EA036420B1 - Method for fixing a resorbable membrane in a cavity of a jaw bone defect - Google Patents

Abstract

The invention relates to maxillofacial surgery, and allows for stable fixing a membrane in a cavity of a bone defect, which permits obtaining a high quality structure of the bone tissue of the required volume due to the fact that a membrane is laid from the root of the tooth under consideration, and the bone defect is filled with hydroxyl apatite grits, a perforated external cortical plate of the bone is covered with the membrane and with a pre-cut mucoperiosteal flap of the required size, with further suturing along the perimeter of this flap.

Description

The invention relates to maxillofacial surgery and relates to methods for fixing a resorbable membrane for subsequent optimization of bone tissue regeneration after cystectomy.

A known method of fixing a resorbable membrane in a bone defect of the jaw, which consists in the fact that the membrane is fixed with sutures to the soft tissues in the area of the formed defect [1-4].

This method is a prototype in relation to the claimed one.

Common features for the proposed method and prototype are the incision of the mucous membrane in the projection of the root apex of the causative tooth of the oral cavity for the subsequent cutting of the muco-periosteal flap, the implementation of cystectomy and resection of the tooth root apex, followed by fixation of the resorbable membrane to the soft tissues.

However, the prototype method has the following disadvantages, since the crumb of hydroxyapatite is introduced into the bone wound directly with the blood clot, which violates its stabilization;

hydroxyapatite crumbs adhere tightly to the bone, which causes an inflammatory response to a foreign body and creates a deficit of space for bone cell regeneration, which slows down their growth;

in addition, the resorbable membrane is fixed to the soft tissues with suture material, which causes additional trauma to the operating field and a pronounced inflammatory reaction, while increasing the healing time.

This method of membrane fixation provides the necessary high-quality stabilization of the blood clot without damaging it in the wound, prevents membrane displacement and allows the volume of the jaw bone tissue to be restored and at the same time protects the wound from contamination by microorganisms.

The objective of the claimed invention is to create a method for stable fixation of a resorbable membrane in the cavity of a bone defect, taking into account the individual clinical situation.

The task is achieved in the following way.

A method of fixing a resorbable membrane in the cavity of a bone defect of the jaw caused by the development of a root cyst of a tooth is proposed, which consists in the fact that an incision of the mucous membrane is made in the projection of the root apex of the causal tooth of the oral cavity for subsequent cutting out of the mucoperiosteal flap, cystectomy, resection of the root apex and retrograde filling the root canal of the tooth, then with a pre-selected membrane, the size of which is 10-15 mm larger than the size of the created operational defect, cover the root of the tooth, after which a crumb of hydroxyapatite is applied to the membrane by grinding 200-1000 microns until the defect is filled with crumb, after which the free edge of the membrane , which protrudes beyond the limits of the operating defect, is tucked and placed on the outer cortical plate of the bone, in which perforations are previously created, in the amount of 5-7 to the depth of the cortical layer of the bone, for the possibility of unhindered release of osteob cells fins into the wound area, over the defect into the base of the mucoperiosteal flap, after which the flap is placed on the membrane and fixed with sutures along the perimeter of the incision.

The applicant, based on the clinical studies of 28 patients observed in the postoperative period for 12 months, created an algorithm for the proposed method, which takes into account the peculiarities of individual clinical situations associated with the cystectomy operation.

The inventive method is shown in FIG. 1-4, where in FIG. 1 shows a diagram of the initial clinical situation, which shows the causative tooth 1, the radicular cyst 2 of the causative tooth 1, the bone defect 3, formed by the development of the radicular cyst 2;

in fig. 2 shows a diagram of the stage of surgical treatment, which shows a cut mucous-periosteal flap 4, causal tooth 1 after cystectomy, resection of the root apex, retrograde filling of the canal 5, perforated cortical bone plate 6, resorbable membrane 7, laid over the root of the causal tooth 1, introduced into the bone defect 3 on top of the membrane 7, hydroxyapatite crumb 8;

in fig. 3 shows a diagram of surgical treatment, which shows the free edge of the membrane 9, tucked to the base of the mucoperiosteal flap 4 and laid on the perforated outer cortical plate 6 of the bone over the defect 3 at the base of the mucoperiosteal flap 4;

in fig. 4 is a schematic diagram of treatment outcomes after 12 months, showing the restored bone structure 10

An example of the method.

For antiseptic treatment, rinse with 0.05% aqueous chlorhexidine solution is used. Local anesthesia, infiltration and conduction are performed. From local anesthetics, Ultracaine Forte 4% - 1.7 ml or Ubistezin Forte 4% - 1.7 ml are used. Then, cytectomy is performed on the upper or lower jaw with resection of the roots of the teeth, followed by replacement of the cavity of the bone defect with a resorbable membrane 7 (Fig. 2) as follows: in the cavity of the bone defect 3 (Fig. 1) above the root of the causative tooth 1 (Fig. 1), the edge of the membrane 7 (Fig. 2) facing the base

- 1 036420 mucoperiosteal flap 4 (Fig. 2), then on top of the membrane 7 (Fig. 2) crumb 8 (Fig. 2) of hydroxyapatite is applied by grinding 200-1000 μm, then the free outer edge of the membrane 9 (Fig. 3) tucked to the base of the mucoperiosteal flap and placed on the outer cortical bone plate with perforations 6 (Fig. 3), then the mucoperiosteal flap 4 (Fig. 2) is placed over the membrane 7 (Fig. 3) for subsequent fixation with separate interrupted sutures along the perimeter of the cut.

The study involved 42 patients. The patients were divided into two groups.

In group I (14 people), patients were observed with a diagnosis of a radicular cyst in the upper or lower jaw, while the study included patients who had a bone tissue defect of more than 2.0 cm on the roentgenogram.The patients underwent cystectomy with resection of the root apex of the causative tooth and replacement of the bone defect in a known standard way [5] (a crumb of hydroxyapatite was placed into the bone defect with a blood clot, then a resorbable membrane was placed on top of the defect and fixed with sutures.

In group II (28 people), patients with a diagnosis of a radicular cyst of the upper or lower jaw were observed, while the bone tissue defect on the roentgenogram was more than 2.0 cm.Cystectomy was performed with resection of the causative tooth apex and replacement of the bone defect by the claimed method.

After 12 months, cone-beam computed tomography (CBCT) was performed to analyze the newly formed bone tissue in the area of the postoperative bone defect based on the Hounsfield index.

The results of applying the standard method and the proposed method for fixing the resorbable membrane showed that 10 patients of group I with standard fixation of the membrane, the values of the total mineral density index corresponded to 500 units. (M ± m) Hounsfield index, i.e. bone tissue in the area of the defect corresponded to the average mineral density. In 4 patients, the values of the general mineral density index corresponded to 380 units. (M ± m) Hounsfield index, which corresponded to low bone mineral density. [6].

In group II with the proposed method, the Hounsfield index in all patients corresponded to 850 units. (M ± m), which indicated the normal value of the mineral density of the jaw bones.

When studying the processes of bone tissue regeneration in the area of a bone defect in group I, it was found that, in most cases, the defect was not completely filled with bone tissue. CBCT after 12 months showed only partial restoration of bone tissue in the area of the defect (on average - 58.0%). In some cases, the border of the regenerate and the wall of the alveolar bone was noticeable.

In the group of patients (28 people), where the claimed method was applied, the structure of bone tissue was determined as coarse-mesh and trabecular, bone tissue recovery was 95.6%, the height of the alveolar ridge compared with the initial level decreased by 0.49 ± 0.07 mm, which is significantly less than in the standard group (p <0.05).

Thus, the achieved technical result of the proposed method for fixing a resorbable membrane is that the technology of its implementation has a positive effect on the processes of active regeneration with the formation of a normal bone structure. All patients were examined by the applicant in the postoperative period after 12 months. The examination showed that the patients of the study group had no recurrence of root cysts of the causative teeth, as well as the absence of postoperative defects in the jaw bone tissue. The method is technologically relatively simple, reliable and effective, allows obtaining high-quality results of surgical treatment and, in this regard, can find wide application in surgical dental practice.

Literature:

1. Reconstructive surgery of the alveolar bone / S.Yu. Ivanov, A.A. Muraev, N.F. Yamurkova. M .: GEOTAR - Media, 2016 .-- 360 p .: ill.

2. Ivanov, S.Yu. The use of membrane technology for targeted regeneration of bone tissue during dental surgical interventions // Ivanov S.Yu., Gazhva Yu.V., Muraev A.A., Bonartsev A.P. // Modern problems of science and education. - 2012. - No. 3.

3. Vedyaeva, A.P. The effectiveness of the use of a bioresorbable collagen membrane in combination with chitosan for the restoration of bone tissue (experimental study) / A.P. Vedyaeva, P.V. Ivanov, N.V. Bulkina, D.V. Nikishin // News of higher educational institutions. Volga region. Medical sciences. - 2015. - No. 3 (35). - S. 50-61.

4. Wolf G.F. Periodontics / Herbert F. Wolf, Edith M. Rateitshak, Klaus Rateitshak; Per. with him. ed. prof. G.M. Barrera. - M .: MEDpress inform, 2008 .-- 548 p .: ill.

5. Cohen E.S. Atlas of Cosmetic and Reconstructive Periodontal Surgery / E.S. Cohen; per. from English. under the general ed. OO Yanushevich. - M .: Practical medicine, 2011. - 512 p .: ill.

6. Pohodenko-Chudakova I.O. Changes in the bone density of the jaw bones in patients depending on the presence of systemic osteoporosis / I.O. Pohodenko-Chudakova, T.L. Shevela // Bulletin of the Fund for Fundamental Research. - No. 4 (82). - 2017 .-- S. 109-113.

Claims (1)

CLAIM A method of fixing a resorbable membrane in the cavity of a bone defect of the jaw caused by the development of a root cyst of a tooth, for which an incision of the mucous membrane is performed in the projection of the root apex of the causative tooth of the oral cavity for subsequent cutting out of a mucoperiosteal flap, cystectomy, root apex resection and retrograde filling of the root canal of the tooth , then with a membrane, the size of which is 10-15 mm larger than the size of the created operational defect, the tooth root is covered, after which a crumb of hydroxyapatite is applied to the membrane by grinding 200-1000 microns until the defect is filled with crumb, after which the free edge of the membrane, which protrudes beyond the operating defect, tucked to the base of the mucoperiosteal flap and placed on the outer cortical plate of the bone, in which perforations were previously created in the amount of 5-7 per cortical layer thickness, for the possibility of unhindered exit of osteoblast precursor cells into the wound the zone, over the defect at the base of the mucous-periosteal flap, after which the flap is placed on the membrane and fixed with sutures along the perimeter of the incision.