RU2288709C2 - Method of increasing vitality of marginal gum tissues in case of paradentium diseases - Google Patents

Abstract

FIELD: stomatology.

SUBSTANCE: invention, which can be used to treat paradentium diseases accompanying inflammation or recession of marginal gum tissues, comprises performing vestibuloplastics and laying Diplen-Denta film containing Oliphen daily starting on the second postoperative day during five days.

EFFECT: increased vitality of marginal gum tissues due to enhanced energy exchange and microcirculation.

6 dwg, 6 tbl, 2 ex

Description

The invention relates to medicine, namely to dentistry, and for increasing the viability of marginal gum tissue in periodontal diseases, accompanied by inflammation or recession by restoring microcirculation and energy exchange at the cellular level, including surgical and medical treatment using Diplen-Dent film, containing oliphene.

According to WHO (1990), a high level of periodontal disease occurs in age groups from 15 to 19 (55-89%) and from 35 to 44 years (65-98%) [1]. One of the constant clinical and morphological manifestations of periodontitis is persistent inflammation of the marginal gums [2]. Destructive-inflammatory processes in the periodontium can be observed for various reasons, including with an improperly formed vestibule of the oral cavity. The periodontal overload caused by this is accompanied by changes in the hydrostatic pressure of the blood, the appearance of hemostasis, entailing the development of the phenomena of hypoxia. All this affects the structure of periodontal tissues. There is swelling and destruction of collagen fibers, leading to a violation of the integrity of the epithelial cover in the area of the gingival connection.

Traumatic factors can cause localized periodontal lesions and exacerbate the generalized process [3]. In particular, a local recession develops in the presence of a small vestibule of the oral cavity or high attachment of connective tissue cords of the oral mucosa [4]. In patients with periodontitis, a small vestibule was detected in 62.6% of cases, along with cords of the transition fold 30%, short frenum of the upper lip - 6.6% and lower lip 22.0% [5].

Based on the microcirculation indices according to laser Doppler flowmetry (LDF), it can be argued that timely surgical treatment of this pathology leads to a decrease in inflammation and an improvement in the trophism of periodontal tissues, which remains long-term [6].

But with tissue damage at the time of surgery, a short-term spasm occurs, followed by paresis and expansion of other small vessels. Slows blood flow in the vessels of the areas adjacent to the wound. This is caused by paralysis of the neuromuscular system, loss of vascular tone, thrombosis of small veins and blood clotting. In the first phase of the wound healing process (1-4 days after surgery), the breakdown of proteins, fat and glycogen increases, their oxidation is impaired, the permeability of cell membranes decreases, protein synthesis and physiological regeneration are inhibited. On days 4–10, in the second phase, protein metabolism is normalized, and regeneration processes are activated [7].

The above changes in the early stages after the operation of deepening the vestibule (vestibuloplasty) reinforce the changes in the marginal gum adjacent to the surgical intervention zone that are present in periodontal pathology, which affects its further condition. It is necessary to develop methods for correcting microcirculation disorders with the elimination of a hypoxic state in the first days after an operating injury, which will enhance the viability of marginal gum cells.

There is a method of normalizing metabolic processes in the cell and a drug for these purposes [8]. The essence of the method consists in the use of a substance consisting of preparations "Olifen" and a hydrolyzate of protein material - a food supplement "Immunovit". Oliphene activates the energy-producing ability of cells, restores their functional activity. The substance is used orally to increase physical endurance and in the treatment of tuberculosis. However, this method does not allow locally use contained in the proposed compositions olifene in the oral cavity.

Also known is a method of treating periodontitis using a 7% aqueous solution of oliphene [9]. Cotton turundas are impregnated with the drug, which are inserted into the periodontal pockets and closed with protective dressings from paraffin for 2-3 hours. In the treatment of the abscessed form of periodontitis, turunds are held in the periodontal pocket for 30 minutes without paraffin application. The use of drying oil leads to a significant improvement in the condition of patients and periodontal tissues (cessation of suppuration, bleeding, edema) without additional use of other drugs. But the methodology of the proposed procedure is complex and only a dentist can implement it. In addition, this technique is not used in the surgical treatment of periodontitis.

A method for the treatment of inflammatory diseases of the maxillofacial region in patients with diabetes mellitus has been proposed [10]. Starting from 3-6 for after surgery (opening the abscess), the wound was loosened daily by tampon with turunda moistened with a 3.5% solution of oliphene for 6-8 days. Patients with severe diabetes mellitus and diffuse purulent-inflammatory processes are simultaneously prescribed 0.5 g tablets of olifen 3 times a day for 7-10 days. Positive effect: regeneration is accelerated and the total duration of treatment is reduced. The proposed method limits the contingent of patients with diabetes.

In order to increase the viability of marginal gum tissue in periodontal diseases accompanied by inflammation or recession of the gum, a treatment method is proposed that consists in restoring energy exchange at the cellular level and microcirculation, including surgical and medical treatment.

The claimed method is as follows. After a preliminary examination, preoperative preparation is carried out, including the removal of dental deposits, the removal of acute inflammation in the periodontium by conventional methods. Deepen the vestibule of the oral cavity operatively. On the 2nd day after surgery on the marginal gum in the projection of the incision, a Diplen-Dent film with olifene is applied, until it is completely absorbed (for 8-10 hours) in the morning and evening, daily from the second day after the operation for 5 days.

Used Diplen-Denta biopolymer film was proposed by G. Chukhadzhyan et al. [11]. It is a thin plate containing hydrophobic and hydrophilic layers. The effect is produced by applying a medicinal film with the hydrophilic side, including a drug of any group, on the oral mucosa. The used drug olifene belongs to the class of antihypoxants (group 7.2 according to the classification of the register of medicines of Russia). The mechanism of its action is to optimize the activity of the mitochondria of the cells and decrease due to this their oxygen consumption, which increases the efficiency of tissue respiration. The presence in the polymer structure of a molecule of a thiosulfate group provides a pronounced antiradical and antioxidant effect of the drug [12].

The method was performed in 36 patients aged 19-54 years with chronic periodontitis of mild to moderate severity who were outpatient treatment in a dental clinic of the Chita State Medical Academy.

Patients, depending on the type of treatment, were divided into 2 clinically equivalent groups. The first group included persons with periodontitis, in the complex treatment of which olifene was not included. In addition to preoperative preparation and surgery to deepen the vestibule of the oral cavity, the patients of the second group received a Diplen-Dent film with oliphene in the morning and evening for 5 days from the second day after the operation and kept until completely dissolved (8-10 hours).

To evaluate the results, patients of both groups were studied microcirculation in the marginal gum in the projection of the surgical intervention zone using laser Doppler flowmetry (LDF) [13, 14].

LDF parameters were measured before the operation, one week later and one month after it. The results are presented in figures 1-6 and in tables 1-6.

The active mechanism of vasomotion ALF / M in terms of microcirculation had similar dynamics in patients of both groups (Fig. 1): a decrease in the week by 47.3% and an increase in the month by 12.6%. The indicators in the group with olifene were higher in the second by 35.9% and in the third measurement by 58.9%. These changes can be more associated with a decrease in a week and an increase in the number of functioning capillaries in a month.

The active mechanism of vasomotion ALF / σ, characterizing the flow of red blood cells, namely, statistically significant fluctuations in their speed (figure 2), in the control group a week after surgery decreased by 10.04%. The use of olifene allowed to maintain the level of vasomotions throughout without measurements.

The mechanism of active blood flow modulation σ / ALF - vascular tone (Fig. 3), characterizing the neurogenic activity of precapillary microvessels in the control group, increased by 4.5%, and in the group with oliphene tended to decrease (by 5.1%) and through the week approached the boundaries of the average indicators (65-83%). A month later, in the group with oliphene, the value of vascular tone was 106.7% and was 3.09% lower than the initial level.

The intravascular resistance (Fig. 4) during the second examination in the control group decreased by 26.9%, after a month - by 6.5%. When using olifen, a decrease in intravascular resistance was noted by 27.9%, and after a month an increase of 122% from the initial level and falling within the boundaries of average statistics (3.8-7.2%), which indicated the normalization of perfusion processes in periodontal tissues.

Passive blood flow modulation - respiratory fluctuations (Fig. 5), regarded as an additional mechanism for activating microcirculation, in the control group had a slight downward trend (by 1.8% after a week, 5.7% after a month). Olyphene contributed to their stable increase. One month after the operation, respiratory fluctuations reached an increase of 19.6% from the initial level.

The passive blood flow mechanism (pulse fluctuations) (Fig. 6), caused by changes in the velocity of red blood cells in microvessels, in the control group increased by 8.4% in the second examination, fell sharply by 26.9%, and changed slightly with olifen from the beginning of treatment to the end of the observation (from 30.08% to 31.18%). It can be concluded: oliphene maintains the stability of hemodynamic mechanisms of blood flow in microvessels.

Example 1. Patient Kostenkova AS, 19 years old, complained of exposure of the necks 31 41. Over the past 2 years she was treated by a dentist for chronic catarrhal gingivitis. About six months ago, I drew attention to the exposure of necks 31 41.

Local status: interdental nipples of the anterior teeth at the level of the lower jaw are slightly swollen, infiltrated, pale pink. Marking of the necks 31 41 by 2 mm is noted. The frenum of the lower lip is wide, short, with a base attached 2 mm below the apex of the interdental papilla 41 31, the depth of the vestibule of the oral cavity in the lower jaw is 6 mm. On the intraoral radiograph 33-43, the radiograph shows a blurred bone pattern in the area of the apices of the interdental septa 32 31 41 42. Diagnosis: Chronic local periodontitis of mild severity, remission, local gum recession 31 41, small vestibule of the oral cavity in the lower jaw. The patient underwent an additional examination - the study of microcirculation of the marginal gum using the LDF method: vasomociation - ALF / M = 8.73%, ALF / σ = 75.41%; vascular tone - σ / ALF = 132.61%; intravascular resistance - ACF1 / M = 4.17%; respiratory fluctuations - AHF / σ = 63.93%; pulse fluctuations - ACF / σ = 36.07%.

The patient underwent an operation of vestibuloplasty from 34 to 44. After the operation, an antiseptic treatment was carried out, the application of iodine wipes with heparin ointment. A week after the operation, the marginal gum is infiltrated, slightly hyperemic, microcirculation indicators: vasomotion - ALF / M = 9.87%, ALF / σ = 107.69%; vascular tone - σ / ALF = 92.86%; intravascular resistance - ACF1 / M = 2.59%; respiratory fluctuations - AHF / σ = 80.77%; pulse fluctuations - ACF / σ = 28.21%.

The patient was examined in a month: the marginal gum in the frontal part is pale pink, exposes the necks of the necks 31 41 by 1 mm, the microcirculation of the marginal gum according to LDF: vasomotomy - ALF / M = 21.84%, ALF / σ = 90.40 %; vascular tone - σ / ALF = 110.62%; intravascular resistance - ACF1 / M = 3.30%; respiratory fluctuations - AHF / σ = 70.24%; pulse fluctuations - ACF / σ = 13.66%.

Example 2. Patient Kharkov I., 42 years old. For 5 years, periodically treated by a dentist for chronic generalized periodontitis of moderate severity. The patient was removed dental plaque, applications.

On examination: the marginal gum is infiltrated, with a slight bluish tinge in the area of the teeth of the upper and lower jaw, at the level of 32 31 41 periodontal pockets 3 mm deep. The depth of the vestibule of the oral cavity in the frontal region is 4 mm. When the lower lip is delayed, blanching of the interdental papilla and marginal gum is 32 to 41. During an X-ray examination, signs of osteoporosis are noted, which are most pronounced in the region 32 31 41 and are accompanied by one third of the destruction of the interalveolar septa. The study of microcirculation according to LDF: vasomotion - ALF / M = 4.02%, ALF / σ = 60.08%; vascular tone - σ / ALF = 166.45%; intravascular resistance - ACF1 / M = 2.62%; respiratory fluctuations - AHF / σ = 75.75%; pulse fluctuations - ACF / σ = 39.18%.

Diagnosis: Chronic generalized periodontitis of moderate severity in remission, a small vestibule of the oral cavity.

According to the comprehensive treatment plan, the patient underwent vestibuloplasty surgery from 34 to 44. From the second day after the operation, the patient used Diplen-Dent films with oliphene for 5 days in the morning and evening by applying narrow strips (7 mm) to the marginal gum in region 34 -44. The film was held until completely resorbed (8-10 hours). A week later, the marginal gum in the region of the front teeth of the lower jaw was pale pink in color, was slightly swollen. According to LDF in the marginal gum in the area of surgical intervention: vasomociation - ALF / M = 4.19%, ALF / σ = 82.48%; vascular tone - σ / ALF = 121.24%; intravascular resistance - ACF1 / M = 1.32%; respiratory fluctuations - AHF / σ = 80.31%; pulse fluctuations - ACF / σ = 26.05%.

Upon examination after a month: the marginal gum is pale pink in color, the depth of periodontal pockets is at the level of 32 31 41 2-3 mm. According to LDF: vasomociation - ALF / M = 27.11%, ALF / σ = 86.33%; vascular tone σ / ALF = 115.83%; intravascular resistance - ACF1 / M = 15.43%; respiratory fluctuations - AHF / σ = 107.17%; pulse fluctuations - ACF / σ = 49.12%.

The results allow us to conclude that the vestibuloplasty and olifen have a positive effect on the microcirculation of marginal gum and periodontal tissues. The combination of surgical intervention to deepen the oral cavity and the use of olifene in the composition of Diplen-Dent films leads to a summation of the effect and the appearance of pronounced changes in the periodontium.

Oliphene, improving the effectiveness of tissue respiration in conditions of hypoxia, eliminates its negative effect in the form of an increase in microcirculation disturbance in the early stages after surgery. At the next stage, the improvement of blood supply in the marginal gum consists of the long-term effect of the drug and the restoration of blood supply due to vascular regeneration. The use of a film simplifies the use of olifen during surgical interventions on periodontal tissues.

LITERATURE

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10. Zabelin A.S. A method for the treatment of inflammatory diseases of the maxillofacial region in patients with diabetes mellitus / L.M. Tsepov, E.L. Suloeva, Yu.V. Medvedev, L.A. Shashkov // RF Patent No.93007469 / 14 of 12/10/1996.

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Claims (1)

A method of increasing the viability of marginal gum tissue in inflammatory periodontal diseases accompanied by gum recession, including surgical treatment and medicinal applications with olifen, characterized in that vestibuloplasty is performed, and olifen is used in Diplen-Denta film daily from the second day after surgery for 5 days.

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