RU-2861584-C1 - METHOD FOR RECONSTRUCTION OF MAXILLOFACIAL DEFECTS

RU2861584C1RU 2861584 C1RU2861584 C1RU 2861584C1RU-2861584-C1

Abstract

FIELD: medicine. SUBSTANCE: invention relates to surgical dentistry and maxillofacial surgery, and is intended for use in the reconstruction of complex defects of the oral cavity and maxillofacial region. The patient with a jaw bone defect undergoes multislice computed tomography. The obtained data are loaded into the modelling program "InVesalius 3.1", using segmentation, a virtual three-dimensional model of the anatomical area is created. Then, in the program "Meshmixer 3.5", an implant for replacing the bone defect is designed, which is imported into the 3D printer slicer program "Cura 3.2.1" followed by printing of the endoprosthesis from PEEK filament with a diameter of 1.75 mm in a 3D printer using FDM technology, with a closed loop and filament heating up to 415°C. After that, the obtained implant is sterilised in an autoclave at a temperature of 121°C, pressure of 1.1 atm for 45 min. Then, a multi-cassette matrix complex consisting of a granular xenograft filler with an L-PRF fibrin clot and a suspension of the patient's PRP plasma with nanodispersed cerium dioxide in physiological saline is applied to the porous structure of the endoprosthesis using a spatula. After that, the implant is surgically placed in the defect area using HiAR G200 augmented reality glasses, into the software of which the multislice computed tomography data are loaded. During the operation by intraoral access for installing endoprostheses in partial jaw defects to retain adjacent teeth and protect from aggressive factors of the oral cavity, an individual mouthguard containing nanodispersed cerium dioxide is used, made on the basis of intraoral digital scanning after surgery. EFFECT: method, by using a polymer implant manufactured and pre-matched on a skull model, allows increasing the effectiveness of treatment of patients with defects of the jaw bone tissue using endoprostheses. 2 cl, 11 dwg, 2 ex

Inventors

NIKANOROV YURIJ ALEKSEEVICH
Chajkovskaya Ilona Vladislavovna
Glazov Dmitrij Olegovich
Bazikyan Ernest Aramovich
Chunikhin Andrej Anatolevich
Majorov Pavel Leonidovich
Fidarova Katerina Bolatovna
Chunikhin Nikita Andreevich

Dates

Publication Date: 20260506
Application Date: 20251128

Claims (2)

1. A method for reconstructing defects in the maxillofacial region, which includes performing a multispiral computed tomography scan on a patient with a jaw bone defect, the data from which is loaded into the InVesalius 3.1 modeling program, using segmentation, a virtual three-dimensional model of the anatomical region is created, then an implant is designed in the Meshmixer 3.5 program to replace the bone defect, which is imported into the Cura 3.2.1 3D printer slicer program, followed by printing an endoprosthesis from PEEK thread with a diameter of 1.75 mm in a 3D printer using FDM technology, with a closed loop and heating the thread to 415 ° C, after which the resulting implant is sterilized in an autoclave at a temperature of 121 ° C, a pressure of 1.1 atm for 45 minutes, after which a multi-cassette matrix complex consisting of granulated xenogeneic filler with a fibrin clot L-PRF and a suspension of PRP plasma of the patient with nanodispersed cerium dioxide in a saline solution, after which the implant is surgically installed in the defect area using HiAR G200 augmented reality glasses, into the software of which multispiral computed tomography data is loaded.
2. A method for reconstructing defects in the maxillofacial region according to paragraph 1, characterized in that when performing an operation through intraoral access for installing endoprostheses in partial jaw defects to hold adjacent teeth and to close them from the effects of aggressive factors in the oral cavity, a custom-made mouth guard is used with the inclusion of nanodispersed cerium dioxide, manufactured on the basis of intraoral digital scanning after the surgical intervention.

Description

The invention relates to medicine, namely to surgical dentistry and maxillofacial surgery, and is intended for the reconstruction of complex defects of the oral cavity and maxillofacial region by replacing the defect with an endoprosthesis made from PEEK material using a 3D printing method using an individual computer model, designed with the possibility of restoring the original shape and size with the inclusion of a multi-cassette matrix complex based on a granulated xenogenic or synthetic filler with nanodispersed cerium dioxide and fixation of an obturating cap made from a photopolymer with the inclusion of nanodispersed cerium, wherein the operation is performed using augmented reality (AR). A known method for reconstructing complex maxillofacial defects (RU Patent 2696533 C1) is used as a prototype. This method involves replacing a bone defect with an endoprosthesis made of a ceramic material based on a ZrO2 - AlO3 composite. The endoprosthesis is individually created using 3D printing techniques in stages using slip casting and gradient sintering. It is then sterilized and installed in the defect area. This is accomplished by preparing the bone edges of the defect, including removing soft tissue around the bone edges and smoothing the bone edge of the defect by milling the bone edges of the wound. Next, openings are created in the defect edges and the endoprosthesis is secured in them using titanium mini-screws, followed by covering with rotated or free revascularized soft tissue flaps. The disadvantages of this method include the multi-stage manufacturing process, which prolongs the preoperative period; the need for specialists for gradient sintering, which also prolongs the process of obtaining the finished endoprosthesis; and the discrepancy between the anatomical shapes of the facial bones, which requires supplementing the method with other structures. Furthermore, the method does not even utilize navigational surgery, significantly reducing the accuracy of the surgical stage and endoprosthesis installation. A method for replacing defects of the lower jaw is known (RU Patent No. 2733687 C1), in which, before surgical reconstructive intervention, computed tomography with bone reconstruction of the facial skeleton is performed, then a model of the facial skeleton area where reconstructive intervention is to be performed is printed on a 3D printer, after which the resulting model is scanned with a Medit i 500 dental scanner and the already lost area or the area to be resected is modeled in the ExoCad program, 0.5 cm smaller than the original, the fragment of the facial skeleton obtained in the program is printed on a 3D-D printer with a model wall thickness of 0.2 cm, then the printed fragment is wrapped in non-woven titanium material in 3-4 layers, then the non-woven titanium material is shaped by cold pressing in accordance with the printed blank located inside the material, during pressing, under pressure, the printed blank is destroyed, the remains of it extracted by dissecting the non-woven titanium material, after which surgical treatment is performed, while at the first stage of surgical treatment, they begin to form a bioengineered composition from bone chips obtained from the ilium and BioOss bone material with filling the defect space with non-woven titanium material, the place of dissection of the form from non-woven titanium material is sutured with a resorbable thread, then through the previously made access in the area of the edge of the ilium, a subcutaneous tunnel is formed into the area of the anterior abdominal wall, the fascia of the rectus abdominis muscle is dissected, the muscle tissue of the rectus abdominis muscle is stratified into a volume corresponding to the volume of the formed structure from non-woven titanium material, and this bioengineered structure is placed into the thickness of the rectus abdominis muscle, after which the fascia is sutured with a resorbable thread. After the bioengineered composition has matured within the rectus abdominis muscle, the second stage of surgical treatment begins, with two surgical teams involved: one provides access to the mature bioengineered composition, while the second surgical team prepares the recipient area to receive the bioengineered composition by preparing the edges of the bone wound, after which the bioengineered composition is fixed to the edges of the bone wound with titanium mini-plates on titanium mini-screws. The disadvantages of this method include a complex two-stage surgical intervention, extensive surgical trauma, lack of sufficient fixation of the endoprosthesis given the fixation using only soft tissue materials, and the inability to accurately fit the endoprosthesis into the surgical bed without additional surgical treatment during the surgical intervention, which carries additional risks of contamination of the surgical wound and the occurrence of complications. The objective of the proposed method is to incr