Romanian Journal of Oral Rehabilitation Vol. 6, No. 1, January - March 2014 EARLY DIAGNOSIS OF ACUTE DIFFUSE PULPITIS, TREATMENT SUCCESS V. Chetruș, I. Roman, S. Ciobanu State University of Medicine and Pharmacy ”Nicolae Testemitanu” - Chisinau, Rep. Moldova, The Department of Stomatological Therapy Corresponding authors: V. Chetruș, S. Ciobanu, DMD, PhD State University of Medicine and Pharmacy ”Nicolae Testemitanu” Chisinau, Rep. Moldova e-mail: [email protected] I. Roman, DMD, PhD State University of Medicine and Pharmacy ”Nicolae Testemitanu” Chisinau, Rep. Moldova e-mail: [email protected] ABSTRACT Purpose of the work: The efficacy of early diagnosis of acute diffuse pulpitis, errors and complications that may occur during treatment. Acute diffuse pulpitis as a result of etiologic factors remains one of the most common dental emergencies that are not diagnosed and treated in time lead to an increased risk in the development of periodontal complications. The study was conducted on a group of 35 patients who were sent for treatment at the Department USMF dentistry, Nicolae Testemiţanu'', of which 12 (34.28%) were female, 23 (65.71% ) males, 16 smokers (45.71%) and 19 smoking (54.28%), 1 patient (2.85%) during orthodontic treatment, aged 19-42 years. The methods of treatment used vital extirpation 32 cases (91.42%), and in 3 cases (8.57%) non vital extirpation. In this study-positive results were achieved demonstrating the success of treatment as a result of an earlier diagnosis of disease data. In this study it can be stated with certainty that diffuse acute pulpitis is a severe clinical evolution, requiring immediate therapeutic treatment to prevent complications. Keywords: acute diffuse pulpitis, diagnosis, treatment, pain, vital extirpation, non-vital extirpation - INTRODUCTION Even if the development of the area of dentistry the last period is very advanced in regards to the biocompatibility of materials for dental tissues, modern equipment reduces the working time of the medical practitioner, dental pulp inflammation is particularly important in emergency of dental pathologies. Sometimes simple steps failure of treatment of dental diseases as: - use strong antiseptics (solution of 3% chloramine, solution of 96% alcohol solution of 3% hydrogen peroxide) in the processing of treatment of deep caries, - - 49 applying permanent fillings without curative liner in treatment of deep caries, use of materials and drugs which are toxic and allergic (acrylate, zinc eugenol pastes, sulfonamides), [2] lead to the appearance of complaints of the patient as: patient astringent suffering with stabbing pain from 2 to 3 hours, pain that occurs spontaneously and gradually increase, pain that some authors are not shy to call this pain ”rabid tooth", pain that may radiate to the trigeminal nerve tract (a very important element in Romanian Journal of Oral Rehabilitation Vol. 6, No. 1, January - March 2014 the diagnosis of acute diffuse pulpitis MATERIAL AND METHODS diffuse). [1, 2, 6, 7, 8] The study was performed on a group of 35 Zone of irradiations when there is acute patients diagnosed with acute diffuse pulpitis, diffuse pulpitis in canines and in incisors in selected according to how they were the upper jaw irradiation of pain can be in addressed for medical care dentistry at USMF nose, in the suborbital and supraorbital Department ,,Nicolae Testemiţanu'', of which region, in temporal region as well. From the 12 (34.28% ) females, 23 (65.71%) males, 16 molar of the upper jaw irradiation of pain is smokers (45.71%) and 19 smoking (54.28%), in the temporal temporal region, supraorbital, 1 patient (2.85%) during orthodontic zigomatic, in healthy teeth, and sometimes in treatment, aged 19-42 years. the lower jaw. For hygienisation, removal of soft and In case of mandibule teeth pulpitis, hard deposits gingival and supra gingival by irradiation of pain is felt in the occipital, ear, scaling, was used ultrasound in all 35 cases submandibular and in the teeth of the upper (100%). For removal of dental plaque have jaw region, the incisors on the lower jaw, the been used Air flow with sodium bicarbonate pain may radiate to the opposite part. The pownder in 20 cases (57.14%), in 15 cases patient can’t specify the aching tooth in (42.85%) was used in professional brushing irradiates pain, and in this case can appear with paste,,Polident nr.1, 2, 3''. some problems and errors in diagnosis. In this For appreciation of dental pulp vitality was case analgesics help a little, for a short time, used warm and cold test, for 30 patients and can not completely to eliminate the pain (85.71%) and the laboratory tests (EOD- Digi (fig.1). test II) 7 patients (20.0%) and simple local radiography in all patients (100%), confirming diagnosis. The methods of treatment used, vital extirpation 32 cases (91.42%), and in 3 cases (8.57%) non vital extirpation using the paraformaldehyde-based paste, ”Devit - C ". For mechanical treatment was used Step Back and Crown Down methods with protaper from Dentsply, 20 cases (57.71%) with mechanically action ”Morita ZXI" and 15 cases (42.85%) manual, drug processing using sol. 3% Na hypochlorite and sol. H2O2 3%, the estimated working length with apex locator ”Bingo 1020". For the filling it was Figure 1. Zone of irradiations pain by used technique using a single cone, Borovski (A – upper teeth, B – lower teeth) containing master 22 cases (62.85%), and 14 Therefore knowledge of etiologic factors patients (37.14%) by the technique of lateral lead to early diagnosis, the use of modern and condensation of gutta percha, with the epoxy well performed by leading dental practitioner resin material ”AH plus”. When applying to minimize treatment failure and the permanent fillings with photopolymerizable development of post-treatment complications. nanocomposite material used from the [9, 10]. company ”Nuritake Kuraray”. [1, 3, 4, 5] In the endodontic treatment have been subjected as lower teeth 68.57% and the 50 Romanian Journal of Oral Rehabilitation Vol. 6, No. 1, January - March 2014 upper 32.43%, 65.71% of them molars, 20% determining working length of the roots premolars and 11.42% incisors, canines channals. 2.85%. During the treatment there were no 5. Mechanical treatment with errors that: fracture of instrument, passage of endoengine ”Morita ZXI” and medicamentos. material after the apex, the root wall 6. Drying canals with paper points. perforation. Only in one case 2.85%. has did 7. Root canal obturation with epoxy an incomplete obturation of 36 tooth MV resin AH-plus and gutta-percha with lateral channel where we did re-obturation in the condensation at cold method. same visit. 8. Making control radiograph 9. Application of provisional fillings ”Dentin paste" that after two days is replaced Clinical case: Patient P.I. asked dental care in the by the permanent Nuritake Kuraray restoring University Clinic, Department of Therapy at 47 tooth morphology. USMF ”Nicolae Testemiţanu ", accusing 10. Control radiograph after 6 months, spontaneous acute pain, pulsating which which proves the correctness of therapeutic intensifies during the night and the heat manipulations. stimuli, pain is long, around of 2 -3 hours. Pain radiating to the ear and the body of the RESULTS AND DISCUSSIONS mandible on the left side. After examining As a result of earlier diagnosis and proper patient was diagnosed with acute diffuse treatment was very impressive results as for pulpitis in tooth 47. Planned treatment of the medical practitioner and for the patient as disease by vital extirpation vital and well. obturation with cold lateral condensation method: CONCLUSIONS 1. Spina Spix anesthesia with sol. This study given us the opportunity to Ubistesin 4%, 1.7 ml. implement fully the research and practical 2. Carious cavity preparation mastery of dentist, our results demonstrating 3. Achieving accessibility to the three certaint, that the acute diffuse pulpitis is a endodontic levels desease with severe clinical evolution A. Access to the pulp chamber (A1) requiring immediate therapeutic treatment to B. Access to root orifices (A2) prevent complications. Early diagnosis C. Acces to dentino-cementing area correct and complete offers treatment success. constriction (A3) Knowledge of topographic anatomy, 4. At the same time watching coronary respecting all the steps of diagnosis and pulp amputation and pulp extirpation, treatment leads to a successful treatment with minimization of complications. REFERENCES 1. Advanced Endodontics 2009 2. Stomatologie terapeuctica E.Borovski 1990 p.175-178 3. Radlinschi V.N., Radlinschi S.V., Tehnologiii moderne de restaurari dentare. Indicatii metodice. Chisinau 2003 p.1-10 4. Eni Ana. Paradontologie. Chisinau 2003 5. John I. Ingle, DDS, MSD, Leif K.Bakland, DDS. Endodontics, Fifth Edition. // BC Decker Inc., 2002,p. 748-762. 6. Ingle's Endodontics 6, John I Ingle, DDSLecturer 2008, p.157 7. Endodontics: Principles and Practice Richard E. Walton 2009 p.380 51 Romanian Journal of Oral Rehabilitation Vol. 6, No. 1, January - March 2014 8. Sjogren U, Haggalund B, Sundqvist G, Wing K. 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