Method for carrying out maxillary dental implantation

FIELD: medicine.

SUBSTANCE: method involves introducing endoscope into maxillary sinus through a bed which depth corresponds or exceeds implant length. Auto-osteogenic tissue as biomaterial is laid on sinus fundus under endoscopic control through remaining beds. The auto-osteogenic tissue contains osteoblasts and chondroblasts in combination with finely granulated porous titanium nickelide having particle size from 1 to 1000 mcm. Implants are set.

EFFECT: enhanced effectiveness of treatment; reduced risk of traumatic complications; improved implant integration conditions.

3 dwg

 

The invention relates to medicine, in particular to the dentist, and can be used for the treatment of edentulous premolar-molar segment of the upper jaw in the conditions of deficiency of bone tissue and low location of the bottom of the maxillary sinus.

The known method of dental implantation upper jaw, including the formation of the bed for dental implants by drilling, ending with 1-2 mm above the bottom of the maxillary sinus, with their subsequent elongation by bit, lifting the bottom of the maxillary sinus, laying on the bottom of the biomaterial (auto, allocato fabric, hydroxylapatite, or combinations thereof), followed by control of the depth gauge of the state of transplantation material and screwing in of the implant in the jaw [1].

The disadvantage of this method is the inability of the visual control of the localization of the biomaterial, low efficiency, due to disharmonious interaction transplant or implant material with recipient tissue, which leads to their exclusion or resorption.

The closest technical solution is a method of dental implantation upper jaw, including the introduction of the maxillary sinus rigid endoscope with a viewing angle of 70° through a natural hole, puncture of the maxillary sinus through the lower nasal passage, ocsla is of the mucous membrane in the region of the floor of the sinus after getroproperty using a trocar and Elevator, the room with a syringe biomaterial in the form of a liquid consistency at the bottom of the sinus under the control of the endoscope, the formation of the bed for implants and their installation [2].

The disadvantage of this method is the high invasiveness of the intervention due to the need to increase natural orifice connecting the maxillary sinus and the middle of the bow, the puncture of the maxillary sinus in the lower nasal passage.

Object of the present invention is to reduce the morbidity and effectiveness of dental implant region premolar-molar segment of the upper jaw in the conditions of low-placed of the bottom of the maxillary sinus.

This object is achieved in that in the method of dental implantation upper jaw, including the introduction of the endoscope into the maxillary sinus, the application of a biomaterial on the bottom of the sinus, the formation of the bed for implants and their subsequent installation, it is new that the endoscope is inserted through the bed, the depth of which corresponds to or is greater than the length of the implant, and at the bottom of the sinus through the remainder of the bed lay a biomaterial in the form of autosteering tissue containing osteoblasts and chondroblasts in combination with fine-grain porous nickelide titanium with a particle size of from 1 to 1000 microns.

The proposed CSP is about dental implantation greatly reduce the invasiveness of the intervention due to the absence of the need for the introduction of the endoscope into the maxillary sinus through the middle of the bow and punctures the maxillary sinus through the bottom of the bow, to increase the effectiveness of the operations, since transplantation autosteering tissue structure which is located between hyaline cartilage and coarse-fibered bone tissue, in combination with fine-grain porous nickelide titanium provides optimal regeneration and the formation of hyaline cartilage bone regenerate in the projection of the bottom of the maxillary sinus. Fine-grain porous, nickelide titanium with a particle size of from 1 to 1000 μm enables to obtain the desired volume of the regenerate with a minimum number of osteogenic tissue.

The method is as follows. After dissection and mobilization of the mucoperiosteal flap in the area of the missing teeth in the rear and/or middle division of the upper jaw to form a bed for the implant by drilling at 0.2-0.3 mm less than the diameter of the dental implant designs with base perforation of the maxillary sinus. Through the hole, with the greatest depth (often in the tuberosity of the maxilla), maxillary sinus insert the endoscope, which controlled through the remainder of the bed to the bottom of the sinus is placed osteogenic tissue in combination with fine-grain porous nickelide titanium with particle sizes from 1 to 1000 microns and install dental implants. Using the endoscope providedental state of the root portion of the implant, transplant and implant materials. After removal of the endoscope in this opening set of dental implanting his design, mucoperiosteal flap is laid back in place and the wound is sutured closed.

Example. Sick Hours, 58 years old, came with the purpose of prosthesis designs based on dental implants. Teeth lost in the last 10 years concerning chronic periodontitis and complicated caries. Objective: the Configuration of the face is not broken. His mouth opened freely. Was determined partial secondary edentulous upper and lower jaws, atrophy of the alveolar bone. On the orthopantomogram shows signs of uneven atrophy of the alveolar processes of the lower, right and left upper jaw, the lower the location of the bottom left and right maxillary sinus. Before surgery, the treatment of a pathology of internal organs, normalized rheological properties of blood, eliminated immunological disorders, deleted, destroyed 22, 37, 44 and 48 teeth. Under local anesthesia a cut trapezoidal mucoperiosteal flaps from the vestibular side of the alveolar ridge in the projection of the missing teeth in the upper and lower jaw, the last debonded from the bone and mobilized. Using a drill and a special cutters formed bone bed into al violari processes in diameter by 0.2-0.3 mm less than the diameter of the dental implant designs. In the projection of the missing molars and premolars right upper jaw formed 3 bed with base perforation of the maxillary sinus. Through the front perforated bed, the depth of which was 12 mm, sinus introduced 2-mm endoscope, which controlled through two distal Lodge located on the bottom of the sinus is placed osteogenic tissue, "grown" in the thickness of the iliac crest, in combination with fine-grain porous nickelide titanium with particle sizes from 1 to 1000 μm, after which they are porous, nickeled-titanium implants with porous neck with a length of 10 mm is Carried out endoscopic monitoring the status of the root portion of the implant, transplant and implant materials. After removal of the endoscope in this and the remaining holes are installed dental implanted constructs. A similar operation was performed on the left. Mucoperiosteal flap is laid back in place, the wound sutured tightly. In the projection of the missing right and left molars of the lower jaw there are two installed dental implant on each side. Sutures were removed after 10 days. The primary wound healing. Dentures made after 3.5 months. When viewed through 3 years of functional disorders of the dental apparatus is not detected.

Figure 1 shows the state subcell the spas apparatus Including patient before treatment;

Figure 2 shows the state of the dental apparatus Including patient after dental implantation;

Figure 3 shows the state of the dental apparatus Including patient after dental implant and dental after 3 years.

The advantages of the proposed method lies in the fact that as a result of use as a transplant material autosteering tissue occurs osseointegration of the implant with the transplanted tissue and the recipient area. Autosteering fabric, being highly inductive due to the presence of cellular elements of mesenchymal origin, has the properties of interstitial growth and anaerobic glycolysis and after transplantation more viable in conditions of tissue hypoxia compared to other auto-, ALLO-, xenotransplantation and implant materials, quickly sprouting blood vessels, which contributes to the formation of the operating wound hyaline cartilage regenerate in accordance with a further regularities indirect osteogenesis. Due to biomechanical and biochemical compatibility of porous titanium nickelide with the tissues of the body tissue grows between the granules and through its porous structure. Osteogenic tissue and the porous nickelide titanium in the form of small pellets that are easy to use, giving them the opportunity vos is travlemate flaws of any configuration. The success of this implant material for repair of defects in combination with autograft should be explained by the fact that for a given volume regenerate fewer osteogenic cells or immature cell of mesenchymal origin, compared with transplantation without implant material.

Clinical trials of the proposed method performed on 5 patients, which established 18 implants. In the observation of patients within 3-4 years, any anatomical and functional disorders of the dental apparatus is not detected, the state dental implants satisfactory.

Sources of information

1. Robustula YEAR Implantation (surgical aspects). M.: Medicine, 2003, s-483.

2. Robustula YEAR Implantation (surgical aspects). M.: Medicine, 2003, s.

The method of dental implantation upper jaw, including the introduction of the endoscope into the maxillary sinus, the application of a biomaterial on the bottom of the sinus, the formation of the bed for implants and their subsequent installation, characterized in that the endoscope is inserted through the bed, the depth corresponding to or exceeding the length of the implant, and at the bottom of the sinus through the remainder of the bed lay a biomaterial in the form of autosteering fabric, contains osteoblasts and chondroblasts in combination with fine-grain porous nickelide titanium with a particle size of from 1 to 1000 microns.



 

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