RU2271212C2 - Surgical method for treating the cases of periodontitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves making surgical intervention after Widman with patient blood taken in the amount of 10-20 ml before placing flap. The blood is centrifuged during 11-13 min at 2400-2800 rpm and divided into 3 fractions like erythrocytes, plasma of high blood platelets content and plasma of low blood platelets content as a result of the treatment. The plasma of high blood platelets content is taken from laboratory glass and mixed with beta-tribasic calcium phosphate powder in proportion of 1:3. Then, the produced mixture is placed into defect zone and the flaps are fixed with sutures.

EFFECT: no additional surgical intervention needed; excluded allergic responses.

Description

The invention relates to medicine, namely to dentistry, and can be used in the surgical treatment of periodontitis.

Periodontitis is very common now. Known methods of treating this disease using osteoinductive and osteoconductive drugs (A.S. Artyushkevich, E.K. Trofimova, S.V. Latysheva "Clinical periodontology", Minsk, 2002, s.261-267). Osteoinductive materials stimulate the growth of new bone, which determines their advantage over osteoconductors (materials that are the framework for the newly formed bone).

Currently, the following osteoinductors are common in practice:

1. Auto-bone. A bone block or shavings are cut out from the donor site in the patient and placed in the area of the defect.

2. Demineralized bone matrix. The donor is another person, cadaveric material is usually taken.

3. Brephost. Fertile material processed according to a special technique.

4. Bio-metals impregnated with blood plasma. Osteoconductive ceramics are impregnated with blood plasma containing growth factors.

Of the osteoconductors used, the following examples can be cited:

1. Hydroxyapatite.

2. Beta-tricalcium phosphate.

3. Bio-sitalls.

The method of surgical treatment of periodontitis according to Widman (A. S. Artyushkevich, E. K. Trofimova, S. V. Latysheva "Clinical periodontology", Minsk, 2002, p. 248) using osteoinductive materials was adopted as a prototype of the invention. A known method is as follows. Two vertical incisions are made within 4 teeth, limiting the flap formation site. These sections begin in the gingival margin and end in the alveolar mucosa. Then the vertical incisions are connected horizontal, which is carried out, slightly departing from the gingival margin. The same incisions are made from the lingual surface of the alveolar process. The mucosal-viscostal flaps are separated, exposing the marginal part of the alveolar process. The cut off marginal part of the gum is removed with a curette. The roots of the teeth are carefully treated. Then, with a drill, smooth irregularities of bone tissue in the tooth area. The classic version of the operation ends with the flaps being put in place and fixed with sutures.

However, the known method has several disadvantages. When using autobone, additional traumatic intervention is required on the donor site. The use of glass ceramics impregnated with blood plasma is limited due to the complexity of the manufacturing technology of this drug. When using demineralized bone matrix and brefokost there is a risk of infection and the development of an allergic reaction.

The essence of the proposed method is that they carry out a classic Widman operation, but before laying the flaps, they take blood from the ulnar vein in the amount of 10-20 ml, centrifuged, for example, on an EVA20 centrifuge manufactured by Hettich (Germany) for 11 -13 minutes at a speed of 2400-2800 per minute. As a result, blood is divided into 3 fractions: red blood cells, plasma with a high platelet content and plasma with a low platelet content. The platelet mass is removed from the tube and mixed with beta-tricalcium phosphate powder in a ratio of 1 part of platelet mass to 3 parts of beta-tricalcium phosphate. The resulting mixture is placed in the area of the defect, after which the flaps are fixed with sutures.

The method is as follows.

The patient makes two vertical incisions within 4 teeth, limiting the site of flap formation. These sections begin in the gingival margin and end in the alveolar mucosa. Then the vertical incisions are connected horizontal, which is carried out somewhat departing from the gingival margin. The same incisions are made from the lingual surface of the alveolar process. The mucoperiosteal flaps are separated, exposing the marginal part of the alveolar process. The cut off marginal part of the gum is removed with a curette. The roots of the teeth are carefully treated. Then, with a drill, smooth irregularities of bone tissue in the tooth area. After that, blood is taken from the patient from the ulnar vein in the amount of 10-20 ml, centrifuged on an EB20 centrifuge manufactured by Hettich (Germany) for 11-13 minutes at 2400-2800 revolutions per minute. As a result, blood is divided into 3 fractions: red blood cells, plasma with a high platelet content and plasma with a low platelet content. The platelet mass is removed from the tube and mixed with beta-tricalcium phosphate powder in a ratio of 1 part of platelet mass to 3 parts of beta-tricalcium phosphate. The resulting mixture is placed in the area of the defect, the flaps are fixed with sutures.

Clinical example.

On 03.11.02, patient V. contacted the dental department of the Moscow Medical University Polyclinic No. 15 in Samara, complaining of tooth mobility, bleeding gums, halitosis. On examination, II degree tooth mobility was found, the gums were swollen, hyperemic. On the teeth, significant deposits of tartar. On the x-ray visible bone resorption to 1 / 2-2 / 3 of the length of the roots of the teeth. Diagnosed with periodontitis III severity. Dental deposits were removed and the flap operation described above by Widman was performed using our technique in succession in several visits in the area of all teeth. On the 2nd day, there was a lack of edema, slight hyperemia and platelet densification. Sutures were removed on the 5th day. After 3 months, tooth mobility decreased significantly, the gums are dense, with no signs of inflammation, there are no pathological periodontal pockets. On the control x-ray 3 months later, we observed the absence of bone pockets, an increase in bone height by 2-3 mm.

The claimed method treated 16 patients. The results obtained confirmed its effectiveness.

Thus, the proposed method has the following advantages: the absence of the need for additional surgical intervention on the donor site, does not cause allergic reactions, is safe in terms of the risk of infection, easy to use.

Claims (1)

A method for the surgical treatment of periodontitis, including the classic Widman surgery, characterized in that before laying the flap, the patient takes blood in an amount of 10-20 ml, then it is centrifuged for 11-13 minutes at a speed of 2400-2800 per minute, resulting in blood is divided into 3 fractions: erythrocytes, plasma with a high platelet content and plasma with a low platelet content, after which plasma with a high platelet content is removed from the tube and mixed with beta-tricalcium phosphate powder in a ratio of 1: 3, for cm resulting mixture was placed in the defect region and the flaps are fixed seams.