Installation of basal implants with a transinusal method on the upper jaw, as an alternative to sinus lift
INSTALLATION OF BASAL IMPLANTS BY THE TRANS-SINUSAL METHOD
V.A. Rybak, M.A. Pavlenko, V.G. Klimentiev.
Institute of Dentistry NMAPE them. IL Shupika. Kiev. Ukraine.
Summary: In this paper, we propose a method of using basal implants in a transinusal way as an alternative solution to the problem, which allows to achieve the optimal therapeutic effect with minimal surgical trauma without the use of sinus lift.
Key words: sinus lift, allografts, autogenous plasma.
Statistics show that in modern medicine, bone tissue is the most frequently transplanted material, lagging behind the number of transplants only from blood products (D.J. Trantolo, D.L. Wise, K. Lewandrowski, J.D. Grosser, 2000). So, Boyne (1973) developed and formulated a set of fundamental scientific installations, according to which an ideal osteoplastic material should:
  • be available in the required quantity;
  • have a high potency for
  • bone formation;
  • promote revascularization of the defect zone;
  • have high osteoinductive potential;
  • provide regeneration of supporting tissues of the tooth with its mobility
  • possess osteoconductive properties;
  • contribute to the formation of a new connective tissue attachment in the area of periodontal defects.
The most widely used clinical practice today is frozen allografts, lyophilized, demineralized lyophilized and irradiated allografts (A. Garg, 2004). Untreated allografts have pronounced antigenic properties, while the existing treatment methods can significantly reduce their antigenicity. while maintaining the properties of the grafts for a rather long period of time. attachments in the area of periodontal defects.
The formation of toxic peroxide compounds, primarily OH- hydroxyl radical, as a result of peroxidation of l and species induces damage to cell structures, primarily membranes. This process is carried out in the presence of free H2O. In this regard, the basis of all modern methods aimed at the long-term preservation of allogeneic bone tissue is the complex process of extracting water from the transplant to the very minimum level. The next variety of transplants are xenogenic bone materials. Xenogenous donors (from Greek xeno — alien, unusual, and genesis — origin) of bone materials are representatives of animals of a species other than the recipient. Assessing the results, we can conclude that even with transplantation of bone material from donors who have a very high structural similarity with humans, for example, primates, the outcome of the operation remains unpredictable and is often pumped up by premature resorption or rejection of the graft.
Today, the use of allogeneic bone material is possible due to additional plasma treatment enriched with growth factors (PRGF-Endoret).
PRGF-Endoret is the first 100% autologous platelet-rich plasma. PRGF®-Endoret® contains a mixture of autologous growth factors that are derived from both plasma and platelets. Platelets have a complex storage system in the form of intracellular granules, which allows them to transport a large number of biologically active molecules. According to some authors, the list of proteins and peptides includes approximately .t00 kinds of molecules. Alpha granules are the most common, since there are from 40 to 80 alpha granules per platelet, and they also have the greatest degree of retention. In addition, they contain a number of antibacterial proteins, which are generally called thrombocidins and are lethal factors for a wide variety of bacterial species.
However, it is important to remember that plasma contains important growth factors, and a combination of plasma and platelet factors is a key element in the biological effects of PRGF-Endoret.
The PRGF-Endoret technology is based on the preparation of 100% autogenous platelet-rich plasma, the application of which on damaged areas increases the regeneration rate in most types of tissues without any side effects. The biological activity of soane obtained using PRGF-Endoret technology is based on two fundamental things. On the one hand, this is the plasma content and specifically platelet growth factors, the action of which regulates the main processes involved in tissue regeneration.
On the other hand, there is a fibrin matrix, which is used as a temporary structure for organizing cells and controlling the release of energy from the growth factors present in PRGF-Endoret. PRGF-Endoret biological mediators stimulate and support important processes such as cell proliferation and migration, chemotaxis (or a signal to cells at a distance to get to the site of injury), inflammation and autoparacrine synthesis of new biologically active molecules.
Studies have shown that using allogeneic bone material + PRGF-Endoret results in 30% of the newly formed bone. If you use autologous bone material + PRGF-Endoret, then the result is 43% of the newly formed bone.
It has been established that the mucous membrane grows much faster than bone, sometimes forming huge defects in the maxillary sinus, which subsequently have to be eliminated with the help of serious surgical intervention of the maxillofacial surgeon.

CLINICAL CASE No. 1


Freestyle Y. born in 1960 (53 years old) was admitted to the center of maxillofacial surgery of the KO KB 09/26/2013 with a preliminary diagnosis of odontogenic left-sided sinusitis. The patient complained of nasal discharge, nasal congestion. Pain in the left infraorbital region, shortness of breath, purulent discharge through the left nasal passage.
Anamnesmorbi
He complained of nasal discharge, nasal congestion, pain in the left infraorbital region, shortness of breath, purulent discharge through the left nasal passage. In 2010, bilateral sipuslifting was carried out.
Statuslocalis
The person is symmetrical. Shkіrnі curve body color without pathological zmіn. Dykhannya through livii nasal passage accelerated. The mantle of an empty company in the area of ​​the 23-27th tooth is mildly hyperemic as the result of cicatricial sores. Palpation: in the region of the maxillary sinus of the malignant malignancy is insignificant. The insignificant serous vision of the left nasal abduction is spared. The mucous membrane of an empty company of a mug-erysipelus colore. In the region of the 23-27th tooth, hyperemia and the lining of the mucous membrane are indicated. The atrophy of the alveolar cavern in the region of the 24-26th tooth is indicated. On 23 and 27 teeth, rukhoma metal-ceramic construction is in place. Vіdkrivannya company vіlnе.
On cone beam computed tomography, the presence of a defect in the alveolar process of the upper jaw on the left at the level of the missing 24-26th teeth with transition to the anterior maxillary sinus and the cheek-alveolar ridge is determined. The sinus is filled with homogeneous contents (Fig. 1, 2,3).
Patient laboratory data on admission without features.
Operation 09/27/2013:
Fence of cortical plate and spongy autograft from the crest of the right ilium.
Operation progress:
After antiseptic treatment of the skin under anesthesia, a skin incision of subcutaneous tissue of 4.0 cm in length from the upper anterior axis parallel to the anterior surface of the iliac crest was performed. The path to the inner surface of the ridge is acutely blunt (Fig. 4). The splits formed splits, the cortical — spongy block was removed from the inner surface of the iliac bone. The spongy bone material was collected (Fig. 5).
The cortical — sponge plate is placed in 0.9% NaCl solution. After installation of tape drainage — seams of silk thread, a / c bandage, alcohol.
Passage to the inner surface of the iliac crest.
statji1z 



Fig. 1. Panoramic radiography of patient Y. before treatment.
Fig. 2. Cone-beam computed tomography of patient Y. before surgery.


statji2z 



Fig. 3. Volumetric modeling based on computed tomography of patient Y. before surgery.
Fig. 4. Photo of the operation. Passage to the inner surface of the iliac crest.
Fig. 5. Photo of the operation. Fence of the cortical-spongy block from the inner surface of the ilium.


statji3z 



 Fig. 6. Photo of the operation. Exfoliation of the mucoperiosteal flap.
Curettage of the maxillary sinus.
Fig. 7. Photo of the operation.
Cortical spongy autograft fitting, fixation with titanium screws.


statji4z
 



Fig. 8. Photo of the operation. Suturing of the surgical wound.
Fig. 9. Postoperative panoramic radiography of patient Y.


statji5z 



Fig. 10. Preoperative panoramic radiography of patient X.
Fig. 11. Photo of the installation of temporary bridges. 3rd day after surgery.


statji6z 



 Fig. 12. Panoramic radiography of patient X six months after surgery.
 Fig. 13. Photo of the installation of permanent ceramic-metal bridges. Six months after surgery.


 
Operation 09/27/2013:
Augmentation of the left upper jaw with an autograft from the iliac crest.
After treatment of the skin and oral cavity with an antiseptic under general anesthesia + infiltration anesthesia Sol. Ultracaini 4% — 4 ml removed the bridge and roots of the 23rd, 24th teeth. A mucosal incision was made according to Neumann-Zaslavsky in the transitional fold in the upper jaw. The mucosal-periosteal flap, curettage of the maxillary sinus is exfoliated (Fig. B). Cortical spongy autograft fitting, fixation with titanium screws (Fig. 7). After immobilization of the mucoperiosteal flap — sutures from the sensory suture, hemostasis during the operation (Fig. 8).
Postoperative drug therapy:
Dopamine (AI) twice a day for laziness:
Ketanov 1.0 century m for pain;
Dalacin 300 one drop twice a day;
Lasix VM once a day.
The operation was carried out by the head of the center of maxillofacial surgery and dentistry of the Kiev regional clinical hospital V.A. The fisherman.
The patient was discharged in satisfactory condition for further dynamic outpatient observation.

CLINICAL CASE No. 2


Patient X used the bicortical technique for installing basal implants in the tubercle — pterygoid suture, on the left side — through the maxillary sinus. Thanks to the polished surface of the implant, one can forget about such a negative postoperative complication as sinusitis, even though part of the structure is located directly in the maxillary sinus. The operation was carried out according to the immediate download protocol. Temporary crowns are installed on the third day after surgery (Fig. 11). Six months later, a permanent ceramic-metal structure was installed.
The operation was carried out by the head physician of the European Dental Center V.G. Klimentiev.
CONCLUSIONS
When using an alternative technique for installing basal implants in a transinusal way, we can talk about a 97% survival rate, an indicator that is important primarily for specialists. It should also be noted that when using this technique as an alternative to sinus lifting, we can talk about a significant improvement in the results for the patient:
  • the rehabilitation period is significantly reduced;
  • indications for the use of this technique are expanding;
  • lack of pain and comfort;
  • lack of risks associated with the sinus lift technique;
Analysis of clinical examples showed that rehabilitation of patients with indications for sinus lift surgery is possible in the shortest possible time using our methods.