Children have differential diagnostics of caries, pulpit and periodontit of temporal and permanent teeth

Modern   endodontical    tools, its setting and governed the use. Practical capture by the methods of endodontical interferences with to the therapeutic pedodontia

Children have methods and facilities of cover of the root ducting of temporal and permanent teeth on the different stages of their development

For differential diagnostics of decay of temporal teeth it follows fully to delete the softened dentine a power-shovel or spherical coniferous forest. If here the cavity of tooth will be opened within the limits of the softened dentine, to find out diagnosis unhardness. The presence of mash which bleeds and reacts on sounding confirms with out symptoms motion of chronic fibrotic pulpit. If sounding of connection of carious cavity with a pulp chamber is painless, it can testify to the chronic gangrenous pulpit or chronic granulating periodontit. For this confirmation it follows carefully to examine soft fabrics of gums and transitional fold in the area of the staggered tooth. Presence even insignificant hyperemia of transitional fold on gums testifies to without symptoms motion of periodontic of temporal tooth. A final diagnosis is set after the lead through of roentgenologic inspection.

It follows to conduct differential diagnostics of sharp superficial caries with a sharp initial and middle caries. A sharp superficial caries differs from sharp initial complete destruction of superficial layer and deepening of pathological process in enamel. Unlike a sharp, middle caries the sharp superficial is characterized the maintenance of safety of enamel dentinal connection which always collapses at a middle caries. At a middle caries a cavity deepens in a dentine, sounding of enamel dentinal connection in the case of sharp motion draws pain.

Middle decay of the second teeth for children it follows to differentiate above all things with a deep caries, it follows to turn time of differentiation of sharp middle and deep caries attention on the depth of carious cavity after its preparing. Thus it follows to take into account that in the second teeth with the unformed root the volume of mash relatively anymore, that is why carious cavity at relatively can be disposed it’s less depth nearer to mash. A sharp deep caries differs the greater sensitiveness of tooth to the thermal and mechanical irritants. From cold in a tooth, staggered a sharp deep caries, there is pain which quickly passes after the removal of irritant. Sounding is an enough thin bottom of carious cavity in the case of sharp deep caries sensible through the near location of mash, in that time as at a sharp middle caries more sensible to sounding are walls of carious cavity.

For children sometimes it will be to differentiate a chronic middle caries with the chronic form of periodontit. By the feature of motion of periodontit for children there can be his development at the closed cavity of tooth. It touches and temporal, and permanent teeth in an identical degree. At differentiation pay a regard to colour of tooth, and also reaction of child during preparing of carious cavity (if it is conducted without anaesthetizing). At chronic periodontit, especially second teeth, the colour of it’s changes on greyish. Preparing of enamel dentinal connection is not accompanied the sickly feelings. These signs are foundation for the lead through of sciagraphy of the staggered tooth, which allows putting a final diagnosis.

Sciagraphy is utillized sometimes for diagnostics of the hidden carious cavities, teeth located on touch surfaces and invisible during a review.

The deep decay of the second teeth for children is diagnosed often enough. This stage of caries is characterized that there is a skim of dentine to mash. A carious cavity is disposed within the limits of near the pulp dentine. Sounding of it’s bottom is sensible enough therefore. To put can grumble also about pain from thermal and mechanical irritants, which quickly passes after their removal.

Differentiating the sharp deep decay of the second teeth follows above all things with a chronic fibrotic pulpit, hyperemia of mash and sharp limited pulpit, chronic form of periodontit.

The basic difference of caries from a pulpit is absence of involuntary attacks of pain. Therefore it follows carefully to find out during collection of anamnesis, whether took a place some time such pain. In addition, for a pulpit characteristic more protracted pain from irritants. Therefore during the lead through of thermodiagnostic it follows to pay a regard to duration of the pain feelings after the removal of irritant. If pain does not disappear at once, but lasts set time, it is the sign of pulpit. After preparing of carious cavity it follows carefully to probe its bottom. Presence on the day of carious cavity of area of the expressed softening influence of dentine, and also sharp pain during sounding of this area is the signs of chronic fibrotic pulpit. During differential diagnostics of deep caries and chronic fibrotic pulpit it follows to take into account the state of somatic health of child also. Indisputably, for children, which are ill chronic splanchnopathies, have sub- decompensation form of activity of caries, a diagnosis is more frequent justified "chronic fibrotic pulpit" at the considerable depth of carious cavity.

For differential diagnostics of defeat of the second teeth with the formed root the method of electroodontodiagnostic can be used. The indexes of electroexitement mash in a norm do not exceed 2-6 mkA. In the case of development of pulpit this index rises to 25-40 mkA . More than 100 mkA testify the indexes of electroexitement to death of all of mash.

 

Instrumental root canal treatment

Instrumental root canal treatment - crucial stage of endodontic treatment. Purpose of tool treatment, removing infected tissue from the root canal and contribute to the creation of favorable conditions for ¬ sealing it to successfully achieve this goal, you need to have a set of necessary endodontic instruments.

 

 

 

First stage : opening the cavity of the tooth to create an opening for direct access to the root canal. The successful implementation of this phase should be well aware of topographic and morphological characteristics of the cavity of the tooth and root canal openings .

Removal of carious dentin seals and expansion of the cavity is carried out using fisurnyh or round burs appropriate diameter. Reveal the tooth cavity carbide or diamond bur fisurnym .

Disclosure oral incisors and canines carried by plowed - surface. Destination boron must meet the axis of the tooth , which allow ¬ lyt prevent perforation its crown.

 

 

Disclosure tooth cavity premolars and molars conducted by the chewing surface. To reach the tooth cavity and removed ¬ ing hanging roof edge using boron carbide fisurnym conical or diamond head with a blunt end to prevent perforation of the floor of the tooth.

 

 

With conventional endodontic or probe determines ¬ tion mouth root canals. In exceptional cases where the mouth abruptly narrowed resort to their expansion , using round burs small sizes on a long rod or vnutrishnoka bor -ing to expand ustiv root canal type Gates Glidden (Gates Glidden).

 

 

They are produced by the number 1 - 6, which corresponds ¬ gives the working part of the tool diameter 0,50,0,70,0,90,1,10,1,30 1.50 mm. Length of the tool 28 and 32 MM.

 

 

 

 

There are tools such as Gates Glidden drills at low speed . At this stage, errors and complications:

1) damage to the walls of the tooth in case of insufficient removal of overhanging edges of the cavity , 2) perforation of the crown , and 3) Perfora ¬ tion of the bottom cavity of the tooth , and 4) holes in the roof cavity of a tooth mistakenly considered the root canal through openings not r ¬ ted overhanging edges of the roof cavity tooth , 5) inability to find holes all channels because of insufficient disclosure of the tooth cavity perimeter.

Second stage : the mechanical preparation of the root canal.

 

 

The success of endo ¬ dontychnoho treatment depends on the quality of cleaning , shaping and filling of root canals. The treated feed to have a conical shape , gradually shrinking in the direction from the mouth to the apical part. Utility processing ends at a distance of 0.5-1 mm from the anatomical apex hole that corresponds ¬ gives apical narrowing ( physiologic hole) root canal. Sometimes it does not match the anatomic orifice reflected in renthenofami . It can be placed on the lateral surface of the root.

In acute purulent exacerbations of chronic periodontitis or periodontal ¬ th is when after removing putrydnyh mass of the root canal is no outflow of pus , you need to uncover the tip ¬ ing hole and drain the periodontal crevice .

Root canal treatment begins with defining its work ¬ Tchoyi length. There are two methods for assessing the length of the root canal - X-ray and elektronnometrychnyy . The length of the root ¬ tion determined by studying x-ray performed before treatment ¬ tion, and transfer it to the endodontic instrument that carefully administered ¬ dyat the root canal to a depth of 2-2.5 mm, shorter than the apparent lengths ¬ tooth well . Working length of tool mark or silicone rubber ¬ ism limiter ( stopper ). Prior to conducting channel endodontych ¬ ing tool to bend according to the configuration of the channel. If the roots of two or three channels , we administered different form tools, for example , one H- file and K in the second file that will be good to identify ¬ Vano renthenofami . Directly to spend renthenofami co ¬ rektsiyu working length by measuring the distance from the tip of the tool to the radiological apex of the root and adding or subtracting 1 mm per ¬ depending on its placement. The distance from the tip to the file limit , which defines a length , measured millimeter ruler and recorded in history.

 

 

To determine the working length without x-ray co- rystuyutsya Asylum ( apex locator ) that defines the location of the apical foramen on the basis of the difference between the electrical resistance of the soft and hard tissues . Modern electronic locators (eg , Evident Farmatron IV) can operate in dry and wet canal, with automatic digital display, underpin ¬ ing light and sound display. However, these devices are not able to replace the X-ray method of research, especially in teeth with incomplete root growth and development in temporary teeth.

Endodontics deciduous teeth

For the instrumental treatment of root canal treatment of teeth used the same tools and techniques, and the treatment of permanent teeth.

Rice . Living Room amputation , the following tools: application to anesthetics and local anesthetic burs for high speed handpiece N 330FG and low-speed handpiece N 8RA, plastic container for mixing , syringe , zinc oxide eugenol from (Kalzinol), a set of thin rabberdamiv , dental mirror, and pulpoekstraktora tweezers, cotton balls (small ) Excavators various sizes, metal spatula , mixing glass sealing material in a ratio of 1:5 Formakrezol

Revealing the tooth cavity must remember its relatively large size with less thickness and density of solid tissue , as well as topographic and anatomical features of pulp cavity compared with permanent teeth. Used mainly manual shall todyky ¬ passage and expansion of root canals. Complete Tool endodontic treatment is possible only at the stage of one hundred ¬ mobilization root , IIa stages of its formation and resorption is especially important right working length of the tooth and its strict adherence to prevent injury emerging peri- alikalnyh tissues or permanent tooth germ . Instrumental vol ¬ opment of root canal treatment of teeth should be done with caution emer ¬ tea , due to the thin walls of the smaller degree of mineralization of dentin and wide apical opening. Often the root canals of deciduous teeth may grow granulation , which usually indicates pain and bleeding during their instru ¬ mental processing. In this case, often have to remove the first visit after granulation processing camphor - pheno scrap of anestezin .

Instrumental root canal treatment in the treatment of periodontitis of deciduous teeth should be accompanied by the influence of medical drugs on mentoznyh - makrokanal , microchannels and periapical inflammatory focus . Detail this aspect of the treatment of periodontitis described under " Treatment of periodontitis in the permanent teeth of children " because drug treatment of deciduous teeth had vidriznyayesya treatment of permanent teeth in children. One need only note that in order temporal ¬ teeth with unformed roots or at the stage of resorption should avoid the use of drugs that are able Irritant ¬ wool or cause burns periapical tissue or immature permanent tooth germ .

The choice of drug for medicinal root canal treatment , especially for root dressings , as well as in the treatment of periodontitis in the permanent teeth of children depends on the form , the stage and severity of periodontal inflammation , the composition of the microflora of root canal stage root development , general ¬ of the child.

Flushing a channel with a syringe spend carefully, without pressure, because of the possibility of solution flowing through a wide apical opening. For irrigation canal to remove dentinal chips that ut ¬ vorylasya during processing tool , can be used for ceiling ¬ rylnyy isotonic sodium chloride solution and sodium hypochlorite .

Hand endodontical tools

A hand tool for treatment of the root ducting is produced different sizes and forms in obedience to ISO. Usually the number of instrument means the diameter of tag which is measured in hundredth millimetre. For example ¹ 10 means that the tag of instrument has a diameter 0,1.The coloured marking means the order of introduction of endodontical instruments (fig. 6) . Character as a triangle on the handle of instrument means that it reamer of Kerra (K-reamer); character as a square marks the file of Kerra (K-file); character as a circle means the file of Khedstrema (H-file).

 

 

 

K- reamer (fig. 1)  is made from a wire three-cornered or square a cut, twisted up in a spiral. An instrument returns ia1/4 or 1/2 rotation, that on 90 -180° and taken out from a channel. Presently produce the instruments of enhance able flexibility (K-flexoreamer) in series from six sizes. Their use is especially expedient in the case of the distorted ducting. The instruments of intermediate sizes (K-Flexoreamer Golden Medium) are intended for treatment of the narrow difficult of access ducting. They are produced in a set ¹ 12, 17, 22, 27, 32,  37.  In the very narrow ducting utillize reamer of K-Reamer of far side ? At, 08, 10, 15 with length of working part 15 – 18.

 

 

Pic. 1. K- reamer (K- of reamer)

 

 

 

K-reamer of firm «KerrHawe».

The file of Kerra (K-file) is made from a wire three-cornered or square a cut and unlike reamer of Kerra stronger twisted up, that forms more shallow step of spiral. It is possible sawing a dentine these instruments on the walls of channel and extends it. A ê-file is executing scraper vertical and insignificant rotators motions in a root-canal (to 90°). Scraper vertical motions give more chances for formation of root-canal like   watering-can  form without ledges and deepening (niches) in apex part (fig. 2) .files of Flexi Cut (F-file), more flexible, for work in the distorted ducting (fig. 3).

An instrument as Flex-o-file is another variety of file of Kerra. He is made from a very flexible steel wire, breaks a secret heavier, and has a safe apex. This instrument is produced also intermediate sizes (K-Flex-o-file Golden Medium).

For passing of the very thin and distorted ducting utillize the instruments of enhance able flexibility, made from a nicel-tytan alloy. The file of Kerra (as K-File of nitiflex) is produced standard sizes. This instrument can not be bent after curvature a channel, as it has memory of form and at once goes back to the previous position

 

     

                         

 

Pic.2. K-file (K-file)

 

 

                                              Pic. 3. Flexofile

The file of K-hedstrem (Í-file, Hedstroem- of file) is made from a wire as a cone by cutting of sharp cuttings appearances as a spiral (fig. 4). During working as this instrument scraper (saw) motions execute only. It is intended for smoothing of walls of channel, they can delete stopping material, in particular gutta-percha, from a root-canal. At an attempt to extend channel rotators motions an instrument

breaks a secret easily 

 

Pic. 4. Í-file (H-file)

Unify (Unifies) is new modification of Í-file. It has two cuttings appearances. Cuttings are in this instrument of identical depth on all of length of bar, due to what he is resilient and more strong on a fracture, at that time as him the apex third is flexible, that allows to process the distorted ducting .

Hellfire – also variety of file of K-hedstrem. This instrument differs that on a cut has three cuttings appearances.

Pulpekstraktor (pic. 5) is intended for the delete of mash. Produced from ¹ 0 to ¹6.

 

 

Pic. 5 Pulpekstraktor

Spreaders Finger- the Hand instrument from stainless steel for lateral condensation of gutta-percha.

Plungers’ Finger is the Hand instrument from stainless steel for vertical condensation of gutta-percha.

Coloured marking

Rose (orange) – 06.

Grey – 08.

Violet – 10.

White – 15,45,90.

Yellow – 20, 50, 100.

Red – 25, 55, 110.

Dark blue –30, 60, 120.

Green – 35, 70, 130.

Black – 40, 80, 140.

 

Pic. 6 the Coloured marking

 

Term for files accepted in modern endodontics

The first file has reached the top , called " initial ".

A file that is maintained patency at canal working length during processing , and produced recapitulation of dentinal chips and paid lubricant called " working " file . "

The maximum file size that is immersed in a length , called

" Master file "

 

Endodontic handpieces and instruments for root canal treatment

Today, manufacturers offer a large selection of endodontic tip (Fig. 7). Their fundamental difference from their custom ¬ angle handpieces is that the rotational speed is reduced (due to the micromotor and gearbox ), sometimes up to 350-400 rev / min. Endodontic tip "Canal-leader 2000" company "SET" provides translational - rotational motion : rotation by 90 ° and reverse ¬ no- movement for 0.4-0.8 mm. It uses a spe ¬ cial endodontic instruments for angular tip. NACO ¬ nechnyk a device for cleaning the root canal. Its possible to use as ¬ fillings channels.

Tip Giromatic provides momentum for and against the clock ¬ ing arrows on the 90th . Tip Canal Finder is designed to poshu ¬ tion channel, it has a combination of vibrating motion with speed.

For machining of root canals using en ¬ dodontychni vibrating system. They were designed to sum ​​¬ tion tool treatment and irrigation of root canals , which will accelerate and improve training techniques to channel sealing. For example , low Bioacoustic Sonic Air System allows variations within a sound wave with a frequency of 1500 to 3000 Hz.

Tip piezoelectric ultrasonic Piezon Master provides a vibration frequency of 28 000 Hz, mahnitoultrazvukovyy in ¬ konechnyk Cavi Endo - 25 000 Hz. For these tips let ¬ be multi endodontic instruments that allow a much faster process root canal : Girocleanser like pulpekstraktor well cleans the root canal from the remnants of Pul ¬ pi or filling material ; Girofile - file Hedstroma for in ¬ konechnyka Giromatic, file type and Kerr Hedstroma for nakonech ¬ tions Canal Finder; tools to tip Sonic Air (shaper, helisonic, nspisonic), for the tip Cavi Endo - Gimlets diamond , diamond file Kerr for ultrasonic tip (Fig. 8).

 

 

Chart. 7. Endodontychyi tips :

and - Giromatic, which provides for cycling and counterclockwise only 90 °;

6 - tip for finding the root canal (Canal Finder) performs vibration and rotational motion ;

in - Sonic Air carries a vibration with a frequency of 1500 Hz ;

g - Piezon Master - piezoelectric ultrasonic tip vibration frequency of 28 000 Hz;

d - Cavi Endo - mahnitozvukovyy tip at a rate of 25 000 Hz

 

Chart. 8. Tools for endodontic handpieces (with IR Stocks, CFWehammer, 1994):

and - Girocleanser, like pulpekstraktora ;

b -Girofile, file Hedstroem to tip Giromatic;

c, d - K files and H for the tip Canal finder system ( system channel search );

d - Shaper,

E -Helisonic;

is - Rispionic - tools to tip Sonic Air;

same - file diamond tip for Caviendo Ultrasonic Sistem;

with - K- file for ultrasonic handpiece

 

Instrumental treatment of the root ducting’s

First stage: opening of cavity of tooth with the purpose of creation of random access to opening of root-canal (fig. 7) Delete carious dentine, stopping and expansion of carious cavity conduct by fissure or the round coniferous forests of the proper diameter.

Opening of cavity of chisels and dog-teeth is conducted from the side of oral surface. Direction of bur must answer wasp of tooth which will allow preventing the perforation of his crown. Opening of cavity of tooth of premolars and molars is conducted from the side of masticators surface. For opening of cavity of tooth and delete of overhanging edge of roof fissure use by the cone-shaped hard-alloy coniferous forest or diamond head with a dull end, to prevent the perforation of bottom of cavity of tooth.

 

 

Pic. 7 access is Wrong formed (the roof of pulp chamber is not remote, as a result of

What an additional channel is skipped)

 

The methods of exposure orifice of ducting:

•sounding (stomatological and endodontical probe);

illuminating (stomatological mirror, optical tip, inside oral cavity video camera) from beneath;

•colouring (caries-marker, fuksin);

Indication by hypochlorite of sodium (landmark  is on the output of small bubbles of gas at dissolution of organic).

Second stage: tooling of root-canal. Success of endodontical treatment depends on quality of cleaning, forming and stopping of the root ducting. The treated channel must have a cone-shaped form, gradually to narrow in direction from orifice  to apex part. Instrumental treatment is completed in the distance 0,5-1 mm to the anatomic apex opening which answers the apex narrowing (physiology opening) of root-canal. Sometimes the anatomic opening does not answer the reflection on a sciagram. It can be contained on the lateral surface of root.

At sharp festering periodontit or sharpening of chronic periodontit in that case, when after deleting of ïóòðèäíèõ the masses from a root-canal there is not an outflow of pus, it is needed to expose the apex opening and drain a periodontal crack.

Treatment of root-canal is begun from determination of him working length. There are two methods of estimation of length of root-canal – roentgenologic and electrometrical. Length of root is determined on the basis of study of radiograph, executed to treatment, and carry it on a endodontic instrument which is carefully entered in a root-canal on a depth 2-2,5 mm, shorter than conceivable length of tooth. Working length of instrument is marked a silicon or rubber terminator (stopper) (iae.8, 9). If in roots two or three channels enter different after a form instruments, for example, in one Í-file, and in second e-file which will be well identified on a sciagram.

For determination of working length without a radiograph use an electronic seeker (apex-locator) which determines the location of the apical opening on the basis of difference between electric resistance of soft and hard fabrics. Modern electronic radars, (for example, Evident Farmatron IV) can work and in dry, and in a moist channel, have an automatic digital indicator, supported a light and voice indicator. However these vehicles helpless to substitute for a roentgenologic method researches, especially in teeth with the uncompleted growth and development of roots and in temporal teeth.

 

Pic. 8. Correct choice of external landmark

 

Pic. 9. Correct and wrong location of feet-mark

 

Children have methods of preparing (forming) of the root ducting of the second teeth with completed forming of root

All of existing presently methods of preparing of root-canal are based on one of two technicians: step-back («back step»). Crown-down («from a crown to apex») or is combining of this technique.

Method of expansion of channel from below upwards with application of instrument from a less size to greater (step back) developed Mubbaney (1979) for treatment of the narrow distorted ducting.

During expansion of channel with application of this method it is desirable to utillize instruments with rounding tags and more flexible. Extend a channel the file of Kerra (e-file), gradually increasing a size. Before the physiology narrowing a root-canal must be extended to the file size ¹ 25. Revolving instruments is needed only clockwise. In the process of expansion it follows constantly to go back to the instrument of less size. After every replacement of instrument a channel needs to be washed, to prevent blocking of apex part dentinal saw dusts. After treatment of channel on all of working length by an instrument ¹25 carried out it subsequent expansion by the instruments of greater sizes, but less length which provides creation of even cone-shaped expansion of channel in direction orifice. After working as the file of any size, but greater after ¹25, it is necessarily needed to level walls an instrument ¹25 (it is possible a Í-file) on all of working length. This procedure also prevents blocking of apical part of channel dentinal sawdust.

Sequence of application of instruments: ¹10- ¹15- ¹10- ¹20- ¹15- ¹25 - ¹20

The sequence of introduction of files of Kerra is schematically represented on.12

 

 

Pic. 12. Sequence of expansion of root-canal from the apex of root to orifice. The dotted line is mark the limits of depth of passing of channel (E.V.Borovskiy, N.S-Zhukhova, 1997)

For smoothing of walls of root-canal utillize the file of Khedstrema (Í-file). Scraper (saw) up-stroke from below smooth out inequalities on the walls of channel, constantly washing saw dusts. Washings of root-canal conduct after every introduction of endodontical instrument. It should be remembered that a washings liquid gets in a channel only to that level, where a needle is. Therefore a diameter of needle must be such, that it freely took a place in a root-canal and on 2 – 2,5 mm did not come to working length of root-canal . It will allow carefully washing down dentinal saw dusts from a root-canal

 

 

Pic. 13. Errors which happen during treatment of the root ducting:

And is a blockade of apex part of channel by dentinal saw dusts;

Is formation of step;

In is formation of niche in apex part of channel;

In, a gramme is forming like knee expansion in more narrow in all part of channel (it is indicated pointers);

A is a perforation of wall of root-canal as a result of treatment of apex part of channel by the instrument of too large-break

Technique of «Crown Down»

The technique of «Crown-Down» was developed for working as hand instruments in certain clinical situations (such, as treatment of gangrenous pulpits). This technique repressing for endodontical treatment of channel from point of asepsis and antiseptic.

Another advantage is a substantial decline of risk of break of instrument in a channel and improvement of control after motion of instrument in a channel. Optimum hand instruments for this method are instruments, made from a nicel-tytan alloy (for example, Nitiflex).

Algorithm of technique of Crown-Down :

1. Treatment of estuarine part;

2. Treatment of middle part of channel;

3. Forming of area of touch is in apical part.

By hand instruments treatment of ducting is carried out the technique of Crown-Down in a sequence from a greater size to more small with conical of instruments of .02.I¹ and these instruments it is needed carefully to work in ducting which pass to each other or unite under an acute angle (II type). It is better to avoid the multiple scrolling in the place of transition of ducting, as it can result in the break of instrument.

 

Stages of vital amputation (step by step )

Before treatment must be carefully assembled a complete medical history and conducted a clinical and radiological examination.

Step 1: Application anesthesia appropriate anesthetic

 

 

Pic. 4.13. Must adequate analgesia. This refers to the mandibular anesthesia for lower teeth and infiltration - to the top . For the lower milk molars , mandibular anesthesia except (a), must always be carried out infiltration anesthesia cheek mucosa (b) to exclude the imposition of the buccal nerve clamp when installing rubberdama .

Step 2: Isolation of the tooth using rabberdama

 

 

Pic. 4.14. 75 tooth isolated using rabberdama . This is to prevent infection of the pulp , formakrezolu hit the soft tissues and to create patient comfort

Step 3 : Remove pathologically transformed caries process tissue and determining the location of the pulp exposure

 

 

Pic. 4.15. Before we reveal the pulp chamber , it is important vidpreparuvaty carious cavity - otherwise bleeding pulp complicate examination of the walls of the cavity. It is also necessary to determine the place of pulp exposure (indicated by arrow) to easier access to the pulp

Step 4 : Remove arch pulp chamber

 

 

Pic. 4.16. Boron is introduced into an open area of ​​the roof of the chamber, then carefully removed all vaults. If the camera does not explicitly opening , the cavity deepens . Then boron prosuvayetya not in depth and moves so to remove the vault chamber ( a). At this stage must be bleeding from the pulp.

Step 5 : Remove the coronal pulp of a large excavator or large round bur

 

 

Pic. 4.17. For removal of coronal pulp tissue is recommended to use a large excavator ( a). When using a round bur with caution. Any excess pressure can lead to perforation of the bottom and complexity vital amputation (b). After removal of the inflamed coronal pulp to stop the bleeding

Step 6: Overlay Formakrezolu cotton ball for four minutes

 

 

Pic. 4.18. A small cotton swab dipped in Formakrezol and vidtyskayut in gauze to remove excess solution ( o) before placing it in the pulp chamber for 4 min

Step 7 : Remove the swab from the test Formakrezolom and stop bleeding.

 

 

Pic. 4.19. If, after the imposition of ongoing bleeding formakrezolu root canal , it means that the root inflamed pulp . In this case, the pulp must be removed completely , that made ​​pulpektomiya (see section V of this chapter ).

 

Step 8 : Fill pulp chamber with cement

 

 

Pic. 4.20 . After the bleeding stops pulpovou chamber filled with a type of zinc oxide eugenol , such as Kalzinol

 

Step 9: restore the tooth with a standard metal crowns

 

 

Pic. 4.21 . Restoration of any tooth after treatment of pulpitis should always end with a statement on his metal crowns. This is done to strengthen and protect the tooth weakened by removing large amounts of hard tissue in the treatment of pulpitis.

 

Step 10: Postoperative radiograph

 

 

Pic. 4.22 . On postoperative radiograph vnutrirotoviy seen as filled with zinc oxide eugenol pulp chamber of the tooth 75 , is completely shut root canals : preoperative radiograph (a) immediately after surgery. Dilution of bone in the area of ​​separation of roots indicates that the treatment performed poorly. In this case, a decision or to remove a tooth, or make pulpektomiyu , and in the absence of changes in destructive periodontal quiet clinical presentation is recommended to observe the condition of the teeth during the follow ups.

 

Stopping (cover) of ducting of temporal tooth

 

Stopping (cover) of ducting of temporal tooth on any stage of forming conduct after their careful instrumental and medicinal treatment and disappearance of clinical signs of sharp inflammation of periodont. The feature of the root stopping in this case is its capacity for osteomalacia, synchronous with osteomalacia Corny of temporal tooth. Consequently, stopping of the roots ducting of temporal teeth must be carried out unhardenings pastes which have an antiseptic action. To that end more frequent all apply pastes on the basis of oxide of zinc and eugenic (paste of Grossmana, Cariosan), iodoform pastes (KRI-paste of Pharmachemie; Switzerland), which contain Iodoformium, camphor, parachlorphenol and Mentholum, paste of Maisto, that, except for the adopted components, the oxide of zinc, thymolum, lanolin, Tempophor of firm Septodont, contains also, Yododent (Russia) – it consist of calciumhydroxid iodoform paste. In the stage of ðîçñìîêòóâàííÿ of root almost always apply 5 % iodoform or iodumfomthymolum paste. Filling of root-canal of temporal tooth is carried out paste by rootfilling. Stopping begin with introduction to pasture liquid consistency on walls and continue condensation of the thicker involved material with application of plagger, amalgam condenser, paper absorption wire.

Iodoform paste is for treatment of periodont

baby teeth of TEMPOPHORE

Properties

TEMPOFOR is used as a medical and prophylactic mean in the cases of sharp or chronic periodontit.

In a pedodontia TEMPOFOR does not hinder formation of permanent dental rudiment. Paste of TEMPOFOR is disinfectant, takes off a smell and bactericidal, does not cause dysbacterial in the cavity of mouth, develops protective properties of per apical fabric. The method of application of it is simple and it is carried by an organism well.

1. TEMPOFOR eliminates previous medicinal treatment of ducting, as possibly, in the first or on a 2 visit, depending on a case, to enter paste directly in a channel.

2. Paste enables exactly to define length of the stopped channel on a sciagram.

3. As paste does not harden, treatment can be picked up a thread during next visits, a risk is eliminated to do a channel inaccessible as a result of his complete and final filling.

4. In the case of the possible going beyond an apex organism better reacts on soft paste and reactions minimum.

5. Possibility at the end of treatment to stop a tooth ordinary paste gives to pasture application, being not afraid of unpleasant complications which often do not succeed to be avoided the most experimental doctors, namely, to the pain reaction after stopping. This incident on the finishing stage of treatment psychologically unpleasant, while during treatment he is perceived as something proper, and in some degree influences on end-point.

Shows

Treatment of pulpits.

Treatment of granulomatous and granulating periodontit is with noritsya.

Treatment of the repeated infections is after stopping.

At periodontit of treatment and stopping of the infected ducting.

Method of application

1. A caries is complicated without pain displays.

A. Wide to expose a pulp chamber, clean included in ducting.

B. Retelling to process the fissure coniferous forest, then spherical, extending, if it is possible, included in ducting.

In. To wash, to dry out warm air and smear the bottom of cavity a two-bit to pasture TEMPOFOR. Carefully to wipe the edges of pulp chamber and take off surplus to pasture, which violates adgasion of cement. Then to seal the bottom of cavity cement, avoiding compressions. If the mouths of ducting are widely exposed and preliminary treated, to enter endodontical instruments, avoiding pushing through of maintenance of channel in per apical fabrics, only in overhead part of channel. Simultaneously with introduction to pasture in a channel to enter a two-bit to pasture in the cavity of tooth.

G to fill the tooth.

2. A caries is complicated with the inflammatory phenomena and pains.

A., to dry up, to enter no-pressure a two-bit to pasture and cover a wadding tampon, moistened peroxide.

B. During 2-3 days, when pain will calm down, to operate as in 1st case, covering for a time cement.

To leave a patient under a supervision 8-10 days. To enter a new dose to pasture and make off stopping.

At presence of noritsya  to process a channel and cavity of tooth as indicated higher. When pain will calm down, to delete paste a power-shovel and carefully to process a channel (avoiding here pushing through of maintenance of channel after apex) by endodontical instruments.

To wash in regular fashion a channel by a peroxide. To dry out and enter TEMPOFOR in a channel by rootfilling to apex. To cover cement and leave under supervision some time.

In a pedodontia after ordinary treatment with the purpose of delete of carious dentine and dead fabrics it is possible to fill a channel Thermoform, then to close the temporal stopping.

During subsequent visits it is possible to take off overhead part of the temporal stopping and begin stopping.

 

Children have instrumental treatment of the root ducting of the second teeth with the uncompleted forming of root

Instrumental treatment of the root ducting of teeth with the uncompleted forming of root has some features, because of more wide apical opening, absence of the apical narrowing, thin low calcium walls of channel. Cleaning is carried out after exact determination of working length of channel (that answers length of the formed part of root) a roentgenologic method. The mainly standard method of treatment of the root ducting is used with the use of files of largeness’s (from ¹ 30 and anymore) with a safe rounding apex. An instrument cuddles to the wall of channel and moves apeak, deleting saw motions the infected is softened predentyne. To work as a file it follows very carefully, not perforate the thin wall of channel.

If there is a requirement in chemical expansion of the narrow root ducting, it is possible to apply preparations of ethylåndiamintetra acid ( EDTA), the best gel-like consistency. However for children such necessity arises up rarely enough.

Children have features of stopping of the root ducting of the second teeth with the uncompleted forming of root

Ductings of the formed root stop within the limits of opening of apex of root pastes or plastic materials on the basis of artificial resins (syllers) in combination with gutta-percha wires, that is instrumental in more effective filling of channel. Widely apply such syllers, as Apexit (Vivadent), SealApex (Kerr), TubliSeal (Kerr), AHPlus (De Trey), Can-a-Seal (H.Shein).

In teeth with the unformed root of stopping of root-canal conduct in 2 stages.

The first stage is stopping of root-canal within the limits of the formed part by pastes which contain hydroxide of calcium. Such paste can be prepared ex tempore from pharmacy powder of hydroxide of calcium by mixing of him with the distilled water or solution of anesthetic. For contrast radiography add a sulfate a barium in ratio 1:8. It is possible to take advantage of the prepared pastes, such as Endocal (Septodont), Calxyl (VOCO), Calcicur (VOCO) or pastes that consist Calcium wires (firm "Roeco"). After stopping of root-canal the temporal stopping belongs from glassinomer cement which provides necessary hermetic.

Under the action of calcium paste there is forming of osteocementum or osreodentyn fabrics in the area of apex of root, which obturating apex of root is due to. This phenomenon is named apexyfication.

The use of calcium paste needs careful clinical supervision during which estimate the state to pasture in a root-canal and dynamics of roentgenologic indexes. Rozsmoktuvannya of calcium paste needs the repeated fillings of channel such paste. The first repeated filling is conducted through a 1 miss, then — each 2-3 months Duration of treatment averages 12-18 months

      Algorithm of application of hydroxide of calcium with the purpose of formation of natural mineral dense barrier, following:

    diagnostics of disease;

    imposition of kofferdame;

    forming of access is to the root-canal;

    determination of working length (for children principle  of apex location  as method of determination  of working length is in teeth with the unformed roots useless);

    the sparing cleaning and expansion of root-canal is with application of neutral chemical matters which own bactericidal properties (0,5%  of hypochlorite natrium,0,05%  of chlorhexidine, Iodinolum);

    immediately in front of  bringing of hydroxide of calcium a root-canal needs to be washed the distilled water;

    temporal stopping    of root-canal  by the hydroxide of calcium;

    imposition of the temporal stopping.

At presence of living mash in a root-canal the hydroxide of calcium is replaced in 3-4 weeks. In gangrenous teeth with the destructive forms of periodontit the hydroxide of calcium is changed in 5-7 days, 1 month, 3 months, 6 months and 1 year.

The first signs of mineral apical barrier usually appear in 3 months. It can be seen on a sciagram. However yet dense it is, formed not fully, that is why for it final forming the change of hydroxide of calcium is needed in a root-canal through 6 misses, 1 year and even in 1,5. A criterion for formation of dense mineral apical barrier is the easy sounding by the K-file of a 30-40 size of ISO and roentgenologic research.

 

With the purpose of stimulation of apical zinceugenol paste can be utillized.

A method of application of ProRoot is for the lead through of speed-up (artificial) method of apical.

After completion of chemimechanical treatment of channel at treatment of destructive forms of periodontit in the second teeth with the unformed apex of root in a root-canal on 5-7 days enter the hydroxide of calcium (for achievement of sterility of root-canal). In the second visit fully delete the hydroxide of calcium, wash the distilled water and apex part of root-canal is filled involved on the distilled water of MTA ProRoot. Wait 5-10 min. In a that visit after hardening of cement stop a root-canal, utillizing new technologies of the three-dimensional filling of channel.

Advantage of the use of MTA for creation of artificial mineral apical barrier between a root-canal and periodont consists in reduction of terms of treatment as compared to the hydroxide of calcium. At creation of artificial apical barrier in the process of treatment of periodontit due to high biocompatibility preparation of MTA ProRoot practically joins in the dense structure of root and cementumblaste complete creation of the unique complex of fabrics of, which executes the function. Application of ProRoot is rotined also at closing of perforations, breaks of crown and root of tooth, for lengthening of the blasted part of root under gums with subsequent restoration of tooth.

The second stage of stopping of root-canal is executed after closing of the apical opening. For this purpose utillize solidifiable pastes or gutta-percha wires in combination from syllers. Metallic anchor and porcelain wires for strengthening of the blasted crown in child's practice is not rotined.

For the rapid artificial forming of mineral barrier between a root-canal and periodont, a firm Dentsply offered new unique preparation of MTA (A mineral Trioksid Aggregate) - ProRoot.

 

 

Children have cover of the root ductings of the second teeth with the completed forming of root

Method of stopping of root-canal by pastes and cement

Before stopping of root-canal pick up the size of rootfilling in size of the last file which is used for expansion of apical part of root-canal. It is desirable, that a diameter of rootfilling was less road clearance of root-canal. It warns air embolism and breakage of rootfilling in a root-canal. After preparation to pasture or to cement rootfilling is dipped in stopping material so that the two-bit of material stayed too long on a spiral. Then by careful motion rootfilling is dipped in a root-canal to the apex, include a micro motor. In the period of rotation of rootfilling at a speed of 600-800 there is distributing of stopping material on the walls of channel. In 10-15 seconds rootfilling which is revolved is drawn out from a channel.

This method is most outage, often used in clinical practice, but has failing, as does not allow well to fill with syller all of micro branch of channel.

 

Method of central wire or one cone

This method is used in teeth with the round road clearance of root-canal. As syller apply one of varieties of pastes, epoxyd resins or cements. As a detective apply the different types of wires (silver, titan, gutta-percha, plastic).

At first pick up necessary size wire (in size of the last instrument for expansion of apical part of root-canal) on which by a notch mark length of root-canal. At first in a root-canal enter syller by rootfilling, as described in a previous method. After it in a channel enters wire, preliminary submerged in syller, and move it toward the apex of root by pincers. Surplus of stopping material is crushed from the mouth of channel delete, and the end of wire is broken off a few bending motions (a break takes a place in the area of the previous created notch of metallic wire). It is important at application of silver wire, that wire was fully surrounded root cement, especially in apical part, as differently corrosion of wire can develop in future. In the case of application of gutta-percha wire he is cut off a warmed-up power-shovel and after it impose stopping.

Advantage of this method of stopping consists in the dense filling of apical part of channel even in the so much arcuated root ductings.

 

Multicone methods of stopping of root-canal

Method of cold lateral condensation of gutta-percha

This method is used in the root ductings with the oval transversal crossing or wrong geometrical form of channel.

 

 

The purpose of method consists in the good filling of all of branches from a main channel. At the beginning in a geared-up to stopping channel enter a spreader with the purpose of determination of his communicating. He must reach approximately on distance 1-2 mm from the apex of root. Then pick up the size of standard gutta-percha wire. He must be on one size more than instrument which preparation of apex part of root-canal was followed by. During that which drove in wire must with small effort to be entered and hatch from a root-canal. On length he must be on 0,5-1 mm shorter than length of root-canal. His size (and thickness) is picked up by cutting-off of tag of wire.

 

 

Picking up a size is needed carefully, as at free introduction of wire it is possible easily to chuck out him for the apical opening of root or, opposite, easily to draw out from a root-canal at the leading out of spreader. For control of introduction of wire it is expedient to do a sciagram.

Before stopping of channel wire is neat and syller conclude on that can be torn off paper block. Then enter syller rootfeeling in a root-canal, the tag of wire is also dipped in syller and, utillizing rotatory motions enter wire in the apex of root-canal. Then carefully he is drawn out and again enters to the apex opening at full length of root-canal. In molars of supramaxilla at first stop the cheek ductings (difficult to the traverse ductings), and then palatal channel; in molars of lower jaw at first stop the medial ductings, and then is a distal root-canal.

 

 

After introduction of basic wire to the root-canal a spreader is slowly entered in a channel, displaced aside, and gutta-percha wire is moved them toward an apex, then a spreader is drawn out from a channel and in that which appeared after drawing out of spreader a channel is entered additional gutta-percha wire. Where upon lateral condensation of entered gutta-percha wire is again conducted by a spreader. It repeats oneself until a root-canal will not be fully filled to the limit. Considerable pressure of spreader is thus created on gutta-percha wire. Under act of pressure wire is deformed, taking a shape channel, and gradually fill all of micro branch of root-canal. At every introduction of new wire and leading out of spreader it is needed to pay a regard to basic cored wire, that him by chance not to draw out from a root-canal and not push through the apex opening deeper. After filling of channel surpluses of gutta-percha (salient grounds of gutta-percha wires) delete a hot instrument. After it do a control radiograph and treatments conclude imposition of the permanent stopping.

This method is most carried out, as gutta-percha practically does not give break and at the use of plastic gutta-percha wire the contours of channel repeat oneself well, that allows obtaining him three-dimensional space of stopping.

Method of hot lateral condensation of gutta-percha

This method is intermediate between the method of cold lateral condensation and hot vertical condensation of gutta-percha. This method assumes application of heat into a channel.

 

 

A gutta-percha is warmed-up better executes configuration of channel, what at the method of cold lateral condensation. At implementation of this method utillize the special instrument is a transmitter of heat for the warming-up of gutta-percha into a root-canal. The method of stopping of channel by warm lateral condensation of gutta-percha is taken to the following.

 

 

Before stopping in a root-canal enter vection of heat, to define length of root-canal and warn possibility of touch

warmed-up vection of heat to the walls of tooth which can serve as reason of break of hard fabrics.

At first, as well as at the method of cold lateral condensation, basic wire is entered in a channel from syller, then yet additional gutta-percha wire. And after it in a root-canal one of neat is entered on length of root-canal of vections of heat. At implementation of this manipulation the vection of heat is warmed-up must constantly move in a channel by application of vertical and rotatory motions, to prevent gluing of gutta-percha to the instrument. Then the vection of heat retires from a root-canal, whereupon in a channel which appeared, enter yet gutta-percha wire and again by a spreader, utillizing the method of lateral condensation, he is tightly condensed in a root-canal, repeating it once or twice to the complete filling of channel.

The method of warm lateral condensation has some advantages before the method of cold condensation, as a warmed-up in channel gutta-percha fills the branch of root-canal of tooth better, repeating him spatial location.

Method of vertical condensation of «warmed-up» gutta-percha

Basic gutta-percha wire was driven in so that him apex part stuck in education of channel in the distance 1-1,25 mm from the apical opening. In a root-canal enter, syller whereupon syller wire a water-wet carefully move toward support. Cut away overhead part of wire, salient above the mouth of channel a warmed-up power-shovel. After it in a root-canal enter incandescent to red lateral condenser (spreader), to soften gutta-percha wire. Then push through the softened gutta-percha a cold vertical condenser (plagger) to the apex of channel. This process is repeated until by a gutta-percha apical part of channel will not be filled. For control of quality of filling of apical part of channel it is necessary to do X-ray research. Part of root-canal of, which remained, stop the cut away ends of wires, warming up and condensing them in a channel. If cementation of inset is foreseen in a channel, it is stopped only to the level of immersion of metallic wire.

 

 

 

 

Cover of the root ductings by a thermoplastic gutta-percha, inflicted on a titanic bar (as «KVIK-FILL»)

«Kvik-fill» is the simplified modification of gutta-percha in a phase alpha, inflicted on the special titanic bar in which a tail press is for fixing in an angular tip.

At first in a root-canal enter the two-bit of syller, moisten «Kvik-fill» of syller, enter in a root-canal to support (approximately on 3-5 mm, not coming to narrowing of channel) include a micro motor, at a speed of 800-1000, and in the moment of rotation «Kvik-fill» press down in a channel. At the friction of titanic bar into a channel under act of temperature gutta-percha is softened well fills all of micro branch of root-canal. Control of stopping is conducted by roentgenologic research. A titanic bar can be used as wire in a root-canal. For this purpose after completion of stopping of hair-cuttings stretches from a tip and cut the coniferous forest in the speed mode.

In the case of necessity preceding in the blasted crown of the tooth with the use of standard or poured wire a titanic bar is drawn out from a root-canal and in place of him enters geared-up anchor wire in a channel, fasten him and use as support for the artificial crown of the tooth.

Method of stopping of root-canal by a thermoplastic gutta-percha simple enough in implementation, and it is possible to obtain good cover of root-canal.

Cover of the root ductings by the system «Termofil»

 

 

Technology of cover of the root ductings is presently developed by the system «Termofil», which is a cone-shaped flexible bar-transmitter, made from stainless steel, titan or contrast radiography plastic and from above covered the layer of gutta-percha in alphaphaza. A bar in size and cone answers the sizes of ISO from 20 to 140.

The gutta-percha of alphaphaza. Owns the low temperature of heating, by high fluidity. High fluidity of gutta-percha provides good penetration it in the micro canals of root. One of lacks of cover of channel thermoplastic gutta-percha is its sinking in a channel after cooling. As a result microspaces  appear between rootfilling and walls of channel. Application of thermofil erects to the minimum this failing in connection with that basic space of channel is filled a central bar indurater, and a gutta-percha occupies an insignificant volume, and that is why it is practically possible its sinking to scorn.

Clinical stages of obturation of root-canal thermofil:

At first pick up thermofil in obedience to the diameter of geared-up to stopping channel. For this purpose usually utillize plastic verifcator, present in a set. He is entered in a channel with small effort and by a silicon terminator mark working length. After it pick up thermofil, proper the size of verificator, and on him mark working length of channel. At stopping of teeth with the distorted ductings the metallic bar of thermofil is preliminary bent on a form curvature of ductings. Bending plastic bars is not needed, as they are more elastic at heating and well repeat the form of channel. Termofil is neat in size of channel add antiseptic treatment by immersion of him on 1 -2 min. in 5,25 % solution of hypochlorite sodium is with the subsequent washing in 70 % alcohol and drying. Termofil treated thus is placed in a stove «Termopren» on 20-30 sec. During heating a termofil doctor enters in a channel the two-bit of encapsulate (syller) at the help of rootfilling or paper wires. Firm of termofil of Tulsa Dental Products as syller recommends to utillize the special encapsulate of Thermaseal. Except for it is possible to utillize any syllers on the basis of epoxyd resins.

Termofil preliminary heated in sand without the special labour and rotatory motions enter in a root-canal to apical just right. Metallic wire of termofil can be used as support for and making of wires’ tooth. In the case of proceeding in crown part of tooth by composition stopping material the handle of termofil is bent by the coniferous forest which is revolved, cut off.

After it conduct condensation and delete of surpluses of gutta-percha in the cavity of tooth, and then proceed to proceeding in the blasted part of crown.

At the use comparatively of simple method of stopping of root-canal termofil is provide effective cover of main channel and him lateral branches. Exact introduction of termofil is instrumental in it on the set depth due to the presence of haptic feed-back at achievement the bar-transmitter of apical just right.

Thus, doctors-stomatologies presently dispose the enough body of methods of cover of the root ductings which in child's practice can used in the second teeth.

Stopping materials for the permanent stopping of the root ductings for children

Zink-Phosfat cements.

Zinkooksideugenol cements.

To pasture on the basis of oxide of zinc, eugenol, Thymolum, paraphormaldegid and other.

To pasture with the hydroxide of calcium.

To pasture  on the basis of epoxyd resins.

Cement is from glassinomer.

Materials on basis cavity-formalin.

Shtifti.