RU2452461C1 - Combined medicated paste for conservative treatment of acute local pulpitis - Google Patents

Abstract

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention refers to medicine and dentistry, namely medical products presented in the form of a paste for acute local pulpitis. The developed combined medicated paste for conservative treatment of acute local pulpitis contains, wt %: lisocyme - 5, vitamin A solution in oil - 5, zinc oxide - 20, 30% dimexide - 5, dexamethasone - 0.1, neomycin - 0.1, Collost-gel - the rest. The paste possesses high penetration strength, stimulates the repair function of a dental pulp.

EFFECT: using the paste provides manifested anti-inflammatory, anaesthetising and antiseptic action.

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Description

The invention relates to medicine and dentistry, namely to medicines made in the form of a paste for the treatment of acute focal pulpitis.

In the treatment of acute focal pulpitis, it is necessary to solve the following tasks: eliminate the pain syndrome, eliminate the focus of inflammation in the pulp, protect periodontal tissues from damage, restore the integrity, shape and function of the tooth. Existing methods of treating pulpitis are divided into conservative ones - aimed at eliminating the focus of inflammation with medical or physiotherapeutic methods while preserving the pulp, and surgical methods involving the complete or partial removal of the latter.

In the conservative treatment of acute focal pulpitis, combined medicinal pastes with a long anti-inflammatory, odontotropic and antiseptic effect are used. There are a number of combined medicinal pastes prepared ex tempore taking into account the clinical situation and the compatibility of the components [1]. Pastes contain odontotropic substances that stimulate the formation of replacement dentin and remineralization processes, glucocorticosteroids, antibiotics, proteolytic enzymes.

The disadvantage of these combined medicinal pastes is that they do not harden, do not have sufficient mechanical strength and quickly lose their activity under the filling, in addition, their common disadvantage is the low level of adhesion to the dentin of the tooth.

A known method of treating acute pulpitis (Patent RU 2309746 C2) [2]. At the first stage, instrumental treatment, hemostasis, antiseptic effect on the carious cavity or tooth pulp are carried out. Then the area of the opened pulp or its stump is washed with a suspension of polysorb in saline. It is dried and filled with a composition based on ultramicroscopic porous hydroxyapatite ceramics, solcoseryl jelly, and a long-acting antibacterial drug in a ratio of 2: 1: 2. Then cover with a gasket and a temporary seal. After 14-21 days, at the second stage, the pad is removed, the cavity is rinsed with an antiseptic solution, followed by a replacement with a composition of finely granulated porous hydroxyapatite ceramics in combination with an antibacterial drug in a 1: 1 ratio. The method ensures the effectiveness of treatment due to the activation of adaptive protective mechanisms, dentinal formation, as well as the protection of periodontium from the spread of the toxic-infectious process.

The disadvantages of the developed combined drug composition in this method of treating acute focal pulpitis is the weak odontotropic effect of ultramicroscopic porous hydroxyapatite ceramics and the low reparative potential of the composition.

Known combination medicinal paste containing crystalline lysozyme, white clay, as well as bone meal and heparin ointment in a ratio of 10: 1, known combination medicinal paste containing 5% ointment of vitamin U on 5% collagen gel with the addition of 0.5% pyromecain [3 ].

These combined medicinal pastes well stimulate the reparative properties of the tooth pulp and the production of replacement dentin, but they have extremely low antiseptic properties and do not affect the redox processes in the pulp.

The closest in technical essence and selected as a prototype is lysozyme-vitamin paste, which consists of three components: lysozyme, an oil solution of vitamin A and zinc oxide [4]. The paste has a pronounced bactericidal and bacteriostatic action, bacteriolytic and odontotropic effects, enhances redox processes in the pulp.

However, the paste does not have a long anti-inflammatory and analgesic effect, does not provide a depot of organic and inorganic substrates in the suprapulpral dentin, the components of the paste are not able to provide the role of a physiological matrix for the normalization of reparative processes in the affected tooth pulp in acute focal pulpitis.

The task: to develop a highly effective anti-inflammatory, analgesic and antiseptic combined medicinal paste, which has a pronounced reparative effect in the conservative treatment of acute focal pulpitis.

The problem is solved by including in the composition of the combined medicinal paste containing lysozyme, an oil solution of vitamin A, zinc oxide, a 30% solution of dimexide, dexamethasone, neomycin, “Kollost-gel” in the following ratio of components, wt.%:

Lysozyme 5 Vitamin A Oil Solution 5 Zinc oxide twenty Dimexide 5 Dexamethasone 0.1 Neomycin 0.1 Callost gel Rest

The parameters introduced into the composition of the inventive paste components were determined empirically. The introduction of components below the lower or above the upper limit does not provide the optimal therapeutic effect, and also worsens the physico-chemical properties of the paste.

Characterization of the components of a combined medicinal paste.

Lysozyme is an enzyme of the class of hydrolases, has an antimicrobial property and accelerates reparative processes in tissues. Lysozyme in combination with an oily solution of vitamin A enhances redox processes and improves contacts with intracellular formations. Zinc oxide is used as a filler.

Dimexide enhances the therapeutic effect of the components of the paste, has anti-inflammatory, antiseptic and analgesic effects. A 30% solution of dimexide promotes the penetration of paste components through biological membranes, enhances the activity of other substances, has a pronounced analgesic effect, exhibits anti-inflammatory, antiseptic and fibrinolytic properties.

Dexamethasone has a pronounced anti-inflammatory and antiexudative effect, stabilizes cell membranes. Neomycin provides an antibacterial effect.

Kollost-gel (BioFARMAKHOLDING CJSC, Russia) - collagen biomaterial, is a fibrillar protein of connective tissue, provides its structural basis, playing the role of a physiological matrix that ensures normal reparative processes in the pulp. The drug is available in the form of a white gel, packaged in 0.7 ml disposable plastic syringes. The “Kollost-gel” preparation provides the correction area (pulp chamber) with the main biological resources required for healing, creates a transition matrix that stimulates the body’s immune system and activation of granulocytes, macrophages and fibroblasts, improves the transfer of growth factors released from cells, and enhances migration fibroblasts and pulp cell proliferation. The drug is characterized by biocompatibility with human tissues and does not cause a rejection reaction; it is characterized by increased odontotropic properties.

A comparative analysis with the prototype showed that the claimed composition of the paste differs from the known introduction of new components, namely a 30% solution of dimexide, dexamethasone, neomycin, collagen biomaterial "Kollost-gel" in a new ratio of components.

The analysis of known pastes, similar to the claimed paste in terms of therapeutic action, showed that the composition of the combined medicinal paste containing lysozyme, oil solution of vitamin A, zinc oxide, 30% solution of dimexide, dexamethasone, neomycin and collagen biomaterial “Collost-gel”, with which all the above ingredients are mixed, have not been previously used in practice.

The combined medicinal paste is prepared as follows.

The calculation is given per 100 g of product. The paste is prepared ex tempore on a sterile glass slide. First, lysozyme (5 g), an oily solution of vitamin A (5 g) and zinc oxide (20 g) are mixed. Then, a 30% solution of dimexide (5 g), dexamethasone (0.1 g) and neomycin (0.1 g) are added to the resulting mixture. After that, the resulting mixture is thoroughly mixed with collagen biomaterial "Kollost-gel" to obtain a paste of a uniform consistency.

The paste is stored in a dark bottle with a ground stopper, and a smoothing, cotton swab or brush is introduced into the cavity of the tooth.

The proposed technical solution allows to obtain an inexpensive, cost-effective tool with high efficiency, as well as reduce the time of conservative treatment of acute focal pulpitis.

The shelf life of the funds received is 1 year.

The parameters of the tool are stable during storage. The product is a light brown mass with a pleasant smell.

The inventive combined medicinal paste is very plastic, easily inserted into the tooth cavity, has a pronounced anti-inflammatory, analgesic and antiseptic effect, has high penetrating ability, stimulates the reparative function of the tooth pulp. The paste stimulates dentinogenesis, is harmless and has no side effects.

The therapeutic effect of the claimed paste is tested in a clinic. There were no complications or side effects when using this paste. The way to use the paste is simple and affordable. The paste is well fixed even on the moistened surface of the walls of the tooth cavity. The breadth of the use of paste in all groups of teeth is explained by the optimal combination of the components introduced into its composition.

Examples of specific performance.

Example 1. Patient V., 23 years old, outpatient card No. 3418.

The patient complained of acute spontaneous paroxysmal pain, aggravated by mechanical, chemical and temperature stimuli during the day and at night in the area of the 15 tooth.

On examination of the 15 tooth, a deep carious cavity with overhanging edges of enamel filled with softened and pigmented dentin. Probing is painful at one point. Percussion is sharply painful. EDI pulp 15 tooth - 20 μA.

Diagnosis: Acute focal pulpitis of 15 teeth.

Treatment. Under conduction anesthesia sol. Ultracaini 4% with an adrenaline of 1: 200000 prepared the bottom and walls of the cavity. Antiseptic treatment of the cavity with a 0.06% solution of warm chlorhexidine bigluconate was carried out. Then the cavity was washed three times for 30 seconds with warm (32-34 ° C) saline. The cavity is dried with a sterile cotton swab. On the exposed surface of the pulp, the claimed combined medicinal paste is applied, which is sealed with a sterile cotton swab over the entire area of the over-pulp dentine. The applied combined medicinal paste is isolated with a sterile cotton swab, a temporary filling for 10 days is installed.

In the second visit, after 10 days, the temporary filling was removed, the EDI of the 15 tooth pulp was 7 μA, an insulating pad was placed under the permanent filling from the photocomposite material.

Example 2. Patient K., 35 years old, outpatient card No. 4132.

Complaints: acute spontaneous paroxysmal pain that began 1 day ago, aggravated by mechanical, chemical and thermal stimuli during the day and at night in the area of 46 teeth.

When examining 46 teeth - a deep carious cavity with overhanging edges of enamel, filled with softened and pigmented dentin. Probing is painful at one point. Percussion is sharply painful. EDI pulp 15 tooth - 22 μA.

Diagnosis: Acute focal pulpitis of 46 teeth.

Treatment. Preparation and formation of the cavity in accordance with generally accepted rules under conduction anesthesia sol. Ultracaini 4% with adrenaline 1: 200000. The developed combined medicinal paste is applied. After 10 days, the EDI of the pulp of 46 tooth is 6 μA, there are no complaints. An insulating gasket is applied and a permanent seal is installed.

Example 3. Patient A., 27 years old, outpatient card No. 4051.

Complaints: acute spontaneous paroxysmal pain that began 1 day ago, aggravated by eating and from temperature irritants during the day and at night in the region of 34 teeth.

When examining 34 teeth, a deep carious cavity with overhanging edges of enamel filled with softened and pigmented dentin. Probing is painful at one point. Percussion is sharply painful. EDI pulp 34 tooth - 18 μA.

Diagnosis: Acute focal pulpitis of 34 teeth.

Treatment. Preparation and formation of the cavity in accordance with generally accepted rules under conduction anesthesia sol. Ultracaini 4% with adrenaline 1: 200000. The developed combined medicinal paste is applied. After 10 days, the EDI of the pulp 34 of the tooth is 5 μA, the patient has no complaints of pain and discomfort. An insulating gasket is applied and a permanent seal is installed.

Example 4 (prototype method). Patient Sh., 29 years old, outpatient card No. 4301.

Complaints: acute spontaneous paroxysmal pain that began 1 day ago, aggravated by mechanical, chemical and thermal stimuli during the day and at night in the area of 46 teeth. When examining 47 teeth, a deep carious cavity with overhanging edges of enamel filled with softened and pigmented dentin. Probing is painful at one point. Percussion is sharply painful. Pulmonary EDI of 47 teeth - 21 μA.

Diagnosis: Acute focal pulpitis of 47 teeth.

Treatment. Preparation and formation of the cavity in accordance with generally accepted rules under conduction anesthesia sol. Ultracaini 4% with adrenaline 1: 200000. The combined medicinal paste was applied according to the prototype method. However, after 3 days, the patient complains of increased pain from thermal and mechanical stimuli, as well as ongoing spontaneous pain at night. The nature of the pain has changed, the pain has become spilled, tearing, throbbing, continuous, gradually subsiding, but not completely resolving, there are no periods of remission. The patient cannot clearly indicate a “causal” tooth.

In the oral cavity: the sounding is painful along the entire bottom of the carious cavity, percussion is painful, the transitional fold in the tooth region 47 is not changed, changes in the region of the tips of the roots of the tooth 47 are not detected on the radiograph, the EDI of the 47 tooth pulp is 32 μA. The transition of pulpitis from acute focal to acute diffuse is obvious.

Diagnosis: acute diffuse pulpitis of 47 teeth.

Treatment: Preparation and formation of the cavity in accordance with generally accepted rules of conduction anesthesia sol. Ultracaini 4% with adrenaline 1: 200000. The patient underwent vital extirpation of the coronal and root pulp. Antiseptic treatment of the tooth cavity and root canals was carried out, the root canals were sealed with hot gutta-percha, and a temporary filling was established. After 7 days, the patient does not complain. A permanent seal made of composite material is installed.

Thus, the use of the developed combined medicinal paste for the conservative treatment of acute focal pulpitis helps to reduce the number of complications due to anti-inflammatory, analgesic, antiseptic effects and stimulation of the reparative function of the pulp.

The data obtained in the clinic allow us to recommend the developed combined medicinal paste as a highly effective means of conservative treatment of acute focal pulpitis, which has a pronounced clinical effect and has wide functionality for dentistry.

Claims (1)

Combined medicinal paste for the conservative treatment of acute focal pulpitis, containing lysozyme, an oil solution of vitamin A, zinc oxide, characterized in that it additionally contains a 30% solution of dimexide, dexamethasone, neomycin and collagen biomaterial “Collost-gel”, in the following ratio components, wt.%:
Lysozyme 5 Vitamin A Oil Solution 5 Zinc oxide twenty Dimexide 5 Dexamethasone 0.1 Neomycin 0.1 Callost gel Rest