INNOVATIVE TECHNOLOGIES IN THE TREATMENT OF PATIENTS WITH TEMPOROMANDIBULAR JOINT DYSFUNCTION

The article presents the results of the treatment of patients suffering from temporomandibular joint dysfunction with the use of the newly developed method of puncture vacuum-darsonvalization. Comprehensive treatment received 66 patients of 2 clinical groups. Objective evaluation of clinical data, as well as the dynamics of the recovery of the TMJ function were made based on the analysis of survey data, clinical examination and study of objective research methods developed by us with the inclusion of prognostic signs. The aim of the study was to improve the results of treatment of patients with TMJ disorder by analyzing prognostic markers and use of individual dental splints with puncture using vacuum-darsonvalization. The results of applied treatments of TMJ disfunctions using developed method of puncture vacuum-darsonvalization showed to be the most effective, allowing to obtain 97.1% of good results in long-term period

ЛЕЧЕНИЕ ПАЦИЕНТОВ С ПОЛНОЙ АДЕНТИЕЙ НИЖНЕЙ ЧЕЛЮСТИ СЪЕМНЫМИ ПЛАСТИНОЧНЫМИ ПРОТЕЗАМИ С ОПОРОЙ НА ДЕНТАЛЬНЫЕ ИМПЛАНТАТЫ

A method of treating fully edentulous mandible with removable designs of dentures relying on dental implants is described. Data from the literature over the past 10 years is studied. After learning deficiencies a new method for fixing the total denture mandible implant is proposed. This method will increase the effectiveness of treatment fully edentulous mandible.Описывается способ лечения полной адентии нижней челюсти съемными конструкциями зубных протезов с опорой на дентальные имплантаты. Изучены литературные данные за последние 10 лет. После изучения недостатков был предложен новый метод фиксации полного съемного протеза нижней челюсти с опорой на имплантаты. Применение этого метода повысит эффективность лечения полной адентии нижней челюсти

Germline mutations in patients with oral mucosal leukoplakia and squamous cell carcinoma: a prospective observational study

Background. The number of studies devoted to the molecular genetics of oral mucosal leukoplakia and squamous cell carcinoma is small, while the obtained results are usually preliminary in nature. We can assume the existence of region-specific pathogenic genetic variants involved in the development of oral mucosal leukoplakia and squamous cell carcinoma. With the knowledge of such variants, it would become possible to develop PCR (polymerase chain reaction) and NGS (next-generation sequencing) test systems for the detection of clinically significant germline mutations.Objectives — to identify pathogenic germline genetic variants in patients with oral mucosal leukoplakia accompanied by grade 1 epithelial dysplasia, as well as oral mucosal squamous cell carcinoma, using new-generation sequencing.Methods. Study design: prospective, observational, cross-sectional, without a control group. The sample included patients (48 persons) of either sex (18 years of age or older) with the following proven and morphologically confirmed diagnoses: oral mucosal leukoplakia accompanied by grade 1 squamous intraepithelial neoplasia of epithelium (24 people) and oral mucosal squamous cell carcinoma (24 people), who sought medical care at the Vitebsk Regional Clinical Dental Center and Vitebsk Regional Clinical Oncological Center in 2019–2020. The identified pathogenic and presumably pathogenic genetic variants involved in the development of these diseases were quantitatively assessed. The study was conducted at the Shareable Core Facilities GENOME of the Institute of Genetics and Cytology of the National Academy of Sciences of Belarus. In order to isolate deoxyribonucleic acid (DNA) from blood samples, a QIAamp DNA FFPE Tissue Kit (Qiagen, Germany) was used. The preparation of DNA libraries and sequencing were carried out by means of an Illumina NextSeq 550 sequencing system (Illumina, Inc., USA) using an Illumina Nextera DNA Exome kit (USA). Bioinformatic analysis was conducted using Illumina BaseSpace specialized software (USA) and Galaxy Project (Galaxy Community, an international non-profit project) in accordance with current guidelines. The obtained data were statistically processed employing specialized software packages Statistica 12 (StatSoft, Inc., USA) and MedCalc 18.9.1 (MedCalc Software, Ltd, Belgium).Results. Next-generation whole-exome sequencing of deoxyribonucleic acid samples isolated from the blood of patients with oral mucosal leukoplakia and squamous cell carcinoma has been conducted in the Republic of Belarus for the first time. The total number of unique germline genetic variants in the exome of both groups of patients was shown to be very high, yet most of them were not pathogenic. In the examined patients, the majority of germline mutations were found to be localized only in 19 exome genes: MAP2K3, DNAH5, HSPG2, OBSCN, SYNE1, HLA-DRB1, HLA-DQA1, HLA-DQB1, HLA-A, HLA-B, PKD1L2, TTN, AHNAK2, PDE4DIP, MUC3A, MUC4, MUC12, MUC16, and MUC17. In both clinical groups, the greatest number of genetic variants (> 40% of the total number) was detected in MUC3A, MUC4, MUC12, and MUC16, responsible for the synthesis of the glycoprotein mucin family.Conclusion. Oral mucosal leukoplakia and squamous cell carcinoma can arise from the pathogenic variants of MUC3A, MUC4, MUC12, and MUC16

Clinical Significance of Pathogenicity of Somatic Mutations in Oral Leukoplakia: a Prospective Observational Study

Background. The vast majority of malignant neoplasms of the oral mucosa refer to squamous cell carcinomas. The development of squamous cell carcinoma of the oral mucosa is often promoted by previous potentially malignant diseases, with oral leukoplakia dominating among them.Objective. To determine the clinical significance of the pathogenicity of somatic mutations in oral mucosal leukoplakia.Methods. The study material included 24 samples of abnormal epithelium of the oral mucosa from leukoplakia patients. QIAamp DNA FFPE Tissue Kit (Qiagen, Germany) was used for deoxyribonucleic acid (DNA) extraction from the samples. DNA sequencing was performed using IlluminaNextSeq 550 sequencer and TruSight™ Oncology 500 DNA Kit For Use with NextSeq (Illumina, USA). All DNA extractions from biological samples, preparation and sequencing of DNA libraries were performed step-by-step in strict accordance with the guidelines provided with the respective reagent kits. Bioinformatics analysis was carried out using specific software Illumina Base Space (Illumina, USA) and Galaxy Project (The Galaxy Community, a non-profit international project) according to current guidelines. The desired power of the study accounted for 90%. Two Proportions Z test was performed by means of The Sample Size Calculation of Statistica 12 (StatSoft, Inc.) with the set option “one-tailed hypothesis”, because it was initially assumed that pathogenic (oncogenic) genetic variants occur in the tissue of oral leukoplakia much more frequently than in the human reference genome used for sequence alignment.Results. The pathogenic somatic mutations in the TP53, KRAS, APC, NRAs and BRAF genes, identified in this study, alone or in combination, are highly likely (hazard ratio 3000-11000) to be associated with the development of oral mucosal leukoplakia and low-grade epithelial dysplasia. The multiplicity of pathogenic and likely pathogenic genetic variants associated with epithelial dysplasia, as well as the fact that a number of variants do not occur in all patients, suggests that the same histotype of oral mucosal dysplasia may develop under the influence of different mutations.Conclusion. The pathogenic and likely pathogenic variants of the TP53, KRAS, APC, NRAS and BRAF genes, identified in this study, alone or in combination, are highly likely (hazard ratio 3000–11000) to be associated with the development of leukoplakia and low-grade epithelial dysplasia

Алгоритм анализа паттерна движения мышечно-суставного комплекса височнонижнечелюстного сустава на основе обработки многоканальных электромиограмм

Musculoskeletal system disorders is one of the priority directions in dentistry. They can manifest as Kosten's syndrome, snapping jaw, painful dysfunction syndrome, increased tooth abrasion, splits, breaks, pain and spasms in muscles, etc. The study set the following objectives: to develop an algorithm for analyzing the movement pattern of the muscular-articular system by developing an algorithm for recording, analyzing, filtering and processing multichannel electromyograms of the maxillofacial muscles. Analysis of the proposed algorithm for processing multichannel electromyograms showed that 7.2 % of multichannel electromyograms could not be analyzed due to patients' violations of the movement algorithm; 8.7 % of electromyogram checkpoint values were corrected. The group without dysfunctions of the temporomandibular joint is characterized by the prevalence of the relaxation coefficient of the left temporal muscle over the coefficient of the right muscle. The dysfunctioned group has the opposite result. The value of the compression ratio of the temporal muscles exceeding 2.5 is typical for the group with dysfunctions of the temporomandibular joint. The studied groups differ as much as possible when analyzing the relaxation coefficients of the temporal muscles. When analyzing this coefficient, it was possible to truly determine the presence or absence of violations in 50 %, falsely – in 16 % of cases. The coefficient of relaxation of the masticatory muscles made it possible to obtain a true state of 24 %, a false one – in 8 %. We concluded that the compression ratio is less suitable for separating patients with and without dysfunction of the temporomandibular joint.Заболевания мышечно-суставного комплекса являются одним из ведущих направлений в обеспечении стоматологического здоровья. Нарушения мышечно-суставного комплекса могут проявляться в виде синдрома Костена, щелкающей челюсти, синдромом болевой дисфункции, повышенной стираемости зубов, сколов, трещин, мышечных спазмов, болями или чувством дискомфорта в мышцах. В исследовании были поставлены следующие цели: разработать алгоритм анализа паттерна движения мышечного-суставного комплекса путем разработки алгоритма регистрации, анализа, фильтрации и обработки многоканальных электромиограмм мышц челюстно-лицевой области. Анализ предложенного алгоритма обработки многоканальных электромиограмм показал, что 7,2 % многоканальных электромиограмм не удалось проанализировать из-за нарушений пациентами алгоритма движения. Среди проанализированных электромиограмм пришлось откорректировать 8,7 % значений контрольных точек. Анализ полученных данных показал, что для группы без нарушений функций височно-нижнечелюстного сустава характерно преобладание коэффициента расслабления левой височной мышцы над коэффициентом правой мышцы. Для группы с нарушениями характерен противоположный результат. Полученные данные также свидетельствуют, что значение коэффициента сжатия больше 2,5 для височных мышц характерно для группы с нарушениями функций мышечносуставного комплекса височно-нижнечелюстного сустава. Максимальное разделение исследуемых групп наблюдается при анализе коэффициентов расслабления височных мышц. При анализе данного коэффициента удалось истинно определить наличие или отсутствие нарушений функций височнонижнечелюстного сустава в 50 % случаев, ложно – в 16 %. Коэффициент расслабления жевательных мышц позволил получить истинное состояние височно-нижнечелюстного сустава в 24 % случаев, ложное состояние – в 8 %. Получен вывод, что коэффициент сжатия менее пригоден для разделения пациентов с нарушениями и без нарушений функций мышечно-суставного комплекса височнонижнечелюстного сустава

Анализ функционального состояния мышц челюстно-лицевой области у стоматологических пациентов с признаками бруксизма в сочетании с синдромом обструктивного апноэ во сне

Using the electromyography data, the functional state of the maxillofacial region muscles of dental patients with bruxism signs and obstructive sleep apnea syndrome was defined. After dental treatment, 122 patients aged 25–47 with bruxism signs and obstructive sleep apnea syndrome and without it were examined. The disease duration was about 5 years. All patients were divided into two groups. The first group consisted of 41 patients, whose bruxism signs were not combined with the obstructive sleep apnea syndrome. The second group included 81 patients with the bruxism signs and the obstructive sleep apnea syndrome. When performing surface electromyography of the maxillofacial region muscles (temporal, chewing, medial digastric) of the both-group patients at rest without load the differences in the bioelectric activity indicators were not observed. The indicator difference between the comparison groups appeared when conducting functional load tests that were expressed through the amplitude difference during tooth compression under the functional activity of the temporal and digastric muscles. Such data illustrate that the patients of the first group have bigger functional compensation than the patients of the second group. There also occurs cross compensation of temporal and digastric muscles. It is expressed symmetrically.На основании данных электромиографии у стоматологических пациентов с признаками бруксизма, страдающих синдромом обструктивного апноэ во сне, определяли функциональное состояние мышц челюстно-лицевой области. В исследовании приняли участие 122 пациента после стоматологического лечения в возрасте 25–47 лет с признаками бруксизма в сочетании с синдромом обструктивного апноэ во сне и без него. Давность заболевания составляла до 5 лет. Все пациенты были разделены на две группы. Первая группа составила 41 человек и включала пациентов, у которых признаки бруксизма не сочетались с синдромом обструктивного апноэ во сне. Вторая группа включала 81 человека, у которых наблюдали признаки бруксизма и синдром обструктивного апноэ во сне. При проведении поверхностной электромиографии мышц челюстно-лицевой области (височных, жевательных, медиальных двубрюшных) у пациентов обеих групп в покое без нагрузки отличий показателей биоэлектрической активности не наблюдалось. Разница показателей между группами сравнения появлялась при проведении проб с функциональной нагрузкой, которые выражались разностью амплитуд во время сжатия зубов у височной и двубрюшной мышц. Такие данные свидетельствуют о том, что пациенты первой группы имеют функциональную компенсацию больше, чем пациенты второй группы, а также происходит перекрестная компенсация функциональной активности височной и двубрюшной мышц, которая выражена симметрично

Laser-optical diagnostics preclinical stage of periodontal diseases

The device for laser-optical diagnostics (LODdsf) in dentistry. The use LODdsf for the functional estimation of periodontal diseases is proved. Sensitivity and high information LODdsf provided an opportunity to evaluate differentiated initial preclinical stage of the inflammatory process in all topographic zones of the gums, which determined the timely assignment of corrective therapy

TREATMENT OF PATIENTS WITH EDENTULOUS LOWER JAW REMOVABLE LAMINAR DENTURES RELYING ON DENTAL IMPLANTS

A method of treating fully edentulous mandible with removable designs of dentures relying on dental implants is described. Data from the literature over the past 10 years is studied. After learning deficiencies a new method for fixing the total denture mandible implant is proposed. This method will increase the effectiveness of treatment fully edentulous mandible

THE STUDY OF LOW-INTENSITY PULSED ULTRASOUND INFLUENCE ON WETTABILITY OF TITANIUM DENTAL IMPLANTS’ SURFACE IN EXPERIMENTAL MODEL

The results of experimental studies, the purpose of which was to study the effect of low-intensity pulsed ultrasound on the wettability of the surface of titanium dental implants are described. We studied 64 titanium dental implants. The control group consisted of 32 dental implants without ultra-sonication. The experimental group consisted of 32 dental implants, which were exposed to low-intensity pulsed ultrasound. Studies using low-intensity pulsed ultrasound showed that the wettability of the surface of all the experimental samples (32 dental implant) was 100 %, and the wettability of control samples (32 dental implant) was not observed. Thus the previously unknown property of low intensity pulsed ultrasound enabling the wetting of entire surface of the dental implant was discovered

ASPECTS OF DIAGNOSTIC ACTIVITIES IN PATIENTS WITH DYSFUNCTION OF TEMPOROMANDIBULAR JOINTS AND SIGNS OF BRUXISM

Aim. The research was conducted to develop and implement the complex of diagnostic activities in patients with dysfunction of temporomandibular joints with signs of bruxism.Materials and methods. To achieve this aim we conducted a comprehensive diagnosis of 61 patients aged 20-29 years with bruxism and temporomandibular joints dysfunction (TMJD), the patients were divided into two groups. To diagnose and analyze the results of the disease treatment in patients we used a computer analysis with visualization of changes of the osteoarticular surface and parameters of the joint gap in the TMJ. Depending on the ratio of prognostic risk criteria and the development of bruxism, we distinguished the area of low, medium and high level of risk of disease progression.Results. Comparison of the treatment results of patients with bruxism from two groups in 12-24 months showed that patients from the second group had good treatment results. Patients of the second group underwent a complex of diagnostic activities and its data increased the treatment effectiveness. The results obtained from the treatment of patients from the first group indicate the lack of data from the standard examination of patients with bruxism.Conclusion. The developed complex diagnostic activities in patients with bruxism in combination with dysfunction of the TMJ and occlusive attrition of teeth allow to assess not only the local status but also to determine the functional state of dentoalveolar system and the cerebral cortex which affects the amount of therapeutic activities in the patient