Excessive alveolar atrophy: causes, symptoms, diagnosis, treatment

Excessive atrophy of the alveolar processes usually occurs as a result of diffuse periodontal damage by an inflammatory-dystrophic process known as periodontosis or periodontitis. Less often, destruction of the alveolar process is caused by odontogenic osteomyelitis, eosinophilic granuloma, tumor, etc. In such cases, it becomes necessary to make complete removable dentures.

If the partial absence of the alveolar process of the lower jaw does not generally prevent the fixation and stabilization of a partial plate denture, then a complete removable denture in this case is poorly fixed, especially its stabilization during eating is impaired, so that the patient cannot use it.

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Treatment of excessive atrophy of the alveolar processes

The treatment consists of increasing the height of the alveolar ridge using a series of operations, the essence of which is reduced to the implantation of autoplastic, alloplastic or explant material under the jaw periosteum. In the latter case, 2-3 pin-like processes protrude into the oral cavity from the vitalium or tantalum framework implanted under the jaw periosteum, on which the lower or upper removable denture is fixed.

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

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

At present, a simpler method of deepening the vault of the oral vestibule is used by moving the mucous membrane of the gum high up; in this case, the alveolar process remains covered only by the periosteum, on which the epithelium soon grows. In order to more reliably hold the mucous membrane of the gum in the new position given to it, it is fixed with percutaneous sutures on the lip and cheeks. To prevent the sutures from cutting through, a lining of a rubber tube is placed in the vault of the oral vestibule, and small buttons with two holes are placed on the skin of the face.

Surgical prevention of alveolar process atrophy

Surgical prevention of alveolar process atrophy has been developed since 1923, when Hegedus reported an operation for periodontitis using an autograft to replace the lost alveolar process bone; he did not describe the long-term results. Then, materials were published on the use of boiled bovine bone powder as an osteogenesis stimulator or substitute for atrophied bone (Beube, Siilvers, 1934); the preparation os purum and autogenous bone chips (Forsberg, 1956); autogenous or bovine bone treated with a 1:1000 merthiolate solution during deep freezing (Kremer, 1956, 1960). Losee (1956) and Cross (1964) used pieces of the inorganic part of bovine bone, from which the organic part was extracted using ethylenediamide. V. A. Kiselev (1968), having highly appreciated the advantages and identified the disadvantages of these materials, as well as the efforts of many authors to prevent alveolar process atrophy, used flour from lyophilized bone in 77 patients; he found that as a result, significant gingival retraction and exposure of the necks of the teeth were not observed.

G. P. Vernadskaya et al. (1992) noted the positive effect on bone (in periodontitis) of new preparations - Ilmaplant-R-1, hydroxyapatite and Bioplant.

Gingivosteoplasty according to the method of Yu. I. Vernadsky and E. L. Kovaleva

Taking into account the technical difficulties in obtaining and processing bone marrow, lyophilization of bone meal, in case of periodontitis of I-II-III degrees we proposed to perform gingivosteoplasty (according to V.A. Kiselev), but to use instead of lyophilized bone a mixture of autogenous and xenogenous plastic materials, which is quite accessible to all practicing doctors. The method of operation:

1. an incision is made in the mucous membrane and periosteum along the gingival margin and the tops of the gingival papillae;
2. a mucoperiosteal flap is peeled off, which is slightly (1-2 mm) larger than the depth of the bone pathological pockets; using a set of sharp instruments (curettes, fissure burs, cutters), stones, the epithelium of their inner surface, and pathological granulations are removed from the bone pockets;
3. from the edges of bone cavities (coves) an excavator takes small pieces of bone tissue, which are used to make plastic material; perform careful hemostasis; bone coves-defects are filled with a special plastic material-paste, developed by us for these purposes; it is a mixture of small pieces of autogenous bone and sterile xenoplastic material. The latter is prepared before the operation as follows: the eggshell is boiled in an isotonic solution of sodium chloride at a temperature of 100 ° C for 30 minutes, the protein membrane is separated from it, the shell is thoroughly crushed together with a binding substance - gypsum (in a ratio of about 2: 1) and processed in a sterilizer in a fireproof test tube;
4. mix pieces of autogenous bone with xenogenic powder, observing the following ratio: autogenous bone - 16-20%, binding agent (gypsum or medical glue) - 24-36%, eggshell - the rest;
5. a mixture of autogenous bone, gypsum and eggshell powder injected into the alveolar ridges and erosions is mixed with the patient's blood, turning it into a paste-like mass;
6. the mucoperiosteal flap is returned to its original place and fixed to the mucous membrane of the gum on the lingual side with a polyamide suture in each interdental space;
7. a medicinal paste-bandage consisting of zinc oxide, dentin (1:1) and oxycort is applied to the operated area. After the operation, oral irrigation, gum application with ectericide, Kalanchoe juice, UHF therapy, and repeated application of the medicinal paste are used. After complete scarring in the area of the gingival margin, iontophoresis of 2.5% calcium glycerophosphate solution is prescribed (15 sessions).

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

G. P. Vernadskaya and L. F. Korchak (1998) use kergap powder, an a-theotropic preparation made of ceramic hydroxyapatite and tricalcium phosphate, as a plastic material for gingivosteoplasty. Kergap is a non-toxic, biologically compatible material whose composition and structure are identical to those of the mineral component of bone, so it has a beneficial effect on reparative osteogenesis and promotes an increase in the rate of healing of bone wounds.

Methodology: after surgical intervention on the gum according to the generally accepted scheme of flap operations, the erosions in the bone and interdental spaces are filled with a paste-like mass prepared from kergap (sterile kergap powder on a sterile glass plate is mixed with a spatula on the patient's blood until a thick paste-like mixture is formed). The mucoperiosteal flap is placed in its original place and carefully sutured with synthetic thread in each interdental space. The sutures are removed on the 8th-10th day. In all cases, the authors noted healing of postoperative wounds by primary intention, stabilization of the process throughout the entire observation period (1-2 years).