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Kamilov Khaydar Pazilovich, DM., Professor of the Department of Hospital Therapeutic Dentistry, Tashkent State Stomatological Institute, Tashkent, Uzbekistan Takhirova Kamolakhon Аbrorovna, Assistant of the Department of Hospital Therapeutic Dentistry, Tashkent State Dental Institute, Tashkent, Uzbekistan E-mail: [email protected]
EFFCIENCY OF THE USE OF PHOTODYNAMIC THERAPY IN COMPLEX TREATMENT
Abstract. A comparative research of treatment of 60 patients at the age from 22 to 55 years old with generalized periodontitis of moderate severity with the use of photodynamic therapy (FDT) was carried out. Analysis of received data showed increased efficiency of treatment of generalized periodontitis (GP) of moderate severity when including of FDT. PDT is an effective antimicrobial treatment system that can be used in conjunction with standard procedures for the mechanical removal of supra- and subgingival dental plaque to increase the efficiency of treatment of patients with GP.
Keywords: periodontitis, periodontopathogenic microorganisms, photodynamic therapy, biocenosis, treatment, disease.
The problem of treatment of periodontal diseases remains relevant, despite the advances in medical science of recent years. Recent studies indicate that the development of periodontitis is associated with increasing of quantity and persistence of peri-odontopatogenic microorganisms (PDPM) [1; 2].
Antibiotic therapy as a method of etiotropic therapy still occupy a leading position in the treatment of GP, but they may develop resistant to microorganisms. However, the most aggressive PDPM, as Act. comitans h P. gingivalis, are very resistant to mechanical and antiseptic processing, which is associated with their ability to invade gum epithelial cells, connective tissue and bone marrow spaces [4].
In recent years, new approaches to the suppression of pathogenic microflora in periodontal diseases are of particular interest, in particular the use of PDT, as a result of which the selective destruction of pathogenic microflora in the inflammatory focus is occurring [5]. This procedure is based on a photochemical reaction leading to the generation of reactive oxygen species that have a cytotoxic effect on bacteria, viruses, and fungi [3; 6].
Purpose of the research was to study the dynamics of changes in microbiosis of periodontal pockets (PP) in patients with moderate periodontitis under the influence of PDT.
Materials and research methods. The study involved 60 patients with GP at the ages of 22 and 55 years old (26 men and 34 women). The patients included in the study were divided into 2 groups. The basic treatment in all groups con-
sisted of sanation of the oral cavity (OC), removal of supra-subgingival dental plaque; smoothing and polishing the root surface of teeth; selective grinding. Then the patients of the 1st control group (30 patients) received traditional antiseptic treatment of the OC using 0.05% chlorhexidine solution digluconate and gel "Metrogil-Denta" was applicated in PP in amount of10 g for 5-7 days.
In the 2nd main groups (30 people) PDT was performed. After occupational hygiene measures, the photosensitizer was slowly injected into the PP with a syringe until they were maximally filled and left to act for 10 minutes. To activate the photosensitizer we used the device "UFD-1" (Uzbekistan). At the end of the procedure the oral cavity was rinsed to remove the photosensitizer, PP were washed with saline.
For objectification of the periodontal status and assessment of the efficiency of treatment, a comprehensive dental examination of patients was performed according to the traditional scheme, which included the collection of complaints and anamnesis, examination, determination of the oral hygiene index (OHI-S) (Green J.C., Vermillion J. R., 1964), and index of bleeding (IB) Muhlemann (1971) in modification of I. Cowell (1975), PI (Russel A., 1956) index. The depth of PP, the amount of gingival recession, the degree of tooth mobility, and furcation lesions were evaluated. To clarify the diagnosis and assess the condition of the bone structures of the periodontal tissues an X-ray examination was performed.
EFFCIENCY OF THE USE OF PHOTODYNAMIC THERAPY IN COMPLEX TREATMENT
Composition of periodontal microflora was explored by polymerase chain reaction (PCR). Clinical examination of patients and analysis of the composition of the subgingival microflora by PCR were carried out before treatment, immediately after on -treatment, then after 3 and 6 months after conservative treatment.
Results and discussion. During clinical examination after 3 and 6 months after treatment, in patients of the 2nd group who received PDT, the OHI-S and IB were significantly lower than in group 1. In addition, patients of the 1st group
showed a significant decrease in the depth of PP and the degree of tooth mobility. On apparently, it can be explained by a pronounced and long-lasting antimicrobial effect of PDT. In the control group in moderately severe GP patients, the antiinflammatory effect of conservative treatment after 3 months almost disappeared or significantly decreased.
According to our results, in the initial study of the contents of PP in patients with GP of moderate severity, both groups revealed the presence of markers of the main periodon-topatogens.
Table. Effect of PDT on the incidence of periodontal pathogens
Periodontal pathogens 1st group (n = 30) 2nd group (n = 30)
Before-treatment After treatment After 3 month-streat-ment After 6 months treatment Before treatment After treatment After 3 months treatment After 6 months treatment
Act. comitans 1.33 0.17 0.8 1.6 1.35 - - 0.15
P. gingivalis 5.64 4.5 4.8 5.4 6.4 - 2.4 4.0
Pr. intermedia 6.37 5.0 5.6 6,6 6.7 - 2.8 4.6
T. forsythensis 7.08 5.3 6,6 7.1 7.4 2.3 4.6 5.2
Tr. denticola 6.57 3.5 4.1 6.2 7.2 1.8 2.8 3.2
As can be seen from the table 1, the ability of laser PDT to reduce the levels of bacterial infectious agents was significantly higher than that of occupational hygienic therapy using a 0.05% chlorhexidine solution and gel "Metrogil-Denta".
Inclusion in the complex conservative treatment of GP of moderate severity PDT can significantly reduce the frequency of detection in the composition of the subgingival microflora of PP. The remote terms of antimicrobial effect of carried out treatment decreased in both groups of patients, even in 6 months after the treatment the frequency of occurrence PDPM in patients of 2nd group received PDT was significantly lower than in patients of 1st group (control). Especially high antimicrobial effect of PDT was observed in relation to two types of microorganisms: P. gingivalis and Pr. intermedia. High bactericidal effect against chromogenic microflora, such as P. gingivalis, Pr. intermedia, was apparently due to the content of light-sensitive porphyrin molecules in the cells of these bacteria which, when activated by corresponding light wave lengths, produce oxygen radicals. In this connection, a part of microorganisms dies upon irradiation with laser light, even if they were not in contact with the photosensitizer.
By the end of PDT in the study group pain intensity decreased by 77.58% (P < 0.01); bleeding gums - by 73.73% (P < 0.01); intensity of breath - by 87.63% (P < 0.01); and
the depth of the PP, tooth mobility and the quantity of exudation from the PP, respectively - by 48.50% (P < 0.01); 48.74% (P < 0.01) and 76.54% (P < 0.01).
At the same time reduction OHI-S decreased by 57.08% (P < 0.01); index of inflammation in periodontium, (PMA) -by 81.06% (P < 0.01) and periodontal destruction index (PI) -by 46.52% (P < 0.01).
Apparently, the high antimicrobial effect of PDT is due to the fact that part of the pathogenic microorganisms, having the ability to invade, penetrates into the epithelial cells of the gum. They are not available for mechanical treatment and the action of antiseptics, therefore, are the cause of the recurrence of the inflammatory process. The destruction of such microorganisms using PDT is possible due to the ability of the photosensitizer and laser radiation to penetrate the gingival tissue to a certain depth.
Conclusions: PDT is an effective antimicrobial treatment system that can be used in conjunction with standard procedures for the mechanical removal of supra- and subgingival dental plaque to increase the efficiency of treatment of patients with GP. In our opinion, PDT in periodontology can be applied after the initial phase of treatment as an addition to professional hygiene measures, as an alternative to the traditional antibacterial and anti-inflammatory treatment.
References:
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2. Zorina O. A., Kulakov A. A., Boriskina O. A., Rebrikov D. V. The ratio of pathogenic microbiocenosis periodontal pockets with varying severity of alodontitis // Acta Nature. 2011; 3(2): 101-4. (in Russian).
3. Krechina E. K., Efremova N. V., Maslova V. V. Pathogenetic rationale for the treatment of periodontal disease with photodynamic therapy // Stomatology. 2006; 4: 20-5. (in Russian).
4. Orekhova L. Yu., Loboda E. S., Oboeva M. L. Photodynamic therapy in the complex treatment of inflammatory periodontal diseases // Periodontology. 2015; 74(1): 44-9.
5. Usmanova I. N., Gerasimova L. P., Kabirova M. F. et al. Clinical and microbiological efficacy of photodynamic therapy of chronic gingivitis and periodontitis in young people // Periodontology. 2015; 75(2): 67-72. (in Russian).
6. Shugailov I. A., Dzhanchatova A. R., Bulgakova N. N. et al. Study of the effectiveness of photodynamic therapy of inflammatory periodontal diseases with the drug "RadaDent" // Russian Dental Journal. 2011; 15(6): 38-40. (in Russian).
