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.

MICROSTRUCTURE OF BIOPOLYMER MICRO-FIBROUS SCAFFOLD AND ITS INFLUENCE ON THE ABILITY TO RETAIN MEDICINES AND TISSUE REGENERATION.

The aim of the research is to study the microstructure, antibiotic-absorbing and framework capacity of the fibrous non-woven PCL matrices designed by us for the regeneration of tissues and capillaries. Samples of microfibrous non-woven matrices made by our technology out of polycaprolactone PCL (invention patent of Ukraine № 119958) were used in the work. Antibiotic retention in samples of matrix materials was evaluated during the 1st, 3rd, 5th, 7th, 14th, 18th and 21st days of the experiment. The experimental part of the research was performed using 30 laboratory animals (rabbits). On the basis of microscopic studies of the biopolymer microfiber matrices obtained by us, the relationship between the increase in polymer concentration in the sucrose melt and the increase in the percentage of thicker microfibers was determined. Microbiological analysis of the antibiotic-absorbing capacity of the obtained microfibrous biopolymer non-woven matrices determined that lincomycin impregnated into polymer matrices is characterized by less stability during storage than cefazolin. Antibiotic concentrations of the impregnated matrix material samples were actively maintained at the level of control values for a period of 5 days. The pathomorphological analysis of soft tissues at all times of subcutaneous implantation in the experiment made it possible to determine the fact of regeneration of tissues and the microcirculatory channel through the entire thickness of the fibrous matrix. This was confirmed by a significant decrease in the area of the connective tissue matrix per vessel from (49345.18+485.63) µm2 to (24797.47+480.28) µm2, an increase in the cross-sectional area of vessels from (697.61+21.79) µm2 to (1321.23+24.82) µm2 and a decrease in the thickness of vascular walls from (3.2+0.05) µm to (2.65+0.07) µm (p<0.01) from the periphery to the center of the frame. These facts, in our opinion, confirm the framework function of the polymer matrix synthesized by us, which is also a means of one-time local delivery of the medicine to the tissues in the damaged area.

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.

EFFECTIVENESS OF THE APPLICATION OF THE DEVELOPED BIOPOLYMER FIBROUS MATRIX WITH CENOBONE® BIOGEL FOR THE RECONSTRUCTION OF BONE TISSUE DEFECTS OF THE JAWS.

The aim of the research was to study the framework ability of the fibrous non-woven PCL matrices we've created during the restoration of bone tissue.There were performed some spectroscopic, histological and immunohistochemical, radiological and clinical analyses of the effectiveness of microfibrous non-woven PCL polycaprolactone matrices developed by us, in the work. The obtained results of morphological studies of bone tissue in the experiment of the implantation of a fibrous matrix indicated an increase in reparative osteogenesis in the form of an increase in osteoid areas up to 34.38% (p<0.05) at an early period. The analysis of clinical data showed the effectiveness of the frame developed by us, which was confirmed by the absence of pronounced compaction of bone tissue in group III, in contrast to group II, where, on the contrary, the use of granulate based on hydroxyapatite and tricalcium phosphate has led to a significant increase in density indices of 974.53+19.74 HU p<0.05, which did not exceed 36.8% of indices of the group III 615.17+24.53 HU p<0.05.The matrix material developed by us is not only a means of delivering some other substances and materials into the damaged area, but also serves as a kind of framework for the restoration of bone tissue.

CLINICAL-MORPHOLOGICAL SUBSTANTIATION OF THE FIBROUS MATRIX WITH BIOGEL CENO BONEТМ APPLICATION FOR PRESERVATION OF THE ALVEOLAR PROCESS OF THE JAWS AFTER THE TEETH REMOVAL.

The aim of the study was to evaluate the possibility and effectiveness of fiber matrix use in order to maintain the original geometric parameters of the bony crest in the area of removed teeth. ; The experimental study was performed on laboratory animals (rabbits). 30 animals of the main group were implanted with a polymer matrix in the area of bone defect, 30 animals of the control group were formed bone defect. Patients in the study group were performed with filling-out of a post-extraction socket by fiber matrix developed by the authors of the article (рatent for invention of Ukraine № 119958) in combination with biogel CenoBoneтм. For patients in the control group filling or overlapping of the post-extraction socket were not conducted. Computed tomography was performed at the period of 4 months after the initial surgical intervention. Analysis of the parameters of bone tissue in the area of the removed teeth 4 months after extraction was performed on the basis of the tomography-results in the ImageJ software (Wayne Rasband (NIH)) using the specialized BoneJ plugin.; The results of experimental studies confirmed that percentage of osteoid in the main group, compared with the control indicators, showed a pronounced framework effect of the implanted microfiber polymer matrix. This fact was confirmed by the presence of complete mineralized bone tissue in the defect zone with lysis of the fibers of the non-woven polymer matrix and the presence of microosteoid foci, the proportion of which was 0.13% (р<0,05), which is 86% less than in the control group. ; The analysis of clinical studies showed that average level of resorption of the medial bone wall of the post-extraction socket was 0,6±0,4 mm (range of indicators - 0,3-0,8 mm), distal bone wall - 0,4±0,3 mm (range of indicators - 0,2-0,6 mm), vestibular bone wall - 1,4±0,7 mm (range of indicators - 0,9-2,0 mm), lingual bone wall - 1,2±0,7 mm (range of indicators - 0,8-1,9 mm). In the control group, the average level of bone resorption reached from the medial side 1,4±0,5 mm (range of indicators - 0,8-1,7 mm), from the distal side - 0,9±0,6 mm (range of indicators - 0,7-1,5 mm), from the vestibular side - 2,2±0,4 mm (range of indicators - 1,5-2,6 mm), from the oral side - 2,1±0,6 mm (range of indicators - 1,3-2,4 mm). In both groups the statistical difference between the change in the vertical parameters of the residual crest from the medial/distal sides and the vestibular/oral sides was noted (p<0,05). ; Obtained results indicate a more pronounced preservation effect of the using fiber matrix compared with the usual healing of the tooth extraction region, which was confirmed by the results of the tomography study. Thus, this approach can be recommended for implementation in practice to optimize the conditions for delayed implantation in the area of the teeth removed due to endodontic, periodontal, traumatic lesions or extensive caries pathology with the expression of inflammatory changes at the time of intervention.

USE OF FIBRE MATRIX FOR PRESERVATION OF THE ALVEOLAR CREST'S GEOMETRIC PARAMETERS AFTER TOOTH EXTRACTION.

The objective of the research consisted in the evaluation of the possibility and effectiveness of fibre matrix use in order to maintain the original geometric parameters of the osseous crest in the places of alveolar sockets of the extracted teeth. Patients in the study group underwent filling of a post-extraction alveolar socket by fibre matrix, developed by the authors of the article, with further overlapping with a polymeric membrane (KLS Martin), which was modified in each certain case according to the peculiarities of defect configuration by means of thermoactive pressing method (Patent for invention of Ukraine №114143). Filling or overlapping of the post-extraction alveolar sockets were not performed in patients of the control group. Computed tomography in patients under research was made 4 months after the initial surgical intervention. Analysis of the parameters of the osseous tissue in the places of the alveolar sockets of the removed teeth was conducted 4 months after the extraction on the basis of the cone-beam computed tomography (CBCT) results in the ImageJ software (Wayne Rasband (NIH)) using the specialized BoneJ plugin. In the study group, the average level of resorption of the medial bone wall of the post-extraction socket was 0.6±0.4 mm (range of indices - 0.3-0.8 mm), distal bone wall - 0.4±0.3 mm (range of indices - 0.2-0.6 mm), vestibular bone wall - 1.4±0.7 mm (range of indices - 0.9-2.0 mm), lingual bone wall - 1.2±0.7 mm (range of indices - 0.8-1.9 mm). In the control group, the average level of bone resorption reached 1.4±0.5 mm (range of indices - 0.8-1.7 mm) from the medial side, 0.9±0.6 mm (range of indices - 0.7-1.5 mm) from the distal side, 2.2±0.4 mm (range of indices - 1.5-2.6 mm) from the vestibular side, 2.1±0.6 mm (range of indices - 1.3-2.4 mm) from the oral side. Obtained results indicate a more pronounced effect of an alveolar socket preservation when using fibre matrix compared with the ordinary healing of the tooth extraction region, which was confirmed by the results of the CBCT examination. Therefore, this approach can be recommended for introduction into practice to optimize the conditions for delayed implantation in the area of the teeth removed due to endodontic, periodontal, traumatic lesions or extensive caries pathology with the pronounced inflammatory changes at the time of intervention.