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14MEDICAL SCIENCES
THE USE OF A DIODE LASER IN THE TREATMENT OF PERIODONTAL DISEASE
Aliyev M.S.A.,
Doctor of Philosophy in Medicine Department of Therapeutic Dentistry Assistant Azerbaijan Medical University Baku, Azerbaijan Yagubova F.M., Department of Pediatric Dentistry Assistant Azerbaijan Medical University Baku, Azerbaijan Jalilova G.J.
Department of Pediatric Dentistry Assistant Azerbaijan Medical University Baku, Azerbaijan DOI: 10.5281/zenodo.7607401
Abstract
To date, periodontitis is the leading cause of tooth loss and alveolar bone loss in adults. One of the urgent problems in dentistry is the treatment of patients with inflammatory diseases of the maxillofacial region. Laser radiation sources are introduced and widely used in many branches of modern medicine
The use of surgical laser technologies opens up new possibilities for optimizing the treatment. Keywords: chronic periodontitis, fixed prosthetics, orthopedic rehabilitation, laser curettage.
In recent years, in addition to diseases of the hard tissues of the tooth, there has been a pronounced trend towards an increase in the prevalence of inflammatory periodontal diseases, especially in patients of the older age group [1]. Patients in the age group of 35-40 years and older are in many cases in need of dental prosthet-ics. It is known that the result of high-quality qualified orthopedic dental care is greatly influenced by the preliminary preparation of the organs and tissues of the mouth for prosthetics. Not performed or poorly performed preliminary treatment may affect the long-term results of dental prosthetics. According to a number of authors, periodontal treatment is an obligatory preparatory stage before orthopedic rehabilitation [2, 3]. However, studies conducted on the quality of orthopedic care show that many orthopedic dentists do not pay due attention to this type of preparation and, as a result, patients' complaints about changes in the gingival contour around the crown, bleeding gums and bad breath. Chronic catarrhal gingivitis, and then periodontitis, occupy a leading place among inflammatory periodontal diseases due to the complexity of treating patients with non-removable orthopedic structures and the likely development of adverse consequences [1]. Due to the fact that the appeal of patients for periodontal care with such complaints remains at a high level, the search for adequate conservative methods for the treatment of inflammatory diseases of the marginal periodontium without harming the fixed orthopedic structure does not stop [4, 5]. At the stage of development of modern periodontol-ogy, the search continues for methods of conservative treatment of inflammatory periodontal diseases (especially in patients with orthopedic structures in the oral cavity), which can reduce the risk of complications, increase the period of remission and lengthen the period of use of orthopedic structures. The use of a diode laser in a pulsed mode provides an anti-inflammatory, analgesic effect, significantly reducing the prescription of
medications at the stage of conservative, surgical treatment [2, 4]. The therapeutic effect is achieved when the energy of the laser beam is absorbed by the tissues, causing such phenomena as destruction, evaporation, amputation, ablation, photodynamics and biostimulation. The onset of exposure is characterized by tissue heating, protein denaturation and dehydration, followed by charring, evaporation and burning of pathological tissues. Since the laser has a biostimulating effect, healing processes proceed faster than with traditional surgical methods [6]. The purpose of the study was to evaluate the results of treatment of inflammatory processes in the marginal periodontium using a diode laser before prosthetics with fixed orthopedic structures. The study involved 60 patients referred by orthopedic dentists at the stage of preprosthetic preparation in order to treat inflammatory processes in the marginal periodontium. All patients who participated in the study were diagnosed with chronic generalized periodontitis of moderate and severe severity. 40 out of 60 patients turned to an orthopedic dentist for the purpose of re-prosthetics, 20 patients had prosthetics for the first time. All patients complained of bleeding gums when brushing their teeth and while eating, pain and discomfort in the gums that appeared periodically, bad breath, slight tooth mobility. Previously, these patients were not under the supervision of a periodontist, professional hygiene was carried out only by 13% of the examined. All patients were divided into two groups. The main group consisted of 36 patients: 20 women and 16 men aged 34 to 55 years. In the main group, all patients underwent conservative treatment using a diode laser. The comparison group consisted of 24 patients: 14 women and 10 men. They underwent anti-inflammatory treatment using the Vector Paro apparatus. Informed consent was obtained from all patients prior to treatment. A comprehensive clinical dental examination was carried out according to the traditional scheme, including
the determination of the papillary-marginal-alveolar index (PMA index) in the Parma modification, the papillary bleeding index according to Muhlemann and Saxer, gingival recession according to Miller, and the depth of the periodontal pocket using a calibrated probe. Before treatment, patients were sent for a complete blood count. At the first stage of treatment, all patients, regardless of the study group, before the start of the main course of anti-inflammatory therapy, underwent professional oral hygiene using an ultrasound machine. At the second stage, after drug treatment of the mouth, patients of the main group were removed granulation tissue from pathological pockets using a diode laser in the gingivectomy mode. The procedure was performed under infiltration anesthesia. In one visit, an area in the area of 6-8 teeth was treated in the "Processing of periodontal pockets" mode, wavelength 970 nm, light guide 400 ^m, power 1.2-1.5 W, frequency 75-100 Hz in a pulsed mode with fiber initiation at for 5-10 s on the marginal gingiva around each tooth. After the procedure, repeated drug treatment was performed. Patients were advised gentle hygiene only on the day of treatment. The control examination was carried out after 3 days, and the issue of the need for repeated laser curettage was decided. Patients of the comparison group underwent treatment of periodontal pockets once with the Vector Paro device (Germany). Clinical examination was performed before treatment, 3, 6 and 12 months after laser curettage. After the course of perio-dontal treatment, the patients were referred to an orthopedic dentist for further prosthetics with fixed orthopedic structures. During laser curettage, patients did not experience pain and noted a short duration of the procedure. After this microsurgical intervention, there were no complaints of patients about pain and discomfort. When examined after 5 days, hyperemia and edema of the treated gums significantly decreased in 31% of patients of the main group (they underwent a second laser curettage procedure) and were completely absent in 69%. Also, there was no bleeding during probing, the gums fit snugly against the tissues of the tooth. The results of the study were evaluated 3, 6 and 12 months after the procedure. Over the entire observation period, all patients of the main group showed a clinically significant decrease in the degree of bleeding according to the index of papillary bleeding according to Muhlemann and Saxer. So, already by the 3rd month of observation, bleeding of the 2nd and 3rd degrees was absent. Starting from the 6th month of observation, the state of the gums in terms of the degree of bleeding stabilized at the level of degree 0-1. In the comparison group, the maximum decrease in the degree of bleeding was registered within the 1 -2 degree, but by the end of the observation period, the bleeding index again increased to the 2 degree in 19% of patients. During the visual assessment at the examination stage, congestive hyperemia of the marginal part of the gums was determined in 60 patients. During visual examination after 3 months, the physiological color of the marginal part of the gums was recorded in patients of the main group, which persisted throughout the entire observation period, and in the comparison group, by the 6th month after the anti-inflammatory treatment, hyperemia of the marginal gums was detected in 17 out of 24 patients. This indicates the need for a course of maintenance
conservative therapy. Before treatment, in patients of both groups, the depth of periodontal pockets averaged 4.98±1.96 mm, and the proportion of pockets more than 4 mm deep was 24.4%. The average value of gingival recession was 0.94±1.02 mm. In the main group during treatment, the depth of periodontal pockets decreased to 3.2±1.4 mm after the first stage of therapy and reached its minimum values after laser curettage. One month after the use of the diode laser, the pocket depth was 2.1±0.5 mm and remained stable after 6 and 12 months (2.11±1.1 and 2.1±0.9 mm, respectively). In the comparison group, the pocket depth after 1 month was 2.7±1.8 mm and remained stable after 6 and 12 months (2.5±1.4 and 3.1±1.6 mm, respectively). Due to the fact that the observation of both groups participating in the study took place for 12 months, by the time of the examination 3 months after the treatment, the patients had already installed fixed fixed orthopedic structures in their mouths. Dentists-orthopedists were recommended to fix all orthopedic structures with temporary cement for a period of 6 months, followed by re-cementation for another 6 months. During the entire period of observation in patients of the main group (40 people), inflammatory processes in periodontal tissues were not observed, however, by the 6th month of observation, they received a course of maintenance anti-inflammatory conservative therapy. Patients of the comparison group (8 people out of 24) after 3 months of observation complained of the appearance of slight bleeding of the gums during brushing their teeth and bad breath. For this reason, they were prescribed a course of conservative maintenance treatment using traditional methods from the 3rd month of observation.
CONCLUSION
The use of laser therapy with a high-intensity diode laser in the complex treatment of periodontal diseases is expedient and effective, as it allows to achieve stable remission (proven by clinical research methods and index assessment) and significantly reduce the period of periodontal therapy before orthopedic treatment, which leads to an acceleration of the complex rehabilitation of the dentoalveolar system patient.
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