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The initial stages of the application of “Trapeks-gel” on delayed treatment of destructive forms of periodontitis

The initial stages of the application of “Trapeks-gel” on delayed treatment of destructive forms of periodontitis

E.V.Volodina, Department of Faculty Therapeutical Stomatology MSUMD

Treatment of patients with chronic periodontitis is a complex and important task in modern dentistry. Frequency of periodontal disease at children and adults is not currently have a tendency to decrease. On average, one person has three endodontic teeth [5].

The causes of periodontitis are different, but infectious agents have the major role: traumatic and chemical effects on periodontal [2, 4). The completed root canal treatment is often mistaken for success, while even at technically perfect root canal, a pathological lesion in periapikal tissues persists for a long time, creating a risk of recurrence and complications [1,3].

The inflammation in destructive forms of periodontal disease contributes to the constant antigenic stimulation, which is largely determined by the conservation of detritus in the hearth of the damaged tissue formed in the alteration phase of the inflammatory process. All long flowing inflammatory processes contribute to the overall reduction of immunological reactivity and nonspecific resistance of the body, which increases the risk of inflammatory complications [6, 7).

The main object of the impact in the treatment of chronic apical periodontitis by conservative method is infected root canal with its many ramifications, dentinal tubules, and periodontal tissue in a state of acute or chronic inflammation.

As numerous studies show mechanically it is impossible to clear completely all the internal surfaces of the root canal, efficiently it is handled 70% of the root canal walls passable. Therefore antimicrobials for intracanal application deserve the attention. They must have a high anti-microbial and anti-inflammatory, non-irritating and sensitizing effects, activate the reparative processes in  periapical tissues. However, even a single drug thorough root canal treatment does not guarantee against recurrence. The main disadvantage of antiseptic treatment is the lack of exposure for the complete elimination of pathogens. The optimal thing is an occlusion of the channel and the removal of material at the tip of the tooth root, combining features of suppressing the inflammatory process in the channel and in the periodontal tissues, eliminates pathogens and damaged tissue structures, and stimulates regeneration of newly complete periodontal tissues.

In our work we studied the efficiency of treatment of destructive forms of apical periodontitis using the technology of the delayed filling of the root canal by the Russian drug "Trapeks", R&P Org. POLYSTOM, which has the properties listed above, due to the combination in the structure of substances with anti-inflammatory properties, suppressing oxidative stress and depositing growth factors.
Our study provides data analysis of the results of examination and treatment of 12 patients with chronic destructive forms of periodontitis. The study excluded patients with accompanying medical conditions that lead to a change in the immune status.
Patients were carried out according to traditional methods, adopted in clinical dentistry. Endodontical and pharmacological treatment was carried out according to standard principles. To improve the efficiency of decontamination of the root canal and periodontal tissues technology of deferred root canal filling with breeding of "Trapeks" in the hearth of destruction was used. The length of temporary obturation was 14 - 30 days, followed by a final sealing of the channels.
Clinical efficacy of treatment of chronic periodontitis defined as the percentage of achieved remission. The evaluation was conducted during the second visit in six months. The criterion for the efficiency of the proposed scheme of therapy was the incidence of clinical remission, confirmed by radiographic images.
Analyzing the results of the next treatment of various forms of chronic destructive periodontitis we came to the following conclusions:
- The results of treatment should be regarded as satisfactory;
- Application for a temporary obstruction of channels of "Trapeks" can improve the results of treatment.

 

References
1. Garagea N.N., Beloy A.V., Volkov E.A. and other. Clinical and radiological assessment of the immediate filling of root canals with modern endodontic filling materials in the treatment of chronic periodontitis / / In Sat: Act. Questions endodontics. Proceedings CSRIS. - M. ​​- 1990.-P.21-24.
2. Maksimovskiy Y.M., Maksimovskaya L.N., Orekhova L.J. Preventive dentistry / / tutorial. - M: Medicine. 2002. - 640.

  1. Maksimovskiy Y.M. How to measure the success or failure of the planned endodontic treatment.// Clinical Dentistry. -1997. - № 3. - P.4-7.
  2. Nikolaev A.I., Tsepov L.M. Practical preventive dentistry. - St. Petersburg: St. Petersburg Institute of Dentistry. 2001.-309 p..
  3. Petrikas A.J., Zakharova E.L., Obraztsova Y.N. Epidemiological data on the study of endodontic lesions of teeth / / Endodontics today. - 2002.-T2. - № 3-4.-35-37.

6.    Naidorf I.J. Endodontic flareups:    bacteriological    and immunological mechanisms. J. Endod. 11:462. 1985.

7.    Schonfeld S.E., Greening A., Click D., Herles M. Endotoxic activity in periapical lesions. 53:82, 1982.

Применение ТрАпекс геля

The 1st visit, destruction of bone tissue in the top with clear contours 1.5

ТраАпекс гель

The 2nd visit, reducing the degradation of bone tissue, 28 days after temporary sealing by “Trapeks”

Применение ТрАпекс геля

The 3rd visit, half a year after the sealing

Trapex-gel

Trapex-gel

Description and main properties. The paste (gel) of white or slightly yellowish colour, is a composition of HYDROXYAPOL (hydroxyapatite, tribasic calcium phosphate), barium sulfate and anti-inflammatory preparations with organic ingredients (ТS 9391-008-77330104-2009).

The main components of TrApex-gel are:

  1. Dexamethazone
  2. Composition of calcium orthophosphates – hydroxyapatite (HA) and β-tricalcium phosphate (TCP) with particles size from 10 to 50 nanometers.
  3. Radiographic contrast medium

 

Clinical effect of the material is determined by the combined effect of these components. Dexamethasone: a) suppresses the abnormal proliferation of granulation tissue in the hearth of destruction, b) promotes resorption of the surrounding bone tissue pathological focus with the release of her local growth factors, and c) promotes the differentiation of fibroblast-like cells (FLC) in the granulation tissue in the hearth osteogenic direction. HA and TCP fix vacated growth factors and provide attraction of undifferentiated in the center, their proliferation and osteogenic differentiation. The composition inhibits the formation of free radicals, suppressing by this the effects of oxidative stress in the hearth.

This pharmacodynamic eventually inhibits destructive inflammatory processes and stimulates osteogenesis

 

instructions for use

TrApex

 

INDOST-gel

INDOST-gel

Description.A fine gel of white or almost white colour packed in disposable syringes with a capacity of 1 ml (ТS 9391-008-77330104-2009).

Properties. The product is a composition of an inorganic hydroxyapatite  and other organic materials. It features the human tissues biocompatibility and does not cause the rejection reaction. It belongs to low toxic substances and does not cause the delayed adverse effects.

Contains composition of the growth factors.

Indications for use. It is indicated for use in patients with reduced regenerative function. The material is used in the recovery of small bone defects of various origins in the maxillofacial region through their completion, with the combined use of various osteoplastic materials, as well as the surgical and therapeutic treatment of periodontitis of moderate and moderately severe. It can be combined with other osteoplastic materials.

 

instructions for use

Indost gel

INDOST 2 plates

INDOST 2 plates

Description. Strips of the sizes 20x8x1,8+0,5 mm, of the weight 0.15+0.05 g, of white or close to white colour (TS 9391-005-77330104-2006).

Properties. The product is a composition of organic and inorganic components of osseous tissues. Contains composition of the growth factors. It is defined as human tissues biocompatible and does not cause any rejection reaction. INDOST 2 plates intensify osteogenesis (bone formation) and restores periodontal tissues. It belongs to low toxic substances and does not cause the delayed adverse effects (inflammatory and allergic reactions), has no mutagenic and immunomodulatory effects.

Indications for use. The material is used in surgical treatment of periodontal disease  of moderate and severe stages by implanting INDOST 2 plates in bone pocket. As a rule, surgical treatment of periodontal disease is combined with the prosthetic one.

 

 

INDOST plates

INDOST plates

Description. Strips of the sizes 20х8×1.2±0,5 mm, of the weight 0.15+0.05 g, of white or close to white colour (TS 9391-005-77330104-2006). The product is a composition of organic and inorganic components of osseous tissues and collagen. Contains composition of the growth factors.

Properties. The material is defined as human tissues biocompatible and does not cause any rejection reaction. It intensifies osteogenesis (bone formation) and stimulates a wound-healing process in soft and osseous tissues. It belongs to low toxic substances and does not cause the delayed adverse effects (inflammatory and allergic reactions), has no mutagenic and immunomodulatory effects, does not influence pregnancy course and child delivery.

Indications for use. The material is used in therapy and surgical treatment of parodontosis of an average and average-serious degree by implanting INDOST plates in osseous pocket, and also at various diseases in maxillofacial area.

instructions for use

Indost plates

PARODONKOL

PARODONKOL

Description. Bylayer plates of the sizes 30×25х0.2 mm, of the weight approximately 0.20 g or different forms of the same thickness (ТS 9391-009-77330104-2010). Contains an active surface (of white colour with rough surface). It consists of modified collagen and sprayed HYDROXYAPOL (powder). Manufacturing of other sizes and forms is possible.

Properties. By preventing the migration of epithelial tissue in the bone wound PARODONCOL intensifies the bone formation (osteogenesis) and stimulates a wound-healing in osseous and periodontal tissues It is completely resorbable.

Indications for use. The material is used in surgical treatment of periodontal disease and parodontosis of moderate and severe stages and also in cases of different bone grafting operations in maxillofacial region: cystectomy, sinus-lift, root recession.

instructions for use

Parodonkol 30x25x0.2

KOLAPOL KP-2

KOLAPOL KP-2

Description. Strips of the sizes 20х8×1.5 mm, of the weight 0.15+0.05 g, of white or close to white colour (TS 9391-003-77330104-2011). The product is a composition of organic and inorganic components of osseous tissues (HA + TCP + collagen). It is defined as human tissues biocompatible and does not cause any rejection reaction.

Properties. KOLAPOL KP-2 intensifies osteogenesis (bone formation) and restores periodontal tissues. It belongs to low toxic substances and does not cause the delayed adverse effects (inflammatory and allergic reactions), has no mutagenic and immunomodulatory effects.

Indications for use. The material is used in surgical treatment of periodontal disease (flap surgery) of moderate and severe stages by implanting KOLAPOL KP-2 in bone pocket. As a rule, surgical treatment of periodontal disease is combined with the prosthetic one.

 

Manufactured forms

 

 

KOLAPOL KP-2
10 fragments 20х1.5mm
KOLAPOL KP-2 №4
4 fragments 20х1.5mm

instructions for use

Kolapol KP2

GAPKOL

GAPKOL

Description. Strips of the sizes 20х8×1 mm, of the weight 0.15+0.05 g, of white or close to white colour (TS 9391-003-77330104-2011).

Properties. The product is a composition of organic and inorganic components of hard  tissues matrix (HA + TCP + collagen). It is defined as human tissues biocompatible and does not cause any rejection reaction. GAPCOL intensifies the bone formation and stimulates a wound-healing process in soft and osseous tissues.

It belongs to non-toxic substances and does not cause the delayed adverse effects (inflammatory and allergic reactions), has no mutagenic and immunomodulatory effects, does not influence pregnancy course and child delivery.

Indications for use. The material is used in therapy and surgical treatment of periodontal disease and parodontosis of moderate and severe stages by implanting GAPCOL in bone pocket, and also in cases of various diseases in maxillofacial region.

instructions for use

Gapkol

INDOST granules

INDOST granules

Description. INDOST granules of round or irregular shaped form of white or close to white colour (ТS 9391-006-77330104-2006). Composition – 30-50% of hydroxyapatite and 50-70% of tricalcium phosphate + composition of noncollagen proteins of the bone tissue.

The material is produced in granular form of the sizes 0,25, 0,5, 1,0 и 2 mm. The product is available in 0,5g and 1 g sterile packing.

Properties. INDOST (granules) is basis of inorganic hard tissues matrix. It has better human tissues biocompatibility and does not cause rejection reaction. It has osteoinductive effect. It intensifies osteogenesis. After the bone cavity filling the material resorbs being substituted by osseous tissue.

Indications for use. The material is recommended for filling of small bone defects of different etiology after surgical treatment in cases of cystectomy, resection and extraction of teeth, for prevention of alveolar process atrophy, etc.

 

 

Instructions for use INDOST granules

Indost granules

INDOST sponge

INDOST sponge

Description. Fragments (patches) of the sizes 20x8x7+1,5 mm, of the weight 0.15±0,05 g, of white or close to white colour with specific odour (ТS 9391-005-77330104-2006). It may be manufactured in the form of plates and strips of different sizes and thickness on consumers’ demand.

Properties. The product is a composition of organic and inorganic components of hard  tissues matrix.. It is defined as human tissues biocompatible and does not cause any rejection reaction. INDOST sponges inforces ostegenesis and stimulates healing of wounds in osseous tissues.

It belongs to non-toxic substances and does not cause the delayed adverse effects (inflammatory and allergic reactions), has no mutagenic and immunomodulatory effects, does not influence pregnancy course and child delivery.

Indications for use. The material is used in surgical, orthopedic and dental practice for infill of bone cavities emerged after resection of cysts and pseudotumors, sequestrectomy, in earlier operated patients with chronic osteomyelitis (including those with complicated pathological fracture). When treating cavities of big size (> 5 cm3) it can be used together with HYDROXYAPOL (in powder or granular form) or INDOST granules.

 

Manufactured forms

INDOST sponge
10 fragments 20х8х8 mm
INDOST sponge № 4
4 fragments 10х8х8 mm

 

INSTRUCTIONS FOR USE INDOST sponge

 

Indost sponges