More than 20 microns from all teeth. The purpose of conducting electroodontodiagnostics. Application in pediatric dentistry

ELECTROODONTOMETRY

Electroodontometry allows you to correctly assess the condition of the dental pulp in case of trauma, neoplasms, inflammatory processes and other diseases of the dental and jaw system, to choose the most rational treatment and monitor its effectiveness.

The method under consideration is based on the property of living tissue to be excited under the influence of irritation. The same tissue, depending on the state (normal, inflammation, atrophy, etc.), has different excitability. The degree of it is judged by the strength of irritation sufficient to get a tissue response. To this end, determine the minimum (threshold) intensity of irritation. If excitability decreases, then to excite the tissue, the intensity of irritation must be increased. With an increase in excitability, the threshold becomes lower, i.e., a lesser intensity of irritation is required to excite the tissue.

The best of inadequate stimuli - electricity. The duration of its action can be dosed, irritation can be repeated many times without damage to the tissue. It can be used as an irritant for tissues not available to other types of irritants.

The electrical conductivity of tissues depends on their water content. The more water in the tissues, the more ions in them - current carriers in a living organism. Therefore, the dental pulp is a better conductor of current compared to dentin, which contains 4-5% water. Enamel is a poor conductor. Changes in the amount of water in tooth tissues can be determined by changing their electrical conductivity. L. R. Rubin found that there are sensitive points on the teeth from which irritation is caused at the lowest current strength. The minimum displacement of the electrode from sensitive points to obtain a response requires greater strength current.

In frontal teeth, sensitive points are located in the middle of the cutting edge, in chewing teeth - at the top of the tubercle. According to Rubin, healthy teeth react from sensitive points to currents from 2 to 6 mA. The reaction to currents less than 2 mA and more than 6 mA indicates the presence of pathology. A decrease in excitability in intact teeth can be observed in older people due to age-related changes(obliteration of the tooth cavity, degenerative changes in the tissues of the dental pulp), as well as in persons suffering from systemic diseases organism (endocrine, nervous, cardiovascular, etc.). More often this phenomenon is noted in molars. Therefore, during electroodontometry of chewing teeth, one should be guided in premolars to the buccal, and in molars - to the bucco-medial tubercles.

When conducting a study, it must be remembered that the same tooth, depending on the state of the body, can react to the electric current in different ways. It is also necessary to take into account the age of the patient and the environment in which the study is carried out (the presence of other instruments and apparatuses in the room, etc.), external interference. The device must be checked against the control. Doctors and nurses must be fluent in the technique of electrometric studies. A change in the sensitivity of teeth can be a consequence of pathological processes not only in the tooth, but also in the jaw bones and soft tissues periorbital region. It must be borne in mind that electroodontodiagnostics - helper method and the diagnosis should be based on the totality of data obtained as a result of comprehensive survey sick.

To make a diagnosis, it is necessary to take into account the following indicators of electrometric studies: pulp healthy teeth responds to a current of 2-6 μA, periodontium - by 100-200 and above, deep caries- by 10-18, necrosis of the coronal pulp - by 50-60, necrosis of the entire pulp - by 100 μA.

With periodontal disease, the electrical excitability of the dental pulp can be normal, slightly increased or decreased to 30-40 μA. The electrical excitability of teeth outside the arch is often reduced.

In the presence of carious cavity the study is carried out from the bottom of the cavity after the completion of its mechanical processing with an excavator and bur. The electrical excitability of the pulp can be normal (2-6 μA) or reduced, especially with deep caries.

The presence of a filling in the tooth, located in the neck area, on the contact surface or in the center of the fissure, does not interfere with the study. If the filling is adjacent to the gum, then the study of electrical excitability is not carried out, since in this case the current goes into the soft tissues.

If there is a seal in place of the sensitive point (hillock, cutting edge), then the exposed active electrode is placed on the seal. It should be borne in mind that plastic and epoxy resin are dielectrics. Therefore, studies with these fillings are not carried out. Cement and amalgam fillings are good conductors, as a result of which the electric current diverges in different directions and partially penetrates into the pulp.

The device's microammeter captures all the current passing through the patient, without isolating the one that irritates the pulp. This distorts the reaction of the tooth to the electric current, and therefore the data obtained cannot be considered accurate. In this case, after removing the filling, to clarify the diagnosis, it is necessary to conduct a study from the bottom of the carious cavity.

If excitability is checked from a seal that is in contact with the seal of an adjacent tooth, then in order to avoid leakage of current, a celluloid plate lubricated with petroleum jelly is inserted between them.

The study of the electrical excitability of the pulp with a radicular cyst is carried out after radiography, which allows to clarify the localization and size of the cyst. All teeth are examined, the tops of the roots of which, on the radiograph, seem to be turned into the cavity of the cyst or are adjacent to it. The causative tooth always responds to a current not higher than 100 μA. In other teeth, depending on the location of the cyst to the examined teeth, electrical excitability can be normal, reduced or increased to varying degrees.

In case of trauma, inflammatory processes and neoplasms, the electrical excitability of the teeth is checked before and repeatedly after surgical interventions at intervals of 7-10 days, since in the process of rehabilitation, the electrical excitability gradually returns to normal.

In the case of neuritis of the inferior alveolar nerve, there is no electrical excitability of the pulp of the teeth receiving innervation from this nerve. After appropriate treatment (gingival galvanization), it gradually recovers.

The electrical excitability of the dental pulp in children depends on the stage of formation and the state of the pulp. Formed baby tooth has normal electrical excitability. As the root resorbs and with the appearance of tooth mobility, its reaction decreases, and disappears with strong mobility.

During the cutting period permanent teeth in children, the electrical excitability of the pulp is usually sharply reduced or absent.

As the roots form, the reaction to the electric current gradually normalizes and returns to normal in teeth with fully formed roots.

When studying the electrical excitability of teeth in children after an injury, it is necessary to take into account the degree of root formation, since a decrease in electrical excitability in this case depends on these factors.

The electrical excitability of the dental pulp is determined using the devices OD-2M and IVN-1, EOM-1, EOM-3.

A doctor and a nurse take part in the study of pulp electrical excitability using the OD-2M apparatus. The patient is explained that when a lung tooth tingling or pushing (trembling, feeling of stirring), he should report this by pronouncing the sound "a".

The research is done like this. The patient holds in his hand a passive electrode wrapped in a thin layer of gauze, which is moistened with water. A thin cotton turunda is wound on the active electrode inserted into the socket of the electrode holder, moistened with water (or saline) and squeezed. The surface of the tooth to be examined is dried with cotton balls.

The active electrode is placed on the sensitive points of the tooth. During the study, this electrode should not be moved from the sensitive point, as well as pressed against the tooth being examined, since with periodontitis, tooth pain may appear from pressure.

The handle of the electrode holder should not touch the soft tissues of the lips, cheeks, for which they are pulled with a plastic spatula (to avoid current leakage). For the same purpose, the doctor puts on a rubber glove on his right hand. During this time, the nurse prepares the equipment for the study.

Voltage switch (127 or 220 V) located on back wall device, set to the appropriate position, the device is grounded and connected to the network. Before turning the switch to the “On” position, the microammeter sensitivity switch must be set to the “50” position, the potentiometer slider to the leftmost lead (zero position), the current type switch to the “DC” position.

Wires are connected to the terminals located on the wall of the apparatus. At the end of one of them there is a passive cylindrical metal electrode. It is connected to the terminal, near which the letter P is indicated. The second wire ends with a handle with an electrode holder for fixing the active electrode in it, resembling a dental probe at an angle. This electrode is connected to the terminal, near which the letter A is indicated. During the study, the active electrode is placed on the tooth.

At the direction of the doctor, the nurse turns the potentiometer slider in the clockwise direction each time by 1-1.5 mm, gradually applying voltage to the patient, and by pressing the "Impulse" button on the control panel of the device closes the electrical circuit. The current pulse should be short-term, so as soon as the microammeter pointer stops on the scale, showing the current that passes through the patient, the electrical circuit should be opened by releasing the button.

When researching intact teeth with well-defined tubercles, depulpated (usually having high enamel resistance), the microammeter needle shifts from zero division after applying the voltage necessary to overcome the resistance. To this end, the potentiometer slider sometimes has to be turned several times (always by 1-1.5 mm) followed by sending a current pulse.

As practice shows, patients often report that there is some kind of sensation in the tooth when the current strength exceeds the threshold, that is, when the stimulus causes a strong reaction. Therefore, as soon as the patient reacts to irritation, the current strength must be reduced and, after the reaction disappears, increase again until it appears. This is important for clarifying the threshold response.

If the examined tooth did not respond to a current of 50 μA, the potentiometer slider is set to zero, the sensitivity switch of the microammeter is switched to the “200” position and the study is continued.

Sometimes, despite the application of maximum voltage to the tooth under study (the potentiometer slider is set to the extreme right position “-”), the microammeter needle is at zero or slightly shifted to the side, but the tooth does not respond to the current. This is due to polarization. It can be avoided by reversing the polarity, i.e. by turning the polarity switch to the “+” position. After that, several current pulses are applied, and, having achieved that with each next turn of the potentiometer slider when the electrical circuit is closed, the microammeter needle moves along the scale to the right, the polarity switch is again transferred to the "-" position.

In rare cases, a change in polarity does not remove polarization and the microammeter needle does not move to the right. Then the electrical excitability of the pulp is examined by alternating current. The current type switch is set to the "Alternating current" position. Since the microammeter built into the device is not suitable for measuring alternating current, pointer deviations are not taken into account. The state of the pulp is judged by the nature of the sensation of the patient.

It is known that the reaction to irritation of both normal and pathologically altered pulp manifests itself slight pain, and the reaction of the periodontal - a sense of touch. Therefore, the irritation must be above the threshold so that the patient can figure out exactly what sensation he has.

In this case, a rough diagnosis is carried out, which makes it possible to judge only whether the pulp in the examined tooth has died or not.

A doctor conducts a study of the electrical excitability of the pulp using the IVN-1 apparatus. The device does not need grounding and can operate from a mains voltage of both 127 and 220 V. There is a voltage switch on the rear wall of the device, which should be set to the appropriate position and turn on the device about 5 minutes before the start of the study.

When you press the "Network" key located on the control panel of the machine, the signal light comes on. After turning on the apparatus, the microammeter pointer is set to zero by turning the slider. The engine is a small gear mounted in the upper right corner of the front panel of the device.

The microammeter has three scales. The upper one is designed for current strength up to 10 μA, the middle one - for 50, the lower one - for 150 μA. To turn on each scale, there are keys labeled 10, 50, 150, respectively.

The study starts with the lowest current strength - turn on the scale with the number 10. If the pulp does not respond to 10 μA, by pressing the "0" key, the microammeter needle is returned to the zero position and turn on the scale with the number 50. If the reaction does not occur at 50 μA, then by setting pointer of the microammeter to zero, by pressing the key with the number 150 turn on the third scale. After completing the study, the microammeter pointer is brought to zero.

The active electrode is placed on the sensitive point of the examined tooth and the measurement is started.

The passive electrode in the form of a metal cylinder has a button on the end. During the study, the patient holds this electrode in his hand. When the patient presses a button on the tooth being examined, current pulses are applied in about a second, which increase with each subsequent inclusion.

As soon as the threshold sensation appears in the tooth, the patient must remove his finger from the button. The arrow of the microammeter stops on the scale, fixing the amount of current that caused the reaction of the pulp or periodontium.

To re-conduct the study, by pressing the "0" key, the microammeter pointer is returned to the zero position. Current pulses can be given by a doctor. To do this, the patient must hold the passive electrode in his hand without pressing the button. The doctor puts an active electrode on the sensitive point of the tooth, presses the key on the control panel of the device with the designation "Imp" and does not release it until the patient reports that he feels a slight tingling in the tooth or a slight push.

To study the root pulp, the electrode with a rubber insert is replaced with a needle, which is available in the kit.

All switching on the device must be performed with the active electrode removed from the patient.

The device EOM-1 (Fig. 04) allows you to carry out electroodontodiagnostics without the help of a nurse.

It operates on AC 127 and 220 V, does not require grounding, gives a constant output impulse voltage, providing a current with a frequency of 0.5 Hz, with rectangular pulses. The current amplitude is measured and recorded with an error of no more than 10%. The EOM-1 set includes a cylindrical passive electrode with a circuit switch button and two active electrodes that are screwed onto the electric holder.

The device is mounted in a metal case. The control panel includes a signal light, a zero-setting knob for the instrument, a “Power” key, microammeter scale range switches, a switch, a manual pulse key, a quick zero-setting key, and a microammeter. On the rear wall there is a mains voltage switch with a fuse.

When preparing the device for operation, the switch is set to the position corresponding to the mains voltage, the range switch key 10 is pressed, the device is plugged into the socket and the “Network” key is pressed, as a result of which the signal light lights up. The apparatus is warmed up for 5 minutes. After that, press the "O" key. The pointer of the measuring device should quickly move to zero. If this does not happen, then it is adjusted with the zero setting knob of the instrument.

A passive electrode is given to the patient in the hand, an active one is applied to the sensitive point of the tooth. The patient presses the switch button located at the end of the passive electrode, and the impulses pass through it. When there is a minimal sensation in the tooth, the patient removes thumb button and opens the circuit. On the microammeter scale, the doctor registers the threshold current strength. The device records the value of the last pulse that passed through the patient.

If the patient does not respond to current strength within 10 μA, then by pressing the quick zero setting key, the arrow is returned to the zero position and the next range (50 or 150 μA) of the sensitivity of the instrument scale is turned on.

If the device is controlled by a patient (for example, when working with children), then the study is carried out in a different order: a passive electrode is given to the patient’s hand, an active electrode is placed on the tooth, the pulse button is pressed and kept on until a sensation appears in the tooth, which the patient reports doctor. At the end of the work, turn off the keys of the scale ranges and the "Network".

The EOM-3 device (Fig. 5) operates from an alternating current network and produces an alternating voltage with a frequency of 50 Hz at the output.

Current measurement error is no more than 8%. The set of the device includes passive and active electrodes.

EOM-3 is mounted in a plastic case. On the control panel there are 2 signal lights of the ranges of 50 and 200 μA, a key for switching the ranges of the microammeter scale, a "Network" key, a key for electrode clamps, a potentiometer knob, a microammeter.

When preparing EOM-3 for operation, the active and passive electrodes are connected to the keys "A" and "P",

the device is grounded, connected to the network, the "On" key is pressed at a range of 50 or 200. Range switching is performed by pressing the "50" and "200" keys and is accompanied by the activation of the corresponding signal light. The study starts at the 50 μA range. After placing the electrodes on the patient, the potentiometer knob is turned to the right until a sensation appears in the tooth (warmth, burning, push), the patient reports this. Then the threshold current strength is registered and the handle is released, which independently returns to its original position. At the end of the work, the device is turned off from the network.

Electrode wires should not be placed close to each other and the study should not be carried out in an office where UHF and microwave devices operate. In order for the readings of the device to be accurate, the handle of the potentiometer with the electrodes open and the device turned on must be moved as far as possible to the right and the current strength should be recorded on the scale of the microammeter. The current value should not exceed 0.5 μA.

This diagnostic method is based on an assessment of the sensitivity of the nerve of the tooth to an electric current. With the help of such manipulations, the dentist can choose best option treatment and most rationally distribute the load on the damaged tooth.

The technique itself originated and has been used for more than half a century ago. However, its popularity began to gain only in the last decade. The method of treatment and diagnosis with current is considered the safest and most effective. The method is based on the principle of excitability of tooth tissues to electric current. The norm of resistance is considered to be indicators from 2 to 6 μA (microamperes). If the indicators exceed this threshold, then this indicates the presence of pathologies or infections in the pulp.

How it works?

The method of electroodontodiagnostics is based on the current that penetrates into the tissues of the tooth, or rather into the pulp. Tissues have the ability to conduct electricity and respond to current. Therefore, it is possible to assess how irritated the pulp is. The electrical conductivity of tissues depends on the amount of fluid they contain. Therefore, in order to achieve the most realistic performance, before the procedure, the patient is removed all possible moisture with cotton swabs. However, water cannot be removed from the tooth itself. Most a large number of moisture is in the pulp. During scientific research special points were identified, with the help of which the diagnostic result is revealed.

The purpose of the technique of electroodontodiagnostics is to determine the possibility of curing a tooth.

Indications for EDI in dentistry

• Pulpitis (inflammation of the internal soft tissues of the tooth, which are located inside the dental canal)
• (damage to hard tissues of the tooth)
• (inflammation caused by bone infection)
• Tumors of the jaws
• Actinomycosis (infectious chronic tissue-producing disease)
• Periodontitis (an inflammatory disease, often found as a complication of caries, gives rise to connective tissue between tooth and socket)
• (chronic inflammatory process in the periodontium)
• Trauma to the teeth or jaw
• radiation injury
• Sinusitis

EDI indicators in dentistry

Each dental disease has its own indicators of the device. A healthy tooth, when exposed to an electric current, gives a reaction of 2-6 μA. The more inflammation, the worse the tissue reacts to the current. When an inflammatory process takes place in the tissues, the performance of the electrical appliance increases. So, 20-40 µA indicates the presence of pathologies or infections on initial stages. When the current strength increases to 60 µA, this indicates necrosis of the coronal pulp, above 60 µA, the presence of gangrenous infections in the pulp. If the indicators of the drug go off scale for 100 μA, then infectious process takes place in ligamentous apparatus. However, the opinion: “the higher the indicators, the higher the degree of tissue damage” is erroneous. The reaction to the electric current is checked in several parts of the tooth. For healthy tissues, the indicators will be the same and within the normal range at each point. Depending on the difference in the reaction in the areas of the tooth, specialists assess the degree of tissue damage and the possibility of their treatment.

The above indicators are typical for teeth of permanent occlusion, since in teeth with reduced functionality, the sensitivity of the pulp is reduced.

EDI table in dentistry

Four types of devices are used for electroodontodiagnostics in dentistry:

• IVN-1
• EOM-1
• EOM-3
• OD-2 (an improved version of the device, used for odontodiagnostics, can work not only on AC, but also on DC). The norms of indicators of devices operating from direct current are different from devices with alternating current.

Pulp tester - device for electroodontodiagnostics

Before the procedure of electroodontodiagnostics, it is necessary to prepare the device for use and the patient.

The patient is comfortably seated in a chair and counseled about the sensations that may arise during the diagnostic process. It can be: tingling, vibrations or jolts. It is important for the patient to report how he feels to the doctor in a timely manner. A rubber mat is placed on the floor for insulation. The EDI apparatus is grounded.

Before the diagnosis, the patient is removed all possible liquid from the oral cavity. The tooth that will be exposed to the current is dried with cotton balls in the direction from the cutting edge to the middle. If there is a filling on the tooth, then it is removed to achieve more realistic diagnostic indicators. If the tooth is susceptible to caries, then it is necessary to remove the softened dentin and dry it.

The apparatus itself consists of two electrodes, with the help of which the reaction of the pulp is detected. The electrodes are carefully wrapped in gauze or cotton wool and moistened.

The operation of the device is preliminarily checked on healthy teeth. If the indicators are normal, then proceed to the diagnosis of diseased tissue areas. In some cases, the response of tissues to an electric current may be distorted:

• if the conductor touched in the oral cavity metal constructions(piercing);
• if the patient has taken painkillers before the procedure;
• if the electrode touched the cheek.

To avoid distortion of indicators, the oral cavity is continuously dried during the procedure.

All indicators of tissue reactions to current are checked twice. After the procedure, the doctor displays the arithmetic mean of the two available values, and this result is considered the most correct.

When conducting a study, it is necessary to strictly follow the instructions for use of the drug and always listen to the opinion of the doctor.

EDI device

Electroodontodiagnosis of a tooth is considered the most budgetary and high-quality research option. The price for the procedure ranges from 150 to 400 rubles. To this cost should be added the cleaning of the teeth, the removal of soft dentin and the unsealing of the teeth, if necessary. It is significantly cheaper than other survey options. These price quotes are average. The cost of EDI diagnostics in dentistry depends on the clinic where the procedure is performed, the region and location.

Many patients have already used the method of electroodontodiagnostics and were extremely satisfied. This method of research allows the doctor to correctly recognize the foci of infection or pathologies in the tissues of the oral cavity and prescribe the optimal treatment plan.

For patients who have contraindications to the use of electroodontodiagnostics ( chronic diseases), this method cannot be considered the only correct one. For achievement maximum effect in such cases, several research methods are used.

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.

This method uses the property nervous tissue excited by an 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 eruption of permanent teeth and the formation of their roots, electrical excitability is either greatly reduced or absent at all, 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:

1. Only a doctor writes a referral for EDI and the whole procedure is carried out under his strict supervision and control.
2. The patient must strictly comply with all recommendations and requirements of the doctor. Before the first procedure, a thorough briefing must be carried out.
3. EOD in dentistry is not recommended immediately after a meal or on an empty stomach. The optimal time is 40-60 minutes after eating.
4. During the procedure, you can not get up, move and talk. Any movement can lead to errors in the results.
5. To avoid electric shock, do not touch the device, try to independently adjust the dose of current.
6. If during the procedure you feel strong pain, burning sensation, dizziness, then you must inform the nurse or doctor.
7. 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 the patient's individual pain threshold.
• 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 apparatus

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:

1. First of all, the active and passive electrodes are connected to the corresponding keys.
2. Carry out grounding.
3. Connect the device to the network.
4. 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 you can get not entirely reliable results. 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:

1. 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 indicators 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 of intact teeth, neighboring and antagonist 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.

ID: 2016-05-5-A-6708

Original article (free structure)

Kozhevnikova A.I., Klyagina A.A.
Scientific supervisors: Ass., Ph.D. Petrova A.P., ass. Venatovskaya N.V.
Department of Dentistry childhood and orthodontics

State Budgetary Educational Institution of Higher Professional Education Saratov State Medical University im. IN AND. Razumovsky Ministry of Health of the Russian Federation

Summary

The presence of an apparatus for electroodontodiagnostics (EDI) is mandatory in every dental office, its use is necessary in the diagnosis of caries (if required) and pulpitis (mandatory). This paper describes the method of operation of the apparatus for electroodontodiagnostics (EDI) "Pulp Tester DY310" ("Denjoy", China). After analyzing scientific sources and testing the EDI methodology on our own, we have identified positive and negative sides this method. Simplicity, accessibility, information content, the ability of a doctor to work independently, without resorting to the help of a physiotherapy room, are the main advantages of EDI. The disadvantages of this method are the high cost of ensuring the correctness of the methodology for the procedure, taking into account the individual threshold pain sensitivity, dependence on age, the need for careful calibration of the parameters of a particular tooth. It is important to take into account these factors, as they can affect the performance of electroodontometry (EOM) and complicate the interpretation of the results.

Keywords

Electroodontodiagnostics, Pulp Tester, pulp electroexcitability

Article

Introduction. The problem of determining the vitality of the dental pulp and its degree functional state relevant for dentists, both practicing and engaged in scientific activities. One of the reliable methods for determining the state of the dental pulp is EDI. EDI is a non-invasive and fairly informative method for assessing the functional state of a vital tooth, it has long been popularized in dentistry, and an apparatus for determining the viability of the pulp (EDI apparatus) is included in the list of required equipment for a dental office (Appendix. 11 Equipment standard dental clinic). However, it is worth noting that EDI informs about the integrity and functionality of the sensitive nervous apparatus of the pulp, and not about the state of the pulp as such (the nature of changes in the cellular composition; the presence and degree (stage) of inflammation; the nature of changes in the pulp (inflammatory, degenerative, etc.). .) .

EDI is based on the determination of the threshold excitation of pain and tactile receptors of the dental pulp in response to stimulation with an electric current. The process of measuring the electrical excitability of teeth is called EOM.

In Russian (Soviet) dentistry, EDI was developed and implemented in clinical practice L.R. Rubin in 1949 and was called electroodontoesthesiometry. In subsequent years, the diagnostic capabilities of this method were studied, and devices for conducting EDI were improved.

Modern dentists doubt diagnostic value EDI, and, accordingly, the feasibility of its implementation at a clinical appointment. There are well-established EOM values ​​in normal and pathological conditions. Healthy teeth respond to a current strength of 2-6 μA, the presence of inflammation is indicated by a decrease in electrical excitability to 20-40 μA, and so on. Of course, it is necessary to adhere to these values, but it is necessary to take into account the characteristics of a particular patient, the rules for conducting the technique and the characteristics of the device for EDI itself. Many experts compare the numerical value of EOM and any disease, which cannot be done, since EOM indicators depend on many points. For example, a doctor conducts an EOM of an intact tooth and obtains a value corresponding to the pathological process in the tissues of the tooth, while he relies on established digital values. This discrepancy makes the doctor think about the serviceability of the device, about the correct setting of the device and, in general, about the reliability of this technique. As a result, a significant number of practitioners are abandoning the use of EDI in everyday practice.

Target: find out the feasibility of EDI in the daily practice of a dentist.

Tasks:

1) identify the positive and negative aspects of the EDI method

2) compare the EOM indicators of different groups of teeth;

3) identify factors that affect changes in EOM indicators (age, gender, etc.);

4) get acquainted with the method of operation of the device for EDI Pulp Tester DY310 ("Denjoy", China).

Materials and methods. The analysis of scientific literature, normative documentation on dentistry was carried out. The electrical excitability of the pulp of various groups of teeth was measured using the Pulp Tester DY310 EDI apparatus (Denjoy, China). Measurements were carried out in sensitive areas according to the method of L.R. Rubina (1976). Analyzed the obtained data, made conclusions.

Results and discussion. The pulp during normal life reacts with an insignificant pain reaction, a feeling of tingling, a slight push to the passage of an electric current through it. Subodontoblastic nerve plexus Rashkov, the odontoblast layer and predentin are rich in sensitive nerve endings (both myelinated and unmyelinated), which explains the significant susceptibility of the pulp to the action of stimuli. With a pathological process in the tissues of the tooth, the electrical excitability of the pulp decreases, and the digital indicators of EDI increase. expressiveness pain attack does not correlate in any way with a decrease in the electrical excitability of the pulp, because the sensitivity nerve endings affects the degree of dystrophic changes and the duration of the pathological process. At pain syndromes central genesis (for example, neuralgia trigeminal nerve) the sensitivity of dental pulp receptors does not change, so this fact is important for differential diagnosis. Electrical excitability of temporary and permanent teeth have their own characteristics. So formed temporary teeth have normal electrical excitability of the pulp. With the gradual resorption of the roots and, as a result, the increasing mobility of the tooth, the electrical excitability of the pulp decreases and may even completely disappear with significant mobility. A decrease in electrical excitability or a general lack of reaction of the dental pulp to an electric current is also observed during the period of eruption of permanent teeth in children. The response to the electric current in the pulp is restored as the roots are formed, and in the teeth with already formed roots, the reaction is normal.

An important role is played by the individual threshold of sensitivity, which is different for each person, so you cannot rely on specific values, which correspond to different pathological processes in the tissues of the tooth. To get more reliable information it is necessary to measure the electrical excitability of the pulp of intact teeth, neighboring teeth and antagonistic teeth. The teeth must be in equal conditions (the same degree of root formation, the correct location in the dental arch, be intact, etc.), which is often impossible in reality. Having compared the results of the EOM of the studied tooth with the indicators of the EOM of the control teeth and having determined the individual physiological norm, one should begin to determine the electrical excitability of the pulp of the studied (“causal”) tooth. A.I. Nikolaev et al. (2014) conducted studies to compare EOM parameters of all groups of teeth in different people. EOM indices of 387 intact teeth were studied - 165 incisors (42.6%), 98 canines (25.3%), 86 premolars (22.2%) and 38 molars (9.8%). A scatter of indicators was revealed for various patients, which confirmed the data on the difference in individual sensitivity to electric current.

After analyzing the article of the staff of the Department of Therapeutic Dentistry of the Izhevsk State medical academy T.L. Redinova, G.B. Lyubomirsky (2009), there were no significant differences in the indicators of electrical excitability in men and women.

Using IVN 1 (USSR) and OSP 2.0 Averon (OOO VEGA-PRO, Russia) devices for diagnosing pulp viability, the same authors revealed the variability of pulp electrical excitability in different groups teeth according to age. So in the incisors more high values Electroodontometry is observed already at the age of 20-30, and in premolars and molars - by the age of 41-60. Changes in the electrical excitability of the pulp are explained by age-related processes in the tissues of the tooth. After 40 years, hypermineralization of the peritubular zone increases, the lumen of the tubules narrows, which leads to a decrease in the electrical conductivity of the dentin and the electrical excitability of the pulp.

A significant difference was also revealed in the parameters of electroodontometry of intact teeth of the anterior and chewing group regardless of age. The electrical excitability of the pulp of premolars and molars does not differ significantly.

The reliability of EOM indicators, in addition to physiological factors, also depends on technical, technological and manipulation factors. One of important factors is the choice of apparatus for EDI. Today, devices IVN-1, EOM-1, EOM-2 and others, which were used in the 40s of the twentieth century, are prohibited for production and clinical use, since they do not meet the electrical safety requirements for medical equipment(GOST R IEC 60601-1-2010). Modern EDI devices correspond to the 5th class of electrical safety. They are convenient to use, reliable in measurements, safe for the doctor and patient, and a huge choice of manufacturers is also available. But the scale, the units of measurement are different from the models of the twentieth century. This is explained by the fact that modern devices use pulsed voltage, while in outdated models - a sinusoidal current. Mastering, interpreting the measurement results causes difficulties for practitioners who have been trained on old equipment.

Employees of the Department of Therapeutic Dentistry of the Smolensk State Medical Academy (Nikolaev A.I. and others) (2014) conducted studies to compare the indicators of electroodontometry of the EOM-1 and PulpEst devices (Geosoft-Dent, Russia). EOM of 425 teeth was performed in 143 patients. Analysis of the measurement results suggests that there are no statistically significant differences in the performance of the devices "EOM-1" and "PulpEst", the indicators are comparable. Thus, PulpEst (Geosoft-Dent, Russia) can replace the old EOM-1 device (USSR) that does not meet the electrical safety requirements, units of measurement for µA devices. For modern apparatus for the diagnosis of pulp viability "PulpEst" maximum value equal to 80 µA, for the outdated EOM-1 device, the maximum value is 100 µA.

EDI, like many other studies, has absolute and relative contraindications.

Absolute contraindications for EDI:

The patient has a pacemaker;

Mental disorders;

Inability to obtain sufficient dryness of the tooth surface;

Intolerance to electric current;

Age up to 5 years

Relative contraindications to EDI (factors leading to a false result):

Severe anxiety of the patient;

Factors causing deviation or leakage of electric current in the oral cavity (crowns, pins, amalgam, root crack, perforation of the root canal wall, the bottom of the tooth cavity, etc.);

Increased threshold of pain sensitivity (individual feature of the patient or he takes analgesics, tranquilizers, drugs, alcohol, etc.);

Obstacles to the passage of electric current (tab, plastic crown and etc.)

Insufficient thickness of the contact layer;

Malfunction or incorrect setting of the EDI device;

Not proper conduct procedures .

The protocol for the management of patients with diseases of the dental pulp (under development) states that the use of EDI is mandatory in every patient with such a problem, and in case of dentin caries, EDI must be used as needed, which is reflected in the approved V.I. Starodubov protocol for the management of patients with dental caries dated October 17, 2006. We set out to reproduce in practice the correct conduct of EDI. In clinical conditions, we have mastered the technique of working with the EDI device Pulp Tester DY310, which is manufactured in China by Denjoy. To perform EDI, we read the instructions for the Pulp Tester DY310 device. This device is powered by a PP3 (9B) battery, has a test electrode (active electrode) and a mouthpiece (passive electrode), can operate in three high-speed current rise modes (high, medium, low), digital values ​​are displayed on the electronic display. According to the instructions, the maximum digital value of the peak of the reaction to irritation is the number 80. The scale is from 0 to 80. If the patient experiences any sensations in the numerical range from 0 to 40, then this indicates the viability of the pulp, in the range from 40 to 80 - partial necrosis of the pulp, if no reaction is observed at an indicator of 80, then this indicates complete necrosis of the pulp.

We carefully studied the instructions and the technique of the procedure, then proceeded to practice. Patient A., 21 years old, KPU=6, PMA=.30%, orthognathic bite, oral mucosa without pathological changes. The patient was informed about the technique of carrying out, about the safety of this technique. We made sure that there are no absolute and relative contraindications. The patient was placed in the dental chair in a sitting position. We agreed with the patient that when the first sensations appear in the tooth (tingling, slight push, etc.), he will inform us by raising his hand or pronouncing the sound “a”. Produced professional cleaning of the studied teeth using the Sultan Topex polishing paste (Sultan, USA), the teeth were isolated from the oral and sulcular fluid using the AmazingDam liquid rubber dam (Amazing White, USA). The crowns of the teeth were carefully dried with cotton balls towards the gums. The mouthpiece (passive electrode) in the Pulp Tester DY310 (Denjoy, China) was placed on the lip in such a way that it did not come into contact with the test tooth and the active electrode, and the mucous membrane at the place of fixation of the passive electrode was wet. On the working part of the active electrode applied Roc gel Medical Minerals ("R.O.C.S", Switzerland) (contact medium) for the passage of current in the tooth tissue. Do not use distilled water as a contact medium. It does not conduct electricity because it does not contain dissolved salts. We place the active electrode on the sensitive points of the teeth (for incisors - the middle of the cutting edge, for canines - the top of the tearing tubercle, for premolars - the top of the buccal tubercle, for molars - the top of the anterior buccal tubercle). At these points there is a sufficient layer of enamel (enamel has a high electrical resistance), so the current flows through the most shortcut and the reaction occurs already at an insignificant current strength. In areas with a thinner enamel (cervical region, fissures), current dissipation is observed and the threshold current strength increases greatly. If the tooth was previously treated and the filling does not affect the area of ​​sensitive points, then this will not affect the measurement results in any way. When the filling comes into contact with the gum, the study of the electrical excitability of the pulp is not carried out, since an electric current leaks and the measurement indicators will be incorrect. If the filling is located on the contact surface of the tooth, then an interdental celluloid strip lubricated with petroleum jelly should be inserted in order to prevent leakage of current into neighboring tooth. When sensitive points are affected carious process, the study is carried out from the bottom of the prepared cavity. We investigated the electrical excitability of the pulp next teeth: tooth 1.1 (intact), 1.2 (intact), 1.3 (intact), 1.4 (intact), 1.5 (intact), 4.6 (treated for dentine caries), 4.8 (intact).

Tab. The results of measuring the vitality of the dental pulp with the Pulp Tester DY310

After analyzing the results obtained, the conclusions were made: the pulp of the teeth 1.1, 1.2, 1.3, 4.8 is viable, the values ​​of the EOM of the teeth. 1.4, 1.5 are close to the values ​​corresponding to partial pulp necrosis, although the teeth are intact. We assumed that this discrepancy is due to the individual sensitivity of the patient or the inaccuracy in determining the viability of the pulp with this apparatus. The reaction of the pulp of tooth 4.6 is quite understandable, since the tooth was previously treated for dentin caries. The patient's tooth does not bother, but we found that there is partial necrosis of the pulp of the 4.6 tooth.

Conclusions.

1) The main advantages of EDI are: simplicity, accessibility, information content, the ability of a doctor to work independently, without resorting to the conditions of a physiotherapy room or a doctor of another specialty. Negative side of this technique, it is necessary to take into account many factors (the correctness of the method of carrying out the procedure, the individual threshold of pain sensitivity, age, tooth group, the characteristics of the apparatus used, the design on the teeth, the degree of root formation, etc.), which can affect the EOM and make it difficult to interpret the results.

2) Indicators of the electrical excitability of the pulp in the anterior and chewing groups of teeth are different. EOM values ​​are lower in incisors than in premolars and molars. The electrical excitability of the pulp of premolars and molars does not differ significantly.

3) The gender of the person does not affect the measurements. Depending on age, the electrical excitability of the dental pulp varies in different groups of teeth. In incisors, higher EOM values ​​are observed at 20–30 years of age, and in premolars and molars, at 41–60 years of age.

4) The device for EDI should be in each office of the dental clinic, its use is necessary in the diagnosis of caries (if necessary) and pulpitis (mandatory). At first glance, the method of work is simple, informative, but this method has enough cons and cons. The technique requires material, time costs, as well as the accuracy of the manipulations. Despite all the difficulties of this technique, EDI is advisable for use by dentists in their daily clinical appointments in every clinical situation, it helps in making the correct diagnosis and further treatment plan.

Literature

1. Molokanov N.Ya., Kupreeva I.V., Stefantsov N.M., Shashmurina V.R. Physical factors in complex diagnostics and treatment dental diseases. - Smolensk: SGMA, 2013. 42 p.

2. Abd-Elmeguid A.Yu D.C. Dental pulp neurophysiology: part 2. Current diagnostic tests to assess pulp vitality / J Can Dent Assoc. 2009. N75(2). P. 139-43.

3. Nikolaev A.I., Petrova E.V., Turgeneva L.B., Galanova T.A., Nikolaev D.A., Medvedeva T.M., Nikolaeva E.A. Electroodontodiagnostics: modern possibilities of the old method // Dental IQ.2014. N 42. From 83-91.

4. Nikolaev A.I., Petrova E.V., Turgeneva L.B., Nikolaeva E.A. Electroodontodiagnostics in modern dentistry// Endodontics Today 2015 N2. pp. 38-42.

5. Nikolaev A.I., Tsepov L.M. Practical therapeutic dentistry: tutorial, 9th ed., revised. and additional - M.: MEDpress-inform, 2013. - 928 p.

6. Nam K.C., Ahn S.H., Cho J.H. et al. Reduction of excessive electrical stimulus during electric pulp testing // Int Endod J. 2005. N38(8). P. 544-549.

7. Lukinykh L. M., Uspenskaya O. A. Physiotherapy in the practice of therapeutic dentistry: Textbook. 2nd ed. - Nizhny Novgorod: Publishing House of the Nizhny Novgorod State Medical Academy. 2005. 36 p.

8. Electroodontodiagnostics: textbook. Ed. A.I. Nikolaeva, E.V. Petrovoy - M.: MEDpress-inform, 2014. 40 p.

9. Chen E., Abbott P.V. Dental pulp testing: a review // Int J Dent. 2009. Epub. 12 p.m.

10. Jafarzadeh H., Abbott P.V. Review of pulp sensitivity tests. Part II: electric pulp tests and test cavities // Int Endod J. 2010. N 43(11). P. 945-958.

11. Jespersen J.J., Hellstein J., Williamson A. et al. Evaluation of dental pulp sensibility tests in a clinical setting // J Endod. 2014. No. 40(3).P. 351-354.

12. Pediatric therapeutic dentistry. National leadership / Ed. VC. Leontiev, L.P. Kiselnikova - M. : GEOTAR-Media, 2010. 906 p.

13. Redinova T.L., Lyubomirsky G.B. Indicators of the electrical excitability of the pulp of various groups of teeth in individuals different ages// Institute of Dentistry. 2009. N2. S. 75.

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Electroodontodiagnostics (abbreviated as EOD) is a method for assessing the condition of the pulp by checking its response to an electric current. Doing it is not painful, but during the diagnosis, discomfort may occur.

Electroodontodiagnostics not only helps to identify pathological changes in the pulp, but is also used to monitor the results of treatment. It can be performed as an addition and alternative to X-ray, if it is not possible to take an X-ray for some reason.

Application in dentistry

For the first time, the technique of electrodiagnostics was introduced into dental practice by the Soviet scientist Lev Rubin in 1949. Soon, EDI became widespread beyond the borders of the USSR. In 1980 it was the only method, which allowed to analyze the condition of the pulp.

At the present stage, EDI is competing with X-ray examination, diagnostics with light (transillumination) and the KaVo DIAGNOdent laser device.

However, radiographic examination is not always effective, transillumination is applicable only in the study of the anterior teeth. Both methods, together with laser diagnostics, only visualize the pathology, but do not provide complete information about its nature.

However, for accurate results of the study, doctors must first conduct x-ray diagnostics (or diagnostics with a laser, light), and only then - EDI. Even before the start of the procedure, the dentist should have assumptions about the area in which pathological changes have occurred.

Laser device Diagnodent

The essence of the EDI methodology

The nerve endings of the pulp, like any other, are capable of conducting current. The response to such electrical stimulation (electroexcitability) differs depending on the state of the neurovascular tissue.

The higher the current strength to which the tooth reacts, the deeper the pathological processes are spread.

For example, an inflamed pulp has less electrical excitability than a healthy one. If healthy molars react to a current with a voltage of 2-6 μA, then with pulpitis, electrical excitability decreases to 7-90 μA. And with periodontitis (inflammation of the tissues between the root of the tooth and the bone) - up to 100 μA or more.

A reduced response to EOD is also observed in milk teeth during the period of root resorption, with tumors of the jaws. Complete absence or, conversely, too low electrical excitability is characteristic of erupting teeth with still insufficiently formed roots. Based on their differences in the response of pulp irritation to the current, the dentist draws a conclusion about its condition.

Indications

EDI is effective in diagnosing diseases such as:

• carious lesions of the crown, including pulpitis;
• traumatic injuries of the dentoalveolar apparatus;
• neoplastic diseases jaws, including the cyst of the root apex;
• purulent inflammation jaw bones;
• actinomycosis maxillofacial area (fungal infection);
• sinusitis spread to bony walls jaws; paralysis and paresis of the facial nerves.

Justified in determining the degree radiation injury enamel and dentin.

Apparatus

For EDI, devices are used, which are called electrodontometers:

• EOM-1 and 3;
• OD-2;
• OD-2M - a modernized odontometer, allows you to use alternating and direct current of the city network.

Portable electronic and digital testers are also used:

• Pulptest-Pro IVN-1;
• Pulp Tester;
• Analytic.

Procedure technique

1. The patient is seated, a rubber mat is placed under his and the doctor's feet.
2. The tooth to be diagnosed is isolated from saliva and dried with cotton wool.
3. The active electrode is installed on the teeth, the passive one is given to the patient in the hand or fixed on the back of the hand, depending on the model of the apparatus.
4. A current is applied, during which the patient may feel heat, a slight burning sensation, a push. He immediately notifies the doctor about all his reactions with a sound or gesture (by raising his hand, for example).

It is very important that during EDI the active electrode does not touch the gums and oral mucosa, and the enamel does not become wet, for this it is periodically dried.

The electrical excitability of each tooth is checked twice, for the conclusion about the state of the pulp is taken average. Incisors and canines respond to current faster, they have thinner enamel and dentin, premolars and molars are slower.

Contraindications

Electroodontodiagnostics is not carried out on teeth with artificial crowns and with a temporary loss of sensitivity of the maxillofacial zone during the period of anesthesia. Also, the procedure is contraindicated in patients with pacemakers, amalgam fillings.

results

To obtain reliable results from EDI, any contact of the electrodes with metals and saliva must be excluded. Very important mental attitude the patient, because out of fear people can signal a reaction to the current even when the device has not yet been energized.

Prices for electroodontodiagnostics

The average cost of an EDI procedure in Moscow dental clinics is 300 rubles. in St. Petersburg and Nizhny Novgorod- 200-250 rubles. It is slightly cheaper than other methods for diagnosing caries and pulpitis.

On our website you can find a list of clinics that successfully diagnose diseases of the dentoalveolar system using electroodontodiagnostics.