Is tooth depulpation necessary before prosthetics?

Tooth depulpation is an endodontic manipulation to remove the neurovascular bundle from the tooth cavity and/or tooth roots. When is tooth removal necessary?

Depulpation of diseased teeth is carried out when the dental pulp is inflamed, due to the penetration of caries through the walls of the tooth to the intrapulp chamber. Through the carious gap created in the enamel and dentin, microbes and toxins enter the pulp, and the death of nerve fibers and capillaries of the pulp begins. Severe pain occurs when the tooth comes into contact with temperature and chemical irritants, i.e. for cold, hot, sour, sweet, etc.

Depulpation of teeth for prosthetic purposes

For grinding for a crown or dental bridge, the teeth are first depulped. High-quality depulpation (depulpation) of intact teeth allows you to avoid inflammatory processes (cysts and granulomas) under the root of the tooth on which the crown is installed. A non-pulp tooth under a crown can cause severe pain due to inflammation of the pulp.

How does pulp removal occur?

The process of depulpation allows you to stop the penetration of infection from the crown and root parts of the tooth under the apex, behind the root of the tooth, into the bone tissue surrounding the tooth. Thus, timely tooth depulpation prevents complications such as periodontitis , cysts or dental granuloma from developing. There are complete removal of the tooth pulp (from the roots and from the coronal part of the tooth) - pulp extirpation, and incomplete removal of the pulp (only from the coronal part of the tooth) - pulp amputation. Pulp amputation is carried out in the initial stage of pulpitis in order to preserve viable pulp in the root canals of the tooth.

What is depulpation and what is its essence?

What does tooth depulpation mean? Let's break the word down into parts - “de” means “removal”, and “pulp” refers to the soft neurovascular bundle that is located inside the tooth cavity and in the root canals. That is, depulpation or depulpation is the removal of the so-called “dental nerve”. After which the “empty” areas are filled with filling mass or pins, and then closed with crowns, inlays or special fasteners for dentures. Depulpation[1] is irreversible, i.e. a new pulp does not form in place of the removed one. Dental tissues cease to receive nutrition from the inside, and the tooth itself is considered “dead.” But this does not mean at all that it will fall out soon.

Any dentist should be able to carry out this procedure, but in the field of work this is most often done by dental therapists or more specialized specialists - endodontists. That is, if a patient comes to an orthopedist for a prosthesis, then if pulp removal is necessary, he will refer the person to a dentist-therapist.

What is the procedure

Depulpation is a dental procedure in which the pulp, the neurovascular bundle of the tooth, is removed. The pulp ensures the vitality of the tooth and, in particular, its sensitivity due to the large number of nerve endings. Depulpation is a complex dental procedure that can cause severe pain. After depulpation, the tooth actually dies, since metabolic and restoration processes no longer take place in it, but retains its chewing function.

What is the purpose of depulpation?

The goal of the procedure is to achieve several important results that will allow the patient to wear the prosthesis for a long time. Moreover, during the entire period of wearing the person will not be bothered by pain and the need to remove, for example, a crown. Let's take a closer look at what effect should be achieved:

• the pulp will not overheat during grinding of the stump and, accordingly, will not become inflamed (i.e., pulpitis will not appear under the crown),
• cariogenic bacteria will not penetrate into the pulp (i.e., pulpitis is again excluded),
• It will be possible to place pins or a core inlay into the canals: this will strengthen the restoration, i.e. it will last longer.

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Should I remove the nerve in the tooth or not? That is the question!

Agree, it is quite a common situation when, after treating caries with a therapist or treating a tooth with a crown by an orthopedist, the latter may begin to bother you. One of the controversial questions that patients have to face at this moment is when to remove the nerve in a tooth , and under what circumstances is there a chance to keep the tooth alive? In reality, this question is not always clear-cut for dentists either. In this article we will try to figure out what the difficulty is here.

Firstly, you need to immediately decide that a “living” tooth is always and definitely better than a “dead” one. Because under the “nerve” there actually lies an entire organ, consisting not only of the nerve, but also of blood vessels and other tissues and cells needed by the tooth. And all this is called pulp. It provides the tooth with both nutrition and protection from any external influences. And therefore, without it, it is difficult for our teeth to count on a long and happy life.

But often as a result of caries, injury or dentist intervention (for example, when grinding living teeth for crowns), an inflammatory process can occur - pulpitis . And here it is very important how reversible this process is. This is what is important for the doctor to determine when rendering a verdict on the pulp - to execute it (i.e., depulpate the tooth) or to pardon it (leave the tooth “alive”).

And here we can say that 100% reliable methods for diagnosing the reversibility of the inflammatory process in the pulp do not yet exist. If we had the opportunity to look inside the tooth with a microscope, then determining the vitality of the pulp would not be difficult. But it is impossible to do this on a living patient; such an opportunity is currently available only to pathologists. As a rather cynical saying goes, this is why these doctors are least likely to make a mistake in diagnosis. So what remains for practicing dentists? How can they avoid making mistakes? Which path should you take? You can only rely on much less informative indirect signs and use your experience and intuition.

Let us briefly examine what is still available to us when making a decision.

Patient complaints.

Of course, one of the most subjective signs, however, sometimes very informative. Therefore, it is often enough to listen to your feelings to understand how bad things are with your tooth. Depulpation certainly cannot be avoided if:

- You feel a fairly strong aching pain that occurs without any apparent reason and does not go away for a long time. At the same time, it can intensify when changing the position of the body (mainly when trying to bend over or lie down), and also noticeably intensifies at night. Usually in such a situation, many people run to the pharmacy for a pack of painkillers, although the most correct thing in this situation is to call your dentist with a request for an urgent appointment...

- You do not feel aching pain all the time, but only from some irritant (most often from cold ). The important point is that this pain does not go away immediately after removing the irritant for some time (from several seconds or more).

If, upon contact with cold, you feel only a short, instantly passing pain, then, most likely, everything for the pulp, maybe not right away, will end well. Any other sensations of discomfort, for example, painful biting or sensitivity when touched by a brush when brushing your teeth, are usually associated with completely different things and do not talk about the condition of the pulp.

Cold test.

This point smoothly follows from the first and is based on the inadequate reaction of the inflamed pulp to irritation (primarily to cold). This can be used for diagnostic purposes and, so to speak, to conduct reconnaissance in force. The technique is simple, but with a touch of slight sadism. The doctor cools the cotton ball with a special spray and touches the “suspected” teeth with it one by one.

The resulting response is compared with that of obviously healthy teeth that are 100% above suspicion (i.e., they are on the other side, on the other jaw and do not have carious holes or any traces of previous treatment). If suddenly someone wants to “play dentist” and can’t wait to find a bad tooth themselves, then at home you can do this test yourself by applying, for example, an ice cube from the freezer to different teeth one by one.

In general, self-diagnosis is pointless, but in this case it can still be useful to understand your own feelings, and then more confidently poke the doctor at the problem tooth.

It should be noted that this method is good primarily only in order to understand which tooth is actually bothering you. After all, pulp pain is quite poorly localized, and the patient often cannot say which tooth is bothering him. It even happens that the pain from the causative tooth radiates to the opposite jaw. This happens especially often with pulpitis of 8 teeth (wisdom teeth). Therefore, if in such a situation you trust only the feelings of the patient himself, you can break a lot of wood and depulpate innocent teeth for no reason. It is almost impossible to judge the severity of the inflammatory process and its reversibility using a cold test. For each patient, “oh-yoyoy” and “ah-yayayy” can mean completely different things. Although, as in the first point, by the duration and severity of the pain reaction, the doctor can indirectly judge the hopelessness of attempts to keep the pulp alive.

X-ray.

Another highly informative technique for most cases, which is completely useless for determining the neglect and reversibility of the pulpitic process. X-rays can also only indirectly help identify a problematic tooth if there is any doubt about the “culprit” of the pain. The pulp itself, like soft tissue, does not show any changes on x-ray if it is inflamed. What signs can help a doctor suspect something is wrong?

— location of the previously installed filling close to the pulp chamber

In this image: the red line marks the border of the filling, the blue line marks the border of the pulp. As you can see, they are located quite close to each other.

- hidden, invisible during visual inspection, deep carious cavity in the interdental space

In this picture: the black arrow shows a hidden carious cavity that formed on the back side of the lower 7th tooth under the gum level and led to inflammation of the pulp. The reason in this case was the 8 (wisdom tooth) that was not removed in time.

-presence of denticles in the pulp chamber or root canals

In this image: the yellow line marks the border of the filling, which is close to the pulp (its borders are marked in red). A denticle has formed in the thickness of the pulp due to chronic irritation (marked in blue).

-small reactive expansion of the periodontal fissure around the apex of the tooth root

Electroodontometry (EDO).

This is an old, if not ancient, way to check the condition of the pulp using essentially the same method as with the cold test. Those. irritate her. Only in this case it is no longer a low temperature, but an electric current. This time, nothing sadistic, as everyone usually thinks when explaining the essence of the technique. To carry it out, it is not at all necessary to pass current through the entire patient in some kind of electric chair. It is enough to connect a special small device to the tooth, which generates rather weak microcurrents.

By the value to which the tooth “responds” with slight tingling and pinching, one can judge (again, very approximately, unfortunately) the degree of pulp viability. The advantage of this method compared to the cold test is that instead of “ouch” and “ouch”, the doctor deals with impartial readings from the device. Another thing is that 100% of these indications can only be used to judge whether the pulp is alive at all, or whether it died a hero’s death. Everything else, again, is very conditional.

In the end, what do we have? There are 2 main problems with teeth suffering from pulpitis (or very similar pain : difficulties in some clinical cases in determining the source of pain, and difficulties in making a decision about preserving/removing the pulp. As we have seen, it is not easy for even an experienced and knowledgeable doctor to objectively understand these issues in all cases. If with the first question mistakes can almost certainly be avoided, then with the second... while there are no methods for objectively assessing the condition of the pulp, each doctor will make decisions at his own discretion. Someone, playing it safe, depulps all the teeth in a row indiscriminately. Someone is trying to keep them alive. The more data a doctor can collect and interpret correctly, the risk of making an erroneous decision will be minimized. In general, this is an iron law of medicine: the better and more thorough the diagnosis, the more correct and effective the treatment.

What happens if a mistake is made? I'll tell you one example from my practice. A young girl went to the doctor complaining of aching pain in her teeth “somewhere on the right side.” Without any special diagnostics, treatment began... First, one tooth with a deep filling was depulped, which seemed the most suspicious to the doctor. The pain remains. Then - the next one, the pain did not go away. Then both right normally erupted wisdom teeth were removed. The pain even intensified for a while... Instead of stopping and thinking at that moment, the doctor depulped another 3 (!!!) completely intact (i.e. untouched) teeth on this side, but on the other jaw. When the pain did not go away even after that, the girl, suspecting something was wrong, went to look for reasons in other places. Ultimately, she was diagnosed with trigeminal neuralgia, which, although it is not always well and quickly treated, in her case it was released quite quickly due to the treatment prescribed with the help of a neurologist. The result of the diagnosis using the “finger in the sky” method was 5 completely needlessly killed teeth.

Therefore, it is so important to collect as completely as possible all possible subjective and objective information if the situation is confusing. In this case, the probability of making a wrong decision will tend to zero. In addition, you should strive to preserve the pulp in the tooth, and do not rush into radical decisions if in doubt. At the same time, in borderline cases, you should always monitor the result of treatment, even if the pain has subsided. A cold test, x-rays, and odontometry will be able to promptly identify asymptomatic (“silent”) pulp death and the need for its removal. Otherwise, a cyst may grow completely unnoticed near the root of the tooth. And then there is a risk of losing the entire tooth.

When a nerve must be removed - indications

Whether tooth depulpation is necessary before prosthetics or not, only a doctor can say after a thorough examination - instrumental and x-ray. Mandatory removal of the dental nerve is necessary for the following indications:

• there are signs of pulpitis, i.e. inflammatory process of the pulp: pain, darkening of the deep layers of dentin,
• the top of the tooth is severely damaged,
• the natural crown has massive fillings,
• the patient often experiences relapses of caries,
• it is planned to install a crown with thick walls (for example, metal-ceramic): in this case, it is necessary to sharpen the stump quite strongly, which will lead to thinning of the dentinal layer (i.e., the pulp underneath will be less protected) and to its potential overheating during treatment with a drill. As a result, if depulpation is not performed, the risk of pulpitis increases and the time for re-prosthetics approaches.

What is pulp and does it need to be removed?

The pulp, or dental nerve, is the connective tissue that fills the tooth cavity. It consists of fibers, nerve endings, lymphatic and blood vessels. The dental nerve supplies bone tissue with nutrients, is responsible for the proper development of the tooth and protects it from infection.

If the pulp is damaged, an inflammatory process begins, and the person experiences severe pain. After removal of the nerve, the tooth becomes “dead,” but with professional manipulation by a doctor, it fully retains its functions.

When can you do without deletion?

Let's consider situations when depulpation can be abandoned, i.e. do not perform it before prosthetics:

• the stump (ground tooth tip) has thick walls,
• the pulp is not inflamed,
• in the future there is no risk of caries/pulpitis under the denture,
• overheating of dentin and pulp is excluded.

For veneers and restorative inlays, you can, in principle, do without depulpation altogether, as well as for thin ceramic crowns - but only if all the requirements just outlined are met.

Indications for nerve removal

Once the nerve is removed, the tooth becomes dead and brittle. Therefore, depulpation is not done immediately; instead, therapeutic treatment is prescribed. However, there are situations when this procedure must be done. It is recommended to remove the nerve in the tooth:

• when there is pulpitis (severe inflammatory process in the pulp);
• when there is periodontitis;
• in case of deep caries, if it has affected the pulp;
• in case the tooth has been injured.

Contraindications to the procedure

Contraindication is children's age. Or rather, a milk bite - here it is forbidden to go through root canals with instruments, because... the developing rudiments of permanent teeth can be damaged. Intolerance or prohibition of the administration of anesthesia is also a contraindication. As well as serious mental disorders, when a person can unknowingly harm himself during dental procedures.

Read on the topic: indications and contraindications for installing dentures.

How is the procedure performed?

How is tooth depulpation done? It is carried out in at least 2 visits to the clinic. In one visit, removing the pulp and immediately placing a filling or pin can be dangerous because if pathological areas remain in the cavities, then over time inflammation will develop under the prosthesis. Next, we will consider how depulpation occurs and what stages are included in it.

First visit to the doctor

First of all, the patient is given an x-ray to find out the condition of the pulp and the presence of inflammation under the roots. Then they give a “freezing” injection with an anesthetic. To remove the pulp, the dentist needs to drill out part of the hard tissues - enamel and dentin. First, the pulp is removed from the pulp chamber. And then, using special endodontic instruments, you will need to remove all the loose pulp from the canals. After this, medicine is put inside and a temporary filling is placed, which lasts for an average of 7-14 days. During the process, you need to take an x-ray to assess the quality of the work. And in the most modern clinics, canals are treated under a microscope.

If the pulp is removed using arsenic paste, the treatment technology is different. Anesthesia is not required here, because... it does not hurt. Paste is placed into the cavity and closed with a filling. After 2-3 days, the patient must return to the clinic, because... It is during this time that arsenic will “kill” the pulp bundle and may begin to negatively affect healthy tissue. If the filling falls out or is damaged, you should immediately contact the clinic.

Second visit to the dentist

At the second appointment with the doctor, the medicine or arsenic paste is removed, the canals are processed, dried and sealed. Next, you again need to take an x-ray to assess the quality of the filling and the absence of “empty” areas. The patient is sent to an orthopedist, where the doctor will unseal the canal a little and place a pin, stump tab or attachment (lock) for a removable denture into it, and then take impressions for a crown or other orthopedic structure.

Pulp - what is it for?

The pulp is a fibrous connective tissue penetrated by nerve endings and blood vessels.

Its shape completely follows the tooth, and is located in the center of the root part, filling the entire cavity. On top, the pulp is protected by a hard enamel layer, which prevents injury from the outside.

Main functions of the dental nerve:

• responsible for the formation, proper growth of teeth and blood supply;
• protects channels from pathogenic microbes;
• supplies the tooth with useful micro- and macroelements.

In addition, the pulp is responsible for the sensitivity of the tooth, that is, for its reaction upon contact with hot, cold, sour, sweet, and so on.

Reference! The dental pulp in adults is thinner than in children. This is due to age-related changes and a slowdown in regeneration processes. The older a person is, the thinner and weaker the nerve becomes, and the tooth begins to experience a deficiency of nutrients.

The appearance of pain and its causes

Why does a tooth hurt after pulp removal? Soreness often occurs after the anesthetic injection wears off. Pain after the procedure occurs for several reasons - normal and pathological. Here you need to understand the nature of the pain and what it is talking about.

For example, if the pain is tolerable or can be easily eliminated with painkillers, if it weakens every day, then this is a variant of the norm. After all, during the passage and expansion of the channels, healthy tissues were slightly injured, and pain is a natural reaction of the body. How long can a tooth without a nerve hurt after the procedure? On average, the discomfort goes away completely in 7-14 days. But in some patients it persists for 4-6 weeks and then disappears.

Read on the topic: what to do if a tooth hurts under a crown - causes of pain and methods for eliminating it.

The pathology is considered to be severe pain for several days, which is practically not relieved by pills. And also the reappearance of pain a few days or weeks after a period of painlessness. Symptoms such as severe redness and swelling of the gums, fever, headache, and bad breath should alert you. These signs most likely indicate that the depulpation was carried out incorrectly and inflammation began under the prosthesis. Or aggressive caries develops under the crown. Dental care is needed here, otherwise complications may arise - periodontitis, for example.

Causes of dental pulp damage

The dentist is often visited because of caries - damage and destruction of enamel, which at the initial stage causes aesthetic discomfort.

Important: if the disease is started, the process affects the deeper layers of the tooth and pulpitis develops, that is, the neurovascular bundle becomes inflamed.

Pathologies arise due to the rapid proliferation of microbes, but in addition, the pulp can be damaged for the following reasons:

• gum disease, in which the neck of the tooth is exposed, the bone tissue is destroyed and harmful bacteria penetrate inside;
• trauma, as a result of which part of the tooth can break off, and then microbes enter the resulting cavity;
• mistake by the dentist who installed the filling or crown. If some actions were incorrect, then the nerve will make itself felt after a while.

These are the main causes of pulp damage. The symptoms of this condition will be acute. The pulp will begin to react to cold, hot, too spicy, sweet foods. Removing the nerve in such situations is a necessity, despite the fact that minerals and nutrients will stop flowing to the tooth.

How long will a tooth last with and without a nerve?

It all depends on the skill of the doctor, on how competently he assessed the future functionality of the tooth with or without the preserved nerve. If metabolic processes are maintained in the supporting unit (i.e., while the pulp is preserved), then its service life is expected to be longer than that of the pulpless one. When all the conditions on the part of the dentist are met, and the patient treats the restorations with care, then, if the nerve is preserved, the support under the prosthesis can last on average 8-10 years (under a single crown) and about 7 years under an extended structure. If a tooth is “dead,” then its service life is shorter by an average of 30%, i.e. about 5 years.

But if the prosthetics are performed poorly, if the patient does not take good care of the prostheses, then the nerve may become inflamed - and very soon treatment and a new orthopedic design will be required.

Why do you need to remove the pulp?

We talked about the main reasons why nerve inflammation occurs, but most often pulpitis becomes a consequence of advanced caries. Therefore, it is very important to visit a dentist, even if nothing bothers you. The decision to remove the pulp is made in the following situations:

• pulpitis has passed into the stage of periodontitis, when inflammation affects the whole complex of connective tissue in the tooth;
• large area of ​​carious lesion;
• the infection spreads through the apex of the tooth root;
• the appearance of unbearable, prolonged pain;
• spread of infection under an artificial crown;
• consequences of improper treatment.

The nerve can be removed either completely or partially, it all depends on the degree of tissue damage. Depulpation will prevent the spread of the inflammatory process under the crown and preserve the natural tooth, which is a priority for endodontic therapy.

Does the shade of dental tissue change after the procedure?

Does the tooth darken after depulpation? Yes, over time the color will change - it will become gray and lifeless, because the tissues do not receive nutrition from the inside. But the pulpless unit is covered with a prosthesis - so the change in shade will be completely invisible from the outside. If the color of the prosthesis itself has changed, then the reason for this may be the following:

• the use of low-quality materials for manufacturing or non-compliance with its technology,
• staining from coffee, wine, food coloring, tobacco,
• formation of plaque and stone due to poor oral hygiene.

What complications may arise

During the process of removing the dental nerve, the following complications may occur:

• perforation of the root wall,
• exit of the instrument or filling mass beyond the root: as a result, periodontitis begins - root inflammation,
• fracture of the instrument in the root canal: such fragments are very difficult to remove, sometimes the entire tooth has to be removed.

Many dentists perform pulp removal only to insure against possible complications after prosthetics - caries or periodontitis. After all, then you will have to remove the prosthesis, treat the tooth, and then make a new prosthesis, because the old one either cannot be removed without damage, or it will not fit on a fresh filling or stump inlay. But let us repeat once again, they will not remove the nerve without clear indications.

How is pain relief performed?

Removal of the nerve takes place under anesthesia. Modern painkillers act quickly and do not harm the patient’s health. In dental practice, both local anesthesia and general anesthesia are used. The first option is applied to the area of ​​the oral cavity in which the tooth is located. The patient is fully conscious. Anesthesia is indicated when the patient, for one reason or another, cannot undergo local injections, or at his own request.

It happens that the patient is afraid of the injection procedure itself. In such cases, the option of preliminary anesthesia of soft tissues by using a spray with an anesthetic composition is provided. After its effect, inserting the needle will not cause pain or inconvenience. Thus, modern dentistry makes it possible to treat teeth without causing discomfort to the patient.

Features of care after removal

Oral care after dental nerve removal and prosthetics must be regular and thorough. Twice a day you need to use a brush and paste, follow the correct cleaning technique (only sweeping movements). It is recommended to rinse your mouth after each meal, and also to exclude toffees, chewing gum, hard pieces of food, and not to chew nut shells or seeds. In order to promptly identify and eliminate dental problems, you should visit an orthopedic dentist at least 1-2 times a year.

“I had a crown placed on a post about 7 years ago. They did it very well and treated it under a microscope. But after the prosthetics, the dentist told me not to forget to come to them every year or every six months for an examination. At the same time, professional hygiene was carried out. I’ve never had any problems in all this time, I eat whatever I want.”

Anna, review from irecommend.ru

Possible complications of dental nerve removal

Complications can occur due to the doctor’s inattention and poor-quality filling of the tooth canal. For example, the dentist did not completely fill the dental canal, did not treat it well enough with an antiseptic solution, and so on. The result will be the development of an inflammatory process. The following symptoms may be evidence of an incorrectly performed nerve removal procedure:

• the occurrence of severe pain, especially during sleep or as a result of mechanical pressure on the tooth;
• swelling and redness of the gums;
• malaise and increased body temperature;
• change in the color of the crown of the tooth and others.

If such symptoms appear, you should consult a doctor as soon as possible. To avoid such a situation, it is necessary to treat diseased teeth in a timely manner. The further the pathological process of destruction has gone, the greater the likelihood of complications.

Advantages and disadvantages of depulpation

The advantages of tooth depulpation are that it will eliminate or almost completely minimize the risks of pathologies appearing under the prosthesis - it all depends on the skill of the dentist and the patient’s attitude towards the new smile. The disadvantage is that the tooth will become “dead”, i.e. more fragile and with a shorter service life than non-pulpless. But these shortcomings are eliminated, again, by high-quality treatment and materials, and competent care of restorations, as well as the absence of extremely high chewing loads.

Activities before visiting the doctor

If the tooth hurts and it is obvious that nerve removal cannot be avoided, you should immediately make an appointment with the dentist. To relieve pain in the period before your visit to the office, you can perform a number of manipulations. Pain can be reduced or relieved by:

• Carefully remove food debris from the cavity in the tooth.
• Rinse with warm soda solution.
• Avoid chewing food on the affected side.
• Minimize exposure to high and low temperatures (including cold air).
• Mouth slightly open. If the bite is incorrect, closing the jaws may increase the pain.
• Painkillers.

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How much does depulpation cost?

How much does tooth removal cost? The cost of the procedure ranges from 3000-4000 rubles per 1 tooth in small cities, and in large cities, when treated under a microscope, from 3000-4000 rubles per 1 root canal (there can be 3-4 of them in one tooth). It is more profitable if the clinic offers turnkey installation of the prosthesis - absolutely all manipulations, examinations and materials are included in the total price.

[1] Shashmurina V.R. Biomechanical features of dental depulpation, 2022.

Author: Dulgarov Zh. G. (Thank you for your help in writing the article and the information provided)

Indications

The need to remove dental pulp may arise in the presence of an inflammatory process, injuries and periodontal diseases. In this case, the final decision on the procedure is made by the attending physician, who needs to analyze a number of factors - namely, the general health of the patient, age, reasons for the development of the pathological condition, and the presence of concomitant periodontal problems.

Depulpation is carried out in the following cases:

• acute or chronic pulpitis;
• tooth injuries that resulted in a fracture of its crown;
• the presence of residual effects after previously performed pulp removal;
• secondary infection of the pulp and development of inflammation;
• development of complications of cervical caries;
• periodontal lesions near the diseased tooth;
• surgical treatment of dental cysts;
• the need to prepare for further orthopedic or orthodontic treatment.

The final cost of tooth depulpation depends on a number of factors, including the complexity of the procedure. The price of depulping one tooth in dental clinics in Moscow starts from 3,000 rubles and above.