RU2701591C1 - Method of impression removal for reconstruction of replacement-occluding prosthesis with extensive defects of hard and soft tissues of upper jaw - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to maxillofacial prosthesis, and is intended for use in taking an impression for reconstruction of a replacement-occluding prosthesis with extensive defects of hard and soft tissues of the upper jaw. Pain syndrome is relieved. After the pain syndrome is removed in the oral cavity together with the pre-existing replacement-absorbing prosthesis, a wax reproduction of the protective-forming vestibular impression surface is performed. Wax reproduction of the protective-forming vestibular surface of the impression is replaced with a hot polymerisation plastic. In the plastic protective-forming vestibular plate, holes are made for better adhesion of the impression material with the individual spoon and its surplus output. Same holes are made on the previously made prosthesis on the side of the removed teeth. Impression is made with alginate material in the bite together with the protective forming plate of the vestibular impression surface and the prosthesis. After impression is cast model together with prosthesis. Missing portion of the alveolar process is formed on the prosthesis model. On the model, the missing teeth are staged on the wax. In the dental laboratory wax is replaced by hot polymerisation plastic. Prepared reconstructed prosthesis is treated and polished.EFFECT: method enables eliminating a possible pain syndrome, taking an impression in an occlusion with a previously made prosthesis for welding of absent teeth and performing a reconstruction of the replacement-occluding prosthesis with extensive defects of hard and soft tissues of the upper jaw in the conditions of a dental laboratory.1 cl, 12 dwg, 1 ex

Description

The invention relates to medicine, namely to maxillofacial prosthetics (orthopedic dentistry), can be used to take an impression to reconstruct a replacement-obstructive prosthesis with extensive defects of hard and soft tissues of the upper jaw.

The relevance is due to the complexity of imprinting in the manufacture of a replacement-obstructing prosthesis with extensive defects of hard and soft tissues of the upper jaw and the difficulty of manufacturing the replacement maxillary dentures themselves.

Replacing dentures (dentures, jaw and facial dentures) are devices for replacing lost tissues and organs with defects in teeth, dentitions, jaws and face.

Replacing dentures include prostheses used after improper adhesion of fragments of the jawbones, after resection of the jaws, injuries and face surgeries, as well as obturators.

Obturators (Latin obturare - to clog, close the exit) - prosthetic devices that eliminate congenital and acquired defects of the palate and isolate (disconnect) the oral and nasal cavities.

(Trezubov V.N. Orthopedic dentistry. Technology of medical and preventive devices: Textbook for students / V.N. Trezubov, L.M. Mishnev, N.Yu. Neznanova, S.B. Fishchev; Ed. N. Russia, Prof. V.N. Trezubova. - M .: MEDpress-inform, 2008. - 320 p.)

Reconstruction of prostheses - change, improvement and addition (artificial teeth, fixators, updating the inner surface of the basis) of dental or jaw prostheses (Trezubov V.N., 2008).

A known method of reconstruction (repair) of a prosthesis made of plastic with the addition of an artificial tooth or clasp using quick-hardening plastic. To set up one or two teeth or transfer the clasp after removing the abutment tooth to an adjacent healthy tooth, it is necessary to obtain an impression together with the prosthesis, as well as an impression from the antagonists. After receiving the models, the clamper is bent onto the tooth and the missing teeth are placed on the wax roller and artificial gum. The model is lowered for several minutes in cold water, then the plaster bed is cast from the vestibular side. After the gypsum has hardened, the bed is removed, the teeth and clasps are cleaned of wax, carefully treated with monomer and molding with self-hardening plastic. After hardening of the plastic, the excess is cut off, the prosthesis is polished and polished.

After repairing the plastic base with the addition of a tooth or clasp, an inaccurate fit of the base to the alveolar process and palatal surface is sometimes found. In such cases, the repair of the plastic prosthesis must be completed by relocation in the mouth with the help of quick-hardening plastic.

(Kopeikin V.N., Knubovets Ya.S., Kurlyandsky V.Yu., Oksman I.M. Denture technology. - Moscow: Medicine, 1978. - 432 p.)

The disadvantage of this method is the presence in the quick-hardening plastic of the residual monomer, which has a toxic effect on the tissue of the prosthetic field.

A known method of repairing prostheses made of plastic using plastic hot polymerization.

(Kopeikin V.N., Knubovets Ya.S., Kurlyandsky V.Yu., Oksman I.M. Denture technology. - Moscow: Medicine, 1978. - 432 p.)

A disadvantage of the known methods is that in all cases (both during cold polymerization and during hot), if necessary, welding the teeth to the prosthesis, it is necessary to remove the impression together with the prosthesis.

Usually, when taking a print together with a previously made prosthesis, standard spoons are used. However, if it is necessary to weld the teeth to the replacement-occlusive prosthesis, it is not always possible to remove the impression with the replacement-occlusive prosthesis with a standard spoon due to poor fixation of the previously made replacement-occlusive prosthesis due to tooth extraction.

In the available literature, we have not seen a way to take an impression together with a replacement-obstructing prosthesis.

The technical result of the claimed invention is the exact restoration of the position of artificial teeth during reconstruction of the maxillofacial prostheses with extensive defects of the hard and soft palate.

The proposed method is used when it is impossible to achieve a result using standard spoons.

A method for impressing for the reconstruction of a replacement-obstructing prosthesis for extensive defects of hard and soft tissues of the upper jaw is proposed, including the removal of pain, the installation of a replacement-obstructing prosthesis in the oral cavity and the production of a wax reproduction of the protective-forming vestibular surface of the impression, which is replaced by hot polymerization plastic , and after taking the impression, the model is cast together with the prosthesis, the missing part of the alveolar process is formed on the model and the post is made replacement of missing teeth, while removing the pain syndrome by applying to the mucous membrane of the mouth over the entire surface of the defect in the application of the Kamistad gel, to restore the missing part of the alveolar bone and welding the artificial teeth to the place of the extracted teeth, the impression in the bite is removed along with the previously made prosthesis, in which holes are made from the side of the extracted teeth, and a protective-forming plastic vestibular impression plate, in which holes are also formed, is then molded Del, on which the prosthesis is reconstructed with the addition of teeth.

Welding of artificial teeth - adding them to a previously made prosthesis using plastic of hot or cold polymerization.

Kamistad gel is a topical dental preparation, the active ingredients of which are lidocaine hydrochloride and chamomile flower extract. Chamomile has an anti-inflammatory and antiseptic effect. Lidocaine provides a local anesthetic effect, contributing to the rapid and lasting reduction of pain during inflammation and damage to the oral mucosa.

(Shumsky A.V. Experience with the use of the drug Kamistad® in patients with infectious-allergic diseases of the oral mucosa with erosive syndrome // Practical Medicine - 2009. - Volume 33 (Dentistry), No. 1. - P. 101-102.)

The present invention allows:

- eliminate a possible pain syndrome when imprinting from the surface of the defect of the maxillofacial region, including at the stage of exacerbation of the process in violation of the integrity of the mucous membrane of the mouth and skin with tissue inflammation;

- remove the impression in the bite with a previously made prosthesis for welding missing teeth;

- reconstruction of the replacement-obstructive prosthesis with extensive defects of hard and soft tissues of the upper jaw in the conditions of a dental laboratory.

The specified technical result is achieved by the fact that in the method of removing the impression for reconstruction of the prosthesis with extensive defects of hard and soft tissues of the upper jaw, a gel with lidocaine is applied to the mucosa before the impression is taken, then (after removal of the pain syndrome) in the oral cavity together with the previously prepared replacement a waxing reproduction of the protective-forming vestibular surface of the impression is made by the obturating prosthesis. The wax is replaced with plastic, and the impression is removed with alginate material in the bite along with the protective-forming plate of the vestibular surface of the impression and the prosthesis.

After taking the impression, the model is cast along with the prosthesis. On the model with the prosthesis, the missing part of the alveolar ridge is formed and the missing teeth are placed on the wax, the wax is replaced with hot polymerization plastic.

The claimed technical solution (its essence) is illustrated by illustrations:

FIG. 1 Extensive defect of the upper jaw and nose, communicating with the nasal cavity.

FIG. 2. A replacement-obstructing prosthesis that eliminates impaired functions.

FIG. 3. Loss of teeth and alveolar process of the upper jaw, due to the progression of the disease.

FIG. 4. The condition of the mucous membranes of the mouth and nose.

FIG. 5. Simulated wax composition of the protective-forming vestibular plate.

FIG. 6. The wax composition of the protective-forming vestibular plate is replaced by plastic.

FIG. 7. View of the protective-forming vestibular plate with the prosthesis.

FIG. 8. Impression in the bite with a prosthesis and a protective-forming vestibular plate.

FIG. 9. Impression in the bite of the prosthetic bed.

FIG. 10. Impression in the bite of teeth-antagonists.

FIG. 11. View of the reconstructed prosthesis.

FIG. 12. Fixation of the reconstructed prosthesis in the oral cavity.

A causal relationship between the features of the claims and the technical result is as follows. With the progression of oncological pathology of the maxillofacial region, the defect increases, some of the teeth can be removed, the integrity of the mucous membranes of the mouth and nose is disturbed, which is accompanied by inflammation and contributes to the appearance of pain. A previously made replacement-obstructing prosthesis does not fulfill its functions and requires reconstruction.

To reconstruct the prosthesis: welding of the extracted teeth, restoring the marginal fit, improving the fixation and stabilization of the prosthesis, restoring the separation of the oral cavity from the nasal cavity and restoring the functions of chewing, swallowing, drinking and speaking, it is necessary to take an impression with the prosthesis.

To relieve pain, a gel with lidocaine is applied to the mucous membrane before the impression is taken. In cases when it is impossible to take an impression with a standard spoon together with the prosthesis for reconstructing the prosthesis, it is necessary to make an individual spoon. For this, in the oral cavity with the previously prepared post-resection prosthesis installed, a wax reproduction of the protective-forming vestibular surface of the impression is made. The wax is replaced with plastic, and the impression is removed with alginate material in the bite along with the protective-forming plate of the vestibular surface of the impression and the prosthesis.

The claimed method is as follows:

- a gel with lidocaine is applied to the mucosa to remove the pain syndrome before the impression is taken

- after removal of pain in the oral cavity, together with the previously installed ready-made replacement-obstructing prosthesis, a wax reproduction of the protective-forming vestibular surface of the impression is made

- wax reproduction of the protective-forming vestibular surface of the print is replaced with plastic of hot polymerization

- holes are made in the plastic protective-forming vestibular plate for better adhesion of the impression material to the individual spoon and the release of its excess

- the same holes are made on a previously made prosthesis from the extracted teeth

- remove the impression with alginate material in the bite along with the protective-forming plate of the vestibular surface of the impression and the prosthesis

- after taking the impression, the model is cast together with the prosthesis

- on the model with a prosthesis, the missing part of the alveolar process is formed

- on the model produce the setting of missing teeth on wax

- in the dental laboratory, wax is replaced with hot polymerization plastic

- they process, polish the finished reconstructed prosthesis.

The reconstructed replacement-obstructing prosthesis made according to the proposed technology is presented in the clinical case. Clinical case.

Patient K., 79 years old, came in September 2016 with complaints of speech impairment, chewing, eating and water, poor fixation of a removable denture.

From the anamnesis it was found out that in 1997 squamous cell carcinoma of the nose was diagnosed, radiation therapy was carried out, complicated by radioepidermitis, which was realized in the ulcer of the mucous membrane of the nasal septum, which is cytologically defined as basalt cell cancer. In 1999, the tumor was excised, cryodestruction was performed. Subsequently, she was repeatedly operated on three times due to the progression of the process, including with plastic elements by local tissues, received radiation therapy (external remote irradiation and interstitial irradiation) and photodynamic therapy (PDT). By 2014, the nasal septum and nasal concha are destroyed by a tumor, there is an ulcer at the base of the nose extending to the lower wall of the nose, the skin of the nose is plastically deformed, and a palate defect has formed. Regional lymph nodes are not palpable. From 2014 to 2016, 2 removable dentures were made.

In 2016, we made a new replacement-obstructing prosthesis that restored the functions of speech, chewing, swallowing, eating and drinking. Fixation and stabilization of a replacement-obstructing prosthesis are good (Fig. 1, 2).

After a year, the patient complained of poor fixation of the prosthesis due to the loss of a large number of teeth. The progression of the disease led to the spread of the process, loss of teeth (with the exception of tooth 1.7) and the alveolar process in the upper jaw. The existing prosthesis ceased to fulfill its functions (Fig. 3).

Violation of the integrity of the mucous membranes of the oral cavity and nose, was accompanied by inflammation and pain (Fig. 4).

A previously manufactured prosthesis was required for reconstruction.

Usually, the manufacture of a new prosthesis is indicated 3-4 months after tooth extraction (remote prosthetics). It is possible to manufacture a new prosthesis immediately after tooth extraction (the nearest prosthesis), but such a prosthesis will be temporary. Due to the fact that after tooth extraction for several months there is an atrophy of the alveolar ridge, the fixation of the prosthesis made shortly after removal worsens.

Therefore, we decided to immediately reconstruct a previously manufactured replacement-obstructive prosthesis.

To weld teeth to the base of a previously made prosthesis, it is necessary to remove the impression with a standard spoon along with the prosthesis. In this situation, this is impossible, because after the loss of a large number of teeth and the progression of the process, fixation of the prosthesis is possible only with clenched teeth. In this case, the functions of the prosthesis are impaired due to violations of the marginal fit.

Violation of the marginal fit of a previously made replacement-obstructing prosthesis is associated not only with tooth extraction and loss of the alveolar process, but also with the progression of the disease. The progression of the disease contributed to the violation of the integrity of the mucous membranes of the oral cavity and nose with the development of inflammation and the appearance of pain.

Therefore, in order to be able to get a complete accurate impression before removing it, it is necessary to reduce inflammation and relieve pain. For this, before taking the impression, the application of the gel with lidocaine (Kamistad gel) was applied on the oral mucosa over the entire surface of the defect for 5 minutes.

After removing the pain syndrome, the impression was taken together with the prosthesis.

To take the impression, an individual protective-forming plate was first made. For its manufacture, the prosthesis was installed in the oral cavity. The teeth were in a closed condition. From the side of the vestibule of the oral cavity, a wax reproduction of the protective-forming vestibular plate was made (Fig. 5).

In the dental laboratory, wax reproduction is a replacement for hot curing plastic. Holes are made in the plastic protective-forming vestibular plate for better adhesion of the impression material to the individual spoon and the release of its excess (Fig. 6).

Similar holes were made on a previously made prosthesis from the extracted teeth (Fig. 7).

In the oral cavity with the old prosthesis installed earlier and the protective-forming plate of the vestibular surface manufactured, the impression was made with an alginate material in the bite (Figs. 8, 9, 10).

The models are cast and the missing teeth are welded to the previously made prosthesis according to the generally accepted technique (Fig. 11).

After reconstruction of the prosthesis, the patient noted an improvement in the fixation of the reconstructed prosthesis, restoration of the function of speech, chewing, swallowing, eating and water (Fig. 12).

Claims (1)

A method of impression taking for reconstruction of a replacement-obstructing prosthesis for extensive defects of hard and soft tissues of the upper jaw, including the removal of pain, the installation of a replacement-obstructing prosthesis in the oral cavity and the production of a wax reproduction of the protective-forming vestibular surface of the impression, which is replaced by hot polymerization plastic, and after taking the impression, the model is cast together with the prosthesis, the missing part of the alveolar bone is formed on the model and teeth, while the removal of pain is carried out by applying to the mucous membrane of the mouth over the entire surface of the defect in the application of the Kamistad gel, to restore the missing part of the alveolar bone and welding the artificial teeth to the place of the extracted teeth, the impression in the bite is removed along with the previously made prosthesis, in which holes from the extracted teeth, and a protective-forming plastic vestibular impression plate, in which holes are also formed, then a model is cast on which Oh, the prosthesis is reconstructed with the addition of teeth.

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