THE INTERPROXIMAL ZONE AND THE INTERDENTAL SEPTUM SYNDROME:
Introduction :
Septal lesions are relatively common; their clinical picture is reminiscent of acute pulp or periapical syndrome.
They affect the interproximal area and are often concomitant with proximal caries.
The lack of cleaning at this level will allow the systematic accumulation of food debris which will be colonized by micro-organisms causing inflammation of the periodontal tissues generally leading to progressive destruction of the different constituents of the inter-proximal zone.
The interproximal contact point plays an important role in protecting the interdental papilla and underlying periodontal tissues.
- reminders of the anatomy of the interproximal zone:
The interproximal zone is the anatomical and functional space located between two contiguous teeth, has the approximate shape of a pyramid of which:
- A base formed by the septal region.
- Two opposing faces represented by the mesial and distal faces of the two teeth in contact.
- Two opposite faces represented by the vestibular and lingual gingival papillae, themselves separated by an interpapillary neck.
- A vertex represented by the contact point.
This point of contact is the essential element in the organization of dental units in the arch; it allows the cohesion and overall participation of the dental units in the masticatory effort and ensures the continuity of this arch.
THE INTERPROXIMAL ZONE AND THE INTERDENTAL SEPTUM SYNDROME
THE INTERPROXIMAL ZONE AND THE INTERDENTAL SEPTUM SYNDROME
- At the level of the cuspid teeth, the contact zone is schematically located:
- At the junction of the occlusal 1/3 and the medial 1/3, in the occluso-cervical direction.
- At the junction of the vestibular 1/3 and the medial 1/3 in the vestibulo-lingual direction.
- The point of contact intervenes in:
- The balance of the teeth.
- Protection of the periodontium.
- Prophylaxis of caries at the proximal level.
- Physiological changes in the interproximal region:
The dentition of an adolescent presents punctiform contacts between each tooth.
In older people the following changes occur:
• Proximal and occlusal wear,
• Abrasion of marginal ridges,
• The contact point becomes a contact surface,
• Dental groove becomes a cleft, and by the collapse of the papilla)
THE INTERPROXIMAL ZONE AND THE INTERDENTAL SEPTUM SYNDROME
- Gum recession,
• Appearance of carious lesions and periodontal pathologies.
- The interproximal space increases in volume and the papilla tends to retract in the absence of inflammation.
- The bolus is still crushed but the flow is more vestibular than lingual because of the contact surface,
- Food stagnation in the interdental space (promoted by concave areas and by the collapse of the papilla).
- etiologies of septal damage:
Several causes of order:
- infectious (proximal dental caries, tartar).
- Iatrogenic (therapeutic).
- Morphological.
THE INTERPROXIMAL ZONE AND THE INTERDENTAL SEPTUM SYNDROME
2.1 Dental caries and the presence of tartar:
The destruction of the dental contact point by caries inevitably results in the compaction and accumulation of food debris, which causes inflammation, deepening of the gingival groove and resorption of the bony septum.
THE INTERPROXIMAL ZONE AND THE INTERDENTAL SEPTUM SYNDROME
THE INTERPROXIMAL ZONE AND THE INTERDENTAL SEPTUM SYNDROME
2.2 Iatrogenic therapies:
Among the most common causes:
• defective modeling of the contact point, marginal ridge and dimples.
• Overflow of the sealing material.
• The absence of polishing and control of the intensity of inter-dental contact.
• Poorly fitting prosthetic covers.
THE INTERPROXIMAL ZONE AND THE INTERDENTAL SEPTUM SYNDROME
- Symptoms:
- Septal syndrome is characterized by:
• At first :
More or less marked discomfort when chewing.
A desire to free up the interdental space after meals.
The pain remains caused by cold and chewing.
- At an advanced stage:
- Pain is provoked and spontaneous, reminiscent of the pain of pulpitis, it can be: continuous or intermittent.
- Localized or irradiated.
- Pulsating.
- If the alveolodental ligament is affected, the pain becomes similar to that of an acute periapical reaction.
- The pain may subside between meals and the patient complains mainly of a strong feeling of compression.
- Diagnosis:
Based mainly on anamnesis, inspection and radiological examination.
• During questioning:
The patient complains mainly of discomfort or, at an advanced stage, of pain, mainly due to compression and cold, or even of violent, continuous, stabbing and pulsating pain.
- The inspection reveals:
- Presence of proximal caries or defective restoration.
- A food blockage in the inter-radicular space is detected with a blunt probe.
- A hypertrophy of the interdental papilla of dark red color, edematous, sometimes purple, bleeding at the slightest touch.
- Its decongestion and hemorrhage calm the pain.
- On contact, the papilla is painful when the probe passes through and when a cold substance or jet of cold air is applied, it bleeds at the slightest contact.
- The tooth is very sensitive to percussion.
- The X-ray:
Shows more or less severe involvement of the septum.
Bone lysis is evident and presents a shape related to the degree of involvement (horizontal, vertical or complex).
THE INTERPROXIMAL ZONE AND THE INTERDENTAL SEPTUM SYNDROME
- Differential diagnosis:
It is posed with:
Symptomatic pulpitis: X-ray will confirm septal involvement.
Acute apical periodontitis: inspection and radiography allow differentiation.
- Therapeutic:
The treatment has a three-fold goal:
- Symptomatic,
- Etiological,
- Prophylactic.
6.1 Symptomatic treatment: this consists of relieving the patient by:
- careful curettage of the interproximal area to remove all debris lodged in the interdental space.
- Touching with 10% chromic acid solution or eugenol.
- Pain-relieving medication and, in advanced stages, anti-inflammatory and antibiotic.
6.2 Etiological treatment:
- Elimination of all causes leading to the retention of food debris.
- Treatment of caries.
- Reconstructions of adequate contact point.
- Morphological corrections of the crest and marginal pits .
- Elimination of overflow of obturating materials.
6.3 Prophylactic treatment:
- Detect proximal caries during periodic visits.
- During therapy, ensure that all coronary elements are correctly restored.
- Use high-performance dies and wooden wedges to avoid overflow.
- Educate the patient on proper and rigorous oral hygiene.
- Complications:
The evolution of the lesion results in:
- Destruction of the septum.
- Complex osteolysis leading to the total destruction of the alveolar bone causing significant mobility of the tooth.
- Subgingival cemental caries.
- Pulpitis in retro.
- Pulp mortifications.
- The formation of intraosseous abscess or Roy’s serpiginous abscess.
- The formation of mucous abscess or paruliia.
THE INTERPROXIMAL ZONE AND THE INTERDENTAL SEPTUM SYNDROME
Untreated cavities can reach the nerve of the tooth.
Porcelain veneers restore a bright smile.
Misaligned teeth can cause headaches.
Preventative dental care avoids costly treatments.
Baby teeth serve as a guide for permanent teeth.
Fluoride mouthwash strengthens tooth enamel.
An annual checkup helps monitor oral health.