RU2151560C1 - Method for treating difficult eruption of lower wisdom teeth - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves applying compact osteotome and orthodontic correction of tooth position. Compact osteotome is carried out on both sides of the jaw depending on tooth inclination. Mucous membrane incision is carried out running from pterygoid mandibular fold to transitory fold in vertical, horizontal and oblique direction. Sorbent is applied for preventing postoperative complications. EFFECT: accelerated treatment course. 2 cl

Description

 The invention relates to medicine, namely to dentistry, and can be used to eliminate the wrong position and preserve the lower wisdom teeth with difficult teething.

 Difficult teething of the dystopian lower wisdom teeth when tilted to the lingual or buccal side is quite common and, according to the data of T. Rudenko (1971), ranges from 5 to 20% (1).

 The most common complication with difficult eruption of the dystrophic lower wisdom teeth is pericoronaritis (66%) (2).

 The tactics of a doctor with this pathology boils down to the elimination of inflammatory phenomena in the retromolar region and the elimination of the abnormal position of the tooth.

 In order to stop the inflammatory process in the retromolar region, medication anti-inflammatory therapy is most often used in combination with washing the pocket under the hood with solutions of antiseptics (furatsilin, dimexidum, chlorhexidine, etc.), antibacterial drugs (bacteriophage, antibiotics) and physiotherapy.

 The most common way to treat the incorrect position of the lower wisdom teeth in the dentition (lingual or buccal tilt) is to remove them (2).

 There is a method of treating difficult teething of the lower wisdom teeth with the help of orthodontic appliances (3). The method consists in creating enough space to accommodate the retarded wisdom teeth by mesial movement of the lateral teeth using removable and non-removable devices due to three between the teeth or dentition defects due to loss of teeth (usually the lower sixth). The application of the method is possible after the elimination of inflammatory phenomena from the tissues surrounding the moved teeth.

 Positive results were noted after 1-2 years, and their number is not high enough.

 In addition, this method of treatment does not allow to eliminate the inclination of the lower wisdom teeth in the buccal and lingual sides, and it is also impossible to apply with an intact dentition. Moreover, lateral tooth displacement requires a long time, which creates inconvenience for patients.

 A known method of treating abnormally located wisdom teeth by moving toward the alveolar ridge, the closest in technical essence and the result to the claimed, taken as a prototype. For this, palatine plates with vestibular arches and springy clasters were used. At the same time, the clamer tightly covered the vestibular surface of the doped tooth, and the base of the plate did not lie on it. As the tooth moved, the clamer was activated and the base of the plate was corrected, making room for further movement. The duration of correction of the position of the teeth depended on their location relative to the crest of the alveolar ridge and the age of the patients. The average treatment time was 3-5 months. To shorten the treatment time before the start of orthodontic treatment, a compactostotomy was performed according to M.S.Shvartsman and F.Ya. Compactosteotomy was performed from the vestibular surface of the jaw in the region of the alveolar ridge and apical basis. After an incision along the transitional fold, from the side of the vestibule of the oral cavity, a mucoperiosteal flap was separated up and down and perforated holes were applied with a spherical bur. A part of the compact bone layer was removed, being careful not to immerse in the spongy substance. The holes were located mainly above the roots of the teeth, along the holes in the area of the interdental septa. Surgical wounds were sutured.

 This method can be used in the treatment of only the vestibular inclination of third molars and is not applicable to eliminate the lingual position of wisdom teeth. In addition, cutting out the mucosal-periosteal flap when using an incision along the transitional fold does not provide sufficient access to the tooth and an overview of the surgical field. When moving a tooth, the necessary pressure and traction can be applied mainly to the crown, which is approximately 2 times shorter than the root located in the bone tissue of the alveoli. Therefore, under the influence of a horizontally directed force applied to the tooth crown by orthodontic structures, even when the cortical plate is removed on one side, it tilts, and not the body movement to the alveolar ridge. Surgery in the oral cavity can lead to the development of postoperative inflammatory complications.

 To increase the effectiveness of treatment, expand indications for preserving the dystopian lower wisdom teeth, reduce the treatment time and the number of possible inflammatory complications, compactosteotomy is performed on both sides of the jaw, moreover, on the side opposite to the inclination of the tooth, the cortical plate is perforated throughout the tooth root, and on on the other side, only in the region of the root apex, the surgical wound is washed with isotonic sodium chloride solution with the SUMS-1 sorbent, the flap is put in place, the wound is sutured, etc. lead orthodontic tooth position correction.

 During compactosteotomy, a mucoperiosteal flap is cut out by a vertical incision along the outer edge of the pterygo-mandibular fold from the base to the retro-molar region, extending it horizontally along the crest of the alveolar process to the crown of the second lower molar and then obliquely down and anteriorly to the transitional fold at the level of the second lower premolar from the vestibular and lingual sides of the lower jaw.

 The method is as follows.

For 3-4 days, after the inflammatory phenomena subside, the patient under an infiltration and conduction anesthesia against the background of sedation on the side of the dystopia of the third molar produce an incision consisting of three parts:
1. Vertical - from the base of the pterygo-maxillary fold along its outer surface to the retro-molar region 0.5-1.0 cm long;
2. Horizontal - along the crest of the alveolar ridge of the retromolar region to the crown of the second molar, without violating the circular ligament of the wisdom tooth;
3. Oblique - down and anteriorly at an angle of 50-60 ^o to the transitional folds from the vestibular and lingual sides of the lower jaw at the level of the second premolar.

 Then, the mucoperiosteal flap is exfoliated from the vestibular and lingual sides of the jaw and the compact plate is perforated with spherical boron No. 3 in a checkerboard pattern without penetrating into the spongy bone. From the side of the tooth inclination, the compact plate is perforated only in the region of the apex of the root of the doped tooth, from the side opposite to the tooth inclination, perforations are made in the projection of the tooth root along its entire length. The number of holes depends on the degree of inclination of the tooth and the direction of movement.

 After weakening the bone tissue, the surgical wound is washed with a suspension of SUMS-1 sorbent in a 0.9% sodium chloride solution in a ratio of 1: 2. The mucoperiosteal flap is placed in place and the wound is sutured.

 After 1-2 days, begin the orthodontic correction of the position of the wisdom tooth. The patient undergoes selective grinding of the hillocks of the eighth upper and lower teeth and mechanotherapy (myotherapy) is prescribed, consisting in pressure on the tooth with the tip of the tongue or in finger pressure on the tooth, depending on the direction of inclination.

 The proposed method of treatment allows you to expand the indications for the preservation of the dystopic lower wisdom teeth due to the ability to quickly move the inclined teeth into the dental arch. The ability to quickly move teeth is provided by weakening the bone tissue of the lower jaw in areas subject to the strongest pressure during body movement of the teeth, based on the biomechanics of the orthodontic effect and the direction of active force, by compactosteotomy on both sides of the jaw.

 For the convenience of compactosteotomy, a complex incision has been developed, consisting of three parts: vertical, horizontal, oblique. It provides sufficient access to the tooth and an overview of the surgical field from the lingual and vestibular sides. In addition, if necessary, using this incision, the hood above the wisdom tooth is simultaneously excised, and the overhanging part of the lower jaw branch is removed. Such an incision allows preserving the circular ligament of the wisdom tooth during compactosteotomy, which plays an important role in the further functioning of the tooth.

 Washing the surgical wound with the SUMS-1 sorbent prevents the possibility of developing inflammatory postoperative complications and thereby contributes to the speedy healing. Sorbent SUMS-1 is a dense rounded granules with a size of 0.1-0.2 mm, containing a standardized mineral matrix coated with chemically pure carbon. The sorbent is used as a suspension of granules in a physiological solution of sodium chloride in a ratio of 1: 2. It is this dispersion that provides the high sorption ability of SUMS-1 in relation to microorganisms and their toxins. The sorbent introduced into the wound is indifferent and does not cause a leukocyte reaction.

 The inventive method was used in 9 patients with difficult eruption of dystopian lower wisdom teeth.

Case Studies
Example 1. Patient M., 20 years old, was admitted to the dental clinic of the ChGMA on 02/14/98 with complaints of aching constant pain in the lower jaw area on the right of a constant nature, aggravated by eating and chewing, pain when swallowing, difficulty opening the mouth.

 An examination revealed a slight swelling of the soft tissues of the cheek and submandibular region on the right, the skin above it was not changed in color, it was painless on palpation, and it collected well. The submandibular lymph nodes are enlarged, tightened, painful, with limited mobility. Opening the mouth is limited, painful.

контактирует со слизистой оболочкой над

.The mucous membrane of the oral cavity is hyperemic, swollen in the retro-molar region on the right, along the transitional fold in the region of the second molar and the anterior palatine arch on the right. The eruption of the medial tubercles of the lower eighth tooth with its inclination to the lingual side was noted. Above the crown of the wisdom tooth there is a mucoperiosteal flap (hood) on the right, from which purulent contents stand out. Palpation of tissues in this area is painful. The tissues of the maxillofacial groove are not changed. When closing teeth

in contact with the mucous membrane over

.

 On the radiograph of the lower jaw in a lateral projection in the angle to the right of 02/14/98, the tooth is inclined to the lingual side, pathological changes in the bone tissue in the region of the eighth tooth are not revealed.

, осложненное острым гнойным перикоронаритом; дистопия

с наклоном в язычную сторону.Diagnosis: Difficulty teething

complicated by acute purulent pericoronaritis; dystopia

with a slope in the lingual side.

. Под проводниковой и инфильтрационной анестезией больному произвели разрез слизистой оболочки по наружной поверхности крыловидно-челюстной складки от ее основания вниз длиной 1 см до ретромолярной области. Далее, продолжая его горизонтально, рассекли капюшон над

и слизистую оболочку по гребню альвеолярного отростка, огибая

с вестибулярной стороны, стараясь не травмировать круговую связку зуба, до

. От

разрез провели косо вниз до переходной складки на уровне второго нижнего премоляра с обеих сторон челюсти. Затем иссекли слизистую оболочку над

и отсепарировали слизисто-надкостничный лоскут с язычной и вестибулярной сторон, обнажая челюсть в области проекции корня

. С помощью шаровидного бора N 3 произвели перфорацию кортикальной пластинки на всем протяжении корня

с вестибулярной стороны и в области верхушки корня с язычной стороны. Операционную рану промыли суспензией сорбента СУМС-1 в 0,9% растворе хлористого натрия в соотношении 1: 2. Слизисто-надкостничный лоскут уложили на место, рану ушили наглухо. Швы сняли на 8-й день после операции, рана зажила первичным натяжением. На 2-й день после операции больному назначили механотерапию - давление языком на коронку

в течение 3-5 минут 3-4 раза в день. Контрольные осмотры проводили 1 раз в неделю и производили избирательное пришлифовывание бугров

с учетом перемещения

. Через 2 месяца при осмотре полости рта отмечалось перемещение

. Зуб в зубной дуге, слизистая оболочка не изменена.Treatment: On the day of admission, the patient was washed with a syringe in the pocket under the hood using a suspension of SUMS-1 sorbent in a 0.9% sodium chloride solution in a ratio of 1: 2. Prescribed antibiotics, sulfonamide and antihistamines, mouth rinses, physiotherapy. Pocket washing was carried out daily for 3 days. After the inflammatory phenomena subsided, on the 4th day, before the operation, they performed selective grinding of the tubercles

. Under conduction and infiltration anesthesia, the patient had an incision of the mucous membrane along the outer surface of the pterygo-maxillary fold from its base down 1 cm long to the retro-molar region. Further, continuing it horizontally, they cut the hood over

and the mucous membrane along the crest of the alveolar process, enveloping

from the vestibular side, trying not to injure the circular ligament of the tooth, until

. From

the incision was made obliquely down to the transitional fold at the level of the second lower premolar on both sides of the jaw. Then the mucous membrane was excised over

and the mucoperiosteal flap was separated from the lingual and vestibular sides, exposing the jaw in the area of the root projection

. Using spherical boron N 3 perforated the cortical plate along the entire root

from the vestibular side and in the region of the apex of the root from the lingual side. The surgical wound was washed with a suspension of SUMS-1 sorbent in a 0.9% sodium chloride solution in a ratio of 1: 2. The mucoperiosteal flap was put in place, the wound was closed tightly. The sutures were removed on the 8th day after the operation, the wound healed by primary intention. On the 2nd day after surgery, the patient was prescribed mechanotherapy - pressure on the crown with the tongue

for 3-5 minutes 3-4 times a day. Control examinations were carried out once a week and the mounds were selectively ground

taking into account the movement

. After 2 months, when examining the oral cavity, there was a movement

. A tooth in a dental arch, the mucous membrane is not changed.

 Example 2. Patient A., 18 years old, was admitted to the dental clinic of the ChGMA on 06/14/98 with complaints of periodic pain in the lower jaw on the left, pain in opening the mouth. Considers himself ill for 1 year, when pain first appeared in the area of the jaw angle on the left. Pain periodically appeared and stopped on its own. 06/10/98 there was a swelling of the gums in the area of chewing teeth on the left and difficulty opening the mouth. When contacting a doctor at the place of residence, anti-inflammatory treatment was prescribed. These phenomena subsided. Directed for consultation at the dental clinic CHGMA.

с наклоном в щечную сторону,

интактный, слизистая оболочка над

утолщена, слабо болезненна при пальпации. На рентгенограмме нижней челюсти в боковой проекции в области угла слева от 17.06.98 отмечается наклон

в щечную сторону, дистальная часть коронки зуба перекрыта передним краем ветви челюсти, в костной ткани ветви, в области зуба отмечается очаг разрежения.A local examination revealed an increase, limitation of mobility and tenderness of the submandibular lymph nodes on the left during palpation. When examining the oral cavity revealed the eruption of the medial tubercles

with a slope to the cheek side,

intact, mucous membrane over

thickened, slightly painful on palpation. On the x-ray of the lower jaw in a lateral projection in the region of the angle to the left of 06/17/98 there is a slope

on the buccal side, the distal part of the tooth crown is overlapped by the front edge of the jaw branch, in the bone tissue of the branch, a rarefaction is noted in the tooth region.

, дистопия

с наклоном в щечную сторону, хронический перикоронарит в стадии ремиссии.Diagnosis: Difficulty teething

dystopia

with a slope to the buccal side, chronic pericoronaritis in remission.

и одновременно удалены патологические грануляции за дистальным отделом коронки

. С язычной стороны нижней челюсти перфорирована кортикальная пластинка альвеолярного отростка в проекции корня

на всем протяжении. Со щечной стороны кортикальная пластинка перфорирована только в области верхушки корня. Операционная рана промыта суспензией сорбента СУМС-1, слизисто-надкостничный лоскут уложен на место, рана ушита. Послеоперационный период протекал без осложнений. Ежедневно во время перевязок на рану накладывали гранулы сорбента СУМС-1. Со 2-го дня после операции больному назначена механотерапия - пальцевой массаж и давление на коронку

в язычную сторону 4-5 раз в день по 5-10 минут. Швы сняты на 6 день. Контрольные осмотры проводили еженедельно. Перемещение зуба в зубную дугу завершилась через 3 месяца.06/18/98 the patient underwent surgery. Under the conduction and infiltration anesthesia, a mucous membrane was cut as in example 1. After peeling of the mucoperiosteal flap, the bone tissue of the anterior edge of the lower jaw branch was removed above the crown

and at the same time, pathological granulations behind the distal crown are removed

. On the lingual side of the lower jaw, the cortical plate of the alveolar process is perforated in the root projection

all over. On the buccal side, the cortical plate is perforated only in the region of the apex of the root. The surgical wound was washed with a suspension of SUMS-1 sorbent, the mucoperiosteal flap was put in place, the wound was sutured. The postoperative period was uneventful. Every day, during dressings, granules of the sorbent SUMS-1 were applied to the wound. From the 2nd day after surgery, the patient is prescribed mechanotherapy - finger massage and pressure on the crown

in the lingual side 4-5 times a day for 5-10 minutes. Sutures were removed on day 6. Control examinations were performed weekly. The movement of the tooth into the dental arch was completed after 3 months.

Claims (2)

 1. A method of treating difficult eruption of dystopic lower wisdom teeth, including orthodontic correction with preliminary compactosteotomy, characterized in that the incision for compactosteotomy is made from the base of the pterygo-jaw fold in the vertical direction along its outer edge to the retro-molar region, continuing it horizontally along the crest of the alveolar ridge to the crown of the second molar, then obliquely down and anteriorly to the transitional fold at the level of the second premolar from the lingual and vestibular sides of the jaw, perforation of the cortical plate is carried out in the projection of the root of the dystopic tooth along the entire length from the side opposite to the slope and in the region of the root apex from the side of the root, the surgical wound is washed with a suspension of SUMS-1 sorbent in an isotonic sodium chloride solution in the ratio 1: 2.  2. The method according to claim 1, characterized in that the orthodontic correction of the position of the tooth is carried out by mechanotherapy.