PREVENTIVE PLASTIC OF BUCCAL FRENUM IN СOMPLEX TREATMENT OF PATIENTS WITH ACQUIRED MAXILLOMANDIBULAR ANOMALIES.

Aim - improving the effectiveness of complex treatment of patients with maxillomandibular anomalies and disorders of the architectonics of the vestibule of the mouth. We conducted clinical, X-ray methods and cytomorphometric, rheographic examination of the oral mucosa of 30 patients 15-17-years old with acquired maxillomandibular anomalies and disorders of the architectonics of the vestibule of the mouth (buccal frenum) and 15 relatively healthy children - norm group. The patients of I group had surgical correction of buccal frenum, where the surgical wound was healing by secondary tension. The patients of II group had proposed surgical correction of buccal frenum, where the surgical wound was healing by primary tension Patients were prescribed chlorhexidine-denta and a preparation based on hyaluronic acid (Gengigel, Italy) in the postoperative period. Statistical processing of the results was performed using a personal computer using the software package Statistica 12.0. Data distribution was assessed using the Kolmogorov-Smirnov test of normality. Mean values and standard errors were calculated for continuous variables. Correlation between parameters was analyzed using Spearman's correlation coefficient and tested for significance. Significance was set at p<0.05. Clinical studies have shown that all patients have anomalies of buccal frenum fixationin the area of the canines and premolars. The results of cytomorphometric and rheographic studies indicated a deficiency of blood supply in these areas. The results of clinical and laboratory examination showed the advantage of the proposed treatment plan. Long-term results indicate the formation of a normorthophic scar, the absence of recurrences and recessions of the gums in the area of projections of the buccal frenum, the normalization of clinical and laboratory parameters. The obtained data in ІІ group significantly differ from those in І group (p <0.05). Surgical correction of disorders of the architectonics of the vestibule of the mouth is an important and necessary stage of complex treatment of patients with maxillomandibular anomalies and disorders of the architectonics of the vestibule of the mouth. We can achieve the desired therapeutic effect in the treatment of such patients and prevent relapses only by eliminating the etiological factor. The use of preparations based on hyaluronic acid in the postoperative period stimulates reparative processes in the operated area and contributes to the formation of a normotrophic scar. Plastic of buccal frenulum is a prevention of abnormal position of premolars and gum recession in the area of canines and premolars. It is important for preventive dentistry.

CLINICOROENTGENOLOGICAL PECULIARITIES OF THE CONGENITAL AND ACQUIRED CRANIOFACIAL ANOMALIES.

The aim of the research was to study the relationship between the X-ray changes in the bones of the skull, the structure of the upper respiratory tract and concomitant general somatic diseases in patients with congenital and acquired craniomaxillofacial anomalies. The study included 52 patients aged 1 to 3 and 3 to 7 years, with congenital and acquired lower micrognathia in 19 (36.53±5.3)% and upper micrognathia in 33 (63.46±5.3)%. There were used clinical methods (questioning, examination, palpation), instrumental methods (multispiral computer tomography, X-ray cephalometric analysis of the bones of the facial skeleton, oropharynx, and bony pharynx). The obtained results of the clinical and radiographic examination made it possible to assert that among the patients with congenital defects of the jaws, not only changes in the facial skeleton dominate, mostly in the form of upper micrognathia and, to a lesser extent, lower micrognathia, but also the presence of somatic developmental defects in the form of disorders of the nervous system, pathologies of ENT-organs and ophthalmic defects. The identified malformations caused the violations of a number of important functions: breathing, swallowing, chewing, and speech formation. This connection was followed in particular in patients with syndromic craniosynostosis, namely, underdevelopment of the skull base combined with upper micrognathia and retroposition of the maxillary complex in the skull. The frequency and spectrum of concomitant somatic pathology depended on the nature of dentofacial anomalies. All patients with upper micrognathia had craniostenosis with the deformations of the brain skull and eye sockets. Among the patients with lower micrognathia, all those examined were found to have disorders of the development of the ENT-organs.

THE EXISTENCE OF A FUNCTIONAL MATRIX IN THE DEVELOPMENT OF THE FACIAL SKELETON IN CHILDREN.

Aim - identifying the relationship between the presence of oral habits and the violation of the formation of the facial skeleton in children. Improving the effectiveness of comprehensive treatment of patients with pathological occlusion and existing oral habits through orthodontic treatment and elimination of oral habits. We conducted clinical, radiological methods of examination of 60 patients 12-15 years old with acquired maxillomandibular anomalies and oral habits, 15 persons aged 12-15 years without maxillomandibular anomalies and acquired deformities (norm group). We studied the data of computer tomograms, performed stereotopometric analysis (three-dimensional cephalometry), determination of the thickness of the masticatory muscles in symmetrical areas of the face. Statistical processing of the results was performed using a personal computer using the software package Statistica 12.0. Data distribution was assessed using the Kolmogorov-Smirnov test of normality. Mean values and standard errors were calculated for continuous variables. Correlation between parameters was analyzed using Spearman's correlation coefficient and tested for significance. Significance was set at p < 0.05. Clinical examination showed that oral habits were manifested in 98.3% of patients. The results of clinical and radiological examination, analysis of cephalometric parameters and data on the thickness of the masticatory muscles on symmetrical areas of the face confirm the relationship between chronic oral habits and formation of acquired maxillomandibular anomalies; confirm the presence of acquired rather than congenital deformity of the facial skeleton, which is associated with changes in the thickness of the masticatory muscles on the part of the deformation та compensatory muscle hypertrophy on the opposite side. After 12 months, the patients' cephalometric parameters differed significantly from the indicators before active orthodontic treatment and elimination of the oral habit, an increase in muscle thickness was observed in the areas where there was a chronic injury (p≤0.05). An increase in the thickness of the bone structure of the facial skull and an increase in the thickness of the masticatory muscles on the side where the oral habit was eliminated were observed. Oral habits progress regardless of the patient's age, they appear in 96.6% of patients in this group of patients. The results of clinical and X-ray research, analysis of cephalometric indicators and level of the thickness of the masticatory muscles confirm the relationship between a chronic oral habit and the development of the bone and muscle system. The obtained results indicate the ability of bone tissue to change its thickness and contours after eliminating a bad habit and confirm the presence of a functional matrix of bone structure development.