RU2288671C2 - Method for treating generalized light-degree parodontitis - Google Patents

Abstract

FIELD: medicine, therapeutic stomatology.

SUBSTANCE: one should apply special medicinal preparations immobilized upon gelatin-glycerin splin, the foundation of which is presented as 28.57% gelatin, 17.86% glycerin and 53.57% water. Moreover, during the first 3 d one should apply malavit thrice daily after breakfast, dinner and before nocturnal period. Then, during 3 d patients should apply medicinal splints with trental in the morning, and before nocturnal sleeping - those with thymogenum, at final stage of therapy for 3 d it is necessary to use splints with collargol in the morning and before nocturnal sleeping. The innovation enables to interrupt inflammatory process efficiently and short period of time due to high-degree releasing of medicinal substances at strong fixation of the splints applied.

EFFECT: higher efficiency of therapy.

2 cl, 1 ex

Description

The invention relates to medicine, in particular to methods of treatment and prevention of inflammatory and destructive processes in periodontal tissues used in dentistry.

One of the most significant stages of the complex treatment of inflammatory periodontal diseases is local drug treatment. Studies conducted over a long period of time have convincingly demonstrated that the suppression of inflammatory and destructive processes in periodontium by local conservative methods is no less, if not more, effective than the use of resecting surgical approaches (1, 2).

One of the fundamental moments of successful local therapy is the choice of a method for delivering a drug substance to a pathology site. The following delivery methods are traditionally used to treat any periodontal disease: aerosol irrigation, inhalation, pressure rinsing from a syringe, oral baths, applications and installations as part of gingival dressings, insertion into periodontal pockets using turundas, electrophoresis, magnetophoresis, injection. The choice of the method of drug treatment and the method of use of drugs is dictated by the characteristics of the disease, pharmacodynamics and pharmacokinetics of drugs, the patient's condition. The possibility of getting it into the focus of inflammation in the periodontium and the effectiveness of treatment largely depend on the route of administration and the method of use of the drug (1, 3).

Traditionally used drugs and methods of their administration have significant disadvantages (4, 5). Antibacterial rinses and irrigation are ineffective due to the rapid washing out of the treatment solution from the gingival pocket due to the high rate of furrow fluid release (6). Applied gels act in the gingival pocket for about 12.5 minutes. After this time, only half of the injected drugs remain in the gingival pocket. In the vast majority of cases, such a concentration is not enough for a full and effective therapy (6, 7, 8). In addition, the articulatory movements of the patient’s lips and cheeks during conversation, swallowing, etc., contribute to the rapid leaching of drugs from the gingival pocket.

Taking these factors into account, many authors consider the use of long-acting immobilized drugs as the most promising for local conservative treatment of inflammatory periodontal diseases (5, 8, 9, 10, 11, 12, 13, 14).

The objective of the present invention is to provide a method for the pathogenetic therapy of inflammatory periodontal diseases (CDW), in particular generalized mild periodontitis.

The proposed method of treatment is based on step-by-step pathogenetic therapy of the inflammatory process in periodontal tissues. Based on the pathogenesis of generalized periodontitis, a treatment regimen has been developed consisting of the following stages:

- basic treatment complex;

- antibacterial therapy;

- normalization of microcirculatory disorders in periodontal tissues;

- stimulation of local immunity, local protective factors;

- stimulation of regenerative processes.

Medicinal tires are used as drugs at all stages. Known medicinal gelatin films (LVPs) used in dentistry are hard plates with 28.57% gelatin, 66.43% water, and 5.00% glycerol as the basis (15). The hardness of the films and the small size do not allow them to be used for the effective treatment of generalized periodontitis. In connection with these circumstances, the composition of 28.57% gelatin, 53.57% water and 17.86% glycerol was chosen as the basis for tires. Glycerin in this concentration gives the tires the softness necessary so that the tire can bend in the shape of the jaw and not injure the mucous membrane. This basis, in addition, provides a duration of action of drugs (3-5 hours when applied during the day and throughout the night when applied before bedtime), strong fixation of the tire on the mucosa due to the adhesive properties of gelatin, a high degree of drug release, economic affordability, associated with the cheapness and availability of gelatin and glycerin. The second difference between the proposed tires and medicinal gelatin films (14, 15) is in a different shape and size. PLWH have an average size of the order of 10 × 8 × 3 mm. Given the length of the pathological process with generalized periodontitis, drug tires should have a length of 50 or 100 mm, a width of 5 mm and a thickness of 2 mm. Such tire sizes provide the possibility of drug treatment of one quadrant or the entire upper or lower jaw by applying one tire.

As medicinal substances immobilized on a gelatin-glycerol carrier, medicines were selected that effectively act on the main pathogenesis of CDW and have a polyvalent effect.

Adverse and allergic reactions were not observed, which is caused by small doses of drugs in the tires (about 1/10 of the dose in standard drugs).

The introduction of tires is not traumatic and easily mastered by patients.

The ease of use and the duration of action of the tires allows for a continuous course of drug therapy both at home and in the office.

Tires can be used as a means of mototherapy, as well as in combination with other methods of treatment (surgical, orthopedic, physiotherapeutic, etc.).

An example illustrating the invention

In the treatment of generalized mild periodontitis in 72 patients, drug tires were used according to the proposed scheme.

Initially, a basic treatment package was carried out, including professional oral hygiene, training and motivation of patients for individual oral hygiene, elimination of local etiological factors leading to chronic microtrauma and functional overload of periodontal tissues (poor quality fillings, dentures, etc.).

Then the patients were taught the use of medicinal gelatin tires and a course of therapy was prescribed according to the following scheme.

In the first 3 days, patients took tires with malavite (TU 9158.0001.29731500-95) three times a day after breakfast, lunch and before bedtime (antibacterial and anti-inflammatory therapy). Given the extremely wide spectrum of action of malavite, you can abandon the preliminary bacteriological analysis of the microflora of periodontal pockets for sensitivity to antibiotics and the systemic use of antibiotics. The duration of dissolution of tires with malavite in the oral cavity (4-5 hours in the daytime and throughout the night after taking before bedtime) with the indicated course of treatment ensures the continuity of antibacterial and anti-inflammatory effects for three days.

Then, for 3 days, patients used medicinal tires with trental in the morning, and thymogen before bedtime. The local use of trental made it possible to quickly stop microcirculatory disorders, improve the rheological properties of blood and normalize the supply of oxygen to tissues, which eliminated such leading pathogenetic factors as venous congestion, increased vascular permeability, cellular exudation and filtration, and hypoxia of periodontal tissues. Timogen enhances immunity and intensifies reparative processes inhibited during CDW, which allows breaking the “vicious circle” of CDW pathogenesis.

At the final stage of treatment, to consolidate the achieved results, patients used tires with collargol for 3 days in the morning and before bedtime. Collargol, having an astringent, antiseptic and anti-inflammatory effect, well epithelizes wound surfaces on the mucous membranes and restores their density and consistency.

As a result of the course of pathogenetic therapy with the composition of immobilized drugs in the main group, the bleeding index PBI (papilla bleeding index) became “0”, while in the control group bleeding persisted in 20% of cases. The Green-Vermillion Hygiene Index (OHI-S) in the main group decreased by 81.6%, in the control - by 79.4%. The Russell periodontal index (PI) in the main group decreased by 62.0%, with 55.9% in the control group. On the ninth day of therapy, in the main group, 100% of patients were in a state of clinical well-being and stable remission, while in the control group of 20% of patients additional treatment was required.

Thus, the proposed method for the pathogenetic therapy of generalized periodontitis of mild severity with a composition of immobilized drugs can effectively and quickly reduce the inflammatory process and achieve not only a state of stable remission, but also a complete cure for this pathology.

Literature

1. Greenstein G. Periodical response to mechanical non-surgical therapy a review // J. Periodontol. - 1992. - G3. - P.118-130.

2. Bezrukova I.V. New methods of treatment of inflammatory periodontal diseases // New in dentistry. - 2001. - No. 4. - S. 55-57.

3. Alyushin M.T., Alekseev K.V., Lee V.N. Rare cross-linked acrylic polymers in pharmacy // Pharmacy. - 1986. - T.35, No. 1. - C.71-76.

4. Higuchi, T. Vision of the future // Acta Pharm. Suec. - 1983. - Vol.20, N 1. - P.70-71.

5. Higuchi W.I., Ho N.F.H .. Meecle H.P. Desing on oral drug delivery systems - past, present and fiiture // Drug Dev. and Ind. Pharm. - 1983. - Vol.9, N 7. - P.1227-1239.

6. Dahlen G. et al. Microbiological observation at periodical sublingual antimicrobal irrigation of periodontal pocets // J. Dent. Res. - 1989. - G8. - P.1714-1715.

7. Goodson J.M. Periodontal response to mechanical non-surgical therapy a review // J. Periodontol. - 1992. - G3. - P.118-130.

8. Oosterwall P.G.M., Mikh F.H.M., Renglli H.H. Clearense of a topically applied fluorescein gel from periodontal pocets // J. Clin, PeriodontoL - 1990. - 17. - P.613-615.

9. Ananyev V.N., Novikov Yu.T., Furies V.A. etc. The use of medicinal gelatin films in medicine. - M .: ed. Kruk, 2001 .-- 199 p.

10. Barer G.M., Lemetskaya T.I. Current trends in the selection of treatment methods for patients with periodontal pathology // Materials of the Russian scientific forum "Dentistry on the threshold of the third millennium". - M., 2001. - S.133-134.

11. Kankanyan A.P., Leontiev V.K. Periodontal disease. - Yerevan, 1998 .-- 358 p.

12. Ushakov R.V., Grudyanov A.I., Chuzhadzhyan G.A., Tsarev V.N. The use of adhesive medicinal films "Diplen-Dent" in dentistry // Periodontology. - 2000. - No. 3. - S.13-14.

13. Oparin S.V. Prevention of periodontal disease // Materials of the First All-Russian Congress "Dentistry of the XXI century: prevention issues". - Perm, 2001. - S.137-138,

14.Application 2003118497 dated June 23, 2003. Novikov Yu.T., Ananyev V.N., Furin V.A. etc. A method for the treatment of diseases of the mucous membranes.

15. RF patent №2147874. Furina E.A., Novikov Yu.T., Azanova T.A. The composition of the base for medicinal films. Declared 03.02.1998. Publ. 04/27/2000. BIPM No. 12.

Claims (3)

1. A method of treating generalized periodontitis of mild severity, including a basic treatment complex, antibacterial therapy, normalization of microcirculatory disorders in periodontal tissues, stimulation of local immunity and regenerative processes, characterized in that malavit is administered as antibacterial therapy to normalize microcirculatory disorders in periodontal tissues trental is administered, to stimulate local immunity, thymogen and regenerative processes are introduced - collargol, while drugs drive immobilized on a gelatin-glycerin tire, the basis of which is 28.57% gelatin, 17.86% glycerol and 53.57% water, and in the first 3 days, patients use tires with malavite three times a day after breakfast, lunch and before bedtime, then for 3 days, patients use medicinal tires with trental in the morning, and with thymogen at bedtime, at the final stage of treatment, medicinal tires with collargol are used for 3 days in the morning and at bedtime. 2. The treatment method according to claim 1, characterized in that the size of the medicinal tires is 50 × 5 × 2 mm or 100 × 5 × 2 mm. 3. The treatment method according to claim 1, characterized in that the basic complex of treatment includes professional oral hygiene, training and motivation of patients for individual oral hygiene, elimination of local etiological factors leading to chronic microtrauma and functional overload of periodontal tissues: poor-quality fillings, dentures.