Summary. Inflammation and pain can lead not only to a deterioration in the patient’s condition, but also to such local consequences as: bone resorption, loss of soft tissue volume, an increase in the wound healing time and patient rehabilitation in general. Inflammation-induced bone resorption in the area of implantation with direct prosthetics, caused by the activity of cytokines and prostaglandins, negatively affects the entire result of treatment of dentition defects in general. This is because the quality and quantity of bone tissue is one of the key points in the success of prosthetics on dental implants, therefore, pharmacological support of dental implantation and direct prosthetics is an important component of treatment. Purpose: to investigate the effect of inflammation and pain on peri-implant bone tissue at the stages of dental implantation and direct prosthetics and scientifically substantiate pharmacological support in order to prevent inflammatory bone resorption. Materials and methods. A clinical prospective study of 57 patients was carried out at the stage of dental implantation and direct prosthetics with randomization according to the type of pharmacological accompaniment: 1) group I received anti-inflammatory therapy in the form of a balanced inhibitor of COX-1, COX-2 and 5-LOG – nimesulide and analgesic therapy – dexketaprofen trometamol; 2) group II received anti-inflammatory therapy – a selective COX-2 inhibitor – meloxicam and analgesic therapy – ibuprofen; 3) group III did not receive anti-inflammatory and analgesic therapy due to contraindications to the use of non-steroidal anti-inflammatory drugs. Patients of groups I, II, III underwent: clinical, radiological and functional research methods by monitoring the state in dynamics. Results. According to the data obtained, the indices of pain intensity in group I were significantly lower (p < 0.05) as of 1 and 2-d days, compared with groups II and III. The stabilization of inflammatory processes in group I was recorded on the 2-d day. There was a significant decrease (p < 0.05) in the signs of the inflammatory process in patients of group I on the 3rd day (3.01±0.11 units), and on the 7-th day – their complete absence (1.12±0.23 units). In group II, significant regression of inflammation was noted on the 4th day (3.14±0.12 units), and on the 7-th day, minimal signs were observed (2.04±0.17 units). A decrease in signs of inflammation in group III occurred from the 5th day (3.31±0.28 units), and inflammatory phenomena were observed on the 7th day of the study (2.65±0.27 units). In group I, there was a significant stop in the loss of stability of the connection between the bone tissue and the dental implant on the 20-th day (65.08±1.03 points). As of the 25-th day, in patients of group I of the study, there was significantly higher (p < 0.05) indicators of the coefficient of stability of the implant (66.21±1.40 points) in relation to group II of patients (62.93±0.94 points), in who used selective COX-2 inhibitors, and group III (62.90±0.75 points), where NSAID’s were not used. The loss of marginal bone around the dental implant during the study period in group I was 0.5±0.23 mm CI, in group II – 1.1±0.34 mm, in group III – 1.3±0.28 mm. Side effects in group I of the study were recorded in 5.3 % of patients taking drugs nimesulide and dexketoprofen, and in 15.8 % of those in group II who took drugs meloxicam and ibuprofen. Conclusions. Complex pharmacological support of dental implantation and direct prosthetics on implants in the treatment of dentition defects, consisting of perioperative analgesia – dexketoprofen trometamol, as well as nimesulide for anti-inflammatory therapy, made it possible to influence the trauma-induced bone resorption in the implantation area by controlling inflammation. As a result, on the 20-th day in the patients of the group I of the study, a significant stop was noted in the loss of stability of the connection of the bone tissue and the dental implant (65.08±1.03 units), and on the 25-th day of the study in the group I it was found significantly higher (p < 0.05) indicators of the coefficient of stability of the implant and less loss of height of marginal bone tissue in relation to groups II and III of patients. This pharmacological complex made it possible to achieve stabilization of pathological processes in soft tissues – stopping the formation of edema on the 2-d day, a significant decrease (p < 0.05) of signs of the inflammatory process on the 3-d day (3.01±0.11 points) and to implement effective pain prevention at the stages of dental implantation and direct prosthetics.
Summary. Partial adentia is a topical issue in modern dentistry. Rational use of dental implants (DI) with direct prosthetics (DP) on installed implants at partial adentia is a modern and quick answer to this question. But still there is a number of unresolved issues in the method of direct prosthetics on DI. The most relevant of these is how to use modern CAD/CAE/CAM technologies to personalize the eruption profile of natural teeth while maintaining the height of periimplantative bone tissue (BT) and the volume of surrounding soft tissues. Purpouse: to improve the quality of stomatological treatment of patients at the stages of dental implantation by applying an improved algorithm of direct prosthetics on dental implants on the basis of scientific justification of rational use of personalized prosthetic constructions and prosthetic elements, as well as pharmacological support of such interventions. Materials and methods of research. The clinical study included 80 patients – 63 patients were included in the main cohort (had dentition defects and/or required tooth extraction) who were randomized into three groups (I–III), according to the applied treatment; 17 patients were included in the additional cohort (group IV – without dentition defects) who’s clinical and laboratory parameters were within the physiological norm. According to the above distribution of patients of the main cohort by study groups (groups I-III), each patient received the following treatment measures according to the study plan. Patients in group I (21 patients) used an improved direct prosthetics (DP) algorithm on DI with screw fixation of prosthetic structures from the level of the implant platform, and patients in group II (21 patients) – from the level of mesostructure of multi-unit abutment with the manufacture of individualized hybrid and/or crowns using CAD/CAE/CAMtechnologies. Prevention of inflammation and pain in patients of groups I–II was carried out by prescribing a complex of pharmacological support, which contained – the drug nimesulide, a complex drug bromelain, trypsin, in combination with drug rutoside threehydrate, and the drug trometamol dexketoprofen. Patients in group III (21 patients) used the conventional protocol of DP on DI with screw fixation of prosthetic structures from the level of the DI platform with the use of standard prosthetic elements and structures of artificial crowns made by traditional laboratory methods, while preventing inflammation and pain in patients of this group was carried out by prescribing a complex of pharmacological support, contained of the drug meloxicam, a complex drug of bromelain, trypsin, in combination with the drugrutoside threehydrate, as well as the drug ibuprofen. Clinical, functional and radiological studies, followed by statistical analysis of the results were provided for the patients of groups I–IV. Results. Prescription of the proposed pharmacological support complex at the stage of direct prosthetics in dental patients of groups I and II allowed to prevent pro-inflammatory resorption of BT due to surgical trauma of bone and soft tissues in the area of dental implantation, minimize loss of marginal BT around DI. Patients of groups I and II achieved a significant (p < 0.05, compared with group III) increase in the coefficient of stability of the implant (CSI) starting from the 20th day (group I – 65.37±1.12 units and group II – 64.93±0.75 units) in contrast to the delayed increase of this coefficient in group III (63.18±0.72 units), in which this indicator began to increase only from the 30th day. As a result, the loss of the height of the marginal BT after 12 months (1.11±0.03 mm) in group III was significantly (p < 0.05) higher than in groups I and II. Structural features of standard abutments, and the lack of ability to reproduce the anatomical features of the natural eruption profile of prosthetic structures made manually in traditional way contributed to a significant increase in the rate of loss of marginal BT (1.20±0.04 mm) in 24 months in patients of group III in contrast to patients of groups I and II. Instead, the minimal loss of marginal BT height throughout the study period was observed in group II which used an improved algorithm of DP on DI with screw fixation of prosthetic structures from the mesostructure of multi-unit abutment with the manufacture of individualized hybrid crowns with the help of CAD/CAE/CAM-technologies. The use of multi-unit abutments allowed to seal the access to the DI shaft and to carry out all subsequent stages of prosthetics at a level higher than the DI shaft. In particular, in group II of the study absence of infection with oral fluid in the DI shaft during the stages of prosthetics, minimization of trauma to the marginal bone, periosteum and soft tissues around the DI during impression obtaining, fixation of temporary and permanent structures of dental prostheses, as well as the author's algorithm of reproduction of a natural profile of eruption allowed to maintain a significantly higher (p < 0.05) volume of BT around the DI after 12 and 24 months in comparison with group I where titanium platforms and personalized constructions of abutments and profiles of eruption of dental prostheses were used and group III, where standard abutments from the level of DI shaft and traditional constructions of dental prostheses were used. The results of remote clinical trials have demonstrated the high efficiency of the proposed complex of treatment measures and the rationality of its components according to the algorithm in patients of groups I and II compared to traditional approaches in patients of group III. The loss of periimplantative soft tissue height after 12 and 24 months of DI was significantly lower (p < 0.05) in patients of groups I and II, compared with group III. In group II after 12 and 24 months the loss of soft tissues around DI was significantly lower (p < 0.05) compared with group I. Conclusions. Prescription of the proposed pharmacological support complex at the stage of dental implantation and direct prosthetics on DI, contained of the drug nimesulide, complex drug bromelain, trypsin in combination with the drug rutoside threehydrate and trometamol allowed to prevent inflammation-induced resorption of BT in areas of surgical trauma of bone and soft tissues, helped to minimize the loss of marginal BT height around the DI. In patients of groups I and II, that received the proposed complex of pharmacological support, the loss of BT in the first 6 months after the intervention was significantly smaller (p < 0,05) (group I – 0,15 ± 0,04 mm, group II 0,10 ± 0,02 mm), and KSI credibly (p < ) bigger in contrast to patients of group III (loss of BT 0.66 ± 0.03 mm, KSI 79.06 ± 0.54 units) in whom pharmacological support contained meloxicam and ibuprofen, the action of which was insufficient for full prevention of trauma and inflammation for induced local resorption of the marginal bones around the installed DI, and as a consequence of the predominance of BT resorption processes over its formation. According to the results of remote (after 12 and 24 months) clinical and radiological examinations in patients of groups I and II who used identical in composition to author's complex of pharmacological support and developed personalized protocol of direct prosthetics on DIfound significant differences in bone and soft tissue loss around DI between these groups. It is proved that the use of personalized protocol of direct prosthetics on dental implants from the level of mesostructures of multi-unit abutments in patients of group II prevented multiple injuries of the marginal bone, periosteum and mucous tunic around the DI during routine prosthetic manipulations. As a result, in group II were found significantly lower (p<0.05) rates of bone and soft tissue loss around DI after 12 and 24 months after dental implantation and direct prosthetics in comparison with group I. The proposed author's protocol of direct prosthetics on dental implants using modern CAD/CAE/CAM technologies allowed reproducing natural eruption profile in personalized way. When used in patients of group II from the level of multi-unit abutments after 24 months significantly better (p<0.05) results were obtained in maintaining the height of periimplantative bone tissue and the volume of surrounding soft tissues compared to traditional prosthetic methods used in patients of group III. Key words: direct prosthetics, dental implantation, personalized approach, CAD/CAE/CAM-technologies, multi-unit abutment.
Background: Secondary to increased development of generic nonsteroidal anti-inflammatory drugs (NSAIDs), there is a lack of simple and inexpensive ways of pilot detection of differences between the batches of generic drugs and the original ones. Objectives: To determine the peculiarities of the use of generic NSAIDs in routine practice through a pilot survey of dentists and to conduct a pilot comparative analysis of generic and original NSAIDs containing nimesulide granules using optical microscopy. Methods: The first part of the study included a pilot survey Convenience sampling of 192 dentists to study the use of generic NSAIDs in their routine practice. The second part included the use of a pilot optical microscopy of nimesulide particles isolated from four drugs: original drug (NA) and generic ones (NB, NC, ND). Results: In the questionnaires, dentists pointed to a 68.7% lower clinical efficacy and a 62.6% higher percentage of side effects of generic NSAIDs compared to the original ones. Based on the results of pilot optical microscopy, a statically significant difference in the size distribution of the drug substance particles in all generic nimesulide granules was determined as follows: NB (χ 2 : 15.15; p < 0.01); NC (χ 2 : 11.09; p < 0.05); ND (χ 2 : 1625.34; p < 0.001) compared with the original drug NA. Conclusions: A pilot survey of dentists showed that doctors noted the practical difference in the effects of the original and generic NSAIDs. A significant difference in the size of nimesulide particles and their distribution in generic drugs NB, NC, ND compared to the original NA suggests a possible difference in bioavailability and bioequivalence.
Резюме. З літературних даних відомо, що віддалений успіх дентальної імплантації залежить не лише від ретельного планування та проведення хірургічного втручання із дотриманням вимог протоколу, але й від виду навантаження на імплантати, яке суттєво залежить від конструктивних особливостей зубних протезів, що на них фіксуються. Наявність значної кількості пропозицій конструкційних матеріалів на ринку України для виготовлення зубних протезів на ортопедичному етапі дезорієнтує лікарів і зубних техніків, які у більшості випадків добирають їх емпіричним шляхом. Метод скінчених елементів дозволяє на доклінічному етапі провести дослідження та експериментальним шляхом обрати максимально ефективні персоналізовані конструкційні рішення для протезування на дентальних імплантатах, а також конструкційні матеріали або комбінацію для їх виготовлення з метою оптимізації навантаження на імплантат та кісткову тканину. Мета: обґрунтувати комбінації конструкційних матеріалів та персоналізованих протетичних елементів для протезування на дентальних імплантатах шляхом проведення дослідження напружено-деформованого стану в імітаційних моделях «кісткова тканина-дентальний імплантат-протетичний елемент-персоналізований абатмент-супраконструкція». Матеріали та методи досліджень. Експериментальне дослідження проводили на багатовимірних імітаційних моделях «кісткова тканина-дентальний імплантат-протетичний елемент-персоналізований абатмент-супраконструкція», що мали сталі фізико-механічні властивості кісткової тканини, імплантатів і стандартних протетичних елементів та умови їх навантажень, а відрізнялись між собою за типами конструкційних матеріалів, з яких були виготовленні персоналізовані абатменти та супраконструкції. Базові типи моделей містили-Т1 персоналізований абатмент з поліефірефіркетону (PEEK), а також Т2 персоналізований абатмент з діоксиду цирконію. У дослідженні базові типи імітаційних моделей комбінували з різними варіантами супраконструкцій, що були виготовлені з: склокераміки на основі дисилікату літію (К1); гібридної кераміки модифікованої композитом (К2); поліметилметакрилату PMMA (К3); багатошарового діоксиду цирконію (К4). Результати. Під час проведення чисельного аналізу напружено-деформованого стану біомеханічних систем «кісткова тканина-дентальний імплантат-протетичний елемент-персоналізований абатмент-супраконструкція» встановлено, що найбільш навантаженими елементами системи були: супраконструкція (σ max екв 143,57 МПа-у моделі з Т1 типом персоналізованого абатменту; σ max екв 156,25 МПа-у моделі з Т2 типом персоналізованого абатменту); губчаста (σ max екв 3,84 МПа-з Т1 типом персоналізованого абатменту; σ max екв 3,36 МПа-з Т2 типом персоналізованого абатменту) та кортикальна кісткова тканина (σ max екв 18,67 МПа-з Т1 типом персоналізованого абатменту; σ max екв 16,46 МПа-з Т2 типом персоналізованого абатменту), з відповідними показниками коефіцієнтів запасу міцності для кожного з цих елементів. Біомеханічні системи з Т1 і Т2 персоналізованими абатментами володіють найбільшою опороздатністю при застосуванні матеріал...
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