RU2626826C1 - Method for hypertrophic gingivitis treatment in patients with non-removable orthodontic devices with application of injection form of autological platelet-rich plasma - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: for conservative treatment of hypertrophic gingivitis in patients with non-removable orthodontic devices against the background of professional oral hygiene and topical application of chlorhexidine within 10 days, fraction of platelet-rich autologous plasma obtained from the supernatant space of tube after centrifugation is injected intrapapillary into the hypertrophic gingiva papillae, and the remaining fraction is introduced submucosally into the transitional fold in a total volume of 8-9 ml in the area of all teeth. The injection procedure is repeated after 7 days.

EFFECT: method allows to shorten the treatment time, to stop the inflammatory process, to stimulate regeneration due to acceleration of its natural mechanisms due to the growth factors contained in platelets in the prevention of relapse.

5 dwg, 1 tbl, 2 ex

Description

The invention relates to medicine, namely to therapeutic dentistry, and is intended for the conservative treatment of hypertrophic gingivitis.

Periodontal disease is widespread throughout the world and affects various segments of the population. Periodontal diseases are an urgent problem of modern dentistry due to the fact that they are difficult to treat. A high percentage of people with periodontal disease is not only among adults, but also among children. The frequency of occurrence of persons with pathology of occlusion is also high. Currently, the number of patients with an established dentition has been increasing to see a dentist orthodontist. This leads to an increase in the duration of orthodontic treatment and an increase in the risks of complications. [Kosyuga S.Yu., Botova D.I. Manifestations of catarrhal and hypertrophic gingivitis in patients with fixed orthodontic structures // Eurasian Union of Scientists. - 2015. - No. 12 (21). - S. 87-88]. Many authors believe that the combined effects of dental plaque and traumatic occlusion are more damaging to periodontal tissues than to each of these factors individually.

At present, the most effective equipment for normalizing the position of the teeth is a fixed orthodontic technique (bracket system), however, the use of fixed orthodontic equipment makes it difficult to care for the oral cavity and predisposes to the development of inflammatory processes in the gums and periodontal tissues. With orthodontic treatment, the frequency of inflammatory events in the periodontium remains high (20-38%) [Petrunina, O.V. Clinical and cytological diagnosis of inflammatory complications in periodontal tissues during orthodontic treatment using fixed technique. Abstract. dis. Cand. honey. sciences. - Moscow, 2008. - 27 p.]. The presence in the oral cavity of braces, arches, rings, ligatures, chains, buttons and other orthodontic designs significantly complicates the daily hygiene procedures, which creates favorable conditions for the accumulation of plaque and the development of an inflammatory process in the periodontium [V. Nikitin et al. Study of the effectiveness of the use of agents based on bacteriophages in the complex treatment of gingivitis in patients with fixed orthodontic structures // Periodontology. - 2014. - No. 3 (72). - S. 36-43].

It is noted that the plaque around the base of the bracket is similar in composition to the hard dental plaque, which is a symbiosis of various microorganisms, which causes the onset and development of chronic gingivitis [Alimova, R.G. Makhsudov S.N. Oral hygiene and modern orthodontics // Stomatologiya. - 2004. - No. 1-2. - S. 102-106].

The treatment of patients with dentoalveolar anomalies using a fixed orthodontic technique (NOT) is accompanied by a deterioration in the level of hygiene of the oral cavity and contributes to the development of various adverse changes, such as: worsening microcirculation and oral fluid parameters, the appearance of destructive processes in periodontal tissues [Denisova Yu.L. The periodontal condition in patients with maxillofacial anomalies during the period of orthodontic treatment with modern fixed technology // Periodontics. - 2004. - No. 1. - S. 23-27].

The principles of treatment of inflammatory periodontal diseases are closely related to the idea of the causes and mechanism of inflammation in periodontal tissues.

The inflammatory reaction, the result of the interaction of a macroorganism with a microorganism, is recognized as the main element in the pathogenesis of inflammatory periodontal diseases. Initially, the body's protective reactions (phagocytosis, immunogenesis) aimed at neutralizing the microbial agent themselves become pathological mechanisms of periodontal tissue destruction. The microflora of the oral cavity, in particular its periodontopathogenic species, causes an increase in vascular permeability, hyperemia, impaired energy metabolism and antioxidant defense, and other metabolic changes characteristic of the inflammatory reaction, including a decrease in the immune response to microbial antigens. The accumulation of plaque in the interdental spaces and at the necks of the teeth leads to gingival inflammation, loss of gingival attachment, destruction of the bone tissue of the alveolar sections of the jaws. In the mechanism of local tissue destruction in periodontitis induced by oral microflora, an important role belongs to the violation of immunological reactivity and a decrease in the regenerative abilities of the body.

There is evidence of an immunodeficiency condition developing during orthodontic treatment, as evidenced by a decrease in the level of CD3 lymphocytes, immunoglobulin A and a change in the immunoregulatory index [Levenets AA, Bril EA, Kozhevnikova TA The state of the immune system in children at the stages of orthodontic treatment // Institute of Dentistry. - 2005. - No. 3. - S. 44-45]. One month after the fixation of the bracket system, the content of interleukin-4 in patients decreases, and the content of interleukin-8, interferon-@ and C-reactive protein increases. The indicated changes in the parameters of the gingival fluid indicate that in response to the influence of the orthodontic apparatus at the level of the gingival sulcus, the content of pro-inflammatory cytokines increases and inflammatory processes develop.

Hypertrophic gingivitis is a chronic inflammatory process of the gums, accompanied by proliferative phenomena. To date, the recognized designations of this condition in foreign literature are such names as “gingival enlargement” and “gingival overgrowth,” which can be translated as “gingival enlargement” and “gum overgrowth” [Zakirov T.E., Bimbas E.S. Sati T.N. Various manifestations of periodontal hyperplasia in children // Problems of Dentistry. - 2013. - No. 3. - S. 56-61].

The causes of gingival hyperplasia are diverse and may be associated with the action of local and systemic factors. Localized gingival hypertrophy develops with crowding of the teeth, trauma to the mucous membrane by overhanging fillings, clasps, artificial crowns, elements of the bracket system, anomalies of the occlusion and oral breathing are of particular importance.

Hypertrophic gingivitis in the general structure of periodontal diseases makes up from 5.2 to 41.6% of cases [Biryukova Yu.A., Morozova SI, Fuchs E.I. Changes in cytomorphometric indicators before and after treatment with orthophene and dioxidine ointments in patients with mild severity of hypertrophic gingivitis, edematous form // Russian Medical and Biological Bulletin named after academician I.P. Pavlova. - 2014. - No. 1. S. 137-140]. The prevalence of chronic catarrhal and chronic hypertrophic gingivitis increases after six months of using NOT, due to the deterioration of the hygienic condition of the oral cavity [Kosyuga S.Yu., Botova DI Manifestations of catarrhal and hypertrophic gingivitis in patients with fixed orthodontic structures // Eurasian Union of Scientists. - 2015. - No. 12 (21). - S. 87-88]. Latent flow in the early stages of inflammatory processes in periodontal tissues in patients with a bracket system makes it difficult to timely diagnose gingivitis and periodontitis of mild severity, and consequently, therapeutic and rehabilitation measures are delayed [Petrunina, O.V. - Clinical and cytological diagnosis of inflammatory complications in periodontal tissues during orthodontic treatment using fixed technique. Abstract. dis. Cand. honey. sciences. - Moscow, 2008. - 27 p.]. This condition requires a complex of medical and preventive measures.

With hypertrophic gingivitis in treatment, one of the key roles is played by the quality of professional oral hygiene. This stage is of great importance since leads to a rupture of the vicious circle, a significant reduction in gum edema, makes it possible to conduct adequate oral hygiene, and also prevents the transformation of the biocenosis of the gingival pockets according to the pathological type with the development of aggressive periodontal pathogens. An important link in the treatment of hypertrophic gingivitis in patients with fixed orthodontic appliances are methods of local stimulation of periodontal tissue regeneration processes and increase local immunity. These methods include methods implemented in the process of drug general and local treatment.

Methods of treating hypertrophic gingivitis, edematous, mild severity are described by applying 5% dioxidine ointment on a hypertrophied gum for 20 minutes daily for 10 days, applying 2% ortofen ointment on a hypertrophied gum for 20 minutes daily for 10 days [Yu.A. Biryukova, S.I. Morozova, E.I. Fuchs Change in cytomorphometric parameters before and after treatment with orthophene and dioxidine ointments in patients with mild severity of hypertrophic gingivitis, edematous form // Russian Medical and Biological Bulletin named after Academician I.P. Pavlova. - 2014. - No. 1. S. 137-140].

A method is described for treating catarrhal gingivitis in orthodontic patients with OKI-ketoprofen with a lysine salt, which is a derivative of 2-arylpropionic acid, in the form of rinses for 3-5 minutes twice a day with a solution prepared in dilution of 10 ml of OKI in 100 ml of water for 10- 12 days after professional oral hygiene [Kosyreva TF, Bagdasarova IV, Safroshkina VV Treatment of chronic catarrhal gingivitis in orthodontic patients // RUDN University Bulletin, a series of Medicine 2009. - No. 4. - 430-435].

At present, the use of phytopreparations, which are more physiological than synthetic means, is promising in dental practice, and it is possible to use all the components that make up the medicinal plant and to combine phytochemicals to enhance the therapeutic effect. They use drugs such as novoimanin (a preparation from St. John's wort perforated), decoctions of marigold flowers, chamomile, oak bark, rhizome and root of the bloodlet, cherry fruits, and others. Rinses are carried out for 2-3 weeks. These herbal remedies contain tannins and have an astringent effect. Tannins (tannin, etc.) form insoluble compounds with proteins (albuminates) in the form of an insoluble film on the surface of the mucosa. They protect nerve endings from irritation by decay products and reduce pain. In addition, they narrow the dilated vessels and tighten their wall, reducing the permeability of blood vessels.

The treatment method is described, which consists in the application of a phytopreparation based on the rhizomes and roots of Leuzea, St. John's wort, calendula, meadowsweet and 2% orthophene ointment on hypertrophied gums for 15-20 minutes 1 time per day, course of 14 days. Immediately after treatment, a significant decrease in the inflammatory-destructive index of VDI in patients with mild and moderate degrees of hypertrophic gingivitis by 60.65% was revealed. [Biryukova Yu.A., Filimonova LB, Galizina O A. Laboratory evaluation of the effectiveness of the use of herbal medicine in the treatment of hypertrophic gingivitis // Russian Medical and Biological Bulletin named after academician I.P. Pavlova. - 2014. - No. 3. S. 139-142]

A method for the treatment of gingivitis in orthodontic patients is described, which consists in the inclusion of glucosaminylmuramyl dipeptide (lycopid) in the form of 1 mg tablets sublingually 1 time per day for 10 days in the complex therapy [Haliullina GR, Blashkova SL. Clinical and immunological studies of inflammatory complications in periodontal tissues during orthodontic treatment using fixed equipment // Kazan Medical Journal, 2014, Volume 95, No. 2. - S. 250-253].

After eliminating inflammatory edema and bleeding gums, biogenic preparations with a mild sclerotizing and keratolytic effect are prescribed. Such drugs include befungin (an extract from fungal growths of birch fungus chaga). It is used in the form of applications 2-3 times a day for 2-4 weeks, diluting 1: 1 with warm boiled water for this purpose. Maraslavin is used - a complex herbal preparation containing extracts of Pontic wormwood, cloves, black pepper, and wine vinegar. Instillations are carried out in the gingival pockets for 15-20 minutes daily for 10-20 days.

It is possible to use physical factors: electrophoresis of 5% potassium iodide, heparin, 10% calcium chloride solution, ronidase or lidase solution daily or every other day for 15-20 days.

A method for treating hypertrophic gingivitis using an ointment preparation of the following composition is described: 70% tincture of rhizomes with roots of a leuzea or Tatar tar grass - 10.0 ml, 70% tincture of St. John's wort - 5.0 ml, 70% calendula tincture - 5.0 ml, 70% tavolga herb tincture - 5.0 ml, clove essential oil - 1.0 g, petrolatum - 35.0 g, lanolin - 39.0 g, which is applied as an applicate on mucous membrane of hypertrophied gums for 15-20 minutes once a day for 14 days, recommending patients to refrain from eating for 2 hours in [patent RU 2519100, 2014].

In the absence of the effect of the above measures, resort to sclerotherapy. For this purpose, the drug is used orthochrom containing chromic anhydride and sulfuric acid.

The drug has cauterizing properties, limiting its effect on the surface for 5-6 seconds. After thorough isolation from saliva, turunda with the drug is introduced into the gingival pocket for 5 seconds, after which it is thoroughly washed with water. The procedures are carried out in 2-3 days (only 5-6 per course).

A method of sclerotherapy is described by applying to the gingival margin and introducing into the clinical pockets of turundum moistened with various sclerotherapy formulations: 20-30% resorcinol solution, 10-25% zinc chloride solution, 5-10% propolis alcohol solution. Effectively applying a mixture of the following composition: salicylic acid - 0.1; crystalline resorcinol - 1.0; camphor - 2.0; menthol - 3.0; thymol - 1.0; alcohol 96 ° - 92.0. The duration of the procedure is 20 minutes, the course of treatment is 3-5 sessions every other day. When conducting applications, it is necessary to ensure that sclerosing compounds do not fall on the surrounding mucous membrane.

If application sclerotherapy is ineffective, they resort to injecting hypertonic solutions of drugs such as 10% calcium chloride solution, 40-60% glucose solution, novembihin, 10% calcium gluconate solution, lidocaine with lidocaine, longidase, hydrocortisone emulsion into the gingival papillae. ethanol solution (deep sclerotherapy). The introduction of sclerosing agents is performed under anesthesia. At the same time, 0.1-0.3 ml of the drug is injected into the 3-4 gingival papilla. The interval between injections is 1-2 days, the course of treatment is 4-8 injections.

In the absence of the effect of conservative therapy in the post-puberty period, as well as with fibrous hyperplasia of the gum tissue, gingivectomy is resorted to. After the excised tissues are removed, the gum surfaces are cleaned and polished with the help of manual and mechanical tools. In conclusion, the wound surface should be cleaned of necrotic tissue and blood clots, treated with antiseptic solutions and covered with periodontal dressings, gingivectomy techniques that provide immediate hemostasis (cryodestruction, diathermocoagulation, laser evaporation, high-frequency surgery) are preferred.

Conservative treatment using applications of drugs and physiotherapeutic methods involves long-term treatment (2-3 weeks), an allergic reaction is possible, therapy is not always effective and often requires supplementation with sclerotherapy or surgery.

Sclerotherapy (both application and injection) is symptomatic, complements drug treatment, requires infiltration anesthesia (which in itself is an intervention), a long time, several visits to the doctor (from 3 to 8), such side effects are possible as an allergic (to both anesthetic and injectable drug), toxic, irritating effects.

Surgical treatment - gingivectomy, is an invasive intervention, can provoke an aesthetic defect of the gingival margin, and, being not a pathogenetic method of treatment, can lead to relapse.

The closest analogue is a method of treating hypertrophic gingivitis, the essence of which is as follows: after professional cleaning, curettage of false periodontal pockets, injecting sclerotherapy with Ethoxisclerol 0.25% in 2 ml in a hypertrophic area of the oral mucosa with further application of a bandage on the basis of furatsilinovoy ointment, a course of treatment of 5 days, daily [patent RU 2568852 C1, 2015].

The main disadvantages of this method are due to the fact that, firstly, with this technique, repeated medical intervention is necessary (daily 5 days); secondly, allergic reactions are noted to the drug; up to anaphylactic shock; thirdly, the immune response and the regenerative potential of the affected tissues are not stimulated, the microcirculation in the affected areas and their trophism are not improved, therefore, injections are not a pathogenetic, but only a symptomatic treatment that does not prevent a relapse of the disease.

The search for methods for minimally invasive effective therapy of hypertrophic gingivitis and its prevention in patients with fixed orthodontic appliances who are pathogenetic (stimulate local immunity, improve trophic processes in areas of increased load in periodontal bone tissue during boosting orthodontic forces, optimize regeneration processes) is relevant.

Today, this method is the injection method using plasma obtained from the patient’s own blood - platelet autologous plasma (TAP), which is a highly active biological stimulator of regeneration processes due to the platelets of various growth factors contained in alpha granules that act on all structural units of surrounding tissues and stimulating regeneration processes.

The reason for using autologous platelet-rich plasma was the discovery of the fact that platelets contain protein factors (PRP-factors) that initiate the cellular regenerative process. One of the first to use Marx R.E. gel plasma with co-authors. They performed plasmogel deposition on a bone graft and the replacement of defects of the lower jaw up to 5 cm or more after tumor resection. In one group, autologous bone mixed with gel was used, and in the control group, only autogenous bone. As a result of the study, scientists proved accelerated bone formation and its better structural organization when using platelet-rich plasma in gel form, as well as the presence of platelet-derived receptors for growth factors in autologous bone. According to the authors, when using autoplasma in the form of a gel after replacing a bone defect, the bone was 2 times more mature than in the control group when monitoring patients for 2, 4, 6 months [Anitua E. Plasma rich in growth factors: Preliminary results of use in the preparation of future sites for implants. Int J Oral Maxillofac Implants 1999; 14: 529-535].

There are also works devoted to the use of autoplasma for sinus lift as an implant on allogeneic bone [Froum SJ, Wallace SS, Tamow DP, Cho SC. Effects of platelet-reach plasma on bone growth and osseintegration in human maxillary sinus grafts: Three bilateral case reports. Int J Periodontics Restorative Dent 2002; 22: 45-53].

Other authors used the gel form of autoplasma in the area of the holes of the extracted teeth. It was found that in those wells that were filled with plasma in the form of a gel, a larger volume of better organized bone was noted and, in shorter periods, wound epithelization also proceeded faster [Froum SJ, Wallace SS, Tarnow DP, Cho SC. Effects of platelet-reach plasma on bone growth and osseintegration in human maxillary sinus grafts: Three bilateral case reports. Int J Periodontics Restorative Dent 2002; 22: 45-53].

In the classical methodology of PRP-therapy, a gel is used, the introduction of which into the tissues is possible in the presence of an operational wound. The use of injections is possible before surgery, after, during and instead of [Akhmerov P.P., Korotkova O.I., Ovechkina M.V., Zarudy R.F., Vorobyov A.A. The use of autoplasma containing platelets in dermatocosmetology and dentistry. Plasmolifting ™ Technology // Plastic Surgery and Cosmetology. - 2013. - No. 1. - S. 1]. That is, the fundamental advantage of the injectable form of autoplasma containing platelets is the ease of use, the possibilities of use not only in surgical but also in therapeutic practice. It is the injection form of autoplasma containing platelets that can significantly expand the scope.

Autologous platelet plasma is obtained by centrifuging the patient’s blood using special tubes and centrifuges, with developed centrifugation modes.

The lower part of the test tube, which makes it possible to obtain highly purified plasma with a therapeutic platelet content, is filled with an adsorption gel that does not affect the properties of the plasma, adsorb red blood cells and low molecular weight fatty acids during centrifugation, and stabilize the erythrocyte-leukocyte clot. To prevent blood coagulation in the upper and middle parts of the tube, finely dispersed sodium heparin of a high degree is applied to the walls.

The autologous plasma obtained by centrifugation contains platelets in high concentration. Platelets are known to contain numerous growth factors and cytokines that contribute to the regeneration of damaged tissues. In the alpha granules of platelets, more than 30 growth factors were identified that can affect the processes of restoration of periodontal tissues simultaneously.

Of greatest importance are: IGF (insulin-like growth factor) - stimulates the differentiation of stem cells, enhances bone metabolism and collagen synthesis. PDGF (platelet growth factor) - activates the proliferation and migration of mesenchymal (osteogenic) cells, stimulates angiogenesis. PDEGF (platelet growth factor of endothelial cells) - has a stimulating effect on endothelial cells and has an angiogenic effect. VEGF or PDAF (vascular endothelial growth factor): - There are 4 types of factor VEGF-A, -B, -C and -D. Participate in angiogenesis, induce proliferation of vascular endothelial cells. EGF (epidermal growth factor) - stimulates the proliferation of fibro and osteoblasts, stimulates the synthesis of fibronectin.

TGF-β ("Family" of transforming growth factor) are multifunctional factors, because not only induce the differentiation of mesenchymal cells, but also cause many cellular and intercellular responses, including the production of other growth factors. Transforming growth factors include bone morphogenetic proteins, some of which (KMB-2, osteogenin or KMB-3, KMB-4, -5, -7, -8 and -9) are pronounced osteoinductors that modulate cell proliferation and differentiation of poorly differentiated cells in osteoblasts. PLGF-1 / -2 (placental growth factors) - potentiate the effect of VEGF, increase the permeability of the vascular wall.

FGF (fibroblast growth factor) - induces bone tissue expression, angiogenesis, ossification, induces TGF production in osteoblastic cells. Osteonectin “culture shock protein”: accounts for 15% of the organic component of the bone matrix, and regulates cell proliferation and interaction with the matrix. Thrombospondin - mediates bone cell adhesion [A.L. Emelin, I.F. Akhtyamov Clinical efficacy of platelet autoplasma in the treatment of osteoarthritis // Bulletin of modern clinical medicine. - 2013. - Volume No. 6, Appendix 1. - S. 26-29]

The clinical efficacy of injecting platelet autologous plasma is shown, expressed in the processes of regeneration of bone tissue and joint tissues, reducing pain, increasing the range of motion in the joint, improving the musculoskeletal function of the limbs, lengthening the period of remission in the treatment of osteoarthritis, injuries of the musculoskeletal system [G .BUT. Kesyan, G.N. Berchenko, R.Z. Urazgildeev. Optimization of osteogenesis processes in trauma and orthopedic patients using platelet-rich autoplasma and biocomposite materials. Medical Technologies M., 2010. - S. 18]; [Kirillova I.A., Fomichev N.G., Podorozhnaya V.T. The combined use of osteoplasty and platelet-rich plasma in traumatology and orthopedics // Traumatology and Orthopedics of Russia. - 2008, No. 3 (49). - S. 63-67].

The use of TAP showed a good clinical effect in the treatment of inflammatory and inflammatory-destructive periodontal diseases: reducing the severity of chronic inflammation, preventing the exacerbation of the inflammatory reaction, prevents the development of necrotic-destructive processes; leads to almost complete regeneration of the epithelial lining; prevents the development of sclerosis [Akhmerov P.P., Zarudy R F., Tsyplakov D.E., Ovechkina M.V., Vorobyov A.A. The study of pathomorphological changes in gum tissue in the treatment of chronic inflammatory and inflammatory-destructive periodontal diseases using the regenerative method Plasmolifting ™. Part 1 // Periodontology. - 2014. - No. 4 (73). - S. 54-56], [Ovechkina M.V., Tsyplakov D.E., Akhmerov P.P., Zarudy R.F. The study of pathomorphological changes in gum tissue in the treatment of chronic inflammatory and inflammatory-destructive periodontal diseases using the regenerative method Plasmolifting ™. Part II // Periodontology. - 2015. - No. 3 (76), Volume XX. - S. 23-25], [Akhmerov P.P., Ovechkina M.V., Tsyplakov D.E., Vorobyov A.A., T.G. Mansurova. Plasmolifting technology - an injection form of platelet autoplasma for the treatment of chronic catarrhal gingivitis // Periodontology. - 2012. - No. 4 (65). - S. 80-84].

The use of TAP injections in the complex treatment of periodontitis provides persistent clinical remission, a stable level of periodontal indices, reduction in the depth of periodontal pocket [Bulyakov RT, Sabitova RI, Gulyaeva OA The experience of conservative treatment of severe periodontitis using modern biofilm destruction methods and Plasmolifting technology // Problems of Dentistry. - 2014. - No. 1. - S. 54-58]

According to studies, the use of TAP injections contributes to a more stable relief of the inflammatory and destructive process in periodontal tissues, stabilization of bone trabecular structures and bone growth, confirmed by cytomorphometry, and can be used as an alternative to surgical treatment [Makhmutova A.F. The effectiveness of complex rehabilitation treatment of patients with inflammatory periodontal diseases: Author's abstract. dis. on sois. ... cand. honey. sciences. - Moscow, 2009. - p. eighteen]

The objective of the invention is to improve the quality and effectiveness of therapy for hypertrophic gingivitis, accelerate the elimination of inflammation in periodontal tissues, activate local immunity, normalize metabolism and accelerate the process of reparative regeneration of periodontal tissues, reduce treatment time, save a doctor’s time, reduce the number of treatment complications and reduce re-appeal.

The technical result when using the invention is the optimization of remodeling of periodontal fibers during orthodontic loading, prevention of hypoxia and microcirculatory disturbances in the process of bone tissue remodeling under the influence of orthodontic forces, stopping the inflammatory process, shortening the treatment time, stimulating regeneration by accelerating the natural mechanisms of tissue regeneration, thanks to in platelets to growth factors, prevention of relapse.

The invention is illustrated by the following figures: in FIG. 1 - moderate hypertrophic gingivitis on the background of orthodontic treatment by the method of fixed technique according to example 1; in FIG. 2 - view of the gums 1 week after one TAP injection procedure according to example 1; in FIG. 3 is a view of the gums 2 weeks after two TAP injection procedures of Example 1, FIG. 4. and FIG. 5 view of the gums before and after 2 weeks against the background of standard treatment without the use of TAP according to example 2.

The proposed method for the treatment of hypertrophic gingivitis is as follows. On the first visit, the patient is instructed on rational oral hygiene (with the selection of hygiene products), professional oral hygiene, including the removal of dental deposits by hardware (ultrasound) method, the removal of bacterial plaque by air-abrasive method (glycine powder 23 μm, Air-Flow Perio , EMS), coating the teeth with fluorine-containing drugs, and injecting platelet autologous plasma in a volume of 8-9 ml in total.

To obtain a TAP, the patient’s own venous blood is used, which is collected according to standard technology in special Plasmolifting original vacuum tubes containing a highly purified anticoagulant sodium heparin and a special separation gel that allows plasma filtration and fixation of an erythrocyte clot. After blood sampling, the tube is placed in an EVA 20 centrifuge (Germany) and centrifuged at 3200 rpm for 5 min, resulting in 3.05 ± 1.5 ml of platelet plasma in each tube located in the upper part of the tube, then comes a separation gel that separates the erythrocyte clot.

In a syringe with a luer-lock system, 2 ml of the obtained plasma is collected from each tube, sampling is made from the supernatant space of the tube - the area directly above the separation gel (with a maximum concentration of platelets), it is this fraction with a needle with a diameter of 0.3 mm, length 13 mm (29G) under application anesthesia (Sol. Lidocaini 10% Spray) is administered intrapapillary into the hypertrophied papillae within 30 minutes after receiving the TAP. The rest of the obtained plasma is administered submucosally into the transitional fold in the area of all teeth. Locally use chlorhexidine for 10 days (toothpaste, rinses, applications, resorption of tablets).

After a week, the injections are repeated.

In the framework of evaluating the effectiveness of the use of platelet autologous plasma injections in the treatment of hypertrophic gingivitis in patients with NOT, the following clinical study was conducted.

The object of the study was 47 patients of the Republican Dental Clinic AUZ in Ufa at the age of 18-32 (25.6 ± 6.4) with symptoms of gingival hypertrophy during orthodontic treatment for various forms of dysocclusion with non-removable appliances, 27 of them (57 , 4%) - women, 20 (42.6%) - men.

In the control group (18 people), the treatment complex included instructing in individual oral hygiene (IGPR) with the selection of hygiene products, removing dental deposits with an apparatus (ultrasound) method using a piezoelectric scaler with simultaneous irrigation with a 0.05% chlorhexidine solution and removing bacterial plaque In an abrasive way (glycine powder with a particle diameter of 23, Air-Flow Perio, EMS), general antimicrobial therapy was prescribed: Metronidazole 500 mg. 2 times a day for 10 days; locally - chlorhexidine 0.1% 10 days (toothpaste, rinses, applications, resorption of tablets).

In the main group, this complex was supplemented by two injections of autologous platelet plasma: on the day of treatment after professional oral hygiene and after 7 days. After professional oral hygiene, an application for gums based on chlorhexidine + metronidazole (Metrogil-Dent) was performed for 20 minutes, then TAP was administered in a volume of 2 × tubes (8-9 ml).

To obtain TAP, the patient's own venous blood was used, the sampling of which was carried out according to standard technology in special Plasmolifting vacuum tubes containing the anticoagulant sodium heparin and a separation gel. After blood sampling, the tube was placed in an EVA 20 centrifuge (Germany) and centrifuged at 3200 rpm for 5 min, resulting in 3.05 ± 1.5 ml of platelet plasma. For injection, disposable syringes with a luer-lock system and needles with a diameter of 0.3 mm and a length of 13 mm (29G) were used.

First, 1-1.5 ml of the obtained plasma was drawn into the syringe from the portion of the tube directly above the separation gel (with a maximum platelet concentration of 600,000 per 1 μl) from both tubes, and under application anesthesia Sol. Lidocaini 10% this fraction (platelet rich) was injected intrapapillary into the hypertrophic papillae, the remaining platelet plasma fraction was submucosally injected along the transitional fold of the oral cavity.

The criteria for evaluating the effectiveness of treatment were the results of clinical examination data and instrumental research methods obtained at the observation stages. The Green-Vermilion Hygiene Index, PBI (papilla bleeding index) (Muhllemann-Sukser), and PMA Index were evaluated. The analysis of the data was performed using standard statistical methods.

Initial indices before treatment in the main and control groups did not differ, they were slightly higher in the main group (tab. 1).

Despite a slightly better level of hygiene in the control group according to the index level, the degree of bleeding in the studied group after a week during treatment was 2.21 ± 0.84, which is 31.7% higher than in the main group (p <0, 01), and the prevalence index of the inflammatory process of RMA in the main group was lower by 42.7% (p <0.01) (table).

After 2 weeks, against the background of ongoing therapy and correction of hygiene skills, there was a positive dynamics of the hygiene index in both groups and dynamics in terms of bleeding and the prevalence of the inflammatory process, significantly more pronounced in the main group (table).

In all patients of the main group, the phenomena of gingival hypertrophy were completely eliminated during the treatment period, in the control group of 10 people (55.6%) there was only a decrease in the severity of hypertrophic changes and they needed further additional treatment, and one of the patients even had to interrupt the orthodontic treatment .

The results obtained in the study showed the effectiveness of the use of platelet autologous plasma in the complex treatment of hypertrophic gingivitis with orthodontic treatment using the fixed technique. In all the parameters compared - the rate of reduction of clinical symptoms of acute inflammation, the achievement of positive results in the long term, the rate of decrease in the volume of hypertrophic tissues, the research method exceeded the classical method of treatment without local stimulation of regeneration by injection of platelet autoplasma.

The invention is illustrated by the following clinical examples.

Example 1. Patient Z., 19 years old. 3 months after the start of orthodontic treatment using the Damon self-ligating technique.

Complaints of bleeding, discomfort in the gums, a change in the appearance of the interdental papilla, an unpleasant aftertaste in the mouth and bad breath.

From the anamnesis: denies concomitant somatic pathology, allergies, parenteral infections, patient denies gum disease before orthodontic treatment.

Objectively (status localis) (Fig. 1): The mucous membrane of the gums is hyperemic, swollen, loose consistency, bleeds when probed, a small amount of supra- and subgingival tartar, plentiful soft coating, false pockets up to 5 mm with serous exudate, papillae are enlarged and deformed, hypertrophy up to 1/2 the length of the crown of teeth, OHI-S 2,3; PBI 2.8; RMA 67%. Radiological: the integrity of the cortical plate is not broken.

Diagnosis: Moderate hypertrophic gingivitis.

Treatment. 1 visit. Evaluation of hygiene indices with a demonstration to the patient. Teaching oral hygiene. Professional oral hygiene with a piezoelectric scaler with simultaneous irrigation with a 0.05% chlorhexidine solution, supra- and subgingival air polishing with glycine powder (23-meter particle diameter, Air-Flow Perio, EMS), application of chlorhexidine + metronidazole for 20 minutes, TAP injections 2 tubes (8 ml TAP) under application anesthesia Sol. Lidocaini 10% intrapapillary (2 ml from each tube with a platelet-rich TAP fraction) and the remaining fraction along the transition fold. A general antimicrobial (Metronidazole 500 mg / 2 times a day), restorative therapy (multivitamins), topical baths and applications of chlorhexidine-containing drugs were prescribed.

2 visit. The patient notes improvement. Objectively: the gingival mucosa is pale pink, slight swelling in the area of hypertrophied papillae, a 2-fold decrease in the volume of hypertrophied papillae, bleeding, exudation is absent (Fig. 2).

Treatment: Ultrasonic irrigation with a 0.05% chlorhexidine solution, air-abrasive powder treatment with glycine, injection of TAP 2 tubes in the transition fold and intrapapillary under the application of Sol anesthesia. Lidocaini 10%.

3 visit. There are no complaints. Objectively: the mucous membrane of the gums is pale pink in color, of dense consistency, probing within the physiological gingival junction is 1-3 mm, the papilla is of normal volume and shape (Fig. 3). OHI-S 0.31; PBI 0.8; RMA 9%.

Example 2. A patient, M., 19 years old, complained of aesthetic dissatisfaction with the appearance of the gums, bleeding, discomfort in the gums, bad breath.

From the anamnesis: concomitant somatic pathology, allergies, parenteral infections denied. He is undergoing treatment with fixed orthodontic equipment for disocclusion, because of the gum overgrowth, braces were removed from the lower jaw, he denies gum disease before orthodontic treatment.

Objectively (status localis) (Fig. 4): The mucous membrane of the gums is hyperemic, swollen, loose consistency, bleeds when probed, a small amount of supra- and subgingival tartar, plentiful soft coating, false pockets up to 10 mm with serous exudate, papillae are enlarged and deformed, hypertrophy of more than 1/2 the length of the crown of teeth, OHI-S 2.5; PBI 2.9; RMA 73%. Radiological: the integrity of the cortical plate is not broken.

Diagnosis: Severe hypertrophic gingivitis.

Treatment. 1 visit. Evaluation of hygiene indices with a demonstration to the patient. Teaching oral hygiene.

Professional oral hygiene with a piezoelectric scaler with simultaneous irrigation with a 0.05% chlorhexidine solution, supra- and subgingival air polishing with glycine powder (particle diameter 23 im, Air-Flow Perio, EMS), application of chlorhexidine + metronidazole for 20 minutes. A general antimicrobial (Metronidazole 500 mg / 2 times a day), restorative therapy (multivitamins), topical baths and applications of chlorhexidine-containing drugs were prescribed.

2 visit (after 1 week). The patient noted an improvement, an unpleasant odor disappeared, bleeding decreased. Objectively: a decrease in edema of the mucous membrane of the papillae, a decrease in hyperemia, and exudation is absent.

Ultrasonic irrigation with a 0.05% chlorhexidine solution, air-abrasive powder treatment with glycine, application of chlorhexidine + metronidazole for 20 minutes.

3 visit (after 2 weeks). The patient notes a decrease in the size of the papillae Objectively: the gingival mucosa has become denser, the probe depth is within 5 mm, but the papillae remain swollen, hypertrophy to 1/2 the length of the crown of the teeth (Fig. 5). OHI-S 0.31; PBI 1.2; RMA 32%, that is, additional treatment is required.

Thus, injections of platelet autologous plasma in the complex treatment of hypertrophic gingivitis and the prevention of inflammatory complications from periodontal tissues with orthodontic treatment using the non-removable technique can reduce the volume of interventions, reduce treatment time and increase treatment efficiency compared to the standard treatment regimen.

Claims (1)

A method for the treatment of hypertrophic gingivitis in patients with fixed orthodontic appliances, including professional oral hygiene, injection therapy with topical application of chlorhexidine for 10 days, characterized in that injections of the platelet-rich autologous plasma obtained from the supernatant of the tube are injected after centrifugation, intrapapillary into the hypertrophied gingival papillae and the remaining fraction submucosally into the transitional fold in total A nominal volume of 8-9 ml in the area of all teeth, after which the injection procedure is repeated after 7 days.

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