Gum coagulation: what is it and how is it done?

General overview of the procedure

Gum coagulation in dentistry is a process during which diseased tissue is treated, cauterized, and also excised under ultra-high temperature. The procedure can be performed using different heating sources: heated instruments, electrocoagulators. Also, such an operation is often performed using a laser - it has the most gentle effect.

The description of the procedure sounds a little scary, but in fact this technique is completely safe for the patient’s health, as well as his psychological state. Do you agree that the absence of a scalpel (in the classical sense) and the need to carry out extensive intervention immediately puts you in a positive mood? In addition, the procedure is performed under local anesthesia, which means you will not feel any pain and will not have to be afraid of extremely high temperatures.

On a note! Thanks to the influence of special devices during cutting off damaged areas, the specialist performs the procedure with maximum accuracy and comfort for the patient. The soft tissues on which the intervention is performed are immediately cauterized using an instrument, so they do not bleed and remain sterile (they are disinfected), and also heal quickly during the rehabilitation period, which avoids complications and significantly reduces treatment time.

What is “hot” filling?

The correct name is the method of vertical condensation of hot gutta-percha. Long, difficult, not clear. Let's figure it out now!

Yes! “Hot” filling is only possible for root canals! There are no “hot” fillings (well, except maybe metal ones - although very few clinics work with them these days).

So, when filling the measles canal, the dentist’s main task is to fill the canal as tightly as possible with filling material. Not even the smallest gap should be allowed between the filling material and the wall of the root canal. If such a gap (empty space) is left, an infection will certainly begin to develop in it, which will ultimately lead to complications and the need to re-treat the tooth. Or even removal.

Today there are four main methods of filling root canals:

one paste method;
single pin method;
method of lateral condensation of cold gutta-percha;
method of vertical condensation of hot gutta-percha.

The first two methods, despite their fairly frequent use, cause quite a lot of complications, because cannot provide maximum obturation (filling) of the root canal with filling material. And if you really have to choose, then you have to choose between the methods of lateral (cold) or vertical (hot) condensation.

What is the difference between “cold” and “hot” filling?

With “cold” lateral condensation, the doctor inserts several gutta-percha pins of different diameters into the lumen of the root canal until the canal lumen is filled as densely as possible. Additional sealing is achieved through the preliminary (before the pins) introduction of a special paste into the canal - a sealer.

A gutta-percha pin is a thin column of a special plastic material (somewhat similar to rubber), which is inserted into the lumen of the root canal to seal it. Gutta-percha points come in different diameters. They should not be confused with titanium or fiberglass posts that are used as a basis for attaching a filling.

So, with “cold” filling, the lumen of the root canal is filled with several gutta-percha pins of different diameters until the entire canal is filled.

During “hot” filling, one thermoplastic pin, preheated in a special oven, is inserted into the lumen of the root canal. The diameter of the “hot” pin is selected so that it fills the entire lumen of the root canal. And, of course, the pins for cold and hot filling are different from each other and are not interchangeable!

Why is the gum most often cauterized?

Most often, patients are recommended to apply electric shock to the affected areas due to hyperplasia or overgrowth of soft gum tissue, also called papillae. They fill the interdental spaces and are very sensitive to any impact. Their excessive enlargement and inflammation are caused by household injuries (occurring when using floss to remove plaque, toothpicks, brushes with hard bristles, or eating hard foods), dental diseases, poor oral hygiene, malocclusions, or hormonal disorders.

In the absence of proper treatment, the area of the interdental papillae increases, the soft tissues begin to become inflamed and bleed, causing pain and discomfort. In addition, the formation of such growths can cause problems with the correct pronunciation of sounds, impaired blood circulation in the gums, lack of adequate nutrition, and the appearance of complexes (overgrown mucous membrane can completely cover the crown part of the tooth, which looks extremely unaesthetic), so dentists recommend cauterizing them in a timely manner.

Stopping bleeding during dental restoration

November 7, 2013

Introduction

Traxodent paste

It would be great if the gums did not bleed, since blood entering the surgical field greatly complicates the restoration of teeth. The cause of bleeding gums during restoration operations is dental plaque or trauma. Plaque leads to gingivitis, caries or periodontitis. Trauma that results in bleeding may occur during surgery. The wedges exert lateral pressure on the periodontal papilla. The cavity sealing process uses metal or plastic matrices with sharp edges that can injure healthy or inflamed tissue. Dental burs are used to remove caries, excise inflamed tissue and widen the gingival sulcus. Retraction cords are placed to deflect or pull back the gum in an attempt to reach the edges of the cavity. All this leads to blood contamination of the restoration area, which in turn complicates procedures such as taking accurate impressions, preparing the dental cavity, prosthetics and cementing. This problem is typical for orthopedic dentistry.

Dental prosthetics and periodontal condition are interconnected. Poor dentures may have ridges and difficult-to-clean areas that allow plaque to accumulate. In adolescents and older adults, oral hygiene may be poor. Insufficient prevention of plaque formation leads to the need for dentures. In addition, the main contributing factor to dental prosthetics in patients in the following case studies is a diet high in highly refined carbohydrates (carbonated drinks) and lack of nutrients (refined foods).

Rice. 1 Blood got into the first impression, resulting in voids

In order to exclude the development of gingivitis or periodontal pathology, it is necessary to ensure an accurate marginal fit of the prosthesis. A good example is fixed orthopedic restoration. The fit of the prosthesis depends on the completeness of the impression. If the dental laboratory receives an impression that is incorrect due to blood contamination, problems with the prosthesis arise. Based on such impressions, stamps will be inaccurate due to the formation of voids and bubbles. (Picture 1). If a commercial dental laboratory produces a denture using an inaccurate die, the dentist will receive an inaccurate denture that will not fit the patient and will be rejected. Everyone will be disappointed - the patient, the doctor, and the dental laboratory. As a result, everyone loses income. The patient will need to take time off work, the doctor will need to provide additional chair time, and the dental laboratory will need to facilitate the entire process. When a problem occurs, people usually blame it on someone else. For the dentist this may seem like a personal failure, but in reality it is a systemic failure. If this system is not corrected, the dental office's main source of income will suffer. The main task is to understand how blood and gingival fluid enter the surgical field during restoration work, and what can be done to improve the control system.

The defective impression was made according to a standard procedure using a retraction cord soaked in a hemostatic solution and a one-step impression. The thread was placed on the inflamed tissue to treat subgingival caries. Treatment of subgingival caries required subgingival extension of the tooth core, which led to the need for subgingival preparation for a crown. Bleeding of the tissue is typical for such cases. The system used must control bleeding during the impression taking process.

Rice. 2 Traxodent paste is applied to the bleeding groove

To ensure the accuracy of the indirect technique, a new impression must be taken. You should wash the bleeding tissue and try to dry the wet area. A straight cannula is attached to the Traxodent syringe. In this case, the cannula was bent over the handle of the mirror at an angle of 90°. This facilitates positioning in posterior areas of the mouth where direct access is not possible. Traxodent paste should be applied over the bleeding tissue, slowly squeezing over the gingival sulcus along the edge of the preparation.

The paste can remain in the groove for 1-2 minutes (Figure 2), then it must be rinsed with a water/air gun. After washing and drying, no bleeding is observed, the gingival sulcus becomes dry. To obtain a one-stage impression, impression material of low and medium viscosity is used. Other types of impression material are used with no less success.

Fig. 3 The repeated impression, in which no blood has entered thanks to Traxodent paste, has no voids

Traxodent paste is a retraction system based on Hemodent paste. The paste contains aluminum chloride, which causes tissue retraction and contraction. Aluminum chloride promotes protein precipitation, contraction of blood vessels and removal of fluid from tissues. Aluminum chloride-based paste reduces the risk of postoperative inflammation. Aluminum chloride is the least irritating of the retraction medications. This drug, placed in the groove, does not cause noticeable gum recession. Pallor of the gums is the first sign of the paste's action. After this, the oozing blood turns brown and stops flowing. These two signs indicate hemostasis and a positive result of impression taking. (Figure 3).

Thanks to the methods used in this system, a flawless re-impression is obtained without the use of additional retraction cords. A re-impression using Traxodent paste is preferable because a small amount of impression material is left behind the preparation edge. This ensures that the edges of the plaster die are precisely processed in the laboratory, resulting in a precise fitting prosthesis.

Rotational curettage with Traxodent paste

Rice. 4 Blood and fluid in the gingival groove

Let's consider the case when the tooth has an inlay for building amalgam on pins. This tooth requires support from the entire crown. This tooth had a healthy groove and sufficient amount of attached gum. The entire crown requires a clasp to improve prognosis. Creating a clasp requires preparing the tooth to the bottom of the gingival sulcus. Rotary curettage was used to create a groove using a high-speed diamond bur to quickly remove epithelial tissue in the groove adjacent to the margin. Studies have shown that rotary curettage has little effect on gingival margin height if there is adequate gingival keratinization.

Rice. 5 Traxodent paste applied close to bleeding tissue

Rotational curettage is necessary to create 0.2 mm of thickness in the sulcus to maintain adequate thickness of the polyvinylsiloxane impression material. This thickness is required to create tensile strength and prevent breakage when removed from the oral cavity. Removal of the sulcus mucosa resulted in bleeding in the repair area (Figure 4).

Traditional methods would require the application of a retraction cord for 4 to 10 minutes to widen the groove. In this case, Traxodent paste was applied for 2 minutes to control the bleeding caused by rotary curettage (Figure 5). Additional deflection was mediated by the use of the Premier retraction cap (Figure 6). After rinsing with a water/air gun, only amalgam residues are retained. The groove is dry, hemostasis has been achieved (Figure 7).

Rice. 6 Premier® Retraction Cap promotes gingival deviation

Rice. 7 Before taking the impression, Traxodent paste is washed off and dried

Application of Traxodent paste in the aesthetic area

For aesthetic procedures on anterior teeth, creating a groove around the edge with a bur, floss or laser may not be desirable as it may detract from the appearance. Cosmetic restoration procedures are difficult because the preparation line is in close contact with the gum. If the root of the tooth is very dark, a dark line appears in the area of the neck of the tooth. Patients view this as a cosmetic defect.

Applying a thread can lead to ulceration or inflammation of the connective epithelium. The problem is that it is difficult to control the force of thread application. Other trauma, such as mechanical pressure or surgical damage, can cause unwanted migration of the gum line away from the margin. Traxodent paste is the least traumatic method of drying the field and causes slight displacement and retraction of the tissue.

Let's consider a clinical case. The patient is very concerned about the aesthetic outcome and does not like the dark contrasting color along the gum line. She had a cracked porcelain veneer that needed replacing. The tooth has already been prepared at the edge of the gingival sulcus. The tooth has already been prepared at the crest of the gingival sulcus, and the edges will remain in the same position (Figure 8). Due to accidental contact of the bur with the groove, some areas were damaged and began to bleed. Traxodent paste is applied to the groove and remains there for 1-2 minutes (Figure 9). The tooth is washed with an air-water jet and dried. The area is ready to receive an impression (Figure 10). A one-step impression using low to medium viscosity tray material will produce an accurate impression without bubbles or voids. When examined after 3 months, the margin remains stable and within the aesthetic zone (Figure 11).

Rice. 8 Preparing a veneer for a bleeding groove	Rice. 9 Extrusion of Traxodent using a cannula parallel to the tooth
Rice. 10 Traxodent paste is washed off	Fig. 11 Complete gum restoration after 3 months

Hemostasis with Traxodent paste for class II fillings

Rice. 12 The gums are accidentally damaged when drilling out caries

The risk of blood entering during the filling of class II cavities is as high as when installing a crown or bridge. This problem may mean longer procedures for the patient and changes in the dentist's chair schedule. Bleeding in the interproximal area is usually associated with caries (Figure 12). Bleeding begins from the inflamed interproximal gingival area if it is touched with a bur during removal of carious dentin.

Bleeding also occurs during isolation of a carious lesion when a ring, wedge or rubber gasket comes into contact with inflamed tissue (Figure 13). Traxodent paste is applied to the bleeding area located in the deepest part of the interproximal pocket (Figure 14). After 1-2 minutes, the paste is washed off with an air-water jet and hemostasis is confirmed. It is obvious that the entire surface of the cavity can be visualized, after which filling is carried out in the usual way.

Rice. 13 Traxodent paste is applied directly to the bleeding tissue

Rice. 14 Traxodent paste is washed off

Discussion

The value of these case reports is that they demonstrate a new hemostasis technology (Traxodent paste) that can solve common bleeding problems in the area of restorative treatment.
Thanks to its balanced fluidity, the paste can penetrate and remain in hard-to-reach areas of the groove. This balanced flow is important when treating the upper and lower dental arches, as the drug remains in the groove without getting into the laryngeal vestibule or throat. This is important for the patient, as the procedure becomes less unpleasant. Typically, hemostatic agents are strong astringents that create a dry, tight, and rough feeling in the mouth. This new technology is important for the dentist because it allows the drug to remain in direct contact and in its entirety in the gingival sulcus. There is no need to re-apply the drug due to dissolution by saliva or leakage. After application, the drug remains in place, even in contact with the tongue or cheek. Paste differs from liquid hemostatic agents in its ability to absorb liquids. Treatment areas adjacent to the mucous membrane of the alveolar processes of the jaw may become contaminated to deeper spaces. The physician should be aware of the problems that arise in such areas with insufficient adjacent keratinized tissue. As one of the warnings, we can mention the risk of leaching of the hemostatic drug into deep areas between tissues that are not intended for applying the product. The paste is not intended for the treatment of gingivitis, periodontitis and other diseases. The doctor should supervise the application of the paste to the dental treatment area. Traxodent paste is intended to be inserted onto the surface of the tissue, like a bandage, and not to be inserted into the submucosa.

Conclusion

Bleeding is a common problem that occurs during the dental restoration process. Common causes include plaque-induced erythema due to gingivitis, along with the use of instruments in the treatment area or the inadvertent use of instruments that create tears in the gingival tissue during restorative procedures. Any injury to the inflamed tissue leads to bleeding in the restoration area. Bleeding leads to deformation of the impressions, lack of adhesion of the filling and contamination of the cement.

Traxodent paste is a retraction system based on Hemodent paste, which contains aluminum chloride. Traxodent stops gum bleeding and causes temporary soft tissue contraction without further tissue damage.

Dean Eledge DDS, MD Associate Professor, AEGD

Therapy for hypertrophic gingivitis

The disease is one of the most common in dentistry - it occurs with equal frequency in both adults and children. It is characterized by the proliferation of soft interdental tissues, which, if left untreated, can overlap the crowns of the teeth. The appearance of pathology is provoked not only by poor oral hygiene and hormonal imbalance in the body, but also by chewing hard pieces of food that injure the interdental spaces, and improper use of personal hygiene items (threads to remove plaque, brushes, etc.).

In complex therapy (taking anti-inflammatory drugs, physiotherapy, gingivectomy) to treat the disease, dentists recommend using a method such as coagulation.

Coagulation of the gingival papilla

The procedure is quite in demand due to the careless attitude of most people towards their own health. Due to limited time or fear of dentists, many simply do not treat diseases of the gums and teeth, such as gingivitis, caries, etc.

As a result, the lesion site becomes overgrown with pathological gum tissue. This disease requires medical intervention, namely coagulation of the gingival papilla.

Inflamed gingival papilla

Cauterization is performed under local anesthesia and during the procedure the patient feels only mild discomfort. Thanks to the use of an electrocoagulator, healthy tissues are not affected by the instrument.

Oral care after the procedure

The postoperative period is quite unpleasant and painful, since, in essence, a part of the living mucous tissue, albeit of a pathological nature, was surgically removed. The pain syndrome will accompany the patient for two days after the operation, after which it will gradually recede. To alleviate the condition, the doctor may prescribe analgesics.

Rinsing with herbal decoctions or chewing propolis will help relieve pain.

The recovery period after surgery takes on average from 2 to 10 weeks . This is exactly how much tissue needs to fully regenerate. During this time, the patient must regularly visit the attending physician’s office to monitor the condition.

The doctor may prescribe rinsing with an antiseptic solution of Chlorhexidine or Furacilin and the use of anti-inflammatory ointments. It is very important to prevent infection from entering the treated tissue areas.

Furacilin

Depending on the nature of the disease, the doctor may prescribe antibiotic medications in order to completely destroy the pathogenic microflora and prevent re-complications.

Other situations when the procedure is performed

Such a modern treatment method as coagulation is often used in dentistry for the following purposes:

removal of formations on the mucous membrane: malignant and benign,
removal of any granulation tissue,
correction and plastic surgery of gums to give an aesthetic smile,
treatment of periodontitis and periodontal disease (only in complex therapy): in particular, the procedure can be carried out to cauterize and treat inflamed gingival papillae that have grown during the course of the disease. And also for removing granulations and pathological tissues from periodontal pockets - at the end of the procedure, the periodontal pockets remain completely sterile, the tissues fit tightly to the tooth, which prevents plaque, bacteria and food particles from getting inside,
cauterization of inflamed gingival papillae: pathology can occur not only against the background of periodontal tissue diseases, but also due to trauma to the mucous membrane, malocclusion, hormonal disorders in the body, incorrectly performed dental treatment, chipped fillings and the presence of uncomfortable prosthetic structures,
removal of papillomas, fibroids: they may look harmless, but sometimes they grow greatly, causing inconvenience, and become dangerous to health.

Who should not undergo the procedure?

Despite the fact that the described technique has a number of advantages (in comparison with traditional methods of surgical interventions), there are also some contraindications to the operation. Coagulation is not performed if the following problems have been diagnosed:

intolerance to low-frequency electric currents: in this case, it is permissible to use only a laser,
exacerbated infectious diseases,
disorders of the cardiovascular system: there is a high probability of increased blood pressure,
disruption of the hemostasis system: the risk of bleeding increases,
chronic diseases: for example, diabetes.

Also, the use of “hot” instruments is unacceptable during the active change from primary to permanent occlusion in children, which occurs between the ages of 6-8 and 12 years.

Important! If the patient has the above conditions, the operation should be performed only under the supervision of a highly qualified specialist, and also provided that the likely harm from the development of the disease outweighs the risks of complications after coagulation.

Coagulation methods

There are several options for treating the affected mucosa. Depending on which device is used, the following methods are distinguished:

cauterization with a metal instrument with a hot tip: the instrument is considered obsolete and is rarely used nowadays - the procedure using it is quite traumatic, and the subsequent rehabilitation period is quite long,
excision with an electrocoagulator: here, with the help of a device, electrical energy is converted into thermal energy. High-frequency alternating electric currents supplied through the tool “dry” and destroy damaged areas,
treatment with a laser device: damaged tissues are “burned out” with a beam of intense light.

Types of coagulation (cauterization) of gums

Monopolar technology

A special return plate is placed on the patient’s body, which is responsible for closing the electrical circuit. A weak electrical impulse is passed through the patient's entire body and through the surgical instrument. With this procedure, you can get rid of even large neoplasms and tumors located in the deep layers of tissue. Due to its effectiveness, this method is used more often than others.

Bipolar technology

An electrical discharge is passed locally, only through the part of the body in which the tumor or inflammation is located. Therefore, the end plate is not used. This method is effective for the treatment of mild dental diseases.

The gum cauterization method is widely used in dental practice and shows good results in the treatment of periodontal diseases.

Before performing the operation, the doctor examines the patient’s oral cavity for injuries to the mucous tissues, since their presence can cause complications.

Bipolar gum coagulation technology

Upon completion of the operation, the patient is given a list of recommendations and a prescription for medications. For each patient, recommendations are made individually, depending on the disease and its severity.

Coagulation techniques and its types

Removal of inflamed tissue can be done using different techniques. Each of them differs in the way the current is supplied. There are two types of coagulation. Let's look at each of them in more detail.

Monopolar method and its features

The doctor uses an instrument that looks like a scalpel. But the effect on tissue is carried out not mechanically, but with the help of an electrode built into the scalpel handle, through which current is passed. In this case, electrical impulses (weak charges of safe alternating voltage) pass through the entire human body, and the safety of the process is ensured by a special return plate with which the tool is equipped. The presence of this element is mandatory, because it is responsible for the process of closing the electrical circuit.

The method is effective when performing coagulation to remove large tumors.

On a note! If cutting is performed with a faulty device or by an unqualified specialist, consequences such as injury and burns to the mucous membrane may occur during the procedure. The method is considered quite outdated these days, so doctors rarely resort to it.

Bipolar method and its features

The main difference between this method of coagulation is that the current passes only through the affected areas of the tissue (the doctor acts on them pointwise), so a return plate is not needed for its implementation. The operation is performed with an instrument with a forked tip, which grips and clamps the gum so that the electrical circuit is closed directly in the area of the procedure.

Available information about root canal treatment…

In one of the previous posts, I tried to talk about what caries treatment should look like at the modern level. Now it’s time to talk about another most common procedure - root canal treatment.

The need for such treatment arises when an infection from a carious cavity reaches the dental pulp, causing its irreversible inflammation - pulpitis. In this case, the only treatment option is its removal from the root canals - depulpation. The second diagnosis that forces the doctor to go so deep is periodontitis. This inflammatory process no longer occurs inside the root canals, but around the roots of the tooth, in the periodontium, causing destruction of bone tissue (and the consequences of this are clearly visible on x-rays). I deliberately do not dwell in detail on the terms, because... On the Internet you can find quite a lot of reference articles of varying degrees of abstruseness about these diseases, their causes, symptoms, varieties, methods of treating these varieties.

It is enough to make a request using the keywords “pulpitis” and “periodontitis”. And I would like to dwell in more detail on the main manipulation that a dentist has to perform in case of these diseases - canal treatment (endodontic treatment). At the same time, I will try to briefly highlight the general principles and methods of treatment that will help you see how competently and modernly your dentist carries out this treatment. This is important, since the consequences of poor-quality manipulations in the root canals directly lead to tooth loss ahead of time.

If you try to outline the standard modern protocol for any endodontic treatment, then in abbreviated form it will look something like this...

First, the doctor makes access to the canal(s) of the tooth. In different teeth there are usually from 1 to 4...sometimes more. In this photo there are two holes in the corners of the tooth cavity - these are the entrances to the root canals

Then the canal is gradually expanded with thin flexible instruments and simultaneous mechanical removal of pulp residues

At the same time, the canal is washed generously with various preparations, primarily with bleach (sodium hypochlorite in a concentration of 3 to 5%)

The canal is also cleaned with ultrasound

After the canal has been sufficiently washed and expanded, it is filled with gutta-percha and a small amount of special paste.

Next, the tooth is restored using the method that is best suited for the specific clinical situation.

So, the main markers of high-quality root canal treatment.

1. Use of rubber dam.

The rubber dam helps the dentist to reliably and hermetically isolate the oral cavity from the tooth being manipulated. Why is it important? During the expansion of the canals, the doctor must rinse the canal abundantly with bleach (I will write why and why below). This is a fairly strong caustic drug and if it comes into contact with the oral mucosa, it can cause a serious chemical burn. In addition, one of the goals of tooth canal treatment is to reduce the amount of microflora in the tooth canal to a slight minimum. If the tooth is poorly isolated from the oral cavity, then it is possible that infected saliva will get there during treatment, which means that the effectiveness of treatment will greatly decrease and complications are possible in the future. For this reason, it is especially difficult to do without a rubber dam when treating the canals of the lower lateral teeth .

Without a rubber dam, it is very difficult to practically treat canals according to all the rules.

2. Copious rinsing of the canals with bleach.

This process can always be felt by the characteristic smell of this drug. Why is this point important? The essence of any endotherapy is to clean the canal system from organic residues (i.e., pulp residues) as efficiently as possible. Because they are the substrate for microflora nutrition. If organic “dirt” remains in the channel and then becomes clogged, then ideal conditions are created for the development of “bad microbes” - there is food, there is no destructive oxygen, which means prosperity for the “microworms”. But the body is forced to react to this with inflammation. This is how granulomas and cysts develop over time. So about bleach and the importance of its use... Large fragments of pulp are removed by mechanically expanding the canal with metal “needles” - files. Small fragments are removed just when the canal is washed. In addition, it is sodium hypochlorite that “knows” how to dissolve the smallest fragments of organic residues. Not immediately, not instantly... but within 40-60 minutes of constant use of “bleach” in one channel, everything completely dissolves without a trace. If the dentist does not do this, then “minced meat” will remain on the walls of even a well-expanded canal, which the microflora will happily feed on, causing a chronic inflammatory process in the bone around the tooth.

Abundant and frequent rinsing of the canals with sodium hypochlorite for 40-60 minutes guarantees complete removal of organic residues, and therefore a good long-term prognosis for the tooth.

3. Ultrasonic cleaning of canals.

This process occurs in parallel with washing the canal with bleach. Using a special tip, the dentist periodically activates the solution directly in the tooth canal. The ultrasonic tip vibrates at high frequencies, creating turbulence in the solution, which is much better at removing organic debris from the dental canals. In fact, it all works on the principle of an ultrasonic cleaner. Thus, working with ultrasound makes it possible to reduce the exposure of the solution in the tooth canal to completely clean it of organic matter to 30-40 minutes. At the same time, the importance of using ultrasound is also due to the fact that the canals in teeth have a complex structure. From the main large canal, which can be washed and cleaned instrumentally, many smaller ones (like branches on a tree), sometimes microscopic, branch off. No tool can get through there. The only way to clean them is to drive “bleach” there with ultrasound to wash out even the microscopic remains of the pulp.

This is a photo of a river delta taken from space. Very often, an identical picture can be seen if you examine the root tip under a microscope - many small branches extending from the main canal. They can be cleaned of pulp residues only through the combined use of bleach and ultrasound for at least 30-40 minutes per channel. Otherwise, the risk of developing chronic inflammation (granulomas, cysts) over time increases significantly

This three-dimensional model of the structure of the canals of a multi-channel tooth shows that at different levels there are small branches that cannot be cleaned only mechanically using instruments

4. Control of work using x-rays and apex locator.
The final goal of the doctor during endotherapy is to expand, clean and fill the entire length of the tooth canal, exactly to the apex. At the same time, it’s bad if there is an “overshoot” or “undershoot.” How to correctly determine the exact length of the channel and why is it important? “Overshooting” or penetration of the filling material beyond the top of the tooth into the surrounding bone is undesirable, because can lead to various complications. An “undershoot,” a tooth that is not filled to the top, most often leads to the appearance of granulomas and cysts, because an untreated zone remains in which “bad” microflora settles. How to accurately determine the length of the channel? To do this, the dentist uses X-rays and/or (preferably “and” is definitely better) an apex locator. I think everything is clear with x-rays; many have encountered it. The dentist inserts an instrument into the canal, marks the length on it and takes a picture. After that, he can objectively adjust this length. An apex locator is a very convenient device, a sort of endodontic parking sensor. It is connected to an instrument with which the doctor expands the canal, and when the tip of the instrument approaches the apex of the root, it begins to squeak, the closer, the more intense... just like the parking sensors in a car. In this way, the dentist can control the immersion depth of the instrument in real time with an accuracy of fractions of a millimeter. Moreover, the first apex locators lied quite strongly, especially if the canal was not dry... Modern devices give very accurate results, practically minimizing the need for constant use of x-rays. However, the gold standard of endodontics is the use of an apex locator throughout the entire treatment, plus 3 x-rays for each tooth: status before treatment, during (usually with instruments or pins immersed throughout the entire length of all canals), after completion of canal treatment and tooth restoration. Moreover, the role of these photographs is rather documentary.

How to prepare for the procedure

There is no need for special preparation before coagulation, but you should do the following:

visit different specialists: before the procedure, if necessary, the doctor may refer you for a consultation with other specialized specialists (infectious disease specialist, oncologist, periodontist),
Avoid drinking alcohol several days before the procedure, as well as on the day of coagulation: it negatively affects blood clotting and the effect of medications and anesthetics used during the procedure,
have a snack before the procedure: the snack should not be heavy, but you should not completely refuse food, because After the operation, you will not be able to eat for at least another 1-2 hours.

How is the procedure performed?

The operation is performed only by an experienced dental surgeon. First, the doctor will sanitize the oral cavity and administer anesthesia (in the case of using a laser, it is often possible to confine oneself to local “freezing” in the form of gels and sprays, since the procedure causes virtually no pain to the patient). Next, the specialist works with an instrument designed for coagulation and performs the necessary manipulations.

Important! The patient should relax in the dentist's chair and not make sudden movements. Otherwise, the hand of even the most experienced specialist may tremble, and the instrument will damage healthy areas.

The duration of the operation directly depends on the degree of complexity of the actions performed, but on average coagulation takes no more than 20 minutes.

When removing a dental nerve, the following methods are used:

- vital extirpation, which involves complete removal of the pulp from a patient under local anesthesia, - devital amputation, in which partial mummification of the nerve is performed using a special drug, - diathermy (diathermocoagulation), during which the pulp is killed using an electric discharge, after which the doctor removes the non-viable nerve.

Vital extirpation

This technique allows the patient to get rid of the diseased nerve in one visit to the dental office. The use of vital extirpation is possible for acute or chronic pulpitis in a tooth with well-passable canals. Depulpation by vital extirpation occurs in 10 stages, during which antiseptic treatment of adjacent teeth is performed, administration of an anesthetic, cleaning of the diseased tooth from caries, opening of the pulp and amputation of the nerve, after which the tooth is filled. The entire procedure takes no more than 2 hours, but requires careful preliminary preparation and diagnosis of the tooth.

Devital amputation

Devital amputation is practically not used in modern medicine, since it is associated with multiple complications and the occurrence of necrotic phenomena in the nerves located in close proximity to the pulp removed by this method.

Diathermocoagulation

The essence of diathermocoagulation is to insert a microscopic electrode into the pulp cavity and apply a small current charge, which kills the nerve and cauterizes the resulting wound. Diathermocoagulation requires minimal doctor intervention in the jaw bone, so the depulpation procedure is almost bloodless. Occasionally, bleeding occurs when a nerve is removed from large molars.

After tooth nerve removal, many patients will experience pain for several days when closing their jaws or when hot or cold food enters the mouth. The pain is relieved with analgesics and does not require additional treatment.

Thanks to qualified treatment, a pulpless tooth can last for several years, especially if it was subsequently covered with a crown.

Advantages of the method

In comparison with the long-familiar, classical methods of surgical interventions, coagulation allows you to gently and painlessly target pathological areas of tissue, as well as destroy pathogenic bacteria. In addition, the gums do not bleed after coagulation, heal faster and look attractive. Therefore, you should not delay your visit to the doctor for fear of unpleasant sensations. Timely assistance will be the key to the health of your oral cavity and the beauty of your smile.

What complications may arise after surgery?

Many patients note that their gums hurt in the first few days after coagulation. This phenomenon is considered a completely natural consequence of the intervention. To reduce discomfort, you can take painkillers that you usually use and keep in your medicine cabinet.

If the pain does not disappear after some time, and additional alarming symptoms appear (inflammation and redness of the mucous membrane, the appearance of bad breath, discharge of pus), then be sure to visit a doctor. The specialist will tell you what to do to make the gums suppurate go away: for these purposes, antibiotics that destroy pathogenic microflora and treatment of the mucous membrane with antiseptics are most often prescribed.