Остеопластика альвеолярной части нижней челюсти комбинированными костными трансплантатами

Introduction. There are various osteoplasty methods aimed at managing the challenge of jaw atrophy. When the scope of the osteoplasty is extensive it is not always possible to prepare an appropriate amount of bone tissue without additional surgeries. In some cases there is a lack of intraoral bone tissue sources for this kind of operations. Using extraoral sources of bone tissue is not always justified; it is invasive and patients take longer to recover and return to work. Using alternative sources of bone biomaterials might help establish a less invasive osteoplasty protocol.Goal. To demonstrate the efficiency of alveolar ridge osteoplasty with the application of laminar technique and using various combinations of autograft and allograft tissues.Materials and methods. To achieve the goal set we have examined and treated fourteen patients (N=14) surgically. All patients presented a clinical picture of severe atrophy in dentoalveolar segments 3 and 4, knife-edged ridge, Cawood and Howell class IV–V. Depending on the combination of autograft and allograft biomaterials patients were split into three study groups and one control group.Results and discussion. Positive outcomes for the treatment administered were observed in 13 out of 14 patients. Complications were determined by the lack of soft tissue, exposure of the graft or its suppuration. All the patients in all the groups underwent a control CT which confirmed the bone tissue growth at the area of the augmentation performed.Conclusion. Using the bone biomaterial allograft in combination with autograft bone makes it possible to get good clinical results in all the groups observed. This method may be a method of choice eliminating the additional invasive procedure of bone transplant harvesting; it does, however, require further, more detailed research.Введение. Существуют различные методики остеопластики, решающие проблему атрофии челюстей. При больших объемах костной пластики не всегда удается произвести взятие должного объема костной ткани без дополнительных хирургических вмешательств, а в некоторых случаях встречается и недостаток внутриротовых источников костной ткани для выполнения данных операций. Использование внеротовых источников костной ткани не всегда оправдано и несет большую инвазию, после которой пациенты временно теряют трудоспособность. Использование альтернативных источников костных биоматериалов могло бы способствовать реализации менее инвазивного протокола остеопластики.Цель. Показать эффективность остеопластики альвеолярного гребня с использованием ламинарной техники и применением различных комбинаций аутогенных и аллогенных трансплантатов.Материалы и методы. Для решения поставленной цели исследования нами было обследовано и проведено хирургическое лечение пациентов (N = 14), у всех пациентов клинически в 3-м и 4-м зубочелюстных сегментах наблюдается выраженная атрофия, саблевидный гребень, 4–5-й класс по Cawood&Howell. В зависимости от сочетания аутотрансплантатов и аллогенных биоматериалов в тех или иных вариациях пациенты разделены на 3 основных и 1 контрольную группы.Результаты и обсуждение. Положительный результат проведенного лечения наблюдался у 13 пациентов из 14. Осложнения были связаны с недостатком мягких тканей, оголением трансплантата или его нагноением. Пациентам всех групп была сделана контрольная КТ, которая показала увеличение объема костной ткани в области аугментации.Заключение. Использование аллогенных костных биоматериалов в комбинации с аутокостью позволяет добиться хороших клинических результатов во всех группах наблюдения. Данный метод может являться методом выбора и исключает дополнительную инвазивную процедуру взятия костного трансплантата, однако требует дальнейшего более подробного изучения

Harnessing Wicked Problems in Multi-stakeholder Partnerships

Despite the burgeoning literature on the governance and impact of cross-sector partnerships in the past two decades, the debate on how and when these collaborative arrangements address globally relevant problems and contribute to systemic change remains open. Building upon the notion of wicked problems and the literature on governing such wicked problems, this paper defines harnessing problems in multi-stakeholder partnerships (MSPs) as the approach of taking into account the nature of the problem and of organizing governance processes accordingly. The paper develops an innovative analytical framework that conceptualizes MSPs in terms of three governance processes (deliberation, decision-making and enforce-ment) harnessing three key dimensions of wicked problems (knowledge uncertainty, value conflict and dynamic complexity). The Roundtable on Sustainable Palm Oil provides an illustrative case study on how this analytical framework describes and explains organizational change in partnerships from a problem-based perspective. The framework can be used to better understand and predict the complex relationships between MSP governance processes, systemic change and societal problems, but also as a guiding tool in (re-)organizing governance processes to continuously re-assess the problems over time and address them accordingly

Maintenance of cross-sector partnerships: the role of frames in sustained collaboration

We examine the framing mechanisms used to maintain a cross-sector partnership (XSP) that was created to address a complex long-term social issue. We study the first eight years of existence of an XSP that aims to create a market for recycled phosphorus, a nutrient that is critical to crop growth but whose natural reserves have dwindled significantly. Drawing on 27 interviews and over 3,000 internal documents, we study the evolution of different frames used by diverse actors in an XSP. We demonstrate the role of framing in helping actors to avoid some of the common pitfalls for an XSP, such as debilitating conflict, and in creating sufficient common ground to sustain collaboration. As opposed to a commonly held assumption in the XSP literature, we find that collaboration in a partnership does not have to result in a unanimous agreement around a single or convergent frame regarding a contentious issue. Rather, successful collaboration between diverse partners can also be achieved by maintaining a productive tension between different frames through ‘optimal’ frame plurality – not excessive frame variety that may prevent agreements from emerging, but the retention of a select few frames and the deletion of others towards achieving a narrowing frame bandwidth. One managerial implication is that resources need not be focussed on reaching a unanimous agreement among all partners on a single mega-frame vis-à-vis a contentious issue, but can instead be used to kindle a sense of unity in diversity that allows sufficient common ground to emerge, despite the variety of actors and their positions

Once the shovel hits the ground : Evaluating the management of complex implementation processes of public-private partnership infrastructure projects with qualitative comparative analysis

Much attention is being paid to the planning of public-private partnership (PPP) infrastructure projects. The subsequent implementation phase – when the contract has been signed and the project ‘starts rolling’ – has received less attention. However, sound agreements and good intentions in project planning can easily fail in project implementation. Implementing PPP infrastructure projects is complex, but what does this complexity entail? How are projects managed, and how do public and private partners cooperate in implementation? What are effective management strategies to achieve satisfactory outcomes? This is the fi rst set of questions addressed in this thesis. Importantly, the complexity of PPP infrastructure development imposes requirements on the evaluation methods that can be applied for studying these questions. Evaluation methods that ignore complexity do not create a realistic understanding of PPP implementation processes, with the consequence that evaluations tell us little about what works and what does not, in which contexts, and why. This hampers learning from evaluations. What are the requirements for a complexity-informed evaluation method? And how does qualitative comparative analysis (QCA) meet these requirements? This is the second set of questions addressed in this thesis

Alveolar Mandible Osteoplasty with Combined Bone Transplants

Introduction. There are various osteoplasty methods aimed at managing the challenge of jaw atrophy. When the scope of the osteoplasty is extensive it is not always possible to prepare an appropriate amount of bone tissue without additional surgeries. In some cases there is a lack of intraoral bone tissue sources for this kind of operations. Using extraoral sources of bone tissue is not always justified; it is invasive and patients take longer to recover and return to work. Using alternative sources of bone biomaterials might help establish a less invasive osteoplasty protocol.Goal. To demonstrate the efficiency of alveolar ridge osteoplasty with the application of laminar technique and using various combinations of autograft and allograft tissues.Materials and methods. To achieve the goal set we have examined and treated fourteen patients (N=14) surgically. All patients presented a clinical picture of severe atrophy in dentoalveolar segments 3 and 4, knife-edged ridge, Cawood and Howell class IV–V. Depending on the combination of autograft and allograft biomaterials patients were split into three study groups and one control group.Results and discussion. Positive outcomes for the treatment administered were observed in 13 out of 14 patients. Complications were determined by the lack of soft tissue, exposure of the graft or its suppuration. All the patients in all the groups underwent a control CT which confirmed the bone tissue growth at the area of the augmentation performed.Conclusion. Using the bone biomaterial allograft in combination with autograft bone makes it possible to get good clinical results in all the groups observed. This method may be a method of choice eliminating the additional invasive procedure of bone transplant harvesting; it does, however, require further, more detailed research