Clinical Evaluation of Periodontal Tissue Status in Prosthodontic Treatment of Patients with Partial Tooth Loss and Generalized Periodontitis

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1 Galician medical journal 2017 Vol. 24, Issue 4, E DOI: /gmj Research Article Clinical Evaluation of Periodontal Tissue Status in Prosthodontic Treatment of Patients with Partial Tooth Loss and Generalized Periodontitis A. Kushlyk *, Z. Ozhogan, M. Melnychuk Abstract The roblem of selection and alication of dental rostheses in eriodontal disease is esecially relevant in case of severe generalized eriodontitis, which is accomanied by mobile tooth removal resulting in overloading the eriodontium of the remaining teeth as well as the increase in tooth mobility. Therefore, in generalized eriodontitis, it is imortant to aly the method of direct since, in case of artial tooth loss, it will revent the develoment of generalized eriodontitis comlications. The objective of the research was to imrove the effectiveness of combination theray for atients with generalized eriodontitis and artial tooth loss alying the develoed method of direct fixed based on the study of the eriodontal status. Materials and methods. The study included 129 atients with general eriodontitis, II-III degree and artial tooth loss over the age of 45 years. According to rosthodontic treatment, all the atients were divided into three grous: Grou I consisted of 42 (20 women and 22 men) atients who immediately after tooth extraction were rehabilitated with the alication of direct lastic laminar immediate rosthesis and selective tooth grinding; ermanent was erformed 6 weeks after tooth extraction; Grou II included 43 (21 women and 22 men) atients who underwent traditional ermanent using fixed dental bridges 6 weeks after mobile tooth removal and wound healing; Grou III comrised 44 (21 women and 23 men) atients who immediately after mobile tooth removal were rehabilitated with the alication of direct fixed tional dental bridge (Ukrainian atent UA Feb 15) and selective tooth grinding; ermanent was erformed tooth extraction. The control grou consisted of 26 eole with intact dentitions over the age of 45 years. Results and discussion. The alication of direct method after mobile tooth removal in combination treatment of generalized eriodontitis allows stabilizing degenerative and inflammatory rocesses in the eriodontium in the initial stages, as well as increasing the resistance of the caillaries and bone mineral density of the interdental seta. The obtained data indicated that the alication of the roosed direct fixed tional dental bridge was more effective as comared to conventional rosthetics methods. Conclusions. 1. Direct fixed rosthodontics using direct fixed tional dental bridge is essential in combination treatment of generalized eriodontitis, esecially if mobile tooth extraction is needed. It allows increasing the effectiveness of treatment in comarison with direct removable rosthodontics using direct lastic laminar immediate rosthesis (Grou I) and traditional treatment methods (Grou II). 2. We have roved the advantages of direct fixed rosthodontics in treatment of atients with generalized eriodontitis, II-III degree based on the imrovement of oral hygiene indices, the gingival bleeding index, the aillary-marginal-alveolar index, the eriodontal index and the deth of eriodontal ockets 6- treatment. Keywords generalized eriodontitis; direct Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine *Corresonding author: kairoskush2@gmail.com Problem statement and analysis of the recent research According to various authors, the revalence of eriodontal diseases among the oulation of Ukraine is % [2]. At the current stage of rosthetic dentistry develoment, its main roblem is the revention and treatment of these diseases [1]. Generalized eriodontitis (GP) is a chronic degenerative inflammatory disease of the olyetiological nature which is characterized by gingival inflammation, formation of eriodontal ockets, bone resortion of the alveolar rocess [3, 4]. In the athogenesis of GP, neurovascular disorders in the eriodontal tissues are the major factor whereas a critical role is layed by vascular disorders [5]. Under the influence of etiological factors, in the eriodontium, athological changes occur which may cause a disturbed bone metabolism as well as metabolic disorders [6]. Local factors are involved as well,

2 Generalized Periodontitis 2/5 rimarily masticatory function [7]. Thus, in case of artial tooth loss, masticatory function leads to the increase in the deformation and secific ressure on the affected eriodontal tissues which, in turn, is accomanied by a greater mobility amlitude of the remaining teeth imairing the blood suly to the eriodontal tissues and resulting in significant changes in tissue metabolism. The elimination of increased deformation and ressure on the reserved eriodontal tissues during mastication is a theraeutic agent and can be accomlished by means of rosthetic methods only [8]. Prosthodontic treatment becomes articularly imortant in artial tooth absence comlicated by GP which is exlained by the fact that in addition to the factor of increased deformation of the bone tissue caused by atrohy the factor of additional arrhythmic functional loads aears and the remaining teeth are exected to ick u the loss in function [7, 9]. It should be noted that not only the increased load which aears due to atrohic rocesses affects the reserved eriodontal tissues, but also additional one - due to the increased number of masticatory movements required for chewing food in dentition defects. Rational rosthodontic treatment of dentition defects in atients with GP should be conducted considering the functional state of the microvascular system of the eriodontal tissue as well as structural and functional changes in the bone tissue of the alveolar rocess. The selection and alication of dental rostheses in eriodontal diseases are esecially relevant in case of severe GP, which is accomanied by mobile tooth removal resulting in overloading the eriodontium of the remaining teeth as well as the increase in tooth mobility [10]. Therefore, in GP, it is imortant to aly the method of direct since, in case of artial tooth loss, it will revent the develoment of GP comlications. The objective of the research was to imrove the effectiveness of combination theray for atients with GP and artial tooth loss alying the develoed method of direct fixed based on the study of the eriodontal status. 1. Materials and methods We have selected the atients whose mobile teeth were removed due to exacerbation of eriodontal disease. The study included 129 atients with GP, II-III degree and artial tooth loss over the age of 45 years. According to rosthodontic treatment, all the atients were divided into three grous: Grou I consisted of 42 (20 women and 22 men) atients who immediately after tooth extraction were rehabilitated with the alication of direct lastic laminar immediate rosthesis and selective tooth grinding; ermanent was erformed 6 weeks after tooth extraction; Grou II included 43 (21 women and 22 men) atients who underwent traditional ermanent using fixed dental bridges 6 weeks after mobile tooth removal and wound healing; Grou III comrised 44 (21 women and 23 men) atients who immediately after mobile tooth removal were rehabilitated with the alication of direct fixed tional dental bridge (Ukrainian atent UA Feb 15) and selective tooth grinding; ermanent was erformed 6 months after tooth extraction. The control grou consisted of 26 eole with intact dentitions over the age of 45 years. In addition to studying oral hygiene indices, the aillarymarginal-alveolar (PMA) index, the gingival bleeding index, the eriodontal index (PI), the mobility index and the gingival recession index, the study of the eriodontal status included the determination of vascular resistance of eriodontal caillaries in the frontal teeth (V.I. Kulazhenko s test, 1961) and combined eriodontal index (CPI) (T.V. Nikitina, 1982). Structural and functional state of the bone tissue was determined by the level of bone turnover markers. Bone mineral density of the alveolar rocess in the interdental seta of the remaining teeth was determined using comuter tomograhy by means of Somatom Emotion Siemens aaratus. The examination of the eriodontal tissues as well as the state of vascular resistance in the eriodontium was erformed before and 6 weeks after mobile tooth removal; 6 months and one year after ermanent. 2. Results and discussion Comlex study of the state of eriodontal indices, functional state of eriodontal vessels as well as structural and functional state of the alveolar rocess bone tissue allowed us to obtain the following results. In Grou I, on the background of oor oral hygiene, there were observed ronounced inflammation in the eriodontal tissues of the mobile teeth, gingival bleeding and eriodontal ockets (Table 1). This was reflected in the indicators of vascular resistance of eriodontal caillaries being accomanied by increased activity of resortion rocesses and decrease in bone mineral density of the interdental seta in the alveolar rocess. The fixation of direct immediate rosthesis after tooth removal in Grou I reduced the inflammatory rocess in the eriodontium, tooth mobility and gingival bleeding within 6 weeks. Further ermanent using fixed restorations had a ositive effect on the eriodontal tissues of the remaining teeth throughout the year, which was reflected in the increase in time for hematoma formation according to the method roosed by V.I. Kulazhenko and the decrease in CPI indicators (Table 1). treatment, the gingival bleeding index imroved significantly u to (1.01±0.07) scores as comared to the initial values - (1.89±0.06) scores. Similar dynamics was observed when analyzing oral hygiene indices and the PMA index. Stabilization of the clinical course of eriodontal disease was confirmed by a decrease in the mobility of the remaining teeth as well as the indicator of bone tissue resortion marker reflected in increased bone mineral density of the interdental seta. In Grou II, the healing rocess 6 weeks after tooth extraction was characterized by oor oral hygiene, further develoment of inflammatory and degenerative henomena in the e-

3 Generalized Periodontitis 3/5 Table 1. Clinical state of the eriodontal tissues, metabolism and bone mineral density in atients of Grou I (M±m) Before tooth 6 weeks after extraction tooth extraction HI-DI-S, oints 2.48± ± ± ±0.06 <0.01 HI-CI-S, oints 2.24± ± ± ±0.17 <0.01 PMA, % 58.6± ± ± ±0.3 <0.05 Bleeding, oints 1.89± ± ± ±0.07 <0.05 PP deth, Mm 5.53± ± ± ±0.03 <0.05 Rtg recession index, 5.81± ± ±0.05 <0.05 mm Kulazhenko s test, 13.4± ± ± ±0.03 <0.05 CPI, oints 8.21± ± ± ±0.01 <0.05 Mobility, oints 2.16± ± ± ±0.04 <0.01 Notes. HI - hygiene index; DI-S - the simlified debris index; CI-S - the simlified calculus index; PP - eriodontal ocket; - significance of differences before tooth extraction and. riodontium and the mobility of the remaining teeth, increased gingival bleeding, dee eriodontal ockets, high recession index (Table 2). The swelling of the mucous membrane in the region of the remaining teeth was accomanied by a decrease in the indicators of vascular resistance - V.I. Kulazhenko s test as well as CPI. treatment, the gingival bleeding index imroved significantly u to (1.31±0.05) scores as comared to the data before treatment - (1.81±0.06) scores. Similar dynamics was observed when analyzing other indices such as the PMA, CPI, oral hygiene indices, although they were worse than those in Grou I. It should be noted that ermanent using fixed restorations stabilized the clinical course of GP, which was exressed by the decrease in tooth mobility, inflammation and gingival bleeding within 6 months. The alication of direct fixed tional dental bridge when rehabilitating atients with GP, II-III degree in case of mobile tooth extraction was characterized by the stabilization of the inflammatory and degenerative rocesses in the eriodontal tissues of the remaining teeth as well as the decrease in tooth mobility and gingival bleeding within 6 weeks. This was accomanied by increased resistance of caillary vessels (V.I. Kulazhenko s test) and the normalization of bone metabolism (Table 3). treatment, the gingival bleeding index imroved significantly u to (0.81±0.06) scores as comared to the initial values - (1.99±0.04) scores. The analysis of the PMA index, CPI and oral hygiene indices demonstrated similar dynamics; however, they were better than indices in Grou I and Grou II. The reduction in the indicator of bone resortion marker (total deoxyyridinoline (DPD)) within 6 months imroved bone mineral density of the interdental seta in the alveolar rocess throughout the year. The alication of direct fixed tional dental bridge allowed stabilizing the resortive rocesses that decreased the indicator of CPI (Table 3). The stabilization of the indices of the functional state of eriodontal vessels as well as structural and functional state of the bone tissue in atients of Grou III had a long-term effect even a year after. Thus, our research has shown that the removal of mobile teeth and traditional in the remote eriod after damaged surface healing caused exacerbation of GP in the eriodontal tissues of the remaining teeth, namely the increase in the PMA index, the gingival bleeding index, the dee of eriodontal ockets as well as the decrease in the caillary resistance. The obtained data are consistent with available literature data and are exlained by overloading the eriodontium of the remaining teeth. Though we can observe the imrovement of the eriodontal status throughout the year, it occurs on the background of increased bone resortion and decreased bone mineral density that may result in further exacerbation of GP. The alication of direct method after mobile tooth removal in combination treatment of GP allows stabilizing degenerative and inflammatory rocesses in the eriodontium in the initial stages, as well as increasing the resistance of the caillaries and bone mineral density of the interdental seta. The obtained data indicated that the alication of the roosed direct fixed tional dental bridge was more effective as comared to conventional rosthetics methods.

4 Generalized Periodontitis 4/5 Table 2. Clinical state of the eriodontal tissues, metabolism and bone mineral density in atients of Grou II (M±m) Before tooth extraction 6 weeks after tooth extraction HI-DI-S, oints 2.56± ± ± ±0.05 <0.01 HI-CI-S, oints 2.31± ± ± ±0.16 <0.01 PMA, % 55.4± ± ± ±0.2 <0.05 Bleeding, oints 1.81± ± ± ±0.05 <0.05 PP deth, Mm 5.61± ± ± ±0.02 <0.05 Rtg recession index, 5.79± ± ±0.04 <0.05 mm Kulazhenko s test, 11.8± ± ± ±0.04 <0.05 CPI, oints 7.91± ± ± ±0.05 <0.05 Mobility, oints 2.24± ± ± ±0.04 <0.01 Note: significance of differences before tooth extraction and. Table 3. Clinical state of the eriodontal tissues, metabolism and bone mineral density in atients of Grou III (M±m) Before tooth extraction 6 weeks after tooth extraction HI-DI-S, oints 2.48± ± ± ±0.05 <0.01 HI-CI-S, oints 2.24± ± ± ±0.16 <0.01 PMA, % 56.5± ± ± ±1.3 <0.05 Bleeding, oints 1.99± ± ± ±0.06 <0.05 PP deth, Mm 5.42± ± ± ±0.04 <0.05 Rtg recession 5.77± ± ±0.04 <0.05 inex, mm Kulazhenko s test, 12.4± ± ± ±0.03 <0.05 CPI, oints 8.12± ± ± ±0.01 <0.05 Mobility, oints 2.16± ± ± ±0.03 <0.01 Note: significance of differences before tooth extraction and. 3. Conclusions 1. Direct fixed rosthodontics using direct fixed tional dental bridge is essential in combination treatment of GP, esecially if mobile tooth extraction is needed. It allows increasing the effectiveness of treatment in comarison with direct removable rosthodontics using direct lastic laminar immediate rosthesis (Grou I) and traditional treatment methods (Grou II). 2. We have roved the advantages of direct fixed rosthodontics in treatment of atients with GP, II-III degree based on the imrovement of oral hygiene indices, the gingival bleeding index, the PMA index, the PI and the deth of eriodontal ockets 6- treatment. 4. Prosects for further research The conducted research has shown the necessity of alying immediate esthetic dentures in combination treatment of atients with GP and further clinical substantiation of the roosed methods. References [1] Vyshnyak GN. Generalizovannyye zabolevaniya arodonta (arodontoz, arodontit). Kyiv; c [2] Kolesova NA, Politun AM, Kolesova NV. Sravnitelnyy kliniko-rentgenologicheskiy i morfologicheskiy analiz mekhanizmov ovrezhdeniya kostnoy tkani alveolyarnogo otrostka chelyustey ri razlichnykh variantakh

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