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ВИКОРИСТАННЯ АВТОЛОГІЧНОГО ДЕНТИН-ГРАФТУ ДЛЯ ЗАМІЩЕННЯ ОБ’ЄМНИХ ПІСЛЯЕКСТРАКЦІЙНИХ ДЕФЕКТІВ

 УДК: 616.314:615.242-071

Метою цієї роботи було на прикладі об’ємного післяекстракційного дефекту нижньої щелепи оцінити збереження вертикальних параметрів альвеолярного відростка за умов використання композиції автологічного дентин-графту та збагаченого тромбоцитами фібрину у найближчі (3 міс.) та віддалені (12 міс.) терміни спостереження. Об’єкт та методи. Представлено клінічний випадок пацієнтки Ж., 45 р., яка звернулась у відділення щелепно-лицевої хірургії Львівської ОКЛ. Виконано конусно-променеву комп'ютерну томографію, ортопантомографію, проведено хірургічне лікування за рекомендованим протоколом. Результати. Часткова або повна втрата зубів, незалежно від причин її виникнення супроводжується фізіологічною редукцією (атрофією) альвеолярних відростків щелеп у вертикальній та горизонтальній площинах, яка є показанням до кістково-пластичного заміщення післяекстракційних дефектів. Технологія виготовлення та застосування подрібненого зубного дентину для заміщення різноманітних дефектів альвеолярних відростків дозволила розглядати автологічний дентин-графт як “золотий стандарт” регенеративної кісткової хірургії завдяки його унікальним остеогенним, остеоіндуктивним та остеокондуктивним властивостям, а його поєднання зі збагаченим тромбоцитами фібрином, що містить фактори росту, має додатковий
позитивний вплив на загоєння м’яко- та кістково-тканинних ран та регенеративні процеси. Продемонстровано клінічний приклад заміщення об’ємного післяекстракційного дефекту нижньої щелепи з використанням композиції автологічного дентину та збагаченого тромбоцитами фібрину з одномоментною імплантацією. Контрольні променеві обстеження, проведені через 3 та 12 міс. після операції засвідчили, що новоутворена кісткова тканина у ділянці колишніх дефектів не відрізняється за структурою та щільністю від навколишніх ділянок, а що найважливіше – не констатовано жодної вертикальної втрати висоти реконструйованого альвеолярного відростка. Висновок. Усе наведене вище свідчить, що композиція автологічного дентину та збагаченого тромбоцитами фібрину може бути перспективною терапевтичною опцією для заміщення післяекстракційних дефектів, проведення горизонтальної або вертикальної аугментації альвеолярних відростків. 

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Maxillofacial Surgery In Ukraine During A War: Challenges And Perspectives. A National Survey

Introduction. The invasion of Ukraine by Russian troops on February 24th, 2022, and
the beginning of the full-scale war had huge humanitarian consequences. The major
challenges facing the Ukrainian health care system included the disruption of medical
infrastructure and logistics, the termination of the supply of expendable materials,
significant migration and a dramatic increase in high-velocity blast and gunshot injuries
among combatants and civilians.
The aim of the present study was to analyze the challenges and solutions in patient
care faced by the Ukrainian system of maxillofacial surgery during the war in different
regions of the country.
Materials and Methods. A cross-sectional study was designed and implemented as an 
online survey to collect national data concerning maxillofacial surgeons’ experiences
and professional activities. The study was initiated and supported by Bogomolets
National Medical University (Kyiv, Ukraine), the Ukrainian representative of AO CMF
(Arbeitsgemeinschaft für Osteosynthesefragen Craniomaxillofacial Surgery) and the
University of Helsinki (Finland).
The questionnaire was developed by specialists in maxillofacial surgery and
sociologists and contained 65 close-ended questions. Surgeons who had not worked in
this specialty in inpatient departments of hospitals since at least the beginning of the
full-scale war were excluded from the study. We received and analyzed 97 responses
that met the abovementioned criteria. The geography of respondents covered all the
regions and the main cities of Ukraine, expect for the occupied territories.
Results. After a year of warfare, the percentage of surgeons who treated patients with
blast and gunshot injuries increased from 43.4% to 86.6%. This percentage was higher
in military hospitals and in regions located in the vicinity of the front line. We found that,
during the war, 78.6% of respondents performed osteosynthesis in cases of high
velocity multifragmented facial bone fractures (in such cases, 58.3% of them strictly
followed AO CMF recommendations, while 41.7% performed the fixation based on
available hardware, existing technical possibilities and their own preferences). We
found that 70.2% of respondents had the opportunity to apply CAD/CAM technology
and patient specific implants (PSI) for the treatment of gunshot injuries, 38.1% reported
that their hospitals were able to perform microsurgical reconstructions for facial
defects, 79.4% of respondents reported that their departments received humanitarian
aid and support from volunteer organizations (either Ukrainian or international), which
significantly facilitated the treatment process.
Conclusions. According to this nationwide survey of Ukrainian maxillofacial surgeons
during a year of the full-scale war, 86.6% of respondents were involved in the
treatment of gunshot and ballistic injuries in civilians and combatants. The main
problems reported by the respondents were 1) a lack of experience and knowledge
related to the treatment of severe wounds, especially by secondary reconstruction, and
2) a deficit of resources (equipment, materials and medications) under conditions of
disrupted logistics and changes in the numbers and nosological distribution of patients.
There were the opportunity to transfer the patients to European clinics (29.9%), online
consultations (45.4%), collaboration with foreign surgeons who come to Ukraine as a
volunteers (32%)


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Analysis of anti pro-oxidant system of test animals in the dynamics of the wound process at local application of hydrogel dressings

UDC 616-001.4-085.262.1:612.015.11]-092.9

Introduction. The development of the inflammatory process is always accompanied by the activation of lipid peroxidation, which is caused by tissue hypoxia. This, in turn, catalyzes a change in the physiological parameters of the antioxidant system.

The aim of the study is to analyze the dynamics of the antioxidant balance of wounds in an experiment using hydrogels saturated with silver ions and an antioxidant drug for the local treatment of inflammatory processes.

Object and research methods. The experimental study was carried out on 80 Wistar rats weighing 150 to 200 grams. Animals were removed from the experiment. for 3, 7, 10, 14 days. Catalase activity in the dynamics of the wound process was determined.

Research results and their discussion. The content of catalase on the 7th day in the third experimental group is 0.51±0.03 μKat/l. On the 10th day, the indicator of the antioxidant system in the second (0.44±0.05 μKat/l) and third experimental groups was 0.42±0.02 μKat/l. At the final stage of the study on the 14th day, the analysis of catalase content showed that in all animals with a simulated inflammatory process, the indicator of antioxidant activity had no significant differences between themselves and, importantly, with the indicators of intact animals (0.33±0.01 μKat /l). The indicators of the control (0.33±0.04 μKat/l) and experimental groups were as follows: the first experimental group – 0.32±0.06, the second experimental group – 0.36±0.04, the third experimental group – 0, 38±0.06 μKat/l. Antioxidant protection was supplemented by local release of a drug with antioxidant action from the hydrogels, which contributed to a reduction in the intensity of free radical oxidation processes. That is, in almost all groups of animals, which were simulated purulent-inflammatory wounds, indicators of catalase activity approached the level of intact animals already on the 14th day.

Conclusions. Application for local treatment of hydrogel bandages saturated with an antioxidant drug, which is released into the wound surface for a long time, promotes the activation of antioxidant protection and suppresses the processes of free radical formation.

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CYTOLOGICAL ASSESSMENT OF HEALING ODONTOGENIC INFLAMMATORY PROCESSES WHEN APPLYING HYDROGELS

 INTRODUCTION: Odontogenic inflammatory processes constitute a significant part among maxillofacial disorders, as well as among all inflammatory processes in organism. The author used hydrogels saturated with silver ions and an antioxidant drug for local treatment of odontogenic abscesses and phlegmons.
AIM OF THE STUDY. To conduct cytological assessment when applying hydrogels saturated with silver ions and an antioxidant drug for local treatment of odontogenic abscesses and phlegmons.
STUDY SUBJECT AND STUDY METHODS. 50 patients with odontogenic abscesses and phlegmons of maxillofacial area had been examined. To study the dynamics of the inflammatory process, cytology was performed on days 1, 3, 5, 7, 10.
STUDY RESULTS AND THEIR DISCUSSION. No differences were found in both groups of patients on the first day of treatment. On the second or third day, there was a higher number of red blood cells and a significant decrease in the number of neutrophilic granulocytes in the study group than in the comparator group. In the fibrin strands, accumulation of single macrophages, histiocytes, fibrocytes and monocytes were noted. During analysis of cytograms, an increase in the number of erythrocytes, histiocytes, fibroblasts, almost complete absence of neutrophilic granulocytes and single macrophages in the main group were observed on the 4-5 day, indicating the formation of granulation tissue and accelerated onset of proliferation. On the sixth day, patients of the study group had almost no neutrophils and no signs of inflammation, unlike patients in comparator group.
CONCLUSIONS. Cytology results has shown that application of hydrogels saturated with silver ions and an antioxidant drug for local treatment of odontogenic abscesses and phlegmons accelerates the healing time of postoperative wounds. 

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CYTOLOGICAL ASSESSMENT OF HEALING ODONTOGENIC INFLAMMATORY PROCESSES WHEN APPLYING HYDROGELS

 INTRODUCTION: Odontogenic inflammatory processes constitute a significant part among maxillofacial disorders, as well as among all inflammatory processes in organism. The author used hydrogels saturated with silver ions and an antioxidant drug for local treatment of odontogenic abscesses and phlegmons.
AIM OF THE STUDY. To conduct cytological assessment when applying hydrogels saturated with silver ions and an antioxidant drug for local treatment of odontogenic abscesses and phlegmons.
STUDY SUBJECT AND STUDY METHODS. 50 patients with odontogenic abscesses and phlegmons of maxillofacial area had been examined. To study the dynamics of the inflammatory process, cytology was performed on days 1, 3, 5, 7, 10.
STUDY RESULTS AND THEIR DISCUSSION. No differences were found in both groups of patients on the first day of treatment. On the second or third day, there was a higher number of red blood cells and a significant decrease in the number of neutrophilic granulocytes in the study group than in the comparator group. In the fibrin strands, accumulation of single macrophages, histiocytes, fibrocytes and monocytes were noted. During analysis of cytograms, an increase in the number of erythrocytes, histiocytes, fibroblasts, almost complete absence of neutrophilic granulocytes and single macrophages in the main group were observed on the 4-5 day, indicating the formation of granulation tissue and accelerated onset of proliferation. On the sixth day, patients of the study group had almost no neutrophils and no signs of inflammation, unlike patients in comparator group.
CONCLUSIONS. Cytology results has shown that application of hydrogels saturated with silver ions and an antioxidant drug for local treatment of odontogenic abscesses and phlegmons accelerates the healing time of postoperative wounds. 

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