Method for measuring mandibular inclination and device for cast model transfer into articulator space
SUBSTANCE: invention refers to medicine, namely to dental orthopaedics and can be used to locate the mandible within the skull and to transfer cast models in the articulator space considering this location. Measuring the mandibular inclination uses prominent X-ray contrast markers fixed on the lower teeth; standard software - a computed tomography viewer - is used to transfer a projection of a standard articulatory mandibular axis on a projection of the individual mandibular axis of the head of the mandible; a virtual system of coordinates is constructed to pass through the projection of the articulatory mandibular axis, and length of segments connecting the X-ray contrast markers and the centres of the system of coordinates and the angles of the above segments and the vertical axis of coordinates is calculated. The presented device for the cast models transfer to the articulator space is provided with telescopic indicators, length and angles of which are adjusted according to the data obtained by analysing the cone-beam computed tomography images; what is also integrated is a platform comprising the mandibular cast model provided with a base hinge to locate the model in the pre-set position and at a specific angle to the standard articulatory mandibular axis. The developed sequential algorithm for calculating the primary parameters of the mandibular inclination according to the cone-beam computed tomography images and transferring the cast models to the articulator space in the same way as the patient's dental arches are arranged within the skull in relation to the mandibular axis passing through the centres of the head of the mandible under an occlusion habit.
EFFECT: presented method and device enable measuring the mandibular inclination in relation to the standard articulatory mandibular axis projected on the individual mandibular axis within the skull, and transferring this position to the articulator.
The invention relates to medicine, namely to prosthetic dentistry and can be used to determine the position of the mandible in the space of the skull and transfer plaster of jaw models in the articulator space with regard to this position.
To date, the problem of manufacturing a dental prosthetic that meets both aesthetic and functional criteria, remains the most important. To solve this problem, modern dental practice offers the use of articulators, enabling the analysis of a plaster model of the jaw in a static position and dynamics.
Depending on the adjustment capabilities of joint parameters (angles sagittal articular path angles Bennett, angles sagittal cutting path) mechanical articulators are divided into unregulated, preregulatory and fully adjustable. The location of plaster of jaw models in the articulator space is in the process of sagipsul in accordance with the selected method of moving the position of one of the jaws. Second antivirusa plaster model pricipalities with interarch or premaxillary of registration.
The position of the lower jaw is determined by the position of the articular head in the glenoid I have ke temporomandibular joint (TMJ). The physiological location of the articular heads TMJ is the Central position, which is characterized by a top-front position of the articular heads TMJ with no lateral displacement. At the present time to assess the situation of the heads of the mandible used clinical tool, hardware and radiation methods. Among radiation methods most widely cone-beam computed tomography, allowing to visualize the shape and position of the bone elements of the TMJ in three-dimensional space.
There is a method of determining the optimal height of the bite, including tomographic study of the temporomandibular joints (TMJ) in the position of the teeth in the Central occlusion and determining the optimum height of the bite by the formula Δh=K·(D-Dk), where Δh is the optimal height of the bite, mm; K is the experimentally observed ratio, characterizing the dependence of the average width of the joint space from a height of occlusion at different nosological forms of dental anomalies and deformations of the maxillofacial area; D is the average width of the joint gap, mm (“method for determining the optimal height of bite”, patent of Russian Federation №2354300, CL A61B 8/13, publ. 10.05.2009).
The drawback of the proposed method lies in the fact that it is not taken into account the size of the lateral and IU the territorial articular spaces and accordingly, the transverse deviation of the mandible from the Central position.
In addition, the proposed solution does not take into account the possibility of transfer of plaster of jaw models in the articulator space, which complicates the process of manufacturing prosthetic dental structures in a given therapeutic situation.
There is a way to determine the location of the prosthetic upper plane in patients with impaired integrity of the dentition (prototype), including computed tomography (CT) study of the TMJ area in the frontal and sagittal projections (“Method for determining the location of the prosthetic upper plane in patients with impaired integrity of the dentition”, patent of Russian Federation №247058, CL A61B 6/14, publ. 27.12.2012). In this way hold the projection definition Kasperovskoy horizontally on the face of the patient by moving the point, the point corresponding to the middle point of the external auditory canal, and the point corresponding to the anterior nasal spine, obtained on CT scan in the sagittal projection on the face of the patient and positioning the prosthetic plane in the sagittal projection as a plane parallel to Kasperovskoy plane, presented in sagittal projection line passing through these points, then on the face PA is the rate determined by pupillary line in the frontal projection position of the maxillary wax basis, line it on pupillary line, obtained by computed tomography of the patient's head in frontal view.
The disadvantage of this method is the calculation of projections of estimated planes with cutaneous radiopaque labels. At the time of the study may bias the skin and, accordingly, the labels that will lead to erroneous calculations.
Another drawback of this method is the lack of interpretation axial tomograms, which can lead to inaccurate measurements of the posterior, lateral and medial articular spaces.
For transfer of jaw models in the articulator space known method for the diagnosis of dentition with regard to the axis of the head of the mandible and device for its implementation, including the articulator, face-bow and removable device for transferring the position of the model of the jaw in the face bow in Miramonte space articulator relative to its axis of opening, as well as a method for the diagnosis of dentition ("Method for diagnosis of dentition with regard to the axis of the head of the mandible and device for its realization", patent of Russian Federation №2461367, CL A61C 11/00, publ. 20.09.2012). In this way the diagnosis of dentition when placing a face-bow on the face of the patient determine the location of the axis of rotation of the mandible, mark is its projection on the skin in the form of a point. When transferring the model of the upper jaw in the articulator shift the axis of rotation of the lower frame relative to the upper frame by an amount equal to the distance between the axis of the lock of the front arc and point - cutaneous projection of the axis of the head, lower jaw, taking into account the angle of this axis relative to the horizontal plane passing through the axis stops. The articulator, in addition to articulated the United upper and lower frames, with the possibility of rotation of the lower frame, means for fixing the models of the upper and lower jaws, provided with a detachable offset of the axis of rotation of the lower frame about the axis of the horizontal pivot of the upper frame in the form of a lever variable length, perpendicular to the axis of rotation of the lower frame. The front arc for each articular emphasis supplied with the specified offset of the axis of the head of the lower jaw in the form of removable lever variable length perpendicular to the axis of emphasis, which is perpendicular to the point of application of the latter, and one end of which is articulated posted on the fence with the possibility of rotation around its axis and the other with placed perpendicular axis shared with cutaneous projection of the axis of rotation of the head of the mandible.
A disadvantage of the known solution is the use of specially designed face-bow and articulator, which prevents the popularization of this method in practical medicine. In addition,this method does not involve an objective rendering of the heads of the lower jaw and their position in space of the articular fossae and skull, that can lead to errors in the dental treatment of patients with severe asymmetry of the location of the articular heads.
There is a device for placing a prosthetic upper plane in patients with impaired integrity of the dentition (prototype device ("Device for placing a prosthetic upper plane in patients with impaired integrity of the dentition", patent of Russian Federation №2470588, CL A61B 7/00, publ. 27.12.2012). This is done by fastening elements on one of the tables of the articulator device, which comprises a rack which is connected intended for accommodation of the wax base of the upper jaw table through a fixed horizontal hinge, to allow tilting of the table relative to the stand in the vertical plane, at this hour connected with the base plate through a fixed horizontal hinge to allow rotation of the table in the horizontal plane around the axis of the rack and the plate is connected with the base with the possibility of apparent movement relative to the base in a horizontal direction.
The disadvantage of this design is the inability to configure the device by value (due to the lack of additional measuring elements g is agoyoanye scales.
The main task to be solved by the invention is the positioning of the plaster model of the lower jaw relative to the individual hinge axis of the patient during the transfer of jaw models in the articulator space and thereby increase the accuracy of manufacturing a dental prosthetic in therapeutic position.
Our proposed method for determining the angle of inclination of the lower jaw includes cone-beam tomographic studies of the maxillofacial region with the use of radiopaque markers, calculating the position of the lower dentition relative to the hinge axis of the heads of the lower jaw, used for the relief of radiopaque markers fixed on the teeth of the lower jaw, using the standard software viewer computer tomograms transferred projection standard articulatory hinge axis to the projection of the individual hinge axes of the heads of the lower jaw, build a virtual coordinate system passing through the projection articulatory hinge axis, and calculate the length of the segments connecting roentgenocontrast markers and the centers of the axes of coordinates and the angles between these lines and vertical axis.
We offer the device for transfer of plaster models in the spaces of the articulator is equipped with telescopic pointers the length and angles are set according to the data obtained in the analysis of cone-beam computed tomograms, and space to install a plaster model of the lower jaw, is provided in the base hinge to install the model in the articulator space in a predetermined position and at a certain angle in relation to the standard articulatory hinge axis.
This method allows us to accurately calculate the angle of the lower dentition in relation to the standard articulatory hinge axis projected on the individual hinge axis in the space of the skull and transfer this position in the articulator. We have developed a sequential algorithm for calculating the basic parameters of the angle of the lower model according to cone-beam computed tomography and migration of jaw models in the articulator space using the device for its implementation allows you to place models of the jaws, as are the teeth of the patient in the space of the skull relative to the hinge axis passing through the centers of the heads of the lower jaw in a state of habitual occlusion.
In the implementation of the proposed method the first step is fixing the three relief radiopaque markers of flowable composite restorative material of light-cured in the field of cutting to the traveler one of the front teeth and the chewing surfaces of the teeth of the lateral parts of the left and right lower jaw (Fig.1). The location of the marker depends on the type of clamping teeth and the location of defects of dentition. Then the state of the habitual occlusion is fixed with the help of interarch registration. As the material for the registration of occlusion can be used silicone, acrylic, bisacrylamide mass and rigid bases with occlusal wax rollers.
Next, perform a tomographic study using the sensor size not less than 15×15 cm, cone beam computed tomography, working with programs with interactive interface axis (OnDemand, Ez-Vision, Ezlmplant, Easy 3D 2009 and recorded in Dicom 3.
Then analyze the received computer tomograms using the viewer CRCT. The analysis algorithm consists of three steps:
the step of calculating the basic parameters of the model location of the lower jaw in the articulator space.
The preparatory phase includes the following steps:
Step 1. Using the shape of the head, shown in the lower right corner, set the volume reformed visually in the FAS.
Step 2. Deploy axial axis parallel to the horizontal plane. The center of the intersection of the two axes have the center of the pharyngeal openings. Thus, the interactive vertical and horizontal axes have the camping in the center of the scanned object. Two parts of an object, obtained by imposing any of the axes, must be symmetric and equal in size.
Step 3. On sagittal reformed the intersection of the coronal and axial axes is set to the middle of the front arc of the first cervical vertebra, and the coronal reformed establish the axial axis is the line connecting the two points of the bases of the articular tubercles on the right and left.
Step 4. Using the scroll wheel of a computer mouse down on axial slices of a reformed to provide a clear visualisation cutting holes in the upper jaw.
Step 5. The axial reformed expose the sagittal axis through the centers of cutting holes in the upper jaw and the anterior arc of the first cervical vertebra. The result is an axial reformed on which it is possible to construct an isosceles triangle whose vertices are located on the tool hole and the styloid processes, and the base parallel to and directed to the coronal axis.
Step 6. The axial reformed climb up the sections by using the scroll wheel of a computer mouse. The result is a coronal image of the reformed, where all fixed anatomical elements of the skull are symmetrical, horizontal (axial) axis passes through the articular fossa above the heads of the lower jaw and the vertical is Naya (sagittal) axis is located at the center of the image.
Step 7. On sagittal reformed moving slice-by-slice using a computer mouse to the right TMJ until uniform visualization of the cortical plates of the head of the mandible and the glenoid fossa.
Step 8. The axial reformed move using a computer mouse down. On sagittal reformed axial axis should be at the point of the geometric center of the head of the mandible to the right. On the coronal reformed move using a computer mouse forward or backward. On sagittal reformed coronal axis should be placed also on the point of the geometric center of the head of the mandible to the right. On the coronal reformed set a marker at the intersection of the sagittal and axial axes, using the tool CRCT "Arrow" ("Arrow").
Step 9. On sagittal reformed move using a computer mouse towards the left head of the mandible. Repeat the steps described in steps 7 and 8. Set the horizontal (axial) axis on the token.
The purpose of the preparatory phase is the creation of a virtual three-dimensional coordinate system, the horizontal (axial) plane which is located on the line connecting the centers of the heads of the mandible (individual hinge axis), vertical (frontal) plane passes across the middle of the articular heads on sagittal and trailing edges of the branches of the lower jaw, and the third plane is perpendicular to the two above-mentioned planes and passes through the center of the skull.
The main stage includes the following steps:
Step 1. Choose the tool "3D Length" ("Ruler"). On the coronal reformed carry out the measurement of the distance between the centers of the right and left heads of the mandible (marked with markers at the preparatory stage). Get the numeric value of the cut individual hinge axis.
Step 2. The calculation of the additional length of the individual segments of the hinge axis, distinguishing it from articulatory hinge axis.
Land(mm) - length of individual hinge axis, measured using the tool CRCT and passing through the center of the heads of the mandible.
Land(mm) - length articulatory hinge axis passing through the centers of the analogues of the heads of the lower jaw in the articulator (La= const = 110 mm).
LOTR(mm) is the length of the optional cut individual hinge axes that distinguish it from articulatory hinge axis.
LOTR(mm) - length of a second segment of the individual hinge axes that distinguish it from articulatory hinge axis.
Using the tool "2D Length" ("Ruler"), the coronal repo the material measure two segments, equal to the calculated values.
Take into account that if LOTR=LOTR<0, then the values obtained segments add two sides to segment individual hinge axis; and if LOTR=LOTR>0, then the values of the segments away from the cut individual hinge axis.
For example: LOTR=LOTR=(103,8-110):2=-3,1 mm
In this case, LOTR=LOTR<0, thus, on the tomogram add from 3.1 mm to individual hinge axis, measured in step 8.
Step 3. Add the received segments to segment individual hinge axis. Celebrate their outer ends by using a tool CRCT "Arrow" ("Arrow").
Step 4. Choose the tool "3D Length" ("Ruler"). On the coronal reformed carry out the measurement of the distance between the markers marked in step 3. Get the image cut individual hinge axis, adapted articulatory hinge axis.
The main stage of this method allows us to use standard articulatory hinge axis to the projection of the individual hinge axes of the heads of the mandible.
The last phase of cone beam computer tomography is the measurement of the main parameters of the angle of the model of the mandible:
Step 1. Starting from the left lower jaw head, moving the tsya slice sagittal plane to the Central part of the skull to render relief radiopaque marker points, located in the left masseter Department of the mandible.
Step 2. The axial reformed down to slice, which is visualized relief roentgenocontrast marker. Control of this movement on the sagittal reformed.
Step 3. By using the tool "3D Length" ("Ruler") on sagittal reformed measure the distance from the center of the coordinate system to the relief radiopaque marker located in the left masseter Department of the mandible. To control the obtained results are the measurement of the axial slice tool "2D Length" ("Ruler").
Step 4. By using the tool "3D Length" ("Ruler") on the coronal reformed measure the distance between the point of intersection of the axes of coordinates and the point of intersection of the articulatory articulated and sagittal (vertical) axes. Using "2D Length" ("Ruler") lay in the same spot on the sagittal reformed along the coronal axis. The beginning of this segment is located at the intersection of the coordinate axes. Measure the distance from the beginning articulatory hinge axis to the right up to the point of intersection of the articulatory articulated and sagittal (vertical) axis.
Step 5. The axial reformed using a computer mouse, up until that moment, until the coronal reformed axial the camping will be installed on articulatory hinge axis.
Step 6. On sagittal reformed check the coincidence of the points of intersection of the axes of coordinates and end point of the delayed cut along the coronal axis for step 5. After that, using the tool " 3D Length" ("Ruler"), measure the distance from the point of intersection of the axes of coordinates to the relief radiopaque marker in the left masseter Department.
Step 7. By using the tool "3D Angle" ("3D Angle measure angle of slope of the resulting line to the vertical axis of the coordinate system.
Step 8. Move slice sagittal plane to the Central part of the skull to render relief radiopaque marker located in the anterior dentition of the lower jaw.
Step 9. Using the algorithm of steps in steps 3-8 to measure the distance from the center of the coordinate system to the relief rentgencontrastnoe marker, located in the anterior dentition of the lower jaw. By using the tool "3D Angle" ("3D Angle measure angle of slope of the resulting line to the vertical axis of the coordinate system.
Step 10. Move slice sagittal plane to the right part of the skull to render relief rentgencontrastnoe marker located in the chewing part of the lower jaw.
Step 11. Using the algorithm of steps in steps 3-8 to measure the distance from C is NTRA coordinate system to the relief radiopaque marker located in the chewing part of the lower jaw. By using the tool "3D Angle" ("3D Angle measure angle of slope of the resulting line to the vertical axis of the coordinate system.
The final step of the proposed method is to transfer the plaster model of the lower jaw in the articulator space using a device to transfer the plaster models in the articulator space according to cone-beam computed tomography.
Our device is a transfer system with adjustable structural elements according to the data obtained in the analysis of cone-beam computed tomograms.
This device (Fig.2) comprises a base (1) dimensions 140×140 mm in the center of which is fixed the articulatory splint-plate with magnetic base (2). On the rear side of splint-plate are two vertical posts (3), ending with the holders of the transverse beam (4). The transverse beam has a graduated scale from 0 to 110 mm, which corresponds to a standard size articulatory hinge axis. The topography of the location of splint plates and racks relative to each other corresponds exactly to the standard location of elements of the lower frame of the articulator.
On splint-plate fixed mate with metal base (5), to which the Oh is a Playground (6) to apply a plaster model of the lower jaw, provided at the base of the hinge (7) and the possibility of movement 50 mm forward or backward. Also there are screws to lock shifts back and forth and swivel movements. Hinge, located at the base of the platform, allows to model slope model of the lower jaw in three mutually perpendicular planes relative to the transverse beams, simulating articulatory hinge axis. Offset models back and forth makes it possible to locate plaster model of the lower jaw at a certain distance from the transverse beams.
Plaster model of the lower jaw mounted on the platform base of the cap and is fixed with the help of two special screws, firmly resting in the base front and rear. The transverse beam has three telescopic pointer (8) with simulation length from 35 mm to 135 mm and set the angle on the hinge (9), by which they are fixed on the beam. Telescopic pointers are moved along a graduated cross-beams and have the opportunity rigid fixation with screws at the specified position.
The transfer of jaw models in the articulator space with devices offered by us includes the following steps :
First get the impressions of the upper and lower jaws. In this reprint from the lower jaw get together with sufix Rovaniemi relief radiopaque markers.
Then make plaster models of the upper and lower jaws on the obtained prints.
Then adjust the length of the telescopic pointers to values obtained when measuring the lengths of segments from the radiopaque markers of a coordinate system.
The setting angles on the joints of telescopic pointers is performed according to the values obtained when measuring the angles between these lines and the vertical coordinate axis.
Set the model of the lower jaw at the site for installation of the plaster model and fix it with screws.
Position the position of the plaster model of the lower jaw with custom telescopic pointers: model cant with the hinge located at the base of the platform and move the platform forward or backward so that the ends of the three telescopic pointers located on three relevant relief tokens plaster model.
Carry a pad with fixed plaster model of the lower jaw in a predetermined position on splint-plate of the lower frame of the articulator and establish a plaster model of the upper jaw to the lower jaw model with the help of interarch registration habitual occlusion.
Prigotovlivajut plaster model of the upper jaw to the upper frame of the articulator, remove the space with fixed plaster the new model of the lower jaw of the articulator space and remove plaster model of the lower jaw.
Then put a plaster model of the lower jaw to the upper jaw model with the help of interarch registration habitual occlusion and prigotovlivajut plaster model of the lower jaw to the lower frame of the articulator.
The proposed method and device make it possible to determine the true individual spatial position of the jaw to the skull and to transfer the plaster models in the articulator space with regard to this position.
In Fig.1 shows the lower jaw (1) with the fixed relief radiopaque markers (2)made of composite material is light-cured.
In Fig.2 shows a device for moving a model of the lower jaw in the articulator space. The device consists of a base (1), in the center of which is fixed the articulatory splint-plate with magnetic base (2). On the rear side of splint-plate are two vertical posts (3), ending with the holders of the transverse beam (4). On splint-plate fixed mate with metal base (5), which is the space (6) for setting the plaster model of the lower jaw, is provided in the base of the hinge (7) and the possibility of movement 50 mm forward or backward. Also there are screws to lock shifts back and forth and swivel movements. The transverse beam has the ri telescopic pointer (8) with simulation length from 35 mm to 135 mm and set the angle on the hinge (9), by which they are fixed on the beam. Offset models back and forth makes it possible to locate plaster model of the lower jaw at a certain distance from the transverse beams.
Example. In the orthopedic Department of the dental clinic has treated the patient K., 47 years of age with partial absence of teeth in the lateral part of the upper jaw and complaining of difficulty in chewing food, the displacement of the mandible and the sense of tension in the region of the masseter muscle.
In the clinical and instrumental study was diagnosed with partial absence of teeth on the upper jaw III class Kennedy, complicated generalized form of increased abrasion of the teeth, decreasing the height of the lower section of the face and secondary deformities of the teeth (the phenomenon Popov-Gogona in the area of the teeth 24, 25, 37, 34). Muscle and joint dysfunction.
Was defined plan dental prosthetic treatment:
1. Myorelaxation sinotype using soft occlusal tires on a minimum interarch dividing (up to 2 mm).
2. Roll sinotype hard-occlusive bus to centralize the lower jaw and restore the height of the lower part of the face.
To calculate the position of the mandible at the stage myorelaxation, stabilizing sincerei patient who was appointed cone beam tomographic study (sensor size - 15×15 cm).
Before the examination the patient in the clinic were recorded relief radiopaque markers on the teeth 37, 31, 46 of flowable composite restorative material Filtek Supreme (3M) light-cured. Received a one-layer prints from a silicone material Hydrorise (Zhermack). Made of hard silicone registrati habitual occlusion of the material Occlufast Rock (Zhermack). After conducting research with the teeth of the lower jaw were removed relief radiopaque markers.
After restoring the computer reformers of the maxillofacial area analysis of tomograms according to the algorithm of proposed method. The values recorded in the Table of basic parameters of angle model of the lower jaw.
|The main parameters||Relief radiopaque markers|
|Right chewing Department||The front part of the lower jaw||Left chewing Department|
|The distance to the center coordinate (mm)||34||71||27|
|the vertical axis||45||56||43|
In the dental laboratory cast plaster models of the upper and lower jaws of super plasters class IV (GC). Model data transferred and gypsum in the space of the articulator using the devices offered by us are pre-configured according to the Table values of the main parameters of angle model of the lower jaw in accordance with the scheme of action described above in our proposed method. In the articulator simulated disocclusion 1.5 mm from the state of habitual relation of the jaws.
This provision is made of soft myorelaxation bus from silicone, which was about and prepisovan the patient in the oral cavity. Terms and mode of carrying not less than 20 hours per day for 2 weeks.
Then in the articulator was selected therapeutic position of the lower jaw, taking into account the interlocking heads of the mandible on the I in the manufacture of rigid centralizing bus from acrylic plastic by the method of injection molding, after that the patient was about and prepisovan hard centralizing the bus in the mouth. Terms and mode of wearing a night for 3 weeks.
In the articulator was conducted wax modeling dentitions in the position that you selected in step stabilizing sincerei. Made of silicone keys for temporary crowns direct method.
The patient is recommended permanent dental orthopedic treatment in the position that you selected in step stabilizing sincerey, after the disappearance of all complaints and objective clinical signs of TMJ.
1. The method for determining the angle of the mandible, including cone beam tomographic studies of the maxillofacial region with the use of radiopaque markers, calculating the position of the lower dentition relative to the hinge axis of the heads of the lower jaw, characterized in that use relief radiopaque markers fixed on the teeth of the lower jaw, using the standard software viewer computer tomograms transferred projection standard articulatory hinge axis to the projection of the individual hinge axes of the heads of the lower jaw, build a virtual coordinate system passing through the projection articulatory hinge axis and expect the live length of segments connecting radiopaque markers and the centers of the axes of coordinates and the angles between these lines and the vertical coordinate axis.
2. Device to transfer the plaster models in the articulator space using data obtained from cone beam CT by the method under item 1, characterized in that it consists of the base, in the center of which is fixed the articulatory splint-plate with magnetic base, with the back side of splint-plate are two vertical posts, ending with holders for cross beam cross beam has a graduated scale from 0 to 110 mm and three telescopic pointer with hinges, by which they are fixed to the beam, the topography of the location of splint plates and racks relative to each other corresponds exactly to the standard the location of the elements of the lower frame of the articulator; splint-plate fixed mate with metal base, which is the site for installation of the plaster cast of the lower jaw, is provided in the base hinge and the possibility of movement 50 mm forward or backward and screws for locking shifts back and forth.
SUBSTANCE: invention refers to medicine, namely to dentistry, and is applicable in recovering the solid tissue volume and filling the denture defects before the final prosthetic repair. A cast dental model is made. Denture defects are filled with artificial acryl teeth with selecting their colour. The dental defect is to be filled. A cellulose plastic tray is made on the cast dental model with artificial teeth fixed. The tray is cut out of the produced plate. The tray is cut off along the dentogingival line of the repaired teeth. After abutment teeth are prepared, the tray with the artificial teeth is fitted to the patient's denture with pink elastic plastic applied on an inner surface of the artificial acryl teeth, and the inner surface of the tray is filled with autopolymer resin within the prepared teeth. The tray is filled with autopolymer resin of the temporary denture at least twice. The first layer of cold polymerisation plastic 1.0-1.5 mm thick is used to fill the solid tissue loss, while the second layer 0.5-1.0 mm thick restores the pink aesthetics and fixes the artificial acryl teeth.
EFFECT: method enables filling the denture defects, preventing the recurrences following the orthopaedic or orthodontic dental displacement by making and fixing the reliable and aesthetic structure with the acryl teeth and autopolymer resins on the patient's denture.
4 cl, 14 dwg, 2 ex
FIELD: medicine, pharmaceutics.
SUBSTANCE: invention relates to chemical-pharmaceutical industry and represents substitute of bone transplant, containing osteogenic agent and zeolite, which contains particles, containing ion-exchange cations of metals, present in quantity, effective for stimulation of osteogenesis in patient who needs it, in which said metal cations are selected from the group, consisting of zinc ions, silver ions, copper ions and their combinations.
EFFECT: invention provides optimal delivery of cations into injured region with resulting formation of healthy bone tissue.
SUBSTANCE: invention refers to medicine, namely to preventive and orthopaedic dentistry, and can be used in assessing the hygienic state of the oral cavity in the patient with removable dentures suffering partial adentia. An inner surface of the denture is coloured. A graphic mesh is applied. It is photographed, and a denture hygienic state index is determined. The graphic mesh is applied with using templates enabling dividing the inner surface of the denture into two segments. The inner surface of the denture is photographed with using a camera with a focusing centre lying along a median palatine suture at a mid-distance between a maxillary frenulum and a distal edge of the for maxillary dentures and along the line drawn between central incisors in the middle between a mandibular frenulum and a posterior edge of the denture, for the mandibular dentures. The dental deposit is assessed in each segment as 0 to 4 by the 4-point system, while the hygiene index is calculated by formula.
EFFECT: by using set of templates, method enables assessing the hygienic state of any removable dentures with partial adentia.
1 tbl, 3 dwg, 1 ex
SUBSTANCE: teeth to be restored are imprinted in silicone for diagnostic purposes without teeth preparation. A gypsum model is casted whereon a desired configuration of the teeth to be restored is modelled in wax. The wax model is contoured in silicone. The dental surface is thoroughly cleaned, and an inner surface of the silicone pattern in coated with an isolate compound. The silicone pattern is filled with acrylic resin polymer and placed onto the teeth to be restored. After the resin hardens, the plastic restoration is left on the patient's teeth. A flowable light cured pattern of a suitable colour is used for the aesthetic correction of an appearance of the plastic restoration in the patient's oral cavity. The plastic restored model is contoured in silicone which is used to make definitive restorations according to a common technique.
EFFECT: by making fit restorations with using the direct techniques, the method enables assessing the restoration result before the teeth preparation, making and placing the definitive restoration, and improving the aesthetic results of the restoration.
4 cl, 6 dwg
SUBSTANCE: invention refers to medicine, particularly to dentistry, and can be used for orthopaedic rehabilitation of the patients suffering postoperative upper jaw defects. A jaw obturator prosthesis comprises a rigid polyurethane basis with prosthetic teeth configured to fit a mucous membrane of the preserved hard palate tightly, and a hollow obturator configured in the form of a soft polyurethane frame within a junction of a scar ring and bearing a thin polished rigid polyurethane lid. The frame and lid are coupled by a mechanical retention of mushroom holes formed on an end surface of the soft polyurethane frame, and congruent mushroom flanges formed on an end surface of the lid.
EFFECT: invention enables recovering the phonetics and provides the reliable fixation of the jaw prosthesis by reshaping the obturator and using the structural materials of various rigidities when making it.
SUBSTANCE: invention refers to medicine, namely to dental orthopaedics, and aims at analysing the strength properties of temporary fixed dentures. A device for making identical experimental constructions of temporary fixed dentures consists of two mated rectangular box-shaped units and a stamp. The box-shaped units are made of a low-melting metal; an inner surface of each unit has a profile of a negative image of the construction of the temporary fixed denture longitudinally, and triangular saw cuts extending from occlusion surfaces of the negative image of each crown denture passing to the end surface of the box-shaped units. The inner surfaces of the box-shaped units have retention guides in the form of triangular spines on one unit and in the form of triangular recesses on the other one. Each of the end surfaces of the units projecting on the surface of abutment teeth has a profile of a positive image of prepared stumps. The stamp is made of a low-melting metal and has a profile of the positive image of the prepared stumps and prosthetic bed.
EFFECT: invention enables making the identical temporary dentures of various lengths made of various structural materials.
SUBSTANCE: space closure is staged: preparing two fibreglass pipes of a diameter of 1 mm having a length of a defect size. A ligature wire of a diameter of 0.250 mm is inserted into the fibreglass pipes. The fibreglass pipes are crossed over in the defect centre, and the ligature wire is hooked to form a figure of eight. Free ends of the ligature wire are fixed to dental brackets of abutment teeth. The fibreglass pipes are impregnated with a 5-Grade adhesive and polymerised with LED light. An individual artificial tooth is made of a photocomposite on the fibreglass pipes.
EFFECT: method enables providing higher quality of life in patients with bounded edentulous spaces, with partial primary and secondary adentia in the period of orthodontic treatment.
3 dwg, 2 ex
SUBSTANCE: invention refers to dentistry and is applicable for orthopaedic rehabilitation of patients with completely absent dentition. A removable denture consists of a basis made of a rigid polymer dental product with fixed false teeth, and an elastic part adjoining a prosthetic bed. Trough-shaped grooves 1 mm deep divergent radially from the centre and extending onto a vestibular surface of the denture within a transient fold into a right-angled chamfer along the perimeter of the denture are formed on the basis from an internal side facing the prosthetic bed.
EFFECT: invention provides the higher adhesion strength of the soft pad and the rigid carrier of the basis, its uniform distribution along the surface of the prosthetic bed, as well as a possibility of re-use of the denture if the physical-mechanical characteristics of the elastic part occurred to be disturbed.
SUBSTANCE: invention refers to veterinary science, namely to prosthodontic treatment, and is applicable in making removable nylon prosthesis for the upper front teeth, including high-crown ones, such as pointed teeth. Both jaws are impressed. Master moulds are cast of die stone. Working and additional models are placed into an occludator. A future prosthesis is delineated on the working model. A wax basis is made of a wax plate. A tooth is moulded in wax, mounted in a tray and placed in boiling water. The wax is extracted and replaced by acryl. After removing, the acryl tooth is processed and polished. A socket is drilled in a base of the acryl tooth. At least two through canals are drilled from the socket above a gingival level on a palatolateral and palatomedial tooth surface. A shallow notch is made a little above the socket bottom on the outside along the whole circular length with using a ball-shaped bur. The artificial tooth with retention canals and peripheral notch is aligned with a bite and mounted on the wax basis. After the tooth is arranged, an incisal-tooth-gingival rest is moulded. The model is prepared for casting in the tray, and the teeth that can be used as retention points are ground off. The model is cast in a lower portion of the tray. Before the upper portion of the tray is cast, a gate system is mould of wax. Both portions of the tray are coupled together and bolted up. Dental stone setting up is followed by unscrewing and placing in boiling water for 10 minutes. The tray is opened, residual wax is washed out with hot water, and mould and counter-mould surfaces are processed with a divisional polish. After the division polish dries, the tray portions are connected and screwed. The prepared tray is inserted into a heated injection machine, wherein nylon under pressure fills all the retention canals of the tooth extending in the cone bells, encloses and crimps the notch along the periphery. Further, the tray is removed from the injection machine. The tray is left at a room temperature for 20 minutes and then placed in cold water until cooled completely. After the tray is opened, the prosthesis is removed, cleaned from dental stone, processed and polished. The prosthesis is applied into an animal.
EFFECT: method enables making the removable nylon prosthesis of the upper front teeth in dogs, including high-crown teeth, such as pointed teeth by creating special retention canals and peripheral notches in the acryl tooth.
4 cl, 9 dwg
SUBSTANCE: rigid splint recording of the lower jaw position in relation to the upper jaw is prepared on a denture of one of the jaws. A surface of the recording splint is adjusted in relation to the denture surface of the other jaw. The patient is adapted to the optimum position of the jaws for at least two months to achieve a symmetrical position of heads of the maxillotemporal joints. The jaw casts are mounted in a regulated articulator with the use of an occlusion splint recording the jaw position to be thereafter removed, and a space for mounting prosthetic structures is formed. The optimum position of the heads of the maxillotemporal joints is determined by multispiral computed tomography findings, at least twice. For the first time - prior to the prosthodontic treatment, for the second time and further - upon completion of optimising the lower jaw position in relation to the upper jaw, and further - after the temporary fixation of the prosthetic structures in the patient's oral cavity.
EFFECT: method enables creating the optimum positions of the heads of the lower jaws in the maxillotemporal joints by using an occlusion splint as the maximum occlusion recorder.
4 cl, 1 ex, 10 dwg
SUBSTANCE: two standard perforated impression trays are used for the upper and lower jaws. A flat steel plate 2 mm thick, 45 mm wide and 34 mm deep is soldered on the tray of the upper jaw from the opposite side of the dental bed at 5 mm from an outer edge. A dished plate 54 mm wide, 27 mm deep and 10 mm high is soldered on the tray of the lower jaw from the opposite side of the dental bed at 3 mm from an outer edge. The upper and lower trays are used to contour a pattern of the upper and lower dental arches alternatively. The prepared patterns are washed in flowing water. The lower impression tray with the prepared contour is inserted into the oral cavity again and applied to the lower dental arch. The upper tray is inserted into the oral cavity and applied to the upper dental arch. The patient is suggested to close the mouth after the trays are fixed in the oral cavity. The patient tenses the masticatory muscles as much as possible and displaces the lower jaw to the side opposite to the dislocation of the intra-articular disc of the temporomandibular joint. The side motion repetition is 5-7; the exposure is 3-5 minutes; the number of procedures is 2-8 every second day.
EFFECT: method enables preventing the postoperative face scars and dislocation of the temporomandibular joint associated with forced mouth opening.
3 dwg, 1 ex
SUBSTANCE: group of inventions refers to medicine, particularly to orthopaedic dentistry, and aims at simulating therapeutic dental prosthesis taking into account habitual movements of a human lower jaw. The method for simulating an individual dental prosthesis involves placing cast models from upper and lower jaws on magnetic carriers in habitual occlusion into an inter-frame space of the device presented in the form of an articulator, adjusting the articulator considering the individual data via electronic axiography. A movable platform of the articulator is used for spatial motion along the six free coordinates of the cast model of the lower jaw. A device for implementing the method is presented in the form of an articulator consisting of a body for mounting the device on the surface and placing the magnetic seats of the casts of the upper and lower jaws in the inter-frame space; there are also provided movable platform, control and graphic user interface unit, as well as a control interface unit and a servo control. The movable platform is used for spatial motion along the six free coordinates and attached to a body element whereto the lower jaw is fastened using a magnetic seat. The PC-based control and graphic user interface unit is used for automatic and distant manual control of the movable platform. The control interface unit is used to translate electronic axiography logs and to match the PC and electronic control interface parameters. The servo control is used to actuate the movable platform.
EFFECT: more individual simulation of the dental prostheses thereby reducing manufacturing errors of the dental prostheses.
2 cl, 6 dwg
SUBSTANCE: invention relates to field of medicine, namely to orthopedic dentistry and is intended for finding plane, parallel to occlusion plane. Anatomical landmarks, corresponding to incisive papilla of upper jaw and apex of styloid process, whose position is determined on the line from point Articulare to point Basion at the distance 0.7-0.9 cm from point Articulare, are determined. Plane, which is parallel to occlusion plane, is drawn through the determined points.
EFFECT: method makes it possible to determine occlusion plane accurately due to finding anatomical plane, which is a parallel landmark for occlusion plane.
SUBSTANCE: group of inventions relates to field of orthodontic dentistry and is intended for treatment of abnormalities of dental occlusion. Method of manufacturing device for teeth positioning, which ensures change of position of, at least, one patient's tooth, includes the following stages: ensuring availability of cast of patient's dental arch, separation from said cast of dental arch of at least one tooth, fixation of post in butt of said at least one separated tooth, as well as non-separated teeth, if there are such, correction of patient's dental arch cast by correction of position of separated teeth in such a way that their position corresponded position of teeth in patient's mouth, and ensuring holding of the post in material softening by heating, heating of section of said material in order to soften it thermally, application of force to the post, which is fixed in said, at least, one tooth in order to displace it in required direction in order to obtain correctible dental arch, cooling of material and formation of device for teeth positioning, corresponding to obtained correctible dental arch. Group of inventions also includes method of analysis of diagnosing placement of teeth on models in order to perform orthodontic correction.
EFFECT: extension of arsenal of technical means of said purpose.
3 cl, 27 dwg
SUBSTANCE: group of invention refers to medicine, dental diagnostic, orthodontic therapy and comprises an articulator, a face bow and a detachable instrument for jaw cast position transfer in the face bow into a space of the articulator relatively to an opening axis, as well as to a diagnostic technique for dentition. Together with pivotally connected upper and lower bows (UB and LB) with the rotatable LB, cast fixators of upper and lower jaws (UJ and LJ), the articulator is equipped with a detachable corrector of the LB rotation axis relatively to a horizontal pivot of the UB in the form of a variable-length lever perpendicular to the LB rotation axis. The face bow for each joint support is provided with said corrector of the LJ head rotation axis in the form of a detachable variable-length lever perpendicular to the support axis perpendicular to an application point of the latter, and one end of which is pivotally arranged on the support and rotatable about its axis, and the other one - with the perpendicular axis adjusted with a skin projection of the LJ head rotation axis. One end of the lever rotatable about the LB rotation axis of the articulator is detachable and fixed thereafter, and the axis is adjusted on the other end of the lever with the axis of the horizontal pivot of the UB. The diagnostic technique for dentition involves placing the face bow on the patient's face to determine a point of the LJ rotation axis; its projection is marked on skin as a point. When the UJ cast is transferred onto the articulator, its LB rotation axis is moved with respect to the UB by the value equal to the distance of the support axis of the face bow and the point of the skin projection of the LJ head taking into consideration an angel of said axis relatively to a horizontal extending through the support axis.
EFFECT: group of inventions provides higher accuracy of patient's UJ position transfer into the articulator.
5 cl, 6 dwg
SUBSTANCE: invention refers to medicine, specifically dentistry and concerns treating temporomandibular joint arthrosis. For this purpose, mesenchymal cord and placental stem cells received after easy delivery. The cells 5-10·106 are injected in the temporomandibular joint in 1-2 ml of patient's blood plasma and intra-articular fluid. taken from a patient's healthy major joint.
EFFECT: while being low-traumatic, the method provides replacement of articular cartilage defects, creating the environments for optimising the repair processes in treating the most severe and frequent temporomandibular joint injures.
FIELD: machine building.
SUBSTANCE: invention refers to robot engineering, particularly to manipulators of industrial robots implemented in medicine as automatic articulators - imitators of lower jaw movement. The robot-articulator consists of a base of a lower and upper jaws and of progressive drives. It is also equipped with guides for progressive pairs (3) connected to the progressive drives designed for facilitation of their rotation around hinges. The hinges are installed between the base of a lower jaw (1) and guiding of the progressive pairs (3). Guides are joined with bases of lower jaw (1) and upper jaw (2). Notably, base of upper jaw (2) is connected to guiding of progressive pairs (3) by means of hinge (4) and is connected with the progressive drives designed for actuating the upper jaw. The progressive drives are secured to pole (11).
EFFECT: facilitating expanded functionality, particularly adjustment according to individual anatomical features of patient, like angle of trajectory incline of motion of temporal low jaw joints, also more accurate reproduction of trajectory of motion due to introduction of additional degrees of freedom.
SUBSTANCE: invention concerns medicine, namely to orthopedic stomatology, and can be used at designing of dentitions in full demountable prostheses. The way of construction of a planes includes projection drawing of the prosthetic plane on the wax platen of the top jaw established in a mouth, in parallel to camper's horizontal, thus the beam of the motionless laser module of construction of lines fixed on the holder is directed at the basis of a wing of a nose or pulled along the nose-ear line, forming a line of camper's horizontal. The beam of the laser module of construction of the lines established on the holder movably, is referred on preliminary certain height of the wax platen of the top jaw, and on it the projection of the prosthetic plane becomes perceptible.
EFFECT: use of the offered invention, at the expense of parallelism of laser beams, allows constructing a prosthetic plane without additional checks and updatings.
SUBSTANCE: invention concerns medicine, namely to orthopedic stomatology, and can be used at designing of dentitions in full demountable prostheses. The parallelometre for construction of the prosthetic plane contains a flange for fastening to the holder, executed on the external glass supplied with opposite apertures for placing of the motionless laser module and opposite vertical cuts in which the internal mobile cylinder with the laser module is coaxially established. The laser module forms a projection line of camper's horizontal and is attached with possibility of axial moving in vertical cuts and formations of a parallel line of a projection of the prosthetic plane. The internal mobile cylinder is supplied by the adjusting screw.
EFFECT: invention use allows quickly, is comfortable and with the raised accuracy to define a prosthetic (occlusal) plane against camper's horizontals, at prosthetics of patients using demountable plate prostheses.
2 cl, 4 dwg
FIELD: medical engineering.
SUBSTANCE: device has removable palatine plate. The plate basis is deocclusion overlays reaching palatine tubercles tops.
EFFECT: enhanced effectiveness of treatment; accelerated adaptation to the treatment device.
4 dwg, 1 tbl
FIELD: medical engineering.
SUBSTANCE: device has polymer articulation heads of elliptic shape of individual articulator hinged connection. Interframe platform is T-shaped and has 3.5 mm inner diameter tubes. Fixing pins of the same diameter are fixed on zygomatic arch. Incisor platform is 35 mm as long. It is manufactured as circle sector of 100 mm large radius. It has internal groove of 22 mm large radius. The platform is fixed allowing rotation from negative angle to 90° on the pin mounted in bushing by means of a screw and arranged in the flexural center of lower frame. A rod resting on incisor platform and fixable in bushing by means of a screw is available in the flexural center of upper frame. The in the lower frame has plate provided with elliptic hole for fastening removable table or removable lens having sector of a diameter of 94 mm. The plate is arranged with mandible model incisor part place being coincident with Bonville triangle apex Two transverse rods for fixing mandible model are available on the upper frame. Members for tuning articulator operation are manufactured as two hemispheres joined by means of screws. Two tuning screws arranged at an angle of 15° to frame planes and a supporting screw resting on bearing platform are available on the upper hemispheres.
EFFECT: enhanced effectiveness in making prosthetic appliances in the cases of partial or complete adentia.