Method of treating chronic generalised parodontitis

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to stomatology, and can be used for treatment of chronic generalised periodontitis. For this purpose cryotherapy is applied on ulnar artery nerve plexus, by exposing ulnar artery in lower part of foream and placing cryoapplicator on it. Application duration is 10 s at temperature -186°C. After that detralex is administered in dose 1 tablet 2 times a day for 2 weeks, then for two weeks: grandaxin 1 tablet in the morning, spasgan 1 tablet in the afternoon and atarax 1/2 tablet before going to bed.

EFFECT: increase of treatment efficiency; increase of disease remission terms due to improvement of peripheral blood circulation at the background of compensation of patient's vegetative profile.

1 ex


The invention relates to dentistry and can be used for the treatment of patients with chronic generalized periodontitis.

Traditional approaches to the treatment of this disease consist in the use of local applications of drugs or surgical methods to reduce the severity of the pathological process (Beck JD, Slade G, Ofrenbacher S. Oral disease, cardiovascular disease and systemic inflammation. Calls 2000; 23:110-120) /1/. This local approach with a large number of unsatisfactory results and the progression of the disease in 52-76% of patients.

Meanwhile, at the present time it is established that chronic periodontitis is a multifactorial disease, in its development in humans have not identified any simple, direct connection "pathogenic factor - disease", which complicates the search for optimal methods of treatment. As one of the factors in the development of periodontitis consider the result of a complex interaction of infectious agents (bacteria) and the immune system of the host, which is often regulated by environmental factors and behavioral characteristics. It is proved, in particular, that on the progression of periodontitis affected by demographic, environmental and biological factors.

Advanced age and the presence of gingivitis are established risk factors is the development of periodontitis. In addition, severe periodontitis significantly associated with risk factors such as male gender, presence of dental calculus, low level of education and oral hygiene and the presence of diabetes.

In the light of recent research a key role in the development of periodontitis divert the immune reactivity of the host, namely such violations in the immune inflammatory response, leading to the destruction of periodontal tissues. Genetic factors probably play a role in the development and progression of periodontitis. It is shown that many of genetically determined disorders of leukocyte adhesion and changes in the Fc-fragment specific leukocytes, as well as metabolic changes leading to impaired bone formation, contribute to the development and rapid progression of periodontitis. According to Japanese researchers, genetic polymorphism of inflammatory mediators and structural proteins of the connective tissue of the periodontium determines the speed and character of the course of pathological processes in periodontitis.

Russian researchers have shown that in the development of generalized periodontitis and related diseases of internal organs play a pathogenetic role violations of peroxide oxidation of lipids, proteins and low molecular weight thiols, and immunologica the cue imbalance and shortage of basic macro - and micronutrients (CA, Mg, K, Na, Zn, Cu, Fe).

Found a significant Association between chronic periodontitis and systemic disease such as atherosclerosis, ischemic heart disease and chronic lung disease. It is also shown that the presence of periodontitis in the past 10 years significantly increases the risk of developing disorders of glucose tolerance with subsequent increased risk of diabetes mellitus type II.

Thus, at the present time practically no doubt that the development and progression of chronic periodontitis play a role as a system component, and the presence of periodontal disease as a chronic inflammation was noted with the system response is a risk factor for other diseases, the pathogenesis of which a systemic inflammatory response plays an adverse role.

There is a method of treatment of chronic generalized periodontitis mild and moderate severity (Patent RU 2248785, publ g) /2/. The known method includes EHF-therapy, which consists of electromagnetic radiation of extremely high frequency on periodontal tissues and biologically active points (BAP) for 20 minutes at 6-7 sessions daily in the treatment of diseases of slight severity and 7-9 sessions in the treatment of periodontitis of moderate severity. This EHF-therapy on the background of medical therap and, involving drugs "Biovita calcium and Complivit" standard schemas.

The result achieved in a known manner, consists in relieving the symptoms of inflammation and normalization of local circulation in the periodontal tissues through physical therapy effects on inflamed periodontal tissues against medical and reflex effects on the body. This approach to treatment can also be attributed to local, it affects the result and not the cause of the disease, and therefore cannot give long-term effect.

The authors have not revealed information about the medical treatment of periodontal disease, taking into account the influence of the system component in the development and progression of this disease.

The present invention is directed to establish such a method of treatment of chronic generalized periodontitis, which would help to compensate for the more complex factors that lead to inflammation and poor circulation in the tissues.

The invention is based on accumulated during the last decade of data that the sympathetic part of the ANS innervates all lymphoid organs, and that the catecholamines are the main mediators of the sympathetic ANS is able to influence some parameters of immunity. It is shown that, firstly, all of the Central and peripheral organs of the immune system have R is switow network noradrenergic nerve endings, and, secondly, all immune cells have receptors for norepinephrine as circulating and secreted locally from asinapticheskikh branches of nerve fibers. Thus, the sympathetic nervous system provides a direct and explicit link between the brain and the immune system.

Currently, it is revealed that the catecholamines, as well as corticosteroids, in certain concentrations and under certain conditions can provide not only immune, but a variety of (often mixed) immunomodulatory effect. Study characteristics influence neuroendocrine influences on the immune response allows a clearer picture of the pathogenesis of many pathological conditions, such as infectious diseases, autoimmune and inflammatory reactions, allergic and neoplastic diseases.

The authors of the present invention require the presence of such interactions in the pathogenesis of periodontitis. In the periodontal tissues may occur functional voltage exceeding physiological, which to a certain extent be compensated by appropriate tissue and vascular reactions of periodontal (compensated functional overload). During its progression opportunities vascular system that supports the appropriate level of metabolism in the tissue is s, exhausted and decompensation occurs.

A leading role in the mechanism of development of dystrophic changes of the periodontium in traumatic occlusion is attached to circulatory disorders. Such changes occur when expressed hesitation functional load. Changes in vascular aging and various diseases also lead to the violation of cushioning and trophic function of the periodontium. In addition, there is excessive stretching of the fibers of the periodontal disease, and congestive changes in the microcirculation system, accompanied by acidosis.

The claimed invention is to eliminate changes in the balance of sympathetic and parasympathetic parts of the autonomic nervous system. Restored balance will cause the autonomic nervous system will be able to determine the nature of the microcirculation, including the seat of chronic inflammation, and modulate immune response. This explanation now seems very likely, since practice has shown that the effects on the autonomic nervous system has a positive effect on the course of periodontitis.

The invention consists in the application of cryotherapy on the nerve plexus ulnar artery duration appliques 10 seconds, the number of cycles 2, at a temperature of -186°C and the subsequent drug is ecene two courses. The first course produced after cryotherapy for two weeks drugs "Detralex" 1 tablet 2 times a day and Nikoshpan 1 tablet 3 times a day. The second course is produced within two weeks drugs "Grandaxin" 1 tablet in the morning, "Sashan" 1 tablet in the afternoon and "Atarax" 1/2 pill at night. The first course of treatment drugs can improve venous blood flow and improve blood flow, the second is to accelerate the payment of the autonomic profile of the nervous system.

In this case, the cryogenic nervous plexus ulnar artery carry out compensation of the autonomic profile of the patient, and using certain way chosen complex drug therapy, carried out within 2 weeks, accelerate treatment time, getting earlier and lasting results.

Thus, a new technical result achieved by the claimed invention is an accelerated improvement of peripheral blood flow on the background of the compensation vegetative patient profile that allows you to achieve better results of treatment of patients with chronic generalized periodontitis, to extend periods of remission, favorably influence the course of comorbidities. In addition, compared with the method /2/ claimed method is more comfortable for the patient is well, since the duration of cryotherapy for 10 seconds in two cycles at one time differs significantly from 20 minutes for 6-9 cycles. Medication takes half the time than in the known method /2/. Equipment for carrying out the treatment is easier and cheaper than devices for EHF-therapy.


Patient Dmitriev, 40 years, complaints about the presence of bleeding gums, sore mouth, loss of teeth within 2 years, the inefficiency of conservative treatment medical therapy. When examination revealed signs of generalized periodontitis.

The condition is satisfactory HELL 130/90, P 80 beats per minute, diseases of the cardiovascular system, internal organs not. If rheoencephalography signs subcompensation peripheral blood flow EN=2,7-3,2, KA=2.5 and α=71-73°. Preparation for surgery traditional. Under local anesthesia Sol. lidocaini 2%-2.0 dissect the skin projection of the ulnar artery in the lower third of the forearm for 1 cm, then install miniature allow that using videoassistance techniques in layers extend deep into the wound, making the dissection of soft tissues. Soft tissue gradually divert the retractor of they, exposing the ulnar artery. The tip of cryoapplicator a diameter of 2 mm are installed on Nude artery, p is izvodyat cryogenic duration appliques 10 seconds the number of cycles 2, at a temperature of -186°C. Then cryoapplicator warm and remove from the wound, the edges of which suture.

After cryotherapy provide medical treatment of a patient with two courses. The first course in the two weeks drugs "Detralex" 1 tablet 2 times a day and Nikoshpan 1 tablet 3 times a day. The second course in the two weeks drugs "Grandaxin" 1 tablet in the morning, "Sashan" 1 tablet in the afternoon and "Atarax" 1/2 pill at night.

In the period after the intervention for cryotherapy pain relief was required during the first days, bed rest is not required, the sutures were removed on the fourteenth day. Complications of surgery were noted. At check in 1.3 months showed signs of compensation of chronic periodontitis, peripheral blood flow, autonomic profile, the patient no complaints. In this way treated 50 patients, complications were not observed.

The claimed method of treatment of patients with chronic generalized periodontitis allows to achieve better results of treatment, to prolong the period of remission of the disease, to have a beneficial effect on the course of diseases and, in particular hypertension. Especially important is that this method of treatment gives a very persistent put the preliminary results in the group of patients previously long and unsuccessfully treated with other methods.

The method of treatment of chronic generalized periodontitis, characterized in that operate at cryogenic nerve plexus ulnar artery by exposure of the ulnar artery in the lower third of the forearm and installation of cryoapplicator with length appliques 10 s at a temperature of -186°C, followed by drug treatment two courses of a duration of two weeks: first course - Detralex - 1 tablet 2 times a day, nikoshpana - 1 tablet 3 times a day; second course-grandaxin - 1 tablet in the morning, sashan - 1 tablet day atarax - 1/2 pill at night.


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1 tbl, 1 ex

FIELD: medicine.

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1 ex