RU2383348C1 - Method of treating chronic generalised periodontitis with aggressive clinical course - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method includes removal of dental deposit, elimination of traumatic occlusion, curettage, drug therapy, surgical treatment. After carrying out surgical treatment administered is intake of preparation Calcoheel in amount 1 tablet three times a day during three weeks, after that intake of preparation Osteoheel C 1 tablet three times a day during three weeks. Three-week break is made and course of intake of preparation in the same succession and dosage is repeated.

EFFECT: method allows to achieve increase of bone metabolism, stable effect of bone tissue regeneration, long term of disease remission, reduction of side effects of applied preparations.

3 ex, 6 dwg

Description

The invention relates to medicine, namely to dentistry, and can be used in the treatment of chronic generalized periodontitis with an aggressive course.

The treatment and prevention of periodontal diseases remain one of the pressing problems of modern dentistry. The prevalence of this pathology is steadily increasing. According to the analysis of WHO data collected in 35 countries from persons aged 31-44 years, very high (over 75%) was noted in 7 countries, high (40-75%) in 13 countries and moderate (less than 40) in 15 countries %) the prevalence of periodontal disease.

Despite the widespread prevalence of this pathology, the problem of effective treatment of periodontal lesions remains unresolved (Kuryakina N.V., Kutepova T.F. Periodontal disease. M., "Medical Book", 2003. - 158 pp .; Talbert J., Elter J ., Jared HL, Offenbacher S. et al. The effect of periodontal therapy on TNF-alpha, IL-6 and metabolic control in type 2 diabetics. // J Dent Hyg., 2006 Spring; 80 (2) - p. 7 ) The identification of periodontal pathology is not particularly difficult, especially in the developed stage of the disease, however, the success of treatment, confirmed by the duration of the phase of remission of the disease, remains a more difficult task, especially in terms of bone tissue regeneration.

A known method of treating periodontitis, which consists in using a lyophilized preparation of thyrocalcitonin in a mixture with glycol in the form of intramuscular injections (USSR AS No. 498005, A61K 5/02, 1976). The physiological effect of the introduced hormone, which is also produced in the body by C-cells of the thyroid gland, is based on the hypocalcemic effect, due to the powerful inhibition of osteoclastic resorption. However, recent studies have shown that cessation of calcitonin production as a result of surgical removal of the thyroid gland does not significantly affect calcium homeostasis (Wuster C., Raue F., Meyer C. et al. Long-term excess of endogeneous calcitonin in pacients with medullary thyroid carcinoma does not affect bone mineral density. J. Endocrinol. 1992; 134: 141-147.). Own research of the authors (Atrushkevich VG, Velichenko OL Features of mineral metabolism in patients with chronic generalized periodontitis. XIV Russian National Congress "Man and Medicine", abstract of reports, Moscow, 2007, p.67), which revealed a decrease in the level ionized calcium in the blood of patients with chronic generalized periodontitis confirmed the inefficiency of using hormonal drugs with hypocalcemic effect in the complex therapy of periodontal diseases, which leads to further mu reducing ionized calcium levels in the blood of a patient, thereby provoking amplification osteoclastic resorption. Thus, the disadvantage of this method is its low efficiency, confirmed by the above studies, the difficulty of using on an outpatient basis, associated with a long course of intramuscular injection.

There is also a method of treating generalized periodontitis, including drug correction of mineral metabolism, based on the use of calcium receptor antagonists (New Zealand Patent No. NZ5072088, C07C 217/22, C07C 217/60, 2003 and New Zealand Patent No. NZ332068, A61K 31/137 , C07C 217/22, 2001). However, the action of these drugs is known to be designed to inhibit the production of parathyroid hormone (hereinafter referred to as parathyroid hormone) in response to a decrease in the level of extracellular calcium in the blood serum and suppression of osteoclastic resorption by reducing the activity of calcium receptors (Yagiela J., Dowd F., Neidle E. Pharmacology and Therapeutics for Dentistry, Fifth Edition. Mosby, 2004, c. 555-656, 928 p.). The disadvantage of this method of treatment is the use of a hormone-like drug, which leads to inhibition of the activity of the patient’s thyroid and parathyroid glands, as well as the effect on only one pathogenesis link, namely, regulation of the activity of calcium-trophic hormones. The disadvantages of this method of treatment also include side effects of drugs based on calcium antagonists, causing edematous form of hypertrophic gingivitis in patients (Yagiela J., Dowd F., Neidle E. Pharmacology and Therapeutics for Dentistry, Fifth Edition. Mosby, 2004, p.441 , 928 p.).

Closest to the proposed one is a method of treating periodontitis (RF Patent No. 2271769, А61С 5/00, А61К 6/033, А61К 35/32, 2004), including the removal of subgingival dental deposits, the elimination of traumatic occlusion, curettage, surgical treatment, and medication treatment, local replenishment of calcium deficiency with the help of the drug "Hydroxyapol".

The disadvantage of this method is only the local use of calcium preparations, which is not sufficient for the successful restoration of bone tissue of the alveolar process, because mechanisms of osteogenesis regulated by various factors, including calcium-tropic hormones, are not taken into account. The polyetiological nature of chronic generalized periodontitis is not taken into account. The disadvantage of this method is expressed in the treatment of local bone defects without addressing the causes of defects. This leads to a low therapeutic effect, a long healing period, a decrease in the period of remission of the disease as the main criterion for successful treatment.

The objective of the invention is to increase the effectiveness of the treatment of chronic generalized periodontitis with an aggressive course.

The technical result of the application of the invention is to increase the therapeutic effect of treatment, improve bone metabolism, the sustainable effect of bone tissue regeneration, long-term remission of the disease, reduction of side effects of the drugs used. The treatment method takes into account the mechanisms of osteogenesis, allows not only to eliminate the consequence of the pathology that has arisen, but also to influence the causes of its occurrence.

The result is achieved as follows. During treatment, dental plaque is removed, traumatic occlusion is eliminated, curettage is performed, surgical treatment, and drug treatment are performed. After surgical treatment, in order to correct mineral metabolism, Calcohel is taken one tablet three times a day for three weeks, then Osteochel C is taken one tablet three times a day for three weeks, then after a break for three weeks the course is repeated taking drugs.

The invention is illustrated by the following graphic materials.

Figure 1 presents the x-ray of patient 1 before treatment of the claimed method.

Figure 2 - x-ray of patient 1 after treatment of the claimed method.

Figure 3 presents the x-ray of patient 2 before treatment of the claimed method.

Figure 4 - x-ray of patient 2 after treatment of the claimed method.

Figure 5 presents the x-ray of patient 3 before treatment.

Figure 6 - x-ray of patient 3 after treatment carried out without correction of mineral metabolism.

The invention is illustrated as follows.

The main problem of treatment is the regeneration of bone tissue of the alveolar bone lost as a result of inflammatory resorption (G. Wolf, E. Rateytshak, K. Rateytskhak. Periodontology. // Moscow, MEDpress-inform, 2008, p. 312). Moreover, the greater the degree of loss of height of the interalveolar septa, the more difficult they are to recover. Surgical treatment of periodontitis with an aggressive course is not always successful and leads to early tooth loss, even when using modern osteoplastic drugs. Recent studies on disorders of mineral metabolism and bone metabolism (Krejci CB Osteoporosis and periodontal disease: is there a relationship? // J. West Soc. Periodontol. - 1996. - 44 (2). - P.37-42. Reddy MS, Geurs NC, Gunsolley JC Periodontal host modulation with antiproteinase, anti-inflammatory, and bone-sparing agents. A systematic review. // Ann Periodontol. 2003, Dec; 8 (1): p.12-37. Tietmann C. , Bissada NF Aggressive periodontitis in a patient with chronic cutaneous lupus erythematosus: a case report. // Quintessence Int. 2006, May; 37 (5): p.401-408) showed the presence of systemic factors that affect bone remodeling processes, including jaws. The function of bone cells is regulated by systemic and local factors affecting its metabolism. Systemic factors, which include parathyroid hormone, calcitonin, calcitriol, glucocorticoids, sex hormones, are directly involved in calcium homeostasis. Local factors, such as cytokines and prostaglandins, growth and differentiation factors, mediate the influence of systemic factors; some of them are produced by bone cells when activated by the paracrine or autocrine method.

A detailed study of the mechanism and features of these processes made it possible to identify a relationship with changes in the bone tissue of the jaw during the development of periodontal pathology, and to learn how to manage them not only with the use of locally osteoplastic materials, but also to regulate the mineral metabolism by introducing various pharmacological preparations into the complex treatment (T. Nikitina B. “Pathogenetic foundations of the complex therapy of periodontal disease.” Abstract of thesis, Doctor of Medical Sciences, M., 1975, 40 pp.).

The invention consists in the following.

During treatment, dental plaque is removed, traumatic occlusion is eliminated, curettage is performed, drug treatment, and surgical treatment are performed. After surgical treatment, in order to correct mineral metabolism, Calcohel is taken one tablet three times a day for three weeks, then Osteochel C is taken one tablet three times a day for three weeks, then after a break for three weeks the course is repeated taking drugs.

The method is as follows.

A preliminary visual examination of the patient is carried out to determine the dental status, an x-ray and laboratory study is carried out, including a general clinical blood test and determination of biochemical parameters (total calcium, ionized calcium, parathyroid hormone, calcitonin).

During treatment, dental plaque removal, elimination of traumatic occlusion, curettage, surgical treatment (a patch operation using osteoplastic drugs), anti-inflammatory treatment (conservative treatment aimed at eliminating inflammation and infection of periodontal tissues) are performed. Immediately after surgical treatment for the correction of mineral metabolism, Calcohel is taken one tablet three times a day for three weeks, then Osteochel C is taken one tablet three times a day for three weeks, then after a break for three weeks the course is repeated taking drugs.

In the course of experimental and clinical studies of the state of mineral metabolism in 48 patients of both sexes, aged 27 to 47 years, suffering from chronic generalized periodontitis with an aggressive course, it was found that the calcium ionized content in these patients was reduced and amounted to an average of 0.88 mmol / l ± 0.06, with a norm of 1.06-1.31 mmol / l, and indicators of calcium-regulating hormones (parathyroid hormone 62.9 ± 0.02 pg / ml with a norm of 7-53 pg / ml and calcitonin 2.3 ± 0, 01 ng / l at a rate of 3-13 ng / l) are in significant imbalance. The similar nature of the indications in all patients from the study group made it possible to conclude that the regulation of these indicators will lead to a significant therapeutic effect in the restoration of bone tissue of the alveolar bone and a long stage of remission. Given the small discrepancies with the norm of calcium ionized and parathyroid hormone and a slight decrease in calcitonin, it is necessary to select a drug that gently affects the identified factors. For the general therapeutic treatment, the group of complex antihomotoxic drugs Kalkohel and Osteochelle C was selected (Russian Drug Register. Pharmacist. 2008, p. 484, 741).

Characteristics of the drugs used.

Calcohel (tablets, registration certificate P-8-242 No. 010589 / 10.12.1998): 4-component preparation (3 components of plant origin, 1 chemical, in the potency range D4-D12). Composition and form of release: 1 sublingual tablet contains Calcium carbonicum Hahnemanni D8 - 180 mg, Solanum dulcamara D6 - 30 mg, Chamomilla recutita D4 - 30 mg, Carbo vegetabilis D12 - 60 mg; in plastic pencil cases of 50 pcs., in a cardboard bundle 1 pencil case. General indications: disturbances in calcium metabolism; hypertrophic processes of the skin, lymphoid tissue; inflammatory diseases of the mucous membranes.

Osteochel C (tablets, registration certificate P-8-242 No. 010590 / 10.12.1998): 8-component preparation (1 component of mineral, 4 - chemical, 2 - vegetable, 1 - animal origin, in the potency range D4-D9). Composition and dosage form: 1 sublingual tablet contains Hekla Lava D6, Kalium jodatum D4, Asa foetida D4, Stillingia sylvatica D4, Aranea diadema D6, Natrium sulfuricum D4 no 30 mg, Mercurius praecipitatus ruber D9, Calcium phosphoricum D6 no 60 mg; in plastic pencil cases of 50 pcs., in a cardboard bundle 1 pencil case. General indications: inflammatory processes in bone tissue, periosteum; disturbances in calcium metabolism; degenerative processes in the connective tissue of any location.

The action of these drugs provides a comprehensive multilevel regulation of the endocrine balance in hormone-dependent diseases (by the feedback mechanism), as well as in the case of a decrease in the adaptive capacity of the body in the presence of a long-existing chronic pathological process, which is a chronic generalized periodontitis with an aggressive course.

The course prescription of the drug was based on the generally accepted practice of prescribing homeopathic medicines. During clinical trials, patients were divided into groups who received drugs with different courses. The effectiveness of the treatment was evaluated by changing the biochemical parameters of the blood (PTH, calcitonin, calcium ionized). The results were statistically processed and analyzed. The best result was obtained in the group receiving the drugs with the proposed course of 3 weeks. During clinical trials, it was also found that the greatest effect is achieved with the claimed sequence of taking the drugs. When taking Calcohel, a gradual, smooth saturation of the body with calcium occurs, it is possible to systematically assimilate it and hypercalcemia is prevented, taking the second drug, Osteochel C, ensures the assimilation of the drug by regulating impaired metabolism, reducing parathyroid hormone in the blood and, as a result, the targeted intake of calcium in places of defects, but not its conclusion in the form of excess under the action of high parathyroid hormone. That is, the first drug provides saturation of the body, and the second is a conductor of calcium to those in need in this area. As a result of examination of all patients who underwent treatment with the claimed method, the normalization of calcium-regulating hormones (parathyroid hormone and calcitonin) was established. Thus, the balance of these hormones in the body is restored, while there is a significant improvement in periodontal conditions and the absence of relapse of the disease over a long period of more than 3 years.

The possibility of implementing the proposed method is shown in clinical examples.

Example 1. Patient K., born in 1961, turned to the Department of Therapeutic Dentistry of the FPDO of the Moscow State Medical-Dental University with complaints of tooth mobility, difficulty chewing food, pain in the gums during brushing and eating. Previously treated by a periodontist in a community clinic. The treatment consisted of removing dental plaque, carrying out anti-inflammatory and antimicrobial therapy, removing a movable tooth 16. A history of chronic renal failure. No occupational hazards; allergies and hepatitis denied.

Visual inspection There are no external changes in facial contours. Lymph nodes are not palpable.

Inspection of the oral cavity. The mucous membrane of the gum is edematous, hyperemic with a bluish tinge, with purulent exudate in the area of all teeth. Tooth mobility II-III degree. When probing in the chewing group of teeth of the upper and lower jaw, periodontal pockets with a depth of 7-8 mm are determined, in the frontal section up to 9 mm. There is a small vestibule of the oral cavity with a decrease in the level of attached gums due to multiple recessions. Oral hygiene is satisfactory. The presence of abundant subgingival dental deposits. The patient has a partial secondary adentia (missing tooth 16). Bite changed due to secondary traumatic occlusion.

X-ray examination data. On the orthopantomogram of the upper and lower jaws, the bone tissue of the interalveolar septa decreases due to resorption of 1/2 or more of the root length in the region of the upper jaw teeth and more than 2/3 of the root length in the region of the lower teeth. In the area of 47, 36 teeth, a round-shaped bone resorption with clear boundaries is diagnosed clinically corresponding to periodontal cysts extending beyond the tooth root.

Laboratory research data. Clinical blood count is normal. PTH = 66.6 pg / ml, calcitonin 2 ng / L, total calcium 2.27 mmol / L, ionized calcium 1.01 mmol / L.

Diagnosis: severe chronic generalized periodontitis with an aggressive course.

The patient underwent complex treatment, including training in oral hygiene, sanitation of poorly filled canals, removal of subgingival dental deposits and curettage of periodontal pockets, antibiotic therapy (sumamed 250 mg - 5 days), removal of 27, 46, hemisection in area 36, fabrication of splinting structures and temporary crowns on the lower and upper jaw. Immediately after the surgical treatment (flap surgery with osteoplasty and the introduction of the drug Osteoplast in the area of vertical bone defects), a course of Calcohel was prescribed one tablet three times a day for three weeks, then Osteochel C, one tablet three times a day for three weeks, then a break of three weeks and again the same drugs in the same course. Re-examination was carried out 11 months after the start of treatment. Examination of the oral cavity showed the following: the mucous membrane of the gums is pale pink, with no signs of bleeding, the depth of periodontal pockets within 3 mm in the area of all teeth. On the orthopantomogram, the closure of vertical bone defects with full bone tissue, the restoration of the shape of the interdental septa, and the appearance of a clear cortical plate along the edge of the bone are determined.

Laboratory research data. PTH = 48.4 pg / ml, calcitonin 4.9 ng / L, total calcium 2.43 mmol / L, ionized calcium 1.18 mmol / L.

The patient himself notes a significant improvement, the disappearance of bleeding gums and tooth mobility, the absence of relapse of the disease for more than 3 years. The example is confirmed by radiographs performed before treatment - figure 1 and after treatment - figure 2.

Example 2. Patient P., born in 1970, turned to the Department of Therapeutic Dentistry of the FPDO of the Moscow State Medical-Dental University with complaints of tooth mobility, difficulty chewing food, pain in the gums during brushing and eating. Previously, I did not contact the periodontist. According to the patient, she is almost healthy. No occupational hazards; allergies and hepatitis denied.

Visual inspection There are no external changes in facial contours. Lymph nodes are not palpable.

Inspection of the oral cavity. The mucous membrane of the gums is slightly edematous, hyperemic, and purulent exudate in the area of 36 and 46 teeth is released upon palpation. The mobility of these teeth is III degree. When probing in region 46, a periodontal pocket is determined with a depth of more than 10 mm, in region 36 - more than 5 mm.

X-ray examination data. On the orthopantomogram of the upper and lower jaws, a decrease in bone tissue in the tooth region 46 is determined for the entire length of the roots of a rounded shape (radiological signs of periodontal cyst). In the area of the tooth 36 there is a bone resorption at 1/2 root length.

Laboratory research data. Clinical blood count is normal. PTH = 61.4 pg / ml, calcitonin 2 ng / L, total calcium 2.22 mmol / L, ionized calcium 0.99 mmol / L.

Diagnosis: severe chronic generalized periodontitis with an aggressive course.

The patient underwent a comprehensive treatment, including training in oral hygiene, removal of subgingival dental deposits and curettage of periodontal pockets, antibiotic therapy (sumamed 250 mg - 5 days), a beam splint was made in the area of 45, 46, 47. Immediately after surgical treatment (patchwork surgery with osteoplasty and the introduction of Osteoplast into the area of vertical bone defects) a course of Calcohel was prescribed, one tablet three times a day for three weeks, then Osteochel C, one at a time th tablet three times a day for three weeks, then a break for three weeks and again the same drugs in the same course. Re-examination was carried out 11 months after the start of treatment. Examination of the oral cavity showed the following: the mucous membrane of the gums is pale pink, with no signs of bleeding. On the orthopantomogram, the closure of vertical bone defects in region 46 is determined to be 1/2 to full bone tissue, in the region of 36 to 1/3.

Laboratory research data. PTH = 34.4 pg / ml, calcitonin 3.9 ng / L, total calcium 2.48 mmol / L, ionized calcium 1.1 mmol / L. The patient herself notes a significant improvement, the disappearance of bleeding gums and tooth mobility, the absence of relapse of the disease for more than 3 years. The example is confirmed by radiographs performed before treatment - figure 3 and after treatment - figure 4.

Example 3. Patient M., born in 1964, turned to the Department of Therapeutic Dentistry of the FPDO of the Moscow State Medical-Dental University with complaints of tooth mobility, difficulty chewing food, pain in the gums when brushing your teeth and eating. Previously treated by a periodontist in a community clinic. The treatment consisted of removing dental plaque, carrying out anti-inflammatory and antimicrobial therapy, and prosthetics. Almost healthy. No occupational hazards; allergies and hepatitis denied.

Visual inspection There are no external changes in facial contours. Lymph nodes are not palpable.

Inspection of the oral cavity. The mucous membrane of the gum is edematous, hyperemic with a bluish tinge, with purulent exudate in the area of all teeth. Tooth mobility II-III degree. The chewing group of teeth on the upper jaw was removed for periodontitis. When probing in the area of the anterior teeth of the upper and lower jaw, periodontal pockets with a depth of 7-8 mm are determined. There is a small vestibule of the oral cavity with a decrease in the level of attached gums due to multiple recessions. Oral hygiene is satisfactory. The presence of abundant subgingival dental deposits. Orthognathic bite.

X-ray examination data. On the orthopantomogram of the upper and lower jaws, a decrease in the bone tissue of the interalveolar septa is determined due to resorption of 1/2 or more of the root length in the region of the upper jaw teeth and within 1/2 of the root length in the region of the lower teeth.

Laboratory research data. Clinical blood count is normal. PTH = 55.6 pg / ml, calcitonin 2.8 ng / L, total calcium 2.49 mmol / L, ionized calcium 1.08 mmol / L.

Diagnosis: severe chronic generalized periodontitis with an aggressive course.

The patient underwent comprehensive treatment, including training in oral hygiene, sanitation of poorly filled canals, removal of subgingival dental deposits and curettage of periodontal pockets, antibiotic therapy (sumamed 250 mg - 5 days), manufacture of splinting structures and temporary crowns on the lower and upper jaw. Surgical treatment (flap surgery with osteoplasty and the introduction of the drug Osteoplast in the area of vertical bone defects) was performed. Correction of mineral metabolism was not carried out. Re-examination was carried out 11 months after the start of treatment. Examination of the oral cavity showed the following: the mucous membrane of the gums is pale pink, with no signs of bleeding, the depth of periodontal pockets within 3 mm in the area of all teeth. The pathological mobility of the anterior maxilla teeth has been preserved within the first degree. On the orthopantomogram, compaction of the bone tissue of the interalveolar septa, restoration of the cortical plate along the edge of the alveolar process is determined. Vertical bone growth is not observed.

Laboratory research data. PTH = 54.9.4 pg / ml, calcitonin 2.9 ng / L, total calcium 2.43 mmol / L, ionized calcium 1.08 mmol / L.

The example is confirmed by radiographs performed before treatment - Fig.5 and after treatment - Fig.6.

Clinical studies, supported by laboratory data, allow us to conclude that it is advisable to use Calcohel and Osteochel C drugs for the correction of mineral metabolism in the treatment of chronic generalized periodontitis with an aggressive course.

Claims (1)

A method for the treatment of chronic generalized periodontitis with an aggressive course, including the removal of dental plaque, elimination of traumatic occlusion, curettage, drug treatment, surgical treatment, characterized in that after the surgical treatment, mineral metabolism is adjusted, prescribing Calcohel to take one tablet three times a day for three weeks, then taking the drug Ostkehel C one tablet three times a day for three weeks, then take a break for three weeks and repeat the chickens receiving the drugs in the same sequence and the dosage.

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