Медицина/7.Клиническая медицина.

Dubrovina – Parus T.A., Bekirov A.A.
Crimean State Medical University named after S. I. Georgievsky, Simferopol

City Dental Clinic, Simferopol

AN INNOVATIVE TECHNOLOGIES OF TREATMENT OF PERIODONTAL DISEASES

In the work of dentists, often founded teeth which was earlier obturated by resorcin-formalin treatment, obturation hard materials, fracture tool in conjunction with periodontal pockets of inflammation, removal of the root filling are not always successful. It is not always possible to make a full instrumental treatment of root canals because of the difficulty of access to them, because of anatomical and physiological characteristics of the patient, presence of dentikles in a root canal or other reasons. For the treatment of these patients, we apply the method depoforez copper-calcium hydroxide.

 Pulpitis and periodontitis are still the main cause of tooth extraction. Teeth with elements of destruction in the apex lesions are chronic infections, sometimes leading to systemic diseases. The reasons for poor quality of sanitation canals, many authors attributedthe presence of additional undisclosed root canals, great difficulty controlling the passage of the canal and its sealing. Mechanical root canal treatment is still an unsolved problem, and the achievement of sterility and side channels of the apical delta. Even the operating microscope can help. "... The teeth usually have a very variable and branched root system channel apical delta and lateral branching" Bayer Zahnarzteblatt 9/98 (S-47) O.Pontius.

Infected side channels are a place of incubation and sources of bacteria, particularly anaerobes, which are well equipped with dead organic substances, such as collagen is insoluble dentin and penetrating serum. It is crucial that these dead infected channels unreachable defense mechanisms of the body. After numerous foraminifers they maintain a state of chronic inflammation, Periodontitis apicalis chronica, is due to the geometric features of the location practically not detected radiographically. Back in the 1970s Mayer (Göttingen), who spent the fundamental studies of the topography of the pulp, analyzing the roots alot of sections taken perpendicular to the axis of the tooth, came to the conclusion that it is impossible to find a medical solution to the problem of treatment of the root, using traditional approaches. In particular, according to him, when apicectomy removed the main instrument for the unattainable part of branches, but the sleeves are stored delta, located adjacent to the crown. Besides resection has negative consequences - shortening root stump, and especially the introduction of enhanced when closing the main foraminifers annoying factor in the form of foreign bodies are often not fully biocompatible materials.

Taking into account these circumstances, to ensure a continuous sterilization of the entire apical deltas and numerous physiological closing foramines, we have chosen a fundamentally different way, namely depoforez copper-calcium hydroxide. In carrying out this procedure under the influence of a constant electric current OH - ions (OH-) ions and gidroksicopper penetrate the apical part of a "core" of the root cannal, and in the deltoid branch. In the lumen of the channels copper hydroxide, calcium builds up, partly precipitated and lines the wall. In the apical hole in the neutral medium decomposes gidroksicopper ions and transition them sparingly soluble copper hydroxide, which also precipitate. This produces "copper tube" that reliably occlusive all outputs on the apical surface of the root of the delta.
Method depoforez copper hydroxide, calcium we started using since September 2009. We have hold the treatment of 100 patients, 120 teeth. Of these, 64 women and 36 men. The age of patients from 16 to 54 years. This method was carried out according to standard procedure apparate "Endoforez" Delta "," patients, root canals are a number of reasons, could not be treated instrumentally and obturated according to the canons of classical endodontics.

Little diagnostic group consisted of patients with inflamed dental pulp, difficult to treat, mostly upper-eighths of the teeth, as well as patients whose teeth depulpirovat for orthopedic indications, anatomical structure which did not allow for traditional endodontic treatment. Semiannual monitoring revealed no periapical changes in these teeth.

The next group consisted of teeth with X-ray picture of chronic fibrous periodontal, root canals which were not at the time adequately treated instrumentally and obturated. Some teeth in this group earlier performed resorcin-formalin method in three cases in the root canal has previously been broken tool. Resorcin-formalin method in these teeth was carried out in such a way that we could not enter the endodontic instrument in the mouth of the channel. Teeth are subjected to revision before orthopedic treatment. Despite the favorable asymptomatic and radiological picture, we still had a method depoforez copper hydroxide calcium in the course of which occurred after the first procedure and teeth sharpening steel percussion sensitive. After the third treatment sensitivity was gone, the teeth are asymptomatic during the six-month period of observation for metal-ceramic crowns.
Two patients referred to us by the exacerbation of chronic periodontitis in the teeth treated similarly to the above, without the expressed periapical inflammatory changes, we were unable to process the traditional channels, due to the reasons mentioned earlier. From tooth extraction patients refused and he proposed and conducted by a method depoforez copper-calcium hydroxide. After the second procedure, patients no longer complain about the pain. During the six-month observation period, the teeth are asymptomatic. These facts we explain the high penetrating power of the drug copper calcium hydroxide, the active ingredients of which, despite the absence of the main channel penetrated the network of microchannels and branches sanitized and obturated them. Furthermore the audit of such teeth, after the method sometimes opened previously inaccessible root canals and branches that can treat and sealed.

In patients with chronic granulomatous and granulating periodontitis, which was conducted method depoforez we have seen positive changes in the near term (1-3 weeks) after the treatment, such as closing the sinus tract, treatment of acute exacerbations of chronic inflammation. The X-ray taken after 6 months in almost all patients had reduction of periapical inflammatory lesions and signs of bone formation.
As a rule, already in the process of depoforez copper - calcium exudation noted termination of sinus tracts, fistulas were scarring, but their complete closure took place at different times, sometimes for 2-3 months. Fistula contributed to the introduction of copper hydroxide, calcium fistula.
We must point out the futility of our attempts to treat the method depoforez copper hydroxide, calcium tooth with severe internal root resorption, probably due to the presence of granulation tissue in the canals of the tooth, the complete removal of which proved problematic.

It is also proved unsuccessful conduct depoforez patient to 40 years old, front upper teeth which previously inadequately obturated and prosthetic metal-ceramic crowns were unfounded doubly exposed root tip resection without retreatment and retrograde root canal filling. The patient came to us with complaints of a s fistulas moves and suppuration of them. 5 procedures performed depoforez calcium hydroxide, copper, which brought only temporary success, then, a month later, inflammatory process has resumed. A second attempt to lie down, the canals of central incisors traditional methods proved to be more successful. The patient has been in remission for 2 months.

Conclusions:
Application of the method depoforez copper-calcium hydroxide in endodontic treatment of teeth 120, the treatment of which the above reasons can not be a sufficient degree of predictability of the result to the traditional methods, in 100 patients for 6 months, was successful in 93.4% of cases, if we consider the immediate results of the treatment . Criteria for success, we considered the following features: relief of the inflammatory process, the closure of sinus tracts, the positive dynamics of the X-ray after 6 months, or in the case of absence of negative treatment of fibrous forms of chronic periodontitis, asymptomatic clinical symptoms at 6 months follow-up.
The method considered certainly opens up new possibilities in endodontics. However, to depoforez copper hydroxide, calcium taken a worthy place in the national dentistry need to be more widely known him practicing physicians to organize relevant scientific and methodological support for the implementation depoforez in practice to develop standards of working time a doctor to carry out the procedure, including an instrumental processing channels. You also need to specify the requirements for the material and technical equipment of the cabinet, which would allow a technically correct conduct depoforez (the presence of saliva ejector, the opportunity to work with an assistant, a chair that allows you to give the patient a horizontal position).

Depoforez can be not only independent method of treatment, but also an integral part of the complex root canal treatment, the main purpose of which, to achieve maximum efficiency, reliability and safety for the patient.

REFERENCES:

1.Depoforez copper-calcium hydroxide. Institute of dental innovations
2. "Journal Star" № 1 (1) 2000 "Comparison System Works:" Traditional "and endodontics depoforez copper hydroxide - calcium» Dr.Frank Jeschke.
3. Depoforez copper-calcium hydroxide. Evidence-based alternative to endodontics. A.Knappvost Clinical Dentistry number 2 June 1998 pp. 12-15
4. ZMK, Nr.3/97 Die Kupfer-Calciumhydroxid-Depotphorese
5. Der Artikulator Nr.61, 4. Quartal 1997. (Durch Mark und Delta.Depotphorese - ein unkonventionelles Verfahren zur endodontischen Behandlung marktoter Zahne)
6. Endodontics fourth edition John I. Ingle, Leif K. Bakland.