RU2519121C1 - Method of treating periodontitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method of treating periodontitis provides professional hygienic oral cleansing, antiseptic therapy, local drug-induced therapy. The local drug-induced therapy is two-staged with the use of zeolite-containing fossil flour with particle size of 0.3-0.4 mm. The first stage involves gingival infriction of a mixture consisting of zeolite-containing fossil flour and distilled water taken in equal weight parts for 10-15 min; the second stage includes applications of tampons impregnated with a mixture containing 2.5-3 weight parts of fossil flour and 1-1.5 weight parts of distilled water on the affected gingiva; the length of the local drug-induced therapy is 12-14 days.

EFFECT: effective treatment of periodontitis enables stable reduction of periodontal inflammation, fastening the remission time and reducing the number of aggravations.

2 tbl, 4 ex

Description

The invention relates to medicine, namely to dentistry, and can be used in the treatment of periodontitis.

Currently, the world community of dentists is concerned about the increase in the frequency of chronic periodontitis [8, 10] and the improvement of their treatment methods [5, 15].

Existing treatment regimens for this disease involve the use of a comprehensive method, including a combination of local therapy with surgical, orthopedic, physiotherapeutic and general treatment [2]. The course of treatment of chronic generalized periodontitis consists of 8-12 visits and lasts 20-40 days, depending on the condition of the dentofacial system and the chosen treatment tactics. On the first visit, after examining the patient and making a diagnosis, they outline a plan for the rehabilitation of the oral cavity and treatment of periodontal pathology, determine which teeth should be removed (usually with a pocket depth of more than 8 mm). Together with an orthopedic dentist, they plan orthopedic treatment (selective grinding, temporary splinting, direct prosthetics, production of permanent prostheses with splinting elements, etc.). In the first 3-4 visits, tooth deposits are removed, periodontal pockets are treated with antiseptic solutions, applications are made on the gums or pastes containing antiseptics, metronidazole, non-steroidal anti-inflammatory drugs, proteolytic enzymes are inserted into the pockets. In parallel with drug therapy, physiotherapy is prescribed (for a course of 5-7 procedures): short-wave ultraviolet radiation, helium-neon laser radiation, anod galvanization, hydrotherapy. The patient is taught the rules of oral hygiene, give recommendations on brushing, help choose a toothbrush and toothpaste, learn to use flosses. After the relief of inflammatory phenomena, patchwork is done (simultaneously in the area of 6-8 teeth) with correction of the gingival margin and the use of agents that stimulate reparative osteogenesis. The main goal of surgical intervention is the removal of periodontal pockets. At the end of the treatment described above, activities are carried out that normalize microcirculation and homeostasis in periodontal tissues: physiotherapy, injections of drugs into the transitional fold, general-purpose drugs. Mandatory is orthopedic treatment, which is planned taking into account the functional state of periodontal tissues and the dentition in general. It should be recognized that, despite the use of the entire arsenal of means and methods of periodontal therapy, the treatment of severe periodontitis is rarely successful, is expensive and does not lead to prolonged remission.

The inefficiency of the standard treatment regimen for chronic generalized periodontitis necessitates the search for new approaches to its treatment.

It is known that the pathogenesis of chronic periodontitis is associated with the presence of microbial flora in the focus, the development of an inflammatory reaction, accompanied by the activation of lipid peroxidation processes in the pathological focus. Monocytes and macrophages activated by periodontal pathogens produce a cascade of proinflammatory cytokines, which ultimately cause microcirculation disturbance in periodontal tissues, tissue hypoxia, collapse of periodontal ligaments, bone resorption of the jaw processes through indirect differentiation of the ancestors [11, 11 precursors, 10 osteopenia, and 10 osteoplasts]. The increase in the content of the pro-inflammatory cytokine interleukin-1 (IL-1β) with periodontitis correlates with the depth of periodontal pockets and the degree of bleeding of the gums. Therefore, the content of this cytokine in the exudate of periodontal pockets can be considered as an additional laboratory criterion for the severity of periodontitis [4]. In this regard, it becomes apparent that important points of influence for conducting pharmacotherapy for chronic generalized periodontitis are immune, oxidative disorders and correction of local hypoxia of periodontal tissues [6, 13, 17, 19].

From the point of view of the main pathogenetic mechanisms of chronic periodontitis (local disturbance of the immune response, imbalance of pro- and anti-inflammatory cytokines), pathogenetic treatment should be aimed at local (mucosal) immunity factors.

The most effective method for correcting the mucosal immune response are those treatments that involve direct contact of the immunotropic drug with the mucous membrane.

A known method for the treatment of periodontitis of moderate severity, including the introduction into the periodontal pockets of a medicinal composition prepared ex tempore containing 2 parts of porous hydroxyapatite ceramics with a granule size of 0.3-0.5 mm, 1 part of zinc oxide powder, with the addition of 30% lincomycin solution hydrochloride, as well as fluoride varnish coating for 12-24 hours with a course of treatment of 6-8 procedures daily RU 2289411, A61K 31/7028, A61K 33/06, A61K 33/30, A61P 1/02, publ. 12/20/2006.

The disadvantages of this method of treatment of periodontitis include the fact that the antibiotic used leads to a violation of microbiocenosis and colonization resistance in the oral cavity and exacerbates the existing immune disorders.

A known method of treating generalized periodontitis of mild severity, including the use of drugs immobilized on a gelatin-glycerin tire, the basis of which is 28.57% gelatin, 17.86% glycerol and 53.57% water. In the first three days, malavit is used three times a day after breakfast, lunch and before bedtime. Then, for 3 days, patients use medicinal tires with trental in the morning, and with thymogen at bedtime, at the final stage of treatment, medicinal tires with collargol are used for 3 days in the morning and before bedtime RU 2288671, IPC A61C 13/23, A61K 31/522 , A61K 33/38, A61K 36/15, A61K 38/32, A61P 1/02, A61K 33/08, publ. 12/10/2006.

However, this method is difficult to implement and requires the use of a sufficiently large number of drugs.

A known method of treating periodontitis, including the removal of tartar and plaque and irrigation of the gums with natural mineral water daily under a pressure of 1.5 atmospheres, while drinking mineral water “Ustkachkinskaya 1/99” with a total salinity of 8.2- is used as natural mineral water 8.6 g / dm ³ at 32-40 ° C for 3-10 minutes for each jaw, the course of treatment is 5-14 days. RU 2221577, IPC 7 A61K 35/08, A61P 1/02, publ. 2004 01.20

A known method of treating periodontitis, including the removal of tartar, plaque and irrigation of the gums with highly mineralized iodine chloride sodium mineral water with a slightly alkaline reaction, total salinity of 14.9-16.6 g / dm ³ from well 1-95 of the Tyumenransgaz sanatorium, irrigation is carried out daily, under a pressure of 1.2 atmospheres, for 10 minutes on both jaws, then the therapeutic sapropelic mud of Lake Schuchye of the Khanty-Mansi Autonomous Okrug is applied, with a total mineralization of 0.2-0.3 g / dm ³ , temperature 38- 40 °, 10 min each, chickens 5-14 days of treatment. RU 2396966, IPC A61K 35/08, A61C 17/00, A61M 35/00, A61P 1/02, publ. 08/20/2010.

However, these methods involve the use of pressure during irrigation of the gums and can be performed only in a medical institution.

A known method of treating periodontitis, including the introduction of drugs and applications on the mucous membrane of the gums, while on the 2nd day after the start of traditional treatment, namely, professional hygienic cleaning of the oral cavity, antiseptic therapy and / or antibiotic therapy, the patient for 10 days every other day, rinse the mouth with a solution based on brine of Lake Baskunchak at t ° 36-37 ° C for 5-7 min once a day and apply gum extract of the lake Baskunchak at t ° 36-37 ° C on a gauze dressing in t chenie 5-7 minutes, 1 time per day. The brine and mud of Lake Baskunchak is rich in magnesium sulfides, iron salts, natural antibiotics, natural hormones and biologically active substances, which not only have a local effect on the oral mucosa, but, when absorbed, affect the body as a whole, increasing its resistance. The alternation of rinsing with a solution based on brine of Lake Baskunchak and applications of its mud extract is due to the intensity of the impact on the body of these procedures. RU 2429859, IPC A61K 35/00, publ. 2011 09.27.

However, this method does not provide immunotropic effects on the oral cavity. In addition, brine, being a hypertonic solution of sodium chloride, and the mud of Lake Baskunchak containing sodium chloride, having a resorptive effect, can have a hypertensive effect. Therefore, this method is contraindicated in patients with hypertension. This method is complicated by the use of pre-heating the brine and mud solution of Lake Basurchak to a temperature of 36-37 ° C.

The closest in technical essence to the claimed invention is a method for the treatment of periodontitis, including the installation and application of the gel "Holisal" 2-3 times a day, for 20 days, the introduction of "Imudon" 6 tablets per day for 20 days and "Polysorb MP ″ 1 teaspoon diluted in 100 ml of water 1 time per day for 20 days. RU 2288724, A61K 33/00, A61K 39/108, A61K 31/14, A61P 1/02, publ. 12/10/2006.

However, this method is cumbersome, besides, it significantly increases the cost of treatment due to the use of expensive medications - imudon (120 tablets per treatment course - 1,500 rubles, a tube of gel cholisal - 213 rubles).

The objective of the invention is the creation of a widely accessible method that increases the effectiveness of treatment of periodontitis, reducing the cost of treatment, as well as expanding the range of natural products for the treatment of periodontitis.

The technical result is:

- increasing the effectiveness of treatment of periodontitis by stopping the inflammatory process and restoring immunobiological reactions in the oral cavity by stimulating mucosal immunity, increasing the functional activity of neutrophilic granulocytes, increasing lysozyme production with local use of zeolite-containing tripoli;

- reducing the time to achieve remission of the disease;

- reduction of treatment costs;

- elimination of the invasiveness of periodontal tissues;

- simplification of therapeutic techniques.

The technical result is achieved by the fact that in the method of treatment of chronic generalized periodontitis, which includes professional hygienic cleaning of the oral cavity, antiseptic therapy, local drug therapy, according to the invention, local drug therapy is carried out in two stages with zeolite-containing tripoli with particle sizes of 0.3 - 0.4 mm, at the same time, at the first stage, rubbing into the gums of the mixture consisting of zeolite-containing tripoli and distilled water taken in equal parts by weight is carried out for 10-15 minutes, and at the second stage, applications are applied to the affected areas of the gums by applying tampons moistened with a mixture of 2.5-3 weight. including tripoli, 1-1.5 weight. h of distilled water, with a duration of a course of local drug therapy of 12-14 days.

The essence of the claimed invention consists in the use of zeolite-containing tripoli for local drug therapy and is illustrated by examples 1-4.

Zeolites are aqueous aluminosilicates of alkali and alkaline earth metals, the crystal lattice of which is built of four-, five-, six-membered and even more complex rings formed by silicon-oxygen tetrahedra. As a result of such a structure, a system of microcavities interconnected with each other and with the environment is formed in the intracrystalline space of zeolites, in which exchange cations and water molecules are located. The porous open microstructure of zeolites predetermines unique useful properties and, in connection with this, the practical use of zeolite rocks in various directions. Dehydrated by heating zeolites acquire the ability to adsorb molecules of various substances, which in size do not exceed the pore diameter. In an aqueous medium, zeolites easily exchange their cations for others in solution. Natural zeolites are a new type of mineral, the potential of which has not yet been fully studied. Large reserves, low cost, a wide range of useful properties of zeolite-containing tripoli in the Pervomaisky deposit of the Alatyr district of the Chuvash Republic allow the introduction of natural zeolites in a wide variety of industries. The content of zeolite (clinoptiolite) in this tripoli is 24-30% [7].

To implement the method, a zeolite-containing tripoli was used in the Pervomaisky deposit of the Alatyr district of the Chuvash Republic, it contains, wt.%: Silicon oxides 60.3-72.5; iron 2.8-4.2; aluminum 8.4-10.1; calcium 2.6-12.3; magnesium 0.9-1.3; sodium 0.18-0.29; potassium 1.4-1.5.

Zeolite-containing tripoli has been used in models of acute toxic hepatitis, acute hyperacid gastritis and gastric ulcers [12] for the treatment of burn wounds [16] and the prevention of experimental caries [14]. Its positive effect on immune-mediated reactions has been shown [1]. Zeolite-containing tripoli is a safe substance that does not irritate the mucous membranes and skin, which has a bactericidal, adsorbing, epithelizing, antioxidant, immunomodulating and anticariogenic effect [9].

Example 1 (standard treatment method). Patient E., born in 1965, body weight 72 kg, honey. Card No. 145, from 08/10/12 to 08/23/12 was on an outpatient basis at the clinic of the Central City Hospital Ministry of Health and Social Development of the Chuvash Republic. Complaints: bad breath, pain in the gums when brushing your teeth and eating food, periodic bleeding of the gums during brushing, tooth mobility. Anamnesis: disease for 2 years, with periodic exacerbations. Previously, I did not contact the periodontist. No occupational hazards, allergies, pathology and somatic diseases denied. Objectively: the face is symmetrical, the height of the lower part of the face is not changed, the chin and nasolabial folds are not very pronounced, the opening of the mouth is free, smooth, the mucous membrane of the gums is swollen, hyperemic, bad breath. Abundant soft plaque, supra- and subgingival dental deposits. Periodontal pockets in the area 1.1, 1.2, 2.1, 2.2, 3.7, 3.8, 4.7, 4.8 3 mm deep, in the teeth 4.3, 4.2, 4.1, 3.1, 3.2, 3.3 - 4 mm. Percussion is painless. Mobility of the 1st degree of teeth 1.1, 1.2, 2.1, 2.2. Hygiene Index (IG) according to the method of Yu.A. Fedorova and V.V. Volodkina unsatisfactory - 2.1 points. Papillary-marginal-alveolar index (PMA) - 29%. Bleeding Index PBI (papillableedingindex).

Mulleman-Saxer: 2nd degree - linear-point bleeding along the edge of the papilla apex. X-ray examination: mixed type bone destruction with a predominance of the vertical resorption type, accompanied by a decrease in the height of the interalveolar septa by 1/4 of the length of the roots of the teeth 3.7, 3.8, 4.7, 4.8 and 1/3 of the length of the roots in the area of the remaining groups of teeth. The structure of the fabric is large and medium mesh. In the immune status, a decrease in phagocytic activity was established: the phagocytic index was 47.1%. The ratio of the levels of cytokines IL-1p / IL-4 is 5.35. The level of lysozyme is 4.7 μg / ml. Diagnosis: periodontitis of mild severity, generalized form.

The complex treatment was carried out: 1. Education of the patient in rational oral hygiene, professional hygiene - removal of supra- and subgingival stones, plaque, polishing of the tooth surface, accessible part of the root, oral cavity sanitation - treatment of caries; 2. Therapeutic treatment: topical application of antiseptic drugs on the gums. General - the use of vitamins (aevit, ascorbic acid). During treatment, the patient's condition improved, the disappearance of signs of catarrhal gingivitis on the 13th day of treatment. An immunological control study showed: a decrease in the IL-1β / IL-4 ratio from 5.35 to 3.3, an increase in the phagocytic index from 47.1 to 49.2%, an increase in lysozyme from 4.7 to 5.1 μg / ml There was a positive dynamics in the index assessment of periodontal status: the degree of bleeding gums decreased from 2 degrees to 1 (single point bleeding); PMA decreased from 29 to 22%, IG - from 2.1 to 1.3 points. The duration of treatment of the patient on an outpatient basis was 17 days.

Example 2 (a standard method of treatment in combination with local use of tripoli). Patient M, born in 1963, body weight 86 kg, honey. Card No. 179, from 09/11/12 to 09/22/12 was on outpatient treatment at the clinic of the Central City Hospital of the Ministry of Health and Social Development of the Chuvash Republic. Complaints: halitosis, pain in the gums when chewing solid food, bleeding gums during brushing, slight tooth mobility. Anamnesis: disease for 2 years, with periodic exacerbations. Objectively: the face is symmetrical, the height of the lower part of the face is not changed, the chin and nasolabial folds are not very pronounced, the opening of the mouth is free, smooth, the mucous membrane of the gums is swollen, hyperemic, bad breath. Abundant soft plaque, supra- and subgingival dental deposits. Adentia 4.5. Periodontal pockets in the area 1.1, 1.2, 2.1, 2.2, 3.1, 3.2, 4.1, 4.2, 2.6, 4.6 - 4 mm. Percussion is painless. Mobility of the 1st degree of teeth 1.1, 1.2, 2.1, 2.2, 3.1, 3.2, 4.1, 4.2. IG - unsatisfactory (2.7 points). PMA - 28%. Bleeding index - 2nd degree - linear point bleeding along the edge of the papilla apex. X-ray examination: mixed type bone destruction with a predominance of the vertical resorption type, accompanied by a decrease in the height of the interalveolar septa by 1/4 of the root lengths of 1.1, 1.2, 2.1, 2.2, 3.1, 3.2, 4.1, 4.2 and by 1 / 3 lengths of roots in the area of other groups of teeth. The structure of the fabric is large and medium mesh. In the immune status, a decrease in phagocytic activity was established: the phagocytic index was 47.0%. The ratio of IL-1β / IL-4 is 5.47. The level of lysozyme is 4.4 μg / ml. Diagnosis: periodontitis of mild severity, generalized form. The complex treatment was carried out: 1. Education of the patient in rational oral hygiene, professional hygiene - removal of supra and subgingival stones, plaque, polishing of the tooth surface, accessible part of the root, oral cavity sanitation - treatment of caries and sanitation of poorly sealed canals; 2. Therapeutic treatment: application of antiseptic solutions to the gums. General - the use of vitamins (aevit, ascorbic acid). 3. Additionally, local drug therapy was carried out in two stages. At the first stage, zeolite-containing ground tripoli was rubbed into the gums with a particle size of 0.3 - 0.4 mm in the form of a mixture consisting of zeolite-containing tripoli and distilled water, taken in equal weight parts, for 10-15 minutes, and at the second stage applied to the affected areas of the gums by applying tampons moistened with a mixture of 2.5 weight. including tripoli, 1 weight. h of distilled water for 15 minutes. The course of local therapy was 12 days. During the treatment, the patient's condition improved, the signs of catarrhal gingivitis disappeared after 10 days of treatment. During the control immunological study, significant changes were found in the indices of the immuno-cytokine system in the oral fluid: the value of IL-1β / IL-4 decreased from 5.47 to 1.3, the phagocytic index increased from 47.0 to 61.2%, and the lysozyme content increased from 4.4 to 7.2 μg / ml. There was a positive trend in the index assessment of periodontal conditions: the degree of bleeding gums decreased from 2 to 1 (single point bleeding); PMA decreased from 28 to 15.5%, IG - from 2.7 to 1.3 points. The duration of outpatient treatment of the patient was 14 days. Example 3 (standard treatment method). Patient A., born in 1962, body weight 88 kg, honey. Card No. 371, from 09/13/12 to 09/29/12 was on outpatient treatment at the clinic of the Central City Hospital of the Ministry of Health and Social Development of the Chuvash Republic. Complaints: bad breath, bleeding gums when brushing your teeth, the allocation of exudate from the gum pocket, periodic aching pain in the gums and periodic swelling of the gums, tooth mobility. Anamnesis: disease for 4 years, with periodic exacerbations. Previously, he underwent two courses of treatment with a periodontist, with little effect. Objectively: the face is symmetrical, the height of the lower part of the face is not changed, the chin and nasolabial folds are not very pronounced, the opening of the mouth is free, smooth, the mucous membrane of the gums is swollen, hyperemic, bad breath. Abundant soft plaque, supra- and subgingival dental deposits. Adentia 3.6, 4.5. Periodontal pockets with suppuration in the areas 1.1, 1.2, 2.1, 2.2, 3.1, 3.2, 3.3, 3.7, 3.8, 4.1, 4.2, 4.3, 4.7, 4.8 with a depth of 4 mm. Tooth mobility 3.1, 3.2, 3.3, 4.1, 4.2, 4.3 2 degrees Percussion is painless. IG at the bad level - 2.6 points. RMA - 59%. Bleeding index - 3rd degree: moderate bleeding from the interdental papilla (in the form of a triangle). When x-ray examination: the destruction of bone tissue in a mixed type with a predominance of the vertical type of resorption, accompanied by a decrease in the height of the interalveolar septa by 1/3 of the length of the roots of the teeth. The periodontal fissure is widened, the bone structure is vague. When analyzing the results of an immunological study, a decrease in phagocytic activity was found: phagocytic index of 46.5%. IL-1β / IL-4 - 5.47. The level of lysozyme is 3.7 μg / ml. Diagnosis: periodontitis of moderate severity, generalized form. Comprehensive treatment was carried out: 1. Education of the patient in rational oral hygiene, professional hygiene - removal of supra and subgingival stones, plaque, polishing of the tooth surface, accessible part of the root, and oral cavity sanitation - treatment of caries and its complications; 2. Therapeutic treatment: topical application of antiseptic solutions. At the systemic level: the use of vitamins, immuno-metabolic therapy drugs (aevit, ascorbic acid, wobenzym, ubiquinone). 3. Surgical treatment: curettage. 4. Orthopedic treatment: temporary splinting of fiberglass-based adhesive splint with GlassSpan material of the front teeth on the lower jaw. An immunological control study showed a slight decrease in IL-1β / IL-4 from 5.47 to 4.5, an increase in the phagocytic index from 46.5 to 49%, and an increase in lysozyme content from 3.7 to 4.9 μg / ml. There was a positive dynamics in the index assessment of periodontal conditions: the degree of bleeding gums decreased from 3 degrees to 2 (linear-point bleeding along the edge of the papilla apex); PMA decreased from 59 to 21%, IG from 2.6 to 1.2 points. The data presented indicate that during the treatment the patient's condition improved, however, by the control period (the 14th day of treatment), it was not possible to eliminate the bleeding and swelling of the interdental papillae).

The duration of outpatient treatment of the patient was 21 days.

Example 4 (a standard method of treatment in combination with local use of tripoli).

Patient N., born in 1970, body weight 88 kg, honey. Card No. 1050, from 09/17/12 to 09/30/12 was on outpatient treatment at the clinic of the Central City Hospital of the Ministry of Health and Social Development of the Chuvash Republic. Complaints: halitosis, periodic bleeding of the gums, the release of exudate from the gingival pocket, periodic aching pain in the gums and periodic swelling of the gums, tooth mobility. Anamnesis: disease for 5 years, with periodic exacerbations. Objectively: The face is symmetrical, the height of the lower part of the face is not changed, the chin and nasolabial folds are not very pronounced, the opening of the mouth is free, smooth, the mucous membrane of the gums is swollen, hyperemic, and the smell of breath.

Abundant soft plaque, supra- and subgingival dental deposits. Adentia 2.4, 3.5, 3.6. Periodontal pockets with suppuration in the areas 1.1, 1.2, 2.1, 2.2, 3.1,3.2, 3.7, 3.8, 4.1,4.2, 4.7, 4.8 with a depth of 5 mm. Tooth mobility 1.1, 1.2, 2.1, 2.2 2 degrees. Percussion is painless. IG - 2.8 points. PMA - 60%. Bleeding index - 3rd degree - moderate bleeding from the interdental papilla. X-ray results: mixed-type bone destruction with a predominance of the vertical resorption type, accompanied by a decrease in the height of the interalveolar septa by 1/3 of the length of the roots of the teeth. The periodontal fissure is widened, the bone structure is vague. The phagocytic index is 44.5%, IL-1β / IL-4 is 5.2. The level of lysozyme is 3.3 μg / ml. Diagnosis: periodontitis of moderate severity, generalized form. Comprehensive treatment was carried out: 1. Education of the patient in rational oral hygiene, professional hygiene - removal of supra and subgingival stones, plaque, polishing of the tooth surface, accessible part of the root, and oral cavity sanitation - treatment of caries and its complications; 2. Therapeutic treatment: application of antiseptic solutions to the gums. General therapy: the use of vitamins, drugs of immuno-metabolic therapy (aevit, ascorbic acid, wobenzym, ubiquinone). 3. Surgical treatment: curettage. 4. Orthopedic treatment: Temporary splinting of fiberglass-based adhesive splint with GlassSpan material of the front teeth on the lower jaw. Additionally, local drug therapy was carried out in two stages. At the first stage, zeolite-containing ground tripoli was rubbed into the gums with a particle size of 0.3 - 0.4 mm in the form of a mixture consisting of zeolite-containing tripoli and distilled water, taken in equal weight parts, for 15 minutes, and at the second stage, they were applied applications on the affected areas of the gums by applying tampons moistened with a mixture of 3 parts by weight Tripoli, 1.5 wt.h distilled water for 25 minutes. The course of local therapy was 14 days. During treatment, a significant positive trend was noted. After 10 days, the signs of gingivitis disappeared. The value of IL-1β / IL-4 decreased from 5.2 to 1.2, the phagocytic index increased from 47.5 to 63%, and the level of lysozyme increased from 3.3 to 7 μg / ml. The degree of bleeding gums decreased from 3rd degree to 1st; PMA decreased from 60 to 10%, IG - from 2.8 to 1 point. The duration of outpatient treatment was 16 days.

The proposed method was tested in the treatment of 15 people - the main group. The comparison group included 15 patients treated in the conventional manner. Both groups were represented by patients with mild and moderate periodontitis, a generalized form, homogeneous in gender, age composition, comorbidity, and the presence of bad habits. Evaluation of mucosal immunity and cytokine status was performed before treatment and 14 days after the start of treatment. Clinical status was investigated on the basis of a study of index indicators for assessing periodontal status in patients, including parameters such as the Fedorov-Volodkina oral hygiene index, gum bleeding rate by the PBI bleeding index, and papillary-marginal alveolar index (PMA) [3]. The results of testing are given in table 1.

Table 1 Comparative assessment of the dynamics of clinical and laboratory parameters in groups of patients with periodontitis, generalized form under the influence of various treatment methods Indicators Standard treatment + treatment with tripoli n = 15 Standard treatment n = 15 P < IL-1β / IL-4 before treatment 5.47 ± 0.30 5.35 ± 0.29 NS on the 14th day of treatment 1.3 ± 0.1 ** 3.3 ± 0.15 * 0.001 Phagocytic index,% before treatment 47.0 ± 1.2 47.1 ± 1.3 NS on the 14th day of treatment 61.2 ± 1.9 ** 49.2 ± 1.5 0.001 Lysozyme, mcg / ml before treatment 4.4 ± 0.02 4.7 ± 0.023 NS on the 14th day 7.2 ± 0.04 ** 5.1 ± 0.03 0.001 Gum bleeding rate before treatment 2.55 ± 0.10 2.55 ± 0.10 NS on the 14th day of treatment 1.41 ± 0.04 ** 1.9 ± 0.08 * 0.01 PMA,% before treatment 59.3 ± 1.2 59.3 ± 1.2 NS on the 14th day of treatment 15.5 ± 1.5 *** 22.3 ± 2.1 ** 0.01 Hygiene index before treatment 2.7 ± 0.10 2.7 ± 0, S NS on the 14th day of treatment 1.3 ± 0.07 ** 1.32 ± 0.06 ** NS Dates of achieving remission, days 15.6 ± 0.23 19.3 ± 0.31 0.001 Notes: PMA - papillary-alveolar-marginal index; asterisks indicate the degree of significance of differences in the values of indicators relative to the initial ones (before treatment): * - p <0.05, ** - p <0.01, *** - p <0.001); p is the degree of significance of differences in the values of indicators in groups of patients treated with various methods; NS - the difference is not statistically significant

From table 1 it follows that in the treatment process in patients receiving rubbing and application of Tripoli, there was a persistent reduction of inflammation in the periodontium under the influence of its anti-inflammatory and immunomodulating properties. Significant shifts occurred in the indices of the immuno-cytokine system in the oral fluid, namely, the ratio of the level of the pro-inflammatory cytokine IL-1β to the level of the anti-inflammatory cytokine IL-4 decreased 4 times (in the comparison group - 1.6 times), the phagocytic index increased 1 , 3 times (in the comparison group - only 1.02 times), the lysozyme content increased 1.6 times (in the comparison group - 1.08 times). At the same time, positive dynamics of indicators for an index assessment of the periodontal condition in patients were revealed: the degree of bleeding of the gums and PMA decreased. Symptom regression was established after 14 days in 90% of patients (in the comparison group - in 65%). Periodontitis remission was achieved in a shorter time frame than in the control group.

Within 3 months after treatment with the described treatment method, 2 cases of exacerbation were observed in the observed group (after treatment with the standard method, in 8 patients). Within 6 months of treatment with the described method, two cases of exacerbation in 4 patients and 1 case of exacerbation in 11 patients. During standard treatment, in 12 patients, an exacerbation of the disease was observed twice in 6 months and only in 3 patients - 1 time.

table 2 Assessing the socio-economic effect of the proposed method for the treatment of mild and moderate periodontitis in comparison with the standard method for 6 months, taking into account the number of remissions and exacerbations (per 26,000 people) at prices in January 2013 (for example, Cheboksary) The number of patients with chronic generalized periodontitis (mild to moderate) in Cheboksary 26000 The average cost of a standard treatment method (professional hygiene, tartar removal using ultrasound equipment, selective grinding, drug treatment of periodontal pockets) of one case of exacerbation of chronic generalized periodontitis using an immunomodulator - imudon 2870 rub The average number of exacerbations against the background of standard therapy in one patient for 6 months 1.8 The total number of exacerbations against the background of standard therapy in all patients for 6 months 46800 The total cost of standard treatment for all cases of exacerbations of chronic generalized periodontitis for 6 months 134.3 × 10 ⁶ rubles The average cost of treating one case of exacerbation of chronic generalized periodontitis (mild to moderate) using tripoli 2130 rub The average number of exacerbations against the background of zeolite-containing tripoli in one patient for 6 months 1.26 The total number of exacerbations during treatment with tripoli in all patients for 6 months 32760 The total cost of treating all cases of exacerbations of chronic generalized periodontitis using tripoli for 6 months 69.7 × 10 ⁶ rubles Savings by reducing exacerbations and lower treatment costs 64.6 × 10 ⁶ rubles Social effect Improving the quality of life

Thus, the use of the proposed method will expand the range of natural products for the treatment of periodontitis. In addition, against the background of treatment with zeolite-containing tripoli, the following was achieved:

- remission of periodontitis is achieved on average within 15.6 days, in a shorter time frame than in the control group (19.3 days);

- reduction in the number of exacerbations per year (1.42 times);

- improving the quality of life;

- pronounced socio-economic effect.

Information sources

1. Agafonkina T.V., Merkulova L.M., Struchko G.Yu. The study of the structures of the thymus and blood parameters of rats during feeding with zeolite-containing tripoli // Bulletin of Chuvash. un-that. - 2006. - No. 2. - p. 46-56.

2. Blashkova, S. L., Makarova N. A. Protocol for the management of patients with chronic generalized periodontitis // Practical medicine. - 2009. - No. 1. - S. 63-67.

3. Gum disease. Periodontal Index Research // Dental Mechanic. - Moscow, 2010.

4. Vedyaeva A.P. Optimization of the complex treatment of patients with rapidly progressive periodontitis using immunomodulating therapy: Abstract. diss. Cand. Medical Science - Saratov, 2011 .-- 27 p.

5. Grudyanov A.S., Grigoryan A.S., Frolova O.A. Periodontal disease: pathogenesis, diagnosis, treatment // Guide for doctors. M., 2004 .-- 320 s.

6. Grudyanov A.I., Bezrukova I.V. Immunological parameters of blood with rapidly progressive periodontitis // Dentistry.-2000.-№3.-P.15-17.

7. Distanova UG, Filko A.F. Non-traditional types of non-metallic mineral raw materials. - M: Nedra, 1990-260 s.

8. Dmitrieva L.A. Modern aspects of clinical periodontology. M., 2001. -128 p.

9. The study and application of tripoli and diatomites: Collection of articles.-Cheboksary: Publishing house Chuvash. University, 2000.-164 p.

10. Karpenko I.N., Bulkina N.V., Ponukalina E.V. Modern ideas about the etiology and pathogenesis of rapidly progressive periodontitis // Archive pathology.-2009.-№1.-p. 57-60.

11. Kovalchuk L.V., Gankovskaya L.V., Rogova M.A. et al. The role of cytokines in the mechanisms of development of chronic inflammation in periodontal tissues // Immunology. - 2000. - No. 6. - S.24-26.

12. Kolotilova M.L. The mechanisms of therapeutic efficacy of zeolite-containing tripoli on models of acute toxic hepatitis, acute hyperacid gastritis and gastric ulcer: Abstract. diss. Doctor of Medical Sciences - M., 2005 .-- 40 p.

13. Konoplya N.A., Uspenskaya M.N. The state of the complement system and cytokine status in chronic generalized periodontitis; correction of violations // Modern problems of science and education. - 2012. - No. 5. S.19-19.

14. Malov I.V., Ivanov L.N., Kolotilova M.L., Pavlov A.F. Zeolite-containing tripoli (CT) in the treatment of experimental caries // Modern technologies - in public health practice.-Cheboksary, 2006.-P.69-70.

15. Soboleva L.A., Lepilin A.V., Shuldyakov A.A. Optimization of treatment of patients with periodontitis // Bulletin of the St. Petersburg State Medical Academy. I.I. Mechnikov. - 2004. - No. 1. - S. 130-133.

16. RU No. 2176510, publ. 12/10/2001.

17. Shmagel K.V., Belyaeva O.V., Chereshnev V.A. Modern views on the immunology of periodontitis // Dentistry. - M: Media Sphere, 2003. - No. 1.-S.61-64.

18. Yudina N.A., Uspenskaya M.N., Konoplya A.I. et al. Changes in the cytokine status, complement system, and lipid peroxidation processes at the local level in inflammatory periodontal diseases // Ros. allergol. journal - 2009. - Issue 1, No. 3. - S. 476-477. // Grew. Allergol. Zhurn. - 2009. - Issue 1, No. 3. - S. 476-477.

19. Yudina N.A., Uspenskaya M.N., Lunev M.A. et al. Correction of immunity disorders in inflammatory periodontal diseases // Honey. immunol. - 2011. - T. 13, No. 4/5. - S.536.

Claims (1)

A method for the treatment of periodontitis, which involves professional hygienic cleaning of the oral cavity, antiseptic therapy, local drug therapy, metabolic therapy preparations, characterized in that the local drug therapy is carried out in two stages with zeolite-containing tripoli with particle sizes of 0.3-0.4 mm, while in the first stage, rubbing in the gums of the mixture consisting of zeolite-containing tripoli and distilled water, taken in equal parts by weight, for 10-15 minutes, and in the second stage, the application is applied s gums at the affected area by applying a swab moistened with a mixture consisting of 2.5-3 parts by weight Tripoli, 1-1.5 parts by weight distilled water, with a duration of a course of local drug therapy of 12-14 days.