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Kharkiv Medical Academy of Post-graduate Education, Ukraine
Championship participant: the National Research Analytics Championship - "Ukraine";
the Open European-Asian Research Analytics Championship;
50 patients residing on the territory under the influence of heavy metal salts of low intensity, were under observation and they were given medical treatment to evaluate the efficiency of periodontitis treatment with the help of alpha-lipoic acid in short-term and long-term period.
The patients were undergone clinical evaluation of periodontal status according to general indexes and data of laboratory examinations prior to treatment, in 14 days and in 12 months.
After intaking of 600 mg of alpha-lipoic acid per day during 14 days the condition of periodontitis tissues in the reference group and in the basic group has no statistically significant differences.
The basic group took alpha-lipoic acid during 2 months, that favored improving of clinical and laboratory indexes. In comparison with the reference group in the basic group PMA index decreased in 2.3 times, IIS in 1.4 times, BPI in 1.8 times, complex parodontal index improved in 1.3 times, leucocytes emigration decreased in 1.2 times and microbial contamination of epithelium in 1.22 times. Efficiency of anti-inflammatory therapy was 1.4 times higher. Depth of gingival pockets and level of oral hygiene had no statistical significant differences.
Keywords: periodontitis; periodontal status; periodontitis treatment; heavy metal salts; end treatment results; alfa-lipoid acid.
Foreword. For the moment native and foreign specialists have many arguments of negative influence of hostile factors of environment on people health [4, 9]. Condition of tissues and organs of oral cavity are closely connected with performance level of different body systems and formation of dental health occurs together with somatic health. Taking this into account, factors of environment have negative effect on them too, that influences essentially on the level of dental health of children and adults. Among many pollutant specialists pay great attention to heavy metals salts (HMS). Prevalence and intensity of periodontitis tissues diseases grow on the territories polluted with HMS among all age groups . A range of methods and solutions was offered for treatment of pathologic conditions, associated with influence of HMS. Our attention was attracted by medications with alpha-lipoid acid (α-lipoic acid, ALA) which showed positive effect during therapy of inflammatory diseases of periodontitis [7, 10]. But experience of its use is limited by evaluation of its efficiency in the short-term period of periodontitis treatment only. The foregoing determines the timeliness of this research.
Goal of research was to study comparative evaluation of efficiency of periodontitis treatment with alpha-lipoic acid in the short-term and long-term period in people which are under the influence of heavy metal salts of low intensity.
Materials and Methods. 50 patients with long-lasting generalized periodontitis of II stage, residing on the territory under the influence of heavy metal salts of low intensity, were under observation. All patients have the same basic therapy: professional oral hygiene was performed, local irritable factors were removed, ptriodontal dressings with gel Indovazin were applied .
For the purposes of this investigation all patients were divided into two groups. The first group (reference group) consisted of 20 persons taking Alpha-lipon (Kyiv vitamin plant), Ukraine) 600mg per day 30 min before a meal during 14 days. The second group of patients (n=30) had been taking this medication during 2 months.
Examination of periodontitis tissue was performed, the level of teeth mobility, depth of gingival pocket (GP) were determined. To perform an objective evaluation of periodontitis tissues condition the X-ray examination and standard indexes: HI – Hygienic Index (OHI-S), PMA – Papilla-marginal-alveolar index (Parma modification), IIS –Iodine index of Svrakov, PBI - Papillary bleeding index (according to Saxer and Muhlemann), CPI – Complex periodontal index were used . The dynamics of inflammatory reaction in gingival was additionally evaluated by leucocytes emigration from the area of inflammation to oral cavity , data of bacterial load of epithelial cells of GP . The efficiency of anti-inflammatory therapy (EAT) was evaluated according to CPI (EAT, %=[(CPI1 - CPIn) × 100] / CPI1), where CPI1- is CPI during primary examination, CPIn- is CPI during n-examination. Clinical and laboratorial examination was performed before the treatment, immediately after treatment (on 14 day) and later (in 12 months).
Statistical analysis of materials was hold according to parametric criterion (mean value – M, error of mean – m), signification of difference – according to non-parametric W-test of Wilkokson with the help of statistical program AtteStat 10.8.4. for MS Excel. Statistically significant differences were considered at р< 0.05.
Study Findings and Discussion. Initial periodontal status of patients from both groups has no statistically significant differences. Indicator values of patients from the 1 and the 2 groups were: HI 4.60±0.28 and 4.43±0.23 points; РМА– 76.97±3.28 and 76.50±2.68%; IIS – 4.18±0.35 and 4.16±0.35 point; РВІ– 2.53±0.11 and 2.43±0.07 points; depth of GP – 4.51±0.10 and 4.49±0.09mm; CPI – 14.48±0.46 and 14.74±0.36 points; white blood count in 1 mcL of oral lavage 395.40±13.8 and 418.10±7.17; quantity of bacterized epithelial cells of GP 70.50±3.22 and 70.00±2.65%. Identity of clinical and laboratorial indications in compared groups of patients let to objectivate the evaluation of treatment efficiency.
In the Table the short-term and long-term results of clinical and laboratorial indexes of periodontitis treatment are showed. In both groups of patients the complex treatment of periodontitis with 600mg of alpha-lipoic acid per day during 14 days favored remitting of inflammatory process in gingival. Periodontitis treatment results in short-term period were characterized by improving of oral hygiene in 6 times in comparison with the initial level. The prevalence rate of inflammatory process according to PMA index and its intensity according to IIS reduced considerably (in 13 and in 6 times correspondingly). Gingival bleeding decreased in 4 times according to PBI. Depth of gingival pocket decreased in 1.3 times. CPI decreased in 2.8 times. Efficiency of anti-inflammatory therapy of periodontitis was 63.35-65.66%. In the result of inflammation elimination in gingival the leucocytes emigration to oral cavity decreased in 2.9 times and bacterial load of epithelial cells of GP decreased in 2 times. Evaluation of clinical condition of periodontitis tissues immediately after treatment (in 2 weeks) showed that differences between two groups of patients were not significant.
Clinical and laboratorial indexes of patients after treatment (М±m)
(in 2 weeks)
(in 12 months)
Leucocytes emigration to oral cavity, quantity in 1 mcl
Bacterial load of epithelial cells of GP, %
Analysis of long-term results of periodontitis treatment (in 12 months) showed significant improvement of most clinical and laboratorial indexes in patients of the 2nd group in comparison with the reference group. Taking 600mg of alpha-lipoic acid per day during 2 months favored decreasing of intensity of inflammatory process in periodontium according to PMA index in 2.3 times (p=1.6E-07), its intensity according to IIS in 1.4 times (p=0.037) and bleeding of gingival papilla in 1.8 times (p=9.8E-07). Tendency to reduction of gingival pockets depth in 1.1 times was registered (р=0.054). Complex periodontal index improved in 1.3 times (р=4.4Е-07). Totally, efficiency of anti-inflammatory therapy was 1.4 times higher in patients from the 2nd group than in patients taking the medication during 2 weeks (р=0.0001). Number of leucocytes emigrated from the area of inflammation to oral cavity and microbial contamination of gingival pockets indicated on expressed resolution of infection in long-term period. Their statistical significant decrease was noticed in 1.2 (р=0.001) and 1.22 (р=0.036) times correspondingly.
Positive results of periodontitis treatment with alpha-lipoic acid during 2 months in patients residing on the territory under the influence of heavy metal salts of low intensity, were achieved due to pharmacologic characteristics of the medication. Alpha-lipoic acid is an important component of biological membranes protecting them from lipid peroxidation, plays an important role in mitochondrial dehydrogenase reactions being cofactor of ferments such as piruvate dehydrogenase and α-ketoglutarate dehydrogenase . Alpha-lipoic acid has positive effect in treatment of different pathological conditions accompanied by oxidative affect . In the result of the experiment on animals taking heavy metals salts, progression of oxidative stress in gingival accompanied with accumulation of products of lipid peroxidation and sharp suppression of enzymetic component of antioxidant system were established. Introduction of alpha-lipoic acid provided statistically significant balance of prooxidant-antioxidant balance in 2 months . Moreover, the inhibit influence of the medication on proinflammatory mediator prostaglandin E2 was noticed. Main component of periodontal complex is alveolar bone of jaw. Its condition determines the severity of periodontitis and the intensity of destructive process in tissues. Alpha-lipoic acid can take osteoprotection effect at admission of heavy metals salts to a body, reducing resorption of alveolar bone and increasing its density .
Moreover, alpha-lipoic acid has positive effect during heavy metal intoxication. It makes stabile chelate bonds with metal ion hereby favoring detoxication [14, 15].
Conclusions. Thus, including of 600mg of alpha-lipoic acid per day during 2 months into complex therapy of patients with periodontitis favors significant improvement of periodontal status in long-term period. It concerns both inflammatory and destructive component of the pathology. Achievement of alpha-lipoic acid treatment results is realized due to its antioxidant properties, capacity to inhibit inflammation mediators, protective effect on alveolar bone and capacity to bind metals, harmonizing bone tissue metabolism. Results of the research let to use suggested scheme of alpha-lipoic acid treatment in patients with periodontitis and to extend clinical indications for its prescription.
Directions for future research. Taking into account the importance of alveolar bone condition in the development of destructive process in periodontitis and in evaluation of severity of periodontal status, there is practical demand to study the influence of alpha-lipoic acid on its mineral density.