CN103494649A - Improvement of bone splitting carried out below lip-cheek crest in oral implantation - Google Patents
Improvement of bone splitting carried out below lip-cheek crest in oral implantation Download PDFInfo
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- CN103494649A CN103494649A CN201310498408.1A CN201310498408A CN103494649A CN 103494649 A CN103494649 A CN 103494649A CN 201310498408 A CN201310498408 A CN 201310498408A CN 103494649 A CN103494649 A CN 103494649A
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Abstract
The invention provides an improvement of bone splitting carried out below a lip-cheek crest in oral implantation. The improvement is characterized in that a splitting inlet is located in the lip-cheek crest, and the starting point of a bone splitting line is designed at the near-root end of a concave area of a lip-cheek side bone. The bone splitting method includes the following steps: a horizontal bone splitting cut line is formed at the near-root end of the concave area of the bone through an ultrasonic bone knife, two longitudinal splitting lines are additionally and respectively formed in a near cut, a distant cut and a middle cut, the bone splitting is carried out through the horizontal cut line, and meanwhile an implant, bone implantation powder and a bone cover membrane are implanted. Usually, a Biogide bone membrane is used for covering when Bio-oss bone powder is implanted. The situation that a bone plate is broken in the bone concave area in the splitting process is avoided, the implantation direction of the implant can be in an ideal position, the condition that the implant is supported by sufficient bones around the implant is guaranteed, and retaining of bone cortex of the crest facilitates stability in the early stage.
Description
Technical field
The present invention relates to the Dental Implant implantation, relate in particular in tooth-planting the lower quadrate bone in the lip buccal side ridge top technology of riving.
Background technology
Implant surgery traditional on put method bone piece transplant to exist need open up the second art district, plastotype bad, infect probability large, be difficult to plant the same period body and many drawbacks such as operative cycle length and the absorption of bone piece.If because of the reduction of dental shelf height, the aesthetic effect after repairing is planted in impact greatly in this zone.Single GBR[GBR (guided bone regeneration) Guided Bone Regeneration technology, refer to utilize the barrier film characteristic, prevention, from the fibroblast of surrounding soft tissue, allows the osteoblast at surface of bone place that time enough propagation is arranged, and finally reaches tissue regeneration, directed purpose of repairing.] very difficult maintenance and the plastotype that obtains good bone-grafting material, the skeletonization effect is also unreliable, especially for bone width<5mm case, is difficult to carry out the implantation same period.
After alveolar ridge broadening, Implant can shorten treatment cycle the same period, reduces wound, is the focus of implantology research always.There is the scholar to report and adopt alveolar ridge extruding broadening art, the standard implantation body of the wide implantable 3.75mm of alveoli dentales maxillae ridge at 3-4mm.This technology is utilized the elasticity of osseous tissue, adopts the osteotomes that diameter increases gradually to enlarge implantation body's nest, words side seam plate is subjected to displacement under pressure, until implantation body implants smoothly.But bone extruding art is only applicable to open-textured alveolar bone, the alveolar bone conference that was stressed causes the bone regeneration around implant osteonecrosis, thereby bone extruding art is few for alveolar ridge broadening gradually.Block bone is transplanted and also often is applied to the alveolar ridge broadening of premanillary teeth district, but will open up the second art district, takes from the body bone, has increased wound and the risk of operation.The bone technology for widening plantation indication of riving, reduced surgical engine meeting that bone is transplanted, and guarantees the position that implantation body implants, and the thickness of direction and lip side seam plate, guarantee the long-term functional effect of planting.
As shown in Figure 1, 2, the rive starting point 1 of line of the bone of existing Split-crest is positioned at the alveolus top, and the line 2 of riving is by side, oblique of alveolus top, and otch is parallel or the root general plan is wide, when the alveolar ridge middle part has significant depressions damaged, adopt Split-crest lip side seam lobe easy fracture.
Summary of the invention
The object of the invention is to overcome the shortcoming existed in existing Split-crest, a kind of technology of riving that can avoid the lower quadrate bone in modified model alveolar bone lip buccal side ridge top of lip side seam lobe fracture is provided.
The technical solution adopted in the present invention is the rive improvement of technology of the lower quadrate bone in lip buccal side ridge top in a kind of tooth-planting, and its main points are that its approach of riving pushes up at the lip buccal side ridge; Bone is rived the start design of line at the nearly butt of lip buccal side bone depressed area.
The method that the present invention carries out Split-crest to traditional lip side seam lobe top is improved, the starting point of existing Split-crest is moved down into to the nearly butt of bone depressed area, avoid the weakest lip buccal side bone depressed area of lip side seam lobe, start operation by the nearly butt of lip buccal side bone depressed area, the success rate that makes operation rises to more than 95% by original 80%.
Bone cleaving method step is as follows: do the horizontal shape bone cut line of riving with piezosurgery osteotomy at the nearly butt in bone depressed area, the additional two vertical shapes line of riving in this otch is near, far away, through horizontal shape cut-off lines row Split-crest, the same period Implant, bone grafting powder, lid periosteum.Be generally and plant Bio-oss bone meal lid Biogide periosteum.
The employing collagem membrane covers, and sees the complete covers implants of new bone during secondary operation.Collagem membrane intensity is low, and when the pressure that is subject to from surperficial soft tissue, film can subside in defective region, thereby the osteanagenesis space is lost, and affects the recovery of alveolar bone profile.Thereby while adopting collagem membrane guiding bone regeneration around implant osteanagenesis, the space that needs implantable artificial bone or autologous bone to repair to maintain osteanagenesis, the implantation body that the lip side seam lobe of simultaneously riving and the same period implant also provides effective reparation space for osteanagenesis, the bone lobe plays the effect of support, collagem membrane can effectively stop growing into of soft tissue, and artificial bone or autologous bone maintain the space of osteanagenesis, thereby effectively guide freshman bone tissue to generate.
Check postoperative healing recovery situation in order better relatively to reach, before usually using the CBCT surveying, postoperative 4 lunar increment situations, the concrete steps of operation are as follows:
The concrete steps of operation are as follows:
(1) local anesthesia (usually adopting block anesthesia);
(2) make otch, in the inclined to one side palate side seam of alveolar ridge crest depressed area, nearly butt is made cross sections, the lip side is made trapezoidal cut in the both sides adjacent teeth is near, open the mucoperiosteum lobe to obviously increase place of alveolar ridge thickness, the otch in the lip side is done closely far with piezosurgery osteotomy or microsaws, otch is parallel or the root general plan is wide, apart from the adjacent teeth root of the tooth > 2.0mm, root side to alveolar ridge obviously thickens place, cuts lip side seam cortex, but can not injure palate side seam cortex;
(3) rive, with splitting osteotome, from alveolar ridge crest, along cut-out direction, to root side, dig into gently, gradually lip side seam plate is separated with palate side seam plate, greenstick fracture is formed on bottom, the lip side forms the cortical bone lobe with periosteum, guarantee palate side seam plate thickness > 1.0mm, while planting a plurality of tooth, rive as otch respectively at plan plantation position;
(4) plantation, rive gap location in the desired direction step by step for hole at bone, Implant;
(5) bone grafting powder, lid periosteum, reset after lip side seam lobe is suitably moulding, repaired sharp bone point and bone edge, fills artificial bone meal at the spatium interosseum place, the covering collagem membrane;
(6) sew up the lip side that relaxes soft tissue flap, tight sew up wound under tension-free state;
(7) postoperative film making, check implantation body's situation in place, confirm to plant the body words to position, be thinner than 1mm once body words side seam wall occur planting, should be at corresponding site bone grafting epiphragma;
(8) postoperative conventional doctor's advice, the various forms of dummies of postoperative forbidding 3 weeks, conventional gargle 2-3 week with collutory with the postoperative 2-7Tian， antibiotic medicine, antibiotic medicine of taking, after 10 days, wound healing and taking out stitches when not red and swollen;
(9) postoperative repairing and treating, within postoperative 6 months, clap X line sheet and check the Osseointegrated implants situation, the row secondary operation, open soft tissue flap, checks the stability of bone increment situation and implantation body, measure the alveolar ridge words to thickness, use the tooth position of steel ligature to remove steel wire, upper gingival former, the capable gingivoplasty of soft tissue, produce die after the soft tissue healing, complete reparation;
(10) postoperative check, repaired latter 6 months, 1 year, 2 years periodic reviews, and clinical examination dummy service condition is clapped X line sheet and checked the Osseointegrated implants situation.
The present invention has avoided in the process of riving hone lamella in the jackknifing of bone depressed area; Having guaranteed to plant body implantation direction can be in desirable position; Around having guaranteed to plant body, there are enough bones to support implantation body; Remaining with of Ji Ding district cortical bone is beneficial to primary stability.
The accompanying drawing explanation
Fig. 1 is traditional Split-crest cut line
Fig. 2 is traditional Split-crest approach of riving
Fig. 3 is improvement Split-crest cut line
Fig. 4 is the improvement Split-crest approach of riving
Wherein: 1 bone line starting point 2 line of riving of riving.
The specific embodiment
Below in conjunction with view, the present invention is described in detail, the following examples can make the professional and technical personnel more understand the present invention, but do not limit in any form the present invention.
As shown in Figure 3,4, embodiment 1, the lower quadrate bone in the lip buccal side ridge top improvement of technology of riving in a kind of tooth-planting, the starting point of existing Split-crest is moved down into to the nearly butt of bone depressed area by the alveolus top, avoid the weakest lip buccal side bone depressed area of lip side seam lobe, nearly butt by lip buccal side bone depressed area starts operation, and its approach of riving pushes up at the lip buccal side ridge; Bone is rived starting point 1 design of line at the nearly butt of lip buccal side bone depressed area.
Bone cleaving method step is as follows: do a horizontal shape bone with piezosurgery osteotomy at the nearly butt in bone depressed area and rive cut line as the rive starting point 1 of line of bone, the additional two vertical shapes line 2 of riving near at this otch, far away, through horizontal shape cut-off lines row Split-crest, the same period Implant, the bone grafting powder, the lid periosteum.Be generally and plant Bio-oss bone meal lid Biogide periosteum.
Before the CBCT surveying, postoperative 4 lunar increment situations, the concrete steps of operation are as follows:
(1) local anesthesia, adopt block anesthesia;
(2) make otch, in the inclined to one side palate side seam of alveolar ridge crest depressed area, nearly butt is made cross sections, the lip side is made trapezoidal cut in the both sides adjacent teeth is near, open the mucoperiosteum lobe to obviously increase place of alveolar ridge thickness, the otch in the lip side is done closely far with piezosurgery osteotomy or microsaws, otch is parallel or the root general plan is wide, apart from the adjacent teeth root of the tooth > 2.0mm, root side to alveolar ridge obviously thickens place, cuts lip side seam cortex, but can not injure palate side seam cortex;
(3) rive, with splitting osteotome, from alveolar ridge crest, along cut-out direction, to root side, dig into gently, gradually lip side seam plate is separated with palate side seam plate, greenstick fracture is formed on bottom, the lip side forms the cortical bone lobe with periosteum, guarantee palate side seam plate thickness > 1.0mm, while planting a plurality of tooth, rive as otch respectively at plan plantation position;
(4) plantation, rive gap location in the desired direction step by step for hole at bone, Implant;
(5) bone grafting powder, lid periosteum, reset after lip side seam lobe is suitably moulding, repaired sharp bone point and bone edge, fills artificial bone meal at the spatium interosseum place, the covering collagem membrane;
(6) sew up the lip side that relaxes soft tissue flap, tight sew up wound under tension-free state;
(7) postoperative film making, postoperative shooting X-ray film or clap CT, check implantation body's situation in place, confirm to plant the body words to position.Be thinner than 1mm once body words side seam wall occur planting, should be at corresponding site bone grafting epiphragma.
(8) postoperative conventional doctor's advice, the various forms of dummies of postoperative forbidding 3 weeks, routine is taken antibiotic medicine (as amoxicillin and metronidazole) 1 week with postoperative, collutory for antibiotic medicine (as chlohexidine) is gargled 2 weeks, the dismounting time of suture, can be according to cutting part, the local blood supply situation, patient age decides, general oral cavity is sewn to postoperative 7-10 days and takes out stitches, general 10 days left and right wounds substantially heal and take out stitches when not red and swollen, the situation such as infection not, this can take out stitches in 7 days smoothly in healing, while taking out stitches, the doctor can make and observing and assessment wound, not good enough if heal, or find that there is the situation of splitting in disconnect process, suitably postpone clearing time.The safety of take is guarded as principle;
(9) postoperative repairing and treating, within postoperative 6 months, clap X line sheet and check the Osseointegrated implants situation, the row secondary operation, open soft tissue flap, checks the stability of bone increment situation and implantation body, measure the alveolar ridge words to thickness, use the tooth position of steel ligature to remove steel wire, upper gingival former, the capable gingivoplasty of soft tissue (plasty is exactly that special cutter excises unnecessary gingiva), produce die after the soft tissue healing, complete reparation;
(10) postoperative check, repaired latter 6 months, 1 year, 2 years periodic reviews, and clinical examination dummy service condition is clapped X line sheet and checked the Osseointegrated implants situation.
Dig into gently to root side along cut-out direction from alveolar ridge crest with splitting osteotome, gradually lip side seam plate is separated with palate side seam plate, greenstick fracture is formed on bottom, and the lip side forms the cortical bone lobe with periosteum, guarantees palate side seam plate thickness > 1.0mm.While planting a plurality of tooth, prepare the bone otch of riving intending the plantation position.Rive gap location in the desired direction step by step for hole at bone, Implant.Reset after lip side seam lobe is suitable moulding, repaired sharp bone point and bone edge, at the spatium interosseum place, fill artificial bone meal, cover collagem membrane.If lip side seam lobe poor stability or fracture, will be used the titanium nail to be fixed, to guarantee the stability of bone lobe.The lip side that relaxes soft tissue flap, tight sew up wound under tension-free state.
2. postoperative
Postoperative bat X line sheet or CT examination implantation body situation in place.The various forms of dummies of postoperative forbidding 3 weeks, the conventional postoperative antibiotic of taking, collutory rinsing the mouth 2 weeks, took out stitches after 10 days.
Within postoperative 3-4 month, clap X line sheet and check the Osseointegrated implants situation, the row secondary operation, open soft tissue flap, check the stability of bone increment situation and implantation body, measure the alveolar ridge words to thickness, upper gingival former, the capable gingivoplasty of soft tissue, produce die after the soft tissue healing, complete reparation.6 months, 1 year, 2 years periodic reviews after reparation completes, clinical examination dummy service condition, clap X line sheet and check the Osseointegrated implants situation.It is identical with upper example that all the other do not state part.
Claims (5)
1. the rive improvement of technology of the lower quadrate bone in lip buccal side ridge top in a tooth-planting, it is characterized in that: its approach of riving is lip buccal side ridge top; Bone is rived starting point (1) design of line at the nearly butt of lip buccal side bone depressed area.
2. according to the rive improvement of technology of the lower quadrate bone in lip buccal side ridge top in the described a kind of tooth-planting of claims 1, it is characterized in that: bone cleaving method step is as follows: with piezosurgery osteotomy, at the nearly butt in bone depressed area, do the horizontal shape bone cut line of riving, the additional two vertical shapes line (2) of riving near at this otch, far away, through horizontal shape cut-off lines row Split-crest, the same period Implant, the bone grafting powder, the lid periosteum.
3. according to the rive improvement of technology of the lower quadrate bone in lip buccal side ridge top in the described a kind of tooth-planting of claims 2, it is characterized in that: described bone grafting powder, lid periosteum cover the Biogide periosteum for planting Bio-oss bone meal.
4. according to the rive improvement of technology of the lower quadrate bone in lip buccal side ridge top in the described a kind of tooth-planting of claims 2, the concrete steps of operation are as follows:
(1) local anesthesia;
(2) make otch, in the inclined to one side palate side seam of alveolar ridge crest depressed area, nearly butt is made cross sections, the lip side is made trapezoidal cut in the both sides adjacent teeth is near, open the mucoperiosteum lobe to obviously increase place of alveolar ridge thickness, the otch in the lip side is done closely far with piezosurgery osteotomy or microsaws, otch is parallel or the root general plan is wide, apart from the adjacent teeth root of the tooth > 2.0mm, root side to alveolar ridge obviously thickens place, cuts lip side seam cortex, but can not injure palate side seam cortex;
(3) rive, with splitting osteotome, from alveolar ridge crest, along cut-out direction, to root side, dig into, gradually lip side seam plate is separated with palate side seam plate, greenstick fracture is formed on bottom, the lip side forms the cortical bone lobe with periosteum, guarantee palate side seam plate thickness > 1.0mm, while planting a plurality of tooth, rive as otch respectively at plan plantation position;
(4) plantation, rive gap location in the desired direction step by step for hole at bone, Implant;
(5) bone grafting powder, lid periosteum, reset after lip side seam lobe is suitably moulding, repaired sharp bone point and bone edge, fills artificial bone meal at the spatium interosseum place, the covering collagem membrane;
(6) sew up the lip side that relaxes soft tissue flap, tight sew up wound under tension-free state;
(7) postoperative film making, check implantation body's situation in place, confirm to plant the body words to position, be thinner than 1mm once body words side seam wall occur planting, should be at corresponding site bone grafting epiphragma;
(8) postoperative conventional doctor's advice, the various forms of dummies of postoperative forbidding 3 weeks, conventional gargle 2-3 week with collutory with the postoperative 2-7Tian， antibiotic medicine, antibiotic medicine of taking, wound healing and taking out stitches when not red and swollen after 10 days;
(9) postoperative repairing and treating, within postoperative 6 months, clap X line sheet and check the Osseointegrated implants situation, the row secondary operation, open soft tissue flap, checks the stability of bone increment situation and implantation body, measure the alveolar ridge words to thickness, use the tooth position of steel ligature to remove steel wire, upper gingival former, the capable gingivoplasty of soft tissue, produce die after the soft tissue healing, complete reparation.
5. according to the rive improvement of technology of the lower quadrate bone in lip buccal side ridge top in the described a kind of tooth-planting of claims 4, it is characterized in that: repaired latter 6 months, 1 year, 2 years periodic reviews, clinical examination dummy service condition, clap X line sheet and check the Osseointegrated implants situation.
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Cited By (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN112641539A (en) * | 2021-01-19 | 2021-04-13 | 青岛大学附属医院 | Method for increasing bone volume of personalized coral hydroxyapatite artificial bone block by oral implantation and application thereof |
| CN115317167A (en) * | 2022-08-31 | 2022-11-11 | 美尚(广州)医疗科技有限公司 | Two-section detachable root dividing device in root shield technology and synchronous implantation method |
| CN116491985A (en) * | 2023-06-30 | 2023-07-28 | 首都医科大学附属北京口腔医院 | Miniature ultrasonic detection positioning device for oral cavity |
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2013
- 2013-10-23 CN CN201310498408.1A patent/CN103494649A/en active Pending
Cited By (4)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN112641539A (en) * | 2021-01-19 | 2021-04-13 | 青岛大学附属医院 | Method for increasing bone volume of personalized coral hydroxyapatite artificial bone block by oral implantation and application thereof |
| CN115317167A (en) * | 2022-08-31 | 2022-11-11 | 美尚(广州)医疗科技有限公司 | Two-section detachable root dividing device in root shield technology and synchronous implantation method |
| CN116491985A (en) * | 2023-06-30 | 2023-07-28 | 首都医科大学附属北京口腔医院 | Miniature ultrasonic detection positioning device for oral cavity |
| CN116491985B (en) * | 2023-06-30 | 2023-12-12 | 首都医科大学附属北京口腔医院 | Miniature ultrasonic detection positioning device for oral cavity |
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Application publication date: 20140108 |