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KEY POINTS IN THE TREATMENT OF RAPIDLY PROGRESSING PERIODONTITIS
Qurbonova Nodira Vohidovna
Asia International University,
Bukhara, Uzbekistan.
Email:
https://doi.org/10.5281/zenodo.14633212
Abstract. Modern dentists, when treating periodontitis, due to long-term results and some
negative aspects, choose surgical treatment instead of conservative treatment; removal followed
by implantology. There is sufficient information on the manifestation of the progressive course of
periodontal disease. Rapidly progressive periodontitis is an increasing, gradually intensifying
lightning process of various forms of periodontitis, leading to rapid tooth loss. Recently,
researchers have proposed many alternative treatment methods, but there is no single view on the
sequence of necessary therapeutic measures. Treatment of patients with rapidly progressive
periodontitis involves an individualized comprehensive approach to therapeutic measures.
Modern periodontology has a large arsenal of treatment methods that are equally applicable to
this course of periodontitis. modern methods of treating patients with rapidly progressive
periodontitis in comparison with our own research. Analysis of literature and experience of
treatment for 30 years with rapidly progressing periodontitis made it possible to identify the stages
of treatment: 1) cooperation of the patient with the doctor; 2) cooperation of the dentist-therapist
with the dental surgeons at the stages of treatment; 3) implementation of individual and
professional hygienic measures with control of plaque growth; 4) surgical treatment; 5) drug
therapy (including antiviral therapy according to indications) and physiotherapy; 6) maintenance
therapy.
Key words: exacerbation of chronic periodontitis, rapidly progressing periodontitis,
periodontitis, treatment, medicinal preparations for sealing.
КЛЮЧЕВЫЕ МОМЕНТЫ В ЛЕЧЕНИИ БЫСТРОПРОГРЕССИРУЮЩЕГО
ПАРОДОНТИТА
Аннотация. Современные стоматологи при лечении пародонтита из-за
отдаленных результатов и некоторых негативных моментов выбирают хирургическое
лечение вместо консервативного; удаление с последующей имплантацией. Имеется
достаточно информации о проявлении прогрессирующего течения пародонтита.
Быстропрогрессирующий пародонтит — это нарастающий, постепенно усиливающийся
молниеносный процесс различных форм пародонтита, приводящий к быстрой потере
зубов. В последнее время исследователями предложено много альтернативных методов
лечения, но единого взгляда на последовательность необходимых лечебных мероприятий
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нет. Лечение больных быстропрогрессирующим пародонтитом предполагает
индивидуализированный комплексный подход к лечебным мероприятиям. Современная
пародонтология располагает большим арсеналом методов лечения, которые в равной
степени применимы к данному течению пародонтита. современные методы лечения
больных быстропрогрессирующим пародонтитом в сравнении с собственными
исследованиями. Анализ литературы и опыта лечения за 30 лет при
быстропрогрессирующем пародонтите позволил выделить этапы лечения: 1)
сотрудничество пациента с врачом; 2) сотрудничество стоматолога-терапевта со
стоматологами-хирургами на этапах лечения; 3) проведение индивидуальных и
профессиональных гигиенических мероприятий с контролем роста зубного налета; 4)
хирургическое лечение; 5) медикаментозная терапия (в том числе противовирусная
терапия по показаниям) и физиотерапия; 6) поддерживающая терапия.
Ключевые
слова:
обострение
хронического
пародонтита,
быстропрогрессирующий пародонтит, пародонтит, лечение, лекарственные препараты
для пломбирования.
The processes occurring in the initial and early stages have been studied (S.P. Rubnikovich,
2011). There is sufficient information on the manifestation of the progressive course of periodontal
disease. Thus, among all forms of periodontitis, rapidly progressive periodontitis deserves special
attention due to its special clinical manifestations: lightning-fast and difficult to control destruction
of bone tissue against the background of a relative absence of local causal factors. The discrepancy
between the actual severity of periodontal tissue damage and visible clinical manifestations
distinguishes rapidly progressive periodontitis from other manifestations of periodontal diseases.
An unfavorable outcome is tooth loss over a relatively short period of time. It is important
to note that, unlike chronic periodontitis, the prevalence of which increases in older age groups,
rapidly progressing.
When treating any form of periodontitis, the main attention should be paid to the
mechanical and drug treatment of the root canal - locally and general drug treatment of the whole
div). Due to the presence of obvious anatomical and functional disorders of the maxillofacial
apparatus as an outcome of rapidly progressing periodontitis (including changes in occlusal
relationships, disruption of chewing function, aesthetics; dysfunction of the temporomandibular
joint (TMJ)), treatment of patients with rapidly progressing periodontitis in the early stages of the
disease, and, consequently, early diagnostics, are relevant areas at present. The earlier rapidly
progressing periodontitis is diagnosed, the greater the likelihood of a positive outcome of treatment
and achieving a stable result.
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Knowledge of the risk factors of this periodontal pathology is mandatory for early
diagnostics and individualized treatment. Among the risk factors of rapidly progressive
periodontitis are the following: (increased number of microorganisms per unit area - more than
104 / unit area, the presence of A. actinomycetemcomitans and P.gingivalis, the presence of herpes
virus, changes in phagocytosis, the emergence of a hypersensitive macrophage phenotype, genetic
factors) and bad habits, alcohol, (smoking, occlusal trauma, emotional stress syndrome,
occupational hazards, nutritional characteristics, loss of the level of gingival attachment due to
tooth migration after the removal of wisdom teeth. (L.N. Dedova et al., 2013) . At the same time,
the opinions of scientists are contradictory in matters of diagnosis and treatment of this category
of pathological process in periodontal tissues. In this regard, it became necessary to summarize the
material on the treatment of patients with rapidly progressive periodontitis in comparison with the
data of our own studies. Treatment of rapidly progressive periodontitis is a set of measures aimed
at the mechanism of development of the pathological process, which requires an individualized
approach and has certain features: cooperation of the dentist with periodontological centers during
the treatment; cooperation of the dentist with internists at the stages of treatment; implementation
of individual and professional hygienic measures with control of plaque growth; surgical
treatment; drug therapy and physiotherapy; supportive therapy.
Additional research methods: determination of the periodontal microcirculation state
(laser-optical diagnostics, vacuum test to determine capillary pressure); bone remodeling process
(determination of bone formation and bone resorption markers - osteocalcin, β-Cross Laps, C-
telopeptide of type I collagen; densitometry); biochemical blood test (determination of elastase-
inhibitory activity of blood serum); study of local inflammatory response (determination of the
functional activity of blood serum neutrophils using the HCT test); morphological methods for
examining the contents of periodontal pockets; study of the state of the immune barrier
(determination of lymphocyte subpopulations by CD markers,
Cooperation of a dentist with doctors of other fields (endocrinologists, hematologists,
oncologists, infectious disease specialists, etc.) at the stages of treatment plays a significant role.
Cooperation with internists is due to the fact that a rapidly progressive course often occurs
against the background of a general somatic disease.
It is known that symptomatic periodontitis is a group of periodontal diseases in which
pathological changes in periodontal tissues are a symptom or result of systemic diseases (diabetes
mellitus, leukemia, anemia, agranulocytosis, HIV infection, collagenoses, osteoporosis, liver
diseases, etc.). The level of development of systemic pathology largely determines the prognosis
of periodontal diseases. The presence of a systemic disease that provokes the development of
symptomatic periodontitis undoubtedly worsens the prognosis of the disease and requires targeted
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comprehensive treatment, which involves an endocrinologist, hematologist, gynecologist,
immunologist, pediatrician, rheumatologist, infectious disease specialist or other internist. In this
case, it is difficult to achieve success only through the efforts of a periodontist, since the effect of
periodontal treatment depends on the state of the general somatic disease. Therefore, the treatment
of a patient with rapidly progressing periodontitis requires cooperation between a periodontist and
an interdisciplinary internist. In addition, cooperation with an internist will help to avoid irrational
and incorrect prescription of both systemic and local drugs to the patient. In addition, cooperation
between a periodontist and an orthodontist is fundamental, as the orthodontist will determine the
stress-strain state of the dentoalveolar system and, depending on it, adjust the frequency and
volume of treatment procedures. It is known that when planning treatment for patients with rapidly
progressing periodontitis, special attention should be paid to normalizing occlusal relationships
that have changed due to tooth migration, the occurrence of supracontacts, rotation of teeth along
the axis, labiolingual or mesiodistal inclination of individual teeth. This will prevent further loss
of bone tissue of the alveolar processes, teeth and TMJ dysfunction.
Carrying out individual and professional hygiene measures with control over dental plaque
growth. A conclusion about the extent to which clinical manifestations of periodontitis and general
somatic disease are related can be made only after complete elimination of local unfavorable
factors that caused the development of inflammatory and destructive changes in periodontal
tissues. In this regard, an important condition for effective treatment is determining access to the
affected tissues, smoothing the root surface with motivating patients on oral hygiene, and
mandatory re-evaluation of the condition after 2-3 weeks. At this stage, it is important for the
patient and the dentist to control the growth of dental plaque. The role of the dentist is to convey
to the patient all the information about the controlled risk factors in an accessible form: a
conversation about the risk factors of periodontal diseases; correction of hygiene skills - a
demonstration of alternative methods of brushing teeth to the patient (the modified Bass method
for patients without gingival recession, as well as the Stillman method for patients with recession,
deserve attention); application of additional hygiene products – interdental stimulators and
irrigators, mouthwashes; correction of hygiene skills. The goal of this stage is to destroy the
bacterial film, reduce the number of bacteria, slow down recolonization by pathogenic
microorganisms, replace pathogenic microflora with one compatible with healthy periodontal
tissues. A. Аctinomycetemcomitans and P. Gingivalis, putative periodontopathogenic bacteria,
have the ability to produce a large number of biologically active substances that can directly affect
the cells of the host organism and disrupt their integrity. The difficulties that arise at the stages of
treating rapidly progressing periodontitis using only hygienic measures are explained by the fact
that the association of A. Аctinomycetemcomitans and P. Gingivalis (these microorganisms are
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preferred over others in the development of rapidly progressing periodontitis) is characterized by
the ability to penetrate into the periodontal tissues. In addition, the species A.
actinomycetemcomitans is known for its ability to form an extremely sticky biofilm. Biofilm
complicates the treatment of periodontitis by isolating microorganisms from local anti-
inflammatory and immune responses, reducing the effectiveness of antibacterial drugs, and
ensuring the diffuse spread of planktonic cells to hard-to-reach places, which can subsequently
lead to reinfection. Mechanical removal of dental plaque and elimination of local irritants,
smoothing the root surface are the quintessence of any periodontal therapy.
Removal of dental plaque can be carried out at one time or in stages, it is necessary to
smooth the surface of the roots of one quadrant of the teeth in one visit. In addition, the method of
antimicrobial treatment of the oral cavity deserves attention, first scraping and smoothing the
surface of the root of all teeth (at one time), and then treating the tongue with a 1% chlorhexidine
solution for 1 minute, rinsing the mouth with solutions of medicinal herbs (chamomile, sage, oak
bark, green tea), biodent, 0.2% chlorhexidine for 2 minutes, irrigation of the peridontal pockets
with a 1% chlorhexidine solution. Complex treatment of periodontitis in almost 90% of cases gives
positive results in the treatment of any form of rapidly progressing periodontitis.
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