Actual problems in dentistry Actual problems in dentistry Проблемы стоматологии 2077-7566 2412-9461 75172 10.18481/2077-7566-2023-19-4-69-76 ХИРУРГИЧЕСКАЯ СТОМАТОЛОГИЯ И ИМПЛАНТОЛОГИЯ SURGICAL DENTISTRY AND IMPLANTOLOGY ХИРУРГИЧЕСКАЯ СТОМАТОЛОГИЯ И ИМПЛАНТОЛОГИЯ RESULTS OF USING COLLAGEN MATRIX IN SOFT TISSUE MANAGEMENT IN THE AREA OF DENTAL IMPLANTS IN THE ANTERIOR REGION OF THE UPPER JAW РЕЗУЛЬТАТЫ ПРИМЕНЕНИЯ КОЛЛАГЕНОВОГО МАТРИКСА ПРИ МЕНЕДЖМЕНТЕ МЯГКИХ ТКАНЕЙ В ОБЛАСТИ ДЕНТАЛЬНЫХ ИМПЛАНТАТОВ ВО ФРОНТАЛЬНОМ ОТДЕЛЕ ВЕРХНЕЙ ЧЕЛЮСТИ Ашурко Игорь Павлович Ashurko Igor P. ashurko@yandex.ru

кандидат медицинских наук;

candidate of medical sciences;

 Крылова Дарья Андреевна Krylova Daria A. daria.savelieva@mail.ru Белкин Владислав Олегович Belkin Vladislav O. vladbelkin2@gmail.com Яценко Анна Георгиевна Yatsenko Anna G. annayats186@gmail.com Тарасенко Светлана Викторовна Tarasenko Svetlana Viktorovna prof_tarasenko@rambler.ru

доктор медицинских наук;

doctor of medical sciences;

 Первый Московский государственный медицинский университет им. И. М. Сеченова Москва Россия First Moscow State Medical University named after. I. M. Sechenova Moscow Russian Federation Первый Московский государственный медицинский университет им. И. М. Сеченова Москва Россия First Moscow State Medical University named after I.M. Sechenov Moscow Russian Federation Первый Московский государственный медицинский университет им. И. М. Сеченова Москва Россия First Moscow State Medical University named after. I. M. Sechenova Moscow Russian Federation Первый Московский государственный медицинский университет им. И. М. Сеченова Москва Россия First Moscow State Medical University named after I.M. Sechenov Moscow Russian Federation Первый Московский государственный медицинский университет имени И.М. Сеченова Москва Россия First Moscow State Medical University named after I.M. Sechenov Moscow Russian Federation 28 12 2023 28 12 2023 19 4 69 76 03 12 2023 10 12 2023 https://dental-press.ru/en/nauka/article/75172/view

Цель — сравнительный анализ применения коллагенового матрикса и свободного соединительнотканного трансплантата при увеличении толщины мягких тканей в области дентальных имплантатов во фронтальном отделе верхней челюсти. Материалы и методы. В исследовании приняли участи 30 пациентов с частичным отсутствием зубов и дефицитом толщины мягких тканей во фронтальном отделе верхней челюсти. В 1-й группе (n = 15) проводилась пересадка свободного соединительнотканного трансплантата (ССТ) из области твердого неба, во 2-й группе (n = 15) использовался коллагеновый матрикс (КМ). Первичной конечной точкой являлась величина прироста толщины мягких тканей через 3 месяца после операции. Вторичными конечными точками являлись: длительность операции, выраженность коллатерального отека и боли, количество потребляемых обезболивающих препаратов, оценка качества жизни, ширины кератинизированной прикрепленной десны, эстетики мягких тканей. Результаты. Через 3 месяца после аугментации прирост толщины мягких тканей с вестибулярной поверхности составил 0,86 ± 0,25 мм и 0,77 ± 0,26 мм (р = 0.34), с окклюзионной — 0,46 ± 0,14 мм и 0,37 ± 0,18 мм (р = 0,137) у пациентов 1-й и 2-й групп соответственно. Применение КМ характеризовалось менее продолжительным хирургическим вмешательством (p = 0,002), менее выраженной послеоперационной болью на 1 и 3-и сутки (p = 0,007; p = 0,023), меньшим потреблением обезболивающих препаратов на 1, 3 и 5-е сутки (p = 0,014; p = 0,033; p = 0,002) и меньшим снижением качества жизни пациентов в первые 7 суток после операции (p = 0,023). При анализе «шкалы розовой эстетики» (PES) у пациентов 2-й группы были выявлены более выраженные несоответствия при оценке уровня зенита (p < 0,001), менее естественный контур мягких тканей (p < 0,001) и более значительный дефицит альвеолярного гребня (p < 0,001). Заключение. Коллагеновые матриксы позволяют получить сопоставимое с применением ССТ увеличение мягких тканей, сократить время оперативного вмешательства и обеспечить более комфортный послеоперационный период. Применение аутогенных трансплантатов обеспечивает лучшие результаты с точки зрения эстетики мягких тканей.

The aim is to comparatively analyze the using of collagen matrix and free connective tissue graft in soft tissue thickness increase in the area of dental implants in the anterior region of the upper jaw. Materials and methods. 30 patients with partial absence of teeth and soft tissue thickness deficit in the anterior part of the upper jaw took part in the study. In the 1st group (n = 15) a free connective tissue graft (CTG) from the hard palate was transplanted, in the 2nd group (n = 15) a collagen matrix (CM) was used. The primary endpoint was the amount of soft tissue thickness gain 3 months after surgery. Secondary endpoints were: duration of surgery, severity of collateral edema and pain, amount of analgesic medication consumed, quality of life assessment, width of keratinized attached gingiva, and soft tissue aesthetics. Results. 3 months after augmentation the increase in soft tissue thickness from the vestibular surface was 0.86 ± 0.25 mm and 0.77 ± 0.26 mm (p = 0.34), from the occlusal surface - 0.46 ± 0.14 mm and 0.37 ± 0.18 mm (p = 0.137) in patients of the 1st and 2nd groups, respectively. The use of CM was characterized by less prolonged surgery (p = 0.002), less pronounced postoperative pain on the 1st and 3rd day (p = 0.007; p = 0.023), less consumption of analgesic drugs on the 1st, 3rd and 5th day (p = 0.014; p = 0.033; p = 0.002) and less reduction of patients' quality of life in the first 7 days after surgery (p = 0.023). When analyzing the "Pink Esthetics Scale" (PES) in patients, group 2 showed more pronounced inconsistencies in the assessment of the zenith level (p < 0.001), less natural soft tissue contour (p < 0.001) and more significant deficit of the alveolar ridge (p < 0.001). Conclusion. Collagen matrixes make it possible to obtain soft tissue augmentation comparable with the use of CTG, to reduce the time of surgical intervention and to provide a more comfortable postoperative period. The use of autogenous grafts provides better results in terms of soft tissue aesthetics.

 ксеногенный коллагеновый матрикс свободный соединительнотканный трансплантат дентальный имплантат увеличение объема мягких тканей пластика мягких тканей xenogeneic collagen matrix free connective tissue graft dental implant soft tissue augmentation gingival surgery

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Tarasenko, A.V. Yesayan, A.I. Galyas, A.V. Lee. Evaluation of the clinical effectiveness of using a free connective tissue graft and collagen matrix to increase the thickness of soft tissue in the area of dental implants. Periodontology. 2022;27:117-125. (In Russ.)]. doi: 10.33925/1683-3759-2022-27-2-117-125 Ashurko I.P., Tarasenko S.V., Esayan A.V., Galyas A.I., Li A.V. Ocenka klinicheskoy effektivnosti primeneniya svobodnogo soedinitel'notkannogo transplantata i kollagenovogo matriksa dlya uvelicheniya tolschiny myagkih tkaney v oblasti dental'nyh implantatov. Parodontologiya. 2022;27:117-125. [I.P. Ashurko, S.V. Tarasenko, A.V. Yesayan, A.I. Galyas, A.V. Lee. Evaluation of the clinical effectiveness of using a free connective tissue graft and collagen matrix to increase the thickness of soft tissue in the area of dental implants. Periodontology. 2022;27:117-125. (In Russ.)]. doi: 10.33925/1683-3759-2022-27-2-117-125