RU2300371C1 - Method for treating chronic apical periodontitis cases - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves carrying out single intracanal electrophoresis with 50% Dimexid solution during 4-6 min from anode before setting permanent filling into dental canals. Then the canals are temporally filled with professional Metrogil gel for 7-10 days.

EFFECT: enhanced effectiveness of treatment; improved bactericidal and anti-inflammatory results.

3 tbl

Description

The invention relates to medicine, namely to dentistry, and can be used to treat chronic apical periodontitis.

Known methods of treating chronic apical periodontitis using paste "Greenazole" containing metronidazole (Borovsky EV, Zhokhova NS Endodontic treatment. - M., - 1997. - P.39).

The disadvantage of this method is the lack of fungicidal, immunotropic, analgesic effects.

The closest analogue is the use of Grinazol paste as an antibacterial agent in the treatment of complicated caries for temporary filling of the root canal with subsequent obturation of the canal using any of the methods of permanent canal filling (Maximova OP, Sheina N.M., Nikolaev A.I. Pharmacological program for endodontics firm Septodont. Clinical Dentistry 1998. - 1 - S.14-17).

The disadvantage of this method is the lack of fungicidal, immunotropic, analgesic effects.

The invention is aimed at solving problems; increasing the effectiveness of treatment of chronic apical periodontitis and reducing the cost of treatment.

Effect: along with bactericidal and anti-inflammatory effects of local fungicidal, immunotropic, analgesic, anticoagulant and antispasmodic effects.

The objectives are achieved by using a 50% solution of Dimexidum in the form of single-channel single-shot electrophoresis within 4-6 minutes from the anode as a local anti-inflammatory, immunotropic, bactericidal, fungicidal, analgesic, antispasmodic, anticoagulant agent and Metrogil Denta Professional gel in the form of material for temporary (for a period of 7-10 days) filling of the channels as a bactericidal agent. This complex for the treatment of chronic apical periodontitis has not been previously used.

It is known that chronic apical periodontitis is a complex disease, in the pathogenesis of which the leading role is played by bacterial infection, inflammation and destruction of periodontal tissues, combined with sensitization and a decrease in body resistance. Therefore, treatment of chronic apical periodontitis should be aimed at eliminating a bacterial infection in the canals of the teeth, eliminating the inflammation in the periodontium and creating optimal conditions for the regeneration of periodontal tissues.

Dimexide (Dimethyl sulfoxide) is produced by Chemreaktivkomplekt Plant OJSC (Russia) in the form of a concentrate for the preparation of solutions for external use. The drug has a pronounced anti-inflammatory and analgesic effect, moderate antiseptic, fibrinolytic, antispasmodic, dehydrating, anticoagulant and fungicidal effect, has the ability to penetrate biological membranes and enhance the penetration of other drugs into the focus of inflammation and the dentinal tubule system. "Dimexide" alters the sensitivity of antibiotic-resistant microorganisms. The drug is used as a solution in bidistilled water as applications and instillations for periodontitis.

Gel "Metrogil Denta Professional" is produced by the company "Unique Pharmaceutical Laboratories" (India).

Composition: each gram of gel contains:

- metronidazole benzoate - 250 mg;

- chlorhexidine gluconate - 1 mg;

- excipients (propylene glycol, carbomer - 940 N.F., disodium edetate, sodium saccharin, levomenthol, sodium hydroxide, the taste base of toothpaste FK245, purified water).

Gel "Metrogil Denta Professional" is used to treat inflammatory and infectious diseases of the oral cavity. Metronidazole benzoate has an antibacterial effect against anaerobic microorganisms, and chlorhexidine gluconate is a broad-spectrum antiseptic, has a bactericidal effect against vegetative forms of gram-negative and gram-positive microorganisms, yeast, dermatophytes, and lipophilic viruses. The gel is used for external use in periodontitis. As a material for temporary filling of the channels has not been previously used.

The method is as follows. After instrumental and drug treatment of the tooth canal with 3% sodium hypochloride solution, intra-channel electrophoresis is carried out with a 50% Dimexidum solution from the anode for 4-6 minutes. Immediately after electrophoresis, the channel is filled with Metrogil Denta Professional gel and the cavity is filled with provisional material for a period of 7-10 days. The treatment is completed with canal filling using gutta-percha and restoration of the tooth crown.

Examples of specific performance.

Example 1

Patient K., born in 1974.

10/12/05. Complaints: 25 tooth discoloration and seal defect.

Anamnesis: the tooth does not hurt, the color change occurred six months ago.

Objectively: on the occlusal-distal surface of the 25 tooth there is a composite filling of dark yellow color, matte, rough with an unsatisfactory edge fit. On the distal surface there is a defect within the seal. The tooth has a grayish color, no enamel shine. Under the seal there is softened and pigmented dentin, the cavity of the tooth is opened, and dry necrotized pulp is in the canals. Percussion of the 25th tooth is painless. On the roentgenogram from 10/11/05, the 25 tooth has 2 channels in one root. Channels 25 of the tooth are free of filling material. There is an extension of the periodontal gap.

Table 1 presents the assessment of inflammation by the general (capillary blood) and local (gingival blood) functional parameters. The leukocyte reaction was assessed by the total number of blood leukocytes (OKL) and the nuclear shift index (INN), and the phagocytic reaction by the absorbing activity of blood neutrophils - the percentage of active phagocytes (PF) and phagocytic number (PS), and the state of endotoxicosis - by leukocyte index intoxication (LII).

Table 1 indicators norm Capillary blood Gingival blood Before treatment In 7 days* Before treatment In 7 days* OKL (10 ⁹ / L) 4.0-9.0 5.3 4.8 5.9 5,0 INS 0.05-0.08 0,07 0,07 0,07 0,07 PF (%) 28-67 61 67 56 64 Ff 0.38-1.24 0.61 0.60 1.33 0.76 LII 0.75-1.5 1.01 0.90 1.17 1,02 Note: * before permanent filling of the canal.
Diagnosis: Chronic fibrous periodontitis of 25 teeth.

Treatment: treatment was carried out in the dental department of POKB No. 2 Heart Institute. Installed "Robert" on the 25th tooth. The seal is removed. The channel was instrumented according to the “Crown Down” ProFile 04 method to an ISO 40 size, the channel was treated with 3% sodium hypochloride solution. The machining was carried out under the control of an apex locator. An intra-channel electrophoresis was performed with a 50% Dimexidum solution for 5 minutes from the anode. The buccal and palatine canals of the 25th tooth are filled with Metrogil Denta Professional gel for a period of 7 days. A temporary seal has been imposed. After 7 days, the canals were obtuated by lateral condensation of gutta-percha with endometasone siller. Conducted x-ray control. Canals are sealed to the level of the anatomical apical foramen. The restoration of 25 teeth with the composite material "Solitaire" was carried out. Radiocontrol is recommended in a year. Examination in a month: no complaints, no post-obstructive pains. The mucosa of the oral cavity and transitional fold is moist, pale pink. The state of restoration of the 25 tooth is good, there is no discoloration, the marginal fit is good. Percussion of the 25th tooth is painless. As a result of treatment, normalization of phagocyte activity occurred.

Example 2

Patient M., born in 1947.

10/11/05. Complaints: about a filling with a defect and a discoloration of 23 teeth.

Anamnesis: 23 tooth was treated 3 years ago for pulpitis, periodically disturbed by pain when biting. The color change of 23 teeth occurred a month after treatment, the seal broke a month ago.

Objectively: on the distal surface of the 23 tooth there is a filling of a dark gray color, with a defect and poor marginal fit. Under the seal, softened and heavily pigmented dentin. There is a partial staining of the dentin in black. At the mouth of the canal 23 tooth phosphate cement. Percussion of 23 teeth is painless. On the x-ray of the 23 tooth from 10/11/05, there is a filling material in the canal that fills the mouth and middle third of the canal, the apical part of the canal is not sealed. In the channel 23 of the tooth there are 2 broken instruments. In the apical third of the canal has a bend at an angle of 110 degrees. In the bending area of the tooth channel 23 there is a ledge created by improper processing of the channel. In the area of the apex there is a rarefaction of bone tissue of a rounded shape, with clear boundaries, with a diameter of 0.7 cm. Table 2 presents the assessment of inflammation by the functional parameters of the blood system.

table 2 indicators norm Capillary blood Gingival blood Before treatment After 10 days* Before treatment After 10 days* OKL (10 ⁹ / L) 4.0-9.0 6.9 6.1 8.1 7.1 INS 0.05-0.08 0.06 0.06 0.08 0.06 PF (%) 28-67 52 51 94 71 Ff 0.38-1.24 0.78 0.81 1.92 0.89 LII 0.75-1.50 1.44 1.30 2.61 1.45 Note: * before permanent filling of the canal.

Diagnosis: chronic granulomatous periodontitis of 23 teeth, a foreign body in the canal.

Treatment: treatment was carried out in the dental department of POKB No. 2 Heart Institute. Installed and fixed "Roberdam". Filled 23 teeth, preparation with partial resection of pigmented dentin. The channel 23 of the tooth is sealed. Using a forehead microscope and an intraoral digital video camera, broken instruments were found in the channel. During instrumental processing, 2 foreign bodies — broken H-files — were extracted from the channel. Due to giving the channel 0.6 taper and preparing the channel up to size 60 according to ISO, the ledge in the channel is removed and access to the apical third of the channel is obtained. The apical part of the canal was processed according to the Double-flared method under the control of an apex locator. Channel irrigation with 3% sodium hypochloride solution. An intra-channel electrophoresis was carried out with a 50% Dimexidum solution for 4 minutes from the anode with temporary filling of the channel with Metrogil Denta Professional gel. After 10 days, the tooth canal 23 was sealed with the Thermophile method with the AN plus sealer. On the control x-ray of the 23 tooth, the canal is sealed to the level of the anatomical apical foramen. 23 teeth were restored with Venus material. No post-obstructive pain was observed. It is recommended to carry out x-ray control of 23 teeth in a year. As a result of treatment, normalization of phagocytic parameters occurred.

Example 3

10/19/05. Patient P., born in 1944.

Complaints: discoloration and carious cavity in 36 tooth. The presence of fistulous passage on the transitional fold in the region of the 36 tooth.

Anamnesis: 36 tooth was repeatedly treated. Destroyed for a long time, does not hurt. On the mucous transitional fold the fistulous passage periodically opens. Objectively: 36 tooth of dark red color. On the occlusal-distal surface of the 36 tooth there is a carious cavity within the peri-pulp dentine. The cavity 36 of the tooth is opened, at the mouth of the canals resorcinol formalin paste. Percussion of 36 teeth is painless. On the mucous transitional fold in the area of the projection of the apices of the roots of the 36 tooth there is a fistulous passage with purulent discharge. There is no infiltration. Palpation of the transitional fold in the area of the 36 tooth is painless. On the x-ray of the 36 tooth, the channels are narrow, partially obliterated. In the mouth and middle third of the canals are filling material. In the area of apexes of the 36th tooth there is a rarefaction of bone tissue without clear boundaries, in the form of tongues of flame, 0.5 to 0.7 cm in size.

Table 3 presents the assessment of inflammation according to functional indicators.

Table 3 indicators norm Capillary blood Gingival blood Before treatment In 7 days* Before treatment In 7 days* OKL (10 ⁹ / L) 4.0-9.0 7.2 6.1 11.3 9.1 INS 0.05-0.08 0.08 0.06 0.09 0,07 PF (%) 28-67 22 33 eleven thirty Ff 0.38-1.24 0.18 0.40 0.08 0.35 LII 0.75-1.50 2.12 1.83 3.07 2.15 Note: * before permanent filling of the canal.

Diagnosis: chronic granulating periodontitis of 36 teeth.

Treatment: treatment was carried out in the dental department of POKB No. 2 Heart Institute. Installed and fixed "Roberdam". The preparation of 36 teeth was carried out, the canals were broken, the StepBack machining and drug treatment of the root canals with a 3% sodium hypochlorite solution under the control of an apex locator were performed. An intra-channel electrophoresis was carried out with a 50% Dimexidum solution for 6 minutes from the anode, followed by temporary filling of the channels with Metrogil Denta Professional gel. The tooth is closed with a temporary filling for a period of 7 days. After 7 days, the tooth does not bother, the temporary filling is preserved, percussion of the 36 tooth is painless. The fistulous course on the mucous transitional fold in the region of the 36 tooth is epithelized. Channels 36 of the tooth were sealed by lateral condensation of gutta-percha with an endometasone sealer. Conducted x-ray control. Canals are sealed to the level of the anatomical apical foramen. After 3 days, the tooth was sealed with Charisma PPF. Post-obstructive pain was not observed. It is recommended to carry out x-ray control of 36 teeth in a year. As a result of treatment, the parameters of the phagocytic reaction and OKL approached the norm. The indicator of endotoxemia (LII) decreased.

The positive effect of the use of the new method of treatment is manifested in the fact that the treatment efficiency has increased and the cost has decreased.

Claims (1)

A method of treating chronic apical periodontitis by temporarily filling the canals with antibacterial agents, followed by permanent filling, characterized in that before permanent filling of the canals, one-time intra-channel electrophoresis is carried out with a 50% Dimexidum solution for 4-6 minutes from the anode, followed by temporary filling of the canals gel "Metrogil Denta Professional" for a period of 7-10 days.