RU2800646C1 - Method of periodontitis treatment using stroma-vascular fraction of human adipose tissue and osteogenesis stimulator medicinal product - Google Patents

Abstract

FIELD: medicine, dentistry.

SUBSTANCE: invention can be used to treat periodontitis. Own stromal-vascular fraction of human adipose tissue is mixed in a test tube with Alloplant osteogenesis stimulator powdered in a mass ratio of 1:1. After that, the resulting composition is introduced into the periodontal pockets of the patient with the help of a trowel. To fix the mass, a Septo-Pack protective dressing is applied. The course of treatment is 7 procedures with an interval of 3 days. Applications are also carried out on the gums with gauze bandages moistened with an Erakond solution diluted with water in a ratio of 1:1, before changing the bandage on days 5, 9, 13, 17, 21 and 25.

EFFECT: simplification of the method, clinical improvement already on the 6th day of observation.

1 cl, 1 ex

Description

The invention relates to medicine, in particular to dentistry, and can be used to treat periodontitis.

Periodontal diseases, which include gingivitis, periodontitis, periodontal disease, according to WHO, affect up to 98% of the population. One of the most common forms is periodontitis, which begins with damage to the marginal part of the gums, followed by involvement in the pathological process of all periodontal structures, namely the alveolar bone. Chronic periodontitis is characterized by a progressive course with the destruction of the gingival junction, the formation of a periodontal pocket and resorption of the bone tissue of the alveolar process. Periodontitis is the main cause of tooth loss in older age.

The insufficient effectiveness of the treatment of this pathology necessitates the improvement of existing conservative and surgical methods. Despite the variety of conservative effects on periodontal tissues, surgical methods of treatment remain fundamental [Gazhva S.I. Surgical methods of treatment of periodontal diseases. N. Novgorod, 2003, p. 4].

A known method for the treatment of periodontal diseases by peeling the flap, curettage, filling the bone pockets with powder from demineralized allograft, which is injected into the bone pockets after they are filled with a blood clot [RF patent No. 2012242, 1994].

A known method for the treatment of periodontal diseases by subgingival and subperiosteal implantation of an osteotropic membrane based on collagen and drugs. The osteotropic membrane additionally contains bone powder, as a drug - glycosaminoglycans [RF patent No. 2159101, 2000).

A known method for the treatment of periodontal diseases using mesenchymal stem cells (MSCs) [RF patent No. 2265445, 2005]. According to this method, a suspension of MSCs or chondroprogenitor cells or their combinations is injected intraligamentally from the lateral and medial sides of each tooth affected by periodontal disease and/or subperiosteally into the periodontal areas of the upper and lower jaws. MSCs according to this method are obtained from fetal donor material or from the recipient's own tissues (for example, from bone marrow, adipose tissue). Foreign chondroprogenitor cells are used as cellular material, sometimes also in combination with foreign MSCs. The introduced MSCs slowly and incompletely acquire the functional properties of osteocytes.

The disadvantages of the known methods of surgical treatment of periodontal diseases include high trauma and the likelihood of complications in the early postoperative period, which does not create favorable conditions for bone tissue regeneration.

A known method for the treatment of periodontal diseases using mesenchymal stem cells (MSCs) [RF patent No. 2785009, 2022], taken as a prototype. The method includes isolating multipotent mesenchymal stem cells (MMSC) from the pulp of an impacted human tooth. Alloplant osteogenesis stimulator powder in the amount of 0.1 g is pre-soaked in a 0.9% sodium chloride solution, then mixed with 150 thousand MMSC cells. The resulting mixture is introduced into the bone (periodontal) pockets of rats in the area of the second molar of the upper jaw with a trowel and fixed with a protective bandage Septopak, the course of treatment is 3 procedures with an interval of 5 days. The disadvantage of this method is the complexity of obtaining MMSCs from human dental pulp and the process of cultivating them in the laboratory.

The objective of the invention is to expand the arsenal of methods for the treatment of periodontitis.

The technical result when using the invention is a simplification of the method.

The proposed method for the treatment of periodontitis is as follows.

First, tumescent lipoaspiration is performed. A skin incision of 5 mm is performed paraumbilically. After that, the subcutaneous fat is infiltrated from the center to the periphery using a thin cannula for infiltration 250 mm long, 3 mm in diameter and a Luer-Lock syringe 50 ml with a solution of Sodium chloride 0.9% in a volume of 500 ml and Epinephrine hydrochloride 1 mg / ml , 0.5 ml. After infiltration, exposure is carried out for 7 minutes. After that, lipoaspiration is performed using a liposuction cannula with a diameter of 4 mm, a length of 300 mm, with one central hole and two side ones and a connector for a 60 ml syringe. Reciprocating movements perform the sampling of adipose tissue in a volume of 150 ml. To isolate the stromal-vascular fraction from adipose tissue, specialized double syringes Arthrex ACP®, 15 ml in volume, are used. After a sufficient volume of adipose tissue has been obtained, 4 Arthrex ACP® syringes filled with adipose tissue are placed in a Rotofix 32 A tabletop centrifuge with cross rotors, freely suspended cups. Centrifugation is carried out at 2500 rpm for 4 minutes. After a single centrifugation, the tumescent fluid is removed and the adipose tissue is transferred into a 10 ml Luer-Lock syringe. Then, using a connector with a diameter of 1.4 mm and two 10 ml Luer-Lock syringes, the remaining adipose tissue is sequentially transferred from the syringe to the syringe through the connector in an amount of 30 times for the purpose of mechanical processing. After that, the treated tissue is transferred into Arthrex ACP syringes for re-centrifugation at 2500 rpm for 4 minutes. According to the results of repeated centrifugation, the adipose tissue is divided into fractions. The final step is to transfer the stromal-vascular fraction using a 1.4 mm connector into a 3 ml Luer-Lock syringe. Thus, 3-5 ml of the stromal-vascular fraction is obtained from 60 ml of adipose tissue.

At the second stage, the obtained own stromal-vascular fraction of human adipose tissue is mixed in a test tube with Alloplant osteogenesis stimulator powder [TU9398-001-04537642-2011 https://alloplant.ru/ru/content/catalogue/files/alloplants_catalogue.pdf] in bulk ratio 1:1. After that, the resulting composition is introduced into the periodontal pockets of the patient with the help of a trowel. To fix the mass, a Septo-Pack protective dressing is applied. The course of treatment is 7 procedures with an interval of 3 days. Applications are also carried out on the gums with gauze bandages moistened with an Erakond solution diluted with water in a ratio of 1:1, before changing the bandage on days 5, 9, 13, 17, 21 and 25.

Erakond is a condensed plant extract of alfalfa (Medicago sativa), obtained from the ground part of the plant by hydrobarometric extraction, contains a multivitamin complex (vit. A, E, B ₆ , L), 8 essential amino acids, macro- and microelements (iron, potassium, phosphorus, magnesium, manganese, sulfur, potassium, silicon, fluorine, zinc, copper), carbohydrates, monosaccharides, uronic acids, flavonoids. Biologically active food supplement, an additional source of iron, zinc and flavonoids.

Erakond has a pronounced modulating effect on all parts of the immune system due to: stimulation of the production of precursors and increased activity of mature immune cells; mobilization of lymphocytes from the depot, stabilization of myelo- and erythropoiesis; antioxidants that have a membrane-stabilizing effect (restore the cell membrane); radioprotectors (humic substances) with ion-sorbing action, binding radionuclides and heavy metal ions; flavonoids with hepatoprotective action; saponins with adaptogenic (anti-stress) activity, stimulating nonspecific immunity.

Erakond has: a detoxifying effect, neutralizing various toxins (man-made, environmental, medicinal, household, including ethanol); anti-inflammatory effect, by suppressing the excessive release of cytokines and reducing the hyperproduction of antibodies, reducing the sensitization of polymorphonuclear leukocytes during HRT and HNT, eliminates the processes of allergization and autointoxication that occur when the body's own tissues are destroyed during the disease; moderate antimicrobial and pronounced antifungal activity; wound healing effect for injuries, burns, chronic skin diseases (neurodermatitis, eczema, psoriasis) and mucous membranes (stomatitis, periodontal disease, pharyngitis, gastritis, peptic ulcer, colitis and others); the ability to stimulate the work of the adrenal glands, improves the structure of bone tissue in osteoporosis, diseases of the joints and spine, accelerates the healing of bone fractures.

Alloplant is a biomaterial for regenerative surgery, has extremely low antigenic properties, practically excluding the immune nature of the reaction after its implantation [RF patent 2189257, 2002].

Alloplant osteogenesis stimulator has high osteoinductive properties. Resistant to oral environment. It is used in periodontology to fill bone pockets, bone defects of the jaws after cystectomy and resection of the root apex, as well as to elevate the bottom of the maxillary sinus (sinus lift).

Alloplant biomaterial is an acellular tissue matrix with certain fibroarchitectonics, mechanical properties and histochemical composition, subjected to radiation sterilization and laser modeling. With the help of Alloplant, it is possible to stimulate the regeneration of various types of tissues and anatomical structures: skin and mucous membranes, peripheral vessels and nerves, skeletal muscles, components of the soft skeleton and the bone skeleton.

At the same time, the use of the proposed method made it possible to achieve clinical improvement already on the 6th day of observation.

The proposed method was treated with a group of patients in the amount of 30 people with a diagnosis of chronic periodontitis.

Evaluation of results.

On the 5th day after applying a mixture of Alloplant osteogenesis stimulator and autostromal-vascular fraction, the results are evaluated. Bleeding was preserved. The discharge from the periodontal pockets was preserved, but had a serous character. The average depth of periodontal pockets on the 6th day of the experiment was (2.30±0.13 mm); note the formation of granulation tissue.

On the 9th day. There is no bleeding and exudate on palpation of the gums. The average depth of periodontal pockets was (2.00±0.10 mm).

On the 13th day, bleeding and exudate were absent on palpation of the gums. The average depth of periodontal pockets was (1.60±0.06 mm).

On the 17th day, bleeding and exudate were absent on palpation of the gums. The average depth of periodontal pockets was (1.48±0.04 mm).

3 months after the treatment procedures, signs of bone neoplasm are determined on radiographs, by 6 months these signs become more pronounced: the foci of patchy osteoporosis disappeared, and began to acquire a finely looped structure, the contours of the interalveolar septa became clear and even, with a simultaneous increase in the height of the resorbed ridges of the interalveolar septa . The immediate and long-term results showed a pronounced therapeutic efficacy of using the method in the treatment of destructive changes in the alveolar bone in periodontitis. Thus, the treatment of periodontal diseases using the proposed method is much more effective, which is reflected in the reduction of the period of treatment of this disease by 2 times in comparison with known methods. The absence of progression and recurrence of periodontal disease can reduce the number of cases of the disease.

The essence of the invention is illustrated by the following example. Patient A. was admitted with a diagnosis of moderate chronic periodontitis. Conducted treatment according to the proposed method. The own stromal-vascular fraction of adipose tissue, mixed with Alloplant osteogenesis stimulator in a ratio of 1:1, was introduced into periodontal pockets using a spatula. To fix the mass, a protective bandage Septo-Pack was applied. The course of treatment was 7 procedures with an interval of 3 days. Applications were also made on the gums with gauze bandages moistened with Erakond solution, diluted with water in a ratio of 1:1, before changing the bandage on the 5th, 9th, 13th, 17th, 21st and 25th days.

On the 5th day after removal of the protective dressing, the results were evaluated.

Bleeding was preserved. The discharge from the periodontal pockets was preserved, but had a serous character. The average depth of periodontal pockets on the 6th day of the experiment was (2.30±0.13 mm); note the formation of granulation tissue.

On the 9th day. There is no bleeding and exudate on palpation of the gums. The average depth of periodontal pockets was (2.00±0.10 mm).

On day 28, bleeding and exudate were absent on palpation of the gums. The average depth of periodontal pockets was (1.60±0.06 mm).

On day 35, bleeding and exudate were absent on palpation of the gums. The average depth of periodontal pockets was (1.48±0.04 mm).

Claims (1)

A method for the treatment of periodontitis, which includes the introduction of a therapeutic mixture containing Alloplant osteogenesis stimulator into the periodontal pockets, fixation with a Septo-Pack protective dressing, characterized in that a mixture is introduced containing the own stromal-vascular fraction of human adipose tissue with Alloplant osteogenesis stimulator in a mass ratio of 1:1 , the course of treatment is 7 procedures with an interval of 3 days, and additionally, applications are applied to the gums with gauze bandages moistened with Erakond solution, diluted with water in a ratio of 1: 1, before replacing the bandage at 5, 9, 13, 17, 21 and 25 day.