RU226421U1 - SPRINT FOR IMMOBILIZATION OF TEETH WITH MILLED CERAMIC SPRINTS - Google Patents

Abstract

The utility model relates to medicine, namely to orthopedic dentistry, and is a splint for immobilizing tooth mobility resulting from periodontal diseases. The splint is made from a Preshade 1100 MPa Omitec zirconium dioxide block by milling based on a computer model obtained in the Exocad Align Technology computer program based on a comparison of the virtual impression of the patient’s dentition and the bite register, by adding stl files of the obtained virtual impressions, separately upper and lower the patient’s dentition without a polymer register, and with a polymer register obtained by 3D printing from Dental Yellow Clear Pro material, as well as in the bite. The splint has an arcuate shape with a flat contact surface and rounded edges for placement on the inner surface of the prepared teeth in a groove obtained with a diamond bur with a rounded edge with a working part diameter of 1.6 mm, a working part length of 4 mm, a grain size of 105-120 microns, a width of 1600 µm and 800 µm deep. The splint has a width of 2.6 mm throughout the immobilization zone and alternating first and second thicknesses. The first thickness is 1600 µm for placement in the sulcus, and the second thickness is 800 µm, wherein the edges of the splint have the first thickness and the splint is designed to be installed in the sulcus, with a 1 mm overlap of the sulcus along the entire perimeter, on Maxcem Elite dual-cure composite cement , Kerr 50 microns thick. The technical result of the utility model is the development of a splint for immobilizing tooth mobility resulting from periodontal diseases, ensuring high precision fit and reliable installation in the position specified by the dentist when splinting mobile teeth after periodontal diseases, with minimal removal of hard tissues of the prepared teeth. 10 ill.

Description

The utility model relates to medicine, namely to orthopedic dentistry, and is a splint for immobilizing tooth mobility resulting from periodontal diseases.

Periodontitis causes inflammation and loss of periodontal bone, leading to loose teeth. Treatment includes specific treatment of periodontal disease depending on its stage and degree (usually non-surgical and surgical), occlusal therapy and splinting Zhekov Y. et al. CAD/CAM Fiber-Reinforced Composite Adhesive Splint //Intern J Sci Res. - 2020. - T. 9. - No. 5. - pp. 206-209.

It is known to use a splint to eliminate tooth mobility, containing a solid metal frame with pins for fixation in the root canals of teeth. In which the metal frame is made in the form of a solid beam with pins, while for pulpless teeth with parallel canals the length of the root pins is 2/3 of the length of the root canals, and for teeth with non-parallel canals the length of the pins is up to 1/3 of the length of the canals and are parallel between each other and all canals of pulpless teeth, to fix the splint on living teeth, the splint is provided with paired parapulp pins up to 2-2.5 mm long, which are parallel to each other and the rest of the pins, and the visible part of the solid splint on the teeth being splinted is covered with a layer of ceramic to match the color of the latter . A tooth mobility splint is used when a natural tooth(s) are missing and contains a cast tooth frame coated with ceramic to match the color of the missing tooth. A splint to eliminate tooth mobility can be used for both anterior and lateral teeth. RF utility model patent 175754 published on December 18, 2017.

It is known to use a splint to stabilize tooth mobility resulting from periodontal diseases, and to replace defects in the dentition. A milled dental splint includes artificial elements of the crown part for moving teeth. For all teeth that have mobility in one of the directions: the vestibulo-oral or mediodistal direction, the artificial elements of the splint are designed to be positioned on the lingual or palatal surface of the teeth, overlapping the clinical equators of the teeth by 2 mm, and the lower border to be located along the border of the marginal periodontium of the marginal gingival margin. For teeth that have mobility in two or more directions: both in the vestibulo-oral and mediodistal directions, the artificial elements of the splint are designed to be positioned on the vestibular surface, repeating the clinical anatomy of the crown of a natural tooth, and have a thickness of 0.5 mm. The splint is made of zirconium dioxide and manufactured using CAD/CAM technology by recognizing the optical impression of the clinical situation in the patient’s oral cavity and is individualized to the existing teeth through the application of ceramic mass and dyes, followed by glazing. The invention allows the production of an adhesive dental splint with artificial elements of the crown part of the most mobile teeth included in its composition, used in the event of subsequent tooth extraction in fixed dentures with the function of immobilization and stabilization of the dentition, patent for the invention of the Russian Federation 2632755, publ. 09.10.2017.

It is known to use a splint to stabilize tooth mobility resulting from periodontal diseases. The milled dental splint is made monolithically from polymethyl methacrylate containing nanosilver particles up to 0.02 wt.% evenly distributed inside, has a body up to 3 mm wide and up to 0.2 mm thick, matching the contour shape with the anatomical structures of the patient’s teeth on their lingual surface, and retention elements, monolithically connected to the body of the tire and made in the form of a hemispherical head on a leg, the edges of the base of which are oval, and the groove between them is U-shaped. The body of the splint is designed to be positioned on the lingual surface of the teeth and pass through its lower border, 1.5 mm away from the marginal edge of the gums. The retention elements are designed to be located in the interdental spaces and transfer to the vestibular surfaces of the teeth. The splint is made by milling a computer model obtained by recognizing an optical impression of the clinical situation in the patient’s oral cavity. The invention makes it possible to increase the adhesive ability of the splint due to the presence of additional retention elements that ensure a high precision of fit depending on the clinical situation, and an antibacterial effect. The patent for the invention of the Russian Federation 2558974 was published on August 10, 2015.

Also known is US patent 9662182 published on May 30, 2017, which describes a method for making a dental splint for stabilizing mobile or unstable teeth or firmly rooted teeth in order to prevent orthodontic relapse. Fabrication of a dental splint involves the following steps: the patient's dental arch to determine the need for lingual reduction, creation of a representative model of the patient's dental arch, manipulation of the representative model to select a group of teeth for inclusion in the dental splint, determination of the height and length of a one-piece extracoronal component adapted to the dentition patient; fabricating a one-piece extracoronal component, dry-fitting the fabricated one-piece extracoronal component to confirm proper fit, and attaching the fabricated one-piece extracoronal component to mobile or unstable teeth, with the one-piece extracoronal component adjacent to the lingual surface of the teeth and virtually invisible on the face.

In this case, the known splints do not take into account the simulated fit of the moving teeth in a given position, which affects the accuracy of the installed design of the dental splint. Also, the prior art does not take into account the relationship between the materials and equipment used, the combination of properties of which, including, for example, shrinkage or bur grain size, affects the accuracy of the installed dental splint design. In addition, the known splints do not take into account the dimensions of the installed dental splints, which would ensure reliable and accurate installation of the splint with minimal removal of hard tissues of the prepared teeth.

Thus, the objective of the claimed utility model is to develop a splint for immobilizing tooth mobility resulting from periodontal diseases, which would eliminate the shortcomings identified in the prior art.

The technical result of the utility model is the development of a splint for immobilizing tooth mobility resulting from periodontal diseases, ensuring high precision fit and reliable installation in the position specified by the dentist when splinting mobile teeth after periodontal diseases, with minimal removal of hard tissues of the prepared teeth.

The technical result is achieved by creating a splint for immobilization of tooth mobility resulting from periodontal diseases made from zirconium dioxide block Preshade 1100 MPa Omitec by milling based on a computer model obtained in the Exocad Align Technology computer program based on a comparison of the virtual impression of the patient’s dentition and the bite register , by adding stl files of the obtained virtual impressions, separately of the patient’s upper and lower dentition without a polymer register, and with a polymer register obtained by 3D printing from Dental Yellow Clear Pro material, as well as in the bite. The splint has an arcuate shape with a flat contact surface and rounded edges for placement on the inner surface of the prepared teeth in a groove obtained with a diamond bur with a rounded edge with a working part diameter of 1.6 mm, a working part length of 4 mm, a grain size of 105-120 microns, a width of 1600 microns and a depth of 800 microns, while the tire has a width of 2.6 mm throughout the immobilization zone, and alternating first and second thicknesses. The first thickness is 1600 µm for in-sulcus placement and the second thickness is 800 µm. The edges of the tire have the first thickness, and the tire is designed to be installed in the furrow with a furrow overlap along the entire perimeter by 1 mm, on dual-curing composite cement Maxcem Elite, Kerr with a thickness of 50 microns.

Brief description of the drawings.

Fig.1. Study of the dentofacial apparatus. Periotestometry of tooth mobility.

Fig.2. Study of the dentofacial apparatus. Doppler ultrasound.

Fig.3. Prepared teeth of the anterior group of the upper dentition.

Fig.4. Virtual (computer) modeling of a dental splint. Stages of visualization of a virtual model.

Fig.5. Virtual (computer) modeling of a dental splint. Tire modeling stages.

Fig.6. Stage of modeling the virtual design of a dental splint. Virtual measurement of design parameters of a virtual dental splint.

Fig.7. The stage of modeling the virtual design of a dental splint taking into account the established parameters. Virtual measurement of design parameters of a virtual dental splint.

Fig.8. Milled dental splint made of zirconium dioxide.

Fig.9. Milled dental splint made of zirconium dioxide at the stage of fixation on the dentition.

Fig. 10. Milled dental splint made of zirconium dioxide after fixation on the dentition.

The claimed utility model works as follows: first, oral hygiene is carried out, which is carried out in 3 stages: the first stage is ultrasonic cleaning using a dental ultrasonic scaler (NSK Nakanishi, Japan), hard supra- and subgingival dental plaque is removed, the second stage is the removal of soft dental plaque and plaque using an Air-flow device (air-abrasive treatment) - cleaning is carried out using a directed flow of water, air and abrasive powder (Air Flow Classic Comfort, EMS), the third stage is polishing the cleaned surfaces - brushes and polishing pastes are used for the procedure (SuperPolish, Kerr, USA).

Next, the surface of the teeth is polished with cap-shaped rubber heads from a polishing set from Densco (Japan) - this surface of the teeth is first polished with a soft rough rubber head (blue), then with a super soft rough rubber head (white) until a mirror shine.

Then a fluoride-containing preparation is applied to the surface of the teeth (transparent fluoride varnish, OmegaDent, Russia).

Then they model in the computer program Exocad Align Technology, USA) (polymer registry (template) (Dental Yellow Clear Pro, HARZ Labs - Iso 10993) and produce a 3D printing method for establishing (fixing) mobile teeth in the position specified by the dentist.

Then they are formed using a cylindrical diamond bur with a rounded edge (835 KR 314.016 - ISO, working part diameter - 1.6 mm, working part length - 4 mm, grit size: standard - 105-120 microns, color: blue, Drendel+Zweiling, Germany) - a groove 1600 microns wide and 800 microns deep in the hard tissues of the prepared teeth, while the polymer register (template) holds (fixes) the moving teeth in a given position.

Then a virtual impression is obtained using separately the upper and lower dentition of the patient without a polymer register, and with a polymer register (template) using a high-speed intraoral 3D scanner Medit i700 (Medit, Republic of Korea), as well as scanning in the bite - in the usual occlusion (bite register).

Next, a virtual impression of the patient’s dentition and the bite register is compared (by adding all stl files obtained by intraoral scanning of the elements of the oral cavity, dentition and in the usual occlusion) in the Exocad computer program.

Then the shape of the future dental splint is modeled in the Exocad computer program on the lingual surface of the immobilized teeth, departing from the edge of the marginal gum at a distance of less than 1 mm and in accordance with the geometry of the marginal periodontium of the patient’s dentition, 2.6 mm wide throughout the immobilization zone, in this case, the width of the simulated dental splint overlaps the groove along the entire perimeter by 1.0 mm.

After applying the contour of the dental splint in a computer program (Exocad), its thickness is set to 800 microns, and in the area of the groove the thickness is 1600 microns and a layer of fixing material is 50 microns, after which the obtained data is transferred to a milling machine, where the dental splint is milled from dioxide zirconium block (Preshade 1100 MPa, Omitec, Republic of Korea).

In this case, the tire is given an arcuate shape with a flat contact surface and rounded edges and a width of 2.6 mm throughout the immobilization zone, as well as alternating first and second thicknesses. The first thickness is 1600 µm for in-sulcus placement and the second thickness is 800 µm. The edges of the tire have the first thickness, i.e. 1600 microns.

Next, the dental splint structure is polished and tried on the teeth in the oral cavity, after which the dental splint structure is fixed with dual-curing composite cement (Maxcem Elite, Kerr, USA).

The proposed utility model is illustrated by the following example.

The patient underwent examination of the dentofacial apparatus by periotestometry of tooth mobility (Fig. 1) followed by Doppler ultrasound examination (Fig. 2). Next, oral hygiene was carried out in 3 stages described earlier. Then transparent fluoride varnish was applied to the surface of the teeth. Then a polymer register was modeled in the Exocad Align Technology computer program (Fig. 4-7) and a polymer register was made from Dental Yellow Clear Pro material using 3D printing to hold the moving teeth in a given position. Then, using a cylindrical diamond bur with a rounded edge with a working part diameter of 1.6 mm, a working part length of 4 mm, a grain size of 105-120 µm, a groove 1600 µm wide and 800 µm deep in the tissues of the prepared teeth (Fig. 3), with In this case, the polymer register held the moving teeth in a given position. Then a virtual impression was obtained by scanning separately the upper and lower dentition of the patient without a polymer register and with a polymer register using a Medit i700 intraoral 3D scanner, and a bitewing scan was performed to obtain a bite register. Next, the virtual impression of the patient’s dentition and the bite register was compared by adding stl files of the resulting virtual impressions, separately the upper and lower dentition of the patient without a polymer register and with a polymer register, as well as in the bite, in the Exocad Align Technology computer program. Then, in the Exocad Align Technology computer program, the shape of a simulated dental splint was modeled on the lingual surface of the immobilized teeth, 2.6 mm wide throughout the immobilization zone, retreating from the edge of the marginal gum at a distance of 1 mm, and the width of the simulated dental splint covered the entire groove perimeter by 1 mm. After applying the contour of the simulated dental splint, the thickness of the simulated dental splint was set in the Exocad Align Technology computer program - 800 μm, and in the area of the groove the thickness was 1600 μm and the layer of fixing material was 50 μm, after which the obtained data was transferred to a milling machine, where the dental tooth was milled tires made of zirconium dioxide block Preshade 1100 MPa, Omitec (Fig. 8). Next, the dental splint structure was polished and tried on the teeth in the oral cavity (Fig. 9), after which the dental splint structure was fixed with double-curing composite cement Maxcem Elite, Kerr (Fig. 10).

Also, when developing a utility model, we tested a diamond bur with a rounded edge with a working part diameter of 1.6 mm, a working part length of 4 mm, a grain size of 105 microns, and a diamond bur with a rounded edge with a working part diameter of 1.6 mm, a working part length of 4 mm, with a grain size of 120 microns, in both cases it was noted that a groove was obtained with neat edges, without damaging adjacent tissues, sufficient for the precise installation of a dental splint, with minimal removal of hard tissues of the prepared teeth.

Tests of the claimed utility model confirmed the implementation of immobilization of tooth mobility resulting from periodontal diseases, and confirmed the high accuracy of fit and reliable installation in the position specified by the dentist when splinting mobile teeth after periodontal diseases, with minimal removal of hard tissues of the prepared teeth.

Claims (1)

A splint for immobilization of tooth mobility, made by milling from a zirconium dioxide block, has an arched shape with rounded edges, a flat contact surface and thickness alternating along the length, characterized in that the splint is made from a zirconium dioxide block Preshade 1100 MPa Omitec, has a width of 2.6 mm throughout, alternating thicknesses - the first is 1600 microns, the second is 800 microns, while the first thickness is designed to be located in the groove of the prepared teeth and overlap the groove along the entire perimeter by 1 mm.