rigjenerimi i drejtuar indor (gbr)
TRANSCRIPT
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Rigjenerimi i drejtuar kockor
Dr. Geralda Himollari
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C’eshte rigjenerimi?
Rigjenerimi: rigjenerimi eshte rritja dhe diferencimi i
qelizave te reja dhe substancave intraqelizore per
formimin e indeve te reja
Rigjenerimi i drejtuar indor: Metode per parandalimin
e migrimit epitelial per gjate murit cementar te
xhepit.
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Objektivat per nje membrane-barriere ideale
1. Duhet te jete biokompatibel dhe/ose te mundesoje
integrimin indor.
2. Nuk duhet te jete toxike dhe karcinogjene
3. Duhet te jete kimikisht inert dhe joantigjenik
4. Te perdoret lehte gjate manipulimit ne fazen
kirurgjikale
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…Objektivat per nje membrane-barriere
ideale
5. Duhet te jete mjaftushem rigide aq sa te ruaje nje
hapesire midis saj dhe siperfaqes se rrenjes
6. Te hiqet lehtesisht ne rast komplikacioni
7. Te mos kete kosto te larte
8. Te vendoset lehte dhe te kete jetegjatesi
9. Duhet te pershtatet sipas situates klinike
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Indikacionet
1. Klasa e II e bifurkacioneve
2. Difektet nenkockore
3. Difektet e recesionit
4. Augmentimi alveolar
5. Riparimi i difekteve post nderhyrjeve
6. Parandalimi i humbjes kockore vecanerisht kur mungon nje ose me shume mure.
7. Rikonstruktimi i kockes alveolare atrofike gjate vendosjes se njeimplanti
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Kunderindikacionet
1. Ne rastet kur vaskularizimi i lembos eshte i
kompromentuar
2. Difektet horizontale
3. Ne rastet e perforimit te lembos
4. Ne difekte shume minimale te periodonciumit
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Klasifikimi i defektit
A. Me i parashikueshmi Ne bifurkacionet e Gr.II me sasi te madhe kocke interproximale
Ne difektet vertikale intrakockore me shume se 4-5 mm dhe perfshin
2/3 e murit intrakockor.
B. E moderuar: Difekt ne 2 prej mureve
Bifurkacionet e klases se II maxillare meziale ose distale
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…Klasifikimi i defektit
C. E ulet: Bifurkacionet e klases se III me sasi te larte kocke interproximale
D. Me pak i parashikueshmi Difekt horizontal kockor
Bifurkacion i klases se III me difekt horizontal kockor
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Procedura kirurgjikale
1. Incizioni
2. Shkolitja
3. Kyretimi
4. Vendosja e graftit kockor
5. Vendosja e membranes se pershtatshme
6. Suturimi
7. Heqja e materialit
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Incizioni primar
a. Incizionet intra sulkulare behen gjate preparimit per nje lembo
te plote mukoperiostale
b. Te gjithe xhepat reziduale epiteliale eleminohen per te lejuar
integrimin midis e-PTFE dhe indeve lidhese te lembos
c. Incizioni mund te shtrihet ne 1-2 dhembe mezialisht dhe/ose
distalisht zones se trajtuar per te patur nje fushpamje me te
qarte
d. Nese eshte e nevojshme, incizioni vertikal mund te vendoset
mezialisht
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Preparimi i difektit
Pastrimi i difektit nga qelizat granulare
“Scaling & root planing”
Largimi i spikulave kockore dhe lemimi per
stimulimin e rritjes se vaskularizimit dhe ate qelizor.
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Zgjedhja dhe vendosja e materialit
periodontal
Ruajtja ne kushte sterile e materialit
Zgjidhet masa e pershtatshme me difektin per ta
mbuluar plotesisht ate.
Me ane te gershereve i jepet forma adekuate dhe
shmanget lenia e pjeseve te mprehta
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Materialet e sutures
1. Sutura Gore-Tex rekomandohet ne vendosjen e
materialit dhe mbylljen e lembos
2. Suturat e mendafshit ose monofilamentet mund te
perdoren per zonat ne largesi te materialit
3. Suturat bioabsorbable nuk jane te rekomanduara
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Teknikat e suturimit
1. Suturimi sling perdoret per te afruar materialin mbi
difekt pa ndihmen e lembos ose indeve
2. Materiali duhet te pershtase ngushtesisht sip.e
dhembit dhe ne te gjitha pikat per te parandaluar
proliferimin epitelial midis dhembit dhe materialit
duke ndihmuar keshtu edhe ne stabilizimin e plages
3. Lemboja marginale idealja eshte 2-3 mm koronal
nga materiali
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Teknikat e suturimit
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Heqja e materialit
1. Heqjen e materialit mund ta bejme 4-8 jave pas
vendosjes ose ne cfaredo lloj kohe nese ndodh nje
komplikacion serioz
2. Nese materiali nuk mund te hiqet lehtesisht,
rekomandohet nje incizion i mprehte
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…Heqja e materialit
3. Per heqjen e materialit perdorim nje pince
anatomike
4. Lemboja ripozicionohet serish mbi indet e reja dhe
suturohet me suturat e mendafshit
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Konsideratat post-operative
Shpelaresit e gojes – per 10 dite
Terapia me antibiotike (7-10 dite) Tetracycline 250 mg q.i.d.
Dixycycline 100 mg b.i.d.
Veshjet periodontale jane ideale
Perdorimi i dental floss eshte mire te evitohet per sakohe materiali eshte aty
Pacienti kontrollohet cdo jave nese ka expozim, nese jocdo 2 jave
Materiali hiqet menjehere nese zhvillohet ndonjekomplikacion
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Konsideratat e zgjedhjes se membranes
Krijimi dhe ruajtja e nje hapesire te mjaftueshme
nen barriere eshte nje faktor mjaft i rendesishem
per nje rezutat te suksesshem
Integrimi indor
Biokompatibiliteti
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Klasifikimi i membranave barriere
Membranat jo te rezorbueshme
Membranat e rezorbueshme
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Membranat jo te rezorbueshme
e-PTFE (Expanded polytetrafluoroethlene )
- Goretex
PTFE (Non-expanded polytetrafluoroethlene)
- Tef Gen-FD
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…Membranat jo te rezorbueshme
Titanium-reinforced expanded
polytetrafluoroethlene
Titanium membrane with microperforation
- FRIOS® Bone shield
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Membranat e rezorbueshme
Barrierat e kolagjenit
- Bio-Guide, Bio-Mend, Colla Tape
Polimeret sintetike
- Vicryl Mesh, Resolut, Resolut XT
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…Membranat e rezorbueshme
Membranat biologjikisht aktive:
Platelet-rich plasma
Materiale te tjera
- Capset, Lambone
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Avantazhet e membranes se titaniumit
Fixim efektiv te grafteve
Stabilitet mekanik optimal
Biokompatibilitet maximal
Fixohet lehte ne saje te tack-eve te membranes
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Disavantazhete membranes se Titaniumit
Rrit mundesine e ekspozimit me ane te
perforimit mukozal
Duhen shmangur ngarkimet direkte me dhembe
Ndjeshmeri teknike
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Konsideratat e perzgjedhjes se
membranes
Membranat shume Flexibile nuk kane rigiditet te
mjaftueshem
Nevojitet me teper membrane jo e rezorbueshme
rigide
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Rigjenerimi i lezionit
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Gjendja fillestare
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Zona per t’u rigjeneruar
Trajtimi Endodontik
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Vendosja e Emdogain
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Bio-oss
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Membrana Bio-gide
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Suturimi
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4 muaj postoperator
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Faleminderit