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7вплоть до полного их выпадения[3]. Но частота рас-фиксации и сколов винира существенным образом не зависит от вида зуба
Циркониевые виниры. Одна из разновидностей виниров, которые изготавливаются из диоксида циркония. Такие виниры имеют главную особенность - они изготавливаются так же в лабораториях, как и керамические виниры, но не руками техника, а посредством автоматизированного, полностью роботизированного оборудования -CAD/CAM. Это позволяет избежать ряда ошибок .
Коронки на основе ICE Zircon с усиленной прочностью облицовки.
Такая коронка из диоксида циркония обладает высокой прочностью в местах, которые подвергаются более повышенной жевательной нагрузке, так как имеет более толстый слой основы из данного .
В отличии от керамических виниров, микропротезы на основе диоксида циркония применяют даже в самых сложных клинических случаях. Например, если цвет зуба настолько изменен, что может просвечивать сквозь керамику, или в зубном ряде имеются большие межзубные промежутки, зубы «находят» друг на друга, имеются повороты зуба вокруг своей оси и т.д. Диоксид циркония очень прочный, и легкий материал, поэтому ви-ниры на его основе тонкие .
Основные преимущества циркониевых вини-
ров:
1. Высокая биосовместимость с тканями зуба и прилежащими тканями, что не вызывает аллергической реакции.
2. Высокая прочность и надежность, без риска сколов. Это обеспечивается за счет прочностных свойств диоксида циркония - он прочнее и легче металла.
3. Долговечность, за счет выше перечисленных свойств.
4. Высокая эстетичность в полости рта. Циркониевые виниры выглядят, как натуральные естественные зубы. Их эстетика сохраняется в течение долгого времени, так как диоксид циркония не окрашивается различными красителями .
Недостатков у циркониевых виниров не столь много, главным существенным минусом является:
1. В отличии от керамических, они имеют высокую стоимость, что связано со сложностью изготовления виниров из диоксида циркония .
Успех препарирования зубов под виниры требует минимального иссечения твердых тканей зубов.
Выводы
Таким образом, проанализировав научные статьи, можно подвести итоги, что керамические ви-ниры несомненно один из оптимальных вариантов для реставрации фронтальной группы зубов и восстановления их эстетики. В качестве наилучшего материала выделяется диоксид циркония. С помощью него можно добиться максимально естественной цветопередачи и светопреломления. Микропротезы менее подвержены сколам, плотно прилегают к тканям зуба, что является профилактикой расфиксации и возникновения вторичного кариеса. Но при этом есть и отрицательные стороны: стоимость намного превышает аналогичные фарфоровые реставрации. В современной стоматологии ви-ниры занимают достаточно важное место.
Список литературы:
1. Виллерсхаузен-Ценхен Б., Эрнст К.-П. // Клин. стоматология. - №2. - 1999. - С.4-7.
2. Виноградова Т.Ф., Уголева С. // Новое в стоматологии. - 1995. - № 6. - С.3-23.
3. Гольдштейн Р. // Эстетическая стоматология. - 2003. - 481 с.
4. Ломиашвили Л.М., Аюпова Л.Г. Художественное моделирование и реставрация зубов. - М., 2005. - С.154;174.
5. Луцкая И.К. // Соврем. стоматология. - 2001. - №2. - 7-16.
6. Луцкая И.К. Основы эстетической стоматологии. - Мн.: Интерпрессервис, 2005. - 332 с.
7. Луцкая И.К. Принципы эстетической стоматологии. - М.: Мед. лит., 2012. - 224 с.
8. Макеева И.М. Восстановление зубов свето-отверждаемыми композитными материалами. - М., 1997.
STATE OF EXTERNAL RESPIRATORY FUNCTION IN PATIENTS WITH ANKYLOSING
SPONDYLITIS
Aliakhunova M.,
professor, Head of the Rheumatology Department, «Republican Specialized Scientific Practical Medical
Center of Therapy and Medical Rehabilitation», Tashkent
Khan T.,
MD, Rheumatology Department, «Republican Specialized Scientific Practical Medical Center of Therapy
and Medical Rehabilitation», Tashkent https://doi.org/10.5281/zenodo.7258638
Abstract
Objective: Comprehensive clinical and functional assessment of the respiratory system in patients with ankylosing spondylitis (AS).
Material and Methods: We investigated 35 AS patients aged between 22 to 60 years, with disease duration of 6.1±2.5 years. We assessed clinical disease indices (ASDAS, BASFI, BASMI), morning stiffness, acute phase reactants, severity of radiological involvement in sacroiliac, vertebral, chest joints, spirometry, and ultrasound
research of hip joints. Results: Lung vital capacity (LVC) reduction was noted in 32 (91.4%) patients and in 28 (80%) patients was below 10% of the due amount. The index FEV1 was reduced in 15 (42.8%) patients, FVC in 13 (37.1%) ones. Conclusions: The obtained results extend the capabilities of early diagnosis of lung lesions in AS, as well as allow us to determine the nature of pulmonary flow process in connection with the degree of air violations, which isof great importance to the timely appointment of adequate therapy.
Keywords: seronegative spondylitis, ankylosing spondylitis, respiratory function
Ankylosing spondylitis (AS) refers to inflammatory diseases of the spine with a chronic progressive course, which leads to ankylosing of the ileosacral and intervertebral joints [2,6]. Due to the inconspicuous onset, course, and difficulty of x-ray diagnosis of sacro-iliitis, AS is detected at the stage of a detailed clinical picture.
Clinically, AS is characterized by a lesion of the axial skeleton with limited mobility, which reduces the function of the organs located in the frame of the spine. Currently, selective lesions of extra-articular tissues are found in AS [1,4]. In 20-22% of patients with AS, lesions of the heart and blood vessels are detected: aortitis with necrosis of the medial layer and its replacement with connective tissue, atrophy of the inner layer, as well as arteritis of large and medium vessels of the upper half of the body, pericarditis.
In 25% of patients, non-granulomatous iritis and iridocyclitis develop, sometimes with significant scarring and the development of secondary glaucoma [5,7,10]. Cases of damage to the conduction system of the heart with the development of all degrees of blockade are described. The incidence of lung damage, according to the literature, reaches 30%, differing from changes in the lungs in other connective tissue diseases, while the degree of respiratory dysfunction has not been studied [12,13].
The first signs of AS are often caused by damage to the costovertebral and costal-sternal joints, which leads to chest rigidity and impaired breathing. In the early period of the disease, with lesions of the thoracic spine, patients are found to have limited respiratory excursion of the chest, which contributes to a decrease in VC and the development of respiratory diseases. Progressive fibrosis of the apex of the lungs goes unnoticed, differs in latency, although sometimes it leads to severe respiratory failure [14].
It is generally accepted that ventilation disorders observed in AS are usually restrictive, and developing respiratory failure is thoraco-diaphragmatic. As for obstructive disorders in AS, there is clearly a "blank spot" here, since there are very few special studies on this issue [15,16]. Similarly, there are few comprehensive clinical and functional studies using modern methods for studying the pulmonary circulation.
There are practically no works on the cytology of bronchoalveolar contents in patients with AS. And although the possibility of impaired respiratory function in AS is constantly declared, there is very little information about bronchopulmonary lesions.
Objective. Comprehensive clinical and functional assessment of the state of the bronchopulmonary system in patients with AS.
Material and Methods The study was conducted in 35 patients with AS aged 22 to 60 years (mean age
32.5±6.5 years). The average duration of the disease was 6.1±2.5 years. The diagnosis of AS was established on the basis of clinical and radiological data, verified by the New York criteria (1966).
The most common variant of the debut of AS was the lesion of the axial skeleton (sacroiliitis and/or spondylitis) - in 19 (54.3%). The variant of debut with peripheral arthritis and sacroiliitis and/or spondylitis was observed in 9 (25.7%) patients, with arthritis of the lower extremities - in 7 (20.0%). Depending on the degree of functional insufficiency (FN), patients with AS were divided into 3 groups: I degree - in 17.1% of patients, II degree - in 54.4%, III degree - in 28.5%.
All patients received non-steroidal anti-inflammatory drugs as basic therapy. Criteria for inclusion in the study: AS without concomitant respiratory diseases. Disease activity was assessed by the ASDAS (Ankylosing Spondylitis Disease Activity Score) index.
This index includes five different signs of the disease: back pain, duration of morning stiffness, pain / swelling in the peripheral joints (the above signs are included in questions 1, 2 and 6 of the BASDAI index (Bath Ankylosing Spondylitis Disease Activity Index), assessed by the patient, as well as ESR and general assessment of disease activity by the patient Functional disorders in patients with AS were assessed using the total BASFI index (Bath Ankylosing Spondylitis Functional Index), which consists of 10 questions assessing daily activities on a visual analogue scale (VAS).
For a cumulative assessment of the patient's functional ability, the BASMI index (Bath Ankylosing Spondylitis Metrology Index) was used - a metrological index that reflects the mobility of the spine and hip joints. The index includes 5 measurements: tragus-wall distance; neck rotation in degrees, lumbar flexion (modified Schober test); lateral flexion in the lower back and distance between the ankles. Instrumental examination included plain radiography of the pelvic bones in direct projection. The stage of sacroiliitis was determined according to the Kellgren classification. An ultrasound examination of the hip joints was performed.
The presence of effusion in the joint cavity was established if the distance between the signals from the joint capsule and the inner part of the femoral neck exceeded 7 mm. External respiration was studied at rest on a Spirost FISP-5000 Fukuda Denshi spirograph with automatic processing of parameters. Vital capacity (VC) - the volume of air that comes out of the lungs during the deepest exhalation after the deepest breath. Forced vital capacity (FVC) - the volume of air exhaled during the most rapid and strong exhalation.
Forced expiratory volume in 1 second (FEV1) is the volume of air exhaled during the first second of forced expiration. The Tiffno index is the ratio of
FEV1/VC. The parameters of the respiratory function were expressed as a percentage of the proper value for a given gender, age, and height of the patient.
The data were processed using the Statistica 6.0 statistical software package. The results are presented as M±m, where: M is the arithmetic mean, m is the standard deviation. Differences were considered significant at p3.5, CRP 19.45 mg/l, ESR 20-25 mm/h.
Results. In patients with AS, chest excursion was limited - the difference between the chest circumference between the maximum inhalation and exhalation decreased to 1-2 cm. In some patients (34%), accessory muscles were involved in the act of breathing. Clinical and radiological symptomatology, indicating damage to the respiratory system (shortness of breath, cough, changes in the lung pattern on chest radiographs) in patients with AS are associated with both time parameters (age, duration of illness) and smoking, and with parameters characterizing the main pathological process from the outside. musculoskeletal system (the degree of disease activity and structural restrictive changes in the
Indicators of respiratory
chest).X-ray signs of damage to the ileosacral joints of different stages were present in all 35 patients with AS. Additionally, damage to only the lumbar spine was observed in 4 (11.4%), thoracic - in 30 (85.7%). Simultaneous damage to the peripheral joints was detected in 5 patients.
Restrictive type of lung ventilation was diagnosed in 69% of patients, bronchial obstruction - in 31%.When analyzing the parameters of external respiration in patients with AS, their changes were revealed in comparison with the proper values. In patients with AS, shortness of breath was recorded with a respiratory rate of 24-26 per minute, an increase in the volume of respiratory movement by 28%, which led to a sharp compensatory increase in the minute respiratory volume up to 60%. All this indicates a significant overload of the external respiration apparatus. To study the relationship between AS activity and respiratory function parameters, we evaluated the ASDAS index in patients with and without deviations in lung functional parameters (Table).
Table1
Parameter Restriction n=23 Obstruction, n=10 FVD without deviation, n=2
FVC, % 71,8±18,2 92,1±13,4 100,2±11,3*
FEV1, % 76,9±14,7 71,5±13,2 94,7±14,2*
VC 61,7±13,4 72,6±14,8 82,4±13,7*
FEV1/ FVC, % 91,7±11,2 74,1 ±15,3 81,7±18,3
Note * p<0,05
The average level of AS activity according to ASDAS in patients with impaired respiratory function was significantly higher than in patients with preserved respiratory function (6.1 ± 3.9 and 5.03 ± 2.5, respectively; p<0.05. During the study, significant negative correlation between AS clinical activity and VC level (r=-0.59; p<0.05.The study revealed changes in respiratory function in patients with AS, and in most cases, VC changed.
The evaluation of the Tiffno index showed the predominance of restrictive changes in patients with AS with impaired respiratory function. Among patients with AS who had an obstructive type of lung ventilation, there were predominantly men; in addition, most of them turned out to be smokers. A high percentage of smokers among patients with AS indicates a significant role of smoking both in the pathogenesis of AS and in the development of lung pathology in this systemic disease.
We have found a significant relationship between the degree of AS activity and the value of VC. When conducting a correlation analysis, a significant relationship between the parameters of external respiration and some clinical and radiological symptoms of the disease was registered. Significant positive correlations were established between the degree of decrease in VC and the activity of the process.
There was a positive correlation between the degree of intervertebral space reduction and the FEV1/VC ratio (r=0.38). With such a symptom as a decrease in height and sclerosis of the vertebral bodies, positive correlations were observed with the level of FVC and FEV1 (respectively r=0.4 and r=0.38). It is
likely that the violation of external respiration in these patients may be associated with mechanical compression of the lungs, which limits the mechanics of respiration, and can also be realized due to the development of vasculitis as a reaction of vessels to the activity of the process.Of the 35 examined patients with AS, a decrease in the VC index was detected in 32 (91.4%), and in 28 (80%) of them this decrease was below 10% of the due value.
When analyzing the state of the parameters of respiratory function, a decrease in FEV1 was revealed in 15 (42.8%) patients, FVC - in 13 (37.1%).n 23 (65.7%) patients during spirometry, a restrictive type of lung ventilation was determined, 10 (28.6%) patients had bronchial obstruction, of which 6 (60%) were smokers. A high proportion of smokers among AS patients with obstructive ventilation may indicate the role of smoking in the pathogenesis of bronchial obstruction. Analysis of chest radiographs was performed in 35 patients with AS observed in dynamics. The period between the onset of spondylitis and pulmonary pleural lesion averaged 10-15 years. In 7 patients, damage to the peripheral joints was noted. All but 2 patients had fibro-bullous changes.
Most of the changes in lung function in AS patients are attributable to chest wall stiffness. Changes in the bronchopulmonary system in AS are heterogeneous and are represented not only by restrictive disorders due to thoraco-diaphragmatic factors, but also by obstructive disorders that play a significant role in the clinic and course of the disease and affect its prognosis. In AS, the first signs of the disease are often caused by damage to the costovertebral and costosternal joints,
which leads to chest rigidity and impaired function in the act of breathing.
Conclusions
1. In patients with AS, changes in respiratory function are detected, mainly VC. Evaluation of the FEV1/FVC index revealed the predominance of restrictive changes in patients with AS with impaired respiratory function.
2. Determination of respiratory function parameters in patients with AS allows not only to assess the functional state of the lungs, but also, probably, to control the activity and progression of the immunopatho-logical process in the lungs.
3. The results obtained make it possible to determine the nature of the course of the pulmonary process in connection with the degree of ventilation disorders, which is important for the timely appointment of adequate therapy.
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