A dentist from RUDN University implemented a new approach to treating of inflammation of tissues around dental root and root canal. The new comprehensive therapeutic method includes the treatment of inflamed tissues with ozone. When used in a complex clinical case, the method helped save a patient's tooth. The case was described in the Clinical, Cosmetic and Investigational Dentistry journal.

Both the dental pulp (loose connective tissue in the dental cavity) and the periodontium (fibers that connect the dental root with the bone of the jaw) can get inflamed. If the infection is not localized only on the inside or the outside but affects both areas, it is much more difficult to completely cure a tooth. Such cases are difficult to diagnose, therefore, professional literature contains only a few descriptions of them, and there are no general treatment recommendations. Some dentists prefer to focus on the internal canals first, while others suggest treating the pulp and the periodontium simultaneously. A dentist from RUDN University implemented a single protocol for comprehensive pulp and periodontium treatment.

Inflammation of periodontal tissues often leads to tooth loss. In some cases, a lost tooth cannot be replaced with an implant, because the consequences of the infection worsen the implantation prognosis. Therefore, keeping the tooth is a more desirable outcome in this scenario."

Dr. Maria Makeeva, PhD, Associate Professor, Department of Conservative Dentistry, RUDN University

The new approach was carried out in a clinical case of a 44 years old patient with significant inflammation of the right mandibular canine. Initially, the patient was diagnosed with periodontium inflammation; the tooth was loose, and a flow of pus was observed. The first steps were typical for a periodontal inflammation treatment protocol: the patient was administered an antibiotic and then was instructed to rinse the tooth with chlorhexidine. Moreover, the dentist carried out the scaling of the tooth. After that, the patient remained under observation for six months. Although the bleeding and pyorrhea stopped, at one examination the dentist discovered tissue injury around the root of the tooth. The process went so far as to cause bone destruction. It turned out that one narrow area had an 8 mm deep periodontal pocket, and that the initial inflammation transferred to the internal tissues of the tooth.

Working together, a periodontologist and an endodontist implemented a comprehensive treatment approach. Their next step was focused on removing the dead pulp from the dental canals. After cleaning, the canals were dried and treated with ozone for 24 seconds for better disinfection. After a week of dressing, the treatment was repeated, and the cavity was covered with a permanent filling made of a light-cured composite material. Ozonetherapy was used to treat the periodontal tissues too: after cleaning, the periodontal pocket was rinsed, dried, and treated with ozone for 18 seconds. A recall examination in six months showed no inflammation of the tooth. Moreover, the bone tissue was recovering, and the periodontal pocket reduced to 4 mm.

"Simultaneous inflammation of the pulp and periodontium tissues is very difficult to treat. It can be caused by several types of pathogens at the same time that migrate between tissues and worsen the prognosis. Our experience shows that such an infected tooth can be saved, but it requires close collaboration of a periodontologist and an endodontist, as well as a patient's complete compliance with oral hygiene recommendations. One should also take into consideration possible bacterial resistance to antibiotics and therefore use additional antibacterial treatment, such as ozone," added Dr.Maria Makeeva from RUDN University.