MINISTRY OF HEALTH OF UKRAINE
KIEV MEDICAL ACADEMY OF POSTGRADUATE EDUCATION NAMED
AFTER P.L.SHUPIK
On the rights of the manuscript
MAZEN SHTAY TAMIMI
UDK 616.31-089.843 (048)
SUBSTANTIATION OF CLINICAL APPLICATION
MODERN SURGICAL METHODS AT
INTRABONE DENTAL IMPLANTATIONS
14.01.22 - dentistry
The dissertation on competition of a scientific degree
The candidate of medical sciences
The supervisor of studies:
Tymofyeyev Aleksey Aleksandrovich,
Honoured Worker of Sciences and
Technics of Ukraine, Doctor of Medical
Sciences, the professor
KIEV – 2005
2
THE MAINTENANCE {CONTENTS}
INTRODUCTION … … … … … … … … … … … … … … … … … … … ….. 3
CHAPTER 1. THE REVIEW OF THE LITERATURE … …… … …………… … 11
0.1. A history of development dental implantations … … … … … … … … … 11
0.2. The general {common} data about dental implantations and materials,
Used in implantology … … … … … … … … … … … … … ….…….... 15
0.3. Operation of a raising of a bottom maxilla sinus … … ……………........ 27
0.4. Reconstructive operations at an atrophy alveolar process of jaw… … …... 34
0.5. Features of the postoperative period of conducting patients with dental
implantation … … … … … … … … … … … … … … … ……………... 37
CHAPTER 2. THE MATERIAL AND METHODS OF INVESTIGATION ……. .42
CHAPTER 3. RESULTS OF INVESTIGATION OF PATIENTS
THE FIRST GROUP OF SUPERVISION … … … … … … … … ……… … … .53
CHAPTER 4. RESULTS OF INVESTIGATION OF PATIENTS
THE SECOND GROUP OF SUPERVISION … … … … … … … … … … ….. .71
CHAPTER 5. RESULTS OF INVESTIGATION OF PATIENTS
THE THIRD GROUP OF SUPERVISION … … … … … ………..… 99
CHAPTER 6. DISCUSSION OF RESULTS OF INVESTIGATION PATIENTS BY
WHOM ARE APPLIED DIFFERENT SURGICAL METHODS OF CARRYING
OUT DENTAL IMPLANTATIONS … … … … ………………… … … … ….. 122
CONCLUSIONS … … … … … … … … … … … … … … … … … … … … .139
PRACTICAL RECOMMENDATIONS … … … … … … … … … … … … … .142
THE LIST OF THE USED LITERATURE … … … … … … … … … … ……. .143
3
INTRODUCTION
Actuality of a theme. There are deformations and atrophies of alveolar jaws
processes after plural removals of a teeth quite often (Onishchenko V.S., Ilyk R.R.,
1997; Tymofyeyev A.A., 1998; Matros-Tarants.e.n 2000; Ruzin G.P., Buryh M.P.,
2000; Pavlenko A.V., 2001; Rjabokon E.N., 2001; Kharkov L.V. And Soavt, 2002;
Robustova T.G., 2003; Metchenok ve., Vankevetsh А., 2004, etc.). The given
circumstance not only stops, but also complicates carrying out of dental prosthetics
since is the reason of bad fixing of dental artificial limbs (Leontjev V.K. and co-aut.,
1995; Kosenko K.N., 1994; Labunets V.A., 1998; Labunets V.O., Sennikov O.M.,
1999; Lamb В.В., Klitinskij J.F., 1999; Bida V.I., 2003; Nesprjadko V.P. and co-aut.,
2004; Flis P.S. and co-aut., 2004, etc.) . The problem of restoration of defects of
dental numbers{lines} with use dental implants gets the increasing urgency (Lamb
В.В., 1995; Paraskevich V.L., 1992; Olesova V.N., 1993; Losev F.F., 1998; Kulakov
A.A., 1997; Kutsevljak V.I., 1998; Robustova T.G., 1999; Dolgalev A.A. and co-aut.,
2000; Potapchuk A.M., 2000; Tymofyeyev A.A., 2002; Sidelnikov P.V., 2004, etc.).
For last decade it has strongly taken root into practical activities of the doctor -
dentist.
At performance dental implantations frequently meet difficulties which can be
connected to anatomic features of a structure of maxillary bones. For doctor of
implantology carrying out dental on the maxilla quite often happens implantation
inconveniently because of a significant atrophy of alveolar processes maxilla bones
(Paraskevich V.L., 1992; Matveeva A.I., 1993; Surov O.N., 1993; Robustova T.G.,
1999; Temerhanov F.T., Anastasov A.N., 1999; Tatym H., 1986; Gowood J.,
Howelle R.A., 1988; Jonsen O. Et al., 1992; Spiekermann H. et al., 1995; Reinhardt
C., Krensser B., 2000; Poticet N., Jirajariyave J., 2001; Palti A., 2003, etc.) . In the
literature there is an opinion, that at height of an alveolar bone less than 5 mm (from
an alveolar crest to
4
the bottom of maxilla sinus) carrying out sinuslifting with simultaneous dental
implantation is problematic (Ugrin M.M., 2001; Paraskevich V.L., 2002;
Tymofyeyev A.A., 2002; Robustova T.G., 2003; Kenneth W.M., Judy et al., 1999;
Misch C. et al, 2001; Teent K., Parma - Benfenati С., 2004, etc.).
On mandible bones of difficulty for implantation arise in that case when is
present sufficient on height, but (narrow) alveolar process insufficient on width.
Narrow the alveolar process is considered when its width is equal 3,5-5 mm. Usually
it is contra-indication to carrying out endoosseous dental implantations. If at
introduction dental implant bone walls with vestibular and palatinum (lingual) the
parties{sides} will have thickness less than 1 mm it has a negative effect on
osseoregeneration processes and stability dental implant (Kulakov A.A., etc., 2001;
Paraskevich V.L., 2002; Robustova T.G., 2003; Misch C. et al., 1998; Zablotsky
M.A., 1998; Palti A., 2003, etc.).
Neurological to the status at patients after carrying out endoosseous dental
implantation it is not removed sufficient attention. In the postoperative period for an
estimation of the clinical status the limited number of methods of investigation is
used. Therefore search of objective tests of efficiency of the lead {the carried out}
operation and the forecast of current of the postoperative period is actual for dental
implantations.
Communication {Connection} of work with scientific programs, plans,
themes.
The executed dissertational work is a fragment of complex research work
«Features of diagnostics and treatment at traumatic damages jaws » which is carried
out on faculty of maxillofacial surgery of the Kiev medical academy postgraduate
educations named after P.L.Shupika МOH Ukraine. Number of state registration РК
0102U001057. In a complex theme the dissertator carries out the separate fragment
devoted to rehabilitation of patients with defects and deformations of dental
numbers{lines} and jaws.
5
The purpose and research tasks.
The purpose of research is perfection of methods of surgical treatment, increase
of their efficiency and expansion of indications for carrying out intrabone dental
implantations at patients with defects of dental numbers{lines} and jaws.
For achievement of an object in view the following problems{tasks} have been
determined:
1. To define{determine} an opportunity of carrying out intrabone dental
implantations at a significant degree of expressiveness of an atrophy of an alveolar
process of maxilla bones.
2. To specify frequency of occurrence of complications which arise at carrying
out of operation closed antrolifting, and to offer a technique of performance of the
operative intervention, reducing number of these complications.
3. To establish necessary minimal thickness of lateral walls of an alveolar
process jaws which needs to be kept at carrying out intrabone dental implantations
depending on density of a bone for favourable current osseoregeneration processes.
4. To reveal presence neurogenic changes on the part of peripheral branches of a
trigeminal nerve which can develop at patients in a place of carrying out of operation
endoosseous dental implantations depending on a technique of its performance.
5. To offer a technique of carrying out of operative intervention on installation
intrabone dental implants, allowing as much as possible to keep available thickness
of lateral bone walls of an alveolar process and to avoid damage of peripheral
branches of a trigeminal nerve.
6. To establish self-descriptiveness and an opportunity of use of additional
modern clinical methods of investigation of patients (contact thermometry,
potenciometry, periotestmetry, etc.) for
6
the control of efficiency of treatment and the forecast of current of the
postoperative period over carrying out endoosseous dental implantations.
Object of research - patients with defects of dental numbers{lines} and jaws by
which operation intrabone dental implantations is lead{carried out}.
Subject of research - different surgical methods of carrying out endoosseous
dental implantations on top and mandibles, studying of features of clinical current, a
functional condition of peripheral branches of a trigeminal nerve and treatment of
patients depending on a degree of expressiveness of an atrophy of height and width
of alveolar processes jaws, frequency of occurrence of postoperative complications
and preventive maintenance of their development.
Methods of investigation. With the purpose of studying features of clinical
current and definition of efficiency of spent treatment at different surgical methods of
carrying out endoosseous dental implantations are applied clinical, thermometry,
potenciometry, periotestmetry, electrophysiological, laboratory, mathematical and
statistical methods of investigation.
Scientific novelty of the received results.
It is proved, that intrabone dental implantation can effectively be carried out at a
significant degree of expressiveness of an atrophy of an alveolar process maxilla
bones. For the first time it is offered to use additional fixing endoosseous implants
titanium miniplates at open and closed sinuslifting. High efficiency of results of
treatment is determined at use of additional fixing in an installation time single and
multiple dental implants.
For the first time use is offered at operation closed antrolifting a method of a
stretching of cells - with the help of silicone - expander. Application of an offered{a
suggested} technique of operative intervention
7
has allowed to lower considerably number of complications which arise at
carrying out of this operation.
It is proved, that for favourable current osseointegration dental implants it is
necessary to keep the certain minimal thickness of lateral bone walls, its{her}
thickness is in dependence from density of a bone cells of a jaw.
For the first time it is established, that at carrying out of traditional surgical
methods of installation dental implants damage of peripheral branches of a trigeminal
nerve with defect of function is observed. Terms of restoration of the broken function
depend on the applied surgical technique, and also a jaw on which operation and
numbers established dental implants is carried out. The technique of carrying out of
operative intervention - splittings and expansions of an alveolar process with use
dental wedges which allows to avoid occurrence of this complication is offered and
to keep having thickness of an alveolar crest.
Objective tests of efficiency executed intrabone dental implantations and the
forecast of current of the postoperative period which allow to diagnose in early terms
development of complications and correct spent treatment are revealed.
The practical importance of the received results and their introduction.
Received, depending on the used surgical technique of carrying out intrabone
dental implantations, the clinical-laboratory data were a basis that additional fixing
dental implants at open and closed sinuslifting, a method exfoliation a mucous
membrane maxilla sinus and has been offered to a cavity of a nose from a bone with
the help of a cylinder - expander, and also operation of splitting and expansion of
alveolar jaws processes with application dental wedges. For carrying out of effective
anesthesia and anti-inflammatory therapy it is offered to use medicament
8
drugs which have allowed to raise{increase} efficiency of treatment and to avoid
occurrence of postoperative complications.
Results of work are introduced into medical practice of surgical dentistry
department of Institute of dentistry АМS of Ukraine (Odessa), maxillofacial surgery
department of the Lvov regional clinical hospital, maxillofacial surgery department
of city clinical hospital № 2 (Vinnitsa) and Vinnitsa regional clinical hospital named
after N.I.Pirogov, maxillofacial surgery department of city clinical hospital the urgent
and first help (Zaporozhye), maxillofacial surgery department of municipal city
clinical hospital № 11 (Odessa), maxillofacial surgery department of the Kharkov
city clinical hospital of fast and urgent medical aid named after prof. A.I.Mechnikov
and the Kharkov regional clinical hospital № 1.
The received results of the lead{the carried out} research are included in a series
of lectures, and also used at carrying out of practical employment{occupations} and
seminars in the following higher educational institutions: to faculty of maxillofacial
surgery of the Kiev medical academy postgraduate educations named after
P.L.Shupika; to faculty of dentistry of the Zaporozhye medical academy postgraduate
educations; to faculty of the general and surgical dentistry of the Kharkov medical
academy postgraduate educations; to faculty of dentistry of faculty postgraduate
formations educations of the Dnipropetrovs’k state medical academy (Krivoi Rog); to
faculty of surgical dentistry and maxillofacial surgery of the Kharkov state medical
university; to faculty of children's age dentistry of Vinnitsa national medical
university; to faculty of surgical dentistry with a rate of bases of dentistry and faculty
of preparation of surgical dentistry with reconstructive surgery of a head and a neck
Ukrainian medical stomatologic academies (Poltava); to faculty
9
of surgical dentistry of the Lvov national medical university named after Danila
Galytckogo.
The personal contribution of the supervisor.
The author personally prepared a set of all patients, their clinical-laboratory
investigation and treatment. Under the direction of the head - prof. A.A.Tymofyeyev
is lead {carried out} the analysis of the received results, their mathematical
processing. Electrophysiological investigations are executed at consultation of
employees of a department on studying hypoxic conditions (chief - the doctor
medical Sciences, the winner of the State premium of Ukraine Mankovskaja I.N.)
institute of physiology named after A.A.Bogomolets NAS Ukraine (director -
academician NAS of Ukraine, the doctor medical Sciences, prof. Kostjuk P.G.).
Under the direction of the supervisor of studies substantive provisions of the
dissertation, conclusions and practical recommendations are formulated.
presentations of results of the dissertation.
16-n the international conference of oral and maxillofacial surgeons (May, 2003,
Athens, Greece); 3-rd congress of the Baltic orthodontic association and 4-th
congress of the Baltic association of maxillofacial surgeons and plastic surgeons
(May, 2002, Riga, Latvia); 19-th Jordanian congress of implantological doctors
(September, 2003, Amman, Jordan); 33-rd international congress dental
implantations DGZI/ICOI (October, 2003, Bonn, Germany); ICOI the international
congress (June, 2004, Las Vegas, the USA); 1-st Arabian implantological congress
DGZI (March, 2005, Dubai, United Arab Emirates); the Alexandria congress
implantological doctors (March, 2005, Alexandria, Egypt); joint faculty meeting of
maxillofacial surgery KMAPE named after P.L.Shupika and faculties of surgical
dentistry and maxillofacial surgery of medical institute UANM (May, 2005).
The dissertation is approved at intercathedral session of stomatologic faculties of
institute of Dentistry of the Kiev medical academy postgraduate education named
after P.L.Shupika (September, 2005).
10
Publications. On materials of the dissertation 13 scientific works, including 10
in the editions recommended VAK of Ukraine, 2 publications in scientific collections
and 1 - in theses are published.
Structure of the dissertation. The dissertation will consist of introduction, the
review of the literature, the chapter{head} "Material and methods of investigation",
three chapters{heads} of own researches, discussion of the received results,
conclusions, practical recommendations and the list of the used sources of the
literature. The list of the literature will consist of 237 sources, from which 122 -
domestic and 115 - foreign. The total amount of work makes 167 pages of the
typewritten text, the dissertation has 22 tables and 29 figures.
11
CHAPTER 1
THE REVIEW OF THE LITERATURE
1.1. A history of development dental implantations
Though dental implantation is considered rather new section in dentistry it is
necessary to note, that the problem of restoration of the lost teeth with the help of an
artificial teeth has a centuries-old history. From the literature it is known, that already
in the third millennium B.C. Egyptians have started to use for these purposes
intrabone implants. In Ancient Rome, Egypt, Central America, India and China At
once after removals {extraction} of a tooth in alveolus inserted the teeth made of
different materials. For implantation used the teeth of animals, an ivory, a stone, gold
and other materials (117, 112, 5). A history of development dental implantations is
standard to divide into six periods:
- The antique period (the first millennium up to Christmas), i.e. the first
attempts of implantation in Ancient Egypt and other countries;
- The medieval period (with 1000 on 1800 after Christmas) - carrying out of
transplantation of a teeth from one person to another (carried out these operations
,barbers). Only in 1774 two Frenchmen (the stomatologist and the pharmacist) have
created an artificial teeth from porcelain for implantation; Allen S. (1685) in New
York for the first time publishes the textbook on dental treatment in which the author
describes a technique dental implantations. In 1756 Gunter D. for the first time has
described results of histological research of a root replantation a tooth;
- The fundamental period (with 1800 on 1900). During this period intrabone
implantation from the following materials starts to develop dental: metal, porcelain,
etc. In 1808 the Italian stomatologist Magillo G. has made a ceramic tooth which has
been put on a platinum pin, and in 1809 - a pin from gold (implantation is carried out
in one stage). In 1839 has been
12
invented a vulcanized rubber and the first attempts to use her{it} for
manufacturing dental implants have appeared. In 1891 Znamensky H.H. has
published researches on implantation to dogs porcelain implants (the author for the
first time in apical parts implant has made a through hole for regeneration of bone in
it). At the end of 19-th century the first researches on studying biocompatibility of
used materials have started to appear. There are attempts of transplantation of a donor
teeth, scientific bases of allotransplantation start to be introduced;
- premodern period (with 1990 on 1930). To 1906-1907 Greenfield E.I. for the
first time has carried out dental implantation 15 cylindrical implants, made of an alloy
of platinum and iridium. These implants function more than 7 years and have been
recognized as stomatologists in the USA. During this period pine forests for formation
of bone cavities under dental implants for the first time are used;
- The period of development with 1930 on 1978. In 1955 in the USSR Vares
E.J.'s master's thesis on studying reaction parodentium on introduction plastic dental
implant for the first time is protected. During the given period of time, to be exact in
1964 Linkow L. offers plate a design dental implants with presence of apertures in
their intrabone part, and since 1972 already this implants together with a complex of
necessary tools for their introduction are made by firm “Oratronics Corporation”. By
the same author are offered cylindrical implants systems Linkow;
- The modern period (since 1978 and on present time). Bone integration which
has been described Branemark P.J. has opened a new era in a history dental
implantations. The author has proved concept "osseointegration" titanium implant
with a bone cells of a jaw. The system implants Brаnemark P.J. has been recognized
all over the world. During this period in all countries of more and more researches
appears by results of use dental implants.
13
The pioneer of implantation in Russia by the right is the senior lecturer of the
Moscow university Znamensky Н.Н. In 1890 Znamenskij N.N. has lead{has carried
out} the first experiment when to a dog after removal of incissors in expanded
alveolus inserted a porcelain teeth with cuttings on periphery of a root. Further the
author has lead{has carried out} experiments on application implants not only from
porcelain, but also rubber. The next years, down to 50th years of XX century about
implantation of a teeth in the literature mentioned incidentally. In 1955 Vares E.J.
(Ukraine) protects the master's thesis « Reaction of a connecting tissues on
polymethilmetakrilat in reactions of parodentium on implantation of an artificial teeth
». In 1956 Mudryj S.P. (Ukraine) also protects the master's thesis « Use of the
implanted roots of a tooth with the adaptation for fixing an artificial limb ». Since
1958 implantation in domestic dentistry has been forbidden by the Ministry of Health
of the USSR. Within almost three decades stomatologists of the former USSR
passively observed under the literature of development and achievements dental
implantations in the world. During this period of time have been published, becoming
known, works Linkow L.J. (1964, 1968), Branemark P.J. (1965, 1969), etc. In 1964
Linkow L. has offered plate a design implant with apertures and further became the
founder onestage fybroosseointegration implants. In 1965 the Swedish national school
implantological doctors has been created led by Branemark P.J. The theory is put in a
basis of this school osseointegration two-stages implants. Carrying out{spending}
experiments on animals, Swedish scientist Branemark P.J. has found out the
phenomenon osseointegration - ability of the titanium to grow together with a bone
tissues without formation of a capsule then has been created screw Branemark’s
implant. Several years later (in 1976) In Germany has been developed cylindrical
implant IMZ (intramobil cylindrical implant) with plasma spraying the powder
titanium. An original component of this system the intermediate element from plastic
which was fixed between implant and established suprastructure was, i.e.
14
function as the shock-absorber from impact. These implants used decade, they
have recommended themselves from the positive party{side}. Since 1975 have started
to be issued cylindrical and screw implants with a ceramic covering, and since 1979 -
by plasma spraying the powder titanium.
In 1981 at congress in Tashkent backlog of the Soviet dentistry in area
implantology has been recognized. In 80th years in the former USSR implantology
enthusiasts were engaged only: Krishtab S.I., Lamb В.В. (Ukraine); Chepulis S.P.,
Surov O.N. (Baltic); Mirgazizov M.Z., Sysoljatin P.G., Olesova V.N., Temerhanov
F.T., etc. (Russia), etc. In 1984 in Kaunas Chepulis S.P., Surov O.N., Chernikas
Ampere-second. Publish methodical recommendations on application stomatologic
implants in dentistry. Development dental to implantation in the USSR was promoted
by the order of Ministry of Health of the USSR from March, 4, 1986 for № 310 «
About measures on introduction in practice of orthopedic treatment with use implants
». The given order has opened ways for development of a method of implantation in
scales of all country (the former USSR). Department implantology in CSIIS
(Moscow) has been organized in 2 months after occurrence of this order.
Since 1986 methodical recommendations are published in the countries of the
former USSR on application dental implants (7, 101, 66 and others). Indications and
contra-indications to their use are proved, influence of implantation on immune
system of patients is studied, new designs and materials intrabone dental implants,
etc. are developed. Dissertations on dental implantations (3, 18, 4, 14, 108, 68, 79, 31,
20, 43, 21, 52 and others) Are protected.
In Ukraine introduction dental implants in stomatologic practice began from the
beginning of 80th years, and in 1985 the master's thesis Lamb В.В has been protected.
« Application implants at prosthetics of trailer defects of dental numbers{lines} ».
Implants various
15
designs from the titanium have started to be applied in Kiev, Lvov, Kharkov,
Dnepropetrovsk, Poltava and other cities of Ukraine.
1.2. The general {common} data about dental implantations and the
materials used in implantology
Depending on mutual relation dental implant with soft and firm tissues of a jaw
of Surov O.N. (1993) allocate 6 kinds dental implantations:
- endodonto-endoosseous,
- endoosseous,
- subperiostal,
- endoosseous - subperiostal,
- Intramucous (insert-implantation),
- submucous.
On a material of which it is made implant, the last are subdivided on biotolerant
(stainless steel, a chrom-cobalt alloy), bioinert (the titanium, nickel lid of the titanium,
gold, zirconium, krondovie ceramics, glass) and bioactive (metal implants, covered
hydroxyapatite or tri calcium phosphate). Biotolerant implants now are not used. It is
connected by that at application biotolerant implants they, after their introduction in a
bone, do not attacht in the thickness of implant, and are surrounded by a thick fibrous
capsule. Therefore such implants cannot provide their steady fixing in a bone. Now
the most widespread dental implants are that are made of the pure{clean} titanium or
the titanium covered with bioceramics (7, 18, 36, 9, 47, 58, 104, 112, 99, 167, 178,
199, 132, 154, 166, 191, 151, 156, 161, 229, Shirokov, 162 and others).
Now dental implantation is considered an alternative method of dental
prosthetics. It is possible and shown at any localization and extent of defect of dental
lines.
16
For carrying out dental implantations should be counted the basis a
uncooperative altitude of the patient to demountable prosthetics, unwillingness of
preparation tolerant teeth, allergic reactions to plastic of which demountable artificial
limbs are made, and also absence of necessary conditions for maintenance of reliable
fixing demountable artificial limbs. Relative contra-indication for carrying out dental
implantations the insufficient quantity{amount} of a bone fabric in a place of carrying
out of operation (an atrophy or defects of alveolar processes jaws, pneumatic type
maxilla sinus, etc.) can be intrabone . It is considered, that for preventive maintenance
of an atrophy of a bone fabric in the after implantation period it is necessary, that at
carrying out of operation around of entered implant there were not less than 2 mm of a
bone fabric (7, 79, 31, 87, 52, 112, 98 and others).
Before to proceed{pass} to methods of carrying out dental implantations we shall
stop on materials which are used at its{her} performance. It is known, that dental
implantation is connected to introduction in a fabric of an organism of the person of
alien materials for it and with reciprocal fabric reaction to these entered materials.
Now for manufacturing dental implants use three basic groups of materials:
metals, ceramics and polymers (99). Depending on reaction of bone and soft fabrics to
an implanted material of them also divide into three groups: biotolerant, bioinert and
bioactive (202).
To biotolerant to materials carry stainless steel, alloys of precious metals, alloys
chrome and cobalt or molybdenum. For this kind of a material it is characteristic
remote osseogenesis is such kind of reaction when around implant (fibrous) capsule
which delimit implant from a surrounding bone fabric of a jaw is formed connective
tissue.
Carbon, ceramics of dioxide of zirconium carry to bioinert materials the titanium
and his{its} alloys, tantalum, aluminium ceramics, niobium. For
17
these materials it is characteristic contact osteogenesis, i.e. formation{education}
of a bone fabric around dental implant, but without penetration inside of the last. Bone
integration occurs that the surface of these materials is chemically inert to surrounding
fabrics and fabric liquids.
It is necessary to attribute{relate} calcium - phosphatic ceramics (bioceramics) to
bioactive materials, hydroxyapatite, the titanium covered with bioceramics. For these
materials it is characteristic so-called bone osteogenesis which has received the name
"osseointegration". At this kind osseogenesis the certain kind of a direct chemical
compound implant with a bone surrounding it{him} is observed due to presence of
free calcium and phosphate on a surface of a material and adequacy of their
interaction with fabric components of a bone (232, 218). It is necessary to note, that
on different surfaces same implant there can be various kinds osteogenesis .
Successful functioning dental implants to a great extent depends on biomechanical
properties neogenic fabrics (137). The author marks adverse results at cicatricial,
osseous and cartilaginous fabrics. In morphogenesis dental to implantation opening an
opportunity to achieve union implant with a bone became new by their direct
connection due to a bone fabric which on its{her} structure and a morphological
structure corresponds{meets} to a normal bone (125, 141). This concept has come in
scientific terminology as "osseointegration" which means structural and functional
connection of an alive bone with a surface bearing{carrying} loading implant.
Biochemical compatibility means absence of immune reactions, inflammatory
processes as consequence{investigation} of tearing away implant. For success of
implantation such properties of metal as corrosion should not be shown.
In modern stomatologic implantation the widest application was found with
metals and their alloys. In 1959 Lew J. has noted, that around of titaniumic implants
the bone is formed faster, than around implants of cobalt and chrome. By the author it
is established, that alloys of the titanium possess anticorrosive properties and good
biocompatibility with fabrics surrounding them. The titanium has very successful
18
combination of necessary properties, i.e. it{he} very much racks to deformation, but
during too time easily is exposed machining. Many clinical and experimental
researches his{its} high biocompatibility and anticorrosive stability{resistance}
proves to be true. In the environment where oxygen contains, on a surface of the
titanium it is formed oxygenic a film (thin dividing{sharing} oxygenic between
implant and the biological environment) which reliably protects metal from
aggressive corrosive environments, i.e. these implants it is possible to
attribute{relate} a layer to biotolerant (3, 28, 125). Oxygenic the layer which is
formed on a surface implant considerably raises anticorrosive properties of a material,
and due to stable and high density oxygenic possesses high viscosity and good
adhesion. In case of occurrence of scratches or other damages on a surface of the
titanium there is a restoration oxygenic a layer (219, 225). Further to some authors it
has been proved, that given oxyd the film can collapse under influence of medical
products which are used for preventive maintenance of caries, and also the medicines
containing fluorides (228).
From positive properties of the titanium also it is necessary to note absence of
allergic reactions to him{it}, however on alloys she{it} comes to light in single
instances (169, 232).
In world{global} stomatologic practice by one of the most widespread materials
used for manufacturing dental implants, the titanium and alloys on his{its} basis - ВТ
1-0 and ВТ 1-00, the so-called pure{clean} titanium is. Domestic alloys ВТ 1-0 and
ВТ 1-00 have more rigid restrictions under the maintenance{contents} of impurity,
than foreign analogue Grade 1, 2. Alloys of titanium ВТ5 and ВТ6 correspond{meet}
to foreign analogues Grade 4, 5. Due to presence of fluorine, a pine forest and
niobium such alloy of the titanium becomes stronger and plastic, but because of
presence of aluminum (up to 5 %) and vanadium, application of it{him} is limited
(68, 52, 225, 228).
19
Last ten years wide application was received with a technique plasma sputtering
nitride of the titanium or a thin layer hydroxyapatite on surface titaniumic implants
that has improved the characteristic used implants (175, 219, 131, and 149).
To experimental researches it has been proved, that the covering titanium implant
hydroxyapatite has allowed to create stronger connection between a bone and the
implant, and also has enabled in early terms (in 32 weeks) to form their dense
connection (187). However some lacks of a covering have been found out also -
ability in due course to be dissolved in the biological environment of an organism.
Therefore further some authors for improvement osseointegration used a double
covering implant - the titanium and hydroxyapatite (64). For smooth transition of
physicomechanical properties of the compact titanium to properties of bioceramics,
and also with the purpose of reduction of internal pressure{voltage}, the structure of
the composite layer consisting of the titanium and hydroxyapatite has been developed.
Their optimum parity{ratio} is chosen in view of the greatest adhesive durabilities
which has made 80-60 % of the titanium and 20-40 % hydroxyapatite. On the basis of
the lead{carried out} researches the way of manufacturing intrabone implants,
consisting in plasma evaporation on a metal basis implant a multilayered covering
with an external bioactive layer (8, 64, 12, 62, 38, 172, 149) has been developed. For
a relaxation of internal pressure{voltage} three transitive layers (small-porous the
titanium, big-porous the titanium, a mix of the titanium and hydroxyapatite) are used,
and the external layer (20-30 microns) is formed by thickness from pure{clean}
hydroxyapatite. General thickness of a covering makes 130-150 microns.
By association of scientific researches of the scientific different countries, and
also on the basis of new technologies are developed implants with memory of the
form from the nicelid-titanium an agglomeration method a porous material on
without-porous to a basis that has considerably raised{increased} his{its} stability to
corrosion (70, 110, 111,
20
183, 127, 175). However clinical supervision is short-term enough to draw final
positive conclusions.
Cobalt-chromic alloys are used in dental implantations about fifty years.
However the basic lack of use of designs from these alloys is the opportunity of an
output{exit} in an environment of a fabric of salts of heavy metals, and around
implant the capsule which contains rough fibres of collagen is formed connective
tissue. Except for it the given alloy possesses insufficient anticorrosive
stability{resistance} that is one of major factors of development of complications in
the postoperative period (18, 102 and others). Opportunities of use for manufacturing
implants argentums -palladium an alloy (18) are shown.
Alongside with wide use and positive clinical results in dental implantology
applications metal implants exists enough given that metal dental artificial limbs
including implants, in conditions of a mouth enter electrochemical reactions and are
exposed to corrosion that considerably reduces their biocompatibility, worsens
processes of regeneration of a bone fabric in the center of implantation and promotes
development post-implantological complications (14, 87, 118, 21, 36, 112, 97, 198,
200, 213, 135 and others).
The basic purpose{assignment} dental implants is a creation of conditions for
manufacturing fixed designs of dental artificial limbs. Therefore in most cases for
implantation use their metal designs. At the same time from the literature it is known,
that for implantation products from different alloys of metals can be used, and on the
head implant the fixed metal designs of dental artificial limbs also made of different
metals and alloys (78, 33, 43, 101 and others) become stronger.
In connection with earlier told, many researchers conduct search new,
possessing by high biocompatibility, nonmetallic materials of which it is possible to
make dental implants. One of such materials is the bioceramics (69, 70, 79, 22, 36,
233, 169, 171, 234 and others).
21
From the point of view osseoconducted potential and interactions with bone
Strunz V. (1984) and Osborn J. (1985) have divided{shared} all biocompatible
materials on: bioactive (as a result of biodegradation in part or are completely
replaced by a bone fabric), bioinert (biodegradations are not exposed and are not
included in a metabolism, and their surface can provide physical and chemical
communication{connection} with bone matrix) and biotolerant (do not resolve and do
not enter a metabolism, but are capable to provide readsorbation fibers on the surface,
around of their surface the fibrous capsule is formed).
Ceramic implant materials also can be divided{shared} into 3 groups (22, 60,
29): bioinert, bioactive and resorbed. Corundum and carbon ceramics carry to bioinert
ceramic materials (15, 83, 11, 22). Into structure корундовой ceramics enters from
99,5 % up to 99,7 % oxide aluminum (Al2O3). Depending on technics {technical
equipment} of manufacturing oxide aluminum it{he} can be in monocrystal
(sapphire) or in the polycrystalline form (cador). It is proved, that the monocrystal
form oxide is twice stronger some aluminum than polycrystalline (202, 187). It is of
great importance for a choice of bioceramics which can be used in quality dental
implants. Sapphire implants find use for manufacturing implants (22, 36, 112, 113).
Are let out{released} endoosseos implants from a ceramic material "Alumag-1" (will
consist from oxide aluminum with addition oxide magnesium). Experimental and
clinical researches prove good biocompatibility before specified implants (22, 36,
112, 113).
All osseoplastic materials which are used in implantology, depending on an
origin, share on:
22
- autogenic (the donor - the patient);
- allogenic (the donor other person is);
- xenogeny (the donor the animal is);
- alloplastic (synthetic materials).
Depending on ability of a material to participate in bone regeneration, Edward S.
Cohen (1988) has divided{shared} osseoplastic materials on:
- osseoinductive, i.e. capable to cause osteogenesis (to them concern auto-and
allotransplantation);
- osseoconductive the materials, capable to play a role passive matrix for again
educated bone (porous hydroxyapatite, bioactive glass, etc.);
- osseoneutral - inert materials which are used only for filling bone space, i.e.
they are not a support for a new bone (not porous hydroxyapatite, tribasic calcium
phosphate, etc.);
- The directed fabric regeneration (Guided Bone regeneration - GBR).
The special place in modern implantology is borrowed{occupied} with bioactive
ceramic materials - calcium - phosphatic and glass ceramics. For manufacturing an
independent design dental implant such bioceramic materials have no sufficient
durability, therefore them, it is possible to use for a covering of a surface metal
implants or as a plastic material (for elimination of bone defect or completion of
available lack of a bone).
All osseoplastic materials depending on ability to resolve are subdivided on:
resorbed and nonresorbed. The first group is completely resorbed materials (porous
hydroxyapatite, polymers, tribasic calcium phosphate, bioactive glass - BioGran, etc.),
the second group - in part or completely nonresorbed materials (not porous
hydroxyapatite, bioactive glass - PerioGlass, etc.). Depending on cleanliness of a
synthetic material the last are subdivided on pure{clean}
23
(will consist of one chemical substance) and combined (from two and more
chemical substances).
Mineralized fabrics of a human body will consist, basically, from different kinds
hydroxyapatite, tribasic calcium phosphate and a carbonate of calcium (49). Wide use
in modern medicine, to be exact stomatologic implantology, was received with
materials on a basis hydroxyapatite and tribasic calcium phosphate. Application of
them is based on high bioactivity, biocompatibility and stimulation with their help of
growth of a bone.
Hydroxyapatite which chemical formula Са10 (РО4)6 (IT) 2, is identical on the
structure and crystal structure to mineral substance of an alive bone, therefore his{its}
biocompatibility with a surrounding fabric surpasses many other materials which are
used in surgical dentistry and maxillofacial surgery. It is known, that hydroxyapatite
the person is represented with a mineral skeleton which is a source of calcium and
phosphorus in fabrics. Synthetic hydroxyapatite, as against natural, is osseoconductive
and can participate in osteogenesisе. Hydroxyapatite has stable molecular structure
and, despite of variable structure, forms and keeps mineralization fabrics at the
different maintenance{contents} of calcium (83).
Hydroxyapatite concerns to calcium - phosphatic connections. It{he} can be
received not only from biological raw material, but also synthetic way (a method of
chemical drainage or sintering, etc.). Synthetic hydroxyapatite it is chemically similar
natural, but represents only ceramic-simple the form (it{he} is more dense, longer
resolves, can resolve in part or not resolve in general). In clinic it is applied both
resolving, and not resolving hydroxyapatite which represents a material received at
sintering (112). Resorbe hydroxyapatite possesses osseoconductive properties,
provides adhesion of bone cells{cages} and fibers, actively
24
it is included in an ionic exchange (80, 81). Hydroxyapatite in the market is
issued as in the pure state, and from a different sort by additions (polymers,
collagens).
Synthetic tribasic calcium phosphate are not analogues of calcium - phosphatic
connections natural hydroxyapatite (their big part is transformed in hydroxyapatite,
and smaller - it is dissolved).
The soluble bioceramics is time spatial fill or a skeleton for development of a
new bone fabric. In the given cases of the phenomenon of regeneration is based on
dissolution of bioceramic materials and abilities of a fabric in passing to replace
bioceramics. One of advantages of soluble bioceramics is that the initial size can be
small, therefore initial mechanical durability of a material is higher, and as the
bioceramics is dissolved, time of her{it} increase in sizes that allows to grow further a
fabric. As a result of it mechanical integrity of the given postoperative site is
supported. Restoration of a bone fabric, i.e. its{her} regeneration, occurs
simultaneously with resorbtion bioceramics (112).
Bioceramic materials can be quickly-resorbed and slow-resorbed. Quickly-
resorbed the bioceramics (tribasic calcium phosphate) is used for elimination of
postoperative bone defects, and slow-resorbed (hydroxyapatite) - for escalating a bone
fabric (after removal{distance} of a teeth with the purpose of preservation of height of
an alveolar crest, etc.). Materials on a basis hydroxyapatite in implantology are used
as dense and porous ceramics (41, 46, 43, 23).
In Ukraine it is made, is issued, it is resolved{allowed} to application for №
310/96 (order MH of Ukraine from 28.08.1996 № 269) and № 1105-161 from
07.06.2000 osseo-likely a preparation under name "Kergap" - from ceramic
hydroxyapatite and tribasic calcium phosphate (bones similar to mineral substance)
for completion of bone defects. Is issued Kergap as a powder, granules, blocks and
products which are made as from porous,
25
and dense osseolikely ceramics. The given preparation has found wide
application in maxillofacial surgery in clinics of Ukraine.
To resorbed materials also it is necessary to attribute{relate} bioactive glass. In
Ukraine the synthetic preparation made of a bioactive glass, under name "Bio-Gran"
(manufactures the USA) is registered and resolved{allowed} to application. Resorbed
term - 6 months, the delay resorbting the certain particles for years is
possible{probable}. Good adhesion of this material is provided due to
formation{education} of a silicon layer atop of which the layer of phosphate of
calcium after which crystallization it will be transformed to a layer
hydroxycarbonapatite (on a surface of the last is formed occurs proliferation
osseological cells{cages} and collagenic fibres) grow.
In quality of osseoplastic material in implantation are used combined
osseoplastic materials: hydroxyapol (69, 15, 49, 83, 52 and others), Kollapan and
Kollapol (15, 49, 10, 11 and others); Tutoplast (2); a mineral trioxide the unit (24) and
other preparations.
At the directed regeneration of a bone (GBR) or directed bone regeneration
(DBR) the question is only restoration of a bone fabric of any defect (44, 5, 23, 54,
55, 119, 120). In this case fabrics parodentium and the teeth which are taking place in
this zone (50, 51, 59, 25, 206, 126, 181, 145, 164, 207 and others) are not taken into
account. Therefore in the stomatologic literature one more close term has appeared is
the directed regeneration of fabrics (GTR) or the directed fabric regeneration
(scientific and technological revolution). Last term mean use for isolation of bone
defect of the mechanical barrier (membrane), warning to growing into bone defect of
bacteria and undesirable (not bone) cellular elements (epithelium, etc.). Healing
parodentium wounds (bone defects of an alveolar process jaws) has the features since
one of wound surfaces has no vessels (an external or internal part of defect, a surface
of a root of a tooth) and speed of regeneration nearjaws fabrics are various
26
(epithelium has the greatest speed of regeneration, and a bone, a periodontium,
cement - smaller) (112, 102).
All paradontological membranes depending on them resorbed abilities share on
not resolving (from polytetraftorethilenum - РТFE, etc.) and resolving (polymeric,
plaster, collagenic, etc.). In opinion of many authors, the most effective for the
directed fabric regeneration are not resolving membranes, however they have some
lacks - necessity of repeated operative intervention (in 6-8 weeks) for their
removal{distance}, at their extraction collapses the external surface bone regeneration
which is intimate, for this period of time, is connected to a membrane (26, 90, 16, 53
and others). Resorbed membranes can have term resorbed from 6 weeks (Kapset,
Rezolyut, Bio-Mend, etc.) till 3-6 months (Bio-Gide, Vykril, Alloderm) and even 6-
12 months (allogenic a membrane - Lambon, a collagenic membrane - Ossix, Wide
fascia hips, laktis polymer - Atrisorb, etc.). Use parodentium with term resorbed
within the limits of 6-8 weeks is usually not enough membranes for increase in height
and width of an alveolar process jaws since for high-grade regeneration of a bone
under favorable conditions it is required not less than 3 months (50, 51, 89, 90, 16, 93,
37, 53, 102, 94 and others).
Before carrying out of operation dental implantations to the patient complex
investigation (108, 43, 112, 113, 100 and is necessary to pass others) which includes
gathering the anamnesis, clinical investigation (the analysis of blood, urine), survey of
an oral cavity (an estimation of a condition of a teeth, alveolar processes, a mucous
membrane, a kind of a bite, temporo-mandibular joint, a condition of hygiene, etc.),
radiological research teeth-jaws systems (aim X-ray, orthopantomography, a
computer tomography), and also tool investigation (measurement of width of alveolar
processes, definition of electrogalvanic potentials - at implantation and prosthetics
with
27
use of diverse metals, etc.) or stereolithograph (27, 30, 39).
For classification on top and mandibles in dentistrymost frequently use ordering
which is offered in 1928 Kennedi J. But, as is known, dental implantation apply at an
atrophy jaws is more often, and quality of a bone estimate on corresponding
classifications. With this purpose use classifications Atwood D. (1971), Wical K. and
Swoope D. (1974), Seibert J.S. (1983), Lekholm U. and Zarb G. (1985), Fallschussel
G. (1986), Judy K. (1987), Howell R.A. (1988). Depending on thickness mucouse-
periosteum a flap it is possible to use of Konstantinu K.P.'s classification (1997).
To carry out {spend} an estimation of quality of a bone fabric on the basis of x-
ray pictures it is possible only roughly. Last years consider, that most authentically it
is possible to judge quality of a bone on a computer tomography (100, 98, 65 and
others). Depending on expressiveness of a degree of an atrophy of a bone of alveolar
processes and qualities of a bone fabric in endoosseous implantations use
corresponding additional operations on top and mandibles which help not only to
establish endoosseous implant, but also to achieve qualitative it{him} heal (224).
1.3. Operation of a raising of a bottom maxilla sinus
In endoosseous dental implantation to the doctor should meet difficulties, which
are connected to anatomic and age features jaws. For the doctor - doctor of
implantology introduction dental implant on maxilla happens a bone inconvenient
because of an atrophy of an alveolar process or at pneumatic type maxilla sinus.
Similar there can be a situation at a significant atrophy of an alveolar process in a
face-to-face department when there is a probability of punching of a bottom nasalis
cavities. For increase in height of an alveolar
process, both in lateral, and in face-to-face departments it is possible to use
different methods: bone plastic (imposing osteoplastic materials on atrophic a part of
28
an alveolar process), a raising of a bottom maxilla sinus (sinuslifting) or a bottom
nasalis cavities (antroplastic, antrolifting).
As bone materials at an atrophy of alveolar processes jaws, i.e. for escalating a
bone and reconstruction of alveolar processes, use as auto-or allogenic bone, and
bioceramics as blocks, etc. (86, 32, 35, 72, 76, 103, 105, 111, 55, 56, 143, 221, 177,
186, 212, 158, 159 and others). Carrying out of reconstructive - regenerative
operations for escalating alveolar processes is carried out duly bone-plastic operations
with various fixing of transplantation material (54, 55, 99, 113, 224 and others).
Depending on type, the size and localization of a bone atrophy of alveolar
process Тyulan J and Pataraya G. (2001) allocate versions of their clinical forms:
1. Anatomic versions - horizontal resorbtion (reduction of thickness of an
alveolar wall which turns to a thin plate, having kept thus sufficient height), vertical
(results in loss of height of an alveolar process and it is observed after traumatic
extract) and mixed resorbtion (simultaneous reduction of height and thickness of an
alveolar crest);
2. Topographical forms - individual (bone deficiency is observed in the field of a
unique tooth and is more often it is observed in the field of cutters), segmentary
(meets in lateral departments of an alveolar process), full (is observed on all jaw).
In practice of the doctor - doctor of implantology the special place
borrows{occupies} planning operation at absence small molars and molars when for
statement implants there is a height of less than 10 mm (35, 115, 56, 123, 148, 170
and others). In this case, at non-observance of an elementary rule when for installation
implant in area small molar or molar on the maxilla the necessary minimal height
of a bone makes 8-10 mm, it is especial in immediate proximity from a sine, to expect
for success it is not obviously possible. In these cases from this position, i.e. at height
of a bone less than 8-10 mm, it is necessary to count a unique output exit} carrying
29
out of operation of a raising of a bottom a sinus of maxilla (or a bottom nasalis
cavities). Thus, it is possible to increase a bone basis in which is dental implant and to
create conditions for osseointegration implant and long-term it{him} there sites.
By means of increase in a bone file in the field of a bottom a sinus of maxilla
there is possible{probable} use of longer dental implants (10 mm, instead of 8 mm),
that is more preferable in lateral departments maxilla bones with the purpose of
creation of adequate resistance occlusion to loading which develops in the given
departments.
On the basis of the saved up practical experience many authors (86, 32, 73, 74,
34, 72, 76, 77, 105, 116, 13, 139, 196, 197, 188, 222 and others) consider, that all
similar cases of lack of a bone on the maxilla need to be divided into 4 groups:
1. The height of an alveolar process maxilla bones makes 10 mm and more -
installation dental implants by a usual technique is possible {probable}.
2. The height of an alveolar process of the maxilla is in limits from 8 up to 10
mm. Perforation of a bottom maxilla sinus and introduction implant on 1-2 mm
in sinus maxilla a sinus in this case is possible. In these cases it is possible to
use soft (closed) sinuslifting. After installation dental implant an obligatory
condition is sufficient primary fixing which is carried out on two cortical bone
layers of the maxilla (the top layer
the bottom maxilla sinus is, and bottom it is considered a crest of an alveolar
process).]
3. The height of an alveolar process makes from 5 up to 7 mm. In these cases
carrying out of classical operation sinuslifting is necessary. The bottom maxilla
30
sinus raises on some mm that the height of an alveolar process has made 8-10
mm. It is possible to fill in the formed cavity auto-or allogenic bone, or
bioceramics. The height of an alveolar process in 5-7 mm is necessary for
primary bone fixing dental implant on the part of an alveolar crest.
4. Height of an alveolar process maxilla bones less than 5 mm. In these cases
installation dental implants is problematic whereas it is not obviously possible
to create even the minimal primary bone stabilization implant. In this case it is
recommended to carry out {spend} at the first stage classical sinuslifting
without installation implants but only to fill in a cavity osteoplastics material.
The second stage is carried out in 8-12 months, installation dental implants are
carried out {spent}. However in this group authors mark high percent {interest}
of failures, and the basic lack should be counted that term of treatment of
patients in 3-4 times increases, i.e. makes from 1, 5 till 3rd years.
Proceeding from earlier told and depending on a degree of an atrophy of
alveolar processes, it is possible to use classification which is offered Misch C.E.
(1987). Depending on a degree of expressiveness of an atrophy of alveolar processes
maxilla bones the author has divided {shared} surveyed on 4 groups. The first group
(SA 1) included surveyed with height of an alveolar process more than 12 mm, i.e. at
absence of an atrophy of an alveolar process. Persons are included in the second
group (SA 2) with an insignificant atrophy of an alveolar process (height of an
alveolar process of 10-12 mm). In the third group (SA 3) - a moderate atrophy -
between
edge {territory} of an alveolar crest and bottom maxilla sinus the height of an
alveolar process makes 5-10 mm. The fourth group (SA 4) - persons with a significant
atrophy of an alveolar process is included. The height of a bone from an alveolar crest
to the bottom makes sinus up to 5 mm. In the third and fourth group, using
31
sinuslifting, in opinion of the author, height of an alveolar process about 16-20 mm
are maximum possible to raise {increase}. Last (fourth) group is characterized by the
highest risk of occurrence of complications because of insufficient fixing endoosseous
implants.
On classification Cawood J.I. and Howell R.A. (1998) it is possible to allocate
5 classes of condition maxilla sinus depending on size resorting a bone fabric of an
alveolar process:
1. An alveolar process with his {its} kept height, i.e. height of an alveolar
process more than 10 mm (100 % an opportunity heal 10 mm dental implants);
2. An alveolar process At once after removals {distances} of a tooth at height
of a process of 7-9 mm (70 % an opportunity heal 10 mm implant);
3. An alveolar process in height from 4 up to 6 mm (40 % of an opportunity
heal 10 mm implant in own bone);
4. An alveolar process with height from 1 up to 3 mm (10-30 % an opportunity
heal 10 mm implant in own bone);
5. Absence or destroyed maxilla’s sinus.
Operation classical sinuslifting all authors (86, 32, 116, 13, 103, 112, 113, 196,
223, 222, 227, 208, 210, 209 and others) recommend to carry out as follows. Under
local anesthesia do {make} a cut {section} on transitive fold from a canine up to tuber
the maxilla with transition to edge {territory} (crest) of an alveolar process. Detach
mucoperiosteal flap. On a vestibular wall maxilla bones, in a projection of an external
wall maxilla sinus, the bone window which breaks inside sinus (without damage of a
mucous membrane) is done {made}. In the formed cavity enter osteoplastic material
(auto-or allogenic bone,
bioceramics). Then an operational wound close bioresorb a membrane (better
that terms resorb were within the limits of 4-6 and more months). This operation, it is
possible to carry out {spend} as simultaneously with introduction dental implants, and
in two stages (the first - sinuslifting, the second - implantation). Classical sinuslifting
32
(open sinuslifting or subantral augmentation) is possible for carrying out in I and II
groups and in part in III group on classification Misch C.E. (1987) since only in those
groups where it is possible to achieve full or partial primary bone stabilization dental
implants.
If the postoperative period at classical (open) sinuslifting proceeds without
complications dental implantation can be carried out {be spent} in terms from 6 till 12
months. The closing date is an absolute guarantee for an opportunity of installation
dental implants in area of a postoperative cavity.
For a raising of a bottom maxilla sinus last years wide application more sparing
operation - soft (closed, sparing) sinuslifting which demands more cautious and
perfected surgical technics {technical equipment} of carrying out of operative
intervention finds. At sparing sinuslifting less operational trauma, but the given
operation is carried out {spent} "blindly". Last factor can be attributed {related} to
lacks. For carrying out of this sparing operation different tools and variants of its
{her} carrying out (86, 32, 74, 34, 110, 76, 77, 103, 105, 123, 148, 170 and others)
are offered.
And co-authors (2003) have offered Bogatov A.I. a tooling and a way of
realization soft sinuslifting in a combination to one-stage implantation. For carrying
out closed sinuslifting authors have suggested metal is pulled out {frayed} - the
puncher. Under local anesthesia implantological the tool form bone to a box screw
dental implant directly up to a wall of a bottom a sinus of maxilla . Then in generated
bone to a box authors screw the device « is pulled out {frayed} - the puncher », punch
a bottom of a sinus, fill in the formed
cavity of osseoplastic material and screw implant. The given device allows
carrying out procedure of punching of a wall and shedding a mucous membrane of a
bottom maxilla sinus (13). However the rigid basis of the metal puncher and
disposable violent exfoliation a bottom maxilla a sinus does not allow to avoid
possible{probable} of perforations shedding epithelial lining maxillary sinus a sinus
33
that causes contamination implanted osteoplastic material and extends terms of the
directed bone regeneration.
The raising of a bottom nasalis cavities at installation implants in the field of
cutters of the maxilla can arise at a significant atrophy (postextraction or
posttraumatic) an alveolar process if between an alveolar crest and a bottom of a
cavity there is a distance less than 10 mm. Basically procedure of a raising of a
bottom of a cavity of a nose same, as well as a bottom maxilla sinus. The given
operation should be carried out {be spent} under the control radiovisiography. For
performance anthroplasty use operations which use for closed (soft) sinuslifting is
more often. However some authors for carrying out anthroplasty offer more complex
{difficult} operative interventions - horizontal osteotomy a face-to-face department of
the maxilla with the subsequent introduction in the educated space auto-or allogenic
bone or bioceramics (138). The given operation has not found wide application.
Thus, it is necessary to note, that till now in the literature there are no data on a
substantiation of application of different methods of a raising of a bottom maxilla
sinus depending on quantity{amount} entered dental implants. Methods and terms of
bone stabilization entered implants are not specified depending on their number. In
the literature there are no data and there are no techniques on carrying out classical
sinuslifting with simultaneous installation dental implants at height of an alveolar
process maxilla bones less than 5 mm.
For carrying out soft sinuslifting in the literature metal devices are described
and used and consequently the degree of batching of pressure for exfoliation a
mucous membrane of a bottom maxilla sinus is not uniform, that causes its{her}
34
damage and extends terms of bone regeneration implantological osteoplastic a
material.
1.4. Reconstructive operations at an atrophy of alveolar processes jaws
It is known, that within the first year after removal {distance} of a tooth or a
trauma of a bone (operational or another) occurs loss of a bone from 20 up to 40 % of
width of an alveolar process (112, 40, 102 and others).
At dental implantations the doctor should collide {face} with necessity, both
increases in height, and width of alveolar processes jaws. For this purpose it is
possible to use bone to plastic with fixing a transplant "with in" (71, 1, 98, 97, 158,
159 and others). For increase in height of an alveolar process of a jaw a transplant
(auto-or allogenic bone) stack as "with in" on an alveolar arch, and on the basis of the
mandible. Misch C. (1993) suggests the given transplant to subject to splitting that
promotes his {its} expansion. About use tutoplast (tutoplasticchips) for plastic
reconstruction of the damaged {injured} sites of an alveolar bone specifies Heroes
В.Н. and со-autors. (2002).
With the purpose of increase in width of an alveolar process installation auto-or
allotransplantation on a lateral narrow site of a bone is carried out{spent}. Imposed on
the given site of a bone the transplant should be fixed screws (99).
It is possible to carry out {spend} osteotomy (vertical or horizontal) a jaw by
the techniques standard in maxillofacial surgery (71, 112, 113, 142, 140, 195 and
others). Arising at carrying out osteotomy the space is filled auto-or allogenic bone or
bioceramics.
For expansion of a narrow alveolar process it is used also vertical it {him}
osteotomy with the subsequent filling the formed space bone-seeking materials. Lack
vertical osteotomy an alveolar process should be counted that she{it} is carried out in
two stages and that this operation is carried out{spent} with a break of a vestibular
35
wall of a bone. The space formed at the first stage is filled by bioceramics and the
postoperative wound (mucoperiosteala flap) is sewn up tightly. Dental implants are
usually entered only in 6-8 months after osteotomy, i.e. installation implant is carried
out {spent} at the second stage of operation. Two-stage performance of operation
considerably extends a method of treatment (140, 195 and others).The efficiency of
the given techniques is from 30 up to 65 %.
Some authors offer reconstruction of an alveolar process with the help vertical
intralaminar osteotomy with use of microfixing implants. For these purposes a
diamond disk carry out {spend} has drunk an alveolar crest, division of a bone carry
out with the help of a chisel. A vestibular bone fragment of an alveolar process
displace as it is possible further in a vestibular direction, insert implant, in the formed
defect fill bone-seeking a material and a microosteosynthesis carry out screws the in
length in 8 mm by a fastening of external and internal bone plates among themselves.
An operational wound, i.e. an alveolar bone together with implant, bone-seeking a
material and the screw cover non-resorbed with a biomembrane from
polytetraphtorethilenum, sew mucoperiosteala flap. For stabilization several implants
authors suggest to use miniplates for an osteosynthesis which are fixed by screws on
an external surface of an alveolar process. In 4-6 months implant open, delete a
membrane and all fixing a bone and implant materials (used for a
microosteosynthesis), establish basic elements and sew mucoperiosteala flap after
his{its} mobilization (203, 155). Lack of this
technique is two-stage, technical complexities at installation implants because
of springing properties of bone fragment s of a bone (the bone aspires to be pulled
together and it creates complexities at formation bone a box), use of the additional
materials remaining in an operational wound (microscrews and microplates for an
36
osteosynthesis, biomembranes). Efficiency of a technique offered {suggested} by
authors makes 86,2 %.
To overcome springing properties of bone fragment s of an alveolar bone at
intralaminar osteotomy Palti A. (2003) recommends using a set osteotoms. However
the author marks, that violent expansion fragment s can cause break off vestibular
fragment of an alveolar process that considerably worsens trophism fabrics, extends
terms of treatment, and also reduces efficiency.
In the literature there is an information on use osteotoms which allow to expand
some a narrow bone crest by means of a compression and pushing away of an alveolar
bone in mainly lateral a direction (217).
Use for expansion of alveolar processes (is possible at defects, deformations,
etc.) osteoplastic materials (hydroxyapatite, Kergap, Kaerasorb, Kollapan, etc.) in a
combination to biomembranes (236, 130, 165, 144, 218, 221, 204 and others) or
titaniumic membranes (82, 163, 168). Efficiency of treatment makes according to
authors from 60 up to 78,3 %.
Dystraction - a modern method of increase in height of an alveolar process
which is alternative of usual augmentation. At dystraction the local bone which
increases the special device which becomes stronger on a jaw after carrying out
segmentary osteotomy is used. At carrying out dystraction an obligatory condition is
performance segmentary osteotomy on a site which is subject to increase. On the last
strengthen dystraction the device and a postoperative wound sew up tightly. Healing
of a wound passes within
7-8 days. After removal of seams start a phase dystraction which is carried out
{spent} within 1-2 weeks. Daily increase carry out {spend} on 1 mm. Then within 1-2
weeks the lifted fragment keep without displacement (a phase of deduction), and then
only take dystraction and start installation implant. At use dystraction a method
achievement of result probably only later 3 months. In parallel to increase in a bone
37
there is a stretching of soft fabrics. The given method yet has not found wide
application, therefore in the literature there are only individual data on this way of
treatment (82).
Thus, in the literature there are enough methods for expansion and increases in
an alveolar process, but not all from them find wide application because of available
lacks of this or that offered {suggested} technique. Efficiency before the specified
methods make from 30 up to 86 %. Methods of expansion of an alveolar process are
still insufficiently developed, since lacks available in earlier described techniques
(duration of treatment, traumatic operations, complication during its {her} carrying
out, etc.) do not give an opportunity to guarantee efficiency of spent treatment.
Therefore in the literature searches of new, more modern methods of surgical
treatment proceed or will be improved earlier known. There is a necessity for a
substantiation of use of modern methods of surgical expansion of alveolar processes
jaws.
1.5. Features of the postoperative period of conducting patients with dental
implantation
Carrying out dental implantations causes the certain changes in a bone and
surrounding soft fabrics as a result of the put operational trauma. In reply to this
trauma inflammatory reaction in fabrics develops. That the postoperative period
proceeded without complications to the patient it is necessary to appoint adequate
treatment.
The subjective burdensome sensation arising at action of damaging {injuring}
factors on a fabric, having painful receptors clinically is characterized by a pain.
Strong painful irritations are capable to cause changes in respiratory and
cardiovascular systems can lead to infringement of function endocrine glands and
immune system. Strong painful irritations also result in an exhaustion of power
reserves of an organism and mentality or to occurrence of other changes in an
38
organism which negatively influence a condition of the patient. For removal of such
painful sensations at the patient it is necessary for it{him} to appoint adequate on
efficiency analgesics. The arsenal analgesics are wide, but not each of them
adequately removes the expressed painful sensations which arise after operative
interventions on a bone at carrying out of implantation. Therefore
purpose{assignment} analgesics means in the postoperative period has great value for
preventive maintenance of development of complications.
As at patients inflammatory reaction to an operational trauma there is a
necessity for purpose {assignment} of antibacterial therapy for decrease {reduction}
in risk of development of postoperative infectious complications develops. The choice
of an antimicrobic preparation is important, but inconvenient, since the microflora of
an oral cavity has the features and in development of inflammatory complications
participate, as a rule, not one microbic activator, and a little - microbic associations.
To the patient symptomatic treatment is appointed. Next day after carrying out
of operation to the patient recommend cautious cleaning a teeth, soda warm trays (3-4
times day after meal), observance of a diet (reception of soft and liquid food of
moderate temperature).
Seams usually recommend to remove from a postoperative wound for 7-10 day
after carrying out of implantation.
In the postoperative period hygienic care of an oral cavity (antiseptic rinsings,
etc.) is recommended to the patient. Hygiene of an oral cavity has great value for long
functioning dental implants. Among smokers the probability of development of
complications, on data Liran Levin et al. (2004), increases.
During carrying out of implantation and in the postoperative period there can
be local complications which reasons can be insufficient investigation of the patient,
underestimation of contra-indications to carrying out of the given operation, inept or
rough work of the surgeon at formation bone a box or carrying out of additional
surgical intervention, non-observance of hygiene of an oral cavity after introduction
39
implant, inadequately picked up medicamentous treatment, etc. (66, 78, 96, 20, 91,
92, 75, 118, 97, 45, 131, 173, 174, 180, 190, 208, 205, 237 and others). According to
these authors during time and after carrying out of operation there can be various local
complications.
Lead {Carried out} dental implantations carry out {spend} an estimation of
results under standards which are offered Smith (1987) or Misch (1999), she {it} is
based on presence of the certain attributes available at the patient:
- An immovability of everyone implant at clinical investigation of the patient;
- Absence bleeding sickness and pockets in area implantо-gingival connections;
- Absence of painful sensations, discomfort, inflammatory complications in
area implant;
- Absence on the X-ray destruction bones around implant;
- Loss of a bone fabric in the first year of functioning implant makes up to 1,5
mm and each subsequent - 0,1-0,2 mm;
- Obligatory supporting adequate hygiene of an oral cavity.
Efficiency of success of the lead {the carried out} implantation makes 95 % at
5-years, 85 % - at 10-years and 80 % - at 15-years use implants. The given estimation
of efficiency of implantation corresponds {meets} to the international standards (183,
198, 127, 201, 220,175, 200, 213, 150, 137, 195 and others).
Thus, on the basis of the lead {carried out} review of the literature becomes
clear that in dental implantations many questions remain still unresolved enough. The
electrogalvanic characteristic of fabrics of an oral cavity of patients before carrying
out dental implantations (at stages osseointegration) is insufficiently investigated. In
the literature are available contradictory opinions on efficiency of use domestic and
foreign bioceramic osteoplastic materials for filling bone defects at carrying out of
implantation or additional operative interventions. Especially big complexities at the
doctor - doctor of implantology arise at a significant atrophy of alveolar processes
40
maxilla bones or at pneumatic type maxilla sinus. Despite of the offered {suggested}
different kinds of operative interventions available in the literature which are used in
these cases, they do not give an absolute guarantee on success. Also the big
difficulties at the doctor arise when the patient has sufficient on height, but (narrow)
alveolar process of a jaw insufficient on width. Now, in many cases, it usually is
contra-indication to carrying out endoosseous dental implantations. Even in those
individual publications when in complex {difficult} cases the most modern additional
operative interventions are offered at implantation the substantiation of use of
different surgical techniques all the same is not carried out {not spent} depending on
number enter edendoosseous dental implants. The question with additional methods
of fixing implants is solved at presence of the expressed atrophy of alveolar processes
maxilla bones. There are no data on terms of final bone stabilization endoosseous
implants depending on their number at carrying out additional operative interventions.
The result of the lead{the carried out} implantation in many respects depends
not only on the correct account of indications and contra-indications, and also a
technique of the executed operation, but also is defined {determined} by current of
the postoperative
41
period, i.e. adequately picked up treatment (pain-killer, anti-inflammatory). At
incorrectly picked up treatment during the period after the lead {carried out}
operative intervention there can be expressed painful sensations or inflammatory
changes on the part of associates implant fabrics and efficiency of implantation is
considerably reduced.
42
CHAPTER{HEAD} 2
MATERIAL AND METHODS OF INVESTIGATION
Under supervision and investigation 151 patient by whom implantation on top
and mandibles has been lead {has been carried out} endoosseous was treated. To all
these patients the surgical stage intrabone dental implantations with subsequent his
{its} orthopedic end has been executed. All surgical (standard and additional
interventions) stages dental implantations were carried out {spent} in the Center
dental implantations Amman (Jordan).
Additional surgical interventions at carrying out endoosseous dental
implantations on top and mandibles are made at 110 patients. The age of all surveyed
is submitted in table 2.1.
Table 2.1
Division of patients on age and a sex
Age groups
surveyed
Sex
All Men Women
absolut. Number
% abs.
Number %
abs. Number
%
16-24 9 6,0 10 6,7 19 12,6 25-34 11 7,3 14 9,3 25 16,6 35-44 20 13,2 18 11,9 38 25,1 45-54 17 11,3 23 15,2 40 26,5 55 and more
14 9,2 15 9,9 29 19,2
In total 71 47,0 80 53,0 151 100,0 All surveyed patients by whom implantation was carried out {was spent}
endoosseous dental, have divided {shared} into three groups:
I group - 41 patient with sufficient on height and sufficient on width an alveolar
process top and mandibles;
43
II group - 57 patients with insufficient height of an alveolar process of the
maxilla;
III group - 53 patients with sufficient on height, but insufficient on width an
alveolar process top and mandibles.
For the decision of a question on necessity of carrying out of additional
operative intervention on maxilla bones, depending on a degree of an atrophy of
alveolar processes, we have taken advantage of the classification offered{suggested}
Misch C.E. (1987). The given classification in the schematic image is submitted in
figure 2.2.
Fig. 2.2. Classification maxilla bones on Misch C.E.
Depending on a degree of expressiveness of an atrophy of alveolar processes
maxilla bones the author of them has divided {shared} into 4 groups (SA1-SA4). The
first group (SA1) included surveyed with height of an alveolar process more than 12
mm (fig. 2.2-a), i.e. with absence of an atrophy of an alveolar process. Persons are
included in the second group (SA2) with an insignificant atrophy (on fig. 2.2-b) an
alveolar process (height of an alveolar process of 10-12 mm). In the third group (SA3)
- a moderate atrophy (fig. 2.2-v), i.e. between edge {territory} of an alveolar crest and
44
a bottom maxilla sinus the height of an alveolar process makes 5-10 mm. Persons are
included in the fourth group (SA4) with a
significant atrophy of an alveolar process (fig. 2.2-g), the height of a bone from
an alveolar crest to the bottom a sine makes up to 5 mm. In the third and fourth
groups, using operation sinuslifting, the height of an alveolar process can be raised
{increased} up to height necessary for implantation. Last (fourth) group is
characterized by the highest risk of occurrence of complications because of
insufficient quantity {amount} of a dense bone and a bad opportunity of fixing
endoosseous implant.
Fig. 2.3. Classification Cawood I.I. and Howell R.A.
At implantation took into account thickness a mucoperiosteum’s flap located
on a crest of an alveolar process of a jaw, width of his{its} bone part and the size of
loops - lacunas of spongy substance of a bone in the planned place of introduction
dental implant. Took into account Konstantinu K.P.'s (1997) opinion, it agrees which
at patients with thickness a mucoperiosteum’s flap located on a crest of an alveolar
process of a jaw in 1-5 mm and in the width of his{its} bone part in 3,5-5,5 mm X-ray
45
corresponds{meets} middle-structure to spongy substance of a bone. At thick (in 5
mm and more) mucoperiosteum flap on a crest of an alveolar
process and narrow (up to 3,5 mm) his{its} bone part the spongy structure of a
bone is defined{determined} finely porous, and at thin (up to 1 mm) mucoperiosteum
flap of an alveolar crest and wide (more than 5,5 mm) his{its} bone part - large-
structure.
Also took into account density of a bone, according to Paraskevich V.L.'s
recommendations (1998). The bone of a jaw of the raised {increased} density is
submitted by a parity {ratio} of compact and spongy substance in a proportion 2 : 1,
aveflape density - 1 : 1, low density - 0,5 : 1.
For definition of contra-indications at carrying out endoosseous dental
implantations, depending on expressiveness of an atrophy of an alveolar process, we
also had been used classification Cawood I.I. and Howell R.A. (1988). According to
this classification, at the third class (fig. 2.3.) is present sufficient height, but
insufficient width of an alveolar process, i.e. it{he} - narrow. Sufficient on height it is
considered an alveolar process at his{its} height approximately in 12-14 mm, and an
alveolar process insufficient on width - at his{its} width in 3,5-5 mm.
In quality endoosseous dental implants we had been used titanium implants
systems IMPLA (Germany). The implants are made of titanium grade 4. The surface
is sandblasted with oxide aluminium and finally acid etched. The IMPLA implant
system is available in six different diameters: Impla DualSurface & MicroRetention-
3.3mm, 4.2mm, 5.3mm; Impla Cylindrical: 3.6mm, 4.5mm, 5.5mm; as a two stage
implant. Plus three one piece implants: Miniballtop: 2.5mm and 2.1mm and
MiniConetop 3mm. Different lenght are available from 6mm to 17.5mm.
46
For filling bone defects, in quality osteoplastic a material, we used a resorbed
synthetic bone - Bio-Gran (USA) and domestic bioceramics - Kergap (Ukraine). Bio-
Gran is synthetic osteoplastic material representing bioactive granules in diameter
300-355 micron. Due to the optimum size of particles, Bio-Gran it is transformed in
hollow an environment. It occurs at penetration of phagocytes through cracks in the
external environment consisting of phosphate of calcium and deducing {removing}
taking place inside oxide of silicon. The hollow environment formed at it stimulates
migration from periosteal and blood not differentiated mesenchymal cells {cages} and
their transformation in osteoblasts. Osteoblasts form a primary spongy
matrix, which further mineralizing. Thus, the bone fabric sprouts from a
granule to a granule and quickly fills in defect. Granules Bio-Gran completely resolve
in an organism and metabolizing as a result of cycle By Krebs. Before entering into a
cavity the preparation is necessary for mixing with blood or 0,9 % a solution of a
physiological solution. Full replacement by a new bone occurs within 9-12 months (at
addition autobone time of regeneration is reduced till 5-6 months).
In Ukraine it is made, is issued, it is resolved{allowed} to application for №
310/96 (order МЗ of Ukraine from 28.08.1996 № 269) and № 1105-161 from
07.06.2000 bone-seeking a preparation with the name "Kergap" - from ceramic
hydroxyapatite and tribasic calcium phosphateа (bones similar to mineral substance)
for completion of bone defects. Given bone-seeking the preparation us also is used in
dissertational work.
For the directed fabric regeneration at carrying out of operations we used
absorbable membranes (plaster, collagenic).
To all patients before operation and in the postoperative period it was carried
out {it was spent} clinical investigation which included survey, palpation,
radiography jaws (orthopantomography) and other special methods of investigation
(tab. 2.4).
47
Contact thermometry carried out{spent} electrothermometer TPEM-1 having
dot thermocouples (gauge) with a range of measurement from 16 up to 42С̊.
Accuracy of registration - 0,2 ˚С. Time of contact of the gauge with a mucous
membrane of an oral cavity - 20 seconds, intervals between repeated investigations
made from 2 till 5 seconds. A touch by the gauge did {made} approximately with the
same force of pressure. Local temperature measured three times and calculated
aveflape arithmetic. Temperature measured on the researched and healthy party
{side}. For research used a difference between surveyed (after operation) and the
healthy party {side} on a symmetric site, i.e. revealed temperature asymmetry
(termoasymmetry).
Table 2.4
Methods of investigation of patients
The name of the used methods
Terms of carry out of investigation Before
implantation In dynamics (During ) of
postoperatrive investigation Clinical investigation (survey, palpation, percussion) + +
Radiography jaws (orthopantomography) + +
Electroodontodiagnostic + + Contact thermometry + + Potenciometry researches + + Periotestmetry + + Definition of functional activity of peripheral nerves on device " DYNE - 1 "
+ +
Definition of a hygienic index + + Revealing of presence of inflammatory process of a mucous membrane
+ +
The note: + investigation was carried out{was spent};
- Investigation was not carried out{was not spent}.
48
Electroodontodiagnostic (EOD) carried out with the help electroodontometric.
By preparation for measurement on the device with researched intact teeth removed
indented a stone, isolated a teeth from a saliva, carefully dried up wadded balls in a
direction from cutting edge{territory} to equator. According to the instruction, we did
not apply chemical substances (an ether, spirit), that could lead to change of a
threshold of excitability of a pulp of a tooth. At manipulations in an oral cavity
(carrying out electroodontodiagnostic) together with the device we used only
disposable wooden spatulas. Caries and treated teeth in research EOD were not
included.
Potenciometry we carried out {spent} researches with the help of automatic
digital potentiometer Pitterling Electronic with 32 cells of memory for reproduction of
results and pair electrodes of measurement from chrome-nickel an alloy in
fluoroplastic holders. The device automatically defines{determines} a potential
difference in a range from 0 up to 999 mV, force of a current in a range from 0 up to
99 mcA and electric conductivity in an oral cavity in microSiemens (mkSm). In the
established mode of measurement (in 10-20 seconds after deenergizing the device) at
contact of one of electrodes to a metal surface implant or abatmen, and the second
with a mucous membrane in hypoglossal area, on a board{panel} highlight of digital
values of a potential difference, force of a current and electric conductivity.
Periotestmetry, i.e. functionality parodentium in researched sites, carried
out{spent} by means of device " Periotest ". The given device corresponds {meets} to
requirements of norms EN 60601-1 and EN 60601-1-2 and is marked is familiar СЕ
according to supervising document 93/42/EWG from June, 14, 1993 on medical
products. « Periotest » calculates ability of fabrics parodentium to return a tooth in a
starting position after action on him {it} of the certain external loading. The device
will consist of the instrument block, the computer analyzer and a tip which are
connected among themselves. A working element in a tip is striker, the including
piezoelement working in two modes. The physical principle of work of the device
49
consists in transformation of an electric pulse in mechanical. A researched tooth or
implant by abatmen to percuss brisk a tip at regular intervals (250 ms) with the effort
being atraumatic for firm fabrics of a tooth, and for fabrics parodentium. During
carrying out of research dental numbers {lines} always should be disconnect. For the
analysis of results took into account aveflape arithmetic of 3 measurements with an
interval of 10-15 seconds.
Definition of functional activity of peripheral nerves carried out {spent} on a
hardware - program complex for electropuncture
diagnostics of "DYNES - 1". The recommended order of investigation of the
patient was strictly observed as directed, applied to the given device. Viewing of the
data and their registration carried out on a computer.
Hygienic index defined {determined} on Green – Vermillion’s index (Green
J.C., Vermilion J.K., 1964). The simplified index of hygiene of an oral cavity (OHI-S)
consists in the visual estimation of the area of a surface of a tooth pruinose and-or by
dental tartar, does not demand use of special dyes. For definition OHI-S investigate a
buccal surface 16 and 26, a lip surface 11 and 31, lingual a surface of 36 and 46 teeth,
moving on the tip a probe from cutting edge {territory} in a direction gingiva.
Absence of a dental strike is designated as 0, a dental strike up to 1/3 surfaces
of a tooth - 1; a dental strike from 1/3 up to 2/3 - 2, a dental strike more than 2/3
surfaces - 3. Then defined {determined} indented a stone by the same principle. The
formula for calculation of an index following:
OHI-S = where
n – quantity {Amount} of teeth, зн (dp) - dental plaque, зк (dt) - dental tartar.
Values of a dental strike the following: 0 - there is no strike, 1 - 1/3 crown of
tooth or any quantity{amount} dense pigment a strike, 2 - on 2/3 crown of tooth, 3 -
more than 2/3 crown of tooth.
50
Values indented a dental tartar: 0 - is not present, 1 - above gingival a stone on
1/3 crown of tooth, 2 - above gingival a stone on 2/3 crown of tooth and-or
subgingival stone as separate conglomerates, 3 - above gingival a stone more than 2/3
crown of tooth or subgingival stone surrounding a neck part of a tooth.
Estimation carried out{spent} under Lutskoj I.K.'s circuit and co-aut. (2001)
which is submitted in table 2.5.
Table 2.5
Estimation of an index of hygiene of an oral cavity
Value An estimation of an index An estimation of hygiene
of an oral cavity 0-0,6 Low Good
0,7-1,6 Aveflape Satisfactory 1,7-2,5 High Unsatisfactory
More than 2,6 Very high Bad
For revealing presence of inflammatory process of a mucous membrane of
alveolar processes carried out {spent} Schiller - Pisarev's test. A mucous membrane
of alveolar processes processed solution by Lyugol. Intensity of colouring estimated
in points: 1 point - is not present colouring, 2 points - weak colouring, 3 points -
intensive colouring. Calculated aveflape value for parameters of the top and mandible.
Feature of fabrics of maxillofacial area is its{her} plentiful innervation and
after operative additional interventions, there can be pains. There fore the expressed
painful clinical semiology which arises after surgical interventions on bones, demands
carrying out of adequate anesthesia. Our attention has involved pain-killer a
preparation - ketanov (ketorolak trometamini), let out{released} by firm " Ranbaxy "
(India). Ketanov is not steroid not narcotic analgetic (pain-killer) which operates on
tcyclooxygenic a way of an exchange arachidonic acid, inhibition biosynthesis
“prostoglandinov”, being mediators painful sensitivity a place of damage of fabrics.
51
Thus, it is considered, that ketanov reduces peripheral notcyceptiv sensitivity, i.e. is
peripheral by pain-killer. Taking into account that the given preparation inhibition
biosynthesis “prostoglandinov” which are mediators as well inflammations, it is
necessary to note presence of anti-inflammatory effect at ketanovа. This circumstance
to us was very favourable, since in aetiology many painful symptoms both at diseases,
and at postoperative complications in maxillofacial area the inflammation is one of
conducting{leading} factors.
Therefore in the postoperative period at operated patient by us of patients has
been used ketanov (ketorolak trometamini).
With the purpose of preventive maintenance of inflammatory complications
during the period after performance of operation we used an antimicrobic preparation
for per oris (oral [enteral]) introductions - Tcyphran СТ manufactures « Ranbaxi
Laboratories Limited » (India). Into structure Tcyphran СТ enters tcyprophloxatcini
(500 mg) in a combination with tinidazolium (600 mg). Pharmacological feature of
preparation Tcyphran-СТ are caused by pharmacological properties of each active
component of a preparation. Tcyprophloxatcini, as well as others fluoroquinolones,
blocks bacterial DNA (desoxyribonucleic acid)-gyraza therefore synthesis bacterial
DNA is broken. Fluoroquinolones - clean burn connections, contact fibers of whey of
blood (the parameter of their linkage does not exceed 40 %) a little. Penetration into
fabrics and liquids of an organism occurs by passive diffusion through walls of
capillaries. Good diffusion of a preparation is caused high lipophilic and the longest
postantibiotic effect (till 6 o'clock). Tcyprophloxatcini bactericide operates on gram-
positive and gram-negative activators, switching culturs of microbes, which resistance
to penicillins, cephalosporins and aminoglycosides. The spectrum of action of
tcyprophloxatcini grasps such aerobic microorganisms, as staphylococcus,
streptococci, an intestinal stick, Proteus and other microbes. Tinidazolium, included in
preparation Tcyphran-СТ, is a synthetic preparation of group nitroimidazolium.
52
Tinidazolium operates bactericide to anaerobic bacteria - Bacteroides, clostridiums,
aeubacteriums, fusobacteriums, peptostreptococcus, peptococcus, etc.
In the rest, in the postoperative period, treatment and care of patients after
carrying out endoosseous dental implantations with
use of additional surgical interventions and without their application differed
nothing from traditional.
The received figures processed the standard calculus of variations-statistical
method with use of a personal computer and a package of statistical programs “ SPSS
11.0 for Windows ” and “ Microsoft Excel 2000 ”. Reliability of results of
investigation estimated by criteria studentized variate. Distinctions were considered
authentic at р <0,05.
53
CHAPTER{HEAD} 3
RESULTS OF INVESTIGATION OF PATIENTS
THE FIRST GROUP OF SUPERVISION
The first group have made 41 patient with sufficient on height and sufficient on
width of an alveolar process top and mandibles. Among surveyed persons there were
25 women and 16 men. Distribution of patients on age and a sex is submitted in table
2.1.
Before performance dental implantations carried out {spent}
electroodontodiagnostic the teeth located in a zone of implantation. Defined
{determined} conformity of radiographic parameters of these teeth with the data of
electroodontodiagnostic. If necessary carried out{spent} corresponding treatment of a
teeth. Established in what hygienic condition there is an oral cavity of the patient. By
means of Schiller - Pisarev's test defined {determined} presence of absence of the
inflammatory phenomena of a mucous membrane of an alveolar process. The index of
hygiene of an oral cavity (Green - Vermillions) before implantation in this group of
patients has made 0,5 ± 0,04, i.e. was estimated as good.
For definition of indications and contra-indications of inclusion of patients in
the given group of supervision we used classification Misch C.E. (1987) and
classification Cawood I.I. and Howell R.A. (1988). According to these classifications
sufficient on height it is considered an alveolar process at his{its} height in 12-14
mm, and insufficient on width - at his{its} sizes in 3,5-5 mm. It is considered, that
that reparative regeneration at implantation proceeded is high-grade it is necessary to
have thickness external and internal bone walls around implant not less than 1 mm.
After selection of patients by us in the first group of supervision we carried out a
surgical stage of introduction endoosseous dental implants under the traditional
circuit. Selection corresponding on the size implant carried out on a cliche which is
54
applied to implantation system IMPLA. dental implantations carried out{spent}
operation under block regional anesthesia with application by anesthetics of articaini
lines. For implantation we used titanium implants systems IMPLA.
The after exfoliation a mucoperiosteum’s flap with the help of osteotome
measured width of an alveolar process for selection corresponding on diameter
implant. We necessarily took into account that circumstance that after creation of the
bone channel for implant around of the last, from the external and internal
parties{sides}, there was a bone wall thickness not less than 1 mm (fig. 3.1, 3.2). With
the help of a spherical pine forest on a crest of an alveolar process bored through a
bone cortical plate, i.e. formed the central point which used as directing at the further
formation a box. Using directing and forming mills, formed the bone channel for
corresponding implant. Depth of immersing of mills supervised with the help depth-
gaugeа. Speed of the preparing tool did not exceed 800-1000 revolutions 1 minute.
Implant it was entered into the bone channel by their twisting by a pressure key. The
effort at a twisting was not more than 25-30 Nsm. Endoosseous the part dental
implant was completely immersed in a bone and implant closed the screw - cork.
Mucoperiosteala flap stacked on a place and carefully sewed up by nonabsorbable
suture. Seams removed for 7-8 day.
After introduction dental implant in a bone (before mending a wound) at once
carried out{spent} potentiometry, i.e. defined{determined} a potential difference and
force of a current between entered implant and a mucous membrane of an alveolar
process, and also established electroconductivity of an oral liquid. The data of these
parameters are submitted in table 3.3.
55
Fig. 3.1. Around of generated for implant bone a box which are necessary for
having that implantation passed appearance of thickness of bone walls in favorable
conditions.
Fig. 3.2. Appearance of a parity{ratio} of bone walls of a jaw and dental
implants at patients I of group of supervision.
56
Table 3.3
Results of carrying out pothencyometry at patients I of group of
supervision.
Dynamics{Changes} of investigation of patients
Number surveyed
Potential drop (in mV)
Current strength (in mcА)
Electric conductivity (mcSim)
At introduction implant (before mending of a postoperative wound)
17 89,4±3,6 р <0,001
7,5±0,4 р <0,001
10,1±0,8 р <0,001
In 2-3 hours after introduction
17 76,7±2,9 р <0,001
6,2±0,3 р <0,001
9,7±0,7 р <0,001
In 1 day after implantation 17 54,7±2, р <0,001
4,9±0,3 р <0,001
7,5±0,2 р <0,001
On 7-10 day after implantation
17 40,0±2,5 р <0,001
3,4±0,2 р <0,001
6,1±0,6 р <0,001
In 1 month after implantation
17 24,7±2,5 р> 0,05
2,4±0,2 р> 0,05
4,4±0,5 р <0,001
In 3-4 months after implantation
15 23,5±2,5 р> 0,05
1,6±0,2 р> 0,05
2,2±0,2 р> 0,05
Norm (according to the literature)
From 15 up to 22
From 1,1 up to 2,0
From 1,5 up to 2,0
The note: р - reliability of distinctions in comparison with norm.
Thus, after installation implant a potential difference between the last and a
mucous membrane of an alveolar process authentically increased up to 89,4±3,6 (р
<0,001), force of a current also was also authentically above and made 7,5±0,4 (р
<0,001), and electroconductivity of an oral liquid - 10,1±0,8 (р <0,001). In 2-3 hours
after mending a postoperative wound the potential difference, force of a current and
electroconductivity of an oral liquid
57
decreased a little, but remained authentically (р <0,001) raised{increased} and
according to told were the following: 76,7±2,9 (р <0,001); 6,2±0,3 (р <0,001) and
9,7±0,7 (р <0,001).
Thermoassymetry a mucous membrane of an alveolar process, i.e. area of a
postoperative wound and a symmetric healthy site, at once after the
termination{ending} of operation and mending of a postoperative wound has made a
minus 0,8±0,1 °С, and on periphery - a minus 0,7±0,1 °С (on the part of the
lead{carried out} operative intervention the local temperature was below healthy site).
It has been connected to infringement vascularity a mucoperiosteum’s flap as a result
of his{its} formation and exfoliation (table 3.4).
Table 3.4
Thermoassymetry a mucous membrane of an alveolar process at patients I
of group of supervision.
Terms of investigation of
patients
Quantity{amount} surveyed
Thermoassymetry (in degrees Celsius) In the center of a
postoperative wound On periphery of a
postoperative wound At once after operations
20 A minus 0,8±0,1
Р <0,001 A minus 0,7±0,1
р <0,001
In 1 day 20 1,1±0,1 р <0,001
0,9±0,1 р <0,05
In 3 days 20 1,5±0,1 р <0,001
1,4±0,1 р <0,001
In 7 days 20 0,5±0,1 р> 0,05
0,5 ± 0,1
Control group (healthy people)
22 0,5±0,1 р> 0,05
The note: р - reliability of distinctions in comparison with healthy people.
After twist in endoosseous dental implant in a bone, i.e. before mending of a
postoperative wound, it is lead{is carried out} periotestmetry
58
which has made 12,4±0,8 standard unit (s.u.). The data of periotestmetry in
dynamics{changes} of healing (osseointegration implant) are submitted in table 3.5.
Table 3.5
Parameters periotestmetry at patients I of group of supervision.
Terms of investigation of
patients
Quantity{amount} surveyed
Data of periotestmetry
M ± m (in standard unit (s.u.)) Р
At installation implant
18 12,5±0,8 <0,001
In 3-4 months 18 5,1±0,5 < 0,05 In 5 months 18 1,1±0,6 > 0,05 In 6 months 18 1,3±0,5 > 0,05
The note: р - reliability of distinctions in comparison with conditional norm
(healthy people).
It is necessary to note, that at once after installation implants parameters
periotestmetry were authentically (р <0,001) raised{increased}. If to compare these
data to a pathology parodentium they corresponded{met} to the data which are
available for patients with parodontitisом an easy degree.
The next day after installation implant parameters pothencyometry were
authentically reduced in comparison with the previous investigation and were the
following: a potential difference - 54,7±2,9 mV; force of a current - 4,9±0,3 mcA;
electric conductivity - 7,5±0,2 mcSim. These parameters were authentically
raised{increased} in comparison with healthy people. The local temperature in the
field of a postoperative wound raised and Thermoassymetry in the center and on
periphery authentically increased in comparison with norm and were accordingly
equaled 1,1±0,1 °С (р <0,01) and 0,9±0,1 °С (р <0,05). Schiller - Pisarev's test was
estimated on 1 point (colourings are not present) at 23 patients (56,1 %) and on 2
59
points (weak colouring) - at 18 patients (43,9 %), i.e. made 1,4±0,2 a point. Green -
Vermillion’s index the next day after operation has made 0,7±0,08 (doubtfully
increased, i.e. р> 0,05), was estimated as satisfactory.
After carrying out dental implantations the local temperature in the center and
on peripheries of a postoperative wound increased for the third day due to its{her}
increase (because of presence of a postoperative hypostasis) and was accordingly
equal 1,5±0,1 °С (р <0,001) and 1,4±0,1 °С (р <0,001). It is necessary to explain
increase of local temperature expansion of peripheral vessels in a kind of presence of
a hypostasis of soft fabrics. Schiller - Pisarev's tests at 19 patients (46,3 %) it was
estimated in 1 point, and at 22 persons. (53,7 %) - in 2 points. The parameter of an
index of Schiller - Pisarev made 1,5±0,2 a point, i.e. it{he} authentically did not
change in comparison with the previous period of investigation. Green - Vermillion’s
index was estimated as satisfactory, doubtfully changed in comparison with the first
postoperative day and has made 0,7±0,05.
After installation implants parameters pothencyometry decreased for the
seventh day in comparison with the previous investigations. But the given parameters
remained authentically (р <0,001) raised{increased} in comparison with norm.
During this period of investigation the potential difference between implant and a
mucous membrane of an alveolar process made 40,0±2,5 mV (р <0,001), force of a
current - 3,4±0,2 (р <0,001) and electroconductivity of an oral liquid - 6,1±0,6 (р
<0,001). Higher parameters of a potential difference, force of a current and
electroconductivity of an oral liquid which were characteristic for this term of
investigation, met only at persons number beside located established implants more
than 2 (two) and the highest - from three and more. The lowest parameters
pothencyometry are marked at installation single endoosseous dental implants.
Thermoassymetry a mucous membrane for 7 day of investigation of patients I
of group of supervision authentically decreased in comparison with 3-rd day of
60
supervision and already authentically did not differ both in the center, and on
periphery
of a postoperative wound from norm, i.e. it was equal 0,5±0,1 °С (р> 0,05).
For 7 day of investigation of patients I of a subgroup of supervision we carried
out{spent} definition of a functional condition of peripheral branches of nerves on top
(forward, aveflape and back top alveolar branches of an infraorbital nerve) and
bottom (the bottom alveolar nerve) jaws. We investigate conductivity of these nerves
at different stages osseointegration implants. Results of studying of conductivity are
submitted in table 3.6.
Table 3.6
Functional condition of peripheral branches trigeminal
Nerve at patients I of group of supervision.
Terms of investigation of patients
Parameters of conductivity of a nerve (in standard unit ) Quantity{Amount}
surveyed Maxilla
Quantity{amount} surveyed
Mandible
For 7 day 20 138,8±3,1 р <0,001
21 144,4±4,5 р <0,001
In 1 month 20 135,6±3,0 р <0,001
21 148,4±4,8 р <0,001
In 3-4 months 20 125,0±2,2 р <0,01
21
133,7±2,8 р <0,01
In 5-6 months 20 110,9±1,1 р> 0,05
21 122,4±1,5 р> 0,05
Control group (healthy people)
24 107,2±1,9 р> 0,05
24 113,0±11,8 р> 0,05
The note: р - reliability of distinctions in comparison with healthy people.
In group of patients which have been taken for investigation of peripheral
branches of a trigeminal nerve on the maxilla we included persons by whom anyone
61
was carried out{was spent} typical endoosseous dental implantation on the top bone.
At carrying out of implantation on the bottom
jaw - only those patients at whom the top established implant settled down in
immediate proximity (less than 2 mm) from mandible the channel since to
Timofeevym A.A. (2003) it has been earlier proved, that at an arrangement of a top
implant are farther than 2-3 mm from mandible than the channel the functional
condition of the bottom alveolar nerve authentically did not differ from norm at all
stages osseointegration dental implant (fig. 3.7). Therefore to include in investigation
of a nerve of persons with an arrangement of a top implant more than on 2-3 mm from
mandible the channel is, in opinion Tymofyeyev A.A. (2003) who have been not
justified.
Fig. 3.7. The X-ray of a sick top with an arrangement dental implant more than
3 mm from mandible the channel (an arrow{a pointer} it is specified mandible the
channel).
62
After installation implant on the maxilla conductivity of the top alveolar
branches of an infraorbital nerve authentically increased for the seventh day up to
138,8±3,1 standard unit (р <0,001). Conductivity of the bottom alveolar nerve also
authentically increased up to 144,4±4,5 standard unit (р <0,001) at patients at an
arrangement of a top dental implant less than 2 mm up to mandible the channel (fig.
3.8).
Fig. 3.8. The X-ray of the patient at an arrangement of a top dental implant less
than 2 mm up to mandible the channel (last is specified by an arrow{a pointer}).
At those patients where damage of the top wall mandible the channel (2
persons. was observed.), there were the highest figures of conductivity of a nerve
which reached{achieved} 170 and 180 standard unit (fig. 3.9.). From 41 patients with
implantation (20 persons. - on top and 21 persons. - on mandibles) at 12 (29,3 %)
from them have arisen the phenomena posttraumatic neuritis with corresponding
clinical semiology (numbness a site of a mucous membrane, a leather{skin}, etc.) .
From them on the maxilla the semiology posttraumatic neuritis at 4 persons. is
registered. (in 20,0 % cases under the attitude{relation} to all implant established on
the maxilla) and at 8 patients on the mandible (in 38,0 %). Posttraumatic neuritis it is
63
possible to explain the mechanism of occurrence to that during formation bone the
box for dental implant occurs as damage of bone blood vessels (there are
haemorrhages and hematomas) with the subsequent compression of nervous trunks,
and probably mechanical (tool) damage of the most peripheral nerve (fig. 3.9).
Fig. 3.9. The X-ray of the patient with damage dental implant the top wall
mandible the channel (it is specified by an arrow{a pointer}).
Thus, for 7 day of spent investigation after installation implant, i.e. at studying
a functional condition of peripheral branches of a trigeminal nerve, we have found
out, that conductivity of a nerve raised up to authentically high figures which arose
not only in result травмирования peripheral nervous branches or at presence of
haemorrhages, but also always was in direct dependence on number entered dental
implants. High figures of conductivity of a nerve also were always observed at
simultaneous introduction by three and more number{line} located dental implants. In
these cases conductivity of a nerve authentically increased and was in limits from 150
up to 160 standard unit
64
For 7 day of treatment Schiller - Pisarev's test at 32 persons. (78,1 %) it was
estimated on 1 point (colourings are not present) and at 9 persons. (21,9 %) on 2
points (weak colouring), i.e. made 1,2±0,2 a point. Green - Vermillion’s index -
0,6±0,1 (hygiene of an oral cavity was estimated as good).
In the first group of supervision, after carrying out of operative intervention, to
24 patients as anesthetizing means appointed well-known analgesics (analginum,
etc.), and to 17 patients - not steroid analgetic (pain-killer)- ketanov. As preventive
maintenance of the inflammatory phenomena in the postoperative period to 25
patients the standard antibiotics of a wide spectrum of action (ampiox, ampicillin,
etc.), and to 16 patients - an antibiotic Tcyphran СТ (tcyprophloxatcini with
tinidazolium) were appointed. High anesthetizing efficiency ketanovand Tcyphran is
established. So, at patients whom appointed in the postoperative period standard
analgesics to 3 day a symptom of a pain it is marked in 83,3 % of cases (20 patients),
and for 7 day - in 33,3 % (8 persons). At use ketanovpains for 3 day are marked in
35,3 % of cases (6 persons), And for 7 day of pains of any character it has not been
revealed. At purpose{assignment} Tcyphran СТ a hypostasis and hyperemia a
mucous membrane of an alveolar process decreased in 2 times faster, than at
purpose{assignment} of traditional antibiotics.
In 1 month after implantation parameters of size of electric potentials and
forces of a current were authentically reduced (tab. 3.3) up to normal amounts and
were accordingly equal: 24,7±2,5 mV and 2,4±0,2 mcA. It is necessary to note, that
electroconductivity of an oral liquid also was reduced in comparison with the last day
investigations, but remained authentically raised{increased} in comparison with
norm. The given parameter considerably has been raised{increased} only at patients
by whom simultaneous introduction more than 3 dental implants is lead{carried out}.
Definition of a functional condition of peripheral branches of a trigeminal nerve
in 1 month after implantation specifies preservation of authentically high figures of
65
conductivity of a nerve both on top, and on the mandible (tab. 3.6). The clinical
semiology fully complied earlier described.
In 1 month after operation Schiller - Pisarev's test at all surveyed was estimated
on 1 point, i.e. colouring is not present. Green - Vermillion’s index was equal 0,5±0,1
- hygiene of an oral cavity was estimated as good.
In 3-4 months after implantation all sizes pothencyometry practically did not
differ from norm (tab. 3.3). Parameters periotestmetry at surveyed patients were
considerably reduced, but nevertheless still remained authentically raised{increased}
in comparison with conditional norm (tab. 3.5). Sizes of parameters of conductivity of
peripheral nerves were kept on high figures (tab. 3.6) both on top, and on mandibles.
In 5 months after implantation on the maxilla and in 6 months on the mandible
parameters periotestmetry and to conductivity of a nerve practically
corresponded{met} to norm, i.e. authentically did not differ from healthy people.
Results osseointegration dental implants on the maxilla (in 5 months after
implantation) and the mandible (in 6 months after operation) should be estimated as
good.
The investigations of patients I of group of supervision lead{carried out} by us
have shown, that the minimal thickness of bone walls (external and internal) around
dental implant, necessary for normal osseointegration is far from being always can
thickness in 1 mm. To us it is proved, that current osseointegration in a zone of
implantation depends on density of a bone fabric which surrounds дентальный
implant. It is necessary to take into account, that in Paraskevich V.L.'s opinion (1998)
it is necessary to allocate three basic types архитектоники maxillary bones (I type -
raised{increased}, II - with aveflape and III - low density). We have analysed clinical
outcomes osseointegration which were observed by us aroundendoosseous dental
implants with different on thickness and density bone walls. It is established, that at
the raised{increased} density of a bone (I type)
66
and thickness of bone walls in 1 mm from 17 implants favorable outcomes
were observed only at 11 persons. (in 64,7 %), and at thickness in 1,5 mm and more -
at all 16 persons. (in 100 % cases). At aveflape and low density of a bone fabric and
thickness of bone walls in 1 mm we observed favorable osseointegrative outcomes
only in 5 cases from 23 established implants, i.e. in 21,7 % cases, and at thickness in
2 mm and more - at all surveyed (in 100 %). Complications were observed as
resorption edges{territories} of an alveolar crest (fig. 3.10) or оголения parts dental
implant (fig. 3.11), that demanded further use osteoplastic materials for closing the
bared sites dental implant.
Fig. 3.10. Appearance resorbed edges{territories} of an alveolar process of a
jaw around endoosseous dental implant at thickness of bone edge{territory} less than
2 mm and aveflape density of a bone (the photo is made in 1,5 months after
implantation).
Summing up to results of investigation of patients I of group of supervision, we
have noted, that for them was available Thermoassymetry a mucous membrane of an
alveolar process in the field of a postoperative wound at once after end of operation.
The local temperature on the part of the lead{carried out}
67
operative intervention was below symmetrically a healthy site (we estimated
her{it} as with "minus" is familiar). It has been connected to infringement vascularity
a mucoperiosteum’s flap at his{its} formation (exfoliation). The next day after
operation dental implantations the local temperature raised and Thermoassymetry
again authentically differed from norm, that also is marked and for the third day after
carrying out of operation. Normalization of local temperature was observed only in 7
days after operative intervention. We establish direct dependence between a degree of
expressiveness of increase of local temperature and number entered dental implants in
dynamics{changes} of healing of a postoperative wound, that necessarily it is
necessary to take into account at the analysis of the received temperature data since at
these patients is longer is kept Thermoassymetry in the postoperative period. At
presence post-implantological inflammatory complications or at more traumatic to the
lead{the carried out} technique of implantation the local temperature remained is
longer (for 2-3 days longer than in typical cases) on authentically high figures, that
specifies an opportunity of use of this test (measurement local thermoasymmetric)
with the forecasting purpose.
Results of investigation of patients a method pothencyometry specified that At
once after introductions dental implant in bone to a box there was an authentic
increase of a difference of electric potentials up to 89,4±3,6 mV, forces of a current
up to 7,5±0,4 mcA and electric conductivity of an oral liquid up to 10,1±0,8 mcSim
68
Fig. 3.11. A failure dental implantations at thickness of an external bone wall in
1 mm and aveflape density of a bone - fenestration of parts implant in 3 months after
his{its} introduction.
In 2-3 hours after introduction implant and his{its} stay in conditions of a
mouth parameters of a potential difference, force of a current and electric conductivity
doubtfully were reduced and remained on high figures. Within 7-10 days after dental
implantations parameters pothencyometry decreased, but remained authentically
raised{increased}. Normalization of parameters of a potential difference and force of
a current occured only in 1 month after operation, and electric conductivity of an oral
liquid - in 3-4 months after implantation. We establish direct dependence between
parameters pothencyometry (size of a potential difference, force of a current, electric
conductivity of an oral liquid) and number entered dental implants. It is marked, that
at all surveyed in dynamics{changes} of current osseoregeneration (osseointegration)
decrease{reduction} and normalization of parameters pothencyometry was observed.
We have revealed, that the size of electric conductivity of an oral liquid always
depend on current osseoregeneration processes in a bone wound. At favorable current
69
- normalization of this parameter occurs in terms till 1 month after operation, and at
adverse current (delay of processes of formation{education} of a bone) - during 1,5
and even 2 months after end of operation. At periimplantitis we at all these patients (4
persons) observed high figures of electroconductivity of an oral liquid which
exceeded normal amounts in two and more times. Normalization of this parameter
occured only after elimination of it postimplantation inflammatory complication.
Investigation of patients I of group of supervision by a method periotestmetry
has shown, that high-grade osseoreparative processes on the maxilla was observed in
5 months after installation dental implants, and on the mandible - in 6 months. High-
grade osseointegration in these terms it was observed irrespective of number entered
implants and it was defined{determined} by a place of carrying out of implantation
(the top or mandible).
At studying a functional condition of peripheral branches of a trigeminal nerve
in dynamics{changes} of healing of a bone wound after carrying out endoosseous
dental we have revealed implantations, that from 20 person by whom have been
established implants on the maxilla, the clinical semiology posttraumatic neuritis has
arisen at 4 person, i.e. in 20,0 % cases, and on the mandible at 8 of 21 patients, i.e. in
38,0 % cases. The mechanism of occurrence posttraumatic neuritis on the maxilla
mechanical damage of the nerve is possible to explain damage as integrity of bone
blood vessels (there are haemorrhages and hematomas which squeeze peripheral
nervous fibres), and, probably, at formation bone a box for implant. The mechanism
of development posttraumatic neuritis on the mandible speaks as damage of a bone
wall mandible the channel with the subsequent wound of a nerve, and occurrence of
bone haemorrhages as a result of infringement of integrity of vessels
with the subsequent mechanical compression nervous trunks. Feature of these
neuritis is that the damaging{injuring} factor (dental implant) after drawing a trauma
70
remains in the same place and in conditions of a long compression long current of the
given neurologic complication is marked slow resorption hematomas (haemorrhage),
and consequently, and.
At studying size of conductivity of a nerve by us it is established, that the
highest figures (170-180 standard unit ) were observed at patients at mechanical
damage of the top wall mandible the channel, and also at traumatized peripheral
nervous branches or at presence of bone haemorrhages (150-160 standard unit ).
These figures of conductivity of a nerve always were in direct dependence on number
entered dental implants and extensiveness of the damaging{injuring} factor. At
favorable postoperative current conductivity of nervous fibres was restored in 3-4
months on the maxilla or 5-6 months - on the mandible. We observed restoration of
conductivity of a nerve at all surveyed patients.
71
CHAPTER{HEAD} 4
RESULTS OF INVESTIGATION OF PATIENTS OF THE SECOND GROUP
OF SUPERVISION
The second group of supervision was made by 57 patients with insufficient
height of an alveolar process of the maxilla. Among surveyed persons there were 28
women and 29 men. The second group of supervision has consisted of 2 subgroups:
the first group - 23 patients by whom operation open (traditional) sinuslifting has been
lead{has been carried out}; the second subgroup - 34 patients by whom the operative
intervention called closed antrolifting (25 person - closed sinuslifting and 9 person -
closed nasolifting) is executed.
For the decision of a question on necessity of performance of additional
operative intervention on maxilla bones, depending on a degree of an atrophy of
alveolar processes, we used classification which has been offered Misch C.E. (1987).
Classification maxilla bones on Misch C.E. is submitted on fig. 2.2. Depending on a
degree of expressiveness of an atrophy of alveolar processes maxilla bones the author
has divided{shared} into 4 groups (SA1-SA4). (SA1) the author has included in the
first group of persons with height of an alveolar process more than 12 mm (at absence
of an atrophy of an alveolar process). In the second group (SA2) - persons with an
insignificant atrophy of an alveolar process (at his{its} height from 10 up to 12 mm).
In the third group (SA3) patients when between edge{territory} of an alveolar crest
and a bottom maxilla sinus the height of a bone makes 5-10 mm are included, i.e.
there is a moderate atrophy of an alveolar process. In the fourth groups (SA4) the
author has suggested to include patients with a significant atrophy of an alveolar
process i.e. when the height of a bone between a bottom a sinus of maxilla and an
alveolar crest makes up to 5 mm.
72
In the fourth group (SA4) on classification Misch C.E. we carried out{spent}
operation traditional (open) sinuslifting in a well-known kind and with
offered{suggested} by us immobilization (fixing) dental implants, i.e. these patients
have been included by us in the first subgroup of the given group of supervision. In
the second subgroup of this group of supervision, i.e. that to whom carried out{spent}
closed antrolifting, we have included patients who on classification Misch C.E.
concerned to the third group (SA3). In quality osteoplastic material at sinusliftingх
used both Bio-Gran (38 patients), and Kergap (19 patients).
Traditional open sinuslifting (the first subgroup ІІ groups of supervision) at 11
patients it is lead{is carried out} by the standard method, and at 12 patients - with our
updating. Updating open sinuslifting consist that the after exfoliation a
mucoperiosteum’s flap on a crest of an alveolar process, i.e. there where in the future
allocation cylindrical implants with the help of titaniumic screws is planned becomes
stronger a titaniumic miniplate of the necessary sizes (fig. 4.1-а).
Fig. 4.1-á. Appearance of an operational wound at modified by us open
sinuslifting at strengthening a titaniumic miniplate on an alveolar crest maxilla bones.
The spherical pine forest placed in a direct tip and working in a mode of 2000
revolutions in 1 minute with plentiful irrigation, on lateral to a wall maxilla sinus all
73
over again "planned", and then bored through a bone for formation{education} of a
bone window. Displaced a bone-mucous flap aside a sinus of maxilla . Thus it is
necessary to observe extra care to not damage{injure} and not penetrate through
internal lining (a mucous membrane of a sine) in maxilla a sinus. In inside and
upwards removed a forward bone wall together with a mucous membrane a sinus of
maxilla to provide enough place for allocation endoosseous parts dental implant.
Through apertures in a titaniumic miniplate planned places for an arrangement
implants. By means of a directing mill (it is possible to remove{take off} temporarily
for convenience a titaniumic miniplate) in a thickness of an alveolar process formed
bone to a box for dental implants (fig. 4.1-б).
Fig. 4.1-b. Appearance of an operational wound after formation bone a box for
dental implants.
74
Dental implants strengthened in a titaniumic miniplate (fig. 4.1-в).
Fig. 4.1-v. Appearance of fixing offered{suggested} by us dental implants to a
titaniumic miniplate.
After introduction in a bone of necessary quantity{amount} dental implants
they became stronger to a titaniumic miniplate due to titaniumic screws. Thus, in
transgingival parts implant the last have been fixed to a metal plate, and the
siteendoosseous parts implant was kept due to the certain thickness of a bone part of
an alveolar process. The big intrabone part dental implant was outside of a bone and
at all adjoin with a bone, i.e. has been located in the generated cavity. Appearance
fortified in a titaniumic miniplate dental implants is submitted on fig. 4.1-g.
75
Fig. 4.1-g. Appearance of an operational wound when dental implants are
attached to a titaniumic miniplate and are closed by screws - plugs.
Implant closed the screw - by plug, and in a cavity filled bone-seeking
bioceramics (14 patients – Bio-Gran, to 9 patients - Kergap), involved on blood of the
patient and covered resorbed with a biomembrane, and then mucose-peryosteal flap.
Appearance dental implants with their strengthening in a titaniumic miniplate on the
X-ray is submitted on fig. 4.1-ñ.
The given surgical method of carrying out dental implantations is closed since
after a premise{room} endoosseous implant in a bone, a mucous membrane and
peryosteal above it{him} sew up, and osseointegration occurs in conditions of
dissociation implant to an oral cavity. This method of implantation also can be named
two-phasic since at the first stage there is a healing (engraftment) dental implants, and
at the second stage - removal (removal{distance}) fixing implants a titaniumic
miniplate by operative disclosing a postoperative wound with
76
the subsequent detorsion titaniumic screws and removal of a titaniumic
miniplate.
Fig. 4.1-d. The X-ray of the patient in 3 months after carrying out open
sinuslifting in our updating - fixing dental implants among themselves with the help
of a titaniumic miniplate.
Closed antrolifting (the second subgroup ІІ groups of supervision) it is lead{is
carried out} at 34 patients. At 25 person we have executed closed sinuslifting, and at
9 - closed nasolifting. At 24 patients at their realization in quality osteoplastic material
it is used Bio-Gran, and at 10 - Kergap. Closed sinuslifting and nasolifting it was
applied at installation 1-2 and much less often 3 dental implants. Closed antrolifting
by a traditional technique it is applied at 21 patients, and by a technique
offered{suggested} by us - at 13 patients. The traditional technique closed antrolifting
is in detail described in the literature. Therefore we shall describe technics{technical
equipment} of performance of operation closed antrolifting (a sine and nasolifting)
77
by a technique offered{suggested} by us with use a silicone cylinder - expander
(a method of a stretching of soft fabrics).
After carrying out exfoliation a mucoperiosteum’s flap in a necessary site of a
jaw formed the bone channel for dental implant. Formation bone a box for
endoosseous dental implant carried out at the minimal revolutions - no more than 500-
600 revo. In the beginning carried out{spent} drilling a bone under the control depth-
gauge. Checked depth-gauge depth of penetration of the tool and compared her{it} to
thickness of an alveolar process on orthopantomogram. After between a bottom of the
bone channel and a bottom maxilla sinus or cavities of a nose there was the bone
partition equal of 1-1,5 mm, into the bone channel inserted an equal diameter tube
through which entered a silicone cylinder - expander (fig. 4.2-а).
Fig. 4.2-a. The after exfoliation a mucoperiosteum’s flap and formation bone
the box is carried out{spent} introduction through a tube fabric expander.
In process of filling a silicone cylinder a liquid (it is carried out with the help
compressive the device in which pressure is created and is filled the cylinder - the
78
maximal pressure in it{him} should not exceed 248 Mbar) it{he} in regular intervals
extends, breaking a bone bottom of the channel due to a liquid which is in a silicon
cylinder. In regular intervals and gradually the mucous membrane of a bottom maxilla
sinus (a cavity of a nose) exfoliates. Thus, the cavity which further will be filled by a
osseoplastic material (fig. 4.2-b) is created.
Fig. 4.2-b. The circuit of expansion a silicone cylinder (expander) at carrying
out antrolifting.
Then the tube together with expander from the bone channel leaves and through
him{it} filling the formed cavity osseoplastic by a material with the subsequent
79
introduction endoosseous dental implant is carried out{spent}. Appearance (as the
circuit) dental implant in the cavity formed after end closed antrolifting is submitted
on fig. 4.2-v.
Fig. 4.2-v. The circuit of appearance dental implant, taking place in a cavity
which was formed after carrying out closed antrolifting with use silicone expander.
For maintenance of additional fixing single implant, at his{its}
presence{finding} in a bone less than half of his{its} length, we offer carrying out of
fixing with the help of a titaniumic miniplate which becomes stronger on a vertical to
an alveolar process maxilla bones (fig. 4.2-g) by the titaniumic screw.
80
In the first and second subgroups ІІ groups of supervision we shall lead{shall
carry out} the description of methods of investigation in parallel with each other,
since it is necessary to compare at once among themselves different methods of
performance antrolifting (open and closed) at all stages of spent treatment of patients.
Fig. 4.2-g. Appearance of additional fixing single dental implant by means of a
titaniumic miniplate at carrying out closed sinuslifting.
After introduction dental implants in a bone at open sinuslifting (the first
subgroup), before mending a postoperative wound
and in the postoperative period, we carried out{spent} potentiometry
(defined{determined} a potential difference, force of a current and
81
electroconductivity of an oral liquid between dental implant and a mucous membrane
of an alveolar process) which results are submitted in tab. 4.3.
At carrying out pothencyometry in the first subgroup of supervision we from 14
patients have selected identical number of patients with traditional and modified (with
additional fixing implants) sinuslifting.
Table 4.3
Results of carrying out pothencyometry at patients of the first subgroup ІІ
groups of supervision (open sinuslifting).
Dynamics{Changes} of investigation of
patients
Number surveyed
Parameters pothencyometry
A potential difference
Force of a current (in
mcA)
Electric conductivity
(mcSim) At introduction implants (before
mending of a postoperative
wound)
14 120,7 ± 4,8 8,8 ± 0,4 11,8 ± 0,8
In 1 day 14 107,9 ± 3,9 р <0,001
6,4 ± 0,3 р <0,001
9,3 ± 0,5 р <0,001
In 7-10 days 14 95,0 ± 2,4 р <0,001
5,1 ± 0,3 р <0,001
5,1 ± 0,3 р <0,001
In 1 month 14 46,4 ± 3,0 р <0,001
3,9 ± 0,3 р <0,001
3,2 ± 0,2 р <0,001
In 3-4 months 14 23,6 ± 2,4 р> 0,05
2,4 ± 0,3 р> 0,05
1,6 ± 0,2 р <0,001
Norm (according to the literature)
From 15 up to
22 From 1,1 up
to 2,0 From 1,5 up
to 2,0
The note: р - reliability of distinctions in comparison with norm.
At carrying out pothencyometry in the first subgroup of supervision we from 14
patients have selected identical number of patients with traditional and modified (with
82
additional fixing implants) sinuslifting. After installation implants on the maxilla the
potential difference authentically raised up to 120,7 ± 4,8 mV (р <0,001), force of a
current - up to 8,8 ± 0,4 mcA (р <0,001), electric conductivity of an oral liquid - up to
11,8 ± 0,8 (р <0,001). Clinical semiology which would be connected to increase of
force of a current and a potential difference in an oral cavity, to us to reveal it was not
possible.
It is necessary to note, that sizes of parameters of change of potentials (a
potential difference, force of a current and electric conductivity of an oral liquid) at
patients with open sinuslifting without additional fixing and with its{her} carrying out
practically did not differ among themselves at corresponding stages of spent
investigation.
ІІ groups of supervision we included patients in the second subgroup as with
closed sinuslifting, and closed nasolifting. At introduction dental implants at closed
antrolifting authentic increase of all parameters pothencyometry was marked:
potential differences - up to 62,7 ± 3,2 mV (р <0,001), forces of a current - up to 5,2 ±
0,4 mcA (р <0,001) and electric conductivity of an oral liquid - up to 5,3 ± 0,4 mcSim
(р <0,001).
It is necessary to note, that increase of parameters pothencyometry at open
sinuslifting in 1,5-2 times were higher in comparison with those at closed antrolifting
.
83
Table 4.4
Results of carrying out pothencyometry at patients of the second subgroup of II
group of supervision (closed antrolifting)
Dynamics{Changes} of investigation of
patients
Number surveyed
Parameters pothencyometry A potential
difference (in mV)
Force of a current (in
mcA)
Electric conductivity
(mcSim) At introduction implants (before
mending of a postoperative
wound)
15 62,7 ± 3,2 р <0,001
5,2 ± 0,4 р <0,001
5,3 ± 0,4 р <0,001
In 1 day 15 46,0 ± 1,8 р <0,001
3,8 ± 0,3 р <0,001
3,6 ± 0,3 р <0,01
In 7-10 days 15 28,7 ± 1,9 р <0,01
3,2 ± 0,4 р <0,01
3,5 ± 0,2 р <0,01
In 1 month 15 18,0 ± 1,7 р> 0,05
2,7 ± 0,3 р> 0,05
2,9 ± 0,2 р> 0,05
In 3-4 months 15 12,0 ± 1,0 р> 0,05
1,9 ± 0,3 р> 0,05
1,3 ± 0,1 р> 0,05
Norm (according to the literature)
From 15 up to
22 From 1,1 up
to 2,0 From 1,5 up
to 2,0
The note: р - reliability of distinctions in comparison with norm.
Thermoassymetry a mucous membrane of an alveolar process of the maxilla At
once after carrying out open sinuslifting, i.e. after mending a postoperative wound,
has made in the center of the center 0,9 ± 0,1 (р <0,05), and on periphery of the center
- 0,7 ± 0,1 (р <0,001). All parameters thermoasymmetric a mucous membrane at
patients of the first subgroup ІІ groups of supervision are submitted in tab. 4.5.
84
Table 4.5
Thermoassymetry a mucous membrane of an alveolar process at patients of the
first subgroup ІІ groups of supervision (open sinuslifting)
Terms of investigation of
patients
Quantity{amount} surveyed
Thermoassymetry (in degrees Celsius) In the center of a
postoperative wound
On periphery of a postoperative
wound At once after operations
17 0,9 ± 0,1 р <0,05
0,7 ± 0,1 р> 0,05
In 1 day 17 1,5 ± 0,1 р <0,001
1,4 ± 0,1 р <0,001
In 3 days 17 1,8 ± 0,1 р <0,001
1,5 ± 0,1 р <0,001
In 7 days 17 0,6 ± 0,1 р> 0,05
0,5 ± 0,1 р> 0,05
Control group (healthy people)
22 0,5 ± 0,1
The note: р - reliability of distinctions in comparison with healthy people.
At closed antrolifting (tab. 4.6) At once after operations Thermoassymetry a
mucous membrane doubtfully raises up to 0,6 ± 0,1 (р> 0,05) in the center of a
postoperative wound and up to 0,5 ± 0,1 (р> 0,05) on periphery of the postoperative
center, i.e. Thermoassymetry remains in norm.
85
Table 4.6
Thermoassymetry a mucous membrane of an alveolar process at patients of the
second subgroup of II group of supervision (closed antrolifting)
Terms of investigation of
patients
Quantity{amount} surveyed
Thermoassymetry (in degrees Celsius) In the center of a
postoperative wound
On periphery of a postoperative
wound At once after operations
16 0,6 ± 0,1 р> 0,05
0,5 ± 0,1 р> 0,05
In 3 days 16 1,0 ± 0,1 р <0,001
0,9 ± 0,1 р <0,05
In 7 days 16 1,3 ± 0,1 р <0,001
1,1 ± 0,1 р <0,001
In 1 day 16 0,5 ± 0,1 р> 0,05
0,4 ± 0,1 р> 0,05
Control group (healthy people)
22 0,5 ± 0,1
The note: р - reliability of distinctions in comparison with healthy people.
At comparison of the first and second subgroups of supervision by us it is
marked, that at closed antrolifting At once after operations thermoasymmetric did not
come to light, that specified on less traumatic operative intervention in comparison
with open (traditional) sinuslifting.
After installation dental implants in a bone, we carried out{spent} Periotestmetry
at patients with open sinuslifting at carrying out of additional fixing dental implants a
titaniumic miniplate and without its{her} realization. It is marked, that without
additional fixing parameters periotestmetry were higher (more than 20 standard unit ),
than at its{her} carrying out (about{near} 10 standard unit ). Thus, at once after
introduction implants us it is established, that due to additional fixing stability
implants which are fastened by a titaniumic miniplate
86
considerably raises. Aveflape arithmetic parameters at surveyed the first
subgroup of supervision are submitted in tab. 4.7.
Table 4.7
Parameters periotestmetry at patients of the first subgroup of II group of
supervision (at open sinuslifting)
Terms of investigation of
patients
Quantity{amount} surveyed
Given{data} periotestmetry M ± m (in standard
unit ) Р
At installation implants
20 15,6 ± 0,6 <0,001
In 3-4 months 20 5,8 ± 0,4 <0,05 In 5 months 20 3,7 ± 0,3 > 0,05
In 7-8 months 20 0,2 ± 0,8 > 0,05 Control group - healthy people
(according to the literature)
From-5 up to +5 standard unit
The note: р - reliability of distinctions in comparison with conditional norm
(healthy people).
At installation several, not connected among themselves, dental implants
Periotestmetry defined{determined} for each of them, and then calculated aveflape
arithmetic number. Thus we have revealed, that at installation dental implants at open
sinuslifting Periotestmetry has made 15,6 ± 0,6 standard unit , that
corresponded{met} to patients with the top border of parodontitis easy degree.
Parameters periotestmetry at closed sinuslifting are submitted in tab. 4.8.
87
Table 4.8
Parameters periotestmetry at patients of the second subgroup of II group of
supervision (at closed antrolifting )
Terms of investigation of
patients
Closed sinuslifting Closed nasolifting Number
of patients
M ± m (in standard unit )
Number of patients
M ± m (in standard unit
) At installation
implant 19
13,5 ± 0,7 р <0,001
9 11,1 ± 0,9 р <0,001
In 3-4 months 19 4,2 ± 0,3 р <0,05
9 -0,44 ± 1,1 р> 0,05
In 5 months 19 0,7 ± 0,6 р> 0,05
9 -1,1 ± 1,0 р> 0,05
In 6 months 19 -0,8 ± 0,8 р> 0,05
- -
Control group - healthy people
(according to the literature)
From-5 up to +5 standard unit
The note: р - reliability of distinctions in comparison with conditional norm
(healthy people).
If to compare Periotestmetry at patients at carrying out closed sinuslifting and
closed nasolifting that it is established, that at the last the size of this parameter is a
little bit lower, that is connected, most likely, by that defect necessary for completion
bone-seeking bioceramics at surveyed with closed nasolifting always did not exceed
20 % of length dental implant, and at closed sinuslifting - reached 30 %.
The next day after open sinuslifting parameters pothencyometry (tab. 4.3) were
authentically reduced, but remained during this period of time authentically (р
<0,001) raised{increased}: a potential difference - 107,9 ± 3,9 mV, force of a current
- 6,4 ± 0,3 mcA, electric conductivity - 9,3 ± 0,3
88
mcSim. At closed antrolifting also next day after operation we have noted
authentic decrease{reduction} in all parameters pothencyometry (tab. 4.4): a potential
difference - 46,0 ± 1,8 mV, force of a current - 3,8 ± 0,3 mcA, electric conductivity -
3,6 ± 0,3 mcSim. Despite of decrease{reduction} in these parameters at surveyed the
second subgroup of supervision, all of them remained at authentically high levels in
comparison with norm.
Next day after carrying out of operation of size thermoasymmetric it is authentic
(р <0,05) raised as in the first, and the given group of supervision second subgroups.
At carrying out open sinuslifting parameters thermoasymmetric in the center of a
postoperative wound have made (tab. 4.5) 1,5 ± 0,1 ºС (р <0,001), and on periphery -
1,4 ± 0,1 ºС (р <0,001).
At closed antrolifting (tab. 4.6.) also were observed similar changes, but
parameters were a little bit lower: in the center of a postoperative wound - 1,0 ± 0,1
ºС (р <0,001), and on periphery 0,9 ± 0,1 (р <0,05). Schiller - Pisarev's test in the first
subgroup has made 1,5 ± 0,3 points, and in the second subgroup - 1,4 ± 0,2 points.
Green - Vermillion’s index - 0,8 ± 0,1 (in the first subgroup) and 0,7 ± 0,09 (in the
second).
In 3 days after operation parameters thermoasymmetric at patients with open
sinuslifting (the first subgroup) raised up to 1,8 ± 0,1 ºС (р <0,001) in the center of a
postoperative wound and up to 1,5 ± 0,1 (р <0,001) on periphery. We have noticed
the similar tendency and at closed sinuslifting (the second subgroup), but on lower
sizes of these parameters: 1,3 ± 0,1 (р <0,001) in the center of a postoperative wound
and 1,1 ± 0,1 (р <0,001) on periphery. Schiller - Pisarev's test at patients of the first
subgroup - 1,6 ± 0,3 points, and in the second - 1,5 ± 0,2 points. Green - Vermillion’s
index was estimated as satisfactory (in the first subgroup - 0,8 ± 0,09, in the second -
0,7 ± 0,05).
For the seventh day after carrying out of operative intervention parameters
pothencyometry went down, but remained on authentically high figures. At open
89
sinuslifting (the first subgroup) they were following (tab. 4.3): a potential difference
95,0 ± 2,4 mV (р <0,001), force of a current - 5,1 ± 0,3 mcA (р <0,001), electric
conductivity - 5,1 ± 0,3 mcSim (р <0,001). At closed antrolifting (the second
subgroup) parameters pothencyometry were much lower than in the first subgroup
(tab. 4.4) and made: a potential difference - 28,7 ± 1,9 mV (р <0,01), force of a
current - 3,2 ± 0,4 mcA (р <0,01) and electric conductivity - 3,5 ± 0,2 mcSim (р
<0,01).
Thermoassymetry a mucous membrane for 7 day of investigation of patients with
open sinuslifting it was normalized and was following: in the center of a postoperative
wound - 0,6 ± 0,1 ºС (р> 0,05), and on periphery - 0,5 ± 0,1 ºС (р> 0,05). Too we
have noted and at surveyed patients with closed antrolifting. Parameters
thermoasymmetric at surveyed this subgroup were normalized and made: 0,5 ± 0,1 ºС
(р> 0,05) in the center of a postoperative wound and 0,4 ± 0,1 ºС (р> 0,05) on
its{her} periphery (tab. 4.5 and 4.6).
For 7 day of investigation of patients of the first subgroup ІІ groups of
supervision, we carried out{spent} definition of a functional condition of peripheral
branches of nerves on the maxilla (forward, aveflape and back top alveolar branches
of an infraorbital nerve). Results of investigation of patients of the first subgroup of
supervision are submitted in tab. 4.9.
It is established, that on 7 day of investigation of patients with open sinuslifting,
parameters of conductivity of the top alveolar nerves made 135,5 ± 2,8 standard unit
(р <0,001), and at closed antrolifting - 123,9 ± 1,6 standard unit (р <0,001). Thus,
parameters of conductivity of peripheral nerves were authentically (р <0,001) above
at open sinuslifting, than at closed, that is connected first of all with less traumatic
spent operative intervention at closed antrolifting .
90
Table 4.9
Functional condition of peripheral branches of a trigeminal nerve at patients
with antrolifting (II group of supervision)
Terms of investigation of
patients
Parameters of conductivity of the top alveolar branches of an infraorbital nerve
Open sinuslifting Closed antrolifting
Number of patients
A parameter of conductivity (in standard
unit )
Number of patients
A parameter of conductivity (in standard
unit )
In 7 days 14 135,5±2,8 р <0,001
14 123,9±1,6 р <0,001
In 1 month 14 139,1±2,0 р <0,001
14 116,6±1,9 р <0,05
In 3-4 months 14 128,2±2,4 р <0,001
14 108,5±0,7 р> 0,05
In 5-6 months 14 111,3±1,4 р> 0,05
14 105,9±0,8 р> 0,05
Control group (healthy people)
107,2 ± 1,9 (it is surveyed of 24 persons.)
The note: р - reliability of distinctions in comparison with healthy people.
For 7 day of treatment Schiller - Pisarev's test at patients of the first subgroup has
made 1,4 ± 0,3 points, and in the second - 1,3 ± 0,2 points. Green - Vermillion’s index
in the first subgroup was 1,4 ± 0,2 (hygiene of an oral cavity satisfactory), and in the
second subgroup - 0,6 ± 0,2 (hygiene of an oral cavity is appreciated as good).
In the first subgroup of supervision after carrying out open sinuslifting from 23
patients as anesthetizing means at 13 persons. Appointed traditional analgesics
(analginum, etc.), and 10 persons. - used ketanov (not steroid analgesic). The
standard antibiotics of a wide spectrum of action are applied for preventive
maintenance of the inflammatory phenomena to 16 patients
91
(ampioxy, ampicillin, etc.), and 7 - an antibiotic Tcyphran СТ (tcyprophloxatcini
with tinidazolium). Higher anesthetizing efficiency ketanovand anti-inflammatory
action Tcyphran СТ is marked in comparison with traditional preparations. At 13
patients whom in the postoperative period used standard analgesics, for 3 day the
symptom of a pain is marked at 10 person (76,9 %), and for 7 day - at 5 persons.
(38,5 %). At use ketanov the pain for 3 day was register at 5 persons. From 10
surveyed, i.e. in 50,0 % of cases, and for 7 day - at 1 persons. (10,0 %). At
application Tcyphran СТ a hypostasis and hyperemia a mucous membrane of an
alveolar process maxilla bones disappeared in 1,6 times faster, than at
purpose{assignment} of traditional antibiotics.
In the second subgroup of supervision, i.e. after performance closed antrolifting,
from 34 patients as anesthetizing means at 20 persons. Appointed traditional
analgesics, and at 14 persons. - ketanov (not steroid analgesic). For preventive
maintenance of the inflammatory phenomena at 24 persons. Traditional antibiotics,
and at 10 persons. are applied. - Tcyphran the ITEM. In this subgroup higher
anesthetizing efficiency ketanovand anti-inflammatory action Tcyphran also is
marked. At use at 20 persons. Standard analgesics for 3 day after operation of a pain
were kept at 11 persons. (55,0 %), and for 7 day - at 6 persons. (30,0 %). At
application ketanov for 3 day of treatment of a pain were kept at 3 surveyed of 14
patients (in 21,4 %), and for 7 day at patients of a pain we have not registered. At use
for anti-inflammatory action of an antibacterial preparation Tcyphran СТ
(tcyprophloxatcini together with tinidazolium), we have revealed, that a hypostasis
and hyperemia a mucous membrane of an alveolar process in the postoperative period
(after application closed antrolifting) disappeared in 2 times faster, than at
purpose{assignment} of the standard antibiotics.
In 1 month after open sinuslifting (the first subgroup) parameters
pothencyometry (tab. 4.3) have authentically decreased in comparison with the
previous period of investigation of patients and have made: a potential difference -
92
46,4 ± 3,0 mV (р <0,001); force of a current - 3,9 ± 0,3 mcA (р <0,001) and electric
conductivity - 3,2 ± 0,2 mcSim (р <0,01). After carrying out closed sinuslifting (the
second subgroup), in 1 month was observed normalization of all parameters
pothencyometry (tab. 4.4) and were the following: a potential difference - 18,0 ± 1,7
mV (р> 0,05), force of a current - 2,7 ± 0,3 mcA (р> 0,05), electric conductivity - 2,9
± 0,2 mcSim (р <0,05). Last parameter authentically differed from norm only at
persons at whom additional fixing by a titaniumic miniplate was used.
Definition in 1 month after operation of a functional condition of peripheral
branches of a trigeminal nerve has shown, that at open sinuslifting the parameter of
conductivity has doubtfully raised{increased} and has remained on high figures
(139,1 ± 2,0 standard unit ), and at closed sinuslifting - has gone down and has made
116,6 ± 1,9 standard unit The parameter of conductivity of a nerve in both groups
remained authentically raised{increased}.
In 1 month after operation antrolifting the parameter in both subgroups was
identical. Schiller - Pisarev's test at all surveyed was estimated on 1 point, i.e.
colouring is not present. Green - Vermillion’s index was equal 0,5±0,1, i.e. hygiene of
an oral cavity was estimated as good.
In 3-4 months after carrying out antrolifting, all parameters pothencyometry were
normalized in both subgroups of supervision (tab. 4.3 and 4.4). The parameter
periotestmetry at open sinuslifting (tab. 4.7) authentically differed from norm and
made 5,8 ± 0,4 (р <0,05).
At closed sinuslifting (tab. 4.8) the parameter periotestmetry also was not
normalized and made 4,2 ± 0,3 standard unit (р <0,05). Parameters of conductivity of
peripheral branches at open sinuslifting (tab. 4.9) remained authentically high - 128,0
± 2,4 standard unit (р <0,001), and at closed antrolifting - were normalized (108,5 ±
0,7 standard unit , р> 0,05).
Terms full osseointegration at traditional sinuslifting without additional fixing
made from 7 till 8 months after carrying out of operation, and at use at open
93
sinuslifting additional fixing of titaniumic miniplates - 5-6 months. Terms
osseointegration were directly proportional to number entered dental implants. At
their number from 3 and more, terms full osseointegration without fixing have made
not less than 8 months and at use of additional fixing implants by means of a
titaniumic miniplate - no more than 6 months. Thus, use at open sinuslifting
additional fixing dental implants with the help of titaniumic miniplates, has allowed to
reduce terms full osseointegration not less, than to 2 months.
At closed sinuslifting (antrolifting ) full osseointegration dental implants passed
in terms from 3 till 5 months and there were in direct dependence on number entered
implants, heights of an alveolar bone and use of additional fixing with the help of a
titaniumic miniplate. At introduction 2-3 dental implants without additional fixing
terms osseointegration were 5 months, and at additional fixing - 4 months, i.e. for 1
month it is less. At introduction of one implant without additional fixing terms
osseointegration have made 3,5-4 months and depend on height of a bone part of an
alveolar process maxilla bones, and at use for additional fixing dental implant a
titaniumic miniplate - no more than 3 months, i.e. were reduced approximately to 15-
30 days. It is necessary to note, that at use in quality bone-seeking bioceramics Bio-
Granа or Kergapа, we have not revealed an authentic difference in terms
osseointegration depending on a used biomaterial.
Summing up to results of investigation of patients of II group of supervision, we
have noted, that Thermoassymetry a mucous membrane of an alveolar process of the
maxilla in the postoperative period authentically raised in both subgroups of
supervision. However it is necessary to note, that thermoassymetry at open
sinuslifting was authentically above in comparison with patients by whom has been
lead{has been carried out} closed sinuslifting. Direct dependence of normalization
94
thermoasymmetric is established in the field of a postoperative wound from
clinical current of the rehabilitation period at patients with antrolifting. At favorable
current of the postoperative period normalization thermoasymmetric is observed in 7
days after performance antrolifting. At development of inflammatory complications in
the postoperative period normalization thermoasymmetric occurs within 14-18 days.
Thus, on the basis of the lead{carried out} studying local temperature of a mucous
membrane of an alveolar process after the lead{carried out} operation antrolifting, we
have established, that the given investigation has prognostic value and can be used for
definition of the forecast of current of healing of a wound in the postoperative period.
Results of investigation of patients of II group of supervision with use of a
method pothencyometry have shown, that at open (traditional) sinuslifting these
parameters (the potential difference, force of a current, electric conductivity)
authentically did not differ among themselves as at use of additional fixing dental
implants by means of a titaniumic miniplate, and without its{her} application. It is
marked, that after installation implants at traditional sinuslifting parameters
pothencyometry authentically differed from norm and were the following: a potential
difference - 120,7 ± 4,8 mV (р <0,001), force of a current - 8,8 ± 0,4 mcA (р <0,001)
and electric conductivity - 11,8 ± 0,8 mcSim (р <0,001), and at closed antrolifting - a
potential difference - 62,7 ± 3,2 mV (р <0,001), force of a current - 5,2 ± 0,4 mcA (р
<0,001), electric conductivity - 5,3 ± 0,4 mcSim (р <0,001). Thus it is established,
that parameters pothencyometry at installation dental implants at patients with open
sinuslifting in 2 times was higher in comparison with closed antrolifting. This
tendency was kept next day after the lead{carried out} operation. For 7-10 day the
difference between these parameters in the first and second subgroups of supervision
was kept. In one month after operation of size of all parameters pothencyometry
remained on
95
authentic (р <0,001) the raised{increased} level with patients with open
sinuslifting (the first subgroup), and at closed antrolifting (the second subgroup) they
were normalized (except for electric conductivity). At open sinuslifting normalization
of all sizes electropothencyometry occured only in 3-4 months after the lead{carried
out} operative intervention. We establish direct dependence between size of a
potential difference, force of a current, electric conductivity of an oral liquid and a
kind of operative intervention (open or closed antrolifting). Also the authentic
difference and direct dependence between number established implants and size of
parameters pothencyometry is revealed. It is marked, that in process osseointegration
decrease{reduction} in these parameters is always observed. Normalization of them
occurs much faster at closed antrolifting (in 1 month after operation), than at open
sinuslifting (in 3-4 months). By us it is revealed, that the size of electric conductivity
of an oral liquid depend on clinical current reparative processes. At favorable current
normalization of this parameter occurs in 1 month (closed antrolifting) or 2-3 months
(open sinuslifting). At inflammatory complications in the field of a postoperative
wound normalization of this parameter is observed for 0,5-1,5 months later, that it is
possible to use with forecasting the purpose.
Investigation of patients of the first subgroup of II group of supervision (open
sinuslifting) has shown, that terms osseointegration without additional fixing make
from 7 till 8 months after performance of operation, and at use of additional fixing
with the help of a titaniumic miniplate - 5-6 months, i.e. not less than for 2 months it
is less. By us also it has been marked, that terms osseointegration always depend on
number entered dental implants. At their number more than 3, without additional
fixing, terms osseointegration have made not less than 8 months, and at its{her} use -
no more than 6 months, i.e. for 2 months it is less.
96
At patients of the second subgroup of II group of supervision (closed antrolifting)
terms osseointegration occured during from 3 till 5 months. These terms also were in
direct dependence on number entered implants, heights of an alveolar process maxilla
bones and use of additional fixing by a titaniumic miniplate. At implantation 2-3
implants without additional fixing terms osseointegration were about 5 months, and at
its{her} application - 4 months, i.e. for 1 month it is less. By us also it has been
marked, that at introduction of one implant without additional fixing terms
osseointegration have made 3,5-4 months and always were in direct dependence on
height of an alveolar process and on use of additional fixing. At application of last
terms osseointegration made not less than 15-30 days are less. We also have found
out, that terms osseointegration did not depend from us of used bioceramics (Bio-
Granа or Kergapа), i.e. The given biomaterials possessed practically identical
osseoplastic properties.
Studying of a functional condition of peripheral branches of a trigeminal nerve at
surveyed has shown II groups of supervision, that for 7 day after carrying out
antrolifting parameters of conductivity authentically raised in comparison with
healthy people and were the following: at open sinuslifting (135,5 ± 2,8 standard unit
) and at closed antrolifting -(123,9 ± 1,6 standard unit ) . In the first subgroup of II
group of supervision parameters of conductivity were authentically (р <0,01) above in
comparison with the second subgroup. In 1 and 3-4 months after operation open
sinuslifting parameters of conductivity at these patients remained at a former level,
i.e. authentically did not change, and were normalized only in 5-6 months. Parameters
of conductivity of peripheral branches of a trigeminal nerve in 1 month after operation
still remained with patients by whom has been lead{has been carried out} closed
antrolifting, at authentically raised{increased} level, and to 3 to month after the
lead{carried out} operation they were normalized. On the basis of the lead{carried
out} investigation it is possible to assert{approve}, that operations closed
97
antrolifting pass with smaller damage of peripheral branches of nerves which
conductivity is restored within the first months after its{her} performance, i.e. in 2
times is faster in comparison with open sinuslifting. Thus, operative interventions
closed antrolifting should be preferred in comparison with an open method of its{her}
carrying out.
Studying of size of conductivity of peripheral branches of a trigeminal nerve has
shown, that the highest figures (more than 150 standard unit) were observed at open
sinuslifting, it is especial at occurrence of postoperative complications.
During performance open (traditional) sinuslifting 5 patients (21,7 % of cases)
had punching of a mucous membrane of a bottom a sinus of maxilla . At these
patients we closed the formed defect a collagenic membrane which covered an
internal surface of a cavity with available defect and with subsequent its{her} filling
osseoplastic a material, and then this material also covered outside of similar with a
biomembrane and mucose-peryosteal flap. In these, complicated, cases open
sinuslifting, we used parodentium membranes with term resorption 8-12 months, and
osseointegration dental implants also passed in longer terms - not less than 8 months
after operation.
At closed antrolifting , executed by the standard method at 21 surveyed
(sinuslifting-15 persons, nasolifting-6 persons), punching of a mucous membrane
maxilla sinus is registered at 4 (26,7 %) patients, and at nasolifting - at 2 (33,3 %)
patients is revealed punching of a mucous membrane of a bottom nasalis cavities. At
performance closed antrolifting by a technique offered{suggested} by us (with use
silicone) such complications we did not observe a cylinder - expander. It allows us to
assert{approve}, that the method of closed antrolifting with application a silicone
cylinder - expander
98
offered{suggested} by us is the most safe and preferable method before similar
operative interventions which are carried out without his{its} use.
Application after carrying out of operation open or closed antrolifting as
anesthetizing means of a preparation ketanov, and with the anti-inflammatory purpose
- Tcyphran СТ has allowed us to lead{carry out} adequate anesthesia and to avoid
inflammatory complications in the postoperative period.
99
CHAPTER{HEAD} 5
RESULTS OF INVESTIGATION OF PATIENTS
THE THIRD GROUP OF SUPERVISION
The third group of supervision was made by 53 patients with sufficient on height,
but insufficient (thickness) on width an alveolar process top and mandibles. Among
surveyed there were 27 women and 26 men. Distribution surveyed on age and a sex is
submitted in tab.2.1. The third group of supervision has been divided{shared} into 2
subgroups: the first subgroup - 29 patients in whom at installation defect of a bone
wall of an alveolar process with the subsequent closing this defect bone-seeking
bioceramics (Bio-Gran - at 20 persons has been found out, Kergap - at 9 persons) and
a biomembrane; the second subgroup - 24 patients by whom operation of splitting
offered{suggested} by us and expansions of alveolar processes on top and mandibles
has been applied.
In the first subgroup of supervision the insufficient width of an alveolar process
arose more often due to postoperative deformations. At detection of an exposure
dental implant (fig. 5.1) defect covered bone-seeking by bioceramics with the
subsequent closing by a biomembrane (plaster or collagenic).
In the second subgroup of the third group of supervision we carried out{spent}
operative intervention offered{suggested} by us - splitting and expansion of an
alveolar process of a jaw. The schematic image of the given operative intervention at
a narrow alveolar process is submitted on fig. 5.2.
100
Fig. 5.1-a. In-time introduction dental implant defect of a bone wall (it is
specified by an arrow{a pointer}) a box dental implant is found out.
Fig. 5.1-b. Bone defect is covered bone-seeking with bioceramics (Bio-Gran).
101
Fig. 5.1-v. The bone-seeking bioceramics is covered bioresorb with a membrane
(Capset).
The substantiation of a method offered{suggested} by us is connected by that at
preparation by traditional way intrabone the box for implant at a narrow alveolar
process to us is necessary to drill a part of a bone fabric which is located on his{its}
crest. After it will be created bone to a box for dental implant, both bone walls
(vestibular and palatine or lingual) it is significant superfine. That has a negative
effect on osseointegrative processes and further functional value endoosseous implant
is reduced.
Therefore we had been offered operation on a thickening of an alveolar process
which is based on his{its} splitting (division) and his{its} subsequent expansion. As
already earlier by us it has been told, that schematically this operative intervention can
be presented as follows. In the beginning of operation, i.e. the after exfoliation a
mucoperiosteum’s flap, it is strict on the middle of a crest it is done{made} has drunk
102
bones along an alveolar process of a jaw on corresponding depth and length (fig. 5.2-
b, 5.2-v).
Fig. 5.2-a. Has drunk an alveolar process it is carried out{is spent} strictly on
his{its} middle.
Then the chisel or a chisel is entered to separate and part bone walls of an
alveolar process.
Fig. 5.2-b. Introduction of a chisel in a place has drunk an alveolar process on the
maxilla.
103
Fig. 5.2-v. Introduction of a chisel in a place has drunk an alveolar process on the
mandible.
As is known, his{its} bone walls spring (because of their elasticity) and aspire to
borrow{occupy} former position. If there is a crisis of one of bone walls springing
properties of a bone are lost and are considerably slowed down osseointegrative
processes. Therefore it is necessary to aspire to move apart these bone walls for the
width which does not exceed those of thickness implant. For these purposes it is
necessary to use metal wedges (fig. 5.2-g) which inserted between bone walls. The
given metal wedges were used only during carrying out of operative intervention for
separation displacement and keeping in extended position of bone walls of an alveolar
process maxilla or mandible bones. For introduction metal dental a wedge used the
tool designed by us (fig. 5.2-d). Further with use of traditional tools formed to a box
for necessary number dental implants, inserted them, and then deleted wedges.
104
Fig. 5.2-g. Appearance metal dental a wedge in comparison with dental
endoosseous implant.
Fig. 5.2-d. Appearance metal dental a wedge and the tool for his{its}
introduction.
105
By virtue of the elasticity, after removal{distance} of metal (titaniumic) wedges
fragment s of a bone, springing, densely nestle to established dental implant, i.e. bone
walls of an alveolar process try to nestle to each other.
Now we shall consider carrying out of the given operative intervention by the
example of the patient. The after exfoliation a mucoperiosteum’s flap, in a zone of
carrying out of operative intervention, did{made} has drunk (division) of a bone on
top of a crest of an alveolar process of a jaw for the corresponding length and depth.
By the special tool (fig. 5.2-d), after cultivation (separation) of bone walls of an
alveolar process, were entered dental metal (titaniumic) wedges which have been
fixed on strings. And then started formation bone a box for entered endoosseous
implants (fig. 5.3-a).
Fig. 5.3-a. Between bone walls of an alveolar process are entered dental wedges
which are fixed on strings. Between external and internal bone walls of an alveolar
process formation bone a box for endoosseous implant is carried out{spent}.
106
Carried out consecutive introduction dental implants by formation bone a box in
defect between bone (external and internal) walls of an alveolar process of a jaw (fig.
5.3-b) with the help of tools traditionally used in these cases.
Fig. 5.3-b. Between bone walls of an alveolar process of a jaw deduction dental
wedges is kept and consecutive introduction endoosseous implants are carried
out{spent}.
After consecutive introduction of necessary number endoosseous dental implants
(fig. 5.3-b) carried out{spent} gradual removal{distance} of metal wedges (from the
center to periphery) which have been fixed on strings. After removal{distance} of
titaniumic wedges, bone walls of an alveolar process were compressed, but
nevertheless between bone walls there was a defect of a bone. For filling this bone
defect the bioceramics (Bio-Gran or Kergap) was used Bone-seeking.
On fig. 5.3-v the stage of operative intervention with filling bone defect between
walls of an alveolar process a synthetic
107
bone is submitted. Further an operational wound covered resorbed with a
biomembrane, mucose-peryosteal flap and sewed up nonabsorbable suture which
removed for 7-9 day after carrying out of operative intervention. It is necessary to
note, that use of metal wedges negatively did not affect stages of formation bone a
box and introduction endoosseous dental implant.
Fig. 5.3-v. After introduction endoosseous implants gradual removal{distance}
dental wedges and filling of bone defect between bone walls bone-seeking
bioceramics is carried out{spent}.
After introduction dental implants in a bone at patients of the first subgroup we
carried out{spent} potentiometry. Results of last are submitted in tab. 5.4.
Table 5.4
108
Results of carrying out pothencyometry at patients
The first subgroup of III group of supervision in dynamics{changes} of
investigation
Dynamics{Changes} of investigation of
patients
Number surveyed
Parameters pothencyometry A potential
difference (in mV)
Force of a current (in
mcA)
Electric conductivity (in mcSim)
At introduction implants
14 61,4 ± 2,8 р <0,001
5,3 ± 0,3 р <0,001
5,5 ± 0,3 р <0,001
In 1 day 14 50,7 ± 2,4 р <0,001
3,6 ± 0,2 р <0,001
4,2 ± 0,3 р <0,001
In 7-10 days 14 32,9 ± 1,9 р <0,05
3,1 ± 0,2 р <0,05
3,7 ± 0,3 р <0,01
In 1 month 14 15,7 ± 1,3 р> 0,05
2,4 ± 0,1 р> 0,05
2,7 ± 0,2 р> 0,05
In 3-4 months 14 12,9 ± 1,2 р> 0,05
1,6 ± 0,2 р> 0,05
1,6 ± 0,2 р> 0,05
Norm (according to the literature)
From 15 up to
22 From 1,1 up
to 2,0 From 1,5 up
to 2,0
The note: р - reliability of distinctions in comparison with norm.
It is marked, that at patients of the first subgroup at once after introduction dental
implants it was observed authentic (р <0,001) increase of parameters pothencyometry:
potential differences - up to 61,4 ± 2,8 mV; forces of a current - 5,3 ± 0,3 mcA;
electric conductivity of an oral liquid - 5,5 ± 0,3 mcSim.
At patients of the second subgroup parameters pothencyometry are submitted in
tab. 5.5. At measurement of sizes of potentials at once after introduction dental
implants in this subgroup of supervision it has been established, that they it is
authentic (р <0,001) increased on all investigated parameters: a potential difference -
up to 108,0 ± 4,9 mV; force of a current - 8,9 ± 0,5 mcA;
109
electric conductivity of an oral liquid - 9,9 ± 0,5 mcSim. It is necessary to note,
that sizes of investigated parameters in the second subgroup were authentically (р
<0,001) above in comparison with the first subgroup of this group. In our opinion, it
is connected by that in the second subgroup during operation three were entered at
least dental implant, and in the first subgroup - only individual since implantation was
carried out{was spent} in the field of bone defects.
Table 5.5
Results of carrying out pothencyometry at patients
The second subgroup of III group of supervision in dynamics{changes} of
investigation
Dynamics{Changes} of investigation of
patients
Number surveyed
Parameters pothencyometry A potential
difference (in mV)
Force of a current (in
mcA)
Electric conductivity (in mcSim)
At introduction implants
15 108,0 ± 4,9 р <0,001
8,9 ± 0,5 р <0,001
9,9 ± 0,5 р <0,001
In 1 day 15 96,7 ± 3,1 р <0,001
7,0 ± 0,5 р <0,001
7,3 ± 0,4 р <0,001
In 7-10 days 15 74,7 ± 3,3 р <0,001
5,5 ± 0,5 р <0,001
4,9 ± 0,3 р <0,001
In 1 month 15 47,3 ± 3,3 р <0,01
4,3 ± 0,4 р <0,001
3,1 ± 0,3 р <0,05
In 3-4 months 15 27,3 ± 2,4 р> 0,05
2,5 ± 0, 3 р> 0,05
1,4 ± 0,1 р> 0,05
Norm (according to the literature)
From 15 up to
22 From 1,1 up
to 2,0 From 1,5 up
to 2,0
The note: р - reliability of distinctions in comparison with norm.
Clinical semiology which would be connected to increase of force of a current,
potential differences and electric conductivity of an oral liquid in an oral cavity, to us
to reveal it was not possible.
110
Thermoassymetry a mucous membrane of an alveolar process of the top and
mandible at once after carrying out dental implantations with use bone-seeking
bioceramics and biometry (the first subgroup) authentically did not change both in the
center, and on periphery of a postoperative wound (tab. 5.6).
Table 5.6
Thermoassymetry a mucous membrane of an alveolar process at patients of
the first subgroup of III group of supervision
Terms of investigation of
patients
Number surveyed
Thermoassymetry (in degrees Celsius) In the center of a
postoperative wound On periphery of a
postoperative wound At once after operations
15 0,6 ± 0,1 р> 0,05
0,5 ± 0,1 р> 0,05
In 1 day 15 1,2 ± 0,1 р <0,001
1,1 ± 0,1 р <0,001
In 3 days 15 1,6 ± 0,1 р <0,001
1,5 ± 0,1 р <0,001
In 7 days 15 0,9 ± 0,1 р <0,05
0,7 ±0,1 р> 0,05
Control group (healthy people)
22 0,5 ± 0,1
The note: р - reliability of distinctions in comparison with healthy people.
After carrying out of operative intervention in the first subgroup of supervision
of authentic changes in parameters thermoasymmetric a mucous membrane both in
the center of an operational wound, and on its{her} periphery, we have not found out
(tab. 5.6). Similar changes of local temperature have been revealed and in the second
subgroup of supervision (tab. 5.7).
111
Table 5.7
Thermoassymetry a mucous membrane of an alveolar process at patients of the
second subgroup of III group of supervision (at patients operation of splitting
and expansion of an alveolar process is lead{carried out})
Terms of investigation of
patients
Number surveyed
Thermoassymetry (in degrees Celsius) In the center of a
postoperative wound
On periphery of a postoperative wound
At once after operations
17 0,5 ± 0,1 р> 0,05
0,5 ± 0,1 р> 0,05
In 1 day 17 0,9 ± 0,1 р <0,05
0,8 ± 0,1 р <0,05
In 3 days 17 1,2 ± 0,1 р <0,001
1,1 ± 0,1 р <0,001
In 7 days 17 0,5 ±0,1 р> 0,05
0,5 ± 0,1 р> 0,05
Control group (healthy people)
22 0,5 ± 0,1
The note: р - reliability of distinctions in comparison with healthy people.
After introduction dental implants in a bone, in dynamics {changes}
osseointegration, us it has been lead{it has been carried out} Periotestmetry at patients
of both subgroups of supervision. In the first subgroup of supervision, at once after
installation dental implant with a covering of defect of a bone bone-seeking
bioceramics and a biomembrane, we have noted, that parameters periotestmetry were
equal 14,6 ± 0,7 standard unit (р <0,001), i.e. they authentically differed from norm
and corresponded{met} to patients with the easy form of disease parodentium (tab.
5.8). At patients of the second subgroup of supervision, i.e. at those to whom
operation of splitting and expansion of an alveolar process was carried out{was
spent}, we have revealed steadier position dental implants. Parameters of
112
periotestmetry in this term have made 12,9 ± 0,8 standard unit (р <0,001), but all of
them authentically differed from norm (tab. 5.9).
Table 5.8
Parameters periotestmetry at patients of the first subgroup
III groups of supervision
Terms of investigation of patients
Number surveyed
Parameters periotestmetry
M ± m (in standard unit ) Р
At installation implant 16 14,6 ± 0,7 <0,001 In 3-4 months 16 8,4 ± 0,5 <0,01 In 5 months 16 3,8 ± 0,3 > 0,05 In 6 months 16 0,8 ± 0,8 > 0,05
Control group - healthy people (according to the
literature) From-5 up to +5 standard unit
The note: р - reliability of distinctions in comparison with healthy people.
Table 5.9
Parameters periotestmetry at patients of the second subgroup
III groups of supervision (after operation of splitting and expansion of an
alveolar process)
Terms of investigation of patients
Number surveyed
Parameters periotestmetry
M ± m (in standard unit ) Р
At installation implant 16 12,9 ± 0,9 <0,001 In 3-4 months 16 2,7 ± 0,6 > 0,05 In 5 months 16 0,1 ± 0,7 > 0,05
Control group - healthy people (according to the
literature) From-5 up to +5 standard unit
The note: р - reliability of distinctions in comparison with healthy people.
113
Next day after performance of operative intervention parameters pothencyometry
were reduced in both subgroups of supervision (tab. 5.4 and 5.5). In the first subgroup
of supervision parameters pothencyometry were the following: a potential difference -
50,7 ± 2,4 mV (р <0,001), force of a current - 3,6 ± 0,2 mcA (р <0,001) and electric
conductivity of an oral liquid - 4,2 ± 0,3 mcSim (р <0,001). That is authentic
decrease{reduction} in these parameters in the first subgroup of supervision next day
the lead{carried out} investigation is marked. In the second subgroup authentic
decrease{reduction} in parameters pothencyometry up to the following sizes also is
marked: a potential difference - 96,7 ± 3,1 mV (р <0,001), force of a current - 7,0 ±
0,5 mcA (р <0,001) and electric conductivity of an oral liquid - 7,3 ± 0,4 mcSim (р
<0,001).
Thermoassymetry a mucous membrane of an alveolar process the next day
supervision at patients of the first subgroup authentically raised in the center of a
postoperative wound up to 1,2 ± 0,1 ºС (р <0,001) and on periphery of a wound - up
to 1,1 ± 0,1 ºС (р <0,001), and in the second subgroup these sizes were smaller, but
also authentically raised{increased}: in the center of a postoperative wound - 0,9 ±
0,1 ºС (р <0,05), and on periphery - 0,8 ± 0,1 ºС (р <0,05).
Thus, next day after operation in the first subgroup of supervision parameters
pothencyometry were reduced, and thermoasymmetric - raised. The same law is
marked and in the second subgroup. At comparison of the first and second subgroups
of supervision among themselves during this period of investigation it is revealed, that
in the first subgroup these parameters were authentically lower in comparison with the
second subgroup.
Schiller - Pisarev's test in the first and in the second subgroups has made 1,4 ±
0,3 points. Green - Vermillion’s index - 0,7 ± 0,1 (in the first subgroup) and 0,8 ± 0,1
(in the second subgroup).
At patients of the first subgroup parameters thermoasymmetric continued to
increase for the third day of investigation: in the center of a postoperative wound up
114
to 1,6 ± 0,1 ºС (р <0,001), and on its{her} periphery - up to 1,5 ± 0,1 ºС (р <0,001).
In the second subgroup similar changes, but with lower parameters are marked: in the
center of a postoperative wound - 1,2 ± 0,1 ºС (р <0,001), and on periphery of a
wound - up to 1,1 ± 0,1 ºС (р <0,001). During this period of investigation parameters
thermoasymmetric in the second subgroup were authentically lower in comparison
with the first subgroup of supervision.
Schiller - Pisarev's test at patients of the first subgroup was 1,5 ± 0,4 points, and
in the second - 1,6 ± 0,3 points. Green - Vermillion’s index was estimated as
satisfactory and in the first subgroup has made 0,7 ± 0,08, and in the second - 0,6 ±
0,09.
For the seventh day after carrying out of operative intervention parameters
pothencyometry were authentically reduced, but still remained on authentically high,
in comparison with norm, figures. In the first subgroup of supervision these
parameters were the following: a potential difference - 32,9 ± 1,9 mV (р <0,05); force
of a current - 3,1 ± 0,2 mcA (р <0,05); electric conductivity of an oral liquid - 3,7 ±
0,3 mcSim (р <0,01). In the second subgroup of size of these parameters were the
following: a potential difference - 74,7 ± 3,3 mV (р <0,001); force of a current - 5,5 ±
0,5 mcA (р <0,001); electric conductivity of an oral liquid - 4,9 ± 0,3 mcSim (р
<0,001). The difference between parameters pothencyometry in the first and second
subgroups of supervision is caused by that in the first subgroup has been used, as a
rule, single dental implants, and in the second - not less than three, and is $more often
more than three implants.
For the seventh day of investigation of patients in the first subgroup of
supervision the local temperature (tab. 5.6) in the center of an operational wound (0,9
± 0,1 ºС, р <0,05) was not normalized. In the second subgroup - the local temperature
was normalized both in the center of a postoperative wound, and on its{her}
periphery (tab. 5.7).
115
For the seventh day of investigation of patients of the first subgroup of III group
of supervision we carried out{spent} definition of a functional condition of peripheral
branches of a trigeminal nerve. Results of investigation of these patients are submitted
in tab. 5.10.
Table 5.10
Functional condition of peripheral branches of a trigeminal nerve at patients of
the first subgroup of III group of supervision
Terms of investigation of
patients
Parameters of conductivity of a nerve (in standard unit ) Number surveyed
On the maxilla Number surveyed
On the mandible
In 7 days 12 140,3±4,5 р <0,001
11 148,9±4,7 р <0,001
In 1 month 12 133,7±5,7 р <0,001
11 150,1±5,2 р <0,001
In 3-4 months 12 127,4±3,9 р <0,01
11 130,9±3,2 р <0,05
In 5-6 months 12 114,2±4,4 р> 0,05
11 122,3±3,6 р> 0,05
Control group (healthy people)
24 107,2±1,9 24 113,0±11,8
The note: р - reliability of distinctions in comparison with healthy people.
At patients of the first subgroup of supervision authentic increase of parameters
of conductivity of a nerve as on the maxilla (140,3±4,5 s.u. was marked., р <0,001),
and on the mandible (148,9±4,7 standard unit , р <0,001). Thus, by us it is
established, that the given parameters authentically differed from group of healthy
people.
In the second subgroup (tab. 5.11) for 7 day of investigation we did not observe
authentic changes in electrophysiological parameters of peripheral branches of a
116
trigeminal nerve, i.e. operation of splitting and expansion of an alveolar process is not
traumatic for peripheral branches of a trigeminal nerve.
Table 5.11
Functional condition of peripheral branches of a trigeminal nerve at patients of
the second subgroup of III group of supervision
Terms of investigation of
patients Parameters of conductivity of a nerve (in standard unit )
Number surveyed
On the maxilla Number surveyed
On the mandible
In 7 days 12 116,3±2,1 р> 0,05
12 121,3±2,2 р> 0,05
In 1 month 12 115,0±2,0 р> 0,05
12 123,4±1,2 р> 0,05
In 3-4 months 12 106,4±0,9 р> 0,05
12 117,4±1,8 р> 0,05
Control group (healthy people)
24 107,2±1,9 24 113,0±11,8
The note: р - reliability of distinctions in comparison with healthy people.
In the first subgroup of III group of supervision from 29 patients as anesthetizing
means at 17 persons. Appointed traditionally used analgesics (analginum, etc.), and at
12 persons. - used ketanov (not steroid analgesic). With the purpose of preventive
maintenance of the inflammatory phenomena to 19 patients the standard antibiotics of
a wide spectrum of action (ampicillin, oxacillini, ampioxy, etc.) have been applied,
And to 10 patients - antibiotic Tcyphran-СТ (tcyprophloxatcini with tinidazolium). As
a result of the given investigation by us it is established, that at application
ketanovand use Tcyphran-СТ postoperative current passed more smoothly than at the
appointed traditional medicamentous treatment. At use in the postoperative period for
treatment standard
117
analgesics for 3 day the symptom of a pain is revealed at 12 persons. (70,6 %),
and for 7 day - at 6 patients (35,3 %). With patients by whom has been used ketanov
for 3 day of supervision of a pain have remained at 5 persons. (in 41,7 %), and for 7
day at 2 persons. (16,7 %). At application Tcyphran СТ a postoperative hypostasis,
and hyperemia a mucous membrane of an alveolar process disappeared in 1,4 times
faster, than at purpose{assignment} of traditional antibacterial preparations.
In the second subgroup of III group of supervision for postoperative anesthesia
from 24 patients traditional analgesics are applied at 14 persons. , and ketanov - at 10
persons. For anti-inflammatory therapy from 24 patients traditional antibiotics are
used at 15 persons. , and Tcyphran СТ - at 9 persons. In this subgroup we also have
noted high anesthetizing efficiency ketanovand anti-inflammatory - Tcyphran the
ITEM. At use at 14 patients for postoperative anesthesia traditional analgesics for 3
day of treatment of a pain were kept at 10 persons. (71,4 %), and for 7 day - at 5
persons. (35,7 %). At application ketanov at 10 patients postoperative pains for 3 day
after operation are revealed at 4 persons. (40,0 %), and for 7 day - at 1 persons. (10,0
%). Using for preventive maintenance of the inflammatory phenomena of an
antibacterial preparation Tcyphran СТ we have noted, that at these patients a
hypostasis, and hyperemia a mucous membrane of an alveolar process disappeared in
1,5 times faster, than at application of traditional antibacterial means.
In 1 month after carrying out of operative intervention in the first subgroup of III
group of supervision parameters pothencyometry were normalized on all investigated
parameters. In the second subgroup of it does not occur, and parameters
pothencyometry were the following: a potential difference - 47,3 ± 3,3 mV (р
<0,001); force of a current - 4,3 ± 0,4 mcA (р <0,001); electric conductivity of an oral
liquid - 3,1 ± 0,3 mcSim (р <0,05). Last parameters authentically differed from group
of healthy people. Parameters pothencyometry authentically differed in the second
subgroup, in comparison with the first. These changes have been revealed only
118
because in the second subgroup for implantation three were used at least dental
implant, and in the first subgroup - one or a maximum two (by tab. 5.4 and 5.5).
Definition of a functional condition of peripheral branches of a trigeminal nerve
in 1 month after operation has shown, that in the first subgroup of supervision of
changes practically was not observed in comparison with the previous period (tab.
5.10), i.e. they remained authentically raised{increased} in comparison with norm. In
the second subgroup of supervision of changes of electrophysiological parameters of
peripheral branches of a trigeminal nerve we have not noted both in this term of
investigation, and during the previous period.
In 1 month after operation Schiller - Pisarev's test was estimated on 1 point in
both subgroups of supervision. Green - Vermillion’s index it was estimated in the first
subgroup 0,4 ± 0,2, and in the second - 0,5 ± 0,2, i.e. hygiene of an oral cavity was
estimated as good.
In 3-4 months after carrying out of operative intervention parameters
pothencyometry authentically did not differ from group of healthy people both in the
first, and in the second subgroups of supervision (tab. 5.4 and 5.5). The parameter
periotestmetry in the first subgroup was not normalized and authentically differed
from norm (tab. 5.8), and in the second subgroup in these terms normalization of the
given parameter (tab. 5.9) has been revealed. Terms osseointegration dental implants
in the first subgroup of supervision occured during the period from 5 till 6 months
after operation, and in the second - in 3-4 months (tab. 5.8 and 5.9).
In 3-4 months after operation in the first subgroup of supervision authentic
changes of electrophysiological parameters of a functional condition of peripheral
branches of a trigeminal nerve, both on top, and on mandibles were marked (tab.
5.10). In the second subgroup of supervision normalization of electrophysiological
parameters of a functional condition of peripheral branches of a trigeminal nerve both
on top, and on mandibles is revealed (tab. 5.11).
119
Summing up to results of investigation of patients of III group of supervision we
have established, that changes of local temperature in the field of a postoperative
wound has the certain law. We have revealed, that at all surveyed this group of
supervision in the postoperative period authentic increase of local temperature that
was shown by change (increase) thermoasymmetric a mucous membrane of an
alveolar process of a jaw was marked. The peak of her{it}, i.e. the highest parameter
of local temperature, have been marked for 3-rd day after carrying out of operative
intervention irrespective of a subgroup of supervision. For 7 day after the executed
operation parameters of local temperature were normalized, i.e. on the party{side} of
the lead{the carried out} operative intervention and the healthy party{side}
parameters of local temperature of a mucous membrane of an alveolar process of a
jaw authentically did not differ among themselves. Us it is revealed, that if the
postoperative period proceeded smoothly normalization of local temperature occured
in earlier specified terms. At presence of the inflammatory phenomena in the field of
a postoperative wound high parameters of local temperature were kept not 3 days (as
at smooth current), and 7-8 days with the subsequent normalization of local
temperature within 14-15 days. On the basis of the lead{carried out} investigation of
patients in this group of supervision we could establish authentically, that
measurement of local temperature in the field of a postoperative wound at carrying
out dental implantations in the first and second subgroups of III group of supervision
has prognostic value and can be used for definition of the forecast of current of
healing of a bone wound in the postoperative period at patients by whom the surgical
stage dental implantations was carried out{was spent}.
Studying of parameters pothencyometry has shown, that in the first subgroup of
III group of supervision of size of all parameters were authentically lower in
comparison with the second subgroup. The potential difference, force of a current and
electric conductivity of an oral liquid at patients of the first subgroup were normalized
in 1 month, and in the second subgroup - only in 3-4 months after operative
120
intervention. In our opinion, it is connected by that in the first subgroup of this group
for dental implantations, in connection with presence of defects of a bone, were used
only individual implants, and in the second subgroup - from three and more intrabone
implants. The raised{increased} parameters pothencyometry in the second subgroup
clinically anything did not show themselves. The degree of increase of these
parameters in the second subgroup always depend on number entered dental implants
and was directly proportional to their number. At introduction of three implants
parameters pothencyometry in 1,5 times were lower, than at introduction of five
implants. Thus, it is established, that sizes of parameters pothencyometry are directly
proportional to number established intrabone dental implants. By us also it has been
marked, that at presence of the inflammatory phenomena in the field of a
postoperative wound and (or) at adverse current reparative processes electric
conductivity of an oral liquid was normalized more slowly, than at favorable current.
Backlog in normalization of the given parameter was marked for 15-30 day in
comparison with patients in similar subgroups of investigation. Hence it is possible to
assert{approve}, that the parameter of electric conductivity of an oral liquid can be
used with forecasting the purpose at patients at carrying out of a surgical stage dental
implantations.
Terms osseointegration dental implants, on parameters periotestmetry, at patients
of the first subgroup (with defect of a bone wall of an alveolar process and his{its}
subsequent closing bone-seeking bioceramics and a biomembrane) were observed
during the period from 5 till 6 months after operative intervention. Osseointegration
dental implants at patients of the second subgroup (persons by whom operation of
splitting and expansion of an alveolar process of a jaw was carried out{was spent})
were observed in terms from 3 till 4 months, i.e. for 1-2 months it is less, than in the
first subgroup.
Studying an electrophysiological condition of peripheral branches of a trigeminal
nerve at patients of the first subgroup of III group of supervision it is necessary to
121
note, that conductivity of a nerve in 7 days after implantation authentically changed:
on the maxilla - 140,3 ± 4,5 standard unit (р <0,001), and on the mandible - 148,9 ±
4,7 (р <0,001). In dynamics{changes} of spent treatment the parameter of
conductivity of peripheral branches of a trigeminal nerve decreased by 3-4 month of
treatment, but remained in the first subgroup authentically raised{increased} and was
normalized only in 5-6 months after the lead{carried out} operative intervention. At
patients of the second subgroup of III group of supervision, i.e. at carrying out of
operation of splitting and expansion of an alveolar process of a jaw the parameter of
conductivity of peripheral branches of a trigeminal nerve remained within the limits
of norm at all stages of spent treatment. It, in our opinion, has been connected to
feature of spent operative intervention when the break of an alveolar process of a jaw
is carried out{spent}, instead of its{her} full crisis and consequently was not observed
damages of peripheral branches of a trigeminal nerve that performs this operation
preferable before others.
Application after carrying out of operative interventions (both in the first, and in
the second subgroups of III group of supervision) for postoperative anesthesia of a
preparation ketanov, and for preventive maintenance of the inflammatory phenomena
- Tcyphran СТ has shown advantage of the given medicamentous means before
traditionally appointed. Use of preparations ketanov and Tcyphran СТ has allowed to
lead{carry out} adequate anesthesia and to avoid the inflammatory phenomena in a
bone wound in the postoperative period.
122
CHAPTER{HEAD} 6
DISCUSSION OF RESULTS OF INVESTIGATION OF PATIENTS BY
WHICH DIFFERENT SURGICAL METHODS OF CARRYING OUT
DENTAL OF IMPLANTATION ARE APPLIED
Under supervision and investigation 151 patient by whom implantation on top
and mandibles has been lead{has been carried out} endoosseous was treated. To all
these patients the surgical stage intrabone dental implantations with subsequent
his{its} orthopedic end has been executed. All surgical (standard and additional
interventions) stages dental implantations were carried out{spent} in the Center dental
implantations Amman (Jordan). Additional surgical interventions at carrying out
endoosseous dental implantations on top and mandibles are made at 110 patients.
All surveyed patients by whom implantation was carried out{was spent}
endoosseous dental, have divided{shared} into three groups:
I group - 41 patient with sufficient on height and sufficient on width an alveolar
process top and mandibles;
II group - 57 patients with insufficient height of an alveolar process of the
maxilla;
III group - 53 patients with sufficient on height, but insufficient on width an
alveolar process top and mandibles.
For the decision of a question on necessity of carrying out of additional operative
intervention on maxilla bones, depending on a degree of an atrophy of alveolar
processes, we have taken advantage of the classification offered{suggested} Misch
C.E. (1987).
Depending on a degree of expressiveness of an atrophy of alveolar processes
maxilla bones the author of them has divided{shared} into 4 groups (SA1-SA4). The
first group (SA1) included surveyed with height of an alveolar process more than 12
123
mm, i.e. with absence of an atrophy of an alveolar process. Persons are included in the
second group (SA2) with an insignificant atrophy of an alveolar process (height of an
alveolar process of 10-12 mm). In the third group (SA3) - a moderate atrophy, i.e.
between edge{territory} of an alveolar crest and a bottom maxilla sinus the height of
an alveolar process makes 5-10 mm. Persons are included in the fourth group (SA4)
with a significant atrophy of an alveolar process, the height of a bone from an alveolar
crest to the bottom a sine makes up to 5 mm.
For definition of indications and contra-indications of inclusion of patients in I
and we used III groups of supervision both classification Misch C.E. (1987), and
classification Cawood I.I. and Howell R.A. (1988). According to these classifications
sufficient on height it is considered an alveolar process at his{its} height in 12-14
mm, and insufficient on width - at his{its} sizes in 3,5-5 mm. It is considered, that
that reparative regeneration at implantation proceeded is high-grade it is necessary to
have thickness external and internal bone walls around implant not less than 1 mm.
After selection of patients by us in the first group (41 persons) supervision we
carried out a surgical stage of introduction endoosseous dental implants under the
traditional circuit.
The second group of supervision was made by 57 patients with insufficient
height of an alveolar process of the maxilla. The second group of supervision has
consisted of 2 subgroups: the first group - 23 patients by whom operation open
(traditional) sinuslifting has been lead{has been carried out}; the second subgroup -
34 patients by whom the operative intervention called closed antrolifting (25 person -
closed sinuslifting and 9 person - closed nasolifting) is executed.
Traditional open sinuslifting (the first subgroup ІІ groups of supervision) at 11
patients it is lead{is carried out} by the standard method, and at 12 patients - with our
updating. Updating open sinuslifting consist that the after exfoliation a
mucoperiosteum’s flap on a crest of an alveolar process, i.e. there where in the future
allocation cylindrical implants with the help of titaniumic screws is planned, the
124
titaniumic miniplate of the necessary sizes becomes stronger, and further to it{her} fix
dental implants.
The given surgical method of carrying out dental implantations c use of a
titaniumic miniplate for fixing implants is closed since after a
premise{room}endoosseous implants in a bone and their fixing to a titaniumic
miniplate, a mucous membrane and periosteum above them sew up, and
osseointegration occurs in conditions of dissociation implants to an oral cavity. This
method of implantation also can be named two-phasic since at the first stage there is a
healing (engraftment) dental implants which are fixed to a titaniumic miniplate, and at
the second stage (the after osseointegration) - removal (removal{distance}) fixing
implants a titaniumic miniplate by operative disclosing a postoperative wound with
the subsequent detorsion titaniumic screws and removal of a miniplate.
Closed antrolifting (the second subgroup ІІ groups of supervision) it is lead{is
carried out} at 34 patients. From them at 25 person we have executed closed
sinuslifting, and at 9 - closed nasolifting. At 22 patients at their realization in quality
osteoplastic material it is used Bio-Gran, and at 12 - Kergap. Closed sinuslifting and
nasolifting it was applied at installation 1-2 and much less often 3 dental implants.
Closed antrolifting by a traditional technique it is applied at 21 patients, and by a
technique offered{suggested} by us - at 13 patients. The traditional technique closed
antrolifting is in detail described in the literature. Therefore we shall describe
technics{technical equipment} of performance of operation closed antrolifting (a sine
and nasolifting) by a technique offered{suggested} by us with use a silicone cylinder -
expander (a method of a stretching of soft fabrics).
After carrying out exfoliation a mucoperiosteum’s flap in a necessary site of a
jaw formed the bone channel for dental implant. Formation bone a box for
endoosseous dental
125
implant carried out at the minimal revolutions - no more than 500-600 revo. In
the beginning carried out{spent} drilling a bone under the control depth-gaugeа.
Checked depth-gauge depth of penetration of the tool and compared her{it} to
thickness of an alveolar process on orthopantomogram. After between a bottom of the
bone channel and a bottom maxilla sinus or cavities of a nose there was the bone
partition equal of 1-1,5 mm, into the bone channel inserted an equal tube on diameter
through which entered a silicone cylinder - expander.
In process of filling a silicone cylinder a liquid (it was carried out with the help
compressive the device in which pressure was created and thus was filled the
cylinder). The maximal pressure in it{him} should not exceed 248 Mbar.The silicone
cylinder in regular intervals extended and broke a bone bottom of the channel due to a
liquid which was in a silicone cylinder. In such way in regular intervals and gradually
the mucous membrane of a bottom maxilla sinus (a cavity of a nose) exfoliated and
the cavity which further was filled osseoplastic by a material was created. Then the
tube together with expander from the bone channel left and through it{her} filling the
formed cavity osseoplastic by a material with the subsequent introduction
endoosseous dental implant was carried out{was spent}.
For maintenance of additional fixing single implant, at his{its}
presence{finding} in a bone less than half of length implant, we have offered carrying
out of his{its} fixing with the help of a titaniumic miniplate which became stronger
on a vertical to an alveolar process maxilla bones the titaniumic screw.
The third group of supervision was made by 53 patients with sufficient on height,
but insufficient (thickness) on width an alveolar process top and mandibles. The third
group of supervision has been divided{shared} into 2 subgroups: the first subgroup -
29 patients in whom at installation defect of a bone wall of an alveolar process with
the subsequent
126
closing this defect bone-seeking bioceramics (Bio-Gran - at 20 persons has been
found out., Kergap - at 9 persons) and a biomembrane; the second subgroup - 24
patients by whom operation of splitting offered{suggested} by us and expansions of
alveolar processes on top and mandibles has been applied.
In the first subgroup of III group of supervision the insufficient width of an
alveolar process arose more often due to postoperative deformations. At detection of
an exposure dental implant defect covered bone-seeking by bioceramics with the
subsequent closing by a biomembrane (plaster or collagenic).
In the second subgroup of III group of supervision we carried out{spent}
operative intervention offered{suggested} by us - splitting and expansion of an
alveolar process of a jaw.
The substantiation of a method offered{suggested} by us is connected by that at
preparation intrabone the box for implant in the traditional way at a narrow alveolar
process to us is necessary to drill a part of a bone fabric which is located on his{its}
crest. After it is generated bone to a box for dental implant, both bone walls
(vestibular and palatine or lingual) it is significant superfine. That has a negative
effect on osseointegrative processes and further functional value endoosseous implant
is reduced.
With the purpose of preservation of all thickness of bone walls of an alveolar
process by us operation on his{its} thickening which is based on his{its} splitting
(division) and his{its} subsequent expansion has been offered. Schematically this
operative intervention can be presented as follows. In the beginning of operation, i.e.
the after exfoliation a mucoperiosteum’s flap, it is strict on the middle of a crest it is
done{made} has drunk bones along an alveolar process of a jaw on corresponding
depth and length.
As is known, bone walls of an alveolar process, after their division and
cultivation, spring (because of their elasticity) and aspire to borrow{occupy} former
position, i.e. are compressed. If there is a crisis of one of bone walls springing
127
properties of a bone are lost and are considerably slowed down osseointegrative
processes. Therefore it is necessary to aspire to move apart these bone walls for the
width which does not exceed those of thickness dental implant. For these purposes we
have offered metal wedges which inserted between bone walls. We used these metal
wedges only during carrying out of operative intervention, i.e. for separation
displacement and keeping in extended position of bone walls of an alveolar process
maxilla or mandible bones. For introduction metal dental a wedge used the tool
designed by us. Then by means of traditional tools formed bone to a box for necessary
number dental implants, inserted them, and then deleted these wedges (after
installation implants).
By virtue of the elasticity, after removal{distance} of metal (titaniumic) wedges
fragment s of a bone, springing, densely nestle to established dental implant, i.e. bone
walls of an alveolar process try to nestle to each other. However after
removal{distance} of titaniumic wedges between bone walls there was a bone defect.
For filling this bone defect used bone-seeking bioceramics (Bio-Gran or Kergap).
Further an operational wound covered resorbed with a biomembrane, mucose-
peryosteal flap and sewed up nonabsorbable suture which removed for 7-9 day after
carrying out of operative intervention. It is necessary to note, that use of metal wedges
negatively did not affect stages of formation bone a box and introductions
endoosseous dental implant.
Surveying patients I of group of supervision (with sufficient on height and
width an alveolar process), we have noted, that for them was available in the
postoperative period Thermoassymetry a mucous membrane of an alveolar process in
the field of a postoperative wound at once after end of operation. The local
temperature on the part of the lead{carried out}
128
operative intervention was below symmetrically a healthy site (we estimated
her{it} as with the minus is familiar). It has been connected to infringement
vascularity a mucoperiosteum’s flap at his{its} formation (exfoliation). The next day
after operation dental implantations the local temperature raised and
Thermoassymetry authentically differed from norm, that also is marked and for the
third day after carrying out of operation. Normalization of local temperature was
observed only in 7 days after operative intervention. We establish direct dependence
between a degree of expressiveness of increase of local temperature and number
entered dental implants, that necessarily it is necessary to take into account at the
analysis of the received local temperature data since at these patients is longer was
kept Thermoassymetry in the postoperative period. At presence post-implantological
inflammatory complications or at more traumatic to the lead{the carried out}
technique of implantation at patients I of group the local temperature remained is
longer (for 2-3 days longer than in typical cases) on authentically high figures, that
specified an opportunity of use of this test (measurement local thermoasymmetric)
with forecasting the purpose.
Surveying patients of II group of supervision (with insufficient height of an
alveolar process of the maxilla), we have revealed, that Thermoassymetry a mucous
membrane of an alveolar process of the maxilla in the postoperative period
authentically raised in both subgroups of supervision (at open and closed antrolifting
). However it is necessary to specify, that Thermoassymetry at open sinuslifting was
authentically above in comparison with patients by whom has been lead{has been
carried out} closed sinuslifting. Direct dependence of normalization
thermoasymmetric is established in the field of a postoperative wound from clinical
current of the rehabilitation period at patients with antrolifting. At favorable current of
the postoperative period normalization thermoasymmetric is observed in 7 days after
performance antrolifting.
129
At development of inflammatory complications in the postoperative period
normalization thermoasymmetric occurs within 14-18 days. Thus, on the basis of the
lead{carried out} studying local temperature of a mucous membrane of an alveolar
process after the lead{carried out} operation antrolifting, we have established, that the
given investigation has prognostic value and can be used for definition of the forecast
of current of healing of a wound in the postoperative period at these patients.
By results of investigation of patients with insufficient (thickness) on width an
alveolar process of a jaw (III group of supervision), we have established, that changes
of local temperature in the field of a postoperative wound had the certain law. We
have revealed, that at all surveyed this group of supervision in the postoperative
period authentic increase of local temperature that was shown by change (increase)
thermoasymmetric a mucous membrane of an alveolar process of a jaw was marked.
The peak of her{it}, i.e. the highest parameter of local temperature, have been marked
for 3-rd day after carrying out of operative intervention irrespective of a subgroup of
supervision. For 7 day after the executed operation parameters of local temperature
were normalized, i.e. on the party{side} of the lead{the carried out} operative
intervention and the healthy party{side} parameters of local temperature of a mucous
membrane of an alveolar process of a jaw authentically did not differ among
themselves. Us it is revealed, that if the postoperative period proceeded smoothly
normalization of local temperature occured in earlier specified terms. At presence of
the inflammatory phenomena in the field of a postoperative wound high parameters of
local temperature were kept not 3 days (as at smooth current), and 7-8 days with the
subsequent normalization of local temperature within 14-15 days. On the basis of the
lead{carried out} investigation of patients in this group of supervision we could
establish authentically, that measurement of local temperature in the field of a
postoperative wound at carrying out dental implantations in the first and second
subgroups of III group of supervision has prognostic value and can be used for
130
definition of the forecast of current of healing of a bone wound in the postoperative
period.
Results of investigation of patients of the first group of supervision by a method
pothencyometry specified that At once after introductions dental implant in bone to a
box there was an authentic increase of a difference of electric potentials up to
89,4±3,6 mV, forces of a current up to 7,5±0,4 mcA and electric conductivity of an
oral liquid up to 10,1±0,8 mcSim. In 2-3 hours after introduction implant and his{its}
stay in conditions of a mouth parameters of a potential difference, force of a current
and electric conductivity doubtfully were reduced and remained on high figures.
Within 7-10 days after dental implantations parameters pothencyometry decreased,
but remained authentically raised{increased}. Normalization of parameters of a
potential difference and force of a current occured only in 1 month after operation,
and electric conductivity of an oral liquid - in 3-4 months after implantation. We
establish direct dependence between parameters pothencyometry (size of a potential
difference, force of a current, electric conductivity of an oral liquid) and number
entered dental implants. It is marked, that at all surveyed in dynamics{changes} of
current osseoregeneration (osseointegration) decrease{reduction} and normalization
of parameters pothencyometry was observed. We have revealed, that the size of
electric conductivity of an oral liquid always depend on current osseoregeneration
processes in a bone wound. At favorable current - normalization of this parameter
occured in terms till 1 month after operation, and at adverse current (delay of
processes of formation{education} of a bone) - during 1,5 and even 2 months after
end of operation. At periimplantitis we at all these patients (4 persons) Observed high
figures of electroconductivity of an oral liquid which exceeded normal amounts in
two and more times. Normalization of this parameter occured only after elimination
of it postimplantation inflammatory complication.
131
Results of investigation of patients of II group of supervision with use of a
method pothencyometry have shown, that at open (traditional) sinuslifting these
parameters (the potential difference, force of a current, electric conductivity)
authentically did not differ among themselves as at use of additional fixing dental
implants by means of a titaniumic miniplate, and without its{her} application. It is
marked, that after installation implants at traditional sinuslifting parameters
pothencyometry authentically differed from norm and were the following: a potential
difference - 120,7 ± 4,8 mV (р <0,001), force of a current - 8,8 ± 0,4 mcA (р <0,001)
and electric conductivity of an oral liquid - 11,8 ± 0,8 mcSim (р <0,001), and at
closed antrolifting - a potential difference - 62,7 ± 3,2 mV (р <0,001), force of a
current - 5,2 ± 0,4 mcA (р <0,001), electric conductivity of an oral liquid - 5,3 ± 0,4
mcSim (р <0,001). Thus it is established, that parameters pothencyometry at
installation dental implants at patients with open sinuslifting in 2 times was higher in
comparison with closed antrolifting. This tendency was kept next day after the
lead{carried out} operation. For 7-10 day a difference between these parameters in
the first (open antrolifting) and the second subgroups (closed antrolifting) supervision
was kept. In one month after operation of size of all parameters pothencyometry
remained on authentically raised{increased} (р <0,001) a level with patients with
open sinuslifting (the first subgroup), and at closed antrolifting (the second subgroup)
they were normalized (except for electric conductivity of an oral liquid). At open
sinuslifting normalization of all sizes electropothencyometry occured only in 3-4
months after the lead{carried out} operative intervention. We establish direct
dependence between size of a potential difference, force of a current, electric
conductivity of an oral liquid and a kind of operative intervention (open or closed
antrolifting). Also the authentic difference and direct dependence between number
established implants and size of parameters pothencyometry is revealed. It is marked,
that in process osseointegration decrease{reduction} in these parameters was always
observed. Normalization of them occured much faster at closed antrolifting (in 1
132
month after operation), and at open sinuslifting (in 3-4 months). By us it is revealed,
that the size of electric conductivity of an oral liquid always depend on clinical
current reparative processes. At favorable current normalization of electric
conductivity of an oral liquid occured in 1 month (closed antrolifting) or 2-3 months
(open sinuslifting). At inflammatory complications in the field of a postoperative
wound normalization of this parameter was observed for 0,5-1,5 months later, that it
is possible to use with forecasting the purpose.
Studying of parameters pothencyometry at patients has shown, that in the first
subgroup (with defect of a bone wall) (with sufficient on height, but insufficient width
an alveolar process) supervision of size of all parameters were authentically lower
than III group in comparison with the second subgroup (at patients by whom
operation of splitting and expansion of an alveolar process is applied). The potential
difference, force of a current and electric conductivity of an oral liquid at patients of
the first subgroup were normalized in 1 month, and in the second subgroup - only in
3-4 months after operative intervention. In our opinion, it is connected by that in the
first subgroup of this group for dental implantations, in connection with presence of
defects of a bone, were used only individual implants, and in the second subgroup -
from three and more intrabone dental implants. The raised{increased} parameters
pothencyometry in the second subgroup clinical semiology of did not show. The
degree of increase of these parameters in the second subgroup always depend on
number entered dental implants. At introduction of three implants parameters
pothencyometry in 1,5 times were lower, than at introduction of five implants. Thus,
it is established, that sizes of parameters pothencyometry are directly proportional
133
to number established intrabone dental implants. By us also it has been marked,
that at presence of the inflammatory phenomena in the field of a postoperative wound
and at adverse current reparative processes electric conductivity of an oral liquid was
normalized more slowly, than at favorable current. Backlog in normalization of the
given parameter was marked for 15-30 day in comparison with patients in similar
subgroups of investigation. Hence, it is possible to assert{approve}, that the
parameter of electric conductivity of an oral liquid can be used with forecasting the
purpose at patients at carrying out of a surgical stage dental implantations for
forecasting current osseoregeneration processes.
Investigation of patients I of group of supervision by a method periotestmetry
has shown, that high-grade osseoreparative processes on the maxilla were observed in
5 months after installation dental implants, and on the mandible - in 6 months. High-
grade osseointegration in these terms it was observed it is not dependent on number
entered implants and it was defined{determined} by a place of carrying out of
implantation (the top or mandible).
We have analysed clinical outcomes osseointegration which were observed by
us around endoosseous dental implants in a jaw with different on thickness and
density bone walls. It is established, that at the raised{increased} density of a bone (I
type on Параскевич В.Л., 1998) and thickness of bone walls in 1 mm from 17
implants favorable outcomes were observed only at 11 persons. (in 64,7 %), and at
thickness in 1,5 mm and more - at all 16 persons. (in 100 % cases). At aveflape and
low density of a bone fabric and thickness of bone walls in 1-1,5 mm we observed
favorable osseointegrative outcomes only in 5 cases from 23 established implants, i.e.
in 21,7 % cases, and at thickness in 2 mm and more - at all surveyed (in 100 %).
Complications were observed as resorption edges{territories} of an alveolar crest or
denudation parts dental implant,
134
that demanded further use osteoplastic materials for closing the bared sites
dental implant.
Investigation of patients of the first subgroup of II group of supervision (open
sinuslifting) has shown, that terms osseointegration without additional fixing made
from 7 till 8 months after performance of operation, and at use of additional fixing
with the help of a titaniumic miniplate - 5-6 months, i.e. not less than for 2 months it
is less. By us also it has been marked, that terms osseointegration always depend on
number entered dental implants. At their number more than 3, without additional
fixing, terms osseointegration have made not less than 8 months, and at its{her} use -
no more than 6 months, i.e. for 2 months it is less.
At patients of the second subgroup of II group of supervision (closed antrolifting
) terms osseointegration occured during from 3 till 5 months. These terms also were in
direct dependence on number entered implants, heights of an alveolar process maxilla
bones and use of additional fixing by a titaniumic miniplate. At implantation 2-3
dental implants without additional fixing terms osseointegration were about 5 months,
and at its{her} application - 4 months, i.e. for 1 month it is less. By us also it has been
marked, that at introduction of one implant without additional fixing terms
osseointegration have made 3,5-4 months and always were in direct dependence on
height of an alveolar process and on use of additional fixing. At application of last
terms osseointegration made not less than for 15-30 days less. We also have found
out, that terms osseointegration did not depend from us of used bioceramics (Bio-
Granа or Kergapа), i.e. The given biomaterials possessed practically identical
osseoplastic properties.
Terms osseointegration dental implants, on parameters periotestmetry, at patients
of the first subgroup of III group of supervision (with defect of a bone wall of an
alveolar process and his{its} subsequent
135
closing bone-seeking bioceramics and a biomembrane) were observed during the
period from 5 till 6 months after operative intervention. Osseointegration dental
implants at patients of the second subgroup (persons by whom operation of splitting
and expansion of an alveolar process of a jaw was carried out{was spent}) were
observed in terms from 3 till 4 months, i.e. for 1-2 months earlier, than in the first
subgroup.
At studying a functional condition of peripheral branches of a trigeminal nerve
in dynamics{changes} of healing of a bone wound after carrying out endoosseous
dental implantations in favorable conditions (I group of supervision), we have
revealed, that 20 person by whom have been established implants on the maxilla, the
clinical semiology posttraumatic neuritis has arisen at 4 person, i.e. in 20,0 % cases,
and on the mandible at 8 of 21 patients, i.e. in 38,0 % cases. The mechanism of
occurrence posttraumatic neuritis on the maxilla mechanical damage of the nerve is
possible to explain damage as integrity of bone blood vessels (there are haemorrhages
and hematomas which squeeze peripheral nervous fibres), and, probably, at formation
bone a box for implant. The mechanism of development posttraumatic neuritis on the
mandible speaks as damage of a bone wall mandible the channel with the subsequent
wound of a nerve, and occurrence of bone haemorrhages as a result of infringement of
integrity of vessels with the subsequent mechanical compression nervous trunks.
Feature of these neuritis is that the damaging{injuring} factor (dental implant) after
drawing a trauma remains in the same place and in conditions of a long compression
long current of the given neurologic complication is marked slow resorption of
hematomas (haemorrhage), and consequently, and.
At studying size of conductivity of a nerve it is established, that the highest
figures (170-180 standard unit ) were observed at patients at mechanical damage of
the top wall mandible the channel, and also at traumatized peripheral nervous
branches
136
or at presence of bone haemorrhages (150-160 standard unit ). These figures of
conductivity of a nerve were always observed during 1-2 month after carrying out of
operation of implantation and were in direct dependence on number entered dental
implants, and also extensiveness of the damaging{injuring} factor. At favorable
postoperative current conductivity of nervous fibres was restored in 3-4 months on the
maxilla or 5-6 months - on the mandible. We observed restoration of conductivity of a
nerve at all surveyed patients I of group of supervision.
Studying of a functional condition of peripheral branches of a trigeminal nerve at
surveyed has shown II groups of supervision, that for 7 day after carrying out
antrolifting parameters of conductivity authentically raised in comparison with
healthy people and were the following: at open sinuslifting (135,5 ± 2,8 standard unit
) and at closed antrolifting - (123,9 ± 1,6 standard unit ) . In the first subgroup of II
group of supervision (open antrolifting) parameters of conductivity were authentically
(р <0,01) above in comparison with the second subgroup. In 1 and 3-4 months after
operation open sinuslifting parameters of conductivity at these patients remained at a
former level, i.e. authentically did not change, and were normalized only in 5-6
months. At patients, by whom has been lead{has been carried out} closed antrolifting
(the second subgroup), parameters of conductivity of peripheral branches of a
trigeminal nerve in 1 month after operation remained at authentically
raised{increased} level, and to 3 to month after the lead{carried out} operation they
were normalized. On the basis of the lead{carried out} investigation it is possible to
assert{approve}, that operations closed antrolifting pass with smaller damage of
peripheral branches of nerves which conductivity is restored within the first months
after its{her} performance, i.e. in 2 times is faster in comparison with open
sinuslifting. Thus, operative intervention closed antrolifting it is necessary to prefer in
comparison with an open method of its{her} carrying out.
137
Studying of size of conductivity of peripheral branches of a trigeminal nerve has
shown, that the highest figures (more than 150 standard unit ) were observed at open
sinuslifting, it is especial at occurrence of postoperative complications.
During performance open (traditional) sinuslifting 5 patients (21,7 % of cases)
had punching of a mucous membrane of a bottom a sinus of maxilla . At these
patients we closed the formed defect a collagenic membrane which covered an
internal surface of a cavity with available defect and with subsequent its{her} filling
osseoplastic a material, and then this material also covered outside of similar with a
biomembrane and mucose-peryosteal flap. In these, complicated, cases open
sinuslifting, we used parodentium membranes with term resorption 8-12 months, and
osseointegration dental implants also passed in longer terms - not less than 8 months
after operation.
At closed antrolifting , executed by the standard method, punching of a mucous
membrane maxilla sinus is registered at 4 (26,7 %) patients, and at nasolifting - at 2
(33,3 %) patients is revealed punching of a mucous membrane of a bottom nasalis
cavities. At performance closed antrolifting by a technique offered{suggested} by us
(with use silicone) such complications we did not observe a cylinder - expander. It
allows us to assert{approve}, that the method offered{suggested} by us closed
antrolifting with application a silicone cylinder - expander is the most safe and
preferable before similar operative interventions which are carried out without
his{its} use.
Studying an electrophysiological condition of peripheral branches of a trigeminal
nerve at patients of the first subgroup it is necessary to note, that conductivity of a
nerve in 7 days after implantation authentically
138
changed: on the maxilla - 140,3 ± 4,5 standard unit (р <0,001), on the mandible -
148,9 ± 4,7 (р <0,001). In dynamics{changes} of spent treatment the parameter of
conductivity of peripheral branches of a trigeminal nerve decreased by 3-4 month of
treatment, but remained in the first subgroup authentically raised{increased} and was
normalized only in 5-6 months after the lead{carried out} operative intervention. At
patients of the second subgroup of III group of supervision, i.e. at carrying out of
operation of splitting and expansion of an alveolar process of a jaw the parameter of
conductivity of peripheral branches of a trigeminal nerve remained within the limits
of norm at all stages of spent treatment. It, in our opinion, has been connected to
feature of spent operative intervention when the break of an alveolar process of a jaw
is carried out{spent}, instead of its{her} full crisis and consequently damage of
peripheral branches of a trigeminal nerve that performs this operation preferable
before others was not observed.
Application after carrying out typical endoosseous implantations, and also at
operations open and closed antrolifting or at other operative interventions at a stage of
installation endoosseous implants as anesthetizing means of a preparation ketanov,
and with the anti-inflammatory purpose - Tcyphran СТ has allowed us to lead{carry
out} adequate anesthesia and to avoid inflammatory complications in the
postoperative period at all surveyed patients.
139
CONCLUSIONS
In the dissertation the actual scientific - practical problem{task} of dentistry-
perfection of surgical methods of treatment, expansion of indications for their
application and increase of efficiency of carrying out intrabone dental implantations at
patients with defects of dental numbers{lines} and jaws is solved.
1. On the basis of the lead{carried out} researches it is proved, that intrabone
dental implantation can be carried out with high efficiency at an atrophy of an
alveolar process maxilla bones of a significant degree of expressiveness. For this
purpose at open and closed sinusliftingх it is offered to use additional fixing intrabone
dental implants by means of titaniumic miniplates, fixing is carried out
simultaneously with installation endoosseous implants. Parameters pothencyometry (a
potential difference, force of a current and electric conductivity of an oral liquid)
authentically do not differ among themselves as at traditional, and modified (with
application of additional fixing) sinusliftingх. Use of the modified technique
sinuslifting allows to reduce terms osseointegration to 2 months and more in
comparison with a traditional method.
2. With the purpose of careful exfoliation a mucous membrane maxilla sinus or
cavities of a nose from a bone the technique of carrying out of operation closed
antrolifting by a method of a stretching of fabrics - with the help of application a
silicone cylinder - expander is offered. Filling of the last with a liquid is carried out
with the help compressive the device at the maximal pressure no more than 248 Mbar.
Use a silicone cylinder at closed antrolifting allows in regular intervals and without
perforations to exfoliation a mucous membrane of a bottom maxilla sinus or cavities
of a nose and, thus to create a cavity which further is filled
140
by a osseoplastic material with the subsequent installation intrabone dental
implants. Application of offered{suggested} operation by us allows to liquidate
occurrence of complications during performance of operative intervention as
punching a mucous membrane which at traditional closed sinuslifting is observed at
26,7 % of patients, and at closed nasolifting - at 33,3 % surveyed and to reduce terms
osseointegration.
3. It is established, that at the raised{increased} density of a bone and thickness
of bone walls (external or internal) in 1 mm favorable outcomes are observed in 64,7
% cases, and at thickness in 1,5 mm and more - in 100 %. At aveflape and low density
of a bone fabric and thickness of bone walls in 1-1,5 mm favorable outcomes
osseointegration are registered in 21,7 % cases, and at thickness in 2 mm and more -
at all (100 %) surveyed patients. Thus it is possible to come to a conclusion, that for
favorable current osseointegration at the raised{increased} density of a bone around
of intrabone dental implant it is necessary to keep thickness of a bone wall not less
than 1,5 mm, and at aveflape and low density of a bone - not less than 2 mm.
4. At performance of traditional surgical methods of installation intrabone dental
implants damage of peripheral branches of a trigeminal nerve with infringement of
his{its} function is observed. At typical endoosseous implantations on the maxilla of
the phenomenon posttraumatic neuritis are revealed in 20,0 %, and on the mandible -
in 38,0 % cases. It is proved, that infringement of a functional condition of a
peripheral nerve is restored in 1-3-5 months after the lead{carried out} operation.
Duration of the period of infringement of a functional condition of a trigeminal nerve
is in direct dependence on a technique of carrying out of operative intervention, a jaw
on which operation and numbers established endoosseous dental implants is carried
out.
5. For preservation of the maximal thickness and height of lateral bone walls of
an alveolar process at carrying out dental to implantation
141
at patients with sufficient on height and insufficient on width the alveolar process
top or mandibles offers operation of splitting and expansion of an alveolar process
with use dental wedges. Studying of a functional condition of a trigeminal nerve has
shown, that due to application of this surgical method of operative intervention for
installation intrabone dental implants it was possible to avoid damage of his{its}
peripheral branches and has allowed to reduce terms osseointegration to 1-2 months.
6. Objective tests of efficiency of carrying out of operation and the forecast of
current of the postoperative period at endoosseous dental implantations is the contact
thermometry and definition of electric conductivity of an oral liquid. If for 7 day after
the lead{carried out} operative intervention there is no normalization of local
temperature and (or) the size of a parameter of electric conductivity of an oral liquid it
specifies development of postoperative inflammatory complications and a delay
osseoregeneration processes in a place of carrying out of implantation does not
decrease.
142
Practical recommendations
1. At a presence{finding} dental implant in an alveolar process maxilla bones
less than 30 % from his{its} length are recommended to carry out {spend} their
additional fixing with the help of a titaniumic miniplate. For strengthening single
intrabone dental implants it is offered to fix a miniplate to maxilla bones, and at
installation several endoosseous dental implants - to fasten them among themselves a
miniplate to their subsequent closing mucose-peryosteal flap.
2. For convenience of performance of installation intrabone dental implants at
carrying out of operation of splitting and expansion of alveolar jaws processes during
realization of operative intervention, it is offered to use dental wedges and the tool for
their introduction.
3. For completion of defects and deformations of bone walls of alveolar
processes jaws, and also for filling the cavities formed during operation at carrying
out sinuslifting, it is recommended to use resorption synthetic osteoplastic material -
Bio-Gran and Kergap.
4. After carrying out typical endoosseous or the operative intervention connected
to installation dental implants, and also in dynamics{changes} osseointegration, the
condition of peripheral branches of a trigeminal nerve in a place of performance of
operative intervention is recommended to define{determine} implantations by
definition of painful, tactile or temperature sensitivity of fabrics, by innervation this
nerve.
5. After carrying out endoosseous dental implantations or performance of the
operative interventions connected to installation intrabone implants, it is
recommended to use as anesthetizing means ketanov, and with the anti-inflammatory
purpose - Tcyphran the ITEM.
143
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