The development of caries requires timely treatment and does not tolerate ignoring the problem. The result of inaction and postponing a visit to the dentist on the back burner ultimately leads to inflammation of the tooth pulp. As a result, pain appears, and so severe that the patient is simply forced to turn to a specialist. And if the disease cannot be cured by medication, then in this case, devital amputation can be prescribed. But what is the procedure?
Classification of pulpitis
Before considering the features of the operation in relation to the dental nerve, it is worth getting acquainted with the varieties of the disease.
Depending on the cause, pulpitis can be:
- Infectious. The main cause of almost any inflammatory process lies in the activity of bacteria. Usually, the infection is able to penetrate from the internal cariouscavity through the dentinal tubules.
- Retrograde. In fact, this is a kind of infectious pulpitis. Its difference is that microorganisms enter the tooth through a hole in the root apex.
- Traumatic. Any damage to the tooth of a mechanical nature can lead to this. Moreover, both as a result of a blow (chips, cracks, fractures), and as a result of caries treatment (accidental opening with boron).
- Concrementary. In this case, the cause of the inflammatory process is a solid formation (denticle) in the internal cavity of the tooth. In another way, it is called "tooth pearl". It can be located near the wall or be in the thickness of the pulp. At the heart of denticles is an amorphous dentine-like substance. This explains their name. At the same time, the process of their formation is invisible to humans. A “tooth pearl” can be detected during therapy or during an x-ray.
In addition, there are acute and chronic stages of the disease. In addition, there may be cases of exacerbation of pulpitis. As for the pulpitis code according to ICD 10, according to the classification of the World He alth Organization (WHO) it is K04.
General information about pulp amputation
The inner cavity of the tooth is filled with pulp - in fact, this is an organ that is rather complicated. Its purpose is to provide nutrition to dental tissues and, consequently, their growth. This is a whole cluster, consisting of nerve fibers, blood vessels, receptors. In fact, the pulp is the dental nerve itself, and as long as it is intact, the tooth lives.
In the event of a disease of such an important and necessary organ, it often has to be removed. The procedure for completely cleaning the internal cavity of the crown, including root canals, is called extirpation. However, there is a more gentle operation. Here it is just called amputation (pulpotomy). And in this case, there is a partial removal of the pulp. That is, it is removed only from the cavity of the crown, and remains in the root of the tooth.
Amputation is relevant in case of minor damage to the pulp and severe curvature of the root canals. As a rule, it is carried out for patients of childhood, when the roots of the teeth are not yet fully formed. Until the age of 25 years, the chance of successful treatment with amputation increases significantly.
There are two types of procedure - vital and devital amputation. Each of them has its own characteristics.
Vital amputation
Currently, the vital technique is widely used in many dental clinics. In this case, the treatment is carried out, as a rule, during one visit to the dentist. Patients are treated with a local method of anesthesia - conduction, infiltration, intraosseous anesthesia. In most cases, anesthetics with articaine, mepivacaine, lidocaine are used.
Application type of anesthesia can serve as additional mucosal anesthesia before injection. For this purpose, anesthetics based on lidocaine or prilocaine in liquid or gel form are used. And in case of losssensitivity under the influence of an anesthetic, the dentist remains to remove the nerve of the tooth at the level of the root canals.
Devital procedure
When treating pulpitis by devital amputation, a special paste is placed in the cavity of the nerve chamber, which leads to a complete disruption of its functions, including loss of pain sensitivity. In other words, the dental nerve is killed. Such preparations are usually made on the basis of arsenic, and arsenic itself is a poison. When it hits the nerve tissues, their hypoxia sets in and the pulp fibers disintegrate.
At the same time, as a result of prolonged exposure to arsenic paste, necrosis of nearby tissues develops and an inflammatory periodontal process occurs. For this reason, this technique has not found wide application in relation to permanent dentition due to its low efficiency.
As noted above, the devital procedure is performed only when the roots of the tooth are at the stage of formation. And at the end of their growth, the pulp is removed from the root canal. In addition, the technique is applicable to elderly patients.
Arsenic-based preparation ingredients
Depending on the manufacturer, the composition of arsenic paste for pulp devitalization may vary slightly. However, the components remain the same. The difference lies in their concentration. Paste Bulk:
- Arsenic trioxide or anhydride - the preparation contains about a third of the total volume.
- Local anesthetic - with hishelp relieve the pain of the inflamed pulp. For this purpose, novocaine, lidocaine hydrochloride or dicaine is usually used. The anesthetic itself in the paste - 27-30%.
- Antiseptic. Its presence is due to the need to disinfect dead tissues and destroy pathogenic microflora. Often thymol, carbolic acid or camphor is used for this purpose. No more than 5% is added to its paste.
- Tanin. It is an astringent component that helps to slow down the spread of arsenic in the pulp. Due to this, the duration of the effect of the paste can be increased. It contains no more than 1%.
- Special filler. Thanks to him, it is possible to form dosed portions in the form of small balls.
In cases where an arsenic-based preparation cannot be used to remove the pulp (for various reasons), it is replaced by an analogue.
As a vivid example of this - paraformaldehyde composition.
Indications for devital pulp amputation
The list of medical indications for devital surgery includes the following cases:
- acute and partially serous form;
- acute common serous stage;
- fibrous chronic variety;
- hypertrophically chronic form of the disease;
- exacerbation of the chronic stage of pulpitis, but so far in the absence of acute periodontitis;
- abnormal location of the element in the dentition;
- too large internal pulp chamber;
- the presence of a large chip, whichexposes the dental nerve.
In addition, a similar procedure is resorted to in case of tooth decay or severe damage.
Contraindications to the procedure
As with any other medical procedure (dentistry is no exception), there are certain contraindications to the devital amputation method. First of all, it should never be performed on patients with hypersensitivity to devitalizing agents.
In addition, the procedure is prohibited in the course of purulent pulpitis. In addition, if the root of the tooth is not yet formed, this is also a direct contraindication.
Performing a devital procedure
Each of us knows perfectly well that dental treatment must be carried out in a timely manner in order to avoid complications. It can even lead to tooth loss. But only dairy ones are renewed, then permanent ones grow. And if one of them is lost, then the new one will not appear.
The process of pulp amputation is often associated with the beginning of the process of tooth loss. After all, after its implementation, it loses its viability. And all because in the absence of connective tissue, nutrition is not delivered to the bone tissues. And if there is no nerve, then it is impossible to send a pain signal in case of damage to the tooth. Because of this, many dentists try to preserve the pulp.
If such an operation is prescribed, it is performed within three visits by the patient to a specialist (at least). The stages of devital amputation themselves are as follows:
- Opening the tooth, applying a devitalizing compound and an airtight bandage.
- Bandage removed.
- The pulp chamber is being prepared.
- The visible part of the pulp is removed.
- The root canal is medicated and dried.
- The root canal is being obturated.
- Filling in place.
This technique may be suitable for those patients who are prone to allergic reactions to anesthetics used in dentistry. Now it is worth revealing the above steps in more detail.
First appointment
On the first visit, the dentist conducts an external examination of the tooth and, if necessary, cleans it from deposits. And since devital amputation is quite painful, application anesthesia is used. After anesthesia, the doctor performs the preparation of the carious cavity. The affected dentin is removed, the cavity itself is treated with an antiseptic and dried with a cotton swab.
Then the pulp horn is opened and a special paste is placed on the nerve. Then the cavity is closed with artificial dentin. It should be noted that during exposure to the placed paste, pulp irritation occurs, and therefore the pain syndrome may increase. For this reason, the doctor recommends in such cases to take some pain medication - Ibuprofen, Ketanov, Analgin, Paracetamol.
In the case of using arsenic paste, the time of the next visit depends on the specifics of the treatment:
- single-rooted teeth – viaday;
- multi-root system (2 or more) - after 2 days.
If during the treatment of acute pulpitis a paraformaldehyde composition was used, then the next dose is postponed for a slightly longer period - about a week or two (6-14 days).
Second appointment
The second visit is strictly obligatory and here it is very important to come at the appointed time without delay. Otherwise, the risk of developing serious complications increases. Mostly, everything is connected with the use of arsenic-based paste. After all, it is poison. But as we found out, the composition also contains other components, among which one will restrain its spread along the nerve.
When the patient arrives, the doctor removes the temporary filling, after which he dissects the carious cavity again. An excavator or a dental bur itself removes part of the pulp from the crown cavity, after which it is treated with an antiseptic ("Chlorhexidine").
At the final second stage of the treatment of inflammation of the root of the tooth, the inside of the crown is dried. Then a healing paste is placed in the cavity, and it is once again closed with a temporary filling.
Third visit
The third time the patient is scheduled to receive after a certain period of time (from 3 to 5 days). The temporary filling is removed by the doctor. After that, it is necessary to cover the pulp stump with a thick resorcinol-formalin paste (or "Forfenan"). The bottom of the tooth cavity is closed with an insulating gasket. At the end, a permanent filling is already placed and withbite is corrected if necessary.
The procedure for amputation of the dental nerve is quite laborious for doctors. And in relation to patients, it can be very painful and lengthy. It is for this reason that it is necessary to treat dental diseases in a timely manner, without triggering a lesion.
Night dentistry
Everyone has experienced toothache, and the one who for some reason has passed such a situation can be considered lucky. After all, about the pain that occurs in case of damage to the teeth, he can only guess from the rumors of others. However, they can probably be counted on the fingers.
Moreover, the pain syndrome can catch at the most inopportune moment. In such cases, many act wisely by heading to the nearest dental clinic. Even if the tooth began to hurt during the day at work, you can always get permission from the authorities to leave. But what to do in the case when a strong and aching discomfort caught a person at night?
Today, this is no longer a problem, since almost every city (in large metropolitan areas, for sure) has round-the-clock dental clinics. At the same time, night dentistry, unlike daytime visits to the clinic, has its own advantages. And above all, there is no big and nervous queue. And if you have your own car, you can get there without traffic jams, although driving it in this state is quite difficult, and dangerous. Therefore, the best option is a taxi.
Development of complications
Sometimes after the eventoperations may begin certain complications. In particular, the following cases are observed:
- Periodontal irritation is a response to nerve separation, accompanied by painful sensations. It usually resolves after taking pain medication.
- Burn of the mucosa. May appear when a devital amputation is performed incorrectly. In this case, the affected area should be treated with an antiseptic, as well as anti-inflammatory therapy.
- Perforation of the dental root system. This complication is associated with a violation of the technique of dental intervention. The result of this is the perforation of the root wall. This ends with the development of the inflammatory process, up to the appearance of osteomyelitis.
- Development of traumatic periodontitis. The reason may be the ingress of filling material beyond the root canal area.
At the same time, complications may also appear due to non-compliance by patients with the doctor's recommendations after the procedure. For example, if at the end of the first stage of treatment (when a special paste is applied) you do not come to the second stage of treatment of inflammation of the root of the tooth on time, then this threatens with the development of periodontitis.
In other words, in any case, it is worthwhile to seek qualified help from a doctor in a timely manner. And even more so, in no case should you endure a toothache, hoping not for traditional medicine. Yes, they can bring relief, but this is a temporary measure so that you can walk to the nearestdental clinic.
