Chronic Fibrous Pulpitis ;

Clinical picture, Diagnosis ,

Endodontic treatement.
By ; Ahmed Eissa
Group ; 16LC1a
 Chronic Fibrous pulpitis ;
 1. pulpitis which takes place when the pulp chamber is open ;
 Complaints: boring pain which appears from mechanical (rough food chewing), thermal (cold water) and
chemical irritants. The pain attack comes after cold water taking and slowly increases, it lasts for 15- 20
minutes. Sometimes pain appears when «suctioning» from the tooth and it goes away quickly. There is constant
heavy feeling in the tooth.
 Medical history: The patient noticed acute spontaneous tooth pain around 7 months ago. The tooth hasn’t
been treated yet. Then acute spontaneous pain disappeared and the pain became causal and long lasting.
 XRay Diagnosing: there is slight dilatation of periodontal fissure, its circuit is damaged. There is a connection 
between carious cavity and pulp chamber in the area of dental pulp .
 Conti..
 Objective patient examination: 
 the examination discovered that the crown of the tooth has changed its color (dull, grey). 
o There is deep carious cavity with wide inlet, the cavity floor is within the bounds of parapulpar dentin. 
o Carious cavity walls dentin is dense and pigmented, it is soft on the floor. 
o When probing there is a connection between carious cavity and pulp chamber discovered. The probing is sharply pain
ful in the place of connection, dental pulp is bleeding. 
o Palpation of tunica mucosa of mouth from the side of oral cavity vestibule in the projection of causal tooth root apex i
s painless. 
o Percussion of causal tooth is sensitive compared to contiguous teeth but painless. 
o Thermodiagnosis is painful from cold water, the pain appears slowly, it becomes stronger step by step, and goes away
 slowly after the irritant is gone.
o EPT ; is 30- 35 microampere. 
 Conti .. 
2.  pulpitis with closed pulp chamber ;
Complaints: boring, pulling tooth pain caused by mechanical irritants (when coarse food chewing), and boring pain
when cold water taking. The pain lasts for long time after the irritants are gone. There is pain which caused by
temperature change (when coming into warm room from cold air). There is also dull pain when cold air breathing in.
This pain lasts for long time. There is a carious cavity in a tooth, food gets stuck in carious cavity, heavy feeling in a
tooth. 
Medical history: the tooth hasn’t been treated yet. The patient noticed acute spontaneous pain approximately 7 months
ago. The pain intensity decreased step by step and the pain was caused only by irritants (mechanical and thermal
ones) and environment temperature change. 
Objective patient examination: there is deep carious cavity in a tooth with wide inlet in the area of parapulpar
dentin. Carious cavity walls dentin is pigmented, it is dense when probing. Carious cavity floor dentin is slightly
soft. Probing of carious cavity floor is sensitive (sometimes painful). Palpation is painless. Percussion (comparative)
is painless. Thermodiagnosis is painful for cold water. There is pain attack which doesn’t go away quickly. EOD is
30-35 microampere. X-Ray Diagnosing: there is slight dilatation of periodontal fissure in the area of root apex,
carious cavity which does not connect with pulp chamber. 
 Treatement ;
 Treatment: Local: Pulp extirpation.
  a)Vital extirpation; 
 b)Devital extirpation.
 Extirpation of pulp ;
  a) Vital extirpation:
  -Antiseptic treatment of oral cavity; -Anesthetic treatment (infiltrate, field ); 
 -Carious cavity preparation taking into account topographic and anatomic peculiarities of the tooth; 
 -Dental cavity opening;
  -Coronal pulp removal (pulpotomy)
  -Medical treatment of pulp stump; 
 -Stop the pulp stump bleeding; 46 -The 
 tooth canal orifices opening; -Root pulp extirpation (pulpectomy); 
 -Stop root canal bleeding; 
 -Tools and medical treatment of root canal(-s) of the whole length with using of endodontic tools of appropriate size; 
 -For medical treatment of root canals it is recommended to use nonirritating periodontium and fast-acting medical agents: antiseptic solutions:
halogens and oxidizers (1% sodium hydrochloride, 1% chlorhexidine solution, 1% iodinol solution, 3% hydrogen peroxide solution etc.);
quaternary ammonium compounds (0,5%-1% etoniy solution, 1% chloride benzalcone solution, 0,15% decamethoxine solution); phenol
compounds (5% phenol solution, 1% camphorparamonochlorophenol solution and its composite preparations), nitrofurans, antimicrobial agents
etc.; 
 -Root canal(-s) filling with material for root filling within the bounds of root apex opening; 
 -Carious cavity filling.
 Devital extirpation ;
  I patient’s visit ;
  -Antiseptic treatment of oral cavity; 
 -Carious cavity preparation (opening and partial necrotomy of carious cavity) taking into account
topographic and anatomic peculiarities of the tooth;
  -Pulp corn opening; 
 -Devitalizing paste input (arsenious, paraformaldehyde etc.); 
 -Carious cavity closing with occlusive dressing.  
 Conti .. 
 II patient’s visit ;
 -Antiseptic treatment of oral cavity; 
 -Carious cavity preparation taking into account topographic and anatomic peculiarities of the tooth; 
 -Dental cavity opening; 
 -Coronal pulp removal (pulpotomy);
  -Medical treatment of pulp stump;
 -Stop the pulp stump bleeding;
  -The tooth canal orifices opening;
  -Root pulp extirpation (pulpectomy);
  -Stop root canal bleeding;
 -Tools and medical treatment of root canal(-s) of the whole length with using of endodontic tools of appropriate size;
  -For medical treatment of root canals it is recommended to use nonirritating periodontium and fast-acting medical agents: antiseptic solutions: halogens and
oxidizers (1% sodium hydrochloride, 1% chlorhexidine solution, 1% iodinol solution, 3% hydrogen peroxide solution etc.); quaternary ammonium compounds
(0,5%-1% etoniy solution, 1% chloride benzalcone solution, 0,15% decamethoxine solution); phenol compounds (5% phenol solution, 1%
camphorparamonochlorophenol solution and its composite preparations), nitrofurans, antimicrobial agents etc.;
  -Root canal(-s) filling with material for root filling within the bounds of root apex opening;
  -Carious cavity filling. .
 If it is necessary – restoration of crown of tooth with cements, compomers, composite materials, silver amalgam etc .. depending on topographic and anatomic
peculiarities of the tooth. It is possible to make prolonged filling when the cavity is closed with temporary filling.
 Medications ;
1. Medications used for antiseptic treatment of carious cavities and root canals ;
 Rp.: Sol. Hydrogenii perozydi dilutae 3% 50 ml 
    D.S. For carious cavity treatment. 
 Rp.: Sol. Chloramini 2% 30 ml 
    D.S. For carious cavity treatment .
 Rp.: Chlorhexidini 0,06% 50ml
    D.S. For carious cavity treatment when there are deep caries and pulpitis. 
 Rp.: Sol. Furacilini 0,02% 20 ml 
    D.S. For carious cavity treatment when there is caries. 
2. Medications for necrotizing of dental pulp ;
 Rp.: Flidi arsenicosi anhydrici
   Dicaini aa 2,0
   Ol. Camfphorae q.s. 
   M.f. pasta 
        D.S. For dental pulp devitalization. 
 Rp.: Paraformaldehydi 3,0
            Novocaini 0,03 
            Azbesti pulverati 0,5
            Vaselini 1,25
            M.f. pasta 
      D.S. For dental pulp devitalization. Apply for 5-6 days. 
 Medications ;
 Preparations, antidotes of arsenic ;
  Rp.: Sol. Unithioli 5% - 5,0 
    D.t.d. N 10 in amp. 
    S. For application on gum mucous tunic. 
 Rp.: Jodoformii 20,0 
    D.S. Powder.
  Rp.: Sol. Jodinoli 1% - 100,0 
    D.S. For application on gum mucous tunic