RU2254072C1 - Method for treating mandibular fractures - Google Patents

Abstract

FIELD: medicine, orthopedics, traumatology.

SUBSTANCE: the present innovation deals with treating mandibular fractures by applying the implants. The innovation enables to perform reposition of fragments into correct position and provide their reliable fixation and compression, especially in case of secondary adentia, avoid more traumatic method of osteosynthesis and favor further orthopedic rehabilitation in patients. The suggested method deals with orthopantomogram, dissection of mucosa, development of osseous channel to place implants into this channel followed by reposition and fixation of mandibular fragments. One should apply crowns onto implants' heads which are rigidly connected with tubes to apply threaded rods with nuts at the ends to carry out reposition of fragments into correct position and their fixation, after consolidation of mandibular fracture crowns and rods should be removed and implants should be applied for prosthetics.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to medicine, namely to orthopedics and traumatology, and can be used to treat fractures of the lower jaw using implants.

The closest technical solution is a method for treating jaw fractures using intraosseous implants, including performing an orthopantomogram, installing a retractor and saliva pump in the oral cavity, performing anesthesia, excising the mucous membrane, forming a bone bed for implants by creating a channel with a thread in the alveolar process, and introducing implants into in the form of hooks, with a thread for bonding fragments, and the distance from the fracture gap to the introduction of the hook is 1 cm, reponition of fragments jaw and matching into a bite that is natural for the patient, fixation by intermaxillary traction with rubber rings 5/16 in size for the short shoulder of the implants, treatment of the mucous membrane with retinol, after 3.5-4 weeks of immobilization of the fragments, performing a control orthopantomogram, unscrewing of the implants (1).

The disadvantage of this method is the lack of fixation and compression of fragments of the jaw to ensure good consolidation of the fracture, especially with adentia, as well as the possibility of injuring the roots of adjacent teeth with the intraosseous part of the hook.

The objective of the invention is to develop a less traumatic method of treating fractures of the lower jaw, capable of repositioning fragments in the correct position and ensuring their reliable fixation and compression, especially with secondary adentia, to avoid a more traumatic method of osteosynthesis and to facilitate further orthopedic rehabilitation of patients.

The problem is achieved in that in the method of treating fractures of the lower jaw, including performing an orthopantomogram, excising the mucous membrane, forming a bone bed and installing implants in the bed, performing reposition and fixation of jaw fragments, the new thing is that crowns are screwed onto the heads of the implants with soldered to them with hollow tubes, into which rods with thread and nuts are inserted at the ends, with the help of which reposition of fragments into the correct position and reliable fixation by twisting g nuts on the rods, after jaw fracture consolidation crown is removed and the implant is used for prosthetics.

The proposed method allows you to securely fix bone fragments in the correct position and create the necessary compression. The use of crowns screwed onto implant heads with hollow tubes soldered to them, into which threaded rods and nuts are installed, makes it possible to repeatedly reposition fragments of the lower jaw to achieve the optimal position.

The application of the proposed method avoids the operation of osteosynthesis of the lower jaw in an open way.

The method is as follows. The orthopantomogram determines the nature of the fracture of the lower jaw. Under conduction anesthesia, departing from the fracture line on each side 10 mm, the mucous membrane is excised with a mucotome at the sites of implant introduction on the alveolar process, then a bone is formed with bone cutters and the required number of implants are inserted, crowns are screwed onto their heads with hollow tubes soldered to them into which insert the threaded rods and nuts, reposition the fragments in the correct position and fix by tightening the nuts. The accuracy of the comparison of fragments is controlled radiologically. 3-5 weeks after consolidation of the fracture of the lower jaw, the nuts are unscrewed, the rods and crowns are removed from the heads of the implants, and the remaining implants are used for prosthetics in the absence of a discharge of bone tissue in the root part.

Example 1. Patient N., 42 years old, was admitted to the Department of Dentistry GBSMP Krasnoyarsk with a diagnosis of a fracture of the lower jaw on the left with displacement of fragments. Secondary adentia.

Dental formula:

0 0 0 0 0 0 eighteen 17 16 fifteen 14 thirteen 12 eleven 21 22 23 24 25 26 27 28 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 0 0 0 0 0 0 0 0 0

Upon admission, the patient was splintered jaws according to Tigerstedt. On the control radiograph of the lower jaw, the displacement of fragments is preserved.

The patient was offered a method of treatment using implants, which was carried out as follows. Figure 1. Under bilateral conduction and infiltration anesthetics Sol. lidocaini 2% - 12.0 with a mucotome excised two round-shaped mucoperiosteal flaps on the alveolar process of the lower jaw 1 on the left in the region of 35.37 teeth. Bone cutters formed a bed for two implants, in which two cylindrical screw implants 3 and 4 were installed, with protruding heads 7 and 8 above the mucous membrane of the alveolar process of the lower jaw 1. Two crowns 11 and 13 were screwed onto the heads 7 and 8 of implants 3 and 4, with hollow tubes 12 and 14 of Figure 2 soldered to them, into which metal rods 19 with thread 20 at the ends were inserted, after which the fragments were finger-repositioned to the correct position, which was rigidly fixed by tightening the nuts 21 on the rods 19. X-ray control after the treatment showed a satisfactory condition of the fragments, the need for additional surgical treatment has disappeared. 4 weeks after consolidation of the fracture of the lower jaw, the rods and crowns were removed, and a bridge was made on the remaining implants in the dental center.

Example 2. A 42-year-old man was admitted to the maxillofacial surgery department of GBSMP in Krasnoyarsk with a diagnosis of bilateral fracture of the lower jaw: mental - on the right, body - on the left with displacement of fragments. Secondary adentia.

Dental formula:

0 0 0 0 0 0 0 0 0 eighteen 17 16 fifteen 14 thirteen 12 eleven 21 22 23 24 25 26 27 28 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 0 0 0 0 0 0 0 0 0 0 0

Upon admission to the patient, the jaw was splintered according to Tigerstedt, the bite was fixed with rubber traction. On the control x-ray of the lower jaw, the displacement of the processes in the mental department of the lower jaw on the right and the body on the left are preserved. The patient was offered a method of treatment using implants, which was carried out as follows. Figure 1, Figure 2. Under bilateral conduction and infiltration anesthetics Sol. Lidocaini with a 2% -12.0 mucotome excised four round-shaped mucoperiosteal flaps on the alveolar process of the lower jaw 1 on the right and left in the region of 45, 43, 35, 37 teeth, a bone for four implants, into which four cylindrical helical implants were placed, with bone cutters of the implant 3, 4, 5, 6 with protruding heads 7, 8, 9, 10 above the mucous membrane of the alveolar process of the lower jaw 1. Four crowns 11, 13, 15, 17 were screwed onto the heads of the implants with hollow tubes 12, 14 soldered to them 16, 18 into which metal rods 1 were inserted 9 with a thread 20 at the ends, after which the displaced fragments of the lower jaw 1 were repositioned to the correct position, which was rigidly fixed by tightening the nuts 21 on the rods 19.

The control x-ray of the lower jaw showed a satisfactory condition of the fragments, the need for surgery was gone. 4 weeks after consolidation of the fracture, the crowns and rods were removed, and the remaining implants in the oral cavity were used to make bridges in the dental center.

The proposed method provides reliable fixation of bone fragments of the lower jaw, makes it possible after implant consolidation to use implants for prosthetics.

Sources of information

RF patent No. 2207073, M.cl. A 61 I 17/24, 17/56, 17/68, 2002.

Claims (1)

A method for treating fractures of the lower jaw, including performing an orthopantomogram, excising the mucous membrane, forming a bone bed and installing implants in the bed, performing reposition and fixation of jaw fragments, characterized in that crowns are screwed onto the implant heads, rigidly connected to the tubes into which the rods are installed with with the thread and nuts at the ends, with which the fragments are repositioned to the correct position and fixation, after consolidation of the jaw fracture, the crowns and rods are removed, and the implants This is used for prosthetics.

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