The application of constructions made from biodegradable material with bioactive action in reconstructive surgery of maxillofacial area

Abstract

Summary. Currently, titanium plates and screws are widely used to fix bone fragments in maxillofacial area (MFA). The need for a second operation to remove the metal structure increases the patient's incapacity for work, the economic costs of treatment and the psychoemotional load on the patient associated with anxiety and additional stress. All this has led to the emergence of an alternative method of osteosynthesis using biodegradable plates and screws, which do not have these disadvantages.

The aim of the study – to increase the effectiveness of surgical treatment of patients with congenital and acquired bone pathology of the maxillofacial area with the use of fixing structures of specified properties from biodegradable material of bioactive action.

Materials and Methods. The following research methods were used in the work: 1) in the experimental part of the work – physicochemical, sanitary-chemical, toxicological-hygienic – in order to determine the possibility of using EPU-GAP-LEV composition for the manufacture of bone fragments during osteosynthesis in MFA, physico-mechanical (to determine the strength, elastic, viscoelastic properties of EPU and its compositions with GAP and LEV), radiological (to control the quality of the experiment on animals), morphological (histological and morphometric studies of bone regenerates in the area of ​​the mandibular defect (mandibular defect)
during implantation of polyurethane and titanium plates and screws) – to study the course of reparative regeneration of soft and bone tissues and bone remodeling in the area of ​​traumatic injury; 2) in the clinical part of the work – clinical and laboratory (to determine the dynamics of the main clinical symptoms and results of treatment of patients), radiological methods (radiography of the bones of the facial skull in traditional layings, orthopantomography, CT 3D, creation and analysis of computer 3-D models, X-ray densitometry, X-ray morphometry) – to determine the nature of the pathological process in bone tissue and study the architecture of bone tissue. (including intraoperative), statistical methods (determination of averages, errors of averages and probability of differences in groups, correlation and regression analysis) – for processing and analysis of the obtained results).

Results and Discussion. The results of the study became the basis for finding ways to obtain a material without a metal defect, from which it would be possible to make a clamp in the form of plates and screws for osteosynthesis of the maxillofacial area. A bioresorptive material of bioactive action (EPU-GAP-LEV) based on a polyurethane composition containing 20 % ​​hydroxyapatite and 6 % levamisole for osteosynthesis has been developed. The results of experimental studies formed the basis of clinical and radiological studies. The effectiveness of EPU-GAP-LEV fixators for osteosynthesis in the treatment of patients with fractures and deformities of the facial skull has been proven.

Conclusions. Positive results of own clinical researches in early and long terms testified to efficiency and perspective of use of polymeric (including EPU-GAP-LEV) miniplasts in surgical treatment of fractures of facial skull with shift. Due to the correct treatment planning, all patients who used polymer fixers were able to receive complete rehabilitation.