RU2494699C1 - Method of dental rehabilitation of musicians paying wind instruments - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to orthopedic dentistry, and is intended for dental rehabilitation of musicians playing wind instruments. Bi-layered silicone impressions are obtained before treatment. Models from scannable supergypsum are manufactured, scanned into computer module of CAD/CAM system, where replication of initial situation is performed. Teeth are prepared in oral cavity and processed with anti-reflective powder. Optic impression is obtained, on which replicant of modelled constructions is applied. Temporary non-detachable prostheses are milled from composite material. Obtained construction is fitted and fixed on temporary cement. Patient estimates preservation of embouchure directly in armchair and is lowered to determine functional and esthetic possibilities of prosthesis. Correction of initial replicant is carried out during the following visit. In case of necessity several more temporary dental prostheses are manufactured until complete satisfaction of required functions. Final temporary prostheses are scanned, connected in computer programme with optic model of prepared teeth. Permanent dental prostheses from ceramic block are milled in accordance with their shape.

EFFECT: method makes it possible to restore lost view of dentition, teeth shape, formed during years due to carrying out step-by-step orthopedic rehabilitation.

1 ex

Description

The invention relates to medicine, in particular to orthopedic dentistry, and can be used for dental rehabilitation of musicians playing wind instruments, with a partial absence of teeth.

Playing a wind instrument is associated with the complex coordinated work of the dentofacial system, the position of the lips and closing of the teeth, and a special breathing technique. It has been established that playing wind instruments for more than three hours a day is a significant risk factor for the development of pathological processes in the dentofacial system, which should be considered by the dentist (Herman E., 1989). Dental diseases, and above all periodontitis, which leads to tooth mobility, increased abrasion of hard tooth tissues, represent a big problem for the professional activity of musicians (Ogareva A.V., 2007).

Orthopedic dental rehabilitation of patients - musicians playing wind instruments is a difficult task for a practicing dentist. The individual parameters of the length, shape and position of the teeth in the dentition of musicians must be taken into account already at the stage of temporary prosthetics. This allows you to improve adaptation to prostheses, and thereby reduce the likelihood of loss of professional fitness or a decrease in skill level.

The medical and diagnostic phase of temporary prosthetics is in many respects the key in the treatment of musicians playing wind instruments. After making temporary crowns and fitting them in the oral cavity, a full-fledged play by a musician on a wind instrument is possible, followed by correction of new orthopedic constructions. With the traditional method of manufacturing temporary restorations, direct and indirect method, a large number of errors can occur at different stages. In particular, a clinical situation may arise when the shape of the teeth changes as a result of the intervention of the dentist, which affects the sound extracted from the musical instrument and the subsequent change in the ear cushion, and this can lead to the loss of professional suitability of the trumpeter musician.

In the CEREC-3D program, it is possible to carry out the replication stage (transferring the initial shape, size and position of the teeth in the dentition before prosthetics to new orthopedic denture designs). The replication stage, in our opinion, is the main one for prosthetics of trumpeters in the front of the dentition, as it allows you to maintain the original shape, size and position of the teeth in the dentition. The musician-oven in a short time adapts to the manufactured prostheses and he will not have problems in his professional activity.

Known methods for the manufacture of temporary fixed dentures made of composite material or plastic (RU 2116767 C1, 08/10/1998; RU 2177276 C1, 12/27/2001).

However, in all cases, the human factor is present in the process of manufacturing dentures, which leads to manufacturing errors and inaccuracies in reproducing occlusal relationships of dentitions.

A known method of manufacturing temporary dentures by computer milling is that, on working gypsum models in the articulator, preliminary functional approximate wax modeling of occlusal relationships in the form of cones is performed to transfer the desired occlusal landmarks of the patient into the software of the apparatus, and then using an optical print the simulated situation is transferred to the computer with the subsequent milling of the block prepared in advance th polyurethane by chemical fixation of a rectangle (block) size corresponding to a standard ceramic block manufactured special prefabricated metal shank, for their possible use in CEREC apparatus (Claim №2010137391 on 09.09.11).

This method is selected for the prototype.

The objective of the invention is orthopedic dental, professional and social rehabilitation of musicians with damaged tooth crowns playing wind instruments.

The technical result of the invention consists in a phased orthopedic dental rehabilitation, starting from replication, transferring the original shape, size and position of natural teeth in the dentition to prosthetics, to new temporary orthopedic designs (artificial crowns), ending with the formation of permanent ceramic fixed dentures that have features earlier lost tooth morphology in patients of wind-playing musicians.

The technical result is achieved by the fact that the method of dental rehabilitation of musicians playing wind instruments is as follows, get two-layer silicone prints before treatment and make models of scanned super gypsum, these models are scanned into the computer module CAD / CAM of the system, where the initial situation is replicated using the program , then the natural teeth are prepared and processed with anti-reflective powder to obtain an optical impression by the intraoral camera in the patient’s chair, on which is superimposed on the image of a replicant of previously simulated structures, after which temporary non-removable prostheses are milled from a composite material, the resulting dental prosthesis design is fitted and fixed in the oral cavity on temporary cement, the patient is evaluated for changes in the ear cushion directly in the chair, the prosthesis is corrected, if necessary, and released for determining the functional and aesthetic capabilities of the prosthesis at home, the next visit by the dentist is carried out the projection of the initial replicant by the formation of the lost volume of hard tooth tissues and harmonious occlusal relationships, if necessary, a series of (several) temporary dentures are produced that change in shape step by step until they fully satisfy the assigned functions, the final temporary dentures are scanned and connected to an optical model in a computer program the prepared teeth and their shape are milled permanent dentures (crowns) from a ceramic block.

When decaying teeth, especially the anterior group, musicians do not knowingly turn to the dentist, fearing that changes in the shape of the teeth will affect sound reproduction. Thus, the results of many years of work on the formation of the professional mastery of a spiritual musician are reduced to zero, in cases of destruction or change in the shape of the teeth of the front group, due to the physiological or increased wear of these teeth. Along with this, it is necessary to clarify that damaged teeth contribute to the occurrence or exacerbation of somatic diseases. The proposed method allows you to reproduce the lost picture of the dentition, the shape of the teeth, formed over the years, by the method of sequential prototyping.

The method of dental rehabilitation of musicians playing wind instruments is as follows:

1) receive two-layer silicone prints before treatment from both jaws;

2) make models of scanned super gypsum;

3) models are scanned into the computer module of the CAD / CAM system, where the program replicates the initial situation;

4) natural teeth are prepared and treated with anti-reflective powder to obtain an optical impression of the intraoral camera in the patient’s chair;

5) an image of a replicant of previously simulated structures is superimposed on the resulting virtual model;

6) temporary fixed prostheses are milled from a composite material manufactured in a factory way;

7) the resulting design of the denture is fitted and fixed in the oral cavity for temporary cement;

8) the patient evaluates the ear cushions directly in the chair, if necessary, a correction is carried out;

9) the next visit by the dentist is the correction of the original replicant, in accordance with the wishes of the patient by the formation of the lost structures of the hard tissues of the teeth and harmonious occlusal relationships;

10) temporary dentures, after the final correction and full adaptation of the patient to them, are scanned, connected in a computer program with an optical model of the prepared teeth;

11) permanent dentures (crowns or bridges) are milled from the obtained patterns from a ceramic block;

12) permanent ceramic structures fit in the oral cavity, their occlusal relationships with the teeth of the antagonists are verified;

13) Permanent ceramic structures are fixed to permanent cement.

Clinical example.

Patient K., 46 years old. Trumpeter musician. I went to the clinic of the Department of CRP with complaints of an aesthetic defect in the anterior part of the dentition and bad breath.

According to the patient, teeth 11, 22 were made of metal-ceramic crowns in 2002. Teeth 12 and 21 were restored with restorations from light-cured composite material in 2009.

On examination:

The configuration of the face is not changed, the chin lymph nodes are not palpable, neutral occlusion, the mucous membrane is pale pink, moderately moist, without visible pathological changes. There is a recession of the gingival margin in the area of the teeth 11, 22. A change in the color of the fillings and marginal fit on the teeth 12 and 21.

Diagnosis:

Partial lack of teeth on the upper and lower jaw: on the upper jaw, grade 1 is subclass 1, on the lower jaw, grade 2 is a subclass according to Kennedy's classification. Chronic generalized periodontitis of moderate severity in remission. Chronic granulomatous periodontitis of the tooth 12.

Recommended by:

Remove the ceramic-metal crowns in the area of teeth 11 and 22. Remove the pin cult tab in area 22, reorganize the root canal of tooth 22. Restore 22 with a pin structure. To produce aesthetic plastic crowns with tooth supports 12, 11, 21, 22, taking into account the preservation of the shape, size and position of the crown of the teeth, as changing these parameters can lead to a change in the sound extracted from the musical instrument and subsequent change in the ear cushion, which directly affects to preserve the professional suitability of a trumpeter musician.

Based on this, it was decided to use CEREC-3 CAD-CAM technology for the manufacture of crowns. In the CEREC-3D program, it is possible to carry out the replication stage (transferring the original shape, size and position of teeth in the dentition before prosthetics on new orthopedic structures).

Treatment:

Received two-layer silicone prints from the upper and lower jaws. Models were cast from scanned super gypsum (Dentona company) for subsequent replication (preserving the shape, size and position of teeth in the dental arch using previously constructed designs). Ceramic-metal crowns were removed from teeth 11 and 22. Retraction threads were installed in the area of teeth 12, 11, 21, 22. Teeth 12, 11, 21, 22 were prepared with a circular ledge of 135 °. Received a two-layer silicone impression from the upper jaw for the subsequent manufacture of aesthetic plastic crowns in the field of 12, 11, 21, 22.

Two models of the upper jaw (before and after preparation) are treated with anti-reflective powder (CEREC Powder). An optical impression of the prepared teeth 12, 11, 21, 22 was obtained by the intraoral camera according to standard technology, an occlusal register was made, optical impressions of the coronal part of the teeth 12, 11, 21, 22 were taken before the preparation began. Virtual crowns of teeth 12, 11, 21, 22 are modeled on the CEREC 3 apparatus. In this case, the “Replication” function was used to create a restoration that follows the shape of the coronal parts of the teeth 12, 11, 21, 22 before the preparation begins.

Crowns with tooth support 12, 11, 21, 22 are fitted in the oral cavity, the occlusal ratios are checked using Bausch articulation paper and sound samples on a musical instrument (trumpet). Plastic aesthetic crowns with tooth supports 12, 11, 21, 22 are fixed on temporary cement.

A day later, the final temporary dentures were scanned and connected in a computer program with an optical model of the prepared teeth, and permanent dentures from a ceramic block were milled in their shape. Permanent ceramic crowns supported by teeth 12, 11, 21, 22 are fitted in the oral cavity and are fixed to a permanent fixing material.

Claims (1)

The method of dental rehabilitation of musicians playing wind instruments is as follows: they receive two-layer silicone prints before treatment and make models from scanning super gypsum, these models are scanned into the CAD / CAM system computer module, where the initial situation is replicated using the program, then the teeth are prepared in the oral cavity and processed with anti-reflective powder to obtain an optical impression by the intraoral camera in the patient’s chair, on which the image of the replica is superimposed ikant of previously simulated structures, after which temporary fixed prostheses are milled from composite material, the resulting denture design is fitted and fixed in the oral cavity for temporary cement, the patient assesses the change in the ear cushion directly in the chair and is released to determine the functional and aesthetic capabilities of the prosthesis, on the next visit the doctor corrects the initial replicant by forming the lost structures of the hard tissues of the teeth and harmonious occlusal interactions. In relation to this, if necessary, they produce several more temporary dentures until they fully satisfy the assigned functions, the final temporary dentures are scanned, connected to the optical model of the prepared teeth in a computer program and permanent dentures are milled from the ceramic block in their shape.