A COMPARATIVE ANALYSIS OF THE CLINICAL EFFICIENCY OF THE TREATMENT OF CHRONIC GRANULOMATOUS PERIODONTITIS USING DIFFERENT PROTOCOLS OF DRUG TREATMENT OF THE ROOT CANALS
DOI:
https://doi.org/10.35220/2078-8916-2019-33-3-17-23Keywords:
chronic granulomatous periodontitis, medical treatment of root canals, tetracycline, 2 % chlorhexidineAbstract
Background. Infectious and inflammatory processes in periapical tissues are the most common diseases of the dentition. In the structure of the provision of dental care in treatment of chronic periodontitis amounted to 30% of the total number of visits to medical institutions of the healthcare system. Promising is the further development and clinical and radiological justification for the use of new effective means for drug treatment of root canals which affect the pathogenic microflora of the infected ca-nal and have a prolonged antibacterial and anti-inflammatory effects and contribute to the processes of reparative regeneration of bone tissue in the area of the focus of inflammation.
Objective. Based on a comparative analysis of the results of clinical and radiological research / treatment of chron-ic granulomatous periodontitis to determine the effective-ness of new drug compositions based on tetracycline and 2% chlorhexidine in the protocol for drug treatment of the root canal system.
Materials and methods. There have been conducted the clinical and radiological study of the effectiveness of treatment of 31 patients with chronic granulomatous per-iodontitis who were divided into two groups: the main and control group. Patients of the main group in the treatment protocol at the stage of instrumental treatment used the drug composition with tetracycline and at the stage of temporary obstruction - a composition with 2 % chlorhexidine in the form of a gel for 3 days under a light-polymerized dressing. After instrumental and drug treatment of the root canal the control group patients un-derwent temporary obstruction with calcium hydroxide for 7 days under an airtight light-polymerized dressing. The effectiveness of the treatment was evaluated on the basis of clinical and radiological data before treatment, after treatment, and after 6 and 12 months.
Results. According to the results of a comparative clinical and radiological study the high efficiency of the use of medicinal compositions based on tetracycline and based on 2 % chlorhexidine for patients with chronic granulom-atous periodontitis (p <0.001) was proved. The high clin-ical efficiency of the proposed treatment method is due to the sensitivity of the pathogenic microflora of the infected root canal to tetracycline and the prolonged antibacterial effect of chlorhexidine on the system of the root canals reducing inflammatory processes in the periapical tissues, which positively contributes to the process of reparative regeneration of bone tissue in the area of the root apex. According to the results of the X-ray examination a re-duction in the focus of the infectious and inflammatory process in the periapical tissues, a probable decrease in the destruction area in the periapical region in the main group, where the medicinal compositions based on tetra-cycline and 2 % chlorhexidine in gel form: from 3.29±0.11 mm2 to 0.03 ± 0.03 mm2 12 months after treat-ment, that is, 99.12 %, which is 18, 28% better, compared to the control group, where 12.8 months after treatment there was a reduction of 80.84 %: from 3.34 ± 0.11 mm2 to 0.64 ± 0.24 mm2 (p <0.001). There were no cases of exacerbation of the process, relapses of the disease, com-plications or allergic reactions during treatment and dur-ing the observation period, which indicates the safety of medical compositions based on tetracycline and based on 2 % chlorhexidine.
Conclusions. Based on the obtained clinical and radio-logical results of the study of treating patients with chron-ic granulomatous periodontitis one can state about the ef-fectiveness and practicability of the combined use of me-dicament compositions based on tetracycline and based on 2 % chlorhexidine in gel form. The offered means for drug treatment has antibacterial, anti-inflammatory properties and contribute to the process of bone tissue re-generation in the area of the apex of the root, which in-creases the effectiveness of endodontic treatment.
The application of the proposed protocol for the medical treatment of infected root canals improves the treatment efficiency by 18.28 % after 12 months of observation, compared with the control group (p <0.001), reduces the time for endodontic treatment, and financial costs are re-duced.
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