ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 41 of 57
УЖМБС 2020, 5(1): 269–276

Clinical Evaluation of the Root Channel Irrigation Method as an Important Stage in Conservative Treatment of Teeth with Significant Destructive Changes in Periapical Tissues

Nazaryan R. S., Fomenko Yu. V., Scheblykina N. A., KolesovaT. A., Golik N. V., Shapovalova A. S.

With the advent of modern endodontic instruments, tools and technologies conservative treatment of apical periodontitis with diameter of bone lysis 10 mm or more, has become possible. Sometimes the diagnosis of a “root cyst” is established by doctors only on the X-ray analysis basis due to its large volume, which is absolutely not true. It is impossible to understand the epithelial lining presence or absence in the formation from the X-ray image. Such a diagnosis can only be confirmed according to a pathomorphological study. It is unrealizable in clinical practice. Material and methods. We conducted examination and treatment of 15 patients aged from 19 to 55 years who had destructive changes (lysis) in periapical tissues larger than 10 mm. In addition, patients underwent intraoral images, orthopantomograms, CBCT of the upper and lower jaws. Results and discussion. Root cysts are of two types: bay-shaped (or stagnant) and true. In the case of the bay-shaped cyst, healing usually occurs after a quality endodontic treatment. In the case of a true cyst, surgical intervention is required. For any volume of periapical lysis endodontic treatment includes: preparation, sterilization (copious irrigation) of the root canals, as well as their obturation. While machining of the root canal there are always dentin areas, which are inaccessible for the endodontic instrument. Therefore, they remain untreated during instrumental preparation. All the shortcomings of this stage must be eliminated by thorough irrigation. With the correct irrigation protocol, the root canal system should be maximally cleaned of microflora. Removing the smeared layer at this stage also improves the quality of the following obturation. Conservative treatment of destructive forms of chronic apical periodontitis is an urgent problem, since elimination of inflammation in the periapical region allows preserving the tooth and eliminating the pathogenic effect of the odontogenic focus on the body. When choosing a method of treating chronic forms of periodontitis with significant destructive changes in bone tissue, one should not immediately use a radical approach (surgical method). In the treatment of patients, a conservative method was used with thorough medical treatment of the root canal system with heated 3% sodium hypochlorite in combination with 18% EDTA solution, using ultrasound and temporary obturation with calcium-containing filling material with iodoform. The criterion for the success periodontitis treatment was the absence of complaints, the regeneration of the periodontal tissue structure and restoration of tooth function. Conclusion. Clinical observations showed that, despite the significant size of bone lysis in the periapical region, complete bone regeneration with further full functioning of the tooth was possible in most cases without surgery. In 94.5 % of cases, positive treatment results were obtained: restoration of the bone structure in the foci of destruction, which indicates the high clinical effectiveness of using this technique. Thus, the applied method can be recommended for use.

Keywords: irrigation, apical periodontitis, root cyst, conservative treatment

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