RU2845322C1 - Method for single-stage dental implantation - Google Patents

Abstract

FIELD: medical science.

SUBSTANCE: invention refers to medicine, namely to surgical and orthopaedic dentistry, is applicable in treating the patients with the use of dental implants with a thin gingival biotype. Under local anaesthesia, the tooth to be removed is non-invasively extracted; the alveolar socket is inspected, and the integrity of the alveolar walls is controlled. Then the socket is treated with 30 % lincomycin hydrochloride at exposition 30 seconds and washed with 0.9 % sodium chloride. Dental implant bed is formed in a palatal wall of the alveolar with taking into account that the distance from the implant to the vestibular wall of the alveolar must not be less than 2 mm. Implant is placed into the formed bed with ensuring primary stability and torque of at least 35-45 N/cm. Bioresorbable collagen membrane pre-corrected for the defect size is laid on the side of the socket on the vestibular wall, and a space between the implant and the laid membrane is loosely filled with a bone-plastic material. Then, an incision is made from a vestibular side of the implanted implant within a marginal gum with oblique papilla incisions; the flap is split to form a pocket inside the flap limited by a periosteum on one side, and by a mucous membrane on the other side with obligatory preserving the connection of the papilla to the periosteum. Then, after anaesthesia, from the hard palate, in the projection from the first premolar to the second molar, a free connective tissue autograft is sampled, wherein before sampling autograft is determined by puncture method, minimum thickness of soft in 3 mm, obtained autograft is placed in 0.9 % sodium chloride solution, wound on palate is sutured, and the resulting autograft is corrected by removing the surface layer of the epithelium, achieving the same thickness along the entire length. Thereafter, the autograft is placed into the recipient's bed. Before placing the graft in the soft tissues, it is sutured from each side as follows: first, the needle is pierced through only the fixed mucous membrane from the vestibular side from the outside, taking the needle out of the "pocket" through the made intra-sulcular incision, then the autograft is reciprocated through in two places, forming a U-shaped suture, after which the needle is directed through the intra-sulcular incision into the "pocket" symmetrically to the first prick in and through the mucous membrane of the vestibular wall to the outside, same fixation seam is made on other side, wherein the free connective tissue graft is completely overlapped with the recipient's soft tissues of the bed, one more suture is additionally applied, pricking the needle from the palatal surface, further, the needle is inserted in an area of a base of a mucoperiosteal graft, then the needle is inserted from a palatine surface with the suture left untied and fixed; a converging U-suture is applied on the mucosa, and the retaining suture is tied up.

EFFECT: by using the protective membrane, the osteoplastic material and a combination of the special internal guide sutures, the method enables eliminating the soft tissue insufficiency of the wall within the dental implant, preventing recessions and prolonging the service life of the dental implant.

1 cl, 5 dwg, 1 ex

Description

The invention relates to medicine, namely to surgical and orthopedic dentistry, and can be used in the treatment of patients with thin gum biotype using dental implants.

One-stage dental implantation is a procedure in dentistry that will help restore defects in dental arches in patients with partial or complete edentia, using intraosseous dental implants in one visit to the doctor.

Modern dentistry knows many ways to perform this procedure, each of which has both advantages and disadvantages.

A method is known for restoring the dental alveolar complex with one-stage dental implantation of the alveolar process by direct dental implantation by cutting out a trapezoid flap, separating it from the bone and filling the space between the implant and the walls of the socket with crushed demineralized allobone (Application for invention RU No. 2003117400, 10.06.2003). The disadvantages of this method are the rather long treatment periods and the impossibility of restoring the vestibular bone wall in its absence.

A method of dental implantation is known (Patent RU 2235523, 30.01.2003) performed simultaneously with vestibuloplasty, which made it possible to increase the effectiveness of treatment, reduce the number of surgical manipulations and, as a result, reduce the treatment time, as well as trauma and discomfort of the patient. After preparing the patient and administering anesthesia, a split flap of the mucous membrane is formed. The tissues are dissected to the vestibular part of the ridge supraperiosteally, while the periosteum with the muscle cords attached to it is exposed, which are bluntly displaced apically. Next, a horizontal incision is made through the periosteum parallel to the ridge apex in the projection of the border, attached and movable mucosa. A full-layer mucoperiosteal flap is folded back over the ridge in the lingual direction. The ridge bone, if necessary, is leveled with a large oval-shaped carbide bur for plastic. The pilot bur is used to mark the positions of each implant. The implant beds are formed. The implants are installed using the traditional method. The free edge of the exfoliated flap of the mucous membrane is immersed into the depth of the newly created vestibule of the oral cavity and the flap is fixed to the periosteum along the edges of the perimeter of the wound surface of the mucous membrane with resorbable sutures. The healing period after surgery is 12-14 days. Further treatment is carried out using the known method. The disadvantage of the above method is that in the case of a deficiency in the thickness and volume of soft tissues around the implant platform, the risk of resorption of the bone adjacent to the implant increases.

A method of soft tissue plastic surgery is known for the simultaneous installation of dental implants and permanent individual abutments in conditions of a thin gum biotype (Patent RU No. 2676458, 03/26/2018). The essence of the method is that an incision is made with a scalpel to the alveolar bone in the center of the alveolar ridge in the area of the planned dental implantation. A blunt raspatory is used to exfoliate a full-layer vestibular flap, which passes into the mucous membrane on the vestibular surface of the alveolar ridge. Using a guiding surgical template, an implant bed is formed in the alveolar process or alveolar part and the implant is installed together with a permanent individual abutment. In this case, the mucous membrane from the lingual or palatal side, after preliminary excision of the epithelial layer with a spherical diamond bur, is pressed in the lingual or palatal direction with an individual abutment, turning the edge of the mucous membrane under itself, forming a ridge. Then, at the coronal end of the vestibular flap, two vertical parallel incisions are made, the distance between which is equal to 2/3 of the diameter of the permanent individual abutment in the mesio-distal direction, and their length is 2/3 of the diameter of the same abutment in the vestibular-lingual or vestibular-palatal direction, thereby forming a fenestrated flap. The epithelial layer of this flap is excised with a spherical diamond bur. Then the fenestrated flap is rotated to the inner surface of the main flap and fixed with a single U-shaped suture. Subsequently, the vestibular flap is placed along the alveolar ridge, tightly covering the neck of the permanent individual abutment. The wound is sutured with simple interrupted sutures. The disadvantage of the above-described method is that the operation is performed by an incision along the alveolar ridge with detachment of the mucoperiosteal flap. As a result, the blood supply to the vestibular wall of the alveolar process is disrupted over the entire surface of the flap. And the risk of peri-implantitis increases.

The technical task of the claimed invention is to develop a method for one-stage implantation with a change in the gum biotype to prevent recession and form a vestibular wall in the area of the dental implant to improve the aesthetic result in the area of the future orthopedic structure using bone plastic material.

The technical result achieved by using this invention is a method of one-stage implantation, with the possibility of eliminating the insufficiency of soft tissues when installing dental implants due to the formation of a buffer zone of the required volume, increasing the service life of the dental implant, increasing the reliability of the orthopedic structure and the long-term operation of it, with the achievement of a high aesthetic result of implant treatment.

The technical result is achieved through the use of the method, namely the use of a protective membrane and bone plastic material and a combination of special internal guide sutures.

The method is carried out as follows. Under local anesthesia Sol. Articaini 4% with a vasoconstrictor 1:100000 or 1:200000 atraumatically using a periotome, piezo - tip, drill and luxator, the "causal" tooth was removed. Then, the socket was revised with a sharp Lucas spoon and the integrity of the alveolus walls was controlled. After that, the socket was treated with a 30% solution of lincomycin hydrochloride with an exposure of 30 seconds, followed by rinsing with a 0.9% solution of sodium chloride. Then, using a pilot drill and osteotomes, a bed for the implant was formed in the palatal wall of the alveolus, taking into account the rules of the aesthetic "window", depending on the diameter of the latter, taking into account that the distance from the implant to the vestibular wall should be at least 2 mm. After the bed was formed, an implant was installed depending on the selected system, achieving primary stability and torque during installation of at least 35-45 N/cm. A bioresorbable collagen membrane of animal origin, previously adjusted to the size of the defect, was placed on the vestibular wall from the side of the socket, the space between the implant, the walls of the alveolus and the membrane was loosely filled with bone-plastic material for bone regeneration.

Then, under local anesthesia with Sol. Articaini 4% with a vasoconstrictor of 1:100,000 or 1:200,000, a free connective tissue autograft was collected from the hard palate. The graft was collected from the area of the hard palate in the projection from the first premolar to the second molar, where the glandular zone of the hard palate was located. Before collecting the graft, the thickness of the soft tissues was determined by a puncture method, with the minimum acceptable thickness considered to be 3 mm (Tsur O. et al., 2014). The connective tissue graft was collected under local anesthesia with Sol. Articaini 4% with a vasoconstrictor of 1:100,000 or 1:200,000, in the area of missing teeth on the upper jaw or 2-3 mm away from the teeth using a 15C scalpel. The connective tissue autograft was collected using a standard method. The superficial epithelial layer was removed using a ceramic bur. The autograft was adjusted so that its thickness was the same throughout, after which it was placed in a 0.9% sodium chloride solution. The wound on the palate was sutured with compression nodal sutures.

Then the recipient bed was prepared. In the area of the installed implant, an incision was made along the marginal gum, from the vestibular side in the area of the installed implant, with oblique incisions along the papillae and a split flap was formed so that a "pocket" was formed inside, limited on one side by the periosteum, on the other - by the mucous membrane. A mandatory condition for the formation of such an incision was the preservation of the connection of the papillae with the periosteum.

The third stage was the placement of the autograft into the recipient bed. Before placing the transplant into the soft tissues, it was sutured as follows: first, the needle pierced only the immobile mucous membrane from the vestibular side from the outside, bringing the needle out of the "pocket" through the intrasulcular incision. Then, with a reciprocating motion, the autograft was pierced in two places (forming a U-shaped suture). After that, the needle was directed through the intrasulcular incision into the "pocket" symmetrically to the first puncture and again passed through the mucous membrane of the vestibular wall to the outside. The same fixation suture was made on the other side, with the SST completely covered by the soft tissues of the recipient bed.

Preliminary sutures on the SST help to position it and fix it with a simple interrupted suture on the vestibular surface. Additionally, another suture is applied. The needle is inserted from the palatal surface, then the needle is inserted in the area of the base of the mucoperiosteal flap. Then the needle is inserted from the palatal surface. At this point, the suture is not tied, but left fixed on the clamp. The suture allows positioning the main mucoperiosteal flap in the correct position, preventing suture divergence. The suture is applied with a resorbable material, such as Monosyn 5-0.

A U-shaped suture was applied to the mucosa using a Prolene 5-0 or Monosyn 5-0 monofilament. After the sutures were applied, a retaining suture was tied. At the end of the operation, the patient was referred to an orthopedic dentist for the installation of a temporary non-removable orthopedic structure.

The achievement of the technical result is illustrated by the following clinical example.

Patient K.

Age: 30 years

Before the surgery, the patient underwent CBCT (Fig. 1 - a, c, 6, d), which determined that the vestibular cortical plate was less than 1 mm thick (with a defect of no more than Vg from the length of the tooth root). Under local anesthesia Sol. Articaini 4% with a vasoconstrictor 1:100000, the tooth was removed atraumatically using a periotome, piezo tip, drill and luxator, after which the socket was revised with a sharp Lucas spoon and the integrity of the alveolus walls was checked. After that, the socket was treated with a 30% solution of lincomycin hydrochloride with an exposure of 30 seconds, followed by rinsing with a 0.9% sodium chloride solution. Then, using a pilot drill and osteotomes, a bed for the implant was formed in the palatal wall of the alveoli, taking into account that the distance from the implant to the vestibular wall was 3 mm. After the bed was formed, the implant was installed (Fig. 2). A bioresorbable collagen membrane of animal origin was placed on the vestibular wall from the side of the socket, having previously been adjusted to the size of the defect, the space between the implant, the walls of the alveolus and the membrane was loosely filled with osteoplastic material for bone regeneration. Then, under local anesthesia, Sol. Articaini 4% with a vasoconstrictor 1:100000, a free connective tissue autograft was taken from the hard palate, from the area of the hard palate in the projection from the first premolar to the second molar, where the glandular zone of the hard palate was located, retreating 2-3 mm from the teeth using a 15C scalpel. Before taking the graft, the thickness of the soft tissues was determined by puncture. The superficial layer of the epithelium was removed using a ceramic bur. The autograft was adjusted to be of uniform thickness throughout and then placed in 0.9% sodium chloride solution. The wound on the palate was sutured with interrupted compression sutures.

Then the recipient bed was prepared. In the area of the installed implant, an incision was made along the marginal gum, from the vestibular side in the area of the installed implant, with oblique incisions along the papillae and a split flap was formed so that a "pocket" was formed inside, limited on one side by the periosteum, on the other - by the mucous membrane. A mandatory condition for the formation of such an incision is the preservation of the connection of the papillae with the periosteum.

Next, the autograft is placed in the recipient bed. Before placing the transplant in the soft tissues, it is sutured as follows: first, the needle pierces through only the immobile mucous membrane from the vestibular side from the outside, bringing the needle out of the "pocket" through the intrasulcular incision. Then, with a reciprocating motion, the autograft is pierced through in two places (forming a U-shaped suture). Then the needle is directed through the intrasulcular incision into the "pocket" symmetrically to the first puncture and again through the mucous membrane of the vestibular wall to the outside. The same fixation suture is made on the other side, while the SST is completely covered by the soft tissues of the recipient bed. Additionally, one more suture is applied. The needle is punctured from the palatine surface, then the needle is punctured in the area of the base of the mucoperiosteal flap. Then the needle is punctured from the palatine surface. At this point, the suture is not tied but left fixed on the clamp. The suture allows positioning the main mucoperiosteal flap in the correct position, preventing suture divergence. The suture is applied with a resorbable material, such as Monosyn 5-0. A U-shaped suture is applied to the mucosa using a Prolene 5-0 or Monosyn 5-0 monofilament. After applying the sutures, a retaining suture is tied. At the end of the operation, the patient was referred to an orthopedic dentist for installation of a temporary non-removable orthopedic structure (Fig. 3), with subsequent observation (Fig. 4, 5).

Brief description of the drawings:

Fig. 1

- a, b - CBCT sections of the patient before surgery

- b - orthopantomogram of the patient before dental implantation

g - clinical picture in the oral cavity before surgery

Fig. 2 - stages of the dental implant installation operation

Fig. 3 Installation of the orthopedic structure

Fig. 4

- a, b - CBCT sections of a patient after installation of a dental implant.

Fig. 5

- a - orthopantomogram of the patient 12 months after dental implantation, stage of fixation of the final orthopedic structures;

- b-e - a series of CBCT sections of patients 12 months after dental implantation;

- f - clinical picture in the oral cavity 6 months after fixation of the final orthopedic structures.

Claims (1)

A method of one-stage dental implantation and elimination of soft tissue deficiency in the area of the installed implant, consisting in the fact that under local anesthesia, the tooth to be removed is atraumatically removed, the socket is revised and the integrity of the alveolar walls is checked, after which the socket is treated with a 30% solution of lincomycin hydrochloride with an exposure of 30 seconds, followed by rinsing with a 0.9% solution of sodium chloride, then a bed for a dental implant is formed in the palatal wall of the alveolus, taking into account that the distance from the implant to the vestibular wall of the alveolus should be at least 2 mm, the implant is installed in the formed bed, achieving, during installation, primary stability and a torque of at least 35-45 N / cm, after which a bioresorbable collagen membrane, previously adjusted to the size of the defect, is placed on the vestibular wall from the side of the socket, and the space between the implant and the laid membrane is loose filled with bone-plastic material, then an incision is made in the area of the marginal gum with oblique cuts along the papillae from the vestibular side of the installed implant, the flap is split, forming a “pocket” inside the flap, limited on one side by the periosteum, and on the other by the mucous membrane, with the obligatory preservation of the connection of the papillae with the periosteum, then, after anesthesia, a free connective tissue autograft is taken from the hard palate, in projection from the first premolar to the second molar, while before taking the autograft, a minimum thickness of 3 mm is determined by a puncture method, the resulting autograft is placed in a 0.9% sodium chloride solution, the wound on the palate is sutured, and the resulting autograft is corrected by removing the superficial layer of epithelium, achieving the same thickness along the entire length, after which the autograft is placed in the recipient bed, before placing the transplant in its soft tissues are sutured on each side as follows: first, the needle pierces through only the immobile mucous membrane from the vestibular side from the outside, bringing the needle out of the “pocket” through the intrasulcular incision made, then with a reciprocating motion, pierce through the autograft in two places, forming a U-shaped suture, after which the needle is directed through the intrasulcular incision into the “pocket” symmetrically to the first puncture and through the mucous membrane of the vestibular wall to the outside, the same fixation suture is made on the other side, while the free connective tissue graft is completely covered with soft tissues of the recipient bed, another suture is additionally applied, inserting the needle from the palatal surface, then the needle is inserted in the area of the base of the mucoperiosteal flap, then the needle is inserted from the palatal surface, while the suture is not tied, but left fixed, a a U-shaped suture is sewn together, after which the retaining suture is tied.