Z. K. Shamanova

Background. A microbial nature of periodontitis requires an accurate analysis of the pathogenic potential of the periodontal pocket microflora thereby enabling correct diagnosis to be made and the most effective pharmacological agent to be selected for treating chronic periodontitis. Metronidazole demonstrates excellent results for anaerobic microorganisms in the periodontal pocket, whereas minocycline hydrochloride, moxifloxacin and amoxicillin/clavulanate are efficient for aerobic microorganisms. However, specialists find considerably relevant to analyze the correlations between specific bacterial associations in the periodontal pocket against local antibacterial therapy, as well as to track the contents of periodontal pockets long after antibacterial therapy. Therefore, a microbiological analysis of periodontal pocket contents is considered necessary in order to select and monitor the effectiveness of local antibacterial therapy.Objective. To evaluate the effectiveness of local antibacterial therapy for chronic generalized periodontitis by means of analysis of changes in the microbiological composition of periodontal pockets.Methods. The clinical trial involved 144 patients with chronic generalized periodontitis. The study included examination of patients and analysis of clinical data bases of the Department for General Practice Dentistry, Kuban State Medical University and the Dentistry Department, Stavropol State Medical University of the Ministry of Health of the Russian Federation. The trial included patients aged 30 to 60 with a diagnosis of chronic generalized periodontitis of different severity. All periodontitis patients were divided into 2 groups depending on the therapy: main and control groups. Each group had three subgroups depending on the severity of the pathologic process. The first subgroup of the control group (chronic generalized periodontitis of mild degree) consisted of 16 people (11.1%), the second subgroup (chronic generalized periodontitis of moderate degree) — 31 people (21.5%), the third subgroup (chronic generalized periodontitis of severe degree) — 7 people (4.9%). The first, second and third subgroups of the main group consisted of 28 (19.4%), 48 (33.3%) and 14 persons (9.7%) respectively. The severity of periodontitis was determined by the depth of the periodontal pocket, degree of bone resorption (according to x-ray examination), and pathologic tooth mobility. A local anti-inflammatory therapy for the patients of the control group included oral baths with propolis (15–20 drops of 10% propolis tincture diluted in 100 ml of warm water) 3 times a day for 7 days starting from the first visit. At the final stage of treatment after preliminary scaling and rootplaning, patients of the control group received antiseptic gel with 10% metronidazole and 2% chlorhexidine bigluconate to be injected into periodontal pockets with over 4 mm depth. Additionally, applications of adhesive dental films Diplene Denta L (with lincomycin) and Diplene Denta M (with metronidazole) were prescribed to be done in the home. In addition to the above-mentioned comprehensive therapy, patients of the main group received a single insufflation of minocycline hydrochloride microspheres into each periodontal pocket. The tools for the patients of the main group included plastic cannulas with minocycline hydrochloride microspheres in the form of powder in the tip of the cartridge, and a special syringe-insufflator. The technique of antibiotic insufflation into the periodontal pocket was preliminary trained on the model of jaws with the studied pathology. Statistical analysis of the results was performed using variance analysis in the Excel Microsoft Office 2016 (Microsoft, USA).Results. According to the systematic observation of the patients from the control group, periodic fluctuations in microbial population in the majority of pathologic pockets obtained a specific regularity: a decrease in the number of microorganisms on day 21 was followed by its increase in the subsequent period of observation after 30 and especially 60 days. According to the ongoing follow-up of the patients of the main group, fluctuations of microbial population in the majority of pathologic pockets obtained a certain regularity: a significant reduction in the number of microorganisms on day 21 was followed by its slight rise in the subsequent period of observation after 30 and a slight increase again in 60 days. Fluctuations in the number of microorganisms of periodontal pockets in the main group reveal their specific character: their number remained invariably lower than that of the control group throughout the observation period, while the total number of detected periodontopathogens decreased.Conclusion. The established correlations between the main indicators of microbiological status of periodontal pockets and the severity of chronic generalized periodontitis within different periods after the local therapy confirm the positive dynamics of treatment in the main group, where patients were insufflated with minocycline hydrochloride microspheres, proved by a change in the typology of microbial status of periodontal pockets and a number of periodontopathogenic microorganisms.

Relevance. The activation of lipid peroxidation in ultrastructural damage to the oral cells and tissues and maintaining periodontal inflammation plays a crucial role in periodontitis development. There is also evidence of the positive role of some calcium-phosphorus metabolism correctors on the condition of inflamed periodontal tissues. Thus, studying the impact of activation of lipid peroxidation and calcium-phosphorus metabolism correctors in chronic periodontitis treatment is of undoubted theoretical and practical interest. The study developed an experimental model of chronic periodontitis, which helped to investigate the effectiveness of therapy with teriparatide (parathormone) and ethylmethylhydroxypyridine succinate (Mexidol).Purpose. The study aimed to investigate the impact of activation of lipid peroxidation and calcium-phosphorus metabolism correctors on the periodontium condition in an experimental model of chronic periodontitis.Material and methods. An experimental study included 48 white laborator y male rats weighing 230-280 grams using the author's experimental periodontitis model. Result processing utilized a specialized complex of histological, immunohistochemical and biochemical research methods.Results. Lipid peroxides proved to play a crucial role in the development and progression of chronic periodontitis. The therapy carried out in the main group of animals is a factor initiating the acceleration of restructuring metabolic processes of periodontium cell membrane structures to activate ion transport and increase the activity of membrane-bound enzymes that block the chain reaction of oxygen molecule transgeneration from precursor cells with the formation of aldehydes, peroxides and ketones.Conclusion. The study results substantiate the need for additional prescription of antioxidants and calcium-phosphorus metabolism correctors to maintain the balance of antiradical and antiperoxide compounds.

Background. Treatment and prevention of inflammatory periodontal diseases represent a serious general medical and social problem, which remains relevant due to the significant prevalence of periodontitis among the population, as well as the associated loss of teeth and the negative impact of periodontal foci of infection on the body as a whole. Chronic generalized periodontitis is difficult to treat: it is only possible to achieve periods of remission. Therefore, it is of great theoretical and practical importance to develop further ways to improve methods for treating inflammatory-dystrophic damage of periodontal tissues in chronic generalized periodontitis.Objective. To perform an index estimation of treatment efficacy in patients with moderately severe chronic generalized periodontitis.Methods. An experimental randomized single-arm study was conducted examining 204 patients diagnosed with moderately severe chronic generalized periodontitis. Patient examination and data analysis were carried out at the Dentistry Department of the Stavropol State Medical University and the Department for General Practice Dentistry of the Kuban State Medical University in 2021–2022. The study included patients aged 35 to 65 years diagnosed with moderately severe chronic generalized periodontitis. Patients with somatic diseases in the decompensation stage were not eligible for the study. The patients were randomly divided into three groups (closed-envelope method). Group 1 was treated using conventional methods. As well as conventional therapy, Group 2 was prescribed vitamin D (Aquadetrim^® at a dose of 5000 IU once per day while monitoring vitamin D blood level). The third group of patients was prescribed conventional therapy along with the developed pharmacotherapy, which included vitamin D (Aquadetrim^® at a dose of 5000 IU once per day), vitamin A (3.44% oil solution of retinol acetate at a dose of 50 000 IU, 15 min after a morning meal), and 2-ethyl-6-methyl-3-hydroxypyridine (Mexidol^® at a dose of 125 mg twice a day). In each patient, the treatment efficacy was analyzed in adjacent oral cavity segments (split-mouth design) according to clinical pocket depth, attachment loss, and bleeding on probing. Also, the authors used the X-ray index to assess the condition of osseous structures and the simplified oral hygiene index. The specified indices were estimated prior to treatment and at one and 12 months following treatment. The statistical analysis of study results was performed using Excel Microsoft Office 2016 (Microsoft, USA).Results. The obtained data indicate that the immediate clinical outcomes (after one month) of combination therapy in patients from all three groups were approximately the same. However, the efficacy of treatment measures in the long-term period (12 months) was different, as evidenced by the dynamics of index values. Only in Group 3 patients, the full implementation of pharmacotherapeutic measures as part of the combination therapy of periodontitis ensured a stable therapeutic effect throughout the entire period of observation.Conclusion. The data obtained 12 months following treatment indicate that the additional prescription of the developed pharmacotherapy contributed to prompt inflammation relief in periodontal tissues, providing a stable treatment outcome and long-term remission.

Эффективная терапия хронического генерализованного пародонтита (ХГП) невозможна без понимания взаимосвязи элементов пародонтального комплекса тканей с микрососудистым руслом пародонта, надкостницей, альвеолярного отростка челюсти. Данные литературы об основных источниках васкуляризации кости и надкостницы при ХГП, сопровождающимся резорбцией и атрофией альвеолярной кости, достаточно противоречивы, что обосновывает актуальность исследования структурно-морфологических элементов микроциркуляторного русла пародонта, надкостницы альвеолярной кости челюсти при искусственно смоделированном на экспериментальных животных ХГП. Цель — определить структурно-морфологические элементы микроциркуляторного русла надкостницы альвеолярной кости челюсти при ХГП. В экспериментальное исследование на животных включено 50 кроликов породы серый великан, которые были распределены на 3 группы: интактная, контрольная и основная. У животных контрольной и основной групп после моделирования ХГП лечение было одинаковым, но в основной группе назначался дополнительный комплекс терапии. В контрольной группе в пародонте, в надкостнице альвеолярной части челюстной кости выявлена перестройка микрососудистого русла, характеризующаяся уменьшением количества микрокапилляров, усилением извилистости венул, появлением варикозных расширений, что свидетельствует о снижении интенсивности обменных процессов и тенденции к застою крови. В препаратах основной группы в аналогичных по площади зубоальвеолярных сегментах установлен рост числа микрокапилляров с увеличением диффузионной поверхности исследуемых сосудов, что подтверждает гипотезу о высокой адаптогенной способности микрососудистого русла к усилению оттока крови в условиях воспаления в пародонте: на 1 мм2 надкостницы в контрольной группе в среднем приходилось 72,9±2,24 капилляра, а площадь их диффузионной поверхности составляла 0,35±0,09 мм2. В основной группе поверхность капилляров для одного зубоальвеолярного сегмента составила 4,62 мм2, что достоверно сопоставимо с показателями интактной группы животных (p<0,05), составляя 66,8% диффузионной поверхности всех исследуемых сосудов, при этом на 1 мм2 надкостницы в основной группе в среднем приходилось 88,6±4,08 капилляра, а площадь их диффузионной поверхности составляла 0,86±0,11 мм2. Полученные данные о морфофункциональных изменениях микроциркуляторного русла надкостницы могут быть использованы для оценки эффективности проводимой терапии при лечении ХГП. Effective therapy of chronic generalized periodontitis is impossible without understanding the relationship of the elements of the periodontal tissue complex with the microvascular bed of the periodontal, periosteum, alveolar bone of the jaw. The literature data on the main sources of bone and periosteum vascularization in chronic generalized periodontitis, accompanied by resorption and atrophy of the alveolar bone, are quite contradictory, which justifies the relevance of the study of structural and morphological elements of the microcirculatory bed of the periosteum of the alveolar bone of the jaw with chronic generalized periodontitis artificially modeled on experimental animals. Objectives: determination of structural and morphological elements of the microcirculatory bed of the periosteum of the alveolar bone of the jaw in chronic generalized periodontitis. . The experimental animal study included 50 rabbits of the Gray Giant breed, which were divided into 3 groups: the intact, the control and the main. In the control group and in the main group of animals after modeling chronic generalized periodontitis treatment was the same, but in the main group was prescribed an additional set of therapy. . In the control group in the periosteum of the jaws were detected pseudoinvolutive changes in the terminal bloodstream, which consist in a decrease in the number of microcapillaries per unit area, increased tortuosity of venules, the...

Background. The significant prevalence of chronic generalized periodontitis, the severity of its course, the increase in the number of complicated forms and short-term remissions cause a constant search for new methods and means of its treatment. When choosing the most effective methods of therapy, specialists mostly prefer a complex effect on the main pathogenetic links of the disease, while often losing sight of the body's own defenses, especially in terms of pharmacotherapeutic support and immunity strengthening. This study presents the results of a study of the clinical efficacy of the treatment of chronic generalized periodontitis by means of the developed therapy complex, including the use of immunomodulatory and osteotropic drugs.Objective — to study clinical efficacy of the developed complex immunomodulatory and osteotropic treatment for chronic generalized periodontitis.Methods. A prospective cohort study was conducted in 154 patients aged 20 to 75 with periodontitis of varying severity. Conventional examination of patients was carried out in specialized dental clinics DentoProma (Krasnodar) and Dentalife (Stavropol) based at the Dentistry Department, Stavropol State Medical University (Russia). The study period was 24 months. The patients were divided into a main group of 118 participants and a control group of 36 participants. The comprehensive treatment plan, prescribed to all patients, included proper oral hygiene education, individual and professional dental hygiene, topical anti-inflammatory agents, Vector therapy, open flap debridement, flap surgery, relevant splinting prosthetics (if necessary). The authors developed a comprehensive therapy, which included administration of the immunomodulatory agent Hepon (Immapharma Company, Russia), glucosamine hydrochloride and chondroitin sulfate sodium. All patients of the main and control groups were additionally ranked into subgroups depending on the severity of diagnosed periodontitis: slight (subgroup 1), moderate (subgroup 2) and severe (subgroup 3). The major focus of the study was to establish efficacy of the developed therapy which was defined by the degree of resolution of the inflammatory process and increase in the period of remission. Reflecting the presence and degree of inflammation, dental plaque index and oral hygiene status were considered to be the target indicators. Analysis and statistical processing of the obtained data were carried out using Microsoft Excel (Microsoft, USA).Results. The analysis of the data revealed that the immediate clinical results of the developed complex therapy both in the main group and in the control group were approximately identical. According to the follow-up data obtained one month after the treatment, additional prescription of complex osteotropic treatment to the patients with chronic generalized periodontitis contributed to rapid resolution of infection in the gingival tissues and provided stable treatment results.Conclusion. Introduction of the complex clinical and hygienic treatment promoted resolution of the inflammatory process in the gingival tissues of all patients who received immunomodulatory and osteotropic therapy.