CC BY
11
https://doi.org/10.29013/ELBLS-21-3-15-18
Yurii Yarov
Donetsk National Medical University, Dental Department 2, Kramatorsk, Ukraine E-mail: [email protected]
CLINICAL AND X-RAY CHARACTERISTICS OF THE CONDITION OF PERIODONTAL TISSUES IN PATIENTS WITH GENERALIZED
PERIODONTITIS ACCOMPANIED BY DIFFERENT TYPES OF REACTIVITY OF THE ORGANISM IN REMOTE PERIODS OF TIME
Abstract. The reactivity of the organism affects the pathogenesis of generalized periodontitis and the subsequent clinical and radiological stabilization of the pathological process after treatment. Key words: periodontitis, reactivity of the organism, stabilization, recurrence.
Introduction. Mass prevalence, significant growth of destructive forms in people of young, working age, high recurrence rate of the disease make the problem of generalized periodontitis one of the central in dentistry [1,2,3]. Inflammatory-destructive lesions of the periodontium lead to tooth loss and dysfunction of the dental-maxillary system, have a negative impact on the body in the whole, which causes not only medical but also socioeconomic significance [4,5,6]. It is a well-known fact that generalized periodontitis is a pathological process that develops in periodontal tissues because of the combined influence of various general and local exogenous and endogenous factors [7,8,9]. At the same time there are many neuro-regulatory, neurotrophic, biochemical, immunological and functional disorders, microcirculatory and metabolic disorders, disorders of almost all the types of metabolism develop: protein, lipid, carbohydrate, mineral, that eventually leads to irreversible destruction of the periodontium and alveolar bones [10-13].
In connection with the above-mentioned facts, the search for new tools, methods and approaches to comprehensive treatment of generalized periodontitis remains relevant [14,15]. General and local
drug therapy has been widely used in the complex treatment of this pathology [16,17]. However, the question of clarifying the key mechanisms of development and course of the disease remains relevant, in particular — depending on the condition of reactivity of the organism, which has a significant impact on the pathogenesis of generalized periodontitis and further clinical and radiological stabilization of the pathological process in the long-term perspective -after the intervention on periodontal tissues [18,19].
Objectives. The aim of this research was to study the clinical and radiological state of periodontal tissues (recurrence, stabilization) after the indications for patch surgery in patients with generalized periodontitis of II, III degrees of severity accompanied by normo-, hyper- and hyporeactivity of the body within the period between 6 months and 2 years.
Materials and methods. 216 patients (82 men and 134 women), at the age between 45 and 55 years with the diagnosis of generalized periodontitis of II, III degree of severity, chronic course were examined. The diagnosis was made on the basis of clinical examination, radiography, determination of periodontal samples in accordance with the International Classification of Diseases ICD-10. Depending on the state
of reactivity of the body, the patients were divided into three groups: the first one included the patients with normoreaction (132 people, 61%); the second group contained the patients with hyperreaction (46 people, 21%); the third one consisted of the patients with hyporeaction (38 people, 18%). The division of patients into groups depending on the state of reactivity of the organism was performed on the basis of the identified clinical and laboratory differences. All the patients underwent patch surgery. Clinical and radiological condition of periodontal tissues was assessed after 6 months, 1 year and 2 years. Special ttention was paid to the color, tightness, relief of the marginal edge of the gums, the presence of edema, the severity of redness, pain. In order to objectively assess the condition of the periodontium, periodontal indices and samples were determined:
• papillary-marginal-alveolar index of PMA (in% — from 0 to 100%);
• intensity of exudation from periodontal pockets (in mm2);
• periodontal index (PI) Russell (in points — from 0 to 8);
• Schiller-Pisarev's test (visual qualitative assessment of the intensity of staining of the oral mucosa).
To assess the degree and nature of the destruction of bone tissue of the alveolar process, radiological examinations were performed (radiography of individual teeth by intraoral contact method; panoramic radiography of the jaws).
Statistical processing of the obtained digital data was performed using the computer program Statis-tica 8.0 (STA862D175437Q).
Results. The results of remote clinical observations in patients with generalized periodontitis of II, III severity with normoreactivity of the body are presented in 6 months after comprehensive treatment the inflammatory-destructive process in patients of the first group on the background of the achieved clinical and paraclinical indicators did not progress in 94.7% ofpeople. At the same time during the exami-
nation there were no clinical signs of inflammation in the periodontal tissues. There was no increase in the index of PMA, Russell, Schiller-Pisarev's test and the amount of exudate from periodontal pockets compared with the data obtained immediately after the treatment. The radiographs confirmed the remission of the process in the interdental alveolar septa: their height was maintained, the cortical layer was dense, osteoporosis ofbone tissue and the expansion of the periodontal gap was not determined. During this observation period, 5.7% of patients had a recurrence of the disease with the corresponding dynamics of clinical and paraclinical parameters. The clinical and radiological signs of the disease corresponded to the initial level. Such patients underwent the necessary set of therapeutic measures. After 1 year, 88.6% of patients in the first group remained in remission, which was characterized by positive dynamics of all the studied indicators. After 2 years, the stabilization of the process was registered in 82.9% of cases.
The results of remote clinical observations in patients with generalized periodontitis II, III degree of severity accompanied by hyperreactivity of the body in 6 months after comprehensive treatment of inflammatory-destructive process in patients of this group on the background of clinical and paraclinical indicators did not progress in 86.9% of people. At the same time during the examination there were no clinical signs of inflammation in the periodontal tissues. There was no increase in the index of PMA, Russell, Schiller-Pisarev's test and the amount of exudate from periodontal pockets compared with the data obtained immediately after the treatment. The radiographs confirmed the remission of the process in the interdental alveolar septa: their height was maintained, the cortical layer was dense, osteoporosis of bone tissue and the expansion of the periodontal gap was not determined. During this observation period, recurrence of the disease with corresponding dynamics of clinical and paraclinical parameters was observed in 3 patients. The clinical and radiological signs of the disease corresponded to the initial level.
Such patients underwent the necessary set of thera- udate from periodontal pockets compared with the
peutic measures. After 1 year, 78.3% of patients in data obtained immediately after the treatment. The
the second group remained in remission, which was radiographs confirmed the remission of the process
characterized by positive dynamics of all the stud- in the interdental alveolar septa: their height was
ied indicators. After 2 years, the stabilization of the maintained, the cortical layer was dense, osteoporo-
process was registered in 69.6% of cases, which was sis of bone tissue and the expansion of the periodon-
13.3% more than in patients with normal body re- tal gap was not determined. During this observation
activity. period, recurrence of the disease with corresponding
The results of remote clinical observations in dynamics of clinical and paraclinical parameters was
patients with generalized periodontitis of II, III se- observed in 2 patients. The clinical and radiological
verity accompanied by hyporeactivity of the body signs of the disease corresponded to the initial. Such in 6 months after comprehensive treatment of patients underwent the necessary set of therapeutic
inflammatory-destructive process in patients of this measures. After 1 year, 78.9% of patients in the third
group on the background of clinical and paraclini- group remained in remission, which was character-
cal indicators did not progress in 89.4% of people. ized by positive dynamics of all the studied indica-
At the same time during the examination there were tors. After 2 years, the stabilization of the process
no clinical signs of inflammation in the periodontal was registered only in 68.4% of cases, which is 14.5%
tissues. There was no increase in the index of PMA, more than in patients with normoreactivity of the
Russell, Schiller-Pisarev's test and the amount of ex- body.
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