Clinical features of prosthetic treatment in edentuluos patients

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Abstract

BACKGROUND: Social adaptation of patients with complete absence of teeth is associated with fixation and stabilization of prostheses during chewing and speech. It is necessary to take into account the somatic status of the patient, the causes of tooth loss, pay attention to the clinical stages of orthopedic treatment.

AIM: Of the study is to increase the efficiency of the orthopedic dentist with full removable prosthetics.

MATERIAL AND METHODS: The conditions for obtaining a compression impression are a rigid spoon, silicone impression material of medium viscosity, constant pressure at the time of impression removal. The indication for removing the compression impression is the mucous membrane of the 1st type according to the Supple. The conditions for removing decompression impressions are a perforated individual spoon, liquid-flowing impression material, no pressure on the oral mucosa. The indication for the use of decompression impressions is a thin, atrophied mucous membrane of the oral cavity of the 2nd type according to Supple. It is necessary to use functional impressions combined according to the degree of pressure on the oral mucosa. This implies the peculiarities of manufacturing a rigid base with wax rollers. After determining the central ratio of the jaws and packing the template basis with bite rollers, the doctor applies the impression material differentially to its inner surface. Both templates with bite rollers are inserted into the oral cavity, the doctor controls the central position of the lower jaw, while functional impressions are taken from the upper and lower jaws, taking into account the functional pressure of the patient’s chewing muscles. This will allow you to evenly distribute the chewing pressure on the oral mucosa. The value of functional rest is determined by measuring two marked points at the base of the nose and on the chin and always exceeds the amount of separation in the state of the central ratio of the jaws by the amount of the interclusal space. Having determined the amount of functional rest, they begin to design the maxillary occlusion pattern, then note the anatomical landmarks. Often, the removal of impressions with a corrective silicone mass is performed in the position of the central ratio.

The value of functional rest is determined by a set of anatomical landmarks in a state of maximum possible muscle relaxation in combination with phonetic tests when closing the lips without tension.

RESULTS: The determination of the central ratio on rigid bases makes it possible to accurately fix the interalveolar distance. Patients adapt to prosthetic structures faster.

The use of a facial arch with an articulator significantly improves the quality of the prosthetic structure, allows you to individualize the anatomical parameters of the patient.

When determining the central ratio of the jaws, checking the design of the future prosthesis, cone-beam computed tomography of the temporomandibular joint was used to control the position of the heads of the lower jaw, confirming the correctness of the actions. At the stage of checking the design of the removable prosthesis, phonetic tests were used.

CONCLUSION: The use of combined impressions with simultaneous determination of the central ratio of the jaws and control of the position of the heads of the lower jaw can accelerate the process of orthopedic treatment (combining two stages) and adaptation to removable prostheses. To improve speech during treatment, it is necessary to use special phonetic tests that allow you to restore the correct ratio between the jaws, find the optimal position of artificial teeth, determine the boundaries and shape of the basis of the prosthesis and design the optimal prosthesis for each patient.

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About the authors

Vasilii V. Babich

Medical Social University of Saint Petersburg

Author for correspondence.
Email: vasvlbabich@yandex.ru

MD, Cand. Sci. (Med.), Associate Professor

Russian Federation, 72, Kondratievsky Av., letter A, 195271, Saint Petersburg

Julia A. Bistrova

Medical Social University of Saint Petersburg

Email: bystrova2002@mail.ru
ORCID iD: 0000-0001-6972-7281

MD, Cand. Sci. (Med.), Associate Professor

Russian Federation, 72, Kondratievsky Av., letter A, 195271, Saint Petersburg

References

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Supplementary files

Supplementary Files
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1. Fig. 1. Wax bite rollers on rigid bases.

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2. Fig. 2. Determination of the central ratio of the jaws.

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3. Fig. 3. Silicone material for edging individual rigid bases.

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4. Fig. 4. The facial arc.

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5. Fig. 5. Cone-beam computed tomography of the temporomandibular joint of the patient to control the central position of the head of the lower jaw

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