RU2554215C1 - Method for temporary tooth defect restoration with standard steel crown with anaesthetic support - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to dentistry, and is applicable in temporary tooth restoration with anaesthetic support. A standard steel crown is chosen with its edges corrected and turned down prior to the anaesthetic support with using a silicone plate made of a high-precision low viscosity impression compound. That is followed by the anaesthetic support. The latter involves the tooth preparation, corner rounding, preparation quality check, final crown edge turndown, crown cementing, excess cement removal, and final crown quality check. The high-precision impression compound is an s-silicone or an a-silicone impression material.

EFFECT: by reducing the number of actions accompanying the anaesthetic support, the method enables increasing the quality and clinical effectiveness.

3 cl, 5 dwg

Description

The invention relates to medicine, in particular to dentistry, and can be used in the restoration of temporary teeth in a child under conditions of anesthesiology benefits (general anesthesia, deep sedation).

A known method of direct setting of a standard steel crown (CCK), described in detail in [1. Daggl M.S., Curzon M.E. J., et al. Treatment and restoration of primary teeth. Section "Crowns from stainless steel for deciduous teeth", Publishing house "MEDpress-inform", 2006, pp. 91-111]. It includes the sequential execution of the following actions:

- local anesthesia and isolation of the working field by the rubber system;

- reducing the height of the bite (using various burs, the preparation of the temporary tooth from the chewing surface is performed);

- preparation of the medial and distal proximal cavities (using the cone-shaped burs, the buccal and lingual surfaces of the tooth are prepared);

- rounding of sharp corners (sharp edges of a tooth stump are rounded with a diamond bur);

- final quality control of the preparation (visual);

- selection of the crown and fitting (SSK are produced in various sizes from 2 to 7, they are tried on the tooth stump until a suitable one is found);

- crown correction (if necessary, the excess length of the SSC is corrected using special scissors, after which the edges of the SSC are smoothed with a carborundum boron);

- bending of the edges of the crown (the edges of the CCK are bent with the help of krampon forceps to create a snug fit to the neck of the tooth);

- cementing of the crown (CCK is filled with glass ionomer or polycarboxylate cement, then fixed on the tooth stump);

- removal of excess cement (performed after the polymerization of cement, its excess is removed using a dental probe or dental floss);

- final quality check of the crown (at the final stage of the SSK check by bite and polish with a special paste).

Similar methods are also described in detail in textbooks:

[2. Ralph E. Mac-Donald, David R Avery. Dentistry for children and adolescents. Section "Stainless Steel Crowns". 2003, pp. 389-393],

[3. Pinkham J.R., Casamassimo P.S. et al., Infancy Thought Adolescence. P.H. - “ELSEVIER SAUNDERS”, 2005, Chapter “Restorative Dentistry for the Primary Dentition”, section “Use of Stainless Steel Crowns”, pp. 341-374].

The disadvantages of these methods of restoration are:

- clinical complexity in the conditions of anesthetic benefits, consisting in a multi-stage restoration process;

- the duration of the procedure.

The time of setting one crown (not counting the treatment of tooth pathology - caries or pulpitis) takes from the dentist from 20 to 40 minutes. The duration of the period of anesthetic benefits is limited (up to 2 hours). It is far from always possible to completely complete the necessary restoration of defects of all needing teeth according to the above method. Increasing the restoration time requires high qualification not only of the dentist, but also of his assistant.

Closest to the claimed method, the method of using standard stainless steel crowns for the restoration of temporary teeth in children, described in [4. Mishutina O.L. The use of standard stainless steel crowns for the restoration of temporary teeth in children. The journal "Pediatric Dentistry and Prevention", 2013, No. 2, pp. 40-48]. It is a modification of the aforementioned known method and contains the following actions indicated in the order of their execution in the described method:

1. Local anesthesia and cofferdam.

2. Measurement of the medio-distal size and height of the tooth crown, which is carried out after the start of anesthesia before preparation, for preliminary selection of the size of the crown in the patient’s mouth with a caliper. At the same time, the author of this article notes that it is necessary to measure these sizes very carefully, including the correct determination of the crown height, and it should be noted that the gingival margin of the crown must completely repeat the anatomical shape of the cervical region of the tooth. The need for careful implementation of this action, noted by the author of the article, determines its substantial duration. It also requires proper illumination of the oral cavity and perseverance of the child.

3. Dissection of the occlusal surface of a temporary molar.

4. Preparation of the vestibular and lingual or palatine and buccal surfaces of the temporary molar.

5. Preparation of the medial and distal surfaces of the temporary molar and quality control of the preparation.

6. The choice of crowns for fitting, carried out by fitting on the tooth to find a suitable size. The author of the article notes that we must remember that the crown is tried on in the mouth, and if the size does not fit, the crown should be sterilized in an autoclave.

7. Correction of the crown if necessary. Preparation and contouring of the crown, i.e. cutting the edge of the crown in accordance with the shape of the gums using crowns scissors for metal or abrasive disc. After undercutting, the crown part is widened at the crown, so it is bent with conventional krampon forceps, after which the edges of the crown are polished with a carbide head, a disk and the edges are smoothed with a rubber head.

8. Fixation of the crown on cement.

9. Final quality check of the crown. The disadvantages of this method are:

clinical complexity in the conditions of anesthetic benefits, consisting in a multi-stage restoration process;

- measurement of the medio-distal size and height of the tooth crown in the patient’s mouth using a caliper, which does not allow to accurately measure the parameters in any direction, and can also be psychologically difficult for the patient to perceive,

- the duration of procedures performed under anesthesia,

- the need for subsequent sterilization of the crown, which did not fit.

Features of childhood, psychological characteristics of children, the presence of concomitant pathologies do not allow proper manipulation of the caliper in the mouth in such patients. Therefore, if you have to use a caliper in young children, it is quite reasonable to measure the medial-distal size and height of the tooth crown precisely under anesthesia, as indicated in the known methods. Therefore, for patients of this age, when restoration of a temporary tooth is required, in such measurements it is necessary to perform operations of selecting and correcting a standard steel crown and preliminary bending of its edges under the conditions of anesthesiology manual.

The objective of the invention is to reduce the time taken to complete the restoration of the teeth during the period of anesthetic benefits without complicating the restoration process as a whole and without increasing the time it takes to complete the restoration of the temporary tooth.

The problem is solved in that the method of restoration of a temporary tooth defect with a standard steel crown includes the selection and correction of a standard steel crown, bending of its edges, preparation of a temporary tooth, rounding of sharp corners, checking the preparation quality, cementing a standard steel crown, final quality control of a standard steel crown and differs the fact that the method is carried out using anesthetic aid, the selection and correction of a standard steel crown and its preliminary bending to of paradises is performed before anesthesia using a silicone template from a high-precision low-viscous impression mass, then anesthesia is performed and during the latter the preparation of the temporary tooth, rounding of sharp corners, checking the quality of the preparation, final bending of the edges of a standard steel crown, cementing, removal of excess cement, final quality control of standard steel crowns.

As a high-precision low viscosity impression mass, a material based on c-silicones can be used.

As a high-precision impression mass of low viscosity, a material based on a-silicones can be used.

The technical result of the invention is to reduce the number of actions performed under the conditions of anesthetic benefits, and as a result, to reduce the total time for performing actions under the conditions of anesthetic benefits, as well as to simplify the restoration process as a whole and to reduce the time it takes to complete the installation of a standard temporary crown tooth up to 40-70%. In addition, the quality and clinical effectiveness of the treatment are improved, because, having time, the doctor has the ability to perform actions more carefully.

The invention is illustrated by graphic materials, where in FIG. 1 shows a photograph of a model of a temporary bite with an impression of a high-precision impression mass; FIG. 2 is a photograph of an impression from the teeth of the upper and lower jaw, in FIG. 3 is a photograph illustrating sizing of the CCK; in FIG. 4 is a photograph explaining the determination of the required height of the CCK from the mold, in FIG. 5 - photo CCK before and after correction.

The novelty and inventive step consists in the fact that restoration activities are carried out in 2 stages:

- at the first stage (before the start of the anesthetic manual), the most time-consuming and longest stages of restoration are carried out with respect to the time of the clinical trial: selection and correction of the SSC and the hem of its edges, and for this they make and use a silicone template from a high-precision impression mass of low viscosity,

- at the second stage (in the conditions of anesthetic aid), the preparation of the tooth, the installation of the SSC and the rest of the final steps are performed.

In more detail, the method includes sequentially performing the following actions:

1. The choice of CCK.

It begins with the fact that before the start of anesthesia in the patient’s mouth, an impression is made (an impression in the bite from the dentition of the upper and lower jaw) from a high-precision impression mass of low viscosity (see Figs. 1 and 2). After polymerization of the impression mass, the impression is a silicone template - a negative display of the dentition of the upper and lower jaw.

Suitable material for the impression mass is described, for example, in [5. Ryakhovsky A.N., Muradov M.A. "Precise imprint." Moscow, Medical Book, 2006, Section “Types of Impression Materials”, pp. 34-53]. As a high-precision impression mass, both material based on the c-silicones group and material based on the a-silicones group can be used. Other suitable materials may also be used. The main thing is that they should have a pleasant color and smell for the child.

The method of manufacturing a silicone template is simple and described, for example, in [6. The use of a silicone template for the restoration of occlusal surfaces depulled according to periodontal indications of teeth. Instructions for doctors. Volgograd, 2010], which describes the use of silicone templates for dental fillings. Impression mass is prepared according to the instructions, fit to the desired tooth with the capture of adjacent teeth on the right and left. If there is a defect in the tooth, the impression mass fills it and forms drops that must be removed with a sharp tool such as a dental excavator so that these drops do not interfere with the selection of the crown. For the convenience of working with the template, you can cut off its edges so that they do not interfere with marking the excess length of the crowns with a marker. It is not advisable to carry out other modifications.

The step of obtaining the silicone template can be completed quickly, in about 5-10 minutes, depending on the perseverance of the child. You don’t even have to put your child in a dental chair. You can fit the impression mass to the tooth and remove it in the conditions of the game room or while waiting for a doctor's appointment. This allows, in addition, to reduce the psychological stress of the procedure.

Next, the CCK of the desired size is selected according to the made silicone template, as shown in FIG. 3. CCK is selected from a standard set produced by manufacturers for restoration of defects of temporary teeth of various sizes from 2 to 7 for each tooth. In this case, the standard crown should freely but tightly fit into the silicone template of the corresponding tooth, but there should be no gaps between the walls of the template on the medial and distal sides.

The size of the SSC selected with the help of a silicone template is not affected by subsequent tooth preparation, since it is possible to bend the edges with forceps and perform correction.

2. Correction of the selected SSC: it is applied to the silicone template and mark (mark) the line along which it should be cut (see Fig. 4), then cut off the excess length using special dental scissors for cutting metal crowns. Grinding the edges of the crown after correction of the length is carried out using rubber finishes with an angled tip.

3. Pre-bending the edges of the CCK using special krampon forceps.

4. Next, anesthesiological aid is carried out and all other actions are performed under the conditions of anesthetic aid.

5. The preparation of the tooth. The preparation of the masticatory surface is performed using diamond burs of a turbine of cylindrical, olive-shaped, conical shape. The preparation of the medial and distal proximal cavities is performed using diamond cones of a peak-shaped turbine.

6. Rounding of acute angles is performed using diamond burs of a turbine of average dispersion of spraying, olive-shaped.

7. Quality control of the preparation.

8. The exact final bending of the edges of the SSC, according to the anatomical features of the cervical region of the tooth, using special krampon forceps.

9. Cementing SSC using high-viscosity glass ionomer cements.

10. Removing excess cement is performed after polymerization of cement using a dental probe or dental floss.

11. The final quality control of the CCM and the final finishing, which is performed using occlusal paper, a brush for the contra-angle and abrasive paste.

As the study shows [7. Sedoykin A.G., Fedotov K.I., Kiselnikova L.P., Drobotko L.N. How to increase effectiveness of primary molar restorations with Stainless Steel Crowns (SSCs) in children treated under general anesthesia. International Journal of Paediatric Dentistry. Vol. 23. - Suppl. 1. June 2013. P. 123], using this method, the time of setting the SSC when restoring the defects of temporary teeth in children under conditions of anesthetic benefits is reduced to 50%.

Claims (3)

1. The method of restoration of a temporary tooth defect with a standard steel crown, including the selection and correction of a standard steel crown, bending of its edges, preparation of a temporary tooth, rounding of sharp corners, quality control of preparation, cementing of a standard steel crown, final quality control of a standard steel crown, characterized in that the method is carried out using anesthetic aid, the selection and correction of a standard steel crown and preliminary bending of its edges are performed to a non-estiological tool using a silicone template from a high-precision impression mass of low viscosity, after which an anesthetic tool is performed and during the last preparation of the temporary tooth, rounding of acute angles, quality control of the preparation, final bending of the edges of a standard steel crown, its cementing, removal of excess cement, final quality control of a standard steel crown. 2. The method according to p. 1, characterized in that as a high-precision impression mass of low viscosity using a material based on c-silicones. 3. The method according to p. 1, characterized in that as a high-precision impression mass of low viscosity using a material based on a-silicones.

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