RU2318467C1 - Device for shaping gingival canal of artificial denture - Google Patents

Abstract

FIELD: medical engineering.

SUBSTANCE: device has conic expansion gingival tissue carcass being adequate to cervical part of dental prosthesis in shape and size and manufactured from biologically inert material, screw-fixing member is attached to conic carcass tip and projecting outside. The gingival tissue expansion carcass is manufactured from superelastic titanium nickelide as voluminous wire conic spiral having windings close to each other.

EFFECT: flexible movable carcass structure prevents base from loosening during osteosynthesis; provided normal gingival tissue metabolism; accelerated gingival inflammation treatment.

2 cl, 5 dwg

Description

The invention relates to medicine, specifically to the technique of surgical dentistry.

One of the modern methods of restitution of lost teeth is the implantation of dentures. It is based on the process of implanting a denture into the alveolar process of the intraosseous area and the installation of a dental crown. In connection with the development and new discoveries of suitable biocompatible implant materials, the emphasis of the task was successively shifted from the intraosseous part of the prosthesis to the cervical and crown. The appearance of a porous alloy based on titanium nickelide quite adequately solved the issue of implant engraftment in bone, and the formation of an implant-gingival joint became more relevant.

In the normal anatomy of the cervical region of the tooth, the dominant organ is the gingival margin (marginal gingival tissue) and the gingival sulcus is a narrow strip of dense connective tissue that completes the gingival margin and is adjacent to the neck of the tooth. The density of its adjacency determines the tightness of the gingival pocket in relation to the bacterial flora of the oral cavity, and, ultimately, the physiological consistency of the entire tooth.

During implant prosthetics, sealing of the newly formed “gum-implant” connection is a special concern of the doctor. Adaptive reconstruction of the gingival tissue in the area of contact with the implant should provide a sufficient fit and reliability of sealing. The solution to this problem is a condition of the prior art and the present invention.

Known two-stage method of prosthetics [T. T. Robustova. Dental implantation. Surgical aspects. M .: Medicine. 2003. P.353], when during the installation of the crown of the prosthesis for intimate conjugation of the neck of the tooth and gingival canal, surgical techniques are used: primary in shape and trajectory [T. T. Robustova. Dental implantation. Surgical aspects. M .: Medicine. 2003. S.295-300] and repeated [T.T. Robustova. Dental implantation. Surgical aspects. M .: Medicine. 2003. P.324] dissection of the gums, formation of the gingival canal with rags of the incision, suturing of tissues repaired around the prosthesis.

The lack of special technical means of forming an adequate gingival canal reduces the viability of prosthetics and motivates the search for such devices.

A device for the formation of the gingival bed of the denture ["The healing screw", T. T. Robustova. Dental implantation. Surgical aspects. M .: Medicine. 2003. S.324-326]. The device is made in the form of a screw with a head having a conical surface (1, Fig. 1). When screwing into the socket of the implanted base of the prosthesis, the device head is located supra-alveolar in the thickness of the gums, acting as a support for the adjacent gingival tissue. The shape of the head is chosen congruent to the cervical, i.e. conical in shape of the area of the crown of the denture, therefore, after standing in the gum during the healing time (1.5-3 weeks), the gum bed tissue forms congruent to the surface of the future crown of the prosthesis (figure 2). As a result, the most favorable conditions for healing the tissue and the intimacy of the ratio of the gums and the implant are created.

In this role, the analogue has disadvantages due to the peculiarities of its design and operation.

1. During the standing of the device, it is subjected to chewing loads of axial and radial directions. The rigid design of the head (spacer frame - in functional terms) leads to a shaky effect on the implant, which may be premature if the process of growing into the bone is not completed. Soft gum tissue adjacent to the rigid support, on the contrary, is deprived of the desired mobility, which accelerates the reparative processes in the tissue. As a result of the healing of the gingival wound and the formation of the bed is not fast enough.

2. During this period, food residues, bacterial and fungal flora penetrate into the contact zone of the gums and head. Infection of tissues leads to their inflammation (3, figure 2) and delay the prosthetics. To prevent infection, the patient is prescribed sanitation of these areas by mechanical removal of food debris and a disinfectant rinse. The monolithic impermeable structure of the device complicates these actions.

The disadvantages of the prototype lead to a decrease in the tightness of the formed implant-gingival ligament and subsequently the viability of the prosthesis.

The technical result of the invention is to increase the tightness of the implant-gingival ligament.

The specified technical result is achieved by the fact that in the device for forming the gingival canal of the denture containing a conical spacer frame of gum tissue with dimensions and shape adequate to the cervical portion of the denture made of bioinert material, and a screw retainer attached to the top of the conical frame and protruding outward , the spacer frame of the gum tissue is made of superelastic titanium nickelide, in the form of a volumetric conical spiral wire with closed turns.

A diameter of a nickel-titanium cone wire of 0.3-0.6 mm is preferred.

The technical result is achievable from an analysis of the operation of the device, the appearance of which is shown in Fig.3.

Two-stage tooth prosthetics, for which the proposed device is intended, is as follows.

At the first stage, a socle 4 - an intraosseous part of the denture is implanted in the thickness of the alveolar ridge; Fig. 4.

Moreover, from the variety of modern implants, implants in the form of a cylinder made of porous titanium nickelide with a reinforcing cage are preferred [Medical materials and shape memory implants. Publishing House of Tomsk University, Tomsk. 1998. S. 413]. A temporary plug 5 is screwed into the threaded hole of the cap, the gum is sutured over it and left for the entire time of implant ingrowth - up to 6 months. Prior to the installation of the crown 8 of the prosthesis, the gum above the implant is punched with a mucotome, the temporary plug 5 is removed and a device for forming 6 is installed in its place by screwing its retainer 2 (Fig. 3) into the threaded socket of the socle. The walls 1 of Fig. 3 of the conical spiral are elastic when they are deformed in the radial direction. Therefore, their compression interaction with the surrounding gum tissue is soft and reversibly elastic. The delicate, gelatinous tissue of the gum, undergoing constant, forming pressure, has the possibility of deformation movement, for example, during a chewing action. This provides an intensification of tissue metabolism and its speedy recovery. At the end of the healing period, the cylindrical perforation channel is transformed to the shape of the cone-shaped bed of FIG. 2 congruent conical neck surface of the crown of the prosthesis 8 of FIG. 4.

The device for forming is removed and the suprastructure 7, the crown of the prosthesis 8 are mounted in its place. In this case, the cervical portion of the crown is located in the coordinates of the gingival bed. The measures taken to correctly perform the prosthesis, comply with the prosthetics regulations and special preparation of the gum bed ensure the success of the operation. The closed shape of the turns of the conical spiral of the device for forming is necessary to prevent the prolapse and proliferation of gum tissue into the cavity of the device, which would create additional difficulties in removing the unevenness of the prepared bed. The hollow space inside the conical spiral provides the possibility of antimicrobial disinfection and sanitation. The strain necessary to practice the strain of the spacer frame is ensured by using a nickel-titanium wire (usually TN-10) with a diameter of 0.3-0.6 mm.

Experimental studies and clinical observations confirm the attainability of the technical result in its average statistical value.

The absence in the prior art of the totality of the features of the claimed device, prompted recommendations and rules of implementation, indicate that the proposal meets the criterion of "inventive step".

The drawings show the following.

Figure 1. Appearance of a device for forming a gingival canal of a denture (prototype). 1 - spacer frame, 2 - screw lock.

Figure 2. Inflammation of the gums near the gingival canal of the dental implant (position 3).

Figure 3. The appearance of the proposed device for the formation of the gingival canal of the denture.

Figure 4. A set of denture parts with a device for forming the gingival canal. 4 - intraosseous base, 5 - plug, 6 - device for forming the gingival canal, 7 - suprastructure of the denture, 8 - crown of the denture.

Figure 5. Fragment of tooth prosthetics.

Practical evidence of the attainability of the technical result is specific examples of the use of the proposed device for prosthetics in the clinic of dental implantology of the Medical Engineering Center (Tomsk).

Example (based on extract from a medical history No. 1243):

Patient K., 55 years old. Diagnosis of the disease: secondary partial adentia - absence of lower jaw teeth 35, 36, 37, 46, 47. Examination of the patient, assessment of the risk and benefits of implantation indicated indications for treatment.

3 months after the intraosseous dental implantation of socle fragments 4 with stubs 5 of the denture (Fig. 4), implants were opened with a mucotome. After removing the locking screws 5, the toilet of the internal thread and soft tissues around the implant, devices for forming the gingival canal are installed (Fig. 3; 6 of Fig. 4). To assess the effectiveness of the invention, 3 known devices (prototype of FIG. 1) and 2 proposed devices (FIG. 2) were installed. The latter had technical characteristics: length and maximum diameter of a conical spacer frame 1-5 mm, retainer 2 8 mm long, with m3 thread, diameter of nickel-titanium wire 0.5 mm.

The action of the device in the function of the spacer frame occurs from the moment of its installation until removal.

In this example, this period was one week, which, with a similar end result from control devices, is 2-3 times shorter. The criterion for the absence of inflammation (mucositis) at the end of this period was the absence of unpleasant subjective sensations, appearance, lack of bleeding, iodine-negative indicators of the Schiller-Pisarev test and unchanged indicators of papillary-marginal-alveolar indices. When viewed after 7 months, after completion of the prosthesis, no inflammatory bone resorption was detected.

According to the methodology, 16 units of the device were involved and tracked in 8 patients. Similar successful results of using the device — simplicity and ease of sanitary-hygienic measures for servicing prostheses and preserved teeth — testify to the functional consistency and advantages of the offer compared to the prototype in the framework of the technical result.

The technological and medical components of the readiness of the device for widespread use meet the criterion of "industrial applicability".

Claims (2)

1. A device for forming the gingival channel of the denture, containing a conical spacer frame of gum tissue with dimensions and shape adequate to the cervical portion of the denture, made of bioinert material, a screw retainer attached to the top of the conical frame and protruding outward, characterized in that the spacer frame gum tissue is made of superelastic titanium nickelide, in the form of a volumetric wire cone spiral with closed turns. 2. The device according to claim 1, characterized in that the diameter of the wire of the conical spiral is selected in the range of 0.3-0.6 mm

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