tozalash usullari.
Objective:
To study the influence of the
method of surface treatment of implants on
the arithmetic mean and quadratic roughness.
Material and methods:
The study of the
microstructure of implant surfaces was
carried out on three groups of samples. The
1st group consisted of titanium implants of
Konmet LLC (titanium alloys of grades VT
1-0 and VT 1-00 (GOST 19807-91),
sandblasted, the 2nd group was treated with
acids, the 3rd combined, i.e. sandblasting and
acid.
Results:
Implant surface sandblasting
to create additional roughness gives an
arithmetic mean roughness of 15.923, rms
20.488, treatment with acid alone gives an
arithmetic mean roughness of 82.647, rms
roughness of 102.093, sandblasting and acid
gives an arithmetic mean roughness of
16.27.127.
Conclusions:
Surface treatment
of implants in a combined way, i.e.
sandblasting and acid does not lead to
additional roughness.
Key words:
dental implants, surface
treatment methods.
UDK: 616.314-089.843.618.176-06
THE ROLE OF BIOCHEMICAL INDICES IN THE DIAGNOSIS OF
OSTEOPOROSIS OF THE JAWS
Pulatova B.Zh., Achilova N.G.
Tashkent State Dental Institute, Tashkent Medical Academy
Relevance of the topic
. Achievements of
recent years in the study of molecular
pathogenetic
aspects
of
osteoporosis
contributed to the search for the most specific
and informative markers which reflect the
intensity of remodeling processes. Although
these markers are divided into synthesis and
resorption markers, it should be kept in mind
that under pathological conditions, when
bone tissue remodeling processes are coupled
and altered in one direction, any of the above
markers will reflect the total rate of bone
metabolism [1,3,5,7,9,10].
Material and research methods
The
planning
of
the
intraosseous
implantation surgery was performed on the
basis of the data of the comprehensive
examination of patients using clinical,
radiological,
functional
and
laboratory
methods. For diagnostics of osteoporosis
various biochemical indices are widely used
which allow to determine the variant of
osteoporosis
(primary,
secondary).
We
performed biochemical tests: calcitonin
parathormone and vitamin D. Menopausal
women were examined and pathogenetic
treatment with miacalcic + vitamin D was
given [2,4,6,8].
The first group (15 people) included
patients with a diagnosis of postmenopausal
osteoporosis (type 1), we gave them
miacalcic + vitamin D. The second group
included 22 patients with a diagnosis of
postmenopause, we conducted a standard
treatment (type 2). The third group (control)
consisted of patients without systemic bone
pathology (Table 1).
Table 1
Distribution of patients by age, abs. (%)
Type
Age
Total number of
patients
40-44 years
45-49 years
50-54 years
55 years and
older
1
15 (25,0)
14 (23,33)
11 (18,33)
7 (11,67)
47 (78,33)
2
-
4 (6,67)
5 (8,33)
4 (6,67)
13 (21,67)
Total
15 (25.0%)
18 (30.0)
16 (26.66)
11 (18.34)
60 (100)
The indicated groups did not include:
- Patients younger than 40 years of age;
- In the presence of allergic phenomena;
- Acute infectious diseases;
- Benign and malignant neoplasms,
including in the anamnesis.
Results
Three biochemical markers of bone
formation performed by osteoblasts are
currently used:
1. Bone alkaline phosphatase (BAP)
produced by osteoblasts and determined in
serum. Specificity, no metabolism in the
liver, cleared from the blood by the kidneys,
approach the BAP to the ideal markers of
osteoblast activity (Bettica R., Moro L.,
2015; Taguchi A. et al., 2013).
2. Osteocalcin (OK) is a noncollagenous
protein synthesized by osteoblasts containing
carboxyglutamic acid. The latter provides
high affinity (binding ability) of OK
molecule to hydroxyappatite, which forms
the matrix and bone mineralization. OC is
released by osteoblasts during osteosynthesis
and partially enters the bloodstream. In
osteoporosis, the level of osteocalcin may be
elevated or normal, depending on the severity
of
osteosynthesis
processes.
The
pathogenetic principle of treating primary
forms of osteoporosis is to prescribe drugs
that
normalize
disturbed
remodeling
mechanisms. Currently, there is a wide range
of drugs for the treatment of osteoporosis, to
a greater or lesser extent satisfying the
criteria for the effectiveness of therapy.
In clinical practice, currently the most
common
synthetic
salmon
calcitonin
(miacalcic) (Mylov N.M., 1998) The most
physiological of all drugs used for the
pathogenetic treatment of osteoporosis are
active metabolites of vitamin Dz (Dambacher
M.A., Schacht E., 2016; Rozhinskaya L.Ya.,
2019; Kassern M., 2013). Based on the
analysis of the results of the examination
there were - allocated 3 groups of patients to
whom implant treatment with the use of
implants was planned,
After the examinations and determination
of the diagnosis, a treatment plan was made,
which
included
implantation
surgery
followed by orthopedic treatment.
During the preoperative period we
performed a thorough sanitation of the oral
cavity and the necessary preoperative
preparation. The question about the number
and localization of the implants was solved
on the basis of the simulation of the situation
dictated by the conditions of the oral cavity
and the condition of the bone tissue of the
implant site. For that purpose the size and
topography of the dentition defect, the
position of supporting teeth, the degree of
atrophy of the alveolar process, the type of
bite, the shape of the occlusal surface, etc.
were determined on the models (Table 1).
Table 2
Distribution of patients by age, abs. (%)
Index
Total number of
patients
Group 1, early
menopausal
period (type 1)
Group 2,
postmenopausal
osteoporosis
(type 2)
Group 3, no
systemic
pathology bone
tissue
Total
60 (100)
15 (25.0)
22 (36.67)
23 (38.33)
Patients in all тhere groups underwent
implantation according to the classic two-
step technique, during which screw implants
were placed. The number of implants
depended on the number of teeth to be
replaced and the amount and quality of bone
in the implant area. The length of the
implants was selected depending on the
height of the alveolar bone. All in all, 103
implants were placed, including 29 (28.2%)
in Group 1 patients, 36 (35.0%) in Group 2,
38 (36.8%) in Group 3.
To create the optimal micro-environment
at the boarder of the implant and the bone
tissue we used the intraosseous implants with
the developed relief surface. From the point
of view of the modern concepts of bone
tissue reparation the surface roughness of the
implants
affects
the
qualitative
and
quantitative
characteristics
of
the
osseointegration, especially in case of
systemic
disturbance
of
the
mineral
metabolism.
Due to low bone tissue resistance at the
stage of implant placement in case of
osteoporosis we used a complex approach
aimed at increasing the implant stability.
The surgery was carried out with maximal
sparing of the bone and minimal damage to
soft tissues, which allowed us to reduce the
zone of tissue necrosis around the implant
and minimize microcirculatory disorders.
Finally, the rules of asepsis and antisepsis
were carefully followed during the surgery,
abundantly irrigating the operating field with
a chilled physiological solution to avoid
temperature effects on the bone during bone
bed preparation. Implants of maximum
length and diameter were used, observing the
distance of 2 mm when placed close to such
anatomical formations as maxillary sinuses,
nasal cavity floor, mandibular nerve canal,
mental orifice. The thickness of the bone
walls around the implant was at least 1 mm
and the distance between the implants or
between the implants and the neighboring
teeth was at least 2 mm. In the vast majority
of cases we used implants of medium length
and diameter (4.0x10 and 3.8x11 mm).
Application of larger implants was not
usually allowed by the significant vertical
and horizontal bone atrophy observed in
many patients.
After
completion
of
the
implant
integration
period,
a
repeat
clinical,
radiological and instrumental examination
was performed.
Conclusion
To improve the quality of osseointegration
of implants in patients with osteoporosis, the
period from implant placement to fixation of
an orthopedic structure was extended, the
second stage was performed after 7-8 months
on the upper jaw and after 5-6 months on the
lower jaw. Introduction of pathogenetically
based approach to treatment will allow to
achieve significant progress in the care of
patients with primary osteopоrosis.
References
1. Adams H.P.J., Nelson L.M. Adolescent
girls, the menstrual cycle, and bone health //
J. Pediatr. Endocrinol. Metab. – 2031. – Vol.
16 (Suppl. 3). – P. 673-681
2. Eisman J.A. Pharmacogenetics of the
vitamin D receptor and osteoporosis // Drug.
Metab. Dispos. – 2019. – Vol. 29, №4 (Pt. 2).
– P. 505-512.
3.
Smetnik
V.P.
Postmenopausal
osteoporosis // Medicine climacteria; Ed.
V.P. Smetnik. – Yaroslavl: LLC "Publishing
House Litera", 2016. – Р. 656-686.
4. Lindsay R., Kleerekoper M. Estrogens
for the prevention of osteoporosis; Ed. by R.
Lindsay // Drugs Osteopor. – 2015. – P. 1-27.
5. Davas I., Altintas A., Yoldemir T. et al.
Effect of daily hormone therapy and
alendronate use on bone mineral density in
postmenopausal women // Fertil. Steril. –
2016. – Vol. 80, №3. – P. 536-540.
7. Grados F., Brazier M., Kamel S. et al.
Effects on bone mineral density of calcium
and vitamin D supplementation in elderly
women with vitamin D deficiency // Joint
Bone Spine. – 2013. – Vol. 70, №3. – P. 203-
208.
8. Achilova N.G. Pulatova B.J. Pre-
operative
training
of
patients
with
osteoporosis during premenopause when
planning dental implantation // Central Asian
J. Med. – 2021. – №11. – Р. 47-58.
9. Achilova N.G., Pulatova B.J. To the
question of preparation of patients with
osteoporosis during the premenopause when
planning dental implantation // Orient. J.
Med. Pharmacol. – 2022. – Vol. 17, №10. –
Р. 82-92.
10. Achilova N.G., Pulatova B.J. Medical
correction in the planning of dental
implantation in patients with osteoporosis in
the menopausal period // Actual problems of
maxillofacial surgery: Мaterials of the
International scientific and practical online
conference. – Tashkent, 2021. – №3. – Р.
56-59.
Актуальность
темы.
Достижения
последних лет в изучении молекулярно-
патогенетических аспектов остеопороза
способствовали
поиску
наиболее
специфичных
и
информативных
маркеров, отражающих интенсивность
процессов ремоделирования. Хотя эти
маркеры подразделяются на маркеры
синтеза и резорбции, следует иметь в
виду, что при патологических состояниях,
когда процессы ремоделирования костной
ткани сопряжены и изменяются в одном
направлении,
любой
из
вышеперечисленных
маркеров
будет
отражать суммарную скорость костного
метаболизма.
Материал и методы:
обследованы
женщины
в
климактерическом периоде, у которых
планировалась операция внутрикостной
имплантации. 1-я группа – 15 пациенток с
диагнозом
постменопаузальный
остеопороз (1-й тип), которым мы
назначали миакальцик + витамин Д, 2-я
группа – 22 пациентки с диагнозом
постменопауза (2 тип), которые получали
стандартное
лечение,
3-я
группа
(контрольная) – пациентки без системной
костной патологии.
Результаты:
для
улучшения качества остеоинтеграции
имплантатов у пациенток с остеопорозом
был увеличен период от установки
имплантата до фиксации ортопедической
конструкции. Второй этап выполнялся
через 7-8 месяцев на верхней, через 5-6
месяцев – на нижней. челюсти.
Выводы:
внедрение
патогенетически
обоснованного
подхода
к
лечению
позволит добиться значительных успехов
в лечении больных с первичным
остеопорозом.
Ключевые
слова:
женщины,
постменопаузальный
остеопороз,
внутрикостная имплантация.
Relevance of the topic
. Achievements of
recent years in the study of molecular
pathogenetic
aspects
of
osteoporosis
contributed to the search for the most specific
and informative markers which reflect the
intensity of remodeling processes. Although
these markers are divided into synthesis and
resorption markers, it should be kept in mind
that under pathological conditions, when
bone tissue remodeling processes are coupled
and altered in one direction, any of the above
markers will reflect the total rate of bone
metabolism.
Material and methods:
The
women in the climacteric period were
examined, in whom the operation of
intraosseous implantation was planned.
group 1 - 15 patients diagnosed with
postmenopausal osteoporosis (type 1), to
whom we prescribed myacalcic + vitamin D,
group 2 - 22 patients diagnosed with
postmenopause (type 2), who received
standard treatment, group 3 (control) -
patients without systemic bone pathology.
Results:
To improve the quality of implant
osseointegration
in
patients
with
osteoporosis, the period from implant
placement to fixation of the orthopedic
structure was extended. The second stage
was performed after 7-8 months on the upper
one, after 5-6 months - on the lower one
jaws.
Conclusions:
The introduction of a
pathogenetically sound approach to treatment
will make it possible to achieve significant
success in the treatment of patients with
primary osteoporosis.
Key words:
women, postmenopausal
osteoporosis, intraosseous implantation.
UDK: 616.314-089.843-06]-092-055.2
THE EFFECTIVENESS OF CALCIUM AND VITAMIN D PREPARATIONS IN
THE TREATMENT OF OSTEOPOROSIS IN THE EARLY MENOPAUSAL PERIOD
Pulatova B.Zh., Achilova N.G., Abdukarimov N.M.
Tashkent State Dental Institute, Tashkent Medical Academy, Fergana Institute of Public Health
Medicine
The relevance of the topic
. In recent years,
considerable attention has been paid to
clarifying the relationship between metabolic
diseases of bone tissue and changes in the
bone tissue of the jaws. It would seem that the
systemic processes occurring in the div
cannot but affect the condition of the tissues of
the dental system. However, the association
between osteoporosis and oral health remains a
controversial issue. Normally, the height of the
alveolar ridge is maintained by a physiological
balance
between
bone
formation
and
resorption.
Some studies have found that the treatment
of osteoporosis improves the condition of
periodontal tissues J. Wactawski-Wende et al.
(2022) believe that in postmenopausal women,
the loss of alveolar height and the number of
lost teeth depend on the severity of osteopenia.
According to E.A. Krall (2011), M.S. Reddy;
(2012), a decrease in bone mineral density in
patients with osteoporosis, both in men and
women, is a risk factor for the development of
