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37ТЕРАПЕВТИЧНИЙ РОЗД1Л
DOI 10.35220/2078-8916-2019-33-3-17-23 УДК 616-071.001.36(001.53):616-08+616.314.163-08 S. V. Khlyebas
Shupyk National Medical Academy of Postgraduate Education
A COMPARATIVE ANALYSIS OF THE CLINICAL EFFICIENCY OF THE TREATMENT OF CHRONIC GRANULOMATOUS PERIODONTITIS USING DIFFERENT PROTOCOLS OF DRUG TREATMENT OF THE ROOT CANALS
ABSTRACT
Background. Infectious and inflammatory processes in periapical tissues are the most common diseases of the dentition. In the structure of the provision of dental care in treatment of chronic periodontitis amounted to 30% of the total number of visits to medical institutions of the healthcare system. Promising is the further development and clinical and radiological justification for the use of new effective means for drug treatment of root canals which affect the pathogenic microflora of the infected canal and have a prolonged antibacterial and anti-inflammatory effects and contribute to the processes of reparative regeneration of bone tissue in the area of the focus of inflammation.
Objective. Based on a comparative analysis of the results of clinical and radiological research / treatment of chronic granulomatous periodontitis to determine the effectiveness of new drug compositions based on tetracycline and 2% chlorhexidine in the protocol for drug treatment of the root canal system.
Materials and methods. There have been conducted the clinical and radiological study of the effectiveness of treatment of 31 patients with chronic granulomatous periodontitis who were divided into two groups: the main and control group. Patients of the main group in the treatment protocol at the stage of instrumental treatment used the drug composition with tetracycline and at the stage of temporary obstruction - a composition with 2 % chlorhexidine in the form of a gel for 3 days under a light-polymerized dressing. After instrumental and drug treatment of the root canal the control group patients underwent temporary obstruction with calcium hydroxide for 7 days under an airtight light-polymerized dressing. The effectiveness of the treatment was evaluated on the basis of clinical and radiological data before treatment, after treatment, and after 6 and 12 months. Results. According to the results of a comparative clinical and radiological study the high efficiency of the use of medicinal compositions based on tetracycline and based on 2 % chlorhexidine for patients with chronic granulomatous periodontitis (p <0.001) was proved. The high clinical efficiency of the proposed treatment method is due to the sensitivity of the pathogenic microflora of the infected
root canal to tetracycline and the prolonged antibacterial effect of chlorhexidine on the system of the root canals reducing inflammatory processes in the periapical tissues, which positively contributes to the process of reparative regeneration of bone tissue in the area of the root apex. According to the results of the X-ray examination a reduction in the focus of the infectious and inflammatory process in the periapical tissues, a probable decrease in the destruction area in the periapical region in the main group, where the medicinal compositions based on tetra-cycline and 2 % chlorhexidine in gel form: from 3.29±0.11 mm2 to 0.03 ± 0.03 mm2 12 months after treatment, that is, 99.12 %, which is 18, 28% better, compared to the control group, where 12.8 months after treatment there was a reduction of 80.84 %: from 3.34 ± 0.11 mm2 to 0.64 ± 0.24 mm2 (p <0.001). There were no cases of exacerbation of the process, relapses of the disease, complications or allergic reactions during treatment and during the observation period, which indicates the safety of medical compositions based on tetracycline and based on 2 % chlorhexidine.
Conclusions. Based on the obtained clinical and radiological results of the study of treating patients with chronic granulomatous periodontitis one can state about the effectiveness and practicability of the combined use of medicament compositions based on tetracycline and based on 2 % chlorhexidine in gel form. The offered means for drug treatment has antibacterial, anti-inflammatory properties and contribute to the process of bone tissue regeneration in the area of the apex of the root, which increases the effectiveness of endodontic treatment. The application of the proposed protocol for the medical treatment of infected root canals improves the treatment efficiency by 18.28 % after 12 months of observation, compared with the control group (p <0.001), reduces the time for endodontic treatment, and financial costs are reduced.
Key words: chronic granulomatous periodontitis, medical treatment of root canals, tetracycline, 2 % chlorhexidine.
С. В. Хлебас
Национальна медична академш шслядипломно! освгги iMern П. Л. Шупика
ПОР1ВНЯЛЬНИЙ АНАЛ1З КЛ1Н1ЧНО1 ЕФЕКТИВНОСТ1 Л1КУВАННЯ ХРОН1Ч-НОГО ГРАНУЛЕМАТОЗНОГО ПЕР1ОДОН-ТИТУ З ЗАСТОСУВАННЯМ Р1ЗНИХ ПРО-ТОКОЛ1В МЕДИКАМЕНТОЗНО1 ОБРОБКИ КОРЕНЕВИХ КАНАЛ1В
Актуальтсть. Iнфекцiйно-запальнi процеси в периа-ткалъних тканинах е найбшьш поширеними захворю-ваннями зубо-щелепног системи. В структурi надання стоматологiчноi допомоги лкування хротчних перiодонтитiв складае до 30 % eid загально'г' клькос-
© Khlyebas S. V., 2019.
mi звернень до л^вально - профшактичних закладiв системи охорони здоров 'я.
Мета. На пiдставi проведеного порiвняльного анализу результатiв клiнiко-рентгенологiчного до^дження лiкування хронiчного гранулематозного перюдонтиту визначити ефективтсть нових медикаментозних композицш на основi тетрациклту та 2 % хлоргекси-дину в протоколi медикаментозное обробки системи кореневих каналiв.
Матер1али та методи. Проведено клiнiко-рентгенологiчне дослiдження ефективностi лкуван-ня 31 пащента ¿з хронiчним гранулематозним перiо-донтитом, як були розподiленi на двi групи: основну i контрольну. Пацiентам основное групи в протокол л^ кування на етапi тструментально' обробки застосо-вували медикаментозну композицт з тетраци^ном, а на етат тимчасово' обтурацИ - композицт з 2 % хлоргексидином в формi гелю на 3 доби пiд свтлопо-лiмеризовану пов 'язку. Пацiентам контрольно' групи тсля тструментально' та медикаментозно' обробки кореневого каналу проводили тимчасову обтура^ю з гiдроокисом кальцiю на 7 дiб пiд герметичну свтло-полiмеризовану пов 'язку. Шсля вказаних термiнiв патентам обох груп 1з кореневих каналiв вилучали тим-часовi обтуранти та проводили 'х постшну обтура-цт. Ефективтсть лiкування оцiнювали на пiдставi клiнiчних i рентгенологiчних даних до л^вання, тсля проведеного л^вання, через 6 i 12 мiсяцiв. Результати дослгджень. За результатами порiвня-льного клiнiко-рентгенологiчного до^дження доведено високу ефективнкть застосування медикаментозних композицш на основi тетрациклту та на ос-новi 2 % хлоргексидину у хворих 1з хронiчним гранулематозним перiодонтитом (р<0,001). За результатами рентгенологiчного спостереження зареестровано редукцiю вогнища iнфекцiйно-запального процесу в периапiкальних тканинах, вiрогiдне зменшення площi деструкци в периапiкальнiй дiлянцi в основнш групi: з 3,29±0,11 мм2 до 0,03±0,03 мм2 через 12 мiсяцiв тсля лкування, тобто на 99,12 %, що на 18, 28% краще, порiвняно з групою контролю, де через 12 мкящв тсля лкування вiдбулася редук^я на 80,84%: з 3,34±0,11 мм2 до 0,64±0,24мм2 (р<0,001).
Висновки. На пiдставi отриманих клiнiко-рентгенологiчних результатiв дослiдження при про-веденнi л^вання пацiентiв з хротчним гранулематозним перiодонтитом можна стверджувати про ефективтсть та доцшьнкть спшьного застосування медикаментозних композицт на основi тетраци^ну та на основi 2 % хлоргексидину в формi гелю. Застосування запропонованого протоколу медикаментозно '1' обробки iнфiкованих кореневих каналiв достовiрно сприяе тдвищенню ефективностi лiкування на 18,28 % через 12 мiсяцiв спостережень, порiвняно з групою контролю (р< 0,001), скороченню термiнiв ендодон-тичного л^вання, фiнансовi витрати при цьому зме-ншуються.
Ключов1 слова: хротчний гранулематозний перюдо-нтит, медикаментозна обробка кореневих каналiв, тетрациклт, 2 % хлоргексидин.
С. В. Хлебас
Национальная медицинская академия последипломного образования имени П. Л. Шупика
СРАВНИТЕЛЬНЫЙ АНАЛИЗ КЛИНИЧЕСКОЙ ЭФФЕКТИВНОСТИ ЛЕЧЕНИЯ ХРОНИЧЕСКОГО ГРАНУЛЕМАТОЗНОГО ПЕРИОДОНТИТА С ПРИМЕНЕНИЕМ РАЗЛИЧНЫХ ПРОТОКОЛОВ МЕДИКАМЕНТОЗНОЙ ОБРАБОТКИ КОРНЕВЫХ КАНАЛОВ
Актуальность. Инфекционно-воспалительные процессы в периапикальных тканях являются наиболее распространёнными заболеваниями зубочелюстной системы. В структуре оказания стоматологической помощи лечения хронических периодонтитов составили до 30 % от общего количества обращений в лечебно - профилактические учреждения системы здравоохранения. Перспективным есть дальнейшая разработка и клинико - рентгенологическое обоснование применения новых эффективных средств для медикаментозной обработки корневых каналов, которые влияют на патогенную микрофлору инфицированного канала и имеют пролонгированное антибактериальное и противовоспалительное действие, способствуют процессам репаративной регенерации костной ткани в участке очага воспаления. Цель. На основании проведенного сравнительного анализа результатов клинико - рентгенологического исследования лечения хронического гранулематозного периодонтита определить эффективность новых медикаментозных композиций на основе тетрациклина и 2 % хлоргексидина в протоколе медикаментозной обработки системы корневых каналов. Материалы и методы. Проведено клинико-рентгенологическое исследование эффективности лечения 31 пациента с хроническим гранулематозным периодонтитом, которые были разделены на две группы: основную и контрольную. Пациентам основной группы в протокол лечения на этапе инструментальной обработки применяли медикаментозную композицию с тетрациклином, а на этапе временной обтурации - композицию с 2 % хлоргексидином в форме геля на 3 суток под светополимеризованую повязку. Пациентам контрольной группы после инструментальной и медикаментозной обработки корневого канала проводили временную обтурацию с гидроокисью кальция на 7 суток под герметичную светополимеризованую повязку. Эффективность лечения оценивали на основании клинических и рентгенологических данных до лечения, после проведенного лечения и через 6 и 12 месяцев.
Результаты исследований. По результатам сравнительного клинико-рентгенологического исследования доказана высокая эффективность применения медикаментозных композиций на основе тетрациклина и на основе 2 % хлоргексидина у больных с хроническим гранулематозным периодонтитом (р<0,001). Высокая клиническая эффективность
предложенного метода лечения обусловлена чувствительностью патогенной микрофлоры инфицированного корневого канала к тетрациклину и пролонгированным антибактериальным действием хлоргек-сидина на систему корневых канальцев, уменьшения воспалительных процессов в периапикальных тканях, что положительно способствует процессу репара-тивной регенерации костной ткани в участке верхушки корня. По результатам рентгенологического исследования зарегистрировано редукцию очага ин-фекционно - воспалительного процесса в периапи-кальних тканях, вероятное уменьшение площади деструкции в периапикальном участке в основной группе, где совместно применяли медикаментозные композиции на основе тетрациклина и 2 % хлоргексидина в форме геля: с 3,29±0,11 мм2 до 0,03±0,03 мм2 через 12 месяцев после лечения, то есть на 99,12 %, что на 18, 28% лучше, в сравнении с группой контроля, где через 12 месяцев после лечения произошла редукция на 80,84 %: с 3,34±0,11 мм2 до 0,64±0,24 мм2 (р<0,001). Случаев обострения процесса, рецидивов заболевания, осложнений или аллергических реакций во время лечения и в период наблюдений не зарегистрировано, что свидетельствует о безопасности медикаментозных композиций на основе тетрациклина и на основе 2 % хлоргексидина.
Выводы. На основании полученных клинико-рентгенологических результатов исследования при проведении лечения пациентов с хроническим грану-лематозным периодонтитом можно утверждать об эффективности и целесообразности совместного применения медикаментозных композиций на основе тетрациклина и на основе 2 % хлоргексидина в форме геля. Предложенные средства для медикаментозной обработки обладают антибактериальными, противовоспалительными свойствами и способствуют процессу регенерации костной ткани в участке верхушки корня, что повышает эффективность эндо-донтического лечения.
Применение предложенного протокола медикаментозной обработки инфицированных корневых каналов способствует повышению эффективности лечения на 18,28 % через 12 месяцев наблюдений, в сравнении с группой контроля (р< 0,001), сокращению сроков эн-додонтического лечения, финансовые затраты при этом уменьшаются.
Ключевые слова: хронический гранулематозный периодонтит, медикаментозная обработка корневых каналов, тетрациклин, 2 % хлоргексидин.
Introduction. The dentomaxillary system is most commonly affected by infectious-inflammatory processes in the periapical tissues. The treatment of chronic periodontitis accounts for about 30 % of all dental visits [1]. Untimely treatment and progression of infectious-inflammatory processes in the periapi-cal area induce chronic intoxication and sensitization of the entire body, can cause the development of purulent-inflammatory processes in the maxillofacial area as well as result in the early tooth extraction [2]. Microbial factors are the leading contributors to the
development of chronic periodontitis, and therefore their control plays an important role in the treatment process. Decontamination of a microbial pathogen in the treatment of chronic periodontitis requires not only modern and high-quality mechanical treatment of the infected root canals, but also new and effective means for their medical treatment.
The promising research directions include further development and clinical-radiological substantiation of the application of new effective agents for the medical treatment of root canals, which affect the pathogenic microflora of the infected canal and have prolonged antibacterial and anti-inflammatory action as well as contribute to the bone tissue repara-tive regeneration in the periapical tissue.
Quality and effective disinfection of the infected root canals with the root apex destruction is required to reduce microbial load within the canal. Sodium hypochlorite and chlorhexidine are most often used for the treatment of root canals. Sodium hypochlo-rite has an effect on the organic material, leaving the inorganic material of the root canal unaffected, and does not remove the smear layer. That is why it is recommended to use this solution with acid, for example, ethylenediaminetetraacetic acid (EDTA) [3].
2 % chlorhexidine (gel and liquid) is widely used against endodontic pathogens [4, 5]. The investigations have shown that this irrigant is more effective against Enterococcus faecalis compared to calcium hydroxide [5,6,7]. In particular, the findings of microbiological studies in vitro have demonstrated a higher efficiency of 2% chlorhexidine gel in inhibition of Enterococcus faecalis growth (100%), compared with calcium hydroxide (58.5 %). Delgado R.J. et al. also stated that 2 % chlorhexidine gel demonstrates higher antimicrobial efficacy against Enterococcus faecalis than calcium hydroxide [8].
In endodontic procedures, the antibiotic pastes are also proposed as root canal medications due to their antimicrobial effect [9]. It should be noted that the development of antibiotic resistance of the pathogenic microflora of the root canal limits their further use. However, the microorganisms found in the samples from the infected root canals appeared to be sensitive to a group of tetracycline drugs that are broad-spectrum bacteriostatic antibiotics produced by Streptomyces species. They interact with the 30 S ribosome subunit and block binding of tRNA to mRNA as well as prevent the inclusion of new amino acids into the polypeptide chain. Tetra-cyclines are active against gram-positive and gramnegative bacteria, as well as mycoplasma and intra-cellular parasites. Nowadays, biosynthetic tetracy-clines have almost been substituted by semisynthetic drugs (doxycycline, minocycline). To stabilize tetra-cycline, an acid (citric or ascorbic acid) is introduced
"BicHUK cmoMamonoziï", № 3, T 33 - 2019
into the formulations. One of the medications that contains semi-synthetic tetracycline is MTAD (BioPure MTAD, Dentsply Sirona Endodontics), which demonstrates high antibacterial activity and suppresses pathogenic microflora [10].
According to the clinical protocol for the treatment of chronic periodontitis, calcium hydroxide-based medications are used for temporary obturation of the root canals [11, 12]. However, there are some difficulties in clearing the root canal from calcium hydroxide prior to permanent obturation, which significantly worsens the results of endodontic treatment in the long term [11]. Alternatively, more effective tetracycline-based and 2 % chlorhexidine gel - based drug compositions that have prolonged antimicrobial activity against pathogenic microflora, reduce pro-inflammatory cytokines and have an os-teotropic effect on periodontium can be suggested. The reduction in treatment time is also of great importance: calcium hydroxide-based medications are left for a minimum of 7 days, and the duration of therapy with 2% chlorhexidine gel is 3 days. Additionally, it should be noted that these drug compositions are easily removed from the root canal with sterile water, and this does not require additional expenses.
Purpose of the study. To determine the effectiveness of new tetracycline-based and 2 % chlor-hexidine gel - based drug compositions in the protocol of medical treatment of the root canal system on the basis of a comparative analysis of the results of clinical and radiological study of the treatment of chronic granulomatous periodontitis.
Research materials and methods. During 20132016, clinical and radiological observations of the effectiveness of treatment of destructive forms of pe-riodontitis were performed with the application of new tetracycline-based and 2% chlorhexidine gel -based drug compositions that were developed at the clinical base of the Institute of Dentistry (NMAPE named after P.L. Shupyk). 31 individuals, mean age 34.00 ± 8.93 years, were included into the study of the clinical efficacy of the application of tetracy-cline-based and 2 % chlorhexidine gel - based drug compositions in two-stage endodontic treatment of chronic granulomatous periodontitis in single root teeth (incisors, canines, premolars of upper and lower jaws, excluding the first premolars). Of these, 19 were women and 12 were men. The patients were randomly placed into two groups: the main group and control group. The main group included 14 patients with a mean age of 34.0±9.50 years. The control group included 17 patients with a mean age of 34.00 ±8.35 years.
All patients underwent an index evaluation of the oral cavity as well as clinical and radiological
examination. An index evaluation of the oral cavity was performed by determining the Green-Vermilion hygiene index, the papillary-marginal-alveolar index, and the DMF index (the total number of decayed, missing, filled teeth). The clinical study methods were conducted for patients in both groups, including: past medical history and history of present illness, absence or presence of pain, evaluation of hard and soft tissues in the affected area (redness, swelling in the apex projection area), palpation of the transitional fold, and a percussion test. Radiographic examinations were performed using periapi-cal radiographs and computed tomography. On the X-ray images, the periapical index (PAI) was determined according to the modification developed by A.M. Solovyova [14], and the area affected by the periapical lesion was measured according to the method presented by P.F. Dudia. The lesion area was estimated using the standard formula for determining the area of the irregular circle S = nxAxB, where A is the smallest diameter radius, B is the largest lesion diameter, and n is 3.14. [15]. The patients underwent a comprehensive examination before treatment, after treatment, 6 and 12 months after treatment. The difference in the area of lesion in the periapical tissues between visits was also determined.
Protocol of endodontic treatment. The patients of the main and control groups were treated according to the protocols of the order No. 566 of November 23, 2004, Ministry of Health of Ukraine.
During the first dental visit, in addition to the instrumental treatment of the root canal, the patients in the main group were treated with tetracycline-based drug composition used against pathogens and as a lubricant (ascorbic acid was introduced into the composition as a tetracycline stabilizer and as a component that has an effect on the inorganic material of the root canal). A 3 % solution of sodium hypochlorite, which was activated by ultrasound, was used for irrigation after each instrument. Before temporary obturation, the root canal was dried with paper points. Then a portion of tetracycline-based drug composition was applied for 5 minutes and after that completely removed with sterile water. After the canal was dried with paper points, 2 % chlor-hexidine gel - based drug composition was administered and remained there for 3 days. The cavity was thoroughly sealed with light-cured bandage. During the first dental visit, after instrumental and medical treatment, the patients in the control group underwent temporary obturation of the root canal with a calcium hydroxide medication, which was left under a sealed light-cured bandage for 7 days. After the indicated due dates, the temporary obturators were removed from the root canals of the patients of both
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groups, and permanent obturation was performed with the application of cold lateral condensation of the gutta-percha. All patients underwent radiological quality control of root canal obturation. Postendo-dontic restoration of the crown part of the tooth was individual and depended on the initial clinical situation. The effectiveness of treatment was evaluated on the basis of clinical and radiological data after treatment, after 6 and 12 months.
Data processing and analysis were performed using the IBM SPSS Statistics 20 application package (trial version). Normality of the sampling distribution of the mean was checked using the one-sample Kolmogorov-Smirnov test. The patient age and periapical defect area are presented as M±SD. The PAI index is presented as M ± SEM. Quantitative values that did not have a normal distribution were presented as median and interquartile range (Me (IQR)). Two groups that had abnormal distribu-
tion were compared using the Student's T-test and those that did not have normal distribution using the Mann-Whitney test. Associated sample comparisons were performed using the Student's T-test for paired samples.
Results of the study and their discussion. In the study groups, the evaluation of the oral hygiene condition revealed no significant difference in the oral hygiene index between the main (1.49 [0.99, 1.99]) and the control groups (1.49 [0.99, 1.74]) (p=0.696). According to the analysis of the intensity of inflammatory processes in periodontal tissues, no significant difference in the level of PMA was found between patients of the main (14.15 [9.68, 19.33]) and control (15.00 [6.70, 27.50]) (p=0.0779) groups. No significant difference in DMF was found between patients in the main (16.00 [12.50, 19.25]) and control (16.00 [12.50, 19.00]) (p=0.996) groups.
Table
PAI level and area of periapical defect in patients with granulomatous periodontitis before treatment,
6 and 12 months after treatment, in groups
№ Indicators Main Group Control group P
PAI before treatment, score 4.21±0,11 4.24±0,14 0,907
1 PAI 6 months after treatment, score 2.14±0,23 2.47±0,24 0, 338
PAI 12 months after treatment, score 0,09±0,03 0,59±0,28 0,021*
Area of periapical defect before treatment, mm2 3,29±0,11 3,34±0,11 0,718
2 Area of periapical defect 6 months after 2 treatment, mm 0,58±0,026 0,98±0,32 <0,001*
Area of periapical defect 12 months af- 2 ter treatment, mm 0,03±0,03 0,64± 0,024 <0,001*
Note : * - significant difference between groups.
Figure 1. Dynamics of changes in the periapical defect area (S) in patients with granulomatous periodontitis before treatment, 6 and 12 months after treatment, in groups.
According to the results of clinical and radio- area were registered in patients with chronic granu-logical studies, positive changes in the periapical lomatous periodontitis. In the main group where tet-
racycline and 2 % chlorhexidine were used, the level of the PAI index decreased from 4.21±0.1 to 2.14±0.23 after 6 months and to 0.09±0.03 after 12 months, respectively. The decrease in PAI in patients in the main group was 97.88 %. In the control group where calcium hydroxide was used, the level of the PAI index decreased from 4.24±0.14 to 2.47 ± 0.24 after 6 months to 0.59±0.28 after 12 months, respectively. The results of a comparative analysis of treatment between study groups showed no significant difference (p>0.05) between PAI before treatment and 6 months after treatment (p=0.338) (Table). However, there was a significant difference (p=0.021) of PAI levels between the groups 12 months after treatment.
The results of the determination of the area of the periapical defect revealed a significant difference (p<0.001) between the areas of the periapical defect 6 and 12 months after treatment, although at the beginning of treatment there was no significant difference (p=0.718) between the groups (Table, Figure). In the main group, the area of the periapical defect decreased from 3.29±0.11 mm2 to 0.58±0.026 mm2 after 6 months and to 0.03±0.03 mm2 after 12 months, i.e. by 99.12 % during the observation period. In the control group, the area of the periapical defect decreased from 3.34 ± 0.11 mm2 to 0.98±0.32 mm2 after 6 months and to 0.64±0.024 mm2 after 12 months, i.e. by 80.84 % over the same observation period.
The cases of exacerbation, disease recurrence, complications or allergic reactions were not reported over the treatment and follow-up periods, giving evidence of the safety of tetracycline-based and 2 % chlorhexidine-based drug compositions.
Thus, in patients treated with a combination of the suggested by the present study drug compositions including tetracycline administration at the stage of the root canal instrumentation and 2% chlorhexidine gel application for temporary obturation, the area of periapical defect decreased by 99.12 % after 12 months after treatment, that is 18.28% more (p<0.001) than in patients who received traditional treatment for temporary obturation with calcium hydroxide (the area of destruction decreased by 80.84 %), thus improving efficiency and reducing the time and cost of endodontic treatment.
The high clinical effectiveness of the suggested method of treatment is observed due to the sensitivity of the pathogenic microflora of the infected root canal to tetracycline, prolonged antibacterial action of chlorhexidine on the root canal system as well as reduction of inflammatory processes in the periapi-cal tissues. All these positive effects promote the bone tissue reparative regeneration in the periapical tissue.
Conclusions. The clinical and radiological findings of the study that were obtained over the period of treatment of patients with chronic granulomatous periodontitis give evidence of the feasibility of including the application of tetracycline-based drug compositions at the stage of the root canal instrumentation performed by both hand and rotary dental instruments and 2 % chlorhexidine gel for temporary obturation in the treatment protocol. The suggested approach increases the effectiveness and reduces the time and cost of endodontic treatme.
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The article was received 07.08.19
Б01 10.35220/2078-8916-2019-33-3-23-28
УДК 616-08+616.314.17-008.1:616.72-002.77
О.А. Глазунов, д.мед.н, Д.В. Фесенко, *С. А. Шнайдер, д. мед. н.
Державний заклад «Дншропетровська медична академш Мшютерства охорони здоров'я Украши»,
Дншро, Украша * Державна установа «1нститут стоматологи та
щелепно-лицево! хiрурril Нащонально! академи медичних наук Украши»
ЕФЕКТИВ1НСТЬ КОМПЛЕКСНОГО Л1КУВАННЯ ПАРОДОНТА У ХВОРИХ НА РЕВМАТО1ДНИЙ АРТРИТ
Мета до^дження. Вивчення ефективностi застосу-вання препаратiв 1мудон та Квертiгiал у складi комплексного лiкування ХГПу хворих на РА. Матерти та методи дослгдження. Проведено сто-матологiчне обстеження та лiкування 80 хворих на РА вiком вiд 24 до 66 роюв, яким дiагностовано ХГП
2 стадИ. В залежностi вiд застосовано'1 схеми лку-вання пащенти розподшет на 4 групи. Патентам групи 1 до традицшно'1 схеми л^вання ХГП, призна-чали 1мудон, групи 2 - аплкацИ гелю Квертгiал, групи
3 - комбiнацiю препаратiв 1мудон та Квертiгiал. Па-цiенти групи 4 отримували традицшну терапт ХГП. Результати дослгдження та ¡х обговорення. Аналез отриманих даних виявив, що провiдними факторами, ят впливають на стан тканин пародонту безпосере-дньо пiсля л^вання хворих на РА е наявний бактерiа-льний фон та показники мiсцевого iмунiтету. Най-бшьш ефективною серед до^джуваних схем лкуван-ня ХГП на фот РА виявився комплекс, що включае комбiнацiю препаратiв 1мудон та Квертiгiал. Ключов1 слова: ревматогдний артрит, пародонтит.
© Глазунов О. А., Фесенко Д. В., Шнайдер С. А., 2019.
