Eine operative Methode für kombinierte atrophische Zustände des Alveolarkamms

Autor u uvodu iznosi različite oblike atrofije alveolarnog grebena, kao ravnomjernu, neravnomjernu atrofiju, prividni višak gingive proprije, plitki forniks itd. Navodi u osnovnim crtama principe kirurškog tretmana svakog pojedinog oblika atrofije. Smatra da su operativne metode svrsishodne, ali i specifične za pojedine oblike atrofije. Problem nastaje kad istovremeno imamo kombinirane različite oblike atrofija i atrofičkih stanja, s različitim popratnim pojavama, što se može izraziti u velikom broju varijanata. Tada često nije dovoljan jedan operativni zahvat. Radi toga je autor izradio operativnu metodu, kojom rješava takva kombinirana atrofička stanja. Rez ide samo kroz sluznicu, po hrptu alveolarnog grebena, uz dva distalna okomita reza, koja omeđuju operativno područje. Sluznica se ispreparira od submukoze onoliko visoko, koliko je potrebno za buduću visinu nepomične sluznice. Zatim se u istom predjelu reza prereže submukoza i periost i potisnu prema forniksu. Neravnine na kosti se modeliraju. Periost se šiva sa sluznicom u onoj visini, do koje je potrebno da se proteže buduća nepomična sluznica. Zatim se šiva sluznica u predjelu rezova. Kad je šivanje završeno, navuče se sluznica prema forniksu, tako da leži priljubljena uz golu host i pričvrsti se čavlićima. Ako se istovremeno produljuje i forniks, nužno je: nakon preparacije sluznice i odljuštenje submukoze i periosta, odrezati submukozu i periost do visine ispreparirane sluznice u predjelu forniksa i tada šivati periost sa sluznicom, dok je ostali postupak nepromijenjen. Kod kesasto izbočene gingive proprije, na hrptu alveolarnog grebena, postupak je isti, samo se prije šivanja rane ekscidira dio viška gingive proprije i to onaj dio, koji od reza, po hrptu grebena, preo- staje palatinalno. Rezultati su vrlo dobri. Postoperativni tijek je uredan, sluznica čvrsto pripijena uz kost, a recidiva u bilo kojem pogledu nije bilo. Alveolarni greben je gladak i izdašan, pokriven u cjelini nepomičnom sluznicom, viška sluznice na hrptu grebena nema, a forniks je dovoljno dubok. Iz svega autor zaključuje, da pri pojedinim oblicima atrofije alveolarnog grebena, treba upotrebljavati poznate metode, koje su svrsishodne za specifično atrofično stanje. Smatra, na temelju iskustva, da njegova metoda ima prednost pred poznatim metodama, u slučajevima kad se radi o kombiniranim atrofijama, jer daje iste rezultate kao i poznate metode, a u jednom se operativnom zahvatu rješava ukupna problematika.In the introduction various types of atrophy of the alveolar ridge, such as uniform atrophy, irregular atrophy, apparent surplus of gingiva propria, a shallow fornix etc. are listed by the author. Principles of surgical treatment for every individual form of atrophy are given. The author maintains that operative methods are purposive but also specific for individual types of atrophy. The problem arises when simultaneously a combination of different types of atrophy and atrophic conditions occurs with various accompanying phenomena which may be reflected in a great number of variants. In such cases one operative intervention is often not sufficient. In view of this the author devised an operative method by means of which he solved combined atrophic conditions. The incision passes only through the mucosa along the crest of the alveolar ridge in addition to two vertical incisions which border the operative field. The mucosa is then separated from the submucosa at the level necessary for the new fixed mucosa. Thereafter in the same region of the incision the submucosa and the periosteum are severed and pushed towards the fornix. The surface on the bone is then smoothed and the periosteum is sutured with the mucosa at the level to which it is necessary for the new fixed mucosa to extend. The mucosa is then sutured in the section of the incisions. When the suturing is completed, the mucosa is drawn towards the fornix to make it adhere close to the bone and it is then with small nails fixed. If the fornix is to be deepened at the same time it is necessary after preparing the mucosa and peeling off the submucossa and the periosteum to excise the submucosa and the periosteum to the level of the prepared mucosa in the region of the fornix and then suture the periosteum to the mucosa while the remaining procedure is unchanged. In cases of a sac-like protruding gingiva propria an the crest of the alveolar ridge the procedure is the same, only before suturing the wound the surplus of gingiva propria is excised, i.e. the palatine part remaining from the incision an the crest of the alveolar ridge. The results were quite good. The postoperative course was normal, the mucosa adhered firmly to the bone and there was no recurrence. The author states that the alveolar ridge was smooth and abundant, covered entirely by an immobile mucosa, there was no surplus of mucosa on the crest of the ridge and the fornix was sufficiently deep.All this prompted the author to conclude that in individual types of alveolar ridge atrophy it is necessary to apply well known methods appropriate for that specific atrophic condition. On the basis of his experience the author considers that his method is to be given priority over the well known methods applied in cases where combined atrophies are involved, since identical results are obtained as with the well known methods while all the problems are solved in one operative intervention.Eingangs werden die Prinzipien der chirurgischen Behandlung für verschiedene Formen und Grade von atrophischen Kieferkammen angeführt. Verschiedene Formen von Atrophien erfordern ein verschiedenes chirurgisches Vorgehen. Schwierigkeiten entstehen wenn gleichzeitig verschiedene Formen der Atrophie mit verschiedenen Begleitsyptomen bestehen. Für solche kombinierte Zustände der Atrophie wird eine operative Methode angegeben. Nach dem Schnitt durch die Schleimhaut am Alveolarkamm wird die Schleimhaut von der Submukose abpräpariert, sodann die Submukosa und Periost durchtrennt und gegen den Fornix bis zur höhe der planierten unbeweglichen Schleimhaut verdrängt. Nach der Naht wird die Schleimhaut gegen den Fornix angezogen, so dass sie dem Kieferkamm eng anliegt und mit Nägeln fixiert. Es werden auch Anweisungen für Schleimhautlappen am Alveolarkamm und Exzision des Schleimhautüberschusses gegeben. Falls gleichzeitig auch der Fornix vertieft werden soll, wird nach der Schleim- hautpräparation die Submukosa und das Periost bis zur Höhe der abpräparierten Schleimhaut im Fornix abgeschnitten, sodann das Periost mit der Schleimhaut vernäht. Die Resultate sind gleich gut und rezidivfrei wie bei konventionellen Methoden, doch der Vorteil besteht darin dass in einem operativen Eingriff die gesammte Problematik gelöst wird