RU2548505C1 - Method of treating chronic apical periodontitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method includes the preparation of a carious cavity, opening the tooth cavity, creation of an access to root canals, extension of their orifice. Removal of a decayed material from the root canals and their drug treatment are carried out. After that, performed are: wide opening of the apical tooth orifice, mechanical and drug removal of periapical pathological exudative formations in the focus of periapical inflammation through the root canal. Before filling the canal with a filling material the gel "Lamifaren" is introduced into the focus of periapical destruction. Such introduction is performed three times after a day under temporary stopping. The gel "Lamifaren" is introduced inside in a dose of 50 g 2 times per day for 30 days.

EFFECT: application of the invention accelerates bone tissue regeneration due to the active release of an active substance calcium alginate, provides stable remission due to local and systemic detoxifying effect.

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Description

The invention relates to medicine, in particular to dentistry, and is used to treat destructive forms of chronic apical periodontitis of single-root and multi-root teeth.

The closest analogue of the invention is a method for the treatment of chronic apical periodontitis, which consists in the preparation of a carious cavity, opening of the tooth cavity, access to the root canals, expanding their mouth, removing pulp decay, cleansing the root canals of the tooth, treating them with medications, wide disclosure apical hole of the tooth, behind which there is a focus of periapical inflammation, mechanical and drug removal of periapical pathological exudative images of periapical inflammation through the root canal, introducing before filling the canal with filling material into the periapical destruction foci a mixture containing 2.0 g of calcilane and 2.0 g of kaolin diluted in distilled water to a paste-like consistency in a ratio of 3: 1, paste is introduced until full filling of the channel and additionally injected capsules of calcylan, sublingually at a dose of 0.5 g 2 times a day for 30 days [patent RU 2449761, 2012]. The main disadvantage of this method is associated with the method of preparation of the drug used, because Calcilan is available in capsules, in the form of a powder, the preparation is carried out in pharmacy at the same time, at one time. After mixing, the useful properties of this preparation are lost, the chemical composition of micro- and macro elements (K, Na, Ca, Mg, I, CI, S, Si and others), vitamins (A, C, D, B1, B2, B3, B6 are destroyed , B12, E, K, PP), the effectiveness of the medicinal properties is deteriorating, as well as the insufficient content of free alginate in the form of calcium and sodium salts.

The technical result when using the invention is the acceleration of bone tissue regeneration due to the active release of the active substance of calcium alginate, the achievement of stable remission due to local and systemic detoxification effects.

The proposed method for the treatment of chronic apical periodontitis (both in exacerbation and in remission) is as follows. Caries are prepared, open the tooth cavity, create access to the root canals, expand their mouths, remove decay from the root canals, chemo-mechanical and drug treatment of the root canals with the definition of the length of the root canal. Then open the apical hole of the tooth up to size 20 according to ISO, forming access to the periapical focal area of bone tissue destruction or inflammation. Mechanical and drug removal of periapical pathological exudative formations is carried out in the focus of periapical inflammation through the root canal. Dry the root canals. The drug “Lamifaren” is administered in the form of a homogenized, finely dispersed thick gel until the channel is completely filled. Additionally, Lamifaren gel is prescribed in a dose of 50 g (2 tablespoons), 2 times a day, 15-20 minutes before a meal, washed down with water or mixed with liquid for 30 days. The introduction of the drug "Lamifaren" in the root canal is repeated three times (every other day) for one week, depending on the dynamics of the process, with the imposition of a temporary filling. Permanent root canal filling is carried out on the 7th day according to generally accepted methods.

Lamifaren is a product of therapeutic and prophylactic action, homogenized, finely dispersed, in the form of a thick gel of brown-green color with the smell of natural seaweed (Laminaria Angustata), completely ready for use. Place of production in the cold waters of the Sea of Okhotsk. 100% natural product, “live” without preservatives with a wide range of biological activity, are not found in other types of medicinal raw materials. It is produced in the form of a jelly-like homogeneous gel by complex low-temperature hydrolysis using a patented technology [patent RU 2230464, 2004], which allows you to save all the useful properties. The kelp extract is similar in chemical composition to D.I. Mendeleev in miniature with 37 elements and their connections. Laminaria Angustata belongs to the genus of brown algae that grow in the cold waters of the Far Eastern seas, off the northern coast of Japan, on the shores of Sakhalin Island near the Kuril Islands. They strongly stand out among other types of algae, forming independent dense thickets. From the depths of the sea, long thalli stretch toward the light, reaching from 1.5 to 20 or more meters in length. Algae, which is estimated to be millions of years old, has a powerful healing effect. The composition of this relict algae is identical to the composition of human blood cells. Laminaria Angustat - macroalgae, which differ from other species in a special color scheme and size. These algae are characterized by tones that vary from olive-green to dark brown and depend on the growing conditions. “Lamifaren” is obtained from the seaweed “Laminaria Angustat” of a 4-year life cycle, unlike other algae that live only 2 years, they are superior in quality to other types of algae. Algae of this species can be found only in the territorial waters of the Far East - in the Sea of Okhotsk in the Shantar Islands. Gel "Lamifaren" is allowed and recommended for use by the Ministry of Health of the Russian Federation, is not a medicine and dietary supplement.

Clinical trials of the drug were conducted at the SSC RF Institute of Immunology, at the Military Clinical Hospital named after Burdenko, at the Russian Research Center for Restorative Medicine and Balneology at the Ministry of Health of the Russian Federation, at the Research Institute of Nutrition of the Russian Academy of Medical Sciences, at the Federal Department of Biomedical and Extreme Problems at the Ministry of Health of the Russian Federation and others. The immunotropic effect of Lamifaren is proved in the course of in vivo experimental studies conducted in the State Scientific Center of the Russian Federation Institute of Immunology.

By orders of the Ministry of Health of the Khabarovsk Territory (No. 144 of May 26, 03, No. 50 of February 10, 03, No. 165 of April 11, 08), schools of young mothers were organized at antenatal clinics and clinics, the training program of which provides the inclusion of Lamifaren in the diets of children nursing mothers; Lamifaren is also included in various regional programs to overcome iodine deficiency. The Lamifaren gel contains the most valuable polysaccharides: fucoidan (has an anticarcinogenic effect); kelp (a powerful anticoagulant); alginates (from 42% to 52%, have a unique ability of enterosorbent: they bind heavy metal salts, toxic and radioactive substances, products of exo - and endogenous origin, forming complex complexes with them, remove them from the body), there are macro- and microelements, vitamins B1, B2, B12, D, C ... (the content is 900 times higher than in plants growing on the ground), carotenoids, fiber, fructose. Laminaria and fucoidan both restore the body's defense, have powerful antiviral and immunomodulating activity, and regulate the water-salt balance. Fucoidan is the most valuable component of Lamifaren gel. It stimulates the production of b-limvocytes and microphages, which are essential for life, that destroy herpes and hepatitis C viruses, inhibits the development of many allergic reactions, and slows down the aging process. Laminaria extract improves blood composition, increases the amount of hemoglobin and red blood cells in the blood due to the content in the gel of fucoidan, the content of which corresponds to more than 34%.

Fucoidan is a sulfate polysaccharide with a very complex structure, its main components are primary sugar (fructose), as well as xylose, mannose, galactose, glucose. It has antibacterial and anti-inflammatory effects. The drug exhibits antibacterial activity in relation to Staphylococcus aureus, Esherehia Koli, Helicobacter. At the same time, fucoidan has a positive effect on the intestinal flora and normalizes the functions of the gastrointestinal tract. The anti-inflammatory effect of fucoiadan is manifested at an early stage of the development of the inflammatory process due to its interaction with P-selectin. Cell regeneration and increased life expectancy. Fucoidan strengthens the immune system by improving phagocytosis, the process of killing bacteria and foreign particles with phagocytes. Fucoidan also increases the number of mature white blood cells in the body, which are an essential part of the body's natural immune system. Fucoidan stimulates the production of vital immune cells: T-lymphocytes and macrophages.

Studies conducted at the St. Petersburg Research Institute of Vaccines and Serums have shown that the use of alginates increases the effectiveness of antiviral vaccines and can reduce the dose of antibacterial drugs when used together. The therapeutic effect of alginic acid salts in immunodeficiencies caused by burns and stress was also studied there.

It was proved that their use helped to reduce toxemia, enhanced the regeneration of burn wounds, and stimulated the activity of B-lymphocytes and macrophages. Alginate drugs contribute to phagocytosis, which ensures their antimicrobial, antifungal and antiviral activity. They attract (sorb) and thereby make the immune complexes circulating in the blood inactive when an excessive amount is formed and the body does not have time to clear them. Their damaging role has been proven in many diseases. Alginates also bind excess amounts of immunoglobulins (E), responsible for the development of acute allergic reactions and diseases. They stimulate the synthesis of antibodies of local specific protection (class A immunoglobulins. The chemical structure and ion-exchange properties of alginic acid determine its sorption and hemostatic effects. Alginates do not alter the water-salt balance, do not absorb hydrogen sulfide necessary for peristalsis in the intestines, and do not undergo metabolic transformations in the body, non-toxic and excreted within 24-48 hours. Reception of alginates helps to reduce intoxication, reduces the content of toxic digestion products (creatinine, urea, aldehydes, alcohols) and reduces food and infectious allergic reactions. Data from numerous clinical trials confirm the high effectiveness of alginates in various disorders of intestinal microbiocenosis, which is most relevant at the present level of dysbiosis. Even in small amounts, alginates exhibit antimicrobial activity, suppressing activity pathogenic microorganisms, such as staphylococcus, fungi of the genus Candida, and contribute to the development of normal microflora. The ability of alginic acid and its salts to stop bleeding is widely used in the treatment of ulcerative and erosive lesions of the gastrointestinal tract. When ingested, alginates have a moderate antacid effect, when interacting with hydrochloric acid of gastric juice, they form a gel that covers the mucous membrane like a "gastric bandage", protecting it from further exposure to hydrochloric acid and pepsin, stopping bleeding. Alginates have beneficial effects on the functions of the liver, pancreas and kidneys. In the wide range of dressings, a special place is occupied by alginate-based absorbable dressings on the wound. The clinical experience of using alginate coatings on wounds and burns has shown that they have good drainage properties, accelerate wound cleansing, reduce their infection, significantly reduce swelling of surrounding tissues, have a pronounced hemostatic effect, and contribute to a favorable course of the wound process.

The invention is illustrated by the following clinical examples.

Example No. 1. Patient K. complained of swelling of the gums, constant aching pain in the tooth, aggravated by biting, when eating. In the anamnesis, the tooth was previously treated for deep caries more than 3 years ago.

Locally: the gingival mucosa in the area of the tooth 3.4 is swollen, hyperemic, smoothed, painful on palpation, the crown of the tooth 3.4 is changed in color, the percussion of the tooth is painful.

On the targeted RVG: expansion of the periodontal gap in the apical region of the tooth 3.4.

At the first visit: forming access to the root canal of the tooth 3.4, chemical and mechanical treatment of the canal with removal of the contents of the root canal, ultrasonic and drug treatment of the root canal with a 3% sodium hypochlorite solution, expanding the apical hole to size 20 according to ISO. Drying of root canals. The introduction of the drug "Lamifaren" under a temporary seal.

The purpose of the drug "Lamifaren" inside at a dose of 50 g (2 tablespoons), 2 times a day, 15-20 minutes before a meal, washed down with water or mixed with liquid for 30 days.

Replacement of the drug "Lamifaren" in the root canal was carried out on the second visit (one day after the first) and on the third visit (one day after the second).

For 4 visits, 7 days: no complaints. Locally: the gingival mucosa in the tooth region 3.4 is pink, painless on palpation, tooth percussion is painless. Treatment: removal of a temporary filling, with the removal of the Lamifaren preparation, permanent filling of the root canal with lateral condensation of gutta-percha, an insulating pad Vitremer, a filling of Charisma light-cured were applied.

Example No. 2. Patient V. went to the clinic with complaints of constant aching tooth pain, pain when biting on a tooth, swelling and tenderness of the gingival mucosa in the area of the causative tooth. A history of the tooth was previously treated for complicated caries more than 2 years ago.

Locally: the gingival mucosa in the area of the tooth 1.2 is swollen, hyperemic, the transitional fold is smoothed, pain on palpation is noted, percussion of the tooth 1.2 is sharply painful. The crown of the tooth 1.2 is changed in color.

On targeted radiography of tooth 1.2: filling material in the canal, incomplete obstruction of the root canal, not all along, there is a lesion of bone tissue with a round shape of 0.3 × 0.3 cm in the apical region.

At the first visit: formation of access to the root canal of the tooth 1.2, chemical-mechanical treatment of the canal, with the removal of the contents of the root canal, ultrasonic and drug treatment of the root canal with a 3% solution of sodium hypochlorite, extension of the apical hole to size 20 according to ISO. Drying of root canals. The introduction of the drug "Lamifaren", under a temporary seal.

The purpose of the drug "Lamifaren" inside at a dose of 50 g (2 tablespoons), 2 times a day, 15-20 minutes before a meal, washed down with water or mixed with liquid for 30 days.

The replacement of the drug "Lamifaren" in the root canal was carried out 3 times every other day.

Significant improvement was noted on the 2nd day: there was no aching pain in the tooth, swelling decreased significantly, pain remained during palpation of the gums in the area of the projection of the tooth root 1.2.

At the 5th visit: no complaints. Locally: the gingival mucosa in the tooth area 1.2 is pink, painless on palpation, tooth percussion is painless. Treatment: removal of a temporary filling, with the removal of the Lamifaren preparation, permanent filling of the root canal with lateral condensation of gutta-percha, an insulating pad Vitremer, a filling of Charisma light-cured were applied.

Control examination after 12 months: no complaints. Locally: the gingival mucosa in the tooth area 1.2 is pale pink, painless on palpation, tooth percussion is painless.

Claims (1)

A method for the treatment of chronic apical periodontitis, including preparation of the carious cavity, opening of the tooth cavity, creating access to the root canals, expanding their mouth, removing decay from the root canals, drug treatment of the root canals, wide opening of the apical opening of the tooth, mechanical and medical removal of periapical pathological exudative formations in the focus of periapical inflammation through the root canal, the introduction of filling material into the focus before filling the canal with filling material riapical destruction of the drug, ingestion of this drug 2 times a day for 30 days, characterized in that the drug is administered with Lamifaren gel three times every other day under a temporary filling, and Lamifaren gel in a dose of 50 g is administered inside.