RU2382615C2 - Method of distraction-injection osteosynthesis of jaw bone and implant for its application - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: osteotomy of jaw bone is performed with microosteotomas from titanium nickelide with form memory. Liquid osteoplastic gel is injected through implant internal hole. Distraction screw is activated for intraosteal distraction osteosynthesis as newly formed bone grows. Osteoplastic gel is periodically injected by short removal of distraction screw. After performing injection distraction screw for dosed intraosteal distraction osteosynthesis is re-activated.

EFFECT: method ensures acceleration of jaw bone osteosynthesis, reduction of traumatism, reduction of treatment terms.

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Description

The invention relates to surgical dentistry and can be used in surgery and orthopedics for atraumatic staged osteoplasty.

A known method of osteoplasty by injecting a liquid osteoplastic preparation into the area of the bone defect in osteomyelitis [1].

However, this method of injection osteoplasty, along with other injection methods, does not include the use of a functional element - a distractor screw for intraosseous osteosynthesis and expansion of the osteoplasty zone by screwing the distractor screw over the osteotomy zone or abutment of the distractor screw into the bone tissue bordering the zone previous osteotomy, with periodic systematic activation of the screw-distractor.

The closest analogue of the proposed method is the Ilizarov apparatus, i.e. rod compression and distraction apparatus for transosseous osteosynthesis [2], the use of which allows metered activation of the distractors of the apparatus and thereby stimulate osteosynthesis in the problem area of the bone.

In cases of closed comminuted fractures of long tubular bones, when open intervention is not required, methods of extra focal compression-distraction osteosynthesis by the Ilizarov apparatus are used with the introduction of osteoplastic gel into the fracture zone by injection with a syringe-container through a catheter [3]. However, the Ilizarov apparatus can only be used for transosseous osteosynthesis of the tubular bones of the limbs and is not used for osteoplasty of the jaw bone.

The problem solved by the invention is to create a method of distraction-injection osteosynthesis using an implant with a screw distractor for intraosseous osteosynthesis, titanium nickelide osteotomes with shape memory effect and liquid osteoplastic material (for example, Collapan-gel material) under conditions of atrophy, osteopenia or local osteoporosis of the jawbone.

The method consists in the following: first, in the jawbone, at the site of distraction-injection osteosynthesis, (for example, with sinus lift, i.e. when raising the bottom of the maxillary sinus), a channel with a diameter of 2.3 mm and a depth of 3-7 mm is drilled and an implant is screwed into this channel for distraction-injection osteosynthesis, which is a sleeve made in the form of a hollow cylinder with a screw-distractor, and along the entire length from the outside, the sleeve has a thread for fixing the implant in bone tissue, and In the morning of the sleeve, a thread was made for connecting to the needle of the syringe or with the thread of the screw-distractor, and on the external surface, the sleeve has a square section “turnkey” fixing element, and the screw-distractor has a slot for a screwdriver.

Figure 1 presents a General view of the implant, figure 2 - screw distractor. The implant is a continuous sleeve in the form of a hollow cylinder, on the outside of which along its entire length a thread 1 is made for fixing the implant in the bone tissue. The end part of the sleeve has a turn-key locking element, and the screw-distractor has a slot 2 for a screwdriver. A thread 3 is made in the bushing channel for connection with a syringe needle. The implant has an opening 4, into which, when carrying out osteosynthesis, an interfaced part is introduced in the form of a syringe needle with a “Kollapan - gel”. The through hole inside the sleeve 4 has a thread for connection with the threaded part of the needle of the syringe container with “Valve gel”. The screw distractor (figure 2) with a screw part is made from 3 to 9 mm long and is intended for screwing into the inner hole 4 of the sleeve.

The implant is screwed so that the end of the implant screwed into the bone is 2-3 mm from the cortical layer of the jaw bone, and the end part of the implant with the fixation element would be above the level of the mucous membrane. Then, a fixator with a fixed nickel-titanium osteotome with a diameter of 1 mm in a cooled straightened state is inserted into the inner hole 4 of the sleeve until the stop of the fixator into the outer end part of the implant and the fixator moves clockwise and counterclockwise to a certain angle specified by the anatomical and topographic parameters to destruction of the bone adjacent to the intraosseous end of the implant, and, at the same time, the creation of a cavity for the introduction of liquid osteoplastic material (for example, “Kollapan - gel”).

After that, the retainer is removed from the oral cavity, and the needle of the syringe container with an osteoplastic gel with a thread cut at the end of the needle is attached to the outside of the implant by screwing it into its internal hole. Then, by pressing the syringe plunger, through the inner hole 4 of the implant into the jawbone cavity formed by the osteotome with a shape memory effect, the volume of liquid osteoplastic material necessary for osteosynthesis is injected (on average 1 cm ³ ). Then, the needle of the syringe container is unscrewed from the inner hole 4 of the implant, and instead of the needle, the screw-distractor is screwed all the way to the tissues that limit the osteotomy zone, in order to distract osteosynthesis, create conditions for replacing the material with new bone tissue, and also to prevent reverse outflow liquid osteoplastic material through the implant. After 3-4 weeks. (time required for engraftment and stabilization of the implant in the bone), supragingival, square cross-section “turnkey” fixation element is fixed with a key, and the distractor is activated by screwing it into the bone (using a screwdriver). Activation of the distractor is carried out regularly at least once every 2 days by screwing the distractor 1-2 turns, depending on the clinical conditions.

After 3-4 weeks, the distractor is unscrewed, a chilled microosteotome is introduced instead, the microosteotomy zone is expanded, a fluid osteoplastic material is introduced, the distractor is screwed into the dense bone again and activated.

Then the distractor is activated again with regularity at least 1 time in 2 days. After 3-4 weeks, the procedure with microosteotomes is repeated (if necessary). The result of distraction-injection osteosynthesis is determined by x-ray.

Examples

Patient S., 41 years old

Diagnosis: secondary adentia of the upper jaw, atrophy of the bone tissue of the upper jaw. Focal osteoporosis of the jaw bones.

Conducted: in the region of absent 17, 16, 12, 11, 21, 25, 26 implants were introduced into the bone tissue for distraction-injection osteosynthesis of the jaw bone. The jaw bone microosteotomy was performed in the region of adjacent and maxillary sinuses, the mucosal-periosteal sinus flap was detached, into the implants alternately, from right to left, i.e. from the side of the missing 17 to the missing 26 teeth, the needle of the syringe container with the Kollapan-gel was screwed in, the required volume of gel was injected into each of the implants (on average 0.5-1 ml), then also alternately, i.e. after injection, a screw-distractor was screwed into the implant and activated by screwing it into a tight bone (behind the osteotomy zone) until it stops.

In this case, the intra-gingival part of the implant was fixed with a key, in order to prevent the implant from fixing in the bone. After 3 weeks, the distractors were successively unscrewed from the implants, the microosteotomy was performed again, a sequential injection osteosynthesis was carried out with the sequential activation of the distractors. After that, with an interval of 1-2 days, the distractors were activated by the patient himself, by screwing the distractor screw into the bone for 1-2 turns, while the intra-gingival part of the implant was fixed by the patient himself using a fixative key. After 3 weeks, the procedure with microosteotomy was repeated, the distractors were replaced with longer ones, the activation of the distractors was carried out both by the patient and the doctor at the reception.

Then, within a month, a microosteotomy was not performed, distractors were removed as necessary, “CollapAN-gel” was introduced (injection), and distractors were activated.

After 3.5 months from the start of treatment, a control radiography was performed, which showed an increase in organotypic bone tissue in the area of distraction-injection osteosynthesis, in a volume sufficient for subsequent dental implantation.

Then implantation was carried out with dental implants with the effect of shape memory. The treatment was completed by fixing the orthopedic cermet structure.

Patient G., 45 years old.

Diagnosis: sharp atrophy of the left mandibular alveolar bone due to incorrect removal of 36, 37 teeth.

Conducted:

At an angle of 60 degrees. implant implantation for distraction-injection osteosynthesis was performed to the crest of the alveolar ridge. An implant is screwed in, a microosteotomy without periosteum and mucosa injury (from the vesicular and lingual sides) is performed, a minimum (0.2 ml) of CollapAn Gel is introduced, the distractor is screwed in and activated.

A month later, the distractor was removed, the microosteotomy was performed in the previous volume, the minimum volume of the “Kollapan gel” was introduced.

After a month, the procedure is repeated.

For two months, the microosteotomy was not performed, only the distractor was removed from the implant, the required volume of gel was introduced, then the activator was screwed in and activated. The activation of the distractor was carried out by the doctor with a regularity of 1 time per week for 1 revolution.

After 4 months, it was noted that the bone in the area of distraction-injection osteosynthesis increased in volume (i.e., its growth was both in width and in height), the implant was removed, and a dental implant was performed with a shape-memory implant.

Thus, it took less than 3.5 months to achieve the result of osteosynthesis. on the upper jaw, and 4 months on the lower jaw, which is shorter than when using other methods of osteosynthesis (autologous bone, alloplasty, xenoplasty, membrane), and the distraction-injection osteosynthesis itself was performed on an outpatient basis, atraumatic and under constant monitoring, as on the part of the doctor, so on the part of the patient.

BIBLIOGRAPHY

1. Urazgildeev Z.I., Bushuev O.M., Berchenko G.N. "The use of Kollapan for plastic osteomyelitis bone defects." Bulletin of Traumatology and Orthopedics. N.N. Priorova, 1998 No. 2 p.31-35.

2. Ilizarov G.A., Gracheva V.I. Bloodless treatment of congenital pseudarthrosis of the lower leg with the simultaneous elimination of shortening by the method of metered distraction. // Orthopedist. traumatol. - 1971. - No. 2. - p. 42-45.

3. Methodological recommendations of the CITO named after N.N. Priorov (compiled by S.P. Mironov, G.A. Kesyan, G.N.Berchenko, R.Z. Urazgildeev, I.G. Arsenyev) - in the journal Biomaterials 2004 No. 2 p. 6.

Claims (1)

A method of distraction-injection osteosynthesis of the jaw bone, characterized in that the osteosynthesis is performed by activating a screw-distractor for intraosseous osteosynthesis after osteotomy with titanium nickelide microosteotomes with shape memory and injection of a liquid osteoplastic gel through the internal opening of the implant for intraosseous vascular implantation -distractor as the newly formed bone grows with periodic injection of osteoplastic one of the gel by extraction of short-distractor screw at the time of injection with subsequent activation of the dispensing intraosseous distraction osteosynthesis.

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