RU2489986C1 - Method of sealing endodontic access - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to therapeutic dentistry, and is intended for sealing endodontic access. After filling root canal, orifice of root canal is closed with glass-ionomer cement. Orifice is photopolymerised for 20-40 sec. First layer of temporary tooth filing, made of zinc-sulfate cement is laid on it to enamel-dentin biundary. Then, primer, which is also photopolymerised for 20-40 sec is applied on walls of endodontic access, free from zinc-sulfate cement. After that, layer of glass-ionomer cement is applied. It is photopolymerised for 20-40 sec and polished.

EFFECT: method makes it possible to obtain reliable sealing of endodontic access due to creation of double barrier from layers of temporary tooth filing for microorganisms.

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Description

The invention relates to medicine and can be used in therapeutic dentistry with endodontic dentistry, in particular the treatment of pulpitis, periodontitis, tooth trauma, orthopedic dentistry in preparing teeth for intra-root structures.

At the moment, the problem of improving the long-term results of endodontic dentistry, which is carried out in several stages, remains relevant.

And during this time, the need for a temporary seal is created.

The establishment of temporary fillings is used in cases where the treatment of caries and its complications does not end in one visit. They are intended for tight closing or filling defects of hard tissues of teeth for a short time. Therefore, the following requirements are imposed on them: they must be ductile, easily introduced and removed from it, not inactivate medicinal substances and ensure tightness (Skorikova L.A., Volkov V.A., Bazhenova N.P. Propaedeutics of dental diseases. Rostov- on-Don "Phoenix", 2002, p. 108). Also, materials should be easy to prepare; tightly close the cavity from access of saliva and bacteria; be mechanically stable in the oral cavity during their use, quickly and completely removed from the cavity; have a good marginal fit; do not dissolve in the oral fluid; not have micro-leaks, be cheap enough. (V.I. Yakovleva, E.K. Trofimova, T.P. Dovidovich, G.P. Prosvyaryak Diagnosis, treatment and prevention of dental diseases. Minsk 1994, p. 147).

A known method of setting temporary fillings using zinc sulfate cement, consisting of zinc oxide, zinc sulfate, calcium sulfate. The material has antibacterial and anti-inflammatory properties, hardens upon absorption of moisture and expands during the hardening process, providing reliable isolation of the cavity. The beginning of the hardening of the paste after entering the tooth cavity after 30-40 minutes.

Material is added in portions into the cavity prepared in the tooth, formed within a few minutes, the cement begins to harden. Final hardening occurs after 30-40 minutes. It has a good marginal fit. (Maksimovsky Yu.M. et al. Therapeutic dentistry, Moscow, 2001, pp. 235-236)

However, the seal does not provide sufficient tightness of the endodontic access due to large shrinkage, which leads to the appearance of microcracks in the tooth cavity. In addition, the seal hardens for a long time, which does not allow us to be sure of the integrity of the seal until the next visit by the patient to the doctor, the seal partially dissolves in the oral fluid.

The closest analogue adopted for the prototype is a method of sealing endodontic access used in the combined method of setting temporary fillings (RU No. 2253398. Op. 2005.06.10), in which, after creating endodontic access by known methods, root canal filling and obstruction of the tooth cavity temporary combined filling made of two layers - the first layer of material based on zinc oxide and zinc sulfate ", - zinc sulfate cement, the second layer of light-cured material on the basis of e polyurethane acrylate polymer and silicon dioxide.In this case, for better adhesion of the two materials, after laying the first layer, a spiral pin is installed in its middle to the bottom of the cavity and then the second layer is laid.

Considering that the top layer is made of polyurethane acrylate polymer and silicon dioxide, which does not adhere to the walls of enamel dentin, a seal made of this material does not provide tight endodontic access and therefore the lower layer of the zinc sulfate cement seal is partially dissolved in the oral fluid, thereby reducing the tightness of the endodontic access due to the appearance of micro-leakage.

The use of a spiral pin does not exclude micro-leakage and, in addition, the pin increases the point load on the bottom of the tooth cavity, which leads to the appearance of vertical cracks, and as a result, the necessary tightness of the endodontic access is not achieved.

The task to which the invention is directed is to increase the tightness of endodontic access.

To solve the problem in a method of sealing endodontic access, including creating endodontic access, filling the root canal of the tooth, obturation of the tooth cavity with a temporary filling, consisting of two layers, the first layer is made of zinc sulfate cement, the second layer is made of photocurable material, according to the invention, the mouth of the root canal after filling the root canal is closed with glass-ionomer cement, the first layer of temporary filling made of zinc-sulfon is laid on it of cement, then a primer is applied to the endodontic access walls, photopolymerized and a second layer of temporary filling is applied, which is made of glass-ionomer cement, which is also photopolymerized.

Zinc oxide, which is part of zinc sulfate cement, the material of the first layer of a temporary filling, prevents the growth of residual microflora in the dentinal tubules.

The material of the second layer - glass-ionomer cement - has a sufficiently high strength characteristics and provides a strong mechanical bond with the dentin of the tooth. In addition to mechanical bonding, this material has a strong chemical bond with the dentin of the tooth. This prevents the leakage of oral fluid into the cavity of the tooth, ensures tightness of the endodontic access.

Applying a layer of glass-ionomer cement to the mouth of the root canal, when removing a temporary filling, avoids excessive removal of dentin in the area of the root canal, leading to weakening of the tooth walls and further fracture.

In addition, in case of accidental violation of the two upper layers of the temporary fillings, a layer of glass-ionomer cement deposited on the mouth of the root canal allows the root canal to be sealed.

The claimed combination of features of the invention allows to achieve the task - to increase the tightness of endodontic access and, as a result, improve the quality of endodontic treatment.

The method is as follows.

1. Create endodontic access by known methods

- excision of inferior fillings, carious dentin, reconstruction of the walls of the tooth crown using a matrix system and composite material

- trepanation of the tooth crown using endodontic boron, etc.

2. Spend mechanical and drug treatment of the root canal.

3. Next, obturation (filling) of the root canal system is performed.

4. The mouth of the root canal is filled with glass ionomer cement.

5. Conduct photopolymerization of the mouth for 20-40 seconds, depending on the characteristics of the glass ionomer cement used.

6. Then fill the endodontic access - create a temporary seal. For this, a material based on zinc oxide and zinc sulfate — zinc-sulfate cement — is placed on the bottom of the endodontic access — to the enamel-dentin border. Next, a primer (glue) is applied to the endodontic access walls free of zinc-sulfate cement, and it is photopolymerized 20-40 sec

Then a layer of glass ionomer cement is laid, photopolymerized for 20-40 seconds and polished. The temporary seal is ready.

7. Next, the patient is sent to the stage of continuous recovery - for example, an orthopedist or therapist.

Patients from 7 to 40 years old were examined - 50 people (1, 2, 3 health groups). We studied 79 teeth with diseases of the endodontic system without destructive changes in bone tissue. The subjects were divided into 4 groups depending on the type of temporary filling that was used to seal the endodontic access:

Group 1: 19 teeth in which, during treatment, the endodontic access was sealed with Clip material (material based on polyurethane acrylate polymer and silicon dioxide);

Group 2: 20 teeth in which, during treatment, the endodontic access was sealed with Cimpat (zinc oxide and zinc sulfate-zinc sulfate cement-based material)

3 group: 20 teeth, in which during the treatment endodontic access was filled with Vitremer material (glass-ionomer cement);

4 group: 20 teeth in which during the treatment endodontic access was sealed with double isolation method (Cimpat + Vitremer);

Comparison of the research results was carried out according to the microbiological parameters of dentin before and after the application of a temporary filling (Table 1) and the radiological indicators of destructive changes in bone tissue (table 2).

Table 1 Microbiological parameters of dentin before and after applying a temporary filling Type of temporary seal
Dentin seeds,% CLIP Cimpat VITREMER CIMPAT / VITREMER Before applying a temporary seal 2.1 4.05 four 3.15 After applying a temporary seal 78 66 twenty 9.5

table 2 X-ray indicators of endodontic treatment Type of temporary seal
Destructive changes in bone tissue,% CLIP Cimpat VITREMER CIMPAT / VITREMER Before applying a temporary seal 1.15 2,31 4.8 3,7 After applying a temporary seal, after 12-24 months 66 52,2 3.17 1.43

The best results were obtained in group 4, during treatment using the proposed method of sealing endodontic access by double isolation using materials zinc-sulfate cement and glass-ionomer cement (Cimpat + Vitremer).

Studies confirmed by case studies

Example 1

Patient Khoroshavtsev D.A., 30 years old. He went to the clinic with the goal of sanitation of the oral cavity and rational prosthetics. When examining the oral cavity was found on the distal surface of the tooth 1.3. defective filling with a broken marginal fit, signs of caries around the perimeter. Hard tooth tissue in color is not changed. Percussion of the tooth is negative, the temperature reaction is painless. Indicators of electroodontometry 10 μA. After removing the defective fillings under anesthesia and under the control of a caries marker, a carious cavity is determined on the distal surface within the peri-pulp dentine, and a brown marbled pattern in the projection area of the pulp chamber. On the roentgenogram of tooth 1.3 .: the carious cavity is separated from the cavity of the tooth with a thin layer of dentin. The root has no bends, the periodontal ligament space is traced along the entire length of the root, of uniform width, there is a slight deformation in the apex region. Clearance of the root canal is traced throughout. During densitometry, bone mineralization in the apical region is 122-128.

Diagnosis: chronic pulpitis of the tooth 1.3.

Treatment: Under Sol. Ultrocaini 4% - 1.7, insulating material was applied around the tooth (cofferdam), defective fillings were removed, necrectomy (carious tissue removal) was performed, the tooth cavity was opened, pulp amputation was performed, the working length was determined with 29 mm instrument if02 / 015, and the root canal was machined (drilling) using the Ra-Ce and Pro-Taper nickel-titanium rotating system to the size ff06 / 03, drug treatment of the root canal with sodium hypochlorite solution of 3.35% -30.0.

Then, the root canal was dried with absorbents and the root canal system was obstructed (filled) by cold gutta-percha lateral compaction using Sealapex sealer.

Immediately after the mechanical and medical treatment of dentin using a sterile Headstrom file, a dentin chip was created, which was collected using a sterile gutta-percha pin, placed in a transport medium and sent to a microbiological laboratory for microbiological research.

The mouth of the root canal is sealed with Vitremer / 3M ESPE glass ionomer cement. Photopolymerization was carried out for 40 sec. A sterile gutta-percha pin is placed at the bottom of the endodontic access. Cimpat / Septodont zinc sulphate cement is placed in the endodontic cavity to the enamel-dentinal border. The residual endodontic access space was primed and filled with Vitremer / 3M ESPE glass-ionomer cement followed by photopolymerization for 40 seconds.

The patient is referred to an orthopedic dentist to further strengthen the pin structure and permanent restoration with the orthopedic structure. After 14 days, during an appointment with an orthopedic dentist, after removing a temporary filling from the endodontic access, the gutta-percha pin from the bottom of the cavity was placed in a transport medium and sent to a microbiological laboratory for microbiological examination.

According to the results of microbiological studies, prior to sealing the endodontic access with a temporary filling, microflora growth was not observed. After applying a temporary seal, microflora growth was also not observed.

After 12 months on the radiograph of the tooth 1.3: the crown part is restored by the orthopedic design. The clearance of the root canal in the estuarine and middle third was made by a non-radiopaque pin design, in the apical third, the canal lumen was uniformly filled to the level of the physiological opening with sealer (filling material for the canal).

Radiologically, the periodontal ligament space (control parameter) is evenly traced throughout. Densitometry (bone mineralization) in the apical region ranges from 124 to 128.

No clinical manifestations, no complaints

Example 2

Patient Ziyaltdinov M.F., 18 years old. He addressed for the purpose of sanitation of the oral cavity. When viewed on the mesio-palatal surface of the tooth 1.1. a carious cavity is determined. Percussion of the tooth is negative, the temperature reaction is painless. Indicators of electroodontometry more than 60 μA.

X-ray of the tooth 1.1. the carious cavity is adjacent to the pulp chamber, an extensive communication with the tooth cavity is determined, the root of the bends does not have, the periodontal ligament space is evenly traced throughout, in the area of the apical third bone destruction is determined, the lumen of the canal is traced throughout.

After necrectomy, a carious cavity is determined under the control of the caries marker within the peri-pulp dentine, and there is a wide communication with the tooth cavity in the bottom area.

Diagnosis: chronic periodontitis of the tooth 1.1.

Treatment: cofferdam, necrectomy, opening of the tooth cavity, determination of the working length of 26 mm, if 02/020, mechanical treatment of the root canal using the Ni-Ti system of the rotating Pro-Taper system to size ff 06 | 050, drug treatment of the root canal with hypochlorite solution sodium 3.35% - 30.0. Drying of the root canal with absorbents and obturation of the root canal system by lateral compaction of cold gutta-percha using Sealapex sealer.

Immediately after the mechanical and medical treatment of dentin using a sterile Headstrom file, a dentin chip was created, which was collected using a sterile gutta-percha pin, placed in a transport medium and sent to a microbiological laboratory for microbiological research.

The mouth of the root canal is sealed with Vitremer / 3M ESPE glass ionomer cement. Photopolymerization was carried out for 40 sec. A sterile gutta-percha pin is placed at the bottom of the endodontic access. Cimpat / Septodont zinc sulphate cement is placed in the endodontic cavity to the enamel-dentinal border. The residual endodontic access space was primed and filled with Vitremer / 3M ESPE glass-ionomer cement followed by photopolymerization for 40 seconds.

To conduct a permanent restoration of the hard tissues of the tooth, the patient is scheduled to receive after 10 days.

When you visit again after 10 days in order to constantly restore the hard tissues of the tooth 1.1. immediately after removing the temporary seal from the endodontic access, the gutta-percha pin was placed into the transport medium and sent to the microbiological laboratory for microbiological research immediately after the extraction of the temporary seal from the endodontic access.

According to the results of a microbiological study, isolated corynebacteria were found before sealing the endodontic access with a temporary filling. After applying a temporary seal, microflora growth was not observed.

After 18 months

On the roentgenogram of the tooth 1.1. restoration fully performs the cavity of the tooth. The lumen of the root canal is uniformly full length up to the level of the physiological opening filled with sealer. The space of the periodontal ligament is evenly traced throughout. According to densitometry, bone mineralization is 128-134.

No clinical manifestations, no complaints

Example 3

Patient Prokopyev S.S. 26 years old complained of pain in the area of the tooth in the lower jaw to the right of the cold, sweet, sometimes the pain appears spontaneously in the evening. When examining a tooth 4.6. previously treated for uncomplicated caries. On the chewing surface, an inferior filling with a broken marginal fit, signs of caries along the perimeter. Percussion of the tooth is negative, the temperature (cold) reaction is sharply painful, fast-passing, Electroodontometry data 30 μA.

On the radiograph of tooth 4.6: on the approximate surfaces of the tooth crown, a decrease in the mineralization of enamel and dentin is determined. A filling on the chewing surface, in the area of the distal horn of the pulp, dentin has a reduced density. The distal root has no bends; the space of the periodontal ligament is evenly traced throughout. In the region of the apex of the root, deformation is determined. Channel clearance is traced throughout. The mesio-buccal root has a slight bend in the region of the border of the middle and apical third, the periodontal ligament space is traced evenly throughout. Channel clearance is traced throughout. The mesi-lingual root has a slight bend at the border of the middle and apical third, the periodontal ligament space is evenly traced throughout.

After removal of the filling and necrectomy under anesthesia, a deep carious cavity is determined on the distal-occlusal-medial surfaces, in the region of the distal horn of the pulp chamber, a message with the tooth cavity bleeds upon probing.

Diagnosis: chronic pulpitis of the tooth 4.6. in the acute stage

Treatment: under Sol.Ultrocaini 4% -1.7 infiltration anesthesia, application of cofferdam, removal of defective fillings, necrectomy, trepanation of the tooth cavity, pulp amputation, determination of the distal canal working length 21 mm, if 02/010, mechanical treatment of the root canal using the Ni- system Ti of the Re-Ce and Pro-Taper rotating system (ff 06/030), drug treatment of the root canal with sodium hypochlorite solution 3.35% -30.0 t-37 C. Determination of the working length of the mesio-buccal canal 22 mm, if 02 / 010, root canal machining using the Ni-Ti bp system -rotating system Re-Ce Pro-Taper (ff 04/030), drug treatment of the root canal with sodium hypochlorite solution 3,35% -30,0 t - 37 ° C. Determination of the working length of the mesi-lingual canal 22 mm, if 02/010, mechanical treatment of the root canal using the Ni-Ti system of the rotating Re-Ce Pro Taper system (ff04 / 030), drug treatment of the root canal with sodium hypochlorite solution 3.35% -30 , 0 t-37 C. Drying of canals with absorbents and obturation of the root canal system by lateral compaction of cold gutta-percha using Sealapex sealer.

Immediately after the mechanical and medical treatment of dentin using a sterile Headstrom file, a dentin chip was created, which was collected using a sterile gutta-percha pin, placed in a transport medium and sent to a microbiological laboratory for microbiological research

The root canal mouths are sealed with Vitremer / 3M ESPE glass ionomer cement. Photopolymerization was carried out for 40 sec. A sterile gutta-percha pin is placed at the bottom of the endodontic access. Cimpat / Septodont zinc sulphate cement is placed in the endodontic cavity to the enamel-dentinal border. The residual endodontic access space was primed and filled with Vitremer / 3M Espe glass-ionomer cement followed by photopolymerization for 40 seconds.

To conduct a permanent restoration of the hard tissues of the tooth, the patient is scheduled to receive after 10 days.

When you visit again after 10 days in order to continuously restore the hard tissues of the tooth 4.6. immediately after removing the temporary seal from the endodontic access, the gutta-percha pin was placed into the transport medium and sent to the microbiological laboratory for microbiological research immediately after the extraction of the temporary seal from the endodontic access.

According to the results of a microbiological study, prior to sealing the endodontic access with a temporary filling, microbiological growth was not detected. After applying a temporary seal, microflora growth was not observed.

After 12 months

On the roentgenogram of tooth 4.6 .: the periodontal ligament space in the region of the distal root is traced uniformly throughout, in the apex region there is slight deformation, in the region of the mesio-buccal and mesio-lingual roots the periodontal ligament space is evenly traced throughout.

No clinical manifestations, no complaints

Example 4

Patient Lebedeva Sasha, 8 years old. They asked about a fracture of the central tooth of the upper jaw as a result of a fall from a bicycle. On examination, the tooth crown 1.1. missing at ½ length. A pulp chamber is defined in the area of the fracture line. Pulp bleeds, sharply painful when sensing. Percussion of the tooth is positive, the cold reaction is sharply painful.

In tooth X-ray 1.1, the fracture line passes through the center of the pulp chamber, the root is not formed, the periodontal ligament space is evenly traced throughout, the lumen of the canal is traced throughout.

Diagnosis: Transverse fracture of the tooth 1.1. Acute tooth pulpitis 1.1.

Treatment: under Ultracaini DS -1.0 infiltration anesthesia, application of cofferdam, tooth cavity openings, amputation of crown pulp, drug treatment of the tooth cavity with 2% chlorhexidine bigluconate solution, hemostasis with 3% hydrogen peroxide solution. Laying mineral trioxidant at the mouth of the canal. MTA is covered with a wet cellulose ball and Vitremer / 3M ESPE glass ionomer cement.

The patient is appointed every other day for further treatment.

On the second visit, the patient makes no complaints, the temporary filling is preserved, percussion is slightly painful, the cold test within the normal range of 9 is less than 20 seconds.

Treatment: under Ultracaini DS -1.0 infiltration anesthesia, application of cofferdam, removal of a temporary filling, removal of a wet cellulose ball, drug treatment of the cavity with a solution of chlorhexidine bigluconate 2%, application of Vitremer / 3M ESPE glass ionomer cement to the mineral trioxidant. Photopolymerization was carried out for 40 sec. A sterile gutta-percha pin is placed at the bottom of the endodontic access. Cimpat / Septodont zinc sulfate cement is placed in the endodontic cavity. The residual endodontic access space was primed and filled with Vitremer / 3M Espe glass-ionomer cement, followed by photopolymerization for 40 seconds.

The patient is put on a medical examination with regular follow-up examinations after 1 month, 3 months, 6 and 12 months,

After 1 month

The patient has no complaints, the temporary filling has a good marginal fit, the percussion of the tooth is negative, the cold reaction is within normal limits.

On the intraoral x-ray of the tooth 1.1 .: on the border of the MTA-root pulp, the dentin bridge from the replacement dentin is determined.

After 12 months

The patient has no complaints, the temporary filling has a good marginal fit, the percussion of the tooth is negative, the cold reaction is within normal limits.

On the roentgenogram of the tooth 1.1. root formation is normal, the periodontal ligament space is traced evenly throughout.

Example 5

Patient Malikov B.C. 31 years old complained of pain in the area of the tooth in the lower jaw to the right of the cold, sweet. When examining a tooth 4.6. not previously treated. On the chewing surface, the carious cavity is made of dense brown dentin. Percussion of the tooth is negative, the temperature (cold) reaction is painful for 30 seconds. Electroodontometry data 35 μA.

On the roentgenogram of tooth 4.6: a carious cavity on the chewing surface, in the region of the distal horn closely adjacent to the pulp. The distal root has no bends; the space of the periodontal ligament is evenly traced throughout. In the region of the apex of the root, deformation is determined. Channel clearance is traced throughout. The mesio-buccal root has no bends; the periodontal ligament space is traced evenly throughout. Channel clearance is traced throughout. The mesio-lingual root has a slight bend in the apical third, the periodontal ligament space is evenly traced throughout.

After necrectomy under anesthesia, a deep carious cavity is determined on the distal-occlusal surfaces, a message with the tooth cavity is determined in the area of the distal horn of the pulp chamber, it bleeds when probed.

Diagnosis: chronic pulpitis of the tooth 4.6.

Treatment: under Sol.Ultrocaini 4% infiltration anesthesia - 1.7 application of cofferdam, removal of defective fillings, necrectomy, pulp amputation, determination of the distal canal working length 23 mm, if 02/015, root canal machining using the Ni-Ti system of the Pro rotating system -Taper (ff 06/030), drug treatment of the root canal with sodium hypochlorite solution 3.35% -30.0. Determination of the working length of the mesio-buccal canal - 23 mm, if 02/010, mechanical treatment of the root canal using the Ni-Ti system of the Ra-Ce rotating system (ff 06/030), drug treatment of the root canal with sodium hypochlorite solution 3.35% - 30.0. Determination of the working length of the mesi-lingual canal 22 mm, if 02/010, mechanical treatment of the root canal using the Ni-Ti system of the Ra-Ce rotating system (ff06 / 030), drug treatment of the root canal with sodium hypochlorite solution 3.35% - 30.0 . Drying the canals with absorbents and obturation of the root canal system by lateral compaction of cold gutta-percha using Sealapex sealer.

Immediately after mechanical and medical treatment of dentin using a sterile Headstrom file, a dentin chip was created, which was collected using a sterile gutta-percha pin, placed in a transport medium and sent to a microbiological laboratory for microbiological research

A sterile gutta-percha pin is placed at the bottom of the endodontic access. Endodontic access is sealed with a temporary seal made of zinc sulfate cement Cimpat / Septodont

To conduct a permanent restoration of the hard tissues of the tooth, the patient is scheduled to be admitted after 14 days.

When you visit again after 14 days in order to constantly restore the hard tissues of the tooth 4.6. immediately after removing the temporary seal from the endodontic access, the gutta-percha pin was placed into the transport medium and sent to the microbiological laboratory for microbiological research immediately after the extraction of the temporary seal from the endodontic access.

According to the results of a microbiological study, before sealing the endodontic access with a temporary filling, the microbiological growth of lactobacilli. After applying a temporary filling, growth is determined: lactobacilli, E.Coli.

24 months later Complaints of pain when biting, from hot.

On the roentgenogram of tooth 4.6 .: the space of the periodontal ligament from the region of the distal root is traced throughout, in the apex region, destruction of bone tissue is significant, in the region of the mesio-buccal and mesio-lingual roots, the space of the periodontal ligament is traced throughout, in the region of the apex of the root spaces of periodontal ligament.

The patient is assigned for repeated endodontic treatment.

Example 6

Patient Peretyatko A.G., 41 years old. He went to the clinic with the goal of sanitation of the oral cavity and rational prosthetics. When examining the oral cavity was found on the distal surface of the tooth 1.5. defective filling with a broken marginal fit, signs of caries around the perimeter. Hard tooth tissues in color are changed. Percussion of the tooth is negative, the temperature reaction is painless. Indicators of electroodontometry 70 μA. After removing the defective fillings under anesthesia and under the control of a caries marker, a carious cavity is determined on the distal surface within the peri-pulp dentine, in the area of the projection of the pulp chamber is a message with the tooth cavity

On the radiograph of the tooth 1.5 .: the carious cavity communicates with the cavity of the tooth. The root has no bends, the periodontal ligament space is traced along the entire length of the root, of uniform width, there is a slight deformation in the apex region. Clearance of the root canal is traced throughout. During densitometry, bone mineralization in the apical region is 122-128.

Diagnosis: chronic pulpitis of the tooth 1.5.

Treatment: Under Sol. Ultrocaini 4% - 1.7, insulating material was placed around the tooth (cofferdam), defective fillings were removed, necrectomy (removal of carious tissues) was performed, the tooth cavity was opened, pulp amputation was performed, the working length was determined with 19 mm instrument if02 / 020, the root canal was machined (drilling) using the Pro-Taper nickel-titanium rotating system system to the size ff06 / 030, drug treatment of the root canal with sodium hypochlorite solution 3.35% - 30.0.

Then, the root canal was dried with absorbents and the root canal system was obstructed (filled) by cold gutta-percha lateral compaction using Sealapex sealer.

Immediately after the mechanical and medical treatment of dentin using a sterile Headstrom file, a dentin chip was created, which was collected using a sterile gutta-percha pin, placed in a transport medium and sent to a microbiological laboratory for microbiological research.

A sterile gutta-percha pin is placed at the bottom of the endodontic access. Clip / VOCO photopolymer composite plastic was laid in the endodontic cavity to the enamel-dentine border, followed by photopolymerization for 40 seconds.

The patient is referred to an orthopedic dentist to further strengthen the pin structure and permanent restoration with the orthopedic structure. After 14 days, during an appointment with an orthopedic dentist, a temporary seal of unsatisfactory quality is determined, the marginal fit is broken, when removing a temporary seal under it, food residues are determined. After removing the temporary filling from the endodontic access, the gutta-percha pin from the cavity day is placed in the transport medium and sent to the microbiological laboratory for microbiological research.

According to the results of microbiological studies, prior to sealing the endodontic access with a temporary filling, microflora growth was not observed. After applying a temporary seal, the growth of microflora is determined: S.aureus, E. Coli, Candida albica.

After 24 months

Complaints about the presence of a fistula in the area of the tooth 1.5.

On the radiograph of the tooth 1.5: the crown part is restored by the orthopedic construction. The clearance of the root canal in the estuarine and middle third was made by a non-radiopaque pin design, in the apical third, the canal lumen was uniformly filled to the level of the physiological opening with sealer (filling material for the canal). In the region of the apical third and middle third from the distal surface, destruction of bone tissue is significant, the space of the periodontal ligament is not traced. Densitometry (bone mineralization) in the apical region ranges from 60 to 68.

The advantages of the proposed method are as follows.

The proposed method allows to achieve reliable sealing of endodontic access by creating a double barrier for microorganisms from two layers of temporary fillings, one of which (upper, photocurable) is made of glass-ionomer cement, which has high strength characteristics and provides strong mechanical and chemical bonding with tooth dentin . This increases the tightness of the endodontic access and prevents the leakage of oral fluid into the tooth cavity.

The material of the first lower layer of temporary fillings - zinc-sulfate cement, due to the zinc oxide included in it, prevents the growth of residual microflora in the dentinal tubules. Moreover, the material is low in cost compared to others and is easy to use.

Applying a layer of glass-ionomer cement to the mouth of the root canal after filling the root canal, when removing the temporary filling, avoids excessive dentin removal in the area of the root canal, leading to weakening of the tooth walls and further fracture.

In addition, in case of accidental violation of the two upper layers of the temporary filling, a layer of glass-ionomer cement deposited on the mouth of the root canal allows the root canal to be sealed.

Thus, the claimed combination of features of the invention allows to achieve the task - to increase the tightness of endodontic access and, as a result, improve the quality of endodontic treatment.

Claims (1)

A method of sealing endodontic access, including creating endodontic access, filling the root canal, obstructing the tooth cavity with a temporary filling, consisting of two layers, the first layer being made of zinc sulfate cement, the second layer made of photocurable material, characterized in that after root canal filling the root mouth the canal is closed with glass ionomer cement, the first layer of a temporary seal made of zinc sulfate cement is laid on it, then on the endodontic walls whom access is applied primer photopolymerizable it and further the second layer is applied a temporary filling which is made of glass ionomer cement, which is also photopolymerizable.