The method of forming a prosthesis-obturator in the complete absence of the upper jaw and denture-obturator

 

The invention relates to medicine, in particular to prosthetic dentistry and is intended to compensate for defects of the upper jaw of different origin, including its complete absence. The technical result consists in simplifying the method of manufacturing a prosthesis-obturator, as well as to simplify the design of the prosthesis and its universality. The prosthesis obturator contains the primary and secondary surfaces and interconnected by additional front, rear and two side vertically oriented surfaces and with the formation of the cavity, the front and rear vertically oriented surface, and recesses in the form of grooves. The method of forming a prosthesis-obturator in the complete absence of the upper jaw, including the removal of the alginate impression mass, casting plaster models on this impression, the fabrication of individual spoons received on the plaster model, the fit of individual spoons with elimination of excess pressure of the muscles of the cheeks on individual spoon, removing functional replica of an individual with a spoon using flowable silicone masses to exclude pererasseyaniya soft tissues, casting plaster working model polsey plastic, the connection of the main and auxiliary parts of the hollow obturator self-hardening plastic. Before making individual spoons covered with wax undercut and form of the bow, working the plaster model is closed with excessive undercut in the field pinktornado ring formed by the muscles of the upper lip to the base of the nose in the front area, the soft palate in the distal area and the muscles of the cheeks in the side sections, the resulting hollow obturator main part is formed as the bottom of the nasal cavity and the auxiliary portion is formed as the hard palate, smooth out the area of the grooves. 2 ad and 3 C.p. f-crystals, 3 ill.

The invention relates to medicine, in particular to prosthetic dentistry and is intended to compensate for defects of the upper jaw of different origin, including its complete absence.

There is a method in the absence of prosthetic upper jaw (Kostur B. K., Minyaeva Century A. “Maxillofacial prosthetics”, Leningrad, Medicine, 1985, S. 17-33), including the removal of the alginate impression mass, casting plaster models on this impression, the fabrication of individual spoons received on the plaster model, punctional cast individual spoon using flowable silicone masses to exclude pererasseyaniya soft tissue, casting plaster working model on the obtained cast, production of primary and secondary parts of a hollow obturator by polymerization basic plastics, main connection and auxiliary parts of the hollow obturator self-hardening plastic.

The known method is difficult to implement, and made prosthesis inconvenient in operation.

The present invention consists in correcting these shortcomings.

The technical result consists in simplifying the method of manufacturing a prosthesis-obturator, as well as to simplify the design of the prosthesis and its universality.

The result is achieved that, in the method of forming a prosthesis obturator in the complete absence of the upper jaw, including the removal of the alginate impression mass, casting plaster models on this impression, the fabrication of individual spoons received on the plaster model, the fit of individual spoons with elimination of excess pressure of the muscles of the cheeks on individual spoon, removing functional replica of an individual with a spoon using flowable silicone masses to exclude pererasseyaniya soft tissues, casting plaster working model on the obtained cast, production of primary and vspomogatel parts of the hollow obturator self-hardening plastic, before making individual spoons covered with wax undercut and form of the bow, working the plaster model is closed with excessive undercut in the field pinktornado ring formed by the muscles of the upper lip to the base of the nose in the front area, the soft palate in the distal area and the muscles of the cheeks in the side sections, the resulting hollow obturator main part is formed as the bottom of the nasal cavity and the auxiliary portion is formed as the hard palate, smooth out the area of the grooves that form the base for perebazirovka pads, clean prepared surface with adhesive, put a soft pad, make denture soft lining in the mouth for a period of polymerization pads, remove the prosthesis, and the fact that before removing the impression alginate mass pre-coat alginate mass of the upper arch of the nasal cavity in places with odnotrahniki, and the fact that the prosthesis-obturator containing the primary and secondary surface, the supporting surface is oriented parallel to the occlusal plane of the teeth on the lower jaw, the primary and secondary surfaces are connected by additional front rear and two side vertically oriented the displacement is made with grooves in the form of the grooves to communicate with the muscles of the lips at the base of the nose and the upper part of the soft palate, respectively, side vertically oriented surface configured to interact with the muscles of the cheeks, and the fact that the main and auxiliary surface is made concave in the direction formed by the cavity of the prosthesis, and the fact that the front and rear vertically oriented surface is made concave in the direction formed by the cavity of the prosthesis.

The implementation of the method of forming a prosthesis-obturator in the complete absence of the upper jaw, the design of the prosthesis-obturator illustrated in Fig.1 and 2, which depicts the prosthesis obturator and its section a-A. In Fig.3 shows a General view of the prosthesis of the obturator.

The prosthesis obturator 1 contains the primary and secondary surfaces 2 and 3 are interconnected by means of an additional front, rear and two side vertically oriented surfaces 4, 5, 6 and 7 with the formation of the cavity 8, the front and rear vertically oriented surfaces 4 and 5 are made with grooves in the form of grooves 9, 10.

The method is implemented as follows.

Removed cast alginate mass YPEEN, SPOPA DENTAL, Praga, Czech Republic, pronation all elements of the nasal cavity and mouth, especially the top of the palate, cheeks, the base of the nose and upper lip, forming synchronou ring. Cast by the raised area of the undercut in the region of the maxillary cavities for subsequent isolation (closing) their base wax THAT 64-2-211-77, firm “STOMA”, ,Kharkov, Ukraine, except for a slight undercut (to the millimeter) in the area of the soft palate (surface 5) and the base of the nose (surface 4) to create the locking grooves (on the prosthesis grooves 10, 9). To model the space is formed for the nasal passage (in the form of a roller, located on the longitudinal axis of the model, the width defined by the wings of the nose, and the length of the soft palate), enough for nasal breathing, from the same base wax. From self-hardening plastic for cold polymerization protocel THE 64-2-267-78 “STOMA”, , Kharkov, Ukraine, made individual spoon, compressing terrain model with closed odnotrahniki and created the nasal passage. The wall thickness of the spoon should be about 1 cm to thinning it with a view to eliminating pererasseyaniya soft tissues encountered during the initial removal of casts alginate mass. In the mouth this spoon prepassivate for the free introduction and removal from the mouth, but with the lock in the region of the grooves on the distal and anterior border (the grooves 10 and 9, respectively, surfaces 5 and 4). Removed the excess plastic in the cheeks, unless there is a primary fixation individuals who de in the area of the palate and the nose is deepening to 0.5 mm in order to reduce pressure on the mucous membrane and create space for a sufficient thickness of the silicone fluid mass BISICO hydrophilsli ADA 19 type 1 iso 4823 type 3, displays the microrelief in the contact area of individual spoons with the mucous membranes. On the obtained cast made a working model of super plasters. On the resulting working model basic wax is crimped received relief, are formed straight edge, facing the cavity of the mouth in the same plane. Formed edges promazyvaetsya vaseline and pressed out another piece base wax to form caps for hollow prosthesis of the obturator. Then cover that form the hard palate (surface 3), removed and gypsums in the cuvette for the polymerization of plastics. The main part of the prosthesis of the obturator also hipoteca in a cell, consisting of two halves. After casting the second half of the wax vivariums of the ditch, the free space is filled with a basic plastic stomachal THE 9391-009-40151387, type 1,class 1, scomagent, Russia. Polymerization in a water bath is carried out under pressure. After polymerization, the prosthesis obturator fits in the mouth on the subject snug fit in the grooves 9, 10 (the surface 4, 5). The prosthesis obturator thinner from the inside out to reduce the weight of the prosthesis. To the edge of the prosthesis of the obturator prepassivate lid (the arch of the hard palate) (surface 3) and is connected to the van as the bottom of the nasal cavity (surface 2), the supporting surface is formed as the hard palate (surface 3).

A new set of activities aimed at the formation of the prosthesis of the obturator, and the design of the prosthesis of the obturator show the novelty of the method and design of the prosthesis, the presence of inventive step for the average person, to confirm industrial applicability here is a photo of the prosthesis with the alveolar ridge and teeth.

Consider the following example.

Excerpt FROM the HISTORY

Sokolov, B. C., born in 1938, has addressed in clinic DSPS “MedBioExtrem” in the orthopedic Department in 1999 with complaints of difficulty swallowing, speech and chewing, destruction of teeth on the lower jaw, Zapadnye upper lip and the absence of teeth on the top.

History: In 1987 he was made a Subtotal resection of the upper jaw about tumors of the hard palate and bottom of the nasal cavity with subsequent radiotherapy.

In 1989, manufactured prosthesis maxillofacial hospital. Made obturator fixed with the help of a spring Pochara. The prosthesis obturator served almost 10 years, helped to separate the nasal and oral cavity. The patient had problems with the installation of the prosthesis in the oral cavity, the spring of Posara who actively: the oral Cavity and the nasal cavity is a single cavity due to the absence of the maxillary bone. In the nasal cavity is missing a Shoe, the lower nasal turbinates. Saved the upper arches of the maxillary cavities, partially - distal, approximal and side walls; the upper and middle nasal turbinates on both sides. On the distal border of the mouth saved the soft palate, the side surface is formed of the soft tissues of the cheeks. Approximal border at the base of the nose is limited to the muscles of the lips. The mucous membrane of the nasal cavity hyperemic, edematous, in the upper and middle nasal passages there are remnants of food and Muco-purulent discharge. When pronouncing the words slurred speech, words are hardly distinguishable, independent swallowing liquids is extremely difficult.

On the lower jaw are missing 47, 46, 45, 42, 35, 38 tooth. Destroyed coronal portion of the teeth 43, 41, 31, 32 to the level of the gums. On the R-picture channels filled with removing sealing material over the top into the cavity of the granuloma. There is a convergence 34, 36 in the direction of the missing 35. 34 stamped crown in satisfactory condition.

Diagnosis: Condition after Subtotal resection of the upper jaw due to surgical treatment on the tumor of the hard palate and bottom of the nose of a decade ago. The absence of zonal bands of the Oh membranes of the nasal cavity, mainly in the area of the nasal Concha. Dysfunction of the swallowing, wrong speech articulation, impaired function of mastication. Violation of the aesthetics of the lower third of the face. Zapadnye upper lip due to the absence of the upper jaw bone. Cosmetic defect due to the lack of upper teeth. Partial absence of teeth in the lower jaw(47, 46, 45, 42, 35, 38) (class III by Kennedy) due to caries and its complications, multiple fillings, changed in color, partial destruction of the tooth crown(43, 41, 31, 32). Convergence 34 and 36 in the area of the missing 35. Dentoalveolar elongation of the anterior teeth in the lower jaw due to the lack of teeth-antagonists. Parodontopathy due to lack of natural self-purification and lack of dental hygiene.

Treatment plan:

1. To manufacture the prosthesis obturator with fixation with preserved soft tissues without the use of a spring Fasara to divide the nasal cavity and the oral cavity. To make tabs LCSW(43, 41, 31, 32), to make a bridge prosthesis with support(48, 44, 43, 41, 31, 32, 33) to restore(47, 46, 45, 42), to align the occlusal plane.

2. At the stage of adaptation to the prosthesis-the obturator fully complete correction of the prosthesis on the subject of eliminating Namin.

3. On stage realine upper lip and restore the front group of teeth with the help of manufacturing the prosthesis-obturator disconnect artificial alveolar bone with teeth. To restore speech to a patient in connection with an altered vault of heaven.

5. To solve the question about the possibility of using implants to restore full function of chewing computer after examination of the skull base and the solution to the financial problems of the patient.

14.01.99. Feel satisfactory. No complaints. Cut the softened tooth tissue, responsivene channels 43, 41, 31, 32, 2/3 modeled tab.

19.01.99. Feel satisfactory. No complaints. Commit tabs on vistat, uncut 48, 44, 43, 41, 31, 32, 33 for the manufacture of bridges. Removed the casts of the lower jaw for the manufacture of stamped crowns. Removed the cast of Oro-nasal cavity for the manufacture of individual spoons.

01.02.99. Feel satisfactory. No complaints. Fitting crowns, removal of the cast for the spikes of the crown and the manufacture of the intermediate part of bridge-like prosthesis. Correction of individual spoons on the contact surface with the soft tissues on the subject of the elimination of extrusion individual spoons muscles of the cheeks, the elimination of excessive undercut in the region of the distal border of the upper edge of the soft palate and approximal border in the upper part of the muscles of the lips in the basics is 99. Feel satisfactory. No complaints. The imposition of the bridge based on 48, 45, 44, 43, 42, 41, 31, 32, 33 and fixing it on vistat. The fitting upper part of the prosthesis of the obturator along the borders of the prosthesis, removal of excessive undercut in the region of the locking grooves in the distal part of the upper edge of the soft palate in the approximal region of the upper edge of the lip and the base of the nose. The deepening of the locking grooves, clinical relocation of soft padding, maximum thinning of the walls of the obturator. Fixing caps for hollow obturator to protocel, processing junctions. Patient education is the imposition and removal of the prosthesis of the obturator. Recommendations on the use and care of the prosthesis.

With 10.02.99. on 16.02.99. Correction of the prosthesis in the area Namin, attend pronunciation of sounds. The patient is warned of perebazirovka pads in 6 months. 13.12.00. Feel satisfactory. Complaints peel pads, the emergence of Namin. To come to the dispensary inspection and replacement pads could not, because he lived in the Tver region, where caring for a sick relative.

Objective: the articulation and swallowing recovered. On the distal border of the prosthesis in blastocladia, the patient is scheduled for an appointment to repair the teeth in the anterior part to correct cosmetic defects of the dentition and the failure of the upper lip as a result.

20.12.00. Feel satisfactory. Complaints about the pain of the prosthesis of the obturator in the area of the soft palate. Made the correction basis of the obturator in the area Namin.

08.10.01. Feel satisfactory. Complaints about the pain of the prosthesis of the obturator in the area of the soft palate.

Objectively: there was a partial peeling pads, violated its elastic properties. Made the relocation of a soft gasket. On the prosthesis-the obturator in the anterior part has three grooves for the orientation of the bite of the roller on the plaster model and the prosthesis-the obturator in the oral cavity. Removed the cast from prosthesis-obturator and lower jaw for the manufacture of roller bite.

15.10.01. Feel satisfactory. No complaints. The definition of centric relation of the prosthesis of the obturator and the lower jaw with wax template.

22.10.01. Feel satisfactory. No complaints. Fitting wax alveolar bone with artificial teeth 45, 44, 43, 42, 41, 31, 32, 33, 34, 35, based on the three guide grooves in front. Fitting the finished artificial alveolar ridge without 45, 35 teeth to reduce the weight of the structure. To create opportunities to implement conditionally demountable prosthesis obturator with artificial alveolar process used attachments firm “Bregent”. Ersatz Patricia strengthened in artificial alveolar ridge, and the matrix in a metal container, strengthened in the base of the prosthesis of the obturator on protocel. Weight loss artificial alveolar process by creating the appropriate holes. Tips on caring for the prosthesis, and the restoration of speech. 06.11.01. Feel satisfactory. No complaints. Made control panoramic x-ray. Recommendations for the care of the prosthesis. Control examination after 6 months. Thus, the resulting prosthesis is very closely matches the borders of the defect formed in the absence of the hard palate and the alveolar ridge, and the parameters pinktornado ring formed by the soft palate, the muscles of the upper lip to the base of the nose and the muscles of the cheeks, which are grooves in which they are fixed, and cheeks on both sides cover the side surfaces of the prosthesis of the obturator. This greatly simplifies the act is the first and universal.

Claims

1. The method of forming a prosthesis-obturator in the complete absence of the upper jaw, including the removal of the alginate impression mass, casting plaster models on this impression, the fabrication of individual spoons received on the plaster model, the fit of individual spoons with elimination of excess pressure of the muscles of the cheeks on individual spoon, removing functional replica of an individual with a spoon using flowable silicone masses to exclude pererasseyaniya soft tissues, casting plaster working model on the obtained cast, production of primary and secondary parts of a hollow obturator by polymerization basic plastics, main connection and auxiliary parts of the hollow obturator self-hardening plastic, characterized in that before making individual spoons covered with wax undercut and form of the bow, working the plaster model is closed with excessive undercut in the field pinktornado ring formed by the muscles of the upper lip to the base of the nose in the front area, the soft palate in the distal area and the muscles of the cheeks in the side sections, the resulting hollow obturator main part of the century

2. Method of forming a prosthesis obturator in the complete absence of the upper jaw in p. 1, wherein before removing the impression alginate mass pre-coat alginate mass of the upper arch of the nasal cavity in places with odnotrahniki.

3. The prosthesis obturator containing the primary and secondary surface, the supporting surface is oriented parallel to occlusional plane of the teeth in the lower jaw, characterized in that the primary and secondary surfaces are connected by an additional front, rear and two side vertically oriented surfaces with the formation of the cavity, with the front and rear vertically oriented surface with recesses in the form of the grooves to communicate with the muscles of the lips at the base of the nose and the upper part of the soft palate, respectively, side, vertically-oriented surface configured to interact with the muscles of the cheeks.

4. The prosthesis obturator under item 3, characterized in that the main and auxiliary surface is made concave in the direction formed by the cavity of the prosthesis.

5. The prosthesis obturator under item 3, characterized in that the front and rear vertically oriented

 

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1 tbl, 3 ex

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