Novoshytskyy V. Clinical and Pathogenetic Substantiation of Vitamin D Application in Complex Treatment of Periodontitis

The dissertation focuses on studying the impact of vitamin D on the course of periodontitis and improvement of complex treatment of periodontitis. The research among adults with periodontal diseases showed that 74.2±6,1% of patients had vitamin D deficiency and insufficiency. The lowest level of vitamin D in men (24.52(20.91-31.07) ng/ml) and women (22.59(16.62-29.01) ng/ml) with periodontal diseases was found in the age group up to 45 years old. The impact of seasonal factors on vitamin D level in patients with periodontal diseases was studied. The highest level of vitamin D was observed in autumn (30.11(21.68-36.15) ng/ml) and the lowest level was observed in spring (20.57(13 80-27.75) ng/ml). There was revealed a clear trend to increase the height loss of alveolar bone of mandible with decreasing concentrations of 25(OH)D (1.84(1.14-3.50) mm at vitamin D sufficiency and 2.53(1.19-3.28) mm at vitamin D deficiency) and increase the activity of bone remodeling in young patients with periodontitis. A significantly lower parathyroid hormone level was found in young patients with periodontitis that had vitamin D deficiency, resulting in a smaller calcium excretion from bones. Middle-aged patients with vitamin D deficiency showed higher level of alveolar bone loss in mandible (2.81(1.68-4.08) mm) and in maxilla (3.36(1.95-3.99) mm) compared with patients with vitamin D sufficiency (2.14(1.43-2.40) mm and 2.92(1.88-3.82) mm respectively). In the presence of vitamin D deficiency and insufficiency, systemic changes of bone metabolism were registered: increased parathyroid hormone secretion and intensifying bone remodeling processes that are aimed at increasing of bone formation and inclusion of compensatory mechanisms. Increasing bone remodelling because of vitamin D level decreasing was observed. It contributes to alveolar bone loss of mandible in patients with periodontitis. As the result, the compensatory mechanisms of the body are activated to increase the mandible body height in response to mastication load. Aggravation of periodontitis in patients who had vitamin D deficiency occurs significantly more often than in patients with vitamin D sufficiency and insufficiency. There is a significant (p<0.001) linear relationship between the number of tooth loss and age in patients with periodontitis who had vitamin D deficiency and insufficiency. However, in patients with vitamin D sufficiency a significant linear relationship between the number of tooth loss and age was not found (p = 0.310), which demonstrates the importance of vitamin D in the prevention of tooth loss.