Improving the efficiency of preoperative preparation of patients with generalized periodontitis, selected for intraosseous dental implantation and prevention of early postoperative complications Текст научной статьи по специальности «Клиническая медицина»

14. Koyanagi T. Comprehensive microbiological findings in periimplantitis and periodontitis / T. Koyanagi, M. Sakamoto, Y. Takeuchil, N. Maruyama // J. Clinical Periodontology.-2013. -№40. -P.218-226.

15. Леус П.А. Значение некоторых индексов в эпидемиологических исследованиях болезней па-родонта / П.А. Леус // Стоматология.-1990. - Т.69, № 1.-С. 80-83.

16. Manchini G. Immunochemical quantitation of antigens by single radial immunodiffusion / G. Manchini, A.O. Garbonara, S.F. Heremans // Immuno-chemistry. -1965. - Vol. 2, N 6. - P. 234-235.

ПОВЫШЕНИЕ ЭФФЕКТИВНОСТИ ПРЕДОПЕРАЦИОННОЙ ПОДГОТОВКИ БОЛЬНЫХ С

ГЕНЕРАЛИЗОВАННЫМ ПАРОДОНТИТОМ, ОТОБРАНЫХ ДЛЯ ВНУТРИКОСТНОЙ ДЕНТАЛЬНОЙ ИМПЛАНТАЦИИ И ПРОФИЛАКТИКА РАННИХ ПОСЛЕОПЕРАЦИОННЫХ

ОСЛОЖНЕНИИЙ

Гударьян А.А. Шандыба С.И.

Самойленко И.А.

ГУ «Днепропетровская медицинская академия МЗ Украины» Кафедра хирургической стоматологии, имплантологии и пародонтологии Днепр, Украина

IMPROVING THE EFFICIENCY OF PREOPERATIVE PREPARATION OF PATIENTS WITH GENERALIZED PERIODONTITIS, SELECTED FOR INTRAOSSEOUS DENTAL IMPLANTATION AND PREVENTION OF EARLY POSTOPERATIVE COMPLICATIONS

Gudaryan A.A., Shandyba S.I., Samoylenko I.A.

SE "Dnipropetrovsk medical academy Ministry of Health of Ukraine" Oral surgery, implantology andperiodontology department

Dnipro, Ukraine

АННОТАЦИЯ

В настоящее время расширены показания к использованию метода дентальной имплантации, что позволяет добиться определенных успехов в реабилитационных мероприятиях у больных с вторичной аден-тией. Однако малоизученными являются особенности подготовки и проведения дентальной имплантации у больных генерализованным пародонтитом, не определены критерии отбора и оценки эффективности им-плантационного лечения у таких пациентов.

Цель исследования: повышение эффективности внутрикостной дентальной имплантации у больных генерализованным пародонтитом путем совершенствования реабилитационных мероприятий на предоперационном этапе и использование в последующем иммунокоррегирующих и антиоксидантных средств.

Проведены общеклинические, биохимические, рентгенологические исследования у 60 человек больных генерализованным пародонтитом которые были разделены на две группы.

Результаты наглядно показали, что поэтапное проведение профессиональных гигиенических вмешательств, фотодинамической антибактериальной терапии, коррекция местного иммунитета и функционирования антиоксидантной системы позволяет качественно улучшить реабилитацию больных хроническим генерализованным пародонтитом, отобранных для осуществления дентальной внутрикостной имплантации.

Разработан комплекс критериев для оценки эффективности реабилитационных мероприятий у больных генерализованным пародонтитом, включающий полноту регрессии клинических симптомов заболевания, уровень нормализации биоценоза пародонтальных тканей, локального иммунитета и перекисного окисления липидов. Высокая успешность реабилитационных мероприятий с использованием метода дентальной имплантации у больных генерализованным пародонтитом достигается при комплексном воздействии, включающем этапное использование профессиональных гигиенических мероприятий, фотодинамическую терапию, иммуномодулирующие и антиоксидантные препараты, что позволяет устранить местные вреднодействующие факторы, добиться элиминации вирулентных бактерий (в том числе пародонтальных) и нормализации функционирования иммунной и антиоксидантной систем организма.

ABSTRACT

Now indications to use of a method of dental implantation that allows to achieve a certain progress in rehabilitation actions from patients with a secondary edentulous are expanded. However, features of preparation and carrying out dental implantation at patients with a generalized parodontal disease are low-studied, selection criteria and estimates of efficiency of implantation treatment at such patients aren't defined.

Research objective: improvement of results of intra bone dental implantation at patients with a generalized periodontal disease by improvement of rehabilitation actions at a preoperative stage and use in the subsequent the immune-corrective and antioxidant means.

All-clinical, biochemical, radiological trials at 60 people of patients are conducted by a generalized periodon-tal disease which were divided into two groups.

Results it is Visually shown that Stage-by-stage carrying out professional hygienic interventions, photody-namic antibacterial therapy, correction of local immunity and functioning of antioxidant system allows to improve qualitatively rehabilitation of patients by the chronic generalized periodontal disease selected for implementation of dental intra bone implantation.

The complex of criteria is developed for an assessment of efficiency of rehabilitation actions at patients with the generalized periodontal disease, the periodontal of fabrics, local immunity and radical oxidation of lipids including completeness of regression of clinical symptoms of a disease, level of normalization of a biocenosis. High success of rehabilitation actions with use of a method of dental implantation at patients with a generalized periodontal disease is reached at the complex influence including landmark use of professional hygienic actions, pho-todynamic, immune-corrective and antioxidant therapy that allows to eliminate local detrimental factors, to achieve elimination of virulent bacteria (including the parodontopatogenic) and normalization of functioning of immune and antioxidant systems of an organism.

Ключевые слова: дентальная имплантация, заболевания пародонта, иммунокорректирующая и анти-оксидантная терапия, Helbo-терапия.

Keywords: dental implantation, periodontal disease, immune-corrective antioxidant therapy, Helbo-therapy.

Every day indication for operation of dental implantation become wider, it ensure success and stablety of positive results at the patients, which are treated by the method of intraosseous dental implantation. It is not discussable question that success of osseointegration depend on preparation of patient to operation of in-traosseous dental implantation [1, 2].

Research purpose: improvement of rehabilitation measures at patients with generalized periodontitis, selected for intraosseous dental implantation.

Materials and research methods

Under a supervision, there was 60 patients with generalized periodontitis selected for intraosseous dental implantation. Among the probed there was 28 (46,6 %) men and women 32 (53,3 %). Middle ages was 48,7±1,1 years. A more than half of patients (61,5 %) was in age from 42 to 57 years. Concomitant pathology absented for them.

The generally accepted clinical researches, including collection of complaints, anamnesis and determination of allergic status, visual instrumental estimation of the state of tissues of gum were conducted all of patients. In area of every tooth measure periodontal pocket and sizes of recession of gum were conducted [3, 4].

Standard orthopantomography was in process utilized on visiograph for more objective diagnostics of the state of bone tissues of alveolar sprouts.

During the leadthrough of these researches patients parted on two groups, comparable on a floor and age. Patients at which professional hygienes conducted in a complex with traditional conservative therapy of generalized periodontitis were plugged in the I group (22 patients). The second group (38 patients) consisted of patients which therapeutic treatment was planned in a greater volume - additionally to the generally accepted therapy a patient was appoint antioxidant preparation of Mexidol and immunological modulator Ron-coleukin in the generally accepted dosage.

As antibiotic therapy at the patients of the I group were natively utillized by containing chlorhexidine fa-

cilities («Givaleks», «Geksoral») as appliques, irrigations and rinses [5]. And for the patients of the II group of - photodynamic impact on a bacterial flora with application system of HELBO (HELBO Photodinamic Systems) [6, 7].

Research results and their discussion

Generalized periodontitis of both groups rotined the analysis of primary inspection of patients their likeness on clinical, paraclinical and laboratory descriptions. The middle indexes of periodontal indexes testified to the presence of the expressed, chronic inflammatory-destructive process in tissues of paradontium. It was set that the state of paradontium was associate with the level of hygiene of cavity of mouth. In both groups the value of the simplified index of hygiene of cavity of mouth of OHI-S varied from 1,99 u. to 2,68 u. and made on the average 2,41±0,3 u.

Results of microbiological efficiency of «Givaleks» and «Geksoral» in relation to a de bene esse-pathogenic flora at patients of the I group were excellent in 90,0% cases. It is set at the same time that on specific periodontal exciters the named preparations rendered insufficient efficiency. So, after two weeks after completion of therapy, frequency of selection from the periodontal pockets of such representatives of microorganisms as Porphyromonas gingivalis, Bac-teroides forsythus at the half of patients practically corresponded initial.

Opposite, at the use of photodynamic therapy at patients of the II group the best clinical and microbiological results were registered by comparison to previous treatment. After 3-4 procedures for 32 (84,2%) patients a clinical picture corresponded a norm - the mucous membrane of gums acquired a pink color, densely adjoined to the necks of teeth, parodontal indexes corresponded a norm. To 7-8 day the use of Helbo-therapy for all of patients (100% cases) complete regression was marked clinical and paraclinical signs of chronic generalized periodontitis.

The microbiological researches conducted in this period testified that the attained results were condi-

tioned due to the expressed antimicrobial action of pho-todynamic therapy on a causing periodontitis bacterium. Frequency of their selection from periodontal pockets already through 3-4 procedures went down. To this time at most patients of the II group (in 61,4% cases) complete elimination of basic exciters of generalized periodontitis is marked under influence of Helbo-therapies. After the use of photodynamic therapy during 7-8 days, disappearing of basic causing periodontitis microorganisms from pathological gingival pockets was observed at 94,4% cases. Thus, the conducted microbiological researches confirmed high antibacterial efficiency of Helbo are therapies and prove possibility of its effective using for the leadthrough of rehabilitation measures at patients with pathology of paradontium.

While at further researches rotined the patients of the I group, that stability by the attained professional hygiene and antimicrobial therapy of rehabilitation at patients generalized periodontitis increases under influence of correction of the initially broken processes of the local immune reacting and antioxidant defence. Appeared, that by reason of instability of the got results at patients generalized periodontitis of the I group are un-removed after the conducted professional hygiene in combination with antibacterial therapy local immunodepression and violation of disbalance in functioning of cytokine and antioxidant systems.

Thus, increase of efficiency rehabilitation measures at patients generalized periodontitis is application of complex influences which include a stage use of professional hygienical measures, photodynamic therapy (systems of Helbo), immuno-modulator of «Roncoleukin» and antioxidant preparation of mexidol and allowed effectively to remove local harmful operating factors (dental deposits), obtain elimination of virulent bacteria, including parodontopathogenic bacteria and normalization of functioning of immune and antioxidant systems of organism.

Conclusions

1. Stage-by-stage leadthrough of professional hygienical interferences, to antibacterial photodynamic therapy, allows the correction of the local immunity and functioning of the antioxidant system high quality to improve the rehabilitation of patients chronic generalized periodontitis, selected for intraosseous dental implantation.

2. Efficiency of rehabilitation at patients generalized periodontitis it is necessary to estimate in accordance with the complex of criteria: plenitude of regression of clinical symptoms of disease, level of normalization of biocenosis of periodontal tissues, local immunity and radical oxidization of lipids.

References

1. Mashchenko I.S. Surgical treatment of generalized periodontitis at the patients with diabetes mellitus type 2 by using various types of autologous platelet rich fibrin / I.S. Mashchenko, A.A. Gudaryan, S.I. Shandyba // J. Clin Med Kaz.- 2015.- Vol. 4.- №№38. - P. 30-36.

2. Wennström J.L., Palmer R.M. Consensus report of Session C.In: Lang N.P., Karring T., Lindhe J. (eds). Proceedings of the 3rd European Workshop on Periodontology; Implant Dentistry. Berlin: Qvint-es-senz, 1999; 255-259.

3. Mashchenko I. Periodontal dis-eases.2003;212.

4. Vered Y. Teeth and implant surroundings: Clinical health indices and microbiologic parameters / Y. Vered, A. Zini, J. Mann // J. Quintessence Interna-tional.-2011.-№42.-P.339-344.

5. Deppe H. Nonsurgical antimicrobial photody-namic therapy in moderate vs severe periimplant defects: A clinical pilot study / H. Deppe, T. Mücke, S. Wagenpfeil, M. Kesting // Quitessence International. 2013. -Vol.44. -№4. -P.609-618.

6. Knopka K. Photodynamic therapy / K. Knopka, T. Goslinski // Dent Res.- 2007.- №86.-P.694-707.