The dissertation is devoted to a comprehensive study of the problem of post - extraction complications, mainly inflammatory (pain, edema, contracture), in patients with retention and dystopia of the third molars of the mandible.
The aim of the study is to increase the effectiveness of surgical treatment of patients with retention of third molars on the mandible by optimizing the processes of osteogenesis and eliminating postoperative complications in the area of postoperative bone defects.
Modern clinical, laboratory and microbiological researches were used in the work. Statistical methods - to analyze the results of the study and evaluate the success of treatment.
To determine the structure and frequency of inflammatory complications associated with retention of the third molars of the mandible, we performed a retrospective analysis of 814 case histories of patients with this diagnosis who were in the inpatient phase of treatment among people of working age (19 to 60 years, mean age 39.5 ± 4.6 years) in the maxillofacial department according toKZ "Dnepropetrovsk Regional Clinical Hospital named after I.I Mechnikov" in the period 2012-2015. 206 (25,3 %) patients were diagnosed with complications related to with retention of TMJ: acute odontogenic osteomyelitis 89 (43,2 %) cases, chronic odontogenic osteomyelitis 7 (3,4 %) cases, acute odontogenic lymphadenitis 51 (24,8 %) cases, pericoronaritis 57 (27,7 %) and phlegmon 2 (0,97 %) cases. Such data indicate a significant prevalence of this disease and related inflammatory complications.
At the first (preoperative) stage of treatment, general and local anti-inflammatory therapy was performed, and after the disappearance of clinical signs of inflammation for 3-5 days, further tooth extraction was performed. At the time of treatment, almost all patients had clinical signs of inflammation around the half-cut lower third molar (soft tissue edema, reddening of the hood mucosa, serous or purulent exudation). According to the indications, a mucosal "hood" was dissected.
In the second (surgical) stage, three groups were formed depending on the method of filling the post-extraction defects. The first group consisted of patients who underwent a standard protocol for this pathology: performed a curettage of a bone defect after removal of the retinal the third molars of the mandible and filled with its own blood clot, then the wound was sutured tightly.
The third group consisted of patients in whom after removal of retinated / dystopian third molars of the mandible, the bone defect was filled with biomaterial based on demineralized bone matrix tricalcium phosphate (TCP), saturated with recombinant bone morphogenetic protein (rhBMP-2).
Scientific novelty of the results.Scientific data on the prevalence and structure of inflammatory diseases in patients with retention and dystopia of the third molars on the mandible, which are treated comprehensively, combined, including several stages.
A comprehensive study of the biocenosis of retromolar areas, local and systemic immunity in patients with retention and dystopia of the third molars on the mandible, which allowed to establish the risk group for the development of inflammatory complications. The key pathogenetic mechanisms that contribute to the initial period of active inflammation, and later - purulent-inflammatory process, which leads to post-extraction complications, have been identified.
It is shown that traditional therapy in patients with retention and dystopia of the third molars on the mandible is not effective enough to affect osteogenesis in the area of the bone defect.
Clinical and microbiological evaluation of the effectiveness of HELBO-therapy, which was used in the complex prevention and treatment of inflammatory complications in patients with retention and dystopia of the third molars on the mandible. Its advantage over traditional antibacterial action is proved.
On this basis, a method has been developed to fill a bone defect after removal of the lower third molar with difficult eruption.
The treatment of post-extraction inflammatory complications has been improved by applying a set of measures, which includes photodynamic therapy and the use of a mixture of biomaterial based on demineralized bone matrix saturated with recombinant bone morphogenetic protein rhBMP-2. It is proved that the inclusion of these drugs in prophylactic and therapeutic schemes contributes to the full recovery of post-extraction bone defects, reducing inflammatory complications, as well as reducing the recovery time of the patient. Based on the obtained clinical and laboratory data, new highly effective methods for the prevention and treatment of inflammatory complications and recovery of post-extraction bone defects in patients with retention and dystopia of the third molars on the mandible have been proposed
