Antiseptics for treating carious cavities. Basic principles of caries treatment for class I carious cavities according to Black. In detail about the stages of treatment of average caries -

Drug treatment is one of the most important stages in preparing a cavity for filling.Basic goalsdrug treatment : - cleaning the cavity fromoral fluid, dentine filings and other contaminants;- bactericidal and bacteriostatic effects on the microflora located in the cavity and parietal dentin;- drying the cavity.For a long time, solutions of aggressive antiseptics, for example, phenol, were used for the medicinal treatment of carious cavities.In our country, in the “pre-composite era”, they used medicinal treatment of prepared cavities before filling.96% alcohol, 3% hydrogen peroxide solution, and the cavity was dried with medical ether. To avoid irritating the pulp, deep cavities were washed with warm solutions (30-35°) of weak antiseptics:1% chloramine solution, 1% hydrogen peroxide, 0.1% furatsilin solution. It was recommended to dry deep cavities with warm air.

With the advent of composite materials, approaches todrug treatment cavities have changed. It is not recommended to use alcohols and ethers for treating cavities due to their high toxicity and low drying ability (Petrikas A.Zh., 1997). In addition, concerns have been expressed that alcohols and ethers can reduce the adhesion of composites, and alcohol destroys the polymer matrix of composites (Borisenko A.V., Nespryadko V.P., 2001). Currently, when filling with composites for the purpose of medicinal treatment, it is recommended to use irrigation of the cavity with warm antiseptics of low concentrations from a syringe. For these purposes, use a 3-5% sodium hypochlorite solution,3% hydrogen peroxide solution, 0.06-0.1% solution of chlorhexidine, 0.02% solution of furatsilin, etc. etc. The cavity is dried using a stream of air from a “gun” or a sterile cotton ball.It should be recognized that treatment in this way, firstly, is not effective enough, and secondly, it is technologically complex, especially since some of the listed drugs have a very unpleasant taste and odor (for example, sodium hypochlorite) and require immediate removal from the mouth ( it is necessary to use a rubber dam and a “vacuum cleaner”). In addition, concerns are currently being expressed about the use of agents that release atomic oxygen or chlorine (hydrogen peroxide, sodium hypochlorite) for medicinal treatment of the cavity. It is believed that these gases can penetrate into the parietal dentin and inhibit the polymerization process of the composite adhesive system, disrupting the properties of the “hybrid layer”.Some experts, in addition to the drugs listed, recommend using products that dissolve the smear layer, for example, citric acid, EDTA, etc. We consider special holding of this stage inappropriate. This is due to the fact that different materials have different mechanisms of connection with tooth tissue, and in some cases, removing the “smear layer” will bring harm rather than benefit. If the filling material forms a bond with the dentin of the tooth due to the removal or transformation of the “smear layer”, then the set of this material includes special preparations for these purposes and their use is provided for in the instructions.Many dentists limit themselves to rinsing the cavity with water from a “gun” and drying it with air. After this, they begin the filling process, hoping that etching the walls of the cavity with phosphoric or maleic acid will have a bactericidal effect. In addition, there is evidence that in dentin sealed with an adhesive system and (or) filling material, the active activity of microflora ceases. This approach is acceptable, but it does not exclude the risk of developing inflammatory complications from the pulp associated with the invasion of microorganisms from the infected dentin adjacent to the cavity.We consider it appropriate to use the following method of antiseptic treatment of the cavity before filling:1. Abundant rinsing of the cavity with water, water-air spray and drying from the “gun” of the dental unit. It is desirable that the “gun” should not be supplied with tap water, but should have an autonomous supply of distilled water from a special container.

Rice. 184 . Preparation based on 2% chlorhexidine solution “Consepsis”, Ultradent:

A - IndiSpense syringe (30 ml);

B - 1.2 ml syringes with cannulas for direct application of the drug into the cavity.

2. Medical treatment of carious cavity 2% aqueous solution of chlorhexidine. For these purposes, you can use a solution purchased at a pharmacy, however, it is most convenient, in our opinion, to use the drug “Consepsis” (Ultradent) for these purposes (Fig. 184). It is a 2% solution of chlorhexidine bigluco-note, containing mild flavoring additives and having a pH of 6.0. Another version of this drug - "Consepsis V" - has a thicker consistency. These drugs are produced in syringes complete with disposable cannula brushes “Black Mini Brush” or “Dento-Infusor” (see Fig. 185).“Consepsis” is applied to the walls and bottom of the cavity with a cannula brush for 30-60 seconds. They can also treat the surrounding tooth tissue and adjacent gums. As necessary, the drug is gradually squeezed out of the syringe.3. The drug is carefully inflated and dried with air. It is not recommended to wash it off.

A b

Rice. 185 . Cannulas-brushes Black Mini Brush (a) and Dento-lnfusor (b), Ultradent.

4. After this, the enamel and dentin are etched, the adhesive system is applied and the cavity is filled in accordance with the instructions for the filling material.Effective use of the adhesive system and qualified, technologically correct filling ensure long-term sealing of the dentin surface and impermeability at the filling/tooth tissue interface. This prevents reinfection of dentin, the development of recurrent caries and complications from the dental pulp.When filling with composites, it is also possible to first etch the cavity, then disinfect it with Consepsis, and then apply adhesive. In this case, the drug is introduced into an already etched cavity, gently inflated with air and not washed off. Studies have found no difference in adhesion strength when using Consepsis before and after etching. This strength does not depend on whether the drug was washed off with subsequent drying of the cavity, or whether it was dried without rinsing off with water (data from the Ultradent company).Another way to disinfect dentin in the area of ​​the bottom of a carious cavity is to apply a therapeutic pad based on a suspension of calcium hydroxide to the bottom of the cavity for several days under a bandage. Of course, it should be recognized that this method is quite time-consuming and labor-intensive, but its use is quite justified in some complex clinical situations.The bactericidal effect on parietal dentin before filling with composites can be enhanced by using etching gels containing bactericidal components. An example of such a drug is a gel based on 35% orthophosphoric acid “Ultra-Etch AB”, Ultradent, containing the antibacterial drug acetylpyridine chloride.As evidenced by literature data, drug treatment of the cavity before filling with composite materials can reduce the number of pathogenic bacteria in the parietal dentin, reduce the risk of “postoperative” sensitivity and inflammatory complications from the dental pulp.

As you know, the most common materials for filling teeth are light-curing composites. Taking this fact into account, let’s consider the technology for installing a photocomposite filling.

The method of filling a tooth directly depends on the volume and depth of the carious process. Based on the depth of the carious cavity, caries is classified as: superficial, medium and deep. With superficial caries, the carious defect is located within the enamel. In moderate cases, the enamel is affected and the dentin is affected. With deep caries, the enamel is damaged and a significant layer of dentin is destroyed by caries.

Superficial caries

Average caries

Deep caries

After the carious cavity is prepared for filling, the tooth must be isolated from saliva. Failure to comply with this requirement can lead to wetting of the prepared cavity with saliva and, as a result, cause a violation of the tightness of the filling to the tooth. This leads to caries at the border of the filling and the tooth, and can also cause “fallout”.

To isolate teeth from saliva, cotton swabs are used, or a more reliable method is isolation using a rubber dam. A rubber dam (or rubber dam) is a thin sheet of latex rubber. Using a special technique, the rubber dam sheet is placed on the tooth, creating a dry working field. Saliva is removed from the mouth using a saliva ejector.

Figure 1: Rubber dam sheet.

Fig. 2: Clasps - metal clips for fixing the rubber dam to the tooth.

Figure 3: Tooth isolated with rubber dam.

Then acid etching of the prepared cavity is carried out using 37% phosphoric acid. This is done in order to remove the so-called “smear layer” and increase the contact area between the surface of the tooth cavity and the filling. During etching, the acid dissolves the inorganic components of the tooth tissue, creating a rough surface. After 20–60 seconds, the acid is washed off with water and the tooth is dried with air.

The next step is to introduce the so-called “bond” into the cavity - its function is to create an “adhesive” layer for reliable “adhesion” of the filling to the tooth tissue.

Applying bond to the walls of the prepared cavity

After bonding, the walls of the cavity are covered with a special special flowable composite. Thanks to its fluidity, it penetrates into all microcavities, creating a thin and smooth “adaptive” layer. This layer helps relieve mechanical stress from the walls of the tooth cavity. Then the flowable composite introduced into the cavity is cured with the light of a special dental lamp.

Dental curing lamp

Light curing of fillings

The filling material is directly introduced into the cavity in portions and evenly distributed in it. After which it is cured with lamp light. So, layer by layer, the entire cavity is filled. It is very important that the thickness of each layer does not exceed 2 mm. This requirement is associated with polymerization shrinkage of the photocomposite (reduction in volume during curing) and the inability to polymerize a “thick” layer of the composite with lamp light. If this rule is not followed, a microgap may form between the filling and the tooth tissue, which leads to recurrent caries. This mistake can also cause pain after the filling is placed.

So, “set.” Now it should be processed, i.e. give the restored tooth the correct anatomical shape and polish the filling. Pre-treatment of the filling is carried out using diamond or carbide burs. Excess filling material is removed, sharp edges are smoothed, and the filling is given a relief characteristic of a given tooth. To control the full contact between the restored tooth and the antagonist (a similar tooth in the opposite jaw), carbon paper is used. When the teeth are closed, the paper leaves an imprint on the filling in the place where the contact is excessive. This point is sanded. This operation is repeated until optimal contact between the antagonists is achieved. For final processing of the filling, polishing rubber bands, abrasive discs and strips are used. After which the filling is polished with a special polishing paste and coated with a protective varnish.

Clinical example of heliocomposite

A: Initial situation (amalgam fillings requiring replacement).

B: The fillings are removed and the resulting cavities are etched and covered with bonding agent.

C, D, E: Stages of restoration of the second upper premolar.

Type of completed dental restoration

Features of the treatment of medium and deep caries

With moderate and, especially, deep caries, the layer of tooth tissue separating the bottom of the carious cavity from the pulp chamber (the inner part of the tooth where the “nerve” is located) can be very thin. As a result, after placing a filling, a complication may occur - (inflammation of the nerve of the tooth). Pulpitis, in this case, can be provoked by chemical irritation of the pulp by dental preparations used to treat the carious cavity.

Also, a significant area of ​​exposed (internal tooth tissue containing nerve endings) can cause pain after tooth filling. In order to prevent these undesirable consequences, before placing a filling, the inner surface of the prepared cavity is covered with a thin layer of glass ionomer cement. The cement layer promotes the regeneration of tooth tissue and isolates sensitive dentin from the irritating effect of the etchant acid.

In case of deep caries, a special therapeutic pad is applied to the bottom of the cavity. It contains calcium hydroxide, which helps restore dentin from the pulp chamber. Then a layer of glass ionomer cement is applied over the treatment pad, after which a filling is placed.

A “good” filling will be obtained if the above principles of caries treatment are observed. In other cases, the filling will most likely not be “good” enough.

Medicinal treatment of a carious cavity is the next stage of preparing it for filling with filling material after preparation. Its main goals are to clean the carious cavity from dentin sawdust, saliva, and microbes; bactericidal effect on microorganisms that remain in dentin; drying of hard tooth tissues

Previously, 96% ethyl alcohol and 3% hydrogen peroxide solution were used for this purpose. To dry the cavity, ether was used, for deeper defects - a stream of warm air, then treated with a heated mixture of antiseptics with a weak concentration of the active substance (0.1% furatsilin solution, 1% hydrogen peroxide). However, with the advent of modern composite filling materials, alcohol and ether have ceased to be used for the treatment of carious cavities, since they impair the adhesion of the filling to the tooth tissue and have a toxic effect.

Nowadays, for medicinal treatment of defects, warm solutions of antiseptics are most often used, which are injected into the cavity using a syringe. Their main active ingredients are chloramine, furatsilin, chlorhexidine, hydrogen peroxide. Drying is carried out with a stream of air or a sterile cotton pad.

It must be admitted that not all of the above solutions are quite effective. For example, sodium hypochlorite has a very unpleasant taste and odor. There is also an opinion that sodium hypochlorite and hydrogen peroxide inhibit the polymerization of composite materials, since they release atomic oxygen and chlorine, which penetrate into dentin.

It is best to choose the following drug treatment algorithm:

1. First, you need to rinse the carious cavity with water and dry it with a puster (a special device in a dental unit). Some dentists limit themselves to this stage, but its implementation is not enough to completely disinfect the defect;
2. Next, they move directly to drug treatment. To do this, it is recommended to use a 2% aqueous solution of chlorhexidine. You can purchase it at a pharmacy kiosk or use a specialized dental product, for example, Consepsis from Ultradent. It is produced in special syringes with disposable tips for applying the substance, and has a pleasant taste. This gel is applied for 30-60 s.
3. The drug is blown with a blower along the walls of the carious cavity. There is no need to wash it off;
4. All subsequent procedures for filling the defect are performed (etching with orthophosphoric acid, applying adhesive, composite material)

There is another way to disinfect dentin: a medicinal material containing calcium hydroxide is applied under a temporary filling for several days. This technique provides high-quality disinfection of the cavity, but is quite labor-intensive.

Before filling - a procedure that is carried out to remove non-viable areas of the tooth, eliminate pathogenic bacteria that cause after the filling is installed. The impact on dentin and the microflora of the oral cavity is carried out using special preparations, devices and dental equipment.

Methods for treating carious cavity

Depending on the purpose of the procedure and the condition of the surfaces preparation for filling carried out in several ways:

1. Mechanical, in which a drill, a laser is used, ultrasonic influence is applied, and manual treatment of carious cavity tool. The use of special equipment makes it possible to perform deep cleaning, preparation, or grinding of the tooth to prepare it for filling.
2. Chemical-medicinal, when antiseptic medical treatment is performed using special means and preparations. Cleaning with medications is a gentle and most painless procedure that has a disinfecting and analgesic effect.
3. Air, which involves sandblasting hard fabrics. Using special nozzles, a directed supply of a mixture of water and powder is carried out, in which abrasive particles act as the active substance.

All these methods can be combined with each other. A filling or orthodontic structures are installed on the prepared surfaces.

Stages of the procedure

Preparing a carious cavity for filling is carried out in several stages. The algorithm of actions is as follows:

• removal of contaminants, dentine filings, oral fluid from surfaces (rinsing, preparation);
• bactericidal treatment of the cavity, its edges and parietal dentin (special preparations are used for medicinal treatment of the oral cavity, including a 2% aqueous solution of chlorhexidine, orthophosphoric acid for etching the enamel);
• thoroughly dry surfaces.

Before installation of a seal Adhesive preparations are applied to ensure better adhesion of the tooth surfaces and the composite material. After completion of the entire process, finishing of the sealed areas is carried out.

For high-quality disinfection of surfaces, a temporary filling with medicinal material can be installed. This procedure is considered quite labor-intensive. It is used, for example, when it is necessary to eliminate complex inflammatory processes in the pulp.

Principles of treatment of carious cavities

Clinics are conducted in compliance with several mandatory principles:

1. Feasibility and validity. Surface treatment is done taking into account the individual characteristics of each specific case, development, and general condition of the patient. The main goal is to remove non-viable, damaged areas.
2. Gentle mode. Treatment tactics should be structured in such a way as to ensure maximum preservation of tissues, including adjacent teeth, and the entire oral cavity.
3. Painless procedures. Use of painkillers. If anesthesia is not possible for any reason, then the doctor must use other methods to reduce pain (intermittent, light movements, water-air cooling, the use of high-speed nozzles, psychological and psychotherapeutic effects).
4. Use of aseptics and antiseptics. All manipulations must be carried out under sterile conditions, in compliance with sanitary standards. Measures should also be taken to preserve the health of not only the patient, but also the medical staff (availability of protective clothing, masks, gloves and other protective equipment).
5. Visual control and convenience. The workplace should be well lit and ergonomic for both the patient and the doctor. It is necessary to have special instrument tables, use saliva ejectors, “vacuum cleaners”, multiseptors, dental lenses and microscopes, and other auxiliary devices.
6. Rationality and manufacturability of manipulations. The treatment regimen must be thought out in advance. The optimal way to resolve the problem must be chosen.
7. Reliable fixation of the filling in the cavity. To achieve this, special technologies are used, including macro and micromechanical retention.
8. The use of materials that correspond to the physical, mechanical, aesthetic and other characteristics of the oral cavity.

Treatment at the Center for Academic Dentistry

Our dental clinic in Moscow carries out diagnosis and professional treatment of oral diseases in compliance with all principles, established rules and regulations. Using our experience, professionalism, modern equipment and the best medicines, we help patients restore dental health and the aesthetics of their smile in the most comfortable conditions.

This is a medical treatment, the main purpose of which is to purify tion of the kar-ri-oz-no-lo-sti, anti-bak-te-ri-cidal effect on the cavity and its su-shi-va-nie. Previously, for these purposes, a 3% solution of re-ki-si water, medical alcohol, for you was used -shi-va-niya - medical ether. For deeper cavities there is a special solution consisting of 1% pere-ki-si in -do-ro-yes, 1% solution of chlor-ra-mi-na, 0.1% solution of fu-ra-tsi-li-na, and su-shi-li is the same with warm air. One-on-one with the appearance of com-po-zit-nyh ma-te-ri-a-lovs media it means that I have re-used alcohol and ether for drying, since it was established, that they are toxic and do not dry well, and also reduce the adhesive properties of composite materials te-ri-a-lov and raz-ru-sha-yut so-called-me-measure-me-ri-tsu. That’s why, in our time, it became necessary to do oro for me-di-ka-men-toz -she-nie warm-ly-mi an-ti-sep-ti-ka-mi (this is hy-po-chlorite sodium, chl-or-gek-si-din, per-re-kis- do-ro-yes, fu-ra-qi-lin), using a syringe for these purposes, and drying the cavity with a jet of air or sterilized wat-ny-mi sha-ri-ka-mi.

One hundred-ma-to-lo-gi recognized that the efficiency of the work-to-work is the same -mi yes-le-ka from you-so-coy, and also the tech-no-lo-gi-che-ski complex. At the same time, the used pre-pa-ra-you are not too pleasant for pa-tsi-en-ta in terms of taste and smell, but without danger -the per-re-ki-si water-do-ro-da and hy-po-chlor-ri-ta na-strium for the future seal would cause doubts . For this reason, the most useful way is considered to be the following an-ti-sep-ti-che-ra-ra- bot-ka ka-ri-oz-noy po-lo-sti:

• for the beginning, generously wash with clean di-steel-li-ro-van-water or water-air-spray. I eat, then dry it from “pi-sto-le-ta”;
• pro-iz-vo-di-xia me-di-ka-men-toz-naya treatment with 2% aqueous solution of chlor-or-hex-di-na pu- That's why it's not possible to put it on the walls and bottom, as well as on the tissue, teeth and gums, brush-stoch-ka-nu-lei (with -measure-but by one-me-well-that). The pre-parat is not washed off.
• after the pro-ve-den-noy ob-ra-bot-ki an-ti-sep-ti-com, the doctor de-la-et treats the ena-li and den-ti-na , on-but-sits the adhesive system and seal-bi-ru-et the cavity with the selected seal-bi-ro-voch-nym ma-te-ri-a-lo .

Modern seal-bi-ro-voch-nye ma-te-ri-a-ly bio-lo-gi-che-ski joint-me-sti-we with tissue-nya-mi people -ka, you have high strength, low heat, water resistance, plasticity, hermeticity. They are also resistant to the hi-mi-che-so-eating-not-yams that are present in a person’s mouth and about -la-da-yut pro-ti-in-ka-ri-es-with action. The filling will be exactly in accordance with the transparency, color and shade of the tooth.

If everything is done correctly - and in the Royal Dent clinic everything is done professionally - then on top -the den-ti-na appears to be her-me-tic for a long time. For this reason, the second reason for the non-infection in the den-tin and the emergence of re-tsi-di-va ka-ri-e-sa , as well as complications in the pulp, impossible. The form-mo-vo-ch-su-su go-to-vyat at pa-tsi-en-te and na-no-syat, when it is still in a plastic state hundred-i-nii. The temperature in the area should be no higher than + 20 degrees Celsius.

You can be sure that le-che-nie ka-ri-e-sa in a private hundred-ma-to-lo-gi-che-che-kli-ke “Ro -yal Dent" will be pro-ve-de-but without-bo-le-z-n-but with-me-not-the most modern anesthetics -shchih ma-te-ri-a-lov, and sa-ma me-di-ka-men-toz-naya ob-ra-bot-ka will pro-from-ve-de-na pro-fes- sio-nal and will give a guarantee that your treated tooth will serve you for a long time.

The cost of the pro-tse-du-ry for the me-di-ka-men-toz-no-work-work can be found out in the section “General” price list "or by telephone numbers indicated on the website kli-ni-ki.

Drug treatment of carious cavity - reviews, questions

Drug treatment of carious cavity - prices

Drug treatment of carious cavity - terms

• Caries

  a disease of the hard tissues of the tooth, which occurs in the presence of microorganisms, resulting in the formation of functional and aesthetic defects.

• Composite

  a type of plastic with a high content of inorganic filler.

• Dentistry

  a science that studies the structure, function of oral tissues and diseases that manifest themselves in the dental system.