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Clinical experience of treating the bottom of the pulp and the side of the root canal

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First location and causes of disease

1.1 Latrogenic perforation

Expand or find a root pipe pile to repair, caries, root canal preparation and pulp often lead to perforation, and expand or find root caries and pulp to mouth, often leads to the pulp chamber floor wear, repair pile and root canal preparation often causes root canal perforation, if the operation failure and experience lack of morphological abnormalities in the root canal, root canal calcification and bending when there are more prone to such factors.

In the 59 cases of accidental perforation, the results show that the perforation may occur in all the teeth, and the maxillary teeth are more common than the mandibular teeth. The incidence of maxillary canines was the highest, followed by lateral incisor, central incisor and premolar, and the incidence of molars was the lowest.

However, the incidence of the mandibular first molar was the highest, followed by the second premolar and the first molar teeth, the lowest incidence rate, the incidence rate of medical and dental pulp. The perforation was most common in the buccal and proximal root, and the second was in the distal root of the root and the bottom of the pulp chamber, and the incidence of perforation of the lingual side was lower.

Maxillary anterior teeth in the buccal perforation, near the side of the root of the wear occurred in the premolar and molar root canal preparation when the probability of occurrence of iatrogenic perforation of the lower root canal nail making and the root tube fixed in the treatment process, calcified root canal perforation appears high probability, curved root canal and looking for the roots probabilistic perforation tube.



1.2 Physiological, pathological and idiopathic absorption

Deciduous teeth period occurs this absorption. Permanent teeth at the root of the bifurcation of the location and near the chronic inflammation. Under normal circumstances, the maxillary lower jaw idiopathic absorption of the probability, but can not be determined, which is associated with trauma. Pulp floor perforation is generally pathological absorption.



1.3 Caries perforation and perforation of pulp floor

Perforation at the bottom of the pulp chamber was caused by the bad perforation of the dental cavity. The incidence rate of the upper part of the upper jaw was lower than that of the lower jaw.



Second, accidental perforation

If the lesion is more serious inflammation, inflammation can spread to other parts of the periodontal, dentin, cementum and alveolar bone absorption and formation of periodontal pocket, loss of periodontal tissue, and then remove the loose tooth.

A common cause of clinical exelcymosis include periodontal abscess, pain, inflammation and root fracture. The following factors related to the degree of filling material toxicity and tightness; the size and location of perforation and sulcus; mechanical trauma degree; there is no infection.



Third, diagnosis of perforation

Because of bleeding and pain the larger perforation is easy to diagnose. Can be inserted into the root canal or gutta percha with perforation X-ray diagnosis of root canal perforation or not easy to find.



Fourth, adverse factors in the treatment of perforation

Once the perforation occurs, it should be closed in time, and the longer the exposure time, the worse the prognosis. Generally, the perforation is relatively small, and the structure and performance of the material because of bleeding and exudation, the environment is wet, most of the equipment can not reach the hole. If the perforation is a bottomless pit type perforation, perforation in soft tissue, easily lead to excessive filling, thus organization structure, the oppression root of poor prognosis.




More than the past due to improper treatment and removal of the teeth, there are more ways to deal with, but should be depending on the specific case may be.



There is no need for special treatment, only in the conventional root canal filling in the treatment of side wear. Two situations apply: perforation near the apical part and in the curved root canal; due to internal absorption caused by small perforation. We used Ca (HO) 2 root filling paste tube, two weeks after conventional root canal treatment and filling.



The perforation as lateral canals to fill. In the first place, the position and depth of the perforation can be detected, and the normal filling can be carried out under the perforation. For the perforation, we can fill it with the appropriate tip of the gum, which can reduce or avoid the damage to the periodontal tissues.



Tooth cutting and root cutting and resection. For perforation repair incomplete, near the root tip, perforation position of the serious infection or the root canal is difficult to get through and so on, we can take the above measures. In the operation process should adhere to the principle of conservative treatment, as far as possible to reduce the surgical resection, reduce the surgical wound.

If the performance of patients with maxillary molars at the buccal root palatal side of the side wear and the mandibular molar near the roots of the far-lateral wear, surgery is difficult to implant the device, so this situation can be cut or half cut for treatment, Reverse filling method to fill.



Filling repair is an effective method for the treatment of the bottom of the pulp chamber. This method is non-toxic, non carcinogenic, will not cause allergic reactions, help to repair the alveolar bone and cementum, the material used more affordable, less costly, is the most ideal filling materials and good performance. The clinical use of strict isolation and disinfection in wet conditions, using Ca (HO) 2 paste perforation covering without symptoms, conventional root canal treatment and filling for two weeks. If the bottom wear is caused by a bad tooth, it should be thoroughly disinfected and anti-inflammatory treatment of pit, and then repair the perforation.



Sixth, problems in clinical practice

1.Inflammation: Mechanical trauma degree and repair material biocompatibility determine inflammation perforation area organization, the key to successful repair is inflammation, main factors and biocompatibility, poor biocompatibility, trauma, inflammation reaction, healing is not good. Perforation repair should be reduced as much as possible to stimulate the perforation area and avoid filling.


2.Extra-fill: In the process of filling, the pressure should be given to the appropriate completion of filling, if perforated for pit type, fill in the material easy compression of periodontal tissue, the prognosis is poor. So when filling without adding too much pressure to reduce the filling possible.


3.Sealing property: Strict isolation of pulp cavity and root tissues is a prerequisite for reducing inflammation, so in the repair of perforation, the material must be tightly covered on the perforation. To sum up, in the town of Nanguan operation process should be reduced or avoided perforation occurred. And once found the perforation should be treated immediately, repair teeth should be try to save.