Dynamics Of Changes In Anthropometric Indices In Patients With Generalized Periodontitis Of I-II Degree On The Background Of Injection Osteoplastic Therapy
Bezrukov S. G.1, Saenko T.S2, Saenko V.L.3, Yelcheva L. A.4
1 Head of the Department of Surgical Dentistry and Maxillofacial Surgery, Professor, Faculty of Dentistry of the Medical Academy named after S. I.
Georgievsky of Vernadsky CFU, Simferopol, 95000, Russian Federation.
2 Assistant of the Department of Theraputical Dentistry, Faculty of Dentistry of the Medical Academy named after S. I. Georgievsky of Vernadsky
CFU, Simferopol, 95000 Russian Federation.
3 Assistant of the Department of Surgical Dentistry and Maxillofacial Surgery, Faculty of Dentistry of the Medical Academy named after S. I. Georgievsky
of Vernadsky CFU,Simferopol, 95000 Russian Federation.
4 Senior teacher of the Department of Surgical Dentistry and Maxillofacial Surgery, Faculty of Dentistry of the Medical Academy named after S. I.
Georgievsky of Vernadsky CFU,Simferopol, 95000 Russian Federation.
*Corresponding Author
Yelcheva L. A.,
Senior teacher of the Department of Surgical Dentistry and Maxillofacial Surgery, Faculty of Dentistry of the Medical Academy named after S. I. Georgievsky of Vernadsky CFU,
Simferopol, 95000 Russian Federation.
Tel: +79787253877
E-mail: lidayelcheva@gmail.com
Received: September 30, 2021; Accepted: Ocotber 28, 2021; Published: January 11, 2022
Citation: Bezrukov S. G., Saenko T.S, Saenko V.L., Yelcheva L. A. Dynamics Of Changes In Anthropometric Indices In Patients With Generalized Periodontitis Of I-II Degree On The Background Of Injection Osteoplastic Therapy. Int J Dentistry Oral Sci. 2022;9(1):5217-5222. doi: dx.doi.org/10.19070/2377-8075-220001046
Copyright: Yelcheva L. A©2022. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Abstract
The dynamics of anthropometric indicators in patients with generalized periodontitis of I-II degree confirms the effectiveness
of injectable use of osteoplastic materials (for example, PRP and Collapan C) in the complex treatment of this pathology.
The most pronounced local augmentation was noted in the 2nd main group, where there were significant differences in alveolar
bone volume indices by the 30-day observation period (P1 < 0.05), then they continued their growth by 3, 6-12 months (P1
< 0.05, P2 < 0.05, P3 < 0.05). In our opinion, the positive osteoplastic therapeutic effect detected in patients in this group is
due to the complementary properties of PRP-gel and the drug Collapan C, which together demonstrate osteoinductive and
osteoconductive properties, manifested in presence of the release of silver ions, which has a local antiseptic and anti-inflammatory
effect. All this, together, creates optimal conditions for preserving and restoring the volume of the alveolar bone.
Patients in the I-th main group also showed a positive result, where, despite the absence of a noticeable increase in bone tissue,
its volume was preserved, which is explained by the pronounced osteoinductive and immunocorregulating properties of
autoplasm with an increased platelet content.
In patients in the control group, the process of gradual loss of the alveolar bone continued after treatment, which had a shortterm
positive result.
The data of anthropometry are confirmed by the results of radiography.
2.Introduction
3.Materials and Methods
3.Results
4.Discussion
5.Conclusion
5.References
Keywords
Anthropometry of the Jaws; Osteoplastic Materials; Collapan C; PRP; Treatment of Generalized Periodontitis of I-II Degree.
Introduction
The morbidity rate of periodontal diseases continues to be high.
In this regard, the problem of the effectiveness of methods of
treatment of this pathology remains important.
In modern surgical dental practice, osteoplastic materials are actively
used. Platelet-rich blood plasma (PRP) is increasingly used
to optimize regeneration processes [1, 2, 5]. It is widely used during
osteoplastic operations (sinus lifting, augmentation of the alveolar
process), for the treatment of the operating area before
dental implantation, etc. [5, 8]. It was found that PRP has a significant
osteoinductive effect. At the same time, it is known that in
the complex treatment of generalized periodontitis, it is advisable to use osteoconductors [4, 7, 9, 10], which allow increasing the
volume of bone tissue. Recently, the range of domestic synthetic
osteoplastic (osteoconductive) drugs has expanded in the medical
market. One of them is the silver-containing material Collapan C.
The purpose of the study. To keep track of the changes in anthropometric
indicators dynamic in patients in the comparison groups
during the complex treatment of generalized periodontitis of I-II
degree, including injection of osteoplastic materials.
Materials And Methods Of Research
The patients were treated on an outpatient conditions. The results
of clinical indices were analyzed during the treatment and
examination of 120 patients of both sexes aged 25 to 50 years (40
patients in the 1st main group, 40 in the 2nd main group and 40
in the control group).
In the control group, the traditional complex treatment of generalized
periodontitis of the I - II degrees was performed with the
injection of aloe extract into soft tissues along the muco-gingival
line in the projection of the causal teeth [3].
In the first main group, the traditional treatment was supplemented
with injection point subcostal and supra-periosteal injection
of PRP into periodontal tissues (at the rate of 0.3-0.5 ml in the
projection of one tooth).
In the second main group, along with complex treatment, injectable
combined osteoplastic therapy of periodontal tissues with
PRP and a suspension of the drug Collapan C was performed,
which were injected separately pinpointly into periodontal tissues
at the rate of 0.3 ml in the projection of one dental segment.
Infiltration anesthesia with 0.5% lidocaine solution was used for
anesthesia.
Anthropometric measurements of the size of the alveolar processes
were performed in the transversal and sagittal directions
before injection therapy, as well as 1, 3, 6, and 12 months after it.
The parameters of the vertical alveolar ridge were determined
by measurements carried out directly in the oral cavity using a
wire probe (cross-section diameter-0.5 mm) and a medical caliper.
To carry out measurements, a wire probe was installed on the
chewing (cutting) surfaces of the teeth (the level of the occlusal
surface), limiting the defect of the dentition. Using a measuring
caliper, the distance between the surface of the probe and the mucosa
of the alveolar ridge in the area of the maximum depression
was determined [2, 6].
Horizontal measurements of the alveolar process were also evaluated
using measurements carried out with a measuring caliper.
The measurements were carried out in the middle of the defect
zone of the dentition or in the narrowest part of the alveolar
process. The contact of the mucous membrane and the working
parts of the instrument was carried out by retreating 5-6 mm
from the muco-gingival lines, without exerting pressure on the
mucous membrane.
All measurements were carried out three times and the arithmetic
mean was calculated.
Results and Discussions
Measurements were carried out separately for each group of teeth
(in the projection of premolars and molars), as well as separately
for the upper and lower jaws. Before injection therapy, the average
values (M ± m) of height and width on the upper jaw were 6.95 ±
0.15 mm and 15.20 ± 0.17 mm, respectively. On the lower jaw, the
values were-7.23 ± 0.16 mm and 13.44 ± 0.19 mm.
1 month after the therapy, the indicators increased slightly in
patients in the control group, but there were no significant differences
(P1> 0.05), as evidenced by the persistence of weakly
expressed inflammatory phenomena in the periodontium. During
this observation period, the distance to the crest of the alveolar
process of the upper jaw averaged 7.14 ± 0.18 mm, and its width
was 15.56 ± 0.19 mm. On the lower jaw, the height index was 8.08
± 0.14 mm, and the width was 14.09 ± 0.16 mm (Table 1).
3 months after the treatment, the amount approached the baseline
level (P1 > 0.05), and after 6 months they became slightly
lower than it. On the upper jaw, the average sagittal parameters
(up to the crest) were 6.93 ± 0.12 mm, and the transversal ones
were 15.34 ± 0.18 mm (at P1> 0.05). In the lower jaw, the dimensions
of the alveolar process corresponded to 7.57 ± 0.15 mm
and 13.64 ± 0.17 mm, respectively (at P1> 0.05).
1 year after injection therapy, a decrease in the volume of the
alveolar bone was registered in the representatives of the control
group: in the upper jaw, the analyzed values were 6.76 ± 0.16 mm
in height and 15.05 ± 0.19 mm in width, that is, the difference,
compared to the baseline level, was -0.19 mm and -0.15 mm, respectively,
in the lower jaw, these indicators were at the level of
6.98±0.18 mm (-0.25 mm) in height and 13.28±0.13 mm (-0.16
mm) in width (at P1> 0.05).
The data of vertical and horizontal measurements during the
entire observation period did not have significant differences (at
P1> 0.05). This indicated that there were no any osteoplastic processes
in the alveolar bone in response to the attempted injection
of 1% Aloe extract, and, in addition, continued sluggish bone
resorption, characteristic of the chronic course of periodontitis,
was recorded.
In the 1st main group, 1 month after the injection of PRP gel
on the upper jaw, the distance to the alveolar process in the most
pronounced area of resorption of the gingival margin in the projection
of the chewing teeth, on average, was 7.68 ± 0.16 mm,
and its width was 16.15 ± 0.14 mm. On the lower jaw, such indicators
were at the level of 8.54 ± 0.13 mm and 13.76 ± 0.16 mm,
respectively (at P1> 0.05, P2> 0.05) (Table 2). Comparing the
values with the initial figures, we obtained the following results:
the sagittal parameter of the alveolar process on the upper jaw
increased by +0.73 mm, and the transversal one-by +0.95 mm.
On the lower jaw, the dimensions of the alveolar ridge were +1.31
mm and + 0.99 mm, respectively.
Thus, in the 1st main group, one month after the treatment, there
was a tendency to an insignificant (P1> 0.05) increase in the volume
of periodontal tissues, probably due to the activation of the
restorative function of the periosteum, which is due to the osteoinductive
properties of the platelet concentrate of autoplasm.
Anthropometric measurements at 3, 6 and 12 months in postinjection
period witnessed the decline, but the numbers still remained
above baseline (when P1> 0,05 P2> 0,05).
After 6 months, the height of a crest on the upper jaw meet was
7.23 ± 0.13 mm and a width of 15.34 ±0.18 mm. On the lower
jaw, these indicators were 7.86 ± 0.15 mm and 13.45 ± 0.18
mm, respectively. Over the past period (from the first to the sixth
months), the height of the process on the upper jaw decreased by
0.45 mm, the width-by 0.81 mm. On the lower jaw – by 0.68 mm
and 0.9 mm (Table 2).
In the subsequent control period (12 months), a slight decrease
in the parameters of the alveolar ridge of the jaws was observed,
but the indicators retained their advantages in comparison with
the baseline level. So, on the upper jaw in the area of molars and
premolars (collectively), the height was 7.12 ± 0.17 mm (+0.17
mm), and the width was 15.28 ± 0.15 mm (+0.08 mm). On the
lower jaw, 7.34 ± 0.14 mm (+0.11 mm) and 13.45 ± 0.18 mm
(+0.01 mm), respectively. All the data have statistically unreliable
differences in relation to the values of the control group and in
comparison with the baseline level (P1> 0.05, P2> 0.05).
Thus, the results of studying the dynamics of changes in bone
volume indices indicate a decrease in the activity of osteolytic
processes in the alveolar bone and, accordingly, the achievement of stable remission during chronic generalized periodontitis in
presence of local injection therapy with PRP gel, which, in our
opinion, is due to the osteoinductive effect of the autograft. The
data of anthropometric measurements correlated with clinical indicators
that corresponded to a pronounced positive dynamics of
treatment.
In the second main group, 1 month after injection of the combination
of PRP with Collapse C, the sagittal and transversal dimensions
(M±m) of the alveolar processes in the projection of
premolars and molars on both jaws differed from the initial values
(P1< 0.05) (Table 3). Thus, in the upper jaw, the height of the
alveolar process increased by 0.93 mm (7.88 ± 0.14 mm), and the
width by 2.05 (17.25 ± 0.14 mm). On the lower jaw – by 1.09 mm
(8.32 ± 0.14 mm) and by 1.89 (15.33 ± 0.12 mm). There was no
statistically significant difference in comparison with the control
group (except for the width of the alveolar process of the upper
jaw, where P2< 0.05) and the 1st main group during this period
of observations (P2> 0.05, P3 > 0.05).
3 months after treatment, the distance to the alveolar ridge on
the upper jaw was 7.92 ± 0.20 mm, the width was 17.54 ± 0.16
mm. On the lower jaw, the average linear dimensions were at the
levels of 8.86 ± 0.17 mm and 15.64 ± 0.16 mm, respectively. The
obtained data significantly differed from the mean values of the
initial level (P1< 0.05), the indicators in the control group (P2 <
0.05) and in the 1st main group (P3< 0.05) (Table 3).
In the period from the third month to the sixth, the levels of
increase in the height and width of the alveolar ridge on the upper
and lower jaws were still statistically significant differences (at
P1< 0.05, P2< 0.05, P3< 0.05).
This trend was most pronounced by 12 months, when, in comparison
with the baseline level, the height and width indicators
on the upper jaw significantly increased (P1< 0.05) by 17.46%
and 15.74%, and on the lower jaw – by 22.43% and 18.3%, respectively.
When comparing the figures in the same observation
period with the values in the control and in the 1st main groups,
it is also possible to identify significant differences in favor of the
2nd main group (P2< 0.05 and P3 < 0.05). The alveolar process
height index was 8.42 ± 0.18 mm, which is 19.72% more than in
the control group and 15.44% more than in the 1st main group.
The width of the alveolar bone increased to the level of 18.04 ±
0.14 mm (16.58% higher than the values of the control group and
15.3% higher than the 1st main group). The height of the alveolar
process of the lower jaw was 9.32 ± 0.16 mm (25.11% more than
in the control, with P2< 0.01 and 21.25% more than in the 1st
main group) and the width was 16.45 ± 0.19 mm (19.27% and
18.24%, respectively).
The diagrams of the dynamics of the average anthropometric indicators
of the height and width of the alveolar process in the
projection of the premolars and molars of the upper and lower
jaws in the comparison groups clearly show that the processes of
preservation and restoration of bone structures were most pronounced
in the 2nd main group (Fig. 1, 2, 3, 4). At the same time,
there were significant differences in the alveolar bone volume indicators by the 30-day observation period (P1< 0.05), then they
continued their growth by the 3rd, 6th and 12th months (P1 <
0.05, P2< 0.05, P3< 0.05). In our opinion, the positive osteoplastic
therapeutic effect detected in patients in this group is due to
the complementary properties of PRP-gel and the drug Collapan
C, which together demonstrate osteoinductive and osteoconductive
properties, manifested in presence of the release of silver
ions, which has a local antiseptic and anti-inflammatory effect.
All this, together, creates optimal conditions for preserving and
restoring the volume of the alveolar bone.
It should be noted that patients in the I-th main group also had a
positive result, where, despite the absence of a noticeable increase
in bone tissue, its volume was preserved (Fig. 1, 2, 3, 4), this is explained
by the pronounced osteoinductive and immunocorregulating
properties of autoplasm with an increased platelet content.
In patients in the control group, the process of gradual decrease
in the anthropometric parameters of sagittal and transversal parameters
continued, which, in general, is typical for chronic generalized
periodontitis duration, accompanied by a constant loss of
the alveolar bone (Fig. 1, 2, 3, 4), that is, the positive therapeutic
result was short-term and did not have a long-term effect.
The data of anthropometry are confirmed by the results of X-ray
examination of the alveolar processes in the comparison groups.
Table 1. Intergroup comparison of demographic characteristics.
Table 2. Intergroup comparison of treatment performed in primary teeth in the three waves.
Table 3. Intergroup comparison of treatment performed in permanent teeth in the three waves.
Figure 1. Dynamics of changes in the average anthropometric indices of the height of the alveolar process in the projection of the premolars and molars of the upper jaw in the comparison groups.
Figure 2. Dynamics of measurements of the average anthropometric parameters of the width of the alveolar process in the projection of the premolars and molars of the upper jaw in the comparison groups.
Figure 3. Dynamics of changes in the average anthropometric indices of the height of the alveolar process in the projection of the premolars and molars of the lower jaw in the comparison groups.
Figure 4. Dynamics of the average anthropometric parameters of the width of the alveolar process in the projection of the premolars and molars of the lower jaw in the comparison groups.
Conclusion
The results of jaw anthropometry confirm a higher efficiency of
treatment of patients in the main groups, where local inflammatory
and atrophic reactions subsided due to injectable local therapy with osteoplastic materials with osteoinductive and osteoconductive
properties (main group 1) and the volume of lost alveolar
bone was partially restored (main group 2). At the same time, the
reliability of differences in the height and width of the alveolar
process was traced from the 3rd to the 12th months of observations.
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