Don saukewa ko buga wannan shafi a cikin wani yare daban, zaɓi yaren ku daga menu na ƙasan ƙasa da farko a hagu na sama.

Takarda Matsayin IAOMT akan Cavitation na Kashi na Mutum

Shugaban Kwamitin Pathology na Jawbone: Ted Reese, DDS, MAGD, NMD, FIAOMT

Karl Anderson, DDS, MS, NMD, FIAOMT

Patricia Berube, DMD, MS, CFMD, FIAOMT

Jerry Bouquot, DDS, MSD

Teresa Franklin, PhD

Jack Kall, DMD, FAGD, MIAOMT

Cody Kriegel, DDS, NMD, FIAOMT

Sushma Lavu, DDS, FIAOMT

Garkuwar Tiffany, DMD, NMD, FIAOMT

Mark Wisniewski, DDS, FIAOMT

Kwamitin yana son bayyana godiyarmu ga Michael Gossweiler, DDS, MS, NMD, Miguel Stanley, DDS da Stuart Nunally, DDS, MS, FIAOMT, NMD saboda sukar da suka yi na wannan takarda. Har ila yau, muna so mu gane gudunmawar da ba ta da mahimmanci da kuma kokarin da Dr. Nunally ya yi a cikin tattara takardar matsayi na 2014. Ayyukansa, himma da aikin sa sun ba da kashin baya ga wannan takarda da aka sabunta.

Hukumar gudanarwar IAOMT ta amince da ita Satumba 2023

Abubuwan da ke ciki

Gabatarwa

Tarihi

ganewar asali

Mazugi mai lissafta tomography (CBCT)

Duban dan tayi

Binciken Halittu da Nazarin Tarihi

Abubuwan Haɓakawa don dalilai na bincike

Labarin Batsa

Acupuncture Meridian Assessment

Dalili na Hadarin

Abubuwan Tsari da Na Clinical

Hanyoyin Magani

Madadin Dabarun Magani

karshe

References

Shafi na I Sakamakon Bincike na IAOMT 2

Shafi na II Sakamakon Bincike na IAOMT 1

Shafi III images

Hoto 1 Fatty degenerative osteonecrosis na kashin jaw (FDOJ)

Hoto 2 Cytokines a cikin FDOJ idan aka kwatanta da Gudanar da Lafiya

Hoto 3 Hanyar tiyata don FDOJ mai jujjuyawa

Hoto 4 Curettage da daidai x-ray na FDOJ

Fina-finai Hotunan bidiyo na tiyatar kashin muƙamuƙi a marasa lafiya

GABATARWA

A cikin shekaru goma da suka gabata an sami karuwar wayar da kan jama'a da ma'aikatan kiwon lafiya dangane da alakar da ke tsakanin lafiyar baki da na tsarin jiki. Misali, cututtukan periodontal cuta ce mai haɗari ga duka ciwon sukari da cututtukan zuciya. An kuma nuna wata hanyar haɗin kai mai yuwuwar sakamako da ƙara bincike tsakanin ilimin cututtukan kashin kashin kashin kashin da lafiyar gaba ɗaya da ƙarfin mutum. Yin amfani da hanyoyin fasaha na fasaha na fasaha irin su cone-beam computed tomography (CBCT) sun kasance kayan aiki don gano cututtuka na kashin jaw, wanda ya haifar da ingantattun hanyoyin bincike da ingantaccen ikon tantance nasarar ayyukan tiyata. Rahotanni na kimiyya, docudramas da kafofin watsa labarun sun kara wayar da kan jama'a game da waɗannan cututtuka, musamman a tsakanin mutanen da ke fama da rashin lafiya na ciwon daji ko yanayin tsarin da ba a bayyana ba ga magungunan gargajiya ko maganin hakora.

Cibiyar Nazarin Magungunan Baka da Magunguna ta Duniya (IAOMT) an kafa ta ne bisa imani cewa ya kamata kimiyya ta zama tushen da za a zaɓa da amfani da duk hanyoyin bincike da magani. Yana da wannan fifikon a zuciyarmu cewa mun 1) samar da wannan sabuntawa zuwa 2014 IAOMT Jawbone Osteonecrosis Matsayin Takarda, da 2) ba da shawara, dangane da lura da tarihin tarihi, ingantaccen sunan kimiyya da likitanci ga cutar, musamman, Cutar Cutar Cutar Cutar Ischemic. na Jawbone (CIMDJ). CIMDJ ya bayyana yanayin kashi wanda ke nuna mutuwar sassan salula na kashi mai sokewa, na biyu zuwa katsewar samar da jini. A cikin tarihinsa, abin da muke magana da shi a matsayin CIMDJ an yi magana da shi ta hanyar ɗimbin sunaye da gajarta waɗanda aka jera a cikin Tebu 1 kuma za a tattauna a ƙasa.

Manufar da manufar wannan Kwalejin da takarda ita ce samar da kimiyya, bincike, da kuma lura da asibiti ga marasa lafiya da likitoci don yanke shawarar da aka sani lokacin la'akari da waɗannan raunuka na CIMDJ, waɗanda aka fi sani da cavitations jawbone. An ƙirƙira wannan takarda ta 2023 a cikin ƙoƙarin haɗin gwiwa wanda ya haɗa da likitoci, masu bincike da kuma fitaccen masanin ilimin kashin kashin jaw, Dokta Jerry Bouquot, bayan bitar labarai sama da 270.

Tarihin

Babu wani kashi da ke da yuwuwar kamuwa da rauni da cututtuka kamar a cikin kasusuwan muƙamuƙi. Bita na wallafe-wallafen da suka shafi batun cavitations na kashin jaw, (watau CIMDJ) ya nuna cewa an gano wannan yanayin, ana kula da shi da kuma bincike tun daga shekarun 1860. A cikin 1867, Dr. HR Noel ya ba da gabatarwa mai suna Lecture akan caries da necrosis na kashi a Baltimore College of Dental Surgery, kuma a cikin 1901 Cavitations jawbone aka tattauna a tsawon da William C. Barrett a cikin littafinsa mai suna, Oral Pathology and Practice: A Textbook for the Use of Students in Dental Colleges and a Handbook for Dental Practitioners. GV Black, wanda sau da yawa ake magana a kai a matsayin uban likitan hakori na zamani, ya haɗa da wani sashe a cikin littafinsa na 1915, Special Dental Pathology, don bayyana ' bayyanar da maganin da aka saba da shi' abin da ya bayyana a matsayin osteonecrosis na jaw (JON).

Bincike kan cavitation na kashin jaw ya yi kama da tsayawa har zuwa shekarun 1970 lokacin da wasu suka fara bincike kan batun, ta yin amfani da sunaye da lakabi iri-iri, da kuma buga bayanai game da shi a cikin littattafan koyarwa na baka na zamani. Alal misali, a cikin 1992 Bouquot et al ya lura da kumburi na intraosseous a cikin marasa lafiya tare da ciwo mai tsanani da ciwo mai tsanani (N = 135) kuma ya sanya kalmar 'Neuralgia-inducing Cavitational Osteonecrosis', ko NICO. Ko da yake Bouquot et al ba su yi sharhi game da ilimin ilimin cutar ba, sun yanke shawarar cewa mai yiwuwa raunuka sun haifar da neuralgia na fuska na yau da kullum tare da siffofi na musamman na gida: samuwar cavity na ciki da kuma tsayayyen kashi necrosis tare da ƙarancin warkarwa. A cikin nazarin asibiti na marasa lafiya tare da trigeminal (N = 38) da fuska (N = 33) neuralgia, Ratner et al, kuma ya nuna cewa kusan dukkanin marasa lafiya suna da cavities a cikin alveolar kashi da kashin jaw. Cavities, wani lokacin fiye da santimita 1 a diamita, sun kasance a wuraren da aka cire haƙoran baya kuma gabaɗaya ba a iya gano su ta hanyar x-ray.

Wasu sharuɗɗa iri-iri na abin da muka bayyana a matsayin CIMDJ sun wanzu a cikin adabi. An jera waɗannan a cikin Tebur 1 kuma an tattauna a taƙaice anan. Adams et al ya kirkiro kalmar Chronic Fibrosing Osteomyelitis (CFO) a cikin takarda matsayi na 2014. Takardar matsayi ta kasance sakamakon ƙungiyoyi masu yawa na kwararru daga fannonin Magungunan baka, Endodontics, Pathology na baka, Neurology, Rheumatology, Otolaryngology, Periodontology, Psychiatry, Oral da Maxillofacial Radiology, Anesthesia, Janar Dentistry, da Magungunan Pain. . Manufar ƙungiyar ita ce samar da dandamali na tsaka-tsaki don magance cututtukan da ke hade da kai, wuya, da fuska. Ta hanyar haɗin kai na wannan rukuni, bincike mai yawa na wallafe-wallafe da tambayoyin haƙuri, wani nau'i na asibiti na musamman ya fito, wanda suka kira CFO. Sun lura cewa sau da yawa ba a gano wannan cutar ba saboda cututtukan da ke tattare da ita tare da sauran yanayin tsarin. Wannan rukunin ya nuna yuwuwar alaƙa tsakanin cutar da al'amurran kiwon lafiya na tsarin da kuma buƙatar ƙungiyar likitoci don tantancewa da kuma kula da mara lafiya yadda ya kamata .

Hakanan an lura da raunin cavitational jawbone a cikin yara. A cikin 2013, Obel et al sun bayyana raunuka a cikin yara kuma sun tsara kalmar Juvenile Mandibular Chronic Osteomyelitis (JMCO). Wannan rukunin ya ba da shawarar yiwuwar amfani da bisphosphonates na ciki (IV) azaman magani ga waɗannan yara. A cikin 2016 Padwa et al sun buga wani binciken da ke kwatanta osteitis mai kumburi mai kumburi a cikin kasusuwa marasa lafiya na yara. Sun yi wa lakabi da raunin yara na yau da kullun marasa ƙwayoyin cuta osteomyelitis (CNO).

Tun daga 2010, Dokta Johann Lechner, marubucin da aka fi bugawa da kuma mai bincike kan raunuka na cavitational jawbone, da sauransu suna yin bincike game da dangantakar waɗannan raunuka da samar da cytokine, musamman ma RANTES cytokine mai kumburi (wanda aka fi sani da CCL5). Dokta Lechner ya yi amfani da kalmomi daban-daban don bayyana waɗannan raunuka waɗanda suka haɗa da NICO da aka ambata a baya amma kuma Aseptic Ischemic Osteonecrosis a cikin Jawbone (AIOJ), da Fatty Degenerative Osteonecrosis na Jawbone (FDOJ). Bayanin sa / lakabin sa ya dogara ne akan bayyanar jiki da / ko yanayin cututtukan cututtuka na macroscopically da ake lura da su a asibiti ko cikin ciki.

A yanzu akwai buƙatar fayyace wani cututtukan da aka gano kwanan nan wanda ya bambanta da batun wannan takarda amma yana iya zama da ruɗani ga waɗanda ke binciken raunukan cavitational. Wadannan raunuka ne na kasusuwa na muƙamuƙi waɗanda ke tasowa sakamakon amfani da magunguna. Launuka suna da kyau mafi kyau ta hanyar asarar samar da jini tare da rashin iya sarrafa kashi na gaba. Wadannan raunuka an kira su Oral Ulceration tare da Kashi Sequestration (OUBS) ta Ruggiero et al a cikin takarda matsayi don Ƙungiyar Amirka ta Likitocin Baka da Maxillofacial (AAOMS), da kuma ta Palla et al, a cikin nazari na yau da kullum. Tun da wannan matsala tana da alaƙa da yin amfani da ko dai ɗaya ko magunguna masu yawa, IAOMT yana tunanin cewa irin wannan nau'in ciwon ya fi dacewa da Osteonecrosis na Jaw (MRONJ) mai alaka da magani. MRONJ ba za a yi magana a cikin wannan takarda ba saboda ilimin ilimin halinsa da hanyoyin magance shi sun bambanta da abin da muke magana a kai a matsayin CIMDJ, kuma an yi nazari sosai a baya.

GANO

Ƙara yawan amfani da na'urorin rediyo na Cone-beam computed tomography (CBCT) da yawancin likitocin hakori ya haifar da karuwa a cikin kiyaye cavitations na intramedullary da muke kira CIMDJ, kuma an yi watsi da su a baya kuma saboda haka an yi watsi da su. Yanzu da aka gano waɗannan raunuka da abubuwan da ba su da kyau a hankali, ya zama alhakin ƙwararrun haƙori don gano cutar da ba da shawarwarin magani da kulawa.

Yabo da gano wanzuwar CIMDJ shine farkon fahimtarsa. Ba tare da la'akari da yawancin sunaye da acronyms waɗanda ke da alaƙa da ilimin cututtuka ba, kasancewar necrotic, ko mutuwa kashi a cikin ɓangaren medullary na kashin jaw yana da kyau.

Lokacin da aka lura yayin tiyata waɗannan lahani na ƙasusuwa suna bayyana kansu ta hanyoyi da yawa. Wasu likitocin sun ba da rahoton cewa sama da kashi 75% na raunuka suna da zurfi sosai ko kuma cike da taushi, launin toka-launin ruwan kasa da nama mai lalacewa/ granulomatis, galibi tare da kayan mai mai launin rawaya (ciyoyin mai) waɗanda aka samu a cikin gurɓatattun wuraren da ke kewaye da ƙashi na al'ada. Wasu sun bayar da rahoton kasancewar cavitations da ke da sãɓãwar launukansa overlying cortical kashi yawa cewa a kan bude, bayyana su da linings tare da fibrous baki, launin ruwan kasa ko launin toka kayan filamentous. Har ila yau wasu sun ba da rahoton manyan canje-canje da aka kwatanta daban-daban da aka kwatanta da "gurna", "kamar sawdust", "ramin rami", da "bushe" tare da sclerotic lokaci-lokaci, taurin haƙori na bangon rami. Bayan binciken tarihi, waɗannan raunuka suna bayyana kama da necrosis wanda ke faruwa a cikin wasu kasusuwa na jiki kuma sun bambanta da ilimin tarihi da osteomyelitis (Duba Hoto 1). Ƙarin hotuna da ke kwatanta cutar CIMDJ, wasu waɗanda ke da hoto a yanayi, an haɗa su a shafi na III a ƙarshen wannan takarda.

Figure 1 Hotunan CIMDJ da aka ɗauko daga wani cadaver

Kamar sauran ma'aikatan kiwon lafiya, likitocin hakora suna amfani da tsari mai tsari wanda ke amfani da hanyoyi da hanyoyi daban-daban don gano cututtukan cavitational. Waɗannan na iya haɗawa da gudanar da gwajin jiki wanda ya haɗa da ɗaukar tarihin lafiya, kimanta alamomi, samun ruwan jiki don gudanar da gwaje-gwajen dakin gwaje-gwaje, da samun samfuran nama don biopsy da gwajin ƙwayoyin cuta (watau gwajin kasancewar ƙwayoyin cuta). Fasahar hoto, kamar CBCT kuma ana yawan amfani da su. A cikin marasa lafiya masu rikitarwa waɗanda ba koyaushe suna bin tsari ba ko dacewa da tsari na yau da kullun na hadaddun alamomi, tsarin ganowa na iya buƙatar ƙarin cikakken bincike wanda da farko zai iya haifar da ganewar asali kawai. An bayar da taƙaitaccen bayanin da yawa daga cikin waɗannan hanyoyin gano cutar a ƙasa.

Mazugi mai lissafta tomography (CBCT)

Dabarun bincike da aka bayyana a farkon 1979 ta Ratner da abokan aiki, yin amfani da palpation na dijital da matsin lamba, bincikar allurar rigakafi na gida, la'akari da tarihin likitanci da wurin da ke haskakawa yana da amfani a cikin gano cavitations jawbone. Duk da haka, yayin da wasu daga cikin waɗannan raunuka suna haifar da ciwo, kumburi, jajaye har ma da zazzabi, wasu ba sa . Don haka, ma'auni mafi maƙasudi, kamar hoto yana da mahimmanci sau da yawa.

Yawancin lokaci ba a gano cavitations akan daidaitaccen nau'i biyu (2-D kamar, na gefe da kuma panoramic) fina-finai na rediyo da aka fi amfani da su a likitan hakora. Ratner da abokan aiki sun nuna cewa 40% ko fiye na kashi yana buƙatar canzawa don nuna canje-canje, kuma wannan yana goyan bayan aikin daga baya , kuma an kwatanta shi a cikin Hoto 2. Wannan yana da alaƙa da ƙayyadaddun ƙayyadaddun ƙirar 2-D wanda ke haifar da superimposition. na tsarin anatomical, masking wuraren sha'awa. A cikin yanayin lahani ko ilimin cututtuka, musamman a cikin mandible, tasirin masking na kashin cortical mai yawa akan tsarin da ke ciki na iya zama mahimmanci. Don haka, ana buƙatar dabarun ɗaukar hoto na fasaha kamar CBCT, Tech 99 scans, magnetic resonance imaging (MRI), ko trans-alveolar ultrasound sonography (CaviTAU™®).

Daga cikin fasahohin hoto daban-daban da ake da su, CBCT ita ce kayan aikin bincike da aka fi amfani da shi da likitocin haƙori ke amfani da su wajen yin bincike ko magance cavitations, don haka wanda za mu tattauna a zurfi. Tushen ginshiƙan fasahar CBCT shine ikonsa na ganin raunin sha'awa a cikin nau'ikan 3 (frontal, sagittal, coronal). CBCT ta tabbatar da zama abin dogaro kuma ingantaccen hanyar ganowa da kimanta girman da girman lahani na ciki-kashi a cikin muƙamuƙi tare da ƙarancin murdiya da ƙarancin haɓakawa fiye da 2-D x-ray.

Figure 2 Bayani: A gefen hagu ana nuna hotunan 2-D na kasusuwan muƙamuƙi waɗanda aka ɗauko daga cadaver da suka bayyana

lafiya. A gefen dama na adadi akwai hotuna na ƙasusuwan muƙamuƙi ɗaya waɗanda ke nuna fayyace cavitation necrotic.

Hoto daga Bouquot, 2014.

Nazarin asibiti sun nuna hotunan CBCT kuma suna taimakawa wajen tantance abubuwan da ke cikin rauni (cike da ruwa, granulomatous, m, da dai sauransu), mai yiwuwa yana taimakawa wajen rarrabe tsakanin cututtukan kumburi, cututtukan odontogenic ko wadanda ba na odontogenic ba, cysts, da sauran m ko m. raunuka .

Software da aka haɓaka kwanan nan wanda aka haɗa ta musamman tare da nau'ikan na'urorin CBCT daban-daban suna amfani da raka'a na Hounsfield (HU) wanda ke ba da damar ƙima daidaitaccen ƙimar ƙashi. HU yana wakiltar girman ƙwayar kyallen jikin jiki bisa ga ma'auni mai girman launin toka, dangane da ƙimar iska (-1000 HU), ruwa (0 HU), da yawan ƙashi (+1000 HU). Hoto na 3 yana kwatanta ra'ayoyi daban-daban na hoton CBCT na zamani.

Don taƙaitawa, CBCT ya tabbatar da amfani a cikin ganewar asali da kuma kula da cavitation na jawbone ta:

1. Gano girman, girman da matsayi na 3-D na rauni;
2. Gano kusancin rauni zuwa wasu mahimman tsarin jikin mutum na kusa kamar su

ƙananan jijiyar alveolar, maxillary sinus, ko tushen hakori kusa;

1. Ƙayyade tsarin kulawa: tiyata tare da marasa tiyata; kuma
2. Samar da hoto mai biyo baya don sanin matakin warkarwa da yuwuwar buƙata

don sake magance rauni.

Figure 3 Ingantacciyar fayyace na hoton CBCT saboda ingantacciyar fasahar software, wanda ke rage kayan tarihi da “hayaniyar” da dasa hakori da gyaran ƙarfe na iya haifarwa a cikin hoton. Wannan yana bawa likitan hakori da majiyyacin damar ganin raunin cikin sauƙi. Babban panel shine ra'ayi na panoramic na CBCT wanda ke nuna hagu (#17) da dama (#32) wuri da iyakar raunin cavitational a cikin majinjin osteonecrosis na jaw. Ƙarshen hagu na ƙasa shine hangen nesa na kowane rukunin yanar gizo. Panel na dama na ƙasa shine ma'anar 3-D na rukunin yanar gizo #17 yana nuna porosity cortical overlying medullary cavitation. Ladabi na Dr. Reese.

Duban dan tayi

Har ila yau, a taƙaice mun ambaci na'urar duban dan tayi, CaviTAU™®, wanda aka ƙirƙira kuma ana amfani dashi a sassa na Turai, musamman don gano ƙananan ƙananan ƙasusuwa na sama da ƙananan kasusuwan da ke nuna alamun cavitets. Wannan na'urar trans-alveolar ultrasonic sonography (TAU-n) tana da yuwuwar daidai idan aka kwatanta da CBCT wajen gano lahani na kashin muƙamuƙi, kuma yana da ƙarin fa'ida na fallasa majiyyaci zuwa ƙananan matakan radiation. A halin yanzu babu wannan na'urar a cikin Amurka amma Hukumar Abinci da Magunguna ta Amurka tana nazari kuma tana iya kasancewa farkon kayan aikin gano cutar da ake amfani da ita a Arewacin Amurka don kula da CIMJD.

Binciken Halittu da Nazarin Tarihi

Saboda yanayin kumburi na cavitations jawbone Lechner da Baehr, 2017 sun bincika yiwuwar dangantaka tsakanin zaɓin cytokines da cutar. Ɗaya daga cikin cytokine na musamman an tsara shi akan kunnawa, al'ada T-cell da aka bayyana da ɓoye' (RANTES). Wannan cytokine, da kuma fibroblast girma factor (FGF) -2, an bayyana a cikin adadi mai yawa a cikin raunuka na cavitational da marasa lafiya tare da CIMDJ. Hoto na 4, wanda Dokta Lechner ya bayar, ya kwatanta matakan RANTES a cikin marasa lafiya tare da cavitations (masanin ja, hagu) tare da matakan da ke cikin kulawar lafiya ( mashaya blue), yana nuna matakan da suka fi girma fiye da sau 25 a cikin wadanda ke da cutar. Lechner et al yana amfani da hanyoyi guda biyu don auna matakan cytokine. Ɗaya shine auna matakan cytokines ta hanyar tsari daga jini (Laboratory Solutions Diagnostics, US.). Hanya ta biyu ita ce ɗaukar kwayar halitta kai tsaye daga wurin da ba shi da lafiya lokacin da aka isa don auna shi ta hanyar likitancin baki. Abin takaici, a wannan lokacin samfurin nama da aka keɓance yana buƙatar aiki mai rikitarwa da jigilar kaya waɗanda har yanzu ba a cimma su ba a wuraren da ba na bincike ba, amma ya ba da alaƙa mai zurfi.

Figure 4 Rarraba RANTES a cikin shari'o'in FDOJ guda 31 da samfurori 19 na kashin muƙamuƙi na al'ada idan aka kwatanta da nunin girman x-ray ga ƙungiyoyin biyu a cikin wuraren da suka dace. Abbreviations: RANTES, wanda aka tsara akan kunnawa, al'ada T-cell da aka bayyana da ɓoye chemokine (CC motif) ligand 5; XrDn, X-ray yawa; FDOJ, m degenerative osteonecrosis na kashin jaw; n, lamba; Ctrl, sarrafawa. Hoton da Dr. Lechner ya bayar. Lambar lasisi: CC BY-NC 3.0

Abubuwan Haɓakawa don dalilai na bincike

Kasancewar cavitations na muƙamuƙi an kafa shi da kyau a asibiti. Duk da haka, bayyanannun cututtuka da mafi kyawun sigogin jiyya suna buƙatar ƙarin bincike. Bisa la'akari da haka ya zama dole a taƙaice a faɗi wasu dabaru masu ban sha'awa da yuwuwar ƙima waɗanda wasu ƙwararru ke amfani da su.

Labarin Batsa

An gane cewa ƙarin ƙididdigar ilimin lissafi zai zama kayan aiki mai mahimmanci da bincike. Ɗaya daga cikin irin wannan kayan aiki da wasu masu aiki ke amfani da shi shine hoton thermographic. Ana iya ganin ayyukan kumburi gabaɗaya ta hanyar auna bambance-bambancen zafi a saman kai da wuya. Thermography yana da lafiya, sauri kuma yana iya samun ƙimar bincike kwatankwacin na CBCT. Babban koma baya shi ne rashin ma'anarsa, yana sa ya zama da wahala a gane gefe ko girman rauni.

Acupuncture Meridian Assessment

Wasu likitocin suna duban bayanin martaba mai kuzari na rauni ta yin amfani da Acupuncture Meridian Assessment (AMA) don tantance tasirin sa akan makamancinsa na meridian makamashi. Wannan nau'in kima yana dogara ne akan Electroacupuncture A cewar Voll (EAV) . Wannan fasaha, wadda ta dogara kan magungunan gargajiya na kasar Sin da ka'idojin acupuncture, an haɓaka kuma ana koyar da su a Amurka. An yi amfani da acupuncture don rage zafi da inganta warkarwa. Ya dogara ne akan ma'auni na kwararar kuzari (watau, Chi) ta hanyar takamaiman hanyoyin makamashi a cikin jiki. Waɗannan hanyoyi, ko meridians, suna haɗa takamaiman gabobin, kyallen takarda, tsokoki da ƙasusuwa da juna. Acupuncture yana amfani da takamaiman maki akan meridian don yin tasiri ga lafiya da kuzarin duk abubuwan jiki akan wannan meridian. An yi amfani da wannan fasaha don bayyana cutar kashin kashin jaw, wanda idan an warware shi, kuma yana magance cututtukan da ba su da alaƙa, irin su arthritis ko ciwon gajiya mai tsanani. Wannan dabarar tana ba da kanta don ƙarin bincike (watau, ana buƙatar rubuta sakamako da samun bayanan dogon lokaci da watsawa).

RUKIN KARANTA

Akwai abubuwa da yawa na ɗaiɗaikun mutum waɗanda ke ƙara haɗarin haɓakar cavitations na kashin jaw amma yawanci haɗarin yana da yawa. Hatsari ga mutum na iya zama ko dai tasirin waje, kamar abubuwan muhalli ko tasirin ciki, kamar rashin aikin rigakafi mara kyau. Tables 2 da 3 suna lissafin abubuwan haɗari na waje da na ciki.

Lura cewa Tebu 2, Abubuwan Haɗari na Ciki, baya haɗa da tsinkayar kwayoyin halitta. Yayin da za a yi tunanin bambance-bambancen jinsin za su taka rawa. babu bambancin jinsi guda ko ma hadewar kwayoyin halittar da aka nuna a matsayin abin hadari, duk da haka akwai yiwuwar tasirin kwayoyin. . Binciken wallafe-wallafen na yau da kullun da aka gudanar a cikin 2019 ya nuna cewa an gano adadin polymorphisms na nucleotide guda ɗaya, amma babu kwafi a cikin karatun. Marubutan sun kammala cewa idan aka ba da bambancin kwayoyin halitta waɗanda suka nuna ƙungiyoyi masu kyau tare da cavitations da kuma rashin sake haifar da nazarin, rawar da kwayoyin halitta ke takawa zai bayyana a matsayin matsakaici da kuma daban-daban. Duk da haka, niyya takamaiman yawan jama'a na iya zama dole don gano bambance-bambancen kwayoyin halitta. Lalle ne, kamar yadda aka nuna, daya daga cikin na kowa da kuma asali pathophysiologic hanyoyin na ischemic kashi lalacewa shi ne wuce haddi clotting daga hypercoagulation jihohin, wanda yawanci da kwayoyin underpinnings, kamar yadda aka bayyana ta Bouquot da Lamarche (1999). Teburin 4 da Dr. Bouquot ya bayar, ya lissafa jihohin cututtukan da suka haɗa da hypercoagulation da sakin layi na 3 na gaba suna ba da taƙaitaccen bayani game da wasu binciken Dr. Bouquot wanda ya gabatar a matsayinsa na Daraktan Bincike a Cibiyar Ilimi da Bincike na Maxillofacial.

A cikin cavitations na kashin jaw akwai bayyananniyar shaida na ischemic osteonecrosis, wanda shine cututtukan kasusuwa na kasusuwa inda kashi ya zama necrotic saboda iskar oxygen da rashin abinci mai gina jiki. Kamar yadda aka ambata, abubuwa da yawa na iya yin hulɗar don samar da cavitations kuma har zuwa 80% na marasa lafiya suna da matsala, yawanci gada, na yawan samar da jini a cikin jini. Ba a saba bayyana wannan cutar yayin gwajin jini na yau da kullun. Kashi yana da sauƙin kamuwa da wannan matsala ta hypercoagulation kuma yana haɓakar tasoshin jini sosai; ya karu, sau da yawa mai raɗaɗi, matsalolin ciki; stagnation na jini; har ma da ciwon ciki. Wannan matsala ta hypercoagulation na iya ba da shawara ta tarihin iyali na bugun jini da ciwon zuciya tun yana ƙarami (kasa da shekaru 55), maye gurbin hip ko "arthritis" (musamman a farkon shekaru), osteonecrosis (musamman a farkon shekaru), zurfi. thrombosis na jijiyoyi, emboli na huhu (jini a cikin huhu), thrombosis na retinal vein thrombosis (cututtuka a cikin retina na ido) da maimaita zubar da ciki. Muƙamuƙi suna da takamaiman matsaloli guda 2 tare da wannan cuta: 1) da zarar ya lalace, ƙasusuwan da ba su da lafiya ba su da ƙarfin jure wa ƙananan cututtuka daga ƙwayoyin cuta na hakori da danko; da 2) ƙashi ba zai iya murmurewa daga raguwar kwararar jini ba ta hanyar maganin sa barci na gida da likitocin haƙori ke amfani da su yayin aikin haƙori. Hoto na 5 yana ba da ra'ayi na microscopic na thrombus na intravascular.

Table 4 Cututtukan da suka shafi hypercoagulation. Hudu cikin biyar daga cikin marasa lafiyar cavitation na muƙamuƙi suna da ɗayan waɗannan gudan jini

matsaloli factor.

Ba tare da la'akari da ainihin dalilin hypercoagulation ba, kashi yana tasowa ko dai ƙwayar fibrous (fibers na iya rayuwa a wuraren da ake fama da yunwa), mai maiko, mataccen mai mataccen ("rigar rot"), bushewa, wani lokacin fata ("bushe rot"). ), ko kuma sararin bargo mai zurfi ("cavitation").

Ana iya shafa kowane kashi, amma kwatangwalo, gwiwoyi da muƙamuƙi sun fi shiga ciki. Ciwo sau da yawa mai tsanani amma kusan 1/3^rd na marasa lafiya ba sa jin zafi. Jiki yana da matsala warkar da kansa daga wannan cuta da 2/3^RDS na lokuta suna buƙatar kawar da bargo da suka lalace ta tiyata, yawanci ta hanyar gogewa da curettes. Yin tiyata zai kawar da matsalar (da zafi) a kusan 3/4^ths na marasa lafiya da hannu a jaw, ko da yake maimaita tiyata, yawanci ƙananan hanyoyi fiye da na farko, ana buƙata a cikin 40% na marasa lafiya, wani lokacin a wasu sassan jaws, saboda cutar akai-akai tana da raunuka "tsalle" (watau, shafuka masu yawa a cikin kasusuwa iri ɗaya ko makamantansu), tare da bargo na yau da kullun tsakanin. Fiye da rabin marasa lafiya na hip a ƙarshe za su sami cutar a cikin kishiyar hip. Fiye da 1/3^rd na majinyatan kashin muƙamuƙi za su kamu da cutar a cikin wasu hudu na muƙamuƙi. Kwanan nan, an gano cewa 40% na marasa lafiya tare da osteonecrosis na ko dai hip ko jaw za su amsa maganin rigakafi tare da heparin low heparin (Lovenox) ko Coumadin tare da ƙuduri na zafi da kuma warkar da kashi.

Figure 5 Ra'ayin microscopic na intravascular thrombi

Idan neman hanyar da ba ta hanyar magunguna ba don rage haɗarin hypercoagulation mutum zai iya yin la'akari da amfani da ƙarin enzymes kamar nattokinase ko mafi ƙarfi lumbrokinase duka biyun suna da fibrinolytic da anticoagulation Properties. Bugu da ƙari, jihohin rashi na jan karfe, waɗanda ke da alaƙa da rashin aiki na coagulation, ya kamata a yi watsi da su saboda yawan haɗarin hypercoagulation da aka lura a cikin marasa lafiya da cavitations jawbone.

SYSTEMIC DA LITTAFI MAI TSARKI

Kasancewar cavitations na kashin jaw da ilimin cututtukan da ke tattare da su ya ƙunshi wasu takamaiman alamun bayyanar amma kuma galibi sun haɗa da wasu alamomin tsarin da ba takamaiman ba. Don haka, ya kamata a tunkari gano cutar ta da kuma maganinta tare da yin la'akari sosai daga ƙungiyar kulawa. Abubuwan da suka fi dacewa da abubuwan da suka faru tun lokacin da IAOMT 2014 matsayi na takarda shine ƙuduri na yanayin da ba'a da alaka da cututtuka na yau da kullum bayan maganin cavitation. Ko cututtuka na tsarin jiki suna da yanayin autoimmune ko kumburi da ke faruwa in ba haka ba, an sami rahotanni masu mahimmanci, ciki har da ingantawa a cikin ciwon daji. Rukunin alamar da ke da alaƙa da waɗannan raunuka an keɓance su sosai don haka ba za a iya ganewa ba ko kuma a sauƙaƙe. Sabili da haka, IAOMT yana cikin tunanin cewa lokacin da aka gano majiyyaci tare da cavitations na kashin kashin baya tare da ko ba tare da haɗuwa da ciwo na gida ba, kuma yana da wasu cututtuka na tsarin da ba a danganta su da cavitations na jawabai ba, mai haƙuri yana buƙatar ƙarin kimantawa don sanin ko rashin lafiya yana hade da shi. , ko kuma sakamakon cutar. IAOMT ta binciki membobinta don ƙarin koyo game da menene alamun cututtuka/cututtuka ke warwarewa bayan tiyatar cavitational. Ana gabatar da sakamakon a shafi na I.

Kasancewar cytokines da aka haifar a cikin marasa lafiya marasa kyau, raunin necrotic na cavitations jawbone suna neman aiki a matsayin mayar da hankali ga cytokines mai kumburi wanda ke kiyaye sauran wuraren kumburi da aiki da / ko na yau da kullun. Taimako ko aƙalla ingantawa daga ciwon muƙamuƙi na gida bayan jiyya ana fatan kuma ana tsammanin, amma wannan ka'idar kumburi, wanda za a tattauna dalla-dalla a ƙasa, na iya bayyana dalilin da yasa yawancin cututtukan da ba su da alaƙa da ke da alaƙa da yanayin kumburi na yau da kullun. Hakanan ana rage su tare da cavitation magani.

Don goyan bayan sakamakon da aka zana a cikin takardar matsayi na IAOMT na 2014 da ke danganta cavitations na kasusuwa da cututtuka na tsarin jiki, bincike da nazarin asibiti kwanan nan da Lechner, von Baehr da sauransu suka buga, sun nuna cewa raunuka na cavitation na jaw sun ƙunshi takamaiman bayanin martaba na cytokine da ba a gani a cikin wasu cututtuka na kashi. . Idan aka kwatanta da samfurori na kashin kashin lafiya, ƙwayoyin cavitation suna ci gaba da nuna haɓakar haɓakar haɓakar fibroblast (FGF-2), antagonist mai karɓa na Interleukin 1 (Il-1ra), kuma, musamman mahimmanci, RANTES. RANTES, wanda kuma aka sani da CCL5 (cc motif Ligand 5) an bayyana shi azaman cytokine chemotactic tare da aiki mai ƙarfi mai haɓakawa. An nuna waɗannan chemokines don tsoma baki a matakai da yawa na amsawar rigakafi kuma suna da hannu sosai a cikin yanayi daban-daban da cututtuka. Nazarin ya nuna RANTES yana da tasiri a yawancin cututtuka na tsarin kamar arthritis, ciwo na gajiya mai tsanani, atopic dermatitis, nephritis, colitis, alopecia, cututtuka na thyroid da inganta ƙwayar sclerosis da cutar Parkinson. Bugu da ari, an nuna RANTES don haifar da haɓakar haɓakar ƙari.

Abubuwan haɓakar fibroblast kuma sun kasance suna da tasiri a cikin cavitations na kashin jaw. Abubuwan haɓakar Fibroblast, FGF-2, da masu karɓa masu alaƙa, suna da alhakin ayyuka masu mahimmanci da yawa, gami da haɓakar ƙwayoyin cuta, rayuwa, da ƙaura. Hakanan suna da saurin kamuwa da kwayar cutar kansa ta kama su kuma suna taka rawa a cikin cututtukan daji da yawa. Misali, FGF-2 yana haɓaka ci gaban ƙari da ciwon daji a cikin ciwon daji na prostate. Bugu da ƙari, matakan FGF-2 sun nuna haɗin kai tsaye ga ci gaba, metastasis da rashin lafiyar rayuwa a cikin marasa lafiya na ciwon daji. Idan aka kwatanta da sarrafawar marasa ciwon daji, marasa lafiya da ciwon daji na ciki suna da matakan girma na FGF-2 a cikin maganin su. Wadannan manzannin masu kumburin sun kasance suna da hannu a cikin manyan cututtuka masu yawa ko suna da yanayin kumburi ko ciwon daji. Ya bambanta da RANTES / CCL5 da FGF-2, an nuna IL1-ra don yin aiki a matsayin mai matsakanci mai karfi mai karfi, yana ba da gudummawa ga rashin alamun cututtuka na yau da kullum a cikin wasu cututtuka na cavitation.

An kwatanta matakan da suka wuce kima na RANTES da FGF-2 a cikin raunuka na cavitation kuma an danganta su da matakan da aka lura a cikin wasu cututtuka na tsarin kamar amyotrophic lateral sclerosis, (ALS) multiple sclerosis (MS), rheumatoid arthritis da nono. Lalle ne, matakan waɗannan manzannin da aka gano a cikin cavitations na kashin jaw sun fi girma fiye da ruwan magani da kuma cerebrospinal na ALS da marasa lafiya na MS. Binciken na yanzu na Lechner da von Baehr ya nuna karuwar RANTES sau 26 a cikin kashin kashin osteonecrotic na marasa lafiya na nono. Lechner da abokan aiki suna ba da shawarar RANTES da aka samu cavitation na iya zama mai saurin haɓaka ci gaban kansar nono da ci gaba.

Kamar yadda aka ambata a baya, akwai lokuta da yawa na asymptomatic cavitations jawbone. A cikin waɗannan lokuta, m cytokines pro-mai kumburi irin su TNF-alpha da IL-6, ba a gani a cikin ƙara yawan lambobi a cikin binciken pathohistological na cavitation samfurori. A cikin waɗannan marasa lafiya, rashin waɗannan cytokines masu kumburi suna da alaƙa da manyan matakan cytokine na anti-inflammatory Interleukin 1-receptor antagonist (Il-1ra). Ƙarshe mai ma'ana shine cewa m kumburi da ke hade da cavitations na kashin jaw yana ƙarƙashin ikon manyan matakan RANTES/FGF-2. A sakamakon haka, don yin ganewar asali, Lechner da von Baehr sun ba da shawarar ƙaddamar da mayar da hankali kan kasancewar kumburi kuma la'akari da hanyar siginar, da farko ta hanyar magana ta RANTES / FGF-2. Babban matakan RANTES/FGF-2 a cikin marasa lafiya na cavitation suna nuna cewa waɗannan raunuka na iya haifar da irin wannan kuma suna ƙarfafa juna ta hanyoyin siginar cututtuka zuwa wasu gabobin. Ana kunna tsarin rigakafi don mayar da martani ga alamun haɗari, wanda ke haifar da hanyoyi daban-daban na kwayoyin halitta waɗanda suka ƙare a samar da cytokine mai kumburi da yiwuwar kunna tsarin rigakafi na daidaitawa. Wannan yana goyan bayan ra'ayin da ka'idar, cewa cavitations na kasusuwa na iya zama tushen asali na cututtukan cututtuka na kullum ta hanyar RANTES / FGF-2 samar da kuma kara bayanin dalilin da ya sa ba a koyaushe ganin alamun kumburi ko jin ta mai haƙuri a cikin raunuka na jawbone. kansu. Don haka, cavitations na kashin jaw da waɗannan manzannin da ke da alaƙa suna wakiltar wani ɓangaren haɗin kai na cututtukan kumburi kuma suna aiki a matsayin yuwuwar ilimin ilimin cutar. Cire cavitations na iya zama mabuɗin don juyar da cututtuka masu kumburi. Ana goyan bayan wannan ta hanyar lura da raguwar matakan jini na RANTES bayan aikin tiyata a cikin marasa lafiya na nono 5 (Duba Table 5). Ƙarin bincike da gwaji na matakan RANTES/CCL5 na iya ba da haske game da wannan dangantakar. Abubuwan da ke ƙarfafawa su ne haɓakar ingancin rayuwa da yawancin marasa lafiya na cavitation na kashin kashin kashin jawabai suka samu, ko ya zama sauƙi a wurin aiki ko rage kumburi na yau da kullun ko cuta a wani wuri.

Table 5

Ragewa (Red.) a cikin RANTES/CCL5 a cikin jini a cikin marasa lafiya na nono 5 wadanda aka yi wa tiyata don osteonecrosis na kashin jaw (FDOJ). Teburin da aka daidaita daga

Lechner et al, 2021. Jawbone Cavitation An Bayyana RANTES/CCL5: Nazarin Case yana Haɗa Kumburi na Shiru a cikin Jawbone tare da Epistemology na Ciwon Nono." Ciwon Kankara: Manufa da Magani.

Hanyoyin Magani

Saboda ƙarancin wallafe-wallafe game da maganin raunuka na cavitational, IAOMT ta yi nazari kan kasancewarta membobinta don tattara bayanai game da abubuwan da ke faruwa da jiyya da ke tasowa zuwa 'ma'auni na kulawa'. An tattauna sakamakon binciken a takaice a shafi na II.

Da zarar an ƙayyade wuri da girman raunuka, ana buƙatar hanyoyin magani. IAOMT na tunanin cewa gabaɗaya ba za a yarda da barin "mataccen kashi" a jikin ɗan adam ba. Wannan ya dogara ne akan bayanan da ke ba da shawarar cewa cavitations na kashin jaw na iya zama tushen tushen cytokines da endotoxins don fara aiwatar da lalata lafiyar majiyyaci gabaɗaya.

A karkashin yanayi mai kyau ya kamata a yi biopsy don tabbatar da kamuwa da cutar sankarau na kashin muƙamuƙi da kawar da wasu jihohin cututtuka. Sa'an nan kuma, magani don cirewa ko kawar da ilimin cututtukan da ke tattare da shi da kuma tayar da haɓakar al'ada, mahimmancin kashi ya zama dole. A wannan lokaci a cikin wallafe-wallafen da aka bita, aikin tiyata wanda ya ƙunshi ƙaddamar da ƙashin da ba shi da mahimmanci ya zama abin da aka fi so don cavitations na kashin jaw. Jiyya ya ƙunshi yin amfani da maganin sa barci na gida, wanda ke haifar da la'akari mai mahimmanci. An riga an yi tunanin cewa epinephrine wanda ke dauke da maganin sa barci, wanda aka sani da kayan aikin vasoconstrictive, ya kamata a kauce masa a cikin marasa lafiya da suka rigaya sun lalata jini da ke hade da yanayin cutar su. Duk da haka, a cikin jerin nazarin kwayoyin halitta, bambancin osteoblastic ya karu tare da amfani da epinephrine. Sabili da haka, likitan likitancin dole ne ya ƙayyade bisa ga kowane hali ko yin amfani da epinephrine kuma idan haka ne, adadin da ya kamata a yi amfani da shi zai ba da sakamako mafi kyau.

Bayan an yi aikin tiyata da kuma gyare-gyare sosai na rauni da ban ruwa tare da salin salin bakararre na al'ada, ana haɓaka waraka ta hanyar sanya fibrin mai wadatar platelet (PRF) a cikin rami mara kyau. Yin amfani da fibrin mai arzikin platelet yana mai da hankali a cikin hanyoyin tiyata ba wai kawai yana da fa'ida daga ma'aunin ƙwanƙwasa ba, har ma daga yanayin sakin abubuwan haɓakawa na tsawon kwanaki goma sha huɗu bayan tiyata. Kafin yin amfani da gyare-gyare na PRF da sauran hanyoyin kwantar da hankali, sake dawowa na kashin kashin osteonecrotic na jaw bayan tiyata ya faru a kusan 40% na lokuta.

Binciken abubuwan haɗari na waje da aka tsara a cikin Table 2 da karfi yana ba da shawarar cewa za a iya kauce wa sakamakon da ba daidai ba tare da dabarar tiyata da ta dace da kuma hulɗar likita / haƙuri, musamman a cikin yawan jama'a. Yana da kyau a yi la'akari da yin amfani da dabarun atraumatic, ragewa ko hana periodontal cututtuka da sauran cututtuka na hakori, da zabar kayan aiki wanda zai ba da damar samun sakamako mafi kyau na waraka. Bayar da cikakkun umarnin kafin- da bayan tiyata ga majiyyaci, gami da haɗarin alaƙa da shan sigari na iya taimakawa rage sakamako mara kyau.

Yin la'akari da faffadan jerin abubuwan haɗari masu haɗari da aka jera a cikin Tables 2 da 3, shawarwari tare da tsawaita ƙungiyar kulawa da marasa lafiya ana ba da shawarar da kyau don tabbatar da duk wasu abubuwan haɗari na ɓoye waɗanda zasu iya ba da gudummawa ga haɓakar cavitations na muƙamuƙi. Alal misali, muhimmin la'akari lokacin da ake kula da cavitations na kashin jaw shine ko mutum yana shan magungunan antidepressants, musamman masu hana masu hanawar serotonin reuptake (SSRIs). An haɗu da SSRIs tare da rage yawan adadin kashi da ƙara yawan karaya. SSRI Fluoxetine (Prozac) kai tsaye yana hana bambancin osteoblast da ma'adinai. Aƙalla bincike masu zaman kansu guda biyu da ke bincika masu amfani da SSRI idan aka kwatanta da sarrafawa sun nuna cewa amfani da SRRI yana da alaƙa da mafi munin fihirisar morphometric panoramic.

Preconditioning na iya ba da gudummawa ga nasarar sakamakon jiyya. Wannan ya haɗa da ƙirƙirar yanayin nama mai dacewa don warkarwa ta hanyar wadata jiki da isassun matakan gina jiki masu dacewa waɗanda ke inganta yanayin yanayin halitta ta hanyar inganta homeostasis a cikin jiki. Dabarun riga-kafi ba koyaushe ne mai yiwuwa ba, ko kuma karɓuwa ga majiyyaci, amma sun fi mahimmanci ga waɗancan marasa lafiya waɗanda suka san abubuwan da za su iya cutar da su, kamar waɗanda ke da tsinkayar ƙwayar cuta, rashin lafiya ko rashin lafiya. A irin waɗannan lokuta, yana da mahimmanci cewa wannan haɓakawa yana faruwa don rage matakan damuwa na oxidative, wanda ba zai iya motsa tsarin cutar kawai ba amma zai iya tsoma baki tare da warkaswa da ake so.

Mahimmanci, rage kowane nau'in mai guba a jiki kamar fluoride da/ko mercury daga cikar haƙoran haƙora yakamata a kammala kafin maganin cavitations na muƙamuƙi. Mercury na iya maye gurbin baƙin ƙarfe a cikin jerin jigilar lantarki na mitochondria. Wannan yana haifar da ƙarancin ƙarfe kyauta (ƙarfe mai ƙarfe ko Fe ++), yana haifar da lalata nau'in iskar oxygen (ROS) wanda kuma aka sani da radicals kyauta, wanda ke haifar da damuwa. Yawan baƙin ƙarfe a cikin nama na kasusuwa kuma yana hana aikin da ya dace na osteoblasts, wanda a fili zai yi mummunan tasiri yayin ƙoƙarin warkar da cutar kashi.

Sauran rashi kuma yakamata a magance su kafin magani. Lokacin da aka sami rashi na jan ƙarfe, magnesium da retinol, metabolism da sake yin amfani da ƙarfe ya zama dysregulated a cikin jiki, wanda ke ba da gudummawar wuce haddi na baƙin ƙarfe a wuraren da ba daidai ba wanda ke haifar da damuwa mai ƙarfi na oxidative da haɗarin cuta. Musamman ma, yawancin enzymes a cikin jiki (kamar ceruloplasmin) sun zama marasa aiki lokacin da rashin isasshen matakan jan karfe, magnesium, da retinol, wanda ke haifar da dysregulation na baƙin ƙarfe na tsarin da kuma sakamakon karuwa a cikin damuwa na oxidative da hadarin cututtuka.

Madadin Dabarun Magani

Madadin dabarun da ake amfani da su azaman jiyya na farko ko tallafi kuma yakamata a kimanta su. Waɗannan sun haɗa da homeopathy, kuzarin lantarki, hasken haske kamar photobiomodulation, da Laser, oxygen grade oxygen/ozone, hyperbaric oxygen, anticoagulation modalities, Sanum magunguna, abinci mai gina jiki da nutraceuticals, infra-red sauna, intravenous ozone far, makamashi jiyya, da sauransu. A wannan lokacin, ba a gudanar da kimiyyar da za ta tabbatar da waɗannan hanyoyin da za a iya amfani da su ba ko kuma ba su da tasiri. Ya kamata a kafa ka'idodin kulawa don tabbatar da ingantaccen warkarwa da detoxification. Ya kamata a gwada dabarun tantance nasara kuma a daidaita su. Ka'idoji ko hanyoyin don taimakawa tantance lokacin da magani ya dace da lokacin da bai dace ba yakamata a fitar da shi don kimantawa.

karshe

Bincike ya nuna cewa kasancewar cavitations na muƙamuƙi wani tsari ne mai banƙyama da ke da alaƙa da raguwar kwararar jini. Rashin daidaituwar jini na medullary yana haifar da ƙarancin ma'adinai da rashin isassun jijiyoyi a cikin yankunan kashin muƙamuƙi wanda zai iya kamuwa da ƙwayoyin cuta, yana haɓaka mutuwar salula. Jinkirin jini a cikin raunuka na cavitational yana ƙalubalantar isar da maganin rigakafi, abubuwan gina jiki da manzannin rigakafi. Hakanan yanayin ischemic yana iya ɗaukarwa da haɓaka masu shiga tsakani na kumburi na yau da kullun wanda zai iya samun ƙarin illa ga lafiyar tsarin. Tsarin kwayoyin halitta, rage aikin rigakafi, tasirin wasu magunguna, rauni da cututtuka, da sauran dalilai kamar shan taba na iya haifar da haɓaka ko haɓaka ci gaban cavitations na muƙamuƙi.

Tare da fitaccen masanin ilimin kashin kashin jaw, Dokta Jerry Bouquot, IAOMT yana gabatarwa da kuma inganta ingantaccen ganewar tarihi da cututtukan cututtuka na cututtukan cavitational cavitational kamar Chronic Ischemic Medullary Disease of the Jawbone, CIMDJ. Ko da yake yawancin sunaye, ƙayyadaddun kalmomi, da sharuddan suna da tarihi kuma a halin yanzu ana amfani da su don nuna wannan cuta, IAOMT ta tabbata cewa wannan shine lokaci mafi dacewa don bayyana yanayin cututtuka da micro-histologic da aka saba samu a cikin cavitations na kashin jaw.

Kodayake yawancin raunuka na cavitational na jaw suna da wuyar ganewa tare da radiyo na yau da kullum kuma yawancin ba su da zafi, wanda bai kamata ya ɗauka cewa tsarin cutar ba ya wanzu. Akwai matakai da yawa na cututtuka waɗanda ke da wuyar ganewa, kuma da yawa waɗanda ba su da zafi. Idan muka yi amfani da zafi a matsayin mai nuna alama don magani, cututtukan periodontal, ciwon sukari da yawancin ciwon daji ba za a iya magance su ba. Likitan hakori na yau yana da nau'ikan hanyoyin da za a yi nasarar magance cavitation na muƙamuƙi da gazawar fahimtar cutar da kuma ba da shawarar magani ba shi da mahimmanci fiye da gazawar ganowa da magance cututtukan periodontal. Don lafiya da jin daɗin majiyyatan mu, canjin yanayi yana da mahimmanci ga duk ƙwararrun ƙwararrun kiwon lafiya, gami da likitocin haƙori da likitocin likita, don 1) gane yawan cavitations na kashin jaw da 2) yarda da haɗin gwiwa tsakanin cavitations na kashin kashin da cututtukan tsarin.

RATAYE I

Sakamako na IAOMT SURVEY 2 (2023)

Kamar yadda aka tattauna a taƙaice a cikin takarda, yanayin da ba shi da alaƙa sau da yawa yakan bar baya bayan tiyatar cavitation. Don ƙarin koyo game da waɗanne nau'ikan yanayi ke warwarewa da kuma yadda kusancin gafara ke faruwa dangane da aikin tiyata, an aika bincike na biyu ga membobin IAOMT. Jerin alamomi da yanayin da membobin wannan kwamiti suka lura don ingantawa bayan an haɗa su don binciken. An tambayi masu amsa ko sun lura da ɗaya daga cikin waɗannan sharuɗɗan da aka saki bayan tiyata, kuma idan haka ne zuwa wane mataki. An kuma tambaye su ko alamun sun warke cikin sauri ko kuma idan haɓakar ya ɗauki fiye da watanni biyu. Bugu da ƙari, an tambayi masu amsa kan ko sun kasance suna yin tiyata a kan rukunin yanar gizo, wurare da yawa, ko duk rukunin yanar gizo a cikin tiyata ɗaya. An gabatar da sakamakon binciken a cikin Hotunan da ke ƙasa. Bayanan sun kasance na farko, idan aka yi la'akari da adadin wadanda suka amsa sun kasance kadan (33) kuma akwai wasu bayanan da suka ɓace.

Bayanin Appx 1 Masu amsa sun ƙididdige matakin haɓakawa (mai sauƙi, matsakaici ko mahimmanci) kuma sun lura ko haɓaka ya faru da sauri (watanni 0-2) ko ya ɗauki tsawon lokaci (> watanni 2). An jera sharuɗɗan/alamomi a cikin tsari mafi yawan rahotanni. Lura cewa yawancin sharuɗɗan / alamomin da aka sake dawowa cikin ƙasa da watanni biyu (gefen hagu na tsakiyar layi).

Bayanin Appx 2 Kamar yadda aka nuna a sama, a lokuta da yawa, Masu amsa ba su lura da lokacin dawowa don ingantawa da aka gani ba.

Bayanin Appx 3 Masu amsa sun amsa tambayar, “Shin kuna yawan ba da shawarar/yi

tiyata don kowane rukunin yanar gizo, wuraren da aka haɗa tare, ko duk rukunin yanar gizon da aka yi wa tiyata ɗaya?”

RATAYE II

Sakamako na IAOMT SURVEY 1 (2021)

Saboda ƙarancin wallafe-wallafen da sake dubawa na asibiti da suka shafi jiyya na raunin cavitational, IAOMT ta yi nazari kan membobinta don tattara bayanai game da abubuwan da ke faruwa da jiyya da ke tasowa zuwa 'ma'auni na kulawa'. Ana samun cikakken binciken akan gidan yanar gizon IAOMT (lura cewa ba duk masu yin aikin ba ne suka amsa duk tambayoyin bincike).

Don taƙaitawa a taƙaice, yawancin masu amsawa na 79 suna ba da magani na tiyata, wanda ya ƙunshi tunani mai laushi, samun damar yin tiyata na wurin cavitation, da hanyoyi daban-daban na 'tsaftacewa' ta jiki da kuma lalata wurin da abin ya shafa. Ana amfani da nau'o'in magunguna masu yawa, abubuwan gina jiki, da / ko samfurori na jini don inganta warkar da raunuka kafin a rufe ƙwayar nama mai laushi.

Ana amfani da burbushin rotary sau da yawa don buɗewa ko samun damar raunin kashi. Yawancin likitocin suna amfani da kayan aikin hannu don warkarwa ko goge kashi mara lafiya (68%), amma ana amfani da wasu dabaru da kayan aiki, kamar rotary bur (40%), kayan aikin piezoelectric (ultrasonic) (35%) ko ER: YAG Laser (36%), wanda shine mitar laser da ake amfani dashi don yawo na hoto.

Da zarar an tsabtace wurin, ɓata, da/ko gyarawa, yawancin masu amsa suna amfani da ruwa/gas na ozone don kashewa da haɓaka waraka. Kashi 86% na masu amsa suna amfani da PRF (platelet-rich fibrin), PRP (Plass mai arzikin platelet) ko PRF ko PRP ozonated. Wata dabarar kawar da cutar da aka ruwaito a cikin wallafe-wallafe kuma a cikin wannan binciken (42%) shine amfani da Er: YAG. 32% na masu amsa ba sa amfani da kowane nau'i na kashin kashi don cika wurin cavitation.

Yawancin masu amsawa (59%) yawanci ba sa bibiyar raunukan da ke bayyana dalilai daban-daban daga farashi, rashin iya samun samfuran nama masu dacewa, wahalar gano dakin binciken cututtukan cututtuka, ko tabbacin matsayin cutar.

Yawancin masu amsa ba sa amfani da maganin rigakafi kafin a yi aiki (79%), yayin tiyata (95%) ko bayan tiyata (69%). Sauran tallafin IV da ake amfani da su sun haɗa da steroids dexamethasone (8%) da Vitamin C (48%). Yawancin masu amsawa (52%) suna amfani da ƙaramin matakin laser (LLLT) bayan aiki don dalilai na warkarwa. Yawancin masu amsa suna ba da shawarar tallafin abinci mai gina jiki ciki har da bitamin, ma'adanai, da magungunan homeopathic daban-daban kafin (81%) da lokacin (93%) lokacin warkarwa.

RATAYE III

images

Appx III Hoto 1 Bangon hagu: 2D bincike na X-ray na yanki #38. Ƙungiyar dama: Takaddun fa'idar FDO) a cikin yankin retromolar 38/39 ta amfani da wakili mai bambanci bayan tiyatar FDOJ.

Abbreviations: FDOJ, fatty degenerative osteonecrosis na kashin jaw.

An karɓa daga Lechner, et al, 2021. "Jawbone Cavitation Bayyana RANTES/CCL5: Nazarin Case Yana Haɗa Kumburi Silent a cikin Jawbone tare da Epistemology na Ciwon Kankara." Ciwon Kankara: Manufa da Magani

Appx 3 Hoto 2 Kwatanta cytokines guda bakwai (FGF-2, IL-1ra, IL-6, IL-8, MCP-1, TNF-a da RANTES) a cikin FDOJ ƙarƙashin RFT #47 tare da cytokines a cikin kashin lafiya mai kyau (n = 19). Takaddun aikin aiki na tsawaita FDOJ a cikin kashin kashin dama na dama, yanki #47 apical na RFT #47, ta hanyar wakilin bambanci bayan cirewar RFT #47.

Abbreviations: FDOJ, fatty degenerative osteonecrosis na kashin jaw.

An daidaita shi daga Lechner da von Baehr, 2015. "Chemokine RANTES / CCL5 a matsayin Haɗin da ba a sani ba tsakanin Ciwon Rauni a cikin Jawbone da Cututtukan Tsarin: Shin Hasashen da Magungunan da aka Yi a Horizon?" Jaridar EPMA

Appx III Hoto 3 Hanyar tiyata don retromolar BMDJ/FDOJ. Bangare na hagu: bayan nadawa gefen mucoperiosteal, an kafa taga kashi a cikin cortex. Panel na dama: curetted medullary cavity.

gajartatattun: BMDJ, lahani na kasusuwa a cikin kasusuwa; FDOJ, fatty degenerative osteonecrosis na kashin jaw.

An daidaita shi daga Lechner, et al, 2021. "Chronic Fatigue Syndrome and Bone Marrow Defects of the jaw - Rahoton Case akan Ƙarin Binciken Haƙori na X-Ray tare da Ultrasound." Jaridar Labaran Kiwon Lafiya ta Duniya

Appx III Hoto 4 (a) Curettage na FDOJ a cikin ƙananan muƙamuƙi tare da jijiyar infra-alveolar. (b) Madaidaicin X-ray ba tare da wani alamun tsari na pathological a cikin kashin jawabai ba.

gajartatattun: FDOJ, fatty degenerative osteonecrosis na kashin jaw

An daidaita shi daga Lechner, et al, 2015. "Peripheral Neuropathic Facial / Trigeminal Pain da RANTES / CCL5 a cikin Jawbone Cavitation." Maganin Shaida da Magunguna dabam-dabam

Appx III Fim 1

Hoton bidiyo (danna sau biyu akan hoton don ganin faifan bidiyo) na tiyatar kashin muƙamuƙi yana nuna kitsewar globules da fitar da ruwa mai fita daga kashin muƙamuƙi na majiyyaci wanda ake zargin yana da necrosis na muƙamuƙi. Ladabi na Dr. Miguel Stanley, DDS

Appx III Fim 2

Hoton bidiyo (danna sau biyu akan hoton don ganin faifan bidiyo) na tiyatar kashin muƙamuƙi yana nuna kitsewar globules da fitar da ruwa mai fita daga kashin muƙamuƙi na majiyyaci wanda ake zargin yana da necrosis na muƙamuƙi. Ladabi na Dr. Miguel Stanley, DDS

Don saukewa ko buga wannan shafi a cikin wani yare daban, zaɓi yaren ku daga menu na ƙasan ƙasa da farko a hagu na sama.

Takarda Matsayin IAOMT akan Marubuta Cavitations Jawbone na Dan Adam