RU2753798C1 - Method for treatment of patients with generalized decompensated pathological abrasion of teeth of 2-3 degrees with intact dentition with 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. 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. The interalveolar height is restored under the X-ray control of the temporomandibular joints. Plaster models of the jaws are made, on which 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, with the subsequent replacement of the wax with hot polymerized plastic.

EFFECT: due to the manufacture of adaptive removable prostheses with the elimination of social and psycho-emotional discomfort during a long preliminary (6-18 months) restructuring of the dentition to the stage of permanent prosthetics, the method makes it possible to combine the stages of preparatory and temporary prosthetics of patients during the treatment of generalized decompensated pathological abrasion of teeth of II-III degrees.

1 cl, 3 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 restructuring 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 interalvellar height should be replaced by a phase of rest, 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 for the manufacture and wearing of the orthodontic apparatus with the elimination of social and psycho-emotional discomfort during a long preliminary (6-18 months) restructuring of the dentition, the need to wear the orthodontic apparatus before the stage of permanent prosthetics.

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 for the treatment of patients with generalized decompensated pathological abrasion of teeth of the II-III degree is proposed, including the manufacture of individual 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 interalveolar 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 grinded, fixed on a wax base, with the subsequent replacement of the wax with hot polymerized plastic.

The proposed method using removable adaptive prostheses allows you 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 includes, as mentioned above, 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 an adaptation prosthesis is achieved by the fact that its tooth part is made from standard artificial teeth, which are attached to the rest of the crowns of natural teeth and create an aesthetic effect of natural teeth.

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 Figs 1-3 are a clinical case with generalized pathological abrasion of teeth of II-III degree on the lower jaw, where

fig. 1 - the state of the dentition in the usual occlusion

fig. 2 - the state of occlusion with an adaptation prosthesis on the lower jaw

fig. 3 - adaptation prosthesis for the lower jaw

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 a wax composition of the bases covering the alveolar processes of the jaws.

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 habitual 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 the worn teeth with their strengthening on the wax composition of the bases covering the alveolar processes of the jaws;

- 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 a removable adaptive prosthesis for the lower jaw.

Patient Ch., 34 years old, came to the clinic for erasing her lower teeth.

On external examination, a decrease in the lower third of the face, a decrease in the visible part of the red border of the lips.

Oral examination:

Erasure of the lower teeth (front III degree, chewing - II degree), in the usual occlusion of the upper anterior teeth completely overlap the lower anterior teeth (Fig. 1). The alveolar processes are not enlarged. The difference between the height of the lower third of the face in relative physiological rest and the usual occlusion is 6 mm.

Diagnosis: Generalized decompensated pathological abrasion of the lower teeth of the II-III degree, secondary distal shift of the lower jaw.

Treatment: Making an adaptive plate prosthesis with subsequent reconstruction (Fig. 2, 3).

Initially, the removable adaptive prosthesis raised the interalveolar height by 2 mm. Two months later, the prosthesis was reconstructed and the interalvular height was raised by another 2 mm.

Replacement of an adaptive prosthesis with a permanent one is possible after restructuring in the temporomandibular joints (after 8-12 months).

Claims (1)

A method of treating patients with generalized decompensated pathological abrasion of teeth of the II-III degree, including the manufacture of individual 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 interalveolar 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 with the calculation of the height of the lower third of the face, restore the interalveolar height under X-ray control of the temporomandibular joints, make plaster models of the jaws, on which plastic teeth are sharpened to the coronal part of the worn teeth with their strengthening on a wax composition of the bases covering the alveolar processes of the jaws, followed by the replacement of the wax with hot polymerized plastic.

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