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RU-2861550-C1 - METHOD FOR TREATING MILLER CLASS IV RECESSION IN ANTERIOR MANDIBLE

RU2861550C1RU 2861550 C1RU2861550 C1RU 2861550C1RU-2861550-C1

Abstract

FIELD: medicine; surgical dentistry; therapeutic dentistry. SUBSTANCE: sequentially carrying out treatment stages: orthodontic intrusion, tunnel technique, bilayer technique. First, performing a comprehensive diagnosis of the patient: cephalometric analysis, occlusiogram. Assessing premature contacts, the value of the incisor inclination angle, the thickness of the vestibular tissue. Based on the diagnostic results, performing orthodontic intrusion of teeth in the recession area. Next, performing the tunnel technique. Wherein, after rinsing the oral cavity for 30 seconds with 0.12% chlorhexidine gluconate solution, performing infiltration anaesthesia with Sol. Articaini 4% - 1.7 ml with adrenaline 1:200000. Then, using a VIPER bendable microsurgical blade, performing an intrasulcular incision on the buccal side in the region of teeth 42 to 32 of the mandible. Using tunnel instruments, forming a combined tunnel on the buccal side: in the papilla and alveolar mucosa area - a split tunnel, in the attached mucosa area - a full-thickness tunnel. Then, muscle and collagen fibres attaching apically and laterally to the inner surface of the alveolar mucosa tunnel are dissected with a VIPER microsurgical blade. The flap mobility is checked with a periodontal probe. Next, using a 15C scalpel, harvesting a free gingival autograft, which corresponds to the length of the buccal tunnel. Wherein, the height of the autograft is 4 mm, the thickness is 2 mm. The graft is de-epithelialised to a thickness of 1 mm on the operating table with a 15C scalpel. Next, the free de-epithelialised autograft is immersed in the buccal tunnel with interrupted sutures. The covering flap is displaced together with the immersed autograft coronally and fixed with wrap-around sutures using 6-0 and 7-0 Polypropylene suture material. The sutures are removed after 14-21 days. After 6 months, performing the bilayer technique. Wherein, after rinsing the oral cavity for 30 seconds with 0.12% chlorhexidine gluconate solution, the contact points are splinted with composite for the suturing stage. Performing infiltration anaesthesia with Sol. Articaini 4% - 1.7 ml with adrenaline 1:200000. Using a VIPER bendable microsurgical blade, performing an intrasulcular incision on the buccal and lingual sides in the region of teeth 42 to 32 of the mandible. Using a tunnel instrument, forming a split mucosal tunnel on the buccal and lingual sides. Then, muscle and collagen fibres attaching apically and laterally to the inner surface of the tunnel are dissected with a VIPER microsurgical blade. The flap mobility is checked with a periodontal probe. Using a 15C scalpel, harvesting two free gingival autografts, one of which corresponds to the length of the buccal tunnel, and the second to the lingual tunnel. Wherein, the height of the autografts is 4 mm, the thickness is 2 mm. The autografts are de-epithelialised on the operating table with a 15C scalpel. Next, the free de-epithelialised autografts are immersed in the buccal and lingual tunnels with interrupted sutures. The covering flaps are displaced together with the immersed autografts coronally and fixed with double crossed sutures according to O. Tsuru using 6-0 and 7-0 Polypropylene suture material. The sutures are removed after 14-21 days. In the postoperative period, rinsing the oral cavity with 0.12% chlorhexidine bigluconate solution twice a day for 3 weeks. 1 week after suture removal, patients begin brushing their teeth with a soft toothbrush using the modified Stillman technique. Control examination is carried out after 1, 2, 3 and 4 weeks and after 3, 6 and 12 months. Follow-up is 12 months. EFFECT: interproximal attachment, increase in the volume of the interdental papilla, increase in the zone of attached gingiva in the treatment and rehabilitation of patients with Miller class IV recessions in the anterior mandible by introducing intrusion into the treatment protocol and using two surgical techniques sequentially. 1 cl, 2 ex

Inventors

  • Khabadze Zurab Sulikoevich
  • Inozemtseva Kristina Sergeevna
  • Magomedov Omargadzhi Ibragimovich
  • Umarov Adam Iunusovich

Dates

Publication Date
20260505
Application Date
20250627

Claims (8)

  1. A method for treating class IV recession according to Miller in the frontal part of the lower jaw, characterized by the fact that the following treatment stages are performed sequentially:
  2. orthodontic intrusion, tunnel technique, two-layer technique;
  3. First, the patient undergoes a comprehensive diagnosis: cephalometric analysis, occlusiogram, premature contacts, the value of the inclination angle of the incisors, the thickness of the vestibular tissue are assessed, and based on the diagnostic results, orthodontic intrusion of the teeth in the area of recession is performed;
  4. Next, a tunnel technique is performed, and after rinsing the mouth for 30 seconds with a 0.12% solution of chlorhexidine gluconate, infiltration anesthesia with Sol is performed. Articaini 4% - 1.7 ml with adrenaline 1:200000, then with a flexible microsurgical blade VIPER make an intrasulcular incision from the vestibular side in the area of 42-32 teeth of the lower jaw, tunnel instruments form a combined tunnel from the vestibular side: in the area of the papilla and alveolar mucosa - a split tunnel, in the area of the attached mucosa - a full-layer tunnel, then muscle and collagen fibers attached apically and laterally to the inner surface of the alveolar mucosa tunnel are dissected with a microsurgical blade VIPER, the mobility of the flap is checked with a periodontal probe, then a 15C scalpel is used to collect a free gingival autograft, which corresponds to the length of the vestibular tunnel, while the height of the autograft is 4 mm, thickness - 2 mm, the transplant is de-epithelialized to a thickness of 1 mm on the operating table with a 15C scalpel, then the free de-epithelialized autograft is immersed in the vestibular tunnel with interrupted sutures, the covering flap is displaced together with the immersed autograft coronally and fixed with encircling sutures using 6-0 and 7-0 Polypropylene suture material, the sutures are removed after 14-21 days;
  5. After 6 months, a two-layer technique is performed, and after rinsing the oral cavity for 30 seconds with a 0.12% solution of chlorhexidine gluconate, the contact points are splinted with a composite for the suturing stage, and Sol infiltration anesthesia is performed. Articaini 4% - 1.7 ml with adrenaline 1:200000, with a flexible microsurgical blade VIPER, an intrasulcular incision is made from the vestibular and lingual sides in the area of 42-32 teeth of the lower jaw, a mucous split tunnel is formed from the vestibular and lingual sides with a tunnel instrument, then muscle and collagen fibers attached apically and laterally to the inner surface of the tunnel are dissected with a microsurgical blade VIPER, the mobility of the flap is checked with a periodontal probe, a 15C scalpel is used to collect two free gingival autografts, one of which corresponds to the length of the vestibular tunnel, and the second - the lingual, while the height of the autografts is 4 mm, the thickness is 2 mm, the autografts are de-epithelialized on the operating table with a scalpel 15C, then free de-epithelialized autografts are immersed in the vestibular and lingual tunnels with interrupted sutures, the covering flaps are displaced together with the immersed autografts coronally and fixed with double crossing sutures according to O. Tsur using 6-0 and 7-0 Polypropylene suture material, the sutures are removed after 14-21 days;
  6. in the postoperative period, rinse the mouth with a 0.12% solution of chlorhexidine bigluconate twice a day for 3 weeks; 1 week after removing the sutures, patients begin to brush their teeth with a soft toothbrush using the modified Stillman technique;
  7. follow-up examinations are carried out after 1, 2, 3 and 4 weeks and after 3, 6 and 12 months,
  8. Follow-up is 12 months.

Description

The invention relates to medicine, specifically surgical and therapeutic dentistry, and can be used to more effectively treat Miller Class IV gingival recession in the anterior mandible. Miller Class IV and Cairo Class III recessions are the most difficult to treat due to the loss of interproximal attachment and result in loss of papillae height, which is currently a pressing issue in gingival volume restoration and patient rehabilitation. The most common classification system for interdental papilla loss was developed by Tarnow in 1998 [1], Zucchelli 2020 [2]. The literature describes factors that influence the size of the interdental papilla: - the distance between the contact point and the bone crest. To achieve complete papilla filling, this distance was set at 5.1 mm. - inter-root distance of at least 2 mm, for the full volume of the interdental papilla. - a triangular crown shape (0.79 mm) is preferable. - the area of the sulcular space is not less than 4.45 mm. - the length of the papilla, measured from the tip of the papilla to the most coronal part of the bone crest, is not less than 4.58 mm. - interproximal thickness of gingival tissue ≥ 1.5 mm; - young age of the patient (for each year of increasing age, the height of the papilla decreases by 0.012 mm) [3, 4]. Evaluating the literature data, we can find a large amount of information on the treatment of recession of classes I, II, III according to Miller, from classical methods to more modern ones in the literature [5, 6, 7, 8], in contrast to the treatment of recession of class IV according to Miller. It is also worth noting that in modern periodontology there is not enough scientific evidence base for the treatment of Miller Class IV recession. In addition, the issue of rehabilitation of patients with Miller Class IV recessions remains quite open and relevant, requiring scientific study, since these conditions can be either independent or accompanied by severe periodontitis. A method for simultaneously eliminating Class III gingival recession and performing vestibuloplasty is known (Patent RU No. 2732313 C1, Published September 15, 2020). The advantage of this method was: closing Miller Class III gingival recession with a shallow vestibule in a single operation. Disadvantage: this technique was not considered for Miller class IV recession, the possibility of closing lingual recessions was not taken into account, and there was no emphasis on achieving interproximal attachment. A method for eliminating gingival recession is known (RU Patent No. 2727027 C1, Published July 17, 2020). The advantage of this method was: improved functional effect, primarily in patients with gingival recession with a shallow vestibule around teeth and implants. Disadvantage: this technique did not take into account the possibility of closing lingual recessions, and there was no emphasis on achieving interproximal attachment. A surgical treatment method for Miller Class III and IV gingival recession is known (Patent RU No. 2823507 C1, Published July 23, 2024). The advantage of this method was that this technique was considered for Miller Class IV recession. Disadvantage: the technique was considered separately from the comprehensive treatment plan, and the sequence of the protocol was not taken into account. Objective: The invention is aimed at solving the technical problem of creating a method for treating class IV Miller recession in the frontal lower jaw. The technical result of this treatment is the development of a method for the treatment and rehabilitation of patients with Miller class IV recessions in the lower jaw, obtaining interproximal attachment, increasing the volume of the interdental papilla, and increasing the area of attached gum. The technical result is achieved by introducing intrusion into the treatment protocol and using two surgical techniques in sequence, which is the novelty of this method. The method for treating class IV recession according to Miller in the frontal part of the lower jaw is carried out as follows. The treatment stages are performed sequentially: orthodontic intrusion, tunnel technique, and two-layer technique. First, the patient undergoes a comprehensive diagnostic evaluation: cephalometric analysis, occlusiogram, assessment of premature contacts, incisor inclination angle, and vestibular tissue thickness. Based on these diagnostic results, orthodontic intrusion of teeth in the recession area is performed. Next, the tunnel technique is performed. After rinsing the mouth for 30 seconds with 0.12% chlorhexidine gluconate solution, infiltration anesthesia is administered with Sol. Articaini 4% - 1.7 ml with adrenaline 1:200,000. Next, an intrasulcular incision is made on the vestibular side in the area of teeth 42-32 of the lower jaw using a flexible VIPER microsurgical blade. Using tunneling instruments, a combined tunnel is formed on the vestibular side: a split tunnel is created in the area of the papilla and alveolar mucosa, an