The most significant periodontal disorders associated with diabetes mellitus are due to changes in bone tissue. It has become necessary for specific osteotropic therapy that can normalize metabolic processes in the alveolar bone. In turn, currently the most promising in terms of improving osteogenic activity are strontium ions. Strontium ranelate is used to treat osteoporosis due to its antiresorptive and osteoanabolic action. However, its effectiveness against alveolar bone has not been sufficiently studied.
The purpose of the work is to conduct a clinical study of complex treatment of generalized periodontitis, supplemented with strontium ranelate, in patients with type 2 diabetes mellitus.
Materials and methods of the research. The study included 60 patients with generalized periodontitis of I-II degree of severity, chronic course, aged 35-45 years. Type 2 diabetes mellitus was diagnosed and two groups were formed. The traditional treatment regimen was used in the group of comparison (main group) where Strontium Ranelate was prescribed additionally. The treatment was evaluated according to the dynamics of clinical observations, orthopantomography and computed tomography data, the results of biochemical studies. As markers of bone resorption, tartrate-resistant acid phosphatase (TRAP) activity was determined in blood serum and the content of β-CrossLaps fragments was determined in urine. As markers of osteogenesis, the concentration of C-terminal propeptide type I procollagen (CICP) was detected in blood plasma, bone alkaline phosphatase (BAP) and osteocalcin were detected in serum. Serum parathyroid hormone concentrations, total blood calcium and total inorganic phosphorus in the blood were studied as indicators of mineral metabolism.
Results of the research. In the earliest possible timeframe the complex treatment of generalized periodontitis was conducted during the observation which led to clinical stabilization of the inflammatorydestructive process in the periodontal tissues without a significant difference between the experimental groups (p ˃ 0.05). However, the condition of periodontal tissues in patients of the experimental groups differed in a year after treatment. In 16.7% of patients from the comparison group, recurrence of the inflammatory-destructive process in periodontal tissues was diagnosed, while the cases the deterioration of the pathological process was not detected in the main group. A significant difference was found for complex periodontal indices (Ramfjord, PI and SPITN) (p <0.05). Clinical and radiological stabilization was observed in 83.3% of patients of the comparison group and in 100% in the main group. According to the results of computed tomography of the alveolar bone, an increase in bone mineral density was established in both groups, but only in the main group the difference between indices before and after treatment was significant (p˂0.05).
In patients of the main group a more pronounced decrease in the activity of tartrate-resistant acid phosphatase (TRAP) was found in the serum and the concentration of β-CrossLaps was found in the urine, indicating inhibition of bone resorption, as well as markers of bone formation the concentration of C-terminal propeptide (CICP) was found in blood plasma, bone alkaline phosphatase (BAP) was found in serum, osteocalcin (p <0.05). Indicators of mineral metabolism in bone tissue, both during treatment and for experimental groups, almost did not differ (p> 0.05).
Thus, the use of strontium drugs in the complex treatment of generalized periodontitis in patients with type 2 diabetes mellitus provides a longer and more stable clinical and radiological stabilization of the pathological process in periodontal tissues, primarily by inhibiting bone resorption and enhancing osteogenesis. So, they can be recommended for the wide use in stomatological practice.
RESULTS OF CLINICAL STUDY OF COMPLEX TREATMENT OF GENERALIZED PERIODONTITIS WITH THE USE OF STRONTIUM DRUGS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS