This article highlights current issues on medical treatment of chronic periodontitis. The lack of effective comprehensive approach to treatment of chronic periodontitis requires to seek for new treatment strategies, which will be based on pathogenetic features of disease development. Experimental study with Wistar rat strain was used as a model of chronic periodontitis created by inserting a 12 mm needle into the periodontal space of the lower incisor. More than 30 models of chronic periodontitis were obtained. A method of conservative therapy by using an immunomodulator (polyoxidonium) was proposed. The aim of the study was to evaluate efficacy of polyoxidonium in treatment of chronic periodontitis model. To do this, we compared efficacy of treatment with polyoxidonium and treatment with an antibacterial drug, Metrogil Denta gel. Development of model of chronic periodontitis was performed in two groups of our study. In the first group, periodontitis was treated with polyoxidonium injected into alveolar process mucosa of the lower jaw. In the second group – antibacterial gel “Metrogil Denta” was applied to the area of inflammation. Finally, clinical and histological assessment of therapeutic efficacy was performed. It was found that the main clinical parameters after immunomodulatory therapy were not inferior to those obtained after treatment with Metrogil Denta gel. During treatment, hyperemia, edema, and bleeding gums were decreased in both groups. Evaluation of clinical data after treatment with polyoxidonium suggested that improved parameters evidenced about good immune-mediated activity of the drug and need to continue further efficacy examination in treatment of inflammatory periodontal diseases. To assess the histological picture, 60 decalcified sections were examined (two per each animal, respectively). Data from control group without treatment were described previously, and were used for comparison. Histological examination confirmed ongoing healing process in all three groups. In group 1 treated with immunomodulator, pharmacological properties of polyoxidonium favorably affected regeneration of periodontal tissue, which, however, required longer period of time, more than 20 days. It proves a pronounced efficacy of polyoxidonium in treatment of inflammatory periodontal diseases, even as a standalone therapy without combining with antibacterial drugs.

Antibacterial drugs are routinely used in therapy of periodontal diseases. However, increasing incidence of antibiotics resistance necessitates development of novel therapeutic approaches for oral diseases. Currently, newly designed antibacterial agents based on natural, semi-synthetic and synthetic peptides is the most promising approach in dentistry. Among them is a product containing synthetic peptide (ZP2) replicating active site of granulocyte-macrophage colonystimulating factor (GM-CSF) as the main active ingredient in Atsegram-spray (manufactured by Academic Innovation Research Center, Chelyabinsk). Our study was aimed at assessing efficacy of a combination therapy of inflammatory periodontal diseases by introducing Atsegram-spray as well as examining potential relationship between peptide ZP2-related biological properties, physicochemical properties of the spray and mechanism of antibacterial and immunotropic action for substantiating its application on oral mucosa. During the first stage experiments, it was found that the peptide ZP2 was able to trigger lymphocyte blast transformation in vitro indicating that it might influence cell proliferation and exhibit marked immunotropic activity. Next, we assessed potential effects of the peptide ZP2 on biofilm formation mediated by staphylococcal clinical isolates. It was shown that peptide ZP2 inhibited biofilm formation in 75.0±9.0% of S. aureus and 50.0±15.1% of S. epidermidis strains, with mean inhibition index of biofilm formation reaching 25.1±3.8 and 50.4±6.0%, respectively. However, peptide ZP2 in 8.3–25.0% of staphylococcal clinical isolates was found to stimulate/lack effect on biofilm formation by 14.9–48.5 and 16.7–25.0% cultures, respectively. Thus, the synthetic peptide ZP2 exerts divergent, but mainly inhibitory effects on biofilm formation with staphylococcal clinical strains, which are characterized by inter- and intraspecific (strain) variability. Use of a synthetic peptide-based spray in antibacterial therapy of mild chronic generalized periodontitis (main group) one month after the onset was found to improve oral hygiene by 28.5% as well as decrease PMA index and gum bleeding index by 82.8 and 100%, respectively. In contrast, such parameters in patients receiving basic therapy (comparison group) were lower on average by 2-fold. While analyzing physicochemical properties of the spray such as pH, buffer capacity and solution osmotic pressure, it was found that they were related to the antibacterial mechanism of drug activity and efficacy in treatment of inflammatory periodontal diseases. Thus, assessing peptide ZP2-related biological properties and physicochemical parameters of the spray allows to evaluate their role in mechanism of previously unknown antibacterial and immunotropic activity. These findings confirm feasibility and efficacy of using Atsegram-spray in dentistry as an alternative means to antimicrobial agents, such as antibacterial drugs.