RU2816035C1 - Method for integrated treatment of gum recession - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgical dentistry, and is intended for use in treating gum recession. Preoperative preparation of soft tissues of periodontium and hard tissues of tooth root in the area of existing gingival recession is performed by single laser photodynamic therapy on “АЛОД-01” apparatus. First, a photosensitizer "Photoditasin" in form of 0.5% gel is applied on the area of soft tissues of periodontium and hard tissues of the exposed tooth root in the area of the planned operation for 10 minutes. After washing off the photosensitizer, the area is exposed to red light at wavelength 662 nm, power 0.2–0.4 W, in a pulsed mode, for 2 minutes. Then a sterile collagen plate "PHARMADONT II" of the required size is applied on the treated area, on which "NIGELLA SATIVA" essential oil is pre-applied in amount of 0.5 ml, and left until complete resorption. Next day, a mucogingival operation is performed to eliminate the recession according to a standard technique. "FARMADONT II" collagen plate with pre-applied "NIGELLA SATIVA" essential oil in amount of 0.5 ml is applied on the postoperative suture area and left until completely absorbed. This procedure is repeated once day for 7 days.

EFFECT: method enables to reduce the length of postoperative rehabilitation, increase the regenerative capacity of the soft tissues of the oral cavity, as well as reduce the risk of recurrences and postoperative complications due to combined application at the stage of preoperative preparation of photodynamic therapy and subsequent application of collagen plates with essential oil applied on them.

1 cl, 2 ex

Description

The invention relates to medicine, namely to surgical dentistry and can be used in the treatment of gum recession.

According to modern ideas about periodontal diseases, gum recession is characterized by a loss of the vestibular gingival margin (less often oral) relative to its physiological position, in which it is located apical to the cemento-enamel junction (CEJ) and leads to exposure of the root surface [Zucchelli, G. Esthetics in periodontics and implantology / G. Zucchelli, P. Sharma, I. Mounssif // Periodontal 2000. - 2018. - Vol.77, No. 1. - P. 7-18].

There are various treatments for gum recession, including conservative treatment and surgical treatment. Drug treatment methods exist and are used, but the results are not permanent [Durnovo E.A., Shashurina S.V., Bespalova N.A., Andreeva M.V. Comparative analysis of the clinical effectiveness of various methods for eliminating gum recession. Immediate and long-term results // Advances in modern science and education. 2016. No. 9. 3. P. 174-181]. Thus, surgical treatment is the most predictable type of treatment, leading to a persistent increase in gum volume, and is also an etiopathogenetic treatment, since it eliminates not only the aesthetic defect and hypersensitivity of the tooth, but also some of the etiological factors, significantly reducing the risk of developing root caries and tooth loss [Badalyan V.A., Baulin I.M., Romanenko N.V. Surgical protocol: features of the use of the MUCOGRAFT collagen matrix during vestibuloplasty surgery in the lower jaw / Russian Dentistry. - 2013. - 4. - P. 32-37].

To eliminate gingival recession, it is necessary to carry out complex treatment, where the main stage is the use of various techniques of mucogingival operations [Davidyan A.L. Using an alternative source of free connective tissue graft / Periodontology. 2007. 4(45). P. 35-40].

In the scientific work of G. Zuccelli (2015), it was noted that in the presence of gingival recession, it is necessary to carry out aseptic treatment of the exposed surface of the tooth root, since apical to the edge of the gum there is a periodontal groove or periodontal pocket [Zucchelli, G. Periodontal plastic surgery / G. Zucchelli, I. Mounssif // Periodontology 2000. - 2015. - Vol. 68, no. 1. - P. 333-368].

Thus, before performing surgical treatment of gingival recession, it is necessary to eliminate the primary inflammation in the area of the exposed tooth root, and to prevent postoperative complications, an important step is preoperative treatment of this area.

Success in treatment can be achieved if the etiological factor is eliminated and stabilized thanks to the joint work of dentists of all profiles, the use of a set of therapeutic measures and means, as well as the actions of the patient himself aimed at restoring home oral hygiene [The effectiveness of the Perio-method flow in the complex of supportive periodontal therapy in patients with inflammatory periodontal diseases during orthodontic treatment / O.A. Gulyaeva, T.S. Chemikosova, D.N. Tukhvatullina [et al.] // Periodontology. - 2016. - No. 3. - P. 72-76].

In the postoperative period, an important task is to create conditions for the healing of the surgical wound, without complications: bleeding, bacterial invasion, etc. In the postoperative period, fibroblasts increase in the damaged area, due to which collagen production occurs. Thus, along with the restoration of the microvasculature, collagen synthesis occurs, which in turn is responsible for the healing phase of the surgical wound by primary intention [Fevraleva A.Yu., Davidyan A.L. Mucogingival surgery, Moscow: Poly Media Press, 2013. - 232 p.].

Currently, various materials and techniques are used to improve tissue regeneration, making it possible to shorten the postoperative recovery period, as well as stabilize the volume of restored structures.

There is a known method of treating marginal gum recession using injections of platelet-rich plasma according to the following protocol: patients receive 3 injections of platelet-rich plasma at intervals of 7-10 days. The authors of this method note that the effect is not permanent and there is a need for repeated courses [Biragova A.K., Belenchekov A.A., Epkhiev A.A. Efficiency of treatment of marginal gum recession using platelet-rich plasma injections // Bulletin of new medical technologies. Electronic edition. 2018. No. 2].

There is a well-known injection method for stimulating regeneration processes using one’s own autologous plasma - the Plasmolifting method. This method requires special equipment; special Plasmolifting tubes with certain reagents are used [Plasmolifting technology - an injectable form of platelet autoplasma for the treatment of chronic periodontitis of I-II severity / R.R. Akhmerov, M.V. Ovechkina, D.E. Tsyplakov [et al.] // Periodontology. - 2013. - T. 18, No. 1(66). - P. 45-52].

There is a known method of surgical treatment of inflammatory periodontal diseases, including peeling of flaps with their simultaneous de-epitalization, removal of granulations and subgingival deposits, antiseptic treatment of wounded surfaces, implantation of osteoplastic material into bone defects using a suspension of cells of the line M-22-diploid fibroblasts of the skin and muscles of the human embryo, which are cultivated in a medium with the addition of 10% cattle serum, suturing [Tsitology, No. 9, v. 43, 2001, p. 853-854].

There is a known method of surgical treatment of inflammatory-destructive periodontal diseases, characterized by the fact that the formed exfoliated flap from the hard palate, before application to the surgical field and to the donor wound, is enriched with allofibroblast, which is used as a suspension of LEC-4(81) cells - a strain of diploid embryonic lung cells humans, which are cultivated in IGLA-MEM growth medium with the addition of 10% fetal blood serum of cattle at the rate of 60-80 thousand cells/ml of growth medium. The surgical field is covered with pholiderm. The top is fixed with an affirming bandage [RF Patent No. 2231986, 2004].

There is a known method for treating gum recession, characterized by cutting out a mucoperiosteal flap with an angular incision through the middle of the gingival papillae to the mobile mucous membrane and an incision along the gingival sulcus on the vestibular side. The flap is placed without tension, covering the defect, with platelets with a high fibrin content (F.R.P.) introduced under the flap, onto the exposed part of the tooth [RF Patent No. 2380052, 2010].

The closest analogue of the invention is a method of surgical treatment of periodontal diseases accompanied by loss of keratinized gums, which consists in the fact that the first stage is preparation of the oral cavity, including professional hygiene, removal of supragingival and subgingival deposits, according to a standard protocol. The main stage is mucogingival plastic surgery using a well-known generally accepted technique with suturing, aimed at eliminating the defect. A sterile collagen plate “FARMADONT III” is applied to the area of postoperative sutures and left until it is completely absorbed [RF Patent No. 2713954, 2020]. The disadvantage of the prototype is that only postoperative treatment is carried out and the lack of preoperative preparation of the surgical field, which in turn can lead to relapses and complications in the form of an inflammatory process in the surgical area. This method is based on the use of FARMADONT III collagen plates, which contain collagen and medicinal substances that have an antibacterial effect. However, this drug does not contain hemostatic substances, so postoperative bleeding is possible when using only this drug.

Thus, the known methods of surgical treatment of periodontal diseases are difficult to use and require special equipment and equipment; their use is very limited by low resistance to the effects of microbial flora of the oral cavity, or the manipulation requires additional invasive intervention, which is a big drawback when performing the proposed treatment. When surgical treatment of gum recession is performed according to standard protocols, which do not include additional preoperative preparation of periodontal tissues and postoperative management of the patient, a large number of relapses are observed. The proposed methods need improvement.

The objective of the invention is to increase the effectiveness of surgical treatment of gum recession.

The technical result of the invention is to improve functional results by preventing postoperative complications and relapses.

The proposed method for complex treatment of gum recession is performed as follows. After performing diagnostic procedures and professional oral hygiene, the patient undergoes comprehensive treatment for gum recession. The first stage is preoperative preparation of soft periodontal tissues and hard tissues of the tooth root in the area of existing gingival recession by performing laser photodynamic therapy on the ALOD-01 device with a wavelength of 662 nm, power 0.2-0.4 W, pulse mode; photosensitizer - “Photoditazine”, exposure time 2 minutes once. First, the photosensitizer “Photoditazine” in the form of a 0.5% gel is applied to the area of soft periodontal tissues and hard tissues of the exposed tooth root in the area of the planned operation for 10 minutes. After this, the gel is washed off with water by rinsing the mouth, then the area marked with “Photoditazine” is irradiated with low-energy laser radiation with a wavelength of 662 nm, the red region of the spectrum for 2 minutes. Then a sterile collagen plate “PHARMADONT II” of the required size is immediately applied to the treated area, onto which NIGELLA SATIVA essential oil is first applied in an amount of 0.5 ml and left until completely absorbed. The next day, mucogingival surgery is performed to eliminate the recession using standard techniques. A collagen plate “PHARMADONT II” is applied to the area of postoperative sutures, onto which NIGELLA SATIVA essential oil is first applied in an amount of 0.5 ml and left until completely absorbed. The patient repeats this procedure at home once a day after meals and before bed for 7 days.

The sterile collagen plate used “FARMADONT II” is a sterile rectangular plate with a spongy structure of various sizes (Registration certificate for a medical device FSR 2012/13717 dated 09/10/2012). The composition of FARMADONT II collagen plates includes: collagen, extracts of chamomile, valerian, arnica, mint, ichthyokol (dry collagen, crushed from the swim bladders of sturgeon fish and large catfish), collagenase. These plates are intended for healing the mucous membrane and soft tissues of the oral cavity. The plates have an analgesic effect, relieve bleeding and strengthen the gums. They have a comprehensive preventive effect, neutralize inflammatory processes and restore periodontal tissue. Promotes the formation of a protective film and prevents wound infection. Natural components completely eliminate the possibility of disturbing the balance of oral microflora (https://mazi.ru/izdeliya_naruzhnogo_primeneniya/farmadont_ii.html).

The NIGELLA SATIVA oil used contains: thymoquinone (up to 60%) and up to 15 types of various substances, including thymol, cymene, thujone and o-cymene. The presence of a complex complex of thymoquinone and hydroquinone - thymoquinhydrone - was found in NIGELLA SATIVA essential oil. It was found that these compounds have antioxidant properties (pro-oxidant in the case of high concentrations). According to the conclusions of American oncologists, thymoquinone blocks the activity of inflammatory cytokines, such as TNF-alpha, interleukin-1beta, interleukin-8, Cox-2 and MCP-1. The substance also prevents the expression and synthesis of NF-kappaB, a factor that influences the development of inflammatory processes.

In 1960, black seed oil was clinically proven to have an anti-inflammatory effect. In 1995, a group of scientists from the pharmacology research laboratories of King's College London tested the effectiveness of nigella oil and its derivative, thymoquinone, as an anti-inflammatory agent. Inhibition of the inflammatory response was greater than would be expected from thymoquinone alone. Then we paid attention to the mix of eicosadiene, eicosatriene and eicosenoic acids, which are responsible for increasing anti-inflammatory activity. The healing and regenerating abilities of the plant allow these tinctures to be used effectively in the complex treatment of dental diseases [Safiullin A.A. Thymoquinone - Application in dentistry // International Journal of Applied and Fundamental Research. - 2016. - No. 12-9. - S. 1660-1662].

Thus, the proposed method of complex treatment of gum recession has significant advantages: the collagen plates used are sterile; the combined use of photodynamic therapy at the stage of preoperative preparation and the subsequent application of collagen plates with NIGELLA SATIVA essential oil applied to them makes it possible to create aseptic conditions for subsequent surgical intervention, providing the maximum antibacterial effect on the treated tissues of the tooth root and periodontal tissue; at the stage of postoperative treatment, the complex use of collagen plates and NIGELLA SATIVA essential oil has an analgesic, hemostatic, wound-healing effect on the operated area, increases the regeneration of periodontal tissue in the area of surgical intervention, while being a barrier from the aggressive environment of the oral cavity and opportunistic microflora. Thanks to the actions provided, the proposed method of complex treatment of gum recession allows for a reduction in rehabilitation time in the postoperative period, increases the regenerative abilities of the soft tissues of the oral cavity, and also reduces the risks of relapses and postoperative complications.

22 patients aged 18-44 years with localized gingival recession of class 1-2 according to Miller were divided into two clinical groups according to treatment methods. Patients of the first group (11 people) were treated for gum recession using the prototype method, patients of the second group (11 people) were treated with complex treatment for gum recession using the proposed method.

To evaluate the effectiveness of the proposed method, patients in both groups underwent clinical studies before surgery, on days 3, 7, and 14 after surgery.

Research results.

According to the results of a clinical study, patients in the second group had no pain and bleeding of the postoperative wound already on the 2nd day after surgery, the wound was epithelialized already on the 3-4th day, and there were no postoperative complications at the time of suture removal on the 14th day.

Patients of the first group had postoperative swelling and hyperemia of soft tissues on the 3rd day after surgery, and pain on the 7th day of the postoperative period.

The essence of the invention is illustrated by the following clinical examples.

Example 1. Patient R., 33 years old, was admitted with complaints of aesthetic dissatisfaction and increased sensitivity in the area of the central tooth in the upper jaw. After a comprehensive diagnosis, the patient was diagnosed with gingival recession of 2.1 teeth, class 1 according to Miller. The mucous membrane of the oral cavity is pale pink, painless on palpation, there is no hyperemia in the area of the 2.1 tooth. There is soft plaque less than 1/3 in the area of teeth 1.3-2.3 in the upper jaw and 3.3-4.3 in the lower jaw. The presence of supragingival and subgingival stone was not detected. The length of the gingival recession is 2 mm, the width is 3.2 mm. Presence of attached keratinized gingiva apical to 4 mm recession. Gingival papillae are normal, gingival peaks are expressed throughout. After performing diagnostic procedures and professional oral hygiene, the patient underwent comprehensive treatment for gum recession. The first stage was preoperative preparation of the soft periodontal tissues and hard tissues of the root of tooth 2.1 in the area of gingival recession by conducting photodynamic therapy on the ALOD-01 apparatus using laser irradiation with red light with a wavelength of 662 nm, radiation power 0.2 W, in pulsed mode using the photosensitizer “Photoditazine” for 2 minutes once. A sterile collagen plate “PHARMADONT II” with 0.5 ml of NIGELLA SATIVA essential oil was immediately placed on the treated area and left until completely absorbed. The next day, a mucogingival operation was performed to eliminate the recession, namely an operation using a coronary displaced trapezoidal flap according to the generally accepted technique. A collagen plate “PHARMADONT II” with NIGELLA SATIVA essential oil in an amount of 0.5 ml was placed on the area of postoperative sutures and left until completely absorbed. Then, at home, the patient applied the PHARMADONT II collagen plate with NIGELLA SATIVA essential oil in an amount of 0.5 ml to the area of postoperative sutures once a day after meals and before bedtime for 7 days.

During the postoperative examination on the 4th day, the presence of epithelization in the area of postoperative interrupted sutures was clinically revealed. There are no complaints of pain, swelling, or increased body temperature. No soft coating on seam areas. On the 12th day, the postoperative sutures were removed. There are no postoperative complications.

Example 2.

Patient V., 27 years old, complained of pain when eating, aesthetic dissatisfaction in the area of the central tooth in the lower jaw. During the examination, objectively: gum recession of 4.1 teeth, class 1 according to Miller, was detected. The mucous membrane of the oral cavity is pale pink, painless on palpation, hyperemia in the area of the 4.1 tooth. The presence of supragingival and subgingival stone was not detected. The length of the gingival recession is 2.5 mm, the width is 3.5 mm. Presence of attached keratinized gingiva apical to 2 mm of recession. Gingival papillae are normal, gingival peaks are expressed throughout. After performing diagnostic procedures and professional oral hygiene, the patient underwent comprehensive treatment for gum recession. The first stage was preoperative preparation of the soft periodontal tissues and hard tissues of the root of tooth 4.1 in the area of gingival recession by conducting laser photodynamic therapy on the ALOD-01 device using laser irradiation with red light with a wavelength of 662 nm, power 0.4 W, pulse mode ; photosensitizer - “Photoditazine”, exposure time - 2 minutes once. A sterile collagen plate “PHARMADONT II” with NIGELLA SATIVA essential oil in an amount of 0.5 ml was immediately placed on the treated area and left until completely absorbed. The next day, mucogingival flap surgery was performed to eliminate the recession using a generally accepted technique. A collagen plate “PHARMADONT II” with NIGELLA SATIVA essential oil in an amount of 0.5 ml was placed on the area of postoperative sutures and left until completely absorbed. Then, at home, the patient applied the PHARMADONT II collagen plate with NIGELLA SATIVA essential oil in an amount of 0.5 ml to the area of postoperative sutures once a day after meals and before bedtime for 7 days.

During the postoperative examination on day 3, the presence of epithelization in the area of postoperative sutures was clinically revealed. No complaints. No soft coating on seam areas. On the 14th day, the postoperative sutures were removed. There are no postoperative complications.

The results obtained allow us to draw a conclusion about the effectiveness of the proposed method of complex treatment of gum recession.

Claims (1)

A method of complex treatment of gum recession, including mucogingival surgery and the application of a collagen plate "PHARMADONT" to the area of postoperative sutures, characterized in that additionally preoperative preparation of the soft tissues of the periodontium and hard tissues of the tooth root in the area of gingival recession is performed by a single application of the photosensitizer "Photoditazin" in the form 0.5% gel with an exposure of 10 minutes and subsequent laser irradiation with red light with a wavelength of 662 nm, a power of 0.2-0.4 W, in pulse mode, for 2 minutes, then a collagen plate “PHARMADONT II” is applied to the treated area , onto which NIGELLA SATIVA essential oil is pre-applied in an amount of 0.5 ml and left until completely absorbed, the next day a mucogingival operation is performed to eliminate recession, a collagen plate “PHARMADONT II” with NIGELLA SATIVA essential oil applied is applied to the area of postoperative sutures amount of 0.5 ml until complete resorption, after which the procedure of applying the PHARMADONT II collagen plate with NIGELLA SATIVA essential oil is repeated once a day for 7 days.