Bobkova S.A., Kazinina E.N.

Department of Prosthetic Dentistry (Head prof. Zhadko S.I)

SI “Crimea State Medical University named after S. I. Georgievsky”

Cytomorphological criteria in prosthetic dentistry

Recent studies have shown that intraosseous implantation does not always provide stable and guaranteed results. 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. Analysis of the literature showed that remaining in sufficiently in studied issues was related to the development of early infectious complications in periimplantic soft tissues and (heir 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. Thus, the purpose of this study was cytomorphometrical monitoring of periodontal cellular elements after implantation m orthopedic patients suffering from peptic ulcer and duodenal ulcer.

This method is based on research cytometric 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 lit ting it to the neck, of the implant (zone interface), the employee base for the prosthesis. The prints were taken from the gingival sulcus of periimplantic 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 Romanovsky-Giemsa method. Further cytological preparations were examined under a microscope. A review on large fields cell count was performed in 2 major cell populations and cytogramms: 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 = (e/n1)+(е2/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 (c.u).

The average values of the index periodontal destruction:

If the state standards - SD1 = 12.09 - 13.03

With weakly expressed inflammation - SD1 - 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: first group consisted of orthopedic patients without, somatic diseases - 20 patients; in the second - orthopedic patients with somatic pathology (peptic ulcer and duodenal ulcer) - 27 patients and third group consisted of 25 patients requiring prosthetic care and with background somatic pathology, which in the first 30 days after implantation through day were introduced immunomodulator “Erbisolum” 1 ml. In addition, we examined 15 healthy persons (norm) without need of prosthetics -as the control group. Prosthetic treatment was carried out by two-stage implantation technique endosteal screw implants «U-Imple».

For the study we have used the drug “Erbisolum” - immunomodulator, restorer and 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 c.u., which was 38% (p<0,01) above the benchmarks (Table 1). A somewhat different pattern was observed, in patients from second and third groups (prosthetic patients with concomitant somatic diseases, gastric ulcer and duodenal ulcer), where the index periodontal destruction increases relative to controls at 53.4% (p<0,01) and amounted to 18,55±0,45 c.u. in the second group and 39,2% (p <0,001) in the third group, and amounted to 16,84±0,31 c.u. By 6 months after implantation in prosthetic 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 that time observing patients of the second group, 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 m patients 3 groups (orthopedic patients with somatic pathology, which after implantation applied immunomodifier «Erbisolum» index of periodontal destruction decreased and amounted to 13,82 0,42 c.u. 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 one year the performance index of periodontal destruction in first and third groups didn’t differ from control group and patients from second group were close to reference data.