RU2751810C1 - Method for treatment of chronic periodontitis - Google Patents

Abstract

FIELD: dentistry.SUBSTANCE: invention relates to medicine and concerns a method for the treatment of chronic periodontitis, in which an oil solution based on the biologically active additive “Yagel” is entered directly into the pathological periodontal pocket and an individually made dental mouth guard filled with an oil solution is additionally applied and fixed in the oral cavity, while the daily procedure includes a one-time administration and application of the solution, the course of treatment is 7-10 procedures, where the drug additionally contains birch bark extract “Betulin”, at the same time, the ratio of components is, weight percentage: biologically active additive “Yagel”, dry residue 66-70; birch bark extract “Betulin” 15-17; linseed oil 15-17.EFFECT: invention provides an increase in the effectiveness of the treatment of chronic localized and generalized periodontitis.1 cl, 10 dwg, 3 tbl, 1 ex

Description

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

A known method of treating periodontitis (see Bezrukova I.V. New methods of treating inflammatory periodontal diseases // New in dentistry. 2001. No. 4. P.55-57), providing for the local use of medical ozone in the form of ozonized physiological isotonic solution and olive oil performed after professional oral hygiene and curettage. Ozonation of solutions is carried out on the "Kvazar" ozonizer. Patients with inflammatory and destructive processes in the periodontal tissues are prescribed rinsing the mouth once a day (250 ml of solution for 2 minutes) and the periodontal pockets are washed from a syringe for 5-10 minutes using an ozonated saline solution with a high concentration of ozone in the mixture - 4000 mcg / l. The course is 8-10 visits. As the inflammatory reaction and suppuration from periodontal pockets decrease and curettage is carried out, rinses are prescribed daily for 3-5 days with an ozonated saline solution with a lower ozone concentration of 1500 μg / l, as well as the application of ozonized olive oil (ozone concentration 3500-4000 μg / l) 10 ml for each jaw for 30 minutes.

The disadvantages of this method include the complexity of the complex therapy of inflammatory periodontal diseases, in addition, to obtain a metered ozonized mixture of saline and olive oil requires the presence of special expensive medical equipment (ozonator "Kvazar").

A known method of treating periodontitis with a drug - essential oil of wormwood (Artemisia glance Pall. Ex. Wilid), obtained by distillation with water vapor of the aerial part of the plant (see RU No. 2104019, CL A61K 35/78, publ. 10.02.1998), while the essential oil is obtained from the ground part of the wormwood by the method of distillation with steam in a special distillation apparatus, which was supplied with live steam. The resulting mixture of essential oil and water vapors is taken to a special refrigerator, in which the vapors condense. Further, the distillate enters the oil separator receiver, where it settles and separates into essential oil and distilled water. The study of the effectiveness of essential oil of wormwood in the treatment of periodontal diseases was carried out in acute purulent periodontitis and periodontitis in the acute stage. For periodontitis, the oil was used topically in the form of dressings on the gums. Evaluation of the effectiveness of the test oil was carried out taking into account the reduction of pain and edema.

The disadvantage of this method is that the absence of an official (finished) form of this drug and the technological complexity of manufacturing requires a large amount of equipment, which is associated with considerable labor costs for production. In addition, the presence of monoterinoids (35%), sequiterpenoids (10%), aromatic terpenoids (4%) and diacetylene compounds (30%) in the essential oil can contribute to the occurrence of various toxic and allergic reactions.

According to another method of treating periodontitis (see RU No. 2143258, cl. A61K 6/00, publ. 12/27/1999), Viferon is introduced into the periodontium, previously introduced into an individual mouthguard, while Viferon is dosed according to therapeutic indications.

At the same time, the drug "Viferon" does not have a direct antimicrobial and bacteriostatic effect in relation to periodontal pathogenic microflora. Thus, the known solution does not directly affect the microflora of the pathological periodontal pocket, which is the main etiological factor, but contributes to the immunomodulatory effect.

A known method for the treatment of chronic periodontitis, including the introduction of medicines (see RU No. 1708615, class A61K 6/00, A61K 31/07, A61K 36/09, A61P 1/02, publ. 10.12.2019), while as a medicinal the drug uses an oil solution based on the biologically active additive "Yagel", obtained by mixing the components with the following composition, in mass. %: biologically active additive "Yagel", dry residue - 65-66, oil solution of vitamin "A" - 34-35, for which, the prepared solution is injected directly into the pathological periodontal pocket and additionally applied by filling with a solution and fixing for 25- 30 minutes in the oral cavity of an individually made dental aligner, while the daily procedure includes a one-time application and application of the solution, the course of treatment is 7-10 procedures, and for prevention, the course is repeated 3-4 times a year with an interval of 2-3 months according to indications ...

The drug has only antimicrobial effect and its use in inflammatory and destructive processes of periodontal tissues is ineffective, since there is no anti-inflammatory effect.

At the same time, as an onlay device, a technical solution is known for a bjaw splint (see RU No. 87905, class A61C 5/00, publ. dental arch of the patient.

The problem to be solved by the claimed invention is expressed in a pronounced reverse development of the inflammatory-destructive process of periodontal tissues with the disappearance of symptoms of bleeding and swelling of the gums in patients with chronic periodontitis.

The technical effect obtained when solving the problem is expressed in obtaining a method for the treatment of chronic periodontitis in patients with external application of an oil solution based on a biologically active additive "Yagel" from an extract of lichen thallus of the genus Cladonia, containing usnic acid, which has an antibiotic effect, and an extract birch bark "Betulin", which has anti-inflammatory and antiviral effects.

To solve this problem, a method of treating periodontitis with the use of an oil solution based on a biologically active additive "Yagel" with an extract of birch bark "Betulin" is built taking into account the assessment of the prevalence of periodontitis, the use of a method for increasing the effectiveness of treatment of inflammatory processes in periodontal tissues and includes daily or every other day administration oil solution into the pathological periodontal pocket. In this case, the drug is obtained by mixing the components in the composition, wt. %: biologically active additive "Yagel", dry residue - 66-70; birch bark extract "Betulin" - 15-17; linseed oil - 15-17. A single procedure includes no more than one injection of an oil solution per day using a disposable syringe through a disposable cannula into a pre-isolated pathological periodontal pocket and additionally applied by filling with a solution and fixing for 25-30 minutes in the oral cavity of an individually made dental aligner, which is fixed on the upper and / or lower jaws, where its edges overlap not only the dentition, but also the entire mucous membrane of the alveolar processes, and this, in turn, contributes to a longer therapeutic effect of this agent in relation to periodontal pathogenic microorganisms of the pathological periodontal pocket. At the same time, the daily procedure includes a one-time application and application of the solution, the course of treatment is 7-10 procedures, where, after the inflammatory process of the periodontal tissues subsides, the patients undergo surgical methods of treatment according to indications, which include open curettage or patchwork operations. At the end of the procedure, recommendations for oral hygiene are given. For prevention purposes, the course is repeated 3-4 times a year with an interval of 2-3 months according to indications.

Comparative analysis of the features of the claimed solution with known features indicates the compliance of the declared solution with the "novelty" criterion.

The features of the distinctive part of the claims provide an increase in the effectiveness of the treatment of chronic periodontitis due to antibiotic and anti-inflammatory actions.

Increasing the effectiveness of the treatment of periodontitis using oil solution "Yagel" with birch bark extract "Betulin" and manufactured individual dental mouthguards is achieved by providing a longer antimicrobial and anti-inflammatory effect in the pathological periodontal pocket, which contributes to the reverse development of the inflammatory and destructive process of periodontal tissues. In addition, the claimed method of treatment is simple to carry out and does not require special experience for use, which is important for patients and novice doctors.

The claimed technical solution is illustrated by the drawings, where figure 1 shows the stages of manufacturing an individual dental aligner; figure 2 - ready-made individual dental aligners covering the mucous membrane of the alveolar process from the vestibular and oral sides of the upper and lower jaws; figure 3 - the components of the oil solution "Yagel" with the extract of birch bark "Betulin" before combining; figure 4 - ready-made oil solution "Yagel" with extract of birch bark "Betulin"; figure 5 - a ready-made oil solution according to the declared solution in a disposable syringe with a cannula for introduction into a pathological periodontal pocket; figure 6 - the management of the oil solution according to the declared solution in the pathological periodontal pocket; Figure 7 shows a filled individual dental aligner; figure 8 - introduction and fixation of an individual dental aligner in the oral cavity; figure 9 - chronic generalized periodontitis of mild severity before treatment; figure 10 - the state of periodontal tissues after the course of treatment with the oil solution "Yagel" with the extract of birch bark "Betulin".

A method of treating chronic periodontitis using an oil solution "Yagel" with an extract of birch bark "Betulin" consists of successive measures. At the initial stage of treatment, a preliminary safety briefing is organized. At the same time, in order to increase the effectiveness of the antibiotic and anti-inflammatory effect of the oil solution "Yagel" with the extract of birch bark "Betulin" in relation to periodontal pathogenic microorganisms and the intensity of the inflammatory process of periodontal tissues in the contingent, a controlled cleaning is carried out based on the removal of tooth and subgingival deposits, instructions on the choice of means oral hygiene, as well as the method of brushing teeth.

Simultaneously, impressions are taken from the patient and an individual dental aligner is made on the basis of silicone materials (see Fig. 1, 2).

Preparation of oil solution "Yagel" with extract of birch bark "Betulin" is carried out by mixing the dry residue "Yagel", extract of birch bark "Betulin" (certificate of state registration RU.77.99.88.003. E.005494.12.17 dated 21.12.2017) (see Fig. 3, 4) and linseed oil (certificate of state registration RU.77.99.11.003.Е.000497.02.19 dated 02/08/2019) to obtain a thick creamy consistency, with the following percentage ratio (wt.%):

dry residue of dietary supplement "Yagel" 66-70 birch bark extract "Betulin" 15-17 linseed oil 15-17

The biologically active additive "Yagel" was developed at the Institute for Biological Problems of Cryolithozone of the Siberian Branch of the Russian Academy of Sciences (Yakutsk) and has a certificate of state registration of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare of the Russian Federation 77.99.23.3.U.3522.5.08 dated 05/04/2008; TU 9219-002-36971185-08; sanitary and epidemiological conclusion of the Federal Service for Supervision of Consumer Rights Protection and Human Wellbeing of the Russian Federation 77.99.03.003.T.000928.05.08 dated 04.05.2008; certificate of state registration in the customs union of the Republic of Belarus, the Republic of Kazakhstan and the Russian Federation RU.77.99.11.003.Е.051236.11.11 dated 17.11.2011; RF patent 2006100978 dated 01.08.2007.

The drug "Yagel" is obtained from the extract of lichen thallus of the genus Cladonia and is recommended for use as an additive in food as a detoxifier of the internal environment of the body (blood, lymph, intercellular fluids, cytoplasm of cells) from a wide range of endo- and exotoxins, as well as to reduce toxic, post-intoxication, narcotic effect of vodka products, without reducing their euphoric effect and as a corrector of metabolic disorders. At the same time, it normalizes blood sugar levels in patients with diabetes mellitus and cholesterol in patients suffering from atherosclerosis. In addition, it has a prophylactic effect against heart attacks and strokes, because exhibits antithrombin activity. Due to the high content in dietary supplements - derivatives of usnic and other lichen acids in the form of clathrate and lichen oligosaccharides, it has an antibiotic effect. "Yagel" contains: the main active substances - amino-oligosaccharides formed from amino-polysaccharides when treated with water in a carbon dioxide medium in a supercritical fluid state, in addition, a complex of antioxidant substances (orselinic, leknoric, griforic, chiastic acids and quinones; vitamin B12, folic acid); natural antibiotics - usnic acids and their derivatives (see table 1).

Further, in the medical institution, measures are carried out for the direct treatment of chronic periodontitis, for which, a pre-prepared oil solution "Yagel" with an extract of birch bark "Betulin" is introduced into the periodontal pocket, for example, using a syringe with a cannula, after which additional action of the drug is performed by means of individual dental aligners with an oil solution "Yagel" and an extract of birch bark "Betulin" by fixing them in the oral cavity for 25-30 minutes (see Fig. 5-8).

Thus, the course of treatment for chronic periodontitis is 7-10 daily and / or every other day injections of the oil solution into the pathological periodontal pocket, followed by additional introduction and fixation of individual dental aligners with the oil solution "Yagel" with the extract of birch bark "Betulin" in the oral cavity. At the end of the procedure, the patient is given recommendations to limit food intake for 4-5 hours.

The claimed method was carried out in the age group 35-44 years: the first group (the introduction of the oil solution "Yagel" with the extract of birch bark "Betulin" into the pathological periodontal pocket, followed by additional introduction of this solution into the manufactured individual dental mouthguard and its fixation in the oral cavity for 30 minutes) - 31 people; the second group (for treatment, a foam pad impregnated with Ozonid oil was used, placed in an individually made dental mouthguard with subsequent fixation in the oral cavity for 15-25 minutes) - 24 people. A description of this treatment method is given in patent RU 2189218 (class A61K 006/02, publ. 09/20/2002). Ozonid oil is a product of deep oxidation of unsaturated carboxylic acids of natural origin in oil. The pharmacological action is anti-inflammatory, anti-allergic; possesses bactericidal, antiviral and fungicidal properties (Certificate of Conformity No. POCC RU.IM02. B14094, No. POCC RU.ME48.B01663, No. POCC RU.PK12.B02491, No. POCC RU.PK12.B02492, No. POCC RU.PK12.B02493) ... Composition: a solution of unsaturated carbonic acid ozonides (of natural origin).

Also, a third control group was formed, where no medical and preventive measures were taken - 11 people.

The results of treatment were assessed by clinical, laboratory, instrumental and diagnostic methods of research and were considered in the dynamics of the intensity and severity of the inflammatory and destructive process of periodontal tissues in patients.

Initial organizational measures included work on the analysis and assessment of the prevalence (from 62.42 ± 0.24 to 98.88 ± 0.07%) and the intensity of periodontal disease (with age, the ratio of healthy sextants sharply decreases from 0.42 ± 0, 03 to 0.01 ± 0.03) among the population of the Republic of Sakha (Yakutia).

For microbiological research, material from a pathological periodontal pocket (inflammatory focus) was obtained using a tampon, which was placed in a liquid transport medium "Amies". The primary inoculation of the material was carried out on anaerobic blood agar, "Chocolate" agar and "Saburo" medium. The incubation of crops was carried out at a temperature of 37 ° C for 24-48 hours. The cups with anaerobic hemagar were incubated in sealed containers with gas generators to create an anaerobic atmosphere "GENbag Anaer" from BioMerieux (France). Inoculations on "Chocolate" agar were also placed in sealed containers, but with gas generators for microaerophiles "GENbag Microaer" from BioMerieux (France).

To count the number of microorganisms in the material, inoculation was carried out according to the Melnikov-Tsarev method: the test material was inoculated with a swab on the 1st sector of a Petri dish with a nutrient medium. After that, a d3 mm bacteriological loop was used to inoculate 4 strokes from sector 1 to sector 2, similarly from sector 2 to sector 3, burning through the loop after reseeding each sector. The number of bacteria in the material was determined using the table (see table 2).

The average number during statistical processing was expressed in lg CFU, where 101 CFU = 1 lg CFU (CFU - colony-forming unit, microbial cell). The identified cultures were identified by time-of-flight mass spectrometry on a Vitek-MS analyzer from BioMerieux (France).

As the results of the study show, the microbiological characteristics of the microflora of the pathological periodontal pocket are represented by gr (+), gr (-) microorganisms and V. parvulla. At the same time, before treatment, the quantitative and qualitative composition of microorganisms in the tissues of the gums in all groups did not differ (P> 0.05). Microorganisms isolated from the periodontal pocket during periodontitis Streptococcus oralis, Streptococcus sanguis, Neisseria flava, Neisseria sicca were used as test cultures. Chryseobacterium gleum, Streptococcus aureus, Human parainfluenzae, Klebsiella pneumonia, gr. Adiatiens, Virus Parvulla.

The results obtained in the group with Yagel oil solution with Betulin birch bark extract indicate its antibiotic action against Streptococcus oralis, Streptococcus sanguis, Neisseria flava, Neisseria sicca, Chryseobacterium gleum, Streptococcus aureus, Human parainfluenzae, Klebsiella pneumonia, gr. Adiatiens, as well as anti-inflammatory action, which determine the basis of clinical efficacy (see table 3). Due to this, starting from the 2nd day, the reverse development of the inflammatory process of the marginal gingiva was determined, which is characterized by a significant decrease in edema and hyperemia of the mucous membrane of the marginal gingival area, which confirms its pronounced clinical effect. In addition, the antiviral action against Virus Parvulla is determined due to the constituent components of the Betulin birch bark extract.

In the group with Ozonid oil, the microbiological examination also determined quantitative and qualitative changes in the types of periodontal pathogenic microorganisms. This, in turn, is associated with the antibiotic effect of Ozonid oil (see table 3). At the same time, starting from 3 days, the reverse development of the inflammatory process of the periodontal pocket is determined, which in clinical terms is characterized by a significant decrease in edema and hyperemia of the mucous membrane of the marginal gingival area, which also confirms its clinical effect.

The satisfactory results of the therapeutic measures in the treatment of chronic periodontitis is explained by the positive effect of antibiotic and anti-inflammatory components contained in the oil solution "Yagel" with the extract of birch bark "Betulin" (see Fig. 9, 10).

For comparison, the clinical efficacy of the group with Yagel oil solution with Betulin birch bark extract is characterized by a similar antimicrobial effect of Ozonid oil, therefore, dynamic changes in periodontal tissues in the form of a reverse development of the inflammatory process are observed starting from 2 days and according to the studied parameters compared to the control group obtained reliable significant differences (P <0.05).

Thus, the pronounced antibiotic and anti-inflammatory properties of the oil solution "Yagel" with the extract of birch bark "Betulin" make it possible to use it in dentistry, in particular, in the treatment of periodontitis, which helps to increase the effectiveness of treatment of inflammatory periodontal diseases, and also prevents their complications and the development of chronic the focus of infection in the oral cavity.

Table 1

The composition of the product based on the extract of lichen thallus of the genus "Cladonia"

"Reindeer moss"

No.
p / p Name
indicators Concentration (%) one Dry residue 98.49916 2 Vitamin B 12 0.00004 3 Folic acid 0.0008 4 Usnic acid sodium salt 1.5

table 2

Calculation table for determining the number of bacteria in the test material

Colonies by sector Quantity, CFU Sector 1 Sector 2 Sector 3 1-6 No growth No growth <1000 (up to 10 ³ ) 8-20 No growth No growth 1000 (10 ³ ) 21-30 No growth No growth 5000 (10 ^3-4 ) 31-60 No growth No growth 10.000 (10 ⁴ ) 70-80 No growth No growth 50.000 (10 ^4-5 ) 100-150 5-10 No growth 100.000 (10 ⁵ ) A very large number 20-30 No growth 500.000 (10 ^5-6 ) A very large number 40-60 No growth 1.000.000 (10 ⁶ ) A very large number 100-140 10-20 5.000.000 (10 ^6-7 ) A very large number A very large number 30-40 50.000.000 (10 ⁷ ) A very large number A very large number 60-80 100.000.000 (10 ⁸ ) A very large number A very large number 80-140 1.000.000.000 (10 ⁹ )

Table 3

Comparative characteristics of the antimicrobial activity of the oil solution "Yagel" with the extract of birch bark "Betulin" in the treatment of periodontitis

Types of microorganisms Quantity, CFU before treatment Quantity, CFU after treatment Yagel with birch bark extract "Betulin" Ozonide Yagel with birch bark extract "Betulin" Ozonide Streptococcus oralis ^five 10 ^five 10 ^five 10 ² 10 ³ Streptococcus oralis ⁶ 10 ⁶ 10 ⁶ 10 ² 10 ³ Streptococcus oralis ⁷ 10 ⁷ 10 ⁷ 10 ² 10 ⁴ Streptococcus oralis ^eight 10 ^eight 10 ^eight 10 ³ 10 ⁴ Streptococcus oralis ⁷ 10 ⁷ 10 ⁷ 10 ^one 10 ^five Streptococcus oralis ⁷ 10 ⁷ 10 ⁷ 10 ^one 10 ^five Streptococcus oralis ⁷ 10 ⁷ 10 ⁷ 10 ² 10 ^five Streptococcus oralis ⁷ 10 ⁷ 10 ⁷ 10 ² 10 ⁴ Streptococcus oralis ⁷ 10 ⁷ 10 ⁷ 10 ² 10 ⁴ Streptococcus sanguis ⁷ 10 ⁷ 10 ⁷ 10 ⁴ 10 ⁶ Streptococcus sanguis ⁷ 10 ⁷ 10 ^eight 10 ⁴ 10 ⁴ Streptococcus aureus ³ 10 ³ 10 ⁴ 10 ^one 10 ² Streptococcus aureus ⁴ 10 ⁴ 10 ⁴ 10 ² 10 ³ Streptococcus aureus ⁴ 10 ⁴ 10 ⁴ 10 ² 10 ³ Streptococcus aureus ^five 10 ^five 10 ^five 10 ³ 10 ³ Streptococcus aureus ^five 10 ^five 10 ^five 10 ² 10 ⁴ Average concentration for the genus Streptococcus 10 ^6.01 10 ^{6, 13} 10 ^2.19 10 ^3.88 Neisseria sicca ⁶ 10 ⁶ 10 ⁷ 10 ³ 10 ³ Neisseria sicca ⁷ 10 ⁷ 10 ⁶ 10 ² 10 ⁴ Neisseria flava ⁶ 10 ⁶ 10 ⁶ 10 ³ 10 ⁴ Neisseria flava ⁶ 10 ⁶ 10 ⁷ 10 ³ 10 ⁴ Average concentration for the genus Neisseria 10 ^6.25 10 ^6.50 10 ^2.75 10 ^{3, 7 five} H. parainfluenzae ⁷ 10 ⁷ 10 ⁷ 10 ² 10 ^five Gr. Adiatiens ⁴ 10 ⁴ 10 ⁴ 10 ² 10 ³ Chryseobacterium gleum ^five 10 ^five 10 ^five 10 ³ 10 ⁴ V. parvulla ⁴ 10 ⁴ 10 ^five 10 ^one 10 ^five

Claims (2)

A method of treating chronic periodontitis, in which an oil solution based on a biologically active additive "Yagel" is injected directly into the pathological periodontal pocket and additionally applied and fixed in the oral cavity for 25-30 minutes in the oral cavity, an individually made dental mouthguard filled with an oil solution, while the daily procedure includes includes a single administration and application of the solution, the course of treatment is 7-10 procedures, where the drug additionally contains the extract of birch bark "Betulin", while the ratio of the components is, wt%: biologically active additive "Yagel", dry residue 66-70 birch bark extract "Betulin" 15-17 linseed oil 15-17

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