{"id":35295,"date":"2019-10-31T22:03:28","date_gmt":"2019-10-31T19:03:28","guid":{"rendered":"https:\/\/prohoster.info\/blog\/sinus-lifting-i-odnomomentnaya-implantatsiya\/"},"modified":"2019-10-31T22:03:28","modified_gmt":"2019-10-31T19:03:28","slug":"sinus-lifting-i-odnomomentnaya-implantatsiya","status":"publish","type":"post","link":"https:\/\/prohoster.info\/ro\/blog\/news\/sinus-lifting-i-odnomomentnaya-implantatsiya","title":{"rendered":"Lift sinusal \u0219i implantare imediat\u0103","gt_translate_keys":[{"key":"rendered","format":"text"}]},"content":{"rendered":"

\"Lift
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\nDragi prieteni, \u00een articolele anterioare, am discutat despre tipurile de din\u021bi de \u00een\u021belepciune<\/a><\/noindex> \u0219i cum se desf\u0103\u0219oar\u0103 extragerea acestor din\u021bi<\/a><\/noindex>. Ast\u0103zi a\u0219 dori s\u0103 m\u0103 ab\u021bin pu\u021bin \u0219i s\u0103 discut despre implantologie, \u00een special despre implantarea imediat\u0103, care se refer\u0103 la momentul \u00een care implantul este plasat direct \u00een alveola din\u021bilor extra\u0219i \u0219i despre liftingul sinusal, care presupune cre\u0219terea volumului de \u021besut osos \u00een\u0103l\u021bime. Acest lucru este necesar atunci c\u00e2nd se plaseaz\u0103 implanturi \u00een zona din\u021bilor 6, 7, \u0219i mai rar 5, pe maxilarul superior. Cre\u0219terea osului este necesar\u0103 deoarece pe maxilarul superior exist\u0103 o cavitate \u2014 sinusul maxilar. Cel mai adesea, acesta ocup\u0103 o mare parte din maxilarul superior, iar distan\u021bele de la marginea osului p\u00e2n\u0103 la baza acestei cavit\u0103\u021bi nu sunt suficiente pentru a plasa un implant de lungimea dorit\u0103. <\/a><\/noindex><\/p>\n

\"Lift
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\nLa tomografia computerizat\u0103 se observ\u0103 clar c\u0103 exist\u0103 o cavitate \u00een zona din\u021bilor lips\u0103.<\/p>\n

Adesea aud cum doctorii spun: \u201eNu, nu, nu, nu po\u021bi plasa implantul imediat! \u00cent\u00e2i extragem dintele, apoi, c\u00e2nd totul se vindec\u0103, \u00eel vom instala!\u201d. O \u00eentrebare rezonabil\u0103 \u2014 de ce? Cine \u0219tie. \u00cemi este \u0219i mie curios. Fie din lips\u0103 de \u00eencredere \u00een prognoze, fie din teama de complica\u021bii, care, de fapt, nu sunt mai multe dec\u00e2t \u00een cazul unei interven\u021bii chirurgicale clasice. Bine\u00een\u021beles, cu condi\u021bia ca totul s\u0103 fie f\u0103cut corect. \u00cen practica mea, procentul implant\u0103rii imediate \u00een compara\u021bie cu abordarea clasic\u0103 este de aproximativ 85% la 15%. Accepta\u021bi, nu este pu\u021bin. Practic, fiecare interven\u021bie \u00een care este indicat\u0103 extragerea unui dinte se finalizeaz\u0103 cu implantare. Singura excep\u021bie ar putea fi inflama\u021bia acut\u0103 \u00een zona din\u021bilor care cauzeaz\u0103 probleme, atunci c\u00e2nd exist\u0103 puroi amestecat cu mucus. Sau c\u00e2nd implantul este complet instabil \u0219i se mi\u0219c\u0103 \u00een alveol\u0103, precum un creion \u00eentr-un pahar. De asemenea, posibilit\u0103\u021bile financiare joac\u0103 un rol important. Oricine va cheltui banii cu mai mult\u0103 u\u0219urin\u021b\u0103 pe orice altceva, dar nu pe din\u021bi. Asta nu poate fi contestat\u0103. Dar exist\u0103 un \u201edar\u201d! Trebuie s\u0103 \u00een\u021belege\u021bi c\u0103 cu c\u00e2t trece mai mult timp \u00eentre momentul extragerii din\u021bilor \u0219i \u00eenceperea protez\u0103rii, cu at\u00e2t condi\u021biile pentru instalarea acelui implant sunt mai slabe. A\u0219a cum se spune: \u201eo zon\u0103 sacr\u0103 nu r\u0103m\u00e2ne goal\u0103\u201d. Cu timpul apar o serie de probleme nepl\u0103cute, care trebuie rezolvate. \u0218i acestea sunt \u00eentotdeauna cheltuieli adi\u021bionale, adesea semnificative. Ave\u021bi nevoie de aceasta?<\/p>\n

Ei bine! S\u0103 trecem la exemple.<\/p>\n

Cea mai simpl\u0103 situa\u021bie de implantare imediat\u0103 este un dinte cu r\u0103d\u0103cin\u0103 unic\u0103. Indiferent dac\u0103 este vorba de maxilarul superior sau inferior.<\/p>\n

Aceast\u0103 tomografie computerizat\u0103 a fost realizat\u0103 \u00eenainte ca dintele s\u0103 se distrug\u0103 complet.<\/p>\n

Ce vedem?<\/p>\n

\"Lift
\n
\nDinte superior st\u00e2nga 5, care nu poate fi tratat nici terapeutic, nici ortopedic. Ce facem? Corect \u2014 extragem dintele \u0219i introducem un \u0219urub.<\/p>\n

\"Lift
\n
\nAm realizat o extrac\u021bie delicat\u0103, atraumatic\u0103 a dintelui \u0219i am instalat un implant cu formator de gingie.<\/p>\n

\"Lift
\n
\nFormatorul de gingie este un fel de ciot metalic sc\u0103zut (de aproximativ 3 mm \u00een\u0103l\u021bime), care iese pu\u021bin deasupra nivelului gingiei, form\u00e2nd astfel conturul acesteia \u00eenainte de instalarea coroanei. Arat\u0103 cam a\u0219a:<\/p>\n

\"Lift
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\nA\u0219a arat\u0103 implantul \u00een sine:<\/p>\n

\"Lift
\n
\nPartea gri reprezint\u0103 implantul \u00een sine. Partea albastr\u0103 este a\u0219a-numitul abutment temporar, pe care se poate fixa o coroan\u0103 temporar\u0103, \u00een cazul \u00een care implantarea este \u00eenso\u021bit\u0103 de o \u00eenc\u0103rcare imediat\u0103. \u00cen principal, acest abutment joac\u0103 rolul de suport pentru implant. Dup\u0103 ce implantul a fost instalat, abutmentul se desfacere cu o \u0219urubelni\u021b\u0103 special\u0103, iar \u00een locul lui se introduce un dop. Acesta se instaleaz\u0103 \u00een cazul \u00een care nu se poate instala imediat formatorul de gingie. Astfel, implantul \u0219i toate componentele sale se afl\u0103 complet sub gingie, ceea ce \u00eenseamn\u0103 c\u0103, dup\u0103 opera\u021bie, nu vom vedea nimic \u00een cavitatea bucal\u0103. \u00cen afar\u0103 de cus\u0103turi \u0219i... ceilal\u021bi din\u021bi, \u00een cazul \u00een care ace\u0219tia mai exist\u0103. \u00cen acest caz, formatorul se instaleaz\u0103 deja dup\u0103 ce implantul se vindec\u0103.<\/p>\n

Apoi alegem un nivel de dificultate mai mare, c\u00e2nd trebuie s\u0103 extragem dintele 6 de la maxilarul inferior. Acest dinte este cu dou\u0103 r\u0103d\u0103cini. Desigur, nu vom instala c\u00e2te un implant \u00een zona fiec\u0103rei r\u0103d\u0103cini, a\u0219a cum ar fi putut crede cineva. De\u0219i am v\u0103zut cazuri similare. Se pare c\u0103 doctorului \u00eei arde creditul pentru ipotec\u0103.<\/p>\n

A\u0219adar, trebuie s\u0103 instal\u0103m un singur implant, dar exact pe centru. Ne vom \u021binti spre septul osos dintre cele dou\u0103 r\u0103d\u0103cini.<\/p>\n

\"Lift
\n
\nInstal\u0103m implantul. \u00c0 st\u00e2nga \u0219i \u00e0 dreapta sa, pe radiografie, se v\u0103d clar g\u0103urile l\u0103sate de dintele tocmai extras, care, pe m\u0103sur\u0103 ce se vindec\u0103, se vor \u00eenchide.<\/p>\n

\"Lift
\n
\nEi bine, a sosit momentul s\u0103 discut\u0103m despre situa\u021bia \u00een care este necesar\u0103 extragerea unui dinte, plasarea unui implant \u0219i efectuarea unui augmentare a \u021besutului osos pe maxilarul superior \u2014 sinus-lifting. \u00centre timp, nivelul de complexitate cre\u0219te. Nu este o misiune cu elicoptere din Vice City, desigur, dar trebuie s\u0103 fim un pic mai aten\u021bi dec\u00e2t \u00een cazul anterior.<\/p>\n

\"Lift
\n
\nAminti\u021bi-v\u0103 c\u0103 am spus c\u0103 implantul trebuie s\u0103 fie plasat \u00een centru? A\u0219adar, un dinte cu trei r\u0103d\u0103cini nu face excep\u021bie. Implantul se instaleaz\u0103, a\u0219a cum am f\u0103cut \u00een cazul anterior, \u00een septul dintelui cu trei r\u0103d\u0103cini. Dup\u0103 cum vedem, \u00een\u0103l\u021bimea osului \u00een aceast\u0103 zon\u0103 este de aproximativ 3 mm. Aceast\u0103 volum nu este suficient pentru plasarea unui implant de lungime optim\u0103, astfel c\u0103 volumul trebuie crescut. Manipularea se desf\u0103\u0219oar\u0103 cu ajutorul unui \u201ematerial osos\u201d special. Unii \u00eel numesc \u201epudr\u0103 osoas\u0103\u201d, dar s\u0103 nu-l confund\u0103m cu \u201epudra alb\u0103\u201d, de\u0219i este alb, este totu\u0219i prezentat sub form\u0103 de granule. Este disponibil at\u00e2t \u00een recipiente din sticl\u0103,<\/p>\n

\"Lift
\n
\nc\u00e2t \u0219i \u00eentr-o form\u0103 mai convenabil\u0103 \u2014 seringi speciale, cu ajutorul c\u0103rora este mai u\u0219or s\u0103 lucrezi \u0219i s\u0103 introduci materialul \u00een c\u00e2mpul operator.<\/p>\n

\"Lift
\n
\nEste gre\u0219it s\u0103 credem c\u0103 sinus-liftingul este o opera\u021bie \u00een sinuzita maxilar\u0103 (sinele lui Haimor). De fapt, manipularea se desf\u0103\u0219oar\u0103 \u201eSUB\u201d aceasta. A\u0219a cum am stabilit deja, sinusul este o cavitate \u00een maxilarul superior, un gol, dac\u0103 dori\u021bi, care este c\u0103ptu\u0219it pe interior cu o membran\u0103 mucoas\u0103 sub\u021bire cu epitel ciliar. Astfel, pentru ca opera\u021bia s\u0103 fie efectuat\u0103, se face o detasare local\u0103 a mucoasei de \u021besutul osos \u0219i \u00een spa\u021biul format \u00eentre baza sinusului \u0219i mucoas\u0103, ca \u00eentr-un plic, se plaseaz\u0103 \u201ematerialul osos\u201d. \u00cen acest caz, cu instalarea simultan\u0103 a implantului.<\/p>\n

\"Lift
\n
\n\u0218i acum un exemplu de sinus-lifting \u0219i implantare, dar dup\u0103 2 luni de la extragerea dintelui 6 de pe maxilarul superior. Acelei paciente i s-a extras dintele 6 acum aproximativ o s\u0103pt\u0103m\u00e2n\u0103 \u00eentr-o alt\u0103 clinic\u0103. Asistenta a efectuat o tomografie computerizat\u0103.<\/p>\n

\"Lift
\n
\nAv\u00e2nd \u00een vedere c\u0103 a trecut doar o s\u0103pt\u0103m\u00e2n\u0103 de la extrac\u021bie, \u00een imagine vedem o \u201egaur\u0103 \u00eentunecat\u0103\u201d, similar\u0103 cu cea l\u0103sat\u0103 \u00een inima ta de c\u0103tre fost\u0103. \u00cen acel loc unde \u00eenainte era un dinte. Deci, \u021besutul osos \u00een aceast\u0103 zon\u0103 nu exist\u0103. Am \u00eenceput opera\u021bia dup\u0103 dou\u0103 luni. Nu am efectuat o nou\u0103 tomografie computerizat\u0103 dup\u0103 vindecarea alveolei, dar crede-m\u0103, totul s-a vindecat suficient pentru a putea efectua opera\u021bia. \u00cen timpul interven\u021biei, nu a reu\u0219it s\u0103 ob\u021bin o stabilizare ferm\u0103 a implantului, prin urmare am decis s\u0103 instalez o dop \u0219i nu un formator de gingie. De ce? Pentru c\u0103 dac\u0103 pacienta va \u00eencepe s\u0103 m\u0103n\u00e2nce biscui\u021bi, implantul, \u00een special formatorul, poate suporta o presiune mare, ceea ce poate duce la sl\u0103birea sau \u201epierdere\u201d \u00een sinus. De asemenea, \u0219i 8-ul a fost \u00eendep\u0103rtat.<\/p>\n

\"Lift
\n
\nIat\u0103 \u0219i ultima exemplificare de ast\u0103zi \u2014 extrac\u021bia a 2 din\u021bi, instalarea a 2 implanturi \u0219i lifting sinusului.<\/p>\n

\"Lift
\n
\nDup\u0103 cum vedem, condi\u021biile sunt \u00een acest caz ceva mai proaste, aproximativ 2mm. Dar acest lucru nu ne-a oprit s\u0103 efectu\u0103m opera\u021bia \u00een \u00eentregime.<\/p>\n

\"Lift
\n
\nPo\u021bi \u00eentreba: - \u201eDe ce sunt 2 implanturi \u0219i nu 3?\u201d \u201eSe va face un protezare pe punte?\u201d \u201eDar cum r\u0103m\u00e2ne cu distribu\u021bia \u00eenc\u0103rc\u0103turii?\u201d, \u0219i a\u0219a mai departe?<\/p>\n

\"Lift
\n
\n\u00cen realitate, problema suprasarcinilor asociate cu protezele pe punte \u021bine doar de din\u021bii proprii. Deoarece din\u021bii au un aparat ligamentos. Acest lucru \u00eenseamn\u0103 c\u0103 dintele nu este fuzionat permanent cu osul, ci cumva este elastic \u00een el. Iat\u0103 schema:<\/p>\n

\"Lift
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\n\u00cen prezen\u021ba unei proteze pe punte, din\u021bii de suport preiau, at\u00e2t propriile lor sarcini, c\u00e2t \u0219i sarcina dinelui lips\u0103. Astfel, se dezvolt\u0103 suprasarcina din\u021bilor, iar apoi ace\u0219tia ajung la z\u00e2na din\u021bilor. Implantul, pe de alt\u0103 parte, nu are aceast\u0103 ligatur\u0103. Se fuzioneaz\u0103 permanent cu \u021besuturile \u00eenconjur\u0103toare, prin urmare, nu apar probleme asem\u0103n\u0103toare cu cele de la din\u021bii naturali. Dar aceasta nu \u00eenseamn\u0103 c\u0103 pe dou\u0103 implanturi se poate instala o punte imens\u0103 pe \u00eentreaga maxilar\u0103. Singurul lucru care sufer\u0103 \u00een prezen\u021ba protezelor pe punte \u2014 este igiena, asupra c\u0103reia va trebui s\u0103 se acorde o aten\u021bie deosebit\u0103. Deoarece este mult mai u\u0219or s\u0103 ai grij\u0103 de din\u021bii individuali dec\u00e2t de astfel de proteze.<\/p>\n

\"Lift
\nIat\u0103, cam at\u00e2t pentru ast\u0103zi. Voi fi bucuros s\u0103 r\u0103spund la \u00eentreb\u0103rile voastre!<\/p>\n

R\u0103m\u00e2ne\u021bi conecta\u021bi!<\/p>\n

Cu respect, Andrei Dashkov.
\n
Sursa: habr.com<\/a><\/p>","protected":false,"gt_translate_keys":[{"key":"rendered","format":"html"}]},"excerpt":{"rendered":"

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