RU2360638C1 - Way of restoration of teeth at pathological erasability - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns stomatology and can be applicable for restoration of teeth at pathological erasability. It is spent staining of defect enamels on 1-1.5 mm on perimetre, staining of dentine. The layer of primer-adhesive is applied on all surface of the defect. Polymerisation by light is spent. The crown of a tooth is restored by formation of a dentine from dentinal shades of a nanofilled composite material. The transparent part of cutting edge is formed by entering of the nanofilled composite material of transparent shades. The enamel surface from the vestibular and oral parties of a crown of the tooth is restored in the thickness by an enamel shade of the nanofilled composite material according to the basic shade of cutting edge of 1-2 mm with augmentation from the basis to the coronal part of cutting edge.

EFFECT: way allows reducing traumatism, to enlarge fastness of restoration to loads.

Description

The present invention relates to medicine, namely to dentistry.

In dentistry, the problem of restoration of teeth subject to pathological abrasion is an urgent task.

Pathological abrasion of the teeth is a fast-moving process, accompanied by changes in the dental and peridental tissues, impaired function of the masticatory muscles and temporomandibular joint.

Pathological abrasion is diagnosed according to clinical (complaints, examination, collection of anamnesis of life and disease) and paraclinical examination (determination of pulmonary excitability, radiography of teeth, jaws and temporomandibular joint, electromyography, study of the function of masticatory muscles (see Kalamkarov Kh.A. , Petrosov Yu.A. Clinic and principles of treatment of diseases of the temporomandibular joint. // Dentistry. - 1982 - No. 2 - p.66-71).

Restoration work with increased tooth abrasion involves the use of a stable material to an occlusive load and long-term preservation of a glossy shade of the vestibular surface.

The main areas of correction of increased abrasion are traditionally considered: elimination of the etiological factor; replacement of the loss of hard tooth tissues with therapeutic or orthopedic methods. The most effective methods are therapeutic correction methods that are used in the first stage of the disease, less often in the second stage, and aimed mainly at the aesthetic and functional restoration of the frontal cavity of the oral cavity.

A known method of forming a cavity for restoration in case of defects in the development of tooth enamel, including the removal of viciously developed enamel to a visually defined border of a healthy tooth enamel and applying restoration material, in which the enamel conductivity is determined on a healthy enamel site, in the area of an enamel defect, at a visually determined border and then conduct point measurements of electrical conductivity, moving from a visually defined boundary in the direction of healthy enamel in increments of 1 mm, to achieve indicators corresponding to their conductivity of healthy enamel, and take the location of these points as the true border of healthy enamel, which is the boundary of the cavity formed for restoration (RF patent for the invention No. 2290124, АСС 5/00).

A known method of restoration of teeth in the oral cavity, including cleaning the surface of the tooth from plaque, determining the primary color of the tooth, choosing the color of the restoration material, preparation, applying the bonding system to the prepared surface, modeling the anatomical shape of the tooth using composite materials and controlling highlighting of the formed tooth after cleaning the surface the tooth and determine the primary color of the tooth are studied in transmitted light the structure, spatial location of the hard tissues of the tooth and coloring structural layers of the tooth, while the shape of the structural layers of the tooth, their geometric dimensions, hue, degree of transparency and brightness are fixed, and the anatomical shape of the tooth is modeled in layers in the following sequence: the most opaque zone, the dentin and the cavity of the tooth are formed, then the replacement dentin of the tooth , after that - the oral petal of the dentin proper to the enamel-dentin border with the obligatory imitation of the coronal part of the mamelon, then - the vestibular petal of the dentin itself, after which - the tooth crown area from the vestibular and oral sides, after which the surface structure of the artificial tooth and the cutting edge of the approximate surfaces are formed, and when choosing the color of the restoration material, the shade for each structural layer is selected in accordance with the recorded one, in addition, they control in transmitted light during modeling the correspondence of each structural layer of the tooth to the fixed shape, geometric dimensions, shade, degree of transparency and brightness, as well as the absence of shadow at the boundary of separation of layers (RF patent for the invention No. 2179834, A61C 5/00, A61C 5/04).

There is a method of layer-by-layer restoration of teeth, including layer-by-layer filling of the carious cavity with a fluid, condensable and traditional light-curing filling material with their photopolymerization, photopolymerization of the filling is carried out with a "smooth start", after which the filling and the area of its marginal adjoining to tooth tissues are covered with composite surface sealant invention No. 2295316, A61K 5/00).

A known method of repairing a defect in hard tissues of a tooth, including etching and bonding preparation of a prepared cavity with or without a matrix, introducing a fluid composite and its subsequent curing, after a bonding preparation, a fluid flow composite is made, and then without prior curing a large portion of the universal composite is brought to the enamel level -dentine border and conduct simultaneous photopolymerization by direct coverage of their surface, then in portions of the universal composite f rmiruyut rays hillocks and final flash coverage and carried prishlifovyvanie suprakontaktov (RF patent № 2285495, A61K 5/00, A61K 5/11 -. prototype).

The following sequence of actions during tooth restoration is well known.

Patient preparation and hygiene analysis.

Before proceeding with the restoration of the teeth, the patient's compliance with hygiene rules and standards is checked. In case of unsatisfactory hygiene, the question is raised about the refusal to restore teeth.

Anesthesia.

An important step is anesthesia. Good anesthesia, excluding the emotional factor at work, allows the doctor to work calmly and feel comfortable for the patient, which greatly facilitates the work.

Surface cleaning.

The tooth is cleaned of plaque and tooth pelicule using fluoride-free pastes. This avoids mistakes in determining the shade of the tooth.

Color definition.

Determination of the shade of the tooth is important in the artistic restoration of teeth. It should be borne in mind that the tooth, as a biological system, has various shades and degrees of transparency from the tooth neck to the cutting edge.

Preparation.

The principle of preparation is to maximize the preservation of healthy hard tooth tissues. To achieve good functional and cosmetic properties, it is necessary to completely remove softened and pigmented dentin. On the vestibular surface, a bevel (fold) of 45 degrees is formed at half the thickness of the enamel. This bevel allows you to hide the border between the tooth and restoration, and also increases the area of adhesion of the composite material to hard tissues.

Macro isolation and micro isolation from moisture.

Macro-isolation is isolation from moisture in the oral cavity using cotton rolls or a latex curtain.

Micro isolation is the use of retraction threads, dies and wedges. This is an important step, because Excessive moisture can reduce strength and affect the artistic properties of tooth restoration.

The imposition of a medical pad.

In the case of a deep cavity close to the pulp, the application of a medical (calcium-containing) pad is required, because in deep cavities, inflammatory changes in the pulp often begin.

Conditioning.

Conditioning or etching is carried out with 30-40% gel (semi-gel) of phosphoric acid. Etching creates a micro-roughness on the enamel surface, which increases the adhesion force of the hard tissues of the teeth to the material. Air conditioning must be done for the bevel enamel at 1-1.5 mm, which avoids the ledge in the area of the tooth seal and achieve a smooth transition. For etching, it is better to use a semi-gel or liquid gel, as it is easier to completely remove.

Bonding system application.

For chemical bonding of tooth tissues with restoration material, bonding systems are used, which consist of a primer and an adhesive. Primer and adhesive can be in different containers or in one. First, a primer is applied within the dentin. The primer is a hydrophilic component, so it penetrates deeply into the dentinal tubules, forming a strong bond. Then, dentin coated with a primer and adhesive are applied to the enamel, followed by photopolymerization for 10 s. If a one-step adhesive is used, it is applied with an applicator immediately to the dentin and enamel, after which it is distributed with a light stream of air, which also allows you to remove excess solvent. Before applying the bonding system, it is important not to dry the dentin, as this leads to a collapse of collagen fibers and a deterioration in adhesion strength.

Layering and photopolymerization of the material.

The material is used according to the selected shade. For curing the first layer of material, it is desirable to use directional photopolymerization, because this compensates for shrinkage of the material. It is also desirable to use a smooth start to start photopolymerization, which will reduce the microdestruction of the material. In photopolymerizers with a smooth start, the first 10 s gradually increases the intensity of the light flux.

When restoring teeth, it is necessary to take into account the three-dimensional structure of the tooth, because it affects aesthetic properties. Even with the right color selection and with an incorrect combination, it is impossible to achieve the perfect result. When building a tooth, you need to repeat the form of dentin and enamel.

Removal of insulating materials (rollers, dies, wedges).

Grinding.

During grinding, the tooth shape is corrected and rough processed. This is done using burs of the desired shape, as well as abrasive discs.

Polishing.

This is a finer tooth treatment, after which it is necessary to achieve a "dry shine". During the polishing process, discs of decreasing abrasiveness, rubber discs and cups, which can also be of different abrasiveness, are used. At the end, polishing paste is used.

Finish highlighting

Finishing is used to increase the reliability of tooth restoration and eliminate the possibility of insufficient photopolymerization of the material.

At the end of tooth restoration, it must be taken into account that the polymerization process continues for 7 days, as a result of which a slight color change occurs, which must be warned to the patient.

The disadvantages of the known methods of tooth restoration include injured patients.

The objective of the invention is to reduce the injuries of patients and increase the effectiveness of treatment with a sparing minimally invasive method for treating carious cavities and facets.

To solve this problem, a minimally invasive method for repairing tooth defects with increased abrasion is proposed, developed on the basis of experimental data on the study of morphostructural changes in tooth hard tissues.

A method for restoration of teeth with abnormal abrasion is proposed, including hygienic preparation, cleaning of the tooth surface, determination of tooth shades and dominant color shade, moisture isolation, infiltration or conduction anesthesia, preparation of the tooth cavity, application of a bonding system, layering and photopolymerization of composite material, and polishing characterized in that the preparation is carried out in a gentle manner with a diamond bur within the sclerosed dentin of the erase facet and a depth of 1 mm in the frontal group of teeth of the lower jaw, 1-1.5 mm in the frontal group of teeth of the upper jaw and 1.5-2 mm in the lateral groups of teeth of the lower and upper jaws, taking into account the size of the crown and group of the tooth, smoothing the edges of the damaged enamels are carried out without the formation of a fold with a fine-grained diamond boron on a water-cooled turbine tip or a flexible abrasive disk on a low-speed tip, and the defect is treated with a 1-3% sodium hypochloride solution as filling m materials use nanofilled composites and nanofilled ormocer in combination with nanofilled adhesive systems, and the phased deposition of a nanofilled system is carried out in the following sequence: etch the defect enamel by 1-1.5 mm along the perimeter for 25-30 s, etch dentin for 15 s a primer adhesive layer is applied over the entire surface of the defect, inflated with air, polymerized with light for 10 s, the tooth crown is restored by forming a thin adaptation layer on the bottom of the cavity of a fluid composite material, the formation of dentin from the dentine shades of the nanofilled composite material, depending on the dentin color of the adjacent teeth to the enamel-dentin border, the transparent part of the cutting edge is formed by introducing the transparent nanofilled composite material, the enamel surface is restored from the vestibular and oral sides of the crown tooth enamel shade nanofilled composite material in accordance with the basic shade of the cutting edge I 1-2 mm thickness with increasing from the base to the crown portion to the cutting edge, the simulation of each layer is carried out under the control translyuminatsii transmitted light curing light waveguide fibers.

In the dental clinic of the Ural State Medical Academy, 256 people were examined and treated with manifestations of increased abrasion of hard tooth tissues of the first and second degrees. The examination of the patients included data from a general clinical study (including the findings of a general practitioner, endocrinologist, neuropathologist, and other specialists), x-rays of teeth and temporomandibular joints, tele-radiography for orthodontic pathology, electroodontometry, functionography, axiography, electromyography, etc.

968 restorations of erasure facets and carious cavities of the 6th class were carried out, including 125 laminates. The quality of filling was assessed 20 minutes after filling, then 10 days, 6 months, 12 months, 2 years, 3 years later.

Thus, the use of the proposed method of tooth restoration with pathological abrasion reduces trauma and increases the effectiveness of treatment.

Claims (1)

A method of tooth restoration with abnormal abrasion, including hygienic preparation, cleaning of the tooth surface, determination of tooth shades and dominant color shade, moisture isolation, infiltration or conduction anesthesia, preparation of a tooth cavity, bonding system, layer-by-layer application and photopolymerization of composite material and polishing, different the fact that the preparation is carried out in a gentle way with a diamond bur within the sclerotized dentin of the erase facet to a depth of 1 mm in the frontal group of teeth of the lower jaw, 1-1.5 mm in the frontal group of teeth of the upper jaw and 1.5-2 mm in the lateral groups of teeth of the lower and upper jaws, taking into account the size of the crown and the group of the tooth, smoothing the edges of the damaged enamel is carried out without forming folds with a fine-grained diamond bur on a water-cooled turbine tip or a flexible abrasive disk on a low-speed tip, medically treat the defect with a 1-3% sodium hypochloride solution, as filling materials and nano-filled composites and nano-filled ormocers are used in combination with nano-filled adhesive systems, and the phased deposition of the nano-filled system is carried out in the following sequence: defect enamel is etched by 1-1.5 mm along the perimeter for 25-30 s, dentin is etched for 15 s, apply a primer adhesive layer to the entire surface of the defect, inflate with air, carry out light polymerization for 10 s, restore the tooth crown by forming a thin adaptation layer at the bottom of the cavity from a fluid composite material, the formation of dentin from the dentin shades of the nanofilled composite material, depending on the dentin color of the adjacent teeth to the enamel-dentin border, the transparent part of the cutting edge is formed by applying the nanofilled composite material in transparent shades, the enamel surface is restored from the vestibular and oral sides of the tooth crown with enamel a shade of nanofilled composite material in accordance with the main shade of the cutting edge with a thickness 1-2 mm with an increase from the base to the coronal part to the cutting edge, the simulation of each layer is carried out under the control of the transmission in the transmitted light of the fibers of the polymerization lamp fiber.