RU2644851C2 - Dental implant and implantation method thereof - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions relates to orthopedic dentistry, specifically to prosthetic teeth, and is intended for use when installing dentures on the alveolar processes of both the upper and lower jaws. Method comprises performing an operation to install a single-stage implant. Treatment of postoperative complications during the rehabilitation period is carried out by carrying out laser therapy sessions through an optical fibre. Dental implant is implanted, said implant comprising an intraosteal part in the form of a cylinder or cone with an end rounding and a head made as a single unit from sapphire. Intraosteal part has a thread. At least part of the surface of the implant that comes into contact with bone tissue is polished or is made with a porous near-surface layer. Throughout the entire length of the implant, a long internal channel, closed from the side of the end rounding, is made. Optical fibre is inserted into the implant channel at any stage of implantation and postoperative implant operation. Disinfection is carried out using laser radiation or laser stimulation for directed osteogenesis.

EFFECT: invention, by enabling laser therapy, can increase the reliability of installation and durability of dental implants.

2 cl, 4 dwg, 2 ex

Description

The invention relates to orthopedic dentistry, namely prosthetics, and can be used to install dentures on the alveolar processes of both the upper and lower jaw.

A known method of implantation [Dobrovinskaya E.R., Litvinov L.A., Pishchik V.V. Sapphire Encyclopedia. - Kharkov: Institute of Single Crystals, 2004. - 508 p.], Including the operation to install a one-stage implant, prosthetics and treatment of postoperative complications in the rest of the period by applying low-intensity radiation from a He-Ne laser through an optical fiber and an adapter into a polished sapphire implant head. Several sessions of radiation stop inflammation, and the next six sessions stimulate osteogenesis.

A one-stage dental implant is known (Dobrovinskaya E.R., Litvinov L.A., Pishchik V.V. Sapphire Encyclopedia. - Kharkov: Institute of Single Crystals, 2004. - 508 pp.) Containing the intraosseous part in the form of a cylinder or cone with end rounding and the head is made as a single unit of sapphire, the intraosseous part is threaded, at least part of the implant surface in contact with the bone tissue is polished and / or made with a porous surface layer.

The positive properties of this sapphire dental implant are inertness, the absence of degradation and the immune response in conditions of a long stay in the body. This device also provides stimulation of osteogenesis by activating the surface of the intraosseous part by creating a large number of defects of various kinds, which accelerates the fusion. Due to the transparency of the sapphire implant material in a wide range of wavelengths of electromagnetic radiation, it is used as a conductor of the acting radiation.

The disadvantage of this sapphire implant and method of implantation is the uneven density of radiation power in the vicinity of the contact of the implant and bone tissue. The implant acts as a light guide in the extraosseous part, since the high refractive index of sapphire placed in the air makes it possible to efficiently capture and transmit radiation, including radiation entering at large angles to the axis of the implant. However, for sapphire in contact with the tissue, the difference in refractive indices decreases sharply, which leads to the highlighting of a significant part of the radiation in the vicinity of the gums or the surface layer of bone tissue. In addition, the radiation is additionally scattered on the surface roughness and surface defects. As a result, radiation reaching the intraosseous part and, especially, the end curvature has a reduced density. Increasing the radiation power to obtain the required power density in the intraosseous part can lead to undesirable tissue overheating, and the range of available laser therapy modes and methods is thus limited by low-intensity stimulation.

The problem to which the claimed invention is directed, is to increase the reliability of the installation and the durability of dental implants, providing laser therapy, diagnostics, as well as cryotherapy on the tissues adjacent to the implant during the installation and operation of a sapphire dental implant.

The problem is solved due to the fact that in the method of implantation of a dental implant, including the operation to install a one-stage implant, prosthetics and treatment of postoperative complications during the rehabilitation period, conducting laser therapy sessions by applying radiation through an optical fiber, a dental implant is implanted, a fiber is inserted into the implant channel onto any stage of implantation and postoperative operation of the implant, disinfection using laser radiation or laser emulation for directed osteogenesis, and in a dental implant that enables disinfection or stimulation of osteogenesis using laser radiation, containing the intraosseous part in the form of a cylinder or a cone with end rounding and a head made as a single unit of sapphire, the intraosseous part has a thread, at least the part of the implant surface in contact with the bone tissue is polished or made with a porous surface layer; an extended internal length is made along the entire length of the implant s channel, closed by the mechanical rounding.

The essence of the invention is illustrated by drawings.

The drawings show:

FIG. 1. Scheme of the implant according to the invention with the intraosseous part in the form of a cylinder (right) and a cone (left).

Figure 2. The scheme of formation of the region of high radiation density in the vicinity of the contact of the sapphire implant with bone tissue.

FIG. 3. Modeling the concentration of radiation with a wavelength of 910 nm in the vicinity of the contact of the sapphire implant and bone tissue.

FIG. 4 The operation of the implant using optical fibers and various radiation patterns on the distal part.

1 - sapphire dental implant,

2 - intraosseous part of the implant,

3 - end rounding of the implant,

4 - the head of the implant,

5 - the outer surface under the tool,

6 - thread on the intraosseous part of the implant (analogue of a triangular or trapezoidal thread),

7 - an extended channel in the volume of the dental implant,

8 is a cylindrical surface,

9 is a cylindrical surface,

10 - conical surface,

11 - conical surface,

12 - radiation propagating mainly in the radial direction,

13 - area of high density of light energy from cylindrical surfaces,

14 - peaks of contractions,

15 and 16 are areas of high density of light energy from narrowing,

17 - envelope of indicatrix,

18 - rays going at a large angle to the axis of the implant,

19 is an optical fiber,

20 - diffuser of the optical fiber,

21 - optical fiber with end glow,

22 - optical fiber with side glow,

23 - light guide with a circular radiation pattern,

24 - polished sapphire implant head,

25 - the surface layer of the bone,

26 is a cross section at the level of the end curve of the implant.

Dental implant 1, a diagram of which is shown in FIG. 1, comprises an intraosseous part 2, an end rounding 3, a head 4 with an outer surface for an artificial tooth and an outer surface for an instrument 5; on the outer surface of the intraosseous part there is a thread (analogue to a triangular or trapezoidal thread), and also in the volume of the sapphire dental implant 1 there is an extended channel 7 closed from the end of the rounding 4 (in the particular case of implementations. The extended channel 7 is designed to accommodate optical fibers for various purposes .

The present invention works as follows. At any stage of standard (or non-standard) one-stage implantation and postoperative implant operation, a sapphire dental implant is a conductor of laser radiation to biological tissue in contact with any part of it, including bacterial flora films (films) attached to the implant surface.

Radiation is introduced through the wall of the extended channel 7 of the sapphire implant in that part that corresponds to the field of laser therapy. The radiation passing through the thickness of the sapphire falls on the contact boundary of the implant and biological tissue, which is a periodic repetition of cylindrical surfaces 8, 9 and conical surfaces 10, 11. Pairs of conical surfaces represent an optical narrowing (optical wedge). Radiation 12, which propagates mainly in the radial direction, is redistributed by the wedge in such a way that regions of high density of light energy 13 lie in the vicinity of the apexes of the constrictions 14. The beams passing through the cylindrical surfaces 8 and 9 do not change their direction, scattered by the tissue in regions 15 and 16 The overall envelope of the indicatrix 17 of radiation thus repeats the thread profile. The thread on the surface of the sapphire implant, on the other hand, effectively limits the irradiation zone in the vertical direction, since the propagation conditions of the rays 18 going at a large angle to its surface are unfavorable, FIG. 2. In FIG. Figure 3 shows the distribution of the power density of laser radiation in a scattering medium around a sapphire implant for the case of a fiber with a 4 mm diffuser in the channel of the implant.

Increasing the effectiveness of the additional action aimed at reducing complications during osseointegration and implant operation consists in increasing the density and uniformity of the field of laser radiation in the vicinity of the intraosseous part of the implant, controlling the shape of the radiation field, and eliminating screening over the entire contact surface of the implant with biological tissue.

The presence of the channel in the volume of the implant allows you to bring the working part of the fiber directly into the channel that you want to irradiate. The thread used to fix the implant in the formed well of the alveolar ridge is a periodic optical structure for radiation, the action of which consists in a sharp local change in the direction of propagation of the beams passing through the contact. This leads to an increase in the density of the light field in the vicinity of the contact, which is also facilitated by the effective scattering of the outgoing radiation by the biological tissue itself.

The use of this implant can improve the fixation of the implant to bone tissue, reduce the inflammatory response and the time of osseointegration of the implant.

Using an implant as a cryo-conduit allows cryotherapy to be applied to contacting tissues, which stimulates osseointegration, has a calming, immunostimulating, and other positive effects on the wound surface.

In addition to uniform irradiation of the implant surface for the purpose of disinfection and / or irradiation of the entire surface of the intraosseous part, a sapphire dental implant can also be used for targeted limited exposure to treat one or another localization of the inflammatory process or for individual treatment tactics. So in FIG. 4 shows the operation of a dental implant using light-delivering optical fibers 19 with different radiation patterns. Using an optical fiber with a diffuser 20 allows you to irradiate the tissue adjacent to the intraosseous part of the implant, or part of them. The use of an optical fiber with end glow 21 makes it possible to form a region of high light energy density in the vicinity of the end curve. An optical fiber with a side glow 22, placed in the channel 7 of the implant, can be used to focus the radiation in the desired sector in the radial direction. For the same purpose, a fiber guide can be used with a circular radiation pattern 23. Together with the movements of the fiber in the implant channel, irradiation of various sections of bone tissue in contact with the implant can be carried out, including with variable modes of laser irradiation. The fibers of the spectrometric system can also be introduced into the implant channel to monitor the state of tissues adjacent to the implant, including for the purposes of fluorescence diagnostics and photodynamic therapy.

Due to the high thermal conductivity of sapphire, the implant can also work as a cryoproduct at any stage of the implant's operation. The use of the implant as a cryo-conduction allows for cryotherapy on tissues in contact with the implant, which stimulates osseointegration, has a calming, immunostimulating, and other effects. The implant can also be cooled by laser irradiation to prevent tissue overheating in the surface layer, where the radiation concentration is highest.

In this case, the cooling of the entire volume of the implant can be achieved either by cooling in any way (nitrogen, gas, Peltier element) a fastener with an external surface for an artificial tooth, providing the possibility of introducing optical fiber into the channel, or using additional channels of the implant to place cold circuits with the possibility of direct intraosseous cooling parts of the implant.

The work of the invention is illustrated by the following clinical examples.

Example 1

Patient, 50 years old, after surgery directed bone augmentation and reconstruction of the maxillary sinus.

The operation consisted in the removal of two teeth and the simultaneous implantation of two sapphire implants. Antiseptic treatment of the skin of the face, the vestibule of the oral cavity, and the oral cavity were successively carried out. Then, after anesthesia was performed, the mucous membrane was cut along the ridge, followed by flaking of the mucoperiosteal flap, removal of the 43rd and 33rd teeth, curettage of the holes, removal of granulation tissue, washing of the wound with 9.0% sodium chloride solution. A surgical template was installed. Next, the alveolar ridge was first prepared with a pilot cutter, followed by an increase to the desired size and diameter. After that, sapphire implants were installed, previously cooled in liquid nitrogen, and temporary plugs were installed.

In the postoperative period after implantation, the implantation area was irradiated with broadband pulsed infrared laser radiation in the wavelength range of 890-960 nm, delivered using an optical fiber with a diameter of 400 μm with a diffuser 5 mm long, the radiating end of which was placed in the implant channel open for the duration of irradiation. Spent 15 sessions of irradiation for 20 minutes.

Pathomorphological tissue changes before the start of the course of laser therapy (section A) and after the course of laser therapy (section B) were observed on sections of mucosal epithelial cells stained with hematoxylin - eosin. At section A, a violation of the "horizontal" cellular connections is observed, the cell organelles are blurred, not structured. Large intercellular spaces. At section B, cell membranes are densely structured, cell organelles are well differentiated, and intercellular spaces are slit-like; intercellular connections are dense. An intraoperative mucosal biopsy after the end of a course of laser therapy shows a large number of phagosomes with signs of active phagocytosis. The mitochondria are rounded, with a bright transverse outline. Chromatin is concentrated. After analysis of the results, the high efficiency of the claimed implantation method was confirmed. There were no complications or side effects of periodontal tissues, as well as bone tissue, contributing to the rapid rehabilitation of patients in the postoperative period. The effectiveness of laser exposure is increased due to the delivery of radiation with a uniform distribution of power density directly to the implantation area through a sapphire implant with an extended channel in the volume.

Example 2

The example demonstrates a significant increase in the efficiency of radiation delivery to the implantation area in the bone when using a sapphire implant with a channel (Fig. 5). For the case of introducing radiation outside through the polished head of the sapphire implant 24 (top left) and for the case of using a channel with an inserted fiber (top right), the laser power densities were measured along the direction of implantation and in section 26 perpendicular to it at the level of the end curve of the implant 3. In the first In this case, a significant part of the radiation is highlighted in the vicinity of the gums or the surface layer of the bone 25. Radiation reaching the intraosseous part and, especially, the end curvature, has creatures permanently reduced, poorly controlled power density. Placing a light-delivering fiber in the implant channel under the same radiation power mode allows increasing the radiation power density in the implantation area three or more times and obtaining an equal level of power density on the entire contact surface, including the most deeply immersed end-face region.

Claims (2)

1. A method of implanting a dental implant, including performing the operation of installing a one-stage implant, prosthetics and treating postoperative complications during the rehabilitation period, conducting laser therapy sessions by applying radiation through an optical fiber, characterized in that the dental implant is implanted according to claim 2, is introduced into the implant channel fiber guide, at any stage of implantation and postoperative operation of the implant, disinfection using laser radiation or laser stimulation is performed to direct osteogenesis. 2. A dental implant that provides the possibility of disinfection or stimulation of osteogenesis using laser radiation, containing the intraosseous part in the form of a cylinder or cone with end rounding and a head made as a single unit of sapphire, the intraosseous part has a thread, at least part of the implant surface in contact with bone tissue, is polished or made with a porous surface layer, characterized in that along the entire length of the implant an extended internal channel is made, closed with on the side of the end curve.

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