Treatment of Acute and Chronic Periodontitis
Treatment of Acute and Chronic Periodontitis
Treatment of Acute and Chronic Periodontitis
Periodontitis
Can be acute and chronic. Acute forms: 1. Serous 2. Purulent Chronic forms: 1. Fibrous 2. Granulating 3. Granulematouz
To keep anatomical and functional completeness of tooth we are going to treat To remove the inflammation and infected tissues with accurate instrumental, medicamental root canal treatment
Remove the pain Make conditions for exudation leakage!!! Antibacterial and anti inflammation treatment Stop the inflammation expansion in surrounding tissues Renew the anatomical form and function of the tooth
Treatment steps:
First visit: 1. Anaesthetization (if patient need it) 2. Mouse washing with antiseptics solution 3. Opening the carious cavity and tooth cavity (pulp chamber) 4. Orifice opening and widening 5. Length determination 6. Removing purulent exudation from the root canals 7. Medicamental cleaning of the root canal
Mouse washing with antiseptic solutions 46 times for a day Anti inflammation drugs Antibacterial therapy (in some cases) Analgetics (in some cases)
Second visit:
1. X-ray for root canals visualization 2. Antiseptic oral washing 3. Removing of the temporary filling 4. Careful carious cavity preparation 5. Root canal cleaning (irritation) with solutions of antiseptics 6. Root canal widening with endodontic instruments 7. Root canal filling 8. X-ray after root canal filling
Third visit
Preoperative carious exposure Dome-ended fissure bur is used to penetrate pulp chamber Roof of pulp chamber removed with round bur Non end-cutting bur is used to 'lift lid' of pulp chamber and refine cavity
The depth of the pulp chamber can be estimated from a preoperative radiograph.
Search the access to pulp chamber and root canals: incisors and canines
Premolars:
Upper molars:
First upper premolar can have two connected canals with one or two apices or just two different canals In 42% medial buccal root of first upper molar has two canals and two apices Lower incisors can have two canals
Lower molars
The completed access cavity gives straight-line access to all the canals.
Root apex.
The average distance between the apical foramen and the most apical part of the root is 0.2-2.0 mm. The constriction can be 0.5-1.0 mm from the apical foramen.
Endodontic instruments:
There are two groups of instruments for root canal cleaning: 1. For coronal preparation 2. For apical preparation Hand instruments Rotary instruments
Endodontic instruments
Irrigation
Irrigating solutions are usually delivered using a syringe with a 27 or 28 gauge needle. Care should be taken to ensure that the needle does not bind in the canal and that irrigating solution does not pass into periapical tissues. The role of the irrigant is to remove debris and provide lubrication for instruments. Specifically, an irrigant such as sodium hypochlorite will dissolve organic remnants and, most importantly, also has an antibacterial action.
Irrigation
Ideally irrigation should be performed between each file, at least every two to three files being the minimum. A most effective way of delivering irrigating solutions is through an ultrasonic handpiece. Ultrasonic agitation (acoustic microstreaming) has been shown to be effective at removing debris from canals.
Irrigants should:
Be antimicrobial Have a low surface tension Not be mutagenic, carcinogenic or overtly cytotoxic Possess tissue-dissolving properties Remain active following storage Be inexpensive
Sodium hypochlorite solution 3% or 5-8% Hydrogen peroxide 3-6% Parachlorophenol, or PCP Chlorhexidinum bigluconate 1-2% Furatsilini (Nitrofural) 0,5% Iodine solution EDTA 17% + hydrogen peroxide (1:1) Citric acid 40%
1.
Bevelled needle: irrigant forced apically; there is a risk of extrusion if the needle becomes lodged in the canal 2. Monoject tip: irrigant can pass sideways 3. Safe-ended tip: irrigant passes sideways
Root canal is free from infected dentine The form of root canal is conical from the opening to the apex Root canal is clean Root canal is sterile Root canal is dry
to prevent reinfection of the cleaned canal system from the coronal end to prevent percolation of periradicular exudate into the root canal space to seal remaining bacteria within the root canal system.
The tooth must be assymptomatic, chemomechanical preparation complete and the root canal dry before a root filling is inserted. Any serous exudate from the periapical tissues indicates the presence of inflammation. If there is persistent seepage, calcium hydroxide may be used as a root canal dressing until the next visit. It is advisable to recheck the canal length in situations of persistent seepage as this may frequently result from overinstrumentation and damage to the periapical tissues.
be easily introduced into the root canal not irritate periradicular tissues not shrink after insertion seal the root canal laterally and apically be impervious to moisture be sterile or easily sterilised before insertion be bacteriostatic or at least not encourage bacterial growth be radio-opaque not stain tooth structure or gingival tissues be easily removed from the canal as necessary.
Kerr's Pulp Canal Sealer is a zinc oxide and eugenol-based sealer with extra working time. It should be mixed carefully to a relatively thick consistency.
Resin sealer
The sealer AH Plus. Equal quantities from each tube are mixed on a paper pad before use.
satisfy the above requirements of a root filling material provide good adhesion to the canal wall have fine powder particles to allow easy mixing or be a two paste system set slowly
OBTURATION TECHNIQUES
Cold lateral condensation Warm lateral condensation Warm vertical condensation Thermocompaction (ultrasonic and mechanical) Injection of thermoplasticized gutta percha
Canals are not accessible A previous treatment didnt heal A proper diagnosis cannot be made nonsurgically
Root-end resection involves opening the gum tissue near the tooth, removing the inflamed or infected tissue
A few stitches are placed in the gum to help the tissue heal.
Over a period of months, the bone heals around the end of the root.
Root amputation
This surgery is performed to remove one or more roots of a multirooted tooth without removing the crown. The root and the crown are sectioned lengthwise and removed.
Hemisection