RU2842197C1 - Method for periodontal tissue regeneration - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, specifically to dentistry, and is intended for use in conservative treatment of periodontitis. Complex exposure is combined with a specific sequence of techniques and regimens. At that, on the first visit, the patient is instructed in hygiene and motivated, in order to obtain a stable result, to follow the oral hygiene rules, sanation, premedication, antiseptic oral treatment and local anaesthesia are carried out, after drug-induced treatment, regeneration, disinfection of the root pocket is successively carried out using a laser with power of 0.2 to 0.5 W, in a continuous mode for 2-3 minutes, then in a pulse mode of 1.0 W in 1 minute, root walls and periradicular space are saturated and sealed with a hydroxyapatite suspension using the apparatus Vector, with the subsequent restoration of the trophism of the paradental soft tissues by performing injections of the Spherodent Light composition in three points of the transitory fold in equal parts in the area of the affected periodontal areas, a second visit is prescribed after 7 days. Second visit involves hygiene control, sanation, premedication, antiseptic preparation of the oral cavity and local anaesthesia, hydroxyapatite and laser treatment in the same regimen as on the first visit, until the abnormal values are eliminated, the next visit is prescribed 7 days later. Third visit involves hygiene control, sanation, premedication, antiseptic preparation of the oral cavity and local anaesthesia, hydroxyapatite and laser treatment in the same mode as on the first visit to eliminate abnormalities. Next follow-up visit is prescribed 3 months later. At follow-up visit 3 months later, the whole periodontal tissues are detoxified and introduced in amount of 0.5 ml once a week at depth of 2-3 mm; Spherodent Light is five injections; recommendations are given on the use of the prescribed preparations and adherence to hygiene rules. That is followed by 6-month intervals; the periodontal health is controlled, and if observing any pathological changes, a supporting therapy is applied that involves 3 equal injections every week of Spherodent Light with a total volume of 0.5 ml into the resuscitated pathological areas.

EFFECT: by means of the integrated exposure with a certain sequence of techniques and regimens, the method enables avoiding bleeding, inflammatory process in gingival papillae, eliminating discomfort, obtaining a healthy tone of the mucosa, reinforcing the teeth, reducing sensitivity and mobility of the teeth.

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Description

The proposed invention relates to medicine and can be used in dentistry for conservative treatment of periodontitis.

According to WHO, the prevalence of periodontitis tends to increase and amounts to 90% per 100,000 adults, leads to the destruction and loss of teeth, and is also a trigger for a more aggressive course of a number of diseases (diabetes mellitus, hypertension, renal failure, gastrointestinal lesions, etc.).

Treatment of periodontitis is a complex task and in 45-50% of cases it cannot be completely cured with therapy (Peter Fedi, Arthur Vernino, John Gray "Periodontal ABC" - M.: Publishing house "ABCs of a dentist" 2008, 76-142 p., Barer G.M., Nemetskaya T.I. Periodontal diseases. Clinic, diagnostics and treatment. Study guide. - M.: VUNMC, 1996, - 85 p.).

In particular, a method for treating periodontitis (analogue) is known (Marisa Roncati “Non-surgical periodontal treatment. Indications, possibilities, protocols for using a diode laser” (M.: OOO “Izdatelstvo “Quitessence”, 2018, - 246-261 p.).

In the analogue of non-surgical periodontal treatment, traditional treatment is used with the addition of a diode laser. First, a full radiograph is taken, after a full examination, diagnosis and treatment planning, they begin removing subgingival and supragingival dental plaque, detoxifying the surfaces of the teeth and the periradicular space using ultrasonic and mechanical curettage methods (manual scaling). Patient appointments take approximately 1.5-2 hours. In some cases, piezosurgical treatment of the periradicular space is used. Next, microorganisms are detoxified using a diode laser (wavelength from 808 to 980 nanometers). The most significant effect of the diode laser is the suppression of microorganisms and weakening of the bonds between deposits and the surface of the teeth. Advantages of laser therapy:

1) bactericidal effect,

2) evaporation of granulation,

3) detoxification of the tissue surface,

4) analgesic effect,

5) biostimulation.

Disadvantage of this method:

Chronic periodontitis is characterized by a disruption of periodontal tissue trophism and a reduction in the intercellular substance. Often, an additional biocompatible drug is required to provide nutrition to the cells and restore the intercellular substance. This treatment method does not always provide a long-term result due to structural disruptions of periodontal tissue and concomitant diseases, which also affect the severe course of periodontal disease.

The closest analogue is the method of treating periodontitis proposed by (Peter Fedi, Arthur Vernino, John Gray “Periodontal ABC” - M.: Publishing house “ABCs of a dentist”, 2008, 76-142 p.).

Once a diagnosis has been made and a prognosis has been determined, treatment planning is undertaken. A treatment plan is a pathway followed in treating a patient to achieve and maintain oral health.

1. Reduction or elimination of the influence of etiologic factors. This is premedication, administration of antibiotics to prevent bacterial endocarditis, hypertension, renal failure and other systemic conditions.

2. Reducing the depth or eliminating pockets and creating a minimal depth of the periodontal sulcus.

3. Restoration of the physiological architecture of the gums and bone.

4. Creation of functional occlusion using restorative techniques and selective grinding.

5. Care of periodontal tissues through independent and professional active removal of bacterial plaque.

Algorithm for decision-making when drawing up a treatment plan (systemic antibacterial therapy is used in all cases)

Disadvantages of the method:

Chronic periodontitis, including the acute stage, disrupts the trophism of periodontal tissues and reduces the intercellular substance. Sometimes it is necessary to introduce an additional biocompatible substance that provides nutrition to the cells and restores the intercellular substance, which promotes rapid tissue regeneration, as well as a long-term result and an increase in the duration of remission. In some cases, the method of treating periodontology does not give a long-term result due to structural disorders of periodontal tissues and concomitant diseases, which also affect the severe course of periodontal disease.

Objectives: improving the treatment effect, reducing bleeding gums, increasing the duration of remission, reducing tooth mobility, stopping inflammatory processes, maintaining and restoring the functions of the maxillofacial system, preventing negative impact on the overall health and quality of life of the patient.

The essence: regeneration and disinfection are consistently performed using a laser with a power of 0.2 to 0.5 W, in a constant mode for 2-3 minutes, then in a pulsed mode of 1.0 W per 1 minute, then the walls of the tooth roots and the periradicular space are saturated and sealed with a hydroxyapatite suspension using the Vector device, followed by injection restoration of the trophism of the periodontal soft tissues from three to five times a week with a total volume of 0.5 ml of the Sferodent composition into the affected periodontal tissues, after which repeated sanitation is carried out for a week - treatment with hydroxyapatite and Sferodent in the same mode until deviations of the indicators from the norm are eliminated, then the first control of the condition is carried out after 3 months, detoxification of the tissues of the entire periodontium is performed and 0.5 ml is administered once a week to a depth of 2-3 mm, a course of five injections of Sferodent, in the same mode perform sanitation and after 6 months - control of periodontal tissue condition indicators and repeat of all regeneration manipulations, after which an interval of 6 months is made, the periodontal condition is controlled and in case of pathological changes, maintenance therapy is performed - 3 injections every week by introducing "Spherodent" in a total volume of 0.5 ml in equal parts.

Technical result

After treating the patient:

- after treatment of periodontitis, absence of gingivitis and bleeding, absence of inflammation in the cheap papillae, complete absence of discomfort, obtaining a healthy shade of the mucous membrane;

- in chronic periodontitis, an increase in the volume of soft tissues, the absence of swelling, redness and soreness of the mucous membrane, a decrease in the pathological depth of gum pockets, strengthening of teeth, a decrease in tooth sensitivity and an almost complete reduction in tooth mobility.

The specified result is achieved by means of a complex effect in the given formula of the invention of the sequence of techniques and modes, using hydroxyapatite and spherodent. In addition, in 70-83% of cases, when tested on 123 patients for 4-5 years, an improvement in the quality of life, a decrease in the severity and an extension of the remission periods of chronic diseases (diabetes mellitus, hypertension, renal failure) was confirmed.

The method is carried out as follows:

During the first visit, the patient is taught hygiene and motivated to follow the rules of oral hygiene in order to obtain a stable result. Premedication is carried out - antibiotics and antihistamines are taken, ultrasonic cleaning of subgingival and supragingival dental plaque, treatment and curettage of periodontal pockets, laser detoxification of pockets, laser evaporation of granulation tissues. Disinfection of pockets with a 2% chlorhexidine solution, treatment of root surfaces in a pulse mode of 1.0 W per 1 minute with a hydroxyapatite suspension on the Vector device, an injection of Spherodent Light with a total volume of 0.5 ml at three points along the transitional fold in equal shares in the area of the most affected areas.

The second visit is scheduled in 7 days, hygiene control is carried out, premedication is administered - antibiotics and antihistamines are taken, ultrasonic cleaning of subgingival and supragingival dental plaque, treatment and curettage of periodontal pockets, laser detoxification of pockets, laser evaporation of granulation tissues, disinfection of pockets with a 2% chlorhexidine solution, treatment of root surfaces in pulse mode 1.0 W per 1 minute with hydroxyapatite suspension on the Vector device, injection of Spherodent Light with a total volume of 0.5 ml at three points along the transitional fold in equal shares in the area of the most affected areas.

The third visit is scheduled in another 3 months. They also perform hygiene control, premedication - take antibiotics and antihistamines, ultrasonic cleaning of subgingival and supragingival dental plaque, treatment and curettage of periodontal pockets, laser detoxification of pockets, laser evaporation of granulation tissues, disinfection of pockets with a 2% chlorhexidine solution, treatment of root surfaces in pulse mode 1.0 W per 1 minute with hydroxyapatite suspension on the Vector device, injection of Spherodent Light with a total volume of 0.5 ml at three points along the transitional fold in equal shares in the area of the most affected areas.

Example 1: Patient N., 49 years old.

Admitted with complaints of pain, bleeding gums, bad breath, difficulty chewing food, loose teeth, inflammation of the gums 4.4, 3.4, 2.1, 2.2, 1.1, a feeling of constant fatigue due to concomitant arterial hypertension, diabetes mellitus.

History: pain and bleeding have been bothering for 3 months. In another medical institution two years ago, the patient underwent treatment, professional oral hygiene and was recommended to rinse at home.

Objectively: soft and hard subgingival and supragingival dental deposits, more pronounced in the anterior parts of the lower teeth and in the distal parts of the upper teeth, the gums are hyperemic, bleeding occurs when probing, fibrous exudate is released from periodontal pockets.

Bite: anomalies in the position of teeth in the frontal region are determined, the depth of periodontal pockets is 4 mm, tooth mobility of the 1st degree is 2.4; 1.4; 3.6; 3.7;

Diagnosis: mild chronic generalized periodontitis.

Treatment: First visit: hygiene training and motivating the patient to follow the rules of oral hygiene in order to achieve a stable result. Premedication - oral administration of antibiotics and antihistamines, ultrasonic cleaning of subgingival and supragingival dental plaque, treatment and curettage of periodontal pockets, laser detoxification of pockets, power of 0.2 W, laser evaporation of granulation tissues. Disinfection of pockets with a 2% chlorhexidine solution, treatment of the root surface in pulse mode at 1.0 W per 1 minute with hydroxyapatite suspension on the Vector device, injection of Spherodent Light with a total volume of 0.5 ml at three points along the transitional fold in equal shares in the area of the most affected areas.

Second visit: after 7 days, hygiene control, premedication - oral antibiotics and antihistamine, ultrasonic cleaning of subgingival and supragingival dental plaque, treatment and curettage of periodontal pockets, detoxification of pockets with a 0.2 W laser, laser evaporation of granulation tissues. Disinfection of pockets with a 2% chlorhexidine solution, treatment of the root surface in pulse mode at 1.0 W per 1 minute with hydroxyapatite suspension on the Vector device, injection of Spherodent Light in a volume of 0.5 ml at three points of the transitional fold in equal shares and the area of the most affected areas.

Third visit: after 7 days, hygiene control, premedication - oral antibiotics and antihistamine, ultrasonic cleaning of subgingival and supragingival dental plaque, treatment and curettage of periodontal pockets, laser detoxification of pockets, laser evaporation of granulation tissues. Disinfection of pockets with a 2% chlorhexidine solution, treatment of the root surface in pulse mode of 1.0 W per 1 minute with hydroxyapatite suspension on the Vector device, injection of Sferodent Light with a total volume of 0.5 ml at three points of the transitional fold in equal shares in the area of the most affected areas. Control visit after 3 months, we perform detoxification of the tissues of the entire periodontium and administer 0.5 ml once a week to a depth of 2-3 mm, a course of Sferodent injections. Recommendations, compliance with hygiene rules using the prescribed drugs. After which we make an interval of 6 months, monitor the condition of the periodontium and, in the case of pathological changes, perform maintenance therapy - 3 injections every week by introducing "spherodent" with a total volume of 0.5 ml in equal parts.

Result: pale pink mucous membrane, no discomfort when eating, no bleeding when eating, no bad breath, improved patient's quality of life, 7 months of remission, no mobility of teeth 2.4; 1.4; 3.6; 3.7, no inflammatory process, improved general condition of the patient, i.e. significant improvement in the functions of the maxillofacial system, more stable blood pressure.

Example 2: Patient A., 55 years old.

Complaints: pain and bleeding gums, bad breath, difficulty eating.

Anamnesis: pain has been bothering for two weeks, bleeding gums for 2-3 months, slight mobility is felt in the area of 4.4; 1.2; 1.1; 2.1; 2.2;

Previously, I went to another clinic, and was offered rinsing and an ointment to use at home.

Objectively: soft and hard subgingival and supragingival dental deposits in the area of the upper and lower jaws, the gums are hyperemic, edematous, bleed upon probing, purulent exudate is released from periodontal pockets 4.4; 1.4; the Müllemann-Saxer index is grade II, the Silne-Loe index is grade III, the width of the attached gingiva is insufficient, there are overhanging edges of the filling in the area of 4.6; 4.4; 2.6; 2.3; Abnormal position of the teeth 3.4; 3.7; Radiographically, bone resorption is determined 4.4; 4.5; 1.3; 1.2; 1.1; 2.1; 2.2;

Diagnosis: chronic local periodontitis in the area of 4.4; 1.4; 1.1; 1.2; 2.1; 2.2;

Treatment:

First visit: hygiene training and motivation of the patient to follow the rules of oral hygiene in order to obtain a stable result. Premedication - oral administration of antibiotics and antihistamine, ultrasonic cleaning of subgingival and supragingival dental plaque, treatment and curettage of root pockets, smoothing and polishing of overhanging edges of the old restoration, laser evaporation of granulation tissue. Disinfection of pockets with a 2% chlorhexidine solution. Disinfection with a laser, with a power of up to 0.5 W, in a continuous mode for 2-3 minutes, then, in a pulsed mode of 1.0 W per 1 minute, treatment of the root surface with a hydroxyapatite suspension on the Vector device, injection of Spherodent Light with a total volume of 0.5 ml at three points of the transitional fold in equal shares and an area of more, affected areas.

Second visit: after 7 days, hygiene control, replacement of some insolvent restorations, premedication - oral antibiotics and antihistamine, ultrasonic cleaning of subgingival and supragingival dental plaque, treatment and curettage of root pockets, laser detoxification of root pockets, laser evaporation of granulation tissues. Disinfection of pockets with a 2% chlorhexidine solution. Disinfection with a laser, with a power of 0.2 to 0.5 W, in a constant mode for 2-3 minutes, then, in a pulsed mode of 1.0 W per 1 minute, treatment of the root surface with a hydroxyapatite suspension on the Vector device, injection of Spherodent Light with a total volume of 0.5 ml at three points of the transitional fold in equal shares and the area of the more affected areas.

Third visit: after 7 days, hygiene control, premedication - oral antibiotics and antihistamine, ultrasonic cleaning of subgingival and supragingival dental plaque, treatment and curettage of root pockets, laser detoxification of root pockets, laser evaporation of granulation tissues. Disinfection of pockets with a 2% chlorhexidine solution. Disinfection with a laser, with a power of 0.2 to 0.5 W, in continuous mode for 2-3 minutes, then, in a pulsed mode of 1.0 W per 1 minute, treatment of the root surface with a hydroxyapatite suspension on the Vector device, injection of Spherodent Light with a total volume of 0.5 ml at three points of the transitional fold in equal shares and the area of the more affected areas. Recommendations, compliance with hygiene rules using the prescribed drugs.

Fourth visit: after 7 days, hygiene control, laser detoxification of root pockets, laser evaporation of granulation tissues. Disinfection of pockets with a 2% chlorhexidine solution, treatment of the root surface with a hydroxyapatite suspension on the Vector device, injection of Spherodent Medium 0.5 ml at three points of the transition fold in equal shares and in the area of the most affected areas. Recommendations, compliance with hygiene rules using the prescribed drugs.

Fifth visit: injection of "Sferodent" Medium 0.5 ml in equal parts and the area of mobile teeth. Recommendations, compliance with hygiene rules using the prescribed drugs. Control appointment after 3 months, we perform detoxification of the tissues of the entire periodontium and administer 0.5 ml once a week to a depth of 2-3 mm, a course of five injections of "sferodent". Recommendations, compliance with hygiene rules using the prescribed drugs. After which we make an interval of 6 months, monitor the condition of the periodontium and, in the case of pathological changes, perform maintenance therapy - 3 injections every week by administering "Sferodent" in a total volume of 0.5 ml in equal parts.

Result: pale pink mucous membrane, no discomfort when eating, no bleeding when eating, no bad breath, improved patient's quality of life, increased remission periods up to 6 months, elimination of tooth mobility, inflammation, thus, the functions of the maxillofacial system are restored. Improvement of the patient's general condition, including decreased blood pressure and blood glucose levels.

Claims (1)

A method of periodontal tissue regeneration that includes a complex effect of a certain sequence of techniques and modes, in which during the first visit the patient is taught hygiene and motivated, in order to obtain a stable result, to comply with the rules of oral hygiene, sanitation, premedication, antiseptic treatment of the oral cavity and local anesthesia are carried out, after drug treatment, regeneration is sequentially performed, disinfection of the root pocket using a laser with a power of 0.2 to 0.5 W, in a constant mode for 2-3 minutes, then in a pulsed mode of 1.0 W per 1 minute, saturation and sealing of the walls of the tooth roots and the periradicular space with a hydroxyapatite suspension are carried out using the Vector device, followed by restoration of the trophism of the periodontal soft tissues by injections of the Spherodent Light composition at three points of the transitional fold in equal shares in the area of the affected areas of the periodontium, a second visit is scheduled in 7 days; During the second visit, hygiene control, sanitation, premedication, antiseptic treatment of the oral cavity and local anesthesia are performed, hydroxyapatite and laser treatment is performed in the same mode as during the first visit until deviations from the norm are eliminated, the next visit is scheduled in 7 days; During the third visit, hygiene control, sanitation, premedication, antiseptic treatment of the oral cavity and local anesthesia are performed, hydroxyapatite and laser treatment is performed in the same mode as during the first visit until deviations from the norm are eliminated, the next follow-up appointment is scheduled in 3 months; During the follow-up appointment in 3 months, detoxification of the tissues of the entire periodontium is performed and 0.5 ml is administered once a week to a depth of 2-3 mm, a course of five injections of Sferodent Light, recommendations are given on the use of the prescribed drugs and compliance with hygiene rules; after which they make an interval of 6 months, monitor the condition of the periodontium and, in the case of pathological changes, perform maintenance therapy - 3 injections in equal parts every week of "Sferodent" Light with a total volume of 0.5 ml in the resuscitated pathological areas.