The method of treatment of periodontitis

 

(57) Abstract:

The invention relates to medicine, namely to physiotherapy, and can be used in the treatment of periodontitis. Perform the three-step laser irradiation in therapeutic dosages, surgical treatment. Additionally before you perform laser therapy medicinal application. At the first stage in the pockets of injected gel helical, and periodontal pockets size 4 mm or more is irradiated through the thin disposable fiber and less depth - side vestibular and oral surfaces of the alveolar ridge, within 5-7 days total time of one session 12-20 minutes. At the second stage during the patchwork operations apply the mixture gels of helical and pantomicina in the ratio of 1:1 in the folded flap and irradiated by laser for 3-7 minutes. At the third stage are applique vasoactive gel on the area of the alveolar ridge of the maxilla and mandible, in the interdental spaces and the exit point of the trigeminal nerve, the laser irradiation in therapeutic dosages performed on the same region, the number of procedures from 5 to 7, the total time of one session 12-20 minutes. The method allows to significantly expedite the reduction of the period of disability of patients, that, in turn, leads to positive economic effect. 1 PL.

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

There is a method of treatment of generalized periodontitis, which was used photophoresis gel “Metrogyl dent”. In this way the treatment of patients with periodontal disease directly after application of the gel was carried out by exposure to laser radiation of a semiconductor laser (Patent RF №2184580, publ. 2002).

The disadvantage of this method is the absence of pathogenic medication effects on one of the most important links of the pathogenesis of periodontitis - a violation of microcirculation, although in the presence of targeted antibiotic therapy taking into account the sensitivity of the most important periodontopathogenic species of bacteria.

There is a method of treating periodontal disease, comprising the application of gel “Pantophagy” on the gums with oral and vestibular side of the alveolar ridge in the interdental spaces and periodontal pockets in 10-12 days against the standard treatment of periodontitis (Mihalinec A. C. Application of gel pantomicina is.

The disadvantage of the proposed method is a slight anti-inflammatory effect, as well as the lack of purposeful vzaimoottalkivaniya physical factors and medication, when it is possible to achieve a gain of therapeutic action and reduction of the period of rehabilitation.

The closest is a method of treating periodontal disease by exposure to laser light in combination with a patchwork operation. Treatment of periodontitis includes the three-step laser irradiation of pathological lesion in therapeutic dosages and surgical treatment: the first stage is irradiated with light of a semiconductor pulsed laser type Pattern, the second stage is carried out patchwork operation in the field of pathological lesion of periodontal with tilting trapezoidal flap and deepithelization the inner surface of periodontal pockets light pulsed erbium laser type “cameo” in the third stage to stimulate regeneration of periodontal tissues in the area of operations it is irradiated with light of a semiconductor pulsed laser type Pattern (Patent RF №2101047, publ. 1998).

Disadvantages of the proposed method is that it does not allow as is well-known methods it is necessary to use different types of laser devices, that is not always possible in clinical settings. Also, do not take into account the need for targeted regenerative therapy, that is, the additional use of drugs, accelerating the regeneration of the periodontal tissues.

The problem posed by the authors, is to eliminate these drawbacks by more effective impact on the elements of periodontal tissues by activation of osteoregeneration and prevention of postoperative neuropathy branches of the trigeminal nerve, reducing treatment time and the maximum term remission.

For this purpose, the method of treating periodontal disease, comprising the three-step laser irradiation in therapeutic dosages, surgical treatment, suggested that further before laser therapy to make medicinal application, at the first stage in the pockets you need to enter the gel helical, and periodontal pockets size 4 mm and more be irradiated through the thin disposable fiber and less depth - side vestibular and oral surfaces of the alveolar ridge, within 5-7 days total time of one session 12-20 minutes. At the second stage during the patchwork operations should be applied to the mixture of the gel is step should be the application of vasoactive gel on the area of the alveolar ridge of the maxilla and mandible, in the interdental spaces and the exit point of the trigeminal nerve, the laser irradiation in therapeutic dosages to spend on these same areas, the number of procedures from 5 to 7, the total time of one session 12-20 minutes.

The proposed sequence effects on the periodontal can prevent the natural development of neuropathy branches of the trigeminal nerve due to aseptic inflammatory process and operating trauma.

The method is as follows.

In the process of eliminating aggravating the clinical picture traumatic factors (overhanging edges of fillings, artificial crowns, the edges of cavities, etc), exposure and control of oral hygiene, removal of dental plaque, the electoral presledovaniya and splinting (if necessary) teeth were applique gel helical in periodontal pockets (probing depth was 4 mm or more). When this gel was applied in each periodontal pocket alternately. Evacuation of saliva was performed using saliva ejector. Major salivary ducts were isolated with cotton rolls. Directly after application was carried out by exposure to laser radiation poluprovodnikovogo in the periodontal pocket, when the wavelength of 0.85-0.95 microns and output power of 15-20 mW in continuous mode, the exposure time for 2-3 minutes on 1 field. With a smaller depth of periodontal pockets held laser irradiation (with the above settings) from the alveolar and oral surfaces of the alveolar ridge. The number of procedures from 5-7 depending on the severity of the process and the treatment. The maximum total time of one session is 20 minutes, the minimum is 12 minutes.

At the second stage during the patchwork operation to impose mixture gels helical, pantovigar in the ratio of 1:1 in the folded flap and expose the flap with a laser while maintaining the above parameters within 3-7 minutes. Longer exposure is necessary when increasing the length of the surgical field.

After surgery on the second day after the operation was performed applique gel "Pantophagy" or other vasoactive gel on the vestibular and oral surfaces of the alveolar bone of the upper and lower jaw, in the interdental spaces and the exit point of the trigeminal nerve, the number of procedures from 5 to 7, the total time of one session 12-20 minutes on three columns as below.

Example 1

Patient W., 41, diagnosed with chronic generalized periodontitis of moderate severity. The patient complained of bleeding gums, bad breath, pain in different parts of the gums, mobility, increased tooth sensitivity when exposed to cold or acidic products. When probing was determined periodontal pockets 4-5 mm Teeth had mobility II and III. Radiograph revealed melkopyatnistoy structure of bone tissue with areas of osteoporosis, installed destruction of interdental septa reaching 1/2 of the length of the root, which was accompanied by a characteristic disturbances of microcirculation in p is of boosting tonic voltage, peripheral resistance, reducing the elasticity of blood vessels and poor blood flow in comparison with indicators of intact periodontium.

After application of the gel Helical in periodontal pockets incisors of the upper and lower jaw (8 fields) through a disposable flexible fiber was carried out by exposure to laser radiation semiconductor laser apparatus "Scalar" CJSC "Penetron") in the infrared range (wavelength of 0.85-0.95 microns) output power of 15-20 mW in continuous mode with exposure time by 1 minute on 1 field. The rest of the teeth was performed laser irradiation (with the above settings) from the alveolar and oral surfaces of the alveolar ridge. Just 5 daily treatments. The maximum total time of one session is 20 minutes.

During bone resective and regenerative operation in the area of the anterior teeth of the upper and lower jaw was introduced gels "Helical and Pantovigar in the ratio 1:1 in the folded flap with laser irradiation in the standard parameters for 5 minutes on the field.

On the following day was appointed photophoresis of pantomicina, originally conducted applique vasoactive gel, pantovigar on the vestibular surface alveopalatal laser fields specified application with the same parameters of laser irradiation. The number of procedures 5 daily, the total time of one session is 20 minutes.

In the early postoperative period showed increased hypersensitive necks of teeth, the natural development of neuropathy branches of the trigeminal nerve due to aseptic inflammatory process and operating trauma that clearly revealed by the increase of blink reflex conducted on the apparatus of Necropolis and increasing digital values discriminatory sensitivity during innervation of the branches of the trigeminal nerve at 65-75% from baseline.

After a course of treatment, the patient noted the disappearance of discomfort in the gums, reducing hypersensitive necks of teeth, leveling painful reaction and numbness in the area of surgical intervention and smell from a mouth, the almost complete disappearance of bleeding. The size of periodontal pockets was reduced to 1-2 mm Revealed a decrease in the degree of pathological tooth mobility. Postoperative period was without pain, the healing occurred on day 5. There is a tendency to normalization of the indicators blink reflex and discriminatory sensitivity and indicators rheography the subject from 3 to 6 months).

At follow-up at 6 and 12 months had no symptoms of inflammation on the background normalization of the local hemodynamics and innervation.

Example 2

Patient L., 46 years old, diagnosis: chronic generalized periodontitis severe. The accompanying background pathology - urolithiasis in remission, arterial hypertension II Art.

The patient complained of pain in the gums, difficulty chewing, bad breath, pronounced gingival hemorrhage spontaneous nature, tooth mobility. Marked by a loose fit of the gingival margin to the necks of the teeth, abnormal tooth mobility II and III, as well as over - and subgingival soft and hard dental deposits. When probing was determined periodontal pockets greater than 5 mm, especially in the area of the molars of the lower jaw. Intubation was painful and accompanied by bleeding 3-4 degree and presence of purulent exudate. The radiological examination was determined by the destruction of bone III degree - resorption exceeded 1/2 of the length of the tooth root in places was determined bone pockets. According to reproduktory and morphological studies of gingival biopsies - Yar the buffer of net stasis, reducing the volume of blood flow in the tissues of the periodontium.

In periodontal pockets molars of the lower jaw were injected gel Helical” (6 fields) and through thin disposable light guide irradiation was performed in the infrared range (wavelength of 0.85-0.95 microns) and output power of 15-20 mW in continuous mode, the exposure time of 3 minutes on 1 field. In parallel, after application of the gel Helical” in front of the group and of the maxilla was performed laser irradiation from the side of the alveolar and oral surfaces of the alveolar ridge. The number of procedures 7 by the day. The maximum total time of one session is 20 minutes.

During bone resective and regenerative operation in the area of the molars of the lower jaw to the right and flap surgeries in the frontal group of teeth of the lower jaw inflicted gels “Helical and Pantovigar in the ratio 1:1 in the folded flap and was affected by the laser in the standard parameters for 5 minutes on the field.

On the following day was appointed photophoresis of pantomicina, originally conducted applique vasoactive gel, pantovigar on the vestibular surface of the alveolar process of the maxilla and mandible, interdental ex is x laser exposure. The number of procedures 7 daily total time of one session of 20 minutes

After the course of treatment up to 6 months was observed to mitigate the symptoms of inflammation and manifestations of neuropathy of the trigeminal nerve. Clinical improvement noted in the background of the normalization of the local circulation by reducing vascular spasm, resulting in normalization of tone, peripheral resistance and elasticity of blood vessels on the background of an improvement in the blood.

A similar technique is treated 57 patients with chronic generalized periodontitis, of which 26 patients with an average severity of periodontitis and 31 patients with severe degree of severity of the disease.

The positive effect up to 12 months was observed in 94.7% of patients with an average severity of periodontitis and 89.8% of the patients with severe degree of severity of the process.

The proposed method through the use of combined exposure to radiation of a semiconductor laser and actions of the gel Helical and Pantophagy", and summing their actions can significantly accelerate the timing of treatment of disease and to increase the period of remission. In addition, this technique p is s, that, in turn, leads to positive economic effect.

A method of treating periodontal disease, comprising the three-step laser irradiation in therapeutic dosages, surgical treatment, characterized in that it further before you perform laser therapy medicinal application, at the first stage of periodontal pockets injected gel helical, with pockets size 4 mm or more is irradiated through the thin disposable fiber and less depth - side vestibular and oral surfaces of the alveolar ridge within 5-7 days, the total time of one session 12-20 min, in the second stage during the patchwork operations applied on the folded flap mixture gels of helical and pantomicina in the ratio of 1:1 and irradiated flap laser for 3-7 min, the third phase will cover the application of vasoactive gel on the area of the alveolar ridge of the maxilla and mandible, in the interdental spaces and the exit point of the trigeminal nerve, the laser irradiation in the same region, the number of procedures from 5 to 7, the total time of one session 12-20 minutes



 

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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.

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EFFECT: enhanced effectiveness of treatment.

4 cl

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1 ex

FIELD: medicine.

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2 ex, 1 dwg

FIELD: medicine.

SUBSTANCE: method involves administering laser radiation therapy once a day using low intensity pulsating radiation of wavelength equal to 890nmand power density of 0.03 mW/cm2. Injured organ projection to frontal abdominal wall is exposed to radiation at the first laser therapy stage in two fields acting upon each field for 2 min with radiation pulse succession frequency equal to 80 Hz in applying stable contact-type method. Total treatment dose on two fields is equal to 0.008 J/cm2. The second laser therapy stage begins immediately after having finished the first one in applying radiation along the large intestine path using labile contact-type method in a way that radiation pulse succession frequency equal to 80 Hz is applied first during 1 min and then frequencies of 600, 150 and 300 Hz are applied also during 1 min, respectively. Total treatment dose is equal to 0.032 J/cm2 at the second stage. Total treatment dose is equal to 0.04 J/cm2 at both stages.

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