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Factors influencing choice of treatment


It is the most difficult task for the doctor, to defend the right treatment, when flesh is open or when clinical signs and symptoms suggest inflammatory participation. Conservative measures saves effort, time and money, while pulpectomy, especially in the posterior teeth, often technically complex and time-consuming procedure. That's why direct pulp capping enjoys a certain popularity over the years to control the pulp expositions: this is a non-invasive, easy to carry and does not usually require complex restoration of teeth after. However, pulpecto-my is the method of choice for the forecast of the tooth pulp survival is considered doubtful. If the flesh is expected to irreversible condition pulpectomy always preferable in a fully developed tooth. treatment predictable and eliminates the risk for subsequent inflammatory decay of tissue infections and co-infections and painful events. If the tooth is not fully developed, pulpectomy shaky and pulpotomy serves as an alternative treatment (Fig.
4.4; Basic concepts 4.2).

Young people with partially developed roots, saving as much cellulose tissue important. This allows for further development of the tooth structure. In pulpectomy, eliminating the soft tissue repair, prevents further growth, and leaves weakened tooth that is vulnerable to destruction. Cvek (19) reported that there is a strong linear relationship between the degree of root closing in the teeth, where the pulp lost and speed inside the fracture of the alveolar process over time. In a very immature roots fracture rates amounted to 80% within 3-4 years after treatment of the root canal. Pulpectomy not only eliminates the pulp, but requires the sacrifice of solid tissues. Often, the loss should be more initiative than the injury itself. This is because the treatment requires access to the root canal system and a sufficient distance from the wall of the channel to ensure the proper filling. Inevitably this will lead to a decrease in resistance teeth to destruction by chewing forces (74). This also means that after a rather extensive restoration is required.

In conclusion, the time, effort, victims of tooth structure and costs pulpectomy more than those for pulp capping or partial pulpotomy procedures. But, critical to the choice of therapy, as in the case, and considered to affect the potential for tooth pulp of survival in a conservative tissue-saving measure. Thus, the decision on conducting an invasive procedure or not should be based on a careful analysis of clinical information, which can be obtained from the patient history and clinical examination of the patient...

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