RU2621392C1 - Method of treatment of acute and chronic vertical periodontitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: caries cavity preparation, mechanical and medicamentous treatment of the root canal are carried out. A 2.5% aqueous solution of Poviargol is injected into the channel, which is activated by ultrasound at a frequency of 26 kHz and 2 watts three times for 20 seconds each, with the solution being renewed. The channel is sealed with gutta-percha pins with an epoxy sealer. The cavity in the tooth is sealed.

EFFECT: method allows to provide high quality and reliability of treatment at reduction of repeated complications in post-filling period.

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Description

The invention relates to medicine, namely to dentistry, and is intended for the treatment of acute and chronic apical periodontitis.

Periodontitis is currently a common dental disease. In 8% of cases of the disease, the development of an infectious process in the root canals leads to tooth loss, and in a complicated form it causes periostitis, abscess, and phlegmon. Problems in the treatment of periodontitis are associated with the inability to completely remove the infection from intracanal dentin, which has a tubular microstructure with a tubule diameter of about 3 μm and an average density of 30,000 tubules per mm ² , which pathogenic microflora seed at a depth of 600 μm or more. The insufficient depth of penetration of antiseptics into dentin, the rapid inactivation of irrigation solutions, bacterial resistance, and the biocidal effect of antiseptics on a limited spectrum of microorganisms lead to the fact that in 35% of cases after tooth filling, the microflora remaining in the dentinal tubes continues to develop and causes further illness.

In medicine, the antimicrobial properties of silver preparations are successfully applied, which secrete bactericidal silver ions that do not cause bacterial resistance and suppress the vital activity of the entire spectrum of microorganisms, including the periodontal region (Bukina Yu.A., Sergeeva EA.Antibacterial properties and mechanism of bactericidal action nanoparticles and silver ions // Bulletin of Kazan Technological University. - 2012. - Issue 14. - T. 14. - P. 170-171).

A known method of treating periodontitis by silvering, which is the chemical recovery of a 30% silver nitrate solution on the channel walls of a thin film of metallic silver that impedes the growth of microflora (Nikolaev A.I., Tsepov L.M. Practical therapeutic dentistry. - M .: MEDpress -inform, 2014 .-- 928 p.).

The disadvantage of this method is that it does not provide reliable disinfection of the root of the channel due to the shallow penetration of silver into the dentinal tubules. In addition, silver nitrate has a toxic and cauterizing effect on periodontium, reduces the aesthetic effect as a result of staining the tooth crown in a dark color. The method is time consuming and requires at least four visits to the patient.

Also known is a method of treating periodontitis (SU 1602505 A1, 10/30/1990), which includes the preparation of the carious cavity of the tooth, the mechanical and drug treatment of the root canal, the introduction of turunda moistened with a silver-containing antiseptic solution, which is prepared as follows. The reaction of joint hydrolytic condensation of sodium methylsiliconate (10 mg) with a solution of silver nitrate (1 mg) is carried out. The resulting sorbent is mixed with an aqueous suspension of furazolidone (1 mg) and metronizadol (1 mg) and dried in a stream of air. The dry mixture is dissolved in a drop of alcohol immediately before introduction into the channel. Turunda is left for 4 days under an airtight dressing. Then, the temporary filling is removed, the canals are repeatedly washed with this mixture, filled with resorcinol-formalin paste for four visits to the patient and closed with a permanent filling. This method is selected for the prototype.

The disadvantages of this method are:

- unreliable disinfection of the root canal due to the shallow penetration of the silver-containing antiseptic solution into the thickness of the infected dentin due to the fact that when the solution is freely penetrated due to the small diameter of the dentin tubes, the surface tension does not allow the solution to impregnate deep inside the dentin;

- a short time of bactericidal action, due to the fact that silver is in an ionized form and is capable of rapid inactivation with the formation of silver cations of inactive insoluble organic and inorganic compounds;

- silver nitrate and metronidozole, especially in combination with ethyl alcohol, can cause toxic and allergenic reactions in the body;

- insufficient sealing of the root canals, arising due to shrinkage of the resorcinol-formalin root filling;

- staining of tooth tissues with silver nitrate and resorcinol-formalin filling paste in brown, which limits the application of the method on the front teeth;

- A long treatment period of about five visits to the patient.

The objective of the invention is to improve the quality and reliability of the treatment of acute and chronic apical periodontitis.

Technical result:

- a deeper penetration of a silver-containing antiseptic solution into infected tooth tissues;

- an increase in the duration of the bactericidal action of an antiseptic;

- increase the tightness of the sealed root canal;

- reduction of toxic and allergenic effects on the body;

- reduction of staining of tooth tissues;

- reduction of treatment time to one visit to the patient.

The technical result is achieved by the fact that in the method of treating periodontitis, including the preparation of the cavity, mechanical and drug treatment of the root canal, the introduction of a silver-containing antiseptic solution into the canal, followed by canal filling and filling, the following differences are provided:

- a 2.5% aqueous solution of Poviargol is used as an antiseptic solution, which is injected into the root canal and activated with ultrasound at a frequency of 26 kHz and a power of 2 W 3 times for 20 seconds with a solution update;

- the root canal is filled with gutta-percha pins with an epoxy sealer.

The domestic pharmaceutical preparation Poviargol (State Register of Medicines of Russia, No. LSR-008192/08, "Technologist SKTB FSUE", St. Petersburg) (http://sktb-teclmolog.ru/pharma/poviargolum) is a metal-polymer composition containing 8 % of finely dispersed silver particles in the polyvinylpyrrolidone polymer matrix, and is an effective antimicrobial agent, in concentrations up to 100 μg / ml, inhibits the growth of most bacteria. Silver in an aqueous solution of Poviargol is in a non-ionized state, and silver ions are constantly released from the surface of the particles, providing a prolonged bactericidal effect. The finely dispersed state of metallic silver with particle sizes of 1–4 nm increases the area of the active surface of ion generation, which makes it possible to reduce the concentration of silver in an aqueous solution by a factor of hundreds while preserving bactericidal activity and reducing the coloring effect. The drug is non-toxic and does not cause allergic reactions in the body.

In the proposed method, the intra-channel administration of a 2.5% Poviargol solution in combination with ultrasound provides deep penetration of silver particles into the infected dentin tubules, which, under the influence of acoustic cavitation, are deposited on bacterial biofilms with the formation of a depot, from which bactericidal silver ions are released for a long time, which inhibit vital activity microflora. The use of ultrasound in the working medium of an aqueous solution of Poviargol additionally has a destructive effect on the bacterial membranes, thereby enhancing the antimicrobial activity of the antiseptic, which generally leads to relief of inflammation in the early stages and prevents repeated complications in the post-filling period.

The method of root canal filling with gutta-percha pins with an epoxy sealer is widely used in dental practice and has the advantage of good adhesion of the material to the canal walls, due to which a high degree of root seal integrity is achieved. The medicinal ingredients of the root filling do not have toxic, allergenic and staining properties.

The novelty of the proposed method lies in the fact that for the first time as an intracanal antiseptic, an aqueous solution of the silver-containing preparation Poviargol was selected, expanding the list of medication endodontics a method has been developed for the deep impregnation of finely dispersed silver particles into the dentinal tubules using ultrasound, which provides a prolonged bactericidal ionic effect; a rational bactericidal concentration of Poviargol aqueous solution was selected and the modes of the procedure for its intra-channel scoring were determined.

The method is as follows. Under adequate anesthesia, a cavity is prepared with the opening of the root canal of the tooth. After mechanical and drug treatment of the tooth canal with a 3% solution of sodium hypochlorite, 17% EDTA, washing with distilled water and drying with paper pins, the canal is filled with an endodontic syringe with a 2.5% aqueous solution of Poviargol. Then, an ultrasonic dental tip of the device for phonophoresis is introduced into the channel and the solution is voiced with a frequency of 26 kHz and a power of 2 W three times for 20 seconds with a solution update, after which the channel is dried. Treatment is completed with canal filling using gutta-percha and epoxy sealer and restoration of the tooth crown.

The comparative penetration depth of the antiseptic solutions of the proposed method and prototype in the dentin of the root of the tooth was determined in the experiment.

Example 1. Both methods were implemented in a laboratory model on teeth removed by orthodontic indications (upper incisors) in patients 35 and 40 years old, who were stored in 0.9% saline solution before the experiment. The crown of each tooth was removed with a diamond bur. The root canals were endodontically dissected to size 30 using K files without expanding the physiological apical openings, then washed with 3% sodium hypochlorite solution, 17% EDTA with distilled water, and dried with paper pins. Tooth No. 1 was installed vertically, fixing its position in impression silicone. After that, the root canal was filled with a 2.5% aqueous solution of Poviargol, which was previously tinted with fuchsin to provide contrast. Then, the ultrasonic tip of the phonophoresis device UDS-L (Woodpecker, UK) was inserted into the channel (Fig. 1), leaving a gap of 1.5 mm to the apical opening, and the solution was dubbed with a frequency of 26 kHz and a power of 2 W three times in 20 seconds with the update of the solution. At the end of the procedure, the tip was removed and the canal was dried with a weak stream of air. Tooth No. 2 was also installed vertically, fixing its position in impression silicone. An antiseptic solution was prepared in accordance with the requirements specified in the prototype, stained red with fuchsin, applied to a cotton turunda and introduced into the root canal under a temporary dressing for 48 hours. Then the teeth were freed from impression silicone, split along the root axis and examined using a dental surgery microscope. The study showed that in tooth No. 1, the voiced Poviargol solution penetrated the depth of the dentinal tubules on average at a distance of 780 μm from the inner wall of the root canal (Fig. 2), while in tooth No. 2, where the method of applying an antiseptic solution using the free method penetration, this distance was about 220 microns (Fig. 3). Thus, in the experimental laboratory model, the penetration of the voiced silver-containing Poviargol solution into the dentinal tubules to a depth of 3.5 times greater compared to the prototype is shown.

The results of applying the method are presented in a clinical example.

Example 2. Patient K., 38 years old, complained of the presence of constant aching pain in the area of 3.6 tooth, intensifying when biting on a causative tooth. According to the patient, tooth 3.6 was previously treated about 1 year ago for acute apical periodontitis.

Objectively: on the chewing surface of tooth 3.6 there is a permanent filling without signs of violation of the marginal fit. On the targeted x-ray (Fig. 4), loose filling of the root canals with filling material, expansion of the periodontal gap and the formation of foci of rarefaction of bone tissue with fuzzy contours in the apex of the anterior (1) and posterior (2) tooth roots are detected.

Diagnosis: Exacerbation of chronic apical periodontitis.

Treatment: under Sol. Ultracaini 2% - 1.7 ml The old filling and the rest of the filling material from the root canals were removed. The traditional mechanical and drug treatment of the tooth root was carried out, including washing with 3% sodium hypochlorite solution, 17% EDTA, distilled water. All channels were dried with paper pins and filled with a 2.5% aqueous solution of Poviargol using an endodontic syringe. Consistently in each root canal, using the ultrasonic tip of the UDS-L phonophoresis device (Woodpecker, UK), the solution was scored at a frequency of 26 kHz and a power of 2 W three times for 20 seconds with a solution update. At the end of the procedure, the root of the tooth was dried with paper pins. We performed root canal filling with gutta-percha pins with an AN-plus epoxy sealer. The cavity in the tooth was filled. Restored the crown of the tooth.

The patient complained of pain. With a delayed clinical examination 12 months after treatment, on the control x-ray, the foci of bone destruction in the periapical region of the roots of the tooth 3.6 significantly decreased in volume (Fig. 5).

The proposed method was used to treat 40 patients, including 9 with fibrous periodontitis, with granulating 27, with granulomatous 4. In all cases, a good clinical effect was achieved. The treatment was carried out in one visit. The proposed method, according to the results of clinical observations, allows to reduce the number of complications after endodontic treatment of acute and chronic apical periodontitis by 25%, that is, to increase the effectiveness of the treatment by the same amount.

The absence of toxic and allergenic components in the materials allows the method to be used in the treatment of pregnant women and children.

Claims (1)

A method of treating acute and chronic apical periodontitis, including the preparation of a cavity, mechanical and drug treatment of the root canal, the introduction of an antiseptic solution into the canal, followed by canal filling and filling, characterized in that a 2.5% aqueous solution of Poviargol is introduced into the canal, which activated by ultrasound with a frequency of 26 kHz and a power of 2 W three times for 20 seconds with the update of the solution, and the channel is sealed with gutta-percha pins with an epoxy sealer.

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