Traditional medicine

Orthodontics (maxillofacial orthopedics). Injuries to the maxillofacial region Typical orthodontic problems: epidemiology of occlusal anomalies

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Introduction

Chapter 1 Reduction devices

1.2 Shura apparatus

1.3 Katz apparatus

1.4 Oxman apparatus

1.5 Brun's apparatus

1.6 Kappa-rod apparatus of A. L. Grozovsky

Chapter 2. Fixation devices

2.1 Sheena Vankiewicz

2.2 Weber bus

2.3 Apparatus of A.I. Betelman

2.4 Plate tire by A. A. Limberg

2.5 Soldered busbar on rings according to A. A. Limberg

Chapter 3. Forming apparatus

Conclusion

References

Introduction

Maxillofacial orthopedics is a branch of orthopedic dentistry that studies the prevention, diagnosis and orthopedic treatment of damage to the maxillofacial area that occurs after trauma, wounds or surgical interventions for inflammatory processes and neoplasms.

In case of serious injuries (fractures) of the jaws, hardware treatment is necessary, which mainly includes both fixing maxillofacial devices and reduction (correction) devices. Fixing devices are used to immobilize undisplaced fragments and to fix corrected displaced fragments in jaw fractures. Basically, fixing devices include splints.

Reducing maxillofacial devices, also called corrective devices, are intended for reduction (reposition) of fractures with displacement of fragments. Reduction of jaw fragments using reduction devices is called long-term reduction

There are 2 types of device manufacturing: Clinical and laboratory.

In my work I will describe methods for manufacturing maxillofacial appliances in a dental laboratory.

Chapter 1.Repairingdevices

1.1 Mouth guards

jaw reduction fracture

For fractures of the lower jaw with displacement and stiffness of the fragments, reduction (regulating) devices with traction of fragments using wire splints and rubber rings or elastic wire splints and devices with screws are indicated. Splints are used if there are teeth on both fragments. Composite splints are bent separately for each fragment along the outer surface of teeth made of elastic stainless steel 1.2-1.5 mm thick with hooks on which rubber rings are placed for traction. Splints are secured to the teeth using crowns, rings or wire ligatures. After the fragments are installed in the correct position, the regulating splints are replaced with fixing splints. It is advisable to use reduction devices, which, after moving the fragments, can be used as splinting devices. Such devices include the Kurlyandsky apparatus. It consists of a mouth guard. Double tubes are soldered on the buccal surface of the aligners, into which rods of the appropriate cross-section are inserted. To manufacture the device, impressions are taken from the teeth of each fragment and, using the resulting models, stainless steel mouth guards are prepared for these groups of teeth. After fitting the manufactured mouth guards in the mouth, they are combined with a model of the upper jaw along the occlusal surfaces and a plaster block, that is, a model, is obtained. The aligners are placed on the occlusal surface of the opposite jaw to determine the direction of displacement of the fragments and reliably fix them after reposition. Double tubes are soldered horizontally to the mouth guards from the vestibule of the mouth and rods are attached to them. Then the tubes are sawed between the trays and each tray is cemented onto the teeth separately. After immediate reposition of jaw fragments or traction with rubber rings, their correct position is secured by inserting rods into tubes soldered to the aligners. For reposition, 1-2 spring arches are used, which are inserted into tubes, or screw devices. Arcs in the form of a loop, reminiscent of a Coffin spring, are bent according to block models and, after fixing the aligners, they are inserted into the tubes. Screw devices consist of a screw mounted into a protruding plate that is inserted into the tubes of one of the aligners. A rigid plate bent in the direction of displacement of the fragments with a stop pad for the screw is inserted into the tubes of the second mouth guard.

1.2 Shura apparatus

The production of the Shura apparatus begins with taking an impression from the supporting lateral teeth. Abutment crowns are made in the usual stamped manner without preparing teeth and are fitted into the oral cavity. Together with the crowns, an impression is taken from the lower jaw, and a plaster working model is cast on which the supporting crowns are located. A rod 2-2.5 mm thick and 40-45 mm long is prepared, ½ of this rod is flattened and accordingly a flat tube is prepared, which is soldered to the supporting crowns on the buccal side. On the lingual side, the supporting crowns are soldered with 1 mm thick wire to strengthen the structure.

After checking the supporting part of the apparatus in the oral cavity, the flattened part of the rod is inserted into the tube, and the round protruding part is bent so that its free end, with the mouth closed and the fragment displaced, is located along the buccal cusps of the antagonist teeth of the upper jaw. In the laboratory, an inclined plane 10-15 mm high and 20-25 mm long is soldered to the round end of the rod along the flattened end of the rod located in the tube.

On the working model, the inclined plane is set in relation to the antagonist teeth at an angle of 10-15 degrees. During treatment, the inclined plane is brought closer to the supporting teeth by compressing the curved arch. Periodically (every 1-2 days), by bringing the inclined plane closer to its supporting part, the position of the fragment is corrected and the patient is taught to place the fragment of the lower jaw in an increasingly correct position when closing the mouth. When the inclined plane comes close to its support, the fragment of the lower jaw will be installed in the correct position. After 2-6 months of using this device, even in the presence of a large bone defect, the patient can freely, without an inclined plane, place the fragment of the lower jaw in the correct position. Thus, the Schur apparatus is distinguished by its good reduction effect, small size and ease of use and manufacture.

More effective devices that are used for displacement of fragments to the midline include the Katz, Brun and Oksman devices.

1.3 Katz apparatus

The Katz reduction apparatus consists of crowns or rings, a tube and levers. In the usual way, orthodontic crowns or rings are stamped onto the chewing teeth; a tube of oval or quadrangular cross-section, 3-3.5 mm in diameter and 20-30 mm in length, is soldered to the vestibular side. The ends of the wire are inserted into the tubes accordingly. The length of the stainless steel wire is 15 cm and the thickness is 2-2.5 mm. The opposite ends of the wire, bending around the corners of the mouth, form a bend in the opposite direction and come into contact with each other. Cuts are made at the touching ends of the wire. To reposition the fragments, the ends of the levers are separated and fixed with a ligature wire at the site of the cuts. The fragments are moved apart slowly and gradually (over several days or weeks) until they are aligned in the correct position. Thanks to the elasticity of the wire, movement of the fragments is achieved.

With the help of the A. Ya. Katz apparatus, it is possible to use fragments in the vertical and sagittal directions, rotate the fragments around the longitudinal axis, as well as reliable fixation of the fragments after their comparison.

1.4 Apparatus Oxmana

I. M. Oksman slightly modified the repositioning apparatus of A. Ya. Katz. He soldered two (instead of one) parallel tubes on each side to the supporting part of the apparatus, and split the rear ends of the intraoral rods into two parts, which fit into both tubes on each side. This modification of the device prevents fragments from rotating around a horizontal axis.

1.5 Brun's apparatus

Brun's apparatus consists of wire and crowns. Some ends of the wire are tied to the teeth or attached to crowns (rings) placed on the lateral teeth of the fragments. The opposite ends of the wire, bent in the form of levers, intersect and stand outside the oral cavity. Rubber rings are pulled onto the ends of the wire, bent in the form of levers. The rubber rings, contracting, push the fragments apart. The disadvantages of the device include the fact that during its operation, the rear parts of the fragments sometimes shift towards the oral cavity or rotate around the longitudinal axis.

1.6 Kappa-rod apparatus of A. L. Grozovsky

It consists of metal guards for the teeth of fragments of the lower jaw, humeral processes with holes for screws, two screws connected by a soldered plate. The device is used for the treatment of fractures of the lower jaw with a significant bone defect and a small number of teeth in the fragments. Manufacturing. Partial impressions are taken from fragments of the lower jaw, models are cast and mouthguards (soldered crowns, rings) are stamped. The aligners are tried on the supporting teeth and impressions are taken from fragments of the damaged lower jaw and intact upper jaw. The models are cast, aligned in the correct position and plastered into the occluder. Two tubes are soldered to the tray of the small fragment (vestibular and oral), and one tube is soldered to the tray of the large fragment (vestibular). An expansion screw, rods with holes, nuts and screws are made. The trays are secured with cement on the supporting teeth, a long lever with a platform is inserted into the oral tube of the small fragment, and a short lever with a nut for the spacer screw is inserted into the vestibular tube of the larger fragment. To fix the achieved position, other rods with matching holes for screws and nuts are inserted into the vestibular tubes.

Chapter 2Fixing devices

Maxillofacial fixation devices include splints that fix jaw fragments in the correct position. Such devices manufactured by laboratory methods include: Vankevich splint, Stepanov splint, Weber splint, etc.

2.1 Sheena Vankiewicz

For fractures of the lower jaw with a large number of missing teeth, treatment is carried out with a splint by M. M. Vankevich. It is a dentogingival splint with two planes that extend from the palatal surface of the splint to the lingual surface of the lower molars or the edentulous alveolar ridge.

When opening the mouth, the planes must maintain contact with the edentulous alveolar processes or teeth. After modeling the splint, the technician attaches a double-folded plate of base wax 2.5-3.0 cm high to it in the area of the chewing teeth, then replaces the wax with plastic and carries out polymerization. After replacing the wax with plastic, the doctor checks it in the oral cavity, adjusts the surfaces of the supporting planes with quick-hardening plastic or stens (thermoplastic impression mass), and then replaces it with plastic. This splint can be used in mandibular bone grafting to retain bone grafts.

The Vankevich splint was modified by A.I. Stepanov, who replaced the palatal plate with an arch (clasp).

2.2 Weber tire

The splint is used to fix fragments of the lower jaw after their comparison and for post-treatment of jaw fractures. It covers the remaining dentition and gum on both fragments, leaving the occlusal surfaces and cutting edges of the teeth exposed.

Manufacturing. Casts are taken from the damaged and opposite jaws, models are obtained, they are compiled in the position of central occlusion and plastered in an occluder. A frame is made of stainless wire with a diameter of 0.8 mm in the shape of a closed arc. The wire should be 0.7-0.8 mm away from the teeth and alveolar part (process) and held in this position by transverse wires passed in the area of interdental contacts. Their cross sections with longitudinal wires are soldered. When using a splint to treat fractures of the upper jaw, oval-shaped tubes are soldered in the lateral sections for the introduction of extraoral rods. Then the splint is modeled from wax, cast into a ditch using the direct method, and the wax is replaced with plastic, after which it is processed.

2.3 ApparatusA.I.Betelman

It consists of several crowns (rings) welded together, covering the teeth on jaw fragments and antagonist teeth. On the vestibular surface of the crowns of both jaws, tetrahedral tubes are soldered for inserting a steel bracket. The device is used when there is a defect in the lower jaw in the chin area with 2-3 teeth on each fragment. Manufacturing. Impressions are taken from jaw fragments to make crowns. Crowns are fitted to the teeth, impressions are taken from jaw fragments and from the upper jaw. Models are cast, compared in the position of central occlusion, and cast into the occluder. The crowns are soldered together and horizontal tubes of quadrangular or oval shape are soldered to the vestibular surface of the crowns of the upper and lower jaws. Two U-shaped brackets are made, 2-3 mm thick according to the shape of the bushings. The apparatus is placed on the jaw, the fragments are aligned in the correct position and secured by inserting a staple.

2.4 Plate busA. A. Limberg

The splint is used to treat fractures of toothless jaws.

Manufacturing. Impressions are taken of each toothless fragment of the lower jaw and intact toothless upper jaw. Individual spoons are made for each fragment of the lower jaw and the upper jaw. Individual spoons are fitted, solid occlusal ridges made of stencil are attached to them, and the centric relation is determined and fixed using a chin sling. In this state, individual trays of the lower jaw are fastened with quick-hardening plastic and removed from the oral cavity. Plaster is placed in an occluder, the stencil rollers are removed and replaced with posts made of quick-hardening plastic. Splints and a chin sling are applied to the jaws.

2.5 Soldered busbar on ringsA. A. Limberg

The splint is used for the treatment of single linear fractures of the jaws in the presence of at least three supporting teeth on each fragment. Manufacturing. Based on the casts, crowns (rings) are made for the supporting teeth, checked in the oral cavity, casts are taken from the fragments on the teeth of which the crowns are located, and a cast is taken from the opposite jaw. In the laboratory, models are cast, fragments with crowns are set in the correct relationship with the antagonist teeth and plastered into an occluder. Wires are soldered to the crowns vestibularly and orally; if the splint is used for intermaxillary traction, then hooks curved towards the gum are soldered to the wire. The soldered splint on the lower jaw can be supplemented with an inclined plane in the form of a stainless steel plate on the vestibular side of the intact half of the jaw. After finishing, grinding and polishing, the splint is secured to the supporting teeth with cement.

Chapter 3Forming apparatus

To impart immobility to the graft during its engraftment and to reproduce the shape of the restored part, various shaping orthopedic devices and prostheses are used. Forming devices consist of fixing, replacing and forming elements in the form of thickened bases against the areas to be formed. They can be removable and combined with a combination of non-removable parts in the form of crowns and removable forming elements mounted on them.

When plasticizing the transitional fold and vestibule of the oral cavity, for successful healing of a skin flap (0.2-0.3 mm thick), a rigid thermoplastic insert is used, layered on the edge of the splint or prosthesis facing the wound.

For this purpose, a simple aluminum wire splint can be used, curved along the dental arch with loops for layering the thermoplastic mass. In case of partial loss of teeth and prosthetics with a removable prosthesis design, a zigzag wire is soldered to the vestibular edge opposite the surgical field, onto which a thermoplastic mass with a thin skin flap is layered. If the dentition opposite the surgical field is intact, then orthodontic crowns are made for 3-4 teeth, a horizontal tube is soldered vestibularly, into which a 3-shaped bent wire is inserted for layering thermoplastic mass and a skin flap.

When plastic surgery of the lips, cheeks, and chin, dentoalveolar prostheses are used as forming devices, replacing defects in the dentition and bone tissue, splinting, supporting and forming the prosthetic bed.

Conclusion

The further fixation of the apparatus for splinting wandering fragments and the further restoration of the jaw due to their fusion in the correct connection with each other depend on the timely and correct reposition and fixation of jaw fragments.

A well-made device should not cause severe pain to the wearer.

Successful treatment of a patient depends not only on the doctor but also on a dental technician who knows his job.

References

Dental prosthetic equipment M. M. Rasulov, T. I. Ibragimov, I. Yu. Lebedenko

Orthopedic dentistry

V. S. Pogodin, V. A. Ponamareva Guide for dental technicians

http://www.docme.ru/doc/96621/ortopedicheskaya-stomatologiya.-abolmasov-n.g.---abolmasov-n...

E. N. Zhulev, S. D. Arutyunov, I. Yu. Lebedenko Maxillofacial orthopedic dentistry

Posted on Allbest.ru

...

Manufacturing of direct replacement prostheses.

The production of these types of prostheses is preceded by an imitation of the operation on plaster models in accordance with the plan outlined by the surgeon. Based on the casts obtained from the jaws, models are cast, the central relationship of the jaws is determined and the models are fixed in the occluder. A partial base is made for the fragment of the jaw that should remain after the operation.

Slide 5

In this case, it is advisable to use support-retaining clasps on all remaining teeth (the use of conventional retaining clasps is allowed). The boundaries of the partial base correspond to the boundaries of a conventional removable denture. If partial resection of the lower jaw in the area of the chin or upper jaw in the group of anterior teeth is expected, a complete denture base is made.

Slide 6

In these cases, the border of the base completely corresponds to the borders of the removable denture. In the area of the teeth that will be removed along with part of the jaw, the border runs along the base line of the prosthesis, as in the case of a partial dentition defect. The prepared partial base is placed in the oral cavity and an impression is taken along with it. This stage is necessary in order to avoid fitting the prosthesis when applying it to the jaw fragment immediately after surgery. The dental technician, having received the impression, places a partial base in it, casts a model with it and fixes it in the occluder.

Slide 7

The next stage is preparing the model for the manufacture of resection and forming parts of the prosthesis. The technician, together with the surgeon or orthopedist, pencils the resection boundaries onto the plaster model and determines the boundaries of the replacement part of the prosthesis. The reference point for the zone of plaster removal of the lower jaw model is the boundaries of the transitional fold on the vestibular and lingual sides, on the upper jaw - the boundary of the transitional fold on the vestibular side and the boundary of the transition of the alveolar process into the hard and soft palate. Thus, first the teeth are cut off, and then the entire alveolar process or the alveolar part of the lower jaw is cut layer by layer (Fig. 1, 2)

Slide 8

Rice. 1. The sequence of manufacturing a direct resection prosthesis replacing a defect in the lower jaw.

Slide 9

Slide 10

Slide 11

Slide 12

Rice. 2. The sequence of manufacturing a direct resection prosthesis replacing the defect of the upper jaw.

Slide 13

Slide 14

Slide 15

Considering that when resection of a part of the jaw during the operation, an additional 1-2 teeth are removed from the side of the resulting defect, then in this area from the alveolar process the technician cuts off only the teeth (indicated by the doctor) and shapes this area, rounding it, simulating a toothless alveolar process. The area where the plaster is cut is smoothed using sandpaper or discs.

Slide 16

The fixing part of the prosthesis is removed from the model and the edge facing the replacement part is processed in the same way as when repairing a denture. The fixing part is again placed on the model, the wax plate is pressed along the marked boundaries, the wax roller replacing the alveolar process is strengthened on it, the teeth are positioned and the forming and replacing parts of the prosthesis are modeled.

Slide 17

The volume of this part of the prosthesis is slightly larger than the alveolar process, but the vestibular border should pass along the level of the transitional fold. The further process does not differ from the technology for manufacturing a removable denture. When making a prosthesis during resection of half of the lower jaw, an inclined plane must be modeled on the fixing part according to the rules specified in the description of the manufacture of a periodontal splint for jaw fractures.

View all slides

Reduction of jaw fragments with reduction devices is called long-term reduction. There are 2 types of device manufacturing: Clinical and laboratory.1 Mouth guards For fractures of the lower jaw with displacement and stiffness of the fragments, reduction adjustment devices with traction of fragments using wire splints and rubber rings or elastic wire splints and fixtures with screws. After fitting the manufactured mouth guards in the mouth, they are assembled with a model of the upper jaw along the occlusal surfaces and a plaster block is obtained...

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Introduction………………………………………………………………………………….….3 pp.

Chapter 1 Reduction devices…......………………………………………4p.

Kappa…………………….……………………………...…….………4p.
1. Shura apparatus..………..………………………………….…...……...5pp.
2. Katz apparatus………...………………...……….………………....7p.
3. Oksman's apparatus …………………………………………...……......8pp.
4. Brun's apparatus………………………………………………………...8 p.
5. Kappa-rod apparatus of A. L. Grozovsky…………………...…9pp.

Chapter 2. Fixing devices………..……………………………..10p.

2.1. Shina Vankevich.………..…….………………..………………….....10p.

2.2. Weber tire….………………….………………….…………………....11p.

2.3. Apparatus of A. I. Betelman…………………………………….…..12p.

……………………………..13pp.

2.5. Soldered busbar on rings according to A. A. Limberg……………………...13pp.

Chapter 3. Forming devices….……………………………..…...15pp.

Conclusion……………………………………………………...………16p.

References……………………………………………………...17pp.

Introduction.

There are 2 types of device manufacturing: Clinical and laboratory.

In my work I will describe methods for manufacturing maxillofacial appliances in a dental laboratory.

Chapter 1. Reduction Devices

1.1 Mouth guards

For fractures of the lower jaw with displacement and stiffness of the fragments, reduction (regulating) devices with traction of fragments using wire splints and rubber rings or elastic wire splints and devices with screws are indicated. Splints are used if there are teeth on both fragments. Composite splints are bent separately for each fragment along the outer surface of teeth made of elastic stainless steel 1.2 x 1.5 mm thick with hooks on which rubber rings are placed for traction. Splints are secured to the teeth using crowns, rings or wire ligatures. After the fragments are installed in the correct position, the regulating splints are replaced with fixing splints. It is advisable to use reduction devices, which, after moving the fragments, can be used as splinting devices. Such devices include the Kurlyandsky apparatus. It consists of a mouth guard. Double tubes are soldered on the buccal surface of the aligners, into which rods of the appropriate cross-section are inserted. To manufacture the device, impressions are taken from the teeth of each fragment and, using the resulting models, stainless steel mouth guards are prepared for these groups of teeth. After fitting the manufactured mouth guards in the mouth, they are combined with a model of the upper jaw along the occlusal surfaces and a plaster block, that is, a model, is obtained. The aligners are placed on the occlusal surface of the opposite jaw to determine the direction of displacement of the fragments and reliably fix them after reposition. Double tubes are soldered horizontally to the mouth guards from the vestibule of the mouth and rods are attached to them. Then the tubes are sawed between the trays and each tray is cemented onto the teeth separately. After immediate reposition of jaw fragments or traction with rubber rings, their correct position is secured by inserting rods into tubes soldered to the aligners. For reposition, 1-2 spring arches are used, which are inserted into tubes, or screw devices. Arcs in the form of a loop, reminiscent of a Coffin spring, are bent according to block models and, after fixing the aligners, they are inserted into the tubes. Screw devices consist of a screw mounted into a protruding plate that is inserted into the tubes of one of the aligners. A rigid plate bent in the direction of displacement of the fragments with a stop pad for the screw is inserted into the tubes of the second mouth guard.

1.2 Shura apparatus.

More effective devices that are used for displacement of fragments to the midline include the Katz, Brun and Oksman devices.

1.3 Katz apparatus.

The Katz reduction apparatus consists of crowns or rings, a tube and levers. In the usual way, orthodontic crowns or rings are stamped onto the chewing teeth; a tube of oval or quadrangular cross-section, 3-3.5 mm in diameter and 20-30 mm in length, is soldered to the vestibular side.The appropriate shape is inserted into the tubesends of the wire. The length of the stainless steel wire is 15 cm and the thickness is 2-2.5 mm. The opposite ends of the wire, bending around the corners of the mouth, form a bend in the opposite direction and come into contact with each other. Cuts are made at the touching ends of the wire. To reposition the fragments, the ends of the levers are separated and fixed with a ligature wire at the site of the cuts.The fragments are moved apart slowly and gradually (over several days or weeks) until they are aligned in the correct position. Thanks to the elasticity of the wire, movement of the fragments is achieved.

1.4 Oxman apparatus

1.5 Brun's apparatus

1.6 Kappa-rod apparatus of A. L. Grozovsky

Chapter 2 Fixing devices.

2.1 Sheena Vankiewicz

Impressions are taken from the upper and lower jaws using alginate mass, plaster models are cast, the central relationship of the jaws is determined, and the plaster working models are fixed in the articulator. Then the frame is bent and a wax splint is modeled. The height of the planes is determined by the degree of opening of the mouth. When opening the mouth, the planes must maintain contact with the edentulous alveolar processes or teeth. After modeling the tire,the technician attaches to it in the area of the chewing teeth a double-folded plate of base wax 2.5-3.0 cm high, then the wax is replaced with plastic,. carries out polymerization. After replacing the wax with plastic, the doctor checks it in the oral cavity, adjusts the surfaces of the supporting planes with quick-hardening plastic or stens (thermoplastic impression mass), and then replaces it with plastic. This splint can be used in mandibular bone grafting to retain bone grafts. The Vankevich splint was modified by A.I. Stepanov, who replaced the palatal plate with an arch (clasp).

2.2 Weber bus.

Manufacturing. Casts are taken from the damaged and opposite jaws, models are obtained, they are compiled in the position of central occlusion and plastered in an occluder. A frame is made of stainless wire with a diameter of 0.8 mm in the shape of a closed arc. The wire should be 0.7-0.8 mm away from the teeth and alveolar part (process) and held in this position by transverse wires passed in the area of interdental contacts. Their cross sections with longitudinal wires are soldered. When using a splint to treat fractures of the upper jaw, oval-shaped tubes are soldered in the lateral sections for the introduction of extraoral rods. Then the splint is modeled from wax, cast into a ditch using the direct method, and the wax is replaced with plastic., after which it is processed.

2.3 Apparatus of A.I. Betelman

Manufacturing. Impressions are taken from jaw fragments to make crowns. Crowns are fitted to the teeth, impressions are taken from jaw fragments and from the upper jaw. Models are cast, compared in the position of central occlusion, and cast into the occluder. The crowns are soldered together and horizontal tubes of quadrangular or oval shape are soldered to the vestibular surface of the crowns of the upper and lower jaws. Two U-shaped brackets are made, 2 x 3 mm thick, according to the shape of the bushings. The apparatus is placed on the jaw, the fragments are aligned in the correct position and secured by inserting a staple.

2.4 Plate tire by A. A. Limberg

The splint is used to treat fractures of toothless jaws.

2.5 Soldered busbar on rings according to A. A. Limberg.

Chapter 3 Forming apparatuses.

Forming devices. After mechanical, thermal, chemical and other damage to the soft tissues of the oral cavity and perioral area, defects and scar changes are formed. To eliminate them after the wound has healed, plastic surgery is performed using tissue from neighboring distant areas of the body. To impart immobility to the graft during its engraftment and to reproduce the shape of the restored part, various shaping orthopedic devices and prostheses are used. Forming devices consist of fixing, replacing and forming elements in the form of thickened bases against the areas to be formed. They can be removable and combined with a combination of non-removable parts in the form of crowns and removable forming elements mounted on them. When plasticizing the transitional fold and vestibule of the oral cavity, for successful healing of a skin flap (0.2-0.3 mm thick), a rigid thermoplastic insert is used, layered on the edge of the splint or prosthesis facing the wound. For the same purpose, a simple aluminum wire splint can be used, curved along the dental arch with loops for layering the thermoplastic mass. In case of partial loss of teeth and prosthetics with a removable prosthesis design, a zigzag wire is soldered to the vestibular edge opposite the surgical field, onto which a thermoplastic mass with a thin skin flap is layered. If the dentition opposite the surgical field is intact, then orthodontic crowns are made for 3-4 teeth, a horizontal tube is soldered vestibularly, into which a 3-shaped bent wire is inserted for layering thermoplastic mass and a skin flap. When plastic surgery of the lips, cheeks, and chin, dentoalveolar prostheses are used as forming devices, replacing defects in the dentition and bone tissue, splinting, supporting and forming the prosthetic bed.

Conclusion.

A well-made device should not cause severe pain to the wearer.

Successful treatment of a patient depends not only on the doctor but also on a dental technician who knows his job.

References.

Dental prosthetic equipment M. M. Rasulov, T. I. Ibragimov, I. Yu. Lebedenko
Orthopedic dentistry
V. S. Pogodin, V. A. Ponamareva Guide for dental technicians
http://www.docme.ru/doc/96621/ortopedicheskaya-stomatologiya.-abolmasov-n.g.---abolmasov-n...
E. N. Zhulev, S. D. Arutyunov, I. Yu. Lebedenko Maxillofacial orthopedic dentistry

The presence of gaps between teeth to one degree or another disrupts the patient’s appearance and speech. The three reasons are the discrepancy between the size of the teeth and the size of the jaw, the absence of teeth, and the incorrect position of individual teeth (protrusion, rotation). If there are gaps between the teeth with the correct relationship of the dentition, treatment is usually not carried out or prosthetics are resorted to; if trema are observed with upper and lower prognathism, open bite, treatment of the underlying anomaly causes their elimination.

Diastema is a gap (from 1 to 6 mm or more) between the central incisors, observed more often on the upper jaw and less often on the lower jaw. It disrupts the appearance and sometimes the speech of the patient. Often the diastema is accompanied by a highly developed frenulum of the upper lip, attached to the crest of the alveolar part, where it connects with the incisive papilla. The roots of the upper central incisors are covered with sufficient thickness of bone or are clearly outlined (as if separated from each other), forming a groove between themselves, into which the frenulum of the upper lip is woven. The radiograph usually shows a wide, dense palatal suture in the area of the central incisors. Sometimes in the anterior area the palatine suture is split and fibers of the connective tissue of the frenulum of the upper lip penetrate there. This diastema is most often observed in intact dentition. Some authors claim that such a diastema is inherited.

Treatment of diastema and consolidation of its results is associated with significant difficulties, since the space between the central incisors is filled not only with bone, but also with the connective tissue of the highly developed frenulum of the upper lip. When teeth are moved, the connective tissue is compressed, but is not rebuilt, and after the equipment is removed, the teeth return to their original place. The bringing together of the teeth also leads to compression of the mucous membrane of the gums, which straightens out after treatment and causes a recurrence of the anomaly.

In order to ensure the success of treatment, it is necessary to first move the frenulum of the upper lip, excise the connective tissue of the palatal suture, and disrupt the density of the bone tissue between the incisors (perform a corticotomy). After the teeth have been brought together, it is sometimes useful to also excise the excess mucosa and the enlarged incisive papilla. Some authors indicate that with the gradual convergence of teeth, atrophy of the frenulum and fibrous cord occurs; therefore, they do not recommend surgery.

Diastema is also a gap between the central incisors, formed as a result of partial edentia (most often the lateral incisors), anomalies in the shape and size of the teeth, retention of teeth and their location between the roots of the central incisors.

When treating diastema, you should pay attention to the location of the central incisors in relation to the midline (they can be located asymmetrically), the degree of formation of their roots, the position, shape of the roots and their inclination, and the width of the diastema. This allows you to select the appropriate equipment.

To eliminate the diastema, removable (plates with springs, vestibular arches, levers) or non-removable (Angle apparatus, crowns with levers, hooks, springs, rubber traction) orthodontic devices are used (Fig. 186). The gaps formed after the central incisors come together are filled with removable or fixed dentures. After surgery and movement of the central and lateral incisors to the midline, the latter are often covered with jacket crowns. This makes it possible to avoid relapse and improve the patient’s appearance and speech. In the lower jaw, the diastema is most often closed with a fixed prosthesis.

Due to the wide variety of anomalies of individual teeth and their combinations, recommended orthodontic appliances should be selected and, if necessary, modified according to the clinical picture and age of the patient. When eliminating anomalies of individual teeth, orthodontic measures are often combined with surgical and prosthetic measures. In older patients who do not want to undergo long-term treatment, if existing irregularities traumatize the psyche or impair speech, anomalies of individual teeth are eliminated by prosthetics.

It is advisable to identify and eliminate anomalies of individual teeth in childhood in order to facilitate their more correct eruption and thereby the formation of dental arches.

The various varieties and forms of dental anomalies described here are not always found in their pure form. More often in the clinic we have to deal with combined or combined anomalies

Yami. Thus, in one patient an open bite can be found, combined with a narrowing of the dental arches, an anomaly in the position of individual teeth, and enamel hypoplasia; in another, hyperplasia of the lower jaw is observed with a simultaneous dorsal position of the upper jaw. In this case, underdevelopment of the anterior part of the upper jaw, close position (crowding) of the upper anterior teeth, the presence of a diastema and three lower dentitions are diagnosed. Mixed forms of anomalies are characterized by a complex clinical picture. They complicate diagnosis and complicate treatment.

^ MAXILLOFACIAL ORTHOPEDICS

It is one of the sections of orthopedic dentistry and includes:

1) orthopedic treatment of jaw fractures and their consequences; 2) prosthetics for congenital and acquired defects of the face and skull; 3) elimination of deformations of the dental system using orthopedic methods; 4) orthopedic measures for reconstructive surgery of the face and jaws; 5) treatment of diseases of the masticatory muscles and temporomandibular joints.

The goal of maxillofacial orthopedics is the rehabilitation of patients with defects of the dentofacial system. To achieve this goal, the following is carried out: 1) studying the frequency, etiopathogenesis, clinical picture and diagnosis of defects and deformations of the dental system; 2) methods of prosthetics are being developed for defects of the face and jaws; 3) prevention of post-traumatic and postoperative deformations of the face and jaws is carried out.

When presenting methods of orthopedic treatment, certain devices will always be named, the classification of which we consider useful to give in advance.

^ CLASSIFICATION OF DEVICES USED IN MAXILLOFACIAL ORTHOPEDICS

It is advisable to divide all orthopedic devices into groups in accordance with their purpose, method of fixation and technology.

According to their purpose, devices are divided into corrective (repairing), fixing (holding), guiding, replacing, forming, disconnecting and combined. When treating jaw fractures, corrective, fixing, and guiding orthopedic devices are used. Corrective or repositioning devices are called orthopedic devices, with the help of which fragments are installed

Get into the correct position. These include wire and plastic splints for intermaxillary traction, devices with screws, and extraoral control levers.

Guides include devices with inclined planes or a sliding hinge, which provide bone fragments with a certain direction. These include Vankevich, Weber tires, wire tires with Schroeder hinges, Pomerantseva-Urbanskaya.

Devices that hold jaw fragments in the correct position and ensure their immobility are called fixing devices. These include various dental splints (smooth wire bracket, aluminum wire splints with spacers, extraoral devices for fixing fragments of the lower jaw). Fixing devices are also used to hold fragments of the lower jaw after its resection.

When plastically compensating defects in the soft tissues of the face, devices are used that serve as a support for the plastic material. They are called formative. With the help of these devices, a bed is also created for removable dentures on the edentulous lower jaw during operations aimed at improving the conditions for fixing the prosthesis.

After resection of the jaws or for jaw defects of traumatic origin, devices are used that replace lost tissue. They are called substitutes. These, for example, include prostheses used after resection of the jaws, called resection ones.

Disconnecting devices include devices that separate the oral and nasal cavities. They are called obturators. Uncoupling devices also include a protective palatal plate and devices used in the plastic elimination of acquired defects of the hard palate.

Combined devices perform several functions. In case of jaw fractures, devices reduce fragments and immobilize them. During plastic surgery, devices can hold fragments of the lower jaw and shape the lower lip.

Based on the method of fixation, maxillofacial devices can be divided into intraoral, extraoral and intra-extraoral. Intraoral devices are located in the oral cavity and are fixed on the teeth and alveolar part. Extraoral are located outside the oral cavity, on the tissues of the face and head. Intra-extraoral devices include devices, one part of which is fixed inside and the other outside the oral cavity. Intraoral appliances can be located within one jaw and are called single-jawed or on both jaws (bijawed appliances, splints).

Devices and splints used in maxillofacial orthopedics, depending on the method of their manufacture, can be standard or individual. In turn, individual devices are prepared by a doctor directly

Vienna at the operating table (chair) or in a dental laboratory. Devices and tires can be made of plastic and metal alloys. The latter are bent, cast, soldered and combined.

^ ORTHOPEDIC TREATMENT OF JAW FRACTURES

Damage to the face and jaws can be of gunshot or non-gunshot origin. There are the following main types of non-gunshot injuries to the maxillofacial area:

1) isolated injuries of soft tissues with violation of the integrity of the skin of the face and mucous membrane of the oral cavity (penetrating into the oral cavity);

2) damage to the soft tissues and bones of the face with a violation of the integrity of the skin or mucous membrane of the oral cavity or closed injuries to the bones of the facial skeleton;

3) damage to soft tissues and bones of the face (open and closed), combined with damage to other areas of the body.

Damage to facial bones is varied. For the purpose of statistical processing of materials from clinical observations, diagnosis and treatment of fractures, B.D. Kabakov, V.I. Lukyanenko and P.Z. Arzhantsev give a working classification of injuries to the facial bones:

I. Damage to teeth (upper and lower jaw):

II. Fractures of the lower jaw:

A. By nature:

Single |

Double g single sided

Plural J or bilateral B. By localization:

Alveolar part

Mental part of the body of the jaw

Lateral part of the jaw body

Jaw angle

Branches of the jaw (the branches themselves, the base or neck of the condylar process, the coronoid process).

III. Fractures of the upper jaw:

Alveolar process

Jaw bodies without nasal and zygomatic bones

Bodies of the jaw with nasal bones (cranial separation).

IV. Fractures of the zygomatic bone and arch: i

Zygomatic bone with or without damage to the walls of the maxillary sinus

Zygomatic bone and arch

Zygomatic arch

V. Fractures of the nasal bones

(with or without displacement of fragments)

VI. Combined injuries of several facial bones

(both jaws, lower jaw, zygomatic bone, etc.).

VII. Combined injuries to the face and other areas of the body.

Gunshot fractures of the facial bones are splintered in nature, have different localizations and occur at the site of direct action of the wounding projectile, and not along the lines of weak points. V.Yu. Kurlyandsky divided them into 4 groups:

1. Fractures of the alveolar process (partial fracture or defect, complete avulsion or defect).

2. Suborbital fractures (fracture or defect within the dentition with opening of the maxillary sinus of the maxillary cavity) and a defect of the palate, unilateral fracture with opening of the maxillary cavity and defect of the palate, bilateral fracture with opening of the maxillary cavities, perforated fracture.

3. Subbasal fractures (separation of the entire upper jaw or separation and crushing of it).

4. Fractures of individual bones of the facial skeleton (fracture or defect of the nasal bones, fracture or defect of the zygomatic bone).

Treatment of fractures has two ultimate goals: restoration of anatomical integrity and restoration of full function of the affected organ. This is solved by: 1) bringing the fragments into the correct position (reposition) and 2) holding them in this position until the fracture heals (immobilization). Both of these problems are solved by orthopedic or surgical methods.

Reposition of jaw fragments can be carried out manually after anesthesia, with the help of devices and surgically (bloody or open reposition). The main method of treating jaw fractures at present is the orthopedic method, which involves solving treatment problems with the help of splint devices. The system of measures for the rehabilitation of patients with injuries of the maxillofacial area also includes physiotherapeutic treatment and therapeutic exercises. Treatment of gunshot fractures of the jaws includes: 1) primary wound treatment, 2) reposition and immobilization of fragments, 3) measures to combat infection, 4) bone grafting, 5) soft tissue grafting, 6) measures to prevent contractures.

^ First medical aid for jaw fractures (transport immobilization)

The first medical aid for jaw fractures is to temporarily secure the fragments in a stationary state. This must be done to stop or prevent bleeding, as well as to stop pain. Temporary splinting of fragments is one of the means of combating shock. Medical assistance for jaw fractures in wartime is provided at the stages of evacuation of the wounded to the maxillofacial area. In peacetime, transport immobilization of fragments is carried out by doctors at local hospitals and ambulance stations before providing specialized care to the patient.

To create immobility of fragments, transport splints are used. The most common and simplest is the hard chin sling. It is used for a short period of time (2-3 days) for fractures of the upper and lower jaws, when there is a sufficient number of teeth holding the interalveolar height. The rigid chin sling consists of a headband and a plastic chin sling. A layer of cotton wool is placed in the sling and attached with rubber bands to the headband with sufficient traction.

To immobilize fragments of the lower jaw and for fractures of the alveolar process of the upper jaw, ligature binding of the jaws is also used. The ligature is bronze-aluminum wire 0.5 mm thick. There are several ways to apply wire ligatures according to Ivey, Vilga, Geikin, Limberg, etc. (Fig. 209). Ligature binding of the jaws should be combined with the application of a chin sling.

Rice. 209. Intermaxillary tying of teeth: a - according to Ivy; b - according to Geikin; in - according to Vilga.

For fractures of toothless jaws, removable dentures of patients can be used as a transport splint if the atrophy of the alveolar processes is moderate and the occlusion of artificial teeth is good. However, in this case, it is necessary to apply a chin sling.

^ Specialized care for jaw fractures

Orthopedic treatment of alveolar bone fractures

Fractures of the alveolar process of the upper jaw are most often observed. They can be with or without offset. The direction of displacement of the fragment is determined by the direction of the acting force. Basically, the fragments are displaced back or towards the midline.

For fractures of the alveolar process without displacement, a single-jaw aluminum splint (smooth wire clamp) is used (Fig. 210). It bends along the dentition on the vestibular side and is fixed to the teeth with a ligature wire. For fresh displaced fractures, the fragments are reduced simultaneously under anesthesia and secured with a single-jaw wire splint. If the patient does not consult a doctor in a timely manner, the fragments become stiff and cannot be straightened immediately. In these cases, intraoral and extraoral traction is used.

Rice. 210. Wire busbars according to Tigerstedt: a - smooth busbar-bracket; b - smooth tire with spacer; c - tire with hooks; g - tire with hooks and an inclined plane; d - splint with hooks and intermaxillary traction; e - rubber rings.

For fractures in the lateral parts of the alveolar process, a spring Angle arch can be used, which is adjusted in such a way as to move the teeth along with the alveolar process in the direction necessary to restore normal occlusion. So, for example, when a fragment is displaced in the palatal direction, the arch fits tightly to the teeth of the healthy side, but is distant from the teeth of the damaged alveolar process. After applying ligatures, the elastic arc will change

Brush the teeth of the damaged side outwards, i.e. to the correct position (Fig. 211).

Rice. 211. Treatment of alveolar process fractures with inward (a), posterior (b) and vertical displacement (c) displacement.

Fig.212. Zbarzh bent wire splint for the treatment of fractures of the upper jaw: a first option; b - second option; c - securing the tires.

For included fractures of the alveolar process and fractures in the anterior part of the dental arch, a stationary steel wire arch with a thickness of 1.2 - 1.5 mm is used. The arch is tied to the teeth of the healthy side, and the fragment is pulled to the arch with rubber rings or a ligature.

^ Orthopedic treatment of fractures of the upper jaw

Fractures of the upper jaw can be unilateral or bilateral. There are three types of fractures of the upper jaw (Fore I, II, III). In addition, there may be impacted fractures of the upper jaw, and sometimes its complete separation. The main symptom of a displaced fracture of the upper jaw is a violation of the closure of the teeth in the form of an open bite.

Treatment of fractures of the upper jaw with severe mobility of the fragments consists of manually reducing the fragments and fixing them in the correct position. To treat bilateral fractures of the upper jaw, wire splints are used, which have an intraoral part fixed to the teeth and an extraoral part connected to a head plaster cast. A similar splint for the treatment of fractures of the anterior part of the upper jaw was proposed by M. Zbarzh (Fig. 212). It is prepared as follows. An aluminum wire 75 -80 cm long is taken. On each side, its ends 15 cm long are bent towards each other and twisted in the form of a spiral. The angle between the long axes of the wire should not exceed 45°. The turns of one process go clockwise, and the other - counterclockwise. The formation of twisted processes is considered complete when the middle part of the wire between the last turns is equal to the distance between the premolars. This part then becomes the front part of the dental splint. The side parts are bent from the free ends of the wire. The intraoral part of the splint is strengthened with a ligature wire to the teeth after the fragments have been reduced. The extraoral processes are bent upward towards the head so that they do not touch the skin of the face. After this, a plaster cast is applied, into which the ends of the wire processes are plastered.

For the treatment of type I and II fractures of the upper jaw, Ya.M. Zbarzh developed a standard set consisting of a splint-arch, a supporting headband and connecting rods (Fig. 213). The device allows you to simultaneously reduce and secure fragments. The splint-arch is a double steel arch covering the dentition of the upper jaw on both sides. The dimensions of the wire arch are regulated by extension and shortening of its palatal part. Extraoral rods extend from the arch, directed back to the auricles. Extraoral rods connecting

They fit with a headband using connecting metal rods. M.Z. Mirgazizov proposed a similar device for a standard splint for securing fragments of the upper jaw, not only using a palatal plate made of plastic

Treatment of fractures of the upper jaw with downward displacement of fragments with an intact lower jaw can be carried out using a Weber type I dental-gingival splint (Fig. 214). It consists of a wire frame and a plastic base that encloses and covers the hard palate and couplings for the extraoral rods. The incisal edges and chewing surfaces of the teeth are left open to control tooth closure. The frame is bent from orthodontic wire with a diameter of 0.8 mm.

Rice. 213. Standard set Zbarzha for the treatment of fractures of the upper jaw a - splint-arch, b - head bandage, c - connecting rods, d - connecting clamps

It covers the dentition in the form of an arch from the vestibular and palatal surfaces. In order for the splint to rest on the teeth and not damage the gingival margin, crossbars are soldered to the frame, which should be located at the contact points of the teeth. Tetrahedral tubes are soldered to the frame, which will hold the extraoral rods. The soldered frame is placed on the jaw model and a splint is modeled from wax. A model with a wax reproduction is plastered into a cuvette and the wax is replaced with plastic. It is possible to produce a periodontal splint using a different technology

Rice. 214. Dental splint for fixing fragments of the upper jaw

Nology. A wire frame with tubes is made. Place it on the model and model the tire from quick-hardening plastic. Polymerization is carried out in a vulcanizer. The tire base turns out to be translucent. This allows you to see where the mucous membrane is compressed under the splint.

Obtaining an impression for making a splint has its own characteristics. They consist in the danger of displacement of fragments when making an impression. Impressions are made with alginate masses, which have the ability to adhere to the mucous membrane. If the impression is roughly removed from the oral cavity, displacement of the fragments may occur. Therefore, before removing the print, it is necessary to bend one of its edges, thereby opening air access under the print.

Rice. 215. Apparatus for the reduction of fragments of the upper jaw according to Schur.

In case of a bilateral fracture of the upper jaw and limited mobility of the fragments, the reduction and fixation of the fragments is carried out using splints. For this purpose, Z.Ya. Shur proposed an apparatus with opposing rods (Fig. 215). It consists of: 1) a plaster cap, into which two vertical rods 150 long are plastered mm; 2) a single soldered splint for the upper jaw with supporting crowns for the canines and first molars of both sides. Flat tubes with a cross section of 2x4 mm and a length of 15 are attached to the splint on the buccal side in the area of the first molar. mm; 3) two extraoral rods with a cross-section of 3 mm and a length of 200 mm. The soldered splint is cemented onto the teeth of the upper jaw. A plaster cap is formed on the patient’s head and at the same time short rods are inserted into it vertically on both sides so that they are located slightly behind the lateral edge of the orbit and descend down to the level of the wings of the nose. Extraoral rods are inserted into tubes and curved along the buccal surface of the tooth. In the area of the fang they are directed backwards, at the level of the short upper shaft they bend towards it. The movement of jaw fragments is achieved by changing the direction of the extraoral rods. After setting the jaw in the correct position, the ends of the levers are tied with a ligature.

Treatment of unilateral fractures of the upper jaw with stiff fragments is carried out using wire splints with intermaxillary traction. A Tigerstedt splint with hooking loops is bent onto the lower jaw. A wire splint with hooking loops is bent onto the upper jaw only on the healthy side, and on the fragment the splint remains smooth and is not fixed with ligatures. After strengthening the splint, an intermaxillary rubber rod is applied on the healthy side, and a rubber gasket is installed between the lowered fragment of the upper jaw. After the fragment has been reduced, the free end of the splint on the upper jaw is tied to the teeth.

In case of complete avulsion of the upper jaw with its displacement back and in case of an impacted fracture, traction of the fragment is carried out using a steel wire rod, one end attached to a plaster head bandage, and the other to an intraoral splint.

^ Orthopedic treatment of mandibular fractures

Fractures of the lower jaw occur along the line of weakness and have a typical localization (Fig. 216). Gunshot fractures, on the contrary, have different locations. Fractures of the lower jaw most often occur with displacement of fragments, which is explained by the traction of the masticatory muscles attached to them.

Rice. 216. Typical location of mandibular fractures.

The choice of method of orthopedic treatment of mandibular fractures depends on the location of the fracture line, the degree and direction of displacement of fragments, the presence of teeth in the jaw and the condition of their periodontium, and the nature of occlusion disorders.

If there are teeth on the jaw, slight displacement of fragments and fractures within the dentition, single-jaw wire splints are used. Fractures outside the dentition or significant displacement of fragments require the use of splints with hooking loops for intermaxillary traction. For the first time, aluminum wire tires were used by the Kyiv hospital doctor S.S. Tigerstedt in 1916. (Fig. 210). Deep bites with vertical or retruded anterior teeth limit the use of wire splints.

^ Fig. 217. Standard tape splint for intermaxillary fixation according to Vasiliev, a - general view of the splint; b - splint on the model (some of the ligatures have been removed).

Method of applying a wire splint. The wire bus is bent from aluminum wire with a diameter of 1.8 mm. The splint is bent outside the oral cavity, constantly trying it on the dentition. The splint is applied after conduction anesthesia. It should fit snugly against each tooth. If part of the teeth is missing, a spacer or retention loop bends in it. The hook loops are bent using crampon tongs. The ends of the splint should cover the last teeth. To secure it, a bronze-aluminum wire 6 - 7 cm long and 0.4 - 0.6 mm thick (ligature) is used. The splint should be located between the equator of the tooth and the gum, without causing damage to the latter. The ligature is bent into a hairpin shape with ends of different lengths. Its ends are inserted with tweezers from the lingual side into two adjacent interdental spaces and brought out from the vestibule (one under the splint, the other above the splint). The ends of the ligatures are twisted and bent into the interdental space. The ligature should not cause damage to the gums. After 2-3 days it is tightened.

Bent wire bars require a lot of time to bend. In 1967, V.S. Vasilyev developed a standard stainless steel dental splint with ready-made hooks (Fig. 217).

Treatment of fractures of the lower jaw with toothless alveolar parts or with the absence of a large number of teeth is carried out with a splint by M.M. Vankevich (Fig. 218a). It is a dental-gingival splint with two planes that extend from the palatal surface of the splint to the lingual surface of the lower molars or the edentulous alveolar ridge.

Rice. 218. Removable splints for securing toothless fragments of the lower jaw: a - Vankevich splint; b - Stepanov tire.

^ Bus technology. Alginate impression mass is used to take impressions from the upper and lower jaws. The central relationship of the jaws is determined and the model is plastered in an occluder. The degree of mouth opening is measured. The frame is bent and a wax splint is modeled. The height of the planes is determined by the degree of opening of the mouth. When opening the mouth, the planes must maintain contact with the edentulous alveolar processes or teeth. Wax is replaced with plastic. This tire can be used

It is also used for bone grafting of the lower jaw to retain bone grafts. The Vankevich splint was modified by A.I. Stepanov, who replaced the palatal plate with an arch (Fig. 2186).

For fractures of the lower jaw outside the dentition, a periodontal splint with an inclined plane on the lower jaw and wire splints with sliding hinges (Pomerantseva-Urbanskaya) are used (Fig. 219).

^ Plastic tires. With the advent of plastics in the practice of orthopedic dentistry, the latter began to be used in the treatment of mandibular fractures. Various modifications of the tire made of fast-hardening plastic were proposed by G.A. Vasiliev, I.E. Koreiko, M.R. Ma-rey, Ya.M. Zbarzh. A tire made of fast-hardening plastic is formed

Rice. 219. Splints for the treatment of fractures of the lower jaw outside the dentition: a, b - Weber gingival splint; c - orthopedic device with a sliding hinge according to Schroeder; g - wire tire with a Pomerantseva-Urbanskaya sliding joint.

According to an arc-shaped metal template. A polyamide thread with plastic beads is first secured to the teeth. Using this method, you can get a smooth tire and a tire with hooking loops (Fig. 220).

F.M. Gardashnikov proposed a universal plastic dental splint with mushroom-shaped rods for intermaxillary traction. The tire is reinforced with a bronze-aluminum ligature (Fig. 221).

A splint made of quick-hardening plastic can be prepared in the form of a mouthguard directly in the patient’s mouth. It is necessary to protect the gingival margin with wax from burns from plastic. E.Ya. Vares proposed making mouthguards by stamping from sheet polymethyl methacrylate in a special mold.

Rice. 220. Scheme for manufacturing a plastic splint for the treatment of fractures of the lower jaw:

A - fixation of beads; b - groove formation; c - groove; d - a splint is applied to the jaw;

D - tire with hook loops; e - fixation of the jaws.

Plastic tires have the following disadvantages: 1) strengthening plastic tires with polyamide thread is not stable enough due to the stretching of the latter; 2) plastic splints in the form of mouthguards change the occlusion, are bulky, damage the gingival papillae and disrupt oral hygiene.