RU2662143C1 - Method for improving trophic processes in gingiva and increasing duration of remission in patients with moderate chronic generalized periodontitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to dentistry, and can be used for improving trophic processes in gingiva and increasing the duration of remission in patients with moderate chronic generalized periodontitis. For this purpose, apparatus Vector is used and a tooth root is polished using the Vector Fluid Polish suspension, and pharmacological preparations for oral administration are also administered. Ozonized distilled water with an ozone concentration of 35 mg/l is used when processing with apparatus Vector. Each tooth is processed for a minute, pressing the foot pedal of the apparatus 36–38 times.

EFFECT: method provides improved gingiva trophism, relief of inflammatory reactions, control of gingival bleeding, improved patients' life quality as a result of elimination of discomfort and xerostomia, prolonged remission period due to the simultaneous effect of gingival pocket sanitation, polishing and grinding with shortened tooth treatment time and reduced amount of the sanitizing liquid and polishing suspension, reduced tooth treatment time as a result of the optimal exposure mode.

1 cl, 2 ex, 2 tbl

Description

The invention relates to medicine, namely to dentistry, and can be used to treat patients with moderate generalized chronic periodontitis.

Known methods for increasing the bases of the relapse period for up to one year in patients with chronic generalized periodontitis (US Pat. RU No. 2550957, publ. 05.20.2015). The authors propose the use of a HELBO 2075 F / Theralite therapeutic diode laser with HELBO Blue Photosensitizer photosensitase, and after laser treatment, an adhesive gum dressing is applied to the affected area of the periodontium using Melaxen antioxidant, Kalanchoe juice, glucosamine hydrochloride , dimethyl sulfoxide, aqueous dentin and solcoseryl dental adhesive paste in certain quantities.

The method requires the use of a large number of medications, herbal components. The preparation of the composition is time-consuming, allergic reactions to its components are possible.

The introduction of new drugs into clinical practice, along with a certain increase in the effectiveness of treatment of periodontal diseases, contributes to an increase in cases of allergic reactions and other side effects, and does not solve the problem of obtaining persistent and prolonged remission of the disease. (http://naukaru.ru/app/uploads/docs/2016-12-27/eaed2c5b2ef8b772b166fbec468f4a37.pdf p. 198).

 In this regard, it seems relevant to use non-pharmacological methods of treatment of inflammatory periodontal diseases (CDW). One such method is the use of ozone. Unlike antibiotic therapy, it has no side effects. It can be recommended for patients with intolerance or ineffectiveness of therapy using other methods. In clinical practice, it is more often used as a local therapy to treat a periodontal pocket. It is known to use ozonated physiological saline solution of sodium chloride, ozonated water, applications with ozonated olive oil. It was shown that ozone has a pronounced antimicrobial activity. (http://www.dslib.net/stomatologia/ispolzovanie-imudona-i-medicinskogo-ozona-v-kompleksnom-lechenii-vospalitelnyh.html, Bezrukova, I.V. Ozone therapy in periodontal practice / I.V. Bezrukova, N. B. Petrukhina. - M.: Medical News Agency, 2008. - 88 p. 616.31 B-405 / h, https://books.google.ru/books?isbn=5000900170 c.6-10).

However, when applied topically, ozone has only a superficial effect and does not affect trophism of bone tissue and periodontal tissues in general, which is a drawback of this technique.

Periodontitis is caused and supported by the vital products of the bacterial microflora, which is part of the biofilm, which is an accumulation of microorganisms in a matrix attached to the surface of the tooth. Therefore, the treatment of periodontitis begins with the mechanical removal of plaque and deposits on the surface of the tooth and the removal of biofilms, for which hand tools and ultrasound devices are used. In this field, the Durr Dental hardware complex (Vector) (http://dentalgroup-company.ru/Vector-vektor-paradontologicheski), which removes biofilm, plaque, tartar, endotoxins, granulation, has proven itself well. tissue, de-epithelization of the inner wall of the periodontal pocket, polishing of the root without excessive removal of cement, which is important for the regeneration of tissue structures, as well as the rapid and effective elimination of bacteria that cause the disease. Thanks to the gentle work of "Vector", long-term preservation of the treated root surfaces and surrounding soft tissues is achieved, as well as maintaining periodontal tissues in remission. The "Vector" apparatus has a number of advantages over other ultrasound systems (skeletons), such as atraumaticity, efficiency in anatomically difficult areas, which is achieved by various shapes of nozzles; root polishing, painless procedure, due to the desensitizing effect of the suspension; due to the absence of oscillatory movements of the instruments, it is possible to completely avoid the formation of an infected aerosol cloud and to prevent the spread of infection.

It is known to use the “Vector” apparatus for the prevention of periodontitis, peri-implantitis (Degtyareva V.I. Special method “vector - system”. Effective and non-invasive struggle with periodontitis at a professional level / Degtyareva V.I. UGRA HEALTHCARE: experience and innovations No. 3 2016 .-- S. 17-20). When using the “Vector” apparatus, the ultrafine particles of hydroxyapatite (a medicinal substance that stimulates bone restoration) optimize polishing and reduce the painful sensitivity of the tooth after treatment. The pathological gingival pocket is washed extensively with water treated with ultrasound, but without the formation of an aerosol. The bacterial content is sharply reduced due to hydrodynamic effects that do not cause damage to the soft tissues of the oral cavity. The author claims that the use of the "Vector" system in the clinical practice of a dentist has the best results compared to other methods of treatment of periodontal diseases, causing persistent remission during the year.

However, it follows from other clinical experience that the positive effect of the treatment is not persistent, many authors note that its antimicrobial effect is insufficient, which entails short periods of disease remission.

EFFECT: improved trophism of gum tissue by stopping inflammatory reactions, eliminating bleeding of gums, improving the quality of life of patients by eliminating unpleasant sensations and dry mouth, as well as manifestations of allergic reactions and other effects of traditional drug therapy, reducing the regimen and duration of dental treatment.

Using the proposed method improves the treatment of chronic generalized periodontitis, increases the timing of remission, relieves the inflammatory process in periodontal tissues in a short time.

It is possible to use the method for the treatment of persons who do not tolerate pharmacotherapy and have a history of polyvalent allergic reactions and concomitant diseases.

The technical result is achieved by ozonation of distilled water using the ozonizer UOTA-60-01 "Medozon" (http://www.medozone.ru/products/uota/uota-manual.pdf s22-33)

Distilled water is poured into a glass bottle with a rubbed rubber cap, then, following the instructions, the ozonation time is set to 5 minutes and the ozone concentration is 35 mg / l. Due to the constant decomposition of ozone in the vial, it is recommended to ozonize the solution immediately before its introduction to the patient.

Ozonated distilled water is poured into a container located under the front cover of the Vector apparatus (www.novodent.ru/files/instructions/17_Instruction%20Vector.pdf p. 23-27)

Each tooth is treated for a minute, making 36-38 presses on the foot pedal of the "Vector", which is 3.3 ml of solution. This time is enough for polishing the root and antiseptic processing of the periodontal pocket when using ozonated distilled water and working with the appropriate nozzle in accordance with the tooth belonging to a certain group. The dentist’s movements are linear, parallel to the root surface, while removing biofilm and granulation, polish the root. A steam-direct probe was used to process the vestibular, lingual and palatine surfaces of incisors and canines, a parolance - to process the same surfaces in premolars and molars, and a parocurette - the most effective nozzle for processing the approximate surfaces of all teeth.

The treatment method was carried out in 91 patients - the main group in which ozonated distilled water supplied from the Vector apparatus was used to treat the surface of the teeth and oral cavity.

 The group included 48 women and 43 men with a moderate course of periodontitis. The age of patients is from 19 to 70 years.

To confirm the technical result, a control group of patients with chronic generalized periodontitis of an average degree of 60 people, 20 men and 40 women aged 19 to 70 years, who used 0.05% solution of chlorhexidine bigluconate for antiseptic treatment of the oral cavity, was created.

All patients in both groups were polished and polished with abrasive paste using brushes and rubber heads. Next, stripping and flossing were performed. Patients were interviewed on proper oral hygiene. Effective brushing techniques were shown on the layout. Individually selected oral hygiene products, such as a toothbrush, toothpaste, and rinse aid. Then the patients were prescribed general treatment - antibacterial - metronidazole 250 mg 1 tablet 2 times a day - 5 days, desensitizing - clarithin 1 tablet at night - 5 days, stimulating - ascorutin 1 tablet 2 times a day - 21 days.

Patients of the main group underwent therapy with ozonated distilled water using the "Vector" apparatus. In patients of the control group, the Vector apparatus was also used, but distilled water was not ozonized. After treatment with the “Vector” apparatus with distilled water, a periodontal pocket from a 5 ml syringe was irrigated at the rate of 3.5 ml per tooth with ozonated distilled water and an antiseptic treatment of the oral cavity with a 0.05% solution of chlorhexidine bigluconate was performed.

To assess the quality of treatment according to the timing of the disappearance of the manifestations of inflammation in the periodontal tissues, a clinical examination was used, including a survey of patients, clarification of complaints, visual examination of the oral cavity. For a more detailed study of periodontium, a cytobacterioscopic examination, stomatoscopy, index, laboratory, radiological and mathematical assessments were used (table 1).

Table 1

Index indicators in patients with chronic generalized periodontitis of moderate degree at the time of the initial examination. (Medians and the 25th and 75th quartiles), (n = 151).

Index The proposed method (n = 91) The known method (n = 60) RMA 39.4 (32.8; 44.9) 39.9 (35.0; 45.1) Hygiene Index (IG) 1.8 (1.2; 2.1) 2.0 (1.6; 2.0) Periodontal Index (PI) 2.7 (2.1; 3.1) 3.1 (2.8; 3.5) Bleeding index 2 (2; 3) 2 (2; 3) Dentoscopy 3 (2; 3) 3 (2; 3)

As can be seen from the material of table 1, the initial level of the clinical condition of periodontal disease in patients of both groups did not have statistically significant differences. The values of the PMA index corresponded to moderate gingival inflammation (39.9 (32.8; 45.1)), the Russell index (PI) - to the middle phase of the inflammatory process in the periodontium (3.7 (2.1; 3.5)), the hygiene index (IG) was high - 1.6 (1.2; 2.1), which characterized unsatisfactory oral hygiene, the bleeding index corresponded to 2 (2; 3), which was characterized by bleeding during probing - the gingival sulcus was quickly filled with blood. During stomatoscopy, the 3rd degree of iodine positivity was determined, which characterized severe inflammation in the periodontal tissues.

A comparative assessment with the traditional methodology used in patients of the control group revealed the advantage of the proposed technology - ozonated distilled water using the "Vector" apparatus. The rapid elimination of inflammatory phenomena and bleeding gums in patients of the main group took place on the day of the visit or the next day. Already on the second day after the start of treatment, most patients noted a significant improvement in the state of the gums, namely a decrease in swelling of marginal periodontal disease, a decrease in the activity of periodontal exudate formation. Patients noted a decrease in gum itching and a feeling of comfort. The effects persisted in follow-up examinations after a week, three, six and twelve months.

We attribute this to the fact that the method of applying the antiseptic solution from the syringe is uneven, the pressure of the supplied solution is difficult to control, irrigating the periodontal pocket. We have developed an optimal regime for irrigating periodontal pockets with ozonated water using the “Vector” apparatus. The continuous flow of the solution is controlled by foot pressing the pedal. When processing one tooth within a minute, 36-38 clicks are required, which is 3.3 ml of solution. This allows for uniform and optimal irrigation of the periodontal pocket with simultaneous polishing of the root with a suspension of “Vector polish fluid”, which leads to recovery and persistent remission of the disease for up to a year.

After the treatment, the expected results were obtained in the control group, which are confirmed by reports of several authors and our studies. In the main group, new effects were revealed: when distilled ozonated water was used in the Vector apparatus, it became possible to reduce the periodontal pocket treatment time to a minute, bleeding by the end of the first visit was not registered, the disease remission lasts up to one year, allergic and other side reactions were avoided. (table 2).

table 2

Dynamics of index and cytobacterioscopic indices in patients with moderate generalized periodontitis at various times after treatment, M ± m, (n = 151)

indicator Known method The proposed method Acute period 7 days 6 months Acute period 7 days 6 months IG 1.9 ± 0.5 0.6 ± 0.1 * 0.8 ± 0.1 * 1.7 ± 0.6 0.6 ± 0.2 * 0.6 ± 0.1 * RMA 38.8 ± 7.5 7.5 ± 3.5 * ^ 21.5 ± 8.9 * ^ 39.1 ± 7.2 2.2 ± 1.1 * ^ 8.3 ± 4.6 * ^ Bleeding index 1.9 ± 0.6 0 * 1.1 ± 0.5 * ^ 2.2 ± 0.7 0 * 0 * ^ PI 3.2 ± 0.5 2.3 ± 0.6 * ^ 2.2 ± 0.7 ^ 3.1 ± 0.6 1.5 ± 0.5 * ^ 1.4 ± 0.4 * ^ Dentoscopy 2.6 ± 0.5 1.5 ± 0.5 * 2.0 ± 0.3 ^ 2.6 ± 0.5 1.0 ± 0.2 * 1.3 ± 0.5 * ^ macrophage 2.3 ± 0.5 0 * 1.0 ± 0.4 ^ 2.3 ± 0.5 0 * 0 * ^ neutrophil 17.9 ± 3.0 7.6 ± 2.5 * ^ 13.6 ± 2.6 ^ 17.8 ± 2.8 3.8 ± 1.1 * ^ 5.1 ± 1.7 * ^ lymphocyte 4.8 ± 1.1 1.1 ± 1.0 * 3.3 ± 1.4 ^ 4.8 ± 1.5 0.5 ± 1.0 * 1.0 ± 1.1 * ^ Gr. candida 10.7 ± 2.4 6.1 ± 2.1 * ^ 5.5 ± 1.5 * ^ 11.8 ± 2.0 2.9 ± 1.1 * ^ 3.6 ± 1.1 * ^ Cocci flora 2.0 ± 0.6 0 * 0.9 ± 0.3 ^ 1.9 ± 0.6 0 * 0 * ^

* - indicators are statistically distinguishable from indicators of the acute period (p <0.05)

^ - indicators are statistically distinguishable from indicators between groups (p <0.05)

Assessing index and cytobacterioscopic indicators, the following conclusions can be made. On the 7th day, the IG in patients of both groups was comparable and corresponded to good oral hygiene, while after 6 months in patients in the control group it increased and corresponded to satisfactory oral hygiene, in patients of the main group it still corresponded to the level of good hygiene. On the 7th day, RMA decreased 5.2 times in the control group and 17.7 times in the main group, which indicates a more effective relief of inflammation. After 6 months, in patients of the control group РМА = 21.5 ± 8.9, which corresponded to a mild degree of periodontitis, and in patients of the main group РМА = 8.3 ± 4.6, which was regarded as a minor point inflammation, which does not have statistical values. On the 7th day, gum bleeding was absent in patients of both groups. After 6 months, bleeding was observed in patients of the control group when probing the periodontal pocket. In the main group, at the same time of observation, the bleeding index was zero, which confirms the absence of inflammation and indicates persistent remission of the disease. PI on the 7th day with the control group decreased 1.4 times, and in the main group 2.1 times. Thus, the degree of involvement of periodontal structures in the pathological process decreases to a greater extent in the main group. These indicators were recorded after 6 months. When viewed after an extended gingivoscopy, the area of inflammation decreased from 90% to 20% on the 7th day in both groups. These levels remained in the main group for six months; in the control group, an increase in indicators was noted to a level comparable to the initial examination.

The level of cytobacterioscopic indicators confirms the conclusions drawn from the study of index indicators. The absence of macrophages and coccal flora on the 7th day confirms the relief of inflammation. In the main group, stable remission was recorded upon examination after 6 months. In the control group, the indicators of inflammation increase and by the 6th month retreatment is required.

On the 7th day in both groups, lymphocytes are single, which indicates the relief of inflammation. When examining the patients of the control group at 6 months, the number of lymphocytes increased (3.3 ± 1.4), which cannot be said about the patients of the main group, in which these indicators did not statistically change.

Thus, based on the results of clinical and laboratory parameters of the patients treated by us, it can be concluded that the use of ozonated distilled water and the Vector apparatus is an effective and reliable method of treating patients with moderate generalized periodontitis, which leads to fast and stable remission of the disease up to a year, reducing the duration of the procedure.

When assessing the microbial status of the periodontal pocket in patients who underwent therapy according to the proposed methodology, positive dynamics were revealed in terms of normalizing cytological parameters, fast positive dynamics of microbiological monitoring, a significant decrease in insemination of Candida genus in comparison with the data in patients of the control group.

In addition, the practical absence of pain in patients with the use of the "Vector" system helps to increase the motivation for carrying out maintenance treatment as part of secondary prevention of CDW using this technology.

Clinical example 1

Patient K., aged 42, turned to a dental clinic complaining of bleeding gums, bad breath and the presence of dental plaque. According to an objective examination, cytobacterioscopic analysis, and X-ray examination, he was diagnosed with K05.3 Chronic generalized periodontitis of moderate degree and treatment was prescribed: general treatment - antibacterial - metronidazole 250 mg 1 tablet 2 times a day - 5 days, desensitizing - clarithin for 1 tablet at night - 5 days, stimulating - ascorutin 1 tablet 2 times a day - 21 days, topically - rinse in the morning and evening with an oral cavity of 0.05% chlorhexidine solution - 5 days. Professional oral hygiene was performed using ultrasonic and sandblasting machines. For antiseptic treatment of the oral cavity, a 0.05% solution of chlorhexidine bigluconate was used. After the procedure, the patient noted discomfort in the oral cavity in the form of a bitter aftertaste, a burning tongue, an uncomfortable state after antiseptic treatment, and dry mouth. The next day, the patient complained of a burning tongue, discoloration of fillings and teeth in the oral cavity, which was confirmed by an objective examination. On this day, they carried out therapy using the Vector apparatus with distilled water without ozonation and subsequent antiseptic treatment of periodontal pockets from a syringe with ozonated distilled water. On examination after a week, the patient also complained of discomfort and dry mouth, burning tongue

Clinical example 2

Patient N., 44 years old, came to the dental clinic complaining of bleeding gums, halitosis and the presence of dental plaque. According to an objective examination, cytobacterioscopic analysis, and X-ray examination, he was diagnosed with K05.3 Chronic generalized periodontitis of moderate degree and treatment was prescribed: general treatment - antibacterial - metronidazole 250 mg 1 tablet 2 times a day - 5 days, desensitizing - clarithin for 1 tablet at night - 5 days, stimulating - ascorutin 1 tablet 2 times a day - 21 days. Professional oral hygiene was performed using ultrasonic and sandblasting machines. For antiseptic treatment of the oral cavity, an ozonated solution of distilled water at a concentration of 35 mg / L was used using the Vector apparatus. After the procedure, the patient noted a pleasant sensation of freshness in the oral cavity. The next day, the patient did not complain. Repeatedly carried out therapy with ozonated water apparatus "Vector". On examination after a week, the patient’s gum condition returned to normal, which is confirmed by cytobacterioscopic and index indicators. A follow-up examination after six months showed a good periodontal condition, the absence of signs of a pronounced inflammatory reaction. The patient did not complain.

Thus, we have developed a method that includes new steps: treating the gingival pockets with ozonated distilled water using the Vector apparatus for a minute in the amount of 3.3 ml of solution per tooth, which made it possible to obtain a new result not known from the prior art: stopping inflammatory reactions for more than one year due to improved trophism of gum tissue, elimination of bleeding gums, improved quality of life for patients by eliminating unpleasant sensations and dry mouth, as well as allergic manifestations reactions and other effects of traditional drug therapy. The method allows to significantly reduce labor costs in the treatment of the patient by reducing the mode and duration of dental treatment.

Claims (1)

A method for improving trophic processes of the gums and increasing the duration of remission in patients with moderate chronic generalized periodontitis, including the use of the “Vector” apparatus, polishing the root with a suspension of “Vector polish fluid” and prescribing pharmacological preparations for oral administration, characterized in that when treated with the “Vector” apparatus "Use ozonated distilled water with an ozone concentration of 35 mg / l, each tooth is treated for a minute, making 36-38 pressing the foot pedal of the" Vector "apparatus.