Treatment options
Biological method of treatment is aimed at reducing the inflammation and renewing of pulp function. Surgical method of treatment envisage total or partly removal of pulp from previously anaesthetized tooth or extraction of pulp after using devitalized substances.
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SURGICAL METHOD |
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VITAL AMPUTATION Indication: pulp hyperemia, acute limited pulpitis, chronic fibrous and hypertrophic pulpitis, acute and chronic forms of pulpitis of temporary teeth in the period of roots resorption and in permanent teeth in the stage of root formation. Pulp amputation is indicated to old-aged patients with sclerosed and obliterated root canals and when roots are severely curved.
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VITAL EXTIRPATION Indication:
traumatic pulpitis (acute trauma with fracture of tooth crown),
acute diffuse pulpitis, acute purulent pulpitis, chronic
hypertrophic pulpitis (pulp polyp), chronic gangrenous pulpitis,
chronic calcified pulpitis (pulp stone). Schematic diagram representing stages of vital extirpation: 1 — before treatment (carious lesion on the proximal surface, tooth previously anaesthetized); 2 — carious cavity preparation; 3 — tooth cavity disclosure; 4 — pulp amputation; 5 — enlargement of root canal orifice; 6 —pulp extirpation; 7 — determination of canal length; 8 — instrumental treatment of root canal; 9 — medicament treatment of root canal; 10 — root canal sealing using canal filler and paste; 11 — final crown restoration. |
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CONSERVATIVE
(BIOLOGICAL) METHOD
Devitalized methods of treatment |
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Devitalized amputation |
Devitalized extirpation |
This method of treatment is of rare use today in modern dentistry. Indication: 1. Treatment of pulpitis in molars with severely curved roots, thus endodontic treatment of root canals is hard. 2. Treatment of pulpitis in old-aged patients (with somatic disorders) when root canals are sclerosed and obliterated. 3. Treatment of pulpitis in patients with allergy to anesthesia. |
Devitalized extirpation is indicated to patients with allergy to anesthetic solutions.
Devitalized extirpation is held in 2 appointments: 1-st appointment - pulp is devitalized using devitalizing agents (arsenic paste, paraformaldehyde paste); 2-d appointment – pulp extirpation is done with a following appropriate instrumentation and medicament treatment of root canal.
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Main symptoms of pulpitis
The characteristic feature of pulpitis it is sharp, spontaneous pain with irradiation that usually increases at night. There are usually attacks of pain, arising spontaneously; sometimes pain is provoked by temperature, chemical or mechanical stimuli, with a duration of pain for a few minutes after stimuli stops its action (for opposite to caries – pain stops immediately after elimination of irritant).
Duration of pain depends on the intensity of irritant, level of pulp tissue inflammation and capacity of organism to manage diseases.
One of the main characteristic features of pain due to pulpitis it is presence of short periods without pain, so called “light periods”. Attacks of pain could be short with long “light periods” or long periods of pain attack with short “light periods” depending from level of pulp inflammation.
Purulent inflammation of pulp is accompanied by long lasting sharp attack of pain without “light periods”. Pain could be weaken by rinsing oral cavity with cold water.
Pain could be localized or irradiate following V cranial nerve (nerve trigeminal) branches.
From affected maxillary tooth pain could irradiate to adjacent teeth, temporal part of head and forehead (following II division of nerve trigeminal).
From affected mandible tooth pain irradiate into occipital part of head and ear.
It is characteristic that spontaneous, stabbing pain is increased at night, during dreaming, when all outer irritants are excluded.
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Irradiation of pain in the course of pulpitis: А - maxillary teeth; Б - mandible teeth. 1 — n. infraorbitals ; 2 — n. maxillaris; 3 — n. mandibularis; 4 — n. occipitalis. Zones of pain irradiation are marked in black color. |
