Biochemical changes of tooth root cementum in patients with generalized periodontitis at the stage of maintenance periodontal treatment

Abstract

Summary. In patients with generalized periodontitis as a result of the clinical attachment loss the dental plaque, changes in the pH of the oral fluid, the consumption of acidic foods, carbonated drinks, and other factors are negatively affected on the exposed root surface. Changes in the structure and biochemical composition of the root cementum have a significant impact on the processes of reparative regeneration of the periodontal complex. The use of toothpastes that has remineralizing properties can help protect the root cementum and promote the reparative regeneration of the periodontal complex.

The aim of the study – to study the biochemical composition of the root cementum in patients with generalized periodontitis under the influence of toothpaste with a wide micro-elemental composition (Ca, P, Mg and others).

Materials and Methods. The study included 60 patients with generalized periodontitis of II-III degree of severity chronic course which were divided into 2 groups: 1 (control) and 2 (main) of 30 people each. Patients from two study groups underwent primary periodontal treatment using instrumental methods of dental treatment – ultrasonic scaler and Gracie curettes and medical treatment of periodontal pockets using 0.2 % chlorhexidine gel/solution. Patients of group 2 in the complex of personal hygiene were additionally prescribed toothpaste with a wide micro-elemental composition (Ca, P, Mg and others) for 6 months. Patients in the control group used fluoride-containing toothpaste. Six months after the initial periodontal treatment, in patients were measured the depth of periodontal pockets, clinical attachment loss and gingival recession. Before performing complex methods of rehabilitation with the use of dental implants and orthopedic methods of restoration of dentition according to orthopedic indications, 12 teeth were extracted in group 1, and 9 teeth in group 2. The samples were embedded in epoxy resin, cross-sections were obtained, polished, and sputter-coated with 30 nm gold and palladium. Using a scanning electron microscope equipped with an energy dispersive spectrometer, the content of chemical elements of the root cementum was determined.

Results and Discussion. There is a significant difference in the content of Ca and P in samples between the group of patients who used fluoride paste in the complex of individual hygiene and the group of patients who used paste with a wide micro-elemental composition (Ca, P, Mg and others) in the complex of individual hygiene. A high content of Ca was found in the cervical, middle, and apical parts of the root of the samples of group 2. A high content of P was found in the cervical and apical parts of the root of the samples of group 2. The obtained data indicate the ability of the applied paste to modify the content of Ca and P in the root cementum, which is damaged as a result of the influence of infectious-inflammatory processes, changes in the pH of the oral fluid, the consumption of acid-containing food, carbonated drinks and influence of abrasive materials (when brushing teeth).

Conclusions. The use of a toothpaste with a wide micro-elemental composition (Ca, P, Mg and others) in complex of oral care in patients with generalized periodontitis significantly increases the content of Ca and P in the root cementum. Due to the positive effect on the structure of the hydroxyapatite crystals of the root cementum, their chemical composition improves and the geometry is normalized, especially the symmetry of the hydroxyapatite crystals. Restoration of hydroxyapatite crystals of root cementum has a positive effect on the connection with collagen fibers of the periodontal ligament and promotes the processes of reparative regeneration of periodontal tissues. In patients with generalized periodontitis, the use of a toothpaste with a wide micro-elemental composition (Ca, P, Mg and others) may be an optimal tool in the prevention of damage of the root cementum and the development of cervical lesions.