RU2415671C1 - Method of treating inflammatory complications in patients in ambulatory surgical operations in oral cavity - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgical dentistry, and can be applied in treatment of patients with hypo-responsiveness of immune system with inflammatory complications in ambulatory surgical operations in oral cavity. Method includes determination of immune status and introduction of antibiotics, with additional introduction after dental implantation of tamerit in dose 100 mg 2 times per day intramuscularly and in form of daily irrigations of operation area with tamerit solution in dose 100 mg/2 ml during 10 days.

EFFECT: invention application ensures increase of treatment efficiency in case of immune system hypo-responsiveness as a result of immune-modulating normobiocenotic and anti-inflammatory action of tamerit.

11 tbl, 4 ex

Description

The invention relates to medicine, in particular to the treatment of inflammatory complications during surgical operations in the oral cavity, and can be used in outpatient surgical dental practice. A method for treating inflammatory complications that developed in patients with outpatient oral surgery is proposed, which allows correcting immune disorders, restoring disturbed oral microbiocenosis and improving the results of outpatient oral surgery: dental implantation, removal of the third molar and cystectomy. For this, along with antibiotics, an immunotropic drug is introduced - tamerite (registration number 2000/113/5 of 04/03/2000) in average therapeutic course doses.

The tactics of treating inflammatory complications in the oral cavity, after surgical operations - removal of the third molar and cystectomy, are the same as in inflammatory processes after dental implantation. It is known that for the treatment of patients with inflammatory complications after surgical operations in the oral cavity, antibiotics are used in combination with anti-inflammatory, desensitizing, restorative drugs and physiotherapy, which is the closest analogue of the invention [T. Robustova Dental implantation (surgical aspects). - M .: Medicine, 2003. - S.386-396, 524-545; Tsarev V.N., Ushakov R.V. Local antimicrobial treatment in dentistry. - M.: MIA, 2004 .-- 136 p .; Bezrukov V.M., Grigoryants L.A., Rabukhina E.A., Badalyan V.A. Outpatient surgical dentistry. - M .: MIA, 2005. - 112 s].

However, none of the currently existing methods of treating patients always provide a warning on the development of early and / or long-term inflammatory complications due to the persistent hypoimmunoreactivity of the body after outpatient surgical interventions in the oral cavity.

This indicates the need to improve the etiotropic and pathogenetic therapy of inflammatory complications during surgical interventions in the oral cavity.

However, dental surgical complications are an urgent public health problem. In Russia, patients with inflammatory diseases of the maxillofacial region make up up to 60% of patients seeking dental care at the prehospital stage [Dental implantology / Ed. prof. S.Yu. Ivanova. - M.: GEOTAR-MED, 2004 .-- 296 s; Durnovo E.A. Inflammatory diseases of the maxillofacial region: diagnosis and treatment, taking into account the immunoreactivity of the body (monograph). - N. Novgorod, 2007. - 196 s].

Given the role of nonspecific and immunological reactivity of the body in the development of inflammatory complications in outpatient surgical interventions in the oral cavity, the use of immunomodulating drugs is logical. Data on the use of these drugs, although numerous, but very controversial [Robustova T.G. Dental implantation (surgical aspects). - M .: Medicine, 2003 .-- 560 p .; Dental implantology / Ed. prof. S.Yu. Ivanova. - M.: GEOTAR-MED, 2004 .-- 296 s; Durnovo E.A. Inflammatory diseases of the maxillofacial region: diagnosis and treatment, taking into account the immunoreactivity of the body (monograph). - N. Novgorod, 2007. - 196 s].

The wide spread of infectious and inflammatory complications during dental interventions, the insufficient effectiveness of existing treatment methods leading to long-term disability, determine the socio-economic significance of this problem in the overall structure of dental morbidity.

It is known that the development of inflammatory complications is determined by the state of the body's immune system, its interaction with microorganisms of the oral cavity, i.e. the course of inflammatory complications and their prognosis depend on the capabilities of the body's anti-infection protection.

The protection of the body from infection consists of the successive inclusion in the fight against pathogenic microorganisms of various links of this defense, which make up a single functional complex: factors of natural resistance and acquired immune response.

The authors chose the traditional method of treating patients with inflammatory complications after surgical dental operations in the oral cavity as a prototype. This method consists in the following: conducting etiotropic (antibacterial), pathogenetic (anti-inflammatory, desensitizing), general strengthening and physiotherapy [Robustova TG Dental implantation (surgical aspects). - M .: Medicine, 2003. - P.386-396; Dental implantology / Ed. prof. S.Yu. Ivanova. - M .: GEOTAR-MED, 2004. - S.272-290].

The prototype has the following disadvantages: various antibacterial agents used in dentistry affect the entire biocenosis of the oral cavity, act briefly, as a result of which the pathogenic microflora's resistance to antibiotics increases and dysbiosis develops in the oral cavity. In addition, therapy is often carried out without taking into account the state of the immune system, which is important in the pathogenesis, course and outcome of inflammatory complications after surgical dental operations in the oral cavity.

The purpose of the invention is to improve the treatment of patients with inflammatory complications after surgical dental operations in the oral cavity.

The essence of the invention is a new pathogenetic approach to the treatment of patients with inflammatory complications during outpatient surgical operations in the oral cavity with the development of a comprehensive treatment regimen including antibiotics and a drug with immunomodulating and anti-inflammatory effects. The method consists in the following: treatment of inflammatory complications during dental implantation in patients with hyperactivity of the immune system, including determining the immune status and the introduction of antibiotics, characterized in that after dental implantation, tamerite is additionally administered 100 mg 2 times a day intramuscularly and in the form of daily irrigation of the area postoperative tamerite solution at a dose of 100 mg / 2 ml for 10 days.

The immunomodulatory effect is manifested in the normalization of the antigen-presenting and secretory function of cells of the monocytic-macrophage series, the stimulation of the microbicidal nature of neutrophils and the cytotoxicity of natural killers.

The anti-inflammatory effect of the drug is due to its ability to inhibit excess production of TNF-alpha interleukin-1, nitro compounds, reactive oxygen species and the severity of intoxication reversibly for 10-12 hours [Burbello A.T., Shabrov A.V. Modern medicines: Clinical and pharmacological directory of a practical doctor. - M .: OLMA Media Group, 2009-273 s].

The method was used in the treatment of 159 patients with inflammatory complications during outpatient surgery in the oral cavity.

Clinical and laboratory data obtained in dynamics indicate a pronounced clinical effect in the correction of disorders of the immune system.

Examples of specific performance of the method:

Example 1. Patient A., 21 years old, came to the clinic at the department of faculty surgical dentistry and implantology of the Moscow State Medical University with complaints about the absence of teeth on the lower and upper jaws. The patient refused the proposed traditional orthopedic treatment. The patient was offered the operation of dental implantation. At the time of the examination, the general condition of the patient is satisfactory. The face configuration is not changed. Open mouth free, regional lymph nodes are not enlarged. In the oral cavity: the mucous membrane is pale pink, normally moistened. A clinical picture of secondary partial adentia is observed. The condition of the alveolar part of the lower jaw and alveolar processes of the upper jaw in the area of missing teeth allowed for dental implantation. The patient was asked to perform the operation in two stages. At the first stage - dental implantation in the lower jaw, as well as the manufacture of temporary removable dentures in the upper jaw. At the second stage - sinus lift, installation of dental implants in the upper jaw. According to the traditional method using premedication, conduction and infiltration anesthesia, the patient underwent dental implantation with 6 implants of the LIKO system in the lower jaw. After dental implantation, 100 mg tamerite was additionally administered 2 times a day intramuscularly and in the form of daily irrigation of the area of postoperative intervention with tamerite solution at a dose of 100 mg / 2 ml for 10 days.

When viewed on the third day after surgery, the patient noted complaints of swelling of the left and right halves of the face. The patient's condition is satisfactory. The configuration of the face is changed due to slight swelling under the mandibular and buccal areas on both sides of the face. The opening of the mouth is free. Regional lymph nodes are not enlarged. In the oral cavity, the mucous membrane in the area of suturing is hyperemic, swollen. Seams are wealthy. Antiseptic treatment of the wound. On the 5th day, the patient complained of swelling of the right and left halves of the face. General condition is satisfactory. When examining the patient, a decrease in soft tissue edema was observed under the mandibular and buccal areas on the right and left, opening the mouth is free. The submandibular lymph nodes are enlarged to 1 cm, soft, painless. When examining the oral cavity, swelling of the mucous membrane in the area of application of postoperative sutures, hyperemia, slight fibrinous plaque of white color in the area of the postoperative wound is preserved. Seams are wealthy. Antiseptic treatment of the wound. On the 8th day, the patient has no complaints. The condition is satisfactory. The face configuration is not changed. Opening is free. Regional lymph nodes are not enlarged. On examination of the oral cavity: the mucous membrane is pale pink, normally moistened, the joints are well-to-do. Postoperative sutures and antiseptic treatment were removed. According to the bacteriological study, the following microbiological picture was observed in the patient on the 8th day after the operation (table 1).

Table 1 Microbiological picture in patient A. on the 8th day after surgery View CFU S.sanguis 5 × 10 ⁷ S. salivarius 3 × 10 ⁶ Peptostreptococcus anaerobius 5 × 10 ⁶ Corinebacterium spp. - Prevotella oralis 2 × 10 ⁵ Prevotella intermedia - Fusobacterium spp. -

These results positively characterize the bacteriological picture in the patient on the 8th day after dental implantation. The patient did not have aggressive species while maintaining the stabilizing component of the microbiocenosis represented by streptococcal flora and the species Prevotella oralis.

After dental implantation during therapy with tamerite, normalization of T-lymphocytes (CD3), T-helper cells (CD4), a decrease in the number of normal killers (CD16), and phagocytic activity were normalized. The phagocytic number has increased.

Example 2. Patient B., 44 years old, went to the clinic at the department of faculty surgical dentistry and implantology MGMSU with complaints of missing teeth on the upper jaw. The patient refused the proposed traditional orthopedic treatment. The patient was offered the operation of dental implantation. According to clinical and X-ray examination, the possibility of installing dental implants on the upper jaw in the area of missing teeth 25, 26 was determined. At the time of examination, the general condition of the patient is satisfactory. The face configuration is not changed. Open mouth free, regional lymph nodes are not enlarged. In the oral cavity: the mucous membrane is pale pink, normally moistened. There is a clinical picture of the absence of 25, 26 teeth. The state of the alveolar process of the upper jaw in the area of missing teeth allowed for dental implantation. According to the traditional method using premedication, conduction and infiltration anesthesia, the patient underwent a dental implantation operation with the installation of two LIKO system implants in the upper jaw. After dental implantation, 100 mg tamerite was additionally administered 2 times a day intramuscularly and in the form of daily irrigation of the area of postoperative intervention with tamerite solution at a dose of 100 mg / 2 ml for 10 days.

When viewed on the 3rd day after surgery, the patient complains of minor pain in the area of the surgical wound. The condition is satisfactory. The face configuration is not changed. The opening of the mouth is free. Regional lymph nodes are not enlarged. In the oral cavity, the mucous membrane in the area of suturing is slightly hyperemic, edematous. Seams are wealthy. Antiseptic treatment of the wound.

On the 5th day, the patient has no complaints. General condition is satisfactory. When examining the patient, palpation of the soft tissues of the buccal, submandibular region on the left is painless. The opening of the mouth is free. When examining the oral cavity, swelling of the mucous membrane in the area of application of postoperative sutures, hyperemia, slight fibrinous plaque of white color in the area of the postoperative wound is preserved. Seams are wealthy. Antiseptic treatment of the wound.

On the 8th day, the patient has no complaints. The condition is satisfactory. The face configuration is not changed. The opening of the mouth is free. Regional lymph nodes are not enlarged. On examination of the oral cavity: the mucous membrane is pale pink, normally moistened, the joints are well-to-do. Postoperative sutures and antiseptic treatment were removed. According to the bacteriological study, the following microbiological picture was observed in the patient on the 8th day after the operation (table 2).

table 2 Microbiological picture in patient B. on the 8th day after surgery View CFU S.sanguis 1 × 10 ⁷ S. salivarius 5 × 10 ⁶ Peptostreptococcus anaerobius 2 × 10 ⁵ Corinebacterium spp. - Prevotella oralis 1 × 10 ⁶ Prevotella intermedia - Fusobacterium spp. -

The obtained results positively characterize the bacteriological picture in the patient on the 8th day after dental implantation. No aggressive species were found in the patient; stabilizing microflora was represented by S. Sanguis, S. Salivarius, Prevotella oralis in the amount of 10 ⁶ -10 ⁷ CFU.

Example 3. Patient B, 44 years old, came to the clinic at the department of faculty surgical dentistry and implantology of the Moscow State Medical University with complaints about the difficult eruption of the 3rd molar in the lower jaw on the right. The patient was offered the operation to remove the 3rd molar.

At the time of the examination, the general condition of the patient is satisfactory. The face configuration is not changed. Mouth opening is free, regional lymph nodes are not enlarged. In the oral cavity: the mucous membrane is pale pink, normally moistened. 48 tooth cut through the distal tubercles. Medially 48 tooth deployed subcortical part of the 47th tooth. An X-ray examination shows a picture of dystopia and half-urethra of the 48th tooth. According to the traditional technique using premedication, conduction and infiltration anesthesia, the patient underwent surgery to remove the 3rd molar in the lower jaw. The wound did not close tightly. The wound was conducted under iodoform turunda. After removal of the third molar, 100 mg tamerite was additionally administered 2 times a day intramuscularly and in the form of daily irrigation of the area of postoperative intervention with tamerite solution at a dose of 100 mg / 2 ml for 10 days.,

When examined on the 3rd day after the operation, the patient complained of swelling of the left half of the face, pain in the region of the extracted tooth, pain when swallowing, and difficulty opening the mouth. The condition is satisfactory. The configuration of the face is changed due to minor swelling of the submandibular and buccal regions on the left. The opening of the mouth is limited to 1.5 cm. Regional submandibular lymph nodes are enlarged to 2 cm, soft, slightly painful, unsoldered with the surrounding tissues. In the oral cavity, the mucous membrane in the area of the postoperative wound is hyperemic, edematous. Seams are wealthy. Antiseptic treatment of the wound with a 0.05% chlorhexidine solution was performed.

On the 5th day, the patient still has complaints of swelling of the left half of the face. General condition is satisfactory. When examining the patient, a decrease in soft tissue edema of the buccal, submandibular region on the left was observed. The opening of the mouth is free. Submandibular lymph nodes are enlarged to 1 cm, soft, painless. When examining the oral cavity, edema of the mucous membrane in the region of the pterygo-maxillary fold is preserved, in the area of postoperative suturing, hyperemia of the edges of the wound. Seams are wealthy. Antiseptic treatment of the wound.

On the 8th day, the patient has no complaints. The condition is satisfactory. The face configuration is not changed. The opening of the mouth is free. Regional lymph nodes are not enlarged. On examination of the oral cavity: the mucous membrane is pale pink, normally moistened, the joints are well-to-do. Postoperative sutures and antiseptic treatment were removed. According to the bacteriological study, the following microbiological picture was observed in the patient on the 8th day after the operation (table 3).

Table 3 Microbiological picture in patient B. on the 8th day after surgery View CFU S.sanguis 3 × 10 ⁶ S. salivarius 5 × 10 ⁶ S.milleri 1 × 10 ³ Peptostreptococcus anaerobius 1 × 10 ⁵ Corinebacterium spp. 5 × l0 ⁴ Actinomices spp. 2 × 10 ³

The results obtained positively characterize the bacteriological picture in the patient on the 8th day after removal of the 3rd molar. The patient almost did not have all the aggressive species, but periodontopathogenic bacteria such as actinomycetes remained in small numbers. A small level of beta-hemolytic streptococcus S. Milleri was also noted. At the same time, stabilizing bacteria S.Sanguis, S.Salivarius were found in large numbers. A fairly high level was observed for corynebacteria.

After immunotropic therapy with tamerite, normalization of the content of T-lymphocytes (CD3), T-helpers (CD4) was observed, the number of normal killers (CD16) remained practically unchanged. The phagocytic number has increased. CD25 receptor expression for the pro-inflammatory cytokine IL-2 was reduced on lymphocytes and monocytes.

Example 4. Patient G., 65 years old, went to the clinic at the department of faculty surgical dentistry and implantology MGMSU with complaints of periodic swelling of the mucous membrane in the region of 42, 41, 31 teeth on the lower jaw on the right. The patient was offered the operation to remove the 3rd molar. An X-ray examination revealed a focal rarefaction of bone tissue in the area of apexes 42, 41 and 31 teeth with clear boundaries of 1 × 2 cm. A diagnosis was made of a radicular cyst in the area of 42, 41 and 31 teeth. A cystectomy operation with resection of apexes of the roots of 42, 41 and 31 teeth is proposed.

At the time of the examination, the general condition of the patient is satisfactory. The face configuration is not changed. Mouth opening is free, regional lymph nodes are not enlarged. In the oral cavity: the mucous membrane is pale pink, normally moistened. The mucous membrane in the projection of 42, 41 and 31 teeth is slightly hyperemic, edematous. A pattern of secondary partial adentia is observed. According to the traditional method using premedication, conduction and infiltration anesthesia, the patient underwent cystectomy of the upper jaw with resection of apexes 42, 41 and 31 of the roots of the teeth. The wound was sutured tightly with interrupted sutures. After cystectomy, 100 mg tamerite was additionally administered 2 times a day intramuscularly and in the form of daily irrigation of the area of postoperative intervention with tamerite solution at a dose of 100 mg / 2 ml for 10 days.

When viewed on the 3rd day after surgery, the patient had complaints of swelling of the face. The condition is satisfactory. The configuration of the face is changed due to edema of the submental area and the area of the lower lip. The opening of the mouth is free. Regional lymph nodes are not enlarged. In the oral cavity, the mucous membrane in the area of suturing is hyperemic, swollen. Seams are wealthy. Antiseptic treatment of the wound with a 0.05% chlorhexidine solution was performed.

On the 5th day, the patient complained of swelling of the right and left halves of the face. General condition is satisfactory. When examining the patient, a decrease in soft tissue edema of the buccal, submental, and lower lip areas was observed. The opening of the mouth is free. When examining the oral cavity, swelling of the mucous membrane in the area of application of postoperative sutures, hyperemia, slight fibrinous plaque of white color in the area of the postoperative wound is preserved. Seams are wealthy. Antiseptic treatment of the wound.

On the 8th day, the patient has no complaints. The condition is satisfactory. The face configuration is not changed. The opening of the mouth is free. Regional lymph nodes are not enlarged. On examination of the oral cavity: the mucous membrane is pale pink, normally moistened, the joints are well-to-do. Postoperative sutures and antiseptic treatment were removed. According to the bacteriological study, the following microbiological picture was observed in the patient on the 8th day after the operation (table 4).

The dominance of stabilizing microflora on the 8th day after surgery is a positive point in terms of the formation of normal microbiocenosis at the end of the postoperative period. The presence of the pathogen pathogen Peptostreptococcus micros is possibly compensated by a large number of species stabilizing the microbiocenosis of the oral cavity (S. Sanguis, S. Salivarius, Corinebacterium spp.).

Table 4 Microbiological picture in patient G. on the 8th day after surgery View CFU S.sanguis 3 × 10 ⁷ S. salivarius 5 × 10 ⁶ Peptostreptococcus anaerobius 1 × 10 ⁷ Peptostreptococcus micros 1 × 10 ⁵ Corinebacterium spp. 1 × 10 ⁶

After immunotropic therapy with tamerite, the patient observed a slight decrease in T-helper cells (CD4), normal killers (CD16). The phagocytic number has increased. Expression of the CD25 receptor for the pro-inflammatory cytokine IL-2 increased dramatically. A significant increase in the expression of transferrin receptor on CD71 lymphocytes was also noted.

Thus, as can be seen from the examples of the performed method, after the complex treatment with antibiotics, anti-inflammatory drugs and the immunomodulator tamerite against the background of normalization of immunity indicators, the symptoms of inflammation of the mucous membrane after ambulatory surgical interventions in the oral cavity disappear.

To assess the impact on the functional state of the immune system of the method we developed for the treatment of patients with inflammatory complications in the oral cavity, a study of 159 patients with outpatient surgical interventions in the oral cavity (age from 20 to 65 years, men 92 and women 67) was conducted. All patients did not have somatic diseases, which are a contraindication to surgical intervention. All patients were divided into 3 main groups who received traditional antibacterial therapy and tamerite. Tamerite was prescribed 100 mg 2 times a day intramuscularly, as well as in the form of daily irrigation of the area of postoperative surgical intervention with a solution of tamerite in a dose of 100 mg / 2 ml for 10 days. The control groups that received only antibiotic therapy included: the first - patients prepared for dental implantation, the second - with retention and dystopia of the 3rd lower molar and the third - radicular cystogranuloma (Table 5).

Clinical examination of patients when contacting the clinic included: identifying complaints of lack of teeth and rejection of the traditional method of prosthetics, difficult eruption of the 3rd molar, pain, swelling in case of exacerbation of the near-root inflammatory process. The examination was carried out according to the generally accepted technique, including questioning and examination of the patient. All patients underwent a study of the immune status.

When collecting an anamnesis, the causes of tooth loss were clarified, attention was drawn to the presence of exacerbation of periodontitis, periodontitis, pericoronitis, and allergies to drugs.

Table 6 The dynamics of clinical manifestations after dental implantation in groups with and without tamerite (%) Symptoms 1st main group (n = 27) 1st control group (n = 26) 3rd day 5th day 8th day 3rd day 5th day 8th day Postoperative wound pain 10.1 4.2 0 15.3 4.2 0 Soft tissue swelling 73,2 31.5 4.2 91.4 49.2 8.4 Mucosal edema in a postoperative wound 78.8 36.1 0 96.1 55,4 4.2 Mucosal hyperemia in a postoperative wound 20.7 13.3 0 29.1 18,4 0 Fever 12,4 0 0 22.4 4.2 0 The reaction of regional lymph nodes 47.4 26.2 4.2 50,4 31,2 8.4

Patients of the main groups received traditional therapy with antibacterial drugs (amoxicillin, roxithromycin) for 1-2 days and the immunotropic drug tamerite for 10 days. Patients in the control groups received only antibiotics.

As can be seen from table 6, in the group of patients after dental implantation with the use of the drug tamerite, there was a reduction in the duration of the clinical manifestations of inflammation in the oral cavity in the postoperative period compared with the control.

The dynamics of clinical manifestations after surgery in the main group of patients receiving tamerite and in the control group receiving traditional therapy is characterized by the normal healing process of the postoperative wound.

Table 7 The dynamics of clinical manifestations after surgery to remove the 3rd molar in groups with and without tamerite (%) Symptoms 2nd main group (n = 26) 2nd control group (n = 28) 3rd day 5th day 8th day 3rd day 5th day 8th day Postoperative wound pain 23.6 10.0 4.2 31.8 14.7 4.1 Pain when swallowing 88.7 21.8 0 89.1 33.3 0 Mouth opening restriction 88.7 25,4 4.2 94.2 38.5 8.2 Soft tissue swelling 94.7 37.1 0 97.2 44.7 0 Mucosal edema in a postoperative wound 94.7 44.3 4.2 one hundred 48.8 4.1 Mucosal hyperemia in a postoperative wound 90.7 33.7 0 97.2 43.5 0 Fever 33.7 0 0 44,2 4.1 0 The reaction of regional lymph nodes 44.8 17.5 4.2 55.7 32.9 4.1

In the main group there was not a single case of the development of inflammatory complications, the wound process was characterized by positive dynamics in all periods of observation. Two patients in the control group developed alveolitis in the postoperative period. The curettage of the hole was performed and antibiotic therapy in combination with tamerite was prescribed, which led to the elimination of alveolitis (Table 7).

Table 8 Dynamics of clinical manifestations after cystectomy surgery in groups with and without tamerite (%) Symptoms 3rd main group (n = 26) 3rd control group (n = 2b) 3rd day 5th day 8th day 3rd day 5th day 8th day Postoperative wound pain 22.7 11.1 0 33.8 12,4 0 Soft tissue swelling 94.1 56.3 8.4 one hundred 75.1 12.6 Mucosal edema in a postoperative wound 96 27.4 0 one hundred 48.7 0 Mucosal hyperemia in a postoperative wound 86.7 39.1 4.2 98.2 55.3 4.2 Fever 17.9 0 0. 22.7 0 0 Regional lymph node reaction 33,2 24.1 4.2 55.6 25.8 8.4

Analysis of the dynamics of clinical symptoms after cystectomy with the use of tamerite showed that the disappearance of a number of symptoms of inflammation of the soft tissues of the oral cavity was observed earlier than in the control (table 8).

Table 9 The dynamics of the microflora of the mucous membrane in the field of dental implantation in groups with and without tamerite Symptoms 1st main group (n = 27) 1st control group (n = 26) 1st day 3rd day 8th day 1st day 3rd day 8th day S.sanguis 3.5 ± 0.2 4,5 ± 0,2 7 ± 0.21 3.8 ± 0.21 5.7 ± 0.19 6.7 ± 0.21 S. salivarius 3 ± 0.21 6.5 ± 0.2 6.7 ± 0.19 3.2 ± 0.2 5.5 ± 0.2 0 Peptostreptococcus anaerobius 3 ± 0.21 6.3 ± 0.2 6.7 ± 0.21 3 ± 0.2 6.1 ± 0.19 5.7 ± 0.2 Corinebacterium spp. 3 ± 0.2 3.4 ± 0.2 0 2.8 ± 0.2 3.3 ± 0.2 0 Prevotella oralis 3.3 ± 0.2 4.7 ± 0.19 5.2 ± 0.2 2.3 ± 0.2 4.1 ± 0.21 4.2 ± 0.2 Prevotella intermedia 2.0 ± 0.21 0 0 2 ± 0.19 3.4 ± 0.21 2.1 ± 0.21 Fusobacterium spp. 2.7 ± 0.2 0 0 2.7 ± 0.2 4.1 ± 0.2 3.7 ± 0.2

In the group of patients after dental implantation as a result of treatment with tamerite, the preservation of stabilizing bacterial species and a decrease in the number of periodontal bacteria in the oral cavity were noted. Apparently, the immunomodulatory effect promotes the healing of the postoperative wound (Table 9).

Table 10 Dynamics of the microflora of the mucous membrane in the area of the operation to remove the 3rd molar in groups with and without tamerite Symptoms 2nd main group (n = 26) 2nd control group (n = 28) 1st day 3rd day 8th day 1st day 3rd day 8th day S.sanguis 6.7 ± 0.2 7.8 ± 0.2 6.2 ± 0.19 6.8 ± 0.21 7.6 ± 0.19 6.5 ± 0.19 S. salivarius 3.0 ± 0.2 6.7 ± 0.19 6 ± 0.2 2.1 ± 0.2 4.7 ± 0.19 5 ± 0.2 S.milleri 6 ± 0.21 6.8 ± 0.2 2.7 ± 0.19 5.7 ± 0.21 7.1 ± 0.21 4.8 ± 0.2 Peptostreptococcus anaerobius 5.2 ± 0.2 6.1 ± 0.21 4.9 ± 0.2 5.1 ± 0.2 b, 2 ± 0.2 6.1 ± 0.2 Peptostreptococcus micros 4.7 ± 0.21 5.5 ± 0.2 0 4.5 ± 0.21 5.9 ± 0.2 0 Corinebacterium spp. 3.2 ± 0.2 5.9 ± 0.21 5.1 ± 0.21 2.7 ± 0.21 4 ± 0.2 0 Prevotella intermedia 5.1 ± 0.21 3.9 ± 0.19 0 5.7 ± 0.21 4.9 ± 0.2 3.7 ± 0.2 Fusobacterium spp. 5.7 ± 0.19 4.8 ± 0.2 0 5.6 ± 0.19 6.0 ± 0.19 4.1 ± 0.2 Actinomyces spp. 4 ± 0.2 5.2 ± 0.21 3 ± 0.2 3.7 ± 0.21 6 ± 0.2 4 ± 0.19

During the operation of removal of the 3rd molar, the qualitative composition of microflora in the area of surgical intervention in the control group noted a wide variety of aggressive microflora. The increase in the number of stabilizing bacteria in the main group can be explained by the positive effect of tamerite on local immunity and the creation of favorable conditions for such stabilizing species as S. salivarius and Corinebacterium spp. (table 10).

Analysis of the microflora of the mucous membrane in the area of the line of surgical sutures after cystectomy using tamerite and antibiotic therapy showed that streptococcal microflora predominates on the mucous membrane. A positive fact should be considered the preservation and increase in the number of S. salivarius and Corinebacterium spp., Stabilizing microbiocenosis in the oral cavity (table 11). The disappearance of periodontogenic species on the 8th day is also a favorable factor in terms of the possibility of developing inflammatory complications during outpatient oral surgery. The complete disappearance of aggressive bacterial species by the 8th day after surgery may indicate the antibacterial effect of tamerite.

Thus, the emerging microbial landscape on the mucous membrane of the oral cavity in the area of the postoperative wound is characterized by the predominance of positive processes in the ratio of stabilizing and aggressive types of bacteria in the oral cavity. The microbiocenosis observed with tamerite is indicative of a favorable course of the postoperative period and a decrease in the number of inflammatory complications, which allows recommending tamerite during surgical interventions in the oral cavity.

Table 11 The dynamics of the microflora of the mucous membrane in the area of cystectomy surgery in groups with and without tamerite Symptoms 3rd main group (n = 26) 3rd control group (n = 26) 1st day 3rd day 8th day 1st day 3rd day 8th day S.sanguis 5.6 ± 0.2 b, 5 ± 0.21 7.2 ± 0.21 4.6 ± 0.2 4.2 ± 0.19 6.1 ± 0.2 S. salivarius 0 4.5 ± 0.21 6.1 ± 0.2 0 3.2 ± 0.2 4.1 ± 0.2 Peptostreptococcus anaerobius 4.0 ± 0.2 6.1 ± 0.2 7.1 ± 0.21 4 ± 0.2 5.1 ± 0.21 6.4 ± 0.2 Peptostreptococcus micros 5.3 ± 0.2 6.2 ± 0.2 5.7 ± 0.21 6.3 ± 0.2 6.4 ± 0.2 6.2 ± 0.19 Corinebacterium spp. 0 3.3 ± 0.2 5.4 ± 0.2 0 3 ± 0.21 0 Prevotella intermedia 4.1 ± 0.2 3.2 ± 0.2 0 3.7 ± 0.2 4.2 ± 0.2 3.2 ± 0.21 Fusobacterium spp. 4.7 ± 0.19 3.9 ± 0.21 0 4.6 ± 0.2 5.9 ± 0.2 4.8 ± 0.21

Positive effect

The positive effect provided by the proposed method is to improve the functional state of the immune system, normalize microbiocenosis in the oral cavity, reduce the time of clinical recovery of patients with inflammatory complications during outpatient surgical interventions in the oral cavity.

Claims (1)

A method of treating inflammatory complications during dental implantation in patients with hyporeactivity of the immune system, including determining the immune status and administering antibiotics, characterized in that after dental implantation, tamerite is additionally administered 100 mg 2 times a day intramuscularly and in the form of daily irrigation of the area of surgical intervention with tamerite at a dose of 100 mg / 2 ml for 10 days.