RU2650588C1 - Method of obtaining functional combined imprint in patients with postoperative defects of the upper jaw - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to orthopedic dentistry, and is intended for use in obtaining a functional combined impression in patients with postoperative defects of the upper jaw. Perform adjustment of individual spoon in the oral cavity, correction of its edges with the help of wax. In this case, additional support of soft tissues is created on the defect side, the defect boundaries are refined by the base wax, which creates an additional compression on the impression mass filling the defect. Two-stage impression is obtained with a silicone impression mass, with functional tests.

EFFECT: method allows to obtain a functional combined impression exactly reproducing the positive imaging of the sky defect, the preserved tissues of the dental alveolar region, and to reduce the compression on the mucous membrane of the preserved tissues, allowing to assess the tightness of the closing valve.

1 cl, 1 dwg

Description

The method relates to the field of medicine and medical technology and can be used in orthopedic dentistry to obtain a functional combined impression in patients with postoperative defects of the upper jaw.

In technology and literature there is an analogue containing a method of forming the edges of an individual spoon [RU 2316286, publ. 02/10/2008].

The aforementioned analogue has drawbacks consisting in obtaining an impression using chewing pressure, which is not applicable in the presence of a postoperative defect of the palate, usually burdened by atony of the chewing muscles and difficulty opening the mouth.

There is also a closer analogue [RU 2274429, publ. 04/20/2006].

The disadvantage of this method is the inability to form uniform borders of the impression tray in the absence of support of soft tissues from the side of the defect and, as a result, the inability to obtain a qualitative display of the defect of the dentoalveolar region.

As a prototype of the invention is a method of obtaining a functional impression after resection of the upper jaw [RU 2423955, publ. 07/20/2011], in which an anatomical impression is obtained with an alginate mass using a standard spoon, according to which a gypsum model is made. An obturator is modeled on it by lining a positive imaging of a sky defect with wax while simulating a resected alveolar ridge. Set the resulting composition in the oral cavity and fit by filling up possible gaps with wax. An impression is obtained, according to which an individual spoon is made. The resulting spoon is adapted in the oral cavity using known functional tests. Set retention metal staples in a wax obturator fixed in the defect of the jaw. A corrective layer of silicone impression mass is applied to the resulting composition, after which an impression is made of a previously made individual spoon with a base layer of impression mass introduced into it.

The disadvantages of the prototype are both a separate impression of the defect and the tissues of the prosthetic bed, which entails an additional technical stage, and the inability to check the integrity of the future prosthesis at the stage of obtaining the impression.

The problem to which the claimed invention is directed, is to obtain a method that allows to obtain a functional combined impression that accurately repeats the structure of architectonics and retention points of the upper jaw defect, as well as preserved tissues of the dentoalveolar region, which allows to assess the tightness of the separation of the oral and nasal cavities, to reduce compression on the mucosa the cover of the prosthetic bed, in particular on the edges of the defect, and form the boundary closing valve of the prosthesis, while avoiding additional s intermediate laboratory stages of its receipt.

The technical result of the invention is to obtain a functional combined impression of the upper jaw with a postoperative defect that meets all the above requirements.

The problem is solved due to the fact that in the method of obtaining a functional combined impression in patients with postoperative defects of the upper jaw, including fitting an individual spoon in the oral cavity, correcting its edges with wax, characterized by the creation of additional support of soft tissues on the defect side, by defining the boundaries of the defect as a basis wax, which creates additional pressure on the impression mass filling the defect and obtaining a two-stage impression with a silicone impression mass with functional tests.

Brief Description of the Drawings

In FIG. 1 presents an individual spoon corrected in the oral cavity, where it is indicated: 1 - the edges of the spoon, adjusted with basic wax; 2 - boundaries of the defect, corrected by basic wax.

The essence of the proposed method is as follows. An anatomical impression is obtained, the model is cast and an individual spoon is made of photopolymer material, after processing the spoon is fitted in the oral cavity, it is necessary to achieve a tight overlap on the jaw. On the buccal surface of the spoon, on the resected side, support is formed for the soft tissues of the cheek. To do this, by grinding individual sections of the spoon or adding warmed-up base wax, the buccal surface of the individual spoon is formed. Of great importance is the design of the posterior border of the prosthesis. To form the posterior border of the prosthesis and improve its fixation, a softened base wax with a thickness of 0.5-1 mm is applied to the palatal surface of the individual spoon, respectively the compliant zone of soft tissues of the hard palate, on the healthy side and, accordingly, to the tissues of the soft palate at the border of the defect. Then, the tested design is introduced into the patient's oral cavity, pressed against the sky. Excess wax displaced outside the spoon is removed. After that, the individual spoon is perforated with a cutter to fix the impression material. C-silicone impression material is used (Zeta +; Spidex, etc.). Next, the first layer of the functional impression is removed with the base material, the main part of which is laid in the region of the defect of the upper jaw and along the edges of the prosthesis in order to form an edge closing valve. At the same time, we tilt the patient’s head down slightly, while exhaling slowly, he pronounces a long “A”. This test is repeated for 1.5-2 minutes. The soft palate thus straightens and rises somewhat. At this moment, a spoon with impression material is pressed against the sky by the force of the thumb and forefinger. In this case, the fingertips should press on the thickened sections of the individual spoon. On the print obtained in this way, not only the tissues of line “A” are optimally compressed, but also compliant tissues that are soft over the entire surface of the hard palate. Situated unevenly on the spoon, in sections, the base impression material also acts as a stopper, which allows for the future unloading, non-compression functional impression. After this, a corrective impression is removed by corrective impression material. An individual spoon is removed from the oral cavity, covered with an even layer of medium viscosity silicone corrective mass ("Stomaflex cream", Zeta +; Spidex, etc.), which does not cause compression of the mucous membrane more than 50%, about 2 mm thick and is again placed in the oral cavity . Imprinting in these clinical situations is often difficult due to limited opening of the mouth. However, the need to create a high obstructive part, which subsequently plays the role of a medical apparatus for mechanotherapy, poses the task of obtaining an impression of the postoperative cavity to the full depth, taking into account all the retention points. In this regard, upon receipt of a working impression, in addition to applying the impression mass on an individual spoon, a preliminary smearing of the walls and the bottom of the defect is carried out using a corrective mass of medium viscosity. At the stage of obtaining a functional impression in the maxillofacial patient, in order to ensure the tightness of separation of the nasal and oral cavities and to obtain a satisfactory regional closing valve of the obstructing prosthesis, the patient must tightly press the external nasal passages and ask the patient to try to exhale through the nose. Repeat the operation several times. To set in motion the facial muscles that make up the model of the vestibule of the oral cavity, that is, with closed lips, the patient makes lip movements forward, backward, tries to raise the corners of the mouth several times. After that, we check the pronunciation of vowels and consonants. Particular attention is paid to the cleanliness of pronunciation of sonorous letters such as H, M, B, H, D, D, etc., as well as "noisy" types of L, P, K, F, W, X, C. The cleanliness of their pronunciation indicates a high-quality airtight dissociation of the oral and nasal cavities and a good marginal closure valve. Thus, it is possible to evaluate the results of a functional impression, which subsequently ensures the quality of the manufactured maxillofacial prosthesis for the rehabilitation of the patient. After the impression mass has cured, the individual spoon is removed from the patient's oral cavity. The removal of the impression in this way allows you to get the most accurate representation of the prosthetic field and reduce the cantilever effect of the future obstructive prosthesis.

Claims (1)

A method of obtaining a functional combined impression in patients with postoperative defects of the upper jaw, including fitting an individual spoon in the oral cavity, correcting its edges with wax, characterized by creating additional support of soft tissues on the defect side, by specifying the boundaries of the defect with base wax, which creates additional pressure on the impression mass , filling the defect, and obtaining a two-stage impression with a silicone impression mass with functional tests.

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