RESEARCH
Relevance. The study aimed to increase the effectiveness of comprehensive diagnosis and treatment of patients with TMD using an intraoral occlusal appliance.
Materials and methods. All patients of the main group underwent a digital comprehensive functional examination, including TMJ magnetic resonance imaging, kinesiography, joint vibration analysis, surface myography and electrical stimulation of the masticatory muscles, followed by a bite registration of the optimal mandible position. According to the bite recorder, the models were mounted in the articulator and the intraoral occlusal appliance was fabricated. This occlusal appliance used the first-class lever principle, which acts on the condyle using a force applied to the mesial part of the canine and rests on the distal part of the upper second molar. After the diagnosis and treatment stage using an occlusal appliance, a digital comprehensive functional examinatio n was performed again.
Results. Analysis of the digital comprehensive diagnosis data evidenced the restoration of the lower jaw movement, the elimination of intra-articular disorder and the normalization of the dentition functioning as a whole, using TENS appliance and an improved intraoral occlusal appliance (Patent # 273 0995, 26.08.2020) in patients with TMD.
Conclusion. Treatment of patients with TMD using an intraoral occlusal appliance, which eliminates condyle compression and dislocation of the articular disc, allows restoring the lower jaw movement and the functioning of the dentition as a whole. Kinesiography at all stages of the prosthodontic treatment allows objectively monitoring the restoration of the mandibular movement pathways, taking into account time inte rvals.
Relevance. In most cases, modern dentistry can successfully treat gingival recessions, thus achieving both aesthetic and functional goals. Conservative, surgical, orthodontic, instrumental, injection procedures and methods, which help adequately manage the position of the gingival margin according to the cementum-enamel junction and keep the smile beautiful and healthy, primarily preserve teeth. Meanwhile, timely identification of risk factors associated with gingival recession is no less of a priority in the individualized preventive approach to supporting patients at the dentist appointment.
Materials and methods. The research was conducted at the Department of Operative Dentistry and Introduction to Dental Diseases of the Ural State Medical University and the Department of Control Systems Modeling of the Ural Federal University in Yekaterinburg. The study examined 60 young adults: 20 men (33.3%) and 40 women (66.7%) who presented to the dentist. The patients were allocated into two groups according to their age. Each group consisted of 30 patients: the first group contained 20 to 24-year -olds and the second group comprised 35 to 44-year -old patients.
Results. The analysis of gingival recession risk factors revealed aggressive tooth brushing in 19% subjects of the first group (р ≥ 0.05), poor oral hygiene in 17% cases (vs 19% in the second group (р ≥ 0,05); overhanging restorations – 12% cases (р ≥ 0.05); thin gingival biotype –14% (р ≥ 0,05).
Conclusion. Effective customized control of gingival recession risk factors primarily allows normalizing oral hygiene, timely arresting inflammation in the marginal and papillary gingiva, eliminating trauma from tooth brushing and interdental cleaning devices, as well it provides an interdisciplinary approach to patient management at the dental appointment.
REVIEW
Relevance. Apical periodontitis is one of the most common periodontal diseases. Enterococcus faecalis, which naturally inhabits the intestine, relatively rarely colonizes the oral mucosa of healthy individuals – in 1-20% of cases. However, 68% of patients with oral infectious diseases (caries, pulpitis, periodontitis, etc.) demonstrate it, especially patients with comorbidity, e.g., diabetes mellitus (60% of cases). It may change the risk profile of the inflammatory periodontal disease progression caused by the appearance of unusual pathogens in the oral cavity. In the primary apical periodontitis, microorganisms usually spread into the periodontium from necrotized tissues of the tooth pulp, in secondary periodontitis – from the endodontically treated root canals. E faecalis has unique properties, i.e. resistance to physical and chemical factors, nutrient deficiency, which leads to the selection of this microorganism during the development of secondary apical periodontitis. 30-90% of root canals demonstrate this microorganism in this pathology. 33% of secondary apical periodontitis treatment fail due to this microorganism infection. E. faecalis exhibits natural and often acquired resistance to local and systemic antimicrobial drugs.
Thus, successful treatment of apical periodontitis requires identifying the microorganism and/or determining the composition of the microbial community that caused its development and determination of sensitivity to antimicrobial drugs due to the high frequency of association of this disease with i nfection of the affected area of E. faecalis.
Relevance. Drug-associated osteonecrosis is known to cause some pathological changes. The titers of biomarkers responsible for bone metabolism are also subject to such changes. They are essential in the diagnosis and treatment planning, especially during surgical interventions, because of the risk of osteonecrosis. Purpose – based on the data of modern scientific literature and articles, identifying markers of bone remodeling and endothelial disorders is of primary importance for optimizing the early diagnosis of microcirculati on disorders in patients with maxillofacial pathologies.
Materials and methods. A review of available data in the literature on normal bone anatomy, bone biomarkers, and regulatory factors. The study of diagnostic modes and identification of the most valuable and fastest in bone and vascular endothelium impairment.
Results. According to the studies, osteocalcin, C-terminal telopeptide, tartrate-resistant acid phosphatase and VEGF are clinically the most informative for predicting jawbone osteonecrosis. With a serum C-terminal telopeptide concentration of less than 100 pg/mL, the risk of osteonecrosis increases. Serum osteocalcin is a specific biomarker of osteoblast function for assessing the rate of bone formation in osteoporosis. The average osteocalcin level revealed a significant difference between postmenopausal osteoporotic (16.16 ± 4.5 ng/ml) and non-osteoporotic (11.26 ± 3.07 ng/ml) women. Tartrate-resistant acid phosphatase (TRAP 5b) is used to reference the activity and number of osteoclasts. TRAP 5b can be specifically detected in serum by immunoassays.
Conclusion. The study of bone degeneration markers and vascular markers allows us to understand the principles of the occurrence of osteonecrosis more clearly, and, therefore, more clearly predict, diagnose osteonecrosis, and also correctly select the tactics of treatment for these patients, the type of surgical intervention, conservative, operative (partial resection, total jaw resection), – palliative, pre- and post-drug preparation of the body for intervention.
Relevance. The growing prevalence of combined endo-perio lesions (EPL) attracts the interest of researchers. Insufficiently covered in the scientific literature, issues of the anatomical and functional relationship between periodontal tissues and dental pulp, the lack of an algorithm for diagnosis and treatment of EPL determine the need for their research. The study aimed to arrange the available data on the morpho-functional aspects of the relationship between dental pulp and periodontal tissues and their features that determine the p athogenesis of EPL.
Materials and methods. The study found 2875 publications, presented in the international electronic scientific databases PubMed, Google Search, Embase, Web of Science, ScienceDirect, SciELO and eLibrary. Following the inclusion and non-inclusion criteria, we selected 52 publications, which included the results on studying the structure and function of periodontal tissues, roots and pulp of teeth in the aspect of EPL development. The methodology of this study meets the criteria for systematic reviews and meta-analyses (PRISMA).
Results. In EPL lesions, inflammation is maintained by an infection, which persists in the additional root canals and dentinal tubules and the periodontal pocket. Prevention of the formation and elimination of infection foci in the root canal system of the tooth, periapical tissues and periodontal pockets is the basis for EPL prevention and treatment. At the same time, there are no diagnostic and therapeutic algorithms, which allow timely detection of EPL and adequate treatment, depending on the primary lesion of pulpal and periodontal tissues and individual characteristics of the patient. The structure specifics of roots, pulp, cementum, periodontium and alveolar bone are described. The characteristic features of blood supply and innervation of the pulpal and periodontal tissues are presented. Promising areas of scientific research in EPL prevention and treatment are identified.
Conclusion. Tooth pulp and periodontal tissues are closely related morphologically and functionally. They are principally connected through the apical foramina and additional canals. Bacterial infection can also penetrate the pulp and periodontal tissues from the infected root canal system of the tooth through the dentinal tubules of the tooth root.
RESEARCH
Relevance. The scientific literature has published a considerable amount of data over the past two years on the manifestation of new COVID infection in the oral cavity during the disease. However, there are only occasional studies on the dental status of patients with the post-COVID syndrome. Purpose – to determine the oral hygiene and some oral fluid indices in patients with post-COVID syndrome using different kin ds of toothpaste.
Materials and methods. The study examined 68 patients aged 27-40 years who had had a coronavirus infection not earlier than six months before the beginning of the study. The control group consisted of patients who had not been ill with COVID-19. At the first stage, we compared oral fluid characteristics and content in the patients who had not had COVID-19 with the same parameters in the patients who had had coronavirus infection and post-COVID syndrome. At the second stage, we divided the patients into groups according to the toothpaste they used. We determined the oral hygiene and oral fluid indices in all patients.
Results. The patients with the post-COVID syndrome had a lower salivation rate, increased saliva viscosity, decreased saliva remineralization capacity, lower lysozyme activity and decreased cathelicidin LL-37 concentration in oral fluid. The patients, who used Moisturizing toothpaste (R.O.C.S. Moisturizing), had a higher salivation rate, lysozyme activity, cathelicidin LL-37 concentration than the patients who used toothpaste with chlorhexidine and sodium lauryl sulfate. Also, the level of oral hygiene was significantly higher in the first group.
Conclusion. The study established that the oral fluid parameters significantly changed in patients with the post-COVID syndrome, and the choice of toothpaste affected those parameters. This group of patients should use toothpaste that improves the properties of the oral fluid. The use of toothpaste "R.O.C.S. Moisturizing" improved the oral fluid characteristics in patients with post-COVID syndrome.
Relevance. In the middle of the last century, based on clinical and physiological studies, the head of the Department of Prosthodontics of the First Leningrad Medical Institute named after Academician I.P. Pavlov, Professor I.S. Rubinov, prepared a scientific base and formulated the doctrine of functional links and reflexes of the masticatory apparatus. In subsequent years, other scientists and clinicians clarified the features of the masticatory apparatus reflex manifestations and functional characteristics of masticatory units in various oral diseases. New characteristics of reflex formation in various pathological conditions of the masticatory apparatus we re revealed.
Materials and methods. The paper presents data from a clinical and physiological study of the masticatory apparatus in 221 people of different age groups with implant-supported prostheses (two-stage endosseous implants). We studied the occlusal force using a gnathodynamometer and measured the muscle tone parameters at rest and the masticatory muscle contraction using a myotonometer. The study describes the masticatory apparatus musculoskeletal physiological reflex features and the manifestation in patients during dental rehabilitation, which was complicated by the gum and/or bone inflammation around the implants (mucositis and peri-implantitis ).
Results. The study found that the development of an inflammatory process in the area of the dental implant in the form of mucositis or peri-implantitis did not lead to a protective change in the kinematics of the lower jaw movement to reduce the load on the masticatory link with developing pathology in the area of peri-implant tissues. The paper shows the pathophysiological features of the manifestation of the masticatory apparatus reflexes when restoring the integrity of dentition using prostheses. It describes the mechanisms of forming a vicious pathogenesis cycle in inflammation development in the tissues adjacent to artificial support.
Conclusion. The clinical and physiological study substantiates the importance of routine preventive examinations, including radiographic examination, for timely diagnosis and treatment of an asymptomatic inflammatory process around a dental implant and an implant-supported restoration to avoid their premature functional and aesthetic failure.
Relevance. Gingival recessions are frequent during or after orthodontic treatment with fixed appliances (65.0-86.7%). They are usually observed in anterior teeth, especially in teeth bodily movements along an archwire outside the bone or in buccal/ labial tipping more than five degrees along the axis (35%). Pre-existing recessions worsen during orthodontic treatment with fixed appliances and up to 5 years after the treatment (47%). The treatment of recessions during or after the orthodontic treatment is not strategically reasonable: the relapse rate is high, and the treatment implies large-scale surgical interventions, including osteoplastic surgery; it is more often performed with free gingival de-epithelized graft after the treatment, which has many comparative disadvantages. Purpose – the study aimed to evaluate the effectiveness of a graft material (allogeneic dura mater) to eliminate gingival recessions before orthodontic treatment or to create/ thicken the volume of the gum buccally/ labially to prevent rec eding gum during or after orthodontic treatment.
Materials and methods. The paper presents and closely analyzes preventive surgical treatment in a patient with pretreatment gingival recessions.
Results. In all cases, using the dura mater demonstrates a positive clinical result by all parameters of the gingival recession assessment. The percentage of root coverage is 100% in all teeth.
Conclusion. Preventive surgical treatment is reasonable in all cases as it eliminates the need for repeated interventions, excludes the onset of gingival recessions during or after orthodontic treatment, as well as the reappearance of gingival recessions. Dura mater is effective and safe in all cases; the response to surgery is normal, dura mater allows avoiding a second surgical field. We recommend including it in the standard protocol of orthodonti c treatment.
Relevance. Plastic and reconstructive surgery of the missing outer ear is not always successful and may cause complications. Prosthetic reconstruction using silicone ectoprostheses (epitheses) is an alternative solution to this problem. Purpose – the study aimed to verify clinical and microbiological protocol of prosthetic rehabilitation of patients with a missing auricle using temporary silicone epitheses during implant osseointegration placed for the final magnet-bar retention system and assessment of the prosthetic reconstruction effe ctiveness.
Materials and methods. The study compared and analyzed the quality of life and microbial colonization of the skin biotope in the main group patients – with temporary silicone auricle epithesis during extraoral implant osseointegration and in the control group without such prostheses. Quality of life was assessed before and after treatment using the automated questionnaires (WHOQOL-BREF and QL PAER) developed by us for mobile devices. We determined the quantitative and qualitative composition of the skin microbiota behind the ear in all patients with fixed silicone samples for seven days.
Results. According to all domains of the "WHOQOL-BREF" and "QL PAER" questionnaires, an integral index of QLI (p < 0.05) was reliably higher after prosthesis fixation in the main group. Skin biotope colonization by strains of resident microorganisms in the region of Technovent silicone epithesis increased if B-460 glue was applied, and the water-soluble G609 glue did not have a similar effect.
Conclusion. A digital protocol for the manufacture of a temporary silicone epithesis of the auricle for the period of extraoral implant osseointegration, with the fixation on a water-soluble glue, improves the quality of life of patients with anotia and minimizes microbial colonization of the biotope of t he skin behind the ear.
Relevance. The etiology of alveolitis distinguishes infectious and traumatic factors, which determine the relevant drugs for preventing the inflammatory process after tooth extraction and local treatment of the developed alveolitis. Purpose – the study aimed to evaluate the effectiveness of a collagen sponge containing lincomycin hydrochloride compared to the traditional method using iodoform packing strips based on clinical, microbiological and immunological research methods.
Materials and methods. The study examined and surgically treated 75 patients with jaw alveolitis (K10.3), including those with eruption disorders, chronic periodontitis and chronic periodontitis in remission. Routine tooth extraction was recommended for them. We treated developed alveolitis in 37 patients and prevented complications during tooth extraction in 38 patients. According to the local exposure, the study allocated two subgroups: A –collagen sponge containing lincomycin hydrochloride and B –iodoform packing strips (traditional method). We comparatively analyzed microbiological parameters and cytokine content in the mixed saliva of patients using enzyme immunoassay (EIA).
Results. In the studied alveolar socket material with a confirmed diagnosis of alveolitis, a spectrum of priority pathogens was established, including mainly microaerophilic streptococci, obligate anaerobes and staphylococci. The monitoring of the local treatment method effectiveness demonstrated that the sponge with lincomycin does not fall behind in the decontamination level regarding streptococci and obligate anaerobes but is less effective against the staphylococcal component of the microbial consortium. Analysis of cytokines confirmed the presence of the immunotropic effect of the collagen sponge with lincomycin.
Conclusion. The possibility of using a collagen sponge with lincomycin hydrochloride has been substantiated as an alternative method of local treatment of alveolitis, which has a pronounced antibacterial and immunotropic effect at the level of regulation of the cytokine status.
Relevance. Inflammatory periodontal diseases, with a 68-98% prevalence, are a risk factor for developing cardiovascular diseases (CVD). There is simultaneously a low awareness of dental diseases and their role in assessing general health. The patient's understanding of the need for prevention and treatment of dental diseases is essential in the successful treatment of cardiovascular diseases. In this regard, the study of dental treatment adherence in patients with cardiovascular diseases is particularly relevant. Purpose – to study the level of adherence to dental treatment in patients with cardiovascular diseases.
Materials and methods. We conducted a dental examination and survey of 121 patients aged 18 to 89 years during treatment of coronary artery disease clinical manifestations, including 48 men and 73 women. The average age of the surveyed was 65.2 ± 0.44 years. Patients completed a modified Morisky-Green questionnaire, which included four questions. We used a written questionnaire, which included 21 closed questions of the original questionnaire, to study the factors affecting adherence to dental treatment.
Results. The study found that 87.6% of cardiovascular patients poorly adhered to dental treatment, 9.1% of patients were at risk, and only 3.3% had strong adherence to treatment. Only half of the respondents (52%) believed that oral diseases could affect the underlying disease course. Adherence to dental treatment did not depend on the age of the examined patients. Adherence was higher among women and those with higher education.
Conclusion. The study revealed that patients with cardiovascular diseases have a high prevalence and intensity of inflammatory periodontal diseases and low adherence to their treatment. Only half of the patients know the relationship between cardiovascular diseases and inflammatory periodontal dis eases.
ISSN 1726-7269 (Online)