RU2343858C1 - Method of surgical treatment serious parodontosis - Google Patents

Abstract

FIELD: medicine; surgical stomatology.

SUBSTANCE: carry out intrasulcular cut and supplement it with the vertical cut from the medial side, forming a triangular mucoperiosteal flap. Bare periapical area of defect. Remove subdingival dental deposit, granulations, sphacelous osteal tissue. Polish roots of the teeth, apply a biological preparation Pref Gel on them. Influence on an operated zone ultrasound. Enter sterile gel Emdogain into osteal defects.

EFFECT: reduction of risk of slipping of flap, wound cure acceleration.

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Description

The invention relates to surgical dentistry and can be used in the treatment of severe periodontitis with a complete loss of supporting and retaining periodontal tissues while maintaining teeth.

Periodontitis - inflammation of the tissues surrounding the tooth, involving bone tissue, which is a treatable pathology, but at the same time requires a multilateral comprehensive approach to treatment.

In recent years, periodontal diseases have rightly attracted increased attention, since after 35 years they are the most frequent tooth loss. In recent years, there is a lot of evidence that periodontopathy may increase the risk of systemic diseases. This applies, for example, to coronary heart diseases, myocardial infarction, stroke, arteriosclerosis, the risk of premature birth, the birth of children with hypertrophy and other serious diseases.

An important task in the treatment are: the exclusion of the most likely pathological factors; elimination of local irritating factors in the oral cavity; the elimination of inflammation of periodontal tissues; suspension of the dystrophic process; restoration of impaired function of periodontal tissues; stimulation of the regeneration process.

Typically, treatment of periodontitis is made taking into account the individual specifics of the disease.

The most radical, but at the same time effective treatment of generalized periodontitis of moderate and severe degree is a flap operation, during which all inflammatory tissues from the interdental spaces are removed, the root surfaces are ground and polished, the mucoperiosteal flap is processed and modeled.

There is a method of treating periodontitis (application for the grant of a patent of the Russian Federation for invention No. 2005124245, А61В 17/00) by cutting out a mucoperiosteal flap, curettage, antiseptic processing, filling a bone defect, applying a membrane, laying a mucoperiosteal flap, stitching a wound, while filling of a bone defect is performed with a medicinal product, including furatsilin, aminocaproic acid, dimethyl sulfoxide, glycerin, oxyl, chitosan, gelatin, purified water, and a membrane is used as a membrane, including containing furatsilin, dimethyl sulfoxide, acetic acid, aerosil, chitosan, and purified water.

A known method of treating periodontitis (RF patent for the invention No. 2292884, A61K 31/355), in which, when performing a patch operation, bone pockets are filled with a paste containing hydroxyapatite and a 10% solution of tocopherol acetate in oil in a ratio of 3: 1.

A known method for the surgical treatment of chronic periodontitis (RF patent for the invention No. 2242253, A61M 1/38), in which the formation and mobilization of mucosal-periosteal flaps, removal of subgingival dental deposits, granulations, areas of necrotic bone tissue, polishing of the roots of the teeth and introduction into the bone defects in sterile osteoplastic material.

A known method for the surgical treatment of periodontitis (RF patent for the invention No. 2271212, A61K 33/06), including the classic Widman surgery, preparing the mixture to fill in the defect areas, the mixture is prepared from beta-tricalcium phosphate powder, which is mixed with high plasma platelets obtained by centrifugation from the patient’s blood (prototype).

A known method of treating periodontitis (RF patent for the invention No. 2012242, A61B 17/00) by peeling off the flap, curettage and filling bone pockets with powder from demineralized allostomy, restoring the resorbed wall of the alveolar ridge of the demineralized perforated cortical strip, which is fixed to the alveolar ridge of the appendix allostia, while the powder from demineralized bone is immersed in a blood clot in a bone pocket.

It is known to use various materials in the surgical treatment of periodontitis, for example:

preparations Bio-Oss, Bio-Gide of the company Geistich (J. "New in Dentistry", No. 8, 2001, p. 72-77);

a suspension of cells of the M-22 line of diploid fibroblasts of the skin and muscles of a human embryo, cultured on a IgLA medium with the addition of cattle blood serum (J. “Cytology”, No. 9, v. 43, 2001, p. 853-854);

polytetrafluoroethylene membranes (J. "New in Dentistry", No. 6, 2001, p. 47-57);

Collapan preparation (“The use of biocomposite materials in maxillofacial surgery and dentistry: materials of the 1st All-Russian Scientific Conference. - M., 1997, p. 39-40);

Emdogain is a biological-based preparation consisting of hydrophobic proteins of the enamel matrix (amelogenins obtained from developing embryos of pig tooth germ), which restores the tissues necessary to create functional attachment in teeth affected by moderate or severe periodontitis.

Emdogain is intended for use in periodontal surgery as an option that contributes to a favorable outcome in the treatment of intraosseous defects formed after moderate or severe periodontitis and periodontitis. After surgery, Emdogain resolves naturally during wound healing, leaving a layer of enamel matrix proteins on the root surface. This layer leads to the formation of cement-producing cells from surrounding tissues.

The use of Emdogain for healing wounds of the skin or mucous membrane is known, in particular, if the wound is damage or trauma associated with surgical intervention in the oral cavity, including periodontal surgery (application for the grant of a patent of the Russian Federation No. 2000124523, A61K 38/39).

The use of ultrasound in the treatment of periodontitis is known (patent application for invention No. 2002118300, publication date 2006.12.20), when the focus of inflammation is affected by ultrasound at a frequency of 26.5 kHz for three seconds.

The disadvantages of the known methods of surgical treatment of periodontitis and the proposed replacement materials are:

the difficulty of manufacturing a replacement material (for example, when using glass ceramics impregnated with blood plasma);

traumatic intervention on the donor site (for example, when using autobone);

risk of infection and the development of an allergic reaction (for example, when using demineralized bone matrix and brefokosti).

The disadvantages of the method adopted for the prototype are:

prolonged healing of the operated area due to circulatory disturbance of the flap;

the formation of a greater recession due to the possible sliding of the flap from the root surface, since bilateral vertical sections, a paramarginal section and removal of the marginal part of the gum contribute to the sliding of the flap;

difficult visualization of the defect due to flaking of the flap only from the exposed marginal part of the alveolar process, if the defect extends to the entire root length in the periapical region, which does not allow the defect to be eliminated while maintaining the teeth and with the complete loss of periodontal supporting and retaining tissues;

a low probability of osteogenic cells getting into the bone wound due to the operation of smoothing bone irregularities, as this weakens the natural support of the teeth;

additional trauma to the patient caused by taking blood from him to prepare the mixture to fill the defect.

An object of the invention is to eliminate these disadvantages and increase the therapeutic effect in severe forms of periodontitis with the loss of supporting and retaining periodontal tissues for the entire length of the root.

SUMMARY OF THE INVENTION

To solve this problem, a method is proposed for the surgical treatment of severe periodontitis, including peeling of the mucoperiosteal flap, removal of the subgingival stone, granulation and necrotic tissue from the bone pockets, filling of bone defects with osteoplastic material, characterized in that the surgical treatment is carried out with a complete loss of supporting and retaining tissues periodontal surgery for the entire length of the root, before surgery, the patient is given an infiltration anesthesia, an intrasulcular incision is performed, additionally they remove it with a vertical incision on the medial side, fold a triangular mucoperiosteal flap, exposing the periapical region of the defect, after removing the subgingival dental deposits of granulations of necrotic bone tissue, polish the roots of the teeth, modify them with Bref Gel biopreparation, apply ultrasound to the operated area, and inject them into bone defects osteoplastic material, a modified flap is sutured, while Emdogain gel is used as a sterile osteoplastic material.

The method is implemented as follows

A group of patients from 20 people aged 24 to 49 years was formed with a diagnosis of severe generalized periodontitis, where bone loss over the entire length of the root was observed in the area of individual teeth.

Preoperative preparation included: training in oral hygiene, selection of hygiene products, antibiotic therapy, topical use of chlorhexedine antiseptics in the form of rinses, grinding, depulpation and splinting with flexo-arch on both sides of the teeth with complete loss of periodontal supporting tissues.

The surgery was performed a month after preoperative preparation with the complete absence of inflammatory phenomena in the area of the operation.

Infiltration anesthesia was performed with 4% Septanest SP solution. With a scalpel No. 15, an intrasulcular incision and one vertical incision were made from the medial side. The triangular mucoperiosteal flap was folded back, exposing the periapical region of the defect. The subgingival stone, granulation tissue, necrotic bone tissue from the intraosseous pockets were removed. With the help of scissors, the flap was depitalized. With the Piezon Master, ultrasound was applied to the intraosseous pockets. All uneven protrusions of the bone surface were left without smoothing, thereby providing “islands of regeneration” and more solid support for the tooth. Gracey's curettes smoothed the root surface, modified the roots using the biological product Pref Gel (24% EDTA) for two minutes. Emdogain gel was applied to the root surface in the area of the intraosseous pockets, the flap was put in place and sewn with Vikril 4-0 material using horizontal, mattress and upholstery sutures.

In the postoperative period, antibiotics were prescribed for 5 days, suprastin for 5 days, 1 tablet 2 times a day, local cold, abstinence from food for three hours after the operation, silent mode and sparing nutrition in the first days after the operation.

They recommended rinsing with preparations based on 0.2% chlorhexedine - 3 times a day for 14 days, solcoseryl on the gum in the operation area 3-4 times a day.

Sutures were removed 10-14 days after surgery.

Periodontal dressings were not used.

Scheduled examinations were performed in the second and fourth weeks. All examinations showed a stable situation.

The table shows the results of using the method of surgical treatment of severe periodontitis with the use of the drug Emdogain in comparison with the use of other osteoplastic materials.

Indicator Units Emdogain Bio-ss Osteomatrix Reducing the depth of periodontal pocket mm 6.38 ± 0.79 4.72 ± 0.67 5.29 ± 0.91 Recession increase mm 1.95 ± 0.57 2.03 ± 0.38 2.9 ± 0.59 Bonding gain mm 4.71 ± 0.65 3.37 ± 0.55 2.33 ± 0.67 X-ray bone growth mm 4.43 ± 0.76 3.34 ± 0.99 2.09 ± 1.14

Thus, the surgical treatment of severe periodontitis with the proposed method using ultrasound and Emdogain for the treatment of intraosseous pockets increases the therapeutic effect, eliminates traumatic intervention on the donor site, expands the possibilities of treating severe periodontitis, which is especially important when there is a complete loss of periodontal supporting and retaining tissues the entire length of the root while maintaining the teeth.

Claims (1)

A method for the surgical treatment of severe periodontitis, including peeling of the mucoperiosteal flap, removal of subgingival stone, granulation and necrotic tissue from bone pockets, filling of bone defects with osteoplastic material, characterized in that the surgical treatment is performed with the complete loss of periodontal supporting and retaining tissues along the entire root length , before surgery, the patient is given an infiltration anesthesia, an intrasulcular incision is performed, supplemented with a vertical incision with a medial c the torons, forming a triangular mucoperiosteal flap, recline it, exposing the periapical region of the defect, after removing the subgingival dental deposits, granulation, necrotic bone tissue, polish the roots of the teeth, apply the Pref Gel biological product on them, act on the operated area with ultrasound, and introduce sterile bone defects into the bone defects osteoplastic material, the flap is sutured, while Emdogain gel is used as a sterile osteoplastic material.