Diagnostic technique for generalised periodontitis

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to dentistry. Diagnosis of generalised periodontitis is enabled by examining crevicular fluids by V-dehydration technique. The presence of three exactly localised facies regions makes it possible to state normal condition of periodontium tissues. The presence of arched cracks in an edge region provides diagnosing slight generalised periodontitis. The presence of arched cracks in the edge region and a band of the lower wave edge region, the absence of an intermediate region and a typical crystalline structure in the central region provides diagnosing a moderate degree. If observing a tendency to fusion of all facies regions and the presence of beam-like cracks in the edge region enables diagnosing severe generalised periodontitis.

EFFECT: technique enables diagnosing generalised periodontitis and determining its severity.

5 dwg


The invention relates to medicine, in particular to dentistry. Can be used to diagnose and assess the severity of generalized periodontitis.

The problem of periodontal disease is one of the major in modern dentistry and General medicine. Among periodontal disease is most common and it is generalized periodontitis. According to epidemiological studies of this disease affects about 80% of the population, it is the main cause of tooth loss. Because of this prevalence of pathology, great importance is the improvement of diagnostic methods.

- Currently one of the main methods to identify generalized periodontitis and to determine the degree of its severity, is an x-ray. (Loosejaw. Periodontal disease. 2004). It allows you to assess the condition of the bone tissue of the alveolar process. With panoramic radiographic study of periodontitis defined focus osteosclerosis, vertical type of destruction, the destruction of compact bone plate. In light of the severity of generalized periodontitis is defined by a lower altitude millionary partitions up to 1/3 the length of the tooth root, with an average severity - from 1/3 to 1/2 the length of the root, with heavy - more than 1/2.

The lack of orthopantomography is that it is not always possible to obtain a clear picture of the structure of the bone tissue. The patient is subjected to radial load. This study is quite expensive, the necessary equipment is not available in each clinic. Visual analysis of radiographs, as a rule, allows to only give a subjective assessment of pathological changes in the bone tissue of the jaw. The definition of severity is complicated by the fact that the pathological process may be expressed differently in different parts of the dental arch.

The use of gingival fluid for the diagnosis of periodontal disease was first justified N.Brill and co-author. (Vshivkov. Periodontal disease. 1998). The authors proposed to use to get the gingival fluid (with intact periodontium) or content periodontal pocket standard filter paper strips. After receiving the gingival fluid filter paper strips were stained with 0.2% alcoholic solution of ninhydrin. Gambari et al. used the index gingival fluid (Tlegenova and other Diagnostics in dentistry. 2006). In addition, the authors propose a method of weighing a standard filter paper strips before and after receiving the gingival fluid on a torsion balance. To calculate the index of the selected indicators of the amount of the gum the second liquid divided by the number investigated pockets. The index value was judged on the condition of periodontal tissues (normal, chronic catarrhal gingivitis, periodontitis).

This technique requires the subsequent use of special reagents and time, as the ninhydrin stain the strip only after some time (sometimes after 1.5-2 hours depending on the temperature of the air in the room. The increase in the number of gingival fluid is most pronounced when the initial pathological changes in the periodontium. In patients with severe periodontitis increasing emphasis on the study of the qualitative composition of the gingival fluid. The methodology does not allow to assess the severity of generalized periodontitis.

- In the ways in which the study was conducted morphological composition of the gingival fluid, the increase in the absolute number of leukocytes was determined by the presence of inflammation in the periodontal tissues (Ashalata, Nigella. Theory and practice of dentistry, 1980). Inflammation and increasing the number of slomannyh epithelial cells in the gingival fluid (Tlegenova and other Diagnostics in dentistry, 2006).

When reading the contents of periodontal pockets increase the number of motile rods indicates a lesion of periodontal tissues and is directly proportional to the increase in gingival index and pocket depth (A. Grudanov, Geschreven, Lioresal. MRF, Section XII, No. 4, 1986). A more detailed study of the microflora of periodontal pockets by PCR detection of "marker" of microorganisms indicates periodontitis. Some of periodontopathogenic associated with most hard place and difficult to treat forms of periodontitis (EverEve. Rapidly progressing periodontitis, 2004). With increasing severity of periodontitis increases the frequency of detection of these microogranisms and the combination of a larger number of representatives at the same time (Aigrumae, You. Dentistry, No. 3, 2009).

In studies on the biochemical composition of the gingival fluid is established that the increase of lactate dehydrogenase activity indicates the presence of inflammation (Thielska, Enimerosi, Lahaina. Dentistry, No. 2, 1983). Activity of β-glucuronidase you can judge the severity of inflammation. In addition, there is a positive correlation between its activity, the depth of the pocket and the degree of destruction of bone tissue, therefore, and severity of periodontitis (Gambari, VII, Ashalata. Dentistry, No. 4, 1986). The degree of inflammation in the periodontal tissues can be judged by the increased activity of acid and alkaline phosphatase gingival fluid. Its activity correlates with the depth of periodontal pockets (IshikawaJ., Cimasoni G. Arch. Oral Biol., 1970). The degree of inflammation in the periodontal tissues can be judged by the concentration of endotoxins (lipopolysaccharides) of microorganisms (Gambari, VII, Ashalata. Dentistry, No. 4, 1986).

All these methods of diagnostics on the composition of the gingival fluid is often difficult to implement, require expensive equipment and specially trained personnel. To get results sometimes requires a significant amount of time, and the result is tentative. For example, direct microscopic examination gives only approximate, rough results, and the cultivation of periodontopathogenic is complicated by their high sensitivity to oxygen and the duration of the study. All these methods allow to describe only one indicator of gingival fluid when it is impossible to assess the overall condition of periodontal tissues. Often there is no opportunity to assess the severity of periodontitis.

- The closest is a method of diagnosing pathologies of the oral cavity by crystallographic picture of oral fluid obtained by the method of the wedge dehydration. The essence of the method consists in drying drops of the oral fluid analysis and morphological patterns obtained facies using microscopic examination. If the process were obtained facies oral liquid is ti and the regularities of their morphological patterns in persons with "natural hygiene", sanitized and pathology of the oral cavity (Snezana Diagnostic and prognostic criteria of dental pathology on morphological picture of oral fluid in patients of different age groups: author. dis ... Prof. the honey. Sciences). In facies oral fluid of patients with healthy periodontium observed a clear system structureborne divided into two zones: the regional amorphous and Central crystal. The systematic organization of oral fluid of patients with pathology of the oral cavity in all cases there were clear differences from facies oral fluid of individuals with a healthy periodontium. Facies fully had the appearance of chaotic substance or chaotic substance occupying most part of it.

The disadvantage of this method is that, allowing to determine the presence of pathology of the oral cavity, the method does not allow differential diagnosis of caries, gingivitis, periodontitis and diseases of the mucous membranes of the oral cavity. It is not possible to determine the severity of the pathological process. Substances that have important diagnostic value in the pathology of the periodontium, oral fluid contained in a large dilution, therefore, negligible amount.

We were the first accurate and informative method for the diagnosis of generalized periodontitis by Chris holographically the film gingival fluid. This method allows to diagnose generalized periodontitis and to determine the degree of its severity. The research material is selected gingival fluid, because it has exceptional diagnostic value. She washes directly periodontal tissues and can most accurately describe their condition.

The method consists in the following.

For fences of the gingival fluid used paper pins No. 30. The pin is placed in the gingival sulcus or periodontal pocket. Gingival fluid at a healthy periodontium collect in the area of the teeth 16, 11, 26, 31 - vestibular surfaces 36, 46 - lingual surface. Chronic generalized periodontitis gingival fluid take in the parts of the dental arch with the most severe pathological changes. After sampling the pin is placed in 40 μl of solvent. As the solvent used distilled water. The volume of solvent was found experimentally, the criterion of selection was the most distinct crystallographic picture facies of the gingival fluid. The material is then centrifuged at 3000 rpm for 10 minutes. On a thin glass slide semi-automatic dispenser is applied supernatant (six drops of each sample) in an amount of 5 μl. The glass is placed in a thermostat at 30 min at 37°C. a total of n the whole study takes about 45 minutes. At the completion of the dehydration receive facies of the gingival fluid, which is subjected to microscopic examination.

When carrying out the work were examined 34 patients, individuals with a healthy periodontium, and diagnosed with chronic generalized periodontitis of varying severity exacerbation. Clinical examination of patients in addition to medical history and examination included determination of the depth of periodontal pockets, the degree of mobility of the teeth, x-ray (orthopantomogram). Assessment of dental status was made on periodontal indices (index of oral hygiene Green J.C.Vermillion J., index ACA, periodontal index, Russel). Material was collected after 3-5 hours after brushing, provided that the individual did not consume food in a specified period of time.

In subjects with clinically healthy periodontal tissues value periodontal indices were within normal limits (hygiene index Wiig - 0-0,6; PMA - up to 30%; PI 0-0,2). Us was first obtained crystallographic picture of the gingival fluid in the norm (figure 1). This clearly defines three characteristic zones facies. The regional area during dehydration of the gingival fluid in normal looks like an amorphous area that does not contain any inclusions (1). The regional area is homogeneous, in the bottom part throughout environment the particular facies has a uniform darker strip (2). The staging area is well expressed (3). OK can distinguish the following morphological feature of the intermediate zone is the presence of two distinct zones. The first zone (closer to the edge) is relatively narrow and presents small crystal formations in the form of a cross (4). The second zone is wider (5), presents a larger right crystals having the form of a fern or crosses (which is less common). These skeletal structures represent the main form of crystals facies of the gingival fluid. The largest area of the Central zone consists of many small crystalline structures having a grid view (6).

Chronic generalized periodontitis showed characteristic clinical picture: pathological tooth mobility, the presence of periodontal pockets, higher values of the indices of hygiene and periodontal indices. On the x-ray destruction of the cortical plate, the centers of osteoporosis, decreased height millionary partitions. All research results were consistent with the severity of generalized periodontitis. When mild severity (figure 2) in crystallographic picture of the gingival fluid are determined by all three zones facies: regional (1), intermediate (3) and Central (6). In the marginal zone are arcuate fractures (7). When media is her severity (figure 3) in the marginal zone (1) throughout the duration determined by the arcuate elements (7). Band (2) in the lower part of the marginal zone is rugged, has the form of waves. The intermediate zone is not defined. In the Central zone there is no typical crystal structure.

The more severe the degree of the pathological process (figure 4) is characterized by the provision of the morphological picture of the destroyed almost completely. There is a tendency to merge all zones facies. In the marginal zone is characterized by the presence of cracks, which have the form of rays (8).

Clinical example. Patient, 45 years old, came with complaints of intermittent bleeding gums, sore gums, bad breath, and tooth mobility. Sick the last 6 years. During the inspection revealed that the presence of dental plaque: soft plaque, above - and subgingival calculus. The mucous membrane of the gums cyanation.

Pathological tooth mobility I-II degree. In the area of the teeth 31, 32, 34, 35, 41 and 42 are determined by the depth of periodontal pockets of 4-5 mm and traumatic occlusion. The hygiene index Wiig - 1,66; PMA - 47%, PI - 3,31.

On the orthopantomogram is determined by the destruction of the cortical plates of interdental septa, vertical type and the destruction of bone, decreased height millionary partitions up to 1/3, in the area of the teeth 31, 32, 34, 35, 41 and 42 to 1/2 the length of the roots of teeth, enlargement of the periodontal gap in the cervical area of the teeth 34, 35.

In the study of morphological pattern disnev the second fluid (figure 5) clearly defined regional area facies (1), which contains the arcuate fractures (7). Dark band (2) marginal zone is uneven, has the form of waves. Typical norms crystal picture intermediate and Central zones is missing.

In this example, the crystallographic picture of the gingival fluid is fully consistent with the clinical picture of moderate severity of periodontitis.

The crystallographic study of the painting of the gingival fluid can be more accurately describe the condition of periodontal tissues, allows you to catch the slightest changes. Pathological processes in the periodontium even at the initial stages of development there are always changes in physico-chemical properties of the gingival fluid. These primary changes primarily occur at the molecular level. The information contained in the gingival fluid at the molecular level, when dehydration is reflected in the different crystal structures. Therefore, this method is extremely sensitive and informative. The method is simple, it does not require expensive equipment and specially trained personnel. In addition, this method allows to install and severity of generalized periodontitis. Crystallographic picture facies of the gingival fluid can give complete information about the General condition of periodontal tissues. Therefore, the investigation of crystal structures on Savoy fluid is of great theoretical and practical importance for Periodontology.

Method for the diagnosis of generalized periodontitis method wedge dehydration, characterized in that examine the gingival fluid and in the presence of three clearly delimited zones facies set the normal state of periodontal tissues; in the presence of the arcuate cracks in the edge zone diagnose mild generalized periodontitis; in the presence of the arcuate cracks in the edge zone and strip the lower part of the marginal zone having the form of waves, the absence of the intermediate zone and the typical crystal structure in the Central zone diagnose medium; when observing a tendency to merge all zones facies and the presence in the marginal zone of cracks, which have the form of rays, diagnosed with severe generalized periodontitis.


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2 ex

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EFFECT: higher accuracy of prediction.

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