RU2233641C1 - Method for restoration of frontal dental groups at complete absence of crown part by applying gilded reinforcing netting - Google Patents

Abstract

FIELD: medicine, esthetic stomatology.

SUBSTANCE: the present innovation deals with preventing shearings and splittings off, increasing durability of restoration at complete absence of crown part in frontal dental groups along with high esthetic quality. The suggested method deals with detecting corresponding color by VITA scale, filling of one third of radicular canal, forming a cavity and two diametrically opposite grooves at radicular bottom performed in mesiodistal direction at 1-2 mm depth, fixing anchor dowel in radicular canal and that of gilded netting with two P-shaped protrusions, correspondingly, in a groove of dowel's caput and grooves of radicular bottom. Dowel's caput should be additionally squeezed to fix a netting, then comes forming of oral and vestibular surfaces of crown part due to by-layer applying opaque and enamel layers of the composite in correspondence with anatomic dental shape followed by grinding and polishing.

EFFECT: higher efficiency of restoration.

1 ex

Description

The invention relates to medicine, in particular to aesthetic dentistry, a method of restoration of the front groups of teeth in the complete absence of the crown part using a gold-plated reinforcing mesh. The reasons for the complete absence of the crown part of the front teeth are: caries, non-carious lesions, trauma.

To restore the destroyed crown part in dentistry, artificial crowns are used with support on pin structures, direct and indirect restorations made of composite materials (2-5, 7-9).

The closest in technical essence is the prototype method of manufacturing cast stump inlays in the oral cavity [1].

The disadvantages of the known methods:

1. the cavity in the root canal should be of sufficient depth so that the root part of the tab is at least equal to its supragingival part;

2. sufficiently voluminous preparation;

3. proppant action under load;

4. lack of elasticity (different physical properties of the tab and hard root tissues);

5. ideal clinical conditions are necessary: a wide, long and straight root;

6. the direct method does not guarantee sufficient accuracy of the manufacture of the tab due to shrinkage and deformation of the plastic model;

7. defects in casting lead to excessive preparation of the tooth, which weakens it and ultimately leads to either cementation or destruction of the root;

8. corrosion of the metal root pin leads to tooth sweating;

9. weak fixation (passive);

10. high cost;

11. a more complex and laborious manufacturing procedure;

12. the need for a dental laboratory;

13. longer treatment times.

The aim of this invention is to increase the durability of the restoration of the front groups of teeth in the complete absence of the crown part, along with high aesthetics.

The advantage of the method of restoration of the front groups of teeth in the complete absence of the crown using a gilded reinforcing mesh:

1. gilded reinforcing mesh provides the perfect shade of the stump, similar to dentin;

2. the yellow color of the metal mesh in the composite layer is less visible, it looks more natural and provides a natural look of the restored crown of the tooth;

3. the crown part of the tooth being restored using a gilded reinforcing metal mesh and composite has excellent adaptation to the remaining tooth structure;

4. the missing crown part of the tooth is restored in a direct way in one visit directly in the chair, which favorably affects the mental state of the patient;

5. restoration is carried out quickly and predictably;

6. reinforced composite, adhesive anchor pin and glass-ionomer cement form a monoblock (multilayer structure without its inherent weak boundaries between them) and provide strong adhesion to the remaining tooth structures;

6. gilded reinforcing mesh and anchor pin are not only aesthetic, but also compatible with composite and tooth tissues;

7. many colors of the composite contribute to achieving the maximum aesthetic result during restoration;

8. the gilded reinforcing mesh is not only a mechanical link between the anchor pin, composite, hard tooth tissues, but also the portions of the composite themselves;

9. the gilded reinforcing mesh and the anchor pin, connecting together mechanically, are presented as a single whole mechanical strong reinforcing structure, immured in a composite material;

10. the gilded reinforcing mesh not only increases the area of contact with the composite, but also provides 95% reinforcement of the crown of the restored tooth;

11. Gold-plated reinforcing mesh helps to reduce the shrinkage of the composite material and leads to an improvement in the marginal fit of the composite to the hard tissues of the tooth;

12. a gilded reinforcing mesh is connected with the base of the tooth root and with the head of the anchor pin, which allows you to evenly distribute the stress on the root under functional loads;

13. Gold-plated reinforcing mesh helps to reduce the stress (stress) that occurs during polymerization;

14. Gold-plated reinforcing mesh provides the prevention of possible complications of chips and spalls after restoration and increases the durability of the restored tooth.

The method of restoration of the front groups of teeth in the complete absence of the crown using a gilded reinforcing mesh is as follows.

Preparing a tooth for restoration.

Mechanically, the surface of the teeth that are near the defect is cleaned with toothbrushes using toothpastes and a suitable color is determined according to the generally accepted VITA scale. After filling the upper third of the canal of the root of the restored tooth, the gum is retracted with retraction thread for greater access to the root of the tooth. After gum retraction, a root cone adjacent to the gum is treated with a thin cone-shaped diamond head.

A semicircular cavity is formed on the basis of the root with the help of a spherical boron. An anchor pin is selected, which is removed after fitting. In the center of the root base, in the mesio-distal direction, with the help of a torpedo-shaped bur, two radial (diametral) grooves are mutually extending each other, one from the medial wall of the tooth root to the root canal, the other from the root canal to the lateral wall of the tooth root, departing from the lateral and the medial walls of the root of the tooth on average 1-2 mm in order to prevent perforation of the walls of the root of the tooth. The depth of the groove is formed taking into account the conical shape of the tooth root, on average it is 1-2 mm.

Fixing the anchor pin.

Before fixing the anchor pin, the root base is etched, while the root canal is closed with cotton wool to prevent acid ingress. The formed semicircular cavity, as well as the grooves, are acid-etched with -3M SCOTCHBOND ETCHANT GEL (Catalog. Dental materials. 2001. 3M Dental, p. 6) to create a microrelief. Acid is applied with a brush on average after 15-20 seconds, after which it is washed off with a stream of water when the saliva ejector is working. Next, the cotton wool is removed from the root canal and the anchor pin is fixed using S.I. (glass ionomer cement. Catalog. Dental materials. 2001. 3M Dental, p. 11) according to the standard method. Given the fact that there is a cruciform groove on the head of the anchor pin, when fixing the pin, one of the grooves of the head must necessarily be in line with the formed groove on the root base. The vestibular and palatine surfaces of the head of the anchor pin are ground 1-2 mm to ensure aesthetics.

Preparation of gilded reinforcing mesh for reinforcing the root and crown parts of the tooth.

As a reinforcing element using a gold-plated mesh with small cells with a thickness of 0.4 mm firm "Renfert" (USA). The mesh is designed to strengthen plastic prostheses (Catalog. Products for dental technicians. 2001-2002, - pages 102 and 103).

The mesh is selected so that the length and width of the mesh correspond to the length and width of the missing crown of the tooth, that is, the mesh has a rectangular shape.

The grid is conditionally divided into three parts: a cutting surface, a body, a cervical surface.

On the cervical surface of the mesh with the help of scissors, two protrusions of a U-shape are created. The width of the protrusions should correspond to the width of the formed grooves on the base of the root, and the distance between the protrusions should correspond to the width of the head of the anchor pin.

Trying on gilded reinforcing mesh.

Two protrusion protrusions without tension should enter the formed grooves on the root base, while the intermediate part between the protrusions should enter the groove of the head of the anchor pin. On approximate surfaces, the width of the mesh should be already 1 mm, and the cutting surface should be shorter by at least 1-2 mm of the edge of the restored tooth to ensure transparency of the cutting edge after restoration.

After fitting, the mesh is washed under running water, dried with air, then two layers of adhesive are applied and polymerized.

The final restoration of the missing crown of the tooth using a gilded reinforcing mesh.

Isolation of the destroyed tooth from the liquid medium of the oral cavity using cofferdam [5].

After fixing the pin, an adhesive is applied both to the semicircular cavity and groove (formed on the root base) and to the head of the anchor pin (Catalog. Dental materials. 2001. 3M Dental, page 6) 3MTM SINGLE BOND DENTAL ADHESIVE SYSTEM using an applicator. Rubbing the adhesive, lightly blow with air; re-apply the adhesive and re-blow with air. Within 10 seconds polymerized by the standard method. Using a macrophilic composite (Catalog. Dental materials. 2001. 3M Dental, p. 4), a border is formed with a height of 1.5-2.0 mm at the gum level around the entire perimeter of the formed cavity.

The grooves are filled with 3MTM Filtec TM Flow fluid composite (Catalog. Dental materials. 2001. 3M Dental, p. 3) and at the same time a metal mesh is installed in the groove so that the two cervical protrusions enter the groove formed in the cavity of the cervical part of the root (without voltage ), and the intermediate part between the protrusions entered the groove of the head of the anchor pin. Before polymerization, the head of the anchor pin (in the groove of which the grid is located) is mechanically compressed, and then polymerization is carried out.

Thus, the mesh, which replaces the missing crown part of the tooth, is connected to the root of the tooth in two ways: adhesive (using the cervical protrusions) and mechanical [the intermediate part of the mesh (between the protrusions) is connected to the head of the anchor pin].

Next, the final restoration of the crown of the tooth is carried out with composite materials for the front teeth groups -3MTM FILTEKTM.

The first portion of the composite material is applied to the mesh and removed to improve the adhesive ability of the material. First, the tooth contour is restored using the macrophile R-60-3MTM SOF-LEX ТМ (Catalog. Dental materials. 2001. 3M Dental, p. 4). Then, the opaque and enamel layers of the composite are applied in layers to the mesh, first to the oral and vestibular surfaces (directional polymerization is carried out from the vestibular and oral sides). To improve grinding and subsequent polishing with circular brushes and pumice, the dispersion layer of the composite (inhibited by oxygen) is removed. The aesthetic effect is achieved after pre-treatment and grinding with standard polishing discs -3МТМ SOF-LEX ТМ (Catalog. Dental materials. 2001. 3М Dental, p. 8) of various thicknesses and grain sizes of abrasive, diamond burs, and the approximate surfaces are treated with strips -3МТМ SOF- LEX TM (Catalog. Dental materials. 2001. 3M Dental, p. 8). Occlusive editing is carried out under the control of occlusal paper with finishing burs, discs. Finishing is performed from the palatine and vestibular surfaces, the rubber dam and retraction thread are removed. The final grinding and polishing is carried out on the 2nd day after polymerization. Thus, this method allows to increase the structural strength, increase the durability of the restoration with the complete absence of the crown of the tooth, along with high aesthetics.

Example

Patient M. 36 years.

Complaints: the complete destruction of the crown, aesthetic dissatisfaction 21.

Anamnesis: 21 previously repeatedly treated for complicated caries. Objectively: the crown of 21 teeth is completely destroyed. Percussion is painless. There are no periapical changes on the x-ray of the 21 tooth, the canal is sealed to the apex.

Diagnosis: complete absence of crown 21.

Treatment. Mechanically, the surfaces of the teeth adjacent to the defect are cleaned with toothbrushes using toothpastes and a suitable color is determined according to the generally accepted VITA scale. Gums are retracted with retraction thread for greater access to the root of the tooth. After gum retraction, a root cone adjacent to the gum is treated with a thin cone-shaped diamond head.

A semicircular cavity is formed on the basis of the root with the help of a spherical boron. Anchor pin is selected, which is removed after fitting. In the center of the root base in the mesio-distal direction, two radial (diametral) grooves are formed using a torpedo-shaped boron, mutually extending each other: one from the medial wall of the tooth root to the root canal, the other from the root canal to the lateral wall of the tooth root, retreat from the lateral and medial walls of the root of the tooth on average 1-2 mm in order to prevent perforation of the walls of the root of the tooth.

Before fixing the anchor pin, the root base is etched, while the root canal is closed with cotton (to prevent acid ingress). The formed semicircular cavity and grooves are subjected to acid etching to create a microrelief. The acid is applied with a brush on average after 15-20 seconds, after which it is washed off with a stream of water with the saliva ejector working. Next, the cotton wool is removed from the root canal and the anchor pin is fixed using S.I. (glass ionomer cement) according to a standard technique. When fixing the anchor pin, the groove of the head is placed in line with the formed groove on the base of the root. The vestibular and palatine surfaces of the anchor pin are ground 1-2 mm.

As a reinforcing element using a gold-plated mesh with small cells with a thickness of 0.4 mm firm "Renfert".

The mesh is selected so that the length and width of the mesh correspond to the length and width of the missing crown of the tooth, that is, the mesh has a rectangular shape.

On the cervical surface of the mesh using scissors create two protrusions of a U-shaped. The width of the protrusions corresponds to the width of the formed grooves on the root base, and the distance between the protrusions corresponds to the width of the head of the anchor pin.

After fitting, the mesh is washed under running water, dried with air; then adhesive is applied, polymerized.

Before the final restoration, the crown parts of the tooth are insulated from the liquid environment of the oral cavity using a rubber dam.

After fixing the pin, adhesive is applied to the semicircular cavity and groove (formed on the root base) and to the head of the anchor pin using an applicator. Rubbing the adhesive, lightly blow with air, re-apply the adhesive and re-blow with air. Within 10 seconds polymerized by the standard method.

The grooves are filled with a fluid composite and at the same time a metal mesh is placed in the groove so that the two protrusions along the jaw enter the groove of the root base (without voltage), and the intermediate part between the protrusions fits into the groove of the head of the anchor pin. Before polymerization, the head of the anchor pin (in the groove of which there is a metal mesh) is mechanically compressed, and then polymerized.

Next, the final restoration of the crown of the tooth is carried out with composite material for the front groups of teeth.

The first portion of the composite material is applied to the restored surface of the mesh and removed to improve the adhesive ability of the material. First, the contours of the tooth are restored using a macrophile. Then, the opaque and enamel layers of the composite are applied in layers to the metal mesh, first to the oral and then to the vestibular surface. To improve grinding and subsequent polishing with circular brushes and pumice, the dispersion layer of the composite (inhibited by oxygen) is removed. After pre-treatment and grinding with standard polishing discs of various thicknesses and grit sizes, diamond bores achieve an aesthetic effect, and proximal surfaces are treated with strips. Occlusive editing is carried out under the control of occlusal paper with finishing burs and discs. Light curing is done from the palatine and vestibular surfaces, the rubber dam and retraction thread are removed. The final grinding and polishing is carried out on the 2nd day after polymerization. The treatment by this method allows to increase the structural strength, increase the durability of the restoration. There were no complications after the restoration in the complete absence of the crown of the tooth by the above method.

Sources of information

1. Shcherbakov M.V., Tlustenko V.P. // Method for the manufacture of cast stump inlays in the oral cavity. Dental Technician. 2002. No. 1. - S. 11. PROTOTYPE.

2. Galimov I.Yu. // Clinical experience with the use of anchor pins to restore the crown of the tooth. Dentist practitioner. 2001. No1. - S.28-30.

3. George Friedman. // Aesthetic treatment using a pin recovery technique. Clinical Dentistry. 2001. No2. - S. 10-15.

4. Kopeikin V.P. Guide to orthopedic dentistry. M. - 1998 S. 496.

5. Nikolaev A.I., Tsepov L.M. // Practical therapeutic dentistry. St. Petersburg. - 2001

6. Nikolishchin A.K. // Restoration (restoration) and dental filling with modern materials and technologies. Poltava. 2001, S. 72-77.

7. Svetlov A.V., Kozitsina S.I. // Experience with the root pins of the COSMOPOST system. Scientific and practical journal. Institute of Dentistry. - 2000. No. 1. - S.28-30.

8. Olesova V.N. // Biomechanical and clinical rationale for fiberglass-based pin designs. Panorama of orthopedic dentistry. 2000. - P.4-6.

9. Jordan R.E. // Composite filling and facing materials in dentistry. A.V. Borisenko, V.N. Not without reason. / Kiev. - 2001 - p. 200.

Claims (1)

The method of restoration of the front groups of teeth in the complete absence of the crown part using a gilded reinforcing mesh, including determining the appropriate color according to the VITA scale, filling a third of the root canal, forming cavity and two diametrically opposite grooves made in the mesiodistal direction with a depth of 1-2 mm, fixing the anchor pin in the root canal and fixing the gilded mesh with two U-shaped protrusions in the groove of the pin head and grooves of the root base, respectively, with the head Tift further clamp for fixing the grid, forming the oral and vestibular surface of crown portion by layering opaque and enamel layers of the composite according to the anatomical shape of the tooth, followed by grinding and polishing.