RU2638286C1 - Method for orthodontic treatment of patients with congenital edentia of permanent teeth with application of basal "biomed" implants - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: complex treatment is carried out with the use of basal implants "Biomed" and the use of orthodontic, surgical, orthopaedic methods of treatment. At that, orthodontic treatment is performed in children older than 14 years and uses braces in the following sequence: fixation of vestibular metal braces Damon (Ormco, United States) on the teeth in the upper and lower jaws using Blu-Gloo composite material (United States), installation of a full-size steel arc 0.14 CuNiTi, 2 months later the arc is replaced by 0.16 CuNiTi, 3 months after by 0.18 CuNiTi railings, and 3 months after by 0.14⋅0.25 CuNiTi. At the orthodontic treatment stage, temporary teeth are retained, braces are not fixed on them. Upon completion of orthodontic treatment and reaching of 18 years by the patient, the braces are removed, and two surgical operations are performed: temporary teeth removal and subsequent implantation in areas of the removed teeth with apical area bone thickness of at least 3 mm. Then the surgical stage is carried out, which consists in application of dental implants in combination with orthodontic treatment in the following sequence: incision and provision of operative access to the alveolar process; creation of a bone bed; implant installation; closure of the surgical wound. The specified surgical treatment is performed in several stages: analgesia; preparation of the implant bed is performed without gum cutting, after anaesthesia, a screw implant is inserted through a small puncture into the prepared hole, the implant is represented by a basal Biomed implant, the implant is installed, so that it is surrounded by at least 1 mm of bone tissue, then the final installation of the implant is performed; installation tool removal; and radiological monitoring. 3 days after implantation, crowns or bridges are prostheses are installed. It is followed by the retention period, during which fixation of a non-removable retainer on the lower jaw teeth is performed and removable retention apparatus delivery on the upper jaw dentition, the retention device is not being fixed to the elements of orthopaedic structure.

EFFECT: method allows reduce the duration of treatment in general and especially the surgical stage of complex treatment, reduce traumatism and cost of treatment, improve patient comfort, reduce the likelihood of complications and relapses.

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Description

The invention relates to medicine, namely to dentistry, and is intended for the complex treatment of patients with permanent teeth adentia.

The basic principle of treating dentition occlusion abnormalities in combination with tooth adentia is the use of an integrated approach in determining indications and choosing a method for eliminating this pathology [John A. Hobckek, Roger M. Watson, Lloyd J. J. Siz. Guide to dental implantology. - Toronto, 2007 .-- 219 p .; Profit U.R. Modern orthodontics. - M, 2008 .-- 560 p.). An integrated approach involves the orthodontic, surgical and orthopedic stages of treatment.

Indications for surgery and denture are specified using x-ray examination of the alveolar ridge, orthopantomography, or panoramic radiography of the jaw. The position and degree of development of the rudiments of permanent teeth, the presence of a place in the dentition for them, the possibility of its preservation or creation (Khoroshilkina F.Y. . - M., 2010 .-- 592 p.).

For the orthodontist, the difference between conventional prosthetics and implantation is the sequence of treatment and how the teeth will be placed. The main conditions necessary for implantation are: sufficient bone tissue, which is a particular problem with primary adentia, and the right amount of space for the implant, both between the crowns of the teeth that limit the defect, and between their roots. There are one- and two-stage implantation techniques, which are basic. The first step in a two-stage technique is the installation of an intraosseous element. The second stage is the excision of the mucous membrane over the intraosseous elements, the installation of the shaper of the gingival cuff, head or other orthopedic component provided by the implant design. In a one-step procedure, the support head (non-separable design) or module protrudes into the oral cavity. Then the head (collapsible design) will be fixed to it (see Khoroshilkina F.Y. Orthodontics. Defects of teeth, dentitions, malocclusion, morphofunctional disorders in the maxillofacial region and their complex treatment. - M., 2010. - 592 s. .).

A disadvantage of the known technique is that it requires a long time for osseointegration of implanted teeth, which increases the cost of treatment and creates inconvenience for the patient, as well as the possibility of various complications and relapses.

The problem solved by the invention is to reduce the duration of treatment in general and especially the surgical phase of complex treatment, reduce the morbidity and cost of treatment, increase patient convenience, reduce the likelihood of complications and relapses.

To solve this problem, a method is proposed for the complex treatment of patients with congenital adentia of permanent teeth with the use of Biomed basal implants.

The main stages of the proposed method

1. An integrated approach includes the use of orthodontic, surgical, orthopedic methods of treatment. Orthodontic (hardware) treatment is carried out in children over 14 years of age and is carried out using a bracket system in the following sequence:

1) fixation of Damon vestibular metal braces (Ormco, USA) on the teeth of the upper and lower jaws using the composite material Blu-Gloo (USA);

2) installation of a full-sized steel arc 0.14 CuNiTi;

3) after 2 months, the arc changes to 0.16 CuNiTi;

4) after 3 months, the arc changes to 0.18 CuNiTi;

5) after 3 months, the arc changes to 0.14⋅0.25 CuNiTi.

A feature of the proposed method is the preservation of temporary teeth in the process of orthodontic treatment. Braces are not fixed on them.

2. At the end of the orthodontic treatment and reaching the age of 18, the braces are removed and two surgeries are performed: removal of temporary teeth and subsequent implantation in the area of extracted teeth.

A sufficient amount of bone (about 5 mm) in the apical region of the well provides good primary stability and protects the mandibular canal from damage. It is important to consider the length of the implant here, since a longer construction than expected may be required to provide better primary stability. Immediate implant placement is most suitable for replacing single-rooted teeth than multi-rooted teeth, since in the latter case it is difficult to achieve adequate implant-bone contact.

3. The surgical stage (implantation) consists in the use of dental implants in combination with orthodontic treatment in the following sequence:

1) ensuring operational access to the alveolar process;

2) the creation of a bone bed;

3) implant placement;

4) closure of the surgical wound.

Stages:

1) Anesthesia: the preparation of the implant bed is carried out without cutting the gum. After anesthesia, a screw implant is screwed into a prepared hole through a small puncture;

2) The basal implant Biomed was used as an implant. For example, a TOI® disk implant (4D implantation), a single GBC® implant, or a GCS® compression implant (see the Oneway Biomed website, Switzerland - http://swissbiomed.ru), which allow the use of dental prosthetics of any complexity patients of all ages, regardless of the degree of bone atrophy; the implant must be installed so that there is at least 1 mm of bone tissue around - this is how the surgical space is determined;

3) final implant placement;

4) removal of the installation tool;

5) x-ray control.

4. 3 days after implantation, prosthetics are performed. The choice of orthopedic design is carried out at the planning stage of treatment with the participation of the surgeon and orthopedist and depends on the specific clinical situation. In the literature (F. Khoroshilkina “Orthodontics”; Prof. UR “Modern Orthodontics”), cases of using crowns and bridges are described.

5. At the end of the orthopedic stage, the retention period begins, which is necessary to stabilize and prevent the recurrence of orthodontic treatment. The fixed retainer is fixed on the teeth of the lower jaw and the surrender of the removable retention apparatus on the dentition of the upper jaw. The retention device is not fixed to the elements of the orthopedic construction.

Features of the proposed orthodontic treatment of patients with congenital adentia of permanent teeth with subsequent implantation and prosthetics:

1. Implantation is carried out after the hardware treatment method, which helps to reduce the time of osseointegration.

2. At the end of orthodontic treatment, plastic surgery of the frenum of the lower lip is not performed. This condition is necessary to preserve the vessels that provide trophic tissue in the region of the central lower incisors.

3. The preservation of temporary teeth provides the creation of a natural support to prevent displacement of adjacent teeth in the mesiodistal direction.

4. The presence of the roots of temporary teeth delays bone atrophy of the alveolar process of the upper jaw and the alveolar part of the lower.

5. The use of basal implants helps to increase the area of contact with the bone tissue of the dental alveoli.

6. The difference in the rate of bone resorption and osteogenesis explains the need for retention of teeth in a new position immediately after movement. The design of the retainer serves as a stable support to prevent the recurrence of orthodontic treatment.

The method is characterized in that it is necessary:

- keep temporary teeth at the time of orthodontic treatment,

- carry out the removal of temporary teeth at the last stage of orthodontic treatment and the implantation of basal implants "Biomed",

- not to conduct plastic surgery of the frenulum of the lower lip in order to maintain the health of the periodontium in the region of the lower central incisors.

The invention is illustrated by drawings, where in FIG. 1 - patient D.'s face, 18 years old (a - face, b - smile, c - profile); in FIG. 2 - dentition of the upper (a) and lower (b) jaws of patient D., 18 years old, closing of the teeth - antagonists (in - on the right, g - of the front teeth, d - on the left); in FIG. 3 - orthopantomogram of patient D., 18 years old; in FIG. 4 - analysis of the interpretation of TRH of the head of patient D. in lateral projection in the Dolphin Imaging program; in FIG. 5 - one-stage implants GCS ("Biomed", Switzerland); in FIG. 6 - surgical stages of installing single-stage Biomed implants: a - removal of the ligature of the bracket system, b - anesthesia, c - preparation and preparation of the implant bed, d - final installation of the implant, e - disconnection of the installation tool, e - result; in FIG. 7 - x-ray control of the installed implants in the field of teeth 3.1 and 4.1; in FIG. 8 - dentition of the upper and lower jaws of patient D., 18 years old, closing of antagonist teeth (a - right, b - front teeth, c - left); in FIG. 9 - prosthetics with metal-ceramic crowns in the area of teeth 3.1 and 4.1: a - front view, b - top view, fixation of the fixed retention device on 3.3, 3.2, 3.1, 4.1, 4.2 and 4.3 teeth.

Clinical example

Patient D., 18 years old. Diagnosis: adentia of teeth 3.1 and 4.1, diastema between teeth 1.1 and 2.1.

He complained of aesthetic disorders (diastema in the area of the central incisors in the upper jaw, the presence of temporary central incisors in the lower jaw).

Conducted a clinical examination (Fig. 1, 2), orthopantomography (Fig. 3), tele-roentgenography with decoding TRG of the head in lateral projection in the program Dolphin Imaging (USA) (Fig. 4).

Clinical examination included: a survey, examination of the face, examination of the oral cavity. During the survey, we clarified complaints, recorded past and related diseases, bad habits, and dysfunctions.

Upon examination, determined the configuration of the face (Fig. 1).

When examining the oral cavity, the timing of the change of teeth was especially noted. The dental formula was filled, the condition of the mucous membrane of the vestibule and the oral cavity, the number and condition of the teeth, their location, the shape of the dentition, the closure of the incisors and molars in three mutually perpendicular directions were noted (Fig. 2).

Based on the data of clinical examination and diagnosis, the diagnosis was made: adentia of teeth 3.1 and 4.1, diastema between teeth 1.1 and 2.1. Appointed a comprehensive orthodontic, surgical and orthopedic treatment.

On the basis of the Department of Pediatric Dentistry of Samara State Medical University, the vestibular metal braces “Damon” (Ormco, USA) were fixed on the teeth of the upper and lower jaws using the composite material Blu-Gloo (USA) according to the method described above. A full-sized steel arc of 0.14 CuNiTi was installed. After 3 months, the arc was replaced with 0.16 CuNiTi. After 3 months, the arc was changed to 0.18 CuNiTi. After 3 months, the arc changes to 0.14⋅0.25 CuNiTi. One year after fixation of the bracket system, the patient was removed with temporary central incisors on the lower jaw, after removing the braces from the teeth being removed, and 2 days later, the implants were implanted in the region of the lower central incisors with Biomed GCS implants (Switzerland) in the following sequence (Fig. 5, 6): anesthesia, providing quick access to the alveolar bone, creating a bone bed, installing an implant and closing the surgical wound. At the end of the implantation, an x-ray control was performed (Fig. 7). 3 days after implantation, the patient is in satisfactory condition (Fig. 8). The prosthetics with ceramic-metal crowns were performed, then the bracket system was removed from the dentition of the lower jaw and the fixed retention apparatus was installed in the region of the anterior tooth group (Fig. 9).

The invention allows to reduce the duration of treatment in general and especially the surgical stage of complex treatment, reduce the morbidity and cost of treatment, increase the convenience for the patient, and reduce the likelihood of complications and relapses.

Claims (1)

A method of treating patients with congenital adentia of permanent teeth using “Biomed” basal implants, comprising the use of orthodontic, surgical, orthopedic methods of treatment, and orthodontic treatment is carried out in children over 14 years of age and is carried out using a bracket system in the following sequence: fixing vestibular metal braces Damon (Ormco, USA) on the teeth of the upper and lower jaws using a composite material Blu-Gloo (USA), installation of a full-sized steel arc 0.14 CuNiTi, through 2 months arc change to 0.16 CuNiTi, after 3 months arc change to 0.18 CuNiTi, after 3 months arc change to 0.14⋅0.25 CuNiTi., Temporary teeth are saved at the stage of orthodontic treatment, braces are not fixed on them, after the end of orthodontic treatment and achievement of a patient of 18 years of age, the bracket system and two surgical operations are performed: removal of temporary teeth and subsequent implantation in the area of extracted teeth with a bone thickness in the apical region of at least 3 mm, then the surgical stage is carried out, which consists in using den full implants in combination with orthodontic treatment in the following sequence: incision and provision of operative access to the alveolar process; creation of a bone bed; implant placement; closure of the surgical wound, the specified surgical treatment is performed in several stages: anesthesia; preparation of the implant bed is carried out without cutting the gum, after anesthesia, a screw implant is screwed into the prepared hole through a small puncture, a Biomed basal implant is used as an implant, the implant is installed so that at least 1 mm of bone tissue is around, then the implant is finally installed; removal of the installation tool; and X-ray control, 3 days after implantation, prosthetics are performed with crowns or bridges, followed by a retention period, in which the fixed retainer is fixed to the teeth of the lower jaw and the removable retention apparatus is placed on the dentition of the upper jaw, and the retention apparatus is not fixed.

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