RU2176490C1 - Method for creating bone tissue volume in the maxilla when preparing to dental implantation - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves preliminarily determining maxillary sinus bay fundus projection at the implantation place. Perforation hole is produced and physiological salt solution is pumped in into it. Maxillary sinus mucosa is separated with water solution from bone. Then the solution is removed. Alloplastic material suspension in autoblood is introduced into the space between the mucous membrane and bone. The perforated hole is closed with dry alloplastic material. The wound is treated with antiseptic solution and sutured. EFFECT: reduced risk of traumatic complications.

Description

 The invention relates to medicine, namely to dentistry, and can be used for dental implantation in the upper jaw.

 There is a method of restoring the volume of bone tissue of the alveolar process of the upper jaw in preparation for dental implantation by operatively replanting bone or bone-like tissue on the bottom of the maxillary sinus [1].

 The disadvantages of this method are the increased invasiveness and duration of surgery during surgery on the maxillary sinus.

 The closest technical solution is the method of prosthetics for partial loss of teeth in the upper jaw, in which the creation of bone tissue in preparation for dental implantation is performed by dissecting the tissues of the oral cavity from the lateral molar 2-4 mm above the transition fold, making an opening in the exposed front wall maxillary sinus and the formation of the bone bed of the dental implant with filling the lower part of the maxillary sinus with artificial bone material [2].

 The disadvantages of this method are the increased invasiveness and the possibility of perforation of the mucous membrane of the maxillary sinus.

 The objective of the proposed method is to reduce the morbidity and duration of surgery in the maxillary sinus.

 This object is achieved by the fact that in the method of creating the volume of bone tissue of the upper jaw in preparation for dental implantation, comprising making holes in the anterior wall of the maxillary sinus and lining the maxillary sinus with bone-plastic material, the projection of the bottom of the maxillary sinus in the implantation site is preliminarily determined at the implant site then dissect the tissue of the vestibule of the oral cavity in the region of the first and second molars and premolars, peel the mucoperiosteal flap and perform perforation a hole with a diameter of 1-3 mm, into which physiological solution is pumped through a needle and the mucous membrane is hydroseparated from the bone, then the solution is removed and a suspension of alloplastic material on autologous blood is introduced into the space between the mucous membrane and the bone, and the perforation hole is closed with dry alloplastic material, the wound is treated with antiseptic solutions and sutured tightly.

 An example implementation of the method.

 An orthopantomogram and an intraoral radiograph are performed using radiopaque patterns and the projection of the floor of the maxillary sinus alveolar bay is determined at the site of the implantation. Under local anesthesia, the tissue of the vestibule of the oral cavity is dissected in the region of the first and second molars and premolars, a mucus-supraclavicular flap is removed with a raspator and a perforation hole of 1-3 mm diameter is made, into which physiological saline is pumped through a needle under pressure, and the mucous membrane is hydroseparated from bones. After removal of the solution, the required amount of alloplastic material is injected into the blood between the mucous membrane and the bone on autologous blood and X-ray filling control is performed. The perforation hole in the anterior wall of the maxillary sinus is filled with dry alloplastic material, the wound is treated with antiseptic solutions and sutured tightly.

Example
Patient K., 44, complained of a lack of teeth in the distal left maxilla. Teeth 24, 25, 26, 27, 28 were removed three years ago.

 Intraoral: the mucous membrane of the oral cavity without features. 21, 22, 23 teeth are filled on proximal surfaces. The mucous membrane of the alveolar ridge in the missing 24, 25, 26, 27, 28 teeth is pale pink, without pathological changes. The alveolar bone in the region of missing teeth is Elbrich's 1st class, conical in shape, width in the crest region 13 - 15 mm.

 Orthopantomogram: satisfactory quality, moderate contrast. Bone tissue of the alveolar process of the left upper jaw without pathological changes, good mineral saturation, the ratio of cortical and cancellous bone as 1: 3. In the area of missing 24, 25, 26, 27 teeth, the bottom of the maxillary sinus is determined. The distance from the crest of the alveolar ridge to the bottom of the sinus is 3 - 6 mm.

 Ds: Secondary partial adentia of the left upper jaw.

 Treatment: Under the Tural and Infraorbital Anesthesia Sol. Lidocaini 2% - 5 ml dissect the tissues of the vestibule of the oral cavity in the area of 24, 25, 26, 27 teeth. The mucoperiosteal flap is stupidly exfoliated, the anterior wall of the maxillary sinus is exposed. At the site of the implantation, in the region of the 26 tooth, guided by Rg-contrast patterns, a perforation hole with a diameter of 3 mm was formed in the area of the sinus floor. A needle was introduced into the hole through which physiological saline was injected and the mucous membrane of the maxillary sinus was hydroseparated from the bone. Saline solution removed. The resulting space is filled with a suspension of alloplastic material on autologous blood. The perforation hole is closed with dry alloplastic material. The wound is treated with solutions of antiseptics, sutured tightly.

 Dressings every day. Sutures were removed on the 7th day.

 After 9 months, after Rg-control, the operation of dental implantation was performed.

 In this way, 24 patients were operated on, among them 15 women and 9 men, 22 of them subsequently underwent dental implantation surgery. The follow-up period of 1 - 2 years, the phenomena of peri-implantitis or implant failure are not marked. In 2 patients, insufficient bone formation was noted, as a result of which further implantation was denied.

The proposed method is less traumatic for several of the following reasons:
- there is no need to create a window in the anterior wall of the maxillary sinus, which reduces the risk of inadvertent perforation of the mucous membrane of the maxillary sinus;
- reduces the possibility of damage to the neurovascular plexuses of the maxillary sinus floor;
- significantly reduces the volume and, accordingly, the time of the intervention, which in turn reduces the possibility of wound contamination with saliva and microorganisms.

Sources of information
1. Temerkhanov F. T., Anastasov A. N. Modern methods of restoring bone volume of the alveolar process of the upper jaw in preparation for dental implantation (Proceedings of the V Congress of the Dental Association "Russia"). - M., 1999, p. 292-294.

 2. RF patent 2143866, A 61C 8/00, 1998.

Claims (1)

 A method of creating a volume of bone tissue of the upper jaw in preparation for dental implantation, comprising making an opening in the anterior wall of the maxillary sinus and lining the bottom of the sinus with bone-plastic material, characterized in that the projection of the bottom of the alveolar sinus of the maxillary sinus is preliminarily determined at the implantation site, then the vestibule tissue is dissected the oral cavity in the region of the first and second molars, premolars, peel the mucoperiosteal flap and perform a perforation hole with a diameter of 1-3 mm, in which d pressure through the needle and injected saline gidrosepariruyut mucosa of the maxillary sinus bone and the solution is then removed to the space between the mucosa and the bone are administered suspension alloplastic material autoblood, the perforation is closed dry alloplastic material wound treated with antiseptic solutions and sutured tightly.