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Chronic fibrous periodontitis is an inflammatory disease connective tissue layer between the root of the tooth and the jaw alveolus(periodontal).

Characterized by gradual replacement of the periodontium coarse fibrous connective tissue resembling a scar.

Causes - long-term infection of periodontal tissues (pulpitis, caries), treatment of other forms of periodontitis, frequent tooth injuries (prostheses, fillings), foreign bodies.

Clinic of chronic fibrous periodontitis, ICD code 10

ICD code 10: K04.5. Chronic apical periodontitis.

The disease is common in elderly patients and is extremely rare in children or adolescents.

Regardless of the cause, changes in the periodontium are irreversible - the periodontal ligament thickens and is replaced by coarse connective (fibrous) tissue, which leads to significant disruption of the dental apparatus.

Collagen fibers, which form the basis of periodontium, lose their elasticity and cease to firmly hold the tooth root in the alveolus, which causes gradual loosening of the teeth.

Symptoms

In most cases the disease is asymptomatic. Patients may experience intermittent pain or a feeling of pressure when eating hard foods, food stuck. When the disease is combined with caries, patients complain of bad breath and carious cavities.

Survey data: the affected tooth was previously sick, patients indicate the transferred treatment for pulpitis or caries. On examination, the mucosa the gum shell in the area of ​​the affected tooth is pale, a carious cavity can be detected. Probing is painless, during percussion there is slight pain.

Differential Diagnosis

The disease is differentiated with other forms of chronic periodontitis: acute periodontitis, chronic gangrenous pulpitis, medium and deep caries, periostitis, osteomyelitis of the jaw.

1. Granulating periodontitis accompanied by a feeling of heaviness, fullness in the diseased organ, pain when biting. A fistula with purulent discharge is periodically detected, which disappears after a while. Percussion of the diseased tooth is painless.
2. Granulomatous periodontitis differs from fibrous in constant pains of a aching nature, aggravated by biting, severe pains when taking hard food.
3. Chronic gangrenous pulpitis characterized by prolonged pain when taking hot or cold food, probing reveals pain in the mouths of the canals of the dental nerve. Palpation is painful.
4. Medium caries manifested by pains of varying intensity, which are caused by temperature and food irritants, characterized by the presence of a carious cavity within the dentin, probing causes pain in the area of ​​the enamel-dentin junction.
5. deep caries manifested by pain from temperature and chemical irritants, on examination, a carious cavity is revealed that reaches the near-pulpal dentin, and on probing - soreness along the bottom.

Photo 1. Deep caries of several teeth. Carious cavities are large, reaching the peripulpal dentin.

1. Acute periodontitis manifested by constant aching pain, asymmetry of the face due to edema in the area of ​​​​the diseased tooth, its mobility, an increase in lymph nodes on the side of the lesion.
2. Periostitis characterized by constant aching pain in the jaw, passing after the development of edema, soreness during percussion and palpation of several teeth, swollen lymph nodes.
3. Osteomyelitis of the jaw(purulent disease of the bone marrow, passing to the bone tissue) is manifested by acute pain in the affected jaw and the presence of an unpleasant purulent odor, swelling of the face on the side of the lesion, mobility of several teeth, palpation reveals a muff-like infiltrate in the jaw, fever and chills are characteristic, a fistulous tract is possible .

Features of treatment

In which cases you can refuse treatment:

• when confirming the fact of tooth treatment(caries, pulpitis, other forms of periodontitis), since in this case fibrous periodontitis is a natural reaction of the body to the disease and treatment;
• in the absence of patient complaints;
• in the presence of fillings in the affected tooth high quality and in good condition.

Methods

Treatment is carried out on an outpatient basis(without hospitalization).

The following methods are used:

• conservative- with the help of drugs (without opening the periosteum);
• surgical- Periostotomy (opening the periosteum with the installation of drainage).

Photo 2. Treatment of chronic fibrous periodontitis with the help of periostotomy. The patient opens the periosteum over the affected tooth.

Stages of therapy

1. During first visit the doctor takes a picture to study the number and patency of the dental canals. Local anesthesia is performed (lidocaine solution). The doctor opens the cavity of the affected tooth and cleans the canals with antiseptic solutions, after which it expands them to the optimal diameter, removing all damaged tissues, and performs temporary filling with the laying of channels with calcium-containing preparations.
2. At the second session (after 1 week), the temporary filling is removed and treat the channels with antiseptic solutions (chlorhexidine), after which lombirovat them permanent materials. A second picture is taken, then the outer part of the tooth is restored.

Attention! If during the second visit the patient complains of pain, permanent filling delayed by a few days leaving the tooth cavity open for rinsing with antiseptics.

According to another method, the tooth is not opened - instead make a small incision along the transitional fold, dissecting the periosteum, and install a rubber drainage, after which antibiotics are prescribed. After pain relief, a permanent filling is performed.

Exacerbation of chronic fibrous periodontitis

Aggravation manifested by persistent aching pain, aggravated by biting (eating), a person describes the sensation as "the feeling of a grown tooth."

Project

Chronic periodontitis

2. Protocol code: P-T-St-012

Code (codes) according to ICD-10: K04

4. Definition: Chronic periodontitis is a chronic inflammatory disease of periodontal tissues.

5. Classification:

5.1. Classification of periodontitis according to Kolesov et al. (1991):

1. Chronic periodontitis:

Fibrous;

Granulating

Granulomatous

2. Aggravated chronic periodontitis

6. Risk factors:

1. Acute or chronic inflammation of the pulp

2. Overdose or prolongation of the exposure of the action of devitalizing agents in the treatment of pulpitis

3. Periodontal trauma during pulp extirpation or root canal treatment

4. Removal of filling material beyond the apex of the root in the treatment of pulpitis

5. The use of strong antiseptics

6. Pushing the infected contents of the root canal beyond the root apex

7. Allergic reaction of periodontium to products of bacterial origin and medicines

8. Mechanical overload of the tooth (orthodontic intervention, overbite on a filling or crown).

7. Primary prevention:

A system of social, medical, hygienic and educational measures aimed at preventing diseases by eliminating the causes and conditions for their occurrence and development, as well as increasing the body's resistance to the effects of adverse factors in the natural, industrial and domestic environment.

8. Diagnostic criteria:

8.1. Complaints and anamnesis:

Complaints usually do not happen, the disease is asymptomatic. May occur as an outcome of acute periodontitis and as a result of the cure of other forms of periodontitis, may be the outcome of previously treated pulpitis, may occur as a result of overload or traumatic articulation.

May be asymptomatic. It usually arises from acute or may be one of the stages in the development of chronic inflammation. There may be slight pain (feeling of heaviness, bursting, awkwardness), slight pain when biting on an aching tooth. From the anamnesis, it can be found that these pain sensations are periodically repeated, there may be a fistula, a purulent discharge may be released from the fistula.

More often subjective and objective data are absent. Sometimes it can give symptoms of chronic granulating periodontitis.

Of the chronic forms, granulating and granulomatous periodontitis is more often exacerbated, fibrous - less often. Constant aching pain, soft tissue swelling, tooth mobility. There may be malaise, headache, poor sleep, fever.

8.2. Physical examination:

Chronic fibrous periodontitis. Percussion of the tooth is painless, there are no changes in the gingival mucosa in the area of ​​the diseased tooth.

Chronic granulating periodontitis. You can detect hyperemia of the gums in the causative tooth. There is a symptom of vasoporesis. On palpation of the gums, unpleasant or painful sensations occur. Percussion is painful. Often there is an increase and soreness of regional lymph nodes.

Chronic granulomatous periodontitis. More often subjective and objective data are absent.

Exacerbation of chronic periodontitis. Collateral edema of soft tissues, enlargement and soreness of regional lymph nodes, tooth mobility, painful palpation along the transitional fold in the area of ​​the diseased tooth.

8.3. Laboratory research: not held

8.4. Instrumental research:

– Sounding;

- percussion;

– X-ray methods of research

Chronic fibrous periodontitis. On the radiograph, you can detect the deformation of the periodontal gap in the form of its expansion at the root apex. There is no resorption of the bone wall of the alveolus and cementum of the tooth.

Chronic granulating periodontitis. On the radiograph, bone rarefaction in the region of the root apex with fuzzy contours or an uneven broken line that limits the granulation tissue from the bone.

Chronic granulomatous periodontitis. The radiograph reveals a small focus of rarefaction with clearly demarcated edges of a rounded or oval shape about 0.5 cm in diameter.

Exacerbation of chronic periodontitis. On the radiograph, the form of inflammation preceding the exacerbation is determined. The clarity of the boundaries of rarefaction of bone tissue decreases during exacerbation of chronic fibrous and granulomatous periodontitis. Chronic granulating periodontitis in the acute stage is manifested by a greater blurring of the pattern.

8.5. Indications for expert advice:

With multiple damage to the teeth by a carious process - a consultation with a dental surgeon, endocrinologist, therapist, otorhinolaryngologist, rheumatologist, gastroenterologist, nutritionist.

8.6. Differential Diagnosis:

Chronic periodontitis is differentiated with medium caries, deep caries, chronic gangrenous pulpitis.

9. List of basic and additional diagnostic measures:

Main:

– collection of anamnesis and complaints;

– external examination of the maxillofacial area;

- definition of bite;

– probing of the tooth;

- percussion of the tooth;

– thermal diagnostics of the tooth;

Additional:

- X-ray methods of research.

10. Treatment tactics: Foci of inflammation in the periodontium are a source of sensitization of the body, so the ongoing therapeutic measures should actively influence the focus of infection, preventing sensitization of the body.

The main principles of the treatment of periodontitis is the careful and careful mechanical processing of infected root canals, the treatment of the apical focus of inflammation until the exudation stops, followed by filling the canal.

The following treatments are used:

1. Instrumental method (including drug treatment);

2. Physiotherapeutic method (intracanal UHF, diathermocoagulation method, iontophoresis, electrophoresis, root canal depophoresis, laser, etc.);

3. Method of partial endodontic intervention (resorcinol-formalin method);

4. Surgical methods of treatment - root tip resection, hemisection, tooth replantation, coronoseparation.

10.1. Treatment goals: Stopping the pathological process, preventing sensitization of the body, restoring the anatomical shape and function of the tooth, preventing the development of complications, restoring the aesthetics of the dentition.

10.2. Non-drug treatment:

Oral hygiene education,

Professional teeth cleaning (by indications),

Opening of the cavity of the tooth

Mechanical treatment of the root canal,

Grinding fillings

The operation of resection of the apex of the tooth root according to indications,

Tooth replantation surgery according to indications,

Operation hemisection according to indications

Operation coronoseparation according to indications

10.3. Medical treatment(medicines registered in the Republic of Kazakhstan) :

Local anesthesia (anesthetics),

General anesthesia (according to indications) - (anesthetics),

Medical treatment of carious cavity,

root canal treatment,

Antiseptics (hydrogen peroxide, chlorphyllipt, chlorhexidine, etc.),

Enzyme preparations (trypsin, chymotrypsin, etc.),

Preparations containing iodine (iodinol, potassium iodide, etc.),

Analgesic and non-steroidal anti-inflammatory drugs,

Antimicrobials (antibiotics, sulfonamides, antihistamines, etc.),

Formaldehyde-containing preparations,

preparations based on calcium hydroxide,

Root canal filling

Retrograde root canal filling according to indications

Filling of the carious cavity (glass ionomer cements, composite filling materials (chemical and light curing)),

Root canal electrophoresis

Root canal depophoresis

Diathermocoagulation of the gingival papilla, canal contents

10.4. Indications for hospitalization: No

10.5. Preventive actions:

Hygienic education and training in oral hygiene;

The use of fluoride-containing toothpastes (with a deficiency of fluoride in water);

Rational nutrition (fortification, consumption of vegetables and fruits and dairy products, restriction of carbohydrate foods);

Sanitation of the oral cavity;

Carrying out remineralizing therapy;

Repeated annual examinations depending on the degree of activity of the carious process;

Preventive sealing of fissures and blind pits (fissuritis, etc.),

10.6. Further management, principles of clinical examination: Not held

11. List of basic and additional medicines:

Ambiguous interpretations of the forms of periodontal inflammation and the main methods of treatment have given rise to many classifications proposed by the world's leading experts in this field of dentistry.

Periodontitis is an inflammatory disease of the periodontium, i.e. connective tissues surrounding the root of the tooth.

It is necessary to classify periodontitis according to a number of features because, with different forms of the course of this disease, treatment tactics can have significant differences.

Origin Classification

Infectious

This form of periodontitis is the most common. The reason for its occurrence is the microflora, most often penetrating into the periodontium from the root canal through the apical foramen.

Other ways of infection are the marginal (marginal) periodontium (with deep periodontal and bone pockets) and the periodontium of the adjacent tooth (with the formation of a cyst of a significant size that has grown to involve the roots of neighboring teeth in the process).

Photo: Marginal and lateral periodontitis

The possibility of microflora entering the periodontal area with the blood flow is regarded by a number of doctors as unlikely and is usually allowed for periodontitis with an unexplained etiology (cause).

Traumatic

Occurs when the periodontium is exposed to a load that exceeds its physiological capabilities.

Such an overload can be acute and short-term (strike, bruise) or chronic (tooth overload with a protruding filling, fixed or removable prosthesis, in case of malocclusion, with bad habits - holding a smoking pipe with front teeth, etc.).

Periodontal injury depends not only on the intensity of the traumatic factor, but also on the state of the periodontium itself. If the periodontium is severely damaged or significantly lost, for example, due to periodontal disease, then even a normal, physiological load can become traumatic.

medical

Occurs when irritating effects on periodontal drugs. This may be the action of erroneously applied substances that are not intended for use in the oral cavity, or necessary preparations, but in violation of the required technology or recommended concentration.

Photo: Medicamentous (arsenic) periodontitis

Medical periodontitis can be caused by outdated methods of treatment (when treating canals according to Dubrovin with a solution of "aqua regia"), long-term application of arsenic pastes in the treatment of pulpitis.

If the technology of intracanal whitening is violated, undesirable complications in the form of periodontitis may also occur.

Traumatic and drug-induced periodontitis at first can behave as aseptic, but the easy accession of infection quickly translates these forms of inflammation into an infectious one.

Video: periodontitis

Classification of periodontitis according to ICD-10 (WHO)

The international organization approached the classification of periodontitis comprehensively. She proposed a classification that takes into account not only the acute or chronic course of the disease, but also the most common types of complications.

This approach to the examination and treatment of various forms of periodontitis helps to more fully influence all the mechanisms of the development of the pathological process, as well as to combine the actions of various specialists (for example, a dentist-therapist, a dentist-surgeon and an ENT).

In the ICD-10, periodontitis is designated in section K04 - diseases of the periapical tissues.

K04.4 Acute apical periodontitis of pulpal origin

Acute apical periodontitis is one of the classic variants, with a clearly defined cause and clinical manifestations. The primary task of the doctor is to remove the severity of the process, as well as the source of infection.

K04.5 Chronic apical periodontitis

Apical granuloma - there is a long-standing focus of infection. With a large size of the granuloma, surgical methods of treatment should also be considered, for example, resection, truncation of the root tip.

K04.6 Periapical abscess with fistula:

• dental
• dentoalveolar,
• periodontal abscess of pulpal origin.

Fistulas are divided depending on what the message is with:

• K04.60 Having communication [fistula] with maxillary sinus.
• K04.61 Having communication [fistula] with the nasal cavity.
• K04.62 Having communication [fistula] with the oral cavity.
• K04.63 Having communication [fistula] with skin.
• K04.69 Periapical abscess with fistula, unspecified

Photo: Fistula with communication with the oral cavity (left) and with the skin (right)

These diagnoses imply the possibility of close collaboration with ENT specialists. If there is a fistulous passage in the maxillary sinus, it will not do without sinusitis.

If the process is old, old, then it is quite possible that the fistula is also formed and after the elimination of the cause it will not resolve itself. Surgical excision should be considered.

K04.7 Periapical abscess without fistula

• dental abscess,
• Dentoalveolar abscess
• Periodontal abscess of pulpal origin,
• Periapical abscess without fistula.

K04.8 Root cyst

• K04.80 Apical and lateral.

Root cyst requires either long-term exposure or more drastic (surgical).

With conservative treatment, the cystic cavity should be drained, as well as the microflora that supports the growth of the cyst should be eliminated. In addition, it is necessary to destroy the inner lining of the cyst, allowing the restoration of bone tissue.

According to Lukomsky

Classification according to Lukomsky is by far the most popular in practical dentistry. With a small volume, it covers and characterizes all clinically significant forms of periodontitis, in the diagnosis and treatment of which there may be fundamental differences.

Acute periodontitis

Acute periodontitis is divided into:

• serous. Complaints of discomfort or soreness, aggravated by tapping on the tooth. There may be a feeling of distension. The intensity of complaints is gradually increasing. On examination, a large filling or a significant defect in the crown of the tooth is revealed, the probing and thermal test of which are painless.
• purulent. Complaints of severe, tearing, throbbing pain, which increases significantly at the slightest touch to the tooth (when closing the mouth). Swelling of the adjacent soft tissues is possible, as well as an increase and soreness of the nearest lymph nodes. Often, acute purulent periodontitis is accompanied by general disorders of the body: weakness, fever, chills.

Chronic forms of periodontitis may be the result of acute, but may also occur as initially chronic. Complaints are usually not expressed or very insignificant, for example, in the form of mild pain when tapping on the tooth.

The tooth may have a large filling or be severely decayed, often discolored.

The main method for diagnosing chronic periodontitis is radiography, it is also a method of differential diagnosis between individual forms of chronic periodontal inflammation.

Granulating

Radiographically, it is manifested by an uneven expansion of the periodontal fissure in the region of the apical foramen. The expansion does not have clear contours, the dimensions range from 1–2 to 5–8 mm.

Granulomatous

In the picture it looks like a rounded focus of destruction of the bone structure with clear, contrasting edges.

It can be located both in the region of the root apex, in contact with it, and border a significant part of the lower third of the tooth root. With further progression of the process, it develops into a periradicular cyst.

Fibrous

It manifests itself in the form of a uniform expansion of the periodontium, either only in the region of the root apex, or throughout its entire length. In this case, often the bone wall of the tooth socket does not show signs of destruction.

If such a process is observed in a tooth previously subjected to endodontic treatment, if there are no complaints and the condition of the root filling is not satisfactory, then treatment is not required.

Chronic in the acute stage

Clinically manifested as acute periodontitis, but has radiographic signs of chronic. Often accompanied by the appearance of swelling (periostitis) and / or the presence of fistulous passages with active purulent discharge.

Chronic periodontitis is a serious complication of untreated or untreated caries. It is a source of a very active microflora that can give both local complications (periostitis, osteomyelitis, abscesses and phlegmon of the maxillofacial region) and cause general harm to the body (sepsis).

Periodontal lesions are especially dangerous during pregnancy. Therefore, the task of each person is to prevent the appearance of any form of periodontitis and contact the dentist in a timely manner to provide qualified assistance.

RCHD (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan - 2015

Chronic apical periodontitis (K04.5)

Dentistry

general information

Short description

Recommended
Expert Council
RSE on REM "Republican Center
health development"
Ministry of Health
and social development
Republic of Kazakhstan
dated October 15, 2015
Protocol No. 12

Protocol name: Chronic periodontitis

Chronic periodontitis- chronic inflammatory disease of periodontal tissues.

Protocol code:

ICD-10 code(s):
K04.5 Chronic apical periodontitis

Abbreviations used in the protocol:
MMSI - Moscow Medical Dental Institute
EOD - electroodontodiagnostics
EOM - electroodontometry
EDTA - ethylenediaminetetraacetate
GIC - glass ionomer cement

Date of development/revision of the protocol: 2015

Protocol Users: dentist-therapist, general dentist, dentist.

Evaluation of the degree of evidence of the given recommendations.

Table - 1. Evidence level scale:

Classification

Clinical classification of periodontitis (MMSI, 1987) :

1. Acute apical periodontitis:
a) phase of intoxication;
b) exudation phase: serous, purulent

2. Chronic apical periodontitis:
a) fibrous;
b) granulating;
c) granulomatous;

3. Chronic apical periodontitis in the acute stage:
a) chronic apical fibrous periodontitis in the acute stage;
b) chronic apical granulating periodontitis in the acute stage;
c) chronic apical granulomatous periodontitis in the acute stage.

Clinical picture

Symptoms, course

Diagnostic Criteria for Making a Diagnosis[ 2, 3, 4, 5, 7 ]

Complaints and anamnesis[ 2, 3, 4, 5, 7 ] :

Chronic apical periodontitis characterized by poor symptoms.

Table - 2. Survey data

Physical examination:

Table - 3

Diagnostics

The list of basic and additional diagnostic measures:

Basic (mandatory) and additional diagnostic examinations performed at the outpatient level:

1. collection of complaints and anamnesis
2. general physical examination (external examination and examination of the oral cavity itself, probing the carious cavity, percussion of the tooth, palpation of the gums and transitional folds)
3. determination of the reaction of the tooth to thermal stimuli
4. EDI
5. radiography of the tooth.

The minimum list of examinations that must be carried out when referring to planned hospitalization: no

Basic (mandatory) diagnostic examinations carried out at the inpatient level (in case of emergency hospitalization, diagnostic examinations not performed at the outpatient level are carried out): no

Diagnostic measures carried out at the ambulance stageemergency care: No

Laboratory studies (according to indications): no.

Instrumental research:

Table - 4

Indications for expert advice: according to indications - consultation of a dental surgeon for periostotomy.

Differential Diagnosis

differential diagnosis.

Chronic forms of periodontitis are differentiated:
- between themselves,
- with chronic gangrenous pulpitis,
- with medium caries,
- with deep slowly progressive caries.

Chronic periodontitis in the acute stage is differentiated from acute periodontitis in the exudation phase, periostitis and acute osteomyelitis.

Table - 5. Differential diagnostic signs of chronic periodontitis

Treatment abroad

Get treatment in Korea, Israel, Germany, USA

Get advice on medical tourism

Treatment

Treatment goals:

stop the development of the pathological process;
Prevention of development of complications;
restoration of the anatomical shape and function of the tooth;
Avoid sensitization of the body.

Treatment tactics[ 6, 7, 8, 9, 10, 11, 12, 13 ] :

Treatment is carried out on an outpatient basis.
The following treatments are used:
1. Conservative method;
2. Surgical methods of treatment (according to indications - periostotomy).
According to the indications, premedication is carried out.

Table - 7. Treatment of chronic forms of periodontitis.

Table - 8 Treatment of chronic periodontitis in the acute stage.

*The number of visits depends on the choice of filling material for root canal obturation.

One visit treatment.
Indications:
- the presence of a fistulous passage in a single-rooted tooth,
- when performing a periostotomy in a single-rooted tooth.
Methodology: anesthesia, preparation of a carious cavity, opening of the tooth cavity, evacuation of pulp decay from the root canal, instrumental, chemical and antiseptic treatment of the root canal, permanent obturation of the root canal, x-ray control, imposition of a permanent filling.

Medical treatment:

Medical treatment provided on an outpatient basis:

Table - 9

Other types of treatment:

Other types of treatment provided at the outpatient level:
Physiotherapy treatment (electrophoresis).

Other types provided at the stationary level: No

Other types of treatment provided at the stage of emergency medical care: No

Surgical intervention:

Surgical intervention provided on an outpatient basis: periostotomy

Surgical intervention provided in a hospital: No

Treatment effectiveness indicators.
· satisfactory condition;
absence of pain
high-quality obturation of root canals;
restoration of the anatomical shape and function of the tooth.

Drugs (active substances) used in the treatment

Hospitalization

Indications for hospitalization: No

Prevention

Preventive actions:
training in oral hygiene;
professional oral hygiene;
timely sanitation of the oral cavity (treatment of caries and pulpitis of the teeth);
fluoridation of drinking water;
The use of fluoride-containing toothpastes (with a deficiency of fluoride in drinking water);
carrying out remineralizing therapy;
preventive sealing of fissures and blind fossae;
Comprehensive prevention of major dental diseases;
normalization of the mode and nature of nutrition;
rational prosthetics and orthodontic treatment;
dental education.

Further management: observation through 1; 3; 6 months.

Information

Sources and literature

1. Minutes of the meetings of the Expert Council of the RCHD MHSD RK, 2015
   1. List of used literature: 1. Order of the Ministry of Health of the Republic of Kazakhstan No. 473 dated 10.10.2006. "On approval of the Instructions for the development and improvement of clinical guidelines and protocols for the diagnosis and treatment of diseases." 2. Therapeutic dentistry: Textbook for medical students / Ed. E.V. Borovsky. - M.: "Medical Information Agency", 2011.-798s. 3. Therapeutic dentistry: Textbook / Ed. Yu.M.Maksimovsky. - M.: Medicine, 2002. -640s. 4. Nikolaev A.I., Tsepov L.M. Practical Therapeutic Dentistry: Textbook - M.: MEDpress-inform, 2008. - 960 p. 5. Periodontitis. Clinic, diagnosis, treatment: Textbook. Zazulevskaya L.Ya., Baibulova K.K. etc. - Almaty: Verena, 2007. -160 p. 6. Nikolaev A.I., Tsepov L.M. Phantom course of therapeutic dentistry. Textbook. Moscow: MEDpress-inform. 2014. -430 p. 7. Antanyan A.A. Effective endodontics. Moscow. 2015. 127 p. 8. Martin Trope. Guide to endodontics for general dentists. - 2005. - 70 p. 9. Lutskaya I.K., Martov V.Yu. Medicines in dentistry. - M.: Med.lit., 2007. -384s. 10. Stephen Cohen, Richard Burns. Endodontics.-S-P.- 2000.- 693s. 11. Muravyannikova Zh.G.// Fundamentals of dental physiotherapy. Rostov-on-Don.-2003 12. Krasner P, Rankow HJ. Anatomy of the pulp chamber floor. Journal of Endodontics (JOE) 2004;30(1):5 13. Witherspoon DE, Small JC, Regan JD, Nunn M. Retrospective analysis of open apex teeth obturated with mineral trioxide aggregate. J Endod 2008;34:1171-6. 14. Banchs F, Trope M. Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol J Endod 2004;196-2004. 15. Friedlander LT, Cullinan MP, Love RM. Dental stem cells and their potential role in apexogenesis and apexification. Int Endod J 2009;42:955-62.

Information

List of protocol developers with qualification data:
1. Yessembayeva Saule Serikovna - Doctor of Medical Sciences, Professor, Director of the Institute of Dentistry of the Kazakh National Medical University named after S.D. Asfendiyarov;
2. Bayakhmetova Aliya Aldashevna - Doctor of Medical Sciences, Professor, Head of the Department of Therapeutic Dentistry of the Kazakh National Medical University named after SD Asfendiyarov;
3. Sagatbayeva Anar Dzhambulovna - Candidate of Medical Sciences, Associate Professor of the Department of Therapeutic Dentistry of the Kazakh National Medical University named after S.D. Asfendiyarov;
4. Smagulova Elmira Niyazovna - Candidate of Medical Sciences, Assistant of the Department of Therapeutic Dentistry of the Institute of Dentistry of the Kazakh National Medical University named after SD Asfendiyarov;
5. Rayhan Yesenzhanovna Tuleutaeva - Candidate of Medical Sciences, Acting Associate Professor of the Department of Pharmacology and Evidence-Based Medicine of the Semey State Medical University.

Indication of no conflict of interest: No

Reviewers:
1. Zhanalina Bakhyt Sekerbekovna - Doctor of Medical Sciences, Professor of RSE on REM West Kazakhstan State Medical University. M. Ospanova, Head of the Department of Surgical Dentistry and Pediatric Dentistry;
2. Mazur Irina Petrovna - Doctor of Medical Sciences, Professor of the National Medical Academy of Postgraduate Education named after P.L. Shupika, Professor of the Department of Dentistry of the Institute of Dentistry.

Indication of the conditions for revising the protocol: revision of the protocol after 3 years and / or when new methods of diagnosis and / or treatment with a higher level of evidence appear.

Attached files

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