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ЭКСПЕРИМЕНТАЛДЫ ЖЭНЕ КЛИНИКАЛЫК ЗЕРТТЕУЛЕР
ЭКСПЕРИМЕНТАЛЬНЫЕ И КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯ
EXPERIMENTAL AND CLINICAL INVESTIGATIONS
UDC: 616,314:617-089.844
M.A. AMKHADOVA1, A.YU. IGNATOV1, B.S. ZHANALINA2, A.I. KAYKAN2
IMPROVING THE METHODS OF REHABILITATION OF PATIENTS WITH DENTITION DEFECTS AFTER A BONE - RECONSTRUCTIVE OPERATIONS
FATD MONICA named after M.Ph. Vladimirskiy1, Russia, Moscow Marat Ospanov West Kazakhstan State Medical University2, Aktobe
Complex treatment of the patients with partial and complete dentition defects after bone-reconstructive operation of the maxillofacial region with using dental implants is the most physiological method of rehabilitation of these category patients.
In present time there is no one complex approach to planning and carrying out dental implants among these category patients [1,3,5].
The basic principle of planning of modern implant treatment is based on the individual three-dimensional computer projecting, possible placement of implants. Examination of their position on a three-dimensional model realizes conformity of the adjacent teeth, dental implants and teeth - antagonists are possible on the screen to a virtual installation of implants. It allows to the surgeon with an orthopedic doctor to plan an operation for implants placement and to achieve their optimal position, to avoid damage of the surrounding soft tissues and teeth [2, 4].
Intended special software for dentistry allows carrying out a detailed preoperative analysis of the structure of the jaws, to visualize the boundaries of the lower jaw canal and the cortical plate bottom of the upper jaw sinus, identify any parameters of bone tissue, including density of bone tissue. On the based data arises volume of virtual model on which is carried out planning the operation.
The navigation template is an accurate means of transferring virtual data of the implant in the operating room. The method allows the installation of implants in complex clinical situations. In the case of implantation of the graft revascularized is not alternative. Reduces the risk of complications related with incorrect positioning implant. Also allows leading an operation without peeling muco-periosteum flap [5,6].
Key words: detailed implant, computer planning, navigational template, bone- reconstructive operation.
The purpose of the research. Clinical and laboratory substantiation of the planning of dental implant by computer modeling with the manufacture of surgical navigation templates.
Materials and methods of the research. On the departments of maxillofacial surgery (MFS) and Surgical Dentistry MONICA named after M.Ph.Vladimirsky, child and surgical dentistry with orthodontics of Marat Ospanov West Kazakhstan State Medical University and dental clinic in Almaty carry out the joint work on the rehabilitation of patients with defects of the jaws with using the method of dental implants and surgical navigation templates. Proposed an examination protocol, planning and carrying out operations of dental implant with the use of surgical navigation templates in patients with dentition defects, atrophy of bone tissue of jaws due edentulous, as well as in patients after bone reconstructive operation. In addition, we study the effectiveness of the method dental implant with the use of surgical navigation templates and virtual planning with the use of various computer programs, develop a protocol for complex rehabilitation of patients with defects of the jaws, the algorithm predicting postoperative complications.
Results of the research and discussion. As part of the preoperative examination held three-dimensional computer and stereolithographic modeling of recipient and donor areas. Selection of recipient vessels was carried out on the basis of duplex
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scanning of the brachiocephalic arteries, besides were evaluated passability, the diameter of the vessels, the condition of the vessel wall, velocity characteristics of blood flow (Figure 1).
Figure 1. The patient was born in 1992, with diagnosis: posttraumatic defect of the chin part of lower jaw, soft tissue of the bottom of oral cavity. The defect of the dentition is in the upper and lower jaw. Three-dimensional computer modeling before treatment.
After the clinical and laboratory and functional examinations the patients held bone plate of revascular autograft with the inclusion of the iliac crest and the internal oblique muscle. Postoperative course was uneventful.
After 6 months, patients re-entered for carrying out a dental implant. On entering, patients have defects in the dentition of the lower jaw in the anterior region, due to the absence of teeth 31, 32,33,34,41,42,43,44, with enough volume bone tissue for dental implant planning (Figure 2).
Figure 2. The patient was born in 1992, with diagnosis: posttraumatic defect of chin part in the lower jaw, soft tissue of the bottom of oral cavity. The defect of the dentition of upper and lower jaw. The view of the oral cavity of the patient after the carrying out bone reconstructive operation. Three-dimensional computer modeling after bone reconstructive operation.
At the planning stage of the operation patients is held computer tomography, with the construction of three-dimensional reconstruction of operation areas, as well as the construction of a panoramic slice with visualization of sectional slices in the area of dental implantation.
After the clinical, laboratory and detailed radiology examination the patient was planned dental implant with using of navigation surgical template on flapless protocol. In the program Simplant (Belgium) held a virtual planning, which was produced by virtual placement of implants in the area of missing 32, 34, 42, 44 teeth, taking into account anatomical peculiarities, virtual planning of orthopedically construction and quality parameters of bone tissue. Patients were planned for installation 4 implants Axiom (France) in the anterior region of the lower jaw by using a flapless protocol with using tooth surgical navigation template. After the virtual planning of surgical navigation template has been made on a 3D printer, laser stereolithography method, and then check the accuracy of fit and fit is on the plaster model and in the patient's mouth. After the local infiltration anesthesia, the navigation pattern was set in the mouth on the teeth without additional fixation (Figure 3).
Further using of physiodispenser and tissue punches from the set of UniversalSurgiGuide® products removing of mucous membranes in the projection places of the installed implants.
Next, the number of consecutive bore with control the direction and depth in the projection of the installation implants,
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according to the protocol of formation for the patient. Finish drilling is done without template, cutter from the surgical set with visual control depth (Figure 4).
At the next stage, the patient was done installation of implants in the formed bed in the bone, according to the position taken in the virtual planning. Installation of the implants is done by physiodispenser, and if necessary can be manually adjusted with ratchet. The installation of dental implants is performed by the planning position obtained on the stage a virtual planning with the exception of possible errors and complications related with incorrect positioning of implants or damage of main anatomical structures (Figure 5).
Figure 3. The Patient was born in 1992, with diagnosis: posttraumatic defect of chin part in the lower jaw, soft tissue of the bottom of oral cavity. The defect of the dentition of upper and lower jaw. View of the oral cavity with installed template. In projection of installed implants removed mucosal membrane.
Figure 4. The Patient was born in 1992, with diagnosis: posttraumatic defect of chin part in the lower jaw, soft tissue of the bottom of oral cavity. The defect of the dentition of upper and lower jaw. Formation of the implant bed using navigation template and a set of UniversalSurgiGuide®.
Figure 5. The Patient was born in 1992, with diagnosis: posttraumatic defect of chin part in the lower jaw, soft tissue of the bottom of oral cavity. The defect of the dentition of upper and lower jaw. Installing the dental implant and the formers of the gum.
After installing all dental implant, technical foramen of the implants is washed by chlorhexidine 0.05 %, in which installed formers of the gum conditioners to thickness of mucosa membrane.
In the postoperative period produced a control image XCTD by which assess the position of the implants (Figure 6).
Postoperative data maintenance of the patients does not differ from the standard protocol administration after the dental
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implant operation to the patients, which includes: monitoring of physician, anti-bacterial, anti-inflammatory therapy, oral cavity hygiene, physical therapy treatment.
After 1 month the patients is appeared a satisfactory condition of the mucous membrane in the area of installed implants (Figure 7).
Figure 6. The Patient was born in 1992, with diagnosis: posttraumatic defect of chin part in the lower jaw, soft tissue of the bottom of oral cavity. The defect of the dentition of upper and lower jaw. Control image XCTD with installed implants.
Figure 7. The Patient was born in 1992, with diagnosis: posttraumatic defect of chin part in the lower jaw, soft tissue of the bottom of oral cavity. The defect of the dentition of upper and lower jaw. Mucosa membrane condition in the area of implants after 1 month implantation. General view of the work in the oral cavity of the patient after 6 months.
Patients were made orthopedic treatment after 6 months of installation of dental implants. It was decided to manufacture metal-ceramic bridges construction with screw fixation. In the first visit, after the installation of transfer on the implants, received one-stage double-layer closed tray impression. Next visit was made fitting of fit frame of bridge prosthesis, main attention, with accuracy of fit of the frame joints and adapter for screw fixing, installed on the implant. After the infliction of ceramics and final fitting, the prosthesis was installed to the patient, screw shafts were closed light-cured composite material, held oclusion correction. A few days later at the visit the patient noted rapid adaptation and getting used to set permanent construction of the teeth prosthesis.
Conclusion. The use of modern computer technology at patients with defects of dentition, evident atrophy of the bone tissue of jaw and extensive posttraumatic defects of jaw after bone reconstructive operation with high accuracy to plan and predict the results of rehabilitation of patients with surgical navigation template, and improve the accuracy of the installation of dental implants and reduction of the risk of complications both during the operation and in the postoperative period. List of the literature:
1. Агапов B.C., Арутюнов С.Д., Дробышев А.Ю. /Применение дентальной имплантации в комплексе реабилитационных мероприятий у больных с дефектами челюстей // Актуальные вопросы детской черепно-лицевой хирургии и нейропатологии: Материалы 4-го Междун. Симпозиума. -2002. - С. 27-28.
2. Патарая Г. /Базовые принципы современной имплантологии: безопасность, надежность, эстетика // Дантист. -2002. - №4(95). -С. 9.
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3. Albrektsson J., Zarb X., Wortmgton P., Eriksson A.R. /A long-term efficacy of currently used dental implants a review and proposed criteria of success. // Int. J. Oral. Maxillofac. Implants. - 1986. - N2 1(1). -P.I 1-25.
4. Todd G. /Subperiostalinyy implant with bilateral globous attachment for frontal division chelyustey // International congress stomatological implantation. - Verona, 1999.
5. Weis C.M., Reunolds T.J. /Special report: a collective conference on the utilization of subperiosteal implants in implant dentistry // J. Oral Implantol. - 2000 - Vol. 26. - P. 2.
6. Tal H., Moses O. /A comparison of panoramic radiography with computed tomography in the planning of implant surgery // Dentomaxillofac. Radiol. -1991- 20(1).- P.40-42.
М.А. АМХАДОВА1, А.Ю. ИГНАТОВ1, Б.С. ЖАНАЛИНА2, А.И. КАЙКАН2
СYЙЕКТI-РЕКОНСТРУКТИВТI ОПЕРАЦИЯЛАРДАН КЕЙ1Н TIC КАТАРЛАРЫНЫН АКАУЛАРЫ БАР НАУКАСТАРДЫ ОНАЛТУ ЭД1СТЕР1Н ЖЕТ1ЛД1РУ
М.Ф. Владимирский атындагы МОГЗИ ДЖФ,Мэскеу1 Марат Оспанов атындагы Б^ММУ, Актебе2
СYЙектi-реконструктивтi операциялардан кешн нау^астарда дентальды имплантаттарды орны^тыру Yшiн навигациялы хирургиялыщ шаблондарды ^олдану ^ателктер мен ас^ынулардыц санын айтарлы^тай темендеттк Ма^алада сYЙектi-реконструктивтi операциядан кейiн навигациялы имплантологиялыщ шаблонды жэне дентальды импантация эдiсiн ^олданумен нау^астыц реабилитациясы мысалы келтiрiлген.
Нег/'зг/ свздер: дентальды имплантация, компьютерлiк жоспарлау, навигациялы шаблон, сYйектi-реконструктивтi операция.
Использование навигационных хирургических шаблонов для установки дентальных имплантатов у пациентов после костно-реконструктивных операций существенно уменьшается количество ошибок и осложнений. В статье приводится клинический пример реабилитации пациента после костно-реконструктивной операции с применением метода дентальной имплантации с использованием навигационного имплантологического шаблона.
Ключевые слова: дентальная имплантация, компьютерное планирование, навигационный шаблон, костно-реконструктивная операция.
ТУЙ1Н
РЕЗЮМЕ
М.А. АМХАДОВА1, А.Ю. ИГНАТОВ1, Б.С. ЖАНАЛИНА2, А.И. КАЙКАН2
СОВЕРШЕНСТВОВАНИЕ МЕТОДОВ РЕАБИЛИТАЦИИ ПАЦИЕНТОВ С ДЕФЕКТАМИ ЗУБНЫХ РЯДОВ ПОСЛЕ КОСТНО-РЕКОНСТРУКТИВНЫХ ОПЕРАЦИЙ
ФУВ МОНИКИ имени М.Ф. Владимирского, Москва1 ЗКГМУ имени Марата Оспанова, Актобе2
E-mail: amkhadova@mail.ru zhanalina57@mail.ru
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