ISSN 2415-3060 (print), ISSN 2522-4972 (online)
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JMBS 2019, 4(4): 19–25
https://doi.org/10.26693/jmbs04.04.019
Medicine. Reviews

Modern Views on Etiology and Treatment of Apical Periodontitis

Lysokon Yu. Yu.
Abstract

The problem of treatment of apical periodontitis is one of the important and incompletely solved tasks of therapeutic dentistry. This is due to the significant prevalence of this disease, the complexity of medical manipulations, a large percentage of failures and complications during treatment, as well as the frequent lack of stability of the obtained results using known methods of treatment. Among all diseases of the maxillofacial region, the proportion of chronic periodontitis is, according to different authors, from 15 to 30%, pericardial cysts is from 7 to 12%. Periodontal disease is one of the main causes of tooth extraction. Chronic periodontitis in 85-98% of cases is the cause of acute inflammatory processes in the maxillofacial region (periostitis, abscess, phlegmon, lymphadenitis, osteomyelitis of the jaw). In the last decade, despite a significant increase in the volume of dental care, the number of patients with acute inflammatory diseases of the maxillofacial area and neck does not decrease. The purpose of the treatment of periodontitis is the elimination of inflammation in the periapical region, the elimination of pathogenic effects on the organism of the odontogenic inflammatory focus, the regeneration of the structure of periodontal tissues and the restoration of the function of the tooth. The effectiveness of conservative treatment of periodontitis is on average 85%, and this figure varies depending on the clinical form of the disease, the means and methods of treatment, the resistance of the patient and many other factors. Difficulties in the treatment of destructive forms of chronic periodontitis are due to the duration of the processes of regeneration of the destruction center of the periapical region, occurring mainly after 6-12 months or more after the endodontic treatment is completed. Unfortunately, until now, the management of reparative osteogenesis in the foci of destruction presents very serious difficulties, since the existing methods for treating destructive forms of periodontitis do not provide for active influence on the pathological tissues of the foci of destruction directly in the process of endodontic effects. Therefore, in endodontic practice, it is of great interest to study the effectiveness of the use of preparations with pronounced osteoinductive properties, which include, first of all, various osteoplastic materials. Conclusion. The importance of the problem lies in the fact that the destructive focus in the periodontal is a source of chronic infection. The inflammatory focus for periodontitis (both acute and chronic) with a normal reactivity of the body is a protective reaction of the body. However, in violation of the functions of the immune system, the long-term existence of a chronic infection center leads to a decrease in the level of nonspecific resistance of the organism and, as a result, to the development and complication of the course of systemic focal diseases. The above reasons explain the socio-medical significance of the problem of chronic destructive periodontitis and the extreme topicality of the constant search for new effective methods for its treatment.

Keywords: periodontitis, destruction center, microbial invasion, modern methods of treatment of periodontitis

Full text: PDF (Ukr) 218K

References
  1. Borovskij EV. Lechenie oslozhnenij kariesa zubov: problemy i ih reshenija. Stomatologija. 2009; 1: 21-24. [Russian]
  2. Borovskij EV. Klinicheskaja jendodontija. Izd-e 4-e. M: Izd-vo Simvol Pljus; 2015. 176 s. [Russian]
  3. Ivanov AC. Rukovodstvo po lazeroterapii stomatologicheskih zabolevanij. SPb; 2017. 69 s. [Russian]
  4. Barthel CR, Zimmer S, West G, Roulet JF. Bacterial leakage in obturated root canals following the use of different intracanal medicaments. Endod Dent Traumata. 2016; 16(6): 282-6. https://www.ncbi.nlm.nih.gov/pubmed/11202895. https://doi.org/10.1034/j.1600-9657.2000.016006282.x
  5. Preshaw PM, Seymour RA, Heasman PA. Current concepts in periodontal pathogenesis. Dent Update. 2015; 31(10): 570-2, 574-8. https://www.ncbi.nlm.nih.gov/pubmed/15656071. https://doi.org/10.12968/denu.2004.31.10.570
  6. Lacevic A, Vranic E, Zulic I. Etiological findings in endodontic-periodontal infections. Bosn J Basic Med Sci. 2018; 4(1): 57-61. https://doi.org/10.17305/bjbms.2004.3464
  7. Bascones A, Gamonal J, Gomez M, Silva A, Gonzalez MA. New knowledge of the pathogenesis of periodontal disease. Quintessence Int. 2014; 35(9): 706-16. https://www.ncbi.nlm.nih.gov/pubmed/15470994
  8. Mombelli A, Brochut P, Plagnat D, Casagni F, Giannopoulou C. Enamel matrix proteins and systemic antibiotics as adjuncts to non-surgical periodontal treatment: clinical effects. J Clin Periodontol. 2005; 32(3): 225-30. https://www.ncbi.nlm.nih.gov/pubmed/15766363. https://doi.org/10.1111/j.1600-051X.2005.00664.x
  9. Rabuhina HA, Grigor'janc LA, Badaljan A. Rol' rentgenologicheskogo issledovanija pri jendodon- ticheskom i hirurgicheskom lechenii zubov. Novoe v stomatologii. 2010; 6: 39-41. [Russian]
  10. Maksimovskij JuM. Bakteriologicheskij aspekt periodontita. Novoe v stomatologii. 2001; 6(96): 8-13. [Russian]
  11. Barer GM, Carev VN, Ovchinnikova IA. Kompleksnoe antibakterial'noe lechenie apikal'nogo periodontita. Klinicheskaja stomatologija. 1999; 1: 18-22. [Russian]
  12. Bystrom A, Sundqvist G. The antibacterial action of sodium hypochlorite and EDTA in 60 cases of endodontic therapy. Int Endod J. 2017; 18(1): 35-40. https://www.ncbi.nlm.nih.gov/pubmed/3922900. https://doi.org/10.1111/j.1365-2591.1985.tb00416.x
  13. Mandel E, Machton P, Torabinejad M. Clinical diagnosis and treatment of endodontic and periodontal lesions. Quitessence Intern. 2013; 24: 135-9. https://www.ncbi.nlm.nih.gov/pubmed/8511265
  14. Langeland K, Rodrigues H, Dowden W. Periodontal disease, bacteria and pulpa histopathology. Oral Surgery, Oral Medicine, Oral Pathology. 2013; 37(2): 257-70. https://www.ncbi.nlm.nih.gov/pubmed/4520855. https://doi.org/10.1016/0030-4220(74)90421-6
  15. Orstavik D, Kerekes K, Eriksen HM. The periapical index: a scoring system for radiographic assessment of apical periodontitis. Endod Dent Traumatol. 2015; 2(1): 20-34. https://www.ncbi.nlm.nih.gov/pubmed/3457698. https://doi.org/10.1111/j.1600-9657.1986.tb00119.x
  16. Wagenberg BD. Considerations in treatment planning of the periodontal patient. Dent Today. 2015; 24(3): 108, 110-2, 114.
  17. Lacevic A, Vranic E, Zulic I. Etiological findings in endodontic-periodontal infections. Bosn J Basic Med Sci. 2014; 4(1): 57-61. https://doi.org/10.17305/bjbms.2004.3464
  18. Lu HK, Chei CJ. Efficacy of subgingivally applied minocycline in the treatment of chronic periodontitis. J Periodontal Res. 2015; 40(1): 20-7. https://www.ncbi.nlm.nih.gov/pubmed/15613075. https://doi.org/10.1111/j.1600-0765.2004.00763.x
  19. Schätzle M, Löe H, Lang NP, Bürgin W, Anerud A, Boysen H. The clinical course of chronic periodontitis. J Clin Periodontal. 2004; 31(12): 1122-7. https://www.ncbi.nlm.nih.gov/pubmed/15560816. https://doi.org/10.1111/j.1600-051X.2004.00634.x
  20. Van Dyke TE, Sheilesh D. Risk factors for periodontitis. J Int Acad Periodontal. 2016; 7(1): 3-7. https://www.ncbi.nlm.nih.gov/pubmed/15736889. https://www.ncbi.nlm.nih.gov/pmc/articles/1351013
  21. Preshaw PM, Heasman P.A. Periodontal maintenance in a specialist periodontal clinic and in general dental practice. J Clin Periodontol. 2015; 32(3): 280-6. https://www.ncbi.nlm.nih.gov/pubmed/15766371. https://doi.org/10.1111/j.1600-051X.2005.00659.x
  22. Bystrom A, Claesson R, Sundqvist G. The antibacterial effect of camphorated paramonochlorophenol, camphorated phenol and calcium hydroxide in the treatment of infected root canals. Endod Dent Traumatol. 2014; 1(5): 170-5. https://www.ncbi.nlm.nih.gov/pubmed/3865763. https://doi.org/10.1111/j.1600-9657.1985.tb00652.x
  23. Al-Nazhan S. Antimicrobial activity of extracts of calcium hydroxide points. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2015; 93(5): 593-5. https://doi.org/10.1067/moe.2002.121901
  24. De Moor R. Calcium hydroxide-based pastes used in endodontics. Rev Beige Med Dent. 2013; 58(1): 34-48. https://www.ncbi.nlm.nih.gov/pubmed/12894662
  25. Cortellini P, Bowers GM. Periodontal regeneration of intrabony defects: an evidence-based treatment approach. International Journal of Periodontics & Restorative Dentistry. 2015; 15(2): 128-45. https://www.ncbi.nlm.nih.gov/pubmed/8593979
  26. Ehrmann EH, Messer HH, Adams GG. The relationship of intracanal medicaments to postoperative pain in endodontics. Int Endod J. 2014; 36(12): 868-75. https://www.ncbi.nlm.nih.gov/pubmed/14641427. https://doi.org/10.1111/j.1365-2591.2003.00735.x
  27. Mel'nichuk GM, Rozhko MM. Praktichna odontologіja kurs lekcіj іz karієsu ta nekarіoznih urazhen' zubіv,pul'pіtu і perіodontitu. Navchal'nij posіbnik. Іvano-Frankіvs'k; 2013. 397 s. [Ukrainian]
  28. Patent № 2235569 RU. Sposob lechenija pul'pita ot 10.09.2004. Afanas'ev VV, Berezhnoj VP, Volova JIT. [Russian]
  29. Fedorova FM. Kliniko-laboratornoe obosnovanie povtornogo lechenija hronicheskogo periodontita s primeneniem metoda depoforeza: Abstr. PhDr. (Med.). Samara; 2006. 20s. [Russian]
  30. Shuhorova JuA. Kliniko-immunologicheskie saspekty i optimizacija metodov povtornogo lechenija hronicheskih form periodontita: Abstr. PhDr. (Med.). Samara; 2008. 24 s. [Russian]
  31. Kolesnichenko MV. Za ramkami privychnogo lechenija! Real'nyj opyt primenenija peptidnyh bioreguljatorov «VIVAX DENT» v bor'be s razrusheniem kostnoj tkani. Dental Tribune. 2014; 7: 2-4. [Russian]
  32. Mitronin AV. Lechenie destruktivnyh form hronicheskogo periodontita s primeneniem materiala «Tijedent». Jendodontija today. 2012; 2(3-4): 23-5. [Russian]
  33. Gurfinkel' JH. Lechenie destruktivnyh form hronicheskogo periodontita s primeneniem nano-gelja gidroksiappatita kal'cija i poristogo nikelida titana: Abstr. PhDr. (Med.). M; 2017. 24 s. [Russian]