Застосування методів симуляційного навчання на кафедрі післядипломної освіти лікарів-стоматологів

Проаналізовано методики симуляційного тренінгу для лікарів-інтернів із надання невідкладної допомоги пацієнтам у термінальних станах. Тренінг сприяє підвищенню компетенції лікарів-стоматологів у наданні допомоги в невідкладних станах, упевненому застосуванню знань для підвищення якості медичної допомоги пацієнтам.The aim is to analyze the peculiarities of emergency care to dental practitioners at the department of postgraduate education of dentistry doctors for improving the quality of manual skills of the doctor in an out-patient department. Within the framework of the program, pilot trainings are held in Poltava and Lviv on the following topics: assistance in sudden coronary and sudden cardiac death, assistance with acute cere-brovascular accident, help with hypertensive crises, help with cardiac asthma and pulmonary edema. The training is carried out according to the methodological design and it consists of the theoretical and practical part. The training is provided by a certified teacher at the regional training and training center at M.V. Skli-fosovsky Poltava Regional Clinical Hospital. The optimal number of listeners is 10-12 people. On the theo-retical part the teacher represents the purpose, the plan of the lesson and in the logical sequence the mate-rial is presented. The theoretical part is equipped with a multimedia presentation. In the process, the teacher defines the basic level of knowledge and skills of listeners. In the practical part, the teacher initially deter-mines the level of possession of clinical skills of doctors, teaches work on dummies, models real, simple and accessible to perception simulation scenarios. Doctors have to solve the tasks and practice practical skills from basic resuscitation measures. At the same time, an important place is given to work in the team.On phantoms, elements of the resuscitation brigade are worked out when providing emergency care to a patient with a terminal state (cardiac arrest) using cardiac-pulmonary resuscitation techniques (CPR).At the same time, artificial ventilation of the lungs (ventilation of the lungs) with exhalation in the mouth or the nose (mask) in the area of the head of the phantom is carried out. The modeling of the air duct is then modeled. This verifies the correctness of the laryngoscope in the oropharynx, and the introduction of the laryngeal mask. Doctors will work with Ambu's bag: the first hand fix the mask of the device in the area of the nose, the mouth of the phantom, and the other - by pressing the camera, the air is poured into the roton-nose area of the phantom with a certain frequency of pressure, followed by the use (if necessary) of an oxygen cylinder of type B. This checks the correctness of each reception. Conducting each manual reception and its effective-ness is fixed and processed by a computer program. The result is displayed on the monitor in the form of vi-tal signs of the patient. In the case of effective doctor actions, the vital parameters of the "patient" on the monitor are normalized. The evaluation of the effectiveness of the manipulations is also carried out in balls. In the beginning, the trainer-instructor shows the order and correctness of carrying out emergency assis-tance measures on phantoms. In the future, monitors the implementation of manual techniques and as-sesses the actions of interns at each individual stage, emphasizing the correct implementation of the manual action. The sequence of the manual training on the "phantom-monitor" system gives confidence to doctors in the correctness and efficiency of manual skills. At the end of the practical cycle of training certified teachers of the department summarize the practical training with doctors-dentists.Practical training with the use of modern phantoms with computer processing of results helps to increase the competence of dental practitioners in providing emergency care and to ensure the use of the knowledge to improve the quality of medical care for patients

Clinical and biochemical indicators in white rats in the treatment of experimental generalized parodontitis

Мета роботи стало дослідження клінічних показників та стан вільнорадикального окислення в крові та тканинах пародонту білих щурів при лікуванні спонтанного генералізованого пародонтиту із застосуванням поліпептидів. Уведення пародонтальних поліпептидів при спонтанному пародонтиті, призводить до зменшення реакцій ВРО ліпідів в тканинах пародонту та крові. В більшій мірі цей ефект характерний для пародонтиліну в порівнянні з тималіном; Целью работы стало исследование клинических показателей и состояние свободнорадикального окисления в крови и тканях пародонта белах крыс при лечении спонтанного генерализованного пародонтита с применением полипептидов. Введение пародонтальных полипептидов при спонтанном пародонтите приводит к уменьшению реакций СРО липидов в тканях пародонта и крови. В большей мере этот эффект характерен для пародонтилина в сравнении с тималином; Summary. A number of scientists put forward and confirmed the assumption of the presence in the body of biological regulators, polypeptides, carrying out the transfer of information necessary for the functioning, development and interaction of cell populations. The problem of studying the mechanism of action and clinical application of polypeptides is key in modern medicine. The aim of the research is to examine the clinical parameters and the state of free radical oxidation in blood and periodontal tissues of white rats in the treatment of spontaneous generalized periodontitis with the use of polypeptides. Materials and methods of the research. Experiments were performed on 280 six-month-old of rats Wistar line of both sexes weighing 120-130 g. During the study, the animals were kept under vivarium conditions in individual cells, food and water were not limited. All animals were divided into the following groups: Group I – intact animals (70), Group II – animals with spontaneous periodontitis (70), Group III – animals with spontaneous periodontitis, treated with thymalin polypeptide preparation in a dose of 0.1 mg / kg i / m daily, for 10 days (70), Group ІV – animals with spontaneous paradontitis, treated with parodontylin polypeptide preparation at a dose of 1 mg / kg i / m, daily for 10 days (70). Blood for research in rats was taken against the background of hexenalum anesthesia with a syringe from the heart into a plastic syringe. Subsequently, it was mixed with sodium citrate (3.8% solution) in a ratio of 9:1 and centrifuged at 1500 rpm for 10 min. Periodontal tissues and jaws of animals were taken and examined immediately after euthanasia. For the study, the collection of periodontal tissues (gums with periosteum) was performed in the area of the upper and lower molars, since periodontitis often affects these tissues. Indicators of free radical oxidation were determined in blood and periodontal tissues. Resorption of bone tissue of the alveolar process was evaluated. Results and discussion. In the treatment of experimental spontaneous periodontitis using thymalin on the 7th day of observations, regression of symptoms of the disease in animals was observed. Hyperemia and edema, bleeding gums remitted. Whereas under the influence of thymalin there is a regression of dental symptoms by 3.8 times, under the influence of parodontylin – by 7.2 times. The condition of periodontal tissues in animals improved more significantly on the 20th day of observation, the scale assessment of dental status indicates that in animals, treated with thymalin, it is 1.1, and by parodontylin – 0.3 points per animal. In studying the processes of lipid peroxidation in periodontal tissues, their significant reduction in rats with spontaneous periodontitis after administering parodontylin has been established. We also observed an increase in the activity of antioxidant enzymes. Hence, the activity of SOD was twice as high, catalase – by 1.95 times. Reactions of lipid peroxidation had the same dynamics in the blood of animals after administering periodontal polypeptides and thymalin, as in periodontal tissues. We observed a significant decrease in the level of conjugated dienes, the concentration of the latter reaches the value of indices of intact animals. Similar results were obtained with regard to the level of TBA-active products, accumulation of MDA, spontaneous hemolysis of erythrocytes. Attention is drawn to the fact that parodontylin reduced lipid peroxygenation of blood to a greater extent than thymalin. We also observed increased activity of SOD, and, on the other hand, the concentration of ceruloplasmin decreased by 25.4%. Thus, administering periodontal polypeptides during spontaneous periodontitis leads to a decrease in the responses of lipid peroxidation in periodontal tissues and blood. To a greater extent this effect is characteristic of parodontylin in comparison with thymalin

ANALYSIS OF RESEARCH WORK OF INTERNS AT THE DEPARTMENT OF POSTGRADUATE DENTAL EDUCATION

Research is a form of learning process, which harmoniously combines training and practice. Within Medicinal Research intern initially acquires skills in research, then begins to implement the theoretical knowledge acquired in the study somehow associated with the practice, and at the end of this process participates in scientific conferences at various levels, including international. The aim was to determine the particular structure of research work of interns in the department of postgraduate education of dentists in HSEI "UMSA." Materials and methods of research. 3 collections of scientific papers of the final scientific conferences of interns, masters and clinical residents, which were held at the academy from 2014 to 2016 academic years in an amount of 127 scientific papers have been analyzed. Number of undergraduates each year was about the same 5-7 people. Results. In the overall structure of interns’ research, we singled out the following main activities: experimental, clinical laboratory, informative and sanitary education. The analysis of the structure of interns’ research works, thus the largest share of the experimental work, was conducted in 2014 and amounted to 4.4% of the total. The largest number of works that were devoted to clinical and laboratory research also were observed in 2014 and amounted to 68.8%. Least of all in 2014 was the number of sanitary and educational work, 2.2% of all work. In 2015 there was one pilot study which amounted to 2.9%. However, there was increase in the number of clinical labs and clinical cases. Number of clinical cases increased to 17.5%. Entrenched differences in health information and educational work were observed. Number of graduate work in 2014 and 2015 was at the same level and amounted to 31% of the total work. The structure of graduate work during these years was dominated by clinical and laboratory work (64% in 2014 and 69% in 2015) and the lowest number in the structure of experimental studies (7.1% in 2014 and 7.7% in 2015). In 2016 the downward trend in experimental work survived. The number of interns working with clinical cases was 20.8% and with information messages was 30.8%. The largest increase was observed in the number of sanitary and educational work (to 10.5%). Number of undergraduate studies decreased to 20%. The works of postgraduates contained 87.5% of clinical and laboratory research. Conclusion. Recent years have seen changes in the structure of interns’ research towards reducing the share of experimental research and increasing the share of research that do not require the involvement of laboratory equipment and technical resources. The increase in the number of sanitary and educational work was noted

APPLICATION OF METHODS OF SIMULATION TRAINING AT THE DEPARTMENT OF POSTGRADUATE EDUCATION OF DENTISTS

The aim is to analyze the peculiarities of emergency care to dental practitioners at the department of postgraduate education of dentistry doctors for improving the quality of manual skills of the doctor in an outpatient department. Within the framework of the program, pilot trainings are held in Poltava and Lviv on the following topics: assistance in sudden coronary and sudden cardiac death, assistance with acute cerebrovascular accident, help with hypertensive crises, help with cardiac asthma and pulmonary edema. The training is carried out according to the methodological design and it consists of the theoretical and practical part. The training is provided by a certified teacher at the regional training and training center at M.V. Sklifosovsky Poltava Regional Clinical Hospital. The optimal number of listeners is 10-12 people. On the theoretical part the teacher represents the purpose, the plan of the lesson and in the logical sequence the material is presented. The theoretical part is equipped with a multimedia presentation. In the process, the teacher defines the basic level of knowledge and skills of listeners. In the practical part, the teacher initially determines the level of possession of clinical skills of doctors, teaches work on dummies, models real, simple and accessible to perception simulation scenarios. Doctors have to solve the tasks and practice practical skills from basic resuscitation measures. At the same time, an important place is given to work in the team. On phantoms, elements of the resuscitation brigade are worked out when providing emergency care to a patient with a terminal state (cardiac arrest) using cardiac-pulmonary resuscitation techniques (CPR). At the same time, artificial ventilation of the lungs (ventilation of the lungs) with exhalation in the mouth or the nose (mask) in the area of the head of the phantom is carried out. The modeling of the air duct is then modeled. This verifies the correctness of the laryngoscope in the oropharynx, and the introduction of the laryngeal mask. Doctors will work with Ambu's bag: the first hand fix the mask of the device in the area of the nose, the mouth of the phantom, and the other - by pressing the camera, the air is poured into the roton-nose area of the phantom with a certain frequency of pressure, followed by the use (if necessary) of an oxygen cylinder of type B. This checks the correctness of each reception. Conducting each manual reception and its effectiveness is fixed and processed by a computer program. The result is displayed on the monitor in the form of vital signs of the patient. In the case of effective doctor actions, the vital parameters of the "patient" on the monitor are normalized. The evaluation of the effectiveness of the manipulations is also carried out in balls. In the beginning, the trainer-instructor shows the order and correctness of carrying out emergency assistance measures on phantoms. In the future, monitors the implementation of manual techniques and assesses the actions of interns at each individual stage, emphasizing the correct implementation of the manual action. The sequence of the manual training on the "phantom-monitor" system gives confidence to doctors in the correctness and efficiency of manual skills. At the end of the practical cycle of training certified teachers of the department summarize the practical training with doctors-dentists. Practical training with the use of modern phantoms with computer processing of results helps to increase the competence of dental practitioners in providing emergency care and to ensure the use of the knowledge to improve the quality of medical care for patients

BIOMECHANICAL STUDY OF SINGLE ROOTED TEETH RESTORED WITH DOWEL CORS

The purpose of the biomechanical study was a comparative analysis of the stress-strain state of the dowel core, dentin of the tooth root, periodontal and bone tissues of the alveolus in the restoration of the first premolars using dowel core, made of zirconium oxide. Materials and methods. Mathematical modeling was carried out using a service modeling and finite element analysis NASTRAN, designed for implementation on a personal computer in a Windows environment. The package, which is built and analyzed considers an elastic three-dimensional models of dental arches on the basis of finite-element procedures, determines the displacement of each node of the finite element with three axes, the normal and shear stresses, and equivalent stresses according to Huber-Mises, which are calculated according to the formula of mechanics of solid deformable body. Teeth with dowel core are located relative to the coordinate axes that the z axis coincides with the longitudinal axis of the tooth, the x-axis in a distal-medial direction (along the tooth row) and the y-axis in the oral-vestibular (in the perpendicular direction of the dentition). As a main evaluation criterion when comparing the stress-strain state of considered mathematical models of the system "dowel core- recovery single rooted tooth - lower jaw" should take the maximum values of equivalent stresses in the dowel core and the dentin of the root part of the tooth recoverable, arising from the action of the calculated values of functional loads , since exceeding these tension can cause destruction of the root of the tooth or core. As additional evaluation criteria appropriate to compare the maximum values of the equivalent stresses in the adjacent to the root portion of the restored tooth in the periodontium, cortical and trabecular layers of the jawbone. As a result of mathematical analysis of a model system “the root of the tooth, dowel core, crown” found that the horizontal component of the functional load and the combined effect of vertical and horizontal components of the load leads to the localization of fields of maximum values of equivalent stresses in the middle third of the pin of the dowel core from the vestibular or oral side, depending on the direction of the horizontal load. In cases where only the vertical component of the maximum load values of the equivalent stresses occur in the zone of junction of the coronal part of the dowel core to pin. The maximum values of the equivalent stresses in the restored tooth and the periodontal and dowel core arise under the combined action of the vertical component of the functional load from the horizontal, directed in the vestibular- lingual direction. The most dangerous area of the root of the tooth from the point of view of localization of maximum values of equivalent stresses is in the area of dentin adjacent to the end portion of the pin. When restoring the coronal portion of premolar using dowel core maximum values of the equivalent stresses in all structural components of the examined bone tissue does not exceed the corresponding values of ultimate strength, the presence and design of the dowel core significantly affect the values of the equivalent stresses in the dentin of the tooth root, and has almost no effect on stresses in the periodontal and bone tissues of the lower jaw; the localization of the fields of maximum values of equivalent stress on the surface of the root portion of the dentin in the tooth a healthy load corresponds to the location and the value of the equivalent stress tooth under load which restores; the most unfavourable loading is the combined effect of the vertical component of the functional load and the horizontal component, targeted in vestibular- lingual direction

Comparative characteristics of the effectiveness of direct and indirect restorations on teeth with discoloration

Проведено оцінку і порівняння якості прямих і непрямих реставрацій зубів фронтальної групи з дисколоритами. Перша група – хворі, яким проведено лікування прямими реставраціями, виконаними світлополімерним реставраційним матеріалом «Estet X HD» («Dentsply») (50 хворих, 125 реставрацій); друга група – хворі, яким проведено лікування з використанням непрямих керамічних реставрацій, виготовлених методом пресування кераміки за високої температури («IPS Emax»). Останню групу було розділено на дві підгрупи залежно від методу лікування: 2А – пацієнти, яким непрямі реставрації фіксували за загальноприйнятими методиками на композит подвійного твердіння «Calibra» виробництва «Dentsply» (20 хворих, 70 вінірів), і 2В – пацієнти, яким вініри було зафіксовано на розігрітий композит «Gradia Direct» виробництва «GC» (20 пацієнтів, 55 вінірів).Порівняльну оцінку проводили через рік після закінчення реставрації. Визначали показники стану цих реставрацій за допомогою модифікованих критеріїв USPHS (United States Public Health Service; Ryge, G., 1980, 1981) для фронтальної групи зубів. Дослідження показали, що найвищий рівень якості спостерігається в групі, де були виготовлені непрямі реставрації (вініри), зафіксовані на розігрітий композит «Gradia Direct» виробництва «GC». Отримані результати підтверджені статистичним аналізом.The rapid development of dental industry and constant improvement of technologies in production of ba-sic dental materials contribute to the increase of the quality of rendering dental care with the obligatory con-sideration not only of functional but also aesthetic parameters during a patient's rehabilitation. However, there is still no precise indication for the use of metal-free structures for the qualitative and durable aesthetic restoration of the frontal group of teeth, white-pink aesthetics and prosthetic rehabilitation, taking into ac-count changes in the parameter of biological width of the tooth and aesthetic criteria.The aim of the research is to improve the effectiveness of treatment of frontal group teeth with discolora-tion using direct and indirect restorations by evaluating and comparing the quality of restorations.Research materials and methods.For clinical substantiation and comparison of direct and indirect ce-ramic restorations with classical fixation and the proposed method of fixation on the heated composite, 90 patients with discoloration and defects of the crown of the front teeth, aged 18 to 65 years, were examined and treated. A comparative evaluation was carried out one year after the restoration was completed.The distribution of patients into clinical groups was as follows: the first group – patients who were treated by direct restorations, performed with light- polymer restorative material Estet X HD (Dentsply) (50 patients, 125 restorations); the second group embraced patients, treated with indirect ceramic restorations manufac-tured by the method of pressing high temperature ceramics (IPS Emax). The latter group was in turn divided into two subgroups, depending on the treatment method: 2A – patients with indirect fixation by conventional methods on the Dentsply dual-cure composite of Calibra production (20 patients, 70 veneers) and 2B - pa-tients with fixation treated on the heated composite Gradia Direct by GC production (20 patients, 55 ve-neers).In order to evaluate the quality of prosthetics in patients with direct and indirect ceramic restorations (ve-neers) it has been determined the status of these restorations using the modified USPHS (United States Public Health Service; Ryge, G., 1980, 1981) criteria for the frontal teeth group. The obtained results were processed by the method of variational statistics using Student's test.Research results. During the clinical evaluation of direct restorations using the modified USPHS criteria for the frontal teeth group, the following complications were identified: tooth sensitivity was present in 5.6% of teeth, fractures, cracks, chips – in 20 restorations (16%); discrepancy between the color of restoration and the color of natural teeth – in 30 restorations (24%); the presence of defects in the texture of the surface – 30 teeth (24%). Impaired marginal adaptation was in 32 restorations, which amounted to 25.6%; loss of restora-tion gloss – in 66,4%, the presence of secondary caries – in 17 teeth (13,6%); deficiency of occlusal contact –in 13 restorations (10.4%), of approximate contact – in 17 restorations (3.6%). A detailed analysis of the condition of indirect restorations and clinical complications in the second group showed that the most com-mon defects are impairment of marginal adaptation – 16 veneers (12.8%), impairment of the integrity of ve-neers due to fractures, cracks, chips – 6 (4.8%), inconsistency of color – 13 veneers (10.4%), the presence of surface texture defects – 0, secondary caries – 3 teeth (2.4%), the position of fixing cement – 4 veneers (3.2%). Impaired occlusal contact was observed in 1 tooth (8.8%). No changes in approximate contacts were detected. The total number of complications was 17%, which indicates the need to find the optimization ap-proaches to treatment with these structures. Comparison of the status of indirect restorations, depending on the method of fixation by subgroups showed that the impaired integrity of veneers due to fractures, cracks, chips in subgroup 2A was detected in 4 teeth (5.7%), and in the subgroup 2B – in 2 teeth (3.6%). Color change in group 2A was observed in 12 teeth (17.1%), in group 2B – in 3 teeth (5.5%). Disorders of marginal adaptation in group 2A were observed in 12 teeth (17.1%), in group 2B – in 4 teeth (6.6%). Secondary caries was observed on 2 teeth (2.9%) in group 2A and in one patient in group 2B (1.8%). According to the criteria for evaluating the state of indirect ceramic restorations and recommended follow-up professional actions, the following estimates were estab-lished: 28% of restorations in the first group, 55.7% of restorations in group 2A, 85.5% of restorations in group 2B received an “excellent” rating; 33.6% of restorations in the first group, 25.7% in group 2A, 5.5% ingroup 2B received a “good” rating; a “satisfactory” rating was obtained by 11.2% of restorations in the first group, 11.7% in group 2A, 5.4% in group 2B. In the first group, 27.2% of restorations needed immediate re-placement, 11.4% – in the second and 3.6% – in the third group.The total score for the first group was 3.87±0.07, for 2A – 4.26±0.12, p.05, for group 2B – 4.73±0,1,p1˂p,05, p2˂0,05.Conclusion.Thus, our studies of direct and indirect restorations after one year of use showed that the highest level of quality was observed in the group where indirect restorations (veneers) were manufactured, which were fixed on the heated Gradia Direct composite by GC production. The obtained results are con-firmed by the statistical analysis.To evaluate the quality and duration of using direct and indirect structures with different types of fixation, it is advisable to carry out a long-term monitoring for up to 10 years

Dynamics of cytokines in oral fluid of completely edentulous patients after prosthetic rehabilitation with implants

Отримані нами дані свідчать про недостатність імунорегуляторних механізмів у тканинах ротової порожнини на етапах адаптації до ортопедичних конструкцій. Виявлено, що у хворих до початку лікування і особливо через 7 днів після протезування спостерігаються максимальні показники рівня концентрації прозапальних і протизапальних цитокінів у ротовій рідині на відміну від практично здорових людей. Ці дані підтверджують, що активація локального синтезу прозапальних цитокінів у ротовій рідині є важливим патогенетичним фактором, який визначає формування і підтримання активної запальної реакції в ясенній тканині та ініціює резорбтивний процес у альвеолярній кістці. ; Полученные нами данные свидетельствуют о недостаточности иммунорегуляторных механизмов в тканях ротовой полости на этапах адаптации к ортопедическим конструкциям. Выявлено, что у больных до начала лечения и особенно через 7 дней после протезирования наблюдаются максимальные показатели уровня концентрации провоспалительных и противовоспалительных цитокинов в ротовой жидкости в отличие от практически здоровых людей. Эти данные подтверждают, что активация локального синтеза провоспалительных цитокинов в ротовой жидкости является важным патогенетическим фактором, определяющим формирование и поддержание активной воспалительной реакции в десневой ткани и инициирует резорбтивный процесс в альвеолярной кости.; One of the most difficult tasks in modern prosthetic dentistry is total rehabilitation of patients with dentition defects. The number of patients with removable dentures is growing due to the widespread dental diseases and progressive aging of the world population especially in industrialized countries, where life is increasing.After a complete loss of teeth, dentition undergoes involute processes, resulting in significant functional and morphological changes. In practice of rehabilitation of toothless jaws certain difficulty of fixation of dentures on the lower jaw appears. As a result, patients rest unsatisfied with the received dentures.The introduction of dental implantation in prosthodontics practice offers the prospect of successful treatment of patients with the manufacture of fixed and conditionally removable dentures.Generally accepted that the combination of modified immunological background before dental implantation and operational stress create conditions for the appearance of secondary immunological suppression, which can be the cause of serious inflammatory and destructive processes in the long-termed period.Basing on the current states of Clinical Immunology, it can be assumed that the cytokine profile of the blood is essential for the overall characteristics immunological pathogenesis of the most chronic diseases, including dental ones. Particularly, current studies have prowed the importance of cytokines and intercellular interactions in the pathogenesis of chronic generalized periodontitis. Proved that elevated level of pro-inflammatory cytokines IL-1β, TNF is seen as a key component of any resorptive and inflammation process in the soft and bone structures. The objective is to study the concentration of proinflammatory cytokines (FNPα, IL-1β) and anti-inflammatory cytokines (IL-10) in the oral fluid of completely edentulous patients after rehabilitation on implants in different periods of observation.Materials and methods: Under our supervision there were 23 completely edentulous patients requiring rehabilitation on implants after one-step mandible protocol. The age of patients is between 67 and 78 years, including 11 males (46.7%) and 12 - females (53.3%).The control group consisted of almost healthy persons - 10 people without defects of dentition and periodontal diseases, aged 45-55 years.The patients of both groups (the basic and the control one) were examined comprehensively using the following methods: clinical, paraclinical, immunological and radiological.Dental status was assessed after finding out of complaints, medical history, review of maxillofacial area with the following objective assessment of teeth and dentition, temporomandibular joint.The research of patients of the control group consisted of determining the status of implants and evaluation of marginal gum mucosa, periimplantal area, the degree of compliance and mobility of soft tissues. Methods of the research of periimplantal area, bone structures, alveolar processes became panoramic radiography and computed tomography.Content in oral fluid FNPα, IL-1 β and IL-10 was evaluated by the method of ELISA, using Pro Con (NPO "Protein circuit" G. Saint - Petersburg). Results: Increased level of TNF, IL-1β and IL-10 before prosthetic rehabilitation relates to dates of prosthetic rehabilitation of the patients of 2 groups. Thought prosthetic rehabilitations were performed on average of 2 weeks after implantation surgery. The high level of cytokines 7 days after the imposition of the prosthesis relates to the restruction of bone tissue and oral mucosa because of the development of adaptation to new conditions of mastication associated with prosthetic treatment.Received data indicates the lack of immunological regulation mechanisms in the tissues of the oral cavity at the stages of adaptation to prosthetic constructions. It was found that patients before treatment and especially 7 days after prosthesis have maximum values of concentrations of proinflammatory and anti-inflammatory cytokines in oral fluid on the contrary to healthy people. This data confirms that the activation of local synthesis of proinflammatory cytokines in oral fluid is an important pathogenic factor that determines the formation and maintenance of active inflammatory reaction in the gingival tissue and initiates resorptive process in the alveolar bone

Methods of fitting dentures in elderly patients with complete lower jaw adentia using implants based on mathematical modeling

Рассмотрены вопросы лечения больных старческого возраста с полной адентией с использованием имплантатов. На основе математического моделирования дополнен алгоритм протезирования. Проведен анализ напряженно-деформированного состояния костной ткани нижней челюсти с опорой несъемного протеза на 4 винтовые дентальные имплантаты с учетом податливости слизистой оболочки тканей протезного ложа и обоснованием использования амортизирующих абатментов. Рассмотрены результаты взаимодействия съемных протезов с тканями протезного ложа, предложены рекомендации по применению. Розглянуті питання лікування хворих похилого віку з повною адентією за допомогою імплантатів. На основі математичного моделювання доповнений алгоритм протезування пацієнтів. Проаналізований напружено-деформований стан кісткової тканини нижньої щелепи з опорою незнімного протеза на 4 гвинтові дентальні імплантати з урахуванням податливості слизової оболонки тканин протезного ложа й обґрунтуванням використання амортизаційних абатментів. Наведені результати взаємодії знімних протезів із тканинами протезного ложа, запропоновано рекомендації щодо застосування. The complete absence of teeth often leads to a decrease not only the vital functions (chewing, speech function), but also significantly affects the socio - psychological scope of the patient. Advancing age determines the main feature and the complexity of orthopedic dental treatment in this group of patients due to lower adaptive capacities of the organism appearing in these age-related changes and disorders. Despite the achievements in medical rehabilitation of patients with a complete lack of teeth, it is not settled the question of Prosthetic Dentistry. The urgency of this problem also undeniable that, according to the World Health Organization, about 26% of patients do not enjoy full removable rotezamy different reasons. This is especially true for patients with totally edentulous mandibular prosthesis in cases of difficulty complete dentures due to lack of adequate fixation and its stabilization. One of the most effective methods of improving fixation and stability of the prosthesis is the installation of implants. However, in elderly patients with the use of implants anatomical and physiological features of tissues of the oral cavity and the presence of somatic changes in the body are decreased. The factors that determine the rationality of functional load transmission is primarily related stress that occurs in the bone around dental implants The purpose of this biomechanical study is to analyze the stress-strain state of bone tissue of the lower jaw with the support of non-removable prosthesis 4 screw dental implants based on compliance mucosa tissue prosthetic bed and justification for the use of shock absorbing abutments. Materials and methods. Mathematical modeling was performed using the well-known package modeling and finite-element analysis NASTRAN, designed for implementation in the Windows environment on a PC. Analysis of mathematical models based on finite-element procedure involves displacements of each node finite element in three coordinate axes, normal and shear stresses and the equivalent voltage Huber-Myzesu. The maximum values of equivalent stresses in cortical and spongy tissues of the jaw bone arising in areas of immediate contiguity to the mesial implant located on the oral side and correspond to the location of the food bolus central incisors. Since moving distally functional load on the alignment load placed mesial implant, and therefore the value of the equivalent stresses in cortical and spongy tissues of the jaw bone is gradually reduced, while the load is perceived extreme distally positioned implant and the value of the equivalent stresses in cortical and spongy tissues of the jaw bone adjacent to the last implant gradually increase and reach maximum values under 43.7 MPa and 9.77 MPa in the localization of functional loading on the second premolar. Further distal movement of the load along functional dentition reduces the value of the equivalent stresses in cortical and spongy tissues of the jaw bone adjacent to both average and extreme implant through the transfer of most of the functional load on the soft gum tissue. The maximum values of equivalent stresses in cortical and cancellous layers adjacent to the extreme central jawbone implant by varying the compliance of supporting gum tissue under saddle complete denture vary considerably smaller than in the case of hard abatmentov. Thus the absolute values of equivalent stresses in cortical and cancellous layers jawbone case with shock absorbing abutment, with varying degrees of support compliances gum tissue below the corresponding limits of strength. With a large supporting gum tissue pliability maximum values of equivalent stresses in cortical and cancellous layers adjacent to the extreme central implant jawbone using cushioning abutments half the size of similar values that arise when the prosthesis is based on four implants with rigid abutments

Dynamics of the level of pro- and anti-inflammatory cytokines in the crevicular fluid after direct and indirect restoration

Мета дослідження – вивчити рівень прозапальних і протизапальних цитокінів ясенної рідини після прямих і непрямих реставрацій за класичної фіксації й запропонованою методикою фіксації на розігрі-тий композит у терміни через добу і 12 місяців.Відсутність достовірних розбіжностей рівня прозапальних цитокінів через 12 місяців у групах не-прямих реставрацій свідчить про відсутність запальних явищ у маргінальному пародонті й доводить можливість застосування методики фіксації вінірів на розігрітий композит.The restoration of discolored teeth is conducted by direct and indirect restoration techniques. Impairment of marginal periodontium is possible during the stages of both direct and indirect restoration in gum retrac-tion, cofferdam application, grinding and polishing for direct restoration, removal of fixation cement residues near indirect restorations and finishing preparation of the connection boundary with the tooth. Furthermore, the restorations affect the periodontal tissues in the long term due to the formation of biofilm and dental plaque in the precervical area of the abutment teeth.One of the earliest ways to detect the inflammatory process in the marginal periodontium is to determine the level of pro-inflammatory and anti-inflammatory cytokines in the crevicular fluid.The aim of the research was to study the level of pro-inflammatory and anti-inflammatory cytokines in the crevicular fluid after direct and indirect restorations, which were performed by classical fixation and via the proposed method of fixation on the heated composite in 24 hours and 12 months. Materials and methods of the research. For clinical substantiation and comparison of direct and indirect ceramic restorations with classical fixation and the proposed method of fixation on the heated composite, we examined and collected the material in 24 hours and 12 months after treatment in 84 patients, aged 18-65, with dental discoloration and defects of the crown of the frontal teeth. All patients were divided into 7 clinical groups with 12 patients in each. Group 1 was a control, which in-cluded patients with intact dentition, without discoloration and defects of the hard tissues of the teeth of the frontal area; group 2 embraced patients who were treated by direct restoration (a day after treatment); group 3 comprised patients, treated with indirect ceramic restorations, which were fixed by conventional methods on a double-cured composite (one day after treatment); group 4 included patients, whose veneers were fixed to the heated composite (one day after treatment); group 5 embraced patients 12 months after treatment with direct restorations; group 6 included patients, treated with indirect ceramic restorations, which were fixed by conventional methods on a double-cured composite (12 months after treatment); group 7 comprised patients, whose veneers were fixed to the heated composite (12 months after treatment). The material for the study was the crevicular fluid. We determined the tumor necrosis factor α (TNF-α), interleukin 6 (IL-6) and inter-leukin 10 (IL-10).The study showed that in all three study groups in 24 hours, the significant predominance of the IL-6 con-tent as compared to the control group was observed. The presence of IL-6 in the crevicular fluid indicates in-flammation in the periodontium. The level of another pro-inflammatory cytokine, TNF-α, was higher in the groups with direct and indirect restorations, which were fixed by conventional methods to the composite of double hardening, which relates to adverse factors, since this mediator activates the processes of osteore-sorption and enhances inflammatory reactions in the periodontal tissues. When comparing the concentra-tions of pro-inflammatory cytokines TNF-α and IL-6 in the crevicular fluid between the direct and indirect res-toration group, we detected their significantly lower level in the groups where indirect restorations were per-formed, fixed on the composite cement and on the heated composite. The concentration of IL-10 in the groups with direct and indirect restoration, fixed on the heated composite, was the same, and in the group with indirect restoration, fixed on the composite cement, it increased significantly. After 12 months, the level of pro-inflammatory cytokines TNF-α and IL-6 was significantly higher in the direct restoration group as com-pared to the indirect restoration groups and with fixation on the composite cement and on the heated com-posite. The absence of significant differences in pro-inflammatory cytokines in this period for the groups of indirect restorations indicates the absence of inflammatory phenomena in the marginal periodontium and proves the possibility of applying the method of veneer fixation on the heated composite

Biomechanical study of single rooted teeth restored with dowel cors

За результатами математичного аналізу моделі системи «корінь зуба, куксова вкладка, коронка» встановлено, що поява горизонтальної складової функціонального навантаження, а також спільна дія вертикальної і горизонтальної складових навантаження викликають локалізацію полів максимальних значень еквівалентних напружень у середній третині штифтової частини вкладки з вестибулярного або орального боків залежно від напрямку горизонтального навантаження. У разі наявності тільки вертикальної складової навантаження максимальні значення еквівалентних напружень виникають у зоні примикання коронкової частини вкладки до штифтової. Максимальні значення еквівалентних напружень у відновлюваному зубі та в його періодонті, а також у штифтовій вкладці виникають за спільної дії вертикальної складової функціонального навантаження з горизонтальною, спрямованої у вестибулярно-язиковому напрямку.Найнебезпечніша зона кореневої частини зуба з погляду локалізації максимальних значень еквівалентних напружень – це ділянка дентину, що примикає до торцевої частини штифта вкладки.;В результате проведенного математического анализа моделей системы «корень зуба, культевая вкладка, коронка» установлено, что возникновение горизонтальной составляющей функциональной нагрузки, а также совместное действие вертикальной и горизонтальной составляющих нагрузки вызывают локализацию полей максимальных значений эквивалентных напряжений в средней трети штифтовой части вкладки с вестибулярной или оральной стороны в зависимости от направления горизонтальной нагрузки. В случае наличия только вертикальной составляющей нагрузки максимальные значения эквивалентных напряжений возникают в зоне примыкания коронковой части вкладки к штифтовой. Максимальные значения эквивалентных напряжений в реставрируемом зубе и его периодонте, а также штифтовой вкладке возникают при совместном воздействии вертикальной составляющей функциональной нагрузки с горизонтальной, направленной в вестибулярно-язычном направлении. ; The purpose of the biomechanical study was a comparative analysis of the stress-strain state of the dowel core, dentin of the tooth root, periodontal and bone tissues of the alveolus in the restoration of the first premolars using dowel core, made of zirconium oxide.Materials and methods. Mathematical modeling was carried out using a service modeling and finite element analysis NASTRAN, designed for implementation on a personal computer in a Windows environment. The package, which is built and analyzed considers an elastic three-dimensional models of dental arches on the basis of finite-element procedures, determines the displacement of each node of the finite element with three axes, the normal and shear stresses, and equivalent stresses according to Huber-Mises, which are calculated according to the formula of mechanics of solid deformable body.Teeth with dowel core are located relative to the coordinate axes that the z axis coincides with the longitudinal axis of the tooth, the x-axis in a distal-medial direction (along the tooth row) and the y-axis in the oral-vestibular (in the perpendicular direction of the dentition).As a main evaluation criterion when comparing the stress-strain state of considered mathematical models of the system "dowel core- recovery single rooted tooth - lower jaw" should take the maximum values of equivalent stresses in the dowel core and the dentin of the root part of the tooth recoverable, arising from the action of the calculated values of functional loads , since exceeding these tension can cause destruction of the root of the tooth or core. As additional evaluation criteria appropriate to compare the maximum values of the equivalent stresses in the adjacent to the root portion of the restored tooth in the periodontium, cortical and trabecular layers of the jawbone. As a result of mathematical analysis of a model system “the root of the tooth, dowel core, crown” found that the horizontal component of the functional load and the combined effect of vertical and horizontal components of the load leads to the localization of fields of maximum values of equivalent stresses in the middle third of the pin of the dowel core from the vestibular or oral side, depending on the direction of the horizontal load. In cases where only the vertical component of the maximum load values of the equivalent stresses occur in the zone of junction of the coronal part of the dowel core to pin.The maximum values of the equivalent stresses in the restored tooth and the periodontal and dowel core arise under the combined action of the vertical component of the functional load from the horizontal, directed in the vestibular- lingual direction.The most dangerous area of the root of the tooth from the point of view of localization of maximum values of equivalent stresses is in the area of dentin adjacent to the end portion of the pin.When restoring the coronal portion of premolar using dowel core maximum values of the equivalent stresses in all structural components of the examined bone tissue does not exceed the corresponding values of ultimate strength, the presence and design of the dowel core significantly affect the values of the equivalent stresses in the dentin of the tooth root, and has almost no effect on stresses in the periodontal and bone tissues of the lower jaw; the localization of the fields of maximum values of equivalent stress on the surface of the root portion of the dentin in the tooth a healthy load corresponds to the location and the value of the equivalent stress tooth under load which restores; the most unfavourable loading is the combined effect of the vertical component of the functional load and the horizontal component, targeted in vestibular- lingual direction