Alienation of Dr. Melikyan's Russian Innovations and Foreign Recognition. The method of vibrational mechanical activation of composite materials according to Melikyan M.L. and a device for its implementation

The invention relates to the field of dentistry and can be used in the elimination of various defects in the hard tissues of the tooth of carious and non-carious origin, in the process of direct or indirect reinforced and non-reinforced composite restorations.

The continuous development of adhesive technologies has contributed to the popularization of the application composite materials in dental practice. Currently, there are many composite materials of chemical and light curing.

In clinical practice, light-curing composite materials are widely used to eliminate various defects in hard tissues of the tooth.

Advantages of composite materials.

Modern composite materials have high physical and mechanical properties, biological inertness, excellent chemical resistance, low shrinkage coefficient, stronger connection and better marginal fit to hard tooth tissues.

Despite the obvious advantages, composite materials also have a number of disadvantages that are characteristic of any artificial material used in dental practice.

After the elimination of defects in the hard tissues of the tooth using composite materials, we highlight complications that are eliminated in various ways:

Grade I (mild) complications - the defect of the composite restoration is eliminated by polishing, or by grinding and polishing.

Complications of the II degree (medium) - the defect of the composite restoration is eliminated with the help of a partial repeated composite restoration.

Complications of the III degree (severe) - the defect of the composite restoration is eliminated with the help of a complete repeated composite restoration.

It has been established that micro- and macro-cleavages occur after composite restoration. Ways to eliminate chips are described in the article Melikyan M.L., Melikyan G.M., Melikyan K.M. "Criteria for assessing the quality of restoration after the elimination of defects in the crown part of the anterior group of teeth using composite materials and a metal mesh-contour reinforcing frame" // Institute of Dentistry. - 2011/2. - P.86-88.

A chip is the partial destruction of a composite restoration.

Microchips are minor imperfections in reinforced and non-reinforced composite restorations that are corrected by grinding and polishing.

Macro chipping is a partial defect of reinforced and non-reinforced composite restorations that are repaired with composite materials.

One of the main reasons leading to the occurrence of chipped composite restorations are large (critical) defects of the pore type. The origin of porosity in composite restorations is different.

Porosity is a property inherent in the actual composite material as such. The degree of porosity of composite materials depends on the following factors:

Quantitative ratio of monomer and filler;

Method of preparation of the material (during the mixing of the material, air bubbles are formed, causing porosity);

Damage to prepolymerized filler particles.

Of the photopolymer materials, hybrid composites (0.18-2.5%) differ in minimum porosity, microfilled composites (0.3-3.8%) have the highest porosity, and traditional materials (0.7-8.4%) have the maximum porosity.

The degree of porosity increases during the restoration process. The formation of pores with air bubbles is due to the manipulation of the application of the composite material during the formation of the composite restoration. The formation of the restoration structure of the tooth consists of gluing the composite material with dental tissues and gluing fragments of the restorative material (layer-by-layer technique for the formation of restorations).

During the polymerization of composite portions without oxygen access, the surface layer polymerizes and forms a strong bond between the composite portions. However, due to the interaction of the surface of the applied layer of the composite material with the oxygen of the air diffusing into the composite, an underpolymerized layer is formed, the so-called “oxygen-inhibited layer”. The layer thickness is 20-30 microns. The polymerization reaction in this layer is impossible, since the formation of the polymer matrix occurs only through an oxygen bond, and in this layer it is already bound by atmospheric oxygen.

If there is an underpolymerized layer between the layers of the composite, the portions of the composite do not connect with each other, so the connection surface becomes a place of mechanical weakness of the restoration and subsequent delamination of the restoration under the influence of chewing load. The results of spectrographic analysis of sections of composite materials confirmed the presence of porosity different nature filled with air bubbles (see Bulletin of Dnepropetrovsk University, series "Physics. Radioelectronics", 2007, issue 14 No. 12/1).

The classification of pores and their description are given in the article Melikyan M.L., Melikyan K.M., Gavryushin S.S., Martirosyan K.S., Melikyan G.M. “Analysis of the strength properties of mesh metal-composite materials used in reinforcing dentistry Melikyan M.L. (ASM) (Part I)" // Institute of Dentistry. - 2012/3. - No. 56. - P.62-63.

Closed (internal);

Open dead ends (external).

Closed micropores are located inside the restored tooth:

Between the hard tissues of the tooth and the adhesive layer;

Between composite material and adhesive layer;

Inside a portion of the composite material;

Between portions of the composite material.

Open dead-end micropores are located on the outer surface of the composite restoration.

According to Griffith's theory, at low loads, the pores are safe, since they do not show a tendency to increase. At heavy loads they may be unstable, capable of rapid growth, merging with each other and the formation of main cracks, leading to the destruction of composite restorations.

According to the principles of mechanics, the destruction of a material occurs not simply under the influence of a load, but due to the fact that this load causes a concentration of stress energy greater than the material is capable of accumulating.

Considering the fact that one of the main reasons leading to the occurrence of chipped composite restorations are large (critical) defects by the type of pores, the development of a technology that will reduce their number and size and, accordingly, increase the strength of the composite restoration is relevant. task of dentistry. Solving this problem will reduce the number of complications and increase the life of the composite restoration. The claimed invention is aimed at solving this problem.

The solution of this problem by methods known from the prior art is reduced to following a certain sequence of composite restoration. At the same time, the following recommended steps for gluing composite portions are known:

Checking for the presence of a surface layer inhibited by oxygen;

The introduction of a portion of the composite;

Adhesion control test;

Plastic processing of the introduced portion of the composite;

control test;

Shape fixation by directional polymerization;

Final polymerization of a portion of the composite.

It is known from the literature that the main difficulties in applying the first layer of composite material to the bottom of the tooth cavity are associated with the adhesion of the composite to the instrument and the formation of voids between the composite material and the adhesive layer.

Many solutions to this problem have been proposed, but it still remains relevant (Joseph Sabbah. SonikFill™ System: Clinical Application. Dental Times. - 2012. - No. 14. - P.6, 8).

In order to carry out plastic processing of the applied portion of the composite material with the help of a trowel plugger, the composite is distributed over the prepared surface of the hard tissues of the tooth, which is covered with an adhesive layer, or over the surface of the previously applied composite layer so that there are no air bubbles under it.

The entire surface of the applied portion of the composite is treated with a certain pressure with the help of a plugger, which ensures the extrusion of the oxygen-inhibited layer and the bonding of the portion of the composite to the surface at a certain point, which is under pressure at that moment.

The method of reducing the porosity of the composite material, implemented in a known method, consists in "smoothing" a portion of the composite material by surface plastic deformation with a sliding tool along the locally contacting surface of the deformable material (Composite, filling and facing materials. Borisenko A.V., Nespryadko V.P. ., Kyiv, Book plus, 2001). This method does not provide maximum extrusion of air from the pores by the tool from the surface of the applied composite layer.

The disadvantage of this method is that during its implementation, as a rule, there is a redistribution of pores inside the material due to their displacement under the smoothing mechanical action of the tool. At the same time, a slight extrusion of air from the pores is non-uniform over the entire surface of the deformable material due to the absence of the same controlled force of the impact of the restoration tool on the surface of the applied composite material.

In order to reduce porosity and increase the strength of the composite material, the manual method of mechanical activation (MCM) of the composite material according to Melikyan M.L. is currently used.

The mechanical activation of a composite material is understood as a mechanical effect on the composite material, which leads to an improvement in its physical and mechanical properties.

This method is described in patents for invention No. 2238696 and No. 2331385, patent holders: Melikyan M.L., Melikyan G.M., Melikyan K.M.

The essence of the invention according to patent No. 2238696 lies in the fact that the missing crown part is restored taking into account the anatomical, topographic and biomechanical features of the structure of the restored tooth using a reinforced mesh metal composite.

To restore the missing enamel layer, the composite material is shaped into a roller by manual action with fingers in gloves with a textured surface made of natural latex without powder. The rollers formed in this way restore the missing walls of the crown part of the restored tooth.

The essence of the invention according to patent No. 2331385 lies in the fact that when eliminating a defect of the cutting edge up to 2 mm deep during the restoration process, the composite material is also subjected to manipulation during the formation of the composite roller.

Patent holders together with scientists from the Moscow State Technical University named after N.E. Bauman, studies of the influence of the manual method of mechanical activation (MCM) on the strength properties of the composite material were carried out. Laboratory studies were carried out on a universal testing machine Galdabini Quasar 50 Italy.

The tests were carried out on samples with a length - 1 equal to 45 mm, a height - a and a width - b equal to 5 mm for a three-point static bend according to the "concentrated load applied in the middle of the span" scheme. During the tests, the load deformation diagram was taken - the maximum deflection, and the breaking load F P (n) was also determined.

To test for three-point static bending, III series of composite material specimens were made in the amount of 15 pieces (5 in each series). All series of samples were prepared at room temperature and after fabrication were stored in water until testing.

Series I (control) - portions of the composite material (0.5 g) were measured by squeezing out from a syringe, weighed and, without subjecting to additional mechanical influences (mechanoactivation), were introduced into the mold. To prepare the first series of samples, a portion of the composite material was taken from a syringe with a metal plug and trowel and weighed 0.5 g; Considering that the length of the sample is 45 mm, the polymerization of each composite layer was carried out 3 times for 20 s along the length of the polypropylene one, thus, the polypropylene mold was sequentially filled layer by layer with a composite material and polymerization was carried out.

The finished sample was removed from the mold and control polymerization was carried out from the side of the outer surfaces. The weight of the samples was measured on a scale with an accuracy of ±0.01 g, the geometric dimensions of the samples were measured with an electronic caliper with an accuracy of ±0.01 mm.

Series II - portions of the composite material (0.5 g) were measured by squeezing from a syringe, weighed, and then formed into balls by manual mechanical action (mechanoactivation). The formed composite balls were introduced into the mould. For the preparation of the second series of samples, a portion of the composite material was taken from a syringe using a metal plugger of a trowel and weighed 0.5 g. diagnostic disposable with a textured surface made of natural latex without powder.

Series III differed from series II in that rollers were formed from the obtained balls (by the method of mechanical activation). The formed composite rollers were introduced into the mold. For the preparation of the III series of samples, a portion of the composite material was taken from a syringe using a metal plugger of a trowel and weighed 0.5 g. . Next, the formed composite roller was installed on the bottom of the polypropylene mold and, using an L-shaped plugger-trowel, was evenly distributed over the entire bottom and polymerization was carried out.

Thus, sequentially, layer by layer, the polypropylene mold was filled with a composite material. The finished sample was removed from the mold and control polymerization was carried out from the side of the outer surfaces. Next, the weight and refined geometric dimensions of the samples were measured with an accuracy of ±0.01 mm. When measuring, the arithmetic mean values ​​of the length, thickness, and width of the sample were used.

Each sample was assigned serial number and arrows indicate the direction of load application.

Samples of series I-III were subjected to three-point static bending tests at a temperature of 20 degrees.

The maximum force generated by the machine is 500 N.

The results of comparing the strength characteristics during tests for three-point static bending of composite samples of I-III series, depending on the manufacturing method, are shown in Table 1.

As a result of tests for three-point static bending of composite samples made from a microhybrid composite material, it was found that when forming a composite material in the form of a ball (by the method of mechanical activation), the ultimate load of the sample increases by 5.7% compared to control samples.

When forming a composite material in the form of a roller (by the method of mechanical activation), the ultimate load of the sample increases by 7.3% compared to the control samples (carried roller).

Studies have confirmed that the manual method of mechanical activation of the composite material reduces:

Porosity by 30%;

Maximum pore size (critical defects) by 45%;

Average pore size by 3%.

The disadvantage of the method of manual mechanoactivation lies in the fact that shaping the composite material in the form of a roller during the restoration process is mainly used when restoring the missing walls of the crown part of the tooth, or when eliminating defects in the cutting edge of the tooth. That is, this method of mechanical activation is used to eliminate specific defects.

Achieved by using the known method, the effect of increasing the strength of the composite restoration is not sufficient to obtain a monolithic composite restoration (MCR).

The inventive method for reducing porosity and increasing the strength of a composite material is based on the use of a fundamentally new method of its hardening due to vibrational mechanical activation (VSM).

When eliminating defects in the hard tissues of the tooth using a composite material, the claimed method is a vibrational effect on the layers of the composite material (vibrational surface plastic deformation). When implementing the claimed method, each subsequent layer of the applied composite material is exposed to vibration before its polymerization.

Vibratory surface plastic deformation is a vibration surface plastic deformation of a material due to mechanical vibration of the tool (GOST 18296-72. Processing by surface plastic deformation. Terms and definitions).

The authors of the invention, together with scientists from the Moscow State Technical University named after N.E. Bauman conducted a study of the effect of vibrational mechanical activation of a composite material (VCM) on the strength properties of a composite material using the test method described above.

Samples of series I (control), made as described above, and samples of series II, which differed from control samples in that during their manufacture, each deposited layer of the composite material was subjected to vibration with an oscillation frequency of 1000 Hz before polymerization, were subjected to the study.

As a result of tests of composite samples of series I and II for three-point static bending, it was found that samples of series II, made from a microhybrid composite material subjected to vibration, increased the ultimate load by 22.5% compared to the control samples of series I.

As a result of subsequent studies carried out jointly with scientists from the Kazan Federal University KFU, the interdependence of the increase in the ultimate load on the degree of porosity of the microhybrid composite material was established.

In samples of series II, subjected to vibrational mechanical activation, in comparison with control samples of series I:

Reduced porosity of microhybrid composite material by 70%;

Reduced maximum pore size (critical defects) by 45%;

Reduced average pore size by 3%.

In the samples of series II, subjected to vibrational mechanical activation, there are no boundaries between the layers of the composite material.

Advantages of the vibrational method of mechanical activation (VSM) of a composite material according to Melikyan M.L.:

The ultimate load increases by 22.5% (without the introduction of additional reinforcing elements into the composite material during the restoration process);

Porosity is reduced by 70%;

The maximum pore size (critical defects) is reduced by 45%;

The average pore size is reduced by 3%.

The vibrational method of mechanical activation of a composite material is used:

When eliminating any defects in the hard tissues of the tooth;

For direct, indirect, reinforced and non-reinforced composite restorations.

The vibrational method of mechanical activation of the composite material provides:

Constant controlled force of the vibration impact of the restorative instrument on a portion of the composite material and its uniform distribution over the entire surface of the defect subjected to adhesive treatment, or over the surface with a previously applied and polymerized composite layer;

The oriented direction of the vibrational action inside the treated surface is perpendicular to the surface of the adhesive layer or the previous layer of the polymerized composite material;

Efficient extrusion of air from the pores (and not their redistribution from the surface of the previously applied composite layer) and filling them with a composite material;

A significant reduction in the size of critical defects, which reduces the likelihood of chipping of the composite restoration;

Tight and strong connection of the composite material with the adhesive layer and with each subsequent portion of the applied composite material;

Formation of a strong compacted monolithic composite structure;

Effective marginal fit of the composite material to the hard tissues of the tooth, which helps to reduce microleakage and the formation of secondary caries.

The vibrational method of mechanical activation of a composite material reduces:

The likelihood of complications and increases the life of the composite restoration;

Retention of dyes by reducing the number and size of open dead-end micropores on the surface of the composite restoration, which ensures high aesthetics of the composite restoration;

Sorption of water and formation of bacterial colonies;

The possibility of pores between the adhesive layer and the composite material, as well as between the layers of the composite material, since the composite material does not adhere to the instrument;

The tension of the muscles of the hand, which occurs when the force of the hand is transmitted through the tool to a portion of the composite material, is excluded.

The use of a vibrational method of mechanical activation of a composite material allows:

Without eye strain and fingers to lead the restoration, including in hard-to-reach areas of the restored tooth;

Reduce the time of composite restoration due to the effective adhesion of a portion of the composite material to the adhesive or composite layer.

Vibration method of mechanical activation of composite materials according to Melikyan M.L. is carried out in the following way. When eliminating a defect in the crown part of the tooth or when eliminating the complications of composite restoration (grades II and III), well-known methods of layer-by-layer restoration / reconstruction of the crown parts of the tooth with composite materials are used, which are described, among other things, in patents for inventions issued to patent holders Melikyan M.L., Melikyan G.M., Melikyan K.M. (No. 2273465, 2331386, 2403886, 2403887). However, when implementing known techniques layer-by-layer deposition of composite materials, each subsequent layer of the applied composite material before polymerization is subjected to vibrational mechanical activation for 20 s with an oscillation frequency of up to 1000 Hz. Permissible level vibration complies with SanPiN, approved by the resolution of the State Committee for Sanitary and Epidemiological Supervision Russian Federation dated January 19, 1996, No. 2.

To implement the proposed method, a special device for vibration mechanical activation of the composite material is used.

The device contains a handle in the form of a tubular body, at one or both ends of which one or two working elements are fixedly fixed, designed to apply a portion of the composite material to the defect area of ​​the crown part of the tooth and distribute it over the defect surface by means of vibration exposure. The working elements are analogous in design to the working element of the known plugger-trowel.

The tubular body contains gripping devices for fixing the battery pack and a micromotor connected to the power source, which provides vibration. On the body there is a button of the activating element, when pressed, the user activates the power source.

The object of the invariant design of the device is the placement of the power source and the micromotor both outside the tubular body and inside the tubular body.

To fix the power supply and the micromotor outside the case, a removable frame with finger clamps is used as a gripping device. The frame is used for internal fastening of the battery pack and the micromotor.

To perform the device with the placement of the frame inside the tubular body, a window is made in the inner wall of the tubular body for the internal placement of the battery power source and the micromotor. The frame is fixed in the window slot with an interference fit.

At the same time, with the internal and external placement of the frame, the frame acts as a cover that isolates the battery power source and the micromotor from the external environment. If it is necessary to replace the battery pack, the frame is removed, the spent battery is removed from it and a new one is installed.

Device for vibratory mechanoactivation of the composite material works as follows.

With the help of a working element, a portion of the composite material is applied to the surface in the area of ​​the defect in the crown part of the tooth.

By means of the button of the activating element, the power supply is activated, which is electrically connected to the micromotor. The activated micromotor creates vibrations that are transmitted to the working element, with the help of which the vibrational mechanical activation of the applied layer of the composite material is performed. In this case, the composite material under the influence of vibration is distributed over the entire surface of the defect and is simultaneously subjected to surface plastic deformation for at least 20 s. Then, using the button of the activating element, the power supply is turned off. The device returns to a static state and is ready to apply the next portion of the composite material.

After completion of the vibration exposure, the layer of the composite material subjected to vibrational mechanical activation is polymerized in a standard way.

Then a new portion of the composite material is applied, which is subjected to vibrational mechanical activation in accordance with the procedure described above. The operations of applying a portion of the composite material, vibration exposure and polymerization are repeated until full recovery integrity of dental hard tissues.

1. The method of vibration mechanical activation of composite restorations in direct and indirect restorations of teeth, characterized in that portions of the composite material applied to the defect area are subjected to vibration before polymerization.

2. The method according to claim 1, characterized in that the vibrational effect on portions of the composite material is carried out with an oscillation frequency of up to 1000 Hz.

3. The method according to claim 1, characterized in that portions of the composite material are subjected to vibration for at least 20 seconds.

4. A device for vibratory mechanical activation of a composite material by the method according to claim 1, containing, according to at least, one working part for applying a composite material to the defect area, fixedly fixed on the handle, characterized in that the handle is made in the form of a tubular body, equipped with an activating element button for actuating the battery power source, electrically connected to a micromotor that creates vibrations, which by means of of the working part are transferred to the layer of composite material by its distribution over the entire surface of the defect and simultaneous surface plastic deformation.

5. The device according to claim 4, characterized in that the battery power source and the micromotor are placed in a frame, which can be fixed with the possibility of removal on the tubular body using a gripping device or in the cavity of the window made on the side surface of the tubular body.

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The invention relates to medicine, in particular to dentistry, and concerns the treatment of chronic fibrous pulpitis of permanent teeth with immature roots. The method includes forming a carious cavity, filling the carious cavity medicinal material and filling. To do this, use the bioactive osteoplastic material "Orgamax" based on allogeneic demineralized bone matrix, which has antimicrobial, osteoconductive and osteoinductive properties. After that, a temporary filling is applied. Then, within 6-12 months, X-ray monitoring of the condition of the tooth is carried out. After the beginning of periodontal formation, a temporary filling is removed, the carious cavity is covered with an insulating gasket and a permanent filling is applied. EFFECT: method provides increased efficiency of treatment due to complete restoration of the tooth pulp and stimulation of the development of immature roots of permanent teeth in children. 2 ill.

The invention relates to medicine, in particular to dentistry, and is intended for use in the rehabilitation of the tooth root canal system. Carry out the standard stages of mechanical and drug treatment of the root canal of the tooth. At the stage of pre-obturation sanitation of the tooth root canal system, further sterilization of the root canals of the tooth is carried out by UVC irradiation with a wavelength of 254-257 nm for no more than 45 s. The disposable tip of the UVC light guide is inserted into the pre-treated canal to the working length of the root canal, which is equal to the working length of the disposable tip of the UVC irradiator, but 1.0-1.5 mm, the tip should be less than the control length of the root canal of the tooth. After the introduction of the light guide, UVC is activated and the walls of the canal are irradiated, gradually moving the emitting tip of the UVC light guide in the root canal of the tooth with reciprocating movements from the apical foramen to the mouth of the canal with a step of 0.3-0.5 mm, treating the corresponding section of the root canal. In this case, the optimal UVC irradiation time is from 20 to 40 s, but cannot be less than 20 s. Irradiation can be carried out simultaneously or fractionally in 2-3 doses of 10-15 s with an interval between each dose of 1.0-3.0 minutes, and single-stage and total-fractional irradiation also does not exceed 45 s. After processing the corresponding section of the root canal, the tip of the light guide is removed from its mouth and the supply of UVC irradiation is turned off. EFFECT: method makes it possible to preserve hard tissues of the tooth, increase sterilization efficiency, and reduce the risk of complications. 1 tab., 7 ill., 4 pr.

The invention relates to medicine, namely to dentistry, and is intended for use in the treatment of periodontitis. The tooth is processed in accordance with the requirements of the technology for installing a permanent filling. A separate obturator is inserted into each canal of a multi-rooted tooth. The tooth tissues are dried and the tooth cavity is filled with filling material so as to completely restore the defect of the tooth crown. The filling material is polymerized and after it has hardened, the obturators are removed. The surface of the seal is treated in accordance with existing requirements. The outlets of each of the obturators on the surface of the seal are marked and, if necessary, separate treatment of each of the canals is carried out in the future. EFFECT: method allows restoring the patient's cosmetic data on the first visit and performing repeated healing procedures without limits on their number. .

The invention relates to medicine, in particular to dentistry, and for the treatment acute pulpitis. The method includes infiltration anesthesia, preparation of a carious cavity, treatment with a 3% hydrogen peroxide solution and application of a herbal preparation under a temporary filling, followed by replacing the temporary filling with a permanent one. As a preparation, an ointment of the following composition is used: prickly argan oil or sunflower oil - 66.0 grams; yellow wax - 22.0 grams; 70% calendula tincture - 5.0 ml; Japanese Sophora tincture - 6.0 ml; ecdysterone - 0.05 grams; clove essential oil - 1 ml. The ointment is obtained in a certain way. Sunflower or prickly argan oil and yellow wax are heated in a water bath until the wax melts. 5 ml of calendula tincture and 6 ml of Japanese saphora tincture are added to the resulting base, in which 0.05 g of ecdysterone is preliminarily dissolved. The mixture is thoroughly emulsified, after which 1.0 ml is added. clove oil and the mixture is homogenized. The use of the obtained drug in the method provides a pronounced reparative, anti-inflammatory, odontotropic and analgesic effect while maintaining the specified effect for a long time. 2 Ave.

SUBSTANCE: group of inventions relates to medicine, namely to dentistry, and is intended for strengthening composite materials used in the elimination of various defects in dental hard tissues of carious and non-carious origin, in the process of direct or indirect reinforced and non-reinforced composite restorations. Vibration mechanoactivation of composite materials is carried out by means of vibration impact on a portion of the composite material applied to the defect area. Vibration action on portions of the composite material is carried out with an oscillation frequency of up to 1000 Hz using a device containing at least one working part for applying the composite material to the defect area, fixedly fixed on the handle in the form of a tubular body, equipped with an activating element button to bring the the action of a battery power source electrically connected to a micromotor that creates vibrations that are transmitted through the working part to a layer of composite material by distributing it over the entire surface of the defect and simultaneous surface plastic deformation. The inventions, due to the controlled effect of the restorative instrument on the surface of the applied composite material, which ensures maximum extrusion of air from the composite layer, make it possible to form a solid monolithic composite structure and an effective marginal fit of the composite material to the hard tissues of the tooth, as well as reduce the likelihood of complications and increase the life of the composite restoration. 2 n. and 3 z.p. f-ly, 2 tab.

“In the treatment and prosthetics of teeth, it is necessary to take into account their anatomical, topographic, biomechanical and functional features, while preserving healthy tissues as much as possible,” says an outstanding scientist and innovator, dentist, doctor of medical sciences Melikset Melikyan. The innovative technology of Dr. M. L. Melikyan has no analogues in the world. Dr. Melikyan and his students, for the first time in the world, developed and patented methods for mechanical activation and reinforcement of composite materials, which allow restoring the integrity of destroyed teeth, taking into account their natural features, preventing and minimizing the likelihood of complications and increasing the life of the restored teeth.

- How did you get into your profession?

– After graduating from school, I graduated from the jewelry school in Leninakan. Throughout my service in the army, I was engaged in construction. Having entered the medical institute at the Faculty of Dentistry, he organized the Evrika construction team and led it for 5 years. But the most important and beloved profession in my life was the treatment of my patients. Although the skills of the first two help to this day.

- After graduating from the medical institute, residency and postgraduate studies, for 10 years I studied in theory and practice all sections of dentistry. The development of minimally invasive, tissue-sparing ways to eliminate defects in the oral cavity prompted me to observe aggressive methods of treatment and the number of complications that arise after such traditional approaches. I want to acknowledge the great merit of my supervisor and teacher Itin V.I., who taught me to pay attention primarily to negative results, subject them to careful analysis, draw appropriate conclusions and find extraordinary solutions.

The development and implementation of new sparing methods of treatment and prosthetics is the most urgent task of our time. And despite the fact that more and more new materials, tools, equipment and technologies appear, unfortunately, in the same America, by the age of 55, 50% of patients after cermet remain without teeth. For dental treatment using composite materials, for example, in the United States, 5 billion dollars are spent annually. And in Russia, already 12 months after the treatment, more than 75% of composite restorations require replacement or significant correction. And given that in general, more than 4 billion people on the planet need dental care, one can imagine the relevance of developments that would reduce the number of complications characteristic of traditional dentistry. We were also driven, first of all, by one desire - to extend the life of the teeth as much as possible. We have been able to achieve this thanks to our innovations, which we have been successfully using for over 20 years.

– Melikset Litvinovich, is it possible to say that such a need for dental care determines its modern high level?

- In my opinion, modern dentistry is in a very difficult situation all over the world. It lags behind other branches of medicine. The number and nature of complications is proof of this. And what depresses me most of all is that those teeth that can still function for decades with the use of our treatment technology are traditionally removed.

- Melikset Litvinovich, what are the causes of complications in the traditional method of treatment?

– Good question. We ourselves received the answer to this question after a thorough study and analysis of the underlying causes that lead to the occurrence of complications in traditional dentistry without taking into account the qualifications of the doctor: the use of artificial materials; traumatic or aggressive preparation of hard tissues of the tooth; removal of the neurovascular bundle (tooth depulpation) under the structure; tooth restoration without taking into account constructive, anatomical, topographic, biomechanical features; the use of artificial crowns and pin structures; lack of a systematic approach.

Unfortunately, at traditional treatment or prosthetics do not take into account the natural features of the tooth. And what is completely unacceptable is that a systematic approach is not used in dental treatment: one tooth heals, the second is removed, the third installs an implant, the fourth prostheses, etc. But at the same time, none of the doctors is responsible for the general condition of the patient's teeth.

When eliminating defects, the dentist has three main tasks - to restore the anatomical shape, function and aesthetics. It would be quite logical and correct to carry out these manipulations using materials similar to natural tooth tissues. But there is no such technology in the world, therefore, metal and non-metal artificial materials have been used, are being used and will probably be used for a very long time, which differ both from each other and from natural tooth tissues in physical-mechanical, physical-chemical and aesthetic properties. Complications that arise from materials are an inevitable, natural and predictable phenomenon due to their shortcomings.

After removal of natural soft tissues (vascular-nerve bundle, which ensures the vital activity of the tooth) or after destruction ligamentous apparatus tooth (periodontium, acting as a shock absorber), it is impossible to restore their integrity and function using modern artificial materials. Currently, with the use of artificial materials, the anatomical shape, function and aesthetics of exclusively destroyed hard tissues of the tooth are restored.

- And when restoring one missing tooth, two adjacent ones are “killed”?

- Yes exactly. Doctors understand this, but they have no other choice. We thought a lot about how not to dissect (grind) adjacent teeth? Another problem is the preparation of a tooth for a specific design. After all, the tooth is ground under a crown or a pin, during which not only destroyed tooth tissues are removed, but also healthy ones. This is aggressive and highly undesirable. Unfortunately, as Professor E. Y. Vares said, barbaric methods are legalized in dentistry.

- If possible, briefly about the essence of your innovations.

– In the process of layer-by-layer composite restoration, a flexible mesh made of stainless medical steel coated with gold is implanted (installed) into a light-cured composite material. Before us, it was used in dentistry in removable dentures. We, giving any desired in a particular clinical case the shape of the reinforcing element from the mesh, set it in the desired projection during the restoration/reconstruction of teeth.

What is Reinforcing Dentistry?

– The philosophy of reinforcing dentistry is fully consistent with the most important postulate in medicine at all times – “Do no harm!” and consists in an individual, exclusive and systematic approach to the patient.

– What are the benefits of reinforcing composite materials?

– Our developments allow for gentle preparation, elimination of any defect in the hard tissues of the tooth without the use of traditional artificial crowns, pins, inlays, veneers, thereby eliminating traumatic and aggressive grinding in our work. We do not grind the tooth under a crown or a pin, but only remove the destroyed tooth tissues, and restore the tooth on the remaining healthy tissues using a composite material and a gilded metal mesh. Thanks to our technology, it has become possible to save most of the teeth that are removed worldwide with the traditional approach. The developed system allows to eliminate any form of pathological tooth wear starting from 2 mm in a direct way without a laboratory. In the vast majority of cases, teeth are restored taking into account their natural features. Our task is to save the teeth and not bring them to extraction with our treatment.

Over the course of 20 years of using the reinforcement of composite materials in the elimination of various defects in the hard tissues of the teeth, we have found that in the reinforced zone of the composite restoration, regardless of the defect, there are no cracks, chips, or spalls of composite restorations. Thus, we have developed innovative technology Reinforcement of composite materials allows minimizing complications and increasing the functioning of restored teeth. Moreover, we work without anesthesia. At the same time, out of 10 patients, 8 fall asleep during treatment due to the unique restoration technique.

- Tell me, if the patient has several problems - one tooth is missing, the other is half-destroyed, the third requires intervention, the fourth must be removed?

– This is precisely the case that requires a systematic approach. This allows our technology. It usually starts with a consultation. We hold at least three consultations. The patient must be informed and have the right to choose. We acquaint with the advantages and disadvantages of traditional and author's methods of treatment. We substantiate indications and contraindications. A plan and milestones are drawn up. After the conclusion of the contract and information consent, we proceed to complex treatment. That is, the doctors in our clinic lead the patient from the beginning to the end of the treatment and are fully responsible for the result of their work. In addition, all patients during the year are on a free dispensary observation.

– People come to you with serious complications after traditional methods of treatment and prosthetics. Tell me, how long does it take for such severe cases with numerous defects?

- Everything, of course, individually. If you take the most running case- about 20 days at the rate of 4 hours a day.

– What is the guarantee after the restoration of teeth by the method of reinforcement?

– In our practice, there has never been a chip in the reinforced zone of a composite restoration. Very rarely, there were micro-chips in the non-reinforced zone of the composite restoration. The complication rate is approximately 5%. This is against 75% after traditional composite restoration. But the use of mechanical activation of composite materials, even without reinforcement with a metal mesh, significantly reduced complications in the non-reinforced zone of composite restoration. Using the mesh and the mechanical activation method when installing the seal, we have achieved a fantastic result. We have scientifically proven that the metal mesh increases the ultimate load of the composite material by 75%, and the vibrational method of mechanical activation - by 23%.

Thus, for the first time in the world, alternative methods have been developed to increase the ultimate load of composite materials in the process of layer-by-layer composite restoration using reinforcement and mechanical activation, which together increase the ultimate load to 98% And this, in turn, led to the minimization of complications during composite restoration. Entire institutions around the world are working on this. But our family team managed to solve this global problem with an extraordinary and highly effective approach.

– Tell me, please, what is mechanoactivation of composite materials? Tell about her.

- By mechanical activation, in the broad sense of the term, one should understand the technological impact on the material, causing the acceleration of technological processes, leading to an increase in the quality of the product, through mechanical influences.

With the traditional method of installing a filling, the composite is “tamped down” in layers using a special dental instrument. As a result of the research, we found that large pores appear between the layers of the composite, over time, in the process of chewing, under pressure, cracks appear from these pores, which, merging with each other, form the main crack. As a result, its growth leads to chipping of the composite restoration. We have developed and patented a device, a vibrational mechanical activator, for mechanical activation of light-cured composite materials. We began to “tamp down” the composite using a vibrator in the process of layered composite restoration. Our Scientific research showed that the vibrational method of mechanical activation of a composite material increases the ultimate load by 22.5%; reduces porosity up to 70%, and the maximum pore size (critical defects) up to 50% and contributes to the formation of a strong compacted monolithic composite structure.

- It turns out that you are seriously engaged not only in the clinic, but also in science?

– The sign of our family clinic says “Institute of Reinforcing Dentistry”. This is in line with our range of activities. But our working day is much longer and ends in the walls of the house.

Over the years, we have not only clinical application of our technology, but also the scientific substantiation of our innovations together with scientists from the Moscow State Technical University named after Bauman, the Research Institute nuclear physics Sarov, Kazan Federal University and the University of Texas. We have found that the metal gilded interlaced mesh increases the ultimate load in composite samples by 75%, reduces and evenly distributes stress in the composite restoration in the area of ​​adhesion (the area where the composite material is connected to the hard tissues of the tooth), and prevents the growth and occurrence of cracks in the reinforced zone of the composite restoration. . For clarity, we can refer to the analogy in construction. There is iron and concrete, completely different materials, but when they are combined, reinforced concrete is obtained with its own physical and mechanical properties. The disadvantages of one material are offset by the advantages of another.

Our discoveries are a common asset. We have patented 71 innovative solutions in Russia. Developments were awarded 10 gold medals international exhibitions ideas, innovations and inventions. For innovations in medicine, I was awarded the Order of the Belgian State. At the World Innovation Forum in Mougins (France) in 2012 among young scientists Melikyan K.M. was awarded the Leonardo da Vinci Grand Gold Medal of the European Academy of Sciences. We have published a large number scientific articles according to the author's technology and an atlas was published. To list all the achievements does not make sense. But one thing I would like to note: everything that we have done and are doing is at the expense of our strengths and resources, while at the same time fighting off organized harassment by a group of those in power in dentistry. Finished dissertations for competition degree candidate of medical sciences at the level of discoveries of my students on mechanical activation and reinforcement of composite materials by the same powerful group of dentists who are obliged to support domestic innovations are not allowed to defend for two years. Complete impunity cultivates the laws of the Italian Camorra in the scientific community. Our repeated appeals to the Deputy Minister of Science and Education Ogorodova L.M. over the course of 8 months resulted in ignoring organized lawlessness in relation to dissertators and their works, as well as me as a scientific supervisor. In the last telephone conversation the Deputy Minister for Science and Education sent us to court, as she, in her words, is not a dentist. Apparently, having no idea either about the ministry where she works, or about her direct official duties, or about the laws that regulate education and science in the Russian Federation. And so it turns out - people who, according to their kind, official duties and the public office they hold to stand guard over the law, they themselves do not observe the laws. Complete mutual responsibility. I am deeply convinced that because of such deputy ministers, less than 1% of innovations in Russia are being introduced to the broad masses, as President of the Russian Academy of Sciences Fortov V.E. said in his article in AiF.

– Do you think the wide introduction of your technology in Russia is impossible?

“We have been seeking widespread adoption of our technology for a long time. In medicine, it is difficult to promote innovations, there must be a scientific and clinical justification, permission from Roszdravnadzor. We have all this, but for the widespread use of these innovations, a government approach is needed. Therefore, we turned to the government and presented our technology, which allows doctors to come to any outback, treat and prosthetics at no additional cost. We turned to all possible authorities with a proposal to create a Center for Reinforcing Dentistry with direct subordination to the Ministry of Health of the Russian Federation, and not on the basis of any dental university, where they teach how to prepare (grind) a tooth and install a crown on it. And we teach that this should not be done. Only Arkady Vladimirovich Dvorkovich answered our appeal. He redirected our appeal to fellow dentists. At a staged meeting of the profile commission, they delivered a verdict that there was no scientific justification and therefore the creation of an innovation center should not be allowed. Although at this point it was great amount scientific articles, patents, awards. My son has already defended his dissertation on our technology.

- In other words, if you create such a center and train doctors, many in dentistry will remain out of work?

- May be. We have developed and offer alternative and atraumatic dentistry. The patient should have the right to choose. For many years we have been trying to convey to the leadership of the country the importance of developments on a national scale. But the fate of innovation is ultimately decided by an organized community that has its own interest in our developments.

- So far, the priority of this technology remains with Russia. If this technology is introduced in another state, it will no longer be Russian. The question will arise as to why ready-made Russian innovations, in this case in dentistry, are not being introduced in Russia? Today, my daughter and I have received the status of outstanding scientists in the USA for the developments in the field of reinforcing dentistry by Melikyan. At the age of 29, my daughter, a co-author of innovative developments, a young and promising scientist with a huge scientific and clinical potential, who is not allowed to defend a finished dissertation in Russia for two years due to lawlessness, is an outstanding American scientist. And this despite the fact that at every step it is said about the importance of domestic developments and their implementation.

Why don't you fight?

– I am a scientist, doctor of medical sciences, author and founder of atraumatic dentistry. My task is to develop and implement innovations. We fought, fight and will fight to the end, because our developments are unique and patients need them. Reinforcement and mechanical activation of composite materials is the future of world dentistry.

The invention relates to the field of dentistry, namely to passive pins used in the restoration of incisors upper jaw, canines, single-rooted premolars, upper and lower molars, destroyed below the level of the gums. The reinforcing mesh pin for tooth restoration is made of gilded metal mesh and consists of root and supra-root parts. The root part of the pin has a tubular shape with a longitudinal slot or a flat shape with bevelled corners and is made of a double layer of mesh, and the root part is made in the form of free mesh wires, the length of which is not more than the height of the crown part of the tooth. The length of the root part of the pin is not less than 1/3-1/2 of the length of the root canal. The technical result - the use of a reinforcing mesh pin in case of significant damage to the tooth allows you to save the root as a basis for its restoration, ensures the strength and durability of the functioning of the restored tooth. 2 n. and 1 z.p. f-ly.

The invention relates to dentistry, namely to passive pins used in the restoration of the incisors of the upper jaw, canines, single-rooted premolars, upper and lower molars, destroyed below the level of the gums.

As follows from the prior art, the restoration of such teeth can be carried out using a cult pin insert, one of the main elements of which is a pin.

The pin should strengthen the crown and root parts of the tooth, evenly distribute the occlusal load along the entire length of the root, have a deep and stable fit without weakening the root.

In particular, a pin tab according to patent RU No. 2031639 is known, which is used in the prosthetics of multi-rooted teeth with a destroyed crown part and non-parallel channels. The tab is fixed in the canals of the tooth by means of a passive cast pin placed in a large diameter root canal and an additional active pin placed in a thin canal.

The prior art metal dental pin according to patent RU No. 2121820 cylindrical shape. A retention coating is applied to the root of a standard pin by plasma spraying. To cover the pin, a powder of various dispersions, homogeneous with the material of the pin, is used. The root part of the pin is installed in a previously prepared root canal using a cementing material, and an artificial stump is formed on the crown part, which is covered with a metal-ceramic crown.

In the prior art, an analogue closest to the claimed invention has not been found.

Known passive pins have low retention and low stability. These shortcomings are manifested in the occurrence of micromovements of the pin fixed in the root canal, which ultimately can lead to the destruction of an already restored tooth and / or to a root fracture.

In practice, the problem of increasing the stability of passive pins is solved by forming retention points not only on the contact surface of the root part of the pin, but also on the contact surface of the root. The manufacture of such a pin is a lengthy, complex and expensive process. To increase the stability of pins of known designs, a significant preparation of hard root tissues is required when forming retention points on its base and on the contact surface of the canal, which can not be achieved in all clinical situations due to the risk of damage to the root walls.

In particular, in the case of tooth decay below the gum level, this method of increasing the stability of the pin, and, consequently, increasing the strength of the restored tooth, cannot be applied due to the insufficient thickness (less than 1 mm) of the dentin of the preserved root. In practice, a tooth with such destruction is usually removed.

The use of the inventive reinforcing mesh pin allows you to save the root as a basis for restoring the crown part of the tooth even with such significant damage, while ensuring the strength and durability of the functioning of the restored tooth due to the design features of the pin.

The inventive pin is made of gold-plated metal mesh with cells of 0.4 mm. The material used is biocompatible, which completely eliminates the manifestations of allergic reactions.

The cellular structure of the mesh of the root part of the pin reinforces the walls of the root canal and improves its retention.

In addition, due to the reinforcement, the walls of the root canal, which are insignificant in thickness, are strengthened, the resistance of the root to the perception of functional loads increases, and their uniform distribution is ensured.

From the practice of prosthetics, it is known that the stability of the fixation of the pin in the root canal also largely depends on the diameter of the pin and the cementing material. The larger the diameter and length of the pin and the higher the fixing properties of the cement, the more strength holding the pin in the root canal.

Increasing the stability of the claimed pin is provided by two factors: the properties of the material from which it is made, and the constructive solution of the shape of the proposed pin.

The inventive reinforcing pin is made of gilded metal mesh with a tubular root with a longitudinal slot.

Due to the flexibility and elasticity of the mesh, the shape of the pin can be adjusted according to anatomical features root. In addition, due to the slot along the generatrix of the tubular root part of the pin, the maximum surface contact of the contacting surfaces of the root part of the pin and the root canal is ensured, the fixing cement is evenly distributed over the entire contact surface, as a result of which the holding force of the pin in the root canal increases and strength and stability increase. its fixation.

The inventive reinforcing pin can be made of a double layer of gold-plated metal mesh with a flat root with beveled corners. The shape of the root part of this embodiment of the pin is determined by the anatomical features of the distal root canal of the lower molar.

In both the first and second embodiments, the reinforcing mesh pin does not have tension zones that are inherent in known pins (due to the implementation of retention points on the root part of the pin in the form of grooves and grooves, and also due to the presence of transition points from the root part of the pin to the pin head).

The retention of the claimed pin is provided by the cellular structure of the gold-plated metal mesh. The absence of tension zones is due to the peculiarities of its design solution: the root part of the inventive pin, instead of the traditional pin head, is made in the form of free mesh wires and is a continuation of its root part.

When fixing the pin, the wires of its root part are distributed over the surface of the cavity formed on the basis of the root, and / or along inner surface coronal part, providing strengthening of the reinforced parts of the tooth, as well as increasing the stability of the fixation of the pin in the root canal, as well as the strength of fixation of the crown part of the restored tooth in relation to the root.

In addition to a simple design solution, the advantages of the proposed reinforcing mesh pin include a simple method for its manufacture, the ability to adjust its size and shape directly in the process of tooth restoration without additional laboratory steps required in the case of known pins.

To increase the strength and durability of the functioning of the restored tooth, a reinforcing mesh pin is used in combination with a reinforcing crown-root or coronal framework made of gilded metal mesh. The crown-root frame is simultaneously fixed on the inner surface of the cavity of the root base and the inner surface of the cavity formed by the restored walls of the root part of the tooth. Or the crown frame is fixed on the inner surface of the cavity of the crown part of the restored tooth. In this case, the wires of the root part of the post are distributed inside the root coronal-root frame (providing double reinforcement of the root base) and fixed with cement. Or the wires of the supra-root part of the pin are distributed inside the crown-root frame (providing double reinforcement of the root base and the restored walls of the crown part of the tooth). Thus, the wires of the root part of the pin, in addition to increasing the strength and stability of the fixation of the pin, provide additional reinforcement of the root base and the coronal part of the restored tooth.

If it is necessary to repeat endodontic root treatment, access to the root canal can be provided without damaging the integrity of the post structure.

The design features of the pin and the material from which it is made ensure the versatility of its use in relation to any standard size of the root canal with the achievement of the expected technical result.

The technical result consists in simplifying the design of the pin, in increasing the stability of its fixation, in ensuring the restoration of a tooth destroyed below the gum level, taking into account the anatomy of the canal and the resistivity of the root.

The essence of the invention.

The reinforcing mesh pin consists of root and supra-root parts.

The pin is made of gold-plated metal mesh with a mesh size of 0.4 mm. The root part of the pin can be made of a tubular shape with a longitudinal slot or a flat shape with bevelled corners, consisting of a double layer of mesh.

The reinforcing mesh pin can be made with a root tubular part with free mesh wires at the end placed in the apical part of the root canal. The free wires of the root part of the pin make it possible to reinforce the root canal and strengthen its walls to the maximum possible depth.

Reinforcing mesh pin with a tubular root is designed to restore maxillary incisors, canines, single-rooted premolars and upper molars.

Reinforcing mesh pin with a flat root is designed to restore the lower molars.

The length of the root part of the pin is 1/3-1/2 of the length of the root canal of the corresponding tooth.

The diameter of the tubular root part of the pin is not less than the diameter of the root canal of the corresponding tooth. The width of the flat root part of the pin is not less than the width of the root canal in the vestibulo-oral direction.

Regardless of the shape of the root part, the root part of the pin is made in the form of continuing free wires of the grid of its root part. The length of the wires of the root part of the pin is not more than the height of the coronal part of the corresponding tooth.

Application of the declared pin.

Carry out a preliminary sealing of the root canal. After gum retraction, demineralized root tissues are prepared and at the same time a shock-absorbing cavity is formed on the basis of the root.

To fix the reinforcing mesh pin with a tubular root part, when restoring the incisors of the upper jaw, canines, single-rooted premolars and upper molars, the root canal is prepared, forming a cylindrical cavity in the canal.

To fix the reinforcing mesh pin with a flat root part during the restoration of the lower molar, the distal root canal is additionally prepared in the vestibulo-oral direction, forming a groove.

The depth of root canal preparation is from 1/3 to 1/2 of the root length.

If necessary, the size and shape of the pin of each standard size can be easily adjusted in accordance with the shape of the channel prepared for fixing the pin.

Due to the peculiarities of the structural structure of the grid (in the form of an interlacing of longitudinal and transverse wires), in the process of installing the root part of the inventive pins in the corresponding root canal, a relative displacement of the longitudinal and transverse wires occurs relative to each other. This changes not only the shape, but also the size of the cells of the grid of the root part of the pin. Due to the flexibility of the mesh and the relative displacement of the wires that make it up, the tubular or flat root part of the pins is installed in the root canal without stress, which eliminates root fracture and provides its reinforcement.

The root part of the pin is fixed in the root canal with cement. After fixing the root part, the root part of the pin is fixed on the surface of the root part of the tooth.

In this case, the root part of the tooth can be pre-reinforced by means of a mesh frame. The wires of the root part are shaped into the inner surface of the crown-root or crown part of the reinforcing frame and fixed with cement, forming a solid monolithic reinforcing pin structure.

In the case of restoration of a multi-rooted tooth, several sizes of reinforcing mesh pins can be used simultaneously (in particular, when restoring the upper molar, which has three roots of different diameters).

After fixation of the supra-root part of the reinforcing mesh pin, the cavity of the supra-root part of the tooth is filled with glass ionomer cement and the final restoration of the crown part of the tooth is started, taking into account its anatomical structure.

CLAIM

1. Reinforcing mesh pin for tooth restoration, made of gilded metal mesh, consisting of root and supra-root parts, moreover, the root part of the pin has a tubular shape with a longitudinal slot and passes into the supra-root part, made in the form of free wires of the mesh of the root part, while the length free wires no more than the height of the crown part of the tooth, the length of the root part of the pin is not less than 1/3-1/2 of the length of the root canal, and the diameter of the root part is not less than the diameter of the root canal of the restored tooth.

2. Reinforcing mesh pin for tooth restoration according to claim 1 is made with a root tubular part with free mesh wires at the end.

3. Reinforcing mesh pin for tooth restoration, made of gilded metal mesh, consisting of root and supra-root parts, moreover, the root part of the pin is made of a double mesh layer and has a flat shape with beveled corners, passing into the supra-root part of the pin, made in the form of free wires grids, the length of which is not more than the height of the crown part of the tooth, while the length of the root part is not less than 1/3-1/2 of the length of the root canal, and its width is not more than the width of the root canal in the vestibulo-oral direction of the root.

(54) METHOD FOR RE-RESTORATION OF REINFORCED CROWN PART OF FOREQUARTERS ON A PRESERVED PIN

(57) Abstract:

The invention relates to dentistry and can be used for the restoration of front teeth. The method for re-restoration of the reinforced coronal part of the anterior teeth on the preserved pin includes the preparation of demineralized tissue on the base of the root, the formation of a groove on the base of the root around the root part of the preserved pin with a depth of 1 mm and the formation of a grid-pin support made in the form of a fixed in a circular groove and on the root part a pin with formed retention points of a reinforcing mesh, the width of which is not more than the width of the crown part of the tooth, and the length is not more than the height of the crown part, and before fixing, the opposite sides of the mesh are cut off by 1/3 of its length and the cut part is given a cylindrical shape, the base diameter of which corresponds to diameter of the root part of the pin. During fixation, the cutting edge of the formed reinforcing mesh is placed parallel to the cutting edge of the crown part, and the cylindrical part of the mesh is additionally fixed on the root part of the pin with the help of released mesh wires, the subsequent restoration of the crown part of the tooth is carried out using composite materials. EFFECT: preservation of a natural tooth as a basis for re-restoration with a composite material of its crown part using a preserved pin.

The invention relates to dentistry and can be used for re-restoration of the crown part of the anterior teeth.

The purpose of the claimed invention is to restore the anatomical shape and function of the anterior teeth on the preserved pin in the event of a partial or complete defect in the coronal part of the pin tooth.

The pin tooth, as follows from the prior art, is a pin structure, which is strengthened in the root canal and is used for subtotal or complete destruction of the natural crown of the tooth.

Mandatory components of this design are a pin fixed in the root canal and an artificial crown. It is also known from the prior art that, as a rule, porcelain or plastic teeth are used to restore the color and anatomical shape of the front teeth. artificial crowns. The fragility of the crown material is the reason for their destruction under the influence of functional loads. The degree of risk of using such crowns increases significantly with deep overlap and deep bite, vertical position of the anterior teeth.

If the pin design is unsuitable, the crown part of the tooth can be restored again by the traditional method of prosthetics using a newly made pin design. However, the possibilities of using traditional methods are significantly limited by the state of the root canal. In particular, the removal of a previously installed post and the need to prepare and expand the root canal to fix a new post are associated with a deterioration in the mechanical strength of the root. When removed, a significant destruction of the hard tissues of the dentin occurs, as a result of which the fixation capabilities of the canal are lost. In this case, the use of a new pin design becomes useless due to the risk of root splitting and tooth loss. In order to avoid unjustified expenditure of time and money, instead of re-using a new pin design, the method of replacing the missing tooth is resorted to.

Unlike known methods, the claimed method has no contraindications for use. The use of a preserved pin completely eliminates the destructive mechanical impact on the root canal, which allows it to be preserved as a strong and stable base for re-restoration of the crown part of the tooth. The reinforcement method used in the claimed method, in addition to the direct function of strengthening the crown part restored using a composite material and strengthening the root base around the preserved pin, performs the additional function of firmly fixing the crown part of the tooth relative to the root part of the pin and the root base. Thus, a monoblock is formed from a natural tooth, mesh-pin support and layers of composite material, and reliable mechanical retention of composite materials is ensured. In addition, the use of a composite material to restore the anatomical shape of the crown part of the tooth ensures hermetic isolation of the root canal from the external environment, thereby ensuring stable fixation of the pin in the root canal.

The technical result achieved in the implementation of the claimed invention is to preserve the natural tooth as a basis for re-restoration with a composite material of its crown part using a preserved pin, to reduce the trauma of the restoration, to increase its strength and durability through the use of the reinforcement method, to reduce the time and restoration costs.

The simplicity of the technology for implementing the claimed method and the availability of the means used in this case with a guaranteed result make this method universal in use and attractive to the patient.

The essence of the invention.

The restoration of the crown part of the anterior teeth by the claimed method is started after the control radiograph. The sealed root canal should not have apical changes.

Mechanically, using toothbrushes and toothpastes, the surface of the teeth near the defect is cleaned and their color is determined according to the generally accepted VITA scale.

The demineralized tissue of the root base is prepared. On the basis of the root around the root part of the pin with ball bur form a circular groove with a depth of 1 mm.

A rectangle is cut out of a metal mesh, for example, by Renfert, the width of which is no more than the width of the crown part of the tooth being restored, and its length is no more than the height of the crown part. Along the length of the rectangle on opposite sides, corner cuts are made for 1/3 of its length, reducing the width of the rectangle from the side of the cut to a size equal to the perimeter of the root cylindrical part of the pin. The cut part of the rectangle is given the shape of a cylinder, the diameter of which corresponds to the diameter of the root part of the preserved pin.

Fitting and correction of the appropriately formed reinforcing mesh are carried out. The cylindrical part of the mesh should be placed without tension on the root part of the pin, with its base located in a circular groove at the base of the root. After fitting and correction, the reinforcing mesh is removed.

The base of the root and the circular groove formed on the base of the root are etched with acid to create a microrelief. The acid is applied with a brush for an average of 15-20 seconds, and then washed off with a stream of water while the saliva ejector and vacuum cleaner are running.

The etched surfaces of the root base and circular groove are air-dried and then adhesive is applied to them. To evenly distribute the adhesive, the surfaces are blown with air, the adhesive is applied to the surfaces again and blown with air again. Within 10 seconds, polymerize in the standard way.

In the formed groove and on outer surface glass ionomer cement is applied to the root part of the preserved post and a reinforcing mesh is installed, deepening the end of its cylindrical part into the formed groove of the root base, and placing its cutting edge parallel to the cutting edge of the restored crown part of the tooth. With the help of fixing wires, previously cut out of the same mesh, the reinforcing mesh is additionally fixed on the root part of the pin. Thus, as a result of double fixation: chemical (using glass ionomer cement) and mechanical (using wires), the reinforcing mesh is firmly fixed on the root part of the pin, forming a mesh-pin support for the restored crown part of the tooth.

Restoration of the crown part of the tooth is carried out using composite materials according to the instructions.

The aesthetic effect is achieved after pre-treatment and grinding with standard polishing discs of various thicknesses and grits of abrasive, diamond burs, as well as after processing the proximal surfaces with strips.

Correction is carried out under the control of the occlusal paper with finishing burs and discs. Produce final illumination.

Thus, due to the reuse of the intracanal pin, the claimed method makes it possible to preserve the natural root of the anterior teeth as a basis for the restoration of the reinforced crown part, while ensuring the aesthetics and durability of the restoration.

Claim

The method of re-restoration of the reinforced crown part of the anterior teeth on the preserved post, including the preparation of the demineralized tissue of the root base, the formation of a groove on the base of the root around the supra-root part of the preserved post with a depth of 1 mm and the formation of a mesh-pin support, made in the form of a fixed with glass ionomer cement in a circular groove and on the root part of the pin with formed retention points of the reinforcing mesh, the width of which is not more than the width of the crown part of the tooth, and the length is not more than its height, and before fixing, the opposite sides of the mesh are cut off by 1/3 of its length and the cut part is given a cylindrical shape, diameter the base of which corresponds to the diameter of the root part of the pin, when fixing the cutting edge of the formed reinforcing mesh, it is placed parallel to the cutting edge of the crown part of the tooth, and the cylindrical part of the mesh is additionally fixed on the root part of the pin with the help of released mesh wires , the subsequent restoration of the crown part of the tooth is carried out using composite materials.