RU2786139C1 - Method for reconstructing an extended free-end defect of the alveolar mandibular bone in the distal region - Google Patents

Abstract

FIELD: dentistry.

SUBSTANCE: invention relates to medicine, namely, to surgical dentistry. The type of bone tissue of the alveolar process is determined prior to the operation. An incision is made of the mucosa of the alveolar process in the proximal region of the defect. Said incision is made starting from the bottom of the oral cavity on the lingual side, passing through the top of the alveolar process to the buccal side, without interrupting the incision line up to the mucobuccal fold. A subperiosteal tunnel is formed, starting from the incision, gradually separating the periosteum until a 5 to 7 mm gap is formed between the top of the alveolar process and the periosteum to a length exceeding the free-end defect by 5 to 8 mm. Horizontal notches are then made on the bone tissue of the alveolar process along the entire length of the formed tunnel. Herewith, if type 1–2 of bone tissue is detected, the notches are made at a distance of 1 to 2 mm from each other, and if type 3–4 of bone tissue is detected, the notches are made at a distance of 3 to 4 mm from each other. Bone material is then inserted into the tunnel until tightly plugged.

EFFECT: possibility of reducing the trauma rate by preserving the periosteum and the mucous flap, shortening the duration and stages of surgical treatment before further implantation, lowering the risk of postoperative complications, such as inflammation, bleeding, allergic reactions, and shortening the time of hospital stay of the patient.

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Description

The invention relates to medicine, namely to surgical dentistry and is used in the reconstruction of an extended end defect of the alveolar bone of the lower jaw in the distal region

A known method of tunnel osteoplasty of the alveolar ridge in the frontal section, including the implementation of a Y-shaped frenuloplasty of the upper lip, which results in a diamond-shaped wound, then blind submucosal and subperiosteal tunnels are formed, and after creating a submucosal tunnel and moving the submucosal muscles upward, the periosteum is horizontally cut at the base the submucosal muscles moved upwards, then a subperiosteal tunnel is formed by making a median vertical incision through the rhomboid wound in the region of the alveolar process, and after the introduction of bone-replacing material into the subperiosteal tunnel, the mucosa and periosteum are attached to the bone with screws and the rhomboid wound is sutured. (Patent RF 2445939, IPC А61С 17/24, publ. 2006).

However, this method has a number of disadvantages: when cutting out a diamond-shaped flap, additional incisions are made, and after cutting out the flap, blind subperiosteal tunnels are formed and a mucoperiosteal flap is cut out. Injury to the mucoperiosteal flap leads to insufficient nutrition of the flap, and as a result, unfavorable healing of the postoperative wound. Additional incisions also increase the risk of possible postoperative complications.

A known method of plastic surgery of the alveolar process or the alveolar part of a partially edentulous jaw, including the formation of a flap, filling the defect with plastic material, closing the defect with a flap, fixing the flap with sutures, characterized in that on the atrophied area of the alveolar process or the alveolar part from the vestibule of the mouth in the direction from one tooth to the other, two incisions are made to the bone, parallel to each other, at a distance of 2-4 mm from each other, while the beginning and end of each incision are 1-1.5 mm from the neck of the tooth, then from the side of the oral cavity itself on the alveolar process or the alveolar part, a trapezoidal incision is made and a flap is formed, the base facing the alveolar edge, through the incisions made, the periosteum is separated from the mucosa from the bone from the vestibular side, from the side of the alveolar edge and from the side of the oral cavity itself, thus forming a tunnel, perforated with a spherical burr cortical plate of the alvea of the olar process or alveolar part from the side of the vestibule, alveolar margin and from the side of the oral cavity itself, a strip of resorbable membrane containing hydroxyapatite is introduced into the formed tunnel from the side of the oral cavity proper, the amount of paste necessary to fill the defect is injected into the space between the bone and the membrane with a syringe with hydroxyapatite granules. (Patent RF 2261674, IPC A61V 17/24, publ. 2005).

The disadvantage of this method is that when decorticating the bone with a spherical bur, there is no adequate visualization, which can lead to damage to the periosteum and malnutrition of the flap. The formation of a trapezoidal flap with its insufficient mobilization can lead to a decrease in the vestibule of the oral cavity, in the future this may lead to the need for plastic surgery of the oral vestibule mucosa, i.e. increase in the stages of surgical treatment. Also, a violation of the integrity of the periosteum can lead to a more pronounced pain syndrome in the early postoperative period.

The closest technical solution, taken as a prototype, is the tunnel method of bone grafting for the reconstruction of the alveolar bone of the jaws (RF Patent 2559923, IPC А61В 17/24, publ. 2015), which includes two incisions under local anesthesia from the top of the ridge of the alveolar process to base, with a continuation towards the transitional fold by 2 mm, at an angle of 80 degrees in the lateral or 100 degrees in the frontal section to the line connecting the edges of the defect in the recipient area along the alveolar ridge. The length of the second cut fully corresponds to the first cut. A mucoperiosteal flap is formed with two feeding bases: at the top and base of the alveolar ridge by peeling off the mucoperiosteal flap in the direction from the first incision to the second. Bone blocks or plates are taken from the retromolar area. The autograft is adapted and leveled to the recipient zone. Fixation of bone blocks or plates is carried out with titanium mini-screws. The wound is sutured.

The disadvantage of this method is a higher traumatization due to additional incisions, and insufficient mobilization of the mucoperiosteal flap leads to excessive pressure on the bone material and, as a result, its partial resorption. Also, the use of bone blocks or plates as osteoplastic material leads to partial resorption of the osteoplastic material due to prolonged vascular germination into the bone block or plate and a longer restructuring of the bone regenerate, and the removal of bone blocks/plates increases traumatization, which leads to prolonged pain syndrome. and increases the risk of inflammation and divergence of the edges of the postoperative wound.

The objective of the invention is to eliminate these shortcomings, increase the effectiveness of surgical treatment in the reconstruction of an extended end defect of the alveolar bone of the lower jaw in the distal region, reduce trauma, fully preserve the nutrition of the periosteum and, accordingly, the mucous flap, reduce the risk of postoperative complications, namely, inflammation, bleeding , allergic reactions.

The task is achieved by making an incision in the mucous membrane of the alveolar process, forming a subperiosteal tunnel, introducing bone material into the tunnel, and suturing the wound. What is new is that it is proposed to determine the type of bone tissue of the alveolar process before the start of the operation, and the incision of the mucous membrane of the alveolar process is carried out in the proximal section of the defect. In this case, the incision is made starting from the bottom of the oral cavity from the lingual side with the transition through the top of the alveolar process to the buccal side without interrupting the incision line to the transitional fold. The formation of the subperiosteal tunnel starts from the incision, gradually exfoliating the periosteum until a gap is formed between the apex of the alveolar process and the periosteum of 5-7 mm for a length exceeding the end defect by 5-8 mm. After that, horizontal incisions are made on the bone tissue of the alveolar process along the entire length of the formed tunnel, and with the identified 1-2 type of bone tissue, the incisions are made at a distance of 1-2 mm from each other, and with the identified 3-4 type of bone tissue - at a distance of 3 -4mm apart. After that, the bone material is introduced into the tunnel until dense obturation.

The technical result of using the proposed method is to restore the height and width of the alveolar bone of the lower jaw in the region of the end defect by a minimally invasive method. This method is less traumatic due to the preservation of periosteum nutrition, and the use of autologous bone chips as an osteoplastic material promotes rapid vascular germination and reorganization of the bone regenerate, which preserves the volume of the bone regenerate and eliminates the need for repeated stages of bone grafting of the alveolar process.

In FIG. 1 - a diagram of the incision of the mucous membrane of the alveolar process from the bottom of the oral cavity from the lingual side with the transition through the top of the alveolar process to the buccal side; in fig. 2 - exfoliation of the mucous flap with preservation of the periosteum; in fig. 3 - making notches depending on the type of bone tissue.

The implementation of the method is shown on specific clinical examples.

Example 1

Patient V., 32 years old. Diagnosis: Atrophy of the alveolar part of the lower jaw on the left in the distal section (in the area of teeth 3.5-3.7). In the preoperative period, the patient underwent standard preoperative preparation and cone-beam computed tomography of the facial skeleton, which revealed type 2 bone tissue.

Under local anesthesia, an incision was made in the mucous membrane of the alveolar process in the region of teeth 3.4-3.5, while the incision was made starting from the bottom of the oral cavity from the lingual side with the transition through the top of the alveolar process to the buccal side without interrupting the incision line to the transitional fold, using a raspator formed the subperiosteal tunnel, by gradually exfoliating the periosteum from the incision in the distal direction until a gap between the apex of the alveolar process and the periosteum is 7 mm, for a length exceeding the end defect by 8 mm, after which, using a bone scraper, horizontal notches were made on the bone tissue of the alveolar process along the entire length formed tunnel, at a distance of 1 mm from each other on the buccal side and 1 mm on the lingual side. With the help of a bone scraper, the autochips were taken in the retromalar region on the left, after which the bone material (bone autochips) was introduced into the tunnel until it was tightly obturated. The wound was sutured.

The postoperative period proceeded without complications.

On control X-ray examinations after 1, 3 and 6 months, the volume of bone regenerate was preserved in height and width.

On examination, the mucous membrane in the area of the tooth of a pale pink color, separated in the area of the postoperative wound, was not noted.

Example 2

Patient S., 41 years old. Diagnosis: Atrophy of the alveolar part of the lower jaw on the right in the distal section (in the area of 4.6-4.7). In the preoperative period, the patient underwent standard preoperative preparation and cone-beam computed tomography of the facial skeleton, which revealed type 4 bone tissue.

Similar to that described in example 1, surgery was performed, an incision was made in the mucous membrane in the region of teeth 4.5-4.6, exfoliation of the periosteum from the incision in the distal direction until a gap between the apex of the alveolar process and the periosteum was formed 5 mm, to a length exceeding the end defect by 5 mm, after this, using a bone scraper, horizontal incisions were made on the bone tissue of the alveolar process along the entire length of the formed tunnel, at a distance of 3 mm from each other on the buccal side and 4 mm on the lingual side.

The postoperative period proceeded without complications. The patient was discharged on the 1st day after the operation.

On control X-ray examinations after 1, 3 and 6 months, the volume of bone regenerate was preserved in height and width.

On examination, the mucous membrane in the area of the tooth of a pale pink color, separated in the area of the postoperative wound, was not noted.

Example 3

Patient D., 44 years old. Diagnosis: Atrophy of the alveolar part of the lower jaw on the right in the distal section (in the area of 4.5-4.7). In the preoperative period, the patient underwent standard preoperative preparation and cone-beam computed tomography of the facial skeleton, which revealed 1 type of bone tissue.

Similar to that described in example 1 and 2, surgical intervention was performed, an incision 1 (Fig. 1) of the mucous membrane in the region of teeth 4.4-4.5 was made, the periosteum was peeled with a raspator 2 (Fig. 2) from the incision in the distal direction until a gap was formed between the top of the alveolar process and periosteum 6 mm, to a length exceeding the end defect by 7 mm. After that, using a bone scraper 3, horizontal notches 4 (Fig. 3) were made on the bone tissue of the alveolar process along the entire length of the formed tunnel, at a distance of 1 mm from each other on the buccal side and 2 mm on the lingual side.

The postoperative period proceeded without complications. The patient was discharged on the 1st day after the operation. On control X-ray examinations after 1, 3 and 6 months, the volume of bone regenerate was preserved in height and width. On examination, the mucous membrane in the area of the tooth is pale pink.

The proposed method carried out surgical treatment of 25 patients aged 18-56 years. In all patients, the treatment outcome was good, the volume of bone regenerate was preserved, no complications were noted in any patient, and the rehabilitation period was reduced.

The proposed method allows to reduce trauma due to the complete preservation of the periosteum and, accordingly, the mucous flap, reduce the risk of postoperative complications, namely, inflammation, bleeding, allergic reactions, reduce the patient's stay in the hospital due to more effective surgical treatment. To minimize the likelihood of postoperative complications. Reduce the time and stages of surgical treatment before further implantation.

Claims (1)

A method for reconstructing an extended end defect of the alveolar bone of the lower jaw in the distal region, including making an incision in the mucous membrane of the alveolar process, forming a subperiosteal tunnel, introducing bone material into the tunnel, suturing the wound, characterized in that, additionally before the start of the operation, the type of bone tissue of the alveolar process is determined; the incision of the mucous membrane of the alveolar process is carried out in the proximal part of the defect, while the incision is made starting from the bottom of the oral cavity from the lingual side, with the transition through the top of the alveolar process to the buccal side without interrupting the incision line to the transitional fold, and the formation of the subperiosteal tunnel starts from the incision, gradually peeling off the periosteum until a gap is formed between the apex of the alveolar process and the periosteum of 5-7 mm for a length exceeding the end defect by 5-8 mm, after which horizontal incisions are made on the bone tissue of the alveolar process along the entire length of the formed tunnel, moreover, when 1-2 type of bone tissue, the incisions are made at a distance of 1-2 mm from each other, and when type 3-4 of bone tissue is detected, at a distance of 3-4 mm from each other, after that, bone material is introduced into the tunnel until dense obturation.

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