RU2445026C1 - Method of vestibular access in operation sinus-lifting with simultaneous implantation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to dentistry and is intended for vestibular access in operation of maxillary sinus bottom lifting. Arch-like cut is made in the region of missing teeth from vestibular side and furrow-like in the region of adjacent to defect teeth. Near the front tooth cut is continued to mucogingival fold, with preservation of gingival papilla. Mucous-periosteal flap is separated and turned away to zogomaticoalveolar crest. Boundaries of osteotomy are determined. Lower boundary of bone window is placed at distance 5-6 mm from supposed level of sinus bottom. Bone window is formed to internal cortical layer. Cortical plate is trepanised. Osteotomic window is formed on the front wall of maxillary sinus without breaking the integrity of sinus mucosa. Maxillary sinus mucosa is detached. To ensure hemostasis and to prevent injury of maxillary sinus mucosa fibrin-enriched platelet plasma is introduced into submembrane space. Bed, which implant is installed into, is formed. Cavity is filled with osteoplastic material. Osteotomic window is closed with absorbable membrane. Flap is mobilised, laid on the place and sutured.

EFFECT: method makes it possible to improve operation field visualisation, facilitates fulfillment of surgical manipulations and post-operative wound monitoring due to making arch-like cut in the region of missing teeth from vestibular side and furrow-like cut in the region of adjacent to defect teeth.

1 dwg

Description

The invention relates to surgery, namely to surgical dentistry.

Scope: maxillofacial surgery, surgical dentistry, dental implantology.

The aim of our invention is the use of the vestibular approach in the operation of raising the maxillary sinus fundus (sinus lift) and simultaneous implantation. This approach improves the visualization of the surgical field, facilitates the implementation of surgical procedures and postoperative wound management.

Raising the bottom of the sinus in order to increase the height of the bone was first proposed by Tatum in the 70s of the last century.

The authors of OJenes, V.Paraskevich, A.Winter, Pollack, R.Odrich, M.Lang at different times described an open technique for sinus lift surgery. According to this technique, an incision of the mucosa and periosteum is performed along the crest of the alveolar ridge or from the palate in the region of missing teeth. Further, vertical sections are made that limit the area of operation along the vestibular surface of the alveolar ridge, retreating one tooth width distally and medially (1, 2, 3, 4, 5, 6).

The essence of our invention is as follows.

Under local (tubular, palatal, infiltration) anesthesia, an arcuate incision is made in the area of missing teeth from the vestibular side and grooved in the area of teeth adjacent to the defect. At the front tooth, the incision continues to the transitional fold, preserving the gingival papilla (Fig. 1).

The mucoperiosteal flap exfoliates and leans back to the cheek-alveolar ridge. After the anterior sinus wall is visualized, the boundaries of the osteotomy are determined. At the same time, the lower border of the bone window should be located at a distance of 5-6 mm from the proposed level of the sinus floor so that during the osteotomy it appears in the sinus cavity and does not damage the residual bone volume of the alveolar bone. The remaining bone rim will contribute to better retention of augmentate. Using a physiological dispenser, a spherical boron and a direct tip with abundant irrigation with physiological saline, we form an oval bone window at a speed of 7000 rpm to the inner cortical layer. Then the boron is replaced by a diamond and the cortical plate is trepaned to the mucous membrane. An osteotomy window is formed on the anterior wall of the maxillary sinus, without violating the integrity of the sinus mucosa (Schneider membrane). The mucous membrane of the maxillary sinus is peeled off with special curettes. For hemostasis and to prevent damage to the maxillary sinus mucosa, platelet-rich plasma enriched in fibrin is introduced into the submembrane space. A bed is formed into which the implant is inserted if the height of the alveolar bone (the distance from the top of the alveolar bone to the bottom of the sinus) is more than 4 mm. In the event that the height is less, delayed implantation is performed. The cavity is filled with osteoplastic material. The osteotomy window is closed with a resorbable membrane, which is fixed to the soft tissues with a 5-0 Vikril thread or pins. The flap is mobilized, laid in place and sutured with an atraumatic thread Prolen 4-0.

The main advantages of our invention are:

1) better visualization of the surgical wound (does not interfere with a large flap);

2) detachment of the mucoperiosteal flap is easier and faster;

3) the flap overlaps the plug of the installed implant;

4 the nutrition of the vestibular flap is better than the palatine (the vasculature is much better developed than on the palatine side), which improves the conditions for wound healing;

5) management of a postoperative wound (drainage, release of wound exudate) and removal of sutures is more convenient from the vestibular side;

6) patients experience less inconvenience, as seams from the palatal side do not interfere.

Bibliography

1. Ivanov S.Yu., Lomakin M.V., Panin A.M. Sinus lifting and options for subantral implantation. // Russian Dental Journal. - 2000. - No. 4. - S.16-21.

2. Losev F.F. Bone grafting of the alveolar process of the upper jaw using directed tissue regeneration and surgery to raise the maxillary sinus fundus. // Dentistry. - 2009. - T.88, No. 1. - S. 54-57.

3. Nikitin L.I., Gromova V.V. Sinus lifting using screw implants. // Materials of the VI Russian scientific forum "Dentistry 2004". - M. - 2004. - P.97 - 98.

4. Paraskevich V.L. The use of monocortical autografts to increase the height of bone tissue in the bottom of the maxillary sinus. // Institute of Dentistry. - 2001. - No. 3. - S. 35 - 40.

5. Yaremenko A.I., Vinogradov S.Yu. Sinus elevator: state of the problem, prospects. // Dental Bulletin. - 2007. - No. 4 (12). - S. 48 - 53.

6. Federico Hernandez Alfaro. Bone grafting in dental implantology. - Quintessence Publishing Co. Ltd. (UK), 2006 .-- 235 p.

Claims (1)

The method of vestibular access during sinus lift surgery, which consists in a modified incision of the mucosa and periosteum under local anesthesia and characterized in that the incision is made in an arcuate manner in the region of missing teeth from the vestibular side and passes into a groove incision in the region of teeth adjacent to the defect, and in the front tooth continues to transitional fold with preservation of the gingival papilla, with simultaneous implantation.

Images