Method for making releasing postoperative maxillofacial prosthesis
SUBSTANCE: invention refers to medicine, particularly to dentistry, and is applicable in making a releasing postoperative maxillofacial prosthesis for all types of maxillectomy. Surgical manipulations are preceded by imprinting both patient's jaws. A dental occlusion is recorded. Models are made after the imprints. The models are fixed in an articulator, and denture teeth are mounted in place of proper missing teeth. The working model is scanned and digitised by means of a computer unit of CAD/CAM system. Planned surgical area boundaries are defined on a basic model, and the above boundaries are virtually engraved vertically and horizontally at a width and a depth of 2.5 mm. The engraved model is scanned by means of the computer unit of CAD/CAM system. The computer unit is also used to model the releasing postoperative maxillofacial prosthesis with retention elements and artificial teeth by matching the prosthetic bed of the engraved model and dental arches of the basic model prepared pre-operatively. The modelled construction of the releasing postoperative maxillofacial prosthesis with artificial plastic-plate teeth is milled. The made prosthesis is processed. The prosthesis is fixed in the patient's oral cavity.
EFFECT: by providing a one-piece plastic configuration of the releasing postoperative maxillofacial prosthesis with the retention elements by computed milling, the method enables recovering the masticatory function, ensuring the prosthetic bed formation within the surgical area and the optimum fixation in the unfavourable clinical environment of the prosthetic bed.
The invention relates to medicine, in particular to the dentist, and can be used for the manufacture of divisive postoperative prosthesis for the upper jaw in all its resection.
Also known construction resection of the denture in the upper jaw, consisting of two detachable parts basis and obturator (see B. K., Koster, C. A. Minyaeva. "Maxillofacial prosthetics". Medicine, 1985, S. 33-34).
There is a method of forming dental and maxillofacial prostheses made of plastic by conventional molding, which consists in obtaining imprint (stamp), the fabrication of the plaster model, modeling wax pattern of the obturator, sagipsul model with a wax pattern in the cell in a vertical position, packing and polymerization of plastics in a vertical direction (see C. N. Kopeikin, J. C. Kubovic, C. Y. Kurland, I. M. Oksman. Prosthodontic appliances, chief 8, 9, Art. "Technology of plastics". M.: Medicine, 1978, S. 105-109; 272-275).
However, these structures dentures are made otsrochennoe - usually 14-20 days after surgery, when the epithelialization of the wound surface finishes, preceded by forming jaw prosthesis of the second stage, and accordingly these prostheses may not be used to formalize the edges of the surgical field, that in due time advance is the duty to regulate further fixation of the prosthesis.
Known immediate prosthesis after resection by the method of I. M. oksman of three reception. First, prepare the hook part of the denture with clasps on the abutment teeth. For this, remove the stamp from the upper jaw cast model, simulate the locking plate of wax and replace it with plastic, then get the auxiliary seal with the lower jaw. Cast models and gypsum them occludator.
This is followed by manufacturing resection of part of the prosthesis. Models of the upper jaw mark the border of the resection in accordance with the plan of operation. Then on the side of the tumor is cut at the level of the cervical one tooth, so that in subsequent prosthesis does not interfere epithelialization of the bone wound. The remaining teeth are cut together with the alveolar ridge to the apical base. The surface of the fixing plates make rough, defect fill with wax and set of artificial teeth in occlusion of the lower jaw. Artificial gum molars and premolars model roller coming in the front-rear direction. In the postoperative period platen forms a bed in the mucosa of the cheeks, which will serve as the point of anatomical retention. A wax reproduction of the prosthesis to replace the plastic. After surgery, the prosthesis is superimposed on postoperative wound (see A. S. Shcherbakov, E. I. Gavrilov, V. N. Tregubov, the.N. Zhulev. Prosthetic dentistry. S.-Pb.: The IPC "Folio", 1998, S. 526-527). This design is chosen for the prototype.
The disadvantages of this design is that the boundaries of the prosthesis corresponding to the boundaries of the surgical field, which does not allow to put additional pressure on this area, and that the inner surface of the prosthesis is made rough, which in turn contributes to increased adhesion aggressive microflora of the oral cavity to her and, as a consequence, the formation of a persistent factor in maintaining inflammation and prolonged wound healing.
A known method of manufacturing a divisive postoperative maxillary denture for the upper jaw by obtaining the plaster model to the mission plan and outline the proposed boundaries of the surgical field and remove the corresponding teeth, engrave data boundaries in the vertical and horizontal directions of the width and depth of 1.5-2.0 mm, and then simulate the wax composition divisive postoperative maxillary denture with artificial teeth, clasps and retention elements, carry out the duplication of the obtained plastic-wax composition, substitution of wax on the plastic with the subsequent recovery of deleted sections forming the outer boundaries of the surgical field soft strip, after it is on record that piece silicone duplicate and will polimerizuet under vacuum, followed by grinding and polishing the surface of the plate, converted to the defect to a mirror finish (Patent RF №2427344).
This method is chosen for the prototype.
The present invention is to restore chewing function and formation of the prosthetic bed of dental prosthesis in cancer patients with postoperative defects of the maxilla and dentition with partial absence of teeth.
The technical result is the production release of postoperative dental prosthesis for the upper jaw in all its resection capable of forming a prosthetic bed in the area of operation, optimal fixation with adverse clinical conditions prosthetic bed, restore chewing function and restore the height of the lower third of the face after surgery.
The technical result is achieved by a method of manufacturing a divisive postoperative dental prosthesis for the upper jaw is getting alginate impression with the upper jaw before the surgery, and making it the plaster model, the performances by hot wax, false teeth on the models obtained in place of their own missing, scanning and digitization of the resulting model scanner CAD/CAM system, the delineation on the original plaster the howl of the model boundaries of the proposed surgical field and engraving data boundaries in the vertical and horizontal directions of the width and depth of 2.5 mm, rescanning already engraved model and simulation on computer module divisive postoperative dental prosthesis retention elements and milled tooth rows and teeth, by comparing the data of prosthetic bed engraved model and dentition model implemented by the production of false teeth, milling simulated prosthesis construction of the plastic disk.
Prosthetic dental rehabilitation of cancer patients with postoperative defects of the jaws is carried out in three stages prosthetics. In the first stage, in the preoperative period, made decoupler plate, bearing function of the separation of the cavities of the nose and mouth and providing initial impact for epithelialization of the borders of the defect. The second stage consists in the manufacture and use of the patient forming a prosthesis-obturator used to temporarily restore chewing efficiency and the formation of the annulus defect sky, playing the role of the additional retention element, which is especially important in patients with complete absence of teeth. And the final stage of the prosthesis is characterized by the fabrication of the final prosthesis-obturator.
The proposed method can be used on the ground is C the suggested steps.
As a result of the treatment the patient is not only the distinction between the mouth and nose, which in turn provides the possibility of a meal, but restores the chewing function and restore the height of the lower third of the face that are due to the presence in the resulting denture teeth and the teeth, which is an exact copy of the dentition and teeth of the patient in the preoperative period.
Design divisive postoperative plate for the upper jaw is illustrated in the drawing, where:
1. the base plate,
2. the retention elements of the prosthesis,
3. the sections forming the outer boundaries of the surgical field,
4. milled artificial teeth.
Divisive postoperative dental prosthesis for the upper jaw is made as follows.
1. Before the operation the patient will receive the impressions of both jaws, register occlusion or Central value of the jaws.
2. On the obtained prints are produced model in accordance with the registration data of the dentition and facial arc, fix the model in the articulator and implement a performance by hot wax, produced dentures in place their own missing,
3. A working model is scanned and transferred to a digital format using a computer module CAD/CAM system.
4. On the original plaster m the Delhi outline the boundaries of the proposed surgical field and engrave the boundaries in the vertical and horizontal directions of a width and a depth of 2.5 mm
5. Engraved model scan using a computer module CAD/CAM system.
6. Simulated on a computer module divisive postoperative maxillary denture retention elements and artificial teeth, by comparing the data of prosthetic bed engraved model and dentitions original model, obtained in the preoperative period.
7. Milled simulated design divisive postoperative dental prosthesis with artificial teeth of the plastic disk.
8. Processed denture, grind, Polish.
9. Fix the prosthesis in the oral cavity of the patient.
A method of manufacturing a divisive postoperative dental prosthesis for the upper jaw is getting alginate impression with the upper jaw before the surgery, and making it the plaster model, the performances by hot wax, false teeth on the models obtained in place of their own missing, scanning and digitization of the resulting model scanner CAD/CAM system, the delineation on the original plaster model of the boundaries of the proposed surgical field and engraving data boundaries in the vertical and horizontal directions of the width and depth of 2.5 mm, rescanning already engraved models and modelling the Institute for computer module divisive postoperative dental prosthesis retention elements and milled tooth rows and teeth, by comparing the data of prosthetic bed engraved model and dentition model implemented by the production of false teeth, milling simulated prosthesis construction of the plastic disc.
SUBSTANCE: invention refers to medicine, particularly to dentistry, and is applicable in making a releasing postoperative maxillofacial prosthesis for all types of maxillectomy. A patient's oral cavity is optically imprinted. An optical imprint is digitised by means of a computer unit of CAD/CAM system. Planned surgical area boundaries are modelled on the formed image, and the above boundaries are virtually engraved vertically and horizontally at a width and a depth of 2.5 mm. A base of the releasing postoperative maxillofacial prosthesis is modelled with retention elements, and scanned patient's dental arch images are attached by matching technique. The modelled construction of the releasing postoperative maxillofacial prosthesis with artificial plastic-plate teeth is milled. The made prosthesis is processed, ground and polished. The prosthesis is fixed in the patient's oral cavity.
EFFECT: by providing a one-piece configuration of the releasing postoperative maxillofacial prosthesis with the retention elements by computed milling, the method enables recovering the masticatory function, ensuring the prosthetic bed formation within the surgical area and the optimum fixation in the unfavourable clinical environment of the prosthetic bed.
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.
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.
FIELD: medical engineering.
SUBSTANCE: method involves producing an opening of diameter reaching 2 mm with diamond or hard alloy bore in adhesive cover after preparing abutment tooth and prosthesis or widening already available perforation also to diameter of 2 mm. The prosthesis is set on the abutment tooth and place is marked for creating and directing pin-canal in the area of cutting one-third of the frontal abutment tooth or in the lateral abutment tooth equator area. The pin-canal direction is to correspond to path for introducing the prosthesis. The pin is screwed-in with screwdriver and holder to a depth of about 2 mm into dentin. The prosthesis is set on the abutment for making control. The pin is filed-off to adhesive cover layer after having fixed the prosthesis on composition cement.
EFFECT: prolonged service life; high functional value.
FIELD: medical engineering.
SUBSTANCE: method involves taking anatomical imprint from jaw under prosthetic repair, casting supergypsum model for carrying out parallelometric studies, model duplication, modeling future clasp carcass skeleton from wax, enclosing the wax model into cell filled with gypsum, evaporating wax and filling the arisen cavity with polymer. The clasp carcass model is reproduced as metal one from polymer model for all models taken in production. Polymer for manufacturing clasp carcass model is reactive composition hardening at room temperature and composed of two ingredients taken in 2:1 proportion by weight. The first ingredient portion is based on polymethyl methacrylate, and the second one is polymethyl methacrylate with dimethylaniline added in the amount of 1-2% by mass.
EFFECT: significantly accelerated carcass manufacturing process; high accuracy in reproducing sizes; improved connection of locks and telescopic crowns to polymer carcass; low production costs.
FIELD: medical engineering.
SUBSTANCE: device has vestibular and oral parts connected to each other with crosspieces manufactured from orthodontic wire placed in interdental spaces by producing jaw imprints. Working and auxiliary models are molded. To place treating bandage, general clinical equator of all teeth included into the splint is to be determined on working model using parallelometer. Then, space between the clinical equator line and gingiva and a gingiva part 7-8 mm remote from gingival papillae are covered with dental wax layer of thickness equal to or less than 1.5 mm. Next to it, duplicate model is produced for manufacturing the splint having recess equal to wax layer thickness 1.5 mm. Changing wax for transparent plastic, filing and polishing the splint is carried out by applying method of common use.
EFFECT: enhanced effectiveness of treatment.
SUBSTANCE: method involves reinforcing crown part defect with wave-shaped wires. The wires are taken in advance from gold-coated metal network, Ѕ tooth root length long wire portion is twisted and fixed in the canal. Free ends of the wires are distributed along vestibular surface of tooth cutting edge and bent towards vestibular tooth surface 1-1.5 mm below the cutting edge. Free ends of the wires are fixed in oval tooth cavity on the vestibular tooth surface side. Artificial enamel layer is produced from macrofilled composite material anatomically matching in shape the incisor crown part, fixing the wave-shaped wires in composite material. Artificial dentine is produced from microfilled composite material.
EFFECT: high strength of incisor walls; long service life under chewing loading.
SUBSTANCE: method involves carrying out odontopreparation, forming cylindrical tooth stump to gingival level, forming a projecting part on this place and fixing net carcass on the stump followed by crown part restoration using composite material. When forming stump, occlusion surface is filed off by 0.9-1.2 mm and additional retention zones like 0.2-0.3 mm deep horizontal grooves are formed on the aproximal surfaces. The carcass is produced from gold-plated metal wire net having 0.4 mm large meshes to fit the stump. Before being fixed, the net carcass is treated twice with masking agent leaving meshes open. Final crown part restoration follows with anatomical tooth shape being taken into account.
EFFECT: fully restored anatomical tooth shape; high strength of tooth walls; long service life; high esthetic quality.
SUBSTANCE: method involves applying preparative endodontic treatment, fixing reinforcing net in prepared cup-like tooth cavity formed and produced in root base zone. The cup-like tooth cavity is formed after having temporarily fixed crown part walls along the fracture line using enveloping composite ring, gingiva retraction and preparing demineralized tissues. The crown part walls are formed from composite material keeping to anatomical shape of tooth under restoration after having fixed root fracture with glass ionomer cement being used. The net is shaped in advance to make it congruent to cavity of tooth under restoration and fixed in the cavity by means of fluid composite. The formed cavity is filled with microfilled composite. Macrofilled composite is used for building tooth crown part and tubercles.
EFFECT: high strength of the structure; long service life.
FIELD: medical engineering.
SUBSTANCE: method involves carrying out electrochemical degreasing metal prosthesis carcass surface, anodic etching and cathodic etching and then coating with 0.1-0.3 mcm thick primary gold layer from acid electrolyte. Next to it, 40-50 mcm thick basic gold layer is deposited from alkaline electrolyte.
EFFECT: improved esthetic properties; lowered toxic properties of alloy.
FIELD: medical engineering.
SUBSTANCE: method involves producing plaster jaw model from imprints taken in advance and modeling half-finished wax bite cap article next to it. Silicon mould is manufactured by applying manual molding method with through sprue holes used for filling space, produced after removing half-finished wax bite cap, with plastic. The silicon mould is withdrawn after having plastic polymerized, flow gates are cut off and their attachment places are polished.
EFFECT: simplified process; normalized lower face part height.
FIELD: medical engineering.
SUBSTANCE: method involves molding plaster jaw models from obtained anatomical imprints. Then, intermediate modeling of future dental bridge structure is carried out using wax, dental row plaster model segment imprint is produced on the area restricted with bearing teeth, intact dental row plaster die is manufactured, transparent dental kappa is produced from acryl using hot forming and adjusting abutment teeth stumps imprints and marginal area of intermediate portion of temporary dental bridge structure.
EFFECT: high strength; stable tooth row occlusion.
SUBSTANCE: method involves applying endodontic treatment of root, fixing pin manufactured from gold-coated metal gauze having free wires on opposite ends and repairing dental crown part with composite materials depending on particular morphological features of the dental row and length of area between the abutment teeth, to be substituted. The pin is fixed in root canal and mediodistal slot made in advance on its base with twisted wires. The wires on the opposite ends are bent towards vestibular side and additionally fixed with beams fixed in advance on the abutment teeth. The wires are brought above the upper and under lower beams. The beams and wires are treated with masking agent before repairing dental crown part.
EFFECT: enhanced effectiveness in restoring functional and esthetic properties of dental row; accelerated treatment procedure; reduced risk of traumatic complications.