RU2808883C1 - Method of obtaining bio composite ex tempore and method of bio sinus lifting using obtained bio composite - Google Patents

Abstract

FIELD: medicine; surgical dentistry.

SUBSTANCE: following is proposed: a method of obtaining a biocomposite ex tempore, according to which bone cells are collected from the patient’s cortical bone in the area of the alveolar process of the upper jaw along its outer surface, the patient’s venous blood is collected using a vacuum tube from the ulnar, radial or median superficial vein of the forearm, and the collected blood is centrifuged for 15 minutes at a speed of 2,000 rpm, the upper dense blood fraction (PRF) is removed from the test tube and grinded into fragments of 1–3 mm in size, mixed the crushed dense blood fraction (PRF) with the bone cells of the patient’s cortical bone and then Nucleostim VEGF osteoplastic material is added to the resulting mixture, with the ratio of the mixture components being: dense blood fraction (PRF) — 25–35 vol.%; bone cells of the patient’s cortical bone — 25–35 vol.%; and Nucleostim VEGF osteoplastic material — 35–45 vol.%. A method of bio sinus lifting using a bio composite obtained by the above method is also proposed.

EFFECT: group of inventions ensures accelerated and predictable acquisition of bone tissue in the lateral part of the upper jaw during its initial deficiency and simultaneous installation of dental implants as a support for future orthopedic dental structures, as well as prevention of the development of complications accompanying sinus lifting surgery.

7 cl, 8 dwg, 1 ex

Description

Technical field

The present invention relates to medicine, namely to surgical dentistry, and can be used to obtain a biocomposite ex tempore from bone cells of the patient’s cortical bone, as well as to a method of biosinus lifting surgery using the specified biocomposite. The invention can be used for sinus lifting surgery, to increase the volume of bone tissue of the alveolar process of the upper jaw in the lateral section for dental implantation, i.e. installation of a dental implant in the alveolar process of the jaw.

Prior Art

The problem of dental implantation in the upper jaw is the anatomical structure of this bone, as well as the large size of the maxillary sinus and possible atrophy of the alveolar process of the upper jaw.

In this case, in order to form the volume of bone of the alveolar process necessary for implantation in the lateral part of the upper jaw, it is necessary to increase the volume of bone tissue of the alveolar process of the upper jaw in the lateral part by performing a sinus lifting operation.

Various sinus lifting techniques are known (see, for example, S.I. Bulanov et al. Methodology for performing a closed sinus lifting operation in conditions of pronounced separation of the maxillary sinus, Journal Bulletin of the Medical Institute "REAVIZ", Samara, 2017, No. 6, p. 1 -8), the use of which depends on the structural features of the sinuses and on access to them.

In the described method during surgery, the authors identified several stages:

- making an incision with the formation of vestibular and palatal mucoperiosteal flaps;

- formation of a bed for the implant using a trephine;

- further, bone tissue extraction;

- then dissecting the remaining millimeter of bone tissue with a bur and exposing the Schneiderian membrane of the maxillary sinus;

- then, using curettes for sinus lifting, transposition of the Schneiderian membrane is carried out;

- ground autologous bone is mixed with the patient’s blood and xenogeneic bone material to create a mixed bone-plastic material;

- using a spreader, the resulting material is placed in the subantral space and compacted quite tightly;

- then the dental implant is installed;

- mucoperiosteal flaps are placed in place and fixed with mattress sutures.

To increase the volume of bone tissue of the lateral part of the alveolar process in the area of the maxillary sinus during sinus lifting, various materials are currently used: auto-, allo-, xenomaterials (see, for example, F.E. Alfaro. Bone grafting in dental implantology, Moscow, 2006, pp. 135-146). The disadvantages of all sinus lift methods used are:

- thermal damage to the bone tissue of the alveolar process during the formation of a perforation hole in the side wall of the maxillary sinus when using a surgical cutter or bur;

- perforation of the mucous membrane of the Schneiderian membrane of the maxillary sinus, during the formation of a perforation hole in the side wall of the maxillary sinus when using a surgical cutter or bur;

- perforation of the Schneiderian membrane of the maxillary sinus, during peeling of the membrane from the bone when using a manual curette;

- perforation of the Schneiderian membrane of the maxillary sinus, during the separation of a bone fragment of the side wall of the sinus from it during the formation of a perforation hole in the sinus;

- migration of bone material into the maxillary sinus in the postoperative period;

- due to the low bioavailability and low affinity of bone tissue of animal origin with human bone tissue, the slow process of transformation of transplanted bone tissue of animal origin into human bone tissue, slow neoosteogenesis and neoangiogenesis;

- a greater number of surgical operations, since they first plant bone tissue (sinus lifting), wait 6-8 months for its engraftment, and then perform a second operation, implantation surgery, and again wait 6-8 months for the implants to engraft, only after that they begin installation of crowns on implants;

- the long waiting time for prosthetics with crowns or bridges on implants with the classical sinus lifting method is twice as long, due to the separation of the sinus lifting operation (bone tissue grafting) and implantation, thus the engraftment of implants and grafted bone tissue does not occur simultaneously;

- when using extraoral collection of autograft bone, the patient is subject to additional trauma at the site of bone tissue collection outside the oral cavity when collecting the autograft;

- when using bone tissue of animal origin, the patient may experience an allergic reaction to bone tissue of animal origin, due to the difference in their antigenic nature;

- when using bone tissue of animal origin, it is possible to infect a person with diseases carried by prions (for example, spongiform encephalitis - mad cow disease), since methods for purifying bone tissue of animal origin do not guarantee the destruction of prions;

- when using bone tissue of animal origin, it is often encapsulated, rather than transformed into human cancellous bone tissue, the reason for this phenomenon is its insufficient osteoinductive potential (see, for example, Cario Majorana and Mammimo Silion. Advanced techniques for bone regeneration with BIO- OSS and BIO-GAID, chapter III. Elevation of the maxillary sinuses, Moscow, 2005, pp. 57-66).

The sinus lifting method for dental implantation is considered as the closest technical solution (see, for example, patent RU 2397719 C1, published on April 20, 2009). The method involves making a perforation hole in the side wall of the maxillary sinus. The mucous membrane of the bottom of the maxillary sinus is peeled off and raised to form a space above the bone tissue of the alveolar process. Alloplant biomaterial in the form of dura mater or fascia, previously obtained from a human corpse, is placed on the exfoliated mucous membrane from the side of the formed space. The rest of the space is filled with bone material and biomaterial, which is used as bone tissue of animal origin.

The disadvantages of this method are:

- thermal damage to the bone tissue of the alveolar process during the formation of a perforation hole in the side wall of the maxillary sinus when using a surgical cutter or bur;

- perforation of the mucous membrane of the Schneiderian membrane of the maxillary sinus, during the formation of a perforation hole in the side wall of the maxillary sinus when using a surgical cutter or bur;

- perforation of the mucous membrane of the Schneiderian membrane of the maxillary sinus, during peeling of the sinus membrane when using a manual curette;

- perforation of the mucous membrane of the Schneiderian membrane of the maxillary sinus, during peeling of the sinus membrane from the bone fragment of the side wall of the sinus when forming access to the sinus;

- migration of the implanted bone material into the maxillary sinus in the postoperative period;

- slow osteogenesis due to the use of bone material of animal origin with low bioavailability and low affinity for human bone tissue;

- slow neoangiogenesis, osteogenesis due to the use of bone material of animal origin with low bioavailability and affinity for human bone tissue;

- a greater number of surgical operations, since they first plant bone tissue (sinus lifting), wait 6-8 months for engraftment, and then perform a second operation - implantation and again wait 6-8 months before prosthetics;

- the long waiting time for prosthetics with crowns or bridges on implants is 2 times longer with the classical sinus lifting technique, due to the separation of the implantation operation and bone grafting, thus the engraftment of implants and bone tissue does not occur simultaneously;

- when using Alloplant, which is obtained from a part of a human corpse, this technique will be unacceptable for most patients due to ethical or religious beliefs;

- when using Alloplant, the patient may experience an allergic reaction to this material due to the difference in their antigenic nature.

After the removal of teeth in the lateral part of the upper jaw, most patients develop a deficiency of bone tissue in the alveolar process of the lateral part of the upper jaw, which is a contraindication for the installation of dental implants and prosthetics on them.

To compensate for destructive changes in the alveolar process, bone materials of animal or synthetic origin are currently used.

Animal bone material is a preparation made from spongy bone of cattle or pigs. Its manufacturing technology involves removing organic substances from raw materials that provoke an immune reaction. The output is bone material, the structure of which is similar in physical and chemical parameters to human bone.

Bone material of animal origin serves as a framework for the formation of new human bone tissue. After placement in the surgical wound, bone material of animal origin is transformed into human bone tissue. However, the use of bone material of animal origin has the following negative consequences:

- when using bone material of animal origin, it is possible to infect a person with diseases carried by prions (for example, spongiform encephalitis or mad cow disease), since methods for purifying bone tissue of animal origin do not guarantee the destruction of prions;

- when using bone material of animal origin, it is often encapsulated, rather than transformed into the necessary spongy human bone tissue, the reason for this is the lack of osteoinductive potential;

- the use of bone material of animal origin is accompanied by slow osteogenesis due to its low bioavailability and low affinity for human bone tissue;

- the use of bone material of animal origin is accompanied by slow neo-angiogenesis and neo-ostogenesis due to its low bioavailability and low affinity for human bone tissue;

- the use of bone material of animal origin is accompanied by allergic reactions to it in the patient due to its low bioavailability and low affinity for human bone tissue;

- the use of bone material of animal origin is accompanied by the formation of connective tissue, and not human bone tissue, necessary for fixing a dental implant.

Creature of invention

The basis of the present invention is the task of creating a method for producing a biocomposite ex tempore, which can be used to increase the volume of bone tissue of the alveolar process of the upper jaw in the lateral region immediately before installing dental implants, which will allow:

- combine two operations (dental implantation and sinus lifting (bone grafting)) into one;

- accelerate osteogenesis due to the bioavailability of the biocomposite and its ability to quickly transform into human bone tissue;

- accelerate neoangiogenesis, thanks to the properties of the biocomposite, accelerate the germination of new blood vessels into the biocomposite;

- potentiate the formation of bone tissue, rather than the formation of connective tissue;

- speed up the treatment time for the patient and carry out prosthetics faster, by combining the processes of engraftment of the planted bone tissue and the engraftment of the installed implant.

The present invention is also based on the task of creating a biosinus lifting method using a biocomposite according to claim 1, in which the use of a biocomposite will allow

- reduce the number of surgical operations due to simultaneous sinus lifting (bone grafting) and installation of implants, i.e. combine two operations into one;

- reduce the waiting time for prosthetics with crowns or bridges on implants by half, by combining the operation of implantation and sinus lifting into one operation, thereby engrafting implants and bone tissue occurs simultaneously;

- potentiate the formation of the necessary bone tissue, rather than connective tissue. At the same time, the use of an ultrasonic piezosurgical system will allow:

- eliminate thermal damage to the bone tissue of the alveolar process during the formation of a perforation hole in the side wall of the maxillary sinus;

- exclude perforation of the Schneiderian membrane of the maxillary sinus during the formation of a perforation hole in the lateral wall of the maxillary sinus;

- exclude perforation of the Schneiderian membrane of the maxillary sinus during its detachment from the bone;

- exclude migration of the implanted bone material into the maxillary sinus in the postoperative period, thanks to the formation of a septum by tucking inside the side wall of the sinus.

The problem is solved by creating a method for producing ex tempore biocomposite, which consists in the following:

bone cells are collected from the patient’s cortical bone in the area of the alveolar process of the upper jaw along its outer surface in the surgical area for sinus lifting and implantation,

the patient’s venous blood is collected using the VACUETTE vacuum tube system without filler from the ulnar, radial or median superficial vein of the forearm,

the collected blood is centrifuged for 15 minutes at a speed of 2000 rpm,

extract the upper dense fraction of blood (PRF) from the test tube (Platelet Rich Fibrin - fibrin with a large number of platelets),

grind the specified dense fraction (PRF)Ha into fragments of 1-3 mm in size, mix the crushed dense blood fraction (PRF) with bone cells of the patient’s cortical bone,

The osteoplastic material “Nucleostim VEGF” is added to the resulting mixture, and the ratio of the mixture components is:

- dense blood fraction (PRF) - 25-35 vol. %,

- bone cells of the patient’s cortical bone - 25-35 vol. %,

- osteoplastic material “Nucleostim VEGF” - 35-45 vol. %.

Osteoplastic material "Nucleostim VEGF" is octacalcium phosphate granules coated with biologically active plasmid DNA nucleic acids with a gene encoding vascular endothelial growth factor (VEGF), stimulating neoangiogenesis and bone tissue regeneration. The main feature of the osteoplastic material “Nucleostim VEGF” is pronounced osteoinduction, leading to accelerated formation and maturation of bone regenerate.

It is preferable that the volume of bone tissue harvested be 1-2 ml.

It is preferable that venous blood is collected in the amount of 3 tubes of 2 ml each, obtaining a total volume of about 6 ml.

The problem is also solved by creating a bio sinus lifting method using a biocomposite according to claim 1, which is that:

a cavity is formed in the maxillary sinus, which is filled with the biocomposite according to claim 1, and to form said cavity, the following steps are carried out:

an incision is made in the oral mucosa in the sinus lifting area and the mucoperiosteal flap is separated from the side wall of the maxillary sinus in a blunt manner using a raspator,

a fragment of the bone of the anterolateral wall of the maxillary sinus is cut off, without separating the said fragment from the Schneiderian membrane, using an ultrasonic piezosurgical system,

a perforation hole is formed in the lateral wall of the maxillary sinus by pressing a separated fragment of the bone of the lateral wall into the maxillary sinus,

the Schneiderian membrane is peeled off and lifted from the bottom and walls of the maxillary sinus in its lower third through the resulting perforation hole using the specified ultrasonic piezosurgical system,

form a septum between the main cavity of the paranasal sinus (upper 2/3 of the sinus) and the rest of it (lower 1/3) by tucking the cut-off bone fragment together with the Schneiderian membrane towards the sinus, forming a cavity under it,

forming at least one hole for at least one implant in the floor of the maxillary sinus using the specified ultrasonic piezosurgical system,

fill the specified cavity with a biocomposite, according to point 1, through the formed hole in the side wall of the maxillary sinus,

install at least one dental implant into the formed at least one hole in the bottom of the maxillary sinus, so that the body of the implant is in contact with the biocomposite, and the neck fixes the implant in the bottom of the maxillary sinus,

close the perforation hole in the side wall of the sinus with a bioresorbable membrane and fix it with titanium pins,

The mucoperiosteal flap is placed in its original position and the wound is sutured.

Preferably, the biocomposite is compacted in the specified cavity to avoid the formation of voids and cavities in its thickness.

Preferably, cutting off a fragment of the lateral wall of the maxillary sinus is carried out by means of an attachment to an ultrasonic piezosurgical system for working with bone tissue.

Preferably, peeling and lifting of the Schneiderian membrane from the bottom of the maxillary sinus is carried out by means of an attachment to an ultrasonic piezosurgical system for working with soft tissues.

The use of a biocomposite as a bone tissue substitute in a cavity in the maxillary sinus ensures rapid and predictable transformation of the biocomposite into human bone tissue, and also ensures hypoallergenicity, increased bioavailability, acceleration of neoangiogenesis and neoosteogenesis.

Thanks to the regenerative (osteoinductive) properties of the biocomposite, a rapid process of its transformation occurs into dense spongy human bone tissue, which is capable of holding dental implants.

Thanks to the use of the patient's bone cells as part of the biocomposite, the formation of the necessary bone tissue is potentiated, rather than the formation of connective tissue.

In contrast to the known methods of extraoral collection of bone cells during sinus lift surgery, in the claimed method, when collecting bone cells for the manufacture of a biocomposite in the area of the alveolar process in the area of the main operation, it is not necessary to cause additional trauma to the patient, since no additional incisions of the skin or mucous membrane are required , if the bone tissue was collected extraorally.

Unlike known methods in which a surgical cutter is used to form a hole in bone tissue, when using an ultrasonic piezosurgical system, there is no crushing of bone cells and blockage of blood vessels of capillaries in the bone with sawdust of bone tissue, which leads to accelerated bone regeneration after surgery.

The regenerative properties and bioavailability of the biocomposite are achieved through the use of the following components:

- patient's bone cells,

- osteoplastic material “Nucleostim VEGF”,

- PRF (Platelet Rich Fibrin - fibrin with a large number of platelets) of the patient, isolated from his blood.

The proposed method of sinus lifting with simultaneous dental implantation in the specified set of essential features of the invention provides a new effect: accelerated and predictable production of bone tissue in the lateral part of the upper jaw with its initial deficiency and one-step (simultaneous) installation of dental implants as a support for future orthopedic dental procedures structures (crowns or bridges), and also prevents the development of complications that accompany sinus lift surgery. The achievement of this result is due to the new property of the biocomposite identified by the authors - to transform at an accelerated pace into the jaw bone and activate regeneration processes by accelerating angiogenesis and proliferation of osteoblasts to create new bone tissue necessary for the installation of dental implants and eliminate complications during the formation of a cavity for the biocomposite, through the use ultrasonic piezosurgical system.

In the claimed invention, the combination of two features - material and tool - gives a positive effect.

Brief description of drawings

The following is a description of preferred embodiments of the invention with reference to the accompanying drawings, in which:

Fig. 1 depicts the detachment of a mucoperiosteal flap of the alveolar process of the upper jaw and the area where bone cells are collected from the patient;

Fig. 2 depicts the formation of a perforation hole in the lateral wall of the maxillary sinus using the attachment of an ultrasonic piezosurgical system;

Fig. 3 depicts peeling of the Schneiderian membrane from the bone of the inner surface of the maxillary sinus using the attachment of an ultrasonic piezosurgical system and bending a bone fragment into the maxillary sinus without separation from the Schneiderian membrane;

Fig. 4 shows the formation of a channel for the implant in the bottom of the maxillary sinus using the attachment of an ultrasonic piezosurgical system;

Fig. 5 shows a formed cavity in the maxillary sinus filled with biocomposite;

Fig. 6 depicts the installation of a dental implant through a canal in the floor of the maxillary sinus;

Fig. 7 shows the closure of the perforation in the lateral wall of the maxillary sinus with a bio-resorbable membrane and its fixation with titanium pins;

Fig. 8A, 8B, 8C show a general view of the attachments of the ultrasonic piezosurgical system.

Description of Preferred Embodiments of the Invention

Method of obtaining the composition: biocomposite:

Before surgery, the patient underwent venous blood sampling from the median superficial vein of the forearm using the VACUETTE vacuum tube system. Three 2 ml tubes were taken. Type of VACUETTE tube used: tubes without filler - red cap.

Immediately after blood collection, it was centrifuged for 15 minutes at a speed of 2000 rpm. The dense fraction PRF (Platelet Rich Fibrin - fibrin with a large number of platelets) was taken from the test tube and crushed with scissors into fragments less than 1-3 mm.

An incision was made in the oral mucosa and a mucoperiosteal flap was peeled off on the alveolar process of the upper jaw, and bone cells of the cortical layer were collected from the outer surface of the alveolar process in a volume of 2 ml.

The crushed dense fraction of PRF blood was mixed with the patient's cortical bone cells.

The drug “Nucleostim VEGF” was added to the resulting mixture in the following ratio of components:

- dense blood fraction (PRF) - 25-35% of the total volume of the mixture,

- bone cells of the patient’s cortical bone - 25-5% of the total volume of the mixture,

- osteoplastic material "Nucleostim VEGF" - 35-45 percent of the total volume of the mixture.

The resulting biocomposite was used to be introduced into the prepared cavity in the maxillary sinus immediately.

The method is carried out as follows.

The patient undergoes a computed tomography scan of the upper jaw to identify individual features of the anatomical structure and determine the location of installation of future dental implants.

During surgery on the upper jaw, an incision was made with a scalpel into the oral mucosa in the sinus lifting area.

Mucoperiosteal flap 2 was separated from the bone base in a blunt manner using a raspator (Fig. 1).

In FIG. Figure 1 shows the alveolar process 1 with a folded flap 2 and exposed bone tissue 3, the upper jaw in the lateral section with the maxillary sinus 4, Schneiderian membrane 5, periosteum 6 and mucous membrane 7 of the oral cavity.

In FIG. 1 also shows zone 8 of the collection of cortical bone cells from the same surgical wound.

Cortical bone cells were collected in the area of the alveolar process of the upper jaw along its outer surface. The total volume of cortical bone tissue harvested is 1-2 ml.

In FIG. Figure 2 shows the formation of a window 9 in the side wall 10 of the maxillary sinus 4 using an attachment for working with bone tissue 11 of the ultrasonic piezosurgical system 12 (the system is not shown).

The window 9 was formed in such a way that part of the bone 13 of the side wall 10 of the maxillary sinus 4 was not removed or separated from the Schneiderian membrane 5 of the maxillary sinus 4, but was tucked inward, forming a septum from it (Fig. 3) in the sinus 4.

The Schneiderian membrane 5 was peeled off and raised from the bone tissue of the bottom 14 of the maxillary sinus 4, while a cavity 15 was formed above the bone tissue of the bottom 14 of the maxillary sinus 4 of the nose.

When peeling off the Schneiderian membrane 5, the attachment 16 was used to work with soft tissues and membranes of the ultrasonic piezosurgical system 12 (not shown).

Using the nozzle 17 (Fig. 4) to form a channel for the implant of an ultrasonic piezosurgical system (not shown), a channel 18 was formed in the day 14 of the maxillary sinus 4, in the place where it was planned to install the dental implant. The prepared biocomposite 19 was introduced into the formed cavity 15 through window 9 (Fig. 5).

Biocomposite 19 was compacted using a plugger (not shown) to avoid the formation of voids and cavities in its thickness and in cavity 15.

Using an implantological physiodispenser (not shown), a dental implant 20 (Fig. 6) was installed in the prepared canal 18 in the bottom 14 of the maxillary sinus 4, so that the body of the implant 20 was in contact with the biocomposite 19. Then the window in the side wall of the maxillary sinus 4 was closed with a bioresorbable membrane 21 (Fig. 7) and fixed it with titanium pins 22 (4 pins are shown in Fig. 7).

Mucoperiosteal flap 2 was returned to its original position and the wound was sutured.

In FIG. 8A, Fig. 8B, Fig. 8C shows the attachments of the ultrasonic piezosurgical system, used respectively to form the window 9, peel off the Schneiderian membrane 5, and form the channel for the implant 20.

Example 1.

Patient S, 65 years old, came to the clinic with complaints of partial absence of teeth in the lateral part of the upper jaw on the left. The patient refused prosthetics with removable dentures. A computed tomography scan of the upper jaw was performed. The height of the bone tissue of the alveolar process of the upper jaw on the right is 4.0 mm; There is atrophy of the alveolar process of the upper jaw in the lateral region in height. The patient was asked to eliminate the dentition defect with prosthetics on an implant using the proposed sinus lift method.

The sinus lift operation was performed in accordance with the method described above.

Before the operation, the patient underwent a computed tomography scan of the upper jaw to identify individual features of the anatomical structure and determine the location of installation of future dental implants.

Before surgery, the patient underwent venous blood sampling from the median superficial vein of the forearm using the VACUETTE vacuum tube system. Three 2 ml tubes were taken. Type of VACUETTE tube used: tubes without filler - red cap.

Immediately after blood collection, it was centrifuged for 15 minutes at a speed of 2000 rpm. The dense PRF fraction was taken from the test tube and crushed with scissors into fragments less than 1-3 mm.

For pain relief, infiltration anesthesia with Ultracaine DS FORTE was used.

During surgery on the upper jaw, an incision was made with a scalpel into the oral mucosa in the sinus lifting area.

The mucoperiosteal flap was separated from the bone base in a blunt manner using a rasp.

Cortical bone cells were collected in the area of the alveolar process of the upper jaw along its outer surface. The total volume of cortical bone tissue harvested is 2 ml.

The ground dense blood fraction (PRF) was mixed with the patient's cortical bone cells.

The osteoplastic material “Nucleostim VEGF” was added to the resulting mixture in the following ratio of mixture components:

- dense blood fraction (PRF) - 25-35% of the total volume of the mixture,

- bone cells of the patient’s cortical bone - 25-35% of the total volume of the mixture,

- osteoplastic material “Nucleostim VEGF” - 35-45% of the total volume of the mixture. A window was formed in the lateral wall of the maxillary sinus using an ultrasonic piezosurgical system using attachments for working with bone tissue. The window was formed in such a way that part of the bone (part of the lateral wall of the maxillary sinus) was not removed or separated from the membrane of the paranasal sinus, but was tucked inward, forming a septum in the sinus.

The Schneiderian membrane of the bottom and walls in the lower third of the maxillary sinus was peeled off and raised, and a space was formed above the bone tissue of the alveolar process in the area of the bottom of the paranasal sinus.

When peeling off the Schneiderian membrane, an attachment for working with soft tissues and membranes of the ultrasonic piezosurgical system was used.

Using an ultrasonic piezosurgical system using a nozzle to form a bed for the implant, channels were formed in the bottom of the maxillary sinus in the place where it was planned to install dental implants.

A biocomposite was introduced into the formed cavity in the maxillary sinus.

The biocomposite was compacted using a plugger to avoid the formation of voids and cavities in its thickness.

Using an implantological physiodispenser, a dental implant was installed in a pre-prepared canal in the bottom of the maxillary sinus, so that the body of the implant was in contact with the biocomposite, and its neck was fixed in the bone of the bottom of the sinus. Plugs were installed on the implants.

Then the perforation hole in the lateral wall of the maxillary sinus was closed with a bioresorbable membrane and fixed with titanium pins.

The mucoperiosteal flap was returned to its original position and the wound was sutured.

After 4 months, gum formers were installed on the implants and a Periotest was performed to determine the degree of osseointegration of the implants.

The periotest was equal to - 6, which indicates high osseointegration of the implants and the formation of dense spongy bone tissue.

After monitoring the condition and stability of the dental implants, prosthetics with a zirconium dioxide crown were performed using the traditional method.

A follow-up examination of the patient after 1 year showed that the patient felt comfortable, the implant was stable, and the crown was functional.

Industrial applicability

The proposed invention provides a good result and can be used for performing a bio sinus lifting operation with simultaneous dental implantation due to the use of a biocomposite as a replanted bone material and accelerating the processes of osteogenesis in the bone tissue of the alveolar process of the lateral upper jaw, as well as accelerating the process of transformation of the graft into spongy bone, and prevent complications (bone burn, membrane perforation) due to the operation using attachments of an ultrasonic piezosurgical system.

Claims (28)

1. A method for obtaining a biocomposite ex tempore, which consists of: taking bone cells from the patient’s cortical bone in the area of the alveolar process of the upper jaw along its outer surface, the patient’s venous blood is collected using the VACUETTE vacuum tube system without filler from the ulnar, radial or median superficial vein of the forearm, the collected blood is centrifuged for 15 minutes at a speed of 2000 rpm, extract the upper dense fraction of blood (PRF) from the test tube (Platelet Rich Fibrin - fibrin with a large number of platelets), crush the specified dense fraction (PRF) into fragments measuring 1-3 mm, mix the crushed dense fraction of blood (PRF) with the bone cells of the patient’s cortical bone, add the osteoplastic material “Nucleostim VEGF” to the resulting mixture, when In this case, the ratio of the mixture components is: - dense blood fraction (PRF) – 25-35 vol. %, - bone cells of the patient’s cortical bone – 25-35 vol. %, - osteoplastic material “Nucleostim VEGF” – 35-45 vol. %. 2. Method step 1, in which the volume of bone tissue taken is 1-2 ml. 3. Method step 1, in which venous blood is collected from three 2 ml tubes to obtain a total volume of venous blood of about 6 ml. 4. Bio sinus lifting method using a biocomposite obtained by the method according to claim 1, consisting in the fact that a cavity is formed in the maxillary sinus, which is filled with a biocomposite obtained by the method according to claim 1, while the following steps are performed to form said cavity: an incision is made in the mucous membrane of the cavity in the sinus lifting area and the mucoperiosteal flap is separated from the side wall of the maxillary sinus in a blunt manner using a raspator, a fragment of the bone of the lateral wall of the maxillary sinus is cut off, without separating the said fragment from the Schneiderian membrane, using an ultrasonic piezosurgical system, a perforation hole is formed in the lateral wall of the maxillary sinus by pressing a separated fragment of the bone of the lateral wall into the maxillary sinus, the Schneiderian membrane is peeled off and lifted from the bottom and walls of the maxillary sinus in the lower third through the resulting perforation hole using the specified ultrasonic piezosurgical system, form a septum between the main cavity of the maxillary sinus and the rest of it by tucking the cut-off bone fragment together with the Schneiderian membrane towards the sinus, forming a cavity underneath it, forming at least one hole for at least one implant in the floor of the maxillary sinus using the specified ultrasonic piezosurgical system, fill the specified cavity with a biocomposite obtained by the method according to claim 1, through the formed hole in the anterolateral wall of the maxillary sinus, install at least one dental implant into the formed at least one hole in the bottom of the maxillary sinus, so that the body of the implant is in contact with the biocomposite, and the neck fixes the implant in the bone of the bottom of the sinus, close the perforation hole in the anterolateral wall of the sinus with a bioresorbable membrane and fix it with titanium pins, The mucoperiosteal flap is placed in its original position and the wound is sutured. 5. The method according to claim 4, in which the biocomposite is compacted in the specified cavity to avoid the formation of voids and cavities in its thickness. 6. The method according to claim 4, in which cutting off a fragment of the anterolateral wall of the maxillary sinus is carried out by means of an attachment to an ultrasonic piezosurgical system for working with bone tissue. 7. The method according to claim 4, in which the peeling and lifting of the Schneiderian membrane from the bottom of the maxillary sinus is carried out by means of an attachment to an ultrasonic piezosurgical system for working with soft tissues.