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7MEDICAL SCIENCES
THE PRINCIPLE OF PROSTHETICS OF PATIENTS WITH COMPLETE REMOVABLE DENTURES
ON THE LOWER JAW
Jafarov R.,
Doctor of Philosophy in Medicine Head of the Department of Stomatology Faculty of Medicine, Nakhchivan State University Nakhichvan. Azerbaijan Aliyev V.
Doctor of Philosophy in Medicine, Azerbaijan Medical University, hourly paid teacher Department of Orthopedic Dentistry.
Baku, Azerbaijan DOI: 10.5281/zenodo.7408559
ABSTRACT
In persons with a complete absence of teeth, atrophy of the tissues of the prosthetic bed increases over time, which creates negative conditions for repeated prosthetics. 70 patients with complete absence of teeth were examined, 45 of them applied for repeated prosthetics. Re-prosthetic patients were divided into two groups, the first group consisted of 25 people who were treated according to the standard method, and the patients of the second group (n=25) were treated with an improved method of local differentiated functional impression. During the examination, a study was made of compliance and functional tolerance to the load of the mucous membrane of the prosthetic bed, measurement of the width of the tongue in the region of 3.3-4.3 teeth, assessment of the function of swallowing and chewing, the rate of saliva secretion, saliva viscosity. Fixation and stabilization of new complete removable dentures were also evaluated.
Keywords: complete absence of teeth, complete removable dentures, atrophy, prosthetic bed.
With the complete absence of teeth, numerous morphofunctional changes occur in the organs and tissues of the oral cavity. Such changes are especially pronounced in the complex of tissues that form the prosthetic bed for a complete removable plate prosthesis [11, 2, 4, 5, 10, 13, 14, etc.]. Over time, these changes increase. The conditions for orthopedic treatment with complete removable lamellar dentures are deteriorating. For repeated effective treatment, adhesive agents, elastic linings are offered [3, 15, etc.], or it is recommended to repeat the basis of the old removable denture [6]. The aim of the study was to improve the methodology for the treatment of re-prosthetic patients with complete removable laminar dentures in the lower jaw.
Research results
In patients receiving prostheses for the first time, the first type of atrophy of the alveolar part of the lower jaw (30.0%) was significantly more common than in patients with repeated prostheses (12.0%) (t=1.96; p<0.05); while the second type of atrophy was significantly more often diagnosed in re-prosthetized patients (46.0%) than in primary prostheses (26.7%) (t=1.76; p<0.05). A similar situation was found in the atrophy of the mucous membrane of the prosthetic bed. Thus, the first type of atrophy according to Supple was significantly more common in patients with primary prosthet-ics (62.0%) than in patients with repeated prostheses (32.0%) (t=2.47; p<0.01), and the second type of atrophy mucosa according to Supple was significantly more often found in patients who were prosthetized again (24.0%) than in patients who were prosthetized for the first time (10.0%) (t=1.65; p<0.05). When measuring the compliance of the mucous membrane of the prosthetic bed, it was found that in patients who are
prosthetized for the first time, in the area of missing 3.6 and 4.6 teeth from the hyoid surface, the compliance of the mucous membrane is 0.54 ± 0.03 mm and 0.53 ± 0.03 mm, and in patients re-prosthetics - 0.36±0.03mm (t=4.38; p<0.001) and 0.37±0.03mm (t=4.34; p<0.001), respectively.
The mucous membrane of the prosthetic bed in re-prosthetic patients was 2.0 times more resistant to injury and withstands a load of 6.6 ± 0.5 N.
The width of the tongue in the area of missing teeth 3.3 and 4.3 in the primary prosthetics was 35.2 ± 1.2 mm, which is significantly less (t = 1.99; p< 0.05) than in the re-prosthetics - 38.3 ± 1.0 mm. Taking into account the obtained data (an increase in the width of the tongue, increased resistance of the mucous membrane of the prosthetic bed to trauma), a method of local differentiated functional impression was proposed, which made it possible to obtain a removable plate prosthesis for the lower jaw with a smaller planar "silhouette" and with increased compression of the mucous membrane in the sublingual region. So, if in the primary prosthetized area of the "silhouette" of the basis of the mandibular prosthesis was 25.11 ± 1.25 cm2, then in the repeatedly prosthetized it was 1.4 times less - 18.30 ± 2.89 cm2 (t = 2.35; p<0.05). The pressure force when taking an impression was from 2 N to 8 N, depending on the tolerance of the mucous membrane to the load. as in the group of patients re-prosthetized by traditional methods, this value was 2.12±0.24 points (t=2.23; p<0.05). indicators in the following terms: 2, 7, 14, 30, 60, 90, 180 days after prosthetics. It has been established that in primary prosthetic patients, the most pronounced positive dynamics is observed when swallow-
ing function is restored. In addition, their chewing efficiency increases already on the 14th day. by the end of the first month (by the 30th day), chewing efficiency improves (from 42.48±1.18% to 46.48±1.15%, t=2.43; p<0.05) food elimination (from 40.84±1.25 seconds to 37.68±0.88 seconds, t=2.07; p<0.05) day) the chewing function improves (the chewing time from 38.88±0.88 seconds is reduced to 36.12±0.42 seconds, t=2.82; p<0.01), and chewing efficiency increases (from 48.24±0.78% to 52.52±0.83%, t=3.74; p<0.001). Swallowing significantly improves on the 30th day (from 752.00±88.28 mg of food substance to 412.00±50.89 mg of food substance, t=3.34; p<0.01). When comparing the indicators in primary and re-prosthetized patients, it was found that in re-prosthetized patients, swallowing function is restored already on the 7th day (t=2.12; p<0.05). When comparing functional indicators in the dynamics of adaptation in patients, re-pros-thetized according to the standard method, and in patients prosthetized according to the improved method, it was found that the functions of chewing and swallowing in patients prosthetized by the improved method are significantly better already on the second day of using new prostheses (t=4.07; p<0.001 and t=2.33; p<0.05, respectively). In patients prosthetized according to the improved method, masticatory efficiency during the entire observation period was at a higher level (54.92±0.73%) compared with patients prosthetized according to the standard method (51.54±1.04%, t=2.65; p<0.05), and chewing time was significantly shorter (32.28±0.62 sec. vs. 34.38±0.38 sec., t=2.87; p<0 01). In primary prosthetic patients, the rate of saliva secretion begins to return to normal (after a sharp increase on the second day of 0.66 ± 0.07 ml / min) only after 2 months (on the 60th day to 0.46 ± 0, 03 ml/min, t=3.68; p<0.01), and saliva viscosity increases from 2.15±0.13 rel. units up to 2.75±0.14 rel. units (t=3.14; p<0.01) only after 3 months (Fig. 2). In patients re-prosthetized according to the traditional method, the rate of saliva secretion is restored by the end of the second week (from 0.65±0.03 ml /min to 0.48±0.03, t=3.80; p<0.001), and saliva viscosity normalizes by the second month (from 2.22±0.15 rel. units to 2.75±0.18 units, t=2.20, p<0.05). 0.03 ml/min to 0.46±0.02 ml/min, t=2.60; p<0.05), saliva viscosity increases in the second month after prosthetics (from 2.91±0.12 relative units up to 3.45±0.15 relative units, t=2.78, p<0.05). When comparing the indicators in primary and re-prosthetized patients, it was found that salivation function is restored in re-prosthetized patients already on the 7th day (t=2.24; p<0.05). When comparing functional indicators in the dynamics of adaptation in patients, re-prosthetized according to the standard method, and in patients prosthetized according to the improved method, it was found that the rate of salivation in patients prosthetized according to the improved method and having a reduced prosthesis base is significantly lower on the second day than in patients pros-thetized according to the traditional method (t=2.36; p<0.05), and saliva viscosity is significantly higher (t=3.50; p<0.01). This is probably due to the smaller volume of prostheses, which irritate the mucous mem-
brane of the prosthetic bed less, reducing the reflex irritation of the salivary glands as a foreign body. tissues of the prosthetic bed, the second type of atrophy of the alveolar part of the lower jaw according to Keller is more common, the compliance of the mucous membrane is reduced, but its functional resistance to load is 2 times higher. This fact allows for soft, bilateral loading of the mucous membrane in the sublingual region during the manufacture of a functional impression, which improves the fixation and stabilization of new complete removable lamellar dentures by 1.5 times and reduces the time for adaptation to them.
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THE USE OF REINFORCING QUARTZ MESH IN THE MANUFACTURE OF PLATE REMOVABLE
DENTURES
Panahov N.,
Doctor of Medical Sciences. Professor Department of Orthopedic Dentistry Azerbaijan Medical University Baku, Azerbaijan Aliyev T.,
Doctor of Philosophy in Medicine, assistant Department of Pediatric Dentistry Azerbaijan Medical University Baku, Azerbaijan Aliyev M.
Doctor of Philosophy in Medicine Department of Therapeutic Dentistry, Assistant Azerbaijan Medical University Baku, Azerbaijan DOI: 10.5281/zenodo.7408547
ABSTRACT
In the practice of orthopedic dentistry, when using partially removable acrylic dentures, patients very often come to the clinic with breakage of partially removable acrylic dentures in places where there are pronounced exostoses on the jaw from the lingual side. We used a method to solve the problem of adaptation and frequent breakdowns of the prosthesis by using reinforcing quartz mesh. The results of orthopedic treatment were evaluated.
Keywords: fracture of the basis of a lamellar prosthesis, reinforcement of prostheses, reinforcing quartz mesh, repair of prostheses.
A 64-year-old patient applied to the Department of Orthopedic Dentistry of the Azerbaijan Medical University for prosthetics. The main complaints are difficulties in getting used to a removable prosthesis in the lower jaw (pain), frequent breakdowns and, as a result, the inability to use it. Prostheses were made repeatedly and in different medical institutions, but there was no positive result. He notes that only in the first year of using the prosthesis he went to the doctor about a fracture of the basis 3 times.
Objectively:
on the lower jaw, a defect in the dentition 1 class 2 subclass (according to Kennedy); there are only teeth 44,43 and 33,34,35 covered with metal crowns; a significant part of uneven atrophy of the alveolar processes and pronounced exostoses on the lingual side. It was exostoses that were the zone of injury to the mucous membrane by the edge of the prosthesis and contributed to frequent breakdowns of the plastic base. The patient's state of health did not allow improving the conditions for prosthetics through surgical preparation - excision of exostoses. To eliminate the shortcomings of the previous prosthetics, isolation of the bone protrusions on a plaster model was carried out in order to exclude the increased pressure of the prosthesis on them. Also, the basis of the lower removable prosthesis was strengthened by reinforcement. The most commonly
used methods for strengthening the bases of the prosthesis is the reinforcement of the acrylic base with a standard metal mesh.
This method, along with advantages, has significant drawbacks: the mesh can be subject to corrosion. But the most significant drawback is the absence of a chemical bond between metal and plastic, so the retention of the reinforcing element occurs only due to mechanical retention. In such cases, the optimal, in our opinion, is the use of a quartz mesh, which is designed specifically for reinforcing acrylic prostheses [1-4]. A particular advantage is that this mesh is able to chemically bond with acrylic base plastics due to the fact that it is pre-impregnated with a special methacrylate resin binder. It should be noted that various QUARTZ SPLINT structures are produced for reinforcing pros-theses: WOVEN (woven tape) (different sizes) or MESH (mesh) [5]. We used a grid because it allowed us to individually select the required size according to the parameters of the jaw. Treatment plan: fabrication of a partial plate denture with a plastic base reinforced with QUARTZ SPLINT MESH and cast retaining clasps. Technically, reinforcement is carried out as follows: after plastering the model into a cuvette and melting the wax, they begin to prepare the reinforcing mesh. To do this, cut a ribbon of the desired width and length from a standard elastic blank, the size of which is 5.5x8.0 cm. Then, on a plaster model, the workpiece is
