STUDY OF ACTIVITY OF BIOCHEMICAL INDICATORS OF BONE METABOLISM IN MANDIBLE AFFECTED BY RADICULAR CYSTS IN PATIENTS WITH DIFFERENT MINERAL METABOLISM STATUS
DOI:
https://doi.org/10.11603/2415-8798.2019.2.10017Keywords:
bone metabolism, alkaline phosphatase, acid phosphatase, mineralization index, mandible, radicular cyst, mineral metabolism, osteoporosisAbstract
In response to growing compression of the increasing volume of radicular cysts from adjacent bone tissue of the jaws, compensatory reorganization of the morphological structure of the spongy substance occurs – its consolidation, which is a morphological manifestation of the local adaptive reaction of the organism. However, in the case of violation of mineral metabolism (osteoporosis) in the bone tissue, morphological changes occur. In postmenopausal women, the expression of alkaline phosphatase decreases on the background of estrogen deficiency, the inhibitory activity of this hormone on osteoclasts is reduced, which is accompanied by an increase in the activity of acid phosphatase and, consequently, an increase in bone resorption.
The aim of the study – to carry out a comparative assessment of the activity of biochemical parameters of bone metabolism in the regions of the mandible affected by radicular cysts in patients with a different state of mineral metabolism.
Materials and Methods. All patients with radicular cysts of the mandible, depending on the state of mineral metabolism, were divided into two clinical groups: clinical group 1 included 21 patients (13 men and 8 women), in which no age-related violations of mineral metabolism were detected; clinical group 2 included 19 patients (14 women and 5 men), in whom age-related violations of mineral metabolism were detected – osteoporosis. Patients were determined the mineral density of bone tissue by using bone ultrasonic densitometry. On orthopantomograms of the facial skeleton localization and size of radicular cysts were revealed. The state of mineral metabolism in the lower jaw was evaluated on X-ray images by using the mandibular – cortical index (MCI) by Klemetti E. and co-authors. Materials for biochemical studies (determination of activity of alkaline and acid phosphatases, index of mineralization) were obtained by taking bone fragments from regions adjacent to the shells of the radicular cysts of the mandible during cystectomy operations. The statistical processing of the obtained research results was carried out using the statistical program of statistical calculations "Statistica 8".
Results and Discussion. In patients with no mineral metabolism disturbances, in bone biopsy samples taken from sites affected by radicular cysts of the mandible, statistically significant (p <0.05) increase in alkaline phosphatase activity (ALP) was found, which directly correlated with the size of these tumorous formations. A statistically significant increase in the activity of acid phosphatase (AP) in these sites was also observed. For radicular cysts of large size, the activity of AP was the highest – (0.82±0.09) IU / g (p<0.005). However, the process of osteogenesis prevailed over bone resorption. The index of mineralization in the jaw regions undergoing chronic compression from tumor-shaped neoplasms increased in comparison with the intact bone. In patients with osteoporosis in the mandibles the processes of resorption over osteogenesis prevail. In the affected areas of the mandibles there was a statistically significant increase of the activity of the AP. In bone tissues exposed to large-sized radicular cysts, the activity of this enzyme increased by 2.4 times compared with intact bones – (1.27±0.13) IU / g (p <0.001). ALP activity also increased, but less intensive in comparison with similar clinical cases in patients without violations of mineral metabolism. The mineralization index of bone tissue increased only in the regions of the mandibles, adjacent to the radicular cysts of small sizes. In bone tissues adjacent to odontogenic cysts of medium to large size, this indicator progressively decreased from (14.60±1.33) units of account to (11.84±1.27) units of account, which, in our opinion, indicates an inadequate level of adaptive potential in jaw bones of patients with broken mineral metabolism.
Conclusions. 1. In patients without violations of mineral metabolism in the bone tissues of the mandible, in response to the destructive effect of radicular cysts, there is a compensatory activation of the osteogenesis process (statistically significant increase in the activity of alkaline phosphatase), which is a local manifestation of the adaptive reaction of the organism in this disease. 2. In patients with osteoporosis in the jaw bones there is a decrease in the process of osteogenesis, under the influence of radicular cysts, resorption processes progress, and the activity of acid phosphatase increases statistically significantly, which correlates directly with the size of these tumor-like neoplasms.
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