RU2652570C1 - Method of substituting absent teeth with bilateral free-end edentulous spaces of tooth row for upper or lower jaw and adhesive teeth prosthesis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions refers to medicine, in particular to orthopedic dentistry, and is intended for use in the prosthetics of patients with free-end edentulous spaces. Method includes processing abutment teeth for survey crowns with chamfering, contouring wax patterns, manufacturing a demountable model, milling a fiberglass frame. Demountable model is cast, scanned together with the abutment teeth or the dental scanner scans the abutment teeth and areas of missing teeth in the oral cavity of the patient, then in a CAD/CAM machine a single frame with crowns for the abutment teeth and cantilevered parts of the prosthesis with artificial teeth of the missing teeth is milled from the fiberglass material. Facing with an orthopedic composite, creating from it a suprastructure on the free cantilevered parts of the prosthesis are performed. Then the prosthesis is polished and then fixed onto a self-adhesive cement on the abutment teeth in the oral cavity of the patient. Adhesive denture for implementing the above-described method comprises a prosthesis body and support elements. Body of the prosthesis is whole-milled frame (1) made of a fiberglass material, and the supporting elements are made of the same material in the form of crowns (2) for abutment teeth (3) and cantilevered parts (4) of the prosthesis with artificial teeth (5) of missing teeth. Frame (1) has facing (6) from an orthopedic composite, and cantilevered parts (4) of the prosthesis have the form of suprastructures (7) repeating the alveolar ridge (8).

EFFECT: inventions allow to restore the aesthetic and functional usefulness of the dentition with bilateral free-end edentulous spaces by creating a light, wear-resistant, non-removable bridge cantilevered prosthesis with reliable fixation for 2 visits to the dentist.

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Description

Technical field

This invention relates to medicine, in particular to orthopedic dentistry, and can be used for fixed prosthetics for patients with end defects of the dentition of the upper and lower jaw, from 1 or more teeth.

The relevance of the use of fiberglass frames for prostheses is due to the desire of patients to have an alternative to removable dentures and the installation of implants to restore the dentition, low aesthetics of removable dentures, the inconvenience of their use. As well as the frequent occurrence of periodontal diseases, which, when using traditional metal frames for prostheses, leads to a frequent exacerbation of periodontal diseases and the loss of supporting teeth. Also, complications after implantation, contraindications for their installation, a long rehabilitation period aggravate the relevance of using whole milled fiberglass frames for this type of prosthetics.

State of the art

From the patent literature there is known a method for replacing missing teeth with an end defect of the dentition and a cantilever prosthesis for eliminating the defect of the dentition (RF patent No. 2541837, IPC А61С 13/225, publ. March 20, 2015), in which retention grooves are created on the occlusal surface supporting teeth. On both sides of the bottom of the groove cavity, internal notches are applied, into which the unpolymerized end of the base of the prosthesis frame is tucked, polymerized. The remaining cantilever part - the free shoulder - is placed parallel to the alveolar process of the jaw. On the cantilever part, prefabricated models of the frames of missing teeth made of fiberglass are strung, fixing them on a fluid composite. The prosthesis frame is modeled, which is then lined with an orthopedic composite with the formation of a washing space. Adjust the height and width of the prosthesis and cover with glaze.

The disadvantages of the prototype method: there is no possibility of prosthetics of the entire dentition in the presence of only 4 teeth, not in all cases the design is able to withstand chewing pressure for a long time at the junction with its own tooth due to pores, there is a possibility of chipping of the lining due to pores that arise in the process of modeling the frame in the oral cavity. The closest in technical essence and the achieved result to the proposed technical solution is a method of manufacturing a bridge frame from fibrous materials, including the preparation of teeth under the crown, casting a mold, manufacturing a collapsible model, forming a fibrous frame and its polymerization. The main difference is the applicability of this design to the prosthetics of the included defects, the use of fibrous material for direct work and its own layer-by-layer polymerization (RF patent No. 2314061, IPC АС 13/225, publ. 10.01.2008). This invention is taken as a prototype for the proposed method.

The disadvantages of the prototype method are the inaccuracy of the design in comparison with digital technologies, the likelihood of pores and unpolymerized areas, with residual monomer due to the manual layered framework polymerization technique on the model. And as a result, weak spots on the prosthesis frame, which will lead to the inevitable chip cleavage. Also, using this method, it is impossible to perform single or double-sided console prosthetics, due to the lack of suprastructure and the probable frailty of the frame described above, as well as the use of polyethylene fibers is unacceptable, due to their insufficient strength and porosity. The frame is not monolithic.

Known adhesive denture containing a plate consisting of a supporting and cantilever part, and an artificial tooth made with a longitudinal groove. In the supporting part, grooves can be made depending on the cases of application of the prosthesis. (RF patent No. 21545420, IPC АС 13/00, publ. 01.27.1999).

The disadvantages of the analog prosthesis are as follows. It is not an integral frame structure, but an artificial tooth, proposed as a replacement for the absent, short-lived, subject to abrasion. The design involves the replacement of only one tooth. An extended structure based on this decision cannot be made. It can not be considered as a reliable design, because the prosthesis body is made of photocomposite material.

The closest in technical essence and the achieved result to the proposed technical solution, the device is an adhesive bridge from the RF patent №2320292, IPC АС 13/225, publ. March 27, 2008. A fiber-composite non-removable adhesive bridge prosthesis for replacing a single missing tooth contains the prosthesis body and supporting elements in the form of adhesive pads covering the palatal surface of the supporting tooth. The prosthesis body is made of a photocomposite material and is equipped with an occlusal pad-pad that rests freely on an existing filling in the tooth from the medial side of the dentition defect, while the adhesive patches additionally cover the vestibular and medial surfaces of the supporting tooth and are equipped with vertical and horizontal ridges on their inner surface.

The disadvantages of the prototype prosthesis are as follows. The design involves the replacement of only one tooth. An extended structure based on this decision cannot be made. It can not be considered as a reliable design, because the prosthesis body is made of photocomposite material.

The task of creating a group of inventions is to develop a method for replacing missing teeth with end defects with a fixed prosthesis of a new design, free from the disadvantages of both the method and the prototype device.

SUMMARY OF THE INVENTION

The problem is solved using the signs specified in paragraph 1 of the claims, such as a method of replacing missing teeth with bilateral end defects of the dentition for the upper or lower jaw, including signs common to the prototype, such as processing of supporting teeth for supporting crowns with the creation ledges, casting, manufacturing a collapsible model, milling a fiberglass frame, and salient features such as a collapsible model are cast, scanned with abutments, or scanned They use dental scanners to provide abutment teeth and parts of missing teeth in the patient’s oral cavity, then a whole frame with crowns for supporting teeth and cantilevered parts of the prosthesis with artificial teeth of missing teeth is milled from fiberglass material in a cad cam machine, faced with an orthopedic composite, create suprastructures from it on free the cantilever parts of the prosthesis, then the prosthesis is polished, followed by fixing it on self-adhesive cement to the abutment teeth in the patient's oral cavity.

According to paragraph 2 of the claims, the prosthesis is installed in the presence of at least four teeth on the upper or lower jaw of the patient. According to paragraph 3 of the claims, suprastructures on the cantilever parts of the prosthesis on the model are performed repeating the alveolar ridge.

The problem is solved using the signs specified in paragraph 4 of the claims common to the prototype, such as an adhesive denture to replace missing teeth with bilateral end defects of the dentition for the upper or lower jaw, containing the prosthesis body and supporting elements, and distinctive essential features such as the prosthesis body is a whole-milled frame made of fiberglass material, and the supporting elements are made of the same material in the form of crowns for supporting teeth and cantilever Tei prosthesis with artificial teeth missing teeth, wherein the frame has a lining of a composite orthopedic and cantilever portion are in the form of the prosthesis superstructure, repeating the alveolar crest. According to paragraph 5 of the claims, a monolithic frame with crowns for abutment teeth and cantilever parts of the prosthesis of missing teeth is made on a cad cam machine. According to paragraph 6 of the claims, the connector between the crowns and the cantilever part of the prosthesis is made of a thickness of at least 2 mm.

The above set of essential features of the method allows to obtain the following technical result - restoration of the aesthetic and functional usefulness of the dentition with bilateral end defects, in the absence of 1-6 teeth, due to the creation of a lightweight (weight of the prosthesis 4 g), a wear-resistant fixed bridge-type console prosthesis with reliable fixation, comfortable operation for 2 visits to the dentist.

The best examples of the feasibility of a group of inventions.

The invention is illustrated by examples, photos and drawings. In FIG. 1 shows the design of the prosthesis, bottom view; in FIG. 2 - general view of the prosthesis, top view; in FIG. 3 - condition of the dentition before prosthetics; in FIG. 4 - photo, view of the lower jaw of the patient after prosthetics.

The prosthesis body (Fig. 1) is an all-milled frame 1 made of fiberglass material, for example TRINIA (Trinia material was first used in the USA in 2010. This is the first metal-free material for frame milling in a cad cam machine. It is described on the website bicon.ru. This material is intended for the manufacture of dentures.) The supporting elements are made of the same material in the form of crowns 2 for supporting teeth 3 and cantilever parts 4 of the prosthesis with artificial teeth 5 missing teeth. The frame 1 has a lining 6 of an orthopedic composite, and the cantilever parts 4 of the prosthesis are in the form of suprastructures 7, repeating the alveolar ridge 8 (Fig. 2).

The monolithic frame with crowns for abutment teeth and cantilever parts of the prosthesis of missing teeth is made on a cad cam machine.

The above device is a monolithic frame made of fiberglass material for cad cam, milled in a machine, having crowns on the supporting teeth, cantilever parts of the prosthesis with a superstructure that determines the stability of the prosthesis and the redistribution of chewing pressure over the entire length of the prosthesis. The cantilever parts can be 2 cm or more long, this length is enough for prosthetics of the chewing group of teeth. A feature of this design is a continuous, non-removable frame with bilateral cantilever parts of the prosthesis. A feature is the thickness of the crowns, the thickness of the connector between the crown and the cantilever part of the prosthesis - they must be at least 2 mm thick. The material for the manufacture of such a fiberglass structure can withstand loads of chewing pressure, does not corrode, is not hygroscopic, does not oxidize, is biocompatible and inert with respect to the tissues of the human body.

The prosthesis design described above is used in the implementation of the method described below for replacing missing teeth with bilateral end defects of the dentition for the upper or lower jaw. If necessary, the abutment teeth are depulped and strengthened after filling the canals with fiberglass pins. The abutment teeth are machined under abutment crowns with the creation of ledges, casting, production of a collapsible model, milling of a fiberglass frame. A collapsible model is cast, abutment is scanned together with abutments, or abutment teeth are scanned with a dental scanner in the patient’s mouth, and then a cad cam is milled from fiberglass material, for example TRINIA, a one-piece frame with crowns for abutments and cantilevered parts of the prosthesis with artificial teeth of missing teeth, faced with an orthopedic composite, create from it suprastructures on the free cantilever parts of the prosthesis, then polish the prosthesis. The finished frame is tried on in the patient’s oral cavity and adjusted if necessary. Then the abutment and prosthesis are prepared for fixation, followed by its fixation on self-adhesive cement to abutment teeth in the patient's oral cavity.

The prosthesis is installed in the presence of at least four teeth on the upper or lower jaw of the patient. Suprastructures on the cantilever parts of the prosthesis on the model are performed repeating the alveolar ridge.

Clinical example

Patient G. turned to the clinic for the purpose of prosthetics of the dentition of the lower jaw; 47, 46, 45, 32, 34, 35, 36, 37 teeth were missing. She cannot wear a clasp prosthesis because of the inconvenience of the design. For health reasons, implants are contraindicated. Planned prosthetics with fixed console design. The existing 44, 43, 42, 41, 31, 33 teeth are prepared (old crowns are removed, support teeth are sanitized); machined to create a circular ledge; casts taken. Further, in the laboratory, a one-piece frame made of Trinia 47, 46, 45 material artificial crowns was milled; 44, 43, 42, 41, 31, 33 support crowns; 32, 34, 35, 36, 37 artificial crowns. Lined with twini orthopedic composite, suprastructure created from twini-gingival mass in the field of artificial teeth. Polishing the prosthesis. Then, after drug treatment of the abutment teeth, the prosthesis was fixed to abutment teeth in the oral cavity on self-adhesive cement. After 2 years, the appearance of the prosthesis is not changed. The mucosa in the area of the cantilever parts of the prosthesis is pale pink, normal. The marginal fit of the crowns is not broken. The supporting teeth are stable, motionless. Changes in the periodontal tissues of the supporting teeth on the x-ray is not observed.

The advantages of this solution are:

1) fixed design - ease of use and good quality of life;

2) metal-free design - there is no oxidation reaction, the color of the crowns does not change;

3) high wear resistance;

4) the adjustable and reversible design - allows you to correct defects directly in the patient's oral cavity;

5) no galvanization;

6) lightweight and comfortable to use design;

7) is suitable for all categories of patients, including those who, due to existing somatic diseases and professional indications (for example, submariners) are not able to wear removable dentures or install dental implants.

Industrial applicability

The proposed prosthesis can be made of available materials in a simple way using modern equipment of orthopedic dentistry. The method was tested in a clinical setting, showed good results. This description, drawings and examples are considered as material illustrating the invention, the essence of which and the scope of patent claims are defined in the following claims, a combination of essential features and their equivalents.

Claims (6)

1. A method for replacing missing teeth with bilateral end defects of the dentition for the upper or lower jaw, including the processing of abutment teeth under abutment crowns with the creation of ledges, casting casts, manufacturing a collapsible model, forming a fiberglass frame, characterized in that the collapsible model is cast, scanned together with abutments or with a dental scanner, scan abutments and parts of missing teeth in the patient’s mouth, then a whole piece of fiberglass material is milled from cad cam k'as with crowns for the abutment teeth and the arm portion of the prosthesis with artificial teeth missing teeth, veneer composite orthopedic create therefrom superstructure on the free cantilevered parts of the prosthesis, the prosthesis then polished and then fixing it on a self-adhesive cement on the abutment teeth in the oral cavity. 2. The method according to p. 1, characterized in that the prosthesis is installed in the presence of at least four teeth on the upper or lower jaw of the patient. 3. The method according to claim 1, characterized in that the suprastructures on the cantilever parts of the prosthesis on the model are performed repeating the alveolar ridge. 4. Adhesive denture for replacing missing teeth with bilateral end defects of the dentition for the upper or lower jaw, containing the prosthesis body, a milled fiber material frame, lined with (6) orthopedic composite, supporting elements and cantilever parts with artificial teeth, characterized in that the prosthesis body is made in the form of an all-milled frame (1) of fiberglass material, with ready supporting elements made of the same material in the form of crowns (2) for supporting teeth (3), and onsolous parts (4) of the prosthesis with artificial teeth (5) of missing teeth, while the cantilever parts (4) of the prosthesis have the form of suprastructures (7), repeating the alveolar ridge (8). 5. The prosthesis according to claim 4, characterized in that the monolithic frame with crowns for the abutment teeth and the cantilever parts of the prosthesis of the missing teeth is made on a cad cam machine. 6. The prosthesis according to claim 4, characterized in that the crowns 2, the connector between the crowns and the cantilever part of the prosthesis are made with a thickness of at least 2 mm.

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