CC BY
50
UDC 616.314-089
DYNAMICS OF WOUND HEALING AFTER SURGICAL INTERFERENCE ON PERIODONTAL TISSUES BY USING TRANSCRANIAL STIMULATION IN POSTOPERATIVE PERIOD
A.A.Kondrateva
Yaroslav-the-Wise Novgorod State University, anna_fenix@inbox.ru
Results of morphological research of marginal gingival tissues before surgical treatment and in process of wound healing in patients with traditional postoperative period and application of transcranial stimulation are presented. It is shown that transcranial stimulation accelerates wound healing and is an effective method of non-drug treatment of periodontal patients after surgery.
Keywords: parodontitis, transcranial stimulation, wound healing, epithelization
Представлены результаты морфологического исследования тканей маргинальной десны до хирургического лечения и в процессе ранозаживления у пациентов с традиционной тактикой ведения в послеоперативном периоде и при применении транскраниальной стимуляции. Показано, что траскраниальная стимуляция ускоряет процесс ранозаживления и является эффективным методом немедикаментозного лечения пародонтологических больных после хирургических вмешательств.
Ключевые слова: пародонтит, транскраниальная стимуляция, ранозаживление, эпителизация
Relevance
Surgical methods take leading place in complex treatment of parodontitis [4-7]. Other means and methods (general drug therapy, physiotherapy, orthopedic and orthodontic treatment) are complementary and enhance results of surgical treatment. The problem of wound healing remains one of the topical problems in modern medicine. Due to increase of allergic and
toxic-allergic reactions improvement of non-drug treatments for patients in postoperative period becomes important.
It is known that opioid peptides are involved in regulation of pain, have marked sedative and anti-stress effect and influence on regulation of various physiological functions including stimulation of reparative regeneration of damaged tissues. The method of activating of opioidergic brain structures is transcranial stimu-
lation (TCS) [1,2,6,7]. TCS therapy was developed by specialists of St. Petersburg center of TCS under the guidance of State Prize laureate of USSR and Russian Federation and Government prize laureate Professor Lebedev V.P., MD.
Previous studies have shown that TCS has limited number of contraindications, allows reducing number of used drugs, and accelerates regeneration. Acceleration of ulcers healing of stomach and duodenum, skin burns, acceleration of scarring processes in myocardium and treatment of sensorineural hearing loss associated with damage of auditory nerve of different origin [6,7] is already confirmed clinically. In dentistry technique of tran-scranial stimulation was first applied by Kiryanova T.D. (1992) for the treatment of pain syndromes of the maxillofacial region.
Goal of the research — to determine the influence of transcranial stimulation on process of wound healing after surgical interference on periodontal tis-
sues.
Materials and methods
The study involved 17 patients with chronic generalized periodontitis of moderate severity with symptoms of hypertrophy of gums between ages of 27 to 77 years. Before treatment all patients were sanitized, trained in oral hygiene. According to indications temporary or-thotic constructions were made. Patients underwent surgery with gingivectomy with gingivoplasty, curettage of teeth-gums.
Depending on treatment in postoperative patients were divided into 2 groups. The first group included 10 patients including 3 men and 7 women. In patients of this group after gingivectomy with gingivoplasty and curettage the wound was covered with gingival dressing «Sep-topak» of «Septodont» for 2 days. After surgical treatment these patients were given «Nimesil» in dosage of 0.1 in case of pain, rinser «Kurasept» 3 times day in form of oral baths and application to gum «Solcoseryl-dental paste» 3 times a day.
The second group included 7 patients including 3 women and 4 men. After gingivectomy with gin-givoplasty and curettage the wound was also covered with gingival dressing «Septopak» of «Septodont» for 2 days. After surgical treatment in this group course of transcranial stimulation by apparatus «Transair 03» by placing electrodes on the frontal and occipital region has been carried out. 5 procedures performed daily starting from the day of surgery. Strength of the bipolar impulse current was up to 1.8 mA, the duration of session 25-30 minutes.
The process of wound healing was assessed during 9 days visually: edema, hemorrhage, fibrinous pellicle, color of gingival margin. When examined wound surface was treated with 0.05% of chlorhexidine.
Gingivectomy with gingivoplasty was performed in traditional techniques. Continuous incision with scalpel HU-FRIADI №15S was performed. Curettage of teeth-gums has been carried out with manual curettes of LM firm with compliance of basic principles of this manipulation. After section tissue was removed in form of whole strips and placed in 40% of
formalin solution. Histological samples were stained with hematoxylin-eosin and examined by light microscopy. Additional correction of gingival margin according to orthopedic indications was performed on the 9th day in 4 patients of the first and in 4 patients of the second group with following histological examination of removed tissue.
Results and discussion
Patients of the first group the day after surgery had slight swelling, fibrinous pellicle and hyperaemia within marginal gingiva or dressing area. During wound toilet with cotton pellet with 0.05% of chlorhexidine wound surface was bleeding. Histology samples taken during surgery showed picture of inflammation. Among thorny layer of epithelial cells adjacent to wound sites, destructive changes as well as leukocytes and macrophages were registered. Number of epithelial cells did not have nucleus. In lamina propria of mucous membrane we identified fibroblasts and macrophages. Mast cells were located along vessels with effects of degranulation. Plasmocytic assosiatins were detected among connective tissue.
Patients of the second group had histology picture of inflamed periodontal tissues that did not differ from the first group of patients. In the same period edema and hyperemia of wound persisted only in marginal gingiva, wound toilet with cotton pellet caused insignificant bleeding.
Edema was not observed in patients of the first group after 9 days, hyperemia persisted only in marginal gingiva, bleeding worried only 2 patients during tooth brushing. Among cell elements of basal layer of epithelium mitotic figures has been revealed. In loose connective tissue of papillary layer cell elements were noted, among which fibroblasts were prevailing. Among normal blood vessels there were small newly-formed ones. The data are shown in Figure 1.
Edema was not visually determined in patients of the second group after 9 days, color of gums was pink and bleeding was not detected. Histological picture differed by great number of mitotic figures among cells of basal layer of epithelium. In loose connective tissue of papillary layer small newly-formed blood vessels, which number was greater than in first group, were determined.
Fig.1. Lamina propria of mucosa of gums. Small, newly-formed vessels. Staining: hematoxylin and eosin. *400
Fig.2. Epithelialization of wound surface of marginal gingiva in patients of the second group. Staining: hematoxylin and eosin. *400
Visual pattern of collagen fibers was comparable to norm. Aareas of epithelialization of the wound (Fig.2).
Conclusion
The results show that using of transcranial stimulation after surgical interference on periodontal tissues accelerates the process of wound healing as evidenced
by significant formation of blood vessels and collagen fibers.
1. Barkova S.V. Dynamics of reparative processes of the oral mucosa in patients with lichen planus on the background of complex treatment with transcranial stimulation / S.V.Barkova, V.F.Mikhalchenko, N.I.Lamtyugina // Proc VolGMU. T.61. Volgograd, 2005. P.301-303.
2. Barkova S.V. Alternative treatment in the therapeutic den-
tistry clinic / S.V.Barkova, V.F.Mykhalchenko, T.S.Chizhikova, N.N.Trigolos, A.G.Petrukhin, E.E. Vasenev,
I. V. Firs ova, O. A. Antipova; ed. RAMS academician prof. V.I.Petrov. Volgograd, 2006. 150 p.
3. Biochemistry of the oral cavity: Guidelines for laboratory and practical work / Comp. L.V.Andreeva. Yaroslav the Wise NovSU, Velikiy Novgorod. 2006. 22 p.
4. Borovskiy E.V., Leont'ev V.K. Biology of the mouth. M.: Medical Books, N. Novgorod: Izd NGMA, 2001. 304 p.
5. Grudyanov A.I. Periodontal disease. Moscow: Publishing
House «Medical informed agency», 2009. 336 p.
6. Periodontal diseases / ed. L.Y.Orekhova. M., 2004. 432 p.
7. Transcranial electrostimulation: an experimental clinical
study. Volume 1. (Third edition). St. Petersburg, 2005. 528 p.
8. Transcranial electrostimulation: an experimental clinical
study. St. Petersburg, 2003. 528 p.
