RU2240847C1 - Method for preparing dental canals for filling - Google Patents

Abstract

FIELD: medicine, therapeutic stomatology.

SUBSTANCE: the present innovation deals with preparing and sterilizing the system of root canals for filling. One should introduce the solution of photosensitizer into dental canal at concentration being 56 µM to treat it for 5-6 min with diode laser ray at 0.5-1.0 W power and wave length of 662 nm, apical area, first, then its middle part, and then stages should be repeated to finish sterilization with irradiation of canal mouth. Photosensitizer solution enters small canaliculi and anastomoses, thus, all root system is subjected for sterilization. Method affect apical and extra-apical pathogenic microflora of the canal.

EFFECT: higher efficiency of endodontic therapy.

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Description

The present invention relates to medicine, namely to therapeutic dentistry, and can be used in the preparation and sterilization of the root canal system for filling.

Many domestic and foreign scientists in recent years have argued that, despite the successes achieved in treating teeth with pulpitis and periodontitis, the percentage of complications after their treatment is still quite high. This is due to the fact that for the final cure and preservation of the tooth it is necessary to qualitatively perform three stages of treatment: mechanical expansion of the canal, chemotherapeutic treatment of the canals of the tooth and a full three-dimensional obstruction of the root canal system. Although the first and third stages are a requirement for all clinical situations, achieving them is not always easy (Brayton, SM, Davis, SR, and Goldman, M .: Gutta-percha root canal fillings. Oral Surg. 35: 226, 1973; Cash , PW: Electronics in endodontics - a clinical report on the Endometer, Tech. Dent. J. 90:21, 1972; Seltzer, S .; Endodontology; biologic considerations. In Endodontic procedures. New York, 1971, MeGraw-Hill Book Co ., pp. 318-325). In addition, the researchers showed that when the canal is sterile, a violation of the marginal fit does not necessarily lead to an inflammatory process in the periapical region (Phillips, JM: Rat connective tissue response to hollow polyethylene tube implants, J. Can. Dent. Assoc. 33:59, 1967; Tomeck, CD: Reaction of rat connective tissue to polypropylene tube implants, part I, Oral Surg. 21: 379, 1966; Tomeck, CD: Reaction of rat connective tissue to polypropylene tubes, part II, Oral Surg. 24: 674, 1967).

Therefore, although the filling of the root canal system plays an important role, careful processing and cleaning of microorganisms are no less important for successful treatment.

Proper cleaning of the root canal system can only be achieved by carefully removing pathogenic microflora from all departments, including lateral branches, blind passages, anastomoses, etc. (Schilder, N., and Yee, F.S .: Canal gebridement and disinfection. In Cohen, S., and Bums, R.C., editors: Pathways of the puip, ed. 3, St. Louis, 1984, The C.V. Vosby Co). Thus, 95% of all surgical complications depend on the quality of biochemical treatment.

Thorough biological and mechanical treatment of the root canal with hand tools has always been a time-consuming process (Rubin, L., et al .: The effect of instrumentation and flushing of freshly extracted teeth in endodontic therapy: a scanning electron microscope study, J. Endod . 3: 194, 1977).

Effective root canal irrigation is also difficult, since it is extremely difficult to deliver the flushing solution to the apical zone. Often, a narrow canal does not allow adequate irrigation, because of which a mixture of dentine sawdust, bacteria and pulp residues remains inside the canal, which helps to block sections of the root canal, including lateral tubules, preventing its biological cleaning.

A known method of sterilizing tooth canals before preparing for filling (Harrison, JW, and Hand, RE: The effect of dilution and organic matter on the antibacterial property of 5.25% sodium hypochlonte, J. Endod. 7: 128, 1981), which involves irrigation of the root canals with a 3% solution of hydrogen peroxide (H ₂ O ₂ ), since this drug has disinfecting properties, and its foaming allows for better penetration of the drug into narrow and small canals.

However, hydrogen peroxide does not dissolve tissue and is ineffective as a lubricant. To cause oxygen evolution, thus increasing the foaming and formation of bubbles necessary for the penetration and removal of residues of organic substances, it was recommended to combine sodium hypochlorite with 3% hydrogen peroxide in the channel. However, this inhibits their individual antibacterial properties.

For the prototype, we adopted a method for chemomechanical treatment of the root canal, which includes washing the canals after they are expanded with a mixture of irrigation solutions. In this case, irrigation solutions are used in the complex: sodium hypochlorite and hydrogen peroxide (Ingle, J.I., and Taintor, J.F .: Endodontics, ed. 3., Philadelphia, 1985, Lea & Febiger, p. 178). It is recognized that the most important irrigation solution used in endodontics is sodium hypochlorite (NaOCl). The concentration of the solution used ranges from 0.5 to 5.25%, but usually it is 2.5%. Sodium hypochlorite has the property of dissolving living, necrotic and fixed tissues well. It has a pronounced bactericidal effect, is an excellent lubricant and bleaching agent, is long-lasting and economically viable (Rosenfeld, EF, James, GA, and Burch, BS: Vital pulp tissue response to sodium hypochlorite, J. Endod. 4: 140, 1978) .

The disadvantages of these irrigants are:

- the need for their use in a strictly limited space of the channel, since the ingress of these solutions outside the channel, especially under pressure, leads to severe toxic effects, tissue damage, as well as the occurrence of acute pain and swelling. These concerns encourage doctors to significantly reduce the concentration of solutions used. However, a decrease in concentration leads to a significant deterioration in the effectiveness of the use of irrigant;

- hydrogen peroxide does not dissolve tissue and is ineffective as a lubricant;

- when combining sodium hypochlorite with 3% hydrogen peroxide, their individual antibacterial properties are inhibited;

- it is extremely difficult to deliver the washing solution to the apical part of the canal;

- Irrigants do not fall into the small tubules and anastomoses, thereby the entire root system is not processed.

Tasks: increasing the efficiency of processing and sterilization of the root canal system.

The essence of the invention lies in the fact that the preparation of the tooth channels before filling is carried out using the introduction of a photosensitizer solution concentration of 56 μM into the channel and the channel is treated with a diode laser beam with a power of 0.5-1.0 W and a wavelength of 662 nm for 5-6 minutes , first the apical zone, then its middle part and then the steps are repeated, completing the sterilization by irradiation of the canal orifice.

The method is as follows.

After trepanation, extirpation of the pulp or residual pulp tissue and mechanical expansion of the root canal, it is treated with solutions of EDTA, sodium hypochlorite or hydrogen peroxide, cleaned and dried with paper pins. Then, the root canal is sterilized using the proposed method.

For this, 56 μM photosensitizer solution is introduced into the channel for 5-6 minutes, so that the photosensitizer is absorbed into all dentinal tubules. The length of the channel, determined by x-ray or using apex locator, is transferred to the laser tip of a flexible fiber with a length of 30 mm and a diameter of 0.4 mm (with a rubber stopper). The fiber is introduced into the channel, not reaching 3 mm to the apex, thereby purposefully the energy of the diode laser is directed to the apical zone.

A diode laser with a wavelength of 662 nm is used, the radiation mode is continuous, the power is 0.5-1.0 watts.

The next step is the fiber is inserted into the middle part of the channel, not reaching the apex by about 7 mm, and the manipulation is repeated again according to the scheme described above to sterilize the central part of the channel. And in conclusion, the light guide is left at the mouth of the channels and treated in the same way.

In this case, the laser beam activates the photosensitizer, resulting in the formation of highly active singlet oxygen and free radicals, which destroy the membrane of all microbial cells, thereby sterilizing the entire network of the root canal with its branches.

After sterilization of the root canal, it is washed with saline and dried with paper pins. Immediately after this, a traditional root canal filling is performed.

It should be remembered that the laser beam should move exclusively in the direction from the apical position - out of the channel. This prevents the jamming of the laser cannula in the root canal.

When preparing root canals for filling, the application of the proposed method was tested in 100 patients aged 26 to 74 years, 50 similar patients made up the control group, the treatment of which was carried out in the traditional way.

Most patients (74%) who had previously applied for dental care to other dental institutions were denied endodontic treatment for various reasons: root canal obstruction (42%), periodontitis with marked changes in the periapical zone (32%). Patients who were preparing root canals for obturation using the proposed method did not complain of pain (discomfort). In 4 patients, inconvenience occurred only when taking solid food, for 2-3 days.

When preparing the canals for filling by the method we proposed, all patients after 1 month fistulous passages and other signs of inflammation disappeared, while monitoring of exacerbation of chronic periodontitis was not observed at a long time.

During an X-ray examination 6 months after preparation of the root canals of the teeth with chronic periodontitis, no destructive processes were detected, partial or complete elimination of the destruction site due to bone tissue regeneration in the periapical site was observed. The preparation of root canals led to a complete sanitizing effect in all cases without exception, that is, under the influence of laser radiation in combination with a photosensitizer, microflora was completely eliminated from the root canals. There were no patients refractory to laser sterilization. In patients of the main group, during the follow-up examination 1 year after treatment using the proposed method, the clinical picture was more favorable. There was no discomfort or pain. Radiologically, no pathological changes were found in periodontal tissues. Periapical changes identified before treatment disappeared.

Laser treatment of the root canal creates the conditions for optimal preparation of the canal with subsequent filling. Laser-assisted root canal treatment reduces the frequency of postoperative complications associated with root canal preparation to zero. Sensitivity when biting after root canal filling is absent.

In 54% of patients in the control group, the treatment of which was carried out in the traditional way, for 4-5 days, pain was felt when biting in the area of the causative tooth.

The pain sometimes intensified when eating, especially hard. And in patients with the initial stages of periodontal disease - and longer.

A follow-up examination 12 months after filling the canals in 5 (10%) patients of the control group revealed slightly painful percussion.

In 4 (8%) 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.

The effectiveness of laser sterilization of root canal is confirmed by the following clinical examples.

Example 1. Patient D. 36 years old, complains of pain in the area of 21 teeth, worse when biting. The pain appeared about 1 month ago. About 1 year ago, this tooth was treated. Objectively: mild swelling along the transitional fold, positive horizontal and vertical percussion on 21 teeth.

Orthognathic bite. CPU = 5 + 4 + 8 = 17. In a small amount, there are soft and hard dental deposits (lingual surface of the front teeth of the lower jaw). EOM data - 2040 m / s. LDF data: MD - 19.6 srvc. units, PS - 24.0 srvc. units, Gy - 0.20. A control visiography of 21 teeth was performed. The picture determines the fragmentary presence of filling material in the channel.

The channel is not sealed up to 3.5 mm apex. The presence of a tool fragment in the central part of the channel is determined. In the region of the apex 21 - the tooth, the rarefaction of bone tissue is round in shape with clear boundaries with a diameter of 7 mm.

On the basis of the history, clinical examination and additional laboratory methods, the diagnosis was made: granulomatous periodontitis of 21 teeth in the acute stage.

Treatment: Antiseptic treatment of the oral cavity. The opening of the channel 21 of the tooth. The opening and sealing of the channel 21 of the tooth. Using an ultrasonic scaler, profiles and Sonik Air, the filling material and the chip were removed from the channel. Expanding the 21 tooth channel with a profile up to 40 ISO size. Laser sterilization of root canal 21 was carried out. The length of the canal, determined using an apex locator, was transferred to a laser endodontic tip with a length of 30 mm and a diameter of 0.4 mm (with rubber stopper). A 56 μM photosensitizer solution was injected into the canal for 5 minutes, so that it was absorbed into all dentinal tubules.

The optical fiber was introduced into the channel, not reaching 3 mm to the apex, thereby directing the energy of the diode laser into the apical zone. The laser radiation power was 0.5 W, continuous mode.

The next stage, the fiber was introduced into the middle part of the channel, not reaching the apex by about 7 mm, and the manipulation was repeated again according to the scheme described above for sterilization of the central part of the channel. And in conclusion, the light guide was left at the mouth of the canal and processed in the same way.

After sterilization of the root canal, it was washed with saline and dried with paper pins. Immediately after this, a traditional root canal filling was performed.

Example 2. Patient K., 48 years old, complained of spontaneous pains in the 36th tooth, arising mainly at night. Soreness was aggravated by eating and from thermal stimuli. According to the patient, spontaneous pains appeared 7 days ago. The tooth was previously treated for tooth decay.

An objective examination of the 36 tooth revealed the remains of an old seal. Probing the bottom of the tooth cavity 36 is sharply painful. The reaction to cold is sharply positive. Percussion is weakly positive. On the R-gram, a carious cavity is visible, communicating with the cavity of the tooth, bone rarefaction is not detected.

Orthognathic bite. CPU = 2 + 6 + 3 = 11. In a small amount there are hard dental deposits (lingual surface of the front teeth of the lower jaw). EOM data - 2548 m / s. LDF data: MD - 18.8 conv. units, PS - 23.0 srvc. units, Gy - 0.12. A control visiography of 36 teeth was performed.

The carious cavity communicating with the pulp chamber is determined in the picture, the periodontal gap is slightly widened, bone tissue discharge in the periapical tissue was not detected.

On the basis of the history, clinical examination and additional laboratory methods, the diagnosis was made: chronic pulpitis of 36 teeth.

Treatment: Under Sol. Ultracain D-S forte, 1.7 ml, 36 tooth cavity was prepared. The tooth cavity is open. After trepanation, extirpation of the pulp and residual pulp tissue and mechanical expansion of the root canals up to ISO size 40, the canals were washed as usual with EDTA and sodium hypochlorite, and the cavity was cleaned and dried with paper pins. Then they sterilized the root canals with a laser. For this, 56 μM photosensitizer solution was introduced into each channel for 5-6 minutes, so that the photosensitizer was absorbed into all dentinal tubules. The length of the channels, determined by x-ray or using apex locator, was transferred to the laser tip of a flexible fiber with a length of 30 mm and a diameter of 0.4 mm (with a rubber stopper).

The optical fiber was alternately inserted into the channels, not reaching 3 mm to the apex, thereby purposefully the energy of the diode laser was directed into the apical zone. Laser power was 1 W, continuous mode.

The next stage, the fiber was introduced into the middle part, not reaching the apex by about 7 mm, and the manipulation was repeated again according to the scheme described above to sterilize the central part of each channel. And in conclusion, the light guide was left at the mouth of the channels and processed in the same way.

After root canal sterilization, they were washed with saline and dried with paper pins. Immediately after this, a traditional root canal filling was performed. Channels 36 of the tooth were sealed with AN 26 material using gutta-perched pins by lateral condensation.

The crown of the tooth was reconstructed with SYNERGY (Coltene, Swiss quality for Dentistry).

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, no changes were found in periodontal tissues.

Thanks to root canal sterilization, good results can be achieved. Even with gangrenous pulpitis, in many cases, if time and circumstances permit, teeth can be filled in one visit. But usually after sterilization, the drug substance is left in the root canal, and during the second visit, the canal is filled. Thus, it is possible to carry out successful root canal treatment and to preserve teeth important for prosthetics.

After that, the canal can be sealed without causing further postoperative complaints. Thanks to the sterilization effect in the apical region, a reduction of bacteria of 99% is achieved. High-quality filling of the canals completely closes the lumen of the canals and completes the treatment.

Laser root canal treatment is efficient, easy and quickly creates the conditions for optimal preparation of canals for filling. Sensitivity when biting after obturation of the root canals is minimal and lasts no more than 2-3 days.

Analyzing the results of testing the method, we can conclude that the proposed method is convenient for use, well tolerated by patients, has no side effects and contraindications.

The technical result of the method is:

- the absence of the need to use irrigants to prepare the channels for filling, which leads to the absence of the risk of these solutions getting beyond their limits, especially under pressure, and does not lead to severe toxic effects, damage to adjacent tissues, as well as the occurrence of acute pain and swelling.

- increases the efficiency of root canal treatment due to the fact that the photosensitizer solution gets into the small tubules and anastomoses, thereby the entire root system is sterilized;

- the possibility of exposure to the apical and periapical pathogenic microflora of the channels, which increases the effectiveness of endodontic treatment;

- the ability to achieve good treatment success without the use of antibiotics and all the negative consequences associated with it.

The clinical advantages of using the proposed method are the ease and speed of use, the sterility of the treated surface.

The method can be recommended to improve the quality of therapeutic treatment of root canals, especially in conditions of insurance medicine.

Claims (1)

A method of preparing tooth channels for filling, including expanding the channels, extirpating the pulp or its tissue, characterized in that a 56 μM solution of the photosensitizer is introduced into the channel and the channel is treated with a 0.5-1.0 W diode laser for 5-6 minutes and with a wavelength of 662 nm, first the apical zone, then its middle part and then the steps are repeated, completing sterilization by irradiation of the canal orifice.