Index Evaluation of Clinical Efficacy of Immunomodulatory and Osteotropic Therapy for Chronic Generalized Periodontitis of Varying Severity: A Prospective Cohort Study
https://doi.org/10.25207/1608-6228-2023-30-3-34-43
Abstract
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.
About the Authors
N. I. BykovaRussian Federation
Natalya I. Bykova — Cand. Sci. (Med.), Assoc. Prof., Department of Children’s Dentistry, Orthodontics and Maxillofacial Surgery.
Mitrofana Sedina str., 4, Krasnodar, 350063
S. V. Sirak
Russian Federation
Sergey V. Sirak — Dr. Sci. (Med.), Prof., Head of Department of Dentistry, Stavropol State Medical University; General Director.
Mira str., 310, Stavropol, 355017; Uzornaya str., 12, Stavropol, 355021
A. A. Ovsyannikova
Russian Federation
Anastasiya A. Ovsyannikova — Cand. Sci. (Med.), Assoc. Prof., Department of Therapeutic Dentistry.
Mitrofana Sedina str., 4, Krasnodar, 350063
A. V. Arutyunov
Russian Federation
Armenak V. Arutyunov — Dr. Sci. (Med.), Prof., Head of Department of Therapeutic Dentistry.
Mitrofana Sedina str., 4, Krasnodar, 350063
A. R. Romanenko
Russian Federation
Alina R. Romanenko — assistant, Department of Dentistry.
Mira str., 310, Stavropol, 355017
E. S. Sirak
Russian Federation
Ekaterina S. Sirak — 4th year Student.
Mitrofana Sedina str., 4, Krasnodar, 350063
V. A. Grigoryan
Russian Federation
Viktoriya A. Grigoryan — Postgraduate Student, Department of Dentistry.
Mira str., 310, Stavropol, 355017
Yu. V. Verevkina
Russian Federation
Yuliya V. Verevkina — Postgraduate Student, Department of Therapeutic Dentistry.
Mitrofana Sedina str., 4, Krasnodar, 350063
Z. K. Shamanova
Russian Federation
Zukhra K. Shamanova — Postgraduate Student, Department of Therapeutic Dentistry.
Mitrofana Sedina str., 4, Krasnodar, 350063
References
1. Ivanov A.N., Savkina A.A., Lengert E.V., Ermakov A.V., Stepanova T.V., Loiko D.D. Vicious circles in chronic generalized periodontitis pathogenesis. Parodontologiya. 2022;27(4):309–317 (In Russ.). DOI: 10.33925/1683-3759-2022-27-4-309-317
2. Inchingolo F., Martelli F.S., Gargiulo Isacco C., Borsani E., Cantore S., Corcioli F., Boddi A., Nguyễn K.C.D., De Vito D., Aityan S.K., Pham V.H., Dipalma G., Ballini A. Chronic Periodontitis and Immunity, Towards the Implementation of a Personalized Medicine: A Translational Research on Gene Single Nucleotide Polymorphisms (SNPs) Linked to Chronic Oral Dysbiosis in 96 Caucasian Patients. Biomedicines. 2020; 8(5): 115. DOI: 10.3390/biomedicines8050115
3. Ushnitsky I.D., Ivanova A.A., Pinelis I.S., Yurkevich A.V., Mikhalchenko D.V. Modern etiological and pathogenetic aspects of inflammatory destructive processes of periodontal tissues. Endodontics Today. 2019; 17(4): 46–49 (In Russ.). DOI: 10.36377/1683-2981-2019-17-4-46-49
4. Shchetinin E.V., Sirak S.V., Grigoryantz L.A., Vafiadi M.Yu.1, Dilekova O.V., Petrosyan G.G., Parazyan L.A., Gatilo Yu.Yu., Adamchik A.A. Reparative regeneration of periodontal tissues — results of experimental studies. Medical News of North Caucasus. 2015; 4(10): 411–415 (In Russ.). DOI: 10.14300/mnnc.2015.10100
5. Schincaglia G.P., Hong B.Y., Rosania A., Barasz J., Thompson A., Sobue T., Panagakos F., Burleson J.A., Dongari-Bagtzoglou A., Diaz P.I. Clinical, Immune, and Microbiome Traits of Gingivitis and Peri-implant Mucositis. J. Dent. Res. 2017; 96(1): 47–55. DOI: 10.1177/0022034516668847
6. Grande M.A., Belstrøm D., Damgaard C., Holmstrup P., Könönen E., Gursoy M., Gursoy U.K. Salivary concentrations of macrophage activation-related chemokines are influenced by non-surgical periodontal treatment: a 12-week follow-up study. J. Oral. Microbiol. 2019; 12(1): 1694383. DOI: 10.1080/20002297.2019.1694383
7. Bibi T., Khurshid Z., Rehman A., Imran E., Srivastava K.C., Shrivastava D. Gingival crevicular fluid (GCF): A diagnostic tool for the detection of periodontal health and diseases. Molecules. 2021; 26(5): 1208. DOI: 10.3390/molecules26051208
8. Kc S., Wang X.Z., Gallagher J.E. Diagnostic sensitivity and specificity of host-derived salivary biomarkers in periodontal disease amongst adults: Systematic review. J. Clin. Periodontol. 2020; 47(3): 289–308. DOI: 10.1111/jcpe.13218
9. Yu B., Wang C.Y. Osteoporosis and periodontal diseases. An update on their association and mechanistic links. Periodontol. 2000. 2022; 89(1): 99–113. DOI: 10.1111/prd.12422.
10. Liu C.L., Lee H.C., Chen C.C., Cho D.Y. Head-to-head comparisons of bisphosphonates and teriparatide in osteoporosis: a meta-analysis. Clin. Invest. Med. 2017; 40(3): E146–E157. DOI: 10.25011/cim.v40i3.28394
11. Adler R.A. Update on osteoporosis in men. Best Pr. Res. Clin. Endocrinol. Metab. 2018; 32(5): 759–772. DOI: 10.1016/j.beem.2018.05.007
12. Arias-Bujanda N., Regueira-Iglesias A., Balsa-Castro C., Nibali L., Donos N., Tomás I. Accuracy of Single Molecular Biomarkers in Saliva for the Diagnosis of Periodontitis: A Systematic Review and Meta-Analysis. J Clin Periodontol. 2020; 47(1): 2–18. DOI: 10.1111/jcpe.13202
13. Brusentsova A.E., Lyashev Y.D., Serikov V.S., Tsygan N.V. Disorders of the biochemical composition of the periodontium in rats with periodontitis and chronic pain syndrome. Bulletin of Experimental Biology and Medicine. 2022; 1 (183): 20–23 (In Russ.). DOI: 10.47056/0365-9615-2022-173-1-20-23
14. Bazarnyi V.V., Polushina L.G., Maksimova A.Yu., Svetlakova E.N., Mandra Yu.V. Clinical and diagnostic characteristics of salivary matrix metalloproteinases as potential biomarkers in chronic periodontitis. Laboratory Service. 2020; 9(4): 54–58 (In Russ.). DOI: 10.17116/labs2020904154
15. Krechina E.K., Smirnova T.N. Modern approaches to periodontal microcirculatory parameters assessment. Stomatologiya. 2017; 96(1): 28–32 (In Russ.). DOI: 10.17116/stomat201796128-32
16. Ito H., Numabe Y., Hashimoto S., Uehara S., Wu Y.H., Ogawa T. Usefulness of hemoglobin examination in gingival crevicular fluid during supportive periodontal therapy to diagnose the pre-symptomatic state in periodontal disease. Clin. Oral. Investig. 2021; 25(2): 487–495. DOI: 10.1007/s00784-020-03396-0
17. Tsepov L.M.. Nikolaev A.I., Petrova E.V., Nesterova M.M. Pathogenetic substantiation of clinical use medicines in complex therapy of inflammatory periodontal diseases (a review of the literature). Parodontologiya. 2018; 23(2): 4–9 (In Russ.). DOI: 10.25636/PMP.1.2018.2.1
18. Reid I.R., Billington E.O. Drug therapy for osteoporosis in older adults. Lancet. 2022; 399(10329): 1080–1092. DOI: 10.1016/S01406736(21)02646-5
19. Shaposhnikov D., Revich B., Bellander T., Bedada G.B., Bottai M., Kharkova T., Kvasha E., Lezina E., Lind T., Semutnikova E., Pershagen G. Mortality related to air pollution with the moscow heat wave and wildfire of 2010. Epidemiology. 2014; 25(3): 359–364. DOI: 10.1097/EDE.0000000000000090
20. Rubnikovich S.P., Denisova Y.L., Vladimirskaya T.E., Andreyeva V.A., Kvacheva Z.B., Panasenkova G.Y., Volotovsky I.D. Regenerative cell technologies for gingival recession treatment. Modern Technologies in Medicine. 2018; 4(10): 94–104. DOI: 10.17691/stm2018.10.4.11
21. Xu S., Zhang G., Guo J.F., et al. Associations between Osteoporosis and risk of Periodontitis: A Pooled Analysis of Observational Studies. Oral Dis. 2020; 27(2): 357–369. DOI: 10.1111/odi.13531
22. Eldzharov A, Kabaloeva D, Nemeryuk D, Goncharenko A, Gatsalova A, Ivanova E, Kostritskiy I, Carrouel F, Bourgeois D. Evaluation of Microcirculation, Cytokine Profile, and Local Antioxidant Protection Indices in Periodontal Health, and Stage II, Stage III Periodontitis. J. Clin. Med. 2021; 10 (6): 1262. DOI: 10.3390/jcm10061262
23. Penoni D.C., Vettore M.V., Torres S.R., et al. An investigation of the bidirectional link between osteoporosis and periodontitis. Arch. Osteoporos. 2019; 14(1): 94. DOI: 10.1007/s11657-019-0643-9
24. Cheng R., Wu Z., Li M., Shao M., Hu T. Interleukin-1β is a potential therapeutic target for periodontitis: a narrative review. Int. J. Oral. Sci. 2020; 12(1): 2. DOI: 10.1038/s41368-019-0068-8
25. Bykova N.I., Odolski A.V., Grigoryan V.A. Indicators of cellular and humoral immunity in experimental inflammation of periodontal tissues. Kuban Scientific Medical Bulletin. 2016; 6: 20–26 (In Russ.). DOI: 10.25207/1608-6228-2016-6-20-26
26. Cannarella R., Barbagallo F., Condorelli R.A., Aversa A., La Vignera S., Calogero A.E. Osteoporosis from an Endocrine Perspective: The Role of Hormonal Changes in the Elderly. J. Clin. Med. 2019; 8(10): 1564. DOI: 10.3390/jcm8101564
Supplementary files
Review
For citations:
Bykova N.I., Sirak S.V., Ovsyannikova A.A., Arutyunov A.V., Romanenko A.R., Sirak E.S., Grigoryan V.A., Verevkina Yu.V., Shamanova Z.K. Index Evaluation of Clinical Efficacy of Immunomodulatory and Osteotropic Therapy for Chronic Generalized Periodontitis of Varying Severity: A Prospective Cohort Study. Kuban Scientific Medical Bulletin. 2023;30(3):34-43. (In Russ.) https://doi.org/10.25207/1608-6228-2023-30-3-34-43