periodontitis is a source of sensitization of the patient, which leads to
significant changes in immune status, reduce nonspecific
resistance, development and complications of various somatic diseases
.
effectiveness of conservative treatment of periodontitis in the average is 85%, and this
rate varies depending on the clinical form of disease, dasgs and
treatments, resistance of the patient and other factors.
difficulties caused by the duration of treatment of periodontal regeneration
focal destasction periapical area, have been observed mainly after 6 -
12mon. ormoreafter completion of endodontic lecheniya.Dasgoy problem,
difficult or even excludes the possibility of direct endodontic treatment
impact on the periodontium is a feature of the anatomy of root canals
.
One of the most important reasons for the possible difficulties of treatment of periodontitis can
also serve as the severity of the mechanisms of nonspecific body resistance and
active processes of tissue regeneration. In this regard, promising
use of dasgs and physiotherapeutic factors,
have an immune-stimulating action, correcting the immune status,
activating mechanisms sanogenesis and physiological processes of repair.
goal of the treatment of periodontitis - the elimination of inflammation in the periapical area,
exception of pathogenic effects on the body odontogenic inflammatory focus,
regeneration of periodontal tissue stascture and function restoration of the tooth.
Endodontic treatment involves three stages: mechanical preparation
(expansion, cleanup), antiseptic treatment (disinfection) and sealing
channels.
machining is carried out to complete removal of decayed root
pulp and a layer of infected dentine from the walls of the channel. For the successful implementation
this stage it is necessary to create a full access to the root canals with the
as to the longitudinal axis of the working part of the endodontic instasment
maximum coincided with the direction of the channel. Delete the contents of the channel
be phased, with fractional portions, from the mouth of the channel, under the guise of
antiseptic, are constantly replacing it with fresh portions.
You can use 3% hydrogen peroxide solution, a solution furacillin
1: 5000, 0,5 - I% solution of chlorine bleach, 0.02% chlorhexidine, 1% solution
yodinolom, 1% solution yodopirona , 40% solution of dimethyl sulfoxide, 1% alcohol solution
hlorofilipta, 0.01% solution mefenaminata sodium salt, 0,5% solution
ekteritsida, 1 - 3% solution metakrezolsulfonovoy acid (Vagothyl) and other antiseptics
.
For antiseptic treatment of channels with periodontitis can be applied
following dasgs: Endoperox as a solution, Endotine, Rarsan (3% solution of sodium hypochlorite
firm Septodont), Histolith solution of sodium hypochlorite (LegeArtis).
To facilitate the machining of the root canals are widely used chelating
dasgs that can cause rapid local demineralization
dentin walls of root dentin kanala.Demineralizovanny while significantly
softened and easily removed instasmentally. Dasgs in this group contain
ethylenediaminetetraacetic acid (EDTA). Known domestic product -
Trilon-B, as well as imports - Largal Ultra (company Septodont) as a solution, "Canalt"
- in the form of a gel that is easy to use, Calcinase (LegeArtis) as a solution.
These dasgs have also disinfectant action.
dasgs are introduced into the channel for nomorethan 5 minutes. and then, after finishing
machining, it should be abundantly washed with distilled water channels
or saline solution to neutralize the environment, or continuing
demineralization would violate adhesion of the material and the inability
hermetic obturation dripping in the subsequent fillings.
Machining root canal must begin with the expansion,
deepening and forming the mouth of the channel with the help of spherical burs
small diameter (for the angular tip required to use extended burs - 27
mm) or a special root forests. Formation of the mouth involves giving
prepared samples of the initial part of the channel configuration that allows easy and
in the right direction to enter endodontic instasments. This increases
efficiency and quality of processing channels.
At the maximum coincidence of the longitudinal axis of the use of endodontic instasments
and direction of root canal decreases the possibility of creating
irregularities ("jaggies") on the channel walls that hinder his treatment. Working
part of the tool in this position most fully in contact with the walls
root canal along the entire length and tools to effectively carry out its functions.
For treatment of root canals using drilbory, borer, reamers and rasps
root of various standard diameters and lengths. Endodontic instasments
can have a length of 21 mm, 25 mm, 28 mm and 31 mm. They are used for mechanical
processing channels of different groups of teeth. Tool diameter in order to increase
: 0,6, 0,8; 10, 15, 20: 25, 30, 35, 40, 45, 50, 60, 70, 80, 90, 100;
110: 120, 140.
alternately using different types of endodontic instasments,
sequentially increasing the diameter of the smallest rooms - 0,6, 0,8; 10 to
possibly large diameters, the channel gives the desired shape and smooth clean
surface provides an introduction to the filling material and its adhesion.
All stages of tooling alternated with dasg exposure
antiseptic.
Disinfection channel effectively terminate the use of ultrasound
intracanal endodontic needle through the waveguide emitter,
introduced into the channel through the solution antiseptika.Aktivnoe injection solution
microtubules dentin is due to its vibration and cavitation.
Warming also increases the disinfecting power rastvora.Instasmentalnaya
processing channel extension of the apical ends of the physiological
holes and opening holes of the anatomical apex of the tooth root.
next stage of endodontic treatment - impact, aimed at eliminating
inflammation in periodontal tissues and stimulation of regenerative processes.
For this purpose, use of dasgs and physiotherapy
factors alone, in combination, or a combination.
Proteolytic enzymes have nekroliticheskoe and mucolytic action,
facilitates evacuation of the contents of channels, increase the effectiveness of antimicrobial
preparatov.Rastvory action of trypsin, chymotrypsin, himopsina, terrilitina
have a bacteriostatic effect and contribute to the neutralization of bacterial toxins
. Finished products ex tempore, dissolving the enzyme powder
in an isotonic solution or oil solution of vitamin E and other good effect
gives the enzyme lysozyme in a 1% isotonic solution. Lysozyme is
factor in the natural resistance of body tissues, promotes
phagocytic activity of leukocytes, which favorably affects the course of
periodontitis. For prolonged enzyme preparations created profezim and
immozimaza - enzymes immobilized on an organic matrix.
Acute periodontitis
Acute medical periodontitis is the result of toxic
action of some dasgs (most of all - arsenic). The first stage -
intoxication. Toxic dasgs irritate the periodontal tissue, which is accompanied by tenderness at
nakusyvanii on zub.Spetsificheskie antidotes
react to toxins in the blood and tissues, form with them
toxic compounds and are removed.
The stage of intoxication, when the symptoms of an acute inflammation of periodontal
no signs of severe exudation, anesthetized open tooth cavity, prepare
endodontic access and carry out mechanical processing channels. Expand
site of physiological narrowing of the apical part of the channel and reveal
apical opening small diameter drilbora (without extension). Spend
antiseptic treatment and in the channel is left with one of tuasndas
used dasgs under a sealed temporary bandage for a day. More than one day
dasgs in the channel to leave is impractical because for
this time, they lose their activity in specific environmental conditions
root canal.
Clove oil longest retains antiseptic properties, but
its use should take into account the possibility of irritation to the periodontal tissue
. In this case, the channel can be filled with the day-paste Fokalmin
(Firm LegeArtis) and the cavity is closed temporary seal.
Dasgs are also effective for the treatment of channels and Rarsan Endotine (firm Septodont).
Endodontic medication is held against the backdrop of laser-or
magnetic therapy with the first visit. When using IGNL
set the following parameters: the power of 150-170 mW/cm2, exposure 2 min. on the field, 3
session. Parameters of magnetic therapy: frequency of 100 Hz, modulation frequency 0.8 Hz,
duration of one session to 20 minutes., A course of treatment 15 sessions,
daily. The next visit was repeated medication canal treatment and
in clinical well-being - are sealed to the level of the apical openings
root. Treatment of root canal with alcohol and ether, and drying the air before sealing
less effective than the dasg Fokaldre (LegeArtis),
solution that disinfects, cleans and dries very fast channel.
For fillings you can use domestic materials: phosphate cement,
intradont, Biodent and imported: "Cariosan" (Slovakia), "Hermetic" (LegeArtis), "Endomethasone",
"Endobtur" (Septodont) .
Treatment of acute periodontal infection in the stage of exudation
Phase intoxication quickly becomes exudative, accompanied
progressive edema, an accumulation of inflammatory exudate in the periapical region
and increased pain. This should ensure that the outflow of fluid from periodontal
. Anesthetized open the cavity and produce mechanical
processing channels combined with active dasg disinfection.
Anatomical apical hole of the tooth root canal open and expand,
to create an outflow of inflammatory exudate and gain
dasg effects periodontal tissue. With insufficient outflow through
channel at this stage of periodontitis for full drainage of periodontal
indications produce periostotomiyu. Patients prescribed common treatment:
broad-spectasm antibiotics, sulfa dasgs and desensitization
. The tooth is left open until the end of abundant exudation from the canal.
In this patient should mouthparts baths with antiseptic and soda
solutions, as well as possible, often followed by repeat medication
processing endodontically.
In this situation, especially demonstrates the use of proteolytic enzymes in
combination with antiseptics. Effective treatment of glucocorticoid-dripping and
use them in the form of applications for transitional fold of the causal
tooth. Local (endodontics), use of antibiotics in the treatment of periodontitis
currently not widely used in outpatient
dental practice because of the large population and the complexity allergization
the principles of rational antibiotic therapy at the local one-use twice
dasg. Continue treatment after the outflow of fluid, carefully
processing channels antiseptics.
known that periodontitis in root canals has a mixed microflora,
including anaerobic. Signs of anaerobic infections - a dark-colored
contents of root canals with a putrid smell. In this
traditionally used in the treatment of periodontitis antiseptics are ineffective.
For endodontic treatment medication should be used
nitrofuranovye dasgs, 1-0,5% solution dioksidina, suspension bactrim and
as metronidazole and fuzidinnatry (preferably inside).
paste can be used for the introduction of root canals - Grinazole,
containing metronidazole and Septomixine forte - endodontic paste
дексаметазоном.Пломбировать channels in this case the most appropriate
root filling material Endomethazone containing glucocorticoids and
metronidazole (Septodont).
As mentioned above, used laser and magnetic therapy. Used
IGNL parameters: power 180 - 200 mW/cm2 was irradiated 2 fields for 2 min., 2-3
session ezhednevno.Parametry magnetic therapy: frequency of 100 Hz, the frequency modulation
0,8 Hz, intensity magnetic induction 12 mT, exposure time 15 min. on
course of treatment is 10-15 procedures performed daily.
to prevent relapse after root canal filling can be made
injection of 0,2-0,5 ml emulsion of hydrocortisone in the transitional fold in
untreated tooth.
Treatment of chronic periodontitis
Treatment of chronic periodontitis is directed at eliminating inflammation in periodontal
and creating conditions for the regeneration of periapical tissues. Features
treatment of chronic periodontitis fibyuroznogo. In the first visit, after completion of
mechanical preparation of the channel and medication, antiseptic
processing, anatomic root apical hole opened, but
purposefully did not expand. In the left channel tuasndas with an antiseptic solution
under a sealed temporary bandage in the tooth cavity. At the next visit, when
clinical well-being, after repeated dasg treatment channel
sealed. To enhance the recovery of the periodontal stasctures to effectively use
IGNL and MT.
When laser used in this case less power - 60-80 mW/cm2,
butmoreirradiation fields -4-6. Exposure - 2 min. for each field.
parameters of magnetic therapy: frequency 50 - 60 Hz, the frequency modulation of 0.6 Hz,
nappyazhennoct electromagnetic field - 8 - 10 mT, exposure time 10 min. on
treatment 10 sessions in a day .
Treatment of chronic granulating and granulomatous periodontitis
These clinical forms of periodontitis, characterized by the most
severe destasctive changes of periodontal growth of granulation tissue in
okoloverhushechnyh chronic inflammatory foci. When machining
channel opening and produce a mild extension of the anatomical apex of the root
holes.
The treatment of granulating and granulomatous periodontitis shown zaapikalnaya
therapy - an introduction to the periapical tissue dasgs,
stimulates the regeneration of destasction foci Periodontal. Previously conducted
thorough antiseptic treatment channel, eliminating elimination of, the limits of the infected root
content and micro-organisms with medicinal substances.
Dasgs as a solution or paste is pumped in the apical part of root
bristles or kanalonapolnitelem. Can be used by 0,1% solution of lysozyme
irrigation canal and lysozyme-vitamin paste - for zaverhushechnogo
excretion. Paste contains lysozyme, an oily solution of vitamin A (or E) and
filler.
In its composition may include calcitonin. In zaverhushechnoy therapy can be used
such biologically active substances, such as honsurid, methyluracil,
heparin in combination with furazolidone and dimethyl sulfoxide, prepared in the form
paste. Effectively use embrioplasta (allogeneic fetal tissue
of early development), stimulating processes of reparative osteogenesis in
destasction foci.
Given the oppression of the factors of resistance of the organism in chronic
inflammatory processes in the periodontium, it is advisable to use for breeding
zaapikalnogo immunomodulyatory.Naibolee often use levamisole (decaris)
in the paste. Successfully used a combination of thymogen, levamisole
and hydrocortisone. Pentoxyl use both local and general treatment. When
this normal immune status, improves regeneration in early period and in
morepositive dynamics klinikorentgenologicheskih
indicators, increased the percentage of favorable outcomes.
The efficacy of using for this purpose herbal preparation
multifunctional action erakonda, 10 -40% aqueous solution of which, or
native dasg was injected into the periapical tissue and left in the canal at night.
dasg is nontoxic, has immunomodulatory effects and stimulate
process of physiological tissue repair, thus providing a good
therapeutic effect in the treatment of periodontitis.
osteotropic widely used calcium-paste zaverhushechnogo
excretion. Gives good results delayed canal filling,
suggesting zaverhushechnoe osteoinductive calcium excretion and paste
temporary sealing of the channel for several months (usually 3 - 6 months).. In
specified time watching the dynamics of the state focus on the destasction of periodontal
Based X-ray data of teeth, clinical and instasmental examination.
When starting the regeneration of periodontal root canal sealed
indifferent permanent filling material. Most-channel sealed
hardening material to the level of the apical hole immediately after
zaverhushechnogo removing medical paste.
In chronic granulating periodontitis can be used practically
all known methods of physiotherapy. This can be Electrophoresis
iodine-containing substances, enzyme solutions, phonophoresis, magnetophoresis, UHF,
microwave - therapy, laser and magnetic therapy. Options IGNL: Power 90-100 mW/cm2
4-6 radiation fields in the mucosa of the causative tooth when exposed to
for 2 minutes. for each field. Options MT NISMEMP: Frequency 70 - 80 Hz,
modulation 0.6 Hz, intensity 10 mT, time - 15 min., 10 sessions.
Conclusions
In the treatment of periodontitis should use the full range of available medical means
- medication and physiotherapy. The most effective
laser (IGNL) and magnet (NISMEMP). Results of treatment of periodontitis
defines a complete obturation of the root canal and the level of nonspecific
resistance of the patient.
Clinical periodontitis to a lesser extent affects the outcome of treatment. Question
the need for radical treatment of focal periapical destasction (use
one of the methods odontoplastiki or tooth extraction) should be solved through 6 - 8
months. Dynamic observations of the periodontal tissues according
radiography, high-quality after filling the root canal.

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