RU-2861726-C1 - METHOD FOR SINUS LIFT IN PRESENCE OF SEPTA IN MAXILLARY SINUS WITH IMMEDIATE IMPLANT PLACEMENT

RU2861726C1RU 2861726 C1RU2861726 C1RU 2861726C1RU-2861726-C1

Abstract

FIELD: surgical dentistry. SUBSTANCE: invention relates to dental implantation, and is intended for use when performing sinus lift surgery in patients with a high degree of atrophy, having bone septa in the sinus area. Cone-beam computed tomography (CBCT) is performed to determine the dimensions of the residual bone of the alveolar ridge, as well as the position and size of the septum inside the sinus. When the residual height of the alveolar ridge bone is 1-3 mm and a septum with a height of 5 mm or more is present, the dimensions and positions of two lateral windows on both sides of the septum are planned, and an implant is selected. Then, after infiltration anaesthesia in the lateral part of the upper jaw, a trapezoidal incision is made, a mucoperiosteal flap is reflected, and two bone windows are formed on the lateral wall of the sinus - a first window medial to the septum with a diameter of 10 mm for detaching the membrane from the sinus floor and along the medial wall of the septum, forming a pocket for osteoplastic material and relieving tension of the Schneiderian membrane in the septum area, and a second window distal to the septum with a diameter of 5 mm for monitoring the integrity of the Schneiderian membrane after implant placement and manipulations. After that, through the first lateral window, the Schneiderian membrane is detached from the sinus floor and along the medial wall of the septum. Then, transcrestally, in the projection of the septum, using a graduated osteotome and osteotomes of successively increasing diameter, a bed for the implant is formed. The last one used is an osteotome with a diameter 2 sizes smaller than the diameter of the selected implant. Then, after forming the implant bed, osteoplastic material is introduced into the formed pocket through the medial window and transcrestally into the bed of the formed implant. After that, the implant is immediately placed in the formed bed in the septum. The lateral windows are closed with a collagen membrane, and the wound is sutured. EFFECT: possibility of reducing the risk of Schneiderian membrane perforation, ensuring optimal distribution of osteoplastic material in the septum area and under it, as well as expanding the indications for immediate implant placement in conditions of severe atrophy and complex sinus anatomy. 1 cl, 12 dwg, 1 ex

Inventors

Filatov Sergei Nikolaevich

Dates

Publication Date: 20260508
Application Date: 20251005

Claims (1)

A method of sinus lifting in the presence of septa in the maxillary sinus with a one-stage installation of an implant, which consists in the fact that cone-beam computed tomography (CBCT) is carried out and the size of the residual bone of the alveolar ridge is determined, as well as the position and size of the septum inside the sinus, and with a residual height of the alveolar ridge bone of 1-3 mm and the presence of a septum with a height of 5 mm or more, the size and position of two lateral windows on both sides of the septum are planned and an implant is selected, then after infiltration anesthesia in the lateral part of the upper jaw, a trapezoidal incision is made, a mucoperiosteal flap is thrown back and two bone windows are formed on the lateral wall of the sinus - the first window medial to the septum with a diameter of 10 mm for peeling off the membrane from the bottom of the sinus and along the medial wall of the septum, forming a pocket for osteoplastic material and relieving tension Schneiderian membrane in the septum area and a second window distal to the septum with a diameter of 5 mm to control the integrity of the Schneiderian membrane after implant placement and manipulations, after which, through the first lateral window, the Schneiderian membrane is peeled off from the bottom of the sinus and along the medial wall of the septum, then transcrestally, in the projection of the septum, using a graduated osteotome and osteotomes of successively increasing diameter, a bed for the implant is formed, while the latter uses an osteotome with a diameter 2 sizes smaller than the diameter of the selected implant, then, after the formation of the implant bed, osteoplastic material is introduced into the formed pocket through the medial window and transcrestally into the bed of the formed implant, after which the implant is simultaneously installed in the formed bed in the septum, the lateral windows are closed with a collagen membrane and the wound is sutured.

Description

The invention relates to surgical dentistry, in particular to osteoplasty methods in preparation for dental implantation in conditions of atrophy of the alveolar process in the lateral sections of the upper jaw, complicated by the presence of bone septa (septa) inside the maxillary sinus. The invention can be used in sinus lift surgery (maxillary sinus floor augmentation) in patients with a high degree of atrophy and bony septa in the sinus area, with simultaneous implant placement. The method reduces the risk of Schneiderian membrane rupture in the presence of septa in the sinus. Sinus lifting is an operation to increase the volume of the alveolar bone of the upper jaw, which is achieved by placing bone substitute material at the bottom of the maxillary sinus, followed by the installation of an implant. Sinus lift with a lateral window is a classic approach to restoring alveolar bone height, first described by Tatum H. Maxillary and sinus implant reconstruction. Dent. Clin. North Am 1986; 30; 207–229, using autogenous bone graft followed by placement of dental implants. In 1994, Summers R.B. A new concept in maxillary implant surgery: the osteotomt technique. Compendiun (Newtown, Pa) 15 154–156 (1994), proposed a transcrestal sinus lift using osteotomes. Both approaches result in implant survival rates comparable to implants placed in normal bone [see Jensen OT, Terheyden H. Bone augmentation procedures in localized defects in the alveolar ridge: Clinical results with different bone grafts and bone-substitute materials. Int J Oral Maxillofac Implants. 2009; 24(Suppl): 218-236]. The clinical decision on the appropriate surgical approaches is based on anatomical parameters, including residual alveolar ridge height and width, sinus floor anatomy, presence of sinus septa, etc. [see Stacchi C, Andolsek F, Berton F, Perinetti G, Navarra CO, Di Lenarda R. Intraoperative Complications During Sinus Floor Elevation with Lateral Approach: A Systematic Review. Int J Oral Maxillofac Implants. 2020; 35(2): 27-38. doi:10.11607/ jomi.7817]. A known method [see Betts NJ, Miloro M. Modification of the sinus lift procedure for septa in the maxillary antrum. Journal of Oral and Maxillofacial Surgery. 1994; 52(3): 332-333. doi: 10.1016/0278-2391(94)90313-1] consists of modifying the lateral approach in the presence of a septum by creating two separate bone windows (one on each side of the septum) to avoid manipulation of the septum itself and lifting the membrane in each compartment of the sinus separately. A method for forming a W-shaped bone window in the lateral wall of the sinus in the presence of low septa is known [see Sailer HF. A new method of inserting endosseous implants in totally atrophic maxillae. Journal of Cranio-Maxillo-Facial Surgery. 1989; 17(7): 299-305. doi: 10.1016/ s1010-5182(89)80057-5]. The known method does not solve the problem of working with the septum itself and the membrane above it. A technique known as the “floating septum” [see Jung J, Kim B, Lee B, Byun S. Mobilization of the bony septum as a “floating bone segment” in sinus floor elevation: technical note. Maxillofac Plast Reconstr Surg. 2019; 41(1): 47. DOI: 10.1186/s40902-019-0230-4], involves forming a window with a distal edge in front of the septum, peeling the membrane off from the sinus floor without extending onto the septum, and then peeling off the septum with an osteotome along with the membrane attached to it, forming a single complex (“floating septum”). There are several known solutions regarding the performance of sinus lift surgery. A method for plastic surgery of perforations of the mucous membrane of the maxillary sinus during sinus lifting is known [see Russian Federation Patent for Invention No. 2428125 dated September 10, 2011, IPC A61B 17/00 (2006.01)]. The invention relates to the field of medicine, namely to surgical dentistry, and can be used to increase the volume and thickness of the alveolar bone during plastic surgery of perforations of the mucous membrane of the maxillary sinus during sinus lifting and implantation. The main objective of the method is to eliminate the defect after perforation caused by various reasons, including the presence of septa. A method for raising the floor of the maxillary sinus during sinus lifting is known [see Russian Federation Patent for Invention No. 2785594 dated December 9, 2022, IPC A61C 8/00 (2006.01), A61N 7/00 (2006.01)]. The invention relates to medicine, specifically dentistry. The method reduces the likelihood of maxillary sinus infection, isolates the maxillary sinus from the oral cavity, and obtains a sufficient volume of bone tissue for the subsequent stage of implantation. A method for sinus lifting during dental implantation is known [see Russian Federation Patent for Invention No. 2563090 dated September 20, 2015, IPC A61B 17/24 (2006.01)]. The invention relates to medicine, in particular to microsurgical dentistry, and can be used to increase the volume of bone tiss