Clinical Justification for Preliminary Thermal Exposure to Composite in the Treatment of Caries: Randomized Clinical Trial

Background. Polymer composites have good aesthetic characteristics and pronounced physicochemical properties, as compared to traditional restorative materials such as amalgam. However, the polymerization reaction of composite material containing bismethacrylate group commonly used in clinical practice is always accompanied by a different degree of volumetric shrinkage (2.7%~7.1%). The resulting stress can lead to adhesion failure and some other unfavorable clinical consequences, such as enamel destruction, microcracking of composite material and formation of microleakage between composite and tooth cavity wall, which can result in recurrent caries and postoperative sensitivity, thereby affecting the long-term effect of restoration. Therefore, studying the effect of preheating on composite restoration is important for its clinical application. Objective. To improve the effectiveness of treatment of patients with dental caries by improving the physicochemical properties of composite restorations.Methods. A randomized clinical trial enrolled 180 patients aged 18 to 45 years, diagnosed with dentin caries class I, according to Black (K02.1 in ICD). The study was conducted in the Dental Clinic of Kuban State Medical University, Russia. 180 composite restorations were performed in the treatment of dentin caries of molars. Patients were randomized into 2 groups): the control group — 90 patients and the main group — 90 patients. The control and main groups, in turn, were divided into three subgroups, depending on the composite used — Estelite Sigma Quick (Tokuyama Dental, Japan), Filtek Bulk Fill Posterior Restorative (3M Espe, USA) and DentLight (VladMiVa, Russia). Each subgroup consisted of 30 patients. In the control group, the classical method of filling with a composite material at “room temperature” was applied. In the main group, a composite heating conditioner “Ena Heat” (Micerium, Italy) was used to heat the composite to 55 °C before adapting the material in the formed cavity with subsequent photopolymerization. The quality of composite restorations within the clinical study was evaluated using the modified Ryge criterion immediately after treatment and after 6, 12, 18, 24 months. Statistical processing of the obtained data was carried out by means of one-factor analysis of variance using the GraphPadPrism 9 program (GraphPad Software, USA).Results. The duration of the clinical study comprised 24 months. The study revealed a statistically significant decrease in the quality of marginal fit of composite restorations (according to the Ryge score) by 20.1% (p = 0.0001) in the control group and by 5.7% (p = 0.0328) in the main group.  At the same time, no statistically significant changes in Ryge scores were reported in the subgroups of composite materials of the main group (pF = 0.9480, pE = 0.1837, pD = 0.2529). As a result of the study, an optimal time algorithm (7 seconds) for using a special furnace for preheating the composite before sealing with subsequent photopolymerization was obtained.Conclusion. The study revealed a statistically significant positive effect of the proposed algorithm for working with a heated composite on the quality of marginal fit in the long term after treatment in comparison with the classical method of working with a composite at “room temperature”

THE USE OF PREDICTIVE CYTOLOGICAL FEATURES FOR THE SELECTION OF THE METHODOLOGY OF REGENERATIVE TREATMENT OF PATIENTS WITH PERIODONTITIS

Aim. This study was conducted to assess the outcome of the results obtained in the treatment of patients with longterm current periodontitis with individual characteristics of the cytological picture of the microenvironment of damaged periodontal tissues.Materials and methods. The main study group included 40 patients with chronical periodontitis of the moderate degree (Mo 56, 7 years). The selection of the regenerative treatment in the main group was carried out in accordance with the preliminary express assessment of the cytological picture of the damaged periodontal tissues. The control group, whose indicators were compared with the main clinical indicators, included 43 patients with randomly selected regenerative treatment.Results. The cell-potential surgical approach statistically induces the growth of new dentogingival junction in patients with critically small amount of morphologically altered neutrophil granulocytes and small cell forms with intense basophilic coloring (≤20%) in cytological samples in comparison with the control decreasing the amount of residual loss of teeth supporting tissues by 2 times.Conclusion. The preliminary express assessment of the cytological picture of the microenvironment of periodontal pockets indirectly indicates the potential of the patient with periodontitis to restore the missing structures of the periodontal membrane. The choice of the surgical tactics of regenerative treatment, taking into account the characteristics of cellular behavior in cytological samples of patients with periodontitis, is advisable to use as a prognostic test to improve the final results

RESULTS OF CELL-POTENTIATED SURGICAL TREATMENT OF CHRONIC PERIODONTITIS (10 years of observations)

Aim. The aim of this study is to systematize the scientific knowledge and reconstructed periodontium reliability degree by means of cell-potentiated surgical treatment of patients with the chronic periodontitis.Materials and methods. All 76 patients included in the study (aged 23 to 68 years, Mo 55.3 years) underwent a surgery for directed regeneration of periodontal tissues which was supplemented by transplantation of vascular stromal cell fraction isolated from the patient's adipose tissue (VSF AT). The evaluation of the results of the main periodontal parameters, processed by means of variation statistics in 690 periodontal defects of different topography, was carried out within 10 years.Results. The use of the VSF AT demonstrated the advantage of the method expressed by the formation of a new timeresistant dentogingival junction with the reconstruction of the alveolar bone with a minimum amount of the marginal recession and the probing depth.Conclusion. The percentage of positive results in the representative statistical sample was 90.3% in the main group, 75.6% in the control group within 10 years