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treatment
Symptoms: uncontrollable pain
swelling and or bleeding
Diagnosis
I- Extra-oral Examination:
[ INSPECTION- PALPATION
HOT:
Hot GP/ Hot burnisher
SURGICAL MICROSCOPE
Precision by:
Enhanced magnification
illumination
instrumentation
I.Pre treatment Emergency
Radiographic Ex
Pulpotomy
Acute pulpitis with apical
periodontitis
Pain {sever throbbing sharp}
Localised
Tendernous to percussion
Tooth elongated and bitting
relief pain
(pushes blood in dilated vessels away)
In late cases bitting increases
pain due to the increase in
the intra periapical
pressure
Radiographically :widened
lamina dura
Treatment
Diffuse pain
Treatment
Hot fomentation and Ab to localize
Cleaning and shaping or total debridment
(irrigation &extirpation)
analgesics
II. Inter-treatment
Flare up
Pain & or swelling
Most depressive……………assure
the pt
Swelling
I.D or through the canal, canal
redebrided and sealed then
analgesics Ab may be
needed.
If the case was not an
emergency one at the start, it
may be called acute
exacerbation of a chronic one
microorganisms
inflamation
Causes Host resistance
1. Microbial factor (aerobes)
2. Chemical mediators
3. Impaired host resistance
4. iatrogenic
Dentist
Controlled Factors
Over-instrumentation
Inadequate debridement
Missed canal
Hyper-occlusion
Debris extrusion
Procedural complications
Procedural Complications
Perforation
Separated instrument
Zip
Strip
NaOCl accident
Air emphysema
Wrong tooth
Treatment
Overinstrumentation
assure the pt, anesthesia
irrigation, relief of occlusion then
analgesics mixture of Ab &
corticosteriods
no instrumentation
Incomplete instrumentation
assure the pt, anesthesia irrigation,proper
cleaning and shaping, then analgesics
Post-treatment
Pain x-ray satisfactory
Assure & analgesics
follow up especially if
performed by another
dentist