RU2797853C1 - Method of chronic periodontitis treatment - Google Patents

Abstract

FIELD: medicine, dentistry.

SUBSTANCE: method of chronic periodontitis treatment is intended for use in the treatment of chronic periodontitis. Before treatment, the depth of periodontal pockets is determined with a periodontal probe at six points for each tooth, corresponding to six parts divided by secant planes, when viewed from the occlusal surface, the area with the deepest point of periodontal probing for each segment is recorded. The obtained measurements of the depth of the periodontal pocket are entered into a computer program and a three-dimensional model of periodontal pockets is created to obtain a periodontal map of the patient. An X-ray examination is carried out. Removal of supra- and subgingival dental deposits, antiseptic treatment of the oral cavity and periodontal pockets are carried out, after which the teeth are polished and closed curettage is performed. The sponge is introduced into the periodontal pockets, where, as a therapeutic agent, the Alvostasis sponge is introduced into the periodontal pockets along the long axis of the tooth congruent to the shape of the periodontal pocket until elastic resistance appears, obturating the space three-dimensionally until loose filling, leaving a free volume 2 mm high above Alvostasis sponge to the gingival margin, followed by the application of Diplen-Dent dental self-adhesive film on the gingival margin in the area of the teeth.

EFFECT: method allows, due to the use of ready-made medicines, their long-term antimicrobial action in the pathological periodontal pocket, to increase the effectiveness of the treatment of chronic periodontitis, to achieve stable remission and reduce the treatment time.

1 cl, 4 dwg, 1 ex

Description

The invention relates to medicine, namely to dentistry, and is intended for the treatment of chronic periodontitis.

Inflammatory periodontal disease is one of the most complex problems of modern dentistry. The development of periodontitis is associated with manifestations of a specific subgingival bacterial flora from the deep sections of the gingival sulcus: exotoxins and endotoxins produced by periodontopathogenic microorganisms lead to prolonged inflammation and destruction of periodontal tissues. It should be noted that the state of local and general protective mechanisms, as well as functional overload of the periodontium, is of some importance in the development of periodontal diseases. The low effectiveness of the treatment of periodontitis is due to unresolved issues of the pathogenetic mechanism of development, as well as the weak motivation of patients to conduct timely therapeutic and preventive measures.

Conservative treatment of periodontal diseases is based on the elimination and neutralization of periodontopathogenic flora and for this purpose a large number of anti-inflammatory and antimicrobial drugs are used. However, further development of more effective drugs and methods for the treatment of periodontal diseases remains relevant.

Known "Method of treatment of periodontitis" (patent for invention RU 2332998, IPC A61K 31/502, A61R 1/02, 09/15/2006), where surgical treatment of a pathological periodontal pocket is performed, during which infected tissues and subgingival deposits are removed, after which they are carried out antiseptic treatment of wound surfaces and carry out drug therapy.

The disadvantage of the above method is the lack of exposure of the drug Tamerit in the periodontal pocket. The release form of the drug Tamerit in the form of a solution is not convenient for the treatment of periodontitis, which significantly reduces the effectiveness of treatment.

Known "Method for the treatment of dystopic semi-retained and impacted wisdom teeth in the lower jaw" (patent for invention RU 2272596, IPC A61C 7/00, 03/09/2004), including local anesthesia, surgical procedures, using the sponge "Alvostaza".

The disadvantage of the above method is the use of laser therapy with the device "Optodan" during the first 3 days on the first channel of the device, for the next 3 days on the second channel of the device, which increases the duration of treatment and the need for the patient to attend physiotherapy treatment.

Known "Method of treating periodontal patients" (patent for invention RU 2561890, IPC A61N 5/067, A61K 31/409, A61K 31/444, A61K 39/00, A61P 1/02, A61M 31/00, A61C 3/06, А61С 17/20, 12/19/2013), which includes a single removal of dental plaque by the ultrasonic method and polishing of the teeth, followed by the introduction of the drug into periodontal pockets.

The disadvantage of the above method is the complexity of its use, the duration of the procedure, the impossibility of covering several treatment areas at once, the need for advanced training of doctors to access work with laser devices, as well as the high cost of equipment and a photosensitizer, which significantly increases the cost of the procedure, thereby limiting its accessibility to the public.

The closest in technical essence and the achieved result to the proposed technical solution is the "Method for the treatment of chronic periodontitis" (patent for invention RU 2301064, IPC A61K 31/4164, A61K 31/722, A61K 38/39, A61R 1/02, 28.04.2005 ), including the removal of supra- and subgingival dental deposits, antiseptic treatment of the oral cavity and periodontal pockets, the introduction of a sterile sponge into periodontal pockets.

The disadvantage of the known technical solution is the use of the NZK-02 tip (oscillation frequency 6100-6500 Hz) to remove supragingival dental deposits, which is more traumatic than the use of the NSK Varios 970 scaler with G1, G6 nozzles (oscillation frequency 28-32 kHz), while There are three power settings. Within each mode, 11-step power adjustment is possible. In addition, inserting a sterile 0.3×0.3 sponge into a periodontal pocket does not cover the entire volume of a large periodontal pocket. An insufficient concentration of medicinal substances is created in the lesion and, as a result, a limited therapeutic effect. The disadvantages of the prototype should also include the duration of the course of treatment -5 sessions.

The objective of the invention is to increase the effectiveness of the treatment of chronic periodontitis, the use of finished official drugs with prolonged action and the achievement of stable remission.

The technical result when using the invention is the expansion of the spectrum of therapeutic effects, reducing the duration of treatment.

The technical problem of the method for the treatment of chronic periodontitis is solved in that the removal of supra- and subgingival dental deposits, antiseptic treatment of the oral cavity and periodontal pockets, the introduction of a sponge into periodontal pockets, characterized in that before treatment, the depth of periodontal pockets is determined and a three-dimensional model of periodontal pockets is created with obtaining a periodontal card of the patient, an x-ray examination is performed, and after removal of supra- and subgingival dental deposits, teeth are polished and closed curettage is performed, and as a therapeutic agent, a special tool "Alvostasis" is introduced into periodontal pockets along the long axis of the tooth congruent to the shape of the periodontal pocket until elastic resistance appears "(sponge), three-dimensionally obturating the space until loose filling, leaving a free volume 2 mm high above the "Alvostasis" (sponge) to the gingival margin, followed by the application of a dental self-adhesive film "Diplen-Dent" on the gingival margin in the area of the teeth.

Signs that distinguish this technical solution from the prototype are not found in known analogues.

The invention is illustrated with graphic materials.

On FIG. 1 shows a preferred selection of 6 tooth points for periodontal pocket measurement.

On FIG. 2 shows the angles of the periodontal probe.

On FIG. 3 shows the periodontal map (1.6, 1.7 teeth).

On FIG. 4 shows the periodontal map of the patient.

The method of treatment of chronic periodontitis is as follows.

Spend application anesthesia Sol. Lidoxori (according to indications, infiltration anesthesia Sol. Ultracaini 1:200,000-1.7 ml).

The depth of the periodontal pocket of the tooth is measured with a periodontal probe at 6 points. In this case, the tooth is mentally divided by secant planes into 6 parts when viewed from the occlusal surface, and the area with the deepest point of periodontal probing is recorded for each segment (Fig. 1).

In this case, an instrument (for example, a periodontal probe) is inserted along the anatomical surface of the tooth root in order to measure the depth of periodontal probing (target point). The working part of the instrument is oriented along the long axis of the tooth perpendicular to the gingival margin with constant contact with the root. The instrument is tilted in the mesio-distal direction "A" or "B", respectively, keeping it parallel to the long axis of the tooth (Fig. 2).

Enter measurements of the depth of the periodontal pocket in a special computer program (www.periodontalchart-online.com), create a graphical registration of the created three-dimensional model of periodontal pockets in an interactive periodontal map, which gives a complete picture of the shape of periodontal pockets of teeth (Fig. 3), where:

pos. 1 - form of periodontal pocket 1.7 tooth,

pos. 2 - form of periodontal pocket 1.6 tooth,

pos. 3 - depth of the periodontal pocket,

pos. 4 - tooth crown,

pos. 5 - gingival margin,

pos. 6 - tooth root,

pos. 7 - long axis of the tooth.

In order to confirm the diagnosis, an X-ray examination is performed.

Remove supra- and subgingival dental deposits, carry out antiseptic treatment of the oral cavity and periodontal pockets. When removing supra- and subgingival plaque, an NSK Varios 970 ultrasonic device and special nozzles - G1.G6 are used, the use of which provides less trauma compared to the NZK-02 tip.

Teeth polishing and closed curettage of periodontal pockets are carried out, followed by antiseptic treatment of the gingival margin in the area of closed curettage and periodontal pockets.

A special tool "Alvostasis" (sponge), produced by LLC "NKF Omega-Dent" (Russia), is introduced into the periodontal pocket.

"Alvostasis" (sponge) is a hemostatic and antiseptic compress for the alveoli, presented in the form of hemostatic collagen cubes (1 × 1 cm), impregnated with a medicinal solution:

- tricalcium phosphate (hemostatic component),

- olive oil - has anti-inflammatory properties.

Linoleic acid, which is part of it, allows wounds and cuts to heal faster: the compound is actively involved in the process of tissue repair (https://www.kp.ru/family/eda/olivkovoe-oil-polza-i-vred/);

eugenol is a strong antibacterial substance (https://www.misma.pro/news/evgenol-kratko-o-svoystvakh/);

- iodoform - antiseptic (https://xumuk.ru/organika/67.html).

"Alvostasis" (sponge) quickly relieves inflammation and pain, has a therapeutic effect for several hours, after which it begins to gradually dissolve. (http://omegadent.ru/catalog/gemostatiki/483/).

"Alvostasis" (sponge) is a special tool for the prevention and treatment of alveolitis. But due to the fact that the periodontium is a complex of closely interconnected tissues (gingiva, periosteum, bones of the alveolar process, periodontium and cement covering the root of the tooth) surrounding and fixing teeth (https://core.ac.uk/download/pdf/ 200101108.pdf), the drug is proposed to be used for the treatment of chronic periodontitis by introducing it into the periodontal pocket.

A dental self-adhesive film "Diplen-Dent" is applied to the gingival margin in the region of the teeth of the upper jaw. The specified film is intended for use in periodontology, therapeutic, surgical and orthopedic dentistry.

Different types of film differ in the content of antibacterial, anti-inflammatory, analgesic, remineralizing and other components.

Films "Diplen Denta" are the most effective means for local antimicrobial and anti-inflammatory therapy in the oral cavity. They are applied directly to the affected area. The release of medicinal components continues for several (6-8) hours. The therapeutic effect is achieved quickly. Acute inflammation is eliminated, bleeding and suppuration stops, puffiness is removed, teeth are strengthened. Films - soft, thin, transparent. They are glued without any auxiliary means to soft, hard, wound and burn surfaces of the oral cavity (http://dentashop.ru/diplen.html).

Treatment using the proposed method and the achievement of the technical result is illustrated by the example of a specific implementation.

Clinical example

Patient M., 57 years old. She complained of bleeding and pain in the gums when brushing her teeth and eating, the presence of dental deposits and exposure of the necks of the roots of the teeth.

From the anamnesis: bleeding and gum pain bothers for a long time with periods of remission and exacerbation.

Allergological and epidemiological anamnesis is not burdened. Hereditary and chronic diseases denies.

Objectively: on external examination, the face is symmetrical. Lymph nodes are not palpable. The mouth opens fully. The mucous membrane of the oral cavity is pale pink in color, moderately moistened.

Gingival papillae are hyperemic, edematous, hypertrophied, bleed during probing and palpation. The gingival margin departs from the neck of the tooth. When examining the dentition, the exposure of the necks of the teeth is determined. When probing in the area of teeth 1.6, 2.4, 2.5, 2.6, 2.7 teeth, the depth of periodontal pockets is from 3 to 5 mm. Abundant supra- and subgingival dental deposits. Percussion of the teeth is painless. Palpation of the gingival margin is slightly painful. Pathological tooth mobility and displacement of teeth are absent. The bite is orthognathic.

Additional examinations:

Index score: IG Silnes-Lohe=3.0.

Schiller-Pisarev test - positive

KPI index-4.0 points.

RMA=2.0

The depth of the periodontal pockets of the upper and lower jaws was measured with a periodontal probe at 6 points for each tooth. Each tooth was mentally divided by secant planes into six parts when viewed from the occlusal surface, and the area with the deepest periodontal probing point was recorded for each segment. In this case, a periodontal probe was inserted along the surface of the tooth root to measure the depth of periodontal probing (target point). The instrument was tilted in the mesio-distal direction "A" or "B", respectively, keeping it parallel to the long axis of the tooth (Fig. 1).

Using a special computer program (www.periodontalchart-online.com), by entering measurements of the depth of periodontal pockets, we created a graphical registration of the created three-dimensional model of periodontal pockets in an interactive periodontal map, which gave a complete picture of the shape of the periodontal pockets of the patient's upper and lower jaw teeth (Fig. 4 ).

An X-ray examination was performed (in order to confirm the diagnosis): an X-ray of OPTG (or 2D), which revealed a generalized horizontal resorption of the bone tissue of the tops of the interdental alveolar septa from 1/3 to 1/2 in the region of the teeth of the upper and lower jaws.

Diagnosis: ICD-10 - K 05.31, chronic generalized periodontitis of moderate severity in the acute stage.

Treatment plan: based on the results of a clinical examination, X-ray diagnosis and index evaluation, it was decided to treat in 2 visits (1 visit - treatment in the area of the teeth of the upper jaw, 2 visits - the next day treatment in the area of the teeth of the lower jaw).

Treatment: Preliminary, that is, before treatment, oral hygiene training and controlled brushing of the teeth were carried out.

Treatment on the first visit.

Conducted application anesthesia Sol. Lidoxori.

Rinsing the mouth and antiseptic treatment in the area of 1.6, 2.4, 2.5, 2.6, 2.7 teeth and the dentogingival margin with an aqueous solution of chlorhexidine bigluconate 0.05%.

Removal of supra- and subgingival plaque using the NSK Varios 970 ultrasonic device with special nozzles - G1, G6.

Polishing of teeth with a circular brush and paste Detartrin Z (Septodont) 1.6, 1.4, 1.3,1.2, 1.1, 2.1, 2.2, 2.3, 2.4, 2.5, 2.6, 2.7 teeth, closed curettage of periodontal pockets of teeth 1.6, 2.4, 2.5, 2.6, 2.7 Gracie curettes, that is, removal of subgingival dental deposits and granulations, ingrown epithelium and affected cementum of the tooth root.

Antiseptic treatment of the gingival margin in the area of closed curettage and periodontal pockets with a 3% solution of hydrogen peroxide, followed by the introduction of a special tool "Alvostasis-sponge" into the periodontal pockets.

A 1×1 hemostatic collagen cube (delivery form) was grasped with dental tweezers. Sterile scissors gave the necessary shape with dimensions according to the obtained three-dimensional model in an interactive periodontal map.

The procedure for the introduction of a special tool "Alvostasis-sponge": a dentist's assistant with a dental instrument (for example, a distal trowel) moved the gingival margin in the area of the periodontal pocket of 1.6, 2.4, 2.5, 2.6, 2.7 teeth, and the dentist with the help of dental tweezers brought and lowered it into the periodontal pocket, and using a trowel No. 1 introduced "Alvostasis" (sponge) congruently to the shape of the periodontal pocket. At the same time, it was allowed to administer the drug in parts (in the form of pyramids, pyramids and cubes, truncated pyramids, cubes ...), obturating the space three-dimensionally, until each periodontal pocket was loosely filled, leaving a free volume 2 mm high above Alvostasis (sponge) up to gingival margin to form and stabilize a blood clot. The drug was injected into periodontal pockets in the axial direction (along the long axis of the tooth) until elastic resistance appeared (to the bottom).

Imposed dental self-adhesive film "Diplen-Dent" type XD on the gingival margin in the area of the teeth of the upper jaw.

After treatment, a diet with restriction of traumatic and solid foods was prescribed for a week.

The second visit to the doctor is scheduled for the next day.

The second visit of the patient to the doctor.

The patient is in the treatment phase.

Objectively: on external examination, the face is symmetrical. Lymph nodes are not palpable. The mouth opens fully. The mucous membrane of the oral cavity is pale pink in color, moderately moistened. In the area of the teeth of the upper jaw, the mucous membrane is slightly hyperemic, dental deposits are determined, bleeding and swelling are absent.

Gingival papillae in the area of the teeth of the lower jaw are hyperemic, edematous, hypertrophied, bleed during probing and palpation. The gingival margin departs from the neck of the tooth. When examining the dentition, the exposure of the necks of the teeth is determined, when probing in the area of 3.6, 3.7 periodontal pockets up to 5 mm. Abundant supra- and subgingival dental deposits in the region of the teeth of the lower jaw. Percussion of the teeth is painless. Palpation of the gingival margin is slightly painful. There is no pathological tooth mobility. There is no displacement of teeth. The bite is orthognathic.

Diagnosis: chronic generalized periodontitis of moderate severity in the acute stage, according to ICD-10 K 05.31

Treatment on the second visit:

Conducted application anesthesia Sol. Lidoxori.

An antiseptic treatment of the oral cavity, areas 4.7, 4.5, 4.4, 4.3, 4.2, 4.1, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7 teeth and the dentogingival margin was carried out with an aqueous solution of chlorhexidine bigluconate 0.05%.

Supra- and subgingival deposits were removed using the NSK Varios ultrasonic device with special nozzles - G1.G6.

Polishing of teeth with a circular brush and paste Detartrin Z (Septodont) 4.7, 4.5, 4.4, 4.3, 4.2, 4.1, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7 teeth, closed curettage of periodontal pockets 3.6, 3.7 with Gracie curette (removed subgingival dental deposits, excised granulations, ingrown epithelium and affected cementum of the tooth root).

Antiseptic treatment of the gingival margin in the area of closed curettage and periodontal pockets with a 3% solution of hydrogen peroxide, followed by the introduction of a special tool "Alvostasis-sponge" into the periodontal pockets.

A hemostatic and antiseptic compress for the alveoli "Alvostasis" (sponge) was introduced into the pathological pockets of the teeth of the lower jaw with a trowel No. 1 along the long axes of the teeth congruent to the shape of the periodontal pocket until elastic resistance appeared, three-dimensionally obturating the space until they were loosely filled, leaving a free volume 2 mm high above "Alvostasis" (sponge) to the gingival margin for the entire depth and volume of periodontal pockets of the teeth of the lower jaw.

Imposed dental self-adhesive film "Diplen-Dent" type XD on the gingival margin of the lower jaw.

Recommendations for oral care are given.

The third visit of the patient in 2 days.

There are no complaints, the patient notes a significant improvement.

Anamnesis: at the stage of treatment.

Objectively: on external examination, the face is symmetrical. Lymph nodes are not palpable. The mouth opens fully. The mucous membrane of the oral cavity is pale pink in color, moderately moistened.

The gingival mucosa is pale pink, does not bleed, there is no edema. Treatment completed. It is recommended to attend a follow-up examination after 3, 6, 12 months.

Thus, the proposed method for the treatment of chronic periodontitis makes it possible to stop inflammation in periodontal tissues in a short time and achieve longer periods of remission.

The use of the present invention provides effective treatment of periodontitis due to prolonged antimicrobial action in the pathological periodontal pocket and contributes to the reverse development of the inflammatory-destructive process of periodontal tissues.

In addition, this method of treatment is simple to perform and does not require special experience for application, which is important for beginner doctors.

Thus, the proposed method for the treatment of chronic periodontitis is effective, which allows it to be widely used in the practice of periodontology.

Claims (1)

A method for the treatment of chronic periodontitis, including the removal of supra- and subgingival dental deposits, antiseptic treatment of the oral cavity and periodontal pockets, the introduction of a sponge into periodontal pockets, characterized in that before treatment, the depth of periodontal pockets is determined with a periodontal probe at six points for each tooth, corresponding to six parts divided by secant planes, when viewed from the occlusal surface, register the area with the deepest point of periodontal probing for each segment, the obtained measurements of the depth of the periodontal pocket are entered into a computer program and a three-dimensional model of periodontal pockets is created to obtain a periodontal map of the patient, an x-ray examination is performed, and after the removal of supra- and subgingival dental deposits, teeth are polished and closed curettage is performed, and as a therapeutic agent, the Alvostasis sponge is introduced into the periodontal pockets along the long axis of the tooth, congruent to the shape of the periodontal pocket until elastic resistance appears, three-dimensionally obturating the space until loose filling, leaving a free volume 2 mm high above the "Alvostasis"-sponge to the gingival margin, followed by the application of a dental self-adhesive film "Diplen-Dent" on the gingival margin in the area of the teeth.

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