RU2405474C2 - Method of alveolar process of mandible plasty - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to surgical dentistry and can be applied for plasty of alveolar process of mandible in case of its atrophy. From vestibular side semi-oval incision of mucous membrane to bone is made, with base facing alveolar process apex. Two vertical saw cuts, perpendicular to alveolar process of mandible and passing through external and internal cortical layers, are made, after which made is horizontal saw cut, connecting vertical saw cuts and passing through external cortical layer and spongy part of bone to internal cortical layer. In zone of vertical saw cut installed is raspatory or osteotom and with rotatory movement bone fragment is lifted from vestibular side with infraction of internal cortical plate. In formed defect osteogenesis-stimulating biomaterial is introduced. Bone fragment is fixed to mandible by means of microplates and microscrews. From above zone of reconstruction is covered with resorbable membrane. Muco-periosteal flap is mobilised and placed on wound without tension. Wound is sewn tightly with knot sutures.

EFFECT: method allows to form bone, able to hold occlusion load on implant.

2 ex, 2 dwg

Description

The invention relates to medicine, namely to surgical dentistry, and can be used for plastic surgery of the alveolar process of the lower jaw during its atrophy before dental implantation.

The closest to the technical solution of the problem is the method of plasty of the alveolar process of the lower jaw during its atrophy, including an incision of the mucous membrane to the bone, peeling and folding of the mucosal-periosteal flap, a horizontal cut and two vertical cuts of the cortical plate, limiting the reconstruction area, raising the bone fragment , fixing it to the lower jaw and suturing the wound (SU 1629042 A1 publ. bull. No. 7 from 02/23/1991). The disadvantages of this method include the fact that there is no possibility of increasing the volume of bone mass in width, due to the lack of volume of automaterial, which, ultimately, leads to insufficient elevation of the alveolar bone.

The technical task according to the invention is the creation of an effective method for plastic surgery of the alveolar bone during its atrophy.

The technical result according to the invention is a persistent clinical effect due to the use of its own alveolar ridge and raising its bone fragment from the vestibular side with a break in the inner cortical plate and due to filling the triangular defect with biomaterial that stimulates osteogenesis or autobone to increase the alveolar ridge in height and width, creating conditions for adequate dental implantation.

The technical result according to the invention is achieved by the fact that in the method of plasty of the alveolar ridge of the lower jaw during its atrophy, including conducting an incision of the mucous membrane to the bone, peeling and folding the mucosal-periosteal flap, conducting a horizontal cut and two vertical cuts of the cortical plate, limiting the reconstruction zone, raising bone fragment, fixing it to the lower jaw and suturing the wound, while from the vestibular side conduct a semi-oval incision of the mucous membrane about the bone, with the base facing the apex of the alveolar ridge, while the mucosal-periosteal flap is not folded from the lingual side, then two vertical cuts are perpendicular to the alveolar ridge of the lower jaw and passing through the outer and inner cortical layers, after which a horizontal cut is performed connecting vertical cuts and passing through the outer cortical layer and the spongy part of the bone to the inner cortical layer, then a sludge distributor is installed in the horizontal cut area and the osteotome and rotational movement raise the bone fragment from the vestibular side with a break in the inner cortical plate, and biomaterial stimulating osteogenesis or autologous bone is introduced into the formed triangular defect from the side of the cortical plate, then the bone fragment is fixed to the lower jaw using microplates and microscrews, and from above the reconstruction zone is blocked with a resorbable membrane, the mucoperiosteal flap is mobilized, it is placed on the wound without tension, the wound is sutured tightly Vym seams.

According to the invention, the formation of a triangular defect by raising a bone fragment from the vestibular side with a break in the internal cortical plate and filling it with bone non-demineralized collagen or autocost allows to restore the previous (necessary) height and width of the alveolar process, and also improves the adaptation of the lower jaw to implantation of an intraosseous screw implant. According to the invention, the defect is filled with biomaterial that stimulates osteogenesis, for example, bone non-demineralized collagen (RU 2278879 C1, 2006), or with the patient’s autobone in order to create the necessary volume of bone tissue to eliminate atrophy and to accelerate the formation of new bone after implantation of an intraosseous screw implant .

According to the invention, the plates and microscrews prevent the displacement of the introduced materials — bone non-demineralized collagen or an autobone fragment, as well as better fusion with the intrinsic alveolar bone.

According to the invention, the reconstruction zone is covered by a resorbable membrane, which ensures the coalescence of the fragments without fibroso formation. As a resorbable membrane, for example, a bone collagen membrane can be used, which is optimal for closing such bone defects and create the necessary conditions for targeted regeneration in the defect zone.

The method of plastics of the alveolar process of the lower jaw during its atrophy is as follows.

Under balanced anesthesia (or anesthesia) from the vestibular side of the alveolar process of the lower jaw, a semi-oval incision of the mucous membrane to the bone is made with the base facing the apex of the alveolar process.

In the presence of teeth restricting the reconstruction zone, the length of the incision corresponds to the length of the dentition; in the absence of teeth, the length of the incision must exceed the reconstruction zone by 5 mm on each side. Next, the mucosal-periosteal flap is peeled off and folded, while the flap does not exfoliate on the lingual side to preserve the attachment of the periosteum to the alveolar process of the lower jaw. The vestibular surface of the alveolar process of the lower jaw is skeletonized. Two vertical cuts are made perpendicular to the alveolar process of the lower jaw and passing through the outer and inner cortical layer. After that, a cut is made, connecting the vertical cuts and passing through the outer cortical layer and the spongy part of the bone to the inner cortical layer.

Then, a raspator is installed in the horizontal cut zone or an osteotome is made and rotated from the vestibular side with a break in the inner cortical plate and biomaterial is introduced into the formed triangular defect from the side of the cortical plate, stimulating osteogenesis or autobone.

In the fracture zone, a continuous connection of the bone fragment with the lower jaw is maintained. Then the bone fragment is fixed to the lower jaw using microplates and microscrews.

From above, the reconstruction zone is covered with a resorbable membrane. The mucoperiosteal flap is mobilized, it is placed on the wound and sutured without tension. The wound is tightly sutured with interrupted sutures.

In the presence of teeth restricting the reconstruction zone, the mucoperiosteal flap is additionally fixed to the neck of the teeth. Next, hemostasis is performed. Sutures are removed on the 7-10th day.

Example 1 (photo 1, 2)

Patient A., 26 years old. Diagnosis: bone resorption after extraction of 4, 5 and 6 teeth on the left of the lower jaw.

According to the invention, the plastic of the alveolar process of the lower jaw of the 5th tooth was produced on the left. An incision was made in the mucous membrane, the length of which exceeds the reconstruction zone by 5 mm on each side. After raising the bone fragment with a break in the inner cortical plate, the formed triangular defect was filled with bone non-demineralized collagen in the form of blocks of 0.5 × 0.5 × 0.5 cm.The reconstruction area was blocked with a resorbable membrane from bone demineralized collagen. The alveolar bone was restored to the previous (necessary 8 mm) height and width.

After 4-5 months, they had a dental implantation of an intraosseous screw implant - the implant is installed in an ideal position. A new bone formed after reconstruction (after 14 months) is able to withstand the occlusive load on the intraosseous screw implant.

Example 2

Patient N., 60 years old. Diagnosis: bone resorption after traumatic removal of 4 teeth on the left of the lower jaw.

A mucosal incision was made to the bone, the length of which corresponds to the length of the dentition defect. After raising the bone fragment with a break in the inner cortical plate, the formed triangular defect was filled with autobone from the chin area. The reconstruction zone was blocked by a resorbable membrane of bone demineralized collagen. The alveolar bone was restored to the previous (necessary 8 mm) height and width.

In this case, the mucosal-periosteal flap is placed on the wound and is additionally fixed to the neck of the teeth with a twisted stitch. The wound is tightly sutured with interrupted sutures. Spend hemostasis. Sutures are removed on the 10th day. According to the invention, plastic surgery of the alveolar process of the lower jaw was performed on 50 patients with 60 teeth, followed by dental implantation after 5-6 months: the intraosseous screw implants were installed in the ideal position, and the new bone formed as a result of the plastic surgery (observation period 15-30 months) is able to withstand the occlusive the load on the implant.

Claims (1)

The method of plastics of the alveolar process of the lower jaw during its atrophy, including conducting a cut of the mucous membrane to the bone, peeling and folding of the mucoperiosteal flap, conducting a horizontal cut and two vertical cuts of the cortical plate, limiting the reconstruction zone, raising the bone fragment, fixing it to the lower jaw and suturing the wound, characterized in that from the vestibular side, a semi-oval incision of the mucous membrane to the bone is carried out with the base facing the apex of the alveolar of the process, while on the lingual side, the mucosal-periosteal flap is not folded, then two vertical cuts are performed perpendicular to the alveolar process of the lower jaw and passing through the outer and inner cortical layers, after which a horizontal cut is made connecting the vertical cuts and passing through the outer cortical layer and the spongy part of the bone to the inner cortical layer, then a raspator is installed in the horizontal cut area or the osteotome is rotated and raised e of the bone fragment from the vestibular side with a break in the inner cortical plate, which is the axis of rotation, and biomaterial stimulating osteogenesis is introduced into the formed defect of the triangular shape from the side of the cortical plate, then the bone fragment is fixed to the lower jaw using microplates and microscrews, and the reconstruction area from above overlap with a resorbable membrane, the mucosal-periosteal flap is mobilized, it is placed on the wound without tension, the wound is tightly sutured with interrupted sutures.

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