It is known that periodontitis is an inflammatory disease ofthe connective tissue anatomical formation located in the space between the compact plate of the dental alveoli and the cement of the tooth root. It has been proven that endodontic treatment for complicated forms of carious lesions is based on invasive interventio

Morozov, A. N.

Nikogosyan, S. M.

Oganesan, A. A.

Ryzhova, I. P.

Tsypkina, A. I.

DSpace at Belgorod State University

EFFICIENCY OF ANTINOCYCEPTIVE SUPPORT OF PATIENTS WITH ENDODONTIC INTERVENTIONS FOR ACUTE PERIODONTITISArman A  O ganesan*\ Satenik M Nikogosyan^, A lexey N. Morozov^, Alina I. Tsypkina \ Irina P. Ryzhova^Belgorod State University^Voronezh State IVIedical University Named after N. N Burdenko^308015, Belgorod, Pobeda Street, 85, Russia Voronezh, 10 Studencheskay, RussiaE-mail: oganesyan@bsu.edu.ruCaries is the most common dental pathology. This disease is extremely common and accompanies the total human population since its inception. In prognostic terms, untreated carious lesions, with the exception o f "suspended caries", necessarily turn into complicated forms - pulpitis and periodontitis. It is known that periodontitis is an inflammatory disease of the connective tissue anatomical formation located in the space between the compact plate of the dental alveoli and the cement o f the tooth root. In the case o f unsuccessful conservative treatment or its impossibility, the issue of conservative-surgical or surgical methods o f treatment - root apex resection or tooth extraction is considered. It has been proven that endodontic treatment fo r complicated forms of carious lesions is based on invasive intervention. In addition to stress, there are other types o f adaptive reactions of the body. A  natural consequence of this is the initiation o f nociceptive, neurovegetative and psychoemotional reactions. The result is the formation of chronic postoperative neuropathic pain syndromes, which affects the patient's dental health and quality of life. In this case, the modulating factors are the individual characteristics of the organism and, to  the greatest extent, the type of dental intervention and the adequacy of the anesthetic.Key words: acute periodontitis, endodontic treatment, antinociceptive support.In troductionAcute com plicated forms o f carious lesions continue to  occupy leading positions in the structure o f m odern dental patho logy (Hillson, 2001, 2018). As part o f this nosological group, acute periodon titis  is a typical representative and one o f the most comm on diseases. The distinctive characteristics o f this patho logy are a severe clinical course and a high risk o f deve loping serious com plications (Zakrzewska, 2013). This circumstance leads to  the need fo r active trea tm ent o f acute periodontitis . In this regard, m odern endodon tic  interventions are often an uncontested option  fo r the optim al solution to  the problem  and have the ir own unresolved aspects tha t significantly affect the overall qua lity o f dental care (Durham, Exiey, John, & N ixdorf, 2013; N, 2013).The problem  is potentia lly  solvable with the help o f a qualified anesthetic m anagem ent (N, V, L, & A, 2011). Im proving the effectiveness and safety o f analgesia in the trea tm ent o f m andibular molars. Institute o f S tom ato logy (Su et al., 2016).However, in ou tpa tien t dental practice, the involvem ent o f anesthesiologists in most cases is not p rovided; in add ition , the anesthetic aid is laborious and therefore not suitable fo r use in thiscase; thus, the im plem entation o f analgesia is entire ly w ithin the purview o f the a ttending dentis t (Vinckier, 2000). A t the same tim e, existing m ethods o f add itiona l anesthesia after dental interventions (for example, oral or intramuscular use o f analgesics) are often not effective enough (Hillson, 2001; Krippaehne & M ontgom ery, 1992; Su et al., 2016; Vinckier, 2000; Zakrzewska, 2013). The trad itional system o f pain re lie f in dentistry (local application, in filtration and conduction anesthesia) does not prevent the deve lopm ent o f pain in the early postoperative period (Kaufman, Epstein, Gorsky, Jackson, &  Kadari, 2005). In practice, this is confirm ed by the fact that the absolute num ber o f patients operated on fo r com plica ted forms o f carious lesions have pronounced sym ptom s o f postoperative pain and associated em otional d iscom fort in the im m ediate postoperative period (Martin, Patterson, M itterm uller, Lee, & M offatt, 2020)The aim o f the study was to  evaluate the trad itional approach to  antinociceptive maintenance in the preoperative period o f endodon tic  interventions fo r acute periodon titis  fo r functional sufficiency.M aterials and research m ethodsThe study was carried ou t in the cond itions o f the Voronezh State Medical University named after N.N. Burdenko Dentistry Departm ent. Its m ethodologica l p la tform , according to  the control points o f the observation periods, included m ethods fo r obta in ing empirical data.Preoperative period: 1 po in t 24 hours before the planned endontic  intervention. W e used a m ethod fo r assessing pain syndrome in patients based on m odern ana log-d ig ita l scales (visual analog scale, d ig ita l rating scale, m im ic pain rating scale). A  m ethod was carried ou t fo r assessing the stress-induced tension o f the autonom ic nervous system o f patients using card io intervalography and mathematical analysis o f the heart rhythm. The Spielberger scale was used to  assess the level o f personal and situational anxiety.The key perform ance ind icator (KPI) in this study refers to  the perform ance indicators o f the deve loped program  o f anti-noceptive maintenance, which assess the achievem ent o f its clinical goals. The indicators were determ ined using the ratio o f the num ber o f patients w ith a specific ind icator to  the to ta l num ber o f patients in the group, expressed in%.During the reporting period, the study included 200 patients w ith acute com plicated forms o f carious lesions. The study participants were stratified into 2 groups o f 100 people  in accordance w ith the app lied m ethod o f antinociceptive support. Standardization o f the com pared groups was achieved by ensuring the identity  o f the in tragroup d istribu tion  o f study participants by age and gender, forms o f acute carious com plications, and m ethods o f local anesthesia.Endodontic trea tm ent was the same in the com pared groups and was perform ed in accordance w ith the "Patient M anagem ent Protocols" o f the Russian Dental Association (Diegritz et al., 2020; Ostrc, Pavlovic, & Fidler, 2021).Local anesthesia, as a com ponent o f antinociceptive support, was the same in the com pared groups, was perform ed according to the fo llow ing  methods: 1) conduction (withblocking o f n. Alveolaris) + in filtration anesthesia: during interventions on teeth No. 8, 7, 6 and 5 o f the lower jaw; 2) only in filtration anesthesia for interventions on the lower jaw, w ith the exception o f teeth No. 8, 7, 6 and 5, and fo r any interventions on the upper jaw; articaine hydroch loride 4% w ith epinephrine hydrochloride in a ratio o f 1: 100,000 in 1.7 ml injection cartridges was used as a local anesthetic preparation; the used dose ranged from  1.7 to  3.4 ml, in most cases - 2.55 ml o f the official solution (Vavina, Koreckaya, Chirkova, N ikogosyan, & Morozov, 2015; Vinckier, 2000).In the study o f the index o f the initial pain syndrome, the fo llow ing  results were obta ined.So, in the control g roup (n1 = 100 people) the ind icator values were 5.3 ± 0.59 points, in the main g roup (n2 = 100 people) - 5.4 ± 0.58 points. It should also be noted that the initial pain syndrome (corresponding to  the clinical p icture o f acute periodontitis) had all 100% o f patients com pared groups. None o f them  had test results on ana log-d ig ita l scales less than 2 points. In add ition , the level o f pain syndrome exceeded the critical one (i.e., 4 points) in the absolute m ajority o f patients in both groups (73% o f the sample size in both cases).Statistical analysis revealed the absence o f significant in tergroup differences in the "baseline pain level" ind icator (Student's param etric t-test fo r unrelated samples: p = 1.111111).The results dem onstrate the statistical "ind is tingu ishab ility" o f the com pared groups according to  the initial the level o f pain in the area o f the causative tooth  and, accordingly, the ir "su itab ility" fo r fu rther statistical comparisons (Martin e t al., 2020)ResultsIn the study o f the ind icator o f personal anxiety (LT), the fo llow ing  results were obta ined. So, in the contro l g roup (n1 = 100 people) the ind icator values were 34.6 ± 3.84 points, in the main group (n2 = 100 people) the ind icator was 35.1 ± 4.81 points.Statistical analysis revealed the absence o f significant in tergroup differences in the "personal anxiety" ind icator (parametric S tudent's t-test fo r unrelated samples: p = 1.111111).In the study o f the ind icator o f situational anxiety (ST), the fo llow ing  results were obta ined: in the contro l g roup (n1 = 100 people) the values o f the ind icator were 48.2 ± 3.13 points, in the main g roup the values (n2 = 100 people) - 49.1 ± 2.92 points. In both groups, the level o f the ind icator exceeded the upper lim it o f the norm (in the control g roup - by 26.7-100%, in the main g roup - by 30-103.3%.).Statistical analysis revealed the absence o f significant in tergroup differences in the ind icator "situational anxiety" (parametric Student's t-tes t fo r unrelated samples: p = 1.111111)DiscussionThe results dem onstrate the statistical "ind is tingu ishab ility" o f the com pared groups in terms o f the level o f personal and situational anxiety and, accordingly, the ir "su itab ility" fo r fu rther statistical comparisons.The results o f the study o f the initial level o f " in term ed ia te " card io in terva lographic indicators o f the m ode, the am plitude o f the m ode and thevariation range in patients o f the compared groups are given according to  the analyzed indicators o f the mathematical analysis o f the heart rate, the absence o f statistically significant in tergroup differences is obvious (Ovechkin, 2016).Accord ing ly, when studying thecard io interva lographic stress index (CSI), the fo llow ing  results were obta ined: in the control g roup (n1 = 100 people), the ind icator values were 543.8 ± 69.71 c.u. There was an excess o f the upper lim it o f the norm by 165.3-302%. In the main g roup (n2 = 100 people), the ind icator values were 544.7 ± 69.73 c.u. The upper lim it o f the norm was exceeded by 166-302.7%.Statistical analysis revealed the absence o f significant in tergroup differences in the KIN ind icator (parametric Student's t-tes t fo r unrelated samples: p = 1.111111).Conclusion1. Patients w ith acute periodon titis  have initia lly pronounced pain syndrome, as well as increased values o f the card io-in terva lographic index o f tension and situational anxiety, which,obviously due to  the clinical and pathogenetic features o f acute periodontitis ;2. The revealed data prove the initial absence o f statistically significant differences in pain syndrome, personal and situational anxiety, as well as the level o f expression o f the autonom ic nervous system between patients in the control and main groups;3. These prelim inary results are an additional factor o f standardization o f the com pared groups in terms o f the initial level o f "stressor" o f the ir participants, which subsequently made it possible to  reasonably make in tergroup comparisons o f antistress effectiveness o f the trad itional and deve loped approaches to  antinociceptive maintenance.ReferencesDiegritz, C., Manhart, J., Bucher, K., Grabein, B., Schuierer, G., KGhnisch, J., . . . Fotiadou, C. (2020). A detailed report on the measures taken in the Department of Conservative Dentistry and Periodontology in Munich at the beginning of the COVID-19 outbreak. Clinical oral investigations, 24(8), 2931-2941. do i:https://doi.org/10.1007/s00784-020- 03440-zDurham, J., Exiey, C., John, M. Т., & Nixdorf, D. R. (2013). Persistent dentoalveolar pain: the patient'sexperience. Journal o f orofacial pain, 27(1). do i:https://doi.orq/10.11607/jop.1022 Hillson, S. (2001). Recording dental caries in archaeological human remains. 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Efficiency of antinocyceptive support of patients with endodontic interventions for acute periodontitis

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Efficiency of antinocyceptive support of patients with endodontic interventions for acute periodontitis

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