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Scaffold-based
tissue
engineering:
rationale
for
computer-aided design and solid free-form fabrication
systems. Trends Biotechnol. 2004; 22: 354—362. doi.
org/10.1016/j.tibtech.2004.05.005.
29.
Jansen J., Melchels F.P., Grijpma D.W., et
al.
Fumaric
acid
monoethyl
ester-functionalized
poly
(D,Llactide)/N-vinyl-2-pyrrolidone
resins
for
the preparation of tissue engineering scaffolds by
stereolithography.
Biomacromolecules.
2009;
10:
214—220. doi: 10.1021/bm801001r.
30. Jones A.C., Ams C.H., Hutmacher D.W., et al.
The correlation of pore morphology, interconnectivity
and physical properties of 3D ceramic scaffolds with
bone ingrowth. Biomaterials. 2009; 30: 1440-1451.
doi: 10.1016/j .biomaterials.2008.10.056.
31.
Jones A.C., Ams C.H., Sheppard A.P., et al.
Assessment of bone ingrowth into porous biomaterials
using MICRO-CT. Biomaterials. 2007; 28: 2491-
2504.
32.
Kanczler J.M., Ginty P.J., Barry J.J., et
al. The effect of mesenchymal populations and
vascular endothelial growth factor delivered from
biodegradable polymer scaffolds on bone formation.
Biomaterials. 2008; 29: 1892-1900. doi: 10.1016/j.
biomaterials.2007.12.031.
33.
Karageorgiou V., Kaplan D. Porosity of 3D
biomaterial scaffolds and osteogenesis. Biomaterials.
2005; 26: 5474-5491.
34. Petrie Aronin C.E., SadikK.W., Lay A.L., et al.
Comparative effects of scaffold pore size, pore volume,
and total void volume on cranial bone healing patterns
using microsphere-based scaffolds. J Biomed Mater
Res A. 2009; 89: 632-641. doi: 10.1002/jbm.a.32015.
35.
Oh S.H., Park I.K., Kim J.M., et al. In vitro
and in vivo characteristics of PCL scaffolds with pore
size gradient fabricated by a centrifugation method.
Biomaterials. 2007; 28:1664—1671.
36.
Rose F.R., Cyster L.A., Grant D.M, et al. In
vitro assessment of cell penetration into porous
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channel. Biomaterials. 2004; 25: 5507-5514.
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Uebersax L., Hagenmuller H., Hofmann S., et
al. Effect of scaffold design on bone morphology in
vitro. Tissue Eng. 2006; 12: 3417-3429.
38.
Francesco Baino, Silvia Caddeo, Giorgia
Novajra,
Chiara
Vitale-Brovarone.
Using
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bioceramic scaffolds to model healthy and osteoporotic
bone. Journal of the European Ceramic Society, 36
(2016), 2175-2182.
39. Dilshat U. Tulyaganov, Avzal Akbarov, Nigora
Ziyadullaeva, Francesco Baino Biological Evaluation
of a New Sodium-Potassium Silico-Phosphate Glass
for Bone Regeneration: In Vitro and In Vivo Studies.
Materials 2021,14,4546.
Аннотация.
Трщмалар
инженериясининг
жадал
ривожланиши
ва
остеопластик
магериаллар тижорат ассортиментининг кенгайиб
бораётганлигига карамай, хозирги вактда дунёда
суяк
тукималари
нуксонларини
даволашнинг
ягона умумэътироф этилган “олтин стандарти”
мавжуд
эмас.
Скаффолдни
танлаш
тукималар
реконструкциясининг
якуний
муваффакдяти
билан
боглик;
булган
асосий
элементларидан
бири булиб хисобланади. Ушбу шарх скаффолд
турлари,
уларга
куйилган
талаблар,
тайёрлаш
технологиялари ва уларни куллаш имкониятларига
багишланган.
Калит сузлар: тукима инженерияси, скаффолд,
скаффолд тайерлаш услублари, биоактив керамика,
остеопластик материаллар.
Аннотация.
Несмотря
на
стремительное
развитие
тканевой
инженерии
и
расширение
коммерческого
ассортимента
остеопластических
материалов,
в
настоящее
время
единый
общепризнанный
«золотой
стандарт»
лечения
дефектов
костной
ткани
в
мире
отсутствует.
Выбор скаффолда является одним из ключевых
элементов, от которого зависит конечный успех
реконструкции тканей. Данный обзор посвящен
видам скафолда, требованиям к ним, технологиям
изготовления и возможностям из применения.
Ключевые
слова:
тканевая
инженерия,
скаффолды,
техника
изготовления
скаффолдов,
биоактивная
керамика,
остеопластические
материалы.
Summary.
Despite the rapid development of tissue
engineering and the expansion of the commercial
range of osteoplastic materials, there is currently no
single universally recognized “gold standard” for the
treatment of bone tissue defects in the world. Scaffold
selection is one of the main elements on which the
ultimate success of tissue reconstruction depends.
This review is devoted to the types of scaffolds,
requirements for them, manufacturing technologies
and application possibilities.
Key words:
tissue engineering, scaffolds, scaffolds
manufacturing,
bioactive
ceramics,
osteoplastic
materials.
88
ОБЗОРНЫЕ СТАТЬИ
УДК: 616.379-008.64:616.31:576.8:616-08
DIABETES MELLITUS AND DENTAL HEALTH: PROBLEMS OF DIAGNOSIS AND
TREATMENT OF PATIENTS IN DENTAL CLINICS
Samatov U.A.
Andijan State Medical Institute
Diabetes mellitus (DM) belongs to a group of
socially
significant
non-communicable
diseases
that are widespread throughout the world. In 2012,
according to various sources, there were from 347
to 371 million patients with diabetes in the world,
of which 490 thousand were children. By 2030, 552
million patients with diabetes are expected (9.9%
of the adult population). Patients with diabetes need
life-long treatment, which is expensive and is not
always fully provided by medical and social insurance
systems [23,25,26,32].
In most cases (from 80 to 97%), patients develop
type 2 diabetes mellitus. Type 1 diabetes (DM-1)
occurs predominantly before the age of 40. More than
half of the sick are children, the peak incidence is at 14
years of age. The disease begins acutely, with classic
symptoms (polyuria, polydipsia, etc.; Table 1), and is
usually quickly diagnosed. Type 2 diabetes (DM-2) is
mainly affected by elderly people, but every year an
increasing number of people who become ill at a young
and even childhood age are registered. The clinical
picture of CD-2 in more than half of patients is not
expressed, in many it manifests itself gradually, with
non-classical
or
minimal
symptoms(fatigue,itching,
increased appetite, etc.;), which do not cause concern
and complaints. Therefore, CD-2 is not diagnosed
for a long time, it is detected by chance. However,
in 20-30% of cases, T2DM in childhood and
adolescence manifests sharply, as T1DM. The danger
of CD-I and CD-2 lies in the development of chronic
hyperglycemia in patients, leading to early and late
vascular complications from many organs and systems
of the div, the most serious are coronary heart
disease (IHD), nephropathy, retinopathy, diabetic foot
syndrome , polyneuropathy, leading to disability and
premature death of patients [11,25,30,33].
What a dentist should know about diabetes. Given
the high prevalence of diabetes mellitus and the
adverse effect on the dental health of patients, dentists
should be well aware of:
Dental health in patients with diabetes is
deteriorating.
There is an accelerated eruption of
permanent teeth in children, more pronounced in girls;
teething is accompanied by gingivitis [19].
-
There are structural changes in the salivary glands,
impaired salivation and biochemical changes in the
composition of saliva, which in turn causes xerostomia
and the development of further complications: multiple
caries, candidiasis, halitosis [6,32].
Against
the
background
of
systemic
immunosuppression, chronic diseases of the oral
mucosa develop (lichen planus, recurrent aphthous
stomatitis,
recurrent
bacterial,
viral
and
fungal
stomatitis),
opportunistic
infections,
multiple
abscesses
during
periodontitis,
halitosis,
surgical
interventions, implant engraftment is worse [25,32].
-
Neurological disorders are manifested in the oral
cavity in the form of stomatalgia (the main symptoms
are burning in the mouth and tongue) and taste
perversion; prolonged existence of stomatalgia leads
to a violation of oral hygiene, and taste perversion
leads to hyperphagia and obesity, inability to follow
a diet; as a result, glycemic control deteriorates in
diabetic patients [32].
-
The composition of microflora in patients with
controlled diabetes is the same as in periodontitis; in
uncontrolled diabetes, it changes: the percentage of
colonies of TM7, Aqqreqatibacter, Neisseria,Gemella,
Eikenella,
Selenomonas,
Actinomyces,
Capnocytophaga,
Fusobacterium,
Veillonella
and
Streptococcus
genera
increases,
Porphyromonas,
Filifactor, Eubacterium, Synerqistetes, Tannerella and
Treponema genera decreases [7].
A
two-way
relationship
between
diabetes
mellitus and periodontitis has been proven.
Most
patients with diabetes develop periodontal disease,
in 10% of cases, patients with periodontal pathology
are diagnosed with diabetes. The interaction model
described by Grossi S.G. and Genco R.J. (1998) is
as
follows.
Developing
inflammatory
periodontal
89
STOMATOLOGIYA
diseases are rapidly progressing, leading to tooth
loss. In turn, severe periodontal disease complicates
glycemic control and increases the severity of diabetes
mellitus [14].
Periodontal disease in patients with diabetes is
characterized by a severe course. At the age of 12-
18 years, there is a progression of gingivitis, loss of
gum attachment, development of periodontitis. At the
age of 15-19, 27% of adolescents have aggressive
periodontitis [20,21].
Compared
with
non-diabetic
patients,
adults
with T1DM and T2DM have a more pronounced
clinic of periodontal diseases: a longer duration of
inflammation; 3 times more often there is a loss of
attachment of the gums to the bone, the development
of periodontitis; increased depth of paradontal pockets;
more destruction of the alveolar bone; more lost teeth
[4,8,31,32,34].
Patients with diabetes often do not have preventive
habits: 90% of adolescents brush their teeth once a day,
60% do
not
use flossing [3,23], adults 40-70 years
old
brush their teeth once in 54% of cases, 77% do not
know their HbAl level, 42% are overweight, 32% are
obese [9]. All this contributes to the worsening of both
diabetes and inflammatoiy periodontal diseases.
Diagnostic signs and risk factors
for
diabetes.
If
we take into account the data of world statistics on
the incidence of diabetes from 4.3 to 10.9% of the
population [10,16,29], it can be assumed that every
twenty-third to ninth visitor to a dental clinic has
diabetes.
In addition, the identification of well-known risk
factors for diabetes will help to improve the diagnosis,
prevention and management of diabetes in dental
patients [5,9,11]:
- overweight and obesity, especially visceral
(BMI >25 kg / m2);
burdened heredity (for example, the risk of CD-I
with a sibling disease - 4%, two siblings - 9.5%, a
parent - 4-6%, a parent and sibling -12%, both parents
- 34%);
-
race (Asian peoples, African Americans,
Hispanics, Indians, residents of the.
This can play the role of a predictor of future
diabetes mellitus [17], and a dentist may
for
the first
time establish a diagnosis of diabetes mellitus, since
patients are poorly aware of the relationship between
oral pathology and diabetes mellitus [13]. Patients
with diabetes are not aware of the increased risk of
developing dental diseases.
Picture 1: Determination
of
blood glucose levels from
the
gingival crest with a portable glucometer
Features of dental treatment for patients with
diabetes
A.M.L. Pedersen [17] developed recommendations
for the
organization of dental treatment of patients
with diabetes: monitoring of glucose levels in a dental
clinic (safe glucose level before invasive procedures -
5-6 mmol /1); appointment of patients in the morning,
a few hours after the injection of insulin and breakfast;
always have sugar in the office to relieve hypoglycemic
attacks arising from waiting, anxiety, delay in eating,
etc .; repeated visits of patients should be every 3
months, with high activity
of
dental diseases -
more
often.
On the one hand, dentoalveolar surgery, infections,
stress from dental procedures can increase blood
glucose
levels
and
patients’
metabolic
insulin
requirements.
On
the
other
hand,
medications
prescribed by dentists can influence diabetic therapy.
For
example,
corticosteroids
significantly
impair
glycemic control; a patient with type 2 diabetes
may require short-term insulin therapy; antifungal
drugs (miconazole, fluconazole) interfere with the
metabolism of tolbutamide. Therefore, the treatment
of patients with diabetes requires interaction between
the dentist and the diabetologist [17,32].
Thus, dental treatment of patients with diabetes
should be carried out on the basis of a team approach,
with the interaction of a dentist with an endocrinologist
(diabetologist) and other specialists. However, in
order to carry
out
this interaction, both dentists and
endocrinologists,and diabetic patients should have
appropriate knowledge about the relationship between
dental and diabetic pathology [2]. Meanwhile, the
results of studies have shown that patients with diabetes
have an insufficient level of knowledge about the
relationship of their disease with dental health [32].
90
ОБЗОРНЫЕ СТАТЬИ
According to our data, 36% of patients in
periodontal offices did not believe that diabetes affects
dental health, 56% recognized the effect of diabetes on
the state of the oral cavity, and only 8% realized that
dental diseases can aggravate the course of diabetes.
... Every second patient (52%) did not understand that
the state of the periodontium may depend on the level
of blood glucose. Therefore, only 16% of periodontal
patients regularly consulted a dentist, the rest - “from
case to case” or “If you have free time.” Only 24%
of patients assumed that they would definitely turn to
an endocrinologist on the referral of a dentist (16%
- “would not apply”, 60% - “if they had found free
time”).
However, dentists also did not have the necessary
knowledge and underestimated the effect of periodontal
disease on the course of diabetes, and 60% of doctors
did not believe that tooth loss and abscesses are more
frequent in patients with diabetes. According to our
data, the knowledge of dentists was limited, only 36%
believed that dental pathology aggravated the course
of diabetes. Only antibiotic therapy was named in
the specifics of providing dental care to patients with
diabetes.
The study of international and domestic practical
recommendations for the management of patients
with diabetes showed that they pay little attention to
the relationship between diabetes and pathology of
the oral cavity [10,26,27,29]. Thus, the urgency of the
problem of the relationship between diabetes mellitus
and dental diseases, due to the high social significance,
widespread prevalence and unfavorable interaction of
pathologies, should be recognized.
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Аннотация.
Рассматривается
взаимосвязь
сахарного диабета и стоматологического здоровья.
Показана
недостаточность
знании
врачей-
стоматологов и стоматологических пациентов о
диабете.
Обсуждается
роль
врача-стоматолога
в
ранней
диагностике
сахарного
диабета
и
особенности
лечения
стоматологических
заболеваний у больных диабетом.
Ключевые слова:
диабет, стоматологическое
здоровье, знания.
Summary. The
article examines the relationship
between diabetes mellitus and dental health. The lack
of knowledge of dentists and dental patients about
diabetes is shown. The role of the dentist in the early
diagnosis of diabetes mellitus and the features of the
treatment of dental diseases in patients with diabetes
are discussed.
Key words:
diabetes, dental health, knowledge.
Xulosa.
Maqolada
diabetes
mellitus
va
tish
salomatligi
o’rtasidagi
bog’liqlik
ko’rib
chiqiladi.
Stomatologlar
va
stomatologlaming
diabet
haqida
bilimlari yo’qligi ko’rsatilgan. Qandli diabetni erta
tashxislashda stomatologning roli va diabet bilan
og’rigan bemorlarda tish kasalliklarini davolashning
o’ziga xos xususiyatlari ko’rib chiqiladi.
Kalit so’zlar:
qandli diabet, tish salomatligi.
92
