RU2712035C1 - Method for treating superficial inflammatory periodontium diseases - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine and dentistry and represents a method for treating superficial inflammatory periodontium diseases involving the use of medicines, characterized by fact that 1 % Rada-dent plus gel is applied to lesion for 30 minutes in the form of an application under moisture-impermeable dressing, 0.1 ml on 1 cmsurface area, after which surpluses of non-absorbed gel are removed and the lesion in continuous mode is irradiated single for 15 minutes with a laser at wave length 662 nm, density 10–20 J/cmand power 1.0 W, wherein in the same mode, the procedure is repeated one day two more times, the efficiency is monitored through 1, 3, 6 and 12 months.EFFECT: method enables increasing the effectiveness of pyoinflammatory diseases treatment due to the fact that the exposure is strictly dosed and targeted to the inflammation center without affecting the body as a whole, achieving complete bactericidal treatment of pathogenic microflora of pathological foci, which increases clinical effectiveness by 30 %.1 cl, 2 ex

Description

The invention relates to medicine and can be used in dentistry in the treatment of inflammatory periodontal diseases. For the treatment of inflammatory periodontal diseases, many different antibacterial and antiseptic drugs are used. Antibiotics, chemotherapy and other drugs used have a bactericidal and bacteriostatic effect on the microbial landscape of the gingival sulcus. In this case, a massive undifferentiated and uncontrolled destruction of the microflora of the entire biotope of the outbreak occurs. In addition, antibiotic therapy leads to the selection of multiply resistant strains of pathogens that contribute to the generalization of the inflammatory process. The number of antibiotic-resistant strains is growing, the list of contraindications is increasing due to mass allergization of the population. All this led to the fact that the problem of suppressing microflora arises especially sharply, the search for fundamentally new effective methods of treating inflammatory diseases is an urgent medical problem (Privolnee V.V., Zubareva N.A., Karakulina E.V. Local treatment of wound infection: antiseptics or antibiotics? // KMAKh. 2017. No. 2 .; Lobzin Yuri Vladimirovich. The problem of infection in medicine // Kazan Medical. 2011. No. 5 .; Gulyaeva Oksana Almazovna, Salyakhova Gulsina Angamovna, Tukhvatullina Damira Nazipovna, Mamatov Yunus Marsovich , Ilchigulova Olesya Evge evna role of non-drug methods in complex periodontal maintenance therapy // Problems of dentistry. 2017. №1) analogues. The antibiotic therapy used is widely known in the treatment of inflammatory diseases. Currently, a large number of antibiotic groups are known (pennicillin, cephalosporins, aminoclycosides, etc.). It is possible to use antibiotics orally in the form of capsules and tablets, parenterally in the form of intramuscular and intravenous administration of solutions, as well as applications, ointment dressings, rinses, and rinses. Local use of antibiotics is ineffective and inappropriate. This is due to the presence of antibiotic-resistant forms of bacteria and the inability to comply with all the principles of antibiotic therapy. Preference is given to the oral or parenteral route of administration, that is, exposure to the entire body. (Fleischer G. Oral hygiene. Monograph. M. - 2019 .; Mazur I.P., Slobodiannik M.V. Systemic antibacterial drugs in periodontics // Modern Dentistry. - 2017. - No. 1. - P. 18-22 .)

Disadvantages.

1. Allergic reactions with uncontrolled intake.

2. The possibility of developing dysbiosis.

3. The occurrence of fungal infections of the skin and mucous membranes.

4. Perhaps a violation in the hematopoietic system.

5. Some antibiotics have ototoxic and nephrotoxic effects.

6. A large number of contraindications for taking antibiotics: not recommended for impaired liver, kidney, with a tendency to allergic reactions, pregnant women.

The closest analogue. A known method of treating various inflammatory periodontal diseases using antibacterial drugs. The average power of exposure is the antiseptic chlorhexidine gluconate (CG), which has been used in medicine for more than 40 years. Chlorhexidine gluconate (CG) is a salt of chlorhexidine and gluconate acid. More often in the clinic they use a solution in a concentration of from 0.05% to 2%, 1% gel or 0.2% hydrophilic ointment based on methylcellulose. Chlorhexidine is introduced into the site of inflammation by rinsing, washing or applying a bandage soaked with CG and exposed for a certain time. Chlorhexidine has a fairly high bactericidal activity against a number of opportunistic microorganisms (Sukovatykh B.S., Grigoryan A.Yu., Bezhin A.I., Pankrusheva T.A., Abramova S.A. Efficacy of the immobilized form of chlorhexidine in the treatment of purulent wounds // Surgery News. 2015. No. 2 .; Dovnar A.G., Rzheussky S.E. Antimicrobial activity of chlorhexidine bigluconate gel, intended for the treatment of oral candidiasis // Bulletin of Voronezh State Medical University. 2017;).

Disadvantages.

1. The ability to select multiple resistant strains of pathogens that contribute to the generalization of the process.

2. Difficulties with accurate dosing of the drug, which leads to uncontrolled administration and a decrease in the effectiveness of treatment.

3. The possibility of allergization of the body, and therefore treatment with this drug becomes a contraindication for a number of patients.

4. Undifferentiated and uncontrolled destruction of saprophytic microflora along with pathogenic, which leads to dysbiosis.

5. Insufficient treatment results that do not satisfy both the patient and the doctor.

6. Possible development of side effects, including the irritating effect of the drug, staining of teeth, fillings and tongue, unpleasant taste and upset taste, desquamation of the epithelium of the oral cavity, inflammation of the parotid glands.

Tasks:

1. Ensuring high efficiency in the treatment of inflammatory diseases by suppressing pathogenic microflora.

2. The exclusion of the possibility of selection of multiply resistant strains of pathogens that contribute to the generalization of the process.

3. Elimination of the complexity of accurate dosing of exposure and allergization of the patient's body.

4. The lack of risk of undifferentiated and uncontrolled destruction of saprophytic microflora along with pathogenic - eliminating the risk of dysbiosis, fungal infections of the skin and mucous membranes.

5. The exclusion of the development of side effects (hepatotoxicity, ototoxicity, etc.); decrease in the volume of contraindications.

6. Reduction of treatment time.

The essence of the invention is that a lesion is applied preliminarily for 30 minutes in the form of an application under a waterproof dressing 1% Rad-Dent Plus gel, on 1 cm ² surface 0.1 ml, after which excess unabsorbed gel is removed and the lesion is in continuous mode irradiated for 15 minutes once with a laser with a wavelength of 662 nm, a density of 10-20 J / cm ² and a power of 1.0 W, and in the same mode, the procedure is repeated two more times after one day, the efficiency is monitored after 1.3, 6 and 12 months.

Medical device "Gel photosensitizer fabrics to light radiation" RadaDent ^® Plus "is a penetrator laser radiation in a tissue and fotosensebilizatorom the laser. The active substance "RadAdent Plus" is the substance "Radachlorin®", which is a 7% aqueous solution of 35 chlorins used to prepare various dosage forms, including 1% of the gel "RadAdent Plus". The medical device gel “RadAdent Plus” is one of the second generation FS. The main components of the substance are sodium salt of chlorin e ₆ (90%), sodium salt of purpurin 5 (2%), sodium salt of chlorin p ₆ (8%). Special preparation for work is not required. Storage conditions must be strictly observed. Store at a temperature of 0 to + 8 ° C, in a place protected from light and out of the reach of children. The technical result of the method is:

отсутствие необходимости применения антибиотиков и антисептиков для лечения гнойно-воспалительных заболеваний, в том числе стоматологических, что ведет к отсутствию риска селекции устойчивых штаммов возбудителей и, таким образом, генерализации процесса, возможности аллергизации организма больного, а также возникновению дисбактериоза;

the absence of the need to use antibiotics and antiseptics for the treatment of purulent-inflammatory diseases, including dental ones, which leads to the absence of the risk of selection of resistant strains of pathogens and, thus, the generalization of the process, the possibility of allergization of the patient's body, as well as the occurrence of dysbiosis;

увеличивается эффективность лечения гнойно-воспалительных заболеваний за счет того, что воздействие происходит строго дозированно и целенаправленно в очаг воспаления, не затрагивая организм в целом;

the effectiveness of the treatment of purulent-inflammatory diseases is increased due to the fact that the effect occurs in a strictly dosed and targeted manner to the focus of inflammation, without affecting the body as a whole;

возможность добиться полной бактерицидной обработки патогенной микрофлоры патологических очагов, что на 30% увеличивает эффективность лечения. Способ апробирован в клинике на 47 больных пародонтитом, при наличии таких патогенных микроорганизмов, как Bacteroides fragilis и Streptococcus intermedins.

the ability to achieve complete bactericidal treatment of pathogenic microflora of pathological foci, which increases the effectiveness of treatment by 30%. The method was tested in a clinic for 47 patients with periodontitis, in the presence of pathogenic microorganisms such as Bacteroides fragilis and Streptococcus intermedins.

The results of testing a method for the treatment of inflammatory periodontal diseases:

предложенный способ удобен для использования,

the proposed method is convenient to use,

хорошо переносится пациентами,

well tolerated by patients

не имеет побочного действия,

no side effects

нет противопоказаний к применению.

there are no contraindications for use.

The clinical advantages of using the proposed method are:

легкость и быстрота применения,

ease and speed of use,

минимальная инвазивность,

minimal invasiveness,

хорошая переносимость пациентами,

good patient tolerance

безболезненность,

painlessness

отсутствие побочных эффектов. Способ можно рекомендовать для улучшения качества лечения воспалительных заболеваний путем подавления патогенной микрофлоры, особенно в условиях страховой и военной медицины.

lack of side effects. The method can be recommended to improve the quality of treatment of inflammatory diseases by suppressing pathogenic microflora, especially in conditions of insurance and military medicine.

The method is as follows: in the treatment of superficially located inflammatory periodontal diseases, a 30% Rada-dent plus gel is applied to the lesion site for 30 minutes in the form of an application under a waterproof dressing, 0.1 ml per 1 cm ^{2 of the} surface, after which excess unabsorbed gel and the lesion is removed continuously irradiated for 15 minutes once a laser with a wavelength of 662 nm, a density of 10-20 J / cm ² and 1.0 W, and in the same operation procedure is repeated after one day two more times, performed dissolved efficiency control after 1, 3, 6 and 12 months.

Example 1

Patient D., 47 years old, complained of recurring bleeding of the gums during brushing, bad breath, mobility of the teeth, especially the frontal group of the lower jaw, exposure of the necks of the teeth and increased sensitivity in the frontal region. According to the patient, the above symptoms appeared about 8 years ago. I have not consulted a doctor before. Over the past 2 years, tooth mobility and gum bleeding have intensified.

Orthognathic bite. The condition of fillings and prostheses is unsatisfactory. There are soft and hard dental deposits in a small amount (lingual surface of the teeth of the frontal group of the lower jaw). The mucous membrane of the gingival margin in the area of all available teeth is hyperemic, edematous, bleeds when probed. Depth of periodontal pockets up to 4 mm with serous-purulent discharge. Pathological tooth mobility of the I degree, exposure of the roots in the frontal teeth of the lower jaw and molars of the upper jaw. The Schiller-Pisarev test is positive, the Kechke test is positive. GI = 3.8, CPITN = 2.0. Data LDF - MD - 23.6; PD - 21.3; PS - 21.4; GR - 0.14.

On the orthopantomogram, a violation of the integrity of the compact plate, the vertices of the interdental septa, their pronounced osteoporosis, the periodontal fissure is expanded, the destruction of the interalveolar septa to 1 / 3-1 / 2 of the root length is determined. Diagnosis: chronic generalized periodontitis of moderate severity.

The treatment was carried out as follows: professional removal of dental deposits from the upper and lower jaws using an ultrasonic scaler, antiseptic treatment of the oral cavity, and training in hygiene. Preliminarily for 30 minutes, 1% Rada-dent plus gel was applied to the lesion site in the form of an application under a moisture-proof dressing, on 1 cm ² of 0.1 ml surface, after which excess unabsorbed gel was removed and the lesion center was continuously irradiated for 15 minutes once laser with a wavelength of 662 nm, a density of 20 J / cm ² and a power of 1.0 W, and in the same mode, the procedure was repeated two more times after one day. The next day, pain, bleeding decreased, bad breath disappeared. Objectively: the gum is pale pink in color, does not bleed when probed.

A month after the treatment, the condition of the periodontal tissues improved, which was manifested by the disappearance of edema and hyperemia of the interdental papillae, a decrease in the depth of periodontal pockets, the absence of discomfort in the gums, bleeding, and suppuration. Three months after treatment, objectively: restoration of the gingival root relief, gum of a pale pink color, dense, does not bleed when probed. Periodontal pockets are missing. The Schiller-Pisarev and Kechke tests are negative. GI - 1.0, CPITN - 0. Data LDF - MD - 23.2; PD - 25.3; PS - 29.2; GR - 0.11.

When examining the patient 6 months after the treatment, the smell from the mouth completely disappeared, tooth mobility decreased, hyperemia in the frontal section disappeared. Clinical improvement was confirmed by the positive dynamics of periodontal indices.

When viewed after 12 months on the orthopantomogram, the cortical closure plate is densified and the foci of osteoporosis disappear, residual resorption is up to 1/3 of the root length without signs of progression.

Example 2

Patient D., 26 years old, complains of gum pain when brushing teeth, sometimes when biting hard foods. From the anamnesis: childhood infections. According to the patient, bleeding gums appeared a month ago, periodically worries when brushing your teeth. Previously, I did not consult a doctor. No treatment has been performed. At the external examination, the configuration of the face was not changed, the opening of the mouth was free, regional lymph nodes were not palpated. On examination of the oral cavity: the mucous membrane of the oral cavity is pale pink, shiny, moistened. Orthognathic bite. The gingival papillae of the upper and lower jaw are swollen, hyperemic, with a cyanotic hue, bleed when probed. Ample soft plaque. Hard dental deposits cover the oral surfaces of the front teeth of the lower jaw. Gingival attachment is not broken. There is no tooth mobility. The Schiller-Pisarev test is sharply positive, the Kechke test is negative. GI = 3.8, CPITN = 1.0. Data LDF - MD - 23.2; PD - 24.3; PS - 28.4; GR - 0.11. On the orthopantomogram: no changes in the bone tissue revealed; the compact plate is not broken. Diagnosis: chronic generalized catarrhal gingivitis.

Treatment: professional application of teeth brushing was performed under application anesthesia. Preliminarily for 30 minutes, 1% Rada-dent plus gel was applied to the lesion site in the form of an application under a moisture-proof dressing, on 1 cm ² of 0.1 ml surface, after which excess unabsorbed gel was removed and the lesion center was continuously irradiated for 15 minutes once laser with a wavelength of 662 nm, a density of 10 J / cm ² and a power of 1.0 W, and in the same mode, the procedure was repeated two more times after one day. Already after the 1st session, the patient noted a significant decrease in bleeding gums when brushing, lack of bleeding when eating hard foods.

After one month, we observed the relief of the inflammatory process, which was confirmed by index indicators: Schiller-Pisarev and Kechke-negative samples. GI - 1.0, CPITN - 0. Data LDF - MD - 23.2; PD - 25.3; PS - 29.2; GR - 0.11.

Control inspection was carried out in accordance with the specified time frame; the patient did not complain and did not need treatment.

Claims (1)

A method for the treatment of superficially located inflammatory periodontal diseases, including the use of medications, characterized in that the lesion is applied for 30 minutes in the form of an application under a waterproof dressing 1% Rad-dent plus gel, on 1 cm ^{2 of the} surface 0.1 ml, after which nevpitavshegosya excess gel was removed and the lesion continuously irradiated for 15 minutes once a laser with a wavelength of 662 nm, a density of 10-20 J / cm ² and 1.0 W, and the same procedure is repeated after one mode de ther twice monitor efficacy at 1, 3, 6 and 12 months.