RESEARCH
Relevance. Currently, there are several basic techniques for the dental implant surface structuring. Laser treatment is an extremely promising technique for the surface structuring. This technology allows creating regular implant surface without using chemicals and in just one technological step. The purpose was to present study aimed to compare and evaluate in vivo the stability and osseointegration of dental implants with 2 different surfaces structured by ytterbium-doped pulsed fiber laser operating at 1064 nm.
Materials and methods. 60 dental implants were placed in the study. 2 types of dental implant surfaces, namely holes and parallel grooves, were created by the ytterbium laser operating at 1064 nm. A polished dental implant (without laser surface structuring) was also included in the experiment for comparison. The study was carried out on 15 laboratory animals (male rabbits, weight 3.5-4 kg). The implants were placed in the tibia. 4 implants with different surface types but of the same diameter and length were placed in each rabbit.
Results. Laboratory animals were sacrificed 1.5 and 3 months after the surgery. The stability of the implants was assessed by RFA (Resonance Frequency Analysis), based on the registration of resonance electromagnetic oscillations of the implant and the surrounding bone when they are exposed to the electromagnetic field (Osstell ISQ). Also, nondecalcified bone blocks were histologically examined using a confocal laser scanning microscope (Carl Zeiss LSM 780) and histomorphometry was performed (BIC-index: Bone-to-implant contact). Bone blocks were prepared according to a special technique: they were soaked and embedded into the plastic and synthetic resin. The obtained blocks were cut into sections, 40-50 µm thick, and stained with toluidine blue.
Conclusion. Laser surface structuring of the dental titanium implants is a promising technique. 59 in 60 (98.3%) implants were osseointegrated, there were no signs of inflammation in the bone tissue. The present results allow further studying of dental implants with various surface designs, structured by ytterbium laser.
Relevance. Creating three-dimensional scaffolds from biodegradable materials and seeding them with stem cells derived from the oral tissues is a promising tool for guided tissue regeneration. Pulp and periodontal stem cells have a high potential for osteogenic differentiation, which biologically determines their use in surgical bone reconstruction. The experiment shows the result of using fibrin glue seeded with pulp and periodontal stem cells on the mandible of laboratory mice. The article presents the results of computed tomography and histological examination. The data provide evidence of the influence of seeded scaffolds on bone remodeling in the area of the defect.
Materials and methods. The Local Ethics Committee of the North-Western State Medical University named after I.I. Mechnikov gave permission for the practical part of the research work. The study included 29 white laboratory mice. Molars were extracted and a bone defect was formed. Pulp and periodontal stem cells were obtained and cell-seeded scaffolds were made, then they were introduced into the defect area. The animals were euthanized, maxillofacial CT scan and histology of the defect area were performed 28 days after the molar extraction.
Results. The oral cavity of mice was examined, molars were extracted, and teeth were morphologically examined under anesthesia. Scaffolds were synthesized and bone defects were filled. CT scans and histology results were analyzed. The bone volume increased in the main group compared to the control group.
Conclusion. The fibrin glue can be used to obtain a material with mechanical characteristics sufficient for a stable shape scaffold. The study proved that the pulp stem cells enclosed in a fibrin glue-based scaffold can maintain the ability to proliferate and osteogenically differentiate. The scaffold based on fibrin glue, which we used, affected the bone remodeling process in the area of jaw defects.
Relevance. Successful treatment of endo-perio lesions depends on the thorough clinical assessment, accurate diagnosis and structural approach to the planning of periodontal and endodontic treatment. Aim – to provide clinical and laboratory evidence about the effectiveness of ciprofloxacin-and-tinidazole-containing antibiotic in the comprehensive treatment of endo-perio lesions with a primary periodontal disease which secondarily affects the pulp.
Materials and methods. We examined 29 patients aged from 35 to 50 (mean age 42.3±3.21) with class II endo-perio lesions according to P. Eickholz classification. The patients were randomly divided into 2 groups. All patients had comprehensive periodontal and endodontic treatment with (Group 2) and without (Group 1) antibiotic therapy. The clinical and paraclinical examination included determination of such indices as OHI-s, SL, PMA, SBI, as well as Doppler ultrasound, EPT, CBCT, microbiological test of the discharge from periodontal pockets and root canal system. We selected the systemic antibiotic after the antibiotic sensitivity testing.
Results. Comprehensive treatment of endo-perio lesions, which included systemic antibiotic therapy with ciprofloxacin and tinidazole, effectively arrested the inflammation in the periodontium and pulp beginning from the 7th day of use.
Conclusion. Cifran ST, a combination broad-spectrum antibiotic, helps reduce periodontal inflammation by effectively eliminating microbiota in the root canals and periodontal pockets in patients with moderate or severe chronic generalized periodontitis.
Relevance. To develop the algorithm for a safe and effective local anesthesia in dental outpatients with arterial hypertension.
Materials and methods. The study was conducted in the laboratory of functional and clinical studies of Moscow State University of Medicine and Dentistry. Electric pulp testing (µA) was performed and pulp microcirculation (PU) was assessed in the intact teeth of patients with hypertension before and 5, 10, 15, 30 and 60 minutes after the administration of local anesthesia. We used 4% articaine solutions without a vasoconstrictor and with its minimal concentration 1:200 000 and 1:400 000, and 3% mepivacaine solution. The safety of the administered local anesthetic was assessed by the continuous hemodynamic monitoring.
Results. 4% articaine solution without epinephrine had a shallow anesthetic effect in the maxilla and anterior mandible. 1:400 000 and 1:200 000 vasoconstrictor concentrations in 4% articaine solution increase the depth and duration of the anesthesia from 20 to 30 minutes respectively. Changes in the pulp sensibility but not in blood microcirculation were demonstrated by the functional parameters of the intact dental pulp in patients with hypertension after the administration of 3% mepivacaine solution at the mandibular foramen. The continuous hemodynamic monitoring data showed no changes in arterial blood pressure, heart rate, oxygen saturation on administration of either of the studied local anesthetic solutions or techniques.
Conclusion. The analysis of the prognosis criteria for a safe local anesthesia allowed us to ground the choice of anesthetic in dental outpatients with arterial hypertension.
Relevance. A wide variety of oral care products is available nowadays. Sometimes aggressive advertising rather than doctor’s advice determines our patients’ choice. In our research, we provide evidence of the clinical use of toothpaste containing fluoride and sodium bicarbonate.
Materials and methods. During four weeks, we followed up a group of students who used the toothpaste containing 1400 ppm fluoride and 67% aqueous sodium bicarbonate solution. The clinical, biochemical and microbiological tests and saliva crystallization score assessed the characteristics stated by the manufacturer.
Results. The statistically significant correlation between all studied criteria is evidence of the effectiveness of the toothpaste. In addition to the significant remineralization and antiplaque effect, biochemical and microbiological tests confirmed the anti-inflammatory effect of the toothpaste. An immediate cleaning effect was observed after the first brushing as well as in long-term use.
Conclusion. Improvement of oral hygiene indices and reduction of periodontal inflammation confirmed the successful result of the comprehensive treatment of chronic gingivitis.
Relevance. The purpose of the research is to improve the functional diagnosis protocol in prosthodontic treatment of patients with TMD.
Materials and methods. The optimal position of the mandible was determined for each patient by two methods: 1) TENS (transcutaneous electrical nerve stimulation) and 2) TENS + kinesiography. Then, the cone-beam computed tomography (CBCT) data were analyzed to determine the most physiological position of the condyles.
Results. The analysis of the CT scans of patients without TMD (control group) showed that the right and left condyles occupy an anterior or central symmetrical position relative to the glenoid fossa. In the first and second methods, the condyles occupy an anterior or central position, which is the most optimal position of the lower jaw for the manufacturing of an occlusal stabilization splint. The statistical coefficients allowed us to determine that the second method was more accurate, since the obtained values were lower than those of the first method.
Conclusion. Based on the results of this study, we can conclude that the improvement of the protocol, namely a new method for determining the optimal position of the mandible is more time-consuming, but more accurate and allows increasing the effectiveness at all stages of treatment of patients with this pathology.
Relevance. It is currently relevant to study and compare the effectiveness of the autologous connective tissue grafts and the combination of collagen-based and autologous platelet-rich plasma in the surgical treatment of Miller Class I gingival recessions.
Materials and methods. We examined and treated 48 (20 male (41.67%) and 28 female (58.33%)) patients aged from 25 to 40 years with Miller Class I gingival recessions. All gingival recessions were treated surgically using a modified twolayer tunnel technique. The patients were divided into two groups according to the graft type. Group I (24 patients (50%) had a connective tissue graft from the hard palate. Group II (24 patients (50%) used the combination of the autologous platelet-rich plasma and 3D collagen matrix Fibromatrix for the regeneration of oral soft tissues. We removed the sutures on the 14th day. The patients were followed up on the 7th and 14th days and in 1.3 months.
Results. 48 Miller Class I gingival recessions were treated between 2018 and 2020. The depth of gingival recessions averaged 3.5 ± 1.13 mm before treatment. The level of the attached keratinized gingiva regarding the cementoenamel junction significantly (p < 0.001) improved in both groups after the surgery. The width and thickness of the keratinized gingiva best increased in group II. The mean effectiveness of gingival recession treatment was 84% in study group I and 96% – in study group II. Pain syndrome, fibrinous plaque and soft tissue edema were insignificant in group II.
Conclusion. The combination of the autologous platelet-rich plasma and Fibromatrix, collagen 3D matrix, for the regeneration of the oral soft tissues is a more effective technique for the treatment of Miller Class I gingival recessions. This technique has several advantages. It is minimally invasive, less painful, soft tissue postoperative swelling is less and the received volume of the attached keratinized gums is larger than with a connective tissue graft.
Relevance. Oral hygiene is of primary importance in the prevention and treatment of tooth sensitivity. Modern oral care products can significantly contribute to the treatment of tooth sensitivity and prevention of its recurrence. Aim – to assess the effectiveness of tooth sensitivity treatment, taking into account the adherence while using a new remineralizing gel manufactured in Russia.
Materials and methods. We evaluated the effectiveness of the tooth sensitivity treatment, satisfaction of 45 patients with the treatment and their adherence to the oral care routine. Group 1 used a special toothpaste ASEPTA "PLUS REMINERALIZATION" twice a day. Group 2 also applied a new remineralizing gel ASEPTA for two minutes after brushing.
Results. The treatment of tooth sensitivity was effective and ranged between 39.46% and 95.56% during the study. The effectiveness of tooth sensitivity treatment and satisfaction with oral care products were inversely associated with the patient adherence to the medical recommendations. Most patients partially (25% to 50%) adhered to the professional recommendations throughout the study.
Conclusion. The tested Russian oral care products effectively prevent tooth sensitivity. During the professional care visit, a dentist or a dental hygienist should pay more attention to increasing patient adherence to the recommendations of a dental professional.
Relevance. The authors have established that the microbiological and local risk factors prevail in changing the clinical condition of the periodontium. Aim – сlinical and diagnosis argumentation of the gingival tissue condition according to the criteria of the New International Classification of Periodontal and Peri-implant Diseases and Conditions and Proceedings of the 2017 World Workshop jointly held together by the American Association of Periodontology (AAP) and the European Federation of Periodontology (EFP).
Materials and methods. Clinical and laboratory assessment of 105 young patients was conducted. Three patient groups were formed according to the detected risk factor and according to the data of the New International Classification of Periodontal and Peri-implant Diseases and Conditions. The main group consisted of 70 (66.6%) patients with diagnosed chronic plaque-induced gingivitis (33.3%) and initial periodontitis (33.3%) (mild chronic periodontitis). The control group comprised 35 patients with clinically healthy gingiva on an intact periodontium (71.1%) and reduced periodontium (22.9%). Periodontal pathogens as a risk factor were assessed by PCR using DNA-express commercial sets (Liteh, LLC, scientific manufacturing company, Russia). Cytology of the gingival crevicular fluid impression smears stained by Romanovsky-Giemsa method was performed.
Results. Changes in the hygiene and periodontal indices were revealed on full dental examination. PCR detected low or critical number of periodontal pathogens in the studied samples. Neutrophilic leukocytes, histiocytes and epithelial cells were present in the impression smears, polymorphonyclear neutrophils significantly increased and macrophages, histiocytes, epithelial cells appeared; macrophages decreased.
Conclusion. Full dental examination and laboratory tests revealed the following clinical conditions: clinically healthy gingiva on an intact periodontium, clinically healthy gingiva on a reduced periodontium, plaque-induced gingivitis, stage I periodontitis – initial periodontitis, which corresponded to the New International Classification of Periodontal and Peri-Implant Diseases and Conditions and Proceedings of the 2017 World Workshop held by the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP).
CASE REPORT
Relevance. Iatrogenic factors are among the significant causes of chronic peri-implantitis, the incidence of which reaches 16-28% according to various data. This article is a clinical case report which describes an approach to the treatment of iatrogenic peri-implantitis associated with a non-absorbable buried suture. Patient Sh., born in 1960, physically healthy, complained of gum bleeding in the region of implant 3.6.
Diagnosis. Сhronic peri-implantitis in region 3.6. The treatment was carried out in two stages. During the first (revision) stage, the buried suture of a non-absorbable 2-0 monofilament thread with uncut ends and a loose titanium pin were removed; during the second (reconstructive) stage, a free gingival graft (FGG) was used.
Results. The inflammation in the area of implant 3.6 resolved, the soft tissue condition was stable in the immediate and delayed postoperative period. In 3 months after the beginning of the treatment, the cervical bone defect repair was confirmed by the control X-ray.
Conclusion. The use of non-absorbable suture material for buried sutures in dental implantation and oral reconstructive surgical interventions is classified as iatrogenesis and is defined as a “medical treatment error”. In the present clinical case, it became the cause of the development of an implant site-specific inflammatory destructive complication. The reduction of chronic peri-implantitis incidence, taking into account its prevalence and problematic nature, requires further research and optimization of the protocols of dental implant treatment.
Relevance. Gingival recession is the apical migration of the gingival tissues associated with the exposure of the roots and alveolar bone loss. The prevalence of single recessions in people over 18 years old is 86.7% whereas multiple recessions, i.e. where all teeth are affected, amount up to 28.6%. High prevalence of the pathology necessitates improvement of the approach and tactic of multiple recession treatment in patients with different phenotypes. Nowadays, the use of autograft is the gold standard of multiple recession treatment. However, the technique has its drawbacks. The purpose of the present work was to assess the response to surgery and evaluate the final result of multiple recession treatment in one subject where the combination of autogenic and allogenic grafts was used in the same study design.
Materials and methods. The paper presents and describes a clinical case where auto- and allografts were used in one patient to treat multiple gingival recessions.
Results. All parameters of the gingival recession assessment showed comparable clinical benefit in all sites of autograft and allograft (dura mater) application. The root coverage was more than 80% around 13 teeth and less than 80% around 11 teeth.
Conclusion. The results of the autograft and allograft (dura mater) application were comparable, response to surgery was the same; besides, the allograft (dura mater) is attractive for combined and independent use during surgical treatment of multiple and especially full-mouth recessions.
Relevance. The paper demonstrates the need to implement modern diagnostic techniques for diagnosis of precancerous and cancerous lesions at early or preclinical stages. Additional diagnostic methods are necessary, e.g. tissue autofluorescence, which allows revealing insidious pathological risk zones, particularly precancerous and cancerous lesions, to evaluate the condition of the oral tissues in patients with chronic oral mucosa disorders, especially caused by trauma. Purpose – to assess trauma-specific effectiveness of autofluorescence spectroscopy (AFS) in risk group patients with chronic trauma of the oral mucosa to reveal early malignization signs.
Materials and methods. 25 subjects were selected for the study and divided into 2 groups: main group – 20 patients with different manifestations of chronic oral mucosa trauma; control group – 5 subjects without visible clinical manifestations and without oral trauma factors. Autofluorescence spectroscopy was performed in both groups using AFS-400 stomatoscope.
Results. The received data demonstrated that the change in autofluorescence doesn’t allow drawing final conclusions on the presence or absence of chronic oral trauma malignization signs.
Conclusion. AFS-400 stomatoscope may be effective in differentiating between healthy and damaged tissues, but there is no solid evidence that the change in fluorescence shade can help differentiate between various types of damaged tissues. Autofluorescence spectroscopy should be considered as an additional method for examination of patients with chronic oral mucosa trauma to reveal early malignization signs.
ISSN 1726-7269 (Online)