RU2714947C2 - Method for making an implanted prosthesis for osteointegration of implants with bone repair of alveolar bone - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to orthopedic dentistry, and is intended for use in making an implanted prosthesis for osteointegration of dental implants with bone grafting of the alveolar process. Anatomical prints of alginate mass are prepared with standard perforated spoons from both jaws to planned implantation with bone grafting and with existing defects of dentition of various localization. One set of models of gypsum upper and lower jaws is made. After completion of crystallization, models are accurately opened and cut off. Central occlusion or central relation is determined by means of bite ridges and model is fixed in articulator. Computerized tomogram of the jaws (obtained earlier) is used to define tooth-free sections of the alveolar process for implantation with insufficient bone volume, restoring the corresponding sections on the model and isolating the undercuts using wax. In the area of absent teeth, an area of the alveolar process restored with simulated wax is simulated with artificial teeth, restoring occlusion and interdental contacts. Individual shape of teeth is created, oriented to teeth and antagonists. Boundaries of the future implied prosthesis on the models that depend on the individual anatomical features of the patient, the degree of atrophy of the alveolar processes, the type of mucous membrane and the bridle topography, as well as the planned volume of bone grafting are marked. Tray is made by vacuum thermoforming and cut to previously defined boundaries. After rinsing and drying in area of absent teeth, tray is filled with cold-hardening plastic to necks of previously modeled teeth. Tray with teeth is fixed and applied immediately after the operation in the oral cavity, controlling absence of the contact of the tray with the alveolar process, in the area of which the plastic is made and implants are installed. 7–10 days after the operation, the area of bone grafting is filled in the tray with soft-plastic A-silicone and applied to the patient for temporary wearing for the period of osteointegration.

EFFECT: method enables improving the osteoplastic surgery result with implantation, increasing the long-term effectiveness of prosthetic repair, and also enables avoiding psychoemotional disorders accompanying long-term treatment at the implantation stages.

1 cl, 10 dwg, 1 ex

Description

The invention relates to medicine, namely to orthopedic dentistry, and is intended for the manufacture of an artificial prosthesis for persons at the stages of preparation for the dental implantation operation, its planning and further use of the prosthesis design for the period of osseointegration of the implants and renewal of the bone base, in persons with defective dentition and insufficient bone tissue in the area of the planned implantation, as well as normalization of the height of the lower part of the face and the creation of stable occlusion of the dentition for this period.

One of the urgent problems in orthopedic dentistry is the timely replacement of defects in the dentition and the prevention of their deformations, the optimal preservation of the tissue volume of the prosthetic bed after tooth extraction and the prevention of diseases of the temporomandibular joint. The search for ways to increase the effectiveness of treating patients during the period from tooth extraction to the manufacture of a permanent orthopedic design, as well as methods to reduce bone atrophy, remains one of the most important tasks of orthopedic dentistry. The rapid development of implantation, nanotechnology and bone replacement materials can significantly expand the indications for fixed prosthetics. A prolonged absence of teeth, as well as the early use of removable dentures, leads to a loss in the volume of the bone of the alveolar processes, which requires bone grafting and delayed prosthetics (Karl E. Miesch “Orthopedic treatment based on dental implants”, 2010). The use of removable implant prostheses at the stages of osseointegration has significant limitations, and sometimes it is completely impossible. An important role is played by the cost of such temporary prostheses.

The studies of many authors have made a great contribution to solving the problem of direct prosthetics. Based on the generalization of the clinical experience of many dental scientists, analogues of direct prosthetics are known. This is the technique of B.M. Bynina, G.P. Sosnina, E.I. Gavrilova, and I.M. Oxman, M.N. Shitova (EI Gavrilov, AS Shcherbakov. "Orthopedic dentistry", M., Medicine, 1984, S. 260-262.). However, the manufacture of prostheses using these techniques is very time-consuming; inaccurate fit of the base to the prosthetic bed leads to balancing of the prosthesis and frequent fractures; frequent repairs are required; it is also difficult to remove gypsum teeth from the cell after wax smelting; prostheses are made of acrylic plastics, which have pronounced allergenic properties; the use of such prostheses at the stages of implantation with bone grafting is not possible, since occlusal pressure is transmitted to the alveolar processes where bone grafting is performed.

A known method of manufacturing an artificial prosthesis for replacing defects in the dentition and enhancing chewing efficiency during the period of rehabilitation of the oral cavity and manufacturing a permanent structure for patients with limited mobility in the form of a mouth guard obtained by vacuum stamping with the addition of artificial teeth in the area of defects in the dentition and elastic relocation silicone mass "Soy-Soft" ("GC", USA) (RF patent No. 2486877 dated 2013.07.10, Fedotova A.V. et al.).

However, the known method has the following disadvantages:

- a high probability of error due to the multi-stage manufacturing of the prosthesis, the manufacture of two sets of models;

- relocation of elastic plastic to the master model, which eliminates the possibility of accurately displaying pliability and elasticity in different parts of the oral mucosa and will require additional relocation in the oral cavity and correction of the soft lining, which is associated with certain difficulties due to its elastic properties;

- mismatch of standard teeth from the headset to the individual anatomical shape of the patient's teeth;

- the discrepancy between the position of the teeth on the model and the final mouthpiece, as the fixing of artificial teeth in the mouthpiece of the cold-hardened acrylic plastic “Carbodent” (“Stoma”, Ukraine) to the color of the teeth has a number of disadvantages: inaccurate immersion of artificial teeth due to the uncontrolled thickness of self-hardening plastic , the impossibility of the complete removal of excess material in the internal occlusal surface of the mouth guard, due to the uneven distribution of self-hardening plastic between the mouth guard and standard teeth, they are grazed ix;

- self-hardening cold-curing plastic changes color on the vestibular surface of artificial teeth, manifesting itself in the form of stains and patterns, violates the aesthetic qualities of the artificial prosthesis,

- this method does not take into account the change in the configuration of the alveolar bone after bone grafting and implantation in this area, and accordingly there is no possibility of wearing a mouth guard as a temporary prosthesis until permanent implant prosthetics;

- the impossibility of using the design made by this method as a temporary prosthesis for extended defects of the dentition and performed bone grafting in this area due to the tight contact of the mouth guard with the prosthetic bed and an increase in chewing load transmitted through the mouth guard to the toothless parts of the jaw with osseointegration.

We first proposed a method of manufacturing a direct prosthesis for the period of osseointegration of implants with bone grafting of the alveolar processes in the form of a mouthpiece, which is carried out as follows. Anatomical impressions are obtained with an alginate mass using standard perforated spoons from both jaws prior to the planned implantation with bone grafting and with existing defects of dentitions of various localization. One set of models of the upper and lower jaws is made of gypsum. After crystallization is complete, the models are carefully opened and trimmed. The central occlusion or central ratio is determined using bite rollers and the models are fixed in the articulator. Using the computed tomogram of the jaws (previously obtained), the toothless areas of the alveolar ridge are used to install implants with insufficient bone volume, the corresponding areas are restored on the model and the undercuts are isolated using pink Renfert GEO wax for undercuts. In the area of missing teeth, on the reconstructed modeling wax section of the alveolar ridge, artificial teeth are modeled with Renfert GEO Classic Natural wax, restoring occlusal and interdental contacts. In this case, an individual tooth shape is created, focusing on antagonists standing next to and teeth. The boundaries of the future implant prosthesis are noted on the model, which will depend on the individual anatomical features of the patient, the degree of atrophy of the alveolar processes, the type of mucous membrane and topography of the frenum, as well as the planned volume of bone grafting. The boundaries of the mouth guard will have a gingival part in the area of all teeth: not only removed, but also preserved. Also (and this is of great importance for the redistribution of chewing pressure) the borders will cover the unaffected portions of the alveolar process with implantation and bone grafting, including hard palate. Capa is made by vacuum thermoforming using Easy-vak Gasket plates and cut to previously defined boundaries, the edges are carefully polished. On the upper jaw, the palatine part of the mouthpiece is not trimmed. After washing and drying in the area of missing teeth, the mouthpiece is filled with GC Tempron cold-curing plastic to the necks of previously modeled teeth, while the shape of the teeth in the mouthpiece exactly matches the previously modeled wax teeth. The mouthpiece with teeth is fitted and applied immediately after surgery in the oral cavity, controlling the absence of contact between the mouthpiece and the alveolar process, in the area of which plastic is made and implants are installed. 7-10 days after surgery, consultations of the surgeon and removal of sutures directly in the oral cavity fill the area of bone grafting in the mouth with Mollosil soft plastic A-silicone (Detax, Germany), which has antibacterial properties. Due to this, the chewing pressure from the mouthguard to the implantation area with plastic is more gentle, and the mouthguard itself does not touch this area with its rigid base and edges. Previously, from the inside, in the region of the alveolar ridge and palate, the mouthpiece is coated with the adhesive included in the A-silicone kit, which ensures the durability of the elastic lining. The soft lining is also an excellent insulator of the mucous membrane from possible diffusion of the residual monomer of self-hardening cold-cured plastic, which has allergenic properties. Thus, the patient gets the opportunity to use the implant-prosthesis for the entire period of osseointegration, which not only restores the dentition, splintes the remaining teeth, but also minimizes the pressure transmitted through the prosthesis to the implantation sites with insufficient bone volume.

The method is illustrated in FIG. 1-10.

In FIG. 1 presents the clinical picture in the oral cavity of patient D., who is planning to install implants and bone grafting in the places of dentition defects: 1 - dentition defects in the upper jaw; 2 - alveolar processes in the area of missing teeth, requiring bone grafting for implant placement.

In FIG. 2 presents a scan of a computer tomogram of patient D. with slices in various projections, where: 1 - defects in the dentition in the upper jaw; 2 - alveolar processes in the area of missing teeth, requiring bone grafting for implant placement.

In FIG. 3 presents models gypsum-plated in the mid-anatomical articulator (front view): 1 - defects in the dentition in the upper jaw; 3 - gypsum model of the upper jaw with preserved teeth that limit the defects of the dentition; 4 - gypsum model of the lower jaw with teeth antagonists; 5 - sections of the alveolar ridge, in the area of which bone grafting for implant placement is planned, which are restored on the model with a margin for future bone volume and isolated undercuts, using pink Renfert GEO wax for undercuts.

In FIG. 4 presents a model of the upper jaw (top view): 3 - gypsum model of the upper jaw with preserved teeth, limiting the defects of the dentition; 5 - areas of the alveolar ridge, in the area of which bone grafting is planned for implant placement, which are restored on the model with a margin for future bone volume and isolated undercuts, using pink Renfert GEO wax for undercuts, while the sky and other parts of the prosthetic bed do not are affected.

In FIG. 5 presents a model of the upper jaw (top view): 3 - a plaster model of the upper jaw with preserved teeth that limit the defects of the dentition; 5 - areas of the alveolar ridge, in the area of which bone grafting is planned for implant placement, which are restored on the model with a margin for future bone volume and isolated undercuts, using pink Renfert GEO wax for undercuts, while the sky and other parts of the prosthetic bed do not are affected; 6 - in the area of missing teeth, modeled artificial teeth with Renfert GEO Classic Natural wax, restored occlusal and interdental contacts, taking into account the anatomy of adjacent teeth.

In FIG. 6 shows models gypsum-plated in a mid-anatomical articulator (front view): 3 - a gypsum model of the upper jaw with preserved teeth limiting dentition defects; 4 - gypsum model of the lower jaw with teeth antagonists; 5 - sections of the alveolar ridge, in the area of which bone grafting for implant placement is planned, which are restored on the model with a margin for future bone volume and isolated undercuts, using pink Renfert GEO wax for undercuts; 6 - in the area of missing teeth, modeled artificial teeth with Renfert GEO Classic Natural wax, restored occlusal and interdental contacts, taking into account the anatomy of adjacent teeth.

In FIG. Figure 7 shows a mouthguard (front view): 7 - a mouthguard made by vacuum thermoforming using Easy-vak Gasket plates according to the working model, cut off in accordance with previously defined boundaries; 8 - the inner surface of the mouthpiece, in the area of defects in the dentition, filled with cold-cured plastic; 9 - missing teeth in the mouthpiece are filled with GC Tempron cold-curing plastic to the necks of teeth previously modeled; 10 - the dentition of the mouthpiece, in the area of the remaining teeth, limiting defects.

In FIG. Figure 8 shows the mouthpiece (top view): 8 - the internal surface of the mouthpiece, in the area of defects in the dentition, filled with cold-cured plastic; 10 - the dentition of the mouthpiece, in the area of the remaining teeth, limiting defects; 11 - extended boundaries of the mouthpiece, exciting alveolar processes, existing teeth and palate.

In FIG. Figure 9 shows the re-placement of mouthguards under an occlusal load with A-silicone: 7 - mouthguard made by vacuum thermoforming using Easy-vak Gasket plates according to the working model, cut off in accordance with previously defined boundaries; 9 - missing teeth in the mouthpiece are filled with GC Tempron cold-curing plastic to the necks of teeth previously modeled; 12 - occlusal contact of the mouthpiece with teeth by the antagonists of the lower jaw during its relocation with soft elastic A-silicone.

In FIG. 10 shows a mouth guard that replaces defects in the dentition with a soft elastic lining in the area of bone grafting and implants installed for the period of osseointegration (6 months) (top view): 10 - the mouth of the mouth guard, in the area of the remaining teeth that limit defects; 11 - extended boundaries of the mouthpiece, exciting alveolar processes, existing teeth and palate; 13 - soft-elastic A-silicone Mollosil, filling as a result of relocation, areas of performed bone grafting and implantation of teeth, taking into account the individual characteristics of the mucous membrane and the topography of the prosthetic bed; 14 - sections of the mouthpiece that fit snugly to the prosthetic bed without a soft lining (where bone grafting was not performed), distributing a significant part of the occlusal load.

Clinical example

Patient D., 54 years old, turned to the clinic of orthopedic dentistry with complaints of a partial lack of teeth, an aesthetic defect, and difficulty chewing food.

Past and concomitant diseases according to the patient: hepatitis, tuberculosis, syphilis denies. An allergic history is not burdened. Chronic pancreatitis.

The development of this disease: teeth are removed due to complicated caries. For 12 years, I used fixed bridges in the lateral parts of the upper jaw, a year ago the structures were removed and the teeth were removed, prosthetics were not performed. About 1 month ago, teeth 1.1, 2.2, 2.3 were removed due to exacerbation of chronic granulomatous periodontitis (Fig. 1).

External examination: nasolabial and chin folds are not expressed, slight lowering of the upper lip.

In the oral cavity: the mucous membrane of the upper jaw is pale pink, moderately moist. Teeth 1.2, 2.1, 2.4, 2.5 intact. The mucosa in the area of recently removed 1.1, 2.2, 2.3 is pale pink, painless on palpation.

Diagnosis: K08.1. Partial absence of teeth on the upper jaw - 1st grade, 2nd Kennedy subclass.

The patient agreed on a plan for the treatment of defects in the dentition of the upper jaw using implants (refused to replace the prosthesis with a removable prosthesis). For treatment planning, computed tomography was performed (Fig. 2).

Treatment: After analysis and measurements, computed tomograms were used to identify implant placement sites with preliminary bone grafting. The patient received an implant prosthesis on the upper jaw by thermoforming in the form of a gingival burl. The area of future alveolar ridge plastic surgery on the working model is pre-modeled (Fig. 3, 4), and artificial teeth are modeled in the area of defects in the dentition (Fig. 5, 6). Then these areas in the mouthpiece are filled to the necks of the teeth with GC Tempron cold-cured plastic (Fig. 7, 8). The prosthesis was applied immediately after implantation with plastic surgery of the alveolar ridge. 7-10 days after the operation, the cap is directly filled with a soft plastic A-silicone Mollosil (Detax, Germany), which has antibacterial properties, using direct relocation (Fig. 9, 10). The patient will use this implant prosthesis throughout the entire period of osseointegration, i.e. not less than 6 months.

The restoration of the integrity of the dentition of the upper jaw using a temporary prosthesis for the period of osseointegration of implants and bone grafting of the alveolar processes (according to the present method).

As can be seen from the description and the above example, the proposed method has the following advantages:

1. All laboratory stages are carried out on one set of models, which reduces the stages and improves accuracy;

2. It takes into account the change in the configuration of the alveolar bone after bone grafting and implantation in this area, due to its modeling on models with a margin, prior to the manufacture of the implant prosthesis. The volume and areas of plastic are determined by the analysis of computed tomograms. Due to the isolation of areas of bone grafting of the alveolar bone (wax on the model, and then with elastic A-silicone in the oral cavity) from the mouth guard with artificial teeth, it is possible to wear the mouth guard for a long time as a temporary prosthesis until permanent implant prosthetics;

3. Individual modeling of missing teeth on the model, in the form of preserved teeth, can improve the aesthetic properties of a temporary denture;

4. Complete matching of teeth in the mouthpiece with the modeled ones. Filling the mouthpiece in the area of missing teeth with cold-hardened plastic is carried out to the necks of the teeth, previously modeled on models, which allows achieving uniformity of color and the possibility of choosing it for the color of the remaining teeth, which allows a temporary denture to be almost invisible in the mouth;

5. Immediate prosthesis made by this method can be applied on the day of surgery, since it does not exert pressure on the area of bone grafting and implantation. At the same time, the healing process is accelerated and infection of the surgical field is minimized;

6. The method allows to make a prosthesis restoring occlusal contact of the entire dentition, preventing the development of deformations and disturbances in the temporomandibular joint region, as well as having a splint effect for the remaining teeth for a long period of osseointegration;

7. Relocation is performed in the oral cavity 7-10 days after surgery in the area of the renewed bone base of the alveolar process with soft A-silicone, under occlusal control. This allows you to accurately display the new relief of the bone base and to use compliance and elasticity in various parts of the oral mucosa for better fixation and stabilization. Adaptation to the prostheses made by the proposed methods is much faster and the service life of temporary prostheses is extended;

8. Through the use of a soft-elastic lining made of A-silicone, which covers the inside of artificial teeth, the negative impact of acrylic plastics on the mucous membrane of the oral cavity is minimized;

9. The extension of the prosthesis borders due to the overlapping of the palate, preserved teeth and areas of the alveolar process where bone grafting was not performed can significantly reduce chewing pressure at the implantation sites with bone grafting, which will lead to a satisfactory result of osseointegration and further effective permanent prosthetics;

10. The method is not expensive, easy to use, avoids psycho-emotional disturbances during long-term treatment at the stages of implantation.

Claims (1)

A method of manufacturing an artificial prosthesis for the period of osseointegration of implants with bone grafting of the alveolar processes, including removal of anatomical impressions from the jaws prior to the planned implantation with bone grafting and with existing defects of the dentition of various localization, manufacturing models of the jaws, determining central occlusion and gypsum modeling characterized in that one set of jaw models is made, sections of the alveolar ridge with insufficient with the volume of bone, restore the corresponding sections on the model and isolate the undercuts using wax, model artificial teeth in the area of dentition defects, focusing on the teeth standing next to each other and antagonists, mark the boundaries of the future temporary prosthesis on the model, make a mouthpiece using vacuum thermoforming according to the model, cut the mouthpiece at the previously defined boundaries, fill the area of defects in the dentition to the necks of the teeth with cold-hardened plastic, fit and place the mouthpiece with teeth in the oral cavity Immediately after implantation with bone grafting, 7-10 days after the operation the area fill of bone grafting in doghouse myagkoplastichnym A silicone and applied to the patient for temporary wearing on the period of osseointegration.

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