Thesis for a candidate of medical science degree in speciality 14.01.22 «Dentistry» (222 Medicine). – Danylo Halytskyi Lviv National Medical University, Ministry of Health of Ukraine, Lviv, 2020.
The thesis is dedicated to the improvement of the efficiency of complex treatment of patients with jaw fractures associated with periodontal tissue diseases through clinical substantiation of treatment and preventive complex.
The retrospective analysis of the terms and results of treatment of patients with jaw fractures according to the data of Ternopil university hospital during 2013-2017 showed that hospitalization period for the patients with the lower jaw fracture was 23.36 bed-days, while for those with an upper jaw fracture was 24.21 bed-days. 59.51% of the patients were discharged from the inpatient facilities after recovery, 35.32% – after improvement, and there were complications of conducted treatment in 5.17%.
The prevalence of the periodontal tissue diseases among the patients with jaw fractures amounted to 60.4%. Concomitant inflammatory diseases of the periodontal tissues amounted to 32.79%, dystrophic inflammatory diseases – 67.21%.
Conducted clinical and laboratory study and assessment of the results of the treatment showed high efficiency of the use of complex therapy in the treatment of the combined dental pathology reduction, which was conformed by a decrease of the value of plaque accumulation index and PMA index in 2.6 times, PI and tooth loosening in 1.6 times, periodontal pocket depth – 1.8 times, р<0.01 and improvement of the hygienic condition of the oral cavity: reduction of OHI–S index in 1.5 times and RMNPI in 3.0 times compared to the data before treatment, which contributed to the improvement of the clinical flow of jaw fractures; the absence of inflammatory complications, and reduction of bed-days in 1.3 times.
The efficiency of the use of the proposed treatment complex in six months was proved by the increase of density of microbial colonization of saprophytic streptococci associated with the decrease of density of microbial content of Corynebacterium, Neisseria, Enterococcus and S. аureus, Candida, periodontal pathogenic microorganisms Porphyromonas gingivalis, Veillonella and Actinomycetes, measurable with respect to the values before treatment. In the longer terms after treatment, increase of the total protein, albumin, lysozyme, phagocytic index, phagocytosis completeness, phagocytic number was detected. Herewith, there was decrease in the levels of γ-globulin, C-reactive protein, NK-cells CD16+CD56+, compared to the values before treatment. Bone mineral density of the lower and upper jaws in the patients with jaw fractures associated with periodontal tissue diseases in different measurement areas was on average in 1.7 times lower compared to the data of the patients with jaw fractures without concomitant periodontal tissue diseases, p<0.01. The offered treatment in the patients of the main group led to the increase of the level of osteocalcin, С-terminal telopeptide collagen, transforming growth factor and decrease of oxyproline, pyridinoline, cartilage oligomeric matrix protein in blood serum, compared to the values before treatment.
Key words: jaw fractures, periodontal disease, biosynthesis markers, bone tissue density, microbiocenosis.
