After 1,5 hours

Patient’s father: Hello Doctor. We’re here!

Doctor: Very well. I’ve just finished consulting the patients, so I can take care of your child. Can you show me the picture, please?

Patient’s father: Here you are.

Doctor: Thank you. Well, it’s just as I thought. The pulp degenerated, and what’s more, inflammation of  the root has already developed. Unfortunately, the apex is not closed, but luckily the root is not fractured.

Patient’s father: So what will we do next?

Doctor: The tooth is eligible for treatment, but it will be quite complicated. The development of the root hasn’t completed yet, and instead of a narrow opening there is a wide hole with inflammatory changes. I must admit that I have never had such a case.

Patient’s father: But I hope the tooth does not have to be removed, does it?

Doctor: No, it doesn’t. You can try the treatment. I unfortunately will not attempt the treatment. I have no experience, and proper equipment for such a case. Once, I attended a lecture and I heard that in such cases you could still try so-called revascularization method.

Patient’s father: What does it mean?

Doctor: Due to some deliberate actions, the root canal is filled with pulp again. What I mean here is,  that there will be increase in pulp-like tissue in the apex, and what is most important, it may lead to closing of the apex opening and to completion of root development.

Patient’s father: So if you can’t do it, where can we get help?

Doctor: There are two surgeries in the city which treat with a microscope. But before I give you the phone number, I would like to talk to the doctors. But I think that they perform this type of treatment.

Patient’s father: Very well, Doctor. How then will we arrange?

Doctor: Please call tomorrow evening. I’ll certainly know something.

Patients father: Well, I’ll call back tomorrow.

Doctor: I’ll hear you then.

Next day

Patient’s father: Hello, I’m calling just as we arranged.

Doctor: Well, yes. I’ve made an appointment for you. Both doctors can perform the procedure, but the surgery on Mickiewicz Street is definitely closer for you.

Patient’s father: That’s right. We live right by Mickiewicz Street.

Doctor: So I’ll give you a phone number. It’s 606 66 77 56, and the doctor’s name is Peter Zaniewski. He told me you could call him every day between 12.00 p.m.-8.00 p.m. The receptionist answers the phone and she’ll make an appointment for you.

Patient’s father: Doctor, thank you very much for your help.

Doctor: No problem. I hope that the treatment is successful. Bye!

Patient’s father: Goodbye.

VOCABULARY PRACTICE

Read the text about regenerative dentistry. Complete it with the words from the table

Regenerative dentistry is the use of biologically based procedures to replace damaged tooth structures such as dentin, root structures and cells of the pulp. Regenerative 1)____________, is the extension of root canal therapy. 2)____________ root canal therapy cleans and fills the pulp 3)_____________ with biologically inert material after destruction of the pulp because of dental caries, congenital deformity or trauma. Regenerative endodontics, 4)_____________, aims at replacing live tissue in the pulp chamber. Main meaning of the word regenerative in this context is to provide an environment where tissues can 5)_____________.

To replace live tissue, either the existing cells of the body are 6)__________ to regrow the tissue native to the area or bioactive substances are inserted in the pulp chamber. These include stem cell therapy, growth factors, morphogens, tissue scaffolds and biologically active delivery systems.

The clinical procedures like apexification and apexogenesis are closely related to the field of regenerative endodontics .

Apexogenesis 7)_________ the root to continue development as the pulp is healed. The exposed pulpal tissue is 8)___________  with a medicament called MTA, or Mineral Trioxide Aggregate. This will allow for the exposed tissue to heal against the MTA, keeping the pulpal tissues 9_____________ and encouraging further maturation and growth of the tooth. This proccess will enable the 10)____________ of the root to close as the child gets older. In turn, the walls of the root canal will become thicker, and the tooth will become stronger. If the pulp heals, no additional treatment will be 11)___________. The more mature the root becomes, the better the chance for the survival of the tooth.

During apexification process the unhealthy pulp is removed. The endodontist will place MTA into the apical portion of the root to12)___________ hard tissue to form near the root tip. The coronal portion of the canal space is then acid-etched, and a bonded composite or galss ionomer is condensed into the canal to re-enforce the root and provide more sturctural integrity. 

Based on the text above match terms with definitions

apexogenesis            regenerative endodontics           apexification

1. ___________– field of dentistry which concentrates on reviving or regenerating the tooth’s natural tissue so the root can continue growing.
2. ___________– this procedure encourages the root to continue development as the pulp is healed. Soft tissue is covered with medication to encourage growth. The apex will continue to close as the child gets older. In turn, the walls of the root canal will thicken. If the pulp heals, no additional treatment will be necessary. The more mature the root becomes, the better the chance to save the tooth.
3. ____________– the unhealthy pulp is removed. The doctors place medication into the root to help a hard tissue form near the root tip. This hardened tissue provides a barrier for the root canal filling. At this point, the root canal walls will not continue to develop, making the tooth susceptible to fractures. So it is important to have the tooth properly restored by your dentist.

Look at the sentences below. Rephrase the sentences by using words in bold print in such a way that the meaning stays the same. Make all the necessary changes

Example:
Dentists contraindicate apexification when the roots are short. IS
Apexification is contraindicated when the roots are short.

1. Apexification can’t be completed when the pulp is vital. MUST

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2. Pulp revascularisation and repair occurs more efficiently in tooth with an open apex. EFFICIENT

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3. Apexification and apexogenesis procedures require use of anesthesia. BOTH

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4. The technique of apexification requires the usual cleaning and irrigation of the root canal. Then
the canals are sealed with a paste composed of camphorated chlorophenol and calcium hydroxide.
FOLLOWED

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5. In apexification procedures every effort should be made to preserve any vital apical pulp tissue
that will help the closure of the immature apex. CRUCIAL

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6. Main goals of apexogenesis are to maintain pulp vitality and to promote root end closure. AT

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7. Some side effects of apexification such as sensitivity, pain, or swelling may be reported.
COMPLAIN

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8. Revascularization and regeneration procedures allow for new living tissue to form in the cleaned
canal space allowing for continued root development in terms of both length and thickness. ENABLE

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Lesson 73 - answers