RU2241408C1 - Method for repairing teeth with failing crown portion and perforated root in the bifurcation area by using reinforcing net ring - Google Patents

Abstract

FIELD: medical engineering.

SUBSTANCE: method involves building failing crown portion walls repairing root perforations by repeatedly applying CollapAn-A granules finishing crown portion reconstruction. The walls are built after having finished preparative root canal treatment and prepared retained crown portion walls at gingival level. The walls are built stage-by-stage from equator to occlusion surface in carrying out intermediate gingivectomy of injured root tissues. Composite material is used and ring fixed in dental cavity produced from fine-mesh net of 0.4 mm large thickness which external surface corresponds to the internal lateral surface of the prepared tooth. Ring diameter from root side is to be selected by satisfying root perforation access condition.

EFFECT: enhanced effectiveness of treatment; full root repair due to osteostimulating material being applied.

Description

The invention relates to medicine, namely to dentistry: to methods of tooth restoration in the absence of a completely crown part and the presence of root perforation in the bifurcation region.

In clinical practice, root perforations in the area of bifurcation in chewing groups of teeth are found with a complete absence of the crown part, the cause of which is caries and its complications.

From publicly available sources of information, it is known that when perforations of the root in the bifurcation region, the tooth function is impaired, which makes it impossible to use it as a support for prosthetics. Due to the presence of microorganisms, their toxins and the inflammatory and destructive process in the periodontium, such teeth are a potential focus of chronic odontogenic intoxication. Persistent clinical symptoms of periodontitis and destruction of bone tissue in the area of perforation of the bottom of the coronal cavity are a direct indication for the surgical treatment of such patients (coronoradicular separation, hemisection on the teeth of the lower jaw). But traditional surgical methods for treating chronic destructive forms of periodontitis that have arisen due to perforations are also not always successful. The development of postoperative inflammatory complications, relapse of the destructive process, incomplete or delayed regeneration further reduces their functionality, which leads to the removal of these teeth [2, 3, 4, 7, 8, 9].

After tooth extraction, prosthetics are performed with various designs (bridges): soldered, solid cast, cermet, cermet with support on the implant.

The prior art (EPO No. 0565889 A1) is a method of restoring the crown of the tooth by using material for fillings and a reinforcing element made in the form of a bracket [1]. It seems that the known method is most similar in technological methods to the claimed method.

The disadvantages of this method are:

1. complex technological manufacturing of the reinforcing element, due to the spatial configuration of the bracket (the presence of welded or solid core and transverse teeth, etc.);

2. the need to make brackets of several sizes and the use of only a certain size;

3. a limited area of reinforcement of the restored tooth cavity, due to the geometrical dimensions of the bracket (in particular, its width), the reinforcement of the opposite walls of the cavity;

4. lack of access to the root of the tooth if endodontic treatment is necessary;

5. the presence of different strength characteristics of the zones of the restored part;

6. the occurrence of additional zones of increased tension due to the formation in the tooth body of elements for attaching the bracket;

7. subject to paragraphs 4 and 5, the likelihood of chipping of the filling material from the restored tooth.

The objective of the invention is to provide a method for tooth restoration, through which the missing crown part of the tooth is restored in combination with the restoration of root perforations in the bifurcation region, while additional reinforcement of the crown restored tooth is carried out through the use of a mesh ring in order to create a monolithic structure. The application of the claimed method eliminates the occurrence of the above disadvantages. In addition, the use of a mesh ring allows you to create a cavity of access to the root of the tooth and thus ensure complete restoration of root perforations due to the repeated placement of osteostimulating material, and the process of restoring root perforations is most comfortable for the patient.

The advantages of the invention are also as follows:

1. treatment of the focus of inflammation and preservation of the tooth;

2. restoration of the functional properties of the tooth;

3. does not require the preparation of intact abutment teeth;

4. does not require depulpation of supporting teeth;

5. no laboratory steps required;

6. allows you to restore the crown of the tooth in the simplest way;

7. the reinforcing mesh ring is presented as the matrix on which the missing crown part of the tooth is built;

8. it increases the mechanical strength of the structure, reduces the shrinkage of the composite material, which leads to an improvement in the marginal fit of the composite to the hard tissues of the tooth;

9. counteracts the stress that occurs during polymerization and reduces polymerization stress;

10. provides reliable mechanical retention of the restored materials;

11. provides high structural strength;

12. the perforated shape of the mesh reduces stress on the formed walls of the crown of the tooth and contributes to an even distribution of pressure that occurs during functional loads on the tooth;

13. in combination with modern adhesive systems creates a monoblock, multilayer reinforced structure without its inherent weak boundaries between the layers, which ensures the reliability and efficiency of the structure;

14. mesh ring - a connecting mechanical link not only between the composite and the hard tissues of the tooth, but also the portions of the composite itself, which prevents chips and chips;

15. processing the mesh with an adhesive and masking agent eliminates the discoloration of the structure of the crown of the tooth;

16. the effectiveness of modeling the crown of the tooth;

17. visual and radiological control in the event of pathological changes in hard tissues after restoration.

18. Access to the root of the tooth for endodontic treatment is maintained.

SUMMARY OF THE INVENTION

This method involves preliminary endodontic treatment. Root canals should be sealed to the physiological opening and should not have periapical changes.

Mechanically, toothbrushes using toothpastes clean the surface of the teeth that are next to the defect and determine their color according to the generally accepted VITA scale. After the control x-ray, anesthesia is performed and the preserved walls of the crown of the tooth are prepared at the level of the gums. Next, acid etching is carried out with acid to create a microrelief. Acid is applied with a brush for an average of 15-20 seconds, then it is washed off with a stream of water when the saliva ejector and the vacuum cleaner are working. The cavity is air dried, adhesive is applied. Next, the adhesive is slightly flushed with air to evenly distribute, applied repeatedly and again flushed with air. Polymerized by a standard method for 10 s.

Composite material designed to restore the chewing groups of teeth form the walls of the crown of the tooth with a thickness of 1.5-2 mm to the equator. A gingivectomy is performed with excision of softened and demineralized root tissues in the bifurcation area and drug treatment of the wound.

Next, restore the walls of the crown of the tooth to the occlusal surface before contact with the antagonist teeth (to prevent the occurrence of the Popov-Godon effect). To reinforce the crown of the restored tooth, a fine-mesh gilded mesh with a thickness of 0.4 mm is used. Using a plug-in, they create a shape that repeats the inner surface of the restored tooth cavity. A cup-shaped form is obtained in which the bottom is cut out to form a ring. Thus, a reinforcing mesh ring is formed.

The mesh reinforcing ring is removed after fitting from the tooth cavity and coated with two layers of adhesive, each polymerizing individually. The tooth cavity is air dried, adhesive is applied. Lightly purge with air for even distribution, apply adhesive repeatedly and again purge with air. Polymerized by a standard method for 10 s. Next, the reinforcing mesh ring is fixed in the formed tooth cavity using a fluid composite.

Thus, the reinforcing mesh ring allows not only to strengthen the thin walls of the crown of the restored tooth, but also to further treat root perforation in the bifurcation area.

To restore root perforation in the bifurcation area, “KollapAn-L” is used in granules, which are placed in the wound. Since “Kollalan-L” is a biocomposite material based on highly pure hydroxyapatite, collagen and a drug used to treat diseases associated with bone pathology, has pronounced osteogenic and anti-inflammatory properties, the reparative processes in damaged tissues are significantly enhanced, contributing to rapid healing of the bone wound and restoration of the bone structure, the prolonged action of the medicines contained in it is ensured. High microbial activity of the material lasts 16-20 days, during which there is a uniform release of antibiotics in the bone cavity; possesses high biocompatibility, does not cause rejection [5, 6, 7].

After applying “CollalAna-L” to the bifurcation area and the base of the root, the tooth is left under a bandage for a month,

A month later, under the control of x-rays, the degree of restoration of perforation in the area of root bifurcation is determined, “KollapAn-L” is added and left under a bandage.

After complete restoration of root perforation in the bifurcation area, the final restoration of the crown of the tooth proceeds. The temporary dressing is removed and the crown of the tooth is restored using the restoration system for chewing teeth according to the manufacturer's instructions. Before polishing and control polymerization, occlusal editing is performed. Final grinding and polishing is carried out on the 2nd day after polymerization. Further, the patient is under clinical supervision.

Thus, this method allows to achieve tooth preservation, increase the durability of the restoration of the missing crown of the tooth.

Example.

Patient S. 54

Complaints: the absence of the crown of the tooth 36, difficulty chewing food.

The development of this disease: previously 36 was under a ceramic-metal prosthesis.

Past and concomitant diseases: peptic ulcer of the duodenum.

External examination: face configuration is not changed; lymph nodes are painless, not enlarged.

Objectively: The mucous membrane of the oral cavity is pale pink. Orthognathic bite. The tooth cavity is filled with hypertrophied and inflamed gums.

On the roentgenogram: in the field of bifurcation of roots 36 there is perforation and rarefaction of bone tissue; the inter-root septum is destroyed by 1/2, the root canals are sealed to the apex, periapical changes are not observed.

DS: localized chronic periodontitis in the area of bifurcation of the roots of the 36 tooth of moderate severity.

Treatment: mechanically, using toothbrushes using toothpastes, clean the surface of the teeth that are next to the defect and determine their color according to the generally accepted VITA scale. After the control x-ray, anesthesia is performed and the preserved walls of the crown of the tooth are prepared at the level of the gums. Then carry out acid etching with acid. Acid is applied with a brush for an average of 15-20 seconds, then it is washed off with a stream of water when the saliva ejector and the vacuum cleaner are working. The cavity is dried with air, adhesive is applied, slightly with air for even distribution, re-applied and again flushed with air. Polymerized by a standard method for 10 s.

Composite material designed to restore the chewing groups of teeth form the walls of the crown of the tooth with a thickness of 1.5-2 mm to the equator. External and internal directed polymerization of the vestibular, oral, and then chewing surfaces is carried out. The polymerization technique allows to reduce the polymerization shrinkage, to improve the edge fit of the directional.

A gingivectomy is performed with excision of softened and demineralized root tissues in the bifurcation area and drug treatment of the wound.

To restore perforation in the area of root bifurcation, “CollapAn-L” is used in granules, which are placed in the wound.

Next, restore the walls of the crown of the tooth to the occlusal surface before contact with the antagonist teeth. To reinforce the crown of the restored tooth, a fine-mesh gilded mesh with a thickness of 0.4 mm is used. Using a plug-in, they create a shape that repeats the inner surface of the restored tooth cavity. A cup-shaped form is obtained in which the bottom is cut out to form a ring. This ring is used as a reinforcing element, which allows not only to strengthen the thin restored walls of the crown of the tooth, but also to further treat root perforation in the bifurcation area.

The mesh ring is removed after fitting from the cavity of the tooth and coated with two layers of adhesive, each polymerizing individually. The cavity is air dried, adhesive is applied. Lightly purge with air for even distribution, apply adhesive repeatedly and again purge with air. Polymerized by a standard method for 10 s. Apply a fluid composite to the reinforcing structure and the internal walls of the tooth, fix the ring on the inner surface of the restored crown of the tooth.

After applying “CollapAn-L” to the bifurcation area and the base of the root, the tooth is left under a bandage for a month.

A month later, under the control of x-rays, the degree of restoration of perforation in the area of root bifurcation is determined, “KollapAn-L” is added and left under a bandage.

After complete restoration of the perforation in the area of the root bifurcation, they begin the final restoration of the crown of the tooth. The temporary dressing is removed and the inner surface of the crown is prepared. The cavity is air dried, adhesive is applied. Lightly purge with air for even distribution, apply repeatedly and again purge with air. Polymerized by a standard method for 10 s. Next, the restoration of the crown part of the tooth is carried out using the restoration system for chewing teeth according to the instructions of the manufacturer. Before polishing and control polymerization, occlusal editing is performed. Final grinding and polishing is carried out on the 2nd day after polymerization.

During the year, the patient is taken to the dispensary: every three months they examine the oral cavity, professionally brush and polish their teeth. The treatment carried out by this method saves the tooth, prevents chips and chips. There were no complications after the restoration by the above method.

Sources of information

1. Application for patent EPO No. 0565899, A 61 C 5/00, 1993 - a close analogue.

2. Abolmasov. N.G., Abolmasov N.N., Bychkov V.A. Orthopedic dentistry. Moscow. 2002 .-- S.211-219.

3. Shargorodsky A.G. Inflammatory diseases of the maxillofacial region and neck. Moscow. 1985. - P.133.

4. Bazhanov N.N. Dentistry Moscow. 1984. - S.113.

5. Dunaev M.V., Bochkareva N.S. The use of the bioactive composite preparation “CollapAn-L” //. Bulletin of dentistry. 1998. No. 6.

6. Languev A.I., Demidenko F.T. The use of the material “CollapAn-L” in the practice of maxillofacial surgery. // Bulletin of dentistry 1997. No. 3.

7. Nikitin A.A., Kazantseva I.A. The study in the experiment and clinic of biocomposite material “KollapAn-L” //. Russian Dental Journal 2001. No. 3.

8. Pekker R.Ya. Diseases of the teeth and oral cavity. Moscow. 1980 .-- S.39-40.

9. Starobinsky I.M. Surgical dentistry of outpatient physician. Moscow. 1977. - S. 75-77.

Claims (1)

A method of tooth restoration with a missing crown part and root perforation in the bifurcation area using a reinforcing mesh ring, including forming the walls of the crown part, restoring the root perforation by repeatedly using CollapAn-A granules and the final restoration of the crown part, with the walls being formed after preliminary endodontic root canal treatment and preparation of the preserved walls of the coronal part at the gum level, the formation is carried out in stages - until the equator and to the occlusal surface, with an intermediate gingivectomy of the damaged root tissues, for the formation of the wall using a composite material and a ring fixed in the tooth cavity made of fine-mesh gilded mesh 0.4 mm thick, the outer surface of which corresponds to the inner side surface of the cavity of the formed tooth, and the diameter holes of the ring from the root side are selected from the condition of providing access to the perforation of the root.