The dissertation looks at treatment optimization in dealing with traumatic fractures of the mandible with non-removable orthodontic appliances.
For the clinical study we selected 134 patients with traumatic mandibular fractures of different localizationThe main group A included 40 patients with 46 mandibular fractures of different localization (however, as a rule - in dental areas), who underwent conservative-orthopedic treatment (mono- and intermaxillary fixation, with non-removable orthodontic appliances); main group B included 44 patients with 62 mandibular fractures of different localization received mono- and intermaxillary fixation using non-removable appliances in combination with intraoral or extraoral osteosynthesis with titanium mini-plates 2.0 system with their mono- or bicortical fixation with screws.
In patients of the comparison group, in 36 (72,0%) cases, the results of conservative-orthopedic treatment using traditional wire or brazed splints were good. In all patients, signs of bone fragment consolidation were clinically and radiologically observed at the time of removal of the fixation devices. No palpatory mobility was noted at that time. In the postoperative period, we did not observe any cases of malocclusion. The teeth that were in the fracture gap were stable and showed positive dynamics of sensitivity restoration at EPT.
At the control follow up radiographic examination 20-22 days after the conservative orthopedic or surgical treatment in 37 (92,5%) patients of the main group A and 42 (95,5%) patients of the main group B the fracture lines were practically not traced, merging with the surrounding bone tissue. While in 11 (22,0%) patients of the comparison group, fracture expansion, resorption of bone fragments, unclear shadows of periosteal layers around the lesion area were visualized.
In total, we found 125 cases contained a particular tooth in the fracture gap. On the basis of a careful study of radiographs, we were able to distinguish the main 4 types of correlation between the fracture itself and the tooth root and to compare them with the results of EPT, which allowed us to recommend differentiated treatment tactics for teeth localized in the fracture gap: removal of the teeth with skeletal apical and entire lateral root surface, which showed electroodontometrically no or dramatic decrease in electrical excitability; in other variants of the fracture-tooth correlation, the tooth remained in situ, even with the lack of electrical excitability, but with the obligatory monitoring of sensitivity in the postoperative period and careful splinting of the tooth, in particular with non-removable orthodontic appliances.
Having conducted the timing assessment of the procedures of mono- and intermaxillary fixation with non-removable orthodontic appliances and bent aluminum splints (Tigerstedt splint), it has been established that for a well-trained surgeon the procedure of a non-removable appliance fixation (mono fixation splint) is almost equal in time to a bent wire (arch bar splint) (22,1± 2,3 min. vs. 18,6 ± 2,7 min.) The intermaxillary splint fixation procedure is significantly shorter than the bimaxillary wire splints with hooking loops (52,3 ± 6,5 min. vs 65,2 ± 7,9 min.).
We also conducted the range of evaluation check ups of hygienic and periodontal status (Schiller-Pisarev test with iodine value assessment by Svrakov, the PMA index in the Parma modification after staining the gums with a Schiller-Pisarev solution, J. Silness and H. Loe index, vacuum test by V. M. Kulazhenko) which clearly demonstrates the benefits of intermaxillary fixation with non-removable orthodontic appliances.
Thus, the results of this study enable us to increase the effectiveness of treatment of mandibular traumatic fractures and dislocation of individual teeth by non-removable orthodontic appliances for implementation of mono- and intermaxillary fixation both in the form of an independent conservative-orthopedic treatment and when we need to ensure the correct occlusal ratio under the conditions of mandibular osteosynthesis.
