Κατανόηση των βιδών οστικής στερέωσης στην οδοντιατρική χειρουργική

In dental surgery, bone fixation screws play a crucial role as a key medical instrument. These screws, often referred to as bone pins or bone support screws, are miniature metal screws primarily made from biocompatible materials such as titanium alloys. The diameter typically ranges from 1.2mm, and the length varies from 6 to 12mm to meet different surgical needs. They are widely used in areas like orthodontics, periodontal disease treatment, and dental implant GBR (Guided Bone Regeneration), providing necessary fixation and support to teeth and alveolar bone.

Choosing the right bone fixation screw is critical for the success of dental surgery. The material, size, specifications, and strength grade of the screw must be precisely matched to the patient’s specific condition and surgical requirements. An improper screw could lead to suboptimal surgical outcomes and potentially pose a threat to the patient’s oral health. Therefore, understanding the basic knowledge of bone fixation screws and how to properly select and use them in dental surgery is an essential skill for every dentist and related professional.

This article aims to address common questions related to bone fixation screws, including their basic concepts, functions, selection criteria, and applications in dental surgery. By providing a detailed introduction to the importance and selection principles of bone fixation screws, this article will serve as a practical reference guide for dentists and related professionals to ensure the safety and effectiveness of surgical procedures.

What Screws Are Used in Dental Bone Surgery?

There are various types of screws used in dental bone surgery, each with its unique advantages and suitable applications. When selecting screws, doctors need to consider the patient’s specific condition, surgical requirements, and the screw’s properties to ensure the safety and effectiveness of the procedure. Here are several common types of screws used in dental bone surgery:

Titanium Screws

Πλεονεκτήματα: Titanium screws are widely used in dentistry due to their excellent biocompatibility, high strength, and corrosion resistance. They do not cause rejection reactions in the body and can remain stable in the human body for an extended period.

Εφαρμογές: Titanium screws are commonly used in dental implants and bone fixation surgeries, such as implant fixation in dental implant procedures and the placement of support screws in orthodontics. They provide reliable fixation and contribute to the success of the surgery and patient recovery.

Stainless Steel Screws

Usage: Stainless steel screws are sometimes used as an alternative to titanium screws, especially when the unique properties of titanium are not required. Stainless steel screws also offer high strength and corrosion resistance, but their biocompatibility may be slightly lower compared to titanium.

Χαρακτηριστικά: Stainless steel screws are durable and offer some flexibility, meeting the strength and stability requirements of dental surgeries. However, in procedures that demand higher biocompatibility, stainless steel screws may not be the optimal choice.

Bioabsorbable Screws

Εφαρμογές: Bioabsorbable screws are widely used in pediatric patients or in non-weight-bearing areas for temporary fixation. These screws are made from biodegradable materials that gradually absorb into the body over time, eliminating the need for a second surgery to remove them.

Πλεονεκτήματα: The use of bioabsorbable screws helps avoid the additional pain and costs associated with screw removal. Their gradual degradation also supports the healing and regeneration of surrounding tissues. However, it is important to note that the strength and stability of bioabsorbable screws may decrease over time, making them unsuitable for surgeries requiring long-term fixation.

Does bone grow back after screw removal?

Bone does have the ability to regrow and heal after screw removal. However, this process is influenced by various factors and requires time to complete. Therefore, during dental surgeries, doctors need to carefully assess the patient’s specific condition, choose the appropriate screw type and size, and provide proper post-removal care and rehabilitation guidance to ensure full healing and recovery of the bone. Below is a detailed explanation of the bone regeneration process after screw removal.

Bone Regeneration Process

Bone healing and regeneration after screw removal:

When a bone fixation screw is removed, a cavity similar in shape to the screw will be left in the bone. However, this cavity does not remain permanently. The alveolar bone, which has a strong ability to repair itself, will quickly initiate the healing process. This process is similar to the healing of a socket after tooth extraction, involving stages such as bleeding, clot formation, reorganization, calcification, and epithelial coverage. Most patients can observe significant healing signs within 1-2 weeks, and the alveolar bone typically completes healing in about 3 months, at which point almost no signs of the implanted screw will be visible.

Factors that affect healing:

• Τοποθεσία: The location of the bone affects the healing speed. For example, bones in the oral cavity typically heal faster than those in other parts of the body due to better blood supply.
• Bone Type: Different types of bone have varying healing capabilities. Cortical bone (compact bone) and trabecular bone (spongy bone) differ in healing speed and method.
• Υγεία των ασθενών: The patient’s overall health, nutritional status, and the presence of any conditions affecting bone healing (such as diabetes or osteoporosis) will all impact the healing process.

Bone Role in Dental Implants

Bone integration with implants after screw removal (osseointegration):

In dental implant surgeries, such as for dental implants, screws (or implants) are placed into the bone to support the teeth. After screw removal, the bone will integrate with the implant surface, a process known as osseointegration, where bone cells grow into the microscopic pores on the implant surface, forming a strong bond. This process requires time and is affected by factors such as the implant material, surface treatment, and patient variability.

Long-Term Effects on Bone

Recovery of Bone Density and Strength after Screw Removal:

After screw removal, the bone’s density and strength will gradually recover. However, the speed and extent of recovery are influenced by several factors, including how long the screw was in place, the initial condition of the bone, and post-removal care. In some cases, if the screw was in place for an extended period or if the bone has underlying issues, it may result in poor healing or decreased bone density. Therefore, after screw removal, patients must follow the doctor’s advice for proper care and rehabilitation to promote complete healing and recovery of the bone.

What Materials Are Bone Fixation Screws Made Of?

• Κράμα τιτανίου: Known for its excellent biocompatibility, corrosion resistance, and long-term durability. It is widely used in dental and orthopedic surgeries due to its ability to integrate well with bone tissue and its minimal risk of rejection.
• Ανοξείδωτο χάλυβα: Commonly used in specific cases where the unique properties of titanium are not required. Stainless steel offers high strength and durability, but may have slightly lower biocompatibility compared to titanium.
• Biodegradable Materials: Used primarily in short-term applications for dental surgeries. These screws are made from materials that naturally break down and are absorbed by the body over time, eliminating the need for a second surgery to remove them. They are ideal for temporary fixation in non-weight-bearing areas or pediatric patients.

What Are the Complications of Bone Screws in Dental Surgery?

While the use of bone screws in dental surgeries provides significant treatment benefits, there are potential complications that can arise. Below is a detailed analysis of these complications and suggested management approaches:

Μόλυνση

• How it occurs: Infections can occur due to bacterial contamination during surgery or poor oral hygiene after the procedure, leading to bacterial invasion.
• Prevention: The surgical site should be thoroughly cleaned and disinfected before surgery. After the procedure, patients should follow proper oral hygiene instructions, and antibiotics may be prescribed as a preventive measure.

Screw Loosening or Fracture

• Potential causes: Loosening of screws can occur due to poor bone quality, inappropriate screw size, or improper fixation techniques. Screw fractures can be caused by material quality, prolonged use, or stress concentration.
• Διαχείριση: If a screw becomes loose or fractures, an X-ray examination is needed to assess the situation. If necessary, further surgery may be required to replace or refix the screw.

Pain or Discomfort

• Causes: The placement of screws can irritate surrounding tissues, causing pain or discomfort. Additionally, improper screw placement or oversized screws may lead to patient discomfort.
• Διαχείριση: If pain or discomfort occurs, patients should promptly inform their doctor. The doctor may adjust the screw placement, replace it with a smaller size, or prescribe pain relief medication to alleviate symptoms.

Nerve or Soft Tissue Injury

• Risk: During screw placement, improper technique can cause damage to nearby nerves or soft tissues, leading to sensory abnormalities, motor dysfunction, or tissue necrosis.
• Prevention: Surgeons should carefully assess the anatomical structure during the procedure to avoid damaging nerves and soft tissues. After surgery, patients should monitor their bodies for any abnormalities and seek medical attention if necessary.

Non-union or Delayed Healing

• Risk: Poor bone healing or failure of the implant to integrate with the bone can result in screw loosening or detachment, compromising the success of the surgery.
• Διαχείριση: In cases of non-union or delayed healing, the doctor may employ interventions such as growth factors, physical therapy, or further surgery to promote bone healing.

Foreign Body Rejection

• Rare occurrence: Although materials such as titanium alloy and stainless steel have good biocompatibility, some patients may experience rejection reactions to the implants.
• Impact: Foreign body rejection can lead to localized inflammation, infection, or screw loosening.
• Διαχείριση: If foreign body rejection occurs, the implant may need to be surgically removed, and appropriate treatment measures should be taken to alleviate symptoms.

Best Practices for Using Bone Fixation Screws in Dental Surgery

In dental surgery, the best practices for using bone fixation screws encompass every aspect from material selection to post-operative care, ensuring the success of the procedure and the rapid recovery of the patient. The following are the key steps in this process:

1. Selecting the Appropriate Material

When selecting the material for bone fixation screws, it is essential to consider the patient’s specific needs and the surgical goals. Titanium alloy screws are typically the first choice due to their excellent biocompatibility, corrosion resistance, and long-term stability. However, in certain cases, such as when a patient has a titanium allergy or when a more cost-effective option is needed, stainless steel screws can be a viable alternative. Additionally, for pediatric patients or situations requiring short-term fixation, bioabsorbable screws are favored for their gradual degradation properties. Doctors need to comprehensively evaluate the patient’s health status, the surgical site, and the expected healing time to tailor the most suitable screw material for the patient.

2. Correct Insertion Technique

The insertion process of bone fixation screws is critical, as the correct technique can significantly reduce the occurrence of complications. Before the surgery, the doctor should plan the insertion path in detail, ensuring that important nerves and blood vessels are avoided. During the procedure, precise surgical instruments and auxiliary devices, such as guides or X-ray fluoroscopy, should be used to ensure accurate placement of the screw. Additionally, the doctor should apply appropriate force and speed to avoid unnecessary damage to surrounding tissues. Through meticulous preoperative preparation and precise intraoperative procedures, the success rate of screw insertion and patient safety can be maximized.

3. Μετεγχειρητική φροντίδα

Postoperative care is a crucial step in ensuring the successful healing of bone fixation screws. Patients should follow the doctor’s guidance, maintain oral hygiene, and avoid infections. The doctor should regularly follow up with the patient to assess the stability of the screw and the bone healing process. If necessary, imaging examinations can be performed to monitor the position of the screw and changes in surrounding tissues. Additionally, the doctor should prescribe appropriate medications, such as antibiotics and pain relievers, to prevent infection and alleviate pain. Through careful postoperative care and timely medical intervention, rapid recovery can be promoted, ensuring the long-term effectiveness of the screw placement.

Συμπέρασμα

In dental surgery, the use of bone fixation screws is crucial as they provide a solid foundation for the repair and reconstruction of teeth and bones. The selection of high-quality screws and precise surgical techniques play an irreplaceable role in reducing surgical complications and promoting the patient’s rapid recovery. To ensure the best treatment outcomes, we strongly urge dental professionals to carefully select the appropriate screw material based on the patient’s specific situation and needs, and to master the correct insertion technique. Through these efforts, we can provide patients with safer and more effective treatment options, promoting their oral health and overall well-being.