Control questions

Date: 2015-10-07; view: 479.

The conservative method of pulpitis treatment is performed in 1-2 dental visits. The traumatic pulpitis may be cured for one visit. Infectious pulpitis should be treated in two visits. Positive effect of treatment may be achieved at adequate anesthesia and keeping to the rules of asepsis and antisepsis.

After the anesthesia it is necessary to perform the necrectomy and formation of the carious cavity. While we prepare the carious cavity, first of all it is necessary to extract the pathologically changed tissues form the carious cavity walls. The necrectomy in the carious cavity floor area and pulp horn projection area should be performed on the final stage of manipulation, and use for it the mechanic tip and spherical bur of appropriate size. The carious cavity is rinsed with a warm solution of antiseptic preparation of wide spectrum of activity (furacillin, ectericid, microcid). The carious cavity is dries and its floor is covered with a polymerizing hydrocalcium-containing preparation, which may form the concentrated alkaline medium (рН>12) (indirect covering of the pulp). The zinc-oxide-eugenol paste may be used for indirect covering of the pulp. Sealing of the carious cavity is performed using the sealing materials with high adhesive properties (composite material, co-polymers).

Direct pulp covering provides for application of the medicaments onto the open pulp surface (at traumatic pulpitis). Soft hydroxide-calcium-containing pastes are used for it: Calcicur (VOCO); Calxyl rot (VOCO); Pulp capping paste (Pulpdent). Their application onto the pulp should be performed without pressure. Then we apply a layer of hardening( polymerizing) calcium hydroxide: Calcimol, Calcimol LC (VOCO); Life, Life fast (Kerr); Dycal (DentSplay).

At expressed exudating component of inflammation in the pulp ( which may be confirmed by the spontaneous dental pain) during the first dental visit a doctor applies onto the floor of the carious cavity a paste with corticosteroids and wide-spectrum-activity antibacterial medications (Oxyzone, Hyoxizone, Ledermix, Pulpovital, Pulpomixine (Septodont). The pulp horn should be opened to provide exudate outflow and a better contact with the medications. The tooth is covered with a hermetic bandage without pressure.

During the second visit the doctor estimates the patient's complaints, removes the bandage and performs the antiseptic processing. The cavity is dried, medical hydroxide-calcium-containing paste is applied, and sealing is performed ( depending on the sealing material, at necessity we may use the isolating lining). At positive treatment results, the pain disappears completely. In 1-2 months there forms a layer of the replacing dentin. In teeth with immature roots the root formation proceeds.

After the pulpitis treatment with a biological method, the child must put under the surveillance of a dentist. If the tooth root isn't mature yet, the surveillance is proceeded until its complete formation. If the tooth root is mature, then, during 12 months the child is observed. The terms of surveillance are: 2 weeks, 3 months, 6 months, 12 months. In 6 months it is necessary to perform the roentgenography for detection of the root formation as well as for possible pathological changes in the periodontal tissues.

The efficiency of pulpitis treatment by a conservative method in 12 months is estimated by the following criteria: absence of toothaches, especially resulting from the mechanic stimuli action; normal data of electrical pulp stimulation, painless tooth percussion, absence of periapical tissue changes, preservation of a sealing quality.

1. Define and name the indications for the biological method of pulpitis treatment in children.

2. Describe methods of conservative pulpitis treatment in one visit and two visits.

3. Recall the hydroxidecalcium-containing medications used at the conservative treatment of pulpitis, what is the mechanism of calcium action at direct and indirect pulp covering?

4. In what cases at the conservative treatment of pulpitis should we use the zinc-eugenol paste. What is its action mechanism?

5. What are the criteria of efficiency of pulpitis treatment with a conservative method?