THE EFFECTIVENESS OF THE TEMPORARY ROOT FILLINGS BASED ON POLYOXIDONIUM THE TREATMENT OF DESTRUCTIVE FORMS OF SECONDARY APICAL PERIODONTITIS

• Main Authors: A. V. Samoylenko, P. I. Gritsenko
• Format: Article
• Language: English
• Published: Ukrainian Medical Stomatological Academy 2016-03-01
• Series: Український стоматологічний альманах
• Subjects: secondary destructive apical periodontitis, gingival fluid, polyoxidonium, clinical and radiological indicators, cytokines.
• Online Access: https://dental-almanac.org/index.php/journal/article/view/212
• ISSN: 2409-0255; 2410-1427

A comparative evaluation of the effectiveness of destructive forms treatment of secondary chronic apical periodontitis of single rooted teeth by delayed root canal obturation, including temporary root canal filling paste based on immunomodulator polyoxidonium (48 teeth), and the traditional method-session (52 teeth) were done. There was an application of the paste on the basis of the medicine, rendering immunotropic effect, due to the participation of immunological mechanisms in the development of centers of periapical bone destruction (FDBT). According to the received information, on the background of the local application of polyoxidonium FDBT there is a tendency to reduce the size within a month after completion of root canal treatment in almost half of the cases (23 teeth - 47.9%). After 3 months of treatment control radiographs showed regression of FDBT 1/3 of the original size in 38 (79.2%) of the teeth, after 6 months destruction foci size decreased to 1/2 in 42 (87.5%) of the teeth after 12 months in 37 (77.1%) were recorded teeth complete restoration of bone structure. Restoration of bone tissue in the comparative group took place much more slowly. Regression of ODKT 1/3 was detected after 3 months in only 16 (30.8%) of the teeth. After 6 months, regression of destructive lesions was noted on 1/2 in 18 (34.6%) teeth in 12 months - in 23 (44.2%) teeth. Full recovery of FDBT structure was observed in 25 (48.1%) of the teeth. In general, local application of polyoxidonium immediately reduced acute periodontitis after the completion of treatment by 5.9 times, there was the absence of exacerbation within 12 months compared with 13% in the control group, and increased rate of regression of bone foci destruction in the area of apex during this period of surveillance by 1.6 times. Positive dynamics of clinical and radiological indicators were accompanied by normalization of cytokine profile in gingival fluid. So, against the background of immune levels of pro-inflammatory cytokines significantly decreased with respect to the index before treatment IL-1β (126,19 ± 10,92 pg / ml vs 164,25 ± 14,73 pg / ml) and IL-6 (72.63 ± 8.76 pg / ml versus 118,37 ± 13,11 pg / ml), and levels of anti-inflammatory cytokine increased IL-4 (11,35 ± 0,97 pg / ml versus 6,93 ± 0,57 pg / ml) in gingival fluid. These changes reflect the decrease in the ratio of IL-1β / IL-4 in more than 2 times (11.11 against 23.70), indicating the positive changes in immunocytokines system. During the examination after 6 and 12 months after permanent root canal obturation patients’ showed indicators are within the target values. However, the ratio of IL-1β / IL-4 at 6 months was higher than the conventional rules of 17.2% (9.19 vs. 7.84). That is, in this period of monitoring the balance in cytokine regulation was not completely restored. Another situation occurred when using the traditional method of treatment of granulomatous periodontitis. The concentration in the gingival fluid IL-1β in all periods after treatment decreased in relation to the index before the treatment, which was not statistically confirmed. It remained significantly higher compared with control values of the interleukin concentration. As for the other pro-inflammatory cytokines - IL-6, the figure also did not differ significantly from baseline immediately after the treatment and examination at 6 months. After 12 months, it recorded a significant decline (from 127,59 ± 12,29 pg / ml to 97,56 ± 8,56 pg / ml, p = 0.05), but the figure was significantly higher than the conventional norm. Studying the dynamics of anti-inflammatory IL-4 showed a significant increase in the rate at 6 and 12 months after treatment (10,70 ± 1,12 pg / ml and 10,67 ± 0,99 pg / ml, respectively, against 6,75 ± 0,64 pg / ml, but in the terms of its concentration in the gingival fluid was significantly different from the values in healthy individuals. Persistent violations in cytokine regulation were confirmed by the dynamics of the ratio of IL-1β / IL-4. Throughout the entire period of observation rate moderately decreased in relation to the original, reaching 19.0, 14.09 and 13.99, respectively, but remained significantly higher than the conventional standards (at 142.3%, 79.7% and 78.4%).