EP1185212A1 - Membrane a usage medical pour stimuler la formation tissulaire - Google Patents

Membrane a usage medical pour stimuler la formation tissulaire

Info

Publication number
EP1185212A1
EP1185212A1 EP00927670A EP00927670A EP1185212A1 EP 1185212 A1 EP1185212 A1 EP 1185212A1 EP 00927670 A EP00927670 A EP 00927670A EP 00927670 A EP00927670 A EP 00927670A EP 1185212 A1 EP1185212 A1 EP 1185212A1
Authority
EP
European Patent Office
Prior art keywords
membrane
medical
pulp
medical membrane
cavity
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP00927670A
Other languages
German (de)
English (en)
Inventor
Domonkos Horvath
Felix Lutz
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
HORVATH, DOMONKOS
Original Assignee
Ivoclar Vivadent AG
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from DE19948787A external-priority patent/DE19948787A1/de
Application filed by Ivoclar Vivadent AG filed Critical Ivoclar Vivadent AG
Publication of EP1185212A1 publication Critical patent/EP1185212A1/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C5/00—Filling or capping teeth
    • A61C5/50—Implements for filling root canals; Methods or instruments for medication of tooth nerve channels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K6/00—Preparations for dentistry
    • A61K6/50—Preparations specially adapted for dental root treatment
    • A61K6/54—Filling; Sealing

Definitions

  • the present invention relates to a medical membrane and a method for applying a medical membrane in dentistry.
  • Medical membranes can be used to selectively influence cell types with different growth rates or attachment properties as part of healing processes in the wound area. For example, undesired cell shapes with a higher growth rate are shielded and the colonization of the defect is promoted with cells that regenerate the desired tissue. This process is referred to as controlled tissue regeneration or “guided tissue regeneration.” “Guided bone regeneration” is used when, with the use of membranes, rapidly growing epithelial and connective tissue cells are specifically prevented from colonizing and proliferation in the wound area, and thus slowly growing bone cells the possibility is given to take over the defect healing.
  • Such membranes are made from various substances, absorbable from “collagen” or “polylactic / polyglycolide acid polymer” or “copolymer” and non-absorbable from “polytetrafluoroethylene”. Absorbable membranes are left in situ; non-resorbable are removed after they have fulfilled their task.
  • This object is achieved with a generic medical membrane according to claim 1.
  • This is a membrane which, particularly with regard to its size and nature, allows a pulp opening to be covered in a cavity in the dentin of a tooth. It turns out that by protecting the membrane, the regeneration ability and vitality of the pulse pa is improved. In addition to the direct opening of the pulp, deep dentin wounds are also caused by tangling the small tubules, which place a great strain on the pulp and thus injure the pulp.
  • a membrane is preferred which is suitable for
  • Sealer or is essentially impervious to cement. Essentially impermeable means that the membrane is impermeable to substances that interfere with pulp and / or dentine regeneration.
  • a membrane is preferred which has at least one roughened surface in order to allow the attachment of fibrin threads, the attachment and ingrowth of pulpafibroblasts and other cells.
  • the roughened surface is porous and / or network-like.
  • the porous and / or mesh-like design of the membrane simultaneously enables molecules or ions to diffuse through the membrane.
  • the membrane has a roughened surface, which is preferably porous and / or mesh-like, but on the other hand, to protect the pulp, it is at least impermeable to substances which interfere with pulp regeneration.
  • This can e.g. can be achieved with a bilayer design in which impermeability to interfering substances is achieved by forming the membrane material more densely than in the area facing away from the pulp.
  • the passage of interfering substances is prevented by a differently structured membrane on the side facing away from the pulp on the side facing the pulp, with a differently structured, especially impermeable
  • the membrane must be so impermeable that, at least for a short time, substances that interfere with pulp and dentin regeneration are prevented, so that a tightly sealing, preferably hard-setting coating is possible in situ after application of the membrane.
  • the pore or mesh portion of the porous or mesh-like surface of the membrane pad facing the pulp be greater than 20%, preferably greater than 50%.
  • the proportion of pores or meshes favors the attachment and the integration of the regenerative cells and thus ensures wound healing, and if the pulp is kept vital, this is preferably followed by hard substance formation which closes the opening of the pulp.
  • a particularly good integration of the regenerative cells occurs when the average pore diameter or mesh size is between 0.5 ⁇ m and 200 ⁇ m, preferably around 1 ⁇ m to 100 ⁇ m.
  • a membrane is advantageous which shows self-adhesion to the hard tooth substance or adheres to the hard tooth substance by adhesive coating without endangering the pulp, so that the sealing overlayer, which in turn preferably shows adhesion to the hard tooth substance, such as, for example, glass ionomer cements or light-curing glass ionomer cements, does not come into direct or indirect contact with the pulp tissue due to the impermeability of the membrane.
  • the medical membrane according to the invention per se or preferably after hard-setting sealing or coating, forms a preferably hard and tight barrier between the pulp opening and the adjacent dental hard substance on the one hand and the restoration built up over the membrane or over the sealed or layered membrane on the other hand, the latter partially or completely replaced the missing tooth structure.
  • the impermeability of the membrane which is inherent or achieved by overlaying, ensures that neither substances from the pulp to the restoration nor substances from the restoration to the pulp can get.
  • the membrane is therefore sealed per se or after overlaying against the penetration of liquids such as blood, serum or water.
  • liquids such as blood, serum or water.
  • it is biologically impermeable to cells and microorganisms and, to the extent necessary for biocompatibility, it is chemically impermeable to molecules and ions, which disrupt the regeneration of pulp and dentin.
  • the membrane has an area of less than 100 mm, preferably less than 50 mm 2 .
  • the medical membranes usually offered in larger units are not only completely unsuitable for covering pulp openings due to the lack of adhesion, thickness and tightness. Also, such membranes cannot be cut to the appropriate size in practice, since the membranes must be very small and also sterile, and thus any cutting and fitting of an unpacked membrane unacceptably increases the risk of infection. The expensive residual membrane pieces should not be picked up for reasons of sterility.
  • membrane pads that are less than 3 mm and preferably se less than about 0.5 mm thick. Since thin membranes can have a porosity or density that is sufficient for dentin regeneration, thin membranes are preferably used because of the improved possibility of adaptation.
  • the membrane pads are used particularly advantageously within generally concave cavities or fracture surfaces, it is proposed that the membrane pads are preferably round or oval. Such a membrane pad shape can be optimally inserted into the resulting hemispherical cavity after excavating dentine caries.
  • a 1 to 2 mm wide, preferably adhesive contact surface on the dental hard tissue surrounding the pulp opening enables the membrane to be placed securely and initially tightly.
  • a concave or convex design of the membrane is also advantageous.
  • the concave, convex or straight version of the membrane enables a dome-like covering of the pulp opening or a clinging of the membrane to the concavity of the existing cavity.
  • the membrane has a carrier film which is biologically and chemically sealed and preferably completely covers the actual membrane pad or at most projects beyond it, the pad-free peripheral part of the carrier film preferably being self-adhesive on the pulp side like a quick dressing.
  • This carrier film facilitates the exact positioning of the membrane pad within a cavity in the tooth.
  • the carrier film provides a tight, adhesive connection to the tooth structure and also acts as a barrier to the superstructure. Good results can be achieved with membranes which are made from a non-absorbable material, such as, for example, poly-tetrafluoroethylene or preferably titanium. These membranes are not rejected by the body and titanium is suitable for the production of po- structures and, on the other hand, particularly good as an impermeable material.
  • membranes made from a resorbable material preferably collagen. These membranes specifically promote the attachment and integration of pulpal fibroblasts and other regenerative cells and in the short term are sufficiently tight for a sealing, hard-setting covering or can be made biologically and chemically tight using a carrier film.
  • the membranes are preferably made tear-resistant, but can be cut.
  • a soft, cloth-like design makes it freely deformable and adaptable.
  • Reinforcements in the membrane body or structural modifications can be achieved, for example, by titanium lamination or another biologically inert material.
  • An individual three-dimensional shape can be achieved with membranes that are plastically deformable (lead-dead) thanks to reinforcements, for example.
  • the surface of the membrane facing away from the pulp and thus facing the restoration is preferably inert, so that no bond to the restoration is created in order to completely avoid the transfer of shrinkage forces which arise from the polymerizing restoration to the membrane.
  • This inertia is preferably achieved by tefionization, hydrophilicity or the use of a non-radical polymer.
  • the surface of the membrane facing away from the pulp and thus facing the restoration forms a mechanical or adhesive bond to the restoration in order to ensure a seamless, tight seal of the membrane-supported pulp covering.
  • This bond is preferably achieved by interlocking, interlocking, homo- or copolymerization or secondary or primary chemical bonds.
  • a dense, mechanical and / or adhesive bond to the hard tooth substance, especially dentine, is preferred. achieved by mechanisms of dentin adhesion, preferably after activation of the adjacent dentin. This can also be achieved by interlocking, interlocking, homo- or copolymerization as well as secondary or primary chemical bonds.
  • the inner surface facing the pulp and thus facing away from the restoration is preferably biocompatible, attachment- or cell integration-friendly and sterile.
  • growth factors or "bone morphogenetic proteins” can be added to the membrane or pharmacological effects, such as “soft” or “hard” chemotherapeutic effects, can be achieved with the membrane, which are based, among other things, on bacteriostatic or bacteriological effects.
  • tissue-stimulating effects which lead to the formation of tertiary dentine, for example, can also be supported by the special design of the membrane.
  • Figure la a small round membrane with a round, overlapping carrier film
  • Figure lb a small round membrane with a round carrier film, which has the size of the membrane
  • FIG. 2a shows a larger round membrane with a round, overlapping carrier film
  • FIG. 2b shows a larger round membrane with a round carrier film, which has the size of the membrane
  • FIG. 2c shows a larger round membrane without a carrier film
  • Figure 3a shows a large round membrane with a round, overlapping carrier film
  • Figure 3b shows a large round membrane with a round
  • Carrier film that is the size of the membrane is the size of the membrane
  • FIG. 4a shows a small square membrane with a square, overlapping carrier film
  • FIG. 4b shows a small square membrane with a square carrier film which has the size of the membrane
  • FIG. 4c shows a small square membrane without a carrier film
  • FIG. 5a an oval membrane with an oval, overlapping carrier film
  • FIG. 5b shows an oval membrane with an oval carrier film, which has the size of the membrane
  • FIG. 5c shows an oval membrane without a carrier film
  • FIG. 6a shows a rectangular membrane with a rectangular, overlapping carrier film
  • FIG. 6b shows a rectangular membrane with a rectangular carrier film, which has the size of the membrane
  • FIG. 6c shows a rectangular membrane without a carrier film
  • FIG. 7 shows a section through a tooth with a cavity on the right
  • FIG. 9 shows a section through a tooth with a deeper right-hand cavity
  • FIG. 10 shows a three-dimensional representation of a tooth with a cavity and an applied membrane
  • FIG. 11 shows a section through a tooth with an applied membrane and inserted filling
  • FIG. 12 shows an enlarged detail from FIGS. 11 and
  • Figure 13 shows an application instrument for a medical membrane.
  • Figures 1 to 6 show different embodiments of membranes 1 to 6, each consisting of a porous membrane part 7 to 12 and a dense carrier film 13 to 18.
  • the carrier film 13 to 18 is each larger than the membrane portion 7 to 12, so that it protrudes beyond the edge area of the membrane part 7 to 12.
  • the carrier film 13 to 18 can also be the same size as the membrane 7 to 12 ( 13 ⁇ to 18N.
  • the function of the carrier film 13 to 18 or 13 'to 18' can also be assumed by coating the membrane in situ , after the membrane has been applied without a carrier film 7 to 12 'primarily adhering to the dentine area surrounding the hard tooth substance.
  • FIGS. 1 to 6 are only exemplary embodiments for frequently used forms. Depending on the application, other forms of medical membranes with and without a carrier film or with and without an overlay can also be used.
  • FIGS. 7 to 9 show a cavity 19 on a tooth 20 which cuts the pulp 22 in the region 21.
  • This area surrounding the open pulp serves as a surface for supporting one of the membranes 1 to 6.
  • FIG. 8 shows another cavity 24 on a tooth 25 through which the left branch of the pulp 26 is cut.
  • This cavity 24 is also designed in such a way that an at least annular contact surface 28 made of dentine remains around the cutting area 27 of the pulp 26.
  • FIG. 9 shows a pulp 30 of a tooth 31 cut laterally through a cavity 29.
  • the cut surface 32 between the cavity 29 and the pulp 30 lies in a vertical plane, with an at least annular contact surface 34 made of dentine also being provided around the cut region 33.
  • the contact surface formed around the cut pulp can also lie obliquely in the tooth and will be designed differently depending on the situation. Therefore, there are various prefabricated, sterile packaged membrane pads 1 to 6, which are shaped differently so that they can be used in a wide variety of situations.
  • the membrane part 7 is supported on an edge between the cavity 35 and the pulp 38 recognizable.
  • the carrier film 13 lies above the membrane part 7. It is designed such that it can be pressed against the lower side of the cavity 35 and ensures a seal between the filling 40 and the pulp 38. What is important here is the sealing of the defect edges by a suitable adaptation of the edges of the membrane pad 1, so that the lateral penetration of undesirable substances, for example when overlaying with a hard-setting sealant adhering to the hard tooth substance, such as a light-curing glass ionomer cement or during the restoration of the Defective tooth structure 40 is prevented.
  • the sectional drawing in FIG. 12 shows the tooth 36 shown in FIG. 10 with a membrane pad placed thereon, which is constructed according to the bilayer principle and has no carrier film. Sealing takes place within the cavity 35 primarily through the membrane in the area of the dentin that surrounds the pulp opening.
  • the membrane is covered in situ with a light-curing glass ionomer cement 39 which is self-adhering to the dentin of the cavity 35 and light-curing.
  • the tooth structure defect is supplemented with the restoration 40, which is imperative adhesive and dense.
  • FIG. 13 shows a device 40 for applying a medical membrane 1 in a dentin cavity 41 of a tooth 42, which cuts the pulp 43.
  • the device 40 comprises a handle 44, to which a fit 45 can be attached and removed.
  • the fit 45 preferably has a shape corresponding to the cavity, for example spherical or flat, in order to allow the medical membrane to be pressed on, so that there is no marginal gap and an overlay with, for example, light-curing glass ionomer cement is possible.
  • the fitting 45 of a material such as composite, ceramic or plastic ⁇ material remaining after hardening in the cavity and becomes a part of the filling.
  • the fit 45 is attached to the handle 44 of the device 40 such that it is easy for the surgeon to put on and take off.
  • the desired diameter of the pulp pads 1 to 6 ranges between 1 mm and 10 mm, depending on the size of the cut surface of the pulp or the cavity. For a sufficient circular seal, an approx. 1 to 2 mm wide zone around the open pulp is required. This is to prevent any contact of the open pulp in the marginal area with foreign and toxic materials a priori.
  • the membranes used are with the
  • the membrane pad can be left in situ indefinitely and thus becomes part of the underfill.
  • the lower side of the pulp pad corresponds to the structure of known medical membranes, an average pore diameter between 1 ⁇ m and 100 ⁇ m and a pore fraction of over 50% being preferred. This pore diameter offers the regenerative cells and extracellular substances such.
  • Successful treatment depends on whether the work is done in a sterile manner, that is to say without germ contamination for the pulp, and whether the pulp is not exposed to filling materials or microorganisms penetrating from the outside except for the sterile membrane. It is also important to ensure that the porous The membrane part is absolutely close to the dentin. Depending on the cavity, the membrane can be placed flat on the pulp or as a convex or concave membrane part.
  • a membrane according to the invention is preferably sterile packed in order to allow sterile working.
  • the membrane pads described are of the greatest importance for medical dental treatment, since no primary wound healing has been achieved so far with pulp openings, but instead, by layering Ca (OH) 2 , necrosis that causes the pulp in the underlying pulp tissue is caused, under whose "protection" Tertiary dentine can then develop as part of an inflammatory reaction.
  • This is only possible in young patients with a high willingness to regenerate pulp. Since the pulp has no collateral circulation and is only capable of limited defense, larger wound cross-sections exceed the ability to regenerate. In the elderly, for whom the number of dentin-forming stem cells is only low, success has rarely been expected.
  • the membrane pads according to the invention offer ideal conditions in the tooth interior for primary wound healing of the opened pulp.

Landscapes

  • Health & Medical Sciences (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Epidemiology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Dentistry (AREA)
  • Materials For Medical Uses (AREA)
  • Dental Tools And Instruments Or Auxiliary Dental Instruments (AREA)
  • Dental Preparations (AREA)

Abstract

La membrane pulpaire dentaire sert à recouvrir de manière stérile et étanche la pulpe ouverte et/ou partiellement résectée, dans une plaie profonde due à un traumatisme ou résultant d'une mesure de restauration. Selon l'invention, cette membrane pulpaire est biocompatible au moins sur le côté qui fait face à la pulpe et s'utilise en raison de sa composition, de sa structure et de la texture superficielle pour favoriser l'accumulation cellulaire, l'intégration cellulaire et la régénération tissulaire, qui sont en outre éventuellement stimulées par des facteurs de croissance et/ou des principes actifs bactériostatiques ou bactéricides. Cette membrane pulpaire est auto-adhésive ou adhésive sur la substance dure de la dent, qui délimite l'ouverture de la pulpe, de manière à assurer une étanchéité hermétique. Ladite membrane est auto-adhésive ou adhésive sur le côté opposé à la pulpe, de manière à être imperméable aux substances solides ou liquides et aux cellules, voir à avoir un effet isolant, afin de permettre l'application d'un revêtement suffisamment imperméable, adhérant à la substance dure de la dent, de préférence un revêtement à prise ferme. Cette membrane fait de préférence moins de 100 mm2 de superficie et moins de 3 mm d'épaisseur. Elle est préfabriquée dans différents formats, sous forme de bloc membranaire et est conditionnée de manière stérile.
EP00927670A 1999-06-10 2000-05-31 Membrane a usage medical pour stimuler la formation tissulaire Withdrawn EP1185212A1 (fr)

Applications Claiming Priority (5)

Application Number Priority Date Filing Date Title
DE19926438 1999-06-10
DE19926438 1999-06-10
DE19948787A DE19948787A1 (de) 1999-06-10 1999-10-10 Medizinische Membran zur Anregung der Gewebebildung
DE19948787 1999-10-10
PCT/IB2000/000730 WO2000076418A1 (fr) 1999-06-10 2000-05-31 Membrane a usage medical pour stimuler la formation tissulaire

Publications (1)

Publication Number Publication Date
EP1185212A1 true EP1185212A1 (fr) 2002-03-13

Family

ID=26053719

Family Applications (1)

Application Number Title Priority Date Filing Date
EP00927670A Withdrawn EP1185212A1 (fr) 1999-06-10 2000-05-31 Membrane a usage medical pour stimuler la formation tissulaire

Country Status (5)

Country Link
EP (1) EP1185212A1 (fr)
JP (1) JP2003501201A (fr)
AU (1) AU4605500A (fr)
CA (1) CA2376328A1 (fr)
WO (1) WO2000076418A1 (fr)

Families Citing this family (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP4056837B2 (ja) * 2002-09-19 2008-03-05 株式会社ジーシー う蝕リスク検査方法
KR101370023B1 (ko) * 2012-04-06 2014-03-06 서울대학교산학협력단 합성고분자 나노섬유메시와 ｍｔａ를 포함하는 치수질환 치료용 조성물
KR101509322B1 (ko) * 2013-07-31 2015-04-07 전북대학교산학협력단 치아 임플란트용 차폐막 및 그 제조방법
WO2015037945A1 (fr) * 2013-09-13 2015-03-19 서울대학교산학협력단 Composition pharmaceutique pour thérapie de régénération de la pulpe dentaire et thérapeutique d'apexification comprenant un inhibiteur de la prolyl-hydroxylase ou un inhibiteur de l'histone désacétylase et des antibiotiques, et réseau de nanofibres de polymères synthétiques comprenant la composition
CN107307914A (zh) * 2017-08-09 2017-11-03 张迎春 一种口腔临床用于牙髓腔减压暂封膜

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* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US2644232A (en) * 1950-03-25 1953-07-07 Vahe S Roubian Insulating and medicinal pad for dental cavities
DE953831C (de) * 1954-04-25 1956-12-06 Dr Julius Walser Einrichtung zur Aufbewahrung und Entnahme von Isolierschichten zum Schutz der Pulpa gegen thermische und chemische Reize durch Zahnfuellungen
DE9317896U1 (de) * 1993-06-09 1994-03-03 Gottschall, Peter, 88524 Uttenweiler Instrument zum Handhaben eines Zahninlays
DE29521058U1 (de) * 1995-05-22 1996-08-14 Schumacher, Dieter, 24768 Rendsburg Kalottenförmige Inlays
DE29608674U1 (de) * 1996-05-14 1996-08-08 Schmidt, Birgit, 47229 Duisburg Provisorische Zahnfüllung
DE19948787A1 (de) 1999-06-10 2001-01-25 Domonkos Horvath Medizinische Membran zur Anregung der Gewebebildung

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
See references of WO0076418A1 *

Also Published As

Publication number Publication date
CA2376328A1 (fr) 2000-12-21
AU4605500A (en) 2001-01-02
JP2003501201A (ja) 2003-01-14
WO2000076418A1 (fr) 2000-12-21

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