EA045576B1 - METHOD FOR MANUFACTURING FUNCTIONAL AND AESTHETIC REMOVABLE DENTURES - Google Patents

Description

The invention relates to the field of medicine, namely to orthopedic dentistry, and can be used for the manufacture of dentures for complete loss of teeth, as well as for the manufacture of removable or conditionally removable structures supported by implants.

The traditional method of manufacturing complete removable dentures includes the following steps: obtaining anatomical impressions from the upper and lower jaws and plaster models; production of individual trays, with the help of which functional impressions are obtained; wax templates are created on models obtained from these impressions to determine the central ratio. Next comes the stage of designing the dentition. The most popular in our country is the method of setting teeth on glass, developed by M.E. Vasiliev. The design of the prosthesis is checked in the oral cavity. At this stage, the doctor evaluates the correspondence of the shape and color of the artificial teeth, the location relative to the soft tissues and each other, and, if necessary, makes corrections. The final stage: plastering wax bases with artificial teeth into a ditch, melting the wax and pressing the plastic (Kopeikin V.N. Guide to Orthopedic Dentistry, M., 1998).

The disadvantages of the method include the frequent need to correct the design of the prosthesis, since the technician places artificial teeth blindly, without seeing the patient’s face. In addition, the individual asymmetry of the dental system is not taken into account.

Other methods for manufacturing complete removable dentures represent only modifications of individual stages of the known method - setting teeth on spherical surfaces, on individual occlusal curves, on three standard setting plates, functional impressions under chewing pressure, the use of two-layer bases, etc. There is a known method for manufacturing a prosthesis from photopolymerizing plastic.

First, a bilateral impression of the upper and lower jaw is obtained and scanned with a three-dimensional laser scanner. Then a digital model of the prosthesis is obtained using the database. Based on the obtained digital data, special transparent shells are made on a lithographic machine for the base of the prosthesis and the dentition; plastic of the color of the gums and teeth is placed in them, respectively, and photopolymerized. The method was proposed by Maeda Y. et al. (Japan) and published in The International journal of Prosthodontics 1994, 7 (1), p. 17-21.

However, the method has not found wide practical application, and the computer-aided design technique is not specified in the study.

From SU 1741790, 06.23.1992, a method for manufacturing a removable denture is known, which includes taking an impression, making a model and an individual impression tray, determining the central occlusion, obtaining a functional sucking impression, casting a model, installing it in an occluder, installing artificial teeth, wax modeling, base of the prosthesis and replacement of wax with plastic. A feature of the proposed technology is that when modeling the wax base of the prosthesis, a thin wax layer is applied to the vestibular slope of the alveolar process, and after replacing the plastic wax, a wax layer is applied to it. A long-acting impression material is applied to the vestibular side of the plastic prosthesis, an individual functional impression is obtained, after which the impression material is replaced with plastic.

From RU 2400179, 09.27.2010, a method for manufacturing a complete removable denture using virtual modeling is known, which consists in taking an anatomical impression of the prosthetic bed of a toothless jaw, according to which a model is cast from plaster, an individual tray with a bite ridge is made on the model from quick-hardening plastic, in the oral cavity, the central relationship is determined with the formation of the occlusal surface of the bite ridge, landmarks of the midline and canines are noted on the vestibular surface, which will serve as reference points during scanning, then a functional impression of the toothless jaw is obtained using the same individual spoon, the face of a smiling patient is scanned with bite roller in the oral cavity, thereby obtaining a virtual model of the face, the resulting functional impression is scanned: the prosthetic bed, the vestibular surface of the roller, the occlusal surface of the roller, a model of the toothless jaw is cast from plaster using the functional impression, plaster is cast into a cuvette for polymerization of the plastic, thus obtaining the first half of the mold, the first half of the mold is scanned, the data obtained during scanning is collected in virtual space, forming a complex virtual model of the dental system involved in prosthetics: the virtual occlusal surface obtained by scanning the occlusal surface of the roller (antagonist prints) serves a guide for virtual setting of lateral teeth; a virtual model of the prosthetic bed, obtained by scanning a functional impression, serves as a guide for modeling the boundaries of the prosthesis base and determining the location of the interalveolar lines necessary for setting the lateral teeth; the vestibular surface of the roller and the marked reference points, as well as a virtual model of the patient’s smiling face, serve as a guide for the virtual setting of the anterior teeth; carry out the selection and virtual placement of teeth using an electronic database of various forms of artificial teeth, mark the boundaries of the prosthetic base on a virtual model of the prosthetic bed, then model the outer surface of the base in accordance with its selected boundary and previously modeled virtual

- 1 045576 dentition, a three-dimensional virtual model of a toothless jaw, placed in the first half of the cuvette, is compared with a virtually modeled prosthesis, the second half of the mold is designed: the external contours are modeled, compared with the first half, the internal contours of the second half are obtained by subtracting from it volume of the external contour of the virtual model of the prosthesis, the thus obtained half of the virtual mold is transferred to a physical model, artificial teeth are inserted into the corresponding sockets of the mold, the halves of the mold are compared and filled with plastic. The following steps correspond to traditional laboratory steps. The invention makes it possible to evaluate the correctness of the placement of artificial teeth in relation to facial features and coordinate them with the wishes of the patient.

The disadvantage of this known method is the lack of accuracy in the manufacture of removable dentures and the aesthetic quality of the prosthesis.

From the monograph Zhulev E.N. Partial removable dentures (theory, clinic) and laboratory equipment. Novgorod: Publishing House of the Novosibirsk State Medical Academy, 2000. - 428 p.) there is a known method of taking impressions with an individual tray for prosthetics with orthopedic structures, including creating a model of an individual tray based on an anatomical cast from the working jaw with marking the boundaries of the individual tray on the model and isolating the undercut with wax , making a model of an individual tray along the designated boundaries and subsequent polymerization, installing the tray in the oral cavity and taking an impression. The known method is as follows.

A rough (anatomical) impression is made using a standard tray using alginate impression material. On the impression model, the doctor outlines the boundaries of a separate tray. They pass through the transitional fold, bypassing the frenulum of the tongue, lips and buccal-alveolar cords of the mucous membrane. In this case, there are three possible options for edging the tray into natural teeth.

In the first option, the edge of the spoon is located on the lingual side, slightly above the neck of the teeth on the lower jaw and lower on the upper jaw; with a pronounced equator or inclination of the teeth to the lingual or palatal side, its use will be difficult. In the second option, the edge of the spoon is located on the cutting or chewing surfaces of the teeth or completely covers them, when the remaining teeth in the oral cavity have low clinical crowns or are tilted towards the labial or buccal side. In the third option, the spoon, completely covering the teeth, moves to the vestibular surface of the alveolar process and reaches the transitional fold.

A rigid individual spoon is made from the first layer of wax or from polystyrene plates using a thermal vacuum apparatus. Before this, the teeth on the plaster model are pre-coated with a 2-3 mm thick layer of plaster to create a space that is filled with impression material. For the same purpose, you can make a spoon on the second layer of base wax, when it also does not fit on natural teeth. The chewing surface of the teeth is completely covered with the material from which the spoon is made.

The prepared individual spoon is carefully placed into the oral cavity. To do this, at the first stage, the boundaries of the tray are visually checked, in which the doctor pulls out the transitional fold along the entire prosthetic bed using a dental mirror. The edge of the spoon, resting on the hood of the transitional fold, is rubbed until the spoon moves under the pressure of the moving mucous membrane. The same technique is used when checking spoons in the area of the frenulum and buccal-alveolar cords. The lingual edge of the individual tray of the lower jaw overlaps the internal oblique lines if they are weakly expressed. If their ridges are sharp, they should not be covered with a spoon. Mucous tubercles always overlap the distal edge of the spoon. The disadvantages of this method include the fact that the doctor has to apply constant equal pressure on the individual spoon until the hardening layer hardens, which is quite difficult. Inevitably, the pressure either increases or decreases, affecting the accuracy of the resulting print.

There may also be minimal lateral movements that can create stress in the impression material, causing it to deform.

From RU 2458654 08/20/2012 a method of taking impressions using an individual tray for prosthetics with orthopedic structures is known. An impression is taken of both parts of the jaw while simultaneously registering the central bite. A model of an individual tray was made, for which the boundaries were marked on a plaster model, and the prepared undercuts of the teeth and dentition were insulated with wax stumps. The nylon mesh is cut out and laid on the chewing surface and cutting edges of the teeth in places where they are closed by antagonists. In places of included or end defects, light-polymerized plastic is placed in excess in a plastic state. An individual tray is formed, repeating the shape of the stumps of the prepared teeth and the tissues of the prosthetic bed, the edges of the nylon mesh are fastened to its sides. The articulator is closed to obtain impressions of the dentition in the area of preparation or missing teeth. The model with the spoon is removed from the articulator and placed in a light curing chamber. After polymerization, the spoon is removed from the chamber. Appliance in the oral cavity, correction of closure in the central bite area is carried out until tight closure is achieved with antagonist teeth. An impression is taken in the position of central occlusion under chewing pressure.

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The method is quite complicated and does not provide the necessary increased precision in the manufacture of a removable denture and the required 100% aesthetic result.

The technical objective of the claimed invention and the achieved technical result is to improve the quality of the prosthesis with complete loss of teeth by improving aesthetics and chewing function.

The stated technical problem and the specified technical result are achieved by the method of manufacturing functional and aesthetic removable dentures declared as an invention, which includes the implementation of the following set of sequentially alternating clinical laboratory (clinical) medical and dental technical stages:

examination and examination of the patient, preparation for treatment, preparation for prosthetics and diagnosis based on the results of the examination, treatment planning, implementation of the following clinical medical and dental stages of manufacturing removable dentures, including the first medical stage, including:

selection of Schreinemakers impression trays, installation of stop stops, determination and marking of the transition boundary of the hard and soft palate - line-A, taking double alginate impressions or taking A-silicone impressions (base mass soft (soft), corrective mass (non-hydrophilic and non-thixotropic), or taking impressions with a polyester mass, and additionally, a corrective mass from a special device (dispenser) is applied along the transitional fold of the upper or lower jaw, along the palate, in the sublingual space, on the prosthetic bed; when taking impressions with any selected masses, functional tests are carried out, while the impression from the lower jaw is taken with the mouth closed and when the impression tray is inserted, the tongue must be raised, and the patient sits on a chair with a hand rest to maintain body posture;

the spoon is brought into the oral cavity and the impression is taken without pressure, while when bringing in the impression tray, the tongue must be raised, the patient sits on a chair with a hand rest, which is important for maintaining body posture, after taking an impression with any masses from the upper jaw, the doctor will follow the transition line from the hard palate to the soft palate, he corrects the impression by removing (trimming) excess mass with a scalpel and thereby marking a clear boundary for the transition of the hard palate into the soft palate to the dental technician, after which the taken impressions are disinfected and transferred to the dental laboratory;

using a papillameter instrument, the doctor determines the height of the upper lip, then the first dental stage is carried out, including edging the boundaries of the impressions before casting them to preserve the working area and casting model impressions with superplaster, making an individual volume tray on a rigid base with prototypes of teeth, and the height of the teeth is set based on the height determined by a papillameter, the width of the teeth is determined using model analysis and checked using a laser-static tool, and using a rim shaper tool, the dentition is given a clear direction of the occlusal plane;

after polymerization (hardening), individual spoons must be sandblasted;

the second medical stage, including:

fitting each individual spoon to the oral cavity so that the spoon does not put pressure on the patient anywhere and that the attachment points of the frenulum of the tongue and upper lip, mucous cords and pterygomaxillary folds are sufficiently cleared;

edging the boundaries of the upper individual tray using special silicone or thermoplastic masses, using the following functional tests for the upper jaw:

wide opening of the mouth, retraction of the cheeks, stretching of the lips as when pronouncing the sound i, stretching the lips with a tube as when pronouncing the sound u, movement of the lower jaw left and right, pronounces a drawn-out sound a, the patient exhales deeply, then inhales air through the nose and the doctor sharply pinches the nose (drain), and the doctor checks for the presence of a marginal closing valve, if necessary, applying special silicone or thermoplastic masses, and repeating these tests; and then the doctor makes small-diameter holes on an individual tray for degassing and better fluidity of the corrective mass along line A, in the area of the palatine folds, incisive papilla, and in places of undercuts;

to prevent squeezing (compression), the doctor places stop stops in the amount of 4-6 pieces,

- 3 045576 wherein the stop stops are placed in the place of dense bone, takes an impression of the prosthetic bed of the upper jaw with a non-hydrophilic and non-thixotropic corrective mass A-silicone or a polyester mass, while carrying out the functional tests described above, then the impression is disinfected, the borders of the lower individual tray are edged, using special silicone or thermoplastic masses, using the following functional tests for the lower jaw:

swallowing saliva, slowly licking the upper and lower lips with the tongue, stretching the lips, as when pronouncing a sound, and stretching the lips with a tube, as when pronouncing the sound u, resting the tongue on the lower incisors (as when spitting), and then the doctor checks for the presence of a marginal closing valve, if necessary, applying special silicone or thermoplastic masses, repeats these tests;

makes small-diameter holes on an individual tray for degassing and better fluidity of the corrective mass to prevent squeezing (compression) and places stop stops in the amount of 4-6 pieces, and stop stops are placed in the place of dense bone, takes an impression of the prosthetic bed of the lower jaw of the non-hydrophilic and a non-thixotropic correlating mass A-silicone or polyester mass, while performing the functional tests described above with the mouth closed, and when an individual spoon is introduced into the oral cavity, the tongue is raised, the patient sits on a chair with a hand rest, which is important for maintaining body posture, they produce disinfection of the impression;

places marks on the protruding parts of the face (tip of the nose and chin) to the patient, who stands, and determines and records on a caliper the height of relative physiological rest, which is achieved using the sound test um-m-m-a or by snorting with the lips, then the doctor takes a special impression tray (center tray), applies an impression mass to this tray, brings it into the patient’s oral cavity, while the patient, wrapping his lips around the edge of the tray (like a mouthpiece), compresses his jaws to the height mark relative to physiological rest, which he previously identified and marked on the caliper;

then the doctor applies a facial bow, measures the height of the upper lip using a papillameter;

determines the projection of the horizon of the future setting of the teeth using a medical clinometer, then carry out the second dental stage, including:

processing of impressions before casting them with a special solution to relieve surface tension;

edging the borders of prints before casting them to preserve the working area, casting models with supergypsum of at least class 3, duplicating models and casting working models;

the technician plasters the model of the upper jaw into the articulator along the face bow, in case of its absence - along the Hip-table, and using a special impression tray (centric tray) plaster the lower jaw into the articulator;

production of individual wax bite ridges on a rigid base, and the upper roller is made according to the height obtained using a papillameter, plus 2-3 mm, the width of the side of the wax bite ridges is made according to model analysis and checked by a static laser, the occlusal plane of the ridges is set using a rim tool former, hard (hard) wax is used;

the third medical stage, which includes the doctor applying marks to the patient who is standing on the protruding parts of the face (tip of the nose and chin), determining and recording on a caliper the height of relative physiological rest, which is achieved using the sound test um-m-m-a or when snorting with the lips, installing the upper bite ridge in the oral cavity and determining with the help of sound tests pine, neighbor, Mississippi, serving the Soviet Union that the edge of the ridge in the frontal region extends 2-3 mm from under the red border of the upper lip;

checking the prosthetic plane on the bite ridge using a device for determining and checking the prosthetic plane, installing the lower bite ridge in the oral cavity and bringing it to a previously determined height relative to physiological rest minus 2-3 mm;

then the doctor makes locks in the lateral sections of the upper and lower bite ridges and registers the bite by pouring bite registration material into these locks (holes);

further marks aesthetic parameters on the rollers: midline, canine line, smile lines of the upper and lower lips; if necessary, the doctor applies a face bow.

the rollers are removed from the mouth and disinfected;

- 4 045576 then the doctor selects artificial teeth for prosthetics;

carry out the third dental stage:

the dental technician casts a model of the lower jaw into the articulator along the bite ridges and sets the articulator pin to the zero position, then he installs the gnathometer (centrofix);

carry out the fourth medical stage, including determining the central ratio using a gnathometer (centrofix) and replastering the lower jaw in the articulator to the position of the central ratio;

the doctor, having retreated 6 mm from the top of the Gothic angle alternately to the left, right, back, sets a trap, records the angles of the anterior articular path and the right and left lateral articular paths using bite registration material;

Using the received recorders, the doctor adjusts these angles in the adjustable articulator and transmits the found parameters to the dental technician;

the fourth dental stage, including setting up an individual incisal table according to the individual values of the angles of a given patient determined above, conducting a model analysis of the upper and lower jaws;

determination using a profile-compass tool (profile-compass) on the model of the lower jaw functional zones on the left and right sides;

placement of artificial teeth on a rigid base using hard (hard) wax, strictly according to model analysis under the control of a laser-static instrument and a laboratory clinometer;

modeling of future removable dentures;

the fifth medical stage, including checking the alignment of the teeth;

the fifth final dental stage, including the manufacture of removable dentures using the method of hot or cold polymerization, or the method of thermal injection (thermomolding), and then the technician carries out reocclusion of the finished dentures, processing of the dentures, application of micro- and macro-relief of the mucous membrane and polishing of the dentures;

the sixth final medical stage, including the application of dentures in the patient’s oral cavity, checking the chewing efficiency of the finished dentures, for which the patient eats an apple or cucumber;

teaching the patient about the hygienic care of dentures and determining the date of the follow-up examination.

The method for producing functional and aesthetic removable dentures according to the invention concerns the production of complete, partial or implant-supported dentures,

In the claimed method, preparation for treatment includes collecting anamnesis and conducting additional studies, such as condylography, MPT, KT, TRG.

Preparation for prosthetics includes surgical intervention - deepening the vestibule of the oral cavity, alveolotomy, removal of exostoses, drainage of the frenulum of the tongue, frenulum of the upper lip, mucous cords; therapeutic training, such as treatment of caries and its complications, periodontal and orthodontic training.

In the claimed method, planning includes the selection of a prosthesis, such as a complete removable denture, a complete removable denture on implants, a clasp denture, with locks, a clasp denture, with a locking fixation system, a telescopic fixation system, a plate removable denture, dentures with a beam fixation system.

When taking double alginate impressions, alginate powder and distilled water are taken strictly according to measuring cups, and the mass is mixed in a special device (algamix), and the alginate impression must be cast immediately, since the material shrinks, and before casting, the impression is placed in a gypsum solution to neutralize alginic acid and provide roughness.

The A-silicone impression is taken only at once, i.e. The base material is placed in the Schreinemakers impression tray and the corrective material is applied to it.

At the same time, when taking impressions with any selected masses, functional tests are carried out, the impression from the lower jaw is taken with the mouth closed, while when introducing the impression tray, the tongue must be raised, the patient sits on a chair with a hand rest, which is important for maintaining body posture.

When implementing the method, gypsum is mixed (powder-liquid) in certain proportions in a vacuum mixer strictly according to the manufacturer’s instructions.

At the same time, functional tests are carried out only with the mouth closed, when introducing a spoon with the mass, the tongue is raised, the patient sits on a chair with a hand rest, which is important for maintaining body posture.

If the volume (length, width) of the edging mass is greater than the length of the individual tray, then, after taking the impression with the correcting mass, a model is cast and a new individual tray is made taking into account the new boundaries obtained, repeating functional tests to obtain an edge closing valve.

To cast the model, use supergypsum of at least class 3, which is mixed (powder

- 5 045576 liquid) strictly according to the instructions specified by the manufacturer, in certain proportions in a vacuum mixer, and the model is cast on a vibrating table, after which the cast model is processed on a trimmer, the technician fills the undercuts with wax on the plaster model.

So, the technical essence of the claimed method lies in the following alternation of successive medical and dental stages.

The method of manufacturing functional and aesthetic removable dentures is characterized by a set of sequentially alternating clinical and laboratory (medical and dental) stages.

Medical stages include examination and examination of the patient. Selecting Schreinemakers impression trays, installing stops, identifying and marking the hard-soft palate junction (Line-A) and taking impressions (double alginate impressions, A-silicone impression or polyester impression) to produce custom trays. The next dental stage is edging the boundaries of the impressions taken before casting the models to preserve the working area. Casting models with class 3 plaster, plastering them and making individual spoons. The next medical stage is edging the edges of the individual tray, performing functional tests, installing stop stops, and taking impressions from the prosthetic bed. Determination of the height of the upper lip using a papillameter. Determination of tooth style NFC+ Candulor. Taking an impression with a centrifuge for preliminary determination of central occlusion, applying a face bow, working with a doctor’s clinometer. The next dental stage is the edging of the boundaries of the impressions taken before casting the models to preserve the functional edge. Casting of models with class 4 plaster, duplication, production of a master model and a working model. Plastering the upper jaw model into the articulator along the face bow. Plastering the lower jaw into the articulator using a special impression tray (centric tray). Manufacturing of individual, aesthetic bite ridges on a rigid base. Working with the Rim Former tool. Next, the next medical stage is the determination of central occlusion. Determination of aesthetic parameters: midline of the face, canine line, smile line of the upper and lower jaw. Next is the dental stage - plastering the models into the articulator. Installation of a gnathometer to determine the central relationship of the jaws and the angles of the anterior and lateral articular paths.

The next medical stage is to determine the central relationship of the jaws, the angles of the anterior and lateral articular tracts. The subsequent dental stage is plaster casting of the lower jaw model taking into account the central ratio, adjusting the angles of the anterior and lateral articular paths. Analysis and marking of models. NFC+ Candulor teeth placement using Statik Pointer and laboratory clinometer. The next medical stage is checking the teeth. Determining the aesthetics of future prostheses: determining and choosing the colors of the base plastic and plastic for individualization. The final dental stage is the final modeling of the prosthesis on wax and its preparation for plaster casting in a Polymaster cuvette, evaporation, isolation. Individualization of prostheses with aesthetic plastics and Candulor intensives. Polymerization, processing, application of macro- and microrelief using the Stippling Instrument, polishing of dentures. Reocclusion of prostheses. The final medical stage is the delivery of prostheses. Teaching the patient how to care for removable dentures.

Below is an example of the method, illustrating the invention, but not limiting it.

Example.

Patient (D), 75 years old, complained of the absence of all teeth and the inability to chew food. History: the last teeth were removed 7 years ago due to chronic periodontitis, type 2 diabetes mellitus. Objectively: in the oral cavity of the upper jaw there is uniform significant atrophy of the alveolar process, pronounced pliable mucosa in the area of the incisive papilla and palatal folds, the palatal torus is moderately pronounced. Lower jaw - total atrophy of the alveolar part, retromolar tubercles are almost completely atrophied, hyoid ridges are preserved, the mucosa is uniformly pliable, implantation in the lower and upper jaws is impossible due to the lack of sufficient bone tissue and the reluctance of the patient.

The diagnosis is complete secondary edentia of the upper and lower jaws, complicated by total atrophy of the alveolar part of the lower jaw and moderate atrophy of the alveolar process of the upper jaw. Diabetes mellitus type 2 for 20 years.

Use the following treatment plan.

Two complete removable functional and aesthetic dentures are manufactured using cold polymerization plastic and Candulor intensives, using nanofilm composite artificial teeth (NFC+) Candulor.

The following clinical and laboratory stages are carried out:

The 1st medical stage includes:

selection of Schreinemakers impression trays, installation of stop stops, determination and marking of the transition boundary of the hard and soft palate (line-A), taking double alginate impressions (in which alginate powder and distilled water are taken strictly according to measuring tapes, and the mass is mixed in a special device (algamix );

The spoon is placed into the oral cavity and the impression is taken without pressure.

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It is important to note that when taking impressions with the selected mass, functional tests are carried out, the impression from the lower jaw is taken with the mouth closed, while when inserting the impression tray, the tongue must be raised, the patient sits on a chair with a hand rest, which is important for maintaining body posture .

After taking an impression from the upper jaw, the doctor corrects the impression along the line of transition of the hard palate to the soft palate, i.e. using a scalpel, removes (cuts off) excess mass and thereby marks a clear boundary for the transition of the hard palate into the soft palate.

After this, the taken impressions are disinfected,

Moreover, the alginate impression must be cast immediately, since the material shrinks, and before casting, the impression is placed in a gypsum solution to neutralize the alginic acid and impart roughness.

After disinfection of the taken impressions, they are transferred to the dental laboratory.

Using a papillameter instrument, the doctor determines the height of the upper lip.

The first dental stage is carried out, according to which the technician edges the boundaries of the impressions before casting them to preserve the working area, while for casting supergypsum of at least class 3 is used, which is mixed (powder-liquid) strictly according to the instructions specified by the manufacturer in certain proportions in vacuum mixer.

The model is cast on a vibrating table, after which the cast model is processed on a trimmer, the technician fills the undercuts with wax on the plaster model, isolates the areas of the palatine folds and the area of the incisive papilla, as well as those places that the doctor noted, the technician draws on the model the boundaries of the individual tray on the upper and lower jaws.

Manufactures individual volumetric trays on a rigid basis with prototypes of teeth, and the height of the teeth is set based on the height determined by the papillameter, the width of the teeth is determined using model analysis and checked using a laser-static tool, and using a rim shaper tool we give the dentition a clear direction of occlusal plane.

After polymerization (curing), individual spoons must be sandblasted.

Next, the following medical stage is carried out:

the doctor fits each individual spoon into the oral cavity, pays attention to the fact that the spoon does not put pressure on the patient anywhere, so that the attachment points of the frenulum of the tongue, upper and lower lips, mucous cords and pterygo-maxillary folds are sufficiently cleared;

carries out edging of the borders of the upper individual tray, using special silicone or thermoplastic masses, using functional tests.

Functional tests for the upper jaw include:

wide opening of the mouth, retraction of the cheeks, stretching of the lips, as when pronouncing the sound u, stretching the lips with a tube, as when pronouncing the sound u, moving the lower jaw to the left and right, pronouncing a drawn-out sound a, the patient exhales deeply, then inhales air through the nose and the doctor sharply pinches nose (plum).

Next, the doctor checks for the presence of a marginal closing valve, if necessary, applying special silicone or thermoplastic masses, and repeats these tests.

The doctor makes small-diameter holes on an individual tray for degassing and better fluidity of the corrective mass along line A, in the area of the palatal folds and the incisive papilla in the places of undercuts.

To prevent squeezing (compression), the doctor places stop stops in the amount of 4-6 pieces, and the stop stops are placed in the place of dense bone, then the doctor takes an impression from the prosthetic bed of the upper jaw with a non-hydrophilic and non-thixotropic corrective mass A-silicone or polyester mass, while the tests described above are functional.

After this, the impression is disinfected. Next, the doctor contours the borders of the lower individual tray using special silicone or thermoplastic masses, using functional tests; tests are carried out only with the mouth closed, when introducing a spoon with the mass into the oral cavity, the tongue is raised, the patient sits on a chair with a hand rest, which is important for maintaining body posture.

The following functional tests are carried out for the lower jaw: swallowing saliva, slowly licking the upper and lower lips with the tongue, stretching the lips, as when pronouncing a sound, and stretching the lips with a tube, as when pronouncing the sound u, resting the tongue on the lower incisors (as when spitting), the doctor checks the presence of an edge closing valve, if necessary, applying special silicone or thermoplastic compounds, repeats these tests.

If the volume (length, width) of the edging mass is greater than the length of the individual

- 7 045576 spoons, then, having taken an impression with the correcting mass, we cast the model, make a new individual spoon taking into account the new boundaries obtained and repeat the functional tests to obtain the marginal closing valve.

The doctor makes small-diameter holes on an individual tray for degassing and better fluidity of the corrective mass to prevent squeezing (compression), the doctor places stop stops in the amount of 4-6 pieces, and stop stops are placed in the place of dense bone.

Next, the doctor takes an impression of the prosthetic bed of the lower jaw with a non-hydrophilic and non-thixotropic corrective mass A-silicone or polyester mass, while performing the functional tests described above with the mouth closed, the patient sitting on a chair with a palm rest. When placing an individual spoon into the oral cavity, the tongue is raised. The impression is disinfected.

For a patient who is standing, the doctor, having applied marks to the protruding parts of the face (tip of the nose and chin), determines and records on a caliper the height of relative physiological rest, which is achieved using the sound test um-m-m-a or by snorting with the lips.

Then the doctor takes a special impression tray (center tray), applies an impression mass to this tray, brings it into the patient’s oral cavity, the patient, wrapping his lips around the edge of the tray (like a mouthpiece), squeezes his jaws to a height relative to physiological rest, which is previously determined by the doctor and marked on the caliper.

The doctor applies a facial bow, measures the height of the upper lip using a papillameter, and determines the projection of the horizon of future teeth placement using a medical clinometer.

The following dental stage is carried out:

Before casting the models, the technician treats the impressions with a special solution to relieve surface tension.

the technician edges the borders of the prints before casting them to preserve the working area; for casting the model, supergypsum of at least class 3 is used, which is mixed (powder-liquid) strictly according to the instructions specified by the manufacturer, in certain proportions, mixed in a vacuum mixer, while The model is cast on a vibrating table, after which the cast model is processed on a trimmer, and a technician fills in the undercuts with wax on the plaster model.

Next, the technician duplicates the models and casts working models.

The technician plasters the model of the upper jaw into the articulator along the face bow, or, if it is absent, along the hip table; then, using a special center-tray impression tray, plaster the lower jaw into the articulator;

the technician makes individual bite ridges on a rigid base (the upper ridge is made according to the height obtained using a papillameter, plus 2-3 mm, the width of the side of the wax bite ridges is made according to model analysis, checked by a static laser, the occlusal plane of the ridges is set using a rim shaper tool , use hard (hard) wax.

Next, the following medical stage is carried out:

for a patient who is standing, the doctor, having placed marks on the protruding parts of the face (tip of the nose and chin), determines and records on a caliper the height of relative physiological rest, which is achieved using the sound test um-m-m-a or by snorting with the lips, an upper bite block is installed in the oral cavity;

using sound tests pine, neighbor, Mississippi, serving the Soviet Union, the doctor determines that the edge of the cushion in the frontal region extends 2-3 mm from under the red border of the upper lip;

the doctor, using a device for determining and checking the prosthetic plane, checks the prosthetic plane on the bite block;

then the doctor installs the lower bite ridge in the oral cavity and brings it to a previously determined height relative to physiological rest minus 2-3 mm;

then the doctor makes locks in the lateral sections of the upper and lower bite ridges and registers the bite by pouring bite registration material into these locks (holes);

then the doctor marks on the rollers the midline, the line of the fangs, the smile lines of the upper and lower lips, if necessary, the doctor applies a face bow;

the rollers are removed from the mouth and disinfected;

The doctor selects artificial teeth.

Next, the following dental stage is carried out:

the dental technician casts a model of the lower jaw into the articulator along the bite ridges and sets the articulator pin to the zero position;

the technician then installs the gnathometer (centrofix);

The following medical stage is carried out:

the doctor, using a gnathometer (centrofix), determines the central relationship and re-casts the lower jaw in the articulator to the position of the central relationship;

the doctor, having retreated 6 mm from the top of the Gothic angle alternately left, right, back, sets a trap, records the angles of the anterior articular path and the right and left lateral articular paths

- 8 045576 using bite registration material; records the angles of the anterior articular path and the right and left lateral articular paths;

Using the received recorders, the doctor adjusts these angles in the adjustable articulator and transmits the found parameters to the dental technician;

The following dental stage is carried out:

The technician, based on the individual angle values determined above for the given patient, adjusts the individual incisal table.

Next, the technician performs a model analysis of the jaws (upper and lower):

using the profile-compass tool (profile-compass) determines the functional zones on the left and right sides on the model of the lower jaw;

then the technician places artificial teeth on a rigid base using hard (hard) wax, strictly according to model analysis under the control of a laser-static instrument and a laboratory clinometer;

the technician models future removable dentures;

Next, the next medical stage is carried out: the doctor checks the setting of the teeth.

The following dental stage is carried out:

the technician produces removable dentures using the cold polymerization method, the technician reoccludes finished dentures;

The technician processes the dentures, applies micro- and macro-relief to the mucous membrane, and polishes the dentures.

The following medical stage is carried out:

placing dentures in the patient’s mouth, checking the chewing efficiency of the finished dentures (the patient eats an apple, cucumber, etc., etc.);

the doctor teaches the patient about the hygienic care of dentures and determines the dates for the follow-up examination.

In a similar way, a method for manufacturing functional and aesthetic removable dentures according to the invention is carried out using impressions with A-silicone (base mass soft), corrective mass (non-hydrophilic and non-thixotropic), or impressions with polyester mass.

Thus, the method of manufacturing functional and aesthetic removable dentures claimed as an invention allows:

ensure 100% functional and aesthetic results; reduce the labor intensity of clinical and laboratory stages during prosthetics;

increase the accuracy of prosthetic manufacturing by creating an original prosthetic technology, including a set of sequentially alternating clinical and laboratory stages (medical and dental stages);

improve the quality of dentures in case of complete loss of teeth by improving aesthetics and chewing function;

improve the patient's quality of life.

Claims (13)

1. A method for manufacturing functional and aesthetic removable dentures, which includes the implementation of the following set of sequentially alternating clinical-laboratory (clinical) medical and dental technical stages: examination and examination of the patient, preparation for treatment, preparation for prosthetics and diagnosis based on examination results, treatment planning, implementation of the following clinical medical and dental stages of manufacturing removable dentures, including the first medical stage, including: selection of individual impression trays, installation of stop stops, determination and marking of the border of the transition of the hard and soft palate - line A, and taking double alginate impressions or taking impressions with a base mass of soft A - silicone, corrective non-hydrophilic and non-thixotropic mass, or taking impressions with a polyester mass, and additionally, the corrective mass from the dispenser device is applied along the transitional fold of the upper or lower jaw, along the palate, in the sublingual space, on the prosthetic bed, and when taking impressions with any selected masses, functional tests are carried out, while the impression from the lower jaw is taken with the mouth closed and when bringing in the impression tray, the tongue should be raised, and the patient should sit on a chair with a hand rest to maintain body posture; the spoon is brought into the oral cavity and the impression is taken without pressure, while when bringing in the impression tray, the tongue must be raised, the patient sits on a chair with a hand rest, which is important for maintaining body posture, after taking an impression with any masses from the upper jaw, the doctor will follow the transition line from the hard palate to the soft palate, he corrects the impression, cutting off the excess mass with a scalpel and thereby marking a clear boundary for the transition of the hard palate into the soft palate to the dental technician, after which the taken impressions are disinfected and transferred to the dental laboratory; using a papillameter instrument, the doctor determines the height of the upper lip, then the first dental stage is carried out, including edging the boundaries of the impressions before casting them to preserve the working area and casting model impressions with superplaster, preparing individual volumetric trays on a rigid base with prototypes of teeth, and the height of the teeth is set based on from the height determined by the papillameter, the width of the teeth is determined using model analysis and checked using a laser-static tool, and using a rim shaper tool, the dentition is given a clear direction of the occlusal plane; after polymerization-hardening, individual spoons must be sandblasted; the second medical stage, including: fitting each individual spoon to the oral cavity so that the spoon does not put pressure on the patient anywhere and that the attachment points of the frenulum of the tongue, upper and lower lips, mucous cords and pterygo-maxillary folds are sufficiently cleared; edging the boundaries of the upper individual tray using silicone or thermoplastic masses, using the following functional tests for the upper jaw: wide opening of the mouth, retraction of the cheeks, stretching of the lips, as when pronouncing the sound u, stretching the lips with a tube, as when pronouncing the sound u, moving the lower jaw to the left and right, pronouncing a drawn-out sound a, the patient exhales deeply, then inhales air through the nose and the doctor sharply pinches the nose - drain, and the doctor checks for the presence of a marginal closing valve, if necessary, applying silicone or thermoplastic masses, repeats these tests; and then the doctor makes small-diameter holes on an individual tray for degassing and better fluidity of the corrective mass along line A, in the area of the palatal folds, the incisive papilla in the places of undercuts; to prevent squeezing or compression, the doctor places stop stops in the amount of 4-6 pieces, and the stop stops are placed in the place of dense bone, takes an impression of the prosthetic bed of the upper jaw with a non-hydrophilic and non-thixotropic corrective mass A-silicone or polyester mass, while performing the functional procedures described above samples, - 10 045576 then the impression is disinfected, the borders of the lower individual tray are edged using silicone or thermoplastic masses, using the following functional tests for the lower jaw: swallowing saliva, slowly licking the upper and lower lips with the tongue, stretching the lips, as when pronouncing a sound and, stretching the lips with a tube, as when pronouncing the sound u, resting the tongue on the lower incisors as when spitting, and then the doctor checks for the presence of a marginal closing valve, when if necessary, apply silicone or thermoplastic masses and repeat these tests; makes small-diameter holes on an individual tray for degassing and better fluidity of the corrective mass to prevent squeezing or compression and places stop stops in the amount of 4-6 pieces, and stop stops are placed in the place of dense bone, takes an impression of the prosthetic bed of the lower jaw of the non-hydrophilic and non-thixotropic corrective mass A-silicone or polyester mass, while performing the functional tests described above with the mouth closed, and when introducing an individual spoon into the oral cavity, the tongue is raised, the patient sits on a chair with a hand rest, which is important for maintaining body posture; the impression is disinfected; places marks on protruding parts of the face, such as the tip of the nose and chin, for the patient, who is standing, and determines and records on a caliper the height of relative physiological rest, which is achieved using the sound test um-m-m-a or by snorting with the lips , then the doctor takes a center-tray impression tray, applies an impression mass to this tray, brings it into the patient’s oral cavity, while the patient, wrapping his lips around the edge of the tray like a mouthpiece, squeezes his jaws to a height relative to physiological rest, which is previously determined by him and marked on the caliper; Next, the doctor applies a face bow and measures the height of the upper lip using a papillameter; determines the projection of the horizon of the future setting of the teeth using a medical clinometer, then carry out the second dental stage, including: treatment before casting impressions with a solution to relieve surface tension; edging the borders of prints before casting them to preserve the working area with supergypsum of at least class 3, duplicating models and casting working models; the technician plasters the model of the upper jaw into the articulator along the face bow, or, if it is absent, along the Hip-table, and using an impression tray, a center-tray plaster the lower jaw into the articulator; manufacturing of individual wax bite ridges on a rigid base, and the upper roller is made according to the height obtained using a papillameter, plus 2-3 mm, the width of the side of the wax bite ridges is made according to model analysis and checked by a static laser, the occlusal plane of the ridges is set using a tool Rome former, hard wax is used; third medical stage, including: the doctor applying marks to the protruding parts of the face - the tip of the nose and the chin, to a patient who is standing, determining and recording on a caliper the height of relative physiological rest, which is achieved using the sound test um-m-m-a or by snorting with the lips, establishing into the oral cavity of the upper bite ridge and determining, using sound tests, pine, neighbor, Mississippi, serving the Soviet Union, that the edge of the ridge in the frontal region extends 2-3 mm from under the red border of the upper lip; checking the prosthetic plane on the bite ridge using a device for determining and checking the prosthetic plane, installing the lower bite ridge in the oral cavity and bringing it to a previously determined height relative to physiological rest minus 2-3 mm; then the doctor makes locks on the lateral sections of the upper and lower bite ridges and registers the bite, pouring material for bite registration into these lock-holes; further marks the aesthetic parameters on the rollers: the midline, the line of the fangs, the smile lines of the upper and lower lips, the rollers are removed from the mouth and disinfected; the doctor gave it and selects artificial teeth for prosthetics; carry out the third dental stage: the dental technician casts a model of the lower jaw into the articulator along the bite ridges and sets the articulator pin to the zero position, then he installs the gnathometer-centrofix; carry out the fourth medical stage, including determination of the central ratio using a gnathometer-centrofix and re-plastering - 11 045576 of the lower jaw in the articulator in the position of the central ratio; the doctor, having retreated 6 mm from the top of the Gothic angle alternately to the left, right, back, sets a trap, records the angles of the anterior articular path and the right and left lateral articular paths using bite registration material; registrates the angles of the anterior articular path and the right and left lateral articular paths; Using the received recorders, the doctor adjusts these angles in the adjustable articulator and transmits the found parameters to the dental technician; fourth dental stage, including: setting up an individual incisal table according to the individual values of the angles of a given patient determined above, conducting a model analysis of the upper and lower jaws; using a profile-compass tool, such as a profile-compass, to determine functional zones on the left and right sides of the lower jaw model; placement of artificial teeth on a rigid base using hard wax, strictly according to model analysis under the control of a laser-static instrument and a laboratory clinometer; modeling of future removable dentures; the fifth medical stage, including checking the alignment of the teeth; the fifth final dental stage, including the manufacture of removable dentures using the method of hot or cold polymerization, or the thermomolding method, and then the technician carries out reocclusion of the finished dentures, processing of the dentures, application of micro- and macro-relief of the mucosa and polishing of the dentures; the sixth final medical stage, including the application of dentures in the patient’s oral cavity, checking the chewing efficiency of the finished dentures, for which the patient eats an apple, a cucumber; teaching the patient about the hygienic care of dentures and determining the date of the follow-up examination. 2. A method for manufacturing functional and aesthetic removable dentures according to claim 1, characterized in that it includes the manufacture of complete, partial or implant-supported dentures. 3. A method for manufacturing functional and aesthetic removable dentures according to claim 1, characterized in that preparation for treatment includes taking an anamnesis and conducting additional studies, such as condylography, MRI, CT, TRG. 4. A method for manufacturing functional and aesthetic removable dentures according to claim 1, characterized in that preparation for prosthetics includes surgical intervention - deepening the vestibule of the oral cavity, alveolotomy, removal of exostoses, excision of the frenulum of the tongue, frenulum of the upper or lower lip. 5. A method for manufacturing functional and aesthetic removable dentures according to claim 1, characterized in that preparation for prosthetics includes therapeutic preparation - treatment of caries and its complications, periodontal and orthodontic preparation. 6. A method for manufacturing functional and aesthetic removable dentures according to claim 1, characterized in that planning includes the selection of a prosthesis, such as a complete removable one, a complete removable one on implants, a clasp denture: clasp, with a locking fixation system, a telescopic fixation system; plate removable dentures, dentures with a beam fixation system. 7. A method for manufacturing functional and aesthetic removable dentures according to claim 1, characterized in that when taking double alginate impressions, alginate powder and distilled water are taken strictly according to measuring cups and the mass is mixed in a device - algamix, and the alginate impression must be cast immediately, in view of this that the material shrinks, and before casting, the impression is placed in a gypsum solution to neutralize the alginic acid and impart roughness. 8. A method for manufacturing functional and aesthetic removable dentures according to claim 1, characterized in that the A-silicone impression is taken only simultaneously, i.e. The base mass is placed in an individual impression tray, and the corrective mass is applied to it. 9. A method for manufacturing functional and aesthetic removable dentures according to claim 1, characterized in that when taking impressions with any selected masses, functional tests are carried out, the impression from the lower jaw is taken with the mouth closed, and when the impression tray is inserted, the tongue must be raised, the patient sits on a chair with a hand rest, which is important for maintaining body posture. 10. A method for manufacturing functional and aesthetic removable dentures according to claim 1, characterized in that gypsum is mixed according to the powder-liquid principle in certain proportions in a vacuum mixer strictly according to the manufacturer’s instructions. 11. A method for manufacturing functional and aesthetic removable dentures according to claim 1, characterized in that functional tests from the lower jaw are carried out only with the mouth closed, when introducing a spoon with the mass, the tongue is raised, the patient sits on a chair with a palm rest, which is important for maintaining body posture. 12. Method for manufacturing functional and aesthetic removable dentures according to claim 1, depending on - 12 045576 due to the fact that if the volume is the length, the width of the edging mass is greater than the length of the individual tray, then, after taking an impression with the correcting mass, a model is cast and a new individual tray is made taking into account the new boundaries obtained, repeating functional tests for obtaining an edge closing valve. 13. A method for manufacturing functional and aesthetic removable dentures according to claim 1, characterized in that for casting the model, supergypsum of at least class 3 is used, which is mixed according to the powder-liquid principle strictly according to the instructions specified by the manufacturer, in certain proportions in a vacuum mixer, and the casting of the model is carried out on a vibrating table, after which the cast model is processed on a trimmer, the technician fills the undercuts with wax on the plaster model.