RU2416373C1 - Method of treating chronic periodontitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine and is intended for treatment of destructive forms of periodontitis in periapical area. Disease is detected in the process of examination, clinical and radiological examination of teeth. Carried out are removal of old filling, mechanical and drug processing of dental cavity with solutions of antiseptics, chemical-mechanical canal processing, unfilling of canals. After that, tooth is closed with temporary filling with preparation "Cresophene" in root canal for 2 days. During the second visit as medication into periapical area introduced is "Bioimplant" together with gel "Collagen" in ratio 1:1, in total dose 0.05-0.1 g. A month after the second visit, the third visit takes place, during which after radiological control in case of necessity into periapical area re-introduced is "Bioimplant" together with gel "Collapan" and permanent canal filling is performed. Regular medical check-up is carried out during 2 years.

EFFECT: method makes it possible to stop inflammatory process in periapical area, restore periodontium functions, to reduce treatment terms.

3 dwg, 2 ex

Description

The invention relates to medicine, namely to dentistry and is intended for the treatment of destructive forms of periodontitis.

The problem of treating various forms of periodontitis is one of the urgent in practical dentistry. In the structure of the dental incidence of periodontitis and near-root jaw cysts in the adult population of Russia, they still occupy third place after tooth decay and pulpitis (Ivanov A.S. et al.). This is due to the high percentage of poorly sealed root canal, which dramatically reduces the favorable outcomes of treatment of complicated caries.

Surgical methods for treating periodontitis (tooth-preserving operations) are known, such as resection of the apex of the tooth root, hemisection of the tooth root, amputation of the tooth root, in which part of the tooth root or one of the root of the large molar involved in the pathological process is removed. However, the disadvantage of these operations may be the need for re-intervention, in the long term after the operation, functional disorders of the periodontal tissues of the operated teeth may occur, periodontal resistance to chewing load can be significantly reduced when one of the roots or part of the tooth root is removed.

A number of methods are known for the treatment of destructive forms of chronic periodontitis, which include the preparation of bactericidal, bacteriostatic and osteostimulating properties after mechanical and drug treatment of the horse canals.

A known method of treating periodontitis [patent RU 2216303, 2003], which includes introducing into the periodontium a mixture of an antibiotic (Cefazolin Sodium), an immunomodulating drug Viferon and a corticosteroid Dexamethasone. The disadvantage of this method is the use of the hormonal (glucocorticosteroid) drug Dexamethasone, its general and local effects are well known (the immunosuppressive effect is the total result of the suppression of different stages of immunogenesis, the development of connective tissue is inhibited, the number of mast cells that are the site of hyaluronic acid formation is reduced; the activity of hyaluronidase is suppressed; under the influence of glucocorticosteroids, synthesis is delayed and the breakdown of proteins is accelerated).

The prototype of the invention is a method for the treatment of periodontitis [RU 2316285, 2008], including instrumental treatment of the canals, treatment with an antiseptic solution in combination with ultrasound treatment, temporary placement in the root canals of the drug containing the Septomixine antibiotic under temporary filling. After a week, the filling is removed, the root canals are treated with medication, Calasept paste is introduced, and the tooth is temporarily filled with glass ionomer cement. Then, every 2-5 weeks, the used preparation is replaced. The disadvantages of this method are the long-term treatment due to the frequent replacement of the drug (because the material "Calasept" resolves in a short time).

EFFECT: relief of the inflammatory process in the periapical region, restoration of periodontal function, reduction of treatment time.

The proposed method is as follows.

1. Identification of the disease during examination, clinical and radiological examination of teeth.

2. Remove the old fillings, mechanically and medically treat the tooth cavity with antiseptic solutions.

3. Carry out the chemical-mechanical processing of the channel, filling the channels. Closing a tooth with a temporary filling with the Krezofen preparation in the root canal for 2 days.

4. The second visit is carried out: removal of a temporary filling, the introduction of the preparation “Bioimplant” into the periapical region together with the preparation “Collapan” (gel) in a 1: 1 mixture, in a total dose of 0.05-0.1 g (depending on volume lesions) using endodontic instruments. The drug "Bioimplant" (Registration certificate: No. 29 (02.13.02.01) 1941-01 dated 05.22.2001) - osteoconductive and osteoinductive biomaterial based on hydroxyapatite, bone collagen and sulfated glycosaminoglycans. “Kollapan” gel (Registration number: 29/13060602 / 4438-02, 29/13091001 / 4437-02. Manufacturer: LLC Intermedapatit, Moscow) - composition: artificial hydroxyapatite, collagen, Lincomycin hydrochloride. The combined use of these drugs gives a more pronounced therapeutic effect.

5. In the third visit, a month later, X-ray control is carried out, if necessary, re-administration of drugs.

6. Canal filling is carried out according to generally accepted methods.

7. Restoration of the crown of the tooth.

8. Control radiography after 5 months, 1 year.

9. Clinical observation for 2 years.

The proposed method is illustrated by the following figures: figure 1 (RVG) shows a 4.6 tooth with destructive changes in the region of the medial root. Figure 2 - control shot 5 months after treatment. Figure 3 is a control image after a year of tooth 4.6, in the aiming image - restoration in the periapical region of bone tissue in the region of the medial root of the tooth 4.6.

Example 1. Patient K. December 24, 2007 turned in the direction of S.P. No. 1 for consultation on tooth extraction 4.6 (Fig. 1), at the request of the patient, therapeutic measures were taken to preserve tooth 4.6. In the process of examination and diagnosis, the following was revealed: 4.6 tooth was previously treated for complicated caries by the resorcinol-formalin method, in the picture 4.6 tooth with destructive changes in the region of the medial root there is a resorption of the medial root, percussion is positive.

First visit: removal of an old filling, mechanical and drug treatment of the tooth cavity with 3% hydrogen peroxide solution, 0.05% miramistin solution. Chemical-mechanical treatment of the canal, filling of the canals, closing the tooth with a temporary filling with the Krezofen preparation in the root canal for 2 days.

On the second visit (December 26, 2007): removal of a temporary filling, introduction of the preparation “Bioimplant” into the periapical region of the lesion site together with “Collapan” in a 1: 1 mixture, in a total dose of 0.05 - 0.1 g with endodontic tools.

Third visit (01/30/2008): X-ray control, temporary filling removed, canal filling with Endo Rez material, the crown part of the tooth was restored according to generally accepted methods.

Control examination after 5 months with a control RVG (Figure 2).

A follow-up examination after a year, on the sighting image - restoration in the periapical region of bone tissue in the area of the medial root of the tooth 4.6 (Figure 3).

Example 2. Patient A. on January 28, 2008, complained of swelling of the gums (in the area of the tooth 4.6), soreness when chewing, from the anamnesis - the periodic appearance of the fistulous passage with purulent discharge (for several years). In the process of examination and diagnosis revealed: 4.6 tooth previously treated for complicated caries, in the picture 4.6 tooth with destructive changes in the apical region of the medial and distal roots, the channels are not sealed throughout, percussion is positive.

First visit: removal of an old filling, mechanical and drug treatment of the tooth cavity with 3% hydrogen peroxide solution, 0.05% miramistin solution. Chemical-mechanical treatment of the canal, filling of the canals, closing the tooth with a temporary filling with the Krezofen preparation in the root canal for 2 days.

The second visit (January 30, 2008): removal of a temporary filling, introduction of the preparation “Bioimplant” into the periapical region of the lesion site together with “Collapan” in a 1: 1 mixture, in a total dose of 0.05-0.1 g using endodontic tools.

Third visit (1.02.2008): X-ray control, temporary filling removed, repeated administration of the “Bioimplant” preparation together with “Kollapan” in the periapical region in a 1: 1 mixture, in a total dose of 0.05 g, filling the channels with “Endo” material Rez ”, the crown of the tooth was restored according to generally accepted methods.

A follow-up examination after a year, on an aiming image - restoration in the periapical region of bone tissue in the area of the roots of the tooth 4.6.

Claims (2)

1. A method of treating destructive forms of periodontitis, including instrumental treatment, antiseptic treatment, closing with a temporary filling with a drug, followed by permanent filling of the canal, characterized in that the tooth is closed with a temporary filling with Krezofen in the root canal for 2 days, the second visit, “Bioimplant” is introduced into the periapical region together with the “Kollapan” gel in a ratio of 1: 1, in a total dose of 0.05-0.1 g, one month after the second visit oestriasis third visit, on which is carried a constant filling channel. 2. The method according to claim 1, characterized in that on the third visit after x-ray control, if necessary, “Bioimplant” is reintroduced into the periapical region together with the “Kollapan” gel.

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