Applied Information Aspects of Medicine (Prikladnye informacionnye aspekty mediciny)Applied Information Aspects of Medicine (Prikladnye informacionnye aspekty mediciny)2070-9277Voronezh State Medical University named after N.N. Burdenko - The State Budgetary Institution of Higher Professional Education «Voronezh State Medical University named after N.N. Burdenko» of the Ministry of Public Health of the Russian795310.18499/2070-9277-2022-25-4-4-8Original ArticleOPTIMIZATION OF GUIDED BONE REGENERATION IN CONDITIONS OF JAW BONE ATROPHYRizaevE. A-BuzrukzodaJ. D-Samarkand state medical university151220222544815012023Copyright © 2022, Applied Information Aspects of Medicine (Prikladnye informacionnye aspekty mediciny)2022In achieving the optimal clinical result of implant treatment, both general factors (smoking, somatic pathology) and local factors (parameters and structure of bone tissue) play an important role. An urgent problem is the rehabilitation of patients with severe atrophy of bone tissue caused by traumatic extraction of teeth, inflammation of bone tissue, prolonged absence of teeth. Modern regenerative surgery has a number of techniques aimed at restoring the lost volume of bone tissue of the jaw bones. These include autotransplantation of bone blocks, guided tissue regeneration (membrane technique) distraction osteogenesis etc. Each of the above methods, of course, has both advantages and a number of disadvantages.guided bone regenerationbone plastic materialsbone graftingdental implantationнаправленная костная регенерациякостнопластические материалыкостная пластикадентальная имплантацияRelevance. Currently, dentists are GBR easingly faced with the problem of bone deficiency, which requires additional interventions to replenish the necessary bone volume for subsequent dental implantation [1, 2, 4]. Atrophy of the bone tissue of the alveolar process/part of the jaw creates significant difficulties for successful rehabilitation of patients using dental implants as a support for orthopedic structures. It was found that in 64% of cases, the main cause of alveolar bone atrophy is a prolonged absence of teeth, as well as: traumatic removal - 17%, jaw injuries - 11%, unsuccessful bone grafting - 8%. And also about 60% of primary patients who have sought dental care have bone atrophy and need preliminary bone reconstruction for dental implantation [3, 5, 6]. One of the most common methods of alveolar ridge remodeling is directed bone regeneration, which has a number of variations depending on the selected bone material and membrane. But the success of each intervention, the timing of bone formation depends on a number of factors that have been studied in the course of scientific research and clinical observations [8, 10, 11]. The aim of the study: Analysis of the data of scientific literature and clinical studies devoted to the study of the principles and factors influencing the results of the alveolar ridge GBR with the use of various osteoplastic materials during dental implantation. Materials and methods. To achieve this goal, we have studied and analyzed scientific articles, studies and clinical cases of GBR performed with the use of osteoplastic materials to create optimal anatomical conditions for further dental implantation. Results and discussion. In the case of GBR, not only bone-plastic, but also insulating/insulating frame materials are used, which provide a barrier function, "equalizing" the potential of soft tissue and bone healing. Due to the closure of the bone defect with an insulating membrane, the probability of connective tissue strands growing into it is practically eliminated in the case of GBR, which provides better conditions for migration and differentiation of cells, precursors of osteogenesis [12, 13]. According to Istvan A. Urban and Alberto Monje (2019), the GBR is to prevent the migration of "undesirable" cells by adapting the barrier membrane to the area that is intended for reconstruction. The barrier membrane ensures the stability of the bone graft, prevents the destruction of soft tissues in the defect, prevents the migration of competing non-osteogenic cells to this place and accumulates growth factors. The course of the wound process after the application of NKR is characterized by difficult conditions for healing, which arise due to excessive tension in the soft tissues. Istvan A. Urban and Alberto Monje identified 4 principles of successful NKR [15]: the primary closure of the wound without tension, which provides optimal conditions for healing due to the closure without tension; angiogenesis, provision of nutrition and oxygen access; creating space to prevent tension; stability of the blood clot. In the conclusions of their article, the authors focus on the most important technical aspects, such as achieving flap closure without tension and stability of the graft and barrier membrane, which are of primary importance for ensuring successful results. The procedure requires a lot of technical experience and is indicated for patients with a low level of risk (for example, with proper personal hygiene measures of the oral cavity and non-smokers). Critical preoperative factors that may negatively affect the outcome of the GBR are: soft tissue phenotype and keratinized mucous membrane. This factor requires building up and iGBReasing the volume of soft tissues by changing the design of the incision and the shape of the muco-periosteal flap. Pre-plastic surgery of soft tissues is not used in this case because of the risk of scar tissue development, which can create excessive tension and lead to an unsatisfactory result in general; choosing the volume of the operation: simultaneous or step-by-step approach. At the same time, Istvan A. Urban and Alberto Monje do not exclude the simultaneous installation of the implant immediately after the GBR only if bone tissue augmentation is required by less than 4 mm, and also if it is possible to achieve primary stability in this particular clinical situation. However, in order to avoid complications, the authors recommend a step-by-step approach; implant positioning: a slightly subcrestal position of the implant in the regenerated bone is recommended; morphology of the defect: with a concave shape of the defect, the results are more favorable than with a convex comb-like shape; systemic factors and bad habits: smoking cessation is recommended 3 months before the bone plastic surgery. It is necessary to additionally control other systemic factors and bad habits that can worsen wound healing; periodontal diseases: the periodontal condition should be stable before planning any reconstructive surgery; periosteum: if the patient has previously had attempts of GBR, the periosteum may be scarred and prevent the closure of the area without tension. Consequently, the important technical aspects that need to be performed in the GBR are to achieve flap closure without tension, to achieve the stability of the graft and the barrier membrane, which is of paramount importance to ensure a successful result. At the same time, as the authors note, the procedure requires a lot of technical experience and is indicated for patients with a low level of risk (i.e., an adequate level of oral hygiene and smoking cessation) [13, 14]. Also, most authors emphasize the importance of postoperative patient care. At the same time, Istvan A. Urban and Alberto Monje (2019) recommend the following scheme of drug therapy after NKR: chemical control of plaque is carried out using 0.12% chlorhexidine solution within 24 hours after surgery and before removal of sutures; anti-inflammatory drugs are prescribed, such as ibuprofen 200/600 mg 3 times a day for 7 days; antibacterial therapy: amoxicillin 500 mg 3 times a day for 7 days or clindamycin 600 mg 3 times a day, used in patients with allergies to b-lactamases; corticosteroids are not commonly used because they can slow healing and iGBRease the risk of postoperative infection. Ibrahim Elgali et al. (2017) claim that GBR with and without a bone graft/substitute is a successful method of iGBReasing alveolar bone defects. However, there are still complications associated with membranes for the GBR. The authors note that the evolution of membranes was mainly due to the desire to provide barrier function, ease of use and application in various clinical situations, rather than a systematic approach to improving biological results [19, 20]. It should be noted that despite a large number of studies devoted to studying the role of permeability and porosity of membranes, there are contradictory results regarding this issue (from submicron to macroscale) and this fundamental problem that prevents the invasion of soft tissues (cells) and affects bone regeneration, respectively, is a serious problem for the proposed concept membrane barrier [7, 16]. The quality of the bone, as well as its quantity at the interface of the implants, determine the stability of the implant system [17, 18]. The aim of this study is to study the elastic modulus (E) based on nanoindentation in various bone areas adjacent to titanium dental implants with directed bone regeneration (GBR) treated with DBM and BMP-2 in various post-plantation periods. Six adult male beagle dogs were used to create circumferential defects with the removal of the buccal bone at each site of the lower jaw implantation. Trenton B. Johnson et al. (2018) studied the effect of GBR on the quality of the bone surrounding dental implants [9]. Implant systems were randomly divided only into groups of GBR (control), GBR with demineralized bone matrix (DCM) and GBR with DCM + recombinant human bone morphogenetic protein-2 (RCMB-2) (KMB). Three animals were killed every 4 and 8 weeks of the post-implantation healing period. Current results have shown that the treatment of RCMB-2 with the help of GBR accelerates the mineralization of bone tissue for a longer healing period, since GBR probably contributes to the creation of a microenvironment providing a greater number of metabolites in the open space of the defect area surrounding the implant. This study shows the importance of choosing not only bone material, but also the presence of additional substances that accelerate the formation of bone tissue and improve the results of the GBR. Conclusions. Thus, based on the results of the analysis of scientific literature and clinical studies, currently the restoration / iGBRease of the alveolar bone volume of the jaws with the help of the GBR is being carried out quite actively, while a number of important issues have not been resolved. These are: a high degree of surgical trauma, due, among other things, to the need for additional surgical access; failure of sutures, exposure of frame materials, reduction in the volume of the graft / regenerate, up to resorption; the development of inflammatory and infectious complications in the reconstruction zone. The iGBRease in the efficiency of the alveolar ridge GBR may be associated with the justification of the use of various osteoplastic materials based on the developed clear indications, including minimally invasive surgical technique, the optimal way of forming a muco-periosteal flap, etc.1.Antonaides H., Williams L. Human platelet derived growth factor. Structure and function // Fed. Proc. 1983, vol. 42, p.2630-2634.2.Birkendahl-Hansen H. Role of cytokines and inflammatory mediators in tissue destruction //j.Periodont. Res.- 1993. -28. - P.500-510.3.Brenemark P.I., Zarb G.A., Albrektsson T. Tissue Integrated Prostheses. Osseointegration in clinical dentistry. 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