RU2616337C1 - Method for plastic surgery on jaw alveolar process - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: prior to surgery, individual allogeneic implant in the form of a bone block is made based on computer processing of the patient study results. During muco-periosteal flap cutting and peeling, the spilt blood is collected by means of a syringe, which is used for allogeneic materials processing in three petri dishes. The recipient bed is prepared, its osteoperforation is performed collecting cancellous bone chips. In the first dish, the chips are mixed with blood and allogenic bone powder of demineralized lamellar bone. The bone block is placed in the recipient bed, holes for screws are drilled in the block, and then the bone block is moved to the second dish, where it is impregnated with the collected blood. In the third dish, the allogenic bone powder of demineralized lamellar bone is impregnated with blood. Channels for screws are slowly reamed in the recipient bed. The contents of the third dish is evenly spreaded on the bone block surface in contact with the recipient bed. The bone block is fixed by screws. The contents of the first dish is applied uniformly to the outer surface of the fixed bone block, and the plastic area is covered by the muco-periosteal flap.

EFFECT: method allows to increase the osteoinductive properties of plastic materials, to improve newly formed bone tissue quality, to reduce the likelihood of post-operative complications.

1 ex

Description

The invention relates to medicine, in particular to surgical dentistry, and is used for plastic surgery of the alveolar ridge of the jaw before performing dental implantation.

A known method of plasty of the alveolar ridge of the jaw is that after curettage and washing of the hole, it is processed with low-frequency ultrasound, then the bottom and walls of the hole are sprinkled with powder of ground allogeneic demineralized spongy or brefocost, the remaining space of the hole and the walls are filled with alveolar allogeneic demineralized lyophilized spongy or brefocosti of the appropriate configuration and volume [1].

The disadvantage of this method is the lack of stability of the blocks in the field of plastics, low osteoinductive potential of untrained allogeneic material, and the slow integration of blocks with bone tissue.

A known method for eliminating defects of the alveolar ridge with subsequent installation of implants, including the main and laxative incisions, detachment of the mucoperiosteal flap, cutting out a bone block corresponding to the size of the defect, drilling channels for titanium screws fixing the graft, processing and fixing the graft with filling the existing voids ground bone from another bone block, wound closure [2].

The disadvantage of this method is the insufficient osteoinductive potential of the applied bone blocks, the high invasiveness of the method for the patient.

There is a known method of dental implantation, in which, after decortication of the surface of the alveolar ridge and perforation of the bone plate, an autoplasma enriched with platelets in the form of a gel is placed sequentially on this area, a surface-demineralized bone allograft in the form of a plate or bone block in which holes are drilled using a surgical template, and a membrane for targeted bone regeneration from canned dura, or amnion, or tendon, or demineralized minutes bone saturated antimicrobial drugs that cause inhibition of growth of aerobic and anaerobic microflora of [3].

The disadvantages of this method are the lack of personalized preoperative planning, the choice of implant; laboriousness - the need for additional time for the preparation of autoplasma enriched with platelets; the use of additional allogeneic material - a membrane for targeted bone regeneration, which increases the likelihood of postoperative immune complications and ultimately reduces the regenerative potential of the plastic materials used and the quality of the newly formed bone tissue.

This method is taken as a prototype.

The technical result of the proposed method is to reduce the complexity of the operation, the likelihood of postoperative complications; increasing osteoinductive properties of materials used for plastic surgery and improving the quality of newly formed bone tissue.

The sizes and configuration of allogeneic implants are selected individually due to personalized preoperative planning. The allogeneic materials used for plastic surgery are treated intraoperatively for a short time together with the patient’s autologous tissues, thereby increasing their osteoinductive potential and reducing the likelihood of postoperative immune complications. All the steps and features of the method ultimately contribute to improving the quality of bone tissue formed in the plastic area.

The technical result is achieved by the fact that before the operation, on the basis of computer processing of the patient’s research results, an individual allogeneic implant is made in the form of a bone block; during the incision and exfoliation of the mucoperiosteal flap, spilled blood is collected using a syringe, which is used to process allogeneic materials in three Petri dishes; prepare the recipient bed, perform its osteoperforation, collecting chips from spongy bone tissue; in the first cup, the chips are mixed with blood and allogeneic bone powder from demineralized lamellar bone tissue; place the bone block in the recipient bed, drill holes for screws in it, and then move the bone block into the second cup, where it is impregnated with the collected blood; in the third cup, allogeneic bone powder from demineralized platelet bone is impregnated with blood; slowly drill holes for the screws in the recipient bed; evenly distribute the contents of the third cup over the surface of the bone block in contact with the recipient bed; fix the bone block with screws; the contents of the first cup are uniformly applied to the outer surface of the fixed bone block and the plastic region is covered with a mucoperiosteal flap.

The method is implemented as follows.

Before the operation, on the basis of computer processing of the patient’s research results, an individual allogeneic implant is made, which is a bone block of a certain configuration and size. During the incision and exfoliation of the mucoperiosteal flap, spilled blood is collected using a syringe, which is used to process allogeneic materials in three Petri dishes. Prepare the recipient bed, perform its osteoperforation, collecting chips from spongy bone tissue. In the first Petri dish, the chips are mixed with blood and allogeneic bone powder from demineralized lamellar bone tissue. Place the bone block in the recipient bed, drill holes for screws in it, and then move the bone block into the second cup, where it is impregnated with the collected blood. In the third cup, allogeneic bone powder from demineralized lamellar bone is impregnated with blood. Slowly drill holes for the screws in the recipient bed. The contents of the third cup are evenly distributed over the surface of the bone block in contact with the recipient bed. Fix the bone block with screws. The contents of the first cup are uniformly applied to the outer surface of the fixed bone block and the plastic region is covered with a mucoperiosteal flap. Suture the wound.

The method is illustrated by a clinical example.

Patient N., 45 years old, came to the clinic with complaints of difficulty chewing food. Categorical refusal to use a removable denture. Objectively: partial absence of lower jaw teeth, Kennedy class II (absent 35, 36, 37, 38), significant and uneven atrophy of the bone tissue of the alveolar bone. Teeth removed at the age of 15-23 years. Based on the computer processing of the results of the patient’s research, an individual allogeneic implant was made. The patient underwent an operation according to the developed technique without technical difficulties. Sutures were removed after 3 weeks. In the postoperative period, no complications were observed. The performed control studies showed the formation of high-quality bone tissue in the area of plastic surgery. This allowed the patient to complete the installation of dental implants.

The proposed method can be used in the departments of maxillofacial surgery and outpatient dental institutions.

Information sources

1. RF patent for the invention No. 2181568, “Method for plastic surgery of the alveolar bone of the jaw”.

2. Losev F.F., Dmitriev V.M., Zharkov A.V. Using the method of directed tissue regeneration and a bone autograft obtained from the lower jaw to eliminate defects in the alveolar ridge with subsequent installation of implants // Russian Journal of Dental Implantology. - 2003 - No. 1 - S. 14-18.

3. Paraskevich V.L. Dental implantology: Fundamentals of theory and practice. - 2nd ed. - M .: Medical Information Agency LLC, 2006. - p. 259.

Claims (1)

The method of plasty of the alveolar ridge of the jaw, which includes performing an incision, peeling of the mucoperiosteal flap, filling the defect area and fixing the bone block and autologous blood components in it, characterized in that before the operation, an individual allogeneic implant is made on the basis of computer processing of the patient’s research results type of bone block; during the incision and exfoliation of the mucoperiosteal flap, spilled blood is collected using a syringe, which is used to process allogeneic materials in three Petri dishes; prepare the recipient bed, perform its osteoperforation, collecting chips from spongy bone tissue; in the first cup, the chips are mixed with blood and allogeneic bone powder from demineralized lamellar bone tissue; place the bone block in the recipient bed, drill holes for screws in it, and then move the bone block into the second cup, where it is impregnated with the collected blood; in the third cup, allogeneic bone powder from demineralized platelet bone is impregnated with blood; slowly drill holes for the screws in the recipient bed; evenly distribute the contents of the third cup over the surface of the bone block in contact with the recipient bed; fix the bone block with screws; the contents of the first cup are uniformly applied to the outer surface of the fixed bone block and the plastic region is covered with a mucoperiosteal flap.