Use of the universal pain assessment tool for evaluating pain associated with temporomandibular disorders in youngsters.

AIM: Determine, whether the UPAT could be used as an extra tool to collect data on functional TMJ pain and to assess orofacial pain levels related to temporomandibular disorder(s) (TMD) in youngsters. METHODS: Patients were screened at the N1 Dental Clinic of Tbilisi State Medical University. The clinical scores of possible functional jaw pain were collected using the UPAT, to indicate pain severity on a visual scale during different jaw movements (opening, closing and lateral). STATISTICS: Comparisons of categorised data have been performed by chi-square test and Fisher's Exact test (where expected values were less than 5). The P value less than 0.05 was considered as statistically significant. RESULTS: Two hundred and ninety-one youngsters were screened by calibrated dentists. The majority (59%) of participants were male; age distribution ranged from 8 to 15 years (mean 11.46 ± 2.11). The results of the UPAT demonstrated the existence of functional TMJ pain in 15.46% (n=45) of the patients without significant prevalence (P > 0.05) in this survey group. CONCLUSION: According to the results of the present study, the UPAT demonstrated that it could be an additional tool to detect the existence of functional jaw pain possibly associated with TMD and also a valid instrument to score pain intensity associated with TMD in youngster patients.

GUIDED REGENERATION OF JAW BONE DEFECTS WITH COMBINATION OF OSTEOPLASTIC MATERIALS AND STEM CELLS.

Reconstruction of mandibular defects is a challenging issue in maxillofacial surgery. Success of the treatment is defined by the process of reparative regeneration of bone tissue, which is often accompanied with wound infection, failure of microcirculation and tissue hypoxia. Aim of our project was to demonstrate the advantage of osteoplastic material and bone marrow derived mesenchymal stem cells combination in regeneration of lower jaw bone defect. For this reason, mandibular bone defect was created in laboratory rats. Experimental treatment of animals was performed in three different ways: group 1. - Bone defect was regenerated without any treatment, group 2. - Bone defect was filled with osteoplastic material (BIO-OSS), group 3. - Bone defect was filled with BIO-OSS, which was previously infiltrated by bone marrow mesenchymal stem cells. Animals were under observation for 6 months. During this period bone regeneration was comparatively analyzed in these tree experimental groups. Observational, histochemical and x-ray research methods were used in this study. Our results suggest that use of osteoplastic material and mesenchymal stem cells combination can increase formation of red bone marrow, which is normally slow under natural condition. Therefore, we can conclude that application of osteoplastic material with bone marrow derived mesenchymal stem cells can decrease time of bone defect osteointegration and define the quality of regenerated bone tissue.

NEW METHOD OF BONE AUGMENTATION DU-RING DENTAL IMPLANTATION IN LAB ANIMALS.

The success of surgical treatment of maxillo-facial bone defects depends on bone regeneration ability. Bone volume can be restored by surgical implantation of various biomaterials, which have ability either to accomplish mechanically the function of bone or to produce the induction effect on bone regeneration process. Latest advancements in tissue engineering are enabling to find new materials with significantly less disadvantages than the currently used osteoplastic materials. Therefore, the aim of our experimental study was to evaluate the efficiency of decellularized bovine bone matrix for reconstruction of jaw bone defects during implantation in animal model. In control group mandibular bone defected has been modelled, while in experimental group in modelled defect has been placed implant and decellularized bone graft. Animals were under surveillance and then sacrificed. Reparative processes in tissues has been monitored by morphologic and radiographic evaluation. The results revealed that the presented bone matrix during dental implantation enables complete reparational regeneration of bone and ideal osseointegration of dental implant, ensures local realization of potential of osteoprogenitor cells, accelerates osteogenesis and decreases the time of healing, due to its osteoinductive and osteoconductive abilities So we can suggest that natural mineral bone matrix developed by us, will meet all the claims mentioned above and will be effective in clinical practice.

Use of the universal pain assessment tool for evaluating pain associated with TMD in youngsters with an intellectual disability.

BACKGROUND: The Universal Pain Assessment Tool (UPAT) was used to assess the level of pain in people with limited communication skills. The UPAT enables clinicians to consult a specialized pain management team more often and lead to earlier interventions. The purpose of this study was to determine, whether the UPAT could be used as an extra tool to collect data on functional TMJ pain and to assess orofacial pain levels related to temporomandibular disorder(s) (TMD) in people with intellectual disabilities (ID). MATERIAL AND METHODS: Non-down syndrome ID Athletes were screened during the Special Olympics European games in 2014. The clinical scores of possible functional jaw pain were collected using the UPAT, to indicate pain severity on a visual scale during different jaw movements (opening, closing and lateral). RESULTS: Two hundred and four youngsters were screened by calibrated dentists. The majority (65%) of participants were male (133 male and 71 female athletes); age distribution ranged from 15 to 23 years (mean 19.25 ± 2.53). The results of the UPAT have shown the existence of functional TMJ pain in 32% (n=65) of the athletes without significant prevalence (P > 0.05) in this survey group. CONCLUSIONS: According to the results of the present study, the UPAT demonstrated that it could be a useful tool to detect the existence of functional jaw pain possibly associated with TMD and also a valid instrument to score pain intensity associated with TMD in people with ID.

Restoration of jaw bone tissue defect using osteoplastic material.

UNLABELLED: The aim of the study was to repair mandibular bone defect using BIO-OSS artificial bone implantation. The experiment was conducted on 30 white laboratory rats. Defect in the bone of lower jaw was created surgically. Animals were divided into 2 groups. 15 animals were allocated in control group. Another 15 animals were allocated in the BIO-OSS treatment group. CONTROL GROUP: analysis revealed bone defect in 6-month after modeling of bone defect. There was no pronounced proliferation of connective tissue visible in the defect area. Treatment group: In the samples of treated group, BIO-OSS bone mass formed basophilic fiber-like structures. It was surrounded with the thin proliferative connective and granulation tissues. CONCLUSIONS: proposed technique of bone defect reconstruction is an effective and sustainable method and can be recommended for wider use in clinical practice.

Temporomandibular joint disorder (review).

Etiopathogenesis and clinical management of TMJD integrates a number of medical disciplines. In particular, dentistry, oral - facial surgery, neurology, rheumatology and so on. Nowadays there is no unified strategy for the management of this disease. Most cases of temporomandibular disorder (TMD) respond to simple treatment and the prognosis is good. Symptoms usually remit with simple care. In cases of secondary involvement of temporomandibular joint (TMJ), the prognosis depends on the primary disease. A comprehensive, chronological history and physical and examination of the patient, including dental history and examination, is essential to diagnose the specific condition to decide further investigations, if any, and to provide specific treatment. in severe cases, a joint consultation of a dentist, neurologist and rheumatologist is needed.

Use of osteoplastic material to guide bone tissue regeneration deffect.

The goal of research was study of restoration processes in jaw-teeth bone defects by application of osteoplastic materials in the experiment. The experiment was performed over 32 white (6-12 month old) rats; the animals were divided into 2 groups; 16 animals were enrolled in the first group; the section was performed in the edge of lower jaw; the lower jaw body was revealed. Under the effect of the dental drilling machine and the # 1 cooling mean by the fissure bohrium (distilled water) the defect of the dimension of 2x2 mm was created; the defect was washed by 0/9% saline to remove the bone sawdust; the wound was sutured tightly, in layers. The second group of the experiment was staffed with 16 animals (main group); the similar bone defect of the size 2 x 2mm was created on the rat's jaw's body. After washing of modeled defect we inserted osteopathic materials PORESORB-TCP crystals with the size of 0,6-1.0 mm the wound was sutured tightly, in layers. After the 3-rd, 15-th, 30-th and 90-th days from the date of operation there was performed X-ray and morphological examination over the animals in the control as well as the main group. The analysis of the examination performed over the experimental materials showed that in the control group in samples taken at 90th day the defects were not completely restored. In the test group in samples taken at 90th day reparative regeneration is confirmed. This is stimulated by the factor that within the main group's animals the defect regeneration process is supported with the osteoplastic material PORESORB-TCP.

[One-stage reconstruction of zygomatico-orbital complex with the use of implants of different origin].

Reconstruction of zygomatico-orbital complex remains as one of the troublesome and topical problems at steady posttraumatic deformations and fresh traumas of the mentioned region. The present work provides analysis of our own experience of surgical treatment of patients suffering from posttraumatic deformations and defects of zygomatico-orbital complex. The work was based on the results of examination and treatment of 33 patients who underwent an operation during the period from 2003 to 2008 years. Of 33, 21 patients were operated due to fresh traumas of the zygomatico-orbital region, and 12 - due to steady posttraumatic deformations of the mentioned region. Of 33 clinical cases, 19 patients underwent reconstruction of zygomatico-orbital complex with the use of implant. In 11 cases implants were perforated titanic plates, in 6 cases - bone cement (Surgical Simplex P), and in 2 cases - combination of titanic plates with bone cement. The results of our investigations have shown that one-stage reconstruction of zygomatico-orbital complex with the use of titanic plates and bone cement liquidates functional and cosmetic disorders. It has been suggested that the use of elaborated complex approaches in treatment of posttraumatic deformations and fresh traumas of zygomatico-orbital region is reasonable and acceptable.

Bone marrow-derived mesenchymal stem cell plasticity and their application perspectives.

The aim of this review is to summarize recent developments in research on the characteristics of bone marrow-derived mesenchymal stem cell plasticity. Stem cells are uncommitted entities capable of both self-renewal and differentiation into multiple cell lineages. In general, there are certain types of stem cell populations that are identified from embryonic and postnatal tissues. Embryonic stem cells are derived from mammalian blastocytes and theoretically have the ability to generate differentiated cell types arising from the three germ layers: mesoderm, ectoderm and endoderm. In contrast, postnatal stem cells are thought to be tissue specific, committed precursors capable of developing into a restricted number of cell lineages. Bone marrow stromal stem cells (BMSSCs), also known as mesenchymal stem cells, have been identified as a population of organized hierarchical postnatal stem cells with the potential to differentiate into osteoblasts, chondrocytes, adipocytes, cardiomyocytes, myoblasts and neural cells. Recently, studies on the plasticity of BMSSCs challenge the traditional dogma that the differentiation and commitment of postnatal stem cells are limited to cell populations resident in their local environment. Current boneregenerative techniques, such as autologous bone grafting, allografts and alloplastic materials, have limitations that hinder their use in a wider range of clinical conditions. Hence, the development of improved methods, such as BMSSC-mediated bone regeneration, is necessary for achieving future viable therapeutic alternatives.

[Osteoplastic materials in the treatment of parodontosis].

Efficiency of bioactive osteoplastic composition HA-phage at a surgical stage of combined treatment of chronic generalized periodontitis was examined. The results obtained in the control and experimental groups proved that HA-phage allows reducing the time of treatment and to achieve remission of the disease. Out of 92 patients with chronic generalized periodontitis 52 undertook microplasmic scalpel-irradiator in complex treatment. The treatment course comprises 3-5 procedures. The quantity of manipulations is determined by the pathological process. Before and after the treatment the radiographic investigations were carried out in persons of both groups. 18 months later after the operation a bone regeneration was shown in 87,8% cases in the investigated group and 60,1%--in the control group patients. The therapy has shown positive results. So, the new method of treatment of chronic generalized periodontitis may prove to be more practical in clinical dentistry. Currently, it is possible to isolate highly purified BMSSCs from bone marrow using STRO-1. The management of periodontal defects has been an ongoing challenge in clinical periodontics. This is mainly a result of the fact that the tissues which comprise the periodontium, the periodontal ligament, and the cementum and alveolar bone represent three unique tissues in their own right. Thus, reconstruction of the periodontium is not just a simple matter of regenerating one tissue but involves at least three quite diverse and unique tissues. Taking into account the results of recent studies we hypothesize that mesenchymal stem cells transplantation should be a perspective approach in the treatment of periodontal defects. For this purpose we plan to perform an experimental investigations which will include an induction of periodontitis, purification of the bone marrow stem cells and their transplantation.

[Morphological peculiarities of consolidation of experimental mandible fractures by osteosynthesis using Kollapan and retabolil].

The Purpose of the research was to study in the experiment morphological particularities of mandible fracture consolidation by osteosynthesis using Kollapan and Retabolil. The experiments were carried out on sexually matured rabbits. In the first series of the experiments (the control group), mandibula bones fracture was prototyped lower, whereas bone fragments were fixed by miniplate. In the second series of the experiments (the study group) bone fragments were bolted by the above mentioned way but diastase between bone fragments was filled by Kollapan granules, containing klaforan, and animals were intramuscularly anabolic material (the retabolil 0.4 mg/kg). On the 3-d and 15-th days, as well as, after 1 and 2 months after operation observing all corresponding rules, animals were killed and patologico-anatomic study of jaw bone was carried out. The analysis of the results showed that in experimental animals both in the control and the study groups reparative regeneration of bone tissues runs with the formation of periosteum and intermedium regenerator, at the same time consolidation of the bone defect in the main group occurs earlier than in the control group. The Results of the studies point out that Retabolil under osteosynthesis is an osteoinductive material and Kollapan, having osteoinductive, osteoconductive, and osteoprotective characteristics, promotes speeding of the process of jaw bones fracture consolidation.

[Ozonotherapy for the treatment of parodontitis].

The positive influence of O(3) ozone oil on the immune-morphological changes of mucous membrane is associated with several factors. It can be assumed that ozone oil has the ability of suppressing antigen binding feature of the mucous membrane of the gum. This may be concluded by the decrease of focal lympho-histio-monocytic infiltration in mucous membrane. On the other hand, ozone oil decreases the signs of catarrhal inflammation and concomitant immune-morphological changes. Ozone normalizes vascular permeability related with delayed-type hypersensitivity reaction. We can conclude that using ozone oil in the complex treatment of parodontitis results in very obvious morphological and clinical effects. This is manifested by the quick normalization of the clinical picture. The clinical indices normalized in three days. Bleeding and mucous discharge from the gums disappeared and the colour of the gums changed positively.

Immune status during fracture of lower jaw.

Immune status during fracture of lower jaw is a very important factor of pathogenesis. Immune depression is developing shortly after the trauma and it turns out to be a bad prognostic sign, during which the risk of developing the bone wound complications and traumatic osteomyelitis increase, and in case of absence of such complications we are faced with significant extension of a term of healing of bone wounds. We have carried out immune studies in 20 patients with lower jaw fractures. To study SlgA and lysozyme activity we took saliva and studied percentage of T- and B-lymphocytes (and their sub-populations) in blood by the use of micro method. Immunoglobulins were defined by the method of radial immuno diffusion; we determined the interferon system by in vitro stimulation of leucocytes; neutrophilic phagocyte activity was studied by the method of Kost U.A. and Stepko M.I. According to the obtained results, during fractures of lower jaw sharp decrease of interferon system and significant decrease of phagocyte activity was observed. Likewise was decreased lysozyme and SlgA indices, which refer to the depression of immune status of mouth cavity. From the cell immunity indices the decrease of T-activators and T-helpers and reduction of immunoregulation index should be emphasized. Quantity of B-lymphocytes was decreased by 10%. With the practical point of view the obtained results refer, alongside with carrying out the surgical, orthopedic and anti-microbial treatments, to the urgency of application of activators of phagocytosis, interferon and lysozyme immunomodulators. With the view of correction of cell immunity it is necessary to correct factors of T-lymphocytes and to increase activity of SigA and lysozyme, as the factors determining local resistance. The results obtained by us are rather important with the view of both immunology and applied, practical medicine. It enables us to lead the substantiated immune therapy, which will be harmonized with other etiotropic anti microbial therapy and will help us to improve significantly the results of anti-inflammation therapy and to decrease cases of purulent complications.

[Peculiarities of mandible fracture consolidation while applying different methods of treatment].

Purpose of the study was the photodensitometrical estimation of the efficiency of using kolapan granules in combination with the retabolil injection, during the osteosinthesis in the cases of mandible fracture. The operative treatment of patients was realized at the second day following the trauma. The Patients were divided into three groups: 1-st group (20 patients), where fixing was done by intermaxillar Tigerstadt device, in the 2-nd group (20 patients) osteosinthesis was carried out by the titanium miniplates ("LIM"), while in the 3-rd group (20 patients) - osteosinthesis with the use of the same titanium miniplates ("LIM"), kollapan granules (the company "Intermedapatit") and intermuscular injection of retabolil (the company "Gedeon Richter") - 50mg (5%) was performed. Radiography was carried out in patients in standardized conditions, at the day of operations, at the 1-st, 4-th and 24-th weeks after trauma. From the gained results the significant advantage of osteosinthesis in combination with filling the defect by Kollapan granules and usage of retabolil in comparison with the intermaxillar fixation and usual osteosinthesis is obviously seen. The process of osteogenesis under such treatment is significantly faster.

Immune status during odontogeneous abscesses and phlegmonas.

Odontogeneous abscesses and phlegmonas are considered as one of the most urgent problems for stomatology. By its localization and complications the patients suffering from this pathology clearly show weakening of protective mechanisms of organism. By the use of modern methods of immunologic research we studied the nonspecific, cell, humoral and specific immune status. Study of immune status proved drastic decrease in nonspecific resistance indices, namely complete phagocytosis, total number of phagocytosis and phagocytosis index, as well as decreased alpha and beta interferon concentration. Cell immunity indices show decrease of number of T-effectors, T-helpers, T-lymphocytes and T-suppressors. Study of humoral immune status proved insignificant decrease of B-lymphocytes, Ig G, Ig M and Ig A. Serologic studies showed many-fold increase of concentration of anti-staphylococcus antibodies and presence of alpha -toxin (alpha -toxin must be absent in the norm). The results obtained by us refer to necessity of carrying out therapy with immune modulators alongside with the etiologic treatment of this pathology.

[Use of plasmic irradiator in complex treatment of odontogenic purulent-inflammatory diseases of maxillo-facial region].

The aim of the work was the study of the possibilities of use of plasmatic stream as a therapeutic mean. The work had both experimental and clinical nature. By means of experiments carried out on the rabbits the influence of plasmatic stream on microorganisms, as well as its influence on the processes of reparative regeneration has been studied. It was shown that the plasmic radiation has a strong bactericidal effect, it causes stimulation of reparative regeneration in the soft tissues of the organism. Plasmic therapy speeds up the process of metabolism in the organism, improves microcirculation and stimulates immune responses. Plasma irradiation quickly removes edemas end pain, speeds up healing of infected or aseptic wounds. Use of plasmatic stream in a complex treatment of different diseases considerably speeds up the time of treatment and is very cost-effective.

[Experience with the use of Soviet interstitial expanders for eliminating soft-tissue defects in the head and neck area]. / Opyt ispol'zovaniia sovetskikh vnutritkanevykh ékspanderov dlia ustraneniia miagkotkannykh defektov v oblasti golovy i shei.

Extension of the skin with the help of an interstitial expander allows to rationally use local tissues. Soviet models of tissue expanders of different designs were developed and approved in clinic. 46 operations were performed on 23 patients. Effective results of using the expanders were obtained during repairing extensive defects of the hairy part of the head.