RU2281058C1 - Denture - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: denture can be used for patients having damaged jaw and teeth available in healthy part of gum. Denture has combined basis. Part of basis turned to denture bed with relief of damage and supporting-holding aids, which are fixed at natural teeth, is made unit-cast of super-elastic titanium nickelide as well as of plastic parts, substituting defect of body of top or lower jaw and defect of their alveolar section, and artificial teeth. Weight of orthopedic structure is reduced due to reduction in basis to 0,3 mm and due to usage titanium nickelide-based alloy, which has 1,25 smaller weight that acrylic plastic at the same thickness. Tissues of denture bed have the same temperature perception due to the fact that the alloy has higher heat conductivity comparing to acrylic plastic. Denture follows the shape of denture bed completely; they follow intricate relief of defect to exclude contact of plastic with tissues of denture bed. Titanium nickelide has minimal shrinkage at casting.

EFFECT: improved reliability; higher comfort.

14 dwg, 2 ex

Description

The invention relates to medicine, namely to orthopedic dentistry, and can be used for prosthetics of patients with jaw defects in the presence of teeth on a healthy part of the jaw.

The closest technical solution is to replace the obstructive dentoalveolar denture, consisting of a combined base in the form of a cast metal frame with support and restraints made of cobalt-chrome alloy and acrylic plastic, rigidly interconnected by means of retention elements, plastic parts replacing the body and alveolar bone of the jaw, artificial teeth (see Kostur B.K., Minyaev V.A. Maxillofacial prosthetics. - L.: Medicine, 1985. - P.57-58) [1].

The disadvantages of the known prosthesis are the significant weight of the structure, which causes inconvenience to the patient and increases the adaptation time, and the lack of biomechanical and biochemical compatibility with the body tissues of acrylic plastic and cobalt-chrome alloy causes traumatic stress in the periodontium of the abutment teeth, their overload and subsequent pathological mobility, when the plastic part is sutured. Inaccurate matching of the base with the prosthetic bed occurs with a metal frame; uneven distribution e chewing pressure and, as a consequence, the prosthetic tissue atrophy bed.

The task of the invention is to reduce the weight of the prosthesis and improve its quality characteristics.

The problem is achieved in that in a denture that consists of a combined base, supporting and holding devices fixed on natural teeth, plastic parts that replace a defect in the upper or lower jaw body and a defect in their alveolar bone, artificial teeth, the new is that the base, facing the prosthetic bed with a flaw relief and supporting and restraining devices, is made of solid cast of titanium nickelide superelastic.

Figure 1 shows a schematic drawing of a transverse section of the prosthesis on a plaster model.

Figure 2 - the state of the oral cavity of a patient R. before orthopedic treatment.

Figure 3 - x-ray of patient R. before orthopedic treatment.

Figure 4 - denture of the upper jaw of the patient R. (antero-upper-lateral projection).

Figure 5 - denture of the upper jaw in the oral cavity of the patient R. in the position of central occlusion.

Figure 6 - denture of the upper jaw in the oral cavity of a patient R. with an open mouth.

In Fig.7 - x-ray of a patient R. with a dentition in the oral cavity.

On Fig - the state of the oral cavity of the patient S. before orthopedic treatment in the position of central occlusion.

In Fig.9 - the state of the oral cavity of the patient S. before orthopedic treatment with an open mouth.

Figure 10 - orthopantomogram patient S. before orthopedic treatment.

Figure 11 - denture of the lower jaw of the patient Sh. (Lower-anterior-lateral projection).

On Fig - denture of the lower jaw of the patient S. (upper-front-lateral projection).

In Fig.13 - denture of the lower jaw in the oral cavity of the patient S. in the position of central occlusion.

On Fig - denture of the lower jaw in the oral cavity of the patient S. with an open mouth.

The dentition consists of a combined basis, with part 1 of the basis facing the prosthetic bed with a flaw relief and supporting and retaining devices fixed on natural teeth 2, made of solid titanium nickelide, as well as plastic parts, replacing the defect of the upper or lower body jaw 3 and a defect in their alveolar bone 4, and artificial teeth 5. A plaster model of a defect in the upper jaw 6.

The prosthesis is made as follows.

Using an individual spoon, an imprint of the defect 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 supporting and holding elements and the metal part of the basis are created, modeling with the palatine (lingual) and vestibular sides a wax strip up to 2 mm wide according to the type of “base limiter”, which provides sufficient thickness and a smooth transition of the plastic part of the prosthesis into the metal. To connect the plastic with the base, arcuate staples are modeled from wax blanks with a diameter of 0.3 mm, 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 for 30 minutes, a casting mold 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 rotate the entire crucible system with flask. Under the action of centrifugal force, the molten titanium nickelide alloy fills the flask, contributing to a uniform casting structure due to the uniform compaction of the metal throughout the volume. The flask is cooled to room temperature, the casting is removed from the flask, cleaned in a sandblasting apparatus, the sprues are cut, polished. The metal part of the basis is fitted in the oral cavity, on which an analog of the alveolar process is modeled from the wax and artificial teeth are staged. The simulated prosthesis is cast into a cuvette consisting of two parts, a bottom and a cover. In the lower part of the cuvette, a model with a prosthesis is plastered in an upright position, the upper part of the cuvette is installed and filled with liquid gypsum on a vibrating table, and the gypsum is fully hardened under pressure. After removing the wax by evaporation, the cuvette is opened, the surface of the gypsum form is isolated with a separating 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, polished and polished, after which the prosthesis is fitted in the oral cavity.

Example 1. Patient R., 49 years old, turned to the orthopedic dentistry clinic with complaints of a defect in the alveolar process and the frontal body of the right and left upper jaws, retraction of the middle zone of the face, difficulty chewing food and getting it into the nasal cavity, slurred, nasal speech.

From the anamnesis: 2 years ago a gunshot wound, as a result of which a defect in the alveolar process and the body of the frontal part of the right and left upper jaws, upper lip, and skin-cartilaginous part of the nose was formed. The upper lip is restored by local tissues, the skin and cartilage of the nose by local tissues and an allograft. Repeated attempts at surgical reconstruction of the alveolar process and the body of the upper jaw did not lead to the desired result. In order to restore impaired functions and eliminate aesthetic deficiencies, there were twice attempts to make a denture of the denture from acrylic plastic, the effect did not occur.

Objectively: violation of the face configuration due to cicatricial deformity and retraction of the soft tissues of the upper lip and nose. In the projection of the missing 13, 12, 11, 21, 22, 23, 24 teeth, an arch-shaped defect of the alveolar process and the frontal body of the right and left upper jaws was detected, communicating with the nasal cavity through a slit-like space of 20 × 5 mm in size. The mucous membrane covering the bone defect is scarred. Dental formula: 17, 16, 26, 31, 32, 33, 34, 35, 37, 38, 43, 45, 47. Defects in the dentition of the lower jaw are partially restored by stamped-soldered metal dentures.

DS: Gunshot defect in the alveolar ridge, the body of the right and left upper jaws in the projection of the missing 13, 12, 11, 21, 22, 23, 24 teeth, oronasal anastomosis, partial secondary adentia of the upper jaw.

A maxillofacial prosthesis with supporting and retaining clasps for 17, 16 and 26 teeth, which were previously coated with artificial solid cast metal crowns, according to the developed technology, was made to the patient in the upper jaw.

Dynamic observation showed that adaptation to the prosthesis took three days, after which the patient noted a satisfactory functional state of the dentition and restoration of speech function. When viewed after 3 years, the patient did not show complaints, the condition of the prosthesis is satisfactory. A morphological study of the biopsy material of the mucous membrane of the prosthetic bed, carried out before and at the indicated time after prosthetics, showed the absence of signs of inflammation and progression of atrophy.

Example 2. Patient S., 54 years old, turned to the orthopedic dentistry clinic with complaints of a defect in the alveolar bone and lower jaw body on the left, difficulty chewing food, and an aesthetic face defect.

From the anamnesis: 1.5 years ago, for osteogenic sarcoma, a resection of the anterior lower part of the branch, body and alveolar process of the lower jaw up to 32 teeth, a course of radiation therapy was performed.

Objectively: soft tissue retraction in the left parotid chewing and buccal regions. When opening the mouth, a large fragment of the lower jaw moves to the left. In the region of the lower jaw to the right of the 32 tooth, a defect in the alveolar bone, body and anteroposterior defect is determined. The mucous membrane of the oral cavity in the area of the flaw is scarred. Dental formula: 11, 12, 13, 14, 16, 17, 18, 21, 22, 23, 24, 25, 27, 31, 32, 41, 42, 43, 44, 45, 47, 48.

DS: Osteogenic sarcoma of the lower jaw on the right, condition after surgical and radiation treatment. Defect of the front-lower part of the branch, body and alveolar process of the lower jaw up to 32 teeth, partial secondary adentia of the lower jaw.

A denture with a mandibular prosthesis with supporting and holding clasps for 48, 47, 45, 44, 32 teeth was manufactured according to the developed technology.

Dynamic observation showed that adaptation to the prosthesis took seven days, after which the patient noted a satisfactory functional state of the dentition. When viewed after 3 years, the patient did not show complaints, the condition of the prosthesis is satisfactory. A pathomorphological study of the biopsy material of the mucous membrane of the prosthetic bed before and at the indicated time after prosthetics showed no signs of progression of atrophy.

Using this technology, 14 patients (10 men and 4 women) aged 27 to 56 years were orthopedically treated. In three cases, the defects of the lower jaw were restored, in the rest - the upper. In all cases, a satisfactory functional and cosmetic result was obtained. Adaptation to prostheses took 3-7 days. Subsequent clinical observations at 6, 12, 24, 36 months after prosthetics did not reveal signs of functional impairment. Analysis of the biopsy material of the mucous membrane of the prosthetic bed before and 36 months after orthopedic treatment allowed us to conclude that there are no inflammatory phenomena and signs of progression of atrophy.

The technical result of the invention is to reduce the weight of the orthopedic structure by reducing the thickness of the base to 0.3 mm and using an alloy based on titanium nickelide, which is 1.25 times less weight than acrylic plastic at this thickness, maintaining the temperature perception of the tissues of the prosthetic bed, so as titanium nickelide has a higher thermal conductivity in comparison with acrylic plastic, the high accuracy of matching the prosthesis to the prosthetic bed, due to the peculiarities of the manufacturing technology of the prosthesis base, in the area of the defect repeating the complex relief of the flaw, excluding the contact of the plastic with the tissues of the prosthetic bed, and minimal shrinkage when casting titanium nickelide.

Claims (1)

Maxillofacial prosthesis, consisting of a combined basis, supporting and holding devices fixed on natural teeth, plastic parts that replace the defect of the upper or lower jaw body and the defect of their alveolar process, artificial teeth, characterized in that the part of the base facing the prosthetic bed with relief flawed and supporting and holding devices, made of solid cast of superelastic titanium nickelide.

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