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Vinogradova A. V.
candidate of medical science, docent of children dentistry's department associate dean of dentistry's faculty, Irkutsk state medical university
Anisova A.A. candidate of medical science Suchilina M.I.
resident of surgical dentistry and maxillofacial surgery's department
Irkutsk state medical university DOI: 10.24411/2520-6990-2019-10520 THE OPTIMIZATION OF OSTEOREPARATIVE PROCESS AFTER VESTIBULOPLASTY
Abstract
The article describes the clinical research about the treatment of patients with parodontium's diseases caused by shallow vestibule of oral cavity using the vestibuloplasty. The postoperative period was compared in two groups of patients: in the first group iodoform tampon wasn't used to cover a wound, and in the second it was used. The more favorable process ofpostoperative period was proved by denial of using of iodoform tampon.
Key words: parodontium, diseases, shallow vestibule of oral cavity, vestibuloplasty, postoperative period, optimization, iodoform tampon.
The problem of parodontium's diseases has a particular importance at this moment. According to the WHO, more than 95% of the population over 45 years old suffers from parodontitis, and the increase of incidence is due to people under 50 years of age. It makes doctors explore the questions of diagnosis, treatment and prevention of this pathology deeper. Treatment of parodontium's diseases is a complex event, and the surgical part occupies a large place in it, because only using of various surgical interventions allows to suspend the progression of the disease and ensure the long-term stabilization of the inflammatory process in the most number of patients.
One of methods of surgical treatment of periodon-tal diseases is the operation which deepens a vestibule of oral cavity — vestibuloplasty. This manipulation is healing and preventing.
A shallow vestibule of oral cavity is a reason of development of local gingival recession, bone destruction and exposure of necks of mandible's front teeth (aesthetic defect). In addition, it leads to a raising of their sensitivity, mobility and to a loss of this group of teeth in the end. Parodontium's changes are hard to notice in children and teenagers cause of its significant compensatory capabilities. However, destruction takes place in surrounding teeth tissues and the consequences of it manifest with the age and need surgical interventions to stabilize a pathological processes in parodon-tium.
Despite the diversity of vestibuloplasty's techniques they pursue one goal — to increase a height of attached gum.
In this work we set a target to compare the postoperative period in patients after vestibuloplasty with io-doform tampon and without it. 38 patients with a shallow vestibule of oral cavity in the ages between 25 and 40 years without serious common pathology were examined and cured to do it. This group of patients didn't have a previous surgical treatment before. We divided them into two groups: the 1st group is the patients with
postoperative wounds which weren't covered by iodoform tampon; the 2nd group is patients which had it on the postoperative wounds.
While the examination, patients complained about pain in the gums, exposure of front lower teeth's necks and roots, mobility and hypersensitivity to chemical and temperature irritants. All patients had a shallow vestibule of oral cavity, mobility of front lower teeth (the Ist-IInd levels), exposure of its necks and roots by 23 mm. A gingival margin was edematosed and slightly hyperemic, the depth of periodontal pockets was from 3 to 5 mm. In 40% of cases, initial changes in the bone tissue were observed on the top of the alveolar ridge, the height of the septums didn't change. The destruction of the interalveolar ridges was by 1/3 in 60% of patients. The areas of osteoporosis were noticed.
Patients of both groups were made the vestibulo-plasty by Edlan-Mejchar in ambulatory conditions. Pre-operative preparation included a professional teeth cleaning, conservative medication. Cifran CT 500/600 mg — 1 tablet 2 times a day was prescribed 2 days before the operation. The stages of the operation: after antiseptic treatment of surgical area by solutions of fura-cillin 1:5000 and chlorhexidine 0,02% and under infiltration anesthesia by Sol. Ultracaini DS — 1.7 1: 200000 the apron-shaped incision is made in the projection of frontal group of teeth of mandible, the mucous flap is formed; the base of it is faced to the alveolar ridge. The mucous membrane of the flap is flaked off the underlying periosteum. The periosteum is displaced on a depth of the arch of the created oral cavity's vestibule. Hemostasis during the operation.
The wounds' surfaces of the 1st group were covered by an iodoform tampon. It was changed in every 2 days. A bandage with solcoseryl or vitamin A was applied on the 7th day.
In the postoperative period, patients of both groups were recommended to continue taking the antibiotic up to 7 days, they were also prescribed NAIDs (Nise, Nimesil) for 3-4 days, antiseptic treatment of oral cavity by chlorhexidine or furacillin solutions (their concentrations were indicated above). As the
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postoperative wound were healing in the 1st group on the 6-7th days and in the 2nd group on 10-14th days the special exercises were prescribed to prevent scarring: to pick air under lower lip (10 times for 10 exercises) and to pull lips like a straw (5 times for 10 exercises); finger and hydromassage in order to restore microcirculation (2-3 times a day for 2 minutes). All patients were prescribed a radiation from a helium-neon laser since the 2nd day after the operation. It has a regenerating, disinfecting and analgesic effects. 5 procedures for 3 minutes were conducted on a skin in projection of a postoperative wound.
During the postoperative period patients were prescribed for a daily examinations to measure a condition of wounds on the 1st, 3rd, 7th, and in patients of the 2nd group on the 10th days according to the following criteria: pain component, edema of postoperative area, hy-
giene of oral cavity (hygiene index by Fedorov-Volod-kina), break of articulation, periods of epithelialization of wound surface, periods of disability.
The 1st day of the examination showed the next: patients of both groups complained about aching pain, increased by eating and talking, which decreased in patients of the 1st group by the 3rd day and was observed only in 30%. Patients of the 2nd group noted the pain component of the same intensity. It can be explained by changing of iodoform tampon on the 2nd day after the operation. It was an additional trauma. In the 1st group pain wasn't observed, and patients felt comfortable after the operation by the 7th day. In the 2nd group, in 80% of patients, the intensity of pain significantly reduced in comparison with the 3rd day. The total relief of pain occurred by the 10th-14th days after replacing the iodoform tampon with a keratoplastic tampon (figure 1).
Figure 1. The indicators of pain component in postoperative period
On the 1st day after operation, edema of soft tissues of the chin region was observed in all patients of both groups, and the volume of it was significantly less in patients of the 1st group than in patients of the 2nd group.
An edema completely disappeared in patients of the 1st group on the 3rd day after the operation, in the 2nd group it remained in 95% of cases. 10% of patients referred to a persistent edema by the 7th day, which completely disappeared by the 10th day (figure 2).
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1st dav 3 ro dav 1" group 100 0
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Figure 2. The edema of postoperative area
We measured the hygiene index by Fedorov-Vo-lodkina and received the following results. All patients had unsatisfactory oral hygiene at the first visit. By the 3rd day, patients of the 1st group were able to perform oral hygiene of sufficient quality, which affected the indicator of its index. The hygiene index was from 4.5 to 5.0 in the 2nd group, it matches to unsatisfactory oral
hygiene. Patients of the 2nd group were able to adequately clear their teeth only by the 7th-10th days. It was connected with pain, edema of postoperative area's soft tissues and presence of an iodoform tampon in oral cavity; these factors created significant difficulties for an adequate oral hygiene (table 1).
Table 1.
The group / days after the operation 1st day 3rd day 7th day
1st group 5,2 1-1,5 1-1,2
2nd group 5,5 4,5-5,0 1,2-1,5
It should be noted that the patients of the 1st group indicated difficulties in speaking and eating only during the first 3 days, then the articulation restored and patients could fully communicate. The patients of the 2nd group had significant difficulties in communicating up to 10-14 days until the moment of extraction of iodo-form tampon.
The initiation of epithelialization of wound surface in patients of the 1st group was noted by the 2-3rd day after operation, it was evidenced by a fibrinous plaque on the wound surface. Moreover by the 6-7th day, epithelialization made possible to prescribe finger massage and myogymnastics, which positively affected the creating of vestibule of oral cavity.
An epithelialization in patients of the 2nd group occurred under iodoform tampon much slower because a fibrinous plaque formed in small quantities on wound surface. Myogymnastics and finger massage were prescribed on the 10th day after replacing iodoform tampon with a keratoplastic tampon.
The middle duration of disability in the 1st group was 5 days, in patients of the 2nd group — 11 days.
A comparative analysis of supervision of postoperative wound under the iodoform tampon and without
it confirms that it is necessary to give up its using. It creates conditions for disappearance of additional pain, provides a better quality of teeth and wound surface's treatment, reduces discomfort while talking and eating, accelerates epithelialization of wound surface in 2 times and decreases a duration of disability in 2 times as well.
In connection with foregoing, it should be noted that using of an iodoform tampon to cover a wound surface after vestibuloplasty is inadvisable and unjustified, a denial of its using leads to the best clinical results.
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