Case history on pediatric dentistry caries. Grinding is done with diamond burs, polishing is done with polyplastic brushes, rubber circles and cups. any formed carious cavity should have an optimal amount of retention retaining

Federal Agency for Health and social development Russian Federation

State educational institution higher professional education

Far Eastern State medical University Roszdrav

Faculty of Dentistry

department therapeutic dentistry

Academic medical history

Clinical diagnosis: 2.1 tooth caries superficial K02.0.

Enamel caries stage of white (chalky) spots, initial caries

Head department:

Teacher:

Khabarovsk 2012

Passport part

FULL NAME: ***************

Gender Female

Age: 69 years old, 03/04/1941

Education: Secondary

Profession: Group III disabled person

Family status: Married

Home address:

Date of contacting the clinic: 01/11/2012

Complaints

At the time of admission to the clinic:

The appearance of a white (chalky) spot

Slight sensitivity

Sensation of grin from chemical irritants

Anamnesis morbi

The patient considers herself ill for about a month, when she first noted the appearance of a white (chalky) spot on the distal-vestibular surface of the central upper incisor on the left, the tooth had not previously disturbed. Appealed on January 11, 2012 to the Dental Clinic "UNI-STOM" located at: st. **** for the purpose of sanitation of the oral cavity. was admitted for treatment with preliminary diagnosis superficial caries of 21 teeth.

1. General biographical information: Born in *** year. Born in a complete family, was the second child of three. The material security and nutritional conditions of the family were unsatisfactory. She grew and developed normally, did not lag behind her peers in physical and mental development.

2. Work biography: labor activity She started at the age of 16, worked on a collective farm doing agricultural work. Since 1972 she has worked as a tram driver. Occupational hazards: work associated with a long stay in a sitting position. Retired at 55.

3. Family and gender: Lives in the city of Khabarovsk in a comfortable two-room apartment in which three people live. Two daughters and a patient. The husband died 10 years ago. Meals are regular, the regime is observed. Gynecological history: Menstruation began at age 13, regular, painless. The beginning of a sexual life of 18 years. Pregnancies 3, childbirth 2. Menopause since 45 years.

4. Past illnesses: Viral hepatitis, Botkin's disease, tuberculosis, HIV, venereal diseases denies, contact with infectious patients and high fever denies. Trauma, blood transfusion denies. Surgery to remove a brain tumor in 2008. Polyarthritis.

5. Allergic history: there were no allergic reactions to drugs and food products.

6. Chronic intoxication: smokes for more than 20 years, rarely drinks alcohol, does not use drugs.

Visual inspection

The face is symmetrical, proportional,

· skin physiological color, clean,

Nasolabial and chin folds are moderately expressed.

The corners of the mouth are lowered, the closing of the lips is free.

Opening of the mouth is complete, free, painless.

· When opening the mouth, the movement of the temporomandibular joints is free, painless, there is no crunching and clicking in the joint when opening the mouth. The nature of the movement: smooth, the amplitude is normal, synchronous in both joints.

· Palpation of masticatory muscles is painless.

Regional lymph nodes are not enlarged, the consistency is soft - elastic, mobile, not soldered to the skin and surrounding tissue.

Oral examination

Examination of the vestibule of the oral cavity

During intraoral examination of the vestibule of the oral cavity - the mucous membrane of the cheeks is pale Pink colour well hydrated. Puffiness, violation of the integrity is not revealed.

· Bridle top and lower lip, language are quite pronounced.

Gums pale pink, puffiness, integrity violations, ulcerations and other pathological changes are absent.

Gingival papillae are pale pink in color, normal in size, without breaking the integrity. When pressed with a tool, the imprint quickly disappears.

· Occlusion orthognathic.

Examination of the oral cavity itself

The mucous membrane of the lips, cheeks, hard and soft palate is pale pink in color, normally moistened, without pathological changes, swelling is not observed.

The tongue is of normal size, the mucous membrane of the tongue is pale pink, well moistened. The back of the tongue is clean, there are no desquamations, cracks, ulcers. Soreness, burning, swelling of the tongue is not detected.

The state of the follicular apparatus of the tongue without pathological changes.

· Pharynx pale pink, normally hydrated, without edema.

The tonsils are not enlarged, purulent plugs not found in lacunae.

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Clinical picture

On the vestibular-distal surface of tooth 2.1 in the cervical region White spot, enamel gloss loss

When probing, the surface of the enamel is rough

· reaction to cold water painless

vertical and horizontal percussion is painless

The mucous membrane of the transitional fold in the region of the root apex is pink, moderately moist, painless on palpation

Additional examination methods

KPU caries intensity index

Conclusion: decompensated form

Hygienic index according to Fedorov-Volodkina

GI = 1+1+2+1+2+2 = 1.5/6

Conclusion: the hygienic condition of the oral cavity is normal.

Vital stain method

The lesion is stained with 2% methylene blue solution, 5% alcohol tincture iodine.

Conclusion: the lesion is stained.

Remineralization Index

IR = 1.3 points

Conclusion: there are remineralization processes.

Caries markers

The presence of staining

Conclusion: the presence of staining indicates the presence of a carious process

Electroodontometry

The tooth pulp responds to a current of 3 μA.

Conclusion: no inflammatory process in the pulp

Luminescent diagnostics

When examining the causative tooth in the area of the stain, the luminescence is extinguished against the background of a bluish glow of intact enamel.

Conclusion: area of demineralized enamel

Clinical diagnosis

Based on the patient's complaints, anamnesis of life and disease, examination and additional methods of examination, a diagnosis was made.

2.1 Caries superficial

K 02.0 enamel caries "stage of white (chalky) spot" initial caries

Differential Diagnosis

Systemic hypoplasia enamel

The symmetry of the defeat of the teeth of the same name, due to the simultaneity of laying, development and mineralization

Localization on the vestibular surface of the frontal teeth, dental tubercles of molars and premolars

stain stability

whitish spots, clear border, shiny dense surface, painless

Local hypoplasia

violation of the formation of enamel permanent teeth as a result of inflammation or mechanical injury of the rudiments of permanent teeth

The endemicity of the lesion

teeth are rarely affected by caries

stain stability

patches are dense, painless, shiny, smooth

do not stain with a caries marker

spotted form of fluorosis

pigmented spots

The endemicity of the lesion

Caries average

a cavity in the mantle layer of dentin

dentin-enamel junction destroyed

affected dentin

painless probing along the dentin-enamel border

Erosive form of fluorosis

pigmented spots

clear borders on matte enamel

Enamel wears off quickly

damage to dentin

enamel erosion

damage to the vestibular surface

The symmetry of the lesion

More often incisors upper jaw

damage to dentin

Dish-shaped defect

the bottom is smooth and shiny

Acid necrosis of enamel

The vestibular surface of the anterior teeth is affected

The symmetry of the lesion

often professional in nature

Sensitivity to chemical irritants

feeling of "sticking together" of teeth

dentin is soft on probing

Pigmented plaque

Removed when cleaning with specialized brushes and pastes

exposed enamel surface

Treatment

Treatment plan

1. Cleaning the tooth surface from plaque

2. Insulation against moisture

3. Treatment of the tooth surface with a 0.5-1% solution of H 2 O 2

4. Drying

5. Application of remineralizing preparations for 15-20 minutes (10% calcium gluconate solution, 3% Remodent solution)

6. Drying the tooth surface for 3-5 minutes

7. Application of fluoride preparations (2% sodium fluoride solution, Sol.Fluocali, Sol.Fluocal-gel)

8. Drying the tooth for 3-5 minutes

The course consists of 10-15 procedures

Implemented within 3-4 weeks

· Held dispensary observation

Preparations for the prevention of dental caries

Fluorine compounds

Rp.: Sol. Natrii fluoridi 0.05% - 50 ml

D.S. For rinsing the mouth.

D.S. For applications on the surface of tooth enamel or for electrophoresis, a course of 4-7 procedures.

Rp.: Phthorlacum 25 ml

D.S. Apply to the surface of the tooth.

Rep.: Tab. Natrii fluoridi 0.0011 № 50

D.S. 1 tablet per day.

Rep.: Tab. Natrii fluoridi 0.0022 No. 50

D.S. 1 tablet per day.

Rp.: Vitaftori 115 ml

D.S. 1 teaspoon 1 time per day with meals for 3 months.

Remineralizing agents

Rp.: Sol. Calcii gluconatis 10% - 10 ml

D.t.d. No. 20 in amp.

S. For applications on hard tissues tooth.

Rp.: Sol. Natrii fluoridi 0.2% - 50 ml

D.S. For applications on hard tissues of the tooth.

Rp.: Remodenti 3.0

D.t.d. No. 10 in pulv.

S. For rinsing the mouth (dissolve 1 powder in 100 ml of boiled water) for 1-2 minutes.

Rp.: Remodenti 3% - 100.0

D.S. For applications on hard tissues of the tooth, 20 minutes.

The course of treatment - 20 procedures.

Rp.: Sol. Calcii glycerophosphatis 0.5

D.t.d. No. 90 in tab.

S. 1 tablet 3 times a day.

Rp.: Sol. Calcii glycerophosphatis 2.5% - 100.0

D. S. For electrophoresis in hard tissues of the tooth, 20 procedures.

Rp.: Tab.Unicap-M No. 30

D.S. 1 tablet 1 time per day after meals for 20-30 days.

Rep.: Tab. “Ascorutini” 0.1 No. 180

D.S. 2 tablets 3 times a day for a month.

Rp.: Phytini 0.25

D.t.d. No. 50 in tab.

Rp.: Methionini 0.1

D.t.d. No. 90 in tab.

S. 1 tablet 3 times a day after meals.

Epicrisis

On January 11, 2012, a patient of *** *** year of birth applied for oral cavity sanitation to the Dental Polyclinic "UNI-STOM" located at the address: st. ***. On the basis of complaints, general and additional methods of examination, the diagnosis was made: 2.1 tooth superficial caries K02.0 Enamel caries stage of white (chalky spots) initial caries. It was decided to therapeutic treatment with the use of remineralizing therapy with the use of fluorine-containing drugs using the technique deep fluoridation. The patient was given recommendations on the rules of oral hygiene.

A diary

Industrial practice

"Dentist's Assistant"

For 4th year students

Student ______________________________

Groups _______ subgroups ______________

Base institution address _____________

______________________________________

Beginning of practice ________________

End of practice _____________

NALCHIK - 2016

In the KBR, the basic medical institutions are the RSP, GPS-1, GSP-2, the polyclinic of the SPH of the KBSU, the dental clinics in Prokhladny, Baksan, Nartkaly, and Tyrnyauz.

Students living outside the CBD may be assigned to practice at their place of residence upon submission of a personal application and written notice to the supervisor medical institution where the practice will be carried out, on the consent to accept this student for practice.

Industrial practice pursues the following goals:

1) test knowledge and consolidate practical skills related to the diagnosis, treatment and prevention of dental caries and periodontal disease;

2) practical development of the structure of the dental clinic;

3) organization of its work to provide dental care population;

4) gaining experience in hygiene education.

The practice is carried out after the end of the spring examination session in the VI semester for all students.

During the internship period, students work according to the schedule of the medical institution, adhering to the internal regulations established for the employees of this medical institution. A student-trainee is busy daily at the reception of patients for 6 hours as a dental assistant and conducts an independent reception of patients under the guidance of a doctor of the therapeutic department.

During the internship, the student must:

Comply with the internal labor regulations in force in the institution;

To study and strictly observe the rules of labor protection, safety and industrial sanitation;

Be responsible for the work performed and its results;

Must remember and follow the basics of deontology;

Demonstrate a sensitive and attentive attitude towards patients;

Strictly observe the principles of professional ethics, properly build your relationships with staff medical institution;

Participate in health education and professional activities;

Participate in medical scientific and practical conferences.

The student must complete the documentation:

Outpatient medical history of the dental patient;

Diary of daily records of patients;

Journal of appointment of patients;

A diary of a student's industrial practice, in which to record the results of their work daily.

During the internship as an assistant to a dentist, a student must:

know:

– organization of a therapeutic office (department);

– sanitary and hygienic requirements;

– anatomical and histological structure of milk and permanent teeth;

- the structure of the pulp and periodontium;

– cavity topography various groups teeth;

- dental instruments;

- etiology, clinic, pathological anatomy of caries, pulpitis, periodontitis, non-carious lesions of hard dental tissues;

– new research methods used in therapeutic dentistry (rheodentography, rheoperiodontography, Doppler flowmetry, radiovisiography, etc.);

– modern filling materials used in therapeutic dentistry;

– modern methods treatment.

be able to:

– conduct anesthesia (application, injection);

- to carry out remtherapy in order to prevent and treat the initial forms of caries, the application of remineralizing preparations (fluorine-containing varnishes, gels, etc.);

- prepare carious cavities I-V classes, atypically located cavities;

- carry out antiseptic treatment and drying of carious cavities;

– mixing filling materials for temporary and permanent fillings, root canals, therapeutic and insulating linings;

- apply medical and insulating pads, temporary fillings and dressings;

- filling carious cavities with cement, amalgam, composite materials;

– grind and polish fillings;

- apply pastes for pulp devitalization;

– remove temporary and permanent fillings;

– open the cavities of the teeth of all groups, trepan the crowns intact teeth;

– carry out amputation and extirpation of the pulp;

– carry out mechanical treatment of root canals in case of pulpitis;

– carry out mechanical treatment of root canals in periodontitis;

– carry out medical treatment and drying of the root canal;

– seal root canals with pastes;

– seal root canals using pins (lateral and vertical condensation);

- seal the root canals with a thermophile;

- prepare a resorcinol-formalin mixture;

- to impregnate poorly passable channels with a resorcinol-formalin mixture;

– to substantiate the choice of instruments for mechanical treatment of the root canal using the Step back method;

– to substantiate the choice of instruments for mechanical treatment of the root canal using the crown down method.

own:

- examination of the patient:

- collection of anamnesis;

– examination of the maxillofacial area;

- percussion;

- probing and palpation;

– differential diagnosis;

- drawing up a plan of examination and treatment;

- determining the type of plaque on the teeth, tartar, its color, consistency;

– holding professional hygiene oral cavity;

- training and monitoring of oral hygiene;

– determination of the working length of the root canal X-ray method;

- determination of the presence of destructive processes in periodontal tissues on the radiograph;

- determination of indications for various methods of treatment of dental diseases;

– registration of documentation (outpatient dental card, sheet of daily record of the work of a dentist, diary of treatment and preventive work, etc.).

- preparation of prescriptions, directions.

At the end of the internship, the student is obliged to submit to the head of the practice a written report on the completion of all tasks, as well as:

Diary of industrial practice;

Recording medical history;

Abstract;

Conclusion of the head of the medical institution;

Sanitary and educational work

2. Issue a sanbulletin.

Educational research work

In order to increase creative activity, each student in the process of industrial practice is obliged to complete a study that has relevant scientific and practical significance.

Topic UIRS

1. The main indicators of the work of a dentist-therapist.

2. The volume of work of a dentist-therapist working on a differentiated therapeutic approach.

3. Precinct principle of public service. Main types of work.

4. Analysis of accounting for the work of a dentist-therapist.

5. Dental morbidity of the served population.

6. Analysis of morbidity with temporary disability.

7. Dispensary care by a dentist-therapist.

8. Clinical examination of patients with dental and general somatic diseases.

9. The effectiveness of clinical examination of dental patients.

10. Mistakes and complications in the treatment of dental caries.

11. Mistakes and complications in the treatment of pulpitis.

12. Mistakes and complications in the treatment of periodontitis.

13. New methods for diagnosing dental caries.

14. New methods for diagnosing caries complications.

15. Preventive work dentist-therapist.

16. Consultative work of a dentist-therapist.

17. Sanitary and educational work of a dentist-therapist.

18. Analysis of scientific articles periodicals in therapeutic dentistry for the last year.

Essay topics

1. Methods of examination of a dental patient.

2. Caries, etiology, pathogenesis.

3. Caries, clinic, differential diagnosis, treatment.

4. Modern filling materials, their properties, indications for use.

5. Non-carious lesions of hard tissues of the tooth.

Topics of sanitary education work:

1. Means and methods for the prevention of dental caries.

2. Prevention of complications of dental caries.

3. Condition of teeth and human health.

4. Hygienic oral care and brushing.

5. What is dental caries?

6. Toothpastes, their classification, selection criteria.

7. Bad habits and their influence on the condition and position of the teeth, alveolar arches and oral mucosa.

8. Bleeding gums: causes, treatment, prevention measures

Literature

Main

1. Therapeutic dentistry: Textbook for medical students / Ed. E.V. Borovsky. – M.: MIA, 2011. – 840 p.

Additional

1. Borovsky E.V., Zhokhova N.S. Endodontic treatment: A guide for physicians. - M., 1997. - 64 p.

2. Yakovleva V.I., Davidovich T.P., Trofimova E.S., Posveryak G.P. Diagnosis, treatment, prevention dental diseases. - Minsk, 1992. - 628 p.

3. Dental caries and its complications: Proceedings of the conference. - Omsk, 1996. - 146 p.

4. Ivanov V.S., Urbanovich L.I., Berezhnoy V.P. Inflammation of the dental pulp. - M., 1990. - 208 p.

Case history on the topic "CARIES"

Medium caries - carious damage to the enamel and dentin of the tooth. This is the second stage, which is preceded by superficial caries. If the disease is not treated, deep caries develops, in which the nerve is affected, the pulp becomes inflamed.

The density of enamel and dentin is different. Therefore, it happens when, when treating a small hole, the doctor is forced to drill out the floor of the tooth in order to leave only healthy areas. You need to know, for this we will consider the reasons for its occurrence.

Causes

Caries is caused by bacteria (streptococci). In the process of their vital activity, substances are released that cause the destruction of enamel, cement, and dentin.

In the history of the disease of medium caries, there are factors that stimulate its development:

The abundance of easily digestible carbohydrates (sweets, muffins) in food contributes to the formation of plaque;
With a decrease in immunity, enamel is weakened;
Chronic diseases in which mineral composition saliva;
Irregular or poor-quality brushing of teeth;
Hereditary tendency to disease;
Flaw minerals in food, consumption of contaminated drinking water;
The period of pregnancy and lactation.

Development

After a meal rich in carbohydrates, the pH of saliva drops to 4 in the acidic direction. The history of caries disease can last more than 4 years. But when the enamel is destroyed, it progresses 2.5 times faster. Most often it occurs on the chewing surface of the molar.

Symptoms

This is a slow disease. The most obvious symptom is pain of moderate intensity. It occurs as a reaction to sour, sweet, cold, hot. Sometimes it is enough to go into a warm room from a frost to feel a short flash of pain.

In chronic caries, pain appears sporadically. A person may not even be aware of the problems, attributing the discomfort to the increased sensitivity of the enamel.

The disease looks like a recess in which food debris accumulates. Perhaps the appearance of a dark rough. With the progression of the disease, bad smell from mouth.

Treatment

Caries treatment is performed only in dental office. At home, you can only reduce the symptoms with painkillers, but it is better to entrust your teeth to a specialist:

First, the doctor removes deposits soft plaque and tartar. Cleaning of the oral cavity is performed with a brush with abrasive paste or ultrasound.
After cleaning, the color of the filling material is selected. This is especially important if it is necessary to treat the anterior teeth.
The doctor gives an injection of painkillers. In the treatment, topical preparations are used.
When the anesthesia takes effect, the carious areas of the tooth are drilled out. It is very important to remove all damaged tissues. Otherwise, after filling, the disease will continue to progress and lead to pulpitis in the shortest possible time.
To protect the area to be sealed from saliva, it is covered with balls of cotton wool and a bandage. But this method is not practical. It is much more effective to use a rubber dam - a latex scarf with cutouts for teeth. After application, it is fixed on the jaw with steel clamps.
To destroy the pathogenic microflora and prevent the development of inflammation, the drilled area is washed with antiseptic solutions.
For better adhesion of the filling to the enamel, a gel with phosphoric acid is applied. After etching, the gel is washed off and dried. Mistakes in this procedure are fraught with serious complications.
The drilled area is treated with an adhesive. After its complete absorption, for better shrinkage of the seal, a gasket is laid out at the bottom of the “hollow”.
A filling is placed and the tooth is restored to its original shape.
The final stage is grinding the filling, removing irregularities.

So that the history of the disease of medium chronic caries does not return, it is necessary to take care of the teeth. Brush your teeth daily, cut down on sweets and hard foods, and visit your dentist annually.

Complaints on admission

The patient does not complain, he came for the purpose of sanitation of the oral cavity.

Anamnesis of the patient's life (Anamnesis vitae)

Past and concomitant diseases - SARS, measles, chickenpox. Tuberculosis, syphilis, alcoholism, mental illness the family did not get sick.
Intolerance medicinal substances - allergic history not weighed down.
Household history -

He lives with his parents in a separate 3-room apartment, the situation in the family is good, he eats regularly 3 times a day, he prefers a variety of foods of plant origin.

Labor history - studies at the institute (2 course).
Bad habits - smoking, drinking alcohol, drugs denies.
Oral hygiene is good. He brushes his teeth 2 times a day, uses various means of caries prevention (floss, tooth elixir, chewing gum).

History of present illness (Anamnesis morbi)

The patient's tooth did not bother. He visits dentists once a year for the purpose of sanitation of the oral cavity.

The present state of the patient (Status praesens)

1. General state sick -

The physique is correct, constitutional type according to the normosthenic type.

Height - 185 cm.

Weight - 67 kg.

Body temperature - 36.6 * C.

The skin is pale pink, normally hydrated, elastic. Rash, hemorrhage, scratching, peeling and ulcers were not detected.

The degree of development of subcutaneous fat is moderate.

The distribution is even. Edema was not found.

The condition of the organs according to the patient is good. Acute and chronic processes not found.

2. External examination of the maxillofacial region.

The configuration of the face is not changed, the skin is pale pink, normally moisturized. There are no skin rashes or swelling. The red border of the lips is without pathological changes, the lips are normally moistened, there are no cracks, erosions, ulcerations.

Regional lymph nodes (submandibular, mental, parotid, cervical) are not enlarged, painless.

3. Examination of the oral cavity -

The smell from the mouth is normal. The mucous membrane of the lips, cheeks, hard and soft palate is pale pink in color, normally moistened, without pathological changes, no swelling is observed.

The gums are pale pink in color, there are no puffiness, integrity violations, ulcerations and other pathological changes. The gingival papillae are normal; when pressed with the instrument, the imprint quickly disappears. There is no increased bleeding. Pathological pockets no.

The tongue is pink, clean, the papillae are without pathological changes, the tongue is normally moistened, the integrity is not broken, no desquamations, cracks, ulcers were found, no teeth marks were found on the surface of the tongue. The state of the follicular apparatus of the tongue without pathological changes.

The pharynx is pale pink in color, normally moistened, without edema.

The tonsils were not enlarged, no purulent plugs were found in the lacunae, and there was no plaque.

Dental formula:

Bite on orthognathic type.

The color of the teeth is white. Anomalies in the shape, position and size of the teeth were not found. Non-carious lesions of the teeth (hypoplasia, fluorosis, wedge-shaped defect, abrasion) are absent.

Soft plaque is colorless, localized in the cervical region of the teeth. Tartar is absent.

Description of the diseased tooth.

. The tooth does not react to mechanical, chemical, temperature stimuli. When probing, it is determined that carious cavity filled with pigmented softened dentin, not communicating with the tooth cavity. Probing is painful along the enamel-dentine junction. Percussion is painless.

Additional research methods

X-ray diagnostics was not performed.

Diagnosis and its rationale

Diagnosis - caries media.

The diagnosis was made on the basis of basic and additional research methods.

On examination, a small shallow carious cavity was found on the chewing surface.

7. The tooth does not react to mechanical, chemical, temperature stimuli. When probing, it is determined that the carious cavity is filled with pigmented softened dentin, it does not communicate with the tooth cavity. Probing is painful along the enamel-dentine junction. Percussion is painless.

Additional research methods:

The tooth pulp responds to a current of 3 μA.

Differential Diagnosis

Average caries differentiate:

With a wedge-shaped defect, which is localized at the neck of the tooth, has dense walls and characteristic shape wedge, asymptomatic;

2. With deep caries, which is characterized by a deeper carious cavity with overhanging edges, located within the peripulpal dentin, probing the bottom is painful, mechanical, chemical and thermal stimuli cause pain, which quickly passes after the elimination of the stimulus. Percussion of the tooth is painless.

For medium caries is characteristic small cavity located within its own dentin. The bottom and walls of the cavity are dense, probing is painful along the enamel-dentin junction.

With chronic apical periodontitis, which can be as asymptomatic as medium caries: no pain when probing along the enamel-dentin border, no response to temperature and chemical stimuli. The preparation of a carious cavity with an average caries is painful, but not with periodontitis, since the pulp is necrotic. The pulp of the tooth with an average caries reacts to a current of 2-6 μA, and with periodontitis - to a current of more than 100 μA. The radiograph in chronic apical periodontitis reveals a uniform expansion of the periodontal gap, destructive changes bone tissue in the projection area of the root apex.

Therapy and prevention

In the treatment of secondary caries, the preparation of a carious cavity is mandatory. The preparation of the walls and bottom of the carious cavity is carried out before crepitus. If softened dentin is left at the bottom of the carious cavity, the process of demineralization under the filling will continue.

The treatment consists of instrumental processing of enamel and dentin, which form the walls and bottom of the carious cavity, and its subsequent filling with filling material. Surgical excision of necrotic and destroyed tooth tissues as a result of the carious process consists in removing functionally defective and infected tooth tissues that are not capable of regeneration. Like any intervention, surgical treatment should be painless.

The preparation is made with sharp carbide or diamond burs, without vibration, at the highest possible speed, with intermittent movements in the form of a "comma". The burs should correspond to the dimensions of the cavity, the work should be carried out within the limits of healthy tooth tissues in compliance with the principle of biological expediency.

During the preparation, cooling is necessary, and when working in a carious cavity, warm irrigation of the tooth tissues is necessary.

Stages of tooth preparation and filling:

Opening of the carious cavity

It comes down to the removal of overhanging edges of enamel that do not have support on dentin.

The goal is to create complete access to all necrotic and demineralized tissues.

The criterion is the absence of undermined enamel edges.

To excise the overhanging edges of the enamel, spherical or fissure burs are not used. large sizes.

A spherical bur is inserted into the carious cavity and the overhanging edge of the enamel is removed outward from the bottom of the cavity. When working with a fissure bur, overhanging edges are removed with its side faces until the walls become sheer.

2. Cavity expansion

The cavity is expanded with large-sized burs. This stage aims to remove softened and pigmented dentin, which is necessary to prevent further spread of the carious process. The expansion begins with the removal of tissue decay with an excavator. The denser dentin is removed ball bur or reverse cone, carefully at low speeds of the drill, so as not to open the tooth cavity. A properly treated cavity should be free of pigmented and softened dentin.

3. Necrectomy

this is the final removal of the affected tissues of enamel and dentin. It is advisable to use fissure and spherical burs.

When performing necrectomy, it should be borne in mind that in the area of enamel-dentinal junction in the zones of interglobular and near-pulp dentin there are zones that are very sensitive to mechanical irritation.

The criterion is the density when sounding the walls and bottom.

Formation of a carious cavity.

this creation best conditions for fixing the filling material.

Principles of cavity formation:

the walls of the carious cavity should be sheer and dense
bottom - flat and creaking when probing
the angle between the walls and the bottom of the formed cavity should be 90 *
the formed cavity can have a wide variety of configurations: triangular, rectangular, dumbbell-shaped, cruciform, oval, etc.

In this patient, the cavity is formed of a rectangular shape.

any formed carious cavity should have the optimal number of retention points that would provide the seal with the best fixation
preparation should be carried out in compliance with the principle of biological expediency.

The cavity is formed according to class 1 (according to Black).

Class 1 Black cavities include cavities in the area of fissures and natural recesses of molars, premolars, and incisors.

Finishing

This is the smoothing of the edges of the enamel.

It is made with a diamond or fissure bur to the entire depth of the enamel at an angle of 45 * along the perimeter of the carious cavity. The resulting fold protects the seal from displacement under chewing pressure.

Medical treatment of the carious cavity.

After preparation, dentinal sawdust remains in the cavity, in order to remove them, the cavity is washed with a warm stream of water or warm physiological antiseptics: 0.02% furatsilina solution, 0.02% ethacridine lactate solution, 0.06% chlorhexidine solution, 5% dimexide solution.

Then the cavity is thoroughly dried, since traces of moisture significantly impair the adhesion of the filling material to the walls. Air drying is optimal. Care should be taken to ensure that the cavity is well isolated from saliva.

It is very important to have and maintain a thoroughly dried cavity during the entire filling process.

Means for antiseptic treatment of the carious cavity.