RU2216303C1 - Method for treating periodontitis - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: one should introduce the mixture of sodium Cephasolin antibiotic, Viferon immunomodulating preparation and Dexametason corticosteroid at ratio of 1:1:0.1, correspondingly at the dosage of 0.5-1 g. Moreover, medicinal mixture should be placed in root canal of the tooth at withdrawing it beyond apical opening. The present method enables to efficiently affect the main pathogenetic mechanisms of periodontitis development. EFFECT: more stable curative effect. 2 ex

Description

 The invention relates to medicine, namely to therapeutic dentistry, and can be used in the treatment of periodontitis.

 Obligatory anaerobes have been found to prevail in pulp-periapical diseases (Pakman, L. M., et al. Root canal infections: symptoms versus bacterial isolates. Abst. Am. Soc. Microbiol., C-38, 80th Annual meeting, 1980). According to a study on monkeys, staphylococci, neisseria, lactobacilli and fungi (Fabricus, L. Oral bacteria and apical periodontitis: an experimental study in mokey (thesis). Department of Oral Microbiology, University of Goteborg, are rarely detected in the root canals with pulp necrosis. Goteborg, Sweden, 1982). In the initial stages of pulp infection, facultatively anaerobic streptococci and staphylococci are detected. One group of researchers found that microbes such as Streptococcus salivarius and Staphylococcus epidermidis (Griffee, M. B., et al .: Bacteriodes melaninogenicus and dental infections: some questions and some answers. Oral Surg. 54: 486) can be causative agents.

 However, by the time the periapical “foci” are formed, the root canals are always infected, and the microflora almost always consists of obligate anaerobes, including bacteroids, fusobacteria, and some gram-positive bacilli. It turns out that deep in the root canal after some time anaerobic conditions are created and there are enough nutrients for microbes in it coming from necrotic pulp tissue. Sundqvist revealed that in teeth with pulp necrosis and periapical lesions, microflora almost exclusively consists of obligate anaerobes. Sundqvist claims that there are over 500 species of microorganisms in the oral cavity, but only a few are constantly detected in the root canals. He also pointed out that the microflora of the root canal is part of the microflora of the periodontal pocket, which, in turn, is part of the microflora of the oral cavity. Therefore, the modern concept is that obligate anaerobes are of the greatest clinical importance, especially with periapical lesions.

 Sundqvist performed an exhaustive bacteriological study of necrotic pulp tissue and in all teeth with acute periapical inflammation (soreness, swelling and exudation) isolated Bacteroides melaninogenicus, which were not present in the teeth without these symptoms (Sundqvist, G. Bacteriological Studies of necrotic dental University pulps, Dissertations, 7, 1976).

 However, endodontic infections are usually mixed. In infectious lesions of the mucous membranes of the oral cavity, the microbes of the oral cavity usually interact synergistically, and Bacteroides melaninogenicus are, apparently, the main ones.

 For the treatment of periodontitis, many different antibacterial drugs are used. Antibiotics, chemotherapy drugs and other used drugs, as a rule, have a bactericidal and bacteriostatic effect on the microbial population of the root canals and periodontium. In this case, there is a massive undifferentiated and uncontrolled destruction of the microflora of the entire biotope of the oral cavity and, first of all, of the saprophytic microflora. In addition, antibiotic therapy leads to the selection of multiple resistant variants of pathogens that contribute to the spread of the inflammatory process.

 In this regard, due to the rare use of antibiotics in dentistry because of the fear of causing serious hypersensitivity reactions and the emergence of resistant strains of microbes, there has been an alarming increase in the frequency of life-threatening infections secondary to pulp-periapical diseases. Many of the patients do not have any clinical signs of impaired resistance and there is no evidence of this in their history. In addition, some life-threatening consequences of periapical pathology of pulpal origin developed in people who, on their first visit, had no adverse symptoms or had minimal negative clinical manifestations. It was found that in all cases with pulp necrosis and periapical lesion, the root canal was infected with obligate anaerobes (Sundqvist, G. Bacteriological studies of necrotic dental pulps, Umena University Odontological Dissertations, 7, 1976).

 In the treatment of any inflammatory processes, the most active are steroidal anti-inflammatory drugs, they inhibit all phases of inflammation: alteration, exudation and proliferation. The anti-inflammatory effect is due to a direct effect on the focus of inflammation and is fully preserved with local application. In a double-blind study, it was shown that the intracanal use of a decadron corticosteroid solution (dexamethasone, 4 mg / ml) as an irrigant and an intracanal drug for treating pain in the first 24 hours after instrumentation with lively inflamed pulp had a statistically significantly better effect than placebo in control (Moskow, A., et al. Intracanal use of a corticosteroid solution as an endodontic anodype. Oral Surg. 58: 600, 1984).

 Of the corticosteroids, dexamethasone (Decadron) has the highest anti-inflammatory activity, 30 times higher than cortisone (Bahn, S. L. Glucocorticosteroids in dentistiry, J. Am. Dent. Assoc. 105: 476, 1982).

 A variety of microorganisms is considered an important indication for the widespread use of antibiotics. The presence of specific antibodies in the blood serves as a recommendation for the use of immunocorrective agents (IV Malanyin, SI Risovanny, ON Risovannaya. 1998).

 Currently, the drug Viferon occupies a worthy place in the arsenal of practical medicine. The interferons that make up Viferon, as natural factors of nonspecific defense of the body and mediators of immunity, have the widest spectrum of action.

 The complex composition of Viferon causes a number of additional effects: in combination with membrane-stabilizing drugs, the antiviral and antiparasitic activity of recombinant interferon-α2 increases up to 10-14 times. Its immunomodulatory effect on T- and B-lymphocytes is enhanced, the content of immunoglobulin E is normalized, there are no side effects that occur with parenteral administration of interferon (Bondarenko A.N., Malanyin I.V., Risovanny, S.I., Risovannaya O.N. Immunorehabilitation of patients with periodontitis using Viferon. International journal on immunorehabilitation. 12, May 1999, p.118).

 Viferon is compatible with antibacterial drugs and glucocorticosteroids, which allows its use in the complex treatment of periodontitis.

 The interaction of the components of Viferon can significantly reduce the dose and duration of courses of antibiotic and hormone therapy (Delenian N.V., Arinenko R. Yu., Meshkova E.N .; Edited by Malinovskaya V.V. Viferon. A guide for doctors. - M. , 1997. - 33s.).

 The antioxidant components of Viferon - ascorbic acid and α-tocopherol acetate - regulate redox processes in the body, carbohydrate metabolism, promote tissue regeneration, participate in protein biosynthesis and tissue respiration, etc. The immunomodulatory effect of α-tocopherol and its protective effect when combined with chemotherapy.

 The above prompted the authors to create a new combined method for the treatment of periodontitis, which includes the use of drugs Cefazolin sodium, Dexamethasone in combination with Viferon.

 It is known to use penicillin G and V or the potassium salt of phenethicillin (for oral administration). In oral infections, microorganisms usually interact synergistically, and penicillin, killing sensitive microbes and making microbes resistant to it, suppresses this synergistic activity (Guralnick, W. Odontogenic infections, Br. Dent. J. 156: 440, 1984).

 Even though penicillin does not affect the cell wall of gram-negative microbes, such as Bacteroides melaninogenicus, it can make them ineffective by destroying gram-positive microbes on which gram-negative microbes depend. One of the possible ways of its action is based on the fact that some gram-positive microbes supply vitamin K for Bacteroides as a necessary metabolite. With the destruction of gram-positive bacteria by penicillin, bacteroids stop receiving vitamin K and therefore die.

 Almost all recent studies indicate that penicillin V remains the most preferred antibiotic for outpatient treatment of odontogenic infections (Sundqvist, G. Bacteriological studies of necrotic dental pulps, Umena University Odontological Dissertations, 7, 1976).

 It has a weak direct toxic effect on tissues, but of all antibiotics used in endodontics, it causes a greater number of allergic reactions.

Disadvantages:
- penicillin does not affect the cell wall of gram-negative microbes, such as Bacteroides melaninogenicus;
- Penicillin from all antibiotics used in endodontics causes a greater number of allergic reactions.

 It is known the use of broad-spectrum antibiotics (Ciancio, S. G. Drugs in dentistry: antibiotics, Dent. Manag. 24 (9): 48, 1984), which we took as a prototype. Broad-spectrum antibiotics, including ampicillin (semisynthetic penicillin) and tetracycline, are less effective than penicillin, since endodontic infections are more often caused by gram-positive microbes that are usually sensitive to penicillin. Other antibiotics can also be used - such as clindamycin (cleocin) and cephalosporins (keflex, duricef).

 However, there is evidence that when using clindamycin, serious or even more fatal reactions may develop. Therefore, it must be used with the ineffectiveness of other antibiotics.

 Erythromycin, lincomycin, clindamycin and tetracyclines inhibit bacterial protein synthesis. Since in this case the direct death of microbes does not occur (as in the case of penicillin), then their protective cells need the help of the host cells to destroy them.

 Lincomycin can cause severe gastrointestinal upset, and clindamycin can cause serious or fatal reactions. One of the benefits of clindamycin is that it produces few hypersensitivity reactions. Neither lincomycin nor clindamycin are as effective against penicillin-sensitive microbes as penicillin itself. Cephalosporins can be cross-allergic to penicillin, therefore, patients with an allergy to penicillin are not indicated. They have a wider spectrum of action and are bactericidal, but more toxic than penicillin.

 Penicillin and erythromycin (in high doses) have a bactericidal effect, while tetracyclines have only a bacteriostatic effect. Other tetracycline deficiencies are listed below (Epstein, S. and Scopp, I.W. Antibiotics and the intraoral abscess, J. Periodontol. 48: 236, 1977).

 Disadvantages.

 1. Their use can lead to increased growth of other microorganisms not sensitive to them.

 2. They can cause frequent development of adverse reaction reactions, both among themselves and with various other drugs.

 3. When used during the period of development of the tooth rudiments, the color of the teeth (photosensitivity) may change.

 4. Cause more side effects than penicillin or erythromycin.

 The above prompted the authors to create a new method for the treatment of periodontitis, including the use of the drug Cefazolin sodium in combination with Viferon and the corticosteroid Dexamethasone.

 The objective of the invention is to increase the effectiveness of the treatment of periodontitis.

 SUMMARY OF THE INVENTION

 A mixture of drugs is injected into the periodontium through a pre-treated root canal. The method differs in that the antibiotic Cefazolin sodium, the immunomodulating drug Viferon and the corticosteroid Dexamethasone in a ratio of 1: 1: 0.1 in a dose of 0.5-1 g are introduced into the lesion for 10-15 days, while the drug mixture is placed in the root canal with its removal by the apical opening, into the focus of inflammation.

 The method is as follows.

 After trepanation, extirpation of the pulp or residual pulp tissue and mechanical preparation of the root canal to a norm of at least ISO 40 (corresponding to 0.4 nm), the canal is, as usual, washed, cleaned, and then dried. Then, using a canal filler, Cefazolin sodium, Viferon and Dexamethasone are introduced into the root canal in a ratio of 1: 1: 0.1 in a dose of 0.5-1 g. When the drug mixture is introduced into the root canal, it is led out of the apical opening. The drugs are left in the canal for 10-15 days. After that, the canal is sealed according to the generally accepted method, preferably with the use of hooked pins and the lateral condensation method.

 In the treatment of periodontitis, the application of the proposed method was tested in 100 patients, 50 patients made up the control group, the treatment of which was carried out in the traditional way.

 52% of patients in the control group, the treatment of which was performed in the traditional way, within 4-5 days, pain was felt when biting in the area of the causative tooth. The pain was sometimes aggravated by eating, especially hard. And in patients with the initial stages of periodontal disease - and longer.

 Patients who were treated using the proposed method did not complain of pain (discomfort). In 4 patients, inconvenience occurred only when taking solid food during the first 2-3 days.

 A follow-up examination 12 months after filling the canals in 5 (10%) patients of the control group revealed slightly painful percussion. In 8 (16%) patients, control x-rays showed an increase in the width of the periodontal gap and foci of rarefaction of bone tissue in the apical part of the roots.

 In patients of the main group, during the follow-up examination after 1 year, after treatment using the proposed method, the clinical picture was more favorable. There was no discomfort or pain. Radiologically in the periodontal tissues, foci of rarefaction of bone tissue in the apical part of the roots were not found.

 Example 1

 Patient S., 27 years old, complained of spontaneous pain in the 35 tooth, which occurs mainly at night. Soreness was aggravated by eating. According to the patient, spontaneous pain appeared 15 days ago. The tooth was previously treated for complicated caries.

 An objective examination of the 35 tooth revealed the remains of an old seal. The sounding of the cavity 35 of the tooth is sharply painful. Percussion is sharply positive. The R-gram shows a carious cavity communicating with the tooth cavity, the remains of filling material in the canal, an increase in the width of the periodontal gap and a rarefaction of bone tissue in the apical part of the root.

 Diagnosis: chronic periodontitis of 35 teeth.

 Treatment: under mandibular anesthesia Sol. Ultracain D-S forte, 1.7 ml, a carious cavity of 35 teeth was prepared. The tooth cavity is open. The remains of the old filling material from the canal have been removed. The channel was machined to the norm of ISO 40. The channel was washed with sodium hypochloride and dried. Then, using a canal filler, Cefazolin sodium, Viferon and Dexamethasone were introduced into the root canal in a ratio of 1: 1: 0.1 at a dose of 0.5 g. The drug mixture was taken out of the apical opening. The drugs were left in the canal for 10 days.

 The tooth channel 35 is sealed with Sealapex material using gutter-pin and lateral condensation method.

 The crown of the tooth was restored with Spectrum.

 When viewed after 3 days, the patient did not complain of pain and discomfort.

 At the control examination 1 year after treatment, the clinical picture was favorable. There was no discomfort or pain. Radiologically in the periodontal tissues, foci of rarefaction of bone tissue in the apical part of the root were not found.

 Example 2

 Patient K., 42 years old, complained of spontaneous pain in 11 teeth. Soreness was aggravated by eating. According to the patient, spontaneous pain appeared 10 days ago. The tooth was previously treated for complicated caries.

 An objective examination of the 11 tooth revealed the remains of an old seal. Probing the cavity 11 of the tooth is painful. Percussion is sharply positive. The R-gram shows a carious cavity communicating with the tooth cavity, the remains of filling material in the canal, an increase in the width of the periodontal gap and a rarefaction of bone tissue in the apical part of the root.

 Diagnosis: chronic periodontitis of 11 teeth.

 Treatment: under mandibular anesthesia Sol. Ultracain D-S forte, 1.7 ml, carious cavity of 11 tooth was prepared. The tooth cavity is open. The remains of the old filling material from the canal have been removed. The channel was machined to the ISO 50 norm. The channel was washed with sodium hypochloride and dried. Then, using a canal filler, Cefazolin sodium, Viferon and Dexamethasone were introduced into the root canal in a ratio of 1: 1: 0.1 at a dose of 1 g. The drug mixture was taken out of the apical opening. The drugs were left in the canal for 15 days.

 The tooth canal 11 is sealed with Sealapex material using gutter-pin and lateral condensation method.

 The crown of the tooth was restored with Spectrum.

 When viewed after 3 days, the patient did not complain of pain and discomfort.

 At the follow-up examination 12 months after treatment, the clinical picture was favorable. There was no discomfort or pain. Radiologically in the periodontal tissues, foci of rarefaction of bone tissue in the apical part of the root were not found.

 It is known that chronic inflammation of the periodontium occurs against the background of a significant change in local protective reactions of both a specific and non-specific nature. The components of specific and non-specific immune defense of the oral cavity act in a complex manner, creating several pathways of the immune response. But with periodontitis, a malfunction occurs in the antibacterial barrier of the oral cavity. Treatment using the proposed method contributed to the reduction of stress factors of natural resistance and the relief of the inflammatory process, which indicated the elimination of local immunobiological tension.

 The proposed method allows: for a short time (10-15 days) to effectively influence the main pathogenetic mechanisms of development of periodontitis; get a persistent therapeutic effect. Analyzing the results of the study, we can conclude that the mixture of cefazolin sodium, viferon and dexamethasone is convenient for use, well tolerated by patients, has no side effects and contraindications. The data obtained allow us to recommend the proposed method for the treatment of periodontitis both in terms of dosage and time of exposure.

 It has been established that the complex treatment of periodontitis with the use of cefazolin sodium, viferon and dexamethasone is a fundamentally new, pathogenetically substantiated approach to the treatment of periodontitis. The action of the drug Viferon is biological, mild, as the autoflora of periodontal tissues is corrected. Dexamethasone reduces trophic tissue and significantly reduces the number and strength of painful periapical reactions.

 The use of a new method of treatment of periodontitis with the help of drugs Cefazolin sodium, Viferon and Dexamethasone demonstrates a pronounced therapeutic effect, which allows us to recommend it in widespread dental practice.

Claims (1)

 The method of complex treatment of periodontitis, including the introduction of drugs into the lesion, characterized in that during the periodontium for 10-15 days, antibiotic Cefazolin sodium, immunomodulating drug Viferon and corticosteroid Dexamethasone are added in a ratio of 1: 1: 0.1 in a dose of 0, respectively , 5-1 g, while the drug mixture is placed in the root canal with its removal beyond the apical opening.