Relevance of non-steroidal anti-inflammatory drugs in periodontology

Relevance. Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed in dental practice to relieve pain and swelling. This study reviews information on NSAIDs, with a particular focus on those aspects that are relevant to the practice of dentistry.Materials and methods. A systematic literature search was conducted, which included studies dating from 1970 to June 2021. The search in the electronic databases e-LIBRARY.ru, Embase, Pubmed and Medline identified the studies. Articles were reviewed by meeting the inclusion and non-inclusion criteria.Results. Initially, the electronic search identified 589 studies. After reviewing the titles and abstracts, 69 potentially relevant studies were subject to full-text evaluation. Of these, 34 studies were excluded based on study design, research question, or lack of numerical data on all variables to be assessed in this study, so 35 studies with a detailed list of such data could be included in the quantitative comparison.Conclusion. The use of non-steroidal anti-inflammatory drugs may alter the inflammatory response in the treatment of oral diseases. The conducted studies have brought up questions about the effectiveness and alternative ways of NSAID delivery in dentistry, namely, dispersible formulation.

Comparative analysis of the effectiveness of the oral mucosa traumatic lesion treatment in patients with a comorbidity

Relevance. Patients with diabetes are prone to complications which negatively affect their quality of life. In such patients, several comorbidities may develop. One of the complications of diabetes mellitus is an impaired wound healing. Oral wound healing associated with the constant chronic trauma by sharp edges of teeth and prostheses is not an exception. Such wounds are characterized by a long, persistent, sluggish process of restoring the integrity of the oral mucosa epithelium.Materials and methods. In this paper, a comparative analysis of the effectiveness of wound treatment was carried out in 52 patients with diabetes mellitus. All patients were randomized into two equal groups. In the first group of patients, wounds were treated with traditional methods of pharmacotherapy, while in the second group, the oral mucosa was exposed to ozone and ozonated oil was applied. The patients were monitored and followed up for 14 days and as the reparative function was restored. The area and depth of the wound, the nature and amount of exudate, destruction, the edges of the wound and the surrounding connective tissue were taken into account.Results. The positive wound healing process was noted in both groups during the follow-up period. However, the inclusion of the ozone therapy in the treatment protocol favored faster restoration of the epithelium integrity.Conclusion. The present data will help dentists monitor and treat the wound process, which in turn will prevent malignancy as well as improve the prognosis for patients with diabetes.

Comprehensive study of the toothpaste containing fluoride and 67% aqueous sodium bicarbonate solution

Relevance. A wide variety of oral care products is available nowadays. Sometimes aggressive advertising rather than doctor’s advice determines our patients’ choice. In our research, we provide evidence of the clinical use of toothpaste containing fluoride and sodium bicarbonate.Materials and methods. During four weeks, we followed up a group of students who used the toothpaste containing 1400 ppm fluoride and 67% aqueous sodium bicarbonate solution. The clinical, biochemical and microbiological tests and saliva crystallization score assessed the characteristics stated by the manufacturer.Results. The statistically significant correlation between all studied criteria is evidence of the effectiveness of the toothpaste. In addition to the significant remineralization and antiplaque effect, biochemical and microbiological tests confirmed the anti-inflammatory effect of the toothpaste. An immediate cleaning effect was observed after the first brushing as well as in long-term use.Conclusion. Improvement of oral hygiene indices and reduction of periodontal inflammation confirmed the successful result of the comprehensive treatment of chronic gingivitis.

Improvement of the prosthodontic treatment protocol in patients with TMD via functional diagnosis

Relevance. The purpose of the research is to improve the functional diagnosis protocol in prosthodontic treatment of patients with TMD.Materials and methods. The optimal position of the mandible was determined for each patient by two methods: 1) TENS (transcutaneous electrical nerve stimulation) and 2) TENS + kinesiography. Then, the cone-beam computed tomography (CBCT) data were analyzed to determine the most physiological position of the condyles.Results. The analysis of the CT scans of patients without TMD (control group) showed that the right and left condyles occupy an anterior or central symmetrical position relative to the glenoid fossa. In the first and second methods, the condyles occupy an anterior or central position, which is the most optimal position of the lower jaw for the manufacturing of an occlusal stabilization splint. The statistical coefficients allowed us to determine that the second method was more accurate, since the obtained values were lower than those of the first method.Conclusion. Based on the results of this study, we can conclude that the improvement of the protocol, namely a new method for determining the optimal position of the mandible is more time-consuming, but more accurate and allows increasing the effectiveness at all stages of treatment of patients with this pathology.

Comparative analysis of the effectiveness of surgical techniques for the treatment of Miller Class I gingival recessions

Relevance. It is currently relevant to study and compare the effectiveness of the autologous connective tissue grafts and the combination of collagen-based and autologous platelet-rich plasma in the surgical treatment of Miller Class I gingival recessions.Materials and methods. We examined and treated 48 (20 male (41.67%) and 28 female (58.33%)) patients aged from 25 to 40 years with Miller Class I gingival recessions. All gingival recessions were treated surgically using a modified twolayer tunnel technique. The patients were divided into two groups according to the graft type. Group I (24 patients (50%) had a connective tissue graft from the hard palate. Group II (24 patients (50%) used the combination of the autologous platelet-rich plasma and 3D collagen matrix Fibromatrix for the regeneration of oral soft tissues. We removed the sutures on the 14th day. The patients were followed up on the 7th and 14th days and in 1.3 months.Results. 48 Miller Class I gingival recessions were treated between 2018 and 2020. The depth of gingival recessions averaged 3.5 ± 1.13 mm before treatment. The level of the attached keratinized gingiva regarding the cementoenamel junction significantly (p < 0.001) improved in both groups after the surgery. The width and thickness of the keratinized gingiva best increased in group II. The mean effectiveness of gingival recession treatment was 84% in study group I and 96% – in study group II. Pain syndrome, fibrinous plaque and soft tissue edema were insignificant in group II.Conclusion. The combination of the autologous platelet-rich plasma and Fibromatrix, collagen 3D matrix, for the regeneration of the oral soft tissues is a more effective technique for the treatment of Miller Class I gingival recessions. This technique has several advantages. It is minimally invasive, less painful, soft tissue postoperative swelling is less and the received volume of the attached keratinized gums is larger than with a connective tissue graft.

Characteristics of examination algorithm of patients with chronic trauma of the oral mucosa using tissue autofluorescence spectroscopy

Relevance. The paper demonstrates the need to implement modern diagnostic techniques for diagnosis of precancerous and cancerous lesions at early or preclinical stages. Additional diagnostic methods are necessary, e.g. tissue autofluorescence, which allows revealing insidious pathological risk zones, particularly precancerous and cancerous lesions, to evaluate the condition of the oral tissues in patients with chronic oral mucosa disorders, especially caused by trauma. Purpose – to assess trauma-specific effectiveness of autofluorescence spectroscopy (AFS) in risk group patients with chronic trauma of the oral mucosa to reveal early malignization signs.Materials and methods. 25 subjects were selected for the study and divided into 2 groups: main group – 20 patients with different manifestations of chronic oral mucosa trauma; control group – 5 subjects without visible clinical manifestations and without oral trauma factors. Autofluorescence spectroscopy was performed in both groups using AFS-400 stomatoscope.Results. The received data demonstrated that the change in autofluorescence doesn’t allow drawing final conclusions on the presence or absence of chronic oral trauma malignization signs.Conclusion. AFS-400 stomatoscope may be effective in differentiating between healthy and damaged tissues, but there is no solid evidence that the change in fluorescence shade can help differentiate between various types of damaged tissues. Autofluorescence spectroscopy should be considered as an additional method for examination of patients with chronic oral mucosa trauma to reveal early malignization signs.

Current antibiotic therapy of endo-perio lesions with secondary endodontic involvement

Relevance. Successful treatment of endo-perio lesions depends on the thorough clinical assessment, accurate diagnosis and structural approach to the planning of periodontal and endodontic treatment. Aim – to provide clinical and laboratory evidence about the effectiveness of ciprofloxacin-and-tinidazole-containing antibiotic in the comprehensive treatment of endo-perio lesions with a primary periodontal disease which secondarily affects the pulp.Materials and methods. We examined 29 patients aged from 35 to 50 (mean age 42.3±3.21) with class II endo-perio lesions according to P. Eickholz classification. The patients were randomly divided into 2 groups. All patients had comprehensive periodontal and endodontic treatment with (Group 2) and without (Group 1) antibiotic therapy. The clinical and paraclinical examination included determination of such indices as OHI-s, SL, PMA, SBI, as well as Doppler ultrasound, EPT, CBCT, microbiological test of the discharge from periodontal pockets and root canal system. We selected the systemic antibiotic after the antibiotic sensitivity testing.Results. Comprehensive treatment of endo-perio lesions, which included systemic antibiotic therapy with ciprofloxacin and tinidazole, effectively arrested the inflammation in the periodontium and pulp beginning from the 7th day of use.Conclusion. Cifran ST, a combination broad-spectrum antibiotic, helps reduce periodontal inflammation by effectively eliminating microbiota in the root canals and periodontal pockets in patients with moderate or severe chronic generalized periodontitis.

How to prevent iatrogenic periimplantitis? A clinical case report

Relevance. Iatrogenic factors are among the significant causes of chronic peri-implantitis, the incidence of which reaches 16-28% according to various data. This article is a clinical case report which describes an approach to the treatment of iatrogenic peri-implantitis associated with a non-absorbable buried suture. Patient Sh., born in 1960, physically healthy, complained of gum bleeding in the region of implant 3.6.Diagnosis. Сhronic peri-implantitis in region 3.6. The treatment was carried out in two stages. During the first (revision) stage, the buried suture of a non-absorbable 2-0 monofilament thread with uncut ends and a loose titanium pin were removed; during the second (reconstructive) stage, a free gingival graft (FGG) was used.Results. The inflammation in the area of implant 3.6 resolved, the soft tissue condition was stable in the immediate and delayed postoperative period. In 3 months after the beginning of the treatment, the cervical bone defect repair was confirmed by the control X-ray.Conclusion. The use of non-absorbable suture material for buried sutures in dental implantation and oral reconstructive surgical interventions is classified as iatrogenesis and is defined as a “medical treatment error”. In the present clinical case, it became the cause of the development of an implant site-specific inflammatory destructive complication. The reduction of chronic peri-implantitis incidence, taking into account its prevalence and problematic nature, requires further research and optimization of the protocols of dental implant treatment.

The study and analysis of the prognosis criteria for a safe local anesthesia in patients with arterial hypertension

Relevance. To develop the algorithm for a safe and effective local anesthesia in dental outpatients with arterial hypertension.Materials and methods. The study was conducted in the laboratory of functional and clinical studies of Moscow State University of Medicine and Dentistry. Electric pulp testing (µA) was performed and pulp microcirculation (PU) was assessed in the intact teeth of patients with hypertension before and 5, 10, 15, 30 and 60 minutes after the administration of local anesthesia. We used 4% articaine solutions without a vasoconstrictor and with its minimal concentration 1:200 000 and 1:400 000, and 3% mepivacaine solution. The safety of the administered local anesthetic was assessed by the continuous hemodynamic monitoring.Results. 4% articaine solution without epinephrine had a shallow anesthetic effect in the maxilla and anterior mandible. 1:400 000 and 1:200 000 vasoconstrictor concentrations in 4% articaine solution increase the depth and duration of the anesthesia from 20 to 30 minutes respectively. Changes in the pulp sensibility but not in blood microcirculation were demonstrated by the functional parameters of the intact dental pulp in patients with hypertension after the administration of 3% mepivacaine solution at the mandibular foramen. The continuous hemodynamic monitoring data showed no changes in arterial blood pressure, heart rate, oxygen saturation on administration of either of the studied local anesthetic solutions or techniques.Conclusion. The analysis of the prognosis criteria for a safe local anesthesia allowed us to ground the choice of anesthetic in dental outpatients with arterial hypertension.

Surgical treatment of multiple gingival recessions by the combination of autograftand allogenic lyophilized dura mater: a clinical case

Relevance. Gingival recession is the apical migration of the gingival tissues associated with the exposure of the roots and alveolar bone loss. The prevalence of single recessions in people over 18 years old is 86.7% whereas multiple recessions, i.e. where all teeth are affected, amount up to 28.6%. High prevalence of the pathology necessitates improvement of the approach and tactic of multiple recession treatment in patients with different phenotypes. Nowadays, the use of autograft is the gold standard of multiple recession treatment. However, the technique has its drawbacks. The purpose of the present work was to assess the response to surgery and evaluate the final result of multiple recession treatment in one subject where the combination of autogenic and allogenic grafts was used in the same study design.Materials and methods. The paper presents and describes a clinical case where auto- and allografts were used in one patient to treat multiple gingival recessions.Results. All parameters of the gingival recession assessment showed comparable clinical benefit in all sites of autograft and allograft (dura mater) application. The root coverage was more than 80% around 13 teeth and less than 80% around 11 teeth.Conclusion. The results of the autograft and allograft (dura mater) application were comparable, response to surgery was the same; besides, the allograft (dura mater) is attractive for combined and independent use during surgical treatment of multiple and especially full-mouth recessions.