RU2348434C2 - Method of treatment of dental nerve neuritis caused by filling material delivery into mandibular canal - Google Patents

Abstract

FIELD: medicine; dentistry.

SUBSTANCE: treatment of inferior dental nerve neuritis caused by filling material delivery into mandibular canal is ensured with introduction of antibacterial agent before operation. Thereafter filling material is surgically removed from mandibular canal. Operation procedure is followed with introduction of antibacterial and immune correcting agents, antisensitisers, Reaferone, vitamins B₁ and B₁₂, adenosine triphosphate. Besides mandibular region is exposure to laser magnetotherapy with using dental apparatus Optodan, accompanied with intraoral HBO-therapy, hydromassage, hydrocortisone phonophoresis, 2% nicotinic acid solution amplipulse phoresis, Tambukan mud therapy, pine needle and pearl baths, acupuncture with using local and regional points.

EFFECT: higher treatment efficiency, restored blood circulation, accelerated rehabilitation, complete relief of evident pain syndrome and post-amputation pains, simplicity, efficiency.

3 ex

Description

The invention relates to medicine, namely to surgical dentistry.

The problem of prevention and treatment of complications arising from filling the root canals of the teeth with various materials remains relevant. One of the causes of complications is the removal of filling material into the mandibular canal due to errors of the dentist and the features of the anatomy of the lower jaw. Damage to the lower alveolar nerve with filling material, expressed in ongoing pain, neuritis, as well as in the possible development of purulent-inflammatory processes in the surrounding tissues, requires surgical treatment and active intraoperative therapy. In this regard, early diagnosis and treatment of this disease, which causes severe suffering to patients, seems to be a socially significant and relevant way to improve dental care.

There is a method of emergency care for neuritis in neurostomatology [1].

With this method, only generally accepted methods of general strengthening treatment are carried out: physiotherapy, novocaine blockade, without eliminating the main cause of the disease - filling material in the mandibular canal.

A known method of treating odontogenic neuritis of the face of various etiologies and genesis [2].

However, the method does not have a way to help patients with neuritis of the lower alveolar nerve caused by the removal of filling material into the mandibular canal.

A known method of treating trigeminal neuritis, glossopharyngeal, lingual and facial nerve [3].

The technique is a combination of methods for treating neuritis in one standard scheme, regardless of the etiology and cause of the disease. Detailed formulations and medication regimens are only advisory in nature.

A known method of treating neuritis of the lower alveolar nerve caused by the excretion of hot gutta-percha in the mandibular canal. On the example of a clinical case, the authors of the method describe the tactics of surgical intervention to remove gutta-percha from the mandibular canal [4].

However, in addition to prescribing antibiotics, intraoperative therapy was not carried out. There are no measures to restore the sensitivity of the zones of innervation of the lower alveolar nerve.

The closest in technical essence is a method of treating an injury of the lower alveolar nerve caused by the removal of filling material into the mandibular canal [5].

After surgery to remove the filling material from the mandibular canal, clinical observation of the patient is carried out for 7 days, 5 physiotherapy sessions are prescribed using the Optodan laser light therapy apparatus. The first 2 procedures are carried out on the 1st channel with an exposure of 2 minutes, then 2-3 procedures - on the 2nd channel with the same exposure of 2 minutes.

However, when using this method, postoperative therapy in the long term after the intervention is not carried out, the process of restoring nerve sensitivity is only monitored at follow-up visits. There is a lack of complexity and a systematic approach to the treatment of neuritis of the lower alveolar nerve caused by the removal of filling material into the mandibular canal.

The purpose of the invention is to increase the efficiency of restoration of the functions of the lower alveolar nerve in the treatment of neuritis caused by the removal of filling material into the mandibular canal.

The goal is achieved as a result of surgical removal of filling material from the mandibular canal, preoperative therapy, including antibacterial, desensitizing, immunocorrective agents, and postoperative therapy, including antibacterial, desensitizing, immunocorrective agents, as well as a course of intraoral HBO therapy, ampliculic acid solution 2% nicotine , vitamins B ₁ and B ₁₂ , mud therapy with Tambukan mud, ATP, hydromassage, coniferous-pearl and sulfide baths, laser and magneto therapy with the Optodan apparatus, acupuncture, phonophoresis with 0.5% hydrocortisone solution, antiviral therapy with Gepon and Reaferon.

THE METHOD OF TREATMENT IS CARRIED OUT BY THE FOLLOWING IMAGE

A detailed x-ray is performed, including panoramic radiographs. Establish the exact localization of the filling material in the mandibular canal. After conduction and infiltration anesthesia, removal of filling material from the mandibular canal is performed.

Preoperative therapy includes the use of antibacterial agents according to the scheme:

- "Amoxicillin / clavunate" 30 minutes before surgery, 1.0 g iv;

with an allergy to penicillins - “Roxithromycin” or “Summamed” 150 mg orally 30 minutes before surgery,

reserve antibiotics - “Clarithromycin” 500 mg i / m or iv, 30 minutes before surgery or “Clindamycin” 600-900 mg iv 30 minutes before surgery.

Postoperative therapy includes:

antibacterial, immunocorrective, desensitizing agents, as well as drugs and therapeutic measures that improve redox processes in the tissues of the lower jaw according to the following schemes:

Antibacterial, immunocorrective desensitizing agents:

- "Amoxicillin / clavunate" 625 mg 3 times a day for 6 days; "Cetrin" 0.2 mg 3 times a day for 7 days. "Neovir" 2 ml / m every other day for 10 days; "Acyclovir" at 0.4 mg 2 times a day for 7 days.

For allergies to penicillins - Clarithromycin 500 mg 2 times a day for 6 days; "Cetrin" 0.2 mg 3 times a day for 7 days. "Neovir" 2 ml / m every other day for 10 days; "Acyclovir" at 0.4 mg 2 times a day for 7 days. If necessary, in cases of herpetic eruptions - appoint applications "Reaferon" - No. 10-12.

With individual intolerance, reserve antibiotics:

- "Clindamycin" at 500 mg 3 times a day for 6 days; "Cetrin" 0.2 mg 2 times a day for 7 days. "Cycloferon" in 2 ml of a 12.5% solution is injected intramuscularly according to the scheme: on days 1, 2, 4, 6, 8, 11, 14, 17, 20, 23, 26 and 29;

With intolerance to beta-lactams, macrolides (Roxithromycin or Summamed) are prescribed

- to normalize blood supply and eliminate tissue hypoxia, especially in individuals with a long period of filling material in the mandibular canal, after surgery, they undergo a course of local (intraoral) HBO therapy (hyperbaric oxygenation). The device in the form of a mouthguard with a suction cup, a vacuum groove and a suction fitting is made of quick-hardening plastic for each patient individually. Oxygen is supplied to the chamber through the air duct through the discharge fitting, creating an increased pressure of 100-150 mm Hg in the chamber. at a constant level for 15 minutes. The course of treatment is 15-25 sessions for 2 months;

- amplipulse phoresis of 2% nicotinic acid solution of 15 procedures for 30 days;

- vitamin therapy - vitamin B ₁₂ - 500 mcg per 1 ml of IM No. 12, B ₁ - 2 ml of 5% solution of IM No. 12;

- mud therapy to restore peripheral circulation and sensitivity in soft tissues - external applications on the mandibular region of the Tambukan mud (Tambukan mud is a unique natural complex of paraffins, oil and resins, extracted in the Stavropol Territory from Lake Tambukan) in an insulating napkin using the Potok-1 apparatus (current strength - 1-2 μA) on the maxillary and submandibular region for 15 minutes per treatment every other day for 30 days;

- ATP for 1 ml / m No. 10-20;

- balneological treatment - with hydromassage No. 10, coniferous-pearl No. 10 and sulfide baths No. 10;

- laser and magnetotherapy using a semiconductor laser diode generating pulsed light with a wavelength of 0.85 to 0.98 μm, a pulse power of 2-4 W, a pulse duration of 40-100 ns, with a pulse frequency of 1.5-2 , 0 kHz, with a magnetic field of 35 mT by the Optodan device. The first 5 procedures are performed on the 1st channel with an exposure of 2 minutes, then 5 procedures - on the 2nd channel with the same exposure of 2 minutes every other day for 20 days;

- acupuncture using local and regional Ballé points (in the projection of the mandibular and chin holes of the lower jaw) with 13 mm long needles at point “3” (third square, in the middle of the upper horizontal line drawn through the earlobe on the affected side) in two courses of 10- 15 procedures with a break of 10 days;

- phonophoresis with hydrocortisone (in patients with a period of stay of filling material in the mandibular canal for more than 6 months) 10-15 procedures for 30 days;

- for the prevention of herpetic eruptions, antiviral drugs are prescribed in the form of 5-10 multiple applications of Reaferon, which is applied to the affected areas of the skin and mucous membrane 5 times a day for 5-10 days.

This method of treatment of odontogenic neuritis caused by the removal of filling material into the mandibular canal was used in 112 patients, of which 109 were women and 3 were men, aged 19 to 55 years. The obtained positive results and short periods of restoration of sensitivity after complex physiotherapeutic rehabilitation of patients according to the above schemes allow us to recommend this method for widespread implementation in practice.

EXAMPLES OF SPECIFIC IMPLEMENTATION

1. 46-year-old patient M., amb. card No. 317, turned 6 months after filling the root canal of the 35th tooth to the dental surgeon at the place of residence due to ongoing pain in the lower jaw on the left. EDI of premolars and molars on the affected side was 75-90 μA, and pulp sensitivity was absent in incisors and canines. The analysis of the orthopantomogram revealed a radiopaque foreign body in the anterior part of the mandibular canal in the region of 35 tooth.

Before surgery, preoperative antibacterial therapy - “Amoxicillin / clavunate” was performed 30 minutes before surgery 1.0 g IV. Surgical removal of filling material from the mandibular canal was performed.

In the postoperative period, the following were used: Amoxicillin / clavunate 625 mg 3 times a day for 6 days; "Cetrin" 0.2 mg 3 times a day for 7 days. "Neovir" 2 ml / m every other day for 10 days; "Acyclovir" at 0.4 mg 2 times a day for 7 days.

Postoperative wound healing was uneventful. After 8 days, the stitches were removed. In the future, a treatment regimen was used to restore peripheral blood circulation: Reaferon applications, injections of vitamin B ₁ and B ₁₂ No. 12, ATP No. 10, and a course of intraoral HBO therapy No. 10, hydromassage No. 5, phonophoresis with hydrocortisone No. 10, amplipulse phoresis with 2% nicotinic acid solution No. 10, mud therapy with Tambukan mud of the mandibular region No. 10, coniferous-pearl and sulfide baths No. 10, acupuncture using local and regional points No. 15.

A follow-up examination after 6 and 12 months revealed a complete restoration of the sensitivity of these departments of the face, EDI of incisors and fangs and molars - 6-8 μA.

2. 38-year-old patient S., amb. card No. 3427 complained of a violation of skin sensitivity in the region of the lower right lip and chin, but without severe pain. The patient reported that 4 weeks ago, channels 46 and 47 of her tooth were sealed.

Objectively: 42, 43, 44, 45, 46, 47 teeth did not respond to thermal and electrical irritation (molar EDI - 75 μA). X-ray examination showed the removal of filling material in the region of the distal root of the 47 tooth into the right mandibular canal.

Preoperative therapy was carried out according to the above scheme. Under appropriate local anesthesia, surgical removal of the filling material from the mandibular canal was performed, with decompression of the lower alveolar nerve. The postoperative period was uneventful, physiotherapy and anti-inflammatory therapy were prescribed according to the given scheme. Sensitivity in the gums and lower lip area was restored after 3 months, molar EDI - 6-12 μA, incisors and canines - 8-12 μA.

3. Patient B., 39 years old, amb. card No. 3120 complained of numbness of the left half of the lower lip and chin, as well as aching, pulling pains. According to the patient, about 10 months ago, the root canals of 47 and 46 teeth were filled in, and after 2-3 days there were minor pain and numbness of the lower lip, after 4 weeks - pain radiating to the ear and temple, numbness not only of the lower lip but also the chin. The analysis of X-ray diffraction patterns showed that in the 47 tooth region, in the projection of the mandibular canal, there is a foreign body, presumably an excess filling material diffusely spreading in the bone tissue. Preoperative therapy was carried out according to the above scheme. Filling material was removed from the mandibular canal. A complex of postoperative rehabilitation was carried out according to the above scheme. 12 months after the operation, the pain, dryness of the mucous membranes and numbness of the skin of the chin do not bother the patient.

4. Patient S.-N.P., Amb. card number 3449. Complaints of constant pain in the lower jaw area on the left, numbness of the lower lip and chin skin. On the roentgenogram - filling material removed into the mandibular canal during endodontic treatment of 45 teeth. The diagnosis is odontogenic neuritis of the lower alveolar nerve, caused by the removal of filling material into the mandibular canal. The treatment was carried out according to the method of the prototype.

The patient underwent surgery to remove the lactating material from the mandibular canal.

Next, postoperative therapy was carried out according to the prototype scheme.

3 months after the operation, complete numbness of the chin skin was preserved, the EDI of molars and premolars - 35-40 μA, incisors and canine - 25-35 μA. After 12 months, the sensitivity of the teeth and gums did not change; numbness of the skin of the lower lip and chin persisted. The patient complains of ongoing nightly phantom pains radiating to the temple and neck. After 1.5 years, the results of EDI of molars were 15-18 μA, premolars - 16-18 μA, incisors and canine - 14-18 μA, which indicates the absence of restoration of blood circulation and innervation in the basin of the lower alveolar artery and nerve.

Therapeutic measures according to the claimed scheme allows you to completely remove severe pain and phantom pain. Methods of restoring blood circulation in the basin of the lower alveolar artery are effective, economically accessible, technically simple and can speed up the rehabilitation process by 75-80% compared with the terms of rehabilitation of patients according to the existing method.

INFORMATION SOURCES

1. Grechko V.E. Emergency care in neurostomatology. - M .: Medicine, 1981. -200 p.

2. Karlov V. A. Facial neurology. - M., Medicine. - 1991 .-- 285 p.

3. Yakovleva V.I., Trofimova E.K., Davydovich T.P., Prosviryak G.P. Diagnosis, treatment and prevention of dental diseases. M., 1994.493 s. - p. 356-357.

4. Blanas N, Kienle F, Sandor GK. Injury to the inferior alveolar nerve due to thermoplastic gutta-percha. J Oral Maxillofac Surg 2002; 60 (5): 574-6.

5. Tomazov M.V. The rationale for the treatment of patients with complications associated with the removal of filling materials in the mandibular canal. - Diss. Cand. honey. Sciences, M., 2003 .-- 147 S.

Claims (1)

A method of treating neuritis of the lower alveolar nerve caused by the removal of filling material into the mandibular canal, including surgical removal of filling material from the mandibular canal, and laser magnetotherapy with the Optodan apparatus, characterized in that antibacterial agents are administered before the operation, and antibacterial drugs are additionally administered after the operation, and antibacterials are administered , desensitizing agents, Reaferon, vitamins B ₁ and B ₁₂ , ATP, and also conduct a course of intraoral HBO therapy, hydromass already, phonophoresis with hydrocortisone, amplipulse phoresis with 2% nicotinic acid solution, mud therapy with Tambukan mud of the mandibular region, coniferous-pearl and sulfide baths, acupuncture using local and regional points.