Background. Treatment and prevention of inflammatory periodontal diseases represent a serious general medical and social problem, which remains relevant due to the significant prevalence of periodontitis among the population, as well as the associated loss of teeth and the negative impact of periodontal foci of infection on the body as a whole. Chronic generalized periodontitis is difficult to treat: it is only possible to achieve periods of remission. Therefore, it is of great theoretical and practical importance to develop further ways to improve methods for treating inflammatory-dystrophic damage of periodontal tissues in chronic generalized periodontitis.

Objective. To perform an index estimation of treatment efficacy in patients with moderately severe chronic generalized periodontitis.

Methods. An experimental randomized single-arm study was conducted examining 204 patients diagnosed with moderately severe chronic generalized periodontitis. Patient examination and data analysis were carried out at the Dentistry Department of the Stavropol State Medical University and the Department for General Practice Dentistry of the Kuban State Medical University in 2021–2022. The study included patients aged 35 to 65 years diagnosed with moderately severe chronic generalized periodontitis. Patients with somatic diseases in the decompensation stage were not eligible for the study. The patients were randomly divided into three groups (closed-envelope method). Group 1 was treated using conventional methods. As well as conventional therapy, Group 2 was prescribed vitamin D (Aquadetrim^® at a dose of 5000 IU once per day while monitoring vitamin D blood level). The third group of patients was prescribed conventional therapy along with the developed pharmacotherapy, which included vitamin D (Aquadetrim^® at a dose of 5000 IU once per day), vitamin A (3.44% oil solution of retinol acetate at a dose of 50 000 IU, 15 min after a morning meal), and 2-ethyl-6-methyl-3-hydroxypyridine (Mexidol^® at a dose of 125 mg twice a day). In each patient, the treatment efficacy was analyzed in adjacent oral cavity segments (split-mouth design) according to clinical pocket depth, attachment loss, and bleeding on probing. Also, the authors used the X-ray index to assess the condition of osseous structures and the simplified oral hygiene index. The specified indices were estimated prior to treatment and at one and 12 months following treatment. The statistical analysis of study results was performed using Excel Microsoft Office 2016 (Microsoft, USA).

Results. The obtained data indicate that the immediate clinical outcomes (after one month) of combination therapy in patients from all three groups were approximately the same. However, the efficacy of treatment measures in the long-term period (12 months) was different, as evidenced by the dynamics of index values. Only in Group 3 patients, the full implementation of pharmacotherapeutic measures as part of the combination therapy of periodontitis ensured a stable therapeutic effect throughout the entire period of observation.

Conclusion. The data obtained 12 months following treatment indicate that the additional prescription of the developed pharmacotherapy contributed to prompt inflammation relief in periodontal tissues, providing a stable treatment outcome and long-term remission.

Background. The available comparative studies on issues of choosing antibiotic regimen in dental implantation are often observational and describe only visible postoperative signs. More objective assessment of postoperative period and comparison of approaches requires laboratory tests. One of the methods to be used at a dental appointment is to study examination of the biochemical properties of saliva.

Objective. To carry out comparative evaluation of single and prolonged regimens of amoxicillin/clavulanate administration after dental implantation indicated by nonspecific immunity in mixed saliva.

Methods. A randomized uncontrolled trial of 30 partially edentulous patients was conducted. The clinical phase of the study was performed at the Department of Propaedeutics of Surgical Dentistry, MSUMD; the laboratory phase — at the Pharmacology and Biological Chemistry Departments, MSUMD, in 2021–2022. The study included patients aged 18 to 75 years, anatomically suitable for dental implant placement. Patients with somatic diseases in the decompensation stage were excluded from the study. Patients were randomized into 2 groups. The group 1 was prescribed to take amoxicillin/clavulanate pills (875+125 mg) 30 minutes before surgery. The group 2 was to take amoxicillin/clavulanate (875+125 mg) 30 minutes before surgery and then 1 pill of Amoxicillin/ Clavulanate (500+125 mg) 2 times a day for 7 days after surgery. To evaluate the efficacy of the applied antibiotic therapy, unstimulated mixed saliva was collected from all patients on an empty stomach, 1 ml before surgery and on the third day after surgery. The amount of immunoglobulins of G, M, A classes (mg/l) and б-amylase activity (IU/l) were determined spectrophotometrically in the saliva samples. Statistical processing of laboratory data was performed using Welch's t-test by means of Statistica 10 Pro (StatSoft, USA). Intergroup and intragroup differences were considered significant at p ≤ 0.05.

Results. Based on the saliva proteins examined, the most pronounced difference between the patient groups was obtained for IgA. For other studied parameters of saliva, no significant difference between the groups was obtained on the third day after the surgery. However, despite the absence of a statistical difference, a tendency to a stronger increase in the amount of IgA, G, IgM, salivary amylase activity was noted for all indicators; moreover, a high correlation between immunoglobulins of class A, G, immunoglobulins of class G, M, and immunoglobulins of class A, M was revealed.

Conclusion. Among patients with the prolonged regimen, the groups did not differ significantly in such saliva parameters as immunoglobulins G and M and salivary б-amylase activity, however, a tendency to a stronger increase of the mentioned immunoglobulins in the saliva of group 1 patients was revealed. The most significant difference was recorded for immunoglobulin A in saliva, the amount of which was significantly lower in the group of prolonged antibiotic administration (p < 0.05).

Background. The vast majority of malignant neoplasms of the oral mucosa refer to squamous cell carcinomas. The development of squamous cell carcinoma of the oral mucosa is often promoted by previous potentially malignant diseases, with oral leukoplakia dominating among them.

Objective. To determine the clinical significance of the pathogenicity of somatic mutations in oral mucosal leukoplakia.

Methods. The study material included 24 samples of abnormal epithelium of the oral mucosa from leukoplakia patients. QIAamp DNA FFPE Tissue Kit (Qiagen, Germany) was used for deoxyribonucleic acid (DNA) extraction from the samples. DNA sequencing was performed using IlluminaNextSeq 550 sequencer and TruSight™ Oncology 500 DNA Kit For Use with NextSeq (Illumina, USA). All DNA extractions from biological samples, preparation and sequencing of DNA libraries were performed step-by-step in strict accordance with the guidelines provided with the respective reagent kits. Bioinformatics analysis was carried out using specific software Illumina Base Space (Illumina, USA) and Galaxy Project (The Galaxy Community, a non-profit international project) according to current guidelines. The desired power of the study accounted for 90%. Two Proportions Z test was performed by means of The Sample Size Calculation of Statistica 12 (StatSoft, Inc.) with the set option “one-tailed hypothesis”, because it was initially assumed that pathogenic (oncogenic) genetic variants occur in the tissue of oral leukoplakia much more frequently than in the human reference genome used for sequence alignment.

Results. The pathogenic somatic mutations in the TP53, KRAS, APC, NRAs and BRAF genes, identified in this study, alone or in combination, are highly likely (hazard ratio 3000-11000) to be associated with the development of oral mucosal leukoplakia and low-grade epithelial dysplasia. The multiplicity of pathogenic and likely pathogenic genetic variants associated with epithelial dysplasia, as well as the fact that a number of variants do not occur in all patients, suggests that the same histotype of oral mucosal dysplasia may develop under the influence of different mutations.

Conclusion. The pathogenic and likely pathogenic variants of the TP53, KRAS, APC, NRAS and BRAF genes, identified in this study, alone or in combination, are highly likely (hazard ratio 3000–11000) to be associated with the development of leukoplakia and low-grade epithelial dysplasia.

Background. Effective treatment of oral candidiasis is especially relevant due to the increase in patients with recurrent fungal lesions of the oral cavity caused by the growing number of Candidaspp. strains refractory to antimycotic drugs. The paper presents the results of the study on the clinical efficacy of etiotropic therapy in patients with chronic recurrent course of oral candidiasis.

Objective. To assess the effectiveness of etiotropic therapy in patients with chronic recurrent oral candidiasis.

Methods. A randomized controlled clinical trial was conducted in 56 patients with chronic recurrent oral candidiasis aged 45 to 74 years. Examination and treatment of patients was performed at the Department of Dentistry of Volgograd State Medical University and at Volgograd Regional Clinical Dental Polyclinic (Volgograd, Russia). Study timeline: September 2020 — November 2022. Patients were divided into 2 groups depending on the antimycotic drug used: in the main group, patients took voriconazole, in the control group — fluconazole. In addition to etiotropic therapy, patients of both groups were prescribed complex treatment aimed at stimulating the immune protection of the body, restoring vitamin and mineral deficiency, and correcting the imbalance of the oral ecosystem. The patients underwent local symptomatic therapy: antiseptic treatment with 0.06% chlorhexidine bigluconate solution, anesthesia with 15% lidocaine gel, and 3.44% retinol oil solution to stimulate epithelization. Oral sanitation and professional hygiene were recommended for patients to prevent oral candidiasis. In order to restore chewing function, patients were referred to prosthodontic treatment. The main reference point of the study was to assess the effectiveness of the therapy, both by clinical criteria and by evaluating the results of bacterial culture test in order to record the quantitative, species and susceptibility profile of Candidaspp. strains in 3 weeks, 6 and 12 months after the end of treatment. Analysis and statistical processing of the obtained data were performed using Excel program to MS Windows 10 (Microsoft Corp., USA).

Results. The most common pathogenic agent of chronic recurrent forms of oral candidiasis is C. albicans (69.6%), followed by C. non-albicans species — C. krusei (10.7%), C. tropicalis (10.7%) and C. glabrata (8.9%). Analysis of the quantitative characteristics of Candidaspp. using bacterial culture test revealed a high and moderate number of Candidaspp. CFU in most clinical isolates before treatment, and no such cases in patients of the main group after treatment. The susceptibility test of yeast fungi to fluconazole and itraconazole showed the presence of isolates with dose-dependent susceptibility, and the resistance of individual samples C. krusei to fluconazole and C. glabrata (16.7% and 60%, respectively) and to itraconazole (33.3% and 100%, respectively). All Candidaspp. isolates were found to be highly susceptible to voriconazole. The efficacy of the combined treatment of an episode with voriconazole is 95.4%. Continued suppressive therapy with voriconazole resulted in relapse prevention in 98.3% of patients. Etiotropic therapy with voriconazole provided a stable clinical effect (92.7%) after a year of follow-up.

Conclusion. The results of the study confirm the effectiveness of etiotropic therapy with voriconazole for chronic oral candidiasis complicated by a recurrent course, especially in case of detected C. non-albicans or fluconazole- and itraconazole-resistant C. albicans, or if it is impossible to identify the pathogenic agent.

Background. At present, the priority direction of medical science and practice is the prevention of dental diseases, especially in patients with somatic pathology. Patients with dyscirculatory encephalopathy develop a complex of neurological disorders, accompanied by impaired motor functions of hands, lips and chewing muscles, which leads to ineffective cleansing of the oral cavity from food residues and formation of soft and mineralized dental deposits on the dental surface. Therefore, these patients should use additional personal hygiene products.

Objective. To evaluate the efficacy of hygienic care in patients with dyscirculatory encephalopathy using mouthwash with synbiotic complex.

Methods. An observational clinical study was conducted on the basis of Neurology Unit No. 2 of Research Center of Neurology, Department of Cariology and Endodontics and Department of Biological Chemistry, A.I. Yevdokimov Moscow State Medical and Dental University. The study enrolled 82 patients aged from 45 to 74 years with cerebrovascular disease, dyscirculatory encephalopathy, decompensation (I68.7, according to ICD-10). Patients were divided into two study groups: group 1 (n = 44) — patients who used mouthwash with synbiotic complex; group 2 (n = 38) — patients who did not use mouthwash. The efficacy of mouthwash with synbiotic complex was assessed by using an index score of a simplified Greene Vermillion Oral Hygiene Index (OHI-S), Russell Periodontal Index (PI), Papillary Bleeding Index (PBI), and physicochemical parameters of the oral fluid. Statistical processing of the results was carried out using Stat Plus 7 (Analyst Soft Inc., USA).

Results. The comparative analysis proved the efficacy of mouthwash with synbiotic complex. The hygienic status improved to (1.50 ± 0.12) points, the state of periodontal tissues — to (PI = (1.94 ± 1.45) points; PBI = (1.12 ± 0.11) points). The hydrogen index (pH) of the oral fluid decreased to weakly alkaline values — (7.92 ± 0.22) points; the activity of alkaline phosphatase decreased by a factor of 1.4, lactate dehydrogenase — by half, aminotransferases — by a factor of 1.3, and D-dimer — by a factor of 1.2.

Conclusion. The obtained results demonstrate the efficacy of mouthwash as an additional means for personal hygiene. Mouthwash with synbiotic complex should be included in the daily oral hygiene care for patients with dyscirculatory encephalopathy.

Background. Polymer composites have good aesthetic characteristics and pronounced physicochemical properties, as compared to traditional restorative materials such as amalgam. However, the polymerization reaction of composite material containing bismethacrylate group commonly used in clinical practice is always accompanied by a different degree of volumetric shrinkage (2.7%~7.1%). The resulting stress can lead to adhesion failure and some other unfavorable clinical consequences, such as enamel destruction, microcracking of composite material and formation of microleakage between composite and tooth cavity wall, which can result in recurrent caries and postoperative sensitivity, thereby affecting the long-term effect of restoration. Therefore, studying the effect of preheating on composite restoration is important for its clinical application.

Objective. To improve the effectiveness of treatment of patients with dental caries by improving the physicochemical properties of composite restorations.

Methods. A randomized clinical trial enrolled 180 patients aged 18 to 45 years, diagnosed with dentin caries class I, according to Black (K02.1 in ICD). The study was conducted in the Dental Clinic of Kuban State Medical University, Russia. 180 composite restorations were performed in the treatment of dentin caries of molars. Patients were randomized into 2 groups): the control group — 90 patients and the main group — 90 patients. The control and main groups, in turn, were divided into three subgroups, depending on the composite used — Estelite Sigma Quick (Tokuyama Dental, Japan), Filtek Bulk Fill Posterior Restorative (3M Espe, USA) and DentLight (VladMiVa, Russia). Each subgroup consisted of 30 patients. In the control group, the classical method of filling with a composite material at “room temperature” was applied. In the main group, a composite heating conditioner “Ena Heat” (Micerium, Italy) was used to heat the composite to 55 °C before adapting the material in the formed cavity with subsequent photopolymerization. The quality of composite restorations within the clinical study was evaluated using the modified Ryge criterion immediately after treatment and after 6, 12, 18, 24 months. Statistical processing of the obtained data was carried out by means of one-factor analysis of variance using the GraphPadPrism 9 program (GraphPad Software, USA).

Results. The duration of the clinical study comprised 24 months. The study revealed a statistically significant decrease in the quality of marginal fit of composite restorations (according to the Ryge score) by 20.1% (p = 0.0001) in the control group and by 5.7% (p = 0.0328) in the main group.  At the same time, no statistically significant changes in Ryge scores were reported in the subgroups of composite materials of the main group (pF = 0.9480, pE = 0.1837, pD = 0.2529). As a result of the study, an optimal time algorithm (7 seconds) for using a special furnace for preheating the composite before sealing with subsequent photopolymerization was obtained.

Conclusion. The study revealed a statistically significant positive effect of the proposed algorithm for working with a heated composite on the quality of marginal fit in the long term after treatment in comparison with the classical method of working with a composite at “room temperature”.

Background. Healing of open wounds in the oral cavity is often accompanied by infection and constant traumatization, which lead to impaired blood supply to the tissues, lack of trophic support and low oxygen supply to increasing proliferative processes. Recently, photodynamic therapy has taken its place among the methods for stimulating regeneration of oral mucosal tissues. The authors consider it essential to study the influence of photodynamic treatment on the functional state of the microvasculature in the wound tissues, which determines the transcapillary exchange and the tissue respiration, providing the tissue regeneration.

Objective. To study the photodynamic effect of sequential dual-wavelength radiation on the microvasculature in the wound tissues of the oral mucosa in vivo.

Methods. The study was carried out on 36 female outbred Wistar rats, weighing 200–250 g. The animals were divided into two groups: control group (n = 18) and experimental group (n = 18). Wound surfaces healed by secondary intention were modeled on the cheek mucosa of the animals. Dual-wavelength photodynamic therapy was performed in the 1st postoperative day in experimental group. The microcirculatory function was assessed by Doppler flowmetry before, and on days 3, 7 and 14 after wounding. The results were processed using IBM SPSS Statistics 26.0.0.1 (IBM Inc., USA).

Results. It has been established that dual-wavelength photodynamic therapy has a positive effect on the restoration of the microvasculature of the wound tissues. This therapy facilitated bypassing for microcirculatory flow on the 3rd day of the study, and increased the perfusion of tissues on the 7th. The experimental group did not have congestive-ischaemic phenomena in the wound region; the microcirculatory flow was augmented through the microcirculation regulation by the 14th day.

Conclusion. Following the obtained results the use of dual-wavelength photodynamic therapy can be considered as a promising method for restoration of the microvasculature of tissues in the oral mucosal trauma.

Background. Rehabilitation of patients with chronic periodontal diseases leading to multiple tooth loss can be carried out using the method of immediate prosthetics. However, the likelihood of atrophy of denture-supporting tissues under non-physiological load with removable dental prostheses imposes special requirements for their design features.

Case description. Two patients seeking for dental surgical and prosthetic treatment for the diagnosis of chronic generalized periodontitis were treated in the dental clinic of Ryazan State Medical University named after academician I.P. Pavlov. Patient A. was mounted immediate prostheses made using additive technologies with the original design of the drug reservoir. Patient B. was mounted immediate prostheses with bases made of acrylic plastic, border ring of elastic polymer, and a drug reservoir made of polymethyl methacrylate. Patients underwent tooth extraction with immediate prosthetics. Patients were followed for 21 days. Criteria for the effectiveness of treatment included visual and palpatory control of extraction sites with a planimetric wound size analysis, assessment of microcirculation at the extraction site, control of the drug persistence in the reservoirs of prostheses.

Conclusion. The observations at the stages of prosthodontic treatment revealed that immediate prostheses made with the help of 3D modeling and printing technologies resulted in a normal course of healing after tooth extraction with the normalization of microcirculatory parameters at the surgical wound sites. When using combined prosthetic structures, healing of postoperative wounds also proceeded favorably, however, congestion in the microcirculatory system was noted.

Background. Currently, the issues of diagnosis and treatment of patients with dentoalveolar injuries combined with temporomandibular joint disorders are highly relevant due to a progressive increase in the number of cases of this pathology among the population. Despite the availability of the comprehensive methodology in diagnostics of dentoalveolar injuries, dentists lack standardized algorithms for effective examination and systematization of the data obtained in the diagnostics of such groups of patients, which is necessary for personalized planning and pathogenetic therapy. The authors present the algorithm they developed for comprehensive assessment of dentoalveolar injuries in patients with temporomandibular joint disorders.

Case descriptions. The paper presents clinical cases of two patients with abnormal occlusion associated with temporomandibular joint disorder. The patients underwent a comprehensive morphofunctional examination of the dentoalveolar complex in accordance with the diagnostic algorithm patented by the authors, including following methods: clinical (interview, examination), anthropometric (anthropometry of dentition), radiological (cone-beam computed tomography, magnetic resonance imaging of the temporomandibular joint), functional (surface electromyography of the masticatory muscles, computer kinesiography, electro-vibrography, ultrasound examination of the temporomandibular joint), to make the final diagnosis and to determine the order and scope of treatment.

Conclusion. The authors presented and proved clinically the algorithm of morphofunctional diagnostics for the dento-alveolar complex of patients with temporomandibular joint disorders, combining clinical, anthropometric, radiological and functional methods of examination, which allow the most dento-alveolar characteristics to be considered in order to make the main diagnosis and a personalized treatment protocol for such groups of patients