The thesis to obtain the academic degree of Doctor of Medical Sciences on specialty 14.01.22 – Stomatology. – Bukovinian State Medical University, the Ministry of Health of Ukraine, Chernivtsi, 2023.
The effectiveness of the use of multipotent mesenchymal stromal cells of the adipose tissue and their combinations in performing dental surgery is confirmed in the research. New scientific data concerning the value of multipotent mesenchymal stromal cells of the adipose tissue in the regeneration processes of the osseous tissue of the jaws are obtained. For the first time, osteoblast-like, immunomodulatory, proliferative and phenotypic properties of the multipotent mesenchymal stromal cells of the adipose tissue are studied. The suggested tissue equivalent of the osseous tissue, containing multipotent mesenchymal stromal cells of the adipose tissue, platelet-rich blood plasma and bone tissue substitute based on hydroxyapatite, does not manifest cytotoxicity in the tissue culture and provides a guided differentiation of the multipotent mesenchymal stromal cells into the cells of osteoblastic series. It is confirmed by the detection of alkaline phosphatase activity, staining for osteopontin, expression of the bone BGP protein genes, marked metabolic activity according to Almar Blue test and slow degradation in vivo. The experimental studies using multipotent mesenchymal stromal cells of the adipose tissue combined with platelet-rich blood plasma and bone tissue substitute based on hydroxyapatite resulted in restoration of the cranial bone defects of the experimental animals. Its clinical reasonability is confirmed, which is manifested by a possitive dynamics of the mineral density parameters and bone tissue density, enlargement of the bone tissue surface (р>0,05). Qualitative positive changes of the regeneration structure were confirmed by morphometric, histological and radiological studies concerning the results of both intact rats (р>0,05) and experimental animals of other groups (р1, р2, р3, р4<0,05; 0,01).
Application of the multipotent mesenchymal stromal cells of the adipose tissue combined with platelet-rich blood plasma and bone tissue substitute based on hydroxyapatite was used for regeneration of the bone tissue volume of the alveolar process during sinus-lifting surgery, extraction of teeth and the third retained molar, osteosynthesis in case of mandible fracture. It is found to be characterized by the lowest score of the main clinical symptoms: intensity of pain syndrome– 0,71±0,13 points; collateral swelling – 0,57±0,11 points; hyperemia – 0,37±0,06 points. Radiologic and CT studies found that application of the multipotent mesenchymal stromal cells of the adipose tissue combined with platelet-rich blood plasma and bone tissue substitute based on hydroxyapatite for regeneration of the bone tissue volume of the alveolar process produced a positive effect. In 6-8 months, the areas of defects were filled with new bone tissue identical with the native bone. 12 months later, after observation of the application of the composition with multipotent mesenchymal stromal cells of the adipose tissue combined with platelet-rich blood plasma and bone tissue substitute based on hydroxyapatite, the mineral density of the osseous tissue in the areas of regeneration improved. The average data were 1036,69±55,53 НИ, which was 31,74% higher than application of the bone tissue substitute based on hydroxyapatite, 45,28% higher than in case of spontaneous healing of the bone wound (р, р1<0,01), and it was 68,85% higher than the initial data. Improvement of regenerative processes after application of our composition suggested is confirmed by 28,68% decreased activity of acid phosphatase against the background of increased activity of alkaline phosphatase, and alkaline phosphatase/acid phosphatase ratio by 25,97% and 77,08%, respectively.
Dental implantation in patients after surgery to enlarge the bone tissue volume using tissue technologies is proved to be successful. The use of the tissue equivalent of the osseous tissue promoted improvement of stability of dental implants according to the coefficient of stability of implants. The values of the coefficient were 6,24% higher the data in implant surgery (р<0,01). It was on an average 15,88%, (р1, р2<0,01) higher than in the rest of groups. After 12months of observation, the level of bone tissue resorption in the areas, where dental implants are placed, was found to be the lowest in patients whose volume of the alveolar process bone tissue increased at the expense of the multipotent mesenchymal stromal cells of the adipose tissue combined with platelet-rich blood plasma and bone tissue substitute based on hydroxyapatite.
Key words: adipose tissue, osteotropic materials, jaw bone, bone regeneration, stomatology, third molars, jaw fracture, osteosynthesis, sinus lifting.
