Method of treatment of dental nerve neuritis caused by filling material delivery into mandibular canal

FIELD: medicine; dentistry.

SUBSTANCE: treatment of inferior dental nerve neuritis caused by filling material delivery into mandibular canal is ensured with introduction of antibacterial agent before operation. Thereafter filling material is surgically removed from mandibular canal. Operation procedure is followed with introduction of antibacterial and immune correcting agents, antisensitisers, Reaferone, vitamins B1 and B12, adenosine triphosphate. Besides mandibular region is exposure to laser magnetotherapy with using dental apparatus Optodan, accompanied with intraoral HBO-therapy, hydromassage, hydrocortisone phonophoresis, 2% nicotinic acid solution amplipulse phoresis, Tambukan mud therapy, pine needle and pearl baths, acupuncture with using local and regional points.

EFFECT: higher treatment efficiency, restored blood circulation, accelerated rehabilitation, complete relief of evident pain syndrome and post-amputation pains, simplicity, efficiency.

3 ex

 

The invention relates to medicine, namely to dental surgery.

The problem of prevention and treatment of complications arising from the filling of root canals of teeth different materials, remains relevant. One of the causes of complications is the removal of filling material in the mandibular canal because of errors dentist and anatomy of the lower jaw. Damage to the lower alveolar nerve filling material, expressed in continuous pain, neuritis, as well as the possible development of inflammatory processes in the surrounding tissues, requires surgical treatment and active intraoperative therapy. In this regard, early diagnosis and treatment of this disease, causing severe suffering to patients, it is socially significant and relevant way to improve dental care.

There is a method of rendering first aid in case of neuritis in neurosonology [1].

With this method are only accepted methods of restorative treatment: physiotherapy, procaine blockade, without addressing the root cause of disease - filling material in the mandibular canal.

There is a method of treatment of odontogenic neuritis persons of different etiology and Genesis [2].

However, in the method of the lack of the comfort a way of helping patients with neuritis of the lower alveolar nerve, caused by the removal of filling material in the mandibular canal.

There is a method of treatment of neuritis of the trigeminal, glossopharyngeal, lingual and facial nerve [3].

The method represents a combination of the methods of treatment of neuritis in one standard scheme, regardless of the etiology or cause of the disease. Detailed recipes and regimens are only Advisory.

There is a method of treatment of neuritis of the lower alveolar nerve caused by excretion of hot gutta-percha in the mandibular canal. For example, clinical case, the authors of the method will describe the approach for surgical intervention to remove gutta-percha from the mandibular canal [4].

However, in addition to antibiotic treatment, intraoperative therapy was not carried out. There are no measures to restore the sensitivity of the zones of innervation of the lower alveolar nerve.

The closest in technical essence is a method of treatment of injuries of the lower alveolar nerve caused by removal of filling material in the mandibular canal [5].

After surgery to remove the filling material of the mandibular canal within 7 days is the clinical observation of patients assigned to 5 sessions of physical therapy with the use of laser light is uchebnogo apparatus "Optodan". The first 2 treatments at 1-m channel with exposure time 2 min, then 2-3 procedures - 2-m channel with the same exposure time 2 minutes

However, when using this method, postoperative therapy in the remote terms after the intervention is not carried out, the process of restoring the sensitivity of the nerve is only monitored at the control visits. There is no comprehensive and systematic approach to the treatment of neuritis of the lower alveolar nerve caused by removal of filling material in the mandibular canal.

The purpose of the invention is improving the efficiency of recovery of function of the lower alveolar nerve in the treatment of neuritis caused by the removal of filling material in the mandibular canal.

The objective is achieved by surgical removal of filling material from the mandibular canal, preoperative therapy, including antibacterial, antisense, immunokorrigiruyuschy tools and postoperative care, including antibacterial, antisense, immunokorrigiruyuschy tools, and course intraoral HBO therapy, amplipulse-phoresis 2% solution of nicotinic acid, vitamin B1and B12, mud Tambukan dirt, ATF, hydromassage, coniferous, pearl and sulfide baths, laser and magnetic therapy apparatus "Optodan", Harel is caterpie, phonophoresis with 0.5% solution of hydrocortisone, antiviral therapy drugs "Gepon" and "IFN".

The METHOD of TREATMENT IS AS follows

Conduct detailed x-ray examination, including panoramic x-rays. Establish precise localization of the filling material in the mandibular canal. After conduction and infiltration anesthesia carry out the removal of filling material from the mandibular canal.

Preoperative therapy includes the use of antibiotics according to the scheme:

"Amoxicillin/clavunate for 30 min before surgery 1.0 g/in;

if you are allergic to penicillins "Roxithromycin" or "Summoned" 150 mg orally 30 min before surgery

the reserve antibiotics - Clarithromycin" 500 mg/m or/in 30 min. prior to surgery or "Clindamycin" 600-900 mg/30 min before the operation.

Postoperative therapy includes:

antibacterial, immunokorrigiruyuschy, antisense drugs, and medicines and therapeutic measures that improve the redox processes in the tissues of the lower jaw according to the following schema:

Antibacterial, immunokorrigiruyuschy antisense funds:

"Amoxicillin/clavunate" 625 mg 3 times a day for 6 days; "Cethrin" 0.2 mg 3 times a day for 7 days. "Euler" 2 ml/m every other day for 10 days; "Acyclovir" 0.4 mg 2 times a day for 7 days.

If you are allergic to penicillins - "Clarithromycin" 500 mg 2 times a day 6 days; "Cethrin" 0.2 mg 3 times a day for 7 days. "Neovir" 2 ml/m every other day for 10 days; "Acyclovir" 0.4 mg 2 times a day for 7 days. If necessary, in cases of herpes sores - assign applications "Reaferona" No. 10-12.

If you are hypersensitive antibiotics reserve:

"Clindamycin" 500 mg 3 times a day for 6 days; "Cethrin" 0.2 mg 2 times a day for 7 days. "Cold" to 2 ml of a 12.5% solution to introduce/m according to the scheme: 1, 2, 4, 6, 8, 11, 14, 17, 20, 23, 26 and 29 days;

With intolerance to beta-lactams prescribed macrolides ("Roxithromycin" or "Summoned"),

- to normalize the blood circulation and the elimination of tissue hypoxia, particularly in individuals with a long term filling material in the mandibular canal, after the operations are performed in the course of local (intra-oral) HBO therapy (hyperbaric oxygen therapy). Device in the form mouthguard with suction Cup, vacuum groove and the suction fitting is made from fast-curing plastic for each patient individually. The duct through the discharge nozzle into the chamber serves oxygen, making the camera an increased pressure of 100-150 mm Hg at a constant level within 15 minutes of the Course of treatment is 15-25 sessions within 2 months;

- amplipulse-phoresis 2% solution of nicotinic acid 15 procedures within 30 days;

- vitamin - vitamin B12- 500 ág 1 ml/m No. 12, B12 ml of 5% solution V/m No. 12;

- mud treatment for the recovery of peripheral blood circulation and sensitivity in the soft tissues - exterior applications on the temporomandibular region of Tambukan dirt (Tambukan dirt is a unique natural complex of paraffin, oil and resin extracted on the territory of Stavropol region of lake Tambukan) isolating a napkin machine "Thread-1" (current - 1-2 µa) on the jaw and submandibular region for 15 minutes in the course of treatment every other day for 30 days;

- ATP at 1 ml/m No. 10-20;

Spa treatment - massage jets No. 10, coniferous, pearl No. 10 and sulfide baths No. 10;

- laser and magnetic therapy with the use of a semiconductor laser diode that generates pulsed light with a wavelength of from 0.85 to 0.98 μm, a pulse power 2-4 W, pulse duration of 40-100 not, with the pulse frequency is 1.5-2.0 kHz, the magnetic field 35 MTL apparatus "Optodan". The first 5 sessions are held on the 1st channel with exposure time 2 min, then 5 procedures - 2-m channel with the same exposure time 2 min every other day for 20 days;

- acupuncture using local and regional points score (proekti the mandibular and chin holes of the lower jaw) needles with a length of 13 mm at point "3" (the third square, in the middle of the top horizontal line drawn through the lobe of the ear on the affected side) two courses for 10-15 treatments with an interval of 10 days;

- phonophoresis with hydrocortisone (in patients with term filling material in the mandibular canal over 6 months) 10-15 procedures within 30 days;

- for the prevention of herpes sores prescribe antiviral drugs in the form of 5-10 multiple applications "Reaferona", which is applied on the affected skin and mucous membrane 5 times a day for 5-10 days.

This method of treatment of odontogenic neuritis caused by the removal of filling material in the mandibular canal was used in 112 patients, of whom 109 women and 3 men, aged 19 to 55 years. Positive results and short-term recovery of sensitivity after a comprehensive physiotherapeutic rehabilitation of patients in these schemes allow to recommend this method for a wide implementation in practice.

EXAMPLES of SPECIFIC performance

1. 46-year-old patient M., AMB. map No. 3117, turned 6 months after the sealing of the root canal 35 tooth to surgeon-dentist by place of residence because of continuing pain in the lower jaw on the left. EDI premolars and molars on the affected side - 75-90 MCA, the sensitivity of the bullets is s the incisors and canines were missing. Analysis of orthopantomogram revealed a radiopaque foreign body in the anterior mandibular canal in the area 35 of the tooth.

Before surgical intervention performed preoperative antibiotic therapy - Amoxicillin/clavunate for 30 min before surgery 1.0 g/century underwent surgical removal of filling material from the mandibular canal.

In the postoperative period used: "Amoxicillin/clavunate" 625 mg 3 times a day for 6 days; "Cethrin" 0.2 mg 3 times a day for 7 days. "Neovir" 2 ml/m every other day for 10 days; "Acyclovir" 0.4 mg 2 times a day for 7 days.

Postoperative wound healing was uneventful. After 8 days were the stitches removed. In the future, for the recovery of peripheral blood used treatment: applications "Reaferona", injections of vitamin B1and B12No. 12, ATP No. 10, and a course of oral HBO therapy No. 10, hydromassage No. 5, phonophoresis with hydrocortisone No. 10, amplipulse-phoresis 2% solution of nicotinic acid No. 10, mud Tambukan mud mandibular region No. 10, coniferous, pearl and sulfide baths No. 10, acupuncture, using local and regional points No. 15.

Follow-up examination after 6 and 12 months revealed complete recovery of sensitivity in azannyh departments face, EDI incisors and canines and molars 6-8 mA.

2. 38-year-old patient S., AMB. map No. 3427 appealed with complaints about the violation of the sensitivity of the skin in the area of the right lower lip and chin, but without obvious pain. The patient reported that 4 weeks ago she had been sealed channels 46 and 47 of the tooth.

Objectively: 42, 43, 44, 45, 46, 47 the teeth did not respond to thermal and electrical stimulation (EDI molars - 75 µa). X-ray study showed the removal of filling material in the region of the distal root 47 tooth in the right mandibular canal.

Preoperative therapy was conducted according to the above diagram. Under appropriate local anesthesia performed surgical removal of filling material from the mandibular canal, with decompression of the lower alveolar nerve. The postoperative period was uneventful, were appointed physiotherapy and anti-inflammatory therapy as shown in the diagram. Sensitivity in the gums and lower lip recovered after 3 months, EDI molars 6-12 MCA, incisors and canines - 8-12 mA.

3. Patient B., 39 years old, AMB. map No. 3120 has complained of numbness of the left half of the lower lip and chin, as well as nagging and nagging pains. According to the patient, about 10 months ago, she sealed the root channels 47 and 46 of the tooth, and 2-3 days immediately is the n minor pain and numbness of the lower lip, after 4 weeks the pain, radiating to the ear and temple, numbness not only the lower lip and chin. X-ray analysis showed that in the region 47 of the tooth, in the projection of the mandibular canal, there is a foreign body, presumably, the excess filling material, diffuse spread in the bone tissue. Conducted pre-operative therapy in the diagram above. Filling material was removed from the mandibular canal. Conducted complex postoperative rehabilitation in the diagram above. 12 months after surgery, pain, dryness of mucous and numbness of the skin of the chin sick't bother.

4. A patient With a-Ko, NP, AMB. map No. 3449. Complaints about constant pain in the left lower jaw, numbness of the lower lip and the skin of the chin. On the radiograph - filling material placed in the mandibular canal during endodontic treatment of tooth 45. The diagnosis of odontogenic neuritis of the lower alveolar nerve caused by removal of filling material in the mandibular canal. Was treated by the method of the prototype.

Patients received surgery to remove lauromacrogol material from the mandibular canal.

Next was held postoperative therapy prototype.

3 months after surgery remained complete numbness of the skin under the of orozca, EDI molars and premolars - 35-40 MCA, incisors and canine - 25-35 µa. After 12 months, the sensitivity of the teeth and gums has not changed, remained numb the skin of the lower lip and chin. The patient complains of ongoing night phantom pain, radiating to the head and neck. After 1.5 years the results of the EDI molars was 15-18 MCA, premolars - 16-18 MCA, incisors and canine - 14-18 μa, indicating the lack of recovery of blood circulation and innervation in the pool signalware artery and nerve.

Therapeutic measures by the present scheme allows for complete removal of pronounced pain syndrome and phantom pain. Methods of reconstruction of the circulation in the pool signalware artery efficient, affordable, technically simple and accelerate the rehabilitation process at 75-80% compared with the period of rehabilitation of patients under the existing method.

SOURCES of INFORMATION

1. Grechko VE Emergency care in neurosonology. - M.: Medicine, 1981. -200 C.

2. Charles C. A. Neurology person. - M, Medicine. - 1991. - 285 S.

3. Yakovlev V.I., Trofimova E.K., Davidovich SO, Proviral G.P. Diagnosis, treatment and prevention of dental diseases. M., 1994. 493 S. - s-357.

4. Blanas N, F Kienle, Sandor GK. Injury to the inferior alveolar nerve due to thermoplastic gutta-percha. J Oral Maxillofac Surg 2002; 60(5):574-6.

5. Tomasov MV Rationale of treatment ill the x with complications associated with the removal of filling materials in the mandibular canal. - Diss. Kida. the honey. Sciences, M., 2003. - 147 C.

A method of treatment of neuritis of the lower alveolar nerve caused by removal of filling material in the mandibular canal, including surgical removal of filling material from the mandibular canal, and carrying out lasermagnetic apparatus "Optodan", characterized in that before the operation, enter an antibacterial agent, and after surgery impose additional antibacterial, immunokorrigiruyuschy, antisense funds, IFN, vitamin B1and In12, ATF, as well as conduct course intraoral HBO-therapy, hydro-massage, phonophoresis with hydrocortisone, amplipulse-phoresis 2% solution of nicotinic acid, mud Tambukan mud mandibular region, coniferous, pearl and sulfide baths, acupuncture, using local and regional points.



 

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4 ex

FIELD: medicine; surgery.

SUBSTANCE: adhesion therapy following thoracic and abdominal organs surgery is ensured with multiple daily applications of Tizol gel and salicylic acid mixed as: salicylic acid 0.2 g and Tizol gel to 10 g, thus coating incision cicatrix and skin, adjacent anterior abdominal wall or thorax part over lesion focus. Thereafter within three months, multiple daily applications of medicinal composition containing Tizol gel and Lidase mixed as: Lidase 128 st.units per Tizol gel 10 g are used for the indicated regions. Herewith three physiotherapeutic procedures are performed every two weeks as follows: either phonophoresis, or electrophonophoresis, or electrodreging with the specified composition containing Tizol gel and Lidase.

EFFECT: creation of medical product depot directly within pathological process, long-acting and continuously pathogenetic affecting connective tissue and preventing adhesions.

3 cl, 9 ex

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