CC BY
8
@ (D
УДК 616.311.2-02
RESEARCH ARTICLE 3. Medical sciences
Corresponding Author: Vokulova Yulia Andreevna - Assistant Professor Deputy Director of the Institute of Clinical Medicine National Research Lobachevsky State University of Nizhny Novgorod, Nizhniy Novgorod, Russian Federation E-mail: vokulova89@mail.ru
© Zhulev E.N., Vokulova YU.A., Yanova N.A., Zhdanova M.L., Plishkina A.A. - 2023
I Accepted: 28.05.2023
http://dx.doi.org//10.26787/nydha-2686-6838-2023-25-5-124-128
РЕЗУЛЬТАТЫ ОПРЕДЕЛЕНИЯ КОЛИЧЕСТВА ДЕСНЕВОЙ ЖИДКОСТИ, У ПАЦИЕНТОВ С НЕСЪЕМНЫМИ ПРОТЕЗАМИ, ИЗГОТОВЛЕННЫМИ ТРАДИЦИОННЫМ И ЦИФРОВЫМ МЕТОДОМ
Жулев1 Е.Н., Вокулова2 Ю.А., Янова2 Н.А., Жданова2 М.Л., Плишкина2 А.А.
ФГБОУ ВО «Приволжский исследовательский медицинский университет», г. Нижний Новгород, Российская Федерация
2ФГАОУ ВО «Национальный исследовательский Нижегородский государственный университет им. Н.И. Лобачевского», г. Нижний Новгород, Российская Федерация
Аннотация. Актуальность. Несъемные протезы, изготовленные традиционным способом, как правило, оказывают влияние на краевой пародонт. Объективным критерием оценки реакции пародонта является количество и качество выделяемой десневой жидкости как физиологической среды организма, транссудата сыворотки крови, заполняющей десневую борозду, количество которой резко возрастает при развитии воспалительного процесса Цель исследования - определить влияние несъемных протезов, изготовленных традиционным и цифровым методом, на состояние тканей пародонта, путем измерения количества десневой жидкости. Материалы и методы. Количество десневой жидкости определяли методом абсорбции при помощи полосок фильтровальной бумаги. Выявление пропитанных десневой жидкостью участков осуществляли методом окрашивания полосок фильтровальной бумаги в голубой или синий цвет 0,2% спиртовым раствором нингидрина, действие которого основано на открытии а-аминогрупп в белке. После этого получали фотографии полосок фильтровальной бумаги и в компьютерной программе Image J измеряли площадь пропитывания полосок десневой жидкостью. Результаты. Было установлено, что количество выделяемой десневой жидкости у пациентов, протезированных с применением цифровых технологий, меньше на 34,3% в сравнении с традиционным методом изготовления ортопедических конструкций. Заключение. Оценка реакции пародонта опорных зубов, покрытых искусственными коронками, изготовленными цифровым методом, посредством изучения количества десневой жидкости показала, что полученные цифры находятся ближе к пограничным значениям (среднее значение 0,4372 ± 0,06277 мм2), отражающих значительно меньшее их влияние на состояние краевого пародонта в сравнении с традиционным методом изготовления несъемных протезов (среднее значение 0,6597 ± 0,106 мм2) прежде всего за счет их более высокой точности.
Ключевые слова: несъемные зубные протезы, цифровые технологии в стоматологии, десневая жидкость, 3D принтер, CAD/CAM системы.
THE RESULTS OF DETERMINING THE AMOUNT OF GINGIVAL FLUID IN PATIENTS WITH FIXED PROSTHESES MADE BY TRADITIONAL AND DIGITAL METHODS
Zhulev1 E.N., Vokulova2 YU.A., Yanova2 N.A., Zhdanova2 M.L., Plishkina 2 A.A.
1 Privolzhsky Research Medical University, Nizhniy Novgorod, Russian Federation
2National Research Lobachevsky State University of Nizhny Novgorod, Nizhniy Novgorod, Russian Federation
Abstract. Relevance. Fixed prostheses made in the traditional way, as a rule, have an effect on the marginal periodontal. The objective criterion for assessing the periodontal reaction is the quantity and quality of the gingival fluid secreted as the physiological environment of the body, blood serum transudate filling the gingival furrow, the amount of which increases sharply with the development of the inflammatory process. The purpose of the study is to determine the effect of fixedprostheses made by traditional and digital methods on the condition of periodontal tissues
2023. Vol. 25. № 5
Issue Doi: 10.26787/nydha-2686-6838-2023-25-5
by measuring the amount of gingival fluid. Materials and methods. The amount of gingival fluid was determined by absorption using strips of filter paper. Detection of areas soaked in gum fluid was carried out by staining strips of filter paper in blue or blue with 0.2% alcohol solution of ninhydrin, the effect of which is based on the discovery of a-amino groups in protein. After that, photographs of strips of filter paper were obtained and the area of impregnation of strips with gingival fluid was measured in the Image J computer program. Results. It was found that the amount of gingival fluid secreted in patients with prosthetics using digital technologies is 34,3% less in comparison with the traditional method of manufacturing prosthodontical structures. Conclusion. Evaluation of the periodontal reaction of the supporting teeth covered with artificial crowns made digitally by studying the amount of gingival fluid showed that the figures obtained are closer to the boundary values (average value 0,4372 ± 0,06277 mm2), reflecting their significantly less influence on the condition of the marginal periodontal compared with the traditional method of manufacturing fixed prostheses (average value 0,6597 ± 0,106 mm2) primarily due to their higher accuracy.
Keywords: fixed dentures, digital technologies in dentistry, gingival fluid, 3D printer, CAD/CAM systems
Introduction. Fixed prostheses made in the traditional way, as a rule, have an effect on the marginal periodontal. An objective criterion for evaluating the periodontal reaction is the quantity and quality of the gingival fluid secreted as the physiological environment of the body, the transudate of blood serum filling the gingival furrow, the amount of which increases sharply with the development of the inflammatory process [1, 2, 3, 4].
The amount of gingival fluid secreted in the gingival groove of the teeth of the chewing group is 2 times higher than in the area of the teeth of the anterior group. The change in the amount of gingival fluid is directly dependent on the nosological form and severity of the inflammatory process in the periodontium. Thus, in the absence of periodontal diseases, the impregnation area is 0 - 0,5 mm2, with catarrhal gingivitis 0,5 - 1 mm2, and with periodontitis - more than 1 mm2 [5, 6, 7]. There are few scientific publications devoted to determining the amount of gingival fluid in patients with fixed prostheses made by traditional and digital methods, which was the justification for the need for this study.
The purpose of this study is to determine the effect of fixed prostheses made by traditional and digital methods on the condition of periodontal tissues by measuring the amount of gingival fluid.
Materials and methods. The clinical study involved 47 patients (22 men and 25 women) aged 31 to 65 years who underwent prosthodontical treatment with ceramic (33 artificial crowns and 10 bridges) and metal-ceramic fixed structures (54 artificial crowns and 7 bridges).
All patients were divided into two groups. The first group consisted of 22 patients whose prosthodontical treatment was carried out using fixed prostheses made by the traditional method. In total, 61 fixed prostheses were manufactured in this group: 54 metal-ceramic artificial crowns and 7 metal-ceramic bridge prostheses.
The second group consisted of 25 patients whose prosthodontical treatment was carried out using fixed prostheses made using digital
technologies (intraoral scanner, CAD/CAM system, 3D printer). In total, 65 fixed prostheses were manufactured in this group: 49 artificial crowns (16 on titanium frames and 33 on zirconium dioxide frames) and 16 bridge prostheses (6 on titanium frames and 10 on zirconium dioxide frames). To study the condition of periodontal tissues of teeth with artificial crowns, the amount of gingival fluid was measured in patients of both groups in the interval 1-1,5 years after the end of prosthodontical treatment.
The amount of gingival fluid was determined by absorption using strips of filter paper measuring 15X4 mm, the end of which was made pointed at an angle of 45 ° for more convenient insertion into the furrow.
At the first stage, professional oral hygiene was carried out, then the study area was isolated from saliva using cotton pads and thoroughly dried. The introduction of paper strips into the gingival furrow to determine the amount of gingival fluid secreted was carried out using the intra-furrow sampling method. Using tweezers, the tip of a strip of filter paper was inserted into the gingival slit without bringing it to the bottom of the groove in order to avoid mechanical irritation of the tissues of the marginal periodontal and subsequent strengthening of the formation of gingival fluid. The time for obtaining gingival fluid was 3 minutes.
Quantitative determination of gingival fluid was carried out by measuring the area of impregnation of paper strips. Detection of areas soaked in gum fluid was carried out by staining strips of filter paper in blue or blue with 0,2% alcohol solution of ninhydrin, the effect of which is based on the discovery of a-amino groups in protein.
After that, photographs of strips of filter paper were obtained and the area of impregnation of strips with gingival fluid in square millimeters was measured in the ImageJ computer program.
Results and discussion. Verification of compliance with the normal distribution using the Shapiro-Wilk test allowed us to conclude that the distribution of
data on measuring the amount of gingival fluid secreted in patients whose prosthetics were performed using fixed prostheses made by the traditional method does not correspond to normal (Table 1).
Table 1
The results of checking the compliance of the sample with the normal distribution
Method of manufacturing fixed prostheses W p
The traditional method 0,91114 < 0,001
Digital method 0,97253 0,079
Таблица 1
Результаты проверки соответствия выборки нормальному распределению
Метод изготовления несъемных протезов W p
Традиционный 0,91114 < 0,001
Цифровой 0,97253 0,079
Therefore, nonparametric methods were used for the analysis, and the data were described using the median, the 25th and 75th percentiles, minimum and maximum values (Table 2).
Table 2
Descriptive statistics of the distribution of values of the amount of gingival fluid secreted
Method of manufacturing fixed prostheses n Median Minimum Maximum 25th percentile 75-th percentile
The traditional method 68 0,67 0,5 0,82 0,575 0,765
Digital method 81 0,44 0,3 0,6 0,38 0,48
Таблица 2
Описательные статистики распределения значений количества выделяемой десневой жидкости
Метод изготовления несъемных протезов n Медиана Минимум Максимум 25-й процентиль 75-й процентил ь
Традиционный 68 0,67 0,5 0,82 0,575 0,765
Цифровой 81 0,44 0,3 0,6 0,38 0,48
The results of the study showed that the average value of the amount of gingival fluid secreted in patients whose prosthetics were performed using traditional technologies was 0,6597 ± 0,106 mm2, which corresponds to the indicators characteristic of catarrhal gingivitis. The average value of the amount of gingival fluid secreted in patients whose prosthetics were performed using digital technologies was 0,4372 ± 0,06277 mm2, which indicates the absence of periodontal diseases. The Mann-Whitney criterion was used for statistical analysis of the results obtained. In this study, the null hypothesis is rejected at the level of statistical significance p < 0,025, i.e. the probability of erroneous recognition of differences as significant is less than 0,025. When calculating the critical significance level, the Bonferroni correction was introduced to account for multiple comparisons: 0,025 = 0,05 / 2, where 0.05 is the generally accepted value of the critical significance level for a single comparison in biomedical research, and 2 is the number of comparisons. Table 3 shows the values of the Mann-Whitney criterion and the corresponding
significance levels of p for pairwise comparison of groups.
Table 3
Results of pairwise comparison of groups
Sign W p
Amount of gingival fluid 5344,5 <0,001***
Note «***» - the presence of a statistically significant difference at the level of p < 0,001.
Таблица 3 Результаты попарного сравнения групп
Признак W p
Количество десневой жидкости 5344,5 <0,001***
Примечание «***» - наличие статистически значимого различия на уровне p < 0,001.
Table 3 shows that digital and traditional methods of manufacturing fixed prostheses are distinguishable with a significance level of p < 0,025 on the basis of "Amount of gingival fluid". Thus, the amount of gingival fluid secreted in patients with digital prosthetics is 34,3% less in comparison with
K-ISSN 2686-6838
the traditional method of manufacturing prosthodontical structures.
The data obtained by us are consistent with the results obtained by A. A. Kopytov [8], who came to the conclusion that prosthodontical treatment with the use of metal-ceramic bridges made by the traditional method leads to an increase in the amount of gingival fluid excretion to the values characteristic of chronic catarrhal gingivitis.
Parkhomenko A. N. et al. [9] found a correlation between the amount of gingival fluid and the accuracy of the fit of artificial crowns in the ledge area, which indicates that the insufficient level of technical performance of the prosthodontical structure determines the risks of complications from marginal periodontal disease (p < 0,05).
Also, the data obtained by us are indirectly consistent with the results obtained by Obidny K. Yu. et al. [10], who, when studying the microbial landscape of the gingival furrow in patients with fixed prostheses, came to the conclusion that the material
REFERENCES
|11. Biochemistry of oral fluid in normal and pathological conditions / under the general editorship of prof. A.V. Shestopalov. M.: ICAR Publishing House, 2017, 64 p. -ISBN978-5-7974-0574-0
[2]. Prokhodnaya V. A., Chibichyan E. H., Lomova A. S., Kosykh A. Yu. Methodological approaches to the collection and study of biological fluids of the oral cavity in the framework of teaching propaedeutics of dental diseases // Chief physician of the South of Russia. 2018. No 1. - P. 4346.
[3]. Yanushevich O.O., Vavilova T.P. Ostrovsky.G., Derkacheva N.I. Molecular Dentistry [Electronic resource] : textbook. M. : GEOTAR-Media, 2020, 160 P. ISBN 9785-9704-5676-7.
[4]. Lepilin A.V., Yerokina N.L., Ivanova I.A., Mironov A.Yu., Grigorieva D.A., Martynova M.I. Diagnostic significance of gingival fluid examination in patients with fixed denture structures // Modern orthopedic dentistry. 2018. No. 29. - P. 13-16.
[5]. Yanushevich, O. O. Gingival fluid. Noninvasive research in dentistry / O. O. Yanushevich, T. P. Vavilova, I. G. Ostrovskaya - Moscow : GEOTAR-Media. - 2019. - 160 p. - ISBN 978-5-9704-5101-4.
[6]. Fatima T., Khurshid Z., Rehman A., Imran E., Srivastava K.C., Shrivastava D. Gingival Crevicular Fluid (GCF): A Diagnostic Tool for the Detection of Periodontal Health and Diseases / Molecules. 2021. Vol. 26. No 5. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7956529/ (дата обращения: 22.04.2023). https://doi.org /10.3390/molecules26051208.
[7]. Barros S.P., Williams R., Offenbacher S., Morelli T. Gingival crevicular fluid as a source of biomarkers for periodontitis / Periodontol 2000. 2016. Vol. 70. No 1. - P. 53-64. https://doi.org 10.1111/prd.12107.
[8]. Kopytov, A. A. Dynamics of indicators of gingival fluid in the process of rehabilitation of patients with bridge prostheses with different inclination of the supporting teeth: abstract. dis. ... Candidate of Medical Sciences : 14.00.21.
...................................Moscow, 2007. 23 jp..................................................................................................................................................................................
of artificial crowns, the method of their manufacture and, as a consequence, the accuracy of the marginal fit play a primary role in the formation of the gingival microbiocenosis furrows and oral cavities in general. Stamped crowns, according to these authors, intensively affect the microbiocenosis of the gingival furrow, and the effect of solid-cast and metal-ceramic crowns is less pronounced, while crowns made of zirconium dioxide have the most minimal effect on the marginal periodontal.
Conclusion. Evaluation of the periodontal reaction of the supporting teeth covered with artificial crowns made digitally by studying the amount of gingival fluid showed that the figures obtained are closer to the boundary values (average value 0,4372 ± 0,06277 mm2), reflecting their significantly less influence on the condition of the marginal periodontal compared with the traditional method of manufacturing fixed prostheses (average value 0.6597 ± 0.106 mm2) primarily due to their higher accuracy.
БИБЛИОГРАФИЧЕСКИМ СПИСОК
|1|. Биохимия ротовой жидкости в норме и при патологии / под общей редакцией проф. А. В. Шестопалова. М.: Издательство ИКАР, 2017, 64 с. - ISBN978-5-7974-0574-0
[2]. Проходная В. А., Чибичян Е. Х., Ломова А. С., Косых А. Ю. Методические подходы к сбору и исследованию биологических жидкостей ротовой полости в рамках преподавания пропедевтики стоматологических болезней // Главный врач юга России. 2018. № 1. - С. 43-46.
[3]. Янушевич О.О., Вавилова Т.П., Островская И.Г., Деркачева Н.И. Молекулярная стоматология [Электронный ресурс] : учебное пособие. М. : ГЭОТАР-Медиа, 2020, 160 с. ISBN 978-5-9704-5676-7.
[4]. Лепилин А.В., Ерокина Н.Л., Иванова И.А., Миронов А.Ю., Григорьева ДА., Мартынова М.И. Диагностическое значение исследования десневой жидкости у пациентов с несъёмными конструкциями зубных протезов // Современная ортопедическая стоматология. 2018. № 29. - С. 13-16.
[5]. Янушевич, О. О. Десневая жидкость. Неинвазивные исследования в стоматологии / О. О. Янушевич, Т. П. Вавилова, И. Г. Островская - Москва : ГЭОТАР-Медиа. - 2019. - 160 с. - ISBN 978-5-9704-5101-4.
[6]. Fatima T., Khurshid Z., Rehman A., Imran E., Srivastava K.C., Shrivastava D. Gingival Crevicular Fluid (GCF): A Diagnostic Tool for the Detection of Periodontal Health and Diseases / Molecules. 2021. № 26(5). URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7956529 / (дата обращения: 22.04.2023). https://doi.org /10.3390/molecules26051208.
[7]. Barros S.P., Williams R., Offenbacher S., Morelli T. Gingival crevicular fluid as a source of biomarkers for Periodontitis / Periodontol 2000. 2016. №70(1). - P. 5364. https://doi.org 10.1111/prd.12107.
[8]. Копытов, А. А. Динамика показателей десневой жидкости в процессе реабилитации пациентов с мостовидными протезами при различном наклоне
E-ISSN 2686-6838
|9|. Parkhomenko A. N., Motorkina T. V., Shemonaev V. I. Studying the influence of various algorithms for preparing teeth for crowns on the outcome of orthopedic treatment // Bulletin of New Medical Technologies, electronic journal. 2018. No 3. - P. 15-21. https://doi.org /10.24411/20754094-2018-15981 [10]. Offending K. Yu., Bolotnaya V. N., Pogorely V. V. Microbial landscape of the gingival furrow in patients with artificial crowns made of various materials // Pacific Medical Journal. 2020. Vol. 80, No. 2. - P. 46-48. https://doi.org/10.34215/1609-1175-2020-2-46-48.
опорных зубов: авторсф. дис. ... канд. мед. наук : 14.00.21. Москва, 2007. 23 с.
[9]. Пархоменко А. Н., Моторкина Т. В., Шемонаев В. И. Изучение влияния различных алгоритмов препарирования зубов под коронки на исход ортопедического лечения // Вестник новых медицинских технологий, электронный журнал. 2018. № 3. - С. 15-21. https://doi.org /10.24411/2075-40942018-15981
[10]. Обидный К. Ю., Болотная В. Н., Погорелый В. В.. Микробный пейзаж десневой борозды у пациентов с искусственными коронками из различных материалов // Тихоокеанский медицинский журнал. 2020. Т. 80, № 2. - С. 46-48. https://doi.org/10.34215/1609-1175-2020-2-46-48.
Author Contributions. Vokulova YU.A. — research concept and design, collection and processing of materials,
writing a text; Zhulev E.N. - approval and final scientific revision; Yanova N.A. - literature review, text editing;
Zhdanova M.L. - literature review, text editing; Plishkina A.A. - literature review.
Conflict of Interest Statement. The authors declare no conflict of interest.
Zhulev E.N. - SPIN ID: 5921-9211; ORCID ID: 0000-0001-9539-3350
Vokulova YU.A. - SPIN ID: 2237-1510; ORCID ID: 0000-0001-5220-2032
Yanova N.A. - SPIN ID: 4826-1927; ORCID ID: 0000-0002-3436-5150
Zhdanova M.L.-SPIN ID: 4333-3575; ORCID ID: 0000-0002-3436-5150
Plishkina A.A. - SPIN ID: 5277-1653; ORCID ID: 0000-0002-2124-9740
For citation: Zhulev E.N., Vokulova YU.A., Yanova N.A., Zhdanova M.L., Plishkina A.A. THE RESULTS OF DETERMINING THE AMOUNT OF GINGIVAL FLUID IN PATIENTS WITH FIXED PROSTHESES MADE BY TRADITIONAL AND DIGITAL METHODS // Medical & pharmaceutical journal "Pulse". - 2023;25(5):124-128. http://dx.doi.org//10.26787/nydha-2686-6838-2023-25-5-124-128.
Вклад авторов. Вокулова Ю.А. - идея и дизайн исследования, сбор и обработка данных, написание текста; Жулев Е.Н. - одобрение и окончательная научная редакция; Янова Н.А. - обзор литературы, редактирование текста; Жданова М.Л. - обзор литературы, редактирование текста; Плишкина А.А. - обзор литературы.
Заявление о конфликте интересов. Авторы заявляют об отсутствии конфликта интересов.
Жулев Е.Н. - SPIN ID: 5921-9211; ORCID ID: 0000-0001-9539-3350 Вокулова Ю.А. - SPIN ID: 2237-1510; ORCID ID: 0000-0001-5220-2032 Янова Н.А. - SPIN ID: 4826-1927; ORCID ID: 0000-0002-3436-5150 Жданова М.Л. - SPIN ID: 4333-3575; ORCID ID: 0000-0002-3436-5150 Плишкина А.А. - SPIN ID: 5277-1653; ORCID ID: 0000-0002-2124-9740
Для цитирования: Жулев Е.Н., Вокулова Ю.А., Янова Н.А., Жданова М.Л., Плишкина А.А. РЕЗУЛЬТАТЫ ОПРЕДЕЛЕНИЯ КОЛИЧЕСТВА ДЕСНЕВОЙ ЖИДКОСТИ, У ПАЦИЕНТОВ С НЕСЪЕМНЫМИ ПРОТЕЗАМИ, ИЗГОТОВЛЕННЫМИ ТРАДИЦИОННЫМ И ЦИФРОВЫМ МЕТОДОМ // Медико-фармацевтический журнал "Пульс". 2023;25(5): 124-128. http://dx.doi.org//10.26787/nydha-2686-6838-2023-25-5-124-128.
