FEATURES OF INCINAL ANESTHESIA IN THE TREATMENT OF ACUTE PERIODONTITIS OF THE FRONTAL TEETH OF MAXILLA IN ADOLESCENT CHILDREN

Actuality. Currently, the problem of treatment of acute forms of periodontitis, especially in children, is related to the use of anesthetic care against the background of increased stress factors and lability of the nervous system. The works of many authors have proven that after conducting incisor guide anesthesia, anesthesia occurs not only of the soft tissues of the anterior third of the palate, but also of the pulp of the incisors, which is especially important when extirpating the pulp and exposing the pulp chamber. Today, many authors recommend using incisive conductor anesthesia as a monomethod of pain relief for incisors, but this technique has not been widely used in practical health care. Some authors prove the effectiveness of the additional use of incisive conduction anesthesia when infiltration is insufficient. It should be noted that the data analysis has a contradictory character without the presence of a single dominant opinion regarding the combined method of using conductive and infiltration anesthesia, especially in adolescents with an odontogenic inflammatory process. 
The purpose of the study: to investigate the anesthetic effect with the combined use of infiltration and incisive conductor anesthesia in the treatment of acute periodontitis of the frontal group of teeth on the upper jaw in children of the adolescent period. 
Materials and methods. The archival data of cone-beam computed tomography of 25 patients on a Planmeca tomograph were studied. Outpatient treatment of 65 patients diagnosed with acute serous and acute purulent periodontitis was carried out. To anesthetize the central or lateral incisor from the side of the causative tooth, infiltration anesthesia with "Ultracain" (4% solution) was performed in the canine area of the maxilla, creating a depot of anesthetic 2-5 mm from the focus of inflammation and blocking the anterior upper alveolar nerves. The VAS (Visual Analog Scale) and the Numerical Rating Scale (NRS) were used to assess pain intensity. 
The results. According to the tomography results, we have found the following features: the incisive canal begins with two separate nasopalatine openings, which open in the front part of the bottom of the nasal cavity on both sides of the nasal septum, with the merging of the two canals into one incisive canal, which looks like a slingshot on the tomogram. The incisor foramen is located behind the central incisors of the upper jaw by 7-8 mm in girls and 8-9 mm in boys, immediately under the incisor papilla. Based on the results of X-ray studies, we established several forms of the channel. In 75-80% of cases, the incisive canal has the shape of an "eight", less often it is found in the form of a funnel and, in two cases, a cylinder. The length from the top of the incisive papilla to the narrowing of the incisive canal is 9.0-10.5 mm in girls and 10.0-11.7 mm in boys. 
In 58% of cases, on the tomogram, we have found the relationship between the alveolar canals and the incisive canal. At the level of the bottom of the nose, the microcanals of the anterior superior alveolar nerves connected with the incisor canal, in 22% of cases opening in the anterior third of the palate through independent openings. According to the obtained data, the combination of analgesia used allows the intervention to be completely painless in 82-87% of cases. In 4% of cases, patients complained of painful sensations, there was no need for additional analgesia. In 3% of cases (75% of cases in girls), endodontic treatment was painless, but at the same time, during the opening and drainage of the infiltrate in 5% of cases, additional infiltration anesthesia was performed. Immediately after incisive conduction anesthesia in 75% of cases, patients felt numbness of the nasal cavity, especially its lower third. When re-examining in 40% of cases, patients noted discomfort in the area of the incisor papilla. 
Conclusions. The use of a combination of infiltration anesthesia and incisive conductor anesthesia allows achieving full analgesia of the pulp and periodontal tissues in the treatment of acute periodontitis of the frontal group of teeth.