Page 217 - My FlipBook
P. 217
:
PULP DEVITALIZATION AND REMOVAL 213
Third. Pulps whose circulatory system is active, but whose ner-
vous system is either deficient in development or is in the stages of
neuroparalysis. Access to the tooth is a factor to be considered and
will I'csult in the more frequent use of this method with the anterior
teeth. The possibility of securing a sterile field of operation must
be considered as ftn advantage.
The Technic of the Operation Avhere a cavity exists is as follows
Apply the rubber dam. Excavate the affected dentine. Sterilize the
remaining cavity. Place in the cavity over the pulp a small pellet
of cotton saturated with either cocaine or novocain. Apply over
this a piece of unvulcanized rubber which will approximately fill the
cavity and with blunt instruments, as amalgam packers, gently force
the mass in the direction of the pulp. It is essential that the rubber
first come into contact with the cavity margins at all points, or the
fluid will not be confined and its escape renders the attempt a fail-
ure. If the first pressure of the confined solution upon the pulp
causes pain the operator should stop increasing the pressure, but
hold the advantage gained by not releasing the pressure already ap-
plied, Avhen, after waiting a minute or two, the pressure may be in-
creased and finally the rubber can be kneaded into the cavity with
considerable force. Sometimes one application thus made will com-
pletely anesthetize a pulp. However, other cases will require two
or more applications. Between such applications the dentine should
be removed from over the pulp to complete exposure where this can
be done without undue pain to the patient.
When, after two or three attempts of the above method there seems
to be no effect obtained, it is generally best for both patient and oper-
ator to resort to the application of arsenic, unless the case is suited
to favor the use of the high pressure syringe.
The High Pressure Syringe is of service where no exposure ex-
ists, and where the necessary puncture for the introduction of the
syringe point can be included in the filling, or where the crown is
to give place to an artificial one as an abutment for a bridge. The
method has to recommend it speed, a certainty of preserving the
color and is generally accomplished with little or no pain to the pa-
tient.
The Technic in Its Use. To the prescription given for the open
cavity add fifteen drops of distilled water and load the syringe, see-
ing that all joints are screwed up tight. Select a point of direct
access either on the dentinal walls or it may be on the external enamel
surface, preferably in the gingival third of the tooth, and drill a
liole directly towards the pulp one millimeter in depth and as much
PULP DEVITALIZATION AND REMOVAL 213
Third. Pulps whose circulatory system is active, but whose ner-
vous system is either deficient in development or is in the stages of
neuroparalysis. Access to the tooth is a factor to be considered and
will I'csult in the more frequent use of this method with the anterior
teeth. The possibility of securing a sterile field of operation must
be considered as ftn advantage.
The Technic of the Operation Avhere a cavity exists is as follows
Apply the rubber dam. Excavate the affected dentine. Sterilize the
remaining cavity. Place in the cavity over the pulp a small pellet
of cotton saturated with either cocaine or novocain. Apply over
this a piece of unvulcanized rubber which will approximately fill the
cavity and with blunt instruments, as amalgam packers, gently force
the mass in the direction of the pulp. It is essential that the rubber
first come into contact with the cavity margins at all points, or the
fluid will not be confined and its escape renders the attempt a fail-
ure. If the first pressure of the confined solution upon the pulp
causes pain the operator should stop increasing the pressure, but
hold the advantage gained by not releasing the pressure already ap-
plied, Avhen, after waiting a minute or two, the pressure may be in-
creased and finally the rubber can be kneaded into the cavity with
considerable force. Sometimes one application thus made will com-
pletely anesthetize a pulp. However, other cases will require two
or more applications. Between such applications the dentine should
be removed from over the pulp to complete exposure where this can
be done without undue pain to the patient.
When, after two or three attempts of the above method there seems
to be no effect obtained, it is generally best for both patient and oper-
ator to resort to the application of arsenic, unless the case is suited
to favor the use of the high pressure syringe.
The High Pressure Syringe is of service where no exposure ex-
ists, and where the necessary puncture for the introduction of the
syringe point can be included in the filling, or where the crown is
to give place to an artificial one as an abutment for a bridge. The
method has to recommend it speed, a certainty of preserving the
color and is generally accomplished with little or no pain to the pa-
tient.
The Technic in Its Use. To the prescription given for the open
cavity add fifteen drops of distilled water and load the syringe, see-
ing that all joints are screwed up tight. Select a point of direct
access either on the dentinal walls or it may be on the external enamel
surface, preferably in the gingival third of the tooth, and drill a
liole directly towards the pulp one millimeter in depth and as much
