[Alveolar distraction osteogenesis: possible complications and methods of their treatment]. / Al'veolyarnyi distraktsionnyi osteogenez: vozmozhnye oslozhneniya i sposoby ikh ustraneniya.

OBJECTIVE: The aim of the study. Analysis of emerging complications during the method of alveolar distraction osteogenesis in patients with jaw defects. A retrospective analysis of foreign and domestic literature was carried out. A systematic literary search was carried out in the electronic bibliographic databases Web of Science (for foreign articles) and Elibrary and Dissercat (for domestic). MATERIAL AND METHODS: In the period from 2005 to 2019 in the clinic of the Department of Maxillofacial and Plastic Surgery of the Moscow State Medical University. Evdokimov conducted an examination and comprehensive treatment of 490 patients with primary and secondary adentia of the upper and lower jaws, accompanied by a significant deficiency of bone tissue of the alveolar ridge vertically. A comprehensive dental rehabilitation of patients with jaw defects by the method of distraction osteogenesis was carried out. RESULTS: The most common complications are: exposure of the fixation modules of the distraction apparatus - 24% of cases, failure of bone regenerate - 13%, inflammatory phenomena - 13%, displacement of the distraction vector - 43%, paresthesia - 7%. CONCLUSION: Based on our analysis of the identified complications during the distraction osteogenesis method, it was found that these complications are not critical in the treatment of patients with jaw bone deficiency and do not jeopardize the success of rehabilitation. With diagnosis and timely approach to treatment, complications are avoidable.

[Virtual planning and intraoperative control using computer navigation systems in orthognatic surgery]. / Virtual'noe planirovanie i intraoperatsionnyi kontrol' s ispol'zovaniem sistem komp'yuternoi navigatsii v ortognaticheskoi khirurgii.

THE AIM: To evaluate versality and accuracy of computer navigation in orthognathic surgery, analyzing the position of osteotomized bone fragments on virtual and postoperative 3D models. MATERIAL AND METHODS: During our study we operated 27 patients with different asymmetric deformations of facial skeleton (13 patients with Class III Angle, 11 patients with Class II Angle and 3 patients with hemifacial microsomia). In 7 clinical cases optical navigation stations BrainLab 18070 Kick («BrainLab¼, Germany) and Stryker CranialMap CMF Version 2.0 («Stryker¼, USA) were used for preoperative virtual planning. In other clinical cases (20 patients) preoperative planning performed with using of 3D-cephafolometric programs Dolphin Imagin¼ and Blender 2.79. Intraoperative control of osteotomized bone fragments performed with using of optical navigation stations BrainLab 18070 Kick («BrainLab¼, Germany) and Stryker CranialMap CMF Version 2.0 («Stryker¼, USA). RESULTS: Mean surgical time was 181 minutes (150-210 min). Mean time of registration procedure was 5 minutes (3-8 min). Mean target registration error (TRE) was 0.9±0.18 mm. Absolute difference values between actual and virtual movements of maxilla was from 0.72 to 1.12 mm in vertical, from 0.56 to 0.94 mm in sagittal (COP) and from 0.39 to 0.58 mm in transversal (MSP) planes. CONCLUSION: Intraoperative control of maxilla-mandibular complex with using of computer navigation in orthognathic surgery allows to simplify bone fragments positioning, reduce surgery time, obtain a satisfactory aesthetic treatment result with occlusion restoration.

World's First Clinical Case of Gene-Activated Bone Substitute Application.

Treatment of patients with large bone defects is a complex clinical problem. We have initiated the first clinical study of a gene-activated bone substitute composed of the collagen-hydroxyapatite scaffold and plasmid DNA encoding vascular endothelial growth factor. The first patient with two nonunions of previously reconstructed mandible was enrolled into the study. Scar tissues were excised; bone defects (5-14 mm) between the mandibular fragments and nonvascularized rib-bone autograft were filled in with the gene-activated bone substitute. No adverse events were observed during 12 months of follow-up. In 3 months, the average density of newly formed tissues within the implantation zone was 402.21 ± 84.40 and 447.68 ± 106.75 HU in the frontal and distal regions, respectively, which correlated with the density of spongy bone. Complete distal bone defect repair with vestibular and lingual cortical plates formation was observed in 6 and 12 months after surgery; thereby the posterior nonunion was successfully eliminated. However, there was partial resorption of the proximal edge of the autograft entailed to relapse of the anterior nonunion. Thus, the first clinical data on the safety and efficacy of the gene-activated bone substitute were obtained. Given a high complexity of the clinical situation the treatment, results might be considered as promising. NCT02293031.

Ordinary and Activated Bone Grafts: Applied Classification and the Main Features.

Bone grafts are medical devices that are in high demand in clinical practice for substitution of bone defects and recovery of atrophic bone regions. Based on the analysis of the modern groups of bone grafts, the particularities of their composition, the mechanisms of their biological effects, and their therapeutic indications, applicable classification was proposed that separates the bone substitutes into "ordinary" and "activated." The main differential criterion is the presence of biologically active components in the material that are standardized by qualitative and quantitative parameters: growth factors, cells, or gene constructions encoding growth factors. The pronounced osteoinductive and (or) osteogenic properties of activated osteoplastic materials allow drawing upon their efficacy in the substitution of large bone defects.