Bobkova S.A., Kushnir K.G., Nepreluk O.A

Crimea state medical university named after S. I. Georgievsky, Simferopol.

The influence of complex therapy on oral fluid lipid peroxidation levels in patients with a fracture of the lower jaw.

In recent years, due to the increased overall level of traumatism the number of affected with injuries in the maxillofacial region increased significantly, both in our country and abroad. The cases of severe complications such as osteomyelitis of the mandible began to appear more frequently. The problem of the prevention and treatment of traumatic osteomyelitis, despite the large number of papers devoted to solving it, continues to be one of the most pressing and complex in the dental surgery. This is due to the complexity of the mechanism of purulent-destructive process in the bone. Many of its links are poorly understood until now. It is known that the effectiveness of treatment of fractures of the mandible is largely dependent on early diagnosis of purulent-inflammatory nature complications.

The purpose of research.

Improve the efficiency of treatment of patients with fractures and traumatic mandible osteomyelitis by including in treatment complex drugs with pathogenic (antihypoxic) therapeutic effects.

Clinical characteristics of patients.

Under clinical supervision there were 97 patients with fractures.

the lower jaw, received to inpatient treatment to dental office RCH named after N.A. Semashko (Simferopol).

The results of the research.

At present, it is generally accepted that the induced chemiluminescence is the most accurate method of determining the intensity of lipid peroxidation (LP), which is characterized by four main indicators of CL kinetics; S (30) - (light sum), Imax - (quick flash intensity CL), ST - (light sum until the maximum intensity) and tg2 (tangent decrease after the peak signal intensity). Last indicator is sometimes also called the maximum rate of inhibition. Tg2 value is greater the higher antioxidant activity present in the reaction system of the chemical compounds.

In the diagnosis of infectious and inflammatory complications of the mandible fractures object of study was to determine the intensity of lipid peroxidation reactions. Results of oral liquid LP allows to reveal the features of the general and local body's response to injury and associated with it pathological changes, to some extent, to predict the future course (or subsiding) local and systemic inflammatory reactions, and to evaluate the chances of a successful reparation.

In the investigation of oral fluid lipid peroxidation activity in victims on admission to the hospital there was a trend to an increase in the mean values of indicators: light sum for 30 seconds. increased approximately 2-fold, compared with health outcomes (47.9%), and Imax - by, 58%, ST - 30%, tg2 - by 114%. In this case, significant differences were observed between the levels of activity of the antioxidant system of the oral fluid of patients with a fracture of the lower jaw to the beginning of treatment and healthy subjects (p <0.05).

LP Indices of oral fluid in patients with a fracture of the lower jaw before treatment (n = 40)

Indicators (unit of measure)	Before treatment (М+m)		Healthy indiv. (normal) (М+m)		Р
Е (30) (conv. unit)	21,86+0,67		11,39+1,7		<0,05
Imax (conv. unit)	2,03+0,87		1,45+0,14		<0,05
ST (conv. unit)		3,14+0,17		2,22+0,12		<0,05
tg2 (conv. unit)		-54,61+3,88		-25,51+2,93		<0,05

Notes: p-significance of differences compared with those of healthy individuals.

According to research results parameters of oral fluid LP were no significant differences in the amplitudes of quick flash Imax -1,085 +0,13 up on the 8th day of traditional treatment, as well as the angle of inclination of the chemiluminescent curve tg2 - (-37,05 +4,56 ). Levels of reducing these parameters were not significant (p> 0.05). However, indicators such as the S (30) (12,21 +0,95), ST (1,99 +0,17) decreased significantly (p <0.01), indicating (indirectly) a significant decline in the intensity of the general and local inflammatory reactions. The findings, in general, confirm the generally accepted notion that the pathogenesis of post-traumatic inflammatory reactions caused by the emergence of the lower jaw fracture is insufficiently studied

On the background of the ongoing course of treatment including Erbisol parameters of the studied parameters of oral liquid LP levels also came to the normal range.
Furthermore, these indicators have a statistically significant reduction in comparison with the data obtained before the treatment (p <0.01 - 0, 05), which also confirms the effect of the drug used (Erbisol) on lipid peroxidation processes.

LP indicators of oral fluid in patients with lower jaw fracture on the 8th day of therapy with Erbisol inclusion (n = 30)

Indicators (unit of measure)	Before treatment (М+m)	8th day of therapy	Р	P1
Е (30) (conv. unit)	21,86+0,67	12,38+1,06	<0,01	>0,05
Imax (conv. unit)	2,03+0,87	1,36+0,11	<0,05	>0,05
ST (conv. unit)	3,14+0,17	2,19+0,21	<0,01	>0,05
tg2 (conv. unit)	-54,61+3,88	-28,56+4,19	<0,01	>0,05

Notes: p - significance compared to the same period prior to treatment;
P1 - the accuracy in comparison with the same period of healthy individuals.

Conclusion

Adding Erbisol in the conservative complex of treatment showed a significant decline in the LP indicators, which meant a reduction in energy deficit and thus reduce the risk of imbalances in the structural organization of cell membranes and a sharp polyvalent violation of biochemical processes in the affected tissues.

The use of an immunomodulator (Erbisol) resulted in improved Energy of tissues, increase resistance to hypoxia, restore microcirculation. In general, complex therapy using Erbisol contributed to the reduction of functional disorders.