RU2407480C1 - Method of teeth prosthetics - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention relates to field of medicine, in particular to dentistry, and is intended for prosthetics of teeth with jaw-bone atrophy. Implants are placed in pairs, with distance between them not more than one tooth width. On two implants simultaneously placed is one abutment with spherical head and two planting places on extended abutment body. Two single implantological bearing units are formed, each of them includes two implants from titanium with ultrafine-grained structure and abutment with spherical head, on extended body of which there are two planting places for coupling with implants. Detachable prosthesis is fastened on two single implantological bearing units. ^ EFFECT: method allows to ensure parallelism of installed implants, release intense-deformed state of bone tissue and manage with lower quantity of implants in case of evident atrophy of jaw-bones of patients of middle and extreme old ages. ^ 9 dwg, 1 ex

Description

The invention relates to the field of dental implantology and is intended for use in surgical dentistry in the presence of extensive defects, accompanied by a sharp atrophy of the jaw bones.

Atrophy of the jaw bones leads to resorption of the bone tissue of the jaw, lowering the height of its alveolar part, which reduces the possibility of using intraosseous implants, because can lead to the development of sinusitis and the formation of sinusoidal fistulas, damage to the mandibular nerve, perforation of the maxillary sinus fundus, etc.

It is known that in these cases subperiosteal implantation can be recommended, which is suitable in the case of severe thinning (resorption) of the jaw bone. Subperiosteal implants are a rather complex metal structure with supports protruding into the oral cavity, which are installed under the gum, between the periosteum and the bone. With this type of implantation, at least 5 mm of bone height is sufficient.

However, at present, this type of implantation is used extremely rarely, because there is no special equipment for the manufacture of subperiosteal implants, few specialists are familiar with this technique, as well as in the manufacture of subperiosteal implants, especially in the upper jaw, the subperiosteal part of the implant is often exposed due to atrophy of the alveolar ridge.

Known methods for the restoration of atrophied jaws. So, for example, with significant atrophy of the alveolar processes in the distal upper jaw, a sinus lift operation is used to raise the maxillary sinus bottom and thereby create a place for implants. For the lower jaw, bone grafting or transposition of the mandibular nerve is used. However, all these methods have contraindications and are sometimes accompanied by complications.

The solution to the problem in complex cases in the presence of extensive defects accompanied by sharp atrophy of the jaw bones can be a method of installing a removable denture on mini-implants, including a preliminary assessment of the patient's condition, planning the stages of implantation, installing implants in the jaw bone, installing an abutment on each implant, attaching removable denture (http://www.rusmedserv.com/dentalimplants/stages/.)

The need for removable prosthetics in these cases is explained by the weakness of the bone tissue itself and the possible likelihood of damage to it with a thin implant with full chewing load on the bridge or denture, which can reach 40-50 kg.

The advantage of this implantation method is its relative cheapness, the ability to use on the jaws with any condition of the bone tissue of the jaw, a fairly low invasiveness.

However, this known method has the following disadvantages:

- low resistance of implants to early load due to the stress-strain state of bone tissue,

- it is difficult to provide parallel implant placement in the jaw bones.

The objective of the invention is the creation of a method of removable prosthetics for patients with extensive defects, accompanied by a sharp atrophy of the jaw bones, devoid of these disadvantages.

It is known that with a minimum interimplant distance around two splinted implants, bone tension is less by 40%, with an inter implant distance of one implant width by 80%, an interimplant distance of 3 mm completely removes the stress-strain state of bone tissue (Tomohiko Arataki, Yasushi Adachi, Masataka Kishi, 1998).

However, the standard method of prosthetics, involving the installation of an individual abutment on each implant, does not provide the necessary parallelism of the implants, which reduces the quality of the prosthetics.

Effect: increasing the resistance of implants to an early load by reducing the stress-strain state of bone tissue by 20-40%, ensuring the parallel installation of implants in the jaw bones.

This technical result is achieved due to the fact that in the known method, including a preliminary assessment of the patient’s condition, planning of the implantation stages, installation of implants in the jaw bone, installation of abutments, fastening of a removable prosthesis, the following improvements are made:

- form two single implantological support units, each of which includes two implants and an abutment with a spherical head, on the elongated body of which there are two seats for interfacing with two implants at the same time, for which the installation of implants in the jaw bone is carried out in pairs at a distance between them no more than the width of one tooth, which provides an increase in the resistance of implants to an early load by reducing the stress-strain state of bone tissue by 20-40%;

- each pair of implants is combined into a single implantological support unit through the use of an abutment made with an elongated body, on which there are two seats for interfacing with two implants at the same time, which ensures the parallel installation of implants in the jaw bones;

- in patients with extensive defects accompanied by severe atrophy of the jaw bones, mini-implants are preferred;

- the use of an abutment, on an elongated body of which there is one spherical head on the coronary part of the abutment body and an additional one or two spherical heads on the end part of the abutment body, improves the quality of removable prosthetics.

The need to install implants in the thin jaw bones, interconnected through miniature connecting nodes in the form of an abutment containing two seats for interfacing with implants, dictates the choice of especially durable titanium, for example, with ultrafine-grained or nanostructure. A coating with bioactive properties, for example, of nanoscale hydroxyapatite, provides accelerated stimulation of restoration of bone tissue defects.

Therefore, a sign that ensures compliance of the proposed invention with the criteria of “novelty” and “inventive step” is the combination of two implants placed at a distance between them no more than the width of one tooth into a single implantological support unit through the use of an abutment made with the possibility of installation simultaneously on two implants due to the presence of two seats on the elongated body of the abutment.

This technical solution allows for simultaneous parallelism of the implants installed and removes the stress-strain state of the bone tissue, i.e. to increase the functional ability and reliability of the functioning of dentures. The method allows to manage with fewer implants with complete and multiple loss of teeth and severe atrophy of the jaw bones in elderly and elderly patients. With especially pronounced atrophy of the jaw bones, mini-implants can also be installed, also made of titanium with an ultrafine-grained structure, which gives it increased strength, and a bioactive coating of nanoscale hydroxyapatite, which provides accelerated stimulation of restoration of bone tissue defects.

The invention is presented in the following drawings:

Figure 1. Image of a complete denture with implant support.

Figure 2. Orthopantomogram of the patient before treatment. The X-ray picture of the periodontium of the remaining teeth and the condition of the jaws are in full accordance with the clinic of the disease.

Figure 3. Preoperative planning of implantation at OPTG: location and positioning of double implants with abutments with a spherical head.

Figure 4. General view of the oral cavity after the installation of dual implants and healing of the mucous membrane around them. Spherical abutment heads are visible.

Figure 5: Ready denture for the lower jaw with recesses for the matrices.

6. The moment of preparation for gluing the matrix.

7. The moment of installation of the prosthesis on the prosthetic bed with spherical heads of the abutments.

Fig. 8. Checking the accuracy of the fit of the prosthesis with central occlusion.

Fig.9. General view after prosthetics.

The method is as follows.

At the first stage, a preliminary assessment of the patient's condition is carried out. Based on the result of the examination and after carrying out all the necessary studies, they make a treatment plan based on the formation of two single implantological support units. The complete removable denture kit with implant support includes two pairs of implants 1, for each pair of implants - one abutment 2, with a spherical head, having two seats on its elongated body to interface simultaneously with two implants 1, prosthesis 3, matrix 4, for which in the prosthesis 3 there are recesses 5 (figure 1).

Install implants 1 in pairs at a distance of no more than the width of one tooth, then abutment 2 with a spherical head is installed on each pair of implants 1, having two seats on its elongated body to mate simultaneously with two implants 1, and a single implantological support unit is formed . To attach the removable prosthesis 3 to the spherical heads of the abutments 2, the matrices 4 are installed. On the removable prosthesis 3 for the matrices 4 there are recesses 5 (Fig. 1).

This method is suitable for both jaws. The advantage is the ability to immediately install a permanent prosthesis. Depending on the indications, the method can be implemented both according to a one-stage and two-stage method, depending on the quality of the bone. With a loose, poorly mineralized bone, for example, with osteoporosis, a two-stage technique is better.

In most cases, implants, especially mini-implants, can be inserted without bone grafting.

An example of the method

Patient P., born in 1952

Diagnosis: Complete absence of upper jaw teeth (condition after prosthetics: full removable prosthesis of traditional fixation with a suction peripheral valve). Type 2 diabetes mellitus in the stage of compensation.

Multiple missing teeth on the lower jaw. Focal periodontitis of a severe degree and functional overload of 33 and 43 teeth. Pronounced atrophy of the alveolar part of the lower jaw in the lateral regions.

Treatment plan: To restore the standard number of teeth of the lower jaw, bone grafting is necessary in order to create conditions for multiple implantation. However, it is contraindicated in connection with diabetes. Therefore, after the removal of teeth 33 and 43, it was planned to install double implants 1 in segments 33 and 34; 43 and 44 (figure 3) and the manufacture of a complete removable prosthesis 3 with recesses 5 for installation using matrices 4 on two single implantological units, including twin implants 1, combined by means of an abutment 2 with a spherical head and two seats on its elongated body. The sequence of prosthetics of the lower jaw on implants according to the proposed method is presented in figures 1-8.

Thus, the above example shows that the presence of a number of diseases that impede the use of known implantological prosthetics does not interfere with the use of the proposed method. Moreover, the proposed method improves the functional ability and reliability of the functioning of dentures due to the fact that it simultaneously provides parallel implants and relieves the stress-strain state of bone tissue. An additional advantage is that the method allows you to manage with fewer implants with complete and multiple loss of teeth and severe atrophy of the jaw bones, which is especially important for patients of old and old age.

Claims (4)

1. A method of prosthetics for patients with extensive defects, including a preliminary assessment of the patient’s condition, planning of implantation stages, installation of implants in the jaw bone, installation of abutments, attachment of a removable prosthesis, characterized in that they form two single implantological support units, each of which includes two an implant made of titanium with an ultrafine-grained structure, installed at a distance between them no more than the width of one tooth, and an abutment with a spherical head, on an elongated body of which contains two seats for interfacing with implants. 2. The method according to claim 1, characterized in that in patients with extensive defects, accompanied by a sharp atrophy of the jaw bones, mini-implants are used. 3. The method according to claim 2, characterized in that a bioactive coating is applied to the surface of the titanium implants with an ultrafine-grained structure. 4. The method according to claim 3, characterized in that an abutment is used, on the elongated body of which one spherical head can be located on the coronary part of the abutment body and additionally one or two spherical heads on the end part of the abutment body.

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