Stomatologiya最新文献

In this article, on the example of a clinical case, the technique of restoring two central teeth in a patient with increased enamel erasability with highly filled fluid composite materials using injection techniques is described. The application of this technique has become possible because the new fluid composites have similar mechanical, physical and aesthetic properties to universal composite materials.

Objective: Determination of the optimal zone of the alveolar process of the upper jaw for bone autograft sampling according to cone-beam computed tomography.

Material and methods: A study was conducted to assess the possibility of taking a bone autograft from the palatine surface of the alveolar process of the upper jaw. The criteria for inclusion of patients in the study were the presence of a complete dentition and the absence of removed teeth in the upper jaw. A total of 50 patients participated in the study. Determination of the optimal zone for bone autograft sampling was carried out using cone-beam computed tomography (CBCT) of the upper jaw.

Results: The optimal area for bone autograft sampling is the area of the palatine surface of the alveolar process in the projection of the frontal group of teeth and the area of the upper jaw mound. When taking bone autograft in he projection of the frontal group of teeth and the area of the upper jaw mound with a probability of 95.11%, a 4 mm long trepan can be used. In 39.6% of cases, the parameters of the alveolar process allow the use of standard trepans with a diameter of 3.5 mm, which makes it possible to obtain a bone cylinder with a diameter of 3 mm. At the same time, in the area of the alveolar process of the frontal group of teeth, it is possible to pick up bone autograft more by 16-23 mm³ than in the the area of the upper jaw mound.

Conclusion: The palatine surface of the alveolar process can be used for bone autograft sampling when planning to eliminate limited defects of the upper jaw. The CBCT method makes it possible to determine the optimal bone autograft sampling zone and the available bone volume, which minimizes injury to the patient.

Objective: Identify structural disorders of the surface of the enamel of a human tooth during the development of the carious process in the «white spot» stage using atomic force microscopy (AFM).

Material and metods: The studies were carried out on 10 molar samples in areas with initial caries in the white spot stage. 6 areas of initial caries were scanned using the atomic force microscope Cetus Light (Nano Scan Technology, Russia) in semi-contact mode. Criteria were proposed for comparing the results of AFM scanning of tooth enamel surface samples and, based on them, the nature of the main structural disorders of the enamel surface in the affected area was determined.

Results: For all the samples studied, the healthy enamel surface was smoother compared to the enamel in the area of the clinically visible «white spot» and in the immediate vicinity of it. The heterogeneity of the enamel surface in the center of the white spot» for all the samples studied was at least 60% higher than at the edge of the process. It was revealed that the heterogeneity of the surface outside the clinically visible white spot at a distance of less than 1 mm from its perimeter is at least 30% higher than that of healthy tissue of the same tooth. It is shown that the heterogeneity of the enamel surface in the center of the caries area in the white spot stage is at least 4 times greater than the heterogeneity of the surface of the healthy enamel of the same tooth, which indicates its demineralization.

Conclusion: The established features of the spread of the initial carious process can be used in clinical practice for the diagnosis and dynamic observation of the processes of enamel demineralization.

Objective: To study the effectiveness of implant-supported full-arch metal-ceramic prosthesis with gold-platinum alloy framework in elderly patients.

Materials and methods: The study included patients with complete and/or partial loss of teeth and terminal dentition. In 2007-2008, 354 implants were inserted in 27 patients. The age of the patients was 61.31±5.08 years. Mombelli index criteria (mBI [modified Sulcus Bleeding Index]) were used. The plaque index was determined using a modified Löe & Silness method. The state of the peri-implant bone (ΔMBL) was determined by a series of OPG. The Geriatric Oral Health Index (GOHAI) was used to assess oral health in the elderly.

Results: Metal-ceramic full-arch implant prostheses with a gold-platinum alloy framework, based on a sufficient and optimal number of implants (6-8), showed high survival rate (100%) after 15 years. Marginal bone loss (ΔMBL) after 15 years was -1.44±1.27 mm. The survival rate of implants was 99.4%. Scores on the GOHAI scale were higher in patients after orthopedic rehabilitation (from 52.7±7.1 to 54.1±8.4, p<0.001).

Conclusion: After 15 years, all prostheses had mechanical defects, which at the same time allowed them to be used without restrictions. Screw fixation of full-arch implant prostheses, although it was associated with mechanical complications, nevertheless made it possible to perform surgical interventions in a timely manner and stop the development of inflammatory complications. Thus, we do not see any grounds for removing metal-ceramic prostheses and replacing them with new implant prostheses even after a 15-year period of operation. At the same time, it is necessary to take into account the reduction in the possibility of individual oral hygiene in elderly patients, as well as possible restrictions on self-visiting a dentist or dental hygienist.

The article is a review of literature on various methods for measuring gingival thickness at implant site and tooth recession. The purpose of the study was to analyze existing methods for assessing volumetric changes in soft tissues based on literature data and give recommendations on the choice of methods. The authors analyzed available methods and identified limitations and recommendations for the use of different methods. The literature review is also helpful to identify promising methods for assessing changes in soft tissue volume, which may help authors of future studies with method selection.

Objective: Improving the effectiveness of treatment of patients with temporomandibular joint (TMJ) dysfunction complicated by bruxism.

Material and methods: 70 patients with signs of parafunction of the masticatory muscles were selected for the clinical study. The patients were divided into 2 groups of 35 people. Splints were made for patients from the groups using 2 different 3D printing methods. The treatment was monitored using clinical and instrumental studies, electromyography of the muscles themselves and computed tomography of the TMJ after 3, 6 and 12 months.

Results: The severity of hypertonicity of the masticatory muscles decreased by the end of 3 months of treatment with the help of repositioning occlusal splints. After 6 months of treatment, the mean BEA decreased in both study groups, but to a lesser extent than in the first 3 months. After wearing a splint after 12 months, the decrease in muscle tone was insignificant.

Conclusion: The clinical use of positioning splints plays a crucial role in the stabilization of occlusion and is a mandatory stage of complex treatment of patients with pathology of the occlusal-musculoskeletal complex.

Objective: To investigate functional and aesthetic role of uvula in cleft palate repair.

Materials and methods: Forty-one patients aged from 1 year 2 months to 7 years were included in this study with congenital cleft lip and/or palate. The morphological investigation of the resected hemi- uvula was done. Palatoplasty was performed in all cases.

Results: According to morphological results, most of the resected hemi-uvula consisted of vascularized fibrous tissue, covered with epithelium. In three groups of patients (with unilateral, bilateral and isolated cleft palate), the duration of the surgery and intraoperative blood loss did not exceed similar values for conventional methods. The volume of infusion therapy revealed a deficit of fluid intake of no more than 30%, which indicates early restoration of swallowing function.

Conclusion: The technique of preserving one of the «hemi-uvulas» lead to excellent aesthetic results and increasing functionality. Resection of one of the «hemi-uvulas» is safe and physiological.

Purpose: To describe the ultrasound anatomy of the masticatory muscles based on a comparison of the results of macroscopic and ultrasound studies of the masticatory muscles in vitro.

Material and methods: In the experimental part, a macropreparation of the masticatory muscle was studied; in a clinical example, an ultrasound of the masticatory muscles was performed on a patient with normal occlusion using the author's methods for analyzing echograms.

Results: The ultrasound anatomy of the masticatory muscles is described based on a comparison of data from the study of a macroscopic specimen and ultrasound images of the masticatory muscle of an experimental animal. Using a clinical example of a patient with normal occlusion, the results demonstrate the usage of the authors' developments in describing ultrasound images of the masticatory muscles.

Conclusion: The study resulted in an algorithm for describing ultrasound images of masticatory muscles, including methods for qualitative and quantitative assessment of ultrasound images using proprietary developments involving elements of artificial intelligence technologies.

Purpose of the study: To study the effectiveness of using the drug Cholisal as part of the conservative treatment of chronic periodontitis.

Material and methods: We selected 100 patients aged 35 to 65 years of both sexes with a diagnosis of moderate chronic periodontitis in the acute phase with a periodontal pocket depth of 3.5-5 mm. Depending on the tactics of conservative treatment of CGP, patients were divided into two groups of 50 people. In the main group, in addition to standard treatment, the dental gel Cholisal was used, and in the control group, therapy was standard. 10 days after professional hygiene, patients in both groups were examined and underwent an index assessment of the condition of periodontal tissues and adherence to treatment.

Results: In patients of the control group, 10 days from the start of treatment, the depth of periodontal pockets in the control group decreased slightly from 4.7±0.28 mm to 4.2±0.21 mm (p=0.074), and the Green-Vermillion hygiene index decreased by 25.3±1.79% (p=0.041), Silnesse-Loe plaque index by 59.1±2.16% (p<0.001), PMA index by 51.5±1.92% (p<0.001) and Muhlemann-Cowell bleeding index by 42.2±1.75% (p<0.001). In the main group, the effectiveness of treatment of chronic periodontitis with conservative therapy using Cholisal was higher. There was a statistically significant decrease in the depth of periodontal pockets from 4.8±0.23 mm to 3.5±0.19 mm (p=0.043), the Green-Vermillion hygiene index decreased by 47.6±2.13% (p=0.0003), Silnesse-Loe plaque index by 78.2±3.05% (p<0.001), PMA index by 69.4±2.74% (p<0.001) and Muhlemann-Cowell bleeding index by 66.9±1.62% (p<0.001).

Conclusions: The use of the drug Cholisal in the conservative treatment of chronic periodontitis has shown convincing positive dynamics in both subjective and objective assessments, which suggests its effective use.

On a clinical example a modified technique for increasing the width of the attached keratinized gingiva zone is presented by taking medallions of a free gingival graft 1.5-2 mm thick from the hard palate using 5 mm mucotomes and transplanting them into the gum defect zones with a simultaneous vestibular deepening in the lateral regions of the jaws. This technology has been tested over a 5-year period with long-term clinical results.