RU2744745C1 - Individual spoon - bite plate, the method of its manufacture and use in the treatment of edentia based on dental implants - Google Patents

Abstract

FIELD: orthopedic dentistry.

SUBSTANCE: group of inventions relates to orthopedic dentistry and is intended for use in orthopedic treatment of patients with complete absence of teeth. Disclosed is a method of treating patients with complete absence of teeth based on dental implants by transferring and fixing the relation of the upper and lower jaws. The treatment is carried out using a spoon-bite plate made of a copy of complete removable dentures in an articulator. The method and the device make it possible to make a permanent structure already on the basis of temporary full removable prostheses during the integration of implants to achieve all the necessary aesthetic, functional characteristics and to build the correct jaw relation. It is possible to approach the stage of implant exposure with a ready-made prototype of a permanent structure (temporary full removable dentures), which makes it possible to reduce the incidence of internal TMJ disorders, aesthetic and functional problems at the stage of permanent prosthetics and to reduce the time of restorative orthopedic treatment.

EFFECT: group of inventions reduces the incidence of internal TMJ disorders, aesthetic and functional problems at the stage of permanent prosthetics and the time of restorative orthopedic treatment.

3 cl, 16 dwg, 1 ex

Description

The invention relates to medicine, namely to orthopedic dentistry, and is intended for use in orthopedic treatment of patients with complete absence of teeth. The present invention discloses a new method of treating patients with complete absence of teeth based on dental implants by transferring and fixing the ratio of the upper and lower jaw using a spoon-bite template made from a copy of complete removable dentures into an articulator. Thanks to the proposed method and device according to the method, it is possible to work out a permanent structure already on temporary full removable prostheses, during the integration of implants, to achieve all the necessary aesthetic, functional data, as well as to build the correct ratio of the jaws, and to approach the stage of opening the implants with a ready-made prototype of a permanent constructions - temporary full removable dentures. The result of using the method and device according to the method will be a decrease in the incidence of internal TMJ disorders, aesthetic and functional problems at the stage of permanent prosthetics, and a decrease in the time of restorative orthopedic treatment.

State of the art

Despite the great achievements of modern dentistry, the improvement of treatment methods, the use of new materials and technologies for the manufacture of orthopedic structures, the rehabilitation of patients with total edentulousness remains extremely relevant and one of the most difficult problems of dental prosthetics around the world. [1,2,3,4,5,6]

The condition of the dentition has a significant impact on the quality of human life. Each tooth in the body plays a very important role, and the loss of even one tooth is inevitably accompanied by psychological discomfort, dysfunction of the chewing apparatus and the body as a whole. Adentia is a type of pathology characterized by a lack of teeth of varying degrees of spread. The disease is usually classified into subspecies, depending on the nature of the appearance (congenital or acquired) and the degree of severity (full or partial). This pathology is a very unpleasant condition associated with a change in the aesthetics of the face and smile, as well as the loss of the ability to eat normally. The total absence of teeth is accompanied by a pronounced imbalance in the dentition, atrophic processes develop in bone tissue, muscles and temporomandibular joints (TMJ). A decrease in the load on the alveolar processes induces their atrophy, which primarily causes a violation of the TMJ biomechanics. In addition, the loss of teeth contributes to the development of somatic pathology. The total absence of teeth often becomes the cause of social maladjustment of patients. People with completely edentulous jaws often report low self-confidence and poor quality of life associated with speech impairment and poor aesthetics. [7.8]

The number of patients with total edentulousness is steadily growing, which is primarily associated with an increase in the life expectancy of people in developed countries. However, at present, even among the young working-age population, there is a steady increase in the number of patients with complete loss of teeth. Moreover, according to forecasts of scientists, in the coming years, about half of patients with total edentulousness will be people aged 30 to 50 years. [9]

Currently, the population's need for orthopedic dental care is increasing everywhere, which is associated with an increase in the socio-cultural standard of living. The need for prosthetics increases with age, and, according to the literature, 20.7% of patients in the age group from 20 to 29 years old need prosthetics, and among people over 60 years old it rises to 78%. [10,11,12]

For many years, the classic way to restore the integrity of the dentition in patients with complete edentulousness was prosthetics with removable plate prostheses. An inexpensive technical solution of a properly designed removable denture, individually adapted to the surrounding tissues of the oral cavity, allows the function of the lower jaw and its appearance to be restored. In the presence of favorable anatomical conditions, such as a pronounced alveolar ridge and a deep vestibule of the oral cavity, the patient can use this type of orthopedic construction for a long time. However, many patients are unable to adapt to a removable denture. In addition, a variety of problems are associated with the use of complete dentures. This method of restoring the integrity of the dentition is accompanied by significant bone resorption, discomfort during communication, and also does not provide complete chewing of food. As a result of unsatisfactory fixation, chafing, injury and the appearance of irritations on the oral mucosa are possible.

The transfer of chewing pressure when wearing a complete removable denture is carried out through the artificial teeth to the base of the prosthesis, and from it to the underlying mucous membrane, periosteum and bone tissue. Since the mucous membrane of the oral cavity does not have morphological structures capable of absorbing this pressure, this way of transferring the masticatory pressure leads to compression of the mucous membrane, impaired blood circulation - all this contributes to the intensification of atrophic processes in the alveolar process. This is a significant disadvantage of partial removable plate prostheses.

Insufficient fixation of the prosthesis on the edentulous jaw is also a very important problem of removable full prosthetics. Up to 50% of patients using such dentures report their unsatisfactory stabilization and fixation. About 15-25% of patients refuse to use prostheses at all. Many different methods have been proposed for optimizing the degree of retention of removable dentures. All kinds of adhesive creams and pastes, magnets, various ways of weighting structures, volumetric modeling and others have been developed and introduced into practical dentistry. However, all these methods often fail to achieve success and improve patient satisfaction.

Improving the efficiency and effectiveness of orthopedic treatment for patients with complete absence of teeth is one of the topical trends in the development of modern dentistry and still cannot be considered a solved problem. The introduction of prosthetics into practical dentistry with the use of implantation technologies has significantly improved the results of the rehabilitation of patients with total edentulousness.

Thus, total adentia is a serious medical and social problem of our time. A full human life is impossible without healthy teeth, since even their partial absence leads to serious consequences for the whole organism. The complete absence of teeth has an extremely negative effect on the quality of human life. The only method of rehabilitation for such patients is prosthetics. However, the effectiveness of orthopedic treatment using complete removable dentures is extremely low. A promising direction in modern orthopedics has become the emergence of implantation technologies that can solve the problem of fixing removable dentures, but in this area there are many unresolved issues.

The fundamental principle of the preparatory stage of high-quality dental implantation is the collection of the most accurate and detailed information about the parameters of the relief structures of the oral cavity. The stage of obtaining functional impressions from edentulous jaws is of fundamental importance in prosthetics. In the works of domestic authors, there are significant disagreements in the choice of the method for obtaining a functional impression. According to some authors, the pressure on the tissues of the prosthetic bed when taking an impression should be equivalent to the pressure arising under the prosthesis during chewing. Other authors are of the opinion that it is necessary to obtain impressions without compression of the mucous membrane. According to these authors, prostheses made from compression impressions constantly fix the mucous membrane in a compressed state, as a result of which lymph and blood circulation is impaired, inflammatory and atrophic processes develop, and in prostheses made from a relief impression, these disadvantages are absent, and chewing the pressure is evenly distributed over the entire prosthetic bed. There are also supporters of the combined method of obtaining an impression. Many methods have been proposed for obtaining an impression from edentulous jaws.

Currently, the introduction of mathematical and computer modeling in practical dentistry has significantly improved the quality of dental services. In modern dental practice, digital technologies are becoming more widespread, which have a number of advantages over the classical method of taking impressions. In domestic dentistry, the first results on the creation of high-precision digital models of teeth were obtained in 1994 within the framework of the project of the Central Research Institute of Dentistry under the leadership of A.N. Ryakhovsky. and Yumasheva A.The. Digital technology for taking impressions from edentulous jaws has great advantages when working with patients suffering from various stomatophobic reactions, among which an increased gag reflex is of particular importance, the presence of which can not only complicate the process of taking an impression, but also make it impossible. A group of Russian scientists conducted clinical trials among patients with an increased gag reflex who need orthopedic treatment. The research results have demonstrated the indisputable advantages of the non-contact method of taking an impression using digital technologies, which provides more comfortable conditions for patients with increased sensitivity to medical and diagnostic dental procedures.

Thanks to the emergence of CAD / CAM systems and their introduction into practical medicine, modern orthopedic dentistry has reached a completely new level in solving professional practical problems. Thanks to the developments of domestic scientists, it became possible to create high-precision digital models of teeth, obtain accurate objective information with its subsequent analysis, which significantly increases the effectiveness of orthopedic treatment. [thirteen]

The lack of anatomical landmarks in patients with complete missing teeth complicates the correct positioning of dental implants. This problem can be solved by the method of preliminary three-dimensional planning with the use of computer technologies and the use of navigational surgical templates. Specially developed software allows for a detailed preoperative analysis of the structure of the jaws, to visualize the boundaries of the mandibular canal and the cortical plate of the floor of the maxillary sinuses, to determine any parameters of bone tissue, including its density. Based on the data received, a volumetric virtual model is created, on which the operation is planned and the template project.

Today, there are various options for prosthetics of the edentulous jaw using implantation technologies, however, the option of complete removable prosthetics based on implants has acquired the most widespread use. With regard to the methods of taking impressions, the most preferable is the "open tray method". However, despite the proven effectiveness of the methods, many questions remain unresolved. After waiting for the patient for osseointegration of implants and using a temporary full removable denture, the patient and the doctor have to go through the stage of determining the bite, the ratio of the jaws, the selection of the shape and position of the teeth for temporary or permanent prosthetics based on dental implants. Among them are the possibilities and prospects of using various temporary structures used for the period of osseointegration of permanent implants. In addition, to date, there are no studies devoted to the study of the function of the temporomandibular joint and its readaptation after prolonged edentulousness with complete removable prosthetics based on implants.

US Pat. No. 6,428,315 "Dental impression tray", priority dated June 29, 2000, describes a variant of a standard impression tray for implants. The holes in this tray can be created by detaching the components in the presence of the patient in the chair, this tray allows the impression of the implants in a more convenient way than with a standard plastic tray. Nevertheless, this spoon can only convey the position of the implants relative to each other and the surrounding soft tissues, but does not help the dentist to fix such parameters as: determining the bite, the ratio of the jaws, the selection of the shape and position of the teeth, and in fact repeats all the same technique as when using a standard spoon.

US Pat. No. 5,551,872 "Dental impression device", priority from 30.09.1994, describes a standard impression tray for implants, the distinctive feature of which is to prevent saliva from entering the impression, however, this tray can only convey the position of the implants relative to each other. friend and the surrounding soft tissues, but does not help the dentist to fix such parameters as: determination of the bite, the ratio of the jaws, the selection of the shape and position of the teeth, and in fact repeats all the same technique as when using a standard spoon.

In the patent US 5890895 "Dental impression tray", priority from 25.07.1995, a standard impression tray is described, which allows more correct distribution of the impression material. The disadvantage is also the impossibility of the dentist to fix such parameters as: determination of the bite, the ratio of the jaws, the selection of the shape and position of the teeth when taking an impression.

In the patent US 6629841 "Adjustable dental impression tray and methods for using the same", priority from 28.08.2000, a spoon is described, a mechanism by which it can be removed from the oral cavity by disassembling. The disadvantage is the impossibility of the dentist to fix such parameters as: determination of the bite, the ratio of the jaws, the selection of the shape and position of the teeth when taking an impression.

In the international application WO 2003086226 "Adjustable impression tray with variable geometry", priority from 15.04.2002, a material of the spoon is described, which allows it to be adapted to the required shape under temperature in the region of the accordion walls. However, this tray is a standard impression tray and repeats existing techniques, and therefore does not sufficiently convey the accuracy of the impression, taking into account the individual aspects of the patient.

In the international application WO2000062703 "Impression tray device with removable segments for dental implant transfers", priority dated 04.16.1999, a spoon is described, the holes in which can be formed by removing parts from the upper part of the tray by unwinding. The disadvantage is the impossibility of the dentist to fix such parameters as: determination of the bite, the ratio of the jaws, the selection of the shape and position of the teeth when taking an impression.

In the international application WO2005107632 "", priority from 05.05.2004, a spoon is described, the holes in which can be formed by disconnecting the components in the presence of the patient in the chair. The disadvantage is the impossibility of the dentist to fix such parameters as: determination of the bite, the ratio of the jaws, the selection of the shape and position of the teeth when taking an impression.

In addition, patents and applications US6428315B1, US 5890895, US 5551872, US 6629841, WO 2003086226, WO2000062703, WO2005107632 require work close to the patient, making it impossible to bring the impression to a more accurate (individual form), thereby making it impossible to obtain a fixed the ratio of the upper jaw to the lower one and carry out a diagnostic setting for a new job already from the level of the implants.

In the patent RU 2601851 "A method of obtaining an impression in prosthetics on implants and teeth", priority from 03/20/2015, a technique for taking an impression from a prepared tooth using a temporary crown is described. This method is not suitable for use in prosthetics on implants in the complete absence of teeth.

In the patent RU2693142 "A method for obtaining a repeated impression for the manufacture of a prosthetic structure with support on implants", priority from 22.05.2018, a technique is described for taking an impression twice to obtain a more accurate framework of a prosthesis on implants. The disadvantage is the lack in the technique of the possibility of fixing the jaws relative to each other by means of an impression tray.

Patent RU2555109C2 "Method and kit for making a denture", priority dated 05/18/2010, describes the manufacture of devices for taking impressions and one-step determination of bite on edentulous jaws. The patent does not describe a robot with implants involved and refers to the primary determination of the jaw ratio.

The international application WO2012061659 "System and process for duplication of dentures", priority from 03.01.2010, describes the technology of a copy of a complete removable denture using digital technology. This technique essentially does not affect and differs from working with implants.

In patent EP2861180 "Method for preparing a partial or full dental prosthesis", priority dated 06/15/2012, a new method of manufacturing complete removable dentures is described. However, the technique is not suitable for working with implants.

In the patent CN107198586 "A kind of Digital Design preparation method of edentulous jaw functional imperative individual tray", priority dated 03.16.2016, the manufacture of trays by the digital method for prosthetics of edentulous jaws is described. This technique does not imply the use of implants to make a spoon.

International application WO2013120955 "Modeling a digital design of a denture", priority from 14.02.2012, describes a method of virtual primary fabrication of removable dentures. This technique does not apply to the transfer from a primary prosthesis to a secondary one (temporary crowns supported on dental implants).

Patent CN105078598 "Digital preparation method of edentulous jaw individual impression tray", priority dated May 14, 2014, describes the manufacture of an individual edentulous jaw tray for primary prosthetics with removable dentures by printing. The technology is not suitable for working with a transfer from a primary to a secondary prosthesis, since a much more complex structure of an individual tray is required.

Despite the substantial list of individual spoons described in patent documents, the issue still remains relevant, since today there is no such method, device or set of devices and their application in the public domain that would allow simultaneously obtaining an impression by the open tray method and solve such problems as: determining the bite, the ratio of the jaws, the selection of the shape and position of the teeth, thereby showing the accuracy of the results, without losing speed and without causing additional discomfort for patients.

As already mentioned, there is no single established standard for the prosthetics process and often specialists work in accordance with their preferences in a particular material or method. Nevertheless, the whole process from the patient's referral to a specialist to the final prosthesis can be clearly divided into stages, and the stages themselves can be described by the methods most common in practice. In the case of the claimed invention, the key stage is after the disclosure of the implants; it is at this stage that the proposed method is applied. The traditional technique includes making a working impression from the implant level or from the multi-unit level. Working models are obtained, then the patient is invited to determine the central ratio of the jaws, then the future design is tried on. All stages and procedures require manual labor, rely solely on the accuracy and perfection of the specialist's skills, and take a rather long period of time when the patient is in a state of expectation, since a constant fitting is required. Often multiple approaches are required to fit a design. The immediate result depends on many factors, for example, the accuracy of the specialist's work, as well as the patient himself, who can in one way or another prevent the specialist from performing the work so that the patient himself does not experience further inconvenience. In addition, there are patients who like to “help” the specialist or keep silent about the discomfort so as not to “offend” the specialist. As a result, work can increase the number of patient visits by 3 or more times. Finally, the patient is given the final design.

In addition to patent documents, some articles were found in which the authors described methods of working with prostheses different from traditional methods. For example, in the article "Protocol for the Successful Placement of a Prosthesis with Fixation on Implants" [14], prosthetics with a removable denture of an incomplete dentition with its fixation with two implants are discussed. The big disadvantages of this approach are the potential destruction of the patient's prosthesis during the manufacture of the tray, the difficulty of adapting the prosthesis for taking an impression in the case of more than 2 implants, the potential destruction of the prosthesis after fabrication of the model and destruction of the transfers.

Another article titled “Digital Duplication Protocol for Removable Dentures” [15] describes additive manufacturing (AM) technology, often also referred to as 3D printing, to duplicate a complete removable denture or to obtain a copy of the current position of the teeth. Nevertheless, the article describes only the fact of obtaining a copy without testing the results in a practical aspect. In addition, working with a copy, as described in the article, requires manual labor, thereby reducing the accuracy of the final work, which is a significant disadvantage.

The object of the present invention is to develop such a method and such a device that would avoid all of the above disadvantages.

The technical result of this invention is to reduce the time of restorative orthopedic treatment, to achieve maximum accuracy of the reproduced implant, and high aesthetic results.

The delivered technical result is achieved by the fact that an exact copy of the prosthesis is made, which was used by the patient during the integration of the implants, namely, using a 3D scanner, an electronic copy of the removable prosthesis is made, by processing three-dimensional images, an individual spoon-copy of the prosthesis is made from the copy of the prosthesis, then with the help of A copy of the prosthesis is made using a 3D printer and a copy of the prosthesis is used as an individual spoon, then an impression of the oral cavity and the position of the implants is taken with a copy of the prosthesis, finally, a model is made from the impression, thus a copy of the prosthesis is obtained that can be loosely worn on the model, which is an excellent initial setting of new teeth. and fixation of the central occlusion.

This method and the device obtained according to the method, as well as the use of the method and the device, make it possible to accelerate the process of complete removable prosthetics based on dental implants. In addition, the method makes it possible to make the patient more comfortable getting used to new prostheses on implants.

Brief description of the invention

The method describes the production of an individual tray, which already has all individual holes and an individual shape along the gingival margin, manufactured in a dental laboratory. The spoon obtained in this way and its use allows, in addition to an impression from the implants, to obtain a fixed ratio of the upper jaw to the lower, as well as a diagnostic setting for new work already from the level of the implants. In addition, the invention describes a method of using an individual spoon obtained by the described method.

Description of drawings

Figure 1 - A patient's prosthesis, where a layer of plastic is selected with a large cutter at the sites of implantation in order to adapt the prosthesis to the prosthetic bed with the presence of gingiva formers.

Figure 2 - Application of a corrective mass to the prosthesis to assess thin layers of the mass and subsequent correction of the prosthesis, if the places of the “smallest” mass thickness in the area of the former are recorded.

Figure 3 - Plaster model of the patient's prosthesis, combined with a prosthesis-spoon.

Figure 4 - Selection of the virtual axis of the implant placement.

Figure 5 - Selection of the virtual axis of the implant placement.

Figure 6 - Selection of the virtual axis of the implant placement.

Figure 7 - Virtual installation of the handle to the denture tray in the ExoCad program.

Figure 8 - View of the device in stl-format.

Figure 9 - Location of the natural support of the physical model.

Figure 10 - View of the short transfer screws with material on them in order to prevent the flow of mass inside the transfers.

Figure 11 - Applying a spoon to the oral cavity.

Figure 12 - A spoon with impression material introduced into the oral cavity.

Figure 13 - Uncovering of implants and adaptation of a complete removable denture in patient C.

Figure 14 - Setting of teeth for the manufacture of temporary crowns using a Kladnichkin-Virich spoon (frontal view).

Figure 15 - Setting of teeth for the manufacture of temporary crowns using a Kladnichkin-Virich spoon (top view).

Figure 16 - Placement of temporary crowns, modeled on the removable denture for patient C.

Detailed description of the invention

In the description of the invention, there are the terms individual spoon, individual spoon-bite template, Kladnichkin-Virich spoon, Kladnichkin-Virich spoon-bite template - these terms should be considered interchangeable.

Before the implants are opened, the patient is offered to put on a removable prosthesis, two points are marked on the upper and lower lips and the distance between them is measured. This operation is performed while wearing a prosthesis in the oral cavity, closed jaws and relaxed soft tissues. The distance is fixed for later comparison.

At the time of the operation to open the implants, the dentist-surgeon works in conjunction with the orthopedic surgeon. First, the temporary implants are removed to fix the temporary removable prosthesis. At the moment of implant opening, the healing abutments are selected and set to the minimum height. If further work will be carried out based on multi-units, then they are selected and installed by a dentist-surgeon together with an orthopedic dentist. After the installation of the healing caps or multi-units, interrupted converging sutures are applied if necessary.

During the surgical manipulation, the dentist-orthopedist in the patient's existing prosthesis, in the places where the implants are installed, selects a layer of plastic with a large cutter in order to adapt the prosthesis to the prosthetic bed with the presence of gum formers (Fig. 1). The holes are made in accordance with those holes that were obtained on the patient's surgical template, which in turn was used for implantation. After the plastic has been selected, the patient is offered to put on the prosthesis on the formers and check the closure and occlusion. The height between the two previously marked points is re-measured and compared with the previous result. After that, the corrective layer is stirred, preferably using a dental silicone impression material, the most preferred option is Speedex Light Body C-silicone. The corrective layer is applied to the gingival surface of the prosthesis, then the patient is invited to put on the prosthesis again and close the jaws. After solidification of the mass, the prosthesis is removed from the oral cavity and the thin layers of the correcting mass are evaluated (Fig. 2). If there are places of the “smallest” mass thickness in the area of the former, then the prosthesis is corrected in these places: additional plastic is selected on the spot. The procedure for checking the corrective layer is repeated. The correctness of the adaptation is checked by three parameters:

1) Feelings of the patient from the prosthesis;

2) The coincidence of two measurements between points;

3) Uniform thin layer correcting the masses on the gingival surface.

An impression of the antagonizing jaw is also removed.

After disinfection of the denture impression using a suitable material, a working plaster model is made, preferably a class III plaster. An antagonizing plaster cast is also produced. It is preferable to select such a grade of gypsum so that the time for the complete setting of the gypsum is minimal. The most preferred option is class III gypsum. After the required time has elapsed, the denture-impression is detached from the plaster cast. The jaw model is evaluated for accurate mapping of the shapers and the prosthetic bed. The plaster cast and the impression prosthesis are folded together and separated. In this way, the working plaster cast is adapted to the existing prosthesis. Next, a plaster cast is performed into the occluder of the lower and upper jaw using the patient's prosthesis.

Then, the denture-impression on the model is prepared for scanning by treating with a special scanning powder, preferably "HELLING 3-D Laser scanning Anti-Glare Spray". The denture is processed from all sides. Using an extraoral scanner, preferably "Shininng 3D", a plaster model (Fig. 3), combined with a prosthetic spoon, is scanned in the standard scanner software. Thus, a 3D model of a removable prosthesis is obtained, virtually combined with a plaster model in one file. The model of the jaw is scanned separately, there is no need for processing with a special gypsum powder. After scanning, a new file of the scanned plaster model is formed with the installed gingiva formers. Both files are combined in space. Thus, it becomes possible to visualize the position of the prosthesis in relation to the installed gingiva formers when opening both files in the program for viewing files of the corresponding format. Scanning results are saved in stl-format. The preferred version of the program is ExoСad. After scanning, the prosthesis is returned to the patient. For the patient's convenience for further use of the prosthesis, while waiting for work, the prosthesis is directly relocated in the oral cavity to the gingiva formers using plastic for the base of the prostheses, the preferred option is Re-Base Yamahachi.

With the help of the program, in a preferred embodiment of the invention, ExoCad, in the “individual tray” modeling module, an individual tray is simulated on a virtual jaw model for the “open tray technique". Moreover, in the outer part of the spoon, teeth should be placed using the “copy” tool in those places where the teeth are located on the virtual model of the patient's removable denture. After modeling, a virtual handle is added to the custom tray to create a working impression tray. After that, the spoon is made transparent and, with great accuracy, with a virtual instrument, through holes are marked in the object in the area of the gingiva formers along the axis of the implants. These holes, being adjacent, are combined into one single field for 2-3 implants, avoiding thin partitions between the holes. The virtual axis of the implant placement is selected as shown in FIG. 4, 5, 6 somewhat arbitrarily focusing on the shaper area.

Thus, the process has three stages:

1) Copying during the manufacture of the spoon of the outer part of the prosthesis and

2) Reflection of the surface of the jaw of the gingival part of the spoon;

3) Virtual hole making.

Next, in the ExoCad program, the handle is virtually installed to the prosthesis tray (Fig. 7), and is separated from the copy of the jaw model, saved to a separate file in stl-format (Fig. 8). A 3D printer is used for the physical manufacture of an individual spoon; in a preferred aspect of the invention, an SLA Form Labs 2 printer with a biocompatible white original polymer is used. A stl-format file is opened with the special printer software for printing.

The preparation of the spoon for 3D printing is carried out in such a way that the natural supports of the physical model, which are necessary in this production, are located only on the gingival part, which allows less correction of the important occlusal surface of the spoon for work (Fig. 9). The spoon is printed in standard mode with an accuracy of 0.1 mm. Typically, printing such a spoon takes about 2-3 hours on such a printer. After printing, the spoon is washed with an alcohol solution to remove the rest of the photopolymer for 20 minutes. Next, the supports of the spoon are removed with the help of an appropriate tool, for example, nippers, and the surface of the spoon is processed with cutters. After processing, the residual polymer is illuminated using a special material exposure lamp, preferably a Yeti Shuttle lamp.

The spoon is checked in the occluder for an exact copy of the patient's prosthesis.

When the spoon is ready, the patient is again invited to the clinic for further work, namely, taking an impression using the open spoon technique. Two marks are made on the lower and upper jaw: the patient is asked to close the teeth with dentures with relaxed soft tissues, the distance between these points is measured and fixed

The transfer modules for the short open tray technique are placed on the patient. Short transfer screws must be used so that they do not interfere with the closure of the mouth with an individual spoon; additionally, the transfer shafts are closed with material in order to prevent the mass flowing into the transfers (Fig. 10). The spoon is checked for the purpose of its free imposition in the oral cavity (Fig. 11), the distance between two points is checked and compared with the first measurement. The distance for a well-made spoon should be the same. The impression taking process is carried out with a corrective layer of low viscosity, the preferred material is Silagum Light DMG and a monophasic material, preferably Elite HD monophase Zhermack. A spoon with impression material is introduced into the oral cavity (Fig. 12). After inserting the spoon, the patient is asked to close the jaws in natural occlusion, thereby stabilizing the spoon in the oral cavity relative to the antagonizing jaw. After taking the impression, the closure with the antagonizing jaw is additionally fixed by means of a strip of base wax.

Thus, the following list of advantages is a significant difference and advantage over other methods:

1) Obtaining a working impression from the level of implants;

2) Positioning by means of a spoon the position of one jaw in relation to the other, which is the preferred alternative in the traditional method of the “bite detection step”;

3) Positioning the teeth in relation to the patient's removable denture for future work.

This method will significantly reduce the manufacturing time of a permanent or temporary prosthesis, improve the accuracy and quality of the prosthesis, since the temporary crowns of the new prosthesis are an absolute copy, or with changes from a copy of the prosthesis, to which the patient has already become accustomed. Thus, the patient will not have problems adapting to the "new" prosthesis. The method also resulted in a decrease in the incidence of internal TMJ disorders, aesthetic and functional problems after permanent prosthetics, and a decrease in the terms of restorative orthopedic treatment.

An example of implementation of the invention

Example 1

When visiting patient S. of the clinic with the direct participation of the authors of the invention, Kladnichkina I.D. and Virich O.N. the first stage was the disclosure of the implants, during the disclosure of the implants, the patient's prosthesis was adapted (Fig. 1), it was checked in the oral cavity, and the complete removable prosthesis was adapted with a corrective mass (Fig. 2). During the patient's rest after the operation, a diagnostic model is cast from the removable prosthesis and scanned together with the prosthesis, after which the prosthesis is cleared of the mass and returned to the patient. After the adaptation of the prosthesis, the patient assessed its position as comfortable, which did not differ in any way from the position before the deployment of the implants (Fig. 13). After the patient left for the laboratory, the Kladnichkin-Virich bite template is made (Fig. 3 - Fig. 9). The patient was invited to the clinic the next day to take an impression and fix the central ratio of the jaws using a spoon-bite template Kladnichkin-Virich. Next, a model was made from the multi-unit level, on which the spoon was perfectly matched with the set teeth, which are aesthetically and functionally suitable for the patient. Produced a virtual setting of the teeth according to the scanned images of an individual spoon (Fig. 14, 15). Temporary crowns, modeled on a removable denture, were made using 3D printing. Temporary crowns were installed in patient S. on the 3rd day after the implants were opened (Fig. 16). The patient noted that all her comments on the removable denture regarding the aesthetics of the teeth were taken into account, and also positively noted the timing of the production of temporary crowns based on dental implants and their functionality. In the process of work, all the stages and regulations prescribed in the description of the invention were observed, which in turn demonstrated the functionality and efficiency of the proposed technique, as well as the convenience and practicality of the device in real conditions. The orthopedic dentist noted the ease and convenience of using an individual bite tray.

List of used literature:

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Claims (3)

1. A method of obtaining an individual tray, characterized in that an exact copy of the prosthesis used by the patient during the integration of the implants is made, and consisting of the following stages: before the implants are opened to the patient with a removable prosthesis, the distance between the upper and lower lips is measured, temporary implants are removed, gum formers are selected and installed, in the patient's prosthesis at the places where the implants are installed, a layer of plastic is selected with a cutter, the distance between the upper and lower lips is repeated when a removable prosthesis is put on, a corrective layer is applied to the gingival surface of the prosthesis, the patient is offered to put on the prosthesis and close the jaws, the layers are evaluated a corrective mass, a working plaster model is made, an electronic copy of a removable prosthesis is made using a 3D scanner, an open individual tray is made from a copy of a prosthesis by processing three-dimensional images, a copy of a prosthesis, including an exact copy of the prosthesis and a pen, then using a 3D printer, an open impression individual tray is made-a copy of the patient's prosthesis, the distance between the upper and lower lips is repeated when the removable prosthesis is put on, then an impression of the oral cavity and the position of the implants of the prosthesis copy is taken, all previously measured distances between lips, a model is finally made from the impression and matched with an individual spoon, which carries the setting of the teeth, which satisfies the patient. 2. An individual tray obtained according to claim 1, characterized in that it has a prosthesis bed and a handle monolithically connected to it, made using 3D printing, while the tray has individual holes in the area of the gingiva formers along the axis of the implants and an individual shape along the gingival edge. 3. The use of an individual tray, obtained according to claim 1, to obtain an exact copy of a temporary prosthesis of a patient with complete edentulousness for the subsequent reproduction of a permanent prosthesis.

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