RU2835910C1 - Method of fixing soft tissue graft when closing wound around healing abutment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, particularly to surgical and orthopaedic dentistry. Soft tissue graft is placed in the wound cavity in the space between the gum and the gum former. It is spread along the width and depth of the cavity by centring its position relative to the vertical axis of the implant with the attached gingiva former. Surgical needle with a suture material is successively passed through the following points located on the medial side of the implant, located closer to the frontal plane of the oral cavity: through the prick in from the outer side of the wound to a point located on the vestibular surface of gum at 5-6 mm from the gum incision, and prick out through the inner side of the wound to a point located on the oral surface of gum at 2-3 mm from the incision. Further, through the prick in from the outer side of the wound to a point located on the vestibular surface of gum 2-3 mm from the incision, and prick out through the inner side of the wound to a point located on the oral surface of gum at 5-6 mm from the incision. Further, the needle with the suture material is transferred to the distal side of the implant, which is located closer to the posterior part of the oral cavity, and successively passed through the following points located on the distal side of the implant: through the prick in from the outer side of the wound to a point located on the oral surface of gum at 5-6 mm from the incision, and prick out through the inner side of the wound to a point located on the vestibular surface of gum at 2-3 mm from the incision. Further, through the prick in from the outer side of the wound to a point located on the oral surface at 2-3 mm from the incision, and prick out from the inner side of the wound to a point located on the vestibular surface of gum at 5-6 mm from the incision. Wound edges are brought together by pulling the ends of the suture material from the medial and distal sides of the implant. Ends of the suture material are connected from the side of the vestibular surface of the gums and fixed by knotting.

EFFECT: method enables fixing and stabilizing the soft tissue graft, providing a tight coverage of the gum former with soft tissues and the graft in the depth of the wound and on its surface, providing blind closure of the wound, reducing the invasiveness of the procedure.

4 cl, 2 dwg, 1 tbl

Description

Field of technology to which the invention relates

The invention relates to medicine, in particular to surgical and orthopedic dentistry, and is intended for fixing a gum transplant when suturing a wound around a gum former in patients with installed dental implants [A61B17/00, A61B17/03, A61B17/04].

Information on the Prior Art

The quality and volume of soft tissues play an important role in achieving good aesthetics, as well as maintaining the health of the implant. In case of insufficient gum tissue volume, surgical procedures to increase the volume of soft tissues are indicated, which are carried out at different stages of implantation, however, the installation of a gingiva former, performed with the opening of the implant, is considered the most suitable, since it is performed at the moment when the soft tissues have already healed, and the implant has taken root. In most cases, the technique for increasing the volume of soft tissues consists in the fact that a flap is peeled off, a soft tissue graft is placed under it and the wound is sutured, while it is important to ensure reliable fixation of the graft, tight adhesion of the gum tissue and graft to the implant and gingiva former, the absence of "pockets" and internal cavities, ensuring rapid healing of the wound and engraftment of the graft.

A METHOD FOR ELIMINATION OF DEFICIENCY OF SOFT TISSUE SURROUNDING AN IMPLANTATE is known (RU 2558996 C1, 2015-08-10), in which a transplant cut in a special way is put on a gum former, straightened inside an artificial cavity in soft tissues and the wound is sutured with U-shaped sutures. The disadvantage of this method is the lack of fixation of the transplant inside the cavity, superficial suturing of the wound with the possibility of formation of internal cavities, insufficiently tight adhesion of the transplant tissues to the gum former.

Also known is a METHOD OF INCREASING THE VOLUME OF SOFT TISSUES USING A FREE CONNECTIVE TISSUE AUTOGRAFT WHEN INSTALLING GUM FORMERS ON DENTAL IMPLANTS (RU 2601918 C2, 2016-11-10), which consists in placing the graft in the gum cavity and fixing it in the recipient zone with mattress sutures, and then connecting the vestibular and palatal parts of the gum using transverse sutures. The disadvantage of this method is the lack of tight adhesion of the graft tissue to the gum former, and high invasiveness due to the use of a large number of sutures.

Also known is a METHOD OF APPLYING A SUTURE TO FIX A GRAFT DURING SOFT TISSUE OPERATIONS (RU 2816033 C1, 2024-03-25), in which a free gingival graft is placed in a formed bed and fixed along the entire length with separate sutures, each of which is a triangle with the apex upward, in which the knot is located. The disadvantage of this method can be considered the lack of tight adhesion of the graft to the gum former and the need to apply additional sutures to close the wound.

The closest in technical essence (prototype) to the claimed method can be considered the method described in the dissertation of A.V. Yesayan for the degree of candidate of medical sciences ("Comparative analysis of the effectiveness of using xenogenic collagen matrices and free connective tissue graft in patients with installed dental implants", https://www.sechenov.ru/upload/iblock/335/nb094bu9nul2e2t2fy7tndtobu7kmxmz/DISSERTATSIYA-Esayan.pdf), in which the fixation of the graft to the vestibular and oral flaps in the recipient bed area was carried out with horizontal U-shaped sutures, and for hermetic suturing of the wound, the vestibular mucoperiosteal flap was mobilized, after which the wound was hermetically sutured with interrupted or continuous sutures. If it was impossible to completely cover the alveolar ridge with one graft, two grafts were used, which were separately fixed to the vestibular and lingual mucoperiosteal flap. Then, during the final suturing of the wound, the needle was inserted through the covering flap, through both grafts, and then punctured through the covering flap on the opposite side. Thus, when tightening the knot, the connective tissue grafts were aligned with each other, forming a single fragment. The disadvantage of the proposed method is its high invasiveness and the lack of tight adhesion of the graft and soft tissues of the gum to the gum former.

For the purposes of this description, the following terms are used: "blind wound closure" means suturing the wound with a surgical suture that ensures the tightest possible approximation of the walls and edges of the wound (https://classes.ru/all-russian/dictionary-russian-academ-term-12989.htm), the terms "from the outside" and "from the inside" in relation to the sides of the wound mean exposure from the outside (outside) or from the inside (from the depth) of the wound cavity, the "medial" side is located closer to the frontal plane of the oral cavity, the "distal" side is located closer to the back of the oral cavity, the "vestibular" surface is the surface that is directed to the outside of the oral cavity, the "oral" surface is the surface that is directed to the inside of the oral cavity (can be palatine or lingual depending on the site of intervention) (https://shopdon.ru/blog/anatomiya-zubov-pyat-poverkhnostey-zuba/).

The essence of the invention

The objective of the invention is to eliminate the shortcomings of analogues and the prototype by creating a method for fixing a soft tissue graft when suturing a wound around a gum former, ensuring tight coverage of the gum former with soft tissues and a graft both in the superficial layers of tissue and in deeper ones, reducing the likelihood of the formation of internal cavities in the wound and having low invasiveness.

The stated problem is solved by the claimed invention, which is a method for fixing a soft tissue graft when suturing a wound around a gum former, including the use of a surgical needle with surgical suture material, in which a soft tissue graft is placed in the wound cavity in the space between the gum and the gum former, straightened over the entire width and depth of the cavity, centering its position relative to the vertical axis of the implant with the attached gum former, the surgical needle with suture material is sequentially passed through the following points located on the medial side of the implant: through a puncture from the outer side of the wound into a point located on the vestibular surface of the gum 5-6 mm from the gum incision, and a puncture through the inner side of the wound into a point located on the oral surface of the gum 2-3 mm from the incision, then through a puncture from the outer side of the wound into a point located on the vestibular surface of the gum 2-3 mm from the incision, and a puncture through the inner side of the wound to a point located on the oral surface of the gum 5-6 mm from the incision, then move the needle with the suture material to the distal side of the implant and sequentially pass through the following points located on the distal side of the implant: through a puncture from the outer side of the wound to a point located on the oral surface of the gum 5-6 mm from the incision, and a puncture through the inner side of the wound to a point located on the vestibular surface of the gum 2-3 mm from the incision, then through a puncture from the outer side of the wound to a point located on the oral surface 2-3 mm from the incision, and a puncture from the inner side of the wound to a point located on the vestibular surface of the gum 5-6 mm from the incision, closely bring the edges of the wound together by pulling the ends of the suture material from the medial and distal sides of the implant, connect the ends of the suture material from the side of the vestibular surface of the gum and fix by tying on node.

In particular, a soft tissue graft is placed into the wound cavity in the space between the gum and the gum former on the vestibular side.

In particular, a soft tissue graft is placed into the wound cavity in the space between the gum and the gingiva former on the oral side.

In particular, a soft tissue graft is placed into the wound cavity in the space between the gum and the gum former from the vestibular and oral sides.

The claimed method of fixing a soft tissue graft when suturing a wound around a gum former ensures the achievement of the following technical results:

- fixation and stabilization of soft tissue graft;

- ensuring tight coverage of the gum former with soft tissues and a transplant in the depth of the wound and on its surface;

- ensuring tight suturing of the wound;

- reducing the invasiveness of the procedure.

Brief description of the drawings

Fig. 1. Diagram of the location of injection and extraction points and the passage of suture material with vestibular placement of the soft tissue transplant.

Fig. 2. Diagram of the location of injection and extraction points and the passage of suture material during oral placement of a soft tissue transplant.

The following are indicated on the figures: 1 - soft tissue graft; 2 - gingiva former; 3 - implant; 4 - vestibular surface of the gum; 5 - medial side of the implant; 6 - oral surface of the gum; 7 - distal side of the implant; a-h - injection points, where points a, c, f, h are located on the vestibular surface of the gum, and points b, d, e, g - on the oral surface.

Implementation of the invention

The claimed method for fixing a soft tissue transplant 1 when suturing a wound around a gum former 2, intended for fixing and stabilizing a soft tissue transplant 1 with ensuring tight coverage of the implant 3 with the installed gum former 2 by soft tissues and the transplant 1 in the depth of the wound and on its surface and ensuring tight suturing of the wound, is carried out as follows:

After exposing the implant 3 and attaching the gum former 2 to it, a visual and/or instrumental assessment of the sufficiency of the gum tissues on the vestibular and/or oral side of the gum former 2 is performed and then, according to indications, a soft tissue graft 1 of the required size is placed in the wound cavity on the vestibular side of the implant 3 with the attached gum former 2 (Fig. 1), or a soft tissue graft 1 is placed in the wound cavity on the oral side of the implant 3 with the attached gum former 2 (Fig. 2), or soft tissue grafts are placed on the vestibular and oral sides of the implant 3 with the attached gum former 2 (not shown in the figures);

straighten the transplant 1 along the width and depth of the cavity, centering its position relative to the axis of the implant 3 with the attached gum former 2, ensuring tight adhesion of the transplant 1 to the soft tissues of the gum;

Use a surgical needle with surgical suture material;

The first injection is made from the outer side of the wound at point a , located on the vestibular surface 4 of the gum on the medial side 5 of the former 2, 5-6 mm from the incision;

The puncture is made from the inner side of the wound through point b , located on the oral surface 6 of the gum on the medial side 5 of the former 2, 2-3 mm from the incision; thus, the suture material passes through all the underlying tissues, including the transplant, if it is located on this side.

The needle with suture material is moved to the vestibular side of the gum;

Next, an injection is made from the outer side of the wound at point c , located on the vestibular surface 4 of the gum on the medial side 5 of the former 2, 2-3 mm from the incision;

The puncture is made from the inner side of the wound through point d , located on the oral surface 6 of the gum on the medial side 5 of the former 2, 5-6 mm from the incision; thus, the suture material passes through all the underlying tissues, including the transplant, if it is located on this side.

The needle with suture material is moved to the distal side of the implant;

The third injection is made from the outside of the wound at point e , located on the oral surface 6 of the gum on the distal side 7 of the former 2, 5-6 mm from the incision;

The puncture is made from the inner side of the wound through point f , located on the vestibular surface 4 of the gum on the distal side 7 of the former 2, 2-3 mm from the incision; thus, the suture material passes through all the underlying tissues, including the transplant, if it is located on this side.

The needle with suture material is moved to the oral side of the gum;

Next, an injection is made from the outside of the wound at point g , located on the oral surface 6 of the gum on the distal side 7 of the former 2, 2-3 mm from the incision;

The puncture is made from the inner side of the wound through point h , located on the vestibular surface 4 of the gum on the distal side 7 of the former 2, 5-6 mm from the incision; thus, the suture material passes through all the underlying tissues, including the transplant, if it is located on this side.

Then both ends of the suture material, located between points a and h, are tightened from the side of the vestibular surface 4 of the gum, with the possibility of creating a tight fit of the transplant 1 and soft tissues of the gum to the former 2 of the gum, as well as bringing the edges of the wound together tightly.

Then connect the ends of the suture material between points a and h from the side of the vestibular surface of the 4th gum and fix it by tying a knot. The knot is preferably made triple.

When pulling the ends of the suture material, stitches ab , cd , fe and gh pull the walls of the wound together, ensuring their tight closure with the transplant 1 and with each other, stitches de and ah (with a knot) compress the walls of the wound with the transplant 1 around the gum former 2, ensuring their tight fit, and stitches bc and fg pull the edges of the wound together, ensuring a tight closure, while the presence of only four injection points makes this method noticeably less invasive than analogues.

The suture is removed after 7-10 days according to indications. Removal is performed by cutting the loop of suture material between points d and e from the side of the oral surface of the 6th gum and pulling the entire thread from the side of the vestibular surface of the 4th gum by the knot located between points a and h .

Thus, it has been shown that the claimed method for fixing a soft tissue graft when suturing a wound around a gum former ensures the achievement of the following technical results: fixation and stabilization of the soft tissue graft, ensuring tight coverage of the gum former with soft tissues and a graft in the depth of the wound and on its surface, ensuring blind suturing of the wound, and reducing the invasiveness of the procedure.

Comparative efficiency of the method

In the period 2022-2023, a comparison was made of the engraftment efficiency of soft tissue gingival grafts in patients who underwent restoration of gingival volume sufficiency using the traditional method (according to the prototype) - fixation of the graft to the vestibular and/or oral flaps in the recipient bed area was performed with horizontal U-shaped sutures, and interrupted or continuous sutures were used for hermetic suturing of the wound (group A), and using the declared method (group B). The efficiency was assessed based on objective and subjective indicators by examination by a specialist and by interviewing the patients themselves. In total, the study took into account the data of 73 patients aged 41 to 67 years, with 29 patients in group A and 44 patients in group B, of which 15 required installation of a graft from the oral side, 16 required installation of a graft from the vestibular side, the rest required installation of a graft from the vestibular and oral sides. Of the total number of patients in Group B, 22 had all punctures and punctures made at a distance corresponding to the smallest proposed ranges for puncture and puncture (2 mm, 5 mm), for the remaining 22 patients in Group B, all punctures and punctures were made at a distance corresponding to the largest proposed ranges of values for puncture and puncture (3 mm, 6 mm). There was no statistically significant difference between these subgroups of Group B in terms of healing results. At the same time, modeling on gum tissues made it possible to establish that using values less than the stated ones does not provide sufficient tissue density around the former, and using larger values leads to excessive tension of the gum tissues and an increased likelihood of suture eruption.

Table 1 shows data on various factors as a percentage of the total number of patients in the group (rounded).

Table 1

Pain sensations for more than 2 days, % Bleeding of wounds and sutures for more than 2 days, % Redness and/or swelling for more than 3 days, % Removal of stitches after 7-14 days Removal of stitches more than 14 days Complications of various nature Group A 20 14 28 83 17 3 Group B 14 9 18 93 7 0

Thus, it has been shown that the claimed method is more effective, less traumatic, promotes faster healing of the surgical wound and has a lower probability of complications, compared to the previously known one.

Claims (4)

1. A method for fixing a soft tissue graft when suturing a wound around a gingiva former, which includes using a surgical needle with surgical suture material, in which a soft tissue graft is placed in the wound cavity in the space between the gum and the gingiva former, it is straightened along the width and depth of the cavity, centering its position relative to the vertical axis of the implant with the attached gingiva former, the surgical needle with suture material is sequentially passed through the following points located on the medial side of the implant located closer to the frontal plane of the oral cavity: through a puncture from the outer side of the wound to a point located on the vestibular surface of the gum 5-6 mm from the gingival incision, and a puncture through the inner side of the wound to a point located on the oral surface of the gum 2-3 mm from the incision, then through a puncture from the outer side of the wound to a point located on the vestibular surface of the gum 2-3 mm from the incision, and a puncture through the inner side of the wound to a point located on the oral surface of the gum 5-6 mm from the incision, then move the needle with the suture material to the distal side of the implant, located closer to the back of the oral cavity, and sequentially pass through the following points located on the distal side of the implant: through a puncture from the outer side of the wound to a point located on the oral surface of the gum 5-6 mm from the incision, and a puncture through the inner side of the wound to a point located on the vestibular surface of the gum 2-3 mm from the incision, then through a puncture from the outer side of the wound to a point located on the oral surface 2-3 mm from the incision, and a puncture from the inner side of the wound to a point located on the vestibular surface of the gum 5-6 mm from the incision, tightly bring the edges of the wound together by pulling the ends of the suture material from the medial and distal sides of the implant, connect the ends of the suture material from the side vestibular surface of the gum and fixed by tying a knot. 2. The method according to item 1, in which a soft tissue transplant is placed into the wound cavity in the space between the gum and the gum former from the vestibular side. 3. The method according to item 1, in which a soft tissue graft is placed into the wound cavity in the space between the gum and the gum former on the oral side. 4. The method according to item 1, in which a soft tissue transplant is placed into the wound cavity in the space between the gum and the gum former from the vestibular and oral side.