RU2267985C1 - Method for evaluating pulp viability after odontopreparation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves recording dental pulp blood vessels rheodendogram and determining vascular tone index value. Patient electrocardiogram is recorded during the whole dental treatment course before and after tooth odontopreparation concurrently with dental pulp blood vessels rheodentogram recording. Parasympathetic division of nervous system activity index is measured. Vascular tone index ratio with respect to parasympathetic division of nervous system activity index value is determined. The value is compared to a reference value corresponding to its value measured before carrying out odontopreparation. The received value deviating from norm and being not greater than 30%, inflammation process progress in dental pulp is considered to be the case and removal of tooth pulp is advised.

EFFECT: high accuracy and information capacity of evaluation results.

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Description

The invention relates to medicine, to therapeutic and orthopedic dentistry, and in particular to methods for assessing the state of the inflammatory process of tooth pulp after odontodiagnosis.

A known method of determining inflammation of the pulp of the tooth by the method of electroodontodiagnosis (Chertykovtsev VN Pulp of the tooth. Modern diagnostic methods. - M., 1999, p.21-23).

The disadvantage of this method is the fact that during electroodontodiagnostics it is necessary to take into account the fact that the digital indicators of its results depend on the age of the patient, his mental state and the excitability of his nervous system, as well as the anatomical size of the tooth, the correct position of the active electrode, the presence of denticles in the pulp chamber.

The closest in technical essence and the achieved result is a method for determining inflammation of the pulp of the tooth by reoentography based on the measurement of complex electrical resistance, the so-called impedance. A tooth impedance is measured by passing a high-frequency electric current through it.

Measurement of tooth impedance occurs at the time of increasing the speed and volume of blood in the vascular system of the pulp with systole of the heart. The magnitude of the impedance of the tooth is observed during reententography on a computer monitor in graphical form. With the complete coincidence of the reententograms according to their configuration, the absence or presence of pathological changes in the pulp of the tooth is diagnosed. In addition to a visual assessment, the pulp vessels tone and their functional state are determined by the amplitude-time segments of the rheodogram (RDG) - numerical indicators such as the peripheral resistance index - IPS, the elasticity index - IE, the vascular tone index - PTS and the rheographic index - RI. (Chertykovtsev V.N. Pulp of tooth. Modern diagnostic methods. - M., 1999, p.21-23).

With all the advantages of the known method, the following disadvantages should be noted: the lack of clear indications for tooth removal, the likelihood of the reversibility of the inflammatory process.

The technical result, the achievement of which the creation of this invention is directed, is to increase the accuracy and information content of assessing the state of the inflammatory process of the tooth pulp after odontopreparation by using the parasympathetic tone index of the patient's autonomic nervous system in the diagnosis of the inflammatory process of the tooth pulp.

The technical result achieved is achieved by the fact that in the method for assessing the inflammatory process of the tooth pulp after odontodiagnosis, based on the registration of the rheodogram of the pulp vessels of the tooth, determining the value of the vascular tone index, throughout the dental treatment, before and after odontopreparation of the tooth, the patient’s electrocardiogram is recorded simultaneously with registration rheodograms of the pulp vessels of the tooth, measure the activity index of the parasympathetic autonomic nervous system Patient system further determines the ratio of the index of vascular tone index to the value of the activity of the parasympathetic division of the autonomic nervous system and by the deviation values derived from the relationship rules judged on the nature of the inflammatory process, the pulp of the tooth of the patient.

The method is as follows.

Prior to the preparation of the test tooth, the pulmonary vessels rheodograms are recorded by the DIASTOM device with a computer analysis of diagnostic indicators (the DIASTOM device was approved by the Committee on New Medical Technology of the Ministry of Health of the Russian Federation in 1996 and mass-produced by the MEDASS company in Moscow), and the indicator value is determined vascular tone (PTS).

Simultaneously with the removal of the reententogram, the patient’s electrocardiogram is recorded with the ELON-001M2 device, which is produced commercially by the New Instruments company (certificate No. POCC Ki.IM02.V08674), and the index of the parasympathetic department (PAR) of the patient’s autonomic nervous system is determined (L. Kalakutsky I., Manelis ES, Clinical Monitoring Equipment and Methods, Textbook, Samara State Pedagogical University named after Academician SP Korolev, Samara, 1999, pp. 31-33).

Next, determine the ratio of the value of the indicator of vascular tone (PTS) to the value of the index of the parasympathetic department of the autonomic nervous system (PAR), expressed as a percentage. The obtained value of the ratio is taken as the norm (initial value), which exceeds 30%, which indicates the viability of the tooth pulp.

After odontopreparation of the studied tooth, the reententogram of the pulp vessels of the tooth is recorded and the value of the vascular tone index (PTS) is determined.

Next, an electrocardiogram is recorded in the patient with the ELON-001M2 apparatus and the index of the parasympathetic division (PAR) value of the autonomic nervous system is determined.

Then determine the ratio of the value of the vascular tonus index (PTS) to the value of the index of the parasympathetic department (PAR) of the patient's autonomic nervous system, expressed as a percentage. The obtained value is compared with the norm (initial value). If the obtained value has a deviation from the norm and does not exceed 30%, then the development of the inflammatory process in the tooth pulp is judged, and the tooth must be depulped.

CLINICAL EXAMPLE. Patient S., 28 years old, turned to the dental department of KMSCH No. 3 for the purpose of sanitation of the oral cavity. He complained of defects in the dentition.

Objectively:

Dental formula FROM FROM ABOUT FROM P P P P FROM FROM P 17 16 fifteen fourteen 13 12 eleven 21 22 23 24 25 26 27 47 46 45 44 43 42 41 31 32 33 34 35 36 37 P FROM FROM FROM ABOUT

C - caries;

P - seal;

About - the absence of a tooth.

The condition of the abutment teeth: 16 and 14 - deep caries, 35 and 37 - intact.

Diagnosis: Partial secondary adentia in the upper jaw and lower jaw, Kennedy Grade 3.

We studied the rheographic index of PTS in the abutment teeth before and after deep odontodiagnosis for ceramic-metal prostheses (Table 1).

Then, an electrocardiogram was recorded at all clinical stages of prosthetics. The value of the parasympathetic department of the autonomic nervous system was obtained: PAR (see Table 1).

We determined the ratio of the value of the vascular tone index (PTS) to the value of the parasympathetic department (PAR) of the autonomic nervous system, expressed as a percentage. It amounted to:

1. In 35 and 37 intact teeth, 35.7% before preparation, 44.4% after preparation, 43.3% after 24 hours, 34.3% after 3 days, 29.4% after 5 days. Inflammation of the pulp 35 and 37 of the tooth developed. The teeth were depulpated.

2. In 14 and 16 teeth, 40% before preparation, 43.2% after preparation, 46.2% in a day, 40.2% in 3 days, and 36.7% in 5 days. These abutment teeth maintained pulp viability after odontodiagnosis.

It is possible to carry out an unlimited number of measurements of the index of the inflammatory process in the tooth pulp at all stages of treatment or prosthetics. The method is absolutely harmless to both the patient and the researcher, non-invasive.

Using the proposed method allows to determine the inflammation of the pulp in an intact tooth, a tooth with a carious process, pulpitis, periodontitis, as well as the reaction to the preparation of hard tooth tissues in therapeutic and orthopedic dentistry.

The studies of 82% of the examined patients showed the effectiveness of this method for assessing the state of the inflammatory process of the tooth pulp, as well as accuracy and information content, as it contains a clear practical recommendation for the dentist about treatment tactics.

Claims (1)

A method for assessing the viability of tooth pulp after odontodiating, including registration of a rheodogram of the pulp vessels of the tooth, determining the value of the vascular tone index, characterized in that during the entire dental treatment of the patient, before and after odontopreparation of the tooth, the patient's electrocardiogram is recorded simultaneously with the registration of the rheodogram of the pulp of the tooth, measure the activity index of the parasympathetic department of the autonomic nervous system of the patient, then the ratio was determined The reasons for the vascular tone index to the value of the activity index of the parasympathetic department of the autonomic nervous system compare the value of the ratio with the norm, which corresponds to the value of the ratio used before odontopreparation, and if the obtained value deviates from the norm and does not exceed 30%, then the development of an inflammatory tooth in the pulp is judged process, which indicates the need to depulpate the tooth.