RU2702141C1 - Device for local anesthesia and eliminating its possible complications during oral surgery (versions) and a method for local anesthesia and eliminating possible complications thereof when performing a surgical intervention in the oral cavity - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions refers to medicine and is intended for use in dentistry, namely in conductive anesthesia of the mandibular nerve. First object of the invention is a device which is a three-dimensional stereolithographic model made using individual 3D computer simulation, including a guide part with a straight end-to-end channel for a needle and a device rigidly fixed to the guide part for fixation of the guide part in the oral cavity, wherein longitudinal axis of rectilinear through channel for guide part needle is oriented so that it passes on required for anesthesia distance from location of nerve, giving pain sensitivity of place to be operated. Another object of the invention is a version of the device, which is a three-dimensional stereolithography model made using individual 3D computer modeling, characterized in that the straight through channel for the needle is made in a device for fixing the guide member in the oral cavity, acting as a guide part with a straight end-to-end channel for a needle, the longitudinal axis of which is oriented so that it passes on the required for anesthesia distance from the location of the nerve, which gives the pain sensitivity of the place. Third object of the invention is a method involving the following sequence of actions: a) diagnosing a patient; b) performing computed tomography of part of jaw of patient with place of operation and location of nerve, providing pain sensitivity of place subject to surgical intervention; c) three-dimensional stereolithographic model of detachable device is made by means of individual computer 3D-modeling in the form of one of devices of device; d) stereolithographic three-dimensional model with fixation device in oral cavity on tooth is installed and fixed? or template for implants, or tray; e) introducing a needle with an anesthetic and/or another required drug into the rectilinear through channel for the stereolithography model of the removable agent; e) perform required operation.

EFFECT: higher accuracy of anesthesia with minimal injuries and possible complications of surgical intervention.

30 cl, 18 dwg, 3 ex

Description

A device for conducting local anesthesia and eliminating its possible complications during surgical intervention in the oral cavity (options) and a method for conducting local anesthesia and eliminating possible complications during surgical intervention in the oral cavity.

The invention relates to medicine, namely to dentistry, and can be used, for example, when conducting conduction anesthesia of the mandibular nerve.

Note: conduction anesthesia is a reversible blockade of transmission of a nerve impulse along a large nerve trunk (nerve, plexus, nodule) by introducing a solution of local anesthetic into the paraneural space.

Local injection anesthesia is the main type of anesthesia in outpatient dentistry.

Local anesthesia in outpatient practice is indicated for all dental interventions, not only surgical, but also therapeutic, as well as orthopedic

(Stosh V.I., Rabinovich S.A., Zoryan E.V. Guidelines for anesthesiology and emergency care in dentistry, - M ,: MED press-inform, 2002. - p. 8.).

There is a method of anesthesia of the mandibular nerve according to Weisbram / 1924 / (Handbook of Dentistry, edited by V. Bezrukov, Moscow, "Medicine", 1998, pp. 35-38).

Weisbram torus anesthesia simultaneously turns off the lower pit, lingual and buccal nerves. A syringe with a needle is placed at the level of the second or third lower molar on the side opposite to anesthesia. The needle is injected into the region of the groove located laterally of the pterygo-mandibular fold, 0.5 cm below the chewing surface of the upper molars. The needle is advanced all the way to the bone, where 2 ml of anesthetic solution is released, and when removing the needle for blockade of the buccal nerve - another 1 ml. Anesthesia occurs in 10-15 minutes.

The disadvantages of the method:

1. It is not guaranteed that the injection needle will hit the right place, for example, at the entry of the mandibular nerve into the mandibular canal;

2. Anesthesia is achieved by increasing the volume of the anesthetic;

3. Requires a wide opening of the mouth, which is not always possible due to the development of the inflammatory process / development of contractures /.

There is another method proposed by Go Gates / 1973 / (Rabinovich SA, Moskovets ON, The riddle of the effectiveness of local anesthesia of the mandibular nerve according to Go Gates, Clinical Dentistry No. 3 for 1999).

A known specified method is as follows.

Ask the patient to open his mouth wide. Taking the syringe in the right hand, place it in the corner of the mouth, opposite the side of the injection. The needle is directed into the pterygo-maxillary space, medial to the tendon of the temporal muscle. A mucosal puncture is made and the needle is advanced slowly until it stops into the bone, the lateral part of the condylar process. The depth of advancement of the needle is an average of 25 mm. Then 1.7-1.8 ml of solution / 1 capsule / is slowly introduced. After administration of the anesthetic solution, the needle is slowly removed from the tissues. Anesthesia of the buccal nerve is performed. The patient is asked not to close his mouth for another 2-3 minutes so that the local anesthetic solution saturates the surrounding tissue.

The disadvantages of the method:

1. After anesthesia, the patient is asked not to close his mouth for another 2-3 minutes to compensate for the possible inaccuracy of the needle due to the mechanical displacement of the anesthetic solution inside the tissue;

2. Inaccuracy of ingestion is partially offset by an increase in the amount of anesthetic administered.

From RU 2294769, C1, 03/10/2007, a method of local anesthesia of the mandibular nerve is known, which can be used when performing conduction anesthesia of the mandibular nerve.

According to this method, the patient is asked to open his mouth, after which the doctor identifies the temporomandibular joint (TMJ) with the index finger of the left hand. Then determine the target point, stepping down from the TMJ along the branches of the lower jaw by 30 mm, and move the index finger there. The needle is injected in the middle of the lateral part of the pterygo-maxillary fold and, directing it to the tip of the index finger, push it all the way into the bone, followed by the administration of 0.5-0.8 ml of anesthetic. After this, anesthesia of the buccal nerve is performed.

EFFECT: method enables rapid adequate anesthesia of the mandibular nerve through the use of small volumes of anesthetics due to the presence of clear extra- and intraoral landmarks that do not depend on the degree of opening of the mouth.

The disadvantages of the method:

It is not guaranteed that the injection needle will hit the right place, for example, at the entry of the mandibular nerve into the mandibular canal.

From RU 2422165, C1, 06/27/2011, a method for intraosseous anesthesia of teeth on the lower and upper jaw is known.

In accordance with it, volumetric dental tomography is first performed. The axial projection images determine the dimensions of the interroot space, the anesthetized zone at two levels: in the area of the upper part of the interdental septum, the area (S1) limited by the roots of adjacent teeth and a compact plate of the jaw body is determined, and in the area of the interroot space at the level of the root tips, the area (S2), limited by the roots of adjacent teeth and the cortical plate of the body of the jaw. In images in a direct projection, determine the height from the upper part of the interdental septum to the apex of the tooth root (H). Then determine the volume (V) of bone tissue in the anesthetized area according to the formula

The amount of drug administered is calculated by dividing the resulting bone volume into two.

The method allows to determine the volume of injected anesthetic solution for intraosseous anesthesia, taking into account individual anatomical features and the desired area of anesthesia, but is not used when administering the drug exactly to the nerve region, i.e. when performing conduction anesthesia, for example, the mandibular nerve.

A known anatomical method of pain relief, in which the doctor evaluates the anatomical landmarks on the face and mouth of the patient (eyes, folds, nose, teeth, etc.). After that, the doctor, in accordance with the established rules for conducting anesthesia (in particular, according to the anatomical atlas where the nerves go), often makes a vaping injection of the drug into the region of the interested nerve, where the operation will be performed so that the patient does not feel pain (see Robustova T. G. Surgical dentistry, M., 2003).

A device for anesthesia of the lower jaw in the form of a syringe with a needle (Bazhanov NN and others. Anesthesia in outpatient dental practice. M., "Medicine", 1979, S. 5.)

However, when using a syringe to turn off the lower pit and lingual nerves, an anesthetic solution may be mistakenly injected into the muscles adjacent to it, not into the pterygo-maxillary space. This reduces the effectiveness of anesthesia and causes a number of complications associated with muscle injury (trismus develops), blood vessels (hematomas form), etc., which sometimes requires long-term additional treatment.

Widely known, for example, traditional methods of conducting mandibular anesthesia, include the introduction of an anesthetic solution to the location of the lower alveolar nerve and provide for the use of an injection syringe containing a housing, a piston with a rod placed inside it, and a hollow needle made in the form of a metal tube with an oblique cut at the working end, which is connected via a cannula to a syringe.

There are many options for needles. In 1911, Guido Fischer proposed a cannula for performing mandibular anesthesia. Since then, the needles have been continuously improved [P.Yu. Stolyarenko, History of the creation of novocaine, - S. 32, 2006].

Mandibular anesthesia with a syringe. For injection, carry out as follows.

The index finger is fixed in the retromolar fossa. The syringe is placed on the opposite side, the needle injection is performed at the level of the middle of the phalanx of the finger. The needle is then advanced to a depth of about 6 mm until it contacts the bone, then about 6 mm further to bypass the temporal scallop and a small amount of anesthetic is released. After that, the needle is moved to its original position and advanced by 10-15 mm to contact with the bone.

The specified method of conducting mandibular anesthesia using an injection syringe is widely used throughout the world.

However, the use of a straight needle during mandibular anesthesia is associated with a high risk of damage to the tendon of the temporal muscle, internal pterygoid muscle, and lower alveolar neurovascular bundle. Quite often, due to an incorrect determination of the needle injection site and its insertion from the pterygo-maxillary fold, the patient has a feeling of numbness in the soft tissues of the pharynx. When deviating from a given trajectory of movement, a straight needle damages the medial pterygoid muscle, injures the vessels, which can lead to necrosis of the muscle area in the anesthesia zone and the opening of the mouth (post-infection contracture), which requires prolonged treatment, sometimes surgical intervention. There is also the appearance of zones of ischemia of the skin due to the vasoconstrictor action of the solution, which fell into the lumen of the vessel, capturing almost the entire half of the face, diplopia. Frequent complications are the occurrence of subsequent pain and a decrease in sensitivity to the branching area of the lower alveolar nerve. Sometimes paresis of the facial nerve is observed (A.I. Evdokimov, G.A. Vasiliev, Surgical dentistry, - P. 41-42., 1964).

From RU 68279, U1, 11.27.2007, a needle for a syringe for a mandibular anesthesia is known.

The needle contains a metal tube with a central channel having a bevel on the working end and a pointed piercing part, as well as a fastening element to the syringe, characterized in that the needle is curved in a horizontal plane from the cannula to the tip, the bending angle is 150-160 °, and the ratio the length of the needle to the height of the arc is 0.4-0.5: 3.5, while the bevel is made on the concave side of the working end of the needle.

When performing mandibular anesthesia with the proposed needle, trauma and the risk of tissue damage in the area of anesthesia are significantly reduced, which can prevent serious complications. The procedure for conducting anesthesia for a doctor is simplified, ensuring its comfort for the patient: on the first attempt, a positive analgesia effect can be achieved. Significantly increases the effectiveness of the anesthesia, which is expressed in accelerating the achievement of a more pronounced analgesic effect.

The disadvantages of the method:

It is not guaranteed that the injection needle will hit the right place, for example, at the entry of the mandibular nerve into the mandibular canal;

From SU 984480, 01/04/1983, there is known a device for lower jaw anesthesia, which provides a more accurate entry of the syringe needle into the pterygo-maxillary space.

The device contains a syringe and is equipped with a rod with a L-shaped working part with a handle and a jaw having a guide and a clamp of the syringe, and the rod is pivotally connected to the jaw.

Anesthesia is performed as follows.

By measuring the width and height (the distance between the front and rear edges of the branch and between the lower edge of the zygomatic arch and the lower edge of the lower jaw) to determine the center of the branch of the lower jaw, two mutually perpendicular lines drawn through this center divide the branch into 4 quadrants. In the front-lower corner of the posterior upper quadrant of the branch, corresponding to the location of the upper edge of the mandibular opening, the working part of the rod is installed, holding the handle in this position with the left hand. A syringe with a needle attached to the spring clip is inserted into the mouth. The needle is injected into the intermuscular triangle and advanced to the site of the bone located at the upper edge of the mandibular opening. In the direction of advancement of the needle, a 3.0 mm 2%; - solution of trimecaine with 1/2 drop of a 0.1% solution of adrenaline is injected at the mandibular opening. After 2 minutes the lower hole is turned off and after 3 minutes. - lingual nerves. The tooth extraction operation takes place without pain.

The use of this device allows you to advance the needle in a strictly specified direction to the nerve trunks to be turned off, which increases the efficiency of the method of conduction anesthesia of the lower jaw, reduces the number of complications, and reduces the time of onset of anesthesia to 3-5 minutes. instead of 15-20 minutes with conventional methods of mandibular anesthesia.

However, the whole process for lower jaw anesthesia using the above device does not provide the most accurate tip of the necessary medication to the exact area of the nerve, since it does not fully evaluate the anatomical landmarks (features) on the patient's face and mouth.

A common disadvantage of all of the above known methods is the lack of accuracy of the tip of the needle in the desired area.

The importance of accuracy during anesthesia, especially conduction (a feature of conduction anesthesia is that it is done in the region of the large nerve) and especially in the region of the lower jaw, caused by the following.

It is not known reliably where the nerve of interest to the doctor is located, since the anatomy of its location is not reliable and the location of not only the nerve, but also the large blood vessel passing nearby is not known. As a result, the anesthetic from the tip of the needle may not enter the nerve, but into the blood stream to the brain (if the needle entered the artery) or to the heart (if the tip of the needle hits the vein). This in turn can lead to complications from these organs (heart attack if the anesthetic has entered the heart, or stroke if the anesthetic has entered the brain).

For these reasons, accurate anesthesia with minimal trauma during anesthesia of the teeth of the lower jaw is one of the urgent problems of outpatient dentistry, since most dental interventions are accompanied by pain of one degree or another.

The technical task of the claimed group of inventions is to increase the accuracy of anesthesia with minimal trauma during anesthesia of the teeth of the lower jaw, to improve the quality of local anesthesia of the mandibular nerve with the introduction of anesthetic (anesthetic), while eliminating possible unwanted (negative) complications during surgery in the patient's oral cavity.

In accordance with the technical task set, the technical result achieved by the claimed group of inventions is to ensure that the tip of the necessary medicine reaches the needle as accurately as possible by more accurately determining the target point and point of administration of the drug (anesthetic) during local anesthesia of the mandibular nerve and thereby prevent ingress anesthetic from the tip of the needle is not in the nerve, but in the blood stream to the brain (if the needle hit the artery) or to the heart (if the tip needle into a vein) and to prevent the complications of these organs (heart attack, if the anesthetic was in the heart or a stroke if the anesthetic was in the brain).

The technical task and technical result achieved are achieved by the claimed group of inventions, in which:

- as one invention, a device for conducting local anesthesia and / or eliminating possible complications during anesthesia during surgery in the oral cavity is included (two options),

- and as another invention, a method of conducting local anesthesia and / or eliminating undesirable complications during anesthesia and a device for its implementation.

Consider each of the inventions separately.

The first object of the claimed invention is a device for conducting local anesthesia and eliminating its possible complications during surgical intervention in the oral cavity, which is a three-dimensional stereolithographic model made using individual computer 3D modeling, including a guide part with a straight through channel for the needle and rigidly fixed with a guide part a device for fixing the guide part in the oral cavity, the longitudinal axis being the straight through channel for the needle of the guide part is oriented so that it passes at the distance required for numbing from the location of the nerve, which gives pain sensitivity to the place to be operated on.

This set of common essential features is the essence of the claimed invention to the device. It is necessary and sufficient in all cases of its implementation.

This technical solution has the following advantage compared to the prototype: the most accurate hit with the needle tip of the required drug is ensured due to a more accurate determination of the target point and point of administration of the drug (anesthetic) during local anesthesia of the mandibular nerve, as well as another necessary drug with such surgical interventions in the oral cavity.

In addition, in relation to the claimed device, it is necessary to highlight the following development and / or refinement of its essential features related to particular cases of implementation or use.

It is desirable that the longitudinal axis of the straight through channel for the needle of the guide piece be oriented so that it intersects the fixture for fixation in the oral cavity.

This modification is most applicable in the case when it is necessary to insert the needle directly near the device for fixing the guide part, for example, attaching it to the last teeth of the lower jaw (6-7 teeth) (i.e. at the end of the lower jaw). This happens, for example, in the case when 6-7 molars are present and it is necessary to attach the device directly to them close to the required point of injection of the needle tip.

In addition, this modification is most applicable with good opening of the mouth.

The device for fixing in the oral cavity is made with the possibility of removable connection directly with the tooth. For example, for this, the device for fixation in the oral cavity can be a part with a cavity, the surface of which repeats at least part of the lateral surface of the tooth with the possibility of tight coverage.

To increase the reliability of the temporary connection, the device can be equipped with means for additional fixation on the tooth, which is, for example, an adhesive layer formed on the edge of the device for fixing the guide part in the oral cavity. This layer can be formed in various ways, for example, by external spraying or extrusion of a sticky substance, in particular, external spraying of a sticky spray or extruding an adhesive substance from a tube.

In some cases, the device for fixation in the oral cavity can be rigidly connected to the template for the installation of implants, intended for fixing in the oral cavity. Such a technical solution is advisable to use in the case of implant placement.

In addition, the device for fixing in the oral cavity can be rigidly connected to the mouth guard. Such a technical solution is preferably used in the case of the presence of all teeth and the need for any surgical intervention.

In addition to the above modification of the claimed device, when the longitudinal axis of the rectilinear through channel for the needle of the guide part is oriented so that it intersects the fixture in the oral cavity, the second modification of the claimed device is also possible when the longitudinal axis of the straight through channel for the needle of the guide part is oriented so that does not cross the device for fixation in the oral cavity, and the guide part itself is a spatial body rigidly connected to the osobleniem for fixing the guide part in the oral cavity.

This modification is most applicable in the case when the last teeth (6-7 molars) are absent and it is necessary to attach the device relatively far from the point of injection of the needle tip, and not close, for example, it is necessary to fix on 4-5 teeth.

In addition, such a modification is most applicable for poor mouth opening, when the device cannot be installed deep in the mouth close to the desired injection site. In this case, the needle should be long.

The device for fixing in the oral cavity can also be made with the possibility of removable connection directly with the tooth. For example, for this, the device for fixation in the oral cavity can be a part with a cavity, the surface of which repeats at least part of the lateral surface of the tooth with the possibility of tight coverage.

To increase the reliability of the temporary connection, the device, and with this modification, can be equipped with means for additional fixation on the tooth, which is, for example, an adhesive layer formed on the edge of the device for fixing the guide part in the oral cavity. This layer can be formed in various ways, for example, by external spraying or extrusion of a sticky substance, in particular by spraying a sticky spray or squeezing an adhesive substance from a tube. Examples of adhesives are, in particular, "protefix", "hazel", etc.

In some cases, the device for fixation in the oral cavity of this second modification can also be rigidly connected to a template for installing implants designed to be fixed in the oral cavity. Such a technical solution is advisable to use in the case of implant placement.

In addition, the device for fixing in the oral cavity can be rigidly connected to the mouth guard. Such a technical solution is preferably used in the case of the presence of all teeth and the need for any surgical intervention.

It is desirable that the longitudinal axis of the straight through channel for the needle be oriented in a three-dimensional stereolithographic model so that it passes at a distance of not more than 5 mm from the location of the nerve, giving pain sensitivity to the place that will be operated on, for example, at a distance of 1 or 2 mm, or 5 mm. The distance is determined on the basis of not reliably getting into the artery or vein, taking into account, for example, the accuracy of the outer diameter of the needle and the inner diameter of the rectilinear through channel.

This is necessary to ensure reliable analgesia in individual cases of the location of the nerve.

On the other hand, the claimed invention has a variant of the claimed device for conducting local anesthesia and eliminating its possible complications during surgical intervention in the oral cavity, which is a three-dimensional stereolithographic model made using individual computer 3D modeling, characterized in that the straight through channel for the needle made in the device for fixing the guide part in the oral cavity, performing the function of the guide part with a straight kvoznym channel for the needle, the longitudinal axis of which is oriented so as to extend at a desired distance from the anaesthetization finding seats nerve, pain sensitivity authorizing place.

This set of common essential features is the essence of a variant of the claimed invention. It is necessary and sufficient in all cases of the implementation of this option.

Such a technical solution has the following advantages compared to the prototype: the most accurate hit of the necessary drug by the tip of the needle is achieved due to a more accurate determination of the target point and point of administration of the drug (anesthetic) during local anesthesia of the mandibular nerve.

In addition, the device according to the variant has the following additional advantage: the presence of a straight through channel for the needle directly inside the device for fixing the guide part in the oral cavity reduces the volume of the device in the oral cavity, which is especially convenient if the mouth is small. In addition, it is safer because it has fewer protruding parts and angles.

In addition, in relation to the claimed option, the applicant considers it necessary to highlight the following development and / or clarification of the set of its essential features relating to particular cases of implementation or use.

The fixture for fixing according to this embodiment can be made with the possibility of removable connection with the tooth, in particular, while the fixture for fixing in the oral cavity can be a part with a cavity, the surface of which repeats the surface of the tooth with the possibility of its tight coverage, in particular, by 6 -7 tooth.

In addition, this device for fixation in the oral cavity according to this option can be rigidly connected to the template for the installation of implants designed to be fixed in the oral cavity or rigidly connected to the mouth guard.

It is preferable that the longitudinal axis of the straight through channel for the needle be oriented in a three-dimensional stereolithographic model so that it passes at a distance of not more than 5 mm from the location of the nerve, giving the pain sensitivity of the place that will be operated on, for example, at a distance of 1 or 2 mm, or 5 mm. The distance is determined on the basis of not reliably getting into the artery or vein, taking into account, for example, the accuracy of the outer diameter of the needle and the inner diameter of the rectilinear through channel.

This is necessary to ensure reliable analgesia in individual cases of the location of the nerve.

To increase the reliability of the temporary connection, the device according to the above described embodiment may be equipped with means for additional fixation on the tooth, which is, for example, an adhesive layer formed on the edge of the device for fixing the guide part in the oral cavity. This layer can be formed in various ways, for example, by external spraying or extrusion of a sticky substance, in particular by spraying a sticky spray or squeezing an adhesive substance from a tube.

In addition to the above described variants of the devices of the claimed invention, the claimed technical solution also relates to a method for conducting local anesthesia and simultaneously eliminating its possible complications during surgical intervention in the oral cavity, including the following sequence of actions:

a) establish the diagnosis of the patient;

b) conduct computed tomography of part of the jaw of the patient with the location of the operation and the location of the nerve, giving pain sensitivity of the place to be operated on;

c) make using an individual computer 3D - modeling a three-dimensional stereolithographic model of a removable tool in the form of a device according to one of claims 1-28;

d) install and fix a stereolithographic three-dimensional model with a device for fixing in the oral cavity on a tooth or a template for implants, or kappa;

e) a needle with an anesthetic and other necessary medication is injected into a straight through channel for a needle of a stereolithographic model of a removable product, for example, an anesthetic antagonist used for surgical interventions in the oral cavity is injected;

e) carry out the necessary operations.

Examples of anesthetic drugs: articaine, bupivacaine, mepivacaine, lidocaine, novocaine, trimecaine, benzocaine, dicaine, anestezin.

An example of an anesthetic antagonist drug is phentolamine mesylate.

This set of common essential features is the essence of the claimed invention to the method. It is necessary and sufficient in all cases of its implementation.

Such a technical solution has the following advantages compared to the prototype: the most accurate hit of the necessary drug by the tip of the needle is achieved due to a more accurate determination of the target point and point of administration of the drug (anesthetic) during local anesthesia of the mandibular nerve.

When implementing the method of local anesthesia and eliminating possible undesirable consequences when carrying out it and performing surgical intervention in the oral cavity, anesthetic is used, for example, anesthetic ultracain 1: 200000, an anesthetic solution of Septanesta 1/100000 and others known for this goals of anesthetics, as well as well-known antagonists of anesthetics and other drugs traditionally used in dentistry during surgical interventions in olosti mouth.

These drugs (anesthetics, antagonists of anesthetics, and other necessary drugs) are administered in various quantities, for example 0.5-0.8 ml of anesthetic, which is determined both by the age of the patient and the nature of the surgical intervention in the oral cavity.

When implementing the inventive method using the described device, which is one of the inventions of the claimed group of inventions, united by a single general inventive concept, the most accurate hit of the necessary drug by the tip of the needle is achieved by providing a more accurate determination of the target point and point of drug administration.

Treatment takes place without impairing the overall well-being of the patient.

In all cases, the depth and time of the analgesic effect was sufficient for the implementation of therapeutic procedures during surgical intervention in the patient's oral cavity.

An important advantage of the claimed inventions is also that the devices can be manufactured on technological equipment already used in the medical industry. The method of conducting local anesthesia and eliminating its possible complications during surgery in the oral cavity, based on the use of the above-mentioned devices, also does not require special tools or devices.

The invention is illustrated in the drawing.

In FIG. 1 shows the first version of the claimed device for performing local anesthesia and eliminating its possible complications during surgical intervention in the oral cavity, namely, the first modification of the first version is shown, according to which the longitudinal axis of the straight through channel for the needle of the guide part is oriented so that it crosses the fixation device in the oral cavity, axonometry;

In FIG. 2 - the same when the device for fixing in the oral cavity is made with the possibility of removable connection with the tooth, the cross section;

In FIG. 3 - the same top view (the sticky layer is not shown, the external contour of the tooth is shown by a dashed line);

In FIG. 4 - the same, axonometry;

In FIG. 5 shows the first modification of the first embodiment of the claimed device (according to which the longitudinal axis of the straight through channel for the needle of the guide part is oriented so that it intersects the device for fixation in the oral cavity), the feature of which is that the device for fixing in the oral cavity is rigidly connected to the template for the installation of implants intended for fixation in the oral cavity, axonometry;

In FIG. 6 is the same cross-section (schematic view);

In FIG. 7 - the same when the device is installed on the lower jaw, axonometry;

In FIG. 8 shows a modification of the first embodiment (according to which the longitudinal axis of the straight through channel for the needle of the guide part is oriented so that it intersects the device for fixing in the oral cavity), the feature of which is that the device for fixing in the oral cavity is rigidly connected to the mouth guard;

In FIG. 9 shows the first variant of the claimed device for local anesthesia and its possible complications during surgical intervention in the oral cavity, namely, another (second) modification of the first variant is shown, according to which the longitudinal axis of the straight through channel for the needle of the guide part is oriented so that crosses the device for fixation in the oral cavity, and the guide piece itself is a spatial body, rigidly fixed to the surface of the device for fixing the guide part in the oral cavity, axonometry;

In FIG. 10 is the same, cross section;

In FIG. 11 - the same when the device for fixation in the oral cavity is made with the possibility of removable fixation on the tooth, the cross section;

In FIG. 12 shows a second modification of the first embodiment of the invention (according to which the longitudinal axis of the straight through channel for the needle of the guide piece is oriented so that it does not intersect the device for fixation in the oral cavity), the feature of which is that the device for fixing in the oral cavity is rigidly connected to a template for implant placement intended for fixation in the oral cavity, axonometry;

In FIG. 13 shows a second modification of the first embodiment of the invention (according to which the longitudinal axis of the straight through channel for the needle of the guide part is oriented so that it does not intersect the device for fixing in the oral cavity), the feature of which is that the device for fixing in the oral cavity is rigidly connected to the mouthguard (axonometry);

In FIG. 14 shows a second variant of the claimed device for local anesthesia and its possible complications during surgical intervention in the oral cavity, according to which the straight through channel for the needle is made in the device for fixing the guide part in the oral cavity, which serves as a guide part with a straight through channel for needles, the longitudinal axis of which is oriented so that it passes at the distance required for pain relief from the location of the nerve giving the pain site sensitivity, cross section;

In FIG. 15 is the same when the device for fixing in the oral cavity is made with the possibility of removable connection with the tooth, the cross section;

In FIG. 16 - the same, axonometry;

In FIG. 17 shows the same second variant of the claimed device, the feature of which is that the device for fixation in the oral cavity is rigidly connected to a template for installing implants designed to be fixed in the oral cavity, a cross section;

In FIG. 18 shows the same second variant of the claimed device, the feature of which is that the device for fixing in the oral cavity is rigidly connected to the mouth guard.

In FIG. 19 shows the same second variant of the claimed device, the feature of which is that the device for fixing in the oral cavity is rigidly connected to the mouth guard.

As noted above, the invention is illustrated by examples of variants of the claimed device and method for conducting local anesthesia and / or eliminating its possible complications during surgical intervention in the oral cavity.

In FIG. 1 shows a device for conducting local anesthesia and eliminating its possible complications during surgical intervention in the oral cavity, which is a three-dimensional stereolithographic model 1 made using individual computer 3D modeling, including a guiding part 2 with a straight through channel 3 for a drug needle and device 4, rigidly fixed to the guide part, for fixing the guide part in the oral cavity, the longitudinal axis 5 being rectilinear th channel 3 through the guide piece 2 is oriented so as to extend at a desired distance from the anaesthetization finding seats nerve, pain sensitivity authorizing location to be operated on.

A feature of this design is that the longitudinal axis 5 of the straight through channel 3 for the needle of the guide part 2 is oriented so that it intersects the device 4 for fixing the guide part in the oral cavity.

This is the first modification of the first option, according to which, as noted in the previous paragraph of the description, the longitudinal axis of the straight through channel for the needle of the guide part is oriented so that it intersects the device for fixation in the oral cavity.

This first modification of the first option is most applicable in the case when it is necessary to insert a needle directly near the device 4 for fixing the guide part 2, for example, attaching it to the last teeth of the lower jaw (6-7 teeth) (i.e. at the end of the lower jaw). This happens, for example, in the case when 6-7 molars are present and it is necessary to attach the device directly to them close to the required point of injection of the needle tip. In addition, this modification is most applicable with good opening of the mouth.

In this case, the device 4 for fixation in the oral cavity is made with the possibility of removable connection directly with the tooth 6 (Fig. 2 - Fig. 4). For example, for this, the device 4 for fixing in the oral cavity can be a part 7 with a cavity 8, the surface of which 9 repeats at least part of the side surface 10 of the tooth 6 with the possibility of tight coverage. A tight grip is necessary to prevent accidental displacement of the fixture for fixing 4 of the guide part, and thereby to ensure that the tip of the needle hits the intended place accurately.

To increase the reliability of the temporary connection, the device can be equipped with means for additional fixation on the tooth, which is, for example, an adhesive layer 11 formed on the edge of the device 4 for fixing the guide part in the oral cavity. This layer can be formed in various ways, for example, by external spraying or extrusion of a sticky substance, in particular, external spraying of a sticky spray or extruding an adhesive substance from a tube. Easily destructible adhesives harmless to humans, for example, “protefix”, “hazel”, etc., can be used as an adhesive substance.

It is desirable that the longitudinal axis 5 of the straight through channel 3 for the needle be oriented in three-dimensional stereolithographic model 1 so that it passes at a distance of not more than 5 mm from the location of the nerve, giving pain sensitivity to the place that will be operated on, for example, at a distance of 1 or 2 mm, or 5 mm. The distance is determined on the basis of not reliably getting into the artery or vein, taking into account, for example, the accuracy of the outer diameter of the needle and the inner diameter of the rectilinear through channel. This is necessary to ensure reliable analgesia in individual cases of the location of the nerve.

The claimed device 4 for fixing the guide part 2, equipped with a straight through channel 3, can be made in conjunction with the template 13 for the installation of implants, designed to be fixed in the oral cavity on the jaw 14 (Fig. 5 - Fig. 7). Such a technical solution is advisable to use in the case of implant placement.

In addition, the claimed device 4 for fixing the guide part 2 provided with a straight through channel 3 can be made integral with the mouthguard 15 (Fig. 8). Such a technical solution is preferably used in the case of the presence of all teeth and the need for any surgical intervention.

Below is a detailed description of the implementation of the claimed invention, for example, the installation on the tooth of the device for fixing the guide part in the oral cavity (Fig. 2 - Fig. 4).

All patients who are referred for planned operations in the oral cavity (implantation, bone grafting, complex tooth extractions) undergo a preliminary computed tomography procedure. Based on the results of computed tomography, you can clearly determine the location of all the nerves of interest. After that, on the basis of the constructed three-dimensional model of the jaw, it is possible to make a three-dimensional stereolithographic model 1 using individual computer 3D modeling, including a guiding part 2 with a straight through channel 3 for the needle and a device 4 for fixing the guiding part in the oral cavity rigidly fixed with the guiding part, and the longitudinal axis 5 of the straight through channel 3 for the needle of the guide part is oriented so that it passes at the distance required for pain relief from ozhdeniya nerve pain sensitivity giving space to be operated, that is, create a custom navigator for anesthetic needle.

Let us explain this with a concrete example.

1. The patient comes.

2. The doctor makes a diagnosis, for example, secondary adentia (absence of one or more teeth).

3. The patient undergoes computed tomography of the jaw of the site of the operation and the location of the nerve, which gives pain sensitivity, the place that will be operated on.

4. Based on computed tomography, a removable three-dimensional stereolithographic model 1 is made with a straight through channel 3 for introducing a needle for introducing, for example, anesthetic, and during computed tomography it was decided that this three-dimensional stereolithographic model 1 should be installed on a separate tooth. In this case, the longitudinal axis of the straight through channel 3 for the needle is oriented so that it passes at a distance not exceeding 5 mm from the location of the nerve, which gives pain sensitivity, the place that will be operated on.

5. After that, the manufactured stereolithographic model 1 is taken and its device 4 for fixing the guide part in the oral cavity is fixed on the tooth, for example, as shown in FIG. 2. For this, the oral fixation device 4 is “put on” on top of the tooth 6, so that the wall of the cavity 8 fits tightly on the side surface 10 of the tooth 6. A tight grip can be achieved by pressing from above on the fixation device 4, “acquired” "Previously on top of the tooth. If the fixture 4 for fixing is made of elastic material, then a tight grip can be achieved, for example, by making the cavity 8 of the fixture 4 for grip a little smaller than the lateral surface of the tooth in cross section. In this case, when "dressing" the device 4 on the tooth 6, the cavity 8 expands somewhat and its walls tightly cover the tooth.

6. To increase the reliability of the temporary connection, the device can be equipped with means for additional fixation on the tooth, which is, for example, an adhesive layer 11 formed on the edge 12 of the device 4 for fixing the guide part in the oral cavity. This layer can be formed by various methods, for example, by external spraying or extrusion of a sticky substance, in particular, external spraying of a sticky spray or by extruding fingers of an adhesive substance from a tube.

7. Then, a syringe needle is inserted into the straight through channel 3 and the drug is administered from it.

8. Remove the syringe needle from the straight through channel 3.

9. By clicking on the guide part, the adhesive layer 11 is destroyed and the three-dimensional stereolithographic model 1 is removed from the oral cavity.

Next, consider the second modification of the first embodiment of the claimed device (Fig. 9 - Fig. 13).

In FIG. 9 shows a device for conducting local anesthesia and eliminating its possible complications during surgical intervention in the oral cavity, which is a three-dimensional stereolithographic model 15 made using individual computer 3D modeling, including a guiding part 16 with a straight through channel 17 for a drug needle and a device 18 rigidly fixed to the guide part for fixing the guide part in the oral cavity, the longitudinal axis 19 of the rectangle of the through channel 17 of the guide part 16 is oriented so that it passes at the distance required for numbing from the location of the nerve, which gives pain sensitivity to the place to be operated on.

A feature of the second modification of the first variant is that the longitudinal axis 19 of the straight through channel 17 for the needle of the guide part 16 is oriented so that it does not intersect the device 18 for fixing the guide part in the oral cavity, and the guide part 16 itself is a spatial body 20 rigidly connected with the outer surface 21 of the device 18 for fixing the guide part in the oral cavity (by a rigid connection here it is understood that the spatial body 20 is molded integrally with the device 18 for fixing the guide piece. This connection is a result of manufacturing model, when the guide piece 16 and the fixture 18 for fixing the guide piece created simultaneously on the basis of computed tomography in the process of manufacturing a removable three-dimensional stereolithographic model.

This modification is most applicable in the case when the last teeth (6-7 molars) are absent and it is necessary to attach the device relatively far from the point of injection of the needle tip, and not close, for example, it is necessary to fix on 4-5 teeth.

In addition, such a modification is most applicable for poor mouth opening, when the device cannot be installed deep in the oral cavity close to the desired injection site. In this case, the needle should be long.

Moreover, the device 18 for fixing the guide part in the oral cavity is made with the possibility of removable connection directly with the tooth 22 (Fig. 10 and Fig. 11). For example, for this, the device 18 for fixing the guide part in the oral cavity may be a part 23 with a cavity 24, the surface of which 25 repeats at least part of the side surface 26 of the tooth 22 with a tight fit. A tight grip is necessary to prevent accidental displacement of the fixture for fixing 18 of the guide part and thereby to ensure that the tip of the needle hits the intended place accurately.

To increase the reliability of the temporary connection, the device can be equipped with means for additional fixation on the tooth, which is, for example, an adhesive layer 27 formed on the edge of the device 18 for fixing the guide part in the oral cavity. This layer can be formed in various ways, for example, by external spraying or extrusion of a sticky substance, in particular, external spraying of a sticky spray or extruding an adhesive substance from a tube. As adhesive substance, easily destroyed human-friendly adhesives, for example, "protefix", "hazel", etc., can be used.

It is desirable that the longitudinal axis 19 of the rectilinear through channel 3 for the needle would be oriented in the three-dimensional stereolithographic model 1 so that it passes at a distance of not more than 5 mm from the location of the nerve, giving pain sensitivity to the place that will be operated on, for example, at a distance of 1 2 mm, or 5. The distance is determined so as not to get into the artery or vein reliably, taking into account, for example, the accuracy of the outer diameter of the needle and the inner diameter of the straight through channel. This is necessary to ensure reliable analgesia in individual cases of the location of the nerve.

The claimed device 18 for fixing the guide part 16, equipped with a straight through channel 17, can be made in conjunction with the template 28 for the installation of implants, designed to be fixed in the oral cavity on the jaw (Fig. 12). Such a technical solution is advisable to use in the case of implant placement.

In addition, the claimed device 18 for fixing the guide part 16, provided with a straight through channel 17, can be made integral with the mouthguard 29 (Fig. 13). Such a technical solution is preferably used in the case of the presence of all teeth and the need for any surgical intervention.

Below is a detailed description of the implementation of the claimed invention, for example, the installation on the tooth of the device for fixing the guide part in the oral cavity (Fig. 11).

All patients who are referred for planned operations in the oral cavity (implantation, bone grafting, complex tooth extractions) undergo a preliminary computed tomography procedure. Based on the results of computed tomography, you can clearly determine the location of all the nerves of interest. After that, on the basis of the constructed three-dimensional model of the jaw, it is possible to make a three-dimensional stereolithographic model 15 using individual computer 3D modeling, including a guiding part 16 with a straight through channel 17 for the needle and a fixture 18 for fixing the guiding part in the oral cavity, rigidly fixed to the guiding part, the longitudinal axis 19 of the rectilinear through channel 17 for the needle of the guide part is oriented so that it passes at a distance from the place required for anesthesia finding a nerve that gives pain sensitivity to the place to be operated on, that is, create an individual navigator for the needle with an anesthetic.

Let us explain this with a concrete example.

1. The patient comes.

2. The doctor makes a diagnosis, for example, secondary adentia (absence of one or more teeth).

3. The patient undergoes computed tomography of the jaw of the site of the operation and the location of the nerve, which gives pain sensitivity, the place that will be operated on.

4. Based on computed tomography, a removable three-dimensional stereolithographic model 15 is made with a straight through channel 17 for introducing a needle for introducing, for example, anesthetic, and during computed tomography it was decided that this three-dimensional stereolithographic model 15 should be installed on a separate tooth. In this case, the longitudinal axis of the rectilinear through channel 19 for the needle is oriented so that it passes at a distance not exceeding 5 mm from the location of the nerve giving pain sensitivity, the place that will be operated on, for example, at a distance of 1 or 2 mm, or 5 mm.

5. After that, the manufactured stereolithographic model 15 is taken and its device 18 for fixing the guide part in the oral cavity is fixed on the tooth 22, for example, as shown in FIG. 11. For this, the oral fixation device 18 is “put” on top of the tooth 22, so that the wall of the cavity 24 fits tightly on the lateral surface 26 of the tooth 22. A tight grip can be achieved by pressing on top of the “acquired” fixation device 18 "Previously on top of the tooth. If the fixture 18 for fixing is made of elastic material, then a tight grip can be achieved, for example, by making the cavity 24 of the fixture 18 for gripping slightly smaller than the lateral surface of the tooth 22 in cross section. In this case, when "dressing" the device 18 on the tooth 22, the cavity 24 expands somewhat and its walls tightly cover the tooth.

6. To increase the reliability of the temporary connection, the device can be equipped with means for additional fixation on the tooth, which is, for example, an adhesive layer 27 formed on the edge 30 of the device 18 for fixing the guide part in the oral cavity. This layer can be formed by various methods, for example, by external spraying or extrusion of a sticky substance, in particular, external spraying of a sticky spray or by extruding fingers of an adhesive substance from a tube.

7. Then, a syringe needle is inserted into the straight through channel 17 and the drug is administered from it.

8. Remove the syringe needle from the straight through channel 17.

9. By clicking on the guide part 16, the adhesive layer 27 is destroyed and the three-dimensional stereolithographic model 15 is removed from the oral cavity.

The following describes the second variant of the claimed device (Fig. 14 - Fig. 18).

In FIG. 14 shows a variant of the claimed device for conducting local anesthesia and eliminating its possible complications during surgical intervention in the oral cavity, which is a three-dimensional stereolithographic model 31 made using individual computer 3D modeling, characterized in that the straight through channel 32 for the needle is made in the device for fixing the guide part 33 in the oral cavity, which acts as a guide part with a straight through channel 32 for the needle, the longitudinal axis 35 of which is oriented so that it passes at the required distance for pain relief from the location of the nerve, which gives the pain sensitivity of the place.

Such a technical solution has the following advantages: the most accurate hit by the needle tip of the required drug is ensured due to a more accurate determination of the target point and point of administration of the drug (anesthetic) during local anesthesia of the mandibular nerve.

In addition, the device according to the second embodiment has the following additional advantage: the presence of a straight through channel for the needle directly inside the device for fixing the guide part in the oral cavity reduces the volume of the device, which is especially convenient if the mouth is small. In addition, it is safer because it has fewer protruding parts and angles.

The fixture 33 for fixing according to this embodiment can be made with the possibility of removable connection directly with the tooth 36, in particular, the fixture 33 for fixing in the oral cavity can be a part 37 with a cavity 38, the boundary of the cavity surface 39 of which repeats the surface of the tooth 36 s the possibility of its tight coverage, in particular, on the 6-7 tooth. Moreover, the surface 39 can accurately repeat the upper and lateral surfaces of the tooth or repeat only the lateral side of the tooth with the formation of a cavity above the surface of the tooth. In FIG. 14 shows an example where surface 39 accurately repeats the upper and lateral surfaces of the tooth without forming a cavity.

In addition, this device 33 for fixing in the oral cavity according to this option can be performed in conjunction with a template 40 for installing implants, designed to be fixed in the oral cavity on the jaw (Fig. 17). Such a technical solution is advisable to use in the case of implant placement.

This device 33 for fixation in the oral cavity according to this option can be performed at the same time with the mouthguard 42 for installation of implants, designed to be fixed in the oral cavity on the jaw (Fig. 18). Such a technical solution is preferably used in the case of the presence of all teeth and the need for any surgical intervention.

It is preferable that the longitudinal axis 35 of the straight through needle channel 32 be oriented in a three-dimensional stereolithographic model so that it passes at a distance of not more than 5 mm from the location of the nerve, giving pain sensitivity to the place that will be operated on, for example, at a distance of 1 or 2 mm, or 5 mm. The distance is determined on the basis of not reliably getting into the artery or vein, taking into account, for example, the accuracy of the outer diameter of the needle and the inner diameter of the rectilinear through channel.

This is necessary to ensure reliable analgesia in individual cases of the location of the nerve.

To increase the reliability of the temporary connection, the device according to the second embodiment described above can be equipped with means for additional fixation on the tooth 36, which is, for example, an adhesive layer 43 formed on the edge 44 of the device 33 for fixing the guide piece in the oral cavity. This layer can be formed in various ways, for example, by external spraying or extrusion of a sticky substance, in particular

spraying a sticky spray or squeezing a sticky substance from a tube.

Below is a detailed description of the implementation of the claimed invention, for example, the installation on the tooth of the device for fixing the guide part in the oral cavity (Fig. 15 and Fig. 16).

All patients who are referred for planned operations in the oral cavity (implantation, bone grafting, complex tooth extractions) undergo a preliminary computed tomography procedure. Based on the results of computed tomography, you can clearly determine the location of all the nerves of interest. After that, on the basis of the constructed three-dimensional model of the jaw, it is possible to make a three-dimensional stereolithographic model 31 using individual computer 3D modeling, characterized in that the straight through channel 32 for the needle is made in the device for fixing the guide part 33 in the oral cavity, which acts as a guide part with a straight a through channel 32 for the needle, the longitudinal axis 35 of which is oriented so that it passes at the distance required for anesthesia from the location of the nerve giving pain sensitivity of the place. Let us explain this with a concrete example.

1. The patient comes.

2. The doctor makes a diagnosis, for example, secondary adentia (absence of one or more teeth).

3. The patient undergoes computed tomography of the jaw of the site of the operation and the location of the nerve, which gives pain sensitivity, the place that will be operated on.

4. Based on computed tomography, a removable three-dimensional stereolithographic model 31 is made with a straight through channel 32 for inserting a needle for introducing, for example, anesthetic, and during computed tomography it was decided that this three-dimensional stereolithographic model 31 should be installed on a separate tooth 36. When this, the longitudinal axis of the straight through channel 35 for the needle is oriented so that it passes at a distance not exceeding 5 mm from the location of the nerve, giving pain sensitivity, places To be operated, e.g., at 1 or 2 mm, or 5 mm.

5. After that, the manufactured stereolithographic model 31 is taken and its device 33 for fixing the guide part in the oral cavity is fixed on the tooth 36, for example, as shown in FIG. 15 and FIG. 16. For this, the oral fixation device 33 is “put” on top of the tooth 36, so that the surface 39 of the cavity 38 fits tightly on the lateral surface 45 of the tooth 36. A tight grip can be achieved by pressing from above on the fixation device 33, " baited ”previously on top of the tooth. If the fixture 33 for fixing is made of elastic material, then a tight grip can be achieved, for example, by making the cavity 38 of the fixture 33 for grip a little smaller than the side surface of the tooth 36 in cross section. In this case, when "dressing" the device 33 for fixing on the tooth 36, the cavity 38 expands somewhat and its walls tightly cover the tooth.

6. To increase the reliability of the temporary connection, the device can be equipped with means for additional fixation on the tooth, which is, for example, an adhesive layer 43 formed on the edge 44 of the device 33 for fixing the guide part in the oral cavity. This layer can be formed by various methods, for example, by external spraying or extrusion of a sticky substance, in particular, external spraying of a sticky spray or by extruding fingers of an adhesive substance from a tube.

7. Then, a syringe needle is inserted into the straight through channel 35 and the drug is administered from it.

8. Remove the syringe needle from the straight through channel 35.

9. By pressing the fixture 33 for fixing, the adhesive layer 43 is destroyed and the three-dimensional stereolithographic model 31 is removed from the oral cavity.

In addition to the above described variants of the devices of the claimed invention, the claimed technical solution also relates to a method for local anesthesia and / or elimination of its possible complications during surgical intervention in the oral cavity, including the following sequence of actions:

a) establish the diagnosis of the patient;

b) conduct computed tomography of part of the jaw of the patient with the location of the operation and the location of the nerve, giving pain sensitivity of the place to be operated on;

c) make using an individual computer 3D - modeling a three-dimensional stereolithographic model of a removable tool in the form of a device according to one of claims 1-28;

d) install and fix a stereolithographic three-dimensional model with a device for fixing in the oral cavity on a tooth or a template for implants, or kappa;

e) a needle with an anesthetic and / or other necessary medicine, such as, for example, an anesthetic antagonist, is introduced into a straight through channel for a needle of a stereolithographic model of a removable drug;

e) carry out the necessary operations.

This method has been illustrated several times in detail above with examples of implementation of variants of the claimed devices.

Industrial applicability

Thus, the invention is intended for use in medicine and relates to a new device (options) for conducting local anesthesia and eliminating its possible complications during surgical intervention in the oral cavity and a method for conducting local anesthesia and eliminating possible

its complications during surgery in the oral cavity.

The invention allows:

- to ensure the most accurate penetration of the necessary drug by the needle tip due to a more accurate determination of the target point and the point of administration of the drug (anesthetic) during local anesthesia of the mandibular nerve and thereby prevent the anesthetic from entering the needle tip not into the nerve, but into the blood stream to the brain (if they got into the artery with a needle) or into the heart (if they hit the vein with the tip of the needle) and prevent complications from these organs (heart attack, if the anesthetic got into the heart, or a stroke, if the anesthetic He fell to the brain);

- accurately determine the volume of injected anesthetic solution, taking into account the individual anatomical features of the patient;

- achieve fast and effective pain relief;

- to avoid excessive administration of anesthetic solution to the patient, which is especially important for patients at anesthetic risk group;

- eliminate unpleasant sensations of numbness of the soft tissues of the oral cavity.

In addition to the above variants of the invention, numerous other modifications are possible.

All of them are covered by the following claims.

Claims (36)

1. A device for conducting local anesthesia and eliminating its possible complications during surgical intervention in the oral cavity, which is a three-dimensional stereolithographic model made using individual computer 3D modeling, including a guiding part with a straight through channel for the needle and a device rigidly fixed to the guiding part for fixing the guide piece in the oral cavity, the longitudinal axis of the straight through channel for the guide needle Details oriented so as to pass on the required for analgesia distance from the nerve location, giving sensitivity to pain location to be operated on. 2. The device according to claim 1, characterized in that the longitudinal axis of the straight through channel for the needle of the guide part is oriented so that it intersects the device for fixation in the oral cavity. 3. The device according to p. 2, characterized in that the device for fixation in the oral cavity is made with the possibility of removable connection with the tooth. 4. The device according to p. 3, characterized in that the device for fixing in the oral cavity is a part with a cavity, the surface of which repeats at least part of the side surface of the tooth with the possibility of tight coverage. 5. The device according to p. 2, characterized in that the device for fixation in the oral cavity is made integral with the template for the installation of implants, intended for fixing in the oral cavity. 6. The device according to p. 2, characterized in that the device for fixation in the oral cavity is made integral with the mouthguard. 7. The device according to claim 1, characterized in that the longitudinal axis of the straight through channel for the needle of the guide part is oriented so that it does not intersect the device for fixation in the oral cavity, and the guide part itself is a spatial body rigidly fixed to the surface of the device for fixing guide parts in the oral cavity. 8. The device according to p. 7, characterized in that the device for fixation in the oral cavity is made with the possibility of removable connection with the tooth. 9. The device according to p. 8, characterized in that the device for fixation in the oral cavity is a part with a cavity, the surface of which repeats the surface of the tooth with the possibility of a snug fit. 10. The device according to p. 7, characterized in that the device for fixation in the oral cavity is made integral with the template for the installation of implants, intended for fixing in the oral cavity. 11. The device according to p. 7, characterized in that the device for fixing in the oral cavity is made integral with the mouthguard. 12. The device according to p. 1, characterized in that the longitudinal axis of the rectilinear through channel for the needle is oriented in a three-dimensional stereolithographic model so that it passes at a distance of not more than 5 mm from the location of the nerve, which gives pain sensitivity to the place to be operated on. 13. The device according to p. 1, characterized in that the longitudinal axis of the straight through channel for the needle is oriented in a three-dimensional stereolithographic model so that it passes at a distance of 2 mm from the location of the nerve, which gives pain sensitivity to the place to be operated on. 14. The device according to claim 1, characterized in that the longitudinal axis of the straight through channel for the needle is oriented in a three-dimensional stereolithographic model so that it passes at a distance of 1 mm from the location of the nerve, which gives pain sensitivity to the place to be operated on. 15. The device according to p. 1, characterized in that the device for fixing the guide part in the oral cavity contains means for additional fixation on the tooth. 16. The device according to p. 15, characterized in that the means for additional fixation on the tooth is an adhesive layer formed on the edge of the device for fixing the guide part in the oral cavity. 17. The device according to p. 16, characterized in that the sticky layer is formed on the edge of the device for fixing by external spraying or extrusion of the sticky substance. 18. A device for conducting local anesthesia and eliminating its possible complications during surgical intervention in the oral cavity, which is a three-dimensional stereolithographic model made using individual computer 3D modeling, characterized in that the straight through channel for the needle is made in the device for fixing the guide part in the oral cavity, which acts as a guide part with a straight through channel for the needle, the longitudinal axis of which is oriented so so that it passes at the distance required for pain relief from the location of the nerve, which gives the pain sensitivity of the place. 19. The device according to p. 18, characterized in that the device for fixation in the oral cavity is made with the possibility of removable connection with the tooth. 20. The device according to p. 19, characterized in that the device for fixation in the oral cavity is a part with a cavity, the surface of which repeats at least part of the side surface of the tooth with the possibility of tight coverage. 21. The device according to p. 18, characterized in that the device for fixation in the oral cavity is rigidly connected to a template for installing implants designed to be fixed in the oral cavity. 22. The device according to p. 18, characterized in that the device for fixation in the oral cavity is rigidly connected to the mouth guard. 23. The device according to p. 18, characterized in that the longitudinal axis of the rectilinear through channel for the needle is oriented in a three-dimensional stereolithographic model so that it passes at a distance of not more than 5 mm from the location of the nerve, giving the pain sensitivity of the place to be operated on. 24. The device according to p. 18, characterized in that the longitudinal axis of the straight through channel for the needle is oriented in a three-dimensional stereolithographic model so that it passes at a distance of 2 mm from the location of the nerve, giving the pain sensitivity of the place to be operated on. 25. The device according to p. 18, characterized in that the longitudinal axis of the straight through channel for the needle is oriented in a three-dimensional stereolithographic model so that it passes at a distance of 1 mm from the location of the nerve, giving the pain sensitivity of the place that will be operated on. 26. The device according to p. 18, characterized in that the device for fixing the guide part in the oral cavity contains means for additional fixation on the tooth. 27. The device according to p. 26, characterized in that the means for additional fixation on the tooth is an adhesive layer formed on the edge of the device for fixing the guide part in the oral cavity. 28. The device according to p. 27, characterized in that the sticky layer is formed on the edge of the device for fixing by external spraying or extrusion of the sticky substance. 29. A method of conducting local anesthesia and eliminating its possible complications during surgery in the oral cavity, including the following sequence of actions: a) establish the diagnosis of the patient; b) conduct computed tomography of part of the jaw of the patient with the location of the operation and the location of the nerve, giving pain sensitivity of the place to be operated on; c) using an individual computer 3D-modeling, a three-dimensional stereolithographic model of a removable means is made in the form of a device according to one of claims. 1-28; g) install and fix a stereolithographic three-dimensional model with a device for fixing in the oral cavity on the tooth, or a template for implants, or kappa; e) a needle with an anesthetic and other, if necessary, drug used for surgical interventions in the oral cavity is inserted into the straight through channel for the needle of the stereolithographic model of the removable means; e) carry out the necessary operations. 30. The method of conducting local anesthesia and eliminating its possible complications during surgery in the oral cavity according to claim 29, characterized in that the other necessary medication is an anesthetic antagonist.

Images