The method of dental implantation

 

(57) Abstract:

The invention relates to medicine, namely to oral surgery, and can be used in the treatment of patients with complete edentulous lower jaw with a narrow zone of attached gingiva. Are vestibuloplasty and installation of one-stage implants. When implementing vestibuloplasty with the help of CO2laser, reveal the site of a bone of the alveolar ridge of the lower jaw width corresponding to the diameter of the larger implant, immediately after which perform the implantation. The method can significantly reduce the treatment time, reduce the number of surgical interventions in the treatment of implant-supported, to ensure high efficiency of treatment by eliminating mechanical trauma, to avoid wound infection due to non-contact method of operation, to lower the costs to provide hemostasis, lymphostasis (dry operative field), to create conditions for accelerated regeneration, to reduce the likelihood of postoperative complications and discomfort (restrictions in food intake, lifestyle of the patient), to eliminate the temporary loss of ability to work, to avoid the necessity of applying bandages, UAM.

The invention relates to medicine, namely to oral surgery, and can be used in the treatment of patients with complete edentulous lower jaw with a narrow zone of attached gingiva.

Toothless jaw atrophy III and class IV are a challenge for implantation and prosthetics, because in such situations the vestibular area of the alveolar ridge is very narrow and, as a consequence, there are a limited number of attached keratinized gingiva. Such patients for the successful functioning of dental implants should be prepatations surgical training. The existing methods of increasing the zone of attached gingiva are not without drawbacks and significantly increase the time of definitive treatment. Therefore, the search for new, effective, modern methods of dental implantation in the treatment of patients with complete edentulous, is the actual problem.

There is a method in which increasing the zone of attached keratinized gingiva conducted through transplantation of free connective tissue autograft (Edward S. Cohen, Atlas of cosmetic and reconstructive periodontal surgery, W&W, 1994, p.82-84), taken from the sky and dental implantation is conducted in two stage who have infiltration anesthesia, pulling his lower lip, to determine far as possible gingival border. Scalpel No. 15 hold the incision that goes by, the medicine gingival border, with the blade held parallel to the alveolar process of the mandible. The incision extends along and apical to separate the mucosa from the periosteum.

Periosteal bed extend in height at 6-8 mm more than the width of the graft (thus take into account the mental topography of holes), to compensate for the primary and secondary wrinkling of the graft during the healing period. If necessary mucosal flap is stitched chromed catgut to the bottom of the vestibule. Scissors with periosteal bed remove any traces of fibers. High-speed handpiece with a diamond Burr spend epithelial exposure of gingival incision to ensure matching of the graft and keratinized tissue. Using sterile foil which is cut along the contour of the surgical field, define the required size of the graft.

The graft is taken from the sky from the area of the premolars-molars, because here is the most extensive gingival area with a thin submucosal layer. Make infiltration anesthesia. To don the second side of the sky. When the scalpel feature parallel to the fabric to achieve the required thickness (0.5 to 1.5 mm). When the slit on the occlusal side is completed, the blade promote apical, with usepreview transplant. The first vertical medial incision is performed and the graft usepreview completely. The graft is placed on gauze moistened with saline. The wound is sutured with catgut or silk.

Then hold the preparation of the graft. Its inner surface is examined for the presence of residues of fat and glandular tissue. Check the thickness of the flap, it should be smooth and homogeneous. If necessary, glandular and fatty tissue excised with a scalpel No. 15. The graft used in the mouth and give final shape with scissors.

The graft is adapted to respicientes bed and hem horizontal stretch seams to eliminate initial shrinkage of the graft. In addition, the seam allows the blood vessels in the flap to stay open.

The second stage 3-4 months carry out dental implant according to traditional methods.

The disadvantages of this method are:

1. A long period of surgery and treatment in General.

2. United postoperative discomfort.

5. Poor hemostasis in the donor area.

6. Damage Palatine vessels.

7. Unaesthetic of the implanted graft.

8. High invasiveness of the surgery.

9. The impossibility of taking graft required size and shape.

There is a way in which before installing dental implants (for 3-4 months), are increasing the zone of attached gingiva using vestibuloplasty.

It is known the use of vestibuloplasty on Adlao-Maharu (see A. E. Stepanov, Frenuloplastika, vestibuloplastika and operations on the periodontal tissues. - M., 2000, S. 127-128).

The method involves pre-anesthesia, incision of the mucous membrane of the lower lip carried out with a scalpel parallel to the bending arc of the lower jaw for 8-10 teeth. Then scissors prepare the chin mucous membrane of the lips towards the jaw to the point of attachment of the mucous membrane of the movable part of the vestibule of the oral cavity to the gum. The scalpel cut the periosteum along the length of the recess of the vestibule of the mouth, not touching this debonded mucous in transition the crease. After this set and scissors prepare the chin muscle-periosteal layer of bone on all tiny flap.

The patches fixed with catgut, placed on the wound surface iodoform swab, and on the outside of the lip impose a pressure bandage. Operation in the presence of an assistant is 120-140 minutes. After 5-10 days dressing change on vitaminology bandage. The healing period after surgery 14-18 days.

This method has the same drawbacks as described above.

It is also known the use of vestibuloplasty on Adlane Maharu modification Schmidt, taken as a prototype (see A. E. Stepanov, Frenuloplastika, vestibuloplastika and operations on the periodontal tissues. - M., 2000, S. 135-137).

This type of vestibuloplasty does not provide for detachment of the periosteum, it is technically more simple way. In the preventive purposes this method is applicable to small vestibule of the oral cavity. The advantage of this method is the absence of relapses.

The method is as follows. After preparation of the patient, the anesthesia, the incision of the mucous membrane of the oral cavity is produced within the lower lip and prepare the chin to the gingival part of the alveolar ridge. From this stage is a fundamental difference from the way Edlina-Mahara. In the modification of the Schmidt periosteum not Odeillo and near the periosteum to the required depth for the entire length of the incision. The free edge of the debonded flap of mucous membrane immersed in the depth of the newly created vestibule of the oral cavity and sew with catgut. The catgut hem flap on the edges of the perimeter of the wound surface of the mucous membrane, placed on the wound surface iodoform swab, and on the outside of the lip impose a pressure bandage. Operation in the presence of an assistant is 120-140 minutes. After 5-10 days dressing change on vitaminology bandage. The healing period after surgery 14-18 days. After removal of the dressing to prevent stiffness of the lips and scarring recommend finger massage the chin-mouth part of the face and active exercises of the lower lip (A. E. Stepanov, the Surgical treatment of periodontal diseases. - M. 1991., S. 61-64.).

The disadvantages of this method is:

1. This intervention may experience significant scarring of the vestibule of the oral cavity with subsequent relapse.

2. Highly traumatic operation.

3. A long rehabilitation period.

4. Prolonged postoperative discomfort.

5. The need to keep the wound in the postoperative period using iodoform swab and swab with vitaminoterapie or the ptx2">7. The duration of the operation.

Objectives: increase the effectiveness of treatment, reducing the number of surgical procedures and, as a consequence, reduction of terms of treatment, trauma and discomfort for the patient.

The essence of the invention is that vestibuloplasty and implants is carried out simultaneously with the implementation of vestibuloplasty with the help of CO2laser, reveal the site of a bone of the alveolar ridge of the lower jaw width corresponding to the diameter of the larger implant, immediately after which perform the implantation.

The method is as follows.

The procedure starts with the fabrication of surgical template in a known manner (I. U. Musheev, C. N. Olesov, O. H., Ramovic. Practical dental implantology. - M., 2000, S. 69-71). Measure the distance between foramina, which is celebrated on the model. The template places the implant boron make holes. Before the operation pattern is subjected to cold sterilization. The template is placed on the ridge and pilot boron through the mucosa and periosteum on the bone mark the places of the future location of the implants.

Sterile marker on the mucous membrane of the alveolar gravage molar - the second premolar, followed through points located on1/2- 2/3 -1/2the distance from the crest to the red portion of the lower lip and to the area of the first molar and second premolar opposite side.

After preparation of the patient, the anesthesia, the focused beam CO2laser power of 4-5 watts in the anterior lower jaw form a split flap of mucous membrane. Fabric cut to the vestibular part of the crest supraperiosteal, when this strip the periosteum with attached muscle fibers and the frenulum of the lower lip. Next scalpel No. 15 spend a horizontal incision through the periosteum, parallel to the top of the ridge. A full-layer mucoperiostal flap throw back over the crest in the lingual direction, for better visualization of the surgical field, the edge of the flap is stitched with silk 3-0 and assign speaking. The periosteum does not prepare the chin from the alveolar ridge, and a beam of CO2laser power 4-5 W dissect the soft tissue, connective-woven fibers, muscle supraperiosteal to the required depth for the entire length of the incision. Determine the topography of the neurovascular bundle. To prevent injury to neurovascular bundle determine distancia implant) below the first horizontal incision is performed a second incision through the periosteum, the formed strip of periosteum is removed using a periosteal Elevator. Bone comb, if necessary, align the large boron carbide for plastic oval.

Pilot boron mark the position of each of the implants, tentatively scheduled using the template. Form a Lodge implants. Following the conventional method of installing the implants.

The free edge of the debonded flap of mucous membrane immersed in the depth of the newly created vestibule of the oral cavity and 4-0 catgut hem flap on the edges of the perimeter of the wound surface of the mucosa to the periosteum. The healing period after surgery 12-14 days.

Further treatment is carried out by well-known methods.

We have conducted the examination and treatment of implant-supported proposed method 16 patients with secondary complete edentulous with narrow (less than 3 mm) zone of attached gingiva. Control was a group of patients of the same age with similar pathology. In the control group preparing the prosthesis was performed according to the standard technique, consisting of two phases: the implementation of vestibuloplasty and after 3-4 months of dental implantation. The evaluation of the treatment results was performed according to Uchenie patients using implants, the proposed method has allowed fewer manipulations (one in the main group versus two in the control) and for a shorter period of time (3-4 months in the study group versus 7-10 months in the control) to complete the surgical phase of treatment and to obtain the necessary for the successful functioning of the implant area attached traditsionnoi gums.

During the observation period (12 months after implant placement) patients of the main group is not marked occurrence of relapses and, as a consequence, mucositis and periimplantitis.

Example 1

Map of the state of the oral cavity and tooth No. 29. Patient D., 49 years old, was sent to the dental examination. Complaints: in the absence of teeth on the lower jaw, cosmetic defect, difficulty chewing.

Considers himself to be patient for about 6 years. Laminar prosthesis in the mandible were used infrequently due to poor fixation. From somatic diseases notes atrophic gastritis. Objective: reduce the height of the lower third of the face. The dental formula

Width of attached gingiva for lower jaw 1 mm Condition prostheses satisfactory.

On the basis of history, clinical survey, the fool began with the production of the surgical template. I measured the distance between foramina, which is noted on the model. The template places the implant boron-made holes. Before surgery, the template was subjected to cold sterilization. The template is placed on the ridge and pilot boron through the mucosa and periosteum on the bone marked the places of the future location of the implants.

Sterile marker on the mucous membrane of the alveolar ridge noted the position of the mental hole and the boundary of the section. It starts with the top of the ridge in the area of the first molar and second premolar followed through points located on1/2- 2/3 -1/2the distance from the crest to the red portion of the lower lip and to the area of the first molar and second premolar opposite side.

Spent anesthesia and focused beam CO2laser power of 4-5 watts in the anterior lower jaw formed by the split flap of mucous membrane. Fabric cut to the vestibular part of the crest supraperiosteal, with exposed periosteum with attached muscle fibers and the frenulum of the lower lip. Next scalpel No. 15 held horizontal incision through the periosteum parallel to the top of the ridge. A full-layer mucoperiostal flashed silk 3-0 and took speaking. The periosteum was not taken away millimetre from the alveolar ridge, and a beam of CO2laser power 4-5 W cut soft tissue, connective tissue fibers, muscle supraperiosteal to the required depth for the entire length of the incision. Determined the topography of the neurovascular bundle. At a distance of 4 mm (because the larger diameter of the implant was 4 mm) below the first horizontal section has a second incision through the periosteum formed strip of periosteum was removed using a periosteal Elevator. Bone crest lined large boron carbide for plastic oval.

Pilot boron noted the position of each of the implants, tentatively scheduled using the template. Formed the bed of the implant. According to traditional methods established the implants.

The free edge of the debonded flap of mucous membrane was immersed in the depth of the newly created vestibule of the oral cavity and 4-0 catgut sewed the flap on the edges of the perimeter of the wound surface of the mucosa to the periosteum. The period of wound healing after surgery was 12 days. The end of treatment was performed according to conventional methods. Full treatment period is 5 months.

Example 2

Map of the state of the oral cavity and teeth No. 34. Balneomedicical lack, violation of mastication.

Considers himself ill for about 6 years. Laminar prosthesis in the mandible was not used. Objective: reduce the height of the lower third of the face. Dental formula:

Width of attached gingiva for lower jaw 2 mm Condition prostheses satisfactory.

Based on the data of anamnesis, clinical examination, was diagnosed with Fully edentulous lower jaw with small vestibule of the mouth.

The procedure began with the fabrication of a surgical template. I measured the distance between foramina, which is noted on the model. The template places the implant boron-made holes. Before surgery, the template was subjected to cold sterilization. The template was placed on the crest and pilot boron through the mucosa and periosteum on the bone marked the places of the future location of the implants.

Sterile marker on the mucous membrane of the alveolar ridge noted the position of the mental hole and the boundary of the section. It started with the top of the ridge in the area of the first molar and second premolar, followed through points located on1/2- 2/3 -1/2the distance from the crest to the red portion of the lower lip and to the first polarizer capacity of 4-5 watts in the anterior lower jaw formed by the split flap of mucous membrane. Fabric cut to the vestibular part of the crest supraperiosteal, with exposed periosteum with attached muscle fibers and the frenulum of the lower lip. Next scalpel No. 15 held horizontal incision through the periosteum parallel to the top of the ridge. A full-layer mucoperiostal flap pulled back over the crest in the lingual direction for better visualization of the surgical field, the edge of the flap sewn silk 3-0 and took speaking. The periosteum was not taken away millimetre from the alveolar ridge, and a beam of CO2laser power 4-5 W cut soft tissue, connective tissue fibers, muscle supraperiosteal to the required depth for the entire length of the incision. Determined the topography of the neurovascular bundle. At a distance of 3 mm (because the larger diameter of the implant was 3 mm) below the first horizontal section has a second incision through the periosteum formed strip of periosteum was removed using a periosteal Elevator. Bone crest lined large boron carbide for plastic oval.

Pilot boron noted the position of each implant, tentatively scheduled using the template. Formed the bed of the implant. According to traditional methods have established the implants.

The advantages of this method are: ensuring high efficiency of the treatment with the use of implants by eliminating mechanical trauma, exclusion of wound infection due to non-contact method of operation, reduce labor costs, reduce treatment time and the number of manipulations, providing hemostasis, lymphostasis (dry operative field), creation of conditions for accelerated regeneration, reducing the likelihood of postoperative complications and discomfort (restrictions in food intake, lifestyle of the patient), the elimination of temporary loss of working capacity, eliminating the need for applying bandages, eliminating stressful situation for the patient, ensuring a good cosmetic effect, the creation of favorable conditions not only for the patient, but for the doctor and, consequently, restoring the quality of life of the patient in a shorter time.

Analyzing the results of the testing method, it can be concluded that the proposed method is easy to use, well tolerated, has no side effects. P ongoing manipulation. The data obtained allow us to recommend this method of dental implantation for the treatment of patients with fully edentulous lower jaw with a narrow zone of attached keratinized gingiva.

The clinical advantage of this method is the use of laser in which there are: a bloodless operative field, the ease and speed of application, the sterility of the wound surface, good hemostasis, a sharp decrease in pain barrier, the lack of post-operative bleeding and swelling, improve reparative processes in the field of surgery.

Applying a new method of treatment shows a marked effect, which can be recommended in the broad practice of dentistry.

The method of dental implantation, including vestibuloplasty, characterized in that in the implementation of vestibuloplasty with the help of CO2laser reveal the site of a bone of the alveolar ridge of the lower jaw width corresponding to the diameter of the larger implant, immediately after which perform the implantation.

 

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