RU2567605C1 - Method of atromatic pre-obturation sanitation of dental root canal system - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: standard stages of mechanical and drug processing of dental root canal are performed. At the stage of pre-obturation sanitation of dental root canal system further sterilisation of dental root canals is realised by UVC irradiation with wavelength 254-257 nm for not longer than 45 s. Disposable tip of UVC light guide is introduced into preliminarily processed canal to working length of root canal, which equals working length of disposable tip of UVC irradiator, but tip must be 1.0-1.5 mm shorter than control length of dental root canal. After introduction of light guide UVC is activated and irradiation of canal walls is performed by gradual movement of irradiating tip of UVC light guide in dental root canal by reciprocating movements from apical hole to canal mouth with 0.3-0.5 mm step, with processing of respective section of root canal. Optimal time of UVC irradiation constituted from 20 to 40 s, but cannot be shorter than 20 s. Irradiation can be performed in one session or in doses in 2-3 10-15 s long sessions with 1.0-3.0 min long interval between each session, both one-session and total-dosed irradiation do not exceed 45 s either. After processing respective section of root canal light guide tip is removed from its mouth and supply of UVC irradiation is switched off.

EFFECT: method makes it possible to preserve hard tooth tissues, to increase sterilisation effectiveness, and reduce risk of complications.

1 tbl, 7 dwg, 4 ex

Description

The invention relates to medicine, in particular to dentistry, and can be used for atraumatic preobstructural rehabilitation of the root canal system of the tooth, characterized by structural safety of hard tissues of the root canal system of the tooth at the stage of preobturation.

It is known that the most common complications of various forms of caries are pulpitis and periodontitis, which require an adequate and effective pre-obstructive stage in the endodontic treatment of root canals of the teeth (Maksimovsky Yu.M., Chirkova T.D. Drug and instrumental treatment of the root canal // New in dentistry. - 2001. - No. 6). Despite the successes in practical endodontics, one of the most important problems remains the quality of pre-obstructive treatment of the root canals of the teeth.

A known method of treating root canals of a tooth in chronic periodontitis using a method of root canal treatment, where after opening the tooth canal, is carried out alternately with abundant rinsing with a medicinal solution under vacuum while removing purulent-necrotic contents and spent drug solution, after which the root canal is drained by vacuum. The method is carried out using an apparatus for treating endodontic cavities in chronic forms of periodontitis (Utility Model Certificate No. 15168, A61K 6/02 of 09/27/2000. Authors: Nedoseko VB, Kuratov I.A). The disadvantages of the method are inadequate extraction of purulent-necrotic contents, the possibility of injury to the teeth and the jaw tissue, prolonged treatment and possible structural damage to the hard tissues of the root canal system due to the action of vacuum.

A known method of preparing tooth channels for filling (RF Patent No. 2240847 from 08/18/2003, IPC: A61N 5/067, authors: Risovannaya ON, Risovanny SI), including channel expansion, the introduction of a photosensitizer solution into the channel 56M concentration and channel processing by a diode laser beam with a power of 0.5-1.0 W and a wavelength of 662 nm for 5-6 minutes. However, the disadvantage of this method is that during the exposure of the laser beam to the hard tissues of the root canal of the tooth, damage to the dentinal tubules occurs in the form of microcracks, which is a structural damage to the hard tissues of the root canal of the tooth, which contributes to the development of the inflammatory process in the postobturation period. This method is contraindicated in individuals with a history of allergic status (http // www / fotoditazin.ru / main / fotoditazin).

A known method of processing root canals using a diode laser (Butaeva N.T., Makeeva I.M., Turkina A.Yu. “Antiseptic treatment of root canals using a diode laser”, Dentistry for all, 2008, No. 2, pp. 60- 63), including opening the tooth cavity and determining the working length of the canal, machining the canal with hand or rotary tools at least up to ISO size 030 using an endolubriant and a 3% sodium hypochlorite solution, first irrigating the channel with a 3% sodium hypochlorite solution, and then distilled minutes with water and drying channel pins with subsequent laser treatment of the root canal. In this case, the fiber length is chosen 1 mm less than the working channel length, the fiber is inserted into the root canal to the maximum depth, the laser is activated and the canal walls are machined, making spiral-like movements from the apical opening to the canal mouth for 20 s, after which the root channel. This method provides the possibility of pre-obstructive treatment of the root canal in the treatment of pulpitis, however, in some cases of its application, complications occurred, as well as the appearance of microcracks of root dentin, burns and necrosis of periodontal tissues in the periapical region, which is a significant disadvantage of the method.

The closest analogue to the prototype is the method of endodontic treatment of teeth with chronic forms of pulpitis (RF Patent No. 2402362 of 10.27.2010, IPC: A61N 5/067, authors: Mitronin A.V., Chunikhin A.A.), in which for root canal treatment, channel scanning sessions are carried out with a laser beam, which irradiate the channel for 5-25 s in one session, while the laser fiber is introduced into the channel without bringing it to the root apex by 1.0-1.5 mm, after which the laser is activated, inside the channel by the light guide and carry out circular movements, gradually remove it from the can and at the exit from the channel, the laser is turned off, and the channel irradiation sessions are carried out from 3 to 5 times with an interval between sessions of 0.5-5.0 min, and a laser with a emitted wavelength of 1.04 microns and with a power in pulsed mode is selected work equal to 0.6-1.1 watts. However, the disadvantage of this method is that during the action of the laser beam on the hard tissues of the root canal of the tooth, damage to the dentinal tubules occurs in the form of microcracks, which is a structural damage to the hard tissues of the root canal of the tooth, contributing to the inflammatory process in the post-obstructive period of endodontic treatment.

The objective of the invention is to develop an atraumatic method of preobstructural debridement of the root canal system of the tooth, providing structural preservation of the hard tissues of the tooth canal, devoid of the above disadvantages.

EFFECT: atraumatic preobstructive rehabilitation of the root canal system of the tooth.

The technical result is achieved in that the method of atraumatic pre-obstructive sanitation of the root canal system of the tooth includes the generally accepted stages of mechanical and drug treatment of the root canal of the tooth, characterized in that at the stage of pre-obstructive sanitation of the root canal system of the tooth, the channel is sterilized (UVC) with ultraviolet radiation with a wavelength of 254-257 nm

The technical result of the claimed method of atraumatic preobstructural sanitation of the root canal system of the tooth is aimed at the fact that at the stage of preobstructural sanitation of the root canal system of the tooth, the structural complex of the root canal system, consisting of hard tissues, namely the system of dentinal tubules, lateral and additional canals, and the apical opening, deeply sanitized due to the bactericidal effect of ultraviolet radiation emitted by the endodontic device-instrument (Utility Model Patent Al No. 131609, A61C 19/06 dated 09/10/2012, author: Larinskaya A.V.), while maintaining the structural integrity of the hard tissue of the root canal of the tooth, which creates favorable conditions for obstruction of the root canal of the tooth, and at the same time reduces the likelihood development of distant complications. The endodontic device-instrument is shown in photo 1, where the body of the endodontic instrument-instrument is shown under number 1, number 2 is the UVC fiber, number 3 is the holder for the UVC disposable fiber tip, number 4 is the UVC disposable fiber tip, number 5 is the power cord, number 6 - toggle switch.

The implementation of the method of atraumatic preobstructural sanitation of the root canal system of the tooth is as follows: using endodontic instruments (http: //bone-surgeiy.m/view/instrumentalnaya_obrabotka_kornevyh_kanalov/), standard mechanical processing of the root canal is performed, namely, preparation of hard tissues, determination of topography, length, root canal (http://mirmedtech.ru/products/apekslokator-ipex). Next, the root canal is processed according to the Crown Down technique with the formation of apical emphasis and taper. Then, a standard medical treatment of the root canal system is carried out using a 17% solution of ethylenediaminetetraacetic acid (EDTA) and a 3% solution of sodium hypochlorite (NaClO) to dissolve the organic part of the lubricated layer, pulp residues, and detritus, with washing with distilled water after each of the above solutions (http: //www.provisor.com.Ua/100matolog/archive/2009/l/kornp_019.php). Using an apex locator, IPEX (http://mirmedtech.ru/products/apekslokator-ipex) or the control length of the channel is measured radiologically. After that, the stopper marks the working length on a disposable tip - the fiber of the UVC-ultraviolet irradiator shown in photo 2, where number 1 is the endodontic apparatus body, number 2 is the UVC fiber, number 3 is the UVC one-time fiber tip, number 4 is the tooth, number 5 - toggle switch. Photo 3 shows a holder for a disposable UVC fiber tip, which shows a beam of transmitted UV light. The working length of the root canal is equal to the working length of the disposable tip of the UVC fiber, and it should be 1.0-1.5 mm less than the control length of the root canal of the tooth. Irradiation of the channel walls is carried out simultaneously for 20-45 s. The exposure time depends on the severity of the pathological process in the root canal of the tooth, which should not exceed 45 s. In the event of a patient's anxious reaction to the ongoing procedure, irradiation can be carried out fractionally in 2-3 doses, each of which can last no more than 10-15 seconds. The intervals between irradiation are from 1.0 to 3.0 minutes. The total fractional exposure time should also not exceed 45 s. During irradiation, a disposable UVC fiber tip is inserted into the pre-treated channel to the working length and UVC is activated, thereby irradiating the channel walls, while the UVC fiber tip is gradually moved back and forth from the apical opening to the channel mouth with a step of 0.3-0, 5 mm, processing the corresponding section of the root canal. After removing the tip of the UVC fiber from the mouth of the channel, the UVC supply is turned off. The duration of exposure and the number of irradiation doses are determined taking into account the degree of damage to the root canal and the patient's response to the procedure.

It was experimentally established that when exposed to UVC irradiation with a wavelength of 254-257 nm with an exposure of up to 20 s, microbiota foci occur in the hard tissues of the root canal, which is shown in photo 4, where number 1 is the apical third of the root canal, a section of decalcified tooth, number 2 - the lumen of the root canal, number 3 - the focus of degenerative calcification, number 4 - the wall of the root canal with an uneven surface with open dentinal tubules, number 5 - transversely cut dentinal tubules, number 6 - the wall of the root canal with a modified layer of detritus and foci of microbism. When the irradiation time is increased to 45 s, the foci of microbiota in the root canal are not fixed, while the structural integrity of the hard tissues of the root canal system of the tooth is preserved, which is shown in photo 5, where number 1 is the apical third of the root canal, a section of decalcified tooth, number 2 is the lumen the root canal, number 3 - dentin of the root of the tooth, number 4 - the wall of the root canal free from the modified layer of detritus and foci of microbism, number 5 - cement of the root of the tooth. Irradiation of the walls of the root canal of the tooth for more than 45 s is not advisable because the positive effect is achieved in the range from 20 to 45 s. Thus, the time interval of simultaneous or total fractional UVC irradiation of the root canal of the tooth should not be less than 20 s and more than 45 s, where 20 s is the minimum exposure time and can be increased to 45 s, and 45 s is the maximum boundary of the time range of the atraumatic sanitation of the root canal system of the tooth.

The inventive method is confirmed in a histological experiment on 30 teeth removed for chronic forms of periodontitis that have not previously undergone endodontic treatment, all the studied teeth are divided into 3 groups depending on the method of root canal treatment. Each group is represented by 10 teeth (roots). All root canals were treated according to the standard method: preparation of hard tissues, determination of topography, length of the root canal, instrumental (mechanical) treatment according to the Crown Down method, drug treatment of the root canal system with EDTA and a stabilized sodium hypochlorite solution with activation of irrigation solutions with ultrasound. In the first group, the root canals were treated only by the standard method, which is shown in photo 6, where number 1 is the apical third of the tooth root, a section of decalcified tooth, number 2 is the lumen of the root canal, number 3 is a modified layer of detritus, number 4 is the transversely cut dentinal tubules , number 5 - foci of microbism, number 6 - dentin of the root of the tooth. In the second group, the root canals were additionally treated with a SIROLaser diode laser from Sirona (Germany) with a wavelength of 980 nm for 20 s, which is shown in photo 7, where number 1 is the middle third of the tooth root, a section of the decalcified tooth, number 2 is the damage sites in the thickness of dentin - microcracks, number 3 - dentin of the root of the tooth, number 4 - foci of microbism. In the third group, the root canals were additionally treated with a device apparatus for sterilization of the root canal system of the tooth - UVC irradiation with a wavelength of 254-257 nm, for 20-45 s (Utility Model Patent No. 131609, A61C 19/06 from 09/10/2012 ., author: Larinskaya A.V.). These histological findings are presented in Table 1, from which it can be seen that the formation of structural damage to the hard tissues of the root canals at the preobturation stage, namely: a modified layer of detritus, foci of microbism, damage areas of the dentinal tubules in the form of microcracks directly depend on the radiation source, its length waves and time of exposure to the walls of the root canal of the tooth. The presence of foci of dystrophic calcification, in%, is a manifestation of a chronic inflammatory process in the root canal system of the tooth and does not depend on the method of processing hard tooth tissues.

The advantages of the method of atraumatic preobstructural rehabilitation of the root canal system of the tooth:

- provides structural safety of hard tissues of the root canal of the tooth at the stage of preobturation;

- increases the sterilization efficiency of pre-obstructive sanitation by reducing microbial contamination in the root canal system of the tooth;

- meets the basic criteria for successful endodontic treatment of the root canals of the tooth.

The invention is confirmed by examples.

Example 1

Patient A., 22 years old, male. When handling no complaints, appealed with a view to reorganization. From the anamnesis: tooth 2.7 in the past was not treated, previously pained by biting, which disappeared spontaneously. On examination, the crown of 2.7 teeth is totally destroyed, the cavity is within the mouth of the root canals, probing of the mouths of the canals is painless, thermometry is not expressed. The reaction to percussion is painless. The mucous membrane in the area of the transitional fold is not changed. The threshold of electroexcitation is more than 100 μA. X-ray uneven expansion of the periodontal gap is observed mainly in the apical third of the root. The structure of the surrounding bone tissue is not broken. Clinical diagnosis: 2.7 - chronic fibrous periodontitis. According to the consultation of the orthopedic dentist: removal of 2.7 root of the tooth is recommended for the purpose of rational prosthetics. A syndesmotomy was performed under infiltration anesthesia, extraction of the roots of 2.7 tooth followed by hemostasis. Then, immediately after the removal, root canal treatment of 3.6 tooth was performed: preparation of hard tissues, determination of topography, root canal length, instrumental processing according to the Crown Down technique with the formation of apical emphasis and taper. Drug treatment of the root canal system was carried out using EDTA and NaClO. Root canals are drained with absorbent pins. After that, each root canal was treated with a UVC beam with a wavelength of 254-257 nm for 40 s (Utility Model Patent No: 131609, A61C 19/06 of 09/10/2012, author: Larinskaya A.V.). Then, the roots of 2.7 teeth were fixed in 10% formalin, followed by demineralization of hard tissues, pouring and preparation of celloidin sections of teeth - root canals (Microscopic technique: Manual / edited by D.S. Sarkisov and Yu.L. Perov. - M., Medicine, 1996 .-- 544 p.).

According to light, immersion microscopy, the root canals of 2.7 teeth have an uneven surface, with open dentinal tubules. A modified layer of detritus, foci of microbism, areas of damage to the dentinal tubules in the form of microcracks and foci of dystrophic calcification were not detected. Conclusion: structural damage to hard tissues in the root canal system of 2.7 teeth after application of a UVC beam with a wavelength of 254-257 nm was not detected for 40 s.

Example 2

Patient P., 23 years old, male. When handling no complaints, appealed with a view to reorganization. From the anamnesis: tooth 4.6 in the past was treated according to the uncomplicated form of caries, more than 5 years ago a filling fell out, after which pains when biting, which disappeared spontaneously, bothered. On examination, the crown of the 4.6 tooth is totally destroyed, the cavity is within the mouth of the root canals, the sounding of the mouths of the canals is painless, thermometry is not expressed. The reaction to percussion is painless. The mucous membrane in the area of the transitional fold is not changed. The threshold of electroexcitation is more than 100 μA. X-ray uneven expansion of the periodontal gap is observed mainly in the apical third of the root. The structure of the surrounding bone tissue is not broken. Clinical diagnosis: 4.6 - chronic fibrous periodontitis. According to the consultation of the orthopedic dentist: removal of 4.6 root of the tooth is recommended for the purpose of rational prosthetics. A syndesmotomy was performed under torus anesthesia, extraction of the roots of a 4.6 tooth followed by hemostasis. Then, immediately after the removal, the root canals of the 4.6 tooth were processed: preparation of hard tissues, determination of topography, length of the root canals, instrumental processing using the Crown Down technique with the formation of apical emphasis and taper. Drug treatment of the root canal system was carried out using EDTA and NaClO. Root canals are drained with absorbent pins. Each root canal of 4.6 tooth was UVC treated with a beam with a wavelength of 254-257 nm for 38 s (Utility Model Patent No. 131609, A61C 19/06 of 09/10/2012, author: Larinskaya A.V.). Then, the roots of 4.6 tooth were fixed in 10% formalin followed by demineralization of hard tissues, filling and preparation of celloidin sections of teeth - root canals (Microscopic technique: Manual / edited by D.S. Sarkisov and Yu.L. Perov. - M., Medicine, 1996 .-- 544 p.).

According to light immersion microscopy, the root canals of the 4.6 tooth have an uneven surface, with open dentinal tubules. In the buccal-distal root canal at the level of the apical third, a focus of degenerative calcification of 0.1 to 0.3 mm is noted. A modified layer of detritus, foci of microbism, areas of damage to the dentinal tubules in the form of microcracks in the root canals were not detected. Conclusion: a lesion of dystrophic calcification in the apex of the buccal-distal root canal was revealed as a result of a chronic inflammatory process. Structural damage to hard tissues in the root canal system of a 4.6 tooth after application of a UVC beam with a wavelength of 254-257 nm was not detected for 38 s.

Example 3

Patient V., 25 years old, male. When handling no complaints, appealed for the purpose of prosthetics. From the anamnesis it was found that tooth 3.6 was not treated in the past, pains when biting on tooth 3.6 were previously disturbed, which disappeared spontaneously. When examining the crown of the 3.6 tooth, the carious cavity within the mouth of the root canals is totally destroyed, probing of the mouth of the canals is painless, thermometry is not expressed. The reaction to percussion is accompanied by mild pain. The mucous membrane in the area of the transitional fold is not changed. The threshold of electroexcitation is more than 100 μA. X-ray uneven expansion of the periodontal gap is observed mainly in the apical third of the root. The structure of the surrounding bone tissue is not broken. Clinical diagnosis: 3.6 - chronic fibrous periodontitis. According to the consultation of the orthopedic dentist: the removal of 3.6 tooth roots is recommended for the purpose of rational prosthetics. A syndesmotomy was performed under torus anesthesia, extraction of the roots of a 3.6 tooth followed by hemostasis. Then, immediately after tooth extraction, root canal treatment of 3.6 tooth was performed: preparation of hard tissues, determination of topography, length of root canals, instrumental treatment using the Crown Down technique with the formation of apical emphasis and taper. Drug treatment of the root canal system was carried out using EDTA and NaClO. Root canals are drained with absorbent pins. Each root canal was treated with a UVC beam with a wavelength of 254-257 nm, namely, the buccal distal root canal - 40 s, the buccal medial root canal - 30 s, the lingual canal - 25 s (Utility Model Patent No. 131609, A61C 19/06 from September 10, 2012. Author: Larinskaya A.V.). Then, the roots of 3.6 tooth were fixed in 10% formalin followed by demineralization of hard tissues, filling and preparation of celloidin sections of teeth - root canals (Microscopic technique: Manual / edited by D.S. Sarkisov and Yu.L. Perov. - M., Medicine, 1996 .-- 544 p.).

According to light, immersion microscopy, the root canals of the 3.6 tooth have an uneven surface, with open dentinal tubules. A modified layer of detritus, foci of microbism, areas of damage to the dentinal tubules in the form of microcracks and foci of dystrophic calcification were not detected. Conclusion: structural damage to hard tissues in the root canal system of the 3.6 tooth after application of a UVC beam with a wavelength of 254-257 nm was not detected.

Example 4

Patient A., 25 years old, male. When handling no complaints, appealed with a view to reorganization. From the anamnesis: 3.6 tooth was not treated in the past; earlier, more than 3 years ago, pains occurred when biting, which disappeared spontaneously. On examination, the crown of the 3.6 tooth is totally destroyed, the cavity is within the mouth of the root canals, probing of the mouths of the canals is painless, thermometry is not expressed. The reaction to percussion is accompanied by mild pain. The mucous membrane in the area of the transitional fold is not changed. The threshold of electroexcitation is more than 100 μA. X-ray uneven expansion of the periodontal gap is observed mainly in the apical third of the root. The structure of the surrounding bone tissue is not broken. Clinical diagnosis: 3.6 - chronic fibrous periodontitis. According to the consultation of the orthopedic dentist: the removal of 3.6 tooth roots is recommended for the purpose of rational prosthetics. A syndesmotomy was performed under torus anesthesia, 3.6 root extraction followed by hemostasis. Then, immediately after the removal, root canal treatment of 3.6 tooth was performed: preparation of hard tissues, determination of topography, root canal length, instrumental processing according to the Crown Down technique with the formation of apical emphasis and taper. Drug treatment of the root canal system was carried out using EDTA and NaClO. Root canals are drained with absorbent pins. Laser treatment of each root canal was performed using a SIROLaser diode laser from Sirona (Germany) with a wavelength of 980 nm, for 20 s at a power of 1.5 W. Then, the roots of 3.6 tooth were fixed in 10% formalin followed by demineralization of hard tissues, filling and preparation of celloidin sections of teeth - root canals (Microscopic technique: Manual / edited by D.S. Sarkisov and Yu.L. Perov. - M., Medicine, 1996 .-- 544 p.). According to light immersion microscopy, the root canals of the 3.6 tooth have an uneven surface with open dentinal tubules, but places on the dentin surface in the projection of the apical third of the root canals are microscopically determined: a modified layer of detritus, foci of microbism, foci of dystrophic calcification. In the buccal medial root canal and in the lingual root canal, at the level of the middle third, the areas of damage to the dentinal tubules - microcracks - are visualized. Conclusion: gross structural damage to hard tissues in the root canal system of 3.6 teeth was detected after using a diode laser with a wavelength of 980 nm for 20 s at a power of 1.5 W.

Claims (1)

The method of atraumatic preobstructural debridement of the tooth root canal system includes the standard steps of mechanical and drug treatment of tooth root canals, further sterilization of the root canals at the stage of preobstructural sanitation of the tooth root canal with UVC irradiation with a wavelength of 254-257 nm for no more than 45 s, characterized in that the disposable tip of the UVC fiber is introduced into the pre-treated channel by the working length of the root canal, which is equal to the working length of the disposable UVC tip of the atrium, but by 1.0-1.5 mm, the tip should be less than the control length of the root canal of the tooth, after the introduction of the fiber, UVC is activated and the walls of the canal are irradiated, gradually moving the emitting tip of the fiber of the UVC in the root canal of the tooth back and forth from the apical opening to the channel mouth with a step of 0.3-0.5 mm, processing the corresponding section of the root canal, while the optimal UVC irradiation time is from 20 to 40 s, but cannot be less than 20 s, while irradiation can be carried out simultaneously or fractionally 2-3 doses of 10-15 s with an interval between each dose of 1.0-3.0 minutes, and simultaneous and total fractional irradiation also does not exceed 45 s, after processing the corresponding section of the root canal, the fiber tip is removed from its mouth and the UVC irradiation is turned off, respectively, the fragmentation of the irradiation is determined by the clinical picture, the degree of damage to the root canal of the tooth, and / or the general reaction of the patient to the ongoing procedure.

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