Medicine

MEDICAL EVALUATION OF DIFFERENTIAL PATIENT CARE AFTER DENTAL IMPLANTATION OPERATION RECENTLY

Yarov Y.Y. stomatologist

Yarova S.P. doctor of medicine, professor

State Higher Educational Institution in Ukraine

"Ukrainian Academy of Medical Dental"

Poltava, Shevchenko, 23

Abstract. The role of dental plaque significantly after surgery and dental implantation and can be a decisive factor in the process of intergatsion. The results of the dynamic clinical monitoring of patients after implantation of up to 3 months presented in article. Significant differences in criteria effectiveness of treatment using the proposed medication depending on the level of mouth hygiene are statistically established. The results allow us to recommend a differentiated method for widespread use.

Key words: dental implants, hygiene, differentiated treatment.

І. Introduction. The development of modern implant dentistry as a science takes place rapidly, acquiring an impressive scale [1-6]. Despite the undoubted achievements, the risk of postoperative complications of inflammatory nature is an important issue of dental implantation [7-14]. Implantation refers to the value-surgical interventions. The role of biofilms increases significantly in the postoperative period and may acquire the status of a decisive factor in the process of rejection [15]. That is why the issue of hygienic status of patients, before and after implantation, causes increased attention. However, the risk of microbial invasion, and there may be a potential threat to the treatment using dental implants. [16] Pathogenic and pathogenic microflora can cause chronic inflammation, rolling out the soft tissue to the bone, and leads to its rapid resorption. After that the continued functioning of the implants becomes impossible, which is confirmed clinically - approximately 30% of patients diagnosed periimplantitis observed a similar situation [17].

ІІ. goal setting. Evaluating the effectiveness of the proposed differentiated drug therapy in the postoperative period for patients who underwent dental implants, the results of dynamic observation of the clinical picture in the coming period of 3 months was the aim of this study.

Subjects and methods. The study involved 124 somatically healthy people (54 men and 70 women) aged 18 to 34 years, including 25 people with intact periodontal 35 patients with chronic catarrhal gingivitis (CCG), 30 patients with generalizovanym periodontitis (GP) Primary - I, first degree, 34 patients with GP I, I-II severity. Diagnosis SG SE was carried out on the basis of clinical examination, radiography, periodontal indices and the definition of samples in accordance with the systematics of periodontal diseases N.F. Danilevsky (1994). Summary hygienic index Green-Vermillion (OHI-S) (Green, Vermillion, 1960) based on a component of plaque and component tartar (in points - from 0 to 3 in total - from 0 to 6) were determined in order to objectively assess the hygienic oral health.

Oral hygiene and professional teeth cleaning were performed before surgery dental implantation for all patients. Complex treatment in accordance with the "Protocol nadannya stomatologіchnoi dopomogi" (Order of the Ministry of Health of Ukraine №566 from 23.11.04y.) was performed prior to implantation for patients who have been diagnosed with CCG and SE.

Intraosseous screw implants used to replace dentition defects. The operation was carried out a two-step process. In the first stage implants were installed, followed by suturing mucosa: the upper jaw - 3 months, on the bottom - 6 months. Weekly inspections were carried out after removal of sutures within 3 months. At the same time we pay attention to the condition of the mucous membrane covering the elements of intraosseous implants. This is due to the fact that during this period can be observed most typical complications such as rejection of implants and peri-implantitis. The clinical picture in periimplantitis introduced during the first stage of intraosseous element is characterized by the appearance of a limited edema and hyperemia, fistula, or granulation in the mucous membrane covering the intraosseous element (after 2-3 weeks). Unlike periimplantitis implant rejection is an inflammatory process that begins in the surrounding bone. The clinical picture of this embodiment, the implant rejection characterized by the appearance of hyperemia, edema, fistula of the intraosseous part (after 2-3 weeks). In the following 1-2 weeks is its spontaneous expulsion of granulation tissue.

Patients were distributed into 2 equal treatment groups: experimental (62 people) - in the early postoperative period was performed proposed differentiated drug therapy, the amount of which is determined by the initial state of oral hygiene; control group (62 people) - used traditional medical therapy. As a special medical therapy after surgery in patients implanted with a healthy periodontium (25) was not appropriate to hold, they have made the comparison group. Monotherapy using the immunomodulator "Imudon" in the form of a suckable tablets 6 tablets a day for two weeks is recommended in patients with postoperative CCG. Patients with GP primary, elementary, first degree, and I, I-II degree combined recommended the appointment of an immunomodulatory drug "Imudon" in this scheme and universal antimicrobial broad-spectrum "Miramistin" for 2 weeks. Control studies were performed 1 week after the stitches are removed, and then weekly during the 3 months before the second stage of the operation.

The resulting digital data is treated variational-statistical methods of analysis on a personal computer IBM PC using standard programs Microsoft Excel.

ІІІ. Results. As can be seen from Table 1, significantly better hygienic condition of the oral cavity in patients CCG main group compared to controls (p <0.05) noted 1 week after removal of sutures. Thus IG Green-Vermillion main group was an average of 1.32 times lower compared to the control. Such differences in nature is preserved in all subsequent periods of observation. It should be noted, that the level of hygiene of patients who received an offer drug treatment drug "Imudon" in this period corresponded to that of individuals with a healthy periodontium. No cases of periimplantitis any primary or control groups were found in the assessment of the state of the mucous membrane of the intraosseous part CCG patients in the postoperative period.

Table 1

IG Dynamics of Green-Vermillion in patients with chronic hepatitis after dental implantation (M ± m, points)

	1st week after removal of sutures	2nd week after removal of sutures	Week 3 after removal of sutures	after 2 months after removal of sutures	3 months after removal of sutures
main group (n=18)	1,58± 0,26*	1,52± 0,25*	1,54± 0,27*	1,48± 0,24*	1,46± 0,26*
Control (n=17)	2,18± 0,36^	2,12± 0,29^	1,92± 0,26^	1,89± 0,23^	1,90± 0,24^
comparison group (n=25)	1,46± 0,16	1,40± 0,15	1,38± 0,14	1,41± 0,18	1,39± 0,14

Note: * - p <0.05 - versus control; * - P <0.05 - with respect to the comparison group

As seen in Table 2, was significantly better hygienic condition of the oral cavity as compared to control (p <0.05) observed in patients with GP primary, elementary, first degree of the main group in all periods of observation, since the 1st week after removal of sutures and 3 months later. IG Green-Vermillion in the study group ranged from 1,48 ± 0,24 to 1,59 ± 0,24 points, and the average was 1.58 times lower in comparison with the control. It should be noted that the level of hygiene in patients who received medical treatment proposed immunomodulatory drug "Imudon" in combination with the universal antimicrobial agents "Miramistin" in this period corresponded to that of individuals with a healthy periodontium. The values of the IG Green-Vermillion in the main group and the comparison group reflect the average level of oral hygiene for patients in the immediate period after surgery dental implantation. In assessing the state of the mucous membrane of the intraosseous part patients GP primary, elementary, first degree in the postoperative period to control identified one case of periimplantitis that the 1st week after removal of sutures manifested as redness and otchechnosti mucosa of the intraosseous part, and 2nd - the appearance of granulation.

Table 2

IG Dynamics of Green-Vermillion CKD patients starting-I, first degree after the dental implant (M ± m, points)

	1st week after removal of sutures	2nd week after removal of sutures	Week 3 after removal of sutures	after 2 months after removal of sutures	3 months after removal of sutures
main group (n=15)	1,59± 0,24*	1,54± 0,22*	1,52± 0,25*	1,48± 0,24*	1,49± 0,23*
Control (n=15)	2,48± 0,26^	2,42± 0,24^	2,38± 0,25^	2,39± 0,23^	2,36± 0,25^
comparison group (n=25)	1,46± 0,16	1,40± 0,15	1,38± 0,14	1,41± 0,18	1,39± 0,14

Note: * - p <0.05 - sraneniyu in the control; * - P <0.05 - with respect to the comparison group

As can be seen from Table 3, was significantly better hygienic condition of the mouth compared with the control, on average, 1.90 times (p <0.05) observed in patients with GP I, I-II degree of the main group, starting from the 1st weeks after the stitches are removed and all subsequent observation periods up to 3 months. This IG Green-Vermillion in the study group ranged from 1,47 ± 0,23 to 1,60 ± 0,26 points (equivalent to the average level of hygiene), and in control - from 2,86 ± 0,29 to 2 98 ± 0,34 points (corresponds to a very poor level of hygiene). It should be noted that the level of hygiene in patients who received medical treatment proposed immunomodulatory drug "Imudon" in combination with the universal antimicrobial agents "Miramistin" in this period corresponded to that of healthy individuals with periodontitis, ie the average level was reached and, on average, , 1,53 ± 0,24 points. One case of periimplantitis, which is on the 1st week after removal of sutures manifested as redness and otchechnosti mucosa of intraosseous element and the 2nd - the appearance of granulation identified when assessing the state of the mucous membrane of the intraosseous part patients GP I, І- second degree postoperatively in the control, as in the case of patients GP primary, primary-I level.

Table 3

IG Dynamics of Green-Vermillion CKD patients I, I-II degree

After dental implantation (M ± m, points)

	1st week after removal of sutures	2nd week after removal of sutures	Week 3 after removal of sutures	after 2 months after removal of sutures	3 months after removal of sutures
main group (n=17)	1,60± 0,26*	1,56± 0,24*	1,52± 0,25*	1,47± 0,23*	1,48± 0,24*
Control (n=17)	2,98± 0,34^	2,92± 0,32^	2,88± 0,30^	2,89± 0,33^	2,86± 0,29^
comparison group (n=25)	1,46± 0,16	1,40± 0,15	1,38± 0,14	1,41± 0,18	1,39± 0,14

Note: * - p <0.05 - versus control; * - P <0.05 - with respect to the comparison group

ІV. Conclusion. Thus, the analysis of dynamics of clinical parameters in patients with chronic catarrhal gingivitis after dental implantation demonstrates the effectiveness of the proposed monotherapy "Imudon" in addition to conventional maintenance therapy as soon as possible from 1 week after the removal of stitches up to 3 months. Analysis of dynamics of clinical parameters in patients with GP primary, elementary, first degree and with GP I, I-II degree after dental implantation demonstrates the effectiveness of the proposed combination of drugs "Imudon" and "Miramistin" in addition to conventional maintenance therapy with the next period of 1 week after removal of sutures to 3- months.

The results allow us to recommend the proposed method of differential medical treatment in the early postoperative period after dental implantation for widespread use in the practice of dentistry.

References:

1. Aidaev G. A. Dental disease and determining the need for prosthetic dental treatment indigenous population of the Turkmen SSR: Author. Dis. ... cand. medical. sciences: 14.01.22 / G. A. Atdaev; MMSI. - M., 1989. - 19 p.

2. Experimental study of the properties of sapphire dental implants. CH.I. The results of clinical and radiographic studies / V. I. Kutsevlyak [et al. ] // News dentistry. - 1998. - № 1. - P. 39 - 41.

3. Ceramic dental implants in experimental and clinical / N. B. Grechko [et al.] / Prosthetics Express prosthetics and biomaterials in orthopedics and traumatology. - Kharkiv, 1987. - p. 77 -79.

4. .Margvelashvili V. V. Defining the needs of the population of the Republic of Georgia in orthopedic care and ways to improve its effectiveness: Author. Dis. ... cand. medical. sciences: 14.01.22 / V. Margvelashvili; MMSI. - M., 1991. - 27 p.

5. Mirzabeckov O. Dental disease and determining the need for orthopedic help urban and rural population of the Kazakh SSR: Author. Dis. ... cand. medical. sciences: 14.01.22 / O Mirzabeckov; MMSI. - M., 1987. - 24 p.

6. The morphological characteristics of bone healing using porous titanium implants in the experiment / A. S. Artyushkevich [et al. ] // Modern stomatologiya.- 2002. - № 2. - p. 43 - 45.

7. Perova M. D. Complications of using the method of dental implants, analysis and prevention / M. D. Perova // Clinical Implant Dentistry and. - 1997. - № 3. - p. 23 - 26.

8. Perova M. D. Evaluation of dental implantation using histogram analysis / M. D. Perova, G. Banchenko // Clinical Implant Dentistry and. - 1997. - № 3. - p. 27 - 33.

9. Perova M. D. solcoseryl Application for the prevention of early complications of dental implantation / M. D. Perova, L. N. Ivanov // Kuban Research Medical Gazette. - 1999. - № 6

10. Features panoramic image of dental systems, obtained in different designs ortopantomografy / N. A. Rabuhina [et al.] // Dentistry. - 1991. - № 3. - p. 63 - 65.

11. Perova M. D. Forecasting and ways to prevent early marginal bone loss by using dental implants osteointegriruemyh / M. D. Perova, V. Kozlov // Clinical Implant Dentistry and. - 1999. - № 1 (8). - p. 31 - 36.

12. Perova M. D. Rehabilitation tissue Dent-alveolar region / M. D. Perov // new in dentistry. - 2001.- № 3. - P. 3 - 15.

13. Perova M. D. The results of the study interferences osteo-integrable dental implants in the state of compromise periodontal tissues in implantology / M. D. Perov, V. Kozlov // Clinical Implant Dentistry and. - 1999. - № 2. - - p. 36 - 42.

14. Vigderovich V. A. Prediction of surgical stage of dental implantation / V. A. Vigderovich // Medicine and Health Care. Occupational Safety and Health. - 1991.- № 12. - p. 48.

15. Brandes R. E. Clinical microscopic observation of ligature-Induced "peri implantitis" around osseointegrated Implants / R. E. Brandes // J. Dent Res -1988. - Vol. 67. - P. 287

16. Buser D. Formation of a periodontal ligament around titanium implants / D. Buser, K. Warrer, T. Karnng // J. Periodontol. - 1990. - Vol. 61. - P. 597.