TREATMENT OF IRREVERSIBLE INFLAMMATORY PULP DISEASE
Biopulpation
I) Introduction
The etiological treatment of pulpitis is impossible to practice due to the irreversibility of the lesion. We then practice a lesion treatment which consists of removing the diseased pulp.
II) Definition:
Pulp removal or pulpectomy is a surgical procedure that consists of removing all the pulp parenchyma, followed by shaping and filling the endodontic cavity to remove the void and allow healing of the periodontal ligament and then cement closure of the apical canal orifice.
It is performed under local or loco-regional anesthesia or after medicinal escharification of the pulp (abandoned method).
Pulpectomy is a cementogenic therapy
III) General indications:
- Failures of dentinogenic interventions
- Acute pulpitis whatever its origin
- Chronic open pulpitis (ulcerative and hyperplastic)
- Resorptions (internal granuloma)
- Some prosthetic requirements
IV) Anatomical limits of pulpectomy:
Because of the morphological complexity of the pulp cavity and the narrow passage between the pulp and the periodontium, pulpectomy can never be total.
The pulpectomy is located at three anatomical levels in relation to the orifices:
- From the apical foramen
- Secondary channels
- Dentin tubules
At the apex: The apical foramen is rarely unique, but often has the shape of a delta. The theoretical limit of the pulpectomy should correspond to the CDJ. The extirpation of the pulp and the canal obturation should be below the apex.
At the level of the secondary canals: it is impossible to extract the pulp contained in all the secondary canals and to fill them.
At the level of the dentinal tubules: The odontoblastic extensions remain walled up in the dentin by the obturating material.
V) Scarring process:
It is a cementogenic process.
At the apex, several possibilities of relationships between the obturator material and the desmodont:
The pulp is in contact with the desmodont: It covers it, it is under the substance that healing occurs; the irritation due to the section of the pulp, to the contact of the pulp and its chemical components, is at the origin of an inflammation – The clot following the extirpation of the pulp also intervenes; after the obturation, the inflammation recedes and the tissue differentiates again with the formation of cementoblasts
A little tissue remains between the pulp and the periodontal ligament: the scar cementum forms beneath it.
The obturator material overflows from the apical foramen: Cementogenesis will not take place around this foreign body as long as it constitutes an irritation for the desmodont and maintains its inflammation
The filling substance has not reached the periodontal ligament and the canal is empty: A dead space is created and infection sets in.
VI) Surgical technique:
2 processes exist:
- Pulp Removal under Anesthesia: BIOPULPECTOMY
- Pulp removal after de-salting: NECROPULPECTOMY
TREATMENT OF IRREVERSIBLE INFLAMMATORY PULP DISEASE
Operating protocol:
- Preoperative X-ray
- Local or loco-regional anesthesia
- Laying the surgical field (dam)
- Trepanation of the pulp chamber and creation of the access cavity
- Pulp extirpation
- Hemostasis
- Catheterization
- Intraoperative X-ray (file in place)
- Root canal preparation and irrigation
- Root canal drying
- Radio cone in place
- Root canal filling
- Post-operative (control) X-ray
- Temporary sealing
VII) Conclusion:
• Like Marmasse, who considered that the living pulp is the best root canal obturation, the practitioner must first of all assess the possibility of preserving the vitality of the pulpo-dentin organ on the basis of the results provided by the clinical and radiological examination. Thus, the clinical symptoms, the extent of the lesion and the age of the patient will make it possible to classify the pulp pathology and determine the choice of treatment.
TREATMENT OF IRREVERSIBLE INFLAMMATORY PULP DISEASE
Wisdom teeth can cause infections if not removed.
Dental crowns restore the function and appearance of damaged teeth.
Swollen gums are often a sign of periodontal disease.
Orthodontic treatments can be performed at any age.
Composite fillings are discreet and durable.
Composite fillings are discreet and durable.
Interdental brushes effectively clean tight spaces.
Visiting the dentist every six months prevents dental problems.