RU2326620C1 - Crown for differential diagnostics of allergic reaction aetiology - Google Patents

Abstract

FIELD: medicine; stomatology.

SUBSTANCE: crown contains metallic layer, ceramic finish on external surface of metallic layer, metallic flange in oral surface of adjoining tooth. Metallic flange is clear of ceramic finish and is placed out of its area. Metallic flange is smaller than occlusive area of adjoining tooth and designed to separate it and perform differential diagnostics of allergic reaction aetiology.

EFFECT: simplified construction and possibility to perform express diagnostics any time after tooth crowning.

4 cl, 3 dwg, 3 ex

Description

The invention relates to medicine and is intended for differential diagnosis of the etiology of an allergic reaction.

In the last decade, when providing orthopedic care, there has been a tendency to increase the number of patients suffering from intolerance to orthopedic structures located in the oral cavity: crowns, bridges, orthodontic appliances (Berdnikova N.P. Comparative evaluation of methods for diagnosing intolerance to metal inclusions in the oral cavity. Abstract. Thesis ... Candidate of Medical Sciences - M., 2002; Gozhaya LD Diseases of the oral mucosa due to materials of dentures / etiology, pathogenesis, clinic, diagnosis stick, treatment, prevention / Abstract of a thesis ... of Doctor of Medical Sciences -...... M., 2001. - 53 c)..

In dentistry, various materials are used for the manufacture of dental crowns and bridges (Onishchenko B.C. Metal alloys used in orthopedic dentistry, and their main characteristic / lecture /. - TSOLIUV, 1982. - 20 p.). Finding metal structures in an electrolytic medium (in particular, saliva) of the oral cavity leads to galvanic processes. As a result of the interaction of metal dentures and fillings, some patients develop pathological "intolerance to metal inclusions in the oral cavity." Three main types of such pathological effects on the human body are possible: toxic-chemical, electro-galvanic and allergic. Perhaps their combined effect, so often there are difficulties in determining the etiological factor.

The clinical picture is characterized by the following symptoms: a change in taste (taste of metal, salt, bitterness), paresthesia, glossalgia, hypo- or hypersalivation, a feeling of "current flow" when metal objects are introduced into the oral cavity. The following reactive manifestations are possible: rhinitis, urticaria, dermatitis, eczema.

A known method for the diagnosis of galvanosis in the oral cavity, which consists in the use of special research methods, which must be carried out in the following sequence.

1. Measurement of the potentials of metal inclusions of the oral cavity.

2. Measurement of the current between metal inclusions in the oral cavity (dentures).

3. Determination of saliva pH in dental patients.

4. Determination of the sensitivity threshold of the oral mucosa.

5. These indicators, combined with the data obtained in the study of the clinical picture and anamnesis, make it possible to establish with relatively high reliability the presence and severity of "oral galvanism", as well as the degree of development of "galvanosis" (Gozhaya L.D. Diseases of the oral mucosa caused by materials of dentures / etiology, pathogenesis, clinic, diagnosis, treatment, prevention /. Abstract of thesis. ... Doctoral Medical Sciences. - M. 2001. - 53 p.).

A limitation of the method for diagnosing galvanosis is the long duration of its implementation, associated with the use of a large number of laboratory methods, and the lack of clear quantitative criteria.

Other methods for diagnosing galvanosis in the oral cavity are also known (RF Patent No. 2212185, АВВ 5/05, publ. 09/20/2003), (RF Patent №2218078, А61В 5/05, publ. 10/12/2003), (RF Patent №2248180 , A61B 5/05, publ. March 20, 2005). These methods are characterized either by measuring the magnitude of the direct current flowing through the metal structures in the oral cavity, or by measuring the potential difference between the metal structures, or by measuring the electrochemical potentials when various metal alloys are introduced into the oral cavity. A limitation of these methods is also a sufficiently long duration of their implementation in time, the unreliability of the results, since the above physical parameters are determined for metal structures made of various metal alloys and previously installed in the patient’s oral cavity. For structures, for example, made of one alloy, a significant potential difference will not arise, but toxic-chemical or allergic intolerance is possible, as well as a combined electro-galvanic effect with the above pathological effects, which are not possible to identify before installing the structure in the patient’s oral cavity .

Intolerance of an allergic nature develops much more often than electro-galvanic (Nagy L ,, Zec T. N. // Clin. Exp. Immunol. - 1982. - Vol.47. - P.541-567.), (Gozhaya L.D. Allergic diseases in orthopedic dentistry. - M .: Medicine, 1988). The problem of intolerance covers a wide range of issues related to the influence of different in nature materials of dentures on the tissues of the oral cavity and the human body, on the one hand, and the reactions of biological media to dentures, on the other. In a healthy person, the action of materials of dentures is within its adaptive capabilities, however, if these capabilities are reduced, then there is a so-called “risk group” (Markov BP, Dzhirikov Yu.A. // Dentistry. - 1995. No. 11. - S.52-94) and various diseases can develop.

Various designs of crowns containing protrusions are known, however, these protrusions are not intended for differential diagnosis of the etiology of an allergic reaction. So, in the application (Japan No. 9122149, A61C 5/04, publ. 13.05.1997) describes a structure containing synthetic rubber, and the crown has a protrusion located on the chewing surface of the tooth.

The closest is a crown containing a layer of fixing cement, a metal layer located on the outer surface of the layer of fixing cement, a ceramic lining located on the outer surface of the metal layer, a metal protrusion located in the area of the oral surface of the adjacent tooth (US Patent No. 5538429, A61C 5 / 08.23.07.1996).

In addition, this crown is equipped with a binder located under the pad, and the metal protrusion cannot serve for diagnosis, because It is completely covered with ceramic cladding.

The problem solved by the invention is the expansion of diagnostic capabilities.

The technical result that can be obtained by carrying out the invention is to simplify the design when possible to carry out rapid diagnostics at any time after installing the crown.

To solve the problem with achieving the specified technical result in a known crown containing a layer of fixing cement, a metal layer located on the outer surface of the layer of fixing cement, a ceramic lining located on the outer surface of the metal layer, a metal protrusion located in the oral surface of the adjacent tooth, according to the invention, the metal protrusion is made free of ceramic cladding and is located beyond, and the metal protrusion made smaller than the occlusal region of the adjacent tooth, and is intended for its separation and differential diagnosis of the etiology of an allergic reaction.

Additional embodiments of the device are possible, in which it is advisable that:

- the metal protrusion was made in the form of an occlusal lining;

- the metal protrusion was made spherical in shape;

- the area of the metal protrusion was less than the area of the occlusal region of the adjacent tooth, at least four times.

These advantages, as well as features of the present invention are illustrated by the best option for its implementation with reference to the accompanying drawings.

Figure 1 schematically depicts a longitudinal section of the crown, right side view;

figure 2 schematically depicts a view of the oral surface of a number of teeth with a crown;

figure 3 is the same as figure 2, another option.

The crown (FIGS. 1-3) contains a fixing cement layer 1, a metal layer 2 located on the outer surface of the fixing cement layer 1, a ceramic lining 3 located on the outer surface of the metal layer 2. The metal protrusion 4 is located in the oral surface of the adjacent tooth. The metal protrusion 4 (figure 2, 3) is free from ceramic cladding 3 and is located outside. The metal protrusion 4 is made smaller than the occlusal region of the adjacent tooth, and is intended for its separation and differential diagnosis of the etiology of an allergic reaction.

The metal protrusion 4 can be made in the form of an occlusal lining (figure 2) for prosthetics of the included defects, one-sided end defects, when there are teeth not covered by crowns in contact with the structure.

The metal protrusion 4 can be made spherical in shape (Fig. 3) for prosthetics of bilateral defects, for prosthetics of defects, when the prosthesis design has no contact with existing teeth.

The area of the metal protrusion 4 may be less than the area of the occlusal region of the adjacent tooth, at least four times (Fig.2, 3) for the absence of supercontacts. The area of the metal protrusion 4 is selected only on the basis of the required amount of material for analysis during the diagnosis.

The crown (Figs. 1-3) is made by traditional standardized methods, taking into account the fact that an additional metal protrusion 4 is made, which is not coated with ceramics at the stage of applying the ceramic cladding 3.

Example 1

Patient J., with a developing state of hypothyroidism, born in 1953, complained of a burning sensation in the tongue, aggravated by acidic foods, dry mouth, tongue sticking to the gums, and general condition deterioration in the form of fatigue. Patients with this pathology are included in the “risk group” identified by Markov B. P., Dzhirikov Yu.A. The authors substantiated the need for individual selection of dental materials after correction of the general somatic state in patients of this group.

According to the patient, these symptoms appeared three months after prosthetics in the clinic at the place of residence (Moscow), taking into account the recommendations received on the use of the claimed device.

Objectively: free opening of the mouth, teeth 24; 25; 26; covered with metal-ceramic crowns for differential diagnosis of the etiology of an allergic reaction.

Diagnosis:

Hard tooth tissue defect 24; 25; 26; intolerance to the material of orthopedic structures.

The separation from the prosthesis of the protrusion of the metal layer, made in the form of an occlusal lining with a cutting tool, made it possible to conduct a subsequent examination in the immunological laboratory of the CDC MGMSU.

At the first stage, an in vitro peroxidase test was performed on the components of the studied metal-ceramic prosthesis alloy present in the separated sample. Metal alloys, presented in the oral cavity in the form of various orthopedic structures, undergoing electrochemical dissolution, are a source of positively charged ions entering the oral fluid and stimulating the course of electro-galvanic processes. The diffusion of metal ions into biological tissues can lead to the formation of haptens, forming an immune response.

These phenomena cause a higher incidence of intolerance to metal alloys, in contrast to the material of fixing cement and ceramic cladding.

The peroxidase test was developed by a group of scientists led by Lebedev K.A., Ponyakina I.D., Mitronin A.V. The basis of this method is the determination of granulocyte damage as a result of contact with the ions or molecules of prosthetic materials by changing their release of peroxidase. Its advantages are the objectivity of evaluating the result and relative simplicity, which makes it possible to simultaneously set the reaction in a series of 8-10 dilutions of the prosthetic material solution.

In the peroxidase method, blood cells are incubated with a solution of the test material in 8-10-fold dilutions (i.e., 8 tests with different concentrations of the test material are put) for 15 minutes. As a control, 8 tests with physiological saline are used. After this, the cells are precipitated by centrifugation, and in the culture medium, the amount of peroxidase released by cells damaged by incubation is determined. To do this, add a solution of tetramethylbenzidine and after the development of staining, the reaction is stopped with a solution of sulfuric acid. The staining intensity is measured using a tablet photometer.

Incubation of cells with a solution of a substance can lead to both stimulation of the release of peroxidase and its suppression. Perhaps this depends on the effect of which mediators prevails under the conditions of exposure to the test substance and its concentration. Therefore, it is necessary to determine the response of cells in a series of serial dilutions of the test substance and take into account not only the deviation of the average value of the indicator in a series of tests, but also the amplitude of fluctuations of the values of the indicator in a series of serial dilutions of it.

Deviation from control of 10% or less is considered insignificant, it corresponds to the lack of sensitivity to the test material.

Deviations in the range of 11-25% correspond to poor sensitivity to the material. The identification of a weak allergic sensitivity to a substance reflects the presence of latent sensitization to it, which under adverse conditions can lead to a pathological reaction.

Deviation of more than 25% of the average value in the control corresponds to a high allergic sensitivity of the patient to this drug.

The peroxidase test showed a high degree of sensitization of the body to a metal alloy.

At the second stage, a fixing cement sample of 1.5 × 1.5 cm was replaced for an additional in vivo test method in the form of a mucous-gingival test. The mucosal-gingival test (SDT) was developed to determine the allergic intolerance of denture materials (Lebedev K.A., Sagan L.G., 2002; Lebedev K.A., Maksimovsky Yu.M., Kulmagombetov I.R., Godunova M. I., 2003). It consists in the fact that a sample of the prosthetic material is introduced into the cheek region of the lower jaw, which is held for 50 minutes The number of leukocytes in the swabs from the oral cavity is determined before and after contact with the material. The results are evaluated by the change in the number of leukocytes that migrated into the oral cavity after application of the material, compared with the original. Testing by this method of the reaction to prosthetic materials, to which allergy intolerance occurred before prostheses were removed, showed a significant increase in the number of leukocytes, and in rare cases, on the contrary, their suppression.

This method has certain disadvantages. In one day, the patient can check the reaction to only one material. Checking the suitability of new materials is possible only after the removal of the prostheses that caused allergic intolerance, and the disappearance of the pathological symptoms caused by them. If there is an active inflammatory process in the oral cavity, overdiagnosis is possible in the case of the use of SDT. There is no doubt that this test does not reveal latent sensitization of the body to prosthetic materials.

This test revealed a lack of sensitization to the sample of fixing cement and confirmed the presence of sensitivity to the studied metal alloy.

Based on the results obtained, it was concluded that patient J. is intolerant of the ceramic-metal crown due to the development of active sensitization to the components of the metal alloy. It is recommended to make a design that replaces the alloy used.

Example 2

A patient O., born in 1947, who had a history of hypersensitivity to many drugs (penicillin group antibiotics, sulfa drugs) complained of a burning tongue in the side sections, aggravated by contact with bridges.

Objectively: 35, 37, 45, 47 - crowns, 36, 46 - facets, bite according to the direct type. The bridges were made a year ago after the removal of the first lower molars due to exacerbation of chronic periodontitis and have protrusions in the form of occlusal plates for the differential diagnosis of allergic reactions located on 44 and 37 teeth. Patients with a burdened allergic history are included in the risk group.

Diagnosis: intolerance of an unknown etiology.

Recommended: to differentiate the etiology of intolerance.

The peroxidase test showed the absence of sensitization to the material of the prosthesis, presented in the form of an occlusal protrusion separated by means of a cutting tool.

A sample of fixing cement in a mixed form (according to the medical history, the cement used for fixation - Fugi 1) showed a high degree of sensitization of the body - a deviation of more than 50% according to the result of the peroxidase test.

Conducted additional peroxidase and mucosal-gingival tests on a sample of Carboco cement did not reveal a high sensitivity to this material.

Thus, pathological phenomena in the form of a symptom complex of intolerance in patient O. were caused by the fixing cement material Fugi 1. The contact of this material with the environment of the oral cavity was probably facilitated by an involutive retraction of the marginal gingival margin. The lack of hypersensitivity according to immunological tests to Carboco fixing cement provides a basis for its further use in fixing orthopedic structures.

Example 3

Patient B., born in 1960, complained of a tingling sensation on her tongue, hard palate, stopping when eating, headaches, and dry mouth. History - an allergic reaction to a stamped-soldered bridge in January 2000. After examination and individual selection of structural material, the stamped-soldered prosthesis was replaced by a ceramic-metal prosthesis.

According to the patient, these symptoms appeared four years after the prosthetics and intensified over time.

Objectively: teeth 25; 26; 27, covered with ceramic-metal crowns for differential diagnosis of the etiology of an allergic reaction, having an occlusal lining in the region of the 24 tooth.

Diagnosis: defect of hard tissues of teeth 24; 25; 26; intolerance to the material of orthopedic structures.

Using a peroxidase test in vitro, the presence of latent sensitization to the components of the studied metal-ceramic prosthesis alloy present in the separated sample was established, indicating the advisability of conducting a mucous-gingival test.

After some time, the mucous-gingival test did not reveal the presence of sensitization to the components of the alloy under study.

The patient in the clinic was made a sample of fixing cement Meron for immunological tests.

The peroxidase test found a deviation from the control of less than 10%, which is considered insignificant and corresponds to the lack of sensitivity to the test material of fixing cement.

Thus, due to the presence of a crown with the claimed structural features, the subsequent differential diagnosis made it possible to establish the absence of a causal relationship between the structural materials and the development of pathological phenomena in patient B. These phenomena could arise due to a violation of the individual characteristics of the innervation of the oral mucosa. Consultation with a dentist is required.

The proposed crown for the differential diagnosis of the etiology of an allergic reaction does not require additional equipment from the dental laboratory, does not increase the number of laboratory stages, and does not extend the duration of the laboratory stage for the manufacture of prostheses. When planning the manufacture of this prosthesis, it is necessary to choose one or another type of structural features (in the form of pearls, in the form of occlusal overlays), which is due to the specific clinical situation.

The most successfully declared crown is industrially applicable in dentistry for express diagnostics of the patient’s hypersensitivity to various dental materials without removing the crown itself and at different times after it is fixed to permanent cement.

Claims (4)

1. A crown containing a metal layer, a ceramic lining located on the outer surface of the metal layer, a metal protrusion located in the region of the oral surface of the adjacent tooth, characterized in that the metal protrusion is free of ceramic lining and is located outside, and the metal protrusion is made smaller than the occlusal region of the adjacent tooth, and is intended for its separation and differential diagnosis of the etiology of an allergic reaction. 2. The crown according to claim 1, characterized in that the metal protrusion is made in the form of a lining. 3. The crown according to claim 1, characterized in that the metal protrusion is made spherical in shape. 4. The crown according to claim 1, characterized in that the area of the metal protrusion is less than the area of the occlusal region of the adjacent tooth, at least four times.

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