RU2697229C1 - Method of lower jaw tissue osteoplasty with its atrophy - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to surgical dentistry, and can be used in osteoplasty of lower jaw at its atrophy. Oral cavity is sanitized, the type of the barrier membrane is selected, prepared in accordance with the size of the defect and fixed to the cortical layer above the defect with the help of pins. Pin securing points are pre-determined considering the future augmentation volume, but not less than 4 pints per 1 cm along the entire perimeter of the defect. At points of pins attachment decortication of dense cortical layer is performed at depth of 0.2–0.4 mm by means of ball-like boron with diameter of 0.2 mm. Barrier membrane is applied and a tactile determination of the location of the decorticated section is ensured by fixing the barrier membrane with the help of pins.EFFECT: method provides mandibular osteoplasty with its atrophy, reduced surgical complications, reduced operation time due to higher reliability of pin fixation in dense cortical bone of lower jaw.1 cl, 1 ex

Description

The present invention relates to medicine, namely to surgical dentistry and can be used in the surgical treatment of pathologies associated with atrophy of bone tissue of the lower jaw, as well as prophylaxis of bone failure.

The relevance of the development of the proposed method is dictated by the fact that in Russia a large part of the population, due to various reasons, needs therapeutic measures to eliminate the deficiency of bone tissue of the lower jaw. Loss or atrophy of bone tissue occurs for several reasons: as a result of inflammatory processes under the influence of pathogenic pathogens, as a result of injuries and mechanical damage to the gums, after tooth extraction, if prosthetics are not performed for a long time, as a result of prolonged wearing of poor-quality dentures, etc. . Extraction or natural tooth loss is the termination of the alveolar ridge, that is, the place of fixation of the root in the jaw bone. The bone without chewing load begins to gradually dissolve, and its atrophy occurs. Atrophy does not pose a threat to health, however, it causes aesthetic and physiological problems: a change in the shape of the face, premature wrinkles, lip sticking and impaired diction, malocclusion, eating problems, disruption of the entire digestive tract. These problems require correction, with which you can completely restore bone volume and lost jaw function. Dentures do not solve the problem with a decrease in bone mass, since the chewing load is distributed unevenly and falls mainly on the gums. With

over time, the bone decreases, a gap forms between the gingival margin and the prosthesis, which will require correction of the prosthesis. Bone atrophy is of particular importance when planning dental implantation. To implant the implant in the jaw, it is necessary that it has a sufficient volume of bone. For implantation to succeed, the implant must be completely immersed in the upper layer of the bone. To do this, before implantation of the titanium root for tooth restoration, bone grafting is also performed.

It is known from the prior art that osteoplasty in dentistry can be carried out in various ways, one of which is directed bone (tissue) regeneration (NTR) - the general name for operations when, with the help of various modern techniques, the mechanism of restoration, building and strengthening is “launched” bone tissue. In dental practice, operations related to bone regeneration are performed to improve periodontal disease (when bone deficiency threatens with tooth loss), when preparing for dental implants (when the amount and density of bone tissue does not guarantee a reliable implant placement), after removal of the cyst, etc. jaw tissue - augmentation - can be carried out using different materials. In each case, the doctor decides on the basis of studies of a particular patient. In most cases, NTR involves the installation of barrier membranes over the area of the defect of the lower jaw. The barrier membrane plays two roles, isolating and contouring. Barrier membranes are installed to preserve the volume of the jaw bone after tooth extraction, to fix the implants and protect them from mechanical damage, to reinforce the jaw bone during dental implantation, and to strengthen mobile teeth during periodontitis. Membranes come in two types of absorbable and non-absorbable. The selection of material is carried out in accordance with

the clinical case of the patient. The non-absorbable membrane is subsequently removed, and implants are implanted into the bone.

Installation of membranes during surgery can be done in several ways:

- the membrane is sewn to the periosteum (not suitable for titanium membranes);

- the membrane is fixed with small titanium screws or pins.

The membrane should not touch adjacent teeth, so as not to break the tight fit to the gum teeth. The success of the process of bone growth (thickening) is ensured by filling the space or cavity under the membrane with material that stimulates bone growth. It also prevents the membrane from falling into the cavity. Several possibilities have been developed for filling the cavity.

For the prototype of the present invention, a well-known method of lower jaw osteoplasty during its atrophy was selected, including oral sanitation, selection of the type of barrier membrane, its preparation in accordance with the size of the defect, and subsequent fixation to the cortical layer over the defect with the help of pins (DonosN, KostopoulosL, Karring T. Alveolarridgeaugmentationbycombiningautogenraft sandnon-resorbablemembranes. Clin Oral Implants Res. 2002 Apr; 13 (2): 185-91.

The known method is as follows.

Assess the general condition of the patient’s body, eliminate contraindications. Carry out the choice of the type of barrier membrane and its preparation in accordance with the size of the defect. Sanitation of the oral cavity is carried out. Under local anesthesia, a piece of gum is exfoliated along with the periosteum. Install the barrier membrane in such a way as to create an empty space under the membrane. Under the membrane lay granular biocomposite material or bone chips. The barrier membrane is fixed to the bone with pins using a pin holder and a hammer. The gingival flap is returned to the site and the wound is sutured.

During the operation of directed regeneration of bone tissue, one of the most important stages is the stage of fixation of the barrier membrane. The quality and speed of this particular stage determines the success of the entire operation as a whole. Unfortunately, the design feature of the pins is the thin part of the pin, which should be fixed in the cortical part of the body of the jaw. In the case of a pronounced cortical bone, which is most often found in the lower jaw, it is extremely difficult to establish a pin fixing membrane, and sometimes it is not at all possible due to a fracture of the pin fixing part or its deformation. Which, in turn, leads to a significant increase in the time of the operation, as a consequence, the possible infection of augmentate

Thus, the disadvantages of this method are injuries of the mucosa of the periosteal flap due to a broken pin, the occurrence of secondary complications and lengthening of the operation time in view of replacing a damaged pin.

The task of the invention is the creation of a method of bone grafting, which is devoid of the disadvantages of the prototype.

The technical result of the proposed method is to increase the reliability of pin fixation in the dense cortical bone of the lower jaw, reduce surgical complications, reduce the time of surgery and reduce the cost of the method.

The technical result is achieved by the fact that in the known method of osteoplasty of the lower jaw during its atrophy, including sanitation of the oral cavity, the choice of the type of barrier membrane, its preparation in accordance with the size of the defect and subsequent fixation to the cortical layer above the defect with the help of pins, the pin attachment points are previously determined taking into account the volume of the future augmentate, at least 4 pins per 1 centimeter around the entire perimeter of the defect, in the places of attachment of the pins, a dense cortical layer is decorticated to a depth of 0.2-0.4 mm with Strongly spherical boron of 0.2 mm diameter, is applied a barrier membrane and tactile location determining dekortizirovannogo barrier membrane fixed portion using pins.

The present invention meets the criteria of "novelty" and "inventive step", since when conducting patent information research, no sources of scientific and medical literature and patent documentation were found that would discredit the novelty of the method, as well as technical solutions with essential features of the proposed method.

The technical result of the proposed method is to increase the reliability of pin fixation in the dense cortical bone of the lower jaw, reduce surgical complications, reduce the time of surgery and reduce the cost of the method.

Preliminary calculation of the attachment sites of the membrane with pins, namely at least 4 pins per centimeter of the bioresorbable membrane, allows you to create the necessary sealing inside the membrane, prevent the membrane from touching adjacent teeth and prevent the membrane from falling into the cavity. The number of fixation points has been obtained empirically and allows you to position the barrier membrane as motionless as possible .

Pre-decortization of the dense cortical layer to a depth of 0.2-0.4 mm in the planned places for fixing the pins eliminates the breakage or deformation of the pins when they are fixed in a dense cortical layer of the lower jaw bone, reduce the time of the operation and economic losses on broken or deformed pins. Thus, the proposed method provides the conditions for effective directed tissue regeneration, reduces the time of surgery, the occurrence of surgical and postoperative complications, simplify the stage of membrane fixation, and reduce economic losses on broken and deformed pins.

The proposed method is as follows.

Sanitation of the oral cavity is carried out, the places of attachment of the pins, the type of barrier membrane and its preparation in accordance with the size of the defect, taking into account the volume of the future augmentate, but not less than 4 pins per 1 centimeter of the membrane, are selected. Any available instrument, such as a dental probe, mark this place. Then, a spherical boron with a diameter of 0.2 mm performs decortization of the dense cortical bone layer to a depth of 0.2-0.4 mm. A barrier membrane is applied to the defect and tactile determining the location of the de-corted area, the membrane is fixed using a pin.

An example of a specific implementation is given in the form of an extract from the medical history

Patient X. 1951 g p

Complaints of difficulty in chewing, cosmetic defect. During an objective examination and analysis of CBCT, the need for implantation in the 43 tooth region and the creation of directed bone tissue regeneration in the area of the proposed implantation is determined. There are no contraindications to the operation according to the general somatic state. After the oral cavity was sanitized, the type of Bio-Gide barrier membrane of 0.25 × 0.25 cm in size was selected. Under the infiltration anesthesia, an incision was made along the top of the alveolar ridge, and the mucoperiosteal flap was exfoliated. Formed bed under the dental implant. Determine the attachment point of the pins of the barrier membrane. Mark the pin attachment points. The implant is installed in the correct orthopedic position. Visualized 6 threads of the thread of the implant. The spherical boron with a diameter of 0.2 mm made a decortication of a dense cortical layer from the vestibular surface

0.4 mm deep. The barrier resorbable membrane is fixed apically tactile, defining areas of decortication, osteoplastic material is introduced in excess. The membrane is fixed coronally also taking into account areas of decortication. The flap is mobilized, laid in place, sutured.

Claims (1)

The method of osteoplasty of the lower jaw during its atrophy, including sanitation of the oral cavity, selection of the type of barrier membrane, its preparation in accordance with the size of the defect and subsequent fixation to the cortical layer over the defect with the help of pins, characterized in that the attachment points of the pins are preliminarily determined taking into account the volume of the future augmentate, but not less than 4 pins per 1 centimeter around the entire perimeter of the defect, in the places of attachment of the pins, a dense cortical layer is decorticated to a depth of 0.2-0.4 mm using a spherical boron with a diameter of 0, 2 mm, impose a barrier membrane and, tactfully determining the location of the decorticated area, fix the barrier membrane using pins.