Method of treating complicated intra-canal perforations of solid dental tissues

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to dentistry. Method includes processing perforated root canal and perforation zone with laser irradiation and covering perforation with sealing material. Introduction of light-guide into perforated root canal is carried out. In processing by laser irradiation translational increase of its power parameters is used. During the first session processing is carried out with power 0.5 W, during the second session - 0.75 W, during the third - 1.5 W. Additionally ozone therapy with saturated physiological solution is performed. Time of saturation with ozone is 5 minutes. Concentration of ozone dissolved in physiological solution is 8.8-9.6 mg/l.

EFFECT: method is painless, does not require carrying out local anesthesia, excludes allergic reactions, ensures optimal bactericidal and bacteriostatic effect, which makes it possible to efficiently stop inflammation and reconstruction of bone tissue, reduces number of complications.

1 ex

 

In the conservative treatment of perforations of the teeth is the key to successful therapy is tight obturation of perforating defect. This is achieved by the use of different materials. However, the main problem in the treatment of this pathology is the risk of the development of the inflammatory process in periodontal tissues due to the development of microbial invasion and destruction of the ligaments of the tooth, which can lead to loss [1]. In modern dentistry, attention has focused on ways of closing directly perforating defect, the bacterial treatment of the perforations remains insufficiently addressed [2]. So you need to choose this method of root canal treatment and the site of perforation, which did not injure the tissues of the periodontium and contributed to the fast recovery.

The invention relates to medicine, specifically to dentistry, and is a method of treatment of perforations of teeth.

There is a method of treatment of periodontal disease, complicated by perforation of the bottom cavity of the tooth, when preliminary single processing zone perforation is carried out by the light of the erbium laser with subsequent closure of perforation amalgam [3].

The disadvantage of this method is that the amalgam can cause staining of the tooth hard tissues and phenomena of galvanism; with whom persons does not allow further antimicrobial treatment group internal perforations, having a large specific weight among all perforations. The method does not consider the use of biologically inert irrigant for root canals with perforation. In the treatment of perforations, complicated resorptive changes in bone, once the procedure of laser treatment is insufficient.

Also known is a method of treatment of perforation of the bottom of the tooth cavity fiber Pleasanton treated with 0.02% chlorhexidine and 1% solution etoniya [4].

The disadvantage of this method is that the method involves medical treatment pleasant and does not consider the use of physical methods of influence, such as laser and ozone, to help prevent sensitization of the organism and the possibility of allergic reactions.

There is a method of treatment of perforations molars when closing the perforation of the bottom cavity of the tooth is made of a polymeric tape, impregnated with a light-cured adhesive. The technique is used to close complicated and uncomplicated furcation perforations molars [5].

The disadvantage of this method is that drug treatment of the perforation defect is limited to a single treatment with 3% hydrogen peroxide solution, which is not sufficient to provide a bactericidal effect. The method does not allow for the combined application of the Oia laser and ozone therapy, did not allow an antibacterial treatment group internal perforations.

There is a method of treatment of complicated perforations of hard tooth tissues with destructive changes in formational the molar region I-II class after perforation of the bottom of the tooth cavity, which provides pre-processing of the bottom of the tooth cavity semiconductor laser three times at a constant power level of laser radiation and the subsequent closure of the perforation defect sealing material. This method is used as a prototype [6].

The disadvantage of this method is the inability of the antibiotic treatment group internal perforations, the method does not allow for additional use of ozone therapy. When using this method is the impact of a semiconductor, not erbium-chromium-laser, the capacity is higher; not used progressive increase capacity, which allows the tissues of the periodontium to adapt gradually to the laser impact.

The aim of the invention is to increase the efficiency of treatment of complicated intra perforations of hard tooth tissues and reduce the number of complications.

This goal is achieved by the fact that the treatment process is used, the introduction of the fiber into perforated arneway channel, preparation of the root canal and the area of perforation by laser radiation with subsequent progressive increase of parameters laser power: first processing session 0.5W; the second 0,75 W, the third 1.5W; in addition, ozone is used saturated saline ozone-oxygen mixture; the feeding of ozone for 5 minutes; the concentration dissolved in physiological solution of ozone is 8.8-9.6 mg/l

Comparison of proposed method with other well-known in this field of medicine means to show compliance with the criteria of the invention.

The method is as follows.

After diagnosing complicated ear perforation clinical and radiographic techniques were removing old fillings, the preparation of necrotic tissue, rasplanirovana causal and other necessary root canal, and then machining. We used the standard technique of mechanical root canal treatment, which was carried out with hand tools K-file, H-file, using a combination of techniques crown-down and step-back; expansion - mechanical rotary instruments Pro Taper (Mallifer, Densply)in combination with ultrasonic treatment (device low-frequency ultrasound "Piezon-Master 600", endotak 120 degrees, the file-sonar 20-25 ISO). As the e chelating agent was used in the preparation of RC-Prep (Premier, USA). For ozonetherapy we used to install ozone therapeutic automatic WATA-60-01 "Madison" (Russia). Using ozone installation saturated saline ozone-oxygen mixture. The feeding of ozone was 5 minutes. Dissolved in physiological solution of ozone ranged from 8.8-9.6 mg/l Volume of ozonized solution used for one treatment ozone therapy, was 2-3 ml Irrigation was carried out using endodontic syringe jet. Laser therapy was performed with the use of modern dental laser systems "Waterlase MD" company Biolase (Germany) with a wavelength of 2780 nm. Used the settings suggested by the author: power - when the first processing session 0.5W; the second 0,75 W, at the third - 1,5 W; pulse duration of 140 µs, frequency - 40 Hz. Processing of data was performed three times with an interval of 2-3 days. Used burst mode laser. Used quartz fiber Z-2 for the treatment of root canals. When processing the root canal length of the fiber was installed less measured the working channel length of 1.2 mm was Introduced the fiber into the channel, activated by the laser, and, holding it at an angle to the opposite wall, out of the channel within 10 seconds. Turning off the laser output from the mouth of the channel. The procedure was carried out 3 times, SC is every time changing the direction of impact. Each session was conducted at the next visit, accompanied by ozone therapy, the interval between visits 2-3 days. As the sealing material used the drug "Trioxide" company "Vladiv" (Russia). In between visits to the root canal was introduced based paste of calcium hydroxide ("Calasept", "Metapasta"). The tooth is covered by a band of glass ionomers cement GC Fuyi IX (PR-VA Japan). The final restoration or prosthesis was performed in follow-up visits.

The proposed method is painless, does not require local anesthesia, has a high antibacterial effect, eliminates allergic reactions on the part of the patient, effectively arrest the inflammation, provides restoration of bone tissue, and reduces the number of both immediate and late complications of treatment ear perforations hard tissues of the tooth.

Using the above method, was conducted in the treatment of complicated intra perforations 24 patients. Among them immediate complications such as pain in namasivaya cause tooth was observed in 5 cases. Pain was relieved during the treatment for 3-4 days. Distant complication in the form of increased hearth resorption was observed in 1 case that was associated with the progression of Zab the diseases of parodontium.

Example. Patient U., 29 years old, came with complaints about the presence of cavities in the tooth 3.6. From the anamnesis revealed that the tooth was cured about pulpitis more than 10 years ago. Objective examination: the mucous membrane of the transition folds and alveolar bone around the tooth 3.6 pale pink color, with no signs of inflammation. The crown part of the tooth is destroyed by¾. On the chewing surfaces - seal with priznaki violations marginal fit. On chewing-distal surface there is a deep carious cavity of medium size. The color change of the tooth crown 3.6. suggests that previously were treated resorcinol-formalin method. Percussion of the tooth 3.6 sensitive. On the radiograph: root canals obturated unsatisfactory, in the middle third of the medial root is determined by the presence of perforation complicated by the hearth resorption of bone tissue with a diameter of 0.4 mm; in the periapical area - extension of the periodontal gap up to 1 mm. diagnosed with chronic fibrotic periodontitis, single complicated intra perforation tooth 3.6.

Treatment. After removing the seals carried out the preparation of the modified tooth tissues, rasplanirovana all three root canals. The treatment was carried out in compliance with current protocols endodontic vmeshatelst is. When rasplanirovana revealed the presence of a perforation in the middle third of the medial lingual root. The root canals were enlarged to 035 size ISO. Audited and machining punching stroke to 025 size ISO. Then was carried out processing of root canals and punching stroke low-frequency ultrasound apparatus "Piezon-Master 600", endotak 120 degrees, file sounder 25 ISO. Irrigation was carried out ozonated saline in a volume of 2 ml inkjet using endodontic syringe. For the ozone therapy was used to install ozone therapeutic automatic WATA-60-01 "Madison" (Russia). Using ozone installation saturated saline ozone-oxygen mixture. The feeding of ozone was 5 minutes. Dissolved in physiological solution of ozone ranged from 8.8-9.6 mg/l was Then performed laser therapy with the use of dental laser systems "Waterlase MD" company Biolase (Germany) with a wavelength of 2780 nm. Used quartz fiber Z-2 for the treatment of root canals. When processing the root canal length of the fiber was installed less measured the working channel length of 1.2 mm was Introduced the fiber into the channel, activated by the laser, and, holding it at an angle to the opposite wall, out of the channel within 10sec. Turning off the laser output from the mouth of the channel. The procedure was carried out 3 times, each time changing the direction of impact. Asked the radiation power at the first session of treatment was 0.5 W; the second 0,75 W, while the third is 1.5 watts. Used burst mode laser. Each session was conducted at the next visit, accompanied by ozone therapy, the interval between visits 2-3 days. In between visits in the root canals were introduced pasta-based calcium hydroxide "Metapasta" under the bandage. Sick invited to check-UPS in 1 week, 3 months, 6 months, 1 year, 2 years.

When you re-examinations: during the second visit, the patient complained of slight pain in namasivaya on the tooth 3.6, in the third and subsequent visits, there was no complaint. The mucous membrane around the tooth 3.6 pale pink color, with no signs of inflammation. Percussion of the tooth 3.6 weakly positive in the second visit. In the third visit perforation defect is closed by the drug "Trioxide" company "Vladiv" (Russia), and also held a permanent obturation of root canals with a control x-ray. In follow-up visits carried out the preparation of root canals under the tab, prosthetics tab and artificial crown. On the control x-ray after 6 months, 1 year, 2 years periodontal ISM is to apical zone and in the area of perforation defect decreased.

The proposed methodology can be used for the treatment of complicated intra perforations hard tissues of the tooth in the primary and endodontic treatment in dental clinics outpatient care.

SOURCES of INFORMATION

1. Borovsky E.V., zhokova NS Endodontic treatment. Manual for doctors. - M, 1997. - 64 S.

2. Khomenko L.A., Bidenko N.V. Practical endodontics. Tools, materials and methods. - M.: Book plus, 2002. - 216 C.

3. Pomoinitskii V.G. Way to close the perforation of the bottom cavity of the tooth. - A.S. No. 1731221 / A61C 5/00. - Bull. Image. No. 17 from 07.05.1992.

4. Serebrennikov E.V., V.N. Timofeev. A method of treating periodontal disease, complicated by perforation of the bottom cavity of the tooth. - Patent RU No. 2238119 / A61N 5/067/. - Bull. image. from 20.10.2004. no application 2002131723/14.

5. Kukushkin V.L., Kukushkin E.A., Smirnitsky MV treatment furcation perforations molars. - RF patent №2345732 from 10.02.2009, the priority of the invention of 13.06.2007.

6. Gerasimov, L.P., Sorokin A.P. Method of treating teeth with destructive changes in formational the molar region I-II class after perforation of the bottom cavity of the tooth. - RF patent №2393850 10.07.2010, priority of invention from 30.12.2008.

The method of treatment of complicated intra perforations hard tissues of the tooth by three-time processing of perforated root canal and the area of perforation laser) is rising and the subsequent closure of perforation sealing material, characterized in that the treatment process are the introduction of the fiber into the perforated root canal treatment root canal and the area of perforation by laser radiation with subsequent progressive increase of parameters laser power: first processing session 0.5W, when the second - 0,75 W, at the third - 1,5 W; in addition, ozone is used saturated saline ozone-oxygen mixture; the feeding of ozone 5 min; concentration of dissolved in physiological solution of ozone is 8.8-9.6 mg/L.



 

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