RU2345734C1 - Method of manufacturing of reinforcing adhesive beam- arch bridge prosthesis in lateral teeth replacement - Google Patents

Abstract

FIELD: medicine; orthopedic stomatology.

SUBSTANCE: method includes formation in defect area between support teeth of beam-net-wire arch lap consisting of beams fixed on support teeth at the level of equator from oral and vestibular sides, and arch framework. Arch framework is formed from stomatologic gilded metal net in form of central net part, whose width corresponds to distance between outer surfaces of fixed beams, and continuing wires released from network. Arch framework is fixed between support teeth from the side of aproximal surfaces 0.5 mm higher than level of gum surface with possibility to rest arc part of arch framework against fixed beams, and arch framework is additionally fixed by means of continuing wires used to envelop beams respectively from oral, vestibular and occlusive sides. On formed beam-net-wire lap by means of composite material crowns of one or two replaced lateral teeth are formed, preliminary placing over gum in defect area limiter of wash space in form of hollow semi-cylinder, made from polypropylene tube with diameter 10 mm and wall thickness 1 mm.

EFFECT: increase of bridge prosthesis rigidity in case of long sections of support teeth replacement.

Description

The invention relates to the field of reinforcing dentistry, and in particular to methods of manufacturing a reinforcing bridge in the patient’s mouth using two wire beams, a dental gilded metal mesh and a composite material.

The invention is intended to replace one or two missing posterior teeth.

According to Orthopedic Dentistry (optional course): Textbook for medical schools. / Ed. V.N.Trezubova. - St. Petersburg: Tome, 2002, p. 188 as a remedy, the bridge should meet the requirements of toxicology, technology, aesthetics, hygiene and function.

Compliance with the listed requirements of the bridge made by the claimed method is ensured by the choice of materials: dental gilded metal mesh and composite material, as well as the design of the supporting part of the prosthesis and its mounting on the abutment teeth.

The prior art method of restoring the dentition in the absence of two posterior teeth using a reinforcing mesh-beam bridge according to the patent of the Russian Federation No. 2261687. The frame of the prosthesis is made up of two wire beams and a gilded metal mesh, which is previously given an M-shape. The mesh is mounted on the bearing parts of the beams fixed to the supporting teeth at the equator level. The mesh is additionally fixed on the beams with the help of thin metal filaments, and then artificial crowns of replaced lateral teeth are formed on the formed supporting part of the beam using composite material.

Significant advantages of the known method include the use as a support for the bridge of teeth with completely and partially destroyed radicular parts. The implementation of the method within the boundaries of the defect area is aimed at maintaining the integrity of healthy teeth bordering the defect area.

However, given the length of the replacement site in the absence of two posterior teeth, the two-beam bridge structure may not be rigid enough to counteract the vertically directed functional load. As a result of the deflection of the intermediate part of the prosthesis, the risk of traumatic contact of the restored composite teeth with the mucous membrane of the alveolar ridge at the replacement site is likely.

The claimed method is aimed at preventing the occurrence of such complications when replacing two posterior teeth, in particular, by increasing the rigidity of the bridge and additional redistribution of the functional load on the supporting teeth.

This goal is achieved as a result of using the arch frame of the dental gilded metal mesh. An arched frame is placed between the abutment teeth. The arched frame is fixed on the proximal surfaces of the crown parts of the abutment teeth at a distance of 0.5 mm above the level of the gum surface with the possibility of contact with the bearing parts of the fixed beams.

Unlike the known prosthesis design, which is “suspended” on the abutment teeth using two beams fixed at the equator level of their crown parts, the claimed bridge prosthesis has a third abutment on the abutment teeth in the place of fixation of the arch frame.

The formation of a three-support structure increases the stability of the bridge, and also provides an additional redistribution of the functional load on the supporting teeth. As a result of the contact of the beams and the arch frame, the functional load is transferred to the crown parts of the abutment teeth partially at the equator through the supporting parts of the beams, and partly through the arch frame to the cervical part of the abutment teeth.

Redistribution of the functional load along the height of the crown part of the abutment teeth reduces the risk of their destabilization, in particular, if teeth with restored coronal parts are used as abutments, as, for example, in the manufacture of a bridge prosthesis according to RF patent No. 2261687.

Maintaining the stability of the supporting teeth increases the longevity of the functioning of the bridge as a whole.

The structural implementation of the inventive bridge is characterized by the presence of two mechanical bonds, which also increase the durability of its functioning. One of the mechanical bonds is formed at the place of direct contact of the arch frame with the beams. The nature of this connection is due to the elasticity of the curved arc-shaped grid of the arch frame. The second mechanical connection, with the help of which the beams and the arch frame are rigidly fastened together, is formed by the hard tissues of the abutment teeth, on which the supporting parts of the beams and the heel of the arch frame are fixed.

Thus, a distinctive feature of the proposed bridge is the inclusion of abutment teeth as an integral element of its structure. When implementing the inventive method, the abutment teeth, in addition to the traditional function of supporting the bridge, also perform the function of mutual retention of the metal elements of its structure.

The arched frame consists of a central mesh part, the width of which corresponds to the distance between the outer surfaces of the fixed beams, and of mesh wires freed from mesh weaving, which are located on both sides of its central part. After fixing the arch overlap on the supporting teeth, the wires are bent in the direction of the beams, and then the wires are bent around the beams, increasing the thickness of their bearing part, and therefore the rigidity of this part of the bridge.

An arched frame fixed on the abutment teeth and additionally fixed to the beams by means of wires forms, together with the beams fixed on the abutment teeth, an arched overlap of the bridge.

During the formation of composite crowns of replaced teeth, the cavity inside the arch overlap is filled with composite material, through which the arch frame and the bearing parts of the beams are additionally fastened together, and also additionally held on the abutment teeth at the junction of the composite material with hard tissues on the approximate surfaces of the crown parts of the abutment teeth.

The technical result achieved by the implementation of the inventive method is to increase the rigidity of the bridge with extended areas of tooth replacement.

The technical result is ensured by a combination of prosthesis structural elements, their interconnections and structural features of structural elements, namely: two beams, an arch frame and abutment teeth, the formation of two mechanical connections - in the place of the arch frame stop in the bearing parts of the beams and by fastening the supporting parts of the beams with heel of the arch frame through the hard tissue of the abutment teeth, as well as the structural design of the beam-mesh-wire arch (overlap). The technical result is also achieved due to the additional "unloading" of the bearing part of the bridge as a result of the redistribution of the functional load on the supporting teeth through the metal elements of the arched ceiling.

The reinforcing beam-arch bridge made by the claimed method belongs to the group of replacement and stabilizing prostheses that combine restored and supporting teeth into a single monolithic block.

SUMMARY OF THE INVENTION

The surfaces of the teeth adjacent to the defect are cleaned mechanically using brushes and toothpastes and the color of the replaced teeth is determined using the standard VITA scale.

On the supporting teeth, support platforms are formed for fixing the supporting parts of the wire beams and for fixing the heels of the arch frame.

The supporting platforms for the heel of the arch frame are formed from the defect side on the approximate surfaces of the supporting teeth at a distance of 0.5 mm above the level of the gum surface. The supporting pads are formed in the form of grooves, the depth and height of which is 0.5 mm, and the length is selected from the condition of matching the distance between the outer surfaces of the bearing parts of the beams fixed on the supporting teeth.

Support sites for fixing the supporting parts of the wire beams are formed at the equator level of the crown parts of the supporting teeth.

The method of forming the supporting sites is selected taking into account the clinical condition of the supporting teeth.

1. In the event that healthy posterior teeth are used as abutments, abutment sites can be formed in the form of cavities in the traditional way by preparing respectively the oral and vestibular surfaces of the abutment teeth at the equator level. The depth of the cavities is 0.6 mm, and their height is 2 mm.

2. With healthy abutments, an atraumatic method of forming the corresponding cavities can be applied. To do this, with the help of flexible contouring / polishing disks of medium grit of different diameters, grinding of the supporting teeth is carried out within the contours of the vestibular and oral surfaces of the crown part.

Then, in each of the supporting teeth, the ground surfaces are etched with acid. After 15 seconds, the etched surfaces are thoroughly washed off with water while the saliva ejector is running and dried with air.

An adhesive is applied to the etched surfaces, slightly blown with air for even distribution, polymerized by the standard method according to the instructions.

Then proceed with the reconstruction of the vestibular and oral surfaces of the abutment teeth using macrophilic composite material. First, the vestibular surfaces of the supporting teeth are reconstructed. To do this, using the composite material, the crown part of the abutment is expanded from the side of the vestibular surface, moving away from the gingival margin at a distance of 0.2 mm. The composite material is applied in thin layers, forming a coating of a composite material with a thickness of 0.3 mm on the vestibular surface. Carry out the polymerization.

A line perpendicular to the axis of the abutment is applied to the coating of the vestibular surface along the equator of the coronal part using a marker pen. After marking, an additional build-up of the composite coating is carried out in the direction, respectively, from the gingival margin and from the chewing surface to the equator line, forming at the level of the equator the maximum thickness of the composite coating layer is at least 1.5 mm.

Composite coating is likewise applied to the oral surface of the abutment. In this way, the reconstruction of the supporting teeth from the side of the vestibular and oral surfaces is carried out for the purpose of fixing the supporting parts of the reinforcing beams of the bridge structure. On the part of the oral and vestibular surfaces of the supporting teeth, rectangular cavities are formed, in which the walls are perpendicular to the bottom surface. The cavities are formed in the mesio-distal direction at the level of the equator with a width of not more than 2 mm. At the same time, the depth of preparation of the composite coating of reconstructed surfaces is progressively increased. First, the cavities are formed depth to the level of the marking line, and then to the level of hard tissues of the crown of the supporting teeth. Thus, in the formed rectangular cavities, the shape of the bottom part repeats the oval shape of the surface of the crown part in the region of the equator.

At the stage of forming rectangular cavities, the pre-marked marking line acts as a preparation depth limiter designed to prevent damage to the integrity of healthy hard tissues of the crown parts of the supporting teeth.

3. In the case when teeth with a destroyed crown part are used as abutment teeth, abutment areas for the abutment parts of the beams can be formed by the method described in RF patent No. 2261687. The tooth supporting area with a completely absent crown part is formed at the equator level by layer-by-layer filling with a macrophilic composite material of a cavity formed by the walls of the crown part, the walls of which were previously restored to the level of the tubercles with a composite material and reinforced with a gilded metal mesh.

To place the supporting parts of the beams on the supporting platform on the approximate surface of the restored wall from the defect side, a through slot is made at the level of the supporting platform. And the supporting area of the tooth with a partially missing crown part is formed in the form of cavities on the oral and vestibular surfaces of the crown part after its restoration with composite material and reinforcement by means of a mesh frame fixed on the stump of this supporting tooth.

After the formation of the supporting platforms on the supporting teeth, they begin to manufacture, try on and fix the reinforcing beams.

Beams are made of orthodontic wire 1 mm thick. The wire is further flattened, forming a cross section of a wire measuring 0.3 mm × 1.2 mm. Two beams are cut from a flattened wire with a length of not less than the sum of the length of the replaced area and the width of the two supporting teeth in the mediadistal direction. The beams form supporting parts. To do this, the ends of the beams are rounded mechanically according to the shape of the mating surfaces of the bearing pads. Carry out fitting and correction of reinforcing beams.

Next, acid etching of the inner surfaces of the formed support sites on the abutment teeth is carried out. After 15 seconds, the etched surfaces are thoroughly washed off with water while the saliva ejector is running and dried with air. Beams and etched surfaces are coated with adhesive and polymerized. Further, the supporting parts of the beams are fixed on the supporting teeth using a composite material.

After fixing the beams, the crown parts of the supporting teeth are restored with composite materials.

The bearing parts of the fixed beams should be located in the horizontal plane at the same level, and should also be parallel to each other in the projection from the side of the occlusal surface.

After fixing the beams, they begin to form and fix the arch frame. To do this, a rectangle is cut out of the gilded dental mesh, the length of which is determined from the condition of the mesh contacting the fixed beams after it is fixed in grooves made on the approximate surfaces of the abutment teeth.

Through the width of the rectangle of the mesh, wires are removed from both sides, while maintaining the center of the mesh weave with a width corresponding to the distance between the outer surfaces of the bearing parts of the fixed beams.

After fitting and correction, the mesh rectangle is fixed between the abutment teeth in preformed grooves using composite material. After fixing, an arch frame is formed, in which the heels are rigidly fixed to the abutment teeth, and the arcuate mesh part of the frame rigidly abuts against the fixed beams. The free wires of the arch frame are bent towards the outer surfaces of the bearing parts of the beams, and then at the level of the occlusal surface of the beams, the wires are additionally bent towards each other, covering the surfaces of the beams. The arch frame together with the bearing parts of the beams, on which the wires of the arch frame are mechanically fixed, form a beam-mesh-wire arch overlap between the abutment teeth.

After the formation of the arched ceiling, they begin to manufacture the limiters of the washing space.

For their manufacture, a polypropylene tube with a diameter of 10 mm and a wall thickness of not more than 1 mm is used. The length of the polypropylene tube should not exceed the length of the replaced section. The polypropylene tube is cut along the length into two parts. The rinsing space limiters are two hollow half-cylinders. The required number of restraints is determined individually, taking into account the distance between the gingival margin and the bottom of the formed composite crown of the restored tooth.

Perform fitting and correction of the length of the limiters of the washing space. Limiters are placed in the area of the defect over the gums with free ends towards the alveolar process and proceed to the final restoration of the missing posterior teeth with the use of macro-profiled composite material. Polypropylene limiters are removed after the final polishing of the restored tooth.

Thus, the inventive method allows for one visit to restore the missing lateral teeth by making a reinforcing beam-arch bridge directly in the oral cavity.

Claims (1)

A method of manufacturing a reinforcing adhesive beam-arch bridge for replacing the lateral teeth, comprising forming in the defect area between the supporting teeth a beam-mesh-wire arch overlap consisting of beams that are fixed on the supporting teeth at the equator from the oral and vestibular sides, and the arch the frame, which is formed from a dental gilded metal mesh in the form of a central mesh portion, the width of which corresponds to the distance between the outer surfaces of the zafi reinforced beams, and continuing wires, freed from mesh weaving, and the arch frame is fixed between the abutment teeth on the side of the approximate surfaces 0.5 mm above the level of the gum surface with the possibility of stopping the arcuate part of the arch frame in the fixed beams and additionally fix the arch frame by means of continuing wires , which cover the beams, respectively, from the oral, from the vestibular and from the occlusal sides, and then on the formed beam-grid-wire arched cross TII by using the composite material forming the crown of one or two substitutable lateral teeth, previously placed in the area over the defect gums limiter leaching space in the form of a hollow half cylinder made of a polypropylene tube of 10 mm diameter and a wall thickness of 1 mm.