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Fig. 7. a — IR; b — diffraction pattern of Ca3 (PO4) 2
As seen from the diffractogram of the sample, the peak at 20 = 300 clearly describes tricalcium phosphate.
Preparation of calcium/phosphate chitosan coatings Ti plate (30 mm. x 10 mm. x 1 mm.) with a roughness of 4.0 microns were cleaned with acetone using ultrasonic, ethanol (96 %), and demineralized water. Electrolytically precipitated calcium phosphate coating was prepared on the Ti cathode plate at 52°C for 10 hours in a TCP (pH 7.0 buffer) supersaturated solution with a supported current 2.0 mA/cm2 galvanostatic installation. Using scanning electron microscopy (SEM) were recorded for
the coating formation TKF Ti plate with a coating thickness of 10 -14 microns.
For electrodeposited on a titanium plate chitosan purified chitosan solution was prepared with a concentration of 0.5 to 0.9 g/l by dissolving chitosan (72 % SDA) in 2 % acetic acid, which is then added to the supersaturated solution TKF. Deposition was done at 52°C for 15 hours in a supersaturated solution with chitosan TKF pH buffer (6.6 ~ 6.7), supported with a current of 2.0 mA/cm2. The plates were then washed with demineralized water and dried at 50°C for 12 hours.
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Yarmukhamedov Bekhzod, Associated professor, PhD, Tashkent state dental institute, Uzbekistan, Department of oral surgery and dental implantology E-mail: yabehzod@gmail.com
Results of dental implantation at patients with the accompanying somatic pathology
Abstract: Until recently operations of dental implantation were performed at patients of not having associated diseases. Now researches of opportunities of dental implantation at different types of the accompanying somatopathies are conducted. Keywords: dental implantation, somatic pathology, cardiovascular system, excretory system.
Section 5. Medical science
Now somatic pathology is considered the relative, and some nosological forms, for example, an uncontrollable diabetes mellitus, chronic general diseases, such as tuberculosis, rheumatism — absolute contraindication to dental implantation [1; 3; 6]. It is bound to the known reasons: decrease in the common and local immunity, microcirculation violation, including in oral cavity fabrics, the lowered response to surgical aggression, progressively increasing risk of development to operational, both local, and systemic complications [2; 6; 8]. Nevertheless, in daily practice such patients meet quite often-1 on 15 addresses [3; 5; 8]. At the same time procedure of implantation at patients with somatic pathology can provoke an aggravation of its clinical manifestations. For example, such factors as fear and pain can provoke development of an ischemia of a myocardium, a bronchospasm, hypertonic crisis [1; 4; 6]. The number ofpatients with arterial hypertension grows in the world. Therefore, the probability of appearance of patients with an idiopathic hyper-tensia on reception at the implantologist annually grows [1; 2; 3; 6]. From the point of view of the implantologist important, that at the long-lived arterial hypertension and the regular reception of hypotensive preparations there is a phenomenon of "exhaustion" that is expressed in reduction of a cooperative surface of exchange vessels [3; 6; 8]. Chronic obstructive pulmonary diseases take the third place in the world on abundance, an invalidism and mortality among other types of pathology. In absolute figures, the number of sick chronic obstructive pulmonary disease comes nearer to 10 million people [1; 4; 7]. Abundance of the listed diseases without their extent of compensation resulted in apparent discrepancy between high needs of patients with the accompanying pathology in implantation and low level of its exercise [2; 4; 5; 8]. In other words, it is not the diagnosis, and in degree of safety of compensatory mechanisms. Therefore, the decision of the implantologist on possibility of carrying out implantation in necessary volume has to develop not only depending on the diagnosis of a disease, but its duration and effectiveness of the carried-out corrective therapy [1; 3]. Extent of influence of the accompanying pathology on osteointegration remains almost not studied question that proves already apparent relevance of the chosen subject.
Research objective: justification of possibility of extension of indications to dental implantation to patients with various somatic pathology, with minimization of operational complications due to complex corrective therapy.
Material and research techniques
Researches are conducted based on policlinic of oral surgery and dental implantology. Shared 201 patients (100 men and 101 women) aged from 39 till 72 years with the diagnosis "Partial secondary adentia" in research.
To all patients standard methods of surgical inspection under the "Dental Implantation" protocol are carried out. For increase of effectiveness of treatment methods of hygiene of an oral cavity are recommended. The sanitation of an oral cavity including therapeutic, surgical and orthopedic actions is carried out. Patients are divided into subgroups depending on a dominance of somatic pathology: the first group — was made by patients (n = 96) with diseases of cardiovascular system; the second group — was made by patients (n = 44) with chronic obstructive pulmonary disease; the third group — was made by patients (n = 39) with diseases of excretory system. The control group included 40 patients, is equivalent men and women, aged from 36 till 69 years, without the accompanying pathology.
Before operation to all patients questioning was carried out. Results of questioning compared to data of an out-patient dossier (family
policlinic) where the clinical diagnoses made by profile experts, results of laboratory, and instrumental researches were specified.
Single-step implantation at a partial secondary adentia at patients with pathology of cardiovascular system was carried out at 39.9 % of patients of 1 group, at 40.1 % of patients of 2 groups and at 40 % of patients of 3 groups. Single-step implantation after extraction of tooth was used in 28.2 % of cases at patients of 1 group, in 27.9 % of cases at patients of 2 groups, and in 28.1 % — patients have 3 groups. The closed sine lifting with single-step implantation was carried out to 18.7 %, 19 % and 40 % of cases in 1, 2 and 3 groups respectively. The open sine lifting with single-step implantation was applied at 13.2 %, 12.9 % and 13.5 % of patients 1, 2 and 3 groups respectively. From the provided data it is visible that distribution of types of implantation in various groups practically did not differ from each other. Most often (in 40 % of cases) single-step implantation at a partial primary/secondary adentia was used.
To all patients in the studied groups dental implantation was carried out in the conditions of the controlled sedation which is followed not by discontinuous monitoring of indexes of a hemodynamic and saturation. The sedation was carried out by a reference technique. The dose was selected for each patient individually, a titration method. Depending on character and expressiveness of somatic pathology to patients anti inflammatory, antiemetic, antibacterial drugs and diuretics were injected. After operation inspection of patients was performed for 1, 7, 30 days, then in 6, 12 months and further, twice a year for the next 2 years.
Results of researches
As a result of the carried-out questioning it is revealed that about a somatopathy, the patient reports only in 10 % cases. It is long the ill patients are informed on parameters of the disease in 60 %. Know 74 % of patients with a cardiovascula about existence of arterial hypertension pathology. In 37 % the patients who transferred a myocardial infarction to the period from 6 to 12 months before the appointed implantation did not adhere to the scheme of treatment appointed by the cardiologist. In 40 % patients with pathology of excretory system did not consider it necessary to report about existence at them of a glomerulonephritis or pyelonephritis in the anamnesis.
In group with pathology of cardiovascular system indicators of arterial pressure were corrected within 140-150/80-90 mm. of a mercury column. Patients with coronary heart disease and a myo-cardial infarction in the anamnesis were allowed to operation in the absence of the negative dynamics on an ECG of the last months. In the 2nd group patients at whom the asthma attack which is completely stopped by single-pass inhalation asthma of a pent developed no more than 1 time a month were allowed to dental implantation. Patients with bronchial asthma were allowed to implantation at an oxygen saturation at the time of survey not lower than 94 %.
In group with diseases of excretory system dental implantation was carried out at decrease in an efficient renal blood-groove not less than 402.9 ± 6.9 ml/min. and increases in resistance of renal vessels not higher than 16 536 ± 106.5 min/see the condition of compensation at patients with somatic pathology was controlled and remained in the set limits for 1 months before alleged implantation.
The maximal number of implants which is possible for establishing at patients of the specified groups, was equal 7. This size is greatest possible for installation for one operation (does not exceed a time interval 2.5 clocks) and allows to solve the patient's problem within single-pass visit of the implantologist. Effectiveness of a controlled sedation along with objective indexes made according to questioning: 85 % of patients considered procedure comfortable; absence of
fear and alarm — at 100 %, amnesia — at 95 % that allows to consider a technique efficient. To all patients in the specified groups the sedation was carried out according to the uniform scheme. Exceptions were made by patients of 3 groups at whom in 15 % delayed awakening was noted. Therefore the dose of all injected drugs in comparison with other groups was 25-30 % lower. In the early postoperative period the qualitative and quantitative comparative analysis of the being available clinical manifestations in each of the allocated groups of patients is carried out. Not expressed pain syndrome was noted at 84-88 % of patients in group of patients with somatic pathology. Thus, in control group this index appeared a little lower-80 than a %. Duration of a pain syndrome did not exceed 6 ± 1 days and was most expressed in the 2nd group of patients (25 % for the 7th days) and less patients have 3 groups. Clinically significant, pain syndrome was registered for 1-2 days at 15 % of patients of 1 group, at 14.7 % of 2 groups and 14.6 % of 3 groups. The increase the regional of lymph nodes was noted at 43-48.2 % of patients in the first days of the postoperative period, but by 7 days the number of patients in such complication decreased to 5-6 % in 1 and 2 groups. Practically at all patients (86 %) in the first days after operation emergence of a light fibrinous raid in the area of seams and a mucous and periosteal rag, at 8-13 % of the gray-brown raid which completely disappeared against reception of antibiotics by 8 days was noted.
At an assessment of the local status on second day it is revealed that in 1 and the 2nd group the slight swelling in the field of seams and a postoperative wound in 86 % and 74 % respectively was noted.
The expressed hypostasis in the field of a seam and a mucous and periosteal rag was defined in 68 % cases in the 3rd group. The atrophy of a bone tissue according to X-ray analysis in the first days after operation is not revealed in one of the studied groups.
In a month after implantation in the analysis of roentgenograms it is established that in 1 and 2nd group the atrophy of a bone tissue made 1-2 mm. By 6th month indexes of an atrophy in these groups remained former that testifies to biointegration process stabilization. In the 2nd group in a month after implantation the atrophy according to X-ray analysis was defined in limits 3-4 ± 0.02 mm., by 6th month of supervision — to 4 ± 0.02 mm. In comparison with control group expressiveness of similar clinical symptoms in group of patients with somatic pathology was brighter. Nevertheless, all symptoms were stopped against the carried-out therapy. In comparison with control in all other groups losses of implants, bound to influence of a number of various factors and the reasons are revealed. At patients of 1 group the total loss of implants for 3 years made 11 %. In the first year there was the maximal loss. In the 2nd group of loss of implants had more uniform character. In the first year the percent of successful implantation made 90.6 %. Losses of implants at patients of 3 groups made the first year 42 %.
Conclusions: thus, the conducted research proved possibility of carrying out dental implantation at patients with a secondary adentia with the relative contraindications: pathology of cardiovascular system, chronic obstructive pulmonary disease, pathology of excretory system.
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