RU2848900C1 - Method for treating chronic forms of periodontitis aggravated by iatrogenic factors - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention is intended for use in the treatment of chronic forms of apical periodontitis. Computed tomography reformats are used to visualise the iatrogenic factor in the canal. The working length of the root canal is measured using the Dentaport ZX OTR J.Morita apex locator, which is fixed on the instrument with a silicone stopper. Mechanical treatment of the root canals is performed with the creation of a shoulder at a distance of at least 1 mm from the end of the working length of the canal, up to size 25 according to ISO. Medication treatment of the tooth canals is performed by alternating irrigation with 7% maleic acid and 1% sodium hypochlorite solutions using an endodontic needle with side holes at a distance of less than 2 mm from the working length of the root canal. Each portion is activated with an endoactivator. Final irrigation is performed with saline solution, and excess fluid is removed from the canals by single insertion of a sterile paper point with 6% taper and size 30 Meta Biomed. Introduce the Phagodent preparation into the canals using a disposable syringe with a plastic cannula. Adapt it in the canal using the Endoactivator Dentsply endoactivator. Remove excess material with Meta Biomed 6% taper size 30 paper points. Apply OpalDam Refill Ultradent methacrylate resin-based passive adhesive material to the canal openings and cure it with a Dentsply SmartLite Focus polymerisation lamp. Place sterile Teflon tape at the bottom of the tooth cavity and cover the tooth cavity with Temp It Spident material. Schedule the next visit in 3 days. After the time has elapsed, remove the Temp It Spident material with a bur, and remove the Teflon tape and OpalDam Refill passive adhesive material based on methacrylate resin with tweezers. Irrigate with saline solution, dry the canals with sterile Meta Biomed 6% taper size 30 paper points, verify with the Thermafil Verifier system with the selection of the appropriate size of the obturator, insert AH Plus Dentsply sealer into the canal, Thermafil Dentsply Maillefer is heated in a ThermaPrep 2 Oven and inserted into the canal while hot until it stops. An adhesive protocol is performed, the integrity of the tooth is restored with Ceram.X SphereTEC one filling material, and the tooth is ground and polished.

EFFECT: method, by performing 3-dimensional canal obturation with filling of all undercuts, allows for the treatment of chronic forms of apical periodontitis of single-root and multi-root teeth, aggravated by bone tissue destruction and iatrogenic factors.

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Description

The proposed invention relates to medicine, namely to therapeutic dentistry, and can be used in the treatment of chronic forms of apical periodontitis.

The lack of positive dynamics and bone tissue restoration in the periradicular area during the treatment of apical periodontitis is often associated with errors made during endodontic treatment. Fragmented instruments, perforations, undetected canals, insufficient sealing, homogeneity, and depth of obturation, or, conversely, the extrusion of filling material beyond the apex in infected canals can lead to the development of refractory inflammatory processes and the need for tooth extraction.

The complex morphology of the root canal system and the ability of microorganisms to form polybacterial intra- and extraradicular biofilms that colonize the isthmuses, main and lateral canals, and the root surface significantly complicate the disinfection of the root canal system.

Enterococcus faecalis is considered to be the main etiologic factor in the development of persistent infections and unsuccessful root canal treatment. A study using polymerase chain reaction analysis showed that the detection rate of Enterococcus faecalis was 79.5%, with 67.5% of primary infections and 89.6% of secondary infections localized in the root canal. Sedgley C, Nagel A, Dahlén G, Reit C, Molander A. Real-time quantitative polymerase chain reaction and culture analyses of Enterococcus faecalis in root canals. J Endod. 2006 Mar; 32(3): 173-7. doi: 10.1016/j.joen.2005.10.037. PMID: 16500220.

In addition, by forming biofilms, this pathogen demonstrates resistance to attacks by the host immune system, various substances, including drugs such as calcium hydroxide, sodium hypochlorite, antibiotics and hormonal agents, reducing their therapeutic effect. Therefore, Enterococcus faecalis should be considered as a main target for therapeutic strategies in the context of root canal infection treatment. Yang S, Meng X, Zhen Y, Baima Q, Wang Y, Jiang X, Xu Z. Strategies and mechanisms targeting Enterococcus faecalis biofilms associated with endodontic infections: a comprehensive review. Front Cell Infect Microbiol. 2024 Jul 18; 14: 1433313. doi: 10.3389/fcimb.2024.1433313. PMID: 39091674; PMCID: PMC11291369.

Traditional mechanical treatment and irrigation of the root canal are insufficient for complete disinfection, thereby hindering the achievement of desired results. Currently, bacteriophage-based biological control methods are gaining increasing popularity, making them a strategically important element in stopping the cascade of pathogenic inflammatory processes.

Phages are viruses that have a unique ability to penetrate and damage bacterial biofilms. Phage therapy has been shown to be superior to conventional antibiotics, especially against multidrug-resistant biofilms. Chan BK, Turner PE, Kim S, Mojibian HR, Elefteriades JA, Narayan D. Phage treatment of an aortic graft infected with Pseudomonas aeruginosa. Evol Med Public Health. 2018 Mar 8; 2018(1): 60-66. doi: 10.1093/emph/eoy005. PMID: 29588855; PMCID: PMC5842392.

Phages exhibit specificity for certain bacterial species or even individual strains, making them an ideal therapeutic option for the selective, targeted elimination of pathogens. Kortright KE, Chan BK, Koff JL, Turner PE. Phage Therapy: A Renewed Approach to Combat Antibiotic-Resistant Bacteria. Cell Host Microbe. 2019 Feb 13; 25(2): 219-232. doi: 10.1016/j.chom.2019.01.014. PMID: 30763536.

Phages destroy bacterial biofilms through a variety of complex mechanisms:

Phages replicate inside bacterial cells, leading to their lysis and subsequent release of progeny phages that gradually destroy biofilms.

Some phages infect dormant cells, remaining latent until these cells become activated, subsequently lysing them.

Phages encode enzymes such as endolysins and cholines that degrade bacterial cell walls, facilitating the release of viral particles and the disruption of biofilm structures. Furthermore, depolymerases produced by phages disrupt the extracellular polymer matrix in biofilms, destabilizing it, thereby enabling deeper penetration and more effective elimination.

Phages disrupt bacterial communication systems such as quorum sensing, thereby interfering with regulatory processes critical for biofilm maintenance and stability Moryl M, Różalski A, de Figueiredo JAP, Palatyńska-Ulatowska A. How Do Phages Disrupt the Structure of Enterococcus faecalis Biofilm? Int J Mol Sci. 2023 Dec 8; 24(24): 17260. doi: 10.3390/ijms242417260. PMID: 38139094; PMCID: PMC10744153.

Phage therapy represents a promising alternative to traditional methods for combating Enterococcus faecalis. Bacteriophage-based agents target the etiologically significant pathogens without affecting eukaryotic cells. Bacteriophages have a very favorable safety profile, and phage therapy is generally associated with a low risk of adverse reactions and effects. Hatfull GF, Dedrick RM, Schooley RT. Phage Therapy for Antibiotic-Resistant Bacterial Infections. Annu Rev Med. 2022 Jan 27; 73: 197-211. doi: 10.1146/annurev-med-080219-122208. Epub 2021 Aug 24. PMID: 34428079.

A method for treating destructive forms of chronic periodontitis (RU2510271 C1) is known by using medicinal preparations introduced into the root canal, according to which, before performing ultraphonophoresis of the medicinal preparation Beresh Plus Drops, a medicinal mixture containing the preparation Beresh Plus Drops, a 10% solution of calcium gluconate and vaseline oil is applied to the skin surface in the area of the causative tooth, then the area is treated with an emitter and after ultraphonophoresis, the root canals are obturation with calcium hydroxide, while prescribing the simultaneous intake of ascorbic acid in a daily dosage of 50-100 mg and the preparation Beresh Plus Drops 1 drop per 2 kg of body weight orally per day; the treatment course is 5-8 procedures.

Disadvantages of this method:

1. High doses of ascorbic acid can provoke an allergic reaction.

2. Before preparation, the working area is not isolated, resulting in the irrigation solution coming into contact with the oral mucosa during medicinal treatment of the canals, which leads to negative consequences such as chemical burns and allergic reactions.

3. Frequent replacement of calcium hydroxide leads to lytic destruction of the dentin structure, weakening the tooth's strength, which can subsequently lead to cracks and fractures in hard tissue. It also exposes collagen fibrils, which are precipitated by adhesins by pathogens such as Enterococcus faecalis, responsible for the persistence of the inflammatory process.

4. Calcium hydroxide has an alkaline pH, even a small amount of it leaving the apical foramen can lead to the activation of immune cells, the development of swelling and pain when biting down on a tooth, and a significant amount of it can lead to liquefaction necrosis and a slowdown in reparative processes.

5. Due to the fact that dentin has a certain buffer capacity, it is impossible to achieve an alkalinity level of 11.5 in the canal, which leads to a decrease in its bactericidal activity, the ineffectiveness of the measures taken and the activation of the adaptive mechanisms of the microflora in the form of the expression of genes responsible for survival under conditions of alkaline stress, an oligotrophic environment and the formation of resistance to intracanal deposits.

6. The small size of the hydroxide particles leads to their precipitation in the lumen of the dentinal tubules, which reduces the quality of subsequent obturation and the tightness of the root filling, and is the cause of repeated contamination of the root canal system with pathogens.

A method for treating chronic apical periodontitis is known (RU 264131 C1), which includes preparing a carious cavity, opening the tooth cavity, removing pulp decay, cleaning the root canals of the tooth, treating them with medications, introducing a temporary medicinal paste into the center of periapical destruction until the canal is completely filled, after temporary filling of the root canal, performing phoresis of the drug, filling the root canal and the cavity of the tooth after physiotherapy and removing the temporary filling, according to which the apical opening of the tooth is additionally opened, behind which the focus of periapical inflammation is located, temporary filling paste "Kalasept" is introduced into the root canal under a temporary dressing for 3 days, then transcanal electrophoresis is performed with a 1% solution of dimexide, with a current of 3 mA, for 15 minutes, for 4 days, which First, it is introduced from the anode, after which the polarity of introduction is alternated every day from the anode to the cathode, after each procedure of transcanal electrophoresis, a prepared extempore mixture containing the preparations "Galavit" and "Trapex-gel", mixed to a paste-like consistency in a ratio of 1:1, is introduced into the focus of periapical destruction as a medicinal mixture until the root canal is completely filled, after the end of physiotherapy treatment, the root canal is filled with a medicinal mixture extempore for 14 days, and before the final filling, a medicinal paste prepared extempore, containing the preparations "Galavit" and "Trapex-gel", mixed to a paste-like consistency in a ratio of 1:1, is introduced into the apical opening of the tooth, behind which the focus of periapical inflammation is located.

Disadvantages of this method:

1. Opening the apical foramen of the tooth during the treatment of apical periodontitis entails negative consequences during root canal obturation, since it is impossible to create a ledge into which the master pin is positioned, and there is a risk of the filling material being pushed into the periapical tissues, which leads to a lack of bone tissue restoration.

2. During a follow-up visit, the canal contents must be eliminated. For this purpose, medicinal treatment with sodium hypochlorite is performed. Without apical constriction, the risk of a complication such as hypochlorite accident is very high.

3. Calcium hydroxide dissociates in a moist environment into calcium ions and a hydroxyl radical, which promotes alkalization and has an antiseptic effect. In a dry canal, dissociation occurs slowly, preventing the high pH values necessary to eliminate pathogens from being achieved.

4. The temporary dressing does not allow the tooth cavity to be hermetically sealed, which results in micro-leakage of saliva from the oral cavity and penetration of microorganisms into the root canals.

5. When any material is removed beyond the apex, a foreign body reaction occurs, attracting immunocompetent cells to the periapical region through chemotaxis, which can provoke an exacerbation of the chronic process.

A method for treating destructive forms of periodontitis (RU 2810245 C1) was chosen as a prototype. According to this method, computed tomography of the area of the tooth to be treated is performed, anesthesia and isolation of the working field are administered, the filling material is removed, the carious cavity is prepared, the canals are mechanically and medicinally treated with irrigation solutions, they are dried and filled, the integrity of the tooth is restored with a filling material, according to which, during the computed tomography of the tooth area, the structural features of its root canal system and surrounding anatomical areas are identified, including concomitant iatrogenic factors, including fragments of instruments, perforations, resorptions, missed canals, insufficiently well-filled canals, the removal of the filling material, preparation of the carious cavity and restoration of the lost walls of the tooth are performed under visual control using an operating microscope, while the presence of missed canals is detected, they are extracted at If necessary, instrument fragments and pins are removed and perforations are closed, canals are deobturated, medicated treatment of the tooth cavity canals is carried out by sequential rinsing with irrigation solutions of 5.2% sodium hypochlorite, 40% citric acid or 18% etidronic acid, after which an antiseptic solution is introduced into the canals, a rotating instrument is immersed and mechanical and, in parallel, medicated treatment of the canal is carried out with its help, then irrigation solutions are introduced and activated in the resulting reservoir of the tooth cavity by creating a hydrowave effect by oscillating the tip of the endoactivator, after drying the canals with paper pins, they are filled with thermoplasticized gutta-percha on a carrier, conducting obturation control using visiography.

The prototype has the following disadvantages:

1. Rotary instrumentation of an infected canal, other than in a reciprocating mode, results in increased formation of sawdust and chips during dentin resection. These chips are forced into anatomical areas such as isthmuses, anastomoses, and lateral canals, significantly reducing the effectiveness of their treatment. Furthermore, the larger number of instruments rotating in the canal, compared to a reciprocating system, increases the risk of instrument fragmentation.

2. In long-term inflammatory processes, microorganisms can penetrate the entire depth of the dentinal tubules and are not affected by antiseptics introduced into the macrocanal. This subsequently leads to the persistence of infection in the root canal system.

3. The omission of phage therapy makes it impossible to eradicate pathogens in "blind spots" for irrigants, such as isthmuses, apical deltas, and lateral canals, where biofilm persists locally. This can lead to canal recolonization and maintenance of immunosuppression in the periradicular lesion.

4. The absence of additional bonding preparation of the canal before obturation reduces the adhesion of the obturation material to the root dentin, which, with prolonged exposure to apical percolation, leads to microleakage of periapical fluid and significantly affects the success of treatment.

The aim of the invention is to cure chronic forms of apical periodontitis of single-root and multi-root teeth, aggravated by destruction of bone tissue and iatrogenic factors, allowing the preservation of teeth with a probability of 0.999 of negative clinical statistics.

The set goal is achieved by visualizing the iatrogenic factor (missed canal) in the canal using computed tomography reformats, measuring the working length of the root canal with the Dentaport ZX OTR J.Morita apex locator, which is fixed on the instrument with a silicone stopper using the Dentsply endodontic ruler, mechanical treatment of the root canals is performed by creating a ledge at a distance of at least 1 mm from the end of the working length of the canal up to size 25 according to ISO, medicated treatment of the tooth canals is carried out by alternately rinsing with irrigation solutions of 7% maleic acid and 1% sodium hypochlorite with an endodontic needle with side holes at a distance of 2 mm less than the working length of the root canal, each portion is activated with an endoactivator, final irrigation is carried out with a saline solution, excess fluid is removed from the canals by a single introduction of a sterile paper point of 6% taper, size 30 Meta Biomed, The phagodent preparation is introduced into the canals using a disposable syringe with a plastic cannula, it is adapted in the canal with the Endoactivator Dentsply, excess material is removed with Meta Biomed size 30, 6% taper paper points, passively adhesive material based on methacrylate resin OpalDam Refill Ultradent is introduced into the canal orifices, it is cured with the SmartLite Focus Dentsply polymerization lamp, sterile Teflon tape is placed on the bottom of the tooth cavity, the tooth cavity is closed with Temp It Spident material, the next visit is scheduled in 3 days, after the time has elapsed, the Temp It Spident material is removed with a bur, Teflon tape and passively adhesive material based on methacrylate resin OpalDam Refill are removed with tweezers, irrigation is carried out with a saline solution, the canals are dried with sterile paper points 6% taper, size 30 Meta Biomed, after verification with the Thermafil Verifier system and selection of the appropriate obturator size, AH Plus Dentsply sealer is introduced into the canal, Thermafil Dentsply Maillefer is heated in the ThermaPrep 2 Oven and inserted in a heated form into the canal until it stops, thereby performing a 3-dimensional obturation of the canal with filling of all undercuts, an adhesive protocol is carried out, the integrity of the tooth is restored with the filling material Ceram.X SphereTEC one, grinding, polishing.

The invention is illustrated by figures, where Fig. 1 shows the data of CBCT reformats before the treatment of periodontitis with periradicular destruction of bone tissue, aggravated by an iatrogenic factor (missed canal), Fig. 2 shows the administration of anesthesia, isolation of the working field, removal of mineralized and non-mineralized dental deposits from the tooth subject to treatment, removal of the filling material, preparation of the carious cavity, Fig. 3 shows the measurement of the working length of the root canal with the apex locator Dentaport ZX OTR J. Morita, which is fixed on the instrument with a silicone stopper using the endodontic ruler Dentsply, mechanical treatment of the root canals with the creation of a ledge at a distance of at least 1 mm. from the end of the working length of the canal to size 25 according to ISO, in Fig. 4, performing medicated treatment of the tooth canal by alternating rinsing with irrigating solutions of 7% maleic acid and 1% sodium hypochlorite with an endodontic needle with side holes at a distance of 2 mm shorter. working length of the root canal, each portion is activated with an endoactivator, final irrigation with a physiological solution, in Fig. 5, dehydration of fluid from the canals by a single introduction of a sterile paper point with 6% taper, size 30 Meta Biomed, introduction of the phagodent preparation into the canals with a disposable syringe with a plastic cannula, adaptation with the endoactivator Endoactivator Dentsply, in Fig. 6, extraction of excess material with paper points with 6% taper, size 30 Meta Biomed. insertion of passive-adhesive material based on methacrylate resin OpalDam Refill Ultradent into the canal orifices, curing it with a SmartLite Focus Dentsply polymerization lamp, laying sterile Teflon tape on the bottom of the tooth cavity, closing the tooth cavity with Temp It Spident material, in Fig. 7, removal of Teflon tape and passive-adhesive material based on methacrylate resin OpalDam Refill with tweezers, irrigation treatment with saline solution, in Fig. 8, dehydration of the canals with sterile paper points of 6% taper, size 30 Meta Biomed, in Fig. 9 verification with the Thermafil Verifier system with selection of the appropriate obturator size, introduction of the AH Plus Dentsply sealer into the canals, heating of the Thermafil Dentsply Maillefer thermofils in the ThermaPrep 2 Oven and introduction of them in a heated form into the canals until they stop, implementation of 3-dimensional obturation of the canals with filling of all undercuts, in Fig. 10 implementation of the adhesive protocol, restoration of the integrity of the tooth with the filling material Ceram.X SphereTEC one, grinding, polishing, in Fig. 11 the result of the control CT scan 12 months after treatment.

The operation to implement the method is carried out in stages.

1. A computed tomography scan of the area of the tooth to be treated is performed.

2. Anesthesia and isolation of the working field are performed.

3. Removal of mineralized and non-mineralized dental deposits from the tooth to be treated and removal of the filling material.

4. The carious cavity is prepared.

5. The working length of the root canals is measured using the Dentaport ZX OTR J.Morita apex locator, which is fixed to the instrument with a silicone stopper using the Dentsply endodontic ruler. Mechanical treatment of the root canals is performed by creating a ledge at a distance of at least 1 mm from the end of the working length of the canal up to ISO size 25.

6. Carry out medicinal treatment of the tooth canals by alternating rinsing with irrigation solutions of 7% maleic acid and 1% sodium hypochlorite using an endodontic needle with side holes at a distance of 2 mm less than the working length of the root canals, each portion is activated with an endoactivator.

7. Perform final irrigation with saline solution.

8. Remove excess fluid from the canals by inserting a sterile 6% taper, size 30 Meta Biomed paper point once.

9. Introduce the phagodent preparation into the canals using a disposable syringe with a plastic cannula.

10. Adapt it in the canals using the Endoactivator Dentsply.

11. Remove excess material with Meta Biomed size 30, 6% taper paper points.

12. Insert OpalDam Refill Ultradent, a passive adhesive material based on methacrylate resin, into the canal orifices.

13. Cures it with the SmartLite Focus Dentsply polymerization lamp.

14. Place a sterile Teflon tape on the bottom of the tooth cavity.

15. Seal the cavity with Temp It Spident. Schedule a follow-up appointment in 3 days, after which the Temp It Spident is removed with a bur.

16. Remove the Teflon tape and the passive adhesive material based on methacrylate resin OpalDam Refill with tweezers.

17. Carry out irrigation treatment with saline solution.

18. Dry the canals with sterile paper points, 6% taper, size 30 Meta Biomed.

19. Verification is performed using the Thermafil Verifier system with selection of the appropriate obturator size.

20. Apply AH Plus Dentsply sealer into the canals.

21. Heat up Thermafil Dentsply Maillefer thermofils in the ThermaPrep 2 Oven and insert them into the canal until they stop, thereby creating a 3-dimensional obturation of the canals, filling all undercuts.

22. The adhesive protocol is carried out.

23. The integrity of the tooth is restored with Ceram.X SphereTEC one filling material, ground and polished.

The proposed method has been implemented in practice and is confirmed by a clinical example.

Patient A complained of pain when biting on tooth 1.5. History: About 5 years ago, the tooth was treated for complicated caries, after which she began experiencing periodic pain when biting on the tooth. Over time, the pain increased in intensity and duration. The patient periodically took antimicrobial medications when pain occurred when biting on the tooth.

There are no comorbidities. The patient has no history of allergies.

At the time of presentation, there were no changes during external examination: the face was symmetrical, the mouth opened freely, silently and painlessly, the skin was of normal color, and the lymph nodes were not palpable.

In the oral cavity: Hygiene Index 1.6 (satisfactory), Periodontal Index 0.6 (initial and mild periodontal pathology). Orthognathic bite, oral mucosa without visible pathology.

Objectively: 1.5 has filling material on the chewing surface, the coronal portion is unchanged in color. In the area of 1.5, the mucosa from the buccal surface of the marginal and alveolar gingiva is hyperemic, edematous, bleeds upon probing, and is slightly painful upon palpation. The tooth is not mobile, percussion is painful. On CBCT, the contents of the palatal canal are homogeneous, up to the apical foramen; radiographically, the apex is obturated, the buccal canal is free of filling material. Bone tissue destruction in the periradicular area, destruction of the cortical plate in the area of 1.5, with a tendency to spread to the area of the medial root of 1.6.

After examination, the diagnosis was: K 04.5 chronic apical periodontitis 1.5, exacerbation.

According to the proposed method, the patient underwent endodontic treatment with restoration of the anatomical and functional integrity of the tooth.

A computed tomography scan of the area of the tooth to be treated was performed, anesthesia and isolation of the working field were performed, mineralized and non-mineralized dental deposits were removed from the tooth to be treated, the filling material was removed, the carious cavity was prepared, the iatrogenic factor (missed canal) was visualized according to the computed tomography reformats, the working length of the root canal was measured with the Dentaport ZX OTR J. Morita apex locator, which was fixed on the instrument with a silicone stopper using the Dentsply endodontic ruler, the Dentsply endodontic ruler was fixed on the instrument with a silicone stopper, mechanical treatment of the root canals was performed with the creation of a ledge at a distance of at least 1 mm from the end of the working length of the canal was carried out up to size 25 according to ISO, medicated treatment of the tooth canals was carried out by alternating washing with irrigation solutions of 7% maleic acid and 1% sodium hypochlorite with an endodontic needle with lateral holes at a distance less than 2 mm of the working length of the root canals, each portion was activated with an endoactivator, final irrigation was carried out with a saline solution, excess fluid was removed from the canals with a single introduction of a sterile paper point 6% taper size 30 Meta Biomed, the phagodent preparation was introduced into the canals with a disposable syringe with a plastic cannula, adapted it in the canal with an Endoactivator Dentsply endoactivator, excess material was removed with paper points 6% taper size 30 Meta Biomed, passive - adhesive material based on methacrylate resin OpalDam Refill Ultradent was introduced into the orifices of the canals, cured it with a polymerization lamp SmartLite Focus Dentsply, sterile Teflon tape was placed on the bottom of the tooth cavity, the tooth cavity was closed with Temp it Spident material, the next appointment was made Visit after 3 days, after the time has passed, the Temp it Spident material was removed with a bur, Teflon tape and passive adhesive material based on OpalDam Refill methacrylate resin were removed with tweezers, irrigation treatment with saline solution was carried out, the canals were dried with sterile paper points of 6% taper, size 30 Meta Biomed, verification was performed with the Thermafil Verifier system with the selection of the appropriate obturator size, AH Plus Dentsply sealer was introduced into the canals, Thermafil Dentsply Maillefer thermafils were heated in the ThermaPrep 2 Oven and inserted in a heated form into the canals until they stop, thereby achieving a 3-dimensional obturation of the canal with filling of all undercuts, adhesive protocol was carried out, the integrity of the tooth was restored with the filling material Ceram.X SphereTEC one, grinding, polishing.

Fig. 11 shows the results of a cone beam computed tomography (CBCT) examination of the patient with restored bone tissue 12 months after treatment.

Thus, this method allows for the effective treatment of chronic forms of apical periodontitis in single- and multi-rooted teeth aggravated by iatrogenic factors. This treatment not only alleviates the symptoms of the disease but also promotes bone restoration in the periradicular area.

Claims (1)

A method for treating chronic forms of periodontitis aggravated by an iatrogenic factor, characterized by the fact that they perform a computed tomography of the area of the tooth to be treated, perform anesthesia and isolation of the working field, remove mineralized and non-mineralized dental deposits from the tooth to be treated, remove the filling material, prepare the carious cavity, then, according to the computed tomography reformats, visualize the iatrogenic factor in the canal, measure the working length of the root canal with an apex locator, which is fixed on the instrument with a silicone stopper using an endodontic ruler, then perform mechanical treatment of the root canals with the creation of a ledge at a distance of at least 1 mm from the end of the working length of the canal, carried out up to size 25 according to ISO, medicinal treatment of the tooth canals is carried out by alternately washing with irrigation solutions of 7% maleic acid and 1% sodium hypochlorite with an endodontic needle with side holes at a distance of less 2 mm of the working length of the root canal, each portion is activated with an endoactivator, final irrigation is carried out with a saline solution, excess fluid is removed from the canals by a single introduction of a sterile paper point of 6% taper, size 30, the phagodent preparation is introduced into the canals, it is adapted in the canal with an endoactivator, excess material is removed with paper points of 6% taper, size 30, a passive-adhesive material based on methacrylate resin is introduced into the mouths of the canals, it is cured with a polymerization lamp, sterile Teflon tape is placed on the bottom of the tooth cavity, the tooth cavity is closed with Temp It Spident material, the next visit is scheduled in 3 days, after the time has elapsed, the Temp It Spident material is removed with a bur, the Teflon tape and passive-adhesive material based on methacrylate resin are removed with tweezers, irrigation is carried out treatment with a physiological solution, dry the canals with sterile paper points of 6% taper, size 30, perform verification with the Thermafil Verifier system with the selection of the appropriate obturator size, introduce a sealer into the canal, heat the Thermafil in an oven and insert them in a heated form into the canal until they stop, thereby performing a 3-dimensional obturation of the canal with filling of all undercuts, carry out an adhesive protocol, restore the integrity of the tooth with a filling material, grind and polish.