Excessive atrophy of the alveolar processes: causes, symptoms, diagnosis, treatment

Excessive atrophy of the alveolar processes usually occurs as a result of a spilled periodontal lesion by an inflammatory-dystrophic process known as parodontosis or parodontitis. Less often, the destruction of the alveolar process is due to odontogenic osteomyelitis, eosinophilic granuloma, tumor, etc. In such cases, it becomes necessary to produce complete removable prostheses.

If the partial absence of the alveolar process of the lower jaw basically does not interfere with the fixation and stabilization of the partial lamellar prosthesis, then a complete removable prosthesis in this case is fixed poorly, especially its stabilization during eating is disturbed. So that the patient can not use it.

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Treatment of excessive atrophy of alveolar processes

Treatment consists in increasing the height of the alveolar ridge with the help of a number of operations, the essence of which is to insert a jaw after the period of the autoplastic, alloplastic or explant material. In the latter case, from the framework of the vitalium or tantalum implanted under the jawbone period, 2-3 appendage-pins protrude into the oral cavity, on which the lower or upper removable prosthesis is fixed.

To increase the height of the alveolar ridge, it is also possible to use subperiosteal implantation of cadaveric cartilage, hydroxylapapatite, a material from a series of silicone resins - silicone-dacron or other, more modern ones.

Until recently, orthopedists and dental surgeons often resorted to surgical deepening of the vestibule with simultaneous free transplantation to the wound surface of the epidermal skin flaps of AS Yatsenko-Tiersch, in other cases to the creation of retention depressions on the surface of the jaw's body or to other rather traumatic interventions.

Currently, a simpler way of deepening the vestibule of the mouth is applied by moving the gingival mucosa high up; while the alveolar process remains covered only by the periosteum, on which the epithelium soon grows. To reliably hold the gingival mucosa in the new position given to it, it is fixed with percutaneous sutures on the lip and cheeks. To prevent slitting of the seams, a gasket from the rubber tube is placed in the vestibule of the mouth, and small buttons with two holes are placed on the skin of the face.

Surgical prevention of atrophy of alveolar processes

Surgical prophylaxis of atrophy of the alveolar processes is being developed since 1923, when Hegedus reported surgery for periodontitis with the use of an autograft to replace the lost bone of the alveolar process; long-term results they were not described. Then materials were published on the use as a stimulant of osteogenesis or a substitute for atrophied bone powder from boiled bovine bone (Beube, Siilvers, 1934); os purum and autogenous bone shavings (Forsberg, 1956); autogenous or bovine bone treated with a 1: 1000 merthiolate solution with deep freezing (Kremer, 1956, 1960). Losee (1956) and Cross (1964) used pieces of the inorganic part of a bovine bone, from which the organic part was extracted with ethylenediamide. VA Kiselev (1968), appreciating the merits and revealing the shortcomings of these materials, as well as the efforts of many authors to prevent atrophy of the alveolar processes, applied flour from lyophilized bone in 77 patients; he found that, as a result, there was no significant retraction of the gum and exposure of the neck of the teeth.

GP Vernadskaya and co-authors. (1992) noted a positive effect on the bone (with parodontitis) of new drugs - Ilmaplant-R-1, hydroxylapatite and Bioplant.

Gingiva-osteoplasty by the method of Yu. I. Vernadsky and E. L. Kovaleva

Given the technical difficulties in obtaining and processing bone marrow, lyophilization of bone meal, with periodontitis I-II-III degrees, we proposed to produce gingival-osteoplasty (according to VA Kiselev), but to use instead of lyophilized bone a mixture of autogenous and xenogenic plastic materials. Procedure:

1. produce an incision of the mucosa and periosteum along the gingival margin and the tips of the gingival papillae;
2. exfoliate the mucus-periosteal flap, which is slightly larger (by 1-2 mm) than the depth of the bone pathological pockets; a set of sharp instruments (curettes, fissure burs, cutters) remove from the bone pits concretions, the epithelium of their internal surface, pathological granulations;
3. from the edges of the bone cavities (coves), the excavator takes small pieces of bone tissue that are used to make plastic material; produce a thorough hemostasis; Bone bays-defects are filled with a special plastic paste material, developed by us for these purposes; it is a mixture of small pieces of autostylicity and a sterile xenoplastic material. The latter is prepared before the operation in the following way: the eggshell is boiled in isotonic sodium chloride solution at a temperature of 100 ° C for 30 minutes, the protein shell is separated from it, the shell is thoroughly ground together with the binder-gypsum (in a ratio of about 2: 1) in a sterilizer in a refractory test tube;
4. mix the pieces of autosty with xenogeneic powder, observing the following ratio: autonomy - 16-20%, binder (gypsum or medical glue) - 24-36%, eggshell - the rest;
5. introduced into the bays and usuras of the alveolar bone, a mixture of autostyrene, gypsum and egg shell powder is mixed with the patient's blood, turning it into a paste-like mass;
6. the muco-periosteal flap is returned to its former place and fixed to the mucous membrane of the gum on the lingual side with a polyamide seam in each interdental space;
7. on the operated site impose a medical paste-bandage consisting of zinc oxide, dentine (1: 1) and oxycorte. After the operation, irrigation of the oral cavity is applied, gum application with ekteritsidom, Kalanchoe juice, UHF therapy, repeated application of medical paste. After complete scarring in the area of the gingival margin, ionophoresis 2.5% of calcium glycerophosphate is prescribed (15 sessions).

Carrying out gingivosteoplasty in this way gives a positive result in 90% of patients, and in similar operations, but without the use of autoxenoplastic mixture - only in 50%.

GP Vernadskaya and LF Korchak (1998), gingivosteoplasty uses plastic powder kergapa-a-theotropic preparation from ceramic hydro-xylapatite and tricalcium phosphate as a plastic material. Kergap is a non-toxic, biocompatible material whose composition and structure are identical to the composition and structure of the mineral constituent of the bone, so it has a beneficial effect on reparative osteogenesis, contributing to an increase in the rate of bone wound healing.

Procedure: after surgical intervention on the gum according to the conventional scheme of patchwork operations, the usuras in the bones and the interdental spaces are filled with pasty mass prepared from the kergap (sterile powder of the kergap on the sterile glass plate is kneaded with a spatula on the patient's blood until a thick paste-like mixture is formed). The muco-periosteal flap is laid back and carefully sutured with a synthetic thread in each interdental space. Sutures are removed on the 8-10th day. In all cases, the authors noted the healing of postoperative wounds by primary tension, stabilization of the process throughout the follow-up period (1-2 years).