Devices used in maxillofacial orthopedics. Methods for manufacturing maxillofacial devices Classification of devices used for the treatment of fractures
20334 0
Treatment of injuries to the maxillofacial area is carried out using conservative, surgical and combined methods.
The main method of conservative treatment is orthopedic devices. With their help, they solve problems of fixation, reposition of fragments, formation of soft tissues and replacement of defects in the maxillofacial area. In accordance with these tasks (functions), devices are divided into fixing, reducing, forming, replacing and combined. In cases where one device performs several functions, they are called combined.
Based on the place of attachment, the devices are divided into intraoral (unimaxillary, bimaxillary and intermaxillary), extraoral, intra-extraoral (maxillary, mandibular).
According to the design and manufacturing method, orthopedic devices can be divided into standard and individual (non-laboratory and laboratory manufacturing).
Fixing devices
There are many designs of fixing devices (Scheme 4). They are the main means of conservative treatment of injuries to the maxillofacial area. Most of them are used in the treatment of jaw fractures and only a few - in bone grafting.
Scheme 4
Classification of fixing devices
For primary healing of bone fractures, it is necessary to ensure the functional stability of the fragments. The strength of fixation depends on the design of the device and its fixing ability. Considering the orthopedic device as a biotechnical system, it can be divided into two main parts: splinting and actually fixing. The latter ensures the connection of the entire structure of the device with the bone. For example, the splinting part of a dental wire splint (Fig. 237) is represented by a wire bent to the shape of a dental arch, and a ligature wire for attaching the wire arch to the teeth. The actual fixing part of the structure is the teeth, which provide connection between the splinting part and the bone. Obviously, the fixing ability of this design will depend on the stability of the connections between the tooth and the bone, the distance of the teeth in relation to the fracture line, the density of the connection of the wire arch to the teeth, the location of the arch on the teeth (at the cutting edge or chewing surface of the teeth, at the equator, at the neck teeth).
With tooth mobility and severe atrophy of the alveolar bone, it is not possible to ensure reliable stability of fragments using dental splints due to the imperfection of the actual fixing part of the device design.
In such cases, the use of periodontal splints is indicated, in which the fixing ability of the structure is enhanced by increasing the area of contact of the splinting part in the form of coverage of the gums and alveolar process (Fig. 238). In case of complete loss of teeth, the intra-alveolar part (retainer) of the device is absent; the splint is located on the alveolar processes in the form of a base plate. By connecting the base plates of the upper and lower jaws, a monoblock is obtained (Fig. 239). However, the fixing ability of such devices is extremely low.
From a biomechanical point of view, the most optimal design is a soldered wire splint. It is attached to rings or full artificial metal crowns (Fig. 240). The good fixing ability of this tire is explained by the reliable, almost motionless connection of all structural elements. The splinting arch is soldered to a ring or to a metal crown, which is fixed to the supporting teeth using phosphate cement. When ligating teeth with an aluminum wire arch, such a reliable connection cannot be achieved. As the splint is used, the tension of the ligature weakens, and the strength of the connection of the splinting arch decreases. The ligature irritates the gingival papilla. In addition, food debris accumulates and rots, which disrupts oral hygiene and leads to periodontal disease. These changes may be one of the causes of complications that arise during orthopedic treatment of jaw fractures. Soldered busbars do not have these disadvantages.
With the introduction of quick-hardening plastics, many different designs of dental splints appeared (Fig. 241). However, in terms of their fixing abilities, they are inferior to soldered splints in a very important parameter - the quality of the connection between the splinting part of the device and the supporting teeth. A gap remains between the surface of the tooth and the plastic, which is a receptacle for food debris and microbes. Long-term use of such tires is contraindicated.
Rice. 241. Tire made of quickly hardening plastic.
The designs of dental splints are constantly being improved. By introducing actuator loops into a splinting aluminum wire arch, they try to create compression of fragments in the treatment of mandibular fractures.
The real possibility of immobilization with the creation of compression of fragments with a dental splint appeared with the introduction of alloys with a “shape memory” effect. A dental splint on rings or crowns made of wire with thermomechanical “memory” allows not only to strengthen the fragments, but also to maintain constant pressure between the ends of the fragments (Fig. 242).
Rice. 242. Dental splint made of alloy with “shape memory”,
a - general view of the tire; b - fixing devices; c - loop providing compression of fragments.
Fixing devices used in osteoplastic operations are a dental structure consisting of a system of welded crowns, connecting locking bushings, and rods (Fig. 243).
Extraoral apparatuses consist of a chin sling (plaster, plastic, standard or customized) and a head cap (gauze, plaster, standard strips of belt or ribbon). The chin sling is connected to the head cap using a bandage or elastic traction (Fig. 244).
Intraoral apparatuses consist of an intraoral part with extraoral levers and a head cap, which are connected to each other by elastic traction or rigid fixing devices (Fig. 245).
Rice. 245. Design inside the extraoral apparatus.
Rehearsal devices
There are one-stage and gradual reposition. One-stage reposition is carried out manually, and gradual reposition is carried out using hardware.
In cases where it is not possible to compare the fragments manually, reduction devices are used. The mechanism of their action is based on the principles of traction, pressure on displaced fragments. Reduction devices can be mechanical or functional. Mechanically operating reduction devices consist of 2 parts - supporting and acting. The supporting parts are crowns, mouthguards, rings, base plates, and a head cap.
The active part of the apparatus are devices that develop certain forces: rubber rings, an elastic bracket, screws. In a functionally functioning reduction apparatus, the force of muscle contraction is used to reposition fragments, which is transmitted through guide planes to the fragments, displacing them in the desired direction. A classic example of such a device is the Vankevich splint (Fig. 246). With the jaws closed, it also serves as a fixation device for fractures of the lower jaws with toothless fragments.
Rice. 246. Shina Vankevich.
a — view of the model of the upper jaw; b — reposition and fixation of fragments in case of damage to the toothless lower jaw.
Forming apparatus
These devices are designed to temporarily maintain the shape of the face, create a rigid support, prevent cicatricial changes in soft tissues and their consequences (displacement of fragments due to tightening forces, deformation of the prosthetic bed, etc.). Forming devices are used before and during reconstructive surgical interventions.
The design of the devices can be very diverse depending on the area of damage and its anatomical and physiological characteristics. In the design of the forming apparatus, one can distinguish the forming part and the fixing devices (Fig. 247).
Rice. 247. Forming apparatus (according to A.I. Betelman). The fixing part is fixed on the upper teeth, and the forming part is located between the fragments of the lower jaw.
Replacement devices (prostheses)
Prostheses used in maxillofacial orthopedics can be divided into dentoalveolar, maxillary, facial, and combined. When resection of the jaws, prostheses are used, which are called post-resection. There are immediate, immediate and remote prosthetics. It is legitimate to divide prostheses into surgical and postoperative.
Dental prosthetics is inextricably linked with maxillofacial prosthetics. Advances in clinical practice, materials science, and technology for manufacturing dentures have a positive impact on the development of maxillofacial prosthetics. For example, methods for restoring dentition defects with solid-cast clasp dentures have found application in the designs of resection dentures and dentures restoring dentoalveolar defects (Fig. 248).
Replacement devices also include orthopedic devices used for palate defects. This is primarily a protective plate - used for palate plastic surgery; obturators - used for congenital and acquired palate defects.
Combined devices
For reposition, fixation, shaping and replacement, a single design that can reliably solve all problems is advisable. An example of such a design is an apparatus consisting of soldered crowns with levers, fixing locking devices and a forming plate (Fig. 249).
Rice. 249. Combined action device.
Dental, dentoalveolar and jaw prostheses, in addition to their replacement function, often serve as a forming apparatus.
The results of orthopedic treatment of maxillofacial injuries largely depend on the reliability of fixation of the devices.
When solving this problem, you should adhere to the following rules:
Maximize the use of preserved natural teeth as support, connecting them into blocks using known techniques for splinting teeth;
. make maximum use of the retention properties of the alveolar processes, bone fragments, soft tissues, skin, cartilage that limit the defect (for example, the cutaneous-cartilaginous part of the lower nasal passage and part of the soft palate, preserved even with total resections of the upper jaw, serve as a good support for strengthening the prosthesis);
. apply surgical methods to strengthen prostheses and devices in the absence of conditions for their fixation in a conservative way;
. use the head and upper body as a support for orthopedic devices if the possibilities of intraoral fixation have been exhausted;
. use external supports (for example, a system of traction of the upper jaw through blocks with the patient in a horizontal position on the bed).
Clasps, rings, crowns, telescopic crowns, mouthguards, ligature binding, springs, magnets, spectacle frames, sling-shaped bandages, and corsets can be used as fixing devices for maxillofacial devices. The correct selection and application of these devices adequately to clinical situations allows us to achieve success in the orthopedic treatment of injuries to the maxillofacial area.
Orthopedic dentistry
Edited by Corresponding Member of the Russian Academy of Medical Sciences, Professor V.N. Kopeikin, Professor M.Z. Mirgazizov
Jaw fragments are secured using various orthopedic devices. All orthopedic devices are divided into groups depending on their function, area of fixation, therapeutic value, design, manufacturing method and material. By function:
– immobilizing (fixing);
– repositioning (correcting);
– corrective (guides);
– formative;
– resection (replacement);
– combined;
– dentures for defects of the jaws and face.
Chapter 12. Orthopedic treatment of patients with maxillofacial pathology 605
According to the place of fixation: – intraoral (single-maxillary, double-maxillary, intermaxillary); – extraoral; – intra- and extraoral (maxillary, mandibular).
By therapeutic purpose: – basic (having independent medicinal value: fixing, correcting, etc.);
– auxiliary (serving for the successful performance of skin-plastic or osteoplastic operations).
By design: – standard; – individual (simple and complex).
By manufacturing method: – laboratory manufacturing; – non-laboratory production.
By materials: – plastic; – metal; – combined.
Immobilizing devices are used in the treatment of severe jaw fractures, insufficient or absent teeth on the fragments. These include:
– wire tires (Tigerstedt, Vasiliev, Stepanov); – splints on rings, crowns (with hooks for traction of fragments); – splint guards:
✧ metal - cast, stamped, soldered; ✧ plastic; – removable tires Port, Limberg, Weber, Vankevich, etc.
Reduction devices that facilitate the reposition of bone fragments,
also used for old fractures with stiff fractures
kami jaws. These include:
– reduction devices made of wire with elastic intermaxillary rods, etc.;
– devices with intra- and extraoral levers (Kurlyandsky, Oksman);
– reduction devices with a screw and a repelling platform (Kurlyandsky, Grozovsky);
– reduction devices with a pelot for a toothless fragment (Kurlyandsky, etc.);
– reduction devices for toothless jaws (Guning–Port splints).
Fixing devices are devices that help to retain a break.
kov jaws in a certain position. They are divided:
– to extraoral:
✧ standard chin sling with head cap; ✧ standard tire according to Zbarzh et al.
Course of orthopedic treatment of patients...
– intraoral: ✧ dental splints:
Aluminum wire (Tigerstedt, Vasiliev, etc.);
Soldered tires on rings, crowns;
Plastic tires;
Fixing dental appliances; ✧ dentogingival splints (Weber, etc.); ✧ supragingival splints (Porta, Limberga);
– combined.
Guides (corrective) are devices that provide
press the bone fragment of the jaw in a certain direction using
an inclined plane, a hinge, a sliding hinge, etc.
– For aluminum wire busbars, the guide planes are curved
beat simultaneously with a bus from the same piece of wire in the form of a row
loops
– Inclined planes for stamped crowns and aligners are made from a dense metal plate and soldered.
– For cast tires, the planes are modeled in wax and cast together with the tire.
– On plastic tires, the guide plane can be modeled simultaneously with the tire as a single unit.
– If there is an insufficient number or absence of teeth in the lower jaw, Vankevich splints are used.
Formative devices are devices that support plastic material (skin, mucous membrane), create a bed for the prosthesis in the postoperative period and prevent the formation of scar changes in soft tissues and their consequences (displacement of fragments due to tightening forces, deformations of the prosthetic bed, etc.). The design of the devices can be very diverse depending on the area of damage and its anatomical and physiological characteristics. The design of the forming apparatus includes a forming part and fixing devices.
Resection (replacement) devices are devices that replace defects in the dentition formed after tooth extraction, filling defects in the jaws and parts of the face that arise after injury or surgery. The purpose of these devices is to restore the function of the organ, and sometimes to keep jaw fragments from moving or the soft tissues of the face from retraction.
Combined devices are devices that have several purposes and perform different functions, for example: securing jaw fragments and forming a prosthetic bed or replacing a jaw bone defect and simultaneously forming a skin flap. A typical representative of this group is the Kappa-rod apparatus of combined sequential action according to Oxman for fractures of the lower jaw with a bone defect and the presence of a sufficient number of stable teeth on the fragments.
Prostheses used in maxillofacial orthopedics are divided into: – dentoalveolar; – jaw;
Chapter 12. Orthopedic treatment of patients with maxillofacial pathology 607
– facial; – combined;
– for jaw resection, prostheses are used, which are called post-resection. There are immediate, immediate and remote prosthetics. In this regard, prostheses are divided into operational and postoperative. Replacement devices also include orthopedic devices used for palate defects: protective plates, obturators, etc.
Prostheses for facial and jaw defects are made in case of contraindications to surgical interventions or in case of persistent reluctance of patients to undergo plastic surgery.
If the defect affects a number of organs at the same time: nose, cheeks, lips, eyes, etc., a facial prosthesis is made in such a way as to restore all lost tissue. Facial prostheses can be supported by eyeglass frames, dentures, steel springs, implants, and other devices.
Maxillofacial apparatuses are distinguished:
By location:
a) intraoral; b) extraoral; c) intra-extraoral; d) single-jawed; e) two-jawed; e) dental; g) supragingival; h) dentogingival; e) bone.
By fixation method:
a) removable; b) non-removable;
By manufacturing method:
a) standard; b) individual (laboratory and non-laboratory production) ;
According to manufacturing materials:
polymer (plastic, composite, polyamide thread);
metal (bent, cast, soldered, combined);
combined (plastic and metal, plastic and polyamide thread, metal and composite, etc.).
By application period:
1) temporary devices for first aid (transport immobilization);
2) permanent devices used to provide specialized medical care and in hospital treatment (therapeutic immobilization);
For therapeutic purposes:
1) main devices, i.e. having independent therapeutic value (for example, fixing, reducing, replacing, combined preventive);
2) auxiliary devices used for bone and skin plastic surgery, when the main type of treatment will be surgical intervention (these include: fixing devices - to hold fragments after surgery and forming devices - serving as a support for plastic material or creating a bed for removable dentures);
By functional purpose:
1) fixing devices (retention devices), hold jaw fragments in the correct position, ensure their immobility;
2) reduction devices (correcting or moving), divided into devices of mechanical and functional action (guides), gradually install jaw fragments into the correct position, used in cases where it is impossible to perform a one-step reduction;
3) shaping devices are used in plastic surgery of soft facial tissues to temporarily maintain the shape of the face, create rigid support, prevent cicatricial changes in soft tissues and their consequences (displacement of fragments due to tightening forces, deformation of the prosthetic bed, etc.).
4) replacement devices (resection and disconnection) are used to replace jaw defects and restore their shape and function;
5) combined devices (multifunctional);
6) preventive devices (mechanotherapy devices, boxing mouthguard, mouth opening limiters) are used to prevent maxillofacial injuries and their consequences;
Means of transport immobilization for jaw fractures.
The simplest bandage.
It is made using available materials (pencil, spatula, etc.).
Indicationsfor use: transport immobilization for isolated fractures of the upper jaw.
Limberg tablet.
Made from plywood 3-4mm thick,
Fixed with bandages or rubber bands
(rubber band) to the headband or cap.
Indications: for use: transport
immobilization for isolated fractures
upper jaw.
Standard transport splints for the upper jaw:
1) Faltina;
2) Vilga;
3) Romanova;
4) Moscow Institute of Traumatology and Orthopedics;
5) Limberg
6) Ulyanitsky.
Parietomental bandage according to Hippocrates.
I 
is the most accessible and simplest method of temporary fixation of fragments. Circular tours of the bandage, passing through the chin and parietal bones, do not allow fragments to move during transportation of the victim. For this purpose, you can use an elastic mesh bandage.
P 
providingfor use:
in case of fractures of the lower jaw, it fixes the fragments to the intact upper jaw. In case of fractures of both jaws, the bandage supports and prevents the displacement of fragments of the damaged jaws, thereby significantly limiting their mobility.
Standard elastic sling bandage (according to Z.N. Pomerantseva-Urbanskaya).
Indicationsfor use: means of transport immobilization for fractures of the upper and lower jaw. It is not recommended to use this bandage on toothless jaws in the absence of dentures.
WITH 
standard sling-shaped transport bandage by D.A. Entin.
Indicationsfor use: means of transport immobilization for fractures of the upper and lower jaw.
IN 
Depending on the number of pairs of rubber rings used in the bandage, the sling can hold the fragments without pressure or apply pressure to them. In case of a fracture of the lower jaw behind the dentition or in case of a fracture of the upper jaw, a standard bandage can be applied using three pairs of rubber rings (as a pressure bandage).
In case of fractures of the lower jaw within the dentition, it should be applied only to support the fragments. Excessive pressure on displaced fragments leads to even greater displacement and the risk of asphyxia.
P 
If removable dentures are preserved in toothless patients, it is possible to use them together with a chin sling as a means of transport immobilization. The dentures are connected to each other in the area of the lateral teeth with ligatures or self-hardening plastic. In this case, the front teeth should be cut off to provide nutrition.
All transport bandages and slings can be applied with pressure (pressure) and without pressure (supportive).
Pressing the bandage is indicated in the following cases:
to stop bleeding;
for all fractures of the upper jaw, preserving a sufficient number of teeth that will allow the fragments to be placed in correct articulation. This prevents additional injury to the brain and its membranes and helps reduce liquorrhea;
for fractures of the lower jaw outside the dental arch.
Standard, gauze bandages and sling as supporting impose in all other cases damage to the maxillofacial area. Their main purpose is to keep massive sagging flaps of soft tissue and fragments in a calm state, which is important during transportation.
Reduction of jaw fragments with reduction devices is called long-term reduction. There are 2 types of device manufacturing: Clinical and laboratory.1 Mouthguards For fractures of the lower jaw with displacement and stiffness of the fragments, reduction adjustment devices with traction of fragments using wire splints and rubber rings or elastic wire splints and fixtures with screws. After fitting the manufactured mouth guards in the mouth, they are assembled with a model of the upper jaw along the occlusal surfaces and a plaster block is obtained...
Share your work on social networks
If this work does not suit you, at the bottom of the page there is a list of similar works. You can also use the search button
Introduction………………………………………………………………………………….….3 pp.
Chapter 1 Reduction devices…......………………………………………4p.
- Kappa…………………….……………………………...…….………4p.
- Shura apparatus..………..………………………………….…...……...5pp.
- Katz apparatus………...………………...……….………………....7p.
- Oksman's apparatus………………………………………...……......8pp.
- Brun's apparatus………………………………………………………...8 p.
- Kappa-rod apparatus of A. L. Grozovsky…………………...…9pp.
Chapter 2. Fixing devices………..……………………………..10p.
2.1. Shina Vankevich.………..…….………………..………………….....10p.
2.2. Weber tire….………………….………………….…………………....11p.
2.3. Apparatus of A. I. Betelman…………………………………….…..12p.
……………………………..13pp.
2.5. Soldered busbar on rings according to A. A. Limberg……………………...13pp.
Chapter 3. Forming devices….……………………………..…...15pp.
Conclusion……………………………………………………...………16p.
References……………………………………………………...17pp.
Introduction.
Maxillofacial orthopedics is a branch of orthopedic dentistry that studies the prevention, diagnosis and orthopedic treatment of damage to the maxillofacial area that occurs after trauma, wounds or surgical interventions for inflammatory processes and neoplasms.
In case of serious injuries (fractures) of the jaws, hardware treatment is necessary, which mainly includes both fixing maxillofacial devices and reduction (correction) devices. Fixing devices are used to immobilize undisplaced fragments and to fix corrected displaced fragments in jaw fractures. Basically, fixing devices include splints.
Reducing maxillofacial devices, also called corrective devices, are intended for reduction (reposition) of fractures with displacement of fragments. Reduction of jaw fragments using reduction devices is called long-term reduction
There are 2 types of device manufacturing: Clinical and laboratory.
In my work I will describe methods for manufacturing maxillofacial appliances in a dental laboratory.
Chapter 1. Reduction Devices
1.1 Mouth guards
For fractures of the lower jaw with displacement and stiffness of the fragments, reduction (regulating) devices with traction of fragments using wire splints and rubber rings or elastic wire splints and devices with screws are indicated. Splints are used if there are teeth on both fragments. Composite splints are bent separately for each fragment along the outer surface of teeth made of elastic stainless steel 1.2 x 1.5 mm thick with hooks on which rubber rings are placed for traction. Splints are secured to the teeth using crowns, rings or wire ligatures. After the fragments are installed in the correct position, the regulating splints are replaced with fixing splints. It is advisable to use reduction devices, which, after moving the fragments, can be used as splinting devices. Such devices include the Kurlyandsky apparatus. It consists of a mouth guard. Double tubes are soldered on the buccal surface of the aligners, into which rods of the appropriate cross-section are inserted. To manufacture the device, impressions are taken from the teeth of each fragment and, using the resulting models, stainless steel mouth guards are prepared for these groups of teeth. After fitting the manufactured mouth guards in the mouth, they are combined with a model of the upper jaw along the occlusal surfaces and a plaster block, that is, a model, is obtained. The aligners are placed on the occlusal surface of the opposite jaw to determine the direction of displacement of the fragments and reliably fix them after reposition. Double tubes are soldered to the aligners from the vestibule of the mouth in a horizontal direction and rods are attached to them. Then the tubes are sawed between the trays and each tray is cemented onto the teeth separately. After immediate reposition of jaw fragments or traction with rubber rings, their correct position is secured by inserting rods into tubes soldered to the aligners. For reposition, 1-2 spring arches are used, which are inserted into tubes, or screw devices. Arcs in the form of a loop, reminiscent of a Coffin spring, are bent according to block models and, after fixing the aligners, they are inserted into the tubes. Screw devices consist of a screw mounted into a protruding plate that is inserted into the tubes of one of the aligners. A rigid plate bent in the direction of displacement of the fragments with a stop pad for the screw is inserted into the tubes of the second mouth guard.
1.2 Shura apparatus.
The production of the Shura apparatus begins with taking an impression from the supporting lateral teeth. Abutment crowns are made in the usual stamped manner without preparing teeth and are fitted into the oral cavity. Together with the crowns, an impression is taken from the lower jaw, and a plaster working model is cast on which the supporting crowns are located. A rod 2-2.5 mm thick and 40-45 mm long is prepared, ½ of this rod is flattened and accordingly a flat tube is prepared, which is soldered to the supporting crowns on the buccal side. On the lingual side, the supporting crowns are soldered with 1 mm thick wire to strengthen the structure.
After checking the supporting part of the apparatus in the oral cavity, the flattened part of the rod is inserted into the tube, and the round protruding part is bent so that its free end, with the mouth closed and the fragment displaced, is located along the buccal cusps of the antagonist teeth of the upper jaw. In the laboratory, an inclined plane 10-15 mm high and 20-25 mm long is soldered to the round end of the rod along the flattened end of the rod located in the tube.
On the working model, the inclined plane is set in relation to the antagonist teeth at an angle of 10-15 degrees. During treatment, the inclined plane is brought closer to the supporting teeth by compressing the curved arch. Periodically (every 1-2 days), by bringing the inclined plane closer to its supporting part, the position of the fragment is corrected and the patient is taught to place the fragment of the lower jaw in an increasingly correct position when closing the mouth. When the inclined plane comes close to its support, the fragment of the lower jaw will be installed in the correct position. After 2-6 months of using this device, even in the presence of a large bone defect, the patient can freely, without an inclined plane, place the fragment of the lower jaw in the correct position. Thus, the Schur apparatus is distinguished by its good reduction effect, small size and ease of use and manufacture.
More effective devices that are used for displacement of fragments to the midline include the following devices: Katz, Brun and Oxman.
1.3 Katz apparatus.
The Katz reduction apparatus consists of crowns or rings, a tube and levers. In the usual way, orthodontic crowns or rings are stamped onto the chewing teeth; a tube of oval or quadrangular cross-section, 3-3.5 mm in diameter and 20-30 mm in length, is soldered to the vestibular side.The appropriate shape is inserted into the tubesends of the wire. The length of the stainless steel wire is 15 cm and the thickness is 2-2.5 mm. The opposite ends of the wire, bending around the corners of the mouth, form a bend in the opposite direction and come into contact with each other. Cuts are made at the touching ends of the wire. To reposition the fragments, the ends of the levers are separated and fixed with a ligature wire at the site of the cuts.The fragments are moved apart slowly and gradually (over several days or weeks) until they are aligned in the correct position. Thanks to the elasticity of the wire, movement of the fragments is achieved.
With the help of the A. Ya. Katz apparatus, it is possible to use fragments in the vertical and sagittal directions, rotate the fragments around the longitudinal axis, as well as reliable fixation of the fragments after their comparison.
1.4 Oxman apparatus
I. M. Oksman slightly modified the repositioning apparatus of A. Ya. Katz. He soldered two (instead of one) parallel tubes on each side to the supporting part of the apparatus, and split the rear ends of the intraoral rods into two parts, which fit into both tubes on each side. This modification of the device protects fragments from rotation around a horizontal axis.
1.5 Brun's apparatus
Brun's apparatus consists of wire and crowns. Some ends of the wire are tied to the teeth or attached to crowns (rings) placed on the lateral teeth of the fragments. The opposite ends of the wire, bent in the form of levers, intersect and stand outside the oral cavity. Rubber rings are pulled onto the ends of the wire, bent in the form of levers. The rubber rings, contracting, push the fragments apart. The disadvantages of the device include the fact that during its operation, the rear parts of the fragments sometimes shift towards the oral cavity or rotate around the longitudinal axis.
1.6 Kappa-rod apparatus of A. L. Grozovsky
It consists of metal guards for the teeth of fragments of the lower jaw, humeral processes with holes for screws, two screws connected by a soldered plate. The device is used for the treatment of fractures of the lower jaw with a significant bone defect and a small number of teeth in the fragments. Manufacturing. Partial impressions are taken from fragments of the lower jaw, models are cast and mouthguards (soldered crowns, rings) are stamped. The aligners are tried on the supporting teeth and impressions are taken from fragments of the damaged lower jaw and intact upper jaw. The models are cast, aligned in the correct position and plastered into the occluder. Two tubes are soldered to the tray of the small fragment (vestibular and oral), and one tube is soldered to the tray of the large fragment (vestibular). An expansion screw, rods with holes, nuts and screws are made. The trays are secured with cement on the supporting teeth, a long lever with a platform is inserted into the oral tube of the small fragment, and a short lever with a nut for the spacer screw is inserted into the vestibular tube of the larger fragment. To fix the achieved position, other rods with matching holes for screws and nuts are inserted into the vestibular tubes.
Chapter 2 Fixing devices.
Maxillofacial fixation devices include splints that fix jaw fragments in the correct position. Such devices manufactured by laboratory methods include: Vankevich splint, Stepanov splint, Weber splint, etc.
2.1 Sheena Vankiewicz
For fractures of the lower jaw with a large number of missing teeth, treatment is carried out with a splint by M. M. Vankevich. It is a dentogingival splint with two planes that extend from the palatal surface of the splint to the lingual surface of the lower molars or the edentulous alveolar ridge.
Impressions are taken from the upper and lower jaws using alginate mass, plaster models are cast, the central relationship of the jaws is determined, and the plaster working models are fixed in the articulator. Then the frame is bent and a wax splint is modeled. The height of the planes is determined by the degree of opening of the mouth. When opening the mouth, the planes must maintain contact with the edentulous alveolar processes or teeth. After modeling the tire,the technician attaches to it in the area of the chewing teeth a double-folded plate of base wax 2.5-3.0 cm high, then the wax is replaced with plastic,. carries out polymerization. After replacing the wax with plastic, the doctor checks it in the oral cavity, corrects the surfaces of the supporting planes with quick-hardening plastic or stens (thermoplastic impression mass), and then replaces it with plastic. This splint can be used in mandibular bone grafting to retain bone grafts. The Vankevich splint was modified by A.I. Stepanov, who replaced the palatal plate with an arch (clasp).
2.2 Weber bus.
The splint is used to fix fragments of the lower jaw after their comparison and for post-treatment of jaw fractures. It covers the remaining dentition and gum on both fragments, leaving the occlusal surfaces and cutting edges of the teeth exposed.
Manufacturing. Casts are taken from the damaged and opposite jaws, models are obtained, they are compiled in the position of central occlusion and plastered in an occluder. A frame is made of stainless wire with a diameter of 0.8 mm in the shape of a closed arc. The wire should be 0.7-0.8 mm away from the teeth and alveolar part (process) and held in this position by transverse wires passed in the area of interdental contacts. Their cross sections with longitudinal wires are soldered. When using a splint to treat fractures of the upper jaw, oval-shaped tubes are soldered in the lateral sections for the introduction of extraoral rods. Then the splint is modeled from wax, cast into a ditch using the direct method, and the wax is replaced with plastic., after which it is processed.
2.3 Apparatus of A. I. Betelman
It consists of several crowns (rings) welded together, covering the teeth on jaw fragments and antagonist teeth. On the vestibular surface of the crowns of both jaws, tetrahedral tubes are soldered for inserting a steel bracket. The device is used when there is a defect in the lower jaw in the chin area with 2-3 teeth on each fragment.
Manufacturing. Impressions are taken from jaw fragments to make crowns. Crowns are fitted to the teeth, impressions are taken from jaw fragments and from the upper jaw. Models are cast, compared in the position of central occlusion, and cast into the occluder. The crowns are soldered together and horizontal tubes of quadrangular or oval shape are soldered to the vestibular surface of the crowns of the upper and lower jaws. Two U-shaped brackets are made, 2 x 3 mm thick, according to the shape of the bushings. The apparatus is placed on the jaw, the fragments are aligned in the correct position and secured by inserting a staple.
2.4 Plate tire by A. A. Limberg
The splint is used to treat fractures of toothless jaws.
Manufacturing. Impressions are taken of each toothless fragment of the lower jaw and intact toothless upper jaw. Individual spoons are made for each fragment of the lower jaw and upper jaw. Individual spoons are fitted, solid occlusal ridges made of stencil are attached to them, and the centric relation is determined and fixed using a chin sling. In this state, individual trays of the lower jaw are fastened with quick-hardening plastic and removed from the oral cavity. Plaster is placed in an occluder, the stencil rollers are removed and replaced with posts made of quick-hardening plastic. Splints and a chin sling are applied to the jaws.
2.5 Soldered busbar on rings according to A. A. Limberg.
The splint is used for the treatment of single linear fractures of the jaws in the presence of at least three supporting teeth on each fragment. Manufacturing. Based on the casts, crowns (rings) are made for the supporting teeth, checked in the oral cavity, casts are taken from the fragments on the teeth of which the crowns are located, and a cast is taken from the opposite jaw. In the laboratory, models are cast, fragments with crowns are set in the correct relationship with the antagonist teeth and plastered into an occluder. Wires are soldered to the crowns vestibularly and orally; if the splint is used for intermaxillary traction, then hooks curved towards the gum are soldered to the wire. The soldered splint on the lower jaw can be supplemented with an inclined plane in the form of a stainless steel plate on the vestibular side of the intact half of the jaw. After finishing, grinding and polishing, the splint is secured to the supporting teeth with cement.
Chapter 3 Forming apparatuses.
Forming devices. After mechanical, thermal, chemical and other damage to the soft tissues of the oral cavity and perioral area, defects and scar changes are formed. To eliminate them, after the wound has healed, plastic surgery is performed using tissue from neighboring distant areas of the body. To impart immobility to the graft during its engraftment and to reproduce the shape of the restored part, various shaping orthopedic devices and prostheses are used. Forming devices consist of fixing, replacing and forming elements in the form of thickened bases against the areas to be formed. They can be removable and combined with a combination of non-removable parts in the form of crowns and removable forming elements mounted on them. When plasticizing the transitional fold and vestibule of the oral cavity, for successful healing of a skin flap (0.2-0.3 mm thick), a rigid thermoplastic insert is used, layered on the edge of the splint or prosthesis facing the wound. For the same purpose, a simple aluminum wire splint can be used, curved along the dental arch with loops for layering the thermoplastic mass. In case of partial loss of teeth and prosthetics with a removable prosthesis design, a zigzag wire is soldered to the vestibular edge opposite the surgical field, onto which a thermoplastic mass with a thin skin flap is layered. If the dentition opposite the surgical field is intact, then orthodontic crowns are made for 3-4 teeth, a horizontal tube is soldered vestibularly, into which a 3-shaped bent wire is inserted for layering thermoplastic mass and a skin flap. When plastic surgery of the lips, cheeks, and chin, dentoalveolar prostheses are used as forming devices, replacing defects in the dentition and bone tissue, splinting, supporting and forming the prosthetic bed.
Conclusion.
The further fixation of the apparatus for splinting wandering fragments and the further restoration of the jaw due to their fusion in the correct connection with each other depend on the timely and correct reposition and fixation of jaw fragments.
A well-made device should not cause severe pain to the wearer.
Successful treatment of a patient depends not only on the doctor but also on a dental technician who knows his job.
Bibliography.
- Dental prosthetic equipment M. M. Rasulov, T. I. Ibragimov, I. Yu. Lebedenko
- Orthopedic dentistry
- V. S. Pogodin, V. A. Ponamareva Guide for dental technicians
- http://www.docme.ru/doc/96621/ortopedicheskaya-stomatologiya.-abolmasov-n.g.---abolmasov-n...
- E. N. Zhulev, S. D. Arutyunov, I. Yu. Lebedenko Maxillofacial orthopedic dentistry
