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11
СМЖ был выше (медиана Lg УЪя - 5,79 (4,16-6,09) коп / мл), чем в группах с энцефалитами неуточненными (4,51 (2,66-4,94) коп / мл р = 0,050 и) и энцефалитами, обусловленными вирусами Эпштейна-Барр, простого герпеса и цитомегаловирусом (4,28 (3,59-4,8) коп / мл р = 0,048 И). Выявлена тенденция к более высокому уровню вирусной нагрузки в СМЖ при туберкулезе по сравнению с церебральным токсоплазмозом и грибковыми поражениями ЦНС.
Ключевые слова: ВИЧ-инфекция, ВИЧ-ассоциированные неврологические заболевания, вирусная нагрузка ВИЧ РНК, спинномозговая жидкость, ЯОС-анализ.
Стаття надшшла: 14.03.18 р.
nervous system, the CSF HIV RNA level was higher (median lg VLs - 5.79 (4.16-6.09) copies/ml) than in other groups of patients with unspecified viral encephalitis (4.51 (2.66-4.94) copies/ml; p = 0.050 U) and encephalitis caused by the Epstein-Barr virus, cytomegalovirus, herpes simplex virus (4.28 (3,59-4.8) copies/ml; p = 0.048 U). Also, a tendency towards a higher level of viral load in CSF at tuberculosis was revealed, than the one at cerebral toxoplasmosis and fungal lesions of the central nervous system.
Key words: HIV infection, HIV-associated neurological diseases, HIV RNA viral load, cerebrospinal fluid (CSF), ROC-analysis.
Рецензент Литвиненко Н.В.
DOI 10.26724/2079-8334-2018-3-65-91-95 УДК: 616.314-089.28.002
FUNCTIONAL COMPARATIVE EVALUATION OF PROSTHESES WITH AND WITHOUT
ELASTIC LINING
E-mail: [email protected]
In accordance with the terms of adaptation in patients with complete removable plate prostheses (CRPP) with and without elastic lining, the functional suitability of prostheses was studied, namely chewing samples were tested, the number of corrections of prostheses with and without elastic lining was determined and the functional possibilities of the chewing system were studied by the gnathodynamometric method. In the first adaptation period the chewing test rate was on average 32±2.4% in patients with non-elastic lining prostheses and 48±1.8 and 52±1.4% in patients with elastic linings PM-S and Ufi Gel P (p<0.05). In the second adaptation period which lasted up to 5 days after the placing of prostheses an improvement in the results of chewing test was noted in the I group of patients the average chewing test was 38±2.1%, while in groups II and III 68±1.6 and 69±1.8% (p<0.001). The same trend is observed in the third adaptation period in patients with a hard acrylic CRPP the average chewing test rate was 64±1.8% and in patients with elastic linings PM-S and Ufi Gel P 92±1.2 and 93±1,6% (p<0.001). The analysis of chewing tests showed that the percentage of food fragmentation was 39% higher in patients who had prostheses with Ufi Gel P lining and 34% higher in patients who had prostheses with an elastic PM-S lining compared to those obtained in patients with prostheses without elastic lining.
Keywords: tooth-jaw system, removable plate prostheses, elastic linings, chewing tests, adaptation to prostheses.
The study is a fragment of the research project "Development and improvement of clinical and technological measures of complex treatment ofpatients with defects and deformations tooth-jaw system" (state registration No.0109U000017).
One of the most common types of dental prothesis, which are used for replasement of lost teeth are partial and full removable dentures. According to a number of authors, the need of removable plate prostheses reaches 40-80% of the total number of patients who apply for prosthetic help. In order of the growth of the part of elder people in the stucture of the population the need of these kind of protheses is becoming obvious [7, 9, 13, 14]. Regardless of the type of removable prosthesis along with the therapeutic properties it has an irritating effect, which is associated with the effect that is provided on the mucosa of the prosthetic bed by the way of chewing pressure transfer, change in the analyzer function of the nerve mucosal receptors, etc [4, 8]. Side effects of dentures are also associated with the principal scheme of their design, as well as problems with self-cleaning, thermoregulation and analyzer functions of the mucous membrane, periosteum and bone of the prosthetic bed.
After placing of the prosthesis in the oral cavity an adaptation process takes place, which shows itself in the gradual decrease of the functional activity of large and small salivary glands, restoring taste, language and motor acts: biting, grinding and swallowing food and the onset of automation of chewing.
There are three periods of adaptation: the first is a strong irritation on the day of the fixation of the prosthesis, which is characterized by increased attention of the patient to the prosthesis, increased salivation, changes in phonetics and decrease in chewing activity, tense lips and even an inadequate general psychomotor reaction; the second period lasts for up to five days, while there is a partial inhibition: the salivation is normalized, dicing and taste sensations are restored, the tense state of soft tissues disappears, chewing activity increases; the third period occurs in 25-30 days, when central inhibitory state occurs: the prosthesis is not already felt as an alien body, there is a complete adjustment of muscular apparatus to the act of chewing, chewing force increases [2, 11].
© V.F. Makeev, Y.S. Leshchuk, 2018
In the orthopedic dental practice the technology of making prostheses using elastic plastics is used to improve the functional peculiarities of complete removable plate prostheses (CRPP) from acrylic plastics. However there are problems of choosing and evaluating the operational properties of various types of elastic plastics and their ability to connect with acrylic plastics, the solution of which will improve the quality of removable plate prostheses, enhance their functional and aesthetic properties, as well as the preservation of surrounding tissues in the oral cavity, remain unresolved [1].
The aim of the study is to improve the quality of orthopedic care for patients with complete absence of teeth by comparative experimental and clinical justification of the use of various types of modern elastic plastics in removable prosthetics.
Materials and methods. To achieve the goal, a clinical examination and treatment of 105 patients with complete absence of teeth was conducted. For each patient a questionnaire was developed that reflected its dental status before, during and after treatment, on the basis of which a computer database was created. Of the 105 patients aged 45-67 there were 53 (50.5%) men and 52 (49.5%) women. Among those who took part in the study patients over 60 years old (44.8%) prevailed; the least were the patients under the age of 50 (22.9%). In total, 176 CRPPs were made, 107 (60.8%) of which were on the lower jaw and 69 (39.2%) on the upper jaw. In the I (control) group, 50 prostheses were made, 32 (64.0%) of which on the lower and 18 (36.0%) on the upper jaw; in the II (experimental) group 65 prostheses were made 39 (60,0%) on the lower and 26 (40,0%) on the upper jaw; in the III (experimental) group 61 prosthesis were made 36 (59,0%) on the lower one and 25 (41,0%) on the upper jaw.
All the patients were divided into three groups:
• Group I (control) - 35 patients, to whom 50 prostheses were made (32 on the lower and 18 on the upper jaw) bases of which are made of acrylic plastics "Ftoraks".
• Group II - 35 patients, to whom 65 prostheses were made (39 on the lower and 26 upper jaw) bases of which were made of acrylic plastics "Ftoraks" and elastic plastic "PM-S".
• Group III - 35 patients, to whom 61 prostheses were made (36 on the lower and 25 maxillary jaw) bases of which are made of acrylic plastics "Ftoraks" and "Ufi Gel P" elastic plastic.
In accordance with the terms of adaptation in patients with CRPP with and without elastic lining the functional suitability of prosthetics was studied, with the administration of chewing test in M.D. Korol modification (1999) the number of prosthesis corrections was determined, as well as the functional possibilities of the masticatory system, the method of gnathodynamometry was used.
In the study we used the proposed gnatodinamometer (patent of Ukraine number 11071) in which removable buccal plates are made of polymer material (fluoroplastics) individually for each patient. The advantages of the proposed gnatodinamometer is that individual removable buccal plates allow a high degree of reliability to measure the chewing pressure that creates the CRPP and also provide for the prevention of infectious diseases. During the gnatodinamometric studies of the stability of the CRPP with and without the elastic lining, the strength created by the prosthesis in the areas of chewing teeth on the left and right and in the frontal section until the displacement of the prosthesis was studied.
Based on the received digital results of experimental and clinical studies databases have been created that have been tested for the normality of distribution using the Epps-Pall's criterion. Since this criterion has shown the normal (Gaussian) character of the data distribution we used the arithmetic mean, its mean square deviation and parametric methods to estimate the probability of the difference in the comparable groups for describing each observation group. In order to assess the reliability of the difference in the results obtained the probability factor (Student's criterion) was used in the study groups.
Results of the research and their discussion. According to the results of the study, it was found that in patients with a non-elastic lining in the prosthesis the need for correction of the prosthesis basis was more frequent compared with patients who were using a CRPP with elastic lining. The correction factor for the basis of prosthesis without elastic plastics averaged 4.2±1.8 and in patients who used dentures with an elastic liner "PM-S" 1.8±1.2 and with an elastic lining "Ufi Gel P" 1.9±1.5 (p<0.05) (Table 1). The results can be explained by the fact that dentures with an elastic lining are softer, cause less injuries to the mucous of the oral cavity, the act of chewing is more comfortable for the patient, and the process of adaptation is faster. Chewing tests at different periods of patient adaptation to CRPP with and without elastic lining showed that prostheses with elastic linings have better functional properties compared to CRPPs without elastic lining. In the first adaptation period (after applying prosthesis) the chewing test rate was on average 32±2.4% in patients with non-elastic lining and 48±1.8 and 52±1.4% in patients with elastic linings of PM-S and Ufi Gel P, (p<0.05). In the second adaptation period, which lasted up to 5 days after the placing of prosthesis an improvement in the results of chewing tests was
noted namely in the I group of patients, the average chewing test was 38±2.1%, while in groups II and III the result was 68±1.6 and 69±1.8% (p<0.001).
Table 1
Correction and Chewing tests (M±m)
Patient groups Prostheses materials Average correction Chewing tests, %
Adaptation periods
1st-period 2nd-period 3rd-period
I Ftoraks 4.2±1.8 32±2.4 38±2.1 64±1.8
II Ftoraks + M-S 1.8±1.2* 48±1.8* 68±1.6** 92±1.2**
III Ftoraks + Ufi Gel P 1. 9± 1.5* 52±1.4* 69±1.8** 93±1.6**
* p<0.05. ** p<0.001.
The same trend is observed in the third adaptation period in patients with a hard acrylic CRPP, the average chewing test rate was 64±1.8%, and in patients with elastic linings PM-S and Ufi Gel P 92±1.2 and 93±1.6% (p<0,001) (Table 1). During the analysis of chewing samples it was found that the percentage of food fragmentation was 39% higher in patients who used Ufi Gel P lining and 34% higher in patients who had prosthesis with an elastic PM-S lining compared to those obtained in patients with dentures without elastic lining. Obviously this is due to the fact that prosthesis with an elastic lining are more stable and adaptation and restoration of functions of the tooth-jaw system is faster. An analysis of gnathodynamometric studies showed that the prosthesis resistance value in patients of the 1st group, who used the CRPP without an elastic lining in the first adaptation period in the left and right side regions was 1.2±0.50 and 1.3±0.25 kg and in the frontal region 1.8±0.25 kg (Table 2).
Table 2
Gnathodynamometric indices (mean values) of prosthesis resistance in compression with _patients of group I in different adaptation periods (M±m)_
Adaptation periods Prostheses resistance pressure, kg
In the lateral right region In the lateral left region In frontal region
1st-period 1.2±0.50 1.3±0.80 1.8±0.25
2nd-period 1.5±0.25 2.0±0.60 2.6±0.35*
3rd-period 2.0±0.25 2.5±0.40* 3.2±0.25*
* p<0.05.
During further observations the stability of the CRPPs increased and in the second adaptation period it was 1.5±0.25 and 2.0±0.60 kg in the lateral regions on the right and left and 2.6±0.35 kg in the frontal section, and in the third adaptation period 2.0±0.25 and 2.5±0.40 kg in the lateral regions on the right and left and 3.2±0.25 kg (p<0.05) in the frontal section.
The results of gnathodynamometric studies in the second group of patients, which made the CRPPs with the elastic PM-S lining showed that in the first stage of adaptation the stability of the prostheses in the lateral sections of the right and left was 1.8±0.50 and 1.9±0.80 kg, and in the frontal section 3.2±0.80 kg. In the second adaptation period the stability of the prostheses was 3.8±0.35 and 3.6±0.25 kg (p<0.05) in the lateral sections of the right and left and 4.6±0.25 kg (p<0.05) in the frontal section, and in the third adaptation period 4.6±0.50 and 4.2±0.25 kg (p<0.05) in the lateral sections of the right and left and 4.8±0.25 kg (p<0.05) in the frontal section (Table 3).
Table 3
Gnathodynamometric indices (average values) of prostheses resistance to compression in _patients^ of group II in different periods of adaptation (M±m)_
Adaptation periods Prostheses resistance pressure, kg
In the lateral right region In the lateral left region In frontal region
1st-period 1.8±0.50 1.9±0.80 3.2±0.80
2nd-period 3.8±0.35* 3.6±0.25* 4.6±0.25*
3rd-period 4.6±0.50* 4.2±0.25* 4.8±0.25*
* p<0.05.
Evaluation of prostheses resistance in patients of the third experimental group who used UFi Gel P elastic lining showed that in the first adaptation period the resistance of the prostheses in the left and right side sections was 1.8±0.25 and 2.0±0.50 kg and in the frontal section 3.8±0.25 kg (Table 4). In the second adaptation period the resistance of the prostheses with the elastic lining Ufi Gel P to compression was 3.7±0.50 and 3.6±0.50 kg (p<0.05) in the lateral sections of the right and left and
4.2±0.50 kg (p<0.05) in the frontal section and in the third adaptation period 4.2±0.80 and 4.2±0.80 kg (p<0.05) in the lateral sections to the right and to the left and 4.4±0.50 kg (p<0.05) in the frontal section.
Table 4
Gnathodynamometric indices (mean values) of prostheses stability in compression with _patients of group III in different periods of adaptation (M±m)_
Adaptation periods Prostheses resistance pressure, kg
In the lateral right region In the lateral left region In frontal region
1 st-period 1.8±0.25 2.0±0.50 3.8±0.25
2nd-period 3.7±0.50* 3.6±0.50* 4.2±0.50*
3rd-period 4.2±0.80* 4.2±0.80* 4.4±0.50*
* р<0.05.
The study of gnathodynamometric parameters revealed significantly better performance in patients using prostheses with an elastic lining. Soft tissue tension is reduced in the shorter term, adaptation to prostheses is faster and chewing activity increases.
Based on the study results, it can be affirmed that prostheses made with an elastic lining are better adopted by patients, the irritation process lasts shorter term. Functional activity of the tooth-jaw system restores in much shorter term. All this leads to an increase in the quality of dentures. Analysis and evaluation of performed functional studies have shown the high efficiency of elastic plastics for the production of CRPP, which in certain clinical situations provides a comprehensive solution to the problem of adaptation, does not require significant material costs. The conducted researches prove the clinical expediency and reliability of the use of CRPPs with an elastic lining in order to prevent the complications that are commonly encountered when using CRPP. The widespread introduction of elastic linings into the practice of health care will increase the effectiveness of orthopedic treatment of patients.
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14. Van der Bilt A. Assessment of mastication with implications for oral rehabilitation: a review. J Oral Rehabil. 2011;38(10):754-780.
15. Williams DW, Chamary N, Lewis MA, Milward PJ, McAndrew R. Microbial contamination of removable prosthodontic appliances from laboratories and impact of clinical storage. Brit Dent J. 2011;211(4): 163-166.
ФУНКЦЮНАЛЬНА ПОР1ВНЯЛЬНА ОЦ1НКА ПРОТЕЗ1В 13 ТА БЕЗ ЕЛАСТИЧНИХ П1ДКЛАДОК Макеев В.Ф., Лещук G.G, Палш А.В., 1ванчишин В.В., Дубровна Л.В.
Вщповщно до термшв адаптаци у пащенив з повними зшмними пластинковими протезами (ПЗПП) i3 та без еластично! тдкладки вивчалась функциональна придатшсть протезiв, а саме, здШснювалися жувальш проби, визначалось число корекцШ протезiв з та без еластично! тдкладки, а
ФУНКЦИОНАЛЬНАЯ СРАВНИТЕЛЬНАЯ ОЦЕНКА ПРОТЕЗОВ С И БЕЗ ЭЛАСТИЧНЫХ ПОДКЛАДОК Макеев В.Ф., Лещук Е.С., Палий А.В., Иванчишин В.В., Дубровна Л.В.
В соответствии с сроками адаптации у пациентов с полными съемными пластиночными протезами с и без эластичной подкладки изучалась функциональная пригодность протезов, а именно, осуществлялись жевательные пробы, определялось число коррекций протезов
також вивчались функцюнальш можливост жувально! системи методом гнатодинамометрй. У першому перюдо адаптацй показник жувальних проб, в середньому, становив 32±2,4 % у пащенив i3 протезами без еластично! пiдкладки та 48±1,8 i 52±1,4 % у пацiентiв i3 еластичними шдкладками ПМ-С i Ufi Gel P вщповщно (p<0,05). У другому пepiодi адаптацй, який тривае до 5 доби шсля накладання пpотeзiв, вiдмiчeно покращення результата жувальних проб, а саме, у I груш пащенив показник жувальних проб, у середньому, становив 38±2,1 %, а в II та Ш групах - 68±1,6 i 69±1,8 % вщповщно (р<0,001). Така ж тенденщя спостepiгаеться i в третьому пepiодi адаптацй - у пацiентiв iз ПЗПП з твердим акриловим базисом середнш показник жувальних проб складав 64±1,8 %, а у пащенив iз еластичними пiдкладками ПМ-С та Ufi Gel P - 92±1,2 i 93±1,6 % вiдповiдно (р<0,001). Аналiз жувальних проб виявив, що вiдсоток pоздpiблeння !ж на 39 % вищий у пацiентiв, як користувались протезами з пiдкладкою Ufi Gel P i на 34 % вищий у пащенив, яю мали протези з еластичною шдкладкою ПМ-С у поpiвняннi з результатами, яю отримано у пацiентiв iз протезами без еластично! пiдкладки.
Kro40Bi слова: зубо-щелепна система, знiмнi пластинюда протези, eластичнi пiдкладки, жувальнi проби, адаптащя до пpотeзiв.
Стаття надшшла 25.06.18р.
с и без эластичной подкладки, а также изучались функциональные возможности жевательной системы методом гнатодинамометрии. В первом периоде адаптации показатель жевательных проб в среднем составил 32 ± 2,4% у пациентов с протезами без эластичной подложки и 48 ± 1,8 и 52 ± 1,4% у пациентов с эластичными подкладками ПМ-С и Ufi Gel P (р<0,05). Во втором периоде адаптации, который длится до 5 суток после наложения протезов, отмечено улучшение результатов жевательных проб, а именно, в I группе пациентов показатель жевательных проб в среднем составил 38 ± 2,1%, а во II и III группах - 68 ± 1,6 и 69 ± 1,8% (р<0,001). Такая же тенденция наблюдается и в третьем периоде адаптации - у пациентов с протезами с твердым акриловым базисом средний показатель жевательных проб составлял 64 ± 1,8%, а у пациентов с эластичными подкладками ПМ-С и Ufi Gel P - 92 ± 1,2 и 93 ± 1,6% (р<0,001). Анализ жевательных проб обнаружил, что процент дробления пищи на 39% выше у пациентов, которые пользовались протезами с подкладкой Ufi Gel P и на 34% выше у пациентов, с протезами с эластичной подкладкой ПМ-С по сравнению с результатами, которые получены у пациентов с протезами без эластичной подкладки.
Ключевые слова: зубо-челюстная система, съемные пластиночные протезы, эластичные подкладки, жевательные пробы, адаптация к протезам.
Рецензент Аветиков Д. С.
DOI 10.26724/2079-8334-2018-3-65-95-99 УДК 616.33/.342-036.12:612.135]-092-053.5
ОСОБЛИВОСТ1 ПЕРЕБ1ГУ ХРОН1ЧНО1 ГАСТРОДУОДЕНАЛЬНО! ПАТОЛОГП ЗА СТАНОМ ПЕРИФЕРИЧНО1 М1КРОЦИРКУЛЯЦП У Д1ТЕЙ ШКЫЬНОГО В1КУ
E-mail: [email protected]
Було обстежено 60 дтей шильного вжу, яю знаходились на стацюнарному лжуванш у гастроентеролопчному вщдшенш з дiагнозом хрошчно! неускладнено! гастродуоденально! патологй. BciM дтм проведено ендоскотчне дослщження верхшх вiддiлiв травного тракту з оцшкою кровонаповнення слизово! оболонки шлунка та дванадцятипало! кишки; проведено капiляроскопiю шгтьового ложа. Пiд час ендоскопiчного дослщження слизово! оболонки шлунка та дванадцятипало! кишки у д^ей iз хрошчними гiпертрофiчними та хронiчними ерозивними гастродуодештами спостерiгались бiльше виражений набряк слизово! оболонки, стаз та наявшсть геморагш, нiж у дiтей з хрошчними поверхневими гастритами та хрошчними поверхневими гастродуодештами, що можна пояснити наслщком порушення кровонаповнення слизово! оболонки шлунка та дванадцятипало! кишки. У д^ей iз хрошчними ерозивними i гшерпластичними гастродуоденiтами частiше виявляли симптоми порушення мкроциркуляцп, а саме: феномен «сладжування», локальний спазм, патологiчну звивистiсть та змшу калiбру капiлярiв, що можна пояснити наслщком вегетативно! дизрегуляцй, яка, в свою чергу, супроводжуеться розладами мжроциркуляцй.
Ключовi слова: дiти шюльного вiку, хронiчна гастродуоденальна патологiя, слизова оболонка шлунка та дванадцятипало! кишки, мкроциркулящя.
Робота е фрагментом НДР «Хронологiчнi аспекти dimbHocmi серцево-судинноi системи у дтей з порушеннями артерiального тиску», № держреестраци 0117U002357.
Гастродуоденальна патолопя посщае провщне мюце в структур! захворюваносп д1тей як i в Укра!ш, так i в свт. За результатами ешдемюлопчних дослщжень, поширенють захворювань гастродуоде-нально! д1лянки в р1зних регюнах Укра!ни становить 140-150 на 1000 дитячого населення i мае тенденщю до зростання [2]. Серед гастродуоденально! патологи у д1тей важливе мюце посщае патолопя шлунка та дванадцятипало! кишки (ДНК), яка становить 50-65% вщ загально! кшькосп захворювань оргашв травлення. За останне десятир1ччя спостерпаеться збшьшення частоти важких форм гастрипв та гастродуодентв у д1тей з розвитком виразково! хвороби, та частотою !х рецидив1в до 75% [1, 2, 8]. Збшьшення кшькосп захворюваносп гастродуоденально! д1лянки у д1тей диктують потребу детального вивчення патогенетичних мехашзм1в захворювання, а також впровадження ефективних метод1в лшування ще! патологи у них [4, 5, 7]. Патогенез уражень гастродуоденально! зони е складним багатофакторним процесом [3, 6]. Внаслщок нерацюнального та неяюсного харчування школяр1в майже у кожно! третьо! дитини в
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