Clinical evaluation of efficiency of extracorporeal shock wave therapy on postoperative hollow bone mandibular defects
DOI:
https://doi.org/10.11603/2311-9624.2020.2.11257Keywords:
bone healing, bone defects, maxillofacial area, extracorporeal shock wave therapyAbstract
Summary. A number of domestic and foreign scientists have proven the effectiveness of extracorporeal shock wave therapy to optimize reparative osteogenesis. However, the clinical efficacy of the proposed method in combination with the classical approach to the replacement of hollow bone defects of the jaws remains unclear.
The aim of the study – to determine the clinical effectiveness of extracorporeal shock wave therapy in order to optimize the healing of hollow postoperative bone defects of the mandible.
Materials and Methods. We examined and treated 18 patients aged 21 to 46 years, who had indications to atypical removal of the third lower molars. Surgical interventions were performed according to the modified method of S. Asanami and Y. Kasazaki; before suturing all defects were filled with collagen sponge impregnated with calcium hydroxyapatite and beta-tricalcium phosphate. In the postoperative period, patients of the main group (n = 12) received a course of extracorporeal shock wave therapy. Quantitative (determination of thickness and relative area) and qualitative (determination of optical density and peculiarities of density histograms) evaluation of regenerate in areas with compact and spongy base were performed on the basis of cone-beam computed tomography. The level of marginal bone loss was also determined.
Results and Discussion. Significant increase in the thickness of bone regenerate was observed in all areas of measurement in the main group. Three months after the intervention, the bone defects of the control group were filled only on 60.16 %, while in the main group there was a replacement up to 98.15 % of the defect. The vertical reduction was up to (1.6±1.0) mm in all studied cases, regardless of the group, with no signs of horizontal bone loss. In the main group, the increase in the optical density of bone regenerate was significantly greater than in the control. In patients of the main group, the structural affinity of the regenerate to intact bone tissue was observed: in areas with a trabecular base, heterogeneous regenerate prevailed, and in areas with a cortical base, the structure of the regenerate was more homogeneous. A homogeneous regenerate with a density gradient decreasing to the middle of the defect was observed in the control group.
Conclusions. The additional use of extracorporeal shock wave therapy significantly stimulates the healing of postoperative mandibular bone defects in patients compared with the filling of defects only with collagen sponge impregnated with calcium hydroxyapatite and beta-tricalcium phosphate.
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