RU2340306C2 - Method of teeth splinting (versions) - Google Patents

Abstract

FIELD: medicine; stomatology.

SUBSTANCE: form cavities on contact surfaces of the splinting teeth or cured filling material. Make a print on which cast a plaster model. Model and produce inlays according the plaster model, filling earlier created cavities. Bridge inlays among them with an elastic splinting element consisting of trailer departments and an intermediate part. Transfer the received design in the form of consolidated by the splinting element inlays to the cavities created in teeth, preliminary filled with filling material and-or materials of adhesive systems, and-or glues. Perform curing of the cement, thus keep blank an elastic intermediate part of the splinting element.

EFFECT: improvement of functional properties of a design and reduction of risk of its destruction.

22 cl, 39 dwg

Description

The invention relates to medicine, namely to dentistry, and can be used for temporary or permanent splinting (fastening) of teeth between themselves for periodontal diseases, for fastening teeth at various stages of orthodontic treatment, for preventing tooth movement or mobility.

Splinting is used to preserve teeth and their function.

Various methods for splinting teeth are currently known. A known method of stabilizing movable teeth during periodontitis or trauma, which consists in the formation of a retention groove for the splint element and the installation of a crimped splint element. The retention groove for the splinting element on the occlusal surfaces of the teeth is formed horizontal, having the shape of a truncated pyramid in the vertical plane of the tooth, with the broad base facing the pulp chamber of the tooth, while the width of the base of the groove is equal to the height of the turn of the splinting element made of a monolithic material made of superelastic material. A retention groove is also performed at the bottom of the obtained pyramid, wherein the width of said extension is equal to the height of the turn of the splint element. After fixing the splinting element, the cavities are filled with filling material according to the type of a beam tire [28].

There is a method of stabilization of teeth during periodontal disease, which consists in installing the beam splint in the profile slot made on the occlusal surface of the teeth, while in each tooth, retention grooves are cut perpendicular to the profile slot, followed by the introduction of metal brackets with shape memory that fix the beam splint [27 ].

A known method of splinting teeth, which consists in the fact that they form cavities on the occlusal-approximate surfaces of adjacent teeth in the place of their greatest contact. Wire holders, curved in the form of a “dumbbell”, are installed in the cavities made. Fasteners are fixed by introducing pins through the centers of the dumbbell rings into the tooth tissue, after which the cavities are closed with filling material [29].

Closest to the claimed inventions method of splinting teeth is that on the oral side of the movable teeth to be splinted, create cuts (grooves). After processing them with a pickling gel, a bonding system is applied, which enhances the adhesion of the filling materials to the tooth surface. A flowing composite light-curing filling material is applied to the prepared surface, into which reinforcement is placed in the form of a flagellum made of fiberglass [GlassSpan, manufacturer GlassSpan, USA] and pre-filled with the same composite filling material. The resulting structure is polymerized. Next, additional portions of the composite are applied and polymerized, completely covering the reinforcement. Thus, a device for splinting teeth includes reinforcement in the form of a hollow flagellum made of fiberglass, as well as composite light-curing filling material [1].

Despite the great variety of known methods of splinting teeth, none of them meets all the requirements at the same time, while it does not always ensure compliance with the basic criteria of biomechanics of the dentition [24].

The intermediate (interdental) parts of the splinting devices of the listed analogues, including the closest analogue, are made rigid by using materials that practically do not have elastic properties (metal, filling material filled with fiber filling material, etc.) for their manufacture and reinforcing. The proposed splinting methods, including the closest analogue, have significant drawbacks associated with rigid fastening of the teeth to each other, and, as a result, the lack of minimal but physiologically necessary mobility of the teeth in relation to each other, to the dentition and to the alveolar process.

The main negative result when using the proposed splinting methods, including the closest analogue, is the rapid destruction of the periodontal support structures of those teeth in the tire composition where such structures were preserved, and due to which the teeth are stabilized in the structure. Periodontal destruction in these areas occurs at the time of loading on that section of the tire where the teeth do not have sufficient periodontal reserves. As a result, traumatic tangential stresses similar to those of cantilevered prostheses arise on the supporting teeth of the splint design [5, 19, 20]. In the cervical third of the periodontium of the supporting teeth, such stresses cause overloads that significantly exceed the compensatory capabilities of periodontal structures, as a result of which they are destroyed. At the same time, in the apical part of the periodontium tooth mobility is minimal, the magnitudes of the arising overloads are not expressed and only slightly differ from the norm, which explains the absence of pronounced pain during overloading of the rigid tire [25, 26].

Violation of feedbacks, lack of true information about the real condition of the supporting apparatus of individual teeth in the tire, their real mobility leads to disruption of the periodontal-muscular reflex, which regulates the strength and direction of chewing pressure [11]. Thus, a rigid tire creates the reflex illusion of a healthy periodontium in all teeth that make up such a tire. In conditions of violation of the reflex regulation of chewing, the critical load on the tire increases, the traumatic overload of the supporting teeth increases, the destruction of periodontal tissues increases.

At the same time, with hard splinting, along with congested areas, non-functioning, underloaded periodontal areas appear, where the necessary micromotion of the periodontal ligament is practically eliminated. In these areas, vasoconstriction of the adducting vessels develops, their functional insufficiency with the development of hemo- and lymphostasis, perivascular edema, diapedesis of blood cells, red blood cell aggregation, embolism and vascular thrombosis [10, 15]. Swelling of elastic and collagen fibers is observed. Dystrophic-destructive processes develop in the periodontal ligament, which are accompanied by atrophy and resorption of adjacent bone tissue.

During periodontitis remission, a decrease in tooth mobility in the composition of a rigid tire may be observed. This is assessed as a positive result of splinting, however, this effect develops due to ankylosing (direct fusion of bone and root cement without the participation of a periodontal ligament, which is destroyed as a result of degenerative-destructive processes). However, a negative consequence of ankylosing is the resorption of root tissues and, as a result, tooth loss [7, 12, 23].

The authors of the closest analogue admit that true fixation in all three directions of occlusal functional forces by the method proposed by them cannot be achieved [2]. A direct contraindication is the inclusion in the design of the closest analogue of teeth with mobility of 3 degrees [4]. It is indicated that reliable fixation can only be achieved using orthopedic structures, which in some cases is unacceptable, since it implies extensive preparation of dental tissues, the complexity and cost of the design, aesthetic problems, etc. [13].

The materials from which the intermediate parts of the hard splinting devices, including the closest analogue, are made, practically do not have elastic properties, do not work well in bending, tension, displacement, shear, etc. At the same time, the adhesion forces of the bonding systems used to fix the tire to the teeth are in some cases insufficient [5]. In particular, to fix the elements of the closest analogue to the teeth, a fifth-generation bonding system “Bond-I” (Jeneric / Pentron, USA) is proposed, which has an adhesion force of up to 31 MPa. Given that the biasing load for different groups of teeth may be from 7 to 17 kg [22], the incorporation into the tire than the reference, two or more teeth with the destruction of periodontal over _^half root length may exceed the adhesive properties of the proposed bond several times [16].

Due to these shortcomings, it is significantly complicated by medical manipulations, such as the removal of dental plaque, curettage of periodontal pockets, patchwork, etc., since such interventions involve serious stress on the roots of the teeth and can cause a splint construction [9].

Imperfection of fixation, lack of damping of the load leads to a violation of the integrity of the tire and its individual elements, defects in the area of interdental spaces, spalling of tooth parts and areas of filling material, separation of individual teeth from the general structure, etc. According to some reports, similar defects of the closest analogue and structures similar to it are observed during the first 6–9 months after installation [3, 4].

The intermediate part of the closest analogue to give the necessary stiffness to the structure is made wide enough, which, together with the layering of additional portions of filling material, leads to a violation of the natural contours of the splinted teeth. At the same time, the distance from the tire to the gingival margin is kept minimal or absent altogether. This leads to the appearance in the interdental spaces of areas with complicated conditions for hygiene. In the area of the interdental spaces, plaque accumulates, deposits appear, and microbial contamination increases. All this negatively affects the development of periodontitis [4].

Changing the natural contours of splinted teeth, in particular the front teeth of the upper and lower jaw, due to changes in the conditions of the tongue adhering to the surface of the tire, can clearly disrupt the patient's diction. This requires a certain, often long-term adaptation and can be negatively evaluated by the patient [8, 21].

Violation of the natural contours of splinted teeth negatively affects the appearance and cosmetic assessment of the design of the closest analogue, since the tire goes beyond the boundaries of natural interdental contacts. This can adversely affect the patient’s aesthetic satisfaction with splinting results [17].

Fiber tapes and bundles used for reinforcing tires require mandatory filling and full closure of filling materials from above, as well as maintaining this state throughout the tire installation period. However, under overload conditions, the complete preservation of structural integrity is a difficult condition. In the case of violation of the integrity of the coating under the influence of moisture in the oral cavity, the fibers used for reinforcement swell, plaque is actively deposited on them, deposits appear, and microflora develops. This can lead to a violation of the integrity of the entire splinting structure, and its individual sections [2].

The problem solved by the proposed group of inventions is to eliminate the disadvantages of analogues, including the closest analogue.

The tasks are solved by using interdental splinting elements with elastic properties in the manufacture of tires. The proposed options for the installation of splinting elements allow the teeth that are part of the tire to maintain mobility at the physiological level, evenly distribute and dampen the load, include a periodontal-muscular reflex in the regulation of chewing load, guarantee the integrity of the structure during chewing and treatment, maintain high functional and aesthetic qualities of the tire, etc.

The first embodiment of the method of splinting teeth is that cavities are formed on the contact surfaces of splinted teeth or cured filling material, then an impression is made on which a gypsum model is cast, on which tabs are made and replenished, replenishing previously formed cavities connect them together with elastic splinting an element consisting of end sections and an intermediate part, while retaining an unfilled material of the elastic intermediate part for the implementation of pla the effect of the splinting element, the resulting design in the form of tabs combined by the splinting element is transferred to the above-mentioned cavities formed in the teeth, which are pre-filled with filling material and (or) materials of adhesive systems, and (or) adhesives or other suitable materials, the tabs are put in place then curing the filling material or the corresponding fixation of the tabs when using other materials. If necessary, in the region of one interdental space, two or more splinting elements can be used.

When installing the splinting element to preserve the elastic intermediate part with unfilled material, a separation matrix is used, which is inserted into the interdental space and put on the intermediate part of the splinting element so that the intermediate part of the splinting element is in the hole of the matrix. In this case, the separation matrix can be made with two or more holes and (or) one or more slots (cuts).

The separation matrix may be in the form of a closed ring and contain at least one hole and at least one slot or only at least one hole without gaps, in the absence of gaps, the separation matrix is put through the hole on the end section splinting element, move to the intermediate part, and after installing and fixing the splinting element, the separation matrix is cut to the hole and removed. The holes and slots of the separation matrix may not repeat the shape and dimensions of the intermediate part of the splinting element.

The separation matrix is made of plastic or rubber or rayon or celluloid or vinyl pyrrolidone or ethyl acrylate or ester of cyanoacrylic acid or polyvinyl butyl ether or polyvinyl chloride or latex or rubber or polyethylene or polyisoprene or cotton fiber or gauze or polyester or polypropylene or lavis or capron or laven or polyethylene foam or foam or polyamide or polycarbonate or diphlon or teflon or poly-4-methylpentene-1 or macrolone or polymethylmethac of rilate or polystyrene or bumetol or from a solution of polybutyl methacrylate in ethyl acetate or from copolymers of butadiene and styrene or copolymers of styrene and methyl acrylate with nitrile of acrylic acid or from a copolymer of ethylene with vinyl acetate or a capron resin or a polyamide resin or an ion-exchange resin or polyvinyl fluorolone or fluoropolyol alcohol or paper, cardboard coated and (or) uncoated or from a composition of polyethylene with polyisobutylene POV - 30, POV - 50 or plastic or foil or cellophane or protacryl whether elastosil or aerosil or cellulose or silicone or ethacryl or plastisol or polyurethane or polyimide or fiberglass, as well as compositions or solutions or plastic compounds or polymers or copolymers or mixtures based on them, and also the matrix is made of steel or titanium or brass or copper, or silver or gold, or bronze or aluminum, or nickel or cobalt, or chromium or vanadium, or alloys based on them or with their inclusion.

The second variant of the method is characterized by the use of a continuous splinting element, which can be made in the form of fishing line or tape, or chain or tow, or in the form of a thread or in the form of continuous, evenly repeating links of various shapes and lengths, as well as other known forms and set on splinted teeth in a single fragment. The installation of a splint element of this design has its own characteristics. A single cavity is formed on the splinted teeth located on the contact and occlusal and (or) contact and buccal (vestibular) and (or) contact and lingual (palatine) surfaces of the splinted teeth with grip and (or) without gripping the cutting edge and (or) chewing tubercles and (or) simultaneously on all surfaces and anatomical formations of splinted teeth, including tooth roots. The cavities are formed in such a way that their shape and size make it possible to place splinting elements in them. Next, a fragment of the required length is cut out from the continuous splinting element. For more reliable fixation of the splinting element in the filling material along its length and (or) at the ends and (or) at the places of immersion in the filling material and (or) at the place of fixing the segment, preliminary presence and (or) additional creation of special holding points, such like impressions or tides of material, or serifs or holes, or other known methods. Next, a portion of filling material is applied to the bottom of each cavity. The splint element is placed in all cavities simultaneously or in each subsequent stage-by-stage. A preliminary curing of the filling material is carried out, and then the cavities are completely filled with the filling material using the separation matrix. The matrix is made in the same way as in the previous method and has a slit (s) and a hole (s) that repeat the shape of the intermediate part (s) of the splint element. The matrix is inserted into the interdental space and put on the intermediate part of the splinting element through the slot so that the intermediate part of the splinting element is in the hole of the matrix. Then, the filling material is cured and the separation matrix is removed.

The formed cavities can have a shape that provides mechanical fixation of the filling material in the tooth tissues, namely, retention points or the shape of a cone or other known means. Moreover, before installing the splinting element or at the same time as installing it, dental treatment can be carried out.

The formed cavities can be specially prepared to provide a more reliable fixation of the filling material to the tooth tissues. To do this, use pickling liquids and gels, special one- or multi-component adhesive and bonding systems, primers or other known means.

It is possible to pre-fill cavities with their further re-preparation, which consists in the fact that cavities are formed in the cured filling material, and the splint element is placed in these cavities.

The materials from which the separation matrix is made are given above.

The third embodiment of the method is used when a continuous splinting element is used, which is installed in the tabs that make up the cavities formed in the splinted teeth. In this embodiment, cavities are formed on the contact surfaces of the teeth to be splinted or of the cured filling material, then an impression is made on which the gypsum model is cast, on which inlays are made of suitable material, and replenishing previously formed cavities are connected together by a continuous elastic splinting element of the required length with preserving the unfilled material of the elastic intermediate part to realize the plastic effect of the splinting element obtained The function in the form of tabs united by a splint element is transferred to the above-mentioned cavities formed in the teeth, which are pre-filled with filling material and (or) materials of adhesive systems, and (or) adhesives or other suitable materials, the tabs are put in place, and then the filling is cured material or the corresponding fixing tabs when using other materials.

When implementing this variant of the method, you can also use a separation matrix. The matrix is inserted into the interdental space of the gypsum model and put on the intermediate part of the splinting element located between the tabs, so that the intermediate part of the splinting element is in the hole of the matrix.

Variants of the shape of the separation matrix and the materials from which it can be made are given above.

The fourth embodiment of the method is characterized in that uniform cavities are formed on the contact surfaces of the teeth to be splinted or of the cured filling material so that their shape and size allow them to be placed in a continuous elastic splinting element, then a portion of the filling material is applied to the bottom of each cavity, continuous splinting the element is placed in all cavities simultaneously or in each subsequent stage-by-stage, preliminary curing of the filling material is carried out, and then the cavities are completely filled with filling material so that the cavities in adjacent teeth are closed with a single filling while preserving the natural contours of the teeth, then, to realize the plastic effect provided by the material of the splinting element, the seal is disconnected, for which, first, with the help of boron or a separation disk in the area of the interdental gap on the obtained the fracture line is marked with a seal, and then the seals are separated so that separate fillings are formed while maintaining the integrity of the splint element .

The fifth and sixth embodiments of the method are used in the case when, together with splinting of the teeth, they are prosthetized with artificial crowns (half crowns).

In the fifth embodiment, the formation of cavities, the installation of splinting element. Simultaneously with the splinting of the teeth, they are prosthetized with artificial crowns or half-crowns, while cavities for elastic splinting elements are formed in the teeth turned under the crowns, then an impression is made from the turned teeth with the formed cavities, on which the gypsum model is cast, artificial crowns are modeled and made on this model , combine them together with elastic splinting elements, cavities formed in honed teeth are used in artificial crowns for placement in end sections splinting or continuous elements a strut element, resulting in a combined construction element splinting crowns or polukoronok transferred to the oral cavity and fixed to the respective teeth using a filling material, adhesive, wherein the elastic material remain unfilled intermediate portion of a strut element.

In the sixth embodiment, simultaneously with the splinting of the teeth, they are prosthetized with artificial crowns or half-crowns, while an impression is made from the teeth turned under the crowns, according to which the gypsum model is cast, artificial crowns are modeled and made on this model, they are combined together by elastic splinting elements, end sections which are placed in the wall of the artificial crown, the resulting structure in the form of crowns or half crowns united by a splinting element is transferred to the oral cavity and fixed comfort on the corresponding teeth using filling material, adhesive, while retaining an unfilled material elastic intermediate part of the splinting element.

According to the fifth and sixth options, in honed teeth on the contact and occlusal and (or) contact and buccal (vestibular) and (or) contact and lingual (palatine) and (or) simultaneously on all surfaces of the teeth, including the roots, cavities are formed that allow placing they have elastic splinting elements. Then, using an orthopedic spoon and cast impression or in another known manner, an impression is made from the turned teeth with the formed cavities, according to which the plaster model is cast. On this model, artificial crowns are modeled and made from filling material and (or) plastic, and (or) ceramics and (or) metal, or from any other suitable material in known ways. In this case, the crowns are combined among themselves with elastic splinting elements while preserving the elastic intermediate part with unfilled material, if necessary using the proposed matrix (described above) with a hole and a slit (section). The cavities formed in the turned teeth are used in artificial crowns to accommodate the end sections of the splinting elements in them. Another option (sixth) of the implementation of the method is used if the wall thickness of the artificial crowns allows you to place the end sections of splinting elements in them without creating additional cavities, then such cavities in turned teeth do not. Further, for the fifth and sixth variants of the method, the resulting structure in the form of crowns (half-crowns) combined by a splinting element is transferred to the oral cavity and fixed on the corresponding teeth using filling material, adhesive or other known methods.

Turned teeth and formed cavities should preferably have a shape that allows the installation and fixation of crowns, namely the shape of a cone or cylinder, or other known methods.

Turned teeth and formed cavities can be specially prepared to provide more reliable fixation of crowns to tooth tissues. For this, it is possible to use pickling liquids and gels, special one or multicomponent adhesive and bonding systems, primers or other known means.

Before the installation of crowns with splinting elements or at the same time as their installation, dental treatment can be performed. If there is a risk of injury to the pulp of the tooth as a result of its grinding, prior to the installation of the structures, the tooth is pulp depot with filling the canals by known methods.

It is possible to carry out simultaneous prosthetics and splinting of two or more teeth. Moreover, in the same tooth for the placement of the end sections of the splinting element, it is possible to use cavities and (or) without using cavities, with the placement of the end sections of the splinting element in the wall of the artificial crown.

The technical result from the use of the claimed variants of the method is to provide for the chinded teeth the ability to maintain mobility close to physiological.

The achievement of this technical result is due to the fact that when implementing the claimed variants of the method, elastic (elastic) elements are used as connecting links (splinting elements) (possible designs of splinting elements are described below and shown in the drawings). Installation of splinting elements is made suitable for a particular patient variant of the claimed method, which avoids a number of negative consequences of hard splinting, for example, such as overload or ankylosing.

Another technical result obtained by using the proposed method of splinting teeth is the ability to dampen the loads that occur when teeth are closed, therapeutic measures, etc., which can prevent the integrity of the entire tire, as well as its individual elements. The elastic properties of splinting elements allow you to distribute the resulting load evenly between all zinnirovannye teeth. At the same time, micromotion of the teeth is maintained, periodontal-muscular reflexes continue to operate. Uncontrolled under conditions of hard splinting overload of individual teeth is prevented. The natural regulation of the forces of chewing pressure is restored.

Also, the proposed invention allows:

- restore the micromotion of teeth necessary for the normal functioning of the periodontal ligament, improve trophism, and prevent dystrophic-destructive processes in the periodontal ligament;

- splinting and guaranteed to keep teeth with mobility of the 3rd degree, which was proposed for the first time to be done with non-orthopedic methods;

- to carry out during the implementation of the method quite gentle preparation of teeth in the process of preparing cavities for fixing splinting elements;

- to provide the ability to effectively maintain oral hygiene in the area of splinted teeth;

- almost completely preserve the functional properties of splinted teeth;

- provide the ability to combine simultaneous dental treatment and tire installation;

- to preserve the natural contours of splinted teeth, which positively affects the appearance and cosmetic evaluation of the proposed designs;

- to preserve the natural contours of splinted teeth, which allows not to disturb the diction of the patient;

- to provide pronounced savings in time required for carrying out splinting;

- significantly reduce the complexity of treatment;

- to provide a pronounced reduction in the cost and final cost of the proposed methods;

- to use for splinting materials that can withstand aggressive factors of the oral cavity without any additional protection for decades.

The invention is illustrated by drawings, where

Figure 1 shows a device for splinting teeth;

In Fig.2 - splinting element installed in the cavities of splinted teeth;

Figure 3 - the same with a portion of the filling material deposited on the bottom of the cavities;

Figure 4 - separation matrix;

Figure 5 - the location of the matrix in the interdental space;

Figure 6 - separation matrix with two slots and holes;

7 - 16 - embodiments of a device for splinting teeth (splinting element);

On Fig, 17A - forms of execution of the separation matrix;

On figb - installation of the separation matrix on the tooth;

On Fig - cavity formed for the manufacture of print;

In Fig.19 - tabs, replenishing the formed cavity;

In Fig.20 - tab with splinting element mounted on splinted teeth;

On Fig - options for performing splinting element continuous;

On Fig - cavity formed for the case when the splint element is made continuous;

On Fig - determination of the required length of a continuous splinting element;

On Fig - arrangement of a continuous splinting element on splinted teeth;

On Fig - the use of a separation matrix and a continuous splinting element when filling the cavity with filling material;

On Fig - cavity formed in several teeth for the manufacture of prints;

On Fig - the formation of a fracture line on the obtained seal in the interdental space;

On Fig - separation of the seal along the fracture line;

In Fig.29 - teeth turned under the crowns;

On Fig - additionally formed cavity;

On Fig - artificial crowns, interconnected by elastic splinting elements;

On Fig - placement of the end sections of the splinting elements without creating additional cavities in the turned teeth;

On Fig, 34, 35, 36 - embodiments of funds that improve the fixation of the splinting element to the tissues of the tooth;

On Fig, 38, 39 - options for devices to improve the fixation of the splint element.

A device for splinting teeth, allowing the claimed method to be implemented, is a splinting element 1 made of an elastic non-metallic material, for example, silicone and consisting, as an option, of three parts: (Fig. 1) - two end sections 2 and an intermediate part 3, connecting the end departments to each other. The splint element may also be continuous.

To install the splinting element on the contact surfaces of the splinted teeth 4 (FIG. 2), cavities 5 must be formed taking into account that their depth, width and relative position allow placement of splinting elements 1. The cavities 5 must have conditions for reliable mechanical fixation of the filling material in tooth tissues (retention points, cavities in the form of an inverse cone, etc.). If necessary, you can conduct parallel dental treatment (caries, treatment of defective fillings, etc.).

A device for splinting teeth can be performed in various ways.

The end sections of the splinting element can be made in the form of circular cylinders, and the intermediate part of the splinting element is made in the form of a cylindrical rod, as shown in figure 1.

The end sections of the splinting element can be made in the form of thickenings 25, spherical or ovoid or conical in shape, and the intermediate part of the splinting element is made in the form of a cylindrical rod, as shown in Fig. 8.

The end sections of the splinting element can be made with holes 24 for filling material, and the intermediate part of the splinting element is made in the form of a cylindrical rod, as shown in Fig.7.

The end sections of the splinting element can be made with annular grooves, and the intermediate part of the splinting element is made in the form of a cylindrical rod, as shown in Fig.9.

The splinting element can be made U-shaped in plan, wherein the intermediate part of the splinting element is made in the form of two cylindrical rods, one end section is made in the form of two thickenings at the ends of the cylindrical rods of the intermediate part, and the second end section is made in the form of a jumper connecting the cylindrical rods as shown in FIG.

One end section of the splinting element can be made in the form of a thickening at the end of the cylindrical rod forming the intermediate part, and the second end section is made in the form of an opening in the said cylindrical rod, as shown in Fig. 10.

The intermediate part of the splinting element can be made in the form of two cylindrical rods connected by two jumpers, while one end sections are made in the form of two pairs of thickenings at the ends of the cylindrical rods of the intermediate part, as shown in Fig. 12.

The splinting element can be made U-shaped in plan, wherein the intermediate part of the splinting element is made in the form of two cylindrical rods connected by a jumper, while one end section is made in the form of two bulges 25 at the ends of the cylindrical rods of the intermediate part, and the second end section is made in in the form of a jumper connecting the cylindrical rods, as shown in Fig.13.

The intermediate part of the splinting element can be made in the form of two cylindrical rods, and the end sections are made in the form of jumpers connecting the said cylindrical rods, as shown in Fig. 14.

The intermediate part of the splinting element can be made in the form of two cylindrical rods connected by two jumpers, and the end sections are made in the form of jumpers connecting the said cylindrical rods at the ends, as shown in Fig. 15.

The intermediate part of the splinting element can be made in the form of a cylindrical rod, and the end sections are made in the form of a rectangular frame, as shown in Fig.16.

Splinting elements can be made by separating them from a continuous chain that combines all of the above figures (1, 7-16) or indicated in Fig.21.

When implementing additional methods, structures and devices (Figs. 33, 34, 35, 36) that improve the fixation of the splinting element 1 to the tooth tissues, for example, screws 29 or tabs 30 inserted in the tooth, or pins 31, the splinting element may have devices for these methods, structures, and devices, for example, openings 24, cavities, or other suitable devices.

To improve the fixation of the splinting element (Fig. 37), devices in the form of an outer ring 32 or a ball 33, or a plate 34 or having other shapes different from the intermediate part of the splinting element can be used. Moreover, they can be made of the same material as the splinting element and (or) of another material and combined with the material of the splinting element in various ways.

The intermediate part and the end sections of the splinting element can be different in shape (prism, cube, ball, ellipse, circular or other cylinder, tetrahedron, parallelepiped, pyramid, and other shapes), size (from 0.1 millimeter to 3 centimeters), contain inside and (or) be covered with various materials (metal, wood, various elastic materials, liquids, etc.) and (or) be hollow. The intermediate part and the end sections of the same splinting element can be made of the same or different materials. The end sections of the splinting element can also take the form of different types of thickenings, holes 24, sagging of the material 25, depressions 26, notches 27, bends 28 and other devices that improve the fixation of the splinting element in the seal material can be made at the end sections.

Various biocompatible materials are used to make the splint element. It can be synthetic polymers - rubber, plastics, rubbers, plastics, etc. (polyethylene, polyamide, silicone, polypropylene, polyimide, polyurethane polyvinyl chloride, etc.) or biopolymers (natural rubber, etc.). To this end, preferably together with the above materials can be used metals and (or) their alloys and (or) wood, other known suitable materials, as well as derivatives of suitable materials obtained as a result of any processing or processing. However, the necessary properties of materials for the manufacture of splinting element are their elasticity, stability, biological inertness.

Fixation splinting elements 1 between the teeth can be done in various ways.

The first embodiment of the method is carried out in the case when the splinting element 1 is installed in a single fragment together with the tabs 20. To do this, an impression is made on the formed cavities using an orthopedic spoon and impression mass or in another known manner (Fig. 18). In this model (Fig. 19), inlays 10 filling the previously formed cavities are modeled and made of filling material, plastic or any other suitable material. In this case, the tabs 10 on the adjacent splinted teeth are made in such a way that they are interconnected by an elastic splinting element 1 while preserving the elastic intermediate part with unfilled material to realize the plastic effect of the splinting element 1. This effect can be obtained using the matrix described below. The resulting design in the form of tabs united by the splinting element 10 (Fig. 20) is transferred to the corresponding cavities 11 formed in the teeth. The cavities are pre-filled with filling material and (or) materials of adhesive systems, and (or) adhesives or other suitable materials. Tabs 10 fit in place. Curing of the filling material or the corresponding fixation of the tabs when using other materials. If necessary, in the area of one interdental space, two or more splinting elements can be used.

The separation matrix is inserted into the interdental space and is put on the intermediate part of the splinting element so that the intermediate part 3 of the splinting element is in the hole of the matrix. When using two or more splinting elements, the separation matrix is made with two or more holes and (or) one or more slots (cuts).

The separation matrix can also be made in the form of a closed ring and contain at least one hole and at least one slot or only at least one hole without gaps, while in the absence of gaps, the separation matrix is put on through the hole on the end section of the splinting element is moved to the intermediate part, and after installing and fixing the splinting element, the separation matrix is cut to the hole and removed.

In some cases, the shape of the holes and slots of the separation matrix cannot but repeat the shape and dimensions of the intermediate part of the splinting element.

The separation matrix of FIG. 17 is made of plastic or rubber or other elastic materials, and may be in the form of a closed ring, may or may not have gaps, and the number and shape of the holes of the matrix preferably repeats the number and shape of the intermediate parts of the splint element. The matrix can repeat the matrix of figure 4, however, without having gaps (figa). Such a separation matrix is put on through the hole on the end section of the splinting element and is fixed on its intermediate part. If the matrix is made in the form of a closed ring, then it is installed on the tooth along the perimeter of its crown part (Fig.17b). After installing and fixing the splint element, an incision is made from the edge of the matrix to its opening and then the matrix is removed.

The second embodiment of the invention consists in the fact that cavities are formed on the contact surfaces of the teeth to be splinted or of the cured filling material, which allow placing an elastic splinting element in them, which is made continuous, and a fragment of the required length is cut out from the continuous splinting element. Next, a portion of the filling material is applied to the bottom of the formed cavities, the splinting element is placed in all cavities simultaneously or in stages for each subsequent one, preliminary curing of the filling material is carried out, then the cavities are completely filled with the filling material using a separation matrix, while the separation matrix is inserted into the interdental space and put on on the intermediate part of the splinting element so that the intermediate part of the splinting element is in the hole m Atrices then carry out the final filling of the cavities and remove the matrix.

According to a third embodiment of the invention, after the formation of the single cavities (Fig. 22), an impression is made from the formed cavities, according to which the gypsum model is cast. In this model, inlays 20 are formed from filling material or plastic or any other suitable material, filling the previously formed cavities 21. In this case, the inlays 20 on adjacent teeth are combined with a continuous splinting element having the required length, while preserving the elastic intermediate part of the splinting element with unfilled material for implementation its plastic effect. For this, the use of a matrix is possible. The resulting structure is transferred to cavities that are pre-filled with filling material or only with bonding system materials, adhesives or other suitable materials. Tabs fit in place. Curing of the filling material or the corresponding fixation of the tabs when using other materials.

The fourth embodiment of the method is carried out in the case when the splint element is made continuous. Unified cavities are formed on the splinted teeth in such a way that their shape and size allows a continuous splinting element to be placed in them (Fig. 26). Next, a portion of filling material is applied to the bottom of each cavity. The splint element is placed in all cavities simultaneously or in each subsequent stage-by-stage. Pre-curing of the filling material is carried out, and then the cavities are completely filled with the filling material so that the cavities in the adjacent teeth are closed with a single filling. When modeling such fillings, they try to maintain the natural contours of the teeth. Then, to realize the plastic effect provided by the material of the splinting element, the seal is disconnected. To do this, if necessary, first using a bur or a separation disk 22 in the area of the interdental gap on the obtained seal, a fracture line is drawn, and then the seals are separated (Fig. 28) so that separate fillings are formed while maintaining the integrity of the splint element. For this, various tools are used, for example, a dental spatula 23, a trowel, a corkscrew, an excavator, etc.

The fifth embodiment of the method is used in the case when, simultaneously with splinting of the teeth, they are undergoing prosthetics with artificial crowns (half crowns). To do this, cavities are additionally formed in the turned teeth (Fig. 29) (Fig. 30), allowing placement of elastic splinting elements 1 in them. Next, using an orthopedic spoon and impression mass or in another known manner, an impression is made from the turned teeth with the formed cavities which casts a plaster model. On this model, artificial crowns are modeled and manufactured from filling material and (or) plastic, and (or) ceramic, and (or) metal, or from any other suitable material by known methods (Fig. 31). In this case, the crowns are interconnected by elastic splinting elements 1 of any design while preserving the elastic intermediate part with unfilled material, if necessary using the proposed matrix with a hole and a slit (section) for this. The cavities formed in the turned teeth are used in artificial crowns to accommodate the end sections of the splinting elements 1 with the end sections 2 in them.

The sixth embodiment of the method is used while splinting and prosthetics with artificial crowns or half crowns, if the wall thickness of the artificial crowns allows you to place the end sections 2 of splinting elements 1 in them without creating additional cavities, then such cavities in turned teeth do not perform (Fig. 32). At the same time, an impression is made from the teeth turned under the crowns, according to which the gypsum model is cast, artificial crowns are modeled and made on this model, they are joined together by elastic splinting elements, the end sections of which are placed in the wall of the artificial crown.

The resulting structure (according to the fifth and sixth variants of the method) in the form of crowns (half-crowns) united by a splint element is transferred to the oral cavity and fixed to the corresponding teeth using filling material, adhesive or other known methods. It is possible to simultaneously combine and install three or more crowns. To combine crowns, a continuous splinting element can be used.

Bibliography

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Claims (22)

1. A method of splinting teeth, including the formation of cavities, installing a splinting element, characterized in that cavities are formed on the contact surfaces of the splinted teeth or cured filling material, then an impression is made on which a gypsum model is cast, on which tabs are made that fill out previously formed cavities, connect the tabs with each other with an elastic splinting element consisting of end sections and an intermediate part, the resulting design in the form of combined the tabbing element of the tabs is transferred to the above-mentioned cavities formed in the teeth, which are pre-filled with the filling material and / or materials of the adhesive systems, and / or with glues, the tabs are put in place, after which the filling material is cured or the tabs are fixed, while keeping them blank material elastic intermediate part of the splinting element. 2. The splinting method according to claim 1, characterized in that in the region of one interdental space, two or more splinting elements are used. 3. The splinting method according to claim 1, characterized in that when installing the splinting element, a separation matrix is used, the matrix is inserted into the interdental space and put on the intermediate part of the splinting element so that the intermediate part of the splinting element is in the hole of the matrix. 4. The splinting method according to claim 3, characterized in that the separation matrix is made with two or more holes and / or one or more slots or cuts. 5. The splinting method according to claim 3, characterized in that the separation matrix is made in the form of a closed ring and contains at least one hole and at least one slot or only at least one hole without gaps, with in the absence of slots, the separation matrix is put through the hole on the end section of the splinting element, moved to the intermediate part, and after installation and fixation of the splinting element, the separation matrix is cut to the hole and removed. 6. The splinting method according to claim 3 or 5, characterized in that the holes and slots of the separation matrix do not repeat the shape and dimensions of the intermediate part of the splinting element. 7. The splinting method according to one of claims 3 or 5, characterized in that the matrix is made of plastic, or rubber, or rayon, or celluloid, or vinyl pyrrolidone, or ethyl acrylate, or cyanoacrylic acid ester, or polyvinyl butyl ether, or polyvinyl chloride, or latex, or rubber, or polyethylene, or polyisoprene, or cotton fiber, or gauze, or polyester yarns, or kapron, or lavsan, or letilan, or polypropylene, or polyphene, or polyethylene foam, or foam, or polyamide, or polycarbonate, or diphlon, or teff it, or poly-4 methylpentene-1, or macrolone, or polymethyl methacrylate, or polystyrene, or bumetol, or from a solution of polybutyl methacrylate in ethyl acetate, or from copolymers of butadiene and styrene, or copolymers of styrene and methyl acrylate with acrylic acid nitrile, or from an ethylene copolymer with vinyl acetate, or kapron resin, or polyamide resin, or ion exchange resin, or polyvinyl alcohol, or fluoroplast, or fluorolone, or ethrol, or paper, cardboard, coated and / or uncoated, or from a polyethylene-polyisobutylene composition m POV - 30, POV - 50, or plastic, or foil, or cellophane, or protacryl, or elastosil, or aerosil, or cellulose, or silicone, or ethacryl, or plastisol, or polyurethane, or polyimide, or fiberglass, and compositions, or solutions, or plastic compounds, or polymers, or copolymers, or mixtures based on them, and the matrix is made of steel, or titanium, or brass, or copper, or silver, or gold, or bronze, or aluminum, or nickel or cobalt, or chromium, or vanadium, or alloys based on them, or with their inclusion. 8. A method for splinting teeth, characterized in that cavities are formed on the contact surfaces of the splinted teeth or cured filling material, allowing placement of a continuous elastic splinting element in them, an elastic splinting element of the required length is cut out, a portion of the filling material is applied to the bottom of the formed cavities, the splinting element is necessary lengths are laid in all cavities simultaneously or in stages in each subsequent one; preliminary curing of the filling mat is carried out rial, then the cavities are completely filled with filling material using a separation matrix, while the separation matrix is inserted into the interdental space and put on the intermediate part of the splinting element so that the intermediate part of the splinting element is in the hole of the matrix, after which the cavities are completely filled and the matrix is removed . 9. The splinting method according to claim 8, characterized in that the continuous elastic splinting element is made in the form of fishing line, or tape, or chain, or tow, or in the form of a thread, or in the form of continuous, uniformly repeating links, and install it on all splinted teeth in a single fragment. 10. The splinting method according to claim 8, characterized in that the separation matrix is made with two or more holes and / or one or more slots or cuts. 11. The splinting method of claim 8, characterized in that the separation matrix is made in the form of a closed ring and contains at least one hole and at least one slot or only at least one hole without gaps, with in the absence of slots, the separation matrix is put through the hole on the end section of the splinting element, moved to the intermediate part, and after installation and fixation of the splinting element, the separation matrix is cut to the hole and removed. 12. The splinting method according to claim 8, characterized in that the holes and slots of the separation matrix do not repeat the shape and dimensions of the intermediate part of the splinting element. 13. The splinting method of claim 8, wherein the matrix is made of plastic, or rubber, or rayon, or celluloid, or vinyl pyrrolidone, or ethyl acrylate, or cyanoacrylic acid ester, or polyvinyl butyl ether, or polyvinyl chloride, or latex, or rubber or polyethylene, or polyisoprene, or cotton fiber, or gauze, or polyester yarns, or capron, or lavsan, or letilan, or polypropylene, or polyphene, or polyethylene foam, or foam, or polyamide, or polycarbonate, or diphlon, or teflon or poly-4 ethylpentene-1, or macrolone, or polymethyl methacrylate, or polystyrene, or bumetol, or from a solution of polybutyl methacrylate in ethyl acetate, or from copolymers of butadiene and styrene, or copolymers of styrene and methyl acrylate with nitrile of acrylic acid, or from a copolymer of ethylene with vinyl acetate, or resin or polyamide resin, or ion exchange resin, or polyvinyl alcohol, or fluoroplastic, or fluorolone, or ethrol, or paper, cardboard, coated and / or uncoated, or from a composition of polyethylene with polyisobutylene POV - 30, POV - 50 or plastic, or foil, or cellophane, or protacryl, or elastosil, or aerosil, or cellulose, or silicone, or ethacryl, or plastisol, or polyurethane, or polyimide, or fiberglass, as well as compositions, or solutions, or plastic compounds, or polymers, or copolymers, or mixtures based on them, and the matrix is made of steel, or titanium, or brass, or copper, or silver, or gold, or bronze, or aluminum, or nickel, or cobalt, or chromium, or vanadium, or alloys based on them, or with their inclusion. 14. A method of splinting teeth, including the formation of cavities, installing a splinting element, characterized in that cavities are formed on the contact surfaces of the splinted teeth or the cured filling material, then an impression is made on which a gypsum model is cast, on which tabs are made that fill out previously formed cavities, connect the tabs with each other by a continuous elastic splinting element, the resulting design in the form of tabs united by the splinting element is transferred in the above-mentioned cavities, which are pre-filled with filling material and / or materials of adhesive systems and / or adhesives, the tabs are put in place, after which the filling material is cured or the tabs are fixed, while the elastic intermediate part of the splinting element is left unfilled. 15. The splinting method according to 14, characterized in that when installing the splinting element, a separation matrix is used, the matrix being inserted into the interdental space of the gypsum model and put on the intermediate part of the splinting element located between the tabs, so that the intermediate part of the splinting element ended up in the hole in the matrix. 16. The splinting method according to claim 15, characterized in that the separation matrix is made with two or more holes and / or one or more slots or cuts. 17. The splinting method according to clause 15, wherein the separation matrix is made in the form of a closed ring and contains at least one hole and at least one slot or only at least one hole without gaps, with in the absence of slots, the separation matrix is put through the hole on the end section of the splinting element, moved to the intermediate part, and after installation and fixation of the splinting element, the separation matrix is cut to the hole and removed. 18. The splinting method according to claim 15, characterized in that the holes and slots of the separation matrix do not repeat the shape and dimensions of the intermediate part of the splinting element. 19. The splinting method of claim 15, wherein the matrix is made of plastic, or rubber, or rayon, or celluloid, or vinyl pyrrolidone, or ethyl acrylate, or cyanoacrylic acid ester, or polyvinyl butyl ether, or polyvinyl chloride, or latex, or rubber or polyethylene, or polyisoprene, or cotton fiber, or gauze, or polyester yarns, or capron, or lavsan, or letilan, or polypropylene, or polyphene, or polyethylene foam, or foam, or polyamide, or polycarbonate, or diphlon, or teflon or poly-4 methylpentene-1, or macrolone, or polymethyl methacrylate, or polystyrene, or bumetol, or from a solution of polybutyl methacrylate in ethyl acetate, or from copolymers of butadiene and styrene, or copolymers of styrene and methyl acrylate with nitrile of acrylic acid, or from a copolymer of ethylene with vinyl acetate, or capron resin or polyamide resin, or ion exchange resin, or polyvinyl alcohol, or fluoroplastic, or fluorolone, or ethrol, or paper, cardboard, coated and / or uncoated, or from a composition of polyethylene with polyisobutylene POV - 30, POV - 5 0, or plastic, or foil, or cellophane, or protacryl, or elastosil, or aerosil, or cellulose, or silicone, or ethacryl, or plastisol, or polyurethane, or polyimide, or fiberglass, as well as compositions, or solutions, or plastic compounds or polymers, or copolymers, or mixtures based on them, and the matrix is made of steel, or titanium, or brass, or copper, or silver, or gold, or bronze, or aluminum, or nickel, or cobalt, or chromium, or vanadium, or alloys based on them, or with their inclusion. 20. The method of splinting teeth, including the formation of cavities, the installation of splinting element, characterized in that on the contact surfaces of splinted teeth or cured filling material form a single cavity so that their shape and size allows you to place a continuous elastic splinting element in them, then to the bottom a portion of filling material is applied to each cavity, a continuous splinting element is placed in all cavities simultaneously or in each subsequent step-by-step, a preliminary curing of the filling material, and then the cavities are completely filled with the filling material so that the cavities in the adjacent teeth are closed with a single filling while preserving the natural contours of the teeth, then the seal is disconnected, for which, first, a line is drawn using the bur or separation disk in the area of the interdental gap on the obtained filling. fracture, and then carry out the separation of the seal in such a way that separate seals are formed while maintaining the integrity of the splinting element. 21. A method of splinting teeth, including the formation of cavities, installing a splinting element, characterized in that at the same time as splinting of the teeth, they are prosthetized with artificial crowns or half-crowns, while cavities for elastic splinting elements are formed in the teeth turned under the crowns, then from the turned teeth with the formed an impression is made in the cavities, according to which the gypsum model is cast, on this model artificial crowns are modeled and made, they are joined together by elastic splint cavities formed in honed teeth are used in artificial crowns to place the end sections of splinting elements or a continuous splinting element in them, the resulting design in the form of crowns or half crowns combined by a splinting element is transferred to the oral cavity and fixed on the corresponding teeth using filling material, adhesive while maintaining the unfilled material elastic intermediate part of the splinting element. 22. A method of splinting teeth, characterized in that simultaneously with splinting of the teeth, they are prosthetized with artificial crowns or half crowns, while an impression is made from the teeth turned on the crowns, according to which the gypsum model is cast, artificial crowns are modeled and manufactured on this model, they are combined between by elastic splinting elements, the end sections of which are placed in the wall of the artificial crown, the resulting structure in the form of crowns or half-crowns united by the splinting element approx transferred to the oral cavity and fixed to the respective teeth using a filling material, adhesive, wherein the elastic material remain unfilled intermediate portion of a strut element.

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