Komparativno ispitivanje efikasnosti bazične, lasero i fitoterapije kod pacijenata sa hroničnom parodontopatijom

Abstract

The aim of the investigation that was conducted as clinical prospective study was to establish efficacy of the basic, low level laser therapy (LLLT) and phytotherapy in patients with chronic periodontitis. Different approaches in the treatment of chronic periodontitis were compared. Beside basic (causal) therapy, that represents the ‟‟gold standard” for the treatment of chronic periodontitis, LLLT and phytotherapy were performed. The study included 111 subjects divided into 4 groups. The first, the second and the third group was constituted as follows: 30 patients with chronic periodontitis, who received basic periodontal treatment (I group), combined basic and phytotherapy (II group) and combined LLLT and basic therapy (III group), for five consecutive days. Clinical parameters were measured before intervention, after the fifth treatment and after a month. All subjects received oral hygiene instructions and full-mouth periodontal treatment (professional removal of dental plaque and calculus, followed by curettage of periodontal pockets). Afterwards, in group II, phytotherapy was applied (Tinctura paradentoica ® Institut “Dr Josif Panĉić”, Beograd), while in group III, Kavo LLLT (980 nm, 0.2 W, 6 J/cm2) was applied. Subgingival samples were collected at baseline and after the fifth treatment to identify following bacterial species: Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis, Tannerella forsythensis and Treponema denticola. Gingival swabs were taken, and direct smears were prepared on slides for cytomorphometric analysis. The fourth group included 21 periodontally healthy subjects in good general health. The results were compared by clinical examination (oral hygiene indices, gingival and periodontal indices), polymerase chain reaction (PCR) method for detection of periodontopathogenic bacteria and cytomorphometric analysis. The evaluation using clinical parameters showed better results in group III, there LLLT was applied. Comparing the values of nuclear area after therapy, it was established that their values were statistically significantly higher in the basic therapy group, compared to the combined therapy groups (II and III), independently (p < 0,001). After treatment, the following bacterial species were found less frequently (Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis, Tannerella forsythensis and Treponema denticola) in all studied groups, compared to before treatment, except bacteria Tannerella forsythensis, that was found more frequently in the basic therapy group. In the combined therapy groups (II and III), a statistically significant decrease in the prevalence of bacteria was observed for Tannerella forsythensis and Treponema denticola (p < 0,001). However, in the LLLT group, statistically significant decrease in the prevalence of the remaining bacteria was observed for the following: Aggregatibacter actinomycetemcomitans and Prevotella intermedia (p < 0,05), as well as Porphyromonas gingivalis (p < 0,01). Based on previous findings, it could be concluded that combined LLLT and basic therapy had better short - term outcomes compared to the basic and phytotherapy as well as basic therapy itself.