General characteristics of work
Relevance of the problem. A priority direction in the development of the methodology of restorative medicine is the development of restorative and corrective technologies aimed at restoring the functional state of a person, compensating for impaired functions and working ability in patients with chronic diseases. At the same time, the use of natural and artificial physical factors turns out to be effective both in the treatment of the underlying disease and in increasing the functional reserves of the body and quality of life (A.N. Razumov, 2003). In relation to the problem of inflammatory-dystrophic periodontal diseases, the prevalence of which currently reaches 90% among people 20-50 years of age, the development of new, more effective non-drug treatment and rehabilitation technologies is an urgent problem of restorative medicine, physiotherapy and dentistry.
At the same time, in the selection of correction methods, the emphasis is deservedly shifted towards physical factors that activate systemic sanogenetic reactions of the body, increase its reserve and regulatory capabilities in conditions of developing pathology (V.K. Frolkov, I.P. Bobrovnitsky, 2007).
Consideration of chronic periodontal inflammation from a systemic perspective, according to a number of authors, characterizes the integral anthropological approach currently dominant in medicine, which allows us to comprehend and evaluate the mechanisms of mutual influence and aggravation of diseases of the internal organs and oral cavity on the basis of the general theory of functional systems by P.K. Anokhin (A.I. Kirsanov, 2000; L.M. Tsepov, 2006). The works of many scientists have convincingly demonstrated the close psychosomatic and morphofunctional relationships between chronic periodontitis, the metabolic regulation system, the immune system and the activity of the effector part of the body (A.I.
Nikolaev, 1998; M.N. Puzin et al., 2001; F.A. Scanapieco, 2005).
The systematic nature of the analysis of pathogenetic mechanisms and relationships of chronic generalized periodontitis (CGP) predetermines the deterioration of a person’s functional state, a decrease in the reserve capabilities and adaptive properties of his body, and changes in indicators of professional activity.
Correction of the functional state and adaptive capabilities of the body in conditions of chronic periodontal inflammation should be based on effective healing technologies, which are based on a course of training aimed at activating adaptive mechanisms of nonspecific resistance, restoring the body’s metabolic reserves, expanding the range of functioning of biochemical and physiological systems for maintaining homeostasis. In this regard, the technique of interval hypoxic training (IHT) deserves special attention, the effectiveness of which has been shown in various pathological conditions associated with metabolic disorders (A.3. Kolchinskaya et al., 2003). At the same time, considering various pathogenetic mechanisms leading to the progression of CGP, most experts highlight circulatory hypoxia of tissues of the periodontal complex with subsequent activation of peroxide metabolism (M.N.
Sorokovik, 2005; O.N. Kravets, 2007). This point of view opens up wide possibilities when conducting pathogenetic therapy for drugs with pronounced antioxidant and membrane protective activity. The Russian drug Mexidol, which inhibits free radical oxidation of cell membrane lipids, modulates the synthesis of prostaglandins, increases the activity of antioxidant enzymes and receptor complexes of cell membranes, is promising in this regard (T.A. Voronina, 2001).
Purpose of the study: to evaluate the effectiveness of interval hypoxic training in combination with the antioxidant Mexidol for the treatment and restorative correction of the functional state of patients with chronic generalized periodontitis.
Research objectives:
1. To conduct a comparative assessment of the clinical effectiveness of standard periodontal therapy and, in combination with it, IHT and the antioxidant Mexidol in patients with CGP.
2. To study the state of peroxide metabolism and antioxidant defense enzymes in patients with CGP under the use of various correction schemes.
3. To evaluate the effect of a course of hypoxic training in combination with a metabolic drug on the functional state and psychological status of patients with CGP.
4. To study the predictive significance of the initial indicators of the morphofunctional status of patients in assessing the effectiveness of complex correction of chronic periodontitis and to study the long-term results of treatment based on the combined use of hypoxic training and the antioxidant Mexidol.
Scientific novelty.
For the first time, from a pathogenetic point of view, the possibility and effectiveness of using interval hypoxic hypoxia for restorative correction of the functional state of patients with CGP has been substantiated and proven. The pathogenetic significance of the disintegration of autonomic regulation and the psycho-emotional sphere in the occurrence of pathology of the periodontal complex is shown. Carrying out a course of hypoxic training in combination with the antioxidant drug Mexidol promotes accelerated restoration of the functional state of patients with CGP, which, through the regulatory mechanisms of maintaining homeostasis, significantly limits the pathological influence of the body’s systemic reactions on the periodontium.
It has been proven that the proposed treatment regimen for CGP, compared to the traditional method, has greater corrective activity in relation to indicators of systemic metabolic processes and local reactions. For the first time, an in-depth study of the mechanisms of the corrective effect of non-drug technology in combination with the metabolic drug Mexidol on the processes of lipid peroxidation and the antioxidant defense system was carried out.
It was established for the first time that periodontal tissue is a sensitive indicator of functional and morphological changes and is closely related to the reactivity of the whole organism, its organs and systems. Against this background, the use of interval hypoxic training in combination with the antioxidant Mexidol in the complex restorative correction of CGP causes a change in the autonomic regulation of the functional state towards increasing the reserve capabilities of the body, aimed at maintaining the structural and functional integrity of periodontal tissues in people suffering from CGP.
For the first time, it has been established that the combined use of IHT and Mexidol against the background of traditional periodontal therapy is accompanied by a pronounced clinical effect that is superior to other correction schemes under consideration. The implementation of this additive interaction occurs due to the common points of corrective activity of hypoxic training and the antioxidant drug and is accompanied by an increase in the regulatory and metabolic potential of the body, providing regression of clinical symptoms, improvement of the periodontal status of patients and a decrease in the intensity of peroxide metabolism against the background of activation of antioxidant stress-limiting reactions.
For the first time, the predictive significance of biochemical variables has been shown, which substantiates their contribution to the implementation of the effectiveness of the use of IHT and Mexidol in patients with CGP, and also proves their informativeness in the construction of decisive prognosis rules and the selection of the most optimal technologies for correcting the functional state.
Practical significance.
The practical value of the study lies in the development and substantiation of an effective non-drug technology for correcting the functional state of patients with chronic periodontal pathology based on the integrated use of the IHT method and the antioxidant Mexidol.
The results obtained reveal the high efficiency of the proposed technology in patients with CGP, based on the system of protective interaction of the corrective factors under consideration. The implementation of the effects is achieved due to the pathogenetic effect on the stress-limiting mechanisms of maintaining homeostasis, as well as through the activation of the regulatory and metabolic potential of the body, which ensures a lasting clinical effect and accelerated regression of psycho-vegetative disorders.
The corrective effect of the combined effect of a hypoxic factor and an antioxidant drug in terms of amplitude of expression is a variant of the additive interaction, realized due to the common points of the restorative activity of interval hypoxic effects and the metabolic potencies of the antioxidant drug.
For the first time, the decisive rules for predicting the effectiveness of complex correction of mild and moderate CGP have been determined. The developed approach makes it possible to demonstrably substantiate the choice of the most optimal technology for correcting the disease itself and the functional state of patients in general, as well as to carry out a prognostic assessment of the periodontal condition and the risk of progression of CGP, taking into account the reserve capabilities of the body.
The developed complex correction system has a lasting clinical effect that lasts for 6 months based on the results of assessing periodontal status and the dynamics of lipid peroxide processes.
In general, the results obtained in the work, as well as the recommendations developed, significantly expand the possibilities of practical application of hypoxic training technology to correct the functional state of patients with inflammatory pathology of periodontal tissue.
Provisions for defense:
1. The therapeutic effectiveness of interval hypoxic training for chronic generalized periodontitis is based on the activation of compensatory and adaptive mechanisms of a biochemical nature, manifested by an increase in the antioxidant potential of the body, a decrease in the concentration of lipid peroxidation products, and the development of membrane-stabilizing effects. The combination of these phenomena ensures regression of subjective signs of the disease, reduction of inflammatory manifestations and improvement of objective indicators of periodontal condition.
2. The corrective effect of the complex use of hypoxic training and the metabolic drug Mexidol is based on the additive nature of the interaction of these factors and is manifested by an increase in the regulatory and metabolic potential of the body against the background of activation of stress-limiting reactions.
3. Interval hypoxic training is an effective method for correcting the functional state of the body in chronic periodontitis. Its course use helps to improve the psycho-emotional status and normalize systemic autonomic reactions aimed at maintaining the structural and functional integrity of periodontal tissues.
4. The following biochemical indicators have predictive significance regarding the effectiveness of using the developed technology for correcting CGP: lactate dehydrogenase activity in oral fluid, SOD activity, content of primary lipid peroxidation products, cortisol and cholesterol in oral fluid. The high information content of the developed discriminant equations and classification rules allows us to recommend this approach for wider use in practical healthcare in determining a rational scheme for correcting the functional state of patients, as well as assessing the risk of reducing the reserve capacity of the human body and the progression of inflammatory periodontal diseases.
Approbation of research materials.
The dissertation materials were reported and discussed at the XI International Symposium “New technologies of restorative medicine and balneology (physiotherapy, rehabilitation, sports medicine)” (Greece, Soloniki, 2006), the IV International Congress “Regenerative Medicine and Rehabilitation 2007” (Moscow, 2007), the All-Russian Scientific Forum on Regenerative Medicine, physical therapy, balneology, sports medicine and physiotherapy “ReaSpoMed 2008”. – (Moscow, 2008), IV All-Russian Forum “The Health of the Nation is the Basis of Russia’s Prosperity” (Moscow, 2008), International Congress and the 61st Session of the General Assembly of the World Federation of Hydrotherapy and Climate Therapy (China, 2008), meeting of the Scientific and Methodological Council of the Federal State Institution “RRC VMiK Roszdrav” (2010).
Publications.
8 scientific papers have been published on the topic of the dissertation, 2 of them in peer-reviewed journals recommended by the Higher Attestation Commission.
Scope and structure of the dissertation.
The dissertation is presented on 145 pages, consists of an introduction, 3 chapters, a conclusion, conclusions, practical recommendations and a bibliography containing 204 sources (176 domestic and 28 foreign), illustrated with 15 tables and 9 figures.
Personal contribution of the author.
The share of personal participation in conducting research was 90%, in generalizing and analyzing the results obtained – 100%.
CONTENT OF THE WORK
General characteristics of the scope and methods of research
In accordance with the purpose and objectives of this work, the research was based on the following principle: Stage I – assessment of the clinical condition of patients with CGP during restorative correction; Stage II – 2 – study of indicators of peroxide metabolism and antioxidant status of the body in patients with CGP using various rehabilitation treatment regimens; Stage III – study of intersystem connections of the functional state of the body and periodontal status under the influence of interval hypoxic hypoxia and the antioxidant drug Mexidol; Stage IV – study of predictors of the effectiveness of restorative correction and assessment of long-term results of treatment of patients with CGP.
The structure, scope and directions of research are presented in Table 1.
The studies were carried out at Dental Clinic No. 15 (Moscow) and the Center for Family Dentistry (Moscow) from 2007 to 2010 with the participation of 78 patients with mild to moderate CGP. All subjects were divided into 3 groups. The first group (control, 27 people) received traditional periodontal therapy, including hygienic treatment of the oral cavity, removal of dental plaque, selective tooth grinding, applications to the gums of antimicrobial (0.06% solution of chlorhexidine, metronidazole) and anti-inflammatory drugs (indomethacin, ASA), curettage of the periodontal pocket). The second group (28 people), along with traditional treatment, took IHT courses.
The third group (23 patients) used a combination of IHT courses and topical Mexidol (rinsing and applications of a 5% solution 2 times a day) as additional treatment and intramuscularly (2.0 ml of a 5% solution 1 time a day) for two weeks. The comparison group consisted of 15 practically healthy people.
Clinical, biochemical, psychophysiological and instrumental data were assessed before treatment, after a 2-week correction course, and also 6 months after the end of therapy.
Assessment of patients' periodontal status
The condition of periodontal tissues was assessed using the simplified hygienic index – OHI-S (J.C. Green, J.R. Vermillion, 1960), gingival sulcus bleeding index – SBI (H.R. Muhelmann, S. Son, 1971), papillomarginal alveolar index – PMA (C. Parma, 1960), periodontal index – PI (A.L.Russell, 1956).
Assessment of the functional state of patients
The study of the functional state of the body was based on indicators of heart rate variability (HRV), which allow for an in-depth analysis of the state and structure of the autonomic nervous system. According to the data of the Polispectr-8 vegetative tester, HRV was studied, and the tension index of regulatory systems (IN), the vagosympathetic balance index (LF/HF) and the centralization index (CI) were calculated.
Biochemical research methods
The biological material for biochemical studies was oral fluid, which was taken from each patient three times: during a background examination, after a 2-week course of treatment, and also 6 months after the end of treatment procedures.
The products of peroxide metabolism – lipid acylhydroperoxides and TBA-active products – were determined by the method of V.B. Gavrilov et al. (1983, 1987, 1988). The activity of the antioxidant enzyme superoxide dismutase in oral fluid was determined using the xanthine-xanthine oxidase system to generate the superoxide anion radical (A. Katz, F. Messineo, 1981). Determination of protein in oral fluid was carried out by the biuret method using test kits from Medix (Finland) on a chemical analyzer FP-901 (Finland). Glutathione peroxidase activity was determined using the Paglia D.E. method. and Valentine W.N. (1967) as modified by B.3.
Lankin (1976). Catalase activity was identified by the loss of hydrogen peroxide at a wavelength of 240 nm (Zh.N. Shalharova, 1987).
The content of cortisol in oral fluid was identified using the enzyme immunoassay method using a Stat Fax 2100 analyzer from Awareness Technology Inc. (USA). The concentration of glucose, urea, total cholesterol in the oral fluid, as well as the enzymatic activity of ALAT, ASAT, alkaline phosphatase, LDH were determined on a Technicon apparatus (USA) and on a chemical analyzer FP-901 (Finland) using test kits from Labsystems (Finland).
Psychological research methods
To assess the psychological status, a set of standardized test methods was used: the test of differentiated self-assessment of the functional state “SAN”, the Spielberger-Khanin test, the level of depression on the Beck scale (V.A. Doskin et al., 1973; A.B. Leonova et al., 1981, 1984; Yu L. Khanin, 1980; A.T. Beck et al., 1961).
Methodology for interval hypoxic training
To carry out IHT, a hypoxicator 10-1000 from Trade Medikal was used, powered by compressed air from transport cylinders. The most rational concentration of O₂ during IHT is 12% for the first three sessions and 10% for subsequent ones. The duration of the hypoxic phase of the cycle, depending on individual resistance to hypoxia, can be 3-7 minutes, the normoxic phase – 3-5 minutes. The IHT session consisted of: 4 cycles, each of which included a hypoxic phase and a reoxygenation phase (air breathing). Duration of cycles is 7-10 minutes. In total, each patient of groups 2 and 3 underwent 14 IHT sessions.
Statistical processing of the results was carried out on a computer using variational, correlation, regression and discriminant analysis programs using the BMDP and Statgraphics application packages.
Research results and discussion.
1. Dynamics of the clinical condition of patients during restorative correction.
As part of the first direction, a comparative assessment of the clinical status of patients with CGP was carried out during standard treatment, as well as in combination with a course of interval hypoxic hypoxia and metabolic therapy. The analysis was based on dynamic observations of the main complaints of patients (pain and swelling of the gums, bad breath, bleeding gums, exposure of the neck of the tooth, loosening and loss of teeth), as well as indicators of the condition of periodontal tissues (indices OHI-S, SBI, PMA, PI).
During the initial examination in patients, depending on the severity of periodontitis, the following complaints predominated: with mild severity – the appearance of pain (28%) and bleeding gums (36%) when brushing teeth, bad breath (53%), the presence of periodontal pockets up to 3 mm deep (64%). In patients of moderate severity, pain (71%) and bleeding gums (82%) were noted not only when brushing their teeth, but also with minor mechanical stress, and bad breath in the vast majority of patients (95%). Tooth mobility was observed in 59% of patients. Along with the presence of plaque, dental deposits, including subgingival tartar, the majority of patients with moderate severity were noted to have swelling (94%) and hyperemia (96%) of the gums, as well as the presence of pockets up to 5 mm deep, of which during probing it was noted bloody or purulent discharge with a pungent, unpleasant odor.
The results of objective assessment of gingival-periodontal status made it possible to establish significant differences in the assessed indicators depending on the severity of the inflammatory process in the periodontium. Thus, in patients with mild CGP, the oral hygiene index was 2.50±0.09 points, which corresponds to unsatisfactory oral hygiene. The PMA index, indicating the prevalence of the inflammatory process on the gums, was 40.30% ± 1.80. Gum bleeding according to the SBI index was 2.00±0.20 points. The periodontal index corresponded to 2.85±0.15. In patients with moderate CGP, the oral hygiene score was even higher (3.00±0.05 points), which indicated greater hygienic problems in the oral cavity.
The value of the PMA index significantly increased to 67.50% + 3.20, which indicated progression inflammatory process in the gums. The bleeding index was 2.80±0.17. The periodontal index corresponded to 3.20±0.15.
Thus, in the initial state, the examined patients had various clinical manifestations of periodontitis, indicating the presence of a pathological process of an inflammatory and dystrophic nature, the severity of which depended on the severity of the disease.
As a result of the treatment, the patients’ well-being improved and dental indices decreased (Table 2). The results of a clinical examination of patients convincingly demonstrated the effectiveness of using IHT in the complex treatment of chronic generalized periodontitis. A comparative analysis of the dynamics of clinical symptoms in the main and control groups made it possible to establish that under the influence of the use of IHT, positive changes were significantly more pronounced compared to standard methods of treating patients. In particular, a pronounced regression of the main clinical manifestations was revealed, which was manifested not only by the disappearance of complaints in patients of mild severity, but also by an improvement in the condition of periodontal tissues, assessed by a decrease in swelling and hyperemia of the gums, as well as by a firm, elastic consistency.
The vast majority of patients in the experimental group observed the disappearance of bleeding gums and discomfort in the gums during chewing load.
Dental examination of patients revealed changes corresponding to the dynamics of subjective sensations. Objectively, a decrease in tooth mobility, compaction of the gingival margin, and a decrease (in some cases, disappearance) of periodontal pockets were noted. The OHI-S index decreased by 39%, SBI – by 65%, PMA – by 58%, PI – by 60%. In the main group, patients showed a significant improvement in their dental status, the severity of which was 19-47% higher than in the control group.
The dynamics of clinical manifestations in patients of moderate severity were also significant, with the severity of the corrective effect exceeding that in the control group and the group with IHT.
The corrective effect of IHT, associated with an increase in the regulatory and metabolic reserves of the periodontium and the body as a whole, opens up wide opportunities for conducting pathogenetic therapy based on the use of drugs with pronounced antioxidant and membrane protective activity. This circumstance served as the basis for conducting an independent experimental series with the combined use of hypoxic training and the antioxidant Mexidol.
In general, the observed corrective effect was superior to the results of the control group and the group with IHT, which proves the additive nature of the interaction between IHT and Mexidol within the parameters under consideration. At the same time, in terms of the amplitude of the severity of such interaction, it is advisable to talk about corrective synergism, which is based on common points of implementation of the biological activity of each of the factors under consideration.
The positive therapeutic effect of Mexidol is based on its ability to provide pronounced antioxidant, antihypoxic, psychotropic and anti-stress effects in combination with the effects of tranquilizers and nootropics. The drug improves microcirculation, normalizes cellular metabolism, and stabilizes cell membranes. The data obtained conceptually combine the identified set of effects into a system of complex protective interaction of the corrective factors under consideration, which is realized thanks to the increased regulatory capabilities of the human body to maintain structural and metabolic processes in the range of their homeostatic response.
2. Study of indicators of peroxide metabolism and antioxidant status of the body in patients with CGP using various rehabilitation treatment regimens.
The second direction of research was devoted to the study of peroxide metabolism and antioxidant status during a course of interval hypoxic training in patients with CGP.
The results of the study convincingly indicate that the concentration of lipid peroxidation products in patients with CGP is 28-56% higher than in healthy people. At the same time, the accumulation of AGP and MDA in the oral fluid in patients with moderate CGP was 32 and 41%, respectively, greater than in patients with mild severity. This fact indicates the pathogenetic involvement of LPO in the severity of the disease.
A comparative analysis of the enzymatic representation of antioxidant defense during a background examination revealed an unequal pattern of changes in the studied parameters: the activity of SOD and catalase was lower than the control by 35-42%, and the activity of GPO was higher by 15%
An integrative assessment of the studied parameters of peroxide metabolism was carried out using the coefficient of antioxidant protection (KAOZ). The latter was calculated using the formula proposed by S.N. Nagornev et al. (1996):
KAOZ = √(((CAT/CATbaseline)² + (SOD/SODbaseline)² + (GPx/GPxbaseline)²) / ((AGP/AGPbaseline)² + (MDA/MDAbaseline)²)).
The IHT course was accompanied by significant dynamics of the studied indicators. Thus, in particular, after 2 weeks of restorative correction in the group with IHT, a significant decrease in the content of AGP (−25%), MDA (−14%) in the oral fluid was observed against the background of increased catalase activity. Changes in SOD and GPO activity were not statistically significant (Figure 1).
The inclusion of an antioxidant drug in complex therapy significantly changed the ratio of lipid peroxidation products and antioxidant enzymes. In particular, it was shown that the accumulation of primary and secondary lipid peroxidation products decreased significantly by 44% (p less than 0.05) and 17% (p less than 0.05). As for the enzymatic link of the antioxidant mechanism, changes were recorded here that were superior to the group with IHT. Thus, SOD activity increased by 96% (p less than 0.05) compared to the control and by 78% (p less than 0.05) compared to the IHT group.
It should also be noted that only in the group with Mexidol a significant increase in the enzymatic activity of GPO was revealed by 35% (p less than 0.05). The results obtained clearly demonstrate that Mexidol has a greater effect on the increase in the activity of antioxidant enzymes, while the use of IHT limits accumulation of LPO products. In general, the use of the antioxidant Mexidol limited the accumulation of lipid peroxidation products against the background of increased activity of antioxidant enzymes.
Thus, the corrective effect of the combined effects of IHT and Mexidol is superior in its severity to other correction schemes under consideration. The implementation of such additive interaction occurs due to the common points of corrective activity of hypoxic training and the antioxidant drug and is accompanied by an increase in the regulatory capabilities and metabolic reserves of the body, providing regression of clinical symptoms, improvement of the periodontal status of patients and a decrease in the intensity of peroxide metabolism against the background of activation of antioxidant stress-limiting reactions.
3. Intersystem connections between the functional state of the body and periodontal status under the influence of interval hypoxic hypoxia and the antioxidant drug Mexidol.
As part of this line of research, we assessed the functional state of patients with mild and moderate CGP during complex correction using a course of hypoxic training and the antioxidant drug Mexidol. The study of the functional state was based on indicators of heart rate variability, allowing for a detailed analysis of the state and structure of the autonomic nervous system (Table 3).
It has been established that as the corrective effect of the combined use of IHT and Mexidol increases, the sympatholytic effect of the combination in question increases. Thus, in particular, the autonomic imbalance noted during the background examination was formed mainly due to a lower level of parasympathetic activity against the background of the predominant level of LF and VLF. After a course of IHT in combination with an antioxidant, a decrease in sympathetic activity was noted (a decrease in the level of VLF by 19%, LF/HF by 63%) and an increase in vagal influences (an increase in the percentage of the HF component of the spectrum to 42%).
The tension index decreased by 18% (control) and 35% (IHT in combination with Mexidol), which indicates an increase in the body’s adaptive potential in the group with IHT and Mexidol, an increase in its regulatory capabilities to maintain homeostasis to a greater extent. wide range of extreme impacts.
The correlation analysis between the values of periodontal indices and indicators of heart rate variability revealed a number of significant relationships: r[PMA-LF/HF]=0.68, r[PMA-HF]=-0.53, r[SBI-IN]=0.51. The data obtained show the presence of a significant connection between vegetative characteristics and inflammatory periodontal diseases. In our opinion, a change in the vegetative balance towards the predominance of sympathicotonia has an independent pathogenetic significance in the occurrence and progression of periodontitis.
Thus, the use of interval hypoxic training in combination with the antioxidant Mexidol in the complex restorative correction of CGP causes a change in the autonomic regulation of the functional state towards increasing the reserve capabilities of the body, aimed at maintaining the structural and functional integrity of periodontal tissues in people suffering from CGP.
Assessment of psychological status indicators in patients with mild and moderate severity of CGP (Table 4) made it possible to establish the obligate nature of the identified emotional and personal disorders, as well as to highlight some features. Firstly, a significant deviation of the personality profile is revealed in the direction of decreasing indicators on all SAN scales, increasing indicators on the scales of reactive and (for moderate severity) personal anxiety, as well as a high level on the BDS. Secondly, the severity of the assessed indicators convincingly correlates with the severity of the disease in question.
The results of the study of psychological status during correction of CGP deserve special attention (Table 5). It was found that in the group with hypoxic training and Mexidol, the severity of changes in the assessed parameters was more pronounced compared to the control group. In general, it should be stated that an integrated approach to the correction of the psycho-emotional state of patients with CGP, implemented using a course of IHT and the antioxidant Mexidol, turns out to be more effective compared to the traditional scheme for the correction of mild and moderate periodontitis.
The results obtained confirm the pathogenetic significance of the disintegration of the psychoemotional and autonomic systems of the body in the occurrence of pathology of the periodontal complex. At the same time, the use of this method along with traditional therapy IHT in combination with the antioxidant drug Mexidol promotes accelerated normalization of the functional state of patients with CGP, which, through systems for maintaining homeostasis controlled by the emotional sphere, significantly limits the pathological influence of the body’s systemic reactions to the periodontium.
4. Study of predictors of the effectiveness of restorative correction and assessment of long-term results of treatment of patients with CGP
The purpose of this section of research was to determine predictors of the effectiveness of restorative correction in patients with CGP. To study the predictive significance of the initial indicators, we conducted correlation and discriminant analyzes. As an initial set of variables, indicators of peroxide metabolism, biochemistry of oral fluid and psycho-emotional status were considered. All patients, depending on the success and effectiveness of rehabilitation measures, were divided into 3 groups:
– group 1 – patients for whom the use of a complex correction scheme with a course of IHT and Mexidol led to the development of the most pronounced effect;
– group 2 – patients for whom rehabilitation measures had an average degree of effectiveness;
— group 3 — patients for whom rehabilitation measures were ineffective.
The effectiveness of the complex therapy was determined based on the subjective assessment of patients, as well as changes in hygienic and periodontal indices. The results of the correlation analysis are clearly presented in Figure 2.
Analysis of the presented dependencies makes it possible to identify the most significant aspects of the pathogenesis of CGP, as well as to determine the set of initial signs, the consideration of which is aimed at increasing the effectiveness of the complex therapy of the disease. Thus, the effectiveness of the use of corrective technologies is largely determined by the initial value of functional reserves, characterized by the state of energy metabolism and energy-plastic potential, the activity of antioxidant mechanisms for protecting the structural and functional integrity of cell membranes and organs and manifested by the regulatory capabilities of the neuroendocrine system to maintain the vital functions and adaptive properties of body systems.
At the same time, the effectiveness of the measures taken is more pronounced in patients with a low level of reactive anxiety STAI and high level on the “well-being” and “activity” scales of the SAN.
To construct classification equations for the effectiveness of corrective measures in patients with CGP, a discriminant analysis was carried out using the most informative biochemical indicators. Mathematical analysis of the variables under consideration showed that the most informative is the following combination: lactate dehydrogenase (LDH), cortisol (COR), superoxide dismutase (SOD), acylhydroperoxides (AHP) and cholesterol (CH). The graphical solution of the classification problem, presented in Figure 3, contains the 3 most probable areas of coordinates of individuals with varying degrees of effectiveness of restoration measures, as well as the centroids of the groups under consideration. The level of significance of determining the decision rules for the individuals surveyed is indicated in Table 6.
Table 6. Normalized centroid coordinates of discriminant functions
| Patient group | F1 | F2 |
|---|---|---|
| Low efficacy | 9,52 | 3,14 |
| Moderate efficacy | 8,65 | 0,61 |
| High efficacy | 3,05 | 2,45 |
Coordinates reproduced from Table 6 of the original thesis abstract.
As a result of the study, analytical dependencies were obtained indicating the possibility of increasing the effectiveness of the prevention and treatment of inflammatory periodontal diseases based on a comprehensive assessment of the initial biochemical status of patients. The high probability of implementing classification rules regarding the division of patients into different levels of effectiveness allows us to recommend this approach for wider use when choosing the most optimal technology for correcting the disease itself and the functional state of patients in general, as well as when constructing expert systems for prognostic assessment of the periodontal condition and the risk of progression of CGP, taking into account the reserve capabilities of the body.
Evaluation of long-term results showed that 6 months after treatment, 85% of patients who completed the IHT course and 96% who took the IHT + Mexidol complex with mild to moderate periodontitis did not have any complaints and noted a comfortable state in the oral cavity. Only 1 patient with moderate periodontitis in the group with the combined use of IHT and an antioxidant began to complain of provocative bleeding of the gums when brushing their teeth.
Discriminant functions: F1 = 0.03×LDH − 0.007×SOD + 0.35×COR − 5.26×AGP + 1.1×CH + 8.7. F2 = 0.02×LDH − 0.004×SOD + 0.12×COR − 1.11×AGP + 1.7×CH + 3.55.
In the comparison group, 9 patients with mild to moderate periodontitis developed complaints of bleeding gums already 4 months after treatment. 20% of patients with moderate periodontitis had complaints of bad breath. There were no periodontal complaints in only 1 patient with mild periodontitis.
In both the main and control groups, 6 months after treatment, the average values of indices characterizing the condition of periodontal tissues were significantly better (p less than 0.05) than the initial indicators, regardless of the severity of the disease. At the same time, the clinical condition of periodontal tissues 6 months after treatment was better in patients who completed a course of IHT with the antioxidant Mexidol. In this group, a lower severity of inflammatory phenomena was observed compared to the control group against the background of reduced hyperemia and periodontal edema. The average values of the papillary bleeding indices, PMA and PI were significantly lower than those of the control group by 22, 35 and 20%, respectively (p less than 0.05).
The activity of the inflammatory process in the group with IHT+-mexidol was determined by a low level of the oral hygiene index, which contributed to the exacerbation of periodontal diseases.
An assessment of the antioxidant status, carried out 6 months after the end of the course of restorative correction, convincingly showed the advantage of using IHT in combination with the antioxidant drug Mexidol (Figure 4).
Figure 4. Changes in antioxidant status during rehabilitation treatment.
Thus, an assessment of the long-term results of various treatment regimens for patients with mild and moderate CGP revealed the obvious advantages of a course of hypoxic training and the antioxidant drug Mexidol, manifested by the preservation of a pronounced clinical effect, as well as the favorable dynamics of peroxide metabolism and antioxidant status of the subjects. In the control group, the therapeutic effect was time-limited, and after 4-6 months regression of the achieved level of correction, assessed by clinical and biochemical criteria, was observed.
Conclusions
1. The effectiveness of using interval hypoxic training to correct the functional state of the body during chronic inflammation of periodontal tissue is based on the ability of this technology to enhance the regulatory influence on stress-limiting systems for maintaining homeostasis, restore reserve capabilities and psycho-emotional status of patients, increase the antioxidant potential of the body, limit the intensity of peroxide metabolism, and enhance the development of membrane-stabilizing effects. The combination of these mechanisms provides a significant increase in clinical effectiveness and accelerated regression of the main symptoms of the disease.
2. The complex use of a course of hypoxic training and the metabolic drug Mexidol in patients with chronic generalized periodontitis causes a significant increase in clinical effectiveness by 26-45%. The severity of the corrective effect is largely due to the increase in the antioxidant potential of the body by 84% as a result of the implementation of the phenomenon of complex protective synergism with the additive interaction of the antioxidant potencies of interval normobaric hypoxia and Mexidol.
3. The course effect of interval hypoxia in combination with the antioxidant Mexidol promotes a significant decrease in sympathetic activity by 19 – 63%, an increase in vagal influences by 42%, a decrease in the activity of the central regulation of heart rate and economization of cardiac activity, which significantly expands the regulatory capabilities of the body to enhance adaptive properties and normalize metabolic disorders in conditions of chronic inflammation of the periodontal complex.
4. Correction of the psycho-emotional status in chronic periodontitis using interval hypoxic training in combination with Mexidol is accompanied by an increase in the subjective assessment of the functional state by 30-44% and a decrease in reactive anxiety and the level of depression by 42 and 23%, respectively. Normalization of the emotional sphere limits the pathological influence of the body’s systemic reactions to periodontal disease, and also increases the stability of the physiological functions of the body in the conditions of the pathology in question.
5. Identification of the main biochemical predictors (lactate dehydrogenase, cortisol, superoxide dismutase, acylhydroperoxides and cholesterol) of the use of corrective technologies in people with chronic generalized periodontitis and conducting discriminant analysis on their basis made it possible to formulate decisive rules for predicting the effectiveness of using the developed correction system with a probability of implementation of 84 – 100%.
6. Assessment of the morphofunctional status of patients with CGP 6 months after restorative correction proves the superiority of the use of interval hypoxic training alone and in combination with Mexidol over the traditional treatment regimen by 20–35%.
PRACTICAL RECOMMENDATIONS
1. When correcting the functional state of the body in chronic periodontitis, it is advisable to use courses of interval hypoxic training along with traditional treatment.
2. An IHT session consists of 4 cycles, each of which includes a hypoxic phase and a reoxygenation phase (air breathing). For the first three sessions, the optimal oxygen concentration is 12%, for subsequent sessions – 10%. The duration of the hypoxic phase of the cycle, depending on individual resistance to hypoxia, can be 3-7 minutes, the normoxic phase – 3-5 minutes. Duration of cycles is 7-10 minutes. The full course consists of 14 IHT sessions.
3. To enhance the corrective effect, IHT should be used in combination with the antioxidant drug Mexidol. Mexidol is recommended for use topically (rinsing and applying a 5% solution 2 times a day) and intramuscularly (2.0 ml of a 5% solution 1 time a day) for two weeks.
4. The use of a complex of IHT and Mexidol is an effective means of correcting the emotional sphere in CGP, helping to increase the overall resistance of the body and activate compensatory-adaptive physiological reactions of a person, which determine the success of the adaptation process.
5. The developed recommendations for correcting the functional state of the body in chronic periodontitis can be used in rehabilitation centers, rehabilitation treatment departments, sanatorium and resort institutions, in dental practice, and in the educational process of universities.
References
Бобровницкий И.П., Нагорнев С.Н., Рыгина К.В. Применение интервальной гипоксической тренировки и антиоксиданта мексидола при хронических генерализованных пародонтитах. Вопросы курортологии, физиотерапии и лечебной физической культуры. 2008;3:27–31.
Рыгина К.В., Михайленко Л.В. Основные диагностические подходы к оценке метаболических резервов организма. Материалы научно-практических конгрессов и IV Всероссийского форума «Здоровье нации — основа процветания России». Т.3. М., 2008. С.216.
Бобровницкий И.П., Рыгина К.В. Исследование восстановительной активности антиоксиданта мексидола в комплексном лечении хронического генерализованного пародонтита. Новые технологии восстановительной медицины и курортологии (физиотерапия, реабилитация, спортивная медицина). М., 2006. С.17–18.
Бобровницкий И.П., Рыгина К.В. Динамика показателей перекисного метаболизма в условиях применения антигипоксантов у больных хроническим генерализованным пародонтитом. Новые технологии восстановительной медицины и курортологии (физиотерапия, реабилитация, спортивная медицина). М., 2006. С.18–20.
Рыгина К.В., Бобровницкий И.П. К вопросу о взаимосвязи тканей пародонта с функциональным состоянием организма у лиц с хроническими генерализованными пародонтитами. Материалы Всероссийского научного форума «РеаСпоМед 2008». М., 2008. С.229–230.
Рыгина К.В., Нагорнев С.Н. Динамика функционального состояния организма при проведении гипоксической тренировки у лиц с хроническими генерализованными пародонтитами. Материалы Всероссийского научного форума «РеаСпоМед 2008». М., 2008. С.230–231.
Рыгина К.В., Михайленко Л.В., Фролков В.К. Биохимические аспекты изучения метаболических резервов организма. Материалы конгресса и 61-й сессии Генеральной ассамблеи всемирной федерации водолечения и климатолечения. Китай, 2008. С.170–171.
Бобровницкий И.П., Нагорнев С.Н., Рыгина К.В., Чаплыгин А.А., Сурков А.В. Эффективность использования немедикаментозной терапии и оценка межсистемных связей функциональных резервов организма и пародонтального статуса у пациентов с хроническим генерализованным пародонтитом. Вопросы курортологии, физиотерапии и лечебной физической культуры. 2009;6:30–34.
Full main-text translation: K.V. Rygina. Intermittent hypoxic training in correction of the functional state of the body in chronic periodontitis. Candidate thesis abstract. Moscow, 2010. 24 pp.
Related resources
Related resources on hypoxic training technology and applications.