RU2532366C1 - Method for making releasing postoperative maxillofacial prosthesis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to dentistry, and is applicable in making a releasing postoperative maxillofacial prosthesis for all types of maxillectomy. A patient's oral cavity is optically imprinted. An optical imprint is digitised by means of a computer unit of CAD/CAM system. Planned surgical area boundaries are modelled on the formed image, and the above boundaries are virtually engraved vertically and horizontally at a width and a depth of 2.5 mm. A base of the releasing postoperative maxillofacial prosthesis is modelled with retention elements, and scanned patient's dental arch images are attached by matching technique. The modelled construction of the releasing postoperative maxillofacial prosthesis with artificial plastic-plate teeth is milled. The made prosthesis is processed, ground and polished. The prosthesis is fixed in the patient's oral cavity.

EFFECT: by providing a one-piece configuration of the releasing postoperative maxillofacial prosthesis with the retention elements by computed milling, the method enables recovering the masticatory function, ensuring the prosthetic bed formation within the surgical area and the optimum fixation in the unfavourable clinical environment of the prosthetic bed.

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Description

The invention relates to medicine, in particular to dentistry, and can be used for the manufacture of a disconnecting postoperative prosthesis for the upper jaw for all types of resection.

Also known is the design of the resection removable denture of the upper jaw, consisting of two detachable parts - the basis and the obturator (see B.K. Kostur, V. A. Minyaev. "Maxillofacial prosthetics." Medicine, 1985, p. 33- 34).

A known method of molding dental and maxillofacial prostheses from plastic by conventional pressing, which consists in obtaining a cast (impression), making a plaster model, modeling a wax obturator template, plastering a model with a wax template in a cuvette in a vertical position, packaging and polymerizing the plastic in a vertical direction (see V.N. Kopeikin, Ya.S. Knubovets, V.Yu. Kurlandsky, I.M. Oksman. Dental prosthetics, chap. 8, 9, art. "Technology of the use of plastics." M: Medicine, 1978 city, pp. 105-109; 272-275).

However, these design prostheses are made delayed, as a rule, on 14-20 days after surgery, when the epithelization of the wound surface ends. Accordingly, these prostheses cannot be used to form the edges of the surgical field, which at one time contributes to the further fixation of the prosthesis.

Known for direct prosthetics after resection according to the method of I.M. Oksman's in three steps. First, the fixing part of the prosthesis with clasps for supporting teeth is prepared. To do this, an impression is taken from the upper jaw, the model is cast, a fixing plate of wax is modeled and replaced with plastic, then an auxiliary impression from the lower jaw is obtained. Cast models and plaster them in an occluder.

After this follows the manufacture of the resection part of the prosthesis. On the models of the upper jaw mark the border of the resection in accordance with the plan of operation. Then, on the side of the tumor, one tooth is cut off at the level of the neck so that the subsequent prosthesis does not interfere with epithelization of the bone wound. The remaining teeth are cut together with the alveolar bone to the apical basis. The surface of the fixing plate is roughened, the resulting defect is filled with wax and artificial teeth are placed in the occlusion of the lower jaw. The artificial gums of molars and premolars are modeled with a roller going in the anteroposterior direction. In the postoperative period, the roller forms a bed in the mucous membrane of the cheek, which will serve as the point of anatomical retention. Wax reproduction of the prosthesis is replaced by plastic. After surgery, the prosthesis is placed on the postoperative wound (see A. S. Shcherbakov, E. I. Gavrilov, V. N. Trezubov, E. N. Zhulev. Orthopedic dentistry. St. Petersburg: ICF "Foliant", 1998, p. .526-527). This design is selected as a prototype.

The disadvantage of this design is that the boundaries of the prosthesis correspond to the boundaries of the surgical field, which does not allow additional pressure to be applied to this area, and also that the inner surface of the prosthesis is roughened, which in turn contributes to increased adhesion of aggressive microflora of the oral cavity to it and, as a result, the formation of a persistent factor for maintaining inflammation and prolonged wound healing.

A known method of manufacturing a disconnecting postoperative maxillary denture for the upper jaw by obtaining a plaster model before surgery, which plan and outline the proposed boundaries of the surgical field and remove the corresponding teeth, engrave these borders in vertical and horizontal directions with a width and depth of 1.5-2.0 mm then model the wax composition of the uncoupling postoperative jaw prosthesis with artificial teeth, clasps and retention elements, duplicate the floor of the studied plastic-wax composition, replacing the wax on the plastic with the subsequent restoration of the remote areas of the formation of the external borders of the surgical field with a soft gasket, then the plate is fixed in a silicone duplicate and polymerized under vacuum, followed by grinding and polishing the surface of the plate facing the defect to a mirror shine (RF patent No. 2427344).

This method is selected for the prototype.

The objective of the present invention is to restore the chewing function and the formation of the prosthetic bed of the denture in cancer patients with postoperative defects of the upper jaw and dentition with tooth integrity.

The technical result is the manufacture of a disconnecting postoperative denture for the upper jaw with all types of resection, which ensures the formation of the prosthetic bed in the area of the operation, optimal fixation under adverse clinical conditions of the prosthetic bed, restoration of masticatory function and restoration of the height of the lower third of the face after surgery.

The technical result is achieved by the fact that the method of manufacturing a disconnecting postoperative denture for the upper jaw consists in obtaining an optical impression of the patient’s oral cavity and digitizing it using the CAD / CAM computer module, modeling the borders of the proposed surgical field on the image with virtual engraving of these boundaries in vertical and horizontal directions with a width and depth of 2.5 mm, further modeling of the basis of uncoupling postoperative onnogo dentoalveolar prosthesis with the retention elements and the adjoining image scanned dentition of the patient by comparing the images, milling, simulated prosthetic structures made of a plastic disc.

Orthopedic dental rehabilitation of cancer patients with postoperative jaw defects is carried out in three stages of prosthetics. At the first stage, in the preoperative period, a disconnecting plate is produced that carries the function of separating the nasal and oral cavities and has an initial effect for epithelization of the defect boundaries. The second stage consists in the manufacture and use by the patient of a forming prosthetic obturator, which serves to temporarily restore masticatory effectiveness and form the fibrous ring of a defect in the sky, which further plays the role of an additional retention element, which is especially important in patients with complete absence of teeth. And the final stage of prosthetics is characterized by the manufacture of the final prosthetic obturator.

The proposed method can be used in the first of the proposed steps.

As a result of the treatment method, the patient not only delimits the oral cavity and nose, which, in turn, provides the possibility of eating, but restores chewing function and restores the height of the lower third of the face, due to the presence of dentitions and teeth in the resulting prosthesis, which are an exact copy dentitions and teeth of the patient in the preoperative period.

The design of the disconnecting postoperative plate for the upper jaw is illustrated in the drawing, where:

1. base plate

2. retention elements of the prosthesis,

3. areas of formation of the external borders of the surgical field,

4. milled artificial teeth.

Dissociating postoperative denture for the upper jaw is made as follows.

1. Obtaining an optical impression of the patient’s oral cavity.

2. Translation of its optical imprint into digital format by means of a computer module CAD / CAM system.

3. Modeling on the obtained image the boundaries of the proposed operating field with virtual engraving of these boundaries in the vertical and horizontal directions with a width and depth of 2.5 mm.

4. Modeling the basis of the uncoupling postoperative denture with retention elements and attaching images of scanned dentition of the patient by image matching.

5. The modeled design of the uncoupling postoperative denture with artificial teeth made of a plastic disc is milled.

6. Process the resulting prosthesis, grind, polish.

7. The prosthesis is fixed in the patient’s oral cavity.

Claims (1)

A method of manufacturing a disconnecting postoperative denture for the upper jaw consists in obtaining an optical impression of the patient’s oral cavity and digitizing it using the CAD / CAM computer module, simulating the borders of the proposed surgical field on the image with virtual engraving of the borders in vertical and horizontal widths and a depth of 2.5 mm, further modeling the basis of the uncoupling postoperative denture with a retention and joining elements bubbled image scanned dentition of the patient by comparing the images, milling, simulated prosthetic structures made of a plastic disc.

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