RU2283062C1 - Method for restoring lateral tooth having no crown part and perforated vertically moved root in bifurcation or trifurcation area and destroyed interradicular septum - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves applying endodontic root canal therapy, treating cavities in each canal being not deeper than 1/2-1/3 times corresponding canal length after preparing demineralized tissues of cervical one-third of the root and interradicular septum with flat surface being formed, forming walls from macro-filled composite material at the level of equator with arisen crown part being formed next using gauze crown carcass fixed in the crown cavity with glass ionomer cement and additionally attached to the root by means of at least one immobilizing pin and three additional pins prefabricated from gold-plated metal wires. The pins are mounted in canal cavities through crown carcass perforation holes and on internal surface of crown carcass bottom part. Intraradicular parts of the immobilizing wire pin manufactured as wire braids are fixed in canal cavities of roots to be united. Crown part walls are reconstructed from equator to occlusion surface using macro-filled composite material with damping cavity built at equator level. The crown part formed by restored walls and damping cavity surface is reinforced with the second prefabricated crown carcass fixed by means of glass ionomer cement and its cavity being filled with macro-filled composite material to the occlusion surface level. Tubercles are rebuilt using macro-filled composite material.

EFFECT: high strength and vertical displacement stability.

6 cl

Description

The invention relates to medicine and can be used for prosthetics of the posterior teeth by the method of reinforcing dentistry.

The invention is aimed at preserving a root in which the hard tissues of the cervical third are destroyed and the bifurcation or trifurcation region is perforated, and the use of such a root for restoration of the lateral tooth and restoration of its full function.

The inventive method of restoration is shown in the case of eliminating the combined defect of the crown and root parts of the lateral tooth, namely when:

- complete destruction of the crown part below the level of the gums;

- destruction of the hard tissues of the cervical third of the root with partial preservation of the walls of the root;

- perforation of the root in the area of bifurcation or trifurcation;

- destruction of the hard tissues of the interroot septum by no more than 1/3 of its height;

- vertical movement of the preserved root part of the tooth.

With such a defect, the preserved root part is weakened due to the destruction of the hard tissues of the cervical third of the root.

The roots of the preserved root part are separated by perforation in the area of bifurcation or trifurcation.

The roots are united only by the thinned preserved walls of the cervical third of the root.

Due to the vertical movement of the preserved root part of the tooth towards the gum, the height of the cervical third of the root is reduced and, accordingly, the height of the preserved walls of the cervical third of the root is reduced.

Thus, the possibility of prosthetics of the lateral tooth with a reinforced composite crown is complicated on the one hand by a weakened and disconnected root, and on the other hand, by a decrease in the height of the walls of the cervical third of the root and the destruction of the interroot septum.

The main task in the restoration of such teeth is to block the defect of the inter-root septum and to restore and harden the root in order to use it for restoration of the crown.

The prior art.

The prior art method of tooth restoration with root perforation in the field of bifurcation using reinforcement according to the application for invention No. 2003102986 of 02/03/2003 (decision to grant a patent of 04/20/2005). When implementing this method, the demineralized tissues of the root base are removed, as well as in the bifurcation area, drug treatment is performed, the root base area and the bifurcation area are filled with “Kollapan-L” and left under a temporary dressing until the root perforation is completely restored. After restoration of the bifurcation region, the cavity formed by the root base and the restored walls of the crown part is reinforced with a metal gilded mesh preformed in accordance with the shape of the reinforcement surface.

Tooth restoration in a known manner is a lengthy process, due to the time of hard tissue regeneration in the bifurcation area, which does not always meet the patient's requirements.

As follows from the practice of prosthetics, in the presence of mobility and destruction of the root by more than 1/4 of its length or defect of any of the walls of the root equal to or greater than 1/4 of the root, because of the risk of a fracture of the root or its walls, it is impossible to form base of the root cushioning cavity to hold the artificial crown.

In the case of applying the known method and known means for eliminating the aforementioned combined defect of the lateral tooth, tooth restoration will either not be carried out, or the strength of the restoration will not be ensured.

Thus, in the case of applying the known method, the goal of preserving the weakened vertically displaced root, disconnected by perforation in the bifurcation or trifurcation region, and using such a root for “high-quality” tooth restoration will not be achieved.

When implementing the inventive method, a strong connection of the root and crown part of the tooth is ensured, the time of tooth restoration and restoration of its function is significantly reduced. The difference between the claimed method and the known method consists in a fundamentally different approach to stabilizing and restoring the strength of a disconnected and weakened vertically displaced root and to ensure strong retention of the artificial crown based on such a root.

Weakened, disconnected roots of a multi-root tooth are immobilized and stabilized, fixing relative to each other and relatively stable inter-root septum by means of a reinforcing mesh crown frame, immobilizing wire and additional pins.

The mesh crown frame using glass ionomer cement is fixed in the crown cavity formed by the flat surface of the prepared cervical third of the root, including the bifurcation or trifurcation region, and the prepared interroot septum, and the walls of the crown part of the tooth restored to the equator level.

Then this frame is mechanically fixed on the root with the help of immobilizing wire pins and additional pins. Depending on the clinical situation, one, two or three immobilizing wire pins and three additional pins are used, which are fixed in the cavity cavities of the combined roots through perforations of the crown frame.

The advantages of using a crown frame in conjunction with immobilizing and additional pins are manifested:

- in strengthening the hard tissues of the cervical third of the root, its walls and base, and the hard tissues of the interroot septum;

- in combining the root separated by perforation;

- in hardening the perforated bifurcation or trifurcation region;

- in the exclusion of a fracture of the walls of the root;

- in stabilization of the root due to fixation with respect to the interroot septum;

- in ensuring the correct occlusal relationship with the antagonist and the exclusion of the progression of root movement;

- in the redistribution of the functional load along the entire surface of the reinforcement, including directly on the interroot partition;

- in ensuring the result of hardening and stabilization of the weakened root, regardless of the anatomy of its channels (their diameter, curvature, length);

- the implementation of the restoration of the crown part of the lateral tooth on the basis of a stabilized and immobilized root using a second reinforcing mesh crown frame.

As a result, the root immobilized by the claimed method becomes more durable and stable compared to the restoration in a known manner.

In addition, to ensure the longevity of the restoration during the implementation of the claimed method, multilevel reinforcement of the root and crown of the tooth is used.

Using the first mesh crown frame, the flat surface of the prepared cervical third of the root is reinforced, including the area of bifurcation or trifurcation, and the prepared inter-root septum, as well as the walls of the crown of the tooth at the equator level. In this case, the bifurcation or trifurcation region and the surface of the interroot septum are covered with glass ionomer cement, the mesh of the bottom of the first root frame, on the inner surface of which the wires of the intermediate supercanal part of the immobilizing pins and wire or the mesh of the root part of the additional pins are fixed.

Using the second mesh crown frame, the walls from the equator to the occlusal surface and the surface of the cushioning cavity formed in the equator area are reinforced at the crown of the tooth.

The surface reinforcement of the cushioning cavity of the tooth crown provides an additional redistribution of the vertical component of the masticatory load.

Thus, the lateral tooth restored by the claimed method is a monolithic grid-composite structure with a reinforced and stabilized root.

The need to use two mesh frames is due to the destruction of the cervical third of the root, burdened by vertical movement of the root. As already noted above, with such a root defect it is not possible to form a cushioning cavity on its basis for firmly holding one frame, similar to the above-mentioned known method.

The inventive method of restoration of the lateral tooth in the event of complete destruction of its crown, perforation of a vertically displaced root in the area of bifurcation or trifurcation and destruction of the interroot septum is simple to implement and can be implemented on an outpatient basis in one visit.

The technical result achieved during the implementation of the method is to ensure the stability and strength of the vertically displaced root with perforation in the bifurcation or trifurcation region and the destruction of the interroot septum, as well as to simplify the procedure for restoration of the posterior teeth.

SUMMARY OF THE INVENTION

The inventive method is aimed at eliminating the combined defect of the lateral tooth, including the complete destruction of the crown part, the destruction of the hard tissues of the cervical third of the root with perforation in the bifurcation or trifurcation region, the destruction of the interroot septum no more than 1/3 of its height, burdened by vertical movement of the root.

Perforation in the area of bifurcation or trifurcation destroyed the natural connection between the roots.

As a result, the roots of the preserved root part of the tooth are united only by the preserved thin walls of the cervical third of the root.

Due to the fragmentation of the roots and a significant loss of hard tissues, the preserved root part is weakened.

The main task in eliminating the combined defect of the claimed method is:

- in the immobilization of disparate root perforation;

- in fixing the movable root with respect to the stable inter-root septum;

- in the restoration and reinforcement of the bifurcation or trifurcation region;

- in creating a structure that would ensure a firm fixation of the crown and root parts of the restored tooth.

As a result, the disconnected roots will not only be fixed relative to each other, but also fixed in relation to the interroot septum.

The moving root will be stabilized.

The probability of root mobility progression is excluded.

The height of the restored crown of the tooth will be formed taking into account the correct occlusal contact with the antagonist.

This method involves preliminary endodontic treatment. Root canals should be sealed to the apex 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.

Conduct a control x-ray. After the control radiographs, they begin to restore the destroyed walls of the cervical third of the root. For this, the demineralized tissues of the cervical third of the root and the inter-root septum are prepared, forming the bottom in the form of a flat surface.

In the root canals form cavities with a depth of not more than 1 / 3-1 / 2 of the root length, depending on the clinical situation.

An acid etching of the base of the cervical third of the root and cavities formed in the channels is carried out to create a microrelief.

The acid is applied with a brush for an average of 15-20 seconds, then the acid is washed off with a stream of water and the etched surfaces are dried with air.

After acid etching and adhesive treatment using macro-profiled composite rollers, the walls of the cervical third of the root are formed with a thickness of 1.5-2 mm at the level of the gums.

Next, they begin to manufacture at least one reinforcing immobilizing wire pin, three additional wire pins and a mesh crown frame.

For the manufacture of a reinforcing immobilizing wire pin using a gold-plated metal mesh with a thickness of 0.6 mm

Wire is released from the mesh.

A number of wires, the number of which is selected taking into account the smallest diameter of the root canal, is bent in half and twisted.

In this way, one of the intra-channel parts of the pin is formed, the length of which is not more than the depth of the previously formed channel cavity of the corresponding root.

Having formed one of the intertwined intracanal parts of the pin, the wires of the intermediate supercanal part of the pin, the length of which is not less than the distance between the channels of the immobilized roots, are not intertwined.

And then the wires are again intertwined, forming the second intra-channel part of the pin, designed to be fixed in the channel of another root in order to combine the roots separated by perforation. The length of this part of the pin is also chosen no more than the depth of the cavity formed in the channel of the corresponding root.

The intertwined intra-channel parts of the pin are bent with respect to the supra-channel intermediate part, taking into account the direction of the channels of their fixation.

The thus formed reinforcing immobilizing wire pin consists of two intra-channel parts in the form of interwoven wires and a super-channel intermediate part of the same, but not interwoven wires.

Reinforcing immobilizing wire pins are made taking into account the anatomical and topographic features of the posterior teeth.

The intracanal portions of the pins are further flattened to flatten them.

When fixing in the cavity of the channels of the corresponding roots, the flat surfaces of the intra-channel parts of the pins should fit snugly against the surface of the cavity of the channels of the joined roots.

When perforating in the area of lower molar bifurcation, one or two immobilizing pins are made to immobilize the mesial and distal roots, depending on the clinical situation.

In the case of using one immobilizing pin, its intracanal parts are fixed in the channel of the distal root and in one of the channels of the mesial root.

In the case of using two immobilizing wire pins, one pin is fixed respectively in the channel of the distal root and in the mesial-buccal channel of the mesial root, and the other in the channel of the distal root and in the mesial-lingual channel of the mesial root.

Thus, each immobilizing wire pin with one intracanal part is fixed in the channel of the distal root (the largest channel), and the second intracanal part, respectively, in the mesial-buccal and mesial-lingual channels of the mesial root.

When perforating in the area of trifurcation of the upper molars, one or two immobilizing wire pins are also made to immobilize the buccal and palatine roots, which are installed in the same way.

In the case of using two pins, one pin is fixed respectively in the palatine root canal and in the mesial-buccal canal of the buccal root, and the other in the palatine root canal and in the distal-buccal canal of the buccal root.

Thus, each immobilizing wire pin with one intracanal part is fixed in the palatine root canal (the largest canal), and the second intracanal part is respectively in the mesial-buccal and distal-buccal canals of the buccal root.

In the case of using three immobilizing pins, their intracanal parts are fixed in pairs in the cavities of the channels of the combined roots.

Then, from the same wire mesh, three additional pins are made to fix the mesh crown frame to the root. The use of additional pins allows you to create a monolithic crown-root structure with additional mechanical connection of the crown and root parts of the tooth.

In particular, during the restoration of the upper molars, three twisted or three twisted wire pins formed from the same wires released from the gold-plated metal mesh as the immobilizing wire pins are used for additional fixation of the crown frame.

Each of the pins form an intra-root part. To form the inner root portion of the twisted pin, at least two wires are bent in half and intertwined, starting from the bend. To form the inner root portion of the twisted pin, at least two wires are twisted together. The length of the root portion of the pin is not more than the depth of the cavity of the corresponding fixation channel.

The intra-root parts of the twisted or twisted wire pins should be installed without voltage in the cavities of the fixation channels together with the intra-channel parts of the immobilizing pins.

The twisted or twisted intra-root part of the pin passes into the free wires of its root part, from which the head of the pin is formed. The length of the wires remaining unbound, choose at least the size of the depth of the cavity of the corresponding fixation channel.

In particular, during the restoration of the lower molars, two twisted or twisted wire pins preformed in the above manner and one flat wire pin are used for additional fixation of the crown frame. The mesh pin is formed from a gold-plated metal mesh. The grid is bent in half. Moreover, the width and length of the resulting mesh rectangle is selected, respectively, no more than the size of the distal root canal in the buccal-lingual direction and at least twice the depth of the distal root canal cavity.

Then form the root portion of the flat mesh pin. For this, corners are cut along the length of the grid rectangle on both sides. The length of the slice is not more than the size of the depth of the cavity of the canal of the distal root.

The formed intra-root part of the flat mesh pin should be placed without tension in the cavity of the distal root canal in the buccal-lingual direction, and the remaining root part of the grid rectangle should be placed in the cavity fixed on the base of the root of the crown frame.

Depending on the diameter of the cavities of the channels, the intra-root parts of the twisted or twisted pins can also be flattened to give them a flat shape.

Thus, at least one immobilizing wire pin and three additional pins are formed.

Carry out the fitting of immobilizing and additional pins. The pins are installed alternately in the cavities formed in the channels of the corresponding roots, in the above order.

The pins must be installed without voltage.

After fitting, the immobilizing pins and additional pins are removed from the cavity cavities.

Next, proceed to the formation of a mesh crown frame.

From a metal gilded mesh 0.4 mm thick, a square is cut out, the size of which is chosen from the condition of fixing the crown frame at the level of the equator of the tooth.

Initially, the bottom of the crown frame is formed. Starting from the center of the grid, a flat bottom of the frame is formed corresponding to the flat surface of the prepared cervical third of the root and the prepared interroot septum. The excess mesh is bent toward the center for the convenience of fitting the bottom of a partially formed crown frame at the root base. Carry out his fitting. After fitting, the frame is removed.

Then proceed to the restoration of the destroyed walls of the crown of the tooth.

The walls of the coronal part are formed from a macro profiled composite with a thickness of 1.5-2 mm to the level of the equator.

The reconstructed walls of the coronal part together with the previously formed flat surface of the prepared cervical third of the root, including the bifurcation or trifurcation region, and the prepared interroot septum form a crown cavity with a height at the equator level. Then, with the help of a plug-in, the walls of the crown part of the mesh crown frame are finally formed to the level of the equator in accordance with the shape of the inner surface of the formed crown cavity of the tooth. A repeated fitting and correction of the crown frame in the coronal cavity of the restored tooth is carried out. After fitting, the frame is removed.

The cavities of the root canals are covered with cotton.

An adhesive is applied to the inner surface of the coronal cavity. Next, the adhesive is slightly flushed with air for even distribution, applied repeatedly and again flushed with air, polymerized by the standard method for 10 seconds.

After adhesive treatment, the reinforcing mesh crown frame is fixed in the coronal cavity using glass ionomer cement. At the same time, the prepared flat surface of the interroot septum is closed with glass ionomer cement.

Thus, using the mesh crown frame, the root base is reinforced, including the flat surface of the interroot septum, and the walls of the crown of the tooth at the equator level. The mesh of the frame strengthens the tissues of the surfaces to be reinforced, unites disjoint roots, is a mechanical link connecting the cervical third of the root, the interroot septum and the crown of the tooth.

Then the root part of the fixed mesh crown frame is perforated in the projection of the canal cavities. Cotton is removed from the cavities.

Carry out a second fitting and correction of the immobilizing pins and additional, installing them in the cavities of the corresponding channels through the perforation of the crown frame.

After fitting, the immobilizing wire pins and additional pins are removed.

The cavity of the channels is filled with glass ionomer cement. Glass ionomer cement is applied to the inner surface of the bottom of the mesh crown frame. Depending on the clinical situation, at least one immobilizing pin is installed according to the scheme indicated above.

In this case, the wires of the supracanal intermediate part of the immobilizing pin, when fixed, are distributed on the inner surface of the bottom part of the mesh crown frame. In the case of using two or three immobilizing wire pins, each subsequent pin is appropriately set.

Simultaneously with the immobilizing pins, three additional pins are installed in the canal cavities, taking into account the clinical situation. The intra-root parts of the additional pins installed in the cavities of the channels are deepened at the level of the inner surface of the bottom of the crown frame. In this case, the free wires of the root part of the twisted or twisted pins or the root part in the form of a double mesh near the flat pin are located above the inner surface of the bottom part of the crown frame.

The root parts of the pins are fixed on the inner surface of the bottom of the crown frame over the wires of the supercanal part of the interlocking pins.

In particular, during the restoration of the upper molars, the free wires of the root part of the additional pins are distributed along the inner surface of the bottom of the frame and fixed.

In particular, during the restoration of the lower molars, after fixing the wires of the root part of two additional twisted and / or twisted pins accordingly, the root part of the mesh flat pin is bent with respect to the center of the bottom part of the crown frame and fixed on top of the previously distributed wires of two additional pins.

Thus, the fixed reinforcing mesh crown frame is held on the base using glass ionomer cement, immobilizing pins and three additional pins.

After fixing the first reinforcing mesh crown frame begin the final restoration of the walls of the crown of the tooth.

The walls of the coronal part with a thickness of 1.5-2 mm from the equator to the level of the occlusal surface are formed from the macrophilized composite.

Then, the cavity of the fixed crown frame is filled with microfilted composite with the formation of a cushioning cavity in the crown of the tooth at the equator level.

The surface of the cushioning cavity and the walls of the coronal part restored to the level of the occlusal surface form a coronal cavity.

The newly formed coronal cavity is reinforced with the help of a second framework - a mesh coronal cavity.

A mesh crown frame is also formed from a fine-mesh gold-plated metal mesh 0.4 mm thick by analogy with a previously formed crown-root frame.

Using a plug-in, the grid is shaped in accordance with the surface shape of the newly formed coronal cavity. The formed reinforcing mesh crown frame is tried on and after fitting and correction is removed from the crown cavity.

An adhesive is applied to the inner surface of the coronal cavity, slightly blown with air for even distribution, the adhesive is applied again, again blown with air and polymerized by a standard method.

The second reinforcing mesh crown frame is fixed in the coronal cavity using glass ionomer cement after adhesive treatment of the inner surface of this cavity.

The second fixed mesh crown frame strengthens the walls of the crown part of the restored tooth at the level from the equator to the occlusal surface and additionally reinforces the crown part of the restored tooth at the level of the equator.

After fixation, the cavity of the second reinforcing mesh crown frame is filled with microfilted composite to the level of the occlusal surface.

Thus, the crown of the tooth is restored taking into account the anatomical structure.

Tubercles form from a macrophilic composite.

Before polishing and control polymerization, occlusal editing is performed.

Final grinding and polishing is carried out on the 2nd day after polymerization.

Claims (6)

1. The method of restoration of the posterior teeth in the complete absence of the crown part with perforation of the vertically displaced root in the area of bifurcation or trifurcation and with the destruction of the interroot septum, including endodontic treatment of the root canals, cavities in each of the channels with a depth of no more than 1 / 2-1 / 3 of the corresponding length channel after the preparation of demineralized tissues of the cervical third of the root and the inter-root septum with the formation of a flat surface, the formation of a macrophilic composite of walls at the equator level with the next reinforcement of the formed coronal cavity by means of a mesh crown frame, which is fixed with the help of glass ionomer cement in the crown cavity and additionally fixed on the root with the help of at least one immobilizing pin and three additional pins preformed from gold-plated metal wires, pins through perforations of the crown the frame is installed in the cavities of the channels and using glass ionomer cement is fixed in the root canals and on the inner the surface of the bottom part of the crown frame, while the intra-channel parts of the immobilizing wire pin, made in the form of interweaving wires, are fixed in the cavities of the channels of the joined roots, the walls of the crown part are restored from the equator to the occlusal surface from the macrophilic composite, and the cavity of the fixed crown frame is filled with microfiled composite depreciation cavity at the equator, and the crown cavity formed by the restored walls and amortization cavity surface, reinforced with a pre-formed second grid coronal frame, which is fixed by means of glass ionomer and a cavity which, after fixing filled to a level occlusal surface mikrofillirovannym composite and then reduced hillocks of makrofilirovannogo composite. 2. The method according to claim 1, comprising immobilizing the roots, separated by perforation in the bifurcation or trifurcation region, by means of two reinforcing immobilizing wire pins, one of the intra-channel parts of the second pin being placed together with the intra-channel part of the previously installed pin in the cavity of the canal of the distal or palatine root, and the other intracanal part of the second pin is placed in the cavity of the free channel of the mesial or buccal root, respectively. 3. The method according to claim 1, comprising immobilizing the roots, separated by perforation in the bifurcation or trifurcation region, by means of three reinforcing immobilizing wire pins, the intra-channel parts of which are pairwise placed in the channel cavities of the combined roots. 4. The method according to claim 1, including the formation of the intra-root part of the two additional pins in the form of weaving or twisting wires. 5. The method according to claim 1, comprising forming an inner root portion of two additional pins in the form of weaving or twisting wires and forming a third flat pin in the form of a rectangle of a double layer of a gold-plated metal grid, the inner root portion of which is made with corners cut from both sides along the length of the rectangle moreover, the width of the rectangle is not more than the size of the channel of the distal root in the buccal-lingual direction, and the length of the slice is not more than the size of the depth of the cavity of the channel of the distal root. 6. The method according to claims 1 to 3, including the additional flattening of the intra-channel parts of the reinforcing immobilizing wire pins and the intra-root parts of additional intertwined or twisted pins to give them a flat shape.