Медицина /7.Клиническая медицина.

Bulyakov R.T, Sabitova R.I., Gulyaeva O.A.

Bashkir state medical University, Russia, Ufa
Role of removal of a biofilm in

prevention and treatment peri-implantitis

Dental implantation is an alternative, and sometimes the only manner recovery aesthetic and functional harmony edentulous patients [1]. Along with the growth in the number of implantation and expansion of indications to the use of this method of rehabilitation of patients in modern dentistry has increased the number of complications. Inflammation of the tissues in the circle of the implant is one of the main problems of implantology. Rough surface of the implant attached to them with the purpose of improvement of osteointegration, contributes to a more rapid accumulation of microbial plaque, as the absence of the periodontal ligament - both mechanical and biological protective barrier from the aggressive environment of an oral cavity subjects fabrics of a periimplant to the increased risk of infection. Therefore, on the first place among the ways of prevention of peri-implantitis worth adequate parodontological patient preparation for implantation and regular professional oral hygiene safe for implants and at the same time effective. Formation on the surface of teeth and imlants biofilm - community of micro-organisms, protected exopolysaccharide shell, blocking receptors bacterial membranes and making them unavailable for antiseptic and local general antimicrobial impact, predetermines the possibility of inflammatory complications implantation and significantly reduces the effectiveness and long-urgency of the results of treatment of peri-implantitis. So the main goal of the treatment and prevention of peri-implantitis - timely removal of on biofilm the surface of the teeth and implants [1].

The aim of our study were to evaluate the clinical effectiveness of modern methods of destruction of biofilms in treatment and prevention of peri-implantitis.
Materials and methods. The group of research - 22 patients parodontists of the cabinet of Republican stomatologic polyclinic, Ufa with active inflammatory process in the field of implants. Age of the patients co-put 24-58 years, 12 men and 10 women, the period of use of implants from 1 to 9 years, with implants as in the frontal areas and in the field of premolars and chewing teeth (only 31 implant). The diagnosis of periimplantal mucositis - in 3 patients, and the rest of peri-implantitis. In the complex treatment of all patients included motivating and training hygiene oral cavity, professional hygiene of the oral cavity: the removal of dental calculus with piezoelectric scaler, with implant surfaces a special ultrasonic tool with plastic- coating PI, supragingival plaque of purified air-abrasive way (AIR-FLOW®) classic powder (sodium bicarbonate, diameter of particles is 65 microns), and in implants Perio powder (glycine, diameter of particles of 25 microns). Subgingival processing was performed in the control group (7 implants) mechanically (with plastic instrument). The main group of divided into 2: in the 1st (12 implants) - method Perio-Flow (EMS) (glycine), 2nd (12 implants) - method Vector (Durr) (carbon fiber instrument in the field of implant) on day 2, 6 weeks, 3 months. Was local and general (according to indications) antimicrobic and anti-inflammatory therapy, physiotherapy (laser), vitamin therapy, local immunocorrection.

Criteria for evaluating the effectiveness of treatment were the results of clinical and x-ray technicians and instrumental methods of investigation, received at the stages of survey: probing depth periimplantal pocket (PP), color periimplant gums, consistence, presence or absence of exudate from periimplant grooves (pocket), the value of periimplant marginal bone resorption, simplified index hygiene OHI-S (J.C. Green, J.K. Vermillion, 1963), the index Silness-Loe (S-L) (Silness J., Loe, H., 1964), index (PMA papillar-marginal-alveolar) (I.Schour, M.Massler, 1947, in the modification of С.Раrма, 1960). Evaluation of the clinical parameters and index score was performed in each patient appointments (1-day, 2-day, 5-day, 10-day, 6 weeks, 3 months, 6 months) - only 7 visits. Data were analysed using standard statistical methods.
Results. Hygiene and periodontal indices before treatment were unsatisfactory in all groups. Depth PP ranged from 3,4 to 5,3 mm, index bleeding PBI an average of 4,2±0,2 index PMA - 58,1±4,6 %, were awarded high index of hygiene - Silness-Loe (2,93±0,1) and OHI-S (3,5±0,11). All patients during treatment hygienic condition of the mouth under the terms of the index of OHI-S normalized and remained stable during the whole period of observation (0,8±0,05; 0,91±0,1; 1,2±0,13). The study revealed from the differences in the degree of reduction of the index Silness-Loe. So, che-cut 6 weeks index S-L amounted to 0,5±0,08 in the main group and 0,9±0,07 in control, after 3 months of 0,6±0,04 and 1,1±0,02 (p<0,01) and after 6 months, the difference was almost 2 times - 0,64±0,05 in the main group and 1,27±0,09 in the control (p<0,01). Reducing the severity of inflammatory phenomena deposits (bleeding gums, the disappearance of halitosis, reduction or complete disappearance of pain in the gums) occurred in the intervention group compared with the control more rapidly - by 18,1±4,1% more reduction of PBI in 3rd visit and 11,2±3,8 % in the 4th (p<0,05). Remove biofilms allowed faster to reduce the phenomenon swelling of the gums, hyperemia, discharge from the PP. Change PMA showed greater efficiency of application of modern methods of removal of biofilms in the removal of clinical symptoms. Dynamics depth PP in the process of observation of: 6 weeks after start of treatment, reduction of the depth of the PP in the main group was 16,8±1,3%, in 3 months to 20,1±1,3%, after 6 months -22,1±0,5% in the control group level reduction of the maximum reached 7.9±1,2 % to 3 month from the beginning of treatment (p<0,01) and slightly decreased in 6 months.

The efficiency of the treatment method of the Vector and Perio-Flow is explained by the active influence on the main etiological factor - the biofilm, which is the basis of the duration of maintaining the proper level of the index hygiene, and therefore clinical settings remission. Objective data hygienic, periodontal indices and the indices characterizing the process of healing in the early and long-term observations have confirmed high clinical effectiveness of the inclusion in the complex occupational hygiene in the treatment of peri-implantitis and periodontitis modern minimally invasive technologies to remove biofilms.

List of literature

1. A. Mariotti A B C in ABC book care implants // Clinical dentistry. - 2013.- № 3. p. 62-65.