RU2542437C1 - Method for conservative treatment of pulpitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: first doctor's appointment involves evaluating pulp cavity injuries visually, and prescribing a therapeutic preparation in the form of a paste for inflammation relief. The paste-like therapeutic preparation is Metrogyl Denta gel with either laevomycetin, or metronidazole; the paste is prepared with ex tempore Metrogyl Denta gel with laevomycetin in the following proportions: Metrogyl Denta gel - 0.25-0.35 g; laevomycetin - 0.07-0.09 g (1/5-1/7 of laevomycetin tablet 0.5 g or 2/5-2/7 of laevomycetin tablet 0.25 g), or ex tempore Metrogyl Denta gel with metronidazole in the following proportions: Metrogyl Denta gel - 0.25-0.35 g; metronidazole - 0.05-0.036 g (1/5-1/7 of metronidazole tablet 0.25 g).

EFFECT: method enables reducing inflammation and reducing the number of complications.

4 dwg, 2 ex

Description

The invention relates to medicine, namely to dentistry.

Currently, methods based on topical application of antiseptic, anti-inflammatory, hypersensitizing and odontotropic drugs are used to treat reversible forms of pulpitis - inflammation of the tooth pulp. They can be used in the form of temporary or permanent applications (dressings), injected into the pulp of the tooth using electrophoresis or phonophoresis.

Known methods for the biological treatment of pulpitis using disinfectant solutions: ethacridine lactate, furatsilina, antimicrobial iodinol, enzymes, antibiotics, hormones (Ivanov BC, Urbanovich LI, Berezhnoy VP Inflammation of tooth pulp. M., Medicine, 1990 , 208 p.).

Various medical pastes are also used: zinc-eugenol, calcium hydroxide, collagen (Dmitrieva L.A., Nezhivenko L.N., Gerasina O.V. et al. Experience in the treatment of pulpitis by vital extirpation using various hemostatic agents. Dentistry, 1986 , No. 3. P. 28-30), bone meal with heparin (Chumakov AA, Kolenova ZD, Leontyev VK, etc. The effect of paste from sterilized bone meal and heparin ointment on the condition of the pulp of the teeth of monkeys with formed deep cavity and traumatic pulpitis. Dentistry, 1986, No. 3. P. 4 5); from dimexide with crystalline lysozyme (Musharanova SI The effectiveness of the conservative treatment of pulpitis with dimexide and crystalline lysozyme. Kazan. medical journal, 1983, No. 6. P. 434 - 435), from algipore (Dmitrieva L.A., Adabatskaya A ., Ulyanova TV and others. The use of algipore for the treatment of pulpitis. Dentistry, 1986, No. 5. P. 28 - 29) and others.

However, all these methods have a number of significant drawbacks. The drugs exert their bactericidal and bacteriostatic effect on microorganisms located in the carious cavity; selectively, many drugs lack a odontotropic effect, i.e. they do not stimulate the formation of replacement dentin and remineralization. Antibiotics and sulfa drugs can cause the emergence of resistant forms of microorganisms or selectively suppress microflora. Many drugs have a sensitizing effect. Some drugs are clinically unstable and lose activity during prolonged storage. Zinc-eugenol paste has a pungent odor. Dimexide is a highly toxic drug. Calcium hydroxide preparations can cause superficial pulp necrosis due to a pronounced alkaline reaction (pH 11 - 12). Some drugs may stain your tooth.

A known method of treating pulpitis (dental filling) using polymethacrylic acid (Japan, application No. 3-22042, publication 05/05/17. M. class. A61K 6/00).

This method also has disadvantages. Polymethacrylic acid (PMAA) is in bound form due to curing, which complicates its positive effect on the pulp of the tooth through the dentinal tubules. This composition does not have a mineralizing and dentin-forming effect, and a change in pH is not provided.

The closest in technical essence to the proposed one is a method of treating dental pulpitis with a biological method by preparing a cavity, subsequent antiseptic treatment of it, covering the bottom with a medical gasket, laying and filling the cavity, while the cavity is treated sequentially with a 1% solution of polymethacrylic acid with a pH of 8.5 - 9.0, then after its mechanical treatment, 1 2% solution of polymethacrylic acid with a pH of 9.0 is introduced into the bottom of the cavity under a dressing of 3-5 days and finally under a permanent seal impose a paste consisting of a mixture of remodet powder and a 2% solution of polymethacrylic acid with a pH of 8.0 (see patent RU No. 2070032 class A61K 6/08, 1996).

The presence of side effects consisting in the possibility of complications in the pulp of the tooth, low antiseptic activity, the formation of denticles - the disadvantages of the prototype.

The technical result of the invention is to reduce side effects consisting in the presence of possible complications in the pulp of the tooth when using a known method of treatment; increased antiseptic activity; the exclusion of the formation of denticles.

The technical result achieved is achieved by the fact that with a conservative method of treating pulpitis, including the use of a visual preparation according to damage to the pulp chamber, for the first visit, a medical preparation in the form of a paste is used, characterized in that a visual assessment of damage to the pulp chamber is carried out, and in the case of if the pulp chamber is not opened, use Metrogil-Dent gel with metronidozole to prepare the paste in the following ratio, g:

Metrogil-Dent gel  0.25-0.35 metronidozole  0.05-0.036,

and if the pulp chamber is opened, then the Metrogil-Dent gel with chloramphenicol in the following ratio, g:

Metrogil-Dent gel  0.25-0.35 chloramphenicol  0.07-0.09

In FIG. 1 shows a view of the carious cavity after preparation; in FIG. 2 - the ratio of the focus of demineralization to the cavity of the tooth; in FIG. 3 - view of the cavity after preparation, with the open horns of the pulp; in FIG. 4 - x-ray picture of the tooth.

The proposed method is implemented as follows: applying medical paste to the tooth cavity (depending on the visual assessment of damage to the pulp chamber of the tooth or not) to maintain the viability of the entire pulp and ensure physiological processes associated with tooth development and preservation of its root part for further tooth development (apexogenesis )

If during the preparation process it is visually estimated that the tooth cavity is not opened:

1. After anesthesia, preparation, application of a medical paste, consisting of a mixture of metronidozole powder with Metrogil-Denta gel for 3-5 days under a temporary dressing, to the bottom of the carious cavity.

2. Second visit - removal of medical paste, drug treatment of the cavity with a chlorhexidine solution of 0.02%, application of Ca-containing paste (trioxident, MTA), insulating linings and fillings.

If during the preparation process it is visually estimated that the tooth cavity has been opened:

1. The first visit - anesthesia, preparation, drug treatment of the cavity, drying. Overlaying the bottom of the cavity or stump of the amputated pulp with medical paste, consisting of chloramphenicol powder and Metrogil-Dent gel, for 3-5 days under a temporary dressing.

2. Second visit - removal of the dressing, medical paste, drug treatment of the cavity with a solution of chlorhexedine 0.02%, application of Ca-containing paste (trioxident, MTA), insulating linings and fillings.

Further follow-up after 3 weeks, 3 months and 6 months.

The end result of the implementation of the method is the elimination of the inflammatory reaction of the pulp, including the pain symptom, preservation of its viability and functions, as well as with unformed roots of the normal process of root development.

The advantages of the proposed method, eliminating the disadvantages of the prototype are the following:

1. Chlorhexidine is an antiseptic that actively destroys both gram-positive and gram-negative bacteria of anaerobic and aerobic forms.

2. Chlorhexidine remains active in the presence of blood, pus, although somewhat reduced.

3. The combination of metronidazole and chlorhexidine acts most effectively bactericidal on the anaerobic flora.

4. Levomycetin is an antimicrobial drug effective against a wide range of gram-positive and gram-negative microorganisms. It has a pronounced bacteriostatic effect, in high concentrations in relation to some strains it shows a bactericidal effect.

Example 1

A young man of 16 years old complained of tooth decay 4.6. The tooth is treated many times, fillings fall out.

Upon examination, it was revealed: the face is symmetrical, SOPR is pale pink. A deep carious cavity was revealed on the medial surface of the tooth 4.6. Percussion is negative, the tooth is motionless. EDI 40 mA. Desna is the usual color. After a necrotomy, the tooth cavity is not opened (Fig. 1) In the picture (Fig. 2), the cavity is not communicated with the tooth cavity.

The carious cavity is washed with a heated solution of chlorhexidine 0.02%. A therapeutic paste consisting of metronidosol powder and Metrogil-Denta gel was applied to the bottom of the cavity for 3-5 days. The cavity is closed hermetically with a parasept dressing (Vladmiva).

After 5 days, the patient reapplied. No complaints, percussion negative. After removing the dressing, the therapeutic pastorality is washed with a chlorhexidine solution of 0.02%, dried with a cotton swab. “Trioxident” paste (Vladmiva) was applied, a lining of SDR ™ Dentsply fluid flowing filling material, Dyract® XP Dentsply filling. When viewed after 7 days, 3 months and 6 months, the patient has no complaints. Percussion, palpation of the tooth 4.6 are painless. EDI 8-10 mAm, no visiographic changes were detected.

Example 2

Mom came with a daughter, 10 years old, with complaints of tooth decay 2.6. The tooth is treated many times, fillings fall out. Upon examination, it was revealed: the face is symmetrical, SOPR is pale pink. Percussions are negative, tooth 2.6 is motionless. Desna is the usual color. Under infiltration anesthesia, the carious cavity of the tooth was treated 2.6. After necrotomy, the tooth cavity was opened at two points (Fig. 3). On visiography, there is also a message of the carious cavity with the cavity of the tooth (Fig. 4). The carious cavity is washed with a heated solution of chlorhexidine 0.02%, bleeding is stopped with a cotton swab.

A medical paste consisting of chloramphenicol powder and Metrogil-Denta gel is applied to the bottom of the cavity. The cavity is closed hermetically with a parasept dressing (Vladmiva). A week later, the patient reappeared. No complaints, percussion negative. After removing the dressing, medical paste, the cavity is washed with a chlorhexidine solution of 0.02%, dried with a cotton swab. “Trioxident” paste (Vladmiva) was applied, a lining of SDR ™ Dentsply fluid flowing filling material, Dyract® XP Dentsply filling. When viewed after 7 days, 3 months and 6 months, the patient has no complaints. Percussion, palpation of the tooth 2.6 are painless. EDI 8-10 mAm, no visiographic changes were detected.

This method has been used since May 2010, at the dental clinic of the Kirov State Medical Academy. During this period, more than 250 patients were cured. All teeth roots completed their formation, two patients had to apply endodontic methods of treatment after the formation of the tooth root, there were no complications.

Reduction of side effects, consisting in the presence of possible complications in the pulp of the tooth, increased antiseptic activity; the exclusion of the formation of denticles is the advantage and advantage of the proposed method for the conservative treatment of pulpitis.

Claims (1)

A method of conservative treatment of pulpitis, including the use in the first visit of a medicinal product in the form of a paste, characterized in that they conduct a visual assessment of damage to the pulp chamber, and if the pulp chamber is not opened, use Metrogil-Dent gel with metronidozole in the following ratio, g:
Metrogil-Dent gel 0.25-0.35 metronidozole 0.05-0.036
and if the pulp chamber is opened, then the Metrogil-Dent gel with chloramphenicol in the following ratio, g:
Metrogil-Dent gel 0.25-0.35 chloramphenicol 0.07-0.09

Images