RU2532399C2 - Method of treating periodontitis - Google Patents

Abstract

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention refers to pharmaceutics and represents a method of treating periodontitis by instillations of the Cholisal gel into the gingival pockets and gingival applications 2-3 times a day for 20 days; the method differs by prescribing the Calcium-vit D₃C preparation 1 capsule twice a day for one month, with the therapeutic course repeated 6 months later.

EFFECT: invention provides the higher effectiveness of the method of treating periodontitis by achieving the osteotropic and immunotropic action alongside with the local bactericidal and anti-inflammatory effect.

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Description

The invention relates to medicine, namely to dentistry, and can be used to treat inflammatory periodontal diseases.

There is a method of treating periodontitis (RF patent No. 2288724 from 10.12.2006), which consists in the instillation and application of the Holisal gel 2-3 times a day, for 20 days, the appointment of Imudon preparations, 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.

The disadvantage of this method is the lack of effectiveness in the treatment of periodontitis due to the lack of osteotropic action of drugs.

Effect: increasing the effectiveness of the method of treatment of periodontitis by achieving an osteotropic and immunotropic effect along with a local bactericidal and anti-inflammatory effect.

The task is achieved by using the following treatment complex: the anti-inflammatory and antiseptic local remedy of the gel “Holisal” and the original osteotropic drug “Calcium-Vit D ₃ C”, which additionally has immunotropic and antitoxic properties.

Periodontitis is known to be a complex, common disease, in the pathogenesis of which dental plaque microorganisms play a role, causing inflammation of periodontal tissues, destruction of the alveolar bone and a decrease in the immunological resistance of the body. In recent years, in the pathogenesis of periodontitis, the role of mineral metabolism disturbance in enhancing osteoclastic bone resorption and disturbance in bone remodeling process (Atrushkevich V.G. Osteoporosis in the periodontal disease clinic // Russian Dental Journal. 2008. No. 1 P.43-46; Dmitrieva L.A., Mkrtumyan AM, Atrushkevich VG Mineral bone density and the state of mineral metabolism in patients with chronic generalized periodontitis // Dentistry. 2009. No. 6. P.24-29; Douglas Miley D., Nathala Garcia M. , Charles F. Hilde-bold et al. Crosssectional study of Vitamin D and calcium supplementation effect on chronic perodontitis // Periodontol / 2009. Vol.80 (9) P.1433-1439).

Therefore, the treatment of periodontitis should be aimed not only at eliminating pathogenic microflora and inflammation of periodontal tissues, but also at conducting anti-osteoporotic therapy, limiting the destruction of the alveolar bone and increasing the immunological resistance of the body.

Gel "Kholisal" is produced by the company "Elfa" (Poland). The drug contains two main active ingredients: choline salicylate (87.1 mg / 10 g), which has a local analgesic and anti-inflammatory effect (inhibits the activity of cytooxygenase, inhibits the synthesis of prostaglandins) and cetalkonium chloride (0.1 mg / 10 g), which, Being an antiseptic, it has antibacterial, antiviral and antifungal effects. The gel ethanol-containing adhesive base provides a rapid development of the effect and for a long time keeps active substances on the mucous membrane. Applied in the form of instillations and applications 2-3 times a day after meals for 14-20 days.

Calcium-Vit D ₃ C is an original osteotropic drug developed at ZAO Medisorb (Perm). The main active ingredients are contained in the capsule: calcium carbonate 750 mg (equivalent to 300 mg calcium), cholecalciferol (vitamin D3) 100 ME, ascorbic acid 50 mg, extracts of rosehip and licorice root (Registration certificate of the Ministry of Health of the Russian Federation No. 001426.P.643) .

Calcium is the most common substance for the prevention and treatment of periodontal disease. It is necessary for the formation and mineralization of bones, contributes to an increase in peak bone mass, has a certain antiresorptive potential, contributing to an increase in the level of ionized calcium in the blood and inhibiting the secretion of paraterioid hormone (PTH). Calcium ions are necessary for the implementation of the process of transmission of nerve impulses, blood coagulation and contraction of skeletal and smooth muscles (Mashkovsky MD Medicines. Part II - M., "Medicine". - 1993. - P.141-143).

Vitamin D3 is one of the main regulators of calcium metabolism in the body, is involved in the regulation of inflammatory reactions and has immunotropic activity. There is a reliable relationship between the vitamin D content and the state of the periodontal complex (Zyablitskaya M.S., Atrushkevich V.G., Toroptseva N.V. The role of vitamin D metabolism disorders in the pathogenesis of inflammatory periodontitis diseases (review) // Periodontology. - T. XVII , No. 1 (62). - 2012. - C.3-10.)

Ascorbic acid and rosehip extract are a source of vitamin C, play an important role in the regulation of redox processes, blood coagulation, tissue regeneration, collagen synthesis and normalization of capillary permeability. With a deficiency of vitamin C, the primary lesion is localized in the periodontal tissues. (Mashkovsky M. D. Medicines. Part II - M., "Medicine". - 1993. - P.26-28).

Licorice root is a source of glycosides, the main component is glycyrrhizic acid, which has immunotropic, antitoxic, anti-inflammatory antioxidant and antiviral effects (WHO, Radix Glicyrri-zae. Monographs on Selectes Medicinal plants. Geneva, 1999 V.1. P.183-194; Tolstikov G.A. et al. Licorice: biodiversity, chemistry, medical applications; Novosibirsk Institute of Organic Chemistry named after NN Vorozhtsov SB RAS. - Novosibirsk: Geo Academic Publishing House, 2007. - 311 p.) .

Calcium-Vit D ₃ C is prescribed as an osteotropic agent. Previously, this drug was not used to treat periodontitis.

The method is as follows: a patient with periodontitis after professional oral hygiene is instilled into periodontal pockets and applications on the gum of the Holisal gel 2-3 times a day for 20 days. At the same time, Calcium-Vit D ₃ C is prescribed, 1 capsule twice a day for a month, with a course of treatment repeated after 6 months.

Examples of specific performance.

Example 1

Patient P., 33 years old.

09.21. 2009: Complaints of bad breath, bleeding and sore gums during brushing and eating solid food. Gum bleeding occurs periodically, for 3 years, mainly in autumn and spring.

Examination results: The patient's appearance corresponds to age, the face is symmetrical, regional submandibular and cervical lymph nodes are not palpated. Frenulum of the lips and tongue of medium attachment height, depth of the vestibule of the oral cavity 14 mm, occlusion orthognathic. The mucous membrane of the cheeks, lips, tongue is pink, clean, moist. Interdental papillae and marginal gums in the area of all teeth of the upper and lower jaw are hyperemic, bleed when probed. There are supra- and subgingival mineralized dental deposits, mainly on the teeth of the lower jaw. The depth of periodontal pockets in the region of 18, 14, 13, 24, 25, 26, 34, 35, 44, 45, 46, 47 is from 3.5 to 4 mm. There is no tooth mobility. Index assessment of the state of the organs of the oral cavity: KPU - 9 (1, 8, 0); OHI-S - 1.9; PMA - 28.7%; SBI - 2.32; Pi - 2.7.

On the orthopantomogram dated September 21, 2009, the destruction of the cortical plates of the interalveolar septa in the area of all teeth, the decrease in the alveolar bone to 1/3 of the root length of 16, 24, 25, 26, 27, 34, 35, 36, 46, 47 teeth are determined.

Table 1 presents biochemical parameters. The severity of inflammatory and destructive changes in periodontal tissues was determined by the content in the liquid of the periodontal pocket of cytokines: osteoprotegerin - OPG (pg / ml) and RANKL ligand (ng / ml). To control osteotropic therapy, the contents of total calcium, inorganic phosphorus and actively alkaline phosphatase in the blood serum were studied.

Table 1 6 months after treatment Indicators Norm Before treatment 1 month after treatment OPG 180.1 342.3 - RANKL 17.4 0,0 - Total calcium 2-3 mmol / l 1,60 1.78 1,67 Inorganic phosphorus 0.65-1.62 mmol / L 0.65 0.61 0.61 Active alkaline phosphatase 0.5-1.3 mmol / L 0.68 0.70 0.74

Diagnosis: Chronic generalized periodontitis of mild degree.

Treatment: professional oral hygiene, removal of subgingival dental deposits, antiseptic treatment of periodontal pockets with 0.1% chlorhexidine solution, instillations in periodontal pockets and applications of the Holisal gel 2-3 times a day for 20 days, as well as taking Calcium-Vit D ₃ C, 1 capsule twice a day for a month, with a repeat of the treatment after 6 months.

10.24.09. After treatment after 1 month, the patient has no complaints. When examining the oral cavity, a pale pink dense gum is observed in the area of all teeth, while probing, bleeding of the gums is not determined. The depth of periodontal pockets decreased to 2.5-3 mm, there is no detachable from periodontal pockets. Index assessment of the state of the organs of the oral cavity: OHI-S - 0; RMA - 5.4%; SBI - 0; Pi is 1.1.

04/25/10. 6 months after treatment, the patient had no complaints. On examination: the gum is dense, pale pink, in the area of 16, 27, 31, 41, 46, 47, bleeding of the gingival papillae is noted, which appears 30 seconds after probing. Depth of periodontal pockets up to 3.5 mm, no detachable from pockets. Index assessment of the state of the organs of the oral cavity: OHI-S - 0.6; RMA - 6.3%; SBI 0.6; Pi - 1.3.

Clinical example No. 2

Patient M., 22 years old.

Complaints 06/15/2010: bad breath, bleeding and sore gums during brushing and when eating solid food. Gum bleeding periodically occurs within 2 years. She was not treated by a periodontist; she brushes her teeth once a day for 1-2 minutes, smokes.

Examination results: The patient's appearance corresponds to age, the face is symmetrical, regional submandibular and cervical lymph nodes are not palpated. Frenulum of lips and tongue of medium attachment height, depth of vestibule 13 mm, occlusion deep. The mucous membrane of the cheeks, lips, tongue is pink, clean, moist. Interdental papillae and marginal gums in the upper and lower jaw are hyperemic, swollen, bleed when probed, and painful on palpation. There are supra- and subgingival mineralized dental deposits and plaque, mainly on the teeth of the lower jaw. The depth of periodontal pockets in the region of 18, 14, 13, 24, 25, 26, 34, 35, 44, 45, 46, 47 from 4 mm to 5 mm, and in the region of 16, 27 - more than 4.8 mm, serosally determined hemorrhagic discharge. Tooth mobility of the 1st degree - 42, 41, 31, 32.

Index assessment of the state of the organs of the oral cavity: KPU - 9 (1, 8, 0); OHI-S - 1.8; RMA - 32%; SBI - 2.91; Pi - 2.6.

table 2 6 months after treatment Indicators Norm Before treatment 1 month after treatment OPG 166.6 178.1 - RANKL 106,2 0.1 - Total calcium 2-3 mmol / l 1,57 1.78 1,67 Inorganic phosphorus 0.65-1.62 mmol / L 0.56 0.61 0.58 Active alkaline phosphatase 0.5-1.3 mmol / L 0.68 0.74 0.76

On the orthopantomogram of June 15, 2010, the destruction of the cortical plates of the interalveolar septa in the area of 16, 24, 25, 26, 27, 34, 35, 36, 46 is determined. 47 teeth, horizontal decrease in the alveolar bone to 1/2 root length in the area of all teeth.

Index assessment of the state of the organs of the oral cavity: KPU - 9 (1, 8, 0); OHI-S - 1.8; PMA - 32%; SBI - 2.91; Pi - 2.6.

Diagnosis: Chronic generalized periodontitis of moderate degree in the acute stage.

Treatment: professional oral hygiene, removal of subgingival dental deposits, antiseptic treatment of periodontal pockets with 0.1% chlorhexidine solution, instillations in periodontal pockets and applications of the Holisal gel 2-3 times a day for 20 days, as well as taking Calcium-Vit D ₃ C, 1 capsule twice a day for a month, with a repeat of the treatment after 6 months.

07.24.10. After treatment after 1 month, the patient has no complaints. When examining the oral cavity, a pale pink dense gum is observed in the area of all teeth, while probing, bleeding of the gums is not determined. The depth of periodontal pockets decreased to 3 mm, there is no detachable from periodontal pockets. Index assessment of the state of the organs of the oral cavity: OHI-S - 0; PMA - 5.42%; SBI - 0; Pi is 1.1.

12/25/10. 6 months after treatment, the patient had no complaints. On examination: the gum is dense, pale pink, in the area 31, 41, bleeding of the gingival papillae is noted, which appears 30 seconds after probing. Depth of periodontal pockets up to 3.5 mm, no detachable from pockets.

Index assessment of the state of the organs of the oral cavity: OHI-S - 0.6; PMA - 6.2%; SBI 0.6; Pi -1.3.

Clinical example No. 3

Patient M., 42 years old.

Complaints 09/17/2011: bad breath, bleeding and sore gums during brushing and eating solid food. Gum bleeding periodically occurs over 10 years. She was treated by a periodontist; she brushes her teeth once a day for 1-2 minutes.

Examination results: The patient's appearance corresponds to age, the face is symmetrical, regional submandibular and cervical lymph nodes are not palpated. Frenulum of lips and tongue of medium attachment height, depth of vestibule 14 mm, occlusion deep. The mucous membrane of the cheeks, lips, tongue is pink, clean, moist. Interdental papillae and marginal gums in the upper and lower jaw are cyanotic, hyperemic, edematous, bleed when probed, and painful on palpation. There are supra- and subgingival mineralized dental deposits and plaque, mainly on the teeth of the lower jaw. The depth of periodontal pockets in the region of 18, 14, 13, 24, 25, 26, 34, 35, 44, 45, 46, 47 from 4 mm to 5 mm, and in the region of 16, 27 - more than 6.7 mm, is determined serously hemorrhagic discharge. Mobility 31, 32, 41, 42.26, 16 teeth of the II degree.

Index assessment of the state of the organs of the oral cavity: KPU - 9 (1, 8, 0); OHI-S 2.7; PMA - 67%; SBI - 2.91; Pi - 7.6.

Table 3 6 months after treatment Indicators Norm Before treatment 1 month after treatment OPG 175.8 166.3 - RANKL 116.9 5.1 - Total calcium 2-3 mmol / l 1,57 1.78 1,67 Inorganic phosphorus 0.65-1.62 mmol / L 0.56 0.61 0.58 Active alkaline phosphatase 0.5-1.3 mmol / L 0.68 0.71 0.76

On the orthopantomogram dated 06/30/2010, the destruction of the cortical plates of the interalveolar septa in the area of 16, 24, 25, 26, 27, 34, 35, 36, 46, 47 teeth to 1/2 the length of the roots in the area of all teeth is determined. Index assessment of the state of the organs of the oral cavity: KPU - 9 (1, 8, 0); OHI-S - 1.8; PMA - 51.2%; SBI - 2.91; Pi - 5.6.

Diagnosis: Chronic generalized severe periodontitis in the acute stage.

Treatment: professional oral hygiene, removal of supragingival and subgingival dental deposits, antiseptic treatment of periodontal pockets with 0.1% chlorhexidine solution, prescribed instillations in periodontal pockets and Holisal gel applications 2-3 times a day for 20 days, as well as taking Calcit-Vit D ₃ C, 1 capsule twice a day for a month, with a repeat of treatment after 6 months.

10.24.11. After treatment after 1 month, the patient has no complaints. When examining the oral cavity, a pale pink dense gum is observed in the area of all teeth, while probing, bleeding of the gums is not determined. The depth of periodontal pockets decreased to 3 mm, there is no detachable from periodontal pockets. Index assessment of the state of the organs of the oral cavity: OHI-S - 0; RMA - 15.3%; SBI - 0; Pi is 2.3.

04/25/12. 6 months after treatment, the patient had no complaints. On examination: the gum is dense, pale pink, in the area of 16, 27, 31, 41, 46, 47, bleeding of the gingival papillae is noted, which appears 30 seconds after probing. Depth of periodontal pockets up to 5.6 mm, detachable from pockets no. Index assessment of the state of the organs of the oral cavity: OHI-S - 0.6; RMA - 12.1%; SBI 0.4 Pi - 1.7.

Claims (1)

A method of treating periodontitis by performing instillations in periodontal pockets and applications on the gum of the Holisal gel 2-3 times a day, for 20 days, characterized in that the drug "Calcium-Vit D ₃ C" is additionally prescribed, 1 capsule 2 times per day for a month, with a repeat of treatment after 6 months.