Хирургическое лечение периапикальных деструктивных изменений зубов с использованием отечественного кальция гидроксилапатита
Indications for surgical treatment of teeth with chronic periodontitis complicated by destructive processes in periapical tissues are:
- unefficacy of conservative treatment methods of chronic periodontitis accompanied with repeated exacerbations;
- excessive lengthening over root apex of filling material with prolonged pain syndrome;
- periapical destructive processes exceed more than 0.5 cm in diameter.
Before the operation all patients got root canal treatment with the usage of depophoresis copper-calcium hydroxide by the method of A. Knappvost (1998). During the postoperative period 56 patients’ bone cavities were filled with blood clot, 60 patients – with native osteoinductive preparation “Calcium hydroxylapatite”.
The results of the research revealed that periapical destructive processes (granuloma, cystogranuloma, cyst) as complications of chronic periodontitis appear more frequently from incisors and canines and localize in upper jaw (75%). In 68% of clinical cases visual analysis of roentgenograms can’t exactly determine character of destructive process in periapical tissues. In 89.7% of cases destruction volume of peripical bone tissues composes 0.5-1.0 cm in diameter. It is 1.5-2 times less than bone tissues defects revealed during the operation.
Using the method of indirect densitymetry of patients’ roentgenograms with chronic periodontitis (Transmis, OD) it was established that increasing or reducing of middle value index of optic passing indicates to increasing or reducing bone tissue’s density in the localization focus of periapical destructive processes and it has both diagnostic and prognostic value.
Our elaborated method of complex (conservative and surgical) treatment of patients with chronic periodontitis complicated by periapical destructive processes (depophoresis by copper-calcium hydroxide without root apex resection of “causal” teeth, filling jaws’ bone cavities with native calcium hydroxylapatite) reduces reinfection of periapical tissues, keeps anatomical form of “causal” teeth.
The usage of indirect densitymetry method considerably simplifies treatment planning of destructive changes in periapical tissues on the chronic periodontitis background and has objective index of its results. The offered method of periapical destructive changes complex treatment helps to restore teeth function keeping its anatomical form out of dependence from the inflammatory process stage.
Filling postoperative defect with osteoplastic material “Calcium hydroxylapatite” (licence N ПП 65984916 P) provides optimum osteogenesis in the region of bone tissue defect, reduces rehabilitation period.
The offered method of destructive changes treatment of teeth tissues with the usage of depophoresis and CH (calcium hydroxylapatite) is recommended for treating these pathologic processes at exacerbation stage.