RU2771074C1 - Method for manufacturing a fixing plate for fixing fragments of the lower jaw in its fractures without displacement of fragments - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely maxillofacial surgery and surgical dentistry. In case of a fracture of the lower jaw without dislocation of the fragments, the patient takes casts from the upper and lower jaws with the help of an alginate impression mass, then the bite is recorded with a heated wax plate. The resulting casts and wax bite plate are given to a dental laboratory, where a technician makes plaster models with bite detection. Next, on a plaster model of the lower jaw, the dental technician models a wax plate, into which they insert four metal mini-plates with a through hole at the distal end, as shown in dwg 1. The manufactured wax plate with metal mini-plates is plastered into a cuvette. Wax is boiled out of the cuvette, so metal mini-plates remain in the plaster. The resulting space is filled with “Fluorax” mixed with the liquid “Protacril”. The cuvette is packed and boiled for 15 minutes, after which the resulting plastic plate with metal mini-plates with through holes is removed, polished and given to the doctor.

EFFECT: method provides stable fixation of the lower jaw, eliminating the displacement of fragments in vertical and horizontal directions, the possibility of opening the mouth throughout the treatment, the ability to carry out full oral hygiene.

1 cl, 3 dwg, 3 ex

Description

The invention relates to medicine, namely to maxillofacial surgery and surgical dentistry. The method can be used in the treatment of fractures of the lower jaw without displacement of fragments in the presence of teeth.

There are numerous ways of splinting the lower jaw in case of its fractures, when fragments are fixed behind the teeth using metal or plastic caps, metal or plastic arc splints. Their common disadvantage is that these structures do not eliminate the horizontal displacement of fragments, do not provide sufficiently rigid fixation, or require mandatory intermaxillary traction. Also, most of the fixing devices inside the mouth are made of aluminum, stainless steel, which does not favorably affect the periodontium and the body as a whole.

The method proposed by Sauer is known, in 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 to each other with a thinner wire passed through the interdental spaces. Such a splint is bent according to a plaster model, which is first sawn at the fracture sites and glued along the bite with the model of the upper jaw.

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 that occur 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 the method of single-jaw splinting for fractures of the lower jaw within the dentition, including the imposition of an aluminum bent tire with hook loops on the lower jaw and fixing it with metal ligatures to the teeth. Next, I put a plastic plate with hook loops made in the laboratory on the occlusal surface of the lower jaw. Rubber rings are put on the tire loops and plates, which ensure reliable fixation of fragments in the structure (Patent No. 2735258, authors Mellin Ruslan Viktorovich, Sivolapov Konstantin Anatolyevich, Malkov Nikolai Vasilievich, publ. 2020.10.29).

This method has several disadvantages:

1. The design adopts an aluminum tire, which adversely affects the periodontal tissue.

2. The manufacture and fixation of an aluminum tire takes a lot of time from the doctor.

3. The metal ligatures fixing the aluminum tire lose their strength over time, loosen, and tear.

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 a complete oral hygiene.

The purpose is achieved by the method of fixing fragments of the lower jaw in case of its fractures, including the manufacture and fixation of a plastic plate. In case of a fracture of the lower jaw without displacement of fragments in a patient, casts are taken from the upper and lower jaws using an alginate impression mass. Then a bite is registered with a heated wax plate. The resulting casts and a wax bite plate are sent to a dental laboratory, where a technician makes plaster models with bite determination. Next, on a plaster model of the lower jaw, the dental technician models the future plate from wax, into which he inserts four metal mini-plates with a through hole at the distal end. The manufactured wax plate with metal mini-plates is plastered into a cuvette. The wax from the cuvette is boiled out, so metal mini-plates remain in the plaster. The resulting space is filled with "Ftorax" mixed with the liquid "Protacryl". The cuvette is packed and boiled for 15 minutes, after which the resulting plastic plate with metal mini-plates with through holes is removed, polished and given to the doctor. Then, under conduction and/or infiltration anesthesia, a plastic plate with metal mini-plates, having occlusal depressions on both sides, is applied to the teeth of the lower jaw from the chewing surface. Through the through holes in the metal mini-plates, using a drill, four milling holes are made within the cortical layer of the bone through the mucous membrane between the teeth 2.3 and 5.6 on both sides. Screws are inserted into the through holes of the metal mini-plates, thereby tightly fixing the plastic plate to the lower jaw.

Novelty of the invention:

1. A plastic plate is made with metal mini-plates with through holes.

2. A plastic plate with metal mini-plates with through holes for fixation, which allows it to be rigidly fixed to the lower jaw, thereby preventing horizontal displacement.

3. The plastic plate repeats the occlusion of the teeth of the upper and lower jaws in the bite.

4. A plastic plate with metal mini-plates with through holes is installed on the teeth of the lower jaw, having occlusal impressions on both sides. Using titanium screws, a plastic plate is fixed through through holes to the lower jaw from the vestibular side between the roots of teeth 2.3 and 5.6.

The proposed method allows to obtain a new technical result:

1. A plastic plate with metal mini-plates with through holes prevents the displacement of fragments in the horizontal and vertical planes.

2. The plastic plate is fixed on the lower jaw by means of screws, which avoids double jaw splinting.

3. A plastic plate with metal mini-plates with through holes has recesses on the upper and lower surfaces, repeating the chewing surfaces of the jaws, which allows you to fix the lower jaw without separating the teeth from the bite.

4. The method allows the patient to open his mouth at the entire stage of treatment, in contrast to the methods of double jaw splinting, which greatly facilitates oral care.

5. Since with the proposed method there is no 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 treatment time of patients in comparison with double jaw splinting, and is also less traumatic.

7. Standard screws of the company "Konmet" are used, which are included in the standard equipment of the department of maxillofacial surgery. Thus, this method can be used in all regions of the country where there are departments of maxillofacial surgery.

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

9. Opening of the mouth throughout the treatment.

The method is illustrated by the drawings shown in Fig. 1-3.

On FIG. 1 - plastic plate with occlusal impressions and metal mini-plates.

On FIG. 2 - lower jaw with a plastic plate.

On FIG. 3 - fixation of a plastic plate by means of metal mini-plates with through holes.

On the figures: 1 - plastic plate, 2 - metal mini-plates with a through hole, 3 - occlusal impressions.

The method is carried out as follows.

In case of a fracture of the lower jaw without displacement of fragments in a patient, casts are taken from the upper and lower jaws using an alginate impression mass. Then a bite is registered with a heated wax plate. The resulting casts and a wax bite plate are sent to a dental laboratory, where a technician makes plaster models with bite determination. Next, on a plaster model of the lower jaw, the dental technician models the future plate from wax, into which he inserts four metal mini-plates with a through hole 2 at the distal end. The manufactured wax plate with metal mini-plates 2 is plastered into a cuvette. The wax from the cuvette is boiled out, so metal mini-plates 2 remain in the plaster. The resulting space is filled with Fluorax mixed with the Protacryl liquid. The cuvette is packed and boiled for 15 minutes, after which the resulting plastic plate 1 with metal mini-plates with through holes 2 is removed (Fig. 1), polished and given to the doctor. Then, under conduction and / or infiltration anesthesia, a plastic plate 1 with metal mini-plates 2, having occlusal depressions 3 on both sides, is applied to the teeth of the lower jaw from the chewing surface (Fig. 2). Through the through holes in the metal mini-plates 2, using a drill, four milling holes are made within the cortical layer of the bone through the mucous membrane between the teeth 2.3 and 5.6 on both sides. Screws are inserted into the through holes of metal mini-plates 2, thereby tightly fixing the plastic plate 1 to the lower jaw (Fig. 3).

Clinical examples.

Clinical example 1.

Patient I., 33 years old, was admitted to the Department of Maxillofacial Surgery, Reconstructive and Plastic Surgery of the Kuzbass Regional Clinical Hospital with a diagnosis of a mandibular fracture along the body on the right in the projection of teeth 4.3-4.4 without displacement of fragments. The bite was registered in the patient with the help of a heated wax plate, the resulting wax impression was transferred to the dental laboratory, where the dental technician made a plastic overlay with metal mini-plates with a through hole. Further, under conduction anesthesia (torusal anesthesia) on both sides Sol. Lidocaini 2%-8.0 ml on the lower jaw, a ready-made plastic plate obtained from the laboratory with metal mini-plates with a through hole is applied to the lower jaw, the through holes of which are located in the projection between the teeth of the lower jaw 2, 3 and 5, 6, and repeating the chewing surface of the teeth from the upper and lower jaws. Through the through holes of the mini-plates, which, after applying the plastic lining, are located on the vestibular part of the lower jaw in the projection between the roots of teeth 2, 3 and 5, 6, four holes are drilled in the bone using a milling cutter, into which the screws of the Konmet company are inserted through the through holes and tightly tightened. Thus, a rigid fixation was achieved between the plastic plate with metal mini-plates and the lower jaw, eliminating the displacement of the lower jaw fragments in the horizontal and vertical planes. The patient was prescribed a fistula diet (liquid, pureed 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 uneventful, on the 27th day from the moment of fixation of the plastic plate with metal mini-plates, this construction was removed to patient I. under the control of X-ray images.

Clinical example 2.

Patient V., 21 years old, was admitted to the Department of Maxillofacial Surgery, Reconstructive and Plastic Surgery of the Kuzbass Regional Clinical Hospital with a diagnosis of a fracture of the lower jaw between teeth 3.1, 3.2 without displacement of fragments. The patient's bite was registered using a heated wax plate, the resulting wax impression was transferred to the dental laboratory, where the dental technician made a plastic plate with metal mini-plates with through holes. Further, under infiltration anesthesia Sol. Lidocaini 2%-6.0 ml on the lower jaw, a ready-made plastic plate obtained from the laboratory with metal mini-plates is applied to the lower jaw, the through holes of which are located in the projection between the teeth of the lower jaw 2, 3 and 5, 6, and repeating the chewing surface of the teeth from the upper and lower jaws. Through the through holes of the mini-plates, which, after applying the plastic plate, are located on the vestibular part of the lower jaw in the projection between the roots of the teeth 2, 3 and 5, 6, four holes are drilled in the bone using a cutter, into which metal screws are inserted through the through holes of the mini-plates firm "Konmet" and tightly tightened. Thus, between the plastic plate with metal mini-plates with through holes and the lower jaw, rigid fixation was achieved, eliminating the displacement of the lower jaw fragments in the horizontal and vertical plane. The patient was prescribed a fistula diet (liquid, pureed food). On the 7th day, the patient was discharged for outpatient aftercare at the dental clinic No. 1 in Mariinsk. Outpatient follow-up care was uneventful, on the 23rd day from the moment of fixation of the plastic plate with metal mini-plates, this construction was removed to patient V. under the control of X-ray images.

Clinical example 3.

Patient Zh., 27 years old, was admitted to the Department of Maxillofacial Surgery, Reconstructive and Plastic Surgery of the Kuzbass Regional Clinical Hospital with a diagnosis of a bilateral fracture of the lower jaw along the body on the left between teeth 3.4, 3.5 and along the body on the right between 4.2-4.3 without displacement of fragments. The patient's bite was registered using a heated wax plate, the resulting wax impression was transferred to the dental laboratory, where the dental technician made a plastic plate with metal mini-plates with through holes. Further, under conduction (torusal anesthesia) and infiltration anesthesia on both sides Sol. Lidocaini 2%-10.0 ml on the lower jaw, a ready-made plastic plate obtained from the laboratory with metal mini-plates with through holes is applied to the lower jaw, the through holes of which are located in the projection between the teeth of the lower jaw 2, 3 and 5, 6, and repeating the chewing surface of the teeth from the upper and lower jaws. Through the through holes, which, after the application of the plastic plate, are located on the vestibular part of the lower jaw in the projection between the roots of the teeth 2, 3 and 5, 6, four holes are drilled in the bone using a milling cutter, into which metal screws from the Konmet company are inserted through the through holes of the mini-plates. ' and tightly tightened. Thus, a rigid fixation was achieved between the plastic plate with metal mini-plates and the lower jaw, eliminating the displacement of the lower jaw fragments in the horizontal and vertical planes. The patient was prescribed a fistula diet (liquid, pureed food). On day 9, the patient was discharged for outpatient follow-up care at the regional dental clinic in Kemerovo. Outpatient follow-up care was uneventful, on the 29th day from the moment of fixation of the plastic plate with metal mini-plates, this construction was removed to patient G. under the control of X-ray images.

Claims (1)

A method for manufacturing a fixing plate for fixing fragments of the lower jaw in case of its fractures without displacement of fragments, characterized in that in the event of a fracture of the lower jaw without displacement of fragments in a patient, casts are taken from the upper and lower jaws with the help of an alginate impression mass, then the occlusion obtained by a heated wax plate is recorded. casts and a wax plate of the bite are given to the dental laboratory, where the technician makes plaster models with bite determination, then on the plaster model of the lower jaw, the dental technician models the plate from wax, into which he inserts four metal mini-plates with a through hole at the distal end, as shown in fig. 1, the made wax plate with metal mini-plates is plastered into a cuvette, the wax is boiled out from the cuvette, so metal mini-plates remain in the plaster, the resulting space is filled with Fluorax mixed with Protacryl liquid, the cuvette is packed and boiled for 15 minutes , then the resulting plastic plate with metal mini-plates with through holes is removed, polished and given to the doctor.

Images