RU2554822C1 - Method of treating periodontal diseases - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: implementing the presented method involves mixing gel Hyaludent 1 ml on a slide with Betaleukin 0.0005 ml dissolved in water for injections 1 ml; the produced content is applied with a single application syringe on a desalivated treated area of the involved periodontal tissues and left until completely absorbed for 1-3 minutes; the involved area is exposed to laser light generated by the laser semiconductor dental therapeutic apparatus Optodan with a periodontal tip in the mode II, with the exposure length for 3-5 minutes; the therapeutic course is 8 days daily.

EFFECT: using the method enables achieving the fast regeneration length, ensuring the intact periodontal state in the most patients.

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Description

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

From the practice of medicine, a method for treating periodontal diseases using the Betaleukin preparation is known, including installation in periodontal pockets according to the scheme of 5 procedures, carried out every other day with an exposure of 15 minutes. The solution is prepared as follows: the contents of 1 ampoule are diluted in 1 ml of sterile 0.9% saline. (Safonova, T. A. Clinical and immunological study of the effectiveness of the drug “Betaleikin” in the complex treatment of periodontitis: abstract of diss. Candidate of medical sciences / T. A. Safonova. Yekaterinburg, 2010, 24 pp.).

The disadvantages of this analogue are:

- during installations in periodontal pockets, the drug solution introduced into the periodontal pockets is quickly washed out of them, thereby the permeability and fixation of the drug is reduced to a minimum amount of injected volume, which reduces the therapeutic effect;

- a decrease in the therapeutic effect of the drug leads to a slowdown in the normalization of microcirculation, a decrease in vascular permeability, and accordingly, the long-term preservation of hyperemia and edema of the gum mucosa;

- the presence of a long period of preservation of hyperemia and edema of the gingival mucosa leads to sustained pathogenicity (aggressiveness) of microflora, thereby reducing the stimulation of general and local factors of immune defense;

- the need for continuous tissue installations complicates the procedure for its use, requires a high consumption of therapeutic agent;

- conducting procedures every other day contributes to the long term of obtaining a positive effect of normalizing indicators of local immunity of the oral cavity and long periods of regeneration.

The closest analogue is known - the prototype by applying on the mucous membrane of the gums and turunda in the periodontal pockets of "Hyaludent" No. 2 for 15 minutes once a day; laser therapy with the Optodan device on the upper and lower jaw, for three minutes, the course depends on the stage of the inflammatory process in periodontal tissues (Bolatova L.Kh. Treatment of inflammatory periodontal diseases with preparations based on the hyaluronic acid of the Hyaludent group: author. Candidate of Medical Sciences / L.F. Bolatova, Stavropol, 2010, 24 pp.).

However, the disadvantages of the prototype are:

- the use of turundum with the use of the "Hyaludent" gel gives ineffective absorption of the drug into the periodontal pockets, ineffective absorption of the periodontal pocket by the drug, gives a low therapeutic effect in the treatment of chronic pathological processes with severe exudative phenomena - tissue edema;

- the use of turundum with "Hyaludent" gel and laser exposure does not fully render the immunocorrecting and immunomodulating effect of the local protective mechanisms of periodontal tissues, which contributes to the development of poly microflora, its long-term persistence, reduction of reparative processes and an increase in the frequency of relapse of periodontal diseases;

- when lengthening the regeneration period, the risk of irreversible processes increases, economic costs increase, which are associated with the search for stronger and more effective medicines;

- when using turund with a medicinal product, there is a possibility of the presence of cotton fiber residues (cotton turundas), which contributes to the maintenance of the infectious and inflammatory process.

The present invention is aimed at enhancing the protective and adaptive pathogenetic mechanisms of correcting immune disorders in periodontal tissues with the subsequent achievement of a quick regeneration period of 8 days.

The specified technical result is achieved by the fact that 1 ml of Hyaludent gel is mixed on a glass slide with 0.0005 mg Betaleikin dissolved in 1 ml of water for injection, then the obtained contents are applied to a treated area of the affected periodontal tissues isolated from saliva and left until it is completely absorbed for 1-3 minutes, followed by laser therapy using the Optodan laser semiconductor dental therapeutic apparatus with a periodontal nozzle , regimen II, with an exposure of 3-5 minutes, a course of treatment for 8 days daily. The proposed method for the treatment of periodontal disease is highly effective and pathogenetically substantiated. It allows you to quickly get a pronounced therapeutic effect and speed up the healing process (for 3-8 visits), eliminate inflammation (especially with its exacerbation), already on the 3rd day there is a decrease in edema and bleeding.

In the inventive method, a “Hyaludent” gel is used, acts as a binder with a high water holding capacity - 1 molecule of hyaluronic acid binds 200-300 water molecules. Due to its physicochemical properties, such as high viscosity, specific ability to bind water and proteins and form proteoglycan aggregates, hyaluronic acid contributes to the manifestation of numerous functions of connective tissue. Hyaluronic acid affects the permeability of tissues and the transfer of other drugs. The role of hyaluronic acid is invaluable not only as an independent drug, but also as a means of transferring other therapeutic substances to damaged tissues, as well as their ability to control release. Hyaluronic acid creates a depot preparation at the place of application and, gradually collapsing, releases the drug, improving its pharmacological profile and preventing the development of possible adverse reactions. The mechanism of action is to bind 1 ml of “Hyaludent” gel mixed with Betaleikin 0.0005 mg soluble in 1 ml of water for injection and transport it to the tissue, followed by a prolonged release of the active substance. The drug "Betaleikin" is a dosage form of recombinant human interleukin-1 beta, obtained by genetic engineering technology. As a stabilizer, the drug contains polyvinylpyrrolidone-medical, low molecular weight. The drug is a porous mass or white powder. Due to the wide range of biological activity of interleukin-1 beta, it is one of the main mediators of the development of protective reactions of the body. "Betaleikin" has a hemostimulating and immunostimulating effect. The immunostimulating effect of the drug is realized by increasing the functional activity of neutrophilic granulocytes, inducing differentiation of immunocompetent cell precursors, enhancing lymphocyte proliferation, activating cytokine production and increasing antibody formation. The main indications for the use of Betaleikin as an immunostimulant are secondary immunodeficiency states that develop after severe injuries, extensive surgical interventions, as a result of purulent-septic and purulent-destructive processes, as well as in chronic septic conditions. After applying the Betaleikin gel form, laser therapy is performed using the Optodan laser semiconductor dental therapeutic apparatus (ALST-01) with a periodontal nozzle, which has an anti-inflammatory effect, normalizes vascular microcirculation and reparative processes in tissues, and normalizes the rheological properties of blood and not accompanied by allergic reactions. The bactericidal and bacteriostatic effect is inherent in laser beams, which is especially valuable from the standpoint of the unconditional etiological and pathogenetic role of the microbial factor in the development of inflammatory periodontal diseases.

The proposed method is tested in GBUZ JSC "City Clinical Hospital No. 3" named. CM. Kirova, State Budgetary Institution of Healthcare of the Astrakhan Region “Children's City Clinical Hospital No. 2” and GBOU VPO AGMA of the Ministry of Health of Russia at the Department of Therapeutic Dentistry for 100 patients during 2012-2014, age of patients 18-60 years old with diagnoses: chronic catarrhal gingivitis, chronic hypertrophic gingivitis, chronic generalized periodontitis of mild to moderate severity.

When handling patients complained of bleeding gums during brushing, unpleasant aftertaste in the mouth and smell, itching of the gums. Great importance was attached to the collection of anamnesis, the identification of errors in individual oral hygiene. During the examination, the state of the oral mucosa, oncological alertness, occlusion were assessed, tooth KPI indices, the simplified Green-Vermilion oral hygiene index (OHI-S), the papillary-marginal-alveolar index (PMA) in the Parma modification, and the level of inflammatory changes in periodontal disease using the Russell periodontal PI index, papillary hemorrhage index (PBI) (Muhlemann). Inspection with the definition of these indices was carried out at 1, 8 and 40 days from the start of treatment. X-ray research methods included an orthopantomogram and targeted radiography. Immunological examination included determination of the content of IL-β, IL-4, IL-6, IL-8 in the gingival fluid. The study was carried out by the method of enzyme-linked immunosorbent assay, using commercial enzyme-linked immunosorbent kits LLC "Cytokine" (St. Petersburg). All patients were divided into two groups. In one group (main), the claimed method of treatment was used, in another (control), treatment was carried out according to the standard scheme: for chronic catarrhal and hypertrophic gingivitis, dental plaque was removed, followed by a rinse with a 0.05% solution of chlorhexidine bigluconate and applications on the affected tissue periodontal "Holisal-gel" or "Metrogil-denta" film "Diplen-denta" with metronidazole. In chronic generalized periodontitis of mild to moderate severity, after removal of dental deposits, an antiseptic was rinsed with further dressings (Dikloran, Cholisal, Arthrodont paste) and systemic vitamin therapy.

The results of the examination of patients with periodontal diseases before treatment (see table. No. 1);

The results of the examination of patients with periodontal diseases on the 8th day of treatment (see table. No. 2);

The results of the examination of patients with periodontal diseases on the 40th day of treatment (see table. No. 3);

The level of cytokines in the gingival fluid in patients with periodontal lesions (pg / ml) (see table. No. 4);

According to the results, it can be argued, in contrast to the standard regimen, where, with therapy, it was possible to achieve control over the course of chronic generalized periodontitis of mild to moderate severity, then transfer the process to the remission stage, in the main group, the use of the Betaleikin gel form made it possible to achieve Intact periodontal conditions in most patients.

Thus, during the study, it was found that a decrease in clinical criteria reflecting the ecosystem of the oral cavity, the level of cytokines was observed in both groups on days 8 and 40. At the same time, the use of the Betaleukin gel form in treatment led to a more dynamic change in indices reflecting the state of periodontal tissues and indicators of the interleukin ensemble. This allowed to stabilize the process in most patients, to prevent the transition to aggressive periodontal inflammation due to the reversibility of the inflammatory process. Below are the results of testing.

Clinical example No. 1

Patient B., 27 years old. Diagnosis: chronic hypertrophic gingivitis. The diagnosis was made on the basis of the data of clinical examination methods (examination, the condition of the oral mucosa, oncological alertness, occlusion were assessed, tooth CPI indices, the simplified Green-Vermilion oral hygiene index (OHI-S), papillary-marginal-alveolar index ( PMA) in the modification of Parma, the level of inflammatory and destructive changes in the periodontium - using the periodontal PI index according to Russell, the papillary hemorrhage index (PBI) (Muhlemarm)), radiological methods of investigation (orthopa tomogram, aiming radiography) and immunological examination (determination of IL-1β, IL-4, IL-6, IL-8 in gingival crevicular fluid).

The treatment was carried out with the removal of dental plaque, followed by a rinse with a 0.05% solution of chlorhexidine bigluconate and applications on the affected periodontal tissues “Metrogil denta”, a film “Diplen-dent” with metronidazole, followed by laser therapy of the laser semiconductor dental therapeutic apparatus “Optodan »With a periodontal nozzle, mode II, with an exposure of 1 minute, daily, treatment for 8 days.

Result: on the 8th day of treatment, a mild inflammatory process was noted, an increase in the tone of weakened blood capillaries, which contributed to a decrease in bleeding and regeneration of periodontal tissues. Despite the treatment, the content of cytokines in the gingival fluid varies slightly, which is associated with persistent inflammation. On the 40th day of the follow-up, according to the result, it was possible to achieve control over the course of the disease and put the process in remission.

Clinical example No. 2

Patient B., 35 years old. Diagnosis: chronic hypertrophic gingivitis. The diagnosis was made on the basis of the data of clinical examination methods (examination, the condition of the oral mucosa, oncological alertness, occlusion were assessed, tooth CPI indices, the simplified Green-Vermilion oral hygiene index (OHI-S), papillary-marginal-alveolar index ( PMA) in the modification of Parma, the level of inflammatory and destructive changes in the periodontium - using the periodontal PI index according to Russell, the papillary hemorrhage index (PBI) (Muhlemann), X-ray methods (orthopan omogrammu, aiming radiography) and immunological examination (determination of IL-1β, IL-4, IL-6, IL-8 in gingival crevicular fluid).

The treatment was carried out according to the claimed method, namely, 1 ml of “Hyaludent” gel was mixed on a glass slide with 0.0005 mg “Betaleikin” dissolved in 1 ml of water for injection, then the resulting contents were applied to a treated area of affected tissues with a disposable application syringe periodontal and left until it is completely absorbed for 1 minute, followed by laser therapy using a laser semiconductor dental therapeutic apparatus "Optodan" with a periodontal nozzle, re Imam II, p 3 minutes exposure, treatment for 8 days on a daily basis.

Result: on the 8th day of treatment, the dynamics of the disease improved markedly, the gum condition stabilized, the mucosa acquired a pale pink color, the interdental gingival papillae were pointed, the bleeding stopped. On the 40th day of the follow-up, when using the Betaleikin gel form, on the basis of the results obtained, it was possible to achieve an intact periodontal condition.

Clinical example No. 3

Patient U., 31 years old. Diagnosis: chronic hypertrophic gingivitis. The diagnosis was made on the basis of the data of clinical examination methods (examination, the condition of the oral mucosa, oncological alertness, occlusion were assessed, tooth CPI indices, the simplified Green-Vermilion oral hygiene index (OHI-S), papillary-marginal-alveolar index ( PMA) in the modification of Parma, the level of inflammatory and destructive changes in the periodontium - using the periodontal PI index according to Russell, the papillary hemorrhage index (PBI) (Muhlemann)), X-ray methods (orthopa) ntomogram, targeted radiography) and immunological examination (determination of the content of IL-1β, IL-4, IL-6, IL-8 in the gingival fluid).

The treatment was carried out according to the claimed method, namely, 1 ml of “Hyaludent” gel was mixed on a glass slide with 0.0005 mg “Betaleikin” dissolved in 1 ml of water for injection, then the resulting contents were applied to a treated area of affected tissues with a disposable application syringe periodontal and left until it is completely absorbed for 3 minutes, followed by

laser therapy using the Optodan laser semiconductor dental therapeutic apparatus with a periodontal nozzle, mode II, with an exposure of 5 minutes, a course of treatment for 8 days daily.

Result: on the 8th day of treatment, the dynamics of the disease improved markedly, the gum condition stabilized, the mucosa acquired a pale pink color, the interdental gingival papillae were pointed, the bleeding stopped. On the 40th day of the follow-up, when using the Betaleikin gel form, on the basis of the results obtained, it was possible to achieve an intact periodontal condition.

The proposed method is achieved: -enhancing protective and adaptive pathogenetic mechanisms that correct immune disorders in periodontal tissues;

- Betaleukin gel form has high fluidity, therefore it completely fills periodontal pockets or other part of the oral mucosa, which contributes to the prolonged effect on periodontal tissues and the convenience of its application with a disposable application syringe;

- acceleration of the regeneration period within 3-8 days, depending on the nosological form of the disease;

- quick control over the course of the disease, which allows to achieve a state of intact periodontal disease in most patients; -exposure to laser therapy using the Optodan laser semiconductor dental therapeutic apparatus with a periodontal nozzle, which has an anti-inflammatory effect, bactericidal and bacteriostatic effect, normalizing vascular microcirculation, tissue repair processes and blood rheological properties;

- the effectiveness of the treatment of periodontal diseases, allows to reduce economic costs during the follow-up of a patient in dental institutions;

- improving the quality of life of the patient in a social society.

Indicators are presented in medians.

∗ significance of differences with the control group p <0.05;

∗∗ significance of differences with the control group p <0.01.

Claims (1)

A method of treating periodontal diseases by local administration of drugs and laser exposure, characterized in that 1 ml of Hyaludent gel is mixed on a glass slide with 0.0005 mg Betaleikin dissolved in 1 ml of water for injection, then the contents are obtained with a disposable syringe applied to the treated area isolated from saliva of the affected periodontal tissues and left until it is completely absorbed for 1-3 minutes, followed by laser therapy using laser semiconductor st of the Optodan therapeutic unit with a periodontal nozzle, mode II, with an exposure of 3-5 minutes, a course of treatment for 8 days daily.