RU2693678C1 - Method of treating chronic generalized periodontitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to dentistry, and can be used for treating chronic generalized periodontitis. For this purpose patient is removed with ultrasound apparatus solid and soft dental deposits, with subsequent polishing of teeth. Periodontal pockets are washed with diluted 1:2,000 Vagothyl solution. Marker "HELBO BLUE Photosensitaiser" is placed on the affected periodontal pocket for 1–3 minutes. Then liquid is washed from periodontal pockets and exposed to therapeutic diode laser "HELBO" 2075 F/Theralite" with wave length 670–690 nm and power density 75 mWt/cm² for 1–2 minutes. After the laser exposure on the affected periodontium, a gingival dressing is applied for 20 minutes from a mixture of substances kneaded by a spatula on a glass ex tempore for 1–2 minutes to a consistence of thick sour cream consisting of 2 g of acetylsalicylic ointment, 2 g of Argosulfan ointment, 2 g oflomelid ointment, 2 g of aqueous dentine, 2 g of zinc oxide, and one tablet of trichopol pre-ground.

EFFECT: method provides high therapeutic effect and prolonged remission, reduced treatment period.

1 cl

Description

The invention relates to medicine, namely to dentistry and can be used for the local treatment of inflammatory periodontal diseases.

There is a method of treatment of periodontitis (Textbook of Barer GM, Lemetskaya T. I. "Periodontal diseases. Clinic, diagnosis and treatment", M .: VUNMTS, 1996), providing, firstly, preliminary therapeutic measures: treatment caries and its complications, replacement of fillings with overhanging edges, restoration of contact points. Then proceed to the removal of dental deposits, removal of plaque, careful oral hygiene, washing of pockets with various solutions (chlordixidine, trichopol, trypsin, chemotrypsin, etc.), scraping of periodontal pockets - curettage according to the technique N.I. Znamensky.

Provided that the patient does not have separate teeth, an orthopedic treatment is carried out. The surgical treatment is completed with antiseptic treatment of the gums, prescription of multivitamins, salicylates, suprastin, physiotherapy, depending on the indications.

The disadvantages of the method include the complexity of the implementation of the full range of treatment, long-term use of various medicines that can cause adverse reactions, for example, dysbiosis, trauma, due to surgical intervention. Often, treatment requires physiotherapy due to the presence of inflammatory processes after surgery.

There is a method of treatment of periodontitis, characterized in that they carry out three-stage laser irradiation in therapeutic dosages, surgical treatment. Additionally, prior to laser therapy, medicinal application is performed. In this case, at the first stage, cholisal gel is introduced into the pockets, and periodontal pockets with a size of 4 mm and more are irradiated through a thin disposable light guide, and a lesser depth from the vestibular and oral surface of the alveolar process, for 5-7 days, the total time of one session 12-20 minutes. At the second stage, during the patchwork operation, a mixture of cholisal gels and pantovegin gels is applied in a 1: 1 ratio on the folded flap and irradiated with a laser for 3-7 minutes. At the third stage, the vasoactive gel is applied to the region of the alveolar process of the upper and lower jaw, to the interdental spaces, and to the exit points of the trigeminal nerve. Laser irradiation in therapeutic dosages is carried out on the same areas, the number of procedures from 5 to 7, the total time of one session is 12-20 minutes [patent RU 2241507, 2004].

The disadvantage of this method of treatment of periodontitis, is that in addition to therapeutic treatment there is a surgical intervention in the form of a patchwork operation.

It is known the use of a new bacterial biopreparation "Azilakt" in the complex treatment of periodontal disease (MM Pozharitskaya, LV Morozova, GM Melnychuk, SS Melnichuk, 1994).

Eubiotic "Acilact" is a complex of live lyophilized lactobacilli of the acidflux type, with high activity against a number of conditionally pathogenic microorganisms. "Acilact" in the form of a suspension in an isotonic solution of sodium chloride is introduced into the periodontal pockets.

When applying this method of treatment, it is possible to select multiple resistant variants of pathogens that contribute to the generalization of the process in the periodontal teeth.

However, it is impossible to accurately dose the drug due to the imperfect route of administration. In addition, there is a diffusion of the drug not only in the periodontal teeth, but also in the oral cavity, thus reducing its concentration and, consequently, the therapeutic effect.

The closest in technical essence to the claimed solution is a method for the treatment of inflammatory periodontal diseases using an antibacterial photodynamic system. It includes a therapeutic diode laser "HELBO" 2075 F / Theralite "with a wavelength of 670-690 nm and an energy density of 75 mW / cm ² , a special liquid (marker) of the photosensitase -" HELBO BLUE Photosensitaiser "(Aleksandrov MT, Prikulis V.F., Bogdanov V.Yu. “Determination of the antimicrobial activity of drugs used in the complex treatment of patients with periodontitis”, Dentistry 2009 No. 2, pp. 13-15).

The method of treatment is as follows.

Periodontal pockets are treated with photosensitase for 2-3 minutes, depending on their depth. Photosensitase after the exposure time is thoroughly washed off with water, after which they produce a laser light on the affected area for 1-2 minutes. After applying photosensitization to periodontal tissues, the cell membranes of periodontal pathogenic and other microorganisms, dystrophically altered epithelial cells, are stained, followed by sensitization of cells to the monochromatic light of a therapeutic diode laser. The monochromatic laser light initiates the emergence of a chemical reaction leading to the release of free atomic oxygen and peroxide radicals, which is accompanied by the destruction of microorganisms and dystrophically altered cells. Exposure of periodontal tissue with light of a therapeutic laser improves metabolic processes, reduces tissue hypoxia

However, as a result of exposure to this laser system, the resulting oxidative stress is not adjustable and is accompanied by a short remission period, i.e. requires frequent repeated procedures.

The method does not provide for the isolation of periodontal tissues from saliva, microorganisms and food residues, which leads to a relapse of the disease.

The task is to develop an effective method of treating chronic generalized periodontitis.

The task is achieved by conducting a hygiene lesson followed by professional cleaning, washing the periodontal pockets with a vagil solution diluted 1: 2000, exposing the affected area of the periodontal pocket with a therapeutic diode laser “HELBO” 2075 F / Theralite ”with photosensitase“ HELBO Blue Photosensitiser ”, and further imposing on his gingival dressing.

The method is as follows.

The patient is given a lesson in oral hygiene, removing hard and soft dental deposits with an ultrasound machine, followed by polishing the teeth. The periodontal pockets are washed with a vagil diluted 1: 2000 solution and the photosensitase marker HELBO Blue Photosensitiser is applied to the affected area of the periodontal pocket for 1-3 minutes. Next, the fluid is carefully washed out of the periodontal pockets and have an impact with the therapeutic diode laser HELBO 2075 F / Theralite with a wavelength of 670-690 nm and an energy density of 75 mW / cm ² for 1-2 minutes. After laser exposure to the affected area of the periodontal gingival bandage is applied for 20 minutes.

A gum bandage consists of a mixture of substances, mixed with a spatula on an ex tempore glass slide, for 1-2 minutes to a consistency of thick sour cream consisting of 2 gr. acetylsalicylic ointment, 2 gr. Argosulfan ointment, 2 gr. ophthalmicide ointment, 2 gr. water dentin, 2 gr. zinc oxide, and one tablet of Trykhopol, previously crushed.

Acetylsalicylic ointment is a nonsteroidal anti-inflammatory drug that has antiseptic, keratolytic and anti-inflammatory effects. The antiseptic effect of acetylsalicylic ointment causes the destruction of pathogenic microorganisms and, as a result, the relief of inflammatory processes occurring in the mucous membrane of the periodontal pocket. The anti-inflammatory effect of acetylsalicylic ointment is the relief of the inflammatory process, the reduction of its severity and the prevention of spread to neighboring tissues. Keratolytic effect - promote lysis of granulation tissue and microbial cells.

Ointment Argosulfan is an antibacterial drug for topical use, which promotes the healing of burn, trophic, purulent wounds, protects the wound surface from infection, reduces the time of treatment. In addition, the drug has an analgesic effect, significantly reduces pain and the intensity of the inflammatory process. Its preparation, silver sulfothiazole, is an antimicrobial, bacteriostatic agent. The silver ions present in the preparation inhibit the growth and division of bacteria by binding to the deoxyribonucleic acid of the microbial cell. Silver ions also weaken the sensitizing properties of sulfanilamide, and minimal resorption of the drug does not have a toxic effect. Silver sulfothiazole contained in the preparation has a low solubility, as a result of which, after topical administration, the concentration of the active substance in the wound is maintained at the same level for a long time and only a small amount of silver sulfothiazole is in the bloodstream.

Trichopolum is a synthetic agent with antimicrobial and antiprotozoal effects. The active ingredient of Trichopolum is metronidazole, which has an effect on bacteria due to the biochemical reduction of the 5-nitro group by intracellular transport proteins of the simplest and anaerobic microorganisms. The restored 5-nitro group, interacting with the deoxyribonucleic acid of the body's cells, inhibits synthesis from nucleic acids and destroys bacteria.

Ophthalmicolide, a multicomponent preparation consisting of ofloxacin, methyluracil and lidocaine, has an antimicrobial, anti-inflammatory, local anesthetic, regenerating effect. - ofloxacin - has an antimicrobial effect from the group of fluoroquinolones, has a bactericidal effect due to the blockade of DNA in bacterial cells, is highly active against gram-positive microorganisms, gram-negative microorganisms, intracellular microorganisms;

- methyluracil - stimulator of tissue repair, has anabolic activity, accelerates the processes of cell regeneration in wounds, growth and granulation tissue maturation, and epithelialization;

- lidocaine has a local anesthetic effect due to the blockade of sodium channels, which prevents the generation of impulses in the terminations of sensitive neurons and the conduction of impulses along the nerve fibers, when used externally, it dilates the vessels and does not have a local irritating effect.

Zinc oxide white powder, without taste and odorless, is used for elasticity of the dressing.

Aqueous dentin is added to accelerate the curing of the gingival dressing in the oral cavity and to ensure the isolation of periodontal pockets from saliva.

A gum bandage is applied to the affected area with a spatula. The curing time of the dressing in the mouth is 3-4 minutes. Due to the dense coverage of the teeth and the alveolar process with a gingival dressing, the medicinal substances contained in the dressing are maximally protected from diffuse erosion by the oral contents and, thus, conditions are created for the formation of the drug “depot” and its deep penetration into the tissues. The optimal ratio of medicinal substances in the gingival dressing, in combination with the exposure of the light to the therapeutic laser, allows to achieve a high therapeutic effect and shorten the period of treatment of inflammatory periodontal diseases.

The effectiveness of the proposed method is confirmed by examples of specific performance.

The study was conducted in 15 patients with chronic generalized periodontitis. Patients were divided into 2 groups, aged 18 to 30 years. The main group - 8 people and the control group - 7 people.

All patients were interviewed, the collection of complaints, anamnesis of life and history of the disease. A lesson in oral hygiene, professional teeth cleaning.

The control group received Helbo Blue (photosensitase) liquid for 1-3 minutes in periodontal pockets, then the liquid was thoroughly washed out of the periodontal pockets and exposed to them with a monochromatic light of a therapeutic laser Helbo with a wavelength of 670-690 nm. and energy density of 75 mW / sq. cm for 1-2 minutes.

Patients of the main group were washed with periodontal pockets with a solution of vagotyl diluted 1: 2000 and infused with a liquid - Helbo Blue marker (photosensitase) for 1-3 minutes. Then the liquid was washed off and affected the affected area of the periodontal pocket with a therapeutic diode laser "HELBO". After laser exposure, a gingival bandage consisting of a mixture of substances mixed with a spatula on an ex tempore slide was applied to the affected area of the parodont for 1-2 minutes until the consistency of thick sour cream consisting of 2 oz. acetylsalicylic ointment, 2 gr. Ointment Argosulfan, 2 gr. ophthalmicide ointment, 2 gr. water dentin, 2 gr. zinc oxide, and one tablet of Trykhopol, previously crushed.

In patients of the control group, the relief of acute inflammatory processes was observed by 5-7 visits. Soreness, swelling and bleeding of the gums also gradually decreased. By the 15th day of clinical observation in patients of this group, the period of treatment was uneventful. However, more than half of the patients in this group showed signs of pathological changes characteristic of periodontitis: the mucous membrane of the cervical area of the teeth was partially hyperemic, sometimes bleeding, the gingival papillae were not always completely formed. The density of adherence of the mucosa to the hard tissues of the teeth was observed in less than half of the patients.

Periodontal indices decreased. The Schiller-Pisarev test was weakly positive in 2 patients, the Parma test was negative in all patients.

After 3 and 6 months after the course of treatment, the patients in the control group continued to complain of gingival bleeding during brushing and when taking solid food. An objective examination of the oral cavity in these patients showed initial signs of an inflammatory process. Indicators of periodontal indices had clinical dynamics, the Schiller-Pisarev test and the Parma test were slightly positive.

As a result of the treatment, positive dynamics was obtained in the patients of the main group. The relief of acute inflammatory processes in patients of the main group was observed at 2-3 visits. Patients noted a decrease in edema, bleeding gums, pain, no bad breath. Decreased sensitivity to temperature and chemical irritants. By the 7th day of clinical observation in patients of this group, the treatment period was uneventful. Signs of pathology of the mucous membrane of the periodontal pocket and gums were not found, they had a natural color, relief, shape, and palpation was painless. When sensing the gums in the cervical area, the gums tightly adhered to the hard tissues of the teeth.

Indicators of periodontal indices decreased and corresponded to normal average indicators. Schiller-Pisarev and Parma samples were negative in all patients in this group.

After 3 and 6 months after the complex treatment was performed, no signs of chronic inflammation were found in the patients of the main group. They did not show complaints, the mucous membrane of the gums had a pale pink color, its palpation was painless, the relief of the gingival margin was fully restored, it was tight to the dental tissues in the cervical area and interdental spaces. The clinical improvement of the periodontal tissues was confirmed by the positive dynamics of changes in the clinical indices of PMA and PI. Samples of Schiller-Pisarev, Parma were negative in all patients of this group.

The use of the proposed method of treatment of chronic generalized periodontitis can reduce the period of treatment of inflammatory periodontal diseases and achieve a high therapeutic effect and long-term remission.

Claims (1)

The method of treatment of chronic generalized periodontitis, including the use of therapeutic diode laser "HELBO" 2075 F / Theralite ", photosensitase" HELBO BLUE Photosensitaiser ", characterized in that the patient is removed with an ultrasound machine with hard and soft dental deposits, followed by polishing the teeth, washed with pockets of the solution vagilum, diluted 1: 2000, and the photosensitase marker “HELBO BLUE Photosensitaiser” is applied to the affected area of the periodontal pocket for 1-3 minutes, then wash off the liquid from the periodontal pockets and exert The effect of a therapeutic diode laser “HELBO” 2075 F / Theralite with a wavelength of 670-690 nm and an energy density of 75 mW / cm ² is applied for 1-2 minutes, and after laser exposure to the affected periodontal area, a gingival bandage is applied for 20 minutes mixtures of substances, mixed with a spatula on an ex tempore slide, for 1-2 minutes to the consistency of thick cream, consisting of 2 g of acetylsalicylic ointment, 2 g of Argosulfan ointment, 2 g of olomeloid ointment, 2 g of aqueous dentin, 2 g of zinc oxide, and one tablet of trichopol, pre-crushed.