VITAL PULPOTOMIYA (AMPUTATION OF PULP)

The essence of the amputation of pulp under the anesthesia consists of the simultaneous removal of the section of the focal inflammation of coronar pulp with the subsequent medicinal action on the stump of pulp, the imposition of therapeutic paste and permanent filling.

All therapeutic measures for the realization of amputation must be directed for the creation of the conditions, which prevent further development of infection, the liquidation of inflammatory process in the stump of pulp and the stimulation of reparative processes in it. Because of the plastic function of pulp the stump can save vital activity, in this case on the surface of amputation wound connective-tissue capsule (connective-tissue scar) is formed or root pulp is replaced by osteoid tissue - dentine and development of dentine tissue. This depends on the composition of biological paste, which is laid on the stump of pulp.

1. Basic
tasks

2. Displays

3. Contraindi-
cations

4. Conditions
of carrying out

5. Mistakes and
complications

7. Efficiency of
treatment in
distant
terms (1-1,5 ye.)

Task	Performance sequence	Warnings to self-control
Carry out method of treatment of pulpitis with vital amputation	Antiseptic processing of oral cavity (irrigation). Givalex; Stomatidin. Local anesthesia (regional and infiltration anesthesia). Isolation of tooth with cofferdam or sterile cotton rolls. Necrectomy. It is removed all carious dentine from walls and bottom of carious cavity as a source of infection and intoxication of pulp. In this case a carious cavity is repeatedly washed by warm neutral, sterile solutions of antiseptics. Formation of carious cavity. A cavity is exposed widely for creation of direct transition of walls of carious cavity into the walls of cavity of tooth. Antiseptic processing of carious cavity with warming neutral solutions of antiseptics or antibiotics: 0,5% solution of aethonium, 0,01% aqueous solution of chlorhexidine; Decoctions of medicinal plants. Do not use alcohol, alcoholic solutions, hydrogen peroxide.. Drying of carious cavity with sterile cotton balls. Opening of pulp cavity: By the spherical bur a circumpulpar arch is thinned; the overhanging edges of enamel and dentine are taken off so that the walls of carious cavity were directly continued in the walls of cavity of tooth; those hanging of the edge of enamel and dentine are removed in such a way, that the walls of carious cavity would be directly continued into the walls of cavity of tooth; perforating opening is enlarged by spherical bur large in the size, by then fissural bur is carved entire arch of cavity. They prepare the cavity of tooth so that after the amputation of coronar pulp on its bottom would be clearly visible the mouths of root canals and the duct inlet was with accessible. Removal coronar pulp. It is carried out with sharp excavator. After the opening of cavity of tooth carefully selected excavator (size of working part, sharpness of working edge) with backside slowly it is moved forward on a lateral wall cavities towards the junctions of the root canals. Then, by ladling motion with a turn on 90^о it is intercepted coronar pulp (a wound must be cut, but it is not lacerated). The spear-shaped or spherical bur is removed pulp from the junctions of the root canals, junctions preliminary are revealed with the endodontic instruments of type of Gates-Glidden, Peeso, giving a cone-shaped form to them. Stopping bleeding from pulp. For a stopping bleeding use hemostatic medicines: 5% solution of aminocapronic acid, hemostatic sponge and others, which enter with the impregnated cotton balls on 3—5 min. For the stopping of bleeding it is possible to use a diathermocoagulation an electrode by force current of 40-50 мcА during 2-3 sec. Do not use hydrogen peroxide. Drying of carious cavity with sterile cotton balls. Covering stump of pulp. For coverage the stump of pulp are recommended pastes with antiinflammatory and odontotropic actions, on the composition they are identical to pastes, recommended with the biological method of treatment of pulpitis. A tooth is closed by the temporal filling. Filling of carious cavity. In the absence complaints into the patient through 5-7 days is superimposed a constant stopping. Patient is taken to the clinic calculation. In the absence the complaints through 1, 6,12 months it is necessary to carry out EOD in order to ascertain that the root pulp did not dead. Roentgenography in the section of this tooth for determining the state of periodontium if necessary is conducted..	During the collection of anamnesis it is necessary to learn about the presence of allergic diseases in patient. During the fulfillment of the stages of treatment it is necessary to adhere to the rules of asepsis and antiseptics.