Conservative (biological) pulpitis treatmentThe biological method of pulpitis treatment isdirected to make pulp healthy with renewal of itsfunction. The important value has its completerenewal or saving its basic functions:• formative• nutritive• reparative• It save the valuable hard tooth tissue structure• made protective• barrier actions• prevented the apical periodontitis development
The pulp has a very good defensiveproperties. It has ability to detain microbialinvasion, especially at first 24-48 hours ofinflammation development. Duringinflammation increasing pulp lymphformation and outflow; increasing nervesregulative influence on pulp trophic. In pulpincreasing formation biological activesubstance, which stimulated its regeneration.
During selection of conservative method of pulpitistreatment the dentist must pay attention to the row of different factors: Clinical form of pulpitis. Disease duration. Patient age. Patient general condition. Available general systemic diseases. Caries cavity localization. Teeth groups (one-root, multy-root). Absence changes in periodontium Infection ingress into tooth pulp. Caries coarse. Absence previous antibiotic or corticosteroid therapy of systemic diseases.
At first appointment1. Oral cavity toilet.2. Preparation of the operation field, isolation by cotton rolls or rubber dam.3. Obtain regional anesthesia:nerve block or infiltration.4. Remove all caries dentin of caries cavity and, with a sharp explorer, test the pulp for depth of anesthesia. When necessary made perforation of pulp chamber for better penetration of medicaments into pulp.5. Irrigation caries cavity with warm antiseptic solution.6. Placing the medicament paste on the caries cavity floor (indirect of direct pulp capping).7. Temporary filling (dressing) of the caries cavity.
Different materials for the biological(conservative) treatment of pulpitis: 1. Antibiotics 2. Sulfonamide 3. Corticosteroids 4. Calcium hydroxide (The most important) 5. Zinc oxide-eugenol
Calcium hydroxidehave a very base reaction – pH=12,5.It has antibacterial, anti-inflammatoryaction,stimulate dentin remineralizationAnd secondary dentin formation.
After 7-14 days at the second patient appointment when pain is absent removed temporary dressing, when need place the fresh portion medicament paste on the caries cavity floor, paced the isolation base and finally close the caries cavity with composite or amalgam restoration. After successfully treatment on the surface of the opened pulp the formation of dental bridge is observed. When indirect pulp-capping method was used in the pulp the formation secondary dentin was observed. When the pain continued (but with lesser insensitivity) the caries cavity repeated filled with temporary dressing. When the pain continued with more insensitivity it means that pulpitis become irreversible and the most effective treatments method is pulpectomy. After vital pulp therapy the dentist must made control examination the tooth through 3, 6 and 12 months after treatment. Clinical estimations based on radiographic examination and pulp vitality test.