EUROPEAN INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY RESEARCH
AND MANAGEMENT STUDIES
ISSN: 2750-8587
VOLUME04 ISSUE11
33
COMPARISON OF THE EFFECTIVENESS OF CONSERVATIVE AND SURGIRAL TREATMENT
OF GENERALIZED PERIODONTITIS
Turayev Alimjan Baxriddinovich
Samarkand State Medical University, Uzbekistan
AB O U T ART I CL E
Key words:
Surgiral Treatment, Conservative
Treatment.
Received:
06.11.2024
Accepted
: 11.11.2024
Published
: 16.11.2024
Abstract:
In the complex treatment of generalized
periodontitis, special attention is paid to the
correct combination of conservative and surgical
methods of treatment, which reduce the activity of
destructive processes in periodontal tissues and
restore the lost anatomy [1-9]. However, despite
various additions and modifications, conservative
and surgical interventions on the periodontal
itself do not create sufficient conditions for
effective relief of pathological processes and
restoration of periodontal tissues [10-18]. In some
cases, the use of new technologies, including the
use of occupational hygiene, dental splints and
other conservative methods of treatment, does
not lead to the stabilization of destructive
processes in the alveolar process, and in some
cases contributes to the further destruction of
periodontal tissues and surrounding bone tissue
with the formation of defects of various sizes. The
problem of dental preservation in patients with
generalized periodontitis of II-III severity is still
relevant. The organizational inconsistency of
dentists of different specialties, the lack of a real
medical examination of patients with periodontal
disease create prerequisites for the interruption
of treatment at the level of conservative
therapeutic agents and the active course of
destruction of bone tissue of alveolar processes.
INTRODUCTION
VOLUME04 ISSUE11
https://doi.org/10.55640/eijmrms-04-11-06
Pages: 33-38
EUROPEAN INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY RESEARCH
AND MANAGEMENT STUDIES
ISSN: 2750-8587
VOLUME04 ISSUE11
34
The purpose of the work
. Comparison of the effectiveness of conservative and surgical treatment of
generalized periodontitis of the object and the method of study of II-III degrees. Clinical X-ray
examination of 123 patients with generalized periodontitis was carried out at the age of 18-64 years.
All patients, depending on their age, were divided into 2 groups: The first age group included patients
with generalized periodontitis of II-III degrees from 18 to 39 years (n=58), and the second age group
included patients with generalized periodontitis of II-III degrees from 40 to 64 years (n=65). The
analysis of clinical and radiological parameters was carried out depending on the comparative aspect
between age groups and subgroups, that is, the age and clinical characteristics of the course of the
pathological process in periodontitis. Depending on the nature of the course of the disease,
comprehensive treatment of the patient was planned and included.Professional oral hygiene; topical
antimicrobial therapy (such as 0.05% chlorhexidine).) and anti-inflammatory therapy of periodontal
pockets. According to the indications, antibacterial therapy, anti-inflammatory treatment by
nonsteroidal anti-inflammatory drugs, bruxism, and articulation of movable teeth were carried out.
Surgical treatment included vestibular plastic surgery, frenulotomy and flap surgery. Defects in the
dentition were artificially eliminated. The results of the study and its discussion. During the study, the
main complaints of patients of the clinical group of 18-39 years were: pain in the gums, bleeding
(sometimes spontaneous), swelling of the mucous membrane of the alveolar process, a pronounced
transition in the duration of the disease of patients of this group at the time of examination ranged from
3 to 10 years from the moment of the disease with drug treatment. It was established from the medical
history that the patient was treated by a general dentist before seeking professional periodontal care.
At the same time, the means of treatment were limited to the removal of dental deposits, and sometimes
to closed curettage. In the mobility of the teeth, some patients were applying splints. None of the
patients examined were under the supervision of the clinic until the moment of contacting the
periodontologist. Laboratory studies have revealed poor oral hygiene in all patients with Grade II and
III systemic periodontitis in this age group. The green cinnabar index was 3.9±0.4, and abundant dental
deposits were noted in patients with grade 3-4 dental mobility and open furcations. At the time of
examination, a high level of tooth mobility was determined. The depth of the periodontal pocket ranged
from 6 to 10 mm.Bone defects in laboratory studies usually reached the end of the molars. During
clinical examination of the oral organs, most patients with generalized periodontitis noted the presence
of non-disinfected foci of caries, which are defects in previously applied seals. In some cases, there is a
decrease in the depth of the vestibule of the oral cavity (especially in the frontal region of the lower
jaw), a significant decrease in the width of the mucosal chain in the anterior pharyngeal region of the
upper and lower jaw, keratinization of the mucous membrane of the alveolar process. Clinical
observations of patients with generalized periodontitis aged 40-64 years show that the main
EUROPEAN INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY RESEARCH
AND MANAGEMENT STUDIES
ISSN: 2750-8587
VOLUME04 ISSUE11
35
complaints of patients of this group are associated with the presence of exposed roots, bleeding gums,
bad breath, loss of mobility and teeth, as well as dental defects. It was shown. The duration of the disease
in this group at the time of seeking professional help ranged from 8 to 20 years. Objective studies of the
oral organs show that in the elderly group, in comparison with young people, symptomatic gingivitis
with pronounced signs of inflammation, atrophic gingivitis in combination with a significant retreat of
soft tissues is observed. Older patients have abundant dental deposits with a large number of the latter
in the frontal region of the lower jaw, periodontal pockets of lower depth with a higher rate of bone
loss, pronounced tooth mobility. H). This figure shows a fairly typical clinical situation where the
condition is age-related or pathological (due to inflammatory processes in periodontal disease), bone
atrophy of the alveolar process is traumatic obstruction The result of the latter in this case, apparently,
is the formation of pathological alveolar bone pockets in the region of 21, 23 teeth. A distinctive feature
of the patients of this group was the absence of signs of proper orthopedic treatment. From the medical
history of the examined patients, orthopedic treatment is not taken into account at all at the pre-stage
of treatment, and sometimes such a high percentage of patients who are not provided with full-fledged
orthopedic treatment, which is the main part of the planned treatment measures in 96% of patients,
helps patients who carry out dental treatment of high incisors of the lower jaw, turns to paradonologists
about the mobility of the incisors of the lower jaw. The attempts of paradontologists in this situation
are surprising, and the cause of the loss of the frontal tooth group of the upper jaw is also considered to
be a traumatic obstruction, not an inflammatory process of periodontitis, the 2 groups examined have
a higher hygiene index, indicating an insufficient level of oral hygiene in different age groups. An
analysis of the values of the Greenvermillion index in young people revealed that the plaque index was
significantly higher than the tartar index, but in older patients the opposite relationship was seen. The
Pma index was higher in the elderly group. At the same time, the bleeding index was high in the group
of patients under the age of 39, as well as in terms of hyperemia and edema of the mucous membrane
of the alveolar process. In older patients, the gums are most often pale pink, with symptoms of atrophy
and a marked retreat of soft tissues. Obviously, this is due to the absence of deep vegetative disorders.
The average depth of periodontal pockets is also lower in older people. The index of the Russell
periodontal index in the elderly patient group was significantly higher. So, based on the analysis of the
results of clinical and X-ray examinations of patients with generalized periodontitis in the 1st and 2nd
degrees of 40-64 years, it can be concluded that generalized periodontitis is characterized by a long-
term chronic course, in which the dystrophic process predominates over inflammatory periodontitis.
During the comparison of indicators of the initial state of periodontal tissues in different age groups, it
was revealed that oral hygiene deteriorates in patients with older layers, but at the same time the
EUROPEAN INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY RESEARCH
AND MANAGEMENT STUDIES
ISSN: 2750-8587
VOLUME04 ISSUE11
36
intensity of inflammatory reactions decreases. This is confirmed by the results of the X-ray examination.
In patients in the young age group, pronounced destruction of the alveolar bone, active foci of
osteoporosis, absorption of the alveolar cavity in the range of 1/2 to 1/2 of the length of the root,
vertical bone resorption, multiple bone pockets 3). X-ray examination of patients with systemic
periodontitis in the elderly group, in addition to the described symptoms, reveals sclerotic bone
reconstruction, mixed type bone resorption, horizontal and vertical complex treatment of alveolar
processes, changes in indicators characterizing the state of periodontal tissues were observed in all
groups of patients at 6 and 12 months after the end of treatment. The results of treatment with or
without surgery were evaluated separately. After the end of conservative treatment, the depth of the
periodontal pocket, the degree of tooth mobility and the presence of dental deposits were determined
in the patient. Diagnostic indicators were used to study periodontal conditions: periodontal indicators
(Russel, 1956), Schiller-Pisarev test, PMA indicators (S.Parma, 1960), indicators of bleeding and
suppuration of the gums. Oral hygiene was assessed according to the methodology of Yu. A. Fedorov
and V.V. Volodkina (1970) al.green, J.Vermilion (1964) (table). Since conservative treatment involves
splints to movable teeth, the mobility of teeth after the end of treatment was not studied. Immediately
after the end of conservative treatment in patients with generalized periodontitis of the degree P-Sh, an
improvement in the parameters of the Schiller-Pisarev trial was noted (1.97 ±0.15 in patients with
grade II GP and 2.11 ±0.17 in patients with grade III GP). The level of oral hygiene is improved (S.Green,
J."I don't know," he said. The PMA index and other periodontal indicators tended to decrease. At the
same time, according to the results of the X-ray examination, the depth of the bone pocket has not
changed. Indicators of bleeding and suppuration changed towards improvement. In general, the
periodontal condition of grade II-III GP patients immediately after the end of conservative treatment
was characterized by remission of underlying diseases, mainly associated with deterioration of oral
hygiene.The condition of periodontal tissues after 6 months after the end of conservative treatment was
characterized by the Schiller-Pisarev test and increased gingival bleeding. Clinically, in the long term
after the end of conservative treatment, all indicators deteriorated. When analyzing the radiological
parameters of the long-term periodontal state after the end of conservative treatment, further
significant loss of bone tissue in the region of pathological alveolar bone pockets was noted. In some
cases, the formation of defects in the bone tissue of the alveolar process was noted. The following
radiation conditions are observed on the lower jaw: Unlike the upper jaw, the lower jaw has a mixed
type of bone atrophy of the alveolar process. In particular, bone atrophy at a horizontal level of sh-1
degrees was manifested in its frontal part. In the movable Sh-1U Class 12.11, 21 teeth were restored
before the start of treatment using a bonding system, and 12 of the most movable teeth were removed.
EUROPEAN INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY RESEARCH
AND MANAGEMENT STUDIES
ISSN: 2750-8587
VOLUME04 ISSUE11
37
The splint was supplemented with a bridge of glue instead of the missing 22 teeth. Various situations
are observed in the outer part of the mandible. Bone atrophy was characterized mainly by the formation
of vertical pockets of considerable depth (more than 4 mm). At the same time, the focus of bone
destruction is due to a clearly chronic inflammatory process of the pericardium in the region of 48 teeth,
the region of 48 preserved teeth, and the distal root of 47 teeth. The clinical situation in this case is
exacerbated by the formation of additional bone pockets in the region of the 47th tooth, which extends
beyond the specified root tip of the tooth. In the region of the 46th tooth, vertical bone pockets are
determined in the region of the distal root of the tooth, in addition to this, vertical bone resorption is
recorded in the fur region of the 46th tooth. Clinically, there is no mobility of these teeth. A similar
situation is observed in the left lower jaw. At the same time, the X-ray image practically reflects the
condition of the lower jaw on the right side, except for the retention and dystopia of the 48th tooth.
CONCLUSION
1. Rehabilitation of patients with generalized paradonitis should be carried out with the compulsory
participation of paradonologists, orthopedic dentists and orthopedic dental surgeons at all stages of
treatment. 2. With the obligatory participation of the hygienist and gynecologist, it is necessary to
conduct a clinic observation at least 6 times in 1 month, taking into account the depth and strength of
the pathological process. 3. Conservative treatment and cutting of teeth do not provide real stabilization
of the pathological process in generalized periodontitis of n degrees and in some cases contribute to the
asymptomatic progression of bone tissue destruction. 4. Surgical intervention, which involves careful
removal of pathologically altered tissue from the bone pocket, subsequent replacement with bone
conduction material and use in combination with other therapeutic agents, helps to reduce the intensity
of bone tissue destruction and, in some cases, create conditions for periodontal tissue regeneration
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