RU2645641C1 - Method of orthodontic treatment of patients with defects of hard teeth tissue - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine and may be used to temporarily replace total and subtotal defects of the crown part of the teeth in cases where it is necessary to install a bracket for orthodontic treatment. Get imprints. Make models. Simulate anatomical form using wax. Positioning and fixing of the orthodontic bracket is performed at the stage of modeling the crown from wax. Braces are installed on the vestibular or oral surface of the tooth. Support area of the bracket is covered with an additional layer of wax, which is replaced by polymerization with plastic. Supporting tooth with wax reproduction of the artificial crown is gypsum plated in a cuvette and placed in boiling water for 10–15 minutes, and then opened. For the production of plastic crowns, plastic is used. Ready-made temporary plastic crown with a bracket installed in it is fixed to the stump of the supporting tooth.

EFFECT: method allows to increase the effectiveness of orthodontic treatment in patients with total and subtotal defects of hard tissues, as well as to prevent the destruction of hard tooth tissues due to the carious process.

1 cl, 6 dwg, 2 ex

Description

The invention relates to medicine, in particular to orthodontics and orthopedic dentistry, and is intended for orthodontic treatment of patients with subtotal and total defects in hard tissue of tooth crowns in cases where it is necessary to install a bracket on them.

There is a method of orthodontic treatment for patients with anomalies of the dentition, complicated by defects in hard tissues of the teeth, in which the orthodontic bracket is fixed to the surface of the ceramic-metal or all-ceramic crown (Horoshilkina F.Ya. “Orthodontics. Defects in teeth, dentitions, malocclusion, morphofunctional disorders in the brow of the facial area and their complex treatment ”, publishing house“ MEDpress-inform ”, M., 2009, p. 472). Fixation is carried out by adhesive technology. The disadvantages of this method are:

- a change in the contour of the gingival margin during orthodontic treatment leads to the fact that the crown does not meet the clinical requirements and requires replacement after such treatment;

- unreliable fixation of the bracket, especially on teeth with low clinical crowns;

- high cost compared to the proposed method.

Also known is a method of orthodontic treatment of patients with defects in hard tissue of teeth using an orthodontic ring with a bracket soldered to it (G.P. F. Schmut, E. A. Holtgrave, D. Drescher “Practical Orthodontics”, published by “GalDent”, Lviv, 1999, p. 166-169). The disadvantages of this method are:

- unreliable fixation of the bracket, especially on teeth with low clinical crowns;

- the impossibility of fixing the orthodontic ring on the teeth with complete destruction of the crown;

- unreliable fixation of the orthodontic ring on artificial crowns.

The technical result of the invention consists in the manufacture of a temporary plastic crown, in the process of modeling which a bracket is positioned and fixed from the wax for further orthodontic treatment.

The essence of the method of orthodontic treatment is the manufacture of a temporary plastic crown for teeth with partial or complete destruction of the crown part, in which at the stage of modeling it is installed and positioned with a bracket, the supporting platform of which is additionally covered with a layer of wax that is replaced during the polymerization with plastic.

The method is as follows: the double prints obtained in the clinic are used to make a working model, preference is given to durable grades of gypsum. Evaluate the quality of the resulting working model, carry out modeling of the anatomical shape using wax. The wax reproduction of the future artificial crown is increased in volume, based on the finishing of the plastic after polymerization, while restoring close contact with the antagonists and adjacent teeth (Fig. 1a; Fig. 2).

The positioning and fixing of the orthodontic bracket is performed at the stage of modeling the crown of wax. Using reverse forceps and an electric spatula, braces are placed on the vestibular or oral surface of the tooth (Fig. 1b; Fig. 3). The positioning of the bracket is carried out by an orthodontist or a specially trained dental technician. The distance from the groove to the occlusal surface is determined using a positioner (Fig. 1B). In this case, the support pad of the bracket is covered with an additional layer of wax (Fig. 1d; Fig. 4), which is replaced during plastic polymerization. Due to this, a reliable fixation of the bracket in an artificial crown is achieved.

An abutment with a wax reproduction of an artificial crown is cut out of the gypsum model together with the adjacent teeth in the form of a block and plaster into the cell vertically. The surface of the hardened gypsum is smeared with liquid paraffin, impose the upper part of the cell and fill it with gypsum. The cuvette with hardened gypsum is placed in boiling water for 10-15 minutes, and then opened. In this case, the tooth stump remains at the base of the cell, and the bracket passes into the counter form. The remnants of the molten wax are thoroughly washed off with hot water and cool the cuvette. For the manufacture of plastic crowns used plastic "Sinma-M".

The crowns are trimmed with various burs and milling cutters, which are mounted in a grinder. After grinding, the crown is washed with a brush in cold water and polished. The finished temporary plastic crown with a bracket installed in it (Fig. 5) is fixed to the stump of the abutment tooth (Fig. 1e).

A plastic crown with a bracket is made and fixed on a tooth with a total and subtotal defect of hard tissues of the crown part of any group accessory (Fig. 6b).

Example 1

Patient B., 22 years old, complained of incorrect position of teeth on the upper and lower jaw. Objectively: when examining the oral cavity and examining control and diagnostic models, a crowded position of the front teeth of the upper and lower jaw, narrowing of the dental arches of the upper and lower jaw in the area of premolars and molars were found. The crown parts of the teeth 2.4 and 3.6 are destroyed to the level of the gingival margin, the root canals are filled throughout.

The diagnosis was made: crowded position of the front teeth of the upper and lower jaw, narrowing of the dental arches of the upper and lower jaw; 2.4, 3.6 - complete destruction of the crown parts of the teeth, chronic fibrous periodontitis.

The defects of hard tissues of teeth 2.4 and 3.6 were replaced, pin stump tabs were made. After the manufacture of the pin cult tabs, preparation, removal of impressions, manufacture and fixation of plastic crowns on teeth 2.4 and 3.6 with braces were performed. Next, the remaining elements for orthodontic treatment are installed - braces and an arch. The stages of orthodontic treatment did not differ from those in patients with integral teeth. At the end of the orthodontic treatment, the plastic crowns with braces were replaced with permanent ceramic-metal crowns.

Example 2

Patient M., 20 years old, complained of incorrect position of teeth on the upper jaw. Objectively: when examining the oral cavity and examining the control and diagnostic models, the crowded position of the maxillary incisors, the vestibular position of the maxillary fangs, the absence of 14, 15, 24 teeth were found (14, 15 - were removed earlier due to caries complications, 24 - according to orthodontic indications). The crown parts of teeth 1.6 and 2.6 are destroyed to the level of the gingival margin, the root canals are filled throughout, the defects of the stumps are replaced by pin stump tabs.

The diagnosis was made: a distal bite, complicated by the crowded position of the front teeth of the upper jaw, a defect in the dentition of the upper jaw of Kennedy class 3; 2.4, 3.6 - defect of hard tissues of the crown parts of the teeth, chronic fibrous periodontitis.

After preparation, impression taking, plastic crowns for teeth 1.6 and 2.6 with braces were made and fixed. Next, the remaining elements for orthodontic treatment are installed - braces and an arch. The stages of orthodontic treatment did not differ from those in patients with integral teeth. At the end of the orthodontic treatment, the plastic crowns with braces were replaced with permanent ceramic-metal crowns.

In the aforementioned clinical situations, the proposed method for replacing a defect in hard tissues of orthodontically moving teeth turned out to be the only possible, since with the complete destruction of the crown part it is impossible to install an orthodontic ring on the tooth being moved, and fixing the bracket on the surface of a ceramic-metal or all-ceramic crown is unreliable and economically disadvantageous. A temporary plastic crown with a bracket was tested in seven patients who were undergoing orthodontic treatment with non-removable equipment for dentoalveolar anomalies and deformities, had defects in the dentition, partial and total defects in the hard tissues of the teeth.

Thus, through the use of the proposed method is achieved:

1) restoration of tooth function due to the replacement of a defect in hard tissues;

2) the ability to install a bracket on a tooth with complete or partial destruction of the crown, the absence of a vestibular or oral wall;

3) reliable fixation of the bracket on the tooth, which makes possible its orthodontic movement, since the supporting platform of the bracket is placed in the thickness of the plastic crown;

4) prevention of further destruction of the hard tissues of the tooth due to the carious process;

5) a change in the contour of the gingival margin of the tooth during orthodontic treatment does not affect the marginal adaptation of the permanent crown, since it is made at the end of orthodontic treatment and removal of orthodontic equipment;

6) economic efficiency (due to the significantly lower cost of plastic crowns compared to metal-ceramic and all-ceramic crowns).

Claims (1)

A method for orthodontic treatment of patients with defects in hard tissue of teeth, including the manufacture and installation of a crown with a bracket on the teeth, characterized in that a temporary plastic crown is made and installed, into which, at the stage of its modeling, the bracket is installed and positioned, the supporting platform of which is additionally covered with a layer wax, replaceable during the polymerization of plastic.

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