Prevention of inflammation, pain and loss of height of marginal bone tissue at the stage of dental implantation and direct prosthetics

Abstract

Summary. Inflammation and pain can lead not only to a deterioration in the patient’s condition, but also to such local consequences as: bone resorption, loss of soft tissue volume, an increase in the wound healing time and patient rehabilitation in general. Inflammation-induced bone resorption in the area of implantation with direct prosthetics, caused by the activity of cytokines and prostaglandins, negatively affects the entire result of treatment of dentition defects in general. This is because the quality and quantity of bone tissue is one of the key points in the success of prosthetics on dental implants, therefore, pharmacological support of dental implantation and direct prosthetics is an important component of treatment. Purpose: to investigate the effect of inflammation and pain on peri-implant bone tissue at the stages of dental implantation and direct prosthetics and scientifically substantiate pharmacological support in order to prevent inflammatory bone resorption. Materials and methods. A clinical prospective study of 57 patients was carried out at the stage of dental implantation and direct prosthetics with randomization according to the type of pharmacological accompaniment: 1) group I received anti-inflammatory therapy in the form of a balanced inhibitor of COX-1, COX-2 and 5-LOG – nimesulide and analgesic therapy – dexketaprofen trometamol; 2) group II received anti-inflammatory therapy – a selective COX-2 inhibitor – meloxicam and analgesic therapy – ibuprofen; 3) group III did not receive anti-inflammatory and analgesic therapy due to contraindications to the use of non-steroidal anti-inflammatory drugs. Patients of groups I, II, III underwent: clinical, radiological and functional research methods by monitoring the state in dynamics. Results. According to the data obtained, the indices of pain intensity in group I were significantly lower (p < 0.05) as of 1 and 2-d days, compared with groups II and III. The stabilization of inflammatory processes in group I was recorded on the 2-d day. There was a significant decrease (p < 0.05) in the signs of the inflammatory process in patients of group I on the 3rd day (3.01±0.11 units), and on the 7-th day – their complete absence (1.12±0.23 units). In group II, significant regression of inflammation was noted on the 4th day (3.14±0.12 units), and on the 7-th day, minimal signs were observed (2.04±0.17 units). A decrease in signs of inflammation in group III occurred from the 5th day (3.31±0.28 units), and inflammatory phenomena were observed on the 7th day of the study (2.65±0.27 units). In group I, there was a significant stop in the loss of stability of the connection between the bone tissue and the dental implant on the 20-th day (65.08±1.03 points). As of the 25-th day, in patients of group I of the study, there was significantly higher (p < 0.05) indicators of the coefficient of stability of the implant (66.21±1.40 points) in relation to group II of patients (62.93±0.94 points), in who used selective COX-2 inhibitors, and group III (62.90±0.75 points), where NSAID’s were not used. The loss of marginal bone around the dental implant during the study period in group I was 0.5±0.23 mm CI, in group II – 1.1±0.34 mm, in group III – 1.3±0.28 mm. Side effects in group I of the study were recorded in 5.3 % of patients taking drugs nimesulide and dexketoprofen, and in 15.8 % of those in group II who took drugs meloxicam and ibuprofen. Conclusions. Complex pharmacological support of dental implantation and direct prosthetics on implants in the treatment of dentition defects, consisting of perioperative analgesia – dexketoprofen trometamol, as well as nimesulide for anti-inflammatory therapy, made it possible to influence the trauma-induced bone resorption in the implantation area by controlling inflammation. As a result, on the 20-th day in the patients of the group I of the study, a significant stop was noted in the loss of stability of the connection of the bone tissue and the dental implant (65.08±1.03 units), and on the 25-th day of the study in the group I it was found significantly higher (p < 0.05) indicators of the coefficient of stability of the implant and less loss of height of marginal bone tissue in relation to groups II and III of patients. This pharmacological complex made it possible to achieve stabilization of pathological processes in soft tissues – stopping the formation of edema on the 2-d day, a significant decrease (p < 0.05) of signs of the inflammatory process on the 3-d day (3.01±0.11 points) and to implement effective pain prevention at the stages of dental implantation and direct prosthetics.