RU2563367C1 - Method for plastic repair of atrophied alveolar process of maxillar - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves making an incision extending along a ridge bone and two vertical incisions, separating and elevating a mucoperiosteal flap. A rectangual autogenous bone is taken from a retromolar space with the use of a piezo surgical apparatus, which is used to make a vertical longitudinal saw-cut in the autogenous bone to make it U-shaped. The autogenous bone fits a recipient area and fixed with titanium micro screws. All undercuts formed are filled with autogenous bone chips mixed with a synthetic osteoplastic material and covered with a collagen resorbable membrane from above. The mucoperiosteal flap is mobilised, placed on the wound loosely; the wound is closed tightly with interrupted sutures. The form defect of the donor area is filled with the synthetic osteoplastic material and covered with the collagen resorbable membrane from above; wound is closed tightly with interrupted sutures.

EFFECT: method enables providing the stable volume of the autogenous bone for the integration period, creating a maximum contact area of the autogenous bone and the recipient area of the atrophied alveolar process of maxilla and ensuring the favourable environment for dental implantation.

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Description

The invention relates to medicine, in particular to surgical dentistry, and is intended for use in dental implantology to increase the size of the atrophied alveolar process of the upper jaw.

Currently, there are a fairly large number of methods for plastic surgery of the atrophied alveolar process of the upper jaw. However, some of them require an extraoral bone autograft graft [1], which significantly increases the complexity and laboriousness of surgical intervention, others require an intraorally taken bone autograft of various shapes and fixations [2, 3, 4], and the third require splitting an intraoral bone autograft into plates (“laminate” or “veneer” technique) [5, 6], violating the integrity of the autograft. In all the proposed methods, the bone autograft is taken by means of an osteotomy using a physiological dispenser and special discs and cutters, which increases the invasiveness of the intervention.

The aim of the invention is to develop a technique for plastic surgery of the alveolar ridge of the upper jaw when it is insufficient for the placement of the implant.

The proposed technique is characterized in that a bone autograft for plastic surgery of the alveolar ridge of the upper jaw is harvested using a piezosurgical apparatus, with which a special U-shape is given to the bone autograft through a vertical longitudinal cut corresponding to the size of the recipient zone.

The method is as follows.

Under infiltration anesthesia, a mucosal incision is made along the crest of the alveolar process of the upper jaw and two vertical incisions. Peel off a full mucoperiosteal flap (photo 1). A rectangular autograft of a rectangular shape corresponding to the length of the recipient zone is taken in the retro-molar region of the lower jaw (photo 2) using a piezosurgical apparatus. The edges of the resulting bone defect are smoothed using a piezosurgical apparatus.

Using a piezo-surgical apparatus, a rectangular autograft with a piezo-surgical apparatus is made U-shaped by means of a vertical longitudinal cut, corresponding in size to the recipient zone (photo 3). The recipient area is perforated in several places, a bone autograft is attached and fixed with titanium microscrews (photo 4).

The resulting undercuts are filled with a mixture of autogenous bone chips and synthetic osteoplastic material, and the top is covered with a collagen resorbable membrane (photo 5). The mobilization of the mucoperiosteal flap is performed. The flap is laid on the wound without tension. The wound is sutured with interrupted sutures (photo 6). The formed defect in the donor zone is filled with osteoplastic material and covered with a collagen membrane. The wound is sutured with interrupted sutures.

The application of the method allows to ensure the stability of the volume of the bone autograft for the period of its integration, to create the maximum area of contact between the bone autograft and the recipient region of the atrophied alveolar process of the upper jaw, and to create conditions for dental implantation. In addition, the use of a piezosurgical apparatus reduces the morbidity of surgical intervention.

Patient Ε., B. 1965 went to the clinic with a defect in the dentition of the upper jaw. It was decided to perform dental implantation. However, on 3D CT, it was found that there was a deficiency in the width of the bone tissue in the area of the intended intervention (1.9 mm). The bone height was 9.2 mm. This served as an indication for bone reconstructive surgery with a bone autograft graft. Surgery was performed according to the above method. On postoperative 3D-CT, bone tissue growth was observed up to 8.7 mm wide and 12.7 mm high. After 4 months, an operation was performed to install three dental implants. Intraoperatively, the stability of the volume of the bone tissue of the autograft was noted, as well as its integration with the bone tissue of the atrophied alveolar process of the upper jaw.

Sources of information taken into account

1. RF patent No. 2417772 IPC А61В, 17/24; 05/10/2011.

2. RF patent No. 2364356 IPC A61C, 8/00; A61B, 17/24; 08/20/2009.

3. RF patent No. 2414181 IPC А61В, 17/24; 03/20/2011.

4. RF patent No. 2451492 IPC А61В, 17/24; 05/27/2012.

5. Kuri F. Regenerative methods in implantology: trans. from English / F. Kuri, - M., 2013.

6. Yamurkova NF, Smirnov S.Yu., Muraev Α.Α .. Vinyl plastic of the alveolar part of the jaw before dental implantation. Dentistry, 2010; 2; 36-41.

Claims (1)

The method of plasty of the alveolar process of the upper jaw during its atrophy, including a cut of the mucous membrane, peeling and folding of the mucosal-periosteal flap, taking a bone autograft in the retro-molar region of the lower jaw, fixing a bone autograft and suturing a wound, characterized in that the shape of the bone has a bone graft corresponding in size to the recipient area, is carried out using a piezosurgical apparatus, with which vertical longitudinal cut in a bone autograft with the latter giving a U-shape, then fitting a bone autograft to the recipient area, fix with titanium microscrews, fill all the undercutes with a mixture of autogenic bone chips and synthetic osteoplastic material, close the collagen-resistant mucosal resorbable membrane above , fits onto the wound without tension, the wound is tightly sutured with interrupted sutures, and the defect formed in the donor area ti fill synthetic osteoplastic material crimped collagen resorbable membrane tightly wound sutured with interrupted sutures.

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