Chapter 4. Discussion of results of researches

the Problem of secondary and recurrent caries remains actual, despite again appearing on the stomatologic market plombirovochnye materials and various techniques of treatment of caries of a dentine.

the morphological estimation of a condition of tissues of a tooth at use of a technique of treatment of caries of a dentine with application of deep fluorination of a dentine and nizkointensivnogo laser radiation, by creation of experimental model of caries of a dentine on a teeth of animals was the research Main task.

With that end in view was ­ 3 not purebred dogs in mass 15,0, 10,0 and 12,0 kg are taken in experiment of 28 rats of line Wistar in mass of 200­ 220 gramme, and. At rats dissected the first molar tooths of the top jaw in limits okolopulparnogo a dentine on II class according to classification Black (1889), at dogs dissected on 4 premolar tooths on the top jaw and 4 premolar tooths on a mandible in limits okolopulparnogo a dentine, cavity creation spent on I class according to classification Black. The stomatologic portable equipment "Vladmiva" was used. Dissected cavities konusnymi diamond borons of the smallest size at rats. At dogs used diamond round burs ¹2. The generated cavities corresponded to width and height of a head of boron. A teeth with the generated cavities processed the sterile distilled water. A teeth of animals was sectioned on two groups: I group - the usual method of treatment (cavity preparing, entering adgeziva OptiBond (Kerr), applying of seal Point 4 (Kerr) was spent. In the first group treatment of 8 teeth is spent. In the second group it was spent - treatment similar to treatment in the first group, but with application dentin-germetizirujushchej liquids and nizkointensivnogo ­ laser radiation. Similar treatment is spent on 48 teeth.

For morphological research firm tissues of a teeth of rats and dogs were used. Research is spent at level of light microscopy with use classical histological, morfometricheskih and immunotsitohimicheskih methods.

As a result of morphological research it is taped, that in preparations of I group of animals fibrilloblasts are presented by one layer of flat and cubic cells under the form whereas on preparations of II group the augmentation of volume density and "poslojnosti" fibrilloblasts in 1,4 times presented cubic and vysokoprizmaticheskimi by cells becomes perceptible, ­ the predentin layer is enlarged. In a pulp the augmentation of the maintenance of cells fibroblasticheskogo a number is noted, are taped malodifferentsirovannye cells.

Despite a prevalence fibroblasticheskih elements in II group of animals, augmentations of the maintenance of collagenic fibers it was not observed. Among fibers of a quaggy connecting tissue of a pulp capillaries settle down, the total amount and which density is enlarged in 3,4 times, in comparison with I group. A specific gravity of kernels of cells of endotheliocytes of capillaries as a part of a pulp of a tooth of investigated animals in control (I group) and pre-production models (II group) is defined.

the augmentation of volume density of nuclear structures of endotheliocytes of capillaries of a pulp in 3,4 times in samples of II group (rat) in comparison with I group Is observed. Morfometrichesky and immunotsitohimichesky the analysis has taped a neoplasm of vessels with a picture of a proliferation of endotheliocytes.

The similar tendency is traced and at dogs. Pathological process (dentine caries) leads to destructive changes of cellular structures of a pulp. Probably, in the conditions of a hypoxia there is a linkage stimulation stressindutsirovannogo the squirrel - the factor of growth of an endothelium of vessels (VEGF) to the raised maintenance of endotheliocytes as a result of their proliferation, that in an end result leads to a neoangiogenesis.

It is possible to assume, that, in reply to stimulating action of deep fluorination of a dentine with nizkointensivnym laser radiation, there is an augmentation of volume of a microcirculatory bed in investigated samples of the second group that improves blood supply of tissues and forms favorable conditions for transformation malodifferentsirovannyh cells in structural elements odontoblasticheskogo a layer. Our assumptions find the
acknowledgement in works of last years on studying of ability of a pulp of a teeth to neogenesis and updating. In work R. Kabir with co-authors (2014) has described «presence at malodifferentsirovannyh cells of a pulp of a teeth of potential to renewal during many long periods through cellular division and-or under certain physiological or experimental conditions, and ability to be differentiated in cells with special functions».

Fawzy el-sayed with co-authors in 2013 studied «therapeutic potential» pulps of a tooth and it regeneratornye abilities. Ability malodifferentsirovannyh pulp cells to restoration of the damaged tissues of an organ, at the expense of possibility of a differentiation of these cells at the adult individual »is noted«.

F. Moazzami with co-authors (2014) has shown regeneratornuju ability of tissues of a teeth of rats in vitro. As a preparation stimulating regeneratornyj potential of a pulp of teeth the isolating lining with a combination of dexamethasone, Z-Glycerophosphatum and Vitamin D was used. By authors it is proved, that at applying of this admixture there is a transformation malodifferentsirovannyh pulp cells in odontoblasticheskie cells, formation of "the dentinal bridge» is as a result observed. Thus, resulted above research do not contradict our assumptions.

In clinic 120 persons at the age of 18-45 years with serious and very serious caries on classification Nikiforuk (1985) have been surveyed. Treatment of 218 teeth, including 124 molar tooths and 94 premolar tooths has been spent. According to topografo-anatomic classification Lukomsky (1955) it there were carious cavities of average depth, on ÌÊÁ-10 - dentine caries, and agree

classifications Black (1889) - cavities of I class. Patients have been parted on groups. The first group (control) included 30 persons by whom 52 seals from svetopolimerizuemogo material Point 4 without any influence for a bottom and walls of a carious cavity have been imposed. In the second group consisting of 30 persons, 48 seals from this a material, but with a provisional cover of a bottom of generated cavity DGL (HUMANCHEMI) have been imposed. The third group
have made as 30 patients by whom 58 seals from material Point 4 with preliminary step-by-step influence for a bottom of generated cavity NILI have been imposed; within 15 seconds the liquid number 2, then an admixture of liquids number 1 and 2 within even 30 seconds was gleamed. In the fourth group there were 30 persons, treatment of 60 teeth is spent. Treatment was spent the same as and in the second group, behind that exception, that before sealing brought in a dissected carious cavity dentin-germetizirujushchaja the liquid was irradiated with the laser within 40 seconds. The seal was imposed also from svetopolimernogo material Point 4.

it has preliminary been spent mikrokristallografija admixtures dentin - germetizirujushchej liquids on purpose to prove a choice of an exposition of influence of laser radiation on DGL for treatment of patients with caries of a dentine of a teeth a method of deep fluorination of a dentine. Preparations of two series have been for this purpose prepared: control and skilled. An admixture dentin-germetizirujushchej liquids placed on subject glasses in volume of 0,05 ml. In skilled 6 series influence on DGL nizkointensivnym by laser radiation with a various exposition of influence - was spent 10, 15, 30, 40, 50, 60 seconds, preparations were dried up at a room temperature. Each exposition was spent with fivefold reproduction. Then preparations were compared to the control where activations dentin-germetizirujushchej liquids it was not spent.

mikrokristallografija preparations it was spent by means of a method of light microscopy on microscope ÌÁÈ-15? S-90, Zeiss at 200-fold augmentation.

the Method mikrokristallografii has allowed to establish, that at an influence exposition nizkointensivnym laser radiation of 40 and 50 seconds forms more ordered, having accurate sides, large crystals dentin - germetizirujushchej liquids that is necessary for deeper penetration likvida at treatment of patients with dentine caries.

the Clinical condition of seals estimated in 9 and 18 months. Regional adaptation of seals defined immediately after applying, and in control
terms of 9 and 18 months. At diagnostics stage and as definition of an excitation threshold of a pulp was spent to control terms.

After 18 months on control survey 98 patients were. From them 48 patients of control group and 50 patients of IV medical group. At 39 patients of 44 seals have changed the properties by criteria Rjuge. Patients of control group have made Of the general number of the patients who had changed seals, 31 persons and 8 persons of IV medical group.

In a percentage parity patients of control group in control terms of observation in 18 months in 79,5 % of cases had modified seals. At patients of IV medical group in control terms in 18 months the changed seals only in 20,5 % of cases were observed.

For the purpose of definition of "secondary" and "recurrent" caries, estimated patients with modified seals of control and IV medical group (only 44 seals). Regional adaptation of seals, a discoloration of edges of a cavity and presence of secondary caries was estimated. Regional adaptation defined by means of a probe and a mirror. Visually with the help fotopolimerizatsionnoj lamps defined change of edges of a cavity. «Secondary caries» diagnosed at detection of a carious lesion of tissues of a tooth near to a seal. The discoloration of firm tissues immediately on border a seal - a tooth, assumed presence of relapsing caries. For the purpose of statistical data processing "descriptive" criteria on Rjuge translated in the digital. & - 1 point, «Bravo» - 2, «Ñharlie» - 3, «Delta» - 4 points, accordingly.

In a percentage parity, from the general number of the patients who had changed seals, surveyed in control terms in 18 months of 73 % patients of control group and 27 % patients of IV medical group have made. In control group of patients 32 changed seals by criteria Rjuge were estimated, in IV medical group of patients an estimation gave to 12 changed seals. In control group of 28 seals have received an estimation «Bravo», 4 seals - an estimation «Charlie», that has made in the sum of 68 points, in a percentage parity of 74 % from the general number of the changed seals. In IV medical group of 12 seals
have received an estimation «Bravo», that has in turn made in the sum 24 points, and in a percentage parity of 26 %. The estimation «Charlie», in IV medical group was received by any seal.

At other patients surveyed in control terms in 18 months, all seals had an estimation «Alfa» by "descriptive" criteria Rjuge. From them 42 patients of IV skilled group and 17 patients of control group, that is, the probability of occurrence of recurrent caries at patients of IV skilled group decreases on 64,7 % in comparison with control group of patients.

Presence, and expression degree posleplombirovochnyh pains estimated in the early and remote control terms after treatment on 10 mark scale at different groups of patients.

Being based on subjective painful sensations of patients, it has been established, that in control group posleplombirovochnaja the pain was present at 40 cases at 48 surveyed in terms immediately after treatment, and was estimated on 10 mark scale of intensity of painful sensations in limits from 1 to 7 points. In terms in 9 months posleplombirovochnye pains noted only 6 patients. They were estimated on 10 mark scale of intensity of painful sensations in limits from 1 to 2 points. 42 patients of control group of complaints to pains did not show the others. In 18 months only one of patients of control group has shown complaints on «feeling of discomfort in a tooth», that has received an estimation in 1 point. Patients of IV skilled group showed complaints on posleplombirovochnye to a pain right after treatments in 4 cases from 50, that was estimated on 10 mark scale of intensity of painful sensations in limits from 1st to 2 points. In control term in 9 months of the complaint to pains were only at 2 patients of IV skilled group. They were estimated on 10 mark scale of intensity of painful sensations on 1 point, in control terms in 18 months anybody from patients of IV skilled group did not show any complaints. A pulp excitation threshold defined by elektroodontometrii from sensitive points on a method of the Ruby (1955) by means of apparatus Diagnostik System (SybronEndo).

the X-ray pattern of a condition of periodontal tissues Has been studied and the comparative analysis dentalnyh pictures at the moment of inspection and in control terms of observation in 18 months after treatment is carried out. As a result of the comparative analysis dentalnyh pictures of a teeth at the moment of inspection and in 18 months after treatment it has been established, that from tissues of a periodontium no visible pathological changes have occurred.

According to histological research of tissues of a teeth at treatment of caries of a dentine with application of the various isolating lining materials, the Berlin spent in university clinic (Germany) doctor Thomas Stiller in 2009, it has been established, that in 4 weeks of 50 % from the general number of a teeth with caries of the dentine, cured with application girookisi calcium and 25 % of a teeth for which as an isolating lining used trikaltsijfosfat-cement had no pathological changes in a pulp, the others had in a pulp the centres giperimii and an initial necrosis. In 12 weeks of control research of tissue specimens, data were similar.

At treatment of caries of a dentine with application nizkointensivnogo laser radiation and a dentine germetizirujushchej liquids it has not been fixed any case of pathological changes from a tooth pulp in investigated samples.

A.V.Malakhov in 2008 in the work «stekloionomernyh prokladochnyh materials at treatment of caries of a dentine of a teeth» has established a clinico-laboratory substantiation of application, that among other observations over groups of an investigated teeth, the electrometric estimation of regional permeability of a current on border «a seal - firm tissues of a tooth» has taped following results: immediately after applying of seals the greatest size elektroprovodnosti ­ has been fixed in 4th group (a composite with linings from gidroksida calcium both SITS Life and Fuji-Ii) - 1,16+0,09 mA, then in 2nd group (a composite with a lining from SITS - "TSemion") - 0,54+0,04 mA, practically same data were in 3rd group (a composite without a lining) - 0,50+0,25 mA. Least

level elektroprovodnosti became perceptible in 1st group (the Composite with a lining from SITS - Lrgetsem) which has made 0,46+0,04 ml. All it testified to most high quality of seals in 1st, 2nd and 3rd groups surveyed.

Monitoring of electrometric researches according to regional permeability «firm tissues of a tooth - a seal» throughout all terms of observation has established the minimum indicators in group at patients where seals with prokladochnym a material "Lrgetsem" 0,55±0,04 were brought. On the second place - with prokladochnym a material "TSemion" 0,63±0,5 and restorations executed on besprokladochnoj to a technique 0,62±0,5, and the greatest value elektroprovodnosti on border «a seal - firm tissues of a tooth» were in group of patients with restorations a composite and linings Life and Fuji-Ii 1,32±0,11.

In L.V.Malakhov's work has established what more effectively to spend complex treatment of caries of a dentine with use prokladochnogo a material "Lrgetsem", incorporating not only fluorine ions, but also silver and material ions "TSemion", in comparison with ftorsoderzhashchim a foreign material «Fuji - II». During too time, in the specified research there are no data of a morphological estimation reparativnyh processes in a pulp of an investigated teeth as a result of application of the given materials used for constant sealing of teeth with caries of a dentine.

Application of deep fluorination of a dentine and NILI promotes appreciable improvement of indicators of an excitation threshold of a pulp. Data EOD at dynamic observation have shown, that in the first and in the second groups of patients the pulp excitation threshold in control terms has decreased slightly, but was above in comparison with the fourth and the third skilled groups, thus remained within physiological norm, and in the third and fourth group electroexcitability of a pulp has considerably decreased in comparison with the first and second groups in all control terms of observation.

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Scientific source KOVALEVA MARIA SERGEEVNA. Clinico-morphological research of a condition of tissues of a tooth at treatment of caries of a dentine with application of deep fluorination and nizkointensivnogo laser radiation. The dissertation on competition of a scientific degree of the candidate of medical sciences. Great Novgorod - & 2014. 2014

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