pulp. The cavity of tooth is prepared so, that after amputation of pulp on the day of it was expressly visible foramen of root channels and included in channels was free.

Third stage: delete of crown pulp (amputation). It follows to carry out this stage of treatment with the least trauma. He is executed the sharp power-shovel of middle sizes, the diameter of which approaches the sizes of cavity of tooth. Farther delete pulp the spear-shaped or spherical coniferous forest from foramen of root channels, foramen expose by endodontical instruments (for example Gates-Glidden, Peeso and other) and give them cone-shaped form.

Fourth stage: medicinal treatment of pulp. During opening of cavity of tooth and conducting of amputation of pulp a carious cavity is constantly irrigated anti inflammatory solutions (furacilini, etoniy and other). With the purpose of prevention of infecting of root pulp all of manipulations must be conducted sterile, expressly and quickly; in good time to change rolls and control work of saliva evacuator for prevention of hit of saliva in the cavity of tooth. After deleting of pulp from the cavity of tooth and foramens channels there can be bleeding from root pulp. For its stopping apply styptic preparations (3 % solution of hydrogen of peroxidum, 5 % solution of aminocapronic acid and others like that) which enter on marbles from cotton wool on From – 5 min; it is possible also to use coagulation.

Fifth stage: coverage of pulp. For this purpose recommend to pasture anti inflammation and odontotrophy actions, the same, that use for treatment of pulpitis after a biological method (for direct coverage of pulp). If in 5 – 7 days of complaint for a patient absent, impose the permanent stopping .

 

VITAL EXTIRPATION OF PULP (PULPECTOMY).

 

Essence of method of pulpectomy consists in the operative delete of crown and root pulp. An operation is conducted after anaesthetizing of pulp. It is considered complete in the case of delete of pulp in the area of apex of tooth with the next medicinal operating on the left fabric of pulp and pericement.

The complete delete of pulp can be conducted at all of forms of its inflammation, however much pulpectomy has direct testimonies.

 

Testimony:

– traumatic pulpitis

– sharp diffuse pulpitis

– sharp festering pulpitis

– concernment pulpitis

– chronic hypertrophy pulpitis

– chronic gangrenous pulpitis

 

Pulpectomy is shown also in such cases: remaining pulpitis (inflammation of crown pulp after its amputation was not liquidated); ascending (retrograde) pulpitis, which arose up as a result of penetration of infection marginal, contact or gematological by a way; in the case of localization of carious cavity in a neck area or in cement of root of tooth; patients with have a pulpitis different somatic diseases; pulpitis, complicated pericementum and limfadenitis; at planning of operative treatment of root cysts; without pulp teeth for patients on general pericementis and after orthopaedic and by ortodontic testimonies.

 

Method of treatment: Complete delete of pulp under anaesthetizing it is possible to conduct for one visit ( ). For the successful conducting this it is needed to adhere to the enough difficult operation the sequence of implementation of all of the stages of treatment.

First stage: hygiene of cavity of mouth, anaesthetizing. Valuable anaesthesia matters very much, as pulp is rich on pain and other receptors which react on different irritants pain. Taking into account, that the method of congratulatory pulpectomy is protracted enough 1,5 – 2 hours, apply the injection anaesthetizing. He is carried out the generally accepted methods. For their conducting use of the anaestetics groups of amid (mepivacain, articain and others like that). These anaestetics slower metabolism in an organism, that is why operate something stronger and give more protracted anaestetics effect. For lengthening of action of anaestetics he is applied together with vasoconstrictors – by adrenalin or noradrenalin.

Second stage: preparing of carious cavity. This stage has for a purpose to create free access to the cavity of tooth. That is why after opening and necrectomy of carious cavity it is extended in accordance with scopes by the cavities of tooth. On the whole it answers the projection of cavity of tooth on the masticatory surface of premolars and molars or tongue (palatal) surface of frontal teeth. For this purpose the coniferous forests of different sizes of fisural drills. Considerably facilitates implementation of this stage of application of turbine drills. A carious cavity which is located on the contact surface of teeth is extended on a masticatory or tongue surface within the limits of projection of cavity of tooth. If a carious cavity is located in frontal teeth, it is necessary from the cosmetic considering maximally to keep a lip wall and cutting edge. In the case of small size of carious cavity on contact surfaces for its expansion beside the purpose to carve plenty of hard fabrics of tooth. In such cases conduct trepanation of intact of masticatory or tongue surface within the limits of projection of cavity of tooth.

Third stage: opening of cavity of tooth. It is expedient to conduct this manipulation in such sequence: carving of vault of cavity of tooth, creation of free access to the root channels, final forming of carious cavity and cavity of tooth.

After completion of preparing of carious cavity sterile spherical or a vault the fissural coniferous forest in the nearest to the cavity of tooth area. Fissural get the coniferous forest of small sizes to the opening and gradually extend him circular motions, carving a vault within the limits of cavity of tooth. It is necessary to work very carefully, under permanent visual control, as carvings of superfluous array of hard fabrics are possible outside the cavity of tooth and even perforation of its lateral walls. It especially easily can take a place in the case of application for work of turbine tip. The degree of carving is controlled a probe: during moving of probe on walls from the depth of cavity outside it must be felt no hindering. The cavity of tooth is correctly exposed almost fully meets with a carious cavity, their walls pass to each other without covers, bends, forming a straight line.

Fourth stage: amputation of pulp. Practically already in the process of opening of cavity of tooth and carving of its vault willy-nilly delete part of crown pulp the coniferous forest. Other part of pulp which remained in a cavity, it is possible also to cut away the coniferous forest, but more expedient – by a sharp power-shovel, as it diminishes the danger of perforation of walls and bottom of cavity of tooth. Tailings of pulp and blood delete from the cavity of tooth, washing it solution of hydrogen of peroxide or other antiseptic.

Fifth stage: opening of foramen channels. After amputation wash the cavity of tooth, stop bleeding and dry out a carious cavity. In multiroot teeth on the day of cavity of tooth by a probe determine foramen of root channels in accordance with the topography of concrete tooth.

The necessary condition of the complete opening of cavity of tooth is creation of comfortable access to the root channels. For this purpose extend foramen of root channels by the spherical coniferous forest of small sizes or special instrument (Gates-Glidden, Peeso and other). After their help give foramens of root channels of cone-shaped form. In subsequent the rightness of opening of cavity is controlled a root needle or other by an endodontical instrument. If foramens to expose correctly, instrument freely, not bending, gets to the root channel.

Sixth stage: extirpation of root pulp (pulpectomy). Root pulp is deleted by pulpextractor. His size is picked up in accordance with length and diameter of root channel. pulpextractor carefully, without large effort enter in a root channel maximally close to the apex opening. It is controlled feeling of resistance the subsequent apical moving of instrument. An instrument is returned on 1-2 turns round an ax and draw out together with the pulp winded on him. Wholly remote pulp has the appearance of rose, worm like sprout which narrows to the apex of root.

Seventh stage: stop bleeding. For this purpose in a root channel it is possible to enter on 3 -5 min roll from cotton wool, moistened one of styptic agents, or to conduct coagulation directly in a channel (during 1-2 s). If pulp is not remote fully, this manipulation is repeated. Wash the root channel of rolls, moistened solution of antibiotic, or not irritate antiseptic from the special endodontic syringe. In subsequent determine length of root channel and execute actually instrumental treatment (preparing) of root channel by endodontic instruments.

Eighth stage: instrumental and medicinal treatment of root channels. The purpose of instrumental treatment of root channel is the complete deleting from him of tailings of pulp, products of its disintegration, not fully mineral fabrics (predentin) from the walls of channel, expansion of channel and giving him of the proper form, necessary for the valuable stopping. After instrumental treatment a root channel must purchase the form of prolate cone with smooth and shiny walls and narrow enough apex opening. Due to the delete of predentin or blasted dentine (for patients with a sharp festering and chronic pulpitis) the general diameter of channel is increased in 1,5 – 2 times. Walls of channel must be presented a dense dentine, that in the case of correct obstruction will provide the reliable pressurizing of the root stopping, will prevent to melt down of stopping material and origin of inflammatory complications in periodonti.

 

Methods of sealing root canal

 

Success of endodontical treatment is in a great deal determined quality of stopping of root channel. Under the high-quality stopping for today there is the three-dimensional pressurizing of all of the ramified system of root channel which acts part reliable barrier between the cavity of tooth and fabrics of pericementum.

For long-term history of endodontic for stopping of root channel different methods and materials were used.

Till recently the basic method of stopping of root channels was a method of filling one paste. Thus the very popular were pastes on the basis of oxide of zinc and evgenol, and also preparations which contain and formaldehyde in the composition. Technique of stopping of root channel by paste simple enough and does not require considerable temporal and financial charges. However much the row of the substantial failings has stopping of channels one paste:

1. At this method material is fill a main channel only, and the numerous forks of the system of root channel remain opened.

2. Very often paste hatches for the apex of root, as there is not adequate control of filling of root channel material.

3. Paste fills a root channel unevenly, abandoning emptinesses and not providing the adequate pressurizing.

4. Pasturing all is given and resolve at a contact with a tissue liquid.

5. Most pastes own an irritate action on pericementum.

Taking into account all of aforesaid, not surprising, that International Association of Stomatologies and Association of Stomatologies of America does not recommend to application the method of obturatsii of root channel by one paste

 

Materials for endodontical treatment

 

Ideal stopping material for root channels must answer the followings parameters:

1. To provide the reliable pressurizing of all of the system of root channel on all of its draught.

2. To be untoxic.

3. Not to irritate pericementum.

4. Not to give in a channel. It is desirable, that he was some increased in a volume at introduction to the channel or in the process of consolidation.

5. To own a bacteriostatic effect or eveot to support growth of bacteria.

6. Easily to be sterilized before the use.

7. To be X-ray contrast.

8. Not to change the color of tooth.

9. If necessary easily removed from a channel.

10. To have a sufficient for comfort work time of consolidation.

11. Not to dissolve in a tissue liquid.

12. To be good adhesive to the dentine and stopping material.

Such ideal material does not exist for today. However in a most degree these requirements are answered by the methods of stopping of root channels by a gutta-percha from siller. Majority of root channels in the whole world for today stopped with the use of gutta-percha.

 

Gutta-percha

 

A gutta-percha is hard, but at the same time elastic and flexible product of coagulation of latex of guttaperch keeping tropical plants. A gutta-percha is subdivided into two types – alpha and beta – which largely differentiate on physical properties.

For the production of gutta-percha sprig a beta-gutta-percha which owns greater hardness and spatial stability and less stickiness is traditionally use. A beta-gutta-percha requires higher temperatures for the softening influence. However lately the more popular is become by more fluid and sticky alpha-gutta-percha that provides at the use of it in the warmed-up state more homogeneous filling of all of the ramified system of root channel.

Alpha-gutta-percha is used for methods which mean work with a termoplastic (warmed-up) gutta-percha: vertical condensation and injection method of termoplastic. In addition, there is the special type of gutta-percha, used for the production of obturators «Thermafil». It is patented the type of gutta-percha on chemical properties is near to the gutta-percha of beta, but, at the same time, has physical descriptions of gutta-percha of alpha.

Mainly the production of gutta-percha sprigs is concentrated in South-east Asia. One of most suppliers of gutta-percha there is Korea. However lately gutta-percha sprigs began to be produced and in Brazil.

Sprigs is subdivided into standard, such which have cone 2% and sizes from 10 to 140 for ISO, and cone, such which have cone from 2% to 12% and sizes from 20 to 30

Gutta-percha sprigs is made or by («hand-rolled») hand, or by a machine method. It is considered that a hand method provides higher exactness of making of sprigs. Sprigs of the machine making does not guarantee exact calibration often. It follows especially to mark that all of sprigs of the Brazilian production are made a machine method.

The commercial name «Gutta-percha sprigs» well known and used everywhere, although maintenance actually in these makes a gutta-percha about 20%. The basic component of sprigs (60-70%) is an oxide of zinc. That remained 10% make the sulfate of barium, beeswax, dyes and other additions.

Main advantage of gutta-percha is foreseen of closing of root channel. Also to its advantages take good low toxicness, capacity for condensation, which provides the dense and even filling of root channel, softening influence at heating, that allows to conduct three-dimensional closing of the system of root channel, spatial stability (in the hardening state it does not change the volume practically) and simplicity of its drawing out from a root channel at a necessity the repeated treatment.

In spite of all of obvious advantages, a gutta-percha has and alongside failings, related to the features of its physical and chemical properties and technology of application.

The lacks of gutta-percha consist in the following:

1. It caot be used without sealer, as does not have adhesiv to the dentine.

2. A gutta-percha does not own bactericidal or by a bacteriostatic effect.

3. Thin sprigs have ever-higher flexibility and mildness which requires high qualification and experience of doctor, especially at stopping of narrow channels

4. Termoplastic a gutta-percha has shrinkage at cooling. For indemnification of this it is needed to continue the process of condensation to its cooling.

 

Sealers

 

It should be noted that a necessity of application of sealer is the relative failing, as for today there is not material, able to provide the foreseen filling of main channel, and here fluid enough in an order to fill all of his branches.

Siler comes forward not only as which fills all of branches of the system of root channel and that provides adhesiv of gutta-percha to the walls of channel but also as lubrikant, that provides the free sliding of gutta-percha sprigs in a root channel.

Siler must answer the followings requirements:

1. After involving must have sticky consistency, that after consolidation to provide good adhesing to the walls of channel.

2. Hermetically to seal up a channel.

3. To be X-ray contrast.

4. Not to give shrincage in the process of consolidation.

5. Not to dye fabric of tooth.

6. To have a bacteriostatic effect or eveot to support growth of microorganisms.

7. Slowly to overtake.

8. Not to dissolve in tissue liquids.

9. Not to irritate apex tissue.

10. To dissolve in standard solvents if necessary to open the channel.

11. Not to cause immune reactions in apical tissue.

12. Not to have a carcinogenic effect.

None of presented on the modern market of sealers can answer all of requirements which are produced to him. Mainly as sealer is today used or natural root cements, or polymeric materials. Natural sealer – Endomethasone (Septodont), Cortisomol (Pierre Rolland), Tubli-seal (Kerr) and etc – basis of which is an oxide of zinc, dissolve in a tissue liquid which can bring the hermetic systems over of root channel to violation. In addition, they own low adhesiv to the dentine and can cause painting of fabrics of tooth. At the same time polymeric sealer – AH Plus (Dentsply), Adseal (META Biomed) and other – in less degree soluble in a tissue liquid, does not dye fabric of tooth and have the best adhesiv to the dentine of root (fig. 4, 5).

To the present tense of question, to what level to stop a root channel, remains opened. Bitter discussions are conducted, whether a gutta-percha must not reach to anatomic apex on 0.5 or stopped directly for him. For today indisputable is only a fact that than less than we extend the apex narrowing, so much the better quality of closing, the more reliable isolation of fabrics of pericementum. In addition, it is necessary to remember, that the theory of active behind apex therapy showed the insolvency. In modern endodontic destroying of sealer does not greet for the apex of root even at presence of inflammatory processes in periodonti, researches showed although, that at destroying of two-bit of sealer in apex tissue was not observed some serious complications after treatment.

 

There are different methods of stopping of root channels by a gutta-percha:

1. method of one (central)

2. lateral condensation

3. termomechanical condensation

4. stopping of root channel by the chemically softened cold gutta-percha, hot vertical condensation

5. termoplastic injection technique.

 

Sealing of root canals by a cold gutta-percha

 

Method of single cone

Beforehand neat which has proper cone and size of tag is entered in a channel. must densely adjoin to the walls of channel. By a warmed-up instrument is cut at the level of mouth and his condensation is conducted in vertical direction.

 

This method can be a good alternative for doctors which consider at better to stop channels monopaste, however here provided filling of road clearance of main channel, but not three-dimensional close of all of the system of root channel is only

This chart means under itself stopping gutta-percha with the lateral pinning each of sprigs to the walls of channel. Long time this method was a «gold standard» which all of other technique of closing channel was compared with.

After drying of root channel sealer besmear oneself by paper sprigs of his wall. Theeat in size master- the tag of which is moistened in that hermetics is entered in a channel. Then by spreader condense master- to the walls of channel, providing sufficient space for introduction of additional sprigs. The closeness of closing channel depends on the depth of penetration and form of spreder. From data of Chohayeb (1993) standardized for ISO hand spreder it is needed to enter in a root channel on distance to 1 from the tag of gutta-percha which improves homogeneity and closeness of stopping. After condensation of of master to him and additional sprigs the tags of which also moisten in closing is condensed the walls of channel. Every subsequent is included in a channel on a less depth. The lateral compression of sprigs is conducted to the homogeneous filling of channel, by a criterion what impossibility to enter spreader in a channel is. Time of pinning of spreader sprigs is made to order to the walls of channels from data of different authors makes 15-30 seconds. After it the salient ends of gutta-percha sprigs cut away by a warmed-up instrument, and close the mouth of channel vertical condensation of gutta-percha.

On quality of closing root channel the great number of factors has influence during conducting of lateral condensation of cold gutta-percha. Above all things, it is a form of the treated channel. A root channel must have even cone on all of length and apical ledge which prevents destroying of material after apex during conducting of condensation. Also a large value has correlation of gutta-percha and sealer. The following correlation is recommended: to a 95% gutta-percha, 5% sealer.

The long-term use of method of lateral condensation of gutta-percha showed its high clinical efficiency, simplicity of application and reliability. Many researchers specify on the high closeness of filling of root channel during conducting of lateral condensation. However much other authors demonstrate, that during conducting of lateral condensation there is a risk of longitudinal break of root from efforts which are added, especially when a root is weakened (for example, at surplus expansion of channels in a thin root). In addition, at this method it is not succeeded to obtain homogeneity of material and filling and apical branches of channel, which can result in development of complications from the side of pericementum tissues – development (or to support) of inflammatory reaction, destruction of bone fabric, the gutta-percha of lateral.

It follows to add, that during work with a cold gutta-percha for the adequate sealing up of mouth of root channel it is desirable by a warmed-up instrument to cut away sprig on 2-3 deeper than mouth of channel and to fill part which remained, by a warmed-up gutta-percha.

With the purpose of improvement of technologies of stopping of root channels a cold gutta-percha was offer different methods which presently are of interest mostly only from point of history of development of endodontical treatment.

 

Stopping of root channels by a warmed-up gutta-percha

Vertical condensation

 

Offered the technique of vertical condensation of warmed-up gutta-percha in 1967 Shilder. At this method gutta-percha (master- ) sneaks up individually on a diameter and cone. He is set in a channel so that his tag did not reach to the apikal’nogo narrowing on 0.5-1 mm.

The technique of vertical condensation consists of the followings stages:

1. Warmed-up spreader is removed surplus of gutta-percha from a root channel.

2. By plagger a warmed-up gutta-percha is condensed in a channel.

3. Spreader of less size is warmed-up submerges on 3-4 in middle part of gutta-percha and after his cooling surplus of gutta-percha is removed from walls.

4. Plagger of less size condenses the softened gutta-percha in apex direction.

5. Spreader of the least size is warmed-up submerges in a gutta-percha, deleting next portion of material.

6. The least plagger condenses apical portion of gutta-percha, closing all of additional channels in this area.

7. Then in a channel the segments of gutta-percha are entered long approximately 3 mm which are softened thermally gradually filling a root channel.

Advantages of this method is indeed the three-dimensional stopping of root channel (that, filling of all of additional channels and branches by the maximal amount of gutta-percha and least of sealer) and homogeneity of the root stopping..

 

Technique of continuous wave

Variation of method of vertical condensation is a technique of «continuous wave», developed Buchanan. During conducting of closing on this method the device of System B (SybronEndo/ Analytic) is using and proper plagger.

A method consists of two stages. On the first stage («Downpack») by warmed-up to 200°С plagger is set in a root channel master- of the proper size and cone is cut away in middle third of channel and condensed in apex direction. Pressurizing of apical part of channel is thus provided.

On the second stage («Backfill») gutta-percha of that size is entered in a root channel, and by plagger of System B, heated to 100°С, cut away and condensed in apical direction, whereupoext is entered in a channel. Procedure repeats oneself to the complete filling of channel.

This method is simpler in implementation as compared to the technique of vertical condensation. Caused basic fears introduction heated to 200° From an instrument so close to apex. However much researches showed that such short time of action of high temperature caot give the damaging operating on periapical tissue.

Termoplastic injection technique means under itself introduction to the root channel of warmed-up to the molten state gutta-percha under pressure by the special syringe. Most popular such system there is Obtura II (Obtura Corp.).

A method is simple enough and comfortable in application. However much such injection provides filling only of basic channel, and for filling of lateral branches and apical delta requires additional hot condensation in apex and lateral direction. In addition, quite often at this method a root channel is filled a gutta-percha not to the apex which often requires the delete of the entered gutta-percha and repeated stopping of channel in order to avoid development of complications from the side of pericementum.

 

Combined methods

Many authors specified on advantages of the combined application of methods of vertical condensation and injection introduction of gutta-percha. However till recently such approach required the use of two separate vehicles (for example, System B and Obtura II). Today there are the systems which allow to unite advantages of methods of vertical condensation and injection introduction of warmed-up gutta-percha with the use of everything one device (Elements Obturation Unit, SybronEndo; E&Q Plus, MetaDental, Co.). Unique such system, presented for today on a market, there is E&Q Plus.

 

System of E&Q Plus

The system of «E&Q Plus» consists of block of management with the digital reflection of temperature of heating of gutta-percha, pistol for the injection of gutta-percha and tip with the special attachments which warm up a gutta-percha in a channel (fig. 12).

 

Thus, «E&Q Plus» actually unites in itself the systems of «System B» and «Obtura II», allowing a doctor to take advantage both. Thus, both functional systems of «E&Q Plus» (tip and pistol) can be used both separately, and jointly.

The method of work with the system of «E&Q Plus» consists in the following:

1. The proper apical master- sneaks up. He must have that cone, that and prepared root channel and to pass on all of his length.

2. The tag of is cut on 0.5-1, that at the compression of gutta-percha it kept indoors a channel for an apex.

3. Sprig was driven home in a root channel.

4. Proper plagger sneak up, and their length is fixed by silicon stopper.

5. Attachment of «E&Q», which on 5-7 does not reach to working length, sneaks up. Length of entrance of attachment is fixed by .

6. After drying of channel and causing of sealer master- is set.

7. On the tip of «E&Q» the temperature of 250°С is proposed. Attachment is entered in a channel on measuring off length and activated, cutting away a gutta-percha in crown part.

8. A warmed-up gutta-percha is condensed by plagger.

9. Procedure of warming-up and compression of gutta-percha repeats oneself until adequate obturating of apical part of channel will not be attained.

Farther stopping can be conducted or by gutta-percha sprigs on the method of vertical condensation, gradually filling middle and crown third of channel, or by a la carte introduction of warmed-up gutta-percha by the pistol of «E&Q» with the subsequent compression of every portion by plagger of the proper size.

The system of «E&Q Plus» provides rapid and foreseen three-dimensional obturation of the system of root channel. Vertical condensation of gutta-percha in apical part allows reliably to seal up it without destroying of material for an apex. In addition, a doctor always is in a position of choice of method of stopping for a concrete clinical situation, and here can use the different methods of closing even in the different channels of one tooth.

 

Obturators «Termafil» are plastic bars (transmitters) with the gutta-percha which has the patented formula inflicted on them. For the warming-up of gutta-percha the special stove is used.

The idea of obturators «Thermafil» belongs W.B. Johnson.

After choosing of which is executed by the special instrument – veriefer, on the walls of channel in the mouth and middle his third by paper the small the amount of sealer is inflicted. Termafil is heated during 15 seconds in the special stove, entered in a root channel oecessary length, whereupon the transmitter of gutta-percha is cut the coniferous forest. Thus a gutta-percha fills all of additional channels and apical delta, providing the three-dimensional stopping of all of the system of root channel.

This method is simple in application and reliable. Its efficiency, especially in the difficult ramified systems of root channels, for today not subject a doubt. It is possible to take to the lacks of this method, presumably, only more high, as compared to other methods, authenticity of the behind destroying of gutta-percha, especially in root channels with the unformed apex, by the large diameter of the apical opening or at active behind apical processes which is the result in resorbtion of apex of the root.