More than 20 microns from all teeth. Reasons for getting incorrect results. Diagnostic technique
Periodontitis- inflammatory disease periodontal tissues (Fig. 6.1). By origin, infectious, traumatic and drug-induced periodontitis is distinguished.
Rice. 6.1. Chronic apical periodontitis of tooth 44
Infectious periodontitis occurs when microorganisms penetrate (non-hemolytic, green and hemolytic streptococci, golden and white staphylococci, fusobacteria, spirochetes, veillonella, lactobacilli, yeast-like fungi), their toxins and decay products of the pulp into the periodontium from the root canal or gum pocket.
Traumatic periodontitis can develop as a result of both acute trauma (tooth bruising, biting on a hard object) and chronic trauma (filling overestimation, regular exposure to the mouthpiece smoking pipe or musical instrument, bad habits). In addition, periodontal trauma is often observed with endodontic instruments during root canal treatment, as well as due to the removal of the tooth root beyond the apex. filling material or intracanal pin.
Irritation of the periodontium in acute trauma in most cases quickly passes on its own, but sometimes the damage is accompanied by hemorrhage, circulatory disorders in the pulp and its subsequent necrosis. In chronic trauma, the periodontium tries to adapt to the increasing load. If the adaptation mechanisms are violated, a chronic inflammatory process develops in the periodontium.
Medical periodontitis occurs as a result of the entry into the periodontal potent chemical substances and medicines: arsenic paste, phenol, formalin, etc. Drug-induced periodontitis also includes inflammation of the periodontium, which has developed as a result of allergic reactions on the various drugs used in endodontic treatment (eugenol, antibiotics, anti-inflammatory agents, etc.).
The development of periodontitis is most often due to the ingress of microorganisms and endotoxins into the periodontal gap, which are formed when the membrane of bacteria is damaged, which have a toxic and pyrogenic effect. With the weakening of local immunological defense mechanisms an acute diffuse inflammatory process develops, accompanied by the formation of abscesses and phlegmon with typical features general intoxication organism. Cell damage occurs connective tissue periodontium and the release of lysosomal enzymes, as well as biologically active substances, causing an increase vascular permeability. As a result, microcirculation is disturbed, hypoxia increases, thrombosis and hyperfibrinolysis are noted. The result of this are all five signs of inflammation: pain, swelling, hyperemia, local boost temperature, dysfunction.
If the process is localized at the causative tooth, a chronic inflammatory process develops, often asymptomatic. When the immunological status of the body is weakened chronic process aggravates with the manifestation of all characteristic features acute periodontitis.
6.1. CLASSIFICATION OF PERIODONTITIS
According to ICD-C-3, the following forms of periodontitis are distinguished.
K04.4. Acute apical periodontitis of pulpal origin.
K04.5. Chronic apical periodontitis
(apical granuloma).
K04.6. Periapical abscess with fistula.
K04.7. Periapical abscess without fistula.
This classification allows you to display clinical picture diseases. In practice therapeutic dentistry most often the basis
accepted clinical classification periodontitis I.G. Lukomsky, taking into account the degree and type of periodontal tissue damage.
I. Acute periodontitis.
1. Serous periodontitis.
2. Purulent periodontitis.
II. Chronic periodontitis.
1.Fibrous periodontitis.
2. Granulomatous periodontitis.
3. Granulating periodontitis.
III. Aggravated periodontitis.
6.2. DIAGNOSIS OF PERIODONTITIS
6.3. DIFFERENTIAL DIAGNOSIS OF PERIODONTITIS
DIFFERENTIAL DIAGNOSIS OF CHRONIC APICAL PERIODONTITIS
(apical granuloma)
DIFFERENTIAL DIAGNOSIS OF PERIAPICAL ABSCESS WITHOUT FISTULA
6.4. TREATMENT OF PERIODONTITIS
TREATMENT OF ACUTE APICAL
PERIODONTITIS AND PERIAPITAL
ABSCESS
Treatment of acute apical periodontitis and periapical abscess is always carried out in several visits.
First visit
2. Using sterile water-cooled carbide burs, softened dentin is removed. If necessary, open or open the cavity of the tooth.
3. Depending on the clinical situation, the tooth cavity is opened or the filling material is removed from it. To open the cavity of the tooth, it is advisable to use burs with non-aggressive tips (for example, Diamendo, Endo-Zet) in order to avoid perforation and change
topography of the bottom of the cavity of the tooth. Any change in the topography of the bottom of the tooth cavity can complicate the search for the orifices of the root canals and negatively affects the subsequent redistribution of the masticatory load. Sterile burs are used to remove the filling material from the cavity of the tooth.
7. Determine the working length of the root canals using electrometric (apex location) and X-ray methods. To measure the working length on the crown of the tooth, a reliable and convenient reference point (cusp, incisal edge or preserved wall) should be chosen. It should be noted that neither radiography nor apex
cations do not provide 100% accuracy of the results, so you should focus only on the combined results obtained using both methods. The resulting working length (in millimeters) is recorded. Currently, it is reasonable to believe that the readings of the apex locator in the range from 0.5 to 0.0 should be taken as the working length.
8. With the help of endodontic instruments, mechanical (instrumental) treatment of the root canals is carried out in order to clean the residues and decay of the pulp, excise the demineralized and infected root dentin, as well as expand the lumen of the canal and give it a conical shape, necessary for full medical treatment and obturation. All methods of instrumental processing of root canals can be divided into two large groups: apical-coronal and coronal-apical.
9. Medication treatment of root canals is carried out simultaneously with mechanical treatment. The tasks of medical treatment are disinfection of the root canal, as well as mechanical and chemical removal decay of the pulp and dentinal sawdust. For this, various drugs can be used. The most effective is 0.5-5% sodium hypochlorite solution. All solutions are injected into the root canal only with the help of an endodontic syringe and endodontic cannula. For effective dissolution of organic residues and antiseptic treatment root canal exposure time of sodium hypochlorite solution in root canal should be at least 30 minutes. To increase the effectiveness of drug treatment, it is advisable to use ultrasound.
10. Carry out the removal of the smeared layer. When using any instrumentation technique, a so-called smear layer is formed on the walls of the root canal, consisting of dentinal sawdust, potentially containing pathogenic microorganisms. A 17% EDTA solution (Largal) is used to remove the smear layer. The exposure of the EDTA solution in the canal should be at least 2-3 minutes. It must be remembered that sodium hypochlorite and EDTA solutions mutually neutralize each other, therefore, when using them alternately, it is advisable to flush the channels with distilled water before changing the drug.
11. Perform the finish drug treatment channel with sodium hypochlorite solution. At the final stage, it is necessary to inactivate the sodium hypochlorite solution by introducing into the root canal large amounts of isotonic
th solution of sodium chloride or distilled water.
12. The root canal is dried with paper points and temporary filling materials are introduced into it. To date, it is recommended to use pastes based on calcium hydroxide (Calasept, Metapaste, Metapex, Vitapex, etc.). These drugs due to the high pH have a pronounced antibacterial effect. The cavity of the tooth is closed with a temporary filling. With a pronounced exudative process and the impossibility of carrying out a full medical treatment and drying of the root canals, the tooth can be left open for no more than 1-2 days.
13. General anti-inflammatory therapy is prescribed.
Second visit(after 1-2 days) If the patient has complaints or painful percussion of the tooth, the root canals are re-medicated and the temporary filling material is replaced. If the patient has clinical symptoms no, continue endodontic treatment.
1.Conduct local anesthesia. The tooth is isolated from saliva using cotton rolls or a rubber dam.
2. The temporary filling is removed and a thorough antiseptic treatment of the tooth cavity and root canals is carried out. With the help of endodontic instruments and irrigation solutions, the remnants of temporary filling material are removed from the canals. For this purpose, it is advisable to use ultrasound.
3. To remove the smeared layer and the remnants of the temporary filling material from the walls of the canals, an EDTA solution is injected into the canals for 2-3 minutes.
4. Perform the final medical treatment of the canal with a solution of sodium hypochlorite. At the final stage, it is necessary to inactivate the sodium hypochlorite solution by introducing large amounts into the root canal. isotonic solution or distilled water.
5. The root canal is dried with paper points and sealed. For filling the root canal, various materials and methods are used. To date, the use of gutta-percha with polymeric sealers is highly recommended for root canal obturation. Install a temporary filling. It is recommended to set up a permanent restoration when using polymer sealers no earlier than after 24 hours, when using preparations based on zinc oxide and eugenol - no earlier than after 5 days.
TREATMENT OF CHRONIC APICAL PERIODONTITIS
Root canal obturation in the treatment of chronic apical periodontitis is recommended, if possible, to be carried out on the first visit. Medical tactics no different from treatment various forms pulpitis.
1. Local anesthesia is carried out. The tooth is isolated from saliva using cotton rolls or a rubber dam.
2. Using sterile water-cooled carbide burs, softened dentin is removed. If necessary, open the cavity of the tooth.
3. Depending on the clinical situation, the tooth cavity is opened or the filling material is removed from it. To open the tooth cavity, it is advisable to use burs with non-aggressive tips (for example, Diamendo, Endo-Zet) in order to avoid perforation and changes in the topography of the bottom of the tooth cavity. Any change in the topography of the bottom of the tooth cavity can complicate the search for the orifices of the root canals and negatively affects the subsequent redistribution of the masticatory load. Sterile burs are used to remove the filling material from the cavity of the tooth.
4. Carry out a thorough antiseptic treatment of the tooth cavity with 0.5-5% sodium hypochlorite solution.
5. The mouths of the root canals are expanded with Gates-glidden tools or special diamond-coated ultrasonic tips.
6. The filling material from the root canals is removed using appropriate endodontic instruments.
7. Determine the working length of the root canals using electrometric (apex location) and radiological methods. To measure the working length on the crown of the tooth, it is necessary to choose a reliable and convenient reference point (cusp, incisal edge or preserved wall). It should be noted that neither radiography nor apexlocation provides 100% accuracy of the results, so you should focus only on the combined results obtained using both methods. The resulting working length (in millimeters) is recorded.
8. With the help of endodontic instruments, mechanical (instrumental) treatment of the root canals is carried out to clean it from residues and decay of the pulp, excise the demineralized and infected root dentin, as well as expand the lumen of the canal and give it a conical shape, necessary
for full medical treatment and obturation. All methods of root canal instrumentation can be divided into two large groups: apical-coronal and coronal-apical.
9. Medication treatment of root canals is carried out simultaneously with mechanical treatment. The tasks of medical treatment are the disinfection of the root canal, as well as the mechanical and chemical removal of the decay of the pulp and dentinal sawdust. For this, various drugs can be used. The most effective is 0.5-5% sodium hypochlorite solution. All solutions are injected into the root canal only with the help of an endodontic syringe and endodontic cannula. For effective dissolution of organic residues and antiseptic treatment of canals, the exposure time of sodium hypochlorite solution in the root canal should be at least 30 minutes. To increase the effectiveness of drug treatment, it is advisable to use ultrasound.
10. Carry out the removal of the smeared layer. When using any instrumentation technique, a so-called smear layer is formed on the walls of the root canal, consisting of dentinal sawdust potentially containing pathogenic microorganisms. A 17% EDTA solution (Largal) was used to remove the smear layer. The exposure of the EDTA solution in the canal should be at least 2-3 minutes. It must be remembered that sodium hypochlorite and EDTA solutions mutually neutralize each other, therefore, when using them alternately, it is advisable to flush the channels with distilled water before changing the drug.
11. Perform the final medical treatment of the canal with a solution of sodium hypochlorite. At the final stage, it is necessary to inactivate the sodium hypochlorite solution by introducing large amounts of isotonic sodium chloride solution or distilled water into the root canal.
12. The root canal is dried with paper points and sealed. For filling, various materials and methods are used. To date, the use of gutta-percha with polymeric sealers is highly recommended for root canal obturation. Install a temporary filling. It is recommended to set up a permanent restoration when using polymer sealers no earlier than after 24 hours, when using preparations based on zinc oxide and eugenol - no earlier than after 5 days.
6.5. ENDODONTIC INSTRUMENTS
Endodontic instruments are intended for:
For opening and expanding the orifices of root canals (QC);
To remove the dental pulp from the QC;
To pass QC;
For the passage and expansion of QC;
For expansion and alignment (smoothing) of the walls of the spacecraft;
For the introduction of the sealer in the QC;
For filling.
According to ISO requirements, all tools, depending on the size, have specific color pens.
6.6. MATERIALS FOR ROOT CANAL FILLING
1. Plastic non-hardening pastes.
It is used for temporary filling of the root canal for the purpose of medicamentous influence on the microflora of endodontics and periodontium. For example, iodoform and thymol pastes.
2. Plastic hardening pastes.
2.1. cements. Used as an independent material for permanent filling of the root canal. This group is not responding modern requirements required for root canal filling materials and should not be used in endodontics.
2.1.1. Zinc-phosphate cements: "Phosphate cement", "Adhesor", "Argil", etc. (Practically not used in dentistry.)
2.1.2. Zinc-oxide-eugenol cements: "Evgecent-V", "Evgecent-P", "Endoptur", "Kariosan"
and etc.
2.1.3. Glass ionomer cements: Ketak-Endo, Endo-Gen, Endion, Stiodent, etc.
2.2. With calcium hydroxide.
2.2.1. For temporary filling of the root canal: "Endocal", "Calacept", "Calcecept", etc.
2.2.2. For permanent filling of the root canal: Biopulp, Biocalex, Diaket, Radent.
2.3. Containing antiseptics and anti-inflammatory agents:"Cresodent paste", "Cresopate", "Treatment Spad", Metapeks, etc.
2.4. Based on zinc oxide and eugenol: zinc oxide eugenol paste (extempore) Eugedent, Biodent, Endomethasone, Esteson
and etc.
2.5. Pastes based on resorcinol-formalin:
resorcinol-formalin mixture (ex temperature),"Rezodent", "Forfenan", "Foredent", etc. (Practically not used in dentistry.)
2.6. Sealants, or sealers. It is mainly used simultaneously with primary solid filling materials. Some may use it as an independent material for permanent root canal filling (see instructions for use).
2.6.1. Based on epoxy resins: epoxy sealant NKF Omega, AN-26, AN Plus, Topseal.
2.6.2. With calcium hydroxide: Apexit Plus, Guttasiler Plus, Phosphadent, etc.
3. Primary solid filling materials.
3.1. Rigid.
3.1.1. Metal (silver and gold) pins. (Practically not used in dentistry.)
3.1.2. Polymeric. Made of plastic and used as a carrier plastic form gutta-percha in the a-phase (see paragraph 3.2.2). Technique "Thermofil".
3.2. Plastic.
3.2.1. Gutta-percha in the ft-phase (pins are used in the "cold" technique of lateral and vertical condensation simultaneously with sealants; see.
2.6).
3.2.2. Gutta-percha in the a-phase is used in the "hot" technique of sealing gutta-percha.
3.2.3. Dissolved gutta-percha "Chloropercha" and "Eucopercha" is formed by dissolving in chloroform and eucalyptol, respectively.
3.3. Combined- "Thermafil".
6.7. MACHINING AND FILLING METHODS
ROOT CANALS
6.7.1. ROOT CANAL MACHINING METHODS
6.7.2. ROOT CANAL FILLING METHODS
CLINICAL SITUATION 1
A 35-year-old patient went to the dentist with complaints of throbbing pain in tooth 46, pain when biting, feeling of a “grown” tooth. Previously noted aching pain in the tooth, pain from temperature stimuli. Per medical care did not apply.
On examination: submandibular The lymph nodes enlarged on the right, painful on palpation. The gum in the area of tooth 46 is hyperemic, painful on palpation, the symptom of vasoparesis is positive. The crown of tooth 46 has a deep carious cavity communicating with the cavity of the tooth. Probing the bottom and walls of the cavity, the mouths of the root canals is painless. Percussion of the tooth is sharply painful. EOD - 120 μA. On the intraoral contact radiograph, there is a loss of clarity in the pattern of the spongy substance, the compact plate is preserved.
Make a diagnosis, differential diagnosis make a treatment plan
CLINICAL SITUATION 2
A 26-year-old patient went to the dentist with complaints about the presence of a carious cavity in tooth 25. The tooth had previously been treated for acute pulpitis. The filling fell out 2 weeks ago.
Regional lymph nodes are unchanged. There is a fistulous tract on the gum in the area of tooth 25. The crown of the tooth is changed in color, has a deep carious cavity communicating with the tooth cavity. Probing the bottom and walls of the cavity is painless. At the mouth of the root canal there are remnants of the filling material. Percussion is painless. EOD - 150 μA. An intraoral contact radiograph revealed: root
the canal was sealed for 2/3 of the length, in the region of the root apex there is a rarefaction of bone tissue with clear contours.
Make a diagnosis, conduct a differential diagnosis, make a treatment plan.
GIVE ANSWER
1. The presence of a fistulous passage is characteristic:
3) periapical abscess;
4) chronic pulpitis;
5) local periodontitis.
2. Differential diagnosis of chronic apical periodontitis is carried out with:
1) acute pulpitis;
2) fluorosis;
3) enamel caries;
4) carious cement;
5) radicular cyst.
3. Differential diagnosis of acute apical periodontitis is carried out with:
1) pulp necrosis (pulp gangrene);
2) pulp hyperemia;
3) dentine caries;
4) carious cement;
5) enamel caries.
4. On the intraoral contact radiograph with a periapical abscess with a fistula, the following is revealed:
5. On the intraoral contact radiograph in chronic apical periodontitis, the following is revealed:
1) expansion of the periodontal gap;
2) a focus of rarefaction of bone tissue with fuzzy contours;
3) the focus of rarefaction of bone tissue is round or oval in shape with clear boundaries;
4) focus of compaction of bone tissue;
5) sequestration of bone tissue.
6. Soreness when biting on a tooth, a feeling of a “grown” tooth are characteristic of:
1) for acute apical periodontitis;
2) chronic apical periodontitis;
3) acute pulpitis;
4) periapical abscess with a fistula;
5) caries cement.
7. Indicators of electroodontodiagnostics in periodontitis are:
1) 2-6 μA;
2) 6-12 μA;
3) 30-40 μA;
4) 60-80 μA;
5) more than 100 µA.
8. The working length of root canals is determined using
1) electroodontodiagnostics
2) electrometry;
3) laser fluorescence;
4) luminescent diagnostics;
5) laser plethysmography.
9. To remove the smear layer in the root canal, use:
1) a solution of phosphoric acid;
2) EDTA solution;
3) hydrogen peroxide;
4) potassium permanganate;
5) potassium iodide solution.
10. To dissolve organic residues and antiseptic treatment of root canals, solutions are used:
1) phosphoric acid;
2) EDTA;
3) sodium hypochlorite;
4) potassium permanganate;
5) potassium iodide.
RIGHT ANSWERS
1 - 3; 2 - 5; 3 - 1; 4 - 2; 5 - 3; 6 - 1; 7 - 5; 8 - 2; 9 - 2; 10 - 3.
AT modern dentistry use more quantity additional methods research. and are prerequisite for staging correct diagnosis. Unfortunately, they cannot always give a complete picture of the disease.
In Soviet times, when such studies were not available, no less informative methods were used. One of these is electroodontometry (EOM).
Electroodontodiagnostics (EOD) is a research method that can be used to assess the viability of the dental pulp in case of traumatic injury, neoplasm, inflammation or any other disease of the teeth and jaws. As a result, the doctor gets the opportunity to choose the most rational methodology treatment and evaluate the results of the therapy.
How it works?
The method of electroodontodiagnostics is based on the ability of living tissues to be excited under the influence of an irritant. The same fabric depending on its functional state at the time of the examination has a different excitability. Conclusions about the degree of excitability are made on the basis of the strength of irritation sufficient to obtain a response from the tissues. To do this, identify the minimum intensity of irritation.
In the case of a decrease in excitability, the response will occur only with an increase in the intensity of the acting stimulus. With an increase, on the contrary, less influence is needed to excite tissues.
Electric current is one of the most effective and accessible pathogens. The time of its exposure can be changed, and the irritation can be repeated several times without harm to the tissue.
The amount of water affects the electrical conductivity in the tissues of the tooth. The larger it is, the higher the number of ions capable of responding to the action of the current. The pulp of the tooth contains a larger volume of fluid than the enamel, therefore, during the study, special sensitive points were identified that correspond to the minimum distance to the pulp chamber.
The purpose of the study is to determine whether the tooth can be cured.
Indications for EDI
Electroodontometry in modern dentistry is used in the following cases:
- differential diagnostics of depth;
- differential diagnosis of pulp damage ();
- diagnostics ;
- detection;
- traumatic damage to the jaws and teeth;
- inflammation of the sinus of the upper jaw;
- jaw tumors of various etiologies;
- neuritis and neuralgia;
- radiation damage;
- treatment with .
Restrictions on the use of this technique
Contraindications to the use of electroodontometry are divided into absolute and relative.
The study will be completely excluded when:
- the patient has a pacemaker;
- there are mental disorders;
- effective drying of the investigated surface is impossible;
- electric current is not transferred for one reason or another;
- the patient is less than 5 years old.
Cases where there is a possibility of obtaining a false result, that is, relative contraindications:
- nervousness of the patient during the reception;
- presence on the tooth;
- presence of metal orthopedic structures in the oral cavity;
- the presence of amalgam fillings;
- root crack;
- root canal or cavity of the tooth;
- malfunction in the equipment used for the study;
- violation of the methodology.
Diagnostic technique
The study involved both a doctor and a nurse.
Used equipment
EOD is performed using the following devices:
- OD-2M;
- EOM-3;
- IVN-1;
- OSM-50;
- Pupptest 2000;
- EOM-1.
Difficulties during the study
During electrodontometry, it is important to remember that the tooth can react differently to the current. Be sure to take into account the age of the patient and the presence of systemic diseases. Also, the sensitivity of the tissues of the tooth is changed by the pathology of the jaw bones and perimaxillary soft tissues.
In addition, external interference can also influence. UHF and microwave devices have a negative effect on devices for electroodontometry and lead to false results.
The most important thing is to fully comply with the research methodology. It must exactly match the instructions for the device. Only in this case can reliable results be obtained.
Deciphering indicators
EDI indicators that dentists are guided by when evaluating diagnostic results:
Research cost
The price of this type of diagnostics varies from 150 to 400 rubles per tooth.
Electroodontodiagnostics is affordable and informative method examination of dental tissues. But it cannot be used on its own. Due to the complexity and a large number Contraindications Electroodontometry can only act as an additional examination.
In combination with other research methods, the doctor will receive full information about the changes that have arisen in the dental tissues and make the correct diagnosis.
EDI has been used in dentistry for over 70 years. This diagnostic method was founded by the Soviet doctor Rubin Lev Rubinovich, it is based on measuring the level of tissue resistance to electric current. An increase in numbers means that a pathological process has begun, as the values increase, we can talk about the penetration of the infection further into the pulp and periodontium. Doctors during their clinical practice established a correspondence between a specific disease and the numbers on the screen of the EDI device. Normally, electrical excitability is 2-6 microamps (microamperes).
EOD in caries
In the carious process, the values of electrical excitability vary depending on the form.
- spot stage, superficial, middle processes 2-6 mA (that is, within the normal range)
- deep stage 10-12 mA, in rare cases up to 20 (this means that the necrotic tissue is extremely close to the pulp and its inflammation will soon begin)
EDI with pulpitis
With inflammation of the pulp, the readings are in the range from 20 to 100 microns.
- acute focal 20-25 microns (this means that the pathology has not yet affected the root part and develops in the crown)
- acute diffuse 20-50mA
- chronic fibrous 30-40 mA
- chronic gangrenous 60-100 microns
EOD for periodontitis
Electrical excitability goes beyond 100 and reaches the mark of 150-300. This means that the pulp is necrotic, and the process has reached the ligamentous apparatus.
Other diseases
In addition to caries and its complications in the face of pulpitis and periodontitis, this species diagnostics is also applied in other conditions. For example:
- trigeminal neuritis from 10 (with mild degree) up to 200 (in severe form)
- trigeminal neuralgia: does not change
- milk teeth in the period of resorption up to 200
- constant during the formation period 50-200
- cyst, examine all the teeth in contact with it (this is checked by a snapshot). In causal indications under 200, in intact 2-6
Methodology
The patient is seated in a chair, the device is connected to the network. It is important to isolate the examined tooth from contact with metals in the mouth (amalgam filling or part of the prosthesis), as well as from saliva. Drying is carried out with cotton balls, but not with a gun (it can provoke an attack of pain and this will change the indications) or even more so with alcohol. The patient holds the passive wire (electrode) in his hand. In modern models, a passive electrode is hung on the patient lower lip in the form of a hook (as when working with an apex locator). The active doctor imposes on him the following points, where, as shown clinical researches, the reaction is called at the minimum values:
- front teeth (incisors and canines) - the middle of the cutting edge
- premolars (small molars) - buccal tubercle
- molars (large molars) - anterior buccal tubercle
Then the current is applied, gradually increasing the values until the patient feels a tingling, pain, push or burning sensation. If there is a seal at the site of the proposed study, then the active electrode is hooked directly to it. When diagnosing caries, it is necessary to place the wire on the bottom of the cavity, for which the softened dentin must first be removed. The same goes for root canals.
For control correct setting device is checked healthy tooth. If the readings are within 2-6, then the results are reliable. In cases where the values \u200b\u200bgo beyond these limits, all procedures should be repeated, the device should be set up correctly, or even completely replaced.
Mistakes
Unreliable results, including positive (but false) ones, occur under the following circumstances:
- conductor touching metal elements in the mouth
- contact with liquids, poor drying
- the patient taking painkillers, alcohol, sedatives before the procedure
- electrode touching the cheek, mucous
- the seal is in contact with another seal from the distal or medial surfaces, from which the current goes to 2 teeth. It is necessary to separate the filling materials
Apparatus
There are two groups of EDI devices in dentistry on our market: domestic and foreign. Of the latter, the most famous are: Gentle Plus, Digitest, Vitapulp, Pulptester (it is indicated in the video above). It should be borne in mind that on some foreign models the scale is represented not by µA, but by conventional units.
Of the Russian models, EOM-3, EOM-1, IVN-01, OD-2 are most often used. EOM-3 needs an assistant to work, which is inconvenient, because not every office has a free nurse or assistant. Modern models make it possible to do with the help of one doctor.
The dental industry is developing quite actively, constantly appearing the latest technology for the treatment and diagnosis of certain pathologies. AT recent times EDI is gaining more and more popularity in dentistry. This technique allows you to accurately diagnose and prescribe effective treatment. Let's see what electroodontodiagnostics (EOD) is, in what cases its use is indicated and whether there are contraindications to the procedure.
The essence of the procedure
This technique has been known in dentistry for more than 60 years, but recently its popularity has been growing. The method is based on measuring the level of tissue resistance oral cavity electric current. The higher the indicators, the deeper the inflammatory process penetrated inside.
AT this method property is used nervous tissue get excited under the influence electric current. During the procedure, the threshold excitation of the tooth receptors is determined. The current at the moment of passing through the pulp does not damage it, as it is strictly dosed. Therefore, to carry out it is necessary to have the necessary knowledge.
Normally, we can talk about such indicators:
- For teeth with formed roots, electrical excitability ranges from 2 to 6 μA.
- For milk teeth, the indicators lie in the same range.
- At the time of cutting permanent teeth and the formation of their roots, the electrical excitability is either greatly reduced or absent altogether, it can be 200-150 μA. When the root is fully formed, the indicator is in the region of 2-6 μA.
The values of EDI in dentistry, compared with the norm, make it possible to judge the development of the pathological process. For example, with the development of caries, electrical excitability drops to 20-25 μA, when the pulp is affected, then the indicators are in the range of 7-60 μA. If the reaction is 61-100 µA, then we can say that the death of the coronal pulp is observed, and the inflammatory process passes to the root of the tooth.
For more accurate results the doctor usually first directs the patient to X-ray diagnostics in order to know approximately the area with pathological changes. But this study does not complete picture what is happening, so electroodontodiagnostics will be much more effective.
Rules for the use of EDI
Since the procedure is associated with the use of electric current, there are several rules for its application:
- Only a doctor writes a referral for EDI and the whole procedure is carried out under his strict supervision and control.
- The patient must strictly comply with all recommendations and requirements of the doctor. Before the first procedure, a thorough briefing must be carried out.
- EOD in dentistry is not recommended immediately after a meal or on an empty stomach. The optimal time is 40-60 minutes after eating.
- During the procedure, you can not get up, move and talk. Any movement can lead to errors in the results.
- To avoid electric shock, do not touch the device, try to independently adjust the dose of current.
- If during the procedure you feel strong pain, burning sensation, dizziness, then you must inform the nurse or doctor.
- After the procedure is completed, the patient needs to rest for 40 minutes.
Purpose of electroodontodiagnostics
The doctor can refer to EDI, pursuing the following goals:
EDI indications in dentistry
The procedure is indicated in the presence or suspicion of the following pathologies:
It can be noted that almost all pathologies dental system require the use of EDI in dentistry for accurate diagnosis and effective treatment.
Contraindications for EDI
Any research and electrodontodiagnosis is no exception, they have their own contraindications for use. They can be divided into relative and absolute.
To absolute contraindications relate:
- The patient has a pacemaker.
- Mental disorders.
- Children's age up to 5 years.
- It is impossible to achieve complete dryness of the tooth.
- The patient does not tolerate electric current.
Pros and cons of the technique
EOD (electroodontodiagnostics of the tooth) has its advantages:
- Ease of use.
- Method availability.
- Excellent information content.
- The doctor has the opportunity to carry out the procedure directly in his office.
But there are also disadvantages:
- It is important to carry out the procedure correctly. Consider individual pain threshold in patients.
- The procedure should be age-appropriate.
- It is necessary to take into account the characteristics of the device. Take into account the degree of formation of the roots.
- The technique requires both material and time costs.
EDI device
Dentistry in its practice uses both domestic and foreign equipment. Among latest models The most popular brands are:
- Gentle Plus.
- digitaltest.
- Vitapulp.
- pulpster.
There are demanded among Russian models:
- EOM-3.
- EOM-1.
- IVN-01.
- OD-2.
The first of the presented Russian models is not so often used, since an assistant is required to carry out the procedure, and not all doctors have their own nurse.
Preparing the device for the procedure
Before the procedure begins, it is necessary to prepare the device for work. This stage includes the following manipulations:
- First of all, the active and passive electrodes are connected to the corresponding keys.
- Carry out grounding.
- Connect the device to the network.
- Press the “On” key, when the device starts working, the signal lamp will light up.
Preparing the patient for the procedure
After preparing the device, it is necessary to deal with the patient:
Tooth preparation is as follows:
- Dry the tooth with cotton swab. For these purposes, alcohol or ether should not be used.
- If there are deposits on the teeth, they should be removed.
- In the presence of caries in the teeth, it is necessary to remove the soft dentin and dry the cavity.
- If there is an amalgam filling, then it must be removed, since this material is a good current conductor.
- Position the electrodes in the desired location.
- The passive electrode is fixed on the back of the hand and fixed.
- The active electrode is fixed on sensitive points.
EDI in dentistry - procedure procedure
After the device and the patient are ready for EDI, the procedure begins. The current is applied, the force gradually increases until the patient feels pain, tingling or burning. The nurse or doctor registers the threshold current and turns off the device. Quite informative EDI in dentistry. Indicators allow you to accurately determine the pathology.
To check the reliability of the results, a healthy tooth is also checked.
It must be taken into account during the procedure that there must be a closed circuit between the device, the patient and the doctor, otherwise, not entirely reliable results can be obtained. The specialist should not wear gloves during the procedure.
For getting reliable results measurements are taken several times and the average value is taken. If the patient's reaction changes slightly, then the results are reliable, but with large deviations, a false positive or false negative reaction can be suspected.
Reasons for getting incorrect results
When EDI is used in dentistry, the readings may not always be correct. False positive reactions are possible if:
- There is contact between the electrode and a metal part, such as a bridge or a filling.
- If the patient is not explained in detail what to expect and how to proceed, then he may raise his hand prematurely.
- Poorly treated pulp necrosis.
- Not well isolated from saliva.
In some cases, it is possible to obtain false negative results:
- The patient used before the procedure alcoholic drinks, sedatives drank painkillers.
- During preparation, the nurse made poor contact between the electrode and tooth enamel.
- The patient has recently suffered a trauma to the tooth.
- The device is not plugged in or the batteries are dead.
- The tooth erupted recently, and the apex is not quite formed.
- Incomplete necrosis of the pulp.
- The electrical circuit breaks because the doctor is wearing rubber gloves.
EDI in some diseases
EDI in dentistry is quite informative for various dental pathologies. According to the obtained values, the doctor puts accurate diagnosis and prescribe appropriate treatment. Consider indicators for some diseases:
- The values of electrical excitability in caries change, depending on the degree of its development:
2. EDI with pulpitis gives the following results:
- The acute and focal form gives values of 20-25 μA, in this case, the inflammation has not yet affected the root of the tooth.
- With diffuse and acute pulpitis, the indicators are in the range of 20-50 μA.
- Chronic fibrous pulpitis- 20-40 uA.
- The gangrenous form is characterized by indicators from 60 to 100 μA.
It must be taken into account if the tooth is covered with metal or ceramic-metal crown, then it will not be possible to determine the electrical excitability.
3. With periodontitis, the readings, as a rule, already go beyond 100 and can reach 150, and in some cases even 300 μA.
4. permanent teeth during the formation period, they show from 50 to 200 μA.
5. Electrical excitability on milk teeth during the period of root resorption reaches 200.
A competent specialist should take into account the pain threshold during the procedure, which each person has his own. That is why you should not rely on the average values for a particular pathology. To obtain a reliable result, it is necessary to measure the electrical excitability intact teeth, adjacent and antagonistic teeth. It is imperative that the teeth are in same conditions, that is, the degree of formation of the roots, the location on the jaw, and in reality this is almost impossible to achieve.
Electroodontodiagnostics is a method with 60 years of practice, which helps to reveal the depth of the pathological process inside the tooth. The main indications for electrodontometry are suspicions of the development deep caries, pulpitis or periodontitis. The method allows you to determine not only the localization of the pathological process, but also its nature.
The interpretation of the results of the procedure is carried out by the doctor on the basis of the threshold current strength indicators registered by the nurse. Although the procedure is considered safe, there are a number of contraindications to it. The price for the diagnosis of one tooth does not exceed 400-500 rubles in the capital's dental clinics.
The essence of the method of electroodontodiagnostics
Electroodontodiagnostics is a method for studying serious dental pathologies, used as an additional diagnostic measure along with radiography and laser research. Thanks to nerve endings have the ability to conduct current - one of the most effective pathogens, the technique allows you to determine the reaction of tooth tissues to electrical stimulation. The electric current does not injure the pulp in any way.
In modern dentistry, EDI is used after radiography or laser diagnostics. Both latest method do not always provide detailed information about the character inflammatory process, they only allow you to visualize it.
When is it used in dentistry?
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Electroodontodiagnostics is a research method that is used in case of suspicion of certain dental diseases. These include:
- caries and pulpitis varying degrees development;
- periodontitis and periodontitis;
- injuries of the dentoalveolar apparatus;
- neoplasms;
- the formation of pus on the jaw bones;
- sinusitis;
- neuritis;
- radiation damage to the enamel;
- fungal infection localized in the dentition.
Not always the dentist sends the patient to the EDI in order to establish or confirm the diagnosis. This diagnostic method is extremely informative for the doctor, since it makes it possible to determine the localization and nature of the inflammatory process.
Possession of reliable information allows the dentist to choose the most optimal and effective treatment strategy.
Devices used
The field of dentistry is developing very rapidly. All used technical equipment is also modernized and improved. In our country, the use of imported and domestic devices is practiced, including:
- Gentle Plus, Digitest, Vitapulp. These are the latest foreign models of EDI devices.
- EOM-1, EOM-3 is considered an obsolete model. An assistant is required to operate the machine.
- OD-2, OD-2M. The second option is a modernized model, which uses alternating and direct current.
EDI technique
Before carrying out the EDI procedure, the dentist needs to prepare the device - turn it on and check the operation of the signal light. If at this stage the doctor does not have any difficulties, he proceeds to prepare the patient. He needs to be seated in a chair and put a rubber mat at his feet. Next, the dentist begins the diagnosis.
Conducting an EDI includes the following steps:
During the study, the doctor must ensure that the active electrode does not touch the gums and oral mucosa, and also dry the enamel from time to time so that it does not become wet. The electrical excitability of one tooth is checked twice, at the end the dentist makes a conclusion based on the average.
Contraindications
Electroodontodiagnostics is not indicated for all patients. There are several categories of people for whom EDI is contraindicated: the dentist prescribes them alternative methods research pathological processes in the tooth. Among them:
Decoding for caries, pulpitis and other diseases
Taking readings during the procedure is carried out by a nurse. It registers the threshold values of the electric current strength. The index of tissue resistance determines the depth of the inflammatory process. Normally, it should be 2-6 µA. An increased reaction of 20-25 μA indicates the development of a carious process, 7-60 μA indicates pulpitis or deep caries (see also:). An indicator above 60 μA in the deviation table is defined as a sign of complete destruction of the pulp and the development of periodontitis. Reduced score observed in patients with underdeveloped roots.
In children during the period of changing teeth, the norm indicators may vary. On the initial stage excitability value can reach 150-200 μA. Further, this indicator becomes 30-60 μA. Normal numbers as a result can be seen only after the roots are fully formed.
Prices
Despite the high information content of the method, its cost is quite budgetary. In metropolitan clinics average cost electroodontometry is 300 rubles per tooth. In other megacities of the country, the price of the procedure will be slightly lower - 200-250 rubles, and in provincial cities the price range varies between 150 and 200 rubles. Electroodontometry costs patients much cheaper than other methods for diagnosing pulpitis, deep caries and periodontitis.
