EA014538B1 - Method for mineralization of root tooth tissue - Google Patents

Abstract

The present invention relates to medicine, namely, dentistry, and may be used in the treatment of caries of a tooth root. The object of the invention is to improve the efficiency of remineralization of hard tooth tissues for the purpose of reducing treatment periods of progressive and/or rapidly progressive supragingival carious stains without dentine defects on the vestibular and/or oral surface of a tooth root. The method consists in the subsequent use, in the course of the medical treatment of demineralization of tissues of a tooth root for the purpose of cleaning a tooth root and for Ph normalization, of the following substances: sodium hydrogen carbonate; 0.01% Myramistin solution for suppressing the activity of pathogenic microflora and for enhancing focal defense reactions; calcium glycerophosphate and nanocrystalline calcium hydroxyappatite as remineralizing components, and finally a fluorinated photocurable dentine cylant (desensitizer) is applied for providing a long-term contact of the above medicaments with complex cavity of a tooth root and for reducing dentine sensitivity of exposed tooth roots. The affected surface of a tooth root is exposed to medicaments during 3 procedures for 2.5 minutes at one day interval.

Description

The present invention relates to medicine, namely to dentistry, and can be used in the treatment of tooth root caries.

Prior to the development of methods for remineralizing therapy for dental caries that proceeds without the formation of a cavity defect in hard tissues, it was believed that the only effective way to treat a carious lesion at any stage is the operative excision of the affected tissue with subsequent filling. However, when preparing and filling carious cavities localized on the surface of the tooth root, certain difficulties often arise. This is due to the small thickness of hard tissues in the area of the root of the tooth, the problem of achieving dryness of the surgical field (due to the presence of gingival fluid, bleeding gums, exudate from periodontal pockets), and the peculiarities of fixing filling materials to dentin and cement.

The caries of the root surface is characterized by a slow spread of the carious process mainly along the surface of the tooth root (and not deep into the tissues) with the formation of shallow carious cavities. These features of the tooth root caries course make it possible in some cases to avoid the preparation and filling of progressive and rapidly progressing supragingival carious spots without dentin defect on the vestibular and oral surfaces of the tooth roots, limiting themselves to minimal grinding of the tooth root hard tissues in combination with the use of medications.

The literature describes various patterns of application of fluorinated varnishes, gels, solutions, systems with controlled release of fluorides, dentin-sealing liquid [1, 2].

There are also known methods of using fluorine-containing drugs in combination with antiseptics (chlorhexidine, triclosan, thymol, phytoantiseptic) for a more effective effect on pathogenic microflora [1, 2].

The experiments showed the effectiveness of casein phosphopeptide amorphous calcium phosphate paste in combination with sodium fluoride [3].

The literature also describes the effect of desensitizers on the initial demineralization of root dentin [4, 5].

The disadvantages of the known methods are the duration of treatment, the low effectiveness of the treatment, the absence of prolonged contact of drugs with caries affected tooth root surface.

The closest in technical essence is the micro-filling method and micro-filling for dental use using the closest drug composition to act on the demineralized tooth tissue [6]. A paste (powder, granules, suspension) containing hydroxyappatite or tetracalcium phosphate is rubbed into the tooth, preferably for 3 minutes, each time after a normal brushing. It is allowed to add tricalcium phosphate, fluoride, protein to the paste (powder, granules, suspension). If necessary, it is recommended to cover the treated area with a fluorine compound or polymer material such as a silant. The disadvantage of this method is the need to use a paste every time after brushing your teeth, that is, the duration of the course of treatment, the lack of control of the procedure by the doctor.

The objective of the invention is to increase the effectiveness of remineralization of hard tooth tissues in order to reduce the treatment time for progressive and / or rapidly progressive supragingival carious spots without dentin defect on the vestibular and / or oral surface of the tooth root.

The problem is solved by the fact that in the complex of generally accepted therapy for progressive and / or rapidly progressing supragingival carious spots without dentin defect on the vestibular and (or) oral surface of the tooth root, specially selected drugs are used as a medical treatment. These drugs are rubbed successively into the affected surface of the tooth root for 3 procedures for 2.5 minutes with an interval of 1 day and with subsequent coating of the root at the end of the course of treatment with a fluorine-containing photocurable dentin silane (desensitizer). For the medicinal treatment of progressive and / or rapidly progressive supragingival carious spots without dentin defect on the vestibular and / or oral surface of the tooth root, sodium bicarbonate (soda) is consistently used - up to 67% paste;

miramistin - 0.01% solution;

calcium glycerophosphate - 2.5% solution;

calcium hydroxyappatite nanocrystalline - gel.

Sodium bicarbonate has buffering and abrasive properties, normalizes pH and additionally cleans the root surface.

Miramistin is a broad-spectrum antiseptic that acts on pathogenic microflora, enhances local defense reactions, regenerative processes (due to modulation of the cellular and local humoral immune response), favorably affects the course of periodontal diseases that precede and accompany root caries. Unlike chlorhexidine, which is proposed in the treatment regimens for root caries, it does not stain teeth and mucous membranes.

Calcium glycerophosphate - a combination of calcium and phosphorus with a high level of biodos

- 1 014538 stupidity, since it is a substrate of phosphatases, enzymes directly involved in the mineralization of tooth tissues. Provides remineralization of hard tissues of the tooth [7].

Nanocrystalline calcium hydrocapatite contains calcium and phosphorus in a molar ratio of 1.67 (the optimal ratio for hard tooth tissues). Nanoparticles are able to penetrate the dentinal tubules and fill demineralized microspaces and small dentin defects. Reduces the sensitivity of dentin, often associated with exposure of roots and caries of the root [8, 9, 10, 11, 12, 13].

The application of a fluorine-containing photocurable silant for dentin (desensitizer) to the surface of the tooth root at the end of the treatment provides long-term contact of drugs with carious lesions of the root of the tooth, a decrease in the sensitivity of dentin to exposed roots, and the release of fluorine ions for a long time [4, 5]. All drugs are non-toxic and non-irritating.

The combination of properties of the proposed drugs and the use of a fluorine-containing photo-curing silant for dentin (desensitizer) can increase the effectiveness of remterapy and reduce the treatment time for progressive and / or rapidly progressing supragingival carious spots without dentin defect on the vestibular and / or oral surface of the tooth root.

The method is as follows. A complex of traditional therapeutic measures is carried out aimed at normalizing oral hygiene and eliminating inflammation in periodontal tissues. Progressive and / or rapidly progressive supragingival carious spots without dentin defect on the vestibular and / or oral surface of the tooth root, if necessary, are ground and polished with rotating tools.

Hygienic treatment of the affected tooth root with a paste containing sodium bicarbonate (up to 67%) is carried out for 30 s using a rotating brush.

The tooth is washed with water, isolated from saliva and dried from a water-air gun.

Then follows the antiseptic treatment of the carious spot with a 0.01% solution of miramistin. The solution is applied to the affected area and to the gingival margin with an applicator for 30 seconds.

The tooth is washed with water, isolated from saliva and dried from a water-air gun.

Next, an application of a 2.5% solution of calcium glycerophosphate is performed for 1 min. Then rub the hydroxyappatite nanocrystalline calcium gel over 30 s using an applicator or a rotating brush.

In total, 3 procedures are carried out with an interval of 1 day.

At the end of the course of treatment, the affected root surfaces are coated with a fluorine-containing photocurable dentin silant (desensitizer).

Clinical trials were conducted on 15 patients aged 45-54 years. Patients were diagnosed with a progressive supragingival carious spot without dentin defect in the vestibular surface of the tooth root. Patients were divided into 3 groups (5 people each). Patients of all groups underwent a set of traditional therapeutic and preventive measures aimed at normalizing oral hygiene and eliminating inflammation in the periodontal tissues. Carious spots on the root surfaces were sanded and polished with rotating tools if necessary. Then, patients of all groups were exposed to carious spots with drugs for various times (1.5; 2.5; 3.5 min). Moreover, the exposure time was changed by reducing / increasing the application time of a 2.5% solution of calcium glycerophosphate and rubbing the nanocrystalline calcium hydroxyappatite gel. All patients underwent 4 treatment procedures. After each procedure, the following indices were evaluated: IR (remineralization index, [14]), KYCHZ (complex index of differentiated tooth sensitivity, [15]), microcrystallization - oral fluid MK (oral microcrystallization test, [16]).

After the 4th procedure, fluorine-containing photo-cured dentin silant (desensitizer) was applied to carious spots. Long-term treatment results were evaluated after 3 months.

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B (2.5min)

B (3.5 min)

The effect of drugs on the mineralization process of hard tissues of the tooth root of the group '~

indices IR KITCH 3 MK IR KITCH MK IR kitches MK Before treatment 3.7 ± * ‘ 3.3 ± 82% - 3.9 ± * 3.4 ** one hundred%- 3.7 ± * 3.1 + ** 40% 1 type 0.24 0.73 2 type 0.37 0.4 2type 0.31 0.31 60% 2type 0.54 1,6 eighteen%- 0.83 0.89 0.7 0.7 1type 1st 3.7 ± 3.3 + 82% 2.9 + 3.1 ± one hundred%- 3.0 ± 3.1 + 40% 1type procedure 0.24 0.73 2type 0.37 0.37 2type 0.31 0.31 60% 2type 0.54 1,6 eighteen%- 0.83 0.83 0.7 0.7 1type 2nd 3.7+ 3.2 ± 63% ^g 2.3 ± 2.7 + fifty%- 2.7+ 2.5 ± 50% 2type procedure 0.24 0.7 2type 0.51 0.2 2type 0.5 0.4 50% 1 type 0.54 1,58 37% - 1.14 0.44 fifty% 1.14 0.89 1type 1type 3rd 3.5+ 2.9 ± 22% 1.5 ± * 1.8 ± ** eighteen% 1.9 ± * 1.8 ± ** 40% procedure 0.24 0.66 2type 0.51 0.2 2t and p 0.48 0.37 2type 0.54 1.48 78% - 1.14 0.44 82% 1.09 0.83 60% 1type hat 1type 1type 4th 2.5 ± * ‘ 2.7 ± 22% 1.5 ± 1.7 + eighteen%- 1.9 ± 1.7 ± 40% 2type procedure 0.24 0.5 2type 0.51 0.24 2type 0.48 0.24 60 / o1 type 0.54 1.14 78% - 1.14 0.54 82% 1.09 0.54 1type 1type After 3 3.1 ± 3.3 ± 82% 1.5 ± ‘ 1.4 + ** 41% -; 1.9 ± * 1.7 + ** 80% 2type of the month 0.31 0.73 2type 0.51 0.37 2 type! 0.48 0.24 20% 1 type after 0.7 1,64 eighteen%- 1.14 0.83 59% - 1.09 0.54 treatment 1type 1type R ** <0.05 * <0.05 ** <0.05 * <0.05 ** <0.05

In group A, a slight positive dynamics of the indices was observed even after the 4th procedure. In groups B and C, there was a significant decrease in remineralization indices and dentin sensitivity compared with the data before treatment. But the differences between the indicators of groups B and C are unreliable. While significant differences in the values of the indices between groups A and B were determined. Therefore, 2.5 minutes can be considered the optimal time of drug exposure. At the same time, significant differences in the values of the indices after the 3rd and 4th procedures (groups B and B) were not determined. This makes it possible to consider the optimal conduct of 3 treatments with drugs. In the long term of treatment in groups B and C, the achieved results were preserved, which was not observed in group A. In groups B and C, there was a more pronounced positive dynamics in the test of microcrystallization of the oral fluid compared to group A. But there were significant differences between groups B and C this parameter was not noted.

The action of the method is confirmed by examples.

Example 1

Patient M. 50 years. Diagnosis: progressive supragingival carious spots without dentin defect of the vestibular surfaces of tooth roots 45, 47.

Complaints about the sensitivity of dentin in the area of 45, 47, dark spots on the teeth.

On examination: tooth 46 is absent, gum recession is up to 2.5 mm on the vestibular and proximal surfaces 45, 47. The gum is pale pink, there is no bleeding when probing. The patient after the preparatory stage of periodontal treatment: measures were taken to normalize oral hygiene and eliminate inflammation in the periodontal tissues.

On the approximate root surfaces 45, 47, the areas of dentin changed in color are brown; when probed, softening of the root tissues without formation of carious cavities is determined, pain on the surfaces of the roots of the teeth is 45, 47. IR = 4 points, KIDCHZ = 5 points (per tactile stimulus). Type 2 microcrystallization of the oral fluid was observed.

The treatment was carried out as follows: plaque was removed from the teeth 45, 47. Then, the lesion site was ground with a diamond bur (yellow stripe), polished with a rubber cup. It was prescribed rubbing the paste containing hydroxyappatite after each brushing. 5 days after the prescribed treatment: IR = 4 points, KYCHZ = 4 points (per tactile stimulus), microcrystallization of the oral fluid was observed according to the 2nd type.

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After 10 days: IR = 3 points, KIDCHZ = 4 points (per tactile stimulus), microcrystallization of the oral fluid was observed according to the 2nd type. 10 days after the start of treatment, the roots of the teeth were coated with fluoride varnish. After 3 months: IR = 3 points, KIDCHZ = 3 points (per tactile stimulus), microcrystallization of the oral fluid was observed according to the 2nd type.

Example 2

Patient S. 52 years old. Diagnosis: progressive supragingival carious spots without dentin defect of the vestibular surfaces of tooth roots 26, 24.

Complaints about dentin sensitivity in the area of 26, 24, dark spots on the teeth.

On examination: tooth 25 is absent, gum recession is up to 3 mm on vestibular and proximal surfaces 24, 26. The gum is pale pink, there is no bleeding when probing. At the preparatory stage of periodontological treatment, measures were taken aimed at normalizing oral hygiene and eliminating inflammation in the periodontal tissues.

On the approximate root surfaces 24, 26, the areas of dentin changed in color have a light brown color, softening of the root tissues without formation of carious cavities is determined by probing, the root surfaces of the teeth 24, 26 are sore. IR = 4 points, KIDCH = 6 points (tactile stimulus). Type 2 microcrystallization of the oral fluid was observed.

The treatment was carried out as follows. The plaque was removed from the teeth 24, 26. Then, the lesion site was ground with a diamond bur (yellow stripe), polished with a rubber cup. Conducted 2 procedures for 2.5 minutes, exposure to drugs (sodium bicarbonate, 0.01% solution of miramistin, calcium glycerophosphate, calcium hydroxyappatite nanocrystalline) in accordance with the proposed method of treatment.

After the treatment: IR = 3 points, KIDCHZ = 4 points (per tactile stimulus), microcrystallization of the oral fluid was observed according to the 2nd type.

After the 3rd procedure: IR = 1 point, KYCHZ = 2 points (per tactile stimulus), microcrystallization of the oral fluid was observed according to the 1st type.

After the 3rd procedure, the roots of the teeth 24, 26 were coated with a fluorine-containing photo-cured dentin silane (desensitizer). After 3 months: IR = 1 point, KIDCHZ = 1 point (per tactile stimulus), microcrystallization of the oral fluid was observed according to the 1st type.

Thus, the application of the method according to the invention provides a reduction in the treatment time for progressive and / or rapidly progressive supragingival carious spots without dentin defect on the vestibular and / or oral surface of the tooth root by increasing the effectiveness of remineralizing therapy.

Claims (7)

1. The method of mineralization of hard tissues of the root of the tooth by exposure to demineralized areas with drugs, followed by coating the surface of the root of the tooth with a fluorine-containing photohardening dentin silant, characterized in that sodium bicarbonate is successively used to reduce the remineralization time in order to clean and normalize the pH on the tooth root, then - to suppress the activity of pathogenic microflora and enhance local protective reactions - miramistin solution, further as remineralizing to the components are calcium glycerophosphate, then calcium hydroxyappatite is nanocrystalline and, in order to ensure long-term contact of the above preparations with carious lesions of the root of the tooth and to reduce the sensitivity of dentin to exposed roots, a fluorine-containing photocurable silant for dentin is applied. 2. The method according to claim 1, characterized in that the total exposure to drugs is carried out for 2.5 minutes 3. The method according to claim 1, characterized in that they carry out hygienic treatment of sodium bicarbonate in the form of 67% paste for 30 s. 4. The method according to claim 1, characterized in that the antiseptic treatment is carried out with a 0.01% solution of miramistin for 30 s. 5. The method according to claim 1, characterized in that the application of 2.5% calcium glycerophosphate solution is carried out for 1 min. 6. The method according to claim 1, characterized in that they rub the gel of calcium hydroxyappatite nanocrystalline for 30 s. 7. The method according to claim 1, characterized in that the treatment is carried out for 3 procedures with an interval of 1 day. Eurasian Patent Organization, EAPO Russia, 109012, Moscow, Maly Cherkassky per., 2