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NEW PERSPECTIVES IN RESEARCH ON THE USE OF
IMPLANTATION MATERIALS IN ORAL SURGERY AND
MAXILLOFACIAL SURGERY (IN THE EXAMPLE
SURGICAL
DENTISTRY).
Scientific adviser:
Khomidov Muhammad Abdusobitovich
Teacher of the
Department of surgical dentistry and dental
implantology
, TSDI
Student of the Institute of Dentistry L.A Komleva
Tashkent State Dental Institute, Tashkent
The Annotation: The aim of the work is to analyze the data of literature on
the use of implantation materials in surgical dentistry and maxillofacial surgery
our days, identify the list of unresolved issues and determine the main directions
for further research. The analysis of the literature containing information about
implantation materials, technology of application and known methods of
predicting the results of their use is carried out. The list of analyzed sources of
special literature includes: periodicals for the last 10 years. The descriptive
method is used for the analysis. Today, specialists have a wide "range" of
osteoplastic materials that are constantly updated and refined . Research is
conducted in three areas. The first is the development of new and improvement of
known osteoplastic materials.
The second is to improve the operational technique of setting and using
these tools to compensate for bone defects. The third is the scientific
substantiation and implementation of auxiliary tools that have a positive impact
on the processes of reparative regeneration of jaw bone tissue and bone
remodeling in general. At the same time, in the specialized literature there is no
coherent scheme of differentiated approach to the use of osteoplastic materials for
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the compensation of jaw bone defects and dynamic monitoring of the patient
using both oral fluid indicators and data from acupuncture diagnostic systems.
The identityed unresolved issues in the use of implantation materials in surgical
dentistry and maxillofacial surgery and the identification of ways to resolve them
will help to reduce the number of complications, the level of disability and
provide cost savings. All this will help to improve the quality of life of patients
and increase the level of dental care to the population.
Keywords: implantation materials, acupuncture diagnostic systems, oral
fluid, physical and biochemical parameters.
Introduction: At the present stage, the improvement of known and the
development of new methods for predicting the results of using and optimizing
the processes of osseointegration of implant materials in surgical dentistry and
maxillofacial surgery have not lost their relevance and social significance [1, 2].
This is due to a number of factors. First, the prevalence of traumatic injuries
of the bones of the facial skeleton [3]. According to the World Health
Organization (WHO), injuries are the causes of permanent disability and disability
of patients in more than 7 million cases [4]. At the same time, recent years have
been marked by a trend towards an increase in the number of injuries of the
maxillofacial region from 3% to 8% [5, 6]. According to a number of authors, the
proportion of traumatic mandibular fractures in the Russian Federation and
countries of the Commonwealth of Independent States (CIS) was 67–92% and
12.2–70.2% in non-CIS countries [4, 7]. Fractures of the upper jaw range from
2% to 6% of the total number of fractures of the bones of the facial skeleton.
Recent years have revealed an increase in the indicator to 8–9% [8]. At the same
time, the issue of effective treatment of traumatic fractures of the jaw bones is still
far from a final decision [9]. Secondly, the number of patients diagnosed with
neoplasms affecting the bones of the maxillofacial region continues to increase
[10, 11]. According to the literature, out of the total number of cavity formations
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of the jaw bones, cysts are diagnosed in 80–95% of cases [12, 13, 14].
The situation is aggravated by the long-term asymptomatic course of the
disease, which results in a significant loss of the volume of the jaw bone tissue
and the formation of an extensive defect [12, 15]. In addition, cystic formations
are distinguished by a high recurrence rate, which, according to various authors,
varies from 7% to 56%. Thirdly, there is no tendency to reduce the number of
reported facts of both systemic osteoporosis [18, 19] and osteoporosis of the jaw
bones.
Fourth, given the aging of the population as a whole, including in the
Republic of Belarus [20], there is an increase in the rates of degenerative age-
related changes in the skeletal system, including those affecting the maxillofacial
region. All of these facts contribute to a significant increase in the number of jaw
bone defects and make research aimed at their effective compensation one of the
priority areas in dentistry. Purpose of the work: after analyzing the literature data
on the use of implant materials in surgical dentistry and maxillofacial surgery at
the moment, to identify a list of unresolved issues and determine the main
directions for further research. An analysis of the literature containing information
about implant materials, application technology and known methods for
predicting the results of their use was carried out. The list of analyzed literature
sources includes periodicals for the last 10 years. A descriptive method was used
to carry out the analysis. Today, specialists have a wide "spectrum" of osteoplastic
materials , which are constantly updated and improved, for which very significant
financial resources are spent. Work is being carried out in three global areas. The
first of these is the development of new and improvement of known osteoplastic
materials. The second direction is represented by a sufficient number of studies on
the improvement of the operational technique of setting and using the indicated
means for compensating bone defects. The third direction includes works devoted
to the development, scientific substantiation and implementation of auxiliary
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agents (drugs, physical and / or physiotherapeutic effects, as well as their possible
combinations) that have a positive effect on the processes of reparative
regeneration of the jaw bone tissue and bone remodeling in general. At the same
time, the issues of optimizing the use of already known and well-proven ones.
Much less attention is paid to the literature review of osteoplastic
preparations, and only a few publications are devoted to predicting the results of
their use. Separately, it should be emphasized that, based on the information
available in domestic and foreign literature, to date, no attempts have been made
to solve the problem of personalizing the use of osteoplastic agents available in
the arsenal of medical specialists. The oral fluid at the present stage is one of the
promising biological environments for research in terms of diagnosis , prediction
and course of pathological processes, as well as for evaluating the effectiveness of
therapeutic and rehabilitation measures and dynamic monitoring of the patient's
condition. This indicates the possibility of using known biophysical and
biochemical tests of the specified biological environment of the human div to
monitor the effectiveness of postoperative treatment of patients who have used
osteoplastic materials, as well as to predict the development of inflammatory and
destructive complications in this variant of rehabilitation care. There are a number
of publications in the literature containing information on the dynamic changes in
the biochemical and immunological parameters of blood, physico-biochemical
parameters and immunological parameters of the oral fluid during damaging
effects on the jaw bones. There is information about the dynamics of some
biochemical parameters of the oral fluid in the dynamics of the treatment of
defects in the jaw bones using bioresorbable membranes . At the same time, in the
annals of the scientific literature there is no information on the presence or
absence of a correlation dependence of the physical and biochemical parameters
of the oral fluid, reflecting the processes of bone remodeling and reparative bone
regeneration with the data of reflexotherapy diagnostic systems, a comparative
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assessment of their effectiveness when used for the purpose of forecasting has not
been carried out. In the available scientific literature at the present stage, there is
no coherent scheme of a differentiated approach to the use of osteoplastic
materials in the compensation of jaw bone defects and dynamic monitoring of the
patient using both oral fluid indicators and data from reflexotherapy diagnostic
systems.
Each of these facts, as well as all of them together, testify to the need and
expediency of conducting research in this direction, confirm the relevance of the
chosen topic and make it undoubted. Conclusion Identified unresolved issues in
the use of implant materials in surgical dentistry and maxillofacial surgery,
determining ways to resolve them will help reduce the number of complications,
reduce the level of disability , and save financial resources spent on the
rehabilitation of persons with jaw bone defects. All of the above will help
improve the quality of life of patients and improve the level of dental care for the
population. Conflict of interest. The authors declare that there is no apparent or
potential conflict of interest related to the publication of the article. Financing.
The study was not sponsored.
Changes in the socio-economic situation in the Nizhny Novgorod region
have led to an increase in the number of patients with severe traumatic injuries of
the bones and soft tissues of the face and their complications. The organization of
the provision of specialized assistance to victims with craniofacial trauma in the
Nizhny Novgorod region, the staff of the department, headed by prof. I.D.
Kinyapina , began to study in the late 90s, but problems in the healthcare system
did not allow this difficult task to be completed. Development of high-tech
assistance and the organization of a specialized department for the treatment of
victims of road accidents in the Nizhny Novgorod region on the basis of the
Design Bureau named after. Semashko was given the opportunity to organize the
provision of specialized surgical care to patients with craniofacial trauma at the
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modern level, with the involvement of the proper number of related specialists,
appropriate emergency examination and treatment, and rehabilitation of patients.
Among the variety of fractures of the bones of the face and their
consequences, injuries of the middle zone of the face occupy a special place. With
fractures of the zygomatic bone, in 39% of cases there is damage to the orbit in
the form of small-comminuted fractures, leading to the prolapse of the entire
contents of the orbit, including the eyeball, into the maxillary sinus, leading to
infringement of the eye muscles and the development of diplopia. Currently, this
global problem is being studied in the doctoral dissertation of N.E.
Khomutinnikova . The use of high technologies in the diagnosis and planning of
reconstructive treatment of traumatic injuries of the maxillary fossa contributed to
the new scientific direction of the department - the development, together with the
firm "REPER NN" (Nizhny Novgorod), of a new method for the treatment of
fractures of the zygomatic orbital complex and new polymer implants for
plasticity of the lower wall of the orbit. Based on the results of this work in 2013,
a grant was received from the Nizhny Novgorod region in the field of science and
technology. In continuation of the work on the rehabilitation of patients and the
development of new modern polymeric materials, the staff of the department,
together with the firm "REPER NN", developed and introduced a new polymeric
membrane. YES. Mochalova data of an experimental study confirmed the
effectiveness of the developed polymer membrane for closing open wound defects
in the oral cavity. The author pointed to the activation of early regenerative
processes of damaged tissues due to the active construction of granulation tissue
and the formation of connective tissue fibers, which led to a significant reduction
in the boundaries of the resulting defect and accelerated healing and
epithelialization of the wound. It should be noted that scientific research in the
field of increasing the efficiency of regeneration of the bone tissue of the jaws and
soft tissues of the maxillofacial region and oral cavity is currently a priority
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research work for the staff of the Department of Surgical Dentistry.
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