Clinical and laboratory rationale for the effectiveness of transcranial electrostimulation in the treatment of chronic generalized periodontitis in elderly patients

Abstract

Relevance. Immunomodulation is becoming increasingly relevant in geriatric dentistry. The administration of this therapy cannot be empirical and requires the study of the corresponding immunological parameters. The study of the gingival crevicular fluid composition allows evaluating not only the immune system ageing processes and their influence on the periodontitis course but the effectiveness of the treatment. The study aimed to evaluate the effectiveness of transcranial electrostimulation (TES) for the treatment of periodontitis in elderly patients and to prove the value of gingival crevicular fluid laboratory testing during immunomodulatory therapy. Materials and methods. We conducted a clinical, prospective, controlled, randomized, unblinded, comparative study. We examined two groups of periodontal patients (68 subjects), aged 60-74, and equally treated them. But the patients in the second group additionally received transcranial electrostimulation (TES). The research included the follow-up assessment of IL-1β, TNF-α, IL-10, sIgA and LDH in the crevicular fluid and periodontal index reduction: SBI and PMA (%), before the treatment and on the 7th, 14th, 21st and 30th day.Results. The study established that the periodontal treatment scheme, which includes TES (immunomodulation), is more clinically effective than conventional treatment. There were statistically significant differences in the clinical and laboratory parameters between the 1st and the 2nd patient groups after the 14th day (p < 0,05). On the 30th day of observation, the described trend persisted: the parameters of crevicular fluid in both groups continued to decrease. Moreover, their mean values were significantly lower in the 2nd group than in the 1st. The level of IL-1β (pg/ml) was 16.9 ± 0.33 and 18.8 ± 0.38;TNF-α (pg/ml): 11.9 ± 0.37 and 14.4 ± 0.4; IL-10 (pg/ml): 11.0 ± 0.35 and 12.9 ± 0.36, respectively (p < 0.05).Conclusion. In elderly patients, TES (as a part of a comprehensive treatment) is more effective clinically than the conventional periodontal treatment alone. In geriatric dentistry, it is of primary importance to test gingival crevicular fluid composition and properties in a laboratory and to select the most significant immunological and biochemical components: IL-1β, TNF-α, IL-10, sIgA, LDH. It allows a periodontist to confirm the changes in the manifestations of periodontitis in the elderly patients and to verify the clinical effectiveness of immunomodulation.