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Таким чином, пюля трьохмюячного спостереження лкування було ефективне в 54 тимчасових зубах, тобто 93,1% випадках, i було не ефективним в 4 зубах, тобто в 6,9% випадках. Слщ зазначити, що причиною негативного результату лкування стали не по-милка у виборi методики, або погршност в ТТ вико-наннi, а порушення крайового прилягання реставра-цiй.
Висновки
1сную^ методи лiкування пульпiту в тимчасових зубах при коректному лкуваны дозволяють в максимально можливш кiлькостi випадкiв не лише зберегти зуб у зубному ряду до його фiзiологiчноТ змiни, але i у рядi випадкiв забезпечити життездатнють пульпи як фiзiологiчного бар'еру.
Л^ература
1. Сунцов В.Г., Скрипкина Г.И., Самохина В.И. Биологический метод лечения хронического пульпита во временных зубах. Современная стоматология.- 2005. -№2. - С.63-65,
2. Бинцаровская Г.В., Демьяненко Е.А., Валеева З.Р., Трофимова Е.К.Ретроспективный анализ результатов лечения пульпитов временных зубов. Стоматологический журнал. - 2008. - №3. - С.241-244
3. Farooq N. S. Success rates of formocresol pulpotomy and indirect pulp therapy in the treatment of deep dentinal caries in primary teeth / N. S. Farooq, J. A. Coll, A.
Kuwabara [et al.] // Pediatr. Dent. - 2000. - №22. - P. 278 - 286.
4. Salako N. Comparison of bioactive glass, mineral trioxide aggregate, ferric sulfate, and formocresol as pulpotomy agents in rat molar / N. Salako, B. Joseph, P. Ritwik [et al.] // Dent. Traumatol. - 2003. - №19. - P. 314 -320.
5. Agamy H. A. Comparison of mineral trioxide aggregate and formocresol as pulp-capping agents in pulpotomized primary teeth / H. A. Agamy, N. S. Bakry, M. M. Mounir [et al.] // Pediatr. Dent. - 2004. - №26. - P. 302 - 309.
6. Кисельникова Л.П. Методы лечения пульпи та времен-них зубов / Л.П. Кисельникова, С.В. Гончарова, О.А. Кочеткова // Институт стоматологи. - 2002. - N 4. - С.28-29.
7. Yoshiba K. Immunolocalization of fibronectin during reparative dentinogenesis in human teeth after pulp capping with calcium hydroxide / K. Yoshiba, N. Yoshiba, H. Nakamura [et al.] // J. Dent. Res. - 1996. - №75. - P. 1590 - 1597.
8. Noorollahian H. Comparison of MTA and FC as pulp medicaments in primary molars / H. Noorollahian // Br. Dent. J. - 2008. - №204(11). - Р. 20
9. Farsi N. Success of minerals trioxide aggregate in pulpotomized primary molars / N. Farsi, N. Alamoudi, K. Balto [et al.] // J. Clin. Pediatr. Dent. - 2005. - №29. - P. 307 - 311.
10. Subramaniam P. Mineral trioxide aggregate as pulp capping agent for primary teeth pulpotomy: 2 year follow up study / P. Subramaniam, S. Konde, S. Mathew [et al.] // J. Clin. Pediatr. Dent. - 2009. - №33(4). - P. 311 - 314.
ENGLISH VERSION: EFFICACY OF PULPITIS TREATMENT IN PRIMARY TEETH USING CALCIUM-CONTAINING MEDICATIONS
Chyzhevskyi I.V., Stulikova V.S.
Donetsk National Medical University n.a. M.Gorkii, Krasnyi Lyman
According to some authors pulp inflammation of primary and permanent teeth of children comprises 40-79%. Among other things, caries in temporary molar teeth is complicated by pulpitis in 36.5% cases. Such a wide prevalence of pulpitis in early age causes relevance of searching for efficient treatment methods. Currently the vital pulp amputation in primary teeth becomes an alternative for devital methods in most cases. Method of formocresol pulpotomy has become widespread within the last decades. In the modern context, it is possible to use for pulp covering the MTA agent which passed sufficient clinical investigation and received positive approval. The authors developed pulpitis treatment methodology in primary teeth using "Trioksident" (ViadMiVa) material, which is similar to MTA material thanks to its characteristics. Basic stages of pulpitis treatment include anesthetics, dental cavitation, and disclosure of pulp cavity. Further, the amputation of crown pulp is performed using sterlle bur. Hemostasis is performed using sterile cotton walls, soaked with distilled water. After drying tooth canal orifice, the pulp is coated with paste made of "Trioksident" powder, mixed with distilled water. Paste is covered with capping of photo-solidifying material (glass ionomer). As a result, tooth crown is restored. After treatment, all children received anti-inflammatory drug "Nurofen" as per age-specific dosage. Patients are at dispensary observation with regular examinations in a week, a month, and later in every 3 months after treatment. The method described above was used to treat 58 primary teeth of 23 children aged from 4 to 6. During the control check in a month, the depressurizing of restoration in two primary teeth was revealed. There were no pathologic changes in other teeth. Radiological inspection did not show the pathologic changes as well. Thus, in a month after treatment its efficiency comprised 96.5%%. After three-month inspection the treatment efficacy comprised 93.1%%. It is necessary to admtt, that even after three-month inspection the reason of negative results in treatment was not the inappropriate choice of treatment method or defect in the process, but breakdown of marginal restoration seal. Conclusion: the suggested method of pulpitis treatment of primary teeth of children contributes to the preservation of pulp and teeth in dentition before its exfoiiation. Thus, it helps to provide integration of dentition in the temporary occlusion.
Key werds: pulp inflammation, primary teeth, efficaly treatment
Problem of primary tooth caries and its complicacies inflammation of primary and permanent teeth occupies remains a topical issue in routine practice of pedodontist. significant place in the structure of dental morbidity rate According to V.G.Suntsov and co-authors (2005), pulp among children and comprises approximately 40-79%
* To cite this English version: Chyzhevskyi I.V., Stulikova V.S. Efficacy of pulpitis treatment in primary teeth using calcium-containing medications //Problemy ekologii ta medytsyny. - 201. - Vol 19, № 1-2. - P. 30 -32.
npoSAeMH eKOAorii Ta MeanuHHH
[1]. According to G.B.Bintsarovska and co-authors (2008), caries is complicated by pulpitis in temporary molars in 36.5% cases [2]. Tactics and choice of method for pulpitis treatment of children depends on various factors, including age and somatic health of child's organism, sociability of children and cooperative attitude of parents, caries resistability, intensity of cariosity, form of pulpitis, dental root formulation stage, tooth-group specificity.
Currently in our country, pulpotomy of children's primary teeth has become a more acceptable alternative to devital pulp extirpation and amputation. According to the recommendations of American Academy for Pediatric Dentistry, there are standards of vital pulpitis treatment for primary teeth at asymptomatic inflammatory conditions in dental pulp.
Back in 1996 J.F. Roberts carried out the analysis of medical cases of applying formocresol (FC) to treat primary teeth. Observation was conducted during all the period of functional activity of treated teeth to the moment of their substitution. According to the results of investigation, clinically successful treatment is observed in 99.3% of cases. In later investigations Farooq N. S et al. 2000; Salako N. et al. 2003; Agamy H. et al. 2004, represented ambiguous data, that clinical and radiological observations of the application of the medication are estimated on a rather high level (70%-90%) [3,4,5]. L.P.Kiselnikova and co-authors (2002) recommend after amputation of crown pulp of primary teeth and hemostasia to put a gauze sponge soaked with 20% solution of formocresol or "EndoG No.3" ("VladMiVa"), on root canal orifice for 5 minutes [6].
To initiate regeneration of root pulp after the amputation of crown pulp calcium hydroxide (CH) is used. However, CH has very strong alkaline reaction (pH 12), often causing formation of necrotic zone, acute or chronic inflammation and dystrophic changes in pulp. These processes are factors, leading to internal desiccation of canal sides, and, finally, CH is not recommended to be used as odonthotropic paste at pulp amputation in primary teeth [7,8].
V.G.Suntsov and co-authors (2006) suggest to use calcium phosphate gel with chlorhexidine with concentration of 0.02%.
MTA (Mineral Trioxide Aggregate) is the material, also recommended for direct caving of pulp root section at vital amputation. This material passed various preclini-cal studies and was approved for wide application by FDA Organization in foreign countries. Clinical efficacy of its application is estimated by different authors within 95100% [8,9,10].
Aim of the research: to explore efficacy of specimen "Trioksident" in treatment of pulpitis of primary teeth with vital amputation method.
Materials and methods
In CIS countries the material "Trioksident" (VladMiva) was created, identical to MTA material due to its characteristics. It was developed and recommended for treatment of permanent teeth. Basic components of water-soluble dental product "Trioksident" are oxides of calcium, silicon, aluminum. Calcium hydroxide during pulp coverage initiates coverage of dentinal ponticulus, has antibacterial properties. Moreover, it is considered that in contrast with pure CH, this material in combination with other components, included into "Trioksident", does not cause internal desiccation of canal sides. As active bactericidal agents, having common chemical nature with
basic components, calcium and cuprum hydroxide are included. The material has high biocompatibility, low solvability and high mechanical strength, as well as provides cavity sealing capacity and nonpenetration of bacteria.
Our developed treatment method for primary teeth pulpitis using "Trioksident" includes the following stages. Examine patient and make a diagnosis, support anesthesia (infiltration anesthesia), using Scandonest for children under 5 years old and Ultracaini 1:200000 of kids over 5. Isolate tooth, clean from dental plaque with rotary brush and paste, prepare decay cavity, open pulp cavity (sterile bur); remove crowned pulp (pulpotomy) using sharp excavator or sterile ball dental bur with water sprinkling, treat with antiseptic solution (0.05% chlorhexidine solution). Conduct hemostasis by means of sterile cotton balls, soaked in distilled water during 3-5 minutes. Later dry canal orifice with sterile cotton ball, cover pulp residual limb with "Trioksident", apply isolation capping from photo-solidifying material, renew (revitalize) the crown part of tooth with glass-ionomer cement, componomer or composite. Put on anti-inflammatory drug "Nurofen" as per age-specific dosage during 3-5 days. Patient is at dispensary observation with regular examinations in a week, a month, and later in every 3 months after treatment.
The method described above was used to treat 58 primary teeth at 23 children aged from 4 to 6. Teeth-group specification was the following: 2 incisors of maxilla, 25 first molars of mandible, 15 secondary molars of mandible.
8 children were treated with local anesthetics, 15 children were treated with general anesthetics due to uneasy behavior and huge amount of work.
All children had high index of caries intensity, comprising 10 on average.
Control checks are conducted in a week after treatment, in a month and three months.
Results of Discussion
First control check was performed in a week after treatment. Oral cavity, color of teeth and mucosa were observed, percussion on a tooth and palpation of mucosa near the tooth were performed. Marginal seal of restoration, reaction to thermal stimulants were estimated. In any of 23, cases no pathologic changes were revealed within the term.
During control check in a month, the following results were received: all the treated teeth were in dentition. 14 teeth (24.14%) had grey dental crowns, however, during final roentgenogram, percussions and thermal probes no pathologic changes were revealed. 2 teeth (3.45%) had restoration depressurizing, thus it was decided to treat the teeth repeatedly by means of devital extirpation. Nearly in 42 teeth (72.41%) the pathologic changes were not revealed both at external investigation and after radiological inspection. Thus, treatment can be considered successful in 96.55% of cases.
Further control inspection was conducted in 3 months. Due to the data revealed, the marginal seal in restoration of two teeth was disturbed, that is why it was decided to provide repeated treatment by means of vital amputation. In areas near other teeth, no pathologic changes were revealed both at external inspection and after radiological investigation.
Thus, after three-month investigation the treatment of 54 primary teeth was efficient, that is in 93.1% of cases,
and non-efficient in 4 teeth, namely, in 6.9% of cases. It is necessary to admit, that even after three-month inspection the reason of negative results in treatment was not the inappropriate choice of treatment method or defect in the process, but breakdown of marginal restoration seal.
Conclusions
The existing methods of pulpitis treatment in primary teeth allows not only to keep the tooth in dentition in most possible cases before its shedding, but also in a number of cases to provide pulp viability as a physiologic barrier.
References:
1. Sunzov V.G., Skripkina G.I., Samochina V.I. Biologicheskiy metod lecheniya chronicheskogo pul'pita vo vremennych zubach // Sovremennaya stomatologiya. -2005. - №2. - S. 63-65.
2. Binzarovskaya G.V., Dem'yanenko E.A., Valeeva Z.R., Trofimova E.K. Retrospektivnyy analiz rezul'tatov lecheniya pul'-pitov vremennych zubov // Stoma-tologicheskiy zhurnal. - 2008. - №3. - S. 241-244.
3. Farooq N. S. Success rates of formocresol pulpotomy and indirect pulp therapy in the treatment of deep dentinal caries in primary teeth / N. S. Farooq, J. A. Coll, A. Kuwabara [et al.] // Pediatr. Dent. - 2000. - 22. - P. 278286.
4. Salako N. Comparison of bioactive glass, mineral trioxide aggregate, ferric sulfate, and formocresol as pulpotomy agents in rat molar / N. Salako, B. Joseph, P. Ritwik [et al.] // Dent. Traumatol. - 2003. - 19. - P. 314-320.
5. Agamy H. A. Comparison of mineral trioxide aggregate and formocresol as pulp-capping agents in pulpotomized primary teeth / H. A. Agamy, N. S. Bakry, M. M. Mounir [et al.] // Pediatr. Dent. - 2004. - 26. - P. 302-309.
6. Кисельникова Л.П. Методы лечения пульпи та времен-них зубов / Л.П. Кисельникова, С.В. Гончарова, О.А. Кочеткова // Институт стоматологии. - 2002. - N 4. - С. 28-29.
7. Yoshiba K. Immunolocalization of fibronectin during reparative dentinogenesis in human teeth after pulp capping with calcium hydroxide / K. Yoshiba, N. Yoshiba, H. Nakamura [et al.] // J. Dent. Res. - 1996. - 75. - P. 1590-1597.
8. Noorollahian H. Comparison of MTA and FC as pulp medicaments in primary molars / H. Noorollahian // Br. Dent. J. - 2008. - 204(11) - P. 20.
9. Farsi N. Success of minerals trioxide aggregate in pulpotomized primary molars / N. Farsi, N. Alamoudi, K. Balto [et al.] // J. Clin. Pediatr. Dent. - 2005. - 29. - P. 307-311.
10. Subramaniam P. Mineral trioxide aggregate as pulp capping agent for primary teeth pulpotomy: 2 year follow up study / P. Subramaniam, S. Konde, S. Mathew [et al.] // J. Clin. Pediatr. Dent. - 2009. - 33(4). - P. 311-314.
Матер/'ал над1йшов до редакц/ 09.07.2015
