Планування дентальної імплантації при складних анатомо-топографічних умовах

Abstract

Робота присвячена проведенню імплантологічної реабілітації стоматологічних хворих в умовах недостатньої висоти кісткової тканини для постановки внутрішньокісткових елементів довжиною більше 10 мм у бокових відділах верхньої та нижньої щелеп. У зв’язку з відмовою деяких хворих від кісткової аугментації прийнято рішення про використання імплантатів коротших розмірів. З метою прецизійної оцінки розмірів було проведено передопераційне комп’ютерно-томографічне дослідження щелеп. Аналіз отриманих результатів показав можливість використання імплантатів довжиною від 5,5 до 9,0 мм. Для заміщення втрачених зубів були застосовані дентальні імплантати КЗРго (ARGON DENTAL, Німеччина). Конструктивні особливості системи дозволили використовувати по три імплантати, сумарна довжина, яких дорівнювала від 20,5 до 23 мм при рекомендованій ЗО мм; Работа посвящена вопросу проведения имплантологической реабилитации стоматологических больных в условиях недостаточной высоты костной ткани для постановки внутрикостных элементов длиной более 10 мм в боковых отделах верхней и нижней челюстей. В связи с отказом некоторых больных от костной аугментации принято решение об использовании имплантатов коротких размеров. С целью прецизионной оценки размеров было проведено предоперационное компьютерно-томографическое исследование челюстей. Анализ полученных результатов показал возможность использования имплантатов длиной от 5,5 до 9,0 мм. Для замещения утраченных зубов были применены дентальные имплантаты КЗРго (ARGON DENTAL, Германия). Конструктивные особенности системы позволили использовать по три имплантата, суммарная длина которых равнялась от 20,5 до 23 мм при рекомендуемой 30 мм.; The use of dental implants in the last decades shows their high efficiency and predictability. In some cases, their usage is a single option method forthe dental rehabilitation of patients. Most often itoccures in patients with terminal defects of dentition or edentulous jaws, especially the lower, when patients are not always able to use non-fixed dentures constructions. However, even the consent of the patient, and his willingness to perform the planned complex of operative and therapeutic actions is insufficient. Primarily, this is caused by the limited bone tis¬sue volume. On the basis of clinical factors, doctor and patient should solve the new problem - to eliminate unfavor¬able anatomical factors. Theirsolutions are various: augmentation of bone tissue volume, and in case of preliminary preparation refusal - positioning of intraosseous elements in unfavorable position for prosthesis. Sometimes the fear of such intervention even prompts the patients to refuse planned implantation. The aim of the study was to carry out implantologic rehabilitation of dental patients in unfavorable anatomical and topographical conditions without bone augmentation. Object and research methods. To achieve the stated objectives, 19 patients with terminal defects of maxilla and mandibula dentition who were treated from June 2013 till December 2015 were chosen. Unilateral defects of the upper or lower jaw were examined in 7 patients, bilateral defects of the upper or lower jaw - in 9 and unilateral defects on the both jaws - in 3 patients. Surgery was performed to replace three teeth of the lateral group, that was depended on the clinical situation. Typically, the implants replaced two premolars and a molar or premolarand two molars. One of the implants in each segment had a length of less than 7.5 mm and diameter of 4.5 mm. Other implants were no longer than 9.0 mm, with diameter of 4.0 mm. Preoperative x-ray examination of the jawbones of all the patients was performed using a helical CT scanner «Siemens somatom Emotion» (Siemens Healthcare GmbH). Postoperative control was carried out using orthopan-tomograph or intraoral x- ray examination of the alveolar process. The results of the study and their discussion. Analysis of the computer tomography results allowed us to obtain qualitative and quantitative characteristics of bone tissue, that has simplified the task of the surgeon in choosing the implant sizes. However, we faced the fact of insufficient bone height for set- up of intraosseous elements of standard length. To avoid additional surgical interventions we have used dental implants КЗРго (ARGON DENTAL, Germany) with certain design features and Protocol setup. The design of the implant is provided: Switch-platform for sub crestal placement; thread type that tightens the spongeous bone in apex region, as well as its oval shape for safe placement underthe mucous membrane of the Highmore’s sinus; conical connection (Morse taper) of implant and abutment that immobilizes and seals critical area in implantology. Such structure allows the usage of short length implants. In particular, for maxilla and mandibula molars replacement, the implant length of 9,0 and 4,0 mm will be proper, in some cases it is possible to apply implants with a length of 7,5 mm, which does not allow to perform most of the systems available on the market. Short implants with a length of 5,5-6,5 mm, diameter 4,5 mm were used while implanting. However, the only requirement pertaining the implants with a length less than 7,5 mm was that they were not used during the replace ment of single defects, but only in combination with implants of 7,5 mm and more. It should be emphasized, that the minimum total length of three implants was 20,5 mm, and the largest 23 mm, with recommended 30,0 mm in classic implants placement.