RU2838796C1 - Method for approach with open sinus lifting - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely surgical dentistry and maxillofacial surgery. Trapezoidal incision of the mucous membrane is performed along an apex of an alveolar crest within the missing teeth of the upper jaw with a transition onto a vestibular surface of the upper jaw with its base to a transitory fold. Then mucous membrane is stripped from periosteum within attached gum. Mucous membrane flap is displaced upwards. Semilunar incision of the periosteum is performed. Periosteal graft is dissected and displaced upwards. Further, bone window 3-5 mm smaller than the cut out periosteal semilunar flap is formed in an anterolateral wall of the maxillary sinus using a diamond spherical bur. After the Schneiderian membrane is peeled off and the created space is filled with an osteoplastic material, the semilunar periosteal flap is laid covering a bone defect of the maxillary sinus wall, and closed with a two-row suture. Then flap mucous membrane is laid back and double-row suture is applied 3-5 mm below and in lateral direction of suture level of periosteal flap, flap mucous membrane is anchored to periosteum.

EFFECT: method allows to increase the open sinus lifting operation efficiency by using own tissues, reliably closing the osteotomy window with the periosteum flap without the use of additional materials in the form of a resorbable membrane, which prevents the bone graft displacement beyond the formed bed, prevents the soft tissue component growing into the augmentation zone, reduces the probability of postoperative complications.

1 cl, 19 dwg, 1 tbl, 1 ex

Description

The invention relates to medicine, namely to surgical dentistry and maxillofacial surgery, and can be used in open sinus lift operations and dental implantation.

There are various known methods of access when performing open sinus lift operations.

A method of sinus lifting in dental implantation is known, which consists in the fact that the tissues of the vestibule of the oral cavity are dissected by a vertical incision from the transitional fold to the neck of the premolar, and then along the crest of the alveolar process of the upper jaw with detachment of a triangular mucoperiosteal flap. (Kislykh F.I., Sergeev A.A. METHOD OF SINUS LIFTING IN DENTAL IMPLANTATION. Patent of the Russian Federation No. 2228722, Published 20.05.2004, Bulletin No. 14). The disadvantage of the above method is the triangular shape of the cut flap, which does not provide a sufficient overview of the surgical field. In addition, the authors do not give clear recommendations on the size and compliance of the edges of the wound.

There is also a method of access during sinus lifting surgery, which consists in making an arc-shaped incision in the area of missing teeth on the vestibular side and a grooved in the area of teeth adjacent to the defect. At the front tooth, the incision is continued to the transitional fold, preserving the gingival papilla. The mucoperiosteal flap is peeled off and thrown back to the zygomaticoalveolar ridge. The osteotomy boundaries are determined. The lower border of the bone window is located at a distance of 5-6 mm from the expected level of the sinus bottom. A bone window is formed to the inner cortical layer. At the end of the operation, the osteotomy window is closed with a resorbable membrane. The flap is mobilized, placed in place and sutured (Razmyslov A.V., Minkin A.U. METHOD OF ACCESS DURING SINUS LIFT OPERATION WITH SINGLE-STAGE IMPLANTATION. Russian Federation Patent No. 2445026, Published 20.03.2012 Bulletin No. 8).

The disadvantage of this method is the technique of cutting out a full-layer flap, as well as the need to use a resorbable membrane as a mandatory component of the operation.

This method was taken as a prototype.

The proposed invention is aimed at solving the following problems: increasing the efficiency of the access method during sinus lifting surgery by using one's own tissues, reliable closure of the osteotomy window with a non-displaceable periosteal flap, and no need to use additional materials in the form of a resorbable membrane.

The specified objectives are achieved by closing the trepanation window with a periosteal flap, which prevents the displacement of the bone graft beyond the formed bed and also prevents the ingrowth of the soft tissue component into the augmentation zone.

The new method is the creation of a non-displaceable flap by splitting the mucoperiosteal flap.

Under conduction and infiltration anesthesia, a trapezoidal incision is made. The tissue dissection line passes along the apex of the alveolar ridge in the area of the missing teeth of the upper jaw with a transition to the vestibular surface of the upper jaw, with the base to the transitional fold. Through the interdental papilla of the previous teeth proximally and the papilla of the subsequent teeth or, in the case of missing teeth, along the tubercle of the upper jaw distally. In depth, the incision is made within the mucous layer to the border with the periosteum.

Next, the mucous membrane within the attached gum and the muscular layer above the transitional fold are peeled away from the periosteum.

The flap of the mucous membrane with the muscular layer is shifted upward. The periosteum is dissected 3-5 mm below the border of the supposed bone window with a semilunar incision. The semilunar flap of the periosteum is peeled off and shifted upward. The resulting bone window is smaller in diameter than the periosteal flap by 3-5 mm on each side.

A bone window is formed in the anterolateral wall of the maxillary sinus with a diamond spherical bur, the borders of which are 3-5 mm smaller than the borders of the cut periosteal semilunar flap. The bone window is formed without damaging the Schneiderian membrane, which is peeled off from the bottom of the maxillary sinus and shifted back and up to the required height (up to 5 mm). The space between the Schneiderian membrane and the bottom of the sinus is filled with any bone plastic material, such as BioOst, Osteon II. The semilunar flap of the periosteum is placed, completely covering the bone defect of the wall of the maxillary sinus, and is sutured with resorbable suture material. The flap of the mucous membrane of the alveolar process of the upper jaw, placed in place, is sutured below and lateral to the level of the sutures (approximately 3-5 mm) of the periosteal flap. The flap of the mucous membrane of the upper jaw is tightly sutured with suture material, suturing it to the periosteum of the upper jaw for stabilization along the zygomatic alveolar ridge of the upper jaw.

We have performed 11 operations using the stated method. All 11 operations were successful, no complications were detected, either during the operation or in the postoperative period.

Computer tomography of operated patients shows a stable positive result - the formation of bone tissue in the area of the surgical intervention, of sufficient volume for performing dental implantation surgery.

The obtained results were analyzed and compared with the analysis of the results of sinus lifting operations using the standard method (Table 1).

Table 1 Analysis of complications resulting from sinus lift surgery

Criterion The stated method Standard way Formation of bone tissue in the area of bone grafting 11/11 9/11 Ingrowth of soft tissue into the maxillary sinus in the area of the operation 0/11 2/11 Formation of a fistula with the release of bone plastic material 0/11 3/11

The data presented above clearly demonstrate the effectiveness and safety of the declared method of performing open sinus lift surgery.

The technical result of the method is a reduction in complications in the postoperative period: displacement of the bone plastic material from the formed bed, ingrowth of the mucous membrane into the maxillary sinus. The method is safe and effective, and does not require the use of additional materials in the form of a resorbable membrane.

Clinical example.

Patient A., 42 years old, came to the clinic complaining of partial absence of teeth on the right upper jaw (Fig. 9). The patient was offered to eliminate the defect of the dental arch using prosthetics on implants. According to CBCT data, the thickness of the bone tissue of the alveolar process of the upper jaw in the sagittal section is from 5 to 2 mm in the area of the missing 15, 16 teeth (Fig. 5, Fig. 6), which is an insufficient volume for the implantation operation. An open sinus lift operation was planned using the declared access method.

Under conduction and infiltration anesthesia, the patient underwent a trapezoidal incision along the apex of the alveolar ridge in the area of the missing teeth of the right upper jaw with a transition to the vestibular surface, the base to the transitional fold (Fig. 10). The boundaries of the incision were through the interdental papilla of tooth 14 proximally and the papilla of tooth 17 distally. In depth, the incision was performed within the mucous layer to the border with the periosteum.

Figure 1 clearly shows the layers of the operation field.

Legend:

1. Cavity of the maxillary sinus;

2. Schneiderian membrane;

3. Bone tissue of the zygomaticoalveolar ridge;

4. Periosteum;

5. Mucous membrane of the zygomaticoalveolar ridge;

6. Bone plastic material.

The mucous membrane within the attached gingiva and the muscular layer above the transitional fold were exfoliated from the periosteum (Fig. 11). The flap of the mucous membrane with the muscular layer was shifted upward. The periosteum was dissected 4 mm below the border of the supposed bone window with a semilunar incision. The semilunar flap of the periosteum is exfoliated and shifted upward. (Fig. 2, Fig. 12)

In the anterolateral wall of the maxillary sinus, a diamond spherical bur was used to form a bone window 8.0 * 5.0 mm, the borders of which are 5 mm smaller than the borders of the dissected periosteal semilunar flap on each of its sides (Fig. 13). The bone window was formed without damaging the Schneiderian membrane, which was peeled off from the floor of the maxillary sinus and shifted back and upward to the required height (3 mm). The space between the Schneiderian membrane and the floor of the sinus was filled with Osteon II bone plastic material (Fig. 3, Fig. 14), and implants were installed (Fig. 15). The semilunar flap of the periosteum was laid (Fig. 16) with complete coverage of the bone defect of the wall of the maxillary sinus, and sutured with resorbable suture material (Fig. 17). The flap of the mucous membrane of the alveolar process of the maxilla, placed in place, is sutured below and lateral to the level of the sutures of the periosteal flap. The flap of the mucous membrane of the maxilla is tightly sutured with suture material, suturing it to the periosteum of the maxilla for stabilization along the zygomaticoalveolar ridge of the maxilla. (Fig. 4, Fig. 18).

A control CT scan performed 6 months after the surgery showed sufficient bone tissue in the area of the bone grafting (Fig. 7, Fig. 8). In the oral cavity, the soft tissues are epithelialized by primary intention, are painless upon palpation, and there is no discharge (Fig. 19). The implants are stable.

Claims (1)

An access method for open sinus lifting that includes creating a trephine hole in the anterolateral wall of the maxillary sinus, peeling off the Schneiderian membrane, filling the resulting space with bone plastic material, characterized in that a trapezoidal incision of the mucous membrane is made along the apex of the alveolar ridge in the area of the missing teeth of the upper jaw with a transition to the vestibular surface of the upper jaw with the base to the transitional fold, then the mucous membrane is peeled off from the periosteum within the attached gum, the mucous membrane flap is shifted upward, a semilunar incision of the periosteum is made, the periosteal flap is peeled off and shifted upward, then a bone window 3-5 mm smaller than the cut periosteal semilunar flap is formed in the anterolateral wall of the maxillary sinus with a diamond spherical bur, then, after peeling off the Schneiderian membrane and filling the resulting space with bone-plastic material, the crescent-shaped periosteal flap is placed, covering the bone defect of the wall of the maxillary sinus, and sutured with a double-row suture, then the mucous membrane flap is placed in place and a double-row suture is applied 3-5 mm below and lateral to the level of the periosteal flap sutures, suturing the mucous membrane flap to the periosteum.