RU2472465C1 - Method of treating acute periodontitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to dentistry, and is intended for treatment of acute periodontodis. Preparation of carious cavity and mechanical and medicamentous processing of root canal are carried out. Sorbent SUMS-1, crushed to granule size 0.02-0.1 mm, is introduced into canal for a day. After sorbent removal 1% vilon solution is introduced into periapical tissues through canal for 3-5 minutes. After that, root canal is filled with paste, which contains calcium hydroxide, zinc oxide and 1% vilon solution in volume ratio1:1:0.5.

EFFECT: method ensures high treatment efficiency with reduction of remote disease consequences.

2 ex, 1 tbl

Description

The invention relates to medicine, namely to therapeutic dentistry, and can be used to treat acute periodontitis.

The problem of treatment of acute periodontitis is one of the urgent in practical dentistry. In the structure of dental morbidity, periodontitis in the adult population of Russia still occupies the third place after tooth decay and pulpitis and makes up 30-50% in the structure of dental pathology. The effectiveness of the treatment of acute periodontitis is on average about 80%, and this indicator varies depending on the means and methods of treatment, the patient's body resistance and other factors. The decrease in favorable treatment outcomes is due to the difficulties of direct therapeutic effect on periodontium, as well as a high percentage of poorly sealed canals of tooth roots. Despite the use of a large arsenal of medications that have an antiseptic, antibacterial, immunostimulating effect, agents that activate reparative processes, the development of new methods for treating periodontitis remains relevant [1, 2, 3].

A known method of treating periodontitis, in which, after endodontic and drug treatment of the root canal, a mixture of an antibiotic (Cefazolin Sodium), an immunomodulating drug Viferon and a corticosteroid Dexamethasone in a ratio of 1: 1: 0.1 in a dose of 0.5-1 g, removing the mixture beyond the apical opening for 10-15 days [4].

The disadvantage of this method is the long duration of treatment. In addition, the use of a hormonal (glucocorticosteroid) drug can cause a violation of reparative processes in the periodontium due to the immunosuppressive effect.

There is a method of treating periodontitis, which consists in using a mixture of royal jelly in a 4% propolis solution in a ratio of 1: 2 to treat the root canal, and the canal is filled with paste containing royal jelly, propolis solution, vegetable oil and zinc oxide [5]. Using the method allows to reduce the treatment time for periodontitis in teeth with impenetrable canals and to increase the effectiveness of treatment due to the effect on periapical tissues.

However, oil-based filling materials have the properties of being washed out of the root canals, which can lead to a violation of the seal integrity and, in the future, to relapse of the disease.

A known method of treatment of acute periodontitis using the sorbent AUVM [6]. The essence of the method lies in the fact that after the preparation of the cavity in the bath of a 2-5% lipin suspension, the canal is endodontically treated, the canal is dried and turunda with lipin is introduced for 3-5 minutes. Then, at the mouth of the canal, a piece of the sorbent AUVM Dnepr MN is applied under an airtight dressing for a day. The next day, the sorbent is removed, the canal is again treated with a 2-5% suspension of lipin, dried and filled. The apical part of the canal is 1/3 filled with a cross-section of the sorbent impregnated with a suspension of lipin, the remaining part of the root canal is filled with any filling material. A permanent filling is placed on the tooth.

However, the fibrous structure of the sorbent AUVM "Dnepr" MN does not allow hermetically to obturate the apical opening of the root canal, which is one of the conditions for the successful treatment of periodontitis. In addition, the non-hardening composition of the sorbent with lipin, after washing the latter, can be reinfected, which can also lead to the development of complications.

As a prototype, a method for the treatment of acute periodontitis using the SUMS-1 sorbent and vilon was selected [10]. The method consists in the preparation of the cavity, mechanical and drug treatment of the root canals, followed by the introduction into the channels of the powdered sorbent SUMS-1 for a day and filling with paste "Radent" with the addition of 0.5 μg of vilon.

However, the method is not effective enough due to the fact that it is not possible to uniformly introduce and distribute the granules of the SUMS-1 sorbent along the entire length of the root canal, especially narrow, due to their significant size. In addition, the lack of accurate volumetric ratios of the ingredients included in the filling paste leads to a violation of its proportions, which can lead to a change in properties, and therefore, a decrease in the therapeutic effect.

To increase the effectiveness of the treatment of acute periodontitis by increasing the therapeutic effect on periodontal tissues, after endodontic and drug treatment, 0.05-0.1 g of SUMS-1 powdered sorbent, ground to 0.02-0.1 mm, is added to the root canal per day. After a day, the canal is again subjected to drug treatment, 1.0 ml of 1% vilon is injected with an endodontic syringe, pumping it into the periapical tissues, after 3-5 minutes the canal is dried and filled with a paste consisting of calcium hydroxide, zinc oxide and vilon solution in bulk ratio: 1: 1: 0.5.

The method is as follows.

After the preparation of the cavity, under the antiseptic bath of a 3% hydrogen peroxide solution, putrid masses are removed from the root canal and its endodontic and antiseptic treatment with a 3% hydrogen peroxide solution is performed. Then the channel is dried with paper pins, 0.05-0.1 g of pre-crushed to 0.02-0.1 mm powdered sorbent SUMS-1 is introduced and closed with a temporary seal made of glass resin cement (SIC) for 1 day. On the second visit, in the absence of clinical signs of an acute inflammatory process, a temporary filling is removed, the SUMS-1 sorbent is washed out of the channel with a 3% hydrogen peroxide solution. Using an endodontic syringe, 0.1-0.2 ml of a 1% vilon solution is injected into the periapical tissues through the canal for 3-5 minutes Then the channel is dried with paper pins. A paste is prepared: calcium hydroxide is mixed with zinc oxide and a 1% solution of vilon is added in a volume ratio of 1: 1: 0.5, mixed until a homogeneous paste-like consistency is obtained. Fill the root canal with paste using a canal filler and gutta-percha pins to the level of the apical opening. After x-ray quality control of filling the canal, a permanent filling is placed on the tooth.

The development of the proposed method for the treatment of acute periodontitis became possible due to the experimentally established ability of the sorbent ground to 0.1-0.2 mm to adsorb microflora infecting them and decomposition products from periodontal tissues more effectively by increasing the total adsorbent adsorbent surface area. At the same time, the process of acute inflammation is rapidly eliminated in the periodontal tissues and reparative regeneration is stimulated. Due to the action of the vilon, a targeted effect on local immunity in pathologically altered periodontal tissues is carried out, as well as the rapid restoration of damaged tissue structures. This in turn affects the reduction of treatment and rehabilitation, reduces the likelihood of complications. Hypersensitivity and allergic reactions after the use of the drug were not detected. In addition, the sorbent ground to 0.1-0.2 mm is easily introduced and evenly distributed along the entire length of the root canal.

The synthetic carbon-mineral enterosorbent SUMS-1 combines the effectiveness of a detoxifying effect with harmlessness (it does not extract useful components from the body). It meets the following basic medical requirements: a) does not have toxic properties; b) is non-traumatic for the mucous membranes; g) has good functional (sorption) properties. The mechanisms of its therapeutic effect of sorption are associated with direct and indirect effects: prevention or weakening of toxic-allergic reactions; sorption of endogenous secretion and hydrolysis products; sorption of neuropeptides, prostaglandins, serotonin, histamine, etc .; correction of metabolic processes and immune status; improving the humoral environment, eliminating the imbalance of biologically active substances; restoration of the integrity and permeability of biological membranes; sorption of pathogenic bacteria and bacterial toxins [7].

Vilon is a dipeptide consisting of two amino acids (Lys-Glu), isolated from thymalin, and then synthesized and superior in its activity to thymogen. It stimulates cellular immunity and nonspecific resistance of the body, significantly enhances the expression of receptors on T and B lymphocytes, and stimulates the production of pro-inflammatory cytokines - IL-1α, IL-1β, IL-8 and TNFα. Vilon is authorized by the Russian Pharmacological Committee as an immunomodulating drug. It has been widely used in adults and children as a stimulator of tissue regeneration in case of purulent-inflammatory diseases and postoperative complications, trophic disorders, as well as diseases accompanied by impaired reparative processes [8, 9].

Due to its high pH - 4.13, Ca (OH) ₂ has an antibacterial effect [11].

ZnO (zinc oxide, amphoteric oxide) is widely used as a component of drugs, because it has anti-inflammatory, drying, adsorbing, astringent and antiseptic effects [3].

The results of applying the treatment method are presented in clinical examples.

EXAMPLE 1. Patient D., 40 years old, applied for acute periodontitis of tooth 22, which had previously been treated for tooth decay. The patient was worried about acute pain, aggravated by biting on the causative tooth.

Objective research: tooth 22 under permanent filling. The reaction to temperature stimuli after its removal is painless. Tooth percussion is sharply painful. The mucous membrane of the gum in region 22 is hyperemic and edematous. The transitional fold is smoothed, its palpation is painful. On the roentgenogram no significant changes in the periodontal gap were noted. On the first visit, the filling was removed, the tooth cavity was opened, the remains of putrid masses were evacuated from the canal. Its endodontic and drug treatment with 3% hydrogen peroxide solution was carried out, the canal was dried with paper pins. 0.05 g of preliminarily ground to 0.1-0.2 mm powdered sorbent SUMS-1 was introduced into the channel. The tooth is closed with a temporary filling from the JRC. After a day, the patient had no complaints, tooth percussion was painless, the mucous membrane of the gums was pale pink, painless on palpation. The dressing was removed, the canal was treated with a 3% solution of hydrogen peroxide, distilled water. 0.2 ml of 1% vilon was injected into the root canal with an endodontic syringe, pumping it into the periapical tissue for 3 minutes. After that, the channel is dried with paper pins. A paste is prepared consisting of calcium hydroxide powder, zinc oxide powder, 1% vilon solution in a volume ratio of 1: 1: 0.5. The canal is sealed with cooked pasta, gutta-percha pins. When x-ray quality control of filling the channel noted that it is sealed to the apical opening. Permanent seal made of composite. No complications were observed after filling. After 12 months on the control x-ray changes in the periapical tissues were not detected.

EXAMPLE 2. Patient P., 27 years old, was undergoing treatment for acute periodontitis of tooth 36. The patient was disturbed by pain in the area of tooth 36, aggravated by biting on him. A day ago, there was an acute pain when biting on a tooth, which gradually increased.

Objectively: there is a permanent filling on the chewing surface of tooth 36. The reaction of the tooth to thermal stimuli is painless, and its percussion is sharply painful. The mucous membrane in region 36 is hyperemic, swollen and painful on palpation. On the radiograph before treatment, the expansion of the periodontal gap is determined.

The patient removed the seal. After preparation of the cavity, putrid masses were removed from the channels under the bath of a 3% hydrogen peroxide solution, endodontic and drug treatment with a 3% hydrogen peroxide solution, distilled water, 1% vilon was performed. The channels are dried with paper pins. About 0.1 g of preliminarily ground to 0.1-0.2 mm powdered sorbent SUMS-1 was introduced into the channels and the tooth was closed with a temporary filling from the SIC. After a day, the patient had no complaints, tooth percussion was painless, the mucous membrane of the gums was pale pink, painless on palpation. Temporary filling removed, canals treated with 3% hydrogen peroxide solution, dried. An endodontic syringe was injected into the periapical tissue 0.2 ml of 1% vilon. After 3 minutes, the channels were dried with paper pins, sealed with gutta-percha pins and a paste consisting of calcium hydroxide powder and zinc oxide powder and 1% vilon solution in a volume ratio of 1: 1: 0.5. Then a permanent seal from the composite is applied. No complications were observed after filling. On the control R-gram, the root canals are sealed all the way to the tops. After 12 months on the control x-ray changes in the periodontium were not detected.

The method is simple and accessible to a dentist of any skill. The use of the proposed method of treatment in 81 patients with acute periodontitis compared with the traditional method and the prototype method showed its high efficiency, especially in long-term follow-up (Table).

Table Clinical performance indicators for the treatment of acute periodontitis Options The traditional way n = 50 Prototype method n = 50 The claimed method n = 81 Number of visits 4.1 ± 0.34 2.2 ± 0.04 2.2 ± 0.05 The average treatment time (days) 7.5 ± 0.4 2.6 ± 0.05 2.5 ± 0.1 Immediate clinical efficacy after 6 months 84.7% 95.5% 96.3% The number of complications after 6 months 15.3% 4,5% 3,7% The number of extracted teeth after 6 months 16% 0 0 The number of complications after 12 months 18.0% 7.2% 3.9% Number of extracted teeth after 12 months 16% 0 0 X-ray evaluation of bone destruction after 12 months (in mm ² ) 5.4 ± 0.4 2.1 ± 0.5 1.2 ± 0.3

Bibliography

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8. Kuznik B.I. The use of peptide bioregulators in dentistry / B.I. Kuznik, I.S. Pinelis, V.Kh. Khavinson. - St. Petersburg: Aesculapius. - 1999. - 142 p.

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Claims (1)

A method for the treatment of acute periodontitis by preparing a cavity, mechanical and drug treatment of the root canal, introducing SUMS-1 sorbent into the canal for 24 hours, followed by filling the canal with paste containing a vilon, and applying a filling, characterized in that the SUMS-1 sorbent is introduced into the root canal , crushed to a particle size of 0.02-0.1 mm, after removal of the sorbent into the periapical tissue, a 1% solution of vilon is introduced through the channel for 3-5 minutes, the root canal is filled with paste containing calcium hydroxide, zinc oxide and 1% ny solution of vilon in a volume ratio of 1: 1: 0.5.