Indicators of bone homeostasis and microcirculatory parameters in the postoperative period of dental implantation using different types of navigation templates in patients with type I diabetes

Abstract

The development of new methods and techniques of dental implants placement with less traumatization of oral tissues narrows the contraindications to orthopedic correction in patients with complex somatic pathology, which includes severe diabetes. The aim of the study is to compare the parameters of bone and microcirculatory homeostasis in diabetic patients using different types of navigational surgical templates and dental implantation techniques.
Materials and methods.
One-stage dental implantation (with prosthetics on the day of surgery according to the type "all on 4" or "all on 6") was performed in 41 patients with severe type 1 diabetes: 21 patients made up Group I (main group) and 20 patients were assigned to group II (control). In group I the implantation was performed using a virtually modeled collapsible navigation template (patent № 2796749, effective from 13.09.2022) without peeling of the mucosal-adcostal flaps according to the developed method (patent 2794843, effective from 01.08.2022). In the control group the implantation was performed according to the standard protocol, with suturing and using the Malo template. Before implantation, on the 1st, 3rd, 10th and 30th days after implantation the dynamics of microcirculatory parameters in the implant area was evaluated. Bone homeostasis control was carried out before the operation, in 1, 2 and 3 months according to the CBCT data, as well as by the dynamics of tartrate-resistant acidic (TRAP5b) and alkaline phosphatase activity in the oral fluid.
Results.
The use of the new method of dental implantation led to the activation of microcirculation in the blood flow zone, which was confirmed by the increase of perfusion by 47.3%, the coefficient of specific oxygen consumption (U) by 32.6% and the efficiency of microcirculation almost 3 times with the decrease of perfusion oxygen saturation index (SOm) by 2 times, which was not observed in the patients of the control group. Improvement of microcirculatory parameters in group I patients was accompanied by faster positive dynamics of bone homeostasis compared to group II patients. In group I the increased level of TRAP5b remained during the 1st month after surgery, and in group II patients by the end of the 2nd month it remained 16—20% higher than the initial observation values, which indicated the prevalence of osteoclastic processes. In 3 months after the placement of dental implants the bone tissue density according to the Hounsfield scale in group I increased in comparison with the initial values in men by 19.0%, in women — by 14.1%. In group II even 3 months after implantation there was no restoration of bone density to the initial level.
Conclusion.
The use of a new collapsible navigation template and surgery without peeling off the mucosal-adcostal flap allows preserving the microcirculatory channel and enables the organism to fully use the regenerative potential aimed at activation of oxygen exchange and increasing the efficiency of metabolism in tissues.