WO1996041586A1

WO1996041586A1 - Device for treating a bone recess

Info

Publication number: WO1996041586A1
Application number: PCT/DE1996/001023
Authority: WO
Inventors: Axel Kirsch
Original assignee: Axel Kirsch
Priority date: 1995-06-08
Filing date: 1996-06-04
Publication date: 1996-12-27
Also published as: AU5891996A; CA2220183A1; DE19520866C2; JPH10510453A; DE19520866A1; BR9608950A; EP0830102A1

Abstract

A device for treating a bone recess (20) formed in the junction region (10) of the two branches (12, 14) of a tooth bifurcation, with a flat covering device having a cell-occlusive covering membrane (18) to provide a temporary covering for the bone recess (20) against the surrounding soft tissue, which can be bent upwards towards the distal end of the tooth after being passed between the branches (12, 14) of the bifurcation and secured to the tooth (16) in the boundary region (22) between the tooth cement (21) and tooth enamel (26) after laying on the two tooth surfaces substantially parallel to the connecting line between the central axes of the two branches. The covering device (18) has a securing aid at its two distal transverse edges corresponding to the boundary region (22) between tooth cement (24) and tooth enamel (26). This device is characterized in that the securing aid has a securing device (28, 30, 34) to secure the covering device (18) interlockingly and/or by frictional engagement to the tooth (16).

Description

Device for treating a bone recess

description

The invention relates to a device for treating a bone recess formed in the connecting region of the two legs of a tooth bifurcation, with a flat covering device which has a cell-clipping covering membrane for temporarily covering the bone recess with respect to the surrounding soft tissue, which after passing between the legs of the bifurcation in the direction of the distal end of the tooth can be bent up and, after being placed on the two tooth surfaces which are essentially parallel to the connecting line of the longitudinal central axes of the two legs, can be fastened to the tooth in the border area between dental cement and tooth enamel, the covering device on both of them the border area between tooth cement and tooth enamel corresponding spacing transverse edges has a fixing aid, characterized in that the fixing aid has a fastening device for positive and / or non-positive fixing of the covering device on tooth a ufweist.

It is known that the refilling of bone recesses with bone material can be made considerably easier in that the bone recess in question is mechanically and mechanically reliable with respect to the surrounding soft tissue by means of a covering device, for example a covering membrane or film made of bioresorbable material is temporarily covered in an essentially liquid-tight manner so that the bone recess can grow exclusively through the bones. Examples of corresponding devices are described in DE-OS 44 14 675, DE-OS 44 18 159, DE-OS 43 02 708 and DE-OS 43 02 709.

Devices of the generic type, such as those used there, generally for treating bone recesses in teeth without expressly addressing the problem of treating bifurcations, in implantology 1995; 1; Pages 21-37, are particularly difficult when they are used to treat bone recesses in the root region of bifurcal teeth, insofar as a reliable application of the covering membrane to the "inner legs" of the bifurcation cannot be easily guaranteed, whereby, especially after the gums are folded up again to the bifurcation, the covering membrane often slips, which leads to a partial opening of the bone recess. As a result, soft tissue can get into the bone recess, so that it will no longer grow through bones properly. So far, such a covering membrane, which has an essentially rectangular cross-section, has been used in bifurcation treatments in such a way that the upper transverse edges of the covering membrane are held there by means of a thread or the like wrapped around the tooth, without reliably penetrating it of soft tissue in the bone recess in the connection area of the legs of the bifurcation.

The invention has for its object to provide a device of the generic type, which flawlessly filling the bone recess exclusively in the connection area of the legs of a tooth bifurcation guaranteed.

According to the invention, this object is achieved in that the fixing aid has a fastening device for positive and / or non-positive fixing of the covering device on the tooth.

It can be provided that the fastening device has a binding screw for passing a binding thread which is firmly connected to the covering device in at least one position.

The invention also proposes that the covering device has at least one of its transverse edges a form-locking projection for engaging in a depression which is present or can be provided in the border area between dental cement and tooth enamel.

According to the invention it can also be provided that the form-locking projection has the shape of a shoulder which projects essentially in an L-shape from the plane of the covering device in the direction of the tooth.

A further embodiment of the invention provides that the form-fitting projection has the shape of a hooking nose projecting from the plane of the covering device in the direction of the tooth.

It can be provided that the form-locking projection has the form of a thickening of the material of the cover membrane.

Furthermore, the invention provides that the thickening is formed like a strip. It is provided according to the invention that the fastening device is formed in one piece with the cover membrane.

It can be provided that the fastening device has an adhesive strip or the like on at least one of the transverse edges of the covering device.

The invention also proposes that at least the covering membrane of the covering device consists of bioresorbable material.

Another embodiment of the invention proposes that the covering device consists entirely of bioresorbable material.

It is provided according to the invention that the covering device is designed to be bi-elastic.

According to the invention it is also provided that the covering device is designed to be shrinkable at least in the region of the transverse edges.

A further embodiment of the invention provides that the covering device is designed to be chemically shrinkable at least in the region of the transverse edges.

It can be provided that the covering device is designed to be thermally shrinkable at least in the region of the transverse edges.

Furthermore, the invention provides that the covering device is pre-shaped with a bulbous shape.

It is also proposed according to the invention that the cover device is preformed like a trousers cut.

Another embodiment of the invention provides that the covering device has a reinforcement in the area of the bone recess.

The invention also provides that the reinforcement consists of a reinforcement grid, such as titanium grid or the like.

It is also proposed according to the invention that the side of the covering membrane facing the soft tissue and / or the bone tissue (each) has / have a retention support device for improving the retention of the soft tissue or the (respective) collagen structure (s) on the covering membrane .

The invention also provides for the retention support device (s) to have at least one mechanical retention aid.

The invention further provides that the mechanically acting retention aid (s) is / are at least partially designed for positive engagement by soft tissue and / or collagen structure (s).

It is further proposed according to the invention that the mechanical retention aid (s) is / are at least partially formed by protrusions and / or depressions in the covering membrane of the covering device.

The invention also provides that the mechanical retention aid (s) is / are at least partially formed by uneven surfaces of the covering membrane of the covering device. It is further proposed according to the invention that the mechanical retention aids are at least partially formed by a tissue and / or knitted structure of the surface of the covering membrane of the covering device facing the soft tissue or the bone tissue.

Furthermore, the invention provides that the retention support devices are / are formed at least in part by appropriate selection of the chemical composition and / or the morphological structure of the material of the cover membrane in the area of the cover membrane facing the soft tissue or the bone tissue.

The invention is characterized by at least two layers of different structure and / or composition, the layer facing the soft tissue and / or the layer facing the bone tissue having the retention support device (s).

The invention is also characterized by open micropores provided in the soft tissue and / or the layer facing the bone tissue.

Finally, the invention is also characterized by chemically and / or physically acting molecular docking aids for the soft tissue or the collagen structure (s) provided in the area facing the soft tissue and / or the area facing the bone tissue.

The invention is based on the surprising finding that bone recesses in the root region of bifurcal teeth can also be perfectly grown out by using a covering device or membrane that reliably connects the tooth to the tooth. brings and can also be fixed in this position.

Additionally, or instead, chemical, i.e. H. Molecularly acting, docking aids are provided, which are optionally formed by a corresponding special "special layer" of the cover membrane, which, for. B. facing the connective tissue. Such a multilayer design of the covering membrane makes it possible to optimize the layer facing the connective tissue or the bone defect site in such a way that a particularly good connection to the growing tissue or the corresponding collagen structures is ensured. The base layer can be formed in such a way that a particularly good cell-occlusive and / or mechanically supporting effect results.

It is essential in any case that through appropriate training, z. B. also structuring, which allows the ingrowth of collagen structures from the connective tissue to the surface facing the soft tissue or bone tissue.

Further features and advantages of the invention result from the following description, in which exemplary embodiments are explained in detail on the basis of the schematic drawing.

It shows:

1 shows a first exemplary embodiment of a device according to the invention in a state attached to a bifurcal tooth, in a side view perpendicular to the connecting line of the longitudinal central axes of the two legs of the bifurcation;

Fig. 2 shows the embodiment of Fig. 2 in 1 side view rotated by 90 °;

3 shows a detail of a further embodiment of the device according to the invention in FIG. 2 corresponding orientation, albeit sectioned;

Fig. 4 shows a detail of the embodiment of

Figures 1 and 2 in plan view, in the state not applied to the tooth;

FIG. 5 shows a detail of the exemplary embodiment according to FIG. 4 in section perpendicular to the plane of the flat covering device in its transverse edge area;

Fig. 6 in Fig. 5 corresponding representation

Detail of a modified exemplary embodiment of a device according to the invention;

Fig. 7 shows the embodiment of Fig. 6 in the

Top view of the level of the covering device;

FIG. 8 in a representation corresponding to FIG. 7 shows a modified exemplary embodiment of a device according to the invention;

9 shows a further exemplary embodiment of a covering membrane of a device according to the invention in section perpendicular to the membrane plane;

FIG. 10 in a representation corresponding to FIG. 9 shows a further exemplary embodiment of a cover membrane of a device according to the invention; and

11 in a representation corresponding to FIG. 10 shows a further exemplary embodiment of a cover membrane of a device according to the invention.

As can be seen in FIG. 1, in a connection area 10 between two legs 12, 14 of a bifurcal root of a tooth 16 there is a covering membrane 18 made of bioresorbable material, such as polylactide or the like. The existing covering device is arranged in such a way for covering a bone recess 20 that the covering membrane 18 in a border area 22 between the tooth cement 24 and the tooth enamel 26 by means of a binding thread 28 which is inserted into a binding screw 30 at the top in FIG. 1 drawn transverse edge or the transverse edges drawn above - the upper transverse edge lying behind the plane of the drawing is not shown in the drawing - is brought into tight contact, the border region 22, as can be seen in FIG. 1, forms a constriction , which may also be created or deepened by the surgeon. By means of the covering membrane 20, the bone recess is protected against penetration of soft tissue coming into contact with the covering membrane 20 below in FIG , exist in the connection area 10, the bone recess 20 can grow through undisturbed bones, as is generally known from the technology of using cover membranes for the treatment of bone recesses. The covering membrane 18 consists of bulbous preformed, moreover bielastic material, so that, with a corresponding cut, they are brought into contact with the "inner leg surfaces" of the two legs 12, 14 as well as with the outer surface thereof by means of the binding thread 28, which is introduced into the binding screw 30 after the "covering", can be fixed reliably and non-slip on the tooth 16.

FIG. 2 shows the individual elements of the device according to the embodiment of FIG. 1 in an arrangement rotated by 90 °, a knot 32 also being recognizable here, by means of which the ends of the binding thread are tightened together by the surgeon while tightening the covering membrane 18 in the region the setting screw 30 to the outer surface of the tooth 16 has been brought to the plant.

FIG. 4 shows an enlarged view of the setting screw 30 and the setting thread 28 of an embodiment corresponding to FIGS. 1 and 2.

FIG. 5 shows an enlarged view of a section through the binding screw 30 of the exemplary embodiment from FIG. 4.

The device is used in the exemplary embodiment from FIGS. 1 to 5 as follows: First, the surgeon folds the gum down from the plane of the drawing in FIG. 1 or the plane parallel to it on the rear side of the tooth 16 until the bone recess 20, e.g. can be caused by an inflammation of the root, is exposed on both sides. Then the covering membrane, which is essentially preformed in a rectangular or trouser-cut manner, is pulled through the cavity, then folded up into the border area 22 between tooth cement 24 and tooth enamel 26, and then by pulling the binding thread 28 into the binding screw 30 of the two transverse edges with the thereby provided fixing device. The binding thread 28 is then pulled taut and knotted by means of the knot 32. The covering membrane then closes off the bone recess 20 in a non-slip manner with respect to the soft tissue. The surgeon then closes the gums again.

In about 4 to 6 months, the bone recess 20 grows bony after the bone skin has been correspondingly loaded, preferably pierced, so that bleeding from the bone material of the tooth is possible. The cover membrane 18, as it consists of bioabsorbable material, as well as the setting thread 30, which also consists of bioabsorbable material, remain in the body.

In the embodiment of FIG. 3, the covering membrane 18 has a strip-like thickening 34 on its upper transverse edge, which engages positively in the naturally existing constriction between tooth cement 24 and tooth enamel 26 in the border area 22 and in this way slides down Cover membrane 18 prevented. An embodiment of such a thickening is shown in FIGS. 6 and 7 in an enlarged view. Another exemplary embodiment is shown in FIG. 8, the thickening 34 being provided here only like a nose and not extending over the entire extent of the transverse edge, as in the exemplary embodiment according to FIGS. 6 and 7.

In the exemplary embodiment of a covering membrane 18 shown in FIG. 9, the surface of the covering membrane 18 facing the connective or soft tissue lying above in the drawing has projections 36 and depressions 38, which are each designed such that they can be positively encompassed by collagen structures of the connective tissue growing in from above, whereby the retention of the connective tissue on the covering membrane 18 is improved.

In the modified exemplary embodiment in FIG. 10, the covering membrane 18 is constructed from a base layer 40 which faces the bone and a cover layer 42, the latter having open micropores 44 which are also suitable for the ingrowth of collagen structures.

In the embodiment of FIG. 11 it is provided that on the side facing away from the cover layer 42 Base layer 40 is a back layer 46, which also has open micropores 44, which are suitable for the ingrowth of collagen structures, specifically out of the bone defect site.

In all of the exemplary embodiments of the invention, it is possible to cover the membrane 18, in particular in the area of the bone recess 20, with a reinforcement, e.g. in the form of a titanium lattice or the like. The covering device can also be fixed by means of fastening nails, preferably consisting of bioresorbable material, either in the area of the bone recess 20 or adjacent thereto, or, optionally, additionally, in the border area 22 on the bone material of the tooth 16, as is the case, for example is described in DE-PS 43 00 039.

The features of the invention disclosed in the above description, in the drawings and in the claims can be essential both individually and in any combination for realizing the invention in its various embodiments.

Claims

claims

1. Device for treating a bone recess formed in the connecting region of the two legs of a tooth bifurcation, with a flat covering device having a cell-clipping covering membrane for temporarily covering the bone recess with respect to the surrounding soft tissue, which after passing through the legs of the bifurcation in the direction of the distal end of the tooth can be bent up and, after being placed on the two tooth surfaces which are essentially parallel to the connecting line of the longitudinal central axes of the two legs, can be fastened to the tooth in the border area between tooth cement and tooth enamel, the covering device having one at its two distal transverse edges corresponding to the border area between tooth cement and tooth enamel Has fixing aid, characterized in that the fixing aid has a fastening device (28, 30, 34) for positive and / or non-positive fixing of the covering device (18) on the tooth (16) is.

2. Apparatus according to claim 1, characterized in that the fastening device has a binding screw (30) for passing a binding thread (28) which is fixedly connected to the covering device (28) at at least one position.

3. Apparatus according to claim 1 or 2, characterized gekenn¬ characterized in that the covering device (18) on at least one of its transverse edges has a form-locking projection (34) for engaging in a in the border area (22) between Dental cement (24) and tooth enamel (16) has existing or attachable recess.

4. The device according to claim 3, characterized in that the form-locking projection has the shape of a substantially L-shaped from the plane of the covering device (18) in the direction of the tooth (16) projecting shoulder.

5. The device according to claim 3, characterized in that the form-locking projection has the shape of a from the plane of the covering device (18) in the direction of the tooth (16) projecting hanging nose.

6. The device according to claim 3, characterized in that the form-locking projection has the shape of a thickening (34) of the material of the cover membrane.

7. The device according to claim 6, characterized in that the thickening (34) is formed like a strip.

8. Device according to one of the preceding claims, characterized in that the fastening device

(30) is formed in one piece with the cover membrane.

9. Device according to one of the preceding claims, da¬ characterized in that the fastening device on at least one of the transverse edges of the cover device (18) has an adhesive strip or the like.

10. Device according to one of the preceding claims, characterized in that at least the covering membrane of the covering device (18) consists of bioresorbable material.

11. The device according to claim 10, characterized in that that the covering device (18) consists entirely of bioresorbable material.

12. Device according to one of the preceding claims, characterized in that the covering device (18) is bi-elastic.

13. Device according to one of the preceding claims, characterized in that the cover device (18) is formed shrinkable at least in the region of the transverse edges.

14. The apparatus according to claim 13, characterized in that the covering device (18) is chemically shrinkable at least in the region of the transverse edges.

15. The apparatus according to claim 13, characterized in that the covering device (18) is designed to be thermally shrinkable at least in the region of the transverse edges.

16. Device according to one of the preceding claims, characterized in that the covering device (18) is pre-shaped with a bulbous shape.

17. Device according to one of the preceding claims, characterized in that the covering device (18) is preformed like a trouser cut.

18. Device according to one of the preceding claims, characterized in that the covering device has a reinforcement in the region of the bone recess (20).

19. The apparatus according to claim 18, characterized in that the reinforcement from a reinforcing grid, such as Titanium lattice or the like.

20. Device according to one of the preceding claims, characterized in that the soft tissue and / or the side facing the bone tissue of the covering membrane (18) (each) has a retention support device (36, 38, 42, 44, 46) to improve the retention of the Has / have soft tissue or the (respective) collagen structure (s) on the covering membrane (18).

21. The apparatus according to claim 20, characterized in that the retention support device (s) (each) has / have at least one mechanical retention aid (36, 38).

22. The apparatus according to claim 21, characterized in that the mechanically acting (s) retention aid (s) (36, 38) is / are at least partially designed for positive engagement by soft tissue and / or collagen structure (s).

23. The device according to claim 21 or 22, characterized gekenn¬ characterized in that the mechanical (s) retention aid (s) at least at least partially by projections (36) and / or depressions (38) of the cover membrane (18) of the cover device tion is / are formed.

24. Device according to one of claims 21 to 23, characterized in that the mechanical (s) Retentions¬ help (s) is / are at least partially formed by uneven surfaces of the cover membrane (18) of the cover device / are.

25. Device according to one of claims 21 to 24, characterized in that the mechanical retention help are at least partially formed by a tissue and / or knitted structure of the surface of the covering membrane (18) of the covering device facing the soft tissue or the bone tissue.

26. Device according to one of claims 20 to 25, characterized in that the retention support devices at least partially by appropriate selection of the chemical composition and / or the morphological structure of the material of the cover membrane (18) in the soft tissue or the area (42) of the covering membrane (18) facing the bone tissue is / are formed.

27. Device according to one of claims 20 to 26, characterized by at least two layers (40, 42, 46) of different structure and / or composition, the layer (42) facing the soft tissue and / or the layer facing the bone tissue ( 46) the retention support device (s) (44) have.

28. The apparatus according to claim 27, characterized by open micropores provided in the soft tissue and / or the layer (42, 46) facing the bone tissue

(44).

29. Device according to one of claims 20 to 28, characterized by chemically and / or physically acting molecular docking aids for the soft tissue or the collagen structure (s) provided in the area facing the soft tissue and / or the area facing the bone tissue.