Partial secondary adentia of the upper jaw. What is partial adentia (partial absence of teeth). Adentia in children

Lack of teeth is a problem that cannot be ignored - the load on the jaw increases, the shape of the face changes. Sometimes it happens that the adentia of the molars is inherited, in this case it is important to recognize and eliminate the problem in a timely manner in childhood.

Partial absence of teeth can occur at any age, but older people most often face this nuisance. In children, adentia appears when milk or molars do not erupt. Let's try to figure out why this pathology occurs, what types of it are, and how to overcome tooth loss.

The concept and causes of adentia

Loss of teeth, or adentia, is a violation of the condition of the oral cavity. The fact of missing teeth can be congenital, this pathology is inherited, so if your close relatives suffer from this disease, you should pay special attention to the condition of the jaw.

There are many reasons why a person develops partial loss of teeth, and one of them cannot be called the main one. It could be an influence wrong image life of the mother during the period of bearing a child, the presence of other diseases of the oral cavity, heredity. Some experts cite the resorption of the follicle as the main cause of tooth loss, which, in turn, is destroyed under the influence of other factors. Thyroid dysfunction can also affect partial tooth loss.

The causes of acquired adentia are pathologies of the oral cavity, especially in advanced form, as well as jaw injuries, poor-quality dental treatment. Untreated caries also eventually leads to missing teeth.

Due to the many factors that can provoke partial loss of teeth, it is important to conduct a comprehensive diagnosis, to cure those areas that are still treatable. After that, you can proceed to the procedure of prosthetics - the only method of salvation from the deformation of the jaw and face.

Varieties and symptoms of pathology

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AT modern dentistry Adentia is usually divided into primary and secondary, and each of these types is subdivided in turn into complete and partial. In accordance with this division, it is possible to identify the nature of the occurrence of the pathology and its prevalence.

Based on the name, it is clear that the main symptom of adentia is the complete and partial loss of all or several teeth. Each of these varieties needs to be discussed separately.

Primary (full and partial)

Complete primary adentia is a pathological congenital condition that occurs infrequently. It is characterized by the absence of milk or molars, while even their rudiments are not observed on the x-ray. Complete adentia leads to deformation and asymmetry of the shape of the face, a change in the mucous membranes is noted, they look dry and light in appearance.

The diagnosis of complete adentia implies the complete absence of units, such a condition can be determined simple method jaw palpation. There are no hints of rudiments on the x-ray, the jaw looks underdeveloped outwardly, and Bottom part faces are visually smaller in size.

The loss of teeth in childhood manifests itself at the moment when dairy teeth must give way to indigenous ones. The X-ray image does not show the origin of indigenous, lower jaw gradually approaches the top, deformation of the circumference of the face begins. Cases of partial tooth loss of this type are quite rare.

Primary partial loss of teeth is more common. Such a diagnosis is made when one or more dairy or root units are missing in a row. The rudiments are not visible on the radiograph, and gaps gradually appear between the chewing organs that have grown. The state of tooth loss leads to deformity and wrong development jaws.

Secondary (full and partial)

Secondary adentia in dentistry is also called acquired. It is characterized by a complete or partial absence of teeth in a row, occurs both among milk teeth and among permanent ones, and occurs in connection with their removal or loss.

Complete secondary adentia is a condition in which the elements of the jaw are completely absent, so it begins to deform. Her top part tends to the nose, it is visually noticeable that the lips tumble inward. With secondary adentia, the alveolar processes and jaw bones die over time, and therefore the patient loses the ability to eat normally. A patient with complete adentia begins to have difficulty pronouncing sounds.

The most common form of secondary adentia is the partial absence of teeth. With this disease, there is a loss of one to several teeth - milk or permanent. Due to insufficient enamel hard tissues are erased, doctors at the same time make a concomitant diagnosis - "hyperesthesia". With secondary partial loss of teeth, the patient complains of pain when chewing, when exposed to hot and cold, gradually develops a habit of eating liquid food, which does not aggravate his condition.

Diagnostic methods

Diagnosis of adentia is not very difficult; at the first examination, the doctor sees the complete or partial absence of teeth in the patient. For the final diagnosis of primary adentia is assigned x-ray examination to clarify whether there are rudiments of milk or indigenous units.

If a we are talking about prosthetics, it is important to note the presence of the following factors that interfere with the procedure:

• the presence of root residues after partial adentia, which are invisible during external visual inspection;
• partial exostoses;
• inflammatory diseases of hard and soft tissues of the oral cavity;
• mucosal diseases.

After completing a full examination, the doctor must tell the patient in detail about all treatment options, paint the pros and cons of each. Only after the specialist is convinced that the client fully understands the prospects and risks, it is possible to proceed with the chosen method of restoring tooth loss.

Features of the treatment of primary and secondary adentia

Treatment of pathology associated with the absence of teeth is carried out by an orthopedic method. The specialist decides on the type of prosthetics, based on the condition alveolar processes.

The primary form of adentia is treated depending on the age of the patient. The most common decision that is made in relation to the majority of patients with this pathology is to wear a pre-orthodontic trainer. In this case, a person with loss of teeth is registered in the clinic.

With partial primary adentia in young children during the appearance of the first permanent teeth it is important to start eruption stimulation in time to prevent the development of jaw deformity. It is necessary to wait for the appearance of the seventh units in a row, and then proceed to work out possible options for prosthetics for those that are not enough.

The treatment for secondary complete edentulism is to restore normal functioning jaws, to prevent deterioration of the patient's condition and deformation of the bones of his jaw, and only then think about prosthetics. The doctor must reassure the patient and present him with the most successful outcome of the operation, so as not to give rise to psychological complexes in a person associated with the absence of teeth.

Adentia in children is the partial or complete absence of teeth due to their loss or anomaly in the development of the dentition. The disease is characterized by a violation of the function of chewing and speech due to the lack of integrity of the dentition. AT severe cases adentia of teeth in children is accompanied by deformation of the facial skeleton and further loss of teeth. At total absence teeth, there is often a displacement of the lower jaw towards the nose, retraction of the soft tissues of the preoral region, and the formation of wrinkles. With partial adentia in children, the remaining teeth are displaced and diverge. And in the process of chewing, an increased load falls on them.

Interesting fact!

The rudiments of milk teeth are formed in babies even in the womb, at about 3-4 months of her pregnancy. The process of their formation takes about a month, so it is important that during this period future mom used dairy products rich in calcium, without which the full formation and subsequent health of teeth is impossible.

Types of adentia in children

Adentia in children is divided into types in accordance with the criteria indicated in the table below.

Causes of adentia in children

Adentia in children can be hereditary, but it can also develop in the process of a child's life. In this regard, there are several causes of adentia in children.

• Absence or death of rudiments of teeth. This may be due to hereditary causes, as well as disorders in the formation of the fetus in the womb. The child’s dental plate is formed even in the prenatal period, and the impact of harmful factors (for example, poor ecology or unhealthy image mother's life) can negatively affect this process.
• Loss of teeth in the course of life. Children, especially boys, are more prone to injury than adults because of their activity. Thus, the teeth of babies often fall out during fights, falls, as well as certain sports (hockey, football, boxing).
• deep caries and its complications. Due to the thin enamel of milk teeth, caries in children develops on them much faster than on permanent ones. Therefore, if it is not cured in a timely manner, there is a risk of losing a tooth as a result of progressive purulent-inflammatory processes in the tissues.

Photo of adentia in children

Treatment of adentia in children

Diagnosis of adentia of teeth in children is carried out by visual and palpation examination, targeted intraoral radiography and orthopantomography. The tactics of treating adentia in children is determined taking into account the physiological, anatomical and hygienic features of the child's dental system. Depending on the degree of the disease, apply following methods treatment of adentia in children.

Stimulation of teething. In some cases, a gum dissection procedure and the placement of special braces that stimulate eruption are used.

Fixed prosthetics. Fixed orthopedic structures (crowns, bridges) are installed for the child.

Removable prosthetics. Removable orthopedic constructions (clasp, laminar prostheses) are installed.

Dental implantation. It is applied only after the jaw bones are finally formed. This process usually ends at the age of 18 in boys and at 16-17 in girls. Until that time, the treatment of adentia is carried out with the use of removable and fixed prostheses.

Consequences of adentia in children

If you do not contact a specialist in time and do not treat adentia in children, this can lead to deformation of the facial skeleton, which results in developmental defects in the child.

• Speech disorder. With the complete or partial absence of teeth, the child pronounces some sounds incorrectly, and may even lose the ability to pronounce them.
• chewing dysfunction. Due to a decrease in the quality of chewing food and a change in the mode of consumption of products, the absence of teeth often leads to diseases of the gastrointestinal tract in a child.
• Mental disorders. The absence of teeth is also cosmetic defect. The kid is embarrassed to smile, as a result, he develops complexes. In addition, a violation in the work of the jaws caused by adentia brings discomfort and causes a deterioration in mood.

Where to apply?

Treatment of complete or partial adentia in children is prescribed and carried out by an orthopedic dentist. Presence of teeth important aspect the health of the child and his psychological state, therefore, it is necessary to carefully approach the process of choosing a nursery dental clinic and explore the range of services related to the treatment of adentia in children, which are offered by different medical institutions. Be sure to pay attention to the fact that dentistry has a license to provide services to children.

How much does the treatment cost?

Treatment of adentia in children begins with an initial examination and preparation of a treatment plan. Usually these services are provided free of charge - as a promotion to attract customers. Also little patient you will need to make an x-ray at a price of 350 rubles and a panoramic x-ray of the oral cavity, the cost of which starts from 1,000 rubles. In addition, before proceeding with the treatment of adentia in children, it is necessary to carry out professional hygiene oral cavity at a price of 2,700 rubles and more. Based on the fact that adentia in children is treated mainly by installing removable dentures, parents should be prepared for the following costs for various types orthopedic structures: a partially removable lamellar denture costs from 1,750 to 60,000 rubles, a complete removable lamellar denture - from 40,000 to 100,000 rubles, a temporary full removable denture - from 2,800 to 3,500 rubles. A removable acrylic denture will cost from 12,000 rubles, bridge prosthesis- from 25 000 rubles. The cost usually includes the manufacture of the structure and its installation by a specialist.

In orthopedic dentistry, partial absence of teeth implies a lack of one or more units. In terms of the impact on functionality and aesthetics, the diagnosis of “partial absence of teeth (partial adentia)” is very ambiguous, because if 2–3 teeth are missing, this is one situation, and if 1–15 is completely different. That is why some experts began to distinguish such a variety as multiple adentia, when more than 10 teeth are missing. However, even without this division, partial adentia has forms and classes that are important to mention.

Forms of partial edentulous teeth

• Primary adentia. Absence or death of rudiments of teeth at the stage prenatal development. This form partial adentia is quite rare and is caused by hereditary factors or diseases and infections that have arisen during pregnancy (hypothyroidism, ichthyosis, pituitary dwarfism). Primary adentia is often combined with an irregular shape of the teeth or underdevelopment of the alveolar processes;


• A person was born with a full set of teeth, but lost some of them due to injuries or dental diseases and complications. Partial secondary absence of teeth is a very common disease. According to statistics, more than 75% of people lose one or more teeth during their lifetime.

Classification of partial adentia

The most popular classification of partial adentia was developed by the American dentist Edward Kennedy. Despite the fact that this happened back in the twenties of the last century, they are actively working on it today. In total, Kennedy identified four main classes of partial adentia, with a focus on which a rehabilitation plan is drawn up.

Kennedy classification of partial absence of teeth

1. First grade. Partial edentulous with bilateral end defect: absence of molars on both sides of the jaw.
2. Second class. Unilateral end defect when the patient has lost chewing teeth on one side of the jaw.
3. Third class. Unilateral included defect. Missing some molars or front teeth.
4. Fourth grade. Included anterior teeth defect. Completely missing teeth in the smile zone.

Treatment of partial adentia

If the patient has a complete or partial absence of teeth, treatment is carried out using two methods: implantation and classical prosthetics. The first method is a priority, since only an implant is able to fully replace the tooth root and prevent bone tissue atrophy. On the other hand, implantation is not always possible due to a number of contraindications, as well as due to a banal lack of funds. In this case classical prosthetics- the only way out.

Treatment methods for partial adentia

Fixed bridge prosthesis

The most popular option when restoring one or more missing teeth in a row. A similar prosthesis is attached to the supporting healthy teeth or telescopic crowns. Often, when restoring one tooth, a recess is made in adjacent teeth, after which the structure is connected by a special bridge, which is attached with composite materials(Maryland prosthesis). The bridge can be metal, metal-ceramic and ceramic (to restore the frontal group of teeth).

• relative durability
• lower cost compared to implantation
• good performance indicators

• turning adjacent teeth
• possible allergy on metal components
• mediocre aesthetics

Dental crown and bridge on implants

It is used for a single defect and in the same situations as a classic bridge prosthesis, but based on implants, and not on adjacent teeth.

• good aesthetics and functionality
• preservation of bone volume at the implantation site
• durability

• high price

Removable and conditionally removable dentures on implants

They are used in the case of multiple adentia, when the doctor removes the remaining teeth and puts an implant-supported structure that completely imitates the jaw. The type of prosthesis (removable or conditionally removable) depends on the method of attachment. Button mount allows you to remove the prosthesis from the oral cavity independently. Beam fastening (implants are connected to each other by a special beam) implies that the prosthesis will be removed only in the dentist's office.

• reliability
• good functionality and acceptable aesthetics
• durability (the old prosthesis is changed after 7 - 10 years, implants can stand for life)

• high price
• the need to remove the remaining teeth

Deformation of the bite with partial absence of teeth

The state of the dentoalveolar system with partial absence of teeth is a topic for a separate discussion. Even the loss of one tooth provokes the displacement of the entire dentition, as the body in this way tries to restore the correct distribution of the load. This process begins in the immediate vicinity of the lost tooth, however, over time, the deformation of the dentition in the partial absence of teeth becomes more pronounced, especially when a significant number of them are lost. The most accurate classification of changes in the position of teeth during adentia was proposed by Dr. E. I. Gavrilov.

Classification of partial absence of teeth according to Gavrilov

1. Vertical movement (elongation of the teeth). Often occurs with the loss of antagonist teeth.
2. Mesial and distal movement.
3. Oral and vestibular movement of teeth.
4. Combined movement of teeth (rotation with an inclination, fan-shaped divergence, and so on).

Correction of tooth deformities occurs with the help of orthodontic, orthopedic and surgical techniques: serious complications placement of a prosthesis or implants may be delayed. Determination of bite in the partial absence of teeth includes the calculation of the occlusal height, prosthetic plane, height lower section face and central ratio of the jaws.

• Which doctors should you contact if you have Partial dentition (partial absence of teeth)

What is Partial adentia (partial absence of teeth)

Adentia- Absence of several or all teeth. There are acquired (as a result of a disease or injury), congenital hereditary adentia.

In the special literature, a number of other terms are used: defect of the dentition, absence of teeth, loss of teeth.

Partial secondary adentia as an independent nosological form of damage to the dentoalveolar system is a disease of the dentition or both dentitions, characterized by a violation of the integrity of the dentition of the formed dentoalveolar system in the absence of pathological changes in the remaining links of this system.

With the loss of part of the teeth, all organs and tissues of the dentition can adapt to a given anatomical situation due to the compensatory capabilities of each organ of the system. However, after the loss of teeth, significant changes can occur in the system, which are classified as complications. These complications are discussed in other sections of the textbook.

In the definition of this nosological form, next to the classical term "adentia" is the definition of "secondary". This means that the tooth (teeth) is lost after the final formation of the dentition as a result of a disease or injury, i.e., the concept of "secondary adentia" contains a differential diagnostic sign the fact that the tooth (teeth) formed normally, erupted and functioned for some period. It is necessary to single out this form of damage to the system, since a defect in the dentition can be observed with the death of the rudiments of the teeth and with a delay in eruption (retention).

Partial adentia, according to WHO, along with caries and periodontal diseases, is one of the most common diseases of the dentition. It affects up to 75% of the population in various regions of the globe.

An analysis of the study of dental orthopedic morbidity in the maxillofacial region according to the data of the appealability and planned preventive sanitation of the oral cavity shows that secondary partial adentia ranges from 40 to 75%.

The prevalence of the disease and the number of missing teeth correlate with age. In terms of frequency of deletion, the first place is occupied by the first permanent molars. Rarely, the teeth of the anterior group are removed.

What provokes Partial adentia (partial absence of teeth)

Among etiological factors that cause partial adentia, it is necessary to distinguish between congenital (primary) and acquired (secondary).

The causes of primary partial adentia are violations of the embryogenesis of dental tissues, as a result of which there are no rudiments of permanent teeth. This group of reasons should also include a violation of the eruption process, which leads to the formation of impacted teeth and, as a result, to primary partial adentia. Both of these factors can be inherited.

The most common causes of secondary partial adentia are caries and its complications - pulpitis and periodontitis, as well as periodontal diseases - periodontitis.

In some cases, tooth extraction is due to untimely appeal for treatment, resulting in the development of persistent inflammatory processes in the periapical tissues. In other cases, this is a consequence of incorrectly carried out therapeutic treatment.

Sluggish, asymptomatic necrobiotic processes in the dental pulp with the development of granulomatous and cystogranulomatous processes in the periapical tissues, cyst formation in cases of a complex surgical approach for resection of the root apex, cystotomy or ectomy are indications for tooth extraction. Removal of teeth treated for caries and its complications is often caused by spalling or splitting of the crown and root of the tooth, weakened by a large mass of the filling due to a significant degree of destruction of the hard tissues of the crown.

The occurrence of secondary adentia is also caused by injuries of the teeth and jaws, chemical (acid) necrosis of the hard tissues of the crowns of the teeth, surgical interventions about chronic inflammatory processes, benign and malignant neoplasms in the jaw bones. In accordance with the fundamental points of the diagnostic process in these situations, partial secondary adentia recedes into the background in the clinical picture of the disease.

Pathogenesis (what happens?) during Partial dentition (partial absence of teeth)

Pathogenetic bases of partial secondary adentia as an independent form of damage to the dentoalveolar system due to large adaptive and compensatory mechanisms dental system. The onset of the disease is associated with the extraction of a tooth and the formation of a defect in the dentition and, as a consequence of the latter, a change in the function of chewing. The dental system, which is united in morphological and functional terms, disintegrates. Xia in the presence of non-functioning teeth (these teeth are devoid of antagonists) and groups of teeth, the functional activity of which is increased. Subjectively, a person who has lost one, two or even three teeth may not notice a violation of the function of chewing. However, despite the absence of subjective symptoms of damage to the dentition, significant changes occur in it.

Increasing over time, the quantitative loss of teeth leads to a change in the function of chewing. These changes depend on the topography of defects and the quantitative loss of teeth: in areas of the dentition where there are no antagonists, a person cannot chew or bite off food, these functions are performed by preserved groups of antagonists. The transfer of the biting function to a group of canines or premolars due to the loss of anterior teeth, and in case of loss of chewing teeth, the function of chewing to a group of premolars or even anterior group of teeth disrupts the functions of periodontal tissues, muscular system, elements of the temporomandibular joints.

Biting off food is possible in the area of ​​the canine and premolars on the right and left, and chewing in the area of ​​the premolars on the right and the second and third molars on the left.

If one of the groups of chewing teeth is missing, then the balancing side disappears; there is only a fixed functional center of chewing in the area of ​​the antagonistic group, i.e., the loss of teeth leads to a violation of the biomechanics of the lower jaw and periodontium, a violation of the patterns of intermittent activity of the functional centers of chewing.

With intact dentition, after biting off food, chewing occurs rhythmically, with a clear alternation of the working side in the right and left groups of chewing teeth. The alternation of the load phase with the rest phase (balancing side) causes a rhythmic connection to the functional load of periodontal tissues, characteristic contractile muscle activity and rhythmic functional loads on the joint.

With the loss of one of the groups of chewing teeth, the act of chewing takes on the character of a reflex given in a certain group. From the moment of the loss of a part of the teeth, a change in the function of chewing will determine the state of the entire dentoalveolar system and its individual links.

I. F. Bogoyavlensky points out that changes that develop under the influence of function in tissues and organs, including bones, are nothing more than “functional restructuring”. It can proceed within the limits of physiological reactions. Physiological functional restructuring is characterized by such reactions as adaptation, full compensation and compensation at the limit.

The works of I. S. Rubinov proved that the effectiveness of chewing with various options adentia practically makes 80 100%. Adaptive-compensatory restructuring of the dentoalveolar system, according to the analysis of masticograms, is characterized by some changes in the second phase of chewing, search correct location food bolus, the total lengthening of one complete chewing cycle. If normally, with intact dentition, it takes 13-14 s to chew the kernel of an almond (hazelnut) weighing 800 mg, then if the integrity of the dentition is violated, the time is extended to 30-40 s, depending on the number of lost teeth and remaining pairs of antagonists. Based on the fundamental provisions of the Pavlovsk school of physiology, I. S. Rubinov, B. N. Bynin, A. I. Betelman and other domestic dentists proved that in response to changes in the nature of chewing food with partial adentia, the secretory function salivary glands, stomach, slow down the evacuation of food and intestinal peristalsis. All this is nothing but a general biological adaptive reaction within the limits of the physiological functional restructuring of the entire digestive system.

Pathogenetic mechanisms of intrasystemic restructuring in secondary partial adentia according to the state of metabolic processes in the jaw bones were studied in an experiment on dogs. It turned out that in early dates after partial extraction of teeth (3-6 months), in the absence of clinical and radiological changes, changes occur in the metabolism of the bone tissue of the jaws. These changes are characterized by an increased intensity of calcium metabolism compared to the norm. At the same time, in the jaw bones in the region of teeth without antagonists, the degree of severity of these changes is higher than at the level of teeth with preserved antagonists. The increase in the incorporation of radioactive calcium into the jawbone in the area of ​​functioning teeth occurs at a level of practically unchanged content. total calcium. In the area of ​​teeth excluded from function, a significant decrease in the content of ash residue and total calcium is determined, reflecting the development initial signs osteoporosis. At the same time, the content of total proteins also changes. A significant fluctuation in their level in the jawbone is characteristic, both at the level of functioning and non-functioning teeth. These changes are characterized by a significant decrease in the content of total proteins in the 1st month of creating an experimental model of secondary partial adentia, then its sharp rise (2nd month) and again decrease (3rd month).

Consequently, the response of the jaw bone tissue to the changed conditions of the functional load on the periodontium is manifested in a change in the intensity of mineralization and protein metabolism. This reflects the general biological regularity of the vital activity of bone tissue when exposed to adverse factors when disappearance occurs mineral salts, but devoid of mineral component the organic base is preserved for some time in the form of osteoid tissue.

The mineral substances of the bone are quite labile and, under certain conditions, can be "extracted" and again "deposited" under favorable, compensated conditions or conditions. Protein base is responsible for the processes of metabolism in the bone tissue and is an indicator of ongoing changes, regulates the processes of deposition of mineral substances.

The established pattern of changes in the exchange of calcium and total proteins in the early periods of observation reflects the reaction of the jaw bone tissue to new conditions of functioning. Here, compensatory capabilities and adaptive reactions are manifested with the inclusion of all the protective mechanisms of bone tissue. In that initial period when eliminating functional dissociation in the dentition caused by secondary partial edentulous, develop reverse processes reflecting the normalization of metabolism in the bone tissue of the jaws.

The duration of the action of unfavorable factors on the periodontium and jaw bones, such as increased functional load and complete shutdown from function, leads the dentoalveolar system to a state of "compensation at the limit", sub and decompensation. The dentoalveolar system with impaired integrity of the dentition should be considered as a system with a risk factor.

Symptoms of Partial dentition (partial absence of teeth)

Patients' complaints are different character. They depend on the topography of the defect, the number of missing teeth, the age and gender of the patients.

The peculiarity of the studied nosological form is that it is never accompanied by a feeling of pain. At a young age and often at adulthood the absence of 1-2 teeth does not cause any complaints from patients. Pathology is detected mainly during dispensary examinations, with planned sanitation of the oral cavity.

In the absence of incisors, fangs, complaints of an aesthetic defect, speech impairment, saliva splashing during conversation, and the inability to bite off food predominate. If there are no chewing teeth, patients complain of a violation of the act of chewing (this complaint becomes dominant only with a significant absence of teeth). More often, patients note inconvenience when chewing, the inability to chew food. There are frequent complaints about an aesthetic defect in the absence of premolars on upper jaw. It is necessary to establish the reason for the extraction of teeth, since the latter has importance for overall assessment state of the dentoalveolar system and prognosis. Be sure to find out whether orthopedic treatment was previously carried out and what designs of dentures. It is indisputable that it is necessary to ascertain the general state of health in this moment which can undoubtedly affect the tactics of medical manipulations.

On external examination, usually facial symptoms missing. The absence of incisors and canines in the upper jaw is manifested by the symptom of "retraction" upper lip. With a significant absence of teeth, "retraction" of the soft tissues of the cheeks and lips is noted. Partial absence of teeth in both jaws without the preservation of antagonists is often accompanied by the development of angular cheilitis (jamming); during swallowing movement, the lower jaw makes a large amplitude of vertical movement.

When examining the tissues and organs of the mouth, it is necessary to carefully study the type of defect, its length (size), the condition of the mucous membrane, the presence of antagonizing pairs of teeth and their condition (hard tissues and periodontium), as well as the condition of the teeth without antagonists, the position of the lower jaw in central occlusion and in a state of physiological rest. The inspection must be supplemented with palpation, probing, determination of the stability of the teeth, etc. An X-ray examination of the periodontal teeth, which will be supporting for various designs of dentures, is mandatory.

The variety of options for secondary partial adentia, which have a significant impact on the choice of a particular treatment method, has been systematized by numerous authors. The classification of dentition defects developed by Kenedy has become the most widespread, although it does not cover combinations that are possible in the clinic.

The author identifies four main classes. Class I is characterized by bilateral distal limited teeth defect, II - unilateral defect not distally limited by teeth; III - unilateral defect limited distally by teeth; Class IV - the absence of front teeth. All types of dentition defects without distal limitation are also called terminal, with distal limitation - included. Each defect class has a number of subclasses. General principle

subclassing - the appearance of an additional defect inside the preserved dentition. This significantly affects the course of the clinical justification of tactics and the choice of a particular method. orthopedic treatment(type of denture).

Diagnosis of Partial adentia (partial absence of teeth)

Diagnosis of secondary partial adentia presents no difficulty. The defect itself, its class and subclass, as well as the nature of the patient's complaints, testify to the nosological form. It is assumed that no other changes in the organs and tissues of the dentoalveolar system have been established by all additional laboratory research methods.

Based on this, the diagnosis can be formulated as follows:

• secondary partial adentia on the upper jaw, class IV, first subclass according to Kenedy. Aesthetic and phonetic defect;
• secondary partial adentia on the lower jaw, class I, second subclass according to Kenedy. Chewing dysfunction.

Clinics with offices functional diagnostics, it is advisable to establish the percentage loss of chewing efficiency according to Rubinov.

During the diagnostic process, it is necessary to differentiate primary from secondary adentia.

For primary adentia due to the absence of rudiments of teeth, underdevelopment in this area of ​​the alveolar process, its flattening. Often, primary adentia is combined with diastemas and tremas, an anomaly in the shape of the teeth. Primary adentia with retention is usually diagnosed after an X-ray examination. It is possible to make a diagnosis after palpation, but with subsequent radiography.

Secondary partial edentulous how the uncomplicated form should be differentiated from concomitant diseases, such as periodontal disease (without visible pathological tooth mobility and the absence of subjective discomfort), complicated by secondary adentia.

If secondary partial adentia is combined with pathological wear of the hard tissues of the crowns of the remaining teeth, it is of fundamental importance to establish whether there is a decrease in the height of the lower face in the central occlusion. This significantly affects the treatment plan.

Diseases with pain syndrome in combination with secondary partial adentia, as a rule, they become leading and understand the relevant chapters.

The rationale for the diagnosis of "secondary partial adentia" is the compensated state of the dentition after partial loss of teeth, which is determined by the absence of inflammation and dystrophic processes in the periodontium of each tooth, the absence pathological abrasion hard tissues, deformations of the dentition (the phenomenon of Popov-God it, displacement of teeth due to periodontitis). If symptoms of these pathological processes the diagnosis changes. So, in the presence of deformations of the dentition, a diagnosis is made: partial secondary adentia, complicated by the Popov-Godon phenomenon; Naturally, the treatment plan and medical tactics management of patients is different.

Treatment of Partial dentition (partial absence of teeth)

Treatment of secondary partial adentia is carried out with bridge-like, removable plate and clasp dentures.

Bridge-like non-removable prosthesis called a medical device that serves to replace the partial absence of teeth and restore the function of chewing. It is strengthened on natural teeth and transmits chewing pressure to the periodontium, which is regulated by the periodontal muscle reflex.

It is generally accepted that treatment with fixed dentures can restore up to 85-100% chewing efficiency. With the help of these prostheses, it is possible to fully eliminate phonetic, aesthetic and morphological disorders of the dentoalveolar system. Almost complete compliance of the design of the prosthesis with the natural dentition creates the prerequisites for rapid adaptation patients to them (from 2 - 3 to 7 - 10 days).

Removable plate prosthesis called a medical device that serves to replace the partial absence of teeth and restore the function of chewing. It is attached to natural teeth and transmits to the mucous membrane and bone tissue chewing pressure regulated by the gingivomuscular reflex.

Considering the fact that the basis of a removable lamellar prosthesis is completely based on the mucous membrane, which in its own way histological structure is not adapted to the perception of chewing pressure, chewing efficiency is restored by 60-80%. These prostheses allow to eliminate aesthetic and phonetic disorders in the dentoalveolar system. However, the methods of fixation and a significant area of ​​the basis complicate the mechanism of adaptation, lengthen its period (up to 1-2 months).

Byugel prosthesis called a removable medical apparatus for replacing the partial absence of teeth and restoring the function of chewing. Reinforced behind natural teeth and relies on both natural teeth and mucous membranes, masticatory pressure is regulated in combination through periodontal and gingivomuscular reflexes.

The possibility of distribution and redistribution of masticatory pressure between the periodontium of the abutment teeth and the mucous membrane of the prosthetic bed, combined with the possibility of refusing to prepare teeth, high hygiene and functional efficiency, made these dentures one of the most common modern species orthopedic treatment. Almost any defect in the dentition can be replaced with a clasp prosthesis, with the only caveat that with certain types of defects, the shape of the arch is changed.

In the process of biting off and chewing food, chewing pressure forces of various duration, magnitude and direction act on the teeth. Under the influence of these forces, responses occur in periodontal tissues and jaw bones. Knowledge of these reactions, the influence of various types of dentures on them underlies the choice and reasonable use of one or another orthopedic apparatus (denture) for the treatment of a particular patient.

Based on this basic provision, the following clinical data significantly influence the choice of the design of the denture and abutment teeth in the treatment of partial secondary adentia: the class of the dentition defect; defect length; condition (tonus) of chewing muscles.

The final choice of treatment method can be influenced by the type of occlusion and some features associated with the profession of patients.

Lesions of the dentoalveolar system are very diverse, and there are no two patients with exactly the same defects. The main differences in the state dental systems two patients are the shape and size of the teeth, the type of bite, the topography of defects in the dentition, the nature of the functional relationships of the dentition in functionally oriented groups of teeth, the degree of compliance and threshold pain sensitivity mucous membrane of the edentulous areas of the alveolar processes and hard palate, shape and size of the edentulous areas of the alveolar processes.

The general condition of the body must be taken into account when choosing the type medical apparatus. Each patient has individual characteristics, and in this regard, two outwardly identical in size and location of the defect of the dentition require a different clinical approach.

Theoretical and clinical basis choice of method of treatment with fixed bridges

The term "bridge" came to orthopedic dentistry from technology during the period of rapid development of mechanics, physics and reflects the engineering structure - the bridge. It is known in technology that the design of a bridge is determined based on the expected theoretical load, i.e. its purpose, span length, ground conditions for supports, etc.

Practically the same problems are faced by an orthopedist with a significant correction for the biological object of influence of the bridge structure. Any design of a dental bridge includes two or more supports (medial and distal) and an intermediate part (body) in the form of artificial teeth.

Fundamentally various conditions The statics of a bridge as an engineered structure and a fixed dental bridge are as follows:

• bridge supports have a rigid, fixed base, while fixed bridge supports are mobile due to the elasticity of periodontal fibers, vascular system and the presence of a periodontal gap;
• the supports and span of the bridge experience only vertical axial loads in relation to the supports, while the periodontium of the teeth in the bridge-like non-removable denture experiences both vertical axial (axial) loads and loads at different angles to the axes of the supports due to the complex relief of the occlusal surface of the supports and the body of the bridge and the nature of the chewing movements of the lower jaw;
• in the abutments of the bridge and the bridge prosthesis and the span after the removal of the load that have arisen internal stresses compression and tension subside (extinguish); the structure itself comes to a “calm” state;
• the supports of a fixed bridge prosthesis return to their original position after the load is removed, and since the load develops not only during chewing movements, but also when swallowing saliva and establishing dentition in central occlusion, these loads should be considered as cyclic, intermittently constant, causing complex a complex of responses from the periodontium.

Clinical stages of treatment with fixed bridges

Having completed the diagnostic process and having determined that the treatment of partial adentia is possible by using a bridge, it is necessary to choose the number and design of the supporting elements: the nature of the preparation of the supporting teeth depends on the type of construction.

Most often used as supports in the clinic artificial crowns. More complex types of supporting elements include inlays, semi-crowns, pin teeth or “stump structures”. General requirement, presented to the abutment teeth for bridges - the parallelism of the vertical surfaces of the supports to each other. If in relation to two supports in the form of stamped or cast crowns it is possible to “by eye” determine their parallelism to each other after preparation, then with an increase in the number of supports it is difficult to assess the parallelism of the walls of the crowns of the prepared teeth. Already at this stage of treatment with fixed bridges, it becomes necessary to study diagnostic models before or after preparation in order to create parallel surfaces of all supporting teeth. The starting point in this case is the orientation when finding parallelism by 1-2 teeth, as a rule, located closer to the front. However, there are often cases when the search for parallelism, especially in the upper jaw, makes you focus more on the molars. By tilting the parallelometer table and, consequently, the diagnostic model, an analysis of the location of the clinical equator is carried out, thereby determining the volume of tissues removed during preparation. Having chosen the position of the model, in which the equator on all abutment teeth comes closer to the cheap edge, take it as best option. An equator line is drawn on the teeth with a pencil, i.e., the zones of the greatest grinding of hard tissues are marked. The position (tilt) of the cast is recorded as this determines the route of insertion of the prosthesis to secure it to the prepared teeth.

It is advisable to check the quality of the preparation in the parallelometer. If the parallelism of all walls on the stumps of the prepared abutment teeth is achieved, the line of the clinical equator will not be indicated - the analyzer pin for all teeth will pass along the level of the gingival margin.

After the preparation of the teeth, it is necessary to take casts from both jaws. The impression can be ordinary (gypsum, from elastic masses), if metal stamped crowns are used as supports. In all other cases, it is almost always necessary to obtain a double, refined impression.

With a significant removal of hard tissues of crowns in order to protect the pulp, it is necessary to cover the teeth with temporary caps (metal) or temporary plastic crowns. Coating the prepared surface with fluoride varnish should also be considered as a preventive measure.

Next clinical stage- determination of central occlusion. The task is to achieve close contact between the natural antagonists and the occlusal planes of the ridges when introducing wax bases with bite ridges into the mouth by correcting them (cut off or build up the ridge). Then diagonal cuts are made on one of the rollers (one, two or three), a wax roller with a diameter of 2-3 mm is applied to the other, it is heated, wax bases with bite rollers are inserted into the mouth and the patient is asked to close his teeth. It is advisable to place the heated wax roller opposite the maximum number of natural teeth. If there are no front teeth, it is necessary to draw a mid-sagittal line (the position of the central incisors) on the vestibular surface of the roller.

If enamel and dentine wear is observed on the remaining antagonistic teeth, as a result of which the height of the lower part of the face in central occlusion is reduced, and also if the preserved teeth do not have antagonists, it is necessary to first establish the normal height of the lower part of the face in central occlusion on the occlusal rollers, and then fix it.

The starting point is to determine the height of the lower part of the face with a relative physiological rest of the lower jaw. The pattern is that the height of the lower part of the face in the central occlusion is 2–4 mm less than this distance. Based on this, by reducing the height of the occlusal roller or by increasing it, this difference is achieved, i.e., the desired height. At the same time, the position of the lips, cheeks, the severity of the nasolabial and chin folds are taken into account. The final stage - fixation - does not differ from that described above. There are frequent cases when, after establishing the height of the lower part of the face in central occlusion, in the presence of teeth that do not have antagonists, the occlusal plane has an atypical curvature. The developed deformation must be eliminated.

Partially secondary adentia is a common disease that occurs in 65% of the world's population - this is tooth loss.

This affects the functionality of the jaw, because of this, problems with the gastrointestinal tract may appear.

Also, this is reflected in appearance - a person has complexes, atrophy may develop facial muscles. Adentia occurs in both adults and children.

Classification

Adentia is divided into two types:

1. Partial secondary adentia. If 1 to 3 teeth are missing in the upper and lower jaw.
2. Full. If more than 80% of the teeth are missing in the oral cavity.

Even if one or two teeth are missing in the upper or lower jaw, adjacent teeth begin to move.

This negatively affects their main function - chewing food.

With adentia, the bone tissue of the teeth begins to rapidly deplete, since an enormous load is placed on the remaining teeth.

Partially congenital adentia occurs when more than 10 teeth are missing from the jaw. In 70% of cases, the lateral incisors of the upper jaw are the first to be lost, and adjacent teeth immediately begin to shift in their place, so biting off hard food brings discomfort.

If the disease progresses and the loss of teeth continues, this means that the process has taken on a multiple form. In this case, if measures are not taken to eliminate and treat the cause, the disease can lead to the loss of all dental units.

Partially secondary adentia is a serious stage of pathology, in which the absence of 5 to 15 dental units in one jaw is diagnosed.

Symptoms of adentia

The general symptoms of any type of adentia are reduced to the complete or partial absence of teeth in the oral cavity. This is the main symptom of the disease. However, there are also indirect signs adentia:

1. There may be a retraction of the soft tissues of the face, which is characterized by a violation of the symmetry of the facial part.
2. May form around the mouth a large number of wrinkles.
3. With the loss of more than 50% of the teeth of the oral cavity, atrophy of the muscles of the face is observed.
4. Dropping corners of the mouth.
5. Changing the shape of the face.

Missing tooth in one row

Partially secondary adentia can also be accompanied by the formation of an incorrect, deep bite. The teeth begin to actively move in the area of ​​the formed voids, due to which the dentoalveolar processes of healthy teeth are lengthened.

Diagnostics

Diagnosing this disease is quite simple.

A dentist can visually assess the picture, name the number of teeth that are missing in both jaws, respectively, determine the type of adentia.

If there is a suspicion of adentia, then the diagnosis should include an x-ray of the oral cavity.

In the picture, the doctor will be able to see all the nuances of interest to him, especially when it comes to children's adentia. It is important to note the presence of rudiments of permanent teeth and their condition.

When diagnosing, it will be effective to carry out panoramic radiography of the upper and lower jaws. A panoramic image will allow you to determine the structure of the teeth, the state of the bone tissue of healthy teeth and the alveolar process.

Diagnostics should be carried out qualified specialist, taking into account the following factors:

1. The presence of roots that have not been previously removed and at the time of the study they are under the mucous membrane. This pathology is dangerous with inflammatory processes, therefore, such roots should be disposed of as soon as possible.
2. The presence of exostoses.
3. Inflammatory or infectious processes flowing in the oral cavity;
4. The defeat of the mucous membrane by tumors.

Partial absence of teeth

If one of the above factors was found, then you must first eliminate it, and then proceed to diagnostic procedures adentia and treatment of the disease.

Diagnosis of adentia allows you to immediately see the severity of the disease, and take measures that will not allow the oral cavity to lose its functionality.

The reasons

One of the main causes of adentia is the abnormal development of the ectodermal germ layer, which is the basis for the formation of tooth buds.

Activity violations endocrine system and poor heredity are two more common factors in the development of primary type adentia.

Partially secondary adentia can develop in a person for the following reasons:

1. Caries. If not treated carious formations on the early stage over time, this can lead to tooth loss.
2. Various diseases of the oral cavity that affect the gums, mucous membranes and are not cured in time. For example, periodontitis or periodontal disease can cause adentia.
3. Diseases of the internal organs, weakened immunity, which negatively affect the activity of the endocrine system.
4. Age. The likelihood of tooth loss progresses with age. However, young people are now also seeking help in the treatment of adentia.
5. Rough mechanical impact on the teeth. This is one of the most common and serious reasons. This includes mechanical cleaning by a non-professional specialist, frequent teeth whitening chemical compounds, trauma to the jaw and gums.
6. Incorrect extraction of milk teeth, because of which the rudiment of a permanent tooth is injured, and it begins to develop abnormally.
7. hereditary factor.

That is, a person for a long period of time may not notice any deviations in the oral cavity, however, at this time it turns out Negative influence on the teeth, which in the future may lead to their partial complete loss.

Gum disease and bone loss can result from improper brushing of teeth. If food particles constantly accumulate, plaque forms on the teeth, this can lead to gingivitis. In the absence of treatment, mechanical cleanings and fluoridation, all of which will also lead to tooth loss. Therefore, it is important to always observe oral hygiene and not neglect preventive visits to the dentist.

Not everyone knows that there is such a pathology as. Read about the causes of this disease in the article.

What a periodontist treats and how an examination by a doctor is carried out, we will tell.

Treatment of adentia

Most effective therapy disease today is orthopedic treatment.

The method of treatment is determined by the attending physician on the basis of diagnostic tests, depending on the number of missing teeth in the oral cavity.

Treatment of primary adentia involves the installation of a pre-orthodontic trainer, the patient himself is registered with the dispensary.

If adentia has been found in a child, it is important to allow the permanent teeth to erupt properly and to eliminate the risk of any jaw defects.

Dentures for adentia are the only option for restoring missing teeth, and the following methods are used for this purpose:

1. Prosthetics with the use of ceramic-metal crowns and dental inlays.
2. Using an adhesive bridge.
3. Installation of the implant in the places of the formed voids.

Treatment should begin with the restoration of the main function of the oral cavity (chewing food). This is necessary in order to prevent the development of any complications and pathological processes that may occur after implantation against the background of an unprepared oral cavity. Only after all diseases, inflammations are eliminated, the main function of the oral cavity is restored, you can proceed to prosthetics.

Installation of a denture

It begins with the installation of a metal pin into the bone tissue, after which an artificial tooth is placed on the pin. The dentist selects a color, a material that will be identical to the natural shade of the tooth enamel.

Prosthetics is effective method treatments, however, are costly. The whole process can take several weeks.

Consequences of adentia

Adentia belongs to one of the most complex and serious dental diseases.

Difficulties are manifested in terms of treatment, and adentia also negatively affects the quality of life.

Complete edentulism can cause speech impairment, it may be difficult to pronounce some sounds, speech becomes slurred.

Difficulties are also manifested in biting and chewing solid food, so you have to consume almost all food in liquid form. Poorly digested pieces of food can cause disruption of the gastrointestinal tract, a deficiency of useful elements and minerals appears in the body, which also negatively affects overall health.

In the absence of more than 75% of the teeth in the oral cavity, there is a violation of the functionality of the temporomandibular joint, which can lead to its inflammation.

should not be overlooked and psychological factor. Lack of teeth does not look aesthetically pleasing and brings mass discomfort which can create an imbalance psychological nature. This can lead to low self-esteem, depression and nervous disorders.

Modern methods of implantation make it possible to restore all lost teeth, without any impairment of the functionality of the oral cavity. If you start treating adentia at an early stage, you can achieve effective results.

Disease prevention

Specific measures that would prevent adentia, both in adults and in children, have not yet been developed. However, to maintain oral health, the following recommendations should be followed:

1. Regularly carry out hygiene procedures of the oral cavity, and do it correctly ( soft brush carry out movements from the bottom up (lower jaw) and from top to bottom (upper jaw), in order to exclude all particles of food between the teeth. Then in a circular motion walk over the entire surface of the oral cavity and finally clean the tongue);
2. During pregnancy, eat foods rich in calcium and potassium. This is necessary, both for the woman herself and for the baby.
3. Regular visits to the dentist in order to identify any diseases, conduct hygienic cleaning oral cavity. If there is a loss of at least one unit of tooth, it is recommended to short time to install an implant in order to exclude the development possible deviations oral cavity.

Partially secondary adentia - serious pathology which requires diagnostics and timely treatment through the placement of implants. Regular visits to the dentist, compliance with all hygiene measures will reduce the risk of developing adentia.

Lack of treatment can lead not only to impaired functionality, but also to inflammation of the joints, asymmetry of facial tissues, and deviations in the psychological state.

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