MD1096Z - Method of treatment of severe form of chronic marginal periodontitis - Google Patents
Method of treatment of severe form of chronic marginal periodontitis Download PDFInfo
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- MD1096Z MD1096Z MDS20160065A MDS20160065A MD1096Z MD 1096 Z MD1096 Z MD 1096Z MD S20160065 A MDS20160065 A MD S20160065A MD S20160065 A MDS20160065 A MD S20160065A MD 1096 Z MD1096 Z MD 1096Z
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Abstract
Description
Invenţia se referă la medicină, în special la stomatologie şi poate fi utilizată pentru tratamentul formei grave de parodontită cronică marginală. The invention relates to medicine, in particular to dentistry, and can be used for the treatment of severe form of chronic marginal periodontitis.
Este cunoscută metoda de tratament al afecţiunilor inflamatorii ale parodonţiului, care constă în prelucrarea ţesuturilor cavităţii bucale prin spălături sau irigări cu soluţie apoasă sau cu soluţie fiziologică, care conţine amestec de ozon şi oxigen, timp de 2…5 zile cu o cantitate de 50…150 mL, amestecul de ozon şi oxigen obţinându-se prin barbotarea în apă sau soluţie fiziologică a ozonului şi oxigenului cu viteza curentului de 1 L/min, timp de 8…10 min, unde concentraţia ozonului este de 2000 µg/L [1]. The method of treating inflammatory periodontal diseases is known, which consists of processing the tissues of the oral cavity by washing or irrigation with an aqueous solution or physiological solution containing a mixture of ozone and oxygen, for 2…5 days with a quantity of 50…150 mL, the mixture of ozone and oxygen being obtained by bubbling ozone and oxygen in water or physiological solution with a flow rate of 1 L/min, for 8…10 min, where the ozone concentration is 2000 µg/L [1].
De asemenea este cunoscută metoda de tratament al afecţiunilor inflamatorii ale parodonţiului, care constă în aceea că substanţa medicamentoasă până la întrebuinţare se barbotează timp de 1…2 ore cu un amestec de ozon şi oxigen, care conţine 2000…3000 µg/L de ozon, totodată în calitate de substanţă medicamentoasă se utilizează ulei vegetal, şi se administrează sub formă de aplicaţii a câte 10 mL pe fiecare jumătate de maxilar sau în instilaţii a câte 0,9…1,0 mL în fiecare pungă gingivală afectată timp de 6...8 zile [2]. Also known is the method of treating inflammatory periodontal diseases, which consists in the fact that the medicinal substance is bubbled for 1...2 hours with a mixture of ozone and oxygen, containing 2000...3000 µg/L of ozone, before use, while vegetable oil is used as the medicinal substance, and it is administered in the form of applications of 10 mL on each half of the jaw or in instillations of 0.9...1.0 mL in each affected gingival pocket for 6...8 days [2].
De asemenea este cunoscută metoda de tratament al afecţiunilor inflamatorii ale parodonţiului, care constă în aceea că se efectuează injectarea locală în mucoasă în regiunile afectate a unei soluţii apoase ozonate, care conţine 8000…10000 µg/L de ozon, în doză de 0,5…1,0 mL. După fiecare şedinţă se fac spălături gingivale cu soluţie apoasă ozonată, care conţine 6000…8000 µg/L de ozon, după care se efectuează aplicaţii locale cu ulei ozonat în concentraţie de 5000…6000 µg/L. Cura de tratament este de 3…4 şedinţe cu un interval de 1…2 zile între ele [3]. Also known is the method of treatment of inflammatory periodontal diseases, which consists in the local injection into the mucosa in the affected regions of an ozonated aqueous solution containing 8000…10000 µg/L of ozone, in a dose of 0.5…1.0 mL. After each session, gingival washes are performed with ozonated aqueous solution containing 6000…8000 µg/L of ozone, after which local applications are performed with ozonated oil in a concentration of 5000…6000 µg/L. The treatment course is 3…4 sessions with an interval of 1…2 days between them [3].
Dezavantajele metodelor cunoscute constau în eficacitatea redusă şi de scurtă durată a tratamentului şi apariţia recidivelor. The disadvantages of known methods consist in the reduced and short-term effectiveness of the treatment and the occurrence of relapses.
Problema pe care o rezolvă prezenta invenţie este elaborarea unei metode pentru sporirea eficacităţii terapeutice, reducerea termenelor de tratament şi evitarea recidivelor la forma gravă de parodontită cronică marginală. The problem solved by the present invention is to develop a method for increasing therapeutic efficacy, reducing treatment times and avoiding relapses in the severe form of chronic marginal periodontitis.
Esenţa invenţiei constă în aceea că se efectuează scalarea şi planarea radiculară, după care se efectuează 6 proceduri de autohemoterapie peste fiecare 3 zile, care constau în prelevarea a 50…150 mL de sânge venos din vena cubitală, barbotarea în cantităţi egale cu un amestec de O2 şi O3, cu concentraţia ozonului de 25 mg/mL şi reinfuzarea ulterioară a amestecului, cu o creştere treptată a concentraţiei de ozon cu 5 mg/mL la procedurile ulterioare, până la concentraţia de 35 mg/mL, apoi cu o seringă se efectuează infiltraţii în stratul submucos la limita dintre mucoasa fixă şi cea mobilă, la fiecare al 3… 4-lea dinte, a 0,5…1 mL de un amestec de O2 şi O3 cu concentraţia ozonului de 5…10 mg/mL, după care pe arcadele dentare se aplică gutiere individualizate cu ulei vegetal ozonat pe 30…60 min. The essence of the invention is that scaling and root planing are performed, after which 6 autohemotherapy procedures are performed every 3 days, which consist of taking 50…150 mL of venous blood from the cubital vein, bubbling in equal amounts with a mixture of O2 and O3, with an ozone concentration of 25 mg/mL and subsequent reinfusion of the mixture, with a gradual increase in the ozone concentration by 5 mg/mL in subsequent procedures, up to a concentration of 35 mg/mL, then with a syringe, infiltrations are performed into the submucosal layer at the boundary between the fixed and mobile mucosa, at every 3…4th tooth, of 0.5…1 mL of a mixture of O2 and O3 with an ozone concentration of 5…10 mg/mL, after which individualized trays with ozonated vegetable oil are applied to the dental arches for 30…60 min.
Rezultatul invenţiei constă în sporirea eficacităţii terapeutice, înlăturarea inflamaţiei ţesuturilor parodontale, stoparea resorbţiei ţesutului osos şi stimularea proprietăţilor de reparare şi regenerare a ţesuturilor, reducerea termenelor de tratament şi evitarea recidivelor. The result of the invention consists in increasing therapeutic efficacy, removing inflammation of periodontal tissues, stopping bone tissue resorption and stimulating tissue repair and regeneration properties, reducing treatment times and avoiding relapses.
Parodontita marginală continuă să reprezinte o problemă majoră de sănătate, fiind una din cele mai răspândite şi frecvente boli ale corpului uman. În patogeneza bolii parodontale rolul determinant îi revine factorului microbian şi răspunsului imuno-inflamator al organismului. Marginal periodontitis continues to represent a major health problem, being one of the most widespread and frequent diseases of the human body. In the pathogenesis of periodontal disease, the determining role belongs to the microbial factor and the body's immuno-inflammatory response.
Prezenţa bacteriilor parodontopatogene a fost demonstrată în numeroase studii (Slots J. et al. The occurence of Actinobacillus actinomycetemcomitans, Bacteroides gingivalis and Bacteroides intermedius in destructive periodontal disease in adults. J. Clin. Periodontol. 13, 1986, p. 570-577). Susceptibilitatea gazdei în declanşarea bolii parodontale este o condiţie obligatorie ((Haffajee A.D., Socransky S.S. Microbial etiological agents of destructive periodontal diseases. Periodontol. 2000, 1994, Jun., p. 78-111, http://www.ncbi.nlm.nih.gov/pubmed/9673164). Răspunsul imuno-inflamator al organismului la agresiunea bacteriană este declanşat printr-un mecanism specific, care este influenţat de predispoziţia genetică a fiecărui individ în parte (Hodgeand P., Michalowicz B. Genetic predisposition to periodontitis in children and young adults, Periodontology, vol. 26, nr. 1, 2001, p. 113-134). The presence of periodontopathic bacteria has been demonstrated in numerous studies (Slots J. et al. The occurrence of Actinobacillus actinomycetemcomitans, Bacteroides gingivalis and Bacteroides intermedius in destructive periodontal disease in adults. J. Clin. Periodontol. 13, 1986, p. 570-577). Host susceptibility in the onset of periodontal disease is a mandatory condition ((Haffajee A.D., Socransky S.S. Microbial etiological agents of destructive periodontal diseases. Periodontol. 2000, 1994, Jun., p. 78-111, http://www.ncbi.nlm.nih.gov/pubmed/9673164). The body's immuno-inflammatory response to bacterial aggression is triggered by a specific mechanism, which is influenced by the genetic predisposition of each individual (Hodgeand P., Michalowicz B. Genetic predisposition to periodontitis in children and young adults, Periodontology, vol. 26, no. 1, 2001, p. 113-134).
Cercetările recente au scos în evidenţă şi rolul factorilor de risc, cum ar fi: formarea radicalilor liberi (El-Shinnawi U., Soory M. Actions of Adjunctive Nutritional Antioxidants in Periodontitis and Prevalent Systemic Inflammatory Diseases. Endocr. Metab. Immune. Disord. Drug. Targets. 2015, 15, p. 261-276, http://www.ncbi.nlm.nih.gov/pubmed/25922082), care provin din mediul interior (fagocitoză, catabolism incomplet, producerea de energie, etc.) şi din mediul exterior (stresul (Satheesh Mannem and Vijay K. Chava.The effect of stress on periodontitis: A clinic biochemical study. J. Indian Soc. Periodontol. 2012 Jul.-Sep., 16, p. 365�369, http://www.ncbi.nlm.nih.gov/pubmed/23162330), tabagismul, alcoolismul, aerul poluat, alimentele procesate, unele tipuri de medicamente, etc.). Alt factor de risc, la fel de important, este trauma cronică parodontală (Логинова Н. К. Механическая теория � фундаментальная основа развитой теории этиологии и патогенеза заболеваний пародонта. Новое в стоматологии. 1993, №4, p. 17-25). Recent research has also highlighted the role of risk factors, such as: the formation of free radicals (El-Shinnawi U., Soory M. Actions of Adjunctive Nutritional Antioxidants in Periodontitis and Prevalent Systemic Inflammatory Diseases. Endocr. Metab. Immune. Disord. Drug. Targets. 2015, 15, p. 261-276, http://www.ncbi.nlm.nih.gov/pubmed/25922082), which come from the internal environment (phagocytosis, incomplete catabolism, energy production, etc.) and from the external environment (stress (Satheesh Mannem and Vijay K. Chava. The effect of stress on periodontitis: A clinical biochemical study. J. Indian Soc. Periodontol. 2012 Jul.-Sep., 16, p. 365-369, http://www.ncbi.nlm.nih.gov/pubmed/23162330), smoking, alcoholism, polluted air, processed foods, some types of medicine, etc.). Another equally important risk factor is chronic periodontal trauma (Логинова Н. К. Механическая теория � fundamentalnaya осна разитой теории етиологии и патогенеза доставка пародонта. Новое в стоматолиии. 1993, №4, p. 17-25).
Elementul de bază în stabilirea diagnosticului şi a planului de tratament al bolii parodontale rămâne examenul clinic şi radiologic. Succesul în tratamentul bolii parodontale, înregistrat în ultimii ani, se datorează metodelor şi tehnicilor noi chirurgicale, materialelor biostimulatoare şi de regenerare tisulară, care permit reabilitarea funcţiilor aparatului dento-maxilar, dar care nu reuşesc să înlăture în totalitate factorii cauzatori ai bolii parodontale. De aceea, pe lângă tratamentul chirurgical, care este doar o etapă terapeutică în tratamentul complex al bolii parodontale, este de o importanţă majoră descoperirea şi aplicarea tratamentelor nechirurgicale, care ar putea influenţa benefic evoluţia bolii parodontale. The basic element in establishing the diagnosis and treatment plan of periodontal disease remains the clinical and radiological examination. The success in the treatment of periodontal disease, recorded in recent years, is due to new surgical methods and techniques, biostimulating and tissue regeneration materials, which allow the rehabilitation of the functions of the dento-maxillary apparatus, but which fail to completely eliminate the causative factors of periodontal disease. Therefore, in addition to surgical treatment, which is only one therapeutic stage in the complex treatment of periodontal disease, it is of major importance to discover and apply non-surgical treatments, which could beneficially influence the evolution of periodontal disease.
În cursul ultimilor ani metodele tradiţionale de tratament nechirurgical al parodontitei şi-au pierdut valoarea, cauza fiind numărul crescut de cazuri de rezistenţă microbiană la antibiotice, apariţia tot mai frecventă a reacţiilor alergice, numărul mare de contraindicaţii şi efecte secundare la medicamente. Toate acestea impun noi abordări şi cercetări a unor metode de tratament alternative. In recent years, traditional non-surgical methods of periodontitis treatment have lost their value, due to the increasing number of cases of microbial resistance to antibiotics, the increasingly frequent occurrence of allergic reactions, the large number of contraindications and side effects of medications. All of this requires new approaches and research into alternative treatment methods.
În acest context terapia cu oxigen activ în forma sa alotropă (ozonul medical) merită să fie recunoscută drept una din cele mai sigure, simple şi eficiente metode (Bocci V. Biological and clinical effects of ozone: Has ozone therapy a future in medicine? Br. J. Biomed. Sci., 1999, p. 270�279, [PubMed] http://www.ncbi.nlm.nih.gov/pubmed/10795372) In this context, active oxygen therapy in its allotropic form (medical ozone) deserves to be recognized as one of the safest, simplest and most effective methods (Bocci V. Biological and clinical effects of ozone: Has ozone therapy a future in medicine? Br. J. Biomed. Sci., 1999, p. 270-279, [PubMed] http://www.ncbi.nlm.nih.gov/pubmed/10795372)
Acţiunea ozonului medical asupra organismului uman este diversă şi multidirecţionată. Ozonul medical posedă efect antimicrobian, antioxidant, imunomodulator, antihipoxic, de dezintoxicare, antiviral, antifungic, de stimulare a proceselor metabolice şi de îmbunătăţire a proprietăţilor reologice ale sângelui (Иванченко С.А. Современное обоснование применения озона в медицине. 1998, p. 40-41). Eficienţa utilizării ozonului medical a fost demonstrată şi argumentată în diverse afecţiuni sistemice preponderent cu caracter inflamator, atât în domeniul chirurgical, cât şi în cel terapeutic (Viebahn-Hansler R. Ozone therapy - the underlying therapeutical concept and models of efficacy. Erfahrungs Heilkunde. 1991, p. 40). The action of medical ozone on the human body is diverse and multidirectional. Medical ozone has antimicrobial, antioxidant, immunomodulatory, antihypoxic, detoxifying, antiviral, antifungal effects, stimulation of metabolic processes and improvement of the rheological properties of blood (Ivanchenko S.A. Modern justification of the use of ozone in medicine. 1998, p. 40-41). The effectiveness of the use of medical ozone has been demonstrated and argued in various systemic diseases, mainly of an inflammatory nature, both in the surgical and therapeutic fields (Viebahn-Hansler R. Ozone therapy - the underlying therapeutical concept and models of efficacy. Erfahrungs Heilkunde. 1991, p. 40).
În chirurgia maxilo-facială se aplică pe larg soluţii ozonate în calitate de remedii antiseptice pentru prelucrarea locală a leziunilor cavităţii bucale (Sandhaus S. http://www.ncbi.nlm.nih.gov/pubmed/5263394 Zahnarztl Prax., 1969 Dec. 15, p. 277-280, http://www.ncbi.nlm.nih.gov/pubmed/5263394), fapt ce îmbunătăţeşte considerabil convalescenţa postoperatorie şi grăbeşte epitelizarea plăgii operate. Ozonul are o influenţă benefică asupra metabolismului şi procesului reparator osos (Sanseverino E.R. Knee joint disorders treated by oxygen-ozone therapy. EuraMedicophys, 1989, p. 163-170). S-a observat că la pacienţii cu osteomielită cronică mandibulară, expunerea la ozonul medical normalizează mai rapid şi complet rezistenţa nespecifică şi imunitatea T-celulară, accelerând astfel vindecarea clinică şi reducând incidenţa complicaţiilor (Agapov V.S., Shulakov V.V., Fomchenkov N.A. Ozone therapy of chronic mandibular osteomyelitis. Stomatologia, 2001, p. 14-17). In maxillofacial surgery, ozonated solutions are widely used as antiseptic remedies for local treatment of oral cavity lesions (Sandhaus S. http://www.ncbi.nlm.nih.gov/pubmed/5263394 Zahnarztl Prax., 1969 Dec. 15, p. 277-280, http://www.ncbi.nlm.nih.gov/pubmed/5263394), which considerably improves postoperative convalescence and accelerates epithelialization of the operated wound. Ozone has a beneficial influence on bone metabolism and repair process (Sanseverino E.R. Knee joint disorders treated by oxygen-ozone therapy. EuraMedicophys, 1989, p. 163-170). It has been observed that in patients with chronic mandibular osteomyelitis, exposure to medical ozone more quickly and completely normalizes nonspecific resistance and T-cell immunity, thus accelerating clinical healing and reducing the incidence of complications (Agapov V.S., Shulakov V.V., Fomchenkov N.A. Ozone therapy of chronic mandibular osteomyelitis. Stomatologia, 2001, p. 14-17).
Scopul studiului dat a fost argumentarea fiziopatogenică a utilizării oxigenului activ în forma sa alotropă în tratamentul complex al formelor grave de parodontită marginală cronică profundă. În conformitate cu scopul propus, au fost selectaţi 96 de pacienţi, femei şi bărbaţi, cu vârsta cuprinsă între 41 şi 73 de ani, cu diagnostic de parodontită marginală cronică profundă. Pacienţii au fost divizaţi în două grupuri - grupul de control 52 de pacienţi, căruia i-a fost administrat un tratament parodontal clasic nechirurgical (scalarea şi planarea radiculară (SRP)) şi grupul experimental 44 de pacienţi, căruia i-a fost administrat un tratament parodontal clasic nechirurgical, complementat cu ozonoterapia sistemică (autohemoterapie majoră (AHTM)) şi locală (infiltraţii submucoase de ozon medical şi aplicaţii de ulei ozonat). Toate metodele de tratament cu ozon medical sunt efectuate conform unor protocoale de lucru stabilite de Societăţile de Ozonoterapie şi sunt incluse în soft-ul de lucru al Generatorului de ozon medical, fapt care exclude posibilitatea unor erori de dozare a ozonului. The aim of this study was to substantiate the physiopathological argumentation of the use of active oxygen in its allotropic form in the complex treatment of severe forms of chronic deep marginal periodontitis. In accordance with the proposed aim, 96 patients, women and men, aged between 41 and 73 years, with a diagnosis of chronic deep marginal periodontitis were selected. The patients were divided into two groups - the control group of 52 patients, who were administered a classical non-surgical periodontal treatment (scaling and root planing (SRP)) and the experimental group of 44 patients, who were administered a classical non-surgical periodontal treatment, complemented with systemic (major autohemotherapy (MAHT)) and local (submucosal infiltrations of medical ozone and ozonated oil applications). All medical ozone treatment methods are performed according to working protocols established by Ozone Therapy Societies and are included in the working software of the Medical Ozone Generator, which excludes the possibility of ozone dosing errors.
Generatoarele de ozon medical, precum şi toate consumabilele de unică folosinţă utilizate pentru tratamentul cu ozon medical trebuie să îndeplinească directivele pentru echipamente medicale MDD (Medical Device Directive) din Europa (Directiva 93/42) şi să fie etichetate cu semnul "CE" (Renate Viebahn-Hänsler, Olga Sonia León Fernández, Ziad Fahmy. Ozone in Medicine: The Low-Dose Ozone Concept-Guidelines and Treatment Strategies Medical Society for the Use of Ozone in Prevention and Therapy, Iffezheim/Baden-Baden, D-76473, Germany, Pharmacy and Food Institute, University of Havana, p. 408-424). Ozonoterapia presupune mai multe metode de administrare. Medical ozone generators, as well as all disposable consumables used for medical ozone treatment, must comply with the European Medical Device Directive (Directive 93/42) and be labeled with the "CE" mark (Renate Viebahn-Hänsler, Olga Sonia León Fernández, Ziad Fahmy. Ozone in Medicine: The Low-Dose Ozone Concept-Guidelines and Treatment Strategies Medical Society for the Use of Ozone in Prevention and Therapy, Iffezheim/Baden-Baden, D-76473, Germany, Pharmacy and Food Institute, University of Havana, p. 408-424). Ozone therapy involves several methods of administration.
Pentru generarea ozonului medical s-a utilizat aparatul universal medical - HERRMANN (Apparatebau Medozon compact, Germania). To generate medical ozone, the universal medical device - HERRMANN (Apparatebau Medozon compact, Germany) was used.
Toţi pacienţii din grupul experimental au urmat: 6 şedinţe de AHTM, o dată la trei zile, cu un amestec de O2/O3, cu o concentraţie a ozonului de 25…35 mg/mL, urmate de infiltraţii submucoase, la limita dintre mucoasa fixă şi cea mobilă, la fiecare al 3…4-lea dinte, cu un amestec gazos de O2/O3, în volum de 0,5…1 mL, cu o concentraţie a ozonului de 5…10 mg/mL şi aplicaţii de ulei ozonat semisolid pe arcadele dentare. Pe arcadele dentare se aplică gutiere individualizate cu ulei ozonat şi se menţin timp de 30…60 min. Apoi gutierele se înlătură şi cavitatea bucală se clăteşte cu apă. All patients in the experimental group underwent: 6 sessions of AHTM, once every three days, with an O2/O3 mixture, with an ozone concentration of 25…35 mg/mL, followed by submucosal infiltrations, at the boundary between the fixed and mobile mucosa, at every 3…4th tooth, with a gaseous O2/O3 mixture, in a volume of 0.5…1 mL, with an ozone concentration of 5…10 mg/mL and applications of semisolid ozonated oil on the dental arches. Individualized trays with ozonated oil are applied to the dental arches and maintained for 30…60 min. Then the trays are removed and the oral cavity is rinsed with water.
Având în vedere că majoritatea pacienţilor prezentau un anumit grad de dezechilibru al markerului stresului oxidativ (SOD), concentraţia iniţială aleasă a ozonului medical a fost de 25 mg/mL, urmată de o creştere treptată, cu 5 mg/mL de ozon la fiecare şedinţă ulterioară, până la concentraţia de 35 mg/mL. Given that most patients had some degree of imbalance in the oxidative stress marker (SOD), the initial concentration of medical ozone chosen was 25 mg/mL, followed by a gradual increase of 5 mg/mL of ozone at each subsequent session, up to a concentration of 35 mg/mL.
Autohemoterapia majoră (AHTM) Major autohemotherapy (MAH)
Pacientul se aşază obişnuit şi comod în poziţia culcat pe spate, pe canapeaua medicală, se prelevă într-o sticlă vidată sterilă, în care iniţial s-a introdus soluţie de citrat de sodiu 3,13% (anticoagulant), o cantitate de sânge venos (50…150 mL) din vena cubitală şi se amestecă cu o cantitate egală de ozon medical de concentraţia menţionată, după care sângele este reperfuzat pacientului. Procedura nu prezintă niciun risc pentru pacient, este fără durere şi durează în totalitate aproximativ 20…30 min. The patient sits normally and comfortably in a supine position on the medical couch, a quantity of venous blood (50…150 mL) from the cubital vein is taken into a sterile vacuum bottle, in which 3.13% sodium citrate solution (anticoagulant) was initially introduced, and mixed with an equal quantity of medical ozone of the mentioned concentration, after which the blood is re-infused to the patient. The procedure does not pose any risk to the patient, is painless and lasts approximately 20…30 min in total.
Scalare şi planare radiculară (SRP) Scaling and root planing (SRP)
Pentru îndepărtarea propriu-zisă a plăcii bacteriene şi a tartrului dentar supra- şi subgingival s-a utilizat instrumentar ultrasonic NSK - Multi Pad Various 170 LUX, sub anestezie locală prin infiltraţie. Resturile de tartru şi placă au fost înlăturate prin Air-Flow utilizând aparatul de profilaxie cu bicarbonat de potasiu NSK ProphyMate. Aparatul funcţionează pe bază de aer comprimat, care proiectează cu o presiune foarte mare, atât pe suprafeţele dentare, cât şi în zonele interdentare şi subgingivale, un jet filiform, constituit dintr-un amestec de apă/aer şi particule abrazive de bicarbonat de sodiu. Pe lângă acţiunea kineto-abrazivă, bicarbonatul de sodiu posedă acţiune terapeutică datorită proprietăţilor sale benefice, inclusiv antiinflamatoare, antifungice, antiseptice şi antibacteriene, de asemenea datorită masajului gingival eficient, se restabileşte circulaţia de tip terminal. În majoritatea cazurilor sângerarea gingiilor şi senzaţia de durere dispar după primele două zile. For the actual removal of bacterial plaque and supra- and subgingival dental tartar, an NSK - Multi Pad Various 170 LUX ultrasonic instrument was used, under local anesthesia by infiltration. The remains of tartar and plaque were removed by Air-Flow using the NSK ProphyMate potassium bicarbonate prophylaxis device. The device operates on the basis of compressed air, which projects with very high pressure, both on the dental surfaces and in the interdental and subgingival areas, a filiform jet, consisting of a mixture of water/air and abrasive particles of sodium bicarbonate. In addition to the kineto-abrasive action, sodium bicarbonate has a therapeutic action due to its beneficial properties, including anti-inflammatory, antifungal, antiseptic and antibacterial, also due to the effective gingival massage, terminal circulation is restored. In most cases, bleeding gums and the sensation of pain disappear after the first two days.
Clinic, s-a înregistrat indicele CPITN, care este prescurtarea de la Community Periodontal Index Treatment Needs. Acesta este un indice ce se foloseşte pentru evaluarea a trei indicatori: prezenţa/absenţa sângerării gingivale, tartrul supra/subgingival şi adâncimea pungii parodontale, indicele de sângerare papilară (PBI) şi fişa parodontală după modelul ZMK Bern. Complementar s-au studiat radiografiile şi s-au realizat teste de laborator, care au inclus testul micro-IDent plus 11 (identificarea bacteriilor parodontopatogene prin tehnica polimerizării în lanţ (PCR) şi analiza markerului stresului oxidativ - superoxiddismutaza (SOD)). Funcţional s-a evaluat microcirculaţia sanguină capilară în ţesutul parodontal prin metoda fluxmetriei laser-Doppler (LDF). Examinarea pacienţilor s-a efectuat în dinamică până la tratament, nemijlocit după tratament şi la intervale de 1, 3 şi 6 luni de la tratament. Clinically, the CPITN index was recorded, which is the abbreviation for Community Periodontal Index Treatment Needs. This is an index used to evaluate three indicators: the presence/absence of gingival bleeding, supra/subgingival tartar and periodontal pocket depth, papillary bleeding index (PBI) and periodontal chart according to the ZMK Bern model. In addition, radiographs were studied and laboratory tests were performed, which included the micro-IDent plus 11 test (identification of periodontopathic bacteria by the polymerase chain reaction (PCR) technique and analysis of the oxidative stress marker - superoxide dismutase (SOD)). Functionally, capillary blood microcirculation in the periodontal tissue was evaluated by the laser-Doppler flowmetry (LDF) method. The examination of patients was performed in dynamics until treatment, immediately after treatment and at intervals of 1, 3 and 6 months after treatment.
Tratamentul complementat cu ozon medical a condus la o micşorare considerabilă a contaminării bacteriene în pungile parodontale, la diminuarea rapidă a fenomenelor inflamatorii în ţesuturile parodontale, la o stimulare a proceselor reparatorii şi la menţinerea de durată mai mare a stării de igienă orală. Rezultatul obţinut a confirmat că pungile parodontale mai profunde de 6 mm prezintă un factor important de limitare în instrumentarea adecvată a acestora şi pot necesita management chirurgical. Modularea nivelului seric al SOD a redus stresul oxidativ, implicat în patogeneza parodontitei marginale cronice profunde şi a condus la echilibrarea homeostaziei redox. Analiza laser-Doppler a indicat tulburări hemodinamice grave existente la nivelul microcirculaţiei în ţesutul parodontal, la pacienţii cu parodontită marginală cronică profundă, iar aplicarea sistemică şi locală a ozonului medical a condus la restabilirea microhemodinamicii la nivelul ţesutului parodontal. The treatment supplemented with medical ozone led to a considerable decrease in bacterial contamination in periodontal pockets, to a rapid decrease in inflammatory phenomena in periodontal tissues, to a stimulation of reparative processes and to a longer maintenance of oral hygiene. The obtained result confirmed that periodontal pockets deeper than 6 mm present an important limiting factor in their adequate instrumentation and may require surgical management. Modulation of the serum level of SOD reduced oxidative stress, involved in the pathogenesis of chronic deep marginal periodontitis and led to the balancing of redox homeostasis. Laser-Doppler analysis indicated serious hemodynamic disorders existing at the level of microcirculation in periodontal tissue, in patients with chronic deep marginal periodontitis, and the systemic and local application of medical ozone led to the restoration of microhemodynamics at the level of periodontal tissue.
În concluzie, rezultatul terapeutic obţinut a demonstrat eficienţa complementării tratamentului parodontal clasic nechirurgical cu oxigen activ în forma sa alotropă aplicat sistemic şi local la pacienţii cu parodontită marginală cronică profundă. In conclusion, the therapeutic result obtained demonstrated the efficiency of complementing classical non-surgical periodontal treatment with active oxygen in its allotropic form applied systemically and locally in patients with deep chronic marginal periodontitis.
Exemplu Example
Pacienta R., în vârstă de 46 ani, s-a adresat cu acuze la dureri difuze ale gingiilor, sângerare spontană şi la periaj, halenă fetidă, tulburări de masticaţie prin instabilitate dentară, abcese parodontale frecvente. La examinare se evidenţiază recesiune gingivală generalizată, mai pronunţată pe grupul lateral de dinţi, pungi parodontale mai adânci de 6 mm, cu exsudat purulent, sângerare la palpare, mobilitate dentară gr. II…III, tartru şi placă bacteriană abundentă. Diagnosticul: Parodontită marginală cronică generalizată severă. S-a aplicat metoda revendicată. După prima şedinţă la pacientă s-a redus esenţial inflamaţia. După cea de-a doua a dispărut sângerarea şi exsudatul purulent. La sfârşitul tratamentului pungile gingivale s-au redus cu 3…4 mm, gingia avea aspect şi consistenţă normală, fără exsudat purulent sau sângerare. Mobilitate dentară redusă semnificativ. Patient R., 46 years old, complained of diffuse pain in the gums, spontaneous bleeding and when brushing, foul breath, chewing disorders due to dental instability, frequent periodontal abscesses. Examination revealed generalized gingival recession, more pronounced on the lateral group of teeth, periodontal pockets deeper than 6 mm, with purulent exudate, bleeding on palpation, tooth mobility gr. II…III, tartar and abundant bacterial plaque. Diagnosis: Severe generalized chronic marginal periodontitis. The claimed method was applied. After the first session, the patient's inflammation was essentially reduced. After the second, the bleeding and purulent exudate disappeared. At the end of the treatment, the gingival pockets were reduced by 3…4 mm, the gums had a normal appearance and consistency, without purulent exudate or bleeding. Tooth mobility was significantly reduced.
1. RU 2146917 C1 2000.03.27 1. RU 2146917 C1 2000.03.27
2. RU 2123319 C1 1998.12.20 2. RU 2123319 C1 1998.12.20
3. MD 2327 G2 2003.12.31 3. MD 2327 G2 2003.12.31
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| SU1706641A1 (en) * | 1989-11-02 | 1992-01-23 | Ташкентский государственный медицинский институт | Method for treating the cases of periodontitis |
| MD734F1 (en) * | 1996-03-20 | 1997-06-30 | Univ De Stat Din Moldova | Process for mineral feeding up of seedlings in the nursery garden |
| RU2123319C1 (en) * | 1996-12-24 | 1998-12-20 | Нижегородская государственная медицинская академия | Method of treating inflammatory diseases of parodontium |
| RU2146917C1 (en) * | 1998-01-16 | 2000-03-27 | Нижегородская государственная медицинская академия | Method of preventing and treating mouth cavity diseases |
| MD2327G2 (en) * | 2003-07-11 | 2004-07-31 | Андрей ПЫРГАРЬ | Method of treatment of parodontium affections |
| MD3938G2 (en) * | 2008-05-07 | 2010-02-28 | Валериу ФАЛА | Method for treating the migratory periodontitis |
Also Published As
| Publication number | Publication date |
|---|---|
| MD1096Y (en) | 2016-11-30 |
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