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CLINICAL LABORATORY ESTIMATION OF THE EFFECTIVENESS
OF LASER CYSTEKTOMY OF ODONTOGENOUS CYST, THAT GERMINATE THE BOTTOM OF THE MAXILLARY SINUS CAVITY
Tukenov Evgenii
graduate student of Operative Dentistry and Maxillofacial Surgery department, Al-tai State Medical University, Barnaul, Russia
Semennikova Nina
ass. prof.,d.d.s. Stomatology department Siberian State Medical University,
Tomsk, Russia
ABSTRACT
The purpose of study. To investigate the effectiveness of laser cystectomy methods with the use of clinical and laboratory parameters in the treatment of radicular cysts germinated on the maxillary sinus floor and the nasal cavity.
Material and methods. The methodology of laser cystectomy, clinical, rengenologicheskie , biochemical , histological
Result. For preventive maintenance of various complicantions at treatment odontogenic cysts of area top of the maxillae we develop the way lazercystecto-my. The basic of the operation stage is the coagulation of cover cyst in the field of germination of its bottom of the cavity of the nose is and sinus maxsillaris. The coagulations cover part does not allow to break integrity of the bottom, warning development of its inflammation, does not break mucocyliar the sine road clearance, does not demand the patients to be in clinic, provides rehabilita-tion of patients in the shortest term - 4,5±1,5 days.
Conclusion. The results of this study allow to characterize the proposed tech-nique as a minimally invasive and ablative because of avoiding the sinusotomy surgery and resection surgery of the root apex of the tooth protruding into the cavity of the cyst. The surgery in a clinic reduces the material costs for the treat-ment and rehabilitation of patients, and consequently considered as a resource saving and inpatient substituting technologies.
Keywords:odontogenic cysts, lazer cystectomy, odontogenic sinuit.
Relevance.
For preventive maintenance of various complications [1, 2, 4] in the treatment of odontogenic cysts of area top of the maxillae, we have developed and experimen-tally substantiated method of laser cystectomy. The basic of the operation stage is the coagulation of cyst wall in the field of germination of its bottom of the cavi-ty of the nose is and sinus maxsillaris. The coagulations cover part does not al-low to break integrity of the bottom, warning development of its inflammation, does not break mucocyliar the sine road clearance (RF patent number 2441619 on 10.02.2012).
The purpose of study is to investigate the effectiveness of laser cystectomy methods with the use of clinical and laboratory parameters in the treatment of radicular cysts germinated on the maxillary sinus floor and the nasal cavity.
Material and methods. The methodology of laser cystectomy. The excision of the trapezoidal mucoperiosteal-bone flap is made after oral cavity sanation and rational dental filling in the area of cyst, and a standard patient examination with the investigation of blood tests in a clinic under local anesthesia (using drugs of the amide series and vasoconstrictors in a ratio 1: 200000 or 1:100000). The incision of the mucosa and periosteum is made 0.5 cm from the edge of the bone defect towards the healthy tissue with a view to overlap the edges of the defect during suturing. The mucoperiosteal flap is then exfoliated from the bone, to the edge of the bone defect, up to approximately 0.5 cm, then a bone flap of a re-quired size and shape is cut out with a scalpel or piezo surgical scalpel and then is fractured in the upper part to lift it up. After that, the cyst wall is exfoliated and removed from the alveolar process and lateral walls. The rest of the cyst wall in the area of the bottom cavity of the maxillary sinus and nose is coagulated with the light guide (980 nm) according to the «Olympic rings» type in a pulsed mode with a power of 5 W for 1-2 seconds x 3-4 times (Diode laser device Prometey, USA is used). The remaining part of the epithelium wall in the area of tooth roots which is protruding into the cavity of the cyst is
coagulated in the same mode. This method of removing of the cyst wall from the surfaces of the tooth roots avoids the root apex resection. To provide favorable environment for the periodontal tissue repair, the tooth apex is covered with «Pro-root» (Dentsp-ly company, USA), which is carried in and fixed with a sponge «Kolapol - KP 3» (Polystom company, Russia) on the surface of the root apex of the tooth protrud-ing into the cavity of the cyst. The conical recess made previously in the tooth root is filled with the creamy consistency material. The rest of the bone cavity is three quarters filled with «Kolapol KP-3» with lincomycin or metronidazole, and «Kollapan» gel (Inter-medapatit, Russia). The flap is laid back and fixed with in-terrupted stitches of prolene. The sutures are removed 7 days after surgery. Be-fore the surgery, endodontic treatment is carried out using a standard antibacteri-al mechanical and pharmacological treatment of canals with their subsequent fill-ing with «Seal-Apex» (Kerr, USA), «Endomethasone N» (Septodont, France), gutta-percha cones by lateral condensation or «Termafil» (Kerr, USA). The final filling and recovery of the crown is carried out using glass ionomer cement «Fu-ji», «Miracle mix» (GC Corp., Japan), Core Max II (Dentsply, USA) in combina-tion with intracanal pins, dental implants, artificial crowns.
The proposed method was applied to 31 patients according to the norms of ethical protocol with their informed consent. Among the patients there are 18 fe-males and 13 males between the age of 25 to 65 years. The median age is 46.7 ± 7.6 years. Effectiveness Criteria of laser cystectomy are: a) condition of mucocili-ary clearance and nasal mucosa of the maxillary sinuses (identified by the use of saccharine test[6], which is carried out before and after the 14th day after sur-gery); b) presence of complications during and after surgery; c) wound healing process controlled by laser thermometry of gums[7], which is carried out before and on the 7th, 14th, 21st days after surgery; d) change in the density of the bone defect before and in 6, 12, 24 months after operative treatment monitored by Multislice
Spiral Somputed Tomography (MSCT) («Aguilion»,Germany) and Hounsfield scale [1,5]; e) the number of days of disability.
Statistical studies. The results are processed by methods of mathematical statistics on PC based on the AMD Athlon processor and the application pack-age Excel 2007 for Windows XP with the calculation of point features (arithmetic average (M), the standard deviation (c), the average error (m)).
Student's t test (t) is calculated to determine the significance of differences of these digital indicators.
When testing the null hypothesis, the critical level of the statistical significance is taken equal to 0.05.
Results and discussion. We found that the figures of the mucociliary clear-ance of nasal surface mucosa study are unaltered and equal to 6.30±0.5 min. Time of the mucociliary clearance of the maxillary sinus had no statistically sig-nificant differences as well (p>0.5) and reached 7.6±0.5 min. and 7.85±0.5 min. before and after surgery, respectively. These data indicate the absence of the damaging effects of electrosurgical effects on the functional state of the mucosa of the maxillary sinus and nasal cavity.
Bleeding, perforation of maxillary sinus bottom during the surgery or inflamma-tory complications during the postoperative period are not observed. Full resto-ration of the density of the bone defect is observed in 26 patients (83.87%, p= 0,001). The reduction of bone defect in 5 patients (16.13%) is carried out on the 85% (p = 0.001). In 24 months the full restoration of the optical density of bones in the postoperative defect is observed in 29 patients (93.55 %, p = 0.001). Op-tical density of bones in 2 patients (6.45%) is 91% (p = 0.001) relative to the norm 760.76 ± 15,77u.e. H (Figure 1). Normalization of temperature in the area of mucosa of the gums at the level of cyst location occurred at the 30th ± 1 day of postoperative period and is equal 35.5±0.50C. Disability terms of patients reached 5.5 ± 1.5 days. The presented results of the study are illustrated in the following clinical example. Patient K. 57 years old appealed to the clinic of Oper-ative Dentistry and Maxillofacial Surgery department, ASMU, complaining of the occasional pain in the areas 1.4, 1.5, 1.6 of teeth and the presence of alveolar bone formation in the area of these teeth. The first symptoms appeared about a year ago. 14, 15, 16 are previously treated for caries complications. External ex-amination is without peculiarities, mouth opening fully. Orthognathic occlusion, 1.4, 1.5, 1.6 are under the fillings, the bulging is painless, mobility of I-II degree. The protrusion on the alveolar process from vestibular surface in projection 1.4, 1.5, . is painless, a symptom of parchment crunch is positive. The
mucosa color is not changed. The electric pulp test indicators are 21, 22, 23 >200 microam-peres. The laser thermometry of mucosa in the projection of bulging is 36.3 ° C (normal - 35.4 ° C).
Root canals are filled with a radiopaque material uniformly over the entire length (on intraoral radiographs (figure 2): 1.4, 1.5, 1.6). Light area with clear contours of a diameter ~ 2,6 cm is located at the tops 1.4, 1.5, 1.6. There is the round light area up to 2.8 cm in greatest dimension (Figure 2, 3, 4 - a) in the coronal, frontal and lateral MSCT projections. The absence of bone wall in the bot-tom of the sinus is applicable to the bottom of the maxillary sinus. Densitometry indicators are 64 units on the Hounsfield scale (norm - 750). The diagnosis is: radicular cyst in the maxilla 14, 15, 16 with the bottom of the maxillary sinus germination. The pathological changes in the results of the study are not found with the standard blood tests. The laser cystectomy surgery under local anesthe-sia against the background of perioperative antibacterial, anti-inflammatory, de-sensitizing and vitamin therapy is carried out in a clinic. Increased body tempera-ture up to 37.7 ° C is observed in the postoperative period during the day of sur-gery. On the next day the patient complained of swelling in the right infraorbital area. During objective examination, the condition is satisfactory, skin color is not changed, swelling of the right buccal area is moderate, palpation is slightly pain-ful. The mucosa on a transitional fold in 1.4,1.5,1.6 is slightly swollen, pale pink, clean, wet; temperature according to the laser thermometry is 37.0 ° C, the stitch-es are well fixed, teeth percussion is painless, mobility of I degree. Antisepsis oral cavity is carried out, «Metrogyl Denta» gel is applied, magnetic laser therapy is assigned (5 treatments). Normalization of body temperature is observed on the next day. Swelling of the tissues of the buccal area is gone on the 5th day, nor-malization of the mucosa temperature is observed on the 31st day after surgery. Disability terms amounted to 5 days. The results of objective examination in 3, 6 and 12 months indicated the absence of tooth mobility in the area of the cyst, the presence of a thin cicatrix, the absence of the alveolar process deformation in the operated area. The enlargement radiography and multislice spiral somputed to-mography results before and after treatment in 12 months (Figures -2b, 3b, 4b) indicated complete recovery of the structure of bone in the area of the bone defect and the absence of symptoms of the maxillary sinus mucosa pathological changes with the almost complete recovery of the sinus volume.
Figure 1
Figure 4a Figure captions
Figure 1. Dynamics of the indicator changes in of densitometric examinations in the area of the bone defect after electrical cystectomy.
Figure 2. Enlargement films 1.4,1.5,1.6 of a patient K., 57 years old, а - before laser cystectomy б - 6 months after
Figure 3. Reformed facial bones of a patient K. 57 years old MSCT in the de-tailed projection: а - before the treatment, b - 12 months after laser cystectomy.
Figure 4. Reformed facial bones of a patient K. 57 years old in the coronal pro-jection: а - before the treatment, b - 12 months after laser cystectomy.
Conclusion. The results of this study allow to characterize the proposed tech-nique as a minimally invasive and ablative because of avoiding the sinusotomy surgery and resection surgery of the root apex of the tooth protruding into the cavity of the cyst. The surgery in a clinic reduces the material costs for the treat-ment and rehabilitation of patients, and consequently considered as a resource saving and inpatient substituting technologies.
Figure 4b
References
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2.Kamaltdinov E.R. Treatment of radicular cysts with the use of a procedure of the trans-channel of the electro-cystthatII: the Author's Abst. dis. ... Cand. med. sciences. - Krasnoyarsk, 2008. - 18s. (in Russia).;
3. Semenikov VI, Shashkov YU.V, Semenikova N.V, Taktak M., Shishkin The o.E.Eksperimentalnoe substantiation of laser tsistektomii of the odonto-genous cysts of overgrown the bottom of the nasal cavity and upper maxillary cavity. // Rossiyskiy stomatological periodical. - 2013 - № 3. - S.34-36 (in Rus-sia);
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jaw/OF A.T. Shakirova // medical visualization. - 2002. - № 1. - S. 28-33(in Russia).;
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КОМПЛЕКСНОЕ ПРИМЕНЕНИЕ ПЕЛОИДОТЕРАПИИ И ФОТОФОРЕЗА ПАНТОВЕГИНА В КОМПЛЕКСНОМ ЛЕЧЕНИИ БОЛЬНЫХ ХРОНИЧЕСКИМ КАТАРАЛЬНЫМ ГИНГИВИТОМ
Хасанова Диана Александровна
Канд. мед наук, г.Москва
INFLUENCE OF COMBINED APPLICATION OF MUD APPLICATIONS, AND PHOTOPHORESIS ПАНТОВЕГИНА ON THE DYNAMICS OF PERIODONTAL STATUS IN PATIENTS WITH CHRONIC GINGIVITIS
Dr.Khasanova Diana
Ph.D Med, Moscow
АННОТАЦИЯ
Таким образом, комплексная терапия хронического катарального гингивита оказывает выраженное корригирующее влияние на ткани пародонтальной области, обеспечивая стойкий клинический эффект. В целом, использованный комплекс выступает весьма эффективным методом восстановительной коррекции пациентов, страдающих хроническим воспалением тканей пародонта, создавая благоприятные условия для купирования воспалительных процессов и регенерации десневой ткани.
ABSTRACT
In the article with the pathogenetic positions analyzes the efficiency of application of photophoresis пантовегина combined with пелоидотерапией. It is shown that корригирующий effect of the combined effects of factors is a variant of additive interaction, implemented through common points of regenerative activity of mud applications, and metabolic potentials пантовегина, reinforced by the influence of the infrared laser. Application photophoresis пантовегина in the complex of peat with «TOMED-APPLICATE» accompanied by growth regulator-the metabolic capacity of the organism, providing persistent clinical effect. Used it is a very effective method of regenerative correction of patients suffering from chronic inflammation of the gum tissues, creating favourable conditions for the relief of inflammation and regeneration of gum tissue.
Ключевые слова: пантовегин, пародонтальный статус, пелоидотерапия, фотофорез, хронический катаральный гингивит.
Keywords:pantovegin, periodontal status, pelotherapy, photophoresis, chronic catarrhal gingivitis.
Введение
Важнейшей проблемой современной стоматологии выступают воспалительные заболевания пародонта, занимающие одно из ведущих мест в структуре стоматологической заболеваемости. При этом хронический катаральный гингивит, встречающийся в 80-85% среди людей работоспособного возраста, способствует появлению в зубочелюст-ной системе очагов хронической интоксикации, снижению реактивности организма, развитию аллергизации, а в итоге - к снижению работоспособности, нарушению психоэмоциональной сферы и снижению качества жизни. Указанные обстоятельства существенно актуализируют поиск и разработку новых эффективных методов восстановительной коррекции воспаленных тканей пародонта, выдвигая их на рубеж приоритетных научно-практических задач современной медицины.
В настоящее время имеются достаточно веские основания для использования в лечении хронического катарального гингивита пелоидотерапии и инфракрасного
лазерного излучения, оказывающих существенное противовоспалительное и трофическое действие. В этом представляется перспективным фотофорез пантовегина, обладающего выраженным биостимулирующим эффектом.
Целью настоящего исследования явилось повышение эффективности восстановительного лечения хронического катарального гингивита на основе комплексного применения пелоидотерапии и фотофореза пантовегина.
Материал и метод исследования
Под наблюдением находилось 67 больных в возрасте 1836 лет. Клиническое обследование включало выявление жалоб пациентов на неприятный запах изо рта, чувство распи-рания, болезненность, отёчность и кровоточивость дёсен, повышенное слюноотделение. Оценку состояния тканей па-родонта проводили, используя упрощенный гигиенический индекс - OHI-S (Green J.C., Vermilion J.R., 1965); индекс кровоточивости десневой борозды - SBI (Muhleman H.R., 1971); папилло-маргинально-альвеолярный индекс (РМА) в
