Orthodontics (as defined by the American Association of Orthodontists) is the field of dentistry concerned with the observation, study, and correction of developing and mature maxillofacial structures, including those conditions that require tooth movement or correction of mismatches and anomalies in said structures by correcting tooth-facial relationships. bones with the application of efforts and / or stimulation and changes in the direction of the functional efforts of the intracranial-facial complex.

The main tasks of orthodontic practice are the diagnosis, prevention and treatment of all forms of dental anomalies and associated changes in the surrounding structure; development, application and control of functional and corrective devices; as well as the control of the dentition and its supporting structures in order to achieve and maintain optimal physiological and aesthetic harmony of the facial and cranial structures 5 .

Common Orthodontic Problems: The Epidemiology of Occlusal Anomalies

What Angle defined as normal occlusion would more correctly be called an ideal standard, especially when all criteria are strictly met. In fact, the perfect closure of teeth along a perfectly even occlusal line is quite rare. Over the years, epidemiological studies of occlusal anomalies have been complicated by significant disagreement between researchers regarding the degree of acceptable deviations from the ideal norm. As a result, from 1930 to 1965, the prevalence of occlusion anomalies in the United States, according to various estimates, ranged from 35 to 95%. Such a huge discrepancy was mainly the result of differences in the criteria of the norm in different researchers. Differences also arose due to the fact that the Angle classification is a description of occlusal relationships, which is not sufficient for epidemiological studies.

Around 1970, in most developed countries, a number of studies were carried out by health authorities and university groups that formed the clearest picture of the prevalence of various occlusal discrepancies around the world. In the United States, the US Health Service (USPHS) conducted two large-scale surveys of children aged 6 to 11 years in 1963-1965. and adolescents from 12 to 17 years old in 1969-1970. 6-7

In 1989-1994 another large-scale US National Health Survey (NHANESIII) studied the prevalence of occlusal anomalies. The study included 14,000 people, statistically reflecting the condition of about 150 million people of various racial/ethnic and age groups. Data were obtained on the oral health of children and adolescents, as well as adults, with separate assessments of racial/ethnic groups 8,9 .

Rice. 1-11. The crowded position of the incisors is usually expressed using the index of irregularity: the total distance in millimeters between the points of contact of adjacent teeth.

Characteristics assessed in the NHANESIII study included irregularity index, incisor position (Figure 1-11), prevalence of diastema larger than 2 mm (Figure 1-12), and prevalence of cross-occlusion (Figure 1-13). In addition, the prevalence of sagittal (Figure 1-14) and deep/vertical incisal disocclusion (Figure 1-15) was assessed. Sagittal incisal disocclusion, which accompanies Class II, Subclass 1, and Angle Class III, can be assessed more accurately than molar occlusion in an epidemiological survey, so molar occlusion was not directly assessed.

Rice. 1-12. The space between adjacent teeth is called a diastema. Diastema between the upper central incisors is quite common, especially during the period of changing teeth. Diastema larger than 2 mm rarely closes on its own.

Rice. 1-13. Cross occlusion occurs when the upper posterior teeth are lingual to the lower, as in this patient. Most often, cross-occlusion reflects the narrowing of the upper dentition, but can also develop for other reasons.

Rice. 1-14. The sagittal fissure characterizes the horizontal overlap of the incisors. Normally, the upper incisors should be in contact with the lower ones, located anterior to them by the thickness of the cutting edge (i.e., the sagittal gap is normally 2-3 mm). If the lower incisors are located anterior to the upper ones, the anomaly is called a reverse sagittal fissure, or anterior reverse occlusion.

Rice. 1-15. Deep occlusion is characterized by deep vertical overlap of the incisors. Normally, the cutting edges of the lower incisors are in contact with the palatal surfaces of the upper incisors at the level of the equator (i.e., the normal incisal overlap is I-2 mm). In an open bite, there is no vertical contact between the incisors. Measure the size of the vertical gap.

NHANESIII data on the prevalence of occlusal anomalies in children (8-11 years), adolescents (12-17 years) and adults (18-50 years) in the United States are presented in tables 1-1 and 1-2 and graphically displayed in figures 1-16-1-19 .

Table1- 1

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.

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. The mouthguards are cemented on the abutment 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 expansion 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.

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 splint is used for fixing fragments of the lower jaw after they have been compared and for post-treatment 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

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 operating field is intact, then orthodontic crowns are made for 3-4 teeth, a horizontal tube is soldered vestibularly, into which a 3-shaped curved 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.

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

Fixing devices are designed for. The main tasks of maxillofacial orthopedics

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Introduction

Chapter 1 Replicating Apparatus

1.2 Schur apparatus

1.3 Katz apparatus

1.4 Oxman apparatus

1.5 Brun's apparatus

1.6 Kappo-rod apparatus A. L. Grozovsky

Chapter 2

2.1 Sheena Vankiewicz

2.2 Weber bus

2.3 The apparatus of A. I. Betelman

2.4 Lamellar tire A. A. Limberg

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

Chapter 3

Conclusion

Bibliography

Introduction

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.Replicatingdevices

1.1 Mouthguards

fracture of the jaw apparatus

In case of fractures of the lower jaw with displacement and stiffness of fragments, repairing (regulating) devices with extension of fragments using wire tires and rubber rings or elastic wire tires and devices with screws are shown. 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 1.2--1.5 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 trays. 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 Shura apparatus

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 ends of the wire are inserted into the tubes of the appropriate shape. 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.

1.4 Apparatus Oxmana

1.5 Brun's apparatus

Brun's apparatus consists of a 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-barbell apparatus of 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 an expansion 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 2Fixing devices

2.1 Sheena Vankevich

When opening the mouth, the planes must remain in contact with the edentulous alveolar processes or teeth. After modeling the splint, the technician attaches a 2.5-3.0 cm high folded plate of base wax to it in the area of the chewing teeth, then replaces the wax with plastic, and polymerizes. 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's tire

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 ditch in a direct way and the wax is replaced with plastic, after which it is processed.

2.3 ApparatusA.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, 2–3 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 tireA. A. Limberg

The tire is used to treat fractures of edentulous jaws.

2.5 Soldered busbar on ringsA. A. Limberg

Chapter 3Forming devices

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 operating field is intact, then orthodontic crowns are made for 3-4 teeth, a horizontal tube is soldered vestibularly, into which a 3-shaped curved 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

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

Dental technique M. M. Rasulov, T. I. Ibragimov, I. Yu. Lebedenko

Orthopedic dentistry

V. S. Pogodin, V. A. Ponamareva Guidelines for dental technicians

http://www.docme.ru/doc/96621/ortopedicheskaya-stomatology.-abolmasov-n.g.---abolmasov-n...

E. N. Zhulev, S. D. Arutyunov, I. Yu. Lebedenko Oral and Maxillofacial Orthopedic Dentistry

Hosted on Allbest.ru

...

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Changing the color of the front surfaces of the brick by applying prepared ceramic mass or dry mineral chips to the clay bar. Pressing two-layer bricks, engobing front surfaces, texturing with dry mineral chips.

abstract, added 07/26/2010

Offset printing technology. Computer-to-Plate technology. Form plates for this technology. The main methods of making printing plates. The essence of indirect and combined methods of manufacturing screen printing forms.

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laboratory work, added 01/15/2011

Technological process of manufacturing the case, its drawing, analysis of the manufacturability of the structure, the route of the manufacturing technology, allowances, technological dimensions and cutting conditions. Methodology for calculating the main time of each of the stages of manufacturing the hull.

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practice report, added 06/07/2014

Requirements for materials for the manufacture of V-cord belts. Formation of losses as a basis for design optimization. Determination of structural and load factors responsible for the formation of losses and calculation of deformation parameters.

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 fit area 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 a 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; c - loop providing 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 tire (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. First of all, this is a protective plate - it is used for plastic surgery 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

Maxillofacial Orthopedics is one of the sections of orthopedic dentistry and includes a clinic, diagnosis and treatment of injuries of the maxillofacial region resulting from injuries, injuries, surgical interventions for inflammatory processes, neoplasms. Orthopedic treatment can be independent or used in combination with surgical methods.

Maxillofacial orthopedics consists of two parts: maxillofacial traumatology and maxillofacial prosthetics. In recent years, maxillofacial traumatology has become predominantly a surgical discipline. Surgical methods of fixing jaw fragments: osteosynthesis for jaw fractures, extraoral methods of fixing lower jaw fragments, suspended craniofacial fixation for fractures of the upper jaw, fixation using devices made of an alloy with shape memory - have replaced many orthopedic devices.

The success of reconstructive surgery of the face also influenced the section of maxillofacial prosthetics. The emergence of new methods and the improvement of existing methods of skin grafting, bone grafting of the lower jaw, plastic surgery for congenital cleft lip and palate have significantly changed the indications for orthopedic treatment.

Modern ideas about the indications for the use of orthopedic methods for the treatment of injuries of the maxillofacial region are due to the following circumstances.

The history of maxillofacial orthopedics goes back thousands of years. Artificial ears, noses and eyes have been found on Egyptian mummies. The ancient Chinese restored lost parts of the nose and ears using wax and various alloys. However, until the 16th century, there is no scientific information about maxillofacial orthopedics.

For the first time, facial prostheses and an obturator for closing a palate defect were described by Ambroise Pare (1575).

Pierre Fauchard in 1728 recommended drilling through the palate to reinforce prostheses. Kingsley (1880) described prosthetic structures to replace congenital and acquired defects of the palate, nose, and orbit. Claude Martin (1889) in his book on prostheses describes constructions to replace lost parts of the upper and lower jaws. He is the founder of direct prosthetics after resection of the upper jaw.

Modern maxillofacial orthopedics, based on the rehabilitation principles of general traumatology and orthopedics, based on the achievements of clinical dentistry, plays a huge role in the system of providing dental care to the population.

Dislocations of the tooth

dislocation of the tooth- This is a displacement of the tooth as a result of an acute injury. Dislocation of the tooth is accompanied by a rupture of the periodontal, circular ligament, gum. There are dislocations complete, incomplete and impacted. In the anamnesis, there are always indications of a specific cause that caused the dislocation of the tooth: transport, household, sports, industrial trauma, dental interventions.

What provokes Damage to the maxillofacial region:

Tooth fractures

False joints

The causes leading to the formation of false joints are divided into general and local. The general ones include: malnutrition, beriberi, severe, long-term diseases (tuberculosis, systemic blood diseases, endocrine disorders, etc.). Under these conditions, the compensatory-adaptive reactions of the body decrease, reparative regeneration of bone tissue is inhibited.

Among the local causes, the most likely are violations of the treatment technique, soft tissue interposition, bone defect and fracture complications with chronic inflammation of the bone.

Contracture of the mandible

Contracture of the lower jaw can occur not only as a result of mechanical traumatic injuries of the jaw bones, soft tissues of the mouth and face, but also from other causes (ulcer-necrotic processes in the oral cavity, chronic specific diseases, thermal and chemical burns, frostbite, myositis ossificans, tumors and etc.). Here, contracture is considered in connection with an injury to the maxillofacial region, when contractures of the lower jaw occur as a result of incorrect primary treatment of wounds, prolonged intermaxillary fixation of jaw fragments, and untimely use of physiotherapy exercises.

Pathogenesis (what happens?) during Injuries of the maxillofacial region:

Tooth fractures

Contracture of the mandible

The pathogenesis of mandibular contractures can be presented in the form of diagrams. In scheme I, the main pathogenetic link is the reflex-muscular mechanism, and in scheme II, the formation of scar tissue and its negative effects on the function of the lower jaw.

Symptoms of Injuries of the maxillofacial area:

The presence or absence of teeth on fragments of the jaws, the state of hard tissues of the teeth, the shape, size, position of the teeth, the state of the periodontium, the oral mucosa and soft tissues that interact with prosthetic devices are important.

Depending on these signs, the design of the orthopedic apparatus, the prosthesis, changes significantly. They depend on the reliability of fixation of fragments, the stability of maxillofacial prostheses, which are the main factors for a favorable outcome of orthopedic treatment.

It is advisable to divide the signs of damage to the maxillofacial region into two groups: signs indicating favorable and unfavorable conditions for orthopedic treatment.

The first group includes the following signs: the presence of teeth on fragments of the jaws with a full-fledged periodontium in fractures; the presence of teeth with a full-fledged periodontium on both sides of the jaw defect; absence of cicatricial changes in the soft tissues of the mouth and oral area; integrity of the TMJ.

The second group of signs are: the absence of teeth on fragments of the jaws or the presence of teeth with diseased periodontal disease; pronounced cicatricial changes in the soft tissues of the mouth and oral region (microstomy), the absence of the bone base of the prosthetic bed with extensive jaw defects; pronounced violations of the structure and function of the TMJ.

The predominance of signs of the second group narrows the indications for orthopedic treatment and indicates the need for complex interventions: surgical and orthopedic.

When evaluating the clinical picture of damage, it is important to pay attention to signs that help to establish the type of bite before damage. This need arises due to the fact that the displacement of fragments during fractures of the jaws can create ratios of the dentition, similar to a prognathic, open, cross bite. For example, with a bilateral fracture of the lower jaw, the fragments are displaced along the length and cause shortening of the branches, the lower jaw is displaced back and up with the simultaneous lowering of the chin part. In this case, the closure of the dentition will be of the type of prognathia and open bite.

Knowing that each type of occlusion is characterized by its own signs of physiological wear of the teeth, it is possible to determine the type of occlusion in the victim before the injury. For example, in an orthognathic bite, wear facets will be on the cutting and vestibular surfaces of the lower incisors, as well as on the palatal surface of the upper incisors. With progeny, on the contrary, there is abrasion of the lingual surface of the lower incisors and the vestibular surface of the upper incisors. For a direct bite, flat abrasion facets are characteristic only on the cutting surface of the upper and lower incisors, and with an open bite, abrasion facets will be absent. In addition, anamnestic data can also help to correctly determine the type of bite before damage to the jaws.

Dislocations of the tooth

The clinical picture of dislocation is characterized by swelling of the soft tissues, sometimes their rupture around the tooth, displacement, mobility of the tooth, violation of occlusal relationships.

Tooth fractures

Fractures of the lower jaw

Of all the bones of the facial skull, the lower jaw is most often damaged (up to 75-78%). Among the reasons in the first place are transport accidents, then domestic, industrial and sports injuries.

The clinical picture of fractures of the lower jaw, in addition to general symptoms (impaired function, pain, facial deformity, impaired occlusion, jaw mobility in an unusual place, etc.), has a number of features depending on the type of fracture, the mechanism of displacement of fragments and the condition of the teeth. When diagnosing fractures of the lower jaw, it is important to highlight the signs that indicate the possibility of choosing one or another method of immobilization: conservative, operative, combined.

The presence of stable teeth on fragments of the jaws; their slight displacement; localization of the fracture in the area of the angle, branch, condylar process without displacement of fragments indicates the possibility of using a conservative method of immobilization. In other cases, there are indications for the use of surgical and combined methods of fixing fragments.

Contracture of the mandible

Clinically, unstable and persistent contractures of the jaws are distinguished. According to the degree of mouth opening, contractures are divided into light (2-3 cm), medium (1-2 cm) and severe (up to 1 cm).

Unstable contractures most often are reflex-muscular. They occur when the jaws are fractured at the attachment points of the muscles that lift the lower jaw. As a result of irritation of the receptor apparatus of muscles by the edges of fragments or decay products of damaged tissues, a sharp increase in muscle tone occurs, which leads to contracture of the lower jaw.

Cicatricial contractures, depending on which tissues are affected: skin, mucous membrane or muscle, are called dermatogenic, myogenic or mixed. In addition, there are contractures temporo-coronary, zygomatic-coronary, zygomatic-maxillary and intermaxillary.

The division of contractures into reflex-muscular and cicatricial, although justified, but in some cases these processes do not exclude each other. Sometimes, with damage to soft tissues and muscles, muscle hypertension turns into a persistent cicatricial contracture. Prevention of the development of contractures is a very real and concrete event. It includes:

prevention of the development of rough scars by correct and timely treatment of the wound (maximum convergence of the edges with suturing, with large tissue defects, stitching of the edge of the mucous membrane with the edges of the skin is shown);
timely immobilization of fragments, if possible, using a single-jaw splint;
timely intermaxillary fixation of fragments in case of fractures in the places of attachment of muscles in order to prevent muscle hypertension;
the use of early therapeutic exercises.

Diagnosis of Injuries of the maxillofacial area:

Dislocations of the tooth

Diagnosis of tooth dislocation is carried out on the basis of examination, displacement of teeth, palpation and X-ray examination.

Tooth fractures

The most common fractures of the alveolar process of the upper jaw with predominant localization in the region of the anterior teeth. Their causes are traffic accidents, bumps, falls.

Diagnosis of fractures is not very difficult. Recognition of dentoalveolar damage is carried out on the basis of anamnesis, examination, palpation, x-ray examination.

During a clinical examination of the patient, it should be remembered that fractures of the alveolar process can be combined with damage to the lips, cheeks, dislocation and fracture of the teeth located in the broken area.

Palpation and percussion of each tooth, determination of its position and stability make it possible to recognize damage. To determine the defeat of the neurovascular bundle of teeth, electroodontodiagnostics is used. The final conclusion about the nature of the fracture can be made on the basis of x-ray data. It is important to establish the direction of displacement of the fragment. Fragments can move vertically, in the palatingual, vestibular direction, which depends on the direction of impact.

Treatment of fractures of the alveolar process is mainly conservative. It includes fragment reposition, its fixation and treatment of damage to soft tissues and teeth.

Fractures of the lower jaw

Clinical diagnosis of mandibular fractures is supplemented by radiography. According to radiographs obtained in the anterior and lateral projections, the degree of displacement of fragments, the presence of fragments, and the location of the tooth in the fracture gap are determined.

In case of fractures of the condylar process, tomography of the TMJ provides valuable information. The most informative is computed tomography, which allows you to reproduce the detailed structure of the bones of the articular region and accurately identify the relative position of the fragments.

Treatment of Injuries of the maxillofacial area:

Development surgical methods of treatment, especially neoplasms of the maxillofacial region, required widespread use in the surgical and postoperative period of orthopedic interventions. Radical treatment of malignant neoplasms of the maxillofacial region improves survival rates. After surgical interventions, severe consequences remain in the form of extensive defects in the jaws and face. Severe anatomical and functional disorders that disfigure the face cause excruciating psychological suffering to patients.

Very often, only one method of reconstructive surgery is ineffective. The tasks of restoring the patient's face, the functions of chewing, swallowing and returning him to work, as well as to perform other important social functions, as a rule, require the use of orthopedic methods of treatment. Therefore, in the complex of rehabilitation measures, the joint work of dentists - a surgeon and an orthopedist - comes to the fore.

There are certain contraindications to the use of surgical methods for the treatment of jaw fractures and operations on the face. Usually this is the presence in patients of severe diseases of the blood, the cardiovascular system, an open form of pulmonary tuberculosis, pronounced psycho-emotional disorders and other factors. In addition, there are such injuries, surgical treatment of which is impossible or ineffective. For example, with defects in the alveolar process or part of the sky, their prosthetics are more effective than surgical restoration. In these cases, the use of orthopedic measures as the main and permanent method of treatment has shown.

Recovery times vary. Despite the tendency of surgeons to perform the operation as early as possible, it is necessary to withstand a certain time when the patient remains with an unrepaired defect or deformity in anticipation of surgical treatment, plastic surgery. The duration of this period can be from several months to 1 year or more. For example, reconstructive surgery for facial defects after lupus erythematosus is recommended to be carried out after a stable elimination of the process, which is about 1 year. In such a situation, orthopedic methods are indicated as the main treatment for this period. In the surgical treatment of patients with injuries of the maxillofacial region, auxiliary tasks often arise: creating a support for soft tissues, closing the postoperative wound surface, feeding patients, etc. In these cases, the use of the orthopedic method is shown as one of the auxiliary measures in complex treatment.

Modern biomechanical studies of methods of fixation of fragments of the lower jaw have made it possible to establish that dental splints, in comparison with known extraosseous and intraosseous devices, are among the fixators that most fully meet the conditions of functional stability of bone fragments. Tooth splints should be considered as a complex retainer, consisting of artificial (splint) and natural (tooth) retainers. Their high fixing abilities are explained by the maximum contact area of the fixator with the bone due to the surface of the roots of the teeth to which the splint is attached. These data are consistent with the successful results of the widespread use of dental splints by dentists in the treatment of jaw fractures. All this is another justification for the indications for the use of orthopedic devices for the treatment of injuries of the maxillofacial region.

Orthopedic devices, their classification, mechanism of action

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

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. 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.

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 a dental wire splint is a wire bent in 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 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 of the teeth) .

In such cases, the use of tooth-gingival splints is indicated, 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. 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. 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. The good fixing ability of this tire is due to a 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 splints have appeared. 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.

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.

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

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.

AST. rehearsal apparatus

Distinguish between simultaneous and gradual reposition. One-moment reposition is carried out manually, and gradual reposition is performed by hardware.

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 tire. With closed jaws, it also serves as a fixing device for fractures of the lower jaws with edentulous fragments.

Forming devices

Replacement devices (prostheses)

Combined devices

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 remaining natural teeth as a support, connecting them into blocks, using the well-known methods of splinting teeth;
make maximum use of the retention properties of 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).

Orthopedic methods of treatment for injuries of the maxillofacial region

Dislocations and fractures of teeth

Dislocations of the tooth

The treatment of complete dislocation is combined (tooth replantation followed by fixation), and that of incomplete dislocation is conservative. In fresh cases of incomplete dislocation, the tooth is set with fingers and strengthened in the alveolus, fixing it with a dental splint. As a result of untimely reduction of dislocation or subluxation, the tooth remains in the wrong position (rotation around the axis, palatingual, vestibular position). In such cases, orthodontic intervention is required.

Tooth fractures

The factors mentioned earlier can also cause fractures of the teeth. In addition, enamel hypoplasia, dental caries often create conditions for tooth fracture. Root fractures can occur from corrosion of metal pins.

Clinical diagnostics includes: anamnesis, examination of the soft tissues of the lips and cheeks, teeth, manual examination of the teeth, alveolar processes. To clarify the diagnosis and draw up a treatment plan, it is necessary to conduct x-ray studies of the alveolar process, electroodontodiagnostics.

Tooth fractures occur in the region of the crown, root, crown and root; cement microfractures are isolated, when cement areas with attached perforating (Sharpey) fibers exfoliate from the root dentin. The most common fractures of the crown of the tooth within the enamel, enamel and dentin with the opening of the pulp. The fracture line can be transverse, oblique and longitudinal. If the fracture line is transverse or oblique, passing closer to the cutting or chewing surface, the fragment is usually lost. In these cases, tooth restoration is indicated by prosthetics with inlays, artificial crowns. When opening the pulp, orthopedic measures are carried out after appropriate therapeutic preparation of the tooth.

In case of fractures at the neck of the tooth, often resulting from cervical caries, often associated with an artificial crown that does not tightly cover the neck of the tooth, removal of the broken part and restoration with the help of a stump pin tab and an artificial crown is indicated.

A root fracture is clinically manifested by tooth mobility, pain when biting. On radiographs of the teeth, the fracture line is clearly visible. Sometimes, in order to trace the fracture line along its entire length, it is necessary to have x-rays obtained in various projections.

The main way to treat root fractures is to strengthen the tooth with a dental splint. Healing of fractures of the teeth occurs after 1 1/2-2 months. There are 4 types of fracture healing.

Type A: fragments are closely compared with each other, healing ends with mineralization of the tissues of the tooth root.

Type B: healing occurs with the formation of pseudoarthrosis. The gap along the fracture line is filled with connective tissue. The radiograph shows an uncalcified band between the fragments.

Type C: connective tissue and bone tissue grow between the fragments. X-ray shows bone between fragments.

Type D: The gap between the fragments is filled with granulation tissue, either from inflamed pulp or gum tissue. The type of healing depends on the position of the fragments, the immobilization of the teeth, and the viability of the pulp.

Fractures of the alveolar process

Treatment of fractures of the alveolar process is mainly conservative. It includes fragment reposition, its fixation and treatment of damage to soft tissues and teeth.

Fragment reposition with fresh fractures can be carried out manually, with chronic fractures - by the method of bloody reposition or with the help of orthopedic devices. When the broken off alveolar process with teeth is displaced to the palatal side, reposition can be performed using a dissociating palatal plate with a screw. The mechanism of action of the apparatus consists in the gradual movement of the fragment due to the pressing force of the screw. The same problem can be solved by using an orthodontic appliance by stretching the fragment to the wire arch. In a similar way, it is possible to reposition a vertically displaced fragment.

When the fragment is displaced to the vestibular side, reposition can be carried out using an orthodontic apparatus, in particular, a vestibular sliding arch fixed on the molars.

Fragment fixation can be carried out with any tooth splint: bent, wire, soldered wire on crowns or rings, made of quick-hardening plastic.

Fractures of the body of the upper jaw

Non-gunshot fractures of the upper jaw are described in textbooks on surgical dentistry. Clinical features and principles of treatment are given in accordance with the Le Fort classification, based on the localization of fractures along lines corresponding to weak points. Orthopedic treatment of fractures of the upper jaw consists in repositioning the upper jaw and immobilizing it with intra-extraoral devices.

In the first type (Le Fort I), when it is possible to manually set the upper jaw in the correct position, intra-extraoral devices supported on the head can be used to immobilize the fragments: a fully bent wire splint (according to Ya. M. Zbarzh), extraoral levers, soldered splint with extraoral levers. The choice of the design of the intraoral part of the apparatus depends on the presence of teeth and the condition of the periodontium. In the presence of a large number of stable teeth, the intraoral part of the apparatus can be made in the form of a wire tooth splint, and in the case of multiple absence of teeth or the mobility of existing teeth, in the form of a dental splint. In the edentulous areas of the dentition, the tooth-gingival splint will consist entirely of a plastic base with imprints of antagonist teeth. With multiple or complete absence of teeth, surgical methods of treatment are indicated.

Similarly, orthopedic treatment of a Le Fort II fracture is carried out if the fracture was without displacement.

In the treatment of fractures of the upper jaw with displacement kza-| di there is a need to stretch it anteriorly. In such cases, the design of the device consists of an intraoral part, a head plaster bandage with a metal rod located in front of the patient's face. The free end of the rod is bent in the form of a hook at the level of the front teeth. The intraoral part of the apparatus can be either in the form of a dental (bent, soldered) wire splint, or in the form of a tooth-gingival splint, but regardless of the design, a hook loop is created in the front section of the splint, in the area of the incisors, to connect the intraoral splint to the rod coming from the headband .

The extraoral supporting part of the apparatus can be located not only on the head, but also on the torso.

Orthopedic treatment of fractures of the upper jaw type Le Fort II, especially Le Fort III, should be carried out very carefully, taking into account the general condition of the patient. At the same time, it is necessary to remember the priority of therapeutic measures according to vital indications.

Fractures of the lower jaw

The main task of the treatment of mandibular fractures is to restore