Removable dentures in edentulous: types of dentures
Complications of caries, trauma, inflammatory periodontal disease (periodontitis) and atrophic (periodontal disease), illnesses – all of which can lead to violation of integrity of the dentition. The complete absence of teeth is not only a great physical problem but psychological. People are starting to do, limit yourself in communication, become independent. Let’s consider, what methods of prosthetics by far the most acceptable and functional characteristics and price. Separately and on the role of implantation in improving the quality of prosthesis, reduction of terms of adaptation.
Functional and aesthetic violations
After the loss of teeth and bone and in mucosa of atrophic processes occur. The severity of which depends on:
- the causes of adentia;
- the time elapsed since the removal;
- the individual characteristics of the organism.
Patients with complete absence of teeth have a characteristic appearance:
- Observed shortening of the lower third of the face.
- Sunken lips.
- Pronounced nasolabial folds.
- The lower jaw becomes wider, protrudes forward (in medicine, the use of the term «old progeny»).
Most often edentulous becomes the cause disorders of the digestive system, leads to deterioration of speech.
The advantages of early prosthetic
The complete absence of teeth is a direct indication for prosthetics. And the sooner you consult a doctor, the better. Why? The fact that after removal of the bone tissue does not receive the required load. And if the «body works,» dystrophic process, there is destruction, or, in other words, the decline in bone tissue. And the longer people do not seek help, the less bone height. And it affects:
- Fit of the denture. Absence of teeth leads to the fact that retention of the prosthesis is achieved by adhesion (the adhesion forces occur between the mucosa and the polished surface of the denture in the presence between them of a thin layer of saliva), and through anatomical structures, which due to its shape, position and serve as the required locking structures. But over time, there is smoothing of relief of the bones, the sky is flat, the hill of the upper jaw unexpressed. Alveolar process «of inactivity» is flattened, which especially complicates the fixation of the prosthesis on the lower jaw. Missing teeth can cause periodontitis. In such cases, there is an even more pronounced bone loss.
- The implantation of the implants. This operation requires the observance of strict rules. Along with a lack of somatic diseases, a necessary condition is the existence of a certain height the bone. As in operations on the upper jaw can injure the maxillary sinus and the bottom of the mandibular canal.
There are certain condition when holding the prosthesis should be postponed.
- Cancer of the disease.
- Mental disorders in the acute stage.
- Diseases of the blood (leukemia).
- Diabetes (severe).
- Allergy to components of the prosthesis.
In viral diseases (ARI, influenza), aphthous or herpetic stomatitis an appointment to the podiatrist need to be written after recovery.
Types of prosthetics
Types of prosthetics in the absence of teeth can be divided into:
- detachable design;
- fixed prosthesis.
The selection of method depends on the initial situation (the degree of atrophy of alveolar crest, bone height, level of anatomical destruction of retention structures), General health status, as well as the financial capacity of the patient.
Removable dentures in the complete absence of all teeth made from acrylic or nylon. Method of fixed prosthesis is made possible by carrying out the implantation.
The phases of treatment with removable structures
Let’s consider the main stages of prosthetics in the absence.
Clinical examination. Held in the office of the dentist-orthopedist. Includes visual evaluation:
- the severity of the alveolar ridge;
- structure of mucous membranes (level of compliance, atrophy);
- the location of attachment of the natural folds of the mucosa;
- of moving strands of mucous (often requires surgical training – excision with subsequent prosthetics).
After taking a history and examination, the podiatrist goes to the removal slakov, which is transmitted to the dental laboratory for further work.
- Technician pours the impressions of the model and bite block together with the rollers gives back to the podiatrist.
- If there are no teeth, the height of the bite is not fixed, so the doctor in the office using wax cylinders, focusing on the specific anatomical and physiological structure, sets the necessary height of the lower third of the face.
- Followed by a laboratory phase, during which the technician models using wax models of dentures.
- In the clinic, podiatrist captures these wax reproductions on prosthetic bed. Evaluates the fit, the closing of the jaws, the height of the bite. Equally important are external reference points: the severity of the folds, the closing of the lips, the ratio of upper, middle and lower third of the face.
- In the laboratory there is a replacement wax on plastic. Polished design.
- At the final stage, the podiatrist conducts the fitting and fixation of the structure, tells the patient about the rules of care for the prosthesis. It is important to consider: what methods of dental prosthetics were not used, after the date definitely shows a correction (and sometimes more than one)!
If dentures partial absence of teeth involves the use of structures, fixed by means of klamer, attachments or telescopic crowns. The removable dentures in edentulous deprived of these holding members.
Made of plastic, is applied in the absence of teeth for a very long time. Among the advantages of this design are:
- reasonable cost;
- in case of breakage of the prosthesis, artificial teeth chip, you can perform the repairs.
But minuses much more. This:
- allergic reaction to acrylic;
- stiffness and hardness of the prosthesis has increased pressure on the prosthetic bed tissue, further exacerbating the degree of atrophy;
- bad plastic simulates the gum, looks unnatural;
- due to the accumulation of acryl pigments food changes the color of the teeth (they turn yellow);
- the massiveness of the structure degrades the phase adaptation. Very often patients refuse from everyday wear dentures, «dressing them only on holidays».
Nylon prosthesis in edentulous made of nylon, artificial teeth of acrylic. If in the case of breakage of acrylic denture, to correct the defect, the spalling of artificial teeth in the nylon construction catastrophic failure.
Also compared to acrylic counterparts, the nylon denture:
- Has less volumetric basis, which improves and shortens the period of adaptation.
- More accurately adheres to the mucosa.
- Good aesthetic characteristics (simulation of vascular pattern of gingiva).
- High wear resistant options.
Hypoallergenic also among the strengths of this design. But along with all the above, this method of prosthetics in the absence of is not a panacea. Design to a lesser extent than, for example, acrylic denture puts pressure on the mucosa and bone, but still has. Costs and also the nylon construction is better.
Important to know: nylon prostheses are afraid of hot water and the direct rays of the sun!
Thanks to the implant prosthetics in the absence of a large number of teeth can be carried out using fixed designs. Of course, this method of treatment does not fit all. And the reason for this is not only the financial aspect of the question. There are a number of General diseases (diabetes mellitus, osteoporosis, osteomalacia, diseases of the blood), when the implantation is contraindicated. The lack of required local conditions (insufficient height of bone) in addition to inadequate hygiene are also among the contraindications to the operation. But the shortage of bone can be compensated in the process of replanting, as this procedure implantologists, due to bone grafting or sinus lift. The study of the state of the bone tissue is carried out using additional diagnostic methods such as orthopantomogram or 3D computer diagnostics.
Dentures on implants in edentulous can be done in the following ways:
- Fixed technique the full implantation is performed by implanting 12-14 implants (in each jaw) in place of missing teeth. The next stage of prosthetics. But this method is rarely used due to the lack of necessary local conditions, high cost, complexity and duration of treatment.
- Fixed method of prosthesis (due to bridges) and implants. Is carried out by implanting in each jaw, 6 to 10 implants. They will be further supporting elements necessary for the fixation of a fixed metal-ceramic or metal-free design.
- The technique «all-on-4» is carried out by implantation in the bone tissue of the front section of only 4 implants, which serve as a support for a removable prosthesis.
- Detachable design can also be based on 2-4 implanted titanium implants due to the locking fasteners push-button type. Attachmen (spherical mounts) are screwed into the implants. In the prosthesis, these push elements correspond to holes. In the absence of teeth this method is one of the most acceptable, as it provides a good fixation of the prosthesis (patients can not be afraid that the denture will fall off during a conversation or while eating), it can be removed for hygiene, but not in comparison with other methods of treatment, much lower.
- Removable prosthesis based on a metal beam that connects 2-4 implants. Increased bearing area improves the fixation structure. In the absence of teeth, this type of prosthesis is characterized by a high functional characteristics. At the time of the hygiene of the oral cavity, the denture is removed.
Many patients place high demands on aesthetic, functional and design parameters. Given this, the maximum effect is achieved when using prosthetic implants.
It is important to remember that the stability of the dentures is important, but not always a decisive condition for the quality of orthopedic treatment. Difficult adaptation period may cause the rejection of the patient from the designs made by all the rules of prosthetics. Therefore, it is necessary from the first visit to give due attention to all the wishes of the patient and his psychological preparation for treatment.