The thesis to obtain the academic degree of Doctor (MD) in specialty 14.01.22 Dentistry. – Shupyk National Medical Academy of Postgraduate Education, Ministry of Health of Ukraine, Kyiv, 2020.
The thesis is devoted to the theoretical substantiation and practical solution of the relevant problem in modern dentistry: increasing the effectiveness of treatment of periodontitis and periodontal diseases depending on the type of the patients’ autonomic nervous system. The research was aimed at experimental and clinical substantiation of the drug complexes use for premedication in the treatment of dental diseases in patients with different types (sympathetic, parasympathetic) of the autonomic nervous system.
The effectiveness of the offered schemes of drug premedication was substantiated in a series of experimental studies.
While reproducing the experimental model of periodontitis and hyperactivity of the sympathetic and parasympathetic nervous systems by injecting epinephrine or pilocarpine into experimental animals, we observed considerable deteriorations of biochemical parameters of the periodontal tissues (gum, bone tissue). The use of the suggested drug composition, respectively, adrenergic blockers or acetylcholine blockers, improves the biochemical parameters of periodontal tissues.
Biochemical parameters in experimental animals indicate the normalizing effect of the suggested drug complexes in case of the reproduction of experimental hyperactivity of the sympathetic and parasympathetic autonomic nervous system.
Several series of clinical studies were conducted to determine the clinical effectiveness of the suggested drug complexes.
Scientific novelty of the results. For the first time, the predominance of the sympathetic nervous system (by administering epinephrine) and the parasympathetic nervous system (by administering pilocarpine) was reproduced on a developed model of experimental periodontitis. On the model of the predominance of the parasympathetic autonomic nervous system (by the introduction of pilocarpine), it was shown that the application of acetylcholine blockers reduces the activity of urease, which may indicate a decrease in bacterial contamination. Acetylcholine blockers increase the level of calcium in the bone tissue of the periodontium. This leads to an increase in the degree of mineralization of the bone tissue, as evidenced by the growth of the mineralizing index and the degree of mineralization of bone tissue. Thus, the use of the suggested drug composition of acetylcholine blockers improves the biochemical parameters of periodontal tissues and has a periodontal protection effect in case of modeling the predominance of the parasympathetic autonomic nervous system. During reproducing the experimental model of periodontitis and hyperactivity of the sympathetic nervous system with the epinephrine injections into experimental animals, the biochemical parameters of the periodontal tissues (gums, bone tissue) are significantly disturbed. The use of the suggested drug composition of adrenergic blockers improves the biochemical parameters of periodontal tissues.
The effectiveness of the suggested premedication in the endodontic treatment of periapical periodontal lesions was shown in conducted clinical and laboratory studies. It was found that the treatment of patients led to a significant improvement in subjective and objective characteristics, laboratory, and index indicators of the periodontal tissue, regardless of the treatment method, but slightly more significant positive changes in patients of the main subgroups.
The priority of thesis research is confirmed by 8 patents of Ukraine.
The practical significance of the results. Complexes of drugs for premedication in the treatment of generalized periodontitis and periapical periodontitis in patients with different types of the autonomic nervous system are offered.
Key words: autonomic nervous system, periodontitis, generalized periodontitis, periapical-periodontal lesions, vegetative modulators, drug complexes, treatment.
