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comparing conventional and advanced innovation-based cellpotentiated methods used to restore jaw bone tissue in case of odontogenic inflammatory & destructive process. The source of regenerative cells and stimuli was autologous stromal vascular fraction of adipose tissue (SVF-AT). The study involved 158 patients with moderate and severe periodontitis; 112 patients with odontogenic cystic formations. Using SVF-AT through directed regeneration of periodontal tissues (n = 95) improved significantly the clinical, functional and aesthetic outcomes of the treatment, ensuring a higher increase in clinical attachment (5.66 ± 0.02 vs 3.27 ± 0.03 mm, p <0.001) with a more complete and stable restoration of the support function, and a minimal residual recession of the gingival margin, if compared with the conventional treatment in the control group (n = 63). In maxillary defects osteoplasty, the removal of odontogenic cystic formations in the experimental group (58 interventions) was accompanied with complications less frequently (1.7% vs. 23.9%, p <0.001), while positive clinical outcomes with no recurring inflammatory & destructive processes were twice as common through the long-term observation period (96.6% versus 47.8%, p <0.001) against the control (67 interventions). The morphological assessment outcomes suggest significant inducing effect that SVF-AT works on reparative osteohistogenesis, evidence to that being multiple tissue remodeling sites with a higher density of microvessels and newly developed bone tissue in the biopsy obtained from the experimental group patients if compared to the control. Therefore, the newly developed cell-potentiated methods increase significantly the effectiveness of the treatment offered to patients with odontogenic jaw destruction. K E Y w o r d s — stromal vascular fraction of adipose tissue, directed periodontal tissue regeneration, in situ bone tissue engineering, restorative dental surgery Article history: Submitted 11 April 2019 Accepted 27 June 2019 s t o M a t o L o G Y C L i N i C a L r E s E a r C h 141 | a r c h i v e u r o m e d i c a | 2 0 1 9 | v o l . 9 | n u m . 2 | tion, had no concomitant somatic diseases that might affect the treatment outcomes, and signed a voluntary informed consent to join the study. Table 1 offers a general view on the clinical material specifics. Table 1. General specifics of the clinical material In case of chronic periodontitis (G1), the access and treatment of periodontal pockets were performed through the standard technique for directed periodontal tissue regeneration (DPTR). The sanitized Group and type of surgery Age, min-max, Ме Distribution by gender, female / male Control subgroup Test Subgroup Group 1. Directional regeneration of periodontal tissues 28-60, 42 83/75 63 95 Group 2. Cystectomy with osteoplasty of the maxillary defect 20-69, 52 44/68 67 58 There were no statistically significant differences identified in terms of the age & gender structure, the initial oral cavity status, the size and topography of the dentomaxillary bone defects between the compared subgroups (p> 0.05). The surgical intervention was preceded by a conservative-hygienic phase, including the oral cavity sanation, the mobile teeth immobilization, the mucogingival disorders elimination, preparing protective temporary orthopedic structures for the surgical treatment and rehabilitation period. In the Plastic Surgery Department, syringe suction of 40–120 ml of subcutaneous adipose tissue from the hypogastric region of the anterior abdominal wall and lateral parts of the body was performed under local infiltration via tumescent anesthesia. The punctures were covered with aseptic cloths with a compression bandage applied. Within one hour, the patient remained in the hospital under observation. Lipoaspirate in syringes was washed with sterile physiological solution with a wide-spectrum antibiotic added, and delivered to the laboratory along with 10–20 ml of the patient’s blood serum. The stromal vascular fraction was isolated in a laboratory meeting all the GMP standard requirements. 40–50 ml of the lipoaspirate were enhanced up to 60 ml with a physiological solution containing collagenase enzyme lyophilisate 50 mg (activity 180–290 units/mg) and placed in a sterile plastic bag. After exposure to a water bath for 20 minutes at 37° C, the suspension was distributed into test tubes and centrifuged for 20 minutes at a speed of 2750–3000 rpm. The upper layer of liquid lipids and floating adipocytes was aspirated, and the supernatant poured off. SVF-AT was collected from the tubes bottom and washed with autologous blood serum. Further on, SVF-AT was resuspended with autologous serum and the composition was analyzed using an automatic cell counter. When delivered from the laboratory to the clinic, the material was accompanied with a passport indicating the number of cells and their viability. periodontal defects in the experimental subgroup (ESG1) were filled with SVF-AT, in the control subgroup (CSG1) a blood clot from the bone marrow spaces and the vital periodontal ligament were used for the same purpose. In both subgroups with deep and wide bone periodontal defects, a granulated osteoconductor was additionally introduced (Biosit-Elcor, St. Petersburg; Bio-Oss, Switzerland; Bone Ceramic, Switzerland). Isolation of the regeneration site was carried out with a biocompatible polytetrafluoroethylene barrier membrane (Ecoflon, St. Petersburg). A mucoperiosteal flap was applied to the site with the wound sutured carefully. The postoperative care included antiseptic treatment of the oral cavity, and application of antibacterial gel. The stitches were removed on Day 12. The time for the membranes to remain in the tissues — 2 to 8 weeks. In case of jaws cystic lesions (G2), cystectomy was performed employing a standard procedure. In the experimental subgroup (ESG2), bone defects of small size (up to 20 mm in diameter) were filled with SVF-AT only. For plastic treatment of mid-sized bone defects (20–30 mm), SVF-AT was used with crushed bone added, which was taken from the patient through the surgery, from intraoral donor sites. To eliminate larger bone defects (exceeding 30 mm), including damage to one or both of the cortical jaw plates, granulated osteoconductor was introduced into the graft in addition to SVF-AT and bone chips (Bio-Oss, Switzerland). The resorbed collagen membrane (Bio-Gide, Switzerland) was placed under the muco-periosteal flap prior to the wound closure. In the control subgroup (CSG2) with small and mid-sized bone defects, treatment was performed either under a blood clot or with an osteo-substituting material combined with a barrier membrane; for large sizes of cystic formations, cystotomy was the choice. The study included modern methods of clinical, radiological, and instrumental diagnostics, as well s t o M a t o L o G Y C L i N i C a L r E s E a r C h 142 | a r c h i v e u r o m e d i c a | 2 0 1 9 | v o l . 9 | n u m . 2 | as cytological and morphological verification of the transplanted material and regenerated tissues. Control terms were set at 6, 12 and 24 months. To evaluate the treatment effectiveness, three categories of indicators were analyzed, including 1) the incidence of complications and positive outcomes; 2) the severity of the clinical symptoms; 3) the results obtained through instrumental, radiological and laboratory tests. The study materials underwent statistical processing using the methods of parametric and nonparametric analysis based on the results of testing the compared sets for normal distribution. In the case of a confirmed normal distribution, the quantitative indicators were presented as arithmetic means (M) and standard errors (m). The quantitative indicators, whose distribution differed from the normal, were described through the values of the median (Me) and quartiles [Q1; Q3]. The differences were considered statistically significant at p <0.05. R e s U L t s The results of cytological tests indicate the reliability of the adipose tissue treatment protocol employed for obtaining SVF-AT. The cells were viable, demonstrated the immunophenotype of multipotent mesenchymal stromal cells (CD13+, CD34–, CD44+, CD90+, CD105+), actively reproduced in vitro and synthesized the extracellular matrix components. The number of viable nucleated cells in a SVF-AT used for a single surgery ranged from 25 to 120 million. Using SVF-AT during DPTR improved significantly the clinical, functional and aesthetic results when treating patients with moderate to severe chronic periodontitis. The incidence of postoperative complications (infection and partial necrosis of the regenerate) was significantly lower in ESG1, compared with CSG1 — 2.1% and 19.1%, respectively (p˂0.05). After a cell-potentiated surgery, accelerated regression of inflammatory symptoms was observed with long-term stability of clinical indicators for the oral cavity status, such as gingivitis index, bleeding index, and periodontal index. The increase in the periodontal attachment after 2 years was 5.66 ± 0.02 mm in ESG1, which is 73% above the similar CSG1 indicator (3.27 ± 0.03 mm) where treatment was performed subject to the standard DPTR protocol (p<0.001). Periotestometry indicated complete restoration of the periodontal support function in the ESG1 patients, while the majority of patients with CSG1 maintained pathological mobility. The average Periotest value 24 months after surgery was 3.8 ± 0.1 and 15.6 ± 0.3 points in the experimental and control subgroups, respectively (p<0.001). An increase in the X-ray contrast structures prevailed in the area of defects, the elimination of which was done with SVFAT (Fig. 1). The results of a comparative histomorphological study suggest significant inducing effect that SVF-AT has on the restoration of damaged tissues in the tooth supporting structures, which can be seen from the fact that the earlier biopsy material obtained from

CELL-POTENTIATED REGENERATIVETECHNOLOGIES FOR RESTORING JAW BONETISSUES IN CASE OF ODONTOGENIC INFLAMMATORY & DESTRUCTIVE PROCESS