RU2580973C1 - Method of treating chronic granulomatous periodontitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, specifically to surgical stomatology and may be used to treat chronic granulomatous periodontitis. Erbium laser is used for mucosal incision in apex of projection of causal tooth in a pulse length long puls. Expanding lesion of bone - at a pulse length of very shot puls. Excision of pathological tissues - pulse length shot puls. Apical part of root of tooth is treated with a diode laser with power of 1.5 W at a pulse length Shot puls controlled by changing temperature of bone tissue. All treatment is carried out under supervision of dental microscope.

EFFECT: method enables to preserve apical part of tooth root, reduce trauma and periapical region adjacent anatomical structures, reduce number of intraoperative and postoperative complications.

1 cl, 1 ex

Description

The invention relates to medicine, namely to surgical dentistry, and can be used to treat chronic granulomatous periodontitis.

Periapical lesions currently occupy a leading position among the complications of the carious process. A number of domestic and foreign authors note that the prevalence of chronic periodontitis is from 7 to 15% of the total number of diseases of the maxillofacial region. There are various methods of conservative non-surgical treatment of periapical lesions [Iordanishvili AK Periodontitis. (Etiology. Pathogenesis. Classification. Clinical picture) / A.K. Iordanishvili, A.M. Kowalski. - St. Petersburg., Endodontia plus, 2001. - S. 30-48]. However, practicing specialists encounter a number of problems when using them: this is a limitation of indications for treatment, the impossibility of qualitatively and with a high degree of predictability and guarantees to conduct treatment, a high percentage of complications during treatment. In this regard, for many years, the main method of surgical treatment of patients with periapical destructive changes such as cystogranulomas and radicular cysts has been cystectomy followed by apexectomy and retrograde root canal filling using rotary and oscillating instruments. But, according to the authors, it is necessary to remember a number of drawbacks of the method, namely: the possibility of divergence of sutures in the postoperative period, infection of the surgical wound and the development of inflammatory processes, high invasiveness of the operation, in connection with which a violation of the viability of the neurovascular bundle adjacent to the affected teeth, damage to adjacent anatomical formations, and as a result, increased rehabilitation time. Work with volumetric and aggressive instruments can lead to significant damage to the cortical bone, inadequate resection of the apical third of the root and, as a result, an unfavorable crown-root ratio. These problems can be solved by using microsurgical techniques and dental microscopes. The use of such a tool as a surgical microscope allowed us to reach a new level of operations to remove periapical lesions. Dental surgical microscopes have a 19-fold increase and xenon illumination with a power of up to 100 W, which allows you to significantly visualize the surgical field, the apical third of the root, additional channels, and this, in turn, will reduce the invasiveness of interventions, determine the need for resection of the apex of the tooth . So, there is a known method of using intraoperative microscopy in the surgical treatment of periapical granulomas [Vyucnov I.N. The use of intraoperative microscopy in the surgical treatment of periapical granulomas: Abstract. dis. ... cand. honey. sciences. / SBEI HPE “Moscow State Medical-Dental University”. - M., 2012. - 97 p.]. The operation is carried out using steel instruments, the incision is made with a scalpel, bone expansion and root apex resection are performed using rotary burs and a turbine tip, the surgical treatment process is carried out using an intraoperative microscope. Disadvantages: an incision with a scalpel increases the rehabilitation period; Bone tissue excision and bone tissue resection are performed with boron and a turbine tip, the effect of which has a highly intense thermal effect on biological tissues, which dramatically reduces the effectiveness of the procedure due to thermal burns.

The permeability of exposed dentin on the resected tooth root surface, incomplete removal of pathological tissues from the lesion site, and the absence of high-quality hemostasis in the surgical area are the main causes of unsuccessful treatment and, as a consequence, relapse of the disease. The solution to these problems can be the use of high-intensity lasers. The main effects of surgical lasers are thermal, hydrodynamic, photochemical, which, in turn, provide ablation, vaporization, carbonization of biological tissues, as well as the phenomenon of recrystallization and inorganic melting of the dentin surface [Luchiano Buchmann. Lasers in dentistry. - Bologna, 2010. - S. 11-13]. These phenomena can significantly limit the process of pronounced inflammatory reactions, reduce the invasiveness of operations, and achieve a better retrograde obstruction of the root canal by occlusion of the dentinal tubules and lower permeability [Laser in endodontology. / Moritz A. et al. // J Oral Laser Application - 2001 .-- Vol. 2. - No. 2. - P. 87-95].

A known method of treating chronic periodontitis, in which there is operative access to the roots of teeth with impenetrable and impassable root canals complicated by a radicular cyst, the treated cavity is treated with a constant current of 4-5 mA for 15 minutes through an isotonic solution of sodium chloride with trypsin in the ratio 0,1: 2 apparatus "Potok-1". Retrograde filling of the root canal with ProRoot glass ionomer cement is carried out. Then they are treated with a semiconductor laser diode generating pulsed light with a wavelength of 0.85 to 0.98 μm, a pulse power of 2-4 W, a pulse duration of 40-100 ns, a pulse frequency of 1.5-2.0 kHz, and magnetic 35 mTl fields for 5 minutes with the Optodan apparatus and subsequently filled with Osteoplast-K osteoinductive bioresorbable material on 2/3 of the bone wound, cover it with a Paradoncol bioresorbable membrane and Diplen-dent film with metronidazole from the oral cavity. The method provides effective tooth-preserving treatment and reduction in the number of postoperative complications due to reliable sterilization of the microtubules of the root of the tooth and cavity of the bone wound, obstruction, biointegration and angiosteogenesis, stimulation of the osteoreparative process in the bone wound, and also by maintaining the stability and occlusal integration of the tooth in the dental arch [Pat . No. 2331363 of the Russian Federation. Publ. 08/20/2008]. The disadvantage is that surgical manipulations were carried out using a scalpel and rotary instruments, which has an intense mechanical and thermal effect on biological tissues and can lead to complications both during the operation and in the postoperative period.

A known method of using an erbium laser for the surgical treatment of radicular cysts of the jaw [Morozova EA The combined use of Er: YAG and Nd: YAG lasers for the surgical treatment of radicular jaw cysts: Dis. ... cand. honey. sciences. / GOU VPO "Moscow State Medical-Dental University". - M., 2011. - 171 p.]. In this method, an erbium laser with a wavelength of 2940 nm is used, departing from the surface of the mucous membrane no more than 0.5 mm, a trapezoidal or arched incision is made in the projection of the cyst at an energy of 100 mJ, a pulse frequency of 10 Hz in the “very shot” mode (short pulses 230 μs), the location of the fiber at an angle of 45 degrees with a light spot diameter of 1 mm. Bone perforation is carried out using an Erbium laser during operation: energy - 150 mJ, pulse frequency 10 Hz, "very shot" mode. Resection of the apex of the tooth roots is carried out with an erbium laser at an energy of 200 mJ, at a pulse frequency of 20 Hz, in the “very shot” mode. The resected surface is treated with an Nd: YAG laser at a power of 1.5 W for 15 s. This method is selected for the prototype. The disadvantages of the prototype: suitable only for the treatment of radicular cysts due to the proposed modes; the resected surface was treated with an Nd: YAG laser, without monitoring changes in bone temperature, which can adversely affect periapical tissues, due to the high penetration depth of the laser beam and a significant degree of heating; in all cases, a root apex was resected, which reduces the crown-root relationship, and does not provide a convincing guarantee for the long-term functioning of the tooth.

The objective of the invention is to increase the effectiveness of the treatment of chronic granulomatous periodontitis.

The technical result consists in preserving the apical part of the root of the tooth, in reducing the number of intraoperative and postoperative complications, in significantly reducing trauma to the periapical region and adjacent anatomical formations, in shortening the terms of rehabilitation, expanding the indications for this treatment.

This is achieved due to the fact that the incision of the mucous membrane in the projection of the apex of the causative tooth is carried out at a pulse length of long puls, the extension of the lesion of bone tissue is very shot puls, and the excision of pathological tissues is performed at the pulse length of shot puls, while the apical part of the tooth root is processed 1.5 W diode laser with a pulse length of Shot puls under the control of changes in bone temperature, and the entire treatment is carried out under the control of a dental microscope.

Preservation of the apical part of the root of the tooth is due to:

a) processing the apical part of the tooth root with a diode laser, which eliminates the need to resect the apex of the tooth root, because the maximum root length is preserved and pathogenic microflora die in the apical delta [Der diodenlaser und seine bakterizide wirkung im wurzelkanal - eine in vitro studie. / Gutknecht N, Moritz A, Conrads G, Lampert F. // Endodontie - 1997. - Vol. 3. - No. l. - P. 217-222];

b) the treatment under the control of a dental microscope makes it possible to repeatedly increase the surgical field, which allows you to significantly treat the root of the tooth with precision [Luchiano Buchmann. Lasers in dentistry. - Bologna, 2010. - P. 11-13], [Gary B. Carr, Arnaldo Castellucci. Endodontics. Florence, 2009. - P. 978-984].

The reduction in the number of complications is provided by:

a) the use of a dental microscope, which minimizes the surgical wound in the area of the causative tooth [Risovanny SI, Risovannaya ON, Masychev V.I. Laser dentistry. Krasnodar, Kuban - Book, 2005. - S. 74-124];

b) an incision of the mucous membrane in the projection of the apex of the causative tooth with an erbium laser with a long puls pulse length, expansion of the bone lesion site - very shot puls and excision of pathological tissues - with shot puls pulse length, since the use of such pulse length parameters will allow avoiding soft overheating and hard tissues, thereby reducing the risks of postoperative complications.

A significant reduction in trauma to the periapical region and adjacent anatomical formations due to:

a) a multiple increase in the surgical field, which allows you to significantly visualize the process of excision of the pathological focus, minimize the surgical wound in the area of the causative tooth [Risovanny S.I., Risovannaya ON.N., Masychev V.I. Laser dentistry. Krasnodar, Kuban-Kniga, 2005. - S. 74-124].

The method is as follows:

The patient undergoes conduction or infiltration anesthesia, under the control of a dental microscope (for example, with a 5-fold increase), an incision of the mucous membrane in the projection of the apex of the causative tooth is carried out using an erbium laser with a pulse length of long puls, the lesion is visualized, the lesion is expanded using erbium lasers with a pulse length of very shot puls, pathological tissues are also excised using an erbium laser, but with a pulse length of shot puls, with an increase in the microscope (for example, 16x), the affected the tooth tip (for example, with a magnification of 16x-25x), the apical part of the tooth root is treated with a diode laser under the control of changes in bone tissue temperature (for example, a contact digital thermometer); suture under the control of a dental microscope (for example, 16x magnification). Examination of the patient is carried out on the 3rd day and removal of sutures on the 7th day. Anti-inflammatory and antibacterial therapy is prescribed according to the stage and severity of the disease.

The advantages of the proposed method:

minimization of tissue damage during surgical treatment using this method; increase tooth viability during treatment using this method; short period of patient rehabilitation, lack of need for a disability certificate; reducing the possibility of relapse of the disease to a minimum; avoids the economic costs of repeated operations on the part of the state (MHI) or the patient himself.

Clinical example.

Patient L. Diagnosis: radicular cyst of the upper jaw on the left, chronic granulomatous periodontitis of the tooth 23. Under the infiltration anesthesia Sol. Ultracaini DC-forte, 1.7 ml under the control of a dental microscope with a 5-fold increase, performed an incision of the mucous membrane in the projection of the tips of the roots of the teeth 22-23-24 using an erbium laser with a pulse length of long puls and a power of 1.5 W; visualized a bone tissue patch in the region of the apex of the root 23; widened the bone window using an erbium laser with a power of 2.5 W and a pulse length of very shot puls; excised pathological tissues using an erbium laser at a power of 2 W and pulse length shot puls; at a 16-fold increase in the microscope under the control of a contact digital thermometer, the tooth tip was treated with a 1.5 W diode laser shot puls; the wound is sutured Rezprin 7-0. Inspection was carried out on the 3rd day, the seams were removed on the 7th day.

Claims (1)

A method of treating chronic granulomatous periodontitis, including the use of an erbium laser, characterized in that the mucosal incision in the projection of the apex of the causative tooth is performed at a pulse length of long puls, the focal lesion of bone tissue is expanded with very shot puls, and the excision of pathological tissues with a pulse length of shot puls while the apical part of the root of the tooth is treated with a 1.5 W diode laser with a pulse length of Shot puls under the control of changes in bone temperature, and all treatment is carried out under the control of the dental about the microscope.