MINIMAL INVASIVE SURGICAL METHODS FOR TREATMENT OF CHRONIC PERFORATED SINUSITIS

The main factors of the odontogenic maxillary sinuses inflammation are perforation of the maxillary sinus bottom during teeth removal, anatomical and physiological features of the maxillary sinus structure when the root or roots are located in the cavity of the maxillary sinus, which is independent of the dental surgeon in any case, a perforation of the maxillary sinus bottom during teeth removal, as well as more complex chronic processes in periodontium, which form resorption of bone tissue within the bottom of the maxillary cavity, and clinical cases with the root penetrating the cavity of the maxillary sinus or the foreign body penetrating the genyantrum. Difficulties appear in the operation of removing the upper jaw teeth, which are located near the bottom of the maxillary cavity or in the genyantrum cavity, and in the presence of inflammation, accompanied by bone resorption. Therefore, in order to prevent complications of perforated sinusitis, there is a need to develop new non-invasive methods of prevention and treatment of perforation of the bottom of the maxillary cavity. One can state with certainty that traditional traumatic surgical interference, such as Caldwell-Luc radical antrostomy, is less frequently used in clinical practice. Nowadays many authors offer less traumatic methods for treating perforations and maxillary sinus fistula. We also offer our options of surgical interference using the domestic bone and plastic material (Kergap), GAP “Biomin”. In the case of the foreign body penetrating the maxillary sinus cavity, under the conduction anesthesia, a mucosal flap from the vestibular side is formed, and, if necessary, another one may be formed from the palatine side. We extend the bone hole to the necessary size so that it is possible to get the foreign body out through it, use a curettage spoon to remove the pathologically altered mucous membrane of the maxillary cavity till a healthy bone, then cover the bone hole with the osteoplastic material and cover it with the mu- cous flap, fix it and suture with the “Vikril 3,0” material. In case of maxillary cavity perforation during teeth removal operation, which roots break through the bottom of the maxillary sinus, which does not depend on the experience and qualifications of the dental sur- geon, the edges of the perforated hole are smoothed with a cutter or bone forceps in such a way that there are no sharp perforation eminences. Be sure to wash the sinus with a warm solution of antiseptic. We cover the bone joint between the maxillary and the oral cavity (with Kergap), GAP Biomin. After that, cover the maim with the cut bone flap and suture with the “Vikril 3.0” material. In more complex clinical cases, such as chronic long-term inflammatory processes without exacerba- tion of pathological processes in the genyantrum sinus of odontogenic origin, when a foreign body pene- trates the maxillary cavity, we decided to modify extreme maxillary sinusotomy using the Caldwall-Luc method, which became the goal of our research. Description of surgical interference: under local anesthesia, we simultaneously carry out an operation for removing the causative tooth and make a trapezoidal incision in the area of the maxillary sinus transi- tional wall. After that, we make a bone hole on the anterior wall of the maxillary sinus, do not sculpt the pathologically altered mucus, remove the foreign body through the bone hole. Antiseptic treatment is carried out during surgical interference. If there is a route between the maxillary sinus and the lower nasal passage, we do not form another one. After applying antiseptic, we put the bone flap onto the place and fixed with non-absorbing sutures, sew the removed tooth well with a pre-closed perforation aperture using osteoplastic material (Kergap), GAP Biomin. After that, we irradiate the surgical wound with a helium-neon laser, which provides a gentler healing period of the wound after surgery. Seams are removed on the 8th-12th day after surgery. The patients were examined both in the short term and in the long-term, after a year or more. No relapses of the oronasal route were found, bone wound healed in the period of 6-8 months, and contrast Rg-scans showed no regression of polyposis and granulation dilatations. In our opinion, this is the result of etiopathological treatment aimed at eliminating the cause. Thus, according to our research treatment and prevention of perforated sinusitis requires etiopathological treatment. The formation of an oronasal route during the causative tooth removal of odontogenic sinusitis re- quires the closure of this route with osteoplastic material (Kergap), GAP Biomin, while suturing the tooth. In the case of a foreign body entering the maxillary cavity, the traditional method opens the maxillary cavity in order to remove the foreign body through the anterior wall of the maxillary sinus and treats it with the solution of antiseptics without making a route with the lower nasal passage. It can be combined with the causative tooth removal and the tight suturing of the mucous flaps, which is less a traumatic surgical interference than the extreme Caldwall-Luc method of sinusotomy. Eliminating the inflammation cause of the maxillary sinus in combination with the osteoplastic closure of the oronasal route with tight suturing is a thorough treatment compared to the traditional technique. The regularities discovered as a result of clinical and X-ray quality assessment of non-invasive surgical methods for the treatment of chronic perforated sinusitis require further long-term studies and evaluation of other factors that influence the success of chronic perforated sinusitis treatment.

Evaluation of Vertical Guided Bone Regeneration Using a Particulate Form of Experimental Bioactive Glass in a Rabbit: A Case Report with Literature Review

Background: There are a large number of different types of bone-grafting materials that are used for the regeneration of atrophied alveolar ridges in order to make dental implantation possible. However, available surgical techniques and materials for bone augmentation do not contribute to the achievement of the desired reliable results and require a search for new solutions to an existing problem. A group of synthetic osteoplastic materials based on bioactive glass (BAG) may become a matter of choice in bone tissue regeneration because of special osteogenic properties. The aim of this study was to visually and histologically evaluate the behavior of an experimental BAG in rabbit tibia bone samples, which were collected from the animal 6 weeks after filling the bone defects. Methods and Results: The observation was carried out on one outbred rabbit whose tibia bone defects were filled with an experimental osteoplastic material based on the BAG. The chemical composition of the experimental osteoplastic material included SiO2 (41%), Na2O (21%), CaO (28.5%), P2O5 (6%), CaF2 (1.5%), MgO (1%), Al2O3 (1%). For histological analysis, H&E staining of paraffin-embedded tissues was performed according to the standard technique. Light microscopy of tissue samples was performed using a Leitz HM-LUX microscope (Germany). Six weeks after filling the bone defects, a strong bond between the augmented hard tissue and rabbit tibia was recognized. Also, a dense fusion of adjacent soft tissues with a newly formed bone without signs of chronic inflammation or graft particles in granular tissue was noted. Microscopic examination of the stained sections showed the presence of mature viable BT with a uniform distribution of osteocytes. Also, residual fragments of the degraded biomaterial surrounded by the fibers of a woven bone were revealed in several slices. Conclusion: In accordance with the results of this experiment, it can be concluded that the usage of BAG related to the system SiO2(41%)-Na2O(21%)-CaO(28.5%)-P2O5(6%)-CaF2(1.5%)-MgO(1%)-Al2O3(1%) may increase the volume of bone without application of barrier membrane. However, further research involving more animals needs to be done to estimate the scientific significance of the obtained data and to evaluate the mechanical properties of augmented bone.

CLINICAL PECULIARITIES OF WOUND HEALING IN THE POSTOPERATIVE PERIOD OF SURGICAL TREATMENT OF ALVEOLAR PROCESS ATROPHY OF THE UPPER JAW AND PART OF THE LOWER JAW IN POSTMENOPAUSAL WOMEN

Introduction. Atrophy of the alveolar process of the upper jaw and part of the lower jaw is often observed after the tooth extraction. It is known that the atrophy of bone tissue is most likely observed in the first 12 months after the tooth extraction. According to the Koln classification, atrophy of the bone tissue of the jaws can be vertical, horizontal and combined. The aim of surgical treatment of jaw bone tissue atrophy is to increase the size in the area of alveolar process of the upper jaw and part of the lower jaw to further restoration of masticatory function, in particular with the use of dental implants. The aim of the study: to study the dynamics of wound healing in postmenopausal women with osteopenia after surgical treatment of jaw bone tissue atrophy using osteoplastic material and ossein-hydroxyapatite compound. Materials and methods of the study. There were observed 63 postmenopausal women with osteopenia, aged from 50 to 59 years, with atrophy of the maxillary and mandibular alveolar process, who were performed surgical treatment. During surgery, patients were divided into 3 groups: Group I – 23 patients with atrophy of the alveolar process of the upper jaw and part of the lower jaw with osteopenia, with the reduced bone tissue density, who were treated surgically for bone tissue atrophy using the method worked out by us. Group II – 23 patients with atrophy of the alveolar process of the upper jaw and part of the lower jaw with osteopenia, with the reduced bone density who were performed surgical treatment of atrophy of the jaw bone tissue using osteoplastic material of animal origin. Group III – 23 patients with atrophy of the alveolar process of the upper jaw and part of the lower jaw with the indices of bone tissue density within normal limits, who were performed surgical treatment of atrophy of the jaw bone tissue using osteoplastic material of animal origin. The results of the study. A total of 69 edentulous areas on the upper and lower jaws were examined after surgery for the treatment of jaw bone tissue atrophy. Examination of the postoperative wound was performed during the 3rd, 9th, and 14th day in the absence of complaints from patients during this period, as well as in the presence of signs of complications. Discussion of the results. According to the offered by us method of decortication of the bone tissue of the jaws, which was used to treat patients of group I, the blood supply to the postoperative area and infiltration of bone material with blood due to provoked by decortication of bone tissue bleeding, are improved. Impregnation of bone material with blood promotes angiogenesis in the postoperative area, increasing cellular activity during wound healing. It is known that due to the absence of sufficient blood supply, tissue necrosis occurs [8,9]. In patients of groups II and III the complete healing of the postoperative wound with primary tension took longer than in patients of group I. Also, in 3 patients of group II and in 1 patient of group III the wound dehiscence in the postoperative area was observed. Conclusions. As a result of the performed observations of wound healing after surgical treatment of jaw bone tissue atrophy in patients of groups I, II and III, the least complications were observed in patients of group I in the early postoperative period.

RESULTS OF X-RAY AND DENSITOMETRIC INVESTIGATION IN PATIENTS WITH DESTRUCTIVE FORMS OF APICAL PERIODONTITIS IN EARLY FOLLOW UP PERIOD

This article presents a comparative analysis of the effectiveness of various treatment approaches, including bone mixture “mp3, Osteobiol, and platelet-enriched plasma, in the therapy of destructive forms of apical periodontitis in the early follow-up. The aim of this work is to investigate the dynamic changes in radiological and densitometric parameters depending on the treatment methods for patients with destructive forms of apical periodontitis in the early follow up period. The study involved 185 patients with destructive forms of apical periodontitis, who were examined and receive the treatment. The subjects were divided into 4 groups. Measurements of the size of the lesion in the bone tissue (for lesions of round shape) were performed by the formula: S = πr2. The area of lesions of elliptical shape was measured by the formula S = π ab, where π = 3.14; r = the radius of the circle; a = the value of the major half-axis of the ellipse; b = the length of the small half-axis of the ellipse. After 3 months of the follow up, the patients of group IV, who received the composition of platelet-rich plasma and osteoplastic material mp3 OsteoBiol, demonstrated an increase in the number of the lesions of the periapical zone sized 1.6-10 mm2 in 1.7 times, while the number of the subjects with foci of bone destruction sized 11–20 mm2 and 21–30 mm2 lowered in 2.8 times and 2.0 times, respectively. In 3 months of the follow up period, the patients of group IV showed the values of Rtg scoring of bone tissues destruction in the apical area with a lesion area of 1.6-20 mm that averaged 2.13±0.10 scores and indicated a reduction of the periapical process by 1/3. The average Rtg score in the patients of group IV (0.92 ± 0.10 points) was significantly higher than in the individuals in groups I and II, p, p 1 <0.01, and was equal to the findings obtained in the individuals of the group III, p2 > 0.05. The relative indicator of bone tissue repair in this follow up was characterized by the minimum values in the individuals of groups I and II: 0.49 ± 0.05 and 0.57 ± 0.06, p <0.05, respectively. In the groups III and IV, the value of the relative indicators of bone tissue repair were significantly higher and scored 4.82 ± 0.54, p, p1 <0.01, and 6.94 ± 0.77, p, p1 <0.01, p2 < 0.05, respectively. At the same time, the average Rtg scoring in patients of group IV was significantly higher than in the participants of groups I and II, and was identical to the values in the subjects of group III. This study has demonstrated the successful outcomes of the treatment of dystrophic forms of apical periodontitis in the early follow up period when applying the composition based on platelet-rich plasma and osteoplastic material "mp3 OsteoBiol".

COMPARATIVE EVALUATION OF NEW OSTEOPLASTIC MATERIALS BASED ON THE RESULTS OF ACUTE TOXICITY STUDIES

Three series of experiments were carried out and lethal doses of the new osteoplastic material 47.5 V were determined by the intraperitoneal and intragastric injection of the material to laboratory animals. A comparative evaluation with Bioactive glass BG-1D was also carried out. It was found that the LD50of 47,5B was 4274.51:4770.58 mg/kg for intragastric injection and 2358.31:2895.65 mg/kg for intraperitoneal injection to rats. In animals getting Bioactive glass BG-1D, these indicators changed slightly, amounting to 3439.04:3810.53 mg/kg and 1732.77:2730.93 mg/kg, respectively. Thus, according to the classification of substances according to the degree of toxicity, these materials can be attributed to practically non-toxic substances (according to the results of intraperitoneal injection of the material suspension to rats and mice) and low-toxic substances (according to the results of intragastric injection of the material suspension to rats)

Treatment of Femoral Non-Union with the Gene-Activated Osteoplastic Material: А Case Report

Background. Non-unions of distal femur fractures are difficult to treat and occur in about 6% of cases. Multifactorial causes of fractures non-unions require individual treatment for each patient in accordance with the “diamond” concept. The standard protocol for patients with atrophic non-unions treatment involves bone autografts using, but there are limitations of size, shape, quality and quantity of autografts. Osteoplastic materials with osteoinductive (angiogenic) and osteoconductive activity can be used as bioresorbable implants in combination with autogenous spongy bone in the treatment of extremities long bones non-unions.Clinical case description. A 63-year-old patient was admitted to the clinic for non-union of distal third of the femur with bone defect, fragments were fixed with a plate. The examination revealed plate fracture, screws migration (group III according to the Non-Union Scoring System). The volume of supposed bone defect was about 8.5 cm3. The surgery was performed: plate removal, debridement of the non-union zone, femur defect replacement with a bone autograft in combination with the gene-activated osteoplastic material “Histograft” in a ratio of 1:1, osteosynthesis of the femur with two plates. After 6 months. during the control computed tomography, consolidation was determined (4 points on the REBORNE scale). Pain was practically absent (NRS-2). The range of motion in the knee joint: flexion — 80o, extension — 180o. According to the Knee Society Score (KSS) — 68 points.Conclusion. In this case report the complete fracture fusion was achieved in patient within 6 months — 4 points on the REBORNE scale. No adverse events were observed. It confirms the safety and efficacy of described method and allows to continue the clinical trials.

IMMEDIATE IMPLANTATION AND AESTHETIC COMPONENT AS A RESULT OF SUCCESSFUL FORECAST TREATMENT

The aim: Improving the method of immediate implantation in the aesthetic zone in case of bone deficiency to obtain the highest aesthetic and predictable treatment result. Materials and methods: Under clinical observation were 32 patients with different clinical diagnoses in the anterior part of the upper jaw aged 30 to 55 years. In the course of recent advances, the following methods have been used: clinical protocol of immediate implantation with passive exceptional loads by temporary orthopedic constructions, X-ray method using cone-beam computed tomography, statistical analysis. Results: After surgical treatment of patients 1 year after surgery, the distribution of biotypes was as follows: in group 1 – thick biotype 12.87%, medium – 87.13%; in group 2 – thick biotype 27.04%, medium – 72.96%, with p <0.05. According to the results of CT, the distance between the implant and the vestibular in the first group was after 6 months – 1.67 ± 0.04 mm (p <0.05); in the second group of the study we obtained the following results after 6 months – 1.59 ± 0.06 mm (p <0.05). Conclusions: The advanced method of immediate implantation in the anterior part of the upper jaw allows to change the biotype of soft tissues, improve the color spectrum of the gums, increase the thickness of soft tissues with connective tissue autograft, and increase gum density and fixation of osteoplastic material in the presence of defect ), as well as reduce the risk of recession.

CREATING OSTEOPLASTIC MATERIALS TO REPAIR JAW BONES DEFECTS

In the course of our research we have developed a technology for fabricating an osteoplastic material from natural bone tissue. The obtained preparation in the form of gel contains hydroxyapatite, calcium triphosphate compounds and stimulators for regeneration. The proposed experimental material produces a stimulating effect on the growth of animal cell types; it enables to produce bioactive materials with increased biocompatibility. Application of the experimental gel facilitates the process of bone-tissue regeneration in the laboratory animals, which, in its turn, confirms the optimal composition of the material. We have established that during the integration of our osteoinductive material the defect zone is completely replaced by the bone tissue.