Cучасні підходи до діагностики й лікування дентальної травми

Abstract

Проблеми лікування дентальної травми в сучасних умовах набувають усе більшої актуальності у зв’язку зі зростанням загального травматизму. Головне завдання – розробка досконаліших способів усунення порушень анатомічної цілісності зубного ряду, повноцінного збереження травмованих зубів і їхніх функцій. Ураховуючи той факт, що травм зубів зазнають переважно діти й люди молодого віку, в яких тканини мають високу здатність до відновлення, основна увага зосереджується на менш інвазивних і біологічно орієнтованіших методах лікування. У статті проаналізовано переваги, показання й обмеження до застосування таких методів як реплантація й аутотрансплантація зубів, що дозволяють відмовитись від видалення травмованих зубів, трансплантації штучних зубів і традиційного протезування

Relevance of the topic. Disruption of the anatomical integrity of the dentition, occurring as a result of dental trauma, not only impairs the patient’s appearance, but can also affect the functional properties of the entire maxillofacial area. Therefore, the choice of optimal methods for treatment of dental traumas remains an urgent problem of dentistry and requires further development. The aim of this study was to offer the most effective methods for treatment of dental traumas, with a view to preserve and restore the damaged structures of teeth and provide positive long-term outcomes. Materials and methods. The research relied on the study and generalization of modern scientific literature. Results and discussion. To diagnose dental traumas and, accordingly, to determine the ways to eliminate their consequences, its classification is of great importance. In this context, the classification by Andreason gained the strongest support in the world dental community. The approaches to the diagnostics and treatment of dental traumas, which have become established in the world of dentistry, largely rely on this classification. In modern conditions, computed tomography provides the opportunity to obtain maximum information about the condition of the injured tooth and bone damage. Cone-beam computer devices are used to study the maxillofacial area, providing high image quality at low radiation exposure. Essential diagnostic methods also include pulp vitality tests (cold test and electroodontodiagnostics). In this case, to exclude the diagnosis of pulp necrosis, it is recommended to check its vitality repeatedly. Currently, as an alternative to classical restoration in case of fracture of the tooth crown, specialists consider the fixation of the proper fragment of the tooth. Recently, this method of eliminating the effects of fractures of the dental crown is becoming increasingly popular due to the significant improvement in quality and enhanced technological properties of adhesive systems and materials. The search for ways to improve medical care in cases of tooth avulsion is mainly associated with the introduction of replantation and autotransplantation of teeth in the clinical practice. It is recommended to replant a tooth with an open apex without its depulpation due to the high ability of the germinal zone and periodontium to revascularize. Immediately after returning the tooth to the alveolus, a flexible splint is applied for a period of 3-4 weeks. Further endodontic treatment is performed only in cases when revascularization does not occur and signs of apical periodontitis appear. When the root apex is formed, the tooth is replanted in the alveolus, splinted for up to 2 weeks. Endodontic treatment should begin before the splint is removed, 7-10 days after replantation. Experts suggest replanting permanent teeth with both open and closed root apices, even in cases where the tooth has been in a dry environment for more than 60 minutes. However, not always after the injury the tooth can be found or it can be destroyed so that replantation becomes impossible. Nevertheless, in modern conditions, having received an in-depth biological justification of the process of engraftment of the transplanted tooth, it becomes possible to widely use the method of autotransplantation in the clinical practice. Conclusions. Thus, based on the study of a significant array of scientific publications, we can conclude that the problems of dental trauma are increasingly attracting the attention of researchers due to the prevalence of this pathology, the complexity of its diagnostics and treatment. The current approach to the treatment of dental trauma is focused on less invasive and more biologically oriented methods of treatment of hard dental tissues, pulp, periodontal ligament and alveolar bone. Research prospects. It is important to develop the best conditions for tooth storage before replantation in order to improve the periodontal regeneration, the quality of the revascularization process, offer better types of splinting, which will ensure the regeneration of periodontal and pulp tissues, prevent inflammatory complications.