Methods of treatment.

Date: 2015-10-07; view: 755.

Study material.

Devital amputation is amethod which provides for the partial extraction of the pulp (crown part) after its previous devitalisation and the subsequent mummification of the root pulp.

The indications for the devital amputation in the temporary teeth, the roots of which are immature or in the resorption stage, are: acute traumatic pulpitis (spontaneous opening of the pulp at preparation of the carious cavity), acute serous diffuse pulpitis, chronic fibrous, chronic hypertrophic pulpitis.

Devital amputation is performed in 2-3 dental visits.

The first visit includes application of the devitalizing paste. The following procedures are performed: partial necrotomy of the carious cavity, opening the horn of the pulp, application of the devitalizing paste, application of the hermetic bandage. The paste that may be used for the temporary teeth is just paraformaldehyde one: Parapasta (Сhemа, Роlfa), Depulpin (VОСО), Devipulp (Septodont)and others.

The mechanism of action of the paraformaldehyde paste: the pulp necrosis is a consequence of reaction of the formaldehyde with amino-groups of the cell proteins, and this causes their denaturation. Paraformaldehyde produces dehydrating effect onto the pulp, which leads to its drying- mummification. The paraformaldehyde paste is applied onto the temporary teeth for the period of 7-10 days.

The second dental visit includes amputation of the crown pulp and covering the crown pulp with a paste having the antiseptic and mummificating properties. To achieve this: the bandage is removed, the temporary tooth cavity is opened taking into account its topography, and the crown pulp is amputated.

After the amputation the crown pulp is covered with a paste that possesses expressed antiseptic and dehydrating properties, containing formalin, paraformaldehyde( as an antiseptic), cresol, thymol and other substances. Also it is possible to administer the zinc-eugenol paste with antiseptics ( thymol, iodiform). The second visit may be completed with application of a permanent filling.

The third visit– includes change of the temporary filling onto the permanent one, if during the second visit the doctor applied a temporary filling.

The method of devital amputation in about 85% of cases gives complications as a chronic periodontitis in 2-3 years, and this may lead to early temporary tooth extraction. That is why after apexfixation ( apexogenesis) of the temporary tooth roots it is necessary to perform its endodontic treatment- the instrumental, medicamental processing of the root canals and filling.

Devital extirpation– is a method of complete pulp extraction after its previous devitalisation.

The indications for the devital extirpation in the temporary teeth are:

1. All forms of acute and chronic pulpitis in the temporary teeth with mature roots.

2. In the temporary teeth with immature roots- acute purulent pulpitis, chronic gangrenous pulpitis, pulpitis with clinical or roentgenological signs of affection of the periodontium.

Methods of treatment. The method of devital extirpation is performed in 2-3 dental visits.

The first visit - includes partial preparation of the carious cavity, opening the pulp horns and application of the devitalizing ( paraformaldehyde) paste for 10-14 days under the hermetic bandage.

The second visit– includesremoval of the bandage, opening the cavity of a temporary tooth taking into account its topography, extirpation of the pulp from the root canals. In the temporary teeth with immature roots before initiating the treatment it is necessary to perform the roentgenography of the tooth to detect the degree of root formation. After the pulp extraction the root canals of the temporary tooth must be sealed up to the apical orifice.

To seal the root canals in the temporary teeth after the devital extirpation we use: zinc-eugenol paste, made ех tempore with addition of roentgen-contrast substances; zinc-oxide-eugenol cements ("Cariosan" Spofa Dental; "IRМ" DentSplay; "Endobtur" – Septodontand and others.); pastes with iodiform, thymol ("Iododent"- ВладиМиВА Russia; 5% iodoform paste- ех tempore; "Теmpophor" - Septodont и "Timophorm" – Alpha Beta).The choice of sealing material for the root canals is caused by the stage of tooth development. As for the temporary teeth with immature root, to seal the root canals it is required to apply the zinc-eugenol paste, prepared ех tempore. It doesn't irritate the periapical tissues and provides for apexification of roots of the temporary tooth. To seal the root canals of the temporary tooth on the stabilization stage we may use all the above-mentioned sealing materials. As for the resorption stage, to seal the root canals we should use the non-firming pastes, which are quickly absorbed- the iodiform, thymol, which are produced ех tempore on the vaseline, glycerin or camphor oil.