Urgency of the topic. Chronic post-implantation maxillary sinusitis (CPMS) develops as a result of intraosseal dental prosthetics of the alveolar process of the upper jaw and differs significantly from chronic odontogenic maxillary sinusitis (COMS).
As clinical observations have shown, the basis of the process of pathogenesis is primarily not the banal infection of the maxillary sinus and the initiation of acute, subacute and/or chronic inflammation, but a significant local immunological conflict (decrease in transplantation immunity) due to the presence of a foreign body (implant, fixing membranes) in the region of the sinus of Highmore lower floor. As a result, at first a dystrophic, and later a chronic inflammatory process develops in the region of the maxillary sinus, whereas numerous implants of the mandible (3 and more), practically do not give such kind of complications.
The materials of the thesis are based on the results of the diagnosis, treatment and monitoring of 157 patients who were observed in the clinic of the Department of Otorhinolaryngology of Odesa National Medical University from 2013 to 2016. Of the 157 patients consisting of 83 women and 75 men aged 30-75, there was I main group of 56 patients with CPMS, 2 main group of 60 patients with COMS, 1 control group of 12 practically healthy volunteers who were examined for sanatorium treatment, 2 control group of 29 patients was without clinical manifestations and complaints after performed dental implantation.
As a result of conducted clinical, immunological and radiological studies and analysis of the indices obtained:
Clinical and CT semiotics of CPMS have been studied and developed. The characteristic CTs, densitometric signs and indices of objective availability of CPMS were determined. It was established that proliferative processes predominated in the cavity of the sinus of Highmore in this pathology.
A comparative analysis of the taxonomic spectrum of bacterial strains in patients with post-implantation maxillitis and banal odontogenic sinusitis has been studied, which showed that in the case of CPMS, monocomponent flora (S. Aureus, St. Epidermalis) predominated in most cases (70%) of saprophytic or opportunistic microorganisms in a low level of concentration in cultured strains.
In the course of immunological studies it was found that in the case of CPMS, the immunological anti-infective component in the blood was expressed slightly, but the level of proinflammatory cytokines was significantly higher (2.5 times) than in the control, where the activation of antimicrobial anti-thylogenesis
This suggests that the inflammatory process in CPMS has the post-traumatic character and in its turn requires new approaches to treatment.
Аccording to the CT scan and diagnostic stenosis of the sinuses with obligatory densitometric analysis and microbiological studies in CPMS, in 80.4% of cases there was a productive (hyperplastic) form of inflammation and it was exudative in 19.6%, whereas in COMS the exudative forms of inflammation prevail - 81.7% of patients, and productive in 18.3%, respectively.
A specific treatment regimen for the treatment of CPMS in the stage of clinical manifestations has been developed, including: local and systemic immunotropic drugs (MMTT and ascorbic acid), preparations used in osteoporosis (DSMBA), phytopreparations (BNO 1985). The conducted clinical studies showed no need to use antibiotics in the treatment of CPMS during exacerbations, increasing the effectiveness of the above drugs and reducing the duration of treatment for 5.1 ± 1.1 days.
The application of BNO-1985, MMTT, complex of calcium with trace elements for the prevention of CPMS, and BNO-1985, MMTT and сombined enzyme medication for metaphylactics reduces the risk of morbidity and recurrence on 89,66 % (Р< 0,009).
