RU2246274C1 - Method for treating pulpitis - Google Patents

Abstract

FIELD: medicine, stomatology.

SUBSTANCE: for radical treatment of pulpitis one should lance pulpal cavity, remove pathogenic pulp and fill it with bioinert material after antiseptic treatment by applying granulated porous titanium nickelide at granules' size being 1-100 mcm and predominant pores' size being 0.5-50 mcm. The method enables to achieve reparation of trophic, protective and plastic functions of the pulp removed.

EFFECT: higher efficiency of therapy.

2 cl, 2 dwg, 1 ex

Description

The invention relates to medical equipment.

The cavity in the dentin of the tooth (pulp cavity) (Fig. 1) is divided into coronal 1 and root 2. The pulp cavity is filled with pulp, a loose connective tissue that performs trophic, protective and plastic functions. Inflammatory processes in the pulp of a variety of endogenous and exogenous etiologies (pulpitis) occur with acute painful sensations, activate the pathology of the hard tissues of the tooth and dictate an emergency medical intervention.

In the practice of radical (surgical) treatment of pulpitis, the most common is the method of pulp extirpation. It is based on preliminary necrotization (devitalization) of the pulp and its subsequent removal from the entire pulp cavity [1]. In this case, a complicating circumstance is the presence in the apical part of the tooth root of multiple and small holes 5 (dentinal tubules), from where the pulp is difficult to remove, and it is mummified if necessary.

After sanitation of the pulp cavity, the last stage of the known methods of operation is the complete, dense and hermetic filling of it with an inert material with spatial stability and biological compatibility. The success of this action depends on the consistency of the material, technology and skill of the surgeon.

Pasting materials (zinc-oxide-eugenol, resins, silicone rubber) are known as filling materials; semi-solid (gutta-percha) and even solid; semi-rigid or flexible (silver pins, stainless steel) [2]. These materials are not adequately adequate to the necessary requirements and determine the low viability of the treatment.

A known method of treating pulpitis [3] by removing pulp, antiseptic treatment of the pulp cavity with physiological saline and enterosorbent powder, filling the cavity with a composition containing ciacrin, calcium oxide and zinc oxide in a ratio of 4: 1: 0.5.

The disadvantage of this method is the low quality of the filling, leading to frequent complications. The causes of complications are the inadequacy of the filling material, in particular its ability to absorb, forming voids in the pulp cavity. The unresolved problem remains the elimination of the remains of necrotic tissue in hard-to-reach and therefore unopened dentinal tubes. Their responsibility in relapsing the disease is so great that it forces them to develop special measures to stop the process, for example, depophoresis [4].

Low consistency of the operation is the final cause and effect link of these disadvantages of the prototype method.

The technical result of the invention is to improve the quality of filling the pulp cavity of the tooth.

The specified technical result is achieved by the fact that in the method of treating pulpitis, which includes arranging access to the pulp cavity, removing the pulp, antiseptic processing and filling the pulp cavity with bioinert material, applying a seal, granular porous titanium nickelide with a granule size of 1-100 μm is used as bioinert material and a predominant pore size of 0.5-50 microns.

It is preferable to fill the pulp cavity with granular porous titanium nickelide mixed with calcium hydroxide in a concentration that provides a gel consistency.

Antiseptic treatment of the pulp cavity with sodium hypochlorite is preferred. The attainability of the technical result is mainly due to the adequacy of the porous granular titanium nickelide to the requirements for ideal filling materials.

Porous titanium nickelide in a granular state in the specified function has the properties:

1. Easy to manipulate for ample working time.

2. It has spatial stability: it does not shrink and does not change shape after insertion into the cavity.

3. Fills the pulpal cavity laterally and alikally, repeating its contours as much as possible, without special labor costs and tricks.

4. Does not irritate periapical tissues.

5. Moisture resistant.

6. Not amenable to the effects of tissue fluids, does not dissolve in them, is resistant to corrosion and oxidation.

7. It has bacteriostatic properties; at least does not support bacterial growth.

8. X-ray contrast, easily detected in the pictures.

9. Easy to sterilize.

Unlike traditional filling materials, one of the main functions of which is to seal the cavity, granular porous titanium nickelide provides hygroscopic (diffuse) permeability to tissue fluids, and subsequently, in the long term, a matrix skeleton for repaired pulp tissues.

Such a mechanism of functioning of granular porous titanium nickelide is fundamentally different from known materials and ensures the attainability of a technical result.

The size of the granules and the preferred pore size are significant. The claimed granule size intervals are due to the filling requirements of the pulp cavity.

From a comparison of the topography and sizes of the pulp cavity and the maximum sizes of granules, it follows that the use of granules with sizes greater than 100 microns is undesirable, because does not guarantee the success of the operation for the specified reason. The smallest size - 1 micron - is dictated by the optimal conditions for impregnating the volume of granules with tissue fluids (hygroscopicity), as well as the technological conditions of the modern production of granular titanium nickelide.

Smallest sizes are also preferable for possible penetration of granules into small dentinal tubules in their lumen or, at least, into their mouths.

The pore sizes are linked to the size of the granules. Their stated interval is determined experimentally and is interpreted by the conditions of hygroscopicity, optimal weight characteristics and technological capabilities for the production of porous titanium nickelide.

The gel consistency of a mixture of granular titanium nickelide and calcium hydroxide facilitates manipulation when filling the pulp cavity. Calcium hydroxide, in addition, is a drug that helps to stop inflammatory processes.

It has been experimentally determined that sodium hypochlorite is the optimal antiseptic agent that is effective and compatible with the filling material used.

Thus, the set of essential features ensures the efficiency of the proposed method, and the difference from the prototype is the attainability of the technical result.

The illustrations show:

Figure 1. Topography of the tooth (diagram, in section).

1 - coronal pulp; 2 - root pulp; 3 - the mouth of the root canals; 4 - holes of the root apex; 5 - dentinal tubules.

Figure 2. Radiograph of the molar of the patient treated for pulpitis of the proposed method.

1 - coronal volume of the pulp cavity; 2 - root canals of the pulp cavity; 3 - inlet seal.

Confirmation of the attainability of the technical result are specific examples of the use of the proposed method in the Clinic of Dental Implantology MP GMP "MITS" (Tomsk).

Example.

Patient A. Vasilenko. The diagnosis of the disease is chronic fibrous pulpitis of the seventh tooth on the left of the lower jaw, which developed after an unsuccessful filling of the carious cavity. The patient was treated with the specified tooth according to the method of the proposed method.

The method is as follows. After mandibular anesthesia, sufficient access was made to the pulp cavity by trepanation of the tooth crown from the deepest place of the fissure. The pulp was extirpated to its achievable volume of the dentinal tubules. The pulp cavity is processed to the apical holes of the root canals with manual files and chemical gels. Drug treatment was performed with a 3% solution of sodium hypochlorite, distilled water. The cavity 1, 2 (Fig. 1) is dried with paper adsorbents and filled using manual and mechanical tools with a mixture of porous granular titanium nickelide and calcium hydroxide in a ratio of 1: 1. The predominant granule size of titanium nickelide is 10-80 microns, the predominant size of the through pores in granules is 5-40 microns. The access hole is closed by applying a seal 3 of glass ionomer cement.

The condition of the tooth (figure 2) after surgery and in the first month of observation is safe. There are no complaints of the patient about pain, including chewing.

The proposed method in the current state of testing is ready for widespread clinical implementation, including for the treatment of previously depulped tooth cavities.

Sources used in compiling the description

1. Therapeutic dentistry / Ed. E.V. Borovsky. M .: Medical Information Agency LLC, 1997. S.231-235.

2. NGUYEN THANH NGUYEN. Endodontics as an art. S.182.

3. A.S. USSR No. 1813437, 5 A 61 K 6/02. Grechishnikov V.I., Voloshin A.I. A method for the treatment of pulpitis (prototype).

4. Rocholl S. Depoferez - an unconventional method of epodontic treatment of devitalized teeth // Der Artikulator. No. 61, 4. Quartol, 1997. International Institute of Dental Innovation.

Claims (3)

1. A method of treating pulpitis by creating an entrance to the pulp cavity, removing pathogenic pulp, antiseptic treatment and filling the pulp cavity with bioinert material, closing the entrance to the pulp cavity with the filling, characterized in that granular porous titanium nickelide with a granule size of 1 is used as bioinert material -100 microns and a preferred pore size of 0.5-50 microns. 2. The method according to claim 1, characterized in that the filling of the pulp cavity with granular porous titanium nickelide is carried out in a mixture with calcium hydroxide in a concentration that provides a gel consistency. 3. The method according to claims 1, 2, characterized in that the antiseptic treatment is carried out with sodium hypochlorite.

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