RU2331387C1 - Method of restoration of group of frontal teeth of upper jaw using reinforcing framework-contour elements when eliminating defects of tooth replacement with metal-ceramic crowns - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to stomatology and can be used for restoration of group of frontal teeth of upper jaw using reinforcing framework-contour elements when eliminating defects of tooth replacement with metal-ceramic crowns. Restoration of crown parts with macrofilled composite material in direction from central incisors to canines is performed. On aproximal surfaces at each crown part, contact sites are formed. Vestibular and oral surfaces of fully restored crown parts are reinforced respectively by means of vestibular and oral framework-contour elements made of metallic gilded framework. Reinforcing framework-comtour elements are fixed by means of macrofilled composite material in vestibular and oral cavities, formed 1 mm off contour of aproximal surfaces and 2 mm off cutting edge.

EFFECT: increased longevity and improved cosmetic properties of restoration when eliminating defects of tooth replacement with metal-ceramic crowns of group of frontal teeth of upper jaw using reinforcing framework-contour elements.

Description

The invention relates to the field of reinforcing dentistry.

The invention is intended to restore the anatomical shape of the group of anterior teeth after removal of ceramic-metal crowns.

The need to replace metal-ceramic crowns arises in the event of the development of complications caused by prosthetic errors.

According to the Guide to Orthopedic Dentistry, ed. V.N.Kopeikina - M .: Medicine, 1993 (pp. 167-173) errors can be formed at any stage of the manufacture and fixation of ceramic-metal crowns. Errors are associated with the need for significant grinding of the hard tissues of the tooth during the formation of the preserved stump under the crown, as well as with the multi-stage and technological complexity of manufacturing these crowns.

The most characteristic errors of prosthetics with ceramic-metal crowns include pinching of the gingival papilla and trauma of the regional periodontal edge of the crown.

In such clinical situations, emergency replacement of crowns helps to prevent the development of irreversible complications associated with damage to the supporting apparatus of the teeth, which according to the mentioned Guidelines cannot be restored by any means.

When chipping the facing coating, ceramic-metal crowns also need replacing them, since according to the Guide, there are currently no effective methods for intraoral repair of chips covering crowns.

However, after removal of the ceramic-metal crowns, a dentition defect is formed in which the chewing function, speech and appearance of the patient are impaired. The latter circumstance negatively affects the well-being of patients. For certain types of public professions, a violation of the integrity of the anterior upper dentition may lead to a temporary cessation of the patient's work.

In this regard, it becomes clear the patient’s desire to fill up the resulting dentition defect as soon as possible.

At the same time, from dental practice it follows that after removal of crowns, immediate restoration of the dentition by traditional methods is usually impossible.

In the absence of contraindications for repeated prosthetics with artificial crowns, the period for restoring the integrity of the dentition will be determined by the duration of the technology for manufacturing new crowns.

If surgical intervention is necessary, for example, with the development of pathological processes in the periodontium, repeated prosthetics with crowns is possible as the surgical wound heals.

Removing ceramic-metal crowns is usually fraught with certain difficulties (see the aforementioned Manual p. 173), which can lead to the weakening and inability to subsequently use the preserved natural stump of teeth as a support for new crowns.

The claimed invention was created with the aim of restoring the integrity of the upper dentition directly in the oral cavity. The restoration of the crown parts of the group of upper front teeth of the claimed method begin immediately after removing the ceramic-metal crowns, regardless of the clinical condition of the preserved natural stump of teeth and the condition of the regional periodontal.

In this case, a complex task is solved, aimed at:

- to strengthen the preserved natural stump of teeth;

- to increase the accuracy of the embedded group of restored teeth in the dental arch of the upper row;

- to increase the strength and durability of the crown part of each restored tooth;

- to increase the efforts of their mutual retention of restored teeth in the restored dentition;

- to ensure a tight fit of the gingival margin to the necks of the restored teeth.

The method of restoration of the group of anterior teeth is implemented using composite materials and a gilded metal dental mesh.

The prior art method of re-restoration of the front tooth (canine) by the method of reinforcing dentistry (application No. 2004139010, publ. 05.04.2006) using composite materials and a gold-plated metal dental mesh. When implementing the known method, the preserved natural tooth stump is strengthened with the help of a mesh-stump frame. The frame is pre-formed from a mesh in accordance with the surface shape of the stump and fixed on the stump with emphasis in the groove, which is performed around the stump at the level of the gums. And then on the reinforced stump using the composite material restore the anatomical shape of the crown of the tooth.

However, the known method of restoration of a single canine is not shown in case of a defect in the group of anterior teeth.

In the case of the development of hard tissue necrosis in the cervical part of the teeth, which is one of the most common defects in prosthetics, the use of the well-known mesh-stump framework for reinforcing the preserved stump and in the whole restored crown part of the tooth is impossible due to the impossibility of forming a groove under its support.

In case of destruction of the group of anterior teeth, the known method is not applicable, since it does not take into account the features caused by the extent of the defect of the dentition. The restoration in a known manner individually of each tooth from the group of damaged teeth can lead to a mutual displacement of the restored coronal parts of the teeth, and hence the error in the formation of the dental arch.

The claimed method of restoration of the group of anterior teeth for defects in prosthetics with metal-ceramic crowns was developed taking into account the specifics of the clinical situation.

Given the extent of the defect of the upper dentition in order to increase the accuracy of the formation of the arch on the defect during the implementation of the claimed method, a preliminary complete restoration of the crown parts of all the front teeth with composite materials is carried out. Crown parts are restored immediately after removal of the crowns and gingivectomy of the inflamed gum tissue in the area of the defect. The front teeth of the same name are restored in pairs in a symmetrical order in the direction from the central incisor to the canine.

Preliminary restoration of all anterior teeth and its sequence allows us to verify the size of the restored crown parts, as well as the inter-occlusal relationship of the restored teeth with antagonists.

In order to enhance the mutual retention of the restored anterior teeth, instead of the traditional contact points during restoration at the crown parts, contact pads are formed. Contact pads form in the continuation of the approximate surfaces in the direction from the location of the natural contact points in the direction of the palatine tubercles. Contact pads perform the function of a kind of composite splinting agent, which provides increased stability of the restored teeth in the dentition.

After complete restoration of the crown parts of the front teeth, they begin to be reinforced with the help of the vestibular and oral mesh-contour elements made of gilded metal dental mesh.

Reinforcing mesh-contour elements are placed and fixed in contour cavities formed respectively from the side of the oral and vestibular surfaces of each restored tooth, and then the crown parts of the teeth are restored finally.

The use of reinforcing grid-contour elements provides:

full reinforcement of the corresponding surfaces of the crown of the restored teeth, which in turn increases the durability of the restoration ;.

high esthetics of restoration due to the optical properties of the gilded mesh;

interlocking adhesion with composite materials due to the mesh structure of the reinforcing elements, which in turn reduces the likelihood of restoration chips.

Double reinforcement of the surface of the crown parts of the restored teeth enhances their flexural strength, and strengthens the preserved natural stump of each restored front tooth. Reinforcing mesh-contour elements in combination with a stump form a monolithic block "solid tissue stump - composite restoration material".

In order to ensure a tight fit of the gingival margin to the necks of the restored teeth of the claimed method involves the restoration of the crown parts immediately after the gingivectomy of the injured tissues of the regional periodontium throughout the defect. In contrast to the traditional approach of repeated prosthetics of teeth only after healing of the gum tissue with the claimed sequence of operations, the gum tissue in the healing process tightly covers the surfaces of the fully restored coronal parts of the front teeth.

The specified difference of the claimed method improves the quality of restoration, its aesthetics, eliminates the re-development of complications caused by injured periodontal tissues.

Thus, the technical result achieved by the implementation of the claimed method is to reduce the recovery time of the upper dentition with a defect in prosthetics of the patient’s front teeth, ensuring the long-term functioning of the restored upper front teeth and a high restoration aesthetics.

SUMMARY OF THE INVENTION

The inventive method involves a preliminary x-ray examination of a group of previously prosthetized anterior teeth in the event of a defect in prosthetics with ceramic-metal crowns.

An X-ray examination is necessary to determine the clinical condition of the anterior teeth in the area of a prosthetic defect, in particular, to identify depulled teeth and assess the need for repeated endodontic intervention after removal of the ceramic-metal crowns.

X-ray examination allows you to draw up a plan and make a prediction of the subsequent restoration of the group of front teeth by reinforcing before removing the crowns.

After an X-ray examination is carried out mechanically, toothbrushes using toothpastes clean the surface of the lateral groups of teeth and determine the color of the restoration according to the generally accepted VITA scale.

Then proceed to the removal of ceramic-metal crowns. In order to prevent damage to the natural stump in the teeth, the crowns are pre-cut.

After removing the ceramic-metal crowns, depending on the clinical situation, an endodontic intervention is performed. The root canals of the restored teeth should be sealed to the apex and should not have periapical changes.

Next, a gingivectomy of the inflamed gum tissue is performed during the defect. After gingivectomy, access to the subgingival part of the group of front teeth of the upper jaw is opened.

After a gingivectomy, they begin to remove the demineralized tissue on the cult and subgingival parts of the teeth and at the same time to form retention points with a depth of 0.2-0.3 mm using a spherical boron with a diameter of 0.5 mm. After the formation of the retention points proceed to the restoration of the crown part of the front teeth.

The restoration of the front teeth is carried out symmetrically in pairs in the direction from the central incisors to the fangs.

Initially, the central incisors are being restored. For this, the surfaces of the preserved cult parts of the central incisors with formed retention points are etched with acid.

After 15 seconds, the etched surfaces are thoroughly washed off with water while the saliva ejector is running and dried with air. An adhesive is applied to the etched surfaces, slightly blown with air for even distribution, polymerized by the standard method according to the instructions.

The restoration of the crown parts of the central incisors with composite materials begins from the subgingival part of the stump in the direction of the cutting edge. First, the subgingival, and then the cervical part is restored with the use of macrophilic composite material of yellow or brown color, depending on the clinical situation.

Then proceed to the restoration of the vestibular surface of the tooth. First, the middle third of the crown part is restored, and then the cutting edge is applied using macrophilic composite material of the main color of restoration.

After the restoration of the vestibular surface, restoration of the oral surface is started using macrophilic composite material.

When forming the oral surface of the coronal part at the central incisors, pronounced contact pads are formed on the side of the approximate surfaces.

As is known, (see V.N. Tregubov et al., “Orthopedic Dentistry”, St. Petersburg, VOLIANT, 2002, p. 36), in contrast to the teeth of the lower jaw, in which a stable interaction is ensured due to the fact that contact the surfaces of adjacent teeth converge (approach) in the lingual side, the upper teeth are devoid of such factors of mutual support. In the upper teeth, the contact surfaces are parallel, since the vestibular and oral surfaces of their crown part are almost the same width. For this reason, stability conditions in upper teeth are less favorable. The formation of contact pads during restoration of the upper dentition allows you to strengthen the mutual retention of the restored teeth and provides the most favorable conditions for their stability in the dentition.

Contact pads are formed on the approximate surfaces of the coronal part of each tooth in the direction from the location of the natural contact points to the oral side. The formed contact pads have the shape of a triangle, the base of which is located closer to the neck of the central incisor, and the top of the triangle is closer to the cutting edge. Moreover, the height of the formed triangle is within the length of the location of the contact points, and the width of the base of the triangle does not go beyond the contour of the dental tubercle in the medial norm. The formed contact pads are located in the plane of the approximate surfaces.

After each stage of formation of the crown, polymerization is carried out in accordance with the instructions.

Then, the lateral incisors and fangs are respectively restored in a similar manner.

After restoration of the front teeth, they begin to form a transparent surface of the cutting edges of the restored front teeth.

To this end, rectangular cavities are formed on the side of the oral surface in each of the restored teeth, 0.5 mm indent. from approximate surfaces and from the cutting edge of the crown.

Cavities form 1/3 of the length of the coronal part, depth to the level of the inner enamel layer of the vestibular surface.

Adhesive treatment of the formed cavities and polymerization of the surfaces of the formed cavities are carried out, then the cavities are filled with a thin layer of a transparent hybrid composite. Polymerization is carried out on the side of the vestibular, and then the oral surface. Further, the cavities are filled layer by layer with macrophilic composite material and the oral surface of the crown of the front teeth is finally restored. Perform occlusal editing. In this way, transparent surfaces of the cutting edges of the restored front teeth are formed.

Considering the fact that when restoring a large volume of defects in the crown of the teeth only with the use of composite material, the functioning of the composite restoration is not ensured, after the complete restoration of the crown parts of all the front teeth in the area of the defect with the composite material, they begin to reinforce the crown parts from the side on the oral and vestibular surfaces .

For this, on the coronal part of each tooth from the side of the oral and vestibular surfaces, respectively, the oral and vestibular contour cavities are formed.

When forming contour cavities from the side of the oral surfaces, they retreat 1 mm from the contour of the approximate surfaces of the crown and 2 mm from the edge of the cutting edge. Cavities form a depth to the level of hard tissues of a preserved tooth stump. After the formation of oral contour cavities, the coronal parts are reinforced from the side of the oral surface. For this, reinforcing mesh-contour elements are made of gold-plated metal dental mesh 0.4 mm thick.

The gold-plated metal mesh is pre-flattened to a thickness of 0.2 mm. Next, reinforcing elements are cut out from the flattened mesh in accordance with the dimensions of the formed oral contour cavities. The reinforcing grid-contour elements are tested and corrected, which should be placed without stress in the corresponding oral cavities. After fitting and correction, the reinforcing mesh-contour elements are fixed in the oral contour cavities in the order of restoration of the crown parts of the front teeth.

First, the oral cavities of the central incisors are treated with adhesive, polymerized and filled with macrophilic composite material. Corresponding reinforcing grid-contour elements are installed in the formed cavity. Using a plug-in, mesh-contour elements are pressed to the bottom of the cavity. With this pressure of the plugs on the reinforcing element, the excess composite material goes out through the mesh cells. Next, the plugger is removed. The reinforcing mesh-contour element pressed by the plugger is held in the cavity in the medium of the composite material. The polymerization is carried out first of the vestibular surface, and then the oral surface of the coronal part. After polymerization using macrophilic composite material, the final restoration of the oral surfaces of the crown parts of the central incisors is carried out. Similarly, the coronal parts of the lateral incisors and canines are reinforced from the side of the oral surface.

After reinforcing oral surfaces, occlusal editing is performed. Further, according to the same scheme, the coronal parts of the front teeth are reinforced from the side of the vestibular surface. The fundamental difference when reinforcing the vestibular surface of the crown of the anterior teeth is that after fixing the reinforcing mesh-contour elements, the final restoration of the vestibular surfaces is carried out taking into account the aesthetic features of the anterior teeth. For this, during the restoration of the cervical, middle part and cutting edge of the crown part, macrophilic composite materials of appropriate shades are used. After the final restoration of the crown parts, they begin grinding and polishing. The approximate surfaces of the crown parts are treated with strips.

Thus, after removing the ceramic-metal crowns, the claimed method of restoration of the crown part of the front teeth of the upper jaw using composite materials and reinforcing mesh-contour oral and vestibular elements can significantly reduce the time to repair a dentition defect compared to traditional repeated prosthetics with artificial crowns, while ensuring durability functioning of restored teeth and high esthetics of restoration.

Claims (1)

The method of restoration of the group of anterior teeth of the upper jaw using reinforcing mesh-contour elements while eliminating prosthetic defects with ceramic-metal crowns, including gingivectomy of inflamed tissues throughout the defect after removal of the ceramic-metal crowns, removal of demineralized tissue from the surface of preserved stumps and subgingival parts of the anterior teeth with formation of retention points , restoration of coronal parts by macrophilic composite material from the center incisors to fangs, forming on the proximal surfaces at each crown part of the contact pads, reinforcing the vestibular and oral surfaces of the completely restored crown parts using the vestibular and oral mesh-contour elements, respectively, while the mesh-contour elements are made of a gold-plated metal mesh with a thickness of 0, 4 mm, additionally tapered to a thickness of 0.2 mm, the reinforcing mesh-contour elements are fixed using a macro profiled composite material and in the vestibular and oral cavities formed 1 mm from the contour of the approximate surfaces and 2 mm from the edge of the cutting edge, the cavities are formed at the level of the hard tissues of the preserved tooth stumps, and at first the coronal parts are reinforced from the side of the vestibular surface, and then from the side the oral surface, the mesh-contour elements are fixed in the contour cavities in the order of priority of restoration of the crown parts, after fixing the reinforcing mesh-contour elements, the crown parts of the teeth are restored They are finally formed using a macro profiled composite material.