[Actual problems and ways of perfection of postgraduate education of dentists in the Russian Federation].
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Biomedical subjects
Publications and source records attributed to S I Abakarov.
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Reaction of the pulp to degree-by-degree changes (from 3 to 18 degrees) in inclination of lateral walls of abutment teeth during preparation for cermet dentures was studied by the functional diagnosis methods (electroodontodiagnosis, rheodentography) in 50 patients with intact abutment teeth. Changes in dental pulp electric conductivity and hemodynamics depended on the inclination angle formed during preparation. The optimal safe angle of the lateral wall inclination was determined to be 3-12 degrees. Increase of the angle (> 12 degrees) can lead to traumatic pulpitis.
Colonization of materials used for making dentures with oral microflora was studied in 12 patients with chronic generalized medium severe periodontitis during remission. Time course of dentures colonization with representatives of oral microflora (S. sanguis, Peptostreptococcus sp., Prevotella oralis) and with bacteria pathogenic for the periodontium (Prevotella melaninogenica, A. naeslundii, Fusobacterium sp.) depends on the material from which the dentures are made. Minimal colonization of bacteria pathogenic for the periodontium was observed on cermet dentures.
Morphological changes in the periodontium during the use of cermet crowns of different design were studied in experimental animals. The status of the periodontium was found to depend on the level of crown fixation with respect to gingival edge. Histological findings had show that position of a cermet crown at the level of the gingival edge does not involve appreciable changes in the periodontium, though preparation of abutment teeth with the formation of a step be considered as preferable. A subgingival position of cermet crowns leads to development of an inflammatory reaction in the periodontium, the severity of this reaction being related to a great measure to the method of the tooth preparation. If a step is formed during preparation of a tooth, the inflammatory changes are less pronounced than when there is no step formed. In the latter case the pathological changes were seen in the periodontium. The authors come to a conclusion that cermet crowns should be fixed at the level of the gingival edge. When making cermet crowns, abutment teeth should be prepared with the formation of a pericervical step.
The results of experimental morphologic studies carried out in 23 dogs evidence that the status of the denture bed tissue beneath a whole-cast bridge cermet denture depends on the tightness of the denture adhesion to the gingival mucosa. If the denture poorly adheres to its bed, no marked changes in the structural components of the gingiva and the underlying bone support are detectable. If the denture adheres tightly to the gingiva, marked inflammatory dystrophic and destructive changes develop both in the gingiva and in the alveolar crest bone tissue. A complex of structural changes in the epithelium, connective tissue base of the gingival mucosa, and alveolar bone crest were traced. The results evidence that inflammatory dystrophic changes in the gingiva augment and result in the development of erosive ulcerative elements in the gingiva in case of a prolonged tight adhesion of the denture to the denture bed; sometimes decubital ulcers may develop in the gingiva. The resorptive processes take place in the underlying bone tissue, causing like smooth resorption of bone matter or to lacunar resorption. Diffuse rarification of bone tissue is also typical of such cases. Excessive pressure of the denture body in case of its tight adhering to denture bed seems to be detrimental not only for the epithelium, but for deeper structures of the gingival mucosa and the underlying bone structures as well.
The author has developed a method for making bilayer impressions to be used in making metal ceramic bridge dentures. Bilayer impressions were obtained by the routine method in the controls. Clinical data evidence that the suggested method permits obtaining an accurate bilayer impression and rules out development of pathologic shifts under the bridge denture.
A ten-years' experience with metalloceramic dentures is analyzed. Orthopedic treatment was performed in patients with different forms of dentomaxillary pathology. Possible sources of construction and fixation errors and complications are exposed, and their prevention described.
The methods of prevention of complications of metalloceramic prostheses are described. A compound is designed for temporary fixation of nonremovable dentures which allowed the 2-months follow-up of the patients and did not prevent corrections at any stage of treatment. Outpatient follow-up is necessary in the cases of metalloceramic prosthesis application.
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The paper presents the results of functional examination of pulpal and periodontal vessels in 57 patients who underwent preparation of supporting teeth for making cermet dentures. Pulpal hemodynamics was studied by using rheodentography before and 1, 3, 7, 14, 21, and 28 days after tooth preparation. After preparation, the tooth pulp exhibited inflammatory sings which gradually alleviated and 14-28 days later there was stabilization of rheographic parameters of regional hemodynamics. In patients with intact periodontium, circulatory recovery occurred on days 14-21, while in those with periodontitis it took place on days 21-28.