Treatment of pulp gangrene
I. Introduction:
The treatment of pulp gangrene is strictly root canal treatment.
It consists of the definitive mechanical and chemical removal of the infectious and necrotic focus, followed by its obturation. This treatment includes 3 stages:
• root canal trimming.
• Root canal disinfection.
• Root canal filling.
II. Root canal trimming :
A. Definition:
Surgically, using various instruments, all necrotic and infected soft tissues are removed until the dentinal surface of the canal wall is completely exposed, which must become hard and clean. This trimming is also associated with a gesture of penetration of the instruments into the entire length of the canal to reach its end, after having widened it if necessary.
B. Principles:
Consist of:
• Removal of gangrenous tissue (necrotic and infected) and disinfecting the entire pulp cavity to sterilize it.
• Make it impossible for germs that might persist to live and develop.
• Make the further development of any new microbial flora in this cavity impossible.
C. Objectives :
• the removal of all soft and necrotic tissues, i.e.:
• The gangrenous pulp or what remains of it.
• The predentine where the highest concentration of germs is found in order to obtain hard dentin surfaces, this will therefore release the light:
• Dentin tubules.
• Secondary channels.
• Canals of the apical region.
• Disinfection of dentinal canals and tubules with special products and destruction of the microbial flora that develops there.
• the elimination and destruction of toxins, microbial enzymes and degradation
D. Instrumentation:
Manual : The H file and the K type file (KERR)
Rotary: Nickel titanium instruments
Ultrasound : The role of ultrasonic instruments in root canal debridement is to enhance root canal irrigation solutions.
The ultrasound preparation seems to have given an exceptional result, it eliminates the dentinal smear completely by combining good irrigation
III. Root canal disinfection:
A. Definition:
It is the action of bringing a liquid through an instrument inside the pulp chamber and the root canals.
This is an important phase of the treatment that must begin even before the introduction of the first instrument into the endodontium, in order to avoid pushing as many microorganisms as possible into the canal space.
B. Objectives:
*Make the development of pathogenic endocanal flora impossible
*Removal of the endodontic smear layer which strongly adheres to the canal walls, it is necessary to use solutions acting on organic and inorganic debris
*Accomplish the role of canal trimming by evacuating debris outside the canal.
C. Different types of disinfection :
It is obvious that the root canal irrigation will start with the access cavity and will not stop until the end of the root canal preparation; this is the necessary principle of any endodontic treatment.
C-1 Immediate disinfection: irrigation
C-2 Intermediate disinfection:
• Temporary medication is essential to complete the most complete disinfection possible of the canal network and this for several reasons:
• -The existence of a canal network inaccessible to mechanical and chemical preparation
• -The duration of endodontic treatments, often too short for the antimicrobial action of sodium hypochlorite to be maximal
• -The presence of bacteria and especially toxins in the dentinal tubules.
- Calcium hydroxide:
. 1. Presentation:
Chemically it is slaked lime presented commercially in several forms and with various additives.
-It was first used in endodontics in 1920 by a German named Hermann. It is not an antiseptic per se, but it is certainly very effective in preventing the growth of anaerobic bacteria found in the root canal system.
-It comes in the form of a fine white powder whose solubility is increased by glycerin and sugars, mainly sucrose. It is a base with a pH of 12.4.
Local antibiotics:
These are locally acting ATBs: polymyxin, neomycin, bacitracin.
They come in the form of:
• A simple formula paste (an ATB).
• Either in the form of a polyantibiotic paste.
• Either in the form of a paste combined with a corticosteroid.
• But the most successful ATB paste is the Metronidazole based paste.
Metronidazole, which has a high activity on anaerobes encountered in pulp gangrene, is non-cytotoxic and non-allergenic.
Corticosteroids:
These drugs are intended to accelerate the resorption of the acute post-endodontic periapical inflammatory reaction. These preparations combine antiseptics or antibiotics in order to optimize root canal disinfection.
The use of corticosteroids (dexamethasone), after canal preparation, significantly reduces pain within 24 hours.
IV. Root canal filling:
• Maintain the disinfection of the canal permanently and also make the development of any new flora impossible.
• It must be very dense, homogeneous and correct (without excess or missing).
V. Conclusion:
Endodontic treatment involves many concepts, whether physiological, bacteriological , chemical or mechanical. Although irrigation is one of the key elements of therapeutic success in endodontics, it would be utopian to want to isolate it from the other stages, namely canal preparation and three-dimensional obturation of the endodontic network . Canal preparation allows for optimal action of irrigants, while three-dimensional obturation perpetuates it.
Treatment of pulp gangrene
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.