No 4 (2003)

Data on the current clinical aspects, diagnosis and treatment of odontogenic inflammations are presented in the paper. The changed clinical aspects related with osteomyelitis of the jaw, and with paradental abscesses and phlegmons are described. The number of diagnostic errors, primarily in osteomyelitis of the jaw and in deep-space phlegmons of the face and neck, is high enough. The changed etiological factors and a diminished immunity cause an aggravation of infection associated with hazardous complications entailing the onset of the chronic stages in purulent pathologies. A classification of the purulent inflammation course as belonging to the norm-ergic- hyperergic- and hypergic types requires appropriate radical surgical interventions and differentiated treatment schemes involving hemosorption, lymphosorption, intravascular administration of antibiotics and immune-correction therapy in severe disease cases. The rate of complications of acutely-progressing odontogenic phlegmons dropped from 50% to 20% amounting to 0.5% of all acute inflammatory pathologies.

Data on the clinical specificity, diagnosis and treatment of atypical purulent-and-inflammatory pathologies in the maxillofacial region are described for 600 patients. Endogenous intoxication was diagnosed in the patients on the basis oj the below investigations: clinical and immunological statuses, microbiology and cytology tests, acid-base balance, electrolytic metabolism. Differential treatment schemes were suggested with respect to an intoxication severity, which ensured the recovery of patients in 94% of cases versus 78% of patients who received the routine therapy.

New immune-modeling drug "Mylife" was used in the treatment of 1328patients with chronic inflammatory pathologies in the periodontium, maxilla and peri-maxilla soft tissues concurrent with endogenous intoxication manifested by changed immune indices. The drug was found to have a favorable impact on the regression of inflammation and on the stabilization of immune parameters. It can also be used in the intraosseous tooth implantation and in jaw-segments plasty. A higher general resistance of the body and immunity was registered in 198 patients after the drug administration; there were no any postoperative inflammatory complications in them.

Tooth implantation has been, during the recent 20 years, on the top of list among the methods aimed at tooth recovering in adentia; it provides for a higher efficiency of the chewing function and for a better facial esthetics. A total of 3250 patients were implanted 6348 dentures after an individual approach was used in each case to ensure the cure efficiency. It is advisable to apply the X-ray-contrast and magnetic-resonance tomography as well as computer modeling within the routine preoperative examinations of patients; besides, parameters of the microcirculation surgical zone should taken into account. The laminar dentures are still used as before since they have a number of advantages: they are implanted in the narrow alveolar arch, they can be used alongside with natural teeth, and they provide for early bearing. The efficiency of root-implanted dentures should be pointed out. Successes of tooth implantation, a high percentage ofengraftment and the implants' normal functioning depend, to a great extent, on an adequate condition of soft tissues, therefore, a considerable number of patients have indications for additional surgeries in soft tissues of the mouth cavity, like plasty of the lips' frenulum and of the tongue, removal of cicatrical adhesions, excision of excessive soft tissues, and elimination of affections of the mucous by soft tissues (630 interventions). Sometimes surgical procedures must be performed in bones prior to implantation, they are: alveolotomy, resection of the maxillary alveolar process and of mandibular alveolar part, removal of exostosis and osseous plasty to increase the bone width and height by applying the autografting or different biomaterials (827 interventions). Russian biomaterials, e.g. "Kolapol KP 2, Kolapol KP 3" and "Kollapan" as well as foreign ones, e.g. "Bio-Oss", "Osteo-Graft" and "Pep-Gen P15", are recommended for use. The remote results traced for as long as 2 to 20 years are in line with international standards.

The maxilla was reconstructed prior to tooth implantation in 52 patients. Osseous plasty by the synthetic bone and reconstruction of the alveolar process were performed through the anterior and anterior-posterior walls of the maxillary sinus concurrently with the sinus-bottom elevation with respect to an alveolar-process size, X-ray findings, including those of the X-ray contrast tomography. The maxillary body and its alveolar process were reconstructed concurrently with the sinus-bottom elevation, after which an immediate or remote implantation was made. Artificial bone was used for plasty; the best effect was ensured in a combined application of 2-3 preparations. The bone remodeling in reconstructing the maxillary body and its alveolar process are not completed by a traditional term of 6 months.

A three-dimension modeling based on X-ray and nuclear-magnetic tomograms was made for 24 patients with malignant neoplasms in the mouth-cavity bottom and maxilla. It ensured an ablastic eradication of tumor and, simultaneously, elimination of the inflicted defect. Besides, such modeling of malignant processes and scheduling of reconstructive procedures provide for defining the treatment efficiency and for forecasting an outcome.