Modified Two-Stage Split Technique for Controlled Ridge Augmentation in Horizontally Atrophic Posterior Mandible: the First Stage of Research.

Various bone grafting methods are applied to eliminate horizontal atrophy of the jaws. However, problem complexity brings about ongoing research and development of new ways to achieve the predicted stable and long-term results of implantological treatment. The aim of the study was to evaluate the results of the developed method for bone grafting, a modified two-stage split technique for controlled ridge augmentation in horizontally atrophic posterior mandible, using radiological analysis data. MATERIALS AND METHODS: The study group included 18 patients with horizontally atrophic posterior mandible. According to cone beam computed tomography, 39 jaw segments were assessed before plastic surgery and after applying the two-stage split-crest technique for controlled ridge augmentation. The alveolar ridge width was estimated in the area of its top and at a distance of 1, 3, 5 mm from it using the vector of future implant position and taking into account the angle of inclination of the atrophic region of the mandible. RESULTS: When analyzing edentulous areas in the posterior mandible before treatment, there was rather a large angle of lingual inclination of the alveolar ridge. After 6 months, the average increase in bone tissue width in the region of the alveolar ridge top was 82%, it was 50.6% at a height of 1 mm from the top of the crest, 58.8% at 3 mm height, 46.7% at 5 mm (p≤0.05). Certain patterns of bone tissue growth were revealed depending on the structure of the reconstructed area. The most significant results were obtained in the molar segments of the mandible. CONCLUSION: The developed modified two-stage split technique for alveolar ridge augmentation allows achieving the required volume of bone tissue in the posterior mandible for successful implant treatment.

[Validation of the Russian version of the Fugl-Meyer Assessment of Physical Performance for assessment of patients with post-stroke paresis]. / Validatsiya russkoyazychnoi versii shkaly Fugl-Meiera dlya otsenki sostoyaniya patsientov s postinsul'tnym parezom.

OBJECTIVE: To perform linguistic and cultural adaptation of the Fugl-Meyer Assessment of Physical Performance. MATERIALS AND METHODS: The study for assessment of psychometric properties included 53 post-stroke patients with neurological deficit presented by hemiparesis of different severity. The patients were assessed twice: at admission and after 14 days of treatment and rehabilitation procedures. The Russian version of the Fugl-Meyer Assessment of Physical Performance was developed with consideration of language and cultural characteristics. RESULTS AND CONCLUSION: Results of assessment of psychometric properties of the Russian-language version show its high validity, reliability and sensitivity. The developed Russian-language version of Fugl-Meyer Assessment of Physical Performance is recommended for using by neurologists and rehabilitation specialists both in everyday clinical practice and in clinical studies of patients with post-stroke paresis. The results obtained in the study show necessity for pre-training of specialists who perform assessment of patients with post-stroke paresis using the Fugl-Meyer Assessment of Physical Performance.

[Rehabilitation of patients with multiple sclerosis]. / Reabilitatsiya patsientov s rasseyannym sklerozom.

Multiple sclerosis is a common cause of disability among young and middle-aged people. Despite the modern possibilities of diagnostics and therapy, over time, the disease acquires a secondary progressive character. Rehabilitation of patients at all stages of the disease plays an important role in improving well-being, improving the quality of life, adapting the patient and restoring motor skills. However, there is currently no clear recommendation for the application of specific techniques in each case. The aim of this work was to analyze the available methods of rehabilitation therapy, to highlight the most used and promising ones. Due to the progressive course of the disease, the benefits of rehabilitation measures are usually higher at the initial stages. Nevertheless, nowadays there is a large number of works devoted to rehabilitation measures in patients with moderate and high levels of disability. It has been shown that both inpatient and outpatient rehabilitation has a positive effect on the quality of life and improvement of clinical indicators. Our review describes the main techniques with recommendations for the scheme of application. A comprehensive assessment of the patient's health status, a multidisciplinary team and a personalized approach increase the quality and effectiveness of rehabilitation measures. We also describe our own experience in the treatment of spasticity in patients with a secondary progressive multiple sclerosis.

Preservation of Bone and Soft Tissue Components of the Alveolar Ridge during Immediate Implantation in the Aesthetic Zone of Jaws with Bone Deficiency.

The use of immediate implantation (directly into the extracted tooth socket) in the aesthetic zone is a rather difficult task due to the specific structural features of the bone tissue of the alveolar processes and parts of the jaw. The aim of the study was to develop and evaluate the efficacy of the new method of immediate implantation during restoration of teeth in the anterior part of the jaw with bone deficiency, which allows obtaining a high aesthetic result. MATERIALS AND METHODS: The clinical study involved patients with partially edentulous anterior maxillae, chronic apical periodontitis and dental root fractures in the absence of possibility to restore these teeth with orthopedic structures. To identify the main criteria determining smile aesthetics, the detailed analysis of changes in the bone and soft tissues of the alveolar processes was made based on tooth extraction causes and dates. These criteria included gum biotype, the height of the distal and mesial interdental papillae; the width of the keratinized attached gingival area, gingival zeniths, the alveolar ridge thickness. The condition of the facial alveolar bone wall in the planned intervention area was assessed and its thickness was measured using cone-beam CT scan of the jaw. These parameters were measured during traditional immediate implantation, immediate implantation with a free connective tissue graft, implantation performed using the method developed by the authors and during delayed implantation in the anterior part. In each patient, the obtained data were compared with the results in the respective teeth area on the opposite side before the surgery, 4, 6 months and 1 year after the surgery. RESULTS: Clinical and X-ray studies of the developed method of immediate implantation in the aesthetic zone of the jaw with bone deficiency in the facial alveolar bone wall have convincingly demonstrated its efficacy in the long term (1 year after the surgery). The proposed protocol has made it possible to reduce the length of rehabilitation time, and most importantly, to stabilize and preserve the alveolar ridge architecture. CONCLUSION: The proposed method showed the promising outlook for dental implant-supported restoration in difficult anatomical conditions.

[Motor learning of the post-stroke patients presenting with upper limb paresis on the mechanotherapeutic system].

BACKGROUND: the relevance of this study arises from the high prevalence of upper limb motor impairment and pathological synergy in the post-stroke patients; these conditions are very difficult to correct with the use of the traditional rehabilitation methods. A promising but insufficiently studied approaches are the virtual reality (VR) technology as well as its combination with other techniques. AIM: The objective of the present study was to evaluate the influence of the training making use of the mechanotherapeutic system on the motor function of the paretic hand. MATERIAL AND METHODS: A total of 30 patients were enrolled in this study. The main group comprised 20 of them who completed the training course on the mechanotherapeutic system allowing for separate adjustment of weight support for the shoulder and the forearm, VR feedback with individual setting of the active working space, and augmented functional exercises. The control group consisted of the patients (n=10) who performed the task-oriented motor training course of an equal duration with arm weight support and visual feedback. RESULTS AND DISCUSSION: The assessment based on the Fugl-Meyer scale (FMA) showed the statistically significant changes in the passive motion range in the patients of both groups, but only those comprising the main group were found to experience the improvement of the major movements of the arm, wrist, and hand as well as movements outside synergy (p<0.005). Fine motor skills estimated from the results of the Action Research Arm test (ARAT) improved only in the main group due to the cylindrical and pinch grip (p<0.005). Also, only patients of the main group, improved daily living skills evaluated based on the Frenchay Arm test (FAT) (p<0.005). CONCLUSION: The results of the present study give evidence that the use of combined training with arm weight support and VR feedback contributes to a more complete recovery of motor and daily living skills in the upper limb of post-stroke patients, compared to the classical task-oriented training with visual feedback.

[The influence of physical training with the use of a lokomat robotic system on the walking ability of the patients with post-stroke hemiparesis].

AIM: The objective of the present study was to estimate the influence of the driven gait orthosis Lokomat on the functional mobility in the post-stroke hemiparethic patients and to elucidate the mechanisms underlying the improvement of functional mobility after the treatment. MATERIALS AND METHODS: The study included 141patients presenting with post-stroke hemiparesis of the mean duration 12.00 [3.0; 14.5] months. The patients of the experimental group (n = 100) completed the robot-assisted training course, those of the control group (n = 41) were given conventional gait training therapy under the guidance of a specialist in therapeutic physical training. The results of the treatment were evaluated using the following clinical scales: Fugl-Meyer assessment scale, Modified Ashworth scale and Perry mobility scale. Step symmetry, intra- and inter-joint kinematics were measured using the 3D gait videoanalysis system before and after the treatment course. RESULTS: The study has demonstrated a decrease of step asymmetry, the improvement of kinematic gait parameters (hip flexion/extension and hip abduction/adduction amplitudes, hip abduction/ adduction and knee flexion/extension torque amplitudes) as well as inter- and intrajoint dynamic interactions. It is concluded that these changes can be the main causes behind the enhancement of the functional mobility of walking under the influence of training with the use of the driven gait orthosis Lokomat.

[Immediate implantation after extraction of teeth with chronic apical periodontitis].

The authors introduced an original method of intraoperative ozone and postoperative millimeter wave therapy which the short-term and long-term results of clinical, radiological, microbiological and immunological studies proved to enhance efficiency of immediate implantation in preliminary infected areas.