Contemporary therapeutic approach in the treatment of pulpal-periodontal disease

Pulpo-parodontne bolesti patološka su stanja koja istovremeno zahvaćaju zubnu pulpu i parodont. Zbog bliske povezanosti zubne pulpe i parodonta patološka stanja lako se šire s jedne cjeline na drugu. Uzročnici bolesti mogu biti mikrobnog i nemikrobnog podrijetla. Mikrobnog podrijetla su bakterije, virusi ili gljivice, dok su nemikrobni uzroci loše endodontsko liječenje, traume, a rjeĎe razvojne i druge anomalije zuba. Pretpostavka za učinkovito liječenje je, uz dobro poznavanje endodontskih postupaka, osiguranje kvalitetnih dijagnostičkih pomagala (digitalni rtg, CBCT), kvalitetnog instrumentarija, ali nadasve sredstava za dezinfekciju tretiranog područja. Uz konvencionalna sredstva, dostupna u svakoj ordinaciji, moguća je i upotreba hladne atmosferske plazme i ozona koji su za sada nedovoljno istraţeni, no objavljeni radovi daju naznake kvalitetnog pomaka u liječenju pulpo-parodontne bolesti. Hladna atmosferska plazma definira se kao djelomično ionizirani plin graĎen od različitih dijelova kao što su elektroni, pozitivni i negativni ioni, slobodni radikali, fotoni uz ostale sastavnice plazme. Visokofrekventni generator Ozonyx (Biozonix, München, Njemačka), proizvodi visokofrekventno električno polje (rezonantna frekvencija 30–50 kHz, impuls frekvencije 470–1050 Hz, napon 3–18 kV, jakost struje 100 μA). Intenzitet aktiviranog plazma polja moţe se mijenjati na različite nivoe a moţe se rabiti kao primarna terapija ili nadopuna drugim vrstama terapija.Pulpal-periodontal diseases are pathological conditions that simultaneously spread to the dental pulp and periodontium. Due to the close connection of the dental pulp and periodontium, pathological conditions are easily spread from one structure to the other. The causes of the disease can be microbial and non-microbial. Bacteria, viruses or fungi are microbial origin, while the non-microbial causes are poor endodontic treatment, trauma, and rarely developmental and other anomalies of the teeth. The prerequisite for effective treatment is, with the good knowledge of endodontic procedures, the provision of quality diagnostic aids (digital X-ray, CBCT), quality instrumentation, but above all the disinfectants used in the treated area. Along with the conventional agents available in each clinic, cold atmospheric plasma and ozone can be used, which have not been studied enough for now, but the published papers show signs of quality shift in the treatment of pulpal-periodontal disease. Cold atmospheric plasma is defined as partially ionized gas composed of various components such as electrons, positive and negative ions, free radicals, photons and other components of the plasma. The high freqency generator Ozonyx (Biozonix, München, Germany), produces a high frequency electrical plasma field (resonant frequency 30 – 50 kHz, impuls frequency 470 – 1050 Hz, trigger voltage 3–18 kV, current 100 μA). Activated plasma field can be adjusted in different levels and can be utilized as a primary therapy or as a support to other types of therapies