Stomatologiya最新文献

The aim of the study: To evaluate the change in the level of concentration of the antibacterial drug Vancomycin registered in the purulent focus area (facial vein) and in the peripheral blood flow (cubital vein) in patients with phlegmon of the maxillofacial region (MFR).

Materials and methods: The clinical material of the study was 12 patients with phlegmon of MFR who were being treated in the maxillofacial department of the N.I. Pirogov State Clinical Hospital No. 1 of the Moscow Medical Center. The drainage of phlegmons was performed on the day of admission of the patient 2-3 days after the onset of the disease. The phlegmons involved two or more spaces of the MFR. As an antimicrobial drug, 500 mg of Vancomycin in 400 ml of saline solution was used intravenously. Quantitative registration of Vancomycin was carried out 2 hours after intravenous infusion. Blood sampling was carried out from the cubital and facial veins in an amount of 7-8 ml intraoperatively at the opening of the phlegmon, under endotracheal anesthesia. The concentration of the antibiotic was determined by high-performance liquid crystal chromatography.

Results and discussion: The study found that the concentration of Vancomycin in the facial vein exceeds similar indicators obtained from the cubital vein. The difference in the percentage ratio averaged 19.2±7.3%. In 10 patients with phlegmons of various localization, it was found that the penetration of the antibacterial drug into the tissues of the inflammatory focus is higher compared to the periphery. However, in a number of patients, the concentration of the drug did not exceed the minimum suppressive concentration recommended for obtaining a therapeutic effect (for Vancomycin, it is at least 2 mcg / ml).

Conclusion: To achieve the therapeutic effect of phlegmon treatment, it is necessary to select an individual dose of the drug for each patient.

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.

Objective: To study the behavior of SHED cell culture on different types of materials for the regeneration of periodontal tissues with different porosity.

Material and methods: Porous collagen material Fibro-Gide (Geitstlich Pharma AG, Switzerland), designed to increase the volume of the gum and the barrier collagen membrane Bio-Gide (Geitstlich Pharma AG, Switzerland) were studied in vitro on SHED cultures. As a control sample, a Spongostan sponge made of gelatin (Johnson & Johnson Medical, UK) with the most pronounced porosity and wettability was used. Acute cytotoxicity was determined using a screening method for assessing the number of living cells in a sample (MTT test). SHED cells were sown on the materials to study the attachment of cells to materials and their migration inside the samples. Before seeding, the cells were stained with vital fluorescent dye PKH26 (red fluorescent cell linker kit, Sigma, Germany) for further visualization.

Results and discussion: Using the MTT test it was shown that they do not have cytotoxic effects. At the same time by the 8th day of the experiment in the presence of Fibro-Gide and Bio-Gide the cells showed an increase in proliferative activity by 19% and 12%, respectively compared with the control group. The cells attached and spread out on the surface of the materials and migrated into the thickness of porous Fibro-Gide and Spongostan.

Conclusion: The in vitro study showed that the most favorable material for SHED cell culture is the collagen material Fibro-Gide with sufficient porosity, elasticity and hydrophilicity. SHED cells attach to the collagen matrix and easily penetrate into the sample, filling the entire internal space, while the proliferative capacity of the cell culture increases.

Objective: The aim of the study is determination of the effectiveness of technologies for predicting the progressive course of dental caries in pregnant women.

Material and metods: We examined 511 pregnant women aged 18-40 years with dental caries (304 were included in a main group, 207 were enrolled in controls), who were assessed the DMFT index sequentially in the 1st, 2nd and 3rd trimesters of pregnancy. The prognosis of recurrence of dental caries was determined by the method of two-stage clinical and laboratory prognosis.

Results: The prevalence of dental caries in the main group was 89.1% (271 out of 304 patients), in the control group - 87.9% (182 out of 207 patients). In the third trimester of pregnancy 36.2% of women in the main group had a recurrence of caries (vs 43.0% in the control group). Early examination of patients in the 1st trimester of pregnancy, followed by monitoring of the state of the organs and tissues of the mouth, made it possible to achieve timely treatment of dental caries and prevent its recurrence. In the third trimester of pregnancy, the DMFT-index in the dispensary group, in contrast to the control group, was statistically significantly (p<0.05) lower by 12.3%, which indicated the effective use of the proposed monitoring.

Conclusion: The use of a system for providing dental treatment and preventive care in the form of screening, dynamic forecasting and assessment of the risk of recurrence of caries in pregnant women with dental caries and a high risk of its progression makes it possible to stop the development of this process and ensure the preservation of dental health.

Objective: To evaluate the initial molecular genetic signs of malignancy of verrucous leukoplakia (VL).

Materials and methods: The study of VL was carried out on biopsies of 21 patients with the diagnoses of verrucous hyperplasia (VH) (15 cases - 71.4%) and verrucous carcinoma (VC) (6 cases - 28.5%). Tissue antigens were determined using mouse monoclonal antibodies to the Ki-67 protein (MM1, Diagnostic Biosystems). Telomerase activity was determined using rabbit immunoglobulin (TRT, Abbiotec). The amplification of the TERC (Telomerase RNA Component) portion of the RNA of the third chromosome was studied by the FISH method.

Results: In the studied groups, high cell proliferation and significant differences between HC and VC were revealed. The amplification of TERC by the FISH method made it possible to carry out differential diagnostics between VG and VC. According to the results of the study, the amplification of the TERC gene was detected in 100% in VC and in 20% in VG.

Conclusion: The FISH method makes it possible to detect VL malignancy at an early stage. Amplification of the TERC gene is characteristic of malignant transformation of epithelial cells in VC. In IG, as a rule, there was no amplification, which can serve as evidence of the benign nature of the pathology of COP.

The aim of thestudy: To develop a method to contain atrophy of the alveolar bone and surrounding soft tissues in the area of many cortical teeth in the first 3 months after removal for subsequent installation of a dental implant.

Materials and methods: A description of a method for containing atrophy of the alveolar bone and surrounding soft tissues after removal of the first molar of the mandible 3 months after tooth extraction is presented. The method consists in closing the mouth of the well with a horizontally oriented fragment of the root of the removed tooth with a preserved section of the ligamentous apparatus. An X-ray assessment of bone restoration in the lumen of the well was carried out according to the Hounsfield coefficient and an assessment of the condition of soft tissues in the area of surgery 3 months after removal. For histological assessment of bone maturity, bone was taken from the implantation area 14 weeks after tooth extraction.

Results: The technique allowed to preserve the quality of soft tissues close to the original; on three-dimensional X-ray images in the lumen of the well, bone restoration sufficient for the installation of a dental implant is diagnosed, the zonal value of the Hounsfield coefficient is more than 300 units; histologically, a well-developed network of coarse-fibrous trabeculae is determined with the beginning of reconstruction into lamellar bone, regeneration of the alveolar process occurs by intramembranous ossification.

Conclusion: The proposed technique contributes to the preservation of the qualities of the marginal gum in the healing zone after tooth extraction and the formation of sufficient bone maturity in the lumen of the well.

A case of treatment of a 35-year-old patient with a retroposition of the lower jaw, distal occlusion of the posterior teeth, deep incisal overlap, narrowing of the deformity of the dentoalveolar arches, protrusion of the lower incisors, crowded position of the teeth, mismatch between the incisor lines, absence due to extraction of tooth 3.6, with impacted dystopic tooth 3.8 is presented. Fixed individual orthodontic appliances of the WIN («DW Lingual Systems GmbH» Germany) were used. It was found that the use of the Herbst apparatus in combination with the WIN lingual bracket system in adult patients helps to achieve optimal functional and aesthetic results. The use of a distal bite correction device is an additional support for the mesialization of the molars of the lower jaw.

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.