RU2070032C1 - Method of pulpitis treatment - Google Patents

Abstract

FIELD: medicine, stomatology. SUBSTANCE: method involves the successive treatment of cavity of decay with 1% solution of polymethacrylic acid at pH = 8.5-9.0 and after mechanical treatment 1-2% solution of polymethacrylic acid is administrated on the cavity bottom at pH = 9.0 under bandage for 3-5 days. Eventually, paste is applied under permanent filling. Paste consists of a mixture of remodent powder and 2% solution of polymethacrylic acid at pH = 8.0. EFFECT: improved functional results.

Description

 The invention relates to medicine, in particular to therapeutic dentistry, and can be used for the biological treatment of pulp hyperemia, acute serous partial pulpitis, acute serous general pulpitis, simple chronic pulpitis / without destructive changes in periodontium /.

 Known methods for the biological treatment of pulpitis using disinfecting solutions / ethacridine lactate, furatsilina and others /, the antimicrobial drug iodinol, enzymes, antibiotics, hormonal drugs (Ivanov VS Urbanovich LI Berezhnoy VP "Inflammation of the tooth pulp", M. Medicine, 1990, 208 p.). Various medical pastes are also used: zinc-eugenol, calcium hydroxide, collagen (Dmitrieva L.A. Nezhivenko L.N. Gerasina O.V. et al. "Experience in the treatment of pulpitis by vital extirpation using various hemostatic agents" J. Dentistry, 1986, N 3. P. 28-30), bone meal with heparin (Chumakov A.A. Kolenova Z.D. Leontiev V.K. et al. "The effect of paste from sterilized bone meal and heparin ointment on the condition of the pulp of teeth of monkeys with formed deep cavity and traumatic pilpitis "J. Dentistry, 1986, N 3. P. 4 5); from dimexide with crystalline lysozyme (SI Musharanova "The effectiveness of the conservative method of treating pulpitis with dimexide and crystalline lysozyme" Kazan. medical journal, 1983, N 6. P. 434 435), from algipore (Dmitrieva L.A. Adabatskaya A. Ulyanova T.V. et al. “Use of algipore for the treatment of pulpitis.” Dentistry, 1986, N 5. P. 28 29) and others.

 However, all these methods have a number of significant drawbacks. The drugs exert their bactericidal and bacteriostatic effect on microorganisms located in the carious cavity; selectively, many drugs lack a odontotropic effect, i.e. they do not stimulate the formation of replacement dentin and remineralization. Antibiotics and sulfa drugs can cause the emergence of resistant forms of microorganisms or selectively suppress microflora. Many drugs have a sensitizing effect. Some drugs are clinically unstable and lose activity during prolonged storage. Zinc-eugenol paste has a pungent odor. Dimexide is a highly toxic drug. Calcium hydroxide preparations can cause superficial pulp necrosis due to a pronounced alkaline reaction (pH 11 12). Some drugs may stain your tooth.

 The closest is a method of treating pulpitis (tooth filling) using polymethacrylic acid (Japan, application N 3-22042, publication 90.05.17. M. class. A 61 K 6/00).

 This method also has disadvantages. Polymethacrylic acid (PMAA) is bound due to curing, which complicates its positive effect on the pulp of the tooth through the dentinal tubules. This composition does not have a mineralizing and dentin-forming effect, and a change in pH is not provided.

 The objective of the invention is to increase the therapeutic effect, reduce the treatment time for pulpitis and reduce complications due to the use of liquid ion-exchange compounds.

 The significance of the signs for achieving the task is confirmed by the following: the use of liquid PMAA provides the possibility of better penetration through the dentinal tubules to the inflamed tooth pulp. At the same time, it becomes possible to normalize the acid reaction of the pulp through the use of solutions with different pH. The use of remodent powder in the composition of the paste allows you to activate the secondary dentin formation and mineralization in the cavity.

 In accordance with the claimed method for the treatment of pulpitis with a biological method, the criterion of "novelty" is confirmed by the following features missing from the prototype. In its liquid form, PMAA is able to penetrate well through the dentinal tubules in the tooth pulp and show its positive properties (to bind microorganisms and products of their vital activity and decay). In this case, a new property of PMAA is used, which is absent in the prototype to give different pH values, which allows you to quickly neutralize the acid reaction of the inflamed pulp. And this, in turn, leads to the activation of the body’s own defenses, whose action in an acidic environment is weakened. The presence in the paste of a remodet containing Ca, phosphate, potassium, iron, etc. ions provides a high remineralizing ability of the therapeutic pad.

 The method is as follows: the cavity before washing is washed with a 1% solution of PMAA with a pH of 8.5 to 9.0 for its disinfection. The contents of the cavity are carefully removed by an excavator: food debris, pieces of decayed infected dentin. The final preparation of the cavity with the help of boron is performed. After opening the carious cavity under application anesthesia with local anesthetics / solutions of novocaine, pyromecaine, lidocaine, etc. / with spherical boron, necrotic dendin is carefully removed from the bottom of the carious cavity. Again, the cavity is irrigated with a warm 0.1% PMAA solution with a pH of 8.5 to 9.0. A cotton swab moistened with 2% PMAA with a pH of 8.5 to 9.0 / is applied to the bottom of the cavity. This pH of the solution is taken to neutralize the existing shift to the acidic side of the inflamed tooth pulp. The tooth is closed with a temporary dressing / without pressure /. In the absence of pain after 3 to 5 days, a temporary dressing and tampon are removed from the tooth, the carious cavity is washed with a warm isotonic solution of sodium chloride or distilled water. The carious cavity is dried with warm air, a creamy consistency paste is applied to its bottom, consisting of remodet powder mixed in 1 2% PMAA solution with a pH of 7.5-8.0 /. The slightly alkaline composition of the solution is necessary to maintain the pH of the inflamed pulp at neutral numbers. The treatment ends with the application of artificial dentin, phosphate-cement gasket and permanent filling onto the medical paste.

 Clinical example: Patient T., aged 8, was treated for acute general pulpitis of the lower first permanent tooth on the left. Two days ago, spontaneous aches and pains appeared after mechanical and thermal stimuli, lasting up to 15 20 minutes. Previously, the tooth was treated for tooth decay. During an objective examination: on the chewing surface of the first permanent lower molar there is a deep carious cavity with the remains of a filling. Probing of the bottom of the carious cavity is sharply painful, the cavity of the tooth is not opened. Percussion is painless. The mucous membrane of the gums in color is not changed. The painful reaction to cold is painful, prolonged after removal of the stimulus. Electrical excitation 45 mA. The carious cavity is washed with a warm 1% PMAA solution with a pH of 9.0, food residues, rests of the seal, putrid masses are removed by an excavator; carious cavity was prepared with fissure boron. Under application anesthesia with a 1% solution of pyromecaine, spherical boron removed necrotic dentin from the bottom of the carious cavity / dentin of the cavity bottom is softened, pigmented /. The carious cavity is again irrigated with a 1% warm PMAA solution with a pH of 9.0. A cotton swab moistened with 2% PMAA with a pH of 9.0 is applied to the bottom of the cavity, and the tooth is hermetically closed with a dentin paste dressing. After 4 days: the patient makes no complaints. Tooth percussion is painless, the bandage is preserved. After removing the dressing and tampon from the cavity, it is washed with a warm isotonic solution of sodium chloride and dried with warm air. At the bottom of the carious cavity without pressure, a paste was applied, kneaded immediately before treatment, consisting of remodet powder and a 2% PMAA solution with a pH of 8.0. Then a lining made of artificial dentin and phosphate cement. Gallodent filling. When viewed after 8 days, there are no complaints, the electrical excitation of the pulp is 18 mA. When viewed after a month, no complaints, electrical excitation 18 mA.

Claims (1)

 A method for treating dental pulpitis with a biological method by preparing a cavity, followed by antiseptic treatment of it, covering the bottom with a medical gasket, laying and filling the cavity, characterized in that the cavity is sequentially treated with a 1% solution of polymethacrylic acid with a pH of 8.5 9.0, then after its mechanical treatment, 1 2% solution of polymethacrylic acid with a pH of 9.0 is introduced into the bottom of the cavity under a dressing for 3 to 5 days and finally a pass is placed under a permanent filling the one consisting of a mixture of remodet powder and a 2% solution of polymethacrylic acid with a pH of 8.0.