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The root treatment of teeth with Toxavit
The root treatment of teeth with Toxavit Report
of a case
Barbara Heling, M.D., Zeev Ram, D.M.D., Jerusalem, Israel DEPARTMENT HADASSAH OMEGA
OF PERIODONTICS SCHOOL
OF DENTAL
AND
and Ilana
ENDODONTICS,
MEDICINE,
HEBREW
FOUNDED
BY
Heling,
D.M.D.,
UNIVERSITYTHE
ALPHA
FRATERNITY
The use of Toxavit preparation for pulpal devitalization in a 20.year-old woman has been presented. The sequelae of leakage of this material, namely, necrosis of the soft tissues and sequestration of the bone, have also been demonstrated.
M
ost patients present for treatment because of an incident of acute pain, the etiology of which most often is pulpitis. Because the pain often causes the patient a sleepless night, he is motivated to seek immediate relief and arrives in a relatively fatigued and tense physical and mental state. Obviously, immediate emergency treatment is necessary. In many cases of mandibular molar pulpitis, it is not possible to obtain effective anesthesia, even with multiple attempts including mandibular block, long buccal infiltration, direct injection into the periodontal ligament, and intrapulpal anesthesia. Consequently, it becomes impossible to extirpate the involved pulp from the wearied and unanesthetized patient without considerable discomfort and trauma to him. In these cases we use a paraformaldehyde preparation, Toxavit Lege Artis.*l This preparation contains, in 1 gram of paste, 460 mg. of paraformaldehyde and 370 mg. of lidocaine HCl. Before placement of the Toxavit material into the pulp chamber, as much decay as possible is removed from the tooth, in order to facilitate as close a contact as possible between the Toxavit and the pulp. An adequate amount to cover the exposed pulp is placed and covered with a cotton pellet and sealed with zinc oxide-eugenol without pressure being applied. The paste should be allowed to remain in contact with the pulp for about 2 weeks. *Lege Artis
306
Manufacturing
Company,
Stuttgart,
West Germany.
Fig. 1. Roentgenogram of teeth showing deep carious lesion in mandibular first molar. Fig. d. Roentgenographic appearance of treated and filled canals after use of Toxavit, showing early stage of sequestration of mesial interproximal bone.
Fig.
3. View
of sequestrum
in interproximal
area 6 weeks after
Toxavit
treatment.
During a period of 5 years, Toxavit was used in the treatment of 146 patients. In this group treated with Toxavit, five patients had the material sealed in the chamber for more than 4 months. Interruption of the treatment schedule was due to the Yom Kippur War of October, 1973. When the patients returned from military service, they were found to have no symptoms or complaints, nor any history of such, and treatment was then successfully completed. The technique used was a chemomechanical preparation of the canal and filling by lateral condensation of gutta-percha points with AH,,.* CASE REPORT A unique contrary finding was recently observed in our clinics. A 20-year-old woman was referred to the student clinic for treatment following a sleepless night that resulted from severe pain apparently in the left side of the mandible. Clinical examination revealed a deep carious lesion in the lower first molar with pulp exposure (Fig. 1). Because of her extreme apprehension, nervousness, and physical fatigue, the patient was treated with Toxavit. When she returned 10 days later, the interdental papilla between the premolar and molar was noted to
Oral alrg. 1+1wuary,
Pig. 4. Radiograph
Fig. 5. View at 6 weeks after
Fig.
6. Large
showing
arca of bone at sequestrum
6 weeks after
187
use of Toxavit.
of necrosis of interdental papilla on mesial aspect of mandibular first molar Toxavit treatment immediately following removal of sequestrum.
piece of crestal
bone which sloughed
from
the action
of the Toxavit.
have an area of necrosis. Local curettage was performed and the root canal treatment was completed (Fig. 2). At the B-week recall appointment, a sequestrum of white bone was found to be sitting freely in the interproximal space; the papilla had disappeared and the crest was resorbed (Figs. 3 and 4). The sequestrum was removed (Figs. 5 and 6). Radiographic examination revealed destruction of bone.
Volume 43 Number 2
Root treatment
of teeth with
Toxavit
309
In the foregoing case the complication resembled that observed with the use of arsenic trioxide.3 When using a paraformaldehyde material for the devitalization of pulps, one must take care to prevent leakage that will result in injury to the gingivae, periodontal membrane, or alveolar process. REFERENCES
1. Erb, A.: The Effects of Toxavit Paste, Refuat Hashinaim (Journal of The Israel Association) 3: l-5, 1964. 2. Heling, B., and Tamshe, A.: Evaluation of the Success of Endodontically Treated ORAL SURG. SO: 533-536, 1970. 3. Ingle, J. I.: Endodontics, ed. 4, Philadelphia, 1970, Lea & Febiger, p. 196.
Dental Teeth,
of a case
Barbara Heling, M.D., Zeev Ram, D.M.D., Jerusalem, Israel DEPARTMENT HADASSAH OMEGA
OF PERIODONTICS SCHOOL
OF DENTAL
AND
and Ilana
ENDODONTICS,
MEDICINE,
HEBREW
FOUNDED
BY
Heling,
D.M.D.,
UNIVERSITYTHE
ALPHA
FRATERNITY
The use of Toxavit preparation for pulpal devitalization in a 20.year-old woman has been presented. The sequelae of leakage of this material, namely, necrosis of the soft tissues and sequestration of the bone, have also been demonstrated.
M
ost patients present for treatment because of an incident of acute pain, the etiology of which most often is pulpitis. Because the pain often causes the patient a sleepless night, he is motivated to seek immediate relief and arrives in a relatively fatigued and tense physical and mental state. Obviously, immediate emergency treatment is necessary. In many cases of mandibular molar pulpitis, it is not possible to obtain effective anesthesia, even with multiple attempts including mandibular block, long buccal infiltration, direct injection into the periodontal ligament, and intrapulpal anesthesia. Consequently, it becomes impossible to extirpate the involved pulp from the wearied and unanesthetized patient without considerable discomfort and trauma to him. In these cases we use a paraformaldehyde preparation, Toxavit Lege Artis.*l This preparation contains, in 1 gram of paste, 460 mg. of paraformaldehyde and 370 mg. of lidocaine HCl. Before placement of the Toxavit material into the pulp chamber, as much decay as possible is removed from the tooth, in order to facilitate as close a contact as possible between the Toxavit and the pulp. An adequate amount to cover the exposed pulp is placed and covered with a cotton pellet and sealed with zinc oxide-eugenol without pressure being applied. The paste should be allowed to remain in contact with the pulp for about 2 weeks. *Lege Artis
306
Manufacturing
Company,
Stuttgart,
West Germany.
Fig. 1. Roentgenogram of teeth showing deep carious lesion in mandibular first molar. Fig. d. Roentgenographic appearance of treated and filled canals after use of Toxavit, showing early stage of sequestration of mesial interproximal bone.
Fig.
3. View
of sequestrum
in interproximal
area 6 weeks after
Toxavit
treatment.
During a period of 5 years, Toxavit was used in the treatment of 146 patients. In this group treated with Toxavit, five patients had the material sealed in the chamber for more than 4 months. Interruption of the treatment schedule was due to the Yom Kippur War of October, 1973. When the patients returned from military service, they were found to have no symptoms or complaints, nor any history of such, and treatment was then successfully completed. The technique used was a chemomechanical preparation of the canal and filling by lateral condensation of gutta-percha points with AH,,.* CASE REPORT A unique contrary finding was recently observed in our clinics. A 20-year-old woman was referred to the student clinic for treatment following a sleepless night that resulted from severe pain apparently in the left side of the mandible. Clinical examination revealed a deep carious lesion in the lower first molar with pulp exposure (Fig. 1). Because of her extreme apprehension, nervousness, and physical fatigue, the patient was treated with Toxavit. When she returned 10 days later, the interdental papilla between the premolar and molar was noted to
Oral alrg. 1+1wuary,
Pig. 4. Radiograph
Fig. 5. View at 6 weeks after
Fig.
6. Large
showing
arca of bone at sequestrum
6 weeks after
187
use of Toxavit.
of necrosis of interdental papilla on mesial aspect of mandibular first molar Toxavit treatment immediately following removal of sequestrum.
piece of crestal
bone which sloughed
from
the action
of the Toxavit.
have an area of necrosis. Local curettage was performed and the root canal treatment was completed (Fig. 2). At the B-week recall appointment, a sequestrum of white bone was found to be sitting freely in the interproximal space; the papilla had disappeared and the crest was resorbed (Figs. 3 and 4). The sequestrum was removed (Figs. 5 and 6). Radiographic examination revealed destruction of bone.
Volume 43 Number 2
Root treatment
of teeth with
Toxavit
309
In the foregoing case the complication resembled that observed with the use of arsenic trioxide.3 When using a paraformaldehyde material for the devitalization of pulps, one must take care to prevent leakage that will result in injury to the gingivae, periodontal membrane, or alveolar process. REFERENCES
1. Erb, A.: The Effects of Toxavit Paste, Refuat Hashinaim (Journal of The Israel Association) 3: l-5, 1964. 2. Heling, B., and Tamshe, A.: Evaluation of the Success of Endodontically Treated ORAL SURG. SO: 533-536, 1970. 3. Ingle, J. I.: Endodontics, ed. 4, Philadelphia, 1970, Lea & Febiger, p. 196.
Dental Teeth,