RU2794844C1 - Method for positioning surveyed fixed plastic prosthesis for dental restoration without incisions and sutures in one day - Google Patents

Abstract

FIELD: medicine; dental orthopaedics.

SUBSTANCE: virtually image fixed plastic prosthesis taking into account individual trajectories of the temporomandibular joint. Then design folding navigational surgical guide including guide for shaping pin holes with tooth support, base with lodgements, template for basement positioning, guide for areas shaping and dental implants with lodgements counterparts fixing and print them with a 3D printer. Virtually introduce counterparts for lodgements, which are connected to a virtual fixed plastic prosthesis, and holes for titanium basements into the prosthesis and make it with a surveyor. Place surveyed prosthesis using counterparts according to the guide and fix it to the titanium basements with flowable light cured material. Unscrew the screws of titanium basements and remove the prosthesis from the oral cavity, remove counterparts, fix the prosthesis to the transmucosal abutments using screws.

EFFECT: allows positioning of surveyed fixed plastic prosthesis for dental restoration.

1 cl, 9 dwg

Description

The invention relates to medicine, namely to orthopedic and surgical dentistry, and can be used in the treatment of patients with complete or partial absence of teeth using dental implants, a collapsible navigational surgical template and a finished milled non-removable plastic prosthesis.

In our country, according to the results of a study by the Dental Association of Russia, the prevalence of secondary partial adentia is from 40 to 75%, the prevalence of complete adentia is 25-40% (Polupan P.V., The use of one-stage dental implants in the treatment of patients with dentition defects and atrophy of the alveolar processes jaws: diss. ... candidate of medical sciences: 14.01.14, - Moscow, 2017.). Complete or partial loss of teeth leads to a violation of the functions of chewing, swallowing, speech, the central ratio of the jaws, a decrease in the height of the lower third of the face, etc.

The solution to this problem is implantation, which is one of the advanced technologies for restoring dentition. Currently, the installation of implants with an immediate load of an orthopedic structure has become widespread.

The development of digital dentistry makes it possible to reduce the period of temporary rehabilitation and the period of permanent prosthetics for patients with partial or complete loss of teeth (Gazhva S.I., Teterin A.I., Kushieva A.O. The use of digital technologies in orthopedic dentistry. – Dental Forum. – 2020; 4 (79): 12-3).

There are a number of ways to restore the dentition with an orthopedic structure in one day.

A known method of restoring a continuous dentition with a permanent fixed bridge prosthesis, in which four permanent implants are installed in the residual bone, then a temporary fixed bridge prosthesis is installed on temporary supports located in the area of the lateral incisors, canines or first premolars, and immediately before the installation of a permanent fixed bridge prosthesis temporary supports are removed. Temporary supports for installing a temporary prosthesis are either the patient's teeth or additionally installed temporary implants (patent RU No. 2618308, A61C13/00, 03.05.2017).

The disadvantages of this method are the need for an additional surgical step when removing temporary implants or teeth, the duration of the patient's treatment, and the absence of a navigational surgical template.

Also known is a method of prosthetics of the dentition using implants by fixing transfers to implants, taking impressions, determining the intermaxillary ratio using bite patterns, cooking and polishing a plastic prosthesis with a cast frame. After that, the orthopedic structure is fixed to the implants in the oral cavity (application for invention RU No. 2777401, A61C8 / 00, 03.08.2022).

The disadvantage of this method is the duration of treatment of the patient, the lack of a navigational surgical template.

However, the analysis of existing methods for positioning a fixed plastic prosthesis for restoring the dentition showed that none of them can be a prototype for the method proposed by the authors.

The problem to which the invention is directed is the restoration of the dentition by positioning a milled fixed plastic prosthesis using dental implants and a navigational surgical template in one day.

The technical result of the invention is the reduction of the treatment time for patients, the possibility of functional and aesthetic rehabilitation due to the immediate loading of dental implants and the achievement of a high functional and aesthetic result.

The specified technical result in the claimed method of positioning a milled non-removable plastic prosthesis for restoring the dentition without incisions and sutures in one day is achieved by the fact that after the functional diagnostics of the dentoalveolar system, a virtual modeling of a non-removable plastic prosthesis is carried out, then a collapsible navigational surgical template is virtually designed, including: a template for forming holes for installing pins based on teeth, a base with lodgments, a template for positioning the base , a template for the formation of lodges and the installation of dental implants with mating parts for lodgements, and they are printed on a 3D printer. After that, virtual changes are made to the virtual non-removable plastic prosthesis, including mating parts for lodgements that are connected to the virtual fixed plastic prosthesis, and holes for titanium bases, and it is manufactured on a milling cutter. After anesthesia, fixation of the collapsible navigational surgical template and installation of dental implants, the milled non-removable plastic prosthesis is positioned with the help of mating parts to the lodgements on the basis of the collapsible navigational surgical template and fixed to the titanium bases using a fluid light-curing material. After that, the screws of the titanium bases were unscrewed and the fixed plastic prosthesis was removed from the oral cavity. Removal of mating parts for lodgements, final grinding and polishing of a milled non-removable plastic prosthesis were performed. After that, the base of the collapsible navigational surgical template with lodgements was removed from the oral cavity and the milled fixed plastic prosthesis was fixed to the transmucosal abutments using screws.

This method is illustrated with images reflecting

the sequence of the proposed method, where

Fig. 1 - carrying out functional diagnostics of the dentoalveolar system;

Fig. 2 - virtual modeling of a non-removable plastic prosthesis;

Fig. 3 - base of a collapsible navigational surgical template with lodgements;

Fig. 4 – template for positioning the base of the collapsible navigational surgical template;

Fig. 5 - making structural changes to a fixed plastic prosthesis;

Fig. 6 - positioning of the base with lodgements using a template for positioning the base;

Fig. 7 - positioning of the orthopedic structure to the base with cradles using counter parts for cradles;

Fig. 8 - fixation of a collapsible navigational surgical template to titanium bases using a fluid light-curing material;

Fig. 9 - fixation of a milled fixed plastic prosthesis to transmucosal abutments with screws.

In practice, the method is carried out as follows.

After the functional diagnosis of the dentoalveolar system (Fig. 1), a virtual non-removable plastic prosthesis is performed (Fig. 2). Then, a collapsible navigation surgical template is virtually designed, including: a template for forming holes for installing pins supported by teeth, a base with lodgements (Fig. 3), a template for positioning the base (Fig. 4), a template for forming lodges and installing dental implants with mates for lodgements and are printed on a 3D printer. Then, virtual changes are made to the virtual non-removable plastic prosthesis (Fig. 5), including counterparts for lodgements that are connected to the virtual fixed plastic prosthesis, and holes for titanium bases, and it is manufactured on a milling cutter. After anesthesia, fixation of a collapsible navigational surgical template (Fig. 6) and installation of dental implants, a milled non-removable plastic prosthesis is positioned with the help of mating parts to the cradles based on a collapsible navigational surgical template (Fig. 7) and fixed to titanium bases using a liquid-flowing light-curing material (Fig. 8). After that, the screws of the titanium bases were unscrewed and the fixed plastic prosthesis was removed from the oral cavity. Removal of mating parts for lodgements, final grinding and polishing of a milled non-removable plastic prosthesis were performed. After that, the base of the collapsible navigational surgical template with lodgements was removed from the oral cavity. The milled fixed plastic prosthesis was then fixed to the transmucosal abutments with screws (Fig. 9).

The method proposed by the authors makes it possible to restore the dentition by positioning a milled non-removable plastic prosthesis using dental implants and a navigational surgical template in one day, to reduce the treatment time for patients, and allows functional and aesthetic rehabilitation due to the immediate loading of dental implants.

The essence of the invention is illustrated by clinical examples.

Clinical example 1.

Patient I., 57 years old, came to the clinic on September 15, 2021 with a complaint of

partial absence of teeth, decay of teeth, difficulty chewing food and aesthetic defect. A functional diagnosis of the dentoalveolar system was carried out. A virtual modeling of a fixed plastic prosthesis was carried out, taking into account the individual trajectories of the temporomandibular joint. A virtual installation of dental implants was carried out in the position of teeth 4.6, 4.4, 4.2, 3.2, 3.4, 3.6, taking into account a virtually simulated non-removable plastic prosthesis. A collapsible navigational surgical template was designed, which includes a template for forming holes for installing pins supported by teeth, a base for a collapsible navigational surgical template with lodgements, a template for positioning the base of a collapsible navigational surgical template, a template for forming beds and installing dental implants with mating parts for lodgements. They were printed on a 3D printer. After that, virtually constructive changes were made to the virtual non-removable plastic prosthesis, including mating parts for lodgements and holes for titanium bases. Produced milling prosthesis. The patient was given general anesthesia for medical reasons. A navigation surgical template was installed, teeth 4.6, 4.5, 4.4, 4.2, 4.1, 3.1, 3.2, 3.3, 3.7 were removed, dental implants were installed in positions 4.6, 4.4, 4.2, 3.2, 3.4, 3.6 of the teeth along with transmucosal abutments and titanium bases. Positioning of the milled non-removable plastic prosthesis to the base with lodgments was carried out using mating parts for lodgments. The milled fixed plastic prosthesis was fixed to the titanium bases using a fluid light-curing material. After that, the screws of the titanium bases were unscrewed and the fixed plastic prosthesis was removed from the oral cavity. Removal of mating parts for lodgements, final grinding and polishing of a milled non-removable plastic prosthesis were performed. After that, the base of the collapsible navigational surgical template with lodgements was removed from the oral cavity. Then the milled fixed plastic prosthesis was fixed to the transmucosal abutments with screws. Healing took place without complications. On the day of the operation, a fixed plastic prosthesis was installed, a high aesthetic result was obtained. The patient undergoes preventive examinations every six months. The condition of the soft tissues is stable, there is no resorption of the bone tissue surrounding the implants.

Clinical example 2.

Patient I., 55 years old, came to the clinic on October 17, 2021 with a complaint of

partial absence of teeth, decay of teeth, difficulty chewing food and aesthetic defect. A functional diagnosis of the dentoalveolar system was carried out. A virtual modeling of a fixed plastic prosthesis was carried out, taking into account the individual trajectories of the temporomandibular joint. A virtual installation of dental implants was carried out in the positions of teeth 1.6, 1.4, 1.2, 2.2, 2.4, 2.6, taking into account a virtually simulated fixed plastic prosthesis. A collapsible navigational surgical template was designed, which includes a template for forming holes for installing pins supported by teeth, a base for a collapsible navigational surgical template with lodgements, a template for positioning the base of a collapsible navigational surgical template, a template for forming beds and installing dental implants with mating parts for lodgements. They were printed on a 3D printer. After that, virtually constructive changes were made to the virtual non-removable plastic prosthesis, including mating parts for lodgements and holes for titanium bases. Produced milling prosthesis. The patient was given general anesthesia for medical reasons. A navigational surgical template was installed, teeth 1.5, 2.4, 2.5, 2.6 were removed, dental implants were installed in positions 1.6, 1.4, 1.2, 2.2, 2.4, 2.6 of the teeth along with transmucosal abutments and titanium bases. Positioning of the milled non-removable plastic prosthesis to the base with lodgments was carried out using mating parts for lodgments. The milled fixed plastic prosthesis was fixed to the titanium bases using a fluid light-curing material. After that, the screws of the titanium bases were unscrewed and the fixed plastic prosthesis was removed from the oral cavity. Removal of mating parts for lodgements, final grinding and polishing of a milled non-removable plastic prosthesis were performed. After that, the base of the collapsible navigational surgical template with lodgements was removed from the oral cavity. Then the milled fixed plastic prosthesis was fixed to the transmucosal abutments with screws. Healing took place without complications. On the day of the operation, a fixed plastic prosthesis was installed, a high aesthetic result was obtained. The patient undergoes preventive examinations every six months. The condition of the soft tissues is stable, there is no resorption of the bone tissue surrounding the implants.

Clinical example 3.

Patient I., 62 years old, came to the clinic on November 3, 2021 with a complaint of

partial absence of teeth, decay of teeth, difficulty chewing food and aesthetic defect. A functional diagnosis of the dentoalveolar system was carried out. A virtual modeling of a fixed plastic prosthesis was carried out, taking into account the individual trajectories of the temporomandibular joint. A virtual installation of dental implants was carried out in the positions of teeth 1.6, 1.4, 1.2, 2.2, 2.4, 2.6, taking into account a virtually simulated fixed plastic prosthesis. A collapsible navigational surgical template was designed, which includes a template for forming holes for installing pins supported by teeth, a base for a collapsible navigational surgical template with lodgements, a template for positioning the base of a collapsible navigational surgical template, a template for forming beds and installing dental implants with mating parts for lodgements. They were printed on a 3D printer. After that, virtually constructive changes were made to the virtual non-removable plastic prosthesis, including mating parts for lodgements and holes for titanium bases. Produced milling prosthesis. The patient was given general anesthesia for medical reasons. A navigational surgical template was installed, teeth 1.6, 1.4, 2.3, 2.4, 2.5 were removed, dental implants were installed in positions 1.6, 1.4, 1.2, 2.2, 2.4, 2.6 of the teeth along with transmucosal abutments and titanium bases. Positioning of the milled non-removable plastic prosthesis to the base with lodgments was carried out using mating parts for lodgments. The milled fixed plastic prosthesis was fixed to the titanium bases using a fluid light-curing material. After that, the screws of the titanium bases were unscrewed and the fixed plastic prosthesis was removed from the oral cavity. Removal of mating parts for lodgements, final grinding and polishing of a milled non-removable plastic prosthesis were performed. After that, the base of the collapsible navigational surgical template with lodgements was removed from the oral cavity. Then the milled fixed plastic prosthesis was fixed to the transmucosal abutments with screws. Healing took place without complications. On the day of the operation, a fixed plastic prosthesis was installed, a high aesthetic result was obtained. The patient undergoes preventive examinations every six months. The condition of the soft tissues is stable, there is no resorption of the bone tissue surrounding the implants.

Claims (1)

A method for positioning a milled fixed plastic prosthesis for restoring the dentition, which consists in the fact that, after performing a functional diagnosis of the dentoalveolar system, a virtual modeling of a fixed plastic prosthesis is carried out taking into account the individual trajectories of the temporomandibular joint, then a collapsible navigational surgical template is virtually designed, including themselves: a template for forming holes for the installation of pins based on the teeth, a base with lodgments, a template for positioning the base, a template for forming lodges and installing dental implants with mating parts for lodgments, and they are printed on a 3D printer, after which they are virtually inserted changes to the virtual non-removable plastic prosthesis, including mating parts for lodgements that are connected to the virtual fixed plastic prosthesis, and holes for titanium bases, and produce it on a router; after anesthesia, fixation of a collapsible navigational surgical template and installation of dental implants, together with transmucosal abutments and titanium bases, a milled fixed plastic prosthesis is positioned with the help of mating parts to the base with lodgements based on a collapsible navigational surgical template and fixed to the titanium bases using a fluid light-curing material ; then the screws of the titanium bases are unscrewed and the non-removable plastic prosthesis is removed from the oral cavity, the mating parts for the lodgments are removed, the milled fixed plastic prosthesis is finally ground and polished, then the base of the collapsible navigational surgical template with the lodgments is removed from the oral cavity and the milled non-removable plastic prosthesis is fixed to transmucosal abutments with screws.

Images