PLATELET-RICH PLASMA WITH BONE GRAFTS FOR BONE GRAFT ENHANCEMENT IN SINUS FLOOR AUGMENTATION WITH SIMULTANEOUS IMPLANT PLACEMENT

O.S .SEIDBEYOV, S.Z. ALIYEV, G.F. HASANOVA

ASATFD named A. Aliyev, Baku, AZERBAIJAN

As it is known, anatomic conditions like defects of a bone tissue of alveolar ridges after removal of teeth and also at the expressed atrophy of toothless departments of jaws are the unfavorable anatomic conditions for implantation . One of the most widespread reasons of absence of necessary volume of a bone for placement implant is the low position maxillary sinus. The sinus - lift for the first time described Boyne and James in 1980 became the optimal surgical intervention to increase alveolar height of a bone for accommodation endoosseous dental implants in maxilla. The researches which have been lead by various authors, have shown, that osteoplasty a biomaterial - autobone, allobone, xenograft, a synthetic bone and their combinations with use of the platelet rich plasma, increases growth of a bone by 30-40 %. On the faculty of stomatology and maxilla-facial surgery of the Azerbaijan State Institute of Improvement of Doctors named A. Aliyev the platelet rich plasma in combination with bone grafts was applied in 34 patients in the age of 40-65 years at implantation to fill lack of a bone tissue. A flap of underlying tissues was dissected to create access to an alveolar bone under local anesthesia. The maxillary sinus was accurately trepanned in the area of lateral wall and a rectangular bone craft was harvested. The efforts were made to leave the top part of a bone craft untouched. Further the craft was cautiously raised not to damage Schneider's membrane. The remaining space of the sinus was filled with bialgine in a combination with platelet rich plasma preliminary mixed on a plate. Thus, the condition for the introduction of dental implant without a risk to damage the sinus was created. After delivery of implants the intervals between implants were filled with biogenic materials and the vestibular window was closed by a cerebral membrane to prevented introduction of a mucous tissue in defect for the purpose of improvement of regeneration of bone tissue. The craft was sewed back. Ortopantomogramms in 6 months after operation have shown new formed bone tissue in a zone of raised maxillary sinus with successful integration of implants. At the moment of control inspection all established implants conformed to all requirements. Thus, application of combination PRP with bone grafts and use of a lyophilized brain environment as a membrane provided good оsseointegration implants.

CONSERVATIVE TREATMENT OF COMPLICATED FORMS OF CHRONIC VENOUS

INSUFFICIENCY OF LOWER EXTREMITIES

N.A.SERGEYEV, V.M.CHERVINES, M.S.SHESTAKOV, M.A.CHISTYAKOV

Tver State Medical Academy, Tver, RUSSIA

Introduction. Chronic venous insufficiency of the lower extremities is often complicated by the development of deep trophic disorders of soft tissues, accompanied by a deterioration of the quality of life of patients. In connection with this further improvement of the treatment methods of complicated forms of chronic venous insufficiency is an urgent problem.

Materials and methods. 82 patients with chronic venous insufficiency of lower extremities were observed. In 72 patients the disease was complicated by the development of trophic ulcers of shinand foot. The area of ​​ulcer defects ranged between 0.2-73.7 cm², and the duration of their existence - between 1 week and 35 years. In 10 patients with chronic venous insufficiency, there was found “preulcercondition” of soft tissues of distal lower extremities. Ultrasound (duplex phleboangioscanning), planimetric (identification of the area of ​​venous ulcers and speed of their healing) and bacteriological (qualitative and quantitative) methodsof examination. In order to improve the results of treatment,laser therapy in the zone of trophic disorders of soft tissues by themethods developed by us (the patent for invention No 2171699 dated 10.08.2001 and patent for invention No 2231377 dated 06.27.2004)were used in addition to traditional conservative methods.

Results.In the process of treatment all patients had earlier relief of pain and itching, decreased edema of tissues and inflammations. In 70 of 72 patients with trophic ulcers complete epithelialization of defects was achieved. In 2 patients with largepostthrombotic ulcers of shin the area of ​​which constituted 67.8 and 73.7 cm², cleaning of ulcer defects and significant reduction of sizes was observed. In all 10 patients with preulcer condition of soft tissue in the result of low-intensity laser radiation, gradual regression of pathological changes with the reduction of the area of ​​skin lesions, relief of signs of dermatitis and eczema was observed. In the process of laser therapy of venous ulcers in many patients microbial associations were replaced by monocultures. The number of bacteria per 1 cm 2 of ulcer surface significantly decreased (at average of up to 7.0 x 10⁴), while in 9 patients no growth of microflora was observed. In addition, there was observed decrease in the number of bacteria in 1 gr of tissues, forming the edges and bottom of ulcers (at average up to 1.1 x 10⁴), with 14 observations the result of bacteriological cultivation was negative. The sensitivity of microflora to antibiotics was differentand did not change in the course of treatment.

Conclusion.Improved conservative treatment of complicated forms of chronic venous insufficiency in the vast majority of cases leads to healing of trophic ulcers and improvement of the local status of patients withpreulcer condition of soft tissues of lower extremities, which generally improves the quality of life of patients.

Date: 2014-12-28; view: 701