RU2843772C1 - Method for installing a dental implant and a gum former with one-step soft-tissue plasty to create an attached gum zone - Google Patents

Abstract

FIELD: medical science.

SUBSTANCE: invention refers to medicine, namely to surgical dentistry, and is applicable in treating the patients with the use of dental implants. U-incision is made under infiltration anaesthesia, with forming lingual and vestibular flaps. Incision is 2 mm deep and extends in the buccal direction at 10 mm from a tongue side of an alveolar process, in the distal direction from a region of the formed attached gingiva, within the border of the attached gingiva and the mobile mucous membrane. Then scalpel is turned on 90 degrees and cut is continued for 10-20 mm along alveolar process with length corresponding to volume of formed zone of attached gum. Scalpel is turned 90 degrees in the medial region from the area of the formed attached gum and the incision is continued towards a border of the attached gum and a mobile mucous membrane from the tongue side of the alveolar process. Further, a split mucous flap 1.5 mm thick is formed with using a scalpel to cut off submucosal tissues from the mucous membrane to the border of the attached gum and the movable mucous membrane. Submucosal tissues are displaced apically by a blunt technique with exposing a periosteum; within a border of an attached gum and a mobile mucosa, an incision is made along the periosteum in the mesio-distal direction along an alveolar process; a full-thickness mucoperiosteal flap is detached from the alveolar process by the blunt technique. Dental implant is installed in the exposed alveolar process, the flap is placed above the implant platforms and in the depth of the newly created vestibule, probe determines the location of the platforms of the dental implants relative to the surface of the formed combined flap and in this area a star-shaped incision is made with a scalpel, into which the gum formers are installed, fixing a full-thickness flap with their help, and the split mucous flap is fixed with resorbable sutures to the periosteum in the depth of the newly created vestibule.

EFFECT: by the one-step installation of the dental implant with the gingival formers by soft-tissue grafting, the method enables reducing the number of surgical manipulations, providing reducing injuries and accelerating the patient’s rehabilitation.

1 cl, 2 ex

Description

The invention relates to medicine, namely to surgical dentistry, and is intended for use in the treatment of patients using dental implants.

A method of treatment related to surgical dentistry and intended for use in vestibuloplasty of the oral cavity is known (Patent RU 2816037 C1). Vestibuloplasty according to Simonyan is performed as follows. Under infiltration anesthesia, a horizontal incision is made on the vestibular side, retreating from the apex of the mucous membrane of the alveolar ridge to the required depth, dissecting the mucous membrane and underlying muscle fibers. The incision is made linearly with the direction of the blade strictly perpendicular to the mucous membrane. The muscle fibers are split towards the apex of the alveolar ridge to the periosteum. Then the flap is split and displaced apically to the required depth. The apically displaced flap is fixed with interrupted sutures of resorbable thread. The coronary flap is fixed to the periosteum as follows: a needle is inserted from the vestibular side, then through the periosteum through the inner surface of the apically displaced flap to the outside. Then resorbable supporting nodal sutures are applied, which fix the apically displaced flap to the coronary flap in the apical-coronary direction. The method, due to obtaining a zone of attached gum and creating a volume of soft tissue in the area of dental implants, allows increasing the volume of attached gum atraumatically without using an autograft.

The disadvantage of this method is the lack of the possibility of simultaneous installation of gum formers, which increases trauma and rehabilitation time.

A known method of treatment related to dentistry and intended for use in implantological restoration of dental arches (Patent RU 2819496 C1). Before each stage of the operation, a fibrin clot is obtained from 5 ml of the patient's venous blood by centrifuging it in a test tube for 15 minutes at a rotation speed of 2000 rpm. After which the fibrin clot extracted from the test tube is placed in a PRF box for pressing and given the shape of a membrane. At the stage of installing the gum former, a PRF membrane with a diameter of 1.5 cm and a 3 mm long cut in the center is prepared. In the area of the integrated dental implant, a horizontal mucosal incision is made in the center between the boundaries of its attachment to the alveolar ridge from the vestibular and lingual-palatine side, the implant plug is removed. The resulting PRF membrane is placed in two layers with a tape in the recipient area. A 3 mm diameter cut is made in the membrane layers above the implant platform with a scalpel, the gingiva former is fixed transmembraneously, the edges of the attached mucosa are pulled together and the wound is sutured with interrupted sutures. At the stage of fixing the orthopedic structure on the implant, a PRF membrane with a diameter of 1 cm and a 3 mm long incision in the center is prepared, the gingiva former is removed, the membrane is placed with an incision in the mucosal shaft above the implant, the orthopedic structure is inserted transmembrane under pressure into the mucosal shaft and fixed on the implant, clamping the membrane between the mucosal shaft and the orthopedic structure. The method, due to the use of platelet-rich fibrin made from the patient's own blood, allows to increase the volume of keratinized gum and strengthen the inner wall of the mucosal crater above the implant.

The disadvantage of this method is the additional trauma caused by fixing the orthopedic structure, as a result of several surgical manipulations performed before fixing the permanent structure.

A known method of treatment pertaining to surgical dentistry and intended for use in treating patients using dental implants (Patent RU 2546104 C2). A split flap of mucous membrane is formed in the area of the alveolar process. The tissues are dissected to the vestibular part of the ridge supraperiosteally. In this case, the periosteum with muscle strands attached to it is exposed, which are bluntly displaced apically. A horizontal incision is made through the periosteum parallel to the ridge apex in the projection of the border of the attached and movable mucous membrane. A full-layer mucoperiosteal flap is formed. It is folded back over the ridge in the lingual or palatal direction. The positions of each implant are marked with a pilot bur. The beds are formed and the implants are installed. Subepithelial connective tissue autograft is collected from the donor area located on the upper jaw. It is fixed with sutures to the inner side of the full-layer mucoperiosteal flap in the projection of the implant platforms. The mucoperiosteal flap with the fixed autograft is placed on the alveolar ridge, and then the free edge of the split flap of the mucous membrane is immersed in the depth of the newly created vestibule of the oral cavity and the flap is fixed with resorbable sutures along the edges of the perimeter of the wound surface of the mucous membrane to the periosteum. The method, due to the creation of a "tissue barrier" of soft tissues in the area of dental implantation, reduces the risk of resorption of the bone adjacent to the implant.

The disadvantage of this method is the creation of additional trauma when collecting the subepithelial connective tissue autograft.

We have taken this method as a prototype.

The purpose of the proposed invention is to reduce trauma and accelerate patient rehabilitation.

The method is carried out as follows. Under infiltration anesthesia, a U-shaped incision is made to form lingual and vestibular flaps: from the lingual side of the alveolar process in the distal area from the area of the attached gingiva being formed, in the area of the border of the attached gingiva and the movable mucous membrane, a 2 mm deep incision is made in order to form a split mucous flap in the buccal direction at a distance of about 10 mm to form the width of the area of the future attached gingiva, then the scalpel is turned 90 degrees and the incision is continued along the alveolar process with a length corresponding to the volume of the attached gingiva being formed. On average, 10-20 mm. Then, in the medial area from the area of the attached gingiva being formed, the scalpel is turned 90 degrees and the incision is continued towards the border of the attached gingiva and the movable mucous membrane. Next, a split mucous flap 1.5 mm thick is formed to form the attached gingiva area. To do this, the submucosal tissues are cut off with a scalpel from the mucous membrane to the border of the attached gingiva and the movable mucous membrane. Then the submucosal tissues are bluntly displaced in the apical direction, thereby exposing the periosteum. After this, in the area of the border of the attached gingiva and the movable mucous membrane, an incision is made along the periosteum in the mesio-distal direction along the alveolar process. A full-layer mucoperiosteal flap is bluntly separated from the alveolar process. Thus, a combined flap is formed, consisting of a split mucosal flap and a full-layer mucoperiosteal flap. A dental implant is installed in the exposed alveolar process. The flap is placed above the implant platforms and in the depth of the newly created vestibule. The probe determines the location of the dental implant platforms relative to the surface of the formed combined flap, and in this area a star-shaped incision is made with a scalpel, into which the gum formers are installed. With their help, the full-layer flap is fixed, and the split mucous flap is fixed with resorbable sutures to the periosteum in the depth of the newly created vestibule.

The proposed method is confirmed by the following clinical examples.

Example #1

Patient N. (45 years old) complained of aesthetic and functional discomfort caused by the absence of teeth 35, 36, 37. There were no concomitant diseases, and no contraindications to implant treatment were identified.

When collecting the anamnesis, it turned out that teeth 35, 37 were removed as a result of destruction under the metal-ceramic structure several years ago.

CBCT analysis revealed bone loss in the area of teeth 35, 36, 37 due to the lack of chewing load in this area, which caused the absence of attached keratinized gum.

Objectively: absence of teeth 3.5-3.6-3.7; volume of available attached keratinized mucosa <1 mm. Pathological strands are visualized, mobile mucosa when pulling the cheek.

Under infiltration anesthesia, a U-shaped incision was made. From the vestibular side of the alveolar process in the distal area from the area of the attached gingiva being formed, in the area of the border of the attached gingiva and the movable mucous membrane, a 2 mm deep incision was made in the buccal direction for a distance of about 10 mm, then the scalpel was turned 90 degrees and the incision was continued along the alveolar process with a length corresponding to the volume of the attached gingiva being formed by 10 mm. Then, in the medial area from the area of the attached gingiva being formed, the scalpel was turned 90 degrees and the incision was continued towards the border of the attached gingiva and the movable mucous membrane. Next, a split mucous flap 1.5 mm thick was formed. For this, the submucosal tissues were cut off with a scalpel from the mucous membrane to the border of the attached gingiva and the movable mucous membrane. Then the submucosal tissues were bluntly displaced in the apical direction, thereby exposing the periosteum. After this, in the area of the border of the attached gingiva and the movable mucous membrane, an incision was made along the periosteum in the mesio-distal direction along the alveolar process. A full-layer mucoperiosteal flap was bluntly separated from the alveolar process. Dental implants were installed in positions 3.5 and 3.7 in the exposed alveolar process. The flap was placed above the implant platforms and in the depth of the newly created vestibule. A probe was used to determine the location of the dental implant platforms relative to the surface of the formed combined flap, and in this area, a scalpel was used to make star-shaped incisions into which the gingival formers were installed. With their help, a full-layer flap was fixed, and the split mucous flap was fixed with resorbable sutures to the periosteum in the depth of the newly created vestibule.

The patient was prescribed drug therapy. During the healing process, preventive examinations, X-rays and professional hygiene were carried out.

The positive effect of using the proposed method is expressed in a reduction in the number of surgical manipulations, and accordingly in a reduction in trauma and, as a consequence, in the acceleration of the patient's rehabilitation.

Example #2

Patient S. (50 years old) complained of aesthetic and functional discomfort caused by the absence of teeth 26, 27. There were no concomitant diseases, no contraindications to implant treatment were identified.

When collecting the anamnesis, it turned out that teeth 26 and 27 were removed due to complications of periodontitis several years ago.

CBCT analysis revealed bone loss in the area of teeth 26 and 27 due to the lack of chewing load in this area, which resulted in the absence of attached keratinized gingiva.

Objectively: absence of teeth 26, 27; volume of available attached keratinized mucosa <2 mm. Pathological strands are visible, mobile mucosa when pulling the cheek.

Under infiltration anesthesia, a U-shaped incision was made. From the vestibular side of the alveolar process in the distal area from the area of the attached gingiva being formed, in the area of the border of the attached gingiva and the movable mucous membrane, a 2 mm deep incision was made in the buccal direction for a distance of about 10 mm, then the scalpel was turned 90 degrees and the incision was continued along the alveolar process with a length corresponding to the volume of the attached gingiva being formed by 20 mm. Then, in the medial area from the area of the attached gingiva being formed, the scalpel was turned 90 degrees and the incision was continued towards the border of the attached gingiva and the movable mucous membrane. Next, a split mucous flap 1.5 mm thick was formed. For this, the submucosal tissues were cut off with a scalpel from the mucous membrane to the border of the attached gingiva and the movable mucous membrane. Then the submucosal tissues were bluntly displaced in the apical direction, thereby exposing the periosteum. After this, in the area of the border of the attached gingiva and the movable mucous membrane, an incision was made along the periosteum in the mesio-distal direction along the alveolar process. A full-layer mucoperiosteal flap was bluntly separated from the alveolar process. Dental implants were installed in positions 25 and 26 in the exposed alveolar process. The flap was placed above the implant platforms and in the depth of the newly created vestibule. A probe was used to determine the location of the dental implant platforms relative to the surface of the formed combined flap, and in this area, a scalpel was used to make star-shaped incisions into which the gingival formers were installed. With their help, a full-layer flap was fixed, and the split mucous flap was fixed with resorbable sutures to the periosteum in the depth of the newly created vestibule.

The patient was prescribed drug therapy. During the healing process, preventive examinations, X-rays and professional hygiene were carried out.

The positive effect of using the proposed method is expressed in a reduction in the number of surgical manipulations, and accordingly in a reduction in trauma and, as a consequence, in the acceleration of the patient's rehabilitation.

Claims (1)

A method for installing a dental implant and a gingiva former with one-stage soft tissue grafting to create an attached gingiva zone, characterized by the fact that under infiltration anesthesia, a U-shaped incision is made, forming lingual and vestibular flaps, an incision 2 mm deep is started, conducting it in the buccal direction at a distance of 10 mm, from the lingual side of the alveolar process, distally from the zone of the attached gingiva being formed, in the area of the border of the attached gingiva and the movable mucous membrane, then the scalpel is turned 90 degrees and the incision is continued 10-20 mm along the alveolar process with a length corresponding to the volume of the attached gingiva zone being formed, then in the medial area from the zone of the attached gingiva being formed, the scalpel is turned 90 degrees and the incision is continued towards the border of the attached gingiva and the movable mucous membrane from the lingual side of the alveolar process, then a a split mucous flap of 1.5 mm thickness, cutting off the submucous tissues from the mucous membrane to the border of the attached gingiva and the movable mucous membrane with a scalpel, then the submucous tissues are bluntly displaced in the apical direction, exposing the periosteum, in the area of the border of the attached gingiva and the movable mucous membrane, an incision is made along the periosteum in the mesio-distal direction along the alveolar process, a full-layer mucoperiosteal flap is bluntly peeled off from the alveolar process, a dental implant is installed in the exposed alveolar process, the flap is placed above the implant platforms and in the depth of the newly created vestibule, the location of the dental implant platforms relative to the surface of the formed combined flap is determined with a probe and a star-shaped incision is made in this area with a scalpel, into which gingival formers are installed, fixing the full-layer flap with their help, and The split mucous flap is fixed with resorbable sutures to the periosteum in the depth of the newly created vestibule.