RU2713257C1 - Method of treating chronic apical periodontitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely dentistry, and is applicable in treating patients with apical periodontitis. Dentine necrectomy is performed, pulp chamber is opened, root canals are identified and found, root irrigation is carried out with Terrylitin solution in amount of 1 ml per 1 channel after each passing of dental instrument till complete removal of chips. Then, Cholisal preparation is added to the root canals. Procedure of treatment and temporary filling of the canal is carried out for 12 days with replacement of temporary material in the channel every three days.

EFFECT: method enables improving the long-term clinical results of chronic apical periodontitis, improving the patients' quality of life, reducing the pharmacoeconomic costs and improving the clinical effectiveness of the treatment.

1 cl, 1 tbl

Description

Currently, it is believed that the inflammatory process in the periodontium occurs as a result of the infectious-toxic contents of the root canals through the apical opening. Moreover, the virulence of microflora is given less importance than the effect on the pericardial tissues of endotoxin, which is formed when the shell of gram-negative bacteria is damaged, which leads to the formation of biologically active products that enhance vascular permeability [Manak T.N. Microbiological aspects of pulp and periodontal tissue diseases // Modern Dentistry. 2011. No. 2].

For effective therapy in the periapical region, the used antiseptic materials, drugs and agents are crucial.

Currently, the most common method of root canal treatment is the use of drugs such as a solution of EDTA (ethylenediaminetetraacetic acid) 17%, a solution of Na hypochlorite 3-5%, heated to 37% and activated by ultrasound, and calcium hydroxide for temporary obturation [Apryatin C .A., Mitrofanov V.I. Features of the complex of drug and instrumental treatment of root canals // ENDODONTIA TODAY. No. 2, 2007 S. 64-68].

Despite the significant success of treatment using this method, some difficult problems can be distinguished: the irritating effect of sodium hypochlorite on healthy periodontal tissues. With excessive removal of the solution beyond the apical hole, which is very difficult to control during canal irrigation, a burn of periapical tissues with subsequent denaturation of native protein structures is possible.

Since chronic apical periodontitis is in most cases an infectious disease, elimination or reduction of endocanal microflora is especially important for the successful outcome of treatment.

Cultural studies of the flora of infected root canals gave the following picture: the predominance of mixed flora, including eubacteria, fusobacteria, peptostreptococci, porphyromonads, preotellas [Margaryan E.G. Development and clinical and laboratory justification for the use of new domestic material for root canals with periodontitis: dis. 14.00.21, Candidate of Medical Sciences, Moscow, 2007. 108 p.].

The search for the optimal effective medication for root canal treatment is more relevant than ever and necessary due to the stability and variability of microorganisms, their ability to form biofilms.

It is known to use the drug Terrilitin as a bactericidal and wound healing [Development of a technology for the production of enzyme-containing wound healing agents. Examination of a wound healing preparation based on active proteolytic enzymes Registration number R&D: 03201250429]. The drug is a proteolytic enzyme - a product of the vital activity of mold fungus. Its use is based on the ability to break down necrotic tissue, thin out purulent exudate and blood clots [found on the Internet https://www.rlsnet.ru/tn_index_id_5250.htm].

Indications Terrylitin - purulent wounds, burns, trophic ulcers, pressure sores.

It is known to use the drug Holisal for topical use on the mucous membranes of the oral cavity as an anesthetic and anti-inflammatory agent in the treatment of periodontal diseases, injuries of the oral mucosa, diseases that occur with an inflammatory reaction and pain [found on the Internet https://www.vidal.ru / drugs / cholisal__1929; Romanovskaya Alexandra Andreevna. Complex use of polychromatic incoherent radiation and Holisal in patients with chronic apical periodontitis: abstract of thesis. Candidate of Medical Sciences: 03/14/11, 2019].

Authors Fisyunov A.D. and Chernyavsky Yu.P. [The results of the use of the drug "Cholisal" in outpatient dental practice // Vestnik of the Voronezh State Medical University, 2012, Volume 11, No.2 165] suggested the use of the drug Cholisal for treatment for the treatment of chronic simple marginal gingivitis, acute pericoronaritis. The first application of the drug was performed on an outpatient basis. Subsequently, patients applied the gel independently after individual dental hygiene 3 times a day after meals. It was recommended to lightly rub the drug into the inflamed areas of the gums with clean hands for 2 minutes, followed by abundant rinsing of the oral cavity with boiled water at room temperature. The course of treatment was 7-10 days.

The disadvantages of the method are the lack of control by the doctor when applying the drug, the relatively short follow-up of patients, not allowing to evaluate the long-term results of treatment.

It is known to use the preparation of pharmaceutical compositions for dental fillings [US Pat. RU No. 2569762 from 02.25.2015 Material for filling the root canals of the teeth in the treatment of destructive forms of chronic periodontitis].

The material for filling the root canals of the teeth in the treatment of destructive forms of periodontitis contains a powder mixed with eugenol and including cetalkonium chloride and choline salicylate as an antiseptic and anti-inflammatory drug, as a stimulator of reparative bone tissue regeneration - chondroitin sulfate and demineralized allogeneic bone as a desensitizing agent, cromolin-sodium, with a certain ratio of components. The material has high anti-inflammatory, antiseptic, reparative and desensitizing properties, which allow reliable obturation of the root canal, stop inflammation in the periodontium and stimulate the optimization of reparative processes in periapical tissues.

However, the authors did not give guidance on the technology of using this tool for the treatment of apical periodontitis.

EFFECT: improving the long-term results of treatment of chronic apical periodontitis, improving the quality of life of patients, reducing pharmacoeconomic costs while increasing the clinical effectiveness of treatment.

The technical result was achieved by observing 157 patients with chronic apical periodontitis aged 18 to 70 years, who do not have chronic diseases of the oral mucosa and somatic pathology in the acute stage.

Using simple randomization, patients are divided into two groups. The first group of 79 people received treatment in a new way, including a combination of root canal treatment with Terrylitin and temporary filling with Holisal. The second group of 78 people received treatment in a common way, including treatment of the root canals with Belodez and temporary filling with Metapasta paste.

During the observation, a survey, examination, assessment of the state of the oral mucosa, questioning of patients about the severity of pain was performed.

The treatment and temporary filling of the canal was carried out for 12 days with the replacement of temporary material in the canal every three days.

The root canal was machine-processed using the Pro-Taper Universal or Pro-Taper Next (Dentsply) machine files with irrigation of the root canal after each passage of the instrument.

Control radiographs and patient surveys on the severity of pain were performed at 6, 12, 24 months after the endodontic treatment was completed.

The protocol for the treatment and endodontic treatment of the root canals in both groups is as follows.

Perform an x-ray examination of the tooth to be treated.

Anesthesia is carried out with solutions of Ubisthesin, Articain, Scandonest.

Perform dentin necroectomy, opening the pulp chamber, determining and finding the mouth of the root canals.

The working length of the root canal is determined with the K-file tool No. 10 under the control of the X-Smart Dual, Dentsply aeslocator.

Root canal irrigation is performed with a solution of Terrylitin, in the first group, or a solution of Belodez in the second group, in a volume of 1 ml per channel.

They carry out the passage and expansion of the root canals - creating a “carpet path” with PathFile machine tools.

Root canal irrigation is performed with the appropriate preparation after each passage of the Pathfile instrument in a volume of 1 ml per channel.

The passage and expansion of the root canals is performed with Pro-Taper Universal, Pro-Taper Next machine tools to size No. 25 and the root canals are irrigated with the appropriate preparation after each passage of the Pro-Taper Universal, Pro-Taper Next tool in a volume of 1 ml per 1 channel until complete removal dentinal shavings, purulent-necrotic detritus.

Drying of root canals with paper pins of size 25 taper 0.6.

 The introduction into the root canals of the drug Holisal in the first group or Metapaste in the second group using the Lentulo, Dentsply canal filler or using a plastic cannula.

Installation of a temporary seal.

Data from bacteriological studies indicate that representatives of various types of microorganisms are contained in the root canals of chronic apical periodontitis. Microbial associations are represented by obligate and optionally obligate bacteria. More often than others, S. sanguis stood out from the studied material (29.1 ± 0.54%), Enterococcus spp prevailed in the associations. - 45.1 ± 0.75%.

Seeding of the contents of the root canals of the teeth with gram-positive cocci amounted to 18.5 × 107 CFU / ml, gram-negative cocci - 9.3 × 108 CFU / ml.

The root canal treatment with Belodez according to the results of the study on the 12th day of treatment made it possible to reduce the seeding by an average of 70%, Staphyloccus aureus was isolated, growth of enterococcus, E. coli, and no porphyromonads were detected.

After treating the root canals with Terrilitin during bacteriological examination, the canals are sterile, no growth was detected.

A survey was conducted of patients of both groups before treatment, 6, 12 and 24 months after its completion. Patients chose one of the answer options: “complete absence of pain”, “weak pain, less than 1 time per month”, “pain attacks 2-3 times a month”, “constant pain”. The survey results are presented in the table.

Table

The nature of the severity of pain in the study groups at different periods of patient observation

The nature of the severity of pain Terrilitin + Holisal
abs (%) Belodez + Metapasta
abs (%) before treatment after 6 months after after 12 months after after 24 months after before treatment after 6 months after after 12 months after after 24 months after complete absence of pain 0 (0.0%.) 73 (92.4%.) 69 (87.3%.) 67 (84.8%.) 0 (0.0%.) 71 (91.0%.) 61 (78.2%.) 8 (10.3%.) weak pain, less than 1 time per month 0 (0.0%.) 6 (7.6%.) 8 (10.1%.) 9 (11.4%.) 0 (0.0%.) 6 (7.7%.) 11 (14.1%.) 36 (46.2%.) pain attacks 2-3 times a month 4 (5.1%.) 0 (0.0%.) 2 (2.5%.) 3 (3.8%.) 5 (6.4%.) 1 (1.3%.) 5 (6.4%.) 25 (32.1%.) persistent pain 75 (94.9%.) 0 (0.0%.) 0 (0.0%.) 0 (0.0%.) 73 (93.6%.) 0 (0.0%.) 1 (1.3%.) 9 (11.5%.)

The data presented in the table allow us to state that an effect not known before from the prior art has been proved - the complete absence of pain in patients with apical periodontitis treated with the Terrilitin and Holisal preparations for two years after the treatment. This effect is indirect evidence of the lack of dynamics of destructive processes in periapical tissues, coupled with apical periodontitis. The currently widespread treatment regimen using Belodez as a root canal antiseptic and temporary filling with Metapasta can achieve good results, however, more than 10% of patients report an increase in pain in the long-term follow-up. An X-ray examination of patients complaining of constant pain after treatment indicates the ongoing development of destructive processes, which led to the development of complications such as fistulas, inflammation of the jaw tissue, odontic sinusitis.

The cost of Terrilitin and Holisal preparations included in our complex is not large, the pharmacoeconomic costs of treating one patient are significantly lower compared to the methods and means currently used.

Claims (1)

A method for the treatment of chronic apical periodontitis, including dentin necroectomy, opening the pulp chamber, determining and finding the root canal mouths, characterized in that the root canal is irrigated after each passage of the dental instrument along the channel in a volume of 1 ml per channel with the Terrylitin solution until the dentins are completely removed chips, purulent-necrotic detritus; bring the drug Holisal into the root canals; the procedure for processing and temporary filling of the canal is carried out for 12 days with the replacement of temporary material in the canal every three days.