RU2848452C1 - Method for preventing complications in dental implantation - Google Patents

Abstract

FIELD: osteopathy.

SUBSTANCE: invention is intended for the prevention of complications in dental implantation. Before performing dental implantation, preliminary laboratory and instrumental examinations of the condition of the motor joints of the head and neck region are carried out, and the functional state of the cardiovascular system of the head and neck region is assessed in terms of venous and arterial blood flow velocity indicators, and the presence or absence of compression affecting innervation and the quality of venous and arterial blood circulation. If signs of somatic dysfunctions leading to disturbances in arterial and venous circulation in the head and neck region are detected, a complete osteopathic diagnosis is performed to identify somatic dysfunctions of the connective tissue. Osteopathic correction of the identified SDs is performed in 4 sessions over 3 weeks: osteopathic correction of functional manifestations of excessive compression and tension of extraocclusal localisation in the pelvic and abdominal regions, osteopathic correction of functional manifestations of venous circulation disorders in the head, neck and abdominal cavity regions, osteopathic correction of somatic dysfunctions in the thoracic region with a predominance of biomechanical (compression) and hydrodynamic components, osteopathic correction of somatic dysfunctions in the neck and head region, primarily with a predominance of the biomechanical (compression) component and the hydrodynamic component. After completing a course of osteopathic correction, repeated laboratory and instrumental studies of the state of vascular circulation in the head and neck region are performed.

EFFECT: increased effectiveness of prevention of dental implantation complications.

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Description

The invention relates to medicine, namely to osteopathy and directly to methods for preventing complications of dental implantation using clinical, laboratory and instrumental diagnostics and osteopathic correction of the neurodynamic and hydrodynamic components of somatic dysfunctions of the head and neck region.

The development of methods for timely and effective osteopathic correction of somatic dysfunctions of the body is currently one of the pressing challenges facing medicine.

Somatic dysfunction (SD) is a potentially reversible structural and functional disorder in tissues and organs, manifested by palpably determined limitations of various types of their movements and mobility [1].

From the point of view of etiological factors influencing the formation of diabetes, physical factors are distinguished in the form of static and dynamic mechanical effects of varying intensity, the consequences of various injuries, metabolic changes in the form of consequences of neuroendocrine and immunological disorders, as well as emotional-sensory factors and emotional reactions of varying duration [1].

In response to the influence of etiological factors, in cases where the strength, intensity and duration of the influence causes an adaptive reaction on the part of the main cells, the structural and functional changes are functional and reversible in nature [2, 3].

In the initial stages of the adaptive response, diabetes can be diagnosed even in the absence of clinical symptoms. The location of dominant somatic dysfunctions may differ from the location of secondary somatic dysfunctions and clinical manifestations. The structure of somatic dysfunction is conventionally divided into three main components: biomechanical, hydrodynamic, and neurodynamic.

The biomechanical component of diabetes mellitus represents various variants of the adaptive response of connective tissue (CT) with changes in its qualitative and quantitative characteristics, in some cases with the formation of fibrosis and sclerosis with an increase in the number of collagen fibers and their relative positions. Furthermore, connective tissue is restructured in the event of circulatory disorders, changes in nutrition, and with age [4].

The hydrodynamic component of SD is a reversible change in hydrophilicity with subsequent disruption of turgor, viscosity, fluidity, production and conduction of global endogenous rhythms.

The neurodynamic component of somatic dysfunction is a reversible impairment in the perception, production, and conduction of nerve impulses. The neurodynamic component of diabetes can occur during the functional adaptation phase without clinical manifestations, or within the context of the disease entity and clinical manifestations.

These three components unite all organs and subsystems of the body into a single, integral system.

In the practice of correcting somatic dysfunctions of the body, numerous options for performing hardware and manual interventions aimed at eliminating macro- and micro-mobility disorders in the human body are known. Various systems of manual medicine, along with various methods of manual diagnostics, distinguish a large number of manual correction methods. Among osteopathic correction methods, a number of basic techniques and approaches are known, relying on which an osteopathic physician performs diagnostics and subsequent interventions on identified disorders and dysfunctions in tissues and organs. Different osteopathic schools may use different classifications of osteopathic techniques, which does not affect their essence. As sources of information on basic techniques, one can cite the works of Mokhov D.E., Aptekar I.A., Belash V.O., and others, who formed domestic recommendations and approaches to osteopathic treatment [1, 2, 4, 5, 6, 7].

In relation to the subject matter of this invention, it is important to note the connection between somatic dysfunctions of the human body and the condition of the dental system, which is a significant aspect in understanding the patient's health. Somatic dysfunctions, such as musculoskeletal disorders, can have a significant impact on the dental system, which, in turn, can lead to various dental problems.

Incorrect alignment of the spine and hip joints can affect the chewing muscles and temporomandibular joint (TMJ). For example, scoliosis or other postural disorders can cause asymmetrical load distribution on the jaw, leading to TMJ dysfunction, which manifests as jaw pain, headaches, and clicking when opening the mouth. These symptoms can be exacerbated by dental implants if the body's overall biomechanics are not considered.

Tension in the neck and shoulder muscles can affect the chewing muscles. Chronic tension can lead to hypertonicity of the chewing muscles, which can cause problems with bite, tooth wear, and increased tooth sensitivity. After dental implants, such problems can impede the healing process and cause discomfort.

Osteopathic correction can play a key role in eliminating complications after dental implantation. Osteopaths view the body as a unified system, where all parts are interconnected. Manual therapy can restore normal functioning of the musculoskeletal system, which can help reduce tension in the masticatory muscles and improve TMJ function. This can promote a more rapid and comfortable recovery after implantation, reducing the risk of inflammation and pain.

Furthermore, osteopathic correction can improve blood and lymphatic circulation in the implantation area, which is important for tissue healing. Improved microcirculation can promote more effective recovery and reduce the risk of complications such as infection or swelling.

The patient's psycho-emotional state is also important for successful healing after dental implantation. Stress and anxiety can contribute to muscle tension and exacerbate somatic dysfunctions. Osteopathic techniques aimed at relaxation and balancing the nervous system can help reduce stress levels, which in turn promotes a more harmonious recovery process.

Thus, the connection between somatic dysfunctions and the condition of the dental system, as well as the possibility of osteopathic treatment for complications after dental implantation, highlights the importance of a comprehensive approach to treatment. This allows not only to eliminate symptoms but also to address the root causes of problems, which contributes to improving the patient's overall health and quality of life.

When discussing osteopathic treatments for various dysfunctions and disorders, a number of patents can be noted that describe the use of osteopathic techniques in complex treatments or as independent methods of therapy, particularly those affecting the condition of the dental and jaw system:

- RU 2 739 128 C1 describes the use of osteopathic treatment methods in outpatient and polyclinic practice to eliminate pain in newborns. Pain syndrome is treated against the background of somatic dysfunctions in newborns. The procedures include osteopathic interventions according to the following scheme: correction of sacrum, pelvis, and spine dysfunctions; correction of internal organ dysfunctions; correction of thoracoabdominal diaphragm dysfunctions; correction of skull bone dysfunctions and spheno-basilar synchondrosis; correction of cerebral ventricular dysfunctions; drainage of venous sinuses; correction of dura mater dysfunctions; synchronization of the body diaphragms (pelvic, thoracoabdominal, and oral); and overall body balancing. The procedures are performed for 20 minutes twice a day for 4 days, in the morning, until the pain decreases and is completely eliminated.

- RU 2 310 431 C1 describes increasing the effectiveness of preventative treatment through the integrated use of osteopathic techniques on all systems of the patient's body, targeting the structural, visceral, and cranial systems. This promotes the normalization of organ and system function and prevents the potential development of diseases. Osteopathic treatment is administered over eight sessions over two months, sequentially, once a week, followed by three sessions, once a month. Each osteopathic session begins with the identification and correction of cranial dysfunctions, followed by myofascial release of the lumbar, thoracic, and cervical spine. Subsequently, structural dysfunctions are corrected, accompanied by correction of the internal organs innervated from the same spinal segments targeted by the structural techniques. The method is suitable for children. Thalassotherapy, treatment with a therapeutic blanket, and gymnastics are also used.

- RU 2 296 551 C1 describes a similar treatment approach and ensures patient recovery through systemic intervention, including a general and osteopathic examination, followed by osteopathic interventions on the structural, visceral, and cranial systems, as well as electropuncture diagnostics using the Voll method, with testing and selection of an effective dose of the necessary biologically active medications. Osteopathic intervention is performed over eight sessions over two months, once a week. Three sessions are then performed once a month, followed by a follow-up examination every three months. During the session, correction of structural dysfunctions is accompanied by correction of internal organs innervated from the same spinal segments, myofascial release of the lumbar, thoracic, and cervical spine, and additional use of laser reflexology, thalassotherapy, SCENAR therapy, or SCENAR therapy with a therapeutic blanket. The method provides comprehensive disease prevention by acting on the body at the systemic and cellular levels and by optimally taking into account the interdependence of organs.

- RU 2 763 645 C1 describes a technique for osteopathic diagnosis and correction of somatic dysfunctions. A palpation-percussion tissue diagnosis is performed, during which one hand (the palpated hand) is placed on the patient's skin (on an arm or leg), while the other hand (the percussion hand) performs two taps on the suspected affected area. The palpating hand evaluates the tissue response as a change in tissue tension, which changes in the presence of dysfunction. A double stimulus reveals a compensatory lesion (secondary somatic dysfunction), while a triple stimulus reveals the primary lesion, which is the true lesion. Next, the identified dysfunctions are corrected, and for this, the doctor simultaneously performs a double percussion stimulus in the zone of the true lesion and compensation, followed by irritation of the periosteum, after which a retest is carried out: the doctor performs a repeated diagnosis of the dysfunctions in the manner described above; if there is no tissue response when tapping the affected areas, the correction is considered complete.

- RU 2 294 188 C2 describes a treatment method for temporomandibular joint dysfunction syndrome. Treatment is performed in two stages: release (relaxation) of the pterygopalatine fossa tissues by stretching the pterygoid muscles, which helps restore the correct position of the intra-articular disc and condyle; harmonization of the TMJ, release of the temporoparietal and temporoparietal sutures, decompression of the bilaminar zone and, consequently, improvement of TMJ nutrition, and return of the intra-articular disc to its correct position.

- RU 2 689 205 C1 describes a method for identifying and planning correction of human body system characteristics associated with malocclusion. This involves collecting a general and dental medical history, examining the musculoskeletal system, performing a polysomnographic examination, and performing an instrumental examination of the head and TMJ. If respiratory pathology is detected in combination with musculoskeletal pathology, orthopedic and/or orthodontic treatment is combined with osteopathic treatment. Prior to orthopedic and/or orthodontic treatment, the desired malocclusion is modeled on a virtual model of the patient's head, followed by splint therapy. This method helps reduce functional problems after malocclusion correction through a comprehensive approach to diagnosis and treatment and a combination of objective functional analysis in various fields of medicine during the treatment planning stage.

- RU 2 770 664 C1 describes a method of manual therapy for TMJ. The technique involves grasping the horizontal branches of the mandible with one hand and the posterior cranial fossa with the other, including the mammillary processes of the temporal bones and the occipital bone. Then, with coordinated hand movements, head flexion is increased. The hands are then smoothly brought together, increasing compression of the TMJ area and maintaining the achieved relative position of the cranial bones and cervical spine. Myofascial release of the TMJ area is performed until muscle relaxation and equilibrium tension under the hands are achieved. This method improves the effectiveness of treatment for temporomandibular joint dysfunction.

It should be noted that during the information search we conducted, we did not identify any osteopathic techniques aimed at preventing and correcting complications after dental implantation.

Complications following dental implantation typically include pain at the implant site, tissue swelling, hematomas, bleeding, suppuration in the implant area, peri-implantitis with inflammation of the bone tissue around the implant, and implant rejection, mobility, and fracture. These complications are typically treated with anti-inflammatory and decongestant medications, antibacterial agents, mechanical curettage in cases of severe pathological processes, removal of granulation tissue, and wound cleansing. In some cases (with peri-implantitis and implant rejection), extraction of the implant, anti-inflammatory treatment, and subsequent insertion of a new implant are also recommended. Laser therapy, darsonvalization, and ultratonotherapy are also used for therapeutic and prophylactic purposes in the early postoperative period following intraosseous dental implantation. To prevent complications after surgery, patients are advised to maintain oral hygiene, follow a diet that excludes foods that irritate the mucous membranes, increase blood flow, and promote the spread of infection, and take painkillers and anti-inflammatory medications as needed. In some cases, prophylactic antibacterial agents may be appropriate.

The following publications can be cited as specific examples of the prevention and correction of complications in the post-implantation period:

- Korchazhkina N.B., Olesova V.N., Radzievskiy S.A., Ruev V.V. The influence of laser therapy, UHF therapy and ozone therapy on the condition of bone tissue in the implant zone // In the book "Modern technologies of restorative medicine", Sochi, 2002, pp. 463-464. A technique of combined (local and acupuncture) laser treatment is described, in which the pulse repetition frequency is 80 and 1500 Hz; the pulse radiation power reaches 3-4 W, the average radiation power is in the range of 0.2-1.1 mW. The exposure time on the field is smoothly increased from 30 to 60 s. For local exposure, the light guide is installed on the surgical area of intervention, the systemic effect is exerted by irradiating acupuncture points responsible for activating the body's non-specific defenses. Five to eight fields are irradiated per session, with a total treatment time of 3-5 minutes. A full course of laser therapy consists of 7-12 treatments administered daily. The main claimed therapeutic effects of this localized method are anti-inflammatory, bacteriostatic and bactericidal, and reparative/regenerative. The systemic effects of irradiating biologically active points include immunostimulating action and increased intensity of metabolic and restorative processes.

- O.I. Efanov, T.F. Dzanagova. Physiotherapy of Dental Diseases. Moscow: Medicine, 1980, pp. 67-69. The article describes the use of the darsonvalization method using the Ultratek and DE-212KARAT devices, which are equipped with electrodes for intracavitary use. For local physiotherapy, pulsed alternating current with a frequency of 110 kHz, a voltage of 20 kV, and a strength of 0.02 mA is used. Current pulses with smoothly increasing and decreasing amplitude are applied sequentially from 50 to 100 times per second. Intraoral use involves contact placement of a gingival vacuum electrode treated with an antiseptic on the postoperative area and smooth movement over it in a circular motion for 3-5 minutes. The duration of the procedure and the intensity of the discharge are increased gradually, focusing on individual tolerance. A course of treatment consists of 5-10 procedures, administered daily or every other day. The physiological effect consists of reducing the excitability of autonomic nerve endings by enhancing inhibition processes, restoring the balance of excitation and inhibition in the central nervous system, reducing pain sensitivity, and activating local metabolic processes and microcirculation.

- V. M. Freilich, Yu. V. Gavinsky. Zonal and Puncture Ultratonotherapy (Practical Guide), Barnaul, 1996, p. 59. Describes the use of ultratonotherapy. Ultratonotherapy is a physiotherapy method based on the use of high-frequency alternating sinusoidal current with high voltage and low amperage, current power of 1-10 W. It reveals significant similarities with the darsonvalization method in the principle of therapeutic action and the effects provided. Implemented using devices of the Ultradar-MedTeko, Electroton, and Ultraton series with an operating frequency of 22 and 44 kHz. Currents are supplied to the patient's body area using vacuum or vacuum-free gas-discharge gingival electrodes, which are disinfected and dried before each use. The frequency of the current used in dentistry is 22 kHz. During the entire procedure, which lasts 5-10 minutes, the electrode is glided in a circular motion along the gingival surface. A treatment course consists of 8-10 daily treatments, with a repeat course possible after 1-2 months. The therapeutic effect is based on a combination of thermal, ultraviolet, ozone, and coronary discharge, which achieve vasodilation, muscle relaxation, improved trophism and regeneration, analgesia, and swelling reduction. Ultratonotherapy is believed to be less irritating than darsonvalization, while its effect is more profound.

- RU 2 620 152 C1 describes the prevention of complications in dental implantation and the acceleration of osseointegration, which is achieved by mesodiencephalic modulation (MDM therapy). Two electrodes are placed: the anode on the center of the forehead and the cathode on the center of the back of the head. Stimulation is performed in pulsed mode with a carrier frequency of 10,000 Hz and a low-frequency range with modulation from 20 to 100 Hz, changing during the session. The current strength, from 0.5 to 4 mA, is selected depending on the patient's tolerance. A course of MDM therapy consists of 13 daily sessions of 30 minutes each, conducted over 10 days. The first three days are two sessions with an interval of at least 6 hours, then one session per day. The method ensures the restoration of bone tissue and improved osseointegration of dental implants, pain relief by improving microcirculation and oxygenation, reducing swelling, localizing and preventing excessive postoperative inflammatory reaction, enhancing immunity, and early epithelialization.

- RU 2 531 941 C1 describes a method for the prevention and treatment of infectious processes during surgical dental interventions. For this purpose, the patient is administered an intravenous penicillin-type antibacterial drug or a third-generation cephalosporin antibacterial drug during surgery. The drug is administered daily for 3-5 days after surgery. Moreover, the drug is administered intravenously once a day during and after surgery by drip over 15-35 minutes at a dose equal to 30-55% of the recommended daily dose. The invention allows for the possibility of reducing the dosage of antibiotics while completely eliminating the need for repeated administration of antibacterial drugs during surgery and in the perioperative period for 24 hours, thereby avoiding the development of infectious and inflammatory complications in the early and late postoperative periods.

- RU 2 705 380 C1 describes a method for the prevention of peri-implant mucositis in patients with chronic periodontitis during dental implantation. The method includes professional oral hygiene using a device, air-abrasive removal of supra- and subgingival biofilm, injections of platelet-rich autologous plasma (PLA) obtained from the supernatant of a Plasmoactive tube after centrifugation into the peri-implant area after implantation before the placement of a former or before the start of the prosthetic stage, repeating the professional hygiene procedures and PLA injections after the placement of the prosthetic structure after 1-3 months, and then at intervals of 6 months. Air-abrasive removal of supra- and subgingival biofilm is performed with erythritol powder. A platelet-rich fraction of TPA is administered into the peri-implant area, with the remaining fraction administered submucosally into the mucosal fold of both jaws. Immediately before implantation, after professional oral hygiene, additional TPA injections are administered. The platelet-rich fraction of TPA is administered into the planned implantation area, and the remaining fraction is administered submucosally into the mucosal fold of both jaws. This method prevents inflammatory complications in patients with dental implants and concomitant chronic periodontitis, and ensures stable functioning of implant-supported orthopedic structures by combining biofilm control with optimization of microcirculation and regenerative processes through the use of autologous platelet-rich plasma.

In our opinion, when preventing complications after dental implantation, it is advisable to use a broader and more effective approach, which consists of the use of osteopathic methods for correcting the somatic functions of the body, both independently and in combination with classical approaches to the treatment of complications.

The proposed method of correction consists of implementing osteopathic correction of the biomechanical, neurodynamic and hydrodynamic components of somatic dysfunctions.

The result is achieved through the consistent implementation of osteopathic techniques based on the anatomical and functional structure of the body, based on the algorithm for their implementation, based on the adaptive abilities of fibroblasts and osteoblasts of human tissues.

Three to four weeks prior to dental implantation, a dental, neurological, and osteopathic diagnosis is performed, along with laboratory and instrumental examinations of the motor joints of the head and neck region. Functional status is assessed, including venous and arterial blood flow velocity, the presence or absence of compression affecting innervation, and the quality of venous and arterial circulation. If signs of somatic dysfunctions leading to vascular (arterial and venous) impairment in the head and neck region are detected, a full osteopathic diagnosis is performed to identify somatic connective tissue dysfunctions. Osteopathic correction of the connective tissue dysfunction is then performed to restore trophic function and innervation, as well as venous and arterial circulation.

Functional assessment can be performed using the following instrumental and laboratory methods: a blood test to evaluate the coagulation system (coagulogram), determination of vitamin D levels, a complete blood count (CBC) with platelet counts, C-reactive protein, and ESR. An ultrasound dopplerography of the head and neck vessels is performed, with mandatory examination of the venous circulation in the head region. If necessary, an MRI of the head with contrast (examination of the vascular system, primarily the arterial and venous systems), and a CBCT scan of the jaws are also performed.

Based on the data obtained, the presence of somatic dysfunction is identified in cases characterized by circulatory disorders in the head and neck region:

- exceeding the standard indicators [8] characterizing the activation of the blood coagulation system; the decisive factor is the general conclusion about the activity of the blood coagulation system, a change in blood pH towards acidosis, an increase in the level of CO2 in arterial blood;

- thrombocytosis;

- hyper- or hypovitaminosis of vitamin D;

- the presence of data indicating an inflammatory process (an increase in ESR and C-reactive protein levels above the norm [8]);

- the presence of local tissue edema, local venous congestion, decreased venous outflow velocity according to ultrasound Doppler imaging of the head and neck, including in the area of the jugular veins;

- decreased level of arterial circulation according to ultrasound data of the head and neck;

- an increase in the free fraction of hydroxyproline and its predominance over the protein-bound fraction of hydroxyproline in the blood and urine;

- other indicators and conditions characterizing disturbances in the blood coagulation system and local blood flow in the head and neck area, venous congestion and hypercapnia.

Evaluation of C-reactive protein and ESR levels allows us to determine the presence of inflammatory processes, accompanied, in particular, by increased blood clotting, swelling, and local venous congestion, which leads to changes in the synthetic properties of connective tissue and an increase in the density of the connective tissue itself.

Ultrasound Doppler imaging of the head and neck region allows us to assess venous blood flow velocity. Reduced venous outflow velocity leads to hypercapnia, which leads to increased collagen content in connective tissue, thereby increasing its density and stiffness. Reduced arterial blood flow leads to decreased tissue nutrition, including bone, decreased bone density, osteopenia, and, consequently, decreased implant acceptance. Quantitative analysis of hydroxyproline in plasma and urine also allows us to assess the amount of collagen synthesized in connective tissue. Determining blood coagulation parameters and vitamin D levels also allows us to indirectly assess the intensity of blood flow and the adequacy of blood supply to the head and neck region. Additional instrumental studies (e.g., MRI with contrast) can identify inflammatory pathologies, vascular occlusions, congestion, structural anomalies, etc.

Based on the studies conducted, a general conclusion is formed about the state of vascular circulation in the head and neck region.

When signs of somatic dysfunctions are detected that lead to disturbances in the vascular (arterial and venous) circulation of the head and neck region, a complete osteopathic diagnosis is performed, during which somatic dysfunctions of the connective tissue are identified.

Osteopathic correction of identified somatic dysfunctions is performed to restore trophic function and innervation, as well as venous and arterial circulation. Correction is performed in four sessions over three weeks. Osteopathic correction involves the sequential application of specific osteopathic techniques in accordance with the identified dysfunctions, with a predictable structural and functional effect:

1. Osteopathic correction of functional manifestations of excessive compression and tension of extraocclusal localization in the pelvic and abdominal region:

- decompression of the pubic symphysis,

- decompression of the sacroiliac joint on both sides,

- L5-S1 decompression

- muscular-fascial release of the thoraco-abdominal and pelvic diaphragm.

Osteopathic correction can be carried out using any acceptable osteopathic techniques, such as:

- Technique of osteopathic correction of somatic dysfunction, decompression of the pubic symphysis.

Initial patient position: The patient lies on their back, legs bent at the knees and hips, adducted, and feet resting on the couch.

The physician's starting position. The physician grasps the patient's knees, resisting the patient's attempt to spread their legs (3-5 seconds). The patient then relaxes, and the physician spreads their knees (keeping their feet close together) and places their cephalad forearm between the patient's knees, making contact with the elbow and heel of the palm. The physician's caudal hand holds the patient's feet.

The patient suddenly and forcefully squeezes their knees and lifts their pelvis off the table. Alternatively, the physician may remove their forearm during the patient's maximum effort. Repeat testing.

If necessary, the number of repetitions can be increased to 5 times.

2. Osteopathic correction of functional manifestations of venous circulation disorders in the head, neck and abdominal cavity:

- Performing osteopathic correction techniques for the pelvic floor muscles and thoracoabdominal diaphragm,

- Osteopathic correction of venous sinuses,

- Osteopathic correction using the CV4-EV4 technique,

- Osteopathic correction of the superior aperture,

- Techniques of osteopathic correction of pelvic diaphragm dysfunction,

- Techniques of osteopathic correction of the thoracoabdominal diaphragm.

Osteopathic correction can be carried out using any acceptable osteopathic techniques, such as:

- Technique for correction of the thoraco-abdominal diaphragm in bilateral somatic dysfunction of exhalation.

Patient position: sitting on the couch, back straight, physiological curves preserved.

Physician's position: standing behind the patient, the physician's position is stable, legs are spread, hips touch the couch, creating an additional point for a stable position, close contact is established between the physician's chest and the patient's back.

Physician's hand position: The physician's forearms are in close contact with the patient's body. During exhalation, fingers 2 through 4 are slowly inserted under the lower edge of the costal arch on both sides, toward the inner surface of the patient's costal arch.

On the doctor's command, after inhalation, the patient leans forward by 10-15 degrees during the exhalation phase, to more fully place the doctor's hands under the edge of the patient's costal arch on both sides.

On the doctor's command, the patient straightens the torso to the starting position. At this point, the doctor applies traction to the ventral edge of the diaphragm in a cranial direction.

Additional diagnostics. While the patient leans forward 10-15 degrees on the doctor's command, to more fully position the doctor's hands under the patient's costal margin on both sides, the doctor rotates their body to the right and left with an amplitude of no more than 45 degrees, determining any limitation of diaphragmatic mobility.

Osteopathic correction: After identifying the restriction, using the direct technique, the therapist rotates the patient's body, maintaining palpatory contact to the elastic barrier until fascial tension is felt. A corrective pause is performed until myofascial release occurs. On the therapist's command, the patient exhales long, holds their breath for 10-15 seconds, and then takes a deep breath.

Repeat diagnostic test.

- Technique of compression of the fourth ventricle (CV4).

The CV4 technique is performed after the venous sinus technique. The goal of the CV4 technique is to enhance cerebrospinal fluid flow not only through the large cerebrospinal fluid outlets but also to propel the cerebrospinal fluid wave into the most distant spaces through the nerve and vascular sheaths, through the fascial channels, and into the extracellular and intracellular fluid. Thus, the ultimate effect of the fourth ventricle compression technique is improved cellular nutrition, lymph flow, and tissue regeneration, as well as stimulation of the cranial nerve nuclei in the floor of the fourth ventricle. The biodynamic, bioelectrical, and biochemical properties of cerebrospinal fluid provide every reason to believe that all metabolic processes in the body are stimulated during the technique (Bolet P., 1993).

Patient position: lying on his back.

Position of the doctor: sitting at the head of the patient, knees apart, heels on the floor, support on the ischial tuberosities.

Position of the physician's hands: fingers 2–5 are closed and crossed, the distal phalanges of the thumbs are positioned close to each other (in a V-shape), the physician's palms are cupped under the occipital bone so that the tips of the thumbs are located approximately at the level of the spinous processes of C2–C3. The thenars of the hands are in contact with the squama of the occipital bone (not higher than the occipito-mastoid suture).

Correction:

1. Synchronization with the craniosacral rhythm.

2. During the exhalation phase of the PDM, the doctor accompanies the occipital bone into extension, slightly strengthening it.

3. During the inhalation phase of the PDM, the therapist holds the occipital bone, preventing its flexion. This is achieved by contracting the deep flexor muscles of the fingers, m. flexor digitorum profundi (Magoun H., 1976). It is important not to completely block the mobility of the occipital bone.

4. In the next phase of exhalation of the PDM, the doctor follows the occipital bone into extension and holds it in flexion, as described above.

5. After several such cycles, the pressure on the thenar muscles during inhalation weakens and ceases. This means the flexion/extension movement has stopped: the still point has been reached.

6. The physician should maintain the position of their hands on the occipital bone, following any slight movement of the nuchal muscles. This movement signifies "unwinding" and relaxation of the fascia, muscles, and bones. This still point can last from a few seconds to several minutes.

7. Signs of successful induction of still point are: deep breathing, light sweat on the forehead, decreased muscle tone, and drowsiness of the patient.

8. At the end of the still point, the therapist should feel a fairly strong pressure in the hands on each side of the occipital bone, moving from the inside out. The therapist follows the movement passively, paying attention to the quality of the craniosacral rhythm. Having assessed the craniosacral rhythm, the therapist should be able to decide whether further still point induction is necessary.

Note: The CV4 technique can be performed in several ways.

Option #1. Through the bone and dura mater. To do this, the therapist must sense changes in the elasticity of the occipital bone during the inhalation/exhalation phases and also assess the treatment effects at the level of the tentorium cerebelli.

Option #2: Direct your attention directly to the fluid component of the skull (intracranial fluid), visualize the skull and the 4th ventricle as a water-filled ball, and apply the technique to this fluid.

Option #3. Focus your attention on the tissues around the fourth ventricle, but simultaneously sense all levels of density in this area. Very gently facilitate the exhalation of the PPM and contraction, without changing the tempo of the movement or limiting the inhalation of the PPM (or expansion). Passively follow the inhalation phase of the PPM. Continue this procedure until you reach a still point.

Option #4. Follow the tissues, be relaxed and empathetic. Synchronize with the existing homeodynamic forces and rhythmic patterns. These are inherent to the primary respiratory mechanism and determine whether CV4 or EV4 has occurred. The osteopath acts as a fulcrum in these processes. This method requires the osteopath to avoid encountering tissue resistance and not "fight" it. This can be achieved through resistance training during the PDM phases.

Option No. 5. Korth, when performing the CV4 technique, focused on the center of the fluid structures and fluid patterns (this method is used when performing intraosseous techniques).

3. Osteopathic correction of somatic dysfunctions of the chest region with a predominance of the biomechanical (compression) component and the hydrodynamic component.

- Correction of pericardial ligament dysfunction and implementation of techniques aimed at increasing the range of motion of the chest.

Osteopathic correction can be carried out using any acceptable osteopathic techniques, such as:

- Technique for diagnosis and correction of the superior pericardiosternal ligament

Patient's starting position: lying on his back.

The doctor's starting position: standing at the patient's head.

Position of the doctor's hands:

The physician places the medial hand with its base on the manubrium of the sternum, the physician's forearm is positioned at 45° in relation to the patient's sternum.

Performing osteopathic correction techniques:

Using the patient's breathing, the osteopath palpates the patient during the exhalation phase, guiding the sternum's movement to the elastic barrier during exhalation and maintaining it during inhalation. The pre-tension is maintained at the elastic barrier until myofascial release occurs. Releasing the tension, we observe the free return of the sternum during the thoracic inhalation phase.

The physician evaluates the freedom of anatomically permitted movements during the phase of thoracic inhalation and exhalation.

We assess the uniformity of the sternum's range of motion during thoracic inhalation and exhalation, as well as the tension of the ligament between the pericardium and the sternum. If a delay is felt, the physician adjusts the pretension parameters to the elastic barrier during the thoracic exhalation phase and repeats the parameter setting technique.

After setting the pre-tension parameters, the doctor asks the patient to take a deep breath, and at the moment of maximum chest tension, for 1/2 of the breath, he performs recoil.

Repeated testing. Evaluation of changes in the quality of anatomically permitted sternum movement and changes in the condition of the sternopericardial ligament.

- Technique for diagnosis and correction of the inferior pericardiosternal ligament

Patient's starting position: lying on his back.

The doctor's starting position: standing at the patient's head.

Hand position:

- We place the medial hand with its base on the area of the xiphoid process (it falls into the fossa between the thenar and hypothenar), the doctor’s forearm and shoulder are vertical.

- The other brush strengthens the contact.

Execution of the technique:

• We look for tension in the ligament by playing with a slight lateral tilt. Then, we create a dorsal movement to the barrier. Releasing the tension, we monitor the freedom of the sternum's return back.

If there is a feeling of delay, we return to the depth, clarify all parameters, ask the patient to take a deep breath, and at the moment of maximum tension in the chest during inhalation, we perform recoil.

- Technique for testing and osteopathic correction of the diaphragmatic-pericardial ligament

Initial position of the patient: lying on the back

The doctor's starting position: sitting at the head.

Position of the doctor's hands:

The arms are placed in front and behind in the projection of the pericardial bed; ventrally, taking into account the axis of the heart, diagonally.

Test execution:

• We create pressure induction with the dorsal hand ventrally, with the ventral hand dorsally (until the pericardium is felt).

• Having accumulated tension in the ventro-dorsal direction (capturing the pericardium), with both hands we create induction along the axis of the heart upward until we feel ligamentous tension from the diaphragm.

• We keep the pericardium from shifting downwards and ask the patient to take a deep, even, slow breath (while gradually increasing the tension on the diaphragm).

• On each exhalation, we select the parameters of the pericardial ligament along the axis of the heart cephalically until we feel the relaxation of the diaphragmatic-pericardial ligament.

- Global osteopathic correction of mediastinal motility

• Initial position of the patient: lying on his back.

• Initial position of the doctor: standing at the side.

• Hand position:

• Palms one on top of the other, on the sternum, lengthwise;

• elbows are in different directions.

• Palpatory agreement with tissues.

• Introduction of tissue tension.

• Performing the technique (phase 1):

• We feel a “keel-like” swaying that is not associated with pulmonary breathing.

• We explore movements in all directions (3 axes and 3 planes)

• If tissue fixation, tension vector and motility disorder are determined, we immediately carry out correction:

• Without losing tissue tension, follow local tissue listening (indirect technique) until balance is achieved.

Phase 2:

To synchronize the movements of the mediastinum and mediastinal mobility, at the end of the technique, after equilibration, we ask the patient to take a slow, smooth inhalation, bringing the mediastinum to a physiological inhalation position, then a smooth exhalation, bringing it to a physiological exhalation position. Repeat several times.

Physiological effects of mediastinal equilibration technique:

• increase in coronary blood flow;

• increasing blood supply to the lungs;

• increased blood flow in the upper limbs;

• increased blood flow in the neck and head;

• improving the function of the bronchial tree.

4. Osteopathic correction of somatic dysfunctions of the neck and head region, primarily with a predominance of the biomechanical (compression) component and the hydrodynamic component.

- Performing techniques for correcting cervical spine dysfunction,

- Performing techniques for correcting the first rib deformity,

- Implementation of techniques for correcting the laryngopharyngeal complex,

- Performing osteopathic correction techniques for the oral diaphragm.

Osteopathic correction can be carried out using any acceptable osteopathic techniques, such as:

- Technique of osteopathic correction of the oral diaphragm.

The patient's starting position. Lying on his back.

The osteopathic physician's starting position: sitting at the patient's head. The fulcrum rests on the elbows (on the table), the back is straight, and the patient rests on the ischial tuberosities.

Osteopathic hand position. Fingers 2-5 of both hands are placed under the horizontal branches of the mandible.

Osteopathic correction:

Lean forward slightly, thereby increasing tension in the oral diaphragm. Focusing on the areas of greatest tension, we ask the patient to swallow.

After the tissues have relaxed, it is necessary to move the fingers deeper until the tissue is completely relaxed or its quality improves.

Retesting.

Following a course of osteopathic correction, repeat laboratory and instrumental studies of the vascular circulation in the head and neck region are performed. The criterion for achieving a therapeutic effect, namely, an improvement in the functional state of the venous and arterial systems, is a change in laboratory and instrumental test results confirming improvement in the condition of connective tissue at the local, regional, and global levels, as well as the circulatory system in the head and neck region.

Literature.

1. Clinical guidelines "Somatic dysfunction", coding according to the International Statistical Classification of Diseases and Related Health Problems: M99.0, M99.8, M99.9. Age group: adults, children. Year of approval: 2023

2. Aptekar I.A. Principles and Methods of Osteopathy Part 1. Biomechanical Method: Textbook. Tyumen: Tyumen Printing House; 2020; 139 p.

3. Aptekar I.A., Kostolomov E.G., Sukhovey Yu.G. Changes in the functional activity of fibroblasts during the modeling of compression, hypercapnia, and hypoxia. Russian Osteopathic Journal. 2019; (1-2): 72-84

4. Babanin Yu.A. Basic concepts and models in osteopathy. Russian Osteopathic Journal. 2017; (1-2): 95-104

5. Mokhov D. E., Aptekar I. A., Belash V. O., Litvinov I. A., Mogelnitskiy A. S., Potekhina Yu. P., Tarasov N. A., Tarasova V. V., Tregubova E. S., Ustinov A. V. Fundamentals of osteopathy: A textbook for residents. M.: GEOTAR-Media; 2020; 400 s.

6. Novoseltsev S.V. Clinical osteopathy. Visceral techniques. OOO Izdatelstvo Foliant. 2013, pp. 97-99. https://med7.net/page/201201231100217222249078099103235023099167032204/

7. Novosel'tsev S.V. Textbook for higher educational institutions. Book 1. 2nd edition, MEDpress-inform, 2022, 688 pp., ill., ISBN: 978-5-907504-20-2

8. Osvaldo Padilla, Jude Abadie. Normal Laboratory Values. https://www.msdmanuals.com/ru-ru/professional/resources/normal-laboratory-values/blood-tests-normal-values

Clinical examples.

Example 1.

Patient L., 32 years old.

An operation has been scheduled to install an implant on the upper jaw, on the left, to replace the removed 6th tooth.

One of the complications after implant installation is the formation of a fibrous ring around the implant and the rejection of the implanted object by the body.

The mechanism of fibrous tissue formation is the cessation of fibroblast activity through apoptosis.

To minimize the risk of implant rejection, the patient underwent an ultrasound examination of the vessels of the head and neck.

Difficulty in venous outflow was detected.

Laboratory tests revealed vitamin D deficiency and elevated ESR.

Consultation with an endocrinologist is recommended.

Osteopathic correction is recommended.

At the initial consultation with an osteopathic physician, extraocclusive compression diabetes mellitus (SD) was diagnosed in the pelvic and abdominal regions, venous circulation disorders in the head, neck and abdominal region, SD in the chest region with a predominance of the biomechanical compression component and hydrodynamic component, SD in the neck and head region with a predominance of the biomechanical compression component and hydrodynamic component.

Decompression of the pubic symphysis, correction of the pelvic floor and thoracoabdominal diaphragm muscles, correction of the CV4-EV4 muscles, correction of the pericardial ligaments and restoration of chest range of motion, correction of the cervical spine, and correction of the oral diaphragm were performed. Rebalancing. Synchronization of the mobility of the motor joints of the body with the rhythmic manifestation of primary breathing.

A total of 4 sessions were performed over 3 weeks.

Repeated examination of the vessels of the head and neck did not reveal any abnormalities in venous circulation in these regions.

After the dental implantation, the implant took root successfully without any complications or side effects.

Claims (7)

A method for preventing complications of dental implantation, characterized by the fact that Before dental implantation, preliminary laboratory and instrumental examinations of the state of the motor joints of the head and neck region are performed, the functional state of the cardiovascular system of the head and neck region is assessed in the form of indicators of the velocity of venous and arterial blood flow, the presence or absence of compression affecting the innervation and quality of venous and arterial circulation; if signs of somatic dysfunctions (SD) are detected, leading to disturbances in the function of arterial and venous circulation in the head and neck region, osteopathic diagnostics are performed, during which somatic dysfunctions of the connective tissue are identified; osteopathic correction of the identified SD is performed in the amount of 4 sessions over 3 weeks; osteopathic correction at each session is performed in the following sequence in accordance with the identified SD: - osteopathic correction of the functional manifestations of excessive compression and tension of extraocclusive localization in the pelvic region and abdominal cavity, which includes decompression of the pubic symphysis, decompression of the sacroiliac joint on both sides, decompression of L5-S1, muscular-fascial release of the thoraco-abdominal and pelvic diaphragm, superior aperture, osteopathic correction of the first rib, laryngeal-pharyngeal complex and diaphragm of the mouth; - osteopathic correction of somatic dysfunctions of the chest region with a predominance of the biomechanical compression component and the hydrodynamic component of somatic dysfunction, in which osteopathic correction is carried out with the patient lying on his back: the base of the doctor's hand is placed on the sternum and, while inhaling, the hand is moved to the elastic barrier, then, while exhaling, the specified position is maintained; - osteopathic correction of functional manifestations of venous circulation disorders in the head and neck region, which involves osteopathic correction of the dominant vascular disorders in the head and neck region, venous sinuses in the head region, using the CV4-EV4 osteopathic technique; - osteopathic correction of somatic dysfunctions of the neck and head region with a predominance of the biomechanical compression component and the hydrodynamic component, in which osteopathic correction of diagnosed SD is performed, including the cervical spine, first rib, laryngeal-pharyngeal complex, and oral diaphragm; Following a course of osteopathic correction, repeat laboratory and instrumental studies of the vascular circulation in the head and neck region are performed; the criterion for achieving a therapeutic effect is the change in the results of laboratory and instrumental studies.