Method for treating destructive forms of chronic periodontitis

FIELD: medicine.

SUBSTANCE: method involves making surgical operation with defect cavity being filled with transplant modified with allofibrobalsts. Non-modified transplant is concurrently used. The modified transplant is introduced portion-by-portion, rubbing along peripheral part and waiting for previous portion to be saturated with blood. Next to it, the non-modified transplant is placed in the cavity center. The number of implants to be used is as follows in % by volume. Modified transplant makes up 70-90%, non-modified transplant 10-30%.

EFFECT: enhanced effectiveness in filling defect cavity with transplant; enhanced therapeutic effectiveness of treatment.

1 tbl

 

The invention relates to medicine, in particular to dentistry and maxillofacial surgery, and can be used for the surgical treatment of diseases periodontitis, for example, when resection of the root apex with cystectomies, when removing a tooth, when the operation of hemisection, with amputation of the root of the tooth, and when Troubleshooting oroantral fistula.

The following common surgical methods of treatment of bone defects and gingival tissues:

- curettage;

- gingivotomy;

- gingivectomy, gingivoplasty;

patchwork operations osteoplasty;

- frenula and vestibuloplasty;

- hemisection, amputation of roots, coronaridine separation;

- combined methods.

[see Dulcorate, Lasaosa “Periodontal disease”, KAZ. SSR, Alma-ATA, ed. “Nauka”, 1978; Apetrov “Surgical treatment of periodontal disease”, M, “Medicine”, 1987; Nfrancisco and other “periodontal Disease”, M, “Medicine”, 1993; A.S. USSR №1024067, IPC And 61 In 17/00, Appl. 25.08.80, publ. 23.06.83, b “Way to replace the post-resection defects tissues”; A.S. USSR №1836939, IPC And 61 With 5/08, Appl. 25.04.89, publ. 30.08.93, b, “a Method for the treatment of apical periodontitis”].

For the regeneration of bone and gum tissue using a variety of upper materials - grafts, which can be divided into osteoinductive, osteobond is effective, osteonecrolsis and materials to ensure the targeted tissue regeneration, as well as materials, combining different properties.

The origin of these materials are divided into:

- autologous (donor is the patient);

allogeneic (donor is another person);

- xenogenic (donor is an animal);

- alloplastic:

- derived from natural minerals, corals, pulp,

- synthetic (synthetic hydroxyapatite, calcium sulfate, bioactive glass, polymeric materials). As a transplant are industrially produced drugs: “Calpol”, “Callahan”, “Ostim-100”, “Collost”, “Zangwill”, “Digesta”, “Oblaka” [see p. the Russian Federation No. 2061402, IPC And 61 In 1/317, Appl. 26.11.91, publ. 10.06.96, b “Method of regeneration of bone tissue in the experiment; p. the Russian Federation No. 2157115, IPC And 61 In the 17/24, Appl. 13.10.98, publ. 10.10.2000, “a Method for the treatment of patients with bone defects of the upper and lower jaws; Vshivkov “periodontal Disease), Medical information Agency, 2001, s-291; Navkratia, Trakhterov “periodontal Disease), Medical book, N.Novgorod, edition NGNM, 2000, p.101-111].

The disadvantages of the known methods are:

- sufficient complexity and invasiveness;

- shortness of biological compatibility and the danger of the of novoobrazovanii;

- low osteoinductive potential, etc.

Known closest to the technical essence and the achieved result of the claimed invention is a method of surgical treatment of inflammatory periodontal disease by surgery (exfoliation of the mucoperiosteal flap, its one dipicolinate, removal of granulation and subgingival deposits, antiseptic wound surfaces) with cavity filling defect modified allofibroblasts (cells LEC-4(81) a strain of diploid lung cells of a human embryo) transplant (osteoplastic material containing collagen and hydroxyapatite). Moreover, the cavity defect is completely filled by the modified graft.

The use of these osteoplastic materials (industrial name “Hapka” or “Callahan”) due to the subsequent inclusion of xenogenic collagen in bone matrix constructed and participation of hydroxyapatite in the mineral metabolism of the body by activating the mechanism of regeneration of the damaged bone tissue. Alleyball are optimizers wound healing, stimulating protein synthesis and proliferation of all types of cellular elements involved in the healing process.

[see p. the Russian Federation No. 2204332, IPC And 61 In 17/00, And 61 To 35/48, C 12 N 7/00, Appl. 7.12.2001,, publ. 20.05.2003,].

The disadvantage of the prototype is the traditional technology of filling the cavity of the defect with a graft, resulting in:

- waste of expensive materials;

- complications and undesirable tissue reactions, including the formation of new due to turbulent flow of the regeneration process.

The present invention is the improvement of technology optimization of the consumption of expensive materials to ensure high therapeutic efficacy.

The problem is solved in that in the known method of surgical treatment of inflammatory periodontal diseases for the treatment of destructive forms of chronic periodontitis by surgery with cavity filling defect modified allofibroblasts transplant, according to the invention optionally use the unmodified graft, and modified contribute portions, grinding on the periphery and waiting for impregnation by the blood of the preceding batch, and then in the center cavity of the defect stack unmodified graft; the number of grafts used the following,%:

Modified graft 70-90%

Unmodified graft 10-30%

The method of treatment of destructive forms of chronic periodontitis is that in the present conditions, with improved technology fill the cavity defect transplant provides the formation of new bone structures, the disappearance or drastic reduction of osteoporosis, increase the clarity of the contours of the bone, the improvement of the mucous membrane of the alveolar process, its dense adhesions with tooth tissues, decrease or decrease in the mobility of the teeth, reducing the healing time of the wound surface, the suppression of inflammatory reactions due to the proliferation of all types of cellular elements, which leads to high therapeutic efficacy. In addition, the number of input graft-modified allofibroblasts, is necessary and sufficient to optimize the consumption of expensive materials.

Analysis of the known technical solutions allows to make a conclusion that the claimed invention is not known from the prior investigational technique that demonstrates its compliance with the criterion of “novelty”.

The essence of the invention for professionals not obvious from the prior art, which allows to make a conclusion about its compliance with the criterion of “inventive step”.

The ability of the method of treatment of destructive forms of chronic periodontitis in an outpatient dental clinic with the use of industrially produced domestic pharmaceuticals demonstrates compliance invention, the criterion of “industrial applicability”.

Claimed is a method of treating passed clinical trials in different dental clinics, Yekaterinburg.

For the implementation of the proposed method used the transplant Callahan-modified allofibroblasts representing diploid cell culture of human rights. This medication comes in Yekaterinburg research Institute of viral infections MZ the Russian Federation (certificate No. 001538, 02-73024) and approved for medical applications (registration certificate R No. 0011402/01-2002 23.05.2002,).

Example 1. Treatment of destructive forms of chronic periodontitis with amputation of the tooth root.

Under local anesthesia was performed by implementing a vertical section along the longitudinal axis of the tooth root from the transition folds to the gingival margin. Mucoperiosteal flaps throw right and left, using boron was produced by removing the outer cortical plate over anotherwoman root, and then his amputation. The depth of the resulting cavity was 1.3 mm, the cavity of the defect was filled by the modified allofibroblasts transplant, which was introduced in portions grinding on the periphery and waiting for impregnation with the blood of the previous portion, and then, in the center of the cavity defect laid unmodified graft. In this case, the number of grafts used was about.%: modified - 90; modified - 10.

Then wound tightly which was stirred with interrupted sutures.

Stitches were removed on the fifth day and watched the status of the patient within six months using traditional methods.

Example 2. Treatment of destructive forms of chronic periodontitis during the tooth removal.

Under local anesthesia was performed sparing surgery tooth extraction, while maintaining inner and outer cortical plate, producing excretion axis of the tooth. Remove sharp edges and interdental septum. Produced mobilization mucoperiosteal flaps buccal and lingual. The depth of the resulting cavities (holes) amounted to 5.5 mm, the cavity of the defect was filled by the modified allofibroblasts transplant, which was introduced in portions grinding on the periphery and waiting for impregnation with the blood of the previous portion, and then, in the center of the cavity defect laid unmodified graft. The number of grafts used was about.%: modified - 80; unmodified - 20.

Then the hole edges tightly sutured interrupted sutures.

The stitches were removed and observed the status of the patient as described in example 1.

Example 3. Treatment of destructive forms of chronic periodontitis with resection of the root apex of a tooth with cystectomy.

Under local anesthesia was performed patchwork operation by dissection of interdental papillae distal and medial is but operated tooth, complementing the vertical slits to transition folds. Stupidly, with the help of raspatory spent peeling mucoperiosteal flap, providing hemostasis. In the area of projection of the apex of the operated tooth using a dental drill was conducted perforation of the outer cortical plate, penetrating into the cavity of the cyst. Remove the outer leaf sheath cysts produced the root apex resection within the edges of the cavity of the cyst has been scraped side and rear part of the cystic membrane, producing a hemostatic and antiseptic treatment cavity with simultaneous smoothing sharp edges mechanically. The depth of the formed cavity was 8.7 mm Cavity defect was filled by the modified allofibroblasts transplant, which was introduced in portions grinding on the periphery and waiting for impregnation by the blood of the preceding batch, and then in the center cavity of the defect laid unmodified graft. Returned to the place of the flap sutured interrupted sutures using non-absorbable material. In place of the projection of the apex from the skin applied a pressure bandage.

The stitches were removed and observed the status of the patient as described in example 1.

At the same time carried out the surgical treatment of inflammatory diseases of the periodontium during tooth extraction know who Tim way taken as a prototype, and the defect depth was 8.5 mm

[see p. the Russian Federation No. 2204332, IPC And 61 In 17/00, And 61 To 35/48, C 12 N 7/00, Appl. 07.12.2001,, publ. 20.05.2003,].

Conditions of the proposed and known treatment methods and the results of observation status patients are shown in table.

As seen from the above examples and data tables, the use of the proposed method for the treatment of destructive forms of chronic periodontitis in comparison with the known method, taken as a prototype [see p. the Russian Federation No. 2204332, IPC And 61 In 17/00, And 61 To 35/48, C 12 N 7/00, Appl. 07.12.2001,, publ. 20.05.2003,], provides the following technical and community benefits:

- improvement of the technology of filling the cavity of the defect graft;

- high therapeutic efficiency (the formation of new bone structures, the disappearance of osteoporosis, increase the clarity of the contours of the bone, the improvement of the mucous membrane of the alveolar process, its dense adhesions with tissue of the tooth, the reduced mobility of the teeth, reducing the healing time of the wound surface, the suppression of inflammatory reactions);

- optimization of the consumption of expensive materials (graft-modified allofibroblasts).

The method of treatment destructiveness is s forms of chronic periodontitis by surgery with cavity filling defect modified allofibroblasts transplant, characterized in that additionally use non-modified graft, and modified contribute portions, grinding on the periphery and waiting for impregnation by the blood of the preceding batch, and then in the center cavity of the defect stack unmodified graft; the number of grafts used the following%: modified graft 70-90, unmodified graft - 10-30.



 

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