RU2299437C1 - Method for examining periodontium state - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves taking gingival fluid from gingival pockets and spaces under supporting members of fixed structures when available. Samples are taken by using strip manufactured from highly hygroscopic rubber foam having absorbing surface of advanced quality and sized 7-10 mm in length, 1.8-2.2 mm in width and 0.8-1.5 mm in thickness. Porolon strips are caught with dental tweezers having two spring-loaded branches having gripping lips shaped as rounded plates on their working ends. The branches are continued with neck parts having their cross-section sizes smaller than branches cross-section sizes. Both neck parts are oriented likely at an angle of 100-145° relative to horizontal direction of the branches. Several native gingival fluid samples are placed on microscope object plates. Imprint cytograms are recorded in several vision fields and their images are saved to enable one to compare them with samples taken from computer library of standards.

EFFECT: high accuracy of examination results.

3 cl

Description

The invention relates to practical medicine - to dentistry and / or to cytology and can be used to study the condition of periodontal tissues in order to diagnose and select the appropriate treatment, as well as for scientific research in experimental medicine.

Known methods for examining the condition of the periodontium on the basis of cytological analysis of gingival fluid - patents RU: No. 1410951 "Method for the diagnosis of gingivitis"; No. 2061961 "Method for the diagnosis of periodontal tissue diseases"; No. 2089908 "A method for assessing the severity of the inflammatory process in periodontal tissues."

Gingival fluid is a physiological environment of the body that has a complex composition: white blood cells, deflated epithelial cells, microorganisms, electrolytes, proteins, enzymes and other substances. The study of gingival fluid, along with studies of the marginal part of periodontal disease, helps to broaden the understanding and knowledge of the local protection of periodontal tissues and the mechanisms of the development of the inflammatory process in them.

Also known is the cytological method for assessing periodontal status ["Periodontal Diseases" by A.S. Grigoryan, A.I. Grudyanov, A.I. Rabukhin, and O. A. Frolov. M.: Medical News Agency, 2004. - 320 p.]. The method begins with obtaining biological material from the gums. Imprints from the gums are obtained using the target - a wedge-shaped fragment of an eraser gum with a narrow part size of not more than 1 mm. Before making prints from the gum, the target is removed from the Petri dish, where it is stored filled with 50% ethyl alcohol, and dried with a stream of air from an air gun. Then the target is easily pressed to the gum in the gingival pocket of the examined tooth. The resulting prints are applied to slides, dried and stained. The result of cytological studies largely depends on the correctness of fingerprinting. Prints should be taken from the lingual surface from the area of the periodontal sulcus or periodontal pocket. The target is tightly pressed with the inner cheek to the tooth surface in the area of the gingival connection, and the outer cheek is pressed against the symmetrical gum section. Prints are applied to a pre-prepared slide, pre-fat free. Each glass contains prints taken from the area of 4-6 teeth, 3-4 prints in each quadrant. The glass is dried and stained. Then a series of cytograms is obtained and the cellular elements in them are characterized according to the chosen technique.

Closest to the claimed method is a method for examining the condition of periodontal disease, based on the study of gingival fluid, described in the patent [RU 2109287 "Method for the diagnosis of periodontal disease"], including the production of biological material by collecting gingival fluid, placing samples on slides, a multiple increase in the format of the studied images, the study of the cellular composition of the gingival fluid by fingerprints, analysis of them of significant parameters, which are used to judge the presence of pathology. As a research method, polarization microscopy is used. Gingival fluid is diluted with saline 20-30 times and viewed under an optical microscope in polarizing light. The severity of periodontal disease is diagnosed by the type of liquid crystal structures, namely: grooves + soft lines - diagnose mild gingivitis; grooves + soft lines + single small domains - gingivitis of moderate severity; radially radiant and / or confocal domains - severe gingivitis; radially radiant and / or confocal domains + needle structures - chronic gingivitis; micellar structures + grooves + soft lines + single small domains - periodontitis of mild severity; needle structures, and / or radially radiant crystals, and / or spruce crystals - periodontitis of moderate severity; massive pathological structures throughout the figure - severe periodontitis.

The disadvantage of this, as well as the above methods, is their unsuitability for accumulating primary initial, undistorted information about the parameters of the gingival fluid, including visual, which can be recorded and stored for processing in the future, including using a computer, and the inability to use the primary information in dynamics not only in the process of studying this particular disease, but also in the subsequent orthopedic dentist after the conclusion of the cytologist, as well as in subsequent periods of the patient’s life. In addition, as a rule, such studies are carried out by specialists of cytological laboratories and to treating doctors, including dentists and orthopedic dentists, this material, if it gets, is already processed - in the form of a description without a saved image captured in different angles that does not allow to draw more private and detailed conclusions, corrections, refinements, as well as a deeper study of certain significant areas, such as, in the immediate vicinity of supporting teeth, which is extremely important when prot , if needed.

With the introduction of dental implant designs and expensive dental prosthesis designs, many conclusions in order to improve the quality of work must be made and decisions made, taking into account them, directly by orthopedic dentists, periodontists, and not just laboratory assistants and cytologists examining the biological material of the cavity the patient’s mouth. Therefore, it is advisable at all stages of preparation of the oral cavity for prosthetics, during and after prosthetics, the physicians performing these works to provide a visually captured image of the results of microanalysis to assess the status of significant places of the gums, periodontal and abutment teeth of prosthetic structures, and in various positions.

The objective of the invention is to remedy the above disadvantages.

The essence of the invention lies in the fact that in the method of studying the condition of the periodontium, which includes obtaining biological material by taking the gingival fluid, placing samples on a glass slide, repeatedly increasing the format of the image being studied, examining the cellular composition of the gingival fluid by fingerprints, evaluating significant parameters from them, according to which judge about the presence of pathology, when sampling gingival fluid from the gingival pockets carry out, including taking samples under the supporting elements of fixed structures with they are present, and they are considered significant, gum fluid is taken, excluding changes in the state picture and tissue invasiveness, several native gingival fluid samples taken from significant places are placed on slides, cytograms of prints are recorded in several fields of view, and their images are preserved for subsequent comparisons with samples from the library of computer standards.

In addition, the claimed method with the above features, the difference of which is that the gingival fluid is collected using disposable sterile strips of highly hygroscopic foam with a developed absorbent surface, having the following dimensions: length 7-10 mm, width 1.8-2.2 mm, thickness 0.8-1.5 mm.

Also disclosed is a method in which a multiple increase in the material being studied in the above method and for fixing images in several fields of view is carried out by a digital camera.

Another improvement of the proposed method is the use of dental tweezers with a jaw bend in the neck region in one direction at an angle with respect to the horizontal direction of the jaw, the magnitude of which is limited to values from 100 ° to 145 ° when sampling the gingival fluid.

The technical result of the claimed invention is to increase the level of research, the ability to automate the final stage of the method using data processing using a computer. Despite the fact that the processing of the obtained data is outside the scope of the method, however, preparations for its high-quality performance are carried out at each stage of the proposed method. Photographing not only cytologists, but also practical dentists, the information they need from a wide variety of perspectives and storing this information in its original form allows you to repeatedly access this information for several years in dynamics, as well as process research results by comparing them with samples from the reference library A computer, which eliminates subjectivity and eliminates a number of errors of the contractor.

Particular care is taken in the collection of biological material without the slightest trauma to the oral cavity during the collection of gingival fluid and the exclusion of changes in the picture of the study field, for example, due to the appearance of blood as a result of touching inflamed areas and tissues and the use of an original and at the same time quite convenient disposable strip from foam rubber, a material used in other branches of medicine and for other purposes, but not in dentistry and not in cytology, allowed to solve some of the problems in the initial stages of the method. The choice of the original material and the optimal size of the strip allows you to absorb a sufficient amount of gingival fluid without deforming its cells. The technical result is enhanced by selecting the optimal size of the absorbent foam strip along the length, width, thickness - see description, nature, formula. The claimed dimensions of the foam strip prevent it from getting stuck in the immersed space, as well as stretching the gingival pocket itself from the excessively large size of the strip. Given the variation in the size of the strips along the length, width and thickness of the foam rubber, the most optimal size for a child or an adult is selected, taking into account the dimensions and anatomy of the patient’s teeth and perineal cavities. A qualitative improvement of the studies occurred in the method due to the study of the material in the problem areas of the patient - without fail the zones of supporting teeth of prosthetic structures and the study of native samples. The technical result is enhanced by the original tools developed by the authors — dental tweezers with bent jaw necks in one direction to expand the dentist’s working field of vision during manipulations related to gingival fluid intake. The narrowed transverse size of the jaw necks, in comparison with the transverse size of the jaws themselves, also works on the effect of visualization and control of the doctor’s actions.

The implementation of the proposed method.

If the patient complains of discomfort and aggravation of inflammatory processes, including the presence of dentures, all removable elements are removed, and non-removable ones are left. A clinical visual examination of the oral cavity is performed. Then carry out the intake of gingival fluid. In this case, special attention is paid to areas of close proximity to the abutment teeth of dentures. It is important in the case of fixed structures not to damage them, trying, if possible, to save them not only for the period of research and treatment, but also after eliminating possible problems. Therefore, gingival pockets and, in the first place, gingival pockets of supporting teeth with prosthetic structures are considered significant places for gingival fluid intake. To prevent contact with saliva and oral fluid, it is necessary to isolate the areas of the marginal parts of the gums of the studied teeth with cotton or gauze rollers. The surface of the teeth and gums is dried by the air stream of the gun. With tweezers, a sterile disposable strip of highly hygroscopic material, for example medical foam, is captured, and carefully placed in a gum pocket of the tooth and allowed to absorb the gum fluid. As a rule, this is 10-15 s. A strip soaked with gingival fluid is placed on sterile numbered glass. The tweezers with a strip are held by the doctor’s hand, and the liquid is allowed to exit the strip. When touching a strip of glass, part of the gingival fluid spontaneously flows onto it. With a light movement on the glass with a strip clamped with tweezers, the doctor provides a more complete release of it from the material obtained. Then the used strip is placed in a special bag for disposal. The procedure is repeated with each tooth indicated for examination. In these procedures, the samples obtained are not diluted, but the native material is placed directly on numbered glasses. Dry the sample on the glass. Air fixation without additional heating is preferred. Then the smears are stained using a standard set of dyes for rapid diagnosis. Staining lasts for 30-60 seconds, after which the smears are ready for viewing. Slides with stained preparations are fixed on a microscope stage. To select the field of view, images are examined through microscope lenses with magnification × 40 - × 100. In the process of research by manipulating macro- and microscrews of the microscope, image clarity is achieved. Then capture the image of the test material. Then change the field of view of the image the required number of times for this study, each time repeating the procedure for fixing images. The resulting material is stored for subsequent comparison with samples from the library of computer standards.

Example 1

Sick Petrov I.A. He complained of the absence of some teeth of the chewing group, discomfort in the gingival margin of 24 and 27 teeth.

After a clinical examination, determination of the occlusal relationship of the dentition, an X-ray examination of the abutment teeth and the teeth, the patient was diagnosed with a defect in the dentition of the upper jaw of class III. according to Kennedy on the right, limited by 24 and 27 teeth, restored by a bridge brazed prosthesis that meets the requirements for designs.

After preparing the oral cavity for research - cleaning teeth from plaque, isolating the gingival segment from saliva and oral fluid with cotton rolls, drying the air stream manipulation zone, in strict accordance with the above method, the gingival fluid was taken. Twelve disposable sterile disposable foam strips of 10 × 2 × 1.3 mm in size were inserted with tweezers into the gingival pockets of 24 and 27 teeth from the vestibular side, which were impregnated with gingival fluid for 10-15 seconds, removed from the pocket and transferred to a glass slide. Gingival smears were stained, viewed through a × 40 and × 90 microscope lens. The rotation of the microscrew of the microscope contributed to a clear image. Having removed the tube with the eyepieces of the microscope, a digital camera was mounted in their place using a tripod, bringing its lens close to the recess for the tube holder of the microscope. An enlarged image, the degree of increase of which corresponded to the degree of magnification of the microscope objective, was fixed with a digital camera in the high-speed sequential shooting mode, which allows taking 2-3 pictures at each shutter release at a speed of 2.1 pictures per second, which also reduces the possibility of distortion when the apparatus is shifted . The image of the field of view of the drug was transmitted to the monitor of a digital camera. Then, using the optical zoom of the camera, the image was enlarged. An image of the field of view of the drug was transmitted to a computer monitor.

Cytograms were recorded - they were photographed in ten fields of view, changing the field of view from one side, on the other hand, and in a variety of interesting angles. The study of photographs of cytograms showed a change in the composition of the gingival fluid in the area of the alleged abutment teeth, corresponding to the inflammatory-degenerative type of cytograms. Professional oral hygiene measures are recommended. 2 weeks after hygienic treatment, a change in the gingival fluid cytograms was observed - the regenerative type.

The method has been tested in the applicant organization, brought to a practical option. The results of cytological studies, obtained by him, coincide with the results of traditional methods, differing in simplicity, reduction in the duration of studies, which, ultimately, affects the quality of dental care for patients.

Claims (3)

1. A method for studying periodontal conditions, including obtaining biological material by taking gingival fluid, placing samples on glass slides, drying, staining them, repeatedly increasing the format of the image to be studied, examining the cellular composition of the gingival fluid, evaluating significant parameters from them, which judge the presence pathology, characterized in that the gingival fluid is taken from the gingival pockets using a strip of highly hygroscopic foam with a developed absorbent surface and having the following dimensions: length 7-10 mm, width 1.8-2.2 mm, thickness 0.8-1.5 mm, while the foam strips are captured with dental tweezers containing two springy jaws with gripping jaws in the form of round plates at their working ends and having a junction in the form of necks with transverse dimensions smaller than the transverse dimensions of the jaws, and orienting both necks in one direction at an angle, the value of which is limited to values from 100 to 145 ° with respect to the horizontal direction of the jaws, on glass slides put n many native samples gingival fluid, fixed cytogram prints in multiple fields of view and ensure the safety of their images for comparison with samples from a computer library of standards. 2. The method according to claim 1, characterized in that in the presence of fixed structures carry out additional sampling under the supporting elements of fixed structures. 3. The method according to PP.1 and 2, characterized in that the multiple increase in the studied material and ensuring the fixation of images in several fields of view is carried out by a digital camera.