Ушницкий Иннокентий Дмитриевич – д.м.н., проф., зав. Кафедрой
Ushnitsky Innokenty Dmitrievich – Doctor of Medical Sciences, Professor, Head of the Department of Therapeutic, Surgical, Orthopedic Dentistry and Pediatric Dentistry
Борисов Николай Иванович – врач-стоматолог.
Якутск
Borisov Nikolay Ivanovich – dentist at the dental
Пинелис Иосиф Семенович – д.м.н. чл.-корр. РАЕН, проф.
Pinelis Iosif Semyonovich – Doctor of Medical Sciences, Professor of the Department of Surgical Dentistry
Юркевич Александр Владимирович – д.м.н., декан, проф.
Yurkevich Alexander Vladimirovich – Dean of the Faculty of Dentistry, Professor of the Department of Orthopedic Dentistry, Far East State Medical university, Doctor of Medical Sciences, corresponding member of RANS
Для улучшения ретенции полных съёмных пластиночных протезов на верхней челюсти проводилось определение дополнительных ретенционных элементов с учетом индивидуальной анатомо-топографической вариабельности расположения зон податливости, мест выхода сосудисто-нервных пучков и мест с плотной слизистой оболочкой на верхней челюсти, которые создают зоны отрицательного давления медиальнее от границ протезного ложа. Разработанный способ значительно снижает вероятность компрессии сосудов с нарушением микроциркуляции и травмирования мягких тканей, к которым прилегает ортопедическая конструкция, и исключает перелом базиса полного съёмного пластиночного протеза. При этом в случае разгерметизации внешних клапанных зон данный способ за счет дополнительных внутренних клапанных зон, расположенных в местах, где имеется достаточная податливость и отсутствуют сосудисто-нервные пучки и экзостозы, обеспечивает увеличение степени ретенции и стабилизации полных съёмных ортопедических конструкций на верхней челюсти при их эксплуатации.
There has been an increase in the ratio of elderly and senile people to the general population who need prosthetics. At the same time, complete teeth loss leads to various anatomical-topographical changes in the denture bed in the elder age group. Meanwhile, there are insufficient researches aimed at improving the fixation and stabilization of complete removable dentures, which determined the direction of our study. The aim of this research was to increase the degree of retention of complete removable dentures by creating additional valve zones, taking into account the individual anatomical-topographical variability of the denture bed structure of the maxilla.
Material and Methods. Prosthetics of 115 people aged from 60 to 93 years old with complete teeth loss on the upper jaw was carried out. Prosthetics were performed by the method of determining the locations of individual valve zones in the area of the pliable mucous membrane of the denture bed on the edentulous upper jaw, including the use of a digital model of the denture bed obtained by cone-beam computed tomography (CBCT) with the use of a contrast agent and subsequent analysis in 3D graphics editors.
Results. Additional retention elements were determined with the individual anatomical-topographical variability of the location of the malleability zones, places of exit of the neurovascular bundles and places with dense mucosa on the upper jaw to improve the retention of the prosthetic structure. At the same time, the obtained results characterize the increase in the efficiency of functional retention of complete removable prostheses due to the creation of consecutive concentrically closed valve zones, which create negative pressure zones medial to the borders of the prosthetic bed.
Discussion. The developed method provides conditions for increasing the efficiency of retention and functionality of complete removable plate prostheses on the upper jaw due to accurate determination of individual anatomical-topographical features of the prosthetic bed, thickness of the mucous membrane, places of exit of neurovascular bundles, torus and exostoses. The probability of vascular compression with microcirculation disturbance and traumatization of soft tissues adjacent to the prosthetic structure was significantly reduced. The method minimizes alternating loads in the area of torus and exostoses in the area of maxillary tubercles, which significantly reduces the probability of fracture of the base of a full removable plate prosthesis.
Conclusion. Our method in case of depressurization of external valve zones increases the degree of retention and stabilization of complete removable orthopedic constructions on the upper jaw during the operation. At the same time, retention is provided by additional internal valve zones located in places where there is sufficient pliability and there are no neurovascular bundles and exostoses.
The authors declare that there are no conflicts of interest present.