Severinova S.K., Kushnir K.G., Lavrovskaya O.M.

State institution “Crimea state medical university named after S. I. Georgievsky” Simferopol, Ukraine

Modern aspects of prognostication after dental implantation

Today Clinical Dentistry is going through a new stage of development, which is characterized by the increasing use of diagnostic and therapeutic activities of dentists of high technology. Recent studies have shown that intraosseous implantation does not always provide stable and guaranteed results. A large number of scientists bend every effort to settle the task, and a special place in the solution of this problem takes up early detection of complications.

Most researchers compare the inflammatory changes in the tissues periimplantatnyh (mucositis and periiplantit) with tissue inflammation (periodontitis) around the natural teeth in the presence of microbial plaque. In recent years for the study of soft tissue of the mouth in the follow doctors periodontists used laboratory cytomorphometric method for typing errors in the gums. The advantage of the cytomorphometric method over other methods of clinical and laboratory methods is that it allows early diagnosis of inflammatory diseases, often in the pre-clinical stage. The aim of our study was the scientific elaboration and the practical implementation of the index periodontal destruction in the monitoring group of orthopedic patients after dental implantation.

The method is based on the basis of the cytomorphometric research of the prints from the gums (CNIIS methodology developed under the leadership of AS Grigoryan). In order to receive the prints the target was used - wedge-shaped piece of gum - the eraser with the size of its the narrowest part of not more than 1 mm. The targets were stored in Petri dishes, filled with 50% ethanol solution. Before taking the gum prints the target were dried with an air jet from the air gun then easily introduced into the gingival sulcus tightly pressed to the inner cheek of the implant surface and the outer portion to the symmetrical gums.

The prints were applied to the skimmed slide. On the glass indicates the protocol number of cytology, the glass is marked with a glass cutter into quadrants are marked according to the areas of the fence prints: "I" - the implant, "D" – gums. The prints taken from the area 1-4 implants were placed on each glass , 3-4 indentations in each quadrant. Glass dried and stained by the method of Romanovsky - Giemsa. Then the cytological preparations examined under a microscope. In reviewing the large fields on cell count was performed in 2 major cell populations cytograms: epithelial and connective tissue (neutrophils). It is noted that the phagedaenic cells are in the gum prints and in standard, but in inflammatory processes of the ratio of epithelial cells and connective tissue sharply change in the direction of increasing the connective tissue.

The method was tested in the survey 58 orthopedic patients. The patients were divided into 2 groups depending on the type of structure which is not removable and which was placed on the implant : the metal prostheses were made for the 1st group, the metal-free ceramic prostheses- for the 2 nd group . In order to obtain more objective data the composition of the patients of the first and the second groups were matched approximately homogeneous in age, the nature of the intervention, the number of installed implants.

In each group a part of the patients received therapy with immunomodulatory and adaptogenic Erbisol to prevent possible postoperative complications, accelerate the adaptation process after prosthesis. The drug was injected intramuscularly 1 ml every day, 10 days a course. This drug of the domestic production of a new generation of drugs combining a unique immunomodulatory properties, Auditor, restorer, adaptogen. The experience of application the Erbisol which has proven itself in the treatment and prevention of periodontal disease has already been in dentistry .

After installing the fixed prostheses made of various materials with implant, the index of the periodontal destruction is almost exactly the same as control. By the second month after the fixation of prostheses in all treatment groups a cascading growth index of periodontal destruction was observed. By the 3 month of the observations in the patients of the 1nd group , group A periodontal destruction index continued to increase, which was higher than controls at 92.0% higher than one month. As for the second group of the observations, that by this time in group A the index of the periodontal destruction was reduced. By the 4th month after the prosthesis in patients of the 1st group, despite the stabilization of the index of the theperiodontal destruction and a certain decrease, rates remained high and were statistically significant in nature, both in relation to the control, as well as with respect to the 1st month after prosthesis with regard to the patients of the 2nd group , and by that time the observations of the index of the peridontalnoy approaching destruction in benchmarks, getting in between-group comparisons statistically significant character. In the long-term period (5-6 months), the index of the periodontal destruction in both groups approached the benchmarks.

Thus, the monitoring of the index of periodontal destruction developing by us allowed to come to the conclusion that the most compatible with the titanium implants are metal-free ceramic fixed restorations. The use of immunomodulatory Erbisol shortens the adaptation course to 2-3 months reduces the risk of complications caused by electrochemical processes using fixed prosthesis on the basis of metal alloys, mounted on titanium implants, which is clearly reflected by the indicators index periodontal destruction. Using the index of the periodontal destruction in the prosthetic dentistry may serve convincing, from the perspective of evidence-based medicine, predictor of the risk of inflammatory and destructive changes in the periodontal and periimplatnyh tissues.