Devices used in maxillofacial orthopedics. Methods for manufacturing maxillofacial apparatus Classification of apparatus used for the treatment of fractures

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Treatment of damage to the maxillofacial region is carried out by conservative, operative and combined methods.

Orthopedic devices are the main method of conservative treatment. With their help, they solve the problems of fixation, reposition of fragments, the formation of soft tissues and the replacement of defects in the maxillofacial region. In accordance with these tasks (functions), the devices are divided into fixing, repositioning, shaping, replacing and combined. In cases where one device performs several functions, they are called combined.

According to the place of attachment, the devices are divided into intraoral (single jaw, double jaw and intermaxillary), extraoral, intra-extraoral (maxillary, mandibular).

According to the design and manufacturing method, orthopedic appliances can be divided into standard and individual (outside laboratory and laboratory production).

Fixing devices

There are many designs of fixing devices (Scheme 4). They are the main means of conservative treatment of injuries of the maxillofacial region. 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 the primary healing of bone fractures, it is necessary to ensure the functional stability of fragments. The strength of fixation depends on the design of the device, its fixing ability. Considering the orthopedic apparatus as a biotechnical system, two main parts can be distinguished in it: splinting and actually fixing. The latter ensures the connection of the entire structure of the apparatus with the bone. For example, the splinting part of the dental wire splint (Fig. 237) is a wire bent in the shape of the 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 ensure the connection of the splinting part with 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 wire arc attachment to the teeth, the location of the arc on the teeth (at the cutting edge or chewing surface of the teeth, at the equator, at the neck teeth).

With the mobility of the teeth, a sharp atrophy of the alveolar bone, it is not possible to ensure reliable stability of the fragments with dental splints due to the imperfection of the fixing part of the apparatus itself.

In such cases, the use of tooth-gingival splints is shown, in which the fixing ability of the structure is enhanced by increasing the area of ​​​​fitting of the splinting part in the form of covering the gums and the alveolar process (Fig. 238). With complete loss of teeth, the intra-alveolar part (retainer) of the apparatus 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 capacity of such devices is extremely low.

From the point of view of biomechanics, the most optimal design is a soldered wire splint. It is mounted on rings or on full artificial metal crowns (Fig. 240). The good fixing ability of this tire is due to the reliable, almost immovable connection of all structural elements. The splinting arc is soldered to a ring or to a metal crown, which is fixed with phosphate cement on the abutment teeth. With ligature binding with an aluminum wire arch of teeth, such a reliable connection cannot be achieved. As the tire is used, the tension of the ligature weakens, the strength of the connection of the splinting arc decreases. The ligature irritates the gingival papilla. In addition, there is an accumulation of food residues and their decay, which violates oral hygiene and leads to periodontal disease. These changes may be one of the causes of complications that occur during orthopedic treatment of jaw fractures. Soldered tires are devoid of these disadvantages.

With the introduction of fast-hardening plastics, many different designs of tooth tires appeared (Fig. 241). However, in terms of their fixing abilities, they are inferior to soldered tires in a very important parameter - the quality of the connection of the splinting part of the apparatus with the supporting teeth. There is a gap between the surface of the tooth and the plastic, which is a receptacle for food debris and microbes. Prolonged use of such tires is contraindicated.

Rice. 241. Tire made of fast hardening plastic.

Tire designs are constantly being improved. By introducing executive loops into the splinting aluminum wire arc, 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 tooth splint appeared with the introduction of alloys with the shape memory effect. A tooth splint on rings or crowns made of wire with thermomechanical "memory" allows not only to strengthen the fragments, but also to maintain a constant pressure between the ends of the fragments (Fig. 242).

Rice. 242. Tooth splint made of an alloy with shape memory,
a - general view of the tire; b - fixing devices; in — the loop providing a compression of fragments.

Fixing devices used in osteoplastic operations are a dental structure consisting of a system of soldered crowns, connecting locking sleeves, and rods (Fig. 243).

Extraoral devices consist of a chin sling (gypsum, plastic, standard or individual) and a head cap (gauze, plaster, standard from strips of a belt or ribbon). The chin sling is connected to the head cap with a bandage or elastic traction (Fig. 244).

Intra-extraoral devices consist of an intraoral part with extraoral levers and a head cap, which are interconnected by elastic traction or rigid fixing devices (Fig. 245).

Rice. 245. Structure inside the extraoral apparatus.

rehearsal apparatus

Distinguish between simultaneous and gradual reposition. Simultaneous reposition is carried out manually, and gradual reposition is performed by hardware.

In cases where it is not possible to manually compare the fragments, repair devices are used. The mechanism of their action is based on the principles of traction, pressure on displaced fragments. Repositioning devices can be of mechanical and functional action. Mechanically acting repositioning devices consist of 2 parts - supporting and acting. The supporting part is crowns, mouthguards, rings, base plates, head cap.

The active part of the apparatus are devices that develop certain forces: rubber rings, an elastic bracket, screws. In a functional repositioning apparatus for repositioning fragments, the force of muscle contraction is used, which is transmitted through the guide planes to the fragments, displacing them in the right direction. A classic example of such an apparatus is the Vankevich bus (Fig. 246). With closed jaws, it also serves as a fixing device for fractures of the lower jaws with edentulous fragments.

Rice. 246. Tire Vankevich.
a — view of the model of the upper jaw; b — reposition and fixation of fragments in case of damage to the edentulous lower jaw.

Forming devices

These devices are designed to temporarily maintain the shape of the face, create a rigid support, prevent scarring of soft tissues and their consequences (displacement of fragments due to constricting forces, deformation of the prosthetic bed, etc.). Forming devices are used before and during reconstructive surgical interventions.

By design, the devices can be very diverse depending on the area of ​​damage and its anatomical and physiological features. In the design of the forming apparatus, it is possible to distinguish the forming part of 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, combined. During resection of the jaws, prostheses are used, which are called post-resection prostheses. Distinguish between immediate, immediate and distant prosthetics. It is legitimate to divide prostheses into operating and postoperative.

Dental prosthetics is inextricably linked with maxillofacial prosthetics. Achievements in the clinic, materials science, technology for the manufacture of dentures have a positive impact on the development of maxillofacial prosthetics. For example, methods for restoring dentition defects with solid clasp prostheses have found application in the construction of resection prostheses, prostheses that restore dentoalveolar defects (Fig. 248).

Replacement devices also include orthopedic devices used for palate defects. This is primarily a protective plate - used in the plastic of the palate, obturators - are used for congenital and acquired defects of the palate.

Combined devices

For reposition, fixation, formation and replacement, a single design is appropriate, capable of reliably solving all problems. An example of such a design is an apparatus consisting of soldered crowns with levers, locking locking devices and a forming plate (Fig. 249).

Rice. 249. Apparatus of combined action.

Dental, dentoalveolar and maxillary prostheses, in addition to the 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, the following rules should be followed:

To use as much as possible the preserved natural teeth as a support, connecting them into blocks, using the known methods of splinting teeth;
. maximize the use of the retention properties of the alveolar processes, bone fragments, soft tissues, skin, cartilage that limit the defect (for example, the skin-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 operational methods for strengthening 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 the blocks with the patient in a horizontal position on the bed).

Clamps, rings, crowns, telescopic crowns, mouth guards, ligature binding, springs, magnets, spectacle frames, sling bandage, corsets can be used as fixing devices for maxillofacial apparatuses. The correct choice and use of these devices adequately to clinical situations allow success in the orthopedic treatment of injuries of the maxillofacial region.

Orthopedic dentistry
Edited by Corresponding Member of the Russian Academy of Medical Sciences, Professor V.N. Kopeikin, Professor M.Z. Mirgazizov

Fastening of fragments of the jaws is carried out using various orthopedic devices. All orthopedic devices are divided into groups depending on the function, area of ​​fixation, therapeutic value, design, manufacturing method and material. By function:

- immobilizing (fixing);

- reponing (correcting);

- corrective (guides);

- forming;

- resection (replacing);

- combined;

– prostheses for defects of the jaws and face.

Chapter 12. Orthopedic treatment of patients with maxillofacial pathology 605

At the place of fixation: - intraoral (single jaw, double jaw, intermaxillary); - extraoral; - intra- and extraoral (maxillary, mandibular).

For medical purposes: - basic (having an independent medicinal value: fixing, correcting, etc.);

- auxiliary (serving for the successful implementation of skin-plastic or bone-plastic operations).

By design: – standard; - individual (simple and complex).

According to the manufacturing method: – laboratory production; - non-laboratory production.

According to the materials: – plastic; - metal; - combined.

Immobilizing devices are used in the treatment of severe fractures of the jaws, insufficient number or absence of teeth on fragments. These include:

- wire tires (Tigerstedt, Vasiliev, Stepanov); - tires on rings, crowns (with hooks for pulling fragments); - Mouthguard tires:

✧ metal - cast, stamped, soldered; ✧ plastic; - removable tires Port, Limberg, Weber, Vankevich, etc.

Repositioning devices that promote the reposition of bone fragments,
are also used for chronic fractures with stiff fractures
kami jaws. These include:

- repositioning devices made of wire with elastic intermaxillary traction, etc.;

- devices with intra- and extra-oral levers (Kurlyandsky, Oks-man);

- repositioning devices with a screw and a repulsive platform (Kurlyandsky, Grozovsky);

– repositioning apparatus with a pelot on an edentulous fragment (Kurlyandskogo, etc.);

– repositioning devices for edentulous jaws (Guning-Port splints).

Fixing devices are called devices that contribute to the retention of breakage.
jaws in a certain position. They are subdivided:
- for extraoral:

✧ standard chin sling with head cap; ✧ standard tire according to Zbarzh and others.

The course of orthopedic treatment of patients...

– intraoral: ✧ dental splints:

Wire aluminum (Tigerstedt, Vasiliev, etc.);

Soldered tires on rings, crowns;

plastic tires;

Fixing dental devices; ✧ tooth-gingival splints (Weber and others); ✧ tire tires (Port, Limberg);

- combined.

Guides (corrective) are devices that provide
bake a bone fragment of the jaw in a certain direction with the help of
schyu inclined plane, pilot, sliding hinge, etc.
– For wire aluminum busbars, the guide planes are curved
they run simultaneously with a tire from the same piece of wire in the form of a row
loops.

- For stamped crowns and mouth guards, inclined planes are made from a dense metal plate and soldered.

– For cast tires, the planes are modeled from wax and cast together with the tire.

– On plastic rails, the guide plane can be modeled simultaneously with the rail as a whole.

- In case of insufficient number or absence of teeth in the lower jaw, tires according to Vankevich are used.

Forming devices are called devices that are the support of plastic material (skin, mucous membrane), create a bed for the prosthesis in the postoperative period and prevent the formation of cicatricial changes in soft tissues and their consequences (displacement of fragments due to constricting forces, deformations of the prosthetic bed, etc.). According to the design, the devices can be very diverse, depending on the area of ​​damage and its anatomical and physiological features. In the design of the forming apparatus, a forming part and fixing devices are distinguished.

Resection (replacement) devices are called devices that replace defects in the dentition formed after the extraction of teeth, filling defects in the jaws, parts of the face that arose after trauma, operations. The purpose of these devices is to restore the function of the organ, and sometimes to keep fragments of the jaw from moving or soft tissues of the face from retraction.

Combined devices are called devices that have several purposes and perform various functions, for example: fixing fragments of the jaw and forming a prosthetic bed or replacing a defect in the jawbone and at the same time forming a skin flap. A typical representative of this group is the kappa-rod device 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 fragments.

Prostheses used in maxillofacial orthopedics are divided into: - dentoalveolar; - jaw;

Chapter 12. Orthopedic treatment of patients with maxillofacial pathology 607

- facial; - combined;

- during resection of the jaws, prostheses are used, which are called post-resection. Distinguish between immediate, immediate and distant prosthetics. In this regard, the prostheses are divided into operational and postoperative. Replacement devices also include orthopedic devices used for palate defects: protective plates, obturators, etc.

Prostheses for defects of the face and jaws are made in case of contraindications to surgical interventions or in case of persistent unwillingness of patients to undergo plastic surgery.

If the defect captures 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 the lost tissues. Facial prostheses can be fixed with spectacle 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) tooth; g) supragingival; h) dentogingival; e) bone.

Fixing method:

a) removable; b) fixed;

According to the manufacturing method:

a) standard; b) individual (laboratory and non-laboratory production) ;

According to the materials of manufacture:

polymeric (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 first aid devices (transport immobilization);

2) permanent devices used to provide specialized medical care and in hospital treatment (therapeutic immobilization);

For medical purposes:

1) basic apparatus, i.e. having independent therapeutic value (for example, fixing, reducing, replacing, combined prophylactic);

2) auxiliary devices used in bone and skin plastic surgery, when the main type of medical care will be surgery (these include: fixing - to hold fragments after surgery and forming - serving as a support for plastic material or creating a bed for removable dentures);

By function:

1) fixing devices (retaining), hold fragments of the jaw in the correct position, ensure their immobility;

2) repositioning devices (correcting or moving), are divided into devices of mechanical and functional action, (guides), gradually set the jaw fragments in the correct position, are used in the case when it is impossible to make a one-time reposition;

3) shaping devices are used in the plastic surgery of the soft tissues of the face 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 constricting forces, deformation of the prosthetic bed, etc.).

4) replacement devices (resection and disconnecting) are used to replace the defect of the jaws and restore their shape and function;

5) combined devices (multifunctional);

6) prophylactic devices (devices for mechanotherapy, boxing mouth guard, mouth opening limiters) are used to prevent injuries of maxillofacial injuries and their consequences;

Means of transport immobilization for fractures of the jaws.

The simplest bandage.

It is made using improvised means (pencil, spatula, etc.).

Indicationsfor use: transport immobilization in isolated fractures of the upper jaw.

Limberg board.

Made from plywood 3-4mm thick

Fixed with bandages or rubber bands

(rubber traction) 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) Wilga;

3) Romanova;

4) Moscow Institute of Traumatology and Orthopedics;

5) Limberg

6) Ulyanitsky.

Parieto-chin bandage according to Hippocrates.

I is the most accessible and simplest method of temporary fixation of bone fragments. Circular tours of the bandage, passing through the chin and parietal bones, do not allow the fragments to move during the transportation of the victim. An elastic mesh bandage can be used for this purpose.

P renderingfor use: in case of fractures of the lower jaw, it fixes 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 jaws. It is not recommended to use this dressing on edentulous jaws in the absence of dentures.

WITH
standard sling-shaped transport bandage D.A. Entin.

Indicationsfor use: means of transport immobilization for fractures of the upper and lower jaws.

IN
Depending on the number of pairs of rubber rings used in the bandage, the sling may hold the fragments without pressure or exert pressure on 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 maintain fragments. Excessive pressure on the displaced fragments leads to their 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 prostheses 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 (pressing) and without pressure (supporting).

pressing bandage is indicated in the following cases:

to stop bleeding;

for all fractures of the upper jaw with the preservation of a sufficient number of teeth that will allow the fragments to be placed in the correct articulation. This prevents additional trauma to the brain, its membranes and helps to reduce liquorrhea;

with fractures of the lower jaw outside the dental arch.

Standard, gauze bandages and sling as supporting impose in all other cases of damage to the maxillofacial area. Their main purpose is to keep massive sagging soft tissue flaps and fragments in a calm state, which is important during transportation.

Repositioning of jaw fragments with repositioning devices is called long-term reposition. There are 2 types of device manufacturing: Clinical and laboratory. screw fittings. After fitting the prepared mouthguards in the mouth, they are made up with the model of the upper jaw along the occlusal surfaces and a plaster block is obtained...

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Introduction………………………………………………………………….….3 page

Chapter 1 Replicating devices………………………………………………4p.

1. Mouthguards…………………….………………………………………….………4p.
   1. Shura apparatus..………..………………………………….…...……...5p.
   2. Katz apparatus………...…………………...……….………………....7p.
   3. Oksman's apparatus ……………………………………………………......8p.
   4. Brun's apparatus………………………………………………………...8p.
   5. Kappo-barbell apparatus of A. L. Grozovsky……………………...…9p.

Chapter 2. Fixing devices………..………………………………..10p.

2.1. Sheena Vankevich.………..…….………………..………………….....10p.

2.2. Weber bus….…………….………………….…………………....11p.

2.3. Apparatus of A. I. Betelman…………………………………….…..12p.

……………………………..13p.

2.5. Soldered tire on rings according to A. A. Limberg……………………...13str.

Chapter 3. Forming devices….………………………………..…...15p

Conclusion………………………………………………………...……… 16p.

References…...…………………………………………………...17p.

Introduction.

Maxillofacial orthopedics is a branch of orthopedic dentistry that studies the prevention, diagnosis and orthopedic treatment of injuries of the maxillofacial region that have arisen after trauma, wounds or surgical interventions for inflammatory processes and neoplasms.

In case of serious injuries (fractures) of the jaws, instrumental treatment is necessary, which mainly includes both fixing maxillofacial devices and repositioning (correcting) devices. Fixing devices are used for immobilization of non-displaced fragments and for fixation of corrected displaced fragments in case of jaw fractures. Basically, tires are classified as fixing devices.

Repositioning maxillofacial apparatuses, also called corrective ones, are intended for reduction (reposition) of fractures with displacement of fragments. The reduction of fragments of the jaw with repositioning devices is called long-term reposition.

There are 2 types of manufacturing devices: Clinical and laboratory.

In my work, I will describe the methods of manufacturing maxillofacial apparatuses in a dental laboratory.

Chapter 1

1.1 Mouthguards

In case of mandibular fractures with displacement and stiffness of fragments, repairing (regulating) devices with traction of fragments using wire splints and rubber rings or elastic wire splints and devices with screws are indicated. Tires are used in the presence of teeth on both fragments. Composite tires are bent separately for each fragment along the outer surface of the teeth from elastic stainless steel 1.21.5 mm thick with hooks on which rubber rings are applied for traction. Tires are fixed on the teeth with crowns, rings or wire ligatures. After establishing the fragments in the correct position, the control tires are replaced with fixing ones. It is advisable to use repairing devices, which, after moving the fragments, can be used as splinting. These apparatuses include the apparatus of Kurlyandsky. It consists of caps. Double tubes are soldered on the buccal surface of the kappa, into which rods of the appropriate section are inserted. For the manufacture of the apparatus, casts are taken from the teeth of each fragment and, according to the obtained models, stainless steel mouth guards are prepared for these groups of teeth. After fitting the prepared mouthguards in the mouth, they are made up with a model of the upper jaw along the occlusal surfaces and a plaster block is obtained, that is, a model. Kappas are placed along the occlusal surface of the opposite jaw to determine the direction of displacement of fragments and securely fix them after reposition. Double tubes are soldered to the kappa from the side of the vestibule of the mouth in a horizontal direction and rods are attached to them. Then the tubes are sawn between the trays and each tray is cemented separately on the teeth. After simultaneous reposition of the jaw fragments or traction with rubber rings, their correct position is fixed by inserting the rods into the tubes soldered to the kappa. For reposition, 1-2 springy archwires are used, which are inserted into the tubes, or screw devices. Arcs in the form of a loop, resembling a Coffin spring, are bent according to block models and, after fixing the kappa, are inserted into the tubes. Screw devices consist of a screw mounted in a protruding plate inserted into the tubes of one of the caps. A rigid plate bent in the direction of displacement of the fragments with a support platform for the screw is inserted into the tubes of the second kappa.

1.2 Schur apparatus.

The manufacture of the Schur apparatus begins with the removal of an impression from the abutment posterior teeth. Abutment crowns are made in the usual stamped way without tooth preparation and fit them in the oral cavity. Together with the crowns, an impression is taken from the lower jaw, 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 for it, which is soldered to the supporting crowns from the buccal side. On the lingual side, the supporting crowns are soldered with a 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 tubercles of the teeth-antagonists 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 in the tube.

On the working model, the inclined plane is set in relation to the antagonist tooth at an angle of 10-15 degrees. In the process of treatment, the inclined plane is brought closer to the abutment teeth by compressing the curved arch. Periodically (every 1-2 days), by approaching the inclined plane to its supporting part, the position of the fragment is corrected and the patient is taught to put the fragment of the lower jaw in a more and more correct position when closing the mouth. When the inclined plane comes close to its support, the fragment of the lower jaw will be set 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, set the fragment of the lower jaw into the correct position. Thus, the Schur apparatus is distinguished by a good repositioning effect, small size and ease of use and manufacture.

More effective devices that are used for displacement of fragments to the median line include devices: Katz, Brun and Oksman.

1.3 Katz apparatus.

The Katz repositioning apparatus consists of crowns or rings, a tube and levers. In the usual way, orthodontic crowns or rings are stamped on the chewing teeth, an oval or quadrangular tube with a diameter of 3-3.5 mm and a length of 20-30 mm is soldered to the vestibular side.The appropriate shape is inserted into the tubeswire ends. The length of the stainless steel wire is 15cm and the thickness is 2-2.5mm. 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 place of the cuts.The fragments are moved apart slowly and gradually (over several days or weeks) until they are compared in the correct position. Due to the elasticity of the wire, the movement of fragments is achieved.

With the help of the apparatus of A. Ya. Katz, it is possible to use fragments in the vertical and sagittal directions, rotate fragments around the longitudinal axis, as well as reliable fixation of fragments after their comparison.

1.4 Oxman apparatus

I. M. Oksman somewhat modified the repositioning apparatus of A. Ya. Katz. He soldered two (instead of one) parallel tubes to the supporting part of the apparatus on each side, and split the rear ends of the intraoral rods into two parts that enter both tubes on each side. This modification of the apparatus prevents fragments from rotating around the horizontal axis.

1.5 Brun's apparatus

Brun's apparatus consists of wire and crowns. One end of the wire is tied to the teeth or attached to the crowns (rings) put on the lateral teeth of the fragments. The opposite ends of the wire, bent in the form of levers, cross and stand outside the oral cavity. Rubber rings are pulled onto the ends of the wire bent in the form of levers. Rubber rings, contracting, move the fragments apart. The disadvantages of the apparatus include the fact that during its action, the posterior parts of the fragments are sometimes displaced towards the oral cavity or rotate around the longitudinal axis.

1.6 Kappo-rod apparatus A. L. Grozovsky

It consists of metal mouthguards for the teeth of fragments of the lower jaw, shoulder 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 on fragments. Manufacturing. Partial casts are taken from fragments of the lower jaw, models are cast and mouthguards are stamped (soldered crowns, rings). They try on mouth guards on the abutment teeth and take casts from the fragments of the damaged lower jaw and the intact upper jaw. Models are cast, matched to the correct position and plastered in an occluder. Two tubes are soldered to the kappa of a small fragment (vestibularly and orally), and one tube is soldered to the kappa of a large fragment (vestibularly). Manufacture of expansion screw, rods with holes, nuts and screws. A mouthguard is cemented on the abutment teeth, a long lever with a platform is inserted into the oral tube of a small fragment, a short lever with a nut for a spacer screw is inserted into the vestibular tube of a 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.

Fixing maxillofacial apparatuses include splints that fix jaw fragments in the correct position. Such devices manufactured by the laboratory method include: Tire Vankevich, Tire Stepanov, Tire Weber, etc.

2.1 Sheena Vankiewicz

In case of fractures of the lower jaw with a large number of missing teeth, treatment is carried out with a splint M. M. Vankevich. It is a periodontal 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 with an alginate mass, plaster models are cast, the central ratio of the jaws is determined, and plaster working models are fixed in the articulator. Then the frame is bent and a wax tire is modeled. The height of the planes is determined by the degree of mouth opening. When opening the mouth, the planes must remain in contact with the edentulous alveolar processes or teeth. After bus simulation,the technician attaches to it in the area of ​​chewing teeth a double-folded base wax plate 2.5-3.0 cm high, then the wax is replaced by plastic,. conducts polymerization. After replacing 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), followed by replacing it with plastic. This splint can be used in mandibular bone grafting to hold bone grafts. Tire Vankevich was modified by A.I. Stepanov, who replaced the palatal plate with an arch (byugel).

2.2 Weber bus.

The tire is used for fixing fragments of the lower jaw after their comparison and for aftercare of fractures of the jaws. It covers the remaining dentition and gums on both fragments, leaving open occlusal surfaces and cutting edges of the teeth.

Manufacturing. Impressions are taken from the damaged and opposite jaws, models are obtained, they are made in the position of central occlusion and plastered into the occluder. A frame is made of stainless wire with a diameter of 0.8 mm in the form of a closed arc. The wire should be separated from the teeth and the alveolar part (process) by 0.7-0.8 mm and held in this position by transverse wires passed in the area of ​​interdental contacts. The places of their section with longitudinal wires are soldered. When using a tire for the treatment of fractures of the upper jaw in the lateral sections, oval-shaped tubes are soldered for the introduction of extraoral rods. Then a tire is modeled from wax, plastered into a cuvette in a direct way and the wax is replaced with plastic., after which it is processed.

2.3 The apparatus of A. I. Betelman

It consists of several crowns (rings) soldered together, covering the teeth on fragments of the jaw and antagonist teeth. On the vestibular surface of the crowns of both jaws, tetrahedral tubes were soldered for the insertion of a steel bracket. The device is used in the presence of a defect in the lower jaw in the chin area with 2-3 teeth on each fragment.

Manufacturing. Casts are taken from the jaw fragments for the manufacture of crowns. They fit crowns on the teeth, take casts from the fragments of the jaw and from the upper jaw. Models are cast, compared in the position of central occlusion, and plastered into the occluder. The crowns are soldered together and horizontal tubes of a quadrangular or oval shape are soldered from the vestibular surface of the crowns of the upper and lower jaws. Two U-shaped brackets are made, 23 mm thick, according to the shape of the bushings. The apparatus is applied to the jaw, the fragments are placed in the correct position and fixed by inserting a staple.

2.4 Lamellar tire A. A. Limberg

The tire is used to treat fractures of edentulous jaws.

Manufacturing. Impressions are taken from each edentulous fragment of the lower jaw and intact edentulous upper jaw. Individual spoons are made for each fragment of the lower jaw and the upper jaw. Individual spoons are fitted, hard occlusal stencils are fixed on them, the central ratio is determined and fixed with the help of a chin “sling”. In this state, individual spoons of the lower jaw are fastened with quick-hardening plastic, removed from the oral cavity. Gypsum is put into an occluder, the wall rollers are removed and replaced with columns of quick-hardening plastic. Impose on the jaw tires and chin "sling".

2.5 Soldered tire on rings according to A. A. Limberg.

The tire is used to treat single linear fractures of the jaws in the presence of at least three supporting teeth on each fragment. Manufacturing. According to the casts, crowns (rings) are made for the abutment teeth, checked in the oral cavity, casts are taken from the fragments on the teeth of which there are crowns, and a cast from the opposite jaw. Models are cast in the laboratory, fragments with crowns are set in the correct ratio with the antagonist teeth and plastered into the occluder. Wires are soldered to the crowns vestibularly and orally; if the tire is used for intermaxillary traction, then hook hooks are soldered to the wire, curved towards the gum. 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 fixed on the abutment 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 the oral region, defects and cicatricial changes are formed. To eliminate them, after the wound has healed, plastic surgery is performed using the tissues of neighboring distant parts of the body. To immobilize the graft during its engraftment and to reproduce the shape of the restored part, various forming 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 fixed parts in the form of crowns and removable forming elements fixed on them. When plasticizing the transitional fold and vestibule of the oral cavity, for successful engraftment of the skin flap (0.2-0.3 mm thick), a rigid liner made of thermoplastic mass is used, which is applied to the edge of the splint or prosthesis facing the wound. For the same, 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, a zigzag wire is soldered to the vestibular edge against the surgical field, on which a thermoplastic mass with a thin skin flap is layered. If the dentition against 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 to layer the thermoplastic mass and the skin flap. In plastic surgery of the lips, cheeks, and chin, dental prostheses are used as forming devices, which replace defects in the dentition and bone tissue, splinting, supporting and forming a prosthetic bed.

Conclusion.

From the timely and correct reposition and fixation of fragments of the jaw depends on the further fixation of the apparatus for splinting wandering fragments and further restoration of the jaw due to their fusion in the correct connection with each other.

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 skilled dental technician.

Bibliography.

1. Dental technique M. M. Rasulov, T. I. Ibragimov, I. Yu. Lebedenko
2. Orthopedic dentistry
3. V. S. Pogodin, V. A. Ponamareva Guidelines for dental technicians
4. http://www.docme.ru/doc/96621/ortopedicheskaya-stomatology.-abolmasov-n.g.---abolmasov-n...
5. E. N. Zhulev, S. D. Arutyunov, I. Yu. Lebedenko Oral and Maxillofacial Orthopedic Dentistry