PRIMENA MEDICINSKIH PREPARATA U PRETPROTETSKE I PROTETSKE SVRHE THE USE OF MEDICINAL PREPARATIONS FOR PREPROSTHETIC AND PROSTHETIC PURPOSES

1 UNIVERSITY OF NIŠ, FACULTY OF MEDICINE, CLINIC OF DENTISTRY, DEPARTMENT OF PROSTHODONTICS 2 UNIVERSITY OF NIŠ, FACULTY OF MEDICINE, CLINIC OF DENTISTRY, DEPARTMENT OF ORAL MEDICINE AND PERIODONTOLOGY UNIVERSITY OF NIŠ, FACULTY OF MEDICINE, CLINIC OF DENTISTRY, DEPARTMENT OF ORTHODONTICS, 4 UNIVERSITY OF PRIŠTINA, FACULTY OF MEDICINE TEMPORARILY SEATED IN KOSOVSKA MITROVICA, CLINIC OF DENTISTRY, DEPARTMENT OF PROSTHODONTICS 5 PRIVATE DENTAL PRACTICE "KALODENT" NIŠ

Aluminium lactate blocks bleeding, aluminum fluoride has anticariogenic property, chlorhexidine digluconate has antiseptic property, bisabolol and allantoin have antiinflammatory and soothing properties.Lacalut active solution prevents the oral biofilm and dental calculus formation, reduces gingival inflammation and caries incidence, which makes it indicated in people with dentures.Chlorhexidine is a cationic antimicrobial bisbiguanid, which in its active form can be adsorbed on the oral tissues.It binds to hydroxyapatite, tooth surface, oral mucosa and salivary mucins for a long period of time, and is released when its concentration in the oral cavity decreases.Its adsorption and slow release enable antimicrobial effect and prevent bacterial recolonization within 24 hours. 11,12The investigations showed chlorhexidine to be effective against grampositive and negative bacteria, fungi, facultative aerobic and anaerobic microorganisms 13 .Fluoride (anions) are used in the prevention of tooth decay and tooth structure strengthening. 14,15During the development of the teeth and after its eruption, the presence of fluorine is essential to form the fluoroapatite that is more resistant to acid (demineralization) from the hydroxyapatite.In high concentrations, the ionic form is toxic to Streptococcus mutans, and at low concentrations it exhibits antienzymatic effect.Inhibition of the enzymes decreases the ability of S. mutans to produce acid and perform glucose metabolism.Allantoin is a very active substance that stimulates cell growth, accelerates epithelization of mucous membranes, has a strong keratolytic and astringent effect, and reduces pain and swelling.Bisabolol, the active ingredient of chamomile, prevents inflammation, sooths irritated and inflamed mucous membranes and exerts strong anti-infective effect.Aluminium lactate exhibits hemostatic and astringent properties 14,15 .

Aims
The aim of the study was to examine the efficacy of Lacalut paste and Lacalut solution in the treatment of periodontal disease within preprosthetic preparation of the patient.

Materials and methods
The study was conducted on a sample of 120 patients who visited the Department of Prosthodontics, Clinic of Dentistry Niš for the prosthetic rehabilitation.The main criteria for selection of patients were determined before testing; then, medical history was taken and dental examination was done.Selected examinees had periodontal disease.The study did not include the population under the age of 18, pregnant women, patients with blood diseases, patients with acute and chronic infections, autoimmune diseases, patients on immunosuppressive therapy and those who were on antibiotic or corticosteroid therapy in the past three months.
The study is in accordance with the ethical standards of the Ethics Committee of the Clinic of Dentistry Niš, i.e. the Helsinki Declaration (1964, amended in 1975 and 1983) of the World Health Organization.
Of the 120 patients, 60 were males and 60 females, aged 18 to 65 years.The examinees were divided into four groups with 30 patients each.
Before prosthetic treatment, all patients were referred to the Department of Oral Medicine and Periodontology, where the periodontal assessment was done before the application of periodontal therapy with the help of Gingival Index Loe-Silness (GI), Plaque Index (PI), Tartar Index (TI), Subgingival Dental Calcus Index (SCI) and the Attachment Level Index (AL). 3,15After that, the basic periodontal therapy that includes the identification and elimination of oral biofilm and other deposits from teeth, motivation and education of patients to maintain oral hygiene, elimination of potential risk factors was applied.Soft deposits were removed using a paste (Vantal, Galenika) and rotating brushes.
Solid deposits (tartar and subgingival dental calculus) were removed with ultrasound Woodpecker (UDS-J) and the rotary instruments.Additionally, periodontal pockets were treated with periodontal curettes and washed with 3% hydrogen peroxide.All patients were given advice concerning proper oral hygiene.In addition to regular oral hygiene measurements group I ispitanici grupe I koristili su Lacalut pastu, grupe II komercijalnu pastu po svom izboru i Lacalut rastvor, grupe III Lacalut pastu i Lacalut rastvor, a ispitanici IV (kontrolne) grupe komercijalnu pastu po svom izboru.
At the first follow-up examination one week after the beginning of the study, GI, Pl, TI and Ikon were determined, and a month after GI, Pl, TI, SCI and AL.
For the primary data analysis, descriptive statistical methods (mean, median, standard deviation and relative numbers) and methods for testing statistical hypotheses (Kruskal-Wallis's, Mann-Whitney U, Friedman and Wilcoxon's test) were used.The criterion for statistical significance was p<0.05, p<0.01.For statistical analysis of the results, a software program SPSS Statistics 21was used.

Results
Comparing the index values in relation to the time of the study, we observed: The difference in the GI values within the group which used a toothpaste or solution (group I and II) was statistically significant (p<0.01)among all the study periods.In the group which used the toothpaste and the solution (group III), the difference in GI values was statistically significant between the time before treatment and one week after treatment (p<0.01) and between the time before treatment and one month after treatment (p<0.01).Gingival index was not statistically significantly different with respect to time between one week after treatment and one month after treatment.In the control group (group IV), the difference in GI values was statistically significant between the time before treatment and one week after treatment (p<0.01), and between the time one week after treatment and one month after treatment (p<0.01).Gingival index was not statistically significantly different with respect to the time between the period before treatment and one month after treatment.
Within the groups I, II and III the differences in Pl and Izk values were not statistically significant between the time before treatment and one week after treatment, as well as between the time before treatment and one month after treatment (p<0.01).The difference in Pl values was not statistically significant with respect to time between one week after treatment and one month after treatment.Within the group IV razlika Pl je statistički značajna između svih posmatranih vremena (p<0,01) Unutar svih grupa, razlika Ikon je statistički značajna između vremena pre terapije i nedelju dana posle terapije, kao i između vremena pre terapije i mesec dana posle terapije (p<0,01).Razlika Ikon nema statistički značajnu razliku u vremenu između nedelju dana posle terapije i mesec dana posle terapije.
IV, the difference in Pl values was statistically significant between all the observed periods (p <0.01).
Within each group, the difference in Ikon was statistically significant rerarding the time before treatment and one week after treatment, as well as between the time before treatment and one month after treatment (p <0.01).The difference in Ikon values was not statistically significant with regard to the time between one week after treatment and one month after treatment.
By comparing the median values of investigated indexes among the groups, a week after applied therapy, we observed the following: -A statistically significant difference between the GI values in all the groups; -A statistically significant difference in Pl values among the examined and control groups, but not among the examined groups; -Among the groups there was no statistically significant difference in Izk and Ikon values (Table1).After one month of applied therapy we observed: -Statistically significant differences in GI and Izk values among the examined groups compared to the control group, but not among the examined groups; -The difference in median of PI values was statistically significant between patients in all groups except in groups I and II; -There was no statistically significant difference in Ikon values between the groups of patients; -The difference in median of Al values was statistically significant between patients in all groups except for groups I and II, I and III (Table1).

Discussion
Mass occurrence and frequent relapses of periodontitis makes this disease a real social problem that highlights the growing importance of prophylaxis, diagnosis and controlled therapy.The researchers recommend the use of clinical parameters such as GI, Pl, Izk, Ikon and NPE in order to establish precise anticipation and plan of periodontal therapy, and adequate monitoring of the achieved results [6][7][8][9][10] .Similarly, in this study the clinical parameters showed in all patients a low level of oral hygiene at the time of beginning of the study (Figures 1, 3 and 5) and an improvement in maintaining it one week after the applied therapy.Good level of oral hygiene was present one month after the completion of therapy in patients who had applied the Lacalut preparations, whereas it was worse in the control group one month after the applied therapy.An increase in the value of Pl can be observed.The above results show a beneficial effect of the Lacalut products that are reflected in the long-term maintenance of good oral hygiene, and the best results were observed in patients who used a combination of the Lacalut solution and paste (group III) (Figures 2, 4 and 6).
Rathe i sar. 24su ispitivali uticaj rastvora na bazi hlorheksidina i aluminijum laktata na inflamaciju gingive i akumulaciju oralnog Chemical agents for the neutralization of the oral biofilm have antibacterial activity which inhibits the formation of oral biofilm.They are in the form of mouth rinses, gels, and they can be added to the toothpaste, too.The best known agents are chlorhexidine digluconate and fluorides [8][9][10] .Similarly, in this study the active ingredients of the Lacalut paste and solutions contributed significantly to the lower values of Pl.The largest decrease in the value of the examined index was observed in the group that used a combination of the Lacalut paste and solutions (group III).These products can never replace the standard toothbrush, and a treatment by chemical means has a secondary role, complementing the other methods in the prevention and treatment of periodontal disease.The choice of chemical agents should be individual and recommended by a dentist 16 .
McDermid et al. 17 noted that the combination of products that have anticariogenic and antiplaque effect can be helpful and provide an additional protective effect, if any substance acts on different causal agents of disease.It was observed that the combination of chlorhexidine and fluoride in products for oral hygiene can contribute to the prevention of caries and gingival inflammation 18 .Chlorhexidine has an inhibitory effect on the formation of oral biofilm and acid production, which significantly reduces cariogenic potential and increases the fluoride effects 19 .Despite their opposite charges they can be successfully combined, without losing individual effects.A combination of chlorhexidine and fluoride has a greater bactericidal effect on Streptococcus mutans structure than when acting alone. 20,21People who are recommended to use a combination of these preparations are those with a high risk of caries, such as children, the elderly, patients with fixed dental restorations, patients under radiotherapy and medical compromised patients. 22,23Patients in this study needed prosthetic rehabilitation and had an increased risk of tooth decay.
Individualni preventivni program obuhvata i organizovano sprovođenje preventivnih mera u rizičnim grupama stomatoloških pacijenata.Posebnu pažnju u toku individualnog preventivnog rada treba posvetiti osobama sa visokim rizikom za nastanak oboljenja parodoncijuma, kao što su i osobe uključene u ovo istraživanje.Za sve oblike individualnog rada značajno je intenzivno, aktivno zdravstveno-vaspitno delovanje, uz primenu svih poznatih motivacionih tehnika, a zbog poznatog gubljenja motivacije kod pacijenata, neophodna je i česta remotivacija. 26 the oral biofilm in two groups of patients for six months.The subjects of the first group used commercial toothpaste and a solution of chlorhexidine and aluminum lactate, whereas control subjects used only commercial toothpaste of their choice.Reduced gingival inflammation was observed in both groups when compared to the beginning of therapy with a significant reduction in the group, with the additional benefit of chlorhexidine and aluminum lactate solution.Similar observations were noticed in this study, in which a significant reduction in GI values was observed among all groups which have used the Lacalut products compared to the control group.Gingival index had a low value even one month after entering the study.Control group which did not use the Lacalut preparations had an increased GI values after a month compared to the values after a week since the beginning of the study.This highlights the beneficial influence of the Lacalut products on reducing gingival inflammation and on lowering the accumulation of oral biofilm over a longer period of time.
Using the analysis for digital recording of oral biofilm (plaque digital imaging analysis -DPIA), Bellamy et al. 25 examined the influence of the solution with chlorhexidine-digluconate, aluminum lactate and aluminum fluoride (Lacalut active) on oral biofilm formation during the period of 17 days, and observed a significantly reduced accumulation of the oral biofilm after solution usage.Similar observations were noticed in this study, where the value of Pl was significantly lower in all investigated groups compared to the control group in all investigated periods with significant maintenance of low Pl value Although the response of periodontal tissue of the host may be sufficient to counteract the aggressive factors of oral biofilm during the preprosthetic therapy, preventive prophylactic measures should not be underestimated and must be implemented in periodontal treatment.
Constant efforts to maintain an exceptional level of oral hygiene are necessary and they require great responsibility of patients.Prior to the prosthetic treatment, patient should be informed about the risk of caries and periodontitis and the necessity of impeccable and regular maintenance of oral hygiene.Selection of patients, education and oral hygiene training associated with preventive prophylactic measures will contribute to the functional and aesthetic success of therapy.Maintaining proper oral hygiene is of great benefit for the health of periodontal tissues throughout life.

Conclusion
Based on the methodology and the obtained results, a significant reduction in the oral biofilm accumulation as well as gingival inflammation of junctional epithelium after periodontal therapy were observed in patients who additionally used the Lacalut toothpaste and/or Lacalut solution, compared to the favorable outcome of periodontal therapy in patients who have not used it.
The best values and maintaining of the obtained results were observed with the application of the Lacalut solution and Lacalut paste.
The Lacalut paste and solution proved to be effective in the elimination of gingival inflammation and are recommended as an adjunct to the treatment of periodontitis in preprosthetic therapy.

Slika 1 . 1 . 2 . 2 . 3 . 4 . 5 .Figure 5 .Slika 6 . 6 .
Promene na oralnoj sluzokoži pre terapije Figure Changes in the oral mucosa before therapy Slika Oralna sluzokoža mesec dana posle terapije Figure Oral mucosa one month after therapy Slika 3. Promene na mekim i čvrstim tkivima pre terapije Figure Changes in the soft and hard tissue before therapy Slika 4. Meka i čvrsta tkiva mesec dana posle terapije Figure Changes in the soft and hard tissue one month after therapy Slika Promene na mekim i čvrstim tkivima pre terapije Changes in the soft and hard tissue before therapy Meka i čvrsta tkiva mesec dana posle terapije Figure Changes in the soft and hard tissue one month after therapy