RU226639U1 - SURGICAL CLAMP FOR HOLDING AND FIXING CONNECTIVE TISSUE GRAFT - Google Patents

Abstract

The utility model relates to medical equipment, namely to a surgical clamp for holding and fixing a connective tissue graft. A surgical clamp for holding and fixing a connective tissue graft contains two jaws with a ratchet on the inner surface, connected by a screw structure, flattened at one end, bent at an angle of 30° and converging with each other in a movable joint. The jaws are designed to transmit movement to the working parts, which are curved in an arc and contain an inner surface with transverse notches. Each working part has two round holes with a diameter of 6 mm, connected to each other by a jumper 4 mm long. The use of the utility model makes it possible to apply U-shaped sutures without intercepting tissue during needle insertions due to the reliable retention of the connective tissue graft with a clamp, which is a navigation template for U-shaped sutures. 4 ill.

Description

The utility model relates to medical equipment, namely to surgical instruments, in particular to instruments and devices used in surgical dentistry, and can be used for surgical interventions in the oral cavity.

In order to create a sufficient volume of gum tissue when installing a dental implant, a large number of standard instruments are used, the functions of which are limited to the area of their use.

In a number of clinical situations, a standard set of tools is not enough to achieve the required result.

For example, when fixing a connective tissue graft to a gingival flap (in case of partial loss of attachment of the mucous membrane of the gums to the periosteum) or to the gingival contour (without loss of attachment of the mucous membrane of the gums to the periosteum), the dental surgeon uses techniques and instruments, guided approximately by eye "

Surgical tweezers are known, with the help of which a connective tissue graft (CT) is retained when a U-shaped suture is applied to fix the ST to the gingival flap (contour). This technique is associated with a number of technical difficulties due to the different thickness of the connective tissue graft; the positioning of the StT to the gingival flap is carried out without clear landmarks, since the puncture of the surgical needle on the gingival flap is done by approximate measurements (Registration certificate: No. FSZ 2009/04963 dated 08/13/2009; Internet resource: https: mydent24.ru/catalog/stomatologam/stomatologicheskie-instrumenty/pintsety) [1].

A known hemostatic clamp of the Moskit type is straight, which allows you to fix a connective tissue graft and a gingival flap when applying a U-shaped suture (Catalogue of medical instruments. Medtekhnika, M., 2021, p. 166, code MT-K-133, Internet resource: https: //www.medtech.ru/catalog/surgery/section-648) [2]. The advantage of the Mosquito straight is the presence of a locking device that allows you to fix the working ends (cheeks) in the desired position.

However, the use of the Mosquito straight clamp is difficult when combining the tissues of the gingival flap and the connective tissue graft, which does not allow uniform pressing of the StT to the gingival flap, and the working ends (cheeks) of the clamp prevent visualization of the needle insertion site.

The closest in essence and chosen as a prototype is the Single-Tuttle fenestrated tweezers, consisting of two spring jaws with oval ends (cheeks) with additional holes, for grasping and briefly holding tissue during surgical operations and other manipulations (Internet -resource: https://uno-med.ru/catalogue/pincet-okonchatyj-singleja-tuttla) [3].

The advantage of tweezers is the presence of oval working ends (cheeks) with additional holes; the material around the holes is corrugated. This design allows for the most convenient grip of tissue, as well as selecting the desired area and inserting a needle in the precisely planned place when applying a simple suture.

At the same time, when using the prototype, it is difficult to keep it in a compressed state for a long time, since it does not have a locking device (mechanism for fixing) the working ends (cheeks) in the desired position, which the Mosquito straight clamp has.

Another disadvantage of the prototype is the impossibility of applying a U-shaped suture, as well as difficulties in applying subsequent U-shaped sutures for fixing the connective tissue graft to the gingival flap (contour).

The technical result consists in providing the possibility of applying U-shaped sutures without intercepting tissue during needle insertions due to the reliable retention of the connective tissue graft with a clamp, which is a navigation template for U-shaped sutures.

This result is achieved through the development of a surgical clamp design for holding and fixing a connective tissue graft, combining the technical capabilities of a straight Mosquito clamp and fenestrated tweezers.

The developed clamp for holding and fixing a connective tissue graft has two jaws with a ratchet on the inner surface, connected by a screw structure, made at one end flattened, curved at an angle of 30° and converging with each other in a movable joint, while the jaws are designed to transmit movement on working parts, which are curved in an arc and contain an internal surface with transverse notches, and in each working part there are two round holes with a diameter of 6 mm, connected by a jumper 4 mm long.

The utility model is illustrated by drawings in which:

in fig. 1 shows the working parts of the clamp for holding and fixing a connective tissue graft, where in FIG. 1.1 - screw connection branches, in Fig. 1.2 - top view of the working parts of the clamp, Fig. 1.3 - side view of the working parts;

in fig. 2 shows a clamp for holding and fixing a connective tissue graft in a closed state;

in fig. 3 shows a clamp for holding and fixing a connective tissue graft in an open state;

in fig. Figure 4 shows a clamp for holding and fixing a connective tissue graft, indicating the elements of its design.

A clamp for holding and fixing a connective tissue graft, containing working parts (1) with two round holes (2), interconnected by a jumper (3), having an arc bend (4) and an internal surface with transverse notches (5), a screw design ( 6), jaws (7), equipped with a ratchet (8), made at one end flattened (9), bent at an angle of 30 degrees (10) and converging with each other in a movable joint (11).

The advantage of the developed clamp for holding and fixing a connective tissue graft is that it actually performs the functions of three different devices and instruments - a navigation template, tweezers and a clamp, which allows you to apply any number of U-shaped sutures due to the reliable retention of the connective tissue graft without intercepting tissue when inserting a needle.

In addition, the advantage of the clamp design is the absence of sharp edges on the working parts to avoid damage to the tissue being operated on, and the small size of the working parts to allow manipulation of defects that are small in length and depth.

A comparative analysis of the features of the claimed solution with the features of the prototype and analogues indicates that the claimed solution meets the criteria of “novelty” and “industrial applicability”.

A clamp for holding and fixing a connective tissue graft is used as follows:

- after mobilizing the edges of the surfaces to be stitched, for example, a gingival flap and a connective tissue graft, the working parts of the clamp are oriented at the site of the intended connection in an open state;

- close the working parts of the clamp, snapping the ratchet into place;

- apply a U-shaped suture, sequentially inserting a needle through each round hole in the working parts of the clamp;

- open the ratchet and separate the working parts of the clamp; The developed clamp for holding and fixing a connective tissue graft was used during surgical interventions to install dental implants and eliminate gum recession in the cervical area in 28 patients.

Surgical interventions were carried out at the clinical base of the Department of Dentistry of the Federal State Budgetary Educational Institution of Higher Education "Stavropol State Medical University" of the Ministry of Health of the Russian Federation (Stavropol State Medical University of the Ministry of Health of the Russian Federation) and the dental clinic "Dr. Konov's Dentistry" (LLC "MIKON") in Stavropol.

The experience of using the claimed instrument has confirmed the positive clinical effect of its use due to the design features that allow the application of any number of U-shaped sutures due to the reliable retention of the connective tissue graft without tissue interceptions when the needle is inserted, to avoid compression and trauma to the tissues, ensuring their reliable fixation and the possibility of necessary surgical manipulations throughout the operation.

Examples of specific use.

Clinical example No. 1.

Patient A., 45 years old, applied to the dental clinic “Dr. Konov’s Dentistry” (MIKON LLC) in Stavropol in order to eliminate gum recession after installing 3 dental implants in the lateral upper jaw on the left. A preliminary diagnosis made on the basis of plain radiography and computed radiography: “gingival recession of 6 mm” in the area of dental implants installed in place of the missing 24, 25, 26 teeth.

The patient underwent surgery to isolate and transpose a connective tissue autograft from the area of the soft palate to the area of dental implants installed in place of the missing 24, 25, 26 teeth to eliminate recession of the gingival margin.

The use of the developed clamp to hold and fix the connective tissue graft made it possible to apply 9 U-shaped sutures on the vestibular and lingual sides, which tightened the edges of the gums due to the reliable retention of the connective tissue graft without intercepting the tissue when inserting a needle. No bleeding or rupture of the gingival margin was noted; the wound healed by primary intention. At follow-up examinations after 3 and 6 months, complete elimination of gum recession was noted after the installation of 3 dental implants in the lateral upper jaw on the left.

Clinical example No. 2.

Patient S., 54 years old, applied to the dental clinic “Dr. Konov’s Dentistry” (MIKON LLC) in Stavropol in order to eliminate gum recession, which arose 8 years after the installation of 2 dental implants in the frontal part of the upper jaw in place of missing 11 and 12 teeth.

A preliminary diagnosis made on the basis of plain radiography and computed radiography: “gingival recession of 7 mm in length” in the area of dental implants installed in place of the missing 11th and 12th teeth.

The patient underwent surgery to isolate and transpose a connective tissue autograft from the area of the soft palate of the upper jaw to the area of dental implants installed in place of the missing 11th and 12th teeth to eliminate recession of the gingival margin.

During the surgical intervention, after mobilizing the edges of the surfaces to be sutured, the working ends of the clamp were oriented at the site of the intended connection in the open state, then the working ends of the clamp were closed with a snap of the ratchet, 6 U-shaped sutures were applied by sequentially inserting a needle through each round hole in the working ends of the clamp .

The use of the developed clamp to hold and fix the connective tissue graft made it possible to apply 6 U-shaped sutures on the vestibular and lingual sides, which tightened the edges of the gums due to the reliable retention of the connective tissue graft without intercepting the tissue when inserting a needle. No bleeding or rupture of the gingival margin was noted; the wound healed by primary intention. At the follow-up examination after 6 and 12 months, a complete elimination of gum recession in the area of 2 dental implants in the lateral upper jaw in place of the missing 11 and 12 teeth was noted.

The absence of sharp edges on the working parts of the developed clamp for holding and fixing the connective tissue graft made it possible to eliminate both traumatic damage to the operated tissues and bleeding.

Thus, in a clinical setting, the convenience and effectiveness of using the developed clamp for holding and fixing a connective tissue graft was confirmed due to its design features, including the ability to perform the functions of 3 different devices and instruments - a navigation template, tweezers and a clamp, which made it possible to apply U-shaped sutures without interceptions tissues when injected with a needle due to reliable retention of the connective tissue graft.

INFORMATION SOURCES

1. Registration certificate: No. FSZ 2009/04963 dated 08/13/2009; Internet resource: https: mydent24.ru/catalog/stomatologam/stomatologicheskie-instrumenty/pintsety.

2. Catalog of medical instruments. Medtekhnika, M., 2021, p. 166, code MT-K-133, Internet resource: https://www.medtech.ru/catalog/surgery/section-648.

3. Internet resource: https://uno-med.ru/catalogue/pincet-okonchatyj-singleja-tuttla.

Claims (1)

A surgical clamp for holding and fixing a connective tissue graft, containing two jaws with a ratchet on the inner surface, connected by a screw structure, made at one end flattened, bent at an angle of 30° and converging with each other in a movable joint, while the jaws are designed to transmit movement on working parts, which are curved in an arc and contain an internal surface with transverse notches, and in each working part there are two round holes with a diameter of 6 mm, connected by a jumper 4 mm long.