Maxillary bones are the most frequent locations of destructive changes, a considerable part of which is located at the level of teeth roots. These foci´s development occurrence corresponds to a high level of complex cavities of teeth in the persons of both sexes in all age groups. The bony tissue reparative regeneration processes´ optimization is one of the most important problems of reconstructive surgery, in the maxillofacial area, in particular.
The major task after the radicular gnathic cyst surgical removal is the defect correction due to new hard tissue formation stimulation. The operative therapy main method, according to many authors , still remains cystectomy with single-step resection of root apexes emerging into the cyst cavity. The resected teeth´s function depression, the possibility of reinfection from the cut off microtubules and traumatism should be referred to disadvantages of the operation . Besides, bone cavities lowering the strength of maxillary bones and able to cause functional and esthetic disorders remain after the excision of radicular cysts.
There appeared new trends in the gnathic cysts treatment, such as filling of bone cavities with biocomposite materials after cystectomy to prevent early complications. It is connected with the fact that at a standard operational intervention the blood clot reduction occurs and it often results in the bone cavity infection and subsequent complications. The filling of bone defects of jawbones with biocomposite materials after cystectomy is aimed at:
- the prevention of possible complications connected with the blood clot reduction and disintegration, and also the secondary infection of the wound;
- the optimization of bone tissue regeneration in the defect area and jawbones´ form and function recovery.
For this reason, the materials used for the bone cavity filling after cystectomy should possess a range of necessary properties.
First, they should have good biocompatibility factors, be biodegradable and not cause inflammatory response in the patients.
Second, they should possess osteoinductivity, actively make osteoblasts and other mesenchymal cells form the bone.
And third, they should implement and steadily substitute the defect capacity, i.e. perform the osteoconductive function.
To solve these problems many stomatologists use native biocomposite materials as they practically do not trail foreign analogues and their cost is considerably lower than that of the imported ones. So, by the present time, the preparations "Hydroxyapol" and "Colapol" (by the "Polystom" firm), "Collapan-L" (by the "Intermedapatite" firm, "Ostim-100" (by the "Ostim" firm) and a range of other preparations are well studied and widely used in operative dentistry and maxillofacial surgery practice [1, 2, 3, 4]. The carried out bioexperimental studies testified that the material on the basis the chitosan-alginate complex "Bol-chital" also corresponds to all the demands placed on the implantation materials inducing the reparative osteogenesis .
The purpose of the present research has been the study of possibility of application and the definition of influence of the material on the basis the chitosan-alginate complex "Bol-chital" on bone tissue reparative regeneration processes at gnathic cyst excision.
Material and research methods
The problem set was settled by means of filling bone cavities with gel-auto-blood mass of the chitosan-alginate complex containing sulphated and non-sulphated glycoseaminoglycans, serum factor of cattle stock growth "adgelon". The method was carried out in the following manner according to the procedure developed by the authors . The cyst focalization was defined with the help of OPG and intraoral roengenograms. Under the local or general anaesthesia a section upon the dental process in the cyst location projection is performed, a mucoperiosteal flap is laminated, the cystectomy and, if needed, radiectomy are performed, the bone cavity is filled with the "Bol-chital" product gel mass after the cyst surgical removal with the following suturing of the wound tightly. The surgical sutures are removed in 6-7 days. 20 patients have been operated on the radicular cysts of maxillary and mandibular bones by the specified method.
Research results and their discussing
During the postoperative period a low-grade postoperative edema of soft facial tissues, insignificant pain sense modality and the alveolar bone´s form steady recovery were registered in all the patients. In all the cases in the observed period from 3 months to 1 year a positive clinical effect with a complete (9 patients) or partial (2 patients) jawbone tissue recovery in the defect area was obtained within the average time-limits from 3 to 5 months after the operational intervention.
During the control examination in three months after the operative treatment the defects´ contours in the roentgenograms are obscure. The reclaimed bone density approximated the density of the surrounding jawbone, the boundary of the bone and the defect being not seen in separate cases. The reclaimed bone shadow is homogeneous, nonstructural, with multiple small ossification foci and early formation of bone trabeculae.
The laboratory and instrumental control of the reparation proved the advantages of the offered method, which consists in the lack of allergenic properties in the "Bol-chital" product, its high compatibility with the bony tissue, its ability to agglutinate microbial cells and bind toxic products, its biodegradability, little traumatism at the implantation, pain-relieving effect, close sticking to the bone, the bony tissues´ blood filling increase due to the formation of new vessels and influence of precursor bone cells on the differentiation.
Thus, the application of the offered method results in the reparative osteogenesis optimization, a quicker recovery of the bony tissue in jawbones´ defects, allows performing denture in the patients in earlier terms.
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The work was submitted to V international scientific conference «Present-day problems of experimental and clinical medicine», Thailand, December 20-30, 2008, came to the editorial office on 07.11.2008.