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Background. Inflammatory process in periapical tissues causes tooth extraction in more than 50% of cases. The development of chronic apical periodontitis can be triggered by an intracanal infection in undetected/missed root canal of the mandibular molars. The morphology of mandibular molars is distinguished by additional canals in the mesial root in some cases. Different studies reveal the middle mesial canal in 4.5% to 26% of cases with quite high incidence in youth. The dental therapy has been searching for effective approaches to diagnosis and treatment of chronic periodontitis, enabling the focus of chronic inflammation to be eliminated and the tooth to be saved. Case descriptions. The paper presents clinical cases of patients with destructive changes in bone tissues in the periapical region of the mesial root in mandibular molars. The developing of this pathology is associated with missed anatomy in the mesial root during primary endodontic treatment. The patients underwent clinical examination consisting of basic methods (interview, examination) and additional techniques (intraoral radiography). An additional middle mesial canal in the root of the mandibular molar was identified taking into account the complex morphology of the root system of the tooth and verified by its careful analysis and radiography. The final clinical diagnosis, chronic apical periodontitis (K04.5), was made following the obtained diagnostic results and the ICD-10 classification. Diagnostic examination and endodontic retreatment were performed using a dental operating microscope. Conclusion. An operating dental microscope provides visualization of microscopic anatomotopographical details, promoting the efficiency of diagnosis and treatment of chronic apical periodontitis in mandibular molars. Using dental microscope facilitates systematization of the data obtained during the examination, making a final clinical diagnosis, and development of a reasonable personalized treatment plan focused on detecting an additional middle canal in the mesio-buccal canal of the mandibular molar. Due to the suggested approach, the long-term outcomes of endodontic treatment can be an objective assessed in dynamics, thereby improving the quality of treatment for chronic apical periodontitis in patients.

Aims. To analyse the impact of electromagnetic oscillations in the sound range on diffusion the 3.25 % solution of sodium hypochlorite in the dentine of the tooth root.Materials and methods. A pilot study on diffusion of 3.25% of solution of sodium hypochlorite with dye fuchsine red was executed on 100 extracted teeth of the person. The control group was made by 40 teeth, the introduction of an antiseptic was conducted without use of sound waves. The main group of 60 teeth was divided into 3 subgroups. For the purpose of intensifying of the penetration of an antiseptic in each subgroup, electromagnetic oscillations (frequency range around 20,000 Hz) were applied with exposition time respectively 1 minute, 2 minutes, 3 minutes.Results. Application of sound waves in the canal of a tooth root led to augmentation of penetration of an antiseptic in the system of dentinal canaliculus and microchannels of the tooth root dentine.Conclusions. This process took place most effectively in single-root teeth when exposed to sound vibrations, smaller efficiency is revealed in multirooted teeth that indicates the difference in physical properties of the tissues of the various groups of the teeth.

Aim. To evaluate the effectiveness of antibacterial treatment of root canals in chronic apical periodontitis with an erbiumchromium laser.Materials and methods. Group I consisted of 16 patients – antibacterial treatment of root canals was carried out with 10 ml of 3% solution of sodium hypochlorite «Belodez». Group II – 29 patients – antibacterial treatment was carried out with an erbium-chromium laser Waterlase MD in the following mode: wavelength – 2780 nm, power – 1.5 W, pulse duration – 140 μs, frequency – 40 Hz. Antibacterial efficacy was assessed by the results of microbiological studies of samples from the root canal before and after antibacterial treatment. Results. During antibacterial treatment with an erbium-chromium laser, a statistically significant decrease in the concentration of Escherichia coli, Staphylococcus aureus, Moraxella lacunata, Actinomyces israelii, Streptococcus mutans, Corynebacterium xerosis occurred in comparison with the control group.Conclusions. The dynamics of clinical signs in patients of the two groups indicates the anti-inflammatory effect of the Waterlase MD erbium-chromium laser, which confirms a pronounced antibacterial effect against Escherichia coli, Corynebacterium xerosis, Actinomyces israelii, Streptococcus mutans, Staphylococcus aureus, Moraxella lacunata.