RU2228722C1 - Method for sinus-lifting in case of dental endoaxial implantation - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: one should dissect tissues of mouth cavity vestibule with vertical incision from transitional fold up to premolar's cervix, and then, along the crest of maxillary alveolar process at exfoliation of triangular mucous-periosteal fragment. One should perform perforation opening in anterior-lateral wall in maxillary sinus. One should lift the mucus of maxillary sinus' bottom. One should form a through canal in the crest of alveolar process from the side of its top with its output into maxillary sinus and osseous bottom of dental implant. Its intraosseous part should be installed in the canal obtained. Allogenic split demineralized osseous transplant should be placed into newly developed cavity so that it becomes the wall of new osseous bottom of maxillary sinus, the rest cavitary part should be filled with granules or collapan gel by homogenously impregnating it with the blood. Perforation opening in anterior-lateral wall of maxillary sinus should be covered with allogenic split demineralized osseous transplant. The present innovation enables to achieve good cosmetic effect. EFFECT: higher efficiency of sinus-lifting. 2 ex

Description

The invention relates to medicine, namely to surgical dentistry, and can be used for sinus lifting with dental endo-axial implantation.

Closest to the claimed invention is a method of sinus lifting for dental endoossal implantation, the technique of which is as follows: the incision is made along the alveolar ridge of the upper jaw and at an angle along the transition fold to the projection of the apex of the tooth root. The mucoperiosteal flap exfoliates from the vestibule of the oral cavity. The wound should be wide enough to provide convenient access to the outer wall of the maxillary sinus. The contour of the future trepanation hole is outlined with a spherical boron, thereby smoothly and uniformly thinning the bone plate until the sinus mucosa is clearly visible. Carefully break off the remains of the thinned bone around the periphery of the intended window with a special spatula and exfoliate the mucosa from the bone, starting from the lower sinus. The remaining bone plate is gradually raised up, thereby freeing the bottom of the sinus. In the usual way, a bed is formed into the endosseous plate implant, and the implant is inserted. The remaining space of the lower maxillary sinus is filled with hydroxylapatite or autobone. The mucoperiosteal flap is returned to the place, the wound is sutured (O. Surov, V. Steponavichus. Possibilities of implantation in the upper jaw. / New in dentistry. - Special issue, 1995, No. 2, p. 28-29).

Disadvantages: the proposed method does not allow the use of an allogeneic demineralized bone graft to form a newly formed bone floor of the maxillary sinus, the perforation window in the anterolateral wall of the maxillary sinus does not close, which leads to the ingrowth of the mucoperiosteal flap in the sinus in the postoperative period.

The invention is aimed at solving problems: increasing the efficiency of the method by the possibility of a controlled increase in the height of the alveolar process of the upper jaw, achieving a cosmetic effect by dissecting soft tissues of the vestibule of the oral cavity, as well as preventing the ingrowth of the mucoperiosteal flap in the maxillary sinus.

These tasks are achieved by dissecting the soft tissues of the vestibule of the oral cavity, making a perforation hole in the anterolateral wall of the maxillary sinus, raising the mucous membrane of the bottom of the maxillary sinus, forming a through channel in the alveolar process crest with access to the maxillary sinus and the implant bed. received channel of its intraosseous part.

New in the method is: dissection of the tissues of the vestibule of the oral cavity is carried out by a vertical incision from the transitional fold to the neck of the premolar, and then along the crest of the alveolar process of the upper jaw with delamination of the triangular mucosal-periosteal flap, allogeneic split demineralized bone graft is laid in the newly created cavity, simultaneously of the new bony bottom of the maxillary sinus, the rest of the cavity is filled with granules or gel of the valve, homogenously impregnating them with blood. After raising the bottom of the maxillary sinus, the perforation hole in the anterior-lateral wall of the maxillary sinus is closed with an allogeneic split demineralized bone graft.

To carry out the claimed method, an implant from Konmet, an allogeneic demineralized bone graft, and the biocomposite material Collap from Intermedapatite are used.

The proposed method of sinus lifting during dental endoossal implantation is carried out in the following sequence.

A mucous membrane is cut under tubular anesthesia from the vestibule of the oral cavity with a vertical section from the transitional fold to the neck of the premolar, then along the crest of the alveolar process of the upper jaw.

Peel the mucoperiosteal flap from the bone to expose the anterolateral wall of the maxillary sinus. The front-side wall of the maxillary sinus is opened with several holes with a spherical bur with a distance of 1.5-2 mm, then they are connected to each other. The cortical plate of the anterolateral surface of the maxillary sinus is removed, the lower edge of which is located 4-5 mm above the crest of the alveolar process of the upper jaw, exposing the mucous membrane of the maxillary sinus. The resulting bone defect should be sufficient to review the surgical field, which is at least 10: 5 mm. With the help of curved and straight raspatora exfoliate the mucous membrane of the maxillary sinus, raising the bottom of the maxillary sinus. The height of the alveolar ridge is measured with a micrometer to more accurately select the type and size of the implant. For primary implant stability, the height of the alveolar ridge should not be less than 50% of the size of the implant. Depending on the chosen implant, a bed is formed in the bone of the alveolar process with access to the maxillary sinus in the traditional way. An allogeneic split demineralized bone graft is introduced into the newly formed cavity and placed below the mucous membrane of the bottom of the maxillary sinus, while it is the new bone wall of the bottom of the maxillary sinus. The remaining cavity is filled with granules or valve gel, homogenously impregnating them with blood. A plate implant is inserted into the formed bone bed. The perforation hole is closed with a split demineralized bone graft. The inner plug is screwed into the implant. The mucoperiosteal flap in front of the oral cavity is laid in place and the wound is sutured tightly.

After 6 months, dentures are performed using previously introduced implants. A sharp instrument is used to find the neck of the implant. At the location of the neck of the implant using a mucotome, the mucous membrane is removed, exposing the inner plug. Remove the internal plug by replacing it with a gingiva former. After 2 weeks, the gingival former is replaced by a suprastructure and prosthetics on implants are performed according to the traditional method.

Example 1

Patient K., 47 years old, went to the clinic complaining of a partial absence of teeth on the upper jaw on the right. The patient refused prosthetics with removable prostheses. An orthopantomogram was performed. The thickness of the bone tissue of the alveolar process of the upper jaw on the right is 4 mm. The patient was asked to eliminate a dentition defect during prosthetics on an implant using the claimed method. Under mucosal dissection, a vertical incision was made from the vestibule of the oral cavity from the transitional fold to the neck of the premolar, and then along the crest of the alveolar process of the upper jaw.

The mucosal-periosteal flap of a triangular shape was exfoliated from the bone to expose the anterior-lateral wall of the maxillary sinus. They opened the antero-lateral wall of the maxillary sinus with a spherical bur using several holes 1.5-2 mm apart, then connected them together. The cortical plate of the anterolateral surface of the maxillary sinus was removed, the lower edge of which was located 4 mm above the crest of the alveolar process of the maxilla, exposing the mucous membrane of the maxillary sinus. The resulting hole should be sufficient to review the surgical field, it was 10: 7 mm. Using a combined raspator, the mucous membrane of the maxillary sinus was exfoliated, raising its bottom. We measured the height of the alveolar bone for a more accurate choice of the type and size of the implant, formed a bed in the bone of the alveolar bone with access to the maxillary sinus for the lamellar implant. We performed plastic surgery on the newly formed sinus bone floor using an allogeneic split demineralized bone graft. The remaining cavity in the alveolar process was filled with granules of the valve, homogenously impregnating them with blood. A 7 × 18 platelet implant with a displaced head was inserted into the formed bone bed, plastic perforation was performed with a split demineralized bone graft. An internal plug was screwed into the implant. The mucoperiosteal flap was placed in place on the threshold of the oral cavity and the wound was sutured tightly.

After 6 months, the prosthetics were performed using a previously inserted implant. Under infiltration anesthesia, the implant neck was exposed with a sharp instrument, in the area of which the mucous membrane was removed using a mucotome, exposing the internal plug. They removed the inner plug, replacing it with a gingiva former. After 2 weeks, the gingival former was replaced by suprastructure and prosthetics were performed on implants using a traditional technique. A follow-up examination after 3 months showed that the prostheses are stable, in the area of the transitional fold the scar is inconspicuous, pink in color, there is no tissue compaction. Radiologically determined bone formation.

Example 2

Patient Sh., 54 years old, went to the clinic complaining of a partial absence of teeth in the upper jaw. The patient refused prosthetics with removable prostheses. An orthopantomogram was performed. The thickness of the bone tissue of the alveolar process of the upper jaw on the right is 5 mm. The patient was asked to eliminate a dentition defect during prosthetics on an implant using the claimed method. Under mucosal dissection, a vertical incision was made from the vestibule of the oral cavity from the transitional fold to the neck of the premolar, and then along the crest of the alveolar process of the upper jaw on the left.

The mucosal-periosteal flap of a triangular shape was exfoliated from the bone to expose the anterior-lateral wall of the maxillary sinus. They opened the antero-lateral wall of the maxillary sinus with a spherical boron with several holes with a distance of 1.5-2 mm, then connected them together. The cortical plate of the anterolateral surface of the maxillary sinus was removed, the lower edge of which was located 5 mm above the crest of the alveolar process of the maxilla, exposing the mucous membrane of the maxillary sinus. The resulting hole should be sufficient to review the surgical field, it was 10: 7 mm. Using a combined raspator, the mucous membrane of the maxillary sinus was exfoliated, raising its bottom. We measured the height of the alveolar bone for a more accurate choice of the type and size of the implant, formed a bed in the bone of the alveolar bone with access to the maxillary sinus for the lamellar implant. We performed plastic surgery on the newly formed sinus bone floor using an allogeneic split demineralized bone graft. The remaining cavity in the alveolar process was filled with granules of the valve, homogenously impregnating them with blood. A 7 × 22 lamellar double-head implant was inserted into the formed bone bed, and a perforation hole was split with a split demineralized bone graft. Internal plugs were screwed into the implant. The mucoperiosteal flap was placed in place on the threshold of the oral cavity and the wound was sutured tightly.

After 6 months, the prosthetics were performed using a previously inserted implant. Under infiltration anesthesia, the implant necks were exposed with a sharp instrument, in the area of which the mucous membrane was removed using a mucotome, exposing the internal plugs. They removed the internal stubs, replacing them with gum formers. After 2 weeks, the gingival formers were replaced by suprastructures and prosthetics were performed on implants using a traditional technique. A follow-up examination after 3 months showed that the prostheses are stable, in the area of the transitional fold the scar is inconspicuous, pink in color, there is no tissue compaction. Radiologically determined bone formation.

The positive effect of using the proposed method is as follows: the possibility of a controlled increase in the height of the alveolar process of the upper jaw, the possibility of prosthetics on implants with a low location of the bottom of the maxillary sinus and atrophy of the alveolar process of the upper jaw, regardless of its height, in addition, the use of the developed method leads to an increase reliability and stability of the implant. The method is effective, less traumatic.

Claims (1)

The method of sinus lifting during dental endoossal implantation, which consists in making a perforation hole in the anterolateral wall of the maxillary sinus, raising the mucous membrane of the bottom of the maxillary sinus, forming in the crest of the alveolar process from the side of its apex of the through canal, with access to the maxillary bosom of the maxillary groin and bones of the maxilla in the obtained channel of its intraosseous part, characterized in that the dissection of the tissues of the vestibule of the oral cavity is carried out by a vertical incision from of the transition fold to the neck of the premolar, and then along the crest of the alveolar process of the upper jaw with delamination of the triangular mucoperiosteal flap, the allogeneic split demineralized bone graft is placed in the newly created cavity in such a way that it is the wall of the new bone floor, the maxillary sinus fills the granule of the sinus, the rest or gel of the valve, homogenously impregnating with blood, the perforation hole in the anterolateral wall of the maxillary sinus is closed with an allogeneic splitting captive demineralized bone graft.