That is a complete loss of teeth. Prosthetics for complete loss of teeth. Problems with psychology

Older people are more likely to experience partial or complete edentulism. Prosthetics in the complete absence of teeth, the price and features of the procedure apply to them everywhere. Which of the options to prefer, what is the advantage of each of them - you need to figure it out before starting the process of complete restoration of the dentition.

Modern dentistry is able to offer several methods of prosthetics. There is no universal or ideal solution among them. In each option, there are pros, cons and contraindications for use. We will try to make a full description of all the methods so that you can navigate in the final choice.

Features of prosthetics in the complete absence of teeth

The loss of dental units has a lot of reasons, which become more and more with age:

• Diseases of the gums and periodontium.
• Caries and its untimely treatment.
• Enamel and dentine wear, natural tissue abrasion.
• The absence of a regular
• Injuries and mechanical damage to the teeth or the entire jaw.
• Various diseases of internal organs, impaired metabolism.

Even with the loss of a few units, there are tangible difficulties in daily life. What to say about the complete, which leads to serious problems? If the situation is not corrected in a timely manner and a suitable prosthesis is not installed, the consequences can become irreversible. And this:

1. Violation of the gastrointestinal tract, poor absorption of food, lack of diversity, forced rejection of most products.
2. Characteristic changes in appearance - distortion of the oval of the face, sunken cheeks, protruding chin, hidden lips, especially noticeable nasolabial folds, etc.
3. Since teeth are an integral part of articulation, their absence completely distorts speech. It becomes inferior and slurred, the ability to pronounce many sounds disappears.
4. The bone tissue atrophies, the alveolar processes become thinner, which makes further implantation impossible.

And all this together leads to restrictions in daily life, creates a lot of complexes for a person and practically reduces communication to a minimum. And the only way to restore the quality of life is complete prosthetics.

Only in the rarest of cases may this be unavailable. Contraindications to it are related problems:

• Allergic reactions to materials used in prosthetics. Although this issue is solved with the help of hypoallergenic structures, for example, nylon prostheses.
• Intolerance to anesthetic drugs. But this is true only for implantation.
• Any infections of the body, and even more so of the oral cavity, in the acute stage. Initially, it will be necessary to treat it and only then proceed to prosthetics.
• Diabetes mellitus of the first type.
• Oncology.
• Any mental disorder or neurological disease.
• Problems with blood clotting, which plays a role in implantation.
• Severe forms of anemia, as well as anorexia, which indicates the complete exhaustion of the body.

It is very important to understand the features of complete prosthetics, when not a single supporting tooth is available on the jaw:

• The entire chewing load will occur on the artificial structure, so the choice of high-quality and durable material is one of the most important parts of prosthetics.
• Loss of dental units occurs most often unevenly throughout life. Therefore, the bone tissue partially or completely atrophies, which makes the implantation process inaccessible. But modern medicine has achieved the ability to increase it. This procedure is called a sinus lift, and it can be performed before prosthetics.
• There are also difficulties of the adaptation period. And in the case of removable structures, patients do not always withstand it, refusing to endure pain and other difficulties. As a result, they only use the plates when "going out", which only exacerbates the problem.
• Unreliable fixation of removable dentures in case of complete loss of teeth often becomes a serious obstacle in comfortable operation, which can only be solved by implantation.

And although the choice of available prostheses with complete adentia is small, it is still there and in almost every case you can choose the right option.

Methods of dentures

Complete prosthetics can be of two types -. The former also include acrylic structures, which, in the absence of all dental units, are attached by suction to the gums or a special glue of temporary action.

Fixed prostheses - implants - differ in more reliable fixation. Depending on the depth of implantation of the rod, classical implantation is available and. In any case, the procedure involves a surgical intervention, which not everyone will agree to.

Complete dentures

Full dentures consist of a removable base, which is held on the gums by suction, and artificial teeth that restore the entire dentition. This type of prosthesis, no matter what material they are made of, has a number of features:

• Lack of fastening, due to which the structure often shifts, and sometimes falls out. Partially this problem can be solved with the help of special glue, but it is not able to fix the prosthesis for a long time. Its maximum effect is 6-8 hours.
• Difficult and lengthy adjustment period. On the upper jaw, the palate is almost completely closed, and on the lower jaw there is little room for tongue movements. This complicates articulation and affects taste sensations. When chewing, pain may be observed in the first months after prosthetics.
• The inability to maintain the perfect balance in the matter of price and quality. Although the structures are made of good and expensive materials, they still have many shortcomings in operation.
• Some patients refuse to wear such prostheses, as removable plates cause them to gag. It appears from irritation in the larynx when the structure is pressed during use.

1. Acrylic dentures are considered more reliable and durable, as they are made of high-quality new-generation plastic. But because of the hardness of the material, the fabrics rub more, and it is also more difficult to adapt to them. The porosity of the base gives additional inconvenience when the plate absorbs odors and stains from food. Acrylic structures are more difficult to care for, and their appearance is far from natural. Nevertheless, these prostheses are the cheapest and most affordable for most patients.
2. The nylon base is made of a special material that is flexible, ductile and soft. Due to this, such a prosthesis is felt more comfortably in the oral cavity, it is easier to get used to it. The appearance is more in line with the natural and enhances the aesthetic qualities of the structure. These prostheses are chosen by those who are prone to allergic reactions to other materials.

But a number of disadvantages, such as high cost, shape changes during operation, lower strength and poor fixation, do not allow nylon prostheses to become an ideal solution.

Implantation

Implants are considered more reliable and strong. Due to the fact that the rod is implanted into the bone tissue, the structure becomes practically indestructible. If the doctor did everything right, then such prostheses can last up to 25 years. Only the outer parts of the artificial crowns themselves are subject to breakage, which are easy to replace if necessary.

The big disadvantage is that it is impossible to install such a prosthesis without surgical intervention. And this leads to an increase in the cost of the procedure, the presence of a large number of contraindications, and also significantly lengthens the period of healing and adaptation.

For reliable fixation, two to four implants per jaw are sufficient. There is no need to use them to replace every lost unit. The structures themselves, which are installed on implanted rods, can be push-button and beam.

The former are considered more convenient for removal, since even if desired, the patient himself can detach the crown from the rod, for example, in order to completely clean the structure. But beam implants are the most durable and reliable, significantly increasing the operational period.

It is important that all diagnostic and preparatory measures are carried out before implantation. The quality of the construction and the possibility of adverse reactions after the operation largely depend on this.

Video: prosthetics in the complete absence of teeth.

Price

The price of prosthetics in the complete absence of teeth largely depends on the chosen method. And although each clinic sets its own pricing policy, it is still possible to single out the average range for various types of removable dentures and implants.

So, nylon plates for one jaw are estimated at about 350-400 dollars. Acrylic designs can cost less - from $ 200 apiece. But implantation is considered the most expensive procedure, and its cost will also depend on the number of rods used.

One implant costs approximately 20,000-40,000 rubles. And the entire implantation procedure will cost 2000-4000 dollars in the case of a beam system, and a little cheaper, about 2000 dollars, with push-button fastening.

Bottom line: what kind of prosthetics is better with their complete loss?

It is impossible to single out one universal method that would suit absolutely all patients. The doctor makes a decision based on the health of the oral cavity, especially the gums. It is also necessary to take into account all contraindications and requirements of the patient himself. In addition, the material side of the issue remains important.

And yet, beam implants are considered the most durable, reliable and durable. In addition, their operation causes a minimum of inconvenience. Having survived the difficult period of the operation and the subsequent healing of tissues, you can not worry about breakages, care features, side effects and aesthetics. After completing all the procedures, the dentition is able to perform the necessary functions, and the smile will become snow-white and radiant.

Complete loss of teeth

Complete absence (loss) of teeth - a pathological condition that has arisen after caries and its complications, periodontal disease, trauma or surgery, when one or both jaws are deprived of all teeth.

This condition is characterized by both morphological and functional disorders.

Morphological changes in the masticatory-speech apparatus can be divided into facial, oral, muscular, articular.

Facial signs complete loss of teeth are quite specific and are explained by the loss of a fixed interalveolar height as a result of the loss of the last pair of antagonist teeth.

The second cause of facial features is the loss of support for the lips and cheeks from the teeth and alveolar parts. These sections of the facial skeleton create the appearance of the face, being a frame for the circular muscle of the mouth, buccal and other facial muscles.

All this grossly violates the appearance of the patient. The chin moves forward, the nasolabial and chin folds deepen, the corners of the mouth fall. Due to the loss of support on the front teeth, the circular muscle of the mouth contracts and the lips sink. Changes in the area of ​​the angle of the jaw, piriform opening and senile progeny further emphasize this appearance of the senile face (Fig. 17.36).

Rice. 17.36. Grimace of a toothless man, D. Lluellini /Wales/, ("Life", USA)

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The term senile progenia denotes the ratio of toothless jaws (Fig. 17.37), resembling lower macrognathia. In this case, the most noticeable symptom is the protrusion of the chin.

Rice. 17.37. Skull of a toothless person (a, b)

To understand the mechanism of formation of senile progeny, one should recall some features of the relative position of the teeth of the upper and lower jaws in orthognathic bite. As is known, in this case, the anterior teeth of the upper jaw, together with the alveolar process, are tilted forward. Lateral teeth are tilted with crowns outward, and roots inward. If at the same time a line is drawn through the necks of the teeth, then the formed alveolar arch will be less than the dental arch drawn along the cutting edges and chewing surfaces of the teeth.

A slightly different relationship develops between the dental and alveolar arches in the lower jaw. With an orthognathic bite, the incisors stand vertically on the alveolar part. The lateral teeth, with their crowns, are tilted to the lingual side, and the roots are outward. For this reason, the lower dental arch is already alveolar. Thus, with an orthognathic occlusion with the presence of all teeth, the upper jaw narrows upward, the lower one, on the contrary, becomes wider downward. After the complete loss of teeth, this difference immediately begins to show, creating a ratio of edentulous jaws that resembles lower macrognathia.

Loss of teeth should not always be attributed to age-related phenomena, since their loss due to age-related atrophy of the alveolar part is observed only in elderly people. From this point of view, the term "senile progeny" should be understood conditionally, since progeny can occur after tooth loss at any age. In the presence of a patient, this term can be used with epithets: senile, age-related, involutional.

In addition to the protrusion of the chin and the retraction of the lips and cheeks, one can often observe a deepening of the chin and nasolabial furrows, the appearance of folds that diverge radially from the oral fissure. Patients look much older than their passport age.

To mouth signs include changes that develop in the oral cavity after tooth extraction, including on the mucous membrane covering the alveolar parts and the hard palate. These changes can be expressed in the form of atrophy, fold formation, changes in the position of the transitional fold in relation to the crest of the alveolar part. The nature and degree of changes are due not only to the loss of teeth, but also to the reasons that served as the basis for their removal. General and local diseases, age factors also affect the nature and degree of restructuring of the mucous membrane after tooth extraction. Knowledge of the characteristics of the tissues covering the prosthetic bed is of great importance both for choosing the method of prosthetics and achieving a good result, and for preventing the harmful effects of the prosthesis on the supporting tissues.

Supple paid the main attention to the state of the mucous membrane of the prosthetic bed. He distinguished four classes.

First class: both the upper and lower jaws have well-defined alveolar parts, covered with a slightly pliable mucous membrane. The palate is also covered with a uniform layer of mucous membrane, moderately pliable in its posterior third. The natural folds of the mucous membrane (bridles of the lips, cheeks and tongue) both on the upper and lower jaws are sufficiently removed from the top of the alveolar part. This class of mucosa provides a comfortable support for a prosthesis.

Second class: the mucous membrane is atrophied, covers the alveolar ridges and the palate with a thin, as if stretched layer. Places of attachment of natural folds are located somewhat closer to the top of the alveolar part. Dense and thinned mucous membrane is less convenient for supporting a removable prosthesis.

Third class: the alveolar parts and the posterior third of the hard palate are covered with a loose mucous membrane. This condition of the mucous membrane is often combined with a low alveolar ridge. Patients with similar mucosa sometimes require prior treatment. After prosthetics, they should strictly observe the mode of using the prosthesis and be sure to be observed by a doctor.

Fourth class: movable bands of the mucous membrane are located longitudinally and are easily displaced with a slight pressure of the impression mass. The bands can be infringed, which makes it difficult or impossible to use the prosthesis. Such folds are observed mainly in the lower jaw, mainly in the absence of the alveolar part. The alveolar margin with a dangling soft crest belongs to the same type. Prosthetics in this case sometimes becomes possible only after its removal.

Mucosal compliance, as seen from the Supple classification, is of great clinical importance.

Based on the varying degree of mucosal compliance, Lund identified four zones on the hard palate: 1) the region of the sagittal suture; 2) alveolar process; 3) area of ​​transverse folds; 4) back third.

The mucous membrane of the first zone is thin, does not have a submucosal layer. Her flexibility is negligible. This area is called by Lund the median (median) fibrous zone.

The second zone captures the alveolar process. It is also covered with a mucous membrane, almost devoid of a submucosal layer. This area is called by Lund the peripheral fibrous zone.

The third zone is covered with a mucous membrane, which has an average degree of compliance.

The fourth zone - the posterior third of the hard palate - has a submucosal layer rich in mucous glands and containing some adipose tissue. This layer is soft, springy in the vertical direction, has the greatest degree of compliance and is called the glandular zone.

Most researchers associate the compliance of the mucous membrane of the hard palate and alveolar parts with the structural features of the submucosal layer, in particular, with the location of fatty tissue and mucous glands in it.

E
. I. Gavrilov believed that the vertical compliance of the mucous membrane of the jaw bones depends on the density of the vascular network of the submucosal layer. It is the vessels with their ability to quickly empty and refill with blood that can create conditions for reducing tissue volume. The areas of the mucous membrane of the hard palate with extensive vascular fields, which, as a result, have, as it were, spring properties, are called by him buffer zones (Fig. 17.38).

Rice. 17.38. Scheme of buffer zones (according to E. I. Gavrilov). The density of shading corresponds to an increase in the buffer properties of the mucous membrane of the hard palate

The alveolar ridge after tooth extraction undergoes restructuring, accompanied by the formation of a new bone that fills the bottom of the hole, atrophy of its free edges. With the healing of the bone wound, restructuring does not end, but continues, but already with the predominance of atrophy. The latter is associated with loss of function of the alveolar part, so it is often called inactivity atrophy. The nature and extent of such atrophy also depend on the cause of tooth extraction. With periodontal disease, for example, atrophy is more pronounced.

There is reason to believe that after the extraction of teeth in this disease, the loss of the alveolar part is a consequence not only of the loss of function, but also of periodontal disease itself, due to the fact that the causes that caused it have not ceased to operate. Here, therefore, we meet with the second type of atrophy - atrophy of the alveolar bone, caused by a general pathology. In addition to atrophy from inactivity, resorption in general and local diseases (periodontal disease, periodontitis, diabetes), senile (senile) atrophy of the alveolar ridge may occur.

Atrophy of the alveolar part is an irreversible process, and therefore the more time has passed since the extraction of teeth, the more pronounced the loss of bone. Prosthetics does not stop the phenomena of atrophy, but enhances them. This is explained by the fact that for the bone an adequate stimulus is the stretching of the ligaments attached to it (tendons, periodontium), but the bone is not adapted to the perception of compression forces that come from the base of the removable prosthesis. Atrophy can also be exacerbated by improper prosthetics with an uneven distribution of masticatory pressure, directed mainly at the alveolar part.

Thus, different individuals may have a different degree of severity of atrophy of the alveolar ridge. It is possible to meet patients in whom the alveolar parts are well preserved. Along with this, there are also cases of extreme atrophy. The hard palate becomes flat, in the anterior part of its atrophy often reaches the nasal spine. Not all departments of the upper jaw are equally subject to atrophy. The least pronounced atrophy of the alveolar tubercle and palatine ridge.

On the lower jaw, atrophy can also have varying degrees of severity: from slight to complete disappearance of the alveolar part. Sometimes, due to atrophy, the mental foramen may be directly under the mucous membrane, and the neurovascular bundle will be infringed between the bone and the prosthesis.

The alveolar part disappears with great atrophy. The bed for the prosthesis narrows, and the points of attachment of the maxillofacial muscles are on the same level with the edge of the jaw. With their contraction, as well as with movements of the tongue, the sublingual salivary gland is superimposed on the prosthetic bed.

In the anterior mandible, bone loss is most pronounced on the lingual side, resulting in a knife-sharp or pineal alveolar margin.

In the region of the molars, the cellular part flattens after the loss of teeth. This is due to the fact that the atrophy of the alveolar margin is most pronounced at its top (horizontal atrophy). As a result, there is a thinning of the maxillo-hyoid lines that complicate prosthetics. In the chin region on the lingual side, at the place of attachment of the muscles (m. geniohyoideus, etc.), a dense bone protrusion (spina mentalis) is found, covered with a thinned mucous membrane.

Along with atrophy of the alveolar part, the position of the transitional fold changes. With advanced atrophy, it is in the same plane with the prosthetic bed. The same happens with the points of attachment of the bridles of the tongue and lips. For this reason, the size of the prosthetic bed in the lower jaw decreases, the definition of its boundaries and the fixation of the prosthesis become more complicated.

On the upper jaw, its buccal side is more exposed to atrophy, and on the lower jaw, the lingual side. Due to this, the upper alveolar arch becomes even narrower while expanding the lower one.

Rice. 17.39. Change in the ratio of the alveolar parts after the loss of teeth: I - the ratio of the first molars in the frontal section; II - alveolar parts after removal of molars, lines a and b correspond to the middle of the alveolar parts; III and IV - as atrophy develops, line a deviates outward (to the left), causing the lower jaw to become visually wider

With a complete loss of teeth, changes in the ratio of the jaws also occur in the transversal direction. The lower jaw thus becomes visually wider (Fig. 17.39). All this makes it difficult to set the teeth in the prosthesis, negatively affects its fixation and, ultimately, affects its chewing efficiency.

The clinical picture becomes even more complicated if the patient has a sharp discrepancy between the sizes of the alveolar arch of the upper and lower jaws, since there is a small upper jaw and a large lower jaw. The greater the discrepancy between the upper and lower dentition, the more pronounced senile progeny and the more difficult the conditions for prosthetics.

The clinical condition of the upper and lower jaws determines the conditions for fixing prostheses.

Rice. 17.40. The outlines of the vestibular slope of the alveolar part: a - gentle, b - sheer, c - with a niche

Of great importance for fixing a complete removable denture in the upper jaw (except for the presence of pronounced areas of anatomical retention with little mobility of the mucous membrane, with the exception of the distal edge of the denture along line A) is the shape of the slope of the alveolar process. There are three variants of the slope of the alveolar process of the upper jaw (Fig. 17.40):

Sloping - in the presence of which the edge of the prosthesis, falling down, slides along the slope, maintaining contact with the mucous membrane along the edge of the prosthetic bed. This is the most optimal variant of the anatomical shape of the slope of the alveolar process for a complete removable denture;

Sheer - in the presence of which the edge of the prosthesis, hanging down, quickly leads to a violation of the closing valve due to loss of contact with the mucous membrane, which is manifested in the loss of stability of the prosthesis;

With canopies (undercuts or niches) - in which good conditions of anatomical retention conflict with the way the prosthesis is applied.

For practical reasons, it became necessary to classify edentulous jaws. The proposed classifications to a certain extent determine the treatment plan, promote the relationship of doctors and facilitate the entry in the medical history, the doctor clearly understands what typical difficulties he may encounter. Of course, none of the known classifications claims to be an exhaustive description of edentulous jaws, since there are transitional forms between their extreme types.

muscle changes include a change in the distance between muscle attachment sites, the absence of former impulses from the central nervous system induced by irritation of periodontal proprioreceptors, a decrease in the activity of masticatory and facial muscles.

Articular changes associated with atrophy of the elements that form the temporomandibular joint. The depth of the articular fossa decreases, the fossa becomes more gentle. At the same time, atrophy of the articular tubercle is noted. The head of the lower jaw also undergoes changes, approaching the cylinder in shape. The movements of the lower jaw become freer. They cease to be combined and, when the mouth is opened to a normal interalveolar height, become articulated with the head located in the cavity. Due to the flattening of all the elements that form the joint, the anterior and lateral movements of the lower jaw can be made so that the alveolar ridges are almost in the same horizontal plane.

With the complete loss of teeth, the protective role of the molars falls out. With the contraction of the masticatory muscles, the lower jaw freely approaches the upper, and the head of the lower jaw is pressed against the articular disc. The only obstacle to the movement of the head is the lateral pterygoid muscle. If the strength of this muscle is insufficient to resist the muscles that lift the lower jaw, then the head of the lower jaw moves into the depth of the glenoid fossa.

Essentially, in edentulous patients, both morphologically and functionally, a new joint appears. Functional overload of the articular surfaces can easily lead to the development of deforming arthrosis. From this it should not be concluded that in all cases of complete loss of teeth, the phenomena of deforming arthrosis will be observed. Adaptive mechanisms neutralize functional overload, and therefore many patients who are deprived of teeth do not complain about the joints.

Functional changes are primarily associated with an altered stereotype of masticatory movements of the lower jaw, which primarily leads to functional overload of masticatory muscles and temporomandibular joints.

The function of chewing with complete loss of teeth is almost absent. True, many patients grind food with the help of gums, tongue. But this in no way can make up for the lost function of chewing. Of great benefit is the intake of culinary processed and crushed food (mashed potatoes, minced meat, etc.). Because chewing is kept to a minimum, people without teeth experience no enjoyment while eating. Reducing the degree of fragmentation of food makes it difficult to wet it with saliva. Therefore, in toothless people, oral digestion is impaired.

Complete loss of teeth entails speech impairment. Speech becomes slurred and slurred. In persons of certain professions, complete loss of teeth can make their professional activity impossible.

Aesthetic disorders (change in appearance, gross speech disorders), difficulty chewing food, obvious signs of disability negatively affect the patient's psyche. By itself, the complete loss of teeth almost always leaves a mark on the patient's psyche.

In young people, complete loss of teeth, even from accidental causes such as trauma, creates a sense of physical inferiority. It is exacerbated to a greater extent in women than in men.

In older people, complete loss of teeth is regarded as a sign of advancing old age. If we take into account that for many this coincides with increasing changes in the physical condition, the fall of many functions, then the difficulties of a purely emotional nature that the doctor will have to face will become obvious. It should be noted that psychological problems always occur in the diagnosis and orthopedic treatment of patients with pathology of the masticatory-speech apparatus, but in this case they are presented to a greater extent.

In older people, complete loss of teeth can be superimposed on a sense of anxiety, anxiety caused by various circumstances of a family, social nature. Persons over 65 years of age, in addition, suffer from atherosclerosis of cerebral vessels with varying degrees of severity of neurotic conditions. It should not be forgotten that for people of certain specialties (artists, announcers, lecturers), tooth loss means parting with a profession, a favorite thing, and sometimes the need to retire, which can also be hard to experience.

Many patients come to see a doctor with a prejudice against removable dentures, with disbelief in the possibility of using them. Such pessimism can be reinforced by carelessly dropped expressions of medical personnel about the difficulties of fixing the prosthesis. In this regard, consultations by incompetent persons who do not have special medical knowledge bring great harm.

Difficulties not only of a social but also of a psychological nature that a doctor may encounter when supervising patients with tooth loss should be taken into account when diagnosing and drawing up a plan for orthopedic treatment. Forgetting them can cause failures even with the perfect performance of the prosthetics itself. Treatment will be successful if there is an atmosphere of trust between the doctor and the patient. Less difficulties are encountered in the prosthetics of patients who previously used prostheses, although in such cases there are psychophysiological features, which will be discussed later.

Total loss of teeth is a pathological condition that can be easily diagnosed. The main difficulty in this is to identify the type of edentulous jaw, determine the state of the mucous membrane of the prosthetic bed, the degree of dysfunction of the temporomandibular joint, masticatory muscles, etc. This part of the diagnosis is the most difficult and responsible and plays an important role in the implementation of prosthetics and achieving good functional result.

Only a thorough examination of the patient will allow the doctor to get the most complete picture of the complexity of the clinical picture. Taking it into account, it is possible to solve the problem of prosthetics with the least effort, while avoiding gross errors.

Examination of the patient with a complete loss of teeth, they begin with a survey, during which they find out:

1) complaints about the organs of the oral cavity and the gastrointestinal tract;

2) data on working conditions, past illnesses, bad habits (smoking, eating spicy food, spices, alcohol, etc.);

3) time and causes of tooth loss;

4) whether the patient has previously used removable dentures.

The doctor should dwell on the last question in more detail, since prosthetics are greatly facilitated if the patient has previously used a prosthesis. Often, when planning a new prosthesis, it is necessary to take into account the design features of previous designs. This is especially important for patients who have used prostheses for a long time. If the patient has not previously used prostheses, the reasons for this should be clarified in detail.

When talking with a patient, one can sometimes get an approximate idea of ​​the nature of his reactions (excitability, irritability, ability to endure the slightest inconvenience from the prosthesis, etc.). These observations will provide additional valuable information.

After the interview, they proceed to examine the face and oral cavity of the patient. Examination of the face should not be done on purpose, as this confuses the patient. It is better to do this during a conversation unnoticed by him. It should be noted the symmetry of the face, the presence or absence of scars of the skin of the face, limiting the opening of the mouth, the degree of decrease in the height of the lower part of the face, the nature of the closing of the lips, the condition of the red border of the lips, the severity of the nasolabial and chin folds, and the condition of the mucous membrane and skin in the region of the corners of the mouth.

When examining the oral cavity, attention is paid to the degree of mouth opening (free or with difficulty), the nature of the ratio of the jaws, the severity of atrophy of the alveolar part in the upper and lower jaws. Alveolar ridges should not only be examined, but also palpated to detect sharp protrusions of the roots and bone, covered by the mucous membrane and invisible during examination.

The method of palpation is also obligatory when examining the area of ​​the sagittal palatine suture. Here it is important to establish the presence of the palatine roller. Pay attention to the shape of the alveolar part, which is also of great importance for fixing the prosthesis. Then they study the condition of the mucous membrane covering the hard palate and alveolar parts (the degree of compliance, lesions of leukoplakia or other diseases).

It is necessary to study the topography of the transitional fold. Distinguish between mobile and immobile mucosa.

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movable mucosa covers the cheeks, lips, floor of the mouth. It has a loose submucosal layer of connective tissue and is easily folded. With the contraction of the surrounding muscles, such a mucous membrane is displaced. The degree of its mobility varies considerably (from large to insignificant).

Rice. 17.41. General view of the oral cavity with edentulous jaws: 1 - frenulum labii superioris; 2,4 - frenulum buccalis superioris; 3 - torus palatinus; 5 - tuber alveolare; 6 - line A; 7 - fovea palatina; 8 - plica pterygomandibularis; 9 - trigonum retromolare; 10 - frenulum lingualis; 11 - frenulum buccalis inferioris; 12 - frenulum labii inferioris

Fixed mucosa devoid of a submucosal layer and lies on the periosteum, separated from it by a thin layer of fibrous connective tissue. Its typical locations are the alveolar parts, the region of the sagittal suture and the palatine ridge. Only under the pressure of the prosthesis, the compliance of the immovable mucous membrane towards the bone is revealed. This compliance is determined by the presence of vessels in the thickness of the submucosal layer.

The mucous membrane covering the alveolar process passes to the lip or cheek and forms a fold, which is called transitional (Fig. 17.41).

On the upper jaw, the transitional fold is formed when the mucous membrane passes from the vestibular surface of the alveolar process to the upper lip and cheek, and in the distal section - to the mucous membrane of the pterygomandibular fold. On the lower jaw, from the vestibular side, it is located at the point of transition of the mucous membrane of the alveolar part to the lower lip, cheek, and on the lingual side, at the point of transition of the mucous membrane of the alveolar part to the bottom of the oral cavity.

The study of the topography of the transitional fold should begin with an examination of the oral cavity with fully preserved teeth, moving on to edentulous jaws with well-defined alveolar ridges. With advanced atrophy of the alveolar part, especially in the lower jaw, determining the topography of the transitional fold is difficult even for an experienced doctor.

In addition to examination and palpation of the organs of the oral cavity, according to indications, other types of research are carried out (radiography of the alveolar parts, joints, graphic recordings of the movements of the lower jaw, recordings of the incisive and articular paths, etc.).

The result of the examination is a clarification of the diagnosis (detection of the degree of atrophy of the alveolar parts, the relationship of edentulous jaws, moments that complicate prosthetics, the topography of the transitional fold, the severity of buffer zones, etc.). In addition, it turns out whether the condition of the tissues of the oral cavity allows prosthetics or the patient needs preliminary general or special preparation. Finally, as a result of the examination, the design features of the future prosthesis and methods for implementing prosthetics become clear.

The loss of even one tooth is stressful and a threat to the health of not only the entire oral cavity, but the whole organism. As you know, there are no extra organs in our body, and teeth in this case are no exception.

The most common causes of tooth loss are caries and its complications, trauma and gum disease. In a word, the threat of losing teeth haunts us throughout our lives.

One way or another, tooth loss leads not only to health problems of the entire digestive tract, but also to psychological changes. Of course, this affects self-esteem, social and personal life.

The most topical problem is the complete loss of teeth, which is often accompanied by bone atrophy.
For a long time, the only way to prosthetic a jaw with a complete absence of teeth was complete removable lamellar dentures, which were held in the oral cavity exclusively on the gums, due to mechanical retention, due to the relief of the alveolar process.

Complete absence of teeth and restoration methods

Even a perfectly made complete removable denture has a number of disadvantages. The design must be periodically removed and washed, such prostheses are bulky and to improve their fixation it is often necessary to use adhesive pastes and creams.

With the advent of dental implants, the situation has improved markedly. For the first time in the history of dentistry, patients have the opportunity to replace lost teeth with equal value. A large selection of different systems and diameters make it possible to install implants, sometimes even in conditions of severe bone atrophy, choosing the most favorable and dense areas of the jaw bone tissue.

Our specialists select implants individually for each patient, taking into account the specific anatomy in each area of ​​the jaw.

A feature of the technique is the speed, atraumaticity and efficiency of implantation and prosthetics. The technique allows you to return lost teeth within just 7 days.

Getting new teeth is easier than you think.

In just 7 days you will be able to fully chew! All inclusive!
The cost of complex implantation of one jaw, together with crowns, is 250,000 rubles.

In the photo: Prosthetics in the complete absence of teeth. Photos before and after visiting the clinic.

Preparation and course of the operation of complex implantation

After a free consultation, a detailed treatment plan and a decision on implantation, a detailed plan for your treatment is drawn up, appointment dates are scheduled. At this stage, implants of the required diameter and length are individually selected, taking into account your anatomical features of the structure of the jaw.

If there are teeth left to be removed, they are removed followed by the immediate installation of implants. Implants can be installed in the socket of the extracted tooth immediately after extraction. Often, implants can be installed without an incision and sutures, using the gum puncture method. This significantly reduces trauma and postoperative swelling and pain symptom. As a result, the postoperative period lasts several days, and the rehabilitation itself proceeds more calmly. Immediately after the installation of the implants, the necessary impressions are taken, the central ratio of the jaws is determined.

On the third day after implantation, the frameworks are tried on, and on the fifth/seventh day, the crowns are fixed with strong cement.
You will immediately be able to chew with your new teeth, take any food. It is easy to get used to such crowns, they do not need to be removed, in terms of comfort crowns on implants are in no way inferior to natural teeth.

The main advantages of complex dental implantation

The shortest terms of treatment. You will receive new teeth in 5-7 days.

Lower cost compared to the classical method of implantation

Predictable and long-term result

Fixed prosthesis design

Distribution of load on the teeth

high aesthetics

Dentures are easy to clean and easy to care for

Complex dental implantation is one of the few dental methods to solve the problems of missing teeth once and for all. Of course, this is a more expensive way to solve this problem compared to removable dentures, but if you have used a complete denture, then you will most likely agree that you should not save on health and comfort, and it is often simply impossible to endure all the inconveniences associated with them. Complex implantation will give you health and joy of life, and thanks to new minimally invasive (low-traumatic) treatment methods and a minimum number of interventions, treatment and prosthetics are much easier to tolerate.

Indications and contraindications

The method of complex implantation, like any other method of treatment, has its own indications and contraindications for use.

Indications for immediate dental implantation

Complete absence of teeth

Inability to use classic removable dentures

bone atrophy

Increased gag reflex

Reduction of terms of treatment. A frequent relative indication for complex implantation is the inability of the patient to expect engraftment.

Contraindications for dental implants

Can be absolute and relative (or temporary), to temporary:

Extreme degree of atrophy of the jaw bone

Loose bone structure, osteoporosis

Pregnancy and lactation

Diseases of the nervous system and mental illness

The period of rehabilitation after an illness or the post-rehabilitation period of surgical interventions performed earlier

Condition of cachexia or dystrophy

Arthritis and arthrosis, especially of the temporomandibular joint.

Drug therapy that is not combined with drugs prescribed by the surgeon after implantation (for example, antidepressants, drugs that affect blood clotting)

Severe allergy to anesthetics

Features of the profession associated with extreme loads and a high risk of injury. For example, contact sports.

Often these factors can be eliminated with the help of appropriate special training and treatment of diseases that prevent the implantation operation. In such cases, implantation is possible.

Absolute contraindications for dental implants include:

AIDS and venereal diseases

Malignant tumors of various organs and systems during the period of special therapy and some time after its completion

Chronic diseases such as: tuberculosis, rheumatic disease, diabetes mellitus, diseases of the oral mucosa, stomatitis, scleroderma, insulin-dependent diabetes

Systemic diseases of the connective tissue: systemic lupus erythematosus, scleroderma, rheumatic, rheumatoid and other diseases make the implant installation process impossible

Diseases of the endocrine system: pituitary gland, adrenal pathology, severe forms of hyper- and hypothyroidism, hyper- and hypoparathyroidism

Pathology of the immune system: lupus erythematosus, polymyositis, severe infections, hypoplasia of the thymus and parathyroid glands

Diseases of the oral mucosa: chronic recurrent aphthous stomatitis, lupus erythematosus, pemphigus, Sjögren's syndrome

Blood diseases and disorders of the hematopoietic function: leukemia, thalassemia, lymphogranulomatosis, hemolytic anemia

Diseases of the skeletal system that impede the normal course of bone tissue regeneration: osteoporosis, congenital osteopathy, osteonecrosis, dysplasia

Diseases of the central and peripheral nervous system: schizophrenia, paranoia, dementia, psychosis, neurosis, alcoholism and drug addiction and other diseases in which the patient may not adequately perceive information about the rules of conduct during and after treatment

Is Immediate Implantation Right for You?

Find out if complex dental implantation is right for you personally at a free consultation, where you will receive a detailed treatment plan and its exact cost. To make an appointment, fill out the online form below, after a short time the clinic administrator will call you back and plan your visit to the RedWhite clinic in the most convenient way for you.

Few of our contemporaries manage to keep their 32 teeth intact. Teeth are lost for a variety of reasons - due to dental diseases, trauma, untimely treatment, and even from an unhealthy lifestyle. But if you have lost only one tooth, problems with your health can appear, your appearance will be spoiled, and life expectancy will be reduced.

Why is tooth loss dangerous?

If a person loses one or several teeth at once, this can significantly change the quality of his life. Many people consider this issue solely from the point of view of aesthetics, and in fact the loss of even one of the teeth will affect the oral cavity and the entire body. The consequences can be very depressing.

Facial features change

When a person loses a tooth, the jawbone begins to change under the place where it was located. It now has less load, and it begins to dissolve. Time passes, and facial features begin to change: lips sink, wrinkles appear on the chin, the corners of the mouth become lowered, the chin doubles, the jaw becomes smaller, even wrinkles begin to appear on the neck.

Problems with psychology

Psychology is also beginning to change. Even if you are not a public person, artist or politician, you still have to communicate with relatives and colleagues, and if you are missing teeth, this inevitably reduces your self-esteem, complexes begin to develop and mental disorders appear. The result is more than grim: a reduction in life expectancy.

Speech is disturbed

The resulting discomfort of a psychological nature, caused by an unaesthetic appearance, is aggravated by speech disorders: if you lose only one front tooth, you will encounter a violation of the correct articulation.

Teeth are crooked

If one and even more so - several teeth are missing, occlusion is disturbed, the correct closure of the teeth of the upper and lower jaws. This is inevitable even if only one tooth is lost. The opposing tooth is unsupported and loosened. Adjacent to the lost teeth converge in an effort to fill the empty space. The entire row of teeth gradually begins to move, the bite is disturbed, after which the impact on the jaw joint appears, which causes headaches, the neck and back begin to hurt.

If the teeth are not replaced by dentures, the gaps between them begin to increase, food gets stuck in these cracks, which causes caries and other diseases.

gums are affected

The destruction of bone tissue also leads to damage to the gums, the layer of the epithelium becomes thinner, and a recess is obtained that changes the aesthetic perception of a smile. This process reinforces the malnutrition that is inevitable due to the inability to properly chew food. In the gum tissue, along with the blood, less and less essential nutrients begin to flow, which is why they are destroyed.

Digestive problems

The absence of chewing teeth, primarily from among the lateral molars, does not allow food to be completely chewed, which causes trouble with the stomach and intestinal tract. If many teeth are missing, the total diet of a person, necessary for his normal life, begins to decrease, the person switches to soft food, which also affects digestion and contributes to the manifestation of related problems.

Treatment of missing teeth

If you had to part with one or even a number of your teeth, this is not at all a reason to get upset and say goodbye to your external attractiveness and good health. Thanks to the achievements of dentistry and implantology, it is possible to use a wide range of methods for restoring missing teeth, which differ in financial capabilities.

Missing part of teeth

In case of loss of several teeth, they can be replaced with plastic or nylon prostheses, clasp and bridges. Dental prosthetics on implants installed in the jaw is considered exceptionally reliable. The latter method also provides the most aesthetic results. When implanting into the body of the bone, the duration of the inserted implants is maximum, the adjacent teeth do not have to be turned, which is necessary when prosthetics with bridges. A dental prosthesis placed on an implant implanted into the bone is quite functional, and from an aesthetic point of view it completely replaces the lost tooth.

Complete absence of teeth

The cheapest solution when all teeth are missing is the fabrication of removable dentures. They are made of nylon, silicone, and acrylic and are widely used in modern dentistry. In the fight against the numerous shortcomings that such prostheses have, specialists prefer to use fixed prosthetics, using implants as a support. There is also a technique of conditionally removable prosthetics, which is a cross between plate-type prosthetics and full-fledged fixed implantation.

If teeth are missing for a long time, it can backfire. In addition to the deterioration of the quality of life, deprivation of external attractiveness, harm is done to the entire human body. But if the teeth are lost, do not rush to put an end to yourself. Using the achievements of modern dentistry, you can restore any number of teeth, from one to all at once. The main thing is to contact an experienced specialist in time, undergo professional diagnostics, choose the right method of prosthetics and immediately begin treatment.

Friends, I never tire of repeating that the main thing in medicine is the head and hands of a doctor. Moreover, the head - in the first place. Materials, equipment, medicines, tools - all this, of course, contributes to achieving the best result, but to a lesser extent.

Today I will show you one of my implantological works. At the same time, I propose to discuss what a person should do in case of loss of all teeth. Can this problem be solved? Is it possible to return teeth if several decades have passed since the last one was removed? Is it possible to improve the quality of life with complete loss of teeth?

This will be discussed below.

I will not talk about the causes of tooth loss. This can be the sequential removal of carious teeth, or the instantaneous removal of all teeth at the same time due to active periodontitis. It is impossible to live without teeth - what to do next?

As soon as the ability to chew normally disappears, atrophy of the muscles, temporomandibular joints, and jaw bones begins. The quality of human life is falling - you have to change your eating habits, complexes and health problems appear. Many patients associate the onset of old age with the appearance of a removable denture.

Speaking of removable dentures. They take up a lot of space in the mouth, are mobile or not kept on the jaws at all, and some patients cannot use them at all due to an increased gag reflex. But the most important thing is that removable dentures negatively affect the condition of the jaw bones - due to constant pressure on the mucous membrane, atrophy of the bone tissue occurs up to its complete loss. This is the reason why removable dentures "sink" over time and have to be redone every few years.

In general, not everyone wants a removable denture. And, thank the robots, we have something to offer such patients.

Here is my friend, let's call him Ivan Petrovich. He is 76 years old. In his youth, he was a very famous athlete, now he lives in another country and periodically visits relatives in Russia.

Despite his venerable age, Ivan Petrovich leads an active lifestyle, travels a lot, communicates, enjoys equestrian sports and photography. Before coming to our clinic, he had been using complete removable dentures for more than 10 years. Needless to say, these prostheses did not suit Ivan Petrovich at all.

So no teeth. Neither upper nor lower jaws. Ivan Petrovich uses removable dentures.

(the points on the prosthesis are the markings for the installation of implants)

We decided to install six Astratech implants in the lower jaw to use them as a support for fixed dentures.

At the first stage, we installed implants in the lower jaw. The operation is performed under local anesthesia, using the existing removable prosthesis as a template.

a month later, we proceed to the installation of gum formers.

Ivan Petrovich complained that the lower prosthesis was not held on the jaw, therefore, instead of gum formers, we installed special locking ball abutments for fixing the puller on two implants. And the reverse parts of the locks were soldered into the prosthesis itself:

With the help of these locks, the prosthesis is very securely fixed on the jaw and is practically immobile.

Then, a few days later, our orthopedic doctor, Artur Makarov, made a compact metal-ceramic prosthesis based on implants:

The photo was taken about a year after prosthetics.

The metal-ceramic prosthesis is fixed on the implants with screws. If necessary, the prosthesis can be removed, cleaned, treated with implant necks, etc. As you can see, it takes up very little space in the oral cavity, and caring for it is the same as for your own teeth.

Naturally, the denture is very securely held in the oral cavity, durable and not much different from natural teeth. Ivan Petrovich has been using it for more than a year and I am sure it will serve him for a very long time.

Note that this is not some kind of exclusive, but a completely ordinary work. Here is another example. Observation period - one and a half years:

Moreover, in this case, the prosthesis is based not on six, but on four implants.

In general, for the manufacture of a fixed prosthesis for the lower jaw, we can use from four to fourteen implants, depending on the specific clinical situation. For example, a forty-year-old man who has lost all his teeth due to active periodontitis needs a minimum. six implants, as the masticatory muscles and joints work almost at full strength and develop sufficient load. And vice versa, for a patient who has been using removable dentures for many years, we can easily “return” her teeth on just four implants.

That is, dear friends, there are no insurmountable obstacles for modern dentistry. Even in the most difficult cases, there is always a solution, the only question is the timing and complexity of such treatment.

As usual, I look forward to your questions and comments.

I wish you great health.

Sincerely, Stanislav Vasiliev.