The method of treatment of periodontitis (options)

 

(57) Abstract:

The invention relates to medicine, namely to dentistry. How is that in light of the severity of periodontitis patient are deepithelization inner wall of the periodontal pocket defocused beam of laser power 1-2 W, at moderate severity are gingivectomy by the focused laser beam with a capacity of 5-6 watts and closed curettage and deepithelization inner wall of periodontal pockets with a capacity of 1-2 watts, with severe conduct gingivectomy, deepithelization inner and outer walls pockets, closed curettage and then patchwork surgery or surgical curettage, then the deepithelization internal and external parts of the flap, while before deepithelization eliminate the inflammatory process by introducing into the gingival surface of immunomodulators, mainly Viferon. The way to increase the effectiveness of treatment. 3 S. and 1 C.p. f-crystals.

The present invention relates to medicine, namely to the dentist, and can be used in the treatment of periodontal disease of varying severity.

According to who, inflammatory periodontal disease suffers currently 70-90% implementing all the new options for the treatment of periodontitis confirms the unresolved problems.

In particular, there is a method of treatment of mild periodontitis (B. C. Ivanov. Periodontal disease. - M.: 1998), providing for curettage of periodontal pockets. This pocket depth of 3-4 mm are treated simultaneously for 2-3 tooth, keeping a high degree of sterility during surgery and careful hygiene of the oral cavity within 2-3 weeks after surgery to prevent postoperative complications. After that, proceed by the same method to the treatment of the next group of teeth (2-3 teeth). Thus, the entire course of treatment is 9-12 months. Unfortunately, the effectiveness of the treatment, despite the duration, remains low, as the most thorough curettage does not guarantee removal of granulation tissue in periodontal pockets, full regeneration of periodontal pockets is 14 days, that is, it occurs before the formation of connective ligaments, which would eliminate recurrence. In addition curettage performed with metal tools (shovels, hooks, surety) that is traumatic, requires highly skilled dentist and his manual skills. According to the scientific literature (N. C. Concanen. Disease Pontica and the depth of periodontal pockets 4-5 mm use the operation of the open curettage. (According to literature data, M Barara, Etc., Nemeckoi, periodontal Diseases, clinic, diagnostics and treatment. // Educational. the allowance. - M: NERC, 1996. -85 C.) Method is as follows: carry out the dissection of the vertices of the interdental papillae and marginal dissection in the region of 5-6 teeth, prepare the chin with vestibular and oral sides of the flaps to the level of the bottom of the gingival pocket. Then under visual control by the excavators (scissors, hooks) clean the stones, the granulation process with an antiseptic solution, put the pieces in place, fix seams and medical bandage of special material for sealing and pressure on the gum tissue. The bandage is removed after daily treatment with antiseptic. The entire course of treatment is 4-5 steps for 12-15 days. In this case the patient should always use drugs (anti-inflammatory, antihistamine) and conduct antiseptic treatment of the oral cavity.

In severe periodontitis (depth of pockets greater than 6 mm) are gingivectomy (simple or radical) and different types of patchwork operations (see ibid.). When simple gingivectomy cut off five or six teeth edge free of attached gingiva in the form of strips of a width of 2-3 mm, Then osushestvlyaetsya excision of gingival margin to the depth of periodontal pockets, with exposure of the bone tissue of the alveolar process and its alignment.

In the presence of bone pockets and mobility of teeth 2-3 degree of bone resorption more than 1/2 the length of the root after gingivectomy spend on these teeth patchwork operation, like open curettage with moderate periodontitis, but additionally smooth out the edge of the alveolar bone and finished treatment as well as with moderate periodontitis.

Surgery performed in a hospital under General anesthesia.

Obvious duration of treatment, the trauma, many contraindications (diabetes, cardiovascular disease, hypertension, poor blood clotting, age limit, bronchial asthma and other).

For the prototype in the treatment of mild severity of periodontitis we adopted the method proposed by N. F. Danilevsky and others (periodontal Disease. - M.: Medicine, 1993). The authors have proposed a preliminary redevelopment of the oral cavity, including the removal of dental deposits and a relatively gradual (2-3 teeth) closed curettage.

Disadvantages: lack of visual control, invasiveness, duration of treatment, incomplete removal of grni gravity accepted method (C. I. Kovalevsky. Treatment of periodontal disease. 1999), performed as follows. First, carry out the removal of dental plaque, and then perform an operation to open curettage, also in groups of 5-6 teeth. Then stitched up and the medical bandage and provide medical treatment for 14-20 days. Stage of treatment the next group of teeth is carried out in a similar way.

Disadvantages: invasiveness, duration, incomplete removal of the epithelium and granulation, a lot of contraindications, the low efficiency of treatment, the inability to conduct normal hygiene in the postoperative period, limitations in food intake, discomfort in connection with speech.

For the prototype with severe periodontitis adopted the method described in the book by A. E. Stepanov "Frenuloplastika, vestibuloplastika and operations on the periodontal tissues". - M.: 2000. In this method, first remove dental deposits, conduct partial or radical gingivectomy or flap surgeries, depending on the state of the bone tissue.

Cons: the trauma, inability to avoid infection of the smoothing of the alveolar ridge, the low efficiency of treatment, the disability of the patient at length the amount of antibiotics and other drugs.

The technical objective of the proposed method is to provide high treatment efficiency by eliminating mechanical trauma, to prevent infection of the wound due to non-contact method of work, maintain sterility of the wound surface during the entire operation and 2-3 days of the postoperative period, treatment in polyclinic conditions, reduce pain barrier, reduce labor costs, reduce the period of treatment, implementation of treatment simultaneously, providing hemostasis, lymphostasis (dry operative field), create conditions for accelerated regeneration, elimination of postoperative complications and discomfort (restrictions in food intake, lifestyle of the patient), eliminate the loss of time disability, exceptions required admission in the postoperative period a large number of medicines, dressings, sutures, eliminate stressful situation for the patient, the absence of recurrence of the disease, provide a good cosmetic effect, a sustainable approach to the tissues.

The essence of the invention is that in light of the severity of periodontitis patient are deepithelization inner wall of the periodontal pocket p of the principles of conduct ultrasound.

When moderate conduct partial gingivectomy focused laser beam with a capacity of 5-6 watts and closed curettage through a combination treatment of periodontal pockets with ultrasound and laser - deepithelization inner wall of the periodontal pocket.

In severe periodontitis (at a depth of pockets to 7 mm) by the focused laser beam with a capacity of 5-6 watts are gingivectomy and decapitalization internal and external walls of periodontal pockets by a laser beam with a capacity of 1-2 watts and closed curettage, laser support. When the depth of the pockets of more than 7 mm spend patchwork surgery, or surgical curettage, and then the deepithelization laser beam power 1-2 W inner and outer part of the flap.

The method is tested on the 109 patients, including severity of 34 patients, with an average of 50 patients, 25 patients with severe.

The method is as follows:

a) light the severity of periodontitis

Phase I operation: laser beam power 1-2 W enter periodontal tip in the periodontal pocket to dehydration and partial destruction of concrements. At this dosage power is deepithelization vnutrennego postoperative wounds, the sealing nerves and lymphatic vessels, providing a dry operative field, and sintering the granulation tissue. Fast horizontal movements introduce the tip into the periodontal pocket, not to destroy the intact tissue, and at the same time carry out vertical movements to achieve decapitalization inner wall of the periodontal pocket.

Phase II operations: washed periodontal pockets with 3% hydrogen peroxide solution. Then an ultrasonic scaler to remove subgingival dental plaque, clean and smooth surface roots.

I'll phase of the operation - deepithelization. In the apical part of the periodontal pocket after curettage of the healing process leads to the formation of a layer of connective tissue (21-day), which is the best protection of periodontal inflammation. And on the inner and outer walls of the periodontal pocket is regeneration, coming from the epithelial cells of gingival edges with different speeds in different parts of the periodontal pocket (on average 10-12 days). For the successful formation of connective tissue is necessary to prevent the germination of the epithelium in the apical part of the periodontal pocket. To do this, and provodilsja laser with output power of 1-2 watts throughout its internal wall of the periodontal pocket fast translational motions of the laser tip on the entire inner surface of the periodontal pocket from the apical side to the edge of the gums, while protecting the hard tissues of the tooth. To the outside of the epithelial cells prematurely was not grown in the periodontal pocket and did not interfere with the regeneration of the circular ligament of the tooth, it is necessary in the field of free gingiva to remove the epithelium to mucogingival boundaries, starting from the epithelial border around the tooth, quick movements across the width of the square to the area of the basal membrane. Complete removal of epithelial cells is assessed visually by starting bleeding from numerous vessels of the connective tissue, which is a clear sign of decapitalization. In conclusion, defocused beam with a capacity of 1-2 watts conduct hemostasis, lymphostasis, sterilization of the gingival grooves and sealing of nerve endings.

b) moderate and severe periodontitis

Treatment of chronic generalized periodontitis of moderate is the following: after infiltration anaesthesia are gingivectomy, i.e. the reduction of the height of the free gum in order to reduce its depth and better approach to periodontal pocket for a full curettage, scaling and cleaning of the roots. The focused beam with a capacity of 5-6 watts at 45oto the surface of dananana purity of the surgical field and to avoid undesirable thermal effects, at the same time simulating it in line with the aesthetic requirements. The gum is removed to a depth of pockets to 3-4 mm, protecting the root surface of the teeth from the laser beam by using special tools (spatula of Heideman), followed deepithelization and sterilization bottom of the gingival pocket. This is followed by curettage, laser support - removal of calculus, smoothing with a scaler surface roots.

When removing infected tissue out of his pocket on the surface of the wound appears carbonized layer, which is repeatedly cleaned with a swab moistened with 3% hydrogen peroxide solution in order to avoid undesirable thermal effects. Then spend coagulation (a power of 1-2 watts, ray rasfokusirovka, the tip angle) and the sterilization of the gingival sulcus, which leads to bacterial stabilization and sterilization of surfaces and suspension migration of epithelial cells in the periodontal pocket. It is the most gentle technique for periodontal tissue.

Treatment of chronic generalized periodontitis severe is the following: medication treat your mouth, hold conduction and infiltration AB, and sometimes in the hospital, under sedation or under General anesthesia in the volume of transactions include the entire jaw. The edges of the surgical field with a scalpel produce two vertical incision that goes from the gingival margin to transition the folds of the mucous membrane and connecting horizontal incisions in the form of partial gingivectomy with buccal and oral sides reached 2-2 .5 mm from the gingival margin. Prepare the chin mucoperiosteal flaps with vestibular and oral surfaces from the alveolar bone within and between the two vertical cuts made earlier. Perform a careful removal of hard dental deposits on the roots of the teeth, freshen the surface of the root of mechanical tools, Polish it, exposed subgingival granulation and cords of epithelial tissue from the bone of the alveolar ridge and debonded mucoperiosteal flaps. Process defocused laser beam with a capacity of 1-2 W, thereby viparita them and removing. Carbonized surface treated with 1% hydrogen peroxide solution. This solution is a good antiseptic. The second property is the separation of the particles from hard to reach places together with bubbles. The third positive feature - obbo defocused beam with a capacity of 1-2 watts conduct hemostasis, lymphostasis, sealing nerve endings and deepithelization inner and outer sides of the flap.

The flaps are placed on their place on the alveolar ridge and fixed with suture material. In the postoperative period prescribed treatment of the oral cavity after eating a weak antiseptic solution, during the day you can rinse the mouth anti-inflammatory herbs. Seams is recommended to delete on the 6th day.

As confirmation of the results obtained here are clinical examples:

Example 1

Map of the state of the oral cavity and teeth N 202. Patient P., 42 years old, was sent to the dental examination. Complaints: bleeding gums when brushing teeth, pain in the gums, bad breath.

Considers himself ill for about 3 years. Previously about periodontal disease is not treated. From somatic diseases notes atrophic gastritis and chronic pneumonia. Objectively: the face asymmetry is absent. Dental formula:

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Bite orthognathic. The condition of the seals and prostheses unsatisfactory. CPU = 1+8+8=-17. There are soft and hard dental deposits in a small amount (the lingual surface of the teeth front A, when probing bleeding. The depth of periodontal pockets up to 4 mm with serous discharge. Pathological tooth mobility and exposure of the tooth roots are not observed. Sample Schiller-Pisarev positive, the sample Kecke negative. KI = 2.6, THE CPITN = 2,3. Data LDF - MD-23,2; PD-21,5; PS-21,3; GR-0,16.

On the orthopantomogram is determined by the violation of the integrity of compact discs, tops interdental septa, marked osteoporosis, periodontal gap widened, destruction millionary partitions up to 1/3 the length of the root.

On the basis of history, clinical examination and additional laboratory studies was diagnosed with chronic generalized periodontitis mild.

3.02.99, Treatment. Antiseptic treatment of the oral cavity. Professional removal of dental plaque ultrasonic scaler.

Fabrication of individual trays. Applique Viferon - 30 minutes Recommended enhanced oral hygiene. Replacement fillings

5.02.99, the Patient noted improvement in the condition of the gums. When the inspection is determined by the less pronounced hyperemia and swelling of the gums. Produced antiseptic mouth. Applicati who were pain, bleeding, gone bad breath. Objectively: is a minor redness and swelling in the area of gingival papilla. Conducted applique Viferon. Treatment of dental caries 6.

9.02.99, no Complaints. Objective: the gums are pale pink in color, when sensing is not bleeding. Treatment: applique Viferon - 30 minutes

10.02.99, Conducted controlled brushing. Applique Viferon - 30 minutes

11.02.99, the Operation is closed curettage, laser support and conducted deepithelization inner wall of the periodontal pocket defocused by a laser beam power of 1 watt. Recommendations for the care of the oral cavity in the postoperative period.

12.02.99, Control and inspection. No swelling of the operating zone. There is a slight soreness from tactile stimuli. Bleeding and hyperesthesia are missing.

13.02.99, Control and inspection. No complaints. Recommended for normal oral hygiene. Inspection 13.03.99,

15.03.99, the Patient was on inspection one month after treatment. No complaints. Objective: restoration of the topography of the gingival margin, the gums are pale pink in color, dense, probing is not bleeding. The parody is PD-25,3; PS-29,2; GR-0,11. Control examination after 6 months.

15.09.99, the Patient was on visual inspection. No complaints. Objective: a small amount of soft plaque on the vestibular surface of the incisors of the lower jaw. On the orthopantomogram - seal cortical reflex plate and the disappearance of foci of osteoporosis, resorption of residual up to 1/3 of the length of the root without evidence of progression.

Example 2

Map of the state of the oral cavity and teeth N 142. Patient M., 46 years old, was sent from the Center of the ROCKS "Chernobyl" on the dental examination. Complaints: bleeding gums when brushing teeth, bad breath.

Considers himself ill about 2 years. Previously about periodontal disease is not treated. From somatic diseases notes arthropathy, gastritis, cholecystitis, pancreatitis, chronic tonsillitis.

Dental formula:

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Bite orthognathic. The condition of the seals and prostheses unsatisfactory. CPU = 1+4+2=7. There are soft and hard dental deposits in a small amount (the lingual surface of the teeth anterior lower jaw). The mucous membrane of the gingival margin in the area of all existing teeth hyperemic, edematous, when sensing is not observed, exposure of roots in the area of the anterior teeth of the lower jaw and molars of the upper jaw. Sample Schiller-Pisarev positive, the sample Kecke negative. GI = 3,8, CPITN = 2,0. Data LDF-MD-23,6; PD-21,3; PS-21,4: GR-0,14.

On the orthopantomogram is determined by the violation of the integrity of compact discs, tops interdental septa, marked osteoporosis, periodontal gap widened, destruction millionary partitions up to 1/3 the length of the root. Diagnosis: mild periodontitis.

1.12.99, Professional removal of dental plaque, antiseptic treatment of the oral cavity, the health education. Fabrication of individual trays. Applique Viferon - 30 minutes Recommended enhanced oral hygiene. Replacement fillings

2.12.99, the Patient noted improvement in the condition of the gums. When the inspection is determined by the less pronounced hyperemia and swelling of the gums. Produced antiseptic mouth. Applique Viferon 30 minutes

3.12.99, no Complaints. The patient noted significant improvement in the condition of the gums. Decreased pain, bleeding, gone bad breath. Objectively: is a minor redness and swelling in the area of gingival papilla. Held funding is not bleeding. Treatment: applique Viferon - 30 minutes

6.12.99, Conducted controlled brushing. Applique Viferon - 30 minutes

7.12.99, the Operation is closed curettage, laser support and conducted deepithelization inner wall of the periodontal pocket defocused beam laser power of 2 watts. Recommendations for the care of the oral cavity in the postoperative period.

8.12.99, Control and inspection. No swelling of the operating zone. There is a slight soreness from tactile stimuli. Bleeding and hyperesthesia are missing.

9.12.99, Control and inspection. No complaints. Recommended for normal oral hygiene. Inspection 13.03.99,

10.01.00, the Patient was on inspection one month after treatment. No complaints. Objective: restoration of the topography of the gingival margin, the gums are pale pink in color, dense, probing is not bleeding. Periodontal pockets are missing. Sample Schiller-Pisarev and Checke - negative. GI - 1,0, CPITN - 0. Data LDF - MD-23,2; PD - 25,3; PS-29,2; GR-0,11. Control examination after 6 months.

2.06.00, the Patient was on visual inspection. No complaints. Objective: a small amount of soft plaque on vestibular the key and the disappearance of foci of osteoporosis, residual resorption up to 1/3 of the length of the root without evidence of progression.

Example 3

Map of the state of the oral cavity and teeth 136 N. Patient B., 46 years old, was sent to the dental examination. Complaints: bleeding gums when brushing teeth, pain in the gums, bad breath.

Considers himself ill about 4 years. Previously about periodontal disease is not treated. From somatic diseases notes of disease in SSA, bronchial asthma, seasonal allergies to pollen, hypofunction of the thyroid gland. Dental formula:

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Bite orthognathic. The condition of the seals and prostheses unsatisfactory. CPU = 2+6+4= 12. There are soft and hard dental deposits. The mucous membrane of the gingival margin in the area of all existing teeth hyperemic, edematous, when probing bleeding. The depth of periodontal pockets up to 5 mm with serous discharge. Pathological tooth mobility is not observed, the exposure of the tooth roots of the upper molars and anterior teeth of the lower jaw. Sample Schiller-Pisarev positive, the sample Kecke negative. GI = 3,8, CPITN = 2,6. Data LDF - MD-23,7; PD-22,2; PS-20,3; GR-0,14.

On the orthopantomogram is defined n the orbital slot extended destruction millionary partitions up to 1/3 the length of the root.

On the basis of history, clinical examination and additional laboratory studies was diagnosed with chronic generalized periodontitis of moderate extent.

16.02.99, Treatment. Antiseptic treatment of the oral cavity. Professional removal of dental plaque ultrasonic scaler.

Fabrication of individual trays. Applique Viferon - 30 minutes Recommended enhanced oral hygiene. Replacement seals

17.02.99, the Patient noted improvement in the condition of the gums. When the inspection is determined by the less pronounced hyperemia and swelling of the gums. Produced antiseptic mouth. Applique Viferon 30 minutes replacement seals

18.02.99, no Complaints. The patient noted significant improvement in the condition of the gums. Decreased pain, bleeding, gone bad breath. Objectively: is a minor redness and swelling in the area of gingival papilla. Conducted applique Viferon .

19.02.99, no Complaints. Objective: the gums are pale pink in color, while sounding not bleed. Treatment: applique Viferon - 30 minutes

24.02.99, Control and inspection. No swelling of the operating zone. There is a slight soreness from tactile stimuli. Bleeding and hyperesthesia are missing.

25.02.99, Control and inspection. No complaints. Recommended for normal oral hygiene. Inspection 25.03.99,

23.03.99, the Patient was on inspection one month after treatment. No complaints. Objective: restoration of the topography of the gingival margin, the gums are pale pink in color, dense, probing is not bleeding. Periodontal pockets are missing. Sample Schiller-Pisarev and Checke - negative. GI - 1,6, CPITN - 1,3. Data LDF - MD-23,8; PD-26,1; PS-29,5; GR-0,16. Control examination after 6 months.

21.09.99, the Patient was on visual inspection. No complaints. Objective: a small amount of soft plaque on the vestibular surface of the incisors of the lower jaw. On the orthopantomogram - seal cortical reflex plate and the disappearance of foci of osteoporosis, resorption of residual up to 1/3 of the length of the root without evidence of progression.

The healing process takes place without bleeding and complaints of patients, the condition de is ndout non-irritating diet and enhanced oral hygiene. A day after the CO2laser surgery patients there is no swelling of the gums. And after 2-3 days, the patients can carry out basic oral hygiene.

Example 4

Map of the examination of the oral cavity and teeth N 300. Patient G., aged 34. Aimed at dental examination from the Center of the ROCKS "Chernobyl". Complaints of pain and bleeding gums, loose teeth, bad breath.

Considers himself ill for about 5 years. Before enrolling in the clinic treatment of periodontal diseases has not been conducted. Suffer from chronic cholecystitis and hypertension. Objective: data external examination without features. Dental formula:

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Bite orthognathic. CPU = 2+0+1=3. Orthopedic design requires replacement. There are abundant soft and hard dental deposits. The mucous membrane of the gums swollen, hyperemic, when probing bleeding. The depth of periodontal pockets up to 6 mm pockets - purulent discharge. Tooth mobility II degree. Uncovering the roots of the anterior teeth of the lower jaw to 1/3. Sample Schiller-Pisarev - positive sample Checke - positive. GI = 2,4; CPITN = 2,8. Data LDF: MD-16,5 have.E.; PD-17,6.E.; PS - 18,3.E.; GR-0,19. Durmanov - IL-1 and 25.8 pg/ml; -DETAILS of 36.5 pg/ml; TNF - 25,7 pg/ml.

On the orthopantomogram is determined by the expansion of periodontal cracks, diffuse osteoporosis millionary partitions and their destruction to 1/2 the length of the roots.

Based on the data of anamnesis, objective clinical and additional methods of research was diagnosed with chronic generalized periodontitis of moderate extent.

5.04.99, Consulting internists. Treatment: antiseptic mouth. Professional removal of dental plaque. Teaching oral hygiene. Fabrication of individual trays. Applique Viferon - 30 minutes

6.04.99, Complaints about bleeding gums. Objective: by a small decrease swelling, redness and bleeding of the gums. Treatment: antiseptic mouth. Treatment of dental caries Applique Viferon - 30 minutes

7.04.99, Treatment of caries Removal of prosthesis Fabrication of temporary bridges. Applique Viferon - 30 minutes

8.04.99, Splinting tape GlassPan and flowable composite moving teeth Applique Viferon.

9.04.99, Endodontic treatment Applique Viferon.

12.04.99, Complaints neznachitelnym when probing. Treatment: antiseptic treatment. Applique Viferon.

13.04.99, Operation - gingivectomy closed curettage, laser support and deepithelization. Tips on caring for the oral cavity in the postoperative period.

14.04.99, Complaints weak soreness operating zone. Objective: saved swelling and redness. Bleeding is absent. Scheduled for inspection in a month.

13.05.99, the Patient was in the control examination after 1 month after the treatment. No complaints. Objectively determined restoration of the topography of the gingival margin. The gums are pale pink in color, dense, probing is not bleeding. Periodontal pockets with a depth of 2 mm, the mobility of the teeth are missing.

Sample Schiller-Pisarev and Checke - negative. GI - 1,5; CPITN - 1,1. The results LDF - MD-20,1; PD-23,3; PS-23,5; GR-0,12.

Data immunologic studies: blood - IL-1 AND 10.3; - INFO - 21,6; TNF - 14,7; flush - YL-1 - 8,3; - INFO - 10,9; TNF - 2,7. Recommendations for the care of the oral cavity. Control examination after 6 months.

10.11.99, the Patient was on visual inspection. No complaints. Objective: the gums are slightly hyperemic, not swollen. Bleeding preach plates, resorption of bone tissue millionary partitions stabilized and meets 1/3-1/2 the length of the root.

Example 5

Map of the state of the oral cavity and tooth No. 31. Patient D., aged 45, was sent to the dental examination. Complaints: bleeding gums when brushing your teeth and eating solid food, pain in the gums, bad breath.

Considers himself ill about 5 years. Previously about periodontal disease is not treated. From somatic diseases notes osteochondrosis of the thoracic spine. Objectively: the face asymmetry is absent. Dental formula:

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Bite orthognathic. The condition of the seals and prostheses unsatisfactory. CPU = 3+13+3= 19. There is a large number of soft and hard dental deposits. The mucous membrane of the gingival margin in the area of all existing teeth hyperemic, edematous, when probing bleeding. The depth of periodontal pockets up to 8 mm with serous discharge. Observed pathological tooth mobility I and II degree, exposure of roots in the field of front groups of the lower and upper jaws. On the upper molars exposed furcation. Sample Schiller-Pisarev and sample Checke - positive. GI = 3.6V, CP the fabric, which leads to the destruction of interdental septa within 2/3 the length of the root, there are bone deep pockets, lots of osteoporosis have saped edge.

On the basis of history, clinical examination and additional laboratory studies was diagnosed with chronic generalized periodontitis severe.

6.10.98, Treatment. Antiseptic treatment of the oral cavity. Professional removal of dental plaque ultrasonic scaler.

Fabrication of individual trays. Applique Viferon - 30 minutes Recommended enhanced oral hygiene.

9.10.98, the Patient noted improvement in the condition of the gums. When the inspection is determined by the less pronounced hyperemia and swelling of the gums. Produced antiseptic mouth. Applique Viferon 30 minutes replacement seals

12.10.98, no Complaints. The patient noted significant improvement in the condition of the gums. Decreased pain, bleeding, gone bad breath. Objectively: is a minor redness and swelling in the area of gingival papilla. Conducted applique Viferon. Treatment of dental caries

14.10.98, Complaints weak aching pain above and the Feron - 30 minutes

11.01.99, Conducted controlled brushing. Applique Viferon - 30 minutes

12.01.99, flap surgery with laser support. Recommendations for the care of the oral cavity in the postoperative period.

13.01.99, Control and inspection. No swelling of the operating zone. There is a slight soreness from tactile stimuli. Bleeding and hyperesthesia are missing.

14.01.99, the stitches Removed. No complaints. Recommended for normal oral hygiene. Inspection 19.02.99,

19.03.99, the Patient was on inspection one month after treatment. No complaints. Objective: restoration of the topography of the gingival margin, the gums are pale pink in color, dense, probing is not bleeding. Periodontal pockets up to 2 mm Samples Schiller-Pisarev and Checke - negative. GI - 1,4, CPITN AND 1.8. Control examination after 6 months.

20.09.99, the Patient was on visual inspection. No complaints. Objective: a small amount of soft plaque on the vestibular surface of the incisors of the lower jaw. On the orthopantomogram signs of progressive destruction of bone tissue after 6 months are not available.

Example 6

Map of the state of the oral cavity and teeth N dreams feeling putrid taste, bad breath, frequent spontaneous bleeding gums, mobility and changing the position of the teeth. An objective examination revealed hyperemia and edema of the mucous membrane of marginal and alveolar gums, excessive over - and subgingival dental plaque, gum recession up to 1/3 of the length of the root, tooth mobility 2-3rd degree. The depth of periodontal pockets is 5-6 mm and more significant Treme, is expressed traumatic articulation. GI is 3.2, CPITN and 3.3. When setting the sample Schiller-Pisarev's painting captures the alveolar gingiva. Sample Kecke positive.

In x-ray picture there is a generalization of the destructive processes in the bone tissue, destruction of interdental septa within 2/3 the length of the root, there are bone deep pockets. There are lots of osteoporosis.

Considers himself ill about 5 years, about periodontal disease is not treated. From somatic diseases notes atrophic gastritis and pancreatic. Objectively: the face asymmetry is absent. Dental formula:

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Bite orthognathic. The condition of the seals and prostheses unsatisfactory. CPU = 5+1+BOV hyperemic, swollen, when probing bleeding. The depth of periodontal pockets up to 5-6 mm with purulent discharge. Abnormal mobility of the teeth of the first degree.

On the basis of history, clinical examination and additional laboratory studies was diagnosed with chronic generalized periodontitis severe.

18.11.99, Treatment. Antiseptic treatment of the oral cavity. Professional removal of dental plaque ultrasonic scaler.

Fabrication of individual trays. Applique Viferon - 30 minutes Recommended enhanced oral hygiene. Replacement fillings

19.01.99, the Patient noted a slight improvement in the condition of the gums. When the inspection is determined by the less pronounced hyperemia and swelling of the gums. Produced antiseptic mouth. Applique Viferon 30 minutes replacement seals 7.

20.01.99, no Complaints. The patient noted improvement in the condition of the gums. Decreased pain, bleeding, gone bad breath. Objectively: is a minor redness and swelling in the area of gingival papilla. Conducted applique Viferon. Treatment of dental caries

21.01.99, no Complaints. Objective/P> 22.01.99) underwent controlled brushing. Applique Viferon - 30 minutes

24.01.99, flap surgery with laser support. Recommendations for the care of the oral cavity in the postoperative period.

25.01.99, Control and inspection. No swelling of the operating zone. There is a slight soreness from tactile stimuli. Bleeding and hyperesthesia are missing.

30.01.99, the stitches Removed. No complaints. Recommended for normal oral hygiene. Inspection 1.03.99,

1.03.99, the Patient was on inspection one month after treatment. No complaints. Objective: restoration of the topography of the gingival margin, the gums are pale pink in color, dense, probing is not bleeding. Periodontal pockets 1-2 mm Samples Schiller-Pisarev and Checke - negative. GI - 2, CPITN - 2,5.

15.09.99, the Patient was on visual inspection. No complaints. Objective: a small amount of soft plaque on the vestibular surface of the incisors of the lower jaw. The condition is characterized as stable. On the orthopantomogram - seal cortical reflex plate and the disappearance of foci of osteoporosis, resorption of residual up to 1/3 of the length of the root without evidence of progression.2laser surgery for patients, there is no swelling of the gums. And after 2-3 days, the patients can carry out basic oral hygiene.

1. A method of treating periodontal disease, comprising the preliminary removal of dental deposits, characterized in that in light of the severity of periodontitis patient are deepithelization inner wall of the periodontal pocket defocused by a laser beam with a capacity of 1-2 watts.

2. A method of treating periodontal disease comprising removing dental plaque and curettage, characterized in that at moderate severity are gingivectomy by the focused laser beam with a capacity of 5-6 watts and closed curettage and deepithelization the inner walls of the periodontal pockets of beam power 1-2 watts.

3. A method of treating periodontal disease comprising removing dental plaque and gingivectomy, characterized in that in severe periodontitis when the depth of periodontal pockets up to 7 mm are gingivectomy by the focused laser beam and the deepithelization inner and outer walls of the pockets, then secretrary curettage, and then the deepithelization laser beam with a capacity of 1-2 watts of internal and external parts of the flap.

4. The method according to PP.1 to 3, characterized in that before deepithelization eliminate the inflammatory process by introducing into the gingival surface of immunomodulators, mainly Viferon.

 

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FIELD: medicine.

SUBSTANCE: method involves introducing 0.1-0.3 ml of photosensitizing gel preliminarily activated with laser radiation, after having removed neovascular membrane. The photosensitizing gel is based on a viscoelastic of hyaluronic acid containing khlorin, selected from group containing photolon, radachlorine or photoditazine in the amount of 0.1-2% by mass. The photosensitizing gel is in vitro activated with laser radiation having wavelength of 661-666 nm during 3-10 min with total radiation dose being equal to 100-600 J/cm2. The gel is introduced immediately after being activated. To compress the retina, vitreous cavity is filled with perfluororganic compound or air to be further substituted with silicon oil. The operation is ended with placing sutures on sclerotomy and conjunctiva areas. Compounds like chealon, viscoate or hyatulon are used as viscoelastic based on hyaluronic acid. Perfluormetylcyclohexylperidin, perfluortributylamine or perfluorpolyester or like are used as the perfluororganic compound for filling vitreous cavity.

EFFECT: excluded recurrences of surgically removed neovascular membrane and development of proliferative retinopathy and retina detachment; retained vision function.

3 cl, 5 dwg

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