RU2393898C1 - Method of treatment patients with chronic forms of periodontitis and periodontitis in acute phase - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to dentistry. Mouth cavity is irrigated with ozonised physiological solution with the ozone concentration of 1500 mcg/litre. The tooth cavity is opened, the contents is evacuated. After each stage of processing of channels the tooth is treated with irrigation of ozonised saline solution with ozone concentration of 1500 mcg/litre. Ozonised saline solution is administered into the root canal at turundae with a concentration of ozone 4000 - 6000 mcg/litre. A sedative filling is set with its subsequent removal and sealing of the root canal. An additional sanitation of the mouth cavity is conducted with ozone-ultrasonic jet spray torch of ozonised physiological solution with the concentration of ozone of 1500 mcg/litre. The sanitation is conducted for 30-90 seconds, with a frequency of ultrasonic vibration 26.5 kHz, amplitude of 50-80 microns. Then an ultrasonic sanitation of periodontal recesses is conducted with the same solution for 20-30 seconds. After insertion of turundae into the root canal and set of a sedative filling 5-8 procedures of phonophoresis of periapical tissue are carried out daily for 20-30 seconds through a pad of ozonised physiological solution with concentration of ozone 1500 mcg/l, with a frequency of 26.5 kHz and amplitude of oscillations 20-50 microns.

EFFECT: method increases treatment efficacy and reduces number of complications due to increase of oxygen and ozone diffusion in tissue increasing the reparative processes in them.

5 tbl, 1 ex

Description

The invention relates to medicine, namely to dentistry, and can be used to treat chronic forms of periodontitis and periodontitis in the acute stage.

The currently used methods of treatment of periodontitis cannot be called perfect (V.A. Kozlov, 1979; A.I. Rybakov, 1981). According to statistical reports, attendance for pulpitis and periodontitis accounted for 35% of all visits for dental treatment. In absolute terms, in 1993 23.9 million visits were made for endodontic treatment. There are basically two reasons for tooth extraction: periodontal disease (52.4%) and caries complications (46%). If we take into account that for every resident aged 35-44 years there are 6-7 extracted teeth and 3-5 of them regarding periodontitis, then all the relevance and importance of this problem becomes clear.

Periodontitis, namely their chronic forms, are the source of odontogenic inflammatory processes, including acute odontogenic sepsis, odontogenic mediastinitis, intracranial inflammatory processes. A feature of odontogenic foci of inflammation is that defects in the hard tissues of the tooth cannot be compensated naturally.

This leads to continuous additional infection of the tissues of the maxillofacial region and contributes to the formation of foci of chronic infection. A peculiar dynamic equilibrium is established between such a focus of infection and the patient’s body. It can be violated as a result of changes in the immunological reactivity of the body, increased virulence of the infectious onset, or damage to the connective tissue capsule surrounding the infectious focus (M.M.Soloviev, I. Khudoyarov, 1979).

In 98-99% of cases, periodontitis of the teeth is the cause of phlegmon of the maxillofacial region, which is a great danger to the health and life of the patient.

From the data presented it follows that the complications of caries - pulpitis and periodontitis - are a common pathology and make up at least 45-50% in the structure of dental diseases under the age of 44 years. The inflammatory process in periodontitis in at least 50% of cases is the cause of tooth extraction in the age group older than 50 years. All this subsequently leads to expensive prosthetics.

Such a high prevalence of chronic odontogenic processes is directly related to the quality of endodontic treatment.

The basic principles of the most effective and gentle treatment of periodontitis were developed by the domestic dentist M.I. Groshikov (M. Groshikov. Clinic and treatment of periodontitis. Textbook. Moscow, 1971, p. 10) based on the previously proposed methods of L.A. Limberg, F.A. Zvereakovsky, consisting in a thorough and careful mechanical treatment of infected root canals, treatment of the topical focus of inflammation until the end of exudation, followed by optimal obturation of the canal and restoration of the defect.

The choice of treatment method and material for filling the channel is directly related to the clinical manifestations of the disease.

Treatment in the traditional way is reduced to the following actions:

- removal of pulp decay;

- impact on the microflora of the root canal with various medications;

- conducting mechanical expansion of the canal and apical foramen;

- effects on the peritoneal tissue with drugs;

- application of physical factors;

- thorough drying of the root canal;

- thorough obstruction of the root canal;

- restoration of the defect.

High-quality preparation of the tooth cavity for endodontic measures is carried out in accordance with all the rules of traditional treatment using thorough mechanical and instrumental treatment, decay removal and preliminary introduction of an antiseptic, 2-3% hydrogen peroxide into the canal. After the canal has been expanded (EDTA can be used), a cotton wool with antiseptic is left in the root canal and the tooth is hermetically closed (M.I. Groshikov, V.K. Patrikeev. Teaching aid in therapeutic dentistry. M .: Medicine, 1975, p. 230).

At the second visit, the bandage is removed, the canal is re-processed, the apical hole expands and the filling is expanded. If the canal is poorly passable, then a turunda with an antiseptic is left in the canal under a bandage up to three days before a clean turunda.

The bandage is removed, in the presence of clean turunda, drug treatment and filling is performed according to the generally accepted method. To accelerate the reparative processes, a biologically active paste can be removed beyond the apex and then fill the tooth canal.

The absolute indication for treatment in one visit is the presence of a fistulous course. Through it there is an outflow of exudate, therefore filling the canal and removing the material beyond the apical opening of the tooth root is not accompanied by an exacerbation of the inflammatory process.

This method is simple to implement and is applicable with low requirements for the result of treatment. However, a 3% hydrogen peroxide solution is not very effective for use as an independent means for washing the root canals. Hydrogen peroxide is unable to dissolve necrotic tissues and other organic residues, and causes irreversible changes in cellular elements. Hydrogen peroxide does not have lytic properties and its antimicrobial effect is very limited. It is not very effective for use as an independent means for washing the root canal, does not have bacteriostatic properties.

The closest is a method of treating patients with chronic forms of periodontitis and periodontitis in the acute stage, published in patent RU 2324452, C1, 05.20.2008, bull. No. 14, IPC А61С 5/00, А61К 33/08, А61К 33/14, А61З 1/02, which includes irrigation of the oral cavity with ozonized saline at an ozone concentration of 1,500 μg / l, opening of the tooth cavity, evacuation of contents, tooth processing . After each stage of processing the channel, irrigation is carried out with ozonized saline at an ozone concentration of 1500 μg / L. An ozonized physiological solution with an ozone concentration of 4000-6000 μg / L is introduced into the root canal on turund. Fill the channel with filling material. Remove the temporary seal and in the presence of clean turunda, after processing the proposed solution put a permanent seal. After treatment, patients conduct oral baths during the day after each meal with a solution with an ozone concentration of 1000-1500 μg / L.

The disadvantage of this method is the insufficiently effective penetration of the drug into the tissues, the need for oral baths, which patients do not always perform.

The objective of the invention is to increase the effectiveness of treatment, reduce the risk of complications by improving the antimicrobial treatment of the oral cavity and the causative tooth and quickly stop the inflammatory process in the gum tissue by saturating them with oxygen and increasing local protection factors.

The problem is solved by a method of treating patients with chronic forms of periodontitis or periodontitis in the acute stage, including irrigation of the oral cavity with ozonized saline solution with an ozone concentration of 1500 μg / l, opening of the tooth cavity, evacuation of contents, tooth treatment after each stage of the canal treatment with irrigation with ozonized saline solution ozone concentration of 1500 μg / l. The method includes introducing into the root canal on turund an ozonized physiological solution with an ozone concentration of 4000-6000 μg / l, installing a temporary filling with its subsequent removal, and filling the root canal.

In addition, oral cavity sanitation is carried out by ozone-ultrasonic treatment with an ozonized physiological saline jet spray with an ozone concentration of 1,500 μg / l for 30-90 seconds, with an ultrasonic vibration frequency of 26.5 kHz, an oscillation amplitude of 50-80 microns. Then carry out ultrasonic sanitation of periodontal pockets through the same solution for 20-30 seconds. After introducing turunda and temporary fillings into the root canal, 5-8 phonophoresis procedures of the tissues of the periapical region are carried out daily for 20-30 seconds through a technological pad with ozonized physiological solution with an ozone concentration of 1500 μg / l at an ultrasonic vibration frequency of 26.5 kHz, vibration amplitude the radiating end of the waveguide tool 20-50 microns.

The novelty of the method lies in the fact that:

- as a solution for irrigation during manipulations in the oral cavity using ozonized physiological solution at an ozone concentration of 1500 μg / L. This product is poured into a tank for distilled water in a dental unit and, with the help of a water blanker, the oral cavity is sanitized and various manipulations are performed when working in the oral cavity. This allows oxygen to enter the tissues of the oral cavity, which leads to improved trophism of the mucous membrane of the entire oral cavity and reduces bacterial contamination;

- before tooth processing at the preparatory stage, an ozone-ultrasonic jet-aerosol torch is used to rehabilitate the oral cavity with the same tool at an ozone concentration of 1500 μg / l for 30-90 seconds with the following parameters and modes of ultrasonic treatment:

- frequency of ultrasonic vibrations 26.5 kHz;

- the amplitude of the oscillations is 50-80 microns;

- the distance from the radiating end of the waveguide tool is not less than 3-5 mm;

This allows you to effectively affect the microbial landscape and significantly reduce the microflora of the oral cavity due to the double effect of ozone and ultrasound. Permeability and tissue respiration in the inflamed oral mucosa are normalized, leukocyte migration and desquamation of the oral epithelium increase.

- conduct ultrasonic sanitation of periodontal pockets through the same solution for 20-30 seconds. This local application of ultrasound allows you to influence the inflammatory process in the gingival mucosa of the causative tooth, the microbial landscape is reduced and a deeper diffusion of oxygen in the tissue is achieved. The intermediate solution is also used to prevent thermal burns of tissues in the area of scoring;

- after introducing turunda with the drug and temporary fillings into the root canal, phonophoresis of the tissues of the periapical region is carried out through a technological pad with ozonized physiological solution with an ozone concentration of 1500 μg / l at a frequency of ultrasonic vibrations of 26.5 kHz, an oscillation amplitude of the emitting end of the instrument waveguide of 20-50 microns, 20-30 seconds daily in a course of 5-8 procedures. First of all, the inflammatory process in the gum is quickly stopped due to the impact on the processes in the deep layers of the tissues of the maxillofacial region, a deeper diffusion of oxygen in the tissue is achieved both from the side of the gum surface and from the turunda installed in the root canal. This effect allows you to enhance reparative processes in the bone tissue. Under the action of ultrasound, the pathological contents are extracted from the voiced tissues of the focus of infection and the rapid rejection of necrotic tissues.

The combined effect of two factors in synergism enhances the effect of each, increasing the therapeutic effectiveness of both ozonized physiological saline and ultrasonic treatment. The release of oxygen from the ozone-oxygen mixture used is enhanced, and the tissues are subjected to mechanical vibrations of vibration and hydromassage at the cellular and subcellular levels, which improves microcirculation and metabolism in tissues and, ultimately, improves reparative and regenerative processes. Tissues are more intensively saturated with ozone and oxygen under the influence of sound-capillary and sound-chemical effects of ultrasound, this increases the range of the drug.

Thus, the set of essential features of the invention allows to obtain a new technical result, which consists in the fact that when washing the root canal, after ultrasound exposure, necrotic tissues and other organic residues are more completely removed due to their more rapid rejection. Duration of treatment is reduced by an average of 2 days due to a significant reduction in bacterial contamination of the oral cavity, increased local immunity, and the rapid relief of the inflammatory process in the gums. Reparative processes are intensified, which contribute to the speedy restoration of tissues, which significantly improves the result of treatment.

The achievement of a positive effect when using ultrasound in the treatment of diseases of the oral cavity and teeth is associated with its pronounced effect on microcirculation and metabolism in tissues, enzymatic activity, tissue trophism, reflex stimulation of neuro-trophic function, reparative and regenerative processes.

The use of ultrasound in the treatment of:

- using ultrasound in therapeutic dentistry, remineralizing therapy is carried out, namely the impregnation of calcium and fluoride in tooth enamel;

- for sterilization of the root canals conduct ultrasound transcanal processing. Studies have shown that ultrasound files are more effective than conventional endodontic instruments to remove tissue, predentin, and dentin residues. Ultrasound activates the cutting ability of these files. This is due to the spatial smoothing of the walls of the canal, making the surface of the walls of the root canal very smooth, which is very difficult to achieve with ordinary endodontic measures;

- for pre-sterilization treatment of instrumentation, including dental, small-sized ultrasonic devices are used, which allows to improve the quality and reduce the time of presterilization treatment of instrumentation. This contributes to more reliable protection of medical personnel and patients from infection with bacterial and viral agents. Certain successes have been achieved in the treatment of:

- trophic ulcers. [The use of low-frequency ultrasound in the treatment of trophic ulcers / Gostishchev VK, Khokhlov A.M., Beichorov E.Kh. et al. // Bulletin of Surgery. I.I. Grekova. - 1984 - No. 3. S.92-95.];

- keratitis [Novitsky I.Ya. The combined use of ultrasound and dioxidine in the treatment of infected keratitis and corneal ulcers. // Ophthalmol. Zhurn. - 1983. - No. 7. S.399-402.];

- urolithiasis;

- urethral strictures;

- viral hepatitis;

- lung diseases;

- lumbar osteochondrosis;

- chronic tonsillitis;

- in the treatment of periodontal disease, which includes not only ultrasonic treatment of the gums and treatment of periodontal pockets, but also the removal of dental deposits [Vinogradova SI Lysozyme ultraphophoresis in the complex treatment of patients with inflammatory periodontal diseases. / experiment. - wedge. Issled. /: Abstract. Dis ... cand. Honey. sciences. - Tver, 1995. - 25 p.].

Ultrasound therapy is considered one of the most common and highly effective methods of modern physiotherapy and active therapy used in the complex treatment of a wide range of diseases in orthopedics and traumatology, surgery and gynecology, dentistry, dermatology. At the same time, a significant place is given to low-frequency ultrasound surgery and conservative therapy, which over the past three decades have been enriched by a number of physiological and experimental studies, on the basis of which the most effective methods of treatment using low-frequency ultrasound have been developed (G.A. Nikolayev, V.I. Loshchilov, 1980) [Ultrasonic technology in medicine. / Ed. V.I.Loshchilova. - M., 1980].

The basis of the biological effect of ultrasound is its ability to be absorbed by the tissues of a living organism and can be due to both direct action of ultrasound (cavitation, acoustic flows, variable sound pressure) and indirect action, that is, secondary effects (biochemical, thermal, electrophysical, etc.). The energy of absorbed ultrasound is transformed into other types of energy, causing a number of physical, physico-chemical processes and biological reactions. They, in turn, lead to a change in the homeostasis of tissue cells and the body as a whole.

Under the action of ultrasound, the tissues alternately compress and stretch the particles, which causes them to oscillate.

Mechanical vibrations of tissue particles lead to cell massage, a shift in physicochemical processes and the formation of heat. With a high intensity of ultrasound in the stretching phase, intermolecular adhesion forces can break, attraction and the emergence of micro cavities - cavitation.

The vapor-gas bubbles formed during cavitation instantly disappear in the compression phase, and the resulting shock waves, electric charges, and high local temperature peaks initiate specific sound-chemical reactions in the voiced medium.

In a heterogeneous medium, in addition to the existing general acoustic pressure, small- and medium-scale flows and turbulations arise. They significantly accelerate the processes of dissolution and dispersion of substances.

The influence of ultrasound changes the pH of the medium towards alkalosis, while the level of tissue absorption increases, and the accumulation of carbon dioxide decreases.

Ultrasound has a pronounced bacteriostatic effect; it does not cause the death of microorganisms, but causes their morphological and functional rearrangements. They lead to a change in their properties.

In general, the action of ultrasound on a biological object occurs through an acoustic medium (solutions of antiseptics, antibiotics, enzymes).

The effect of ultrasound through intermediate solutions of drugs helps to ensure complete or partial suppression of the action and development of microbial flora, extraction of pathological contents from the pathological focus. This achieves a deeper penetration of drugs. This increases the coverage of the drug, and therefore the rapid development of regenerative processes. We have proposed the use of ozonized physiological solution as an intermediate solution. This solution in itself already has a pronounced bactericidal, fungicidal, viralolytic, anti-stress, desensitizing and immunomodulating effect. Ozone has a bactericidal effect on microorganisms located in the root canal and oral cavity.

In our method, the joint repeated use of an ozonized agent is introduced, which is introduced into the oral cavity and root canal on the turunda, and ultrasound treatment, which intensifies the release of the therapeutic substance in the desired phase of treatment, is as close as possible to the focus of inflammation due to diffusion into the deeper layers of the gums, which allows significantly improve the result. All this in total affects the patient’s body as a whole and, taking into account the stimulation of the processes occurring in it, contributes to the healing of the pathological focus.

The proposed method is as follows.

In our work, we used a 0.9% solution of sodium chloride for local ozone therapy of patients with chronic periodontitis and periodontitis in the acute stage, the ozonation of which was carried out using a commercially available apparatus for gas ozone therapy "Ozotron" GKTE. 941714. 001 Substation, LLC Research and Production Company METROMED, Omsk, under the guidance of Academician RAMTN Pedder V.V. This device is equipped with special tube nozzles of various lengths and configurations for ease of use. The operating modes of the apparatus: the calculated oxygen concentration at the apparatus outlet is 1 l / min, the maximum supply of ozone-oxygen gas mixture at the apparatus outlet is 10,000 μg / l.

Ozonized saline was prepared by barbation with an ozone-air mixture for 15-20 minutes at 250 ml of solution and 20-25 minutes at 400 ml. In this case, a concentration of 100 ml of physiological saline equal to 5000-7000 μg / L was obtained. To calculate the time of barbation, in order to achieve the concentrations of ozone in physiological saline necessary for our study, the data were used [Durnovo EA The rationale for the use of ozone in the complex treatment of phlegmon of the face and neck. Dis ... cand. Honey. sciences. Nizhny Novgorod, 1998; 187]. The time of barbation was chosen taking into account the necessary concentration of ozone in the solution.

As a solution for irrigation during manipulations in the oral cavity, an ozonized physiological solution is used at an ozone concentration of 1500 μg / L. This product is poured into a tank for distilled water in a dental unit and, with the help of a water blanker, the oral cavity is sanitized and various manipulations are performed while working in the oral cavity.

Before tooth processing, we additionally carry out ozone-ultrasonic sanitation with a jet-aerosol plume of the oral cavity with an ozonized physiological solution at an ozone concentration of 1500 μg / L. Parameters and modes of ultrasonic processing:

- frequency of ultrasonic vibrations 26.5 kHz;

- the amplitude of the oscillations is 50-80 microns;

- the distance from the radiating end of the waveguide tool is not less than 3-5 mm;

- exposure 30-90 seconds.

Ultrasonic processing is carried out using the apparatus "STOMATON-1" - the generator of ultrasonic vibrations URSK-18 LLC "Research and Production Company" METROMED ", Omsk.

Periodontal pockets are rehabilitated by sounding through an ozonized physiological solution with an ozone concentration of 1,500 μg / l, a waveguide tool in the form of a cylindrical rod with a working end, beveled at an angle of 45 °.

Open the cavity of the tooth. Spend the evacuation of putrid masses from the root canal with a pulp extractor. Necrotic tissue and predentin are removed with augers and rasps with irrigation of an ozonized solution (endodontic syringe) with a concentration of 1,500 μg / L after each stage of processing the tooth canal. Extend the apical third of the root canal and give it a conical shape with files and rimers with irrigation of an ozonated solution with a concentration of 1500. Thoroughly rinse the root canal with turundas moistened with ozonized saline with an ozone concentration of 1500 μg / l until they are clean. Set turunda moistened with ozonized physiological solution with an ozone concentration of 4000-6000 μg / l, establish a temporary filling with its subsequent removal.

Phonophoresis of tissues of the periapical region of the causative tooth is carried out through the technological pad in the form of 2-4 layers of gauze soaked in ozonized physiological solution with an ozone concentration of 1500 μg / L. The frequency of ultrasonic vibrations is 26.5 kHz, the amplitude of oscillations is 20-50 microns, for 20-30 seconds daily with a course of 5-8 procedures.

Remove the temporary seal. In this case, an ozonized physiological solution with an ozone concentration of 1500 μg / L is supplied from the puster for irrigation and rinsing of the oral cavity with all manipulations in the oral cavity requiring rinsing with water. In the presence of pure turundum, we carry out drug treatment of the tooth canal with ozonized saline solution with a concentration of 1500 μg / l.

The treatment of periodontitis is completed with root canal filling, thereby stopping the passage of microorganisms, microbial toxins and pulp decay products from the root canal to the periodontium.

A study of the comparative dynamics of the pathological process was carried out in 120 people with chronic destructive periodontitis and periodontitis in the acute stage. Of these, 75 women and 45 men of the middle age group (from 25 to 55 years). In formulating the diagnosis, we, like most dental therapists, adhered to the generally accepted classification of I.G. Lukomsky (1955) with a definition of the type of inflammatory reaction and the boundaries (limited and diffuse).

In the vast majority of patients, the reason for seeking dental care was their further prosthetics, to eliminate dentition defects.

Table 1 Distribution of patients by age groups 25-30 30-35 35-40 40-45 45-50 50-55 Women 12 13 19 6 eighteen 7 Men 8 eleven 12 7 3 four

From the data of table 1 it can be seen that mainly women, from 35-40 (25.3%) and 45-50 (24%) years with chronic periodontitis and periodontitis in the acute stage, took part in the study. All patients did not have serious somatic concomitant chronic inflammatory diseases.

Of the 120 patients, 68 (56.6%) were diagnosed with chronic fibrous periodontitis, and 17 (14.1%) had chronic granulomatous periodontitis.

35 (29.1%) of the 120 patients examined were diagnosed with chronic granulating periodontitis, and 6 (5%) of 35 referred for exacerbation of this form of the disease.

table 2 Distribution of patients by nosological form of the disease Periodontitis form Number of patients % of the total number of subjects Chronic fibrous periodontitis 68 56.6 Chronic granulating periodontitis 29th 24.1 Chronic granulomatous periodontitis 17 14.1 Chronic periodontitis in the acute stage 6 5

Table 2 shows that mainly patients with chronic fibrous periodontitis (56.6%) took part in the study.

Depending on the method of treatment, 3 groups of patients were allocated:

- control, treatment in the traditional way;

- treatment with ozonized saline;

- treatment with ozonized saline in combination with exposure to ultrasound.

The diagnosis was made on the basis of complaints and objective research methods. As an additional research method, the x-ray method was carried out (intraoral and according to the indications of the orthopantomogram).

The general condition of the patients did not suffer, elevated body temperature was not observed. Complaints consisted in some cases of pain when biting, a feeling of heaviness in the area of the causative tooth, sometimes swelling and discoloration of the tooth. In general, patients did not present complaints, but came to prepare the oral cavity for further prosthetics.

An objective examination revealed a change in the color of the crown of the causative tooth, and often the crown was intact. In people of the older age group who were preparing for prosthetics, the crowns were destroyed or had large carious cavities. Probing is painless, percussion in some cases was painful. On the alveolar process, in the area of the causative tooth, a fistulous course was found in some patients, sometimes with purulent discharge. Localization of fistulas was different. Most often, they opened at the level of the apex of the root of the causative tooth, from the vestibular surface of the gums, most likely due to the fact that this wall is thinner. Often around the mouth there were growths of bleeding granulations of pink color, and sometimes, instead of a fistula, in some cases scars were observed. From the anamnesis, it turns out that the causative tooth bothers the patient for a long time. At first, the pain was paroxysmal in nature, intensifying with biting and swelling of the gums. With the expiration of purulent contents through the hole in the gum, the pain passed and the general condition improved.

All patients underwent x-ray examination in the form of intraoral images. On radiographs in the bone near the top of the tooth, a site of destruction of bone tissue with uneven and fuzzy contours was noted. In some cases, partial resorption of the root of the tooth was detected. Bone tissue destruction often passed to the alveoli of adjacent teeth.

All patients were advised not to take any medicine and brush their teeth before taking the smears. The material was transported to a bacteriological laboratory for examination in sterile tubes filled with culture medium with a sterile tube. The material was delivered within 20 minutes. The content was taken according to all the rules of the bacteriological research technique. All patients are trained in hygiene skills.

At the time of admission, the Silnes-Loe Oral Hygiene Index (GI) was determined, which was repeated after individual stages of treatment. The treatment was carried out according to the prototype method and according to the method proposed by the authors.

Table 3 Oral hygiene index depending on the concentration of ozonized saline Ozone concentration in 0.9% saline solution (μg / L) GI at the time of receipt GI after irrigation of the oral cavity with an ozonized solution GI after ozone-ultrasonic sanitation of the oral cavity 500 2.74 ± 0.04 2.77 ± 0.04 2.05 ± 0.05 1000 1.56 ± 0.05 1.26 ± 0.04 1500 1.68 ± 0.06 0.89 ± 0.08 2000 0.64 ± 0.06 0.76 ± 0.07 2500 0.79 ± 0.08 0.74 ± 0.08

When evaluating the effectiveness of these methods, it was found that a significant decrease in the microflora of the oral region occurs at ozone concentrations of 1500, 2000 μg / l of physiological saline, which indicates a high degree of effectiveness of these concentrations. And with ozone-ultrasonic sanitation of the oral cavity, efficiency occurs at a lower ozone concentration of 1000-1500 μg / l of ozonized solution. The pathogenetic effect is based on a double effect: ozone and ultrasound. Therefore, the use of a higher concentration of ozonized solution for irrigation of the oral cavity with the ozone-ultrasonic method in the treatment of chronic periodontitis and periodontitis in the acute stage does not make sense.

Table 4 Oral hygiene index after treatment of periodontal pockets depending on the concentration of ozonized solution Ozone concentration in 0.9% saline solution (μg / L) GI at the time of receipt GI after irrigation of the oral cavity with an ozonized solution GI after ozone-ultrasonic treatment 500 2.74 ± 0.04 2.77 ± 0.04 0.65 ± 0.04 1000 1.56 ± 0.05 0.64 ± 0.06 1500 1.68 ± 0.06 0.62 ± 0.08 2000 0.64 ± 0.06 0.65 ± 0.05 2500 0.79 ± 0.08 0.67 ± 0.09

From the table it is seen that the optimal concentration of saline is 1500-2000 μg / l, which has the maximum bactericidal effect. This suggests that there is no further need to increase the concentration of saline. Moreover, with additional ozone-ultrasonic treatment of periodontal pockets, we obtain a better bactericidal effect and a more pronounced result.

After opening the tooth cavity for the first visit with thin cotton turunds on the root needle (everything is sterile, in dry heat cabinets for 1 hour at a temperature of 165-170 degrees or for two hours at a temperature of 155-160 degrees), the contents of the root canal and periapical region were taken. In well-traveled canals, we used ready-made paper turunds. Immediately after taking the sample, the turundas were lowered into the nutrient medium, while the usual bacteriological technique for sowing the burner flame was observed.

The treatment was completed in accordance with all the rules of the treatment process, as a filling material for root canal filling, the calcium-containing preparation KALASEPT was used, and gutta-percha pins were used as an additional obturator. We took the material for research according to all the rules of the microbiological method of research in the dental office at the reception.

When used in the complex treatment of patients with chronic periodontitis and periodontitis in the acute stage of ozone-ultrasonic treatment, the onset of the bactericidal effect is reduced by an average of 3 minutes.

Table 5 The time of the onset of the bactericidal effect, depending on the concentration of the oxygen-containing medicinal product during ozone-ultrasonic treatment Groups Ozone concentration in 0.9% saline (μg / L) and ultrasonic treatment The composition of the microflora of the root canal Onset of bactericidal effect (average) twenty 1000 Green Streptococcus Escherichia coli Bacteroids Epidermal staphylococcus 15-20 (17.5) 25 2000 Green streptococcus 8-12 (10) twenty 4000 No microflora growth 5-10 (9) fifteen 5000 No microflora growth 3-10 (6.5) 10 7000 No microflora growth 3-5 (4)

Example 1

Patient D. complained of constant aching pains in region 24, tooth decay, and impossibility of biting at 24. History 24 was previously treated, cantilever structure 26 was adjacent to the distal surface. On examination, swelling of the soft tissues of the cheek on the left in region 24 was determined, transitional smoothness folds in the area. On the vestibular surface of the cheek in area 24 fistulous passage, with serous discharge. Crown 24 is changed in color, a deep carious cavity, the cavity of the tooth is opened, probing of the opened cavity is painless, the reaction to temperature stimuli is painless, percussion 24 is painful. On palpation of the transitional fold, pain is determined. An X-ray examination determines the uniform expansion of the periodontal gap. The diagnosis was made: exacerbation of chronic fibrous periodontitis 24 and treatment was carried out, including trepanation measures, followed by filling the canals with osteostimulating paste (“Kalasept”), with the obligatory removal of the paste beyond the apical hole, and a gutta-percha pin was used as an additional obturator.

The treatment was as follows:

- ozone-ultrasonic treatment of the mucous membrane of the oral cavity with a jet-aerosol torch ozonized saline solution with an ozone concentration of 1500 μg / l;

- ultrasonic sanitation of periodontal pockets by voicing them through an intermediate ozonized physiological solution with a concentration of 1500 μg / l;

- evacuation of putrid masses from the root canal with a pulp extractor;

- removal of necrotic tissue and predentin with augers and rasps, with irrigation of ozonized physiological saline (endodontic syringe) with a concentration of 1500 μg / l;

- expansion of the apical third of the root canal and giving it a cone-shaped shape with files and rimers, with irrigation of an ozonized physiological solution with a concentration of 1500 μg / l;

- thorough washing of the root canal with turundas moistened with ozonized physiological saline to their purity with a solution concentration of 1500 μg / l;

- installation of turunda moistened in a solution with a concentration of 4000 μg / l, installation of a temporary seal;

- phonophoresis of tissues of the periapical region in the field of 11 and 12 with a course of 6 procedures;

- removal of a temporary filling, in the presence of clean turundum, we carry out drug treatment with ozonized saline;

- root canal filling in order to stop the entry of microorganisms, microbial toxins and pulp decay products from the root canal into the periodontal tissue;

- washing the oral cavity with ozonized physiological solution with a concentration of 1500 mg / l with all manipulations.

After the measures taken, the patient did not complain, the tooth actively takes part in the act of chewing, the mucous membrane is pale pink, without visible changes. After ozone-ultrasonic exposure, the fistulous course healed after the first visit.

Clinical and radiological control of the long-term results of the treatment of chronic apical destructive process was carried out in the period from 3 to 18 months.

After 3 months, the patient after treatment did not show complaints. The teeth were actively involved in the act of chewing, palpation and percussion examination of the changes did not reveal.

In the period from 3-6 months, favorable results were revealed in the form of almost complete restoration of the destruction focus.

When assessing the effectiveness of changes in the tissues of the periapical region, studying the immediate and long-term results, we came to the conclusion that the use of ultrasound in the complex treatment of chronic destructive periodontitis and periodontitis in the acute stage indicates its undoubted advantage over traditional treatment methods. As a result, the treatment time was reduced, the time of remission increased, the number of expensive drugs used, including antibiotics, the relative ease of use and the decrease in the amount of time allotted to one patient decreased, which allows to increase the number of visits and virtually no contraindications to this technique. Our treatment of patients with this safe, effective method allows us to consider it promising for outpatient practice.

Claims (1)

A method of treating patients with chronic forms of periodontitis or periodontitis in the acute stage, including irrigation of the oral cavity with ozonized saline solution with an ozone concentration of 1500 μg / l, opening of the tooth cavity, evacuation of the contents, tooth treatment after each stage of the canal treatment with irrigation with ozonized saline solution with an ozone concentration of 1500 μg / l, introduction of ozonized physiological saline with ozone concentration of 4000-6000 μg / l into the root canal on the turunda, installation of a temporary filling followed by m by its removal, root canal filling, characterized in that the oral cavity is also sanitized by ozone-ultrasonic treatment with a spray-aerosol torch of an ozonized physiological solution with an ozone concentration of 1500 μg / l, for 30-90 s, with an ultrasonic vibration frequency of 26.5 kHz, with an amplitude of oscillations of 50-80 microns, then ultrasonic sanitation of periodontal pockets through the same solution is carried out for 20-30 s, and after introducing turunda into the root canal and installing a temporary filling, it is carried out for 20-30 s daily about 5-8 procedures of phonophoresis of tissues of the periapical region through a technological pad with ozonized physiological saline with an ozone concentration of 1500 μg / l, with a frequency of ultrasonic vibrations of 26.5 kHz, and an amplitude of oscillations of 20-50 microns.