DETERMINATION OF THE NEED FOR SURGICAL TREATMENT OF PATIENTS WITH GENERALIZED PERIODONTITIS BY THE METHOD OF FLAP OPERATIONS
Authors: Zaiats S. V. , Rozhko M. M. 
Published: October 2022

Aim: to study of the need and justification for flap operations in the complex treatment of patients with generalized periodontitis (GP).

Materials and methods. 280 people with GP were examined. Patients were divided into the following age groups: Group I - 136 (48.6%) patients aged 30-44 years and Group II - 144 (51.4%) patients aged 45-60 years. The initial state of oral hygiene was assessed using the OHI-S index (Oral Hygiene Index Simplified). In order to determine the degree of disease development and the need for the use of surgical methods of treatment, the depth of periodontal pockets (PC), levels of epithelial attachment loss  and gum recession (classification according to P.D. Miller) were determined. The degree of multirooted teeth furcations damage in the horizontal direction was studied according to the Hamp classification (1975). The degree of tooth mobility was determined according to Entin. The obtained data during the examination of patients were entered into specially developed periodontological maps. The diagnosis was made on the basis of a clinical and radiological examination, according to the classification of Danylevsky M.F. (1994).

Results. Initial -1st degree of development of GP was diagnosed in 73 (53.7%) examined persons aged 30-44 years and in 59 (41.0%) persons aged 45-60 years. Such patients do not require surgical interventions, therefore conservative treatment was prescribed to them.

In the 1st age group, 38 (27.9%) patients were diagnosed with GP of the II degree of development, II-III degree of development – in 25 (18.4 %) patients. In the 2nd age group, 40 (27.8%) people were diagnosed with GP of the 2nd degree of development, 45 (31.3%) of the 2nd-3rd degree of development. The average value of the depth of periodontal pockets , as well as the level of epithelial attachment loss differed in age groups and was higher in patients older than 45 years. Gum recession was observed in all patients with II, II-III stage of development of GP. At the II stage of the development of GP, the average value of the recession of the gums varied between 1.49 ± 0.23 mm in the I age group and 1.98 ± 0.25 mm in the II group, which corresponds to a light degree of recession. With GP II-III stage of development, the average value of recessions was 2.20 ± 0.46 mm in the I age group and 2.43 ± 0.50 mm in the II age group, which also corresponds to a mild degree of gum recession. Class III and IV recessions, which have an unfavorable treatment prognosis, were more often observed in patients of the II age group. Involvement of multirooted teeth furcations in the pathological process was observed in patients with II-III degree of development of GP. In the majority of  patients with II, II-III degree of GP, I-II degree of tooth mobility was registered. III degree of mobility was diagnosed in 5 (20%) patients of the I age group and in 12 (26.7%) patients of the II age group.

Conclusions. According to the results of our research, the peculiarities of the clinical picture in patients with generalized periodontitis I, II and II-III stages of development aged 30-44 and 45-60 years were established. In particular, the indicators of the OHI-S hygiene index indicate the unsatisfactory state of oral hygiene of the examinees, and the criteria for surgical interventions in complex treatment are the depth of periodontal pockets, the level of loss of epithelial attachment and the type of gum recession.

We established that 17.1% of the examined patients require surgical treatment by the method of flap operations, of which 14.0% of patients in the I age group (30-44 years) and 20.1% of the II age group (45-60 years).