RU2851945C1 - Method for restoration of cervical areas of teeth - Google Patents

Abstract

FIELD: medicine; therapeutic dentistry.

SUBSTANCE: invention is intended for use in restoring the anatomical shape and function of the cervical areas of teeth. After diagnosis, professional oral hygiene and colour diagnostics of the restoration according to the VITA scale are performed. Then, preparation of the hard tissues of the tooth is carried out, a cavity is formed and conditioning is performed. Then, adhesive treatment with a bond is carried out, polymerised, the bottom is treated with a high-flow composite, distributing it with a brush, polymerised. Then, a thread made of polyethylene impregnated on all sides with composite, equal to the restored area of the tooth, is cut off. Then, threads with composite material are laid, wherein the threads are placed vertically, condensed, distributing the element over the entire area of the defect in the cervical area, polymerised. Then, application of a composite corresponding in colour to the hard tissues of the tooth is carried out, then modelling of the cervical area is performed; the surface of the restoration is polished and ground.

EFFECT: the method, due to the reinforcement of the cavity, allows for high-quality and long-term treatment of teeth.

1 cl, 4 tbl, 8 dwg, 1 ex

Description

The invention relates to medicine, namely to therapeutic dentistry, and can be used to restore the anatomical shape and function of the cervical areas of teeth in the case of various defects of carious and non-carious origin.

The well-known methods for restoring the crown portions of teeth, developed by M.L. Melikyan in collaboration with G.M. Melikyan and K.M. Melikyan, relate to direct restorations/reconstructions of the crown portions of teeth, which are performed directly in the patient's oral cavity. The essence of the methods lies in modeling the missing crown portion of the tooth using a composite material and a reinforcing gilded metal mesh, for example, from the company "Dentaurum". Patents for inventions No. 2262904, 2276594, 2233641, 2282418, 2238698, 2253402, 2252729, etc. cover various clinical situations. All these methods, where the reinforcing element is a metal mesh, should be combined with an opaque material so that the metal in the final structure does not show through. Opaque composites in the cervical areas look like "patches", because do not have the transparency that is necessary in this area, and the restorations are “dead” (A new method for restoring the frontal group of teeth using preliminary polishing of the dentin layer of composite material / Kovalevsky A.M., Vorobyova Yu.B., Malysheva D.D., Nikitenko V.V. // In the collection: Theoretical and practical issues of clinical dentistry. Proceedings of the All-Russian scientific and practical conference. Edited by V.V. Nikitenko, V.A. Zheleznyak. St. Petersburg, 2021. - Pp. 86-89; Finishing of composite dental restorations - comparative characteristics of polishing systems / Malysheva D.D., Vorobyova Yu.B., Kovalevsky A.M. // Medical and pharmaceutical journal Pulse. 2022. Vol. 24. No. 4. -Pp. 28-32). Restoration of this area is complicated by micromovements under occlusal load during the act of chewing food, due to which the problem of marginal adaptation of the composite is aggravated and leads to depressurization and loss of the filling (Use of pre-polymerization composite material in the restoration of carious cavities of class 5 according to Black. Report of laboratory and clinical studies / Kovalevsky A.M., Vorobyova Yu.B., Malysheva D.D. // Institute of Dentistry. 2021. No. 2 (91). - P. 99-101). Research in recent years has shown that the quality of restorations in the long term after filling is low (Prevention of marginal depressurization of adhesive filling of cavities of class V according to Black / Vorobyova Yu.B., Balin V.V., Malysheva D.D., Kriventseva V.A. // Dentistry. - 2022. Vol. 101. No. 5. - Pp. 7-10), which is associated with the degradation of the hybrid zone, microleakage, the appearance of chips and cracks in the composite associated with the consequences of polymerization stress. This entails the development of secondary caries and the need for repeated retreatment or replacement of the restoration (Monochrome restorations in the practice of a dentist / Vorobyova Yu.B., Latif A.R., Gulyakin S.Yu., Kriventseva V.A. // In the collection: Theoretical and practical issues of clinical dentistry. Proceedings of the All-Russian scientific and practical conference. St. Petersburg, 2023. - Pp. 24-26). The closest analogue for the development of a new method is RU2548798C1 Indirect atraumatic method of restoration/reconstruction of teeth destroyed below the gum level using a reinforced mesh-metal-composite (SMC) denture according to Melikyan M.L. This method is not relevant due to the translucency of the metal frame, which is part of the reinforced mesh-metal-composite element.

The invention is based on the task of creating a method for restoring the cervical areas of teeth with a reinforcing element that ensures high-quality and long-term dental treatment.

The solution to the set problem is ensured by the fact that in the method of restoration of the cervical areas of teeth, including oral hygiene and color diagnostics of the restoration, after the diagnosis is made, professional oral hygiene and color diagnostics of the restoration are carried out, then the hard tissues of the tooth are prepared, the cavity is formed, conditioning is carried out, then adhesive treatment with a bond is carried out, polymerization is carried out, the bottom is treated with a composite of increased fluidity, polymerization is carried out, then threads with a composite material are applied, while the threads are placed vertically, condensed, distributing the element over the entire area of the defect of the cervical area, polymerization is carried out, then a composite is applied that matches the color of the hard tissues of the tooth, then the cervical area is modeled; then the surface of the restoration is polished and ground.

We suggest replacing this element during restoration of cervical areas with polyethylene threads impregnated with composite on all sides (for example, ARKONA “Caterpillar”).

The invention is explained by Fig. 1, which shows the performance of professional oral hygiene and color diagnostics, Fig. 2 shows the preparation of hard tooth tissues and the formation of a cavity, shows the performance of adhesive treatment, Fig. 4 shows the treatment of the bottom with a composite of increased fluidity, Fig. 5 shows a thread with a composite, Fig. 5a shows the process of applying a reinforcing element and distributing a mesh element over the entire area of the defect of the cervical region, Fig. 6 shows how to apply a composite that matches the color of the hard tooth tissues, Fig. 7 shows how to model the cervical region, Fig. 8 shows the process of polishing and grinding the surface of the restoration.

After diagnosis, professional oral hygiene and restoration color diagnostics are performed using any acceptable method (Fig. 1). The hard tissues of the tooth are prepared, a cavity is formed (Fig. 2), conditioning is performed, followed by adhesive treatment with a bond of any generation (Fig. 3), polymerization is carried out, the bottom is treated with a composite of increased fluidity (Fig. 4), polymerization is carried out, then a thread with composite equal to the area of the tooth to be restored is cut (Fig. 5), an element is applied - a fiber with composite located vertically, condensed, distributing it over the entire area of the defect in the cervical area (Fig. 5a), polymerization is carried out, the next step is application of a composite corresponding to the color of the hard tissues of the tooth (Fig. 6), modeling of the cervical area is carried out (Fig. 7). Then, in conclusion, the surface of the restoration is polished and ground (Fig. 8). The proposed method of tooth reinforcement in the cervical area ensures high-quality and long-term dental treatment.

The proposed method of treating the cervical region using a composite thread is effective when placed vertically in the cavity, as demonstrated by a study on a Shimadzu tensile testing machine.

We examined 30 teeth removed for medical reasons.

10 teeth were restored using the classical method with composite material according to Black class 5.

Table 1

Max force (compression)
N Max stress N/m ^m2 Max deformation % Modulus of elasticity
GPa 1 group of samples, 5th grade according to BLACK 1832.29 64.8041 35.8889 0.923

Ten teeth were restored using the proposed method using composite material and a thread with composite material according to Black class 5; the thread was condensed horizontally (Table 2).

Table 2

Max force (compression)
N Max stress N/m ^m2 Max deformation % Modulus of elasticity
GPa 2nd group of samples, 5th grade according to BLACK 1908.51 19.7541 14.2179 0.35

Ten teeth were restored using the proposed method using composite material and a thread with composite material according to Black class 5; the threads were condensed vertically (Table 3).

Table 3

Max force (compression)
N Max stress N/m ^m2 Max deformation % Modulus of elasticity
GPa 3rd group of samples, 5th grade according to BLACK 1155.81 41.5630 16.3540 1.39

The best results were shown by an experiment where the threads with the composite were condensed vertically.

The method was tested on 31 patients. Control group 1, consisting of 26 patients with Black Class 5 and a cervical defect, underwent treatment using the traditional method without the use of composite threads. Group 2, with Black Class 5 and a cervical defect, was restored using ARKONA "Caterpillar" composite threads. Both groups were followed for 6 months and 1 year, with an additional follow-up of 18 months. This follow-up included probing and vital staining of the restorations, which revealed marginal depressurization of the composite material and hard dental tissue. The results of vital staining and probing for the two groups are presented in Table 4.

Table 4

Patient group 6 months 12 months 18 months 1 (n 26) 3% of restorations were stained around the perimeter of the filling 7% of restorations were stained around the perimeter of the filling 10% of restorations were stained around the perimeter of the filling 2 (n 31) 0 0 1% of restorations were stained around the perimeter of the filling

Research conclusion: using ARKONA "Caterpillar" composite threads in cervical restorations reduces marginal depressurization of restorations. It should be noted that the composite thread can withstand maximum tension when condensed in a vertical position, which improves the quality of dental treatment.

CLINICAL EXAMPLE

Patient U. sought oral hygiene. She complained of a filling falling out 5 days ago and pain that subsided quickly after the irritant was removed. Tooth No. 44 was treated 2 years ago. Probing revealed transient pain (Fig. 1), and positive, quickly subsiding temperature stimuli. Electrodynamics (ED) was 5 μA. Diagnosis: wedge-shaped defect, Black class 5.

Professional hygiene was performed using toothbrushes and pastes, the tooth surface was cleaned, and the color was determined using the generally accepted VITA scale (Fig. 1). The preparation (Fig. 2) was then acid-etched using an applicator for an average of 15 seconds, then rinsed with running water for 15 seconds with a saliva ejector and vacuum cleaner running. The cavity was air-dried, adhesive was applied (Fig. 3), and gently air-blown to ensure even distribution. The cavity was polymerized for 10 seconds using a standard lamp. The next step was to apply a high-flow composite and distribute it with a brush (Fig. 4). A thread with the composite was then cut to a length equal to the area of the tooth being restored (Fig. 5). The threads with the composite (ARKONA Caterpillar) were condensed vertically toward the tooth cavity (Fig. 5a), and the walls of the restored surface were formed from the composite (Fig. 6). The restoration was polished and ground (Fig. 7 and Fig. 8).

Claims (1)

A method for restoring the cervical areas of teeth, which consists in the fact that after establishing a diagnosis, professional oral hygiene is carried out and a color diagnostics of the restoration is performed according to the VITA scale, then the hard tissues of the tooth are prepared, a cavity is formed, conditioning is carried out, then adhesive treatment with a bond is carried out, polymerization is carried out, the bottom is treated with a composite of increased fluidity, distributing it with a brush, polymerization is carried out, then a polyethylene thread impregnated on all sides with the composite, equal to the area of the tooth to be restored, then threads with the composite material are laid, and the threads are placed vertically, condensed, distributing the element over the entire area of the defect in the cervical area, polymerization is carried out, then a composite is applied that matches the color of the hard tissues of the tooth, then the cervical area is modeled; the surface of the restoration is polished and ground.