RU2332998C2 - Method for treatment of parodonthosis - Google Patents

Abstract

FIELD: medicine; stomatology.

SUBSTANCE: after a surgical treatment of parodontal pocket an aqueous solution of Tamerite with concentration of 0.03-0.06 g/ml is applied on a vulnerary surface of parodontal pocket.

EFFECT: stabilisation of pathological process; simplification of treatment and reduction of terms.

2 ex

Description

The invention relates to dentistry and can be used in the treatment of periodontal diseases of varying severity.

Known methods of treating periodontal diseases, in which, along with surgical intervention, various medications are used to enhance the therapeutic effect.

A known method for the treatment of periodontitis [RU 2271212], including the classic Widman surgery, in which, before laying the flap, the patient is taken blood, then it is centrifuged for 11-13 minutes, as a result of which the blood is separated into fractions, after which a fraction representing a plasma with a high platelet content, mix it with beta-tricalcium phosphate powder, then the resulting mixture is placed in the area of the defect, and the flap is fixed with sutures.

In this method, the medicament used for drug therapy is prepared during surgery, which leads to an increase in the time of its implementation and the complexity of the method.

A known method of treating inflammatory and destructive forms of periodontal disease, including surgical intervention and drug therapy [RU 2231986]. According to the specified method, standard preparation of the surgical field is carried out, including the formation and exfoliation of periodontal flaps, applying them to the surgical field, treating donor wounds. Before applying the exfoliated flap, it is enriched with an allofibroblast before applying it to the surgical field and a donor wound, using a suspension of LEC-4 cells (81), a strain of human embryo diploid cells that are cultured in the growth medium IGLA-MEM with the addition of blood serum from large horned fruits cattle. The surgical field is closed with a folderm and a hardening dressing is applied from above.

In this method, by using the specified medicament, the healing time of surgical wounds is reduced. However, since the agent used in the method is a suspension of living cells, it requires rapid use, which may limit the use of the method in question.

A known method of treating periodontitis, including surgical intervention and drug therapy [Kovalevskaya E.O. Experimental and clinical justification for the use of tamerite in the complex treatment of periodontal diseases. Abstract of the dissertation, Moscow, 2004, p.10], selected by the authors as the closest analogue.

The method under consideration includes closed curettage of pathological gingival (periodontal) pockets, treatment with chlorhexidine solution, drug therapy using ascorutin and tamerite drug, which is a combination of synthetic phthalhydroside derivatives and has immunomodulating properties.

In this method, an aqueous solution of tamerite is used, which is administered intramuscularly daily for 5 days before conducting closed curettage, then daily for the first 5 days after curettage and then 1 time in 2 days for 5 days.

Due to the use of tamerite in the considered method, the therapeutic effectiveness of the complex therapy of periodontal diseases is increased.

However, the need for a long course of drug therapy by intramuscular injection of an aqueous solution of tamerite leads to an increase in the period of treatment of periodontitis and complicates the method under consideration.

The objective of the invention is to simplify the method of treatment of periodontitis and reduce its duration.

The essence of the invention lies in the fact that in the method of treating periodontitis, including surgical treatment of periodontal pocket and drug therapy using an aqueous solution of tamerite as a medicine, according to the invention, drug therapy is carried out by applying an aqueous solution of tamerite with a concentration of 0.03-0, 06 g / ml on the wound surface of the periodontal pocket after surgical treatment.

During experimental studies and clinical trials, the authors found that the use in the treatment regimen of various forms of periodontitis of local drug therapy with an aqueous solution of tamerite with a concentration of 0.03-0.06 g / ml by applying this solution to the wound surfaces of the periodontal pocket after its surgical treatment It turned out to be extremely effective in terms of stabilizing the pathological process. Moreover, drug therapy is carried out by one-time treatment of tissues in the lesion during surgery, which significantly reduces the duration of the method of treatment of periodontitis and simplifies its implementation.

The inventive method is as follows.

Surgical treatment of the pathological periodontal pocket is carried out, during which infected tissues and subgingival deposits are removed, and then antiseptic treatment of wound surfaces is performed. An aqueous solution of tamerite with a concentration of 0.03-0.06 g / ml is applied to the dried wound surface, for example, by irrigation of the indicated surface using a syringe with a blunt needle. If necessary, a complex of therapeutic measures is carried out, in particular, bone defects are filled. Then close the periodontal pocket by applying a bandage or sutures.

The possibility of implementing the proposed method is shown in examples of specific performance.

Example 1. Patient K., 58 years old, turned to the Dental Clinic “Copper” with complaints of bleeding gums when brushing your teeth, sensitivity from all cold teeth, tooth mobility, impaired diction due to progressive tooth loss. Previously, comprehensive treatment of periodontal diseases has not been carried out. The teeth were removed in the clinic at the place of residence as mobility progressed. History: chronic gastritis, long-term occupational hazards (work in the North).

Examination of the oral cavity: the gum is slightly hyperemic throughout, abundant supra- and subgingival deposits, gum recession up to 9 mm in the area of individual teeth, periodontal pockets up to 6 mm deep on the upper and lower jaws. The bleeding index is 3-4 points, PMA = 75%. Poor bridges. On x-rays, uneven resorption of bone tissue, in the region up to 2/3 of the root length, complete resorption of the interdental septa, a change in the position of the teeth.

Diagnosis: chronic generalized periodontitis, severe.

The patient was treated, including surgery on separate segments, covering 2-6 teeth.

Under infiltration anesthesia "Ultracain DS" - 2.0 ml in the selected segment, surgical treatment of pathological periodontal pockets was performed. During the treatment, a horizontal incision was made along the tops of the interdental papillae in the area of the segment being operated, the mucosal-periosteal flap was peeled off, subgingival dental deposits were removed, the root surface was leveled, granulation curettage, de-epithelization of the flap were performed. Antiseptic treatment of wound surfaces was carried out with a 0.05% chlorhexidine solution.

Ex temporo prepared an aqueous solution of tamerite with a concentration of 0.05 g / ml. Then, the dried wound surfaces (bones and de-epithelized flap) from the syringe with a blunt needle were irrigated with the indicated tamerite solution. At the same time, 1.5-2.5 ml of the indicated solution was used for irrigation.

Conducted further therapeutic measures using well-known techniques. Bone defects were filled with Bio-Oss Collagen, isolated with a Bio-Hyde membrane, flaps were placed in place, Vikril sutures were applied.

On the 2nd day, the course of the postoperative period was monitored: edema was practically absent, the gingival margin was pale pink, smooth, shiny tightly covered the neck of the tooth. There are no complaints about pain.

The operation on the next segment was performed after 2-3 weeks.

Assessment of treatment results was carried out after 6 months. At the same time, normalization of the appearance of the gums was noted: the gum tissue is dense, adjacent to the neck of the tooth, physiological color. Bleeding -1 point. When probing - periodontal pockets no more than 2 mm. Tooth mobility - no more than 1 degree.

On X-ray photographs: no progressive loss of bone tissue was noted, the formation of a cortical plate in the area of the interdental septa, the formation of a bone structure in the area of vertical pockets was observed.

After 12 months, stabilization of the clinical and radiological picture continued.

Example 2. Patient M., 31 years old, came to the Dental Clinic “Copper” with complaints of bleeding gums when brushing her teeth, an increase in the size of the interdental papillae. Previously, periodontal disease has not been treated. History: atopic dermatitis.

Examination of the oral cavity: all teeth except 38, 48 are available, swollen gingival papillae are hyperemic in all departments, abundant supra- and subgingival hard and soft dental deposits, periodontal pockets up to 4 mm in the side sections, mobility 1-2 degrees in the side sections . Bleeding index 3-4 6alla, PMA = 70%. On x-rays, the resorption of the tops of the interdental septa in all departments, the violation of the integrity of the cortical plate.

Diagnosis: chronic generalized periodontitis, moderate.

The patient was treated, including surgery on separate segments, covering 2-6 teeth.

In the selected segment under Ultracain DS infiltration anesthesia - 2 ml, the method of closed curettage was used to perform surgical treatment of periodontal pocket, during which LM curettes removed subgingival dental deposits (subgingival scaling), aligned root surfaces, and removed granulation. Antiseptic treatment of wound surfaces was carried out with a 0.05% chlorhexidine solution.

Ex temporo prepared an aqueous solution of tamerite with a concentration of 0.05 g / ml. Then, the wound surfaces of the bone and gingival tissues were irrigated with the indicated solution using a syringe with a blunt needle, introducing the latter into the cavity of the periodontal pocket. At the same time, 1.5-2.5 ml of the indicated solution was used for irrigation. A protective periodontal bandage “Koe-Pak” was applied.

On the 2nd day, the course of the postoperative period was assessed: there was no edema, pain, the gingival margin was a dense pale pink color.

Treatment in the next segment was performed after 1 week.

Assessment of treatment results was carried out after 3 months.

Clinically noted: the absence of signs of inflammation, the gingival margin is pink, tightly covers the gum. Bleeding no more than 1 point. No mobility. When probing, the depth of periodontal pockets is not more than 2 mm.

On x-rays, it was noted: the absence of progressive loss of bone tissue, the formation of a cortical plate in the area of the interdental septa, an increase in the density of periodontal bone according to the results of optical osteodensitometry,

After 6 and 12 months, the stability of the clinical and radiological picture was noted.

Claims (1)

A method of treating periodontitis, including surgical treatment of periodontal pocket and drug therapy using an aqueous solution of tamerite as a medicine, characterized in that the drug therapy is carried out by applying an aqueous solution of tamerite with a concentration of 0.03-0.06 g / ml to wound the surface of the periodontal pocket after its surgical treatment.