Initial radiological signs of dentofacial deformity in juvenile idiopathic arthritis

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in childhood and the temporomandibular joint (TMJ) is often involved. TMJ arthritis in growing individuals can cause deformation of facial skeleton (dentofacial deformity) and TMJ components (TMJ deformity). Treatment outcome hinges on early initiation of anti-inflammatory treatment and orthopaedic treatment with dental splints. The aim of the present study was to characterize the radiological signs of dentofacial deformity in patients with a JIA-induced need for orthopaedic treatment. We retrospectively studied 96 patients with JIA and 20 non-JIA controls to identify the initial radiological signs of JIA-induced dentofacial deformity leading to initiation of orthopaedic treatment. We found that initial radiological signs of dentofacial deformities were subtle and characterized by minor mandibular asymmetry and occlusal plane steepening. Radiological findings of TMJ deformity associated with initial dentofacial deformity were frequent and characterized by condylar articular surface flattening (OR 8.42), condylar subcortical cyst (OR 5.94), condylar surface erosion (OR 5.38) and condylar deviation in form (OR 25.39). Radiological signs of TMJ deformity were also documented in TMJs considered “healthy” during initial clinical and radiological examination. This study presents new knowledge of importance for early diagnosis of dentofacial deformity in JIA. Early diagnosis of dentofacial deformity is important as treatment outcome is greatly influenced by timely initiation.

Orthopaedic medical examination for young amateur athletes: a repeated cross-sectional study from 2014 to 2018

ObjectivesMedical examinations for adult elite athletes are performed all over the world, however, no studies in the relevant English literature have reported on orthopaedic medical examinations for young amateur athletes. The purpose of this study was to report the results of orthopaedic medical examinations of the spine and lower extremities in young amateur athletes.MethodsThis repeated cross-sectional study from 2014 to 2018 included a total of 323 young amateur athletes (age, 12–18 years) who were active in one of the following four sports: boxing, canoeing, weightlifting and track and field. The orthopaedic medical examination consisted of six assessments (physical examinations, the generalised joint laxity, muscle and joint tightness, static alignment and muscle volume of the lower extremities and the medial longitudinal arch of the foot). Questions regarding pain in the spine and lower extremities were also performed.ResultsAmong 323 young amateur athletes, 17 (5.3%) had received orthopaedic treatment at the time of the medical examination, with spondylolysis being the most common cause (29.4%, 5/17). Among 306 young athletes who had not received orthopaedic treatment, 61 (19.9%) had at least one positive finding in physical examinations or had pain in the spine or lower extremities. Anterior drawer test of the ankle and Kemp test for the spine accounted for 34% and 28% of positive findings, respectively. Low back pain and knee pain accounted for 58% and 16% of pain, respectively.ConclusionsThe present study showed that approximately one-fifth of young amateur athletes who had not received orthopaedic treatment had pain in the spine and lower extremities and positive findings in physical examinations that may require orthopaedic treatments. In addition to the early detection of injuries, orthopaedic medical examinations for young amateur athletes provide an opportunity to educate such athletes.

On how to surgically treat uterine tilts and retractions through the vagina

In the introduction to his work, the author provides statistics on uterine dislocations, looks at their orthopaedic treatment and gives a brief overview of surgical aids.

DETERMINATION OF THE QUALITY OF LIFE OF PATIENTS WITH CONGENITAL CLEFT OF THE UPPER LIP AND PALATE BEFORE AND AFTER THEIR ORTHOPEDIC REHABILITATION

Congenital malformations remain one of the most pressing medical and social problems, and their frequency is an important characteristic of the population health status. Unfortunately, the tendency to their decrease is not observed in recent years, on average from 450 to 500 newborns per year. In this regard, it is important to study different aspects of the life quality of patients of different ages and with different types of congenital malformations of the upper lip and palate. The positive dynamics of changes in the life quality can be evidenced by the survey data of these patients, which must be conducted after each stage of their rehabilitation with the use of special validated questionnaires. Objective. The aim of the study was to assess the life quality of patients with congenital malformations of the upper lip and palate before and after the final stage of orthopedic treatment with different types of aesthetic designs of dentures. Material and methods. An investigation of the life quality related to the oral health was proposed using data of 37 patients aged 17 to 36 years, including 26 men and 11 women with congenital malformations of the upper lip and palate, using the OHIP-14 (Oral health impact profile) questionnaire. Non-removable structures are made for 27 patients, combined (non-removable + removable) - for 10 patients. The questionnaire was conducted before treatment and one month after their orthopaedic its completion. The analysis was conducted on individual questions, which were grouped into separate blocks: questions related to problems with eating, questions related to communication problems, questions related to problems in everyday life. Research results. There was a significant improvement in the life quality of patients with congenital malformations of the upper lip and palate after completion of their orthopaedic rehabilitation as separate blocks of questions (Block I 12,703 ± 0,915 before, against 1,784 ± 0,165 after orthopaedic treatment; Block II 13,378 ± 0,672 before, against 1,405 ± 0,175 after orthopaedic treatment; Block III 9,919 ± 0,736 before, against 0,676 ± 0,155 after orthopaedic treatment), confirmed by statistical processing of the material (p <0,001) as well as the total number of points in the questionnaires (95,142 ± 1,405 before, against 10,214 ± 1,209 after orthopaedic treatment; p <0,001). It should be considered that the life quality of patients with congenital malformations of the upper lip and palate, as well as other dental patients is a non-permanent category. It usually changes with age, as well as a result of treatment and prevention measures, so it must always be assessed in the dynamics. As a rule, successful treatment improves the life quality. Inadequate aesthetic condition of the oral cavity, which is formed after a comprehensive treatment, along with the functions of chewing and speech, most significantly affects the life quality. Thus, a study of the life quality associated with oral health of patients in this category suggests that adequate orthopaedic rehabilitation can significantly improve their life quality. In addition, the presence of either a fixed or a combined prosthesis, including in the area of the split (mouthpiece) aesthetically raises the upper lip and allows you to perform additional plastic surgery on it if necessary. Conclusion. The life quality of patients with congenital malformations of the upper lip and palate associated with oral health is usually a temporary category and tends to change depending on the type of split, time and method of rehabilitation, especially orthopedic treatment. Adequate and high-quality prosthetics of defects and deformations of the teeth rows can significantly improve both the subjective assessment of the life quality and the objective improvement of the functional state of the dental-jaw system, as evidenced by these objective research methods.

Change in the Dominant Side of Chewing as a Serious Factor for Adjusting the Prophylaxis Strategy for Implant-Supported Fixed Dental Prosthesis of Bounded Lateral Defects

Objective The main purpose of this article is to study the effect of a change in the dominant side of chewing after prosthetics with fixed structures on implants on the main indicators of osseointegration, adaptation to dentures, and the clinical dental status of patients. Materials and Methods In a clinical trial, an analysis was made of the adaptation of 64 patients to intraosseous implant-supported fixed dentures and 56 apparently healthy volunteers. The examination complex included determination of the functionally dominant side of chewing, gnathodynamometry and electromyography indicators of masticatory muscles, and radiological osseointegration criteria. The overall treatment outcomes were evaluated using a visual analogue scale and an objective medical questionnaire, “Prognosis of Adaptation to Orthopedic Structures.” Results Patients were divided into two subgroups: with a change in the dominant side of chewing after completion of orthopaedic treatment (40 cases) and without a change in the dominant side of chewing (24 cases). In the second subgroup of patients, in contrast to the first subgroup, relatively better indicators of gnathodynamometer and electromyography were observed. So, in the first group, gnathodynamometry indicators on the dominant side were 255.7 N and in the second group 225 N after 9 to 12 months. Electromyography indices amounted to (198.5 μV s) to (166.3 μV s) after 9 to 12 months. Bone density remained at the required level, and overall treatment outcomes were higher. Namely, the compact plate of the alveolar ridge was preserved, and the condition of the bone tissue around the implants testified to stable osseointegration. The participation of surface masticatory muscles in adaptation of patients to intraosseous implant-supported fixed orthopaedic structures and the necessity and importance of changing the dominant chewing side for the general outcomes of orthopaedic treatment have been discussed. Conclusions It has been established that a change in the functionally dominant chewing side is accompanied by relatively unstable indicators of chewing function, which is combined with increased loads on the installed prostheses during 3 to 6 months of adaptation. This must be taken into account when planning an individual patient adaptation complex for dental orthopaedic structures.