RU2254859C1 - Method for treating parodontitis - Google Patents

Abstract

FIELD: medicine, stomatology.

SUBSTANCE: one should inject richlocaine simultaneously as irrigations of mouth cavity, as applications onto gingival mucosa and into gingival pouches, as gingival electrophoresis and submucous injection in therapeutic dosages. The present innovation enables to prolong remission terms and decrease the number of disease relapses due to stabilizing pathological processes in parodontium tissues.

EFFECT: higher efficiency of therapy.

1 ex, 5 tbl

Description

The present invention relates to medicine, in particular to dentistry, and can be used on a mass outpatient basis in dental clinics, departments and hospitals in the treatment of various forms of periodontitis.

Improving the effectiveness of the prevention and treatment of periodontitis is one of the important problems of modern dentistry. High frequency of spread, varying severity, premature tooth loss, decreased performance and impaired psycho-emotional sphere determine the medical relevance and social significance of this problem [8].

Currently, in periodontics, a large number of various drugs and medicines are used to treat pathological conditions of periodontal teeth and oral mucosa. However, despite this, dentists are not always able to achieve persistent and prolonged remission of the disease and stimulate regenerative processes in the periodontal tissues. In this regard, there is a need to develop new and use previously known drugs in order to increase the effectiveness of etiotropic, pathogenetic and symptomatic therapy of periodontal diseases [6].

It is well known that one of the etiological factors in the occurrence of inflammatory periodontal diseases is microbial. The toxins and enzymes secreted by microorganisms activate cellular, humoral mediators and modulators of inflammation, and the permeability of the vascular walls increases. White blood cells respond to the neutralization of the damaging agent, while releasing highly active intracellular enzymes (prostaglandins, proteases, trypsin, cathepsins, etc.), and mast cells located in the interstitial spaces - heparin, histamine, serotonin. This process is an acute inflammation with quite strong pain sensations, aggravated by the accumulation of small peptides and bradykinin in the tissues. It is known that pain mediators are a number of chemicals involved in the mechanisms of formation of nociceptive irritation at different levels of conduct. Correspondingly, at the level of periodontal tissue receptors, histamine, serotonin, bradykinin, prostaglandins, and others have an exciting effect. Therefore, to reduce pain and regression of pathological conditions in the periodontium, it is necessary to neutralize the tissue-destroying enzymes and toxins secreted by microbes, and also to destroy the microbial cells themselves. In this regard, the inclusion in the complex therapy of periodontitis of pharmacological agents with a “double” effect - anesthetizing and antimicrobial, is of great interest in dentistry [4, 7].

In recent years, the search for drugs with topical anesthetic and antimicrobial activity among piperidine derivatives has gained great importance. In this regard, of great interest is the anesthetic of this series - richlocaine (synonyms: rinocaine, ridocaine), CAS registration number (Chemical Abstracts Servis index namber) - 543336 is 1-allyl-2,5-dimethylpiperidol-4 benzoic ester hydrochloride. It is registered as a medicine in the Republic of Kazakhstan - RK No. 5-000-860 and in the Russian Federation, registration certificate No. 95/250/2 and is approved for medical use and industrial production.

There is evidence that richlocaine has a number of positive qualities, namely: local anesthetic, central analgesic and antimicrobial activity. It does not have a local irritant effect. It is effective in inflamed and scarred tissues, has a pronounced bactericidal effect, has antihistamine, antiarrhythmic, anticonvulsant, dermatoprotective, immunocorrective actions, is also compatible with adrenergic agonists and can be used as a solvent for antibiotics [2, 3, 5].

A known method for the treatment of periodontitis [1], involving the use of local medical ozone in the form of ozonized physiological isotonic saline and olive oil, after professional oral hygiene and cortege. Ozonation of solutions was carried out on a quasar ozonizer. Patients with inflammatory and destructive processes in the periodontal tissues were prescribed mouth rinses daily 1 time per day (250 ml of solution for 2 min) and periodontal pockets were washed from the syringe for 5-10 min using ozonized physiological solution with a high concentration of ozone in the mixture - 4000 mcg / l. The course was 8-10 visits. To reduce the inflammatory reaction and suppuration from periodontal pockets and curettage, rinses were prescribed daily for 3-5 days with ozonized saline solution with a lower ozone concentration of 1500 μg / l, as well as applications of ozonized olive oil (ozone concentration of 3500-4000 μg / l) 10 ml per jaw for 30 minutes.

The disadvantages of this method include the difficulty of implementing the full complex of treatment, since obtaining a dosed ozonized mixture of physiological saline and olive oil requires special expensive medical equipment (ozonizer “Quasar”).

There is a method of treating periodontitis with a medicinal product - sulfur wormwood essential oil (Artemisia glance Pall. Ex. Wilid), obtained by steam distillation of the aerial parts of the plant, see patent No. 2104019, MKI A 61 K 35/78. “A medicinal product for the treatment of periodontitis” from 10.02.98, bull. Number 4. The essence of this invention lies in the fact that the essential oil was obtained from the ground part of the wormwood with sulfur by distillation with water vapor in a special distillation apparatus into which acute steam was supplied. Steam in contact with the raw material extracted the essential oil. The resulting mixture of vapors of essential oil and water was taken to a special refrigerator, in which vapor condensation occurred. Further, the distillate entered the oil separator receiver, where it was settled or separated into essential oil and distilled water. The essential oil was collected, dried over anhydrous sodium sulfate, filtered and sealed in glass containers or sealed in ampoules.

A study of the effectiveness of sulfuric wormwood essential oil in the treatment of periodontal diseases was carried out in acute purulent periodontitis and periodontitis in the acute stage. With periodontitis, oil was used topically in the form of dressings for gums. Evaluation of the effectiveness of the studied oil was carried out taking into account the reduction of pain, swelling. The observation was carried out for outpatients who sought dental care for periodontal diseases in the amount of 9 people.

The disadvantage of this method is that the absence of the official (finished) form of this drug and the technological complexity of manufacturing requires a large amount of equipment and labor for its production. The presence of monoterinoids (35%), sequiterpenoids (10%), aromatic terpenoids (4%) and diacetylene compounds (30%) in the composition of essential oil can contribute to various toxic and allergic reactions. Due to the lack of a preliminary stage of treatment of periodontitis (removal of dental deposits, closed curettage of the gingival pockets, grinding and polishing of the cervical region of the root of the teeth, etc.), the severity of the therapeutic effect of the treatment is likely to be small. The small number of patients treated by this method does not allow an objective assessment of the treatment of periodontitis in this way.

For the prototype we adopted patent No. 2168977, MKI A 61 K 6/02, A61P1 / 02 “Method for the complex treatment of periodontitis”.

The method involves applying to the lesions at a temperature of 40-42 ° C a mixture containing an antimicrobial preparation, mainly Metrogil Dent, and an immunomodulating preparation Viferon in a ratio of 1: 1 in a dose of 5-10 g, while the drug mixture is previously placed in an individual kappa. The drugs are applied directly to the focus of inflammation, and the dose of drugs corresponds to the degree of damage and the exposure time varies from 10 to 15 minutes. The course of treatment is 6-7 procedures with an interval between visits of 1 day.

The disadvantages of this method of complex treatment of periodontitis are that it is possible to select many stable variants of pathogens that contribute to the generalization of the process in periodontium. In addition, the need for expensive medical equipment, as individual mouth guards for patients are made using a special vacuum apparatus. The complexity of the execution (taking impressions, casting the model, their processing, etc.), the presence of a technical laboratory, as well as the need for a certain skill of the dental technician complicate the application of this method. The entire course of treatment is 15-18 days, i.e. Metrogil Denta and Viferon are not sufficiently effective treatment effects.

The objectives of the proposed method are:

- increasing the effectiveness of complex treatment of periodontitis;

- expanding the arsenal of effective low-toxic drugs;

- simplification of therapeutic methods of treatment;

- decrease in the level of value;

- reduction of treatment time;

- the creation of a widely accessible method;

- the use of a ready-made official drug with a prolonged effect;

- reduction of labor costs.

The indicated technical and medical effects are achieved in that the treatment of chronic generalized periodontitis (CGP) is carried out by a complex treatment with the drug richlocaine on the gingival mucosa in the form of irrigation of the oral cavity, applications on the gums, introduction of gum pockets on the gum, electrophoresis on the gums and injection mucosal administration.

To develop and justify the proposed method, experimental and clinical studies have been conducted.

The experimental part of the work was carried out on animal rats. At this stage, the proliferative activity of osteoblasts and the level of free intracellular calcium in the presence of various concentrations of richlocaine were studied. To carry out this part of the work, cultured osteoblasts of newborn white rats obtained from the parietal bone of the skull were used.

To study the effect of richlocaine on the number of cells of the obtained culture and their metabolism, various concentrations of its solutions were used at dilutions of 1:10, 1:50, 1: 100, 1: 500.

To assess the effect of the drug under hypoxic conditions, a solution of Na cyanide in final concentrations of 0.2 mM was used. Evaluation of the cytotoxicity of richlocaine was carried out using the MTT test [9].

The study of the effect of richlocaine on the level of free intracellular calcium was carried out using a fluorescent probe. To determine the concentrations of Ca ²⁺ , a fluorimeter and richlocaine solutions in final concentrations of 1-0.001 mg / ml were used. The work used standard methods of statistical analysis.

As a result of the studies, it was found that the introduction of richlocaine (1-0.001 mg / ml) into the incubation medium of the cell culture of rat osteoblasts caused dose-dependent changes in their proliferation and metabolism. So, rikhlokain in a large concentration (1 mg / ml) showed cytotoxicity of the action (cell death was observed), which was confirmed by microscopy. At a concentration of 0.01-0.001 mg / ml, the metabolism and number of cells increased by 15-36%, respectively. This suggests that richlocaine in low concentrations can cause stimulation of proliferative activity and metabolism of rat parietal osteoblasts (Table 1).

When modeling hypoxia by introducing a subtoxic dose (0.2 mM) of Na cyanide into the incubation medium, it was found that richlocaine (0.001 mg / ml) levels the hypoxic state of osteoblasts, inducing stimulation of their proliferative activity (Table 2). Histologically, the cells (osteoblasts) were viable and did not differ from the control.

The results of a study of the effect of richlocaine on the level of free intracellular calcium showed that the drug in concentrations of 0.1-0.001 slightly reduces the level of free intracellular calcium, which may indicate a decrease in calcium intake from the environment, or an increase in its exit from the cell or intracellular binding. It should be noted that stimulation of proliferative activity, as a rule, is accompanied by a decrease in calcium level (Table 3).

Rihlokain is non-toxic for osteoblasts in the concentration range of 10 ^-1 -10 ^-4 mg / ml, both normal and when exposed to subtoxic doses of sodium cyanide. In a high concentration (1 mg / ml), the drug exhibits cytotoxicity, which is accompanied by a significant increase in the concentration of intracellular calcium, probably associated with impaired functioning of the ion channels or the integrity of the membranes.

Thus, richlocaine at a concentration of 1 mg / ml exerts a cytotoxic effect on osteoblasts of the parietal bone of rats. At dilutions of 0.01 and 0.001 mg / ml, both under intact conditions and when exposed to sodium cyanide, it increases the number of osteoblasts in the incubation medium. At a concentration of 1 mg / ml, the drug increases the content of intracellular calcium in osteoblasts. The noted effects of richlocaine (0.01 and 0.001 mg / ml) may be due to their activation of metabolic processes in osteoblasts.

The obtained positive results of experimental studies gave us a certain theoretical basis for conducting clinical observations, the purpose of which was to study and justify the prospects of using richlocaine as a local anesthetic, antimicrobial drug, as well as a drug with reparative properties in the complex medical treatment of periodontitis.

To achieve this goal, 54 patients of the main and control groups who were diagnosed with chronic generalized periodontitis of moderate severity (HCGST) aged 36 to 69 years were treated. The duration of the disease was 5-20 years. The study did not include patients with irreparable malocclusion or malocclusion, a small number of remaining natural teeth (less than 6 on the jaw) and parafunctions of the masticatory muscles. The main and control groups were comparable in terms of periodontal pathology, age, gender and other characteristics.

The main group, where the treatment was carried out by the proposed method, with the use of richlocaine in the complex therapy, consisted of 33 patients with HGFV in the acute stage, among whom were 2 women and 3 men aged 36-39 years, 5 women and 4 men aged 40-49 years, 10 women and 9 men aged 50 years and older. A history of 6 patients had somatic pathology: chronic pharyngitis, chronic cholecystitis, peptic ulcer and hypertension.

The control group (richlocaine was not used) included 21 patients with HGFV in the acute stage, among whom were 2 women and 1 man aged 36-39 years, 4 women and 3 men aged 40-49 years, 7 women and 4 men in 50 years old and older. A history of 4 patients had somatic pathology: peptic ulcer and hypertension, coronary heart disease.

All patients were examined according to the generally accepted methodology in dentistry, including basic and additional research methods. The clinical effectiveness of the treatment was evaluated before, on day 15 and 1 and 6 months after treatment.

An objective examination of patients with HGFST noted the presence of inflammation of the oral mucosa and gums: they evaluated color, relief, hyperemia, pain, swelling, bleeding, the presence of fistulas, ulcerations, abscesses, changes in the configuration of the gums, hypertrophy and tightness of the interdental gingival papilla and gingival edges to the teeth, exposure of the necks of the teeth.

To detect the presence of dental plaque, staining with a 1-2% solution of methylene blue was used. Periodontal status was assessed using periodontal (PI) and papillary-marginal-alveolar indices (PMA). Functional tests of Schiller - Pisarev, Kechke, Parma were used to assess the condition of periodontal tissues and determine the effectiveness of the treatment.

The proposed method of treatment was carried out as follows. All patients underwent oral sanitation, eliminated the elements of traumatic occlusion of periodontal and retention of microbial plaque, performed an audit of periodontal pockets, prescribed antibacterial, anti-inflammatory, general strengthening, stimulating and desensitizing drug therapy. If necessary, immobilization (splinting and prosthetics) or removal of mobile teeth was performed.

Patients of the main group, along with traditional treatment, were additionally prescribed richlocaine for 10-14 days, 2 ml of a 0.25% solution in the form of injections under the oral mucosa along the transitional fold. At the same time, richlocaine was introduced in the form of 5% ointment on turundas into periodontal pockets, irrigation and applications with a 0.5% solution of this drug on the gingival mucosa were performed for 20 minutes daily, physiotherapy was prescribed in the form of electrophoresis on the gums.

For an objective assessment of the work performed, X-ray research methods were used: intra-oral dental radiography of the teeth and orthopantomography of the jaws under the same physical and technical conditions of the survey.

X-ray studies were performed before and 6 months after the end of the complex treatment. The dynamics of changes and the severity of pathological processes in the bone tissue were performed using densitometric analysis of x-rays using the VideoTesT - Master (Morphology) program. Alignment of the optical density of scanned x-ray images was carried out using the program Adobe Photoshop version 7.0. The data obtained were analyzed using the software package of mathematical analysis Excel and Statistica V.5 [10].

As a result of the treatment of patients with hGFST, positive dynamics were obtained in both groups, however, the best results were observed in the main group, where in addition to the traditional drug treatment, richlocaine was used.

Relief of acute inflammatory processes in patients of the main group was observed at 2-3 visits. Patients noted a decrease in edema, bleeding gums, pain, lack of halitosis. Sensitivity to temperature and chemical stimuli decreased. By the 15th day of clinical observation in patients of this group, the treatment period was uneventful, there were no signs of gum mucosal pathology, it had a natural color, relief, shape, and was painless on palpation. Probing of the gingival pockets did not cause bleeding, the gingival papillae were located in the interdental spaces, and in the cervical region the gum was tightly attached to the hard tissues of the teeth. The amount of exudate of periodontal pockets decreased sharply. Pathological tooth mobility (1-2 degrees before treatment) significantly decreased and approached the physiological norm.

The indices of periodontal indices decreased and corresponded to normal average indices (Table 4). The Schiller – Pisarev, Parma, and Kechke samples were negative in all patients of this group (before treatment, the Schiller – Pisarev test was positive, and Parma and Kechke were 28.9 and 26.5%, respectively).

In patients of the control group, relief of acute inflammatory processes was observed by the 5-7th visit. Soreness, swelling and bleeding of the gums also gradually decreased. By the 15th day of clinical observation in patients of this group, the treatment period proceeded without complications. The amount of exudate secreted from pathological gingival pockets decreased. Pathological tooth mobility decreased. However, more than half of the patients had signs of pathological changes characteristic of periodontitis: the mucous membrane of the cervical region of the teeth was partially hyperemic, sometimes bleeding, the gingival papillae were not always formed completely; the adherence of the mucous membrane to the hard tissues of the teeth was observed in less than half of the patients. Indicators of periodontal indices decreased (Table 5). The Schiller-Pisarev test was weakly positive in 2 patients (9.53%), the Parma and Kechke samples were negative in all patients.

After 1 and 6 months after the complex treatment, there were no signs of chronic inflammation in the patients of the main group. They did not complain, the mucous membrane of the gum was pale pink, its palpation was painless, the gingival margin was completely restored, tightly adhered to the tissues of the teeth in the cervical region and interdental spaces. Discharge from periodontal pockets was not determined, their depth decreased and amounted to 2.27 ± 0.34 mm (against 3.85 ± 0.42 mm before treatment). Pathological tooth mobility was absent. Pathological gingival recession was 0.1-0.2 mm. Clinical improvement in periodontal tissues was confirmed by the positive dynamics of changes in the clinical indices of PMA and PI (Table 4). Samples of Schiller - Pisarev, Parma and Kechke were negative in all patients in this group.

After 1 and 6 months after the course of treatment, out of 21 patients in the control group, 12 patients (57.2%) still complained of tooth mobility, bleeding gums during brushing and when eating solid food. An objective examination of the oral cavity in 9 patients (42.9%) revealed the initial signs of an inflammatory process; in 2 patients (9.5%), discharge from periodontal pockets was found, the depth of which was 3.47 ± 0.24 mm. Pathological tooth mobility of the 1st degree was observed in 12 patients; pathological gum recession was 0.3-0.7 mm. Indicators of periodontal indices had clinical dynamics (table 4). The Schiller-Pisarev test was weakly positive in 12 patients; the Parma and Kechke tests were positive in 9.52% and 4.76% of cases, respectively.

At the time of treatment of patients with HGFST in the clinic, the x-ray picture was characterized by an expansion of the periodontal gap, destructive changes in the bone tissue in the area of the interalveolar septa to the level 1/2 of the root length with the formation of bone pockets and the effects of osteoporosis.

After complex treatment was carried out in dynamics (from the beginning to 6 months after the end of treatment), a positive tendency was observed in patients of both groups to stabilize destructive processes in the bone tissue of the alveolar processes, and to stop the formation of new foci of bone destruction and bone pockets. However, more active reparative processes of bone structures were determined on radiological images in patients of the main group than was the case in the control group. The boundaries of the destroyed interdental alveolar septa were more clearly contoured, the clearance in the periodontal fissure significantly decreased, the foci of osteoporosis disappeared, and there was a clear tendency to osseointegral reconstruction of the bone structure.

The data of densitometric analysis of X-ray diffraction patterns showed that the optical density of the bone structure of the alveolar processes in the main and control groups of patients had different optical densities. However, in patients of the main group, the positive dynamics of compaction of the bone structure of the alveolar processes (both interdental septa and the jaw body) was more pronounced in comparison with the initial radiographs. In the control group, the optical density of the bone structure changed slightly compared to that before treatment (Table 5).

Example. Boy K., 57 years old. Diagnosis: periodontitis, generalized form, moderate severity in the acute stage. There is bad breath, bleeding gums, serous-purulent discharge from periodontal pockets, hypersensitivity to temperature and chemical irritants. In the oral cavity, there was a recession of the gingival margin 1 / 4-1 / 3 of the root length, hypertrophy of the interdental papillae, copious dental deposits, pathological tooth mobility of the I-II degree.

An index assessment of the periodontal condition was: RMA - 37.44%, PI - 2.96, samples Schiller-Pisarev, Parma and Kechke are positive.

Treatment: under conduction and infiltration anesthesia, 0.25% richlocaine solution, dental deposits were removed and antiseptic treatment of the oral cavity was carried out in the form of irrigation with a 0.5% richlocaine solution. The patient is prescribed antibacterial, anti-inflammatory, restorative, stimulating and desensitizing therapy. In addition, to the main course of treatment, richlocaine was prescribed in 2 ml of a 0.25% solution in the form of injections under the oral mucosa along the transition fold in the upper and lower jaws, richlocaine in the form of 5% ointment on turundas in periodontal pockets and daily applications 0, 5% solution of richlocaine on the mucous membrane of the gums for 20 minutes for 14 days; electrophoresis with richlocaine for 10 days. At the same time, the patient received recommendations on oral hygiene and control of brushing.

The relief of inflammatory and destructive processes in the patient was noted on day 3. In the cavity, a decrease in edema, bleeding gums, pain, bad breath was determined. Sensitivity to temperature and chemical irritants decreased. The mucous membrane of the gums acquired a natural color, relief, shape, palpation was painless. Probing of the gingival pockets did not cause bleeding, the gingival papillae were located in the interdental spaces, and in the cervical region the gum was tightly attached to the hard tissues of the teeth. The amount of exudate of periodontal pockets decreased sharply. Pathological tooth mobility (1-2 degrees before treatment) significantly decreased and approached the physiological norm.

The indices of periodontal indices decreased and amounted to: RMA - 3.12%, PI - 1.25, Schiller - Pisarev, Parma and Kechke tests were negative.

Control examination was carried out after 1 month. The patient did not complain of pain factors. Objectively in the oral cavity: pathological tooth mobility was absent, bleeding of the gums was not observed. The condition of periodontal tissues corresponded to the concept of the physiological norm (the mucous membrane of the gums is pale pink, in the cervical region it was firmly attached to the neck of the teeth, no recession of the gingival margin was noted).

6 months after the end of treatment, the condition of the periodontal tissues was normal, bleeding of the gums and discharge from the periodontal pockets were absent. The gingival papillae formed a clear scallop in the cervical region and tightly occupied the interdental spaces. The mucous membrane of the gums was dense, painless, the depth of periodontal pockets was 1-1.5 mm. On the moving mucous membrane, the vascular pattern of the capillary network became more clearly manifested. Pathological tooth mobility was absent.

Thus, the results of experimental and clinical studies allow us to conclude that the proposed method for the treatment of hGFST using the drug richlocaine is a fundamentally new, pathogenetically substantiated approach to the treatment of periodontitis. The results of a comparison of experimental and clinical studies showed that with different approaches to the treatment of hGFST, higher efficacy occurred in the case where richlocaine was included in the complex therapy regimen of drugs, compared to traditional treatment methods.

Table 1. The effect of richlocaine on the number of osteoblasts and their metabolism, estimated by the optical density of the dye formazan formed in the MTT test (1 day). The concentration of richlocaine mg / ml. Optical density,% of control 1 0 * 0.1 84.6 ± 7.5 0.01 115.4 ± 8.1 0.001 136.6 ± 11.4 * 0.0001 102.2 ± 9.2 The control 100 Note. Here and in tables 2 and 3 * - significant differences from control at p≤0.05.

Table 2. The effect of richlocaine on the number of osteoblasts and their metabolism in the presence of Na cyanide 0.2 mM (1 day). The concentration of richlocaine, mg / ml Optical density,% of control 1 0 0.1 85.8 ± 5.7 0.01 113.8 ± 10.5 0.001 138.6 ± 14.2 * 0.0001 89.3 ± 15.1 Table 3. The effect of richlocaine on the level of free intracellular calcium in rat osteoblasts The concentration of richlocaine, mg / ml The concentration of CA ⁺⁺ , nm 1 205 ± 12.9 * 0.1 98.7 ± 8.5 0.01 90 ± 7.5 0.001 84.25 ± 4.35 Note. The concentration of free intracellular calcium in intact osteoblasts was 89.2 ± 6.5 nM.

Table 4. Comparative dynamics of changes in PMA and PI of patients with moderate CGP with richlocaine in combination with traditional treatment Indices Before Main group Control group treatment 15 day 1 month 6 months 15 day 1 month 6 months PMA% 39.17 ± 3.76 2.96 ± 0.12 * 2.98 ± 0.07 * 2.99 ± 0.47 * 6.27 ± 1.02 * 7.35 ± 1.34 9.61 ± 1.01 * PI 3.19 ± 0.12 1.29 ± 0.08 * 1.30 ± 0.27 * 1.32 ± 0.06 1.87 ± 0.7 * 2.37 ± 0.89 * 7.44 ± 1.73 * * p <0.05 compared with data before treatment.

Table 5. Indices of densitometric analysis of radiographs of patients with moderate severity of CGP when using richlocaine in combination with traditional treatment Indicators Main group Control group before treatment after 6 months before treatment after 6 months Mid 27.41 ± 1.97 48.39 ± 3.91 * 27.64 ± 2.03 40.17 ± 4.81 * Standard deviation 4.08 ± 0.09 6.63 ± 0.12 * 4.12 ± 1.07 5.70 ± 0.33 * Median 26 ± 2.82 49 ± 3.04 * 25 ± 3.11 31.42 ± 2.97 * Pixels 14538 ± 137.5 26873 ± 214.76 * 14567 ± 154.28 21084 ± 205.64 * * p <0.05 compared with data before treatment.

Based on the foregoing, we can conclude that the use of the proposed method of treatment allows you to quickly stop the inflammatory processes in the periodontal tissues, reduce the treatment time for periodontitis, and improve the possibilities of drug therapy. The proposed method can significantly increase the period of remission, reduce the number of relapses, reduce the number of prescribed medications and reduce the material costs of their acquisition, as well as extend the functional value of the remaining natural teeth and, most importantly, stabilize pathological processes in periodontal tissues and increase the effectiveness of complex treatment of periodontitis. The obtained positive results allow us to recommend this drug for its wide use in the complex therapy of periodontitis.

LITERATURE

1. Bezrukova I.V. New methods of treatment of inflammatory periodontal diseases. // New in dentistry. 2001. No4. S.55-57.

2. Bordyushkov Yu.N., Golotina L.Yu. Rihlokain as an immunocorrector and activator of antitumor drugs. // Kuban Scientific Medical Bulletin. 2000. No4. S.107-109.

3. Gumenyuk S.E., Babichev S.A., Galenko-Yaroshevsky A.P. et al. Comparative evaluation of the antibacterial properties of the local anesthetic richlocaine. // Kuban Scientific Medical Bulletin. 2000. No4. S.110-113.

4. Dolgikh V.T., Matusov I.E., Chesnokov V.I. et al. Clinical pathophysiology for the dentist. Ed. prof. V.T. Long. - M.: Medical book, N. Novgorod: Publishing house of the Novosibirsk State Medical Academy, 2000. - 200 p.

5. Indosova G.Sh. Clinical rationale for the use of various local anesthetics in orthopedic dentistry. Abstract. Diss. honey. sciences. Republic of Kazakhstan, Almaty, 1998.

6. Ivanov B.C. Periodontal disease. - 4th ed., Revised. and add. - M.: Medical News Agency, 2001. - 298 p.

7. Kosyakova G.N., Galenko-Yaroshevsky A.P., Ponomarev V.V. et al. The antibacterial effect of some local anesthetics on the microflora of animal skin wounds. // Collection of materials scientific and practical. conf. “Medicine of the future”. Krasnodar - Sochi, 2002. S.100-101.

8. Tsepov L.M., Nikolaev A.I. Diagnosis and treatment of periodontal diseases. - M.: MEDpressinform, 2002 .-- 192 p.

9. Mosmann, T. Rapid colorimetric assay for cellular growth and survival: application to proliferation and cytotoxity assays // J. Immunol. Methods - 1983. - Vol. 65, No. 1. - p. 55-63.

10. Tufiel E.R. Envisioning Informaition. - Chesheri (Conn.): Cirades Press. 1994.

Claims (1)

A method for the treatment of periodontitis, including the prescription of drugs, characterized in that the patient is prescribed a piperidine derivative - richlocaine simultaneously in the form of an irrigation of the oral cavity, applications on the gums mucosa, gum pockets on the gums, gum electrophoresis and mucosal injection therapeutic doses.