Topic 41: Vital extrapatient method of pulpitis treatment: essence, indications, stages

of implementation. The effectiveness of the method, possible complications.

Diathermocoagulation. Indications, technique, complications.

1. A 20-year-old patient complained of the occurrence of unreasonable pain attacks

(5-7 minutes) in the area of the 36 tooth during the day. Objectively: tooth 36 has a
deep carious cavity on the chewing surface. Sounding painful at one point, painful
cold test, with aftereffect of 5 minutes. Percussion is painless. On the roentgenogram,
the root canals have a slight bend, the canal lumen is clearly reflected. The tooth is
planned as a support for the bridge. Which of the following treatments is most
appropriate?
Vital extirpation
Filling a carious cavity
Devital amputation
Biological method
Vital amputation

Solution algorithm:
1. Analyze the patient's complaints: the occurrence of unreasonable pain attacks (5-7
minutes) in the area of the tooth on the lower jaw during the day.
2. Please note that the tooth has a deep carious cavity on the chewing surface, probing
is painful at one point, the cold test is painful, with an aftereffect of 5 minutes, the
percussion is painless. On the roentgenogram, the root canals have a slight bend, the
lumen of the canals is clearly reflected, which is characteristic of the indication for
vital extirpation.
3. Note that the tooth is planned as a support for a bridge, which is an indication for
vital extirpation.

2. A 25-year-old patient complains of involuntary paroxysmal pain in the left temple.

The pain occurs spontaneously in the evening. Sometimes pain occurs when the head
tilts, when the plane takes off. Objectively: all teeth are intact; exposure of the necks
of teeth 24 and 36. Percussion of the 24 tooth gives mild pain. On the roentgenogram
of the 24 tooth in the central part of the coronal cavity, the dentine density of the
formation is determined - 0.5x 0.5 mm. Suggest a treatment method:
Vital extirpation of 24 tooth pulp
Electrophoresis with potassium iodide in the projection of the apex of the 24 tooth
Vital amputation of 24 tooth
A course of novocaine blockade with vitamin B1
Remineralizing therapy in the cervical region of teeth 24 and 36
Solution algorithm:
1. Analyze the patient's complaints: involuntary paroxysmal pain in the left temple.
The pain occurs spontaneously in the evening. Sometimes pain occurs when the head
is tilted, when an airplane takes off.
2. Note that all teeth are intact; exposure of the necks of teeth 24 and 36. Percussion
of the 24 tooth gives mild pain, which is a characteristic indication for vital
extirpation.
3. Please note that on the roentgenogram of the 24 tooth in the central part of the
coronal cavity, the dentin density of the formation is determined - 0.5x0.5 mm.

3. The patient complained of pain at 26, arising when eating hot food, bad breath.
History: occasional spontaneous pain occurs. Objectively: in 26 there is a deep
carious cavity, communicates with the tooth cavity. Sensitive percussion, probing,
thermal diagnostics are painless. EOD - 70 μA. Which of the treatment methods will
be optimal in this case?
vital extirpation
devital amputation
conservative
vital amputation
devital extirpation

Solution algorithm:
1. Analyze the patient's complaints: pain in the tooth in the upper jaw on the left,
which occurs when eating hot food, bad breath. History: occasional spontaneous pain
occurs.
2. Note that there is a deep carious cavity in the tooth, which communicates with the
tooth cavity. Percussion is sensitive, probing, thermodiagnostics are painless, which
is a typical indication for congratulatory extirpation.
3. Pay attention to the increase in EOD, which is a characteristic indication for
congratulatory extirpation.