Abstract:
Process for devitalizing a tooth by transmission of a high-frequency electric pulse to the vascular and nervous tissue in the root canal by insertion in said canal of an electrode in the form of a needle ( 100 ), said pulse being generated by an electronic apparatus ( 10 ), values of power, time and frequency of said electric pulse being automatically regulated by the electronic apparatus in accordance with the control given by pressing one or another of four push buttons ( 30-33 ) one for each of the different types of teeth.

Description:
The invention concerns medical equipment for dental use. 
     Before operating on a tooth to remove decay or for other purposes it is known that the vascular and nerve tissue inside the canal in the root of the tooth concerned has to be removed. 
     This is done by introducing into said canal an instrument which by lateral and rotary movements can bring to the surface the material inside it. There may be one or more canals according to the type of tooth. The operation may involve some considerable difficulty because of curves in canals and their divisions. 
     The instrument used for the purpose does not always achieve the desired results because of the above-mentioned anatomical characteristics. This operation is long and laborious. 
     It also requires repeated X-ray checks to see that the work is proceeding correctly. To ensure that the canal has been devitalized it is essential not only to clean it out but also to avoid penetrating beyond the lower end of each canal. 
     A certain distance, about mm 1.5, must be maintained from the apical foramen to avoid infection and bacterial complications generally. Bearing in mind that to devitalize the canal root is a dental treatment that requires great precision and careful attention, dealing correctly with the problems that arise using present methods must clearly depend on the dentist&#39;s ability. 
     SUMMARY OF THE INVENTION 
     The present invention eliminates the above drawbacks almost entirely both as regards the patient and the operator as will be explained below. Subject of the invention is a process to devitalize the canal root of a tooth in which the vascular nervous material receives a fractionally long high frequency electric pulse, power values, time and frequency, being adjusted to suit the type of tooth. 
     To carry out this procedure an electrode in the form of a needle is inserted into the canal in the root; the electrode is of a length that allows it to penetrate until it reaches the right distance from the apical foramen and is connected to a pulse-generating apparatus. 
     Emission of high frequency pulses can be assisted by electrically connecting the electronic circuit that generates them to some other part of the patient&#39;s body, the hand for example, by a so-called neutral handle-type metal object, or by some other suitable tool. 
     The effect of this high frequency pulse that acts only along the whole surface of the needle-type electrode, is to disintegrate the vascular nerve matter and simultaneously coagulate the part of the vascular bundle that is not destroyed, as well as to sterilize the root canal. 
     In order to insert the needle-type electrode into the root canal, anaesthetic is applied to the area of the tooth concerned which is then opened up till entry into the root canal is visible. 
     The high frequency electric pulse is preferably provided by an apparatus that comprises an electronic circuit able to estimate the correct distance from the apical foramen to which the needle must penetrate and to give an acoustic and visual warning as soon as that position is reached. In this way the operator can have suitable electric current generated for destroying the nerve bundle in the root canal when the needle has reached the above position. 
     Closure of the electric circuit is preferably pedal-operated. 
     Values of electric current suitable for destroying the nerve bundle in the root are automatically regulated by the electronic apparatus according to which of the four buttons is pressed, these being respectively for the four types of teeth: incisor, canine, premolar and molar 
     Value of the electric current can be increased by pressing a button for this purpose placed on the apparatus. 
     The needle-type electrode, preferably of stainless steel, that transmits the high-frequency pulse, can be of different lengths, average mm 30, and may be of a tapering structure with a base diameter of about mm 0.25 and a tip diameter of about mm 0.1. 
     In a preferred execution the needle has a haft, about mm 1 in diameter, comprising a rear section about mm 15 long and a front section about mm 5 long set at an angle of about 110° in relation to the rear section. 
     The apparatus that actuates the described process comprises a cable for electric feed, a cable for pedal control of the devitalization pulse, a socket for a cable connecting it to a so-called active handle of insulating material with a metal core, and can comprise a socket for the cable connecting it to the so-called neutral handle. 
     At the front end of said active handle is a head into which the needle can be introduced and fixed. 
     The cable connected to the so-called neutral handle can include insertion of a branch cable to carry a kind of pincer which is preferably applied to the lip of the patient during the measuring operation. 
     The apparatus here concerned may be equipped with the following main electronic circuits: input filters, feeder, RF pulse generator or pulser, for setting output power, a power visualizer for setting Burst time, for the change-over from manual to automatic functioning or vice versa, for protection against an increase in the output power setting, for safety to prevent involuntary repetition of the devitalization movement before a set time, for example 10 seconds, has passed, for an acoustic two-tone warning when, during the measuring operation, the needle has penetrated to the correct distance from the apical foramen and for a single-tone sound to indicate that the devitalizing electric pulse has been given and that the operation has therefore been completed. 
     The process offers evident advantages. 
     Present mechanical methods involve a risk of bacteria remaining in the canal of the root that may lead to pathological conditions of the tooth or of its adjacent structure producing haemorrhage or infection. 
     The method described makes it possible to devitalize the root canal quickly and painlessly using very little anaesthetic which is therefore less toxic for the patient. 
     After the operation the root canal is completely sterilized both in its main part and in its lateral branches. 
     Any haemorrhage or infections are entirely avoided. 
     The risk is also avoided of penetrating beyond the apical formen, a risk always present with the manual instruments in use, and one that can lead to considerable complications. 
     To sum up these advantages, with a small low-cost easily operated apparatus, for the first time in the field of dentistry apical measurement and electronic devitalization can be done limiting the operation exclusively to disintegration of the vascular nerve bundle. 
     In conclusion, this method enables both dentists and patients to undertake dental treatment in an entirely new way which offers important advantages, not only in time and cost but also in patient comfort, maximum reliability and elimination of errors. 
    
    
     Characteristics and purposes of the invention will be made still clearer by the following example of its execution illustrated with diagrammatically drawn figures. 
     FIG. 1 Perspective view from above of the apparatus used to execute the invented process. 
     FIG. 2 Longitudinal section of a decayed molar tooth. 
     FIG. 3 The tooth in FIG. 2 after opening it for access to entry to the root canal. 
     FIG. 4 The tooth during measurement of depth of the root canal. 
     FIG. 5 The patient during measurement of depth of the root canal. 
     FIG. 6 The patient during the process of devitalizing the root canal. 
     FIG. 7 The tooth in FIG. 2 after devitalization and the canal closed. 
     FIG. 8 Electronic diagram of the apparatus. 
     FIGS. 9-11 Electronic diagram of the feeder 
     FIGS. 12-13 Electronic diagram of RF output and controls. 
     FIGS. 14-22 Electronic diagram of time selection and CLK. 
     FIG. 23 Electronic diagram of the RF power pulser. 
     FIGS. 24-26 Electronic diagram of RF output power regulation. 
     FIGS. 27-29 Device for delaying involuntary movements. 
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     The apparatus  10  comprises a substantially parallelepiped box  11 , flat with a front  12  inclined at about 45°. 
     Approximate dimensions of this box are mm 250×250×100. 
     The following controls are placed on the front of the box: 
     Push button  20  with pilot light  21  for turning the apparatus on and off. 
     Push botton  22  with pilot light  23  for passing to the measuring “mode”. 
     Push button  24  with pilot light  25  for manual increase of power of the electric pulse. 
     Using the respective push buttons  30 ,  31 ,  32 ,  33 , each with pilot light, the apparatus can operate suitable functional characteristics for the different types of teeth: incisor, canine, premolar, molar. 
     Sockets  35  and  36  receive the plugs  51  and  61  respectively for the active handle  50  and the neutral handle  60 . 
     At the back of the apparatus, not seen in FIG. 1, there is a socket for plug  71  for working the pedal  70 . 
     Electric feed is supplied through the plug  80 . The active handle  50  is made of insulating material and includes an electrically conducting metal core  53  for contact with the metal needles. Said metal core is connected internally to the plug  51  through the wire  54 . 
     Length of said handle is substantially mm 100, with a diameter of mm 12 in the head  52  into which can be inserted the haft  101  of the needle  100  as seen in FIG. 4 
     An assortment of needles is provided comprising various lengths, but the average length is about mm 30. 
     Their shape is tapered, diameter varying from about mm 0.25 at the base to about mm 0.1 at the tip (FIG.  4 ). 
     The needles are made of stainless steel. 
     Diameter of the haft  101  for the needles is about mm 1, length of the rear section  102  being about mm 15 and that of the front section  103  about mm 5. 
     The fore end is bent at an angle of about 110° compared with the rear. The active handle can be assisted by electric connection to the electronic circuit, that generates the high frequency pulses, with another part of the patient&#39;s body, the hand for example, by means of a so-called neutral handle  60 . 
     Length of said neutral handle is about mm 100, diameter about mm 25; it is made of electrically conducting metal and is connected by the cable  62  to the plug  61 . 
     There is a branch line  65  from said cable  62  to connect with an electrically conducting pincer  64  that can be fixed to a sensitive part of the human body, especially to the lip. 
     By means of the pedal  70  and electric cable  72  that connects to the plug  71 , the devitalizing electric pulse can be controlled by the foot. To devitalize the root canal properly, it is necessary to penetrate close to the apical point but to avoid going beyond it. 
     FIGS. 2 and 3 show in perspective, a cross section of a premolar  80  with its crown  81 , dentine  82 , pulp  83 , root canals  84 ,  85 , bundle of nerves  40 , artery  41  and vein  42 . 
     These canals have an anatomical apex  90  and a radiological apex  91 . It is known that devitalization must be done close to the anatomical apex  90  but must not go beyond it, so that the length of the root canal must be measured from the top  93  of the tooth down to the anatomical apex  90 , tooth by tooth. 
     These measurements are obviously necessary because of the great variety of tooth sizes among types of person, age and other factors. The needle  100  already described permits these measurements to be made. 
     Assuming that a tooth  80  with a caries  88  on the crown  81  has to be treated, an anaesthetic is given and an aperture  95  of a diameter of mm 2-4 is made in the crown  81  until the entrances  96  and  97  to the root canals  84  and  85  (FIG. 3) can be seen. 
     Said canals are then probed to calculate the necessary depth which must correspond to the entire length of the canal less about 1 mm from its apex. 
     By using the needle  100  already described it is possible to calculate the length of intervention by electronic means. 
     For this purpose the push button  22  on the apparatus  10  is pressed and the machine is set for measuring the root canal. 
     This setting is confirmed by illumination of the pilot light  23 . Then, as seen in FIG. 5, the pincer  64  is applied to the lower lip  111  of the patient  110 , said pincer being on cable  65  connected to cable  62 , after which the needle  100  mounted in the handle  50  is introduced into the root canal to which treatment has to be given, for example the canal  84  (see FIG.  4 ). 
     When the tip  105  of said needle  100  reaches the beginning of the apical area, a two-tone warning sound is given. 
     This signal announces that the correct depth for devitalization has been reached, namely the depth of about mm 1.5 from the apex. 
     At this point the operator removes the pincer from the lip of the patient who than takes hold of the neutral handle  60  (FIG. 5) and presses the button concerned with the treatment from among buttons 30-33 on the apparatus. 
     When the right button has been pressed, the apparatus automatically sets the time, power and frequency necessary and automatically passes from the setting for measuring depth to that for distributing energy. The operator then presses the control pedal  70  determining generation, inside the root canal in which the needle is lodged, of an electric pulse sufficient to devitalize said canal. 
     A single-tone warning signal indicates completion of the treatment. 
     Power of the current used for this purpose is substantially 70 W RF, at 300 Ohm, high frequency of about 0.5 Mhz and is applied for about one tenth of a second. 
     After the operation the machine automatically returns to the “measuring” position ready to repeat the cycle. 
     The pulse of current emitted by the machine acts on the bundle comprising nerves, vein and artery in the canal. 
     The bundle of nerves is disintegrated and blood in the vein is coagulated at the same time. 
     Practically speaking the whole of the material in the canal is removed and the canal, as well as its branches (FIG. 4) is sterilized. 
     The operator then closes the canals with special cement  45  and can treat the caries  88  and complete the filling  46  (FIG.  7 ). 
     The whole apparatus is electronically controlled as seen in the block diagram in FIG. 8, 
     This diagram comprises the entry filter  120 , feeder  121 , RF pulser, generator of pulse radio frequency  122 , the circuit  123  for setting output power shown on the display  124 , the circuit  125  for setting Burst time, the circuit  126  for passage, by control  127 , from manual to automatic operation and vice versa, the circuit  128  that automatically protects the output pulse so that it does not exceed the set power value and the safety circuit  129  that prevents involuntary repetition of the devitalizing process before 10 seconds have passed. 
     The circuit  130  is an acoustic warning whose two-tone signal warns when the apical point has been reached during measuring, and whose single tone sounds warns that the devitalizing pulse has been applied and the operation completed. 
     When in its automatic setting the apparatus selects, by buttons 30-33 the type of tooth to be treated and then automatically adjusts power and time for that type of tooth. 
     Output power can be adjusted with button  24  that acts on the circuit  131 .