RU2698999C1 - Method for manufacturing an intermediate portion of adhesive bridge prostheses using individual silicone templates (indirect method) - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to orthopaedic dentistry, and is intended for use in treating patients with denture defects included. Reinforcing structure is selected and the support teeth are prepared, an impression of the denture is made on which an adhesive bridge prosthesis is to be made, a gypsum model is made and a silicone template is made. Artificial tooth is stitched on the plaster model, a rinsing space is created, a silicone template is made by applying from the oral surface of teeth and a gingival edge of the A-silicone material, closing the gingival sulcus, on the neck portion of the supporting teeth, not reaching the support elements by 0.5 cm, ready silicone template is installed in the oral cavity and on the intermediate part of the reinforcing structure, and on the silicone template is applied a fluid composite repeating the intermediate part of the artificial tooth facing the gum, and then performing modelling of adhesive bridge prosthesis, then silicone template is removed.

EFFECT: method makes it possible to produce an intermediate part of reinforced adhesive bridge prostheses (ABP) maximally adapted to individual type of alveolar process.

1 cl, 11 dwg

Description

The invention relates to medicine and can be used in orthopedic dentistry.

A common form of pathology of the dentition is included defects in the dentition. Traditionally, orthopedic treatment of patients with a similar pathology is carried out mainly by fixed bridges with the preparation of supporting teeth.

The emergence of new materials and, accordingly, new technologies, allowed to change the approach to treatment. In particular, it became possible to eliminate some of the included defects without preparation of supporting teeth, while achieving great strength, high aesthetics, and significant functional value (Smerdina Yu.G., Smerdina LN, 2001).

The prototype of such prosthetics can be considered the Start dentures, which at the beginning of the 20th century suggested strengthening single missing teeth with transverse pins located in the horizontal direction. For this, it is necessary to prepare reliable cavities-nests for cementing the pins in the abutment teeth (N. Astakhov et al., 1940).

Kopeikin V.N. (1961-1963) suggested gluing artificial teeth - the body of the prosthesis, to the teeth that limit the defect of the dentition.

Advances in the field of adhesive technology for orthodontics have made it possible to achieve good results by strengthening bridges by gluing. In 1981, Livaditis and Thompson from the University of Maryland's Baltimore Institute of Dental Surgery proposed an improved form of prostheses, which became known as the Maryland Bridge or adhesive prostheses, as well as a method for fixing them (Kopeikin V.N., 1993).

Bridges are called adhesives, the fixing parts of which (occlusal lining, clasps and other devices) are fixed on the abutment teeth with adhesive materials. This avoids such traumatic surgery as the preparation of hard tooth tissues. Since the fixation devices are located on the invisible surfaces of the tooth, these prostheses are aesthetically beneficial.

Adhesive bridges (AMPs) are used to replace single missing teeth.

(Orthopedic dentistry, 1998.)

The capabilities of the method provide the creation of minimally invasive permanent, temporary or conditionally temporary adhesive bridge structures.

One of the most important advantages of such prostheses is the lower degree of processing of the abutment teeth in comparison with traditional processing for crowns. Manufactured by a direct or indirect method, these designs completely eliminate or delay traditional invasive prosthetics.

Traditionally, indications for the manufacture of fiber-reinforced AMPs are:

1. An included defect in the dentition of short length (maximum two front teeth, or two premolar, or one missing molar) in cases when one or both of the abutment teeth is intact, or there is a convergence of the abutment teeth of more than twenty degrees, or there is a need for simultaneous splinting with periodontal disease.

2. The need for urgent replacement of a missing tooth for aesthetic purposes.

3. The manufacture of a temporary bridge (for example, with two-stage implantation).

4. The desire of the patient to maintain the viability of the pulp of the supporting teeth, the rejection of the classical methods of prosthetics.

5. An allergic reaction to metals in the oral cavity.

Methods of manufacturing AMPs are divided into direct and indirect, invasive and non-invasive.

Laboratory (indirect) method of manufacturing AMP provides:

- a significant reduction in the patient’s stay at the dental appointment, as well as a reduction in the time and labor costs of the dentist due to the capabilities of the dental laboratory;

- the exclusion of individual factors on the part of the patient that have a negative impact on the direct restoration (bleeding gums, increased salivation);

- laboratory simulation, polymerization and polishing in the complex provide high quality, strength and durability of the structure.

The advantages of the direct method (directly in the oral cavity) are the possibility of simultaneous fabrication of the structure and lower cost compared to the indirect method. In addition, adhesive systems used in direct restoration, in comparison with fixative composite cements, provide higher adhesion to hard tooth tissues.

(Dvornikova T.S., 2009).

Our long experience working with polymer frames allows us to clarify indications and formulate practical recommendations.

The instructions for the use of polymer frames indicate that this method can restore defects in the area of the frontal and chewing groups of teeth "in the absence of up to two units."

However, we noticed that a more reliable result is achieved when replacing:

- one of the upper incisors,

- one or two lower incisors,

- one premolar

- the first molar, provided that the defect in its absence has decreased to the size of the premolar.

An important point is that even with secondary tooth displacements, the technology of manufacturing bridges with polymer frames does not require traumatic preparation of the abutment teeth in order to create their parallelism (Smerdina Yu.G., Smerdina L.N., 2001).

In a survey of dentists of various specialties, it was found that practical practitioners more often recommend fiber-based designs than cast ones from various AMPs, which is associated with low invasiveness, rapid production, cost-effectiveness and the possibility of manufacturing a design at the dentist's office of any specialization without the use of additional dental equipment and personnel (Chernyavsky Yu.P., Kavetsky V.P., 2011).

One of the complications of the use of AMP is the development of gingivitis in the area of the body of AMP, due to two reasons: poor oral hygiene and an improperly formed wash space, in cases where the wash space is modeled too low or saddle (Grishin S.Yu., Zholudev S.E. , 2006).

The bridge consists of supporting elements and an intermediate part. As supporting elements can be used: crowns; half-crowns; tabs supporting and retaining clasps or their elements in collapsible or adhesive prostheses. The part of the prosthesis that is located between the supporting elements is called the intermediate part or body of the prosthesis.

The intermediate part, depending on its position in relation to the mucous membrane of the alveolar part, can be:

- hanging, which is often created in the lateral part of the lower dentition, while a flushing space is created between the alveolar ridge, devoid of teeth, and the body of the bridge;

- tangent, which is used to replace defects in the anterior dentitions and lateral divisions of the upper dentition. The body of the prosthesis has light linear contact with the mucous membrane of the alveolar process, devoid of teeth.

The flushing space is the gap between the body of the bridge and the alveolar ridge, devoid of teeth, created for the prevention of pressure sores of the mucous membrane and the possibility of hygienic care of the prosthesis (Trezubov V.N., 2008).

The clinical conditions (abnormalities in the development of the jaw and alveolar processes, the height of the abutment teeth, the degree of exposure of the crowns of the teeth and alveolar parts with a smile, the length of the upper and lower lips, the cross-sectional shape of the toothless alveolar ridge) (Trezubov V.N. 2008 )

In the available literature, we did not find a description of how the intermediate part facing the alveolar process is modeled and polished, and how the wash space in the AMP is created.

E.V. Borovsky, M.E. Antonov, when replacing a single missing tooth at the same time, to create a lavage space, they suggest introducing a transparent plate between the gum and the base of the artificial tooth covering the mucous membrane over the entire gap between the teeth, eliminating the contact of the composite material with the gum. (Borovsky E.V., Antonov M.E., 1997).

THEM. Rabinovich et al. Uses for this purpose a metal matrix with an emphasis on the alveolar process and fixation by its wedges. (Rabinovich I.M. et al., 2012).

In the works of SV. Radlinsky, dedicated to adhesive bridge structures, noted that for the prevention of gingival inflammation under an artificial tooth, the artificial tooth modeling technique is complemented by reserving space for interdental papillae with transparent wedges. A lavsan strip is introduced above the reinforcing beam, which is fixed by transparent wedges in the form of a groove, freeing up space for the interdental papillae and under the reinforcing beam. (Radlinsky S.V., 1998).

T.S. Dvornikova, to create a washing space when constructing the intermediate part of adhesive bridges, uses a cap matrix, filling it sequentially with a fluid and pasty composite. The technique for creating a washing space and the features of the final processing of a part of the prosthesis adjacent to the gum are not described. The adequacy of the gap between the gum and the prosthesis is assessed by introducing a dental probe under the intermediate part of the prosthesis. (Dvornikova T.S., 2009).

The final stage - grinding and polishing the surface, is recognized as decisive, but at the same time, no author details the features of the processing of the intermediate part facing the washing space.

The disadvantage of all known methods of creating a washing space when constructing the intermediate part of adhesive bridges is the use of standard devices to isolate the mucous membrane in the area of the missing tooth (matrices, caps) that are not able to adapt to the individual type of alveolar process.

The technical result is the creation of a method for manufacturing the intermediate part of reinforced adhesive bridges (AMP), which allows them to be adapted to the individual type of alveolar bone.

A method for manufacturing the intermediate part of adhesive bridges using individual silicone templates is proposed, including the choice of a reinforcing structure and preparation of abutment teeth, impression taking from the dentition, manufacturing of a model from super gypsum on which a standard artificial tooth is ground, manufacturing of a silicone template.

The difference is that the interdental silicone template is made on the model by applying a corrective A-silicone material (polymerized by the type of polyaddition) from the oral surface of the teeth and gingival margin, starting from the gingival part, closing the gingival sulcus, the interdental spaces are filled perpendicular to the marginal gingival margin, the cervical part of the supporting teeth, the material is applied, without reaching the supporting structural elements by 0.5-1 mm, and then the silicone template is installed in the oral cavity for subsequent preparation of adhesive bridges, on the intermediate part of the reinforcing structure and on the silicone template that displays the surface of the artificial tooth facing the alveolar process, a fluid composite is applied, repeating the intermediate part of the artificial tooth facing the gum, then the final modeling of the artificial tooth of the bridge using the traditional or condensable composites from the vestibular surface, taking into account individual anatomical features, etc. the middle part.

The method consists in the manufacture of individual silicone templates, according to which the body of the adhesive bridge is subsequently modeled in the oral cavity.

The silicone template allows you to create a washing space when building the intermediate part of the adhesive bridges, taking into account individual characteristics.

AMP reinforcement is made of fiberglass. The rinsing space is created using a fabricated silicone mold. The intermediate part (the body of the bridge) is made of composite materials by the technique of puff restoration and does not require grinding and polishing of the surface facing the alveolar process in the oral cavity.

The technique of puff restoration provides for the combined use of adhesive systems of the fifth or sixth generation, “traditional”, liquid and condensable composites. Moreover, the materials are combined in such a way as to maximize their positive properties and minimize negative ones (Nikolaev A.I., Tsepov L.M., 2007).

A method of manufacturing an intermediate portion of adhesive bridges using silicone templates is shown:

- in the manufacture of AMP direct method,

- in the manufacture of AMP indirect method,

- in the manufacture of AMP by direct and indirect method with the simultaneous splinting of supporting teeth, limiting the defect.

The silicone template itself can be made on the model (indirect method) or, in the absence of a dental laboratory in the clinic, in the oral cavity (direct method).

When making a silicone template on the model, it is necessary to remove the impression from the dentition or from a fragment of the dentition. The choice of impression material when taking the impression will depend on the degree of compliance of the mucosa.

The essence of the proposed method is shown:

in FIG. 1 - shows a fragment of the dentition on which it is necessary to produce AMP;

in FIG. 2 - shows the grinding of a standard artificial tooth on a plaster model;

in FIG. 3, FIG. 4, FIG. 5 - manufacture of a silicone template and the use of A-silicone material as a protective template;

in FIG. 6 - installation of a silicone template in the oral cavity;

in FIG. 7, FIG. 8 shows a simulation of an artificial tooth;

in FIG. 9, FIG. 10 - removal of the silicone template;

in FIG. 11 - finished adhesive bridge.

The method consists in the following (clinical case):

- choice of reinforcing structure and preparation of abutment teeth;

- the impression is removed from the dentition or from a fragment of the dentition, on which it is necessary to produce AMP (Fig. 1)

Then, a model of super gypsum is cast on the taken impression, on which a standard artificial tooth is ground (Fig. 2), especially carefully from the side of the alveolar bone. The artificial tooth is polished and glued on the model to the teeth that limit the defect. Thus, the model reconstructs the future bridge and flushing space in the area of the prosthesis body.

After that, a silicone template is made.

The gingival interdental silicone protective template is made on the model by applying a corrective A-silicone material (polymerized by the type of polyaddition) from the oral surface of the teeth and gingival margin, starting from the gingival part, closing the gingival sulcus; interdental spaces are filled perpendicular to the marginal gingival margin; the material is applied to the cervical part of the abutment teeth, not reaching the supporting structural elements by 0.5-1 mm. (Fig. 3, Fig. 4, Fig. 5).

Silicone material is applied from the cartridge by means of a dispensing gun with an intraoral cannula placed on the mixing cannula or by manual mixing with a syringe to apply a fluid impression material.

The use of A-silicone material as a protective template is justified by its medical and technical characteristics: A-silicones are characterized by optimal compatibility with the skin and oral mucosa, which makes them well tolerated by patients; possess thixotropy, hydrophilicity, moderately short working time and setting time; do not absorb water; they have no taste or smell, which is known from the prior art. For example, Ryakhovsky A.N., Muradov M.A. Accurate impression. - M., 2006 .-- 227 p. (S. 44-48).

Excess silicone is cut off from the lingual or palatal surface of the teeth at the borders corresponding to the AMP retaining plates. On the vestibular side, the excess is removed in the area of the artificial tooth and, if necessary, in the area of the interdental papillae. Excess material from the vestibular side is removed for ease of application of the template in the oral cavity and ease of removal of the template after manufacturing AMP. The artificial tooth is extracted from the silicone template. The template is removed from the model and disinfected.

The silicone template is installed in the oral cavity for the subsequent manufacture of the AMP (Fig. 6). The steps are taken to fix the AMP to the abutment teeth.

The body of the bridge is made using the principles of puff restoration technique. On the intermediate part of the reinforcing structure and on the silicone template that displays the surface of the artificial tooth facing the alveolar process, a fluid composite is applied, repeating the intermediate part of the artificial tooth facing the gum (Fig. 7). Polymerization is being carried out.

The final modeling of the artificial tooth (Fig. 8) of the bridge using the traditional or condensable composites from the vestibular surface is made taking into account the individual anatomical features of the intermediate part. Modeling of the vestibular surface of the intermediate part is carried out, focusing on the shape and severity of the equator of teeth that limit the defect.

Modeling of the part of the bridge from the lingual or palatine side not shown on the silicone template is carried out taking into account the anatomical shape of the abutment teeth and the body of the AMP, but the reinforcing part (in this case, the polymer frame) must be covered with a composite material (to prevent damage to the tape fibers ) completely.

After manufacturing the AMP, the silicone template is easily removed (FIG. 9, FIG. 10).

After removing the template, the adhesive bridge is machined and polished. Polishing of the intermediate part facing the alveolar ridge is not required. (Fig. 11 - finished AMP).

Claims (1)

A method of manufacturing an intermediate part of adhesive bridges using individual silicone templates, including the selection of a reinforcing structure and preparation of abutment teeth, impression taking from the dentition, manufacturing of a model from super gypsum on which a standard artificial tooth is stitched, manufacturing of a silicone template, characterized in that it is an interdental silicone the template is made on the model by applying corrective A-silicone material from the oral surface of the teeth and gingival margin, interdental spaces are filled perpendicular to the marginal gingival margin from the gingival part, closing the gingival sulcus, the material is applied to the cervical part of the supporting teeth, not reaching the supporting structural members from 0.5 mm to 1 mm, and then a silicone template is placed in the oral cavity for subsequent of manufacturing adhesive bridges, a fluid component is applied to the intermediate part of the reinforcing structure and to the silicone template displaying the surface of the artificial tooth facing the alveolar process um repeating the intermediate portion of the artificial tooth facing to the gum, then, a final modeling of the artificial tooth bridge using conventional or condensable composites vestibular surface tailored to the individual anatomical features of the intermediate portion.

Images