JP2011218054A - Peeling device for mucous membrane of maxillary sinus - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a peeling device for mucous membrane of maxillary sinus safely and extensively peeling sinus mucous membrane off a supramaxilla (subantral bone) without using a cutting tool for reaching the sinus mucous membrane.SOLUTION: The peeling device for mucous membrane of maxillary sinus 10 to press a liquid 22 into the supramaxilla B and to peel the mucous membrane of maxillary sinus A off the supramaxilla B comprises a hollow head member 20 formable of watertightness in relation to the supramaxilla B, an injection means 16 to inject the liquid 22 at predetermined pressure from the hollow head member 20, and a flexible tube 18 whose one end is connected to the hollow head member 20 and the other end is connected to the injection means 16.

Description

  The present invention relates to a maxillary sinus mucosa peeling device that presses water such as physiological saline into the maxilla and peels the maxillary sinus mucosa from the maxilla.

  When the artificial root is applied to the maxillary bone that has lost teeth, especially the molar part of the maxilla, especially in cases where the bone thickness of the part is thin, ie from the maxillary ridge side of the maxilla to the maxillary sinus In cases with a short distance, there is a risk that the artificial root protrudes into the maxillary sinus and develops maxillary sinusitis, and even if the artificial root can be combined with the bone without causing maxillary sinusitis, The occlusion and chewing ability is not sufficient. When an artificial tooth root is applied, the thickness of the maxilla is usually required to be at least 6 mm, but there are very many cases of the maxilla without the thickness.

  The maxillary maxillary bone usually decreases in thickness after tooth extraction due to growth and expansion of the maxillary sinus and bone resorption from the suppository side. In extreme cases, it may reach a state of 1 mm or less. When an artificial tooth root is applied to such a case, a bone proliferating operation for increasing the bone thickness must be performed in advance or simultaneously with the application of the artificial tooth root. In cases where the upward movement of the jaw ridge is strong, bone growth on the jaw ridge side is necessary, and the present inventor has proposed a new technique for bone growth on the chin ridge side (see Patent Document 1). However, in cases where the maxillary ridge is thin and the maxillary bone is thinned due to the enlargement of the maxillary sinus, bone augmentation surgery (so-called sinus lift) on the maxillary sinus side is necessary.

  The sinus lift on the side of the maxillary sinus is a technique in which bone growth is compensated between the maxillary bone constituting the maxillary sinus base, that is, the sinus base bone and the very thin sinus mucosa attached thereto. When supplementing the growth, it is necessary to exfoliate the sinus mucosa from the bone in an intact state in advance. This sinus mucosal detachment is the most difficult procedure in this operation, and if the sinus mucosa detachment can be done safely, the subsequent bone growth can be compensated relatively easily.

  Such sinus lifts can be divided into narrow sinus lifts and socket lifts. The sinus lift in the narrow sense is used for cases where the maxilla is thin over a wide range and a plurality of artificial dental roots are to be applied. This sinus mucosal detachment in the sinus lift is also called a lateral approach. Conventionally, a round bar attached to the electric engine above the buccal side of the maxilla, that is, the buccal wall of the maxillary sinus, will not damage the mucous membrane. A method has been adopted in which a bone is drilled and a hole is made in the bone (open window), and after this fenestration, the sinus mucosa is enlarged and peeled away from the sinus floor bone with a bent spatula-like tool. This technique for making holes in bones is an advanced technique that is equivalent to making holes in an egg shell without damaging the inner thin membrane, and has a high risk of damaging the sinus mucosa at the same time as making holes in the bones. It was. Also, even if a hole can be drilled in the bone without damaging the sinus mucosa, there is a risk that the sinus mucosa will be broken in the process of expanding the exfoliated part of the sinus mucosa, and the shape of the maxillary sinus base is complicated. In some cases, this risk was even higher.

  In order to reduce such a risk, recently, a technique called piezosurgery has been introduced in which fine vibrations are applied to various forms of metal tools (terminals, chips, cutting tools) to cut bones (for example, Patent Document 2). reference). However, even with this expensive special tool, there is a risk of damage to the mucosa because part of the tip locally contacts the sinus mucosa in the final stage of bone cutting, and as soon as the bone is cut. There is still a risk that the tip will compress and break the mucous membrane. In addition, the risk of mucosal damage in the process of exfoliating the mucosa extensively by hand is still present.

  On the other hand, the socket lift is usually used for cases in which there are one or two maxillary teeth missing and the maxillary bone thickness is about 4 to 5 mm. Applying sinus lift as described above to such a small defect site is that the site is narrow, the maxillary sinus floor is locally lowered, and the shape of the sinus floor bone is complicated Because of the large number of bones on the side wall of the maxillary sinus and the fact that many of these defects are molars and the surgical site is in the back of the oral cavity. It is more difficult than the case where the deficit range is wide. In cases where the missing part of the tooth is narrow and the maxillary bone thickness is about 4-5 mm, a corresponding part of the bone has been drilled from the suppository side to the vicinity of the sinus floor bone with a normal cutting instrument (Crestal approach). In many cases, a technique has been adopted in which the remaining bone (sinus floor bone) is struck and the sinus mucosa is peeled off along with the fractured bone fragment. However, this technique not only breaks the sinus mucosa, but also has a high risk of causing bone fragments to enter the maxillary sinus.

  Therefore, recently, the last bone is cut with a special bar instead of making a bone fracture after additional hitting, the cutting bone piece is fed to the tip of the blade, and when the bone is completely cut, the cutting piece is cut into the tip and mucous membrane of the blade. Cutting tools that try to push up and peel off the mucous membrane without damaging the mucous membrane by being interposed in between have been commercialized. However, such a special bar also has a sharp blade at its tip, and there is a risk that the bone cutting piece does not intervene between the two well and breaks the mucous membrane.

  In addition, the piezosurgery described above has been applied to such a crestal approach, but it is not necessarily safe as in the lateral approach. Furthermore, at the time of immediate artificial tooth placement immediately after tooth extraction, a diamond bar is attached to the air turbine toward the maxillary sinus and the bone is cut through the extraction cavity, and the sinus mucosa is removed with water and air blowing from the hole when the hole is made. How to do it is also introduced. In any case, the sinus mucosa adjacent to the sinus mucosa is cut with a certain tool, and the risk of damage to the sinus mucosa is not eliminated. Even if the sinus mucosa is pushed up without damaging the mucosa by these methods, the mucosa around the hole cannot be sufficiently replenished unless the mucosa around the hole is exfoliated extensively. The risk remains.

Japanese Patent No. 3965204 JP 2001-204735 A

  As described above, various surgical methods and tools have been developed for detachment of the maxillary sinus mucosa, but the risk of damaging the sinus mucosa still remains.

  An object of the present invention is to provide a maxillary sinus mucosa peeling device that can peel the sinus mucosa from the maxilla (sinus floor bone) safely and extensively without using a blade that reaches the sinus mucosa. . The present invention is fundamentally different from the concept of making a hole in the bone that reaches the sinus mucosa with the blade or metal tool as described above and then attempting to exfoliate the mucosa extensively.

  As mentioned above, the first step of sinus mucosal detachment has been thought to be equivalent to piercing an egg shell without breaking the thin membrane inside. It is true that the inner membrane of the egg shell is as thin as the sinus mucosa, and the shell-membrane connection is loose, similar to the sinus floor bone-sinus mucosa connection relationship. Is relatively easy and has many similarities.

  However, as a result of conducting research without being bound by such a general concept, the present inventor has come to the view that there has been a great mistake in equating the maxillary bone with the egg shell. In other words, the bones of the maxilla, particularly the bones of the jaw crest, have a sparse structure as a whole, unlike the egg shell, which has a dense structure, and even a relatively dense sinus floor bone is thin, It was noted that many small holes such as blood vessel passages for feeding the sinus mucosa were opened (see FIG. 13).

  By injecting a liquid such as physiological saline into the maxilla at a predetermined pressure, the inventor first flows out bone marrow tissue (mainly fat cells) from the maxilla, thereby lifting the sinus mucosa, After that, the sinus mucosa was lifted by the injected liquid flowing out of the maxilla, and by these actions, it was found that the maxillary sinus mucosa was peeled off from the maxilla without being damaged, and it was lifted up widely, and the present invention was completed. It came to do.

  That is, the present invention provides (1) a device that presses liquid into the maxilla and peels the maxillary sinus mucosa from the maxilla, a tip hollow member capable of forming a watertight state with respect to the maxilla, and the tip A pouring means for pouring liquid from the hollow member at a predetermined pressure; and a flexible tube having one end connected to the tip hollow member and the other end connected to the pouring means. The maxillary sinus mucosa exfoliation device characterized by the above, and (2) the distal end hollow member holds a hollow member that can be inserted in a water-tight state into an opening formed in the maxilla, or an adhesion material for adhering to the maxilla The present invention relates to a maxillary sinus mucosal peeling device as described in (1) above, which is a hollow member provided with a holding member.

  Further, according to the present invention, (3) the maxillary sinus mucosal stripping device described in (1) or (2) above, wherein the dispensing means is a means provided with a syringe; The maxillary sinus mucosa peeling device according to any one of the above (1) to (3), or (5) the distal end hollow member is gradually expanded from the distal end side. A male screw is formed on the outer peripheral surface of the maxillary sinus mucosa peeling device according to any one of the above (1) to (4), or (6) a distal end hollow member, The maxillary sinus mucosa peeling device according to any one of (1) to (5) above, and (7) the holding member is a plate-like member provided around the distal end hollow member, The maxillary sinus mucosa peeling device according to any one of (2) to (6), or (8) a housing case The maxillary sinus mucosal stripping device described in any one of (1) to (7) above, or (9) the maxillary sinus mucosal stripping device described in (1) above, A hollow member provided with a holding member for holding a close-contact hollow member, (10) a hollow member that can be inserted in a water-tight state into an opening formed in the maxilla, or a close-contact material for bringing it into close contact with the maxilla. The present invention relates to the hollow tip member according to (9) above.

  According to the maxillary sinus mucosa exfoliation device of the present invention, the sinus mucosa can be exfoliated widely from the maxilla (sinus floor bone) safely.

It is explanatory drawing at the time of applying the maxillary sinus mucosa peeling method using the maxillary sinus mucosa peeling apparatus which concerns on one Embodiment of this invention to a socket lift. It is explanatory drawing at the time of applying the maxillary sinus mucosa peeling method using the maxillary sinus mucosa peeling apparatus which concerns on one Embodiment of this invention to sinus lift. It is explanatory drawing at the time of applying the maxillary sinus mucosa peeling method using the maxillary sinus mucosa peeling apparatus which concerns on other embodiment of this invention to sinus lift. It is explanatory drawing at the time of applying the maxillary sinus mucosa peeling method using the maxillary sinus mucosa peeling apparatus which concerns on other embodiment of this invention to a socket lift. An X-ray photograph at the first visit of a patient with a deficiency of the upper left first molar is shown. 2 is an X-ray photograph after bone amplification surgery (socket lift) according to Example 1. FIG. It is an X-ray photograph after artificial tooth implantation. It is X photograph after the bone amplification operation which concerns on Example 2 (sinus lift in a narrow sense). It is an X photograph in which an artificial tooth root is implanted and one year has passed. It is a photograph which shows an example of the maxillary sinus mucosa peeling apparatus provided with the holding member of this invention. It is a figure which shows the state which applied the apparatus shown in FIG. 10 to the cheek side surface of the maxilla of the dog immediately after excision, and formed the watertight state. It is a photograph which shows the state by which the nasal mucosa of a dog was peeled and raised by press-fitting physiological saline. It is the HE dyeing | staining photograph (photographing magnification: 2 * 3.3) of the demineralized section of a human upper molar part. It has been shown that the sea surface bone of the maxillary molar part has a rather sparse structure, and that a relatively dense sinus floor bone has small holes penetrating from the sea surface bone region to the sinus mucosa in various places.

  The maxillary sinus mucosal stripping device of the present invention is a device that presses a liquid into the maxilla and peels the maxillary sinus mucosa from the maxilla, a distal hollow member capable of forming a watertight state with respect to the maxilla, A pouring means for pouring liquid from the tip hollow member at a predetermined pressure; and a flexible tube having one end connected to the tip hollow member and the other end connected to the pouring means. As long as the device is not particularly limited, each means (member) may be sold separately, or all the means may be sold in a storage case such as a bag or a box. Good. In addition, when accommodating in a storage case, each means may be connected and does not need to be connected.

  As said extraction | pouring means, the means provided with the pump and the means provided with the syringe can be illustrated. The dispensing means provided with the syringe may be a manual dispensing method or an automatic dispensing method provided with an actuator. As a syringe, a general configuration in which the rear end portion of the piston is pressed to pour out liquid inside the cylinder, or a screw structure is given to the piston end, and the piston end is rotated to gradually advance the piston. Such as a structure that pours liquid into the tube, or a structure that pours the liquid inside the cylinder by pressing a pressing portion provided on the side (see, for example, Japanese Patent Laid-Open No. 58-86175). The thing of a structure can also be used.

  The distal hollow member is a member capable of forming a watertight state with respect to the maxilla, for example, a hollow member that can be inserted in a watertight state into an opening formed in the maxilla, or an adhesive material for closely contacting the maxilla The hollow member provided with the holding member which hold | maintains can be illustrated.

  The distal hollow member that can be inserted into the opening formed in the maxilla in a watertight state may be a cylindrical (columnar) member having substantially the same diameter as the opening formed in the maxilla, but gradually from the distal end side. It is preferable that the member has a taper portion that expands in diameter, and specifically, the tip portion has a taper portion having a diameter smaller than the diameter of the opening formed in the maxilla. However, it is preferable because a reliable watertight state can be secured. It is preferable that a large-diameter portion is provided at the rear portion of the distal end hollow member so as to be easily gripped, and it is more preferable that the large-diameter portion is provided with a slip stopper. In addition, being able to be inserted in a watertight state means that the liquid can be inserted without being actively discharged from between the outer peripheral surface of the distal end hollow member and the inner peripheral surface of the opening of the maxilla. The intraosseous insertion portion of the distal hollow member preferably has an outer diameter of, for example, 1.0 to 8.0 mm, more preferably about 2.0 to 6.0 mm, and an inner diameter of 0.5 mm. It is preferable that it is -7.5mm, and it is more preferable that it is about 1.5-5.5mm. In addition, it is preferable that a male screw is formed on the outer peripheral surface of the distal end hollow member because the distal end hollow member is prevented from being removed from the opening by water pressure and higher water tightness can be realized. A device having such a distal end hollow member that is inserted into the opening of the bone is suitable for a socket lift or sinus lift in a case where the maxilla remains relatively thick.

  The distal hollow member provided with a holding member for holding an adhesion material for closely attaching to the maxilla is a member capable of peeling the maxillary sinus mucosa without forming an opening in the maxilla. Any shape can be used as long as it can hold the adhesion material so as to be in close contact with the maxilla, for example, a plate-like member provided around the distal end hollow member, Examples include a hook-shaped member that is provided around the hollow member and curves upward. By placing, filling, etc., a close contact material on the holding member, and closely contacting with the maxilla, the liquid poured out from the distal end hollow member does not leak from the side, thereby being dispensed from the distal end hollow member. The liquid can first pass through the maxilla to push out the bone marrow tissue, and then the liquid can reach the maxillary sinus mucosa, where it can be safely detached from the maxilla. In cases where the bone of the jaw crest is extremely thin, opening the bone with a blade itself may cause damage to the sinus mucosa, but according to the present invention, this risk can be avoided. In addition, there are many small holes on the surface of the maxillary ridge of the maxilla, and when the ridge is thin, the hydraulic resistance from the surface of the maxillary ridge to the maxillary sinus mucosa is low, and the liquid easily reaches the maxillary sinus mucosa. To reach. The distal end diameter of the hollow distal end member does not need to be inserted into the opening, and is preferably larger than the type inserted into the opening. For example, the inner diameter is preferably 3.0 mm or more, and 4.0 to 4.0. More preferably, it is 10.0 mm.

  Examples of the material of the tip hollow member include metals, ceramics, resins, and the like, and when inserted into the opening formed in the maxilla, the water tightness can be reliably maintained by pressing or screwing in by hand. It is preferable that the material has rigidity so that it can be used. Here, the material having rigidity refers to a material having a rigidity that does not deform even when pressure is applied by a human hand. Moreover, the distal end hollow member may be curved, and the angle thereof is preferably 70 to 110 °, more preferably 80 to 100 °, and 90 ° with respect to the axial direction. More preferably. This is particularly useful when used in the maxillary buccal sidewall bone.

  The flexible tube has one end connected to the tip hollow member and the other end connected to the dispensing means, but not only directly but also indirectly through other members. Including the case where it is connected to. The length of the tube is preferably 50 mm or more, more preferably 100 to 1000 mm, and further preferably 300 to 600 mm. In addition, constituent members such as the distal end hollow member, the dispensing means, and the flexible tube may be integrated, or may be connected at the time of operation. When connecting the respective members, it is preferable that the members are securely connected by a screw structure or the like.

  By using the maxillary sinus mucosa exfoliation device of the present invention, the sinus mucosa is first lifted by bone marrow tissue discharged from various parts of the sinus floor bone, and then the sinus mucosa is lifted by the injected liquid. Since the sinus mucosa is peeled off, the sinus mucosa can be lifted uniformly without applying local external pressure to the sinus mucosa. In particular, it is considered that the detachment of the sinus mucosa by the bone marrow tissue that first oozes from the sinus floor bone greatly contributes to the safe and reliable removal of the sinus mucosa. In addition, most of the volume in the maxilla lacking teeth is occupied by adipocytes and is in a very low activity state, but the injected fluid removes these fat cells from the bone and causes blood to flow after surgery. Since filling and tissue differentiation begins, the maxilla is highly activated and a large amount of new bone is formed. This osteogenic activity is thought to contribute to bone formation in the elevated region by supplementing with bone growth. With such a peeling method, even in the case of a complex shape of the maxillary sinus bottom, there is little risk and the operation can be performed safely.

  Further, the maxillary sinus mucosal exfoliation method of the present invention is particularly limited as long as it is a method in which a distal end hollow member is connected to the maxilla in a watertight state and liquid is poured out from the distal end hollow member at a predetermined pressure. Rather, an opening (hole) having a diameter of preferably 1.0 to 8.0 mm, more preferably 2.0 to 6.0 mm, and a bone having a thickness of at least about 1 mm on the maxillary sinus side. , Preferably after forming at a depth of 1.0-5.0 mm, more preferably 3.0-5.0 mm, depending on the thickness of the maxilla, and then inserting a distal end hollow member into the opening, Examples include a method of pouring liquid from the hollow hollow member at a predetermined pressure, and a method of pouring liquid from the hollow member at a predetermined pressure by bringing the hollow hollow member into close contact with the maxilla via a holding member with an adhesive. And using the above-described maxillary sinus mucosal stripping device of the present invention Preferred. In the case where the former method of forming the opening is performed using a distal end hollow member having a male screw formed on the outer peripheral surface, it corresponds to the male screw on the inner peripheral surface of the opening of the maxilla to fix the distal hollow member. An internal thread may be formed. When the latter method using the adhesive material is applied to cases where the jawbone is relatively thick or the buccal side of the maxilla, it is preferable to remove the bone surface with high bone density, thereby reducing the hydraulic resistance. be able to.

  As the liquid to be used, a pharmaceutically acceptable liquid such as physiological saline, patient's plasma and the like can be used. The amount used depends on the amount flowing out from the surface of the ridge, but for example, 1 It is about -20cc, and it is preferable that it is about 3-15cc. The predetermined pressure can be adjusted appropriately by the operator to such an extent that the sinus mucosa can be peeled off. For example, the pressure is 1.2 to 7 atm, preferably 1.5 to 5 atm, and a large pressure is necessary. Absent.

  After removing the sinus mucosa by each of the above methods, in the case of socket lift, the opening of the maxilla is penetrated to the maxillary sinus, and then the thickness of the planned artificial tooth root is made to facilitate the introduction of bone growth. Preferably, the opening is enlarged to a near diameter, and the bone growth is compensated between the sinus floor bone and the detached sinus mucosa. Before filling with bone growth, use a mirror to visually confirm that there are no holes in the sinus mucosa, and let the patient breathe out while pinching the patient's nose to prevent air from leaking. It is preferable to confirm this. Further, the peeled state of the sinus mucosa can be confirmed by CT having an X-ray characteristic that can identify the sinus mucosa and a contrast medium injected into the peeled portion and a normal panoramic X-ray photograph. On the other hand, in the case of sinus lift in a narrow sense, after the opening of the maxilla is penetrated to the maxillary sinus, the fluid is repeatedly injected and discharged from the opening in order to widen the detachment range of the sinus mucosa, Since the amount of compensation is large, it is preferable to make a large hole in the bone on the buccal side of the maxillary sinus and sufficiently compensate while confirming the compensation state from the hole.

  Hereinafter, the maxillary sinus mucosa peeling method using the maxillary sinus mucosa peeling device of the present invention will be described with reference to the drawings. FIG. 1 is an explanatory view when a maxillary sinus mucosal stripping method using a maxillary sinus mucosal stripping apparatus according to an embodiment of the present invention is applied to a socket lift, and FIG. 2 is according to an embodiment of the present invention. It is explanatory drawing at the time of applying the maxillary sinus mucosa peeling method using the maxillary sinus mucosa peeling apparatus to sinus lift. FIG. 3 is an explanatory diagram when the maxillary sinus mucosal peeling method using the maxillary sinus mucosa peeling device according to another embodiment of the present invention is applied to a sinus lift, and FIG. 4 shows the other embodiment of the present invention. It is explanatory drawing at the time of applying the maxillary sinus mucosa peeling method using the maxillary sinus mucosa peeling apparatus to a socket lift.

  As shown in FIGS. 1 (A) and 2 (B), a first maxillary sinus mucosal stripping device 10 of the present invention is attached to a syringe 16 having an outer cylinder 12 and a piston 14 and to the tip of the syringe 16. A tube 18 having flexibility and a distal end hollow member 20 attached to the other end of the tube 18 are provided. The distal hollow member 20 has a tapered shape that gradually increases in diameter from the distal end portion, and a large diameter portion 21 is provided at the rear end portion so as to be easily gripped. A physiological saline 22 is accommodated in the syringe 16.

  In order to peel the sinus mucosa A using the maxillary sinus mucosa peeling device 10, first, the distal hollow member 20 is held in the cylindrical opening C formed in the maxilla B by grasping the large diameter portion 21 of the distal hollow portion. Insert. While fixing the distal end hollow member 20 by hand as necessary, the piston 14 of the syringe 16 is pressed, and the physiological saline 22 in the syringe 16 is press-fitted from the distal end hollow member 20. Thereby, the physiological saline 22 is continuously introduced into the maxilla B, and first, the bone marrow tissue in the maxilla flows out from the bone surface on the oral cavity side and the sinus mucosa side, and then the physiological saline 22 is supplied. Flows out of the bone surface on the oral cavity side and sinus mucosa side. By these bone marrow tissue and physiological saline 22, the sinus mucosa A is detached from the maxilla (sinus floor bone) and lifted up over a wide area. As described above, in the maxillary sinus mucosa peeling method using the maxillary sinus mucosa peeling device 10 of the present invention, the sinus mucosa A can be injured without being damaged. In addition, injection pressure can be grasped | ascertained from the volume change of the air in a syringe.

  In the case of the socket lift, as shown in FIG. 1 (B), the opening C of the maxilla B is penetrated to the maxillary sinus, and the opening C is enlarged to a diameter close to the planned thickness of the artificial tooth root. The bone growth material 24 is supplemented between B and the detached sinus mucosa A. On the other hand, in the case of sinus lift, since the amount of bone growth material 24 is large, as shown in FIG. 2 (C), a large opening D different from the opening C opened for peeling is formed in the bone on the buccal side of the maxillary sinus. And the bone growth material 24 is supplemented through the openings C and D.

  As shown in FIG. 3, in the maxillary sinus mucosa peeling device according to another embodiment of the present invention, a disc-shaped holding plate 28 is provided around the distal end hollow member 26 and is poured out from the distal end hollow member 26. The adhesive 30 is used in close contact with the maxilla B so that the liquid does not leak to the surroundings. Normally, it is in close contact with the lower surface of the maxilla as shown in FIG. 3 (B), but it may be in close contact with the cheek side surface of the maxilla as shown in FIG. 3 (C). As in the case of using the maxillary sinus mucosa peeling device according to the above-described embodiment, the physiological saline 22 is continuously inserted into the maxilla B by pressing the physiological saline 22 in the syringe 16 from the distal end hollow member 20. First, bone marrow tissue in the maxilla flows out from the bone surface on the sinus mucosa side, and then physiological saline 22 flows out from the bone surface on the sinus mucosa side. By these bone marrow tissue and physiological saline 22, the sinus mucosa A is detached from the maxilla (sinus floor bone) and lifted up over a wide area. The maxillary sinus mucosa peeling device according to this other embodiment is particularly advantageous when the maxilla B is very thin, and can peel the sinus mucosa A without forming an opening in the maxilla B. Subsequent filling of the bone growth material is performed by the method shown in FIG. 2 (C) or an opening opened in the buccal bone.

  Moreover, as shown in FIG. 4, the maxillary sinus mucosal stripping apparatus according to another embodiment of the present invention can be applied to a socket lift in a case where the jawbone is relatively thick. In this case, the bone density is high. The bone surface is slightly removed and physiological saline 22 is introduced into the maxilla B. Subsequent filling of the bone growth material is performed by the method shown in FIG.

  Bone amplification surgery (socket lift) is performed on the maxillary sinus side of the maxillary left first molar deficiency patient using the maxillary sinus mucosal stripping device of the present invention (the device shown in FIG. 1A). It was. FIG. 5 shows an X-ray photograph of the patient at the first visit. In the first molar portion, the downward extension of the maxillary sinus is seen and the upward movement of the maxillary ridge is hardly seen, and the vertical width of the maxillary ridge is about 4 mm in the near-distal central part.

  First, a corresponding portion of the mucous membrane of the ridge was incised and peeled, and a hole (opening) having a diameter of about 4 mm and a depth of more than 2 mm was formed in the near-centrifugal central portion of the exposed bone surface. A hollow hollow member having an outer diameter of about 4 mm provided with a flexible tube having a length of about 500 mm was press-fitted into the opening, and a 10 cc syringe was attached to the other end of the flexible tube. The syringe contained 7 cc physiological saline and 3 cc air. When the pressure of the syringe is gradually increased while checking the injection pressure, the injection starts at 2 to 3 atmospheres, and then it is easily injected at a lower pressure than at the start of injection, and finally about 5 cc of physiological saline is injected. .

  After injecting physiological saline, the bone hole was further deepened and the sinus floor bone was removed. At this time, since the sinus mucosa is separated from the sinus floor bone, the sinus mucosa is not damaged. As a precaution, after confirming that the corresponding sinus mucosa was not damaged, injection and discharge of physiological saline from the opening were repeated several times. After confirming that the sinus mucosa was not torn again, about 0.5 cc of bone growth was filled between the sinus mucosa and the sinus floor bone through the opening, and the bone opening was also filled.

  FIG. 6 is an X-ray photograph after bone amplification surgery. As shown in FIG. 6, the bone growth is filled up to the height of the root tips of both adjacent teeth.

  After 4 months, an artificial tooth root having a maximum diameter of 5.0 mm and a length of 10 mm was embedded in the corresponding part. During the operation, it was confirmed that bone was formed from the surface of the jaw crest to a depth higher than 10 mm. It can be seen that the progress after bone augmentation surgery on the maxillary sinus side prior to the artificial tooth placement was smooth. The patient reported that there was no bleeding from the nose after bone augmentation surgery and artificial tooth placement surgery. FIG. 7 is an X-ray photograph after artificial root placement.

For patients with cases where the maxillary molar teeth are missing extensively, using the maxillary sinus mucosal stripping device of the present invention (device and method shown in FIG. 2) Narrowly defined sinus lift) was performed on the maxillary sinus side.
In this case, the sinus mucosa was exfoliated from the side of the maxillary ridge, the bone on the buccal side of the maxillary sinus was opened, and about 2 cc of bone growth was supplemented between the sinus floor bone and the sinus mucosa from the fenestration. The sinus mucosa was peeled off from the base of the jaw by the same method as in Example 1 above.

  FIG. 8 is an X-photograph after bone amplification surgery. As shown in FIG. 7, it can be seen that a large amount of bone growth is supplemented above the relatively thin maxilla. Further, FIG. 9 is an X-photograph in which an artificial tooth root was embedded half a year after the sinus lift and another year passed. As shown in FIG. 9, no abnormal findings are found in the artificial tooth root that bears the occlusion / mastication function.

Using the maxillary sinus mucosal stripping device provided with the holding member of the present invention shown in FIG. 10, as shown in FIG. 11, physiological saline is applied to the cheek lateral surface without making a hole in the maxillary bone of the dog just after excision. An experiment was conducted in which the nasal mucosa was peeled off and raised from the buccal sidewall bone. The result is shown in FIG. As shown in FIG. 12, it was revealed that the physiological saline penetrates the maxillary buccal side wall bone and the nasal mucosa is exfoliated and raised by pressing the physiological saline.
In the case of dogs, the nasal mucosa was peeled and raised because there was almost no maxillary sinus inside the buccal bone and the nasal mucosa was removed. Since it is almost the same as the buccal sidewall bone and the sinus mucosa, the device of the present invention can naturally be applied to the peeling and raising of the human sinus mucosa.

DESCRIPTION OF SYMBOLS 10 Maxillary sinus mucosa peeling apparatus 12 Outer cylinder 14 Piston 16 Syringe 18 Tube 20 Tip hollow member 21 Large diameter part 22 Saline 24 Bone proliferative material 26 Tip hollow member 28 Holding plate 30 Adhesive material A Sinus mucosa B Maxilla (sinus) Bottom bone)
C opening D opening

Claims (10)

A device that presses liquid into the maxilla and peels the maxillary sinus mucosa from the maxilla,
A tip hollow member capable of forming a watertight state with respect to the maxilla;
Pouring means for pouring liquid from the tip hollow member at a predetermined pressure;
A flexible tube having one end connected to the tip hollow member and the other end connected to the dispensing means;
A maxillary sinus mucosal stripping device comprising:   The distal end hollow member is a hollow member that can be inserted in a watertight state into an opening formed in the maxilla, or a hollow member that includes a holding member that holds an adhesion material for closely adhering to the maxilla. Item 1. The maxillary sinus mucosa peeling device according to Item 1.   The maxillary sinus mucosal stripping device according to claim 1 or 2, wherein the dispensing means is a means provided with a syringe.   The maxillary sinus mucosa peeling device according to any one of claims 1 to 3, wherein the distal hollow member is a member made of a material having rigidity.   The maxillary sinus mucosal stripping device according to any one of claims 1 to 4, wherein the distal hollow member has a tapered portion that gradually increases in diameter from the distal end side.   The maxillary sinus mucosa peeling device according to any one of claims 1 to 5, wherein a male screw is formed on the outer peripheral surface of the distal hollow member.   The maxillary sinus mucosa peeling device according to any one of claims 2 to 6, wherein the holding member is a plate-like member provided around the distal end hollow member.   The maxillary sinus mucosa peeling device according to any one of claims 1 to 7, wherein the maxillary sinus mucosa peeling device is housed in a housing case.   A hollow tip member used in the maxillary sinus mucosal stripping device according to claim 1.   The distal end according to claim 9, wherein the distal end is a hollow member that can be inserted in a watertight state into an opening formed in the maxilla, or a hollow member that includes a holding member that holds an adhesion material for closely adhering to the maxilla. Hollow member.