First, open drainage
The total principle of root canal treatment is sterile. All work is done in order to minimize the number of bacteria in the root canal. And must be meticulous, any one of the bacteria will be a hidden danger.
Evaluation of a root canal treatment success is not an overnight thing, generally at least time for two years. Bacteria cause inflammation, it is necessary to reproduce to a certain number, only by virtue of the recent efficacy is not scientific.
Some doctors often do Jerry for patients after root canal therapy pleased with oneself, because they mistakenly believe that as long as the patient complained after filling teeth have symptoms or even if successful in short-term effect to prove their success.
So I personally believe that the success of root canal therapy should allow the teeth will not occur until the tooth crack or other disease symptoms leading to tooth loss.
The root canal treatment routine procedure is to open the pulp, painless to pull out the pulp, tooth root canal disinfection, sealing dead space, and repair the functional form of teeth.
Open pulp drainage is the pulpitis and apical periodontitis acute attack when the most effective. At present, there is still a lot of controversy on the open pulp drainage, one is to its indications, as well as the size of the opening of the hole.
I personally think that as long as there is acute symptoms must be open pulp drainage, or you can skip this step, direct removal of pulp, of course, does not include periapical periodontitis, periapical periodontitis generally open to the roots Department of inflammatory substances. As for the size of the mouth of the pulp, I think as long as it can let the pulp chamber is communicated with the outside is enough, about a ball drill size. No need in the drainage time deliberately to increase the pulp to open mouth, that will only increase the suffering of patients.
Medullary pain is an action moment, the expansion of the opening is a continuing pain, many doctors will tell the patient to endure, when he lay himself in the dental chair, he can endure it?
You know we only for the purpose of drainage, like acute medullary cavity is filled with a balloon, just take the needle, the balloon is broken, and then high pressure is released.
Some people can put forward the pulp in the anesthetic condition, but as far as I know in the inflammatory state of the teeth of the drug tolerance is high, there are many patients in a local anesthetic or will feel pain.
Some doctors in order to shorten the time of diagnosis, in the pulp directly to let the patient reluctantly pulls out marrow(I think that method is extremely inhumane, now popular in painless treatment in the environment of pulpectomy who will pull out, but the level of technology is that you can let the patient in a painless condition to pull out of pulp) Or is the sealing deactivator and probe into a hole in the temporary sealing material, which is a very dangerous practice, let the inactivation agent with the oral environment is to let the patient eat poison and what is the difference? Or get a small hole, it is easy to plug, what is the role of drainage?
Summary of acute pulpitis and periapical inflammation to open drainage, the pulp size as long as the guarantee can make the medullary cavity is communicated with the outside can (usually can see the blood). But don't forget to drop the bite.
Second, painless pull out of the pulp
Painless pull the marrow. The current mainstream is the use of inactivators and anesthetic two methods.
For the non-acute inflammation of the teeth I advocate anesthesia pull the marrow, because it can greatly shorten the course of treatment, generally as long as a referral once. Generally, the upper jaw can be infiltrated with anesthesia, because the upper bone of the upper jaw is loose, and the effect is good. The lower jaw can block plus infiltration, the effect is very good.
Some people put anesthesia will pull pull pulp is not complete. In fact, they think wrong. They believe that the inactivator is more thorough because the inactivation of the pulp system can make the loss of activity, remove the drug after the removal of pulp expansion of the patient will not feel pain.
Anesthesia and pull the marrow is the same reason, in anesthesia under the pull the marrow, and then expand the tube, seal disinfectant. I recommend that the tube be extended to 35 or 40. The reason is that it can be more easily washed out of the foreign body, the next root filling more easily filled.
For acute inflammation of the teeth, the general open drainage for three days, and then re-diagnosis of inactivation of the seal or anesthesia to pull pulp expansion.
I used the inactivation agent is formaldehyde and arsenic. A lot of people like to seal melamine, because it is relatively mild. In fact, arsenic is actually a very good deactivants, as long as the dental pulp bottom of good quality, no crack, general closure of arsenic is no problem, but your time is short, can shorten the course of treatment.
In many cases, patients with end-of-life agents will complain of toothache, this time to get a small probe in the temporary seal above a small hole, the reason is very simple, because the temporary closure of the medullary cavity and the formation of high pressure. If you can not solve the problem, because the excessive pressure of the inactivator to the medullary cavity, can only re-seal, pay attention to gentle movements, do not push the deactivation agent.
Some people can put forward the local pulp pulp removed, of course, if the effect of local anesthesia can make patients painless that is the best. I have also been efforts, the effect is not very perfect but some patients make drug or pain, so that patients have a feeling of being cheated on the doctor. But for trauma and deep caries cases of pulp marrow can choose to use anesthetic. In short three kinds of methods to be flexible application, do not have to look for a method to use.
Summary: for dental conditions poor teeth, suggestions don't use arsenic. In non acute teeth with anesthetic effect is very good.
Third, pull the pulp preparation
Pulp loss of vitality or after being paralyzed, you can use the needle to pull the cord. The residual vital cases for root tip, can be used to expand the needle reaming, of course, the patient will feel the pain, or you choose FC, but it increased the frequency of visit.
For the preparation of the root canal, to promote the expansion to the beginning of the tip of the big two to three, because the purpose of the root canal is to expand the root canal wall attached to the bacteria to expand and get down and prepare a conical root canal.
Bacteria are not simply attached to the surface of the root canal wall, they will enter the deep, so it is best to each direction of the face down, and to rub to a certain thickness.
Root canal preparation sometimes encountered a root canal expansion does not go, there are a lot of reasons, there may be calcification, likely is the root of Guan Xiazhai, this time to seal root canal enlargement liquid; there may be a step, see the steps can be used against lower fold H bending down to remove stage in the book, I also not used, so I do not know whether the effect such as the book said; there is reaming change, sometimes because of the expansion needle pulp wall block with root canal and root pulp of different direction of expansion continues, this time can get rid of the pulp wall part to solve the problem, of course, take a piece of more targeted. In addition to the small part of the mobile phone grinding to remove, to avoid side wear.
After the end of the expansion can be sealed disinfection drugs. General can use calcium hydroxide iodoform, for root canal conditions are relatively good, can be FC, because of strong stimulation, has been reported to be carcinogenic, so to avoid the formation of chemical exudation of apical periodontitis.For the exudation of root canal can be selected creosote and camphor phenol, but its disinfection is weak.
Fourth, root canal filling
The purpose of root filling is to close the dead space, and then sure enough, in fact, is the purpose of root canal treatment. It is still emphasized that the root canal filling should be done in the case of sterile and well separated.
Usually the first measurement of the main tip length, after charging is finished with lateral pressure to the tip of the main needle length, this can be more closely enclosed the root canal, should not turn from large to small filling, such as you are filled with the No. 35 gutta, then No. 30 is likely not to pressure the apical position, also perhaps only to the root, and you can use the No. 25 well reach the apical foramen. By this time you will be able to charge 25, and then charge 30, so that you can better seal the root tip hole. After that is the restoration of tooth shape.
So after root filling can not solve all the pulpal and periapical inflammation? Evaluation of a root canal treatment is successful, not only rely on short-term patient response, the general should be a two-year period. There is a part of periapical periodontitis is caused by adhesion in the apical external bacteria, for the periapical periodontitis, root canal treatment effect is not so large that Endodontium treatment success rate is not so high, so we in the operation process should be more strict in demands, as far as possible to reduce the bacteria and periapical root canal.
In the end, it must be closely packed, with antibacterial treatment, and the bacteria in the root tip can be controlled in a certain range.
Fifth, reduce the number of referral
Many patients may complain about a root canal treatment is long, visit more frequently.Actually the doctor want to choose good records, is completely can reduce the number of patient's return. Not blindly adhere to the same program.
Can a root canal filling of individual once I think it is two cases. One is traumatic crown pulp leakage of front teeth, there is another chronic apical fistula periarthritis.
Second root filling had chronic maxillary dental pulp disease. If you do not consider completely painless treatment of mandibular molar can also consider this method. That is the first time in the pulp, pulp removed under local anesthesia, cleaning of root canal, root canal preparation, temporary sealing disinfection cotton twist, visit it after a week. But when the root canal preparation to try not to spread out the contents of the apical sealing, otherwise will appear after the acute periapical periodontitis symptoms, you can only open again.
Third root filling had acute symptoms and medical records of chronic apical periodontitis with fistula. For acute symptoms should be open for three days. So the number of follow-up is one more time. And a lot of chronic periapical periodontitis in root canal preparation is over, if root canal sealing drugs now, maybe it will appear acute symptoms. So for the sake of insurance, after the first treatment can be opened.
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