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827. Вшей Кумар. Абул К. Аббас. Джон К. Ас-тей.// Основи патологи за Роббшсом.- 2020. - Т. 2, -с. 208.
28. Евтушенко А.И. // Ендоскопия пищевода, желудка и двенадцатиперстной кишки.- К.; Вютка - 2007. - 187 с.
29. Патент на корисну модель 137083 Украша, МПК А61В 17/00 Споаб Максимчука Дмитра Во-
лодимировича та Максимчука Володимира Дмит-ровича мобшзацп дванадцятипало1 кишки при xi-рурпчному лiкуваннi виразково1 хвороби шлунка i дванадцятипало1 кишки / Максимчук Д.В., Максим-чук В.Д.; заявник та патентовласник Максимчук Д.В., Максимчук В.Д. - № u201904357. - Заявл. 22.04. 2019. - Опубл. 25.09.2019, Бюл. №18.
COMBINED APPROACH TO THE TREATMENT OF SECONDARY ADENTIA OF THE
MAXILLARY CENTRAL INCISOR
Navolskyi N.
Higher State Educational Establishment of Ukraine "Bukovinian State Medical University ", Chernivtsi,
assistant of department ofpediatric dentistry
Abstract
The paper presents a case of early loss of the maxillary central incisor and a combined approach in the treatment of secondary adentia.
Keywords: esthetics, adentia, braces-devices.
Introduction. Nowadays esthetic requirements play a crucial role in dentistry. The results of the survey by Emnid institute for public opinion research (German) conducted in June 2002 showed that 85% of respondents consider well-attended teeth are a sign of human attraction. According to the poll conducted by the Bengerno Institute for 52,2% of Germans esthetically perfect teeth are of very important value, and for the rest 39,7% it was always of great importance. Both advertisement and mass media in their announcements about "good-looking teeth" increase the interest of patients to the subject of esthetics [1, 2].
Restoration of esthetic smile for a patient is often an important event moving back normalization of occlusion. The "beauty" of the teeth in the lip line is more
important that position of other teeth visually invisible [3].
Clinical case. Our article contains one of such cases. Patient N., 27 years old, complained of esthetic disorders of her smile (Fig. 2). She wanted to restore esthetics quickly by means of orthopedic treatment using prosthetics method. The clinical examination of the patient, her oral cavity, dentition and orthopantomo-gram (that became one of the main diagnostic methods) (Fig.1) enabled to make the diagnosis: secondary adentia of 1.1 tooth (it was extracted in childhood as the patient said) causing pathological occlusion (II class, 2 subclass according to Angle classification).
Fig. 1. Patient's orthopantomogram.
Fig. 2. Patient's dentition on the moment of visit.
The patient was explained that one prosthetics only would be not enough to achieve high esthetic results, since the space for frontal teeth was insufficient. Due to this fact the width of the teeth would be reduced considerably, and gingival zenith would not correspond to the zenith of artificial crowns. Therefore, an important rehabilitation stage for the patient should include a comprehensive approach consisting of orthodontic preparation (making space of a missing 1.1 tooth and simultaneous correction of II class) followed by a surgical stage of implantation and prosthetics by means of an artificial crown or its further replacement by means of dental bridge prosthesis.
Dental braces were applied. Dentsply GAC (OMNI-ROT 0.18) braces were used. The shape of the upper and lower dental arches were normalized. The following stage was making space by means of an expansion spring according to the mesiodistal size of the
central left incisor. To close esthetic defect a false tooth with braces was applied on the rectangular arch in the place of a formed space till completion of orthodontic treatment.
After the braces were removed a fixed retainer was applied on the lower frontal teeth from the lingual side.
The patient rejected an offer to place an implant. She decided on dental bridge prosthesis on the basis of zirconium dioxide. Therefore, the following stage in treatment was orthopedic preparation of 1.2, 2.1 and 2.2 teeth and making temporary dental bridge prosthesis. The final stage included adjustment and fixation of the orthopedic construction (Fig. 3).
By means of a combined approach to an unusual clinical situation esthetic of the smile and function of the dentition were restored, and the patient was satisfied with the treatment performed.
Fig. 3. Adjustment and fixation of the orthopedic constrution.
References
1. Doroshenko S.I. Clinical and differential diagnostics of various forms of dentition retention in children / S.I. Doroshenko, Y.A. Kulgynskyi // Modern Orthodontics. - 2010. №01(19). - P. 3-13.
2. Mankhart Yu. Restoration of the frontal tooth by means of esthetic application technique of composite layers / Yu. Mankhart // News of Stomatology. -2009. - №1(58). - P. 29-33.
3. Khoroshylkina F.Ya. Orthodontics. Defects of the teeth, dentition, malocclusion, morphofunctional disorders in the maxilla-facial area and their comprehensive treatment / F.Ya. Khoroshylkina - M.: Ltd «Medical Information Agency», 2006. - 544p.
THE ROLE OF MELATONIN DEFICIENCY IN SYSTEMIC INFLAMMATION IN PATIENTS WITH TERMINAL RENAL FAILURE TREATED WITH HEMODIALYSIS
Kondratiuk V.
MD, PhD, professor, heads the department ofpropedeutics of internal medicine № 2, Bohomolets National
Medical University, Kyiv, Ukraine Petrova A.
postgraduate student of the Department ofpropedeutics of internal medicine № 2, Bohomolets National
Medical University, Kyiv, Ukraine.
ORCID: https://orcid.org/0000-0002-1648-1481.
Karpenko O.
PhD, assistant professor, Department ofpropedeutics of internal medicine №2, Bohomolets National Medical University, Kyiv, Ukraine
Abstract
The aim of the study. Make analyze of the status of systemic inflammation in patients with chronic kidney disease (CKD) stage 5 treated with hemodialysis (HD) by assessing the level of C-reactive protein (CRP) and ferritin and to determine the relationship between disorders of melatonin-forming function of the epiphysis (MFE) and markers inflammation of CKD.
Materials and methods. 130 patients with stage 5 CKD (50% of men) aged 58.5 years were examined [43; 66] on permanent hemodialysis treatment. Controls consisted of 20 healthy individuals of equal age and sex. All surveyed performed the determination of the level of melatonin (MT) in saliva during the day and night. Depending on the violation of MFE patients are divided into two groups: group I - 110 patients with impaired MFE, group II - 20 patients with normal MFE. All patients performed clinical laboratory tests. The levels of ferritin, CRP, measured blood pressure (BP) are determined.
Results. We found high incidence of MFE disorders and their association with inflammatory activity in examined patients. Analysis of the data shows that patients with CKD stage 5 treated with HD, compared with the control group, higher levels of CRP, ferritin (17 [8; 23] vs 5 [3; 6,5] mg / ml, 311,4 [ 172.6; 505.4] vs. 73.3 [62.85; 105.9] ng / ml, both p <0.001). Greater activity of inflammation by the value of CRP is observed in patients with disorders of MFE (18 [12; 24] vs. 5.5 [4,5; 8] mg / ml). The level of CRP increases in the case of increased SBP (r = 0.389, p <0.05), DBP (r = 0.282, p <0.05), duration of hypertension (r = 0.278, p <0.05), HD (r = 0,257, p <0,05) and at the decrease of Hb (r = - 0,203, p <0,05), albuminemia (r = - 0,338, p <0,05). There were negative correlations between daytime and nighttime CRP and MT (r = - 0.267 and r = - 0.518, both p <0.05). We established positive associations of ferritin level with CRP levels (r = 0.614, p <0.05) and negative with MT level during the day (r = - 0.261, p <0.05) and at night (r = - 0.461, p <0,01). Positive associations of albuminemia with MT levels during day and night were identified (r = 0.231 and r = 0.303, both p <0.05).
Conclusions. There is a frequent violation of MFE in the form of MT deficiency and moderate activity of systemic inflammation, which is accompanied by increased ferritin, CRP and decreased levels of albuminemia in patients with stage 5 CKD undergoing hemodialysis treatment. The magnitudes of direct and indirect inflammatory markers are significantly increased in patients with NTF in the event of an MFE disorder, indicating an association between epiphysis dysfunction and inflammatory activity. In patients receiving HD therapy, the severity of inflammation is determined by the duration of NRT, the length and severity of hypertension, the severity of anemia, the depth of disorders of circadian rhythms MFE.
Keywords: chronic kidney disease, hemodialysis, melatonin, inflammation, ferritin, C-reactive protein, albumin.
Introduction. Chronic kidney disease (CKD) is an important problem of modern medicine, both in Ukraine and in the world. The number of patients undergoing renal replacement therapy (RRT) has increased faster than the world's population during recent years [6].
The combination of chronic inflammation syndrome with oxidative stress is more common and becomes more pronounced with the development of the terminal stage in patients with CKD. The increase in the activity of inflammation in patients with RRT may be
