Essence of the biological method
The biological treatment method (preservation of pulp vitality) implies a conservative approach. The basis of this method consists of therapeutic agents used to stop the inflammatory process and stimulate tissue regeneration.
Two main pulp capping techniques are distinguished:
- Direct capping — the therapeutic agent is applied directly to the exposed pulp tissue.
- Indirect capping — the therapeutic base is applied to a thin layer of preserved, thinned dentin separating the pulp from the carious cavity.
The algorithm of the biological method requires a strict sequence of actions. It includes the careful selection of necessary instruments, the use of appropriate medications and therapeutic pastes. The final stage is the correct placement of base linings and the selection of optimal materials for permanent filling.
Access to the tooth cavity and surgical alternatives
In the classification of pulpitis treatment methods, alongside the conservative (biological) approach, surgical methods are widely represented. Prior to performing them, the stage of opening the tooth cavity is required. This procedure has its own execution techniques depending on the clinical situation: opening can be performed either from an existing carious cavity or through the hard tissues of an intact tooth.
Surgical methods involve pulp removal — extirpation:
- Vital extirpation — a method in which the removal of the neurovascular bundle is performed under anesthesia without prior tissue destruction. The procedure has its own strict step-by-step algorithm.
- Devital extirpation — a method requiring the prior application of devitalizing agents. The number of patient visits (appointments) in this method depends on various factors, including the chosen technique.
Pulp devitalization
If preserving pulp vitality is impossible, devitalizing agents are used. These agents differ in types and their mechanism of action on the neurovascular bundle.
A classic representative is arsenic paste. There is a strict technique for its application, violation of which can lead to a number of serious complications. In the event of such complications or overdose, special agents are used — arsenic antidotes, neutralizing its toxic effect.
Basics of endodontic treatment
After pulp removal (extirpation), the stage of endodontic treatment begins. It is based on the general principles of endodontics and includes successive stages of root canal preparation and filling.
Medication treatment requires the use of certain groups of drugs that must meet a number of strict requirements (properties). To increase the efficiency of root canal negotiation, chemical expansion using chelants and lubricants is used.
Instrumental preparation is performed using endodontic instruments, which are classified and standardized according to the ISO system. The following preparation techniques exist:
- Traditional canal preparation technique.
- The Step-back technique — includes its own specific steps.
- The Crown-down technique — an alternative step-by-step approach.
Root canal filling (obturation)
The final stage of endodontic intervention is obturation. There is a wide range of root canal filling methods. Depending on the clinical situation and the chosen tactics, special instruments intended exclusively for filling are used.
Main techniques distinguished in the classification:
- Filling using a single paste or cement.
- Filling using hardware or manual methods, in particular — using a lentulo spiral and a root canal needle for adequate material distribution.
Briefly: answers to topical questions
What groups of therapeutic agents are used to preserve pulp vitality?
To preserve pulp vitality, therapeutic lining materials are used, which are classified according to their action. The following groups of drugs are distinguished:
- Biological — possess antimicrobial and anti-inflammatory properties.
- Odontotropic — promote the formation of reparative dentin.
- Combined — exert an odontotropic effect, contain calcium hydroxide preparations in an aqueous or polymer vehicle.
Combined bases containing broad-spectrum antibacterial agents, anesthetics, and proteolytic enzymes are also used. The use of strong antiseptics (70% and 96% alcohol, 3% hydrogen peroxide) is strictly unacceptable.
What drugs are used as antidotes for arsenic paste overdose?
Sodium thiosulfate is used as an antidote in case of overdose or poisoning with arsenic preparations. This drug enters into a chemical reaction with heavy metals (which include arsenic, as well as mercury and lead) and forms non-toxic sulfites. This process is an example of chemical antagonism, in which interaction between substances occurs with the formation of inactive compounds.
What types of devitalizing agents are used in endodontics besides arsenic paste?
In addition to arsenic paste, arsenic-free (paraformaldehyde) pastes are used in endodontics for pulp devitalization.
- Paraformaldehyde paste — contains paraformaldehyde and an anesthetic (cocaine or benzocaine [Anesthesin]) in a 2:1 ratio in its powder composition.
The basis for mixing such pastes is eugenol or phenol. Their mechanism of action consists in the slow depolymerization of paraformaldehyde at oral cavity temperature with the cleavage of formaldehyde molecules, which causes pulp dehydration and mummification. The paste is mixed only in oil, strictly excluding the presence of water.
What requirements are imposed on medicinal preparations for root canal preparation?
Medicinal preparations for root canal preparation are subject to a number of strict requirements. They must meet the following criteria:
- Possess bactericidal properties.
- Be harmless to periapical tissues.
- Not exhibit a sensitizing effect and not cause the appearance of resistant strains of microorganisms.
- Exert a rapid action and penetrate deeply into dentinal tubules.
- Not lose their effectiveness in the presence of organic substances.
- Where possible, not possess an unpleasant odor and taste.
- Be chemically stable and retain their activity for a long time.
What is the essence of the Step-back technique in root canal widening?
The essence of the Step-back technique consists in the sequential widening of the root canal from the apex to the orifice using instruments of increasing size and a gradual decrease in working length. The direction of work is carried out from the root apex to the tooth crown. The main principle of the method is preparation with periodic return to the instrument of the previous size (recapitulation). The goals of this technique are:
- Removal of infected dentin from the root canal walls.
- Giving the canal the correct tapered shape.
At the first stage of the Step-back phase, the working length is reduced by 2–3 mm compared to the previous one. In subsequent steps, the working length is reduced by 4–5 mm, then by 6–8 mm, and further by 8–10 mm compared to the initial one. Canal irrigation is mandatory.
Class and exam questions
What does the biological method of pulp treatment entail?
This is a method aimed at preserving pulp vitality using special therapeutic agents and direct or indirect capping techniques.
What methods exist for opening the pulp chamber?
Opening of the tooth cavity can be performed either through a formed carious cavity or through the tissues of an intact tooth.
What are chelants and lubricants used for in endodontics?
These agents are used for the chemical widening of the root canal, which significantly increases the efficiency of its instrumental gliding path.
What else to study on this topic
- Mechanism of action of devitalizing agents and arsenical paste
- Step-by-step algorithm for vital extirpation
- Stages of endodontic treatment using the Step-back and Crown-down techniques
- Standardization of endodontic instruments according to the ISO system
- Requirements for agents used in root canal medication
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