RU2417772C2 - Method of plastic surgery on alveolar process of lower jaw - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to surgical dentistry, and can be applied for plastic surgical of a nonfunctional alveolar process of a lower jaw. A semi-oval incision of a mucous membrane with its base facing a vertex of an alveolar crest is executed. Vertical saw cuts pass perpendicularly to the alveolar process through an external cortical shell. A horizontal saw cut joining the vertical saw cuts passes along the alveolar crest. A bone bed is smoothed down with a bone cutter. A bone L-fragment is sampled from a patient's iliac crest and laid in the created bone bed, fixed with microplates and microscrews and closed with a resorbed membrane. A mucoperiosteal graft is mobilised, laid on a wound freely. The wound is closed tightly with interrupted sutures.

EFFECT: method allows creating a bone able to carry an occlusion implant load.

2 ex, 2 dwg

Description

The invention relates to medicine, namely to surgical dentistry, and can be used for plastic surgery of the alveolar process of the lower jaw during its atrophy before dental implantation.

The closest to the technical solution of the problem is the method of plasty of the alveolar process of the lower jaw during its atrophy, including an incision of the mucous membrane to the bone, peeling and folding of the mucosal-periosteal flap, horizontal and vertical cuts of the cortical plate, limiting the reconstruction area, fixing the autograft to the lower jaw and suturing the wound (SU 1629042 A1, publ. Bulletin No. 7 of 02/23/1991).

The disadvantages of this method include the fact that there is no possibility of obtaining a simultaneous optimal height and width of the reconstructed area, due to the lack of volume and mobility of the bone fragment of the alveolar bone, which, ultimately, leads to insufficient elevation of the alveolar bone.

The technical task according to the invention is the creation of an effective method for plastic surgery of the alveolar bone during its atrophy.

The technical result according to the invention is a persistent clinical effect due to the use of a bone L-shaped fragment of an autograft from the patient ileum as an autograft, an increase in the area of simultaneous reconstruction in width and height, fixation with microplates and microscrews, and closure of the plastic zone from above with a resorbable membrane.

The technical result according to the invention is achieved by the fact that the method of plasty of the alveolar process of the lower jaw during its atrophy, including performing an incision of the mucous membrane, peeling and folding the mucosal-periosteal flap, performing horizontal and vertical cuts of the cortical plate, fixing the autograft and suturing the wound, is characterized in that carry out a semi-oval incision of the mucous membrane with the base facing the top of the alveolar ridge to the bone, with vertical cuts passing perpendicularly to the alveolar process through the outer cortical layer to form a bed on the vestibular side, and then a horizontal cut is made along the alveolar ridge connecting the vertical cuts, the bone bed is aligned with a milling cutter, then a bone L-shaped fragment is taken from the iliac crest , which is placed in the formed bone bed from the side of the cortical plate, is fixed with microplates and microscrews, the top is closed with a resorbable membrane, Zist-periosteal flap is mobilized, it is placed on the wound without tension, the wound sutured tightly interrupted sutures.

According to the invention, the use of a L-shaped autograft from the ileal crest of the patient (due to its configuration and thickness) allows for simultaneous elevation of the reconstruction area in height and width, which in addition allows for full compatibility with the patient’s bone tissue.

According to the invention, the processing of the formed bone bed with a cutter allows a tight fit of the autograft to the patient’s inert tissue and thus improves the adaptation of the lower jaw to the subsequent implantation of the intraosseous screw implant.

According to the invention, the mobilization of the autograft with microscrews and microplates prevents the autograft from shifting.

According to the invention, the reconstruction zone is covered by a resorbable membrane, which ensures the coalescence of the fragments without fibroso formation. As a resorbable membrane, for example, a bone collagen membrane can be used, which is optimally suitable for closing such bone defects and creates the necessary conditions for targeted regeneration in the defect zone.

The method of plasty of the alveolar process of the lower jaw during its atrophy according to the invention is as follows.

Under balanced anesthesia (or anesthesia) from the vestibular side of the alveolar process of the lower jaw, a semi-oval incision of the mucous membrane to the bone is made with the base facing the apex of the alveolar process.

In the presence of teeth restricting the reconstruction zone, the length of the incision corresponds to the length of the dentition; in the absence of teeth, the length of the incision must exceed the reconstruction zone by 5 mm on each side.

Next, the mucosal-periosteal flap is peeled off and folded, while the flap does not exfoliate from the lingual side, in order to maintain the attachment of the periosteum to the alveolar process of the lower jaw.

The vestibular surface of the alveolar process of the lower jaw is skeletonized.

Vertical cuts are made, passing perpendicularly to the alveolar process through the outer cortical layer to form a bed on the vestibular side, then horizontal cuts are made along the alveolar ridge, connecting vertical cuts, the bone bed is aligned with a milling cutter, a bone L-shaped fragment is taken from the iliac crest which is placed in the formed bone bed from the side of the cortical plate, fixed with microplates and microscrews, the resorbiru is closed from above my membrane, muco-periosteal flap is mobilized, it is placed on the wound without tension, wound tightly sutured with interrupted sutures.

In the presence of teeth restricting the reconstruction zone, the mucoperiosteal flap is additionally fixed to the neck of the teeth. Next, hemostasis is performed. Sutures are removed on the 7-10th day.

Figure 1 and 2 presents a diagram of the plastic alveolar bone during its atrophy.

Example 1

Patient A., 26 years old. Diagnosis: bone resorption after extraction of 4, 5 and 6 teeth on the left of the lower jaw.

According to the invention, an alveolar ridge of the lower jaw of the 5th tooth was plastic on the left (the length of the incision exceeded the reconstruction zone by 5 mm on each side). Under balanced anesthesia from the vestibular side of the alveolar process of the lower jaw, a semi-oval incision of the mucous membrane to the bone was performed with the base facing the apex of the alveolar process.

Then, the mucoperiosteal flap was peeled off and folded, while the flap was not peeled from the lingual side to preserve the attachment of the periosteum to the alveolar process of the lower jaw. The vestibular surface of the alveolar process of the lower jaw was skeletonized.

Vertical cuts were made, which passed perpendicularly to the alveolar process through the outer cortical layer, to form a bed on the vestibular side, then a horizontal cut was made along the alveolar ridge, which connected the vertical cuts, the bone bed was aligned with a milling cutter, and a bone L-shaped fragment was taken from the crest the bones, which were placed in the defect on the cortical plate side, were fixed with microplates and microscrews, and the resorption was closed from above membrane, the mucoperiosteal flap was mobilized and laid on the wound without tension, the wound was sutured tightly with interrupted sutures.

The alveolar bone was restored to the previous (necessary 8 mm) height and width.

After 4-5 months, they had a dental implantation of an intraosseous screw implant - the implant is installed in an ideal position. A new bone formed after reconstruction (after 14 months) is able to withstand the occlusive load on the intraosseous screw implant.

Example 2

Patient N., 60 years old. Diagnosis: bone resorption after traumatic removal of 4 teeth on the left of the lower jaw.

According to the invention, an alveolar ridge of the lower jaw of the 5th tooth was plastic on the left (the length of the incision exceeded the reconstruction zone by 5 mm on each side). Under balanced anesthesia from the vestibular side of the alveolar process of the lower jaw, a semi-oval incision of the mucous membrane to the bone was performed with the base facing the apex of the alveolar process.

Then, the mucoperiosteal flap was peeled off and folded, while the flap was not peeled from the lingual side to preserve the attachment of the periosteum to the alveolar process of the lower jaw.

The vestibular surface of the alveolar process of the lower jaw was skeletonized.

Vertical cuts were made, passing perpendicularly to the alveolar process through the external cortical layer, to form a bed on the vestibular side, then a horizontal cut was made along the alveolar ridge, connecting the vertical cuts, the bone bed was aligned with a milling cutter, and a bone L-shaped fragment was taken from the iliac crest , which was placed in the formed bone bed from the side of the cortical plate, was fixed with microplates and microscrews, the resorb was closed from above membrane, the mucoperiosteal flap was mobilized and laid on the wound without tension, the wound was sutured tightly with interrupted sutures. The alveolar bone was restored to the previous (necessary 8 mm) height and width.

After 4-5 months, they had a dental implantation of an intraosseous screw implant - the implant is installed in an ideal position. A new bone formed after reconstruction (after 14 months) is able to withstand the occlusive load on the intraosseous screw implant.

According to the invention, plastic surgery of the alveolar process of the lower jaw was performed on 50 patients with 60 teeth, followed by dental implantation after 5-6 months: the intraosseous screw implants were installed in the ideal position, and the resulting plastic surgery (observation period 15-30 months) was able to withstand the occlusive load, provided to the implant.

Claims (1)

The method of plasty of the alveolar process of the lower jaw during its atrophy, including performing a mucosal incision, peeling and folding of the mucoperiosteal flap, performing horizontal and vertical cuts of the cortical plate, fixing an autograft and suturing a wound, characterized in that they carry out a semi-oval incision of the mucous membrane with the base facing to the top of the alveolar ridge to the bone, first vertical cuts are carried out, passing perpendicular to the alveolar process through the bones the cortical layer to form the bed on the vestibular side, and then a horizontal cut is made along the alveolar ridge, connecting the vertical cuts, the bone bed is aligned with a cutter, then a bone L-shaped fragment is taken from the ileal crest of the patient, which is placed in the formed bone bed with the sides of the cortical plate are fixed with microplates and microscrews, closed with a resorbable membrane from above, the mucoperiosteal flap is mobilized, it is placed on the wound without tension zheniya, wound tightly sutured with interrupted sutures.

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