RU2481802C1 - Method of treating dental caries with application of ozone therapy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to therapeutic dentistry, and can be used in treatment of deep dental caries. For this purpose preparation of caries cavity with its further antiseptic processing with ozone-oxygen mixture possessing high bactericidal effect is carried out. Ozone concentration in mixture constitutes 30-40 mcg/ml. Processing is carried out for 25-40 seconds. After that, self-hardening radiopaque material, containing calcium hydroxide "Life" is used as medicinal padding and filling is performed.

EFFECT: method makes it possible to perform tooth filling during the first visit due to antiseptic processing not only on the surface of caries cavity, but in dentin tubes.

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Description

The invention relates to medicine, namely to therapeutic dentistry, and can be used to treat deep dental caries.

Untimely and poor-quality treatment of deep caries leads to infection and subsequent inflammation of the pulp of the teeth and its necrosis, and in the future to the development of periodontitis, which can lead to serious complications in the form of inflammatory processes in the maxillofacial region. The outcome of the treatment of deep caries depends not only on the quality of the preparation of the carious cavity, but also on the antiseptic treatment of the carious cavity and the properties of the treatment pad, which should have antiseptic and anti-inflammatory properties, as well as the ability to stimulate the production of replacement dentin by the pulp. Requirements for medical pads:

- Do not irritate the pulp of the tooth;

- have anti-inflammatory and reparative effects on the pulp;

- possess bactericidal and bactericidal action;

- have good adhesion;

- be plastic;

- withstand pressure after hardening [Kostromskaya NN, Glotova ON "Therapeutic and insulating pads in dentistry", M., Medical book, 2001, p.6].

An example of medical pads is zinc-eugenol, based on zinc oxide and eugenol. The disadvantages of these materials are: incompatibility with composite filling materials and they can cause allergies.

Calcium hydroxide-based treatment pads are most commonly used in therapeutic dentistry. Known hydrocalcium medical material "Calradent" (VladMiVa company), which is available as a paste as a liner for permanent fillings in the treatment of deep caries. The disadvantages of this material: poor adhesion, does not withstand pressure during hardening, in order to accelerate the hardening reaction (the reaction of calcium hydroxide with carbon dioxide) and drying the moisture requires air blowing pasta [Kostromskaya NN, Glotova ON. "Therapeutic and insulating pads in dentistry", M., Medical book, 2001, S. 22-23].

Closest to the claimed method of treating deep caries is the "Method of treating deep caries" [patent RU 2228164 C1].

To carry out this method of treatment, a 2% chitosan ascorbate gel with a deacetylation degree of 95% and a molecular weight of 100-120 kDa and zinc oxide in a ratio of 1: 2, which is a white amorphous paste that is unable to harden, are used as a medical pad. therefore, it is additionally coated with aqueous dentin. An additional stage of filling increases the labor costs and time of filling a tooth, which is a disadvantage of this treatment method. The disadvantage of this method of treatment should also include the use in the antiseptic treatment of the carious cavity of an aqueous solution of 0.06% chlorhexedine, which, as shown by antimicrobial tests, does not provide the necessary and sufficient antimicrobial effect on some types of strains [Elyutina S. V. Baysongurova D.A. . The bactericidal effect of ozone in the complex treatment of teeth with dentin caries in children in a removable bite "System analysis and control in biomedical systems", Volume 10, No. 1, M. 2011, S123-125].

The aim of the invention is: increasing the effectiveness of antiseptic treatment of the cavity, reducing the treatment time and steps in the treatment of deep caries, preventing relapse of caries. The task is achieved due to the fact that after the preparation of the cavity, the antiseptic treatment is carried out with an ozone-oxygen mixture with an ozone concentration of 30-40 μg / ml for 25-40 seconds and a self-hardening radiopaque material containing Life hydroxide is used as a medical pad. After applying the medical gasket, the latter is covered with filling material for permanent fillings.

Medical ozone is an ozone-oxygen mixture obtained from pure oxygen by its decomposition in a weak electric discharge or through ultraviolet radiation. In medicine, ozone is used in the form of an ozone-oxygen mixture in concentrations up to 40 μg per 1 ml of oxygen [Bezrukova IV, Petrukhina NB, Ozone therapy in periodontal practice. // M, Medical News Agency, 2008, p.19]. Ozone as a disinfectant has a significant advantage over other disinfectants [Antimicrobal efficacy of ozonated water, gaseous ozone, sodium hypochlorite and chlorhexidine in infected human root canals. / Estrela C, Estrela CRA, Decurcio DA, Hollanda ACB, Silva JA. Int endod. J. 2007; 40: 85-93], because: ozone is a powerful disinfectant that has an antimicrobial effect on 99.9% of known pathogenic microorganisms;

- ozone is very active and reactions with ozone occur faster than reactions with liquid antiseptic agents;

- ozone penetrates well into nanostructures, since its molecule is on average 150% smaller than the molecules of liquid disinfectants used;

- bacteria, viruses and fungi lack resistance to ozone;

- in permissible concentrations, it does not have a damaging effect on healthy body tissues, including periapical tissues and the oral mucosa;

- There are no allergic reactions to ozone.

From the comparative microbiological tests during the antiseptic treatment of the carious cavities of the teeth with an aqueous solution of chlorhexedine and an ozone-oxygen mixture, it can be seen that the antimicrobial effectiveness of ozone is several times higher than that of an aqueous solution of chlorhexedine [Elyutina S.V. Baysongurova D.A. The bactericidal effect of ozone in the treatment of teeth with dentin caries in children in a removable bite "System analysis and control in biomedical systems", Volume 10, No. 1, M., 2011, C 123-125].

The self-hardening medical hydro-calcium gasket “Life” (Kerr company) meets the high requirements for medical gaskets and is recommended for direct and indirect coating of tooth pulp and as a cement base for all filling materials, including amalgam. When placed in the Life cavity, it is well modeled and well set.

Advantages of the Life medical pad:

- promotes the formation of secondary dentin;

- excellent ductility characteristics;

- supports the viability of the pulp when it is exposed;

- high resistance to rapid increase in pressure;

- isolation of the pulp from thermal shock;

- does not inhibit the polymerization of composite restorations;

- resistant to acid etching;

- protects the pulp from the allocation of monomers from permanent fillings;

- has a bactericidal and bactericidal effect;

- radiopaque. [Kostromskaya N.N., Glotova O.N. "Therapeutic and insulating pads in dentistry", M., Medical book, 2001, S. 27-28].

The odontotropic effect of the “Life” medical pad is provided by the content of calcium ions in its composition.

The proposed method for the treatment of deep caries is as follows: carry out the preparation of the carious cavity. After the preparation of the cavity, an antiseptic treatment is carried out with its ozone-oxygen mixture with an ozone concentration of 30-40 μg / ml using the PROZON apparatus for 25-40 seconds. At the bottom of the cavity impose a curative gasket "Life". Next, the medical gasket is covered with an insulating gasket made of glass ionomer cement and a permanent seal is applied.

The treatment proposed method was 36 people (16 men and 20 women) aged 18 to 62 years and 9 children aged 5 to 11 years. A total of 49 teeth were diagnosed with a diagnosis of deep caries. Using the proposed method for the treatment of deep caries in chronic and acute forms of deep caries allowed filling the teeth in the first visit. The near and long-term results showed high therapeutic efficacy of the proposed method for the treatment of deep caries. Observations of changes in the state of dentin and the electrical excitability of the pulp of the teeth were carried out in the period from 2 to 24 months.

The electrical excitation of the pulp as a result of treatment of chronic forms of deep caries remained unchanged at 2 μA. The normal state of dentin and dental pulp was established within 22-24 days. Control X-ray photographs after 12-16 months showed the odontotropic effect of the Life dental material on the pulp of the tooth, resulting in deposition of a layer of replacement dentin at the bottom of the carious cavity, which was observed in the x-ray.

We conducted microbiological studies in the process of comparative clinical treatment of the claimed method in comparison with the well-known on the basis of the Clinical Dental Clinic VHMA. Teeth with dentin caries were studied in 8 patients (4 men and 4 women) aged 18 to 62 years old (group 1). After the preparation of the carious cavity, a drug treatment of the cavity with chlorhexedine 0.06% was carried out. Then a sterile boron was taken and the cavity was dissected again. Boron was placed in a sterile tube. After that, the cavity was treated with an ozone-oxygen mixture with an ozone concentration of 30–40 μg / ml using the PROZON apparatus for 25–40 seconds, after which the cavity was again prepared with sterile boron and the boron was placed in another labeled tube. For two hours, the tubes were delivered to the laboratory for inoculation on a nutrient medium, and the burs were additionally placed in a glucose broth, which, after turbidity, was seeded on a nutrient medium. The composition and degree of growth was recorded in special table 1

Table 1 shows that the examination revealed four types of microorganisms - Streptococcus sanquis. Streptococcus mutans (strain 1), Cloctridium spp. and Staf.saprophytic. After preparation of the carious cavities and drug treatment of them with a 0.06% chlorhexedine solution, in 25% of cases, the sowing of these microorganisms did not produce growth. After processing the same cavities with an ozone-oxygen mixture, the growth of the same microorganisms did not produce in 87.5% of cases. Studies show that the antiseptic ability of the ozone-oxygen mixture is more than 3 times higher than chlorhexedine.

Thus, the use of an ozone-oxygen mixture for antiseptic treatment of cavities in dentin caries allows for antiseptic treatment not only on the surface of the carious cavity, but also in the dentinal tubes, which in turn helps to reduce the recurrence of caries.

EXAMPLE 1. Patient L., 30 years old. Diagnosis: deep caries of 16 teeth was made on the basis of complaints, medical history, objective data and an indicator of pulmonary excitability equal to 10 μA. On the aiming x-ray of the tooth 16, made by medium hardness rays, a focus of enlightenment is visible, which corresponds to the carious cavity. The carious cavity is not connected to the pulp chamber, but is located in

close proximity to the horn of pulp. There are no changes in periodontal tissues. Carious cavity was prepared. After the preparation of the cavity, the antiseptic treatment was carried out with an ozone-oxygen mixture with an ozone concentration of 30-40 μg / ml using the PROZON apparatus for 25-40 seconds.

At the bottom of the cavity, a “Life” medical pad was applied with the Kerr applicator. Next, the treatment pad was coated with an insulating pad of Ionoseal light-curing glass ionomer cement, polymerized using a halogen lamp for 20 seconds. Cement Ionoseal releases fluoride ions, which prevent the development of secondary caries [Kostromskaya NN, Glotova ON "Therapeutic and insulating pads in dentistry", M., Medical book, 2001, with 64-65].

The cavity was etched with etching gel. An adhesive system was applied. The cavity was then sealed with a Charisma refill composite. Performed grinding, polishing. At the control reception after 22 days the patient did not show complaints, electroexcitation 2 μA. When viewed after a year on an aiming x-ray taken with medium hardness rays, the following was observed: a blackout focus, which corresponds to the filling material. A layer of replacement dentin is visible at the bottom of the horn of the pulp. There are no changes in periodontal tissues.

EXAMPLE 2. Patient O., 6 years old. Diagnosis: deep caries of 74 teeth was made on the basis of complaints, medical history, objective data and an indicator of pulmonary excitability equal to 10 μA. On the x-ray image of the tooth 74, made by medium hardness rays, a focus of enlightenment is visible, which corresponds to the carious cavity. The carious cavity is not connected to the pulp chamber, but is located in the immediate vicinity of the pulp horn. There are no changes in periodontal tissues. The follicular plate the rudiment of a permanent tooth is preserved throughout. Carious cavity was prepared. After the preparation of the cavity, the antiseptic treatment was carried out with an ozone-oxygen mixture with an ozone concentration of 30-40 μg / ml using the PROZON apparatus for 25-40 seconds. At the bottom of the cavity, a “Life” medical pad was applied with the Kerr applicator. Next, the treatment pad was coated with an insulating pad of Ionoseal light-curing glass ionomer cement, polymerized using a halogen lamp for 20 seconds. Put seal Fuji IX. At the control reception after 22 days the patient did not show complaints, electroexcitation 2 μA. During the examination after 6 months, the tooth seal 74 is airtight, there is no trace of secondary caries. When viewed after a year on a targeted x-ray taken with medium hardness rays, a dimming center was observed, which corresponds to the filling material. A layer of replacement dentin is visible at the bottom of the horn of the pulp. There are no changes in periodontal tissues.

Thus, the use of the proposed method in the treatment of deep caries with the use of an antiseptic treatment of the tooth cavity with an ozone-oxygen mixture and the use of the “Life” medical pad provide along with a high bactericidal effect in the antiseptic treatment of the tooth and odontotropic effect, resulting in deposition of replacement dentin at the bottom of the carious cavity . The use of the proposed method in the treatment of deep caries contributes to the rapid elimination of inflammation in the pulp, the cessation of its infection and reduce the time and stages of treatment.

Claims (1)

A method of treating deep tooth decay by preparing a carious cavity, its antiseptic treatment, filling, characterized in that after preparing a carious cavity, it is carried out antiseptically with an ozone-oxygen mixture having a high bactericidal effect, with an ozone concentration of 30-40 μg / ml for 25-40 with and as a medical pad use self-hardening radiopaque material containing calcium hydroxide "Life".