The aim of the present research is increasing the effectiveness of complex treatment of generalized periodontitis in patients with a compensated form of type 2 diabetes by the way of the clinical and experimental substantiation of osteotropic therapy of the disease.
To achieve this aim, the work was carried out in two stages. At the first (experimental) stage, to substantiate the feasibility of supplementing osteotropic therapy with strontium ranelate, its effect on periodontal tissues was studied in a model of periodontitis on the background of diabetes mellitus, reproduced on rats, using the methods of computer tomography, atomic emission spectrometry and histological, particularly immunohistochemical methods. At the second stage of the dissertation research, they carried out the clinical trial of the complex treatment scheme for generalized periodontitis using osteotropic therapy supplemented with strontium ranelate, developed on the basis of the experimental research results.
It was conducted the comparative study of the mineral density and chemical composition of the mandibular bone tissue in rats in the modelling of generalized periodontitis, which develops against the background of metabolic disorders in type 2 diabetes mellitus, and after additional use of strontium ranelate.
So, according data of computer tomography, it was found that in the control group the average values of the mineral density are 1450.0 ± 125.0 HU, in the first group – 1320.0 ± 120.0 HU (p > 0.05), in the second group – 1100.0 ± 110.0 HU (p ˂ 0.05), in the third group – 1400.0 ± 137.0 HU (p > 0.05). Thus, the most pronounced decrease in mineral density was observed with the combined use of nicotinamide, streptozotocin and penicylamine, while strontium ranelate helped to normalize this indicator.
In turn, according to atomic emission spectrometry, the mineralization index (calcium / phosphorus ratio) was 1.14 in the control group, it was 1.05 in the first group, it was 1.0 in the second group and it was 1.26 in the third group. The strontium content in the samples of the third group exceeded the control values by almost in two times (p ˂ 0.001) in comparison with its significant decrease in the samples of the first and second groups (p ˂ 0.05). An increase in the strontium content led to a decrease in the content of other elements, which was explained by the competitive substitution in apatite crystals. So, strontium ranelate could activate remineralization of the periodontal bone component.
The clinical trial included 60 patients with generalized periodontitis of I-II degree of severity, chronic course, aged 35-45 years, who were diagnosed with compensated form of type 2 diabetes mellitus, from whom two groups were formed. They were group of comparison, in which the traditional treatment regimen was used, and main group, where patients were prescribed strontium ranelate additionally. The treatment effectiveness was evaluated according to the dynamics of clinical observations, orthopantomography and computed tomography data, the results of biochemical studies. As markers of bone resorption, tartrate-resistant acid phosphatase activity in blood serum and the content of β-CrossLaps fragments in urine were determined. As markers of osteogenesis, the concentration of C-terminal propeptide type I procollagen in blood plasma, bone alkaline phosphatase and osteocalcin in blood serum were determined. Serum parathyroid hormone concentrations, total calcium and total inorganic phosphorus in the blood were studied as indicators of mineral metabolism.
Thus, the use of strontium ranelate in the complex treatment of generalized periodontitis in patients with type 2 diabetes mellitus provides a longer and more stable clinical and radiological stabilization of the pathological process in periodontal tissues, primarily by inhibiting bone resorption and enhancing osteogenesis. The obtained results allow us to recommend the wide use of strontium ranelate in stomatological practice.
