RU2753796C1 - Method for treatment of patients with generalized pathological abrasion of teeth, combined with the absence of teeth, removable adaptive prostheses - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to orthopedic dentistry, and is intended for use in the treatment of patients with generalized decompensated pathological abrasion of teeth of the II-III degree. Removable adaptive prostheses are made. At the same time, the preparatory stage of the manufacture and wearing of the orthodontic appliance is excluded, which allows the patient to adapt to the new interalviolar height, but creates inconvenience in use. The height of the lower third of the face is measured in a state of relative physiological rest and in a state of habitual occlusion with the calculation of the height of the lower third of the face. Plaster models of the jaws are made, on which plastic teeth are sharpened, to the crown part of worn teeth with their strengthening on the wax composition of the bases covering the alveolar processes of the jaws, plastic teeth are installed to replace dentition defects, fixed on the wax base, followed by the replacement of wax with plastic hot polymerization.

EFFECT: due to the manufacture of adaptive removable prostheses, the method makes it possible to exclude the preparatory stage of manufacturing and wearing the orthodontic apparatus, as well as to improve the psychoemotional state of the patient.

1 cl, 11 dwg, 1 ex

Description

The invention relates to medicine, in particular to dentistry, can be used in the treatment of patients with generalized decompensated pathological abrasion of teeth of the II-III degree.

The relevance is due to the fact that patients with such a pathology, prior to permanent prosthetics, require a long preparatory period, including orthodontic reconstruction and temporary prosthetics, therefore it is important that these long stages of treatment (6-18 months) pass without dysfunctions, aesthetics, social and psycho-emotional discomfort.

In patients with generalized decompensated pathological abrasion, the interalveolar height and the height of the lower third of the face are reduced, which leads to changes in the temporomandibular joints, the occurrence of pain in them, in the ears, and the appearance of headaches.

There are several methods for the preparatory stage of treatment of patients with generalized decompensated pathological abrasion of teeth.

I.S.Rubinov proposes a step-by-step restructuring of the myostatic reflex using removable plastic mouth guards, since non-removable structures that inflate the bite contribute to the introduction of abutment teeth, which further reduces the bite.

According to I.S. Rubinov, each phase of the development of the myostatic reflex to raise the inter-alveolar height should be replaced by a rest phase, equal in time to the phase of the development of the myostatic reflex.

The development of the myostatic reflex and its consolidation takes 30-60 days.

It is possible to raise the interocclusal height by reconstructing the aligners in several stages, depending on the magnitude of its decrease.

(Rubinov I.S. Physiological foundations of dentistry. - Publishing house "Medicine", Leningrad branch, 1970. - p. 13-19, p. 214-221.)

VA Khvatova and SO Chikunov propose to use occlusal splints and "bite plates" in order to relax the masticatory muscles, raise the interocclusal (interalveolar) height, change the position of the heads of the temporomandibular joints.

(Khvatova V.A., Chikunov S.O. Occlusal splints (current state of the problem). - M .: MIG "Medical book", 2012. - pp. 7-43.)

VA Khvatova uses different types of occlusal splints to perform the tasks of the preparatory stage: separating, centering, stabilizing. The type of splint is chosen depending on the clinical picture and the determination of the prevalence of muscle or joint disorders.

Removable occlusal splints, creating a new occlusal surface, correct occlusion, create new jaw ratios, which is a preparation for permanent prosthetics. At the same time, the author points out possible complications when using occlusal splints and ways to eliminate them.

(Khvatova V.A. Clinical gnathology. - M .: JSC "Medicine Publishing House", 2008. - p.209-222.)

I.Yu. Lebedenko et al. To restore the height of the lower part of the face use uncoupling elastic aligners and rigid mandibular positioners, which restore the lost height of the lower part of the face and the central position of the lower jaw.

Uncoupling elastic aligners and rigid mandibular positioners are used by the authors in the first preparatory stage; at the second stage of treatment, temporary prosthetics are performed; at the third stage - permanent prosthetics.

(Prosthetic dentistry: national guidelines / ed. By I.Yu. Lebedenko, S.F. Arutyunov, A.N. Ryakhovsky. - M .: GEOTAR-Media, 2016. - p.202-206.)

The disadvantage of the known methods of the preparatory stage are:

1. Finding a patient in a state of discomfort for a long time (from 6 months to 18 months).

2. Violation of chewing and speech functions during the entire preparatory stage.

3. Violation of aesthetics.

4. Difficulty communicating with people.

5. Difficulties in performing professional duties.

The technical result of the claimed invention is the elimination of the preparatory stage of the manufacture and wearing of the orthodontic apparatus, due to the manufacture of adaptive removable prostheses and the improvement of the psychoemotional state of the patient.

The term "adaptation" (Latin adaptatio - fitting) is used in orthopedics to refer to getting used to prostheses.

The term "adaptive prosthesis" is introduced by us to explain that the devices used are prostheses, but they are used temporarily - to adapt (get used to) the patient to the new position of the lower jaw and the restored interalveolar height.

A method of treating patients with generalized decompensated pathological abrasion of teeth of the II-III degree is proposed, which consists in the manufacture of removable adaptive prostheses.

The difference is that they exclude the preparatory stage of manufacturing and wearing the orthodontic appliance, which allows the patient to adapt to the new interalviolar height, but creates inconvenience in use, measure the height of the lower third of the face in a state of relative physiological rest and in a state of habitual occlusion with an accurate calculation of the height of the lower third persons who make plaster models of the jaws on which standard plastic teeth are ground, to the crown part of worn teeth with their reinforcement on a wax composition of bases covering the alveolar processes of the jaws, standard plastic teeth are installed to replace dentition defects, fixed on a wax base, followed by the replacement of wax with plastic hot polymerization.

The technical result with the help of removable adaptive prostheses makes it possible to provide:

1. Restoration of interalveolar height and height of the lower third of the face.

2. Normalization of the ratios of the elements of the temporomandibular joints.

3. Restoration of the anatomical size and shape of the crowns of worn teeth.

4. Restoration of the occlusal surface of the chewing teeth.

5. Restoration of chewing and speech functions.

6. Restoration of aesthetics.

7. Elimination of inconveniences in communicating with people.

8. Removing obstacles in the performance of professional duties.

9. Elimination of social and psycho-emotional discomfort.

The method of treating patients with generalized decompensated pathological abrasion of teeth of the II-III degree, as mentioned above, includes the manufacture of removable adaptive prostheses.

In this case, the removable adaptive prosthesis performs preparatory and retention functions, i.e. combines two stages of treatment of patients with a similar pathology, while remaining comfortable to use and restoring all anthropological parameters of teeth, dentition, occlusion, elements of the temporomandibular joints.

The comfort of long-term use of the adaptation prosthesis is achieved by the fact that its tooth part is made from standard natural teeth that are attached to the rest of the crowns and create an aesthetic effect of natural teeth, and missing teeth are restored using standard artificial teeth installed in a removable prosthesis.

A removable adaptive prosthesis allows you to raise the interalveolar height with restoration of the height of the lower third of the face at the same time, if the difference between the height of the lower third of the face in the state of relative physiological rest and the height of the lower third of the face in the state of occlusion is 4-5 mm.

With a larger difference, the adaptation prosthesis will require reconstruction in two months.

The number of reconstructions depends on the degree of wear and the amount of decrease in interalveolar height.

The claimed technical solution is illustrated by drawings, in which Fig. 1-11 clinical case with generalized pathological abrasion of teeth of II-III degree combined with the absence of teeth on both jaws, where

fig. 1,2,3 - the state of the dentition in the usual occlusion

fig. 4 - the state of the dentition in a state of relative physiological rest

fig. 5,6,7 - the condition of the dentition with adaptive removable dentures

fig. 8 - lower dentition before orthopedic treatment

fig. 9 - lower dentition with an adaptive removable denture

fig. 10 - upper dentition before orthopedic treatment

fig. 11 - upper dentition with an adaptive removable denture

The causal relationship between the features of the claims and the technical result is as follows.

Removable adaptive prosthesis allows to combine two stages of preliminary treatment of patients with generalized decompensated pathological abrasion of teeth of II-III degree, providing the comfort of long-term treatment:

1) the aesthetic effect of well-preserved natural teeth is created;

2) the anthropological parameters of the teeth, dentition, occlusion, elements of the temporomandibular joints are restored;

3) chewing and speech functions are restored;

4) difficulties in communicating with people and in performing professional duties are eliminated;

5) social and psycho-emotional discomfort is eliminated.

The specified technical result is achieved by the fact that in the treatment of patients with generalized decompensated pathological abrasion of teeth of the II-III degree, removable adaptive prostheses are made.

Adaptive prostheses begin to be manufactured after measuring the height of the lower third of the face in a state of relative physiological rest and in a state of occlusion with the calculation of the amount of decrease in the height of the lower third of the face.

The direct manufacture of adaptive prostheses begins with taking impressions from the upper and lower jaws, casting plaster models, determining the central occlusion with restoration of interalveolar height and X-ray control of the temporomandibular joints.

On plaster models, standard plastic teeth are sharpened to the coronal part of worn teeth with their strengthening on the wax composition of the bases covering the alveolar processes of the jaws, standard plastic teeth are installed to replace defects in the dentition.

Wax bases are replaced with plastic by hot polymerization. Dentures are processed and polished. The finished prostheses are fitted in the oral cavity.

The terms of using adaptive prostheses and the number of their reconstructions depend on the degree of abrasion, the amount of decrease in interalveolar height and, accordingly, the amount of decrease in the lower third of the face.

The patient can be made a removable adaptive prosthesis for one jaw, if there is a generalized abrasion of teeth on one jaw, and two prostheses, if there is a generalized decompensated abrasion of the teeth of the upper and lower jaws.

The claimed method for the treatment of patients with generalized decompensated pathological abrasion of teeth of the II-III degree is as follows:

- the height of the lower third of the face is measured in a state of relative physiological rest and in a state of occlusion with the calculation of the height of the lower third of the face;

- impressions are taken from the upper and lower jaws, plaster models are cast;

- central occlusion is determined with restoration of interalveolar height and position of the lower jaw;

- on plaster models, standard plastic teeth are sharpened to the coronal part of worn teeth with their strengthening on the wax composition of the bases covering the alveolar processes of the jaws, standard plastic teeth are installed to replace defects in the dentition;

- wax bases are replaced with hot polymerized plastic, processed and polished;

- ready-made prostheses are fitted in the oral cavity, the rules of use are explained;

- the terms of use of adaptive prostheses and the number of their reconstructions depends on the degree of tooth wear.

Here is a clinical case.

Clinical case - production of removable adaptive prostheses for the upper and lower jaws.

Patient K., 68 years old, came to the clinic with complaints of missing teeth and erasure of the remaining teeth.

He removed his teeth starting at the age of twenty-five, but never had prosthetics.

On external examination, there is a decrease in the lower third of the face, deepening of the nasolabial and collecting folds, and a decrease in the visible part of the red border of the lips.

Oral examination: missing teeth,

O O O O O O eight 7 6 5 4 3 2 1 1 2 3 4 5 6 7 eight O O O O O O O O O

erasure of all remaining teeth II-III degree, secondary vertical displacement 7 6 I 4 5 6 7 teeth, secondary horizontal displacement I 3 4 teeth (Fig. 1, 2, 3).

Dissociation of the dentition in relative physiological rest in relation to the usual occlusion is 5 mm. (fig. 4). The alveolar processes are not enlarged.

Diagnosis: absence of teeth in the upper and lower jaws, generalized decompensated pathological abrasion of teeth of the II-III degree, secondary vertical and horizontal displacement of the teeth.

Treatment. Removable adaptive plate prostheses were made for the upper and lower jaws (Figs. 5, 6, 7, 8, 9, 10, 11) with an increase in the interalveolar height by 2.5 mm.

These adaptation prostheses were left as permanent with a recommendation to replace them after three years.

Claims (1)

A method of treating patients with generalized decompensated pathological abrasion of teeth of the II-III degree, which consists in the manufacture of removable adaptive prostheses, characterized in that they exclude the preparatory stage of manufacturing and wearing the orthodontic apparatus, which allows the patient to adapt to the new interalviolar height, but creating inconvenience in use, measure the height the lower third of the face in a state of relative physiological rest and in a state of habitual occlusion by calculating the height of the lower third of the face, making plaster models of the jaws, on which plastic teeth are sharpened, to the crown part of worn teeth with their strengthening on the wax composition of the bases covering the alveolar processes of the jaws, set plastic teeth for replacing dentition defects, fixed on a wax base, followed by the replacement of the wax with hot polymerized plastic.

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