Method of treating lower molars accompanying destruction in root bifurcation

FIELD: medicine.

SUBSTANCE: invention refers to medicine and is applicable in treating lower molars with destruction in root bifurcation. Laboratory and radiographic examinations of an involved tooth are performed. A crown-radicular separation is followed by introducing an osteotropic material. Residual dental stumps are prepared for whole-piece crowns. A working impression of the lower jaw and an auxiliary impression of the upper jaw are made. The whole-piece crown with a washing space surrounding the separated bifurcation is made. It is fixed on dental cement.

EFFECT: method ensures the integrated treatment involving surgical and orthopaedic interventions and enables preserving the dental functions and restoring its anatomical shape.

1 ex

 

The invention relates to medicine and can be used in the practice of dentistry.

In dental practice, there are several causes of the destructive processes in the area of the bifurcation of the roots of teeth. These causes directly or indirectly related or dental manipulation in the mouth, or failure to comply with hygiene practices, or with various changes in the patient's body (weakened immunity, tumor growth, and so on). These include:

- damage to the gums in the area of the bifurcation (II, III degree) with lysis top micornesia partitions;

- perforation of the bottom of the tooth cavity in the destructive process, the availability of additional channels connecting the cavity of the tooth with periodontal in the area of the bifurcation [1];

- perforation of the bottom of the tooth cavity in the medical manipulations;

- damage caused by decay in the area of the bifurcation of dvukhmernogo tooth formation in the apex of the tooth root cysts or granulomas [2];

- tumors in the bone of the lower jaw.

Because in modern dentistry, the main priority is the preservation of the teeth, holding the teeth maintaining operations is the main task of the dentist, especially in complex cases.

To ensure the destruction of bone tissue in the area of the bifurcation of the roots and thereby save C the BA should be the complex of therapeutic measures, which includes surgical, orthopedic intervention.

Among the known methods of treating the closest to the claimed method is corono-radicular separation with subsequent covering the stump of the tooth two independent steel stamped crowns, United into a monolithic, by soldering, with a total occlusal surface and the equator. As well as the method of coating the stump of the tooth cast crown with a total occlusal surface and the General equator [3].

The disadvantages of these methods, in our opinion, are:

In the first case:

1. Method of stamping does not provide dense coverage of cervical crown of the tooth.

2. Stamped crowns often deeply moving under the gums that leads to the development of cervical caries, chronic periodontitis.

3. Method of soldering is used to join two crowns, does not provide adequate strength for the connection.

4. The use of solder may cause phenomena of galvanism due to the heterogeneous nature of metals and allergic diseases of the oral cavity.

5. The complexity of the implementation of preventive measures for the care of the periodontal tissues, including under the spikes.

In the second case, we consider the following disadvantages:

1. No washing space in the area of the bifurcation prevents the formation of izunaso papilla.

2. Possible overload of the abutment teeth.

The purpose of the invention: restore anatomical form and function of the tooth if it is impossible conservative therapeutic treatment.

The goal is achieved by performing a complex of therapeutic measures, including surgical, orthopedic treatment.

Involvement is divided into several stages.

At the first stage: going thorough medical history, consultation, therapist public profile and, if necessary, laboratory tests and analyses, performed radiological control of the affected tooth.

On the second (surgical phase): under regional anaesthesia is a trapezoidal cross-section in the area of the projection of the root of the affected tooth; exfoliate mucoperiosteal flap; trapanese vestibular bone wall (if necessary); separated the crown of the affected tooth in the buccal-lingual direction; with the help of an excavator, a thorough reorganization of the affected area, retrieved the remains of the filling material and/or residues demineralized, the diseased bone in the area of the bifurcation of the tooth; the operative field abundantly processed antiseptic R-rum (0,05% R-RA chlorhexidine, 1% R-rum furatsilina); in the area of bifurcation paid osteo material (BIO-OSS, BIO-Gide®); Muco-nadco tiny flap fits into place and sutured with stitches from catgut; the place of separation companywide iodoform torontoy. The next day, the patient is assigned to physiotherapy (laser therapy). Control examinations are held through the day.

After 5-7 days at the control examination, a dentist, a surgeon removed the remaining seams, is a revision of postoperative wounds.

The third (orthopedic) stage begins 14 days after the last examination by the dental surgeon. In the first visit, carry out the dissection of the remaining stump of the tooth under solid crowns, receive double-layer work impression of the lower jaw with silicone weight (silicone), supporting the impression of the upper jaw alginate mass. Next, the job falls to the dental laboratory where the dental technician models and manufactures Celerity crown with proryvnym space in the area divided bifurcation. Simulated washing space located at a distance of 4 mm from the level of the gingival margin, and relieve occlusal surface. The doctor the stomatologist-orthopedist and tries papasamyam crown on the abutment stumps, and then is fixed on the dental cement. Inspection physician, dentist, podiatrist after 7 days.

Example. Patient K., 1948, R., applied to the base dental clinic GBOU VPO "Ryazgmu of the Ministry of health of the Russian Federation" on the café is ru prosthetic dentistry and orthodontics with complaints of pain in the area of the tooth on the lower jaw on the left side (tooth 3.6), occur during chewing and spontaneously.

From the anamnesis: the tooth 3.6 previously cured about complicated caries, covered with stamped steel crown. On an x-ray image 3.6 depression in the area of the bifurcation, the traces of the filling material. The root canal is sealed to the radiographic apex.

Diagnosis according to ICD-10: 04.5

Recommended: conduct coronaro-radicular separation with subsequent fabrication and coating the stump of the tooth cast crown.

The patient gave his written voluntary informed consent to conduct this type of therapeutic measures.

At the first stage after collecting a complete medical history and physician physician public profile was assigned to day operations.

At the second stage surgery: coronary angiography-radicular separation with a thorough rehabilitation of the affected area. When performing curettage were obtained remnants of the filling material.

The third stage began 14 days after surgery. Were prepared tooth stump 3.6 and manufactured molded crown with proryvnym space on the tooth 3.6.

3 months after fixation of crowns on the x-ray picture of bone formation between the stumps prepositional tooth 3.6.

The treatment outcome is positive. The forecast is positive.

So the m way this method of treatment allows you to retain the functionality of the tooth and restore its anatomical shape.

Sources of information

1. Operative dentistry: a national guide / Ed. by L. A. Dmitrieva, Y. M. Maximov. - M.: GEOTAR-Media, 2009. - 459 S.

2. www.alternativa-mc.ru/koronko_radikulyarnaya_separaciya.

3. Application No. 96107862/14, IPC AS 5/08, AS 13/00, declared 22.04.1996, published 10.02.1998, "the Prosthesis to the tooth exposed corono-radicular separation".

A method of treatment of molar teeth of the lower jaw at the destruction in the area of the bifurcation of the roots, namely, that carefully collect anamnesis, conduct the consultation of a General practitioner General practitioners, laboratory, x-ray examinations, conduct corono-radicular separation with subsequent submission of an osteo-material; prepare the remaining stump of the tooth under solid crowns, receive a working impression of the lower jaw, an auxiliary seal with the upper jaw is made Celerity crown with proryvnym space in the area divided bifurcation, fix it to the dental cement.



 

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17 cl

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1 tbl, 3 dwg, 1 ex

FIELD: medicine.

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4 cl, 6 dwg

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.

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