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9.1. Studying of a problem of occurrence intraoperatsionnyh complications dentalnoj the implantations, the anatomicstructures bound to damage

In the previous heads of our work it has been spent complex kraniologicheskoe research of a structure of the top and bottom jaws of adult people with an intact occlusion, partial and full absence of a teeth.

The data testifying to their appreciable change of basic morfometricheskih of characteristics, including data on change of genyantrums have been as a result obtained at loss of a teeth, an angle of an inclination of a body of the mandible, and also quality of an osteal tissue of jaws. So complex approach has been caused by aspiration to improve existing techniques of treatment of patients with the okkljuzionno-caused diseases of the chewing apparatus, thanks to data on an anatomic structure of its components.

These data have the greatest value at treatment of patients with partial and full loss of a teeth. Speaking about treatment such okkljuzionno - the caused diseases as partial and full loss of a teeth, it is necessary to notice, that now there is enough of methods of orthopedic treatment of patients with disturbance of integrity of dentitions. To them carry, first of all, classical methods of prosthetics with use of demountable and fixed designs. In chapter 1 the basic merits and demerits of use of bridge-like designs, partial demountable and full demountable prostheses are in detail described.

In connection with development of new technologies the method dentalnoj implantations gains prompt diffusion. According to G.M. Raghoebar, A. Vissink
(2003), R.E. Jung et al. (2009) quantity of the various complications bound to this kind of treatment reaches 45 % of all cases of stomatologic implantation. The most widespread errors and complications on intraoperatsionnom a stage of stomatologic implantation are damage of a mucosa of a bottom of genyantrums, nasal cavities, the channel of a mandible, a mental foramen, punching of cortical plates of jaws, damages of the next teeth, a mucosa and organs of an oral cavity, a bleeding, the overheat of a bone resulting in subsequent to its necrosis.

Damage of the bottom alveolar nerve, punching of a mucosa of a bottom of a genyantrum - typical complications dentalnoj implantations (Nechaeva N.K., Vasilev A.J., 2011). In many respects errors during the operation are caused by disturbance of technics of an intervention, and also insufficiently careful planning of stomatologic implantation (Hurzeler M et al., 2007). One of the unconditional reasons is also the insufficient quantity of data on an anatomic structure of a zone of an operative measure.

As a result of the carried out research we had been studied changes of the basic morfometricheskih characteristics of the top and bottom jaws at loss of a teeth which need to be considered at operation carrying out dentalnoj implantations. The equipment dentalnyh implantatov without anatomic features of a zone of implantation leads to occurrence of variety of complications.

For the purpose of revealing of prevalence of complications of operation dentalnoj iplantatsii, the anatomic structures bound to damage, such as damage of the bottom alveolar nerve and genyantrum punching, we have carried out the analysis of 87 medical cards of stomatologic patients by which have been established dentalnye implantaty at treatment of partial or full loss of a teeth in stomatologic clinics of Open Company "Alpha-dent" and Open Company «gross national product of Ostomies» (drawings 91, 92, 93).

Drawing 91. Ortopantomogramma patient P with partial loss of a teeth on

Mandible.

Defects are restored with use 2 implantatov with memory of the form and 1 of th screw implantata. An apical part implantatov

Is on dostatochnochnom distance from the mandible channel.

Drawing 92. Ortopantomogramma patients K with full loss of a teeth on

The top jaw. Integrity of a dentition is restored with use 7 implantatov in the form of a tooth root. Apexes implantatov are on sufficient distance from a bottom of genyantrums.

Drawing 93. Ortopantomogramma patient G with partial loss of a teeth on a mandible. Defect of the bottom dentition is restored with use 6 and implantatov with memory of the form. Diameter of the channel of a mandible appreciable, an apex of 3rd implantata at the left is in immediate proximity with the top wall of the channel, however its damage is not observed.

It is established, that at 7 (8 %) patients as a result of the equipment dentalnyh implantatov have arisen oroantralnoe the report in connection with damage of a mucosa of a bottom verhnecheljustoj sinuses, and at 3 (3,4 %) - have been injured the bottom alveolar nerve as at a stage of preoperative planning clinically significant features of a structure and a locating of the channel of a mandible (a drawing 94) have not been considered.

In addition all medical cards have been systematised on an installation time implantata after an odontectomy or its root. The share of patients by which immediate implantation was carried out, has made 26,4 % (23 persons). To the remained 64 patients the delayed implantation has been spent. Thus as artificial legs of tooth prostheses at immediate implantation were used exclusively implantaty with memory of the form.

That fact is indicative, that from 10 patients who have received complications after spent implantation in the form of damage of a mucosa of a bottom of a genyantrum or a trauma of the bottom alveolar nerve, 8 the delayed implantation has been spent.

Drawing 94. Distribution of patients on an installation time dentalnyh

implantatov and to development intraoperatsionnyh complications: 1 - immediate implantation; 2 - the delayed implantation.

Thus, the occurrence problem intraoperatsionnyh method complications dentalnoj the implantations, the anatomic structures bound to damage, is rather actual now. As one of the reasons of damage of a mucosa of a bottom of a genyantrum or the bottom alveolar nerve is the appreciable atrophy of jaws, in following section the complex anatomic substantiation dentalnoj is given implantation at full absence of a teeth. These data are comprehensible and at treatment of patients with partial loss of a teeth as after the lapse of the appreciable period of time after an exodontia in the field of defect and at partial loss of a teeth the appreciable atrophy of an osteal tissue of the jaws is observed, essentially complicating carrying out of operative measures in the given area.

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Scientific source GAJVORONSKAYA Maria Georgievna. ANATOMO-CLINICAL SUBSTANTIATIONS of TREATMENT of the OKKLJUZIONNO-CAUSED DISEASES of the CHEWING APPARATUS. The dissertation on competition of a scientific degree of the doctor of medical sciences. St.-Petersburg - 2014. 2014

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