With each new generation of drills are becoming increasingly high-speed, so the perforation of the tooth does not present any special difficulties.
Yes, and the state of health of the teeth of modern man in comparison with that of an ancestor who lived in distant times leaves much to be desired.
Reducing the load on the jaw when chewing soft food leads to a decrease in the density of hard tissues of the teeth. Hence the frequent cases of perforation of teeth "natural", carious. Although under the law of nature it is just as unnatural as the perforation created by the dental instrument.
An unnatural message is formed between the inner environment of the tooth and the external surrounding tissues, perforation is a straight stroke, the boron is laid when removing or treating the tooth, or a sinuous "hole", protruded by caries.
As a result of loss of tightness, the soft inside of the tooth becomes accessible to food and microbial acids that destroy it from the inside.
Depending on the location, perforation is distinguished:
A fragment of the dental instrument can cause the
- perforation of the tooth wall in the crown area;
- its root;
- the bottom of its cavity. The cause of mechanical damage to the tooth can be an application in the process of dental treatment of a force significantly exceeding the required level:
- if the resistance of the tooth wall is less than expected, due to the low density of the tooth tissues due to excessive erosion or due to the pathology of metabolic processes in them;
- when passing a dental instrument through materials that are different in properties from dental tissues( for example, through an artificial dental crown).
Another category of common causes that provoke tooth perforation is the abnormal direction of the tooth axis with a deflection towards the lips, cheeks, tongue.
Contents
- Root and channel damage
- Diagnosis and therapy
- In the risk zone of the tooth crown
- Medical assistance and diagnostics
- Perforation of the maxillary sinus is a common matter
- To remove the tooth is necessary if. ..
- About the prognosis and consequences
- Prevention measures
Root and canal injuries
Perforation of the root and / or canal of the tooth occurs when:
- gradually forming a carious course, or if its treatment is poor in the past;
- production of manipulation in the dental canal, expressed curved, narrow, difficult to pass( especially if necessary to expand it to install the pin, correcting the defect of the wrongly sealed channel);
- inadequacy of the caliber of the instrumentation for the purposes of manipulation.
Depending on the place of formation, perforation in the root zone is distinguished:
- apical( in the apex region);
- bifurcation( in the zone of branching of the roots);
- average.
Root perforation - creating a message with periodontal tissues in both the middle and bifurcation zones, often accompanied by the development of severe inflammatory changes in the tissues followed by tooth loss.
Because of the impossibility of visually detecting the perforation of the canal, the symptoms of its appearance during manipulation are:
- insignificant but persistent bleeding from the root canal;
- acute acute toothache;
- a sharp deviation in the direction of the tool's stroke with a change in its position in the channel.
If the canal injury occurred without visible and tangible signs, then in the future, her clinic is determined by the symptoms of periodontitis:
- with pain in the area of the treated tooth;
- by changing the condition of the gum above the zone of inflammation( edema and hyperemia);
- general toxic and cerebral symptoms: headaches, weakness, frustration, malaise, hyperthermia.
Diagnosis and therapy
For emergency diagnosis, the channel is expanded and a paper pin is inserted into it. The orientation of the blood traces on the extracted pin indicates the intended perforation zone.
For the final diagnosis of perforation, a radiopaque method is used with the introduction of a file into the channel where the perforation occurred.
For the treatment of perforation resort to methods of repairing the defect:
- conservative;
- surgical;
- combining both directions.
The choice of a particular treatment is determined by both the ability to access the damaged area and the severity of the clinical case. If it is possible to see the perforated channel all the way through and find a defect in the accessible zone, its preservation-closing is performed.
The procedure assumes 2 options:
- sealing( sealing) of the main channel, ensuring the closure of the perforation;
- preservation of the defect with a preliminary attachment to the main channel of the file to seal the main cavity.
If the perforation of the apical zone leaves no choice, only the resection of the apex of the root is applicable here, in the case of an unsuccessful sealing attempt, other methods of influence, both surgical and conservative, are used in the bifurcation perforation.
The microsurgical section of the gum provides access to the defect area, and its sealing - sealing is carried out using a special cement( MTA or glass ionomer).
Periodontal tissue necrotomy with osteoplasty of bone defects completes treatment within the walls of the dental clinic.
Continuation of treatment at home includes the use of drugs with a maximum antibacterial effect, with good
resorption in bone structures in combination with anti-inflammatory and analgesic drugs. As rinses are used solutions of iodine-containing antiseptics, Chlorhexidine, etc.
One of the methods for removing a hole when it is impossible to access it is tooth replacement - extracting it from the jaw with sealing the perforation defect, cleaning and healing the jawbone and implanting the tooth back into place with the tire applied for the fixation strength.
In the risk zone, the tooth crown
The appearance of perforation in the area of the crown and tooth walls can be caused by:
- anatomy of the tooth structure( abnormal thinness of the adult wall or the bottom of the milk tooth, unnatural deviation from the normal direction of the tooth axis);
- incorrect selection of the caliber of tools and rotation speed of boron;
- errors in the performance of dental manipulation, so in the case of re-treatment it may be a lack of a review of the prepared area due to insufficient opening of the cavity.
Symptoms of fresh perforation are intense toothache and bleeding from the damaged tooth, the dentist also feels a "failure" of the instrument at this stage of treatment.
Perforations carious, chronic, for the most part, do not manifest themselves in any way, or are accompanied by recurring aching pains, which is associated with a sluggish course of the inflammatory process. Inspection of the dentist reveals a loose, bleeding from touching granulation tissue in the area of the perforation.
Medical assistance and diagnostics
Freshly wrought perforations are eliminated by sealing. With a defect channel diameter not exceeding 1-2 mm, this measure is sufficient to effectively seal the tooth. With a larger diameter of the canal, the filling compound is often rejected, which, when introduced into periodontal tissues, leads to infection and to subsequent severe destructive periodontitis.
Fresh damage to the dental crown in the visible part of it is easily noticeable on the eye, in a doubtful case, as in the variant of perforation of the bottom of the tooth cavity, X-ray diagnostics with contrast are performed( the contrast can be a pin or file).
The method of treatment of the perforation of the tooth crown is hermetic sealing by filling, which is performed immediately after the appearance of the defect - procrastination leads to penetration of the infection into the tooth cavity.
Conducting therapeutic manipulation under the microscope allows you to treat the defective area more carefully than under the control of vision.
The use of modern sealing fillings( in particular, quick-hardening and non-tearing MTA cement with high adhesiveness and biocompatibility with hard tooth tissues) is used to seal fresh perforation defects.
Sealing is a possible, but not always sufficient, solution when perforating
Self-treatment in case of perforation of the tooth is unacceptable, because it can aggravate the condition by the development of severe inflammatory processes up to sepsis! In case of any malaise after dental treatment, you should immediately contact a dental clinic.Perforation of the maxillary sinus is a common matter
Perforation of the maxillary sinus with removal of the upper premolars and molars is rare, but quite possible.
The peculiarity of the maxillary paranasal sinus is the small thickness of its bottom. The roots of the teeth of the upper jaw are often separated from the cavity only by a layer of the sinus mucosa, at best the thickness of its bone "floor" is 1 cm.
The ease of possible perforation of the maxillary sinus is caused by the fineness of the bone jaw trabeculae of the upper jaw that easily melt when there is purulent processes in the jaw: periodontitis, periodontitis, cysts.
These two conditions are already sufficient, so that even a slight effort by the dentist to remove the tooth results in a perforation of the bottom of the maxillary sinus.
Symptoms of newly emerging perforation include:
- discharge from the socket of the tooth of the blood containing air bubbles, and their number increases when forcing the expiration of the nose;
- allocation of blood from the nasal cavity at the side of the perforation of the maxillary sinus;
- change the tone of the patient's voice to a "nasal" tint.
There may be complaints about passing through the nose of the breathing air through the socket of the removed tooth, or a feeling of bursting and heaviness in the area of the maxillary sinus.
A measure for the treatment of fresh perforation of the bottom of the maxillary sinus( in the absence of signs of the presence of foreign bodies) is the formation and preservation of a blood clot-convolution poking the well.
In the absence of the possibility of its formation, dense closure of the well with a swab of gauze impregnated with iodine solution is used.
Iodine treatment is carried out for 6-7 days, with the addition of the solution, but without removing the tampon, until the hole is closed by the formed granulations.
To temporarily disentangle the oral cavity and the maxillary sinus, a plastic plate is applied to the defect, fixed on the proximal teeth by clasps. Or, the option is applied when seams are superimposed on the gum with a perforating hole.
In addition to creating a barrier between the cavities, a full course is prescribed to prevent the development of infectious complications, including the use of antibiotics, vasoconstrictor and anti-inflammatory drugs.
In the case of the presence of a foreign body in the maxillary cavity, it is operatively removed with the plastic of the perforated canal and subsequent medical measures.
If treatment with perforation of the maxillary sinus is absent, then infection occurs with the development of acute sinusitis.
To remove a tooth it is necessary, if. ..
To keep a tooth at its perforation it is possible not always. The need for its removal occurs in the following cases:
- of irreversible root damage;
- achieving tooth mobility of 3-4 degrees;
- presence in the jaw of purulent process with melting of tissues;
- technically impossible closure of the perforated channel due to unrecoverable anomalies of the tooth structure.
About the prognosis and consequences of
The filling of the dental canal with the perforation of the channels gives a prognosis that depends both on the location of the hole and on the promptness of the dental care.
When a defect in the dental crown is formed with its immediate closure, the prognosis is usually favorable.
With perforation of the root, even if the tooth is retained, it ceases to fulfill its purpose, in particular, can not be used as a support in the case of prosthetics. In addition, there is a high risk of distant fetal complications.
Prevention measures
A dentist who performs endodontic manipulations should take prophylaxis measures that include:
- the mandatory nature of the radiographic examination for the presence of anomalies in the root canals of the patient;
- modeling of the shape of tools in accordance with the shape and curvature of the patient's roots;
- providing good visual control of the operational field;
- control of the direction of movement and the degree of freedom of moving the working tool;
- weakening of the degree of pressure when there are even supposed obstacles in the path of the tool.