RU2260391C2 - Method for setting dental prostheses in lateral maxillary region - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves carrying out dental prosthetics in lateral maxillary region when bone tissue height from alveolar process to the maxillary sinus is equal to 0.5-0.7 cm by increasing bone tissue height. Incision is made along alveolar process crest, mucoperiosteal flap is separated, rectangular fragment is formed in the lateral region and mucous membrane is lifted in the vicinity of maxillary sinus fundus. The newly created space is filled with osteoplastic material, intraosseous dental implants are set, the mucoperiosteal flap is laid, the wound is sutured and prosthetic repair follows. A rectangular bone fragment is formed separable. Its lower boundary is an area located at the level of maxillary sinus fundus or 1 mm higher and its upper boundary is an area planned for building new maxillary sinus fundus. When formed, the boundaries are joined with vertical saw cuts. The fragment is placed into physiologic saline. 2-3 mm thick fragment is cut out with a saw from the maxillary sinus fundus exposing a part of compact plate. After having filled the newly created space with osteoplastic material, the lateral rectangular opening is covered with the fragment taken out from the physiologic saline and fixed.

EFFECT: enhanced effectiveness of treatment; reduced risk of traumatic complications; enforced osteogenesis process.

18 dwg

Description

The invention relates to medicine, namely to surgical dentistry, and is intended for use in prosthetics using implants.

Significant atrophy of the alveolar process of the upper jaw and a decrease in its height in the lateral sections of less than 7-8 mm makes it impossible to use removable prostheses and reliable fixation of the implant, on which the duration of use of a fixed prosthesis depends.

The most common method for increasing the volume of bone tissue of the alveolar process in the bottom of the maxillary sinus is sinus lift (raising the bottom of the maxillary sinus).

The known technique of the so-called "soft" sinus lift [1]. The operation is performed as follows. Under local anesthesia in the toothless area of the alveolar process, the mucoperiosteal trapezoidal flap is cut out and flaked. Then open the compact outer plate of the alveolar process of the upper jaw. Next, the channel-bed for a screw implant is formed by the implant mill and the bottom of the maxillary sinus is perforated. Then, using a special tool, carefully peel the mucous membrane of the sinus floor from the underlying bone. Using a tap, threads are cut in the bone surrounding the implant bed. Osteoplastic material is placed in the formed cavity, filling the entire volume. Then, a screw implant with a plug is installed in the prepared bed and the operation is completed by hermetic suturing of the wound of the mucous membrane. After 6-8 months after the control x-ray studies, the second stage of implantation is performed with the installation of the implant head and fixation of the artificial crown or bridge.

A disadvantage of the known method of “soft” sinus lifting is that trepanation of the sinus floor and plastic surgery are performed “blindly”.

Currently, the most common method is sinus lift with opening the anterolateral sinus wall, filling the formed space with osteoplastic material and with the simultaneous installation of implants [2]. The operation is as follows. A gingival incision is made to the bone along the crest of the alveolar ridge in the mesio-distal direction with additional vertical dissection in the teeth that limit the defect. Then carry out the detachment of the mucoperiosteal flap and skeletonization of the anterolateral sinus wall. Next, a semi-oval or trapezoidal bone fragment is formed in the region of the anterolateral wall. The preparation of the bone is performed over its entire thickness without damaging the mucous membrane. The size of the bone fragment depends on the size of the sinus. Ideally, when displaced, it should touch the back of the sinus. The displacement of the bone fragment back and up leads to the formation of an additional cavity under the sinus, the upper boundary (wall) of which becomes the displaced bone fragment. The filling of the newly created cavity is carried out, as a rule, with a combination of osteoplastic materials. Then the implants are installed and the filling of the free space with bone-plastic material is completed. Next, the contour of the anterolateral wall of the maxillary sinus is restored by applying a membrane, preferably resorbable. After returning to the place of the mucoperiosteal flap, the wound is sutured. Implants installed simultaneously with sinus lift can be opened and loaded 6–9 months after surgery. A gradual increase in load contributes to the formation of a stronger bone regenerate.

The disadvantages of this method is the trauma and increased likelihood of postoperative sinusitis, due to the fact that the upper part of the implant is directly adjacent to the sinus membrane and can be damaged when the implant is installed.

The task to which the invention is directed is to improve the quality of treatment of patients by creating conditions for good osseointegration and positive results of prosthetics.

The technical result from the use of the invention is to reduce the risk of damage to the mucous membrane of the bottom of the maxillary sinus, enhance the process of osteogenesis, reduce the risk of postoperative sinusitis.

The essence of the invention lies in the fact that in the method of prosthetics of the teeth in the lateral part of the upper jaw, by increasing the height of the bone tissue, including an incision along the crest of the alveolar process, detachment of the mucosal-periosteal flap, the formation of a rectangular hole in the side, raising the mucosa in the bottom of the maxillary sinus, filling newly created space with osteoplastic material, placement of intraosseous dental implants, placement of a mucoperiosteal flap and suturing of a wound with subsequent prosthetics, a rectangular hole in the lateral part of the gum is formed with the possibility of its separation, it is placed in physiological solution, then a fragment 2-3 mm thick is cut from the bottom of the maxillary sinus, it is lifted up together with the mucous membrane to the level of a new bottom of the maxillary sinus, this part of the compact plate is exposed, then after filling the newly created space with osteoplastic material, the rectangular opening in the gum is closed with fra gment and fix it.

With the proposed method, the mucous membrane is not separated from the bottom of the maxillary sinus, but with the help of a special tool the lower bone fragment is lifted together with the mucous membrane (not touching it, but only touching the bone) to replace the new bottom of the maxillary sinus, which reduces the likelihood of damage to the mucous membrane of the maxillary sinus . In addition, with the proposed technique, the upper part of the intraosseous implant is adjacent to the bone fragment (which is raised together with the mucous membrane), which eliminates the likelihood of damage to the mucous membrane during implant placement and reduces the risk of postoperative sinusitis. In this method, the sixth and seventh cuts are carried out to a compact plate and when the lower bone fragment is lifted up, a compact plate is exposed and the osteoplastic material is laid directly on it, providing better blood supply, which leads to an intensification of the osteogenesis process.

The invention is illustrated by graphic materials, where figure 1 shows the location of the bottom of the maxillary sinus with respect to the edge of the alveolar ridge in the lateral region of the upper jaw in the area of missing teeth before sinus lift surgery, side view; figure 2 is the same, cross section; figure 3 - the formation of the lateral foramen and fragment from the bottom of the maxillary sinus, side view; figure 4 is the same, cross section; figure 5 shows the removal of the lateral bone fragment, exposure of the mucous membrane of the maxillary sinus; figure 6 is also a transverse section; Fig.7 shows the displacement of the lower fragment up to the level of the new fundus of the maxillary sinus and the formation of the newly created space in the lower part of the sinus; Fig.8 is the same, cross section; figure 9 shows the filling of the newly created space with osteoplastic material; figure 10 is the same, cross section; figure 11 presents the installation of intraosseous dental implants; Fig.12 is the same, cross section; in Fig.13 shows the return of the removed upper bone fragment into a rectangular opening and thus restoring the contour of the anterolateral wall of the maxillary sinus; Fig.14 is the same, cross section; on Fig shows the prosthetics of intraosseous dental implants with a metal-ceramic construction, the location of the new bottom of the maxillary sinus with respect to the edge of the alveolar ridge in the lateral part of the upper jaw after sinus lift surgery. The new height of the alveolar ridge in this area is sufficient for the installation of an intraosseous dental implant; in Fig.16 is the same, cross section. On Fig presents x-ray before surgery; in Fig.18 is the same after the operation according to the proposed method.

The proposed method is as follows.

The operation is performed if the height of 1 bone tissue in the lateral part of the upper jaw (from the edge of the alveolar process 2 to the bottom 3) is within 0.5-0.7 cm (see figures 1, 2). An incision is made to the bone along the crest of the alveolar ridge 2 in the region of missing teeth 4 in the mesio-distal direction with an additional vertical dissection of the tissue in teeth 5 that limit the defect. The mucoperiosteal flap is peeled off in the region of the maxillary sinus 6 and the anterolateral wall 7 of the maxillary sinus 6 is skeletonized. Then, a rectangular bone fragment 8 is formed (see Figs. 3, 4) in the region of the anterolateral wall. The preparation of the bone is carried out over its entire thickness without damaging the mucous membrane 9. When forming a bone fragment, its borders are taken into account: the lower border (cut 10) is the region that is at or 1 mm above the bottom of the maxillary sinus, the upper border (cut 11) is the area at the level of which they plan to create a new bottom of the maxillary sinus. Then connect the edges of the 1st (10) and 2nd (11) cuts with additional vertical cuts 12. A horizontal cut 13 is made into the thickness of the bone tissue of the alveolar process 2 below 2-3 mm of the level of the bottom 3 of the maxillary sinus 6. From the edges of the cut 13 to a compact plate 14 (see Figs. 7, 8) of the sinus, additional vertical cuts are carried out 15. A lateral bone fragment 8 and a lower bone fragment 16 are obtained (see Figs. 3, 4). The lateral bone fragment 8 is gently broken and separated from the mucous membrane 9 of the maxillary sinus 6 and temporarily placed in physiological saline. The lower bone fragment 16 is carefully broken and shifted up to the level of the upper cut 11, exposing the inner compact plate 14 (see Figs. 7, 8). This creates a new bottom 17 of the maxillary sinus 6 and obtain a new height 18 of the alveolar bone 2 in the lateral part of the upper jaw, which is 1.2-1.7 cm. The newly formed space 19 is filled with osteoplastic material 20 (see Figs. 9, 10) . Then, intraosseous dental implants 21 are installed. Then, the contour of the anterolateral wall of the maxillary sinus 6 is restored by returning the bone fragment 8 from the physiological solution to the created wall defect. The mucoperiosteal flap is returned to the place and the edges of the wound are brought together by sutures. Sutures are removed after 7-10 days. Six months later, prosthetics is started, i.e. on the intraosseous dental implants 21, a ceramic-metal construction 22 is installed.

The possibility of carrying out the invention is confirmed by the following example.

Patient M.A. turned to the clinic of maxillofacial surgery St. Petersburg State Medical University named after Acad. I.P. Pavlova, July 5, 2002, complaining of the absence of a 5th tooth on the upper jaw on the right and asking to install an implant in this area so as not to include adjacent teeth under a ceramic-metal construction. The patient was diagnosed with a unilateral included defect in the dentition on the upper jaw on the right. Assessing the x-ray data, we saw that the height of the bone tissue in this area is 6 mm, which does not allow the installation of intraosseous dental implants by a known method (Fig. 17). The patient decided to perform osteoplastic surgery, including increasing the height of bone tissue in this area according to the proposed new technique. Under local anesthesia, an incision was made with a scalpel to the bone along the crest of the alveolar ridge in the mesio-distal direction with additional vertical dissection of the tissue from the teeth bordering the defect. The mucoperiosteal flap was exfoliated and the anterolateral wall of the maxillary sinus was skeletonized using a curved raspator. A rectangular bone fragment was formed in the anterolateral wall of the maxillary sinus. For this, a turbine tip and a spherical boron with a diameter of 1.0 mm were used. The bone was prepared over its entire thickness without damaging the mucous membrane and with a continuous supply (about 100 ml / min) of sterile cooled physiological saline to boron, the rotation speed of which was 16,000 rpm. When the bone fragment was formed, its borders were taken into account: the lower border 10 was the region that was 1 mm above the bottom of the maxillary sinus, the upper border 11 was the region at which level it was supposed to create a new bottom of the maxillary sinus, i.e. cut 11 6 mm above the level of cut 10. Then, the edges of cuts 10 and 11 were connected by additional vertical cuts 12 (see Figs. 3, 4). We performed a horizontal cut 13 in the thickness of the bone tissue of the alveolar process below 2 mm of the level of the bottom 3 of the maxillary sinus. Additional vertical cuts 15 were carried out from the edges of cut 13 to the compact sine plate 14. The lateral bone fragment was carefully broken with a special tool and separated from the mucous membrane of the maxillary sinus and placed in physiological saline. Using a special tool, the lower bone fragment was carefully broken and shifted up to the level of the upper cut 11. As a result, an additional space 19 was formed under the maxillary sinus (see Figs. 7, 8). The newly formed space 19 was filled with bioplastic material manufactured by Kommektbiofarm Biomatrix LLC (see Figs. 9, 10). Then, one intraosseous screw one-stage implant was installed. After that, the contour of the anterolateral wall of the maxillary sinus was restored by returning the lateral bone fragment 8 from physiological solution to the created wall defect. Then they returned the mucoperiosteal flap into place and sutured the wound. Vertical U-shaped seams were applied; the distance between the seams was 0.5 mm. The postoperative period was uneventful. Antibacterial therapy and rinsing the mouth with decoctions of herbs were prescribed. The wound healed by first intention. Sutures were removed after 7 days. After 4 months, a clinical and radiological examination of the patient was performed (see Fig. 18). The data obtained showed complete osseointegration of the intraosseous dental implant and the formation of organotypic bone regenerate. The distance from the edge of the alveolar process to a new level of the bottom of the maxillary sinus in this region was 13 mm (see Fig. 18). After 6 months, a ceramic-metal crown was installed on the implant. Further dynamic observation revealed the stability of the prosthesis, an acceptable level of hygiene, and the absence of clinical signs of inflammation around the implant. Based on this, we conclude that the treatment was successful and positive results were obtained in the use of sinus lift surgery according to the proposed method.

Sources of information:

1. Clinical implantology and dentistry. International Scientific and Practical Journal, No. 3-4 (17-18), St. Petersburg, 2001, p.51-52.

2. The collection "Dental implantology", authors: Ivanov S.Yu., Bizyaev AF, Lomakin MV et al. Moscow, 2000, p. 44 (prototype).

Claims (1)

A method of prosthetics in the lateral part of the upper jaw with bone height from the alveolar bone to the bottom of the maxillary sinus in the range of 0.5-0.7 cm by increasing the height of the bone tissue, including an incision along the crest of the alveolar bone and the detachment of the mucoperiosteal flap, the formation of a rectangular fragment in the lateral part, raising the mucous membrane in the bottom of the maxillary sinus, filling the newly created space with osteoplastic material, installing intraosseous dental implants c, laying of the mucoperiosteal flap, suturing the wound with subsequent prosthetics, characterized in that the bony rectangular fragment is formed with the possibility of its separation, while its lower border is the region located at or 1 mm above the bottom of the maxillary sinus, and the upper border - the area at the level of which it is supposed to create a new bottom of the maxillary sinus, having formed the indicated boundaries, they are connected by vertical cuts, after which this fragment is placed in physiological saline, then From the bottom of the maxillary sinus, a 2-3 mm thick fragment is cut out, lift it up together with the mucous membrane to the level of the new bottom of the maxillary sinus, exposing part of the compact plate, then, after filling the newly created space with osteoplastic material, the lateral rectangular hole is closed with a fragment extracted from physiological saline and fix it.

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