PECULIARITIES OF THE INFLAMMATORY AND DESTRUCTIVE PROCESS IN PERIODONTAL TISSUES IN PATIENTS WITH GENERALIZED PERIODONTITIS UNDERGOING ORTHODONTIC TREATMENT

Abstract

Purpose of the study. To compare the changes in the periodontal status, the qualitative and quantitative composition of the microflora and the level of cytokines that affect the activity of osteoclasts in the gingival crevicular fluid of patients with partial defects and deformations of the dentitions during orthodontic treatment at the stage of preparation for dental prosthetics, under the conditions of healthy periodontal tissues and generalized periodontitis I-II degree of severity, chronic course. Research methods. 60 persons aged 32-45 years, equally men and women, who underwent orthodontic treatment using bracket systems at the stage of preparation for dental prosthetics were examined. 30 patients had generalized periodontitis of the I-II degree of severity, chronic course; the remaining 30 ones had healthy periodontal tissues. Clinical and laboratory examinations were performed before beginning orthodontic treatment, and in 6 and 12 months. Clinical study included index assessment of periodontal state, orthopantomography and/or computer tomography. The presence of Porphyromonas gingivalis, Actinobacillus actinomycetem comitans, Bacteroides forsythus, Treponema denticola, Prevotella intermedia and the level of IL-1β, IL-6, TNF-α and IL-4 in the gingival crevicular fluid were determined using enzyme-linked immunosorbent assay. Microbiological research included isolation and identification of microorganisms from gingival crevicular fluid using aerobic and anaerobic cultivation techniques. Scientific novelty. Orthodontic preparation for dental prosthetics of partial defects of dentitions with the use of bracket systems causes the development of gingival inflammation, which is associated with oral hygiene disorders. At the same time, in contrast to persons with healthy periodontal tissues, in patients with generalized periodontitis gingivitis is accompanied by the progression of the destructive process in bone tissue. The qualitative and quantitative composition of the microflora of periodontal pockets in patients with generalized periodontitis differs from the dental-gingival sulcus in healthy persons both at the beginning of orthodontic treatment and in its dynamics, firstly, with a greater degree of microbial colonization; secondly, with the presence of periodontal pathogens and their associations; thirdly, with an unexpressed tendency to normalize the gingival microbiome. The active course of the inflammatory process in the periodontal tissues of patients with generalized periodontitis during orthodontic treatment was accompanied with an increase in the content of pro-inflammatory cytokines and a decrease in anti-inflammatory IL-4 in the gingival crevicular fluid, which persisted throughout the observation period; it was able to support destructive phenomena in bone tissue. Conclusions. It is possible to prevent the complication of the course of the inflammatory-destructive process in the periodontal tissues during the orthodontic treatment of patients with generalized periodontitis with defects and deformations of the dentitions during preparation for dental prosthetics by increasing the control of oral hygiene and by increasing the resistance of periodontal tissues to orthodontic load.