Classification
of inflammatory processes of MFA.
Periodontitis: etiology, pathogenesis, classification, clinical course of,
complications, prophylaxis. Odontogenic granuloma of face : clinic, treatment.
Detained and halfdetained teeth. Etiology, clinic, diagnostics, treatment,
complications. Pericoronaritis. Odontogenic jaw periostitis: etiology, clinic,
diagnostics, treatment, complications, prophylaxis.
Acute
inflammatory processes belong to the category of diseases in which mostly shows
therapeutic intervention in the early hours of addressing patients for medical
care, ie diseases that require immediate surgery.
Such
diseases include acute odontogenic inflammatory maxillofacial area: abscess,
osteomyelitis, abscesses, cellulitis, and lymphadenitis, which is a consequence
of pathological processes that develop in the mouth, and so on. (Table 1).
Keep
in mind that the efficiency of the physician in these diseases is needed
quality because often only immediately conducted surgery can prevent serious
complications and relieve the patient from suffering.
Given
the proximity of the brain, anatomically-topographic features that contribute
to the rapid spread of the inflammatory process, as well as massive
vascularity, which causes active inflammation and absorption of food
intoxication, meaning immediate surgery can not be overemphasized.
It
is likely that doctors in any specialty should have a basic knowledge for
establishing the correct diagnosis and an immediate intervention for acute
purulent diseases of maxillofacial area.
Among
the inflammatory diseases of the maxillofacial area and neck most common
odontogenic processes.
Acute Periodontitis
Etiology and pathogenesis
Acute
periodontitis may be acute primary or secondary, is a consequence of worsening
of existing chronic periodontitis.
Periodontitis
are infectious and nein-fektsiyni that arise from the chemical (during dental
treatment) or mechanical (blow, bruise, fall, etc.). Periodontal injury.
Most emerging infectious
periodontitis.
The
source of infection matched enters the periodontal is usually numb the tooth
pulp. With
a root canal tooth germs get into periodontal through apical opening of the
root. This
contributes to pressure food during chewing: putrid contents of the channel
while moving, "utrambovuyetsya" and enters the periodontium. Infection
comes from channel Periodontal and during medical manipulations in the
treatment of "gangrenous" or pulpitnyh teeth. Because
promotion infection top emerging so-called apical (apical) periodontitis.
Recently,
there are toxic pulpit as a consequence use photopolymers
kariyesnyh
filling cavities and wedge cervical defects of teeth. These
"fotopolimerpulpity" later complicated by toxic periodontitis.
The
second way of infection in periodontal - gum over the edge, that is the bottom
gingival groove, resulting in developing so-called marginal (marginal)
periodontitis matched captures the part of the periodontium, which is adjacent
to the neck of the tooth.
The
third way of infection in Periodontal - hematogenous and lymphogenous (during flu,
sore throat, fever and other infectious diseases).
The
fourth way - consistent distribution, which happens when hinhivostomatytah,
osteomyelitis, inflammation of the maxillary sinus, ne-rykoronitah.
Osteomiyelitychni
periodontitis occur simultaneously in several intact teeth (at Odon-tohennomu
or neodontohennomu osteomyelitis of the jaws).
Among neinfektsiyyyh
periodontitis distinguished:
1)
those arising from chemical injury periodontal (there are in treating tooth
roots formalin, aqua regia, arsenic trioxide and other toxic and caustic
substances);
2)
traumatic periodontitis, emerging from both acute (one-stage) or injury-hit
during rozkushuvannya nuts, sugar or ankles, use millerivskoyu needle, and with
chronic injury (permanent overload tooth prosthesis, peeling seeds, holding
nails or other objects between teeth).
Depending
on the clinical course, the extent of the prevalence and nature of pathological
changes
I. Acute (exudative) periodontitis:
a) serous (limited and diffuse);
b) septic (limited and diffuse).
II. Chronic (proliferative)
periodontitis:
a) fibrous;
b) granulating;
c) granulomatous.
III. Exacerbations of chronic periodontitis.
A. 1. Evdokimov
distinguishes among chronic periodontitis these, combined with
hipertsemen-tozom.
Hospital acute serous periodontitis
Characteristic
blurred spontaneous pain that increases with pressure on the tooth and the use
of hot food or water. The
patient feels as if a tooth "grown up" or moved from the tooth
socket. The pain
is not radiating, so the patient can accurately show struck tooth. Although
during chewing and pain increases, but if the patient somknite teeth and keep
some time locked jaw, the pain gradually subsides almost completely or
significantly reduced.
OBJECTIVE:
usually no signs of swelling of the mucous membrane of the gums and periosteum
is not visible, static tooth is not broken. Regional
lymph nodes (pidboridni or submandibular) slightly enlarged and slightly
painful. Percussion tooth accompanied by
acute pain.
Pathological Anatomy. Redness
and thickening of the periodontal tooth root apex (macroscopically):
microscopically - redness, swelling and slight leukocytic infiltration apical
perytssmentu.
Treatment
of serous periodontitis at an early stage of the disease may be conservative
(if the tooth is value in functional and cosmetic regard). Unfortunately,
the sick, of course, go to the doctor when the stage serous inflammation is
gone and there is purulent inflammation of periodontium. Often
acute purulent peryudontyt is a consequence not of serous periodontitis, and
purulent pulpitis.
Hospital
acute suppurative periodontitis
Complaints
of patients with sharp constant pain that radiates to the ear, temple, eye -
over the course of the branches of the trigeminal nerve, patients say that the
pain slightly reduced from the effects of cold and aggravated by heat. Serried
teeth impossible for tooth sharply reacts to the slightest touch antagonist and
even the tongue. Lips are not fully merge. The
patient can not sleep because supine pain intensified.
OBJECTIVE:
countenance distressing, restless (fear to touch the tooth). Around
the patient's tooth gums swollen and slightly hyperemic alveolar increase
smoothed, navkoloshelepni tissue normal or slightly swollen.
Regional lymph
nodes are enlarged and painful on palpation. Vertical
percussion of the tooth, which make it very gently, causing excruciating pain. Horizontal
percussion also causes sharp pain reaction. Causal tooth
usually "gangrenous" loose and lively.
In
the blood, sometimes there is a slight leukocytosis with an increase in the
number of segment-nuclear and young neutrophils, erythrocyte sedimentation rate
accelerated slightly (up to 20-
Body
temperature is usually not increased, but sometimes there are low-grade. The
degree of changes in body temperature and blood depends on the individual
condition of the patient reactivity.
In
primary acute periodontitis significant changes on radiographs is not observed.
In
the case of the development of acute process (due to exacerbation of chronic
periodontitis) shows similar to flame or rounded thinning of bone tissue.
Pathological Anatomy. In
periodontal leukocyte infiltration, mainly due to the large kilkosh. lymphocytes,
there are small pockets of pus, which gradually merge, destroying and
vidsharovuyuchy perytsement from the root. In bone hole-reactive
dystrophic changes. In
the walls of the hole, preferably I Lyantse its bottom, bone reconstructed:
resolves it appears a number of gaps filled osteoclast, we, expanding holes in
the bone, through which the Paris-DonNTU combined with bone marrow, bone marrow
is pulling some holes * Normally separated from
periodontal bone. In
the bone marrow - swelling and infiltration leykotsytamh sometimes diffuse
purulent infiltration of certain bone marrow spaces.
It
should be noted that necrosis Bone "Mr. Brain" tissue not ^
vschouyshltish: Because purulent infiltration of cells in the absence of bone,
can not be regarded as a "classic" manifestation osteomiyelitychnoho
process (by G. Vasilyev, 1956).
Thus,
clinical and histological data provide a basis for the acute purulent
peri-dontyt a separate nosological form and do not consider it an initial phase
of osteomyelitis.
Microflora
in Periodontitis usually mixed, characterized by content Root canal tooth -
purulent and putrefactive microbes. However,
according to FI Ishanhodzhayevoyi (1965), possible dominance monomikrobnoyi
flora, including streptococci.
Treatment
The
task of the doctor is to first reduce and then eliminate pain, eliminate
inflammation, prevent the spread of purulent process in the adjacent tissue. All therapeutic
measures are divided into local and general. To
address these three tasks should provide vidtikannya purulent exudate from
periodontal. This
should first resolve the issue of functional value "causal" tooth
(which is usually a large defect) and the feasibility of its preservation.
There
are several ways through which you can provide with periodontal vidtikannya
manure. If
the tooth is not destroyed and saving it is desirable and necessary, open the
pulp chamber, clean and extend the root canal, after which the cavity drop out
manure. This
pain immediately begins to subside, reduced severity of inflammatory process. If
the tooth is sealed to ensure vidtikannya manure a little harder, but possible
good anesthesia. The
doctor must firmly hold tooth fingers that it will not move during
manipulation.
Ineffectiveness
of conservative therapy may be caused by obstruction of channels (their
obliteration), the presence of channel-pulpoekst raktora or boron, curved
roots, as well as a decrease in protective immunological properties of the
organism. In
the absence of a vidtikannya purulent exudate through the canal and pulp
chamber doctor has to find another way for drainage periodontium. In
such cases, or when. Despite the ongoing drainage canal, acute effects are
increasing, making the cut in the transitional crease roztynayuchy mucosa and
periosteum, in 1-2 days you can try again to create a channel patency. Sometimes
combined vidtikannya pus through the tooth and root canal through an incision
in the crease of the transition.
If
the tooth is significantly damaged and is not an anatomical and functional
value for the prosthesis, and attempts to save him were unsuccessful, the tooth
is removed, then the hole for 24-28 minutes drain narrow rubber or gauze strip.
Questions
about tooth extraction in acute inflammation of the periodontium and jaws long
comprehensively discussed in domestic and foreign literature. The
fact that an isolated tooth is not always quickly leads to the elimination of
inflammation. Moreover,
sometimes when the patient agrees to remove long tooth (or his doctor does not
offer this operation), and then still removes tooth, then, in spite of this,
the inflammatory process may progress: vidtikannya provided as inflammation increases,
because the body already unable to cope
with infection and intoxication.
In
this situation, patients tend to associate the deterioration of his condition
with the removal of the tooth.
As
the observations of several authors, the earlier the beginning of acute
periodontitis tooth is removed, the terms are shorter elimination of
inflammation and the easier it is to prevent the spread of acute suppurative
process in adjacent bone and soft tissue. Hence
the conclusion: if the doctor is no certainty in the possibility and necessity
of conservative therapy must remove tooth earliest.
However,
one should bear in mind that even early (in the 1-day illness) tooth is not
always prevents inflammation in the periosteum, bone, soft tissue around them,
especially in those patients who have periodontitis often exacerbated and
contributed to the development of in
the body of sensitization and training ground for hyperergic course of
inflammation.
For
this reason it is desirable in the scheme sedation before removing a tooth or
before the opening of the crease in the transition include gums, sybilizuvalni
drugs can reduce the degree hyperergic response to injury, which has a doctor. This
intervention should be to give the patient any antihistamine (pipolfen, suprastin,
diphenhydramine, diazolin etc.).
If
the tooth has a functional value that is anatomically quite full, you can
delete it, and then, after subsiding acute effects of inflammation,
replantuvaty.
In
case of refusal of tooth extraction should invite him to make the cut in the
transitional crease and hold general therapeutic measures (antibiotics,
sulfanilamide
drugs,
etc.), assign UHF-therapy sessions 10.18), electrophoresis of potassium iodide to
the area of inflammation.
General
therapeutic measures after tooth extraction or cut on the crease transition are
as follows: after securing vidtikannya manure prescribed bacteriostatic drugs,
sulfonamides (sulhin, streptotsid 0,5-
Results and complications
If
treatment was correct and timely, comes complete elimination of inflammation,
but if the treatment is not performed, purulent exudate, without affecting
significantly the bone, periodontal penetrate directly into the periosteum (via
lymphatic vessels and advanced breakthrough and haver-Owl channels), causing
acute purulent periostitis of the jaw.
Purulent
exudate, hitting a bone, can cause limited or diffuse osteomyelitis, and in
adjacent navkolosche-lepnyh soft tissues and lymph nodes, cellulitis,
abscesses, lymphadenitis. However,
most manure flowing through the gingival pocket or fistula, and then acute
periodontitis becomes chronic, combined with chronic lymphadenitis. If
the treatment is carried out correctly or are ineffective, they can develop the
same complications (abscess or osteomyelitis of the jaw, abscess,
lymphadenitis, chronic periodontitis). Perhaps
a combination of all or some of these processes, the transition to another one
complications.
Chronic periodontitis
Etiology and pathogenesis
Certainly
chronic periodontitis due to continuous and prolonged infection periodontal
microflora of the root canal tooth. Sometimes
chronic periodontitis is the result of acute periodontitis. Pathogens
are streptococci, staphylococci, sometimes - Various mixed flora.
Lethargy,
gradual increase of chronic periodontitis due to the presence of local
mesenchymal protective mechanisms in periodontal and mobilization of all
protective devices against micro organism, which gradually penetrates into it.
The
clinical course and nature of pathological changes in lohoanatomichnyh
navkoloverhivkovyh tissues of chronic periodontitis may be divided into stable
(fibrotic, granulomatosis-tion) and the active flow (granulating, pointed
granulomatous) forms. Thus,
the presence of chronic inflammation of complete cells indicates a
stabilization process, and their disappearance - his aggravation.
Chronic
fibrotic periodontitis may occur as a result of feedback granulating or granulomatous
(mostly), periodontitis or as the first form of chronic periodontitis.
Clinic
Certainly
no complaints, only in case of aggravation, pain during chewing and percussion
(in the vertical direction).
X-ray
determined advanced periodontal gap, especially in the apical part; outlines
perytsementu - unequal matched tumor caused by cement (so-called
hipertsementozom). Bone
wall peri-dontalnoyi slit thickened, sklerozovana and gives denser and wider
than normal, shadow.
Pathological Anatomy. Macroscopically
perytse-ment thickened or navkoloverhivkoviy part or the entire length of the
color thickened parts - white, microscopically - bundles grubovoloknistye
connective tissue between the beams sometimes placed kruhloklitynnyh cell
infiltrates.
Treatment
If
the tooth is not treated conservatively and does not represent value for the
prosthesis, it is removed and the hole carefully vyshkribayut kyuretazhnoyu
small spoon. If
the tooth is not destroyed, but can not be treated conservatively, it replantuyut
acc known procedures.
Chronic granulating periodontitis
The most active form of
chronic periodok-Titus.
Clinic
Complaints
of patients: pain during pryymank * solid or hot food on the gums is usually a
fistula (long), which is periodically opened and closed **-vayetsya. Before
vidkrytttyam fistula pain exacerbated deteriorating health. However: the presence of the
fistula is not required. Sometimes zovesh no complaints of pain. The
patient only Note ^ ': weak redness (hyperemia) gums and their Dialled
Chronic periodontitis
Etiology and pathogenesis
Certainly
chronic periodontitis due to continuous and prolonged infection periodontal
microflora of the root canal tooth. Sometimes
chronic periodontitis is the result of acute periodontitis. Pathogens
are streptococci, staphylococci, sometimes - Various mixed flora.
Lethargy,
gradual increase of chronic periodontitis due to the presence of local
mesenchymal protective mechanisms in periodontal and mobilization of all
protective devices against micro organism, which gradually penetrates into it.
The
clinical course "and the nature of the pathological changes in
lohoanatomichnyh navkoloverhivkovyi tissues of chronic periodontitis may be
divided into stable (fibrotic, granulomatosis-tion) and the active flow
(granulating, pointed granulomatous) forms. Thus, the presence of chronic
inflammation of complete cells indicates stabilization
process, and their disappearance - his aggravation.
Chronic
fibrotic periodontitis may occur as a result of feedback granulating or
granulomatous (often periodontitis or as the first form hronichnoh:
periodontitis.
Clinic
Certainly
no complaints, only in case of aggravation, pain during chewing and pr *
percussion (in the vertical direction).
X-ray
defined extensions periodontal gap, especially at the top;-hand side;
perytsementu shape - rough, Sw due to tumor cement (so-zvyi him
hipertsementozom). Bone
wall perk-dontalnoyi slit thickened, sklerozovan enables denser and wider than
normal, shadow.
Pathological Anatomy. Macroscopically
featherbeds cop thickened or navkoloverhivkoviy his chi sity matrix, or the
entire length of the color thickened h sity matrix - white, microscopically -
bundles hrubovolok stand connective tissue between the beams sometimes pc>
mishuyutsya kruhloklitynnyh cell infiltrate. "
Treatment
If
the tooth is not treated conservatively and does not represent value for
protezuye ^-tion, it is removed and the hole carefully vyshkry-bayut
kyuretazhnoyu small spoon. I
have a tooth that is not destroyed, but can not be treated conservatively, it
replantuyut also known procedures.
Chronic granulating periodontitis
The most active form of
chronic period Titus.
Clinic
Complaints
of patients: pain during adoptee "solid or hot food on the gums is usually
a fistula (long), which periodically opens and closes. Before
vidkrytttyam fistula pain exacerbated deteriorating health. Av fistula presence is not required. Sometimes zova no complaints of pain. Patient
notes only faint redness (hyperemia) and gum swelling.
OBJECTIVE:
usually broken tooth, "gangrenous" percussion has a weak pain
hipereminovani gums, swollen, pressing tool is long depression (dimple). Often
seen on the gums fistula with protrusion of granulation, it can be localized
and the face, chin, near the edge of the mandible or the inner corner of the
eye, in the zygomatic region, the neck.
Root
canal moist, with traces of blood due to germination had granulation.
The
X-ray visible nekonturovana, uneven strip thinning of bone around the tooth.
Pathological Anatomy. Evidently
overgrowth of granulation outside periodontium, this caused lobular,
polum'yapodibna resorption cortical substance wall socket tooth that appears on
the radiograph. Among
granulation - accumulation of leukocytes and histiocytes, a small number of
plasma cells, resorption of cement and dentin of the root, along with
proliferative phenomena is clearly identified and exudation, especially during
exacerbations that are associated with closing the fistula or weakening
immunity (due with
a history of flu, sore throat, general cooling, overwork or nutrition, injury,
etc.).
Pathological,
microbiologically and clinically granulating periodontitis should be regarded
as most typical and most formidable cell odontogenic infection. In
this cell in the body receives food poisoning, causing him sensitization.
Residual granuloma of filling material in the area of the removed tooth 46.
Treatment
Conservative
treatment is successful only good patency of roots and their possible
obturation filling material, then comes fybrotyzatsyya, scarring, ie clinical
recovery.
Surgical
treatment is indicated in case of obliteration of the roots, and after
ineffective conservative treatment. One of the following surgical
treatment:
1)
tooth extraction and curettage of granulation with small holes kyuretazhnoyu
spoon;
2)
if the tooth is sufficiently complete, until Zana replantation (see below);
3)
if granulation formed in migratory subcutaneous granuloma, you should remove
it; transition to the crease to cut cord, and the "causal" tooth
remove or hold it replantation.
Chronic
granulomatous periodontitis
If
chronic granulating periodontitis can not be cured completely, it can become
hidden, torpid and asymptomatic pe-
Chronic
granulomatous periodontitis
If
chronic granulating periodontitis can not be cured completely, it can become
hidden, torpid and asymptomatic. Around
the diseased granulations gradually grows fibrous, connective tissue capsule. This
process of gradual coverage, a kind of "taming", "blocking"
granulation IG Lukomski called granulomatous process that eventually ends basal
formation of dental granulomas.
Clinic
Complaints
usually does not happen, because the phenomenon of exudation hardly expressed.
The
X-ray shows roundish shape dilution with equal, sharp edges, size - from millet
seed to a small pea.
Pathological Anatomy
Macroscopically:
on top of the removed tooth root "hanging" round growths, the color
of it - from light yellow to dark red, it is - granuloma closely associated
with the root and is therefore usually removed with it.
Microscopically 1.1. Davydenko (1966)
distinguishes between three types of granules:
1. Simple
granuloma:
a) simple cell;
b) simple fibrotyzyvni;
c) simple cystic.
2. Epithelial
granuloma:
a) epithelial cell;
b) epithelial fibrotyzyvni.
3. Epithelial cystic granuloma:
a) nefibrotyzyvni;
b) fibrotyzyvni.
Epithelial
cavity in granuloma subsequently merged, filled with inflammatory exudate and
fatty detritus, forming first kistohranulomu, and then - cyst. Increasing
in size, granuloma leads to atrophy and bone deformities gums. It
can be localized not only in the thickness of bone (spongy), but also under the
periosteum, under the mucous membrane of the gums and under the skin (A. X. Asiyatylov,
1969).
In
electron microscopic examination (GP Bernadska, LO Stenchenko, T. Andrienko,
1991) plot odontogenic granulomas found that they are characterized by the
formation of monocytic infiltration and proliferation of connective tissue
elements. The
cellular composition of granulomas characterized by containing cellular
elements: some in the cell game nulematoznoho inflammation dominated by mature
epithelial oyidni cells, along with other epitelioidnymy cells multinucleated
giant cells are present. Ultrastructural
organization of cells shows a different degree of their maturity and functional
activity. Thus,
mononuclear phagocytes are represented mainly by monocytes and their more
mature forms - macrophages. Monocytes
- small cells with a smooth surface, in the nucleus is diffuse chromatin,
cytoplasm - moderate electron density with developed endoplasmic grid, Golgi
apparatus, mitochondria, and a large number of small-sized dense bodies. Macrophages
are more diverse in structure and polymorphic form. Number
of inclusions and vacuoles varies in different cells, consider the criterion
intensity of their metabolism and phagocytosis. Mature
macrophages have on their surface thin finger spines. In
their cytoplasm many phagocytic vacuole, primary and secondary lysosomes,
multyvezykulyarnyh cells, the remaining cells of different types, fragments of
red blood cells and neutrophils. In
macrophages degraded organelles undergo degradation in the cytoplasm appear
great autofahosomy, sehresomy and lamellar bodies.
Epitelioschni
cells are characterized by flattened with numerous folds on the cell surface. Typically,
these cells form aggregation hatsiyni clusters are closely intertwined with
their shoots on the type of connection "zip". In
epithelioid cells developed as energy and synthetic machinery, as evidenced by
the presence of well-developed granular endoplasmic ungrainy and nets, numerous
mitochondria. About
secretory function epitelioidnyh cells indicates the presence in their
cytoplasm elektronnoschilnyh granules restriction membranes. In some
granules, their central part is elektronnoprozoroyu.
Some
patients in the cell granulomas are multinucleated giant cells, which is
inherent polymorphism. Often
they contain from 5 to 10 nuclei, which are characterized by diffuse chromatin
deployment, intussusception keriolemy, presence of nucleoli. The cytoplasm of
giant cells rich in cell organelles. Well-developed
endoplasmic mesh elements, there are many mitochondria roundish shape and small
size. External
and internal rishnomitohondrialna membrane characterized by distinct
tortuosity. As
epitelioschni cells, giant cells containing dark osmiofilni pellets, which are
predominantly elongated shape. Moreover,
in the cytoplasm of giant cells are lamellar osmiofilni cells, which may
indicate an intensification peroksndnoho lipid in the cell.
In
addition to the aforementioned cellular elements in the focus of granulomatous
inflammation are sometimes aggregation of neutrophils, lymphocytes,
fibroblasts, plasma cells. The latter have different
functional activity. Tanks
endoplasmic mesh in some of them considerably expanded. Can
vybuvatysya separation tanks filled secret in the intercellular space
containing collagen fibers of varying degrees of maturity, elastic fibers, yarns
and conglomerates of fibrin.
Blood
microvessels in the focus of granulomatous inflammation characterized not only
by changes in the structural organization of the vascular wall, but blood
rheological disorders. Red
blood cells are often deformed shape with pronounced psevdopodiyamn, marked
adhesion of erythrocytes and leukocyte and elements to the vascular wall,
diapedesis of blood cells. In
such microvascular endothelial for aqueous lining pathologically characterized
by alternating light and dark endoteliopytiv.
Endothelial
cells of capillaries most swollen, their nuclei are characterized by leaching
chromatin maybe mikroplazmatozu phenomenon in the cytoplasm appear
mikrofibrylyarni structure. Basement
membrane of capillaries extended a fibrous structure. There tumor capillaries.
So
electronmicroscopic study area granulomatous inflammation gives grounds to
conclude preferential development in patients with epithelioid granulomas, the
hallmark of which is the aggregation of epithelioid cells and giant cell
formation.
Ultrastructural
study of odonto-genic areas radykulyarishh cysts indicate their formation in
cell chronic inflammatory periodontitis. This
is confirmed by the presence of cellular infiltration, mainly of macrophages,
plasma cells and cellular elements of the blood. Notably
prevalence of degenerative and destructive processes in cells infiltrate up to
their necrosis. Characteristic
is the formation of giant vacuoles elektronnoprozoryh. They
compress adjacent tissue, cause deformation and destruction of their
components. The
structure of the walls of cystic formations represented mainly by fibroblasts,
remnants of proliferating cell structures and elements of connective tissue
composed of collagen fibers of varying degrees of maturity, and conglomerates
of fibrin strands.
Thus,
a possible source of odoptohennyh cysts of the jaws with odoiitoheyishi
granulomas. Since
the presence of chronic inflammation may be the only source kistoutvorennya but
constitute peredpuhlytshy state should take measures to prevent the development
of granulomas in jaw bones.
Treatment
May be conservative or surgical. If
the size of granulomas small (up to 0.5-
If
conservative treatment is not indicated or proved ineffective, use one of the
surgical methods: 1) tooth (root) followed by curettage hole or spoon
excavator: 2) root apex resection with simultaneous removal of granulomas, 3)
removal of granulomas (without resection root
apex), 4) tooth replantation, 5) gen-misektsiya, 6) koronaroradykulyarna
separation.
Anikotomiya, resection
(amputation) root apex
Indications apikotomiyi:
1) the presence of large granulomas;
2)
random polamannya pulpoekstraktora or boron in the apical part of the root:
3)
traumatic fracture or perforation of the root of its forest area in the top,
removing bone sequestration in the treatment of chronic osteomyelitis;
4) nedoplombuvannya
and failed pereplombu-ing roots;
5) curved root.
Contraindications:
1) extensive destruction crown and no prospect of use for tooth prosthesis, 2)
significant mobility of root and 3) lateral placement granulomas, 4) poor
general condition of the patient, which does not allow an
operation-apikotomiyu.
Preparing
for surgery is that the morning of the operation complete treatment fastening
their roots.
Method of operation
Perform
local anesthesia, making trapezoidal or oval cut gum mucous membrane and
periosteum. Basis flap should
be returned to the transitional folds. Flap
size should be larger than the estimated bone defect at the site of granuloma. Detach
the flap rugine, trepanuyut bone, transmitting amputation root apex (better not
chisel and fisurnnm boron) and extracted granuloma. Smooths out of
the stump, acting, ie the root of the tooth. Cavity
in the bone vyshkribayut and washed with antiseptic solution or antibiotics. Flap
puts in its place and fixes 3.4 kethutovymy knotted sutures or polyamide
fishing line. Sutures are removed on the 5-6th day.
Retrograde
amalgam filling upper root canal during resection of the root apex:
and
vidpylyuvannya root apex boron fisurnnm b treatment stump root cutter: in
amalgam fillings root canal extended areas: the upper section of root canal
sealed: the muco-oxide flap imposed seams (with G. Vasilyev).
During
surgery should pay attention to obturation canal cement. If not,
consider making retrograde amalgam fillings.
Stages
transaction root apex resection with retrograde filling of.
Operation removal granulomas and cysts, granulomas, some
authors (MA Bildyukevych and VP Kamashyna, 1964) performed without resection of
the root apex of the tooth. This
allows the teeth to provide a more reliable stability in the alveolar process.
One
of the surgical treatments for chronic and exacerbations of chronic
periodontitis tooth replantation is proposed by Ambroise Pare in 1594 Now it is
used more and more by the significant research aimed at substantiating
nayratsio-nalnishoyi operation technique. For
example, only one issue "stomatology» (№ 5, 1995, p. 77-85) published 24
articles on the experience of using the method of replantation and
transplantation of teeth (
The
operation is as follows: after careful tooth removal (not to damage the root
and the wall socket) vyshkribayut hole, sealed channels and cavity of the
tooth, saw off the top of the roots are removed from the wells blood clots and
washed with a solution of antibiotics. Then
introduce a tooth in his hole and ukriplyayut Kapova apparatus with bus rapid
kotverdnuchoyi plastic or wire. Prescribe antibiotics
(intramuscular). After
1.5-2 months tooth survives and can function long (5.2.10 and older).
Engraftment
replantovanoho tooth is one of three types: 1) periodontal-him (with the full
preservation of the periosteum alveoli and residual periodontal replantata on
the vine), 2) periodontitis-fibrous (when they are partially preserved), 3)
osteoid (when they are completely absent) .
In
acute odontogenic inflammatory processes (exacerbations of chronic and acute periodon-tytah
and acute osteomyelitis) is sometimes also used method of tooth replantation. Engineering
operations in this case differs from the above in that it is conducted in two
stages. The
first stage is to remove a tooth and filling the hole swab dipped in a solution
of a mixture of antibiotics. The
patient was released home, making the appropriate destination to eliminate
acute inflammation i. After 5-20 days. ie
after missing signs of acute inflammation, tooth that is stored in antibiotic
solution at 4 ° C, sealed and replsshtuyut the usual method of removing pre
wells swab and granulation. So
tooth replantation performed on the second stage, after the elimination of
acute inflammation (periodontitis, osteomyelitis or periostitis).
There
are reports of successful use of one-stage replantation of permanent teeth and
acute exacerbations of chronic peri-dontytah, abscess and osteomyelitis, even
with tight jaws (BS Cherkassky, 1967 VI Serdyukov, M. Mitkov, 1989).
In
this one-stage replantation (both single-rooted and permanent teeth) should not
only carefully pull the tooth, but also make the cut along the crease of the
transition following its drainage rubber strip and within 6-7 days to
deliberate the total en-tybiotykoterapiyu.
Before
replantation tooth (pre-sealed) the hole vyshkribayut granulation. This
should keep cement replantovanoho tooth resection do its apex, but Periodontal
contrary, be removed because he in'yektovanyy leukocytes, and in the top
section - just melted. Replantation
is unsuccessful in applying it at the sharp granulating periodontitis.
Some
authors recommend not to hold any special fixing replantovanoho tooth because
it may give teeth unnatural position.
Forecast
Replantovanyy
acute inflammation of the tooth is strengthened and can operate over 30-45
days. According
to VA Kozlov (1974), which summarized a great personal experience replantation
2249 teeth and literature data on long-term effects of teeth replantation is
4313 (from 2 to 11 years) conservation replantovanyh teeth observed on average
82.9%.
The
reasons for the forced removal or loss of self replantovanyh teeth are often
gradual resorption of roots, at least - incorrect technique immediate
replantation of acute and chronic inflammatory diseases of the genital periodontium
and jaw bones.
Thus,
contributes to tooth replantation as chronic and acute odontohennph processes
in periodontal and surrounding tissues, if you follow the technique of this
operation.
It
should be noted that in recent years some authors have often used such methods
and treatment of chronic leriodontytiv as transplantation of teeth from the
corpse, hemisektsiya ^ removal of one of the roots and the preservation of the
other to be used as a support dental bridges) and koronaroradykulyarna separation.
Hemisektsiya
Indications
for this surgery: the presence of deep bone pockets in the area of one of the roots of the premolars or molars, fracture of one of the roots
of the tooth mizhko-radicands granuloma pulp chamber floor perforation in the
treatment of the tooth, resulting in thinning top interalveolar septum after
thinning of bone tissue near
one of its roots, and the inability of the resected root apex of the tooth.
By
contraindications include: significant defect bone tissues hole where a tooth
has no cosmetic or functional value, the increased presence of roots, acute
inflammation of the oral mucosa, impassable canals tooth root, the mobility of
his general condition, which does not allow the operation.
This
operation can be done in two ways - with detachment muco-oxide layer without
delamination. Next
fisurnym boron or separation disc cut the crown of the tooth and bifurcation
and remove the broken part of the tooth. It
should be remembered that complications may be the same as when removing a
tooth.
The
literature (VP Poltava, 1976, VP Pochyvalin, 1984, etc.). Indicate high
efficiency (90-100%) of these surgical interventions in patients with chronic
periodontitis.
During
koronaroradykulyarnoyu separation must be understood dissection tooth into two
parts (used in the treatment of periodontitis at the mandibular molars) in the area
of bifurcation followed carefully smoothing
overhanging edges, carrying plot curettage mizhkorenevoyi pathological pocket
and covering every segment of the root crown.
Displayed:
mizhkorenevoyi presence of granulomas small, perforated bottom tooth watering
top mizhkorenevoyi partitions.
Operation
is contraindicated in pathological processes in the field mizhkorenevoyi
partitions (liquidation of which can lead to exposure of more than 1/3 the
length of the root), fused roots, low-hosted bifurcation mobility
5uba,
pathological bone deep pockets, an inflammatory condition, sho does not allow
the operation. Where
not Realize-gi or that surgery, surgeon WMD-tions do surgery tooth extraction.
Operation is contraindicated in pathological
processes in the field mizhkorenevoyi partitions (liquidation of which can lead
to exposure of more than 1/3 the length of the root), fused roots, low-hosted
bifurcation mobility
5uba,
pathological bone deep pockets, an inflammatory condition, sho does not allow
the operation. Where
not Realize-gi or that surgery, surgeon WMD-tions do surgery tooth extraction.
Accumulation
of experience in applying these methods in the future will tell how effective
they are (in the case of a positive long-term results).
Prevention
of acute and chronic apical and marginal periodontitis
Given
that periodontal infection is untreated or poorly sealed teeth causes
"occupation" approximately 30-50% bed vrho fund Maxillofacial
branches (CIS) patients with acute inflammation of the face and neck, and the
number of outpatient and hospitalized patients
tends to decrease (AG Shargorodsky et al., 1990), requires that prevention of
acute and inflammatory odontogenic periodontitis conducted in the following
areas:
1)
persistent state multifaceted prevention of dental caries;
2)
systematic, convincing that comes to people's minds, health and educational
work through the media about zhubnosti untimely treatment of teeth and gums
(the demonstration of television movies and featuring in newspapers fizionomiy
patients affected by acute abscess, osteomyelitis, cellulitis, mediastinitis ,
sepsis, thrombophlebitis, and others., experience shows that the
sanitary-educational work without such impressive demonstrations, usually does
not cause listeners or readers desire to quickly get rid of the "hole in
the tooth" or the rotten roots;
3)
providing low-income individuals free dental care;
4)
establishing strict systematic control over the quality of treatment and
sealing
canals,
especially multi (found that only 15.2% of their channels obturuyutsya on the
length), using all modern medication and physical means (laser, ultrasound,
iontophoresis, etc..) in the treatment of acute and sharp periodontitis;
5)
abolish the practice of conservative treatment of chronic periodontitis when
there are contraindications (such as distortion or permeability of root
canals), while managed tysya to surgical treatment method (APiK-volume,
hemisektsiya etc.);
6)
establish a rigorous outpatient Choco terihannya every conservatively treated
periodontytnym tooth within 12-24 months, and in the case of apparent lack of
normalization in the periapical area - remove the tooth (to avoid aggravation
periodontytuta developing more severe complications, including severe
osteoflehmony) or use a surgical technique treatment
of the tooth;
7)
in all public and private dental clinics provide patients with the necessary
tools and techniques painless treatment of caries, pulpitnyh and
periodon-tytnyh teeth to dental chair and drilling machine ceased to be
intimidating (since childhood) attributes of medical care;
8)
to improve the quality of treatment of chronic marginal periodontitis
періодонтитів.Профілактика and other surgical inflammation in zuboscheleppiy
system is to prevent disease steam DonNTU, including dental caries, gingivitis,
pulpitis, periodontitis, on the basis of total nozmitsnyuvalnoyi prevention of
all diseases in humans: a rational food,
a combination of work and rest, oral hygiene, prevention and hypokinesia
hypofunction of masticatory system is "coronary heart disease in the
maxillofacial area" (AA Skaher, 1985 NK Loginova, 1993, 1995).
Clinical migrating
subcutaneous granuloma.