Experimental and Clinical Substantiation of the Use of Radiosurgery and Local Ozone Therapy in the Combined Treatment of Patients with Precancerous Diseases of the Oral Mucosa

The dissertation is devoted to the experimental and clinical substantiation of the combined use of radio-wave surgery and local ozone therapy in the treatment of patients with precancerous diseases of the oral mucosa. The study is aimed at investigating the effect of the radiosurgical method on free-radical oxidation processes and antioxidant defence of tissues, the morphological features of operative wound healing, and the bactericidal properties of ozonated olive oil. In the clinical part, the dynamics of the postoperative period in patients with precancerous pathology of the oral mucosa are analysed depending on the chosen method of surgical intervention and the method of postoperative wound management with the use of local ozone therapy. On the basis of the obtained experimental and clinical data, a method of combined treatment of this category of patients has been developed and proposed for practical public health.

Relevance of the research topic. At present, one of the pressing issues in dentistry remains the choice of treatment tactics for patients with diseases of the oral mucosa. Due to the specific features of their aetiology and pathogenesis, their possible progression, transformation and malignisation, they occupy a special place in the structure of dental morbidity. The problems of diagnosis and treatment of precancerous diseases of the oral mucosa attract particular interest and attention, which is primarily associated with their high prevalence (12.5 % of all oral diseases and 26.6 % of all neoplasms), and with certain difficulties in selecting a treatment method and patient management tactics (Pashkov B.M., Belyayeva E.F., 1966; Kutina S.N., 1980; Borovskiy E.V., Danilevskiy N.F., 1981; Dunayevskiy V.A., Shelomtsev Yu.A., 1986; Yenokhovich V.A. et al., 1986; Volozhin A.I., 1992; Banchenko G.V., 1993; Paches A.I., 1997; Vagner V.D., 2002; Dolgopyagova E.V., 2004; Scully C., Beyli M., Ferreiro M.C. et al., 1998).

Many methods of treating precancerous diseases of the oral mucosa exist, depending on the pathogenetic mechanisms and clinical manifestations. Treatment tactics always depend on the character of the course of the process, the time and duration of the lesion, the state of local and general immunity of the organism, the present microflora, the timeliness of elimination of irritating or traumatic factors, and the effectiveness of previous conservative treatment (Grigoryants L.A., Badalyan V.A., 2000; Rabinovich I.M., 2000; Rabinovich O.F., 2001).

In combined conservative treatment, topical preparations with analgesic, anti-inflammatory, antimicrobial and keratoplastic properties are used (Petrova L.V., 1991; Lukinykh L.M., 1993; Safina G.G. et al., 2000; Tsarev V.N., Ushakov R.V., Plakhtiy L.Ya. et al., 2002; Lundguist G., 1995; Carbone M. et al., 1997, 1999).

However, far from always, using only therapeutic methods of treating diseases of the oral mucosa, can a positive result be achieved in the form of complete structural and functional restoration of the oral mucosa. When the disease acquires a protracted, prolonged or recurrent character, frequently complicated by secondary infection or malignisation, the only method of treatment is surgical.

Any surgical treatment is characterised by the development of a wound process, the course and outcome of which depend on many factors: localisation of the wound, state of general and local immunity, degree of microbial contamination, virulence of the present microflora, therapeutic measures, as well as the character and severity of the inflicted trauma. In this connection, there arises the need to use special minimally invasive methods of surgical intervention. It is precisely these characteristics that are possessed by the radiosurgical method, the prerequisite for the use of which is the sparing mechanism of action on biological tissues (Drabkin R.L., 1973; Doletskiy S.Ya. et al., 1980; Ovchinnikov Yu.M. et al., 1990; Grudyanov A.I. et al., 1996; Maysterenko N.A. et al., 1997; Nikogda L.I., 1997; Leyzerman M.G. et al., 1999; Novichkov G.I., 2004; Lazutikov O.V. et al., 2004; Shvyleva O.S., 2008; Maness W.L., Roeber F.W., et al., 1978; Pollack S.V., 1991; Miller W., Hertzmann P., 1992; Brown J.S., 1997; Hensman C., Baty D., Willis R.G., Cuschieri A., 1998).

Methods of combined postoperative treatment of patients with precancerous diseases of the oral mucosa must be aimed at the earliest possible relief of the inflammatory reaction, prevention of secondary infection of the wound surface and stimulation of regeneration processes. One such method is ozone therapy. The prerequisite for the local use of medical ozone is its physico-chemical and biological properties, which determine bactericidal, fungicidal, anti-inflammatory, haemostatic, antihypoxic and immunocorrective effects, as well as stimulation of epithelialisation and healing, and the absence of carcinogenic properties (Vasilyev I.T., 1995; Kontorshchikova K.N., 1995, 2000; Durnovo E.A., 1998, 2003; Veretennikov Yu.V., Koltsov V.S., 1998; Khomutinnikova N.E., 2002; Alekhina S.P., Shcherbatyuk T.G., 2003; Dushkov V.A. et al., 2005; Nesterov O.V., Nesterova E.E., 2009; Hernandez F., Menendaz S., Wong R., 1995; Bocci V., 1996; Bocci V. et al., 1998; Antoszewski Z. et al., 1997). However, we have not found data on the combined use of radiosurgery and local ozone therapy in the combined treatment of precancerous diseases of the oral mucosa in the available literature. In this connection, it seemed expedient to us to study the influence of radiosurgery and local ozone therapy in the surgical treatment of precancerous diseases of the oral mucosa.

Aim of the study: the experimental and clinical substantiation of the effectiveness of the use of the radio-wave surgery method and local ozone therapy in the combined treatment of patients with precancerous diseases of the oral mucosa.

Objectives of the study:

1. To study the character of the effect of the radio-wave surgery method on the state of free-radical oxidation processes in oral mucosal tissues in the experiment.

2. To study the morphological features of the course of the wound process on the oral mucosa when using radio-wave surgery in the experiment.

3. To carry out an experimental evaluation of the bactericidal properties of ozonated olive oil.

4. To evaluate the dynamics of clinical manifestations in the postoperative period in patients with precancerous diseases of the oral mucosa depending on the choice of the method of surgical treatment and postoperative wound management.

5. To study the features of tissue regeneration in the postoperative period and the level of antimicrobial defence of the oral cavity in patients with precancerous diseases of the oral mucosa when using the radio-wave surgery method and local ozone therapy.

6. To develop and introduce into practical public health a method of treatment of precancerous diseases of the oral mucosa using the radio-wave surgery method and local ozone therapy.

Scientific novelty:

As a result of the work, a number of new scientific data of substantial theoretical and practical significance have been obtained:

1. For the first time, an evaluation has been made of the radio-wave method of exposure on the intensity of free-radical oxidation processes and the activity of antioxidant defence of oral mucosal tissues in experimental animals.

2. For the first time, on the basis of computer quantitative morphometry, the features of oral mucosal wound healing using the radiosurgical method of exposure in experimental animals have been analysed.

3. Using the technique of anaerobic cultivation of microorganisms, an evaluation has been made of the bactericidal properties of ozonated olive oil in the experiment.

4. For the first time, the clinical effectiveness of the radio-wave surgery method and local ozone therapy in the postoperative period in patients with precancerous diseases of the oral mucosa has been determined.

5. For the first time, the features of postoperative wound tissue regeneration and the state of antimicrobial defence of the oral cavity with the local use of ozonated olive oil in the combined treatment of patients with precancerous diseases of the oral mucosa have been studied.

6. A method of treatment of patients with precancerous diseases of the oral mucosa using the radio-wave surgery method and local ozone therapy has been developed and scientifically substantiated.

Practical significance. A comparative analysis of the use of traditionally employed cutting instruments and radio-wave surgery has been carried out on an experimental model of an operative wound on the oral mucosa; the effectiveness of the use of the radio-wave scalpel has been shown. Clinical substantiation of the effectiveness of the combined use of the radio-wave scalpel and ozonated olive oil in the postoperative period in the treatment of precancerous diseases of the oral mucosa has been carried out, which has been confirmed by the data of morphological and immunological studies.

Statements submitted for defence:

1. The use of the radio-wave method in the surgical treatment of precancerous diseases of the oral mucosa does not lead to a persistent intensification of free-radical oxidation processes in the tissues in the area of the operative wound, which is confirmed by a high level of local antioxidant defence; it exerts a minimal damaging effect on the tissues and is accompanied by marked regeneration of the mucosa and restoration of local blood circulation.

2. The use of the radio-wave surgery method and local ozone therapy in the combined treatment of patients with precancerous diseases of the oral mucosa makes it possible to improve the clinical course of the postoperative period, promotes activation of regeneration processes in the wound and increases the local antimicrobial defence of the organs of the oral cavity.

Approbation of the work. The main propositions and results of the dissertation were reported at the annual meeting of the Nizhny Novgorod Association of Stomatologists (N. Novgorod, 2006), at the XI International Scientific and Practical Conference of Maxillofacial Surgeons and Stomatologists (Saint Petersburg, 2006), at the VIII Scientific Session "Modern Solutions to Urgent Scientific Problems in Medicine" (N. Novgorod, 2009), and at a joint meeting of the staff of the departments of therapeutic dentistry, orthopaedic dentistry, paediatric dentistry, surgical dentistry and maxillofacial surgery, propaedeutic dentistry, and the dentistry course of the Faculty of Advanced Training and Professional Retraining of the Nizhny Novgorod State Medical Academy (N. Novgorod, 17 June 2009).

Personal contribution of the author: consists in the independent planning and conducting of the experimental study, processing of the experimental material of the morphological and cytological studies, clinical examination and planimetric studies. Surgical treatment of 81 patients with precancerous diseases of the oral mucosa was performed independently. All the obtained information was analysed, systematised and processed by statistical methods.

Seven scientific works have been published on the topic of the dissertation, of which three are in journals reviewed by the Higher Attestation Commission of the Russian Federation.

Structure and scope of the dissertation. The dissertation consists of an introduction, a review of the literature, a chapter "Material and Methods", results of the author's own studies, a discussion of the obtained results, conclusions and practical recommendations, and appendices. The work is presented on 209 pages, contains 53 figures and 35 tables. The reference list consists of 456 sources, 301 Russian and 155 foreign.