(7) Клиническая медицина
O.A. Neprelyuk, S.I. Zhadko,
P.N. Kolbasin, O.L. Irza, T.P. Sataieva
Department
of Prosthetic Dentistry (Head - prof. Zhadko SI)
Crimean Medical State University,
Simferopol.
Cymorphological
indices in patients with peptic ulcer
and duodenal ulcer after installation
of dental implants.
Recent studies have shown that intraosseous
implantation does not always provide stable and guaranteed results. Analysis
of the literature showed that remaining
insufficiently in studied
issues was related to the development
of early infectious complications in periimplantational soft tissues and their
effect on the dates of the beginning of prosthetics, especially in patients
with background somatic pathology. In recent
years, to study the soft tissues of the oral cavity in dynamics the dentists use laboratory
cytomorphometrical method by taking print from the gums. Clinical research
methods, based on use of hygiene and periodontal indices, in spite of
widespread use, are, to some extent, subjective, and give only a qualitative
assessment of tissue structures. Thus, the purpose of this study was
cytomorphometrical monitoring of periodontal cellular elements after
implantation in orthopedic patients suffering from peptic ulcer and duodenal ulcer.
This method is based on research
tsitomorfometricheskogo prints with gum (a technique developed by ZNIIS under
the leadership of A. Grigoryan).
Biopsy was performed at 1, 3, 6, 12 months after
prosthesis by smear-print from the gums, taken from the lingual or buccal
surface by fitting it to the neck of the implant (zone interface), the employee
base for the prosthesis. The prints were taken from the gingival sulcus of
periimplantational area after 4 (±1) hours after brushing.
Each glass was covered with
prints made from the region of 1-4 implants for 3-4 indentation in each
quadrant. The glass was dried and stained by the method of Romanovsky-Giemsa. Further
cytologic preparations were examined under a microscope. A review on large fields cell count was performed in 2
major cell populations and cytograms: epithelial and connective tissue
(neutrophils).
Field
selection was arbitrary, but they must be at least 3. In each selected field of view it was counted the total number of
epithelial cells (varying degrees of maturity) and the number of neutrophils.
It is noted that in the gingival impressions has normally present neutrophil
cells, but inflammatory processes in the proportion of epithelial cells and
connective tissue changes sharply upward connective tissue. To display the
index of periodontal destruction we proposed to count the number of epithelial
cells (regardless of their degree of maturity) and the number of neutrophils in
the field of view.
Next, it was calculating the
index periodontal destruction (SPD) by the formula:
IAP = (e1/n1) + (e2/n2) + (e3/n3)
Where E - the total number of epithelial cells
in the field of view,
n - the
number of neutrophils in the field of view,
1,2,3 - field of view Index of periodontal destruction expressed in
convoluted units (conv)
The average values of the index periodontal
destruction:
If the state standards - SDI = 12.09 - 15.03
With weakly expressed
inflammation - SDI = 15.04 - 22.05
With moderate inflammation - IAP = 22.06
and>
The method was tested in a survey of 87
patients (37 women and 50 men) aged 21-64 years. By selecting patients, we
considered the general condition of the deferred and related diseases,
anatomical and physiological condition of the oral cavity. Patients were divided into 3 groups: 1-st group
consisted of orthopedic patients without somatic diseases - 20 patients; in the
2 - orthopedic patients with somatic pathology (peptic ulcer and duodenal
ulcer) - 27 patients and 3 group consisted of 25 patients requiring
orthopedic care and with background somatic pathology, which in the first 30
days after implantation through day were introduced immunomodulator
"Erbisol" 1 ml. In addition, we examined 15 healthy individuals
(normal), not in need of prosthetics – as the control group. Orthopaedic treatment was carried out by two-stage
implantation technique endosseous screw implants "Wimple". The
study we have used the drug "Erbisol - immunomodulator, reparants,
adaptogen. By 1 month after implantation, with
statistically significant (p <0,01-0,001) growth index of periodontal
destruction in all the groups studied. In the next 3 months after installation
of implants in group 1 cases (orthopedic patients without somatic pathology)
index periodontal destruction is practically no different from the figure of 1
month and amounted to 16,35±0,21 conv, which was 38% (p<0.01) above
the benchmarks (Table 1). A somewhat different pattern was observed in patients
of 2 and 3 groups (orthopedic patients with concomitant somatic diseases,
gastric ulcer and 12 duodenal ulcer), where the index periodontal destruction
increases relative to controls at 53.4% (p<0,01) and amounted to 18,55±0,45
conv the second group and 39.2% (p <0,001) in
Group 3, and amounted to 16,84±0,31 conv. By 6 months after implantation in
orthopedic patients with periodontal destruction index declined, acquired in
relation to the control of unreliable (p> 0.05) in this case, with respect
to 1 month after implantation, it decreased by 16,8%, which was of a statistically
meaningful (p2<0,05). By this time observing patients of group 2,
despite the slight decrease in the index of periodontal destruction, remained
at a fairly high level and amounted to 15,82±0,34 conv, which was above 30,0%
(p<0,01) benchmarks. By that time
observations in patients 3 groups (orthopedic patients with somatic pathology,
which after implantation applied immunomodulator "Erbisol" index of
periodontal destruction decreased and amounted to 13,82 0,42 conv gaining
relative to control unreliable (p>0,05), with ratio to 1 month after
implantation the performance index periodontal destruction became statistically
significant (P2 <0,05).
In the remote periods of
observations, by 1 year, the performance index of periodontal destruction in 1
and 3 groups did not differ from controls and patients of group 2 were close to
reference data.
О.А.Непрелюк, С.И. Жадько, П.Н.Колбасин, О.Л.Ирза, Сатаева Т.П.
Сотрудники кафеды
ортопедической стоматологии
(зав.- проф. С. И. Жадько)
Крымского государственного медицинского университета
им. С.И. Георгиевского,
г.Симферополь.
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