RU2470609C2 - Method of orthodontic microimplant installation and mould for its realisation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to orthodontic dentistry and can be used for increasing accuracy of orthodontic microimplant installation at stages of planning and carrying out surgical stage of complex treatment of patients with abnormalities of dentoalveolar system. Method of orthodontic microimplant installation includes obtaining working gypsum model, manufacturing by it mould in form of kappa, its fixation in oral cavity, making radiograph, determination of place of orthodontic microimplant installation by it, making guide hole in pattern, after that, its re-introduction into oral cavity and installation of microimplant. Mould is made from elastic material, in the process of forming metric radiopaque grid from metal thread is pressed into workpiece in zone of projection of orthodontic micrimplant introduction.

EFFECT: increase of accuracy of selection of microimplant installation place, reduction of risk of trauma of teeth roots, naso-palatine, greater palatine, lower alveolar nerves due to more accurate determination of place of introduction, possibility of planning interference on vestibular surface of alveolar processes, simplification of method of orthodontic microimplant introduction, possibility of repeated application of one and the same mould in the process of complex treatment of patients with abnormalities of dentoalveolar system.

2 dwg, 1 ex

Description

The invention relates to medicine, namely to orthodontic dentistry, and can be used to increase the accuracy of the introduction of orthodontic microimplants at the planning and surgical stages of the complex treatment of patients with anomalies of the dentition.

In the process of complex treatment of patients with anomalies of the dentoalveolar system, orthodontic microimplants are increasingly being used, which raises the question of the most rational method of their installation.

Known surgical polymer template, which is a burl structure made of acrylic plastic with a thickness of about 5 mm, the structure of which is placed metal conductors for the targeted introduction of dental implants of a cylindrical shape (Dental rehabilitation using dental implants. Clinical manual. / N. Zitsman and P. Scherer, under Lomakin. - M.: Publishing House "Alphabet", 2005. - 26 p.).

The disadvantage of this method is that the polymer surgical template does not allow planning the introduction of microimplants from the vestibular surface of the alveolar processes of the jaw, and also between the diagnostic and surgical stages it is necessary to introduce a conductor, or to make a new design of the template.

The most perfect approach to planning the placement of dental implants and their installation is represented by computer application systems integrated with the intervention protocols and focused on the specifics of the products of specific manufacturers (for example, Nobel Guide from Nobel Biocare). The bottom line is that computed tomography data is transferred to this program, where the surgeon virtually installs the implants according to the prosthetics plan in the safest places. The program allows you to avoid contact of the implant with important anatomical formations of the jaws, choose the optimal parameters of the implants and the features of their installation. All data is recorded in the form of a final implantation project. The created project is sent to one of the Nobel Biocare factories, where a special mouthguard with holes is made in the places of implant placement with the specified insertion angles (Nobel Biocare official website).

The disadvantages of the program are the high cost of this procedure and the failure to meet its requirements when planning the installation of orthodontic microimplants, since it involves the installation of surgical implants.

The closest is the installation method of the orthodontic microimplant and the conductor used for its implementation, which includes x-ray, the choice of the point, direction and depth, as well as the installation of the conductor having a horizontally located connecting element and a sleeve tube located on one of its ends, and the installation through it of an orthodontic microimplant. Radiography is performed using computed tomography. The conductor is assembled in the patient's oral cavity, for which a metric rod is prefabricated from disposable material, the labels on which are set by computed tomography marks, a horizontal rod, the length of which is determined by computed tomography data, and the sleeve, all parts of the conductor are fixed using a transparent quick-hardening viscous fluid silicone mass (description of patent RU 2332186, IPC A61C 8/00 (2008.08.27)).

The disadvantages of this method are the difficulties arising when the components of the conductor are fixed in the patient’s oral cavity with a transparent quick-hardening viscous silicone mass, which reduce the accuracy of positioning at the selected location of the guide sleeve for introducing the microimplant. In addition, the high complexity of the assembly technology of the conductor with its simultaneous use at each stage of the microimplant installation increases the cost of the operation, the latter also increases the use of computed tomography.

We were the first to propose a method for installing an orthodontic microimplant and a template used for its implementation, in the form of a mouthpiece made of elastic material, the technical result of which is to increase the accuracy of the choice of installation site, reduce the risk of trauma to the roots of the teeth, nasal-palatine, large palatine, lower protrude nerves, the possibility planning of intervention on the vestibular surface of the alveolar processes of the jaws, simplification of installation technology, the possibility of its re-use and cost reduction the introduction of orthodontic microimplants in the complex treatment of anomalies of the dentition.

The technical result is achieved by the fact that for the installation of an orthodontic microimplant, a conductor is made in the form of a mouthguard from an elastic material with a metric grid.

To implement the method, a working gypsum model of the patient’s jaw is obtained, using which a conductor template in the form of a mouthguard is made of an elastic material that repeats the shape of the surfaces of the vestibular dentition, alveolar bone and hard palate. The template is obtained by thermal stamping on Mini Star or Easy-Vac devices from 0.75 or 1 mm polymer blanks (Ideal Clear, GAC-Dentsply). During stamping, a metric X-ray contrast mesh of a metal thread 0.3 mm in diameter with a side of the coordinate cell of 5 mm is pressed into the workpiece in the projection of the microimplant implantation zone.

The fabricated template is fixed in the oral cavity and X-ray diffraction of the hard palate is carried out using contact focal irradiation or by the method of visiography to diagnose and select the installation site and surgical intervention in the next step. X-ray contrast mesh on an elastic template allows you to accurately determine the injection site of orthodontic microimplants.

Having determined the standard sizes of microimplants and the place of their installation, guide holes are made in the selected place in the template in accordance with the shape and size of the microimplants.

Figure 1 shows the location of the holes on the elastic template in the lateral projection: 1 - teeth; 2 - elastic pattern; 3 - holes for the introduction of implants; 4 - radiopaque grid.

Figure 2 shows the location of the holes on the elastic template in the projection from above: 1 - teeth; 2 - elastic pattern; 3 - holes for the introduction of implants; 4 - radiopaque mesh; 5, 6 - bone holes.

The template with the holes is re-fixed in the oral cavity by putting on the vestibular dentition, and orthodontic microimplants are inserted through the holes. After installing microimplants, the template is removed and removed from the oral cavity. In the future, it can be used repeatedly if necessary to control the installation or to clarify treatment tactics.

During the year, we carried out a comprehensive treatment of 20 patients with anomalies in the position of individual teeth using an elastic template for the introduction of orthodontic microimplants.

Example. Patient A. turned to the Department of Pediatric Dentistry and Orthodontics of S.I.Razumovsky SSMU with complaints of an aesthetic deficiency in the lateral dentition of the upper jaw. Objectively: crowding in the oral cavity in the lateral part of the dentition, palatinal arrangement of teeth 26, 27. Diagnosed with anomaly of the dentition I class according to Engle (anomaly in the position of individual teeth)

Patient A., the proposed method, we made an elastic template for the introduction of orthodontic microimplants. X-ray examination was carried out when fixing the template on the dentition. Due to this, orthodontic microimplants were introduced from the vestibular surface of the jaw in the projection between teeth 26 and 27 without the risk of root injury.

As can be seen from the description and the above example, the proposed method has the following advantages:

1) this template allows you to more accurately determine the place of introduction of the orthodontic microimplant, as it has a radiopaque metric grid, as well as due to the rigid fixation of the template on the entire jaw;

2) a decrease in the risk of trauma to the roots of the teeth, naso-palatine, large palatine, lower testicular nerves, due to a more accurate determination of the injection site;

3) a simplification of the method of introducing orthodontic microimplants due to the absence of the need to assemble a conductor directly in the patient's oral cavity;

4) due to the elasticity of the template, it can be reused at the stages of complex treatment of anomalies of the dentition;

5) reducing the cost of introducing orthodontic microimplants due to the lack of the need for computed tomography. In contrast to the prototype method, which uses a single-use design, the proposed method allows multiple applications of the same template in the entire complex treatment of patients with anomalies of the dentofacial system.

Claims (1)

A method of installing an orthodontic microimplant, including obtaining a working gypsum model, making a template in the form of a mouthguard, fixing it in the oral cavity, performing an x-ray, determining the location of the orthodontic microimplant using it, making a guide hole in the template, then reintroducing it into the oral cavity and the installation of a microimplant, characterized in that the template is made of an elastic material, and during the stamping process into the workpiece in the projection area of the introduction of orthodontic th microimplant pressed metric radiopaque mesh of metal thread.

Images