Have lead a clinic-laboratory estimation of a new way
purification of roots spaces of a teeth at endodontic treatment chronic
apical periodontitis with the help of nanoparticles copper-calcium
hydroxide (CCH) galvanophoresis. In research with participation of 60
patients by a double-blind method have estimated quantitative dynamics
and structure allocated of root channels of a single-root teeth of a
liquid within 2 weeks with use of three different galvanic couple. Have
compared efficiency of decontamination root channels at the standard
report irrigation and CCH galvanophoresis. It is revealed that intensity
of allocation of a liquid from root channels at CCH galvanophoresis is
gradually increased to 4 - to 5 days, and then reduced to 10 - to 12
days. At an allocated liquid there are proteins and carbohydrates,
characteristic pulps for the rests and a biofilm. CCH galvanophoresis
suppresses aerobic and anaerobic micro-flora, then irrigation more
effectively: on the average on 22,0 % for 6 day and on 65,5 % for 12
days. Modern endodontics the new paradigm representing a root of a tooth
as porous biological structure that will allow to increase quality of
treatment due to use nanotechnologys is necessary.
Keywords: Apical periodontitis; Nanotechnology; Treatment of the root channel; Endodontic irrigation
Individual distinctions of anatomy of root channels
of a teeth, variability of their number, the form and degree of
passableness remain the reason of low efficiency endodontic treatments
[1-3]. However, besides this problem there is also another – presence in
dentine a root of the big number of dentine tubules. On 1 mm2
pathogenic or conditionally pathogenic microflora (biofilm) is
necessary the area of a wall of the root channel up to 80 000 apertures
such tubules with diameter near 800 nm, in which persist. This biofilm,
remote for irrigants, results not only in formation of the chronic
center odontogenic infections, but also to demineralization of a root
dentine [4, 5]. For today there is up to the end unsolved a question
about effective purification systems of root channels of a teeth and
dentine tubules a root from the albuminous rests of a pulp, components
of a biofilm and products of its ability to live. Be-sides action
antiseptic irrigants is limited on time and a degree of their
penetration in dentine tubules [6,7].
Modern ways of purification of endodontic spaces,
such as use irrigant by sodium hypochlorite and other antiseptics,
photo-dynamic inactivation microflorae, influence by ultrasound or cold
plasma, time obturation antiseptic materials, do not allow to clear on
100 % porous of dentine structure a root of the albuminous rests and
microflora [8,9]. For treatment apical periodontitis of a teeth with
difficultly passable root channels professor A. Knappwost (Germany,
1998) was offered a method "depotphoresis" a complex ionic preparation –
copper-calcium hydroxide (CCH) [10,11]. Its updating is galvanophoresis
at which instead of the electric device use galvanic pairs (galvanic
pins) [12]. Particles CCH having the size 50 - 100 nm, under action of a
galvanic current easily will penetrate into spaces of a root of a
tooth, switching and dentine tubules. Due to the chemical properties,
they promote disintegra-tion and destruction of biofilm extracellular
matrix, chitinous environments microbic dispute, lysed the rests of
cel-lular and fiber elements of a pulp. Being late in dentine tubules on
long term, they actively destroy bacterial toxins, occlusive themselves
narrow dentine tubules.
Galvanic pins in depth of the root channel of a tooth
with CCH paste become a source of a galvanic current with potential
near 0,5 V in and size near 0,1 mA. Such current allows slowly, but in
regular intervals and to big enough depth to deliver CCH nanoparticles
in dentine tubules and also to cover them walls macro channel,
additional channels and sleeves apical deltas. Procedure is painless,
and during its reali-zation the tooth continues is high-grade to
function. Being engaged on an extent more than 15 years studying of a
method CCH galvanophoresis, we count, that its opportunities undervalued
modern by endodontics. In particular, clinical supervision has shown,
that in the begin-ning of realization of galvanophoresis procedures
occurs active purification systems of the root channels, accompa-nying
deproteinization and decontamination a root spaces of a tooth. The
purpose of research: a clinic-laboratory estimation and a substantiation
of a method purification a root spaces dentine of a tooth at endodontic
treatment of apical periodontitis with the help by copper-calcium
hy-droxide galvanophoresis.
According to the purpose of research, have formulated
the following tasks: (1) - at chronic apical periodonti-tis to study
dynamics of allocation of a liquid from root channels of a teeth at
realization in them CCH galvanophore-sis, and also its qualitative
structure; (2) - to compare this dynamics at realization CCH
galvanophoresis to applica-tion of three different galvanic pairs,
distinguished in the size of potential of a galvanic current; (3) - to
compare in-fluence of procedures CCH galvanophoresis and the standard
report irrigation on microflora of root channels to the help of a
microbiological method and electronic microscopy.
Research have lead a double blind method with
participation of specially picked up patients – volunteers for which
clinically and radiologically was diagnosed chronic fibrous apical
periodontitis of a single-root teeth with kept crowns (52 cutters, 8
canines). On intraoral roentgenograms observed only expansion
periodontal cracks or resorp-tion of a cortical plate. For reception of
the most representative data in research with destructive forms of a
periodon-titis or patients did not participate in a stage of its
aggravation. Among patients appeared 24 men and 36 women in the age of
from 22 till 56 years.
In total – 60 person which have any way united in 4
groups (on 15 people in every-one). After identical in all cases of tool
processing of root channels with the help of rotating nickel-titanic
tools ap-plied various ways cleansing systems of root channels. Ways
were coded in a computer and are unknown to the head of research down to
an analysis stage of the received data. In I group of patients applied
the standard report irrigaton root channels with use of solutions sodium
hypochlorite - 5,25 %, EDTA - 17 %, chlorhexidine bigluconate - 0,2 %, a
citric acid - 50 %, distilled water and ultrasonic activation. After
that root channels sealed up, that is used one-session a method of
treatment. In other groups applied a new way cleansing root channel with
the help CCH galvano-phoresis [12]. It consists of that root channels
unitary washed out 17 % solution EDTA and distilled water.
Then in them on 2/3 filled CCH paste and entered a
galvanic element representing a galvanic pair (Figure 1). Intra radix
part of an element as a needle (a bimetallic pin) consist of an alloy
copper, and extra radix (head) – from other metal. In II group of
patients for extra radix parts used chemically pure zinc, in III group –
an alloy of aluminium and in IV – an alloy of magnesium. Real potential
of elements determined with the help by voltmeter directly in a tooth
after their introduc-tion in root channels. In wellhead a part of the
channel placed identical on the sizes of foam balls for the subsequent
gathering allocated in result electric osmosis from the root channel of a
liquid. A cavity closed by time light-curing material so that to
provide contact of the head of a galvanic element to an oral liquid. In
quality CCH applied a prepa-ration "Cupral" firms «Humanchemie GmbH»
(Germany). Patients II - IV groups daily visited the doctor during 2
weeks except for revival. Each day at them deleted a time seal and foam
balls. Last placed about a sterile plastic glass and carefully washed
out its distilled water. A glass with a washing liquid dried up on air
at 200 C. Remaining dry rest weighed on analytical weights, and also
subjected to the spectrometer analysis. Into a cavity of a tooth entered
a new foam ball and closed a time seal before the follow-ing visiting.
All research in these three groups last 12 day
(excepting revivals) and began on Mondays. On Wednesday of 1 week,
Monday and environment (Wednesday) of 2 weeks in root channels changed
CCH paste for a new portion and entered a new galvanic element. On
Saturdays of 1 both 2 weeks a galvanic element and CCH paste from
channels took and took tests of contents of the channel for
microbiological research. On Sunday between two weeks a galvanic element
took from the root channel and in it left only CCH paste. At 3 patients
under indications a tooth for realization of further their research
having chopped off on were removed an electronic microscope. At the
patient who was not including in one of groups, – without realization of
any procedures root channels cleansing. At two others – right after
realizations of those procedures: in II group – after the report
irrigation (1 tooth) and in III group – after realization CCH
galvanophoresis for 6 day (1 tooth). All pa-tients were warned about
necessity of removal of these teeth and gave the consent to
participation in research.
Spectra of absorption by the dry rest of the liquid
allocated from root channels, measured a method of the broken full
internal reflection. The analyzed area of wave numbers made from 400 up
to 4000 sM- 1. A spectrum of absorption of air containing carbonic gas
and pairs of water, automatically subtracted from a spectrum of a
sample. Infra-red spectra of absorption registered on an infra-red
spectrometer «Nicolet iS10» («Thermo SCIENTIFIC») with automatic record
of a spectrum in the field of 400-4000 sM- 1 at speed of 64 sM- 1/ min.
Processing of spectra spent in the computer program "OMNIC-2". For
microbiological research a fence of a material spent the sterile paper
pins impregnated with a physiolog-ical solution. A pin placed for 10
seconds in the root channel, and then – in the transport environment for
delivery in laboratory. Colonies of microorganisms raised in Petry cups
during 2 day in thermostat at temperature 36,70 C: aero-bic cultures –
on Endo environments, Saburo, Columbia, М118 and the Streptococcal
environment. Anaerobic – in bifidus environments and Schaedler. Colonies
identified up to a sort and counted up. For research of the removed
teeth with the help of an electronic microscope their roots split along
root channels. Chipped carefully ground. Research spent in a tunnel
electronic microscope «Tecnai G2 20F U-TWIN STEM» at accelerating
voltage 20 kV. The received data having normal distribution, processed
by variation statistical method with application of criterion “t”.
Research is approved by ethical committee of the Tver medical
university. All surveyed gave the written informed consent to
participation in research.
The potential of the used galvanic elements differed
(Table 1). In the least potential the galvanic pair «copper - zinc», and
the greatest - «copper - magnesium» had. Distinction between
theoretical and real values of potential speaks electroresistance of
fabrics of a tooth (2 - 10 ohms) and presence CCH at root channels. In
clinic under influence CCH galvanophoresis, since the first day, we
observed active allocation in a cavity of a tooth gel with a yellow
shade (Figure 2). After drying a liquid received dense vitreous weight
which subjected to the analysis. In the first day’s process of cleansing
most actively went in those teeth where used galvanic couples «copper -
magnesium» with a maximum of this activity for 4 day (Figure 3). Hardly
less active it was in a tooth where for CCH galvanophoresis applied
galvanic pairs «copper - aluminium» with a maximum on 5 days. And
practically weight of the dry rest of a liquid down to 5 day in direct
ratio accrued at application galvanic pairs «copper - zinc». After the
expiration 4 - 5 day weight of the dry rest was slowly reduced at
application of all galvanic pairs: about 12 day in a teeth with elements
«copper - zinc», about 11 day - «copper - aluminium» and about 10 day
at application galvanic pairs «copper - magnesium».
The analysis of an infra-red spectrum of the dry rest
of a liquid, liberated from root channels of a teeth, has shown
presence in an analyzed sample of an organic component (Figure 4).
Maxima testified to it in zones of the spec-trum, the appropriate 2917
and 2852 sM- 1 (symmetric and asymmetric fluctuations methylene groups).
It is con-firmed also with a strip at 1397 sM- 1, appropriate to
deformation fluctuations of СН-groups. Besides appeared, that the
researched material contains in the structure also a carbohydrate
component. It is known that presence of a plenty hydroxyl groups in
structure of carbohydrates results information of system of hydrogen
connections specific to everyone connection. On an infra-red spectrum
wide and intensive enough strip testified to it in the field of wave
numbers 3500 - 3200 sM- 1. In a spectrum of absorption weaker strips of
absorption are visible in 1747 and 1651 sM- 1, characteristic for valent
fluctuations carbonyl groups S=O which alongside with OH-groups are
present at carbohydrates more often. In a spectrum of absorption of
862,9 sM- 1 were determined the strips appropriate to sulphidic groups,
present in polysaccharides. Besides there were strips of absorption in
the field of 1000-1100 sM- 1 caused by fluctuations of a skele-ton of a
molecule (pyranose rings).
Thus, the liquid, liberated from root channels of a
teeth, besides albuminous components contain also the rests
extracellular polysaccharides, being an obligatory component of a
biofilm. We believe, that at CCH galvanophoresis from the root channel
of a tooth the albuminous rests of microflora, and also fabrics of a
pulp and contents den-tine tubules are actively allocated. It is marked,
that the proportion of a carbohydrate component in the dry rest was
gradually reduced with increase of duration galvanophoresis, that,
apparently, corresponded decontamination systems of the root channel of a
tooth. The kept albuminous component specified longer process of
deproteinization. This conclusion also is confirmed with results of
electron-microscopic research. Without procedures cleansing on walls of
root channels found out the numerous colonies of microorganisms closing
apertures of dentine tubules (Figure 5a, 5В). The ambassador irrigation
on walls of the root channel of microbe colonies became less and on
electron diffraction apertures of dentine tubules (Figure 5c) were
precisely visible. After 6 day of galvanophoresis apertures of dentine
tubules visualized under an electronic microscope for the account
contouring their walls CCH particles (Figure 5d). Besides sites inter
tubules dentine, in part CCH impregnated were revealed. Apparently, it
is sites which electroresistance is reduced due to microbe
demineralization.
The microbiological analysis of contents of root
channels of a teeth (Table 2) has shown, that in them up to cleansing
prevails anaerobic microflora. The average of anaerobes colonies
exceeded those among aerobes on 18,5 % (р<0,05, t=2,7). From aerobic
forms it is most of all revealed Enterococci, on the average on 25,0 %
it is less - than Streptococci and on 39,3 % - Peptokokki. The
ambassador irrigation root channels of a teeth the reduction of number
of anaerobes colonies has made on the average 52,5 %, and aerobic
microorganisms – 58,3 % (р<0,05). At the same time at realization CCH
galvanophoresis during 6 and 12 day these numbers, accordingly, have
made 68,5 % and 66,7 % (р<0,05). And reduction of number of colonies
of aerobic forms has made 93,2 % and 90,2 %, accordingly (р<0,05).
That is, appeared, that pro-cedure of CCH galvanophoresis is more
effective irrigation on the average on 22,0 % at duration of 6 day and
on 65,5 % at duration of 12 days thus for 12 days with the help CCH
galvanophoresis was inactivated on the average about 92 % of microflora
of root channels system.
The carried-out research confirms the known data that
under influence CCH galvanophoresis occurs lysis fossils of a pulp and a
microbe biofilm in spaces of root of a tooth. Under influence of
powerful process electro osmosis of proteolysatis it is allocated from
macro channel in a cavity of a tooth that is it is carried out
deproteinization and decontamination not only systems of root channels,
but also dentine tubules. The algorithm of CCH galvanophoresis includes
double replacement in root channel CCH and a galvanic element during 10 -
12 days. The investigated way of cleansing root channels spaces of a
teeth when it terms of treatment allow, can be effective alternative to
known reports irrigation at endodontic treatment of apical
periodontitis. Besides the spent research shows, that modern endodontic
for qualitative treatment of a teeth the new paradigm representing a
root of a tooth as porous biological structure is necessary. Such
approach assumes development of essentially new technologies of
cleansing all spaces of a root with the help by nanotechnology and
mechanisms of delivery medical products nanoparticles in the remote
sites of spaces root dentine.
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