Transplant mixture

FIELD: medicine.

SUBSTANCE: transplant mixture has liophylized allogenic bone tissue and allogenic hydroxyapatite and patient autoblood platelets gel with Metronidazole, taken in the following components proportions (%): liophylized allogenic bone tissue - 65; allogenic hydroxyapatite - 10; patient autoblood platelets gel - 20; Metronidazole - 5.

EFFECT: enhanced effectiveness of treatment; no clamps required; reliably and tightly closed bone tissue defect; accelerated regenerate reorganization; improved antiseptic and immunomodulating action.

 

The invention relates to medicine, namely to the dentist, and can be used in reconstructive bone plastic surgery to replace bone defects of different etiology, especially in complex treatment of patients with periodontitis.

The basis of a microcosm of the oral cavity are prokaryotic microbes bacteria. It is believed that up to 50% of the microbial landscape consists of a variety of gram-positive cocci, mainly streptococci and peptostreptococci, 20-25% are gram-negative anaerobic cocci - veillonella and 20-25% of gram-positive bacilli, which preserved the old umbrella term diphtheroids. Less than 10% of other microbial groups, of which the main number and roles in pathological processes is a group of gram-negative anaerobic rods and ovoid, grouped bactery. Unlike the previous group, suggested that part of the resident microbial flora to call "aggressive". In addition to typical bacteria in the mouth can be detected also Mycoplasma, chlamydia, which also have a prokaryotic type of cell structure, and the herpes viruses. However, always present and germs-the eukaryotes: fungi (Candida sop.) and the simplest (Entamebae gingivalis and Trichomonas tenax), which may be activated under conditions of antibacterial therapy, ned is statusnote immune system and severe somatic diseases.

Data analysis molecular genetic and microbiological studies allowed us to conclude that in patients with chronic generalized periodontitis in the acute stage, the frequency of occurrence of different species, which is considered periodontopathogenic, differed considerably. The Association was dominated by representatives of the species Prevotella intermedia, Porphyromonas gingivalis, Bacteroides forsithus, Fusobacterium nucleatum, A. actinomycetemcommitans, Treponema denticola, Actinomyces naeslundii, A. israelii. Streptococcus intermedius, Peptostreptococcus micros (Musheireb infection control: the war of the worlds //the Maestro of dentistry, 2004 - № 1-2. - P.34-38). Thus, in the development and exacerbation of periodontitis play a decisive role anaerobic gram-positive and gram-negative microorganisms.

The urgency of the problem is that conduct osteoplastic surgery in patients with periodontitis have knowingly infected wound with reduced immune response. When using autograft patient to apply additional injury, as required additional surgery for fence material, and place of the intake material is a defect that requires further substitution of (Losev FF, Dmitriev V.M., ALEXANDER Zharkov use of the method of targeted tissue regeneration and bone autograft obtained from the lower jaw, to eliminate the defects Alva is a regular process with subsequent implant placement // Russian Bulletin of dental implantology - 2003 - No. 1 - P.14-18). Transplanted genetically alien tissue allograft and xenograft is for the recipient's organism pathogenic agent and causes a number of immunogenic reactions, leading in some cases to graft rejection. Synthetic grafts may be used only if the defect is limited to two or three walls, that is, when there is a high probability of rapid bone regeneration (Anemadina, Mbvt, Agustiana, LCA the Condition of the bone tissue of the alveolar bone after periodontal surgery with the use of osteoplastic material Cerasorb and membrane Epi-Guide // Dental market news in the dental industry, 2003. No. 6 - p.4-7). In addition, synthetic osteoplastic material is not rebuilt, the stimulation of osteogenesis secondary, because porous crystals serve as adsorbent for growth factors, videloudici in tissue environment if damaged bone. Granules are immured in the newly formed bone.

The closest in technical essence and the achieved result is widely used in practice for carrying out bone-plastic surgery allografts with a simplified antigenic structure, lyophilized (Nasprotnikov Bone grafting of the lower jaw. Medicine., 1979. - S.; LET the tin, Way, Aggieland, Vmmdev the Lyophilized allatini in reconstructive operations. // Abstracts. 34 - scientific-practical conference of physicians of the Ulyanovsk region. "Problems of theoretical and practical medicine", - U., 1999. - S-500.). Freeze-dried allogenic bone creates optimal conditions for reparative morphogenesis in the recipient after osseous defect. There is complete recovery of the total volume of the remote site of a bone and the preservation of its original structure, shape and function. In addition, it is easy to saturation drugs. (Kirilenko A.G. New allogenic cancellous porous materials and clinical aspects of their application. - Samara, 1999. - P.66-73 - the Dissertation on competition of a scientific degree of candidate of medical Sciences).

With all the advantages of the known graft should be noted disadvantages: the fragility of dried transplantation material, complexity, giving it the necessary forms, the undesirability of a transplant in a deliberately affected a bed, especially when the reduction of local immunity of the oral cavity, the length of the process of osseointegration, the need to use clamps.

The technical result, which directed the establishment of this invention is to improve the plasticity of transplantati is authorized mixture and, therefore, the modeling capability of the graft from the mixture of the necessary forms, and reduce the time of perestroika transplant, they can transplant it obviously affected the couch, giving immunomodulatory properties to increase local immunity of the oral cavity, excluding additional surgical treatment of the patient's tissue by eliminating the use of clamps, requiring subsequent removal.

The technical result is achieved by grafting a mixture containing freeze-dried allogenic bone further comprises allogeneic hydroxyapatite, platelet gel, autologous blood of the patient and metronidazole at the following ratio of components (%): freeze-dried allogenic bone - 65, allogeneic hydroxyapatite - 10, platelet gel, autologous blood of the patient 20, metronidazole - 5.

The cooking process transplantation mixture is carried out as follows.

From the cubital vein of the patient in centrifuge tubes collect 18 ml of venous blood and put them in FR - a centrifuge to obtain platelet gel (blood is centrifuged at a speed of 2400 Rev/min - 12 min). Freeze-dried allogenic bone grind using a bone mill Bone-mill 3 KM to the state of small bone on which the ilok, who poured in sterile Cup, pour antiseptic solution of a wide range of actions, such as Butal, Hexanal, and voiced by low-frequency ultrasound by using the apparatus of Piezon-Master 400 set No. 403. Then saturated with an antiseptic solution bone sawdust transferred into a sterile Cup (e.g., Petri). Then to filings freeze-dried allogenic bone tissue in the amount of 65% from the desired volume of cell-based mixture powder allogeneic hydroxyapatite in the amount of 10% from the desired volume transplant mixes and metronidazole, first milled (for example, in a ceramic pestle a mortar or coffee grinder, as used tablets), in the amount of 5% from the desired volume transplant mixture, and mix thoroughly with a glass rod. After that, the already available components contribute platelet gel, autologous blood of the patient in the amount of 20% from the desired volume transplant mixture and again mix thoroughly. Transplant the mixture is ready for use. Ready transplantation mixture, if necessary, divided into parts and make the bone cavity, filling the available bone defect.

Thus, the proposed transplantationa mixture has all the good qualities of its constituent components, which in turn eliminate n the abundance of each other. Creates optimal conditions for reparative osteogenesis and does not cause immunogenic reactions, leading in some cases to graft rejection, as allogeneic and allogenic bone hydroxyapatite lyophilized and have simplified antigenic structure. Prevents the development of secondary infections, as freeze-dried allogenic bone tissue is saturated, using low-frequency ultrasound, antiseptic solution, broad-spectrum (effective against gram-positive, gram-negative aerobic bacteria and fungi), and metronidazole, part of the transplant mixture is effective against many periodontopathogenic anaerobic gram-positive and gram-negative microorganisms (antimicrobial and anti-inflammatory therapy in periodontics / Aigrumae, VNV, N.A. Dmitrieva. - M., 2004. - Page 16, 32-33), and platelet gel obtained from autologous blood from the patient. Allogenic hydroxyapatite allows a long time to maintain the volume of bone tissue and stimulates local homeostasis, also accelerates the formation of bone tissue at the site of demineralized bone matrix (RF Patent 2219933 for the invention "Method of promoting osteogenesis" authors Volovoi LT, Podkowka V.G., M. Vlasova). Platelet gel, autologous blood will patientsusual not only in the role of a plasticizer, mixed with freeze-dried allogenic bone, allogeneic hydroxylation and metronidazole is a plastic mass, which is easily divided into strips, which facilitates the input of the graft in the bone defect, the graft can be formed to a desired size and shape. In addition, he and platelet-rich plasma, autologous blood of the patient, reduces the time of perestroika transplant mixture by increasing the concentration of platelets increases the concentration of growth factors: platelet-derived growth factor (PDGF-aa, PDGF-bb, PDGF-ab), transforming growth factor (TGF - β1, TGF - β2), a growth factor, vascular endothelial (VEGF) and growth factor epithelium (EGF). These natural factors are biologically predetermined ratio. Mixed with bone graft material accelerates the process of osseointegration in 1,5-2 times. (Robert E. Marx, DDS platelet-Rich plasma: what can be called PRP and what is not // Dental Market-news dental market, 2003 - 6. - P.10-13) and yet contains the blood in high concentrations, thereby providing anti-infective and immunomodulatory effects, boosting local immunity of the oral cavity.

This transplant mixture for a long time and retains its volume and does not require overlay retainers, which would require subsequent removal. In addition, reliability is about and hermetically closes the bone defect, reduces the time of perestroika regenerate 1.5-2 times, gives the possibility of transplantation in a deliberately affected a bed in periodontal pockets of periodontitis and other bone cavities and defects.

Transplant mixture containing freeze-dried allogenic bone tissue, characterized in that it further comprises allogeneic hydroxyapatite, platelet gel, autologous blood of the patient and metronidazole at the following ratio of components, %:

freeze-dried allogenic bone65
allogeneic hydroxyapatite10
platelet gel, autologous blood patient20
metronidazole5



 

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