RU2216365C1 - Method for treating parodontitis - Google Patents

Abstract

FIELD: medicine, namely complex treatment of patients suffered from parodontitis. SUBSTANCE: method is realized due to combined action of application of drug preparation onto diseased zones and irradiation of said zones by means of semiconductor laser with output 5 - 6 Wt in pulse mode with frequency 1.5 -4.0 Hz and exposure 2 - 5 min for one zone. Method comprises steps of preliminarily injecting under mucous integument of porodontium tissue of one diseased zone 0.7 -1.7 ml of solution of venotropic drug preparation selected from group of angioprotectors; realizing irradiation by means of laser beam at above mentioned mode in limits of injection field; then performing application with use of gel of the same pharmacological action onto remaining diseased zones; performing similarly next procedure at changing injection field at the same parameters of laser irradiation; carrying out 6 - 10 procedures depending upon severeness degree of disease. EFFECT: enhanced efficiency, reduced time period of treatment, maximum remission period. 1 n

Description

 The invention relates to medicine, namely to physiotherapy, and can be used in the complex treatment of periodontitis patients.

 A known method for the treatment of generalized periodontitis, when the complex treatment along with conventional therapeutic agents used the light of a semiconductor laser with a wavelength of 0.85-0.95 μm, a power of up to 4.0 W, a frequency of 0.1-3.0 kHz (1 channel , 2 minutes on the field, 3-5 procedures) (Prokhonchukov A.A., Zhizhina N.A. Vasiliev K.V. Metelnikov M.A. Universal laser apparatus of the new generation "Optodan" for laser physical, magnetic and reflexology of dental diseases. // Dentistry. - 2000. - 2. - P. 45-49).

 The disadvantage of this method is the lack of targeted drug vasoactive therapy, which does not allow to fully influence the links of pathogenesis.

There is a method of complex treatment of periodontitis patients with mild, moderate and severe degrees of severity, in which patients received a course of laser therapy in the form of He-Ne laser radiation ("ULF-01") on the gum surface in the upper and lower jaws with a radiation energy density of 5-7 J / cm ² in continuous mode with an exposure of 4 minutes on the gums of each jaw; The course of laser therapy was 10-15 procedures. The same author investigated the use of a 2% Troxevasin gel in the complex treatment of mild to moderate periodontitis patients. The gel was applied to periodontal pockets and fixed with a protective dressing for 2-3 hours. The course of treatment amounted to 10-15 procedures (Krechina E.K. Microcirculatory disorders in periodontal tissues in case of diseases and clinical and functional justification of methods for their correction. Abstract for the academic degree in medical sciences - Moscow, - 1996. - 41 s.).

 The disadvantage of this method is that the light of a helium-neon laser has a rather pronounced reflection from the surface of the mucous membrane of the oral cavity, resulting in the loss of a large amount of reflected energy, which reduces the penetration of periodontal tissue and worsens the effectiveness of the therapeutic effect.

 The use of local drug therapy in the form of dressings for insertion into the periodontal pocket, as suggested by the author of the method for treating periodontitis discussed above, has a short-term effect, since the drug is washed out with saliva and then gets into the gastrointestinal tract, which is also a disadvantage of this method.

 Closest to the proposed method is a method of treating patients with periodontitis by photophoresis of the gel Metrogil Dent. In this method, immediately after the gel was applied to the lesion area, a laser was applied to a semiconductor laser (Scalar apparatus of Panatron CJSC) with an output power of 5-6 W in a pulsed mode with a frequency of 1.5-4.0 kHz, with an exposure of 2-5 minutes on 1 field (4 fields on one jaw) (Prikuls VF, Filatova EV, Nevrov AN et al. Photophoresis of the Metrogil Denta gel in the complex treatment of patients with chronic generalized periodontitis. B Sat: Actual problems of rehabilitation medicine, balneology and physiotherapy. International Congress "Health Hotel-2001". - Moscow. - 2001. - S. 161-162).

 The disadvantage of this method is that it carries out targeted effects only on the inflammatory component of the disease (aerobic and anaerobic flora).

 The task posed by the authors is to eliminate these shortcomings by directing more prolonged exposure to the affected areas, which allows influencing the pathogenesis of the inflammatory process, which has a pronounced vascular effect, increasing efficiency and shortening treatment time while achieving the maximum period of remission in patients with periodontitis.

 For this, in a method of treating periodontitis patients, including the effect of applying the drug on the lesion and radiation of a semiconductor laser with an output power of 5-6 W in a pulsed mode with a frequency of 1.5-4.0 kHz, exposure 2-5 minutes per field, it is proposed pre-inject 0.3-1.7 ml of a venotropic drug solution from the group of angioprotectors under the mucous membrane of periodontal tissue of one of the affected areas; laser irradiation is performed in the indicated mode within the injection field and a gel applique performed the same pharmacological effect on the rest of the lesion, the following procedure carried out analogously to change the injection region for the same parameters of the laser exposure of procedures from 6 to 10 per course of treatment depending on the severity of the disease.

 This allows the correction of violations in the venular part of the microvasculature, which in turn contributes to the normalization of blood rheology in microvessels.

 With the combined physico-pharmacological effect of the radiation of a semiconductor laser, which allows to increase the permeability of cell membranes, improve microcirculation, increase the adsorption capacity of the tissue, and the action of a drug from the group of angioprotectors introduced into these tissues immediately before irradiation and having venotonic, anti-inflammatory, decongestant and antioxidant effects, there is an increase in the effectiveness of pathogenetic therapy of periodontal disease.

 The method is as follows.

 After eliminating traumatic factors aggravating the clinical picture (overhanging edges of fillings, artificial crowns, edges of carious cavities, etc.), training and control of oral hygiene, removal of dental deposits, selective grinding of tooth surfaces, surgical treatment in the amount dictated by the severity of the disease, splinting (if necessary) of the teeth proceeded to a combined physico-pharmacological effect. Saliva was evacuated using a saliva ejector. The main salivary ducts were isolated with cotton rolls. The injector prepared for action was brought to the injection field (one of the lesion areas), the ampoule end was perpendicular to the surface of the mucous membrane, removed from the fuse and needleless injection of 0.3 to 1.7 ml of the drug was carried out (for example, 10% Troxerutin solution ") needleless injector" Injex "tm company" Rosch Medizintechnik "(Germany) in periodontal tissue.

 The introduction of the drug is carried out as a result of pressing the trigger and the subsequent movement of the plunger inside a special ampoule filled with the drug "Injex" tm under the influence of the energy of the compressed spring. Then, under the influence of the indicated initial energy, a trickle of the drug is released and penetrated from the hole with a diameter of 0.15 mm in front of the ampoule through the epithelial layer of the mucous membrane. The duration of the injection is 0.2 seconds. After penetrating through this layer, the drug stream releases so much energy that the drug is distributed in the submucosal tissue in the shape of a cone without causing damage to other structures: vessels or nerves. After the injection, the syringe should remain for 1-2 seconds at the injection site.

 Immediately after drug administration, a semiconductor laser was applied by laser radiation (Scalar apparatus of Panatron CJSC) with a wavelength of 0.85-0.95 μm and an output power of 5-6 W in a pulsed mode with a frequency of 1.5-4, 0 kHz, with an output power of 5-6 W and an exposure of 3 minutes per field (number of fields depending on the severity of the pathological process, in the first jaw) along the vestibular surface on the upper and lower jaws to the remaining lesion areas. In one procedure, mesophotophoresis — the combined effect of a drug solution injected into the tissue and laser radiation — was performed in the area of only one field, avoiding local drug overdose in a limited area of periodontal tissue. After the mesophotophoresis procedure, 2% Troxevasin gel was applied sequentially along the length of the remaining lesion fields. Immediately after this, photophoresis of the indicated preparation was carried out with the same semiconductor laser with similar exposure parameters.

 The maximum total time for one session is 24 minutes with the number of procedures from 6 to 10 per treatment course, depending on the severity of the inflammation.

 Similarly to 10% Troxerutin solution and 2% Troxevasin gel, other drugs from the group of angioprotectors that have capillary protective effect can be used, which are available both in the form of a solution and a gel.

 The needleless injector "Injex" tm of the company "Rosch Medizintechnik" can be replaced with an ordinary karpulny syringe used in dental practice, or a disposable syringe.

 The implementation of the method is illustrated by the following clinical examples.

 Example 1

 Patient T., 36 years old, diagnosis: chronic generalized periodontitis of moderate severity. Concomitant background pathology - chronic gastritis in remission. The patient complained of bleeding gums, which occurs not only when brushing your teeth, but also taking hard foods, bad breath, soreness in different parts of the gums, tooth mobility. Puffiness and hyperemia of the gums, pronounced cyanosis of the interdental papillae and marginal gums in the molars in both jaws and premolars in the lower jaw on the right were revealed. When probing, a periodontal pocket of 4-5 mm was determined. The teeth had I and II degree of mobility.

 The values of the clinical indices: PMA (PARMA) 52.4% and RI (Russel, 1956) - 2.2 and IGR-U (Greene, Wermillion, 1964) - 2.3, which reflected the degree of inflammation.

 The deterioration in the quantitative indicators of RPG from the norm level was recorded reographically: an increase in PTS by 47.23%, IPA by 40.22%, and a decrease in IE by 26.11%.

 Morphological study of gingival biopsy specimens revealed vacuole cell dystrophy in the granular layer, moderately pronounced acanthosis. Angiomatosis, a single inflammatory infiltrate represented by lymphocytes, was noted in the underlying connective tissue.

 According to the proposed method, treatment was carried out. Injected 0.5 ml of a 10% solution of "Troxerutin" injector "Injex" TM in the area 1.7.-1.6. from the buccal surface of the alveolar ridge, after which the indicated field was exposed to laser radiation in the above modes, with an exposure of 4 minutes. Then, 2% Troxevasin gel was applied to the remaining lesions (vestibularly) in the upper and lower jaw and laser irradiated in the same mode. A day later, a similar injection was introduced in the area 2.6.-2.7. and repeated the same manipulations as in the previous procedure. Over the next three procedures, injections and laser irradiation were performed on sections 4.7.-4.6., 4.5.-4.3., 3.6.-3.7. with subsequent exposure to gel applications and laser radiation on their respective areas.

 Throughout the course of the patient, the application of 2% Troxevasin gel on periodontal tissue 2 times a day at home was recommended.

 The patient noted the disappearance of discomfort in the gums and bad breath. A significant decrease in swelling and hyperemia of the alveolar gum was found. There were no cyanosis phenomena. Gum bleeding has not been established. The gingival papillae fit more tightly to the surface of the teeth, did not swell, the size of the periodontal pockets decreased to 1.5-2 mm.

 A decrease in the degree of pathological tooth mobility was revealed. A decrease in PI values by 46.5%, PMA by 50.1%, and IGR-U by 60.2% were observed.

 Reducing symptoms of inflammation occurred against the background of normalization of local hemodynamics. The values of the quantitative indices of RPGs improved: the values of the TCP decreased by 34.6%, the IPS - by 25.2%, the values of IE increased by 18.4%.

 A morphological study of gum biopsy specimens revealed moderate parakeratosis in the surface areas.

 Consequently, there was a decrease in the symptoms of inflammation, as evidenced by a decrease in patients' complaints and an improvement in clinical indices against the background of improved microcirculation in the studied tissues.

 In the control after 6 months, no increase in symptoms of inflammation was noted. The values of the clinical periodontal and quantitative indices of RPG did not undergo significant changes.

 When monitoring after 12 months, the patient did not show complaints of the previous nature. An objective examination revealed a slight swelling and loosening of the interdental papillae, as well as hyperemia of the marginal and alveolar gums in the area of 1.7., 3.6., 3.7. The value of the GAME increased by 15.3%, PMA - by 8.2%, PI - by 6.1% of the indicators noted in the previous control.

 The analysis of quantitative indices of RPG revealed no changes.

 Thus, the results of the treatment suggest that there is a pronounced therapeutic effect in the form of a significant reduction in the symptoms of inflammation characteristic of this severity of periodontitis, against the background of a steady improvement in local blood circulation both after treatment and after 6 and 12 months.

 By a similar technique, 21 patients with chronic generalized periodontitis were treated, of which 10 patients with moderate severity of periodontitis and 11 patients with severe disease severity.

 A positive effect of up to 12 months was observed in 100% of patients with moderate severity of periodontitis and in 81.8% of patients with severe disease severity. In the rest of the patients, remission was 8-10 months.

 The proposed method can significantly accelerate the treatment of the disease and increase the period of remission.

Claims (1)

 A method for the treatment of periodontitis, including the combined effect of the application of the drug on the lesion and radiation of a semiconductor laser with an output power of 5-6 W in a pulsed mode with a frequency of 1.5-4.0 kHz, exposure 2-5 min per field, characterized in that pre-injected under the mucous membrane of periodontal tissue of one of the affected areas of 0.7-1.7 ml of a solution of a drug of venotropic action from the group of angioprotectors, carry out laser exposure in the specified mode within the injection field, then carried out appliqué gel of the same pharmacological effect on the rest of the lesion, the following procedure is carried out as a change in the injection region for the same parameters of the laser exposure of procedures from 6 to 10 per course of treatment depending on the severity of the disease.