substantiation of clinical application modern surgical methods at intrabone dental implantations

MINISTRY OF HEALTH OF UKRAINE

KIEV MEDICAL ACADEMY OF POSTGRADUATE EDUCATION NAMED

AFTER P.L.SHUPIK

On the rights of the manuscript

MAZEN SHTAY TAMIMI

UDK 616.31-089.843 (048)

SUBSTANTIATION OF CLINICAL APPLICATION

MODERN SURGICAL METHODS AT

INTRABONE DENTAL IMPLANTATIONS

14.01.22 - dentistry

The dissertation on competition of a scientific degree

The candidate of medical sciences

The supervisor of studies:

Tymofyeyev Aleksey Aleksandrovich,

Honoured Worker of Sciences and

Technics of Ukraine, Doctor of Medical

Sciences, the professor

KIEV – 2005

2

THE MAINTENANCE {CONTENTS}

INTRODUCTION … … … … … … … … … … … … … … … … … … … ….. 3

CHAPTER 1. THE REVIEW OF THE LITERATURE … …… … …………… … 11

0.1. A history of development dental implantations … … … … … … … … … 11

0.2. The general {common} data about dental implantations and materials,

Used in implantology … … … … … … … … … … … … … ….…….... 15

0.3. Operation of a raising of a bottom maxilla sinus … … ……………........ 27

0.4. Reconstructive operations at an atrophy alveolar process of jaw… … …... 34

0.5. Features of the postoperative period of conducting patients with dental

implantation … … … … … … … … … … … … … … … ……………... 37

CHAPTER 2. THE MATERIAL AND METHODS OF INVESTIGATION ……. .42

CHAPTER 3. RESULTS OF INVESTIGATION OF PATIENTS

THE FIRST GROUP OF SUPERVISION … … … … … … … … ……… … … .53


THE SECOND GROUP OF SUPERVISION … … … … … … … … … … ….. .71


THE THIRD GROUP OF SUPERVISION … … … … … ………..… 99

CHAPTER 6. DISCUSSION OF RESULTS OF INVESTIGATION PATIENTS BY

WHOM ARE APPLIED DIFFERENT SURGICAL METHODS OF CARRYING

OUT DENTAL IMPLANTATIONS … … … … ………………… … … … ….. 122

CONCLUSIONS … … … … … … … … … … … … … … … … … … … … .139

PRACTICAL RECOMMENDATIONS … … … … … … … … … … … … … .142

THE LIST OF THE USED LITERATURE … … … … … … … … … … ……. .143

3

INTRODUCTION

Actuality of a theme. There are deformations and atrophies of alveolar jaws

processes after plural removals of a teeth quite often (Onishchenko V.S., Ilyk R.R.,

1997; Tymofyeyev A.A., 1998; Matros-Tarants.e.n 2000; Ruzin G.P., Buryh M.P.,

2000; Pavlenko A.V., 2001; Rjabokon E.N., 2001; Kharkov L.V. And Soavt, 2002;

Robustova T.G., 2003; Metchenok ve., Vankevetsh А., 2004, etc.). The given

circumstance not only stops, but also complicates carrying out of dental prosthetics

since is the reason of bad fixing of dental artificial limbs (Leontjev V.K. and co-aut.,

1995; Kosenko K.N., 1994; Labunets V.A., 1998; Labunets V.O., Sennikov O.M.,

1999; Lamb В.В., Klitinskij J.F., 1999; Bida V.I., 2003; Nesprjadko V.P. and co-aut.,

2004; Flis P.S. and co-aut., 2004, etc.) . The problem of restoration of defects of

dental numbers{lines} with use dental implants gets the increasing urgency (Lamb

В.В., 1995; Paraskevich V.L., 1992; Olesova V.N., 1993; Losev F.F., 1998; Kulakov

A.A., 1997; Kutsevljak V.I., 1998; Robustova T.G., 1999; Dolgalev A.A. and co-aut.,

2000; Potapchuk A.M., 2000; Tymofyeyev A.A., 2002; Sidelnikov P.V., 2004, etc.).

For last decade it has strongly taken root into practical activities of the doctor -

dentist.

At performance dental implantations frequently meet difficulties which can be

connected to anatomic features of a structure of maxillary bones. For doctor of

implantology carrying out dental on the maxilla quite often happens implantation

inconveniently because of a significant atrophy of alveolar processes maxilla bones

(Paraskevich V.L., 1992; Matveeva A.I., 1993; Surov O.N., 1993; Robustova T.G.,

1999; Temerhanov F.T., Anastasov A.N., 1999; Tatym H., 1986; Gowood J.,

Howelle R.A., 1988; Jonsen O. Et al., 1992; Spiekermann H. et al., 1995; Reinhardt

C., Krensser B., 2000; Poticet N., Jirajariyave J., 2001; Palti A., 2003, etc.) . In the

literature there is an opinion, that at height of an alveolar bone less than 5 mm (from

an alveolar crest to

4

the bottom of maxilla sinus) carrying out sinuslifting with simultaneous dental

implantation is problematic (Ugrin M.M., 2001; Paraskevich V.L., 2002;

Tymofyeyev A.A., 2002; Robustova T.G., 2003; Kenneth W.M., Judy et al., 1999;

Misch C. et al, 2001; Teent K., Parma - Benfenati С., 2004, etc.).

On mandible bones of difficulty for implantation arise in that case when is

present sufficient on height, but (narrow) alveolar process insufficient on width.

Narrow the alveolar process is considered when its width is equal 3,5-5 mm. Usually

it is contra-indication to carrying out endoosseous dental implantations. If at

introduction dental implant bone walls with vestibular and palatinum (lingual) the

parties{sides} will have thickness less than 1 mm it has a negative effect on

osseoregeneration processes and stability dental implant (Kulakov A.A., etc., 2001;

Paraskevich V.L., 2002; Robustova T.G., 2003; Misch C. et al., 1998; Zablotsky

M.A., 1998; Palti A., 2003, etc.).

Neurological to the status at patients after carrying out endoosseous dental

implantation it is not removed sufficient attention. In the postoperative period for an

estimation of the clinical status the limited number of methods of investigation is

used. Therefore search of objective tests of efficiency of the lead {the carried out}

operation and the forecast of current of the postoperative period is actual for dental

implantations.

Communication {Connection} of work with scientific programs, plans,

themes.

The executed dissertational work is a fragment of complex research work

«Features of diagnostics and treatment at traumatic damages jaws » which is carried

out on faculty of maxillofacial surgery of the Kiev medical academy postgraduate

educations named after P.L.Shupika МOH Ukraine. Number of state registration РК

0102U001057. In a complex theme the dissertator carries out the separate fragment

devoted to rehabilitation of patients with defects and deformations of dental

numbers{lines} and jaws.

5

The purpose and research tasks.

The purpose of research is perfection of methods of surgical treatment, increase

of their efficiency and expansion of indications for carrying out intrabone dental

implantations at patients with defects of dental numbers{lines} and jaws.

For achievement of an object in view the following problems{tasks} have been

determined:

1. To define{determine} an opportunity of carrying out intrabone dental

implantations at a significant degree of expressiveness of an atrophy of an alveolar

process of maxilla bones.

2. To specify frequency of occurrence of complications which arise at carrying

out of operation closed antrolifting, and to offer a technique of performance of the

operative intervention, reducing number of these complications.

3. To establish necessary minimal thickness of lateral walls of an alveolar

process jaws which needs to be kept at carrying out intrabone dental implantations

depending on density of a bone for favourable current osseoregeneration processes.

4. To reveal presence neurogenic changes on the part of peripheral branches of a

trigeminal nerve which can develop at patients in a place of carrying out of operation

endoosseous dental implantations depending on a technique of its performance.

5. To offer a technique of carrying out of operative intervention on installation

intrabone dental implants, allowing as much as possible to keep available thickness

of lateral bone walls of an alveolar process and to avoid damage of peripheral

branches of a trigeminal nerve.

6. To establish self-descriptiveness and an opportunity of use of additional

modern clinical methods of investigation of patients (contact thermometry,

potenciometry, periotestmetry, etc.) for

6

the control of efficiency of treatment and the forecast of current of the

postoperative period over carrying out endoosseous dental implantations.

Object of research - patients with defects of dental numbers{lines} and jaws by

which operation intrabone dental implantations is lead{carried out}.

Subject of research - different surgical methods of carrying out endoosseous

dental implantations on top and mandibles, studying of features of clinical current, a

functional condition of peripheral branches of a trigeminal nerve and treatment of

patients depending on a degree of expressiveness of an atrophy of height and width

of alveolar processes jaws, frequency of occurrence of postoperative complications

and preventive maintenance of their development.

Methods of investigation. With the purpose of studying features of clinical

current and definition of efficiency of spent treatment at different surgical methods of

carrying out endoosseous dental implantations are applied clinical, thermometry,

potenciometry, periotestmetry, electrophysiological, laboratory, mathematical and

statistical methods of investigation.

Scientific novelty of the received results.

It is proved, that intrabone dental implantation can effectively be carried out at a

significant degree of expressiveness of an atrophy of an alveolar process maxilla

bones. For the first time it is offered to use additional fixing endoosseous implants

titanium miniplates at open and closed sinuslifting. High efficiency of results of

treatment is determined at use of additional fixing in an installation time single and

multiple dental implants.

For the first time use is offered at operation closed antrolifting a method of a

stretching of cells - with the help of silicone - expander. Application of an offered{a

suggested} technique of operative intervention

7

has allowed to lower considerably number of complications which arise at

carrying out of this operation.

It is proved, that for favourable current osseointegration dental implants it is

necessary to keep the certain minimal thickness of lateral bone walls, its{her}

thickness is in dependence from density of a bone cells of a jaw.

For the first time it is established, that at carrying out of traditional surgical

methods of installation dental implants damage of peripheral branches of a trigeminal

nerve with defect of function is observed. Terms of restoration of the broken function

depend on the applied surgical technique, and also a jaw on which operation and

numbers established dental implants is carried out. The technique of carrying out of

operative intervention - splittings and expansions of an alveolar process with use

dental wedges which allows to avoid occurrence of this complication is offered and

to keep having thickness of an alveolar crest.

Objective tests of efficiency executed intrabone dental implantations and the

forecast of current of the postoperative period which allow to diagnose in early terms

development of complications and correct spent treatment are revealed.

The practical importance of the received results and their introduction.

Received, depending on the used surgical technique of carrying out intrabone

dental implantations, the clinical-laboratory data were a basis that additional fixing

dental implants at open and closed sinuslifting, a method exfoliation a mucous

membrane maxilla sinus and has been offered to a cavity of a nose from a bone with

the help of a cylinder - expander, and also operation of splitting and expansion of

alveolar jaws processes with application dental wedges. For carrying out of effective

anesthesia and anti-inflammatory therapy it is offered to use medicament

8

drugs which have allowed to raise{increase} efficiency of treatment and to avoid

occurrence of postoperative complications.

Results of work are introduced into medical practice of surgical dentistry

department of Institute of dentistry АМS of Ukraine (Odessa), maxillofacial surgery

department of the Lvov regional clinical hospital, maxillofacial surgery department

of city clinical hospital № 2 (Vinnitsa) and Vinnitsa regional clinical hospital named

after N.I.Pirogov, maxillofacial surgery department of city clinical hospital the urgent

and first help (Zaporozhye), maxillofacial surgery department of municipal city

clinical hospital № 11 (Odessa), maxillofacial surgery department of the Kharkov

city clinical hospital of fast and urgent medical aid named after prof. A.I.Mechnikov

and the Kharkov regional clinical hospital № 1.

The received results of the lead{the carried out} research are included in a series

of lectures, and also used at carrying out of practical employment{occupations} and

seminars in the following higher educational institutions: to faculty of maxillofacial

surgery of the Kiev medical academy postgraduate educations named after

P.L.Shupika; to faculty of dentistry of the Zaporozhye medical academy postgraduate

educations; to faculty of the general and surgical dentistry of the Kharkov medical

academy postgraduate educations; to faculty of dentistry of faculty postgraduate

formations educations of the Dnipropetrovs’k state medical academy (Krivoi Rog); to

faculty of surgical dentistry and maxillofacial surgery of the Kharkov state medical

university; to faculty of children's age dentistry of Vinnitsa national medical

university; to faculty of surgical dentistry with a rate of bases of dentistry and faculty

of preparation of surgical dentistry with reconstructive surgery of a head and a neck

Ukrainian medical stomatologic academies (Poltava); to faculty

9

of surgical dentistry of the Lvov national medical university named after Danila

Galytckogo.

The personal contribution of the supervisor.

The author personally prepared a set of all patients, their clinical-laboratory

investigation and treatment. Under the direction of the head - prof. A.A.Tymofyeyev

is lead {carried out} the analysis of the received results, their mathematical

processing. Electrophysiological investigations are executed at consultation of

employees of a department on studying hypoxic conditions (chief - the doctor

medical Sciences, the winner of the State premium of Ukraine Mankovskaja I.N.)

institute of physiology named after A.A.Bogomolets NAS Ukraine (director -

academician NAS of Ukraine, the doctor medical Sciences, prof. Kostjuk P.G.).

Under the direction of the supervisor of studies substantive provisions of the

dissertation, conclusions and practical recommendations are formulated.

presentations of results of the dissertation.

16-n the international conference of oral and maxillofacial surgeons (May, 2003,

Athens, Greece); 3-rd congress of the Baltic orthodontic association and 4-th

congress of the Baltic association of maxillofacial surgeons and plastic surgeons

(May, 2002, Riga, Latvia); 19-th Jordanian congress of implantological doctors

(September, 2003, Amman, Jordan); 33-rd international congress dental

implantations DGZI/ICOI (October, 2003, Bonn, Germany); ICOI the international

congress (June, 2004, Las Vegas, the USA); 1-st Arabian implantological congress

DGZI (March, 2005, Dubai, United Arab Emirates); the Alexandria congress

implantological doctors (March, 2005, Alexandria, Egypt); joint faculty meeting of

maxillofacial surgery KMAPE named after P.L.Shupika and faculties of surgical

dentistry and maxillofacial surgery of medical institute UANM (May, 2005).

The dissertation is approved at intercathedral session of stomatologic faculties of

institute of Dentistry of the Kiev medical academy postgraduate education named

after P.L.Shupika (September, 2005).

10

Publications. On materials of the dissertation 13 scientific works, including 10

in the editions recommended VAK of Ukraine, 2 publications in scientific collections

and 1 - in theses are published.

Structure of the dissertation. The dissertation will consist of introduction, the

review of the literature, the chapter{head} "Material and methods of investigation",

three chapters{heads} of own researches, discussion of the received results,

conclusions, practical recommendations and the list of the used sources of the

literature. The list of the literature will consist of 237 sources, from which 122 -

domestic and 115 - foreign. The total amount of work makes 167 pages of the

typewritten text, the dissertation has 22 tables and 29 figures.

11

CHAPTER 1

THE REVIEW OF THE LITERATURE

1.1. A history of development dental implantations

Though dental implantation is considered rather new section in dentistry it is

necessary to note, that the problem of restoration of the lost teeth with the help of an

artificial teeth has a centuries-old history. From the literature it is known, that already

in the third millennium B.C. Egyptians have started to use for these purposes

intrabone implants. In Ancient Rome, Egypt, Central America, India and China At

once after removals {extraction} of a tooth in alveolus inserted the teeth made of

different materials. For implantation used the teeth of animals, an ivory, a stone, gold

and other materials (117, 112, 5). A history of development dental implantations is

standard to divide into six periods:

- The antique period (the first millennium up to Christmas), i.e. the first

attempts of implantation in Ancient Egypt and other countries;

- The medieval period (with 1000 on 1800 after Christmas) - carrying out of

transplantation of a teeth from one person to another (carried out these operations

,barbers). Only in 1774 two Frenchmen (the stomatologist and the pharmacist) have

created an artificial teeth from porcelain for implantation; Allen S. (1685) in New

York for the first time publishes the textbook on dental treatment in which the author

describes a technique dental implantations. In 1756 Gunter D. for the first time has

described results of histological research of a root replantation a tooth;

- The fundamental period (with 1800 on 1900). During this period intrabone

implantation from the following materials starts to develop dental: metal, porcelain,

etc. In 1808 the Italian stomatologist Magillo G. has made a ceramic tooth which has

been put on a platinum pin, and in 1809 - a pin from gold (implantation is carried out

in one stage). In 1839 has been

12

invented a vulcanized rubber and the first attempts to use her{it} for

manufacturing dental implants have appeared. In 1891 Znamensky H.H. has

published researches on implantation to dogs porcelain implants (the author for the

first time in apical parts implant has made a through hole for regeneration of bone in

it). At the end of 19-th century the first researches on studying biocompatibility of

used materials have started to appear. There are attempts of transplantation of a donor

teeth, scientific bases of allotransplantation start to be introduced;

- premodern period (with 1990 on 1930). To 1906-1907 Greenfield E.I. for the

first time has carried out dental implantation 15 cylindrical implants, made of an alloy

of platinum and iridium. These implants function more than 7 years and have been

recognized as stomatologists in the USA. During this period pine forests for formation

of bone cavities under dental implants for the first time are used;

- The period of development with 1930 on 1978. In 1955 in the USSR Vares

E.J.'s master's thesis on studying reaction parodentium on introduction plastic dental

implant for the first time is protected. During the given period of time, to be exact in

1964 Linkow L. offers plate a design dental implants with presence of apertures in

their intrabone part, and since 1972 already this implants together with a complex of

necessary tools for their introduction are made by firm “Oratronics Corporation”. By

the same author are offered cylindrical implants systems Linkow;

- The modern period (since 1978 and on present time). Bone integration which

has been described Branemark P.J. has opened a new era in a history dental

implantations. The author has proved concept "osseointegration" titanium implant

with a bone cells of a jaw. The system implants Brаnemark P.J. has been recognized

all over the world. During this period in all countries of more and more researches

appears by results of use dental implants.

13

The pioneer of implantation in Russia by the right is the senior lecturer of the

Moscow university Znamensky Н.Н. In 1890 Znamenskij N.N. has lead{has carried

out} the first experiment when to a dog after removal of incissors in expanded

alveolus inserted a porcelain teeth with cuttings on periphery of a root. Further the

author has lead{has carried out} experiments on application implants not only from

porcelain, but also rubber. The next years, down to 50th years of XX century about

implantation of a teeth in the literature mentioned incidentally. In 1955 Vares E.J.

(Ukraine) protects the master's thesis « Reaction of a connecting tissues on

polymethilmetakrilat in reactions of parodentium on implantation of an artificial teeth

». In 1956 Mudryj S.P. (Ukraine) also protects the master's thesis « Use of the

implanted roots of a tooth with the adaptation for fixing an artificial limb ». Since

1958 implantation in domestic dentistry has been forbidden by the Ministry of Health

of the USSR. Within almost three decades stomatologists of the former USSR

passively observed under the literature of development and achievements dental

implantations in the world. During this period of time have been published, becoming

known, works Linkow L.J. (1964, 1968), Branemark P.J. (1965, 1969), etc. In 1964

Linkow L. has offered plate a design implant with apertures and further became the

founder onestage fybroosseointegration implants. In 1965 the Swedish national school

implantological doctors has been created led by Branemark P.J. The theory is put in a

basis of this school osseointegration two-stages implants. Carrying out{spending}

experiments on animals, Swedish scientist Branemark P.J. has found out the

phenomenon osseointegration - ability of the titanium to grow together with a bone

tissues without formation of a capsule then has been created screw Branemark’s

implant. Several years later (in 1976) In Germany has been developed cylindrical

implant IMZ (intramobil cylindrical implant) with plasma spraying the powder

titanium. An original component of this system the intermediate element from plastic

which was fixed between implant and established suprastructure was, i.e.

14

function as the shock-absorber from impact. These implants used decade, they

have recommended themselves from the positive party{side}. Since 1975 have started

to be issued cylindrical and screw implants with a ceramic covering, and since 1979 -

by plasma spraying the powder titanium.

In 1981 at congress in Tashkent backlog of the Soviet dentistry in area

implantology has been recognized. In 80th years in the former USSR implantology

enthusiasts were engaged only: Krishtab S.I., Lamb В.В. (Ukraine); Chepulis S.P.,

Surov O.N. (Baltic); Mirgazizov M.Z., Sysoljatin P.G., Olesova V.N., Temerhanov

F.T., etc. (Russia), etc. In 1984 in Kaunas Chepulis S.P., Surov O.N., Chernikas

Ampere-second. Publish methodical recommendations on application stomatologic

implants in dentistry. Development dental to implantation in the USSR was promoted

by the order of Ministry of Health of the USSR from March, 4, 1986 for № 310 «

About measures on introduction in practice of orthopedic treatment with use implants

». The given order has opened ways for development of a method of implantation in

scales of all country (the former USSR). Department implantology in CSIIS

(Moscow) has been organized in 2 months after occurrence of this order.

Since 1986 methodical recommendations are published in the countries of the

former USSR on application dental implants (7, 101, 66 and others). Indications and

contra-indications to their use are proved, influence of implantation on immune

system of patients is studied, new designs and materials intrabone dental implants,

etc. are developed. Dissertations on dental implantations (3, 18, 4, 14, 108, 68, 79, 31,

20, 43, 21, 52 and others) Are protected.

In Ukraine introduction dental implants in stomatologic practice began from the

beginning of 80th years, and in 1985 the master's thesis Lamb В.В has been protected.

« Application implants at prosthetics of trailer defects of dental numbers{lines} ».

Implants various

15

designs from the titanium have started to be applied in Kiev, Lvov, Kharkov,

Dnepropetrovsk, Poltava and other cities of Ukraine.

1.2. The general {common} data about dental implantations and the

materials used in implantology

Depending on mutual relation dental implant with soft and firm tissues of a jaw

of Surov O.N. (1993) allocate 6 kinds dental implantations:

- endodonto-endoosseous,

- endoosseous,

- subperiostal,

- endoosseous - subperiostal,

- Intramucous (insert-implantation),

- submucous.

On a material of which it is made implant, the last are subdivided on biotolerant

(stainless steel, a chrom-cobalt alloy), bioinert (the titanium, nickel lid of the titanium,

gold, zirconium, krondovie ceramics, glass) and bioactive (metal implants, covered

hydroxyapatite or tri calcium phosphate). Biotolerant implants now are not used. It is

connected by that at application biotolerant implants they, after their introduction in a

bone, do not attacht in the thickness of implant, and are surrounded by a thick fibrous

capsule. Therefore such implants cannot provide their steady fixing in a bone. Now

the most widespread dental implants are that are made of the pure{clean} titanium or

the titanium covered with bioceramics (7, 18, 36, 9, 47, 58, 104, 112, 99, 167, 178,

199, 132, 154, 166, 191, 151, 156, 161, 229, Shirokov, 162 and others).

Now dental implantation is considered an alternative method of dental

prosthetics. It is possible and shown at any localization and extent of defect of dental

lines.

16

For carrying out dental implantations should be counted the basis a

uncooperative altitude of the patient to demountable prosthetics, unwillingness of

preparation tolerant teeth, allergic reactions to plastic of which demountable artificial

limbs are made, and also absence of necessary conditions for maintenance of reliable

fixing demountable artificial limbs. Relative contra-indication for carrying out dental

implantations the insufficient quantity{amount} of a bone fabric in a place of carrying

out of operation (an atrophy or defects of alveolar processes jaws, pneumatic type

maxilla sinus, etc.) can be intrabone . It is considered, that for preventive maintenance

of an atrophy of a bone fabric in the after implantation period it is necessary, that at

carrying out of operation around of entered implant there were not less than 2 mm of a

bone fabric (7, 79, 31, 87, 52, 112, 98 and others).

Before to proceed{pass} to methods of carrying out dental implantations we shall

stop on materials which are used at its{her} performance. It is known, that dental

implantation is connected to introduction in a fabric of an organism of the person of

alien materials for it and with reciprocal fabric reaction to these entered materials.

Now for manufacturing dental implants use three basic groups of materials:

metals, ceramics and polymers (99). Depending on reaction of bone and soft fabrics to

an implanted material of them also divide into three groups: biotolerant, bioinert and

bioactive (202).

To biotolerant to materials carry stainless steel, alloys of precious metals, alloys

chrome and cobalt or molybdenum. For this kind of a material it is characteristic

remote osseogenesis is such kind of reaction when around implant (fibrous) capsule

which delimit implant from a surrounding bone fabric of a jaw is formed connective

tissue.

Carbon, ceramics of dioxide of zirconium carry to bioinert materials the titanium

and his{its} alloys, tantalum, aluminium ceramics, niobium. For

17

these materials it is characteristic contact osteogenesis, i.e. formation{education}

of a bone fabric around dental implant, but without penetration inside of the last. Bone

integration occurs that the surface of these materials is chemically inert to surrounding

fabrics and fabric liquids.

It is necessary to attribute{relate} calcium - phosphatic ceramics (bioceramics) to

bioactive materials, hydroxyapatite, the titanium covered with bioceramics. For these

materials it is characteristic so-called bone osteogenesis which has received the name

"osseointegration". At this kind osseogenesis the certain kind of a direct chemical

compound implant with a bone surrounding it{him} is observed due to presence of

free calcium and phosphate on a surface of a material and adequacy of their

interaction with fabric components of a bone (232, 218). It is necessary to note, that

on different surfaces same implant there can be various kinds osteogenesis .

Successful functioning dental implants to a great extent depends on biomechanical

properties neogenic fabrics (137). The author marks adverse results at cicatricial,

osseous and cartilaginous fabrics. In morphogenesis dental to implantation opening an

opportunity to achieve union implant with a bone became new by their direct

connection due to a bone fabric which on its{her} structure and a morphological

structure corresponds{meets} to a normal bone (125, 141). This concept has come in

scientific terminology as "osseointegration" which means structural and functional

connection of an alive bone with a surface bearing{carrying} loading implant.

Biochemical compatibility means absence of immune reactions, inflammatory

processes as consequence{investigation} of tearing away implant. For success of

implantation such properties of metal as corrosion should not be shown.

In modern stomatologic implantation the widest application was found with

metals and their alloys. In 1959 Lew J. has noted, that around of titaniumic implants

the bone is formed faster, than around implants of cobalt and chrome. By the author it

is established, that alloys of the titanium possess anticorrosive properties and good

biocompatibility with fabrics surrounding them. The titanium has very successful

18

combination of necessary properties, i.e. it{he} very much racks to deformation, but

during too time easily is exposed machining. Many clinical and experimental

researches his{its} high biocompatibility and anticorrosive stability{resistance}

proves to be true. In the environment where oxygen contains, on a surface of the

titanium it is formed oxygenic a film (thin dividing{sharing} oxygenic between

implant and the biological environment) which reliably protects metal from

aggressive corrosive environments, i.e. these implants it is possible to

attribute{relate} a layer to biotolerant (3, 28, 125). Oxygenic the layer which is

formed on a surface implant considerably raises anticorrosive properties of a material,

and due to stable and high density oxygenic possesses high viscosity and good

adhesion. In case of occurrence of scratches or other damages on a surface of the

titanium there is a restoration oxygenic a layer (219, 225). Further to some authors it

has been proved, that given oxyd the film can collapse under influence of medical

products which are used for preventive maintenance of caries, and also the medicines

containing fluorides (228).

From positive properties of the titanium also it is necessary to note absence of

allergic reactions to him{it}, however on alloys she{it} comes to light in single

instances (169, 232).

In world{global} stomatologic practice by one of the most widespread materials

used for manufacturing dental implants, the titanium and alloys on his{its} basis - ВТ

1-0 and ВТ 1-00, the so-called pure{clean} titanium is. Domestic alloys ВТ 1-0 and

ВТ 1-00 have more rigid restrictions under the maintenance{contents} of impurity,

than foreign analogue Grade 1, 2. Alloys of titanium ВТ5 and ВТ6 correspond{meet}

to foreign analogues Grade 4, 5. Due to presence of fluorine, a pine forest and

niobium such alloy of the titanium becomes stronger and plastic, but because of

presence of aluminum (up to 5 %) and vanadium, application of it{him} is limited

(68, 52, 225, 228).

19

Last ten years wide application was received with a technique plasma sputtering

nitride of the titanium or a thin layer hydroxyapatite on surface titaniumic implants

that has improved the characteristic used implants (175, 219, 131, and 149).

To experimental researches it has been proved, that the covering titanium implant

hydroxyapatite has allowed to create stronger connection between a bone and the

implant, and also has enabled in early terms (in 32 weeks) to form their dense

connection (187). However some lacks of a covering have been found out also -

ability in due course to be dissolved in the biological environment of an organism.

Therefore further some authors for improvement osseointegration used a double

covering implant - the titanium and hydroxyapatite (64). For smooth transition of

physicomechanical properties of the compact titanium to properties of bioceramics,

and also with the purpose of reduction of internal pressure{voltage}, the structure of

the composite layer consisting of the titanium and hydroxyapatite has been developed.

Their optimum parity{ratio} is chosen in view of the greatest adhesive durabilities

which has made 80-60 % of the titanium and 20-40 % hydroxyapatite. On the basis of

the lead{carried out} researches the way of manufacturing intrabone implants,

consisting in plasma evaporation on a metal basis implant a multilayered covering

with an external bioactive layer (8, 64, 12, 62, 38, 172, 149) has been developed. For

a relaxation of internal pressure{voltage} three transitive layers (small-porous the

titanium, big-porous the titanium, a mix of the titanium and hydroxyapatite) are used,

and the external layer (20-30 microns) is formed by thickness from pure{clean}

hydroxyapatite. General thickness of a covering makes 130-150 microns.

By association of scientific researches of the scientific different countries, and

also on the basis of new technologies are developed implants with memory of the

form from the nicelid-titanium an agglomeration method a porous material on

without-porous to a basis that has considerably raised{increased} his{its} stability to

corrosion (70, 110, 111,

20

183, 127, 175). However clinical supervision is short-term enough to draw final

positive conclusions.

Cobalt-chromic alloys are used in dental implantations about fifty years.

However the basic lack of use of designs from these alloys is the opportunity of an

output{exit} in an environment of a fabric of salts of heavy metals, and around

implant the capsule which contains rough fibres of collagen is formed connective

tissue. Except for it the given alloy possesses insufficient anticorrosive

stability{resistance} that is one of major factors of development of complications in

the postoperative period (18, 102 and others). Opportunities of use for manufacturing

implants argentums -palladium an alloy (18) are shown.

Alongside with wide use and positive clinical results in dental implantology

applications metal implants exists enough given that metal dental artificial limbs

including implants, in conditions of a mouth enter electrochemical reactions and are

exposed to corrosion that considerably reduces their biocompatibility, worsens

processes of regeneration of a bone fabric in the center of implantation and promotes

development post-implantological complications (14, 87, 118, 21, 36, 112, 97, 198,

200, 213, 135 and others).

The basic purpose{assignment} dental implants is a creation of conditions for

manufacturing fixed designs of dental artificial limbs. Therefore in most cases for

implantation use their metal designs. At the same time from the literature it is known,

that for implantation products from different alloys of metals can be used, and on the

head implant the fixed metal designs of dental artificial limbs also made of different

metals and alloys (78, 33, 43, 101 and others) become stronger.

In connection with earlier told, many researchers conduct search new,

possessing by high biocompatibility, nonmetallic materials of which it is possible to

make dental implants. One of such materials is the bioceramics (69, 70, 79, 22, 36,

233, 169, 171, 234 and others).

21

From the point of view osseoconducted potential and interactions with bone

Strunz V. (1984) and Osborn J. (1985) have divided{shared} all biocompatible

materials on: bioactive (as a result of biodegradation in part or are completely

replaced by a bone fabric), bioinert (biodegradations are not exposed and are not

included in a metabolism, and their surface can provide physical and chemical

communication{connection} with bone matrix) and biotolerant (do not resolve and do

not enter a metabolism, but are capable to provide readsorbation fibers on the surface,

around of their surface the fibrous capsule is formed).

Ceramic implant materials also can be divided{shared} into 3 groups (22, 60,

29): bioinert, bioactive and resorbed. Corundum and carbon ceramics carry to bioinert

ceramic materials (15, 83, 11, 22). Into structure корундовой ceramics enters from

99,5 % up to 99,7 % oxide aluminum (Al2O3). Depending on technics {technical

equipment} of manufacturing oxide aluminum it{he} can be in monocrystal

(sapphire) or in the polycrystalline form (cador). It is proved, that the monocrystal

form oxide is twice stronger some aluminum than polycrystalline (202, 187). It is of

great importance for a choice of bioceramics which can be used in quality dental

implants. Sapphire implants find use for manufacturing implants (22, 36, 112, 113).

Are let out{released} endoosseos implants from a ceramic material "Alumag-1" (will

consist from oxide aluminum with addition oxide magnesium). Experimental and

clinical researches prove good biocompatibility before specified implants (22, 36,

112, 113).

All osseoplastic materials which are used in implantology, depending on an

origin, share on:

22

- autogenic (the donor - the patient);

- allogenic (the donor other person is);

- xenogeny (the donor the animal is);

- alloplastic (synthetic materials).

Depending on ability of a material to participate in bone regeneration, Edward S.

Cohen (1988) has divided{shared} osseoplastic materials on:

- osseoinductive, i.e. capable to cause osteogenesis (to them concern auto-and

allotransplantation);

- osseoconductive the materials, capable to play a role passive matrix for again

educated bone (porous hydroxyapatite, bioactive glass, etc.);

- osseoneutral - inert materials which are used only for filling bone space, i.e.

they are not a support for a new bone (not porous hydroxyapatite, tribasic calcium

phosphate, etc.);

- The directed fabric regeneration (Guided Bone regeneration - GBR).

The special place in modern implantology is borrowed{occupied} with bioactive

ceramic materials - calcium - phosphatic and glass ceramics. For manufacturing an

independent design dental implant such bioceramic materials have no sufficient

durability, therefore them, it is possible to use for a covering of a surface metal

implants or as a plastic material (for elimination of bone defect or completion of

available lack of a bone).

All osseoplastic materials depending on ability to resolve are subdivided on:

resorbed and nonresorbed. The first group is completely resorbed materials (porous

hydroxyapatite, polymers, tribasic calcium phosphate, bioactive glass - BioGran, etc.),

the second group - in part or completely nonresorbed materials (not porous

hydroxyapatite, bioactive glass - PerioGlass, etc.). Depending on cleanliness of a

synthetic material the last are subdivided on pure{clean}

23

(will consist of one chemical substance) and combined (from two and more

chemical substances).

Mineralized fabrics of a human body will consist, basically, from different kinds

hydroxyapatite, tribasic calcium phosphate and a carbonate of calcium (49). Wide use

in modern medicine, to be exact stomatologic implantology, was received with

materials on a basis hydroxyapatite and tribasic calcium phosphate. Application of

them is based on high bioactivity, biocompatibility and stimulation with their help of

growth of a bone.

Hydroxyapatite which chemical formula Са10 (РО4)6 (IT) 2, is identical on the

structure and crystal structure to mineral substance of an alive bone, therefore his{its}

biocompatibility with a surrounding fabric surpasses many other materials which are

used in surgical dentistry and maxillofacial surgery. It is known, that hydroxyapatite

the person is represented with a mineral skeleton which is a source of calcium and

phosphorus in fabrics. Synthetic hydroxyapatite, as against natural, is osseoconductive

and can participate in osteogenesisе. Hydroxyapatite has stable molecular structure

and, despite of variable structure, forms and keeps mineralization fabrics at the

different maintenance{contents} of calcium (83).

Hydroxyapatite concerns to calcium - phosphatic connections. It{he} can be

received not only from biological raw material, but also synthetic way (a method of

chemical drainage or sintering, etc.). Synthetic hydroxyapatite it is chemically similar

natural, but represents only ceramic-simple the form (it{he} is more dense, longer

resolves, can resolve in part or not resolve in general). In clinic it is applied both

resolving, and not resolving hydroxyapatite which represents a material received at

sintering (112). Resorbe hydroxyapatite possesses osseoconductive properties,

provides adhesion of bone cells{cages} and fibers, actively

24

it is included in an ionic exchange (80, 81). Hydroxyapatite in the market is

issued as in the pure state, and from a different sort by additions (polymers,

collagens).

Synthetic tribasic calcium phosphate are not analogues of calcium - phosphatic

connections natural hydroxyapatite (their big part is transformed in hydroxyapatite,

and smaller - it is dissolved).

The soluble bioceramics is time spatial fill or a skeleton for development of a

new bone fabric. In the given cases of the phenomenon of regeneration is based on

dissolution of bioceramic materials and abilities of a fabric in passing to replace

bioceramics. One of advantages of soluble bioceramics is that the initial size can be

small, therefore initial mechanical durability of a material is higher, and as the

bioceramics is dissolved, time of her{it} increase in sizes that allows to grow further a

fabric. As a result of it mechanical integrity of the given postoperative site is

supported. Restoration of a bone fabric, i.e. its{her} regeneration, occurs

simultaneously with resorbtion bioceramics (112).

Bioceramic materials can be quickly-resorbed and slow-resorbed. Quickly-

resorbed the bioceramics (tribasic calcium phosphate) is used for elimination of

postoperative bone defects, and slow-resorbed (hydroxyapatite) - for escalating a bone

fabric (after removal{distance} of a teeth with the purpose of preservation of height of

an alveolar crest, etc.). Materials on a basis hydroxyapatite in implantology are used

as dense and porous ceramics (41, 46, 43, 23).

In Ukraine it is made, is issued, it is resolved{allowed} to application for №

310/96 (order MH of Ukraine from 28.08.1996 № 269) and № 1105-161 from

07.06.2000 osseo-likely a preparation under name "Kergap" - from ceramic

hydroxyapatite and tribasic calcium phosphate (bones similar to mineral substance)

for completion of bone defects. Is issued Kergap as a powder, granules, blocks and

products which are made as from porous,

25

and dense osseolikely ceramics. The given preparation has found wide

application in maxillofacial surgery in clinics of Ukraine.

To resorbed materials also it is necessary to attribute{relate} bioactive glass. In

Ukraine the synthetic preparation made of a bioactive glass, under name "Bio-Gran"

(manufactures the USA) is registered and resolved{allowed} to application. Resorbed

term - 6 months, the delay resorbting the certain particles for years is

possible{probable}. Good adhesion of this material is provided due to

formation{education} of a silicon layer atop of which the layer of phosphate of

calcium after which crystallization it will be transformed to a layer

hydroxycarbonapatite (on a surface of the last is formed occurs proliferation

osseological cells{cages} and collagenic fibres) grow.

In quality of osseoplastic material in implantation are used combined

osseoplastic materials: hydroxyapol (69, 15, 49, 83, 52 and others), Kollapan and

Kollapol (15, 49, 10, 11 and others); Tutoplast (2); a mineral trioxide the unit (24) and

other preparations.

At the directed regeneration of a bone (GBR) or directed bone regeneration

(DBR) the question is only restoration of a bone fabric of any defect (44, 5, 23, 54,

55, 119, 120). In this case fabrics parodentium and the teeth which are taking place in

this zone (50, 51, 59, 25, 206, 126, 181, 145, 164, 207 and others) are not taken into

account. Therefore in the stomatologic literature one more close term has appeared is

the directed regeneration of fabrics (GTR) or the directed fabric regeneration

(scientific and technological revolution). Last term mean use for isolation of bone

defect of the mechanical barrier (membrane), warning to growing into bone defect of

bacteria and undesirable (not bone) cellular elements (epithelium, etc.). Healing

parodentium wounds (bone defects of an alveolar process jaws) has the features since

one of wound surfaces has no vessels (an external or internal part of defect, a surface

of a root of a tooth) and speed of regeneration nearjaws fabrics are various

26

(epithelium has the greatest speed of regeneration, and a bone, a periodontium,

cement - smaller) (112, 102).

All paradontological membranes depending on them resorbed abilities share on

not resolving (from polytetraftorethilenum - РТFE, etc.) and resolving (polymeric,

plaster, collagenic, etc.). In opinion of many authors, the most effective for the

directed fabric regeneration are not resolving membranes, however they have some

lacks - necessity of repeated operative intervention (in 6-8 weeks) for their

removal{distance}, at their extraction collapses the external surface bone regeneration

which is intimate, for this period of time, is connected to a membrane (26, 90, 16, 53

and others). Resorbed membranes can have term resorbed from 6 weeks (Kapset,

Rezolyut, Bio-Mend, etc.) till 3-6 months (Bio-Gide, Vykril, Alloderm) and even 6-

12 months (allogenic a membrane - Lambon, a collagenic membrane - Ossix, Wide

fascia hips, laktis polymer - Atrisorb, etc.). Use parodentium with term resorbed

within the limits of 6-8 weeks is usually not enough membranes for increase in height

and width of an alveolar process jaws since for high-grade regeneration of a bone

under favorable conditions it is required not less than 3 months (50, 51, 89, 90, 16, 93,

37, 53, 102, 94 and others).

Before carrying out of operation dental implantations to the patient complex

investigation (108, 43, 112, 113, 100 and is necessary to pass others) which includes

gathering the anamnesis, clinical investigation (the analysis of blood, urine), survey of

an oral cavity (an estimation of a condition of a teeth, alveolar processes, a mucous

membrane, a kind of a bite, temporo-mandibular joint, a condition of hygiene, etc.),

radiological research teeth-jaws systems (aim X-ray, orthopantomography, a

computer tomography), and also tool investigation (measurement of width of alveolar

processes, definition of electrogalvanic potentials - at implantation and prosthetics

with

27

use of diverse metals, etc.) or stereolithograph (27, 30, 39).

For classification on top and mandibles in dentistrymost frequently use ordering

which is offered in 1928 Kennedi J. But, as is known, dental implantation apply at an

atrophy jaws is more often, and quality of a bone estimate on corresponding

classifications. With this purpose use classifications Atwood D. (1971), Wical K. and

Swoope D. (1974), Seibert J.S. (1983), Lekholm U. and Zarb G. (1985), Fallschussel

G. (1986), Judy K. (1987), Howell R.A. (1988). Depending on thickness mucouse-

periosteum a flap it is possible to use of Konstantinu K.P.'s classification (1997).

To carry out {spend} an estimation of quality of a bone fabric on the basis of x-

ray pictures it is possible only roughly. Last years consider, that most authentically it

is possible to judge quality of a bone on a computer tomography (100, 98, 65 and

others). Depending on expressiveness of a degree of an atrophy of a bone of alveolar

processes and qualities of a bone fabric in endoosseous implantations use

corresponding additional operations on top and mandibles which help not only to

establish endoosseous implant, but also to achieve qualitative it{him} heal (224).

1.3. Operation of a raising of a bottom maxilla sinus

In endoosseous dental implantation to the doctor should meet difficulties, which

are connected to anatomic and age features jaws. For the doctor - doctor of

implantology introduction dental implant on maxilla happens a bone inconvenient

because of an atrophy of an alveolar process or at pneumatic type maxilla sinus.

Similar there can be a situation at a significant atrophy of an alveolar process in a

face-to-face department when there is a probability of punching of a bottom nasalis

cavities. For increase in height of an alveolar

process, both in lateral, and in face-to-face departments it is possible to use

different methods: bone plastic (imposing osteoplastic materials on atrophic a part of

28

an alveolar process), a raising of a bottom maxilla sinus (sinuslifting) or a bottom

nasalis cavities (antroplastic, antrolifting).

As bone materials at an atrophy of alveolar processes jaws, i.e. for escalating a

bone and reconstruction of alveolar processes, use as auto-or allogenic bone, and

bioceramics as blocks, etc. (86, 32, 35, 72, 76, 103, 105, 111, 55, 56, 143, 221, 177,

186, 212, 158, 159 and others). Carrying out of reconstructive - regenerative

operations for escalating alveolar processes is carried out duly bone-plastic operations

with various fixing of transplantation material (54, 55, 99, 113, 224 and others).

Depending on type, the size and localization of a bone atrophy of alveolar

process Тyulan J and Pataraya G. (2001) allocate versions of their clinical forms:

1. Anatomic versions - horizontal resorbtion (reduction of thickness of an

alveolar wall which turns to a thin plate, having kept thus sufficient height), vertical

(results in loss of height of an alveolar process and it is observed after traumatic

extract) and mixed resorbtion (simultaneous reduction of height and thickness of an

alveolar crest);

2. Topographical forms - individual (bone deficiency is observed in the field of a

unique tooth and is more often it is observed in the field of cutters), segmentary

(meets in lateral departments of an alveolar process), full (is observed on all jaw).

In practice of the doctor - doctor of implantology the special place

borrows{occupies} planning operation at absence small molars and molars when for

statement implants there is a height of less than 10 mm (35, 115, 56, 123, 148, 170

and others). In this case, at non-observance of an elementary rule when for installation

implant in area small molar or molar on the maxilla the necessary minimal height

of a bone makes 8-10 mm, it is especial in immediate proximity from a sine, to expect

for success it is not obviously possible. In these cases from this position, i.e. at height

of a bone less than 8-10 mm, it is necessary to count a unique output exit} carrying

29

out of operation of a raising of a bottom a sinus of maxilla (or a bottom nasalis

cavities). Thus, it is possible to increase a bone basis in which is dental implant and to

create conditions for osseointegration implant and long-term it{him} there sites.

By means of increase in a bone file in the field of a bottom a sinus of maxilla

there is possible{probable} use of longer dental implants (10 mm, instead of 8 mm),

that is more preferable in lateral departments maxilla bones with the purpose of

creation of adequate resistance occlusion to loading which develops in the given

departments.

On the basis of the saved up practical experience many authors (86, 32, 73, 74,

34, 72, 76, 77, 105, 116, 13, 139, 196, 197, 188, 222 and others) consider, that all

similar cases of lack of a bone on the maxilla need to be divided into 4 groups:

1. The height of an alveolar process maxilla bones makes 10 mm and more -

installation dental implants by a usual technique is possible {probable}.

2. The height of an alveolar process of the maxilla is in limits from 8 up to 10

mm. Perforation of a bottom maxilla sinus and introduction implant on 1-2 mm

in sinus maxilla a sinus in this case is possible. In these cases it is possible to

use soft (closed) sinuslifting. After installation dental implant an obligatory

condition is sufficient primary fixing which is carried out on two cortical bone

layers of the maxilla (the top layer

the bottom maxilla sinus is, and bottom it is considered a crest of an alveolar

process).]

3. The height of an alveolar process makes from 5 up to 7 mm. In these cases

carrying out of classical operation sinuslifting is necessary. The bottom maxilla

30

sinus raises on some mm that the height of an alveolar process has made 8-10

mm. It is possible to fill in the formed cavity auto-or allogenic bone, or

bioceramics. The height of an alveolar process in 5-7 mm is necessary for

primary bone fixing dental implant on the part of an alveolar crest.

4. Height of an alveolar process maxilla bones less than 5 mm. In these cases

installation dental implants is problematic whereas it is not obviously possible

to create even the minimal primary bone stabilization implant. In this case it is

recommended to carry out {spend} at the first stage classical sinuslifting

without installation implants but only to fill in a cavity osteoplastics material.

The second stage is carried out in 8-12 months, installation dental implants are

carried out {spent}. However in this group authors mark high percent {interest}

of failures, and the basic lack should be counted that term of treatment of

patients in 3-4 times increases, i.e. makes from 1, 5 till 3rd years.

Proceeding from earlier told and depending on a degree of an atrophy of

alveolar processes, it is possible to use classification which is offered Misch C.E.

(1987). Depending on a degree of expressiveness of an atrophy of alveolar processes

maxilla bones the author has divided {shared} surveyed on 4 groups. The first group

(SA 1) included surveyed with height of an alveolar process more than 12 mm, i.e. at

absence of an atrophy of an alveolar process. Persons are included in the second

group (SA 2) with an insignificant atrophy of an alveolar process (height of an

alveolar process of 10-12 mm). In the third group (SA 3) - a moderate atrophy -

between

edge {territory} of an alveolar crest and bottom maxilla sinus the height of an

alveolar process makes 5-10 mm. The fourth group (SA 4) - persons with a significant

atrophy of an alveolar process is included. The height of a bone from an alveolar crest

to the bottom makes sinus up to 5 mm. In the third and fourth group, using

31

sinuslifting, in opinion of the author, height of an alveolar process about 16-20 mm

are maximum possible to raise {increase}. Last (fourth) group is characterized by the

highest risk of occurrence of complications because of insufficient fixing endoosseous

implants.

On classification Cawood J.I. and Howell R.A. (1998) it is possible to allocate

5 classes of condition maxilla sinus depending on size resorting a bone fabric of an

alveolar process:

1. An alveolar process with his {its} kept height, i.e. height of an alveolar

process more than 10 mm (100 % an opportunity heal 10 mm dental implants);

2. An alveolar process At once after removals {distances} of a tooth at height

of a process of 7-9 mm (70 % an opportunity heal 10 mm implant);

3. An alveolar process in height from 4 up to 6 mm (40 % of an opportunity

heal 10 mm implant in own bone);

4. An alveolar process with height from 1 up to 3 mm (10-30 % an opportunity

heal 10 mm implant in own bone);

5. Absence or destroyed maxilla’s sinus.

Operation classical sinuslifting all authors (86, 32, 116, 13, 103, 112, 113, 196,

223, 222, 227, 208, 210, 209 and others) recommend to carry out as follows. Under

local anesthesia do {make} a cut {section} on transitive fold from a canine up to tuber

the maxilla with transition to edge {territory} (crest) of an alveolar process. Detach

mucoperiosteal flap. On a vestibular wall maxilla bones, in a projection of an external

wall maxilla sinus, the bone window which breaks inside sinus (without damage of a

mucous membrane) is done {made}. In the formed cavity enter osteoplastic material

(auto-or allogenic bone,

bioceramics). Then an operational wound close bioresorb a membrane (better

that terms resorb were within the limits of 4-6 and more months). This operation, it is

possible to carry out {spend} as simultaneously with introduction dental implants, and

in two stages (the first - sinuslifting, the second - implantation). Classical sinuslifting

32

(open sinuslifting or subantral augmentation) is possible for carrying out in I and II

groups and in part in III group on classification Misch C.E. (1987) since only in those

groups where it is possible to achieve full or partial primary bone stabilization dental

implants.

If the postoperative period at classical (open) sinuslifting proceeds without

complications dental implantation can be carried out {be spent} in terms from 6 till 12

months. The closing date is an absolute guarantee for an opportunity of installation

dental implants in area of a postoperative cavity.

For a raising of a bottom maxilla sinus last years wide application more sparing

operation - soft (closed, sparing) sinuslifting which demands more cautious and

perfected surgical technics {technical equipment} of carrying out of operative

intervention finds. At sparing sinuslifting less operational trauma, but the given

operation is carried out {spent} "blindly". Last factor can be attributed {related} to

lacks. For carrying out of this sparing operation different tools and variants of its

{her} carrying out (86, 32, 74, 34, 110, 76, 77, 103, 105, 123, 148, 170 and others)

are offered.

And co-authors (2003) have offered Bogatov A.I. a tooling and a way of

realization soft sinuslifting in a combination to one-stage implantation. For carrying

out closed sinuslifting authors have suggested metal is pulled out {frayed} - the

puncher. Under local anesthesia implantological the tool form bone to a box screw

dental implant directly up to a wall of a bottom a sinus of maxilla . Then in generated

bone to a box authors screw the device « is pulled out {frayed} - the puncher », punch

a bottom of a sinus, fill in the formed

cavity of osseoplastic material and screw implant. The given device allows

carrying out procedure of punching of a wall and shedding a mucous membrane of a

bottom maxilla sinus (13). However the rigid basis of the metal puncher and

disposable violent exfoliation a bottom maxilla a sinus does not allow to avoid

possible{probable} of perforations shedding epithelial lining maxillary sinus a sinus

33

that causes contamination implanted osteoplastic material and extends terms of the

directed bone regeneration.

The raising of a bottom nasalis cavities at installation implants in the field of

cutters of the maxilla can arise at a significant atrophy (postextraction or

posttraumatic) an alveolar process if between an alveolar crest and a bottom of a

cavity there is a distance less than 10 mm. Basically procedure of a raising of a

bottom of a cavity of a nose same, as well as a bottom maxilla sinus. The given

operation should be carried out {be spent} under the control radiovisiography. For

performance anthroplasty use operations which use for closed (soft) sinuslifting is

more often. However some authors for carrying out anthroplasty offer more complex

{difficult} operative interventions - horizontal osteotomy a face-to-face department of

the maxilla with the subsequent introduction in the educated space auto-or allogenic

bone or bioceramics (138). The given operation has not found wide application.

Thus, it is necessary to note, that till now in the literature there are no data on a

substantiation of application of different methods of a raising of a bottom maxilla

sinus depending on quantity{amount} entered dental implants. Methods and terms of

bone stabilization entered implants are not specified depending on their number. In

the literature there are no data and there are no techniques on carrying out classical

sinuslifting with simultaneous installation dental implants at height of an alveolar

process maxilla bones less than 5 mm.

For carrying out soft sinuslifting in the literature metal devices are described

and used and consequently the degree of batching of pressure for exfoliation a

mucous membrane of a bottom maxilla sinus is not uniform, that causes its{her}

34

damage and extends terms of bone regeneration implantological osteoplastic a

material.

1.4. Reconstructive operations at an atrophy of alveolar processes jaws

It is known, that within the first year after removal {distance} of a tooth or a

trauma of a bone (operational or another) occurs loss of a bone from 20 up to 40 % of

width of an alveolar process (112, 40, 102 and others).

At dental implantations the doctor should collide {face} with necessity, both

increases in height, and width of alveolar processes jaws. For this purpose it is

possible to use bone to plastic with fixing a transplant "with in" (71, 1, 98, 97, 158,

159 and others). For increase in height of an alveolar process of a jaw a transplant

(auto-or allogenic bone) stack as "with in" on an alveolar arch, and on the basis of the

mandible. Misch C. (1993) suggests the given transplant to subject to splitting that

promotes his {its} expansion. About use tutoplast (tutoplasticchips) for plastic

reconstruction of the damaged {injured} sites of an alveolar bone specifies Heroes

В.Н. and со-autors. (2002).

With the purpose of increase in width of an alveolar process installation auto-or

allotransplantation on a lateral narrow site of a bone is carried out{spent}. Imposed on

the given site of a bone the transplant should be fixed screws (99).

It is possible to carry out {spend} osteotomy (vertical or horizontal) a jaw by

the techniques standard in maxillofacial surgery (71, 112, 113, 142, 140, 195 and

others). Arising at carrying out osteotomy the space is filled auto-or allogenic bone or

bioceramics.

For expansion of a narrow alveolar process it is used also vertical it {him}

osteotomy with the subsequent filling the formed space bone-seeking materials. Lack

vertical osteotomy an alveolar process should be counted that she{it} is carried out in

two stages and that this operation is carried out{spent} with a break of a vestibular

35

wall of a bone. The space formed at the first stage is filled by bioceramics and the

postoperative wound (mucoperiosteala flap) is sewn up tightly. Dental implants are

usually entered only in 6-8 months after osteotomy, i.e. installation implant is carried

out {spent} at the second stage of operation. Two-stage performance of operation

considerably extends a method of treatment (140, 195 and others).The efficiency of

the given techniques is from 30 up to 65 %.

Some authors offer reconstruction of an alveolar process with the help vertical

intralaminar osteotomy with use of microfixing implants. For these purposes a

diamond disk carry out {spend} has drunk an alveolar crest, division of a bone carry

out with the help of a chisel. A vestibular bone fragment of an alveolar process

displace as it is possible further in a vestibular direction, insert implant, in the formed

defect fill bone-seeking a material and a microosteosynthesis carry out screws the in

length in 8 mm by a fastening of external and internal bone plates among themselves.

An operational wound, i.e. an alveolar bone together with implant, bone-seeking a

material and the screw cover non-resorbed with a biomembrane from

polytetraphtorethilenum, sew mucoperiosteala flap. For stabilization several implants

authors suggest to use miniplates for an osteosynthesis which are fixed by screws on

an external surface of an alveolar process. In 4-6 months implant open, delete a

membrane and all fixing a bone and implant materials (used for a

microosteosynthesis), establish basic elements and sew mucoperiosteala flap after

his{its} mobilization (203, 155). Lack of this

technique is two-stage, technical complexities at installation implants because

of springing properties of bone fragment s of a bone (the bone aspires to be pulled

together and it creates complexities at formation bone a box), use of the additional

materials remaining in an operational wound (microscrews and microplates for an

36

osteosynthesis, biomembranes). Efficiency of a technique offered {suggested} by

authors makes 86,2 %.

To overcome springing properties of bone fragment s of an alveolar bone at

intralaminar osteotomy Palti A. (2003) recommends using a set osteotoms. However

the author marks, that violent expansion fragment s can cause break off vestibular

fragment of an alveolar process that considerably worsens trophism fabrics, extends

terms of treatment, and also reduces efficiency.

In the literature there is an information on use osteotoms which allow to expand

some a narrow bone crest by means of a compression and pushing away of an alveolar

bone in mainly lateral a direction (217).

Use for expansion of alveolar processes (is possible at defects, deformations,

etc.) osteoplastic materials (hydroxyapatite, Kergap, Kaerasorb, Kollapan, etc.) in a

combination to biomembranes (236, 130, 165, 144, 218, 221, 204 and others) or

titaniumic membranes (82, 163, 168). Efficiency of treatment makes according to

authors from 60 up to 78,3 %.

Dystraction - a modern method of increase in height of an alveolar process

which is alternative of usual augmentation. At dystraction the local bone which

increases the special device which becomes stronger on a jaw after carrying out

segmentary osteotomy is used. At carrying out dystraction an obligatory condition is

performance segmentary osteotomy on a site which is subject to increase. On the last

strengthen dystraction the device and a postoperative wound sew up tightly. Healing

of a wound passes within

7-8 days. After removal of seams start a phase dystraction which is carried out

{spent} within 1-2 weeks. Daily increase carry out {spend} on 1 mm. Then within 1-2

weeks the lifted fragment keep without displacement (a phase of deduction), and then

only take dystraction and start installation implant. At use dystraction a method

achievement of result probably only later 3 months. In parallel to increase in a bone

37

there is a stretching of soft fabrics. The given method yet has not found wide

application, therefore in the literature there are only individual data on this way of

treatment (82).

Thus, in the literature there are enough methods for expansion and increases in

an alveolar process, but not all from them find wide application because of available

lacks of this or that offered {suggested} technique. Efficiency before the specified

methods make from 30 up to 86 %. Methods of expansion of an alveolar process are

still insufficiently developed, since lacks available in earlier described techniques

(duration of treatment, traumatic operations, complication during its {her} carrying

out, etc.) do not give an opportunity to guarantee efficiency of spent treatment.

Therefore in the literature searches of new, more modern methods of surgical

treatment proceed or will be improved earlier known. There is a necessity for a

substantiation of use of modern methods of surgical expansion of alveolar processes

jaws.

1.5. Features of the postoperative period of conducting patients with dental

implantation

Carrying out dental implantations causes the certain changes in a bone and

surrounding soft fabrics as a result of the put operational trauma. In reply to this

trauma inflammatory reaction in fabrics develops. That the postoperative period

proceeded without complications to the patient it is necessary to appoint adequate

treatment.

The subjective burdensome sensation arising at action of damaging {injuring}

factors on a fabric, having painful receptors clinically is characterized by a pain.

Strong painful irritations are capable to cause changes in respiratory and

cardiovascular systems can lead to infringement of function endocrine glands and

immune system. Strong painful irritations also result in an exhaustion of power

reserves of an organism and mentality or to occurrence of other changes in an

38

organism which negatively influence a condition of the patient. For removal of such

painful sensations at the patient it is necessary for it{him} to appoint adequate on

efficiency analgesics. The arsenal analgesics are wide, but not each of them

adequately removes the expressed painful sensations which arise after operative

interventions on a bone at carrying out of implantation. Therefore

purpose{assignment} analgesics means in the postoperative period has great value for

preventive maintenance of development of complications.

As at patients inflammatory reaction to an operational trauma there is a

necessity for purpose {assignment} of antibacterial therapy for decrease {reduction}

in risk of development of postoperative infectious complications develops. The choice

of an antimicrobic preparation is important, but inconvenient, since the microflora of

an oral cavity has the features and in development of inflammatory complications

participate, as a rule, not one microbic activator, and a little - microbic associations.

To the patient symptomatic treatment is appointed. Next day after carrying out

of operation to the patient recommend cautious cleaning a teeth, soda warm trays (3-4

times day after meal), observance of a diet (reception of soft and liquid food of

moderate temperature).

Seams usually recommend to remove from a postoperative wound for 7-10 day

after carrying out of implantation.

In the postoperative period hygienic care of an oral cavity (antiseptic rinsings,

etc.) is recommended to the patient. Hygiene of an oral cavity has great value for long

functioning dental implants. Among smokers the probability of development of

complications, on data Liran Levin et al. (2004), increases.

During carrying out of implantation and in the postoperative period there can

be local complications which reasons can be insufficient investigation of the patient,

underestimation of contra-indications to carrying out of the given operation, inept or

rough work of the surgeon at formation bone a box or carrying out of additional

surgical intervention, non-observance of hygiene of an oral cavity after introduction

39

implant, inadequately picked up medicamentous treatment, etc. (66, 78, 96, 20, 91,

92, 75, 118, 97, 45, 131, 173, 174, 180, 190, 208, 205, 237 and others). According to

these authors during time and after carrying out of operation there can be various local

complications.

Lead {Carried out} dental implantations carry out {spend} an estimation of

results under standards which are offered Smith (1987) or Misch (1999), she {it} is

based on presence of the certain attributes available at the patient:

- An immovability of everyone implant at clinical investigation of the patient;

- Absence bleeding sickness and pockets in area implantо-gingival connections;

- Absence of painful sensations, discomfort, inflammatory complications in

area implant;

- Absence on the X-ray destruction bones around implant;

- Loss of a bone fabric in the first year of functioning implant makes up to 1,5

mm and each subsequent - 0,1-0,2 mm;

- Obligatory supporting adequate hygiene of an oral cavity.

Efficiency of success of the lead {the carried out} implantation makes 95 % at

5-years, 85 % - at 10-years and 80 % - at 15-years use implants. The given estimation

of efficiency of implantation corresponds {meets} to the international standards (183,

198, 127, 201, 220,175, 200, 213, 150, 137, 195 and others).

Thus, on the basis of the lead {carried out} review of the literature becomes

clear that in dental implantations many questions remain still unresolved enough. The

electrogalvanic characteristic of fabrics of an oral cavity of patients before carrying

out dental implantations (at stages osseointegration) is insufficiently investigated. In

the literature are available contradictory opinions on efficiency of use domestic and

foreign bioceramic osteoplastic materials for filling bone defects at carrying out of

implantation or additional operative interventions. Especially big complexities at the

doctor - doctor of implantology arise at a significant atrophy of alveolar processes

40

maxilla bones or at pneumatic type maxilla sinus. Despite of the offered {suggested}

different kinds of operative interventions available in the literature which are used in

these cases, they do not give an absolute guarantee on success. Also the big

difficulties at the doctor arise when the patient has sufficient on height, but (narrow)

alveolar process of a jaw insufficient on width. Now, in many cases, it usually is

contra-indication to carrying out endoosseous dental implantations. Even in those

individual publications when in complex {difficult} cases the most modern additional

operative interventions are offered at implantation the substantiation of use of

different surgical techniques all the same is not carried out {not spent} depending on

number enter edendoosseous dental implants. The question with additional methods

of fixing implants is solved at presence of the expressed atrophy of alveolar processes

maxilla bones. There are no data on terms of final bone stabilization endoosseous

implants depending on their number at carrying out additional operative interventions.

The result of the lead{the carried out} implantation in many respects depends

not only on the correct account of indications and contra-indications, and also a

technique of the executed operation, but also is defined {determined} by current of

the postoperative

41

period, i.e. adequately picked up treatment (pain-killer, anti-inflammatory). At

incorrectly picked up treatment during the period after the lead {carried out}

operative intervention there can be expressed painful sensations or inflammatory

changes on the part of associates implant fabrics and efficiency of implantation is

considerably reduced.

42

CHAPTER{HEAD} 2

MATERIAL AND METHODS OF INVESTIGATION

Under supervision and investigation 151 patient by whom implantation on top

and mandibles has been lead {has been carried out} endoosseous was treated. To all

these patients the surgical stage intrabone dental implantations with subsequent his

{its} orthopedic end has been executed. All surgical (standard and additional

interventions) stages dental implantations were carried out {spent} in the Center

dental implantations Amman (Jordan).

Additional surgical interventions at carrying out endoosseous dental

implantations on top and mandibles are made at 110 patients. The age of all surveyed

is submitted in table 2.1.

Table 2.1

Division of patients on age and a sex

Age groups

surveyed

Sex

All Men Women

absolut. Number

% abs.

Number %

abs. Number

%

16-24 9 6,0 10 6,7 19 12,6 25-34 11 7,3 14 9,3 25 16,6 35-44 20 13,2 18 11,9 38 25,1 45-54 17 11,3 23 15,2 40 26,5 55 and more

14 9,2 15 9,9 29 19,2

In total 71 47,0 80 53,0 151 100,0 All surveyed patients by whom implantation was carried out {was spent}

endoosseous dental, have divided {shared} into three groups:

I group - 41 patient with sufficient on height and sufficient on width an alveolar

process top and mandibles;

43

II group - 57 patients with insufficient height of an alveolar process of the

maxilla;

III group - 53 patients with sufficient on height, but insufficient on width an

alveolar process top and mandibles.

For the decision of a question on necessity of carrying out of additional

operative intervention on maxilla bones, depending on a degree of an atrophy of

alveolar processes, we have taken advantage of the classification offered{suggested}

Misch C.E. (1987). The given classification in the schematic image is submitted in

figure 2.2.

Fig. 2.2. Classification maxilla bones on Misch C.E.

Depending on a degree of expressiveness of an atrophy of alveolar processes

maxilla bones the author of them has divided {shared} into 4 groups (SA1-SA4). The

first group (SA1) included surveyed with height of an alveolar process more than 12

mm (fig. 2.2-a), i.e. with absence of an atrophy of an alveolar process. Persons are

included in the second group (SA2) with an insignificant atrophy (on fig. 2.2-b) an

alveolar process (height of an alveolar process of 10-12 mm). In the third group (SA3)

- a moderate atrophy (fig. 2.2-v), i.e. between edge {territory} of an alveolar crest and

44

a bottom maxilla sinus the height of an alveolar process makes 5-10 mm. Persons are

included in the fourth group (SA4) with a

significant atrophy of an alveolar process (fig. 2.2-g), the height of a bone from

an alveolar crest to the bottom a sine makes up to 5 mm. In the third and fourth

groups, using operation sinuslifting, the height of an alveolar process can be raised

{increased} up to height necessary for implantation. Last (fourth) group is

characterized by the highest risk of occurrence of complications because of

insufficient quantity {amount} of a dense bone and a bad opportunity of fixing

endoosseous implant.

Fig. 2.3. Classification Cawood I.I. and Howell R.A.

At implantation took into account thickness a mucoperiosteum’s flap located

on a crest of an alveolar process of a jaw, width of his{its} bone part and the size of

loops - lacunas of spongy substance of a bone in the planned place of introduction

dental implant. Took into account Konstantinu K.P.'s (1997) opinion, it agrees which

at patients with thickness a mucoperiosteum’s flap located on a crest of an alveolar

process of a jaw in 1-5 mm and in the width of his{its} bone part in 3,5-5,5 mm X-ray

45

corresponds{meets} middle-structure to spongy substance of a bone. At thick (in 5

mm and more) mucoperiosteum flap on a crest of an alveolar

process and narrow (up to 3,5 mm) his{its} bone part the spongy structure of a

bone is defined{determined} finely porous, and at thin (up to 1 mm) mucoperiosteum

flap of an alveolar crest and wide (more than 5,5 mm) his{its} bone part - large-

structure.

Also took into account density of a bone, according to Paraskevich V.L.'s

recommendations (1998). The bone of a jaw of the raised {increased} density is

submitted by a parity {ratio} of compact and spongy substance in a proportion 2 : 1,

aveflape density - 1 : 1, low density - 0,5 : 1.

For definition of contra-indications at carrying out endoosseous dental

implantations, depending on expressiveness of an atrophy of an alveolar process, we

also had been used classification Cawood I.I. and Howell R.A. (1988). According to

this classification, at the third class (fig. 2.3.) is present sufficient height, but

insufficient width of an alveolar process, i.e. it{he} - narrow. Sufficient on height it is

considered an alveolar process at his{its} height approximately in 12-14 mm, and an

alveolar process insufficient on width - at his{its} width in 3,5-5 mm.

In quality endoosseous dental implants we had been used titanium implants

systems IMPLA (Germany). The implants are made of titanium grade 4. The surface

is sandblasted with oxide aluminium and finally acid etched. The IMPLA implant

system is available in six different diameters: Impla DualSurface & MicroRetention-

3.3mm, 4.2mm, 5.3mm; Impla Cylindrical: 3.6mm, 4.5mm, 5.5mm; as a two stage

implant. Plus three one piece implants: Miniballtop: 2.5mm and 2.1mm and

MiniConetop 3mm. Different lenght are available from 6mm to 17.5mm.

46

For filling bone defects, in quality osteoplastic a material, we used a resorbed

synthetic bone - Bio-Gran (USA) and domestic bioceramics - Kergap (Ukraine). Bio-

Gran is synthetic osteoplastic material representing bioactive granules in diameter

300-355 micron. Due to the optimum size of particles, Bio-Gran it is transformed in

hollow an environment. It occurs at penetration of phagocytes through cracks in the

external environment consisting of phosphate of calcium and deducing {removing}

taking place inside oxide of silicon. The hollow environment formed at it stimulates

migration from periosteal and blood not differentiated mesenchymal cells {cages} and

their transformation in osteoblasts. Osteoblasts form a primary spongy

matrix, which further mineralizing. Thus, the bone fabric sprouts from a

granule to a granule and quickly fills in defect. Granules Bio-Gran completely resolve

in an organism and metabolizing as a result of cycle By Krebs. Before entering into a

cavity the preparation is necessary for mixing with blood or 0,9 % a solution of a

physiological solution. Full replacement by a new bone occurs within 9-12 months (at

addition autobone time of regeneration is reduced till 5-6 months).

In Ukraine it is made, is issued, it is resolved{allowed} to application for №

310/96 (order МЗ of Ukraine from 28.08.1996 № 269) and № 1105-161 from

07.06.2000 bone-seeking a preparation with the name "Kergap" - from ceramic

hydroxyapatite and tribasic calcium phosphateа (bones similar to mineral substance)

for completion of bone defects. Given bone-seeking the preparation us also is used in

dissertational work.

For the directed fabric regeneration at carrying out of operations we used

absorbable membranes (plaster, collagenic).

To all patients before operation and in the postoperative period it was carried

out {it was spent} clinical investigation which included survey, palpation,

radiography jaws (orthopantomography) and other special methods of investigation

(tab. 2.4).

47

Contact thermometry carried out{spent} electrothermometer TPEM-1 having

dot thermocouples (gauge) with a range of measurement from 16 up to 42С̊.

Accuracy of registration - 0,2 ˚С. Time of contact of the gauge with a mucous

membrane of an oral cavity - 20 seconds, intervals between repeated investigations

made from 2 till 5 seconds. A touch by the gauge did {made} approximately with the

same force of pressure. Local temperature measured three times and calculated

aveflape arithmetic. Temperature measured on the researched and healthy party

{side}. For research used a difference between surveyed (after operation) and the

healthy party {side} on a symmetric site, i.e. revealed temperature asymmetry

(termoasymmetry).

Table 2.4

Methods of investigation of patients

The name of the used methods

Terms of carry out of investigation Before

implantation In dynamics (During ) of

postoperatrive investigation Clinical investigation (survey, palpation, percussion) + +

Radiography jaws (orthopantomography) + +

Electroodontodiagnostic + + Contact thermometry + + Potenciometry researches + + Periotestmetry + + Definition of functional activity of peripheral nerves on device " DYNE - 1 "

+ +

Definition of a hygienic index + + Revealing of presence of inflammatory process of a mucous membrane

+ +

The note: + investigation was carried out{was spent};

- Investigation was not carried out{was not spent}.

48

Electroodontodiagnostic (EOD) carried out with the help electroodontometric.

By preparation for measurement on the device with researched intact teeth removed

indented a stone, isolated a teeth from a saliva, carefully dried up wadded balls in a

direction from cutting edge{territory} to equator. According to the instruction, we did

not apply chemical substances (an ether, spirit), that could lead to change of a

threshold of excitability of a pulp of a tooth. At manipulations in an oral cavity

(carrying out electroodontodiagnostic) together with the device we used only

disposable wooden spatulas. Caries and treated teeth in research EOD were not

included.

Potenciometry we carried out {spent} researches with the help of automatic

digital potentiometer Pitterling Electronic with 32 cells of memory for reproduction of

results and pair electrodes of measurement from chrome-nickel an alloy in

fluoroplastic holders. The device automatically defines{determines} a potential

difference in a range from 0 up to 999 mV, force of a current in a range from 0 up to

99 mcA and electric conductivity in an oral cavity in microSiemens (mkSm). In the

established mode of measurement (in 10-20 seconds after deenergizing the device) at

contact of one of electrodes to a metal surface implant or abatmen, and the second

with a mucous membrane in hypoglossal area, on a board{panel} highlight of digital

values of a potential difference, force of a current and electric conductivity.

Periotestmetry, i.e. functionality parodentium in researched sites, carried

out{spent} by means of device " Periotest ". The given device corresponds {meets} to

requirements of norms EN 60601-1 and EN 60601-1-2 and is marked is familiar СЕ

according to supervising document 93/42/EWG from June, 14, 1993 on medical

products. « Periotest » calculates ability of fabrics parodentium to return a tooth in a

starting position after action on him {it} of the certain external loading. The device

will consist of the instrument block, the computer analyzer and a tip which are

connected among themselves. A working element in a tip is striker, the including

piezoelement working in two modes. The physical principle of work of the device

49

consists in transformation of an electric pulse in mechanical. A researched tooth or

implant by abatmen to percuss brisk a tip at regular intervals (250 ms) with the effort

being atraumatic for firm fabrics of a tooth, and for fabrics parodentium. During

carrying out of research dental numbers {lines} always should be disconnect. For the

analysis of results took into account aveflape arithmetic of 3 measurements with an

interval of 10-15 seconds.

Definition of functional activity of peripheral nerves carried out {spent} on a

hardware - program complex for electropuncture

diagnostics of "DYNES - 1". The recommended order of investigation of the

patient was strictly observed as directed, applied to the given device. Viewing of the

data and their registration carried out on a computer.

Hygienic index defined {determined} on Green – Vermillion’s index (Green

J.C., Vermilion J.K., 1964). The simplified index of hygiene of an oral cavity (OHI-S)

consists in the visual estimation of the area of a surface of a tooth pruinose and-or by

dental tartar, does not demand use of special dyes. For definition OHI-S investigate a

buccal surface 16 and 26, a lip surface 11 and 31, lingual a surface of 36 and 46 teeth,

moving on the tip a probe from cutting edge {territory} in a direction gingiva.

Absence of a dental strike is designated as 0, a dental strike up to 1/3 surfaces

of a tooth - 1; a dental strike from 1/3 up to 2/3 - 2, a dental strike more than 2/3

surfaces - 3. Then defined {determined} indented a stone by the same principle. The

formula for calculation of an index following:

OHI-S = where

n – quantity {Amount} of teeth, зн (dp) - dental plaque, зк (dt) - dental tartar.

Values of a dental strike the following: 0 - there is no strike, 1 - 1/3 crown of

tooth or any quantity{amount} dense pigment a strike, 2 - on 2/3 crown of tooth, 3 -

more than 2/3 crown of tooth.

50

Values indented a dental tartar: 0 - is not present, 1 - above gingival a stone on

1/3 crown of tooth, 2 - above gingival a stone on 2/3 crown of tooth and-or

subgingival stone as separate conglomerates, 3 - above gingival a stone more than 2/3

crown of tooth or subgingival stone surrounding a neck part of a tooth.

Estimation carried out{spent} under Lutskoj I.K.'s circuit and co-aut. (2001)

which is submitted in table 2.5.

Table 2.5

Estimation of an index of hygiene of an oral cavity

Value An estimation of an index An estimation of hygiene

of an oral cavity 0-0,6 Low Good

0,7-1,6 Aveflape Satisfactory 1,7-2,5 High Unsatisfactory

More than 2,6 Very high Bad

For revealing presence of inflammatory process of a mucous membrane of

alveolar processes carried out {spent} Schiller - Pisarev's test. A mucous membrane

of alveolar processes processed solution by Lyugol. Intensity of colouring estimated

in points: 1 point - is not present colouring, 2 points - weak colouring, 3 points -

intensive colouring. Calculated aveflape value for parameters of the top and mandible.

Feature of fabrics of maxillofacial area is its{her} plentiful innervation and

after operative additional interventions, there can be pains. There fore the expressed

painful clinical semiology which arises after surgical interventions on bones, demands

carrying out of adequate anesthesia. Our attention has involved pain-killer a

preparation - ketanov (ketorolak trometamini), let out{released} by firm " Ranbaxy "

(India). Ketanov is not steroid not narcotic analgetic (pain-killer) which operates on

tcyclooxygenic a way of an exchange arachidonic acid, inhibition biosynthesis

“prostoglandinov”, being mediators painful sensitivity a place of damage of fabrics.

51

Thus, it is considered, that ketanov reduces peripheral notcyceptiv sensitivity, i.e. is

peripheral by pain-killer. Taking into account that the given preparation inhibition

biosynthesis “prostoglandinov” which are mediators as well inflammations, it is

necessary to note presence of anti-inflammatory effect at ketanovа. This circumstance

to us was very favourable, since in aetiology many painful symptoms both at diseases,

and at postoperative complications in maxillofacial area the inflammation is one of

conducting{leading} factors.

Therefore in the postoperative period at operated patient by us of patients has

been used ketanov (ketorolak trometamini).

With the purpose of preventive maintenance of inflammatory complications

during the period after performance of operation we used an antimicrobic preparation

for per oris (oral [enteral]) introductions - Tcyphran СТ manufactures « Ranbaxi

Laboratories Limited » (India). Into structure Tcyphran СТ enters tcyprophloxatcini

(500 mg) in a combination with tinidazolium (600 mg). Pharmacological feature of

preparation Tcyphran-СТ are caused by pharmacological properties of each active

component of a preparation. Tcyprophloxatcini, as well as others fluoroquinolones,

blocks bacterial DNA (desoxyribonucleic acid)-gyraza therefore synthesis bacterial

DNA is broken. Fluoroquinolones - clean burn connections, contact fibers of whey of

blood (the parameter of their linkage does not exceed 40 %) a little. Penetration into

fabrics and liquids of an organism occurs by passive diffusion through walls of

capillaries. Good diffusion of a preparation is caused high lipophilic and the longest

postantibiotic effect (till 6 o'clock). Tcyprophloxatcini bactericide operates on gram-

positive and gram-negative activators, switching culturs of microbes, which resistance

to penicillins, cephalosporins and aminoglycosides. The spectrum of action of

tcyprophloxatcini grasps such aerobic microorganisms, as staphylococcus,

streptococci, an intestinal stick, Proteus and other microbes. Tinidazolium, included in

preparation Tcyphran-СТ, is a synthetic preparation of group nitroimidazolium.

52

Tinidazolium operates bactericide to anaerobic bacteria - Bacteroides, clostridiums,

aeubacteriums, fusobacteriums, peptostreptococcus, peptococcus, etc.

In the rest, in the postoperative period, treatment and care of patients after

carrying out endoosseous dental implantations with

use of additional surgical interventions and without their application differed

nothing from traditional.

The received figures processed the standard calculus of variations-statistical

method with use of a personal computer and a package of statistical programs “ SPSS

11.0 for Windows ” and “ Microsoft Excel 2000 ”. Reliability of results of

investigation estimated by criteria studentized variate. Distinctions were considered

authentic at р <0,05.

53

CHAPTER{HEAD} 3

RESULTS OF INVESTIGATION OF PATIENTS

THE FIRST GROUP OF SUPERVISION

The first group have made 41 patient with sufficient on height and sufficient on

width of an alveolar process top and mandibles. Among surveyed persons there were

25 women and 16 men. Distribution of patients on age and a sex is submitted in table

2.1.

Before performance dental implantations carried out {spent}

electroodontodiagnostic the teeth located in a zone of implantation. Defined

{determined} conformity of radiographic parameters of these teeth with the data of

electroodontodiagnostic. If necessary carried out{spent} corresponding treatment of a

teeth. Established in what hygienic condition there is an oral cavity of the patient. By

means of Schiller - Pisarev's test defined {determined} presence of absence of the

inflammatory phenomena of a mucous membrane of an alveolar process. The index of

hygiene of an oral cavity (Green - Vermillions) before implantation in this group of

patients has made 0,5 ± 0,04, i.e. was estimated as good.

For definition of indications and contra-indications of inclusion of patients in

the given group of supervision we used classification Misch C.E. (1987) and

classification Cawood I.I. and Howell R.A. (1988). According to these classifications

sufficient on height it is considered an alveolar process at his{its} height in 12-14

mm, and insufficient on width - at his{its} sizes in 3,5-5 mm. It is considered, that

that reparative regeneration at implantation proceeded is high-grade it is necessary to

have thickness external and internal bone walls around implant not less than 1 mm.

After selection of patients by us in the first group of supervision we carried out a

surgical stage of introduction endoosseous dental implants under the traditional

circuit. Selection corresponding on the size implant carried out on a cliche which is

54

applied to implantation system IMPLA. dental implantations carried out{spent}

operation under block regional anesthesia with application by anesthetics of articaini

lines. For implantation we used titanium implants systems IMPLA.

The after exfoliation a mucoperiosteum’s flap with the help of osteotome

measured width of an alveolar process for selection corresponding on diameter

implant. We necessarily took into account that circumstance that after creation of the

bone channel for implant around of the last, from the external and internal

parties{sides}, there was a bone wall thickness not less than 1 mm (fig. 3.1, 3.2). With

the help of a spherical pine forest on a crest of an alveolar process bored through a

bone cortical plate, i.e. formed the central point which used as directing at the further

formation a box. Using directing and forming mills, formed the bone channel for

corresponding implant. Depth of immersing of mills supervised with the help depth-

gaugeа. Speed of the preparing tool did not exceed 800-1000 revolutions 1 minute.

Implant it was entered into the bone channel by their twisting by a pressure key. The

effort at a twisting was not more than 25-30 Nsm. Endoosseous the part dental

implant was completely immersed in a bone and implant closed the screw - cork.

Mucoperiosteala flap stacked on a place and carefully sewed up by nonabsorbable

suture. Seams removed for 7-8 day.

After introduction dental implant in a bone (before mending a wound) at once

carried out{spent} potentiometry, i.e. defined{determined} a potential difference and

force of a current between entered implant and a mucous membrane of an alveolar

process, and also established electroconductivity of an oral liquid. The data of these

parameters are submitted in table 3.3.

55

Fig. 3.1. Around of generated for implant bone a box which are necessary for

having that implantation passed appearance of thickness of bone walls in favorable

conditions.

Fig. 3.2. Appearance of a parity{ratio} of bone walls of a jaw and dental

implants at patients I of group of supervision.

56

Table 3.3

Results of carrying out pothencyometry at patients I of group of

supervision.

Dynamics{Changes} of investigation of patients

Number surveyed

Potential drop (in mV)

Current strength (in mcА)

Electric conductivity (mcSim)

At introduction implant (before mending of a postoperative wound)

17 89,4±3,6 р <0,001

7,5±0,4 р <0,001

10,1±0,8 р <0,001

In 2-3 hours after introduction

17 76,7±2,9 р <0,001

6,2±0,3 р <0,001

9,7±0,7 р <0,001

In 1 day after implantation 17 54,7±2, р <0,001

4,9±0,3 р <0,001

7,5±0,2 р <0,001

On 7-10 day after implantation

17 40,0±2,5 р <0,001

3,4±0,2 р <0,001

6,1±0,6 р <0,001

In 1 month after implantation

17 24,7±2,5 р> 0,05

2,4±0,2 р> 0,05

4,4±0,5 р <0,001

In 3-4 months after implantation

15 23,5±2,5 р> 0,05

1,6±0,2 р> 0,05

2,2±0,2 р> 0,05

Norm (according to the literature)

From 15 up to 22

From 1,1 up to 2,0

From 1,5 up to 2,0

The note: р - reliability of distinctions in comparison with norm.

Thus, after installation implant a potential difference between the last and a

mucous membrane of an alveolar process authentically increased up to 89,4±3,6 (р

<0,001), force of a current also was also authentically above and made 7,5±0,4 (р

<0,001), and electroconductivity of an oral liquid - 10,1±0,8 (р <0,001). In 2-3 hours

after mending a postoperative wound the potential difference, force of a current and

electroconductivity of an oral liquid

57

decreased a little, but remained authentically (р <0,001) raised{increased} and

according to told were the following: 76,7±2,9 (р <0,001); 6,2±0,3 (р <0,001) and

9,7±0,7 (р <0,001).

Thermoassymetry a mucous membrane of an alveolar process, i.e. area of a

postoperative wound and a symmetric healthy site, at once after the

termination{ending} of operation and mending of a postoperative wound has made a

minus 0,8±0,1 °С, and on periphery - a minus 0,7±0,1 °С (on the part of the

lead{carried out} operative intervention the local temperature was below healthy site).

It has been connected to infringement vascularity a mucoperiosteum’s flap as a result

of his{its} formation and exfoliation (table 3.4).

Table 3.4

Thermoassymetry a mucous membrane of an alveolar process at patients I

of group of supervision.

Terms of investigation of

patients

Quantity{amount} surveyed

Thermoassymetry (in degrees Celsius) In the center of a

postoperative wound On periphery of a

postoperative wound At once after operations

20 A minus 0,8±0,1

Р <0,001 A minus 0,7±0,1

р <0,001

In 1 day 20 1,1±0,1 р <0,001

0,9±0,1 р <0,05

In 3 days 20 1,5±0,1 р <0,001

1,4±0,1 р <0,001

In 7 days 20 0,5±0,1 р> 0,05

0,5 ± 0,1

Control group (healthy people)

22 0,5±0,1 р> 0,05

The note: р - reliability of distinctions in comparison with healthy people.

After twist in endoosseous dental implant in a bone, i.e. before mending of a

postoperative wound, it is lead{is carried out} periotestmetry

58

which has made 12,4±0,8 standard unit (s.u.). The data of periotestmetry in

dynamics{changes} of healing (osseointegration implant) are submitted in table 3.5.

Table 3.5

Parameters periotestmetry at patients I of group of supervision.


patients


Data of periotestmetry

M ± m (in standard unit (s.u.)) Р

At installation implant

18 12,5±0,8 <0,001

In 3-4 months 18 5,1±0,5 < 0,05 In 5 months 18 1,1±0,6 > 0,05 In 6 months 18 1,3±0,5 > 0,05

The note: р - reliability of distinctions in comparison with conditional norm

(healthy people).

It is necessary to note, that at once after installation implants parameters

periotestmetry were authentically (р <0,001) raised{increased}. If to compare these

data to a pathology parodentium they corresponded{met} to the data which are

available for patients with parodontitisом an easy degree.

The next day after installation implant parameters pothencyometry were

authentically reduced in comparison with the previous investigation and were the

following: a potential difference - 54,7±2,9 mV; force of a current - 4,9±0,3 mcA;

electric conductivity - 7,5±0,2 mcSim. These parameters were authentically

raised{increased} in comparison with healthy people. The local temperature in the

field of a postoperative wound raised and Thermoassymetry in the center and on

periphery authentically increased in comparison with norm and were accordingly

equaled 1,1±0,1 °С (р <0,01) and 0,9±0,1 °С (р <0,05). Schiller - Pisarev's test was

estimated on 1 point (colourings are not present) at 23 patients (56,1 %) and on 2

59

points (weak colouring) - at 18 patients (43,9 %), i.e. made 1,4±0,2 a point. Green -

Vermillion’s index the next day after operation has made 0,7±0,08 (doubtfully

increased, i.e. р> 0,05), was estimated as satisfactory.

After carrying out dental implantations the local temperature in the center and

on peripheries of a postoperative wound increased for the third day due to its{her}

increase (because of presence of a postoperative hypostasis) and was accordingly

equal 1,5±0,1 °С (р <0,001) and 1,4±0,1 °С (р <0,001). It is necessary to explain

increase of local temperature expansion of peripheral vessels in a kind of presence of

a hypostasis of soft fabrics. Schiller - Pisarev's tests at 19 patients (46,3 %) it was

estimated in 1 point, and at 22 persons. (53,7 %) - in 2 points. The parameter of an

index of Schiller - Pisarev made 1,5±0,2 a point, i.e. it{he} authentically did not

change in comparison with the previous period of investigation. Green - Vermillion’s

index was estimated as satisfactory, doubtfully changed in comparison with the first

postoperative day and has made 0,7±0,05.

After installation implants parameters pothencyometry decreased for the

seventh day in comparison with the previous investigations. But the given parameters

remained authentically (р <0,001) raised{increased} in comparison with norm.

During this period of investigation the potential difference between implant and a

mucous membrane of an alveolar process made 40,0±2,5 mV (р <0,001), force of a

current - 3,4±0,2 (р <0,001) and electroconductivity of an oral liquid - 6,1±0,6 (р

<0,001). Higher parameters of a potential difference, force of a current and

electroconductivity of an oral liquid which were characteristic for this term of

investigation, met only at persons number beside located established implants more

than 2 (two) and the highest - from three and more. The lowest parameters

pothencyometry are marked at installation single endoosseous dental implants.

Thermoassymetry a mucous membrane for 7 day of investigation of patients I

of group of supervision authentically decreased in comparison with 3-rd day of

60

supervision and already authentically did not differ both in the center, and on

periphery

of a postoperative wound from norm, i.e. it was equal 0,5±0,1 °С (р> 0,05).

For 7 day of investigation of patients I of a subgroup of supervision we carried

out{spent} definition of a functional condition of peripheral branches of nerves on top

(forward, aveflape and back top alveolar branches of an infraorbital nerve) and

bottom (the bottom alveolar nerve) jaws. We investigate conductivity of these nerves

at different stages osseointegration implants. Results of studying of conductivity are

submitted in table 3.6.

Table 3.6

Functional condition of peripheral branches trigeminal

Nerve at patients I of group of supervision.

Terms of investigation of patients

Parameters of conductivity of a nerve (in standard unit ) Quantity{Amount}

surveyed Maxilla


Mandible

For 7 day 20 138,8±3,1 р <0,001

21 144,4±4,5 р <0,001

In 1 month 20 135,6±3,0 р <0,001

21 148,4±4,8 р <0,001

In 3-4 months 20 125,0±2,2 р <0,01

21

133,7±2,8 р <0,01

In 5-6 months 20 110,9±1,1 р> 0,05

21 122,4±1,5 р> 0,05


24 107,2±1,9 р> 0,05

24 113,0±11,8 р> 0,05


In group of patients which have been taken for investigation of peripheral

branches of a trigeminal nerve on the maxilla we included persons by whom anyone

61

was carried out{was spent} typical endoosseous dental implantation on the top bone.

At carrying out of implantation on the bottom

jaw - only those patients at whom the top established implant settled down in

immediate proximity (less than 2 mm) from mandible the channel since to

Timofeevym A.A. (2003) it has been earlier proved, that at an arrangement of a top

implant are farther than 2-3 mm from mandible than the channel the functional

condition of the bottom alveolar nerve authentically did not differ from norm at all

stages osseointegration dental implant (fig. 3.7). Therefore to include in investigation

of a nerve of persons with an arrangement of a top implant more than on 2-3 mm from

mandible the channel is, in opinion Tymofyeyev A.A. (2003) who have been not

justified.

Fig. 3.7. The X-ray of a sick top with an arrangement dental implant more than

3 mm from mandible the channel (an arrow{a pointer} it is specified mandible the

channel).

62

After installation implant on the maxilla conductivity of the top alveolar

branches of an infraorbital nerve authentically increased for the seventh day up to

138,8±3,1 standard unit (р <0,001). Conductivity of the bottom alveolar nerve also

authentically increased up to 144,4±4,5 standard unit (р <0,001) at patients at an

arrangement of a top dental implant less than 2 mm up to mandible the channel (fig.

3.8).

Fig. 3.8. The X-ray of the patient at an arrangement of a top dental implant less

than 2 mm up to mandible the channel (last is specified by an arrow{a pointer}).

At those patients where damage of the top wall mandible the channel (2

persons. was observed.), there were the highest figures of conductivity of a nerve

which reached{achieved} 170 and 180 standard unit (fig. 3.9.). From 41 patients with

implantation (20 persons. - on top and 21 persons. - on mandibles) at 12 (29,3 %)

from them have arisen the phenomena posttraumatic neuritis with corresponding

clinical semiology (numbness a site of a mucous membrane, a leather{skin}, etc.) .

From them on the maxilla the semiology posttraumatic neuritis at 4 persons. is

registered. (in 20,0 % cases under the attitude{relation} to all implant established on

the maxilla) and at 8 patients on the mandible (in 38,0 %). Posttraumatic neuritis it is

63

possible to explain the mechanism of occurrence to that during formation bone the

box for dental implant occurs as damage of bone blood vessels (there are

haemorrhages and hematomas) with the subsequent compression of nervous trunks,

and probably mechanical (tool) damage of the most peripheral nerve (fig. 3.9).

Fig. 3.9. The X-ray of the patient with damage dental implant the top wall

mandible the channel (it is specified by an arrow{a pointer}).

Thus, for 7 day of spent investigation after installation implant, i.e. at studying

a functional condition of peripheral branches of a trigeminal nerve, we have found

out, that conductivity of a nerve raised up to authentically high figures which arose

not only in result травмирования peripheral nervous branches or at presence of

haemorrhages, but also always was in direct dependence on number entered dental

implants. High figures of conductivity of a nerve also were always observed at

simultaneous introduction by three and more number{line} located dental implants. In

these cases conductivity of a nerve authentically increased and was in limits from 150

up to 160 standard unit

64

For 7 day of treatment Schiller - Pisarev's test at 32 persons. (78,1 %) it was

estimated on 1 point (colourings are not present) and at 9 persons. (21,9 %) on 2

points (weak colouring), i.e. made 1,2±0,2 a point. Green - Vermillion’s index -

0,6±0,1 (hygiene of an oral cavity was estimated as good).

In the first group of supervision, after carrying out of operative intervention, to

24 patients as anesthetizing means appointed well-known analgesics (analginum,

etc.), and to 17 patients - not steroid analgetic (pain-killer)- ketanov. As preventive

maintenance of the inflammatory phenomena in the postoperative period to 25

patients the standard antibiotics of a wide spectrum of action (ampiox, ampicillin,

etc.), and to 16 patients - an antibiotic Tcyphran СТ (tcyprophloxatcini with

tinidazolium) were appointed. High anesthetizing efficiency ketanovand Tcyphran is

established. So, at patients whom appointed in the postoperative period standard

analgesics to 3 day a symptom of a pain it is marked in 83,3 % of cases (20 patients),

and for 7 day - in 33,3 % (8 persons). At use ketanovpains for 3 day are marked in

35,3 % of cases (6 persons), And for 7 day of pains of any character it has not been

revealed. At purpose{assignment} Tcyphran СТ a hypostasis and hyperemia a

mucous membrane of an alveolar process decreased in 2 times faster, than at

purpose{assignment} of traditional antibiotics.

In 1 month after implantation parameters of size of electric potentials and

forces of a current were authentically reduced (tab. 3.3) up to normal amounts and

were accordingly equal: 24,7±2,5 mV and 2,4±0,2 mcA. It is necessary to note, that

electroconductivity of an oral liquid also was reduced in comparison with the last day

investigations, but remained authentically raised{increased} in comparison with

norm. The given parameter considerably has been raised{increased} only at patients

by whom simultaneous introduction more than 3 dental implants is lead{carried out}.

Definition of a functional condition of peripheral branches of a trigeminal nerve

in 1 month after implantation specifies preservation of authentically high figures of

65

conductivity of a nerve both on top, and on the mandible (tab. 3.6). The clinical

semiology fully complied earlier described.

In 1 month after operation Schiller - Pisarev's test at all surveyed was estimated

on 1 point, i.e. colouring is not present. Green - Vermillion’s index was equal 0,5±0,1

- hygiene of an oral cavity was estimated as good.

In 3-4 months after implantation all sizes pothencyometry practically did not

differ from norm (tab. 3.3). Parameters periotestmetry at surveyed patients were

considerably reduced, but nevertheless still remained authentically raised{increased}

in comparison with conditional norm (tab. 3.5). Sizes of parameters of conductivity of

peripheral nerves were kept on high figures (tab. 3.6) both on top, and on mandibles.

In 5 months after implantation on the maxilla and in 6 months on the mandible

parameters periotestmetry and to conductivity of a nerve practically

corresponded{met} to norm, i.e. authentically did not differ from healthy people.

Results osseointegration dental implants on the maxilla (in 5 months after

implantation) and the mandible (in 6 months after operation) should be estimated as

good.

The investigations of patients I of group of supervision lead{carried out} by us

have shown, that the minimal thickness of bone walls (external and internal) around

dental implant, necessary for normal osseointegration is far from being always can

thickness in 1 mm. To us it is proved, that current osseointegration in a zone of

implantation depends on density of a bone fabric which surrounds дентальный

implant. It is necessary to take into account, that in Paraskevich V.L.'s opinion (1998)

it is necessary to allocate three basic types архитектоники maxillary bones (I type -

raised{increased}, II - with aveflape and III - low density). We have analysed clinical

outcomes osseointegration which were observed by us aroundendoosseous dental

implants with different on thickness and density bone walls. It is established, that at

the raised{increased} density of a bone (I type)

66

and thickness of bone walls in 1 mm from 17 implants favorable outcomes

were observed only at 11 persons. (in 64,7 %), and at thickness in 1,5 mm and more -

at all 16 persons. (in 100 % cases). At aveflape and low density of a bone fabric and

thickness of bone walls in 1 mm we observed favorable osseointegrative outcomes

only in 5 cases from 23 established implants, i.e. in 21,7 % cases, and at thickness in

2 mm and more - at all surveyed (in 100 %). Complications were observed as

resorption edges{territories} of an alveolar crest (fig. 3.10) or оголения parts dental

implant (fig. 3.11), that demanded further use osteoplastic materials for closing the

bared sites dental implant.

Fig. 3.10. Appearance resorbed edges{territories} of an alveolar process of a

jaw around endoosseous dental implant at thickness of bone edge{territory} less than

2 mm and aveflape density of a bone (the photo is made in 1,5 months after

implantation).

Summing up to results of investigation of patients I of group of supervision, we

have noted, that for them was available Thermoassymetry a mucous membrane of an

alveolar process in the field of a postoperative wound at once after end of operation.

The local temperature on the part of the lead{carried out}

67

operative intervention was below symmetrically a healthy site (we estimated

her{it} as with "minus" is familiar). It has been connected to infringement vascularity

a mucoperiosteum’s flap at his{its} formation (exfoliation). The next day after

operation dental implantations the local temperature raised and Thermoassymetry

again authentically differed from norm, that also is marked and for the third day after

carrying out of operation. Normalization of local temperature was observed only in 7

days after operative intervention. We establish direct dependence between a degree of

expressiveness of increase of local temperature and number entered dental implants in

dynamics{changes} of healing of a postoperative wound, that necessarily it is

necessary to take into account at the analysis of the received temperature data since at

these patients is longer is kept Thermoassymetry in the postoperative period. At

presence post-implantological inflammatory complications or at more traumatic to the

lead{the carried out} technique of implantation the local temperature remained is

longer (for 2-3 days longer than in typical cases) on authentically high figures, that

specifies an opportunity of use of this test (measurement local thermoasymmetric)

with the forecasting purpose.

Results of investigation of patients a method pothencyometry specified that At

once after introductions dental implant in bone to a box there was an authentic

increase of a difference of electric potentials up to 89,4±3,6 mV, forces of a current

up to 7,5±0,4 mcA and electric conductivity of an oral liquid up to 10,1±0,8 mcSim

68

Fig. 3.11. A failure dental implantations at thickness of an external bone wall in

1 mm and aveflape density of a bone - fenestration of parts implant in 3 months after

his{its} introduction.

In 2-3 hours after introduction implant and his{its} stay in conditions of a

mouth parameters of a potential difference, force of a current and electric conductivity

doubtfully were reduced and remained on high figures. Within 7-10 days after dental

implantations parameters pothencyometry decreased, but remained authentically

raised{increased}. Normalization of parameters of a potential difference and force of

a current occured only in 1 month after operation, and electric conductivity of an oral

liquid - in 3-4 months after implantation. We establish direct dependence between

parameters pothencyometry (size of a potential difference, force of a current, electric

conductivity of an oral liquid) and number entered dental implants. It is marked, that

at all surveyed in dynamics{changes} of current osseoregeneration (osseointegration)

decrease{reduction} and normalization of parameters pothencyometry was observed.

We have revealed, that the size of electric conductivity of an oral liquid always

depend on current osseoregeneration processes in a bone wound. At favorable current

69

- normalization of this parameter occurs in terms till 1 month after operation, and at

adverse current (delay of processes of formation{education} of a bone) - during 1,5

and even 2 months after end of operation. At periimplantitis we at all these patients (4

persons) observed high figures of electroconductivity of an oral liquid which

exceeded normal amounts in two and more times. Normalization of this parameter

occured only after elimination of it postimplantation inflammatory complication.

Investigation of patients I of group of supervision by a method periotestmetry

has shown, that high-grade osseoreparative processes on the maxilla was observed in

5 months after installation dental implants, and on the mandible - in 6 months. High-

grade osseointegration in these terms it was observed irrespective of number entered

implants and it was defined{determined} by a place of carrying out of implantation

(the top or mandible).

At studying a functional condition of peripheral branches of a trigeminal nerve

in dynamics{changes} of healing of a bone wound after carrying out endoosseous

dental we have revealed implantations, that from 20 person by whom have been

established implants on the maxilla, the clinical semiology posttraumatic neuritis has

arisen at 4 person, i.e. in 20,0 % cases, and on the mandible at 8 of 21 patients, i.e. in

38,0 % cases. The mechanism of occurrence posttraumatic neuritis on the maxilla

mechanical damage of the nerve is possible to explain damage as integrity of bone

blood vessels (there are haemorrhages and hematomas which squeeze peripheral

nervous fibres), and, probably, at formation bone a box for implant. The mechanism

of development posttraumatic neuritis on the mandible speaks as damage of a bone

wall mandible the channel with the subsequent wound of a nerve, and occurrence of

bone haemorrhages as a result of infringement of integrity of vessels

with the subsequent mechanical compression nervous trunks. Feature of these

neuritis is that the damaging{injuring} factor (dental implant) after drawing a trauma

70

remains in the same place and in conditions of a long compression long current of the

given neurologic complication is marked slow resorption hematomas (haemorrhage),

and consequently, and.

At studying size of conductivity of a nerve by us it is established, that the

highest figures (170-180 standard unit ) were observed at patients at mechanical

damage of the top wall mandible the channel, and also at traumatized peripheral

nervous branches or at presence of bone haemorrhages (150-160 standard unit ).

These figures of conductivity of a nerve always were in direct dependence on number

entered dental implants and extensiveness of the damaging{injuring} factor. At

favorable postoperative current conductivity of nervous fibres was restored in 3-4

months on the maxilla or 5-6 months - on the mandible. We observed restoration of

conductivity of a nerve at all surveyed patients.

71

CHAPTER{HEAD} 4

RESULTS OF INVESTIGATION OF PATIENTS OF THE SECOND GROUP

OF SUPERVISION

The second group of supervision was made by 57 patients with insufficient

height of an alveolar process of the maxilla. Among surveyed persons there were 28

women and 29 men. The second group of supervision has consisted of 2 subgroups:

the first group - 23 patients by whom operation open (traditional) sinuslifting has been

lead{has been carried out}; the second subgroup - 34 patients by whom the operative

intervention called closed antrolifting (25 person - closed sinuslifting and 9 person -

closed nasolifting) is executed.

For the decision of a question on necessity of performance of additional

operative intervention on maxilla bones, depending on a degree of an atrophy of

alveolar processes, we used classification which has been offered Misch C.E. (1987).

Classification maxilla bones on Misch C.E. is submitted on fig. 2.2. Depending on a

degree of expressiveness of an atrophy of alveolar processes maxilla bones the author

has divided{shared} into 4 groups (SA1-SA4). (SA1) the author has included in the

first group of persons with height of an alveolar process more than 12 mm (at absence

of an atrophy of an alveolar process). In the second group (SA2) - persons with an

insignificant atrophy of an alveolar process (at his{its} height from 10 up to 12 mm).

In the third group (SA3) patients when between edge{territory} of an alveolar crest

and a bottom maxilla sinus the height of a bone makes 5-10 mm are included, i.e.

there is a moderate atrophy of an alveolar process. In the fourth groups (SA4) the

author has suggested to include patients with a significant atrophy of an alveolar

process i.e. when the height of a bone between a bottom a sinus of maxilla and an

alveolar crest makes up to 5 mm.

72

In the fourth group (SA4) on classification Misch C.E. we carried out{spent}

operation traditional (open) sinuslifting in a well-known kind and with

offered{suggested} by us immobilization (fixing) dental implants, i.e. these patients

have been included by us in the first subgroup of the given group of supervision. In

the second subgroup of this group of supervision, i.e. that to whom carried out{spent}

closed antrolifting, we have included patients who on classification Misch C.E.

concerned to the third group (SA3). In quality osteoplastic material at sinusliftingх

used both Bio-Gran (38 patients), and Kergap (19 patients).

Traditional open sinuslifting (the first subgroup ІІ groups of supervision) at 11

patients it is lead{is carried out} by the standard method, and at 12 patients - with our

updating. Updating open sinuslifting consist that the after exfoliation a

mucoperiosteum’s flap on a crest of an alveolar process, i.e. there where in the future

allocation cylindrical implants with the help of titaniumic screws is planned becomes

stronger a titaniumic miniplate of the necessary sizes (fig. 4.1-а).

Fig. 4.1-á. Appearance of an operational wound at modified by us open

sinuslifting at strengthening a titaniumic miniplate on an alveolar crest maxilla bones.

The spherical pine forest placed in a direct tip and working in a mode of 2000

revolutions in 1 minute with plentiful irrigation, on lateral to a wall maxilla sinus all

73

over again "planned", and then bored through a bone for formation{education} of a

bone window. Displaced a bone-mucous flap aside a sinus of maxilla . Thus it is

necessary to observe extra care to not damage{injure} and not penetrate through

internal lining (a mucous membrane of a sine) in maxilla a sinus. In inside and

upwards removed a forward bone wall together with a mucous membrane a sinus of

maxilla to provide enough place for allocation endoosseous parts dental implant.

Through apertures in a titaniumic miniplate planned places for an arrangement

implants. By means of a directing mill (it is possible to remove{take off} temporarily

for convenience a titaniumic miniplate) in a thickness of an alveolar process formed

bone to a box for dental implants (fig. 4.1-б).

Fig. 4.1-b. Appearance of an operational wound after formation bone a box for

dental implants.

74

Dental implants strengthened in a titaniumic miniplate (fig. 4.1-в).

Fig. 4.1-v. Appearance of fixing offered{suggested} by us dental implants to a

titaniumic miniplate.

After introduction in a bone of necessary quantity{amount} dental implants

they became stronger to a titaniumic miniplate due to titaniumic screws. Thus, in

transgingival parts implant the last have been fixed to a metal plate, and the

siteendoosseous parts implant was kept due to the certain thickness of a bone part of

an alveolar process. The big intrabone part dental implant was outside of a bone and

at all adjoin with a bone, i.e. has been located in the generated cavity. Appearance

fortified in a titaniumic miniplate dental implants is submitted on fig. 4.1-g.

75

Fig. 4.1-g. Appearance of an operational wound when dental implants are

attached to a titaniumic miniplate and are closed by screws - plugs.

Implant closed the screw - by plug, and in a cavity filled bone-seeking

bioceramics (14 patients – Bio-Gran, to 9 patients - Kergap), involved on blood of the

patient and covered resorbed with a biomembrane, and then mucose-peryosteal flap.

Appearance dental implants with their strengthening in a titaniumic miniplate on the

X-ray is submitted on fig. 4.1-ñ.

The given surgical method of carrying out dental implantations is closed since

after a premise{room} endoosseous implant in a bone, a mucous membrane and

peryosteal above it{him} sew up, and osseointegration occurs in conditions of

dissociation implant to an oral cavity. This method of implantation also can be named

two-phasic since at the first stage there is a healing (engraftment) dental implants, and

at the second stage - removal (removal{distance}) fixing implants a titaniumic

miniplate by operative disclosing a postoperative wound with

76

the subsequent detorsion titaniumic screws and removal of a titaniumic

miniplate.

Fig. 4.1-d. The X-ray of the patient in 3 months after carrying out open

sinuslifting in our updating - fixing dental implants among themselves with the help

of a titaniumic miniplate.

Closed antrolifting (the second subgroup ІІ groups of supervision) it is lead{is

carried out} at 34 patients. At 25 person we have executed closed sinuslifting, and at

9 - closed nasolifting. At 24 patients at their realization in quality osteoplastic material

it is used Bio-Gran, and at 10 - Kergap. Closed sinuslifting and nasolifting it was

applied at installation 1-2 and much less often 3 dental implants. Closed antrolifting

by a traditional technique it is applied at 21 patients, and by a technique

offered{suggested} by us - at 13 patients. The traditional technique closed antrolifting

is in detail described in the literature. Therefore we shall describe technics{technical

equipment} of performance of operation closed antrolifting (a sine and nasolifting)

77

by a technique offered{suggested} by us with use a silicone cylinder - expander

(a method of a stretching of soft fabrics).

After carrying out exfoliation a mucoperiosteum’s flap in a necessary site of a

jaw formed the bone channel for dental implant. Formation bone a box for

endoosseous dental implant carried out at the minimal revolutions - no more than 500-

600 revo. In the beginning carried out{spent} drilling a bone under the control depth-

gauge. Checked depth-gauge depth of penetration of the tool and compared her{it} to

thickness of an alveolar process on orthopantomogram. After between a bottom of the

bone channel and a bottom maxilla sinus or cavities of a nose there was the bone

partition equal of 1-1,5 mm, into the bone channel inserted an equal diameter tube

through which entered a silicone cylinder - expander (fig. 4.2-а).

Fig. 4.2-a. The after exfoliation a mucoperiosteum’s flap and formation bone

the box is carried out{spent} introduction through a tube fabric expander.

In process of filling a silicone cylinder a liquid (it is carried out with the help

compressive the device in which pressure is created and is filled the cylinder - the

78

maximal pressure in it{him} should not exceed 248 Mbar) it{he} in regular intervals

extends, breaking a bone bottom of the channel due to a liquid which is in a silicon

cylinder. In regular intervals and gradually the mucous membrane of a bottom maxilla

sinus (a cavity of a nose) exfoliates. Thus, the cavity which further will be filled by a

osseoplastic material (fig. 4.2-b) is created.

Fig. 4.2-b. The circuit of expansion a silicone cylinder (expander) at carrying

out antrolifting.

Then the tube together with expander from the bone channel leaves and through

him{it} filling the formed cavity osseoplastic by a material with the subsequent

79

introduction endoosseous dental implant is carried out{spent}. Appearance (as the

circuit) dental implant in the cavity formed after end closed antrolifting is submitted

on fig. 4.2-v.

Fig. 4.2-v. The circuit of appearance dental implant, taking place in a cavity

which was formed after carrying out closed antrolifting with use silicone expander.

For maintenance of additional fixing single implant, at his{its}

presence{finding} in a bone less than half of his{its} length, we offer carrying out of

fixing with the help of a titaniumic miniplate which becomes stronger on a vertical to

an alveolar process maxilla bones (fig. 4.2-g) by the titaniumic screw.

80

In the first and second subgroups ІІ groups of supervision we shall lead{shall

carry out} the description of methods of investigation in parallel with each other,

since it is necessary to compare at once among themselves different methods of

performance antrolifting (open and closed) at all stages of spent treatment of patients.

Fig. 4.2-g. Appearance of additional fixing single dental implant by means of a

titaniumic miniplate at carrying out closed sinuslifting.

After introduction dental implants in a bone at open sinuslifting (the first

subgroup), before mending a postoperative wound

and in the postoperative period, we carried out{spent} potentiometry

(defined{determined} a potential difference, force of a current and

81

electroconductivity of an oral liquid between dental implant and a mucous membrane

of an alveolar process) which results are submitted in tab. 4.3.

At carrying out pothencyometry in the first subgroup of supervision we from 14

patients have selected identical number of patients with traditional and modified (with

additional fixing implants) sinuslifting.

Table 4.3

Results of carrying out pothencyometry at patients of the first subgroup ІІ

groups of supervision (open sinuslifting).

Dynamics{Changes} of investigation of

patients

Number surveyed

Parameters pothencyometry

A potential difference

Force of a current (in

mcA)

Electric conductivity

(mcSim) At introduction implants (before

mending of a postoperative

wound)

14 120,7 ± 4,8 8,8 ± 0,4 11,8 ± 0,8

In 1 day 14 107,9 ± 3,9 р <0,001

6,4 ± 0,3 р <0,001

9,3 ± 0,5 р <0,001

In 7-10 days 14 95,0 ± 2,4 р <0,001

5,1 ± 0,3 р <0,001

5,1 ± 0,3 р <0,001

In 1 month 14 46,4 ± 3,0 р <0,001

3,9 ± 0,3 р <0,001

3,2 ± 0,2 р <0,001

In 3-4 months 14 23,6 ± 2,4 р> 0,05

2,4 ± 0,3 р> 0,05

1,6 ± 0,2 р <0,001


From 15 up to

22 From 1,1 up

to 2,0 From 1,5 up

to 2,0


At carrying out pothencyometry in the first subgroup of supervision we from 14

patients have selected identical number of patients with traditional and modified (with

82

additional fixing implants) sinuslifting. After installation implants on the maxilla the

potential difference authentically raised up to 120,7 ± 4,8 mV (р <0,001), force of a

current - up to 8,8 ± 0,4 mcA (р <0,001), electric conductivity of an oral liquid - up to

11,8 ± 0,8 (р <0,001). Clinical semiology which would be connected to increase of

force of a current and a potential difference in an oral cavity, to us to reveal it was not

possible.

It is necessary to note, that sizes of parameters of change of potentials (a

potential difference, force of a current and electric conductivity of an oral liquid) at

patients with open sinuslifting without additional fixing and with its{her} carrying out

practically did not differ among themselves at corresponding stages of spent

investigation.

ІІ groups of supervision we included patients in the second subgroup as with

closed sinuslifting, and closed nasolifting. At introduction dental implants at closed

antrolifting authentic increase of all parameters pothencyometry was marked:

potential differences - up to 62,7 ± 3,2 mV (р <0,001), forces of a current - up to 5,2 ±

0,4 mcA (р <0,001) and electric conductivity of an oral liquid - up to 5,3 ± 0,4 mcSim

(р <0,001).

It is necessary to note, that increase of parameters pothencyometry at open

sinuslifting in 1,5-2 times were higher in comparison with those at closed antrolifting

.

83

Table 4.4

Results of carrying out pothencyometry at patients of the second subgroup of II

group of supervision (closed antrolifting)


patients

Number surveyed

Parameters pothencyometry A potential

difference (in mV)


mcA)

Electric conductivity

(mcSim) At introduction implants (before

mending of a postoperative

wound)

15 62,7 ± 3,2 р <0,001

5,2 ± 0,4 р <0,001

5,3 ± 0,4 р <0,001

In 1 day 15 46,0 ± 1,8 р <0,001

3,8 ± 0,3 р <0,001

3,6 ± 0,3 р <0,01

In 7-10 days 15 28,7 ± 1,9 р <0,01

3,2 ± 0,4 р <0,01

3,5 ± 0,2 р <0,01

In 1 month 15 18,0 ± 1,7 р> 0,05

2,7 ± 0,3 р> 0,05

2,9 ± 0,2 р> 0,05

In 3-4 months 15 12,0 ± 1,0 р> 0,05

1,9 ± 0,3 р> 0,05

1,3 ± 0,1 р> 0,05


From 15 up to

22 From 1,1 up

to 2,0 From 1,5 up

to 2,0


Thermoassymetry a mucous membrane of an alveolar process of the maxilla At

once after carrying out open sinuslifting, i.e. after mending a postoperative wound,

has made in the center of the center 0,9 ± 0,1 (р <0,05), and on periphery of the center

- 0,7 ± 0,1 (р <0,001). All parameters thermoasymmetric a mucous membrane at

patients of the first subgroup ІІ groups of supervision are submitted in tab. 4.5.

84

Table 4.5

Thermoassymetry a mucous membrane of an alveolar process at patients of the

first subgroup ІІ groups of supervision (open sinuslifting)


patients



postoperative wound

On periphery of a postoperative

wound At once after operations

17 0,9 ± 0,1 р <0,05

0,7 ± 0,1 р> 0,05

In 1 day 17 1,5 ± 0,1 р <0,001

1,4 ± 0,1 р <0,001

In 3 days 17 1,8 ± 0,1 р <0,001

1,5 ± 0,1 р <0,001

In 7 days 17 0,6 ± 0,1 р> 0,05

0,5 ± 0,1 р> 0,05


22 0,5 ± 0,1


At closed antrolifting (tab. 4.6) At once after operations Thermoassymetry a

mucous membrane doubtfully raises up to 0,6 ± 0,1 (р> 0,05) in the center of a

postoperative wound and up to 0,5 ± 0,1 (р> 0,05) on periphery of the postoperative

center, i.e. Thermoassymetry remains in norm.

85

Table 4.6


second subgroup of II group of supervision (closed antrolifting)


patients



postoperative wound

On periphery of a postoperative

wound At once after operations

16 0,6 ± 0,1 р> 0,05

0,5 ± 0,1 р> 0,05

In 3 days 16 1,0 ± 0,1 р <0,001

0,9 ± 0,1 р <0,05

In 7 days 16 1,3 ± 0,1 р <0,001

1,1 ± 0,1 р <0,001

In 1 day 16 0,5 ± 0,1 р> 0,05

0,4 ± 0,1 р> 0,05


22 0,5 ± 0,1


At comparison of the first and second subgroups of supervision by us it is

marked, that at closed antrolifting At once after operations thermoasymmetric did not

come to light, that specified on less traumatic operative intervention in comparison

with open (traditional) sinuslifting.

After installation dental implants in a bone, we carried out{spent} Periotestmetry

at patients with open sinuslifting at carrying out of additional fixing dental implants a

titaniumic miniplate and without its{her} realization. It is marked, that without

additional fixing parameters periotestmetry were higher (more than 20 standard unit ),

than at its{her} carrying out (about{near} 10 standard unit ). Thus, at once after

introduction implants us it is established, that due to additional fixing stability

implants which are fastened by a titaniumic miniplate

86

considerably raises. Aveflape arithmetic parameters at surveyed the first

subgroup of supervision are submitted in tab. 4.7.

Table 4.7

Parameters periotestmetry at patients of the first subgroup of II group of

supervision (at open sinuslifting)


patients


Given{data} periotestmetry M ± m (in standard

unit ) Р

At installation implants

20 15,6 ± 0,6 <0,001

In 3-4 months 20 5,8 ± 0,4 <0,05 In 5 months 20 3,7 ± 0,3 > 0,05

In 7-8 months 20 0,2 ± 0,8 > 0,05 Control group - healthy people

(according to the literature)

From-5 up to +5 standard unit


(healthy people).

At installation several, not connected among themselves, dental implants

Periotestmetry defined{determined} for each of them, and then calculated aveflape

arithmetic number. Thus we have revealed, that at installation dental implants at open

sinuslifting Periotestmetry has made 15,6 ± 0,6 standard unit , that

corresponded{met} to patients with the top border of parodontitis easy degree.

Parameters periotestmetry at closed sinuslifting are submitted in tab. 4.8.

87

Table 4.8

Parameters periotestmetry at patients of the second subgroup of II group of

supervision (at closed antrolifting )


patients

Closed sinuslifting Closed nasolifting Number

of patients

M ± m (in standard unit )

Number of patients

M ± m (in standard unit

) At installation

implant 19

13,5 ± 0,7 р <0,001

9 11,1 ± 0,9 р <0,001

In 3-4 months 19 4,2 ± 0,3 р <0,05

9 -0,44 ± 1,1 р> 0,05

In 5 months 19 0,7 ± 0,6 р> 0,05

9 -1,1 ± 1,0 р> 0,05

In 6 months 19 -0,8 ± 0,8 р> 0,05

- -

Control group - healthy people

(according to the literature)

From-5 up to +5 standard unit


(healthy people).

If to compare Periotestmetry at patients at carrying out closed sinuslifting and

closed nasolifting that it is established, that at the last the size of this parameter is a

little bit lower, that is connected, most likely, by that defect necessary for completion

bone-seeking bioceramics at surveyed with closed nasolifting always did not exceed

20 % of length dental implant, and at closed sinuslifting - reached 30 %.

The next day after open sinuslifting parameters pothencyometry (tab. 4.3) were

authentically reduced, but remained during this period of time authentically (р

<0,001) raised{increased}: a potential difference - 107,9 ± 3,9 mV, force of a current

- 6,4 ± 0,3 mcA, electric conductivity - 9,3 ± 0,3

88

mcSim. At closed antrolifting also next day after operation we have noted

authentic decrease{reduction} in all parameters pothencyometry (tab. 4.4): a potential

difference - 46,0 ± 1,8 mV, force of a current - 3,8 ± 0,3 mcA, electric conductivity -

3,6 ± 0,3 mcSim. Despite of decrease{reduction} in these parameters at surveyed the

second subgroup of supervision, all of them remained at authentically high levels in

comparison with norm.

Next day after carrying out of operation of size thermoasymmetric it is authentic

(р <0,05) raised as in the first, and the given group of supervision second subgroups.

At carrying out open sinuslifting parameters thermoasymmetric in the center of a

postoperative wound have made (tab. 4.5) 1,5 ± 0,1 ºС (р <0,001), and on periphery -

1,4 ± 0,1 ºС (р <0,001).

At closed antrolifting (tab. 4.6.) also were observed similar changes, but

parameters were a little bit lower: in the center of a postoperative wound - 1,0 ± 0,1

ºС (р <0,001), and on periphery 0,9 ± 0,1 (р <0,05). Schiller - Pisarev's test in the first

subgroup has made 1,5 ± 0,3 points, and in the second subgroup - 1,4 ± 0,2 points.

Green - Vermillion’s index - 0,8 ± 0,1 (in the first subgroup) and 0,7 ± 0,09 (in the

second).

In 3 days after operation parameters thermoasymmetric at patients with open

sinuslifting (the first subgroup) raised up to 1,8 ± 0,1 ºС (р <0,001) in the center of a

postoperative wound and up to 1,5 ± 0,1 (р <0,001) on periphery. We have noticed

the similar tendency and at closed sinuslifting (the second subgroup), but on lower

sizes of these parameters: 1,3 ± 0,1 (р <0,001) in the center of a postoperative wound

and 1,1 ± 0,1 (р <0,001) on periphery. Schiller - Pisarev's test at patients of the first

subgroup - 1,6 ± 0,3 points, and in the second - 1,5 ± 0,2 points. Green - Vermillion’s

index was estimated as satisfactory (in the first subgroup - 0,8 ± 0,09, in the second -

0,7 ± 0,05).

For the seventh day after carrying out of operative intervention parameters

pothencyometry went down, but remained on authentically high figures. At open

89

sinuslifting (the first subgroup) they were following (tab. 4.3): a potential difference

95,0 ± 2,4 mV (р <0,001), force of a current - 5,1 ± 0,3 mcA (р <0,001), electric

conductivity - 5,1 ± 0,3 mcSim (р <0,001). At closed antrolifting (the second

subgroup) parameters pothencyometry were much lower than in the first subgroup

(tab. 4.4) and made: a potential difference - 28,7 ± 1,9 mV (р <0,01), force of a

current - 3,2 ± 0,4 mcA (р <0,01) and electric conductivity - 3,5 ± 0,2 mcSim (р

<0,01).

Thermoassymetry a mucous membrane for 7 day of investigation of patients with

open sinuslifting it was normalized and was following: in the center of a postoperative

wound - 0,6 ± 0,1 ºС (р> 0,05), and on periphery - 0,5 ± 0,1 ºС (р> 0,05). Too we

have noted and at surveyed patients with closed antrolifting. Parameters

thermoasymmetric at surveyed this subgroup were normalized and made: 0,5 ± 0,1 ºС

(р> 0,05) in the center of a postoperative wound and 0,4 ± 0,1 ºС (р> 0,05) on

its{her} periphery (tab. 4.5 and 4.6).

For 7 day of investigation of patients of the first subgroup ІІ groups of

supervision, we carried out{spent} definition of a functional condition of peripheral

branches of nerves on the maxilla (forward, aveflape and back top alveolar branches

of an infraorbital nerve). Results of investigation of patients of the first subgroup of

supervision are submitted in tab. 4.9.

It is established, that on 7 day of investigation of patients with open sinuslifting,

parameters of conductivity of the top alveolar nerves made 135,5 ± 2,8 standard unit

(р <0,001), and at closed antrolifting - 123,9 ± 1,6 standard unit (р <0,001). Thus,

parameters of conductivity of peripheral nerves were authentically (р <0,001) above

at open sinuslifting, than at closed, that is connected first of all with less traumatic

spent operative intervention at closed antrolifting .

90

Table 4.9

Functional condition of peripheral branches of a trigeminal nerve at patients

with antrolifting (II group of supervision)


patients

Parameters of conductivity of the top alveolar branches of an infraorbital nerve

Open sinuslifting Closed antrolifting

Number of patients

A parameter of conductivity (in standard

unit )

Number of patients

A parameter of conductivity (in standard

unit )

In 7 days 14 135,5±2,8 р <0,001

14 123,9±1,6 р <0,001

In 1 month 14 139,1±2,0 р <0,001

14 116,6±1,9 р <0,05

In 3-4 months 14 128,2±2,4 р <0,001

14 108,5±0,7 р> 0,05

In 5-6 months 14 111,3±1,4 р> 0,05

14 105,9±0,8 р> 0,05


107,2 ± 1,9 (it is surveyed of 24 persons.)


For 7 day of treatment Schiller - Pisarev's test at patients of the first subgroup has

made 1,4 ± 0,3 points, and in the second - 1,3 ± 0,2 points. Green - Vermillion’s index

in the first subgroup was 1,4 ± 0,2 (hygiene of an oral cavity satisfactory), and in the

second subgroup - 0,6 ± 0,2 (hygiene of an oral cavity is appreciated as good).

In the first subgroup of supervision after carrying out open sinuslifting from 23

patients as anesthetizing means at 13 persons. Appointed traditional analgesics

(analginum, etc.), and 10 persons. - used ketanov (not steroid analgesic). The

standard antibiotics of a wide spectrum of action are applied for preventive

maintenance of the inflammatory phenomena to 16 patients

91

(ampioxy, ampicillin, etc.), and 7 - an antibiotic Tcyphran СТ (tcyprophloxatcini

with tinidazolium). Higher anesthetizing efficiency ketanovand anti-inflammatory

action Tcyphran СТ is marked in comparison with traditional preparations. At 13

patients whom in the postoperative period used standard analgesics, for 3 day the

symptom of a pain is marked at 10 person (76,9 %), and for 7 day - at 5 persons.

(38,5 %). At use ketanov the pain for 3 day was register at 5 persons. From 10

surveyed, i.e. in 50,0 % of cases, and for 7 day - at 1 persons. (10,0 %). At

application Tcyphran СТ a hypostasis and hyperemia a mucous membrane of an

alveolar process maxilla bones disappeared in 1,6 times faster, than at

purpose{assignment} of traditional antibiotics.

In the second subgroup of supervision, i.e. after performance closed antrolifting,

from 34 patients as anesthetizing means at 20 persons. Appointed traditional

analgesics, and at 14 persons. - ketanov (not steroid analgesic). For preventive

maintenance of the inflammatory phenomena at 24 persons. Traditional antibiotics,

and at 10 persons. are applied. - Tcyphran the ITEM. In this subgroup higher

anesthetizing efficiency ketanovand anti-inflammatory action Tcyphran also is

marked. At use at 20 persons. Standard analgesics for 3 day after operation of a pain

were kept at 11 persons. (55,0 %), and for 7 day - at 6 persons. (30,0 %). At

application ketanov for 3 day of treatment of a pain were kept at 3 surveyed of 14

patients (in 21,4 %), and for 7 day at patients of a pain we have not registered. At use

for anti-inflammatory action of an antibacterial preparation Tcyphran СТ

(tcyprophloxatcini together with tinidazolium), we have revealed, that a hypostasis

and hyperemia a mucous membrane of an alveolar process in the postoperative period

(after application closed antrolifting) disappeared in 2 times faster, than at

purpose{assignment} of the standard antibiotics.

In 1 month after open sinuslifting (the first subgroup) parameters

pothencyometry (tab. 4.3) have authentically decreased in comparison with the

previous period of investigation of patients and have made: a potential difference -

92

46,4 ± 3,0 mV (р <0,001); force of a current - 3,9 ± 0,3 mcA (р <0,001) and electric

conductivity - 3,2 ± 0,2 mcSim (р <0,01). After carrying out closed sinuslifting (the

second subgroup), in 1 month was observed normalization of all parameters

pothencyometry (tab. 4.4) and were the following: a potential difference - 18,0 ± 1,7

mV (р> 0,05), force of a current - 2,7 ± 0,3 mcA (р> 0,05), electric conductivity - 2,9

± 0,2 mcSim (р <0,05). Last parameter authentically differed from norm only at

persons at whom additional fixing by a titaniumic miniplate was used.

Definition in 1 month after operation of a functional condition of peripheral

branches of a trigeminal nerve has shown, that at open sinuslifting the parameter of

conductivity has doubtfully raised{increased} and has remained on high figures

(139,1 ± 2,0 standard unit ), and at closed sinuslifting - has gone down and has made

116,6 ± 1,9 standard unit The parameter of conductivity of a nerve in both groups

remained authentically raised{increased}.

In 1 month after operation antrolifting the parameter in both subgroups was

identical. Schiller - Pisarev's test at all surveyed was estimated on 1 point, i.e.

colouring is not present. Green - Vermillion’s index was equal 0,5±0,1, i.e. hygiene of

an oral cavity was estimated as good.

In 3-4 months after carrying out antrolifting, all parameters pothencyometry were

normalized in both subgroups of supervision (tab. 4.3 and 4.4). The parameter

periotestmetry at open sinuslifting (tab. 4.7) authentically differed from norm and

made 5,8 ± 0,4 (р <0,05).

At closed sinuslifting (tab. 4.8) the parameter periotestmetry also was not

normalized and made 4,2 ± 0,3 standard unit (р <0,05). Parameters of conductivity of

peripheral branches at open sinuslifting (tab. 4.9) remained authentically high - 128,0

± 2,4 standard unit (р <0,001), and at closed antrolifting - were normalized (108,5 ±

0,7 standard unit , р> 0,05).

Terms full osseointegration at traditional sinuslifting without additional fixing

made from 7 till 8 months after carrying out of operation, and at use at open

93

sinuslifting additional fixing of titaniumic miniplates - 5-6 months. Terms

osseointegration were directly proportional to number entered dental implants. At

their number from 3 and more, terms full osseointegration without fixing have made

not less than 8 months and at use of additional fixing implants by means of a

titaniumic miniplate - no more than 6 months. Thus, use at open sinuslifting

additional fixing dental implants with the help of titaniumic miniplates, has allowed to

reduce terms full osseointegration not less, than to 2 months.

At closed sinuslifting (antrolifting ) full osseointegration dental implants passed

in terms from 3 till 5 months and there were in direct dependence on number entered

implants, heights of an alveolar bone and use of additional fixing with the help of a

titaniumic miniplate. At introduction 2-3 dental implants without additional fixing

terms osseointegration were 5 months, and at additional fixing - 4 months, i.e. for 1

month it is less. At introduction of one implant without additional fixing terms

osseointegration have made 3,5-4 months and depend on height of a bone part of an

alveolar process maxilla bones, and at use for additional fixing dental implant a

titaniumic miniplate - no more than 3 months, i.e. were reduced approximately to 15-

30 days. It is necessary to note, that at use in quality bone-seeking bioceramics Bio-

Granа or Kergapа, we have not revealed an authentic difference in terms

osseointegration depending on a used biomaterial.

Summing up to results of investigation of patients of II group of supervision, we

have noted, that Thermoassymetry a mucous membrane of an alveolar process of the

maxilla in the postoperative period authentically raised in both subgroups of

supervision. However it is necessary to note, that thermoassymetry at open

sinuslifting was authentically above in comparison with patients by whom has been

lead{has been carried out} closed sinuslifting. Direct dependence of normalization

94

thermoasymmetric is established in the field of a postoperative wound from

clinical current of the rehabilitation period at patients with antrolifting. At favorable

current of the postoperative period normalization thermoasymmetric is observed in 7

days after performance antrolifting. At development of inflammatory complications in

the postoperative period normalization thermoasymmetric occurs within 14-18 days.

Thus, on the basis of the lead{carried out} studying local temperature of a mucous

membrane of an alveolar process after the lead{carried out} operation antrolifting, we

have established, that the given investigation has prognostic value and can be used for

definition of the forecast of current of healing of a wound in the postoperative period.

Results of investigation of patients of II group of supervision with use of a

method pothencyometry have shown, that at open (traditional) sinuslifting these

parameters (the potential difference, force of a current, electric conductivity)

authentically did not differ among themselves as at use of additional fixing dental

implants by means of a titaniumic miniplate, and without its{her} application. It is

marked, that after installation implants at traditional sinuslifting parameters

pothencyometry authentically differed from norm and were the following: a potential

difference - 120,7 ± 4,8 mV (р <0,001), force of a current - 8,8 ± 0,4 mcA (р <0,001)

and electric conductivity - 11,8 ± 0,8 mcSim (р <0,001), and at closed antrolifting - a

potential difference - 62,7 ± 3,2 mV (р <0,001), force of a current - 5,2 ± 0,4 mcA (р

<0,001), electric conductivity - 5,3 ± 0,4 mcSim (р <0,001). Thus it is established,

that parameters pothencyometry at installation dental implants at patients with open

sinuslifting in 2 times was higher in comparison with closed antrolifting. This

tendency was kept next day after the lead{carried out} operation. For 7-10 day the

difference between these parameters in the first and second subgroups of supervision

was kept. In one month after operation of size of all parameters pothencyometry

remained on

95

authentic (р <0,001) the raised{increased} level with patients with open

sinuslifting (the first subgroup), and at closed antrolifting (the second subgroup) they

were normalized (except for electric conductivity). At open sinuslifting normalization

of all sizes electropothencyometry occured only in 3-4 months after the lead{carried

out} operative intervention. We establish direct dependence between size of a

potential difference, force of a current, electric conductivity of an oral liquid and a

kind of operative intervention (open or closed antrolifting). Also the authentic

difference and direct dependence between number established implants and size of

parameters pothencyometry is revealed. It is marked, that in process osseointegration

decrease{reduction} in these parameters is always observed. Normalization of them

occurs much faster at closed antrolifting (in 1 month after operation), than at open

sinuslifting (in 3-4 months). By us it is revealed, that the size of electric conductivity

of an oral liquid depend on clinical current reparative processes. At favorable current

normalization of this parameter occurs in 1 month (closed antrolifting) or 2-3 months

(open sinuslifting). At inflammatory complications in the field of a postoperative

wound normalization of this parameter is observed for 0,5-1,5 months later, that it is

possible to use with forecasting the purpose.

Investigation of patients of the first subgroup of II group of supervision (open

sinuslifting) has shown, that terms osseointegration without additional fixing make

from 7 till 8 months after performance of operation, and at use of additional fixing

with the help of a titaniumic miniplate - 5-6 months, i.e. not less than for 2 months it

is less. By us also it has been marked, that terms osseointegration always depend on

number entered dental implants. At their number more than 3, without additional

fixing, terms osseointegration have made not less than 8 months, and at its{her} use -

no more than 6 months, i.e. for 2 months it is less.

96

At patients of the second subgroup of II group of supervision (closed antrolifting)

terms osseointegration occured during from 3 till 5 months. These terms also were in

direct dependence on number entered implants, heights of an alveolar process maxilla

bones and use of additional fixing by a titaniumic miniplate. At implantation 2-3

implants without additional fixing terms osseointegration were about 5 months, and at

its{her} application - 4 months, i.e. for 1 month it is less. By us also it has been

marked, that at introduction of one implant without additional fixing terms

osseointegration have made 3,5-4 months and always were in direct dependence on

height of an alveolar process and on use of additional fixing. At application of last

terms osseointegration made not less than 15-30 days are less. We also have found

out, that terms osseointegration did not depend from us of used bioceramics (Bio-

Granа or Kergapа), i.e. The given biomaterials possessed practically identical

osseoplastic properties.

Studying of a functional condition of peripheral branches of a trigeminal nerve at

surveyed has shown II groups of supervision, that for 7 day after carrying out

antrolifting parameters of conductivity authentically raised in comparison with

healthy people and were the following: at open sinuslifting (135,5 ± 2,8 standard unit

) and at closed antrolifting -(123,9 ± 1,6 standard unit ) . In the first subgroup of II

group of supervision parameters of conductivity were authentically (р <0,01) above in

comparison with the second subgroup. In 1 and 3-4 months after operation open

sinuslifting parameters of conductivity at these patients remained at a former level,

i.e. authentically did not change, and were normalized only in 5-6 months. Parameters

of conductivity of peripheral branches of a trigeminal nerve in 1 month after operation

still remained with patients by whom has been lead{has been carried out} closed

antrolifting, at authentically raised{increased} level, and to 3 to month after the

lead{carried out} operation they were normalized. On the basis of the lead{carried

out} investigation it is possible to assert{approve}, that operations closed

97

antrolifting pass with smaller damage of peripheral branches of nerves which

conductivity is restored within the first months after its{her} performance, i.e. in 2

times is faster in comparison with open sinuslifting. Thus, operative interventions

closed antrolifting should be preferred in comparison with an open method of its{her}

carrying out.

Studying of size of conductivity of peripheral branches of a trigeminal nerve has

shown, that the highest figures (more than 150 standard unit) were observed at open

sinuslifting, it is especial at occurrence of postoperative complications.

During performance open (traditional) sinuslifting 5 patients (21,7 % of cases)

had punching of a mucous membrane of a bottom a sinus of maxilla . At these

patients we closed the formed defect a collagenic membrane which covered an

internal surface of a cavity with available defect and with subsequent its{her} filling

osseoplastic a material, and then this material also covered outside of similar with a

biomembrane and mucose-peryosteal flap. In these, complicated, cases open

sinuslifting, we used parodentium membranes with term resorption 8-12 months, and

osseointegration dental implants also passed in longer terms - not less than 8 months

after operation.

At closed antrolifting , executed by the standard method at 21 surveyed

(sinuslifting-15 persons, nasolifting-6 persons), punching of a mucous membrane

maxilla sinus is registered at 4 (26,7 %) patients, and at nasolifting - at 2 (33,3 %)

patients is revealed punching of a mucous membrane of a bottom nasalis cavities. At

performance closed antrolifting by a technique offered{suggested} by us (with use

silicone) such complications we did not observe a cylinder - expander. It allows us to

assert{approve}, that the method of closed antrolifting with application a silicone

cylinder - expander

98

offered{suggested} by us is the most safe and preferable method before similar

operative interventions which are carried out without his{its} use.

Application after carrying out of operation open or closed antrolifting as

anesthetizing means of a preparation ketanov, and with the anti-inflammatory purpose

- Tcyphran СТ has allowed us to lead{carry out} adequate anesthesia and to avoid

inflammatory complications in the postoperative period.

99

CHAPTER{HEAD} 5

RESULTS OF INVESTIGATION OF PATIENTS

THE THIRD GROUP OF SUPERVISION

The third group of supervision was made by 53 patients with sufficient on height,

but insufficient (thickness) on width an alveolar process top and mandibles. Among

surveyed there were 27 women and 26 men. Distribution surveyed on age and a sex is

submitted in tab.2.1. The third group of supervision has been divided{shared} into 2

subgroups: the first subgroup - 29 patients in whom at installation defect of a bone

wall of an alveolar process with the subsequent closing this defect bone-seeking

bioceramics (Bio-Gran - at 20 persons has been found out, Kergap - at 9 persons) and

a biomembrane; the second subgroup - 24 patients by whom operation of splitting

offered{suggested} by us and expansions of alveolar processes on top and mandibles

has been applied.

In the first subgroup of supervision the insufficient width of an alveolar process

arose more often due to postoperative deformations. At detection of an exposure

dental implant (fig. 5.1) defect covered bone-seeking by bioceramics with the

subsequent closing by a biomembrane (plaster or collagenic).

In the second subgroup of the third group of supervision we carried out{spent}

operative intervention offered{suggested} by us - splitting and expansion of an

alveolar process of a jaw. The schematic image of the given operative intervention at

a narrow alveolar process is submitted on fig. 5.2.

100

Fig. 5.1-a. In-time introduction dental implant defect of a bone wall (it is

specified by an arrow{a pointer}) a box dental implant is found out.

Fig. 5.1-b. Bone defect is covered bone-seeking with bioceramics (Bio-Gran).

101

Fig. 5.1-v. The bone-seeking bioceramics is covered bioresorb with a membrane

(Capset).

The substantiation of a method offered{suggested} by us is connected by that at

preparation by traditional way intrabone the box for implant at a narrow alveolar

process to us is necessary to drill a part of a bone fabric which is located on his{its}

crest. After it will be created bone to a box for dental implant, both bone walls

(vestibular and palatine or lingual) it is significant superfine. That has a negative

effect on osseointegrative processes and further functional value endoosseous implant

is reduced.

Therefore we had been offered operation on a thickening of an alveolar process

which is based on his{its} splitting (division) and his{its} subsequent expansion. As

already earlier by us it has been told, that schematically this operative intervention can

be presented as follows. In the beginning of operation, i.e. the after exfoliation a

mucoperiosteum’s flap, it is strict on the middle of a crest it is done{made} has drunk

102

bones along an alveolar process of a jaw on corresponding depth and length (fig. 5.2-

b, 5.2-v).

Fig. 5.2-a. Has drunk an alveolar process it is carried out{is spent} strictly on

his{its} middle.

Then the chisel or a chisel is entered to separate and part bone walls of an

alveolar process.

Fig. 5.2-b. Introduction of a chisel in a place has drunk an alveolar process on the

maxilla.

103

Fig. 5.2-v. Introduction of a chisel in a place has drunk an alveolar process on the

mandible.

As is known, his{its} bone walls spring (because of their elasticity) and aspire to

borrow{occupy} former position. If there is a crisis of one of bone walls springing

properties of a bone are lost and are considerably slowed down osseointegrative

processes. Therefore it is necessary to aspire to move apart these bone walls for the

width which does not exceed those of thickness implant. For these purposes it is

necessary to use metal wedges (fig. 5.2-g) which inserted between bone walls. The

given metal wedges were used only during carrying out of operative intervention for

separation displacement and keeping in extended position of bone walls of an alveolar

process maxilla or mandible bones. For introduction metal dental a wedge used the

tool designed by us (fig. 5.2-d). Further with use of traditional tools formed to a box

for necessary number dental implants, inserted them, and then deleted wedges.

104

Fig. 5.2-g. Appearance metal dental a wedge in comparison with dental

endoosseous implant.

Fig. 5.2-d. Appearance metal dental a wedge and the tool for his{its}

introduction.

105

By virtue of the elasticity, after removal{distance} of metal (titaniumic) wedges

fragment s of a bone, springing, densely nestle to established dental implant, i.e. bone

walls of an alveolar process try to nestle to each other.

Now we shall consider carrying out of the given operative intervention by the

example of the patient. The after exfoliation a mucoperiosteum’s flap, in a zone of

carrying out of operative intervention, did{made} has drunk (division) of a bone on

top of a crest of an alveolar process of a jaw for the corresponding length and depth.

By the special tool (fig. 5.2-d), after cultivation (separation) of bone walls of an

alveolar process, were entered dental metal (titaniumic) wedges which have been

fixed on strings. And then started formation bone a box for entered endoosseous

implants (fig. 5.3-a).

Fig. 5.3-a. Between bone walls of an alveolar process are entered dental wedges

which are fixed on strings. Between external and internal bone walls of an alveolar

process formation bone a box for endoosseous implant is carried out{spent}.

106

Carried out consecutive introduction dental implants by formation bone a box in

defect between bone (external and internal) walls of an alveolar process of a jaw (fig.

5.3-b) with the help of tools traditionally used in these cases.

Fig. 5.3-b. Between bone walls of an alveolar process of a jaw deduction dental

wedges is kept and consecutive introduction endoosseous implants are carried

out{spent}.

After consecutive introduction of necessary number endoosseous dental implants

(fig. 5.3-b) carried out{spent} gradual removal{distance} of metal wedges (from the

center to periphery) which have been fixed on strings. After removal{distance} of

titaniumic wedges, bone walls of an alveolar process were compressed, but

nevertheless between bone walls there was a defect of a bone. For filling this bone

defect the bioceramics (Bio-Gran or Kergap) was used Bone-seeking.

On fig. 5.3-v the stage of operative intervention with filling bone defect between

walls of an alveolar process a synthetic

107

bone is submitted. Further an operational wound covered resorbed with a

biomembrane, mucose-peryosteal flap and sewed up nonabsorbable suture which

removed for 7-9 day after carrying out of operative intervention. It is necessary to

note, that use of metal wedges negatively did not affect stages of formation bone a

box and introduction endoosseous dental implant.

Fig. 5.3-v. After introduction endoosseous implants gradual removal{distance}

dental wedges and filling of bone defect between bone walls bone-seeking

bioceramics is carried out{spent}.

After introduction dental implants in a bone at patients of the first subgroup we

carried out{spent} potentiometry. Results of last are submitted in tab. 5.4.

Table 5.4

108

Results of carrying out pothencyometry at patients

The first subgroup of III group of supervision in dynamics{changes} of

investigation


patients

Number surveyed


difference (in mV)


mcA)

Electric conductivity (in mcSim)

At introduction implants

14 61,4 ± 2,8 р <0,001

5,3 ± 0,3 р <0,001

5,5 ± 0,3 р <0,001

In 1 day 14 50,7 ± 2,4 р <0,001

3,6 ± 0,2 р <0,001

4,2 ± 0,3 р <0,001

In 7-10 days 14 32,9 ± 1,9 р <0,05

3,1 ± 0,2 р <0,05

3,7 ± 0,3 р <0,01

In 1 month 14 15,7 ± 1,3 р> 0,05

2,4 ± 0,1 р> 0,05

2,7 ± 0,2 р> 0,05

In 3-4 months 14 12,9 ± 1,2 р> 0,05

1,6 ± 0,2 р> 0,05

1,6 ± 0,2 р> 0,05


From 15 up to

22 From 1,1 up

to 2,0 From 1,5 up

to 2,0


It is marked, that at patients of the first subgroup at once after introduction dental

implants it was observed authentic (р <0,001) increase of parameters pothencyometry:

potential differences - up to 61,4 ± 2,8 mV; forces of a current - 5,3 ± 0,3 mcA;

electric conductivity of an oral liquid - 5,5 ± 0,3 mcSim.

At patients of the second subgroup parameters pothencyometry are submitted in

tab. 5.5. At measurement of sizes of potentials at once after introduction dental

implants in this subgroup of supervision it has been established, that they it is

authentic (р <0,001) increased on all investigated parameters: a potential difference -

up to 108,0 ± 4,9 mV; force of a current - 8,9 ± 0,5 mcA;

109

electric conductivity of an oral liquid - 9,9 ± 0,5 mcSim. It is necessary to note,

that sizes of investigated parameters in the second subgroup were authentically (р

<0,001) above in comparison with the first subgroup of this group. In our opinion, it

is connected by that in the second subgroup during operation three were entered at

least dental implant, and in the first subgroup - only individual since implantation was

carried out{was spent} in the field of bone defects.

Table 5.5

Results of carrying out pothencyometry at patients

The second subgroup of III group of supervision in dynamics{changes} of

investigation


patients

Number surveyed


difference (in mV)


mcA)

Electric conductivity (in mcSim)

At introduction implants

15 108,0 ± 4,9 р <0,001

8,9 ± 0,5 р <0,001

9,9 ± 0,5 р <0,001

In 1 day 15 96,7 ± 3,1 р <0,001

7,0 ± 0,5 р <0,001

7,3 ± 0,4 р <0,001

In 7-10 days 15 74,7 ± 3,3 р <0,001

5,5 ± 0,5 р <0,001

4,9 ± 0,3 р <0,001

In 1 month 15 47,3 ± 3,3 р <0,01

4,3 ± 0,4 р <0,001

3,1 ± 0,3 р <0,05

In 3-4 months 15 27,3 ± 2,4 р> 0,05

2,5 ± 0, 3 р> 0,05

1,4 ± 0,1 р> 0,05


From 15 up to

22 From 1,1 up

to 2,0 From 1,5 up

to 2,0


Clinical semiology which would be connected to increase of force of a current,

potential differences and electric conductivity of an oral liquid in an oral cavity, to us

to reveal it was not possible.

110

Thermoassymetry a mucous membrane of an alveolar process of the top and

mandible at once after carrying out dental implantations with use bone-seeking

bioceramics and biometry (the first subgroup) authentically did not change both in the

center, and on periphery of a postoperative wound (tab. 5.6).

Table 5.6

Thermoassymetry a mucous membrane of an alveolar process at patients of

the first subgroup of III group of supervision


patients

Number surveyed


postoperative wound On periphery of a

postoperative wound At once after operations

15 0,6 ± 0,1 р> 0,05

0,5 ± 0,1 р> 0,05

In 1 day 15 1,2 ± 0,1 р <0,001

1,1 ± 0,1 р <0,001

In 3 days 15 1,6 ± 0,1 р <0,001

1,5 ± 0,1 р <0,001

In 7 days 15 0,9 ± 0,1 р <0,05

0,7 ±0,1 р> 0,05


22 0,5 ± 0,1


After carrying out of operative intervention in the first subgroup of supervision

of authentic changes in parameters thermoasymmetric a mucous membrane both in

the center of an operational wound, and on its{her} periphery, we have not found out

(tab. 5.6). Similar changes of local temperature have been revealed and in the second

subgroup of supervision (tab. 5.7).

111

Table 5.7


second subgroup of III group of supervision (at patients operation of splitting

and expansion of an alveolar process is lead{carried out})


patients

Number surveyed


postoperative wound

On periphery of a postoperative wound

At once after operations

17 0,5 ± 0,1 р> 0,05

0,5 ± 0,1 р> 0,05

In 1 day 17 0,9 ± 0,1 р <0,05

0,8 ± 0,1 р <0,05

In 3 days 17 1,2 ± 0,1 р <0,001

1,1 ± 0,1 р <0,001

In 7 days 17 0,5 ±0,1 р> 0,05

0,5 ± 0,1 р> 0,05


22 0,5 ± 0,1


After introduction dental implants in a bone, in dynamics {changes}

osseointegration, us it has been lead{it has been carried out} Periotestmetry at patients

of both subgroups of supervision. In the first subgroup of supervision, at once after

installation dental implant with a covering of defect of a bone bone-seeking

bioceramics and a biomembrane, we have noted, that parameters periotestmetry were

equal 14,6 ± 0,7 standard unit (р <0,001), i.e. they authentically differed from norm

and corresponded{met} to patients with the easy form of disease parodentium (tab.

5.8). At patients of the second subgroup of supervision, i.e. at those to whom

operation of splitting and expansion of an alveolar process was carried out{was

spent}, we have revealed steadier position dental implants. Parameters of

112

periotestmetry in this term have made 12,9 ± 0,8 standard unit (р <0,001), but all of

them authentically differed from norm (tab. 5.9).

Table 5.8

Parameters periotestmetry at patients of the first subgroup

III groups of supervision


Number surveyed

Parameters periotestmetry

M ± m (in standard unit ) Р

At installation implant 16 14,6 ± 0,7 <0,001 In 3-4 months 16 8,4 ± 0,5 <0,01 In 5 months 16 3,8 ± 0,3 > 0,05 In 6 months 16 0,8 ± 0,8 > 0,05

Control group - healthy people (according to the

literature) From-5 up to +5 standard unit


Table 5.9

Parameters periotestmetry at patients of the second subgroup

III groups of supervision (after operation of splitting and expansion of an

alveolar process)


Number surveyed

Parameters periotestmetry

M ± m (in standard unit ) Р

At installation implant 16 12,9 ± 0,9 <0,001 In 3-4 months 16 2,7 ± 0,6 > 0,05 In 5 months 16 0,1 ± 0,7 > 0,05

Control group - healthy people (according to the

literature) From-5 up to +5 standard unit


113

Next day after performance of operative intervention parameters pothencyometry

were reduced in both subgroups of supervision (tab. 5.4 and 5.5). In the first subgroup

of supervision parameters pothencyometry were the following: a potential difference -

50,7 ± 2,4 mV (р <0,001), force of a current - 3,6 ± 0,2 mcA (р <0,001) and electric

conductivity of an oral liquid - 4,2 ± 0,3 mcSim (р <0,001). That is authentic

decrease{reduction} in these parameters in the first subgroup of supervision next day

the lead{carried out} investigation is marked. In the second subgroup authentic

decrease{reduction} in parameters pothencyometry up to the following sizes also is

marked: a potential difference - 96,7 ± 3,1 mV (р <0,001), force of a current - 7,0 ±

0,5 mcA (р <0,001) and electric conductivity of an oral liquid - 7,3 ± 0,4 mcSim (р

<0,001).

Thermoassymetry a mucous membrane of an alveolar process the next day

supervision at patients of the first subgroup authentically raised in the center of a

postoperative wound up to 1,2 ± 0,1 ºС (р <0,001) and on periphery of a wound - up

to 1,1 ± 0,1 ºС (р <0,001), and in the second subgroup these sizes were smaller, but

also authentically raised{increased}: in the center of a postoperative wound - 0,9 ±

0,1 ºС (р <0,05), and on periphery - 0,8 ± 0,1 ºС (р <0,05).

Thus, next day after operation in the first subgroup of supervision parameters

pothencyometry were reduced, and thermoasymmetric - raised. The same law is

marked and in the second subgroup. At comparison of the first and second subgroups

of supervision among themselves during this period of investigation it is revealed, that

in the first subgroup these parameters were authentically lower in comparison with the

second subgroup.

Schiller - Pisarev's test in the first and in the second subgroups has made 1,4 ±

0,3 points. Green - Vermillion’s index - 0,7 ± 0,1 (in the first subgroup) and 0,8 ± 0,1

(in the second subgroup).

At patients of the first subgroup parameters thermoasymmetric continued to

increase for the third day of investigation: in the center of a postoperative wound up

114

to 1,6 ± 0,1 ºС (р <0,001), and on its{her} periphery - up to 1,5 ± 0,1 ºС (р <0,001).

In the second subgroup similar changes, but with lower parameters are marked: in the

center of a postoperative wound - 1,2 ± 0,1 ºС (р <0,001), and on periphery of a

wound - up to 1,1 ± 0,1 ºС (р <0,001). During this period of investigation parameters

thermoasymmetric in the second subgroup were authentically lower in comparison

with the first subgroup of supervision.

Schiller - Pisarev's test at patients of the first subgroup was 1,5 ± 0,4 points, and

in the second - 1,6 ± 0,3 points. Green - Vermillion’s index was estimated as

satisfactory and in the first subgroup has made 0,7 ± 0,08, and in the second - 0,6 ±

0,09.

For the seventh day after carrying out of operative intervention parameters

pothencyometry were authentically reduced, but still remained on authentically high,

in comparison with norm, figures. In the first subgroup of supervision these

parameters were the following: a potential difference - 32,9 ± 1,9 mV (р <0,05); force

of a current - 3,1 ± 0,2 mcA (р <0,05); electric conductivity of an oral liquid - 3,7 ±

0,3 mcSim (р <0,01). In the second subgroup of size of these parameters were the

following: a potential difference - 74,7 ± 3,3 mV (р <0,001); force of a current - 5,5 ±

0,5 mcA (р <0,001); electric conductivity of an oral liquid - 4,9 ± 0,3 mcSim (р

<0,001). The difference between parameters pothencyometry in the first and second

subgroups of supervision is caused by that in the first subgroup has been used, as a

rule, single dental implants, and in the second - not less than three, and is $more often

more than three implants.

For the seventh day of investigation of patients in the first subgroup of

supervision the local temperature (tab. 5.6) in the center of an operational wound (0,9

± 0,1 ºС, р <0,05) was not normalized. In the second subgroup - the local temperature

was normalized both in the center of a postoperative wound, and on its{her}

periphery (tab. 5.7).

115

For the seventh day of investigation of patients of the first subgroup of III group

of supervision we carried out{spent} definition of a functional condition of peripheral

branches of a trigeminal nerve. Results of investigation of these patients are submitted

in tab. 5.10.

Table 5.10

Functional condition of peripheral branches of a trigeminal nerve at patients of

the first subgroup of III group of supervision


patients

Parameters of conductivity of a nerve (in standard unit ) Number surveyed

On the maxilla Number surveyed

On the mandible

In 7 days 12 140,3±4,5 р <0,001

11 148,9±4,7 р <0,001

In 1 month 12 133,7±5,7 р <0,001

11 150,1±5,2 р <0,001

In 3-4 months 12 127,4±3,9 р <0,01

11 130,9±3,2 р <0,05

In 5-6 months 12 114,2±4,4 р> 0,05

11 122,3±3,6 р> 0,05


24 107,2±1,9 24 113,0±11,8


At patients of the first subgroup of supervision authentic increase of parameters

of conductivity of a nerve as on the maxilla (140,3±4,5 s.u. was marked., р <0,001),

and on the mandible (148,9±4,7 standard unit , р <0,001). Thus, by us it is

established, that the given parameters authentically differed from group of healthy

people.

In the second subgroup (tab. 5.11) for 7 day of investigation we did not observe

authentic changes in electrophysiological parameters of peripheral branches of a

116

trigeminal nerve, i.e. operation of splitting and expansion of an alveolar process is not

traumatic for peripheral branches of a trigeminal nerve.

Table 5.11

Functional condition of peripheral branches of a trigeminal nerve at patients of

the second subgroup of III group of supervision


patients Parameters of conductivity of a nerve (in standard unit )

Number surveyed

On the maxilla Number surveyed

On the mandible

In 7 days 12 116,3±2,1 р> 0,05

12 121,3±2,2 р> 0,05

In 1 month 12 115,0±2,0 р> 0,05

12 123,4±1,2 р> 0,05

In 3-4 months 12 106,4±0,9 р> 0,05

12 117,4±1,8 р> 0,05


24 107,2±1,9 24 113,0±11,8


In the first subgroup of III group of supervision from 29 patients as anesthetizing

means at 17 persons. Appointed traditionally used analgesics (analginum, etc.), and at

12 persons. - used ketanov (not steroid analgesic). With the purpose of preventive

maintenance of the inflammatory phenomena to 19 patients the standard antibiotics of

a wide spectrum of action (ampicillin, oxacillini, ampioxy, etc.) have been applied,

And to 10 patients - antibiotic Tcyphran-СТ (tcyprophloxatcini with tinidazolium). As

a result of the given investigation by us it is established, that at application

ketanovand use Tcyphran-СТ postoperative current passed more smoothly than at the

appointed traditional medicamentous treatment. At use in the postoperative period for

treatment standard

117

analgesics for 3 day the symptom of a pain is revealed at 12 persons. (70,6 %),

and for 7 day - at 6 patients (35,3 %). With patients by whom has been used ketanov

for 3 day of supervision of a pain have remained at 5 persons. (in 41,7 %), and for 7

day at 2 persons. (16,7 %). At application Tcyphran СТ a postoperative hypostasis,

and hyperemia a mucous membrane of an alveolar process disappeared in 1,4 times

faster, than at purpose{assignment} of traditional antibacterial preparations.

In the second subgroup of III group of supervision for postoperative anesthesia

from 24 patients traditional analgesics are applied at 14 persons. , and ketanov - at 10

persons. For anti-inflammatory therapy from 24 patients traditional antibiotics are

used at 15 persons. , and Tcyphran СТ - at 9 persons. In this subgroup we also have

noted high anesthetizing efficiency ketanovand anti-inflammatory - Tcyphran the

ITEM. At use at 14 patients for postoperative anesthesia traditional analgesics for 3

day of treatment of a pain were kept at 10 persons. (71,4 %), and for 7 day - at 5

persons. (35,7 %). At application ketanov at 10 patients postoperative pains for 3 day

after operation are revealed at 4 persons. (40,0 %), and for 7 day - at 1 persons. (10,0

%). Using for preventive maintenance of the inflammatory phenomena of an

antibacterial preparation Tcyphran СТ we have noted, that at these patients a

hypostasis, and hyperemia a mucous membrane of an alveolar process disappeared in

1,5 times faster, than at application of traditional antibacterial means.

In 1 month after carrying out of operative intervention in the first subgroup of III

group of supervision parameters pothencyometry were normalized on all investigated

parameters. In the second subgroup of it does not occur, and parameters

pothencyometry were the following: a potential difference - 47,3 ± 3,3 mV (р

<0,001); force of a current - 4,3 ± 0,4 mcA (р <0,001); electric conductivity of an oral

liquid - 3,1 ± 0,3 mcSim (р <0,05). Last parameters authentically differed from group

of healthy people. Parameters pothencyometry authentically differed in the second

subgroup, in comparison with the first. These changes have been revealed only

118

because in the second subgroup for implantation three were used at least dental

implant, and in the first subgroup - one or a maximum two (by tab. 5.4 and 5.5).

Definition of a functional condition of peripheral branches of a trigeminal nerve

in 1 month after operation has shown, that in the first subgroup of supervision of

changes practically was not observed in comparison with the previous period (tab.

5.10), i.e. they remained authentically raised{increased} in comparison with norm. In

the second subgroup of supervision of changes of electrophysiological parameters of

peripheral branches of a trigeminal nerve we have not noted both in this term of

investigation, and during the previous period.

In 1 month after operation Schiller - Pisarev's test was estimated on 1 point in

both subgroups of supervision. Green - Vermillion’s index it was estimated in the first

subgroup 0,4 ± 0,2, and in the second - 0,5 ± 0,2, i.e. hygiene of an oral cavity was

estimated as good.

In 3-4 months after carrying out of operative intervention parameters

pothencyometry authentically did not differ from group of healthy people both in the

first, and in the second subgroups of supervision (tab. 5.4 and 5.5). The parameter

periotestmetry in the first subgroup was not normalized and authentically differed

from norm (tab. 5.8), and in the second subgroup in these terms normalization of the

given parameter (tab. 5.9) has been revealed. Terms osseointegration dental implants

in the first subgroup of supervision occured during the period from 5 till 6 months

after operation, and in the second - in 3-4 months (tab. 5.8 and 5.9).

In 3-4 months after operation in the first subgroup of supervision authentic

changes of electrophysiological parameters of a functional condition of peripheral

branches of a trigeminal nerve, both on top, and on mandibles were marked (tab.

5.10). In the second subgroup of supervision normalization of electrophysiological

parameters of a functional condition of peripheral branches of a trigeminal nerve both

on top, and on mandibles is revealed (tab. 5.11).

119

Summing up to results of investigation of patients of III group of supervision we

have established, that changes of local temperature in the field of a postoperative

wound has the certain law. We have revealed, that at all surveyed this group of

supervision in the postoperative period authentic increase of local temperature that

was shown by change (increase) thermoasymmetric a mucous membrane of an

alveolar process of a jaw was marked. The peak of her{it}, i.e. the highest parameter

of local temperature, have been marked for 3-rd day after carrying out of operative

intervention irrespective of a subgroup of supervision. For 7 day after the executed

operation parameters of local temperature were normalized, i.e. on the party{side} of

the lead{the carried out} operative intervention and the healthy party{side}

parameters of local temperature of a mucous membrane of an alveolar process of a

jaw authentically did not differ among themselves. Us it is revealed, that if the

postoperative period proceeded smoothly normalization of local temperature occured

in earlier specified terms. At presence of the inflammatory phenomena in the field of

a postoperative wound high parameters of local temperature were kept not 3 days (as

at smooth current), and 7-8 days with the subsequent normalization of local

temperature within 14-15 days. On the basis of the lead{carried out} investigation of

patients in this group of supervision we could establish authentically, that

measurement of local temperature in the field of a postoperative wound at carrying

out dental implantations in the first and second subgroups of III group of supervision

has prognostic value and can be used for definition of the forecast of current of

healing of a bone wound in the postoperative period at patients by whom the surgical

stage dental implantations was carried out{was spent}.

Studying of parameters pothencyometry has shown, that in the first subgroup of

III group of supervision of size of all parameters were authentically lower in

comparison with the second subgroup. The potential difference, force of a current and

electric conductivity of an oral liquid at patients of the first subgroup were normalized

in 1 month, and in the second subgroup - only in 3-4 months after operative

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intervention. In our opinion, it is connected by that in the first subgroup of this group

for dental implantations, in connection with presence of defects of a bone, were used

only individual implants, and in the second subgroup - from three and more intrabone

implants. The raised{increased} parameters pothencyometry in the second subgroup

clinically anything did not show themselves. The degree of increase of these

parameters in the second subgroup always depend on number entered dental implants

and was directly proportional to their number. At introduction of three implants

parameters pothencyometry in 1,5 times were lower, than at introduction of five

implants. Thus, it is established, that sizes of parameters pothencyometry are directly

proportional to number established intrabone dental implants. By us also it has been

marked, that at presence of the inflammatory phenomena in the field of a

postoperative wound and (or) at adverse current reparative processes electric

conductivity of an oral liquid was normalized more slowly, than at favorable current.

Backlog in normalization of the given parameter was marked for 15-30 day in

comparison with patients in similar subgroups of investigation. Hence it is possible to

assert{approve}, that the parameter of electric conductivity of an oral liquid can be

used with forecasting the purpose at patients at carrying out of a surgical stage dental

implantations.

Terms osseointegration dental implants, on parameters periotestmetry, at patients

of the first subgroup (with defect of a bone wall of an alveolar process and his{its}

subsequent closing bone-seeking bioceramics and a biomembrane) were observed

during the period from 5 till 6 months after operative intervention. Osseointegration

dental implants at patients of the second subgroup (persons by whom operation of

splitting and expansion of an alveolar process of a jaw was carried out{was spent})

were observed in terms from 3 till 4 months, i.e. for 1-2 months it is less, than in the

first subgroup.

Studying an electrophysiological condition of peripheral branches of a trigeminal

nerve at patients of the first subgroup of III group of supervision it is necessary to

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note, that conductivity of a nerve in 7 days after implantation authentically changed:

on the maxilla - 140,3 ± 4,5 standard unit (р <0,001), and on the mandible - 148,9 ±

4,7 (р <0,001). In dynamics{changes} of spent treatment the parameter of

conductivity of peripheral branches of a trigeminal nerve decreased by 3-4 month of

treatment, but remained in the first subgroup authentically raised{increased} and was

normalized only in 5-6 months after the lead{carried out} operative intervention. At

patients of the second subgroup of III group of supervision, i.e. at carrying out of

operation of splitting and expansion of an alveolar process of a jaw the parameter of

conductivity of peripheral branches of a trigeminal nerve remained within the limits

of norm at all stages of spent treatment. It, in our opinion, has been connected to

feature of spent operative intervention when the break of an alveolar process of a jaw

is carried out{spent}, instead of its{her} full crisis and consequently was not observed

damages of peripheral branches of a trigeminal nerve that performs this operation

preferable before others.

Application after carrying out of operative interventions (both in the first, and in

the second subgroups of III group of supervision) for postoperative anesthesia of a

preparation ketanov, and for preventive maintenance of the inflammatory phenomena

- Tcyphran СТ has shown advantage of the given medicamentous means before

traditionally appointed. Use of preparations ketanov and Tcyphran СТ has allowed to

lead{carry out} adequate anesthesia and to avoid the inflammatory phenomena in a

bone wound in the postoperative period.

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CHAPTER{HEAD} 6

DISCUSSION OF RESULTS OF INVESTIGATION OF PATIENTS BY

WHICH DIFFERENT SURGICAL METHODS OF CARRYING OUT

DENTAL OF IMPLANTATION ARE APPLIED

Under supervision and investigation 151 patient by whom implantation on top

and mandibles has been lead{has been carried out} endoosseous was treated. To all

these patients the surgical stage intrabone dental implantations with subsequent

his{its} orthopedic end has been executed. All surgical (standard and additional

interventions) stages dental implantations were carried out{spent} in the Center dental

implantations Amman (Jordan). Additional surgical interventions at carrying out

endoosseous dental implantations on top and mandibles are made at 110 patients.

All surveyed patients by whom implantation was carried out{was spent}

endoosseous dental, have divided{shared} into three groups:

I group - 41 patient with sufficient on height and sufficient on width an alveolar

process top and mandibles;

II group - 57 patients with insufficient height of an alveolar process of the

maxilla;

III group - 53 patients with sufficient on height, but insufficient on width an

alveolar process top and mandibles.

For the decision of a question on necessity of carrying out of additional operative

intervention on maxilla bones, depending on a degree of an atrophy of alveolar

processes, we have taken advantage of the classification offered{suggested} Misch

C.E. (1987).

Depending on a degree of expressiveness of an atrophy of alveolar processes

maxilla bones the author of them has divided{shared} into 4 groups (SA1-SA4). The

first group (SA1) included surveyed with height of an alveolar process more than 12

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mm, i.e. with absence of an atrophy of an alveolar process. Persons are included in the

second group (SA2) with an insignificant atrophy of an alveolar process (height of an

alveolar process of 10-12 mm). In the third group (SA3) - a moderate atrophy, i.e.

between edge{territory} of an alveolar crest and a bottom maxilla sinus the height of

an alveolar process makes 5-10 mm. Persons are included in the fourth group (SA4)

with a significant atrophy of an alveolar process, the height of a bone from an alveolar

crest to the bottom a sine makes up to 5 mm.

For definition of indications and contra-indications of inclusion of patients in I

and we used III groups of supervision both classification Misch C.E. (1987), and

classification Cawood I.I. and Howell R.A. (1988). According to these classifications

sufficient on height it is considered an alveolar process at his{its} height in 12-14

mm, and insufficient on width - at his{its} sizes in 3,5-5 mm. It is considered, that

that reparative regeneration at implantation proceeded is high-grade it is necessary to

have thickness external and internal bone walls around implant not less than 1 mm.

After selection of patients by us in the first group (41 persons) supervision we

carried out a surgical stage of introduction endoosseous dental implants under the

traditional circuit.

The second group of supervision was made by 57 patients with insufficient

height of an alveolar process of the maxilla. The second group of supervision has

consisted of 2 subgroups: the first group - 23 patients by whom operation open

(traditional) sinuslifting has been lead{has been carried out}; the second subgroup -

34 patients by whom the operative intervention called closed antrolifting (25 person -

closed sinuslifting and 9 person - closed nasolifting) is executed.

Traditional open sinuslifting (the first subgroup ІІ groups of supervision) at 11

patients it is lead{is carried out} by the standard method, and at 12 patients - with our

updating. Updating open sinuslifting consist that the after exfoliation a

mucoperiosteum’s flap on a crest of an alveolar process, i.e. there where in the future

allocation cylindrical implants with the help of titaniumic screws is planned, the

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titaniumic miniplate of the necessary sizes becomes stronger, and further to it{her} fix

dental implants.

The given surgical method of carrying out dental implantations c use of a

titaniumic miniplate for fixing implants is closed since after a

premise{room}endoosseous implants in a bone and their fixing to a titaniumic

miniplate, a mucous membrane and periosteum above them sew up, and

osseointegration occurs in conditions of dissociation implants to an oral cavity. This

method of implantation also can be named two-phasic since at the first stage there is a

healing (engraftment) dental implants which are fixed to a titaniumic miniplate, and at

the second stage (the after osseointegration) - removal (removal{distance}) fixing

implants a titaniumic miniplate by operative disclosing a postoperative wound with

the subsequent detorsion titaniumic screws and removal of a miniplate.

Closed antrolifting (the second subgroup ІІ groups of supervision) it is lead{is

carried out} at 34 patients. From them at 25 person we have executed closed

sinuslifting, and at 9 - closed nasolifting. At 22 patients at their realization in quality

osteoplastic material it is used Bio-Gran, and at 12 - Kergap. Closed sinuslifting and

nasolifting it was applied at installation 1-2 and much less often 3 dental implants.

Closed antrolifting by a traditional technique it is applied at 21 patients, and by a

technique offered{suggested} by us - at 13 patients. The traditional technique closed

antrolifting is in detail described in the literature. Therefore we shall describe

technics{technical equipment} of performance of operation closed antrolifting (a sine

and nasolifting) by a technique offered{suggested} by us with use a silicone cylinder -

expander (a method of a stretching of soft fabrics).

After carrying out exfoliation a mucoperiosteum’s flap in a necessary site of a

jaw formed the bone channel for dental implant. Formation bone a box for

endoosseous dental

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implant carried out at the minimal revolutions - no more than 500-600 revo. In

the beginning carried out{spent} drilling a bone under the control depth-gaugeа.

Checked depth-gauge depth of penetration of the tool and compared her{it} to

thickness of an alveolar process on orthopantomogram. After between a bottom of the

bone channel and a bottom maxilla sinus or cavities of a nose there was the bone

partition equal of 1-1,5 mm, into the bone channel inserted an equal tube on diameter

through which entered a silicone cylinder - expander.

In process of filling a silicone cylinder a liquid (it was carried out with the help

compressive the device in which pressure was created and thus was filled the

cylinder). The maximal pressure in it{him} should not exceed 248 Mbar.The silicone

cylinder in regular intervals extended and broke a bone bottom of the channel due to a

liquid which was in a silicone cylinder. In such way in regular intervals and gradually

the mucous membrane of a bottom maxilla sinus (a cavity of a nose) exfoliated and

the cavity which further was filled osseoplastic by a material was created. Then the

tube together with expander from the bone channel left and through it{her} filling the

formed cavity osseoplastic by a material with the subsequent introduction

endoosseous dental implant was carried out{was spent}.

For maintenance of additional fixing single implant, at his{its}

presence{finding} in a bone less than half of length implant, we have offered carrying

out of his{its} fixing with the help of a titaniumic miniplate which became stronger

on a vertical to an alveolar process maxilla bones the titaniumic screw.

The third group of supervision was made by 53 patients with sufficient on height,

but insufficient (thickness) on width an alveolar process top and mandibles. The third

group of supervision has been divided{shared} into 2 subgroups: the first subgroup -

29 patients in whom at installation defect of a bone wall of an alveolar process with

the subsequent

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closing this defect bone-seeking bioceramics (Bio-Gran - at 20 persons has been

found out., Kergap - at 9 persons) and a biomembrane; the second subgroup - 24

patients by whom operation of splitting offered{suggested} by us and expansions of

alveolar processes on top and mandibles has been applied.

In the first subgroup of III group of supervision the insufficient width of an

alveolar process arose more often due to postoperative deformations. At detection of

an exposure dental implant defect covered bone-seeking by bioceramics with the

subsequent closing by a biomembrane (plaster or collagenic).

In the second subgroup of III group of supervision we carried out{spent}

operative intervention offered{suggested} by us - splitting and expansion of an

alveolar process of a jaw.

The substantiation of a method offered{suggested} by us is connected by that at

preparation intrabone the box for implant in the traditional way at a narrow alveolar

process to us is necessary to drill a part of a bone fabric which is located on his{its}

crest. After it is generated bone to a box for dental implant, both bone walls

(vestibular and palatine or lingual) it is significant superfine. That has a negative

effect on osseointegrative processes and further functional value endoosseous implant

is reduced.

With the purpose of preservation of all thickness of bone walls of an alveolar

process by us operation on his{its} thickening which is based on his{its} splitting

(division) and his{its} subsequent expansion has been offered. Schematically this

operative intervention can be presented as follows. In the beginning of operation, i.e.

the after exfoliation a mucoperiosteum’s flap, it is strict on the middle of a crest it is

done{made} has drunk bones along an alveolar process of a jaw on corresponding

depth and length.

As is known, bone walls of an alveolar process, after their division and

cultivation, spring (because of their elasticity) and aspire to borrow{occupy} former

position, i.e. are compressed. If there is a crisis of one of bone walls springing

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properties of a bone are lost and are considerably slowed down osseointegrative

processes. Therefore it is necessary to aspire to move apart these bone walls for the

width which does not exceed those of thickness dental implant. For these purposes we

have offered metal wedges which inserted between bone walls. We used these metal

wedges only during carrying out of operative intervention, i.e. for separation

displacement and keeping in extended position of bone walls of an alveolar process

maxilla or mandible bones. For introduction metal dental a wedge used the tool

designed by us. Then by means of traditional tools formed bone to a box for necessary

number dental implants, inserted them, and then deleted these wedges (after

installation implants).

By virtue of the elasticity, after removal{distance} of metal (titaniumic) wedges

fragment s of a bone, springing, densely nestle to established dental implant, i.e. bone

walls of an alveolar process try to nestle to each other. However after

removal{distance} of titaniumic wedges between bone walls there was a bone defect.

For filling this bone defect used bone-seeking bioceramics (Bio-Gran or Kergap).

Further an operational wound covered resorbed with a biomembrane, mucose-

peryosteal flap and sewed up nonabsorbable suture which removed for 7-9 day after

carrying out of operative intervention. It is necessary to note, that use of metal wedges

negatively did not affect stages of formation bone a box and introductions

endoosseous dental implant.

Surveying patients I of group of supervision (with sufficient on height and

width an alveolar process), we have noted, that for them was available in the

postoperative period Thermoassymetry a mucous membrane of an alveolar process in

the field of a postoperative wound at once after end of operation. The local

temperature on the part of the lead{carried out}

128

operative intervention was below symmetrically a healthy site (we estimated

her{it} as with the minus is familiar). It has been connected to infringement

vascularity a mucoperiosteum’s flap at his{its} formation (exfoliation). The next day

after operation dental implantations the local temperature raised and

Thermoassymetry authentically differed from norm, that also is marked and for the

third day after carrying out of operation. Normalization of local temperature was

observed only in 7 days after operative intervention. We establish direct dependence

between a degree of expressiveness of increase of local temperature and number

entered dental implants, that necessarily it is necessary to take into account at the

analysis of the received local temperature data since at these patients is longer was

kept Thermoassymetry in the postoperative period. At presence post-implantological

inflammatory complications or at more traumatic to the lead{the carried out}

technique of implantation at patients I of group the local temperature remained is

longer (for 2-3 days longer than in typical cases) on authentically high figures, that

specified an opportunity of use of this test (measurement local thermoasymmetric)

with forecasting the purpose.

Surveying patients of II group of supervision (with insufficient height of an

alveolar process of the maxilla), we have revealed, that Thermoassymetry a mucous

membrane of an alveolar process of the maxilla in the postoperative period

authentically raised in both subgroups of supervision (at open and closed antrolifting

). However it is necessary to specify, that Thermoassymetry at open sinuslifting was

authentically above in comparison with patients by whom has been lead{has been

carried out} closed sinuslifting. Direct dependence of normalization

thermoasymmetric is established in the field of a postoperative wound from clinical

current of the rehabilitation period at patients with antrolifting. At favorable current of

the postoperative period normalization thermoasymmetric is observed in 7 days after

performance antrolifting.

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At development of inflammatory complications in the postoperative period

normalization thermoasymmetric occurs within 14-18 days. Thus, on the basis of the

lead{carried out} studying local temperature of a mucous membrane of an alveolar

process after the lead{carried out} operation antrolifting, we have established, that the

given investigation has prognostic value and can be used for definition of the forecast

of current of healing of a wound in the postoperative period at these patients.

By results of investigation of patients with insufficient (thickness) on width an

alveolar process of a jaw (III group of supervision), we have established, that changes

of local temperature in the field of a postoperative wound had the certain law. We

have revealed, that at all surveyed this group of supervision in the postoperative

period authentic increase of local temperature that was shown by change (increase)

thermoasymmetric a mucous membrane of an alveolar process of a jaw was marked.

The peak of her{it}, i.e. the highest parameter of local temperature, have been marked

for 3-rd day after carrying out of operative intervention irrespective of a subgroup of

supervision. For 7 day after the executed operation parameters of local temperature

were normalized, i.e. on the party{side} of the lead{the carried out} operative

intervention and the healthy party{side} parameters of local temperature of a mucous

membrane of an alveolar process of a jaw authentically did not differ among

themselves. Us it is revealed, that if the postoperative period proceeded smoothly

normalization of local temperature occured in earlier specified terms. At presence of

the inflammatory phenomena in the field of a postoperative wound high parameters of

local temperature were kept not 3 days (as at smooth current), and 7-8 days with the

subsequent normalization of local temperature within 14-15 days. On the basis of the

lead{carried out} investigation of patients in this group of supervision we could

establish authentically, that measurement of local temperature in the field of a

postoperative wound at carrying out dental implantations in the first and second

subgroups of III group of supervision has prognostic value and can be used for

130

definition of the forecast of current of healing of a bone wound in the postoperative

period.

Results of investigation of patients of the first group of supervision by a method

pothencyometry specified that At once after introductions dental implant in bone to a

box there was an authentic increase of a difference of electric potentials up to

89,4±3,6 mV, forces of a current up to 7,5±0,4 mcA and electric conductivity of an

oral liquid up to 10,1±0,8 mcSim. In 2-3 hours after introduction implant and his{its}

stay in conditions of a mouth parameters of a potential difference, force of a current

and electric conductivity doubtfully were reduced and remained on high figures.

Within 7-10 days after dental implantations parameters pothencyometry decreased,

but remained authentically raised{increased}. Normalization of parameters of a

potential difference and force of a current occured only in 1 month after operation,

and electric conductivity of an oral liquid - in 3-4 months after implantation. We

establish direct dependence between parameters pothencyometry (size of a potential

difference, force of a current, electric conductivity of an oral liquid) and number

entered dental implants. It is marked, that at all surveyed in dynamics{changes} of

current osseoregeneration (osseointegration) decrease{reduction} and normalization

of parameters pothencyometry was observed. We have revealed, that the size of

electric conductivity of an oral liquid always depend on current osseoregeneration

processes in a bone wound. At favorable current - normalization of this parameter

occured in terms till 1 month after operation, and at adverse current (delay of

processes of formation{education} of a bone) - during 1,5 and even 2 months after

end of operation. At periimplantitis we at all these patients (4 persons) Observed high

figures of electroconductivity of an oral liquid which exceeded normal amounts in

two and more times. Normalization of this parameter occured only after elimination

of it postimplantation inflammatory complication.

131

Results of investigation of patients of II group of supervision with use of a

method pothencyometry have shown, that at open (traditional) sinuslifting these

parameters (the potential difference, force of a current, electric conductivity)

authentically did not differ among themselves as at use of additional fixing dental

implants by means of a titaniumic miniplate, and without its{her} application. It is

marked, that after installation implants at traditional sinuslifting parameters

pothencyometry authentically differed from norm and were the following: a potential

difference - 120,7 ± 4,8 mV (р <0,001), force of a current - 8,8 ± 0,4 mcA (р <0,001)

and electric conductivity of an oral liquid - 11,8 ± 0,8 mcSim (р <0,001), and at

closed antrolifting - a potential difference - 62,7 ± 3,2 mV (р <0,001), force of a

current - 5,2 ± 0,4 mcA (р <0,001), electric conductivity of an oral liquid - 5,3 ± 0,4

mcSim (р <0,001). Thus it is established, that parameters pothencyometry at

installation dental implants at patients with open sinuslifting in 2 times was higher in

comparison with closed antrolifting. This tendency was kept next day after the

lead{carried out} operation. For 7-10 day a difference between these parameters in

the first (open antrolifting) and the second subgroups (closed antrolifting) supervision

was kept. In one month after operation of size of all parameters pothencyometry

remained on authentically raised{increased} (р <0,001) a level with patients with

open sinuslifting (the first subgroup), and at closed antrolifting (the second subgroup)

they were normalized (except for electric conductivity of an oral liquid). At open

sinuslifting normalization of all sizes electropothencyometry occured only in 3-4

months after the lead{carried out} operative intervention. We establish direct

dependence between size of a potential difference, force of a current, electric

conductivity of an oral liquid and a kind of operative intervention (open or closed

antrolifting). Also the authentic difference and direct dependence between number

established implants and size of parameters pothencyometry is revealed. It is marked,

that in process osseointegration decrease{reduction} in these parameters was always

observed. Normalization of them occured much faster at closed antrolifting (in 1

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month after operation), and at open sinuslifting (in 3-4 months). By us it is revealed,

that the size of electric conductivity of an oral liquid always depend on clinical

current reparative processes. At favorable current normalization of electric

conductivity of an oral liquid occured in 1 month (closed antrolifting) or 2-3 months

(open sinuslifting). At inflammatory complications in the field of a postoperative

wound normalization of this parameter was observed for 0,5-1,5 months later, that it

is possible to use with forecasting the purpose.

Studying of parameters pothencyometry at patients has shown, that in the first

subgroup (with defect of a bone wall) (with sufficient on height, but insufficient width

an alveolar process) supervision of size of all parameters were authentically lower

than III group in comparison with the second subgroup (at patients by whom

operation of splitting and expansion of an alveolar process is applied). The potential

difference, force of a current and electric conductivity of an oral liquid at patients of

the first subgroup were normalized in 1 month, and in the second subgroup - only in

3-4 months after operative intervention. In our opinion, it is connected by that in the

first subgroup of this group for dental implantations, in connection with presence of

defects of a bone, were used only individual implants, and in the second subgroup -

from three and more intrabone dental implants. The raised{increased} parameters

pothencyometry in the second subgroup clinical semiology of did not show. The

degree of increase of these parameters in the second subgroup always depend on

number entered dental implants. At introduction of three implants parameters

pothencyometry in 1,5 times were lower, than at introduction of five implants. Thus,

it is established, that sizes of parameters pothencyometry are directly proportional

133

to number established intrabone dental implants. By us also it has been marked,

that at presence of the inflammatory phenomena in the field of a postoperative wound

and at adverse current reparative processes electric conductivity of an oral liquid was

normalized more slowly, than at favorable current. Backlog in normalization of the

given parameter was marked for 15-30 day in comparison with patients in similar

subgroups of investigation. Hence, it is possible to assert{approve}, that the

parameter of electric conductivity of an oral liquid can be used with forecasting the

purpose at patients at carrying out of a surgical stage dental implantations for

forecasting current osseoregeneration processes.

Investigation of patients I of group of supervision by a method periotestmetry

has shown, that high-grade osseoreparative processes on the maxilla were observed in

5 months after installation dental implants, and on the mandible - in 6 months. High-

grade osseointegration in these terms it was observed it is not dependent on number

entered implants and it was defined{determined} by a place of carrying out of

implantation (the top or mandible).

We have analysed clinical outcomes osseointegration which were observed by

us around endoosseous dental implants in a jaw with different on thickness and

density bone walls. It is established, that at the raised{increased} density of a bone (I

type on Параскевич В.Л., 1998) and thickness of bone walls in 1 mm from 17

implants favorable outcomes were observed only at 11 persons. (in 64,7 %), and at

thickness in 1,5 mm and more - at all 16 persons. (in 100 % cases). At aveflape and

low density of a bone fabric and thickness of bone walls in 1-1,5 mm we observed

favorable osseointegrative outcomes only in 5 cases from 23 established implants, i.e.

in 21,7 % cases, and at thickness in 2 mm and more - at all surveyed (in 100 %).

Complications were observed as resorption edges{territories} of an alveolar crest or

denudation parts dental implant,

134

that demanded further use osteoplastic materials for closing the bared sites

dental implant.

Investigation of patients of the first subgroup of II group of supervision (open

sinuslifting) has shown, that terms osseointegration without additional fixing made

from 7 till 8 months after performance of operation, and at use of additional fixing

with the help of a titaniumic miniplate - 5-6 months, i.e. not less than for 2 months it

is less. By us also it has been marked, that terms osseointegration always depend on

number entered dental implants. At their number more than 3, without additional

fixing, terms osseointegration have made not less than 8 months, and at its{her} use -

no more than 6 months, i.e. for 2 months it is less.

At patients of the second subgroup of II group of supervision (closed antrolifting

) terms osseointegration occured during from 3 till 5 months. These terms also were in

direct dependence on number entered implants, heights of an alveolar process maxilla

bones and use of additional fixing by a titaniumic miniplate. At implantation 2-3

dental implants without additional fixing terms osseointegration were about 5 months,

and at its{her} application - 4 months, i.e. for 1 month it is less. By us also it has been

marked, that at introduction of one implant without additional fixing terms

osseointegration have made 3,5-4 months and always were in direct dependence on

height of an alveolar process and on use of additional fixing. At application of last

terms osseointegration made not less than for 15-30 days less. We also have found

out, that terms osseointegration did not depend from us of used bioceramics (Bio-

Granа or Kergapа), i.e. The given biomaterials possessed practically identical

osseoplastic properties.

Terms osseointegration dental implants, on parameters periotestmetry, at patients

of the first subgroup of III group of supervision (with defect of a bone wall of an

alveolar process and his{its} subsequent

135

closing bone-seeking bioceramics and a biomembrane) were observed during the

period from 5 till 6 months after operative intervention. Osseointegration dental

implants at patients of the second subgroup (persons by whom operation of splitting

and expansion of an alveolar process of a jaw was carried out{was spent}) were

observed in terms from 3 till 4 months, i.e. for 1-2 months earlier, than in the first

subgroup.

At studying a functional condition of peripheral branches of a trigeminal nerve

in dynamics{changes} of healing of a bone wound after carrying out endoosseous

dental implantations in favorable conditions (I group of supervision), we have

revealed, that 20 person by whom have been established implants on the maxilla, the

clinical semiology posttraumatic neuritis has arisen at 4 person, i.e. in 20,0 % cases,

and on the mandible at 8 of 21 patients, i.e. in 38,0 % cases. The mechanism of

occurrence posttraumatic neuritis on the maxilla mechanical damage of the nerve is

possible to explain damage as integrity of bone blood vessels (there are haemorrhages

and hematomas which squeeze peripheral nervous fibres), and, probably, at formation

bone a box for implant. The mechanism of development posttraumatic neuritis on the

mandible speaks as damage of a bone wall mandible the channel with the subsequent

wound of a nerve, and occurrence of bone haemorrhages as a result of infringement of

integrity of vessels with the subsequent mechanical compression nervous trunks.

Feature of these neuritis is that the damaging{injuring} factor (dental implant) after

drawing a trauma remains in the same place and in conditions of a long compression

long current of the given neurologic complication is marked slow resorption of

hematomas (haemorrhage), and consequently, and.

At studying size of conductivity of a nerve it is established, that the highest

figures (170-180 standard unit ) were observed at patients at mechanical damage of

the top wall mandible the channel, and also at traumatized peripheral nervous

branches

136

or at presence of bone haemorrhages (150-160 standard unit ). These figures of

conductivity of a nerve were always observed during 1-2 month after carrying out of

operation of implantation and were in direct dependence on number entered dental

implants, and also extensiveness of the damaging{injuring} factor. At favorable

postoperative current conductivity of nervous fibres was restored in 3-4 months on the

maxilla or 5-6 months - on the mandible. We observed restoration of conductivity of a

nerve at all surveyed patients I of group of supervision.

Studying of a functional condition of peripheral branches of a trigeminal nerve at

surveyed has shown II groups of supervision, that for 7 day after carrying out

antrolifting parameters of conductivity authentically raised in comparison with

healthy people and were the following: at open sinuslifting (135,5 ± 2,8 standard unit

) and at closed antrolifting - (123,9 ± 1,6 standard unit ) . In the first subgroup of II

group of supervision (open antrolifting) parameters of conductivity were authentically

(р <0,01) above in comparison with the second subgroup. In 1 and 3-4 months after

operation open sinuslifting parameters of conductivity at these patients remained at a

former level, i.e. authentically did not change, and were normalized only in 5-6

months. At patients, by whom has been lead{has been carried out} closed antrolifting

(the second subgroup), parameters of conductivity of peripheral branches of a

trigeminal nerve in 1 month after operation remained at authentically

raised{increased} level, and to 3 to month after the lead{carried out} operation they

were normalized. On the basis of the lead{carried out} investigation it is possible to

assert{approve}, that operations closed antrolifting pass with smaller damage of

peripheral branches of nerves which conductivity is restored within the first months

after its{her} performance, i.e. in 2 times is faster in comparison with open

sinuslifting. Thus, operative intervention closed antrolifting it is necessary to prefer in

comparison with an open method of its{her} carrying out.

137

Studying of size of conductivity of peripheral branches of a trigeminal nerve has

shown, that the highest figures (more than 150 standard unit ) were observed at open

sinuslifting, it is especial at occurrence of postoperative complications.

During performance open (traditional) sinuslifting 5 patients (21,7 % of cases)

had punching of a mucous membrane of a bottom a sinus of maxilla . At these

patients we closed the formed defect a collagenic membrane which covered an

internal surface of a cavity with available defect and with subsequent its{her} filling

osseoplastic a material, and then this material also covered outside of similar with a

biomembrane and mucose-peryosteal flap. In these, complicated, cases open

sinuslifting, we used parodentium membranes with term resorption 8-12 months, and

osseointegration dental implants also passed in longer terms - not less than 8 months

after operation.

At closed antrolifting , executed by the standard method, punching of a mucous

membrane maxilla sinus is registered at 4 (26,7 %) patients, and at nasolifting - at 2

(33,3 %) patients is revealed punching of a mucous membrane of a bottom nasalis

cavities. At performance closed antrolifting by a technique offered{suggested} by us

(with use silicone) such complications we did not observe a cylinder - expander. It

allows us to assert{approve}, that the method offered{suggested} by us closed

antrolifting with application a silicone cylinder - expander is the most safe and

preferable before similar operative interventions which are carried out without

his{its} use.

Studying an electrophysiological condition of peripheral branches of a trigeminal

nerve at patients of the first subgroup it is necessary to note, that conductivity of a

nerve in 7 days after implantation authentically

138

changed: on the maxilla - 140,3 ± 4,5 standard unit (р <0,001), on the mandible -

148,9 ± 4,7 (р <0,001). In dynamics{changes} of spent treatment the parameter of

conductivity of peripheral branches of a trigeminal nerve decreased by 3-4 month of

treatment, but remained in the first subgroup authentically raised{increased} and was

normalized only in 5-6 months after the lead{carried out} operative intervention. At

patients of the second subgroup of III group of supervision, i.e. at carrying out of

operation of splitting and expansion of an alveolar process of a jaw the parameter of

conductivity of peripheral branches of a trigeminal nerve remained within the limits

of norm at all stages of spent treatment. It, in our opinion, has been connected to

feature of spent operative intervention when the break of an alveolar process of a jaw

is carried out{spent}, instead of its{her} full crisis and consequently damage of

peripheral branches of a trigeminal nerve that performs this operation preferable

before others was not observed.

Application after carrying out typical endoosseous implantations, and also at

operations open and closed antrolifting or at other operative interventions at a stage of

installation endoosseous implants as anesthetizing means of a preparation ketanov,

and with the anti-inflammatory purpose - Tcyphran СТ has allowed us to lead{carry

out} adequate anesthesia and to avoid inflammatory complications in the

postoperative period at all surveyed patients.

139

CONCLUSIONS

In the dissertation the actual scientific - practical problem{task} of dentistry-

perfection of surgical methods of treatment, expansion of indications for their

application and increase of efficiency of carrying out intrabone dental implantations at

patients with defects of dental numbers{lines} and jaws is solved.

1. On the basis of the lead{carried out} researches it is proved, that intrabone

dental implantation can be carried out with high efficiency at an atrophy of an

alveolar process maxilla bones of a significant degree of expressiveness. For this

purpose at open and closed sinusliftingх it is offered to use additional fixing intrabone

dental implants by means of titaniumic miniplates, fixing is carried out

simultaneously with installation endoosseous implants. Parameters pothencyometry (a

potential difference, force of a current and electric conductivity of an oral liquid)

authentically do not differ among themselves as at traditional, and modified (with

application of additional fixing) sinusliftingх. Use of the modified technique

sinuslifting allows to reduce terms osseointegration to 2 months and more in

comparison with a traditional method.

2. With the purpose of careful exfoliation a mucous membrane maxilla sinus or

cavities of a nose from a bone the technique of carrying out of operation closed

antrolifting by a method of a stretching of fabrics - with the help of application a

silicone cylinder - expander is offered. Filling of the last with a liquid is carried out

with the help compressive the device at the maximal pressure no more than 248 Mbar.

Use a silicone cylinder at closed antrolifting allows in regular intervals and without

perforations to exfoliation a mucous membrane of a bottom maxilla sinus or cavities

of a nose and, thus to create a cavity which further is filled

140

by a osseoplastic material with the subsequent installation intrabone dental

implants. Application of offered{suggested} operation by us allows to liquidate

occurrence of complications during performance of operative intervention as

punching a mucous membrane which at traditional closed sinuslifting is observed at

26,7 % of patients, and at closed nasolifting - at 33,3 % surveyed and to reduce terms

osseointegration.

3. It is established, that at the raised{increased} density of a bone and thickness

of bone walls (external or internal) in 1 mm favorable outcomes are observed in 64,7

% cases, and at thickness in 1,5 mm and more - in 100 %. At aveflape and low density

of a bone fabric and thickness of bone walls in 1-1,5 mm favorable outcomes

osseointegration are registered in 21,7 % cases, and at thickness in 2 mm and more -

at all (100 %) surveyed patients. Thus it is possible to come to a conclusion, that for

favorable current osseointegration at the raised{increased} density of a bone around

of intrabone dental implant it is necessary to keep thickness of a bone wall not less

than 1,5 mm, and at aveflape and low density of a bone - not less than 2 mm.

4. At performance of traditional surgical methods of installation intrabone dental

implants damage of peripheral branches of a trigeminal nerve with infringement of

his{its} function is observed. At typical endoosseous implantations on the maxilla of

the phenomenon posttraumatic neuritis are revealed in 20,0 %, and on the mandible -

in 38,0 % cases. It is proved, that infringement of a functional condition of a

peripheral nerve is restored in 1-3-5 months after the lead{carried out} operation.

Duration of the period of infringement of a functional condition of a trigeminal nerve

is in direct dependence on a technique of carrying out of operative intervention, a jaw

on which operation and numbers established endoosseous dental implants is carried

out.

5. For preservation of the maximal thickness and height of lateral bone walls of

an alveolar process at carrying out dental to implantation

141

at patients with sufficient on height and insufficient on width the alveolar process

top or mandibles offers operation of splitting and expansion of an alveolar process

with use dental wedges. Studying of a functional condition of a trigeminal nerve has

shown, that due to application of this surgical method of operative intervention for

installation intrabone dental implants it was possible to avoid damage of his{its}

peripheral branches and has allowed to reduce terms osseointegration to 1-2 months.

6. Objective tests of efficiency of carrying out of operation and the forecast of

current of the postoperative period at endoosseous dental implantations is the contact

thermometry and definition of electric conductivity of an oral liquid. If for 7 day after

the lead{carried out} operative intervention there is no normalization of local

temperature and (or) the size of a parameter of electric conductivity of an oral liquid it

specifies development of postoperative inflammatory complications and a delay

osseoregeneration processes in a place of carrying out of implantation does not

decrease.

142

Practical recommendations

1. At a presence{finding} dental implant in an alveolar process maxilla bones

less than 30 % from his{its} length are recommended to carry out {spend} their

additional fixing with the help of a titaniumic miniplate. For strengthening single

intrabone dental implants it is offered to fix a miniplate to maxilla bones, and at

installation several endoosseous dental implants - to fasten them among themselves a

miniplate to their subsequent closing mucose-peryosteal flap.

2. For convenience of performance of installation intrabone dental implants at

carrying out of operation of splitting and expansion of alveolar jaws processes during

realization of operative intervention, it is offered to use dental wedges and the tool for

their introduction.

3. For completion of defects and deformations of bone walls of alveolar

processes jaws, and also for filling the cavities formed during operation at carrying

out sinuslifting, it is recommended to use resorption synthetic osteoplastic material -

Bio-Gran and Kergap.

4. After carrying out typical endoosseous or the operative intervention connected

to installation dental implants, and also in dynamics{changes} osseointegration, the

condition of peripheral branches of a trigeminal nerve in a place of performance of

operative intervention is recommended to define{determine} implantations by

definition of painful, tactile or temperature sensitivity of fabrics, by innervation this

nerve.

5. After carrying out endoosseous dental implantations or performance of the

operative interventions connected to installation intrabone implants, it is

recommended to use as anesthetizing means ketanov, and with the anti-inflammatory

purpose - Tcyphran the ITEM.

143

THE LIST OF THE USED LITERATURE

1. Alexanders N.M. Operation on the maxilla // the Management{Manual} on

operative maxillofacial surgery / Under cor. V.V.Balina. – S.-Pt., 1999. - P. 430-

450.

2. Aleshchenko I.E., etc. Bioimplants “Tutoplast” - the modern decision of problems

of restoration of a bone fabric // Clinical dentistry.-2002. - № 4. - P. 52-55.

3. Amrakhov E.G.Comparative an experimental - clinical estimation domestic

intrabone implants: Thesis for the Candidate’s Degree of Medc.Sciences. - М.,

1986. - 20 P.

4. Baluda I.V. Condition of fabrics orthopedic a box at patients with trailer defects of

dental numbers{lines} at treatment with use implants: Thesis for the Candidate’s

Degree of Medc.Sciences. - М., 1990. - 22 P.

5. Bezrukov V.M., A.A. Dental's Fists implantation - from a century XIX in a century

XX // the Russian bulletin dental implantology. - 2003. - № 1. - P. 4-7.

6. Bezrukov V.M., Matveeva A.I., A.A.Result's Fists and prospect of research of

problems dental implantology in Russia // Dentistry. - 2002. - № 1. - P. 52-55.

7. Bezrukov V.M., Chernikis F.S., Surov O.N., Матвеева A.I.application implants in

dentistry: the Method. Recommendations. - М., 1987. - 35 P.

8. Bekrenev N.V., Калганова This year, Vereshchagina L.A., Obydennaja S.A.,

Лясников V.N.application implants in dentistry// New in dentistry. Спец. вып. -

1995. - № 2. - P. 19-22.

9. Beljayeva L.G., Бєляєв E.V.Zam_shchennja дистально необмежених дефектів

dental to a number{line} мостоподібними artificial limbs з двобічною опорою

on імплантати // Матеріали І (V ІІ) з ’ їзду Асоціац і ї стоматологів України. -

Київ, 1999. - P. 467.

144

10. Берченко G.N.influence хитозановой губки, containing рекомбинатный a

major factor of growth фибробластов on healing полнослойных wounds //

Application биокомпозитных materials in maxillofacial surgery and dentistry. -

1997. - № 4. - P. 13.

11. Berchenko G.N., etc. Use of plastic materials on a basis hydroxyapatite as a

matrix for formation of a bone fabric // Application биокомпозитных materials in

maxillofacial surgery and dentistry. - 1997. - № 8. - P. 14.

12. Bejdik O.V., Butovskij K.G., Ljasnikov V.N., Kataev I.A., Ostrovskij N.V.,

Котельников G.P.experimental research of integration of biocomposite coverings

stomatologic and orthopedic implants with a bone fabric // Materials of conference

of young scientists of Russia with the international participation « Fundamental

sciences and progress of clinical medicine », devoted to 240-anniversary ММА by

him{it}. I.M.Setchenov. - М., 1998. - P. 117-118.

13. Bogatov A.I., Revjakin A.I., Схабицкий E.V.way and a set of devices for

realization soft sinuslifting in a combination to one-stage implantation // Росс. The

bulletin dental implantology. - 2003. - № 3. - P. 20-23.

14. Вигдерович V.A.forecasting of results of a surgical stage dental implantations:

Thesis for the Candidate’s Degree of Medc.Sciences. - М., 1991. - 24 P.

15. Volozhin A.I., etc. Clinical approbation of a preparation on a basis hydroxyapatite

in dentistry// New in dentistry. - 1993. - № 3. - P. 29-31.

16. Volozhin A.I., Barer G.M., Janushevich O.O., Chepel A.A., Лебедев

V.G.research of properties of the biomembranes used in osseoplastic with the

purpose of directed regeneration of a fabric, on model of long cultures of a bone

brain // Dentistry. - 2002. - № 6. - P. 12-15.

17. Вовк V.E.Subkortikalnaja implantation at an atrophy of an alveolar process jaws

// Clinical implantology and dentistry. - 2001. - № 3-4. - P. 49-51.

18. V.A.restoration's sparrows of trailer defects of dental lines of the mandible

мостовидным an artificial limb with дистальной a support on implant from

145

серебряно-палладиевого an alloy: Thesis for the Candidate’s Degree of

Medc.Sciences. - Omsk, 1988. - 21 P.

19. Heroes В.Н., Aleshchenko I.E., Yeltsin A.G.application биоimplants тутопласт

in surgical dentistry// Modern problems implantology. Сб. Scientific articles on

materials of 6-th International conference on May, 20-23, 2002 - Saratov. - 2002. -

P. 95-97.

20. Гветадзе R.SH.complex an estimation of the remote results dental implantations:

Thesis for the Candidate’s Degree of Medc.Sciences. - М., 1996. - 25 P.

21. I.JU.Клинико-laboratory's potters a substantiation and optimization of application

domestic пластиночных implants in stomatologic practice. Thesis for the

Candidate’s Degree of Medc.Sciences. - М., 1999. - 25 P.

22. Гречко N.B. Peculiarities of treatment of patients by dental implants from із

сапфіру з застосуванням the гел_й-neon laser (експериментально-клінічне

дослідження): Автореф. Thesis for the Candidate’s Degree of Medc.Sciences:

14.01.22 / Полтавська honey. стомат. акад. - Poltava, 1998. - 16 P.

23. Григорьян Ampere-second., Kulakov A.A., Volozhin A.I., Losev F.F., Хамраев

T.K.experimental an estimation osteoplastic the materials used in maxillofacial

surgery and dental implantology, and their influence on репаративный

osteogenesis // the Russian bulletin dental implantology. - 2003. - № 1. - P. 38-44.

24. Grigorjants L.A., Badalyan V.A.experience of application a mineral триоксид the

unit on out-patient surgical reception // Clinical dentistry. - 2002. - № 3. - P. 42-

46.

25. Danilevskij N.F., Borisenko A.V. // Diseases parodentium. - К.: Здоров'n. - 2000.

- 464 P.

26. Дианова E.JU.experimental studying domestic биодеградирующих membranes

for the directed regeneration of a bone fabric: Thesis for the Candidate’s Degree of

Medc.Sciences: - М., 1998. - 17 P.

146

27. Dolgalev A.A., Epanov V.A., Гречишников V.I.computer a tomography with

three-dimensional reconstruction of the image as a method of an estimation of a

condition имплантационного a box at planning dental implantations // Dews.

стоматол. Magazine. - 2000. - № 2. - P. 37-38.

28. Дудко A.S.Клинико-experimental a substantiation of application of a new design

dental implant: Thesis for the Candidate’s Degree of Medc.Sciences. 14.00.21 / It

is white. гос. инст. Moustaches. Doctors. - Minsk, 1993. - 22 P.

29. Дюшене П., Кью K.Bioaktivnaja ceramics: influence of an active surface on

formation of a bone fabric and function of cells{cages} of a bone // Clinical

implantology and dentistry. - 2002. - № 1-2 (19-20). - P. 88-96.

30. Evseev A.V., Kotcuyba E.V.remote laser stereolithograph for cranial -

maxillofacial surgery // VII International conference. - ИПЛИТ the Russian

Academy of Science (Russia), June 2001. - P. 176-201.

31. Жусев A.I.Mikrotsirkuljatornye of infringement of a mucous membrane of an oral

cavity and their correction atendoosseous implantations: Thesis for the Candidate’s

Degree of Medc.Sciences. - М., 1995. - 22 P.

32. Жусев A.I.Sinuslifting: an estimation of an opportunity of development of a

method at application osteoplastic materials // Инфодент. - 1998. - № 1. - with 2-

3.

33. Zhusev A.I., Robustova T.G., Ushakov A.I.microcirculation in a mucous

membrane atendoosseous implantations // the Kazan bulletin of dentistry. - 1996. -

№ 5. - 133 P.

34. Ivanov S.J., Bizjaev A.F., Lomakin M.V., Panin A.M.clinical results of use of

various костно-plastic materials at sinuslifting // New in stomatologists. - 1999. -

№ 5. - P. 51-55.

35. Ivanov S.J., Lomakin M.V., Panin A.M., Саващук D.A.Sinuslifting and variants

субантральной implantations // Clinical implantology. - 2000. - № 4. - P. 16-23.

147

36. Ілик R.R.Vikoristannja металевих that керамічних імплантатів at виготовленні

незнімних зубних протезів: Автореф. Thesis for the Candidate’s Degree of

Medc.Sciences: 14.01.22 / Українська honey. стоматологічна академія. -

Poltava, 1999. - 14 P.

37. Калайдов A.F.use of barrier membranes in dental implantations. With what to

start? // New in dentistry. - 2002. - № 6. - P. 59-62.

38. Калганова This year, Лясников V.N.scientific of a basis of creation modern

dental implants with a bioactive covering // New in dentistry. - 1999. - № 2. - P.

48-54.

39. Калугин V.V.stereolithograph in the medical industry // New in dentistry. - 2002.

- № 3. - P. 37-38.

40. Kaminskiy V.V. “Clinical Substantiation of Using Osteogenic Ceramics in

Complex Treatment of Patients with Mandible Posttraumatic Defects.”- : Thesis

for the Candidate’s Degree of Medc.Sciences: 14.01.22 / Нац. Honey.

університет. - Київ.-2002. - 20 P.

41. Kashirin O.A.application of a biogenic composite material at a surgical stage

dental implantations: Thesis for the Candidate’s Degree of Medc.Sciences. - М.,

1994. - 25 P.

42. Konstantinu K.P. Clinico-іnstrumental evaluation of jaws bone tissue condition at

the time of dental implantation operation (clinical-and- experimental

investigation): Thesis for the Candidate’s Degree of Medc.Sciences: 14.01.22. -

Львів, 1997. - 123 P.

43. A.A.surgical's fists aspects of rehabilitation of patients with defects зубних

numbers{lines} at use of various systems dental implants: Автореф. дис.... Dr.s

honey. Sciences. - М., 1997. - 27 P.

44. Kulakov A.A., Хамраев Since, Abdulla¾v F.M., Ан A.V.Клинико-experimental

a substantiation of methods of direct implantation // Works of VI congress of

Stomatologic Association of Russia. - М., 2000. - P. 368-369.

148

45. Kulakov A.A., etc. Surgical aspects dental implantations: the Method.

Recommendations. - М., 2001. - 26 P.

46. Kurdyumov This year, Volozhin A.I., etc. Creation of new biocompatible

preparations - "гидроксиапол", "колапол" // the Collection научн. Works III

Всерос. нац. The congress « the Person and medicines ». - М., 1996. - P. 31-32.

47. Labunetc В. A., Sennikov O.M. The clinical substantiation of using dental

implants on the matter dentists examination //Materials of І (VII) з ’ їзду Асоціац

і ї стоматологів України. - Київ, 1999. - P. 469-471.

48. Levandovskiy R.A. Early substitution end- and big defects of dental lines by

bridge prosthetic on the Thesis for the Candidate’s Degree of Medc.Sciences:

14.01.22 / Медичний університет ім. акад. O.O.Bogomoltsja. - Київ, 1996. - 17

P.

49. Leontjev V.K., etc. Application of new preparations "гидроксиапол" and

"колапол" in clinic // Dentistry. - 1995. - № 5. - P. 69-71.

50. Losev Ф.Ф. About a method of the directed fabric regeneration // Dentistryfor all.

- 1998. - № 1 (2). - P. 9-12.

51. Losev F.F.foreign experience of use in пародонтологии a principle of the

directed regeneration of fabrics // New in dentistry. - 1998. - № 10. - P. 3-10.

52. Losev F.F.experimental a substantiation of use of materials for the directed

regeneration of a maxillary bone fabric at its{her} atrophy and defects different

этиологии: Thesis for the Candidate’s Degree of Medc.Sciences- М., 2000. - 36 P.

53. Losev F.F., Zharkov A.V., Dmitriyev V.M.bone of plastic with application of

membranes: indications to application, possible{probable} mistakes and

infringements of a principle of action of the directed fabric regeneration //

Dentistry. - 2002. - № 6. - P. 27-30.

54. Losev F.F., Zharkov A.V., Дмитриев V.M.application of a method of the directed

fabric regeneration for bone plastics at a various degree of an atrophy of an

149

alveolar process jaws // Росс. вестн. дент. implantology. - 2003. - № 3/4. - P. 10-

13.

55. Losev F.F., Dmitriev V.M., Жарков A.V.use of a method of the directed fabric

regeneration and bone autoтрансплантата, received from the mandible, for

elimination of defects of an alveolar process with the subsequent installation

implants // the Russian bulletin dental implantology. - 2003. - № 1. - P. 14-18.

56. Losev F.F., Smurova L.F., Буланников A.S.preliminary planning bone plastics at

defects and atrophies of alveolar processes // Росс. вестн. дент. implantology. -

2003. - № 3/4. - P. 34-36.

57. Lamb V.V.application implants at prosthetics of trailer defects of dental

numbers{lines}: Thesis for the Candidate’s Degree of Medc.Sciences:

14.01.22/Kiev honey. Institute him{it}. A.A.Bogomoltsa. - Kiev, 1985. - 17 P.

58. Lamb В.В., Клітинський JU.V.problem виготовлення протезів з опорою on

імплантат з урахуванням функціонально ї підготовки зубощелепно ї системи

// Матеріали I (VII) з ’ їзду Асоціац і ї стоматологів України. - Київ, 1999. - P.

471-473.

59. Loshkarev V.P., БаученковаЕ.В. Application Тедо of the Gene - membrane in

пародонтологии // Dentistry. - 1999. - № 2. - P. 57-58.

60. Лысенок L.N.Osteogenez and opportunities osseoreplacement // Clinical

implantology and dentistry. - 2001. - № 1-2 (15-16). - P. 107-111.

61. Лясников V.N. Application plasma sputtering in manufacture implants for

dentistry. Saratov. Saratov Technics Univers. - 1993. - P. 40.

62. Lyasnikov В., Butkovskiy К., Lepilin А., Fomin I. Sciences of a basis of

development and application modern dental implants // Clinical implantology and

dentistry. - 1998. - № 2. - P. 30-34.

63. Ljasnikov V.N., Fomin I.V., Lepilin A.V., Korchagin A.V., Doctors А.А., Giller

L.I., Воложин A.I.influence of modes plasma sputtering the titanium and

150

hydroxyapatite on structure of a surface intrabone implants // New in dentistry. -

1998. - № 4. - P. 45.

64. Ljasnikov V.N., Vereshchagina L.A., Lepilin A.V., etc. Intrabone stomatologic

implants. - Saratov, 1997. - 87 P.

65. A poppy єє in В.Ф., Stupnitskij R.M., Стиранівська O.J.Osoblivost_ кістково ї

будови нижньо ї щелепи for даними комп'ютерно ї a tomograph і ї // Новини

the stomatologist і ї. - 2004. - № 3. - P. 9-13.

66. Matveeva A.I., Балуда I.V.research of reserve opportunities of vessels

регионарного blood circulations at revealing risk of occurrence of postoperative

complications in the field of implantation // Деп. In НПО "Союзмединформ". -

№ 21867, 1991.

67. Matveeva A.I., etc. Application domestic implants in clinic of orthopedic

dentistry: the Method. Recommendations. - М., 1991. - 20 P.

68. Матвеева A.I.complex a method of diagnostics and forecasting in dental

implantations: Thesis for the Candidate’s Degree of Medc.Sciences- М., 1993. - 36

P.

69. Миргазизов M.Z.orthopedic treatment адентии with use implants // the

Management{Manual} on orthopedic dentistry. M.: Medicine, 1993. - P. 406-443.

70. Mirgazizov M.Z., Gjunter V.E., Itin V.I., etc. Superelastic implants and designs

from alloys with memory of the form in dentistry// Quintessence. - 1993. - № 7. -

231 P.

71. Muhin M.V., Alexanders N.M.general principles of the most widespread plastic

операцій // the Management{Manual} on operative maxillofacial surgery / Under

ред. V.V.Balilin. - СПО. - 1999. - P. 37-100.

72. МушаевИ.У., Framovich O.Z., Олесова V.N.new approaches to

technics{technical equipment} of implantation at sinuslifting // Clinical

implantology. - 2000. - № 4. - P. 27-28.

151

73. Nikitin A.A., Pjanzin V.I., Kurdyumov S.G.clinical application osteoplastic

materials at an atrophy of alveolar jaws processes // Тез. докл. IV Межд. конф. -

Saratov, on May, 25-27, 1998. - P. 118-119.

74. Nikitin A.A., Pjanzin V.I., Hlestkin J.L., Kurdyumov This year and co-aut.

Resultsendoosseous implantations with one-stage correction of a bottom maxillary

sinus sinus // Тез. докл. IV Межд. конф. - Saratov, on May, 25-27, 1998. - P. 17-

19.

75. Nikogda L.N., Semenovich O.A., Максимова T.S.complication dental

implantations // Present-day implantological problem. - Saratov, 1998. - P. 32-33.

76. Novikov S.V., Kalakutskij N.V., Tchebotaryov S.JA.carrying of reconstructive

plastic operations together with intrabone implantation for prosthetic dentistry //

Clinical implantology and dentistry. - 2000. - № 3-4. - with 34-38.

77. Novikov S.V., Kalakutskij N.V., Tchebotaryov S.JA.carrying of reconstructive

костно-plastic operations together with intrabone implantation for prosthetic

dentistry // Clinical implantology and dentistry. - 2000. - № 3-4. - with 53-57.

78. Olesova V.N., etc. The Клинико-morphological characteristic of a mucous

membrane of an oral cavity around of intrabone implants. New methods of

diagnostics, treatment and preventive maintenance of diseases. - Novosibirsk. -

1992. - P. 124.

79. Олесова V.N.complex methods of formation orthopedic a box with use implants

in clinic of orthopedic dentistry: Thesis for the Candidate’s Degree of

Medc.Sciences- Omsk, 1993. - 45 P.

80. Opanasjuk I.V., Опанасюк J.V.Kostnoplasticheskie materials in modern

dentistry(a part 1) // Modern dentistry. - 2003. - № 1. - P. 77-80.

81. Opanasjuk I.V., Опанасюк J.V.Kostnoplasticheskie materials in modern

dentistry// Modern dentistry. - 2003. - № 3. - P. 101-105.

82. Opanasjuk I.V., Опанасюк JU.V.modern methods of reconstruction of an alveolar

crest. The directed bone regeneration with use нерезорбируемых membranes.

152

Augmentation by a technique of installation of a titaniumic grid // Modern

dentistry. - 2003. - № 3. - P. 69-83.

83. Orlovskij V.J., Kurdyumov This year, Сливко O.I.synthes, properties and

application hydroxyapatite calcium // Dentistry. - 1996. - Т. 5, № 5. - P. 68-73.

84. Osipov A.V., Olesova V.N., Зисман V.A.use porous implants in lateral a

department of the maxilla at a simultaneous raising of a bottom a sinus of maxilla

// Росс. Stomatologic magazine. - 2001. - № 5. - P. 23-26.

85. Ostrovsky A.Osteoplasticheskie materials in modern пародонтологии and

implantology // New in dentistry. - 1999. - № 6. - P. 39-52.

86. Параскевич V.L.Endoossalnaja implantation at an atrophy of an alveolar process

of the maxilla // New in dentistry. - 1992. - № 3. - P. 21-23.

87. Параскевич V.L.comparative an estimation of two types intrabone implants for

restoration of trailer defects of dental numbers{lines} of the maxilla // New in

dentistry. - 1997. - № 4. - P. 23-26.

88. Параскевич V.H.reaction of a bone fabric on preparation a box under cylindrical

implants in dentistry: Thesis for the Candidate’s Degree of Medc.Sciences. -

Minsk, 1991. - 25 P.

89. Perov M.D.some organizational aspects of rendering assistance with application

of a method of dental implantation in out-patient practice // Clinical implantology

and dentistry. - 1998. - № 1 (4). - with 33-36.

90. Perov M.D.clinical results of regenerative treatment damaged{injured}

parodentium at use new membrane a barrier with a biocompatible covering //

Clinical implantology and dentistry. - 2001. - № 3-4. - with 72-78.

91. Perova M.D., Банченко G.V. Estimation of results dental implantations with

application гистограммного the analysis // Clinical implantology and dentistry. -

1997. - № 3. - P. 27-33.

153

92. Perov М., Колеснев Ю., Vedernikov A.Oslozhnenija at use of a method of dental

implantation, their analysis and preventive maintenance // Clinical implantology

and dentistry. - 1997. - № 3. - P. 23-26.

93. Perova M.D., Clerks В.Е., Fedotova L.M., Кортун JU.V.estimation of efficiency

new нерезорбируемой ПТФЭ-MEMBRANES at the directed regeneration of

fabrics parodentium // New in dentistry. - 2002. - № 6. - P. 47-57.

94. Plyoger М. Clinical comparison of collagen membranes: nature collagen is

improve to wounds regeneration // News of the stomatology . - 2004. - № 3. - P.

88-91.

95. Потапчук A.M.Zastosuvannja кальцій-фосфатних керамік that їх композитів at

ендосальній дентальній імплантац і ї (експериментально-клінічне

обґрунтування): Автореф. дис.... Doctors honey. Sciences: 14.01.22 / Львів.

держ. Honey. унів. - Львів, 2000. - 27 P.

96. Rabuhina N.A., Матвеева A.I.radiological the control dental implantations //

Dentistry. - 1993. - № 4. - P. 50-53.

97. Робустова T.G.additional of operation at dental implantation // Пробл. стоматол.

And нейростоматол. - 1999. - № 2. - P. 23.

98. Robustova T.G., Bezrukov V.M.dental and maxillofacial implantology // Surgical

dentistryand maxillofacial surgery. - M.: Medicine, 1999. - P. 348-365.

99. Robustova T.G., Bezrukov V.M.dental and maxillofacial implantation // the

Management{Manual} on surgical dentistryand maxillofacial surgery. - M.:

Medicine, 2000. - Т. 2. - P. 1040-1072.

100. Robustova T.G., Feh A.R., Гокоева A.A.interrelation of parameters of the

person and parameters of computer three-dimensional reconstruction for dental

implantation // Росс. стоматол. Magazine. - 2000. - № 5. - P. 20-23.

101. Robustova T.G., Ushakov A.I., Абу Асали Ияд, etc. Clinical, mathematical,

иммунологические aspects of dental implantation: the Method.

Instructions{indications}. - М., 1987. - 26 P.

154

102. Robustova T.G., Абу Асали Ияд, Ushakov A.I., etc. The Remote results

stomatologicendoosseous implantations // New concepts in technology,

manufacture and application stomatologic implants. - М., 1996. - P. 35.

103. Robustova T.G., Feh A.R., Ushakov A.I., etc. Эндоскопически

ассистированный sinuslifting // Росс. стоматол. журн. - 2001. № 3. - P. 21-27.

104. Rubanenko V.V., ТесленкоО.І., Тесленко Б. _. Experience of orthopaedic

medical treatment with application of intra-bone stomatological implants // Materials

And (VII) with ’ ride of Asotsiats and I stomatologies of Ukraine. -Kyiv, 1999. - P.

477-478.

105. Samsonov V.E.clinical aspects of use sinuslifting and anthroplasty in a

combination to one-stage implantation // Clinical implantology and dentistry. -

2001. - № 3-4. - P. 51-55.

106. Samsonov V.E., Ivanov A.P., Vasiljev M.V., Медвецкий V.I.some clinical

aspects in treatment периимплантита // Materials of the Second International

scientific - practical conference « Pressing questions of stomatologic implantation

». / Under ред. V.L.Paraskevicha. - Minsk, 1998. - P. 40-45.

107. Sivovolih S.I. // Пародонтология. - M.: the Triad. - 126 P.

108. Сидельников A.I.planning of operation of implantation in view of

anthopometrical parameters of the person: Thesis for the Candidate’s Degree of

Medc.Sciences. - М., 1992. - 20 P.

109. Sidelnikov A.I., Амерханов M.V.application of modern medical products at

dental implantations // Present-day implantological problem. - Saratov. - 1998. - P.

53-55.

110. Temerhanov F.T., Анастасов A.N.application of technics{technical equipment}

sinuslifting at an atrophy of an alveolar process of the maxilla // Materials of a

symposium « Problems of efficiency stomatologic implantology ». - М., 1999. - P.

73.

155

111. Temerhanov F.T., Anastasov A.N., Evstratov O.V., Mukhin A.V.comparative

the characteristic of methods субантральной implantations // Clinical

implantology and dentistry. - 2002. - № 1-2. - P. 16-18.

112. Тимофеев A.A.management on maxillofacial surgery and surgical dentistry. -

Kiev. - 2002. - P. 944-961.

113. Тимофеев A.A.management on maxillofacial surgery and surgical dentistry. -

Kiev. - 2004. - P. 973-1002.

114. Trezubov V.N., Suharev M.F., Шпынова A.M.analys of results of implantation

after direct prosthetics // Present-day implantological problem. - Saratov. - 1998. -

P. 28-29.

115. Тюлан Ж.-ö., Pataraja G. Autokostnaja of plastic in implantology // Clinical

implantology and dentistry. - 2001. - № 3-4. - with 46-49.

116. Ugrin M.M. Experience of using elevation techniques a sinus maxilla bottom

during stomatological implantation // News of the stomatology. - 2001. - № 4. - P.

6-9.

117. Ushakov A.I., ЕлизароваН.О., Ushakov T.M.stomatologic implantation. A

modern condition of a problem // International medical magazine IMJ. - 1998. - №

3. - P. 250-252.

118. Ushakov A.I., Panin A.M., Bozhukov D.A., Ushakov T.M.application of

preparation МК-9М for prevention of postoperative complications at operations on

an alveolar process jaws // Present-day implantological problem. - Saratov. - 1998.

- P. 51-53.

119. Fedjaev I.M., Volova L.T., Nikolsky V.JU.plastic of alveolar jaws processes

аллогенными materials at early compensation of defects of dental numbers{lines}

by a method dental implantations // Works of the Second All-Russia congress on

dental implantology. - Samara, 2002. - P. 162-168.

120. Fedjaev I.M., Nikolskij V.J., Volova L.T., etc. The Estimation of clinical

efficiency of application of a membrane аллогенной лиофилизированной dura

156

mater at direct and early deferred dental implantations // Dentistry. - 2003. - № 3. -

P. 41-43.

121. Tsarev V.N., Chuvilkin V.I.application макролидных antibiotics of new

generation for preventive maintenance and treatment inflammatory осложений in

stomatologic practice: Methodical instructions{indications}. - М., 2000. - 27 P.

122. Шутурмінський V.G.Ots_nka динаміки репаративного osteogenesisу at

вживленні імплантатів з покриттям (експериментально-клінічне

дослідження): Thesis for the Candidate’s Degree of Medc.Sciences: 14.01.22 /

Укр. Honey. стомат. академія. - Poltava, 1997. - 18 P.

123. Adell R., Lekholm U., Cröndabe K., Branemark P-I et al. Rekonstruction of

severely resorbed edentulons maxillae using ficstures in immediate autoqenous

bone grafts // Oral. Max. Impl. - 1990. - № 3. - Р. 233-246.

124. Albrektsson T., Gottlander M., Johansson C. et al. Interface reactions to implant

materials. - Berlin: Vortflap AGI der DGZMK, 1992. - 12 s.

125. Albrektsson T., Branemark P.-I., Lindstrom J. Osseointegrerade benimplantat,

undersokning av interfacezonen // Abstract. Hygiea. - 1980. - N 89. - S. 386.

126. Anderegg C.R., Martin S.L., Gray J.l. et al. Clinical evaluation of the use of

decalcified freeze-dried bone allograft with guided tissue regeneration in the

treatment of molar furcation invasions // Peridontol. - 1991. - Vol. 62. - P. 264-

268.

127. Apse P., Ellen R., Overall C., ZarbG. Microflora and crevicular fluid collagenase

activity in the osseointegrated dental implant sulcus: A comparison of sites in

edentulous and partially edentulous patients // J. Periodont. Res. - 1989. - Vol. 24.

- P. 96-105.

128. Atwood D. Reduction of residual ridges. A major oral disease entily // J. Prosth.

Dent. - 1971. - Vol. 25. - P. 266.

157

129. Augthum M., Vildirim M., Dent M. et al. Healing of bone defects in combination

with immediate implants using the membrane technigue // Int. J. Oral Maxillofac.

Impl. - 1995. - Vol. 10. - P. 421-428.

130. Bahat O., Handelsman M. Controled tissue expansion in reconstructive

periodontal surgery // Int. J. Periodont. Restor. Dent. - 1991. - Vol. 11. - P. 33-47.

131. Balshi T. Resolving esthetic complications with osseointegration: using a

double-casting prosthesis // Quintess. Int. - 1986. - Vol. 17. - P. 281.

132. Batenburg R.H., Meijer H.J., Flaphoebar G.M., Vissink A. Treatment concept

for mandibular overdentures supported by endosseous implants: a literature review

// Intern. Joum. Oral Maxillofac. Impl. - 1998. - Vol. 13, N 2. - P. 539-545.

133. BaumanG., Rapley J., Hallmon W., Mills M. The peri-implant sulcus // Int. J.

Oral Maxillofac. Impl. - 1993. - Vol. 8, N 3. - P. 264-272.

134. Becker W., Becker B., Handlesman M. et al. Bone formation at dehisced dental

implant sites treated with implant augmentation materials: a pilot study in dogs //

Int. J. Periodont. Restor. Dent. - 1990. - Vol. 10. - P. 92-101.

135. Becker W., Schenk R., Higuchi K. et al. Variationes in bone regeneration

adjacent to implants augmented with barrier membranes alone or with

demineralized freeze-dried bone or autologous grafts: a study in dogs // Int. J. Oral

Maxillofac. Impl. - 1995. - Vol. 10. - P. 143-154.

136. Becker W., Becker B., Berg L. et al. New attachement after treatment with root

isolation procedure: report for treated class III and class II furcations and vertical

osseous defects // Int.j. peridontics restorative dent. - 1998. - Vol. 8, N 3. - P. 2-16.

137. Behneke A., Behneke N., d'Hoedt B., Wagner M. Hard and soft tissue reactions

to ITI screw implants: 3-year longitudinal results of a prospective study // Int. J.

Oral Maxillofac. Impl. - 1997. - Vol. 12. - P. 749-757.

138. Block M., Kent J. Factors associated with soff-and hard tissue compromise of

endosseous implants // J. Oral Maxillofac. Surg. - 1993. - Vol. 48. - P. 1153-1160.

158

139. Block M., Kent J. Placement of endosseus implants into tooth extraction sites //

Int. J. Oral Maxillofac. Impl. - 1991. - Vol. 49. - P. 1269-1276.

140. Borgner R. Clinical experience and Statistical Analysis of Endoosseous Implants

in the Atrophic Maxilla Meeting of American Academy of Implant Dentistry. -

Atlanta, 1995.

141. Branemark P.I., Zarb G.A., Albrektsson T. Tissue - integrated prostheses.

Osseointegration in clinical dentistry // London. Quintess. Publ. Co Ins., Edit. -

1985. - P. 350.

142. Bruggenkate C., Kraaijenhagen H., van der Kwast W. et al. Autogenous

maxillary bone grafts in conjunction with placement of ITI endosseous implants. A

preliminary report // J. Oral Maxillofac. Surg. - 1992. - Vol. 21. - P. 81-84.

143. Breine U., Branemark P. Reconstruction of alveolar jaw bone. An experimental

and clinical study of immediate and performed autlogous bone grafts in

combination with osseointegrated implants // Scand. J. plast. reconstr. Surg. -

1980. - Vol. 14. - P. 23-48.

144. Buser D., Dula K., Belser U. et al. Localized ridge augmentation using guided

bone regeneration. II. Surgical procedure in the mandible // Int. J. Periodont. Rest.

Dent. - 1995. - Vol. 15. - P. 11-29.

145. Caffese R.G., Quinones C.R. Guided tissue regeneration: biologic rationale,

surgical technique, and clinical results // Compend. Contin. Educ. Dent. - 1993. -

Vol. 13. - P. 166-178.

146. Callan D., Rohrer M. Use of bovine-derived hydroxyapatite in the treatment of

edentulous ridge defects: a human clinical and histologic report // J. Periodontol. -

1993. - Vol. 64. - P. 575-582.

147. Cawood J., Howell R. A classification of the edentulous jaws // J. Oral

Maxillofac. Surg. - 1988. - Vol. 17. - P. 232-236.

148. Collins T.A., Nunn W. Autu … veneer grafting for improved esthetics with

dental implants. // Compend Contin Educ. Dent. - 1994. - N 15. - P. 370-376.

159

149. DaltonJ., Cook S. In vivo mechanical and histological characteristics of HA-

coated implants may vary with coating vendor // Biomed. Mater. Res. - 1993. -

Vol. 19. - P. 39-245.

150. DuCoin F. Dental implant hygiene and maintenance: home and professional care

// J. Oral Impl. - 1996. - Vol. 22. - P. 72-79.

151. Duyck J., Van Oosterwyck H., Vander Sloten I., De Cooman M., Puers R., Naert

J. Influence of prosthesis material on the loading of implants that support a fixed

partial prosthesis: in vivo study // Clin. Impl. Dent. Res. - 2000. - Vol., N 2. - P.

100-109.

152. Duyck J., Van Oosterwyck H., Vander Sloten I., De Cooman M., Puers R., Naert

J. Magnitude and distribution of occlusal forces on oral imflants supporting fixed

prostheses: an in vivo study // Clin. Oral Implants Res. - 2000. - Vol. 11, N 5. - P.

465-475.

153. Eckert S.E., Koka Sr., Wolfinger G., Choi Y.-G. Survey of implant experience

by prosthodontists in the United States // Journal of Prosthodontists. - 2002. - N 3.

- P. 194-201.

154. El-Askary A., Pipso D. A new paradigm for the construction and service of fixed

prosthodontics // Dent. Today. - 1999. - Vol.18, N 6. - P. 62-69.

155. Engelke Wilfried G.H. et al. Reconstruction of an alveolar process with the help

intralaminar osteotomy and microfixings implants // Quintessence. - 1998. - № 4. -

P. 36-43.

156. Eliasson A., Palmogwist S., Svenson B., Sondell K. Five-year results with fixed

complete-arch mandibular prostheses supported by 4 implants // Int. J. Oral


157. Fallschusser G. Zahnaurztliche implantologie // Berlin: Quintessenz. - 1986. - N

4. - S. 203.

160

158. Fonseca R., Frost D., Zeitler D., Stoelinga P. Osseous reconstruction of

edentulous bone loss // Reconstructive preprosthetic oral and maxillofacial surgery

/ Eds. R. Fonseca, W. Davis. - St. Louis (MO): Mosby, 1995. - P. 117-165.

159. Fonseca R., Davis H., Reitzik M. et al. Osseus Reconstruction for Impl. - New

York: Moshy, 1995. - Ch. 15. - P. 383-479.

160. Fonseca R., Davis H., Traplett G., Bolding S. Cuided Tissue Regeneration in

Association with Dental Impl. - New York, 1995. - P. 391-416.

161. Glantz P.O., Nilner K. Biomechanical aspects of prosthetic implant-borne

reconstructions // Periodontology. - 2000. - Vol. 17. - P. 119-124.

162. Goodacre Ch. J., Bemal., Rungcharassaend K., Ken I.J.K. Clinical complications

with implants and implant prostheses // The Journ. of Prosthet. Dentistry. - 2003. -

Vol. 90, N 2. - P. 121-132.

163. Hassfurther N. Kiefenkammrekonstruktion mittels membrangesteuerter

Knochenregeneration mit einer nichtresorbiebarem Membran // Implantologie

Journal. - 2003. - N 4. - P. 36-43.

164. Hendelsman M., Dacarpanah M., Celletti R. Guidet tissue regeneration with and

without citric acid treatment in vertical osseous detects // Int. j. peridontics

restorative dent. - 1993. - Vol. 11, N 5. - P. 350-363.

165. Hendrick R.T., Dove S.B., Peters D.D. et al. Radiographic determination of canal

length: direct digital radiography versus conventional radiography // J. Endodont. -

1994. - Vol. 20, N 7. - P. 320-326.

166. Henry P.J. Clinical experiences with dental implants // Adv. Dent. Resp. - 1999.

- June. - P. 147-152.

167. Hertel R.C., Blijolorp P.A., Kalk W., Baker D.L. Stage 2 surgical techniques in

endosseous implantation // Int. J. Oral Maxillofac. Impl. - 1994. - N 9. - P. 273-

278.

168. Hoffmann J., Heinermann F. Stabilisierung von Knochenaugmentaten in der

orales implantologie. - Implantologie Journal. - 2003. N 4. - P. 32-35.

161

169. Hohman D., Legal H. Application of titaniumium alloys for orthopedic surgery //

Proc. of the fifth World conference on titaniumium. - 1984. - Vol. 2. - P. 1365-

1372.

170. Hurzeler M.B. et al. Application dental implants at the expressed atrophy of the

alveolar bone, established in the field of the reconstructed bottom maxilla sinus //

Quintessence. - 1998. - № 1. - with 54-61.

171. Jarcho M. Retrospective analysis of hydroxyapatite development for oral implant

application // Dent. Clin. North Amer. - 1992. - Vol. 36. - P. 19-26.

172. Jeffcoat M., Jeffcoat R.L., Reddy M.S., Berland L. Planning interactive implant

treatment with 3D computed tomography // J. Amer. Dent. Assoc. - 1991. - Vol.

122. - P. 40-44.

173. Johansson C., Palmqvist S. Complicationes, supplementary treatment and

maintenance in edentulous arches with implant supported fixed prostheses // Int. J.

Prosthodont. - 1990. - Vol. 3. - P. 89-92.

174. Jovanovic S., Spiekermann H., Richter E. Bone regeration around titaniumium

dental implants in dehisced defect sites: a clinical study // Int. J. Oral Maxillofac.

Impl. - 1992. - Vol. 7, N 2. - P. 228-232.

175. Jemt T., Lanely W., Harris D. et al. Osseointegrated Implants for single tooth

replacement: a 1-year report from a multicenter prospective study // Int. J. Oral


176. Jensen O., Perkins S., Van De Water F. Nasal Fossa and maxillary sinus grafting

of implants from a palatal approach // J. Oral Maxillofac. Surg. - 1992 - Vol. 50. -

P. 415-418.

177. Kay J. Calcium phosphate coatings for dental implants: current status and future

potential // Dent. Clin. North. Amer. - 1992. - Vol. 36. - P. 1-18.

178. Kent D., Koka S., Froeschle M. Retention of cemented implant-supported

restorations // Journ. Prosthodont. - 1997. - Vol. 6, N 3. - P. 193-196.

162

179. Klinge B., Petersson A., Maly P. Location of the mandibular canal: Comparison

of macroscopic findings, conventional radiography, and computer tomography //

Int. J. Oral Maxillofac. Impl. - 1989. - Vol. 4. - P. 327-332.

180. Lang N., Bflapger U., Walther D. Ligature-induced peri-implant infection in

cynomolfus monkeys. I. Clinical and radiographic findings // Clin. Oral Impl. Res.

- 1993. - Vol. 4. - P. 2-11.

181. Lekovic V., Kenney E.B., Carranza F.A., Massimiliano M. The use of

autogegenous periosteal grafts as barriers for the treatment of class II furcation

involvements in lower mplars // Peridontol. - 1991. - Vol. 61. - P. 775-780.

182. Lekholm U., Zarb G.A. Patient selection and preparation // Tissue-Integrated

Prostheses Osseointegration in Clinical Dentistry. / Eds. P.I. Branemark et al. -

Chicago: Quintessence Publishing, 1985. - P. 199-210.

183. Lekholm U., Adell R., Lindhe J. et al. Marginal tissue reaction at osseointegrated

titaniumium fixtures. A cross-sectional retrospective study // Int. J. Oral


184. Linkow L.I. Theories and techniques of oral implantology. - Glarus Publishing

Co. - North Haven, CT. - 1977.

185. Liran Levin et al. Smoking and Complications of Onlay Bone Grafts and Sinus

Lift Operations // Dental i Q. - 2004. - N 4. - P. 96-101.

186. Loukota R.A., Isaksson S.G., Linner E.L. et al. A technigue for inserting

endosseous implants in the atrophic maxilla in a single stage procedure // Brit. J.

Oral Maxillofac. Surg. - 1992 - Vol. 30. - P. 46-49.

187. Lum L., Beirne O., Curtis D. Histologic evaluation of hydroxyapatite-coated

versus uncoated titaniumium blade implants in delayed and immediately loaded

applications // Int. J. Oral Maxillofac. Impl. - 1991. - Vol. 6, N 4. - P. 456-462.

188. Marx R. Philosophy and particulars of autogenous bone grafting // J. Oral

Maxillofac. Surg. Clin. Amer. - 1993 - Vol. 5. - P. 599.

163

189. Misch C. Maxillary sinus augmetation for endosteal implants: organized

alternative treatment plans // Int. J. Oral Maxillofac. Impl. - 1987. - Vol. 4. - P. 49-

58.

190. Misch C. The repair of localized severe ringe defects for implant placement

using mandibular bone grafts // Impl. Dent. - 1995. - Vol. 4. - P. 261-267.

191. Misch C.E. Bonedensity, its effect on treatment planning, surgical appeoract

healing and progressive toading // Int. J. Oral Maxillofac. Impl. - 1999. - Vol. 6. -

P. 23-31.

192. Misch C. Contemporary implant dentistry. - St. Luis: Mosby - Year Book, 1993.

193. Misch C.E. Implant design considerations for the posterior regions of the mouth

// Implant Dent. - 1999. - Vol. 8, N 4. - P. 376-386.

194. Misch C., JudyK. Classification of partially edentulous arches for implant

dentistry // Int. J. Oral Maxillofac. Implantol. - 1987. - Vol. 4. - P. 7-12.

195. Misch C., Hoar J., Beck G. et al. A bone quality-based implant system: A

Peliminary Report of stage I and stage II // Impl. Dentistry. - 1998. - Vol. 7, N 1. -

P. 35-42.

196. Misch C.M., Misch C.E., Resnik R., Ismail Y.H. Reconstruction of maxillary

alveolar defects with mandibular symphysis grafts for dental implants: a

preliminary procedural report // Int. J. Oral Maxillofac. Impl. - 1992. - Vol. 7, N 3.

- P. 360-366.

197. Moy P.K., Lundgren S., Holmes R.E. Maxillary sinus augmentation:

Histomorphometric analysis of graft materials for maxillary sinus sex

augmentation // Int. J. Oral Maxillofac. Surg. - 1993. - Vol. 51. - P. 857-862.

198. Muzzin K., Johnson R., Carr P., Daffron P. The dental hygienist's role in the

maintenance of osseointegrated implants // J. Dent Hyg. - 1988. - Vol. 62, N 9. - P.

448-453.

164

199. Newman P., Watson R.M. Replacement of successtully fixed implant prostheses

using duplication technique // Int. J. Prosthodont. - 1997. - Vol. 10, N 6. - P. 531-

535.

200. Novaes A. Jr., Novaes A. IMZ-implant placed into extraction sockets on

ossociation with membrane therapie (Gengifex and porus hidroxylapatite a sase

report) // Int. J. Oral Maxillofac. Impl. - 1992. - Vol. 7. - P. 536-540.

201. Olive J., Aparicio C. The Periotest method as a measure of osseointegrated oral

implant stability // Int. J. Oral Maxillofac. Impl. - 1990. - Vol. 5. - P. 390-400.

202. Osborn J., Kovacz E., Kallenberger A. Hydroxysapatitkeramik-Entwicklung

eines neuen Biowerkstffes und erste tierexperimentelle Ergebnisse // Dtsch.

Lahndeztl. - 1980. - Vol. 35. - P. 54.

203. Osborn J.F. Die Alveolarextensionsplastik // Quintessenz. Berlin. - 1985. - S. 9-

16.

204. Palti A. Moderne Verfabren der augmentativen Chirurgie // Implantologie

journal. - 2003. - N 6. - P. 38-42.

205. Personn L., Ericsson I., Berglundh T., Lindhe J. Guided bon regeneration in the

treatment of periimplantitis // Clin. Oral Impl. Res. - 1996. - Vol. 7. - P. 366-372.

206. Pontoriero R., LinheJ., Nyman S. et al. Guided tissue regeneration in the

treatment of furcation defects in the mandibular molars // J. din. peridontol. - 1989.

- Vol. 16. - P. 170-174.

207. Polson A.M., Southard G.E., Dunn R.l. et al. Periodontal healing after guided

tissue regeneration with ATRISORB barriers in beagle dogs // Int. J. Periodontics

Restorative Dent. - 1995. - P. 575-589.

208. Regev E., Smith R., Perrott D., Pogrel M. Maxillary sinus complications related

to endosseous implants // Int. J. Oral Maxillofac. Impl. - 1995. - Vol. 10. - P. 451-

461.

209. Reinhardt C., Krensser B. Retrospective Study of the dental implantation with

sinus lift and Cerasorb ® augmentation // Dent. Impl. - 2000. - N 4. - P. 18-26.

165

210. Flaphoebar G., Batenburg R., Vissing A. et al. Augmentation of localized defects

of the anterior maxillary ringe with autogenous bone before insertion of implants //

Int. J. Oral Maxillofac. Surg. - 1993. - Vol. 51. - P. 857-862.

211. Salata L., Craig G., Brook I. Bone healing following the use of hydroxyapatite or

ionomeric bone substitutes alone or combined with a guided bone regeneration

techigue: An animal study // Int. J. Oral Maxillofac. Impl. - 1998. - Vol. 13. - P.

44-51.

212. Schliephake H., Neukam F., Hutmacher D., Becker J. Enhancement of bone

ingrowth into a porous hydroxyapatite-matrix using a resorbable polylactic

membrane: an experimental pilot study // J. Oral Maxillofac. Surg. - 1993. - Vol.

52. - P. 57-63.

213. Schnitman P., Wohrle P., DaSilva J., Wang N. Branemark omplants loaded at

implant placement: 9-year Follow-up // Int. J. Oral Maxillofac. Impl. - 1996. - Vol.

11 (1). - P. 124.

214. Seibert J.S. Reconstruction of deformed, partialli edentulous ridges, using full-

thickness onlay grafts. Part I: Technique and wound healing. Compend. Contin.

Educ. Dent. - 1983. - 4. - P. 437-453.

215. Seddon H. Three types of nerve injury // Brain. - 1943. - Vol. 66. - P. 237-288.

216. Shultz A.J., Gager A.H. Guided tissue regeneration using an absorbable

membrane (polyglactin 910) and osseous grafting // Int. j. peridontics restorative

dent. - 1990. - Vol. 10, N 1. - P. 8-17.

217. Silverstein L., Lefkove M., Garnick J. The use of free gingival soft tissue to

improve the implant / soft-tissue interface // J. Oral Impl. - 1994. - Vol. 20, N 1. -

P. 36-40.

218. Spiekermann H., Donath K., Hassell T. et al. Color Atlas of Dental Medicine

Implantology. - New York: Thieme, 1995. - P. 14, 59-76.

219. Steinemann S., Perren S. Titaniumium alloys as metallic biomaterials // Proc. of

the fifth World conference on titaniumium. - 1984. - Vol. 2. - P. 1327-1334.

166

220. Strub J., Gobarthuel T., Grunder U. The role of attached gingival in the health of

periimplant tissues in dogs. Part I. Clinical findings // Int. J. Periodontol. Res.

Dent. - 1991. - Vol. 11. - P. 317-333.

221. Tatum H. Maxillary and sinus implant reconstructions // Dent. Clin. North Amer.

- 1986. - Vol. 30. - P. 207-229.

222. Tatum H. Jr., Lebowitz M., Tatum H. III, Borgner R. Sinus augmentation:

rationale, development, long-term results // N.Y. State Dent. J. - 1993. - Vol. 59. -

P. 43-48.

223. Tidwell J., Blijdorp P., Stoelinga P. et al. Composite grafting of the maxillary

sinus for placement of endosteal implants. A preliminary report of 48 patients //

Int. J. Oral Maxillofac. Surg. - 1992. - Vol. 21. - P. 204-209.

224. Тинти К., Parma - Бенфенати S.Klinicheskaja classification of bone defects in

view of installation implants // Dental International Quarterly. - 2004. - N 2. - P.

79-85.

225. Thompson-Neal D., Evans G., Meffert R. Effects of prophylactic treatments on

titaniumium, sapphired and hydroxyapatite-coated implants: An SEM study // Int.

J. Paradont. - 1989. - Vol. 9. - P. 300-301.

226. Ulm C., Pechmann U., Lill W. et al. Anatomische untersuchungen an der

atrophen mandibula. Teil 2. Das foramen mentale und der canalis mentalis // Z.

Stomatol. - 1990. - N 87. - S. 7.

227. Ulm C., Solar P., Krennmair G. et al. Incidence and suggested surgical

management of septa in sinus-lift procedures // Int. J. Oral Maxillofac. Impl. -

1995. - Vol. 10. - P. 462-465.

228. Wang R., Fenton A. Application of the titanium in orthopedic dentistry//

Quintessence. - 1997. - № 1. - P. 7-13.

229. Wat P.Y., Pow E.H., Chow T.W. A new prosthodontic technique for fabricating

cement-retained implant-supported prostheses // Quintessence Int. - 2000. - Vol.

31, N 3. - P. 187-190.

167

230. Watanabe F., Uno I., Hata Y., Neuendorff G., Kirsch A. Analysis of stress

distribution in a screw-retained implant prosthesis // Int. J. Oral Maxillofac. Impl. -

2000. - Vol. 15, N 2. - P. 209-218.

231. Weingart D., Duker J. Rontgentomjgraphische technik zur darstellung des

atrophierten alveolarfortortsatzes vor endossaler implantation // Z. Zahnarztl. Impl.

- 1991. - N 7. - S 271.

232. Weiss Ch. Fibro-osteal and osteal integration: A comparative analysis of blade

and fixture type dental implants supported by clinical trials // J. Dent. Educ. -

1988. - Vol. 52, N 12. - P. 706-711.

233. Wical K., Swoope D. Studies of residual ridge resorption. Part 1: Use of

panoramic radiographs for classification of mandibular resorption // J. Prosth.

Dent. - 1974. - Vol. 32. - P. 7.

234. Worthington P. Clinical aspects of severe mandibular atrophy // Worthington P.,

Branemark P.-I. Advanced osseointegration surgery. - Berlin: Quintessenz, 1998. -

P. 98.

235. Yosue N., Brooks S.L. The appearance of mental foramina on panoramic and

periapical radiographs: II Experimental evaluation // Oral Surg. Oral Med. Oral

Pathol. - 1989. - Vol. 68. - P. 488-492.

236. Zablotsky M., Meffert R., Caudill R., Evans G. Histological and clinical

comparisons of guided tissue regeneration on dehisced hydroxyapatite-coated and

titaniumium endosseous implant surfaces: a pilot study // Int. J. Oral Maxillofac.

Impl. - 1991. - Vol. 6, N 3. - P. 294-303.

237. Zablotsky M. A Retrospective Analisis of the Management of Ailing and Faling

Endosseous Dental Implants // Implant Dentistry. - 1998. - Vol. 7, N 3. - P. 185-

189.

substantiation of clinical application modern surgical methods at intrabone dental implantations

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