Effect of local immunotherapy on the indexes of mucosal immunity in patients with surgical dental pathology

Abstract

Currently, inflammatory processes and injuries of maxillofacial region, occupy leading positions in the overall structure of surgical morbidity. Restoration of dentition integrity is based on intraosseous dental implants, being a widespread method of treatment in dentistry. The aim of the present work was to perform a comprehensive analysis of cytokine contents (IL- 1β, IL-1ra, IL-2, IL-8, IL-10, TNFα, IFNγ) in maxillary sinus discharges and mixed oral fluid in the patients with surgical dental pathology (chronic odontogenic maxillary sinusitis, complicated by mandibular fracture, as well as during simultaneous dental implantation) and to assess the effect of locally applied immunotherapy on the parameters studied. As a part of the two-stage study, 218 people were comprehensively examined, divided into groups depending on the type of disorder and methods of treatment. The patients with chronic odontogenic sinusitis (J 32.0, n = 44) were treated with topical immunotherapy with Cycloferon (meglumine acridonacetate), patients with a mandibular fracture (S 02.6, n = 70) and with a dental implant (K 08.1, n = 70) received Betaleucine (recombinant IL-1β). At the first stage of the study, examination of all the patients with surgical dental pathology showed immunological predictors of low-efficient acute inflammatory response associated with imbalance of the pro- and anti-inflammatory cytokine system. These predictors were primarily found in the patients with chronic odontogenic sinusitis, i.e., a decrease in IL-1β at high IL-1ra values in the maxillary sinus secretions. In the patients with complicated mandibular fractures, there was a pronounced dynamic decrease in IL-1β with consistently low values of TNFα in mixed saliva. There were distinct dynamic features of IL-1β, IL-8, and IL-1ra levels in oral fluid of the subjects undergoing implantological procedures. The second stage of the study, associated with the local use of Cycloferon and Betaleucine, and analysis of the data revealed different effects of the drugs on the studied parameters, presuming an integral effect of topical immunotherapy, i.e., some leveling of the previously detected imbalance of the cytokine system, due to normalization of their concentrations. Hence, the results obtained may indicate that the patients with surgical dental diseases treated with local immunotherapy had a higher adaptive potential of the local mucosal immunity.