RU2328266C1 - Agent for deep caries treatment - Google Patents

Abstract

FIELD: medicine; stomatology.

SUBSTANCE: agent contains extract of silt-sulphide mud "Esobel", antibacterial agent nitrofurantoin and zinc oxide; components are taken in specified proportion. Agent is made immediately prior to application by mixing of components and addition of the distilled water to paste consistence.

EFFECT: increased efficiency of caries treatment owing to decrease in relapses number.

1 ex, 4 tbl

Description

The invention relates to medicine, namely to dentistry, and relates to medicines used to treat deep carious lesions.

Dental caries is the most common dental disease, which, on the one hand, is due to the multifactorial nature of its etiology, on the other hand, frequent complications and insufficient effectiveness of treatment and preventive measures.

The prevalence rates of caries have made it possible to designate this disease as a “pandemic” [1]. Caries does not spare hard tooth tissues either in early childhood or in old age.

So, according to the results of a situational analysis, 85% of children by the age of one and a half years need the help of a dentist, and 50% of them have enamel defects. In 74% of two-year-old children, caries of temporary teeth was diagnosed. The prevalence rate of carious pathology of temporary teeth in children of five years reaches 95%, and the number of teeth affected by caries in them is 6. Permanent teeth erupt from 4 to 6 years and already in six-year-old children the incidence is 25%. The prevalence of caries in 9-year-olds increases by 30%, and in schoolchildren 12 years old it is 78-85%. The number of carious destruction in them varies from 0.6-9.3. In 15-year-olds, these values are even more pronounced 1.9-13.6. In the age group from 35 to 44 years, the incidence is 98-100% [2].

There is evidence that a significant percentage of dental visits is the treatment of deep caries. In the adult population, this type of carious pathology is diagnosed in 43% of cases, and among children during the initial examination, deep carious cavities were found in 50%. Particularly noteworthy are indicators of the complications of unsuccessful treatment of deep tooth decay. The cause of complications of caries is precisely poor-quality or untimely treatment of deep dental caries. This pathology in more than 50% of cases contributes to tooth extraction in people older than 50 years [3, 4, 5].

Thus, the results of epidemiological studies indicate the need to continue the search for the most effective methods and means of treating dental caries and its complications.

There is a method of treating deep caries, which involves increasing the effectiveness of treatment by irrigation with a warm (36-37 ° C) 0.1% solution of cobalt chloride during the preparation of the cavity and applying to its bottom medical paste prepared ex tempore, which is a mixture in equal amounts of glycerophosphate and calcium hydroxide in a 0.1% solution of cobalt chloride. A regular lining of artificial dentin and a temporary filling are applied over a layer of medical paste. After 7-10 days, the control temporary filling is replaced with a permanent filling. The course of treatment is designed for 10 days. After a ten-day break, it is repeated [6].

However, this method of treatment requires, on the one hand, a 2-time intervention, which is fraught with the danger of opening the tooth cavity during removal of the control and temporary fillings.

Secondly, according to the data of A.V.Salova, V.M. Rekhachev (2004), a period of 7-10 days is not always sufficient to develop a significant layer of substitution dentin, even though calcium is added to the paste [7].

Known paste for the treatment of deep caries, including streptocide, norsulfazole, sulfadimezin, thymol, zinc oxide and glycerin. The paste is prepared before use, put on the bottom of the cavity for 7-10 days under a temporary filling. In the absence of complaints, a temporary seal is replaced with a permanent one [8].

However, it is irrational to leave the used antimicrobial agents as a therapeutic pad, because their effect is short [9]. In addition, thymol has an irritating effect on tissues, and at high concentrations it can cause necrosis [10]. Glycerin based pastes require additional coating with a layer of aqueous artificial dentin, which subsequently worsens the fixation of a permanent filling [11].

A known method of treating deep caries using a medical pad consisting of thymol, zinc oxide, eugenol, taken as a prototype [Borovsky EV et al., 1973]. After the preparation of the cavity, the paste is applied to the bottom and spread evenly with a cotton swab, covered with a layer of water dentin, an insulating phosphate cement pad and a permanent seal are applied.

The advantage of this paste is that it contains substances that have antibacterial properties that inhibit the growth of bacteria on the walls of the cavity. It has the property of anesthetic and is used as a painkiller, and also tightly adhering to dentin, provides a good marginal fit [11].

The disadvantage of this paste is that it contains substances with irritating (thymol) and toxic effects (eugenol), which can lead to complications of caries [7, 10, 11]. Used means, possessing antibacterial, analgesic properties, weakly stimulate the formation of replacement dentin, which can contribute to the development of complications [S. Cohen, Richard S., 2000].

In addition, the application of several gaskets (paste, water dentin, phosphate cement) reduces the quality of filling [11].

To increase the effectiveness of the treatment of deep caries by reducing the possibility of relapse, use a medical paste containing furadonin, esobel and zinc oxide in the following proportions (g):

Furadonin 0.03-0.09

Esobel 0.03-0.09

Zinc oxide - 0.02-0.06

Esobel is an extract from natural mineral raw materials. [9]. This is a water-soluble sulphide mud extract containing a complex of water-soluble biologically active mineral and organic substances. The composition of minerals is determined mainly by cations Na ⁺ , Ca ^{2 + 2} , Mg ^{2 + 2} , K ⁺ and anions Cl ^- , SO ₄ ^2- , CO ₃ ^2- , HCO ₃ ^- . The main trace elements are Mn, Ag, Co, P, Zn. Water-soluble organic compounds are amino acids, unsaturated fatty acids, dicarboxylic acids, humic and fulvic acids, prostaglandins.

Experimental studies have shown that "Esobel" has anti-inflammatory and analgesic properties: it has a pronounced decongestant effect, lowers capillary permeability, and prevents tissue damage (anti-alterative effect) in acute and chronic inflammation [12].

Esobel inhibits the action of histamine, serotonin, kinins, prostaglandins. It stabilizes the lysosome membrane, has antioxidant properties, and inhibits the functional activity of fibroblasts.

Clinical trials (ENT diseases, diseases of the musculoskeletal system, diseases of internal organs) showed its high anti-inflammatory effectiveness (eliminates pain, redness and swelling). "Esobel" causes tissue regeneration in the focus of inflammation and helps to restore the damaged tissue structure. A special characteristic of Esobela is the absence of negative side effects [12].

Furadonin is a derivative of nitrofuran, has antimicrobial activity and is used in medical practice in the treatment of infectious diseases [13].

Chemically, these compounds are characterized by the presence of a nitro group (—NO ₂ ) at position C ₅ and various substituents at position C _{2 of the} furan core.

Nitrofurans are effective against gram-positive and gram-negative bacteria (staphylococci, streptococci, E. coli, causative agents of typhoid fever, paratyphoid, dysentery, various strains of Proteus), as well as some large viruses, trichomonads, giardia.

In some cases, they inhibit the growth of microorganisms resistant to sulfonamides and antibiotics.

Furadonin is a yellow or orange-yellow crystalline powder that has an amino hydantoin core in its side chain.

Zinc oxide - odorless amorphous white or white with a yellowish tint. It has antiseptic, astringent, anti-inflammatory effects. The mechanism of the systemic action of zinc preparations that affect metabolic and immune processes is described [13].

The concentration and content of the ingredients of the medical paste was determined experimentally.

Pasta is prepared immediately before use. Take 0.09 g of furadonin, 0.09 g of Esobela and 0.06 g of zinc oxide, mix, add distilled water to a paste consistency.

Treatment is as follows. A cavity is prepared. Using an excavator, carefully remove the infected dentin from the bottom of the cavity, leaving a thin layer of demineralized suprapulpular dentin without effort. Prepare the pasta. After drug treatment of the carious cavity with a 1% solution of chloramine, distilled water and drying with warm air, the prepared therapeutic paste is applied to its bottom, closed with a cotton swab and a temporary filling made of glass-ionomer cement. After 1 month, remove the seal, cotton swab and the rest of the medical pad. The cavity is stained with a caries detector and the remaining demineralized dentin is removed. After this, drug treatment and drying of the cavity are carried out, a permanent filling is applied.

Long-term results are evaluated after 1 month.

The criteria for the effectiveness of treatment are:

- determination of the difference in the degree of density of colony forming units (CFU) (III-0-I) of microorganisms in the carious cavity before and after treatment;

- the functional state of the tooth pulp (EDI, UFM);

- X-ray characteristic of the formation of replacement dentin;

- the absence of relapse and complications.

Table 1
Indicators of bacterial density of dentin in deep caries before and after application of medical pads Type of treatment pad Class of bacterial density CFU / mg). Before treatment After treatment Eugenolthymol treatment pad (n = 16) III (10 ^7.5 -10 ⁸ ) I (10 ³ ) Combined treatment pad (Esobel-Furadonin-Zinc Oxide) (n = 17) 0 (<10 ³ )

The studied spectrum of some types of microorganisms localized in the carious cavity was presented by Str. Iniae, Str. Salivarius, Str. Mitis, Str. Mutans (MS) and Lactobacterii (LB), from the enrichment medium obtained St. Hominess.

Against the background of the presence of a total microbial mass, cariesactive MS and LB were calculated in large numbers.

The microbial contamination of the cavity was estimated by the number of germinated colonies of Streptococcus Mutants and Lactobacterii (Table 2) [14].

table 2
Criteria for the selection of Streptoccocus Mutans and Lactobacterii Microorganism Density Class CFU 0 0 to 10 ³ I 10 ³ to 10 ⁵ II 10 ⁵ to 10 ⁶ III Over 10 ⁶

The number of colonies - forming units (CFU) of MS and LB varied in the range of 10 ^7.5 -10 ⁸ (Table 1) and belonged to class III in terms of bacterial density classes (Table 2).

After the use of all drugs, the dynamics of the content of MS and LB in the dentin of the carious cavity made it possible to determine a decrease in the number of CFU. In both cases, a sharp decrease in the concentration of bacteria MS and LB was found.

However, after the use of the eugenol-thymol medicinal pad, I class of bacterial density was recorded, and after using the combined medicinal pad, 0 class of bacterial density.

However, the complete disappearance of microorganisms in no deep carious cavity after the application of all types of medical pads did not occur.

There is a point of view that bacterial plaque is a complex, living object with a developed structure of internal connections, which allows it to maintain viability even in the most emergency conditions.

Probably, one should agree with the opinion of J. Einwag (2004), which indicates that, firstly, even highly concentrated drugs interact only with the surface layers of bacteria, and the deeper layers are less sensitive to the effects of drugs.

Secondly, obviously, there is the so-called “cariogenic community” of structured bacteria, which provides the greatest resistance to the effects of antibacterial drugs and, thirdly, it seems that microorganisms have such a biological nature that stimulates the accelerated reproduction of certain types of bacteria in case of imbalance in the "cariogenic community" [15].

Thus, the results of the study confirm the antibacterial effect of the considered medical pads, the most pronounced when using our therapeutic paste.

Table 3
Comparative characteristics of the hemodynamic pulp of carious teeth before and after applying medical pads (M ± M) Vs cm / s Pi Ri Carious tooth (n = 42) 1.04 ± 0.15 2.53 ± 0.24 0.73 ± 0.09 Eugenol-thymol treatment pad (n = 16) 1.67 ± 0.23 * 2,50 ± 0,20 0.74 ± 0.07 Therapeutic pad ("Esobel" -furadonin-zinc oxide) (n = 17) 1.79 ± 0.18 * 2.72 ± 0.19 0.79 ± 0.08 Note:
* - significant differences in Vs when using medical pads compared with a carious tooth

To study the microvasculature of the tooth pulp, the ultrasound flowmetry method was used, based on the Doppler effect — changing the frequency of the reflected signal from a moving object (red blood cells) by a value proportional to the speed of the reflector. The state of blood flow in the vessels of the tooth pulp was determined non-invasively using the minimax-Doppler-K ultrasonic computerized complex according to the spectral analysis of the Doppler signal, automatically, using the SP Minimax software.

The following indicators were evaluated: linear blood flow velocity (cm / s) Vs - maximum systolic velocity along the curve of maximum (envelope) velocity; Pi is the ripple index (Gosling index), which characterizes the elastic-elastic properties of arteries; Ri is the index of resistance to blood flow distal to the measurement site (Purselo index) [16].

The treatment of the carious pathology of hard tooth tissues, accompanied by the application of drugs in the form of an eugenol-thymol medicinal pad and combination paste (Esobel-furadonin-zinc oxide), tended to have a positive effect on microcirculation in the pulp. Of all the studied parameters of blood flow, only the blood flow velocity significantly changes, and there are no differences between the compared methods.

In the presence of an active carious process in dentin after the restoration, the inflammation in the pulp becomes reversible, i.e. strives for normalization. At the same time, changes in the form of “scar tissue” are always observed in the tooth pulp, which do not allow the studied hemodynamic parameters in loose connective tissue to reach the initial level of intact teeth [Beer R., 2004].

The state of the pulp nerve elements was studied using electric current (electroodontometry) using the Pulpotest electrodiagnostic device [18].

Table 4
Indicators of electroodontometry of pulp of teeth with deep caries before and after application of medical pads (M ± m) Type of treatment pad Electrodontometry (μA) Before treatment (n = 42) After treatment Eugenol-thymol treatment pad (n = 16) 14.2 ± 0.3 8.1 ± 0.17 * Combined treatment pad (Esobel-Furadonin-Zinc Oxide) (n = 17) 5.7 ± 0.18 * p <0.001 Note:
* - significant differences between indicators before and after treatment
p is the significance level of the differences between the pads after treatment.

Deep dentin caries was accompanied by significant changes in the indicators of pulp electric excitability (Table 4).

However, when using the Esobel-Furadonin-Zinc Oxide combination cushion, the electroodontometry of the pulp of the teeth decreased by 2.5 times compared to the eugenol-thymol cushion.

To clarify the nosological form of pathology, assess the quantity and quality of restoration of replacement dentin in the pulp, intraoral radiography was used with the help of a dental apparatus in a patient's sitting position [11].

Table 5
Indicators of X-ray examination of dentin in deep caries before and after application of medical pads (M ± m) Type of treatment pad The size of the replacement dentin layer (mm) Before treatment After treatment Eugenol-thymol treatment pad (n = 16) 0.5 + 0.02 1.3 ± 0.03 * Combined treatment pad (Esobel-Furadonin-Zinc Oxide) (n = 17) 3.1 ± 0.07 * p <0.001 Note:
* - significant differences between indicators before and after treatment
p is the significance level of the differences between the pads after treatment.

The reparative activity of the pulp increased with the use of medical pads, but a more pronounced replacement dentin layer was detected after application of the Esobel-furadonin-zinc oxide therapeutic pad (Table 5). Its thickness increased by 58% (p <0.001) compared with the eugenol-thymol treatment pad.

The pulp reacts to dentin damage with caries by depositing a layer of reparative dentin over the dentinal tubules of primary or secondary dentin, which communicate with a carious lesion. The formation of reparative dentin allows the pulp to "hide" behind a barrier of mineralized tissue, because it creates a relatively impenetrable barrier that prevents irritants from entering the pulp and compensates for the loss of primary dentin.

The formation of replacement dentin rarely occurs before the 30th day, which is due to the time period for applying the medical pad proposed by us, and the quality and quantity of dentin formed depend on the environment surrounding the matrix cells [11, 19].

All of the above medical pads have a restorative effect on microcirculation in the pulp of the tooth and improve the electrical excitability of the pulp, and when using a combined therapeutic pad, the electroodontometry data returns to normal. The density class of pathogenic microorganisms under the influence of the Esobel therapeutic paste-furadonin-zinc oxide is reduced to the minimum figures: from 10 ⁷ -10 ⁸ to 10 ³ CFU or less. Along with this, the reparative activity of the pulp increases significantly and the level of formation of substitution dentin increases to a greater extent with the use of a combined medical pad (Esobel-furadonin-zinc oxide)

Examples of specific performance.

Example 1

Patient S.P.S., 20 years old, medical record No. 14441. I complained about the presence of a cavity in the tooth 36.

D-s: Caries of dentin (deep) tooth 36.

The density class of microorganisms is III (10 ⁷ ).

Electroodontometry - before treatment, 10 μA.

Microcirculation in the pulp of a tooth:

Vs - 1.46 cm / s.

Pi - 2.41.

Ri 0.76.

R-graphy: 0.5 mm replacement dentin layer.

The cavity was prepared, the drug was treated with a 1% solution of chloramine, distilled water, and dried. A medical pad (“Esobel” 0.03 + furadonin 0.03, zinc oxide 0.02) was placed on top of a cotton ball, a temporary filling from the SIC.

Within a month, no complaints. The temporary seal was removed, additional studies were carried out:

The density class of microorganisms is 0 (10 ³ or less).

Electroodontometry - 3 μA.

Microcirculation in the pulp of a tooth:

Vs - 1.77 cm / s.

Pi - 2.70.

Ri 0.89.

R-graphy: 3 mm replacement dentin layer.

Permanent seal imposed.

Example 2

Patient S.I.V., 27 years old, medical record No. 29344.

Complaints about the presence of a cavity in the tooth 47.

D-s: Dental dentin (deep) tooth 47.

Dissection of the cavity, drug treatment with a 1% solution of chloramine, drying, medical pad ("Esobel 0.09 + furadonin 0.09 + zinc oxide 0.06)", cotton ball, SIC. Within a month, no complaints. Temporary seal removed, permanent seal applied.

The density class of microorganisms is I (10 ³ -10 ⁵ ).

Electroodontometry - 6 μA.

Vs - 1.77 cm / s.

Pi - 3.10.

Ri - 1.00.

R-graphy: 2 mm replacement dentin layer.

With the help of the combined therapeutic paste "Esobel" -furadonin-zinc oxide, 40 patients were treated. Dynamic follow-up for 6 months following the treatment showed no complaints, relapses and complications.

Thus, in addition to the antibacterial effect, the Esobel drug, which is part of the combined therapeutic pad, allows you to extremely quickly remove a typical pain syndrome caused by initial and reversible inflammation of the pulp. One month after application of the Esobel-Furadonin-Zinc Oxide combination cushion, a pronounced dentin replacement layer is formed that provides effective protection of the pulp from bacteria. This treatment technique prevents the inflammation and death of the pulp.

This drug is easy to prepare, has a pronounced anti-inflammatory and reparative activity, contributing to the normalization of the functional state of the pulp and increase the production of replacement dentin, and can be widely used in dentistry to treat deep caries.

LITERATURE

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Claims (1)

An agent for the treatment of deep caries, containing zinc oxide and an antibacterial agent, characterized in that it additionally contains Esobel sludge-sulphide mud extract, and furadonin is used as an antibacterial agent in the following ratio of components, g: Esobel sludge-sulphide mud extract 0.03-0.09 furadonin 0.03-0.09 zinc oxide 0.02-0.06