Nepreluk O.A., Bobkova S.A., Roganov G.G.

Crimea State Medical University named after S. I. Georgievsky

«Microbiological quality criteria set endosseous implants in orthopedic patients with chronic nicotine addiction»

According to the Ministry of Health Ukraine, the number of tobacco smoking is about 40% of the population, and this figure is growing rapidly every year.
You must install the effects of smoking on the condition of organs and mucous membranes of the mouth, as new methods of orthopedic treatment (using dental implants) have a number of contraindications associated with not satisfactory hygienic measure and inflammatory processes. Smokers with more than 10 years we have to develop as a separate disease nicotine stomatitis (nicotine leykokeratoz palate, leukoplakia smokers), arising in the mucous membrane of the mouth is in direct contact during smoking with tobacco smoke - on the hard palate, in the anterior soft palate. In 90.8% of smokers identified micro-environmental violations of the oral mucosa - changes in the level of total microbial contamination, quantitative content of certain types of bacteria and their frequency of detection, the violation ratio of aerobic and anaerobic microorganisms.Violation peculiar mouth healthy human relationships aerobic and anaerobic (1:10) Modern researchers have observed in 68.4% of patients. The ratio of 1:1 was found in smokers with the greatest experience. Because of the predominance of oral anaerobic bacteria due to a reduction of the redox potential increases the risk of inflammatory and degenerative processes in the mouth.In the case of chronic nicotine intoxication microflora balance significantly disrupted, causing violation of the implant integration. But this balance be corrected through the use of antibiotics, antiseptics, probiotics, prebiotics. Of these prebiotics are the most gentle and mild method, since they act on the useful microflora, creating a barrier to pathogen without significant imbalance FMS.
Microbiological studies were performed in 55 patients between 18 and 45 years, of which 40 - Representatives of the experimental groups, with chronic nicotine intoxication and orthopedic pathology. Fifteen patients - healthy patients
without nicotine intoxication. The observation was carried out for 12 months. Microflora was analyzed after 3, 6 and 12 months after implant placement.
For treatment with orthopedic implants were used titanium implants system "Uimpl" (Switzerland - Ukraine). A two-stage implantation technique, providing healing of the root portion of the implant in complete isolation from the oral fluid, and in the future - after 3-6 months the connection and the root of the implant head. A total of 102 found implant. In the future, patients were fitted with various fixed constructions. Scraping the mucous membrane of the mouth whether the conductivity standard swab transport system of the company «Sarsteds» (Germany, thus increasing transport times in bacteriological laboratory to 72 - hours.

Analysis of the microbial status of orthopedic patients with a history of nicotine dependence showed that before the implantation of the total microbial count was 1,8 ± 0,05, which was 50% higher than the control, which was 1,2 ± 0,07, for The ratio aerobic / anaerobic micro-flora of oral cavity was 7/3, which was 22.2% (p1 <0.05) lower or higher, respectively, control which accounted for 9/1.
By 3 months after installation of dental implants in this group of patients, despite the nicotine intoxication, showed stabilization of the studied parameters, which apparently was the result of the treatment, carried Dima in this group of orthopedic patients. By 6 months after installation of dental implants in this group of patients had the regularity, leading to normalization of microbiological indicators. Thus, TBC was 1,35 ± 0,09, which bore relative to control invalid character (P1> 0.5), while the comparison with the index before implantation (p2) TBC was below 25% (p2 <0 05), wherein the ratio of anaerobes to aerobic was 8.5 / 1.5. In long-term follow at 1 year of studied parameters were approaching the maximum control, while the comparison with microbiological parameters before implantation, they acquired a statistically pronounced (p2 <0.01).
Thus, our study cytomorphometric and microbiological studies of the allowed to come to the conclusion that orthopedic patients with a history of no-kotinovuyu observed toxicity of reliable ¬ but tall and wearing a statistically significant character (pi <0,05) compared to control changes in the study parameters before implantation. After the dental implant to 1-3 months in this group of patients had progressive increase in the full range of the studied parameters, which reaches its apotheosis to 3 months after implantation. In the subsequent period of observation 6 months was observed a clear trend towards the stabilization and reduction of the studied parameters (pi> 0,5), which, in our opinion, has been a positive impact of the treatment (the use of immuno-and prebiotics). In long-term follow 11-12 months in this group of orthopedic patients the full range of the studied parameters (despite the nicotine intoxication) as close to the benchmarks.