RU2138996C1 - Method for eliminating perforations of crown cavity bottom or tooth root and treating chronic periodontitis caused by perforation - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves filling perforation hole with filling material and additionally cutting out trapezoid mucoperiosteal graft along gingival edge. Pathologically changed tissues are removed from tooth root surface. Recess is formed around the perforation hole and filled with glass ionomeric cement or light-hardening compomer. The arisen bone defect is filled with material based on hydroxyapatite. EFFECT: enhanced effectiveness of treatment.

Description

 A method for eliminating perforations of the bottom of the coronal cavity or tooth root and treating chronic periodontitis that has developed as a result of perforations.

 This invention relates to medicine, namely to surgical dentistry, and can be used in the treatment of patients with perforations of the bottom of the crown cavity or root of the tooth.

 In the process of endodontic treatment, complications often arise in the form of perforations of the bottom of the coronal cavity due to a carious process or accidental perforation with boron. In addition, during instrumentation of the root canals due to anatomical features or as a result of improper use of endodontic instruments, perforation of the roots of the teeth is possible.

 A known method of eliminating perforations of the bottom of the coronal cavity or root of the tooth by closing the holes with filling material during filling [V. S. Ivanov and others. "Inflammation of the pulp of the tooth", Moscow, 1990, S. 193].

 In case of unsuccessful conservative treatment, traditional surgical methods are used: coronary-radicular separation, hemisection or amputation of the root.

 The disadvantages of this method include the fact that when sealing the perforations of the coronal cavity, it is possible to push excess filling material into the periodontium, composite filling materials require certain conditions: the absence of moisture and blood in the cavity for good adhesion, preliminary etching of the cavity. Because of this, they do not provide tightness: granulation tissue grows in the tooth cavity, pain occurs, bleeding, tooth function decreases, fillings fall out.

 Filling of perforations of the root canal by conventional methods is often ineffective, since there is no tight seal on the periodontal side, resorption of the filling material and destruction of bone tissue occur. When filling, it is possible to remove the filling material beyond the root during the periodontium.

 Traditional surgical methods for treating chronic periodontitis (root apex resection, hemisection, root amputation, coronary-radicular separation) do not always ensure the success of the operation as a result of the development of postoperative complications, relapses of the destructive process, incomplete or delayed regeneration, which makes the tooth functionally inferior.

 The aim of this invention is to reduce complications and preserve the anatomical integrity of the tooth and the full function of the tooth.

 This goal is achieved by the fact that in the method of eliminating the perforation of the bottom of the crown cavity or root of the tooth and treating chronic periodontitis that developed as a result of perforations by filling the perforation hole with filling material, a distinctive feature is that an additional trapezoidal mucosal-periosteal flap is cut along the gingival margin and removed pathologically altered tissues, on the surface of the tooth root around the perforation hole form a recess that fills the stack oionomernym cement or light-curing compomer formed bone defect filling material based on hydroxyapatite.

 The essence of the proposed method.

 Perform appropriate conduction or infiltration anesthesia. Next, a trapezoidal mucoperiosteal flap is cut out along the gingival margin. After folding the mucosal-periosteal flap in the absence of destruction of bone tissue, the cortical plate is trepanized in the perforation zone. Then, a portion of the root cement around the perforation is removed with boron or a protruding fragment of a metal tool is removed with the formation of a lunate depression in the perforation area. Using a light-curing compomer or glass ionomer chemical curing cement, the formed semilunar recess is filled, thus isolating the perforation hole and (or) the metal tool from the surrounding tissues. The resulting bone defect is filled with hydroxyappatite-based material (Ostim-100). In case of destructive changes in bone tissue, pathological tissues are carefully removed with the subsequent filling of the Ostim-100 defect with the addition of antibiotics or sulfonamides.

 In conclusion, the wound is sutured.

 Example 1. Patient B. complained of periodically occurring pain in the area of the 15th tooth. The tooth has been previously treated. In the x-ray, the root canal is sealed to the apex, an anchor pin is inserted in the upper third of the canal, the axis of which does not coincide with the axis of the root canal, the distal root wall is perforated. In the area adjacent to the perforation, there is a focus of rarefaction of bone tissue such as cystogranulomas. Palpation over the area of perforation is painful. The patient is offered surgical treatment. Under conduction anesthesia, a trapezoidal mucoperiosteal flap was cut along the gingival margin. Then, using a raspator, a detachment of the mucoperiosteal flap was made. A defect in the cortical plate was revealed on the surface of the alveolar ridge. The existing defect is expanded with a spherical bur, access to perforation is obtained, the protruding part of the anchor pin is ground, a half-moon recess has been created on the root in the perforation area, which is closed with Base Line glass ionomer cement. Then, a thorough curettage of the bone wound was made (pathologically altered tissues were removed). The bone defect is filled with OSTIM 100 hydroxyapatite. The operation is completed by suturing the wound.

 3 months after surgical treatment, there are no complaints from the patient. In the x-ray, the defect area is significantly reduced due to the formation of new bone tissue.

 Example 2. Patient M. during endodontic treatment while trying to unseal a previously treated canal, perforated the wall of the root canal of the 34th tooth, performed hemostasis, the true canal was sealed, enlarged, washed with sodium hypochlorite, dried, sealed with AN-26 filling material with gutta-percha . False perforation washed with sodium hypochlorite, dried, sealed with AN-26. An X-ray after filling revealed an excess of filling material outside the root canal into the surrounding bone tissue in the area of perforation. Surgical treatment was performed. Under conduction anesthesia, a trapezoidal mucoperiosteal flap was cut along the gingival margin. Then, using a raspator, it was detached. Cortical plate trepanation was performed with a spherical boron over the perforation area, a root section with a perforation hole and extracted filling material were exposed. Then the excess material is removed. On the root surface in the perforation zone, a rounded indentation is formed, which is then filled with glass ionomer cement. The bone defect is filled with OSTIM 100 hydroxyapatite. Stitched.

 The advantages of this method include the fact that the method is applicable for the treatment of old perforations or immediately after perforations. The use of Base Line glass ionomer cement or Dyrect compomer in this method, which are durable and have excellent adhesion to dentin and cement, are easy to use, since the hardening of these materials takes place directly during surgery, which allows for tight sealing of perforations. The use in the proposed method of hydroxyapatite "OSTIM 100" of high dispersion allows you to stimulate reparative osteogenesis and reduce inflammatory reactions in the bone tissue. This method allows, together with maintaining the anatomical integrity of the tooth, to reduce the number of complications and preserve the functional integrity of the tooth.

Claims (1)

 A method for eliminating perforations of the bottom of the coronal cavity of the tooth root and treating chronic periodontitis that developed as a result of perforations by filling the perforation hole with filling material, characterized in that a trapezoidal mucosal-periosteal flap is additionally cut out along the tooth-gingival margin, pathologically altered tissues on the tooth root surface are removed, a recess is formed around the perforation hole, which is filled with glass ionomer cement or a light-curing compomer, forming Bone tissue defect is filled with hydroxyappatite-based material.