RELATIONSHIP BETWEEN THE DYSTROPHIC MANIFESTATIONS IN THE PERIODONTIUM AND INTESTINAL DYSBACTERIOSIS.

OBJECTIVE: The aim: of our work was investigation of dystrophy in periodontal tissues and an attempt to establish the correlation between dystrophy in the periodontium and presence of intestinal disbacteriosis. PATIENTS AND METHODS: Materials and methods: Clinical-radiological examination was carried out in 146 patients with generalized periodontal pathology at the age from 26 to 59 years old. Among them in 92 persons generalized periodontitis was diagnosed and in 54 - periodontosis. The first stage of heaviness of the pathological process in the periodontium was revealed in 50 patients with generalized periodontitis and 28 persons with periodontosis. Other patients suffered from heavier forms of periodontal pathology (II and III stages), 42 persons with generalized periodontitis and 28 persons with periodontosis accordingly. Bacteriological analysis of feces for disbacteriosis was carried out in all patients. RESULTS: Results: Changes in the physiological contour of the gums (that is macro relief of marginal periodontium) were found in the majority of examined patients. Because of the development of pathological gingival contour and recession of the gums, 72,5% of examined patients suffered from root denudation and different pathological conditions of roots cement structure - pigmentation, demineralization, wedge-shaped defects, caries. According to our clinical investigations it was found out that in majority of patients (83%) both inflammatory and dystophic changes were present, only 17% of patients had purely atrophic process in the periodontium without inflammation. In patients with GP and periodontosis, in whom dystrophic changes were accompanied by inflammation, clinical appearance was more expressed with redness, bleeding and suppuration from the pockets, thus hiding dystrophic signs. CONCLUSION: Conclusions: According to clinical and radiological findings numerous dystrophic changes were found in all structures of the periodontium and teeth of patients with periodontosis and generalized periodontitis. Changes intensify in disease progressing into the II-III stages. In patients with periodontosis clinical- radio¬logical peculiarities of dystrophy were revealed in early stages of disease progression, while in generalized periodontitis dystrophic changes become apparent in late stages of disease. The presence of colon disbacteriosis was established in patients with periodontosis and generalized periodontitis. Disbacteriosis intensifies when diseases progress into II-III stages of heaviness. These data indicates to possible correlation between the development of dystrophic changes in periodontal tissues and the presence of intestinal disbacteriosis.

OPTIMIZATION OF LOCAL ANESTHESIA OF DENTAL PATIENTS DURING CYSTECTOMIES OF RADICULAR CYSTS THAT HAVE GROWN INTO THE MAXILLARY SINUS OR NASAL CAVITY.

OBJECTIVE: The aim: To provide clinical evaluation of the effectiveness of anesthesia for cystectomy of radicular cysts that have grown into the maxillary si-nus or nasal cavity using different techniques of endonasal block-ade of the nasopalatine nerve. PATIENTS AND METHODS: Materials and methods: Clinical observations were conducted on 52 patients of different age and sex. These patients were diagnosed with large radicular cysts (more than 3.0 cm in diameter) that had grown into the maxillary sinus (33 cases) or into the nasal cavity (19 cases). The surgical excisions of cysts (oroantral cystectomies) were performed un-der local potentiated anesthesia. Patients were divided into two clinical groups, depending on the methods used for endonasal blockade of the nasopalatine nerve: the main and the control group. Patients in the main group underwent endonasal blockade of the nasopalatine nerve at the point of its emergence from the pterygopalatine ganglion. In the control group, the neural blockade was performed at the entry of this nerve into the incisive canal. Pain sensitivity and perception in patients were studied using subjective and objective methods. The data was analyzed by means of the Pearson's chi - square tests. RESULTS: Results: During the enucleation of radicular cysts that grew into the inferior nasal meatus and maxillary sinus in patients of the main group there was no pain observed. There were no manifestations of pain-induced stress neither from the side of autonomic system, nor physical or emotional manifestations of pain, which confirmed the effectiveness of nasopalatine nerve anesthesia. In patients of the control group during similar operation the full effect of local anesthesia was achieved in 56.0% of cases (χ2 - 9,270, р = 0,003). The rest of the patients during cystectomies showed some signs of pain-induced stress from the side of autonomic system or in the form of physical or emotional manifestations. CONCLUSION: Conclusions: Endonasal blockade of the nasopalatine nerve at the point of its emergence from the pterygopalatine ganglion invariably provided a complete analgesia during enucleation of radicular cysts that have grown into the maxillary sinus or nasal cavity. Anesthesia of the nasopalatine nerve at its entry into the incisive canal allows pain-less cystectomy of radicular cysts that have spread to the front of the inferior nasal meatus from the front teeth.

Clinical evaluation of the effectiveness of the developed method of conductive anesthesia of the facial branches of great auricular nerve

Introduction: The most common method of local anesthesia of maxillofacial region in the modern surgical practice is conductive anesthesia of the peripheral branches of trigeminal nerve. In order to reach the total anesthesia of the lateral facial region it is necessary to block not only auriculo-temporal and buccal nerves, but also facial branches of great auricular nerve taking part in the innervation of parotid-masticatory area and the part of the cheek. Topographic-anatomical investigations of corpses revealed the anatomical variability of the branching of great auricular nerve on the neck and the head. Taking into account the topographic-anatomical aspects of variability of innervation of the lateral facial region, we developed the method of conductive anesthesia of the facial branches of great auricular nerve. The aim: To evaluate the clinical effectiveness of the developed method of conductive anesthesia of the facial branches of great auricular nerve taking into account individual anatomical peculiarities of its branching in patients with the different forms of the skull. Material and methods: Clinical observations were conducted on 69 patients of different age (from 18 to 70) and sex (43 males and 26 females). Under the local anesthesia we conducted surgery in the parotid-masticatory region including: disclosure of the abscesses, excision of migrating granulomas or lymph nodes (in the cases of chronic hyperplastic lymphadenitis); excision of the benign tumors of the soft tissues (atheromas, lipomas, fibromas and keratoacanthomas), excision of the salivary fistulas and keloid scars. Depending on the used methods of local anesthesia of the soft tissues of the parotid-masticatory region the patients were divided into two clinical groups. The first group (30 patients) was exposed to conductive anesthesia of great auricular nerve by the method of P. Raj (2002). according to which the blockade of the nerve is conducted ahead the apex of mastoid process of the temporal bone. 39 patients after the signing of the written agreement were exposed to the developed method of conductive anesthesia of the facial branches of great auricular nerve. In order to detect the individual anatomical features of the facial part of the head in patients, the facial index was determined by the Garson`s formula. Pain sensitivity and perception in patients were studied using subjective and objective methods. The data were analysed by means of the Pearson's chi­square tests. Results: It is revealed that total anesthesia of the soft tissues of the parotid-masticatory region in all cases was reached in patients with euriprosopic face shape (broad-faced) ­ in 8 patients of the first clinical group and 10 patients of the second. The least effective was the anesthesia of the anterior branch of great auricular nerve conducted according to P. Raj's method (2002) in patients with leptoprosopic face shape. In patients with leptoprosopic face shape of the second clinical group after administering anesthesia according to the developed method in 9 cases total anesthesia was reached, in 2 cases pain sensitivity in the inferior-anterior quadrant remained (χ2 = 5,70; р < 0,05). Generally, in patients of the first clinical group the method of conducted anesthesia by P. Raj was effective in 19 cases (63,3 %), and the developed method of conductive anesthesia of the facial branches of great auricular nerve ­ in 36 cases (92,3 %) ­ χ2 = 8,85, р < 0,01. Conclusions: The results of the research confirm that the developed method of conductive anesthesia of the facial branches of great auricular nerve is more effective in comparison to methods of anesthesia commonly used in today dentistry surgical practice. It allows to reach the total anesthesia of the soft tissues of the parotid-masticatory region in 92,3 % patients with different face shapes.