RU2801340C1 - Method of making a drain for decompression of the epithelial cyst of the jaw in the area of the dentition - Google Patents

Abstract

FIELD: medicine, maxillofacial surgery.

SUBSTANCE: invention can be used as drainage in the surgical treatment of epithelial cysts of the jaw in the area of the dentition using cyst decompression by creating permanent drainage in the cyst cavity, in particular: root cyst (radicular), cyst of the incisive canal (nasopalatine duct). The method of manufacturing a drain for decompression of the epithelial cyst of the jaw in the area of the dentition is as follows: using the data of cone-beam computed tomography (CBCT), the optimal access route to the cyst cavity from the side of the oral mucosa is determined and fixed. Its length is measured. In the industrial 3D modeling system, a virtual simulation of the drainage for decompression of the cyst is performed in the form of a tubular cylindrical segment, the ends of which are provided along the perimeter with a continuous rim. Drainage is modeled with a length between the sides equal to the measured length of the optimal access path to the cyst cavity from the side of the oral mucosa, with a wall thickness of 1 mm and an inner diameter that is the diameter of the drainage outlet, 2–3 mm, and the sides are modeled with a width of 1 mm and with a height of 1 mm relative to the outer surface of the cylindrical segment. According to the virtual drainage model, a virtual simulation of a template for manufacturing a physical drainage is performed by casting and a cylindrical liner, an outlet shaper. Using 3D printing technology, a physical template and an insert are made. Physical drainage is made of silicone. The method solves the problem of the duration of the drainage function.

EFFECT: increase in the duration of the drainage function; the possibility of medicinal product treatment of the internal cavity of the cyst without removing the drainage; improving the safety of the method; increasing the physiology of the method, increasing aesthetics, due to the possibility of using drainage made according to the claimed method in the smile area; simplification of hygiene during the medical treatment of the internal cavity of the cyst by reducing the risk of infection of the wound and simplifying the performance of medical treatment of the internal cavity of the cyst by the health worker and the patient.

1 cl, 21 dwg

Description

The invention relates to medicine, in particular to maxillofacial surgery, and can be used as drainage in the surgical treatment of epithelial cysts of the jaw in the area of the dentition using cyst decompression by creating permanent drainage in the cyst cavity, in particular: root cyst (radicular ), cyst of the incisive canal (nasopalatine duct).

A cyst is a tumor-like formation, which is a cavity, the shell of which consists of an outer connective tissue layer and an inner one, lined mainly with stratified squamous epithelium. The cyst cavity is usually filled with liquid or semi-liquid contents (serous fluid, pus, waste products of the epithelial lining - colloids and crystalloids (cholesterol crystals)). The accumulation of waste products of the epithelial lining, inflammatory processes lead to an increase in hydrostatic pressure in the cyst cavity and to the growth of the cyst.

It is known from the literature that cysts of the jaw in the area of the dentition, namely: root cyst (radicular), cyst of the incisive canal (nasopalatine duct), - refer to epithelial cysts of the jaw "Clinical recommendations, p. 7 - Cysts of the maxillofacial region and neck - 2021-2022-2023 (06/22/2022) - Approved by the Ministry of Health of the Russian Federation").

Very often, the jaw cyst can increase in size asymptomatically and is detected at the stage when the inflammatory process has already formed and surgical treatment is required. In this case, a cystectomy is performed. However, cystectomy is a very traumatic operation. In addition, for example, with the diagnosis of "cyst of the incisive canal of the upper jaw", often the cyst communicates with the nasal cavity and, if it is removed, there is a risk of perforation of the lower nasal passages, and there is also a risk of perforation of the vestibular cortical plate and trauma to the roots of adjacent teeth.

To get out of such situations, beforehand, before cystectomy, a method is used that consists in decompressing the cyst. The method of cyst decompression stops its growth by lowering the hydrostatic pressure inside the cyst shell by creating conditions for the outflow of cystic contents. As a result, there is a problem of creating a method for manufacturing drainage for decompression of the epithelial cyst of the jaw in the area of the dentition with a long time for performing the drainage function, sufficient to carry out the outflow of the contents from the cystic cavity for a long period of time.

The results of the patent information search have shown that at present, for decompression of the epithelial cyst of the jaw in the area of the dentition, drainage is performed in the form of a thin tube with a hole that ensures the outflow of contents from the internal cavity of the cyst.

A method for performing drainage for decompression of the epithelial cyst of the jaw in the area of the dentition is described, according to which the drainage is performed in the form of a thin tube, the length of which corresponds to the depth of the inner membrane of the cyst. For fixation on the mucous membrane of the jaw, the proximal end of the tube is beaded by melting. The distal end of the drainage tube has no means of fixation inside the cyst shell (“Jaw cyst: causes, symptoms and treatment”, article, dentist-surgeon Badalyan K.Yu., https://probolezny.ru/kista-chelyusti/).

A method for manufacturing a drain for decompression of an epithelial cyst of the jaw in the area of the dentition for the treatment of an extensive periapical lesion without curettage of a festering radicular cyst in the area of teeth 1.1, 1.2 and 2.1 is described. (S Balaji Tandri “Surgical treatment of a suppurated radicular cyst by decompression”, Fig. 1f; (Apical surgery) // Source: PubMed Central® Translation from English Stankevich E.V., Kovshik E.V. for the BELODENT.ORG portal https ://belodent.org/article/khirurgicheskiy-method-lecheniya-nagnoi nsheysya-radikulyarnoy-kisty-methodom-dekompressii). In accordance with the method, drainage is made in the form of a thin tube with a hole that ensures the outflow of contents from the internal cavity of the cyst. To ensure an active outflow of fluid, drainage is performed in the form of two independent tubes. The length of each tube is selected in accordance with the required depth of immersion in the cyst cavity. At the outer end of the tubes, for example, by melting, flanging is performed to fix it on the mucous membrane of the alveolar process and to fix the depth of immersion of the tube into the cyst cavity.

Closest to the proposed is a method of manufacturing drainage for decompression of the epithelial cyst of the jaw in the area of the dentition, namely, in the area of the missing 36th tooth ("Decompression technique in the treatment of periapical cysts" D.V. Korotkikh, dental surgeon, chief physician of the clinic "Dent and K" https://dentalmagazine.ru/posts/metodika-dekompressii-pri-lechenii-periapikalnyx-kist.html). In accordance with the method, drainage is made in the form of a thin tube with a hole that ensures the outflow of contents from the internal cavity of the cyst, for which a tube from a standard infusion system is used - a dropper. The advantage of using such a tube is that it has a sufficient diameter, which prevents the formation of various clots; moreover, it can be easily installed and just as easily removed. The end of the tube, which is inserted into the cyst, is cut at an angle of 45°, thereby increasing the area of fluid sampling. The length of the tube is chosen such that it is inserted until it stops. For the manufacture of drainage, a piece of the tube is cut off, longer than necessary, and one end of it is melted to form a flanging, which ensures that the tube is installed inside the cyst to the required depth. Since the plastic melts not only outside, but also inside, after the tube cools down, the excess plastic inside the tube is cut off, restoring the inner diameter of the tube. After that, the beveled end of the tube is inserted into the cyst cavity with rotational movements and the tube is directed into the deepest part of the defect until it stops in the back wall of the focus. In this case, if the tube has an excess length, visually remember the distance at which the tube flange goes above the surface of the oral mucosa. The tube is taken out and, also along the oblique, is cut to the noticed value. As a result, the tube completely enters the defect and the flanging is located on the surface of the mucous membrane. (“Decompression technique in the treatment of periapical cysts” (Fig. 3 - Fig. 6, Fig. 7, Fig. 8, Fig. 11, Fig. 12). D.V. Korotkikh, dental surgeon, chief physician of the Dent clinic and K").

The methods of making drainage for decompression of the epithelial cyst of the jaw in the area of the dentition, identified in the process of information retrieval, have a number of common drawbacks. The rigidity of the material of the drainage tubes does not allow them to adapt to the shape of the inner shell of the cyst during installation and take the optimal position in the cyst cavity, which reduces the efficiency of the outflow of the contents from the cyst cavity. In addition, since the drains for decompression of the cyst of the tooth, made by the identified known methods, are placed inside the cyst shell, in order to prevent the tube inlets from being closed by the internal tissues of the gradually emptying cyst shell, frequent monitoring of the decrease in the level of content in the cyst cavity is required, and, therefore, frequent replacement of drainage tubes is required to change their dimensions. As a result, the drains have a low duration of the drainage function. The low duration of the drainage function of the above drains for decompressing the cyst requires a visit to the doctor every 2 weeks to check the functioning and sufficiency of the length of the tube, and its replacement, which creates discomfort for the patient. At the same time, the drainage occupies the inner space of the cyst membrane, which does not allow performing effective medical treatment of the inner cavity of the cyst without removing it from the cyst cavity. The need to remove it from the cyst cavity for periodic medical treatment of the internal cavity of the cyst and install it in a working position after medical treatment creates discomfort for the patient when performing self-treatment of the internal cavity of the cyst, and is also traumatic. At the same time, since the material of the tubes is hard, the distal ends of the drainage tubes are traumatic, especially in the method closest to the proposed one, in which the distal end of the drainage tube is bevelled at an angle of 45° with a sharp point. As a result, it is difficult and traumatic for the patient to independently perform medical treatment of the internal cavity of the cyst, since the patient must remove the tube from the cavity of the cyst, and then, almost blindly, independently install it in place. In addition, the need for the patient to remove the drainage from the cyst cavity for medical treatment of the internal cavity of the cyst does not allow hygiene conditions to be observed, which can infect an open wound. In addition, in drains made by known methods, there are no means for fixing the distal end of the drain tube, which causes the mobility of the drain, creates discomfort for the patient and reduces the physiology of the drain. In addition, the lack of fastening of the distal end of the drainage tube reduces the reliability of fixation of the drainage in the cyst cavity and may lead to loss of the drainage from the cyst cavity.

In addition, in the known methods, drains are made directly during the operation, which requires the surgeon's experience both in choosing the length of the drainage tube and in choosing the location for its installation. The strong influence of the subjective factor makes the effectiveness of the drainage function dependent on it. In addition, the manufacture of drainage directly during the operation lengthens the duration of the operation, which creates discomfort for the patient and reduces the physiology of the identified methods.

At the same time, the installation of drainages for decompression of the cyst, made according to known methods, is possible only from the vestibular side, which reduces the physiology of the methods, since it creates inconvenience when eating and talking, as well as unaesthetic and imposes restrictions on their installation in the smile area.

Thus, from the foregoing, it follows that at present there is a problem of creating a method for manufacturing a drain for decompressing an epithelial cyst of the jaw in the area of the dentition, with a long time for performing a drainage function.

The proposed method for the manufacture of drainage for decompression of the epithelial cyst of the jaw in the area of the dentition, when implemented, solves the problem of the duration of the drainage function.

In addition, the proposed method of manufacturing drainage for decompression of the epithelial cyst of the jaw in the area of the dentition, when implemented, achieves the technical result: increasing the duration of the drainage function; the possibility of medical treatment of the internal cavity of the cyst without removing the drainage; improving the safety of the method; increasing the physiology of the method, increasing aesthetics, due to the possibility of using drainage made according to the claimed method in the smile area; simplification of hygiene during the medical treatment of the internal cavity of the cyst, by reducing the risk of infection of the wound and simplification of the medical worker and the patient performing medical treatment of the internal cavity of the cyst.

The essence of the invention lies in the fact that in the method of manufacturing drainage for decompression of the epithelial cyst of the jaw in the area of the dentition, including specifying the location of the cyst, the new thing is that cone-beam computed tomography (CBCT) of the head is performed, with the help of which the location of the cyst is specified, then, using CBCT, the optimal access path to the cyst cavity from the side of the oral mucosa is determined and fixed, namely: from the starting point on the oral mucosa to the opening point of the cyst cavity at the access site, the length of the optimal access path to the cyst cavity is measured and the obtained the result, after which, in the industrial 3D modeling system, a virtual simulation of the drainage for decompression of the cyst is performed in the form of a tubular cylindrical segment, the ends of which are provided around the perimeter with a continuous rim that forms a single whole with the cylindrical segment and is bent outward at right angles to the generatrix of the cylindrical segment, which are modeled with a length between the sides equal to the measured length of the optimal access path to the cyst cavity from the side of the oral mucosa, with a wall thickness of 1 mm and an inner diameter that is the diameter of the drainage outlet, 2-3 mm, and the sides are modeled with a width of 1 mm and with a height of 1 mm relative to the outer surface of the cylindrical segment, after which, using the virtual drainage model, a virtual modeling of the template for the manufacture of physical drainage by casting is performed, while the template is modeled in the form of two identical hollow molds with the inner surface of the congruent outer surface of the half of the virtual drainage model formed by the plane passing through the longitudinal axial line of the cylindrical segment, in addition, a cylindrical liner is modeled - the shaper of the outlet (hereinafter referred to as the liner), with a length exceeding the length between the ends of the cylindrical segment, and with a diameter equal to the diameter of the drainage outlet, while in the form of a template on the side of the ends of the cylindrical section, coaxially with the longitudinal axial line of the cylindrical section, recesses are modeled in the form of a semicircle with a radius that ensures the placement of the ends of the cylindrical insert in them with a force, then, according to the obtained virtual models of the template and the cylindrical insert, using 3D printing technology, a physical template and a physical cylindrical liner, then a physical drainage is made of silicone to decompress the cyst, for which liquid silicone is completely filled in the template molds, then a cylindrical liner is placed in one of the template molds, the ends of which are placed in the recesses made in the template, after which both halves of the template are connected, fixed and hold until the silicone solidifies, after which the finished drainage is removed from the template molds and the cylindrical liner is pulled out of the drainage.

The figures from Fig. 1 in FIG. 21 explain the implementation and application of the claimed method of manufacturing a drain for decompression of the epithelial cyst of the jaw in the area of the dentition.

Due to the fact that the information illustrating the simulation of the drainage and the template, as well as the photo of the physical drainage and the physical template do not visually differ for Example 1 and Example 2, then to explain the implementation of the method, the corresponding photographs taken for Example 1 are presented: Fig.1 - Fig. 8.

Figure 1 shows a photograph from the computer screen: a fragment of the virtual simulation of drainage for decompression of the epithelial cyst of the jaw in the area of the dentition; in fig. 2 - fig. 3 shows a photograph from a computer screen: fragments of a virtual simulation of a template for making physical drainage for decompression of the epithelial cyst of the jaw in the area of the dentition; in fig. 4 shows a photograph of a physical template made by 3D printing for manufacturing by casting a physical drainage for decompression of the epithelial cyst of the jaw in the area of the dentition (hereinafter referred to as the template); in fig. 5 shows a photograph of a template with an inserted liner - an outlet shaper (hereinafter referred to as the liner); in fig. 6 shows the moment of connection of both parts of the template; in fig. 7 - both parts of the template are connected and fixed; in fig. 8 is a photograph of a physical drainage for decompression of an epithelial cyst of the jaw in the area of the dentition, made using a physical template made of silicone by casting.

Fig. 9 to FIG. 13 illustrate Example 1: FIG. 9 shows a photograph of the oral cavity, the upper jaw, the visible part of the cyst of the incisive canal of the upper jaw - tooth 2.1 (central left incisor); in fig. 10 - CBCT of the upper jaw: a rounded formation with clear boundaries was found in the region of the upper jaw; preliminary diagnosis: cyst of the incisive canal of the upper jaw; the size of the cyst in the most protruding parts of 21/19/15 mm was determined; the cyst communicates with the nasal cavity; in case of surgical removal of the cyst, there is a risk of perforation of the lower nasal passages; the root of tooth 2.1 protrudes into the cavity of the cyst (central left incisor); in fig. 11 - photograph illustrates the process of medical treatment after opening the cyst before installing the drainage; in fig. 12 - drainage installed in the cyst cavity for decompression of the cyst - view from the oral cavity; in fig. 13 - CBCT of the affected area of the cyst 6 months after the installation of the drainage: a comparative analysis shows that after 6 months there was a partial restoration of the bone tissue in the area of the apex of tooth 2.1; the zone of epithelialization of the inner membrane of the cyst is clearly expressed.

Fig. 14 to 21 illustrate Example 2: FIG. 14, fig. 15, fig. 16 photos of the CBCT result, which revealed the formation of a rounded shape in the area of the tops of the roots 1.1, 1.2; dimensions in the most protruding parts of 14.6/14.9/15 mm, thinning and deformation of the outer cortical plate from the vestibular side, a change in the contour of the alveolar process of the upper jaw due to the growth of the formation, "bulging" in the region of the roots of teeth 1.1, 1.2 from the vestibular side were diagnosed sides; in fig. 17 - photo of the dentition of the upper jaw of the patient, which shows metal-ceramic crowns, due to which access to the root canals of teeth 1.1, 1.2 is difficult; in fig. 18 - photo of the CBCT result, which shows that the cyst was formed in the region of the apices of the roots of teeth 1.1, 1.2, while deformation of the outer cortical plate from the vestibular side, its thinning, change from the vestibular side of the contour of the alveolar process of the upper jaw due to the growth of the formation; in fig. 19 - photo of CBCT, in which the arrow indicates the direction of projection of the starting point on the mucous membrane of the oral cavity to the most convex part of the cyst, where the cortical plate is most thinned; in fig. 20 - control image of the CBCT after the installation of the drainage (the arrow points to the drainage); the drain is placed in accordance with the planned installation position; in fig. 21 - photo of the hard palate of the patient in the area of teeth 1.1 and 1.2 and the rim of the distal end of the drain, fixed on the oral mucosa by means of the rim.

The solution of the identified problem and the achievement of the claimed technical result is carried out as follows.

The essential features of the restrictive part of the claims of the claimed invention: “A method for manufacturing a drain for decompression of the epithelial cyst of the jaw in the area of the dentition, including specifying the location of the cyst, ...” - are an integral part of the claimed method and ensure its feasibility, and therefore provide a solution to the identified problem and achieve the stated technical result.

The use of cone beam computed tomography (CBCT) makes it possible to clarify the size and topography of the cyst, the condition of the mucous membrane and bone walls of the maxillary sinus, and the nasal cavity (Fig. 10, Fig. 14-16). In addition, the use of CBCT provides an increase in the safety and physiology of the claimed method.

In the claimed method, performing CBCT of the head provides the possibility of using specific anatomical parameters that specify the location of the cyst for virtual drainage modeling, namely:

specify the location of the cyst;

determine the optimal access path to the cyst cavity from the side of the oral mucosa from the starting point on the oral mucosa to the opening point of the cyst cavity at the access site;

measure the length of the optimal path of access to the cavity of the cyst.

Cone beam computed tomography (CBCT) allows obtaining a high-quality X-ray image of the dentition and maxillofacial region in three mutually perpendicular planes. Unlike conventional radiography, CBCT is the most informative, as it allows you to obtain images of any anatomical formations in three planes, highlight the layer of the object of interest and nearby organocomplexes with a thickness of 1 to 10 mm [Fadeev, R.A., Sheveleva, Yu.P ., Chibisova, M.A. Methodology for assessing the position of impacted teeth according to dental computed tomography (part 2) / R.A. Fadeev, Yu.P. Sheveleva, M.A. Chibisova // Institute of Dentistry. - 2013. - No. 1. - S. 30-33.]

CBCT uses a single planar sensor for scanning; the generated beam is collimated in the form of a cone. During shooting, the emitter operates continuously, and information is read from the sensor several times per second. Then the information is processed in a computer and a virtual three-dimensional model of the scanned area is restored [Rogatskin, D.V. Radiodiagnostics of the maxillofacial region. Cone beam computed tomography. Fundamentals of visualization / D.V. Rogatskin. - Lvov: GalDent, 2010. - 148 p. ].

As a result, CBCT allows you to perform a similar study, with less radiation exposure, compared to other radiological methods, such as OPTG, TRH, which is extremely important for patients. Radiation exposure from one CBCT study varies from 0.04 to 0.08 mSv depending on the type of tomograph. According to SanPin 2.6.1.802-99, for practically healthy individuals, the annual effective dose during preventive medical radiological procedures should not exceed 1 mSv. Based on these data, the method of cone-beam computed tomography can be attributed to low-dose studies [SanPin 2.6.1.802-99 "Hygienic requirements for the design and operation of X-ray rooms, apparatus and X-ray examinations"].

The study is not burdensome in terms of patient positioning, non-invasive, with low radiation exposure when using CBCT, namely, when implementing this method, from 0.01 mSv (for children) to 0.05 mSv (for adults).

In the claimed method of manufacturing drainage for decompression of the epithelial cyst of the jaw in the area of the dentition, 3D modeling is used. In the system of industrial 3D modeling, a virtual simulation of the drainage for decompression of the cyst (Fig. 1) is performed in the form of a tubular cylindrical segment, the ends of which are provided along the perimeter with a continuous rim that forms a single whole with the cylindrical segment and is bent outward at right angles to the generatrix of the cylindrical segment, which is modeled with a length between the sides equal to the measured length of the optimal access path to the cyst cavity from the side of the oral mucosa, with a wall thickness of 1 mm and an internal diameter that is the diameter of the drainage outlet, 2-3 mm, and the sides are modeled with a width of 1 mm and with a height of 1 mm relative to the outer surface of the cylindrical segment (Fig. 1).

Performing a virtual simulation of the drainage for decompression of the cyst in the industrial 3D modeling system allows you to visually evaluate the simulation result and eliminate the observed shortcomings before making a physical drainage. At the same time, the use of virtual 3D modeling in conjunction with the results of CBCT makes it possible to make drainage for decompression of the cyst without the participation of the patient in advance, before the operation, and for a specific patient.

In addition, the use of virtual drainage simulation for the manufacture of physical drainage makes it possible to implement it using a template, which, in turn, in the claimed method allows you to make a template in the form of a casting mold and make a physical drainage using a silicone casting method, providing the possibility of obtaining elastic drainage for cyst decompression for a specific patient with individual geometric dimensions.

In this case, the template is modeled in the form of two identical hollow forms with an inner surface congruent to the outer surface of half of the virtual drainage model, formed by a plane passing through the longitudinal axial line of the cylindrical segment, which, in the future, ensures the accuracy of reproducing the geometric dimensions of the physical drainage in silicone (Fig. 2 , Fig. 3). In addition, a cylindrical liner outlet shaper (hereinafter referred to as the liner) (not shown) is modeled, with a length exceeding the length between the ends of the cylindrical segment, and with a diameter equal to the diameter of the drainage outlet. In this case, in the forms of the template, from the side of the ends of the cylindrical segment, coaxially with the longitudinal axial line of the cylindrical segment, recesses are modeled in the form of a semicircle with a radius that ensures the placement of the ends of the cylindrical insert in them with force.

According to the obtained virtual models of the template and the cylindrical liner using 3D printing technology, a physical template and a physical cylindrical liner forming the outlet are made (Fig. 4, Fig. 5).

Physical drainage for cyst decompression is made of silicone, which is widely used in dentistry, which ensures the physiological nature of the proposed method. The molds of the template are completely filled with liquid silicone (in order not to darken the elements of the template, the molds are not filled with silicone in Figs. 4-7). In one of the forms of the template, a cylindrical insert is placed, the ends of which are placed in the recesses made in the template (Fig. 5). After that, both halves of the template are connected (Fig. 6, Fig. 7). Since the recesses for setting the ends of the cylindrical insert are modeled on both forms of the template from the side of the ends of the cylindrical segment coaxially with the longitudinal axial line of the cylindrical segment, while the recesses in the form of a semicircle have a radius that ensures the placement of the ends of the cylindrical insert in them with force, the forms are connected strictly along the axial . At the same time, the liner, due to the proposed placement in the template and due to the given dimensions, forms a drainage outlet, and strictly along the axial cylindrical segment. Excess silicone is squeezed out through the side connecting seams at the moment of joining the halves of the template. After the silicone has hardened, the connecting seams are cleaned. The connected halves of the template are fixed and kept until the silicone hardens (Fig. 7). The finished drainage (Fig. 8) is taken out of the molds of the template and a cylindrical insert is pulled out of it. In this case, the resulting wall thickness of the physical drainage will be equal to half the difference between the outer diameter of the cylindrical part of the drainage and the diameter of the liner, i.e. 1 mm: (4 mm - 2 mm) / 2 or (5 mm - 3 mm) / 2 - for the diameter of the liner 2 mm and 3 mm, respectively, the diameter of which is the diameter of the drainage outlet.

Virtual simulation of drainage for decompression of a cyst in the form of a tubular cylindrical segment, that is, with a cylindrical shape of the drainage channel, is optimal due to the absence of sharp corners and edges, which, together with the elastic material of the physical drainage (silicone), makes the shape of the drainage outlet channel physiological for a living organism. Due to the fact that the ends of the cylindrical segment are provided along the perimeter with a continuous rim, which forms a single whole with the cylindrical segment and is bent to the outside at a right angle to the generatrix of the cylindrical segment, and also due to the elasticity of the physical drainage material, it is possible to move the drainage inside the cyst shell along the access made in cyst. At the same time, the rim of the distal end of the drainage is pressed against the side surface of the cylindrical segment, and inside the cyst shell, the rim, due to the elasticity and elasticity of silicone, straightens out. As a result, the drainage is fixed by the side of the distal end inside the cyst on the mucous membrane at the site of access to the cyst. With the side of the proximal end, the drainage is fixed on the surface of the oral mucosa at the starting point of the optimal access path to the cyst cavity. At the same time, since the cylindrical segment is modeled with a length between the sides equal to the measured length of the optimal access path to the cyst cavity from the side of the oral mucosa, the physical drainage with the distal and proximal ends is securely fixed both in the cyst cavity and on the oral mucosa, and does not move further. At the same time, since the drainage is modeled based on the possibility of access to the cyst cavity from the side of the oral mucosa, and also with the possibility of fixing the proximal end of the drainage from the side of the oral cavity, this makes it possible to install drainage even in the smile area, which increases the aesthetics of the claimed decompression method. At the same time, since after the installation of the drainage, the side of the proximal end fits snugly against the mucous membrane of the oral cavity, its presence in the oral cavity does not inconvenience the process of chewing food, and also does not affect articulation, which increases the physiology of the claimed method.

At the same time, the implementation of physical drainage from silicone provides, during its installation, the possibility of deformation of the drainage, as a reaction to the shape of the surface of the installation path mating with it, without reducing the size of the outlet due to the elasticity and resilience of silicone, and, therefore, without further reducing the drainage efficiency, without reducing the reliability of attachment of its distal end to the walls of the cyst, and the proximal end to the oral mucosa. In addition, due to elasticity, the rim of the distal end of the drain adapts to the shape of the inlet to the cyst, which eliminates the rupture of the cyst tissues and ensures reliable fixation of the distal end of the drain inside the cyst on the mucous membrane.

The side of the distal end of the cylindrical segment of physical drainage due to elasticity, pressing against the inner surface of the cyst, keeps the drainage hole in the cyst open, keeping the height of the internal volume of the cyst. As a result, the possibility of closing the drainage inlet with an emptying cyst shell is excluded, despite the decreasing pressure difference, which makes it possible to remove the contents from the cyst as much as possible and thereby reduce the time of cyst epithelialization. As a result, a free volume is constantly formed near the drainage inlet inside the cyst to receive the remaining liquid medium, which ensures continuous outflow from the cyst cavity through the drainage and ensures that the drainage function is performed for a long time. At the same time, drainage replacement is required only if it is clogged with food debris, which, when performing drainage with the stated dimensions, was not detected as a result of control after 3 months from the date of installation of the drainage (as experience showed, Example 1).

If necessary, the drainage is pulled out from the mucous membrane of the oral cavity. At the same time, the side of the distal end of the physical drainage, due to the elasticity of the silicone, is compressed towards the axial line of the cylindrical segment, without creating obstacles for removing the drainage from the cyst shell.

Accepted in the claimed invention, the quantitative values of the geometric dimensions of the drainage in virtual modeling are due to the following. It is known from the literature that cystogranuloma is a harbinger of a cyst. In this case, the maximum diameter of the cystogranuloma is 0.8 cm. Thus, the formed cyst has a size of more than 0.8 cm (Textbook "Therapeutic Dentistry", Borovsky, Ivanov, Maksimovsky, Maksimovskaya. Moscow: "Medicine", 2001, p. 338 ). Also known from the literature is the accepted division of odontogenic cysts into small, medium and large. Small cysts include cysts up to 1.5 cm in diameter, not extending beyond the alveolar process, medium-sized cysts up to 2.5 cm in diameter with spread to the jaw body, and large cysts more than 2.5 cm in diameter also extending to the jaw body (“Surgical treatment of odontogenic jaw cysts”, Folia Otorhinolaryngologica, Vol.15, No. 2, 2009, p. 17). In the claimed method, in virtual simulation, the maximum transverse dimension of the tubular cylindrical section of the drainage is 0.5 cm (wall thickness plus the diameter of the outlet), and the maximum transverse dimension of the drainage as a whole, including the sides, is 0.7 cm. the size of the drain allows the use of the claimed method of manufacturing a drain for decompression of the epithelial cyst of the jaw in the area of the dentition in a wide size range of cysts, which provides a solution to the problem and the claimed technical result.

The height of the side of 1 mm was obtained empirically and is optimal. An inner diameter of 2-3 mm, as experience has shown, provides an effective outflow of the contents of the cyst membrane and increases the duration of the drainage function, and is optimal. The thickness of the drainage walls of 1 mm ensures the strength of the drainage in combination with elasticity and resilience and is optimal.

In the claimed method, it is possible to fix the distal end of the drainage on the mucous membrane of the inner wall of the cyst, as a result of which the drainage does not occupy the internal space of the cyst shell. This eliminates the need to remove the drainage for effective medical treatment of the inner space of the shell of the hand.

Reliable fixation of the drainage both in the cyst shell and on the mucous membrane of the oral cavity, as well as the absence of the need to remove it for medical treatment of the inner space of the shell of the hand, creates comfortable and safe conditions for the patient to perform independent antiseptic medical treatment of the internal cavity of the cyst by the patient and for observance of hygienic rules, the risk of infection of the wound is reduced and the performance of medical treatment of the internal cavity of the cyst by the medical worker and the patient is simplified.

Thus, from the foregoing, it follows that the proposed method for manufacturing drainage for decompression of the epithelial cyst of the jaw in the area of the dentition, when implemented, solves the problem of the duration of the drainage function.

In addition, the proposed method of manufacturing drainage for decompression of the epithelial cyst of the jaw in the area of the dentition, when implemented, achieves the technical result: increasing the duration of the drainage function; the possibility of medical treatment of the internal cavity of the cyst without removing the drainage; improving the safety of the method; increasing the physiology of the method, increasing aesthetics, due to the possibility of using drainage made according to the claimed method in the smile area; simplification of hygiene during the medical treatment of the internal cavity of the cyst, by reducing the risk of infection of the wound and simplification of the medical worker and the patient performing medical treatment of the internal cavity of the cyst.

The inventive method of manufacturing drainage for decompression of the epithelial cyst of the jaw in the area of the dentition is as follows. A cone beam computed tomography (CBCT) of the head is performed to clarify the location of the cyst (Fig. 10, Fig. 14-16). Then, using CBCT, the optimal access path to the cyst cavity is determined and fixed from the side of the oral mucosa, namely: from the starting point on the oral mucosa to the opening point of the cyst cavity at the access site, the length of the optimal access path to the cyst cavity is measured and the obtained result. After that, in the system of industrial 3D modeling, a virtual simulation of the drainage for decompression of the cyst (Fig. 1) is performed in the form of a tubular cylindrical segment, the ends of which are provided along the perimeter with a continuous rim that forms a single whole with the cylindrical segment and is bent outward at right angles to the generatrix of the cylindrical segment. A cylindrical segment is modeled with a length between the sides equal to the measured length of the optimal access path to the cyst cavity from the side of the oral mucosa, with a wall thickness of 1 mm and an inner diameter that is the diameter of the drainage outlet, 2-3 mm, and the sides are modeled with a width of 1 mm and with a height of 1 mm relative to the outer surface of the cylindrical segment. After that, according to the virtual drainage model, virtual modeling of the template for the manufacture of physical drainage by casting is performed (Fig. 2, Fig. 3). The template is modeled in the form of two identical hollow molds with an inner surface congruent to the outer surface of a half of the virtual drainage model, formed by a plane passing through the longitudinal axial line of the cylindrical segment. In addition, a cylindrical liner is modeled - the outlet hole shaper (hereinafter referred to as the liner), with a length exceeding the length between the ends of the cylindrical segment, and with a diameter equal to the diameter of the drainage outlet. In this case, in the forms of the template, from the side of the ends of the cylindrical segment, coaxially with the longitudinal axial line of the cylindrical segment, recesses are modeled in the form of a semicircle with a radius that ensures the placement of the ends of the cylindrical insert in them with force. According to the obtained virtual models of the template and the cylindrical insert, a physical template (Fig. 4, Fig. 5) and a physical cylindrical insert (not shown) are made using 3D printing technology. Then, a physical drainage is made of silicone for decompression of the cyst, for which the template molds are completely filled with liquid silicone, then a cylindrical insert is placed in one of the template molds (Fig. 6, Fig. 7), the ends of which are placed in the recesses made in the template, after which both halves of the template are connected, fixed and held until the silicone hardens. The finished drain (Fig. 8) is removed from the molds of the template and a cylindrical insert is pulled out of the drain.

The finished drainage is removed from the molds of the template using a cylindrical insert, the length of which exceeds the length between the ends of the cylindrical segment. To do this, the length of the liner is chosen to provide a comfortable grip of the liner with the fingers both when it is laid in the form of a template, and when it is removed from the finished drainage. After that, the cylindrical liner is pulled out of the drainage. The silicone that comes out is cleaned to a smooth surface.

Currently, there is a wide range of programs for virtual 3D modeling in dentistry, such as Exocad, 3Ds Max, Inlab, etc.

In the claimed method of manufacturing a drain for decompression of the epithelial cyst of the jaw in the area of the dentition, Exocad software, the most widely used at present, was used for virtual modeling.

Currently, Exocad Software is the complete and most advanced solution designed for digital dentistry (https://3d-m.ru/programmnoe-obespechenie-exocad/).

Exocad has a wide range of applications that enhance its functions and, in addition, offer a reliable, simple and stable platform for most of today's applications.

Exocad software has a number of advantages that determine its popularity and demand, in particular: a comprehensive software solution focused on digital dentistry;

high speed of data processing and work;

a wide range of indications;

the presence of a wide range of applications that provide the ability to connect extensions for other indications.

Thus, in the claimed method of manufacturing drainage for decompression of the epithelial cyst of the jaw in the area of the dentition to form a virtual model of drainage for decompression of the jaw cyst and a template for the manufacture of drainage by casting in an industrial 3-D modeling system, the Exocad software is used for virtual modeling - as the most widely used at present. The result of virtual simulation using the Exocad Software is illustrated by the figures attached to the description of the invention, made from a computer screen and explaining Examples of the claimed method, which, in turn, confirm the possibility of implementing the claimed method, solving the identified problem and achieving the claimed technical result (Fig. 1 , Fig. 2, Fig. 3).

3D printing is a technique for manufacturing three-dimensional products based on digital models. Regardless of the specific technology, the essence of the process is the gradual layer-by-layer reproduction of objects. In this process, a special device is used - a 3D printer that prints certain types of materials. The 3D printing process includes the following operations: perform 3D modeling of the required object according to certain rules; a file with a digital model is loaded into a slicer program, in which a control code for a 3D printer is generated; set the necessary 3D printing parameters; the code is written to a removable storage medium that is connected to a 3D printer; The 3D model is reproduced.

The possibilities of 3D printing are almost endless, up to the use in technologies for the manufacture of very thin overhanging elements https://3ddevice.com.ua/faq-voprosy-i-answer-o-3d-printerakh/chto-takoe-3d-pechat/ For the implementation of the claimed method of manufacturing drainage for decompression of the epithelial cyst of the jaw in the area of the dentition, a Formlabs 3 3D printer was used.

In the exemplary embodiments, a HARZLabs Model Resin photopolymer, transparent, which is widely used for making navigation templates, was used as the printer material for the manufacture of the physical template and the physical cylindrical insert.

For the manufacture of physical drainage by casting, for example, Flexilis silicone can be used: food, medical, platinum-based. Safe, non-toxic, good flowability, curing at room temperature, used in particular for casting, for rapid prototyping. Due to the high tensile and tear strength and excellent resistance to deformation, ready-made molds made of J-series silicones not only have a long service life, but also perfectly retain their characteristics when replicated (https://propitay.ru/product/silikon-flexilis -pishhevoj/).

The possibility of implementing the proposed method for manufacturing a drain for decompression of the epithelial cyst of the jaw in the area of the dentition and an example of the use of a drain made in accordance with the claimed method are confirmed by the following examples of the method.

Example 1. Patient Yu., aged 34, applied for orthodontic treatment and bite correction using a bracket system.

Complaints: malocclusion, discomfort during meals, reaction of tooth 2.1 to temperature stimuli, aesthetic disorders.

During the examination, a cone-beam computed tomography was performed, which revealed a rounded formation in the central part of the upper jaw. The dimensions in the most protruding parts are 21.06 / 19.45 / 15.67 mm (Fig. 10). Education was located symmetrically with respect to the left and right half of the upper jaw (Fig.9, Fig. 10). In the picture (Fig. 10), resorption of the apex of the root of tooth 2.1 was diagnosed. Change in the contour of the alveolar process of the upper jaw in the central section due to the growth of the formation. Destruction of the end cortical plate in the area of the hard palate, on the border of the nasal cavity. A preliminary diagnosis was made: a cyst of the incisive canal of the upper jaw.

When such a formation is detected, as a rule, the tactics of radical surgical treatment are used - cystectomy, that is, the removal of the cyst along with the membrane.

However, cystectomy is a very traumatic operation. In addition, in this case, the cyst communicates with the nasal cavity and, if the cyst is removed, there is a risk of perforation of the lower nasal passages, perforation of the vestibular cortical plate, trauma to the roots of teeth 1.1, 2.1. At the same time, the root of tooth 2.1 (central left incisor) protrudes into the cavity of the cyst. Tooth 2.1 is alive, and for the operation of cystectomy, this tooth needs to be endodontically treated: treat the canal and seal it, which is not desirable.

Taking into account the above, it was decided to decompress the cyst before the cystectomy operation by creating a permanent drainage in the cyst cavity, performed in accordance with the claimed method of making a drainage for decompressing the epithelial cyst of the jaw in the area of the dentition.

Perform a cone beam computed tomography (CBCT) of the head (Fig. 10), which specifies the location of the cyst. Then, using CBCT, the optimal access path to the cyst cavity is determined and fixed from the side of the oral mucosa, namely: from the starting point on the oral mucosa to the opening point of the cyst cavity at the access site, the length of the optimal access path to the cyst cavity is measured and the obtained result.

In this example, the drainage installation site is performed from the side of the hard palate. Since tooth 1.2. protrudes into the cyst cavity, then, using the results of CBCT, the starting point on the oral mucosa was chosen in the central section of the hard palate opposite tooth 1.2 in the area of violation of the contour of the alveolar process of the upper jaw. In this case, the opening point of the cyst cavity at the site of access to the cyst shell is a projection onto the root of the tooth 1.2 of the starting point on the oral mucosa. Thus, in the exemplary embodiment, the optimal way to access the cyst cavity from the side of the oral mucosa is the projection line on the root of the tooth 1.2 of the starting point on the oral mucosa. Since in this place the cortical plate of the bone tissue itself is destroyed by the cyst cavity, the length of the drainage between the sides will correspond to the thickness of the oral mucosa in the region of the starting point, namely 4 mm.

The choice of the access site was also chosen due to the lack of a cortical plate, so as not to additionally resect the bone tissue to fix the drainage.

It was decided to make the inner diameter of the drainage 2 mm for the free passage of the antiseptic solution during processing.

In the system of industrial 3D modeling, a virtual simulation of the drainage for decompression of the cyst is performed in the form of a tubular cylindrical segment with a wall thickness of 1 mm and an inner diameter that is the diameter of the drainage outlet, 2-3 mm, the ends of which are provided along the perimeter with a continuous rim that forms a single rim with the cylindrical segment. whole and bent to the outside at a right angle to the generatrix of the cylindrical segment (Fig. 1). The length of the cylindrical segment between the sides is modeled equal to the measured length of the optimal access path to the cyst cavity from the side of the oral mucosa, and the sides are modeled with a width of 1 mm and a height of 1 mm relative to the outer surface of the cylindrical segment.

After that, according to the virtual drainage model, virtual modeling of the template for the manufacture of physical drainage by casting is performed (Fig. 2, Fig. 3). The template is modeled in the form of two identical hollow molds with an inner surface congruent to the outer surface of a half of the virtual drainage model, formed by a plane passing through the longitudinal axial line of the cylindrical segment.

In addition, a cylindrical liner is modeled, the outlet shaper (hereinafter referred to as the liner), with a length exceeding the length between the ends of the cylindrical segment, and with a diameter equal to the diameter of the drainage outlet (not shown). In this case, in the forms of the template, from the side of the ends of the cylindrical segment, coaxially with the longitudinal axial line of the cylindrical segment, recesses are modeled in the form of a semicircle with a radius that ensures the placement of the ends of the cylindrical insert in them with force. The length of the liner is chosen to provide a comfortable grip of the liner with the fingers both when it is laid in the form of a template, and when it is removed from the finished drainage.

According to the obtained virtual models of the template and the cylindrical liner, a physical template (Fig. 4) and a physical cylindrical liner (not shown) are made using 3D printing technology.

A physical drain was then made from Flexilis silicone to decompress the cyst. The template forms are completely filled with liquid silicone, then a cylindrical insert is placed in one of the template forms (Fig. 5 - the form is not filled out for informational content), the ends of which are placed in the recesses made in the template. After that, both halves of the template are connected, fixed and held until the silicone solidifies (Fig. 6, Fig. 7).

The template forms are disconnected. The finished drainage (Fig. 8) is removed from the molds of the template using a cylindrical liner, the length of which exceeds the length between the ends of the cylindrical segment, for which the length of the liner is chosen to provide a comfortable grip of the liner with the fingers both when it is laid in the template and when the finished drainage is removed . At the same time, the silicone is easily separated from the surface of the mold and the liner. After that, the liner is pulled out of the drainage. If necessary, the joints of the halves of the drainage are cleaned to a smooth surface.

The patient was assigned the day of the operation to install a drain to decompress the epithelial cyst.

At a doctor's appointment, at a pre-selected starting point (see above) of the optimal access route to the cyst cavity, an incision was made with a scalpel on the oral mucosa, symmetrical with respect to the starting point, with a length equal to the outer diameter of the drainage along the sides. After that, the same scalpel was used to access the cyst cavity from the side of the oral mucosa along the fixed optimal access route and the cyst membrane was opened. Then, using a tube and a syringe (Fig. 11), through the access made, aspiration of the contents of the cyst and medical treatment of the inner membrane of the cyst were performed. After that, the drainage was installed, moving it into the cyst cavity from the side of the oral mucosa along the access made. As a result, the rim of the distal end of the cylindrical segment of the drainage was brought inside the cyst shell, and the proximal end of the drainage was fixed by means of the rim and additionally with non-absorbable suture material on the surface of the oral mucosa in the region of the starting point of the optimal access path to the cyst cavity (Fig. 12). At the same time, due to the fact that the length of the drainage between the sides is equal to the length of the selected access path to the cavity of the cyst shell, the side of the distal end of the drainage is pressed from the inside to the mucous membrane of the cyst and is securely fixed due to the formed tension of the drainage.

Drainage is left in the cyst cavity until there is no exudate to be separated from the cyst cavity.

Given the large size of the formation, the timing of treatment is not exactly known. According to the literature, the decompression period can reach up to 2 years.

The patient was examined after 3 and 6 months. After 6 months, the drainage retained its drainage function. The drainage was replaced with a similar one for hygienic reasons. In the intervals between examinations, the patient independently performed medical treatment of the cyst cavity through drainage: daily, 2-3 times a day. However, she did not experience any problems.

The results of the survey after 6 months are shown in Fig. 13. After 6 months, restoration of bone tissue in the area of the apex of tooth 2.1 is visible.

The size of the cyst has noticeably decreased:

was 21.06/19.45/15.67 mm (Fig. 10);

became 15.62 / 11.63 / 11.37 mm (Fig. 13).

EXAMPLE 2. Patient Yu., 33 years old, turned to a dentist-therapist with complaints of discomfort in the area of teeth 1.1, 1.2, the appearance of "bulging" in the area of the roots of teeth 1.1, 1.2 from the vestibular side, the appearance of increased mobility of teeth 1.1, 1.2.

Anamnesis: teeth 1.1, 1.2 previously treated for complicated caries about 7 years ago. After endodontic treatment, teeth 1.1, 1.2 were covered with ceramic-metal crowns.

8 during the examination, a cone-beam computed tomography was performed (Fig. 14-16), on which a rounded formation was found in the area of the tops of the roots 1.1, 1.2. The dimensions in the most protruding parts are 14.6 / 14.9 / 15 mm. The picture shows a deformation of the outer cortical plate from the vestibular side, a change in the contour of the alveolar process of the upper jaw due to the growth of the formation. The diagnosis was made: radicular cyst of the upper jaw in the area of teeth 1.1, 1.2.

Root (radicular) cyst (K04.8) occurs in the presence of a chronic inflammatory process in the periapical tissue of the tooth. The accumulation of waste products of the epithelial lining, inflammatory processes lead to an increase in hydrostatic pressure in the cyst cavity and to the growth of the cyst. Clinically, a root cyst is usually found in the area of a destroyed or treated tooth. (Clinical guidelines - Cysts of the maxillofacial region and neck -2021-2022-2023 (06.22.2022) - Approved by the Ministry of Health of the Russian Federation)

Conservative treatment includes treatment or re-treatment of root canals and their filling. In this case, access to the root canals of teeth 1.1, 1.2 was difficult due to the presence of metal-ceramic crowns (Fig. 17). The procedure for removing crowns involves sawing them along, which often leads to a fracture or crack in the roots of the abutment teeth. A radical method of treatment, namely: the extraction of teeth 1.1, 1.2, can lead to the appearance of a large defect in the bone tissue in the area of the extracted teeth 1.1, 1.2, which in the future will lead to the impossibility of carrying out the method of prosthetics using dental implants.

A treatment option was chosen that includes two stages. At stage I, a decompression operation is performed, namely: a cystotomy type communication with the oral cavity is created, sufficient to carry out the outflow of contents from the cystic cavity for a long period.

At stage II, after complete decompression of the cyst, it is planned to perform the extraction of teeth 1.1, 1.2, followed by the installation of dental implants and prosthetics.

Given the significant volume of the cyst, its intimacy with important anatomical formations: the bottom of the nasal cavity, the roots of the teeth 1.1,1.2.; possible risks during radical cystectomy surgery: perforation of the nasal cavity, perforation of the vestibular cortical plate, trauma to the roots of teeth 1.1, 1.2, it was decided to decompress the cyst in accordance with the claimed method of decompression of the epithelial cyst of the jaw in the area of the dentition.

To perform the decompression of the cyst, by analogy with Example 1, a drain was made in accordance with the claimed method for manufacturing a drain for decompression of the epithelial cyst of the jaw in the area of the dentition.

The geometric dimensions of the drainage were determined as follows. Based on the CBCT data (Fig. 18), in contrast to Example 1, in Example 2, the cyst was formed in the area of the tops of the roots 1.1, 1.2. At the same time, the following is observed: deformation of the outer cortical plate from the vestibular side, its thinning, change from the vestibular side of the contour of the alveolar process of the upper jaw due to the growth of the formation, "bulging" in the region of the roots of teeth 1.1, 1.2 from the vestibular side (Fig. 14-16; Fig. . 18).

The place of installation of the drainage was performed from the side of the oral cavity: from the side of the hard palate. The starting point on the oral mucosa was chosen in the central part of the hard palate opposite the teeth 1.1 and 1.2 in the area of violation of the contour of the alveolar process of the upper jaw.

Using CBCT data (FIGS. 14-16; FIG. 18), the starting point on the oral mucosa was projected to the most convex part of the cyst, where the cortical plate was most thinned (FIG. 19, in the direction of the arrow). Thus, in Example 2, the optimal way to access the cyst cavity from the side of the oral mucosa is the projection line of the starting point on the oral mucosa to the access point in the cyst cavity, which passes from the starting point on the oral mucosa through the thinnest place in the cortical plate in the region of teeth 1.1, 1.2 to the access point to the cyst cavity, namely to the point of projection of the starting point on the mucous membrane of the oral cavity on the most convex part of the cyst. The measured length of the optimal access path to the cyst cavity from the side of the oral mucosa was 4 mm.

The length of the cylindrical segment of the drainage between the sides was modeled equal to 4 mm, the wall thickness was 1 mm, the sides were modeled with a width of 1 mm and a height of 1 mm relative to the outer surface of the cylindrical segment. The inner diameter, which is the diameter of the drainage outlet, is chosen to be 3 mm for the free passage of the antiseptic solution during processing.

The patient was assigned the day of the operation to install a drain to decompress the epithelial cyst.

At the doctor's appointment, the patient underwent local infiltration anesthesia in the area of the hard palate. At a pre-selected starting point of the optimal path of access to the cyst cavity on the oral mucosa, an incision was made with a scalpel of the mucosa to the bone, the mucoperiosteal flap was peeled off with a raspator within 3 mm to create access for surgical cutters. With the use of a physiodispenser and surgical cutters, a staged perforation of the bone cortical plate was performed in accordance with the chosen optimal path of access to the cyst cavity. The cutters were used starting with a Lindemann pilot cutter with a diameter of 2 mm, and ended with a cutter of 5 mm, which corresponds to the outer diameter of the drain (inner diameter 3 mm, wall thickness 1 mm). The cyst cavity was washed with an antiseptic solution of chlorhexidine 0.05%, by analogy with Example 1.

After that, the drainage was installed, moving it into the cyst cavity from the side of the oral mucosa along the access made. As a result, the rim of the distal end of the cylindrical segment of the drainage was brought inside the cyst shell, and the proximal end of the drainage was fixed by means of the rim on the surface of the oral mucosa in the region of the starting point of the optimal access path to the cyst cavity. Additional fixation of the drainage with suture material was not required (Fig. 21).

Control computed tomography was performed (Fig. 20, drainage in the direction of the arrow).

Drainage was left in the cavity of the cyst until the complete absence of discharged exudate from the cavity of the cyst.

After 7 days, the patient was invited for a follow-up examination. The condition of the surgical wound is satisfactory. The patient was taught how to independently wash the cyst cavity with an antiseptic solution of chlorhexidine 0.05%. Washing is prescribed twice a day: in the morning after breakfast and in the evening before bedtime.

A visit to the doctor is scheduled every three months.

Claims (1)

A method for manufacturing a drain for decompression of an epithelial cyst of the jaw in the area of the dentition, including specifying the location of the cyst, characterized in that cone-beam computed tomography (CBCT) of the head is performed, with the help of which the location of the cyst is specified, then the optimal access path to the the cyst cavity from the side of the oral mucosa, namely: from the starting point on the oral mucosa to the opening point of the cyst cavity at the access site, the length of the optimal access path to the cyst cavity is measured and the result obtained is recorded, after which in the industrial 3D modeling system virtual simulation of drainage for decompression of the cyst is performed in the form of a tubular cylindrical segment, the ends of which are provided along the perimeter with a continuous side, which is integral with the cylindrical segment and bent outward at a right angle to the generatrix of the cylindrical segment, which is modeled with a length between the sides equal to the measured length optimal access path to the cyst cavity from the side of the oral mucosa, with a wall thickness of 1 mm and an inner diameter, which is the diameter of the drainage outlet, of 2-3 mm, and the sides are modeled with a width of 1 mm and a height of 1 mm relative to the outer surface of the cylindrical segment , after which, according to the virtual drainage model, virtual modeling of the template for the manufacture of physical drainage by casting is performed, while the template is modeled in the form of two identical hollow molds with the inner surface of the congruent outer surface of the half of the virtual drainage model, formed by a plane passing through the longitudinal axial line of the cylindrical segment, in addition, a cylindrical liner is modeled - the shaper of the outlet (hereinafter referred to as the liner), with a length exceeding the length between the ends of the cylindrical segment, and with a diameter equal to the diameter of the drainage outlet, while in the forms of the template from the ends of the cylindrical segment coaxially with the longitudinal axial with a line of a cylindrical segment, recesses in the form of a semicircle with a radius ensuring the placement of the ends of the cylindrical liner with force are modeled, then, using the obtained virtual models of the template and the cylindrical liner, a physical template and a physical cylindrical liner are made using 3D printing technology, then a physical drainage is made from silicone for decompression of the cyst, for which the molds of the template are completely filled with liquid silicone, then a cylindrical insert is placed in one of the molds of the template, the ends of which are placed in the recesses made in the template, after which both halves of the template are connected, fixed and held until the silicone hardens, after which the finished the drainage is taken out of the molds of the template and the cylindrical liner is pulled out of the drainage.