CLINICAL AND LABORATORY ASSESSMENT OF THE RESULTS OF EXAMINATION OF PATIENTS WITH GENERALIZED PERIODONTITIS COMPLICATED BY TRAUMATIC OCCLUSION

Abstract

Studying the factors influencing the progression of the chronic course of generalized periodontitis (GP) in young individuals remains a relevant issue. Modern studies of the pathogenesis of GP focus on several conceptual approaches reflecting the principles of established patterns in the formation of infectious and dystrophic processes. The most notable research involves examining the microbiological composition of dental deposits in periodontal pockets and the vascular response accompanied by changes in the permeability of vessel walls in the microcirculatory bed and activation of local immune complexes. Clinical efforts are directed toward maintaining a stable remission of GP by reducing the number of periodontopathogens in oral eco-niches. However, the long-term use of broad-spectrum antimicrobial agents for both treatment and daily prevention creates a persistent substrate of dysbiosis in the oral cavity. This leads to atypical clinical presentations of chronic GP, even at the initial first stage of disease development. The study presents research results involving the functional activity of endothelial cells in periodontal space. A comparative analysis of functional loads on the periodontium caused by existing supra(hyper) contacts holds significant diagnostic and prognostic value. To substantiate this, it is necessary to adhere to a clinical, radiological, and functional examination protocol. This includes identifying pathological occlusion through intermaxillary impression with A-silicone, conducting orthopantomography, and 3D computed tomography of the jaws, alongside comparative assessment of software-based densitometry in areas of localized osteoporosis. This enables clinicians to detect hypercontacts and disruptions in the microstructure of cancellous bone. Additional functional analysis of occlusal relationships, differentiating contacts by time, force, and plane of occlusion using a T-scan device, holds significant practical relevance. The study found that 98.3 % of patients with initial-stage GP and a chronic course showed occlusal load imbalances due to inadequate dental restorations and carious lesions of Class I, II, and III (Black's classification). This imbalance in load leads to selective disruption of the microcirculation system in the periodontium, accompanied by cell-specific processes regulated by phagocytes, lymphocytes, and endothelial cells. Thus, trophic changes linked to hemodynamics are mediated by intercytokine response and endothelial state. A comparative analysis revealed that determining tumor necrosis factor-alpha (TNF-α) and vascular endothelial growth factor (VEGF) levels in periodontal pockets during chronic inflammation has predictive and differential diagnostic significance. A statistical increase in TNF-α concentration up to sixfold (568 %) in hypercontact areas, compared to a twofold increase (207 %) in chronically inflamed periodontal pockets, indicates a significant statistical difference (P<0.05) relative to the control group. VEGF-A activity showed similar trends: a 22 % increase in periodontal pockets with chronic inflammation and up to a fourfold increase (370 %) in hypercontact areas (P<0.05). The obtained results allow clinicians to determine the sequence and scope of therapeutic measures for periodontologists. Implementing modern diagnostic methods such as orthopantomography, 3D computed tomography, and T-scan analysis has practical importance in identifying vascular disorders and structural disorganization of periodontal tissue complexes, supported by scientific immunological research.