RU2813523C1 - Method of increasing soft tissue volume during dental implants installation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to dentistry. Soft tissue graft is sampled from the palate. Two flaps are cut and detached: vestibular and oral. Soft tissue graft is positioned and fixed at the beginning of the wound with an interrupted suture. Needle is inserted perpendicular to tissues at 4 mm from the wound edges. Vestibular flap is pierced through, a soft tissue graft is pierced through, an oral flap is pierced through and a simple interrupted suture is applied. Vestibular and oral flaps are pierced through the needle with the same suture without piercing the soft tissue graft at 6 mm from the interrupted suture. After the needle is pricked out from the oral flap, the suture is not withdrawn completely, making a loop from the vestibular side. Needle is passed through this loop and the suture is pulled to match the wound edges in the required position and form two stitches: parallel and perpendicular to the wound. Perpendicular stitch is placed over the soft tissue graft, pressing it to the bone for fixation. Then the same suture is applied with the same sutures every 6 mm to the end of the wound. Further, 360° loop is made at the outermost stitch. Needle is passed through this loop, the suture is pulled, and the condition of the stitches and the wound edges are checked. Vestibular flap is pierced through. Soft tissue graft is pierced through, the oral flap is pierced through and the suture is pulled. Needle is inserted from the oral side in the middle between the stitches perpendicular to the wound. After the needle is pricked out from the vestibular flap, the suture is not removed completely, making a loop from the oral side. Needle is passed through the loop from the oral side and the suture is pulled to match the wound edges in the required position above the soft tissue graft, completely covering it and forming a stitch above it. Same suture is used to apply stitches to the end of the wound. After reaching the end of the wound, the oral and vestibular flaps are pierced through and the knot is tied using the existing free end of the interrupted suture.

EFFECT: method enables positioning and fixing the soft tissue graft from the palate, matching and adapting the wound edges in height and width, suturing the oral mucosa wounds with a minimum number of knots, reduce manipulation time, relieve tension of wound soft tissues from both sides and regulate tension force of wound edges.

1 cl, 15 dwg, 1 ex

Description

The invention relates to medicine, in particular to dentistry, and can be used for positioning, fixing a soft tissue graft and connecting the edges of a wound of the alveolar process of the jaw with a continuous suture.

There is a known method of fixing a soft tissue graft using positioning sutures (Zur, Otto. Plastic and aesthetic surgery in periodontology and implantology / Otto Zur, Mark Hurtseller - M., 2014. - 850 p. p. 276).

The disadvantage of this method is the need to apply additional sutures to position the soft tissue graft and connect the edges of the surgical field, uneven tension of the soft tissues of the wound, the inability to change the degree of tension of the suture, as well as the presence of multiple ends of the nodes, which causes discomfort to the patient in the postoperative period.

The objective of the invention is positioning, fixation of a soft tissue graft, suturing wounds of the oral mucosa with a minimum number of nodes, relieving tension in the soft tissues of the wound on both sides, reducing manipulation time and adjusting the tension force of the suture, suturing the wound surface with one suture.

The objective is achieved by the fact that in the method of increasing the volume of soft tissues during the installation of dental implants, including positioning and fixation of the soft tissue graft, suturing the edges of the wound of the mucous membrane in the area of the alveolar process of the jaw with a continuous suture, a soft tissue graft is taken from the palate, an incision is made and detachment of two flaps: vestibular and oral, position the soft tissue graft and fix it at the beginning of the wound with an interrupted suture, while inserting a needle perpendicular to the tissue, 4 mm away from the edges of the wound, pierce through the vestibular flap, pierce through the soft tissue graft, pierce through the oral flap and apply a simple interrupted stitch,

then, with a needle with the same thread, the vestibular and oral flaps are pierced through, without piercing the soft tissue graft, 6 mm away from the interrupted suture; after the needle is punctured, the thread is not completely removed from the oral flap, making a loop on the vestibular side,

a needle is passed through this loop and the thread is pulled until the edges of the wound are aligned in the desired position and two stitches are formed: parallel and perpendicular to the wound, and the perpendicular stitch is placed over the soft tissue graft, pressing it to the bone for fixation,

then the same sutures are applied with the same thread at intervals of 6 mm to the end of the wound,

then a 360º loop is made at the outermost stitch, a needle is passed through this loop, the thread is pulled and the condition of the stitches and the alignment of the edges of the wound are checked,

pierce through the vestibular flap, pierce through the soft tissue graft, pierce through the oral flap and pull the thread,

insert a needle from the oral side in the middle between the existing stitches perpendicular to the wound,

after the needle is pricked out of the vestibular flap, the thread is not completely removed, making a loop from the oral side,

pass the needle through the loop from the oral side and pull the thread until the edges of the wound are aligned in the desired position over the soft tissue graft, completely covering it and forming a stitch above it,

stitches are applied with the same thread to the end of the wound,

Having reached the end of the wound, the oral and vestibular flaps are pierced through and a knot is tied using the already existing free end of the interrupted suture thread.

If it is necessary to increase the tension force, make a 360º loop, pass a needle through this loop and tighten the thread.

A method has been proposed to increase the volume of soft tissues during the installation of dental implants. The method consists of taking a soft tissue graft from the palate, inserting a needle perpendicular to the tissue, 4 mm away from the edges of the wound, piercing the vestibular flap through, piercing the soft tissue graft through for its correct positioning and fixation, piercing the oral flap and applying a simple interrupted suture. Then the vestibular and oral flaps are pierced through with the same thread, 6 mm away from the interrupted suture; after the needle is pricked out of the oral flap, the thread is not completely removed, making a loop on the vestibular side. A needle is passed through this loop and the thread is pulled until the edges of the wound are aligned in the desired position and two stitches are formed: parallel and perpendicular to the wound, with the perpendicular stitch placed on top of the soft tissue graft, pressing it to the bone wound for fixation. Then identical stitches are applied with the same thread at identical intervals of 6 mm. To change the tension force to a greater one, make a 360º loop, pass a needle through this loop, and tighten the thread, eliminating the sagging of the thread. Using the same thread, identical stitches are applied at identical intervals of 6 mm to the end of the wound. Having reached the end of the wound, a 360º loop is made at the extreme stitch, a needle is threaded through this loop and pulled tight. Then the vestibular flap is pierced through, the soft tissue graft is pierced through for its correct positioning and fixation, the oral flap is pierced through and the thread is pulled, and a needle is inserted from the oral side in the middle between the existing stitches perpendicular to the wound. After the needle is punctured from the vestibular flap, the thread is not completely withdrawn, making a loop on the oral side; the needle is passed through the loop on the oral side and the thread is pulled until the edges of the wound are aligned in the desired position over the soft tissue graft, completely covering it, and a stitch is formed over it. Identical stitches are applied with the same thread. To change the tension force to a greater one, make a 360º loop, pass a needle through this loop, and tighten the thread, eliminating the sagging of the thread. Having reached the end of the wound, the oral and vestibular flaps are pierced through and a knot is tied using the existing free end of the interrupted suture thread.

Figure 1 shows the initial state of the wound before suturing.

Figure 2 shows positioning, fixation of the soft tissue graft and application of an interrupted suture at the beginning of the wound.

Figure 3 shows the formation of stitches parallel and perpendicular to the wound.

Figure 4 shows positioning and fixation of the soft tissue graft at the end of the wound.

Figure 5 shows the final view of the seam.

The method is carried out as follows.

A soft tissue graft is taken from the palate, a needle is inserted perpendicular to the tissues, 4 mm away from the edges of the wound, the vestibular flap is pierced through, the soft tissue graft is pierced through for its correct positioning and fixation, the oral flap is pierced through and a simple interrupted suture is applied. Then the vestibular and oral flaps are pierced through with the same thread, 6 mm away from the interrupted suture; after the needle is pricked out of the oral flap, the thread is not completely removed, making a loop on the vestibular side. A needle is passed through this loop and the thread is pulled until the edges of the wound are aligned in the desired position and two stitches are formed: parallel and perpendicular to the wound, with the perpendicular stitch placed on top of the soft tissue graft, pressing it to the bone wound for fixation. Then identical stitches are applied with the same thread at identical intervals of 6 mm. To change the tension force to a greater one, make a 360º loop, pass a needle through this loop, and tighten the thread, eliminating the sagging of the thread. Using the same thread, identical stitches are applied at identical intervals of 6 mm to the end of the wound. Having reached the end of the wound, a 360º loop is made at the extreme stitch, a needle is threaded through this loop and pulled tight. Then the vestibular flap is pierced through, the soft tissue graft is pierced through for its correct positioning and fixation, the oral flap is pierced through and the thread is pulled, and a needle is inserted from the oral side in the middle between the existing stitches perpendicular to the wound. After the needle is punctured from the vestibular flap, the thread is not completely withdrawn, making a loop on the oral side; the needle is passed through the loop on the oral side and the thread is pulled until the edges of the wound are aligned in the desired position over the soft tissue graft, completely covering it, and a stitch is formed above it. Identical stitches are applied with the same thread. To change the tension force to a greater one, make a 360º loop, pass a needle through this loop, and tighten the thread, eliminating the sagging of the thread. Having reached the end of the wound, the oral and vestibular flaps are pierced through and a knot is tied using the existing free end of the interrupted suture thread.

Clinical example.

The example is illustrated by images (Fig. 6 - Fig. 15).

Fig. 6 OPTG before surgery based on CBCT.

Fig. 7 Condition before surgery.

Fig.8 The vestibular and oral flaps are detached, a bed for the implants is formed.

Fig. 9 Soft tissue graft from the palate.

Fig. 10. Positioning of the soft tissue graft.

Fig. 11 Fixation of the soft tissue graft at the beginning of the wound with an interrupted suture.

Fig. 12 Suturing the wound with the formation of two stitches, a perpendicular stitch is placed over the soft tissue graft, pressing it to the bone wound for fixation.

Fig. 13 Positioning and fixation of the graft at the end of the wound.

Fig. 14 The wound is tightly sutured.

Fig. 15 Result after 3 months.

Patient Z, 55 years old, complained of the absence of 3.5; 3.6 teeth, deficiency of soft tissues in the edentulous area (Fig. 6, Fig. 7.).

The decision was made: installation of implants in position 3.5; 3.6 teeth, collection and fixation of the soft tissue graft, and suturing the edges of the wound in the oral cavity in order to increase the volume of soft tissue in the area of implantation, precise positioning and fixation of the soft tissue graft from the palate, matching and adapting the wound edges in height and width, suturing mucosal wounds membranes of the oral cavity with a minimum number of nodes, reducing manipulation time, relieving tension in the soft tissues of the wound on both sides and regulating the tension force of the wound edges.

Under local anesthesia, an incision and detachment of two flaps was made: vestibular and oral, forming a bed for implants in position 3.5; 36 teeth (Fig. 8).

In order to increase the volume of soft tissue in the implantation area, a soft tissue graft was taken from the palate (Fig. 9)

The soft tissue graft was positioned and fixed at the beginning of the wound with an interrupted suture (Fig. 10, Fig. 11).

Then the wound is sutured with the formation of two stitches: parallel and perpendicular to the wound, and the perpendicular stitch is located on top of the soft tissue graft, pressing it to the bone wound for fixation (Fig. 12).

Having reached the end of the wound, the vestibular flap is pierced through, the soft tissue graft is pierced through for its correct positioning and fixation at the end of the wound, the oral flap is pierced through and the thread is pulled (Fig. 13).

Next, the wound was tightly sutured. The wound is hermetically sutured (Fig. 14).

The result after 3 months is an increase in the volume and area of the attached mucous membrane in the area of implantation (Fig. 15).

The proposed invention allows us to obtain the following technical result - precise positioning and fixation of a soft tissue graft from the palate, comparison and adaptation of wound edges in height and width, suturing wounds of the oral mucosa with a minimum number of nodes, reducing manipulation time, relieving tension in the soft tissues of the wound on both sides and regulation of the tension force of the wound edges.

Claims (2)

1. A method for increasing the volume of soft tissue during the installation of dental implants, including positioning and fixing the soft tissue graft, suturing the edges of the wound of the mucous membrane in the area of the alveolar process of the jaw with a continuous suture, characterized in that the soft tissue graft is taken from the palate, an incision is made and two flaps are detached : vestibular and oral, position the soft tissue graft and fix it at the beginning of the wound with an interrupted suture, while inserting a needle perpendicular to the tissue, 4 mm away from the edges of the wound, pierce through the vestibular flap, pierce through the soft tissue graft, pierce through the oral flap and apply a simple interrupted suture, then the vestibular and oral flaps are pierced through with a needle with the same thread, without piercing the soft tissue graft, departing 6 mm from the interrupted suture, after the needle is punctured, the thread is not completely removed from the oral flap, making a loop on the vestibular side, a needle is passed through this loop and pull the thread until the edges of the wound are aligned in the desired position and two stitches are formed: parallel and perpendicular to the wound, and the perpendicular stitch is placed on top of the soft tissue graft, pressing it to the bone for fixation, then the same stitches are placed with the same thread at intervals of 6 mm to the end of the wound , then a 360° loop is made at the outermost stitch, a needle is passed through this loop, the thread is pulled and the condition of the stitches and the comparison of the edges of the wound are checked, the vestibular flap is pierced, the soft tissue graft is pierced, the thread is pierced through the oral flap and the thread is pulled, the needle is inserted from the oral sides in the middle between the existing stitches perpendicular to the wound, after puncturing the needle from the vestibular flap, the thread is not completely removed, making a loop on the oral side, pass the needle through the loop on the oral side and pull the thread until the edges of the wound are aligned in the desired position over the soft tissue graft, completely covering it and forming a stitch above it, stitches are applied with the same thread to the end of the wound, having reached the end of the wound, the oral and vestibular flaps are pierced through and a knot is tied, using the already existing free end of the interrupted suture thread. 2. The method according to claim 1, characterized in that, if it is necessary to increase the tension force, a 360° loop is made, a needle is passed through this loop and the thread is pulled.