Orthopedic Restoration of Partial Tooth Loss and Ways of Its Improvement

Abstract

The increase in the prevalence and intensity of dental diseases in modern conditions, such as caries and its complications, non-carious lesions and pathological abrasion of dental hard tissues and periodontal diseases, leads to partial tooth loss and persistent pathological morpho-functional changes of the dentoalveolar system.
 Partial tooth loss is accompanied by changes in almost all areas of the dentoalveolar system and leads to a number of complications, including deformations of the dentition. At the same time, changes in the neuromuscular system, dysfunction of the temporomandibular joints (TMJ), aesthetic, phonetic and functional disorders are often involved in clinical symptoms. Pathological morphological changes significantly complicate orthopedic treatment, and often make it impossible without the use of a set of special preparatory measures.
 To restore the integrity of the dentition and the functional efficiency of the masticatory apparatus, various designs of dentures are used, which are divided into fixed and removable according to the terms of fixation, and their choice is determined by the list of indications and contraindications for manufacturing.
 It is known that non-removable structures are much more widely used as compared to removable prostheses, as they have a number of advantages: restoration of masticatory efficiency by 95-100%, high aesthetics and accuracy, good fixation and quick adaptation to them. The main condition of orthopedic treatment with bridges is the presence of defects limited by teeth. They are used in case of a defect of the dentition, which consists in the loss of no more than 3 lateral teeth and 4 teeth in the frontal jaw.
 The sizes of dental bridges do not go beyond the dentition and they transfer the masticatory load to the jawbone through the periodontium, i.e., naturally. Because of this, they are considered more physiological than other prostheses. Bridge prostheses virtually do not disrupt the speech, temperature, tactile and taste sensitivity.
 Orthopedic treatment of dentition defects is also carried out with the help of removable structures, which include removable bridges, arches and partial laminar dentures. The advantage of removable dentures is their high hygiene, but the problems include proper fixation, long-term adaptation, aesthetic requirements and full recovery of masticatory efficiency.
 The aim of the research is to improve the quality of orthopedic care for patients with defects of the dentition with the help of bugel prostheses on clasps by introducing an original method of their manufacture.
 Material and methods of experimental studies. We made 138 solid bugel prostheses (84 – the upper jaw, and 54 – the lower jaw), 48 bridge prostheses (39 metal-ceramic, 9 with photopolymer facing). We observed 95 patients aged from 23 to 74 years (52 men, 53 women) during the period of 5 years. In all patients, the defects of the dentition were replaced with solid bugel prostheses on the clasps, according to our original method:
 Upon receipt of the impression for the metal-ceramic non-removable structure with a clasp, the previously made temporary plastic crowns were fixed on the prepared teeth, and then the impression was obtained with the impression spoon together with the temporary crowns and removed from the oral cavity. The working model was cast on the obtained imprint.
 The proposed method makes it possible to simultaneously obtain an impression on the basis of which a working model is made for the manufacture of both fixed and removable parts of the orthopedic structure, which avoids the repetition of clinical and technical stages of prostheses manufacture, reduce their number, improve the accuracy of connecting removable and non-removable structures, and saves materials and time for doctor and patient.