Diagnostic and Prognostic Value of Indicators of Bone Metabolism Markers in Patients Following Mandibulectomy and Free Fibula Flap Reconstruction with Endosteal Implants.

Purpose: To evaluate and assess the indicators of bone metabolism markers osteocalcin and ß-Cross-Laps in blood serum as a tool for monitoring bone regeneration and determining the time of implantation in patients after mandibulectomy and reconstruction of a free fibular flap with subsequent endosteal implants. Materials and Methods: Forty-eight patients in a 6-year period participated in this study, due to resection for tumors. All patients underwent reconstruction with fibula free flap after tumor resection, 4-6 months after osteoectomy, dental implants were installed with further orthopedic rehabilitation. To assess the rate of bone remodeling after transplantation, the content biochemical markers of bone remodeling osteocalcin and ß-Cross-Laps serum were determined by enzyme immunoassay. Results: All 46 fibular free flaps were healed without complications and were survived. A total 326 implants installed, 8 implants failed to osseointegrate, and 6 implants failed after 5 years of loading (peri-implantitis). Success rate of implants after 5 years was 95,7%. In patients before surgery, the mean of osteocalcin levels was 8.5 ng/ml, two months later, there was a sharp increase in the content of osteocalcin by 15.4 ng/ml, after four months reached 24.7 ng/ml, after six months of 28.6 ng/ml, then the indicator began to decrease and after 12 months it was approaching the norm of 14.7 ng/ml. In patients before surgery, the mean level of ß-Cross-Laps was 0.76 ng/ml, after two months bone transplantation the mean level of ß-Cross-Laps decreased to - 0.65 ng/ml, after four months the indicator increased and reached of 0.98 ng/ml, after six months the indicator was - 1.56 ng/ml, then these indicators began to decrease and after 12 months, approaching normal values of - 0.87 ng/ml. There is a correlation between different concentrations of osteocalcin or ß-Cross- Laps and the success rate of implants. Implants were shown to be unsuccessful low concentrations of osteocalcin and high concentrations of ß-Cross-Laps in serum. Conclusion: Studies have shown that the long-term survival and success rates of implants placed in the reconstructed areas may guarantee an excellent prognosis of implant-supported prostheses. Bone markers in blood serum osteocalcin and ß-Cross-Laps can be used to evaluate the rate of bone remodeling, which allows you to determine the time of implantation.

Efficacy of the transcutaneous electrostimulation in treatment dysfunctions of the TMJ associated with occlusion distortions.

BACKGROUND: The study evaluation of the effectiveness the method of electrostimulation in treatment TMJ associated with occlusion disorders with the use of a patches by the company "Aganyan''. METHODS: The study included 54 patients with temporomandibular dysfunction syndrome who had previously undergone endodontic dental treatment. In patients temporomandibular disorders (TMD) determined on the basis of Diagnostic criteria for temporomandibular disorders(DC/TMD).All patients had occlusion disorders due to errors after dental filling restoration. To diagnose the TMJ, a CT scan was used. The complex therapy also included therapy and with the use of a patches by the company "Aganyan''. The wearable patch includes a flexible substrate, a binder an adhesive layer, with an electrode foil attached to it. Patients applied one patch behind each TMJ. The patches were applied for eight hours every third day for three months. All the patients were given full-fledged endodontic treatment and restoration of the crown part, taking into account anatomical features. RESULTS: The dynamics of the complex treatment of patients diagnosed with TMJ dysfunction syndrome showed that after treatment, the clinical symptoms gradually decreased and disappeared at the end of treatment. CT scan a year after treatment showed a normal ratio of TMJ elements. Сomplex treatment was effective in 87% of patients, after 3-5 months gradually decreased pain, noise in the joints, restriction of opening and closing of the mouth disappeared. Patients recovered their chewing functions, psycho-emotional state. CONCLUSION: The results of the studies revealed a positive effects for the complex treatment dysfunctions syndrome TMJ the using the patches by the company "Aganyan" through electrical stimulation with low intensity.

Clinical Outcome of Immediate Loading UV-Photofunctionalized Implants in Patients with Completely Edentulous Mandible, Placed with Guided Surgery.

Objectives: The purpose of this study was to evaluate clinical results of immediate loading UV-photofunctionalized dental implants placed using guided surgery in patients with completely edentulous mandible. Material and Methods: In this study, 58 fully edentulous patients were treated with immediate loading implant-supported mandibular prostheses. All patients underwent a thorough clinical examination according to the generally accepted scheme; qualitative and quantitative parameters of the jaw bones patients were diagnosed with cone beam computerized tomography (CBCT). Surgical templates modeled in the 3 Shape software were made from biocompatible polymeric materials and provided with depth-calibrated drill sleeves for preparing osteotomies using a 3D printer (Stratasys). Before short implant placement, ultraviolet functionalization of implant surfaces was performed by UV Activator YWJ-QSY001 (Foshan, Wenjian Medikal Enstriman) in the device for 20 s. After flapless surgery, implant sockets were prepared with guided surgery and implants were placed through the sleeves of the surgical template tightening torque of 35-45 Ncm. An implant-supported temporary prosthesis made of acrylic resin was installed 6 h after implantation. Final dental prosthetics was performed 2 months after implant placement.The patients had 128 short (length 5-6 mm, diameters 4,5-5 mm) and 256 implants with length greater than 10 mm in bone segments with sufficient bone parameters. The following parameters were assessed: implant success, prosthetics survival and changes in peri-implant marginal bone loss (MBL). Results: During a clinical examination, no serious biological or prosthetic complications have been reported. The esthetic result evaluated from patients was excellent. The mean ISQ of short implants was 69.2 ± 8 for primary stability at implant placement and 73.6 ± 4 ISQ after 3 months. The mean of implants with length greater than 10 mm was 71,2ISQ at implant placement, respectively, and 75,6 ISQ after 3 months. After 3 months of prosthetic loading for short implants marginal bone loss (MBL) 0.74 mm, after 1 year of MBL 11.21 mm, after 5 years of MBL 1,37 mm, for implants with length greater than 10 mm after 3 months of MBL 0.72 mm, after 1 year of MBL 1.19 mm and after 5 years of MBL 1.35. There was no statistically significant difference in clinical indices between short and standard implants. After 5 years of follow-up, stable levels of bone tissue around the implants and healthy tissues around the implants were recorded, and postoperative occlusal function was favorable. The success rates of the short implants in maxilla were 95.5%, and the success rates of the short implants in mandible were 98.7%. The success rates of the implants with length greater than 10 mm in maxilla were 97.8%, and the success rates of the implants with length greater than 10 mm in mandible were 98.8%. Conclusion: Computer-guided implant surgery and immediate loading of UV-photofunctionalized implants in patients with completely edentulous mandible are a predictable and effective method with a minimum rehabilitation period.