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Tulanov Dilshodbek Shoalievich, Dekan of dentistry faculty Raimjonov Rustamjon Ravshanbekovich, Head of chair therapeutic dentistry Dalimova Shoira Kasimjanovna, Assistant therapeutic dentistry ASMI Juraeva Nigora Imimnjanovna, Asisstant of chair therapeutic dentistry Iminjonova Gulmirakhon Ravshanbek qizi, Undergraduate student 4 course ASMI Mamarasulova Sofiya Ravshanbekovna, Undergraduate student 3 course ASMI E-mail: dilya_o@mail.ru
RESULTS OF ENDODONTIC APPLICATION OF VARIOUS ANTIBACTERIAL AGENTS AND CLINICAL AND MICROBIOLOGICAL FEATURES
Abstract. In recent years, it has become apparent that the pathogenesis of periodontal diseases is more complex than the presence of virulent microorganisms. In fact, it is now widely accepted that susceptibility to periodontitis varies greatly between individuals who harbor the same pathogenic microflora. To date, the bulk of evidence points to the host response to bacterial challenge as a major determinant of susceptibility. In this review, we will assess the data implicating various inherited and acquired risk factors for susceptibility to periodontal diseases.
Keywords: periodontal diseases, inflammatory.
Actuality
Treatment of acute forms of periodontitis is one of the urgent problems of dentistry. Inflammation in apical tissues in 98-99% of cases is the cause of various forms of odontogenic infection (abscess, phlegmon, periostitis, etc.) representing a potential danger to the body [1; 3; 7]. The acute course of the periapical inflammatory process is accompanied by an adverse effect on the course of concomitant diseases of the body, causing their exacerbation [4; 8]. It was found that microbial contamination of apical periodontium occurs after pulp necrosis [5; 6; 8]. There are known data on the development of anaerobic bacterial flora capable of causing destructive changes in the periodontium and bone tissue in the conditions of communication of the root canal and oral cavity environment [3; 5]. Acute periodontitis and periapical abscess are accompanied by diffuse lesions, the analysis of patients ' referral to the clinic shows that in 32% of cases it is accompanied by the formation of purulent, in 16.8%- serous exudate [1; 4]. Many studies have found that the main source of colonization of bacteria in periodontitis is in the root canal system [2; 6]. However, the works devoted to the etiology of periodontitis are controversial, there are no patterns of microflora participation in different approaches to the treatment of the disease. It is important to note that in clinical practice, the methods of therapy of acute
apical periodontitis are mainly reduced to trepanation of the crown, opening the tooth cavity, creating conditions for the outflow of exudate with leaving the tooth "open" for several days. Scientific data on changes mikrobiotsenoza during this period, we have not met. Then the traditional endodontic treatment using irrigants and permanent obturation of the canals. Meanwhile, many antibacterial agents have a short-term effect and are ineffective, which leads to complications and relapses of the disease [8]. The need for dental treatment is 3 times higher than the need for primary treatment [6; 7].The success of primary endodontic treatment in Russia is only 29%, and re-treatment is even lower [7]. All this explains the relevance of the search for new methods and drugs to improve the effectiveness of therapy of acute apical periodontitis and, above all, in the initial treatment of the patient. It is also important to explain the causes of complications of apical periodontitis in the long term after treatment, the role of microbial flora in the pathogenesis of recurrent inflammation in the periodontium, to determine the indications and develop rational methods of local and General therapy. In recent years, the market of dental materials, new antiseptics, as well as drugs with prolonged antibacterial properties, having a bactericidal effect on the intra-channel microflora. However, the issue of optimizing the choice of methods and endodontic antibacterial agents for the most
Section 5. Medical sciences
effective treatment of acute forms of periodontitis remains unresolved. This is the subject of this thesis.
Purpose of research
Improving the efficiency of diagnosis and treatment of acute periodontitis using the method of prolonged antibacterial sanation of the root canal system and periapical tissues based on the study of microbiological factors.
Survey materials and methods
The materials and methods of examination included 80 patients with acute forms of periodontitis. Microbiological studies were conducted in 51 patients (18-65 years) with acute forms of periodontitis, including against the background of General somatic diseases. Microbiological studies included: molecular genetic method using polymerase chain reaction (PCR), method of cultural (bacteriological) research, determination of bacterial cultures sensitivity to antibiotics and other drugs, including in the form of gels and pastes.
Results and discussions.
In the study of the prevalence of periodontal disease (analyzing orthopantomograms), it was noted that in the age group of 15-64 the number of teeth with radiological changes in the periodontium per person is 5.6 of them previously treated 2.5, and not treated 2.9. The highest level of growth of new foci of periapical pathology was observed even in the young age group (20-29 years). In the second visit, after the traditional treatment of tooth canals, microbiological studies of the contents of the root system of 17 teeth were carried out. Comparative frequency of detection of virulent anaerobic bacteria from the root canal by PCR before and after traditional antiseptic treatment (n= 17) After traditional endodontic treatment bacteria were found: A. actinomycetemcommitans - in 17.7%; B. forsythus - in 17.7%; P. intermedia - in 11.8%; P. gingivalis - in 11.8%; T. dentikola - in 11.8% (Fig. 4.1). These data show that traditional endodontic treatment of root canals is insufficient for antiseptic effect on pathogenic root canal infection present in acute forms of periodontitis.
In the clinical evaluation of traditional endodontic treatment of teeth and temporary filling, after 2 days, patients noted pain when biting in 5 cases (29.4%), including 2 patients teeth could not withstand hermetic closure (11.8%).
In this regard, additional antibacterial therapeutic measures are needed to sanitize the root canal system and peri-apical focus.
Clinical and microbiological evaluation of the effectiveness of endodontic application of the paste " Apexdent»
The main group is "A" subgroup. The results of microbiological examination before endodontic treatment of teeth showed that such types of bacteria as A. actinomycetemcommitans were found in 4 (36.4%), a B. forsythns, P. intermedia,
P. gingivalis, T. denticola - in 3 (27.3%). (table. 4.2, before treatment).
After 7 days of calcium hydroxide in the root canals, the percentage of detection of A. actinomycetemcommitans bacteria decreased by 18.2% and after 14 days by 27.3%; B. forsythus - by 18.2%, and after 14 days this species was not detected at all; R. intermedia, P. gingivalis, T. denticola after 7 days, the percentage of their detection decreased by 9.1% and after 14 days by 18.2%, respectively, P 0.05.
After 7 days of calcium hydroxide in root canals the percentage of detection of bacteria A. actinomycetemcommitans, Blforsythus decreased, 18.2% and after 14 days they were not found; while P. intermedia and T. denticola after 7 days the percentage of detection decreased by 9.1% and after 14 days 18.2%, respectively; the P. gingivalis neither 7 nor 14 days of stay; the canals of the drug "Apeksdent" not detected, P < 0.05.
It should, however, be noted a large antibacterial activity of calcium hydroxide after 14 days against bacteria such as A. actinomycetemcommitans, B. forsythus and P. gingivalis - this can be attributed to the fact that the root canals of the teeth in patients of subgroup "B" were not left open for drainage and as a consequence the lack of conditions for secondary infection. However, no effective bactericidal action of calcium hydroxide on pigment-forming microbes P. intermedia and T. denticola has been established.
However, the clinical picture of root after the introduction of drugs has evolved in different ways. Thus, in the near future after filling the root canals with Apexdent, there was a slight pain of 1-2 days when biting in one patient of subgroup "A" (9.09%). Then, as in subgroup "B" after the use of the drug Apexdent clinical pain reaction was observed in 2 patients (18.2%), including one patient noted pain for 5-7 days, docked with anti-inflammatory drugs with preliminary root canal filling. In the future, this patient underwent endocanal treatment in two visits with the use of the drug Collapse-K and clinical well-being was noted.
Summary
In patients with acute apical periodontitis in the content of the root canal system by the method of modern microbiological technologies, representatives of flora with both obli-gate-anaerobic and facultative-anaerobic and microaerophilic type of respiration were identified and a high frequency of detection of virulent anaerobic bacteria species was noted.
Traditional endodontic treatment of root canals in the treatment of acute periodontitis should be supplemented with temporary filling of root canals with calcium hydroxide or Collapse preparations, which contributes to more effective sanitation of the canal system and prevention of exacerbation of the inflammatory process.
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