RU2665137C1 - Method for treatment of destructive periodontitis forms - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, in particular to dentistry, and can be used to treat chronic destructive periodontitis. Method of treatment of destructive forms of periodontitis consists in pre-mixing the bone-plastic material "Orgamax" with pasty material for sealing the canals of teeth, in which the composition contains calcium hydroxide, in a ratio of 10:1. After instrumental and medicamentous treatment of the root canals of the tooth, the resulting composition is introduced into the site of destruction, then the root canals of the tooth and the carious cavity are sealed.EFFECT: use of the method provides for a complete restoration of the periapical foci of destruction by the newly formed bone and restoration of the functional and masticatory function of the tooth.1 cl, 2 dwg, 1 ex

Description

The invention relates to medicine, in particular to dentistry, and can be used to treat chronic destructive periodontitis.

Despite significant advances in preventive dentistry, the problem of treating complicated caries remains relevant. Chronic periodontitis occurs in 15-30% of the total number of patients visiting the clinic of therapeutic dentistry.

A known method of treating periodontitis, including the removal of pulp decay, exposure to the microflora of the canals with various medications, mechanical expansion of the canals and the apical hole, exposure of the pericardial tissues with drugs and filling of the root canals with hardening materials (Therapeutic dentistry / E.V. Borovsky, Yu.D. Barysheva, Yu.M. Maksimovsky and others / Under the editorship of Prof. E.V. Borovsky. - M .: Medicine, 1988. - S. 276-280).

However, medicinal substances discharged beyond the apical foramen of the tooth root most often do not have a complex of medicinal properties and cannot affect most pathogenetic parts of the pathological process in chronic periodontitis.

A known method of exposure to periapical tissue, in which, after instrumental and drug treatment of the root canals, the Ostim-100 paste or its modifications with antibiotics is administered at the top of the tooth root. The tooth is covered with a bandage for up to 14 days. Then, the canals are filled with gutta-percha pins with sealant (Rabinovich I.M., Lukicheva L.S., Dmitrieva N.A. Possibility of using Ostim-100 ultra-high dispersion hydroxyapatite in the treatment of chronic periodontitis // Clinical Dentistry. - 1999. - No. 4. - S. 28-30.).

The disadvantage of this method is the need for prolonged instrumental treatment, removal after 3-4 months from the material channels, repeated antiseptic and instrumental processing, and repeated introduction of material into the channels and periapical focus. Such procedures are carried out repeatedly 3-4 times during the year until the final tooth filling. Nevertheless, this does not always lead to a positive result - restoration of the periapical bone structure (50%). Relapses of the inflammatory process occur, which lead to tooth loss.

Closest to the proposed is a method of treating destructive forms of periodontitis (RF patent for the invention No. 2229858, MPK A61C 5/04, A61K 6/00, A61K 31/00, A61P 1/02, publ. 10.06.2004), including instrumental and drug treatment of the root canals of the tooth, introduction of a 4.6 or 8% gel form of chitosan and chitosan-containing paste into the area of periodontal destruction, filling the canals and carious cavity.

The disadvantage of the method according to the patent of the Russian Federation No. 2229858 is the low osteoplastic effect, due to the fact that chitosan is biologically incompatible with the tissues of the human body. Chitosan is a foreign protein, as a result of which allergic reactions and rejection of the material introduced into the destruction center are possible.

The task (technical result) of the present invention is to increase the effectiveness of treatment due to the full restoration of the periapical focus of destruction of the newly formed bone and the full restoration of the functional and chewing function of the tooth.

The problem is solved in that in a method of treating destructive forms of periodontitis, including instrumental and drug treatment of the root canals of the tooth, introducing an osteotropic preparation into the lesion focus, filling the tooth channels and the carious cavity, the Orgamax bone-plastic material is previously mixed with the paste-like material for filling tooth canals containing calcium hydroxide in a ratio of 10: 1, after instrumental and drug treatment of tooth canals obtained the th composition is introduced into the destruction site, then the tooth canals and the carious cavity are filled.

It has been experimentally established that a mixture of "Orgamax" with a calcium-containing paste in the claimed ratio ensures complete restoration of bone tissue due to the dissolution of necrotic tissues and connective tissue, which prevent the osteogenic preparation from coming into close contact with bone tissue. Due to faster healing, the likelihood of reinfection and rejection of the material introduced into the destruction site is reduced. There is a full restoration of the periapical focus of destruction of the newly formed bone and a full restoration of the functional and chewing effectiveness of the tooth. Thus, the effectiveness of treatment is significantly increased.

The effectiveness of the treatment of the proposed method is illustrated by drawings, where in FIG. 1 shows the dynamics of the relative optical density of bone tissue in the focus of destruction in chronic periodontitis at various times after endodontic treatment with the use of the drug "Kalasept"; in FIG. 2 - the dynamics of the relative optical density of bone tissue in the focus of destruction in chronic periodontitis at various times after treatment by the proposed method.

An example of a specific implementation of the proposed method

To create convenient access to the channels, the tooth cavity was opened, the correct contour and the correct axial direction were widely created. The walls of the carious cavity were preserved if possible, the roof of the tooth cavity was completely removed. Having exposed the mouths of the root canals, they funnel-shaped expanded, thereby removing the overhanging dentinal cornices over the mouths of the root canals. After the passage of the channel with a file or example No. 10 (15), the apical hole was expanded to size 25. The working length was determined with an apex locator, confirmed by x-ray. Antiseptic root canal treatment was performed. The periapical destruction site was filled transcanally with a mixture of Orgamax bone-plastic material with a paste-like material for filling the tooth canals, which contains calcium hydroxide, in a ratio of 10: 1. Such pastes as “Kalasept”, “Metafix” and others can be used as a paste-like material for filling the tooth canals. The plastic mass was introduced at the tip of the probe into the mouth of the root canal and, using the canal filler and file No. 20, they were taken out from the apex of the root to the apical site of the destruction of the jaw bones. This manipulation was repeated 2-3 times. The amount of osteoplastic material displayed at the apex of the root corresponded to the size of the bone destruction site on the radiograph. After the plastic mass was introduced beyond the apex, the root canal was expanded by 2 sizes to create an apical focus. Then the root canal was subjected to antiseptic treatment, dried with an adsorbent and sealed by lateral condensation of gutta-percha with "AN +". X-ray control was performed and the crown of the tooth was restored by direct restoration with a heliocomposite.

Dental dispensary observation was carried out with x-ray control of the reparative regeneration of the periapical jaw defect by the newly formed bone tissue.

Clinical and radiological observations showed that in patients complete replacement of the defect occurred by 4-6 months after treatment with a full restoration of the aesthetic, functional and chewing function of the tooth.

The advantages of the proposed method are to improve regeneration due to:

- better bone adhesion;

- reduce the likelihood of secondary infection due to the introduction of osteogenic material into the lesion and into the canals of the tooth.

In addition, the number of instrumental manipulations during treatment is reduced from 6-8 to 1-2.

Claims (1)

A method of treating destructive forms of periodontitis, including instrumental and drug treatment of the root canals of the tooth, introducing an osteotropic preparation into the lesion focus, filling the tooth canals and the carious cavity, characterized in that the Orgamax bone-plastic material is previously mixed with the paste-like material for filling the tooth canals, as a part which contains calcium hydroxide, in a ratio of 10: 1, after instrumental and drug treatment of the root canals of the tooth, the obtained composition is DYT degradation in focus, then seal up the tooth root canals and cavities.

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