Indications for the vital amputation in the permanent teeth:

Date: 2015-10-07; view: 768.

Study material

Topicality.

Treatment of pulpitis of the permanent teeth in children. Vital methods. Indications, methods of implementation, choice of the filling materials for the root fillings.

The biological and vital (amputation) methods of treatment of pulpitis in the permanent teeth with immature root are the most preferred in modern dentistry. These methods provide for preservation of functional activity of the root pulp and provision of all the required conditions for growth and formation of roots of permanent teeth, which further will provide for functional activity of the tooth.

Aims:To master the methodsof vital amputation and vital extirpation at treatment of pulpitis of the permanent teeth in children.

Vital amputation– is a method which provides for removal of the crown part of the pulp under the local (general) anesthesia and preservation of vitality and functional activity of the root pulp.

In teeth with immature roots these are: acute serous diffuse pulpitis (without expressed reaction from the periodontium); acute traumatic pulpitis (if the trauma occurred longer than 6 hours ago or the pulp is considerably denuded); as a method of previous treatment- at a chronic fibrous pulpitis; chronic hypertrophic pulpitis, in cases, when the biological methods of pulpitis treatment have proven to be ineffective or just contraindicated.

Methods of treatment.

Vital amputation is performed for one visit..

Stages of treatment: The first stage is local anesthesia. Infiltration anesthesia is often used for children, especially for the children under 10 years. The medications used are anesthetics on the basis of urticaine - Ultracain DS (1:200000) (Hochst); Septanest (1:200000) ( Septodont); 4% Ubistesin (ЕSРЕ).The second stage is – preparation of the carious cavity considering the topography of the tooth cavity. The third stage – opening the tooth cavity and extraction of the crown pulp. The procedure is performed using the sterile spherical burs, amputation of the crown pulp is performed with a pointed excavator. The carious cavity is permanently processed with warm solutions of non-irritating antiseptic substances ( furacillin, extericid and others). According to the level of pulp amputation there exist the crown, orifice and root amputation ( subtotal extirpation). The fourth stage – is arresting the bleeding from the pulp stump. We may apply aminocapron acid, capropher, hemophbin, Racestypine (Septodont), Vasosерtin, Viscostat (Ultradent). The fifth stage – on the surface of the root pulp we apply soft calcium-containing paste: Calcicur (VОСО), Саlcipulре (Septodont), Саlasept RО (Nordiska), Саlхуl rot (ОСО). It is covered with hardening calcium-containing layering: Саlcimol, Саlcimol LС (VОСО), Dусаl (DеntSрlау), Lifе , Lifе fast (Кеrr). After the calcium- containing layering we put isolating layering from the GIC. The 6^th stage is – is sealing of the carious cavity with a permanent filling. The post-discharge supervision: in 10-14 days, then –in 3, 6 months and in a year. The criteria of treatment efficiency are: formation of the dentine bridge on the border of the pulp amputation, which is detected roentgenologically, completion of maturation of the root and absence of pathological changes in the periodontium.

Vital extirpation– is a method of treatment of pulpitis which stipulates for absolute extraction of the pulp under anesthesia and sealing of the root canals.

Indications for the vital extirpation in the permanent teeth:

In teeth with completely mature root these are: all forms of acute and chronic pulpitis, if the conservative methods have proven to be ineffective.

In the permanent teeth with immature root these are: acute purulent pulpitis, pulpitis with expressed signs of perifocal or focal periodontitis, chronic gangrenous pulpitis.

Before the initiation of the vital extirpation in the permanent tooth with immature root it is necessary to perform roentgeography to determine the degree of root maturation- the working length of the tooth.

Methods of treatment: method of vital extirpation is performed for one visit.

Stages of treatment: The 1^st stage – is local anesthesia.It is performed with the above-recalled anesthetics of urticaine group. We may perform infiltrative or intraligamentary anesthesia, rarely- mandibular anesthesia. After opening the tooth cavity we may additionally perform the intrapulpal anesthesia, the second stage is preparation of the carious cavity and opening the tooth cavity. It is performed taking into account the topography of the tooth cavity. The third stage is extraction (extirpation) of the pulp. The 4^th stage – is arresting bleeding from the root canal. The root canal is sealed just after arresting bleeding. If it is impossible to arrest bleeding, turunda with blood-stopping medication or a suspension of Са(ОН)2 is left in the canal. Sealing of the root canal will be performed during the next visit. The 5^th stage – is sealing of the root canals. The choice of polymerizing material is determined by the degree of root maturation. In permanent teeth with mature root the preferred equipment is gutta-percha pins with hardening sealers : Sеаl Арех (Кеrr), Тubli SеаL (Кеrr), Арехit (Vivadent), АН Рlus (DentSplay). The canal sealing is performed predominantly by the methods of lateral condensation of gutta-percha. The quality of the root canal sealing must be roentgenologically controlled.

In the permanent teeth with immature root sealing of the root canal after the pulp vital extirpation is performed in two stages. The first stage is temporary sealing of the root canal within the formed with the pastes part ( the pastes may contain calcium hydroxide: Саlcicur (VОСО), Саlхуl blau (ОСО), suspension “Саlаsерt”(Sреikо). The subsequent formation of the apical third of the root is possible under the action of hydroxide-calcium-containing paste after the vital extirpation, as well as closure of the apical orifice and formation of the periodontium( apexogenesis), which evidences about the treatment effectiveness. The application of hydroxide-calcium-containing paste for sealing the root canal requires post-discharge supervision for 12-18 months.

The second stage is continuous sealing of the root canal; it is performed after closure of the apical orifice. We may use gutta-percha pins with sealers, hardening pastes for the root canals.