RU2735258C1 - Method for single-jaw splinting in lower jaw fractures - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to maxillofacial surgery and surgical dentistry, and is intended for use in treating lower jaw fractures. Patient's bite is recorded with the help of a heated arched wax plate. In the produced wax bite pattern six metal loops are inserted in projection 2, 4 and 6 of teeth, excess wax is removed, edges are smoothed. Further, the wax pattern of the occlusion with metal hook loops is gypsum-plated; a plastic plate with engaging loops is made from the wax pattern of the occlusion. Then, under conductor and/or infiltration anaesthesia on teeth of lower jaw from vestibular surface individual bent splint from aluminium wire is applied, having six metal hooked loops in projection of 2, 4, 6 teeth. Tire is fixed to teeth by means of metal ligatures. To the chewing surface of teeth of the lower jaw, a plastic plate with metal hook loops is applied, having occlusion impressions on both sides. By means of rubber rings plate is fixed to tire by means of metal engaging loops.

EFFECT: method enables fixing the lower jaw in fractures without dividing the teeth from the occlusion, prevents displacement of fragments in the horizontal plane, creates additional fixation in the vertical plane, simplifies speech and oral care, is easy to use, low-traumatic, available for use in dental polyclinics, departments of maxillofacial surgery.

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Description

The invention relates to medicine, namely to maxillofacial surgery and dental surgery.

There are numerous ways of splinting the lower jaw in case of its fractures, when the fragments are fixed by the teeth using metal or plastic aligners, metal or plastic arc splints. Their common disadvantage is that these structures do not eliminate the horizontal displacement of fragments, do not provide sufficient rigidity of fixation or require mandatory intermaxillary fixation, and significantly complicate oral hygiene.

There is a known method proposed by Sauer according to which a wire splint is applied to the vestibular and lingual surfaces of the dentition of the lower jaw and both parts of the splint are fixed between themselves with a thinner wire passed through the interdental spaces. Such a tire is bent according to a plaster model, which is pre-sawn at the fracture sites and glued along the bite with the upper jaw model.

However, the above technology has significant disadvantages:

1. The fixing ability of these tires and their subsequent modifications is insufficient, they do not eliminate the horizontal displacement of fragments;

2. With micromovements of fragments arising during the act of swallowing and during conversation, the fracture gap becomes infected with the contents of the oral cavity;

3. Satisfactory oral hygiene is difficult.

The closest in essential features to the claimed method is a method of splinting for fractures of the lower jaw, including the coverage of the dentition with a splint on both sides, characterized in that the fixation of the vestibular and lingual parts of the splint is carried out by means of a continuous double polyamide thread, which is sequentially fixed on the splint by a knot in each interdental space alternately from the vestibular and lingual sides, and before each subsequent fixation, the thread is stretched, and the teeth limiting the fracture gap are captured with one loop (Patent No. RU 2072808 C1, authors Centilo Vitaly Grigorievich [UA], Matros-Taranets Igor Nikolaevich [UA] , Pristrom Mikhail Vladimirovich [UA], publ. 1997.02.10).

This method has several disadvantages:

1. The splint does not provide satisfactory fixation of the fragments;

2. Does not eliminate the horizontal displacement of fragments;

3. The fixing thread loses its strength over time, becomes unfixed, and breaks.

4. Due to the large number of retention points for food residues on the tire and the presence of intermaxillary fixation, it is impossible to maintain the hygienic maintenance of the patient's oral cavity. All this increases the frequency of inflammatory complications of fractures of the lower jaw, slows down the fusion of fragments and lengthens the period of temporary disability of patients.

The purpose of the present invention is to create a method for stable fixation of the lower jaw, excluding the displacement of fragments in the vertical and horizontal directions, the possibility of opening the mouth throughout the treatment, which makes it possible to carry out full oral hygiene.

The purpose is achieved by the method of single-jaw splinting for fractures of the lower jaw. The bite is recorded in the patient with the help of a heated arcuate wax plate, six metal hook loops are inserted into the resulting wax bite template in the projection of teeth 2, 4 and 6, excess wax is removed, and the edges are smoothed. Next, the wax bite template with metal hook loops is gypsum into a cuvette, a plastic plate with hook loops is made from the wax bite template. Then, under conduction and / or infiltration anesthesia, an individual bent splint made of aluminum wire is applied to the teeth of the lower jaw from the vestibular surface, which has six metal hooking loops in the projection of 2, 4, 6 teeth. The splint is fixed to the teeth using metal ligatures. On the chewing surface of the teeth of the lower jaw, a plastic plate with metal engaging loops is applied, having occlusal impressions on both sides. With the help of rubber rings, the plate is fixed to the tire by means of metal hook loops.

The novelty of the invention

1. The patient's bite is recorded with the help of a heated arcuate wax plate. In the resulting wax bite template, the technician inserts six metal hooking loops in the projection of the 2, 4 and 6 teeth, which is then cast into a cuvette.

2. A plastic plate with hook loops is made.

3. On the teeth of the lower jaw from the vestibular surface, an individual bent splint made of aluminum wire is applied with six metal hooking loops. The splint is fixed to the teeth using metal ligatures.

4. The plastic plate has metal engaging loops, which allows it to be rigidly fixed to an individual bent tire fixed to the lower jaw, thereby preventing horizontal displacement.

5. The plastic plate follows the occlusion of the teeth in the bite.

6. On the chewing surface of the teeth of the lower jaw, a plastic plate with metal hook loops is applied, which has occlusal impressions on both sides. With the help of rubber rings, the plate is fixed to the applied tire by means of metal hook loops.

The proposed method allows you to obtain a new technical result:

1. A plastic plate with hook loops prevents the displacement of fragments in the horizontal plane, creates additional fixation in the vertical plane.

2. The plastic plate allows fixing the lower jaw in case of fractures, avoiding double-mandibular splinting.

3. A plastic plate with hook loops has from the upper and lower surfaces of the cavity repeating the chewing surfaces of the jaws, which allows fixing the lower jaw without separating the teeth from the bite.

4. This method allows the patient to open his mouth, in contrast to the methods of two-jaw splinting, which facilitates speech and oral care.

5. Since the proposed method does not have intermaxillary fixation, in case of regurgitation, the patient is not threatened with aspiration asphyxia.

6. The method is easy to use and does not exceed the time of treatment of patients in comparison with two-jaw splinting, and is also low-traumatic.

7. The cheapness of the method makes it available for use in dental clinics, departments of maxillofacial surgery.

8. Possibility of immobilization of the lower jaw without involving the upper jaw.

9. Opening the mouth throughout the treatment.

The method is illustrated by the drawings shown in FIG. 1-5.

FIG. 1 - registration of the bite of the upper and lower jaw.

FIG. 2 - plastic plate with hook loops and occlusal impressions.

FIG. 3 - individual bent tire with hook loops fixed on the lower jaw.

FIG. 4 - the lower jaw with a fixed bent splint and an imposed plastic plate.

FIG. 5 - fixing an individual bent tire and a plastic plate by means of hooking loops and rubber rings.

On the figures: 1 - wax plate, 2 - wax bite pattern, 3 - metal hooking loops of the plate, 4 - plastic plate, 5 - bent splint, 6 - metal hooking loops of the splint, 7 - metal ligatures, 8 - occlusal impressions, 9 - rubber rings.

The method is carried out as follows.

In case of a fracture of the lower jaw without displacement of fragments in a patient, the bite is recorded using a heated arcuate wax plate 1 (Fig. 1). The resulting wax bite template 2 is sent to a dental laboratory, where the technician inserts six metal hook loops 3 into the bite wax template in the projection of teeth 2, 4 and 6, removes excess wax, smoothes the edges. Next, the manufactured wax bite template 2 with metal hook loops 3 is gypsum into a cuvette (Fig. 2). The wax from the cuvette is boiled out and the resulting space is filled with Ftorax mixed with Protacryl liquid. The cuvette is packed and boiled for 15 minutes, after which the obtained plastic plate 4 with hook loops 3 is removed, polished and given to the doctor. Then, under conduction or infiltration anesthesia, an individual bent splint 5 made of aluminum wire is applied to the teeth of the lower jaw from the vestibular surface, which has six metal hook loops 6 in the projection of teeth 2, 4, 6. The splint is fixed to the teeth using metal ligatures 7 (Fig. 3). On the chewing surface of the teeth of the lower jaw, a plastic plate 4 with metal engaging loops 3 is applied, which has occlusal impressions 8 on both sides (Fig. 4). With the help of rubber rings 9, the plate is fixed to the previously applied tire by means of metal hooking loops 3 and 6 (Fig. 5).

Clinical examples.

Clinical example 1

Patient M., 43 years old, was admitted to the Department of Maxillofacial Surgery, Reconstructive and Plastic Surgery of the Kemerovo Regional Hospital with a diagnosis of fracture of the lower jaw along the body on the right in the projection of teeth 4.3-4.4 without displacement of fragments. The patient's bite was registered with the help of a heated wax plate, the resulting wax impression was transferred to the dental laboratory. Further, under torusal anesthesia on both sides, Sol. Lidocaini 2% -5.0 ml on the lower jaw was applied and fixed with metal ligatures an individual bent splint with six hooking loops in the projection of teeth 2, 4, 6. A finished plastic plate obtained from the laboratory with hooking loops at the level of teeth 2, 4, 6 and repeating the chewing surface of the teeth from the upper and lower jaws is superimposed on the teeth of the lower jaw. Rubber rings are put on the hinges of the bent tire and the plastic plate. Thus, a rigid fixation is achieved between the plate and the splint, eliminating the displacement of the jaws in the horizontal and vertical planes. The patient is prescribed a fistula diet (liquid, mashed food). On the 7th day, the patient was discharged for outpatient follow-up care at the dental clinic No. 1 in Kemerovo. Outpatient follow-up care was unremarkable; on day 23, patient M. had the structure removed under the control of X-ray images.

Clinical example 2

Patient K., 21 years old, was admitted to the emergency department of the Department of Maxillofacial Surgery, Reconstructive and Plastic Surgery of the Kemerovo Regional Hospital, where the diagnosis was made: Concussion. Fracture of the lower jaw along the body on the left in the projection of teeth 3.5-3.6 without displacement of fragments. Contusion of the soft tissues of the left periorbital region.

A neurologist recommended to postpone double-jaw splinting for 3 days in order to prevent the throwing of vomit into the upper respiratory tract. Selected treatment according to the proposed method.

The bite was registered to the patient with the help of a heated wax plate, and the resulting wax impression was transferred to the dental laboratory. Then under torusal and infiltration anesthesia on both sides of the Sol. Lidocaini 2% -10.0 ml on the lower jaw was applied and fixed with metal ligatures an individual bent splint with six engaging loops with the loops located in the projection of 2, 4 and 6 teeth. A ready-made plastic plate obtained from the laboratory with engaging loops located coaxially to the 2nd, 4th and 6th teeth and repeating the chewing surface of the teeth from the upper and lower jaws is applied to the teeth of the lower jaw. With the help of rubber rings, a rigid fixation was made between the bent tire and the plastic plate. Thus, a rigid fixation is achieved between the plate and the splint, eliminating the displacement of the jaws in the horizontal and vertical planes. The patient is prescribed a fistula diet (liquid, mashed food). On day 10, the patient was discharged for outpatient follow-up care by a dentist-surgeon in the Kemerovo Regional Dental Clinic. Outpatient follow-up treatment took place without signs of inflammation, on day 21, patient K. under the control of X-ray images was removed from the structure.

Clinical case 3

Patient Sh. 45 years old, was admitted to the Department of Maxillofacial Surgery, Reconstructive and Plastic Surgery of the Kemerovo Regional Hospital with a diagnosis of bilateral fracture of the lower jaw in the chin on the right in the projection of teeth 4.1, 4.2, along the body on the left in the projection of teeth 3.5, 3.6 without displacement fragments.

The patient's bite was removed with the help of a heated wax plate inserted into the mouth, the resulting wax impression was transferred to the dental laboratory. Further under torusal and mental anesthesia on both sides of the Sol. Lidocaini 2% -10.0 ml on the lower jaw was applied and fixed with metal ligatures an individual bent splint with six hooking loops in the projection of teeth 2, 4 and 6. A ready-made plastic plate obtained from the laboratory with hooking loops in the projection of teeth 2, 4, 6 and repeating the chewing surface of the teeth from the upper and lower jaws is superimposed on the teeth of the lower jaw. Rubber rings are put on the hinges of the bent tire and the plastic plate. Thus, a rigid fixation is achieved between the plate and the splint, which eliminates the displacement of the jaws in the horizontal and vertical directions. The patient was prescribed a fistula diet (liquid, pureed food). On the 7th day, the patient was discharged with improvement for outpatient follow-up care at the dental clinic No. 1 in Kemerovo. Outpatient follow-up care was uneventful, under the control of X-ray examination for 4 weeks of patient Sh. The construction was removed.

Claims (1)

The method of single-jaw splinting for fractures of the lower jaw, including fixing the splint, characterized in that the bite is recorded in the patient with the help of a heated arcuate wax plate, six metal hooking loops are introduced into the resulting wax bite template in the projection of teeth 2, 4 and 6, and excess wax is removed, the edges are smoothed, then the wax bite template with metal hooking loops is cast into a cuvette, a plastic plate with hooking loops is made from the wax bite template, then under conduction and / or infiltration anesthesia on the teeth of the lower jaw from the vestibular surface, an individual bent tire made of aluminum wire is applied six metal hooking loops in the projection of 2, 4, 6 teeth, the splint is fixed to the teeth using metal ligatures, a plastic plate with metal hooking loops is applied to the chewing surface of the teeth of the lower jaw, having occlusal impressions on both sides, using rubber of the rings, the plate is fixed to the tire by means of metal hook loops.

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