RU2181575C2 - Method for carrying out immediate two phase implantation - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves setting immersible implant into the cell at once after antiseptic treatment in removing molar tooth in the mandible. Implant bed is preliminarily formed in preparing two vertical cylindrical grooves within the cell boundaries of the medial and distal tooth roots. The walls and bottom of the formed bed are dusted using crushed demineralized lyophilized spongious bone transplant. Two cylindrical screw implants of immersible type are set. Each of them has intraosseous part and temporary seal member. Enzymes of demineralized lyophilized spongious bone of corresponding shape and size are distributed over the alveolus edges. Mucoperiosteal flap is mobilized on the vestibular surface of alveolar process of the mandible. The mucous membrane is tightly sutured. The seal members are changed for permanent supporting heads 4- 6 months later after setting the implants through the mucous membrane perforation. Artificial crown to be supported by two implant heads is manufactured. EFFECT: enhanced effectiveness of treatment+ADs- accelerated prosthesis production+ADs- improved implant integration.

Description

 The invention relates to medicine, in particular to dentistry, and is used to replace an artificial crown based on the implant of a removable molar tooth of the lower jaw.

 A known method of using the construction of a dental implant [1], which contains the intraosseous part and the coronal part, consisting of the outer and inner parts, while the inner part is located in the corresponding recess of the intraosseous part and is equipped with a shock absorber. The concrete implementation of this decision by the authors is as follows: after tooth extraction, an impression is taken off the root, a model is cast on this impression, according to which the intraosseous part of the implant is subsequently made, while the technology may differ depending on the material. Then, an internal fragment of the coronal part is inserted and fixed into the sterilized intraosseous part. After that, the entire structure is inserted into the hole of the extracted tooth and is fixed with a temporary bus. The implant suprastructure is made after completion of the osseointegration processes.

 The disadvantages of this method are that the intraosseous part is made individually, which takes time from several hours to several days, thus double-traumatizing both the patient's psyche and tissues in the area of surgical intervention; using a non-submersible implant design, which virtually eliminates the possibility of osseointegration of the implant; the coronal part is fixed in the intraosseous part due to a layer of shock-absorbing material, for example silicone rubber, which does not seem sufficiently reliable.

 A known method of direct implantation in the field of single-root teeth, i.e. incisors, fangs and premolars [2]. This method does not take into account the specifics of the lateral part of the lower jaw and cannot be used for direct implantation in the well of the lower molars. As a means of optimizing the processes of osseointegration, biological cement is used, which is prepared by mixing hydroxylapatite with collagen and diluting the mixture in a 2% dioxidine solution. However, the proposed composition is not universal and the most effective tool that improves osseointegration of the implant. In addition, this method involves the use of a non-submersible implant design, i.e. the techniques are single-phase, which reduces the possibility of achieving osseointegration, worsens the prognosis and functional results of treatment.

 There is also a method of prosthetics based on the simultaneous removal of a tooth by implantation [3]. However, the implementation of this method assumes the presence of a toothless bone tissue site next to the removed tooth and, accordingly, cannot be addressed to cases of a single tooth being removed from the intact dentition. In addition, as an agent that optimizes reparative osteogenesis, an allograft of demineralized brefosteomatrix is used, which, as in relation to the previous method, is not a universal and most effective solution.

 The technical result achieved by the invention is to improve the integration of the implant, reduce the time of prosthetics and improve the functional results of treatment.

 The invention consists in the following. Gentle removal of the molar tooth of the lower jaw is performed, while the bone tissue of the interroot septum is maximally preserved, pathologically altered periapical tissues (cyst, granuloma) are removed, then the antiseptic treatment of the socket is performed - with low-frequency ultrasound through an antiseptic solution, an implant bed is formed, dissecting two vertical cylindrical grooves within the holes of the medial and distal roots of the tooth, sprinkle the walls and bottom of the formed bed with powdered crushed demineralized lyophilized spongy bone graft, install two screw-type cylindrical implant implants of immersion type, each of which consists of an intraosseous part and a temporary plug, fragments of a demineralized lyophilized spongy bone allograft of an appropriate configuration and size are placed along the edges of the alveoli, and a mucosal-periosteal flap from the vestibular surface of the alve is mobilized , the mucous membrane is sutured tightly, 4-6 months after the implants are established through a puncture with izistoy shell temporary plugs replace the constant reference head and the artificial crown is made with a support on two head implants.

 In practice, the method is as follows. After adequate pain relief, a sparing removal of the molar tooth of the lower jaw is performed, while the bone tissue of the interroot septum is maximally preserved. After that, pathologically altered periapical tissues are removed with a curettage spoon and a spherical mill. Then perform the antiseptic treatment of the hole of the newly extracted tooth with low-frequency ultrasound, for example, by installing URSK-7N-18, using a special waveguide through an aqueous 0.5% solution of chlorhexidine bigluconate. Then, a bed for two implants is formed, using a surgical milling cutter of the corresponding diameter, two vertical cylindrical grooves within the holes of the medial and distal roots of the tooth. In this case, a cutting tool rotational speed of about 500 rpm and a jet cooling of sterile saline are used. The walls and bottom of the thus formed bed under the implants are sprinkled with demineralized lyophilized allogeneic cancellous bone graft powder. Two screw implants of a submersible type of standard production are installed, corresponding in diameter and length, each of which consists of an intraosseous part and a temporary plug made of titanium. The incongruence of the tooth well and implants in the region of the edges of the alveoli is made up for with fragments (blocks) of the demineralized lyophilized spongy bone allograft of a suitable configuration and size. Then, two vertical incisions are made to the bone from the vestibular and oral surfaces of the alveolar ridge, the mucoperiosteal flaps are peeled and mobilized, and sutured tightly.

 After 4-6 months, when osseointegration of implants is achieved, mucosal punctures are made and temporary plugs are replaced with permanent heads.

 After another week, an orthopedic suprastructure is made - an artificial crown based on two implant heads.

The advantages of the proposed method are as follows:
- installation of implants is carried out simultaneously with tooth extraction, i.e. there is a combination of two surgical interventions into one, which reduces the trauma of the patient's psyche and the actual tissues in the area of the operation;
- directly install the implant in the well of the tooth just removed, use the allograft of demineralized lyophilized cancellous bone, which optimizes the processes of reparative osteogenesis and reduces the reduction of the alveolar process;
- apply a submersible implant design (two-phase implantation technique), fill the tooth hole with a spongy bone allograft, tightly suture the mucous membrane, which allows for sealing the bone wound, eliminates the adverse effects of oral factors and promotes osseointegration of the implants;
- restoration of the anatomical shape and functional ability of the extracted tooth is carried out by manufacturing an artificial crown based on implants, which eliminates the need for preparation, and therefore, damage to adjacent teeth;
- reduced time from tooth loss to restoration of a dentition defect with a prosthesis, i.e. the terms of restoration of cosmetic and functional optimum are reduced, deformation of the elements of the dentofacial apparatus, functional disorders in the masticatory muscles and temporomandibular joint are prevented.

Sources of information
1. Patent RU 2023437. Dental implant. A 61 C 8/00.

 2. Nazarov S. G., Kopeikin V. I., Maloryan E. Ya. Dental prosthetics using direct implants. - Dentistry, 1991, 2, p. 61-64.

 3. Patent RU 2150914. Method of dental prosthetics. A 61 C 8/00.

Claims (1)

 The method of direct two-phase dental implantation, which consists in installing an implant of a submersible structure in the hole simultaneously with the removal of a molar tooth of the lower jaw after antiseptic treatment, characterized in that they form a bed for implants, preparing two vertical cylindrical grooves within the holes of the medial and distal roots of the tooth, sprinkle the walls and the bottom of the formed bed with an allograft powder of demineralized lyophilized spongy bone, set two screw Immersion-type implants, along the edges of the alveoli and over the inter-root septum, the allograft blocks-blocks of the demineralized lyophilized spongy bone of the appropriate configuration and size are laid, the mucosal-periosteal flaps are peeled and mobilized and sutured tightly, after 4 to 6 months have passed and the temporary plugs have been replaced permanent support heads make an artificial crown based on two implant heads.