Hard Tissue Changes Research Articles

A randomized controlled trial evaluating hyaluronic acid gel as wound healing agent in alveolar ridge preservation.

To compare the results of administration of hyaluronic acid (HA) gel to no gel administration following alveolar ridge preservation (ARP) in terms of changes in wound dimensions over time. Systemically healthy patients scheduled for ARP at one or two sites in the incisor, cuspid, or premolar area with at least one neighbouring tooth and >50% buccal bone present following extraction were included. ARP consisted of socket grafting with collagen-enriched, deproteinized bovine bone mineral and socket sealing by means of a collagen matrix. Following surgical therapy, sites were randomly allocated to the control group (no gel application) or the test group (0.8% HA gel applied onto the collagen matrix three times per day for 7 days). Bucco-lingual and mesio-distal wound dimensions were registered at T0 (immediately post operation), T1 (1 week), and T2 (3 weeks). Patient-reported outcomes, clinical outcomes, and hard and soft tissue changes were recorded up to 4 months (T3). In the control group, 20 patients (7 males, 13 females; mean age 53.30) with 23 sites, and in the test group 18 patients (9 males, 9 females; mean age 52.56) with 23 sites, were included. There were no significant differences between the groups in the changes in wound dimensions from T0 to T2 (bucco-lingual aspect: p=.340; mesio-distal aspect: p=.883). Three sites (13%) in the control group and six (26%) in the test group demonstrated complete wound resolution at T2 (p= .259). HA failed to show any effect on the number of analgesics taken (p= .175), patient-reported outcomes (p ≥ .263), alveolitis (p= .136), socket healing (p ≥ .424), soft tissue changes (p ≥ .064), or mucosal scarring (p=.548). However, significantly more horizontal bone loss at the coronal aspect was found in the test group (p ≤ .025). HA failed to promote wound resolution on a collagen matrix. This study was registered in ClinicalTrials.gov (NCT04467736).

Comparative Efficacy of Different Flapless Ridge Preservation Techniques: A Systematic Review and Meta-Analysis.

Although the efficacy of ridge preservation is well documented, there is a lack of robust evidence regarding the influence of different surgical techniques. Flapless approaches are thought to be better at preserving soft tissue architecture and have been suggested for mild to moderate defects. This review investigates the efficacy of different flapless techniques for ridge preservation in mild to moderate defects with <50% buccal bone loss. PubMed, EMBASE, and Cochrane Library databases were searched to obtain relevant articles published in English from 1974 to December 2019. The primary outcome was horizontal and vertical hard tissue dimensional changes. Soft tissue changes were evaluated as a secondary outcome. The Bio-Col technique, subperiosteal tunnel technique, and hard tissue with autogenous soft tissue graft/collagen matrix technique were identified. Eight studies were included, and quantitative analyses were performed for 4 studies for the primary outcome variables. The meta-analysis revealed significant reductions for horizontal changes (weighted mean difference [WMD] = 2.56 mm, 95% CI [2.18, 2.95]), vertical mid-buccal (WMD = 1.47 mm, 95% CI [1.04, 1.90]), and vertical mid-lingual (WMD = 1.28 mm, 95% CI [0.68, 1.87]) in favor of flapless ridge preservation techniques. Subgroup analysis based on technique suggests minimal hard tissue differences. The efficacy of flapless ridge preservation techniques on soft tissue changes was inconclusive. In conclusion, flapless ridge preservation techniques are effective for mild to moderate defects. The technique or material used to close the extraction socket does not seem to significantly affect hard tissue changes, while the effect on soft tissue changes warrants further investigation.

Clinical and Radio Graphical Evaluation of Implants Placed in Ridge Preserved Sites versus Naturally Healed Sites

Introduction: Dental implant has proved to be a pioneer in prosthetic rehabilitation overcoming the disadvantage of a removable or a fixed partial denture. The aim of the study was to clinically and radiographically evaluate and compare changes of hard and soft tissues around the implants which will be placed in ridge preserved sites with implant placed in naturally healed extraction sites.&#x0D; Materials and Methods: In this study 10 Patients having tooth with hopeless prognosis requiring tooth extraction followed by implant placement were enrolled. These patients were randomly divided in to two groups. Group I: Socket preservation with demineralized bone matrix putty group. Group II: Naturally healed socket after extraction, followed by implant placement in both groups.&#x0D; Results: The results of the current study indicated that demineralisedbone matrix putty, when used in patients for dental augmentation in either mandibular or maxillary sites, resulted in replacement of the graft material with bone by as early as 4-6 months, there upon enabling implant placement and subsequent prosthetic reconstruction.&#x0D; Conclusion: Bucco lingual ridge width and width of keratinized gingiva can be preserved by ridge preservation after extraction. Short-term survival rates and clinical outcomes of both groups were similar and were comparable. Further clinical trials with longer duration follow up with larger sample size should be done to get more affirmative and conclusive results.

The raman spectroscopy method for evaluation of structural changes in hard tissues of teeth after in-office whitening

Start The experiments in evaluation of hard tissues using the Raman spectroscopy method have been made. Spectral differences between the tooth enamel and dentin before and after the in-office whitening procedure were found as a result of the work. It was shown with the use of the Raman spectroscopy method that the whitening process causes changes of tooth enamel and dentin related to the changes of organic and mineral components.

Comparison of the hard and soft tissue changes of bimaxillary protrusion patients treated with Begg and MBT techniques: a cephalometric study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The effective treatment of bimaxillary protrusion needs a sound knowledge of the mechanics and expertise to control the tooth movement and the unwanted side effects. To obtain a desired finish there is a need to study and compare the mechanics used for correction of bimaxillary protrusion. The aim of this study was to quantify and compare the skeletal, dentoalveolar and soft tissue effects of Begg and MBT mechanotherapies in the treatment of bimaxillary protrusion cases.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In the present study, cephalometric comparison of the two mechanotherapies, Begg and MBT appliances was done retrospectively. The subjects were selected on the basis of pretreatment characteristics. The sample consisted of 40 patients (20 in each group) with an age range of 12-24 years. Pre- and post-treatment cephalograms were taken and traced on 75μm lacquered polyester acetate tracing papers using a 0.05” lead pencil.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The present study showed that Begg and the MBT appliances were equally effective in treating bimaxillary protrusion with first premolar extraction to satisfactory end results. Treatment with both the appliances resulted in significant amount of upper and lower anterior retraction and achievement of a pleasing facial appearance and profile.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Good torque control, if used in Begg mechanotherapy will result in achieving similar treatment outcome as obtained with MBT technique.&lt;/p&gt;

Evaluation of facial soft tissue thickness in asymmetric mandibular deformities after orthognathic surgery

ObjectivesThe purpose of this study was to compare differences in facial soft tissue thickness in three-dimensional (3D) images before and after orthognathic surgery in patients with skeletal Class III malocclusion and to obtain a better understanding of the relationship between hard and soft tissue changes after surgery.Materials and methodThe present retrospective study included 31 patients with skeletal Class III malocclusion with mandibular chin deviation greater than 4 mm who had undergone cone-beam computed tomography before and 6 months after surgery. Seven bilateral points were established. Measurements were taken from software-generated multiplanar reconstructions. The predictor variables were timing (pre- and postoperatively) and side (deviated vs. nondedicated). A regression model and correlation analysis were conducted for statistical analysis.ResultsThe difference of bilateral facial soft tissue thickness was statistically significantly different between deviated and nondeviated sides (P < 0.05), with lower values observed on the deviated side. The soft tissue thickness has become nearly symmetric at local regions of the lower thirds of the face after orthognathic surgery. However, most measurements showed a negative correlation between changes in soft tissue thickness and changes in bone tissues.ConclusionsSkeletal Class III malocclusion with facial asymmetry is accompanied by differences in soft tissue thickness when comparing Dev and N-Dev sides of the posterior region of the mandible, where soft tissues are thinner on the Dev side. Soft tissue thickness can compensate for or camouflage the underlying asymmetric mandible. In addition, the asymmetric soft tissue thickness on the lower third of the face can be partially improved by orthognathic surgery, but the amount of soft tissue thickness change is not consistent with that of hard tissue positional change.

Soft and Hard Tissue Changes Subsequent to Spontaneous Healing of the Extraction Sockets Using Cone-Beam Computed Tomography: A Cross-Sectional Study.

This study sought to compare the thickness of hard and soft tissues between edentulous and contralateral tooth sites. This split-mouth study evaluated 153 partially edentulous patients. The measurements were made on cone-beam computed tomography (CBCT) scans. The soft tissue thickness was measured at the cementoenamel junctional (CEJ) level, and at 2, 4, and 6mm apical to the CEJ in the facial and palatal aspects. The bone thickness of the opposite quadrant was also recorded at 2, 4, and 6mm apical to the CEJ. The Mann-Whitney U test and the Spearman's rank correlation coefficient were applied for further statistical analyses. At the edentulous sites, significant soft tissue loss was noted at the CEJ level (p < 0.0001) and a considerable gain was noted at 2, 4, and 6mm apical to the CEJ (p = 0.004, p < 0.0001, p ≤ 0.0001, respectively). A significant hard tissue loss was noted at 2mm apical to the CEJ but a significant hard tissue gain was observed at the edentulous sites (p < 0.0001). The soft tissue gain at 6mm apical to the CEJ was significantly associated with an increase in buccolingual diameter (p = 0.004) while the hard tissue loss at 2mm apical to the CEJ was significantly correlated with a reduction in buccolingual diameter (p = 0.020). Different amounts of tissue thickness alterations occurred in different levels of socket.

Determinants of Upper Lip Form: An Analysis Using Geometric Morphometrics

Orthodontics and orthognathic surgery can alter an individual's facial form, and it is the clinician's goal to predictably control changes in the facial soft tissues to achieve treatment goals. Within the facial profile, controlling projection of certain structures, such as the chin, is predictable, as the soft-tissue response to hard-tissue changes in such areas is predictable. The upper lip, on the other hand, presents a different challenge. While multiple studies have shown relationships between advancement of the upper incisor and advancement of the soft-tissue lip, unlike the chin, the anterior position of the upper lip is only a small component of upper-lip profile esthetics. Given the structure of the upper lip, the angulation plays a prominent role in upper-lip profile esthetics besides just its anteroposterior projection. No direct or indirect relationships have been established between the maxillary incisal orientation and upper-lip angulation. The clinical significance in understanding the upper lip to hard-tissue relationship is to predictably control the upper-lip angulation in orthodontics and/or orthognathic surgery in patients with dentofacial deformities. In the absence of reliable data, planning often becomes overly subjective or arbitrary, which could lead to poor esthetic outcomes. To the author's knowledge, there are no studies that analyze the relationship between the hard tissues and the upper-lip angulation. This is presumably the case because of the difficulty in comparing the contours of the hard and soft tissues in these non-linear structures. Any “parallelism” cannot be reliably measured in a reliable or quantitative way using conventional cephalometric or other linear techniques.A retrospective cross-sectional study was designed to analyze cone beam computerized tomography (CBCT) scans from 104 patients, using geometric morphometrics. The contour of the hard tissue was evaluated by taking a point below anterior nasal spine (ANS) at the point of greatest convexity between ANS and maxillary alveolus, as well as the most anterior point of the maxillary alveolar bone between the central incisors. Once these points were identified, 3 semi-landmarks were taken at equidistant points between these in order to best trace the curvature of this area. For the soft-tissue analysis, subnasale and labrale superioris were identified and, once again, 3 semi-landmarks were taken at equidistant points between these landmarks to map the upper-lip curvature.The data were then compiled, giving a total of 1040 data points, 520 hard-tissue and 520 soft-tissue points. While the results of the principal components analysis and partial least squares are pending, the initial data show a positive correlation between contour of the alveolar bone and teeth and the upper-lip position and form.Based on these findings, it appears that the upper-lip contour in the dentofacial deformity patient can be predictably controlled by manipulating the position of the maxillary alveolus and incisor position via orthodontic and surgical means.

EVALUATION OF EFFICACY OF DEMINERALIZED FREEZE DRIED BONE ALLOGRAFT WITH AND WITHOUT PLATELET-RICH FIBRIN IN THE TREATMENT OF INTRABONY DEFECTS BY CONE BEAM COMPUTED TOMOGRAPHY: A CLINICAL AND RADIOGRAPHIC STUDY

Background: Eventhough the combination of DFDBA (demineralized freeze dried bone allograft) with PRF (platelet-rich fibrin) has been attempted in periodontal practice with significant results, assessment of the intrabony defect and defect bone fill largely done with two-dimensional imaging modalities. Three dimentional analysis of the intrabony defect and defect bone fill has not been attempted with cone beam computer tomography (CBCT). The present study evaluated the efficacy of DFDBA with and without PRF in the treatment ofintrabony defects by CBCT. Methods: 60 defects in systemically healthy patients ranging from 18 to 50 years of age will be included in the study.30 defects were treated with PRF+DFDBA and 30 defects were treated with DFDBA alone. The study will include the assessment of clinical parameters involving probing depth (PD), relative attachment level(RAL), full mouth bleeding scores(FMBS),plaque index and gingival index from baseline to 3 , 6, 9 months. Hard tissue changes will be assessed radiographically by evaluating defect fill and defect resolution by CBCT at baseline&amp; 9 months. Results: The results of the present study are statistically significant in both groups in terms of clinical and radiographical parameters (P &lt; 0.001). In inter-group comparison, there was a statistically significant greater PD reduction and attachment gain while there was not significant reduction in terms of PI, GI, FMBS, defect fill and defect resolution in DFDBA+ PRF group. Conclusion: DFDBA along with PRF failed to provide additional value in terms of defect fill and defect resolution over DFDBA alone.

Three-dimensional analysis of lip soft tissue changes and related jaw changes in patients with skeletal class III malocclusion and facial asymmetry.

To investigate three-dimensional soft tissue changes of lips and related jaw changes in patients with skeletal class III malocclusion and facial asymmetry using cone-beam computerized tomography (CBCT). This study included 46 CBCT scans of patients with aforementioned character before (T1) and 6-12 months after orthognathic surgery (T2). Subjects were divided into 2 groups according to two types of orthognathic surgery namely, the one-jaw surgery group who underwent bilateral sagittal splint ramus osteotomy (BSSRO) and the two-jaw surgery group who underwent Le Fort I osteotomy and BSSRO. Mimics 19.0 software are used for model reconstruction, landmark location and three-dimensional cephalometric analysis. Descriptive statistics and correlation analyses are used to investigate jaw hard tissue and lip soft tissue changes. In one-jaw group, the mandible shows changes in contour and position (p < 0.05), and the surgery causes changes of lip structure on the deviated side. While in two-jaw group, jaws only show changes in spatial position, and surgery changes contour of bilateral lips and nasolabial angle (p < 0.05). At the same time, lip symmetry increases significantly in both groups postoperatively. Orthognathic surgery can improve lip aesthetics in patients with skeletal class III malocclusion and facial asymmetry. However, changes induced by two surgical approaches are different. Surgeons should have a clear acquaintance with this difference to deal with different situations.

ORAL HYGIENE STATE AND ITS CORRECTION OPTIONS IN CHILDREN WITH HODGKIN’S DISEASE

The Hodgkin’s disease (lymphogranulomatosis, LGM) stands at the top of the list among malignant lymphomas in children. The highest rate of it occurrence coincides with childhood. LGM is most common at 4-6 and 12-14 years. The scope of scientific clinical research on odontoand parodontopathology is limited among pediatric population. The quantitative and qualitative composition of plaque, its thickness and area is primary pathogenic chain. In turn, unsatisfactory oral hygiene contributes to the development of decay and periodontal and oral mucosal disease in children with LGM.&#x0D; Our research aims to study the oral hygienic condition in patients with LGM during different clinical stages of the underlying disease. In order to reduce the toxic effect of LGM treatment, rational oral hygiene preventive measures shall be implemented.&#x0D; Matherials and methods. A total of 45 patients of both sexes in the 5-15 year age group diagnozed with lymphogranulomatosis (LGM) were examined. 243 healthy age-and-sex-matched children were included in the control group. The patients with lymphogranulomatosis (LGM I) were examined after the initial diagnosis. Group II (LGM II) consisted of patients who had completed the first polychemestry treatment cycle. Group III (LGM III) included patients who had a constant remission period (from over 6 months to 5 years).&#x0D; The oral hygienic condition was studied using the Pahomov’s hygienic index, the simplified oral hygiene index (OHI-S by Greene and Vermilion), the PHP hygiene hygiene efficiency index (Podshadley, Haley, 1968), the modified Turesky index (1970), and API surfaces [6]. The data was statistically analyzed using Student's-Fisher's method.&#x0D; The Pahomov's hygienic index (PHI) in children aged 5-15 with LGM was quite different in the main and control groups (p&lt;0.05). The score of PHI was 2.3 ± 0.05 (p&lt;0.05) in patient group with LGM (LGM I). The Pahomov's hygienic index had increased in the children aged 5-15 diagnozed with LGM. The Pahomov’s index values from the second (LGM II) and third (LGM III) examinations were found to be quite different when compared to the control group of children of the same age (p&lt;0.05). This PHI value was 3.39 ± 0.11 (very poor) after the second examination (LGM II) and was at 2.7 ± 0.10 (poor) during the third examination (LGM II). The satisfactory and unsatisfactory oral hygiene conditions according to the Pahomov’s index were observed in 5-15 year old children with LGM.&#x0D; The satisfactory and unsatisfactory oral hygiene conditions have been established using the Pahomov’s index, Green-Vermilion, Tureski, PHP, API in 5-15 year old children with LGM. The children might have completely given up on tooth brushing due to increased trauma and bleeding gums.&#x0D; Soft plaque is often responsible for dental decay in primary and permanent teeth in children and periodontal diseases. The analysis of the individual oral hygiene condition determined poor level of hygiene skill in patients with LGM compared to somatically healthy children. Hygienic condition and care depend on age, clinical stage of the underlying disease, the course of pathological complications in hard dental and soft oral tissues.&#x0D; Conclusion. Our clinical study established a poor oral hygiene condition by using different groups of dental hygiene indicators in patients with LGM. This condition particularly worsens during chemotherapy, which causes significant changes in periodontal, oral mucous and hard dental tissues. Children have low awareness of oral cavity care requirements or the specifics of selecting hygiene supplies and facilities. In those cases, the dental examination was required for raising awareness and providing oral hygiene control which was carried out among patients at different stages of the Hodgkin’s disease and it remission. Therefore, adopting such measures would provide an opportunity to increase the resistance of hard dental and periodontal tissues.

The socket shield technique for immediate implant placement: A systematic review and meta-analysis.

Immediate implant placement with socket shield technique (SST) may maintain the buccal bone plate and soft tissue levels, however, the potential clinical benefits of SST lack strong scientific evidence. The aim of this systematic review and meta-analysis was to evaluate the effects of SST on dimensional changes of hard tissues, esthetic outcomes, implant stability, complication, and implant failure rates. Electronic databases were searched to identify randomized controlled trials (RCTs) that compared immediate implant placement with and without SST. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. Data were analyzed using a statistical software program. A total of 982 studies were identified, of which, seven RCTs with 206 immediately placed dental implants in 191 participants were included. Overall meta-analysis showed significant differences in the changes in buccal bone plate width (mean difference (MD) -0.22; 95% confidence interval (CI) -0.30 to -0.15; p <0.0001) and height (MD -0.52; 95% CI -0.85 to -0.18; p =0.002) in favor of SST. The use of SST was also associated with significantly less changes in peri-implant marginal bone levels and better pink esthetic score than immediately placing implants without SST. The differences in implant stability, complication and implant failure rates were not statistically significant between immediate implant placement with or without SST. The short-term complication and implant failure rates following immediate implant placement with or without SST were comparable. The SST has short-term positive effects on the changes in width and height of buccal bone plate, peri-implant marginal bone levels and esthetic outcomes. Further evidence from long-term RCTs are still required to substantiate the current findings. SST can reduce changes in buccal plate width and height and improve the soft tissue profile following immediate implant placement in esthetic zone.

Polyetheretherketone patient-specific implants (PPSI) for the reconstruction of two different mandibular contour deformities.

This study aims to prospect the soft and hard tissue changes after augmentation of two different local mandibular contour defects using polyetheretherketone (PEEK) patient-specific onlay implants. Six patients with disfiguring local mandibular deformities were included in this study (five males and one female) and received seven PEEK patient-specific implants (PSI), virtually designed and surgically settled to augment seven mandibular defects, three deficient chins, and four mandibular angels. The analysis of the soft and hard tissue changes utilized the superimposition of the preoperative and the 6-month postoperative sagittal and coronal CT views, after standardizing the radiographic interpretation. The soft tissue gain for the chin was 6.8mm ± 0.98 with a 45.8% increase versus 4.42mm ± 0.41 with a 22.9% increase for the angle. The difference in the soft tissue gain between the two groups was statistically significant (P = 0.0001). Comparing the soft tissue gain to the planned implant thickness, the percentage of the soft tissue gain for the chin recorded 109.2% versus 65.57% for the angle. The difference between the two groups was also statistically significant (P < 0.0001). PEEK patient-specific onlay implants represented an efficient and straightforward modality to augment local mandibular contour deformities with favorable esthetic outcomes; the total soft tissue profile gain of the chin region markedly exceeded that of the mandibular angle.

One-Abutment One-Time Effect on Peri-Implant Marginal Bone: A Prospective, Controlled, Randomized, Double-Blind Study.

Objective: To evaluate the peri-implant hard tissue change at 6 and 12 months after implant placement between definitive abutment placed at the same time of implant surgery, never removing it, and healing abutment disconnected and reconnected three times until the placement of the final rehabilitation. Material and methods: Each partial edentulous patient could receive between 1 and 4 platform-switched implants in the posterior regions. If the implants had primary stability—implant stability quotient (ISQ) equal to or greater than 50, they were randomized to the test group with the abutment inserted at the same time of implant placement (DA) or to the control group, receiving a healing abutment (PA). At 6 and 12 months after surgery, data related with vertical bone level changes (primary outcome) and other clinical parameters (implant mobility, bleeding on probing, probing depth, plaque index) were assessed. Results: 53 implants were included in the trial and completed 12 months follow-up (overall survival rate: 100%). All implants achieved primary stability, with an average ISQ value of 80.9 on the day of surgery. From surgery to 6 months, the mean bone loss was 0.14 ± 0.18 mm for the DA group and 0.23 ± 0.29 mm for the PA group, without statistical significance difference. Between 6 and 12 months, the mean bone loss was 0.14 ± 0.21 mm for the DA group and 0.21 ± 0.27 mm for the PA group, also without statistical significance between the two groups. There were no statistically significant differences (p = 0.330) in total bone loss after 12 months between the control and the study groups. Conclusions: The one abutment one time protocol has at least an equivalent effect on the peri-implant bone level changes when compared with the use of healing abutments that are disconnected and reconnected at least three times.

A Split Mouth Study on Crestal Bone Architectural Changes by Flapped and Flapless Implant Surgical Procedures

Background: Rehabilitations by dental implants have often been utilized as an efficient procedure for restoring missing teeth. For implant placement two types of surgical methods are well documented. Conventional surgical approach involves raising a mucoperiosteal flap to gain access and see the underlying alveolar bone, instead there is this procedure which does not involve the reflection of the flap. Both the techniques are known to have their individual benefits and shortcomings. The present study was aimed to evaluate the longitudinal comparison and evaluation of hard tissue changes around endosseous implants placed using flapped as well as flapless surgical procedures in mandibular first molar region.&#x0D; Materials and Methods: A total of 10 healthy patients with bilateral mandibular first molar were involved in the study and 20 endosseous implants were inserted (10 in each group). Radiographic assessment was done for deviations in the marginal bone levels on both mesial and distal side and their average value was calculated at 1 month, and 3 months. All these parameters were statistically analyzed using the paired Student t test, and two-way ANOVA test and were considered to be significant if the p value was ≤ 0.05.&#x0D; Results: During the 3 months observation period, the change in crestal bone height around the implants placed by flapless and flap surgery were statistically significant. The flapless group showed less reduction in the crestal bone height compared to the flap group.&#x0D; Conclusion: Both flap and the flapless techniques of endosseous implant placement had statistically significant effect on peri-implant bone loss over the 3 month period.

МИНЕРАЛЬНЫЙ ГОМЕОСТАЗ РОТОВОЙ ЖИДКОСТИ У ДЕТЕЙ И ПОДРОСТКОВ, ПЕРЕНЕСШИХ ЛЕЧЕНИЕ ЗЛОКАЧЕСТВЕННЫХ НОВООБРАЗОВАНИЙ

Annotation. The authors' study highlights the urgent problem of the development of toxic damage to the dentition under the influence of anticancer therapy in children and adolescents. The aim of the study was to study the violation of the homeostasis of the oral fluid and the severity of the carious process. Materials and methods. As part of a pilot study at the Russian Field Treatment and Rehabilitation Center, 63 children were studied the severity of mineral homeostasis disorders and damage to the dentoalveolar system. Results. In 67% of patients in the main group, there was an increased tendency to form carious cavities. 54.5% of them have complicated caries. One third of patients had more than five carious teeth. In the control group, carious lesions of the teeth in only three patients (20%), with the involvement of 1-3 teeth in the pathological process. Violation of enamel formation was diagnosed in 36% of children of the main group. There is a tendency for the accumulation of the studied microelements in the oral fluid, while in the blood serum there is a normal or insignificant decrease in their content. According to the literature, this may indicate destruction in the oral cavity. Deviations in the homeostasis of chemical elements in children who completed the treatment of malignant neoplasms and children in the control group were revealed. An increased content of osteotrophic microelements was found to correlate with the destructive processes of the teeth. Conclusion. It seems appropriate to study the severity of morphological changes in hard tissues of teeth and the electrolyte composition of mixed saliva in children and adolescents who have been cured of malignant neoplasms. The results of studies of gastric cancer, as an indicator of metabolic disorders, will make it possible not only to reveal the imbalance of macro- and microelements, but also to establish the effectiveness of adaptation mechanisms aimed at normalizing the elemental composition of the oral fluid.

THE CONCEPT OF A COMPREHENSIVE PROGNOSTIC MODEL OF THE EFFECTIVENESS OF IMPLEMENTATION OF MINIMALLY INVASIVE INTERVENTIONS IN THE TREATMENT OF CARIOUS PATHOLOGY

The research presents a prognostic model of the effectiveness of minimally invasive interventions in the dental patients’ treatment of carious pathology, which was developed to reduce the impact of iatrogenic interventions, increase the results of biological, biomechanical and financial feasibility of treatment.&#x0D; The aim of research is to develop a mathematical representation of a comprehensive prognostic model of the minimally invasive treatment effectiveness of carious pathology.&#x0D; Materials and methods of research. Comprehensive prognostic model of comparative efficiency of minimally invasive implementation of treatment protocols of carious pathology included consideration of relative risk indicators of biological complications (secondary caries and affected tissue pulp), decreased biomechanical forecast of the tooth (based on the performance index IROPZ and IHRKCHZ) and the financial feasibility of these methods, taking into account the ratio of material costs and unit labor intensity of the biological level and biomechanical forecast of the functioning of the dentition unit.&#x0D; Results of the research. The factors were identified during the scientific research; it was provided that the volume of iatrogenic interventions in the dental patients’ treatment of caries can be minimized. The structure of a complex prognostic model of the effectiveness of realization minimally invasive methods of treating caries of hard tooth tissues was developed. A comparative assessment of the biological, biomechanical and financial feasibility of treatment of carious pathology depending on the depth of damage to the hard tissues of the tooth using classical (invasive) and mini-invasive methods of treatment was held. The study showed that the implementation of minimally invasive approaches to the treatment of carious pathology in terms of risk and complications in secondary destructive changes of dental hard tissues and pulp tissue damage contributes to the effectiveness of limited nuclear interventions with controlled enamel reduction and determination of connection of restoration with the bottom of the formed cavity. The highest biomechanical feasibility of minimally invasive dissection protocols has been established in the defects treatment within the enamel in order to minimize unreasonable enamel reduction and dentin tissues, carious cavities treatment at the border of medium-deep types of lesions to limit the caries spreading in the cavities deep localization in order to prevent the development of associated lesions of the pulp complex, which in terms of biological prognosis can provoke the development of irreversible changes.&#x0D; Conclusion. As a result of scientific research and comparative analysis of the effectiveness of caries treatment by mini-invasive methods of intervention, the fact of improving the biological and biomechanical prognosis of the affected units of the dentition compared to the results of treatment of pathological lesions by surgery in accordance with classical protocols, confirming the developed complex prognostic model of efficiency of use of minimally invasive methods of treatment of carious pathology of dental patients. However, the creation of a unified comprehensive forecasting model, which would include the most complete reflection of all these criteria and was at the same time reliable, is impossible. Biological stacking relative risk indicators in the process of secondary development and pulpitis indicate the excess of minimally invasive treatment in all analyzed clinical cases, cases of initial treatment in relation to the risk of pulp production and cases in the center of caries relative to the risk of the previous year.

Preservation of Alveolar Ridge using Graft Material after Tooth Extraction: A Clinical Trial.

Background:The alveolar process is a tooth-dependent structure, and hence, removal of teeth results in the alteration of alveolar process. To alter bone remodeling after dental extraction, various techniques have been put forward for ridge preservation.Aim:The aim of this study is to evaluate and compare the changes of hard and soft tissues in postextraction socket after the application of bone graft material.Materials and Methods:Healthy patients of sample size of 40 were selected who underwent the extraction of anterior tooth irrespective of the arch, from premolar of one side to another, with the exception of incisors in mandible. Twenty patients were randomly selected as the control group and other 20 as the experimental group using an allograft bone material, i.e., beta-tricalcium phosphate to fill the socket. Cone-beam computed tomography (CBCT) was done as baseline preoperative and postoperative at 14 weeks after the extraction. CBCTs data help in recording linear and volumetric measurements which was performed by calibrated examiners to record all the measurements. After measurements, digital planning of dental implants was performed.Results:Forty participants were selected, in which 20 patients each were as the experimental and control groups. No significant difference was found at basal line at any of the cases. At follow-up of 14 weeks, statistical significance was seen in buccal and lingual plate height in the experimental group, and no significant difference was seen in the control group.(P = 0.023).Conclusions:This study clearly points out that an alveolar ridge preservation technique provides therapeutic benefit by limiting bone resorption in comparison to extraction alone.

Midfacial soft tissue changes after maxillary expansion using micro-implant-supported maxillary skeletal expanders in young adults: A retrospective study.

ObjectiveThe aim of this retrospective study was to assess the midfacial soft tissue changes following maxillary expansion using micro-implant-supported maxillary skeletal expanders (MSEs) in young adults by cone-beam computerized tomography (CBCT) and to evaluate the correlations between hard and soft tissue changes after MSE usage.MethodsTwenty patients (mean age, 22.4 years; range, 17.6–27.1) with maxillary transverse deficiency treated with MSEs were selected. Mean expansion amount was 6.5 mm. CBCT images taken before and after expansion were superimposed to measure the changes in soft and hard tissue landmarks. Statistical analyses were performed using paired t-test and Pearson’s correlation analysis on the basis of the normality of data.ResultsAverage lateral movement of the cheek points was 1.35 mm (right) and 1.08 mm (left), and that of the alar curvature points was 1.03 mm (right) and 1.02 mm (left). Average forward displacement of the cheek points was 0.59 mm (right) and 0.44 mm (left), and that of the alar curvature points was 0.61 mm (right) and 0.77 mm (left) (p < 0.05). Anterior nasal spine (ANS), posterior nasal spine (PNS), and alveolar bone width showed significant increments (p < 0.05). Changes in the cheek and alar curvature points on both sides significantly correlated with hard tissue changes (p < 0.05).ConclusionsMaxillary expansion using MSEs resulted in significant lateral and forward movements of the soft tissues of cheek and alar curvature points on both sides in young adults and correlated with the maxillary suture opening at the ANS and PNS.

Ten Year Clinical and Aesthetic Outcomes of an Immediately Placed and Restored Implant in the Anterior Maxilla: A Case Report

The nature of immediate implant placement followed by an immediate restoration protocol makes it particularly suited to the anterior maxilla. In addition to saving treatment time and avoiding additional surgical procedures, this protocol has been reported to improve aesthetic outcomes by supporting the peri-implant tissues during the implant healing phase through the use of a provisional restoration. This case report documents the use of this protocol in a patient with a failing maxillary anterior tooth and reports on the soft and hard tissue changes over an observation period of 10 years. An implant was immediately placed after removal of a failing maxillary central incisor followed by the provision of a screw retained provisional crown on the same day. A definitive restoration was placed after a 3-month healing period. Not only did this protocol manage to maintain peri-implant bone levels over the 10-year follow-up period, excellent aesthetic outcomes and very limited soft tissue recession were observed with the use of this technique.