Osteoplastic Surgery Research Articles

Application of autogenous dentinal block to increase alveolar bone volume: a clinical case

Introduction. Materials based on extracted teeth in various studies have been radiographically and histologically proven to be effective in osteoplastic operations. These materials can be used in the form of crushed dentin matrix, a fragment of the tooth’s root and an autogenous dentin block. The purpose of this clinical case was to evaluate the effectiveness of using an autogenous dentin block to increase the alveolar process of the jaws in the preimplantation period.Description of a clinical case. Patient F., 30 years old, applied to the clinic of the Clinical Center of Maxillofacial, Plastic Surgery and Dentistry Russian University of Medicine with a complaint of a missing tooth in the frontal region of the lower jaw. At the time of treatment, the patient was already undergoing orthodontic treatment in another medical institution in Moscow. The patient underwent a clinical and radiological examination together with a prosthodontst. A diagnosis of «partial secondary adentia», «atrophy of the alveolar ridge in the frontal part of the lower jaw» and «dystopia of teeth 1.8, 2.8, 3.8, 4.8» was established. A comprehensive treatment plan has been drawn up. At the first stage, the patient underwent extraction of teeth 1.8, 2.8, 3.8, 4.8 for orthodontic indications with simultaneous bone grafting of the alveolar ridge in the area of the missing tooth 3.1. At the second stage, the patient underwent a trephine biopsy in the area of augmentation and installation of a dental implant in the area of missing tooth 3.1. The third stage was rational prosthodontic treatment on a dental implant in the department of prosthodontics.Results. The present study showed that autogenous dentinal block can serve as an alternative material for alveolar ridge augmentation.

Predicting the results of osteoplasty in oral surgery

The article presents the results of the outcomes analysis of osteoplasty in the rehabilitation of patients using dental implants, examines its various types and biological factors affecting the success of these operations. An attempt has been made to find possible solutions to the problem of bone insufficiency in the treatment of patients with missing teeth.The aim of the study is to study the results of various bone grafting techniques in patients in preparation for dental implantation and the success factors of this surgery.Materials and methods: the results of 281 osteoplasties were evaluated. The patients were divided into 4 groups according to the surgery technique performed: guided bone regeneration (GBR); bone block transplantation (BBT); open sinus-lifting (OSL); local bone modifying (LBM). Complications and results of these surgeries were evaluated.Results: significant and critical complications were more common in the operations of GBR (61.7% and 21.28%, respectively) and BBT (28.57%). After evaluating the outcomes of osteoplastic surgery, it was found that the acceptable result of OSL was 93.27%, LBM 88.43%; while we noted an unacceptable result during GBR in 76.59%, and BBT 57.14%. Complications in the form of non-critical reversible ones were more common during OSL (42.3%), however, significant and critical complications were detected after operations of GBR (61.7%) and BBT (28.57%). The results of the analysis of the outcomes of bone plastic surgery in the oral surgery indicate a significant percentage of unsuccessful outcomes of the GBR (76.59%) and BBT (57.14%).Conclusion: the study demonstrates the clinical value and effectiveness of various osteoplasties’ methods. In our opinion, outcomes and complications is associated, among other things, with a different factors, the main of which are the number of existing bone walls of the defect (atrophy), the volume of replacement, age and localization, which must be taken into account when predicting the results of this surgery.

Promising osteoplastic materials and surgical technologies in reconstructive treatment of patients with bone nonunion and defects

Introduction Some progress has been made in the development of innovative implantation materials for osteoplastic surgery. However, the problem of bone defect management still remains relevant due to the continued high prevalence of injuries resulting from road accidents, catatrauma, man-made disasters and military operations.The purpose of the work was to analyze the relevant literature and to identify options for solving the problems of bone nonunion and defect management using materials developed on the principles of orthobiology and surgical technologies based on autologous repair.Materials and methods The search for sources was carried out with the ConnectedPapers analytical tool and the capabilities of the eLibrary electronic library using keywords and without restrictions on publication date.Results and discussion Recent publications contain information about the effectiveness of the combination of Masquelet technology and Ilizarov bone transport in patients with acquired and congenital defects, including in the conditions of active purulent infection. According to the literature, a promising autologous bone plastic material is the contents of the bone marrow cavity, containing osteogenic growth factors and bone morphogenetic proteins. Biomaterial is collected using the Reamer-Irrigator-Aspirator system (RIA) from the intramedullary canal of the femur or tibia. Currently, the effectiveness of bone morphogenetic proteins rhBMP-2 and rhBMP-7 in the restorative treatment of patients with bone defects and nonunion of various etiologies has actually been proven. The use of bone morphogenetic proteins has been introduced into foreign treatment protocols. Recent positive results of a combination of surgical technologies have proposed the combined use of the Ilizarov and Masquelet technologies, supplemented by PRP therapy. The basis for the expected effect from the combination of surgical technologies and orthobiological materials are the results of preclinical studies of the osteogenic potential of PRP therapy.Conclusion There are grounds for studying the clinical effect of the combined use of surgical technologies based on autologous reparative processes and materials developed on the principles of orthobiology. It is necessary and advisable to clinically implement the use of bone morphogenetic proteins rhBMP-2 and rhBMP-7 in the reconstructive treatment of patients with bone defects and nonunion of various etiologies. Multicenter clinical studies of a high level of evidence are needed to determine the effectiveness of PRP therapy in the reconstructive treatment of patients with bone nonunion and defects.

Study of the biocompatibility of porous 3D-TiNi implants in vivo

Introduction. Porous TiNi alloys are widely used in medicine as osteoreplacement implants due to their unique properties of superelasticity and biocompatibility, but their clinical use is severely limited by time-consuming manual fabrication and the inability to create precise geometries. Reconstructive surgery for the replacement of bone defects requires biocompatible endoprostheses of individual shape and complex geometry. The use of porous 3D-TiNi implants can be a solution to many problems in traumatology and bone oncology.Aim: To evaluate the possibility of using porous 3D-TiNi implants in osteoplastic surgery based on a study of the structure and biocompatibility of the material under in vivo conditions.Material and Methods. Porous samples in the form of cones and a single implant for maxillofacial surgery were prepared from TiNi powder by selective laser melting. To print an individual implant for maxillofacial surgery, the personal data of the patient at the Oncology Research Institute were used. The macrostructure, elemental and phase composition of porous titanium nickelide samples were investigated using scanning microscopy and X-ray diffraction analysis. The biocompatibility of porous cone-shaped samples was evaluated in vivo using guinea pigs whose condition was analysed by CT scanning.Results. Structural studies of porous titanium nickelide samples showed that selective laser melting can be used to obtain a continuous porous structure with strong contact bridges between particles of a three-phase powder. In vivo testing of the cone-shaped implants showed no local inflammatory changes, rejection or deformation of the hind limb axes of the experimental animals. The basic feasibility of fabricating a custom implant of complex geometry from TiNi powder using selective laser melting according to a patient’s MSCT data was demonstrated.Conclusions. Porous 3D-TiNi implants obtained by selective laser melting showed high biocompatibility under in vivo conditions. An experimental study confirmed the efficacy and ease of use of 3D TiNi implants, their excellent self-fixation in bone tissue, and bone tissue augmentation at the interface with the implant. The macrostructure, chemical and phase composition of the implant material was found to be close to traditional porous TiNi alloys. It was shown that the method of selective laser melting makes it possible to create complex geometric defects in bone tissue from TiNi.

Results of bone grafting using a xenogenic cortical plate BiOTECK

BACKGROUND: The fundamental condition that determines the effectiveness of treatment, with immediate and long-term positive results, is the amount of bone tissue in the jaws at the proposed implantation site. Defects in the dentition to a large extent and severe atrophy of the bone tissue of the jaws due to the loss of teeth significantly limit the use of dental implantation. It is reasonable to expand the indications for the use of dental implants in cases of atrophy of the jaw bone tissue in the installation site. This allows the optimization of surgical techniques aimed at increasing the volume of the jaw bone tissue, such as the use of new osteoplastic materials for guided bone regeneration.
 AIM: This study aimed to analyze the results of a jawbone graft using a BiOTECK xenogeneic cortical plate.
 MATERIALS AND METHODS: The test group consisted of 22 patients (11 men and 11 women) with jawbone atrophy. All patients underwent bone graft surgery using a BiOTECK xenogeneic cortical plate (BiOTECK, Italy).
 In the course of the study, all patients with jawbone loss underwent a dynamic clinical and X-ray examination during the following stages: during the dental implant surgery planning stage aimed at determining the volume of the bone tissue available and identifying the associated conditions and diseases (prior to conducting an osteoplastic procedure), prior to dental implant installation (6 months after osteoplastic surgery), and prior to the start of the orthopedic stage of treatment (12 months after osteoplastic surgery).
 RESULTS: The cone beam computed tomography data were analyzed and statistically processed to obtain the results. It was revealed that the values of the “bone densitometry” indicator increased 6 months after the bone graft using the BiOTECK xenogeneic cortical plate, and the values of the “densitometric density of jaw bone tissue” indicator increased.
 Immediately after bone grafting using the BiOTECK xenogeneic cortical plate, the thickness of the bone tissue of the upper jaw increased by an average of 5.0±0.1 mm and that of the lower jaw increased by an average of 3.9±0.1 mm. In the first stage of the dental implant surgery (6 months after osteoplastic procedure), due to resorption, the thickness of the bone tissue of the alveolar process of the upper jaw decreased by 1.1±0.1 mm and amounted to 6.8±0.1 mm (bone resorption rate: 13.9%), and the thickness of the bone tissue of the alveolar process of the lower jaw decreased by 0.8±0.2 mm and amounted to 6.6±0.3 mm (bone resorption rate: 10.3%).
 CONCLUSION: The clinical and X-ray results obtained 1 year after installing dental implants and performing bone graft surgery using the BiOTECK xenogeneic cortical plate indicate a stable volume of marginal bone tissue in the area of alveolar crest reconstruction.

РОЛЬ ЧАСТОТНО- РЕЗОНАНСНОГО АНАЛИЗА В ИССЛЕДОВАНИИ ДЕНТАЛЬНЫХ ИМПЛАНТАТОВ, УСТАНОВЛЕННЫХ В РЕКОНСТРУИРОВАННЫЕ АЛЬВЕОЛЯРНЫЕ ОТРОСТКИ С НЕБОЛЬШИМ ОБЪЕМОМ КОСТИ ЧЕЛЮСТЕЙ

The use of dental implants being the intraosseous artificial fixtures is often required for orthopedic rehabilitation of completely edentulous patients; for their placement, adequate amount of bone tissue is needed, which in many cases is insufficient due to physiological bone loss, long-term wearing of full dentures, the duration of edentulism and complex clinical situations caused by maxillofacial injuries or general somatic diseases. Implant placement in the above situations requires timely preparation of deficient alveolar ridge by means of osteoplastic surgery. In its turn, the newly formed regenerated bone by its histological, physicomechanical and structural-functional properties can only approach the recipient bone tissue; therefore, the issue of implant osseointegration and its functional loading in regenerated bone remains debatable. This research uses the method of frequency-resonance analysis showing implant stability coefficient numerically equal to the ISQ (Implant stability Quotient) values and reflecting the percentage of the osseointegration area of the intraosseous part of the implant. The results of research obtained by means of frequency-resonance analysis have proved that with the timely start of implant usage and adequate functional loading, ISQ values increase, that is, increases the osseointegration area along the interface of the intraosseous part of the implant placed in regenerated bone. Comparative results of research reflecting ISQ values in 12 months after implant placement in bone augmented using various forms of autogenous bonegrafts, have been presented; therefore, a conclusion can be made that there is a direct relationship between osseointegration under conditions of functional chewing load and the shape and size of autogenous bonegrafts.

Efficiency of antiseptic agents for treatment of autogenous dentinal blocks

BACKGROUND: Autogenous material is currently one of the most common and effective materials used for bone grafting. In recent years, materials based on extracted teeth have attracted attention. When analyzing modern articles, all authors agree that before using autogenous dentinal material, it is necessary to carry out antiseptic treatment to prevent possible complications.
 AIM: A comparison was made of various antiseptic agents for the treatment of autogenous dentinal blocks with subsequent osteoplastic operations in the pre-implantation period.
 MATERIALS AND METHODS: At the Department of Maxillofacial and Plastic Surgery of the Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, 43 teeth were removed for orthodontic indications, the teeth were processed mechanically and fragmented into 125 autogenous dentinal blocks. Then they were treated with antiseptic agents (0.01% Miramistin solution, 95% ethyl alcohol solution, 0.05% and 2% chlorhexidine solution) for 15 min and were sent to the Department of Microbiology, Virology, Immunology of the Moscow State University of Medicine and Dentistry named after A.I. Evdokimov for the isolation of microbial cultures.
 RESULTS: The use of antiseptic agents showed a significant reduction in microbial contamination compared with the control group, which did not undergo antiseptic treatment, which indicates the effectiveness of the treatment of extracted teeth before using it as an osteoplastic material for bone grafting.
 CONCLUSION: Autogenous dentinal blocks must be processed before being used as an osteoplastic material.

РЕЗУЛЬТАТЫ ИССЛЕДОВАНИЙ ДЕНТАЛЬНЫХ ИМПЛАНТАТОВ, УСТАНОВЛЕННЫХ ПАЦИЕНТАМ ПОСЛЕ ПРОВЕДЕНИЯ КОСТНО-ПЛАСТИЧЕСКИХ ОПЕРАЦИЙ ПО УВЕЛИЧЕНИЮ РЕДУЦИРОВАННЫХ АЛЬВЕОЛЯРНЫХ ОТРОСТКОВ ЧЕЛЮСТЕЙ МЕТОДОМ ЧАСТОТНО-РЕЗОНАНСНОГО АНАЛИЗА

The use of dental implants being the intraosseous artificial fixtures is often required for orthopedic rehabilitation of completely edentulous patients; for their placement, adequate amount of bone tissue is needed, which in many cases is insufficient due to physiological bone loss, long-term wearing of full dentures, the duration of edentulism and complex clinical situations caused by maxillofacial injuries or general somatic diseases. Implant placement in the above situations requires timely preparation of deficient alveolar ridge by means of osteoplastic surgery. In its turn, the newly formed regenerated bone by its histological, physicomechanical and structural-functional properties can only approach the recipient bone tissue; therefore, the issue of implant osseointegration and its functional loading in regenerated bone remains debatable. This research uses the method of frequency-resonance analysis showing implant stability coefficient numerically equal to the ISQ (Implant stability Quotient) values and reflecting the percentage of the osseointegration area of the intraosseous part of the implant. The results of research obtained by means of frequency-resonance analysis have proved that with the timely start of implant usage and adequate functional loading, ISQ values increase, that is, increases the osseointegration area along the interface of the intraosseous part of the implant placed in regenerated bone. Comparative results of research reflecting ISQ values in 12 months after implant placement in bone augmented using various forms of autogenous bonegrafts, have been presented; therefore, a conclusion can be made that there is a direct relationship between osseointegration under conditions of functional chewing load and the shape and size of autogenous bonegrafts.

МАТЕМАТИЧЕСКОЕ МОДЕЛИРОВАНИЕ БИОМЕХАНИЧЕСКИХ ОСОБЕННОСТЕЙ ИМПЛАНТАТОВ, РАСПОЛОЖЕННЫХ ПОД НАКЛОНОМ, С РАЗЛИЧНЫМИ КОНФИГУРАЦИЯМИ ИМПЛАНТАТ – АБАТМЕНТ – ФИКСИРУЮЩИЙ ВИНТ

Subject. Various options for internal connections of implants, abutments and screws have biomechanical features that affect the success of implant treatment.
 All structures of the implant system, including the internal connection, are subjected to masticatory stress. The most favorable location of the implant is the position coaxial to the occlusal load. However, in many clinical cases, due to anatomical limitations and the presence of contraindications for osteoplastic surgery, it becomes necessary to install implants at an angle.
 At present, angular dental implants are being successfully introduced in dental practice - implants with an orthopedic platform located at an angle to the axis of the implant and a fixing screw shaft.
 A clear understanding of the features of stress distribution within various types of implant connections allows you to optimize planning and treatment, thereby reducing the risk of complications.
 Purpose. To study the features of stress distribution in implant systems with different designs of connections between an implant located at an angle, a screw and a suprastructure.
 Methods. A study of the stress-strain state of implant systems was carried out using the finite element analysis method when using straight and angled implants for dental orthopedic treatment using non-removable structures.
 Results. Peak stress values for models with a direct implant with different options for the direction of the occlusal load varied from 43 to 45 MPa. For the model with the use of an angled implant, the maximum stresses reached 70 MPa under a coaxial load, and 265 MPa under an angled load.
 Conclusions. It is shown that the different structure of the inner connection largely affects both the localization and the absolute value of the maximum stresses. In the case of a model with a straight implant, the maximum stress values are significantly lower than the fatigue failure limits; when considering a model with an angled implant, the maximum stress values and their localization are comparable to the fatigue strength value under certain load directions, which can potentially lead to damage in the internal connection of the implant.

Unilateral, Rostral Maxillary Sinusitis Resulting from Displacement and Retention of an Alveolar Plug in a 4-Year-Old Horse.

Sinusitis is a common occurrence in horses and often develops secondary to dental disease. Extraction of cheek teeth in horses is associated with variable degrees of complications and although postoperative displacement and retention of alveolar plugs has been identified as one such potential complication, few cases of resulting sinusitis have been reported. This manuscript describes a four-year-old Thoroughbred mare that was presented for chronic unilateral left-sided mucopurulent nasal discharge after extraction of the left maxillary second molar tooth two months earlier. Radiographic and computed tomographic (CT) examinations revealed a well circumscribed, soft tissue opacity in the left rostral sinus compartment. Intraoral examination revealed feed impacted in the alveolus of the extracted tooth and an oral sinus fistula. Upper airway endoscopy showed thick, purulent material at the nasomaxillary aperture. Sinoscopy showed unexpectedly clean frontal, dorsal conchal and caudal maxillary sinuses. The alveolar dental plug associated with previous exodontia became apparent within the sinus and was removed through the sinoscopy portal. Repeat endoscopies confirmed progressive clearance of the sinusitis during hospitalization. Unilateral nasal discharge returned three months later. An abscess within the sinus had formed. Complete resolution of the sinusitis was achieved after lancing the abscess and further sinus lavage. Sinoscopy through a frontal sinus trephination portal proved useful in diagnosis and treatment. Detailed evaluation of structures allowed for rapid establishment of adequate drainage and communication between all sinus compartments without osteoplastic surgery.

The results of using various methods of bone grafting in the oral cavity. Local bone modeling.

The purpose of the article was to study the results of using various methods of bone grafting in preparation for dental implantation and the success factors of these surgical interventions.
 Material and methods. The results of 314 osteoplastic surgeries were evaluated. The patients were divided into 4 groups according to the performed bone grafting operations: guided bone regeneration (GBR); bone block transplantation (BBT); open sinus lift (OSL); local bone modification (LMB). Complications and results of surgical interventions were evaluated.
 Results. Significant and critical complications were more common during GBR (61.7% and 21.28%, respectively) and BBT
 (28.57%) surgeries. After evaluating the outcomes of osteoplastic operations, it was found that the acceptable result of OSL operations was 93.27%, LMB — 88.43%; while an unacceptable result during the operations of the GBR was noted in 76.59%, and in the BBT — 57.14%. To describe the configuration of atrophy (defect), the concept of the W-factor (factor of the number of walls) is introduced.
 Conclusions. The study demonstrates the clinical value and efficacy of various bone grafting techniques. The results of the analysis of the outcomes of osteoplastic surgeries in the oral cavity indicate a significant percentage of unsuccessful outcomes of osteoplastic surgeries of GBR (76.59%) and BBT (57.14%). According to the authors, this is due to a number of factors, the main of which is the number of existing bone walls of the defect (atrophy), its volume and the state of the periosteum in the area of osteoplastic surgery.

The use of osteoplastic operations To correct foot deformities in children with cerebral palsy: clinical and radiological substantiation and analysis of results

The work was grounded on the examination and treatment of 119 patients with cerebral palsy, aged 3-14. In 100% of cases the disturbances of anatomical functional state due to bone foot deformity were revealed. In 80% of cases marked concomitant multicomponent changes of foot bones were detected. Taking into account the results of x-ray examination different methods of surgical correction were elaborated. Application of those operative techniques allowed to achieve good and satisfactory outcomes in 96.4%) of patients. Those operative technique with the use of bone grafts enabled to correct the foot deformity and prevent the deformity recurrence.

The effectiveness of allogeneic dura mater for the preventive surgical treatment of single and multiple gingival recessions before orthodontic treatment with fixed orthodontic appliances: a clinical research

Relevance. Gingival recessions are frequent during or after orthodontic treatment with fixed appliances (65.0-86.7%). They are usually observed in anterior teeth, especially in teeth bodily movements along an archwire outside the bone or in buccal/ labial tipping more than five degrees along the axis (35%). Pre-existing recessions worsen during orthodontic treatment with fixed appliances and up to 5 years after the treatment (47%). The treatment of recessions during or after the orthodontic treatment is not strategically reasonable: the relapse rate is high, and the treatment implies large-scale surgical interventions, including osteoplastic surgery; it is more often performed with free gingival de-epithelized graft after the treatment, which has many comparative disadvantages. Purpose – the study aimed to evaluate the effectiveness of a graft material (allogeneic dura mater) to eliminate gingival recessions before orthodontic treatment or to create/ thicken the volume of the gum buccally/ labially to prevent rec eding gum during or after orthodontic treatment.Materials and methods. The paper presents and closely analyzes preventive surgical treatment in a patient with pretreatment gingival recessions.Results. In all cases, using the dura mater demonstrates a positive clinical result by all parameters of the gingival recession assessment. The percentage of root coverage is 100% in all teeth.Conclusion. Preventive surgical treatment is reasonable in all cases as it eliminates the need for repeated interventions, excludes the onset of gingival recessions during or after orthodontic treatment, as well as the reappearance of gingival recessions. Dura mater is effective and safe in all cases; the response to surgery is normal, dura mater allows avoiding a second surgical field. We recommend including it in the standard protocol of orthodonti c treatment.

Патофизиологические аспекты регенерации костной ткани при увеличении ширины тонкого альвеолярного гребня челюстей с применением пьезохирургической техники

One of the main problems that impede dental rehabilitation with the use of dental implants is the limited amount of bone tissue in cases of its pronounced atrophy. According to a number of authors, about 50% of patients need additional osteoplastic operations before or at the stage of dental implantation. Objective. The aim of the paper is to assess the effectiveness of piezosurgical apparatus for splitting the alveolar crest of the jaw in the insertion of dental implants. Materials and methods. Forty adult patients (15 men and 25 women) aged 36 to 49 years who had undergone surgery for partial tooth loss on one and/or both jaws were evaluated. All in all, 48 implants were placed against the narrow alveolar crest of the jaws, which was surgically split using microsaws (Group 1- 11 patients), thin dental drills (Group 2 -15 patients) and piezosurgery apparatus (Group 3, 14 patients). The postoperative follow-up period was 4 to 6 months before the orthopaedic treatment. Results. During crestal splitting, the smallest bone reduction was obtained using piezosurgical technique, which was 0.84±0.22 mm, while with microsaws and dental drills, this figure was slightly higher, 0.93±0.21 mm (p≥0.05) and 1.23±019 mm (p≤0.05), respectively. One of the properties of a piezosurgical instrument is the effect on protein molecules, namely, their denaturation. This reduces the number of postoperative complications. Conclusion. The technique of alveolar crest splitting with a piezosurgical instrument works according to the absolutely natural and unique mechanism of bone healing - the mechanism of fracture repair. This technique uses the local bone resource and avoids or significantly reduces the use of foreign bone grafting materials. There is a tendency to a better rate of restoration of the lost width of the alveolar crest of the jaw when using the piezosurgical apparatus, in contrast to the use of microsaws and dental drills.

Composite Polyvinylpyrrolidone-Sodium Alginate-Hydroxyapatite Hydrogel Films for Bone Repair and Wound Dressings Applications.

Today, the synthesis of biocompatible and bioresorbable composite materials such as “polymer matrix-mineral constituent,” which stimulate the natural growth of living tissues and the restoration of damaged parts of the body, is one of the challenging problems in regenerative medicine. In this study, composite films of bioresorbable polymers of polyvinylpyrrolidone (PVP) and sodium alginate (SA) with hydroxyapatite (HA) were obtained. HA was introduced by two different methods. In one of them, it was synthesized in situ in a solution of polymer mixture, and in another one, it was added ex situ. Phase composition, microstructure, swelling properties and biocompatibility of films were investigated. The crosslinked composite PVP-SA-HA films exhibit hydrogel swelling characteristics, increasing three times in mass after immersion in a saline solution. It was found that composite PVP-SA-HA hydrogel films containing HA synthesized in situ exhibited acute cytotoxicity, associated with the presence of HA synthesis reaction byproducts—ammonia and ammonium nitrate. On the other hand, the films with HA added ex situ promoted the viability of dental pulp stem cells compared to the films containing only a polymer PVP-SA blend. The developed composite hydrogel films are recommended for such applications, such as membranes in osteoplastic surgery and wound dressing.

Эффективность современных методик оперативного лечения передней рецидивирующей нестабильности плечевого сустава в зависимости от анатомо‑функциональных изменений

Introduction Traumatic anterior dislocation of the shoulder usually results in chronic recurrent shoulder instability, especially in young adults. To reduce the rate of recurrent dislocations, various options of osteoplastic operations have been proposed. The purpose of our study is to determine the significance of anatomical and functional disorders in patients with anterior shoulder joint instability; to evaluate the results of the methods for surgical treatment of patients with anterior recurrent instability of the shoulder joint, depending on the anatomical and functional disorders. Materials and methods The results of diagnostic examination and treatment of 169 patients with recurrent post-traumatic dislocation of the shoulder who were operated on at the Federal State Budgetary Organization “Federal Center for Traumatology, Orthopedics and Arthroplasty” (Cheboksary) were analyzed. The average age of patients was 31.1 ± 13.1 years; the average period of postoperative follow-up was 49.5 ± 24.0 months. Clinical data were assessed by angulometry, using the ROWE, ASES, UCLA, VAS scales. The size of bone defects was determined using radiological methods. 99 patients (58.6 %) underwent arthroscopic Bankart repair, 24 patients (14.2 %) with more than 15 % anterior glenoid bone defect underwent Latarjet operation. Bankart + Remplissage surgery was performed in 39 patients (23.1 %), Latarjet + Remplissage in 7 (4.1 %) patients. Results Bone defect of the glenoid of more than 15 % of the area was detected in 32 patients. Hill-Sachs grade 3 injury was reported in 24 patients. Most of these patients had a history of more than 20 dislocation episodes. Hyperelasticity of the shoulder joint was found in 34 patients. In the postoperative period, there was a slight improvement in the mean indicators of flexion and abduction in the shoulder joint from 174.2 ± 15.9° and 170.6 ± 17.8° to 175.6 ± 9.3° and 173.0 ± 12.3°, respectively. The mean external rotation worsened from 61.6 ± 25.7° to 55.9 ± 14.4°. Indicators of the ROWE, ASES, UCLA rating scales improved significantly from 38.5 ± 8.5, 76.0 ± 13.2 and 20.8 ± 3.0 to 89.9 ± 17.5, 94.0 ± 7.1 and 32.7 ± 3.7 points, respectively. Poor results were observed in 7 patients (4.1 %), of which three had a relapse. Conclusions Critically significant anatomical and functional disorders in patients with anterior instability of the shoulder joint are the defect of the anterior rim of the articular process of the scapula more than 15 %, the defect of the posterior surface of the humeral head (Hill-Sachs defect) of grade 3, hyperelasticity of the soft tissues of the shoulder joint. The severity of bone defects is directly proportional to the total number of dislocations. The effectiveness of surgical techniques for stabilizing the shoulder joint, depending on the above anatomical and functional disorders, was 95.9 %.

Osteoplastic operations in the anterior part of the mandible for correction of malocclusion

Correction of disorders during transformation into one of the most difficult tasks, both in orthodontics and in maxillofacial (orthognathic) surgery. This article presents two clinical cases of median osteotomy/ostectomy. The stages of operations are described. Surgical technique of transversal correction by osteotomy/ ostectomy is presented. Operation is combined with bilateral retromolar osteotomy. Three dimensional fragments moving helps to change lower jaw shape. Indications for this surgical manipulation: one or two side cross-bite, discrepancies between size of teeth and length of alveolar bone (lower macrognathia, microdentia, extra-teeth, huge diastema), asymmetry of mandible.

Dental rehabilitation of total adentia at pensioners of the Ministry of defense and contingent attached to military medical organizations

Legal, economic and clinical aspects of treatment of military personnel, retired military personnel, as well as the attached contingent in the conditions of hospitals of the Ministry of defense are presented. The study is based on the results of studying the number of dental implants installed in patients from 2014 to 2019 based on the medical records and outpatient records of a dental patient in two specialized departments of multidisciplinary hospitals of the Ministry of defense of the Russian Federation. Primary medical records were studied, data on the sex and age of patients, the presence (absence) of opportunistic diseases used implant system, the installation of dental implants and their amount and frequency of soft tissue and osteoplastic operations (to increase the volume of the bone and soft tissues of the alveolar bone (part) jaws) and the Protocol of the temporary and permanent prosthesis. Based on the analysis, we describe the current possibilities of medical and diagnostic work and present various types of orthopedic structures on dental implants for the dental rehabilitation of the above-mentioned contingents with complete adentia of the jaws (including in cases where absolute indications require the removal of all teeth due to foci of chronic odontogenic infection or periodontitis). The methods of treatment of patients in cases of combination of adentia with varying degrees of atrophy of the alveolar processes (parts) of the jaws are analyzed in detail. Clinical examples of dental rehabilitation are shown both with and without the use of methods for increasing the volume of jaw bone tissue, using various modern protocols for fixing orthopedic structures on zygomatic and root dental implants, and the frequency of their use in military medical organizations of the Ministry of defense of the Russian Federation during the reporting period. Based on the presented results, it is shown that the military medical organizations of the Ministry of defense of the Russian Federation have a full range of opportunities to provide comprehensive dental care to patients with complete secondary adentia, even in the presence of extreme bone atrophy of the jaws.

Complications during guided bone regeneration using a membrane based on titanium thread «Titanium silk»

The titanium based membrane «Titanium silk» is widely used in guided bone regeneration (GBR) in the oral cavity, but the literature does not mention possible complications and methods of dealing with them. Improving the treatment of patients in cases of complications during GBR using a membrane based on titanium thread «Titanium silk». 25 patients who applied to the Federal State Institution Central Research Institute of Dental and Maxillofacial Surgery, Ministry of Health of the Russian Federation underwent an operation of guided bone regeneration in order to create optimal conditions for dental implantation. In the postoperative period, dynamic monitoring of the condition of patients was carried out, where the healing of soft tissues was assessed and, if possible early or late complications were identified, timely measures were taken to combat them. Of the 25 patients in the early postoperative period, in 2 cases, complications were identified, associated with exposure of the membrane, and in one case 4 months after osteoplastic surgery. However, adequate postoperative administration of these conditions allowed us to achieve a positive outcome of the treatment. Only in one case, addition GBR was required. Most of the complications presented in this study during GBR had a multifactorial causes, depending on local and general factors of the patient. Early identification of complications and adequate postoperative management can lead to a positive final outcome of treatment.

Fungus Ball of the Maxillary Sinus—Modern Treatment by Osteoplastic Approach and Functional Endoscopic Sinus Surgery

Functional endoscopic sinus surgery (FESS) is considered standard surgical therapy for fungus ball of the maxillary sinus. However, recent findings have indicated an odontogenic etiology, which requires simultaneous treatment of the dental origin. This study presents the authors' treatment results of fungus ball of the maxillary sinus using a combination of FESS and an endoscopically assisted osteoplastic approach through the anterior wall of the maxillary sinus, enabling simultaneous treatment of the dental origin. A cohort of 22 patients with histopathologically confirmed fungus ball of the maxillary sinus was retrospectively analyzed. Clinical records and medical imaging data were reviewed to evaluate the etiology, clinical and radiologic findings, and postoperative outcome. Only 15 patients presented nonspecific clinical symptoms compatible with chronic unilateral maxillary sinusitis. Computed tomography visualized complete opacity of the maxillary sinus in 11 patients and intralesional hyperdensity in 12 patients. An odontogenic association was verified in 18 patients. Twenty-one patients underwent endoscopically assisted osteoplastic surgery through the anterior maxillary sinus wall. In 12 cases, the assumed persistent odontogenic source was treated simultaneously. Depending on the patency of the ostiomeatal complex, the accompanying chronic sinusitis was treated by FESS. The present data support the assumption of an odontogenic etiology of fungus ball ofthe maxillary sinus. Hence, surgical management requires simultaneous treatment of the fungal mass, the odontogenic origin of the disease, and the accompanying chronic sinusitis. To properly treat fungus ball, the authors present a modern treatment concept, using a minimally invasive endoscopically assisted osteoplastic approach through the anterior maxillary wall, for sufficient and necessary surgical treatment.