Temporary teeth

periapical desease
(periodontitis)
 Temporary teeth periapical osteitis
treatment
І. Classification
The most common forms of temporary teeth
preiapical inflammation :

Periodontitis
 Periodntitis chronica diffusa cum fistula
Sine fistula

 Chronica exacerbata
cum endostitis
Cum abscessus submucosus ( subperiostalis)
 Temporary teeth periodontitis

classification

GANGRENAE SIMPLEX?
Gangraena pulpae
GANGRENAE COMPLICATA?

PERIODONTITIS ACUTA SEROSA

PERIODONTITIS ACUTA PURULENTA
PERIODONTITIS CHR. GRANULOMATOSA DIFUSA
PERIODONTITIS CHRONICA EXACERBATA
Characteristics of the temporaty
teeth endodontium
Dentine
– wide dentine tubules / lower degree of
mineralization
–Excessive dentine canals over the apical
delta
Pulp
– different degree of maturation, stages of
pulp development, biomorphosis
– size of pulp chamber
–Width of the root canals
 Characteristics of the
temporaty teeth
endodontium
stages of root development
Root walls formation
Apex formation
 Physiological resorption
resorbing stage
Pulp reactivity
 Degree of alveolar bone formation
 Temporaty moalrs
formation stages

Pre-eruptive
period
 Etiology of pulpal
inflamation
 Infection
Complicated or lack of pulp
treatment.
trauma

 Cause by :
– Microorganisms
– their toxins
 The inflamed pulpa causes
complications in the apical
and later in the marginal periodontium
 Meaning of the physiological
phase of the pulp
 root walls formation and simultaneous
pulp formation:

The inflamation easily passes to from the

coronar to the radirular pulp and engages
the developping parodont and the growth
zone
 The functional (active) stage of pulp :
** the toxins and the enzymes of the MO
stimulate the pulp to defend 
transparend sclerotic dentin formation
(under the dentin)
? Secundary protective dentine (in the
pulp chamber, under the carious process)
 this blocks the attack of the etiological
factors in depth.
 Biomorphosis of pulp perdiod– (resorbtion
stage):
*** lowered exchange and defense
possibilities of the pulp
*** the odontoblasts do not function corectly

sclerotic and reparative dentine is not

formed
*** all cels, neural fibers and blood vessels
are asthenic
 Exit : ** the necrotoxins are an
etiologic factor of pulp inflamation
** in the resorption stage
(biomrphosis) pulpal inflamation is
easily spread in the apical and
marginal periodontium.
 NB! While the toot are in I and
III stage of development, the
inflamation can not be limited
 only in the pulp, and not in
the periodontium.
Clinical features of

temporary teeth

periodontitis
The most common
periodontitis are the
chronic ones
The most common is

the resorbtive

form,the prolerative

one is vary rarely

found.
Exacerbation of
periodontitis chronica
leads to a fast exudative
inflamation and abscess
.But very soon the process
become chronic with
fistula tract.
 Diagnostics
 Anamnesa - ** tooth
decay ** pain
– can not be described by
children. During the
exacerbation the pain is
severe and after the
process became chronic
there is no such a pain
,but only fistula or swelling
.
 Clinical examination
Visual examination
Probing
Percussion
Looking for a fistula in the apexes
projection area.
 Paraclinical examination
 Visual examination
 Extraoral – lymphadenitis
 Vestibulum oris – periapical region
 Caries decay depth – is the pulp horn
destroyed ?
 Carious dentine color
 Smell of the carious dentine
 Periapical mucusa erythema
 Fistula, Fistula tract
 Probing
 Pain

 depth of the decay

 tooth mobility
 Paraclinical examination

 radiograph

EOD –do not use on temporary

teeth
 The diagnosis is made after :
 Initial diagnosis
 differential diagnosis
The softer desease
The most probable diagnosis
the more severe diagnosis
 The final diagnosis is more likely to be made during the
working process
 NB! There can be a different diagnosis in
each canal of the tooth
 NB! We always accept the most severe diagnosis
 Periodontitis and
gangrena treatment
 Formalin- resorcin methodic is used
 first visit – temporary formalin 0
resorcin pillow
 Second visit Втори сеанс-
formalin – resorcin paste and ZnO
liner and obturation
Temporary molars teeth
Endodontic treatment

First temporary molar

– mortal amputation (
pulpotomia)
Second temporary
molar – mortal
extirpation (
pulpectomia)
Temporary molar treatnetnt

Crown pulp
amputation
Paste placement in
the ofirices and the
floor of the pulp
chamber
treatment

 liner
 obturation
Temporary molar
radiograph

 Mortal amputation
 Temporary teeth periodontitis treatment
-If physiologic
exfoliation is not
expected soon
Indications - if the tooth is
necessary in the
dentition
Goal – to inactivate and to disarmament
of the pathogenic micro flora
- Limit the disintegration of the pulp and
periodontium
- Disarm the putride tissues, and stop
the toxic disintegration
- - stimulate the defense and healing
process of the periodontium
 Temporary teeth periodontitis treatment

Methods
Two visits Formalin-resorcin method:
First visit – caries removal,
- pulp access
- crown pulp amputation -1mm
below the orifices
-temporary pellet with FR

Formalin 40 % + resorcin (crystals) tor 2-3 days

One drop till supersaturated solution
 Pharmacologic action:
 Formalin and resorcin are antiseptics which supress and disarm
the patogenic MF and gangrenous disintegration
 Affect the infected root pulp
 Affect the microtubules system on the floor of the pulp chamber
 Affect the microtubules in the dentine and in the root canals
 By exuding paraformaldehide gas affect the periodontium
 Form bakelite resin, wich mumificates , impacts, and does not
permit reinfection, because it incorporates organic debris from
the pulp gangrene and stops the process of putrification
 Paraformaldehide gas is exuded.
It difuses and has a strong antiseptic activity.
Mainly in the first 2-3 h.
It slowly decreases it’s action till 48h.
A minimal effect can be found after this
period.
This is enough to support a good results

Coagulates the proteins in the superficial layers,

and stimulates the cells of the deeper layers.
Stimulates the cells of the deeper layer to
Produce young granulomatous tissue
 The exchange and defense mechanisms in the
prediodontium can limit the inflammation
 Healing process in the periodontium is related to
the proliferation process of the young
granulomatous tissue. This tissue undergoes a
process of fibrosis and ossification and can
transform into normal bone tissue.
 If there is a fistula tract FR coagulates the
superficial epithelium layer and stimulates the
underlying layer to form young granulomatous
tissue – closing of the fistula.
 Features of the fist apointnent
 Pre-fistula stage – fistula must be created
 If there is a fistula, the tracts must be treated
with AgNO3.
 If there is an old endodontic treatment the
bakelite should be removed
 dried RF pellet can be left.
 If the sympthoms do not disappear the tooth can
be extracted.
Second appointnent : put amputation paste
In the orifuces. Keep everything sterile

Ex tempore
Formalin 40% resorcin- crystals+ ZnO= paste
1 drop supersaturated solution

Liner + obturation
The paste is a temporary source of PFA gas.
This gas performs the disinfection of the root
Canals in distant places. The paste strengthens
the effect and provides protection for a long
period of time
 advantages: has stronger and long
Lasting action, affecting the infection and the
Doxic decay comparing to stranski’s
Bakelitisation method.
Disadvantages: the dosage of the medicaments
is not precise, the method is gentle, but
Creates good possibilities for healing process

Remark: the resorcin can be replaced with

Carbamide
Stranski’s bakelitisation method
Indications:
only for gangrenae simplex treatment
First appointment – caries removal
create pulp access
crown amputation 1mm in the orifices
temporary Tricresol formalin 1:1 dryied pellet
For 2-3 days
Second appointment – under aseptic conditions
-bakelitisation with impatcin
A+B+C --- bakelite resin
cavity is filled with ZnO- eugenol thymol-
-one week observation
 Third appointment – liner from the egenolat –
obturation
 Extraction treatment
 If the inflamation is chronic and the resorbtion Is
advanced
 If the tooth causes focal inflammation
 If there is a focal syndrome
 Treatment of periodontitis chr. exacerbata
 Antibiotics
 Hydratation
 Vitamins
 Mechanical and chemical treatment of the tooth.
 Provide drainage and time for chronification of
the proces.
 What to do when there is a fistula ?
 The fistula must be treated together with the
tooth.
 The epithelium covering of the fistula have to be
removed by using AgNO3.
 Stimulate its closing.
 If the temporary tooth can not be treated with
the discussed methods ,it must be extracted ,no
matter of the future orthodontic problems . The
usage of space maintainers could prevent this
complications.