A Clinical Case of the Use of an Immunomodulatory Drug in the Complex Therapy of Severe Generalized Periodontitis

Abstract

Disorders in the periodontal tissues in generalized periodontitis have a significant negative impact on the patient’s somatic and psycho-emotional health, causing not only dental, but also medical and social difficulties. Although scientific research has been studied, the search for new drugs for treatment and prevention of periodontal tissue diseases, the introduction of new methods have been provided, but the prevalence of generalized periodontitis includes 88-100% among adults. Destructive periodontal changes in chronic generalized periodontitis (CGP) are often irreversible and, in combination with dysfunction of the dento-alveolar apparatus and premature loss of teeth, they impair the quality of patients’ life and decrease their social adaptation.
 SIgA is the most important external secretory immunoglobulin. The functions of sIgA are the following: agglutination of bacteria, change of bacterial metabolism, delayed colonization of microorganisms, neutralization of viruses, bacterial toxins, enzymes, decrease the virulence of infectious agents and increase the opsonization of microorganisms. Receptors of slgA molecules have an affinity for some proteins of pathogens and, therefore, provide the formation of passive immunity against bacterial and viral infections.
 The aim of the work was to evaluate the clinical efficacy of the proposed immunomodulatory treatment for patients with severe generalized periodontitis. To achieve this goal, a clinical case of the drug Derinat as an addition to the complex therapeutic treatment of severe generalized periodontitis in a patient with a deficiency of secretory immunoglobulin A in the oral fluid (54, 6 mg/l) was used and presented by us.
 The patient’s treatment was done comprehensively, purposefully, individually including local and general therapy, and effective, conservative, surgical and orthopedic measures in the conditions of outpatient supervision of patients were also performed. The periodontal protocol included following steps: 1) a comprehensive examination of general and dental status; 2) professional oral hygiene, elimination of aggravating factors, selective grinding of teeth; selection of individual care products; 3) the appointment of the antibacterial drug such as Azithromycin 500 mg - 7 days; 4) immunomodulatory therapy with the use of Derinat by applications in periodontal pockets for 15 minutes - 7 days; 5) prosthetics with partial removable plate prostheses on the upper and lower jaws; 6) evaluation of intermediate results of treatment: repeated clinical examination and completion of a control periodontal card.
 The data, which has been obtained, indicated a significant positive trend in treatment, the absence of complaints on 2nd day of treatment and clinical improvement on 3rd or 4th days. Dental status data (hygiene index (1,0), PMA index (0%), periodontal index (1,2), bleeding index (1) and depth of periodontal pockets (2-3 mm)) has been significantly improved after the proposed treatment. The extension of the remission period is more than a year.
 Conclusions. The use of immunomodulatory drugs in the complex therapy of patients with chronic generalized periodontitis can significantly improve the results of conservative treatment, reduce the treatment time and prolong the period of remission due to the pathogenetic effect on the key links of the immune defense in the oral cavity.