Objective: іmproving the effectiveness of complex treatment, rapidly progressing generalized periodontitis based on overcoming the acquired resistance of periodontal pathogenic microflora to standard (protocol) antibacterial therapy by correcting immune defense mechanisms and restoring normobiosis of periodontal econiche.
As part of our study, we examined 134 patients with generalized periodontitis I-II-III severity, with a rapidly progressive course of the disease. At the age of 25 to 49 years (average 32.9 ± 1.4 years). Among the observed patients, 71 (53%) were women and 63 (47%) were men. The control group for the establishment of normal values consisted of 24 apparently healthy patients.
Patients of I (comparison group), II and III main groups received standard antibacterial therapy: chlorine-containing agents (0.2% chlorhexidine solution), "Givalex", "Hexoral" were used locally. General antibiotic therapy included the appointment of amoxiclav or lincomycin (in a daily dose of 875 mg and 0.5 g 3 times a day for a course of 6-7 days).
For patients of group IV, the treatment complex provided for the replacement of drugs used in the previous group with photodynamic therapy carried out using the HELBO system.
In patients of groups I and II, immunocorrection was carried out with polyoxidonium. The treatment regimen for group III patients included the use of combined immunomodulatory therapy (polyoxidonium and lycopid). In order to restore the normobiosis of the periodontal ekonichi, upon completion of treatment, all patients were prescribed eubiotic Linex (1 tablet daily, lasting 6-7 days).
The analysis of the results of complex therapy in 44 patients with rapidly progressive generalized periodontitis, initiated by drug-sensitive opportunistic and periodontal pathogenic bacteria (group I), testified to its adequacy. It was found that the relief of the inflammatory process in patients of this group was achieved within 6-7 days of treatment (on average, after 6.4 ± 0.2 days) in 40 (95.2%) patients. During treatment, the release of periodontopathogens took place in 2 (4.8%) cases and only in patients with incomplete elimination of signs of an inflammatory reaction in the gingival tissue. Moreover, the burden of the periodontal econiche decreased by more than 3 times compared to the initial one. At the end of treatment, patients of group I achieved normalization of periodontal indices and samples, as well as indices of systemic and local immunity in all patients with eliminated inflammatory process in the periodontium. The achieved results were characterized by stable stability 6-12 months after the treatment. X-ray examination of the state of bone structures indicated the suspension of further resorption of the interdental alveolar septa, the disappearance or reduction of foci of osteoporosis in 38 (90.4% of patients).
The obtained results of the immunological study immediately after the end of treatment revealed that in patients of group III, under the influence of complex therapy, the indicators sIgA, IgM, α-INF, γ-INF, PhAN, PhN and PhI tended to the level of healthy (respectively 1.2 ± 0.3 g / L; 0.67 ± 0.02 g / L; 13.8 ± 0.7 pg / ml; 32.4 ± 1.2 pg / ml; 72.1 ± 1.8%; 5.8 ± 0,3 and 54.2 ± 1.8) to the normal level of systemic immunity values.
Thus, the use of photodynamic therapy instead of standard antibacterial agents in the complex treatment of rapidly progressing generalized periodontitis is very effective, according to clinical and radiological, microbiological and immunological data.
