RU2491031C1 - Method of treating complicated intra-canal perforations of solid dental tissues - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to dentistry. Method includes processing perforated root canal and perforation zone with laser irradiation and covering perforation with sealing material. Introduction of light-guide into perforated root canal is carried out. In processing by laser irradiation translational increase of its power parameters is used. During the first session processing is carried out with power 0.5 W, during the second session - 0.75 W, during the third - 1.5 W. Additionally ozone therapy with saturated physiological solution is performed. Time of saturation with ozone is 5 minutes. Concentration of ozone dissolved in physiological solution is 8.8-9.6 mg/l.

EFFECT: method is painless, does not require carrying out local anesthesia, excludes allergic reactions, ensures optimal bactericidal and bacteriostatic effect, which makes it possible to efficiently stop inflammation and reconstruction of bone tissue, reduces number of complications.

1 ex

Description

With conservative treatment of tooth perforations, the key to successful therapy is a tight obstruction of the perforation defect. This is achieved by using various materials. However, the main problem in the treatment of this pathology is the risk of developing an inflammatory process in periodontal tissues due to the development of microbial invasion and destruction of the ligamentous apparatus of the tooth, which may lead to its loss [1]. In modern dentistry, close attention is paid to methods of closing a perforation defect directly, but the issue of antibacterial treatment of a perforation zone remains insufficiently covered [2]. Therefore, it is necessary to choose a method of root canal treatment and perforation that would not injure periodontal tissue and contribute to a quicker recovery.

The invention relates to medicine, and more particularly to dentistry, and is a method of treating perforations of teeth.

There is a method of treating periodontitis complicated by perforation of the bottom of the cavity of the tooth, when a preliminary single treatment of the perforation zone is carried out by the light of an erbium laser, followed by closing the perforation with an amalgam [3].

The disadvantage of this method is that the amalgam can cause staining of the hard tissues of the tooth and the phenomenon of galvanism; the method does not allow for further antibacterial treatment of a group of intracanal perforations having a large specific weight among all perforations. The method does not consider the use of a biologically inert irrigant for root canals having perforations. In the treatment of perforations complicated by resorptive changes in bone tissue, a single laser treatment procedure is insufficient.

There is also a method for the treatment of perforation of the bottom of the tooth cavity with a fibrous carbon sorbent treated with a 0.02% chlorhexidine solution and 1% ethonium solution [4].

The disadvantage of this method is that the method provides for drug treatment of carbon sorbent and does not consider the use of physical methods of exposure, such as laser and ozone, which can eliminate the sensitization of the body and the possibility of allergic reactions.

A known method of treating perforations of molars, when closing the perforation of the bottom of the tooth cavity is made with a polymer tape impregnated with a light-cured adhesive. The technique is used to close complicated and uncomplicated furcational perforations of molars [5].

The disadvantage of this method is that the drug treatment of the perforation defect itself is limited to a single treatment with a 3% hydrogen peroxide solution, which is insufficient to ensure a bactericidal effect. The method does not provide for the combined use of laser and ozone therapy, does not allow for antibacterial treatment of a group of intracanal perforations.

A known method of treating complicated perforations of hard tooth tissues with destructive changes in the furcation region of class I-II molars after perforation of the bottom of the tooth cavity, which involves pretreating the bottom of the tooth cavity with a semiconductor laser three times while maintaining a constant laser radiation power level and then closing the perforation defect with a sealing material. This method is taken as a prototype [6].

The disadvantage of this method is the impossibility of antibacterial treatment of a group of intracanal perforations, the method does not provide for the additional use of ozone therapy. When using this method, a semiconductor, rather than an erbium-chromium laser is applied, the power indices of which are higher; no progressive increase in power is used, which allows periodontal tissues to gradually adapt to laser exposure.

The aim of the invention is to increase the effectiveness of the treatment of complicated intracanal perforations of tooth hard tissues and reduce the number of complications.

This goal is achieved by the fact that during the treatment the fiber is introduced into the perforated root canal, the root canal and the perforation zone are treated with laser radiation, followed by progressive increase in the laser radiation power parameters: during the first treatment session, 0.5 W; in the second - 0.75 W, in the third - 1.5 W; in addition, ozone therapy with a saturated physiological solution of an ozone-oxygen mixture is used; ozone saturation time 5 minutes; the concentration of dissolved in physical. ozone solution 8.8-9.6 mg / L.

Comparison of the proposed method with other methods known in the field of medicine shows compliance with the criteria of the invention.

The method is as follows.

After the diagnosis of complicated intracanal perforation by clinical and radiological methods, the old fillings were removed, the necrotic tissues were dissected, the causal and, if necessary, other root canals were sealed, and then they were machined. We used the standard method of mechanical processing of root canals, which was carried out with the K-file, H-file using hand tools, using a combination of crown-down and step-back techniques; expansion - with Pro Taper mechanical rotary tools (Mallifer, Densply), combining with ultrasonic processing (Pyezon-Master 600 low-frequency ultrasound apparatus, endo chak 120 deg, ISO-25 sonars file). An RC-Prep preparation (Premier, USA) was used as a chelating agent. To carry out ozone therapy, we used the automatic ozonation therapeutic unit UOTA-60-01 "Medozon" (Russia). Using an ozonizer, the physiological solution was saturated with an ozone-oxygen mixture. Ozone saturation time was 5 minutes. The concentration of dissolved in physical. ozone solution ranged from 8.8 to 9.6 mg / L. The volume of the ozonized solution used for one ozone therapy procedure was 2-3 ml. Irrigation was carried out using an endodontic syringe jet. Laser therapy was carried out using a modern dental laser system "Waterlase MD" company Biolase (Germany) with a wavelength of 2780 nm. The parameters proposed by the author were used: power - at the first processing session 0.5 W; in the second - 0.75 W, in the third - 1.5 W; pulse duration - 140 μs, frequency - 40 Hz. Processing was carried out three times with an interval of 2-3 days. A pulsed laser mode was used. A quartz fiber Z-2 was used to process the root canals. When processing the root canals, the fiber length was set to 1.2 mm less than the measured working channel length. A fiber was introduced into the channel, the laser was activated, and holding it at an angle to the opposite wall, it was removed from the channel for 10 seconds. Turned off the laser at the exit from the mouth of the channel. The procedure was performed 3 times, each time changing the direction of exposure. Each session was held at the next visit, accompanied by ozone therapy, the interval between visits is 2-3 days. As a sealing material used the drug "Trioxident" company "VladMiVa" (Russia). In between visits, a paste based on calcium hydroxide (Calasept, Metapasta) was introduced into the root canal. The tooth was covered with a bandage made of glass ionomer cement GC Fuyi IX (made in Japan). The final restoration or prosthetics were carried out on subsequent visits.

The proposed method is painless, does not require local anesthesia, has a high antibacterial effect, eliminates allergic reactions from the patient, effectively relieves inflammation, provides bone tissue repair, and also reduces the number of immediate and long-term complications of the treatment of intracanal perforations of hard tissues of the tooth.

Using the above method, the treatment of complicated intracanal perforations was performed in 24 patients. Among them, immediate complications in the form of pain when biting on a causative tooth were observed in 5 cases. The pains were stopped during the treatment within 3-4 days. A remote complication in the form of an increase in the resorption site was observed in 1 case, which was associated with the progression of periodontal diseases.

Example. Patient U., 29 years old, complained of a cavity in the tooth 3.6. From the anamnesis it was revealed that the tooth was treated for pulpitis more than 10 years ago. Objective examination: the mucous membrane of the transitional fold and alveolar bone around the tooth 3.6 pale pink, with no signs of inflammation. The crown of the tooth is destroyed by ¾. On the chewing surface - filling with signs of violation of the marginal fit. On the chewing-distal surface there is a deep carious cavity of medium size. Change in color of the crown of the tooth 3.6. gives reason to believe that treatment with the resorcinol-formalin method was previously performed. Tooth percussion 3.6 is sensitive. On the roentgenogram: the root canals are obtuated unsatisfactorily, in the middle third of the medial root, the presence of perforation is determined, complicated by a bone resorption site with a diameter of 0.4 mm; in the periapical zone, an extension of the periodontal gap to 1 mm. Diagnosed with chronic fibrous periodontitis, single complicated intracanal perforation of the tooth 3.6.

Treatment. After removal of the filling, the modified tooth tissues were prepared, and all three root canals were filled. The treatment was carried out in compliance with modern protocols of endodontic interventions. When filling, the presence of perforation in the middle third of the medial lingual root was revealed. Root canals expanded to 035 ISO size. We performed revision and machining of the punching stroke up to 025 ISO size. Then the root canals and the perforation course were processed by low-frequency ultrasound using the Pyezon-Master 600 apparatus, endochak 120 degrees, file sonar 25 according to ISO. Irrigation was carried out with ozonized saline in a volume of 2 ml jet using an endodontic syringe. For ozone therapy, an automatic ozonation therapeutic unit UOTA-60-01 "Medozon" (Russia) was used. Using an ozonizer, the physiological solution was saturated with an ozone-oxygen mixture. Ozone saturation time was 5 minutes. The concentration of dissolved in physical. ozone solution ranged from 8.8 to 9.6 mg / L. Then, laser therapy was performed using the Waterlase MD dental laser system from Biolase (Germany) with a wavelength of 2780 nm. A quartz fiber Z-2 was used to process the root canals. When processing the root canals, the fiber length was set to 1.2 mm less than the measured working channel length. A fiber was introduced into the channel, the laser was activated, and holding it at an angle to the opposite wall, it was removed from the channel for 10 seconds. Turned off the laser at the exit from the mouth of the channel. The procedure was performed 3 times, each time changing the direction of exposure. The preset radiation power during the first processing session was 0.5 W; in the second - 0.75 watts, in the third - 1.5 watts. A pulsed laser mode was used. Each session was held at the next visit, accompanied by ozone therapy, the interval between visits is 2-3 days. Between visits, a paste based on calcium hydroxide “Metapasta” was introduced into the root canals under a bandage. The patient was invited to follow-up examinations after 1 week, 3 months, 6 months, 1 year, 2 years.

At repeated examinations: on the second visit, the patient complained of minor pain when biting on a tooth 3.6, in the third and subsequent visits there were no complaints. The mucous membrane around the tooth 3.6 is pale pink in color, with no signs of inflammation. Tooth percussion 3.6 is slightly positive on the second visit. On the third visit, the perforation defect was closed with the Trioxident drug of the VladMiVa company (Russia), and a constant obstruction of the root canals was performed with control radiography. In subsequent visits, preparation of the root canals was carried out for the tab, prosthetics with the tab and artificial crown. On control radiographs after 6 months, 1 year, 2 years, periodontal changes in the apical zone and in the area of the perforation defect decreased.

The proposed technique can be used to treat complicated intracanal perforations of hard tooth tissues during primary and repeated endodontic treatment in dental institutions of an outpatient unit.

INFORMATION SOURCES

1. Borovsky EV, Zhokhov N.S. Endodontic treatment. Manual for doctors. - M, 1997 .-- 64 p.

2. Khomenko L.A., Bidenko N.V. Practical endodontics. Tools, materials and methods. - M .: Book plus, 2002 .-- 216 p.

3. Pomoynitsky V.G. The method of closing the perforation of the bottom of the tooth cavity. - A.S. No. 1731221 / A61C 5/00. - Bull. Fig. No. 17 dated 05/07/1992.

4. Serebrennikova E.V., Timofeev V.N. A method for the treatment of periodontitis complicated by perforation of the bottom of the tooth cavity. - Patent RU No. 2238119 / A61N 5/067 /. - Bull. fig. from 10.20.2004. - application number 2002131723/14.

5. Kukushkin V.L., Kukushkina E.A., Smirnitskaya M.V. A method for the treatment of furcational perforations of molars. - RF patent No. 2345732 of 02/10/2009, priority of the invention of 06/13/2007.

6. Gerasimova L.P., Sorokin A.P. A method of treating teeth with destructive changes in the furcation region of molars of the I-II class after perforation of the bottom of the tooth cavity. - RF patent No. 2393850 07/10/2010, priority of the invention from 12/30/2008.

Claims (1)

A method of treating complicated intracanal perforations of hard tooth tissues by triple processing the perforated root canal and the perforation zone with laser radiation and then closing the perforation with a sealing material, characterized in that during the treatment the fiber is inserted into the perforated root canal, the root canal and the perforation zone are treated with laser radiation subsequent progressive increase in laser radiation power parameters: during the first processing session 0.5 W, during the second m - 0.75 W, at the third - 1.5 W; in addition, ozone therapy with a saturated physiological solution of an ozone-oxygen mixture is used; ozone saturation time 5 min; the concentration of ozone dissolved in physiological solution is 8.8–9.6 mg / l.