The dissertation is devoted to studying of clinical course features and common units of pathogenesis of inflammatory diseases of periodontal tissues (IDPT) and gastric, duodenal ulcer (GDU), and the effects of fixed metal (FMD), cermet (FCMD) and ceramic dentures (FCD) on periodontal tissues, on the basis of what the method of comprehensive treatment, prevention of tooth loss is optimized and algorithm for efficient dental prosthetics is developed.
Object – pathological changes in periodontal tissues in 177 patients with GDU with FMD, FCMD or FCD, clinical efficacy of antioxidants and complex stabilizers of connective tissue. Subject of research: the state of periodontal tissues, the hygienic state of the oral cavity in the presence of fixed dentures of different materials, oxidant-antioxidant homeostasis; the intensity of nitrosis stress, endotoxicosis, the state of the components of the connective tissue, the content of proinflammatory cytokines (TNF-α, IL-1β) and the transforming growth factor (TGF-β1) in the blood of patients with GDU. Aim – to improve orthopedic treatment of patients with GDU on the basis of rational methods of fixed dentures, optimization of complex therapy of IDPT taking into account oxidant antioxidant homeostasis, state of protein carbohydrate components of the extracellular matrix and their cytokine regulation. Methods – epidemiological, clinical, laboratory, biochemical, instrumental, immuno-enzymatic, functional and statistical.
It was established that IDPT determined in 100 % of cases in the patients with GDU. Most of patients with ulcer had FMD (48,5 %), the part of established FCMD (31,4 %) and FCD (20,1 %) was significantly lower. 32,2 % of patients with GDU without dentures, 35,4 % – with FMD, 11,9 % – FCMD, 3,7 % – with FCD and 5,0 % of practically healthy persons (PHP) had the prosthetics requirement of edentulous spaces.
Scientific innovation. Based on clinical, biochemical, immunoenzyme researches it was conducted for the first time a comparative assessment of changes in dental status and periodontal conditions, indicators of oxidant-antioxidant homeostasis, endotoxicosis, metabolism of extracellular matrix (ECM) components of periodontal connective tissue and their cytokine regulation in prosthetics of patients with GDU with fixed dentures made of different constructional materials. Based on scientific data it was significantly complemented the concept of pathogenesis of IDPT and GDU, which are complicated, in the presence of FMD, the pathogenetic basis of further tooth loss was established and ways to prevent them were described.
For the first time it was proposed and proved the effectiveness of comprehensive therapy of IDPT in patients with GDU with metal dentures with the inclusion to basic treatment L-glutathione (enterally and locally) and Nemolix C3, which reduces the intensity of LPO and OMP, NOIS, endotoxicosis, promotes strengthening of the activity of ADS factors, restoration of the metabolism of components of the ECM in periodontium (strengthening of intensity of collagen, glycosaminoglycans and glycoproteins synthesis on the background of a possible collagenolysis slowdown and and fukoglycoproteins degradation).
The practical significance of the results. Based on the study of the particularities of clinical course and common pathogenesis links of IDPT and GDU, and the effects of FMD on periodontal tissues, the increase of efficiency of tooth loss comprehensive prevention was achieved and the algorithm of efficient prosthetics of patients using FCD because of their biological inertness. Without the possibility of FCD installing the prosthetics using FCMD was recommended.
The author developed and introduced in public health practice pathogenetically reasonable method of complex treatment of patients with comorbid IDPT and GDU, which must be repeated every six months for persons with fixed metal dentures.
