RU2395241C1 - Method of surgical treatment of alveolar defects - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention relates to dentistry and can be applied for surgical treatment of alveolar defects. Preparation of bed for bone transplant is carried out through tunnel access made mesially from defect zone. As autogenic bone transplant, cortical part of tibia 2-3 mm thick is taken, from which two plates and crushed bone tissue are prepared in amount sufficient for defect filling. One bone plate is placed in defect zone with formation of vestibular wall. Volume of defect is filled with crushed bone tissue. The second bone plate is placed with formation of occlusion wall. Bone plates are fixed. ^ EFFECT: method allows to accelerate transplant vascularisation and change. ^ 2 ex

Description

The invention relates to medicine, namely to dentistry, and can be used for surgical restoration of the anatomical form of the alveolar process of the upper jaw and the alveolar part of the lower jaw.

A known method of plasty of the alveolar process for congenital clefts (RF Patent No. 2217083, IPC A61B 17/24, publ. 2006), including the transplant from the external cortical plate of the parietal bone at the border with the temporal and frontal bones to the cancellous layer. The defect is filled with a mixture of spongy substance and bone sawdust, and then a cortical bone autograft is placed on the vestibular side and fixed with titanium screws to the alveolar bone. Then cut out the mucoperiosteal flaps and close the wound.

The disadvantage of this method is that the operation is performed in a specialized hospital, when the graft is taken, complications such as cerebrospinal fluid, subdural and pedural hematomas are possible, due to the low ability to regenerate bones in this area, the likelihood of impression fractures of the bones of the cranial vault with damage to the brain increases with comparative minor traumatic efforts.

The closest is the method of surgical treatment of defects of the alveolar ridge (V.I. Zausaev et al. Surgical dentistry, Moscow, Medicine, 1981, p. 530-531), including preparing a bed for a bone graft, taking an autologous bone graft from the rib or the iliac crest of the patient according to the size of the defect, suturing soft tissues.

The disadvantages of this method is a rather complicated operation, due to the need to take the graft from the rib or crest of the ilium of the patient, which causes additional trauma and creates a risk of complications, performed in a hospital. In addition, the selected bone tissue undergoes significant resorption after transplantation, the bone graft density is low, which leads to insufficient primary stabilization of the implants. Cutting out and exfoliation of the mucoperiosteal flap can lead to a violation of the blood supply to the soft tissues in the transplantation area, and the occurrence of edema. The graft is fixed in the recipient region in the form of an undigested cortical-spongy block, which leads to difficulties in its vascularization and rearrangement.

The task of the invention is to remedy these shortcomings, increase the effectiveness of surgical treatment by providing improved reconstruction and engraftment of the transplants, reducing the invasiveness of the intervention, reducing the postoperative inflammatory response, and reducing the duration of treatment. The method allows for the installation of implants 4 months after transplantation.

For this, in a method for the surgical treatment of defects of the alveolar ridge, including preparing a bed for a bone graft, taking an autogenous bone graft according to the size of the defect, suturing soft tissues, it was proposed to take a tibial cortical plate as an autogenic bone graft. At the same time, two blocks 2-3 mm thick and crushed bone tissue are prepared from it in a volume sufficient to fill the defect, and preparation of the bone graft bed is carried out through tunnel access made mesially from the defect area. Then a bone block is placed through it with the formation of one of the defect walls, the defect volume is filled with crushed bone tissue, a second bone block is placed with the formation of a second defect wall, and the bone blocks are fixed.

The implementation of the method shown in specific clinical examples.

Example 1

Patient Sh., 52 years old (East. Bol. No. 15198, 2006), complained of a lack of teeth in the anterior maxilla.

After the examination, the diagnosis was established: partial tooth loss, defects in the dentition of Kennedy class 3, defect in the alveolar process of grade 3 according to Zilber in the frontal part of the upper jaw.

Clinical and laboratory examinations were carried out, there are no contraindications to the operation.

In a day hospital, under local and total intravenous anesthesia, a vertical incision was made in the area of the alveolar ridge along the midline. Tissues dissected to the bone, periosteum and muscle attachments exfoliated tunnel. The cortical plate of the alveolar ridge in the area of the defect is cleared of fibrous cords.

At the same time, the second operating team from the cortical part of the metaepiphysis of the left tibia took a graft of 2 × 5 cm in size with a thickness of 0.3 cm.

2 plates corresponding to the dimensions of the missing defect walls were prepared from the transplant. After determining the defect volume, the required amount of bone chips was prepared from the remaining cortical graft using a bone mill.

On the vestibular side, a plate was fitted in the area of the defect so as to create a bone wall, fixed with screws. The defect was filled with crushed bone tissue. The second plate was fitted on the occlusal side of the defect, fixed with screws.

The wound was sutured using mattress sutures.

The postoperative period was uneventful, the wound healed by first intention.

After 4 months, dental implants were installed in the area of transplantation, on which dentures were made.

During the follow-up examination after 1 year, a clinical and radiological assessment of the tissues in the area of the operation was performed, during which a stable level of bone tissue, soft tissues without signs of inflammation were not revealed.

Example 2

Patient M., 55 years old, (East. Bol. No. 15592, 2007), complained of partial absence of teeth, bleeding gums, and mobility of existing dentures.

After the examination, the diagnosis was established: chronic generalized periodontitis of moderate, and in some severe cases, partial tooth loss, defects in the dentition of Kennedy class 3, a defect in the alveolar process of grade 3 according to Zilber in the lateral part of the lower jaw on the left, a small vestibule of the oral cavity.

Clinical and laboratory examinations were carried out, periodontitis was treated.

According to the above method (example 1), an operation was performed to reconstruct a defect in the alveolar part of the lower jaw on the left.

After 4 months, dental implants were installed in the area of transplantation, vestibuloplasty was performed. Dentures were made on implants.

A follow-up examination after 6 months revealed a healthy state of soft tissues surrounding the implants, bone tissue without signs of resorption.

According to the proposed method, 40 patients aged 18 to 59 years were treated, for whom 192 implants were installed in the field of transplantation. The effectiveness of the treatment was 96.9%.

The method allows to reduce the duration of treatment compared to traditional by 1.5-2 months, to reduce invasiveness and postoperative inflammatory reactions, to treat on an outpatient basis or in a day hospital, which reduces the cost of treatment, it is possible to carry out reconstructive interventions for large bone defects at the same time in several areas.

It is possible for patients with complete or partial loss of teeth to make removable or semi-removable prostheses, to carry out a comprehensive rehabilitation of violations of the maxillofacial region associated with tooth loss and leading to impaired diction.

Claims (1)

A method for surgical treatment of alveolar defects, including preparing a bed for a bone graft, taking an autogenous bone graft according to the size of the defect, suturing soft tissues, characterized in that as an autogenic bone graft take a cortical part of the tibia 2-3 mm thick, from which they are prepared two plates and crushed bone tissue in a volume sufficient to fill the defect, and preparation of the bed for bone graft is carried out through tunnel access, made mesial from the defect area, then one bone plate is placed in the defect area with the formation of the vestibular wall, the defect volume is filled with crushed bone tissue, then the second bone plate is placed with the formation of the occlusal wall, the bone plates are fixed.