RU2508057C1 - Method of preventing perforations of maxillary sinus floor in extraction of maxillary molars - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgical dentistry and maxillofacial surgery, and is intended for application in the process of extraction of maxillary molars. After carrying out X-ray examination of maxillary molar which is to be extracted and in case of detection that tops of its roots protrude into maxillary sinus cavity, appropriate processing of operation field and anesthesia are performed. Remaining hard tissues of tooth crown are removed to the gum level by dental drilling machine with turbine handpiece. Roots of molar are cut in the area of trifurcation until roots are separated from each other completely. Circular ligament and, if possible, periodondal ligaments are separated from each tooth root by means of periotome. Loosening and extraction of, first, each buccal root, and then palatal root of extracted tooth are carried out by means of thin straight elevator in cautious non-traumatic way. After extraction of roots, diagnostics aimed at identification of absence of maxilla perforation is carried out. Edges of socket are pressed with fingers with gauze pad to approach soft tissues. Patient is recommended to bite gauze pad.

EFFECT: method makes it possible to eliminate risk of perforation of maxillary sinus floor due to reduction of trauma from operation of tooth extraction.

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Description

The invention relates to medicine, namely to surgical dentistry and maxillofacial surgery, and can be used to remove molars of the upper jaw.

There is a classic way to perform surgery to remove molars of the upper jaw, in which, after appropriate treatment of the surgical field, anesthesia is performed. With a smoothing machine, the circular ligament of the tooth is exfoliated. S-shaped curved forceps with a spike are applied to the tooth (with the tooth crown preserved) and advanced to a sufficient depth, then closed and fixed. The first dislocating movement is done to the buccal, then to the palatine side and, increasing the amplitude of the movements, the tooth is extracted, then, after making, the curettage of the socket is carried out, the soft tissues of the wound edges are brought together, hemostasis is given, recommendations [1, 2].

The disadvantage of this method is that with the pneumatic structure of the maxillary sinus, the tops of the roots of the molars of the upper jaw protrude into the lumen of the maxillary sinus and, accordingly, the use of the classical method of tooth extraction often leads to perforation of the bottom of the maxillary sinus, which leads to additional surgery to remove the oroantral message. The communication between the oral cavity and the maxillary sinus requires urgent measures to close the defect, since the oroantral communication is the future gateway for infection and the cause of odontogenic sinusitis, which in the future may lead to the need for radical maxillary sinusotomy.

The objective of the proposed method: to eliminate the risk of perforation of the maxillary sinus during the operation to remove molars of the upper jaw.

The problem is solved due to the fact that in case of detection of the standing of the apices of the molar roots in the cavity of the maxillary sinus, a drill with a turbine tip is cooled, cutting the tooth crown to the level of the gingival margin, sawing and disconnecting the molar roots in the trifurcation region, peeling of the circular ligament and, opportunities - periodontal ligaments from each tooth root using a periotome, then carefully carefully extract each tooth root separately using a thin direct elevator.

The method is as follows.

After an X-ray examination of the molar of the upper jaw to be removed, and detection of the standing of the tops of its roots in the cavity of the maxillary sinus (Fig. 1), the corresponding treatment of the surgical field and anesthesia are performed.

A drill with a turbine tip with cooling is cut down the remaining solid tissue of the tooth crown to the gum level (Fig. 2), the molar roots are sawn in the trifurcation area until the roots are completely separated from each other (Fig. 3). The circular ligament and, if possible, the periodontal ligaments from each tooth root are peeled off using a periotome.

Using a thin direct elevator, gently and atraumatically loosening and first removing each buccal root (Fig. 4, 5) and then the palatine root of the extracted tooth (Fig. 6). After removing the roots, a diagnosis is made for the absence of perforation of the maxillary sinus, after which the edges of the hole are squeezed with fingers with a gauze swab to bring together soft tissues. The patient bites a gauze swab. Recommendations are the same as after tooth extraction in the usual way.

The results of the removal of 10 molars of the upper jaw, the roots of which stood radiologically in the cavity of the maxillary sinus, using the proposed method in 10 patients of the study group showed that all patients had no signs of perforation of the bottom of the maxillary sinus during and after tooth extraction. As a result, the hole of the extracted tooth was epitalized in the period from 21 to 30 days.

All patients received positive treatment results. At the same time, an additional operation was avoided to eliminate the oroantral communication, as well as hospitalization of patients in the department of maxillofacial surgery.

In 11 patients of the control group with radiological standing (finding) of the tops of the roots of the upper molars in the cavity of the maxillary sinus, the tooth extraction operation was carried out by the generally accepted method using surgical forceps.

In four patients of the control group (36.4%) after tooth extraction, perforation of the bottom of the maxillary sinus was diagnosed, which required urgent measures to close the defect: anastomosis plastic surgery. After one plastic surgery, one of these four patients had repeated anastomosis with maxillary sinus, which required hospitalization of the patient in the maxillofacial surgery department and radical maxillary sinusotomy with repeated plastic surgery of the anastomosis. The term of his hospitalization was 11 days.

Clinical example 1. A patient, 36 years old, turned to a dental clinic for help on 04/12/2012, complained of a chipped crown of a tooth 26, and slight pain when chewing food.

From the anamnesis, it was found that 26 tooth was previously treated for complicated caries. April 10, 2012, while eating, I felt a click, and then found a chip on the chewing surface of the 26 tooth. There was a slight pain during biting on the 26th tooth.

Locally: the 26 tooth crown is preserved, there is a large filling on the chewing surface, the marginal fit is broken. Palatine wall 26 of the tooth when probing is stiff, percussion of 26 tooth is painless.

In the dental image, the canals of the 26th tooth are sealed to the tops along the entire length. The palatine root of the 26 tooth protrudes into the lumen of the left maxillary sinus (Fig. 7).

After removal of the filling, a crack was found that runs parallel to the longitudinal axis of the tooth.

Dental formula: ABOUT P P P P P P ABOUT eighteen 17 16 fifteen fourteen 13 12 eleven 21 22 23 24 25 26 27 28 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 ABOUT R O where O - missing tooth, P - filling, R - root.

The patient was diagnosed with a longitudinal fracture of 26 teeth.

Removal of 26 tooth was carried out by the proposed method: after appropriate treatment of the surgical field and anesthesia, a drill with a turbine tip was cooled down, the preserved solid tissues of the tooth crown 26 were cut to the gum level, the roots of the 26 tooth were sawn in the trifurcation area until the roots were completely separated from each other (Fig. 8). The circular ligament and, if possible, the periodontal ligaments from each tooth root were exfoliated using a periotome.

Using a thin direct elevator, neatly, atraumatic loosening and first removal of each buccal root and then of the palatine root of the 26th tooth was carried out (Fig. 9). After removal of the roots of the 26th tooth, a diagnosis was made for the absence of perforation of the maxillary sinus, after which the edges of the socket of the 26th tooth were squeezed with fingers with a gauze swab to bring together soft tissues and allowed to bite an aseptic gauze swab. The patient was given recommendations.

A follow-up examination of the patient 8 days after the extraction of 26 teeth showed that in the oral cavity, the hole of the removed 26 tooth is epithelized, there are no signs of perforation of the left maxillary sinus and no complaints.

Clinical example 2. Patient AA, 48 years old, applied for help to a dental clinic on 06/25/2012 and complained of pain in a 16 tooth.

From the anamnesis it was found that 16 tooth was previously treated for complicated caries. The pain appeared about a month ago, did not consult a doctor. 06/23/2012, the pain intensified sharply.

Locally: the crown of the 16 tooth is preserved, there is a large filling on the chewing surface, the marginal fit is broken, the percussion of the 16 tooth is sharply painful.

In the dental image, the anterior buccal and palatine canals of the 16th tooth are sealed to the apices along the entire length. In the distal buccal canal, the shadow of the filling material is not visible. The palatine root of the 16th tooth protrudes into the lumen of the right maxillary sinus (Fig. 10).

Dental formula: ABOUT ABOUT P TO TO AND AND TO TO AND TO ABOUT ABOUT eighteen 17 16 fifteen fourteen 13 12 eleven 21 22 23 24 25 26 27 28 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 where O - missing tooth, P - filling, R - root, K - crown, And - artificial tooth

The patient was diagnosed with: Exacerbation of chronic periodontitis of 16 teeth. The patient categorically refused the therapeutic treatment of the 16 tooth, insisted on removal.

Removal of the 16 tooth was carried out by the proposed method: after conducting the appropriate treatment of the surgical field and using a turbine, a drill with a turbine tip was cooled to cut the remaining solid tissue of the 16 tooth crown to the gingival level, sawed the roots of the 16 tooth in the trifurcation area until the roots were completely separated from each other (Fig. eleven). The circular ligament and, if possible, the periodontal ligaments from each tooth root were exfoliated using a periotome.

Using a thin direct elevator, neatly, atraumatic loosening and first removal of each buccal root, and then the palatine root of the 16th tooth was carried out (Fig. 12). After removing the roots of the 16th tooth, a diagnosis was made for the absence of perforation of the maxillary sinus, after which the edges of the socket of the 16th tooth were squeezed with fingers with a gauze swab to bring together soft tissues and allowed to bite an aseptic gauze swab. The patient was given recommendations.

A follow-up examination of the patient 12 days after the extraction of 16 teeth showed that in the oral cavity, the hole of the removed 16 tooth is epithelized, there are no signs of perforation of the right maxillary sinus and no complaints.

The proposed method eliminates the risk of perforation of the bottom of the maxillary sinus by reducing the morbidity of the tooth extraction operation. Thanks to this, patients do not need to perform an additional operation to eliminate the oroantral message, which avoids the development of odontogenic sinusitis and in the future - the operation of radical maxillary sinusitis.

Literature

1. Robustova T.G. "Surgical dentistry" M. 2003. - 504 p.

2. Evdokimov A.I. "Surgical dentistry" M. 1964. 484 p.

Claims (1)

A method for the prevention of perforation of the maxillary sinus bottom when removing molars of the upper jaw, characterized in that in the event that the tops of the molar roots are exposed to the cavity of the maxillary sinus, a drill with a turbine tip is cooled, cutting the tooth crown to the level of the gingival margin, sawing and separation into the root area trifurcations, flaking of the circular ligament and, if possible, periodontal ligaments from each tooth root using a periotome, then carefully each separately extracted Oren tooth by a thin direct elevator.

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