RU2231986C1 - Method for surgical treating inflammatory-destructive parodontium diseases - Google Patents

Abstract

FIELD: medicine, stomatology.

SUBSTANCE: one should perform standard preparation of operative field including anesthesia, development and exfoliation of parodontal fragments, their application onto operation field, treatment of donor's wounds. Moreover, as parodontal fragments at closing gingival recession one should apply a free mucous or connective tissue fragments, and as parodontal fragment to deepen the vestibule of mouth cavity it is necessary to use mucous fragment from the area of hard palate. Developed exfoliated fragment should be enriched with allofibroblast before applying onto operation field and onto donor's wound, as allofibroblast one should apply suspension of pulmonary cells of human embryo (PCHE-4/81) - the strain of diploid pulmonary cells of human embryo cultivated in Eagle's -MEM growth medium at addition of 10%-fetal blood serum of cattle at 60-80 thousand cells/ml growth medium. Operation field should be covered with foliderm, from the top it should be fixed with hardening bandage. The method declared enables to increase the quality of rehabilitation of peridental gum.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to dentistry and can be used in the surgical treatment of inflammatory and destructive forms of periodontal disease, for example, recession of the connective tissue of the gums and small (low) vestibule of the oral cavity.

Periodontal pathology is one of the leading places among dental diseases.

Periodontal disease, being a serious ailment, is the fourth most common non-communicable disease in terms of prevalence, second only to pathology of the cardiovascular system, cancer and diabetes mellitus. The incidence among young people is steadily increasing.

In the occurrence of periodontal diseases, the combination of exogenous and endogenous factors affecting the body as a whole (climatogeographic conditions, nutrition, occupational hazards, diseases of internal organs, immune and hormonal homeostasis) and factors directly affecting periodontal (microflora, tartar, overload and underloading, composition and properties of saliva, personal hygiene, etc.). The combination of many factors sets in motion triggers, among which the leading ones are the immunopathological and vascular trophic mechanisms. The period of age-related hormonal changes also affects the state of organs and systems of the oral cavity. The most acute glands, periodontal and bone tissue react.

A recession of the connective tissue of the gum - a reduction in the size of the attached gum - is classified according to Miller:

Grade I - recession does not cross the mucogingival line, interdental gingival papillae are attached normally;

P class - recession reaches the mucogingival line, interdental gingival papillae are attached normally;

Grade III - the recession goes beyond the mucogingival line and there is a recession of the interdental gingival papillae;

Grade IV - recession goes beyond the mucogingival line and there is a bone defect.

The small vestibule of the mouth is the tension of the highly attached tendons of the muscles of the lower lip to the alveolar process, which leads to exfoliation of the gums from the neck of the tooth and the development of periodontal disease.

The elimination of this drawback is performed by vestibuloplasty, a deepening of the vestibule of the mouth.

There are many known methods of redistribution of soft tissues, carried out with the aim of deepening the vestibule of the mouth and expanding the area of the attached gums. For this purpose, flaps of the mucous membrane of the lips, gums, transplantation of free grafts of the skin, mucous membrane, “peeling of the alveolar ridge”, the formation of a tunnel, oncoming triangles, rectangular flaps, etc. are used.

The Clarke method of deepening the vestibule of the oral cavity gained the widest practical recognition: after anesthesia, a mucous membrane is cut through the transitional fold through the frenum to the periosteum, then a mucous flap up to 10 mm long is exfoliated; at the same distance deepen the vestibule. At the arch of the new vestibule, a mucous flap is sutured to the periosteum. The wound surface is covered with iodoform turunda.

Another method of surgery is as follows: two converging semi-oval sections of the mucous membrane to the periosteum are made through the site of attachment of the frenum of the upper or lower lip. Soft tissues bluntly peel off apically to the arch of the jaw at a distance that excludes trauma to the gingival margin (8-10 mm), and the mucous membrane is sutured to the periosteum with kengut. Guiding sutures are placed on the mucous membrane of the lips. The wound surface on the alveolar process is covered with a collagen film or a free allogeneic transplant of the mucous membrane is sutured to it (AP Bezrukova Surgical treatment of periodontal diseases. M: Medicine, 1987, p. 136-138).

Analysis of analogues of the surgical treatment of periodontal disease.

A known method of surgical treatment of periodontal disease according to US Pat. RF №2012242, А 61 В 17/00 by exfoliation of the flap, curettage, filling of bone pockets with powder from demineralized allocost, which is introduced into bone pockets after filling them with a blood clot.

A known method of treating periodontal disease by subgingival and subperiosteal implantation of an osteotropic membrane based on collagen and a drug according to US Pat. RF №2159101, A 61 17/24.

It is known that Geistlich preparations are used in the surgical treatment of periodontal diseases (Bio-Oss, Bio-Gide preparations). Before use, the granules are moistened with saline, or with blood from the wound surface (New in dentistry, No. 8, 2001, pp. 72-77).

A known method of surgical treatment of periodontal disease according to US Pat. RF №2130293, А 61 В 17/04, in which a mucoperiosteal flap is cut out and exfoliated, granulations from bone pockets and subgingival deposits are removed, pathologically altered sections of the alveolar ridge are treated, the bone defect is filled with biocomposite material, sutures are made.

A known method for the surgical treatment of inflammatory periodontal diseases, including exfoliation of the mucoperiosteal flaps with their simultaneous de-epithelialization, removal of granulations and subgingival dental deposits, antiseptic treatment of wound surfaces, implantation of osteoplastic material into bone defects using suspension of M-22 fibroblast cell line and fibroblast cells muscles of the human embryo, which are cultivated on the medium Needle with the addition of 10% serum of cattle (cattle), the imposition of WWII (Cytology, No. 9, vol. 43, 2001, p. 853-854).

It is known to use the culture of allofibroblasts in the complex treatment of periodontal diseases (Science - practice, Materials of the scientific session of the Central Scientific Research Institute of Scientific Research, - M, 1998, pp. 164-166).

The culture of allofibroblasts is populated on the dura mater. At the first stage, a human fibroblast culture is obtained by fragmentation and enzymatic processing of the human fetus dermis. After receiving the primary fibroblast culture, transplants are made by culturing fibroblast cells on implant materials.

It is known to use a polytetrafluoroethylene membrane (PTFE membrane) for directed regeneration of periodontal tissues (New in dentistry, No. 6, 2001, p. 47-57).

From known sources of information, we can conclude that the role of soft tissue structures in the pathogenesis of periodontal disease is quite clearly accentuated.

Reducing the size of the attached gums as a result of the inflammatory and destructive process in the periodontium, gingival recessions create a situation of chronic trauma.

The devastating effects of prolonged exposure to local traumatic factors, expressed by symptoms of gingival tension due to the close proximity of the frenum and / or strands of the mucous membrane, are well known, as are numerous methods for the surgical correction of these disorders (Bezrukova A.P. Surgical treatment of periodontal diseases .-- M .: Medicine, 1987).

Known methods for surgical treatment of inflammatory and destructive periodontal diseases are either complex, or their use is very limited by low resistance to the effects of the microbial flora of the oral cavity, or they need improvement.

An object of the invention is to improve the quality of rehabilitation of the posterior gum, as well as the expansion of the application of the method without the use of scarce and expensive techniques.

As a prototype, a method for surgical treatment of inflammatory and destructive periodontal diseases is considered, in which periodontal flaps are used - split from connective tissue or connective tissue flaps to be applied to the surgical field when exposing the neck of the teeth during gum recession, and using the positional to eliminate the small vestibule of the oral cavity mucous flap from the sky (Bezrukova A.P. Surgical treatment of periodontal diseases. M: Medicine, 1987, p. 94-100).

In the prototype, patchwork operations with gingivoplasty are performed as follows: after anesthesia, formation and exfoliation of the flap in the region of the anterior teeth, curettage, de-epithelization and refreshment of the root cement are performed according to the usual method. Then, two converging laxative triangular incisions are made in the region of teeth 1I1. The formed triangular flaps are pulled down and fixed with seams. The wound surface on the mucous membrane along the transitional fold heals by secondary intention.

When eliminating the small vestibule of the oral cavity, the graft is formed from the mucous membrane of the hard palate and transferred to a prepared bed, fixing with sutures, or dressings.

To improve the structural and functional state of periodontal tissues, free allogeneic transplants of the oral mucosa are used, which are preserved in a 0.05% glutaraldehyde solution, 0.1% formalin solution with the addition of glycerol in a ratio of 4: 1.

The use of cultured allofibroblasts is also known from other sources of information, for example, according to the methodology of RF patent No. 1699047. The transplant is prepared as follows: type R collagen layers are applied to the human dura mater and the matrix is placed in a sterile growth medium with cultured human allofibroblasts (4-5 passage) a day before surgery. A combined allograft is used to fill in a bone defect. The operation is carried out in a known manner. (Periodontology, No. 3 (9), 1998, p. 18).

To solve this problem, a method is proposed for surgical treatment of inflammatory and destructive periodontal diseases in case of gum recession and small vestibule of the oral cavity, including anesthesia, formation and flaking of flaps in the teeth and hard palate, preparation of the surgical field, closing the defect, closing the donor wound, applying the folder and a curing or pressure dressing, and to close the recession of the gums using a free mucous or connective tissue flap, to deepen the vestibule use a mucous flap taken from the palate of the mouth, the flaps are enriched with allofibroblast before applying to the defect, and suspension of LEC-4 cells (81), a strain of human diploid cells of the lung embryo that are cultured in the growth medium IGLA-MEM with the addition of 10, is used as a fibroblast % blood serum of cattle fruits at the rate of 60,000-80000 cells / ml growth medium.

The method is implemented as follows.

Twenty-four patients aged 18 to 46 years were operated on with the following diagnoses: recession of the connective tissue of the gums of I and II classes and 10 patients with the diagnosis of a small vestibule of the oral cavity, where the level of gum attachment ranged from 0.5 to 2.5 mm.

Preoperative preparation of the patient includes:

- training in oral hygiene;

- local and general anti-inflammatory therapy;

- examination.

During gum recession surgery under infiltration anesthesia with a 2% solution of septonest 1: 1,000,000, an incision is made in the mucosa bordering the edge of the recession, and the mucoperiosteal flap is peeled off by 2-3 mm along the defect contour. Then, in the region of the lateral slope of the hard palate, a connective tissue flap is taken that corresponds to the size of the defect and fits into the formed mucoperiosteal pocket, is treated with allofibroblasts and the foldermon is closed, closed with a hardening dressing from above.

A donor wound is treated with fibroblast. The wound surface on the mucous membrane heals by secondary intention.

In the operation of the small vestibule of the oral cavity after anesthesia along the transitional fold, an incision of the mucous membrane through the frenum to the periosteum is performed. After anesthesia, a mucous flap is formed and exfoliated in the area of the hard palate, treated with allofibroblast and placed into a defect, closed with a folderm from above and a pressure bandage is applied.

A donor wound is treated with allofibroblast. A donor wound on the mucous membrane of the sky heals by secondary intention.

Allofibroblast prepares as follows.

The cell culture used is a strain of diploid cells of a light human embryo LEC-4 (81), developed by the Yekaterinburg Research Institute of Viral Infections (AS USSR No. 114748), and registered as the original and stored in a low-temperature bank - the Museum of the Applicant ( ENIIVI).

Allofibroblasts were grown in the laboratory of cell cultures of JINIVI.

The drug is available in the form of a monolayer culture in the form of a suspension for immediate use and in the form of cells on a synthetic substrate such as Folderm, Biokoll, Polypor.

A monolayer culture has the appearance of a morphologically homogeneous layer of cells attached to glass and coated with a transparent nutrient medium.

The culture suspension is a reddish-orange turbid liquid containing 500-600 thousand cells in 1 ml.

Work with the drug is carried out under sterile conditions.

The cell culture in the form of a monolayer is used to obtain suspensions. In a bottle with a monolayer (from which the medium is first drained), 10-15 ml of a 0.02% Versen solution and 0.25% trypsin solution are added and left to contact the cells for 2-3 minutes. The solutions are drained, and the cells are poured with Earl, Hanks or sterile buffer solution in the amount of 50 ml, then shaken until a homogeneous suspension is formed. The suspension is centrifuged for 10 minutes at 1500 rpm, the supernatant is drained, and the precipitate is diluted with the indicated buffer solutions to a concentration of 40 ± 10 thousand cells, after which it is applied to the prepared flap and to the donor wound. If a film coating is used (film grafting), then a film coating is applied to the wound on the wound.

Living cellular elements integrate well in the recipient's body. The healing time of the operated field and donor wounds is reduced.

The table shows the results of the use of allofibroblasts - suspension of LEC-4 cells (81) compared with operations without the use of allofibroblasts.

Claims (1)

A method for the surgical treatment of inflammatory and destructive periodontal diseases by standard preparation of the surgical field, including anesthesia, formation and exfoliation of periodontal flaps, applying them to the surgical field, treating donor wounds, characterized in that free mucous or connective tissue is used as periodontal flaps to close the gum recession flaps, and as a periodontal flap to deepen the vestibule of the oral cavity, use a mucous flap from the area of your In the case of palate, the formed delaminated flap before application to the surgical field and to the donor wound is enriched with allofibroblast, which is used as a suspension of LEC-4 cells (81), a strain of human embryo diploid cells that are cultured in the IGLA-MEM growth medium with the addition of 10% blood serum of cattle fruits at the rate of 60-80 thousand cells / ml of growth medium, the surgical field is closed with a folderm, fixed with a curing dressing from above.