RU2270636C1 - Complete removable dental maxillary prosthesis - Google Patents

Abstract

FIELD: medical engineering.

SUBSTANCE: device has double layer base and artificial teeth. Base layer, facing prosthesis bed having external edges positioned in active movable part of mucous membrane in making engagement to transition vault fold enveloping upper lip frenulum and buccal folds with closing valve being formed, is manufactured from superelastic titanium nickelide. The base layer compensating alveolar process bone tissue atrophy is manufactured from acrylic plastic.

EFFECT: accelerated adaptation period; improved strength characteristics.

19 dwg

Description

The invention relates to medicine, namely to orthopedic dentistry, and can be used for prosthetics of patients in the complete absence of teeth of the upper jaw.

A known denture containing a two-layer basis consisting of soft and hard layers, the peripheral edge of the soft layer of the prosthesis is made protruding beyond the hard layer, curved according to the shape of the transition folds and made with variable thickness, decreasing to the edge (SU 1554906 A1, 04/07/1990).

The known prosthesis has the following disadvantages: the thickness of the basis of acrylic plastics is 2.5 mm or more, which, due to the considerable mass, causes inconvenience to the patient and increases the adaptation time, in addition, the perception of temperature irritants is violated, since the basis of the prosthesis is made of a material that is poorly conducting the heat and insufficient strength of the prosthesis due to the fragility of the plastic reduces its useful life, and the lack of biomechanical compatibility with body tissues in basic plastics does not contribute to a uniform distribution chewing pressure on the prosthetic bed, which leads to its atrophy.

The objective of the proposed complete removable denture of the upper jaw is to reduce the timing of adaptation, increase the strength properties, reduce the processes of atrophy of the tissues of the prosthetic bed due to the uniform distribution of chewing pressure.

The problem is achieved in that in a full denture, consisting of a two-layer basis and artificial teeth, the new is that the base layer facing the prosthetic bed, the outer edges of which are located in the active-moving part of the mucous membrane, in contact with the dome of the transition fold enveloping the bridle of the lip and buccal folds with the formation of a closing valve is made of superelastic titanium nickelide, and the base layer compensating for atrophy of the bone tissue of the alveolar process is made of acrylic astmassy.

Figure 1 shows a transverse section of the prosthesis.

A full removable denture of the upper jaw contains a two-layer basis consisting of a superelastic layer 1 made of titanium nickelide, a layer 2 of acrylic plastic and artificial teeth 3. The outer edges of the superelastic layer are located in the active-movable part of the mucous membrane, in contact with the dome of the transition fold bend around the bridle of the lip and buccal folds with the formation of a closing valve 4.

The prosthesis is made as follows.

Using an individual spoon, a functionally absorbable impression is obtained, a working model is made of high-strength gypsum, the boundaries of the basis are marked out, the working model is duplicated and a copy of it is made of refractory mass, a wax reproduction of the metal base is modeled, a standard clasp wax plate 0.3 mm thick having a microrelief the mucous membrane of the prosthetic bed, soften and squeeze on a refractory model, while the wax covers it from the palatine and vestibular surfaces, remove excess wax according to To these boundaries, along the edge of the wax blank and on the palatine side of the metal base, a wax strip is modeled up to 2 mm wide as a “base limiter”, which provides a sufficient thickness of the base plastic edge and a smooth transition of the plastic part of the prosthesis to the metal, preventing injury during operation of the prosthesis mucous membrane of the tongue. To connect plastic with a metal base, arcuate staples are modeled in the projection of the top of the alveolar ridge of the model from wax blanks with a diameter of 0.3 mm and a height of 2 mm at a distance of 5 mm from each other, create a gating system, make a casting mold, wax is melted at a temperature of 300 ° C in for 30 minutes, the mold is calcined to a temperature of 950 ° C for 30-40 minutes, after which the temperature is increased to 1230-1250 ° C for 20-30 seconds and the entire crucible system is rotated with a flask. Under the action of centrifugal force, the metal fills the flask, contributing to a uniform casting structure due to the uniform compaction of the metal throughout the volume. After casting is completed, the flask is cooled to room temperature, the casting is removed from the flask, cleaned in a sandblasting apparatus, the sprues are removed, and polished. Then fit a metal frame in the oral cavity. Next, they simulate a wax analogue that compensates for atrophy of the bone tissue of the alveolar process, and artificial teeth are staged. The simulated prosthesis is cast into a cuvette consisting of two parts, a bottom and a cover. The cuvette is equipped with grooves and protrusions for fixing its detachable parts. In the lower part of the cuvette, the model is plaster with the prosthesis in an upright position, then the upper part of the cuvette is installed and filled with liquid gypsum on a vibrating table. The cuvette is maintained until the gypsum has completely hardened under pressure. After removing the wax by evaporation, the cuvette is opened, the surfaces of the gypsum molds are isolated with a separation varnish. The upper part of the cuvette is filled with pasty-like acrylic plastic, the halves of the cuvette are joined and pressed in the vertical direction. The plastic is polymerized. The prosthesis is removed from the cuvette. Grinding and polishing are carried out, after which the prosthesis is fitted in the oral cavity.

Example 1. Patient K., 56 years old, turned to the clinic of orthopedic dentistry with complaints of a lack of teeth in the upper jaw, the inability to chew food, an aesthetic defect.

From the anamnesis. The teeth of the upper and lower jaw were removed at different times due to complications of caries and chronic periodontitis. In order to restore chewing effectiveness, there were three attempts to manufacture dentures; the effect did not occur.

An external examination revealed a decrease in the height of the lower part of the face, the severity of the nasolabial and chin folds, the omission of the corners of the mouth.

From the side of the vestibule and the oral cavity proper, the complete absence of teeth of the upper and lower jaw was determined, the type of toothless upper jaw according to Schroeder I, the lower according to Keller I, the shape of the alveolar slope of the upper and lower jaws was sheer, the palatine arch was deep, the alveolar tubercles of the upper jaw were pronounced, the relationship the alveolar process of the upper jaw and the alveolar part of the lower jaw in the sagittal plane orthognathic, in the transversal - the alveolar part of the lower jaw corresponded to the alveolar process the upper jaw, the mucous membrane of the jaws of normal density is not atrophied, the labial and lingual frenums, the cheek folds are attached close to the apex of the alveolar process of the upper jaw and the alveolar part of the lower jaw.

DS: Complete secondary adentia of the upper and lower jaws.

A full removable denture consisting of a two-layer base and artificial teeth was made to the patient in the upper jaw. The base layer facing the prosthetic bed, the outer edges of which are located in the active-movable part of the mucous membrane, in contact with the dome of the transition folds, the lips enveloping the frenulum and buccal folds with the formation of a closing valve, are made of superelastic titanium nickelide, and the base layer compensating for bone atrophy tissue of the alveolar ridge, made of acrylic plastic. A ceramic-metal denture based on implants was made on the lower jaw.

Dynamic observation showed that adaptation to the maxillary prosthesis proceeded within 3 days, after which the patient noted a satisfactory functional state of the dentition. When viewed after 2 years, the patient did not show complaints, the condition of the prosthesis is satisfactory. A morphological study of the mucous membrane of the prosthetic bed performed before and after prosthetics showed no signs of inflammation and atrophy.

Figure 2 - patient K. to orthopedic treatment (direct projection).

Figure 3 - patient K. to orthopedic treatment (right lateral projection).

Figure 4 - the state of the oral cavity of the patient K. before orthopedic treatment.

Figure 5 - full removable denture of the upper jaw of patient K. (upper anterolateral projection).

Figure 6 - full removable denture of the upper jaw (posterior upper projection).

In Fig.7 - a complete removable denture of the upper jaw in the oral cavity of the patient K. in a state of central occlusion.

On Fig - a complete removable denture of the upper jaw in the oral cavity of the patient K. with an open mouth.

In Fig.9 - patient K. after orthopedic treatment (direct projection).

Figure 10 - patient K. after orthopedic treatment (right lateral projection).

Example 2. Patient T., 60 years old, when contacting the clinic of orthopedic dentistry complained of the absence of teeth of the upper jaw, the inability to chew food, an aesthetic defect.

From the anamnesis. The teeth on the upper and lower jaw were removed at different times due to complications of caries and chronic periodontitis. In 2000, the dental implantation was performed on the upper and lower jaw and fixed plastic prostheses were made. After a year, the orthopedic design on the upper jaw was removed with dental implants in connection with peri-implantitis.

An external examination revealed a decrease in the height of the lower part of the face, the severity of the nasolabial and chin folds, the omission of the corners of the mouth.

From the vestibule and the oral cavity proper, the complete absence of teeth of the upper jaw was determined, the type of toothless upper jaw was determined by Schroeder III, the shape of the alveolar slope of the upper jaw was deflated, the palatine arch was flat, the alveolar tubercles of the upper jaw were not expressed, the mucous membrane was thinned, atrophic, labial frenum, buccal folds attached close to the top of the alveolar process of the upper jaw. In the lower jaw, the state of dental implants and orthopedic design is satisfactory.

DS: Complete secondary adentia of the upper jaw, condition after dental implantation and dental prosthetics of the lower jaw.

A full removable denture was made to the patient in the upper jaw according to the developed technology.

When viewed after 2.5 years, the patient did not complain, functional disorders of the dentition were not revealed, reviews about the prosthesis are satisfactory. A pathological study of the mucous membrane of the prosthetic bed showed a lack of progression of atrophy.

In Fig.11 - patient T. before orthopedic treatment (direct projection).

On Fig - patient T. before orthopedic treatment (right lateral projection).

In Fig.13 - the state of the oral cavity of the patient T. before orthopedic treatment.

On Fig - full removable denture of the upper jaw of patient T. (lower anterolateral projection).

On Fig - full removable denture of the upper jaw of patient T. (posterolateral projection).

In Fig.16 - a complete removable denture of the upper jaw in the oral cavity of the patient T. in a state of central occlusion.

On Fig - a complete removable denture of the upper jaw in the oral cavity of the patient T. with an open mouth.

On Fig - patient T. after orthopedic treatment (direct projection).

In Fig.19 - patient T. after orthopedic treatment (right lateral projection).

The technical result of the invention is to reduce the adaptation time and increase the strength properties of the prosthesis by reducing the thickness of the superelastic base layer to 0.3-0.5 mm, which makes it possible to obtain an orthopedic design that is functionally adapted for the patient while maintaining the temperature perception of the tissues of the prosthetic bed, since The basis of this prosthesis has a higher thermal conductivity compared to plastic. The features of this design do not provide for the contact of the plastic part with the tissues of the prosthetic bed, and the shock-absorbing function of titanium nickelide due to the elastic properties contributes to an even distribution of chewing pressure on the prosthetic bed, which prevents its atrophy. The absence of macroshifts on the contact surface of the prosthesis with supporting tissues eliminates the inflammatory reaction and promotes the distribution of chewing load on low-, medium- and well-compliant tissues, thereby increasing the volume of supporting structures.

Claims (1)

A complete removable denture of the upper jaw, consisting of a two-layer base and artificial teeth, characterized in that the base layer facing the prosthetic bed, the outer edges of which are located in the active-movable part of the mucous membrane, are in contact with the dome of the transition fold, envelopes the bridle of the lips and buccal folds with the formation of a closing valve, made of superelastic titanium nickelide, and the base layer compensating for atrophy of the bone tissue of the alveolar process is made of acrylic plastic.

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