Complete loss of teeth

Complete absence (loss) of teeth - a pathological condition that occurs after caries and its complications, periodontal diseases, injuries or operations, when one or both jaws lose all teeth.

This condition is characterized by both morphological and functional disorders.

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

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

The second cause of facial signs is loss of support for the lips and cheeks from the teeth and alveolar parts. These sections of the facial skeleton create the appearance of the face, serving as a framework for the orbicularis oris muscle, cheek muscles and other facial muscles.

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

Rice. 17.36. Grimace of a Toothless Man, D. Llewellini /Wales/, (Life, USA)

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The term senile progeny denotes the relationship of toothless jaws (Fig. 17.37), reminiscent of lower macrognathia. The most noticeable symptom is a protruding chin.

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

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

A slightly different relationship develops between the dental and alveolar arches in the lower jaw. With an orthognathic bite, the incisors stand vertically on the alveolar part. The lateral teeth with their crowns are inclined towards the lingual side, and their roots - outwards. For this reason, the lower dental arch is narrower than the alveolar arch. Thus, with an orthognathic bite with all teeth present, the upper jaw narrows upward, while the lower jaw, on the contrary, becomes wider downward. After complete tooth loss, this difference immediately begins to affect itself, creating an edentulous jaw relationship reminiscent of lower macrognathia.

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

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

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

Supple paid main attention to the condition of the mucous membrane of the prosthetic bed. He identified four classes.

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

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

Third class: the alveolar parts and the posterior third of the hard palate are covered with loose mucous membrane. This condition of the mucous membrane is often combined with a low alveolar ridge. Patients with such mucous membranes sometimes require pre-treatment. After prosthetics, they should especially strictly observe the regime for using the prosthesis and must be observed by a doctor.

Fourth class: movable strands of the mucous membrane are located longitudinally and are easily displaced with slight pressure from the impression mass. The bands may become pinched, making it difficult or impossible to use the prosthesis. Such folds are observed mainly on the lower jaw, mainly in the absence of the alveolar part. The alveolar edge with a dangling soft ridge belongs to the same type. In this case, prosthetics sometimes become possible only after its removal.

The pliability of the mucous membrane, as can be seen from Supple's classification, is of great clinical importance.

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

The mucous membrane of the first zone is thin and does not have a submucosal layer. Its flexibility is insignificant. This area is called the median (middle) fibrous zone by Lund.

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

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

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

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

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

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

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

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

Atrophy of the alveolar part is an irreversible process, and therefore the more time passes after tooth extraction, the more pronounced the bone loss. Prosthetics does not stop the phenomena of atrophy, but enhances them. This is explained by the fact that for the bone, an adequate stimulus is the stretching of the ligaments attached to it (tendons, periodontium), but the bone is not adapted to perceive the compressive forces that come from the base of the removable denture. Atrophy can also be exacerbated by improper prosthetics with uneven distribution of chewing pressure, directed predominantly at the alveolar part.

Thus, different individuals may have different degrees of alveolar ridge atrophy. You can find patients whose alveolar parts are well preserved. Along with this, cases of extreme atrophy are also observed. The hard palate becomes flat, in the anterior part its atrophy often reaches the nasal spine. Not all parts of the upper jaw undergo atrophy to the same extent. Atrophy of the alveolar tuber and palatine ridge is least pronounced.

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

The alveolar part disappears with great atrophy. The denture bed narrows, and the attachment points of the mylohyoid muscles are at the same level as the edge of the jaw. When they contract, as well as when the tongue moves, the sublingual salivary gland is applied to the prosthetic bed.

In the anterior mandible, bone loss is most pronounced on the lingual side, which may result in a knife-edge or knobby alveolar margin.

In the area of ​​molars, the cellular part becomes flattened after tooth loss. This is due to the fact that atrophy of the alveolar edge is most pronounced at its apex (horizontal atrophy). As a result, there is a thinning of the maxillary-hyoid lines, complicating prosthetics. In the chin area on the lingual side, at the site of muscle attachment (m. geniohyoideus, etc.), a dense bony protrusion (spina mentalis) is found, covered with a thinned mucous membrane.

Along with atrophy of the alveolar part, the position of the transitional fold changes. With advanced atrophy, it finds itself in the same plane as the prosthetic bed. The same thing happens with the attachment points of the frenulum of the tongue and lips. For this reason, the size of the prosthetic bed in the lower jaw decreases, determining its boundaries and fixing the prosthesis becomes more difficult.

In the upper jaw, the buccal side is more susceptible to atrophy, and in the lower jaw, the lingual side is more susceptible. Due to this, the upper alveolar arch becomes even narrower while the lower one expands at the same time.

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

With complete loss of teeth, changes in the relationship of the jaws also occur in the transversal direction. At the same time, the lower jaw becomes visually wider (Fig. 17.39). All this complicates the placement of teeth in the prosthesis, negatively affects its fixation and, ultimately, affects its chewing efficiency.

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

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

Rice. 17.40. Outlines of the vestibular slope of the alveolar part: a - flat, b - steep, c - with a niche

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

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

Sheer - in the presence of which the edge of the prosthesis, hanging down, quickly leads to disruption of the closing valve due to loss of contact with the mucous membrane, which manifests itself in loss of stability of the prosthesis;

With overhangs (undercuts or niches) - in which good conditions for anatomical retention conflict with the method of applying the prosthesis.

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

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

Joint changes associated with atrophy of the elements forming the temporomandibular joint. At the same time, the depth of the articular fossa decreases, the fossa becomes flatter. At the same time, atrophy of the articular tubercle is noted. The head of the lower jaw also undergoes changes, approaching the shape of a cylinder. Movements of the lower jaw become more free. They cease to be combined and, when the mouth is opened to normal interalveolar height, they become articulated with the head located in the cavity. Due to the flattening of all the elements forming the joint, the anterior and lateral movements of the lower jaw can be performed in such a way that the alveolar ridges will be located almost in the same horizontal plane.

With complete loss of teeth, the protective role of molars disappears. When the chewing muscles contract, the lower jaw unhinderedly approaches the upper jaw, and the head of the lower jaw is pressed against the articular disc. The only obstacle to the movement of the head is the lateral pterygoid muscle. If the strength of this muscle is not sufficient to resist the muscles that lift the mandible, then the head of the mandible moves into the depth of the articular fossa.

Essentially, in edentulous patients, both morphologically and functionally, a new joint arises. Functional overload of the articular surfaces can easily lead to the development of deforming arthrosis. One should not conclude from this that in all cases of complete tooth loss the phenomena of deforming arthrosis will be observed. Adaptive mechanisms neutralize functional overload, and therefore many patients without teeth do not complain about joints.

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

The function of chewing with complete loss of teeth is almost absent. True, many patients grind food using their gums and tongue. But this cannot in any way compensate for the lost function of chewing. Eating cooked and crushed food (mashed potatoes, minced meat, etc.) is of great benefit. Since chewing is kept to a minimum, people without teeth do not experience pleasure while eating. Reducing the degree of fragmentation of food makes it more difficult to wet it with saliva. Consequently, edentulous people have impaired oral digestion.

Complete loss of teeth also leads to speech impairment. Speech becomes lisping and slurred. For people in certain professions, complete loss of teeth can make their professional activities impossible.

Aesthetic disturbances (changes in appearance, gross speech disorders), difficulty chewing food, and obvious signs of disability have a negative effect on the patient’s psyche. The complete loss of teeth itself almost always leaves a mark on the patient’s psyche.

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

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

In older people, complete loss of teeth can be layered with a feeling of anxiety, concern caused by various circumstances of a family and social nature. People over 65 years of age, in addition, suffer from atherosclerosis of the cerebral vessels with varying degrees of severity of neurotic conditions. We should not forget that for people in certain professions (artists, announcers, lecturers), the loss of teeth means parting with a profession, a favorite activity, and sometimes the need to retire, which can also be difficult to experience.

Many patients come to see a doctor with a prejudice against removable dentures, with disbelief in the ability to use them. Such pessimism can be strengthened by inadvertently dropped expressions of medical personnel about the difficulties of fixing the prosthesis. Consultations from incompetent persons who do not have special medical knowledge bring great harm in this regard.

Not only social but also psychological difficulties that a doctor may encounter when supervising patients with tooth loss must be taken into account when diagnosing and drawing up an orthopedic treatment plan. Forgetting them can cause failures even with perfect execution of the prosthetics itself. Treatment will be successful if there is an atmosphere of trust between the doctor and the patient. Fewer difficulties are encountered when installing prosthetics for patients who have previously used prostheses, although such cases have their own psychophysiological characteristics, which will be discussed later.

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

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

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

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

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

3) time and causes of tooth loss;

4) whether the patient previously used removable dentures.

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

By talking with the patient, you can sometimes get a rough idea of ​​the nature of his reactions (excitement, irritability, ability to tolerate the slightest inconvenience from the prosthesis, etc.). These observations will provide additional valuable information.

After the interview, they proceed to examining the patient’s face and oral cavity. Examination of the face should not be done on purpose, as this confuses the patient. It is better to do this during a conversation without him noticing. It should be noted the symmetry of the face, the presence or absence of scars on the skin of the face that limit the opening of the mouth, the degree of reduction in the height of the lower part of the face, the nature of the closure of the lips, the condition of the red border of the lips, the degree of severity of the nasolabial and mental folds and the condition of the mucous membrane and skin in the area of ​​the corners of the mouth.

When examining the oral cavity, pay attention to the degree of mouth opening (free or with difficulty), the nature of the jaw relationship, the severity of atrophy of the alveolar part of the upper and lower jaws. The alveolar ridges should not only be inspected, but also palpated to detect sharp projections of roots and bone, covered by the mucous membrane and invisible during examination.

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

It is necessary to study the topography of the transition fold. There are mobile and immobile mucous membranes.

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movable mucous membrane covers the cheeks, lips, floor of the mouth. It has a loose submucosal layer of connective tissue and easily folds. When the surrounding muscles contract, this mucous membrane is displaced. Its degree of mobility varies widely (from large to insignificant).

Rice. 17.41. General view of the oral cavity with toothless jaws: 1 - frenulum labii superioris; 2.4 - frenulum buccalis superioris; 3 - torus palatinus; 5 - tuber alveolare; 6 - line A; 7 - fovea palatina; 8 - plica pterygomandibularis; 9 - trigonum retromolare; 10 - frenulum lingualis; 11 - frenulum buccalis inferioris; 12 - frenulum labii inferioris

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

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

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

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

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

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

In the modern world, people pay great attention to their appearance. Plastic surgery, rejuvenation and other services are very popular today. Dental restoration is also no less popular. After all, a smile is a person’s calling card. A lot depends on her at the first meeting. That is why people are so sensitive to their dental organs and when they are chipped, deformed or destroyed, they immediately look for ways to correct the situation.

When is it necessary to restore a tooth?

Front and chewing teeth can be destroyed for various reasons.

One of these reasons is caries. It occurs due to acids produced by carbohydrates during their fermentation. For this reason, people with a sweet tooth are most susceptible to this disease, since sugar is the main carbohydrate.

Externally, caries can be determined by the presence of dark spots and further tooth decay. The disease can develop into pulpitis and periodontitis. But its most terrible consequence is the harm caused to hard tissues. The disease can lead to the destruction of most of the tooth, for the treatment of which it will be necessary to remove absolutely all damaged areas.

It is also necessary to restore a tooth due to jaw injuries. The front teeth are especially susceptible to this effect. The treatment aims to restore not only the functionality of the tooth, but also the aesthetics of the smile. It is important to carry out restoration as soon as possible, because the imperfection of a smile is perceived quite painfully by every patient.

It is also necessary to restore teeth:

• on enamel that has chips, cracks, stains that cannot be bleached, or the surface has completely worn off;
• between which there are gaps, which looks unaesthetic;
• with malocclusion.

Restoring tooth functionality

Patients often turn to dentistry with a request to restore the functionality of a tooth. The need for this procedure is usually caused by problems resulting from an inflammatory process, mechanical damage or caries. When restoring such a dental organ, a specialist recreates its anatomical shape. And this work is very painstaking.

It is important to take into account the position of the dental organ during its functional restoration. The difficulty extends to both molars and incisors. It is very labor-intensive to create an aesthetic appearance of teeth in the smile area, because they should not differ from real ones.

The doctor decides what method of restoration will be used, what materials and technology will be used individually for each patient.

Correction Methods

There are cases when it is important to restore not only the functionality of a tooth, but primarily its aesthetic appearance. Then, for restoration, they practice the use of lumineers, veneers, inlays, crowns and other structures.

Depending on the complexity of the situation, restoration methods can be as follows:

1. Minor chips and other imperfections in the front and other teeth can be easily masked with veneers. They also perfectly protect the dental organs from destruction. The disadvantage of such devices is that their attachment requires preliminary grinding of healthy teeth. But the result is excellent. The patient receives a highly aesthetic dentition.
2. In cases where it is no longer possible to fill a tooth, but it is still possible to preserve it, onlays are used.
3. Installation of crowns is the most popular restoration method. Their types are varied, which allows each patient to choose the most suitable one.
4. Restoration using composite materials is also quite common, especially when it comes to treating caries and restoring enamel. New techniques for their creation contribute to obtaining very durable and aesthetic fillings. Thanks to the large number of shades, they can be matched as accurately as possible to the color of natural tooth enamel, which will make the filling, even in the smile area, completely invisible to others. In addition to high aesthetics and preservation of more healthy tooth tissue, the advantage of this method is the speed of treatment.
5. You can avoid prosthetics when the tooth is slightly damaged through artistic restoration. The result depends on the dentist’s ability to do this type of restoration; the specialist must have artistic skills.
6. If a dental organ is broken, it is either restored using a crown, or, if the damage is minor, a composite material is used.
7. Even if a tooth is more than 50% destroyed, it can be restored using a pin. For this, it is important what condition the root of the dental organ is in, and also requires high-quality preparation for the procedure. To extend the service life of the oral organ restored in this way, a crown is placed on the pin.
8. In case of severe destruction of the coronal part of the dental organ due to various diseases, stump inlays are used. The designs are reliable and highly accurate. Using a custom-made structure inserted into the tooth root, the dental crown is secured. The crown can be ceramic, platinum, gold, etc.
9. In addition to composite material, enamel can also be restored using ceramic microprostheses. Their price is not low, but the results are excellent. For minor lesions, remineralizing compounds are used, which are quite affordable.
10. Implantation is used to restore dental bone tissue. After a tooth is removed, an implant is implanted in place of its root, on which a new tooth is built up. This is how he gets a second life.
11. If the molar is completely lost, prosthetics are used. This procedure has almost no contraindications, and it gives a fairly high-quality result.

Note! You can restore teeth even if they are completely missing. And for this there is no need to place an implant under each lost tooth - an analogue of a living root, and the prosthesis will be fixed within 1-3 days. From 3 to 10-12 implants are sufficient for one jaw (depending on the condition of the jaw bone). But the most common method is the treatment protocol, of course, quite high. But if the doctor carried out the treatment responsibly and professionally, your new teeth will serve you for the rest of your life.

Fiberglass

Restoring dental organs using fiberglass is a new method. Thanks to him, the destroyed organ is restored and made more durable. Fiberglass has become used in dentistry due to its strength and perfect safety for the human body.

Comparing it with other materials used for dental restoration, it should be noted that fiberglass is not inferior in almost all respects, and in some cases even outperforms. Its great strength allows it to be used for prosthetics and implants. Teeth after restoration with fiberglass look natural due to the quality and aesthetics of the material.

Glasspan technology

The use of Glasspan technology to restore a tooth is also one of the modern methods. The technology itself is a flexible ceramic ligament used to restore anterior and lateral teeth. This technology makes it possible to use any type of dental material.

Glasspan technology is used when it is necessary to replace or restore a dental organ. It has proven itself excellent in the manufacture of bridges, both temporary and intermediate, and adhesive. Using this method, the position of the affected dental organs is also stabilized.

The technology does not cause complications, and the rehabilitation time when using it is less than when the tooth is restored with a pin or crown.

Cosmetic restoration

To restore a tooth cosmetically means to restore its color or whiteness. This also includes microprosthetics of cracks formed in the enamel. The procedure is performed by a dentist-cosmetologist, using composite and filling materials.

Having restored teeth cosmetically, the specialist gives the patient recommendations on how to shorten the duration of the rehabilitation period and maintain the attractiveness of the dentition for as long as possible.

The price of such a procedure depends on the complexity of the work being performed. It is advisable to carry out the cosmetic restoration procedure in a specialized clinic.

Restoration with photopolymers

Dental restoration using polymers allows you not only to get rid of cracks and stains on tooth enamel, but also to restore the tooth, returning it to the desired color, shape and functionality.

First, the tooth is processed to give it the desired shape. Then the missing areas are expanded with photopolymers, recreating the desired size and shape. The result obtained is confirmed by exposure to a special lamp.

The hardened material is sanded so that it does not change its shade when exposed to coloring products. After this, in order to preserve the color, the surface of the tooth is coated with a special compound.

Photopolymers do not help in the following cases:

1. With a severely weakened root.
2. If there is inflammation in the root system.
3. Pathological mobility of the fourth stage.
4. When restoring two adjacent teeth.

Features of extensions on a pin

The pin is a special design that plays the role of a base that provides the tooth with reliability when chewing. They are made from alloys of gold, palladium, titanium, stainless steel, as well as ceramics, carbon fiber and fiberglass. The pins vary in shape, composition and size.

Main types of pins:

1. Standard conical or cylindrical design. They are used when tooth decay is minor.
2. Individual designs. They are made taking into account the topography of the root system. Such pins are very reliable and hold firmly in the root canals.
3. Metal rods are used when there is significant tooth decay, when a large part of it is missing. With its help, the tooth can withstand heavy chewing loads.
4. Anchor pins are made from titanium alloys.
5. Fiberglass structures are very flexible. Fiberglass does not react with saliva and oral tissues.
6. Carbon fiber pins are the most advanced material available. They are very durable and distribute the load on the dental organ evenly.

Today, fiberglass pins are the most commonly used. With their help, you can completely fill the root canals. Also, fiberglass interacts well with composite materials, which makes it possible to restore a tooth without a crown.

When choosing a pin, it is important to consider the following nuances:

1. How badly the root is damaged, how thick its walls are, how deep the pin can be placed.
2. At what level relative to the gum did the tooth decay?
3. What load will the tooth be subjected to? Will it support a bridge or is it freestanding?
4. When choosing a material, it is important to take into account the patient’s characteristics and the possibility of an allergic reaction to a particular material.

Installation of a pin is contraindicated in the following cases:

• disruption of the central nervous system;
• blood disease;
• periodontium;
• the thickness of the root walls is less than two millimeters;
• complete absence of the crown part in the front part of the tooth.

Stages of extension onto a pin

1. Preparation of tooth canals using special instruments. Their cleaning and processing.
2. Inserting the pin into the canals so that it fits into the bone.
3. Fixing the product with filling material.
4. Fastening the crown, if its fixation is provided.

Enamel restoration

Strong enamel is the basis of a healthy tooth. When it is weakened and damaged, the tooth can be affected by caries, infections and dental plaque.

Let's look at the main ways to restore enamel:

1. The use of filling materials for the restoration of cracks and chips.
2. One of the effective ways to restore enamel is fluoridation. A composition rich in fluoride is applied to the tooth, which restores and strengthens the enamel.
3. Remineralization is the saturation of the tooth with fluoride and calcium, which are very beneficial for the dental organs.
4. Using veneers.
5. Application method - the use of overlays filled with a special compound.

Restoration of teeth with minor damage

Cracks in tooth enamel, its thinning, the presence of interdental spaces and chips are minor damage. Composite materials are used to disguise them. Thus, restoration can be done by visiting the clinic once, since the process is quite fast.

Modern materials for restoration can take any shape, harden quickly, have a highly aesthetic appearance and are absolutely compatible with oral tissues. Their structure is as close as possible to the structure of tooth enamel, and the oral mucosa is not damaged during chewing.

The advantages of this recovery method:

1. Preservation of pulp.
2. Speed ​​of the procedure.
3. Maximum resemblance to tooth enamel.
4. Possibility of correction of shape and size.
5. Ability to hide minor defects such as stains.

Stages of the teeth restoration procedure with extensions:

1. Professional cleaning of plaque and stone in order to enhance the effect of attaching the filling material.
2. Selection of photocomposite shade.
3. Local anesthesia if necessary.
4. Using a burr to drill out areas damaged by caries and darkened fillings.
5. Isolate the tooth from saliva using a latex lining, because moisture can greatly reduce the effectiveness of treatment.
6. Using a pin when more than half of the tooth is destroyed. It is used to normally withstand the load of the crown during chewing.
7. Applying filling material layer by layer.
8. Polishing and grinding.

New technologies

Modern technologies for dental restoration change and improve every day, and new types appear. The restoration process with their help is fast, painless, high-quality, while giving an effective and durable result.

Note: The main feature of new restoration methods is the use of modern materials. The composite materials used for reconstruction are very durable and safe.

Dentures made using new technologies are of the highest quality; in addition, they perfectly match the color of living teeth, repeating their individual characteristics. New technologies make it possible to restore a lost tooth from scratch, when there is no remnant bone tissue.

Should damaged teeth be saved?

When a small piece breaks off from a tooth or when a crack appears on it, it should, of course, be restored. But if there is more serious damage, you should think about the need to restore this organ.

Restoration with composites and inlays is quite safe. When installing them, the enamel is processed slightly. Having removed them, the patient can continue his usual activities. What cannot be said about the use of veneers. Removing them makes the teeth vulnerable, because there is no protection, there is no enamel and a ceramic plate. The tooth will become as sensitive as possible to any irritants. Its appearance will also be greatly affected. In addition, in order to replace veneers, the teeth are ground down again each time, which over time leads to their thinning, rendering them unusable and requiring the defect to be hidden with crowns.

And crowns are already a dental prosthesis, not restoring, but replacing a tooth. Crowns are quite strong and will last much longer than veneers. Also, their use will be more profitable relative to the cost.

Therefore, it is important to think about the use of ceramic plates.

If the tooth cannot be restored, what should I do?

When a tooth can no longer be restored, a crown is used. But such a solution may not be suitable in all cases. If the tooth root is also destroyed, even installing a pin will not save you. After all, the crown will be very heavy for him, and the tooth will have to be ground down to install it, depriving the pin of external support.

The best solution for losing a tooth along with the root is to install a prosthesis on an implant. Despite the complexity of implantation, it gives highly effective results. A metal rod is implanted into the bone, which replaces the tooth root and serves as a support for the crown. Most implants come with a warranty of about twenty years, but if used correctly, they can last much longer.

What happens if we draw an analogy between dental materials (for example, implants) and artistic paints? Then most art historians and art lovers would be interested in only one question: “What colors did Leonardo Da Vinci use to paint his famous Mona Lisa?” And on art forums they would seriously discuss what watercolor to use to paint the future masterpiece and what oil would be better suited for the ceremonial equestrian portrait of Barack Obama.

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

Today I will show you one of my implantological works. At the same time, I propose to speculate on what a person should do if he loses all his teeth. Is it possible to solve this problem? Is it possible to get teeth back if several decades have passed since the last one was removed? Is it possible to improve the quality of life with complete tooth loss?

This will be discussed below.

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

As soon as the ability to chew normally is lost, atrophy of the muscles, temporomandibular joints, and jaw bones begins. A person’s quality of life decreases - they have to change their eating habits, complexes and health problems appear. Many patients associate the onset of old age with the appearance of removable dentures.

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

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

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

Despite his advanced age, Ivan Petrovich leads an active lifestyle, travels a lot, communicates, and enjoys horse riding and photography. Before coming to our clinic, he had been using complete removable dentures for more than 10 years. Needless to say, Ivan Petrovich was not at all satisfied with these prostheses.

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

(the points on the prosthesis are markings for installing implants)

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

At the first stage, we installed implants on the lower jaw. The operation is performed under local anesthesia and an existing removable denture is used as a template.

in a month we will begin installing gum formers.

Ivan Petrovich complained that the lower prosthesis did not stay on the jaw, so instead of gum formers, we installed special locking ball abutments on two implants to fix the puller. And the reverse parts of the locks were soldered into the prosthesis itself:

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

Then, after a few minutes, our orthopedic doctor, Arthur Makarov, made a compact metal-ceramic prosthesis supported by implants:

The photo was taken about a year after prosthetics.

The metal-ceramic prosthesis is fixed to the implants using screws. If necessary, the denture can be removed, cleaned, the necks of the implants processed, etc. As you can see, it takes up very little space in the mouth, and caring for it is the same as caring for your own teeth.

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

Please note, this is not some kind of exclusive, but a completely ordinary job. Here's another example. Observation period - one and a half years:

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

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

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

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

I wish you good health.

Best regards, Stanislav Vasiliev.

Complete absence of teeth (edentia), which occurs mainly in older people, is a common problem. Regardless of the reasons, edentia is a complete and unconditional indication for urgent prosthetics. Which dentures are best for complete absence of teeth? This article will help you understand the variety of dental services aimed at restoring your teeth.

Several factors contribute to the occurrence of adentia: natural wear and tear of enamel and dentin, periodontal disease, late visit to the dentist, ignoring basic hygiene requirements, injuries, chronic diseases.

The lack of even 2-3 teeth is very noticeable and unpleasant, and when it comes to their complete absence, we can say without exaggeration that such a condition is a serious pathology that entails many negative consequences:

Adentia can be a consequence of injuries, as well as various diseases.

• Ailments of the gastrointestinal tract (GIT), as a result of poor chewing of food and poor nutrition.
• Negative changes in appearance - a patient with a complete absence of teeth acquires a characteristic elongated oval face, a protruding chin, sunken cheeks and lips, pronounced nasolabial folds.
• Significant impairments in spoken speech: teeth are the most important and integral part of the articulatory apparatus, and their lack, and even more so their absence, leads to the appearance of very noticeable aural defects in diction.
• Dystrophy of the bone tissue of the alveolar processes (gums), which, in the absence of roots, become thinner and decrease in size, which in the most advanced cases complicates or makes high-quality implantation (prosthetics) impossible.

The cumulative result of all the above problems is significant psychological discomfort, impaired communication skills, and limitation of oneself in vital needs: communication, work, nutritious nutrition. The only way to return to a quality life is to get dentures.

Contraindications for prosthetics

Cases in which dental prosthetics are prohibited are rare, but nevertheless, a qualified dentist must ensure that his patient does not suffer from one of the following ailments:

• individual allergic reaction to the chemical components included in the material;
• intolerance to local anesthesia (relevant for implantation);
• any viral disease in the acute stage;
• severe form of diabetes mellitus;
• cancer;
• mental and neurological disorders during exacerbation;
• bleeding disorders;
• serious lack of weight and exhaustion of the body (anorexia, cachexia).

It is obvious that many contraindications are temporary, while others lose their relevance with the correct choice of restoration method.

Removable dentures in the absence of teeth: difficulties and features

Another negative aspect of edentulism is the very small choice of possible methods for restoring teeth. Existing methods are either expensive or have many disadvantages. Nylon dentures are in great demand in cases of complete absence of teeth. But, when choosing the optimal method of prosthetics, you should remember that a complete removable restoration of the entire dentition has a lot of features:

The main feature of complete dentures is that they have no attachments.

Does this mean that it is better not to resort to this method of restoration? Certainly not. Despite the fact that the best method of restoration for completely missing teeth is, the use of a covering prosthesis also has a reason. It will help out those who do not have the financial ability to get implants, as well as patients whose bone tissue is loose, which is a contraindication to implantation.

Types of complete dentures

Orthopedic products used to restore completely missing teeth have approximately the same design. These are arched dentures that on the lower jaw are supported only by the gum, and on the upper jaw they also rest on the palate. The teeth in dentures are almost always plastic, and the base can be made of different materials. It is on this basis that they are classified.

Expert opinion. Dentist Yanovsky L.D.: “ are named after the polymer from which their base is made. Nylon is a translucent, durable, flexible and elastic material with good wear-resistant properties. Its advantages include good aesthetics and hypoallergenicity, which distinguish this type of dental structures from others. Considering that two out of ten people on the planet suffer from allergies to acrylic or various types of metals, for many, a nylon prosthesis in the absence of teeth is a panacea in terms of convenience and quality.”

Made of acrylic - a more modern and advanced type of plastic. It is distinguished by its resistance to wear and the effects of aggressive acid-base environments, which makes acrylic a fairly popular material in dental practice. At the same time, he has a number of shortcomings, which place it an order of magnitude lower than nylon:

Both nylon and acrylic prostheses do not have any fastenings - this causes difficulties in fixing them. The situation can be slightly improved by using a special glue that lasts for 3-4 hours, but this only brings temporary comfort. The only way to get rid of discomfort is to install polymer prostheses on implants.

Prosthetics on implants with complete absence of teeth: advantages and types of procedure

The main advantage of implantation is reliable fixation, thanks to which the patient does not have to worry about the prosthesis falling off at the most inopportune moment. Chewing food is also significantly easier: there is no need to limit yourself to eating hard and viscous foods, and this has a positive effect on the state of the gastrointestinal tract and intestinal motility.

One of the first questions that interests people who decide to undergo implantation is the required number of implants. In each specific clinical case, this is decided individually, and the decisive factor is the condition of the patient’s bone tissue. On average, at least two implants must be installed on each jaw to support the entire structure.

If the patient is determined to undergo surgery, but the condition of the alveolar processes does not allow it, he can undergo a sinus lift - a technique for increasing bone tissue using special materials. Modern dentistry has several methods for implanting implants, however, in the absence of teeth, it is rational to use only two of them - beam and push-button.

Implantation with buttons– a fairly reliable and relatively inexpensive method of restoration. During the operation, two implants are implanted into the gums, which end in a ball that looks like a clothing button. On the side of the prosthesis there are holes, which are the second part of the fastening. This device allows the patient to remove the denture daily for thorough cleaning.

Implantation on beams provides for the implantation of 2 to 4 implants connected to each other by metal beams, increasing the supporting area for more thorough fixation of the prosthesis. Just like push-button implantation, it requires periodic removal, but at the same time pleases with good functionality.

In case of complete or partial absence of teeth, one of the main treatment methods is the production of a complete or partial removable denture. At the same time, despite the fact that from an aesthetic point of view, at first it can completely satisfy the patient, from a physiological point of view there is a certain range of problems that it does not solve in any way and which are worth paying attention to.

Improving facial aesthetics is the only problem that a removable denture can solve. However, this effect is temporary; the patient must periodically reline it.

Let's consider the main consequences of tooth loss in patients. Spend 5-10 minutes reading this material, the information contained in it can be very useful.

Consequences for bone structures

Reduction in the width and height of the supporting bone.

The alveolar bone of the jaw remodels depending on the forces applied to it. Whenever the function of a bone undergoes modification, significant changes occur in its internal architecture and external configuration. Bone needs stimulation to maintain its shape and density. The tooth is necessary for the development of alveolar bone, and it requires stimulation to maintain its density and volume.

When a tooth is lost, insufficient bone stimulation causes a decrease in bone density in the area with loss of width (and then height) of the bone. During the first year after tooth loss, bone width decreases by 25%, and the total height loss in the first year after tooth extraction for emergency prosthetics is more than 4 mm.

When teeth are completely missing, a removable denture does not stimulate or support the bone: it accelerates the loss of bone volume. The load from chewing is transferred only to the surface of the bone. As a result, blood supply is reduced and there is an overall decrease in bone volume.

This problem is of paramount importance, but in the past it has tended to be recognized but ignored by conventional dentistry.

Tooth loss causes remodeling and resorption of the surrounding alveolar bone and ultimately leads to atrophy of the edentulous ridges. Although the patient is often unaware of the possible consequences, they become apparent over time.

Initially, loss of bone volume leads to a decrease in bone width. The remaining narrow ridge often causes discomfort when the thin overlying tissues begin to experience stress from the soft tissue-supported denture.

The process is further accelerated if the patient wears a poorly fitting soft tissue-supported prosthesis, but patients generally do not realize this. As a rule, patients neglect regular examinations of the condition of their teeth and come to the doctor only after several years, when the artificial teeth are worn out or cannot be tolerated any longer.

Patients who wear dentures around the clock, which is about 80%, expose hard and soft tissue to greater forces, which can accelerate bone volume loss.

Increased risk of mandibular fracture due to significant loss of bone volume.

Loss of bone volume in the upper or lower jaw is not limited to the alveolar bone. Parts of the main bone of the lower jaw can also be subject to resorption (resorption, thinning), especially in its posterior parts, where severe resorption can lead to the loss of 80% of its volume. In this case, the body of the lower jaw has an increased risk of fracture even under the action of low-impact forces.

Other possible problems associated with thinning bone and partial or complete missing teeth include:

• Protrusion of mylohyoid and internal oblique ridges with increasing pressure sores;
• Protrusion of the anterior mental tubercles, bedsores and increased mobility of the prosthesis;
• Incorrect muscle attachment - near the top of the ridge;
• Vertical displacement of the prosthesis during contraction of the mylohyoid and buccal muscles;
• Shift of the prosthesis forward due to rotation of the lower jaw;
• Increased sensitivity when brushing teeth due to thinning of the mucosa;
• Increased mobility of the prosthesis and functional bedsores.

Effects on soft tissue

As the bone loses width, then height, width and height again, the attached gum gradually decreases. When there is severe atrophy of the lower jaw, it is usually covered by a thin layer of attached tissue or is completely absent. The gums are prone to sedimentation, which is caused by the overlying prosthesis.

Conditions such as hypertension, diabetes, anemia, and eating disorders have a devastating effect on the blood supply and quality of nutrition of the soft tissues under the removable denture. As a result, the thickness of the surface tissues gradually decreases. All this leads to the formation of bedsores and discomfort from wearing removable dentures.

A patient's tongue with edentulous ridges often enlarges, filling the space previously occupied by teeth. At the same time, the tongue is used to limit the movement of the removable denture and takes a more active role in chewing.

Aesthetic consequences of loss of bone volume due to missing teeth

The facial changes that naturally occur with age can be exacerbated and accelerated by tooth loss. Pronounced aesthetic consequences result from loss of alveolar bone. Patients do not even suspect that all these changes in soft tissues are associated with tooth loss:

• Reduction in facial height occurs due to disturbances in the vertical dimension of the alveolar bone.
• A change in the labiomental angle and deepening of the vertical lines in this area give the face a rougher appearance.
• A malocclusion develops. As a result, the chin turns forward.
• The corners of the lips droop, the patient's face has an unhappy expression.
• Due to poor support of the lip by dentures and loss of muscle tone, the border of the red border of the lips becomes thinner.
• Age-related deepening of the nasolabial philtrum and other vertical lines on the upper lip is more pronounced with loss of bone volume.
• In edentulous patients, the decrease in the tone of the facial muscles that support the upper lip occurs faster, and the lengthening of the lip occurs at an earlier age. As a result, the smile ages.
• Bone atrophy has a negative effect on the attachment of the mental and buccal muscles to the body of the mandible. The fabric sags, creating a double chin. This effect is caused by decreased muscle tone when teeth are lost.

Psychological aspects of tooth loss

Psychological effects range from minimal to neurotic. It gets to the point that people are not able to wear dentures at all, and thinking that they will have to communicate with someone, they do not leave the house at all.

• Fear of an awkward situation if the prosthesis accidentally detaches.
• Losing teeth affects relationships with the opposite sex
• The occlusal (chewing) load is reduced, and the patient cannot afford to eat all the food he would like.
• Inability to eat in public.
• Speech problems. Diction problems in patients can be very serious.

The effect of missing teeth on the body as a whole

The deterioration of the functions of the dentofacial and other body systems when wearing removable dentures is largely due to a decrease in the quality of life due to the lack of adequate nutrition and psychological aspects.

Chewing efficiency decreases, which means the consumption of foods rich in fiber decreases, which can cause problems with the gastrointestinal tract. As a result, the consumption of drugs for the treatment of the gastrointestinal tract increases and the load on the liver increases.

Changes in facial features and diction also do not have a beneficial effect on the patient’s psychological health.

All this together can lead to a decrease in life expectancy.

Previously, there were no treatment options with predictable results to avoid bone changes associated with tooth loss. Modern techniques make it possible to take into account all aspects associated with both tooth loss and bone volume loss. Even with the complete absence of teeth, there are prosthetic methods that, depending on the clinical situation, allow you to restore the functions of the dental system up to 90%.

Read the material: advantages of implant-supported dentures, and mini-dental implantation. The main difference between mini-implantation and regular implantation is that it is used for severe thinning of the alveolar ridge. The doctor will tell you more about implantation methods during your consultation.