Modern Views on Etiology and Treatment of Apical Periodontitis

The problem of treatment of apical periodontitis is one of the important and incompletely solved tasks of therapeutic dentistry. This is due to the significant prevalence of this disease, the complexity of medical manipulations, a large percentage of failures and complications during treatment, as well as the frequent lack of stability of the obtained results using known methods of treatment. Among all diseases of the maxillofacial region, the proportion of chronic periodontitis is, according to different authors, from 15 to 30%, pericardial cysts is from 7 to 12%. Periodontal disease is one of the main causes of tooth extraction. Chronic periodontitis in 85-98% of cases is the cause of acute inflammatory processes in the maxillofacial region (periostitis, abscess, phlegmon, lymphadenitis, osteomyelitis of the jaw). In the last decade, despite a significant increase in the volume of dental care, the number of patients with acute inflammatory diseases of the maxillofacial area and neck does not decrease. The purpose of the treatment of periodontitis is the elimination of inflammation in the periapical region, the elimination of pathogenic effects on the organism of the odontogenic inflammatory focus, the regeneration of the structure of periodontal tissues and the restoration of the function of the tooth. The effectiveness of conservative treatment of periodontitis is on average 85%, and this figure varies depending on the clinical form of the disease, the means and methods of treatment, the resistance of the patient and many other factors. Difficulties in the treatment of destructive forms of chronic periodontitis are due to the duration of the processes of regeneration of the destruction center of the periapical region, occurring mainly after 6-12 months or more after the endodontic treatment is completed. Unfortunately, until now, the management of reparative osteogenesis in the foci of destruction presents very serious difficulties, since the existing methods for treating destructive forms of periodontitis do not provide for active influence on the pathological tissues of the foci of destruction directly in the process of endodontic effects. Therefore, in endodontic practice, it is of great interest to study the effectiveness of the use of preparations with pronounced osteoinductive properties, which include, first of all, various osteoplastic materials. Conclusion. The importance of the problem lies in the fact that the destructive focus in the periodontal is a source of chronic infection. The inflammatory focus for periodontitis (both acute and chronic) with a normal reactivity of the body is a protective reaction of the body. However, in violation of the functions of the immune system, the long-term existence of a chronic infection center leads to a decrease in the level of nonspecific resistance of the organism and, as a result, to the development and complication of the course of systemic focal diseases. The above reasons explain the socio-medical significance of the problem of chronic destructive periodontitis and the extreme topicality of the constant search for new effective methods for its treatment.