Dental implantation in the absence of bone tissue (atrophy)

• What is atrophy
• Types of atrophy
• Osteoplasty
• Implantation methods
• Alternative Methods
• Prices
• Work examples
• Doctors
• Reviews

Bone atrophy is the process of cell destruction due to disruption of tissue nutrition. The process can be stimulated by tooth loss, gum disease, endocrine diseases, infections, and the age factor. Implantation with a lack of tissue is difficult: there is no way to correctly position and fix the implant. Implantation is carried out using the classical method (with mandatory preliminary osteoplasty) or according to the protocol with immediate loading (bone grafting is indicated only in conditions of severe atrophy).

• When used:
  missing 1 or more teeth due to bone deficiency
• Type of anesthesia:
  local anesthesia
• Procedure time:
  from 15 minutes
• Treatment period:
  up to 4 months
• Healing period:
  up to 7 days
• Age restrictions:
  from 18 years old

What is bone atrophy

Bone atrophy, or loss, is a result of tooth loss. Due to uneven load, the jaw loses volume - in the first year, tissue loss is 25%.

Atrophy can be stimulated by gum disease, endocrine, infectious diseases and the age factor. In patients, the blood supply to the jaw deteriorates, there is a lack of oxygen - the pressure on the tissue changes. The central or spongy layer, which has a porous structure, is subject to the process.

Jaw deformation has different intensity:

• I degree.
  The blood supply is not impaired. It is possible to install a classic implant.
• II degree.
  The mucous membrane contracts. The operation is performed after plastic surgery.
• III degree.
  The contour is smoothed from the chin and in the oral cavity. Bone augmentation is a must.

The results of the deficiency are expressed in deterioration of speech, changes in facial proportions, and the appearance of wrinkles in the oral area. An advanced degree of atrophy causes displacement of the dentition, loss of adjacent or opposite units. Classical implantation is not possible with bone atrophy.

How to use prosthetic teeth for periodontitis and periodontal disease

Periodontitis and periodontal disease are gum diseases with different origins. The first pathology occurs due to pathogenic microorganisms, and the cause of the second is a metabolic disorder in tissues. The processes in both cases lead to loose teeth, so it is much more difficult to prosthetize teeth. However, modern dentistry can cope with such situations and return the aesthetics of a healthy smile to the patient.

Types of bone atrophy in the upper and lower jaw

Destruction of the bone structure of the upper jaw is fraught with injury to the closely localized maxillary sinus. The cells in this area have a loose structure, the bone is thinner, and is actively resorbed in the area of ​​the masticatory elements. When fixing long implants, there is a risk of injury to the sinus membrane, which can stimulate its rupture and the development of sinusitis or chronic runny nose.

The Schroeder classification identifies three types of atrophy of the upper jaws

:

1. The jaw tubercles are pronounced, physical abnormalities are not visible, the mucosa is noticeably curved, the palate is deep. Implantation is possible without complications.
2. The alveolar processes are not clearly expressed, the palate is of medium depth. Installing implants using the classical method is doubtful, but using a one-stage method is possible.
3. The cells are seriously atrophied, the alveolar processes are smooth, the palate is flat, the fold at the level of the palate does not hold its shape. Fixation of classical implants is not possible; it can be done in one stage, depending on the location of the defect.

The tissue of the lower jaw is dense from below and does not decrease so rapidly, but as atrophy progresses, the dentist is faced with the problem of the nearby localized mandibular nerve (it is located under the roots of natural elements). Nerve injury can cause complete or partial loss of sensation in the lower facial part.

According to Keller, there are four types of mandibular atrophy

:

1. The tubercles of the alveoli are visible on the jaw, a fold of the mucous membrane is noticeable. You can install classic or one-stage implants.
2. The ridge becomes sharper, and muscles are attached at its base. Installation of a classic implant may cause discomfort, but a one-stage implant does not cause complications.
3. The jaw of patients with early removed lateral teeth - the alveoli are thinned, the volume in the center does not decrease. It is not possible to implant classical artificial roots; one-stage ones are possible, but there is a fear of the implant shifting when chewing food in case of a single defect.
4. In the area of ​​the frontal incisors, the bone is clearly atrophied; the lateral row is not affected. Implantation for such bone tissue atrophy is possible using a combined method.

Disadvantages and contraindications

In addition to a sufficient number of advantages, there are also disadvantages, which include:

• If the material is fragile or poorly made, then the dentures will not last long. Approximately 4 years.
• Not all prosthetic methods are suitable for replacing chewing rows, which is also due to low strength and wear resistance.
• It should not be used if you have bad habits, malocclusion, or serious diseases, especially infectious ones.
• Noticeable location of fasteners that will be located on the lingual side.

Osteoplasty

Classic dental implantation for bone tissue atrophy (height less than 10 mm) is preceded by bone augmentation surgery - osteoplasty. The procedure is carried out to ensure stable fixation of the implant and to avoid aesthetic complications during subsequent restoration of the element with prosthetics. For this purpose, the implantologist acts using one of the methods:

• Sinus lift.
  The operation is performed on the upper jaw - the doctor lifts and displaces the maxillary sinus, making room for new bone.
• Guided bone regeneration.
  Bone material is added, covered with a membrane and sutured until it fuses with the jaw.
• Replanting bone blocks.
  The person's own bone material is used. It is removed from the lower jaw in the area of ​​the wisdom teeth. The bone block is fixed with screws, bone granules are placed around it, and a membrane is attached.
• Splitting of the alveolar ridge.
  The dentist cuts the appendage and increases its thickness using a graft or artificial material.

It takes 3-6 months for the new bone to heal. It is possible to combine osteoplasty and implantation operations. The decision-making algorithm for performing osteoplasty simultaneously with implant fixation is as follows:

1. Studying the possibility of positioning the artificial root in the correct position (using wax-up and surgical templates).
2. Choice of osteoplasty technique. Depends on the degree of bone atrophy and its spread in height or width.
3. If it is impossible to achieve stability of the artificial root with the existing bone volume, the extension is carried out in a separate stage.

Types and causes of pathology - etiopathogenesis

Microstomia is of two types - congenital and acquired. In the first case, it develops against the background of systemic disorders in the mother’s body during her pregnancy or directly in the child at the stage of its intrauterine development. That is, the anomaly becomes obvious immediately after the birth of the baby. It must be admitted that this form is extremely rare. More often it is an acquired anomaly, and its etiology is usually associated with the following conditions:

• permanent mechanical injury to the soft tissues surrounding the oral opening from the inside,
• unsuccessful plastic surgeries,
• surgical interventions performed to remove tumors or for osteomyelitis,
• serious facial burns,
• purulent and ulcerative processes,
• tuberculous lupus,
• chronic scleroderma.

Burns and scars can cause pathology.
An unpleasant feature of this pathology is that a person is deprived of the ability to articulate normally. This often creates certain difficulties when eating, while talking, and especially when visiting the dentist, where you need to open your mouth wide.

How to install implants in conditions of bone deficiency

Classic dental implantation in case of insufficient bone tissue is preceded by bone augmentation surgery or sinus lift. Before implantation, a period of engraftment of the grafting material (4-6 months) is waited. During this period, the patient is fixed with a removable prosthesis.

If I and II degrees of loss are diagnosed, implantation and replanting of cells can be organized simultaneously. It is possible to exclude bone grafting if all or almost all teeth in a row are missing - artificial roots are implanted using a one-stage protocol at an angle (into the deep bone layers).

Nesterenko Alexey Pavlovich Implant surgeon, doctor of the highest category

Can implantation stop cell loss?

In addition to solving the problem of aesthetics and restoring the functionality of the dentition, installing implants helps prevent resorption. Due to the implants, the load on the jaw is distributed evenly, internal metabolic processes in the cells are activated, cellular nutrition is established - the atrophy process stops.

Restoration of molars – defect included

An included defect means that there are living teeth on either side of the defect. In this case, the recovery options available to the patient are:

• Removable dentures
• Implantation
• Fixed prostheses (bridges)

A bridge can be used to restore molars if the defect extends to 1-2 missing teeth. In some cases, orthopedists can use a bridge of three artificial teeth, but this depends on the individual clinical picture.

Prosthetic bridges for molars are made from various materials. So, to restore the chewing area, they most often choose:

• Metal-ceramics - the basis of artificial teeth made of metal, on top - an aesthetic ceramic veneer. This is a popular and widespread option due to its affordability.
• Zirconium is the choice of patients who are focused on premium prosthetics. In such an orthopedic design, the base is made of zirconium dioxide. The top part is ceramic.

All-ceramic dentures for the chewing zone are not used due to their relatively low strength indicators.

Classic delayed load protocol

Classic surgery is performed when there is sufficient bone tissue (at least 10 mm) in two stages. The protocol involves delayed loading on the implants: they need time to fuse with the jaw.

An implant with dismountable elements (an abutment and an intraosseous part) is fixed using the method of detaching a gum flap - the gum is cut and sutured.

2-6 months after the operation, the implant is opened, a gum former is placed on it, and two weeks later - an abutment and an individual permanent prosthesis.

1

Implantation

Implantation

2

Prosthetics

Installation of a butterfly prosthesis or temporary crown (if it is possible to remove the bite)

4-6 months

Installation of abutment and permanent crown

Osteoplasty in case of a lack of tissue is organized before the implantation of titanium roots or simultaneously. The operation is justified for single defects. If the patient has multiple defects or complete edentia, classical surgery is difficult due to acute bone loss and the need to build up a large volume of bone.

If there is not enough bone tissue for implantation, classical implants in some clinics are implanted without tissue augmentation. The doctor suggests:

• install titanium roots only in the frontal zone (signs of atrophy rarely appear here);
• fix the implant in the area of ​​the posterior wall of the maxillary sinus at the end of the dentition, behind the maxillary sinus (the height of the bone here reaches 20 mm);
• implant short and thin implants - implantation is possible in case of atrophy of the bone tissue of the lower jaw, without touching the jaw nerve.

But the described methods are unreliable: the risk of weak primary stability of the implant and its loosening cannot be excluded. The most reliable method in case of severe atrophy of bone tissue in the upper jaw can be pterygoid implants

ROOTT. These implants are longer than classic ones and are implanted into the zygomatic bone, bypassing the maxillary sinuses. Pterygoid implantation differs from zygomatic zygomatic implantation in its safety and low trauma.

When performing an operation, it is important to use implants from the same manufacturer (with the same impurities - metals in a titanium alloy). When fixing implants, impurity metals of different brands in the acidic environment of the oral cavity may not combine and cause allergies, galvanic syndrome, and rejection of titanium roots. The ROOTT implant system is unique: a range of implants from one manufacturer is used in all clinical cases.

Differences and characteristics of diseases

Periodontal disease occurs when there is a metabolic disorder, which leads to a failure in the process of renewal of gum tissue. This, in turn, causes loose teeth. In the early stages, the pathology is almost impossible to detect, since there is no pain or bleeding. Other signs include:

• bad breath is noticeable;
• gums become pale;
• the roots of the teeth are exposed.

Important: without treatment, the patient may completely lose teeth.

Periodontitis is different in that it is caused by gum inflammation and in most cases it is a consequence of bacterial gingivitis. The disease has characteristic symptoms:

• swelling and severe pain;
• bad breath;
• redness of the gums.

The acute form is manifested by bleeding and constant pain. Without treatment, gum tissue erodes and cannot hold teeth in place. These pathologies have several treatment options, which are prescribed by the dentist. Advanced stages definitely require one of the prosthetic methods.

One-stage protocol with immediate loading

A one-stage operation is performed if 3 or more teeth are missing. The protocol helps avoid tissue buildup. Single-component (not divided into an abutment and an intraosseous part) implants are installed in the deep layers of bone, which are not subject to resorption. For a larger area of ​​contact between the bone and the titanium root, the product is fixed at an angle, identifying areas of bone tissue that are less susceptible to atrophy.

The implant is implanted using a minimally invasive method: it is screwed through a puncture in the gum. The top of the artificial root (abutment) rises above the gum - the dentures are installed immediately after implantation (on 2-3 days). After a year, the lightweight adaptive prosthesis is replaced with a permanent one.

1

Implantation

Implantation of 8-12 implants into deep bone layers (without bone grafting)

2 - 3 days

2

Prosthetics

Fixation of an adaptive prosthesis with a titanium arch and metal-plastic crowns

in a year

Permanent prosthetics

One-stage dental implantation for abnormal bone deficiency (less than 2.5 mm) is impossible without tissue augmentation. The operation is not performed for large maxillary sinuses, which cannot be avoided when installing implants at an angle.

Among the complexes of the one-step protocol:

• All-on-4.
  The technique is used if the patient is missing all the teeth on the jaw. The dentition is restored using 4 implants (2 in the smile area and 2 on the sides). To avoid complications, “all-on-4” implantation for atrophy of the bone tissue of the upper jaw is carried out with caution, taking into account the close location of the maxillary sinuses.
• All-on-6.
  A modernized version of the All-on-4 method (implantation for severe bone deficiency). The increased number of supports (6 instead of 4) expands the scope of application of the method and allows for more stable fixation of the structure.
• Basal implantation.
  The method is used for acute bone loss. Suitable for missing three or more teeth in a row. For complete edentia, 8-12 implants are used on one row of teeth. They are fixed into the deep layers of the jaw bone.

All-on-4 and all-on-6 protocols involve the use of surgical templates to determine the location of the implant, without taking into account the condition of the bone. With basal implantation, templates can be dispensed with; this expands the scope of application of the technique. Implantologists at the ROOTT Clinic, using computed tomography, select suitable jaw sites for fixation with sufficient bone volume. If circumstances require it, a couple of additional implants are installed free of charge - if one of the titanium roots does not take root, there are enough implants left for prosthetics.

Medical Internet conferences

Relevance: Prosthetics for patients with acquired jaw defects is one of the most difficult tasks in dentistry. Due to the complexity of the relief of the prosthetic bed, and the variety of clinical cases, it is necessary to have a clear understanding of the technique of prosthetics for such defects and the design of dentoalveolar prostheses.

Goals and objectives : To become familiar with the technique of prosthetics for patients with acquired defects of the upper and lower jaws. As well as the design features of dentures.

Article: Prosthetic designs used to treat patients with jaw defects, depending on the topography of the defect of the face and jaws, are classified into intraoral dentofacial ones, as well as combined ones, combined with extraoral facial epitheses.

Orthopedic structures are divided into preoperative and postoperative (post-resection) jaw prostheses.

The designs of ectoprostheses used at different stages of prosthetics have significant design differences, which is associated with their functional purpose.

Goals and objectives of direct prosthetics:

— formation of the future prosthetic bed.

- prevention of the formation of keloid scars.

— reposition and fixation of the fragments of the lower jaw remaining after the operation.

- restoration of speech and chewing disorders.

- prevention of severe facial deformations and changes in appearance.

- awareness of the therapeutic and protective regime.

Technique of prosthetics for patients with jaw defects.

The existing principles of providing orthopedic dental care to patients with acquired jaw defects are based on the use of effective design solutions when creating prostheses and methods for their manufacture, and improved dental materials. This concept and model of complex rehabilitation is multi-stage and for almost every stage of treatment of patients with acquired defects of the upper or lower jaw requires the manufacture of several medical devices using special and auxiliary materials and technologies.

Design features of dentures.

Features of fixation.

The effectiveness of orthopedic treatment of patients with facial and jaw defects largely depends on the reliability of fixation of replacement prostheses, which is optimally ensured in the presence of teeth.

When choosing a design and planning treatment stages, you must:

— Make maximum use of remaining teeth, even mobile ones, by splinting them first.

— Take into account the conditions that have formed after surgical intervention, and to improve the fixation of the prosthesis, make maximum use of the retention properties of the alveolar processes, bone fragments, soft tissues, and cartilage that limit the defect.

In the early postoperative period, in the complete absence of teeth and difficult anatomical and topographic conditions of prosthetics, when it is impossible to achieve high-quality fixation of the structure using conservative methods, surgical methods are used to strengthen the disconnecting prostheses.

The number of fixing elements of a dentoalveolar prosthesis should increase as the volume of the structure increases.

Methods aimed at increasing retention and stabilization of dentures are very diverse. As a rule, clasps (retaining and support-retaining), artificial crowns, magnetic retainers, telescopic, locking and beam systems are used as fixing elements of dentures. It is especially important, taking into account the basics of biomechanics, to use indirect fixators (kipmakers), which protect the prosthetic structure from tipping over.

The correct choice of fixation method is determined not only by the fixation characteristics of the device, but also by the ability to redistribute functional loads, which reduces the risk of overloading the periodontal tissues of abutment teeth. The rational use of fixation methods, taking into account existing individual characteristics and anatomical conditions, ensures the restoration of the basic functions of the dental system, facial aesthetics and improvement of the psychological state of patients.

In the case of complete absence of teeth, the structure of the jaw prosthesis is fixed using the remaining anatomical formations. In most clinical cases, fixation of jaw prostheses in the complete absence of teeth is difficult and sometimes impossible, so it is advisable to use dental intraosseous or magnetic implants. Along with this, it is necessary to take into account that creating reliable fixation using artificial supports is not always possible in cancer patients, especially those who have received radiation therapy and chemotherapy, since relatively often they need surgical correction due to the progression of the underlying disease. In addition, the formation of scars and the loss of a large mass of the bone skeleton of the upper jaw do not always allow the use of dental implants in patients with defects of the upper jaw caused by trauma and benign neoplasms. In such cases, the obturating part of the jaw prosthesis can be used as a retainer.

Arutyunov A.S. in 2012, a model of the defect of the upper jaw with different thickness and compliance of the free edge of the mucous membrane of the prosthetic bed for the obturating part of the dentoalveolar prosthesis was proposed, the advantages of one or another configuration of the obturator holding the maxillary prosthesis on the upper jaw with partial and complete absence of teeth were determined. Based on the established dependence of the forces of insertion and removal of the obturator of the jaw prosthesis on the properties of the elastic base materials and in accordance with the individual characteristics of the geometry of the defect of the upper jaw, it is possible to calculate the optimal design parameters of the obturator. This approach makes it possible to design an obturator of a dentofacial prosthesis in the presence of teeth of the “lid” type, without penetrating into the space of the anastomosis between the oral and nasal cavities, and in the absence of teeth of the “plug” type, which increases the efficiency of the jaw prosthesis due to the optimal design parameters of the obturator.

This is especially effective when a rigid base polymer is combined in the design of a prosthesis with an elastic polymer of acrylic nature or a special silicone material.

Often, the clinical situation of a postoperative defect in the complete absence of teeth does not allow the use of obturators made of rigid structural materials due to the thinned mucous membrane lining the anastomosis, to ensure sufficient fixation of the structure of the maxillary prosthetic obturator on the upper jaw. To eliminate this problem, it is recommended to use a jaw prosthetic obturator, the base of which is made of a rigid material, and the full obturator is made of an elastic structural material.

This design allows for retention and stabilization of the jaw prosthetic obturator, taking into account the elasticity of the mucous membrane of the edge of the defect (fibrous ring of the anastomosis) of the upper jaw and the structural material of the obturator.

Along with this, to improve the fixation of jaw prostheses in the complete absence of teeth, the use of fixatives of a chemical nature is indicated - films, adhesive gels, powders that swell in the oral cavity and provide stickiness and adhesiveness, anti-inflammatory and wound-healing effects, capable of compensating for the lack of congruence between the inner surface of the prosthesis base and relief of the mucous membrane of the prosthetic bed. These products are widely used by patients with large plate dentures and complete absence of teeth.

In case of jaw defects, there is often a need for combined prosthetics, when fixed dentures are used to splint teeth and provide fixation of removable dentures.

Features of the manufacture of dentoalveolar and maxillary prostheses for both the lower and upper jaws are that at the first stage it is necessary to make a construction base (metal and plastic) with support-fixing elements, which is carefully fitted in the mouth and used in determining the central occlusion and positioning of teeth and checking the design of the prosthesis. This approach makes it possible to facilitate clinical stages and accurately adjust the boundaries of the prosthesis, especially in the area of ​​scar tissue.

However, in a number of cases, experienced orthopedic dentists make dentures without the fitting stage, if there are antagonizing pairs of teeth that make it possible to fix the height of the lower part of the face and the position of the lower jaw in the usual occlusion.

The objectives of maxillofacial prosthetics, the choice of a replacement structure and the planning of prosthetic features are determined by the volume of surgical intervention:

- on the upper jaw - during resection of the alveolar process, unilateral and bilateral resection of the body of the upper jaw.

- on the lower jaw - during resection of the alveolar part, the chin with loss of continuity of the bone, while maintaining the continuity of its body, half of the jaw and its complete removal.

Prosthetics of defects of the upper jaw.

Resection of the alveolar process, one- and two-sided resection of the body of the upper jaw are the main surgical interventions on the upper jaw, leading to the formation of defects of the same name.

Before taking an impression of the upper jaw, which has an oronasal anastomosis, it is necessary to replace the defect with a long gauze swab, previously soaked in a glycerin mixture. The tampon is placed sequentially in continuous layers, taking into account the remaining anatomical formations, and carefully so as not to push it into the nasopharynx, the defect is completely isolated. With a correctly placed tampon, the impression material does not penetrate into the undercuts of the nasal cavity and maxillary sinus. Otherwise, when removing the impression, part of the impression mass may come off, it may be retained in the niches formed after surgical intervention, which subsequently threatens inflammation, the etiology of which doctors do not immediately and not always recognize. Sometimes only surgical revision allows one to identify the cause of inflammation and stop it.

Using a thermoplastic mass, a standard tray is adapted to the oral cavity, active and passive movements are used, and the edge of the impression is formed along the border of the transitional fold and in the area of ​​the defect. The spoon is inserted into the mouth and pressed all the way to the jaw. Active and passive movements are used to form the edge of the impression along the border of the transitional fold and in the area of ​​the defect. The spoon is removed until the mass has completely hardened and the outer gauze is removed. An impression mass is applied to the surface of the preliminary impression, covered with an inner layer of gauze. The spoon is inserted into the mouth and pressed against the jaw. After structuring the impression mass, the impression is removed from the oral cavity and a plaster model is made from it, on which the areas to be isolated, as well as the remaining teeth, are covered with adhesive plaster or lead foil. If the model has a complex defect relief, then use a parallelometer to fill in the undercut areas. An individual spoon is prepared according to traditional methods

An individual spoon is fitted, the edges are formed with thermoplastic mass. Functional tests are performed under the pressure of the forces of the masticatory muscles and under the supervision of a physician. The impression is made using impression material. After its structuring, the impression is removed from the oral cavity along with a tampon, a fragment of which connected to the impression is cut off. The remaining part of the tampon is removed with tweezers. The upper jaw defect is washed with an antiseptic solution.

There is another method of taking an impression, when the alginate impression mass is applied to a standard tray and then covered with two layers of gauze. The tray is placed on the upper jaw and, after structuring the impression mass, removed from the oral cavity. Despite the simplicity of the method, the orthopedic dentist must have extensive experience in order to avoid the complications described above.

Arutyunov proposed a method for obtaining an anatomical impression with an alginate mass using a standard spoon, according to which a plaster model is made. An obturator is modeled on it by lining the positive image of the palate defect with wax while simultaneously modeling the resected alveolar ridge. The resulting composition is placed in the oral cavity and adjusted by filling any gaps with wax. An impression is obtained from which an individual spoon is made. The resulting spoon is adapted to the oral cavity using functional tests. Retention metal staples are installed in a wax obturator fixed in the jaw defect. A corrective layer of silicone impression mass is applied to the resulting composition, after which an impression is obtained using a previously made individual tray with a base layer of the same mass added to it.

Prosthetics for mandibular defects.

The effectiveness of prosthetics for patients with acquired defects of the lower jaw largely depends on the etiology, topography and extent of the defect in the lower jaw, as well as changes in the mucous membrane.

In the modern world, the approach to replacing defects of the lower jaw has changed significantly. Successfully performed osteoplastic operations make it possible to obtain an optimal prosthetic bed for prosthetics.

However, traditional orthopedic treatment of patients with dentures with polymer bases is not always effective, this is due to the occurrence of functional overloads of the tissues of the prosthetic bed when biting and chewing food. The load falls through the artificial teeth onto the base or frame of the prosthesis, which leads to the appearance of a deflection zone under the saddle or base. In the zone of concentrated load, tension occurs not only in the soft tissues, but also in the bone around the graft or implant, which leads to disruption of tissue trophism and their subsequent atrophy, as well as scarring of the mucosa.

To avoid the above complications, Astashina proposed an alternative method of prosthetics for patients using dentoalveolar prostheses with multi-thickness solid titanium frames after plastic preparation of the prosthetic bed. The use of such a design prevents the occurrence of functional tissue overload.

The technique for making such a design consists of taking an impression, making and analyzing diagnostic models, planning the design of the prosthesis in accordance with the recommendations of the maxillofacial surgeon. Next, a plaster working model is made, and an individual tray is made from it, and it is fitted in the oral cavity. The boundaries of the spoon are clarified visually, and then fixation is achieved using functional tests. The functional impression is obtained using alginate or silicone impression materials, the choice of which is based on the pliability of the mucous membrane. To create volume, the edges of the working print are edged.

Subsequent stages include obtaining a functional impression from the lower jaw and an anatomical impression from the upper jaw, making working models from superplaster, determining the central occlusion or central relationship of the jaws. For microstomia, it is necessary to use wax templates with rigid bases. The dentofacial prosthesis is constructed in an articulator, and the spatial arrangement of the jaws is determined by the upper jaw and transferred using a face bow.

The main difference between creating prostheses of different thicknesses with titanium frames is the peculiarities of the stage of formation of the wax composition. According to standards, the thickness of the saddle part is 0.5 mm, and the dimensions of the arc are 4.0x2.0 in diameter, while the edge of the base is edged with a wax blank in the form of a cord with a diameter of 0.8 mm.

When modeling the frame or base of a prosthesis to replace a defect, it is rational to increase their thickness to 2.0-2.5 mm in the following areas: in the area of ​​the saddle located above the graft or implant, as well as in the zone of transition of the structure’s saddle into the arch. The edge of the base stop must be edged with a wax blank with a diameter of 1.0-1.2 mm. This approach ensures a reduction in the level of developing functional stresses in the area of ​​the graft or implant. Since titanium alloy has a low specific gravity, such an increase in the volume of the structure frame does not negatively affect the functions of the dentofacial system.

After the wax reproduction modeling stage, the frame of the removable structure is cast on a fireproof model. Minor casting defects (cracks, pores) are eliminated using solid-state laser welding and titanium powder.

Next comes the fitting of the frame on the model and in the mouth. Installation of artificial teeth. It is better to carry out this stage in the articulator. When checking the denture in the oral cavity, you should pay attention to the articulation of the lower jaw. Next, the wax is replaced with plastic. Before handing over the work, the prosthesis must be carefully ground and polished.

Conclusion: We examined the technique of prosthetics of jaw defects with dentoalveolar prostheses. The advantage of orthopedic treatment of patients using dentofacial prosthetic structures made on the basis of titanium alloys is their durability, the possibility of reusing frames in case of loss of supporting teeth and correction of the structure in order to reduce the adaptive period.

Alternative Methods

Removable dentures Recommended if there are absolute contraindications to implantation or if there is a limited budget

ReSmile Modern technology for rapid restoration of teeth with complete edentia with the installation of a permanent prosthesis

Mini-implants Removable prosthetics with mini-implants MDI

Article Expert

Nesterenko Alexey Pavlovich Surgeon-implantologist, doctor of the highest category

Work experience: more than 11 years

Are there any restrictions for dental prosthetics without grinding?

Like many other orthodontic procedures, this one has its limitations and contraindications. These include:

1. Presence of cancer.
2. Mental disorders.
3. Problems with the cardiovascular system.
4. Blood diseases (poor clotting).
5. Physical exhaustion, weakness due to recent illnesses and attacks.
6. Presence of sources of infection in the oral cavity.
7. Inflammation in the gums.
8. An allergic reaction to the material from which the prosthesis is made.

These are the main points that should be taken into account when installing prostheses without contact.

So, the types of prosthetics, contraindications have already been described above, and the advantages and disadvantages of non-contact installation of a prosthesis have been indirectly mentioned.

Prices

The cost of the operation depends on the chosen technique. The most expensive will be implantation with preliminary osteoplasty: the process is labor-intensive and expensive artificial material is used.

A classic operation and a protocol with an immediate load will cost approximately the same if several elements need to be restored. When a complete or almost entire row of teeth is missing, one-stage implantation is cheaper due to fewer implants and a reduction in the number of operations.

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Etiology of the disease

Forms of microstomia:

1. Congenital - a rare form, develops due to a disorder in the development of the fetus inside the womb.
2. Acquired - appears during life due to certain reasons.

Acquired microstomia can never become hereditary or be transmitted through contact with a sick person.

Reasons for the acquired form:

• mechanical impact on areas that are located near the mouth;
• operations to change appearance;
• surgery to remove a tumor on the face or for osteomyelitis;
• burns that may be localized on the face;
• purulent inflammation, ulcerative processes;
• tuberculous lupus;
• systemic scleroderma.

A person with microstomia is limited in opening their mouth, eating, and even speaking.

Work examples

All works

Implantation for 2 jaws with artificial gum

Complete restoration of the upper jaw on implants

Complete restoration of the upper jaw using a zygomatic implant

Stage III periodontal disease: complex dental implantation Restoration of both jaws in 4 days

Sinus lifting with simultaneous implantation

Implantation of both jaws with ROOTT implants for stage II periodontal disease

Restoration of two jaws with one-stage implantation using sinus lift

Sinus lift with simultaneous implantation

All works

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Microstomia correction

Elimination of pathology is possible by orthopedic or surgical means. The dentist selects treatment tactics taking into account the clinical picture.

Before the correction begins, a number of activities are carried out:

• visual assessment of the oral cavity, examination using professional technologies;
• removal of dental plaque;
• treatment of caries and other dental diseases.

Symptoms you can't ignore

A person who does not have specialized education may note such symptoms as:

• inability to eat and bite;
• external changes on the face, features become rougher;
• the mouth becomes smaller.

During examination, the doctor may note:

• changes in the teeth and jaw system;
• narrow mouth opening.

Symptoms of microstomia in the photo:

Forecast

Microstomia is a serious disease. The sooner the patient seeks help, the lower the likelihood that the defect will change its appearance.

Early surgical or orthopedic treatment will not leave a trace of the disease.

Long-existing scars cause deformation of the dentition and facial disfigurement, which leads to mental disorders. All this makes it difficult to choose a design and perform orthopedic manipulations. Sometimes it is difficult for a doctor to establish psychological contact with a patient.

The prognosis is also influenced by the patient's age.