RU2722567C1 - Method for evaluating electroexcitability of root pulp of permanent multichannel teeth after pulpotomy - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, particularly to dentistry, and can be used to control viability of pulp in the root canals of pulp-amputated teeth, to track the dynamics of the pathological process, to assess the effectiveness of the treatment. Method for assessing the electrical excitability of the root pulp of permanent multichannel teeth following pulpotomy involves determining the electrical resistance of the root pulp by an odontometer. Cavity of access is pre-filled with filling material by placing a steel pin into a projection of a root canal mouth. Active electrode of the odontometer is brought directly to the pin; in the multichannel tooth, one steel pin is placed opposite the mouth of each root canal isolated from each other by coating the vertical surface, excluding the end face of each of the pins with a layer of medical cyan-acrylic adhesive for additional electroinsulation of the pins from each other. If values are 3–16 mcA, the pulp of the multichannel tooth is considered to be healthy, indices 20–100 mcA correspond to pulpitis, and 100–200 mcA - periodontitis and devital pulp.EFFECT: technical result of the proposed invention is the possibility of taking accurate EDI readings from each root canal in multichannel pulp-amputated teeth for the whole period of treatment up to the final fixation of the permanent artificial crown, or, in the absence of planning further prosthetic repair - determining a rational plan for tooth treatment depending on the pulp vitality in each separate root canal.1 cl, 4 dwg

Description

The invention relates to medicine, in particular to dentistry, and can be used to control the viability of the pulp in the root canals of multichannel pulp-amputated teeth, to monitor the dynamics of the pathological process, to evaluate the effectiveness of the treatment.

A device for conducting electroodontodiagnostics (EDI) on devital teeth is known (RF patent for utility model No. 104448). The essence of determining the electrical excitability of this device is that after drug treatment and drying of the root cavity and root canals, the doctor inserts a root needle fixed in an electrically conductive tip and brings its tip directly to the apical periodontal. The patient holds a passive electrode in his hand by pressing a button. The device is included in the network. As soon as the patient feels a push, a slight pain, the doctor fixes the digital indicators within the microamps of the periodontal excitability threshold.

The disadvantages of this method include: the inability to perform electroodontodiagnosis of pulp-amputated teeth (namely, to take accurate readings of electrical excitability from each channel); the impossibility of taking readings from periodontal tissues without direct access to them.

Another analogue is the method of electroodontodiagnosis on vital teeth from the bottom of the carious cavity (Beloshenkov V.V., Kuryanina N.V. et al. Anatomical and physiological features of the maxillofacial region and methods of its research, 2005), which consists in that previously it is necessary to remove the softened dentin and dry the cavity. At the same time, cotton wool or conductive rubber does not need to be placed on the working part of the active electrode, and the metal working part of the active electrode should touch the bottom of the cavity. The study is carried out at 3-4 points. A guideline for excitability is the minimum current obtained at any point.

The disadvantages of this method is the unreliability in the diagnosis of electrical excitability in multichannel and filled teeth:

1) the inability to determine the exact EDI reading from each root canal in multichannel teeth; 2) the inability to determine the exact EDI reading after filling the tooth cavity and manufacturing an artificial crown.

The closest analogue (prototype) to the proposed one is a method for evaluating the electrical excitability of the root pulp of permanent teeth after pulpotomy using a metal electrode that is embedded in one channel of a single-channel tooth or in one of the channels of a multi-channel tooth (1. Kartoshkin A.A., Zhuravlev O.N. , Kotiai Yu.Yu. Endodontics for dental prosthetics. Pilot study / MATERIALS of the 62nd All-Russian Student University Scientific Conference with international participation "Youth, Science, Medicine" with an open competition for the best student scientific work. - Tver, April 21, 2016 g. - pp. 199-200.

2. Petrikas A.Zh., Petrikas O.A., Kartoshkin A.A., Zhuravlev O.N. Pulpotomy with prosthetics. Pilot study. // Problems of dentistry. - 2018. - T. 14. - No. 2. - p. 48-51.)

The disadvantages of this method: 1) the inability to determine the exact reading of the EDI from each root canal in multichannel teeth in order to determine the vitality of the pulp in specific root canals;

2) the generalized nature of the data in the diagnosis of electrical excitability in multichannel teeth and, therefore, the difficulty of informed planning of treatment of a multichannel tooth.

The aim of the invention is to clarify the vitality or devitality of the dental pulp in each of the root canals of a multichannel tooth.

The technical result of the invention is the ability to take accurate EDI readings from each root canal in multichannel pulp-amputated teeth for the entire treatment period until the final fixation of the permanent artificial crown, or, in the absence of further prosthetics planning, to determine a rational tooth treatment plan depending on the pulp vitality in each separate root canal.

This goal is achieved by the fact that after filling the access cavity with filling material, metal electrodes are installed - steel pins into the projection of the root canal mouths, and the active electrode of the apparatus for electroodontodiagnosis (odontosensimeter) is fed directly to the pin.

The proposed method for evaluating the electroexcitability of the root pulp of permanent multichannel teeth after pulpotomy is as follows (Fig 1):

On the mouth of the root canals (1) and the bottom of the tooth cavity (2), MTA ANGELUS (Mineral Trioxide Aggregate, layer thickness of about 2-3 mm) is applied with a thin plugger (3). To take EDI readings from the root pulp of each channel from a steel clasp wire d = 1 mm (orthodontic wire, stainless steel, diameter 1 mm TU 64-2-112-76), a metal electrode is prepared - a pin that is longer than the height of the clinical tooth crown. The vertical surface (except the end) of each of the pins is covered with a layer of medical cyan-acrylic glue for additional electrical insulation (6). Glass ionomer cement is introduced into the cavity (7); steel pins are immersed in the cement to the MTA layer (a separate pin is inserted into the projection of the mouth of each channel). Light curing of glass ionomer cement is performed. After the final polymerization, the protruding tips of the pins are removed with a diamond bur. Spend grinding of the seal.

Then, the EDI readings are taken using an odontosensometer — an apparatus for conducting an electroodontodiagnosis OSM-50 (Fig. 2): a passive electrode (8) is given to the patient’s hand, a cotton wool moistened with water is placed on the needle (9) of the active electrode (10) and the needle is placed on the places where the pins exit onto the occlusal surface of the tooth.

Then press the keys “50-200” (I) (range switching), while the signal lamp “50” or “200” lights up. Research begins on a range of 50 μA. When working with the OSM-50 apparatus, after placing the electrodes on the patient, the odontosensometer handle (12) is gently and slowly withdrawn to the right until a sensation in the tooth (heat, burning, jolt) occurs, which the patient notifies with the sound “AA”. The threshold current strength is recorded according to the position of the arrow (13) and the handle (12) of the odontosensimeter is released, the “Network” key is turned off. It is necessary to ensure that there is no contact of the electrode holder of the active electrode with the mucous membrane. During the procedure, the teeth are periodically dried, because they moisturize when breathing.

The proposed method for evaluating the electroexcitability of the root pulp of permanent multichannel teeth after pulpotomy is illustrated by the following examples.

The following EDI indicators serve as a guideline for assessing the vitality of dental pulp, as well as the presence of any pathological changes:

2-6 μA - normal for anterior teeth (incisors and canines)

3-8 μA - the norm for premolars

4-16 μA - for molars

20-100 μA - pulpitis

100-200 μA - periodontitis

(1. Borovsky E.V., Barysheva Yu.D., Maksimovsky Yu.M. et al. // Therapeutic dentistry, ed. Prof. Borovsky E.V., M, 1997.

(2. Zyuzkov DI The condition of the tooth pulp in inflammatory periodontal diseases. // Abstract of thesis. Candidate of Medical Sciences //. Tver, 2004.)

Example 1

Patient M., 37 years old, turned to the orthopedic dentistry clinic with complaints of discomfort in the area of the bridge due to the lack of a tooth 46. The brazed bridge made 7 years ago did not meet the functional and aesthetic requirements: artificial crowns on the teeth were noticeable with a smile 45 and 47 loosely covered the neck of the teeth, and after removing the prosthesis, a pressure sore was determined in the area of his body. The diagnosis was made: partial loss of teeth in the lower jaw (Kennedy grade 3), tooth crown defect 45 and 47. The evaluation of electroexcitability (EDI) from the chewing surface of the teeth 45 and 47 (3 μA and 8 μA, respectively). It is planned to replace the old brazed bridge with a metal-ceramic prosthesis based on teeth 45 and 47, as well as, subsequently, all available stamped crowns with metal-ceramic ones.

Due to the need for significant additional preparation of supporting teeth 45 and 47 in a patient of a relatively young age (a significant volume of the tooth cavity), the coronal pulp of these teeth was amputated with isolation of the root pulp with MTA. For this, electrodes were prepared from steel clasp wire - steel pins (4 pcs., Respectively, to the total number of root canals in both teeth) 10 mm long (Orthodontic wire, stainless steel, diameter 1 mm TU 64-2-112-76), Vertical the surface (except the end) of each of the pins was covered with a layer of medical cyan-acrylic glue for additional electrical insulation. The pins were installed in the projection of the root canal mouths (up to the MTA layer) into the yet-polymerized filling material (Vitremer glass ionomer cement), which filled the access cavities in teeth 45 and 47. Polymerization was performed using a halogen lamp. After 10 minutes, after the final polymerization, the protruding tips of the pin are removed with a diamond bur. The EDI values of teeth 45 and 47 were measured (tooth 45 - 5 μA; tooth 47 - 4 μA and 8 μA from the medial pins and 9 μA from the distal, respectively). Light sensitivity in the neck region was determined during air cooling (cold test). The preparation of teeth 45 and 47 (without anesthesia) was performed under a ceramic-metal bridge (Fig. 3), the protruding ends of 3 pins (14) are visible on the occlusal surface of tooth 47 and the 1st pin - tooth 45. The patient only occasionally felt mild tolerable soreness when processing the cervical region of the teeth.

After 3 and 6 months, repeated measurements were made of the EDI of 45 and 47 teeth (tooth 45 - 5 μA and 5 μA; tooth 47 - 8, 8, 10 and 8, 9, 10 μA, respectively).

Example 2

Patient S. 52 l. appealed to the clinic of orthopedic dentistry with complaints of violation of chewing due to the absence of lateral teeth of the upper jaw and malocclusion. Objectively: there is a combined dentition defect in the upper jaw (included - on the left and end - on the right). On the lower jaw, deformation of the dentition in the vertical plane due to the movement of tooth 36 by 3 mm up is noted (Fig. 4). Tooth 36 is stable, on the occlusal-medial surface there is an old cement filling with a violation of the marginal fit. EDI - 8 μA.

It was planned to prosthetize the patient with an arch prosthesis on the upper jaw with preliminary shortening of the tooth 36 and its coating with a ceramic-metal crown. In order to preserve the vitality of the root pulp with significant grinding of the hard tissues of the tooth 36 and subsequent preparation under an artificial crown, a pulpotomy of tooth 36 was performed.

For this, steel pins (3pcs, respectively, the number of root canals) with a length of 10 mm (orthodontic wire, stainless steel, 1 mm diameter TU 64-2-112-76) were prepared from steel clasp wire. The vertical surface (except the end) of each of the pins was covered with a layer of medical cyan-acrylic glue for additional electrical insulation. The pins were installed in the projection of the root canal mouths (up to the MTA layer) into the yet-polymerized filling material (Vitremer glass ionomer cement) with which the access cavity was filled. Polymerization was carried out using a halogen lamp. After 10 minutes, after waiting for the final polymerization, the protruding tips of the pin were removed with a diamond bur. Using the OSM-50 apparatus, EDI values were measured for all 3 channels of tooth 36: distal, medial buccal and medial lingual (4 μA, 8 μA and 6 μA and 14 μA, respectively). Light sensitivity was determined in the neck region when dried by a stream of air (cold sample). Without anesthesia, shortening and preparation of tooth 36 was performed under a ceramic-metal crown - the patient only occasionally felt mild tolerable pain when processing the cervical region of the tooth. There were 3 metal dots on the chewing surface — the exit of the metal pins. The prosthetics of the tooth 36 was first temporary, then a ceramic-metal crown; and an arch prosthesis was made on the upper jaw.

The EDI of 3 channels of tooth 36 was repeated after 3 and 6 months (the term of permanent fixation of the ceramic-metal crown), the readings were: for the distal, medial buccal and medial lingual channels 4 μA, 8 μA and 6 μA and 16 μA, respectively. Conclusion: the vitality of tooth 36 is preserved.

Claims (1)

A method for assessing the electroexcitability of the root pulp of permanent multichannel teeth after pulpotomy, which consists in determining the electrical resistance of the root pulp using a odontosensimeter, pre-filling the access cavity with filling material, placing a steel pin in the projection of the root canal root and leading the active electrode of the odontosensometer directly to the pin, characterized in that in the multichannel tooth one steel pin is installed opposite the mouth of each root canal in isolation from each other by covering the vertical surface, excluding the end, of each of the pins with a layer of medical cyan-acrylic glue for additional electrical insulation of the pins from each other, and with indicators 3 -16 μA of the multichannel tooth pulp is considered healthy, indicators of 20-100 μA correspond to pulpitis, and 100-200 μA to periodontitis and devital pulp.

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