Documente Academic
Documente Profesional
Documente Cultură
Gr.T.Popa IASI
FACULTATEA DE MEDICINA DENTARA
Coordonator tiinific
Prof. dr. VATAMAN RADU
DOCTORAND
LCTU (PDURARIU) ALEXANDRA
- 2011-
CUPRINS
Partea generala.
INTRODUCERE.....................................................................1
CAP.I.
BOALA
PARODONTALA
ASPECTE
GENERALE ............................................................................2
I.1. Definiie. Clasificarea bolilor parodontale..........................2
I.2. Aspecte microbiologice.......................................................4
I.3.Aspecte privind reaciile inflamatorii locale........................8
I.4. Aspecte privind rspunsul imun local...............................11
I.5. Aspecte privind rolul factorilor genetici........................ ..12
CAP.II. ASPECTE GENERALE PRIVIND TEHNICI SI
MIJLOACE
DE
DIAGNOSTIC
AL
BOLII
PARODONTALE..................................................................15
II.1. Metode de diagnostic convenionale................................15
II.2.Teste n diagnosticul activitii bolii parodontale ............18
II.3.Teste biochimice i imunologice utilizate n diagnosticarea
i monitorizarea evoluiei bolii parodontale ...........................21
CAP.III.
PROCEDURI
TERAPEUTICE
PARODONTALE
CU
ROL
ANTIBACTERIAN,
ANTIINFLAMATOR SI TROFIC.....................................25
III.1. Terapia parodontal clasic non-chirurgical................25
III.2. Ageni medicamentoi cu rol antibacterian i
antiinflamator...........................................................................29
III.3. Laseroterapia...................................................................35
III.4. Ozonoterapia...................................................................37
III.5. Terapia de biostimulare prin infiltraii cu Gerovital.......42
CAP.IV.BIOMARKERI
BIOCHIMICI
SI
IMUNOLOGICI
CU
ROL
IN
MODULAREA
PROCESELOR DE DISTRUCTIE SI REPARATIE LA
NIVEL PARODONTAL.......................................................43
INTRODUCERE
In Europa exist puine studii cuprinztoare care s
conduc la date naionale representative asupra prevalenei i
gradului de extindere a bolilor parodontale. Evaluarea
prevalenei i severitii bolilor parodontale este ngreunat de
discuiile nesfarite la nivel global asupra unei definiii comune
i asupra unor sisteme de indici comune care s evite
interpretarea diferit a datelor clinice i epidemiologice i s
permit o evaluare obiectiv a necesitilor de tratament
parodontal (237). Studiile longitudinale constat c la
majoritatea situsurilor i la majoritatea subiecilor rata de
progresie a leziunilor parodontale este foarte redus n
condiiile meninerii unei bune igiene orale . In acest context,
procesele de iniiere i progresie a bolii parodontale sunt
deosebit de complexe, pentru nelegerea acestora fiind
necesare cercetri clinice i paraclinice aprofundate. O atenie
deosebit este generat de apariia unor teste de diagnostic care
pot oferi informaii asupra procesului propriu-zis de distrucie,
starea de activitate de boal, rata de progresie a bolii, tipare de
distrucie, extensia i severitatea distruciei, rspunsul la
tratament. Examenele paraclinice includ metode biochimice i
imunologice care permit determinarea nivelului unor anticorpi,
citokine, colagenaze, care fac parte din rspunsul individual la
infecia parodontal. Rspunsul gazdei n boala parodontal
implic aspecte ale inflamaiei acute i cronice, rspunsuri
imune umorale i celulare. Msurarea nivelelor acestor
mediatori implic recoltarea de eantioane (saliv, fluidul
crevicular, serul sangvin, urina) prin tehnici neinvazive sau
tehnici minim invazive. Utilizarea acestor teste paraclinice
asigur succesul tratamentului prin depistarea afeciunii n
stare incipient. Totui, n prezent metodele curente de
diagnostic se bazeaz nc pe examen clinic i radiologic.
CAP.V.
MOTIVAIA STUDIULUI.
SCOPURILE
STUDIULUI. OBIECTIVE GENERALE. CULEGEREA
SI PRELUCRAREA DATELOR.
V.1. Motivaia studiului
Motivaia alegerii acestui subiect pentru teza de
doctorat a fost determinat de posibilitatea de a aprofunda o
serie de aspecte clinice i paraclinice (teste biochimice,
imunologice) privind eficiena unor terapii parodontale bazate
pe asocierea dintre terapia convenional etiologic i o serie
de proceduri terapeutice alternative (adjuvante). In acest scop
am solicitat i primit suport teoretic i practic n cadrul
Disciplinelor de Parodontologie, Biochimie i Imunologie,
ceea ce a permis realizarea unor studii complexe de ordin clinic
i paraclinic.
V.2.Scopurile, obiectivele si metodologia cercetarii.
In cursul pregtirii doctoratului mi-am propus:
- selectarea datelor din literatura de specialitate privind
aspectele etiopatogenice, clinice, paraclinice ale
diversele categorii de afeciuni parodontale, aspecte
privind markeri biochimici i imunologici, terapii nonchirurgicale convenionale i adjuvante;
- efectuarea unui studiu epidemiologic clinicoradiografic i statistic pe un lot de pacieni personal
privind prevalena diverselor afeciuni parodontale,
severitatea i distribuia i stabilirea unor corelaii
statistice n raport cu factori precum varsta, sexul,
grupul dentar, tipul de afeciune parodontal;
- monitorizarea dinamicii unor parametri clinici,
biochimici i imunologici n cursul unor terapii
parodontale convenionale (detartraj subgingival,
detartraj subgingival asociat cu surfasaj radicular);
10
11
12
CAP.VI.
STUDIU
EPIDEMIOLOGIC
PRIVIND
PREVALENA, DISTRIBUIA I SEVERITATEA
AFECIUNILOR PARODONTALE IN CADRUL UNUI
LOT DE PACIENI CU VRSTA 15-65 ANI
VI.1. Introducere.
Epidemiologia reprezint un domeniu central al
sntii orale i trebuie s fie considerat un instrument de
analiz major pentru planificarea programelor i procedurilor
terapeutice precum i pentru evaluarea i controlul eficienei
terapiilor aplicate. In acest context, n Europa exist puine
studii cuprinztoare care s conduc la date naionale
reprezentative asupra prevalenei i gradului de extindere a
bolilor parodontale.
VI.2. Scopul studiului.
Studiul i-a propus s evalueze prevalena i severitatea
bolii parodontale precum i existena unor corelaii ntre aceti
parametri i sexul, grupa de vrst, grupul dentar n cadrul unui
lot de pacieni cu vrste cuprinse ntre 15 i 65 ani.
VI.3. Material si metoda.
Studiul epidemiologic a fost efectuat pe un numr de
143 pacieni de sex masculin (n=58) i sex feminin (n=85), cu
vrste cuprinse ntre 15 i 65 ani (fig.1,2). Pacienii s-au
prezentat n cabinetul de practic privat n perioada martie
2009-decembrie 2010. Pacienii au fost mprii n urmtoarele
grupe de vrst: 15-24 ani (n=46); 25-34 ani (n=38); 35-44 ani
(n=27); 45-54 ani (n=12); 55-64 ani (n=20). Distribuia
leziunilor parodontale a fost urmrit prin corelarea prezenei
acestora cu sexul subiecilor (masculin, feminin), grupa de
13
58
M
F
85
12
15-24
25-34
35-44
45-54
27
55-64
38
14
15
4%
6%
30%
Sanatos
Gingivita
PMC
PRP
60%
6%
8%
0
1
2
22%
3
4
47%
16
24%
absenta
redusa
medie
severa
28%
17
5%
29%
Sanatos
Gingivita
PMC
PRP
64%
5%
21%
10%
0
1
2
21%
3
4
43%
12%
36%
absenta
R.r edusa
medie
26%
sever a
26%
18
7%
8%
Sanatos
31%
Gingivita
PMC
PRP
54%
7%
14%
7%
0
1
2
24%
3
4
48%
11%
38%
22%
absenta
R.r edusa
medi e
sever a
29%
19
In figurile 10.a-c.
sunt prezentate rezultatele privind
distribuia resorbiei alveolare pe grupe de dini (grup molar,
grup premolar, grup frontal).
Fig.10.a. Relaia alveoliza-grup dentar molar
M O LA R I
4%
16%
37%
43%
absenta
redusa
medie
severa
3%
13%
37%
47%
absenta
redusa
medie
severa
9%
17%
38%
36%
absenta
redusa
medie
20
severa
13%
Sanatos
Gingivita
PMC
PRP
83%
8%
8%
16%
Sanatos
Gingivita
PMC
PRP
68%
21
4% 0%
Sanatos
Gingivita
PMC
PRP
96%
In tabelele urmtoare
Status
(diagnostic)
sanatos
gingivita
PLP
PRP
Masculin
Col %
5.2%
31.0%
63.8%
.0%
Varsta
Feminin
Col %
7.1%
30.6%
55.3%
7.1%
15- 24 ani
Col %
13.0%
82.6%
.0%
4.3%
25-34 ani
Col %
7.9%
15.8%
68.4%
7.9%
35-44 ani
Col %
.0%
.0%
96.3%
3.7%
45-54 ani
Col %
.0%
.0%
100.0%
.0%
55-64 ani
Col %
.0%
.0%
100.0%
.0%
Grad de
resorbtie
osoasa
absenta
redusa
medie
severa
Sex
Masculin
Feminin
Column N % Column N %
36,2%
37,6%
27,6%
28,2%
24,1%
23,5%
12,1%
10,6%
15- 24 ani
Column N %
95,7%
2,2%
,0%
2,2%
25-34 ani
Column N %
23,7%
55,3%
18,4%
2,6%
22
Varsta
35-44 ani
Column N %
,0%
59,3%
33,3%
7,4%
45-54 ani
Column N %
,0%
8,3%
75,0%
16,7%
55-64 ani
Column N %
,0%
5,0%
45,0%
50,0%
23
24
25
0.52
0.5
0.35
0.4
SRP
S
0.3
S/MZ
0.15
0.2
0.1
0
SRP
S/MZ
26
7
5.97
5.75
6.325
5.6
4.65
5
4
Series1
Series2
2
1
0
SRP
S/MZ
3.4
3.25
3.5
3
2.5
1.9
Series1
1.4
1.3
1.5
Series2
1
0.5
0
SRP
S/MZ
2.8
2.75
2.6
2.5
2
1.6
Series1
1.5
1.1
Series2
0.9
1
0.5
0
SRP
S/MZ
27
S/MZ
75%
80%
SRP
60%
30%
20%
10%
0%
S/MZ
SRP
28
29
30
31
32
0.52
0.5
0.375
0.4
SRP
S
0.3
S/L
0.15
0.2
0.1
0
SRP
S/L
33
5.97
5.75
5.95
5.6
5.575
4.65
5
4
Series1
Series2
2
1
0
SRP
S/L
3.35
3.25
3.5
3
2.5
1.9
1.6
1.3
1.5
Series1
Series2
1
0.5
0
SRP
S/L
2.8
2.7
2.6
2.5
2
1.6
1.5
1.25
Series1
Series2
0.9
1
0.5
0
SRP
S/L
34
S/L
80%
SRP
70%
60%
30%
20%
10%
0%
S/L
SRP
35
36
37
IX.4.Rezultate i discuii
In figurile urmtoare sunt prezentate aspecte clinice
pretratament i posttratament pentru situsuri parodontale tratate
prin detartraj subgingival asociat cu ozonoterapie (lot S/OZ).
Fig.27.a. T.R., 50 ani, PMC. Aspect clinic (arcada
maxilar)
38
Fig.27.b-c.
Sedina
1.3.(DV), 2.3.(DV)
ozonoterapie-situsuri
parodontale
39
0.52
0.5
0.4
0.4
SRP
S
0.3
S/OZ
0.15
0.2
0.1
0
SRP
S/OZ
5.75
5.9
5.6
5.55
4.65
5
4
Series1
Series2
2
1
0
SRP
S/OZ
3.3
3.25
3.5
3
2.5
1.9
1.65
1.3
1.5
Series1
Series2
1
0.5
0
SRP
S/OZ
2.8
2.6
2.5
2
1.65
1.6
1.3
1.5
Series1
Series2
0.9
1
0.5
0
SRP
S/OZ
40
41
S/OZ
75%
80%
SRP
60%
30%
20%
10%
0%
S/OZ
SRP
42
CAP.
X.
STUDIU
CLINIC,
BIOCHIMIC
SI
IMUNOLOGIC PRIVIND ROLUL INFILTRATIILOR
LOCALE
CU
GEROVITAL
IN
TERAPIA
PARODONTITELOR CRONICE MARGINALE
X.1.Introducere.
Un tratament al parodontopatiei prin mijloace care s
fie eficiente din punct de vedere al costului poate oferi
populaiei, care nu are acces la servicii medicale
ultraspecializate datorit lipsei de resurse financiare, un mijloc
eficient de a menine o dentiie funcional pentru o perioad
lung de timp. Procaina, componenta principal a produsului
Gerovital H3, a fost utilizat pentru prima dat, n terapia
parodontal cu rol de stimulare parodontal, n Germania n
1967 (310). Totui absena unor studii longitudinale nu a
permis impunerea n practica de rutin a infiltraiilor locale cu
produse de stimulare parodontal de tipul procainei sau
Gerovitalului ca o component a terapiei parodontale de
meninere.
X.2.Scopul studiului.
Studiul prezentat n acest capitol are rolul de a evalua
posibilitile de accelerare a proceselor de vindecare
parodontal (efectele antiinflamatorii, trofice, de stimulare
parodontal) n urma asocierii terapiei etiologice convenionale
cu infiltraii cu Gerovital.
X.3.Material si metod.
Studiul a fost efectuat pe un lot de 30 subieci cu
parodontit cronic marginal moderat sau sever, care s-au
prezentat n cabinetul de practic privat n perioada august
2010- decembrie 2010. Varsta pacienilor a fost cuprins ntre
35 i 50 ani. Subiecii au fost mprii n trei loturi, n raport
cu tipul terapiei parodontale, rezultatele fiind evaluate la un
interval de 30 zile:
43
X.4.Rezultate i discuii
In figurile urmtoare sunt prezentate aspecte clinice i
radiografice caracteristice unor situsuri cu boala parodontal
tratate prin detartraj subgingival asociat cu infiltraii cu
Gerovital.
44
45
Fig.35. Profunzime
postttratament)
0.6
pungi
parodontale
(pretratament;
0.52
0.5
0.35
0.4
SRP
S
0.3
S/MZ
0.15
0.2
0.1
0
SRP
S/MZ
5.75
5.775
5.6
5.575
4.65
5
4
Series1
Series2
2
1
0
SRP
S/G
3.4
3.25
3.5
3
2.5
1.9
Series1
1.4
1.3
1.5
Series2
1
0.5
0
SRP
S/MZ
2.8
2.6
2.6
2.5
2
1.6
1.4
1.5
Series1
Series2
0.9
1
0.5
0
SRP
S/G
46
47
S/G
50%
40%
90%
SRP
65%
60%
30%
20%
10%
0%
S/G
SRP
48
CONCLUZII FINALE
49
50
51
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