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INTRODUCTION

Theme urgency. Treatment of patients with a pathology of an osteal tissue takes a special place in practice of doctors-stomatologists [7, 16, 56]. From the middle of 50th years of XX century in therapy of patients with various disturbances of osteal system began to apply bisfosfonaty.

Bisfosfonaty (BF) - steady synthetic analogues of a pyrophosphate, effective at treatment of the conditions accompanied raised rezorbtsiej of an osteal tissue by osteoclasts (illness Pedzheta, an osteoporosis), and also treatments of paraneoplastic complications (a hypercalcemia, osteolizis, pathological fractures) [49, 65]. To patients with an osteoporosis bisfosfonaty are prescribed in the peroral form [45] whereas in complex therapy sick of a plural myeloma, by a prostate cancer, a mammary gland cancer, a kidney cancer are etc. applied bisfosfonaty, entered intravenously [72].

Jaw osteonecrosis - serious complication which meets at the patients receiving treatment with application bisfosfonatov. Development bisfosfonatnogo an osteonecrosis can be caused carrying out of invasive stomatologic interventions (for example, odontectomy operations) or a chronic trauma of a mucosa of a mouth irrationally made prostheses [19, 168]. Bisfosfonatnyj

The osteonecrosis of jaws (BONCH) at sick of malignant neoplasms has been described for the first time Marx and Stern in the book «Oral and Maxillofacial Pathology: A Rationale for the Diagnosis and Treatment» in 2001 [141]. Subsequently by various authors it is published more than 1100 articles devoted to an osteonecrosis of a jaw at patients, receiving therapy bisfosfonatami.

Frequency of occurrence of an osteonecrosis of a jaw at patients with the malignant neoplasms, receiving therapy bisfosfonatami,

5 makes from 0,8 to 18,6 % [134]. However, in the researches spent Brown and co-workers. In 2013 [96], it has been shown, that frequency of development of an osteonecrosis of a jaw at the patients receiving therapy zolendronovoj by acid, after an exodontia, against bad hygiene of an oral cavity or using demountable prostheses, considerably above and makes 86,4 %.

Degree of a readiness of a theme

In the countries of Europe and America since 2001 the considerable quantity of the researches devoted to problems of diagnostics and treatment bisfosfonatnogo of an osteonecrosis of jaws is published. The American association cheljustnoyolitsevyh surgeons (2009) offers various schemes of treatment of patients with an osteonecrosis of a jaw depending on a stage of process [169]. Treatment consists of antiseptic processing of the centres in a combination to antibacterial therapy, and in the presence of sequesters includes the surgical treatment consisting in a sequestectomy, in some cases - jaw resections.

However the problem of preventive maintenance, diagnostics and effective treatment bisfosfonatnogo an osteonecrosis of jaws till the present moment definitively is not solved. It is especially actual for sew the countries as in Russia the scientifically-proved references on treatment of the given group of patients are not developed. Attracts attention insufficient knowledge of patients, doctors-stomatologists and doctors-oncologists of the given problem.

Taking into consideration all aforesaid, is obvious, that working out of effective methods of preventive maintenance and treatment of an osteonecrosis of jaws at the patients receiving therapy bisfosfonatami, is an actual problem of modern surgical stomatology, maxillofacial surgery and oncology.

Research objective

Rising of efficiency of preventive maintenance and treatment of an osteonecrosis of jaws at sick of various primary tumours with metastatic lesions of bones to which treatment were applied bisfosfonaty.

Research problems

1. To study features of a clinical picture bisfosfonatnogo an osteonecrosis of jaws at patients with malignant neoplasms.

2. To study features of a X-ray pattern bisfosfonatnogo an osteonecrosis of jaws.

3. To study morphological features of an osteal tissue at bisfosfonatnom an osteonecrosis.

4. To study efficiency of application of ozonotherapy at treatment of an osteonecrosis of a jaw on the basis of clinical inspection, radiological and immunologic researches.

5. To develop principles of preventive maintenance and complex treatment bisfosfonatnogo an osteonecrosis of jaws.

Scientific novelty

1. For the first time data about features clinical and a X-ray pattern bisfosfonatnogo an osteonecrosis at patients with malignant neoplasms of various localisation with a metastatic lesion of bones are obtained. Working classification bisfosfonatnogo an osteonecrosis of jaws is offered.

2. Prominent features of a morphological picture bisfosfonatnogo an osteonecrosis by results of a morphometry are studied and defined.

3. Efficiency of application of ozonotherapy is proved at treatment bisfosfonatnogo an osteonecrosis on the basis of dynamics of indicators of local immunity, clinical and a X-ray pattern, change of a painful syndrome.

4. For the first time principles of preventive maintenance of development of an osteonecrosis are offered at carrying out of surgical interventions at the patients receiving therapy bisfosfonatami.

5. The treatment report bisfosfonatnogo an osteonecrosis of jaws at the patients receiving therapy bisfosfonatami in connection with presence of osteal metastasises of various malignant neoplasms is offered.

The theoretical importance:

Characteristic clinical and radiological features bisfosfonatnogo an osteonecrosis are defined. On the basis of the spent morphometry the features distinguishing bisfosfonatnyj a necrosis from other atypical necrosises of jaws are taped.

Working classification bisfosfonatnogo an osteonecrosis of jaws that is important for definition of a stage of disease, possible risks and the treatment forecast is offered.

Efficiency of application of local ozonotherapy for preventive maintenance and treatment bisfosfonatnogo an osteonecrosis of jaws is proved.

The practical importance:

Practical references on diagnostics and necessary additional methods of inspection for diagnosis statement «bisfosfonatnyj a jaw osteonecrosis» are offered.

Are developed and introduced in practice of clinic of the Center of stomatology and maxillofacial surgery (TSS and CHLH) MGMSU of A.I.Evdokimova preventive maintenance and treatment reports bisfosfonatnogo an osteonecrosis of jaws at sick of malignant neoplasms.

Results of research are included in the program of lectures and a practical training with students and interns on chairs of maxillofacial surgery, geriatric stomatology and radial diagnostics GBOU VPO Moscow
The state mediko-stomatologic university of a name of A.I.Evdokimova MZ and SR the Russian Federation.

Methodology and research methods

In work standard clinical methods of research (finding-out of complaints, the collecting of the anamnesis of patients, survey), and also additional methods of research are used: radiological inspection (ortopantomografija, a multispiral computer tomography), the analysis of indicators of the general immunity and local immunity in an oral cavity, pathomorphologic and morfometrichesky the analysis of samples of remote sequesters.

The received results are subjected statistical processing with application of methods of variation statistics.

The substantive provisions which are taken out on protection

1. Bisfosfonatnyj the osteonecrosis of jaws at sick of malignant neoplasms represents the separate nosological unit possessing nearby clinical, radiological and morphological features, distinguishing it from other pathological processes in an osteal tissue.

2. Application of a multispiral computer tomography for patients with bisfosfonatnym an osteonecrosis of jaws effectively for diagnostics carrying out, and also during dynamic observation in the course of treatment.

3. The technique of complex treatment bisfosfonatnogo an osteonecrosis of jaws with application of local ozonotherapy is developed. The developed report of treatment bisfosfonatnogo an osteonecrosis with application of local ozonotherapy is effective, is minimum invasive, allows to raise quality of a life of patients.

4. References on development preventive maintenance bisfosfonatnogo ostenekroza jaws after carrying out of the surgical stomatologic are developed
Interventions at patients with the malignant neoplasms, receiving therapy bisfosfonatami.

Work approbation

Dissertation substantive provisions have been reported on joint faculty meeting of maxillofacial surgery, chair of geriatric stomatology and chair of radial diagnostics 23.12.2013г.

Dissertation materials are reported and discussed on:

1. V Euroasian conference on a maintenance therapy at oncologic patients. On March, 9-10th 2012г., St.-Petersburg.

2. A global oncologic forum of the Euroasian federation of oncology. On May, 4-6th, 2012, Moscow.

3. 21 congress of the European association of cranial-maxillofacial surgeons. On September, 11-15th, 2012. Dubrovnik, Croatia.

4. The Euroasian forum on hospisnoj, the palliative help and a maintenance therapy (at support of the World Organization of Public health services). On April, 27-28th 2013г, Moscow.

5. I interdisciplinary congress on diseases of organs of a head and a neck. On May, 27-29th, 2013, Moscow.

6. XXI international conference of surgeons of stomatologists and cheljustnoyolitsevyh surgeons. On October, 21st-24, 2013. Barcelona, Spain.

7. II interdisciplinary congress on diseases of organs of a head and a neck. On May, 27-29th 201 4 years, Moscow.

Publications

By results of research 20 works, including 4 articles in the magazines recommended VAK the Russian Federation for the publication of results of dissertational researches are published.

Personal participation of the author

The author personally spends clinical inspection of 75 patients, the analysis and statistical processing of 150 questionnaires of a painful questionnaire. The analysis of 67 computer tomograms and 75 ortopantomogramm patients, the comparative analysis informativnosti radial methods of research is carried out.

Personally the author develops the report of treatment of patients with bisfosfonatnym an osteonecrosis of jaws with application of courses of local ozonotherapy, and also the report of preventive maintenance of development of an osteonecrosis at carrying out surgical vmeshateostv at the given category of patients. Treatment of 75 patients, including surgical interventions - 20 sequestectomies, excision of 15 teeth according to the developed report of preventive maintenance of development bisfosfonatnogo an osteonecrosis of jaws is spent. In the course of treatment of patients of 1 and 2 groups of research results of immunologic research are analysed and statistically processed. The analysis of results morphological and morfometricheskih methods of researches is carried out.

Personally the author spent preparation of publications on the executed work, scientific works on a dissertation theme.

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Scientific source ZASLAVSKAYA NATALIA ALEKSANDROVNA. OPTIMIZATION of PREVENTIVE MAINTENANCE And TREATMENT BISFOSFONATNYH of OSTEONECROSES of JAWS At PATIENTS WITH MALIGNANT NEOPLASMS. The dissertation on competition of a scientific degree of the candidate of medical sciences. Moscow - 2014. 2014

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