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introduction

a research Urgency

the Problem of treatment of caries of a dentine till the present moment remains not decided owing to that the success of treatment of disease in much is defined by the chosen technique (Gizzatullina L.L.

from co-workers., 2008; Qureshi A. E. S., et al., 2014). Certainly, huge influence on a treatment outcome renders age, nonspecific and specific factors of protection of an oral cavity, a mineral exchange. For this reason the researches till now are carried out, allowing to find an alternative method of treatment of caries of a dentine which could guarantee a positive take, namely ability of a pulp of a tooth in short terms to produce reparativnyj a dentine (Moazzami F., et al., 2014). Quite often after treatment of patients there are complications as the tooth pulp settles down in immediate proximity with a dissected pulp cavity (Peters M.C., 2010). One of actual problems of modern therapeutic stomatology is working out of the medical actions normalising structure and function at caries of a dentine (Chen F., et al., 2010). Necessity of application of the medical linings meeting the basic demands, such as is well-known: absence of toxicity, bactericidal properties, antiinflammatory effect, odontotropnoe action, analgezirujushchee action, stimulation reparativnyh processes, convenience of application (Ahovuo-Saloranta A., et al., 2013).

last decades practising stomatologists activly apply a method of deep fluorination of a dentine with use dentin - germetizirujushchej the liquids, including simultaneous application of liquids different in structure (Lehmann R., 2012): fluoric silicate of magnesium, a hydroxide of copper-calcium and fluoric sodium as the stabilizer. The a part highly dispersive hydroxide of copper-calcium possesses in 100 times more powerful disinfectant force, than the hydroxide of calcium which is a part of medical linings (Buchalla W., et al., 2007). At deep fluorination, it is dense
filling a lumen of the dentinal tubules, containing copper a substance (alkaline fluoride of copper), has permanent bactericidal an effect, at the expense of the small size of crystals 50 And, that there is less than diameter of dentinal canaliculuses. On observations A. Knappwost (1999), crystals should not have very small sizes, for the purpose of prevention of their "washing away" from dentinal canaliculuses during cavity processing ortofosfornoj acid. Crystals dentin-germetizirujushchego likvida at their penetration into dentinal canaliculuses, «are fixed in them». Put for a bottom and walls of a cavity the preparation is capable to prevent decades secondary caries (Fuss Z., et al., 2002).

At caries diagnostics the special attention should be given a condition of a pulp of a tooth as the first reaction in a pulp is observed right after diffusions of carious process from an enamel on a dentine (Erofeeva L.M. from co-workers., 2013). Depending on it choose a treatment method: applying for a bottom of a dissected cavity kaltsijsoderzhashchih linings (at an intact pulp and a dentine dense bed) with a cavity pretreatment weak solutions of an antiseptic (Frentzen M., et al., 2001.) or the delayed sealing of a teeth (Lutskaja I.K., 2000).

In practice of therapeutic stomatology the given methods not always showed the solvency as besides immediate influence on the centre of the raised demineralization there was no mediated ­ influence on a tooth pulp, and, proceeding from the general principles of physiology it is necessary sochetannoe influence on the pathological centre which, in this case is represented the demineralization centre (Cox C.F, et al., 2001).

for this reason method search «preventive sealing­» is conducted not the first year (Kiselnikova L. P, 2000).

For activization of processes of a mineralization of a dentine the method of deep fluorination (Hetz G is used., 2004) and influences of physical factors, such as nizkointensivnoe laser radiation (Yilmaz H.G., et al., 2014).

In works of last years it is shown, that high informativnostju at various inflammatory processes of maxillofacial area the estimation of the immune status, activity of the immunocompetent cells which are carrying out ­ the basic protective reactions (Maksimovskij J.M. from co-workers differs
­., 2003). It is proved, that to one of the conditions contributing to development of complications of caries, the immunodeficiency that causes necessity to consider an immunity condition at stomatologic interventions (Safiullina is

A. M., 1996; Stack W.E. et al., 1990; Heumader E. et al., 1995). However, with the account the big interest is localised-nosti the inflammatory centre represents studying of immuno-logic indicators not only bloods, but also immediately tissue of a pulp of a tooth involved in pathological process (Nakanishi T. et al., 2005; Freitas P. et al., 2007; Staquet M.J. et al., 2008). In medical practice including in stomatology, wide application was found by the laser technics (Kita T., et al., 2014).

protivokariesnoe action of impulsive laser light develops of several components: immediate action on firm tissues of the tooth leading to change of permeability of an enamel, microhardness and remineralization intensifying; the mediated influence through the tooth pulp, showing - gosja microcirculation and metabolism stimulation, rising of activity of fibrilloblasts with formation of a replaceable dentine. (George R., et al., 2014). Except immediate local, laser radiation has the general an effect expressed in stimulation of mechanisms of immune protection of an organism, nejrogumoralnoj and other systems, leading mobilisation of the general adaptive to organism reaction, conservation of level of its homeostasis (Chudnovsky

B. M, from co-workers., 2002).

Medical action NILI proves to be true indicators of cytochemical analyses with definition of dynamics of the fermental status of lymphocytes since exist incontestable that certificate, that metabolic changes in leucocytes of peripheric blood reflect similar changes in internal organs, activity of pathological processes in an organism, expression of a hypoxia, definitions of efficiency of spent methods of treatment (Partenadze A.N., Jatsyk G. V, 2010) also give the chance.

Degree of a readiness of a theme of research

Proceeding from the above-stated, for the purpose of rising of efficiency of treatment, the new method (the Patent for the invention ¹ 286816) treatments of caries of the dentine, consisting in simultaneous application dentin-germetizi - rujushchej liquids with influence on it nizkointensivnogo laser radiation is developed. The data confirming efficiency of the spent technique at structural level are not present, in this connection additional morphological researches are used. For acknowledgement of efficiency of a technique the analysis of structural changes of firm tissues of a teeth to an intervention and in control terms after application of the method of treatment of caries of a dentine set forth above is extremely actual.

the Research objective

the Purpose of the given work is working out and an experimentally-clinical ­ substantiation of a method of treatment of caries of a teeth, with use of deep fluorination of a dentine and immediate influence nizkointensivnogo ­ laser radiation.

Research problems

1. To study morphological changes in tooth tissues (a dentine and a pulp) at rats and dogs at the standard technique of treatment of caries of a teeth.

2. To investigate structural features of a pulp and a dentine at treatment of caries of a teeth with application of a method of deep fluorination of a dentine and nizkointensivnogo laser radiation.

3. To carry out the comparative analysis of structural changes of a dentine and a pulp in ekperimentalnyh groups of animals at the standard method of treatment of caries of a teeth and with use of a technique of deep fluorination of a dentine and nizkointensivnogo laser radiation.

4. To prove a choice of an exposition of influence nizkointensivnogo the laser

radiations by means of a method mikrokristallografii a dentine -

germetizirujushchej liquids.

5. To develop a technique and to estimate clinical effect of treatment of patients with caries of a dentine with application of deep fluorination and nizkointensivnogo laser radiation.

Scientific novelty

1. For the first time the comparative analysis of the structural organisation of a dentine and a pulp at experimental animal (rats and dogs) is carried out at the standard technique and with application of a method of deep fluorination of a dentine and laser therapy.

2. On experimental model the morphological picture of the reactive changes arising in a pulp and firm tissues at treatment of experimental caries of a dentine with application of a method of deep fluorination of a dentine and laser therapy is described.

3. For the first time with the help mikrokristallografii in vitro influence nizkointensivnogo laser radiation on kristalloobrazovanie in dentin - germetizirujushchem likvide is studied and the influence exposition ­ nizkointensivnogo laser radiation is proved­.

4. The substantiation of a method of treatment of patients with caries of a dentine with application of deep fluorination of a dentine and nizkointensivnogo laser radiation is given.

5. For the first time the estimation of efficiency of a method of deep fluorination of a dentine and nizkointensivnogo laser radiation is given at treatment of caries of a dentine.

the Theoretical and practical importance of work

the Offered method is alternative to the standard way of treatment of caries of a dentine with application of linings on a basis odontotropnyh and
anti-infectives. Application of this method promotes depression posleplombirovochnyh pains at patients. Histological acknowledgement of improvement of a condition of a pulp of a tooth is presented to the remote terms of observation.

Methodology and research methods

For all participants of clinical research acquaintance and signing of the informed consent approved in local ethical committee of Federal state budgetary educational institution of the higher vocational training «the Novgorod state university of a name of Yaroslav Mudrogo» was obligatory.

the Experimental model was formed taking into account literary data in own updating. Conditions of the maintenance and feeding of experimental animals were carried out according to «to Sanitary rules on the device, the equipment and the maintenance of experimentally-biological clinics», by confirmed Order MZSSSR ¹ 1179 from 10.10.83 of Research were carried out according to the European convention on protection of vertebrate animals, ispolzueiyh for experiments or in other scientific purposes (ETS ¹ 123) (Strasbourg, on March, 18th 1986.

the Methodological basis of dissertational research was consecutive application of methods of scientific knowledge. Work is executed according to principles of demonstrative medicine, in design kogortnogo prospektivnogo researches. In research clinical, tool, laboratory, analytical, statistical methods of research were used. Object of research - patients with caries of a dentine of the teeth, being on an out-patient treatment. The experimental model is generated on a teeth of animals - rats and dogs. An object of research - features of the reactive changes arising in a pulp and firm tissues at treatment of experimental caries of a dentine with application obshcheprijantoj of a technique of treatment and a method of deep fluorination of a dentine and laser therapy.

the Substantive provisions which are taken out on protection

1. Use of a method of treatment of caries of a dentine on experimental models with application of deep fluorination of a dentine and nizkointensivnogo ­ laser radiation causes augmentation of population of fibrilloblasts in 1,4 times, enlarges the maintenance of cellular elements of a pulp, in particular: fibroblasts, macrophages; leads to augmentation of volume density of vessels of a microcirculatory bed of a pulp in 3,4 times, stimulates a proliferation of endotheliocytes, improves blood supply and, hence, raises it regeneratornyj potential.

2. Use of a method of deep fluorination dentin-germetizirujushchej a liquid with immediate influence on it nizkointensivnym laser radiation reduces risk of occurrence of recurrent caries in 3,9 times and occurrences posleplombirovochnoj pains, guaranteeing thus good aesthetic result of constant seals.

Degree of reliability and approbation of results

Reliability of results of the carried out research is defined by appreciable and representative volume of clinical observations (n=218) and gistolgicheskih preparations of a teeth of experimental animals (n=214) with use of a modern objective method of research, and also adequate statistical processing.

the Basic results of dissertational research were reported and discussed at IV international scientifically-practical conference «Health and formation in the XXI-st century» (Moscow, 2005), XII scientific conference of Institute of medical education NovGU «Aktalnye problems of modern medicine» (V.Novgorod, 2005), on republican interuniversity ­ nauchnoprakticheskoj conferences IMO NovGU (V.Novgorod, 2006), on X ­ nauchnoprakticheskoj conferences on children's stomatology «Ogomatologija children's age and preventive maintenance of stomatologic diseases» (St.-Petersburg,
2014), at joint session of chairs of therapeutic stomatology, morphology of the person (V.Novgorod, 2013), the problem commission of Institute of a medical education of the Novgorod state university of a name of Yaroslav wise (2014), on the problem commission «Stomatology, cheljustnolitsevaja ­ surgery» GBOU VPO SZGMU of I.I.Mechnikova of Ministry of Health of Russia (2014).

Results of research are used in educational process on chair of stomatology IMO NovGU, TSNIUL IMO NovGU, on chair of morphology IMO NovGU, brought in practical activities of stomatologic unit of Open Company "Sonata" (V.Novgorod).

On a dissertation theme 8 works, including 7 articles in the reviewed editions recommended VAK the Russian Federation are published.

Personal participation of the author in reception of results

the Personal contribution of the author was carried out at all stages of preparation and carrying out of scientific work. The author analyses the modern domestic and foreign literature on a theme of dissertational research, earlier techniques of treatment of caries of a dentine are studied, mastered. The modified technique of treatment of caries of a dentine is developed. The patent for the invention ¹ 2286816 from 10.11.2006 Personally is received by the author techniques of morphological research of preparations of tissues of a teeth of experimental animals on chair of morphology of person IMO NovGU are mastered. A fence, preparation and the analysis of an investigated material it was carried out personally by the author. The author independently develops design of research, the anamnesis collecting, clinical inspection and treatment of patients, statistical processing of results of research, a substantiation of the formula of the forecast is spent, the analysis, generalisation, interpreting of the received data is carried out, conclusions, the positions which are taken out on protection are formulated, practical references are given.

All materials presented to the dissertations and published in the press, are collected, processed and analysed personally by the author.

Volume and dissertation structure

the Dissertation consists of the introduction, four heads, discussion of results, conclusions, practical references and the literature list, from them 102 domestic and 191 foreign authors. Work is stated on 141 page typewritten the text, contains 42 drawings, 28 tables.

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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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