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MODERN ASPECTS OF CHOICE OF MATERIAL FOR ORTHOPEDIC TREATMENT
OF PATIENTS IN NEED OF DENTAL PROSTHETICS
Kuzieva Madina Abdusalimovna
Asian International University
Email:
kuzievamadina84@gmail.com
https://doi.org/10.5281/zenodo.14633193
Abstract. The most common structural material in removable prosthetics is acrylic plastic.
However, it has a number of disadvantages:
1) residual monomer, which increases to 8% when the polymerization mode is violated,
which causes local and general allergic reactions;
2) microporosity of acrylic plastic bases;
3) low strength of acrylic plastics. As an alternative to removable dentures made of acrylic
plastics, new technologies for the manufacture of removable orthopedic structures from
thermoplastic materials have appeared on the dental market. Their chemical structure is devoid
of the main negative properties inherent in acrylic plastics, and their strength indicators are many
times better.
Thermoplastic materials used in dentistry are of 5 types:
1. polyoxymethylene
2. nylon
3. ethylene-vinyl acetate
4. acrylic
5. monomer-free
Thus, the range of thermoplastic base masses, as an alternative method of prosthetics for
people with intolerance to acrylic plastics, is quite large, which allows choosing the type of base
material depending on the specific clinical situation.
Key words: allergic history, removable dentures, acrylic plastics, thermoplastic materials.
СОВРЕМЕННЫЕ АСПЕКТЫ ВЫБОРА МАТЕРИАЛА ДЛЯ ОРТОПЕДИЧЕСКОГО
ЛЕЧЕНИЯ ПАЦИЕНТОВ, НУЖДАЮЩИХСЯ В ЗУБНОМ ПРОТЕЗИРОВАНИИ
Аннотация. Наиболее распространенным конструкционным материалом в
съемном протезировании является акриловая пластмасса. Однако она имеет ряд
недостатков:
1) остаточный мономер, который при нарушении режима полимеризации
увеличивается до 8%, что вызывает местные и общие аллергические реакции;
2) микропористость базисов акриловых пластмасс;
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3) низкая прочность акриловых пластмасс. В качестве альтернативы съемным
зубным протезам из акриловых пластмасс на стоматологическом рынке появились новые
технологии изготовления съемных ортопедических конструкций из термопластичных
материалов. Их химическая структура лишена основных отрицательных свойств,
присущих акриловым пластмассам, а прочностные показатели во много раз лучше.
Термопластичные материалы, используемые в стоматологии, бывают 5 видов:
1. полиоксиметилен
2. нейлон
3. этиленвинилацетат
4. акриловые
5. безмономерные
Таким образом, ассортимент термопластичных базисных масс, как
альтернативного метода протезирования для людей с непереносимостью акриловых
пластмасс, достаточно велик, что позволяет выбирать вид базисного материала в
зависимости от конкретной клинической ситуации.
Ключевые слова: аллергический анамнез, съемные зубные протезы, акриловые
пластмассы, термопластичные материалы.
Orthopedic treatment of patients with complete or partial absence of teeth using removable
dentures occupies a leading place in the clinic of orthopedic dentistry. However, it is extremely
difficult in the presence of diseases of the oral mucosa due to intolerance to the materials used to
make the bases of removable dentures. One of the reasons for this phenomenon in recent years is
the increase in the number of patients with intolerance to drugs or with a history of allergic
diseases. Due to insufficient information, lack of clear recommendations and practical skills,
dentists avoid patients with a burdened allergy history. This is due to the danger of the negative
impact of structural materials on the mucous membrane of the prosthetic field and on the patient's
div as a whole. Therefore, the choice of structural material is made based not only on its physical
and chemical characteristics, but also on the biological impact on the surrounding tissues of the
oral cavity. The most common construction material in orthopedic dentistry is acrylic plastic.
However, it can cause allergic reactions, manifested in the form of inflammation of the oral
mucosa. The main etiological factor in the development of allergy to acrylate is considered to be
the residual monomer contained in the plastic in the amount of 0.2%, which increases to 8% when
the polymerization mode is violated. Plastics used in dentistry for orthopedic treatment are high-
polymer organic compounds. They do not have a protein nature and therefore cannot cause
allergies by themselves.
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The monomer, methacrylic acid ester, is a low-molecular compound, i.e. it is a potential
hapten, and when combined with div tissue proteins, it turns into an antigen. Its direct toxic effect
on the cells of the oral mucosa, including mast cells and basophils, leads to non-specific release of
histamine, which is capable of modulating the allergic response to the effects of causative
allergens, thereby causing allergic contact dermatitis. It has been established that the monomer
reduces the titer of lysozyme in saliva. The residual monomer washed out of the dentures, even in
small quantities, affects the functional state of neutrophils in the oral cavity and suppresses their
activity. According to some authors, the monomer is a protoplasmic poison, extremely active when
in contact with tissues and capable of producing an irritating and toxic effect on the entire div.
A significant disadvantage of acrylic plastic dentures is the microporosity of the bases,
which inevitably occurs for technological reasons, due to shrinkage occurring during
polymerization. The third disadvantage is the low strength of acrylic plastics to variable loads
during chewing. Nevertheless, acrylic plastics in many clinics are still often the only material for
the manufacture of removable denture bases, as they are inexpensive, have a simple manufacturing
technology, and do not require expensive equipment. Recently, new technologies for the
manufacture of removable orthopedic structures from thermoplastic materials (thermoplastics)
have appeared on the domestic dental market, which have been used in world dentistry for over 20
years. The general characteristic of thermoplastics is defined by the formulation "material that is
plastic when heated", i.e. the materials are packed in a heated state without the use of monomers.
Thermoplastics are devoid of the main negative properties of acrylic plastics in their
chemical structure, and their strength indicators are many times better. When processing
thermoplastics into products, a highly toxic monomer is not used. Thermoplastics, after heating at
a temperature of 160 to 200 °C, acquire a viscous flow state and are introduced into a pre-closed
form through a casting channel under pressure up to 50 atm. Thus, thermoplastics have a number
of advantages: - unpleasant sensations in the oral cavity that patients experience during treatment
with orthopedic structures made of different alloys can be eliminated by using thermoplastic
dentures - to improve the aesthetic properties of removable dentures, instead of metal clasps that
can lead to cracks and fractures of the base of removable dentures, thermoplastic clasps are used
to match the color of the supporting teeth - thermoplastic dentures do not have a toxic or allergic
effect, so they are indicated for patients with an allergic status, diseases of the immune, nervous,
endocrine systems, gastrointestinal tract - dentures, made using thermoplastics, have sufficient
elasticity, precise fit, good fixation and are aesthetic - the dentures do not contain micropores and
practically do not cause imbalance of the microflora in the oral cavity - in terms of mechanical
strength to variable loads in the oral cavity, they are many times stronger than dentures made of
acrylic plastics - due to their physical and chemical characteristics, thermoplastics expand the
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doctor's capabilities in treating patients with partial absence of teeth, bruxism, diseases of the
temporomandibular joint, can be used in the manufacture of occlusal splints, sports mouthguards,
immediate dentures and in the complex treatment of periodontal diseases. The materials used in
dentistry do not contain chemical additives, which often cause reactions in people prone to allergic
diseases. At room temperature, these polymers are practically non-toxic. They are resistant to the
action of highly aggressive model environments, due to which they are widely used in medicine.
In toxic experiments, the polymer was found to have no toxic properties. The use of
thermoplastics based on polyformaldehyde allows for the production of many types of orthopedic
structures. The strength of the prostheses is comparable to that of metal ones. Due to elasticity, a
more precise and tight fit to the teeth is ensured, and, accordingly, a more reliable fixation of the
prosthesis. Polyoxymethylene can be used to manufacture one-sided removable dentures with a
terminal defect of the dentition on a telescopic fixation system; in case of intolerance to the metal
base of the clasp denture, and for aesthetic purposes, the frame with clasps can be cast from
thermoplastic based on polyoxymethylene in the treatment of periodontal diseases and with
included defects of the dentition, splinting of teeth and restoration of the dentition with a
removable denture with a base and a multi-link clasp made of thermoplastic is rational; in
implantology and with a long post-surgical healing period, polyoxymethylene is used to
manufacture temporary orthopedic structures. Thermoplastics made of nylon. Polyamides are
heterochain polymers containing macromolecules in the main chain - amide groups. However,
migration of toxic caprolactam and hexamethylenediamine from materials is observed.
Polyamides change the organoleptic properties of model media in contact with them;
monomers and oligomers are found in extracts. In medicine and dentistry, only non-toxic aliphatic
polyamides (Polyamide 12) are used to produce synthetic fibers that are durable, abrasion-
resistant, highly flexible and plastic. Currently, materials for the manufacture of nylon dentures
are manufactured in the USA (Valplast, Flexite), Israel (Flexy-Nylon), San Marino (T.S.M. Acetal
Dental), Singapore (Vertex ThermoSens), Germany (Flexiplast). Nylon is used to manufacture:
partial removable dentures with alveolar denture clasps; combined dentures; removable dentures
with a base and a splinting multi-link clasp; anti-snoring device. Dentures made of polypropylene.
In its main characteristics, polypropylene is close to nylon, but is inferior to it in some
physical and chemical characteristics. However, it is many times stronger than acrylic plastics, has
a high accuracy of fit. Polypropylene is a colorless polymer (contains methyl groups) without a
characteristic odor and taste, a soft, rubber-like material, softens at high temperatures. Dentures
are biologically neutral in relation to div tissues and are stable in the oral cavity. Биологическая
нейтральность обусловлена отсутствием мономеров, ингибиторов, катализаторов и других
реактивных включений. Currently, polypropylene, USA ("ProFlex Clear Wire" Dental
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Resources), Ukraine ("NDlex" New Dental), injection molding thermoplastic brand developed by
Professor E.Ya. Vares "Lipol" (Ukraine) is used to manufacture orthopedic structures as a cheap
alternative to nylon. Intraoral devices made of ethylene vinyl acetate. Amorphous transparent
colorless polymer without smell and taste, its monomer and polymer are non-toxic. It has a high
degree of elasticity, has very little water absorption, excellent resistance to acids. Sanitary and
chemical studies have revealed migration of small amounts of oxidizable and brominated
compounds from the material. Thermoplastics based on ethylene vinyl acetate polymers are
produced in Italy (Flexidy), in San Marino (Corlex Orthodontic), etc. With the advent of
thermoplastic materials from ethylene vinyl acetate in dentistry, it became possible to manufacture
individual positioners, dental protectors for sports, and individual mouthpieces for diving in dental
laboratories. Dentures based on monomer-free acrylic plastics. The main characteristics of these
materials are the absence of free monomer, sufficiently high strength, and aesthetics, which allows
for the production of particularly thin removable dentures. They have a wide range of colors.
Complete and partial plate dentures, as well as saddles for clasp dentures, are made from
monomer-free acrylic plastics. Currently, monomer-free materials based on acrylic plastics are
produced in the USA (Flexite M.P.), Israel (Acre-Free), San Marino (Thermo Free), Italy
(Fusicril), and Germany (Polyan). Thus, the range of modern base masses, as an alternative method
of prosthetics, is quite large. However, today the issue of studying the mechanisms of
biodegradation and metabolism of polymers during a long stay in the div, as well as the
development of "criteria of biocompatibility" of polymers remains relevant. Which in the future
will allow 44 patients with intolerance to acrylic plastics and the presence of signs of diseases of
the oral mucosa to reduce the content of residual monomer, by using modern base materials,
thereby preventing the occurrence of intolerance to acrylic plastics, which significantly increases
the effectiveness of orthopedic treatment of patients with aggravated allergological anamnesis.
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