THE PROSTHODONTIC TREATMENT OF THE MANDIBLE EDENTULOUSNESS. CLINICAL CASE

The article presents a clinical case of the prosthodontic treatment of the mandible edentulousness. Edentulousness is a widespread pathology that depends on the social and economic situation in the country, the demographic situation, the level of dental care and prevention organization. The current worldwide trend of population aging leads to an increase in the number of the elderly, and this number is expected to increase in the future. According to the WHO, today about 600 million people are people over 60, and this number will have doubled by 2030 and will constitute 2 billion in 2050 mostly in developed countries. The situation in Ukraine is not better. Functional and aesthetic rehabilitation of patients with edentulousness requires a comprehensive approach to the prosthodontic treatment planning. Complete removable laminar dentures on the mandible have a number of disadvantages. Insufficient fixation, stabilization, diction problems, aesthetic problems, decreased self-esteem of the patient are among the key ones. Modern protocols of the prosthodontic treatment require the manufacture of dental prostheses based on intraosseous dental implants. Complete dentures based on intraosseous dental implants have a number of advantages over the fixed dentures. Compensation for deficient bone support of the facial soft tissues occurs by means of the basis. Patients’ possibility to remove a secondary restoration by themselves lead to proper hygiene of the oral cavity and peri-implant area in particular. The clinical research conducted by S. Wolfart (2016) showed the possibility of fixed/removable dental prosthesis fixation in 14-31 days (early loading) after the surgical stage of implantation provided that 4-6 intraosseous dental implants were installed. The maximum mobilization of the patient to comply with the recommendations and prescriptions is the main task considering the limited postoperative period before the dental prosthesis fixation. Our publication describes the treatment of a patient born in 1967, who was diagnosed with a mandible complete absence of teeth. Diagnosis, examination and treatment were performed on the basis of the Department of Dentistry Postgraduate Education of Ivano-Frankivsk National Medical University. The described prosthodontic treatment plan involves the manufacture of a complete denture with bar system based on four intraosseous dental implants according to the early loading protocol in a patient with primary treatment of mandible edentulousness. The choice of treatment plan was based on the results of past medical history, the patient’s disease, basic and additional methods of examination, analysis of individual indications and contraindications and readiness for the selected treatment plan. This treatment protocol has its advantages over the protocol of manufacturing a fixed prosthesis based on intraosseous dental implants such as a higher level of proprioceptive sensations, increased level of hygiene, lower complexity of clinical and laboratory stages, affordability. The term of clinical and laboratory stages of manufacturing (from the surgical stage of implant treatment to the fixation of the dental prosthesis) constituted 16 days. Additional opportunities for success in clinical and laboratory stages of treatment, the accuracy of manufacture and minimization of complications in the future were created as a result of the combination of digital and analog treatment methods in dental prosthesis manufacturing.

Influence of wt. % and Specific Area of HRGO Nanoplatelets Addition on Physical, Thermal, Mechanical Behaviour and Processing Evolution of PMMA Bone Cement for Orthopaedic and Trauma Surgery

Bone cement, mainly based in PMMA, is commonly used in different arthroplasty surgical proce-dures, and its use is essential for prosthesis fixation. However, its manufacturing process reaches high temperatures that can produce necrosis in the patients' surrounding tissues. In order to con-tribute to avoid this problem, the addition of graphene could delay the polymerisation of the MMA and, simultaneously, contribute to the optimisation of the composite material's properties. This article analysed the effect of the addition of different percentages of Highly Reduced Graphene Oxide (HRGO) with different wt. % (0,10, 0,50 and 1,00) and surface densities (150, 300, 500 and 750 m2/g) on the physical, mechanical, and thermal properties of commercial PMMA-based bone cement and its processing. It was noticed that a lower sintering temperature would be reached with this addition, making it less harmful to use in surgery and as it reduces its adverse effects. In contrast, the materials' density does not show significant changes, which indicates that the addi-tion of HRGO does not significantly increase its porosity. Lastly, the mechanical properties are re-duced by almost 20 %. Nevertheless, these properties are high enough so that these new materials can still fulfil their structural function.

Antibiotics in Bone Cements Used for Prosthesis Fixation: An Efficient Way to Prevent Staphylococcus aureus and Staphylococcus epidermidis Prosthetic Joint Infection

Prosthetic joint infections (PJIs) are one of the most frequent reasons for arthroplasty revision. These infections are mostly associated with the formation of biofilm, notably by staphylococci, such as Staphylococcus aureus and Staphylococcus epidermidis. To minimize the rates of PJIs following primary or revision total joint arthroplasty, antibiotic-loaded bone cements (ALBCs) can be used for prosthesis fixation. However, its use is still debated. Indeed, various studies reported opposite results. In this context, we aimed to compare the prophylactic anti-biofilm activity of ALBCs loaded with two antibiotics with ALBC loaded with only one antibiotic. We compared commercial ready-to-use cements containing gentamicin alone, gentamicin plus vancomycin, and gentamicin plus clindamycin to plain cement (no antibiotic), investigating staphylococcal biofilm formation for 10 strains of S. aureus and S. epidermidis with specific resistance to gentamicin, vancomycin, or clindamycin. Firstly, we performed disk diffusion assays with the elution solutions. We reported that only the cement containing gentamicin and clindamycin was able to inhibit bacterial growth at Day 9, whereas cements with gentamicin only or gentamicin and vancomycin lost their antibacterial activity at Day 3. Then, we observed that all the tested ALBCs can inhibit biofilm formation by methicillin-susceptible staphylococci without other antibiotic resistance ability. Similar results were observed when we tested vancomycin-resistant or clindamycin-resistant staphylococci, with some strain-dependent significant increase of efficacy for the two antibiotic ALBCs when compared with gentamicin-loaded cement. However, adding vancomycin or clindamycin to gentamicin allows a better inhibition of biofilm formation when gentamicin-resistant strains were used. Our in vitro results suggest that using commercially available bone cements loaded with gentamicin plus vancomycin or clindamycin for prosthesis fixation can help in preventing staphylococcal PJIs following primary arthroplasties, non-septic revisions or septic revisions, especially to prevent PJIs caused by gentamicin-resistant staphylococci.

A novel method of treament of ascending aortic aneurysm

The need for surgical treatment of ascending aortic aneurysms is due to a number of severe complications that occur during the natural course of the disease, such as aortic dissection and rupture. Such interventions show good immediate and long-term treatment outcomes, but they are often accompanied by high blood loss and surgical trauma, which in elderly patients with concomitant pathology can lead to serious cardiac and extracardiac complications and prolongation of treatment in general. We present a technology of external wrapping of the aorta that reduces surgical trauma while maintaining effect of operation. A clinical case of application of this technology in a 63-year-old patient hospitalized to the clinic of the Heart Institute, Ministry of Health of Ukraine, with a diagnosis of aortic insufficiency of the 3rd degree (tricuspid aortic valve), dilatation of the root and ascending aorta, tricuspid insufficiency of the 2nd degree, high pulmonary hypertension, heart failure with reduced left ventricular systolic function. The use of the proposed method has following advantages compared to the established method of fixation of the vascular prosthesis: fixation of the proximal part of the vascular prosthesis is performed using vascular suture material; elimination of the risk of damage to the aortic wall; elimination of the risk of massive bleeding from the aorta at the site of the prosthesis fixation; decreased duration of surgery. Key words: aortic aneurysm, surgical treatment, wrapping of the ascending aorta.

The choise of an extraoral implant with a total facial defect

Subject. Despite upgrading of methods of surgical recovery of total face defects it’s hard to achieve esthetic results. Thanks to implementation of extra-oral implants and production of individual silicone prostheses of external ear, orbit, nose and their compilations it became possible to achieve high esthetic results and firm prosthesis fixation. In the article there is an algorithm showing the choices of extra-oral implants at total face defects keeping in mind the origin of the defect (innate, acquired posttraumatic, postresection) local beam-therapy, which is carried out during the illness and the expected lifetime of the patient. The goal of the research is working out an algorithm of application various implants for innate or acquired total face defects. Methodology. The experience of various extra-oral implants that were used for 50 patients with total defects of external ear, orbit, nose and compilation of those defects was analyzed. Results. The analysis showed that with beamed orbit (total radiation dose higher than 46gr) the implant’s success was 92.5%(25 implants). 2 times implants did not receive osseointegration and during the step of placing the healing cap were removed. With patients with the defect of external ear the frequency of successful osseointegration was 96.2%. 2 times due to cicatricial deformity of skin and periosteal coverage in the zone of defect acquired during thermic burn implants were not integrated. 1 time during the application of covered osseofixated magnet implant in orbit of a 10 year old child a decubital gangrene was formed. Conclusions. Application of extra-oral implants of various types for total face defects proved to its clinical efficiency by differentiated approach considering individual anatomical conditions, cause of the defect and the expected lifetime of the patient.