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To a question of efficacy of multifactorial therapy application in prophylaxis and treatment of periimplantitis Feshchenko I.1, Sysoev N.2, Andreas Nikolaidis3, Podkladnev E.4, Vishnikov I.5, Kirilenko
A.6, Kotelnikov D.7 (Russian Federation)
К вопросу эффективности применения многофакторной терапии в профилактике и лечении периимплантита Фещенко И. Ф. , Сысоев Н. П. , Андреас Николаидис ,
Подкладнев Е. А.4, Вишников И. А.5, Кириленко А. С.6, Котельников Д. В.7
(Российская Федерация)
1 Фещенко Ирина Федоровна /Feshchenko Irina - ассистент, кафедра терапевтической стоматологии;
2Сысоев Николай Петрович /Sysoev Nikolai - доктор медицинских наук, профессор, кафедра ортопедической стоматологии;
3Андреас Николаидис / Andreas Nikolaidis - студент;
4Подкладнев Евгений Александрович /Podkladnev Evgenii - студент;
5Вишников Иван Александрович / Vishnikov Ivan - суб. ординатор,
Медицинская академия им. С. И. Георгиевского
Федеральное государственное автономное образовательное учреждение Высшего образования Крымский федеральный университет им. В. И. Вернадского, г. Симферополь;
6Кириленко Анатолий Сергеевич /Kirilenko Anatoly - заслуженный врач Республики Крым,
Коммунальное лечебно-профилактическое учреждение Сакская стоматологическая поликлиника, г. Саки;
7Котельников Дмитрий Валерьевич / Kotelnikov Dmitry - хирург-имплантолог, врач клиники «Медисса», г. Симферополь,
Медицинская академия им. С. И. Георгиевского
Федеральное государственное автономное образовательное учреждение Высшего образования Крымский федеральный университет им. В. И. Вернадского, г. Симферополь
Abstract: the most common complication of dental implantation, which occurs in post implantation period is periimplantitis. The effectiveness of multifactorial therapy in dental implantation, individual prevention of periimplantitis. Prevention, treatment of complications during dental implant reduces and prevent complications normobioza reach the mouth.
Аннотация: наиболее частым осложнением при дентальной имплантации, которое возникает в пост имплантационный период, является периимплантит. Эффективность применения многофакторной терапии при дентальной имплантации, индивидуальная профилактика развития периимплантита. профилактика. Лечение осложнений при дентальной имплантации позволяет снизить и предотвратить возникновение осложнений, достичь нормобиоза полости рта.
Keywords: treatment, prevention, implant, physiotherapy.
Ключевые слова: лечение, профилактика, имплантат, физиотерапия.
UDC 616.314-77-00-084+615.83
Introduction
Now dental implantation has found the widest application in practical stomatology [1, 10]. Scientific researches and introductions of last years have provided development of dental implantations methods as standard way of replacement of dentitions defects. The major practical achievement of dental implantations of the last years was creation of implants with bioactive and osteoconductive properties at the expense of a microrelief of a titanic surface [1, 2]. Thanks to optimization of the factors influencing on the osteointegration of an implant, for today it was possible to achieve high clinical efficacy [2, 9, 10]. The most frequent complication at dental implantation, which arises in the post postimplantational period, is periimplantitis, which depends on stability to the biodamages caused by microorganisms-bioincinerators. On researches of many authors early periimplantitis and implants breakages (8-13,5 %) can appear, as in a consequence of reaction of an organism on entered of dental implant, and at infection of a bone wound at unsatisfactory hygiene of an oral cavity [3, 5, 12, 13]. It is known that round a neck of implant it is formed a gingival ring, which warns hit of bacteria in a bone tissue. Until recently staphylococci were not considered as a resident component of microflora of an oral cavity. However, as a result of the analysis spent by A. J. Smith and at al [13, 16], it has been shown that prevalence of Staphylococcus aureus in an oral cavity considerably higher than was considered earlier, by a number of authors had been drew a conclusion, that the given microorganism concerns to autochthonous (to constants, basic) a kind of microflora of an oral cavity of healthy people-bacteria carriers, and the oral cavity is the tank of staphylococci [1, 4, 12]. It is shown that at odontogenic inflammatory diseases staphylococci are sowed in 15 % of cases. It is possible under certain conditions colonization of a tooth plaque by respiratory pathogens - S. aureus in 45 % of examined patients are found out [12, 13, 16]. The staphylococcal biofilms containing protein Var (biofilmassociated protein) thanks to which rises ability of bacteria to adhesion, participates in realization of chronic infectious processes [3, 4, 12, 16]. Mucous of the open cavities of a macroorganism represent uniform system. Their
microbiocenosis - is a dynamic microecological system, which components are a macroorganism, its microflora and environment characterized by unity and ability to the self-regulation, making an integrated part of an organism and local immunity, in particular. The complex includes local factors to which belong inhibitors of microbic adhesion, biocidic and biostatic products of secrets, normal microflora, mechanical factors (mucous), congenital and adaptive immunity [4, 8, 12]. Proceeding from told earlier, in case of unsatisfactory hygiene of an oral cavity, the patient has inflammatory complications, which lead to rejection of dental implant [2, 8, 9, 11].
Research object
A substantiation of efficacy of application of multifactorial therapy at dental implantation, individual prophylaxis of periimplantitis development.
Materials and research methods
The main prophylactic and medical factors of pathogenetic therapy at occurrence of periimplantitis were antiinflammatory and anti-edematous action, microcirculation stimulation, regeneration and a metabolism of tissues, the local mechanism of immunological protection, etc. Examination is spent on 26 patients, at the age from 25 till 58 years. Among them was 15 (62,5 % of women) 11 (37,5 % of men) selected for installation of stomatologic intrabone implants without accompanying diseases. Examination of patients spent according to the report of carrying out of treatment with application of dental implants, including (cross-) examination, the analysis of the anamnesis and survey of a clinical condition of an oral cavity. Radiological research performed at all patients before operation, before carrying out of the second stage and in the remote terms in 4-6 months after operation. In dynamics of supervision estimated a hygienic condition of an oral cavity on Green-Vermillion’s index, on A. L. Russel’s parodontal index [8]. In an oral liquid, which collected on an empty stomach [4], defined activity of lysozyme by a bacteriolytic method, activity of elastase and degree of dysbiosis of an oral cavity by a fermental method [4]. All patients have been divided into 2 groups: the basic (15 peoples), control (11 peoples). Technology of carrying out of dental implantations in the basic and control groups was identical. If it was established no more than 4 implants in the post operative period anaesthetizing preparations are recommended for 1-5 days and rinsing of an oral cavity by a composition of Brine of the lake in Saky by mineralization (to 200g/l) in cultivation by the ozonized distilled water, an oral cavity irrigation, irrigation by Brine dissolved by ozonized distilled water of balm «Aromasept» [6, 7, 14] (essential oils of: lavender, thuya, valerian, eucalyptus, camomile, calendula) during of 1-5 days were recommended. If dental implantation was carried out of big volume and complexity for 2nd-3rd day anaesthetizing, anti-inflammatory and hyposensitized means were prescribed, and also antibiotics («Augmentin» etc., under the sensitivity scheme) for 1-5 days. To patients spent an irrigation, irrigation of the ozonized composition of Brine and aromabalm «Smile» (essential oils of: peppermint, basil, anise, lemon, an extract of calendula, camomile, lavender, an oak bark, sage, rose) during of 1-2 weeks. To patients of the basic group besides of base therapy after operation on wounded surface put down applications by gel «Gialudent № 2» (with chlorhexedin and nitromedasol), which is active to gram-positive, but also to gram-negative microbes and as possesses by antimycotic action: (yeast-like fungus of genus Candida, Microsporus, Histoplasma etc.). The thickness of a layer of a preparation was 0,5-0,7 mm. Patients are instructed about application at home of gel «Solkoseril» 2-3 times a day during of 5-7 days (according to character and severity of process). Pursuing the aim to accelerate osteointegration from 10th day, when bone plate was formed for acceleration of recalcination applied: aeroionotherapy by a dose 75-150*109 ion/sm3, duration of procedure 15-30 minutes daily, the course consists of 15-20 procedures. For individual screening programs of complications prophylaxis at dental restorations it was used by us «Megasonex» an ultrasonic brush and nano-hydroxyappatit tooth-paste into which structure is included dioxide titan, which is more preferable for today. For today algorithm of periimplantitis treatment expect mechanical clarification, decontamination and antiseptic processing of a implant surface, orthopedic designs, periimplantitis tissues. Mountain calcium D3, on recommendations of doctor Perfectil, a course 1-1,5 months under the scheme.
Results and discussions
In the first group of patients good result - 47 %, satisfactory - 53 %, for the 3rd day the painful syndrome remained in 35,4 % of patients, discomfortable sensations in 52,1 %, and on the 5th day - in 6,3 % and 31,3 % accordingly. In the second group receiving physiotherapeutic treatment before and after operation in a composition with О3 intensity of painful sensations has made 0 points in 80 % of patients, 1 point - in 9 %, 2 points - in 11%. On the 5th day in the second group edema, hyperemia were observed in 41,6 %, and on the 7th day in 16 % of patients. In the first group these indicators made accordingly 59,3 % and 29,1 %. Activity of elastase: intact parodontium (control group) 2,3±0,12 before treatment 4,4±0,14 (nmol/ml), (р<00,5) after treatment (the first group 2,9±0,11), (р<00,5), the second group 2,5±0,12, (р<00,5) Green-Vermillion’s index - control group 1,12±0,07; the basic group - 0,85±0,06. A.L. Russel’s index - control group 0,32±0,05; the basic group - 0,23±0,01. Activity of lysozyme mkg/ml - control group 76,39±3,05; the basic - 87,32±3,81. Relative lysozyme activity: 0,81±0,02, the basic -0,93±0,03. Degree of dysbiosis: 1,72±0,02, the basic - 1,16±0,03. The received results are subjected the statistical analysis with application of non parametrical criterion X2 adjusted for Yeyts’s continuity. The statistical analysis was carried out by means of the Russified package of program Primer Biostatistics version 4.04 by Stanton A. Glantz [a statistical package of «Biostatistics» (version 4.03)]. Kept away supervision have shown that throughout the year after carrying out of dental implantations in patients of the first group 3 cases of rejection of implant and 10 cases of periimplantitis are fixed, that is total number of complication has made 4,2 %, in the second group of late complications within a year is not fixed. Success of dental implantation after a surgical stage is possible only in the
event if the patient correctly carries out hygienic procedures on care of an oral cavity during the postoperative period.
Conclusions. The analysis of the received data gives the foundations to consider that the multifactorial physiotherapy before and after operation of dental implantation makes positive influence on a condition of tissues. Efficacy of the medical actions including pathogenetic therapy, physiotherapeutic methods of an irrigation of an oral cavity, irrigation before operation, normalize a level of various groups cytokines, and complex prophylaxis and physiotherapeutic treatment in the postoperative period including ozonotherapy, aeroionotherapy, hydroaeroionotherapy, aerosoltherapy, applications, reduces of tissues edema, regulates microcirculation, accelerates epithelization, stimulates reparation processes.
The problem of prolongation of duration of implants functioning, prophylaxis of periiplantitis, medicamental therapy is complicated by increased allergization, combinations of medical preparations are not always allow to receive desirable result, often there are side effects. The way of prophylaxis offered by us, treatment of complications at dental implantation, allows decreasing and preventing occurrence of complications, to reach normobiosis of an oral cavity. Application of gel «Gialudent № 2» at intrabone implantation, promotes to stimulation of processes of bone tissue reparation around implant during the early postoperative period.
Results of the spent researches give the foundations to recommend the offered multifactorial therapy and the individual program of prophylaxis from preparation of the patient for operation, at stages and the remote terms of rehabilitation for the prevention of destructive-inflammatory processes in tissues.
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