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19<<C@[LL©qUQUM~J©U©MaL>>#4!&)),2©2© / MEDICAL SCIENCES
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Vinogradova A. V.
candidate of medical science, docent of children dentistry's department associate dean of dentistry's faculty Irkutsk state medical university Sergeeva N.D. candidate of medical science assistant professor of children dentistry's department Irkutsk state medical university Suchilina M.I.,
assistant professor of surgical dentistry and maxillofacial surgery department
Irkutsk state medical university DOI: 10.24411/2520-6990-2020-11367 THE PRACTICAL USAGE OF THE REMEDY CONTAINING AN ALDEHYDE GROUP OF FORMALDEHYDE IN VITAL AMPUTATION OF THE TEMPORARY MOLARS
Abstract
The article reveals the experience of using of the drug "Pulpodent" in the treatment of the temporary molars by the method of vital amputation, proves the high efficiency and feasibility of its applying for preserving chewing group of the milk teeth until the physiological replace with minimal risk of useless treatment and development of complications. It recommends the remedy for usage.
Key words: vital amputation, temporary molars, pulp, treatment, effectiveness.
The complicated forms of dental caries are often found in children who are subject to an intensive carious process. Therefore, the problem of the teeth saving in the dentition before a physiological replace is especially relevant. Early loss of the temporary teeth because they are "childish" without concern for a further development of the dentition in a child at the present stage of development of pediatric dentistry is not justified.
During treatment of complicated forms of caries in children, dentist has the following goals: preservation of the temporary molars with pulp and periodontal lesions till a permanent tooth eruption, which ensures normal growth and development of the jaws, prevention of bad habits (for example, the obsessive introduction of the tip of the tongue into the space at the site of the extracted tooth), preservation of the chewing function, aesthetic appearance of the child.
The main requirement in the treatment of pulp inflammation is the removal of affected tissue and processing of the wound to prevent the further spread of inflammation.
Vital amputation is the procedure of removing of the inflamed and infected coronal pulp with maintaining the root pulp in the vital state. It provides a preservation of vital activity of the unchanged root pulp, which is a reliable barrier to penetration of infection into the periapical tissues and prevents development of odontogenic foci of inflammation.
Many clinicians have difficulties in deciding whether vital pulp amputation should be performed in the temporary tooth with a carious cavity in absence of pulpitis pains. It is believed that glass-ionomer cements have the ability to prevent the carious process, releasing fluorine, even if a certain number of affected tissues is left. Experience shows that this incorrect concept leads to an unsuccessful outcome of treatment, because most of these fillings remains insolvent. The same is true for amalgam fillings, which are placed without complete
removal of caries-affected tissues. The reason of it is that in the milk teeth pulp inflammation develops before the symptoms of pulpitis are clinically determined. Fundamental research by Hobson (1970) showed that more than in 50% of the temporary molars, which had destroyed proximal surface of the crown, pulp inflammation was irreversible. Conducted studies of the department of pediatric dentistry at the dental institute Leeds confirmed these data. They proved that pulp inflammation in milk molars develops in the early stages of proximal caries, and by the time proximal carious defect appears clinically, pulp inflammation has been already progressing. Usage of the method of preservation of the coronal pulp is contraindicated due to such an early beginning of inflammation of the coronal pulp of the temporary molars.
Indications for vital pulp amputation:
1. A deep carious cavity with significant destruction (more than one third) of the proximal surface of the tooth crown.
2. The absence of inflammation in the root pulp according to the following signs:
1) anamnesis — the absence of spontaneous or permanent pains. Pain means irreversible pulpitis spreading to the root pulp.
2) bleeding after removal of the coronal pulp stops quickly. Profuse and prolonged bleeding indicates a presence of inflammation in the root pulp.
3. The roots of the temporary tooth were resorbed by no more than one third of the length according to the X-ray snapshots.
4. Absence of fistulous passage.
5. There is no destruction of bone tissue in the area of the root furcation. Bone destruction in this area would indicate the need for endodontic treatment.
6. There are no signs of resorption in the pulp chamber and in the root canals.
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7. Cases, when the extraction of the milk tooth is contraindicated due to certain diseases (for example, hemophilia).
Local contraindications to vital pulp amputation:
1. The tooth that cannot be restored.
2. Bone tissue destruction in the area of the root furcation.
3. Expressed resorption of the roots.
4. The permanent tooth closed to eruption.
Medical contraindications:
1. Heart diseases: heart defect, rheumatism, etc. due to the high risk of developing bacterial endocarditis from any invasive procedure.
2. Children with weakened immunity or suffering from malignant diseases (for example, leukemia), in whom neutropenia persists despite treatment. The risk of serious complications is high.
Currently, the most widely used drug, the effectiveness of which was proven by a large number of researches, is formocresol. It was proposed by Buckley in a ratio 1:5. It was found that formocresol acts through the aldehyde group of formaldehyde, forming bonds with side groups of amino acids — both bacteria and pulp proteins. It also inactivates the oxidative enzymes of the pulp tissue at the site of direct contact and can affect the action of hyaluronidase. An ability to bind proteins and inhibit enzymes provides mummifying and bactericidal properties of the drug. Only the estuar-ial part of the pulp, which directly touches the paste, is mummified.
Fears about the possible toxicity of formocresol were expressed not so long ago. There are data of an experiment about appearance of some symptoms of intoxication after 16 vital amputations of the pulp of the same dog. However, data, confirming the toxic effects of formocresol in humans, absent in the literature. There were attempts to find an alternative to formocre-sol, for example, calcium hydroxide, widely used for the permanent teeth, for pulpotomy of the vital temporary teeth, was evaluated. Efficiency of its usage was about 60% (Schroder U. A., 1978). It is incomparable with the efficiency indicators of formocresol (98% of effectiveness, Rolling et al., 1978). The most common complication of using calcium hydroxide is the ongoing destruction of the pulp tissue below the amputation site. Therefore, using of calcium hydroxide in the treatment of the pulp of the temporary teeth by pulpotomy is not recommended at present.
We tested the drug «Pulpodent» of the firm «VladMiva» for vital amputation of the pulp in the temporary molars, which is the Russian analogue of foreign drugs containing aldehyde group of formaldehyde and is more accessible for Russian consumer. This drug due to its components has antiseptic, mummifying (polyoxymethylene, iodoform, phenol, formaldehyde), anti-inflammatory and antihistamine effects (dexomet-hasone).
23 temporary molars were treated in 18 children aged from 3 to 5 years.
Each of them was treated according to the following methodic:
1. Effective anesthesia;
2. Disclosure and preparation of the carious cavity, determining the location of the exposure of the pulp;
3. Antiseptic treatment of the carious cavity;
4. Disclosure of the tooth cavity;
5. Removal of the coronal pulp by a large excavator or large round burr;
6. Stopping bleeding with any available hemo-static remedy;
7. The imposition on the mouth of the root canals of the paste "Pulpodent" under the bandage;
8. After 2-3 days, in the absence of pains, changes of the transitional fold in the area of the causative tooth, painless percussion, one part of the dressing was removed, and the rest part was left as an insulating pad. A permanent glass-ionomer cement or composite filling was applied above it.
Assessment of treatment results was carried out in 6 and 12 months. Clinical and radiological signs were evaluated. A conclusion about the successful treatment was drawn in a good clinical condition (no complaints, percussion is painless, the gum and the transitional fold in the area of the treated tooth are not changed) and the absence of radiological signs of pathology in the site of the root furcation.
As part of the observation, only one patient had a loss of filling due to significant destruction of the crown in 6 months. Signs of forming of a fistula along the transitional fold in the projections of the treated teeth were determined in two patients. During a survey of parents, it was found out that these children had SARS in medium to severe form. In all other cases, the clinical and radiological signs made it possible to judge that the treatment was successful. Control examination and studying of radiographs in a year in children did not reveal any signs of an unsuccessful outcome.
Thus, the obtained positive results of treatment using the vital amputation method in the temporary molars with applying of the drug «Pulpodent» give us the reason to recommend it for the treatment of pulpitis of the temporary teeth.
References
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