The dissertation work is devoted to improving the quality of treatment of destructive forms of apical periodontitis by improving the drug treatment of root canals with the developed antibacterial compositions.
The results of the study showed that the incidence of chronic apical periodontitis in dental patients was 34.13 %, the most common of which was chronic apical periodontitis (CGP) (23.06 %).
The effectiveness of the use of the developed drug composition based on 2.5 % tetracycline was evaluated during a one-stage endodontic root canal treatment. X-ray morphometric results of the study showed that PAI levels 6, 12 and 24 months after treatment in patients from the IA subgroup were lower compared with patients of the IБ subgroup. In patients from the IA subgroup, the area of the periapical lesion 6 and 12 months after treatment (1.55 [1.16–1.68] mm and 0.99 [0.84–1.14] mm, respectively) was significantly smaller (p<0.001 and p=0.001, respectively) compared with patients from the IБ subgroup (2.16 [1.80–2.27] mm and 1.32 [1.17–1.42] mm, respectively).
Clinical and radiological evaluation of the effectiveness of the use of the developed drug composition based on 2 % chlorhexidine for endodontic treatment of root canals in two stages in patients with apical periodontitis was carried out. The results of determining the area of the periapical lesion revealed the presence of a significant difference (p<0.01) in the area of the periapical lesion 6 and 12 months after treatment between IIA (0.46±0.15 mm and 0.09±0.06 mm, respectively) and IIB (0.98±0.32 mm and 0.64±0.024 mm, respectively) subgroups, although at the beginning of treatment there was no significant difference (p=0.941) between the subgroups.
Evaluation of the effectiveness of the combined use of the developed drug compositions based on 2.5 % tetracycline and 2 % chlorhexidine for endodontic root canal treatment in two stages was carried out. According to the results of clinical and radiological studies, it was found that in subgroup IIБ, the level of the PAI decreased from 4.21±0.11 to 2.14±0.23 after 6 months, to 0.09±0.03 after 12 months and up to 0.02±0.01 after 24 months. The decrease in the PAI level in patients of II subgroup was 97.88 %. In the IIB subgroup (control), the level of RAI decreased from 4.24±0.14 to 0.59±0.28 after 12 months. There is a significant difference (p=0.021) in PAI levels between the subgroups 12 months after treatment. The results of determining the area of the periapical lesion revealed a significant difference (p<0.001) in the area of the periapical lesion 6 and 12 months after treatment. In the subgroup IIБ, the area of the periapical lesion decreased from 3.29±0.11 mm2 to 0.58±0.026 mm2 after 6 months and to 0.03±0.01 mm2 after 12 months. In the control group, the area of the periapical lesion decreased from 3.34±0.11 mm2 to 0.98±0.32 mm2 after 6 months and to 0.64±0.024 mm2 after 12 months. Long-term treatment results did not reveal a significant difference between the subgroups (p>0.05). Thus, the use of the developed drug compositions based on 2.5 % tetracycline and on the basis of 2 % chlorhexidine promotes a rapid reduction of destructive manifestations in the periapical area during the treatment of apical periodontitis.
Clinical and cytological research methods studied the effectiveness of the proposed drug compositions in relation to the microbial biofilm of root canals in patients with apical periodontitis. As a result of cytochemical analysis of the root canals material in patients with apical periodontitis, it was found that after treatment, the overall metabolic activity of the microbial biofilm significantly decreased and is almost absent. The obtained results of the cytochemical study indicate that the proposed complex of treatment with drug compositions based on 2.5 % tetracycline and 2 % chlorhexidine is a highly effective antibacterial agent against the microbial biofilm of root canals in patients with apical periodontitis.
Key words: chronic forms of apical periodontitis, chronic granulomatous periodontitis, endodontic treatment, area of periapical lesion, drug compositions, tetracycline, chlorhexidine, microbial biofilm.
