Method for dental reconstruction at root perforation in bifurcation area due to reinforcing

FIELD: medicine, stomatology.

SUBSTANCE: the suggested method deals with applying infiltration anesthesia, preparing intact walls of dental crown part up to healthy solid tissues and their reconstruction up to equator's level, moreover, osteostimulating material based upon hydroxyapatite, collagen and "Collapan-L" medicinal preparation should be applied in area of root foundation and bifurcation after removal of demineralized tissues of foundation and medicinal treatment to be isolated due to temporal bandage. After complete reconstruction of root perforation one should additionally reinforce a cavity developed with walls and foundation of reconstructed root due to applying a metal netting pre-formed in accordance to reinforcing cavity, moreover, the next final reconstruction of dental crown part should be fulfilled by applying restorative system for masticatory dental group. The innovation enables to minimize traumatism of impact in the course of reconstruction along with the control for regeneration of root's solid tissues and higher strength of dental root and crown parts.

EFFECT: higher efficiency of dental reconstruction.

 

The invention relates to medicine, namely to the dentist, and can be used to restore a tooth with perforation of the root in the area of the bifurcation using reinforcement metal grid.

Currently, in clinical practice, there are root perforations in the area of the bifurcation of the teeth, caused by caries and its complications.

When the perforations of the root in the area of the bifurcation disturbed function of the tooth, which makes it impossible to use as a support for the prosthesis. Such teeth are a potential nidus of chronic odontogenic intoxication, which is a direct indication for their removal.

The prior art solution perforations tooth root according to the patent of Russian Federation №2138996. The essence of this method consists in the following. Carry out infiltration anesthesia and cut out for gingival edge of the mucoperiosteal flap. After his reclining perform trepanation cortical plate over the area of the perforation. The resulting bone defect fill osteoplastic material based on hydroxyapatite. In conclusion, spend wound closure.

Indications for use of this method is limited, in particular

the lack of direct access to the root;

lack of control over the regeneration process is ostroy the root tissue;

possible complications arising from the choice of the size and shape of the incision peelable flap, and incomplete removal of perforation of the root.

Due to these constraints the expected result when implementing the known method (fewer complications and preserving full functionality restored tooth) may not be reached.

Among the significant disadvantages of the known method include the difficulty of implementation, increased invasiveness, limited indications for use and possible postoperative complications.

To address these shortcomings developed the inventive method of restoring a tooth with perforation of the root in the field of bifurcations.

Technical result achieved when implementing the inventive method, is to simplify the process of restoring the tooth along with minimizing trauma exposure, control the regeneration of hard tissues of the root and increasing strength of the root and coronal parts of the tooth.

The technical result is achieved by forming vertical access to the lesion, which in addition to an accurate assessment of the extent of damage and the location of the hearth is provided "direct" access to the root canals. Access is in the form of restored to the level of the equator of the walls of the tooth. Through the cavity formed h is ichno restored walls, in the area of bifurcations enter osteosclerosis material on the basis of pure hydroxyapatite, collagen and medicines. The degree of recovery of perforation is controlled with roentgenogram and, if necessary, osteosclerosis material is advanced. The final restoration of the tooth crown is carried out after the complete restoration of the perforation of the root.

When applying the inventive method, the restored tooth is significantly strengthened through the use of reinforcing wire mesh and extend its functioning. The effect of reinforcement is manifested, in particular, to increase the stability of the restored root, because the preserved tissue and regenerated bone tissue of the root is additionally fastened to each other.

The essence of the invention.

Mechanically toothbrushes using toothpastes clean the surface of teeth, which are located near the defect and determine their color according to the standard scale VITA. After controlling x-rays, perform the retraction of the gums with retractive yarns "Unident". Then hold the insulation of the oral cavity from the liquid medium by using a cofferdam. Under infiltration anesthesia dissect preserved walls of the coronal part of the tooth to a healthy hard tissue. Spend cyclotrimethylene acid - 3M SCOTCHBOND ETCHANT GEL (Catalog. Dental materials 2001. 3M Dental, page 6) to create a surface. The acid is applied with a brush, on average, 15-20 sec., then wash off with running water while running the saliva ejector. The cavity is dried by air, put adhesive 3MTMSINGLE BOND DENTAL ADHESIVE SYSTEM Directory. Dental materials 2001. 3M Dental, P6). Further, the adhesive lightly blow air to distribute, put again and again rinsed with air. Within 10 sec will polimerizuet standard method.

Composite material designed to restore chewing teeth groups R-60 3MTMSOF-LEXTM(The directory. Dental materials 2001. 3M Dental, p.4), form the ruined walls of a coronal part of the tooth thickness of 1-1 .5 mm. Conduct external and internal directional polymerization vestibular, oral, and then the chewing surfaces, the Method of the directed polymerization can reduce polymerization shrinkage, improve the regional seal.

Next, perform a dissection of demineralized tissue in the area of the base and the bifurcation of the root. Provide medical treatment. To restore the perforation in the area of the bifurcation of the root is used "Callahan-L" in the granules, so as Callahan-L - osteosclerosis material based on highly pure gidroksiapatit is a, collagen and medicines used for the treatment of diseases associated with abnormal bone tissue, has a strong osteogenic and anti-inflammatory properties, significantly enhances the reparative processes in the damaged tissues, promoting faster healing of bone wounds and restoration of bone structure, provides prolonged action of the contained drug. High microbial activity of the material is retained 16-20 days, during which there is a uniform allocation of antibiotics in the bone cavity. "Callahan-L" has a high biocompatibility, does not cause rejection.

After applying Callahan-L" in the area of bifurcation and the base of the root of the tooth temporarily leave the bandage.

Every month remove temporary bandage and add "Callahan-L". Under the control of the x-rays is determined by the degree of recovery of the perforation in the area of the bifurcation of the root. To the final restoration of the tooth crown start after full recovery perforation of the root.

Restoration of the tooth crown by the method of reinforcement.

Isolation from the liquid environment of the oral cavity is carried out with the help of the cofferdam. Remove temporary bandage and carry out the dissection of the inner surface of the crown part of the tooth. After conducting acid tra is of acid - 3M SCOTCHBOND ETCHANT GEL (Catalog. Dental materials 2001. 3M Dental, page 6) to create a surface. The acid is applied with a brush, on average 15-20 seconds, then wash off with running water while running the saliva ejector. The cavity is dried by air, put adhesive 3MTMSINGLE BOND DENTAL ADHESIVE SYSTEM Directory. Dental materials 2001. 3M Dental, P6). Further, the adhesive lightly blow air to distribute, put again and again rinsed with air. Within 10 sec will polimerizuet standard method.

For the reinforcement of the tooth crown as a reinforcing element using a metal mesh made of stainless steel with small cells with a thickness of 0.4 mm firm "Renfert" (the Directory. Products for dental technicians 2001-2002, - p.102-103). The mesh is intended to strengthen the plastic prostheses. Metal grid select the required size and using stopper create a shape that mirrors the inner surface of the restoring of the tooth cavity, so that the outer surface of the mesh tightly to the inner surface of the prepared cavity. Metal mesh should not overstate the equator of the tooth. After trying on a metal grid is removed from the cavity of the tooth and hold the acid etching and adhesive processing. The outer and the inner surface of the metal mesh covering maskirovka is the principal agent (the Directory. Dental materials 2001. 3M Dental, p.11) and conduct the polymerization.

Then the cavity is filled flowable composite (the Directory. Dental materials 2001. 3M Dental, p.3) and establish a grid. Conduct external and internal directional polymerization vestibular, oral, and then the chewing surfaces. After fixing a metal grid spend the final restoration of the tooth crown, using restoration system for posterior teeth. Before polishing and controlling the polymerization is conducted occlusive editing. The final grinding and polishing is performed on the 2nd day after polymerization.

Thus, this method allows you to achieve preservation of the tooth, increasing the longevity of the restoration of the tooth crown by the method of reinforcement with high aesthetics.

During the year the patient is taken to the dispensary account: every three months to inspect the oral cavity, professional cleaning and polishing of teeth.

The treatment used in this method saves the tooth, prevent chipped and split. Complications after the restoration by the above method was not found.

The method of restoring a tooth with perforation of the root in the area of the bifurcation with the use of reinforcement, including an infiltration is statii, dissection of the preserved walls of the coronal part of the tooth to a healthy hard tissue and restore them to the level of the equator, while osteosclerosis material based on hydroxyapatite, collagen and medicines ″Callahan-L″ impose in the region of the base and the bifurcation of the root after removal of demineralized tissue Foundation and medical treatment and isolated by a temporary bandage, and after full recovery perforation of the root cavity formed by the walls and base of the restored root, optionally reinforced with the use of metal mesh, pre-formed in accordance with the cavity of the reinforcement, and the subsequent final restoration of the tooth crown conduct, using restoration system for the chewing teeth groups.



 

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