RU2525702C2 - Method of treating destructive forms of chronic apical periodontites - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, in particular to dentistry, and can be used for treatment of destructive forms of chronic periodontites of single-rooted and multi-rooted teeth. An access to the area of periodontitis is formed. Laser irradiation is carried out by passing the laser lightguide into the periapical space to the area of periodontitis in a pulse-periodic mode. The wavelength is 980 nm, irradiation is carried out for 30-60 s with reciprocating movements of the lightguide and laser radiation power 0.5-0.9 W. After 3-5 days additional irradiation of the periapical space of the periodontitis area by radiation of a low-intensity laser with the wavelength 66 nm, power 200 mW is performed also in a pulse-periodic mode for 2 min.

EFFECT: method makes it possible to accelerate regeneration of the bone tissue due to expressed anti-inflammatory, bacteriostatic, bactericidal and reparation-stimulating effects, stable remission is achieved due to local immunomodulating impact, reduction of destructive changes in the periapical tissues, increase of density and homogeneity of the bone tissue.

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Description

The claimed invention relates to medicine, namely to dentistry, and can be used in the treatment of chronic periodontitis, namely in the treatment of destructive forms of chronic apical periodontitis of single-rooted and multi-rooted teeth.

A known method of treating chronic apical periodontitis [Ivanov B.C., Ovrutsky GD, Gemonov V.V. Practical endodontics. - M.: Medicine. - 1984. - p.114-131], the essence of which is that a carious cavity is sequentially prepared, the tooth cavity is opened, access to the root canals is expanded, their mouths are expanded, the length of the root canal is determined, and mechanical cleaning is carried out with appropriate endodontic instruments, medically treat the root canal with antimicrobial and anti-inflammatory drugs (with antibiotics and derivatives of glucocorticoids), as well as remineralizing drugs (with oxide or calcium hydroxide tion), and finally, seal up the root canal.

The main disadvantage of this method is that the recovery effect of the periapical bone is based only on the alkalizing effect of preparations with calcium oxide and hydroxide in relation to the tissues surrounding the top of the tooth. However, the remineralizing effect in the zone of periapical destruction is not effective enough, since the material is brought only to the apex of the root and the apical transition of calcium cations is carried out only slightly. In addition, there is absolutely no local support for the processes of reparative osteogenesis with protein plastic components.

There is a method of treating chronic destructive apical periodontitis of the teeth, which consists in the fact that they use a combination of solcoserylagel and granules of porous hydroxyapatite ceramics of varying degrees of dispersion, while the ratio of ingredients in the composition depends on the stage of development of the regenerative process [patent RU 2149626, 2000] .

A known method of treatment for exacerbation of chronic periodontitis [patent RU 2268679, 2006], including exacerbation of destructive forms of chronic apical periodontitis, which consists in the fact that at the first stage of treatment anesthesia is performed, a cavity is prepared, the cavity of the tooth is opened, access is created to the root canals, their mouths are expanded, the pulp decay is removed, the root canals are mechanically cleaned using appropriate endodontic instruments and the canals are washed with antiseptic solution E. Then, the apical opening of the tooth is widely opened, behind which the focus of periapical inflammation is located, mechanical (using endodontic instruments such as a rasp and root drill) is performed mechanically (using antiseptics and enzyme preparations) to treat pathological soft tissue formations in the focus of periapical inflammation in order to eliminate them. The tooth is left open to the outflow of exudate. After 3-5 days, additional instrumental and pharmacological treatment of the root canals and the apical focus is carried out, the root canals are dried and medical dressings are left in them with preparations with a pronounced antimicrobial and anti-inflammatory effect, such as Septomixine (Septodont) and Puloseptin "(Omega company), which contain antibiotics and glucocorticoid derivatives, after which the tooth is closed with a temporary filling. After another 5-7 days, a temporary filling and root medication dressings are removed, additional instrumental and pharmacological treatment of the root canals and the topical focus is performed, then the canals are dried and filled with medication dressings with calcium oxide or hydroxide preparations, as well as with iodoform, like Vitapex materials "(Diadent), Metapex and Metapasta (Meta). At the second stage of treatment, a temporary filling and root medicinal dressings are removed, and if the canals are dry and clean, then a finely fragmented demineralized lyophilized allocity is introduced into the top hole of the tooth, behind which the focus of periapical inflammation is located, after which all root canals and the carious cavity are filled the use of any filling material.

The main disadvantage of this method is that, despite the described properties of pulposeptin in practice (in vivo) under laboratory conditions (in vitro), it is proved that the severity of inflammation does not completely stop under conditions of provocation by a non-negative flora. Endotoxin prolongation is recorded from 10-30 days, i.e. tissue detoxification is almost blocked. Complicated forms of caries are reflected in the imbalance of the immune responses of the organism as a whole. The longer and running the process, the more tangible the shift. According to literature data, the absence of the effect of pulposeptin on the protective reactions of the body is described, which requires immunomodulating correction.

There is a method of treating apical periodontitis, which consists in opening the tooth cavity, machining the root canals and medically using a 5% solution of metronidazole, after which, in the treatment of two or more visits to the root canals, turunda moistened with a polyoxidonium solution prepared by extempore under the blindfold, then the mouths of the canals were closed with sandarak plus in the form of a temporary seal (Journal Dentist. Scientific and practical journal. Non-commercial partnership Publishing House Pros broadcasting. ”Moscow. 2008, 7, S.16-20). The authors studied the possibility of using polyoxidonium as a drug with detoxifying properties in the complex treatment of acute inflammation in periodontal disease. The introduction of polyoxidonium with the help of turunda due to the hygroscopicity of cotton wool does not release the active substance of interferon and its ingress into the top space of the periodontium, provoking the accumulation of exudate at the apex of the tooth root, i.e. treatment is ineffective.

A method is also known in which, in the treatment of root canal preparation, ultrasound-activated aqueous sodium hypochlorite solution and a 17% sodium ethyleneiminetetracetate solution are used, then local antibacterial therapy is carried out by introducing a mixture of equal parts by weight of metronidazole, ciprofloxacin and minocycline into the root canals, and for stimulation Calcium hydroxide preparation is introduced intra-channelly of reparative processes (Pat. RF 2158123, MPK7 A61K 6/00. Method for the treatment of apical periodontitis. G. Barer, I. Ovchinnikova, Tsa s VN, Bull. 30, 2000).

It is also proposed that the periodontium be added for a period of 8-12 days in a mixture of calcium hydroxide, the antibiotic Doxycycline hydrochloride, the glucocorticoid preparation Triacort and the antifungal agent Clotrimazole in a ratio of 4: 3: 1: 2, respectively, in a dose of 0.5-1 g, while the drug mixture is placed in the root canal, avoiding excretion beyond the apical foramen. (RU 2270018, 2006)

There is a method in which an ozonized 0.9% physiological solution with an ozone concentration of 4000-6000 μg / l on turundum is introduced into the root canal. Fill the root canal with filling material. In addition, before the tooth is treated, the oral cavity is irrigated at an ozone concentration of 1500-2000 μg / L. After each stage of the processing of the tooth canal, irrigation with this agent is carried out with an ozone concentration of 1500-2000 μg / L. And after treatment, patients conduct oral baths during the day after each meal with a solution with an ozone concentration of 1000-1500 μg / L. (RU 2324452, 2008)

Despite the continuous improvement of traditional methods of treatment of periodontitis, including destructive forms of chronic apical periodontitis, the percentage of complications remains especially high. Despite the fact that at present a large number of agents and methods for the treatment of apical periodontitis have been proposed, and the agents used have a greater effect only on the microflora of the root canal, there remain problems associated with the regeneration of bone tissue of the periapical region. A promising direction in the treatment of inflammatory periodontal diseases is the use of laser technology.

There is a method for the treatment of apical periodontitis, which can be used in destructive forms of chronic apical periodontitis, by using a low-frequency pulsed complex modulated field. Inductors emitters are placed in the area of the causative tooth externally. The pulse repetition rate is selected in the range of 50-100 Hz, the modulation frequency is in the range of 0.6-10.0 Hz, the magnetic induction intensity at the site of exposure is in the range of 8-9 mlT, and the exposure time is 5-10 sessions. (RU 95106522, 1997)

A known method of treatment by exposure to laser irradiation on a pathological lesion in the area of projection of the apex of the root of the tooth and periapical tissues, including in destructive forms of chronic apical periodontitis. In this case, they are percutaneously exposed to light from a semiconductor pulsed laser with a wavelength of 0.85-0.98, a power of 0: 5-4 W, a frequency of 0.08-2 kHz, and an exposure of 2 minutes. The course of treatment is 2 procedures with an interval of two days for the prevention of complications, 2-5 procedures daily using first anti-inflammatory parameters: power 3-4 W, frequency 0.8-0.1 kHz, followed by a transition to stimulating dosages: power 0.5 -1 W, frequency 1.5-2 kHz in case of complications of pulpitis and periodontitis. (Patent RU 2128534, 1999). However, the main disadvantage of this treatment method is the low efficiency of percutaneous laser radiation on the periapical focal point, which results in low regeneration and long bone restoration time.

A known method of treatment of chronic apical periodontitis, which is also applicable in the treatment of destructive forms of chronic apical periodontitis, including photodynamic therapy with photolone. A wavelength of 662 nm is used with an optical conductor (power 0.5-1.0 W). A solution of photolon is introduced intra-channelly, and into the area of the transitional fold in the form of an application followed by laser processing. After filling the canal in the next 2-3 visits, photolon is applied on the transitional fold with subsequent laser exposure. The restoration of bone tissue in the periapical foci of destruction 1 year after the treatment (according to x-ray) occurs in 91.0% of cases. (Bychkova, N.P. Study of the effectiveness of laser therapy in the treatment of dental caries complications / N.P. Bychkova // VI All-Russian University Scientific and Practical Conference of Young Scientists and Students in Medicine: Sat. Materials. - Tula, 2007. - p. .46-48.)

A known technique for the treatment of apical periodontitis, including destructive forms of chronic apical periodontitis, using intra-channel diode laser radiation, in which the root canal is treated with nickel-titanium instruments with a taper of 6-8%. The fiber is introduced into the root canal, taking into account the size of the bone destruction site and the depth of laser light penetration of 4 mm. When carrying out laser therapy in the channels, the power should not exceed 3 W, and also maintain a super-pulse radiation regime. The restoration of bone structure after 18 months occurs in 85.7% with chronic granulating periodontitis and 92.3% with chronic granulomatous periodontitis. (Naibov OV Lasers in dentistry [Text] / O.V. Naibov // Dentistry for small cities of Russia: abstract. All-Russian scientific-practical conference. - Khanty-Mansiysk, 2005.-S.107-110.)

The closest analogue of the invention is a method of treating periodontitis, including destructive forms of chronic apical periodontitis, in which laser irradiation is used (for example, a Lami-S diode laser device with a wavelength of 980 nm, in one visit). For this, the root canal after the preparation of the cavity, its antiseptic treatment should be expanded to at least ISO size 30 for free introduction of the fiber. The depth of advancement of the fiber must be shorter than the working length by 1.5 mm. When carrying out laser therapy in the root canals, the power can not exceed 1 W, and a super-pulse radiation regime must also be maintained. The exposure time of the diode laser is 30 s in each root canal. Six months after treatment, complete restoration of bone tissue was detected in 55.8% of cases after laser treatment, after 12 months - complete restoration of bone tissue in 86% of cases (Mamedova L.L., Dmitrieva N.A., Khasanova E.V. The effectiveness of the use of a diode laser in the treatment of chronic periodontitis // Military Medical Journal. - 2008. -. - No. 4. - P.66.)

The information on the use of a diode laser is somewhat general. The specific optimal parameters and methods of exposure to periapical tissues with laser radiation have not been determined, which would significantly improve the quality and effectiveness of treatment, accelerate the elimination of inflammation of periapical tissues, shorten treatment time, improve regeneration and recovery time of bone tissue, and reduce re-circulation. In addition, only one laser radiation parameter is used, without going beyond the channel, which does not allow to fully affect the pathological destruction center located in the near-root region.

The objective of the invention is to develop a more effective method for the treatment of destructive forms of chronic apical periodontitis, providing a stable remission of the disease due to restoration of bone tissue of the periapical region by improving the method of treatment with a diode laser, reducing the risk of complications, improving the regeneration and restoration of bone tissue, reducing treatment time and re-reversibility.

The technical result when using the invention is to increase the effectiveness of treatment by accelerating bone tissue regeneration due to pronounced anti-inflammatory, bacteriostatic, bactericidal and stimulating repair effects, achieving stable remission due to local immunomodulatory effects, reducing destructive changes in periapical tissues, increasing bone density and homogeneity.

The specified technical result is achieved by the fact that in the treatment of destructive forms of chronic apical periodontitis, including the formation of access to the periodontitis region and exposure to laser radiation with a wavelength of 980 nm, in accordance with the claimed invention, laser irradiation is carried out by conducting a laser fiber into the periapical space to the periodontitis region in a pulse-periodic mode for 30-60 s with reciprocating movements of the fiber and the laser radiation power of 0.5-0.9 W, after 3- 5 days spend additional irradiation of the periapical space of the periodontitis region by radiation of a low-intensity laser with a wavelength of 660 nm, a power of 200 mW, also in a pulse-periodic mode for 2 minutes

The inventive method is as follows.

First visit - preparation of the cavity, opening of the tooth cavity, access to the root canals, expansion of their mouth, removal of decayed pulp, cleansing of the root canals of the tooth, standard chemomechanical treatment of the canals with wide expansion of the apical third with an endodontic instrument. Then the channels are treated with aseptic solutions and dried with sterile paper pins. The wavelength of laser irradiation during treatment is 980 nm (surgical port), power 0.5-0.9 W in a pulse-periodic mode, depending on the size of the focus. The laser fiber is inserted into the root canal to the apex and, taking into account the size of the destruction focus, is brought into the periapical space. If there is a fistulous passage leading to the site of destruction and impossibility of endodontic treatment, irradiation is carried out after treatment of the fistulous passage in order to form access through it to the periapical or bifurcation region according to the method described above. The time of exposure to laser irradiation is 30-60 s, depending on the volume of the destruction focus. At the same time, they make constant reciprocating movements with the light guide. After that, the light guide is removed from the channel, and a swab soaked in antiseptic liquid is applied to the mouth. Impose a temporary filling with the exception of the tooth from the bite.

A second visit is scheduled for 3-5 days. The patient is warned of possible complications in the form of pain.

The second visit - a temporary filling is removed, a cotton swab is removed and the canals are irrigated with antiseptic solutions. The canal is dried with sterile paper pins. Select a fiber with a wavelength of 660 nm (therapeutic channel) with a power of 200 mW, set the mode F2, pulse-periodic. The light guide is introduced along the entire length of the channel with the removal of destruction into the pericardial focus. In the presence of a fistulous passage leading to the site of destruction and the impossibility of endodontic treatment, irradiation is carried out after treatment of the fistulous passage in order to form access through it to the periapical region or bifurcation region according to the method described above. Irradiation is carried out for 2 minutes.

Impose a swab moistened with antiseptic liquid. The tooth is closed with a temporary filling. Subsequently, in the absence of complications in the form of pain, the canal is obstructed to the apex according to standards, a permanent filling is applied with restoration of the anatomical shape, or orthopedic assistance according to indications, with the inclusion of the tooth in the bite.

The advantages of the proposed method are as follows:

- direct complex effect on the destruction site by high and low-intensity laser radiation;

- reduction of destructive changes in periapical tissues, increase in bone density and homogeneity, restoration of bone tissue pattern after 1 month;

- the method is practically non-medicinal, which allows you to abandon expensive medications, including antibiotics, which does not contribute to the sensitization of the focus of inflammation of the irradiated tooth;

- reduction of treatment time, restoration of bone tissue of the periapical region after 1 month;

- persistent remission of the disease, reducing the risk of complications and re-treatment for exacerbations.

The inventive method is illustrated by the following clinical examples. Clinical example 1.

Patient N. complained of aching pains in the lower tooth on the left, aggravated by biting. Objectively: the left submandibular lymph node is enlarged, painful on palpation, not fused with the surrounding tissues. In the oral cavity: the mucous membrane in region 3.6 is swollen and hyperemic. 3.6 previously treated for complicated caries, a tooth under a permanent filling. Thermometry is painless, percussion is sharply painful. On the targeted x-ray (Fig. 1), destruction of bone tissue with fuzzy borders in the area of the interroot septum (1) and the apex of the medial root up to 0.3 cm in size is detected (2). Diagnosis: destructive form of chronic apical periodontitis.

Treatment: first visit. After anesthesia, the permanent filling was removed, 3 canals were sealed, chemical and mechanical expansion of the root canals was carried out using appropriate endodontic instruments, and the canals were washed with 2% chlorhexidine solution. Dried with sterile paper pins. The apparatus was prepared: for radiation with a wavelength of 980 nm (surgical port), a power of 0.9 W was set in a pulse-periodic mode. The fiber was inserted into the root canal to the apex and, taking into account the size of the destruction focus, it was brought into the periapical space of this region by 0.2 cm. The time of exposure to laser irradiation was 45 s, while constant reciprocating movements were made by the fiber. After that, the light guide was removed from the channel and a swab soaked in Cresophene antiseptic liquid was placed on the mouth. The Ketac ™ Molar Easymix was temporarily closed with exclusion of the tooth from the bite.

A repeat visit was scheduled after 5 days. The patient was warned of possible complications in the form of pain.

The second visit - a temporary filling was removed, a cotton swab was removed and the canals were irrigated with 2% chlorohexidine solution. The canal was dried with sterile paper pins. For radiation with a wavelength of 660 nm (therapeutic channel) with a power of 200 mW, pulse-periodic mode F2 was set. The fiber was introduced along the entire length of the channel with the removal of destruction into the periapical focus (periapical space). Irradiation was carried out for 2 minutes

The canal was blocked to the apex with gutta-percha pins on the strength of the EPE Plus, a permanent seal was applied with restoration of the anatomical shape. X-ray control after 1 month. Represented in Fig. 2: an increase in bone density of the interroot septum (1) and a decrease in the size of the destruction of the periapical region to 0.1 cm (2), restoration of the cortical plate.

Clinical example 2.

Patient K. complained of aching pain in the upper tooth on the right, aggravated by biting. Objectively: tooth 1.6 under the crown, the mucous membrane of the vestibule of the oral cavity in the region 1.6 is edematous and hyperemic, there is a fistulous passage with scanty sacred discharge, in the area of the projection of the distal-buccal root of the tooth 1.6. Thermometry is painless, percussion is sharply painful. On the roentgenogram of Fig. 3 rarefaction of bone tissue in the region of the apex of the distal-buccal tooth root 1.6 with fuzzy borders (1) of sizes up to 0.2 cm. Diagnosis: destructive form of chronic apical periodontitis.

Treatment: after anesthesia, tooth 1.6 was isolated from saliva with cotton rolls. The apparatus was prepared: for radiation with a wavelength of 980 nm (surgical port), a power of 0.5 W was set in a pulse-periodic mode. The light guide was introduced through the access in the pre-processed with the aim of forming access fistulous passage into the periapical space. The time of exposure to laser irradiation was 30 s, while constant reciprocating movements were made with the optical fiber. After that, the light guide was removed.

A second visit was appointed after 3 days. The patient was warned of possible complications in the form of pain.

Second visit: tooth 1.6 was isolated from saliva. For a fiber with a wavelength of 660 nm (therapeutic channel) with a power of 200 mW, pulse-periodic mode F2 was set. The light guide was introduced into the fistulous passage to the pericardial focus of destruction. Irradiation was carried out for 2 minutes

X-ray control after 1 month. Represented in Fig. 4: an increase in bone density in the region of the root apex (1), a decrease in the size of the destruction of the distal buccal root.

Clinical example 3.

Patient M. asked about planned rehabilitation of the oral cavity. Chronic diseases and allergic reactions denied. Objectively: tooth 4.6 under a permanent filling. Palpation of the submandibular lymph nodes is painless. Transitional fold in area 4.6 is normal, comparative horizontal and vertical percussion are painless. There is no reaction to temperature stimuli. On the targeted radiograph (Fig. 5), the focus of enlightenment of bone tissue of the interroot septum (1). Diagnosis: destructive form of chronic apical periodontitis.

Treatment: after anesthesia, the permanent filling was removed, 3 canals were sealed, chemical and mechanical expansion of the root canals was carried out using appropriate endodontic instruments, and the canals were washed with 2% chlorhexidine solution. Dried with sterile paper pins. The apparatus was prepared: for radiation with a wavelength of 980 nm (surgical port), a power of 0.7 W was set in a pulse-periodic mode. The fiber was inserted into the root canal to the apex, and, taking into account the size of the destruction focus, it was brought into the periapical space (periapical space) of this region by 0.1 cm.The exposure time of the laser irradiation was 60 s, while constant reciprocating movements were made by the fiber. After that, the light guide was removed from the channel and a swab soaked in Cresophene antiseptic liquid was placed on the mouth. The Ketac ™ Molar Easymix was temporarily closed with exclusion of the tooth from the bite.

A second visit was appointed after 3 days. The patient was warned of possible complications in the form of pain.

The second visit - a temporary filling was removed, a cotton swab was removed and the canals were irrigated with 2% chlorohexidine solution. The canal was dried with sterile paper pins. For radiation with a wavelength of 660 nm (therapeutic channel) with a power of 200 mW, pulse-periodic mode F2 was set. The optical fiber was introduced along the entire length of the channel with the removal of destruction into the near-apical focus. Irradiation was carried out for 2 minutes

The canal was blocked to the apex with gutta-percha pins on the sealer AN Plus, a permanent seal was applied with restoration of the anatomical shape.

X-ray control after 1 month (Fig. 6): increase in bone density of the interroot septum (1).

Claims (1)

A method of treating destructive forms of chronic apical periodontitis, including access to the periodontitis region and exposure to laser radiation with a wavelength of 980 nm, characterized in that the laser irradiation is carried out by conducting a laser fiber into the periapical space to the periodontitis region in a pulse-periodic mode for 30- 60 s with reciprocating movements of the fiber and the laser radiation power of 0.5-0.9 W, after 3-5 days, additional irradiation of the periapical space is carried out periodontitis t he area of low intensity laser radiation of 660 nm wavelength, 200 mW pulsed in a batch mode for 2 minutes.

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