ALGORITHM OF COMPLEX REHABILITATION OF PATIENTS WITH IATROGENIC OCCLUSAL DISORDERS COMBINED WITH VERTICAL MALOCCLUSION.

OBJECTIVE: The aim: To propose the algorithm of complex rehabilitation of patients with iatrogenic occlusal disorders combined with vertical malocclusion and prove its efficiency. PATIENTS AND METHODS: Materials and methods: 55 patients with iatrogenic occlusal disorders combined with vertical malocclusion aged from 23 to 47 years old (mean age 36.1±5.2 years) including 32 females and 23 males were examined at Dental Medical Center of Bogomolets National Medical University during 2019-2021 years. All patients before and 6 months after treatment underwent clinical and laboratory examination, X-ray, electromyography, T-Scan Digital Occlusal Analysis. RESULTS: Results: In all 3 groups of patients we observed complete disappearance or significant reduction of complaints and symptomatic manifestations after 6 months of complex rehabilitation. CONCLUSION: Conclusions: Our study showed that the proposed algorithm of complex rehabilitation of patients with iatrogenic occlusal disorders combined with vertical malocclusion, which provides a multidisciplinary and individualized approach, improves the efficiency of orthodontic treatment of such patients and significantly reduces the duration of treatment in all 3 groups. This sequence of diagnostic and treatment measures gives the best opportunities for the patient to achieve maximum functional and aesthetic result.

The regulatory role of the RANKL/RANK/OPG signaling pathway in the mechanisms of tooth eruption in patients with impacted teeth.

BACKGROUND: Tooth impaction is a common problem in orthodontic practice and in some cases accompanied by pain and pathological changes of surrounding teeth. Understanding the cellular and molecular mechanisms underlying tooth impaction allows finding the most effective orthodontic treatment for patients with impacted teeth (IT). RANK (receptor activator of NF-κB) / RANKL (RANK ligand) / OPG (osteoprotegerin) signaling pathway controls bone resorption and may be involved in the regulation of tooth eruption. The study aimed to evaluate bone remodeling based on the assessment of the RANKL/RANK/OPG status in patients with IT. METHODS: Bone samples from 18 patients (mean age 25.27 ± 3.34) were divided into 3 groups: 1 - bone tissue of healthy persons (control group); 2 - bone tissue, that was taken near the healthy tooth in patients with tooth impaction; 3 - bone tissue, that was collected near the IT. Levels of RANKL, RANK, OPG, osteocalcin (OC), NF-κB p65 subunit, NFATc1, and caspase-3 were determined by western blotting. The difference between groups was assessed using ANOVA followed by Tukey's post-hoc test. P-value ≤0.05 was considered statistically significant. RESULTS: We established a 1.73-fold elevation of RANK level in the IT area vs. control, indicating the recruitment of preosteoclasts. An increase in RANKL, OPG, and OC content was demonstrated (1.46-, 1.48-, and 1.42-fold respectively), reflecting the high activity of osteoblasts near the IT. Despite the activation of the RANKL/RANK/OPG system in the impaction area, NF-κB and NFATc1 levels did not change compared vs. control, indicating a blocked/delayed process of osteoclastogenesis. We found a decrease in the content of procaspase-3 (1.28-fold), while the level of its active form p17 increased by 2.26 folds near the healthy tooth in patients with IT compared with control. In the area of ​​IT, we observed an increase in procaspase-3 and p17 levels (1.32 and 1.78 folds). This reflects impairments of caspase-3 activation and accumulation of its inactive form in the IT area that may contribute to the tooth eruption failure. CONCLUSIONS: Tooth impaction may be associated with the disturbances in the caspase-3 cascade activation and the imbalance in the RANKL/RANK/OPG system, and as a result, blocked bone resorption.