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 1. G. Lukomski distinguishes three forms of periodontitis:

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 20-30 mm in 1 h). Maximum resistance of erythrocytes increased and the minimum - remains the norm (0.36).

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 0,5-1 g 3-4 times a day), combining them with antibiotics. Simultaneously used analgesics-Amidopyrine, fenatsytyn, acetylsalicylic acid (in 0,25-0 ^ 5 g 3 times a day), combining these tools with caffeine (0.3 g) *. 2-3 days after cutting the boil to apply heat (blue light, sollux - 15 minutes every 2-3 hours), diadynamic (currents Bernard), UHF and others.

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 0.5-0.8 cm), conservative treatment leads to regression of granulomas with its epithelial elements.

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 (LA Cor-shunovoyu - in 80 patients; V. S. Vorobyov et al, - 284; A. Akhmedov - 86, VP-Chun Cove - 25, I. Engelmann - 202, VP Dana-hatch - 141; A. Trushnykovym - 305, AV Yarovykovoyu et al. - 141, EN Buch-man - 188; A. Afanasyev - 476, etc.).

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.