STATE OF BONE METABOLISM IN PATIENTS WITH VARIOUS OPTIONS OF THE COURSE OF GENERALIZED PERIODONTITIS

Generalized periodontitis is one of the most common dental conditions that is difficult to treat. This is largely due to aggressive forms of the clinical course and, as a result, to the acceleration of destructive processes in the periodontal bone structures, which is due to the depth of bone metabolism disorders that arise as a result of various pathogenetic factors: insufficiency of hormones that regulate calcium metabolism, excessive production of pro-inflammatory cytokines, imbalance in the system of radical oxidation of lipids and the antioxidant defense system, etc. At the same time, information on the state of bone metabolism in various variants of the course of generalized periodontitis has not yet been fully studied and is based on a small clinical and laboratory material. The aim of this study is to study the variability of bone metabolism in patients with various manifestations of generalized periodontitis. To achieve the goal, 92 patients with generalized periodontitis of II-III severity were included in a continuous simultaneous clinical and laboratory study: group I with a chronic course (30 people), group II with an aggravated chronic course (31 people), and group III with an aggressive (rapidly progressing) course (31 people). In addition to standard clinical, paraclinical and laboratory methods, orthopantomography and dental volumetric tomography were used to clarify the diagnosis and dynamics of the destructive process in periodontium. Clinical and paraclinical studies did not reveal differences in the manifestations of the aggravated and rapidly progressing course of generalized periodontitis. In turn, the results of the study of markers of osteogenesis and osteoresorption showed that in patients of all groups the same orientation of the processes of osteoblastogenesis and bone formation is observed. However, in patients with a chronic and exacerbated manifestation of generalized periodontitis, the separation of bone metabolism is due mainly to increased osteoresorption and a moderate decrease in osteosynthesis. On the contrary, in patients suffering from rapidly progressing generalized periodontitis, a deep inhibition of bone regeneration processes was determined against the background of a significant increase in osteoresorption in periodontal bone tissues. A study using dental volumetric tomography on the Hounsfield index (HU) revealed a decrease in mineral density in 100% of patients with rapidly progressive course, and only in 12.9% of patients with chronic course.