Stomatologiya最新文献

Objective: To analyze the results of specialized medical care (SMC) to the injured in the maxillofacial region using the principles of multi-stage surgical treatment.

Material and methods: To achieve the purpose of the study, the results of surgical treatment of the wounded with combat wounds of the maxillofacial region in military medical hospitals and medical institutions performing qualified and specialized care were analyzed. Clinical examination, observation and treatment were carried out using a comprehensive multidisciplinary approach (examination by an anesthesiologist, intensive care specialist, neurosurgeon, maxillofacial surgeon, traumatologist, surgeon, ophthalmologist and otolaryngologist). Qualified medical care was provided for urgent indications (elimination of asphyxia and control of continuing bleeding. fixation of bone fragments). SSC requires the participation of high-class specialists and appropriate equipment to achieve maximum quality of treatment.

Results: According to the experience of combat operations in the Republic of Afghanistan and the counter-terrorism operation in the North Caucasus, isolated and combined (leading damage to the maxillofacial region) MFZ injuries in the overall structure of combat surgical trauma amounted to 4.3% and 4.5-5.0%, respectively, taking into account concomitant wounds - 8.5% and 8.3-10.7%.

Conclusion: Multi-stage surgical treatment tactics in the specialized medical care section led to a 3.4% decrease in mortality; the number of complications decreased by 2 times; the number of bed days in the ICU decreased by 1.8 times; the duration of functional and aesthetic rehabilitation of casualties decreased.

The aim of the study: Was the analysis of the values of torque and primary stability of dental implants with «classical» and «active» threads, placed in low-density bone with different methods.

Material and methods: Implants were placed into the cancellous bone of pig's breastbone that represents low-density bone. Specimens were divided into 2 groups according to used protocols with 10 samples of each type with «classical» and «active» threads, 40 implants overall. In the first group osteotomy was performed according to the standard technique using the cutting drills, in the second one using osseodensification method. The torque was measured during implantation with physiodispenser and the implant stability quotient with the help of Osstell Beacon device.

Results: Comparative analysis of obtained values showed statistically significant difference with the advantage of using osseodensification protocol in each case. For example, the median torque value of the implants placed by the standard protocol was 15 N/cm and 44 N/cm when using osseodensification method. When comparing implants with «classical» threads, the median value of torque was 15.5 N/cm in the first group and 52.5 N/cm in the second group, and the arithmetic mean of ISQ when using the Smartpeg pin was 69 and 78 units, respectively. A similar result was obtained when comparing implants with «active» threads, in which the arithmetic mean of the torque in the first group was 13.5 N/cm and 35.8 N/cm in the second group, and the stability quotient when using the Smartpeg pin was 67 and 77.1 units, respectively. When using implants with «classical» thread design with an osseodensification protocol hypertorque was obtained.

Conclusion: When working in low-density bone the use of a standard preparation protocol is ineffective, unlike the osseodensification method. The use of the latter with implants with a classic «non-aggressive» macro design should be carried out carefully.

The aim of the study: Was to determine the signs of TMJ dysfunction in patients with complete removable dentures who did not complain of discomfort or pain.

Materials and methods: The study included 264 patients with complete absence of teeth, who had complete removable dentures for at least 6 months. Two groups of subjects were formed, 20 of whom (the control group) had no clinical signs, MRI examination in the TMJ did not reveal any pathological changes, and manual examination did not reveal pathological symptoms. The remaining 244 patients formed the main group, who also did not complain of any complaints. In these patients, tooth extractions were performed 6-12 months ago.

Results: In the main group, it was determined that only 36 patients (15%) presented complaints when using complete removable dentures, and 224 patients (85%) had no symptoms, and crunching and clicking in the TMJ, accompanied by discomfort and minor pain were observed in 7 patients (20% of those presenting complaints). According to the results of the MRI study, it was determined that all 56 patients regardless of gender have an asymmetry in the shape of the articular heads and their sclerotic changes, 44 patients with complete edentia showed a posterior displacement of the joint heads and a narrowing of the joint space. At the same time 46 of the 56 patients were over 70 years old and used dentures for more than 4 years, a visual examination determined a decrease in the height of the lower part of the face, including due to the wear of artificial teeth installed in the denture.

Conclusion: Thus, it has been determined that a significant number of patients using complete removable dentures have dysfunctional disorders in the temporomandibular joint, which are detected only by special examination methods. This category of patients does not seek dental care from medical organizations due to the absence of complaints of painful sensations.

The aim of the study: Was to investigate the dynamics of maxillary movement after surgically assisted maxillary expansion in adult patients with cleft lip and palate.

Material and methods: The study involved 15 adult patients aged 18-47 divided into three groups based on upper jaw pathology. Group 1 consisted of 5 patients with the diagnosis of «Upper micrognathia», group 2 included 5 patients with «Upper micrognathia after a series of surgeries for unilateral cleft lip and palate» and group 3 comprised 5 patients with diagnosis of «Upper micrognathia after a series of surgeries for bilateral cleft lip and palate». Movement of the maxillary fragments was measured 3 and 6 months after activation using cone beam computed tomography and intraoral scanner data. The data was analyzed using specialized software Amira 5.4.5 to create a 3D-model of the upper jaw. This allowed for precise measurement and analysis of the movement of the maxilla over time.

Results: Despite the initial goal of surgically assisted maxillary expansion being to correct transverse deficits it has been found that spatial changes occur in all planes and axes. Patients with upper micrognathia resulting from bilateral cleft lip and palate are more likely to experience recurrence of displacement of the fragments of the upper jaw following expansion, compared to patients with a unilateral cleft during the postoperative period. The most favorable stability indicators were noted among patients without clefts.

Conclusion: Comparison of three-dimensional jaw models obtained from CT and intraoral scanning data allows for accurate visualization and calculation of changes occurring in the postoperative period and can be the method of choice in dynamic monitoring of patients.

Objective: To determine the optimal type of compression distraction device (CDA) for the treatment of mandibular underdevelopment in children.

Materials and methods: The archival data of 50 pediatric patients with underdevelopment of the mandible of various etiologies were analyzed. The patients were divided into two groups: group 1 with congenital pathology (syndrome I-II of the branchial arch, unilateral lesion) Group 2 with acquired pathology (consequences of TMJ ankylosis or injury of the condylar process without ankylosis). According to CT data, the length of the body and the height of the mandibular branch on the affected and intact sides were determined, and the degree of asymmetry was calculated. Depending on the nature of the deformation, either a rectilinear intraosseous distractor or a curved one (with a radius of curvature R40-R100) was used. The distribution of types of devices into groups and the correspondence of the choice of KDA to morphometric indicators were evaluated.

Results: In both groups, the majority of cases (≈90%) required the use of curved distractors, while direct devices were used in only 5 patients (10%). Rectilinear distractors were installed mainly with an isolated horizontal shortening of the mandible body, or with an isolated decrease in the height of the branch. The curved devices made it possible to simultaneously lengthen the body and the mandible branch in one step, eliminating the combination of horizontal and vertical deficits. The radius of curvature was selected individually: for severe vertical underdevelopment of the branch (hemifacial microsomy), a smaller radius (R40) was used, whereas for post-traumatic underdevelopment without a significant decrease in height, a larger radius (R70-R100) was used. In both groups, a significant elongation of the mandible was achieved: an increase in body length averaged 12-14 mm, and the height of the branch was 15-17 mm, which practically eliminated the initial asymmetry.

Conclusion: In children with combined mandibular underdevelopment, the use of intraoral curved distractors is optimal, which simultaneously compensate for horizontal and vertical deficits. Rectilinear QDs can only be used for isolated shortening in one direction (only the length of the body or only the height of the branch).

Objective: The aim of this study was to develop and characterize the properties of biocompatible photopolymerizable composites based on hyaluronic acid and polyethyleneglycol diacrylate.

Materials and methods: A method for chemical modification of hyaluronic acid using glycidyl methacrylate was considered. The influence of the composition of photopolymerizable polymer composites on their physical and mechanical properties, swelling rate, and resistance to degradation in vitro was studied. A comparative analysis of the effectiveness of type I photoinitiators was conducted.

Results: Photopolymerizable composites containing methacrylated hyaluronic acid showed greater structural strength and a lower swelling rate in the cured samples. The highest values of strength and hydrolytic stability were demonstrated by the photopolymerizable composition containing 0.5% wt. of lithium phenyl (2.4,6-trimethylbenzoylphosphinate), 15% wt. of methacrylated hyaluronic acid and 25% wt. of polyethylene glycol diacrylate.

Conclusion: Based on the study's results, it was concluded that polymeric materials with optimal mechanical properties and controlled degradation rates can be created by incorporating them into methacrylated hyaluronic acid.

Objective: To evaluate the long-term clinical results of the gene-activated bone substitute based on octacalcium phosphate and plasmid DNA encoding vascular endothelial growth factor in bone grafting for dental implantation.

Materials and methods: This clinical study analyzed the long-term treatment results of 100 patients with alveolar ridge atrophy and acquired bone defects of the jaws who underwent bone grafting with gene-activated bone substitute, starting with registration clinical trials initiated in 2017. All patients enrolled in the study underwent bone grafting of the upper or lower jaws using the gene-activated bone substitute in standard surgeries (sinus lifting, guided bone augmentation, cystectomy, etc.). The results of delayed clinical observation were assessed at different time points from 6 months to 7 years after bone grafting using clinical methods and computed tomography (CT), as well as histological analysis of trephine biopsy specimens.

Results: Newly formed tissues of bone density were detected in the bone grafting area in all patients within 6 months after surgery. The density remained at a high level during 7 years of follow-up. The volume of the newly formed tissues was maintained with minimal resorption: the decrease in volume was 12±5.9%. Histologically, newly-formed bone tissue with partially resorbed bone substitute fragments were indentified in trephine biopsy specimens.

Conclusion: Thus, the gene-activated bone substitute has proven its safety and long-term effectiveness in jaw bone grafting for up to 7 years, and it can be used to treat patients requiring dental implantation.

Modern technologies in implantology can significantly improve the accuracy and safety of surgical interventions. The use of MSCT and CBCT provides a detailed assessment of anatomical structures, while CBCT has a lower radiation load. Digital modeling of dental arches is carried out using intraoral scanners or digitization of plaster models, which achieves high accuracy and allows for the creation of effective orthopedic structures. 3D printing and milling from various materials, such as PMMA or polylactic acid, are used to manufacture surgical templates, which ensures their stability and compliance with the patient's anatomy. The use of radiopaque materials improves the visualization of templates in images, and the combination of CT data and optical models allows for accurate planning of the location of implants. The introduction of these technologies contributes to more accurate installation of dental implants, reducing risks and achieving optimal aesthetic and functional results.

The aim of the study: To study the trace element composition of various areas of hard tooth tissues in caries, pathological attrition and periodontal diseases on the archaeological material of dental remains of the X-XX centuries.

Materials and methods: The microelement composition of hard dental tissues of X-XX centuries' teeth was analyzed using the TM 3000 electronic microanalyzer (Hitachi, Japan).

Results: The patterns of microelement composition in diseases of hard dental tissues and periodontal disease have been revealed. The results of two-factor analysis of variance confirmed a statistically significant dependence of the average values of O and C content in enamel over the centuries (p<0.0001), the average values of P, Zn, O and Mg in dentin (p<0.0001), the average values of O and C content in cement (p<0.0001). High correlation between Ca and Sr in enamel (Pearson's r=0.847; t-criterion=7.98; statistical significance p<0.01; n=27) and a noticeable correlation in dentin (Pearson's r=0.512; t-criterion=2.46; p<0.05).

Conclusion: The results indicate that with the relative constancy of anatomical and morphological characteristics, the variability of the mineral composition is observed, as well as its pronounced dependence on exogenous factors.

The paper presents a clinical case of a 55-year-old patient with a diagnosis of extensive lipomatosis of the right and left occipital, parotid-masticatory areas, submandibular area, neck areas on all sides, supra-scapular area; Madelung's disease. The first stage of reconstructive surgery was performed. During the healing period, highly absorbent dressings were used to control the level of wound exudate, which prevents over-wetting of the wound and promotes better healing.