RU2240077C1 - Method for forming obturator prosthesis with no maxilla being present - Google Patents

Abstract

FIELD: medical engineering.

SUBSTANCE: device has principle and auxiliary surface connected to each other with additional frontal, back- and two lateral vertically arranged surfaces forming cavity. The frontal and back vertically arranged surfaces have groove-like recesses. Method involves taking imprint with alginate mass, casting gypsum model using the imprint, manufacturing individual impression tray from produced gypsum model. The individual impression tray is fitted with excessive pressure against the individual impression tray on the part of chicks being removed. Functional imprint is produced with the individual impression tray using fluid flow silicon mass to exclude soft tissue over strain. Working gypsum model is manufactured using the produced imprint. The principle and auxiliary parts of hollow obturator are manufactured by polymerizing the base plastic. The principle and auxiliary parts of hollow obturator are connected with self-hardening plastic material. Before manufacturing individual impression tray, undercuts are closed with wax and the nasal entrance is built. Excessive undercuts are closed in the vicinity of sphincter ring formed by upper lip muscles in the nose base area in the frontal zone with soft palate in distal area and with chick muscles in the lateral areas. The base part is built as nose cavity bottom and the auxiliary part is formed as hard palate. Grooves area is cleaned.

EFFECT: simplified method of high reliability; reduced risk of traumatic complications.

5 cl, 3 dwg

Description

The invention relates to medicine, in particular to orthopedic dentistry, and is intended to make up for defects of the upper jaw of various origins, including in its complete absence.

A known method of prosthetics in the absence of an upper jaw (Kostur B.K., Minyaeva V.A. “Maxillofacial prosthetics”, Leningrad, Medicine, 1985, p.17-33), including casting an impression with an alginate mass, casting a gypsum model according to this cast, making an individual spoon according to the obtained gypsum model, fitting an individual spoon with eliminating excessive pressure of the cheek muscles on an individual spoon, taking a functional impression with an individual spoon using a fluid silicone mass to prevent overstretching soft tissue, casting a working gypsum model according to the cast, manufacturing the main and auxiliary parts of the hollow obturator by polymerizing the base plastic, connecting the main and auxiliary parts of the hollow obturator with self-hardening plastic.

The known method is difficult to implement, and the manufactured prosthesis is inconvenient in operation.

An object of the present invention is to correct these drawbacks.

The technical result consists in simplifying the method of manufacturing the prosthetic obturator, as well as in simplifying the design of the prosthesis and its versatility.

The result is achieved by the fact that in the method of forming the prosthesis of the obturator in the complete absence of the upper jaw, including casting an impression with an alginate mass, casting a gypsum model using this cast, manufacturing an individual spoon according to the obtained gypsum model, fitting an individual spoon with eliminating excess pressure on the cheek muscles on an individual spoon, taking a functional impression with an individual spoon using a fluid silicone mass to prevent overstretching of soft tissues, casting a working gypsum divide by the obtained cast, manufacture of the main and auxiliary parts of the hollow obturator by polymerization of the base plastic, the connection of the main and auxiliary parts of the hollow obturator with self-hardening plastic, close the undercut with wax and form the nasal passage before making an individual spoon, in the working plaster model close undercut in the area of the sphincter ring is closed formed by the muscles of the upper lip in the region of the base of the nose in the front section, the soft palate in the distal section and the muscles in the lateral sections, in the obturator obtained by the hollow, the main part is formed as the bottom of the nasal cavity, and the auxiliary part is formed as a hard palate, the area of the grooves is cleaned, a place for relocation of the soft pad is formed, the prepared area is cleaned, greased with adhesive, a soft pad is applied, and the prosthesis is applied with with a soft pad in the oral cavity for the period of polymerization of the soft pad, the prosthesis is removed and the upper arch of the nasal stripe is pre-coated with the alginate mass before taking the impression in places with undercuts, and the fact that in the prosthetic obturator containing the main and auxiliary surfaces, the auxiliary surface is oriented parallel to the occlusal plane of the teeth in the lower jaw, the main and auxiliary surfaces are connected by additional front, back and two lateral vertically oriented surfaces with the formation of a cavity moreover, the front and rear vertically oriented surfaces are made with recesses in the form of grooves for interaction with the lip muscles in the main nose and with the upper part of the soft palate, respectively, the lateral vertically oriented surfaces are made with the possibility of interaction with the muscles of the cheeks, and the fact that the main and auxiliary surfaces are concave towards the formed cavity of the prosthesis, and the fact that the front and rear vertically oriented surfaces are made concave towards the formed cavity of the prosthesis.

The implementation of the method of forming the prosthetic obturator in the complete absence of the upper jaw, the design of the prosthetic obturator is illustrated in figures 1 and 2, which depict the prosthetic obturator and its incision along AA. Figure 3 presents a General view of the prosthetic obturator.

The prosthetic obturator 1 contains the main and auxiliary surfaces 2 and 3, interconnected by additional front, rear and two side vertically oriented surfaces 4, 5, 6 and 7 with the formation of a cavity 8, the front and rear vertically oriented surfaces 4 and 5 are made with recesses in the form of grooves 9, 10.

The method is implemented as follows.

A mold is taken with an alginate mass of YPEEN, SPOPA DENTAL, Praga, Czech Republic, with the expres sion of all elements of the nasal cavity and mouth, especially the upper edge of the palate, cheeks, base of the nose and upper lip, forming a sphincter ring. A cast is cast of the Tnixo-Rock Din En iso 26873 super gypsum, Bredent, Germany. On the gypsum model, undercut zones in the region of maxillary cavities are determined for subsequent isolation (closure) with their base wax TU 64-2-211-77, STOMA firm, Kharkov, Ukraine, with the exception of slight undercut (up to a millimeter) in the region soft palate (surface 5) and the base of the nose (surface 4) in order to create fixing grooves (on the prosthesis grooves 10, 9). The model forms a space for the nasal passage (made in the form of a roller located along the longitudinal axis of the model, the width determined by the wings of the nose and the length to the soft palate), sufficient in volume for nasal breathing, from the same basic wax. A self-hardening plastic for cold polymerization protocryl TU 64-2-267-78 “STOMA”, Kharkov, Ukraine, an individual spoon is made, squeezing the relief of the model with closed undercuts and created nasal passage. The wall thickness of the spoon should be about 1 cm for the possibility of thinning it in order to eliminate overstretching of soft tissues that arose during the initial casting of impressions with an alginate mass. In the oral cavity, such a spoon is fitted for free introduction and removal from the oral cavity, but with fixation in the groove area along the distal and anterior border (grooves 10 and 9, respectively, surfaces 5 and 4). Surplus plastic is removed in the cheek area until primary fixation of an individual spoon occurs along the interface between the prosthesis 1 and the sphincter ring, then a 0.5 mm deepening is made in the individual spoon along the groove in the palate and nose to reduce pressure on the mucous membrane and create places for a sufficient thickness of the flowing silicone mass BISICO hydrophilsli ADA 19 type 1 iso 4823 type 3, showing the microrelief in the area of contact of the individual spoon with the mucous membrane. According to the cast, the working model is cast from super gypsum. On the obtained working model, the obtained relief is crimped with base wax, even edges are formed, facing the oral cavity in one plane. The formed edges are smeared with petroleum jelly and crimped with another base wax plate in order to form a lid for a hollow prosthetic obturator. Then the lid, forming a solid palate (surface 3), is removed and gypsum-plated into a cuvette for polymerisation of the plastic. The main part of the prosthetic obturator is also gypsum in a cell consisting of two halves. After casting the second half, the wax is boiled from the ditch, the free space is filled with basic plastic stomacryl TU 9391-009-40151387, type 1 class 1, “Stomadent”, Russia. The polymerization in a water bath is carried out under pressure. After polymerization, the prosthetic obturator is tried on in the oral cavity for a snug fit along the grooves 9, 10 (surfaces 4, 5). The prosthetic obturator is thinning from the inside to reduce the weight of the prosthesis itself. A lid (arch of the hard palate) is attached to the edge of the prosthetic obturator (surface 3) and is connected using self-hardening plastic protocryl. In the obtained obturator prosthesis, the main surface is formed as the bottom of the nasal cavity (surface 2), the auxiliary surface is formed as a hard palate (surface 3).

A new set of actions aimed at the formation of the prosthetic obturator, and the design of the prosthetic obturator itself show the novelty of the method and design of the prosthesis, the presence of their inventive step for the average specialist, to confirm industrial applicability, we present a photograph of the prosthesis with the alveolar process and teeth.

Consider an example.

EXTRACT FROM THE MEDICAL HISTORY

Sokolov B.C., born in 1938, went to the orphopedic department in 1999 with complaints of difficulty swallowing, impaired speech and chewing, tooth decay on the lower jaw, lowering of the upper lip and lack of teeth from above.

Anamnesis: In 1987, a subtotal resection of the upper jaw was performed for a tumor of the hard palate and the bottom of the nasal cavity, followed by radiation therapy.

In 1989, prosthetics were performed at the maxillofacial hospital. An obturator is made, fixed with the help of Fauchard springs. The prosthetic obturator served for almost 10 years, helping to separate the nasal and oral cavity. The patient had problems installing the prosthesis in the oral cavity, Foshar springs caused an injury to the cheek on both sides.

In 1999, the prosthesis was stolen along with a bag in an electric train.

Objectively: The oral cavity and nasal cavity are a single cavity due to the absence of the maxillary bone. In the nasal cavity there is no opener, lower nasal concha. The upper arches of the maxillary cavities, partly the distal, proximal and lateral walls, are preserved; upper and middle nasal concha on both sides. A soft palate is preserved along the distal border of the oral cavity, lateral surfaces are formed by soft tissues of the cheek. The approximate boundaries in the area of the base of the nose are limited by the muscles of the lip. The mucous membrane of the nasal cavity is hyperemic, swollen, in the upper and middle nasal passages there are food debris and mucopurulent discharge. When pronouncing words, speech is slurred, words are poorly distinguishable, independent swallowing of the liquid is very difficult.

On the lower jaw there are no 47, 46, 45, 42 and 35, 38 teeth. The crown of the teeth 43, 41, 31, 32 is destroyed to the level of the gums. In the R-image, the channels are sealed with the removal of filling material beyond the apex into the granuloma cavity. There is a convergence of 34, 36 towards the absent 35. At 34, the stamped crown is in satisfactory condition.

Diagnosis: Condition after subtotal resection of the upper jaw due to surgical treatment for a tumor of the hard palate and the bottom of the nasal cavity ten years ago. The lack of separation of the nasal cavity and oral cavity, complicated by throwing food into the nasal cavity, catarrhal inflammation of the mucous membrane of the nasal cavity mainly in the region of the nasal concha. Violation of swallowing function, improper speech articulation, impaired chewing function. Violation of the aesthetics of the lower third of the face. The retention of the upper lip due to lack of upper jawbone. Cosmetic defect due to lack of upper teeth. Partial absence of teeth of the lower jaw (47, 46, 45, 42, 35, 38) (Kennedy class III) due to caries and its complications, multiple fillings that have changed color, partial destruction of the crown of the tooth (43, 41, 31, 32 ) Convergence 34 and 36 in the region of the absent 35. Tooth alveolar elongation of the frontal group of teeth in the lower jaw due to the absence of antagonist teeth. Periodontopathy due to the lack of natural self-cleaning and insufficient dental hygiene.

Treatment plan:

1. To make a prosthetic obturator with fixation using stored soft tissues without using Fauchard springs to separate the nasal cavity and oral cavity. To make LKShV tabs (43, 41, 31, 32), to make a bridge with a support (48, 44, 43, 41, 31, 32, 33) for restoration (47, 46, 45, 42), to align the occlusal plane.

2. At the stage of adaptation to the prosthetic obturator, complete the correction of the prosthesis to eliminate naminov.

3. At the rehabilitation stage, normalize full swallowing and speech.

4. With successful adaptation and rehabilitation, eliminate the lowering of the upper lip and restore the frontal group of teeth by making a detachable artificial alveolar process with teeth for the obturator prosthesis. Restore speech to the patient due to the changed arch of the sky.

5. Solve the question of the possibility of using implants to restore full chewing after a computer examination of the base of the skull and solve the financial problems of the patient.

01/14/99. I feel satisfactory. There are no complaints. The softened hard tissues of the tooth were cut off, the channels 43, 41, 31, 32 were sealed, tabs were modeled on 2/3.

01/19.99. I feel satisfactory. There are no complaints. The tabs were fixed on the visfate, 48, 44, 43, 41, 31, 32, 33 were prepared for the manufacture of a bridge. Casts from the lower jaw for the manufacture of stamped crowns. A cast of the nasal cavity was taken to make an individual spoon.

02/01/99. I feel satisfactory. There are no complaints. Fitting crowns, taking an impression for soldering crowns and making the intermediate part of the bridge. Correction of an individual spoon on the contact surface with soft tissues to eliminate extrusion of an individual spoon by the cheek muscles, elimination of excessive undercutting in the distal border of the upper edge of the soft palate and the approximate border in the region of the upper lip muscles in the area of the base of the nose. An impression was taken of an individual spoon with Cielast-69 for the manufacture of a hollow prosthesis of the obturator.

02/09/99. I feel satisfactory. There are no complaints. The application of a bridge with a support of 48, 45, 44, 43, 42, 41, 31, 32, 33 and its fixation on the visfat. Fitting the upper part of the obturator prosthesis along the borders of the prosthesis, eliminating excessive undercut in the area of the retaining groove in the distal part in the region of the upper edge of the soft palate in the proximal region of the upper edge of the lip and base of the nose. Deepening of the retaining groove, clinical relocation with a soft pad, maximum thinning of the walls of the obturator. Fixing the lid for the hollow obturator on the protocryl, processing the junction. Training a patient to apply and remove an obturator prosthesis. Recommendations for use and care of the prosthesis.

From 10.02.99. on 02.16.99. Correction of the prosthesis in the area of naminas, classes in pronunciation of sounds. The patient is warned about the need to relocate the soft pad after 6 months. 12/13/00. I feel satisfactory. Complaints about the peeling of the soft pad, the appearance of naminas. I could not appear at the dispensary examination and replace the soft pad; He lived in the Tver region, where he looked after a sick relative.

Objectively: articulation and swallowing recovered. Minor naminas appeared along the distal border of the prosthesis in the soft palate area.

The obturator prosthesis was relocated with a soft pad, the patient was assigned to receive tooth restoration in the frontal area in order to eliminate the cosmetic defect in the dentition and the failure of the upper lip as a result.

12.20.00. I feel satisfactory. Complaints of pain from a prosthetic obturator in the soft palate. The correction of the basis of the obturator in the area of namin.

10/08/01. I feel satisfactory. Complaints of pain from a prosthetic obturator in the soft palate.

Objectively: There was a partial detachment of the soft strip, its elastic properties were violated. Relocated by soft pad. Three grooves are applied to the obturator prosthesis in the anterior portion to orient the bite roller on the gypsum model and the oral prosthesis obturator. An impression was taken from the prosthetic obturator and lower jaw for the production of a bite roller.

10/15/01. I feel satisfactory. There are no complaints. Determination of the central ratio of the prosthetic obturator and lower jaw using a wax pattern.

10/22/01. I feel satisfactory. There are no complaints. Trying on a wax alveolar ridge with artificial teeth 45, 44, 43, 42, 41, 31, 32, 33, 34, 35, oriented along three guide grooves in the frontal section of the obturator and occlusion of teeth in the region of 45, 44, 34, 35. 29.10 .01. I feel satisfactory. There are no complaints. Trying the finished artificial alveolar bone without 45, 35 teeth to reduce the weight of the structure. To create an opportunity to carry out a conditionally collapsible prosthesis-obturator with an artificial alveolar process, attachments of the Brentent company were used. The patrician ersatz is fixed in an artificial alveolar ridge, and the matrix in a metal container, fixed in the base of the prosthetic obturator to protocryl. Reducing the weight of the artificial alveolar bone by creating appropriate holes. Recommendations for prosthesis care and speech restoration. 11/06/01. I feel satisfactory. There are no complaints. A control panoramic x-ray was taken. Recommendations for the care of the prosthesis are given. Control examination after 6 months. Thus, the obtained prosthesis very precisely corresponds to the boundaries of the defect formed due to the absence of a hard palate and alveolar ridge, and the parameters of the sphincter ring formed by the soft palate, the muscles of the upper lip in the area of the base of the nose and the muscles of the cheeks, for which grooves are created in which they are fixed, and the cheeks on both sides cover the lateral surfaces of the prosthetic obturator. This greatly simplifies the method of formation of the prosthetic obturator, increases its reliability and makes the design of the prosthesis quite simple and universal.

Claims (5)

1. A method of forming an obturator prosthesis in the complete absence of the upper jaw, including casting an impression with an alginate mass, casting a gypsum model using this cast, making an individual spoon using the obtained gypsum model, fitting an individual spoon with eliminating excess pressure on the cheek muscles on an individual spoon, removing a functional impression individual spoon using a fluid silicone mass to prevent overstretching of soft tissues, casting a working gypsum model according to the cast, made the manufacture of the main and auxiliary parts of the hollow obturator by polymerization of the base plastic, the connection of the main and auxiliary parts of the hollow obturator with self-hardening plastic, characterized in that before the manufacture of the individual spoons they close with undercut wax and form a nasal passage, in the working plaster model close undercuts in the area of the sphincter ring are closed, formed by the muscles of the upper lip in the region of the base of the nose in the anterior portion, the soft palate in the distal portion and the cheek muscles in the sides In the obtained areas, in the hollow obturator obtained, the main part is formed as the bottom of the nasal cavity, and the auxiliary part is formed as a hard palate, the area of the grooves is cleaned. 2. The method of forming the prosthesis of the obturator in the complete absence of the upper jaw according to claim 1, characterized in that before taking the impression of the alginate mass, the upper arch of the nasal cavity is pre-coated with alginate mass in places with undercuts. 3. The prosthetic obturator containing the main and auxiliary surfaces, the auxiliary surface is oriented parallel to the occlusal plane of the teeth in the lower jaw, characterized in that the main and auxiliary surfaces are connected by additional front, rear and two lateral vertically oriented surfaces with the formation of a cavity, the front and rear vertically oriented surfaces are made with recesses in the form of grooves for interaction with the muscles of the lips in the region of the base of the nose and with the top s part of the soft palate, respectively, side vertically oriented surface adapted to cooperate with a cheek muscles. 4. The prosthesis-obturator according to claim 3, characterized in that the main and auxiliary surfaces are made concave towards the formed cavity of the prosthesis. 5. The prosthetic obturator according to claim 3, characterized in that the front and rear vertically oriented surfaces are concave towards the formed cavity of the prosthesis.

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