RU2512944C1 - Transdental implantation procedure - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: trapezoid mucoperiosteal flap is formed. A bone tissue is trepanized in a projection of a root end. That is followed by root resection and sharp edged smoothing in the resected portion. Root canal walls are prepared with a drill of a diameter one millimetre more than a diameter of a transdermal implant. An inverted-cone cavity is formed on the resected root portion with a burr; a cone base faces a crown so that a distance from the edges of the formed vortex of the cone cavity to external walls of the root makes at least 1.5 mm. Glass ionomer cement in a root filler is introduced into the root canal. Thereafter the transdental implant is inserted. Excess cement is cleaned from the formed cone cavity until the cement crystallised. Further, a surgical tool for retrograde filling is inserted and condensed. An intraoperative defect is filled with a bone-replacement preparation. The wound is closed.

EFFECT: method enables providing higher quality of tooth-preserving operations using the transdental implants by improving the high-quality immobilisation of the intraradicular portion of the transdermal implant and reducing the resected portion of the root.

1 dwg, 1 ex

Description

The invention relates to medicine, namely to surgical dentistry, and can be used to restore biomechanical parameters of teeth with resected and amputated roots.

At present, tooth-preserving technologies in the outpatient practice of a dental surgeon are one of the priority areas in surgical dentistry. As a rule, the mentioned manipulations are accompanied by a violation of the integrity of the crown and tooth root. The most commonly used operation in a dental clinic is resection of the apex or amputation of a part of the root of the tooth due to chronic forms of periodontitis, caries complications.

Often a chronic process in the region of the apex of the root leads to its resorption, and subsequent resection - to even greater shortening of the root.

It is well known that in teeth with resected roots (with a shorter root length) biomechanical indices decrease and previously normal functional load is inadequately perceived, which leads to the occurrence of mobility and subsequent tooth loss.

Quite often, such teeth are used under the supports of various designs of dentures, which further aggravates the stress-strain state of the module “tooth stump - bone tissue” and leads to local destruction of the system, i.e. irreversible complications occur. In this regard, the problem of restoring the biomechanical parameters of a tooth with a resected apex or amputated part of the root is solved by reinforcing them with endodonto-endoossal (transdental) implants.

The prior art method of endodonto-endoossal implantation, which includes preoperative preparation of the tooth for endodonto-endoossal implantation, preparation of the root canal of the tooth with drills, successively increasing the diameter, screwing the endodonto-endoossal implant into the prepared hole in the tooth using a key for manual insertion. To prepare the orthopedic design, a transfer is screwed onto the implant and the impression is taken with an open or closed standard spoon or an individual spoon with a silicone mass, an impression is taken from the oral cavity, while the transfer remains in the mold. An analog of the implant is inserted on the transfer in an impression, filled with super gypsum and a collapsible model is made according to standard technology, an abutment is put directly on the crown of the implant, then a plastic cap, the stump of the prepared tooth is modeled with wax, the wax composition is traditionally replaced with metal, and together with wax they burn out the plastic cap, fit the finished structure and fix it on the orthopedic cap using laser welding, make a permanent prosthesis. In cases of obstruction of the size of the postoperative bone defect in the fixation of the implant without effort in the bone, an additional rotary ratchet with reverse is used (RF patent 2320290).

A known method of endodontic-endoossal implantation, in which a hole is drilled in the tooth root with a diameter corresponding to the diameter of the shaft; the hole in the upper part of the root of the tooth is expanded to such an extent that the rod can be inserted to a depth corresponding to its intra-root part; then, a depression is formed in the jaw bone under the intraosseous part of the rod, while its diameter should be slightly less than the diameter of the rod to ensure reliable fixation when screwing it into the bone. After this, the rod is installed by screwing it into the jaw bone. Then install the rod by screwing it onto the rod; an additional fixing rod is screwed into the crown part of the shaft. The core is installed on phosphate cement (RF patent 2209049).

A known method of endodontic-endoossal implantation, in which, after resection of the apex of the root, the bone cavity was thoroughly cleaned from the remains of pathological granulation tissue and washed with an antiseptic solution. Further, the root stump was treated, which consisted in the formation of a box-shaped or oval cavity. For this purpose, a spherical surgical bur with a minimum diameter for straight tips or a Soniflex (Kavo) tip with special nozzles were used. Further, a bed for the apex of the implant was formed in the jaw bone through a canal of the tooth root with a special drill of the corresponding diameter.

Before the final insertion and fixation of the implant into the root canal, one of the three fixation cements (Pro Root - Dentsply, Cemfil superior - Dentsply, Fugi I - GC) was introduced using the canal filler. The same cement was applied to the body of the implant (the part that should be located in the channel). An endodontic-endoossal implant was inserted into the canal and, using a special key, rotating clockwise, was fixed in the bone tissue. Cement was densely rammed on the root cult. Excess cement was removed from the bone cavity. Next, the bone cavity was treated with an antiseptic solution, filled with a drug that stimulates bone tissue regeneration. The flap was placed in place and sutured tightly with interrupted sutures (Development and clinical and experimental justification for the use of endodontic-endoossal implants in the surgical treatment of patients with chronic periodontitis. A. Mokhov, dissertation, Candidate of Medical Sciences, page 68). The disadvantages of this method are the insufficient fixation of the transdental implant in the root of the tooth and the destruction of the fixation cement in the preserved part of the root. Glass ionomer cements used to fix the intra-root part of the implant, such as Cemfil superior (Dentsply), Fugi I (GC), do not provide the absence of microbial permeability and poorly condense in the humid environment that accompanies surgery. At the same time, cements used to seal the resected part, such as Pro Roo (Dentsply), are not able to fix the implant in the channel.

The problem to which the invention is directed is to improve the quality of tooth-preserving operations performed using transdental implants.

The technical result of the invention is to improve the quality of fixation of the intra-root part of the transdental implant, as well as to reduce the micropermeability of the resected root part.

The technical result is achieved due to the fact that the method of transdental implantation consists in resection of the root, smoothing the pointed edges of the resected root part, preparation of the walls of the root canal with drills with a diameter exceeding the diameter of the transdental implant by one millimeter, and then on the resected part of the root with a cone-shaped milling cutter form a cavity of a conical shape, the base facing the crown of the tooth, while the distance from the edges of the formed tops of the conical cavity d about the outer walls of the root is at least 1.5 mm, after which glass-ionomer cement is introduced into the root canal and the transdental implant is inserted, excess cement is removed from the previously formed conical cavity until the cement crystallizes, then surgical cement is introduced and condensed into the cleaned cavity intended for retrograde filling, the intraoperative defect is made up for with a bone replacement drug, the wound is sutured.

The most important condition for the clinical use of transdental implants is their primary stabilization, ensured by immersion of the threaded part of the implant in the bone tissue and fixation of the implant in the root canal. Fixation of the implant in the bone is not always possible and depends on the volume of the interoperative defect, and the quality of the intracanal fixation leaves much to be desired, since the cements used for fixation do not provide the absence of microbial permeability and poorly condense in the humid environment accompanying the surgical intervention. At the same time, the cements used to seal the resected part are not able to fix the implant in the root canal. And only verification of cements by indicators, adhesion to metal and permeability in an aggressive environment and their combined application can solve the indicated problem - improving the quality of tooth-preserving operations performed using transdental implants.

The method of transdental implantation is illustrated in the drawing, where

1. Tooth

2. The resected part of the root

3. Transdental implant

4. The conical cavity in the stored part of the root

5. Glass ionomer cement

6. Surgical cement intended for retrograde filling

7. Intraoperative defect

The method of transdental implantation is as follows.

Resection of tooth root 1 and smoothing of the pointed edges is performed. The root canal is prepared with drills with a diameter exceeding one millimeter the diameter of the transdental implant 3, after which a cavity of the conical shape 4 is formed on the resected part of the root 2 with a milling cutter, having the base facing the crown of the tooth, so that 6 is the distance from the edges the formed top of the conical cavity to the outer walls of the root would be at least 1.5 mm. Glass ionomer cement 5 (for example, Fugi I (GC)) is introduced into the root canal on the filling channel and a transdental implant 3 is inserted, excess cement is removed from the previously formed conical cavity 4 until the cement crystallizes. Surgical cement intended for retrograde filling 6 (for example, Pro Root (Dentsply)) is introduced and condensed into the cleaned conical cavity 4. Intraoperative defect 7 is made up with a bone substitute preparation, the wound is sutured.

Clinical example

The patient K., born in 1985, came to the clinic. with complaints of an aesthetic defect in the frontal group of teeth of the upper jaw.

Past and concomitant diseases: an allergic history is not burdened, she denies infectious diseases.

The development of this disease: 21 - was treated for tooth decay 5 years ago.

External examination: The configuration of the face is not changed, the skin is clean, without rashes; the height of the lower part of the face within the anatomical and physiological norms, nasolabial and chin folds are not expressed. TMJ movements are uniform, the compression test is negative. Chewing muscles on palpation are elastic, painless. Parotid, submandibular salivary glands are not enlarged, painless on palpation. Regional lymph nodes are palpated, painless, soft consistency, unsoldered with the surrounding tissue.

Examination of the oral cavity: The mucous membrane of the oral cavity, alveolar processes and palate is pale pink, moderately moist, the mucous membrane of the tongue without visible changes, without plaque, pale pink. In the cervical region of the anterior teeth of the lower, upper jaw, there is a large number of soft and hard dental deposits, the marginal periodontium is hyperemic, swollen, and bleeds upon palpation.

Bite: Orthognathic.

Status localis: 21 - in the crown of the tooth on the proximal, distal surfaces, a seal made of composite material is determined; when probing, a defect in a filling with a violation of the marginal fit to the tooth.

X-ray examination data: 21 - the crown part is partially destroyed, the tooth was previously filled, there is no message with the tooth cavity.

In the periapical tissues 21 there is no periodontal gap, a focus of dimming 3 × 4 mm, with clear boundaries.

Diagnosis: Chronic apical periodontitis.

Treatment: Under the application and infiltration anesthesia Sol. Ubistesini - 4% - 2.4 ml, a trapezoidal mucoperiosteal flap is formed, the bone tissue in the projection of the root apex is trepanated with an ultrasonic tip. Resection of the root of the tooth 21 and smoothing of the pointed edges of the root. The preparation of the walls of the root canal. A conical cavity is formed on the preserved part of the root, with the base facing the crown of the tooth. Fugi I glass ionomer cement (manufacturer GC), on which a transdental implant is fixed, is inserted into the root canal on the canal filling. Surgical cement Pro Root (manufacturer Dentsply) was introduced and condensed into the conical cavity, cleared of residues of Fugi I. The intraoperative defect is made up by a bone substitute preparation, the wound is sutured tightly. Recommendations are given.

Claims (1)

The method of transdental implantation consists in resection of the root, smoothing the pointed edges of the resected part of the root, preparation of the walls of the root canal with drills with a diameter exceeding one millimeter the diameter of the transdental implant, after which a cavity with a cone shape is formed on the resected part of the root with a cone-shaped cavity with the base facing to the crown of the tooth, while the distance from the edges of the formed tops of the conical cavity to the outer walls of the root is at least 1.5 mm, why glass ionomer cement is introduced into the root canal and the transdental implant is inserted, excess cement is removed from the previously formed conical cavity until the cement crystallizes, then surgical cement intended for retrograde filling is introduced and condensed into the cleaned cavity, the intraoperative defect is replaced by a bone replacement the wound is sutured.

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