6. Treatment of Acute and Chronic Periodontitis

7/30/2019 6. Treatment of Acute and Chronic Periodontitis

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Treatment of acute and chronicperiodontitis. Basic principles andmedication

Therapeutic dentistrydepartmentSukhovolets I.O.


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Periodontitis

Can be acute and chronic.

Acute forms:

1. Serous

2. Purulent

Chronic forms:

1. Fibrous2. Granulating

3. Granulematouz


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How to choose the treatment tactics?

It depends on:

- General condition of the patient- Etiology and pathogenesis of pathological

process

- Type of periodontitis (acute or chronic)


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Acute periodontitis treatment.


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The main aim is:

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


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Acute periodontitis treatment.

We have to:

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


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Treatment steps:

First visit:

1. Anaesthetization (if patient need it)

2. Mouse washing with antiseptics solution

3. Opening the carious cavity and tooth cavity (pulpchamber)

4. Orifice opening and widening

5. Length determination

6. Removing purulent exudation from the root canals

7. Medicamental cleaning of the root canal


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First visit: recommendations

Mouse washing with antiseptic solutions 4-

6 times for a day Anti inflammation drugs

Antibacterial therapy (in some cases)

Analgetics (in some cases)


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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 ofantiseptics

6. Root canal widening with endodontic instruments

7. Root canal filling

8. X-ray after root canal filling


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Third visit

Removing of the temporary filling

Permanent filling


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Access cavity preparation

1. Preoperative carious exposure

2. Dome-ended fissure bur is used to penetrate pulp chamber

3.

Roof of pulp chamber removed with round bur4. Non end-cutting bur is used to 'lift lid' of pulp chamber and refine cavity


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The depth of the pulp chamber can beestimated from a preoperative radiograph.


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Search the access to pulp chamber

and root canals: incisors and canines


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Premolars:


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Upper molars:


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First upper premolar can have two connected

canals with one or two apices or just twodifferent canals

In 42% medial buccal root of first upper

molar has two canals and two apices

Lower incisors can have two canals


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Lower molars


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The completed access cavity gives

straight-line access to all the canals.


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Root apex.The average distance between the apical foramen and themost apical part of the root is 0.2-2.0 mm. The constriction

can be 0.5-1.0 mm from the apical foramen.


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Endodontic instruments:

There are two groups of instruments for root

canal cleaning:1. For coronal preparation

2. For apical preparation

- Hand instruments

- Rotary instruments


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Ins truments for Coronal Flar ing

The following rotary instruments are used to prepare

the coronal part of the root canal before the main

part is prepared by hand instruments.

Orifice openers are usually relatively thick in diameter

and are consequently not very flexible. They are

designed for coronal flaring, and should only be used

in the 'straight' part of a root canal.The most common: Gates-Glidden Burs, Nickel-

Titanium Orifice Openers


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Left: Gates- Glidden burs

Right: The Profile orifice openers


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Hand instrument for apical preparation

K-files

K-Flex files Flexofiles

Hedstroemfiles

Protapers


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Colors and Sizes of Endodontic Files


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Endodontic instruments


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Rotary endodontic instruments

Rotary endodontic instruments manufactured fromnickel-titanium are 3-4 times more flexible than

equivalent flexible stainless steel instruments. The instruments have a greater taper than standard

instruments (0.02 mm per mm), while retainingflexibility.

They are designed for use in a continuous rotaryaction at a slow speed (150-350 rpm).

There are now many different systems available,but the basic principles for their use are similar.


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The most common rotary systems:

Tapered rotary files are available in tapers of 0.04,0.06, 0.08, 0.10 and 0.12. Instruments are used in a

crown-down manner Profiles and protapers (Dentsply),

Quantec (Analytic Endodontics, Glendora, CA,USA),

Hero (Micro-mega, Geneva, Switzerland),

K3 (Kerr, Bretton, Peterborough, UK) and GreaterTaper files, which are essentially used to flare rapidlya pre-prepared pilot channel in the apical part of theroot canal.


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A range of Profile 0.06 taper

instruments


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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 (acousticmicrostreaming) has been shown to be

effective at removing debris from canals.


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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


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Antiseptic solutions for root canal

treatment:

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%


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Left: ready to use iodine solution

Right: EDTA solution


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Monoject syringe, which has a safe-

ended tip


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Hand irrigation in a mandibular molar.


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1. Bevelled needle: irrigant forced apically; there is a risk ofextrusion if the needle becomes lodged in the canal2. Monoject tip: irrigant can pass sideways

3. Safe-ended tip: irrigant passes sideways


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Root canal cleaning can be finished

when:

Root canal is free from infected dentine

The form of root canal is conical from theopening to the apex

Root canal is clean

Root canal is sterile

Root canal is dry


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Only after all thatwe can fill the root

canal


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Obturation has three aims:

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.


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Requirements before root canal filling

- The tooth must be assymptomatic, chemomechanicalpreparation complete and the root canal dry before a root fillingis inserted.

- Any serous exudate from the periapical tissues indicates thepresence of inflammation.

- If there is persistent seepage, calcium hydroxide may be usedas 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 fromoverinstrumentation and damage to the periapical tissues.


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Filling materials for the root canal:

Fillers

- Metallic (silver, titanium)

- Non metalic (gutta-percha

points, plastic points)


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Ideally, a root canal filling material

should:

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.


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Gutta percha points


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Filling materials for the root canal:

Sealers:

- With calcium hydroxide (Sealapex (Kerr))- With zinc and eugenol (Grossmans, Tubliseal

(Kerr))

- With synthetic resin (AH Plus (Dentsply))

- With glass-ionomer cement (Ketac Endo

(ESPE, Germany))


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Zinc oxide eugenol sealer

Kerr's Pulp Canal

Sealer is a zinc oxide

and eugenol-basedsealer with extra

working time. It should

be mixed carefully to a

relatively thickconsistency.


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Resin sealer

The sealer AH Plus.

Equal quantities from

each tube are mixed ona paper pad before use.


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Ideally, a sealer should:

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


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Root canal treatment:

Few words about modern concepts of root canal

treatment:

1. Silver points are not recommended (especially forfrontal teeth) as they do not seal the canal laterally

or coronally and may cause tooth or gingival

staining.

2. Medicated pastes include N2, Endomethosone,Spad, Kri and are not recommended as they may

contain paraformaldehyde, which is cytotoxic.


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OBTURATION TECHNIQUES

Cold lateral condensation

Warm lateral condensation Warm vertical condensation

Thermocompaction (ultrasonic and mech-

anical)

Injection of thermoplasticized gutta percha


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Treatment of chronic

periodontitis

Ch i i d titi id d i d t l


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Chronic periodontitis widened periodontalligament on the lateral incisor


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Chronic periodontitis granulationsnear lover right incisor

C


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Chronic periodontitis granulomaon the premolar tooth


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Treatment of chronic periodontitis:

First visit

1. X-ray for root canals visualization

2. Carious cavity preparation3. Pulp cavity opening

4. Orifice opening and widening

5. Removing the infected tissues from the root canals

6. Medicamental cleaning of the root canal

7. Root canal widening8. Root canal filling

9. Temporary filling

10. X-ray after treatment is must have


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Treatment of chronic periodontitis:

Second visit:

1. Removing of temporary filling2. Permanent filling


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Endodontic surgery

may be needed when:

Canals are not accessible

A previous treatment didnt heal A proper diagnosis cannot be made

nonsurgically


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The most commonendodontic surgical procedure iscalled root-end resection.


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Root end resection

Root-end resection

involves opening the

gum tissue near thetooth, removing the

inflamed

or infected tissue


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Root end resection

and the

possible

placement

of

a filling in

the rootend.


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Root end resection

A few

stitches are

placed in

the gum

to help the

tissue heal.


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Root end resection

Over a

period of

months, thebone heals

around the

end of the

root.


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Treatment of chronic periodontitis

Root amputation

This surgery is performed to remove one or more

roots of a multirooted tooth without removing the

crown.

Hemisection

The root and the crown are sectioned lengthwiseand removed.


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Advance protaper technology in

modern root canal treatment


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Periodontitis treatment with using

profiles

M d t l t t t ith i


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Modern root canal treatment with usingprotaper technology


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Thank you for your attention!

6. Treatment of Acute and Chronic Periodontitis

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