RU2738008C1 - Implant unit - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to surgical dentistry, and can be used in dental implantation in insufficiency of bone tissue of alveolar process of upper jaw. Disclosed is an implant unit comprising a threaded implant for through screwing in bone tissue of the maxillary alveolar process and a supporting member for installation in the maxillary sinus with support on the prepared bed in interaction with the implant, characterized in that support element of elastically deformable material is made with central dome-shaped part with inner cavity for accommodation in last osteotropic biomaterial and peripheral support part for contact with said bed, note here that central dome-shaped part has n outlets made from its top to form n lobes, where n is any integer not less than 2. Preferably, said lobes are made with truncated apices to form a hole adapted to the size of the implant, facilitating passage of the implant when it is screwed into the support element, and the edges interacting with the implant thread, preferably in the support element on the side of the peripheral support part, additional grooves not crossing with the slots are made.

EFFECT: method allows higher quality of implantation due to structural provision of conditions for stable postoperative osteogenesis in the implantation area.

3 cl, 8 dwg

Description

The invention relates to medicine, in particular to surgical dentistry, and can be used when carrying out dental implantation in case of bone insufficiency of the alveolar process of the upper jaw.

A known block of an implant and a method of reconstruction of an atrophied alveolar part of the jaw, which consists in using a bone block of an autograft, consisting of bone plates and bone chips, filling the reconstruction space, limited by the bone plate and the alveolar part of the jaw. The method provides for fixing the bone plates using intraosseous screws to the bone edge of the atrophied alveolar part of the jaw. The bone plate is fixed parallel to the bone edge of the atrophied alveolar part of the jaw (Khoury F., Narre A .: Zur Diagnostik und Methodik von intraoralen Knochenentnahmen. Zzahnarztl Implantol 1999: 15 (3): 167-176).

This analog has the following disadvantages:

- the analogue design is not able to ensure the stability of the volume of the bone block during the formation of the regenerate;

- the method of fixation of the bone block, proposed in the analogue, is impossible with pronounced in the vertical direction atrophy of the edge of the bone of the alveolar part of the jaw;

- conditions are not provided for creating the maximum area of contact of the bone block with the bone of the recipient bed of the edge of the bone of the atrophied alveolar process;

- simultaneous implantation of a denture is impossible.

The closest to the claimed - prototype - is an implant block made of biocompatible structural material, including a threaded implant designed for through screwing into the bone tissue of the alveolar process of the upper jaw, and a flat supporting element designed for installation in the maxillary sinus with support on a prepared bed and screwing the indicated implant into it (RF patent No. 2649570, publ. 03.04.2018).

The prototype is characterized by the possibility of simultaneously fixing the base plate and dental implants in it, reducing the duration of prosthetics from 2-6 months to 1-3 days, reducing the cost of temporary installations (prostheses) and replacing the bone tissues of the alveolar process.

The disadvantages of the prototype include postoperative adentia of the bone tissue of the alveolar process, due to the complete or partial (in the presence of perforation in the support plate) limitation of normal osteogenesis of the bone tissue of the alveolar process by the adjacent support plate. Moreover, since the thickness of the base plate is very significant, since it requires the execution of blind threaded holes in it, the growth of the bone tissue through the plate seems to be problematic.

The technical problem solved by the claimed invention is the elimination of the noted disadvantages.

The technical result consists in improving the quality of implantation due to the constructive provision of conditions for stable postoperative osteogenesis in the implantation zone.

The problem is solved, and the claimed technical result is achieved by the fact that in the implant block containing a threaded implant for through screwing into the bone tissue of the alveolar process of the upper jaw, and a support element for installation in the maxillary sinus with support on the prepared bed in interaction with the implant, a support element made with a central dome-shaped part with an internal cavity for placement in the last osteotropic biomaterial, and a peripheral supporting part for contact with the said bed, while in the central dome-shaped part there are n grooves emanating from its apex with the formation of n petals, where n is any integer not less than 2, it is preferable to make said petals with truncated vertices, preferably in the support element from the side of the peripheral support part to make additional grooves that do not intersect with the said grooves, it is recommended that the support element be made of an elastically deformable material.

The invention is illustrated by the following images:

FIG. 1 - assembled implant block;

FIG. 2 - elements of the implant block;

FIG. 3 - prototype installation of the implant block in the maxillary sinus through the lateral window;

FIG. 4 - supporting element of the implant block, execution in accordance with claim 1 of the claims, enlarged, bottom view;

FIG. 5 - supporting element of the implant unit, execution in accordance with clauses 2 and 3 of the claims, enlarged, top view;

FIG. 6 - supporting element of the implant block, execution in accordance with clauses 2 and 3 of the claims, enlarged, top view;

FIG. 7 - supporting element of the implant unit, execution in accordance with claim 1 and 2 of the claims, enlarged, bottom view;

FIG. 8 - installation of a double block of the implant.

The positions in the images have the following meanings:

1 - implant;

2 - supporting element;

3 - implant thread:

4 - groove of the support element;

5 - petal of the support element;

6 - peripheral supporting part of the supporting element;

7 - perforation of the support element;

8 - hole for the passage of the implant;

9 - edge for interaction with the implant thread;

10 - upper jaw;

11 - alveolar process;

12 - lateral window;

13 - bed for the supporting element;

14 - additional groove of the support element;

15 - central domed part of the support element (dome outside / cavity inside);

16 - flanging of the support element petals.

In accordance with the invention, the block of the implant is made of a biocompatible structural material and includes a threaded implant 1 (Fig. 1, 2), intended for through screwing into the bone tissue of the alveolar process 11 of the upper jaw 10 (Fig. 3), and a supporting element 2 (Fig. . 1, 2, 3, 4, 5, 6, 7), intended for installation in the maxillary sinus with support on the prepared bed 13 and screwing the indicated implant 1 into it (Fig. 3). The supporting element 2 is made with a central dome-shaped part 15 (dome on top / cavity inside), the internal cavity of which is intended to be filled with osteotropic biomaterial during the installation of the implant block and the regenerated body of the bone of the alveolar process 11 after the installation of the implant block, and with the peripheral supporting part 6, intended for contact with said stock 13 in the installed state (Fig. 3). In the central dome-shaped part 15 there are n grooves 4 (for example, in Figs. 1, 2, 6, 7 - four grooves, in Fig. 4, 5 - three grooves), dividing it into n petals 5, where n is any integer at least 2. The mentioned petals 5 at the starting point (point of intersection) on the central dome-shaped part 15 form a hole 8, the size of which during implantation is adapted to the inserted implant 1 due to the elastic compliance of the petals 5, however, for the most correct screwing of the implant 1, petals 5 are recommended to perform with truncated tops to form a hole 8 ¹ previously adapted to the parameters of the thread 3 of the implant 1 with edges 9 (Fig. 5, 6), facilitating interaction with the thread 3 of the implant 1, or with flanges 16 (Fig. 7). Depending on the required flexibility / compliance of the petals 5, the grooves 4 can be radially, tangentially, along a helical line and / or in another way and / or a combination of the listed / possible designs made / oriented on the surface of the central dome-shaped 15. In the peripheral part of the support element 2 in in order to ensure the greatest flexibility of the latter, it is desirable to make additional grooves 14 that do not intersect with the grooves 4, the execution / orientation of which is formed by analogy with the grooves 4. It is recommended to make the support element 2 from an elastically deformable material or material. In addition, the claimed block of the implant, if necessary, can be made type-setting, that is, it includes several implants 1 and several supporting elements 2 connected into a single whole (welded, glued, made as one) within the scope of the planned implantation (see, for example, Fig. 8).

Let us dwell in more detail on the essential features of the claimed technical solution and the properties manifested by these features. A biocompatible structural material is understood as a group of materials, mainly metals, when the bone does not react to the material as to a foreign body, but recognizes it as immunologically similar to itself. Such materials include, for example, gold, titanium, tantalum, zirconium, molybdenum, stainless steel, alloys of cobalt and chromium, zirconium dioxide and a number of others. The most progressive (at the moment) include third-generation titanium alloys, which, in addition to titanium, contain zirconium, tantalum and molybdenum. It is advisable to subject the elements of the implant block to a special treatment before sterilization. For titanium alloys, this is a double etching with a mixture of HCL + H2SO4 at a temperature of 100 ° C, which provides a pronounced porosity of the surface, which enhances the osseointegrative properties of the surface on which the mineralized bone matrix can be located and become covered with plasma proteins released from the blood, such as fibropectin and vitropectin. The lipophilic properties of the implant block surface support protein binding and the subsequent formation of a temporary fibrin network. A dense network of fibrin ensures fast adhesion of osteogenic osteoblast cells. Due to the hydrophilicity of the surface of the implant block, an adequate blood supply is provided between the bone tissue and osteogenic cells located on the surface of the implant block. Accelerated recruitment of osteoblasts to the surface of the implant block leads to a fairly rapid formation of bone tissue.

The implementation of the supporting element 2 with a central dome-shaped part 15 with a cavity filled with osteotropic biomaterial during the installation of the implant block, in addition to replacing the degraded bone tissues of the alveolar process, contributes to stable osteogenesis in the implantation zone. At the same time, due to the grooves 4 and additional grooves 14 made in the supporting element 2, the possibility of deformation of the latter is formed during the installation of the implant (compression in the direction of the axis of the implant). At the same time, using an elastically deformable material (for example, titanium alloys of the third generation mentioned above), the support element 2 is elastically deformable and, together with the adjacent bone tissue (bed 13) of the alveolar ridge 11, forms a prestressed volumetric structure, functioning as an arch - that is having a very high load capacity. In this case, in the arched structure formed, the support element 2 is a compressed belt, and the portion of the alveolar process 11 - bed 13 - adjacent to it inside the peripheral support part 6 of the support element 2 - is an extended belt. The latter circumstance significantly affects osteogenesis in the implantation zone. For a better understanding of the essence of the claimed technical solution, let us explain that, according to various authors, the process of bone formation de novo in the zone of the implant block occurs through contact and distant osteogenesis. In distant osteogenesis, the formation of bone structures occurs from the side of the superficial layers of old bone tissue in the peri-implant area. This bony surface provides the osteogenesis area with a population of osteogenic cells producing a new bone matrix oriented towards the implant surface. In contrast to distant osteogenesis, in contact osteogenesis, a new formation of bone substance occurs directly on the surface of the implant itself. This mechanism is implemented by analogy with osteoconduction processes, during which the implant surface acts as a passive matrix for osteogenesis. In this case, progenitor cells migrate to the implant surface from the maternal bed, which begin to differentiate into mature osteoblasts, which secrete bone matrix on the implant surface. Obviously, in different parts of the peri-implant area, the processes of distant and contact osteogenesis occur in parallel (see, for example, S.V. Poroisky et al., On the issue of osseointegration of dental implants and methods of its stimulation, Bulletin of the Volgograd State Medical University, issue 3 ( 55), 2015, p. 6-9). The existing state of the art makes it possible to combine various biological, physical, chemical and other techniques aimed at stimulating the osseointegration of dental implants. The claimed technical solution, in addition to those mentioned, also implements the so-called method of distraction osteogenesis (see, for example, https://dentaltechnic.info/index.php/implanty/regenerativnye-metody-v-implantologii/3330-distrakcionnyj-osteogenez). This method is based on tissue stretching in the osteogenesis zone, is characterized by a very high efficiency and low risk of complications, and, as a rule, is quite compatible with other methods mentioned above. In other words, the claimed constructive means increased osteogenesis of the aforementioned "stretched belt" of the arch structure - in the implantation zone. In addition, said grooves 4 and additional grooves 14, together with the cavity of the central dome-shaped part 15, form a space for filling the alveolar bone 11 with the regenerated body after the implant block is installed. Thus, a spatially developed bone structure is formed, which significantly increases the carrying capacity of the alveolar process in the implantation zone. The perforation 7 formed in the support element 2 further contributes to its osseointegration into the bone tissue of the alveolar process.

Installation of the declared block of the implant is carried out as follows. The 3D computed tomography of the upper jaw is preliminarily performed based on the anatomical features of the alveolar process and the required number of dental implants; the bed, the through hole for the implant and the intra-axial support element are modeled congruently with the shape of the bed, taking into account the bottom of the maxillary sinus. The implant block is formed as described above. During the operation, soft tissues are exfoliated along the anterior wall of the maxillary sinus and a window of the appropriate size is formed, a bed for the support element is formed by skeletonizing and / or milling the corresponding section of the maxillary sinus floor, an opening is made in the alveolar process for the introduction of a dental implant, the support element is filled with osteotropic biomaterial and installed in the bed under the Schneider's membrane, while aligning the hole in the alveolar ridge with the hole in the supporting element, fixing and simultaneously elastically deforming the supporting element in the axial direction using, for example, tweezers, screwing a threaded dental implant into the hole in the alveolar ridge and the hole in the supporting element. Then, an uncoupling automembrane is installed between the implant block and the Schneider's membrane, the lateral window is closed using standard means, and the wound is sutured. The pre and postoperative care is standard; suture removal and prosthesis placement are recommended for 10 days.

Clinical example.

Patient O., 52 years old, complained about the absence of tooth 26. After the study and CT examination in the area of the missing tooth, it was revealed: the bone height is 4 mm, the width is 8 mm. Surgery planned: open sinus lifting with one-stage implantation using the declared implant block to ensure reliable primary stability and consistency after prosthetics. Under infiltration anesthesia with Ultracaine 1.7 ml No. 2, the soft tissues were incised and the flaps were detached, the lateral surface was skeletalized, the lateral window was cut with a piezoelectric knife, the lateral window cover was carefully removed without damaging the Schneider's membrane. Then Schneider's membrane is separated from the floor of the maxillary sinus, thereby freeing up the space between the bone tissue and Schneider's membrane. At the same time, a through hole was drilled into the bone of the alveolar ridge and a bed was formed. A cylindrical implant with a diameter of 4 mm was selected. From the side of the maxillary sinus above the implantation hole, the support element is fixed and compressed in the axial direction by means of a special holding forceps so that when the implant is passed (screwed in), the end entered the hole of the support element to the planned height and was fixed in it. This achieves reliable primary stability. An auto-release membrane is placed between the Schneider membrane and the implant block. Since the support element is domed and perforated, an osteotropic material is embedded in the dome space and around the implant block. The lateral window was covered with a bone fragment that remained after the piezo cut, the edges of the fragment were reinforced with microscrews for stability. The lid of the lateral window was also covered from above with an automembrane. The flaps were put in place, tightly sewn up. At home, in the postoperative period, a soft diet, oral baths, antibiotic Cifran St500 were prescribed 2 times a day for 7 days. Removal of sutures and installation of a denture were carried out on day 10. The patient's state of health is normal. The examination performed 3 months later showed the formation of a developed bone structure in the volume of the graft block.

The foregoing allows us to conclude that the technical problem posed has been solved, and the claimed technical result - an increase in the quality of implantation due to constructive provision of conditions for stable postoperative osteogenesis in the implantation zone - has been achieved.

Claims (3)

1. Implant block containing a threaded implant for through screwing into the bone tissue of the alveolar process of the upper jaw and a support element for installation in the maxillary sinus with support on a prepared bed in interaction with the implant, characterized in that the support element is made of an elastically deformable material with a central dome-shaped part with an internal cavity for placement in the latter of an osteotropic biomaterial and a peripheral support part for contact with the said bed, while in the central domed part there are n grooves emanating from its apex with the formation of n petals, where n is any integer not less than 2. 2. The block of the implant according to claim 1, characterized in that said petals are made with truncated vertices. 3. An implant unit according to claim 1, characterized in that additional grooves that do not intersect with said grooves are made in the support element from the side of the peripheral support part.

Images