RU2414181C2 - Methods of plasty of alveolar process of lower jaw in case of its atrophy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, to surgical dentistry and can be applied for plasty of alveolar process of lower jaw in case of its atrophy. First horizontal saw cut is made for entire length parallel to apex of alveolar crest indent from 7-10 mm on the depth of cortical layer to spongy substance. Second horizontal saw cut is made on alveolar process apex from tongue side on the depth of cortical layer. Two vertical saw cuts, connecting edges of horizontal saw cuts, and parallel to external surface of alveolar process, to the depth 3-5 mm. Formed bone fragment by means of chisel is mobilised with saw cut plane, passing on tangent to low alveolar canal and is displaced upwards to the height to 5 mm. Into formed defect introduced is biomaterial, stimulating osteogenesis, which is covered from above with resorbable membrane.

EFFECT: method makes it possible to restore necessary height of alveolar process, improve adaptation to implant.

2 ex, 3 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, a cortical plate that limits 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 obtaining the optimal height of the reconstructed area due to the lack of volume and mobility of the bone fragment, 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 formation of a bone fragment with a chisel, lifting and shifting it to a height of 3-5 mm, fixing with microscrews and filling the defect with biomaterial that stimulates osteogenesis, which is covered with a resorbable membrane from above, the mucoperiosteal flap is mobilized, it laid on the wound without tension, the wound is tightly sutured with interrupted sutures.

The technical result according to the invention is achieved by the fact that in the method of plastics of the alveolar process 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, a cortical plate limiting the reconstruction zone, raising the bone fragment, fixing it to the lower jaw and suturing the wound, while the first horizontal cut is carried out along the entire length parallel to the apex bivalve ridge is indented from 7-10 mm to the depth of the cortical layer to the spongy substance, and the second horizontal cut is carried out along the top of the alveolar process from the lingual side to the depth of the cortical layer, then two vertical cuts are made connecting the edges of the horizontal cuts and parallel to the outer surface of the alveolar process, to a depth of 3-5 mm, then with a chisel, the formed bone fragment is mobilized with a cut plane passing along the tangent to the lower alveolar canal, and it is shifted up to a height of 5 m microscrews fixed, and the generated defect is introduced by the cortical plate biomaterial stimulating bone formation, which is closed on top resorbable membrane mucoperiosteal flap is mobilized, it is placed on the wound without tension, the wound sutured tightly interrupted sutures.

According to the invention, the formation of a “moving fragment of the alveolar bone” allows raising the bone fragment, mobilizing it and filling it with biomaterial stimulating osteogenesis, which is covered with a resorbable membrane from above, allows to restore the necessary height of the alveolar bone, and also to improve the adaptation of the lower jaw to implantation of the intraosseous screw implant.

According to the invention, the defect formed is filled with biomaterial stimulating osteogenesis, for example, bone non-demineralized collagen saturated with sulfated glycosaminoglycans, or 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 bone fragment and the introduced materials — bone non-demineralized collagen or autobone fragment, as well as better fusion with the alveolar bone itself.

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 that is optimally suitable for closing such bone defects can be used and the necessary conditions for directed regeneration in the defect zone can be created.

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. Then produce a cut connecting the vertical cuts and passing through the outer cortical layer of 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 rotated and the inner cortical plate is produced from the vestibular side with a fracture and biomaterial or autobone is introduced into the formed triangular defect from the cortical plate side.

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

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, while the first horizontal cut was performed along the entire length parallel to the top of the alveolar ridge, indented from 7-10 mm to the depth of the cortical layer to the spongy substance, and the second horizontal cut was carried out along the top of the alveolar process from the lingual side to the depth of the cortical layer, then two vertical cuts are made, connecting the edges of the horizontal cuts and parallel to the outer surface of the alveolar process a, to a depth of 3-5 mm, then a formed bone fragment was mobilized with a chisel with a cut plane passing tangentially to the lower alveolar canal, and it was shifted up to a height of 8.0 mm, fixed with microscrews, and introduced into the defect from the cortical plate a crumb of non-demineralized bone collagen saturated with sulfated glycosaminoglycans, which was covered with a resorbable bone collagen membrane on top, the mucoperiosteal flap is mobilized, it is laid on a wound without tension I wound tightly sutured with interrupted sutures.

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.

An incision was made in the mucous membrane, the length of which exceeds the reconstruction zone by 5 mm on each side, while the first horizontal cut was performed along the entire length parallel to the top of the alveolar ridge, indented from 7-10 mm to the depth of the cortical layer to the spongy substance, and the second horizontal cut was carried out along the top of the alveolar process from the lingual side to the depth of the cortical layer, then two vertical cuts are made, connecting the edges of the horizontal cuts and parallel to the outer surface of the alveolar process a, to a depth of 3-5 mm, then a formed bone fragment was mobilized with a chisel with a cut plane passing tangentially to the lower alveolar canal, and it was shifted up to a height of 8.0 mm, fixed with microscrews, and introduced into the defect from the cortical plate a crumb of non-demineralized bone collagen saturated with sulfated glycosaminoglycans, which was covered with a resorbable bone collagen membrane on top, the mucoperiosteal flap is mobilized, it is laid on a wound without tension I wound tightly sutured with interrupted sutures.

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 7-10th day.

The operation is illustrated by a diagram.

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 resulting plastic surgery (observation period 15-30 months) was able to withstand the occlusive load, provided to the implant.

Claims (1)

The method of plasty of the alveolar process of the lower jaw during its atrophy, including a cut of the mucous membrane, peeling and folding of the mucosal-periosteal flap, two horizontal 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 characterized in that the first horizontal cut is carried out along the entire length parallel to the top of the alveolar ridge indent from 7-10 mm to the depth of the cortical layer to spongy substance, and the second horizontal cut is carried out along the top of the alveolar process from the lingual side to the depth of the cortical layer, then two vertical cuts are made, connecting the edges of the horizontal cuts and parallel to the outer surface of the alveolar process, to a depth of 3-5 mm, then the formed bone fragment is mobilized with a chisel with a cut plane passing tangentially to the lower alveolar canal, and it is shifted up to a height of 5 mm, fixed with microscrews, and introduced into the defect from the side us cortical plate biomaterial stimulating bone formation, which is closed on top resorbable membrane mucoperiosteal flap is mobilized, it is placed on the wound without tension, the wound sutured tightly interrupted sutures.

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