Trans dental stabilizers

Trans-teeth-stabilizers (TTS) are not very popular in the dental practice in our country. They are titanium screws with a small thread, narrow turn and we generally use them to "stabilize" the teeth in apical osteotomy and cystectomy when the pathological process covers a large part of the tooth root and after resection remains unfavorable clinical root - clinical crown ratio ( Figures 1 and 2).


A similar ratio occurs when the pathological process does not cover a large part of the root, but the tooth has an advanced degree of periodontitis. If we do not apply TTS in the above cases, the operation becomes meaningless; moreover, there is no indication for such. In other words, we prolong the life of teeth that we have to extract, expanding the indications for apical osteotomy and cystectomy, respectively (Figs. 3 and 4).

In Fig. 3, the diagnostic radiography of the case, we can see a large radicular cyst of 12 teeth, recurrence of non-radical surgery 5 years ago. The clinical root is shorter than the clinical crown. The tooth has a pathological mobility of II degree. Fig. 4, control radiography three years later, illustrates the result of cyst reoperation using TTS. The osseo integration of TTS is indisputable. The tooth is stable. The clinical case is 6 years old.

The surgical technique of the operation in principle does not differ from that of an apical osteotomy (cystectomy), but it has its characteristic specificity, which consists in the fact that we expand and fill the root canal with an intraoperative operation. In cases of acute or exacerbated process, it is good to trepan the tooth the day before and leave it open. We perform the operation under premedication with a macrolide antibiotic, a non-steroidal anti-inflammatory drug and an antihistamine. After removal of the granuloma (cyst) and treatment of the root canal through it, we make an opening in the "ceiling", for upper teeth, resp. "floor" - for the lower, the formed bone cavity of about 5-6 mm in strong bone with calibrated according to the pre-selected TTS drill. We use two TTS standards, respectively u 1.2 and 1.8 mm depending on the thickness of the root of the operated tooth. We process the root canal with a significantly larger diameter than that of the screw. We pierce the TTS through the canal and screw it into the hole in the bone, which gives it initial stability, and then we fill the loose space between it and the root wall with Carbofine and thymol. We wait for the cement to harden, clean the excess, put hydroxyapatite in the cavity around the screw in the former cavity of the pathological process, absorbable membrane and suture. Then cut the screw remaining outside the crown. We prescribe an osteostimulant (Osteogenon or Osteovital). It is good to do a course of lasers.


We cement the trans dental part of the screw firmly in the root canal, and the part outside the apex of the tooth - osseointegrate. Thus, we get elongation of the clinical root of the tooth and its stabilization. We also use TTS to stabilize severely shaken periodontal teeth, in which case we deliberately make a bone cavity above the tooth apex.

Conclusion:

From the above follow several conclusions:

1. We expand the indications for apical osteotomy.
2. The operative technique for placing the TTS is not complicated.
3. TTS osseointegrate.
4. We also place TTS on periodontal teeth.

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