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principles and tactics of treatment of patients with defects okkljuyozionnyh surfaces of a lateral teeth

To patients of the first worker spent inspection under the traditional scheme and received diagnostic models and okkljuzogrammu in position of the central occlusion, discussed a design of the future restoration.

Under anaesthesia dissected a cavity under vkladku taking into account zones bezoyo
pasnosti and anatomo-topographical features of a tooth (fig. 21). At razyolichnyh preparing variants under vkladki were guided obshcheyoprinjatymi by references.

Fig. 21. A photo of an oral cavity of patient G, 26 years, after prepayorirovanija 4.6 and 4.7 teeth under vkladki.

If necessary after excision kariozno the changed tissues nayonosili cement on a basis gidroksida calcium for an indirect covering of a pulp and lining stekloionomer for interlocking of undercuts that has allowed to standardise depth of cavities.

For reception correct occlusal mutual relation taking into account adequate functioning of masseters and visochnoyonizhnecheljustnogo a joint spent diagnostic wax modeliroyovanie on models. For this purpose defined new position of a mandible, being guided on the central line, degree of overlapping of a teeth in fronyotalnom a site (fig. 22).

Fig. 22. A photo of dentitions of patient A, 38 years, in position

The central occlusion.

New position of a mandible fixed with the help A - silikonovogo a material for occlusion registration. According to received registratam models of jaws established in an articulator, where proizvodiyoli diagnostic modelling of time restorations (fig. 23).

Fig. 23. Diagnostic wax modelling.

Then received prints from a surface of models monophasic A -

silikonovym a material (fig. 24).

Fig. 24. Prints taken out from models after the diagnostic wax

Modelling.

After necessary preparing in an oral cavity time restorations were made of a composit material chemical otverzhdeyonija by its entering into a print and positioning a print in an oral cavity on jaws (fig. 25).

Fig. 25. Time restorations from a composit material.

Ready time restorations established in an oral cavity and koryorektirovali a relief of an occlusal surface under the control elektroyomiografii masseters (fig. 26).

Fig. 26. A photo of an oral cavity of patient A, 38 years, after fiksayo

tsii time designs

Thus, reconstruction of an occlusion at the patient was carried out. poyosle adaptations and reorganisations of the chewing apparatus took out prints for manufacturing of a constant design.

At restoration manufacturing on technology IPS EMPRESS during the third visiting spent primerku vkladki. Regional adaptation and density of proximal contacts were estimated them stayobilnost. During time primerki vkladki were entered and deduced without a friction.

In the fourth visiting adhesively fixed glazurirovannuju restoration. In vreyomja the third and fourth visiting at manufacturing of restoration with poyomoshchju kopirovalno - milling manufacturing techniques of a skeleton from diyooksida zirconium with the subsequent drawing and ceramics roasting provoyodili primerku vkladki. In the fifth visiting bracing komyopozitnym by cement double otverzhdenija was made.

Vkladki, made by a method of moulding from alloys of metals and polimeyorizatsii from a composit material were fixed in the third visiting (fig. 27).

Fig. 27. Made vkladki: a method of moulding from metal; polymerisations from svetootverzhdaemogo a composite; a method litevogo porcelain pressing; g, a method of milling of a skeleton from oksida tsiryokonija with the subsequent level-by-level drawing and porcelain roasting;

Technique of adhesive bracing tselnokeramicheskih vkladok.

Internal surfaces have subjected to sandblasting chastiyotsami oksida aluminium in the size 50 microns under the pressure of 0,6 MPA. Then these surfaces pickled 10 %-s' fluoric acid during 60 seyokund. After a lavage on the same surfaces for 60 seconds put si - lant and dried it. Then a pulp cavity cleaned Pasta with pumice and pickled gel 35 %-s' phosphoric acids, washed out water and akyokuratno dried, trying to avoid peresushivanija tooth tissues. poyo
verhnost a dentine processed dentinal bondingom. Subsequently a dissected cavity and internal surfaces ceramic vklayodok covered with a layer bondinga which distributed a current of air, but not polimerizovali light. For bracing of all vkladok used tseyoment double otverzhdenija, following instructions of the manufacturer. FiksiYOrujushchy the agent subjected photopolymerizations from the different parties (on 60 sec each party).

In a week after bracing estimated all restorations by means of mirrors and probes according to the modified criteria of service of public health services of the USA (Ryge, G., 1980, 1981). The Same inspection proyovodili is repeated in a year after cementation vkladok.

Extract from a case history №9.

Patient U, 28 years, has addressed with complaints on skol seals, popayodanie nutrition between a teeth in the field of a lateral teeth on a mandible on the right and at the left. At survey defect of a seal 4.6, 3.6 teeth (fig. 28) is found out.

Fig. 28. A photo of an oral cavity of patient U, 28 years, before treatment.

Teeth has pinkish colour, as consequence of spent earlier lecheyo
nija. The percussion negative, on the roentgenogram in periapical tkayonjah is not present pathological changes, channels obturirovany gomogenno to apical apertures.

Dignoz: Defect of a coronal part of 4.6 and 3.6 teeth.

Before the treatment beginning following methods issledovayonija have been executed: studying of individual movements of a mandible with the help sisyotemy ARCUSdigma and superficial EMG masseters. At funkyotsionalnom research on ARCUSdigma are received azygomorphous dviyozhenija mandible condyles on the right and at the left, with different amplitude of shift at mouth opening (fig. 29).

Fig. 29. Amplitude of movements of the right and left condyle at

Opening of a mouth of patient U, 28 years, before treatment.

Laterotruzionnye reztsovye movements were azygomorphous (fig. 30). Bennet's movement in the right was temporal-nizhnecheljustom a joint of 9,3 mm, fir 8,5мм (fig. 31).

Fig. 30. Laterotruzionnyereztsovye movements of patient U, 28 years, before treatment

Fig. 31. Amplitude of the right and left condyle at laterotruzijah before treatment

At carrying out of an electromyography of masseters are taped nayorushenie synchronism of reduction of muscles, presence torsionnogo shift, loyokalizatsii «the chewing centre» in face-to-face group of a teeth and snizheyonie efficiency of chewing (fig. 32, 33).

Fig. 32. The basic electromyographic indicators of patient U,

28 years, before treatment

Fig. 33. Graphic display of an index of efficiency of chewing

Patients U, 28 years, before treatment

Treatment: After preparing of a cavity of a teeth 4.6, 3.6 have been received the worker and auxiliary prints. Ceramic vkladki for vosstayo

n

novlenija defects of a coronal part 4.6, 3.6 were made by a method of pressing of porcelain (fig. 34).

Fig. 34. A photo ceramic vkladok

As a fixing material for vkladok it was used to a clod

Item cement double otverzhdenija (fig. 35).

Fig. 35. A photo of an oral cavity of the patient At. 28 years, after fiksayo

tsii vkladok on 3.6 and 4.6 teeth

The patient is satisfied by results of prosthetics.

In 3 months control survey and the functional analysis dvizheyony a mandible with use ARCUSdigma also are obtained following data: symmetric shift of a condylar process on the identical
Distance at mouth opening (fig. 36), symmetric laterotruzion - nye movements (fig. 37).

Fig. 36. Amplitude of movements of the right and left condyle at opening of a mouth of patient U, 28 years, after treatment.

Bennet's movement after treatment in the right was temporal-nizhnecheljustom a joint of 6,7 mm, in left-6,5 mm (fig. 38).

Fig. 37. Laterotruzionnyereztsovye movements of patient U, 28 years,

After treatment

Fig. 38. Amplitude of the right and left condyle at laterotruzijah after

Treatments

Results superficial EMG masseters have shown stabilisation of the basic EMG indicators and rising of an index of efficiency of chewing (fig. 39,40).

Fig. 39. The basic electromyographic indicators of patient U,

28 years, after treatment

Fig. 40. Graphic display of an index of efficiency of chewing

Patients U, 28 years, after treatment

3.3.6.

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Scientific source BESHTOKOVA FATIMA HAMIDBIEVNA. the COMPARATIVE ESTIMATION of EFFICIENCY of RESTORATION of the BLASTED OCCLUSAL SURFACE of the LATERAL TEETH. The dissertation on competition of a scientific degree of the candidate of medical sciences. Stavropol - 2010. 2010

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