UA66733A - Technique for preparing individual dental and gingival protective device - Google Patents

Abstract

The technique for preparing the individual dental and gingival protective device comprises the preparation of the complete anatomical auxiliary impresses of upper and lower jaws, the molding of the gypsum pattern, the plastering in the occludator, the preparation of the functional impress and its treatment. The functional impress is prepared with the aid of the individual spoon for molding teeth prepared directly in the oral cavity.

Description

Description of the invention

The invention relates to medicine, namely to stomatology and can be used in the manufacture of individual tooth-gum fuses.

Individual dental and gingival fuse (IZYAZ) is made by doctors based on individual impressions in dental laboratories. A sufficient number of such devices and methods are described in professional literature.

So, for example, E. Neipgisp (1931, 1942) proposed his modification of the fuse consisting of only one part - for the upper jaw with the crown part of the lower teeth overlapping up to two thirds, which, in his 70 opinion, compensated for the need to manufacture bilateral fuses, and also excluded the possibility of a moment of sliding articulation.

In addition, E. Neipgis. suggested making a fuse from a mixture of hard and soft rubber in a ratio of 1:2. With such a combination of rubbers, according to the author, the fuse turns out to be elastic enough, but also hard enough to take heavy blows. 19 In this way, the author avoided the need to weld metal inclusions proposed by previous developers. According to 5.I Adugeip (1955), the biggest drawback of E. Neipgis's fuse is the lack of a palatal part and the palatal support is too small. Therefore, the boxer is forced to keep his teeth closed all the time so that the fuse does not fall out during the fight. In addition, the width of the vestibular part of the fuse according to E. Neipgis is only one finger, that is, it is far from the transitional fold (Neipgis E. Mypazsptzigarragai dedep

Vohmegieiigipdep. - 2appai, Kypazspats. - 1931. - MoI.46. - R.20-76; Neipgisp E. KaiopeMez Agreyep ip adeg 7app-peiKkipave. - Vegiip, 1942).

N. Meaeg (1949) recognizes the expediency of the one-sided mouth fuse proposed by E. Neipgis!, but objects to the use of hard material, which in case of breakage can cause serious injuries, and advises instead of hard soft rubber, but with the inclusion of an elastic wire in one and a half millimeters from the palatal side (Medegh N.N. Oie Oegtepzogzspiepe. - gappaigi. Kypazspai. - 1949. - Moi|.19. - R.376-378.). "

K.Rare (1950) proposed a fuse of his design: instead of metal inclusions, use hard rubber, but on the palatal side, and the oral part of the fuse consists entirely of hard rubber, or the surface adjacent to the mucous membrane and teeth can be lined with a layer of soft rubber at

Later, K. Rare (1957) abandoned the use of hard rubber in order to avoid damage to soft tissues, and came to the conclusion that fractures and dislocations of the lower jaw can be avoided if both jaws are connected in a single block. This allegedly distributes the force of the impact over the entire skeleton of the face and skull, therefore, in the author's opinion, bilateral, separate mouth fuses for each jaw are impractical. The new design is a Ge) fuse on the upper jaw, the cell is made of soft rubber, but covers up to half of the lower teeth 32 on both sides, both from the vestibular and lingual. what

In practical terms, it offers the following: 1) removal of anatomical stent impressions; 2) determination of bite separation (both rows of teeth are fixed with wax at a distance of 4 mm); "

C) plastering of models in the articulator, modeling of the fuse, the upper border of the vestibular part of Z 50 is thickened, this contributes to better suction. Other technical performance - as usual. For stabilization, you can weld metal rods (Rare K. JuOie OegGepzogespiepe. - 7appagigI. Kypazspatsy. - 1950. - Moi. 10/11.

From" - R. 193-194; Rare K. YuOeg 7app-, Mypa-, pa Kietegespci: deg Voheg. - Oivsp. Biota. -1957.-My. 7, 11.-R. 677-679).

A significant contribution to the design of mouth fuses was made by VgoskK (1954) (VgoskK U. Et petzahideg

Vohegespci". - Oivsp. Mea. MUvsnHg. - 1953. - My/.3. - R.27-28;

Vgosk 3). Vohvrohimegivigyipdep it Vegeispy deg 2appe pi Kieieg pa iige Megpshipu igsy eip petsev

Me Vokhzspsh2degai Tg o daz Sebrivv. - 2appai. MUey - 1954. - MoI.4. - R.97-104; Hgosk in Oie (igashtaiyivspep

Ge») Mepeigipdep it Vegeispy deg 7apype pa Kiegeg apa iige Megpshipud tii Brezopaegeg VegysKwispidtspud dez

Vokhzrogievz. - Yuivzeidop, 1953; Vgosk 9. Eiip petagpideg Vohegesptsi2 2!ig Rgorpuiahe mop Mepeigipdep it 2annp-, this. Kiyeteg-, ipa KiegegdeiepkK-begevsy. - Ag2i and bBrogpi. - 1953. - My 1.2. - R.14-21.). Its fuse is one-sided,

Ge) 20 made of soft material, covers the entire upper tooth row, including both cusps. The lower dentition did not overlap lingually, but only vestibularly. c" The palatal hard palate is only partially covered. The upper border of the vestibular part reaches the transitional fold as much as possible, and towards the lower jaw forms a ridge that covers the lower tooth row up to 2/3 only from the vestibular side. This, according to the author, enables the boxer to breathe through his mouth with 29 closed rows of teeth. In addition, the thickness of the vestibular part of the fuse must be individually vary depending on the position of the surrounding tissues in order to create a so-called artificial line of impact perception between the two natural lines: the first runs along the zygomatic arch, the zygomatic bone to the front nasal spine; the second, passes along the base of the lower jaw from the angle of the lower jaw to the chin.

According to the author, the protrusion of the vestibular part of the fuse should theoretically be 60 mm in the area of molars and premolars, about 5 mm in the area of canines, Zmm of incisors. In order to avoid impacts on both rows of teeth, the fuse on the chewing part has an overbite roller approximately 4 mm thick. The author considers this thickness to be optimal. A thicker chewing part does not allow the athlete to freely connect the lips, and a thinner one - it is soon bitten.

Another way of manufacturing individual mouth fuses was proposed by MU. Neipi2 (1959) (Neipi2 M.O. bo Makhitit totsii rgoiesiop og sopiasi zro. - U. Rgoviais OUepiivigu. - 1959. - Moi.9, 5. - R.874-880) .

The author was not satisfied with the existing time-consuming process of technical production: wax modeling of the prototype of the future fuse, trying it on in the mouth, plastering, vulcanization, processing, etc. In the opinion of the author, all this can be avoided by using liquid latex to which is added for the manufacture of mouth guards

Viscose fiber. The manufacturing procedure is simple. An impression is taken with alpnate mass and a model is cast.

The model is heated in a plywood box measuring 25x35x5O0cm to 70-807"C (an ordinary 100-watt electric light bulb is inserted into the box). The limit of the fuse is marked on the model. The first layer of liquid latex is applied to the heated model with a metal spatula or brush, approximately in mm. The model is placed for 45 minutes in a heating box. The temperature should not exceed 807"C. The layer of latex is vulcanized when 7/0 its milky color turns to clear amber, and no scar remains from indentation with a nail or any other instrument. At room temperature, this procedure requires several hours. Then the second layer is applied, after which it is heated again; then third layer and fourth layer also heated.

After the third layer, the thickness of the fuse is checked with a graduated tool, which should be 1.5-1.6 mm on the vestibular surface, on the palatal surface and on the chewing surfaces. After the last layer has been vulcanized, without removing the fuse, the model is boiled for 15 minutes. This provides, in the opinion of the author, complete vulcanization, and also eliminates the possible aftertaste of rubber. The fuse is removed from the model (the model can be used many times), if it is too thin somewhere, then it is put on again and the necessary places are corrected by adding latex. After cutting off the excess, the fuse is released.

I. I. Revzin and V. 0 dealt with the design and manufacture of mouth guards for boxers.

Marskyi (I.I. Revzin, V.A. Marskyi. Instructions for making protective jaw splints for boxers from elastic plastic ZG mass-12. - M., 1951; Revzyn I.I. Protective jaw splint from elastic plastic for boxers / / Dentistry. - 1956. - Mo5. - P.42.)3. According to the authors, the mouth guard should be made of elastic plastic EG Mass-12 (author's certificate Mo87118) and with a normal bite, when the upper teeth overlap the lower ones, it is made on the upper jaw with the calculation that it covers all the teeth, the immovable mucous membrane of the alveolar process to the neutral zone, more or less hard palate. With a backbite, the fuse is placed on the lower jaw. "

To make a fuse, plaster casts are removed from the upper and lower jaws. On the resulting model, outline the boundaries of the future fuse with a pencil. When making a fuse on the upper jaw, the boundary line should pass on the vestibular side - along the fixed part of the mucous alveolar process, from left to neutral zone, bypassing the labial, front and back buccal frenulum by 1.5-2 mm and covering the alveolar tubercle. On the oral side - along the hard palate, capturing all the transverse folds and naturally narrowing to the post-dumolar alveolar tubercle, the torus, as a rule, does not overlap. Fuses according to 1. I. Revzin (1956) can also be manufactured without a circuit. The borders of such a fuse from the oral side capture only some part of the hard palate at a distance of 3-4 mm from the necks of the teeth. To ensure re) good fixation of the palatal fuse - the lingual and buccal surfaces of the molars and the labial surfaces of the front teeth on the plaster model must be cut into a cone below the equator to the base of their neck by 0.5-0.75 mm, without disturbing the general configuration tooth This achieves tight coverage of the fuse with all the teeth in the mouth, due to which the size of its palatal part can be significantly reduced.

A prototype of the future fuse is modeled from wax. Prepared, wax pattern «

It is used to determine the bite. By asking the athlete to cover his mouth, they try to obtain a tight simultaneous closing of all the teeth of the jaw with a wax pattern. The bite is determined by the impression on

And the roller of the entire antagonistic row of teeth to such a depth that a layer of wax remains between the antagonists and?" 1.5-1.6 mm. I.I. Revzin does not recommend determining the bite outside the oral cavity by arranging the models and then fixing them in the occluder, because in the future this will not ensure uniform closing of the tooth row with the fuse. The upper and lower plaster models assembled according to the wax pattern are fixed in the occluder. The final modeling of the wax pattern would be done. When modeling, it should be assumed that the finished processed fuse should have a plastic thickness of 1.8-2 mm in all areas. The edges of the wax roller

Me, rounded to the impressions of the opposing teeth. The depth of the impressions of the molars on the roller should be 1 mm, and the depth of the front teeth - 2 mm. The outer surface of the wax template is smoothed. Plastering is done in the usual dental cuvette in the reverse way. o After pouring the counterform and complete hardening of the plaster, the wax is removed with a stream of boiling water. Next, 4) proceed to the preparation of the material, molding and vulcanization, as indicated in the instructions.

This method of manufacturing an individual tooth-gingival fuse is the closest to what is claimed in terms of technical essence and the result that can be achieved, therefore it was chosen as a prototype.

The main drawback of the prototype method is the insufficient functionality of the fuse, since the processed fuse has the same thickness in all areas of the jaw, which does not take into account the anatomical features of the patient.

R In connection with the above, the invention is based on the task of increasing the functionality of an individual tooth-gum fuse.

The problem, which is the basis of the invention, is solved by the fact that in the known method of manufacturing an individual tooth-gingival fuse, which includes obtaining complete anatomical auxiliary impressions from the upper and lower jaws, casting a model from ordinary medical plaster, plastering in an occluder, obtaining a functional impression and its processing, according to the invention, a functional impression is obtained with the help of an individual spoon made in the laboratory or directly in the oral cavity.

At the same time, the spoon is formed from transparent plastic plates "AKR-P", and holes are perforated on the vestibular part 65 of the surface of the spoon.

Increasing the functionality of the individual dental and gingival safety device is achieved by forming the vestibular surface of the safety device uneven in thickness due to the individual anatomical features of the patient's oral cavity.

The method is performed as follows:

For the manufacture of the fuse, complete anatomical auxiliary impressions of the upper and lower jaws are obtained.

Models are cast from ordinary medical plaster. On the obtained model of the upper jaw, the boundaries of the future fuse are outlined with a pencil. The boundary line should pass on the vestibular side - along the immovable part of the mucous membrane of the alveolar process, not reaching the neutral zone of 1.5-2 mm, going around the labial, anterior and posterior buccal frenulums and overlapping the alveolar tubercle. On the oral side - along the hard palate, taking all the transverse folds and naturally narrowing to the post-dumolar alveolar tubercle. The torus does not overlap.

Then the models of the upper and lower jaws are plastered in the articulator (occluder), where a slight separation of the bite is made - up to 2 mm.

The next stage is the manufacture of an individual spoon for the upper jaw. It must be made in an articulator or occluder. The thickness of an individual spoon on the vestibular and palatal surfaces is 2 mm (thickness of the wax plate), and on the chewing surface - up to 4 mm (thickness of 2 wax plates).

On the chewing surface, it is necessary to obtain an impression of the entire antagonizing tooth row to a depth of 1.5-2.0 mm.

An individual spoon can be made in the laboratory or directly in the oral cavity.

Preference is given to the laboratory way of making an individual spoon. In this case, on the received

Models in the dental laboratory form a spoon from plastic plates "AKR-P" (necessarily transparent), which are manufactured in a factory way. They are softened in hot water, pressed according to the model, and then fitted in the oral cavity. You can prepare a wax pattern of a spoon, which is replaced by plastic in the usual way. It is better to use a colorless base plastic so that, during the fitting of an individual spoon in the oral cavity, it is possible to visually assess the separation of the bite.

In the oral cavity, an individual spoon is fitted, and the correctness of the separation of the tooth rows is checked. The palatal part of the spoon should be well polished. A rough surface is formed on the vestibular, chewing and internal surfaces of the spoon. A small layer of plastic is removed from the inner surface with a cutter in order to create additional space for the impression material. Holes are perforated on the vestibular surface of the spoon. зо зо Then they proceed to obtain a functional impression. Before carrying out this procedure, the oral cavity should be rinsed with water, and it is even better to brush the teeth in order to remove soft dental plaque and food residues. A functional impression is obtained with a silicone impression mass (corrective paste). M

Conducted clinical studies have shown that it is better to use a medium-viscous type of impression material. From the tube, a silicone mass is squeezed onto a glass plate, which is mixed with a catalyst, one drop per centimeter of paste. The amount of catalyst should not be increased, otherwise the mass will harden faster and there will be less time for the formation of the vestibular surface. The paste is stirred for one minute - no more - and quickly put in a spoon with excess. A small amount of material can be placed on the chewing and vestibular surface. The spoon is inserted into the oral cavity, pressed evenly, if possible deeper, and the patient is offered to bite it for 3-5 minutes. Surplus material exits through perforation holes on the vestibular surface of an individual spoon. In the period before the beginning of vulcanization, the formation of the vestibular surface of the future IZAZ is made from the impression material by active-passive movements of soft tissues. Then the fuse is pulled out, rinsed, the excess is cut off, and the existing pores and ;" artifacts are leveled with a small amount of wax. It is possible to edging the edges of the impression to prevent violation of the valvular area, as in the manufacture of complete removable plate prostheses. After that, the model is cast in the usual way. We recommend using stone gypsum (supergypsum).

Gypsum casting of an individually formed reproduction of IZAZ is done in the reverse way in a dental cuvette.

After the casting of the counter-form and the complete hardening of the plaster, the reproduction of the IZAZ is taken out of the cuvette and started to

Me, preparation of the material, molding and vulcanization, as indicated in the instructions for its use. -I The method is illustrated by the following example:

Excerpt from medical history Mo29777: on September 26, 2003, Ya., born in 1982, asked to make him an individual tooth-gingival fuse.

Objectively: The face is symmetrical, the nasolabial folds are moderately pronounced. The lower third of the face is not shortened.

Mobility of the temporomandibular joint is not limited. The teeth are intact, all are present. 35 protrudes from the tooth row in the vestibular direction by one third. The mucous membrane of the oral cavity throughout is without pathological changes. Orthognathic bite.

R» Treatment plan: It is recommended to make an individual tooth-gum fuse using the proposed method from the "Boxyl-Extra" material

Diary of a doctor. on September 26, 2003 Obtaining complete anatomical auxiliary impressions from the upper and lower jaws "Stomalgin-04". 30.09.2003 Obtaining a functional impression using an individual spoon with simultaneous formation of the vestibular surface of the "Sielast-21" tooth-gingival fuse.

The thickness of the individual spoon for obtaining a functional impression with the simultaneous formation of the 65 vestibular surface of the individual tooth-gingival fuse: from the vestibular surface - 1.0-1.5 mm; from the palatal surface - 0.8-1.0 mm; from the occlusal surface - 1.5-2.0 mm.

In fig. the numbers indicate the thickness of the individual tooth-gum fuse in different areas of the tooth row. The smaller value corresponds to the distance from the equator of the tooth to the outer surface of the IZYAZ, the larger - from the middle part of the alveolar process to the outer surface of the IZYAZ (in brackets, the region of the corresponding tooth according to WHO is indicated). 03.10.2003 Introduction of ready-made IZAZ into the oral cavity. Audit. Providing recommendations.

The IZAZ made in this way have a number of advantages: 1) the fixation is so strong that even the impression is difficult to remove from the oral cavity; 2) an individual vestibular surface of IZAZ is formed, which is uneven in different areas along its entire length in accordance with the anatomical features of the patient.

Claims (2)

The formula of the invention 1. The method of manufacturing an individual dento-gingival retainer, which includes obtaining full anatomical auxiliary impressions from the upper and lower jaws, casting a model from ordinary medical plaster, plastering in an occluder, obtaining a functional impression and its processing, which is characterized by the fact that the functional impression is obtained with the help of an individual spoon made in the laboratory or directly in the oral cavity. 2. The method according to claim 1, which differs in that the spoon is formed from transparent plastic plates of AKR-P, and holes are perforated in one vestibular part of the surface of the spoon. « (ze) (ze) cha (Se) (Se) - with . and? (o) (o) -I (95) syu" 60 b5