MD580Z - Method for minimally invasive, early installation of intraosseous dental implants in two stages - Google Patents
Method for minimally invasive, early installation of intraosseous dental implants in two stages Download PDFInfo
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Invenţia se referă la stomatologie, în special la implantologia dentară şi poate fi utilizată pentru instalarea miniinvazivă, timpurie a implantelor dentare endoosoase. The invention relates to dentistry, in particular to dental implantology and can be used for the early, minimally invasive installation of endosseous dental implants.
Este cunoscută instalarea implantelor dentare endoosoase în doi timpi chirurgicali, propusă de către P. Branemark, care a devenit clasică în implantologia orală. Ea prevede extragerea dinţilor afectaţi, inserarea implantelor peste 6...12 luni după extracţia dentară şi instalarea implantelor pe o perioadă de aşteptare a integrării implantelor, la mandibulă 3...4 luni, la maxilă 4...6 luni [1]. The two-stage endosseous dental implant placement proposed by P. Branemark is well known and has become a classic in oral implantology. It involves the extraction of the affected teeth, the insertion of the implants 6-12 months after the tooth extraction, and the installation of the implants during a waiting period for the integration of the implants, 3-4 months for the mandible, and 4-6 months for the maxilla [1].
Este cunoscută instalarea implantelor dentare endoosoase în doi timpi chirurgicali, care prevede extragerea dinţilor afectaţi, peste 6...12 luni după extracţia dentară se efectuează decolarea lambourilor mucoperiostale şi înlăturarea din alveolă a ţesutului de granulaţie, apoi se instalează implantul, iar în spaţiul dintre peretele alveolei şi implant se introduc grefe pentru fixarea implantului. După perioada de aşteptare a integrării implantelor, la mandibulă 3...4 luni, la maxilă 4...6 luni, se efectuează a doua etapă [2]. It is known that endosseous dental implants are installed in two surgical stages, which involves the extraction of the affected teeth, 6...12 months after the tooth extraction, the mucoperiosteal flaps are lifted and the granulation tissue is removed from the alveolus, then the implant is installed, and grafts are inserted into the space between the alveolus wall and the implant to fix the implant. After the waiting period for the integration of the implants, 3...4 months for the mandible, 4...6 months for the maxilla, the second stage is performed [2].
Astfel, dezavantajul acestor metode este că tratamentul protetic poate fi iniţiat nu mai devreme de 10...16 luni după pierderea dinţilor. În această perioadă de timp pacienţii au un disconfort funcţional şi estetic, fapt ce a impus efectuarea cercetărilor pentru a scurta acest termen, cu obţinerea ratei înalte de succes. Totodată este traumatică decolarea lambourilor mucoperiostale şi are loc înlăturarea prin chiuretare a conţinutului alveolei aflate în faza de vindecare, ceea ce duce la o reabilitare mai târzie a pacienţilor. În această perioadă de timp apofiza alveolară suferă o resorbţie considerabilă şi condiţiile de instalare a implantelor devin dificile. Thus, the disadvantage of these methods is that prosthetic treatment can be initiated no earlier than 10...16 months after tooth loss. During this period of time, patients experience functional and aesthetic discomfort, which has necessitated research to shorten this period, achieving a high success rate. At the same time, the removal of mucoperiosteal flaps is traumatic and the contents of the alveolus in the healing phase are removed by curettage, which leads to a later rehabilitation of patients. During this period of time, the alveolar process undergoes considerable resorption and the conditions for implant installation become difficult.
Problema pe care o rezolvă invenţia constă în optimizarea reabilitării protetice a edentaţiilor prin elaborarea unei metode miniinvazive de instalare timpurie a implantelor dentare endoosoase pentru înlăturarea dezavantajelor menţionate, minimalizarea traumatizării pacientului, evitarea complicaţiilor postoperatorii caracteristice metodelor cu prepararea lambourilor mucoperiostale şi totodată micşorarea timpului de reabilitare. The problem solved by the invention consists in optimizing the prosthetic rehabilitation of edentulous teeth by developing a minimally invasive method for early installation of endosseous dental implants to eliminate the aforementioned disadvantages, minimize patient trauma, avoid postoperative complications characteristic of methods with mucoperiosteal flap preparation, and at the same time reduce rehabilitation time.
Conform invenţiei revendicate, metoda se efectuează în doi timpi, unde în primul timp se extrag dinţii afectaţi, peste 4…8 săptămâni după vindecarea completă a gingiei se efectuează ortopantograma, apoi cu freza dentară gradată se penetrează fără turaţii gingia şi conţinutul alveolei, cu frezele dentare de diferite dimensiuni se prepară locaşul implantului în aşa fel ca diametrul ultimei freze să fie cu 1,0…1,5 mm mai mic decât diametrul implantului, se determină adâncimea locaşului, mărimea determinată se compară cu datele de pe ortopantogramă, în baza datelor obţinute se selectează un implant de tip şurub, implantul, în cazul absenţei dinţilor monoradiculari, se inserează în centrul alveolei, în absenţa dinţilor molari inferiori se inserează în alveola posterioară a mandibulei şi în absenţa dinţilor molari superiori - în alveola palatină, implantul se instalează cu ajutorul cheii dinamometrice cu o forţă de 35…50 N/cm, în aşa fel ca el să depăşească nivelul gingiei cu 1,0 mm, apoi se înşurubează şurubul de acoperire, după care în scop profilactic, timp de 5…7 zile, se administrează o terapie antiinflamatoare şi se respectă regimul antiseptic al cavităţii bucale, iar peste 3…4 luni de la instalarea implantului pentru mandibulă şi peste 4…6 luni pentru maxilă se iniţiază al doilea timp care constă în aceea că se decolează gingia deasupra şurubului de acoperire printr-o miniincizie, apoi şurubul se înlătură, cu o forţă de 10…15 N/cm se înşurubează un conformator de gingie, care peste 2…3 min se înlătură, se determină corectitudinea instalării lui, după care în cavitatea implantului cu seringa se introduc 0,1…0,3 ml de unguent Levomicol şi repetat se instalează conformatorul de gingie. According to the claimed invention, the method is performed in two stages, where in the first stage the affected teeth are extracted, after 4…8 weeks after the gum has completely healed, an orthopantogram is performed, then with a graduated dental bur the gum and the contents of the alveolus are penetrated without speed, with dental burs of different sizes the implant location is prepared in such a way that the diameter of the last bur is 1.0…1.5 mm smaller than the diameter of the implant, the depth of the location is determined, the determined size is compared with the data on the orthopantogram, based on the data obtained a screw-type implant is selected, the implant, in the absence of monoradicular teeth, is inserted in the center of the alveolus, in the absence of lower molar teeth it is inserted in the posterior alveolus of the mandible and in the absence of upper molar teeth - in the palatine alveolus, the implant is installed using a torque wrench with a force of 35…50 N/cm, so that it exceeds the gum level by 1.0 mm, then the cover screw is screwed in, after which, for prophylactic purposes, for 5…7 days, an anti-inflammatory therapy is administered and the antiseptic regime of the oral cavity is observed, and after 3…4 months from the installation of the implant for the mandible and after 4…6 months for the maxilla, the second stage is initiated, which consists in lifting the gum above the cover screw through a mini-incision, then the screw is removed, with a force of 10…15 N/cm a gum conformer is screwed in, which is removed after 2…3 min, the correctness of its installation is determined, after which 0.1…0.3 ml of Levomicol ointment is introduced into the implant cavity with a syringe and the gum conformer is repeatedly installed.
Rezultatul invenţiei constă în optimizarea reabilitării protetice a edentaţiilor prin elaborarea unei metode miniinvazive de instalare timpurie a implantelor dentare endoosoase, minimalizarea traumatizării pacientului şi evitarea complicaţiilor postoperatorii, micşorarea timpului de reabilitare şi reducerea disconfortului funcţional şi estetic al pacientului. The result of the invention consists in optimizing the prosthetic rehabilitation of edentulous teeth by developing a minimally invasive method for early installation of endosseous dental implants, minimizing patient trauma and avoiding postoperative complications, shortening rehabilitation time and reducing the patient's functional and aesthetic discomfort.
Avantajele metodei propuse constau în: gingia deasupra alveolei este vindecată, este redus riscul de infectare şi perioada tratamentului, ceea ce minimalizează disconfortul funcţional şi estetic al pacientului. Prin instalarea timpurie a implantelor este posibilă o reabilitare implanto-protetică a pacienţilor mai devreme cu 4...8 luni. The advantages of the proposed method are: the gum above the alveolus is healed, the risk of infection and the treatment period are reduced, which minimizes the functional and aesthetic discomfort of the patient. By early installation of implants, it is possible to perform implant-prosthetic rehabilitation of patients 4...8 months earlier.
În dependenţă de timpul după extracţia dentară au fost propuse unele clasificări ale instalării implantelor. Wilson T. şi Weber H. (Wilson T., Weber H. Calssification of and therapy for areas of deficient bony housing prior to dental implant placement. Int. J. Periodontics Restorative Dent. 1993, 13, 451-459) au utilizat termenii imediat, recent, amânat şi matur pentru a menţiona timpul plasării implantelor în relaţie cu vindecarea ţesuturilor moi, factor important în procedeele de ghidare a regenerării osului. Mayfield L. (Mayfield LJA. Immediate. Delayed and late submerged and transmucosal implants. In. Lindhe J. Proceedings of the 3rd European Workshop on Periodontology: Implant Dentistry.BerlintQuintessenz, 1999, 520-534) a folosit termenii imediat, amânat şi târziu pentru a menţiona intervalul de timp 0 săptămâni, 6...10 săptămâni şi ≥6 luni respectiv după extracţia dentară. Intervalul dintre 10 săptămâni şi 6 luni de către autor a fost omis. În majoritatea studiilor prin expresia „instalare imediată” se subînţelege că instalarea implantului are loc în acelaşi timp cu extracţia dentară. Schropp şi colaboratorii (Schropp L., Kostopoulos L., Wenzel A. Bone healing folowing immediate versus delayed placement of titanium implants into extraction sockets: A prospective clinical study. Int. J. Oral Maxillofac Implants. 2003,182, 189-199) sub acest termin au în vedere instalarea implantelor în intervalul dintre 3 şi 15 zile după extracţia dintelui, iar Gomez-Roman (Gomez-Roman G., Schulte W, d'Hoedt B. et al. The Frialit-2 implant system: Five-year clinical experience in single-tooth and immediately postextraction applications. Int. J. Oral Maxillofac Implants. 1997, 12, 299-309) în intervalul cuprins între 0 şi 7 zile. Depending on the time after tooth extraction, some classifications of implant placement have been proposed. Wilson T. and Weber H. (Wilson T., Weber H. Classification of and therapy for areas of deficient bony housing prior to dental implant placement. Int. J. Periodontics Restorative Dent. 1993, 13, 451-459) used the terms immediate, recent, delayed, and mature to refer to the time of implant placement in relation to soft tissue healing, an important factor in guiding bone regeneration procedures. Mayfield L. (Mayfield LJA. Immediate. Delayed and late submerged and transmucosal implants. In. Lindhe J. Proceedings of the 3rd European Workshop on Periodontology: Implant Dentistry. BerlintQuintessenz, 1999, 520-534) used the terms immediate, delayed and late to refer to the time interval 0 weeks, 6...10 weeks and ≥6 months respectively after tooth extraction. The interval between 10 weeks and 6 months was omitted by the author. In most studies, the expression “immediate installation” implies that the implant installation takes place at the same time as the tooth extraction. Schropp and collaborators (Schropp L., Kostopoulos L., Wenzel A. Bone healing following immediate versus delayed placement of titanium implants into extraction sockets: A prospective clinical study. Int. J. Oral Maxillofac Implants. 2003,182, 189-199) consider the installation of implants between 3 and 15 days after tooth extraction, and Gomez-Roman (Gomez-Roman G., Schulte W, d'Hoedt B. et al. The Frialit-2 implant system: Five-year clinical experience in single-tooth and immediately postextraction applications. Int. J. Oral Maxillofac Implants. 1997, 12, 299-309) in the interval between 0 and 7 days.
Prin expresia „instalare amânată” (delayed placement) în multe studii implantele au fost instalate în perioada între 4 şi 8 săptămâni după extracţia dentară. În alte publicaţii acest termin este egal cu 8...14 săptămâni (Hammerle C., Lang N.). By the expression "delayed placement" in many studies implants were installed between 4 and 8 weeks after tooth extraction. In other publications this term is equal to 8...14 weeks (Hammerle C., Lang N.).
Single-stage surgery combining transmucosal implant placement with guided bone regeneration and bioresorbable materials. Clin Oral Implants Res. 2001; 12:9-18) implantul se instalează în intervalul cuprins de la 6 săptămâni până la 6 luni (Zitzmann N, Naef R., Scharer P. Resorbable versus nonresorbable membranes in combination with Bio-Oss for guided bone regeneration. Int. J. Oral Maxillofac Implants. 1997, vol. 12, p. 844-852) implantul se instalează în intervalul cuprins de la 1 săptămână până la 9 luni (Gomez-Roman G., Schulte W., d'Hoedt B. et al. The Frialit-2 implant system: Five-year clinical experience in single-tooth and immediately postextraction applications. Int. J. Oral Maxillofac Implants. 1997, vol. 12, p. 299-309) implantul se instalează îndată după extracţie. Single-stage surgery combining transmucosal implant placement with guided bone regeneration and bioresorbable materials. Clin Oral Implants Res. 2001; 12:9-18) the implant is installed in the interval from 6 weeks to 6 months (Zitzmann N, Naef R., Scharer P. Resorbable versus nonresorbable membranes in combination with Bio-Oss for guided bone regeneration. Int. J. Oral Maxillofac Implants. 1997, vol. 12, p. 844-852) the implant is installed in the interval from 1 week to 9 months (Gomez-Roman G., Schulte W., d'Hoedt B. et al. The Frialit-2 implant system: Five-year clinical experience in single-tooth and immediately postextraction applications. Int. J. Oral Maxillofac Implants. 1997, vol. 12, p. 299-309) the implant is installed immediately after extraction.
Pentru unificarea acestor termeni Grupul de cercetări ştiinţifice „IU" la a treia sa Conferinţă de Consensus în august 2003 (Gstaad, Elveţia) a definit termenii de instalare a implantelor după extracţia dentară. La baza acestor definiţii a fost evoluţia vindecării plăgii postextracţionale (Hammerle C., Chen S., Wilson T. Consensus statements and recommended clinical procedures regarding the placement of implants in extraction sockets. Int. J. Oral Maxillofac Implants. 2004, 19(suppl), 26-28). Viabilitatea şi valoarea practică a acestei definiţii au fost confirmate peste 4 ani, la a IV-a Conferinţă de Consensus, care a avut loc în 2007 (Ştudgard, Germania) (Chen S., Beagle J., Jensen S. et al. Consensus Statements and Recommended Clinical Procedures Regarding Surgical Techniques. Int. J. Oral Maxillofac Implants. 2008; 24(suppl), 272-278). Conform acestei definiţii (clasificări) implantaţia după extracţia dentară poate fi de 4 tipuri: tipul 1 este considerată implantaţia efectuată imediat, la finele extracţiei dentare; tipul 2 - implantaţia timpurie efectuată după vindecarea definitivă a ţesuturilor moi cu „sigilarea biologică" a alveolei; tipul 3 - implantaţia timpurie după o substanţială vindecare osoasă a alveolei confirmată clinic şi radiografic şi tipul 4 este considerată implantaţia după vindecarea definitivă a alveolei cu modificările respective în sectorul edentat. De menţionat faptul că pentru toate variantele de instalare a implantelor este recomandată metoda în doi timpi chirurgicali cu decolarea lambourilor mucoperiostale. In order to unify these terms, the "IU" Scientific Research Group at its third Consensus Conference in August 2003 (Gstaad, Switzerland) defined the terms for implant placement after tooth extraction. The basis of these definitions was the evolution of post-extraction wound healing (Hammerle C., Chen S., Wilson T. Consensus statements and recommended clinical procedures regarding the placement of implants in extraction sockets. Int. J. Oral Maxillofac Implants. 2004, 19(suppl), 26-28). The viability and practical value of this definition were confirmed over 4 years, at the 4th Consensus Conference, which took place in 2007 (Studgard, Germany) (Chen S., Beagle J., Jensen S. et al. Consensus Statements and Recommended Clinical Procedures Regarding Surgical Techniques. Int. J. Oral Maxillofac Implants. 2008; 24(suppl), 272-278). According to this definition (classification), implantation after tooth extraction can be of 4 types: type 1 is considered implantation performed immediately, at the end of tooth extraction; type 2 - early implantation performed after definitive healing of soft tissues with "biological sealing" of the alveolus; type 3 - early implantation after substantial bone healing of the alveolus confirmed clinically and radiographically and type 4 is considered implantation after definitive healing of the alveolus with the respective changes in the edentulous sector. It should be noted that for all variants of implant installation, the two-stage surgical method with the lifting of mucoperiosteal flaps is recommended.
În studiu au fost incluse 25 persoane (9 bărbaţi, 16 femei) cu vârsta cuprinsă între 32 şi 64 ani. De la pacienţi cu scopul sanaţiei cavităţii bucale cu 4...8 săptămâni în urmă au fost extraşi 29 dinţi (18 molari - 12 la mandibulă şi 6 la maxilă, 7 premolari - 5 la mandibulă şi 2 la maxilă şi 4 incisivi la maxilă - 2 centrali şi 2 laterali). Condiţiile obligatorii pentru includerea pacienţilor în studiu au fost prezenţa gingiei vindecate deasupra alveolei şi absenţa semnelor clinice de inflamaţie. După informaţia respectivă şi cu acordul pacienţilor în alveolele epitelizate prin chirurgia fără lambou au fost instalate implante tip şurub (sistemele Alpha Bio, Israel) cu diametrul maxim posibil ce permite lăţimea apofizei alveolare. Diametrul implantelor a variat între 3,75 şi 6,0 mm, iar lungimea - între 10 şi 16 mm. Cu freza dentară gradată s-a penetrat fără turaţii gingia şi conţinutul alveolei, cu frezele dentare de diferite dimensiuni s-a preparat locaşul implantului în aşa fel ca diametrul ultimei freze să fie cu 1,0…1,5 mm mai mic decât diametrul implantului, s-a determinat adâncimea locaşului, mărimea determinată comparându-se cu datele de pe ortopantogramă (OPG). În baza datelor obţinute s-a selectat un implant de tip şurub, implantul, în cazul absenţei dinţilor monoradiculari, a fost inserat în centrul alveolei, în absenţa dinţilor molari inferiori - în alveola posterioară a mandibulei şi în absenţa dinţilor molari superiori - în alveola palatină, implantul s-a instalat cu ajutorul cheii dinamometrice cu o forţă de 35…50 N/cm, în aşa fel ca el să depăşească nivelul gingiei cu 1,0 mm, apoi s-a înşurubat şurubul de acoperire, după care în scop profilactic, timp de 5…7 zile s-a administrat o terapie antiinflamatoare respectând totodată regimul antiseptic al cavităţii bucale. Peste 3…4 luni de la instalarea implantului pentru mandibulă şi peste 4…6 luni pentru maxilă s-a iniţiat al doilea timp, şi anume s-a decolat gingia deasupra şurubului de acoperire printr-o miniincizie, apoi şurubul a fost înlăturat, cu o forţă de 10…15 N/cm s-a înşurubat un conformator de gingie, care peste 2…3 min de asemenea a fost înlăturat, s-a determinat corectitudinea instalării lui, după care în cavitatea implantului cu seringa s-a introdus 0,1…0,3 ml de unguent Levomicol şi repetat s-a instalat conformatorul de gingie. Stabilitatea implantului a fost apreciată cu aparatul Periotest (Siemens Gulden-Medizintechnik, Bensheim, Germany). The study included 25 people (9 men, 16 women) aged between 32 and 64 years. 29 teeth (18 molars - 12 in the mandible and 6 in the maxilla, 7 premolars - 5 in the mandible and 2 in the maxilla and 4 incisors in the maxilla - 2 central and 2 lateral) were extracted from the patients 4...8 weeks ago for the purpose of oral cavity rehabilitation. The mandatory conditions for including patients in the study were the presence of healed gum above the alveolus and the absence of clinical signs of inflammation. After the respective information and with the consent of the patients, screw-type implants (Alpha Bio systems, Israel) with the maximum possible diameter that allows the width of the alveolar process were installed in the alveoli epithelialized by flapless surgery. The diameter of the implants varied between 3.75 and 6.0 mm, and the length - between 10 and 16 mm. The graduated dental bur was used to penetrate the gum and the contents of the alveolus without any speed changes. The implant site was prepared with dental burs of different sizes so that the diameter of the last bur was 1.0…1.5 mm smaller than the implant diameter. The depth of the site was determined, the determined size being compared with the data on the orthopantogram (OPG). Based on the data obtained, a screw-type implant was selected. In the absence of monoradicular teeth, the implant was inserted into the center of the alveolus. In the absence of lower molar teeth, it was inserted into the posterior alveolus of the mandible. In the absence of upper molar teeth, it was inserted into the palatine alveolus. The implant was installed using a torque wrench with a force of 35…50 N/cm, so that it exceeded the gum level by 1.0 mm. Then the cover screw was screwed in. After that, for prophylactic purposes, anti-inflammatory therapy was administered for 5…7 days, while also respecting the antiseptic regimen of the oral cavity. After 3-4 months after the implant installation for the mandible and after 4-6 months for the maxilla, the second stage was initiated, namely the gum was lifted above the covering screw through a mini-incision, then the screw was removed, with a force of 10-15 N/cm a gum conformer was screwed in, which after 2-3 min was also removed, the correctness of its installation was determined, after which 0.1-0.3 ml of Levomicol ointment was introduced into the implant cavity with a syringe and the gum conformer was installed again. The stability of the implant was assessed with the Periotest device (Siemens Gulden-Medizintechnik, Bensheim, Germany).
Evoluţia osului şi a spaţiilor periimplantate au fost studiate radiografic. Pe OPG postoperator ca puncte de reper au fost luaţi umerii platformei implantelor. Osul nou format a fost determinat anterior şi posterior de implant prin măsurările efectuate pe OPG utilizând programul Adobe Photoshop CS3. Analiza statistică a inclus calcularea valorii medii, deviaţia şi eroarea standardă. The evolution of the bone and peri-implant spaces were studied radiographically. On the postoperative OPG, the shoulders of the implant platform were taken as landmarks. The newly formed bone was determined anteriorly and posteriorly to the implant by measurements made on the OPG using the Adobe Photoshop CS3 program. Statistical analysis included the calculation of the mean value, deviation and standard error.
La instalarea timpurie (tip - 2) a 29 de implante, conform metodei elaborate, s-a constatat că gingia deasupra alveolei (respectiv şi a implantului) către a 8…10-a zi se vindecă per secundam, se maturizează în continuare şi la a 6…8-a săptămână aprofundarea gingivală, care se aprecia anteoperator deasupra alveolei, treptat dispare. Analiza ortopantogramelor a demonstrat că fisura între implant şi pereţii alveolei la 26 (89,66%) implante a dispărut, osul periimplantar devenind un tot unic, iar în 3 (10,34%) cazuri fisura evident s-a micşorat. Prin aceasta se poate afirma că implantul instalat fără lambou nu influenţează negativ procesul natural de vindecare a alveolei, substratul căruia este matricea provizorie. When installing early (type - 2) 29 implants, according to the developed method, it was found that the gum above the alveolus (and the implant) by the 8th…10th day heals per secundam, further matures and at the 6th…8th week the gingival deepening, which was appreciated anteoperatively above the alveolus, gradually disappears. The analysis of orthopantograms demonstrated that the crack between the implant and the walls of the alveolus in 26 (89.66%) implants disappeared, the peri-implant bone becoming a single whole, and in 3 (10.34%) cases the obvious crack decreased. This can be stated that the implant installed without a flap does not negatively influence the natural healing process of the alveolus, the substrate of which is the provisional matrix.
Unul din parametrii osteointegrării implantelor dentare este stabilitatea lor. În studiul efectuat ea a fost apreciată cu aparatul Periotest (Siemens Gulden-Medizintechnik, Bensheim, Germany). La toate implantele valorile periotestului au fost negative, ceea ce a confirmat osteointegrarea lor. One of the parameters of osseointegration of dental implants is their stability. In the study, it was assessed with the Periotest device (Siemens Gulden-Medizintechnik, Bensheim, Germany). The periotest values were negative for all implants, which confirmed their osseointegration.
La pacienţi incluşi în studiu s-a constatat că în toate cazurile vindecarea alveolei a decurs fară complicaţii. La momentul adresării plaga era epitealizată, fără semne de inflamaţie. Deasupra alveolei gingia era aprofundată. În patru cazuri din partea vestibulară a apofizei alveolare se aprecia o denivelare neînsemnată. Pe radiogramele retroalveolare şi OPG în proiecţia dinţilor absenţi s-a constatat o radiotransparenţă, pe fundalul căreia se apreciau pereţii alveolelor cu marginile lor la creasta alveolară „şterse”. La a 8…10-a zi după instalarea implantelor, conform metodei elaborate, miniplaga gingivală era cicatrizată. Procesele regenerative în mucoasă au continuat şi la a 4-a săptămână cicatricea era înlocuită cu un înveliş epitelial subţire şi prin el era vizibilă (transparentă) culoarea albăstruie a şurubului de acoperire. Peste 6...8 săptămâni gingia a devenit mai groasă (matură), culoarea albăstruie a şurubului de acoperire prin ea nu se mai aprecia, iar aprofundarea, care a fost atestată pe apofiza alveolară preoperator, a devenit mai slab pronunţată. La a doua etapă chirurgicală gingia deasupra implantului macroscopic nu se deosebea de cea adiacentă. Prin examenul radiografic, după prima etapă chirurgicală, a fost stabilit că în majoritatea cazurilor (89,7%) la apofiza alveolară între implant şi pereţii alveolei era prezentă o fisură radiotrasparentă de diverse dimensiuni. Mai mare ea era la dinţii multiradiculari. Conţinutul acestei fisuri, cu certitudine se poate afirma, este reprezentat de ţesutul alveolei aflate în curs de vindecare. La a doua etapă chirurgicală această fisură în jurul a 26 (89,66%) implante a dispărut şi osul periimplantar la creasta alveolară era corticalizat, 5 (17,24%) implante fiind acoperite parţial sau în totalitate de os. La 3 (10,34%) implante fisura evident s-a micşorat şi a rămas vizibilă numai la creasta alveolară. La aceste implante valorile periotestului, ca şi la toate celelalte, au fost negative şi ele au fost considerate ca osteointegrate. Stabilitatea preprotetică (valorile periotestului), apreciată după instalarea conformatorului gingival, la toate implantele a fost negativă şi a variat între -3 şi -7 (-5,81±0,22). Instalarea timpurie a implantelor conform metodei elaborate asigură osteointegrarea lor fară augmentare de materiale osteoplaste micşorând astfel timpul şi costul tratamentului. In the patients included in the study, it was found that in all cases the healing of the alveolus proceeded without complications. At the time of referral, the wound was epithelialized, without signs of inflammation. Above the alveolus, the gingiva was deepened. In four cases, a slight unevenness was observed in the vestibular part of the alveolar process. On the retroalveolar radiographs and OPG in the projection of the absent teeth, a radiotransparency was observed, against the background of which the walls of the alveolus could be appreciated with their edges at the alveolar crest “erased”. On the 8th…10th day after the installation of the implants, according to the developed method, the gingival mini-wound was scarred. Regenerative processes in the mucosa continued and at the 4th week the scar was replaced by a thin epithelial covering and through it the bluish color of the covering screw was visible (transparent). After 6...8 weeks the gum became thicker (mature), the bluish color of the covering screw through it was no longer noticeable, and the deepening, which was attested on the alveolar process preoperatively, became less pronounced. At the second surgical stage, the gum above the implant macroscopically did not differ from the adjacent one. By radiographic examination, after the first surgical stage, it was established that in most cases (89.7%) at the alveolar process between the implant and the walls of the alveolus there was a radiolucent crack of various sizes. It was larger in multi-rooted teeth. The content of this crack, it can be stated with certainty, is represented by the tissue of the alveolus that is in the process of healing. At the second surgical stage, this crack around 26 (89.66%) implants disappeared and the peri-implant bone at the alveolar ridge was corticalized, 5 (17.24%) implants being partially or completely covered by bone. In 3 (10.34%) implants, the obvious crack decreased and remained visible only at the alveolar ridge. In these implants, the periotest values, as in all the others, were negative and they were considered osseointegrated. The preprosthetic stability (periotest values), assessed after the installation of the gingival conformer, in all implants was negative and ranged between -3 and -7 (-5.81±0.22). Early installation of implants according to the developed method ensures their osseointegration without augmentation with osteoplastic materials, thus reducing the time and cost of treatment.
1. Branemark P., Adell R., Breine U. et al. Intra-osseous anchorage of dental prostheses In: Scand. J. Plast. Reconstr. Surg. 1969, nr. 3, p. 81-100 1. Branemark P., Adell R., Breine U. et al. Intra-osseous anchorage of dental prostheses In: Scand. J. Plast. Reconstruction Surg. 1969, no. 3, p. 81-100
2. Schrop L., Kostopoulos L., Wenzei A. Bone Healing Following Immediate Versus Delayed Placement of Titanium Implants intro Extraction Sockets: A Prospective Clinical Study. Int. J. Oral Maxillofac Implants. 2003, nr. 18, p. 189-199 2. Schrop L., Kostopoulos L., Wenzei A. Bone Healing Following Immediate Versus Delayed Placement of Titanium Implants in Extraction Sockets: A Prospective Clinical Study. International J. Oral Maxillofac Implants. 2003, no. 18, p. 189-199
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| MD721Z (en) * | 2013-06-04 | 2014-08-31 | Валериу ФАЛА | Method for prosthetic treatment of temporo-mandibular disorders |
| MD948Z (en) * | 2015-04-02 | 2016-04-30 | Валентин ТОПАЛО | Method for directional simultaneous placement of second-stage dental implants |
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| RU2180197C2 (en) * | 2000-01-26 | 2002-03-10 | Самарская областная клиническая стоматологическая поликлиника | Method for carrying out direct dental implantation |
| RU2181576C1 (en) * | 2001-03-13 | 2002-04-27 | Никольский Вячеслав Юрьевич | Method for carrying out early dental implantation |
| RU2228722C1 (en) * | 2003-02-17 | 2004-05-20 | Государственное образовательное учреждение высшего профессионального образования "Пермская государственная медицинская академия" | Method for sinus-lifting in case of dental endoaxial implantation |
| MD2355G2 (en) * | 2003-08-07 | 2004-07-31 | Валериу РУДИК | Method of preimplanting preparation |
| MD2973G2 (en) * | 2005-03-29 | 2006-09-30 | Валериу ФАЛА | Method of sinus-lifting at the dental endo-osseous implantation |
| MD3118G2 (en) * | 2005-09-29 | 2007-03-31 | Георге НИКОЛАУ | Method of dental implantation |
| MD91Z (en) * | 2009-05-13 | 2010-05-31 | Валентин ТОПАЛО | Method for dental implantation by transalveolar access with maxillary sinus floor elevation |
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| Publication number | Priority date | Publication date | Assignee | Title |
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| RU2180197C2 (en) * | 2000-01-26 | 2002-03-10 | Самарская областная клиническая стоматологическая поликлиника | Method for carrying out direct dental implantation |
| RU2181576C1 (en) * | 2001-03-13 | 2002-04-27 | Никольский Вячеслав Юрьевич | Method for carrying out early dental implantation |
| RU2228722C1 (en) * | 2003-02-17 | 2004-05-20 | Государственное образовательное учреждение высшего профессионального образования "Пермская государственная медицинская академия" | Method for sinus-lifting in case of dental endoaxial implantation |
| MD2355G2 (en) * | 2003-08-07 | 2004-07-31 | Валериу РУДИК | Method of preimplanting preparation |
| MD2973G2 (en) * | 2005-03-29 | 2006-09-30 | Валериу ФАЛА | Method of sinus-lifting at the dental endo-osseous implantation |
| MD3118G2 (en) * | 2005-09-29 | 2007-03-31 | Георге НИКОЛАУ | Method of dental implantation |
| MD91Z (en) * | 2009-05-13 | 2010-05-31 | Валентин ТОПАЛО | Method for dental implantation by transalveolar access with maxillary sinus floor elevation |
Non-Patent Citations (2)
| Title |
|---|
| Branemark P., Adell R., Breine U. et al. Intra-osseous anchorage of dental prostheses In: Scand. J. Plast. Reconstr. Surg. 1969, nr. 3, p. 81-100 * |
| Schrop L., Kostopoulos L., Wenzei A. Bone Healing Following Immediate Versus Delayed Placement of Titanium Implants intro Extraction Sockets: A Prospective Clinical Study. Int. J. Oral Maxillofac Implants. 2003, nr. 18, p. 189-199 * |
Cited By (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| MD721Z (en) * | 2013-06-04 | 2014-08-31 | Валериу ФАЛА | Method for prosthetic treatment of temporo-mandibular disorders |
| MD948Z (en) * | 2015-04-02 | 2016-04-30 | Валентин ТОПАЛО | Method for directional simultaneous placement of second-stage dental implants |
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