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UDK: 616.31-006.2:616.31-089
Vinogradova A. V.
candidate of medical science, docent of children dentistry's department
associate dean of dentistry's faculty Irkutsk state medical university Suchilina M.I.
resident of surgical dentistry and maxillofacial surgery's department
Irkutsk state medical university DOI: 10.24411/2520-6990-2019-10561 THE EVALUATION OF EFFECTIVENESS OF ODONTOGENOUS CYSTS' TREATEMENT IN CHILDREN USING OPERATING'S STRESS-RESTRICTING
Abstract
The article describes the research of effectiveness of surgical treatment of odontogenous cysts in children with usage of stressor-restricting method and without it. The better impact was confirmed when the stressor-re-striction was conducted.
Key words: odontogenous cysts, children, treatment, effectiveness, stress-restriction, impact.
The creation of effective methods of treatment of odontogenous cysts in children is one of actual problems in dentistry. The reasons of it are the significant prevalence of this pathology among inflammatory diseases of the maxillofacial area and a high number of cases of unsatisfactory treatment's results. It's also severely due to the unresolved problem of osteoreparative process after operation.
Odontogenous cysts have the origin of a secondary inflammatory disease in more than 90% of cases, they form a focus of infection of the dento-facial system, having a negative impact on a whole body. Only 7% of them have a dysontogenetic nature.
On the other side, periapical cysts create a threat to follicles of permanent teeth, saving of which has a big importance for the formation, development and functioning of the chewing apparatus. The existing methods of surgical treatment of odontogenous cysts in children are far from perfection, because during operation the strong operational stress develops.
The main target of the research is the valuation of possibilities of restriction of the operating stressor's expression by activation of antioxidative glycinergic stress-restricting systems of organism during a surgical treatment of odontogenous cysts in children.
The complex clinical examination of 43 children, admitted to the treatment at the ages of 4-13 years, identified the 47 odontogenous cysts in area of temporary teeth. The analysis of clinic data showed that the reasons of cysts' appearance were the 7.4, 7.5 and 8.4, 8.5 teeth. 4 patients (9,3%) had odontogenous cysts on both sides of jaw.
There was no pathology of organs and systems in these patients.
14 children (32,5%) mostly complained to the dull pains of low intensity and less often to the constant pounding pains, the swelling, the slight increasing of temperature (37,8-38°C), sleep and appetite deprivation. While the examination regional lymphatic nodes were enlarged, painful a bit on palpation, elastic and mobile. The mucous membrane of the oral cavity in the place of swelling was edematose without hyperemia, the transitory fold was smoothed, palpation of the mucous membrane was painful, soft tissues weren't soldered with the underlying jaw bone.
The fistulas in the area of the "causal" tooth were detected in 2 children (4,6%). The bulging of bone with unexpressed soft tissue's edema was determined in 24 children (55,8%). As a rule, the boundaries of the bulging were blurred in 16 children (37.2%), bone compliance on palpation was in 7 patients (16,3%), and symptom of «parchment crunch» of these was detected only in 2 children (4,6%). It is probably due to elasticity of bone tissue, which predominantly has a spongy structure.
A painful percussion of 7.4, 7.5 and 8.4, 8.5 teeth was detected in 13 children (30,2%), a slight pain was in 2 patients (4,6%), an increased sensitivity was detected in 8 patients (18,6%); a reaction to percussion was not determined in 22 children (52,2%).
The clinical examination of patients with odonto-genous cysts according to the classification of V.A. Mironyuk (1964) revealed the festered cysts in 14 children (32,5%). The course of the disease was asymptomatic in 27 children (62,7%). It allowed to attribute the detected odontogenous cysts to non-festered. Such cysts were often detected accidentally during a preventive examination by a dentist or if it was a clear deformation of the jaw.
The radiological examination was conducted for all 43 patients. Intraoral radiography and orthopanto-mography were used. With the introduction of it into widespread practice a frequency of detecting of cysts increased significantly, including a preclinical stage of disease. This method made it possible to see a wide overview of the alveolar ridge and dentition, determine relationships of cyst cavity with roots of neighboring teeth, and due to enlargement of image early detect initial signs of roots' resorption and symmetry of sides of jaw.
The radiological image of the cystic lesion from temporary teeth had distinctive features, associated with the age characteristics of the child, the presence of a round-oval shape bone defect with clear boundaries and a restricting cortical rim. Rudiments of neighboring permanent teeth were displaced by cyst and didn't projected on its background, which was a characteristic of temporary tooth's root cyst.
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In 29 patients (67,4%) the rudiments of permanent teeth were projected on background of focus of rarefaction of bone tissue, the cortical lamina of which remained in area of root part and was absent in area of crown. Such cyst was diagnosed as a tooth-containing because a crown of rudiment permanent tooth's rudiment entered into cyst cavity, and a degree of roots' formation of rudiments of the permanent teeth corresponded to the age of the patient.
A characteristic of radiological image of a tooth-containing cyst was a preservation of structural pattern of bone tissue on background of bone rarefaction. It interpreted by significantly smaller destructive disorders in jaw in comparison with such in children with root cysts, because tooth-containing cysts increased in their size mainly due to displacement of external cortical lamina vestibularly. As a result, two shadows of bone tissue destruction, called «the symptom of the rings», were often determined on the roentgenogram: a large shadow were formed due to deformation of the external cortical lamina, and a shadow of a smaller diameter was the center of the destruction of spongy substance of jaw.
A millimeter grid, anatomical and topographic parameters were used to determine a size of cysts. Defects, located into the alveolar ridge within one tooth and had a diameter of 1,5 cm were referred to small cysts. Medium-sized cysts, occupied the area of two teeth and passed from the alveolar process to the jaw body, had a size of 2,0-2,5 cm. Large cysts were cysts that captured the alveolar process in the area of three teeth, spread to the body of jaw, and had sizes more than 3,0 cm.
Clinical and radiological data made possible to establish the presence of treated teeth due to complicated caries by resorcinol-formalin method and cysts with them in 16 children (37,2%); those teeth didn't have fillings. The period from the time of treatment of "causal" teeth to the detection of a cyst, mostly ranged from 2 to 24 months, which confirmed a shorter latent period of odontogenous cysts' development in children in comparison with adults.
All patients were divided into two groups according to the method of surgical treatment. The researches were made with informed agreement of parents and were in accordance with the ethical principles of the Helsinki Declaration of the World Medical Association (The World Medical Association Declaration of Helsinki, 1964, the 2000th edition).
The comparison group was the children of 4-13 years old, operated by the traditional method (16 people); the main group was the children of the same ages, which took 3 days before and 3 days after the operation the natural antioxidant □ dikvertin (at the dose from 20 to 30 mg per day depending on the age) and glycine (at the dose from 200 to 300 mg).
The effectiveness of surgery was determined in patients of both groups by the absence of complications, the speed of restoration of bone tissue with the further formation of permanent teeth's rudiments. For this purpose a clinical and radiological analysis of the results was made in the period from 3 weeks to 2 years.
Our research showed that the patients of the comparison group had complications such as edema of the mucous membrane of oral cavity on the operated area, inflammation of soft tissues and divergence of sutures
in the early postoperative period. In a later period, the next complications were detected: the vestibular eruption of a permanent tooth, the breaking of mineralization of hard tooth tissues, the late eruption of a permanent tooth and delayed reparative regeneration of bone tissue.
In the main group of children, where the treatment was carried out by using the activation of stress-restricting systems of organism, these complications weren't stayed. However, 2 patients had a vestibular eruption of a permanent tooth. It was probably due to a previous staphylococcal infection.
A comparative clinical and radiological analysis in dynamics showed that with approximately equal sizes of odontogenous cysts in children in the comparison group (22,73 ± 3,47 mm) and in the second (21,44 ± 4,35 mm) group the speed of reparative processes was significantly higher with using the restriction of operational stressor.
So, on the 39,1st ± 3,4th days after surgery the average size of the cyst cavity decreased by 27,1% in patients of the comparison group. The cyst cavity wasn't determined after surgery in patients of the main group, where the activation of stress-restricting systems of organism was used. According to our data, a different tendency of decreasing of radiological sizes of the cavity of the odontogenous cyst in the comparison group and in the main group of patients was directly connected to the restriction of the expression of the surgery's stress, the usage of which made possible to repair bone tissue already on the 39,1st ± 3,4th days after surgery.
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