The dissertation is devoted to the solution of the scientific problem, which is to increase the effectiveness of treatment and preventive measures aimed at preparing patients with dentoalveolar anomalies (DA) with compromised periodontal complex, namely, with diagnosed chronic generalized periodontitis (CGP) of the initial-I degree of severity, for active orthodontic treatment by reducing the stress-modulating effect of fixed orthodontic appliances and preventing oxidative metabolic disorders in periodontal tissues provoked by it. To achieve these objectives, the preclinical and clinical stages of research were conducted. At the preclinical stage, a periodontal gel composition under the patented name "Benzidaflaziverdin" (BFD) was developed, which included pathogenetically substantiated active components - flavonoid complex (FC) (Proteflazid®) and benzidamine hydrochloride (BG) (non-steroidal anti-inflammatory drug T-Sept®).
According to the results of the examination of 220 orthodontic patients (112 women and 108 men aged 20 to 35 years) with dentoalveolar anomalies (DA) at the clinical stage of the study, it was found that occlusion pathology can be a diagnostic marker of the risk of developing periodontal tissue diseases.
Along with the diagnosed TMDs, patients were found to have various manifestations of periodontal tissue pathology. We also identified concomitant local factors, which in the examined orthodontic patients without somatic pathology could be a potential cause of the onset and progression of periodontal tissue diseases in the setting of TMD.
The development of a treatment and prophylactic complex (TPC) for patients with primary grade I BPH and BCC required preclinical studies on GCB. Experimental study of acute toxicity, skin resorptive and irritant effects in animals. Using an alternative model, the chorioallantoic membrane of a chicken embryo, it was found that the irritant effect coefficient of GCB was 5, which is considered as a compound with a moderate irritant effect on mucous membranes in the category of irritant hazard. Studies of the cumulative activity of GKB, the processes of lipid peroxidation intensity and the state of the antioxidant system in the blood of experimental animals revealed a weak cumulative activity at the cumulation coefficient. The results of determining the antimicrobial effect using a modification of the suspension method showed a well-defined antibacterial activity of GCB, which was not inferior to the results of the drug "Holisal".
The study of the biotolerance, cytocompatibility, genotoxicity, pro/antioxidant activity of GCB components on cultured human and mammalian cells revealed that GCB inhibited macrophages the least, i.e., showed the highest regenerative potential. GCB also did not show a pronounced suppressive effect, causing significantly less DNA damage. The combination of GCB with electrophoresis was effective, which allowed to influence the cells of the experimental imitation environment of periodontal tissues and to prolong the action of active components.For patients of the main group with TMD (n=60) against the background of initial-type CGP, a treatment and prophylactic complex (TPC) was developed, which was used in preparation for the active period of orthodontic treatment in order to eliminate inflammatory phenomena and adaptation of periodontal tissues and to reduce the stress-induced effect of fixed orthodontic appliances. General drug therapy was used - multimineral complex "Biotus" and antioxidant "Resveratrol". Local therapy measures included Tantum Verde® mouthwash, professional hygiene, SRP protocol, oral cavity sanitation, use of individual mouthguards with GCB, gingival electrophoresis with GCB (4-5 procedures). During the active period of orthodontic treatment, after obtaining a stable remission of initial stage I CGP, patients were prescribed a second course of general medications. Maintenance therapy, which was performed every month, included professional hygiene with a course of Tantum Verde® rinses, individual periodontal guards made of GCB, and electrophoresis with GCB.
Patients in the comparison group (n=58) received a conventional treatment regimen, which included chlorhexidine bigluconate 0.05%, Holisal gel, and hygiene control once every three months. The periodontal indices BOP, API and GI, data on the level of lactate dehydrogenase (LDH), superoxide dismutase (SOD), catalase activity (CA) and amylase activity (AA) in the oral fluid were obtained before and after periodontal treatment of initial-IV severity of primary TMD in patients with primary TMD of the main group immediately before the installation of fixed orthodontic appliances; further, at the 3rd and 6th months of the active period of orthodontic treatment, all the advantages of the developed LPK were shown.
