RU2402362C1 - Method of endodontic treatment of teeth with cronical forms of pulpitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to dentistry and is intended for preparation of root canals to filling. Mechanical and drug treatment of root canal and its drying are carried out. After that session of canal scanning with laser ray is carried out for 5-25 sec each session, stopping 1-1.5 mm from root apex. After that laser is activated and circular movement with light guide is performed inside canal, gradually moving it out of canal. At the outlet of canal laser is turned off. Irradiation of canal is performed from 3 to 5 times with interval between sessions 0.5-5.0 minutes. Laser with length of irradiated wave 1.04 micron and power in pulse mode of operation equal to 0.6-1.1 W is chosen.

EFFECT: method allows to process systems of root canals, increase treatment quality, reduce probability of post-operational complications.

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Description

The invention relates to medicine, namely to radiation therapy using laser radiation, and can be used in dentistry, for example, in preparation for filling the root canals of the teeth in chronic forms of pulpitis.

A known method of preparing tooth channels for filling (see, for example, RF patent No. 2240847 with a priority of 08/18/2003, IPC: A61N 5/067), including expanding the channel, introducing a 56M concentration of the photosensitizer into the channel and treating the channel with a diode beam a laser with a power of 0.5-1.0 W and a wavelength of 662 nm for 5-6 minutes, with the first processing of the apical zone, then the middle part of the channel, after which these steps are repeated and sterilization is completed by irradiation of the channel mouth.

The known method provides the possibility of sterilization of the root canals, however, due to the use of photosensitizers, its use is not indicated for persons prone to allergies (see, for example, http // www / fotoditazin.ru / main / fotoditazin).

The closest analogue to the prototype is the method of root canal treatment using a diode laser (see, for example, Butaeva N.T., Makeeva I.M. and Turkina A.Yu. “Antiseptic treatment of root canals using a diode laser”, Dentistry for all, 2008, No. 2, pp. 60-63), including opening the tooth cavity and determining the working length of the canal, machining the canal with hand or rotary tools to at least ISO size 030 using endolubrient and 3% sodium hypochlorite solution, canal irrigation first 3% sodium hypochlorite solution, and then with distilled water and drying the canal with pins, followed by laser treatment of the root canal. In this case, the fiber length is chosen 1 mm less than the working channel length, the fiber is inserted into the root canal to the maximum depth, the laser is activated and the canal walls are machined, making spiral-like movements from the apical opening to the canal mouth for 20 s, after which the root channel by lateral condensation of cold gutta-percha in combination with AN Plus sealant.

This method provides the possibility of treating pulpitis, however, in a number of cases of its use, there were complications, as well as the appearance of root dentin microcracks, burns and necrosis of periodontal tissues in the periapical region, which, in our opinion, indicates the need to refine this technique.

The objective of the invention is to develop a method that enables the effective treatment of pulpitis of chronic forms.

The essence of the invention lies in the fact that in the method of endodontic treatment of teeth with chronic forms of pulpitis, based on the processing of the root canals, first mechanical and drug treatment of the root canal and its drying are carried out, and then the channel is scanned with a laser beam that irradiates the canal for 5 -25 s in one session, while the laser fiber is introduced into the channel without bringing it to the root apex by 1-1.5 mm, after which the laser is activated, circular movement is carried out inside the channel by the fiber, gradually but it is removed from the channel and the laser is turned off at the channel exit, and the channel is irradiated from 3 to 5 times with an interval between sessions of 0.5-5.0 minutes, and a laser with an emitted wavelength of 1.04 microns and s is selected power in pulsed operation, equal to 0.6-1.1 watts.

The technical result of using the proposed method is the effective treatment of the root canal system due to the sterilizing effect of laser irradiation and sealing of the walls of the dentinal tubules, which creates a barrier to the penetration of microorganisms into periodontium and periodontium, as well as improving the quality of treatment and, as one of the consequences of this quality improvement, reducing the likelihood postoperative complications.

The implementation of the proposed method for endodontic treatment of teeth with chronic forms of pulpitis is as follows.

When examined with an IVD-01 PulpTest-Pro electrodontometer apparatus (see, for example, http://www.aldera.ru/show_items.php), sensitivity measurements of the nerve endings of the pulp are made to distinguish the degree of pulp damage (see, e.g. http://www.averon.ru/dental).

Using endodontic instruments (see, for example, http://www.bing.com/search?), Root canals are machined to a size of 035 according to ISO and they are cleaned of pulp and soft dentin residues, then drug treatment using 3% sodium hypochlorite (NaClO) solution to dissolve the pulp residues and the organic part of the lubricated layer, followed by washing with distilled water and drying with pins. Using, for example, the BINGO 1020 apex locator (see, for example, http: // www. 8a..ru / firms / b766.php) or measure the channel length radiologically and select a working one 1.2-1.5 mm less than the measured one the length of the laser introduced into the channel of the fiber, for example, the Lami semiconductor laser apparatus (see, for example, http://www.laser.dentarus.ru/) with a wavelength of 1040 ± 10 μm and a power of up to 5 Tue The fiber thickness of the fiber is chosen equal to 150 microns.

Laser irradiation of the walls of the channel is carried out 3-5 sessions lasting from 5 to 25 seconds. During the session, the fiber is introduced into the pre-processed channel to the working length, the laser is activated, the radiation power level is set in the pulse mode from 0.6 to 1.1 W and the channel walls are irradiated circularly, processing the corresponding strip, while for complete processing the channel is scanned ( gradually move) the radiating tip of the fiber from the apical opening to the mouth of the channel with a pitch of about 100 microns. After removing the fiber from the mouth of the channel, the laser is turned off, a pause of 30 seconds to 5 minutes is made depending on the patient's condition, and then the session of irradiation of the channel walls is repeated. The duration of each session and their number, as well as the set laser radiation power, are determined taking into account the degree of pulp damage and the patient's response to the procedure.

The inventive method has been tested in the treatment of 34 teeth with chronic pulpitis in 33 patients.

Subsequent clinical and radiological observation was carried out for 3-12 months.

No changes in periapical tissues were detected. There are no complaints about the results of treatment.

The invention is supported by examples.

Example 1

Patient G., 46 years old.

He complained of aching pains in the lower left molar (tooth 37), arising during the intake of hot food and lasting 2-3 hours after eating.

Six months ago, the tooth was filled, after which after a while the patient began to feel discomfort while chewing food, but after 20-30 minutes the pain passed.

On examination, a deep carious cavity, gray enamel, the pulp is slightly painful, bleeds when probed.

Electric Pulp Excitability (EOM) 65-80 μA.

Diagnosis: chronic ulcerative pulpitis of the tooth 37.

Conducted treatment.

A carious cavity of the tooth was prepared under infiltration anesthesia. After extirpation of the pulp, mechanical processing and expansion of the canals with endodontic files up to ISO size 035 were carried out, which were first washed with sodium hypochlorite solution, and then with distilled water and dried with pins.

Using the apex locator BINGO 1020, the working length of the tooth was determined. Radiologically determined the length of the channels.

Then, alternately introducing a fiber with a fiber thickness of 150 μm and connected to the laser of the Lami equipment into the channels during the first session up to 1.5 mm to the apex, the laser was turned on (activated) and, turning the fiber head around the circle, and then sequentially moving 100-120 μm fiber to the mouth of the corresponding channel, the walls of the channels were irradiated, and when the fiber exited the channel, the laser was turned off (its radiation was interrupted). In the second and third sessions, the fiber was introduced at a distance of 1-1.2 mm to the apex and the procedure was repeated. The preset radiation power during the first session was 0.6 W, and during the next sessions, due to the patient’s calm reaction, it was increased to 1.1 W.

The time of the first session was 20 s per channel, the second and third sessions - 25 s per channel, the interval between channel processing during one session was approximately 0.5 minutes, and the interval between sessions was 5 minutes between the first and second and about 3 minutes between the second and third sessions.

After carrying out the above procedures, the canals were sealed with cold gutta-percha by lateral condensation with the sealer AN-Plus (Dentsply) until the physiological narrowing at the apex of the tooth root. The filling was carried out under x-ray control.

Subsequent clinical and radiological follow-up, conducted within 9 months, no complaints were noted.

Example 2

Patient B., 36 years old.

When handling a complaint of paroxysmal pain in the lower right molar (tooth 46) that occurs when rinsing the mouth with cold water while brushing your teeth.

About a year before the treatment, the tooth ached, a carious cavity appeared, then paroxysmal pains began, intensifying at night. The patient treated the tooth with rinses, took painkillers, but did not go to the dentist, since he worked in the geological party and was on an expedition.

When sensing marked tenderness of the bottom of the carious cavity. Electric Pulp Excitability (EOM) 40-45 μA.

Diagnosis: chronic pulpitis of the tooth 46.

Conducted treatment.

A carious tooth cavity was prepared under infiltration anesthesia. After extirpation of the pulp, mechanical processing and expansion of the canals with endodontic files up to ISO size 035 were carried out, which were first washed with sodium hypochlorite solution, and then with distilled water and dried with pins.

Using the apex locator BINGO 1020, the working length of the tooth was determined. Then, alternately introducing a fiber with a fiber thickness of 150 μm and connected to the laser of the Lami equipment into the channels at the distance of up to 1.2 mm to the apex during the first session, the laser was turned on (activated) and, turning the fiber head around the circumference, and then sequentially moving 100-120 μm fiber to the mouth of the corresponding channel, the walls of the channels were irradiated, and when the fiber exited the channel, the laser was turned off (its radiation was interrupted). In the second, third and fourth sessions of irradiation, the fiber was introduced at a distance of 1 mm to the apex and the procedure was repeated. The preset radiation power during the first session was 0.6 W, during the next sessions it was increased to 1.0 W, and during the fourth session it was 1.1 W.

The time of the first session was 5 s per channel, the second and third sessions - 15 s per channel, the fourth session 25 s, the interval between channel processing during one session was approximately 1.5 minutes, and the interval between sessions was 5 minutes between the first and second, about 0.5 min between the second and third, and 3.5 min between the third and fourth sessions.

After carrying out the above procedures, the canals are sealed with cold gutta-percha by the lateral condensation method with sealer to physiological narrowing at the apex of the tooth root. The filling was carried out under x-ray control.

During the subsequent clinical and radiological follow-up performed during the year, no complaints were noted.

Example 3

Patient E., 60 years old.

When handling complaints about a defect in the upper right molar (tooth 16) and periodically appearing about a month ago aching pains. I have not consulted a doctor about this before.

Upon examination, a carious cavity was detected, the sounding was painless, a message was determined with the tooth cavity and the mouths of the root canals. On the x-ray marked rarefaction of bone tissue. The electroodontometry performed using the IVN-01 PulpTest-Pro apparatus determined the absence of pulp excitability (EOM 90-100 μA). Percussion is painless. However, there are no clinical symptoms characteristic of acute periodontitis.

Diagnosis: tooth pulp necrosis 16.

Conducted treatment.

A carious tooth cavity was prepared under infiltration anesthesia. Its working length is determined. After removal of the necrotic pulp, mechanical processing and expansion of the canals with endodontic files up to 035 ISO size was carried out. Irrigation of canals with sodium hypochlorite solution, and then with distilled water. Drying with paper pins.

Then, alternately introducing a fiber with a fiber thickness of 150 μm and connected to the laser of the Lami equipment into the channels during the first session up to 1.5 mm to the apex, the laser was turned on (activated) and, turning the fiber head around the circle, and then sequentially moving 100-120 μm fiber to the mouth of the corresponding channel, the walls of the channels were irradiated, and when the fiber exited the channel, the laser was turned off (its radiation was interrupted). In the second, third, fourth and fifth sessions of irradiation, the fiber was introduced at a distance of 1 mm to the apex and the procedure was repeated. The preset radiation power during the first and second sessions was 0.6 W, and during the next sessions it was increased to 1.0 W.

The time of the first session was 10 s per channel, the second and third sessions - 20 s per channel, the fourth and fifth sessions - 25 s, the interval between channel processing during one session was approximately 1.5 minutes, and the interval between sessions It was 5 minutes between the first and second, about 1.5 minutes between the second and third, and 3.0 minutes between the third, fourth and fifth sessions.

After carrying out the above procedures, the canals are sealed with cold gutta-percha by the lateral condensation method with sealer to physiological narrowing at the apex of the tooth root. The filling was carried out under x-ray control.

Subsequent clinical and radiological follow-up for 3 months after endodontic treatment no complaints.

Claims (1)

A method of endodontic treatment of teeth with chronic forms of pulpitis, based on root canal treatment, characterized in that the root canal is mechanically and medically treated and dried first, and then the channel is scanned with a laser beam that irradiates the canal for 5-25 s one session, while the laser fiber is introduced into the channel, without bringing it to the root apex by 1-1.5 mm, after which the laser is activated, circular motion is carried out inside the channel by the fiber, it is gradually output the laser is switched off from the channel and at the exit from the channel, and the irradiation sessions of the channel are carried out from 3 to 5 times with an interval between sessions of 0.5-5.0 min, and a laser with a emitted wavelength of 1.04 μm and pulse power is selected operating mode equal to 0.6-1.1 watts.