Patent RU-2766977-C1 (RU)
Title: Method for stacking and stabilising granular osteoplastic materials in the recipient bed when eliminating complex defects of the jaw bones
Inventor: SLESAREV OLEG VALENTINOVICH
IPC: A61B17/24
Filed: 2021-01-13
Granted: 2022-03-16
Abstract: FIELD: medicine. 
     SUBSTANCE: invention relates to the field of medicine, in particular, to surgical dentistry. 3D computer modelling of the jaw bone defect reconstruction is executed. The defect is reformed in the 3D model of the jaw, the volume of bone reconstruction is modelled, the volume of reconstruction is calculated in a computer program, the template of the reinforced membrane is modelled, and surgical reconstruction is performed. An incision is made in the mucous membrane within the topography of the jaw bone defect: the mucous membrane and periosteum are incised along the greatest length of the defect, at a step of 4 to 5 mm to the oral side from the demarcation line of the multilayer flat keratinising and non-keratinising epithelium so that keratinising epithelium is present on both sides of the wound surface. The vestibular part of the muco-periosteal flap lining the bone defect is immobilised. A first lobe is formed, wherefor an incision is made along the periosteum from the inside of the flap at a step from the edge thereof of 10 to 12 mm. The flap is separated along the incision line of the periosteum into upper and lower segments. The upper segment of the flap with the periosteum remains on the tissues of the first lobe, and soft tissues are immobilised in the lower segment along the incision line of the periosteum, detaching the soft-tissue mass from the edge of the periosteum along the entire surface thereof to a depth of 10 to 15 mm, a second lobe is obtained. The lower segment of the periosteum is then completely released and a third lobe is obtained, wherefrom a consolidated muco-periosteal flap is modelled by including a membrane therein, made of a soft-tissue xenogenic collagen frame with integration of the cellular pool of a stromal vascular fraction, a platelet mass, and blood plasma fibrinogen. Implants with plugs are installed along the ridge of the defect. The vestibular muco-periosteal flap is divided into three lobes: muco-periosteal, soft-tissue, periosteal. The osteoplastic material is then laid in the bone defect, and the external relief of the reconstruction is modelled based on the calculated restoration boundaries. The layout of the osteoplastic material in the bone defect is therein executed above the upper border of the defect by one fourth of the vertical length thereof by a width exceeding the depth of the lower quarter of the defect by three times, with the osteoplastic material being supported in the upper part of the restoration on the native bone of the upper borders of the defect. The membrane is sutured to the oral segment of the muco-periosteal flap. The third lobe of the vestibular segment of the muco-periosteal flap is prepared for suturing the membrane covering the osteoplastic material thereto. The membrane is then laid to the third lobe in the vestibular direction from the oral to the vestibular part of the muco-periosteal flap and secured with a horizontal transmembrane external-internal suture, beginning from a puncture of the muco-periosteal mass in the distal direction outside the lower edge of the defect at a step from the medial border of 5 mm. Non-absorbable number 5.0 or 6.0 thread is used for suturing. A vertical suture is then applied, extending transmembranely, from the oral part of the muco-periosteal flap to the second lobe of the vestibular flap. A transmembrane return is performed through said lobe, exiting through the oral part, both ends of the ligature are tied, resulting in a consolidated muco-periosteal flap constituting a soft-tissue graft jacket. A continuous suture is then applied with a non-absorbable number 5 thread, and the wound is sutured tight. The stitches are removed after 10 to 14 days. A control examination and radiography are performed after four and twelve months. 
     EFFECT: method provides a possibility of creating a stable soft-tissue jacket for the external surface of the graft, preventing uncontrolled change in the shape and volume of the graft while eliminating external, internal, and combined bone defects of the bones of the facial skull of complex geometric shapes with restoration of the anatomical shape of the body part, ensuring predictable behaviour of the graft within the designed boundaries of the recipient bed, eliminating a second operation, and preventing impairment of vascularisation of the regenerating bone in the area of the eliminated defect, ensuring complete biotransformation of osteoplastic material and a predictable clinical outcome, reducing the material costs and the emotional discomfort of the patient. 
     1 cl, 12 dwg, 1 ex