Method for setting dental prostheses in lateral maxillary region

FIELD: medicine.

SUBSTANCE: method involves carrying out dental prosthetics in lateral maxillary region when bone tissue height from alveolar process to the maxillary sinus is equal to 0.5-0.7 cm by increasing bone tissue height. Incision is made along alveolar process crest, mucoperiosteal flap is separated, rectangular fragment is formed in the lateral region and mucous membrane is lifted in the vicinity of maxillary sinus fundus. The newly created space is filled with osteoplastic material, intraosseous dental implants are set, the mucoperiosteal flap is laid, the wound is sutured and prosthetic repair follows. A rectangular bone fragment is formed separable. Its lower boundary is an area located at the level of maxillary sinus fundus or 1 mm higher and its upper boundary is an area planned for building new maxillary sinus fundus. When formed, the boundaries are joined with vertical saw cuts. The fragment is placed into physiologic saline. 2-3 mm thick fragment is cut out with a saw from the maxillary sinus fundus exposing a part of compact plate. After having filled the newly created space with osteoplastic material, the lateral rectangular opening is covered with the fragment taken out from the physiologic saline and fixed.

EFFECT: enhanced effectiveness of treatment; reduced risk of traumatic complications; enforced osteogenesis process.

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The invention relates to medicine, namely to surgical dentistry, and is intended for use in dentures with implants.

Significant atrophy of the alveolar ridge of the upper jaw and the decrease of its height in the lateral parts of less than 7-8 mm makes it impossible to use removable dentures and reliable fixation of the implant, which depends on the duration of use of non-removable prosthesis.

The most common method of increasing the volume of bone tissue of the alveolar process in the region of the floor of the maxillary sinus is a sinus lift (lifting the bottom of the maxillary sinus).

A known technique is the so-called "soft" sinus [1]. The surgery is performed as follows. Under local anesthesia in the edentulous area of the alveolar ridge cut out and prepare the chin mucoperiosteal trapezius flap. Then open the compact outer plate of the alveolar process of the maxilla. Next implant cutter to form the channel-bed for screw and perforined the bottom of the maxillary sinus. Then use the special tool to carefully prepare the chin mucous membrane of the bottom of the sinus from the underlying bone. Using the tap thread in the bone surrounding the implant bed. Formed in the cavity, zapolnjaete volume, stack osteoplastic material. Then in the prepared bed set screw implant with a cover and the surgery is completed sealed the wound closure of the mucosa. 6-8 months after carrying out x-ray studies to perform a second stage implant installation of the head of the implant and fixation of artificial crowns or bridges.

The disadvantage of this method of "soft" sinus lift is that the trepanation of the bottom of the sine and plastic spend blindly.

The most common way nowadays is the sinus lift with the opening of the anterior-lateral wall of the sinus, filling the resulting space osteoplastic material and with simultaneous implant placement [2]. The operation is conducted as follows. Spend gum incision to the bone at the alveolar ridge in mesio-distal direction with additional vertical dissection of the teeth, limiting defect. This was followed by a detachment of the mucoperiosteal flap, skeletization of anterolateral wall of the sinus. Next, form a semi-oval or trapezoid bone fragment in the area of anterolateral wall. The dissection of bone perform throughout its thickness without damage to the mucosa. The size of the bone fragments depends on the volume of the sinus. In the ideal case, when the offset it should touch the back wall of the sinus. The displacement of the bone fragments back up and leads to the formation of additional cavity under the sinus, upper boundary (wall) which becomes displaced bone fragment. Filling the newly created cavity spend, typically, by a combination of osteoplastic materials. Then install implants and completing the free space osteoplastic material. Then restore the contour of the anterolateral wall of the maxillary sinus overlay membrane, preferably resorbable. After returning to the place of mucoperiosteal flap wound is sutured. The implants are installed simultaneously with the sinus lift, you can expand and loaded in 6-9 months after surgery. A gradual increase in load contributes to the formation of stronger bone regenerate.

The disadvantages of this method is the trauma and increase the likelihood of postoperative sinusitis, due to the fact that the upper part of the implant is directly adjacent to the membrane of the sinus and can be damaged during installation of the implant.

The challenge which seeks the invention is to improve the quality of treatment of patients by creating conditions for good is osteointegration and positive results prosthetics.

The technical result from the use of the invention is to reduce the risk of injury to the mucosa of the bottom of the maxillary sinus, strengthening the process of osteogenesis, reducing the risk of postoperative sinusitis.

The invention consists in that in the method of prosthetic teeth in the lateral part of the upper jaw, by increasing the height of the bone tissue, including the incision along the crest of the alveolar ridge, the detachment slidescontainer flap, forming a rectangular hole in the side, lifting the mucosa in the region of the floor of the maxillary sinus, filling the newly created space osteoplastic material, installation of intraosseous dental implants, putting mucoperiosteal flap and wound closure with subsequent prosthetics, rectangular hole in the side of the gums form with the possibility of separation, it was placed in a physiological solution, then from the bottom of the maxillary sinus cut a slice thickness of 2-3 mm, lift it up together with the mucous membrane to the level of the new bottom of the maxillary sinus, thus revealing part of the compact plate, then fill the newly created space osteoplastic material rectangular hole in the gum cover removed from the physiologist the ical solution of the fragment and fix it.

With the proposed method does not separate the mucosa from the bottom of the maxillary sinus, and using a special tool to raise the lower bone fragment together with the mucous membranes (not touching her, but only touching bone) to place the new bottom of the maxillary sinus, which reduces the likelihood of damage to the mucosa of the maxillary sinus. In addition, when the proposed method the upper part of the intraosseous implant attached to a bone fragment (which raise together with the mucous membranes), which eliminates the possibility of damage to the mucous membrane during installation of the implant and reduces the risk of postoperative sinusitis. In this way the sixth and seventh cuts carried out before compact discs and lifting up the lower bone fragment bare compact disc and directly at her stack of osteoplastic material, ensuring the best possible blood supply, which leads to the intensification of the process of osteogenesis.

The invention is illustrated graphic materials, in which figure 1 shows the location of the bottom of the maxillary sinus in relation to the edge of the alveolar ridge in the lateral part of the upper jaw in the area of the missing teeth before surgery sinus lift, side view; figure 2 is the same cross section; figure 3 is undoubtedly the Finance side holes and fragments from the bottom of the maxillary sinus, side view; figure 4 is the same cross section; figure 5 shows the removal side of the bone fragment, the exposure of the mucous membrane of the maxillary sinus; figure 6 is also a cross section; figure 7 shows the displacement of the lower fragment up to the level of the new bottom of the maxillary sinus and the education of the newly created space in the lower part of the sinus; Fig the same cross section; figure 9 shows the filling of the newly created space osteoplastic material; figure 10 is the same cross section; figure 11 presents the installation of intraosseous dental implants; Fig - same, lateral the incision; Fig depicts the return of the remote upper bone fragment in a rectangular hole, and recovering thus the contour of the anterolateral wall of the maxillary sinus; Fig the same cross section; Fig depicted prosthetics intraosseous dental implants ceramic-metal design, the location of the new bottom of the maxillary sinus in relation to the edge of the alveolar ridge in the lateral part of the upper jaw after surgery sinus lift. The new height of the alveolar ridge in this area is sufficient for installation of intraosseous dental implant; Fig the same cross section. On Fig presents the radiograph to the Opera the AI; on Fig the same, after the operation of the proposed method.

The proposed method is as follows.

Surgery is performed in the case, if the height of 1 bone in the lateral part of the upper jaw (from the edge of the alveolar ridge 2 to the bottom 3) within 0.5-0.7 cm (see figure 1, 2). Spending cut to the bone at the alveolar ridge 2 in the area of the missing teeth 4 in mesio-distal direction with additional vertical dissection of tissue from the teeth 5, the limiting defect. Prepare the chin mucoperiosteal flap in the area of the maxillary sinus 6 and skeletonize anterolateral wall 7 of the maxillary sinus 6. Then form a rectangular bone fragment 8 (see figure 3, 4) in the area of anterolateral wall. Dissection of the bone is performed on full thickness without damaging the mucous membrane 9. During formation of the bone fragment consider its boundaries: the lower boundary (cut 10) is an area that is at or 1 mm above the bottom of the maxillary sinus, upper limit (cut 11) is the area at which assume to create a new bottom of the maxillary sinus. Then connect the edges of the 1 (10) and 2nd (11) additional vertical cuts cuts 12. Spend a horizontal cut 13 in the thickness of the bone tissue of the alveolar process 2 below 2-3 mm level is 3 maxillary sinus 6. From the edges of the cut 13 to compact plate 14 (see Fig.7, 8) sine spend additional vertical cuts 15. Get a side of the bone fragment 8 and the lower bone fragment 16 (see figure 3, 4). Lateral bone fragment 8 carefully podumyvayut and separated from the mucous membrane 9 of the maxillary sinus 6 and temporarily placed in a physiological solution. The lower bone fragment 16 carefully podumyvayut and move up to the upper level of the cut 11, exposing the internal compact plate 14 (see Fig.7, 8). This creates a new bottom 17 of the maxillary sinus 6 and get the new height 18 of the alveolar ridge 2 in the lateral part of the upper jaw, which is 1.2-1.7 to see the Newly formed space 19 is filled osteoplastic material 20 (see figures 9, 10). Then establish intraosseous dental implants 21. Then restore the contour of the anterolateral wall of the maxillary sinus 6 by returning bone fragments 8 of saline solution into the created defect wall. Return mucoperiosteal flap back in place and bring the wound edges by seams. Stitches are removed after 7-10 days. Six months later, proceed to the prosthesis, i.e. intraosseous dental implicate 21 establish metal-ceramic structure 22.

The possibility of carrying out the invention is confirmed by preveden is m the following example.

The patient M.A. applied in the clinic of maxillofacial surgery, St. Petersburg state medical University n.a. Acad. Pavlov 05.07.2002 g with complaints about the lack of the 5th tooth on the upper jaw to the right and with a request to install an implant in this area, not to include the adjacent teeth under metal-ceramic construction. Patient diagnosed with unilateral, the defect of dentition in the upper jaw on the right. Evaluating x-ray data, we have seen that the height of bone in this area is 6 mm, which does not allow to establish intraosseous dental implants by well-known methods (Fig). The patient decided to spend osteoplastic operation, including increased bone height in this area on the proposed new methodology. Under local anesthesia spent incision with a scalpel to the bone at the alveolar ridge in mesio-distal direction with additional vertical dissection of tissue from the teeth, limiting defect. Has taken away millimetre mucoperiosteal flap and skeletonema anterolateral wall of the maxillary sinus with the help of curved raspatory. Formed rectangular bone fragment in the area of anterolateral wall of the maxillary sinus. Used turbine handpiece and spherical boron diameter of 1.0 mm bone Dissection was performed on full thickness without damaging SL is sistas shell and with a continuous flow (about 100 ml/min), chilled sterile saline solution at Bor, the speed of which was 16000 rpm During formation of the bone fragment was taking into consideration its boundaries: the lower boundary 10 was an area that was located 1 mm above the bottom of the maxillary sinus, upper boundary 11 was the area level, which was supposed to create a new bottom of the maxillary sinus, i.e. cutting 11 at 6 mm above the level of the cut 10. Then put the edges of the sections 10 and 11 additional vertical cuts 12 (see figure 3, 4). Held horizontal cut 13 in the thickness of the bone tissue of the alveolar process below 2 mm above the bottom 3 of the maxillary sinus. From the edges of the cut 13 to compact plate 14 sine conducted additional vertical cuts 15. Lateral bone fragment was carefully podumyval special tool and was separated from the mucous membrane of the maxillary sinus and put it in a physiological solution. The lower bone fragment with a special tool was carefully podumyval and moved up to the upper level of the cut 11. This resulted in additional space 19 below the maxillary sinus (see Fig.7, 8). The newly formed space 19 is filled bioplastic material company LTD Commedbioprom "Biometrics" (see Fig.9, 10). Then installed one of intraosseous screw the one piece implant. Then restored the circuit per Nabokova wall of the maxillary sinus through the return side of the bone fragment 8 of saline solution into the created defect wall. Then returned mucoperiosteal flap back in place and tighten up her wound. Put a vertical U-shaped joints, the distance between beads of 0.5 mm in the Postoperative period was uneventful. He was appointed antibiotic therapy and rinse the mouth with herbal decoction. The wound healed by primary intention. The stitches were removed after 7 days. After 4 months spent clinical and radiological examination of the patient (see Fig). The data obtained showed a complete osseointegration of intraosseous dental implant and the formation of hyaline cartilage bone regenerate. The distance from the edge of the alveolar ridge to a new level of the bottom of the maxillary sinus in this area amounted to 13 mm (see Fig). After 6 months, the implant was installed crown. During further follow-up revealed the stability of the prosthesis, an acceptable level of hygiene, the absence of clinical signs of inflammation around the implant. On this basis we conclude that the treatment was successful and received positive results in the use of surgery sinus lift according to the proposed method.

Sources of information:

1. Clinical implant dentistry and stomatology. International scientific-practical journal, No. 3-4 (17-18), St. Petersburg, 2001, p.51-52.

2. The book "Dental implantology", authors: Ivan is in HE, Bizyaev A.F., Lomakin M.V. and others, Moscow, 2000, p.44 (prototype).

The method of prosthetic teeth in the lateral part of the upper jaw when the height of the bone tissue from the alveolar ridge to the bottom of the maxillary sinus in the range 0.5-0.7 cm by increasing the height of the bone tissue, including the incision along the crest of the alveolar ridge and detachment of the mucoperiosteal flap, forming a rectangular slice in the side, lifting the mucosa in the region of the floor of the maxillary sinus, filling the newly created space osteoplastic material, installation of intraosseous dental implants, putting mucoperiosteal flap, wound closure and subsequent prosthesis, characterized in that the bone rectangular portion is formed with the possibility of separation, the lower boundary is a region located at or 1 mm above the bottom of the maxillary sinus and the upper boundary of the region at which assume to create a new bottom of the maxillary sinus, forming limits, they connect the vertical cuts, then put this snippet in a physiological solution, then from the bottom of the maxillary sinus cut a slice thickness of 2-3 mm, lift it up together with the mucous membrane to the level of the new bottom vernaculus what about the sine, exposing the compact part of the plate, then, after filling the newly created space osteoplastic material side of the rectangular hole close extracted from saline fragment and fix it.



 

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