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REHABILITATION OF PATIENTS AND MODERN METHODS OF THEIR
RESTORATION USING VARIOUS TYPES OF REMOVABLE PLATE DENTURES
Kuzieva Madina Abdusalimovna
Asian International University
https://doi.org/10.5281/zenodo.14840169
Abstract.
This literature review presents modern views on options for orthopedic
rehabilitation of patients using removable plate dentures, including their technological,
functional, operational, phonetic, chewing features, as well as information about modern
materials for the manufacture of dentures. Based on the literature data, we can conclude that
despite the active development of the technological component of the manufacture of removable
dentures, the basic principles of their design, methods for assessing the effectiveness and comfort
of use have not undergone significant changes. However, there are a significant number of factors,
the influence of which on the success of orthopedic rehabilitation with removable dentures has not
been fully studied. For example, dentists, orthopedists often do not analyze the volume of atrophy
of the bone tissue of the jaws and design the basis of a denture without taking these indicators into
account. Another important issue that remains unexamined is taking into account the design and
architectonics of the resulting prosthesis and its effect on the speed and direction of respiratory
flows in the oral cavity. All this creates a technological window that allows, by complying with the
physiological requirements of the factors described above, to significantly increase the functional
properties of the denture and facilitate the patient’s adaptation to the denture by reducing the
adaptation period.Research conducted in this area of knowledge will allow us to obtain both new
scientific data and develop a number of practical recommendations aimed at improving the quality
of orthopedic rehabilitation using removable dentures made of various materials.
Key words
: plate prostheses; orthopedic removable prosthetics; prosthetics after surgery;
chewing efficiency; acrylic plastics; thermoplastic plastics.
РЕАБИЛИТАЦИЯ ПАЦИЕНТОВ И СОВРЕМЕННЫЕ МЕТОДЫ ИХ
ВОССТАНОВЛЕНИЯ С ИСПОЛЬЗОВАНИЕМ РАЗЛИЧНЫХ ВИДОВ СЪЕМНЫХ
ПЛАСТИНЧАТЫХ ЗУБНЫХ ПРОТЕЗОВ
Аннотация.
В данном обзоре литературы представлены современные взгляды на
варианты ортопедической реабилитации пациентов с использованием съемных
пластинчатых зубных протезов, включая их технологические, функциональные,
эксплуатационные, фонетические, жевательные особенности, а также сведения о
современных материалах для изготовления зубных протезов. На основании данных
литературы можно сделать вывод, что несмотря на активное развитие технологической
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составляющей изготовления съемных зубных протезов, основные принципы их
конструирования, методы оценки эффективности и комфортности использования не
претерпели существенных изменений. Однако существует значительное количество
факторов, влияние которых на успешность ортопедической реабилитации съемными
зубными протезами изучено не в полной мере. Так, например, врачи-стоматологи-
ортопеды зачастую не анализируют объем атрофии костной ткани челюстей и
проектируют базис зубного протеза без учета этих показателей. Другим важным
вопросом, который остается неизученным, является учет конструкции и архитектоники
получаемого протеза и ее влияние на скорость и направление дыхательных потоков в
полости рта. Все это создает технологическое окно, позволяющее за счет соблюдения
физиологических требований факторов, описанных выше, существенно повысить
функциональные свойства зубного протеза и облегчить адаптацию пациента к зубному
протезу за счет сокращения периода адаптации. Исследования, проводимые в этой
области знаний, позволят получить как новые научные данные, так и разработать ряд
практических рекомендаций, направленных на повышение качества ортопедической
реабилитации с использованием съемных зубных протезов из различных материалов.
Ключевые слова:
пластинчатые протезы; ортопедические съемные протезы;
протезирование после хирургических вмешательств; жевательная эффективность;
акриловые пластмассы; термопластичные пластмассы.
The leading place in prevalence among all causes of tooth loss throughout life is occupied
by dental surgical removal of teeth. Tooth extractions are often an inevitable outcome of caries
complications in the form of irreversible periodontal changes with the impossibility of
conservative treatment and, as a consequence, the inability to save individual teeth or sections of
the dentition. Another, no less common cause is chronic periodontitis, which leads to significant
loss of bone tissue of the alveolar process of the jaws, and therefore tooth-preserving manipulations
have either a minor or short-lived effect due to the aggressive course of this disease. In this regard,
to prevent the formation of chronic inflammation and, against this background, persistent
resorption of the bone tissue of the jaws, as well as a significant decrease in the dental health of
patients, chronic periodontitis in the severe stage of its course is a direct indication for tooth
extraction.
Moreover, this nosology tends to be generalized, which leads to multiple tooth extractions.
Various traumatic situations, in particular mechanical injuries and non-gunshot lesions of the
maxillofacial area in peacetime, also often result in the need to remove teeth for preventing
inflammatory complications and relieving pain in patients seeking dental care. In addition,
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traumatic situations themselves lead to tooth loss.
The above reasons for tooth loss significantly increase the population's need for dental
orthopedic treatment. At the same time, a large proportion of patients in need of orthopedic
restoration of dentition defects need to be treated with removable orthopedic structures.
This is due to the fact that the impossibility of using fixed structures supported by teeth or
dental implants lies in the lack of conditions for their fixation due to multiple missing teeth,
terminal defects of the dentition, deformation of the jaws and resorption of their bone tissue.
Currently, there is a wide variety of materials for the manufacture of removable laminar
dentures. One of the first and most widely used technologies for manufacturing plate dentures is
the technology for producing a denture by polymerizing acrylic plastics. These plastics are
chemically acrylates. The advantages of this material are that it has a relatively low percentage of
side substances that irritate the oral mucosa, which will be discussed in more detail below; in
addition, it has good color stability and a high level of chemical adhesion to artificial teeth that
recreate the patient’s dentition.
Along with acrylic materials, there are wide possibilities for using thermoplastic and elastic
polymers for the manufacture of laminar dentures. These materials differ from classic acrylic ones
in that they have the ability to control their shape when exposed to a higher temperature
environment. Such materials include nylons, polyamides, ethylene vinyl acetates, polypropylenes,
polyoxymethylenes. A feature of the polymers from which prostheses are produced using injection
technology is the absence of residual monomer. Other positive qualities of these dentures are
elasticity, high strength, and a more uniform distribution of the chewing load between the tissues
of the denture bed and natural teeth.
The peculiarity of these technologies is that the finished design of the plate prosthesis is
formed in a closed ditch by injection or injection of the material for the base of the prosthesis under
pressure, supplied in special cartridges, through a gating system brought to the place of the wax
base of the prosthesis, plastered directly, into the ditch.
At the same time, in this technology, as well as in the technology of hot polymerization of
plastics, there is a stage of melting wax, which allows you to create the necessary space between
the layers of gypsum for filling it with plastic directly on the working model of the jaw plastered
in a ditch.
For dental orthopedic structures, polymers are currently used, which are macromolecules
with a molecular weight from several thousand to several million, consisting of two or more units
of different composition. The synthesis of polymers occurs using a polymerization reaction, the
essence of this reaction consists in the fact that molecules of low molecular weight substances,
which are monomers by nature, attach to the active centers of polymers, which are high molecular
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weight substances. During this reaction, the above macromolecular units are formed, which differ
in composition from the original monomers and are formed by their sequential “cross-linking”
with the release of low-molecular-weight by-products. Due to the peculiarities of their polymer
structure, plate prostheses have a certain fragility, as a result of which they are dependent on
excessive mechanical loads. Thus, there are common methods for assessing the strength properties
of prostheses, including tensile, bending, impact, torsion, and compression tests.
In addition to the listed parameters, the most important is the assessment of the hardness
or elastic modulus of the prosthesis. It is this parameter that characterizes the wear resistance of
the plate structure, which is especially important under constant mechanical loads that can cause
abrasive wear of the polymer.
Thus, plate prostheses, despite the long history of their existence, still remain the subject
of research. This is due to the fact that modern, constantly improving materials are endowed with
not only the functional properties necessary for the successful use of a prosthesis, but may also
contain some unstudied side effects. In addition to the study of physical, functional and
biocompatible properties, plate prostheses were the subject of an in-depth study of the patient’s
adaptation processes to these structures, including occlusal and phonetic-speech, which is also
used to assess the quality of removable prosthetics.
The maximum functional efficiency of plate prostheses occurs when there is no discomfort
or pain during its use and phonetic and motor adaptation is formed. The time of adaptation to a
removable prosthesis depends on the onset of the phases of partial and complete nervous inhibition.
The presence of painful sensations when using a prosthesis can delay the onset of final
adaptation, while the prosthesis is felt as a foreign div. Based on the classical understanding of
physiological adaptation to a prosthesis, three phases of habituation are considered according to
V. Yu. Kurlyandsky: irritation, partial inhibition, complete inhibition.
A correctly selected occlusion scheme is one of the most important functional, as well as
phonetic and aesthetic components of creating plate prostheses. Analysis of the accuracy of
placement and position of artificial dental arches and individual teeth is an important criterion for
assessing a plate prosthesis, determining the degree of recreation of chewing and speech functions,
which allows for a qualitative assessment of orthopedic treatment.
In addition, it is worth paying attention to the chewing function formed by artificial
dentition. The issue of monitoring chewing efficiency is one of the most important aspects
affecting the quality of treatment, rehabilitation and life of patients with partial or complete loss
of teeth, since especially in the latter case there is a complete decrease in chewing ability due to
morphofunctional changes in all elements of the dental system.
For the chewing process, it is customary to use the concept of "chewing efficiency", which
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is characterized by the degree of grinding of food by the dental system during the physiological
function of chewing. It is this concept that provides a qualitative characteristic, with the help of
which can be used to evaluate the chewing process in conditions of tooth loss or in conditions of
the patient using a plate prosthesis. To control the increase and restoration of the degree of chewing
efficiency using removable plate prostheses, various studies are used, which include static,
functional and graphic methods and tests.
To control the increase and restoration of the degree of chewing efficiency with the help of
removable plate dentures, various studies are used, which include static, functional and graphic
methods and tests. For the most accurate and objective measurement of the degree of chewing
efficiency after complete or partial replacement of dental defects, it is customary to use functional
chewing tests.
They often consist of three main stages: 1 - selection and preparation of a portion of the
test product; 2 - chewing the test portion; 3 - granulometric (sieve) analysis of the crushed material
and processing of the results. Most functional chewing tests are reduced to chewing specially
selected food or a special synthetic material for a certain time or taking into account the amount
and hardness of the test material with subsequent calculation of the chewing efficiency
coefficients.
The most common tests were proposed by I. S. Rubinov, A. N. Ryakhovsky, V. N.
Trezubov. Thus, these studies allow us to obtain a dynamic assessment of the effectiveness of plate
dentures, which directly affects the quality of orthopedic dental treatment of patients with partial
or complete loss of teeth. Static methods for assessing chewing efficiency are more applicable to
assessing the chewing ability of those patients who are indicated for prosthetics using fixed
structures. However, such methods can also be effective in the case of using partial removable
plate dentures combined with fixed orthopedic structures; such methods include the systems
proposed by N. I. Agapov and I. M. Oksman. Graphic methods for assessing chewing efficiency
can be implemented using masticatiography with subsequent interpretation of the study results and
compilation of tables of chewing ability coefficients.
Conclusions
: based on the literature data, it can be concluded that despite the active
development of the technological component of the manufacture of removable dentures, the basic
principles of their design, methods for assessing the effectiveness and comfort of use have not
undergone significant changes. However, there are a significant number of factors, the influence
of which on the success of orthopedic rehabilitation with removable dentures has not been fully
studied. For example, dentists and orthopedists often do not analyze the volume of atrophy of the
jaw bone tissue and design the base of the denture without taking into account these indicators.
Another important issue that remains unconsidered is taking into account the design and
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architectonics of the resulting prosthesis and its effect on the speed and direction of respiratory
flows in the oral cavity. All this creates a technological window that allows, due to compliance
with the physiological requirements of the above factors, to significantly improve the functional
properties of the denture, facilitate the patient's addiction to the prosthesis by reducing the
adaptation period. Research conducted in this area of knowledge will allow us to obtain both new
scientific data and develop a number of practical recommendations aimed at improving the quality
of orthopedic rehabilitation using removable dentures made of various materials.
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