Несъемное протезирование на зубных имплантах

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Олимов, А., & Маннанов, Ж. (2020). Несъемное протезирование на зубных имплантах. in Library, 20(2), 109–112. извлечено от https://inlibrary.uz/index.php/archive/article/view/14287
Азимжон Олимов, Ташкентский государственный стоматологический институт

Ассистент кафедры хирургической стоматологии и дентальной имплантологии

Жавлонбек Маннанов, Ташкентский государственный стоматологический институт

Ассистент кафедры хирургической стоматологии и дентальной имплантологии

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Аннотация

Ортопедическое лечение частичной и полной адентии – протезирование на дентальных имплантатах. Идет разработка методов снижения травматизма, снижения затрат, сокращения времени ожидания окончания лечения и увеличения срока службы конструкций. Целью данного исследования был анализ эффективности протезирования на имплантатах при частичной и полной адентии. Объектом исследования явились 42 пациента с частичной или полной адентией. Протезирование выполняли методом одноэтапной или двухэтапной имплантации имплантатов. Развитие методов протезирования на имплантатах идет по пути снижения травматизма, снижения затрат, сокращения сроков ожидания окончания лечения и увеличения срока службы конструкций.

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ÁÈÎÌÅÄÈÖÈÍÀ ÂÀ ÀÌÀËÈ¨Ò ÆÓÐÍÀËÈ

ÆÓÐÍÀË ÁÈÎÌÅÄÈÖÈÍÛ È ÏÐÀÊÒÈÊÈ

JOURNAL OF BIOMEDICINE AND PRACTICE

Olimov Azimjon,

Mannanov Javlonbek

Assistants department of surgical dentistry and dental implantology,

Tashkent State Dental Institut, Uzbekistan

FIXED PROSTHETICS ON DENTAL IMPLANTS

http:// dx.doi.org/10.26739/2181-9300-2020-SI-103

ANNOTATION

Orthopedic treatment of partial and complete adentia is prosthetics on dental implants.

The development of methods is on the way to reduce injuries, reduce costs, reduce
waiting times for the end of treatment and increase the service life of structures. The
purpose of this study was to analyze the effectiveness of prosthetics on implants in partial
and complete adentia. The object of the study was 42 patients with partial or complete
adentia. Prosthetics were performed after the method of one-stage or two-stage implantation
of implants. The development of methods of prosthetics on implants is on the way to
reduce injuries, reduce costs, and reduce waiting times end of treatment and increase
the service life of structures.

Keywords:

fixed prosthetics, secondary adentia, dental implants, treatment,

antimicrobial agent, osteointegration.

Îëèìîâ Àçèìæîí,

Ìàííàíîâ Æàâëîíáåê

Àññèñòåíòû êàôåäðû õèðóðãè÷åñêîé

ñòîìàòîëîãèè è äåíòàëüíîé èìïëàíòîëîãèè,

Òàøêåíòñêèé ãîñóäàðñòâåííûé ñòîìàòîëîãè÷åñêèé èíñòèòóò, Óçáåêèñòàí

ÍÅÑÚÅÌÍÎÃÎ ÏÐÎÒÅÇÈÐÎÂÀÍÈß ÍÀ ÄÅÍÒÀËÜÍÛÕ
ÈÌÏËÀÍÒÀÒÀÕ

ÀÍÍÎÒÀÖÈß

Îðòîïåäè÷åñêîãî ëå÷åíèÿ ÷àñòè÷íîé è ïîëíîé àäåíòèè ÿâëÿåòñÿ ïðîòåçèðîâàíèå

íà äåíòàëüíûõ èìïëàíòàòàõ. Ðàçâèòèå ìåòîäîâ èäåò ïî ïóòè óìåíüøåíèÿ
òðàâìàòè÷íîñòè, ñíèæåíèÿ ñòîèìîñòè, óìåíüøåíèÿ ñðîêîâ îæèäàíèÿ îêîí÷àíèÿ
ëå÷åíèÿ è óâåëè÷åíèÿ ñðîêà ñëóæáû êîíñòðóêöèé. Öåëüþ íàñòîÿùåãî èññëåäîâàíèÿ


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ÿâèëñÿ àíàëèç ýôôåêòèâíîñòè ïðîòåçèðîâàíèÿ íà èìïëàíòàòàõ ïðè ÷àñòè÷íîé è
ïîëíîé àäåíòèè. Îáúåêòîì èññëåäîâàíèÿ ñëóæèëè 42 ïàöèåíòà ñ ÷àñòè÷íîé èëè
ïîëíîé àäåíòèåé. Ïðîòåçèðîâàíèå îñóùåñòâëÿëîñü ïîñëå ïðîâåäåíèÿ ìåòîäà
îäíîýòàïíîãî èëè äâóõýòàïíîãî âæèâëåíèÿ èìïëàíòàòîâ. Ðàçâèòèå ìåòîäîâ
ïðîòåçèðîâàíèÿ íà èìïëàíòàòàõ èäåò ïî ïóòè óìåíüøåíèÿ òðàâìàòè÷íîñòè,
ñíèæåíèÿ ñòîèìîñòè, óìåíüøåíèÿ ñðîêîâ îæèäàíèÿ îêîí÷àíèÿ ëå÷åíèÿ è
óâåëè÷åíèÿ ñðîêà ñëóæáû êîíñòðóêöèé.

Êëþ÷åâûå ñëîâà:

íåñúåìíîãî ïðîòåçèðîâàíèÿ, âòîðè÷íàÿ àäåíòèÿ, çóáíûå

èìïëàíòàòû, ëå÷åíèå, ïðîòèâîìèêðîáíîå ñðåäñòâî, îñòåîèíòåãðàöèÿ.

Olimov Azimjon,

Mannanov Javlonbek

Xirurgik stomatologiya va dental implantologiya kafedrasi assistentlari,

Toshkent davlat stomatologiya instituti, O'zbekiston

DENTAL IMPLANTATSIYADA OLIB QO`YILMAYDIGAN
PROTEZLASH

ANNOTATSIYA

Dental implantatsiyada qisman va to'liq adentiyali tishlarni ortopedik davolash bu

protezlashdir. Usullarning rivojlanishi - shikastlanishni kamaytirish, harajatlarni
kamaytirish, davolanish muddatini qisqartirish va tuzilmalarning xizmat muddatini
uzaytirish yo'li bilan amalga oshiriladi. Ushbu tadqiqotning maqsadi qisman va to'liq
adentiyada implantlarda protez samaradorligini tahlil qilishdir. Tadqiqot ob'ektida qisman
yoki to'liq adentiyaga ega bo'lgan 42ta bemor olindi. Protezlash bir bosqichli yoki ikki
bosqichli usulda implantlar qo`yilganidan keyin amalga oshirildi. Implantlarda protezlashda
- usullarini ishlab chiqish, shikastlanishni kamaytirish, harajatlarni kamaytirish, kutish
vaqtini qisqartirish samaradorligi amalga oshiradi.

Kalit soz:

olib qo`yilmaydigan protezlash, ikkilamchi adentiya, tish implantatlari,

davolash, antibakterial moddalar, osteointegratsiya.

R

elevance. Mass infection of the modern population with dental diseases such as
caries and periodontitis leads to the loss of a significant number of teeth, starting

from an early age.

Analysis of data on the frequency of dental defects in the adult

population of the Republic of Uzbekistan showed that partial and complete secondary
adentia occurs in 68.8% of the examined patients. At the same time, the largest percentage
of missing teeth by group affiliation were molars (70.2%).

The appearance of defects in the dentition contributes to the violation of its integrity,

which means that the performance of functions, including chewing and aesthetic].
Restoration of dentition is performed most often by orthopedic means or is not performed
at all. The objective reasons for the latter fact can be considered fear of extensive
interventions, unwillingness to "grind" healthy teeth, high cost of work, insufficient
duration of use of prostheses. Currently, methods that can provide an alternative to
orthopedic prosthetics are being used and improved. Designs on implants implanted in
the alveolar bone are becoming increasingly popular. Despite the vast number of
publications that still cover various aspects of the theory and practice of implantology,
there are still little-studied questions that require answers. In particular, data on the need


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for such treatment in certain age groups, the frequency of errors and complications are
poorly covered. There is clearly insufficient information about the role of the dentist in
the preparation and management of patients with implants and subsequent prosthetics.

A number of people who have removable dentures in the oral cavity refuse to perform

two-stage implantation, which is performed in several surgical stages and requires a long
waiting time, usually from 6 months or more.

The method of one-stage implantation with immediate loading allows the patient to

install implants and fixed orthopedic structures without the use of bone augmentation
and sinus lifting, directly into the wells of the removed teeth after the operation of their
removal. Prosthetics are performed within 3-7 days after surgery. However, old age is not
a contraindication for this type of implantation.

Purpose of research. Analysis of the effectiveness of prosthetics on implants in partial

and complete adentia.

Material and research methods. The object of the study was 62 patients who underwent

implantation operations in the surgical room followed by the installation of fixed prostheses.
A total of 143 implants were introduced. Single-stage implantation surgery was performed
in 45 patients who had 95 implants integrated, 17 patients had two-stage implantation
and 48 implants integrated.

In the study groups, women made up 48%, men-52%, while 47.5% - patients under

the age of 45 years, 52.5% - over 45 years. About 50% of individuals suffered from
complete secondary adentia, 46% had chronic generalized periodontitis, with partial
adentia, the included defects of the dentition were 41.9%, and the end defects were
58.1%. Determination of indications for the choice of treatment method in each case
was carried out after a diagnostic assessment: anamnesis (General, special); examination
of soft and hard tissues; assessment of dental and periodontal status; functional diagnostics;
analysis of models; radiography.

We studied the causes of tooth loss (caries, periodontopathies, trauma, tumor); the

prognosis of implantological intervention depending on the cause of tooth loss; the
prognostic assessment of teeth preserved in the bite and their orthopedic significance in
conjunction with the implantation prognosis. A General treatment plan was drawn up.
The plan of orthopedic treatment is focused on restoring lost structures, functions and
aesthetics; preventing the progression of pathological processes; preserving existing tissue
structures (hard tooth tissue, bone, soft tissue); long-term functional usefulness of the
orthopedic structure; the possibility of extending the prosthetic structure in the future.
Since the service life of implants largely depends on the hygienic state of the oral cavity,
an important role was given to training in individual hygiene. Self-care products for
patients with implants can significantly facilitate the removal of plaque.

The main means of self-hygiene is a soft toothbrush, and it can be both manual and

mechanical. Plaque in the interdental spaces can be removed using regular dental floss
(floss, superfloss), nylon thread, mono beam brush, or other devices that can also be
threaded under the prosthesis and remove plaque around the abutments. Irrigation
devices (in the minimum power mode) facilitate the removal of food residues from
under and around the prosthesis. Antimicrobial mouthwashes (for example, with
chlorhexidine and loraben 200ml) can reduce the formation of plaque over the gums.

For cleaning implants, it is not recommended to use pastes, mouthwashes and

deodorants for the oral cavity that contain chlorine in the ionized state - halogen-
containing toothpastes. For professional oral hygiene in the area of implants, the least
abrasive methods of removing dental deposits were used. For manual removal of deposits,


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curettes and skelers were used, the working parts of which are made of plastic, nylon
or special alloys.

One of the ultrasound devices recommended for professional hygiene in the field of

implants is the Vector-system (Durr Dental). In addition, this ultrasonic dental system
is designed for supporting the treatment of inflammatory periodontal diseases (hygiene
of the periodontal pocket), and the removal of supragingival dental deposits. Removal
of dental deposits from the implant surface was performed with a set of carbon fiber tools
(black) in combination with a polishing liquid based on hydroxyapatite. Subsequent
treatments with carbon instruments (maintenance therapy) were performed no earlier
than 3 months later.

According to the indications, methods of one - or two-stage dental implantation

were performed. The list of necessary equi pment, reagents, medications, and medical
devices includes a dental unit, a physiodispenser, a standard set of dental instruments,
monolithic and two-component implants, bone-expanding screws, installation tools
and auxiliary devices, and an x-ray machine.

It was planned to fill out a detailed outpatient dental card with a detailed examination

of the patient and establish the reason for treatment, determine the state of General
health in order to identify risk factors for local anesthesia, and determine the allergological
status to exclude allergic reactions to local anesthetics. The choice of design was influenced
by the volume of the preserved bone, the contours of the alveolar ridge, and the
intended location of the implants. You can expect a positive effect of treatment with a
normal occlusal ratio of the jaws and a sufficient height of the alveolar ridge.

A General plan for the patient's treatment was drawn up based on the results of the

examination, including therapeutic preparation of teeth before prosthetics. Conducted
professional hygiene of the oral cavity. The patient was trained in implant care and
signed a reasoned consent. It was planned to install implants directly into the wells of the
removed teeth, as well as in the intact alveolar bone.

Orthopedic planning included determining the location of the implants, the optimal

height of the artificial crowns, and the possibility of hygienic care for the prosthesis.
Surgical placement of implants was focused on the planned orthopedic design.

The operation was performed in accordance with the rules of asepsis and antiseptics

in the conditions of the surgical room (operating room). Before surgery, rinse the mouth
with a 0.05% solution of chlorhexidine or loraben 200ml. the same drug is used to treat
the red border and the skin around the li ps.

Anesthesia was provided by local (conductor, infiltration) anesthesia. The correct

position of the implants it is determined visually or by a surgical template. The operation
was performed in accordance with the Protocol of surgical intervention. The main
objective of orthopedic treatment was recovery chewing function, which required the
creation of optimal contact surfaces. The immediate load is based on production of an
orthopedic structure with a rigid fixation in the next 3 days after surgery.

Metal-plastic prostheses are convenient orthopedic structures that can be easily corrected

and repaired in the oral cavity, so they are used as temporary prostheses. As permanent
structures, after 6 months, metal-ceramic or highly esthetic, compatible with soft
tissues of the oral cavity, zirconium prostheses.

Results and discussion. The patients were examined after a week, 1, 3, 6 months, and

a year. During the observation period, occlusion correction and professional oral hygiene
were performed. After 6 months, mandatory control orthopantomography was performed,
and if necessary, patients were sent for 3D studies. The second stage of prosthetics was


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performed after 6 months with the replacement of temporary structures with metal-
ceramic ones. All patients were registered at the dispensary for dynamic monitoring.

The main criteria for evaluating the state of the dental implant in the bone tissue were

considered:

1) the degree of mobility of the implant;
2) the presence of bone damage;
3) the degree and rate of bone atrophy;
4) condition of the mucous membrane adjacent to the implant;
5) the depth of the pocket between the implant and the mucosa;
6) the quality of the implant's fit to adjacent teeth;
7) the effectiveness of functional load;
8) the ratio of the implant and anatomical structures.
When evaluating the quality criteria for installing dental implants in the postoperative

period (7-14 days after surgery), subjective criteria were taken into account: pain from
minor soreness to severe localized pain.

When evaluating the quality criteria for installing dental implants (3-4 months after

surgery), we performed a subjective assessment of pain; clinically determined the degree
of soft tissue edema, inflammatory phenomena in the area of implant placement, bleeding
of the gingival mucosa during probing, and monitored the mobility of the implant, the
presence of plaque was evaluated. The degree of implant engraftment in the bone tissue
(orthopantomography, dental program, or cone-beam computed tomography) was
determined during the radiological examination.

The following parameters were used for radiological diagnostics: bone tissue is tightly

attached to the implant surface; there is no bone tissue in the implant area for two turns
of thread; horizontal resorption of bone tissue for 1/2 of the implant length; vertical
unilateral resorption of bone tissue.

The results of the postoperative examination (7-14 days) showed that in 55% of

cases, patients experienced minor pain, and in 45% -localized pain. The presence of
soft tissue edema localized in the area of implant placement was observed in 75% of
cases, and in 25% - edema in the area of implant placement and the mucosa of the
alveolar process of the jaw.

In 77% of cases, hyperemia of the mucous membrane in the area of the dentoalveolar

papilla was registered, in 23% - hyperemia of the marginal edge with bleeding during
probing. An objective examination found that in 100% of cases, the mobility of the
implants was not observed.

Examination of the aesthetic condition of the dentition showed that the color and

shape of the artificial crown is not broken. After the operation, in the control period of
3-4 months, there were no pain, no inflammatory phenomena were observed, the
implants were stationary, the bone tissue was tightly attached to the entire surface of the
implant, hygiene the oral cavity is on average satisfactory in terms of ONI-S, and there
are no signs of mucositis or perimplantitis.

In one case of two-stage implantation, osteointegration did not occur, vertical unilateral

bone resorption was registered on the x-ray, pronounced implant mobility, edema and
hyperemia of the gum and mucosal tissues were clinically determined, the implant was
located in soft tissues and was removed.

Evaluation of the quality criteria for installing dental implants after 6 months showed

that during two-stage surgery in the long term, patients had no pain, no inflammatory
phenomena were observed, the implants were motionless, and the bone tissue was tightly


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attached to the entire surface of the implant.

During a single-stage operation, pain and inflammation were also not observed, the

implants were stationary, and the bone tissue was tightly attached to the entire surface
of the implant.

The assessment of the aesthetic state indicated that the color and shape artificial

crowns are not broken, orthopedic supra-constructions with - when stored, still fixed,
occlusion is uniform. The analysis of the state of prostheses in the observation period
from 6 months to 1 year after performing operations, he testified that the frequency of
requests for implant removal as a result of the absence of osteointegration was 1.04% of
cases. The use of basal implantation allows for the installation of implants without
exfoliation of the Muco-periosteal flap (transgingival), as well as directly into the wells
of the removed teeth after deleting them. This method is a minimally invasive method
of surgical treatment, which can significantly reduce the time of the postoperative
period and the patient's disability.

Conclusion. According to the world health organization, there is a steady increase in

the number of people with complete or partial loss of teeth among people of working
age. In addition to impaired chewing and speech functions, adentia leads to changes in
the anatomical and topographic proportions of the face and facial skeleton, progressive
atrophy and osteoporosis of the jaws, atrophy of the masticatory and mimic muscles,
dysfunction of these muscles and temporomandibular joints.

Thus, the treatment of people suffering from adentia is not only an urgent interdisci plinary

task of therapeutic, orthopedic and surgical dentistry, but also a social problem.
Rehabilitation tasks should include: restoring the function of chewing and speech;
prevention of atrophy and osteoporosis of the jaws; maximum possible reduction in the
terms of functional adaptation of patients to dentures; creating conditions for effective
social adaptation patients with complete adentia.

The solution of these problems can be carried out only taking into account the

pathogenesis of morphological and functional changes in the dental system that are the
result of the loss of teeth.

The use of intra-osseous implants for fixing dentures increases chewing activity

compared to traditional removable prosthetics by 19-44%, and also allows you to
almost completely restore the motor and tonic activity of the chewing muscles.

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