RU231269U1 - Removable orthopedic disengaging centering prosthesis - Google Patents

Abstract

The utility model relates to medicine, namely to orthopedic dentistry, and will find application in the comprehensive treatment of patients with dental arch shape anomalies. The removable orthopedic disengaging centering prosthesis consists of two parts - internal and external, wherein the internal part, preliminarily designed individually for each patient, is manufactured by milling from a multilayer plastic block, it has a thickness of 0.2-0.3 mm and embraces the crowns of all teeth from the vestibular, occlusal and oral surfaces; a multi-rope reinforcing wire made of stainless steel is fixed on the internal part; the external part is manufactured by thermal vacuum stamping in a vacuum former from plates made of 1 mm thick polyvinyl chloride, with subsequent layer-by-layer application of transparent quick-hardening plastic in an articulator, the removable orthopedic disengaging centering prosthesis can be fixed on the crowns of the teeth of the lower and upper jaws. The useful model can be recommended in a wide range of dental and orthopedic practice at the treatment stage before the start of treatment of patients with anomalies of the shape of dental arches, to carry out orthopedic treatment with the proposed SORCP devices in the implementation of CAD/CAM systems for the restoration of the central ratio of the jaws and the normalization of the articular relationships of the elements of the temporomandibular joint.

Description

The utility model relates to medicine, namely to orthopedic dentistry, and will find application in the complex treatment of patients with dental arch shape anomalies.

The need for comprehensive orthopedic and orthodontic care in adults in the Russian Federation ranges from 35 to 83%. Anomalies in the shape of the dental arches and their defects cause responses of the masticatory-speech apparatus in the form of the development of pathological occlusion, increased abrasion of hard dental tissues, muscle and joint dysfunctions (Litovchenko Yu.P. 2019; Kalinichenko Yu.A. 2019; Samoilova N.V. et al. 2019; Shabalina I.M. 2022; Lapina N.V. et al. 2023; Khadzhaeva P.G. 2023).

Physiological occlusion from the standpoint of harmony can only be ensured by ideal dental arches relative to the age of the individual, the shape and three-dimensional dimensions of his teeth, dental arches and their functionally correct relationship (Lebedenko I.Yu. et al. 2019; Maksyukov S.Yu. et al. 2020; Persin L.S. 2020; Ivanova O.P. 2021; Dmitrienko S.V. et al. 2022; Jabri M.A. et al. 2019; Basseti N. 2021).

At the current stage of development of medicine, digital images are acquiring important comparative value in diagnostics, planning and treatment. 3D digital methods of analyzing the size and shape of teeth, dental arches, and their compliance in the form of programs for working with virtual models are gaining popularity (Ryakhovsky A.N. and Boytsova E.A. 2020; Rogatskin D.V. 2021; Saleeva G.T. et al. 2022; Lo Giudice A. et al. 2020; Rao A. et al. 2021).

The success of effective treatment is determined by the condition of correct 3D positioning of the lower jaw in the skull, normalization of intra-articular relationships of the temporomandibular joints (TMJ). The practical capabilities of CAD/CAM systems have made possible digital planning and precision implementation of suprastructures of various materials, fixation methods and purposes (Silin A.V. et al. 2019; Chkhikvadze T.V. 2020; Gabdrafikov R.P. 2021; Gioeva Yu.A. et al. 2021; Basieva E.V. 2022; Sollenius O. et al. 2020; Bellot-Arris C. et al. 2021).

However, the available sources do not yet present schemes for the comprehensive rehabilitation of adult patients taking into account their individual stable 3D cephalometric landmarks, which makes further research work in this area relevant.

The existing level of technology includes a mouthguard for normalizing the occlusion of teeth after orthopedic treatment, which consists in the fact that it is made of a thermoplastic transparent material 1.5 mm thick, tightly adhering to the chewing and palatal surfaces of the upper jaw dentition and, in continuation, to the inner and outer surfaces of the anterior teeth, and on the buccal side of the chewing teeth there are 2 mm high pads, lagging behind the buccal side of the dentition by 0.5-0.7 mm (patent PM RF No. 175108, published 21.11.2017).

The disadvantages of this technical solution are the lack of digital technologies at the planning and manufacturing stage, which leads to a loss of precision in the fit of the structure and, as a consequence, its poor fixation in the patient's oral cavity. Also, the proposed cap does not put the lower jaw in a comfortable position and does not take into account the position of the articular head of the temporomandibular joint, which can lead to complications in the future.

A direct removable denture is known, which consists of a 2 mm thick base and artificial teeth of the dentition, wherein the base is made of transparent thermoplastic by vacuum thermopressing, and its borders are adapted to the tissues of the denture bed by an intraoral method with a light-curing dental polymer, the artificial teeth of the dentition are made of polymer by the method of additive 3D printing technology, wherein the virtual setting of the teeth is carried out in a virtual articulator, and their shape and position are coordinated with the personalized aesthetic features of the patient, the printed dentition is connected to the denture base by means of a light-curing dental polymer ..., with the possibility of repeated use in the same patient on subsequent replaceable bases manufactured by a similar technique at later stages of the postoperative period, up to the formation of the denture bed for final prosthetics, wherein the borders of the removable denture and its valve zone are specified with a light-curing polymer when applying the removable denture in the patient’s oral cavity (RU Patent No. 2709109, published on 16.12.2019).

The disadvantages of this technical solution are the lack of personalized planning of the prosthesis design in the digital articulator, which can lead to frequent breakdowns or the inability to use the prosthesis, as well as intraoral clinical correction of the border of the removable prosthesis and its valve zone with a light-curing polymer, which can lead to an individual allergic reaction upon direct contact with the mucous membrane or to a chemical burn.

The prior art discloses a direct removable dental prosthesis that enables programming of the volume and shape of the alveolar bone for subsequent dental implantation in the area of the performed tooth extraction operation, comprising a base, the shape of which is designed to create, based on previously obtained data from a patient's computed tomography scan in the preoperative period, conditions for the required reduction of the prosthetic bed and/or recreation of additional space in the area of future bone augmentation, and artificial teeth, wherein the prosthesis is made of a monolithic polymer using the additive computer manufacturing method based on the original digital model obtained after intraoral scanning of the patient's own dentition and jaws in the preoperative period, with subsequent individualization of the prosthesis base using the method of deep staining with acrylic dyes (RU Patent No. 2678930, published on 04.02.2019).

The disadvantages of this technical solution are the use of acrylic dyes, which cause an individual allergic reaction upon direct contact with the mucous membrane or to a chemical burn, as well as the presence in some patients of a limitation in opening the mouth of various origins, which can lead to the impossibility of intraoral scanning of their own dentition and jaws.

The closest to the claimed technical solution is a separating postoperative maxillary dentofacial prosthesis for the upper jaw for the formation of a prosthetic bed in the area of the performed operation and the initial effect for epithelialization of the defect boundaries, containing a base, a scar ring former, retention elements and artificial teeth obtained according to the initial model after scanning the patient's own teeth in the preoperative period, while the prosthesis is made monolithically using the computer milling method from a plastic disk (RU Patent No. 2535078, published on 12/10/2014).

The shortcomings of the prototype are eliminated in the declared technical solution.

The task, which the claimed utility model is aimed at solving, is to increase the effectiveness of personalized complex treatment of patients with anomalies in the shape of dental arches with concomitant anomalies in occlusion through the use of digital 3D technologies and CAD/CAM systems.

This problem is solved due to the fact that the claimed removable orthopedic disengaging centering prosthesis consists of two parts, internal and external, wherein the internal part, pre-designed, is made by milling from a multilayer plastic block, it has a thickness of 0.2 to 0.3 mm and embraces the crowns of all teeth from the vestibular, occlusal and oral surfaces; a multi-rope reinforcing wire made of stainless steel is fixed on the internal part; the external part is made by the method of thermal vacuum stamping in a vacuum former from plates made of polyvinyl chloride 1 mm thick with subsequent layer-by-layer application of transparent quick-hardening plastic in an articulator, the removable orthopedic disengaging centering prosthesis can be fixed on the crowns of the teeth of the lower jaw and upper jaw.

The technical result provided by the given set of features is the production of a removable orthopedic disengaging centering prosthesis (ROCCP) for the lower jaw, which ensures the restoration of the spatial position of the lower jaw in the skull with the normalization of intra-articular relationships of the elements of the temporomandibular joints (TMJ) and the creation of tight occlusal contacts, which leads to an increase in the effectiveness of personalized complex treatment of patients with anomalies in the shape of dental arches with concomitant occlusion anomalies and a decrease in the possibility of relapse.

The cause-and-effect relationship between the features of a utility model and the technical result is determined by the following.

Personalized parameters of 3D odonto- and biometric, and stable craniometric landmarks, implemented using extended 3D cephalometry, significantly expand the ability to obtain precise 2D and 3D data on the sizes of crowns of individual teeth, their groups and dental arches, differentiate dental arches into dental and arcade types, determine the depth of the sagittal curve of Spee on the right and left, determine the internal angles of eruption of the third molars, calculate the parameters of the TMJ with elements of the CFO and skull types in vivo.

The obtained 3D biometric parameters of teeth, dental arches, 3D anthropometric and 3D occlusiographic parameters make it possible to develop an effective scheme for the comprehensive rehabilitation of patients with anomalies in the shape of dental arches with concomitant pathological occlusion with complete and incomplete dental arches, including orthopedic and retention stages in the implementation of CAD/CAM systems.

Reliable fixation and stabilization of the device in the oral cavity is achieved through preliminary digital design of the internal part, and the multi-rope reinforcing wire increases the strength of the entire device. A layer of transparent, fast-hardening plastic creates tight occlusal contacts between the prosthesis and the teeth of the upper jaw, and also restores the spatial position of the lower jaw in the skull.

The design of the removable orthopedic disengaging centering prosthesis (ROCCP) is explained in Fig. 1 - detailing of the ROCP and Fig. 2 - view of the finished ROCP on a plaster model.

Detailed description of the device and an example of its practical implementation

The design of the removable orthopedic disengaging centering prosthesis (ROCCP) is illustrated in Fig. 1, where the following are indicated:

1 - the inner part. The design of the inner part is carried out in the EXOCAD automated modeling program, then it is manufactured by milling on a Coritec 350i (Imes-Icore) milling machine from a standard multilayer plastic block. It has a thickness of 0.2 to 0.3 mm;

2 - multi-rope reinforcing wire made of stainless steel is fixed along the clinical equator of the crowns of all teeth from the vestibular side;

3 - outer part. Made from a standard 1 mm thick polyvinyl chloride plate by drawing the inner part in a vacuum former;

4 - a layer of transparent fast-hardening plastic. Applied in an articulator to the outer part of the 3rd layer of transparent fast-hardening plastic with final polishing of the prosthesis;

5 - plaster model of the lower jaw with teeth and installed SORC;

6 - plaster model of the upper jaw.

The inner part 1 embraces the crowns of all teeth from the vestibular, occlusal and oral surfaces. Accurate transfer to the digital space for digital planning and design of the future structure in the EXOCAD automated modeling program for CAD systems was carried out using a laboratory 3D scanner integrated with the Splitex system and is manufactured using the computer milling method. Then the inner part 1 is installed on the working plaster model 5, and along the clinical equator of the crowns of all teeth from the vestibular side, a multi-rope reinforcing wire 2 made of stainless steel is fixed, which is finally fixed by the outer part 3 using the pulling method in a vacuum former. The manufacture of the SORCP is completed by applying a layer of transparent quick-hardening plastic 4 to the outer part 3 and final polishing of the device.

Similar actions are carried out for the upper jaw using plaster model 6.

The manufacturing process of the Removable Orthopedic Disconnecting Centring Prosthesis (ROCPP) includes successive clinical stages of work with the Artex analog articulation system from Amann Girrbach.

Accurate transfer into digital space for digital planning of the internal part of the SORC in the EXOCAD automated modeling program for CAD systems was carried out by obtaining optical impressions with the Medit-i700 intraoral scanner.

The SORC is manufactured using a milling method on a computerized Coritec 350i machine from a standard multilayer plastic block Zubaks. The position of the upper jaw was registered using a face bow, and the central relationship of the jaws was fixed using an individually made wax register. Technical stages of manufacturing personalized SORC:

1. Impressions are taken from the patient using silicone impression material on both jaws.

2. Using a face bow, the position of the upper jaw is fixed relative to the temporomandibular joints.

3. Fixation of the central relationship with an individually made wax register.

4. Accurate transfer into digital space for digital planning and design of the future structure in the EXOCAD automated modeling program for CAD systems using a laboratory 3D scanner.

5. Plastering of working models in the articulator using a wax register.

6. Design of the internal part in the EXOCAD automated modeling program and its production by milling on a Coritec 350i (Imes-Icore) milling machine from a standard multilayer plastic block.

7. Multi-rope reinforcing stainless steel wire is fixed along the clinical equator of the crowns of all teeth from the vestibular side.

8. Pulling the working model in a vacuum former through a 1 mm thick plate.

9. Application of a layer of transparent, quick-hardening plastic to the outer part in an articulator and final polishing of the prosthesis.

The efficiency of the claimed utility model is confirmed by the following clinical example.

Example 1

1. Diagnostic stage

Clinically and during the photo protocol, facial signs characterizing distal occlusion in a state of relative physiological rest were recorded. After collecting complaints, conducting a clinical examination, a medical photo protocol, digital 3D odonto- and biometrics on virtual dynamic 3D jaw reformats, the patient of the 1st main subgroup was diagnosed with "distal occlusion" in the lateral segments (class II, subclass 2) (K 07.20 according to ICD 10), deep incisor occlusion in the anterior segment, limitations of temporomandibular joint movements in the sagittal and transverse planes.

We performed 3D odontometric measurements of the patient S., 23 years old, determined the dental parameters of the arches, determined the normodont type of the upper dental arch with the sum of the medial-distal sizes of the crowns of 14 teeth of 112.03 mm and the microdont type of the lower dental arch with the sum of the medial-distal sizes of the crowns of 14 teeth of 112.03 mm and the microdont type of the lower dental arch with the sum of the medial-distal sizes of the crowns of 14 teeth equal to 102.91 mm.

Conducted virtual constructions of dental arches and determined the types of anomalies of their shapes on virtual diagnostic 3D jaw reformats using an original technique. Conducted 3D biometric measurements of dental arches in transverse, diagonal and sagittal directions, determined the depth of the sagittal occlusal curve Spee on the left and right on virtual diagnostic 3D jaw reformats.

Upon completion of the proposed treatment and diagnostic scheme of complex rehabilitation, carried out in full, the linear and angular 3D biometric parameters of the dental arches registered positive dynamics. The depth of the Spee curve on the left decreased by 1.02 mm, becoming flat, the depth of the Spee curve on the right decreased by 0.54 mm, also becoming flat.

On a diagnostic panoramic reformat of cone-beam computed tomography measuring 13 × 15 cm from extended 3D cephalometry in the position of habitual occlusion, the diagnosis of "distal occlusion" (K 07.20 according to ICD 10) was radiologically confirmed, complete dental arches, distalization of the heads of the lower jaw on both sides, erupted teeth 1.8 and 2.8 with normal 2D-precision angular parameters of more than 90 ° (tooth 1.8 - 126.9 °; tooth 2.8 - 120.5 °), impacted teeth 3.8 and 4.8 with abnormal 2D-precision angular parameters of less than 70 ° (tooth 3.8 - 42 °; tooth 3.8 - 28.2 °) were visualized, these were regarded as unfavorable features of the topical and morphological location in the thickness of the bone tissue and found unfavorable conditions for their eruption: both retained teeth 3.8 and 4.8 were recommended for removal.

To prevent the development of relapse of occlusal pathology, they were removed. At the patient's own discretion, the erupted teeth 1.8 and 2.8 were also removed, which, according to patient S., 23, caused inconvenience when cleaning them.

On the control panoramic CBCT reformat measuring 13 × 15 cm in the position of habitual occlusion after completion of the comprehensive rehabilitation scheme carried out in full, radiologically confirmed the closure in the area of the first molars and canines according to class I, the absence of asymmetry in the area of the central line and disocclusions in the lateral and anterior segments, the physiological position of the heads of the lower jaw on both sides. Erupted teeth 1.8; 2.8 and impacted teeth 3.8 and 4.8 with abnormal 2D-precision internal angular parameters and unfavorable conditions for further eruption were removed.

On the diagnostic 3D semi-reform of the skull, combined from the isolated 3D semi-reform of the skull at the level of the TMJ and the isolated 3D semi-reform of the skull at the level of the antagonist teeth from the extended 3D cephalometry, a digital craniometric analysis of the parameters of the TRG and TMJ on the right and left was performed.

Upon completion of the proposed treatment and diagnostic scheme of complex rehabilitation, positive dynamic changes in the personalized angular craniometric parameters of patient S., 23 years old, were noted.

We determined the precision 2D and 3D parameters of the occlusal compression time of the teeth, the distribution of the occlusal load on each tooth or group, the number and localization of occlusal interferences, the percentage of the maximum value of the compression force and the occlusion balance on both sides according to 3D occlusiography data before and after the completion of the comprehensive rehabilitation scheme carried out on the patient in full.

As a result of completion of the comprehensive rehabilitation of the patient S., 23 years old, carried out in full with the obligatory orthopedic stage of the SORCP, after receiving control 3D occlusionography (T-Scan III, BioPak), the following positive results were recorded in the form of a decrease in the time of occlusal compression of the teeth, the absence of occlusal interferences at the beginning of the closure of the dental arches, so that at maximum compression, visualization of multiple fissure-tubercle contacts between the antagonist teeth of all functional groups occurred. A percentage increase in the maximum value of the compression force of the antagonist teeth and an almost uniform distribution of the occlusion balance on both sides were recorded.

2. Treatment stage

To fix the jaws in the CC position, level the distal shift of the lower jaw, restore control over protrusive and laterotrusive movements of the lower jaw, form tight contacts of occlusal contacts and a new myotatic reflex, orthopedic treatment was carried out with the claimed utility model of the SORCP device with a wearing mode of 22 hours a day for 60 days. The internal part of the SORCP was made by computer milling from a multilayer plastic block with a thickness of 0.2-0.3 mm.

Multi-rope reinforcing wire made of stainless steel is fixed along the clinical equator of the crowns of all teeth from the vestibular side. The outer part of the SORC was made of standard 1 mm plates made of polyvinyl chloride by final thermal vacuum stamping in the vacuum former "Plastvac P7" (Bio-Art, Brazil) with subsequent layer-by-layer application of fast-hardening plastic in the articulator of the "Artex" system (Amann Girrbach, Austria).

Clinical and laboratory stages of manufacturing the SORCP device:

Registration of the position of the upper jaw using the Artex facebow from Amann Girrbach;

scanning of working plaster models in the Identica T500 (Medit) 3D scanner;

digital planning (CAD) of the interior of the SORC using the computer-aided design program for CAD systems EXOCAD;

milling machine Coritec 350i (Imes Icore), vacuum former Plastvac P7;

After 2 months from the beginning of the orthopedic treatment of the SORC, orthodontic treatment was started with fixed vestibular metal SWA appliances with a working slot of .022". In the following 2 months, orthopedic treatment was carried out in combination with orthodontic treatment, and from the 4th month, only orthodontic treatment was carried out with mandatory wearing of intermaxillary rubber tractions according to class II according to the standard protocol. The size of the metal arches was carried out strictly individually, based on the personalized 3D odonto- and biometric features of the dental arches of patient S., 23 years old.

The active period was 16 months, which consisted of 2 months of orthopedic treatment with the SORCP apparatus with fixation on the lower jaw; 2 months of orthopedic treatment with SORCP in combination with orthodontic treatment with SWA NiTi arch .014 on the upper jaw; 2 months of orthodontic treatment with SWA NiTi arch .016 on the upper jaw and SWA NiTi arch .014 on the lower jaw; 2 months of treatment with SWA NiTi arch .016 × 0.16 on the upper jaw and SWA NiTi arch 0.16 on the lower jaw; 2 months of treatment with SWA NiTi arch .016 × 0.22 on the upper jaw and SWA NiTi arch .016 × 0.16 on the lower jaw; 2 months treatment with SWA SS wire .017 x 0.25 on the maxilla and SWA NiTi wire .016 x 0.22 on the mandible; 4 months treatment with SWA SS wire .017 x 0.25 on the maxilla and SWA SS wire .017 x 0.25 on the mandible

3. Retention stage

To maintain the obtained result of orthopedic and orthodontic treatment after 2 sessions of selective grinding of occlusal interferences obtained during 3D occlusiography, achieving dense interdental contacts, closure in the area of the first molars and canines according to class I, coincidence of the central line, physiological position of the heads of the lower jaw on both sides, confirmed by the control panoramic reformat CBCT, non-removable metal retainers were fixed on the teeth of the anterior segment of both dental arches.

The remote one and a half year clinical result of treatment of patient S., 23 years old, with the achievement of 6 keys of physiological occlusion in retention is stable.

The claimed device was used to treat 70 patients with dental arch shape anomalies with concomitant occlusion anomalies. As a result of comprehensive rehabilitation with a mandatory orthopedic stage in the form of wearing a removable orthopedic disengaging centering device, in all 100% of observations, according to data confirmed by the results of digital 3D odonto- and biometrics, abnormal V-shaped, saddle-shaped, triangular, trapezoid and asymmetric shapes of the upper and lower dental arches were eliminated, achieving shapes as close as possible to physiological ones, in the form of a semi-ellipse (upper dental arch) and a parabola (lower dental arch) with complete normalization of all linear and angular biometric parameters of the dental arches. In 97.14 ± 1.99% of observations of the main subgroups, according to data confirmed by digital analysis of OPG from extended 3D cephalometry, closure in the area of the first molars and canines according to Angle's class I, the absence of asymmetry in the area of the central line and disocclusions in the lateral and anterior segments, and the physiological position of the heads of the lower jaw on both sides were radiologically visualized.

In 2.86 ± 1.99% of observations of the main subgroups, digital analysis of OPG from extended 3D cephalometry radiographically visualized distalization of the head of the lower jaw on one side.

In all 100% of observations, craniometric analysis of the TRG and TMJ parameters from extended 3D cephalometry recorded positive dynamics of the interincisal angle parameters formed by the upper and lower incisal angles on both sides that changed with positive dynamics upon completion of personalized complex treatment in full in patients in the main subgroups. Digital and graphic indicators of 3D occlusion parameters showed positive dynamics, which manifested differently in the subgroups in the form of a decrease in the time of occlusal compression of teeth, the absence of occlusal interferences, an increase in the percentage of the maximum value of the compression force and restoration of the occlusion balance on the left and right.

Statistical processing of the obtained data was performed using a personally completed study matrix and the standard SPSS 23.0 for Windows software package. For continuous numerical indicators, an analysis of the distribution and criteria for its compliance with the normal distribution (Kolmogorov-Smirnov criterion) was performed. If the distribution in the group was normal, the data were presented as the arithmetic mean and standard deviation (M ± SD). When comparing two groups by quantitative characteristics, nonparametric criteria were used. The significance of differences between the groups was assessed using the Wilcoxon criterion for two related groups (before and after treatment). Differences were considered statistically significant at p < 0.05.

The main results of the study have been implemented in the educational process of the departments of orthopedic dentistry, therapeutic dentistry, surgical dentistry and maxillofacial surgery of the Federal State Budgetary Educational Institution of Higher Education Stavropol State Medical University of the Ministry of Health of the Russian Federation, the department of dentistry No. 3 of the Federal State Budgetary Educational Institution of Higher Education Sverdlovsk Region Novosibirsk State Medical University of the Ministry of Health of the Russian Federation, the orthopedic department of the State Autonomous Healthcare Institution of the Stavropol Region “City Dental Clinic No. 2” of Stavropol, and the orthopedic department with implantology of the dental clinic of the Federal State Budgetary Educational Institution of Higher Education Sverdlovsk Region Novosibirsk State Medical University of the Ministry of Health of the Russian Federation.

Thus, we have developed and tested a treatment and diagnostic scheme for the complex rehabilitation of patients with anomalies in the shape of dental arches with concomitant pathological occlusion in the implementation of CAD/CAM systems, which contributes to an increase in the clinical effectiveness of treatment, normalization of occlusal and articular relationships, improvement of aesthetics and minimization of the development of relapse of pathology.

Advantages of the method

Due to the use of digital 3D technologies and CAD/CAM systems, the claimed device allows to obtain the following positive results in the form of a decrease in the time of occlusal compression of teeth, the absence of occlusal interferences at the beginning of the closure of the dental arches, multiple fissure-tubercle contacts between antagonist teeth of all functional groups at maximum compression, a percentage increase in the maximum value of the compression force of antagonist teeth and a virtually uniform distribution of the occlusion balance on both sides.

These results allow us to recommend in a wide range of dental and orthopedic practice at the treatment stage before starting treatment of patients with anomalies of the shape of dental arches to carry out orthopedic treatment with the proposed SORCP devices in the implementation of CAD/CAM systems to restore the central relationship of the jaws and normalize the articular relationships of the elements of the temporomandibular joint.

Claims (1)

A removable orthopedic disengaging centering prosthesis characterized by the fact that it consists of two parts - internal and external, wherein the internal part is designed individually for the patient and manufactured by milling from a multilayer plastic block, has a thickness of 0.2-0.3 mm and embraces the crowns of all teeth from the vestibular, occlusal and oral surfaces; a multi-rope reinforcing wire made of stainless steel is fixed to the internal part of the prosthesis; the external part of the prosthesis is manufactured by the method of thermal vacuum stamping by pulling the internal part of the prosthesis with the wire fixed to it through a 1 mm thick polyvinyl chloride plate in a vacuum former, followed by layer-by-layer application of transparent quick-hardening plastic in an articulator.