[Experience of non-pharmacological physiotherapeutic technologies application in surgical patients with post-operative inflammatory complications and endothelial dysfunction].

Abstract

The risk of vascular endothelial dysfunction development, which is an activator of inflammatory complications, increases in orthognathic patients immediately after surgery. An adequate correction is required in the case of vascular endothelial dysfunction in order to provide the control over possible complications after the surgery, that determines the study's relevance.

Objective: To develop and scientifically substantiate non-pharmacological rehabilitation treatment technology of orthognathic patients after the surgery for the purposes of endothelial dysfunction inactivation and the risks of inflammatory odontogenic complications decrease by inclusion of low-intensity pulsed laser radiation of different wavelength (635 and 904 nm) in the basic pharmacological therapy program (anti-inflammatory, symptomatic drugs).

Material and methods: A number of patients with orthognathic pathology equal 121 divided into 4 groups were under observation. Extraction and implantation (K04.5; K06.0) with exposure by low-intensity pulsed laser radiation of different wavelength (635 and 904 nm, pulse - 100 s, PFD - 25 mW/cm² on vestibular and oral surface in the projection of surgery area and epidermally in the projection of wound) immediately after the surgery were performed in the 1st group (31 patients); in the 2nd group (30 patients) - implantation due to anodontia (K00.0) with subsequent exposure by low-intensity pulsed laser radiation of 904 nm wavelength (pulse - 100 s, PFD - 25 mW/cm² epidermally in the projection of wound).

in the 3rd group (30 patients) - implantation (K05.3) with subsequent exposure by low-intensity pulsed laser radiation of 635 nm wavelength (pulse - 100 s, PFD - 25 mW/cm² on vestibular and oral surface in the projection of surgery area; in the 4th group (30 patients, control) - extraction and implantation (K04.5, K05.3) without laser exposure. The level of pain in the wound by visual analogue scale, Muhlemann bleeding index, Purselo resistance index, hygiene index were determined, enzyme-linked immunosorbent assay (VEGF-A, sVEGF-A/R¹, sVEGF-A/R²) was carried out for assessing endothelial support, radiation control (orthopantomogram, radiograph, magnetic resonance imaging).

Results: Clinical dental status of orthognathic patients after the surgery has been characterized by changes in bleeding index by 86%, in resistance index by 21.7% from the reference physiological values correlating with endothelial parameters: between the level of plasma factor (VEGF-A) and bleeding index (r=-0.734; p<0.05), between the level of VEGF-A plasma vascular factor and pain in the wound (r=-0.574; p<0.05).

Conclusions: The use of combined spectrum of laser radiation with different wavelength (904 and 635 nm) in the early post-operative period corrects the ratio between heterodimeric receptors to physiological values: sVEGF-A/R1 from 0.26 [0.25; 0.27] to 0.40 [0.38; 0.48] ng/ml (p<0.05) and sVEGF-A/R2 - from 22.6 [21.9; 2 3.2] to 28.9 [27.5; 30.3] ng/ml (p<0.01), and eliminates the risks of inflammatory complications developing in presence of post-operative endothelial dysfunction progression.