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Installation of dentures after jaw resection. Replacement prostheses for jaw resection

For direct prosthetics after resection upper jaw Claude Martin proposed a very ingenious design of resection prostheses back in the 80s of the last century. He made a rubber prosthesis from two parts: horizontal and vertical. The horizontal part corresponded to the soft, hard palate and dental arch, the vertical part replaced the facial part of the resected jaw and was divided into two parts along a vertical line. On both sides of this line there were hinges connected by wire, which made it easier to remove the device from the oral cavity.

The apparatus was supplied a network of channels through which the wound was irrigated with an antiseptic liquid, resulting in the removal of secretions and rinsing of the surgical wound.

D. A. Entin, wanting to eliminate the shortcoming of Claude Martin's direct prosthetic irrigator, proposed his own design of the prosthesis in 1922. He made a prosthesis from rubber and thus obtained a prosthesis that was “soft, elastic, but not elastic enough so that it could withstand scar contractures and, as needed, change its volume without dramatically changing its shape.” Considering a necessary condition for successful prosthetics to be complete correspondence between the prosthesis and the anatomical shape of the resected bone, D. A. Entin, based on anthropometric measurements that determined “not only the available sizes of the jaw, but also the type of skull and face that corrects the type of jaw,” created a strictly individual anatomical shape prosthesis.

Direct pneumatic prosthesis, according to D. A. Entin, consisted of two parts: a palatal plate made of hard rubber and a pneumatic rubber cylinder. The balloon was filled with air and filled the wound cavity. After approximately 2 months, the pneumatic prosthesis was replaced by a subsequent full denture made of hard rubber, which could be equipped with an irrigation system to irrigate the cavity antiseptic solutions. The production of these devices is labor-intensive and therefore they were not widespread.

IN as orthopedic devices used for resection lower jaw, some surgeons used resection splints, others - resection prostheses. Resection splints fix jaw fragments in the correct position. However, the purpose of resection devices should be to protect fragments of the lower jaw not only from displacement, but also from scarring contractures, and from deformation of the tissues of the oral and chin areas.

In the hospital Perm Dental Clinic We provided prosthetics to patients whose jaws were resected due to malignant neoplasms. In the upper jaw, in almost all cases the same denture design was used. This is explained by the fact that the resections were mostly typical: half of the upper jaw was resected - from the midline to the maxillary tubercle. Consequently, the location of the defect was the same: the manufactured prosthesis always had one-sided support. The prosthesis was fixed on the healthy side. The basis had the form of a forming plate protruding beyond the cavity formed by resection of the jaw. The protruding part of the plate supported the soft tissue of the cheek.

Teeth on site prosthesis, corresponding to the resected side of the jaw, were not placed or were placed only in the frontal part. The device was fixed to the teeth using saddle-shaped clasps according to Richelman. Sometimes a pin was used that fit into a tube soldered to metal crowns placed on natural teeth. The pin was welded in the appropriate place into the plate.

On mandibular defects after resection are more varied. According to the location of the defect, patients can be divided into three categories: the first category - patients in whom the middle part of the lower jaw was resected; the second category - patients in whom half of the body of the lower jaw was resected to the angle; the third category - patients in whom half of the body of the lower jaw and the entire adjacent branch were resected, i.e., resection was accompanied by disarticulation. The following two designs can serve as an example of a resection prosthesis for patients of the first category, i.e., in the presence of bilateral support.

First design: the device is fixed on two supporting teeth, covered with crowns that have two protrusions on the vestibular side. In the space between the protrusions there is a clasp. The lower protrusion serves as a support for the device, the upper - for fixing it. For this design, it is necessary that the crowns of the supporting teeth be high.

Other design: the device consists of fixing and operating parts. The fixing part, in turn, consists of two crowns, placed on the teeth close to the defect and welded together with a barbell. The active part is a prosthesis, on the basis of which inside There is a corresponding recess for the rod.

For patients of the second category(with unilateral support) a base is made that replaces the resected part of the lower jaw. The device is fixed on the healthy side using supported clasps. Resection devices are not equipped with artificial teeth at all, or the teeth are placed in such a way that there is no contact with the upper dentition. On the side adjacent to the healthy part, the device is equipped with an inclined plane that protects the fragment of the lower jaw from displacement.

For patients of the third category resection prostheses are made of the same design as for patients of the second category, but they are sometimes favorable conditions are also supplied with a shoot that replaces the branch. The process is connected to the horizontal part using a ball-and-socket joint (3. Ya. Shur). I.M. Oksman speaks out against the movable branch (hinge) due to its traumatic nature.

This is typical design of resection devices for each category of patients. As can be seen from the description, in all cases one should strive to reduce the moments of trauma and pressure, which can have a harmful effect on the damaged tissue. For this purpose, it is necessary to cover the model with tin foil before polymerizing the plastic and require careful finishing and polishing of the apparatus. Thanks to these measures, the surface of the prosthesis is very smooth. In addition, the device is fixed on the teeth of the healthy side in such a way that minimal pressure is transferred to the mucous membrane of the operated area.

To reduce chewing pressure does not place teeth in the area of the resected area or, as stated above, they are placed so that they have only cosmetic value, but not functional. This does not reduce the value of the device, since the patient after jaw resection uses only liquid food in the postoperative period.

Resection of the jaws is carried out for various neoplasms. Prostheses designed to replace lost tissues and organs, restore impaired functions (chewing, swallowing, speech, breathing), and form a bed (prosthetic field) for a permanent prosthesis are called replacing dentures. Prostheses made during jaw resection are called post-resection. Distinguish immediate post-resection prosthetics And delayed prosthetics. At immediate post-resection prosthetics a replacement prosthesis is made before surgery and put on immediately after surgery (on the operating table), but no later than 24 hours (immediate prostheses). Delayed prosthetics divided into early or immediate prosthetics, which is carried out shortly after surgery during the wound healing period, that is, in the first two weeks, and late or distant prosthetics, no earlier than in 1.5-2 months.

Prosthetics in the treatment of acquired defects

Lower jaw.

On the lower jaw, resection is distinguished alveolar process, mental part of the lower jaw with loss of bone continuity, economical resection of half of the lower jaw while maintaining the continuity of its body, resection of half of the jaw with disarticulation and its complete removal.

Classification of acquired defects of the lower jaw (according to L.V. Gorbaneva, with additions by B.K. Kostur and V.A. Minyaeva). According to this classification, acquired defects of the lower jaw are divided into 6 classes:

1. defects and deformations during correct fusion of fragments of the lower jaw. In these cases, a defect in the dentition and alveolar part may be observed.

lower jaw, which sometimes extends to the basal part of the jaw. In addition, the defect can be combined with cicatricial changes in the surrounding soft tissues;

2. defects and deformations of the lower jaw due to fusion of fragments in the wrong position. In this case, significant disturbances in the articulation of the dentition are observed as a result of the inclination of fragments with preserved teeth in the oral direction or towards the shortened part of the body of the lower jaw. Cicatricial changes in nearby soft tissues are also observed;

3. defects and deformations of the lower jaw during fusion of fragments using a bone graft;

4. defects and deformations in unfused fragments of the lower jaw after traumatic injuries;

5. defects of the lower jaw after resection of its individual sections;

6. defects after complete removal of the lower jaw.

Thus, according to this classification, the 1st-3rd class includes defects and deformations of the lower jaw, when the continuity of the jaw body is restored due to the fusion of fragments with each other (classes 1 and 2) or with the help of a bone seedling (3- 1st class), and with defects of classes 4-6, the continuity of the lower jaw is broken.

The design of prostheses used for resection of the lower jaw is determined by the location and extent of the resected area, the number of teeth on the remaining part of the jaw and the condition of their periodontium.

Direct prosthetics after resection of the chin of the lower jaw (according to I.M. Oksman) indicated for a small defect and in the presence of a sufficient number of stable teeth for clasp fixation.

The fixing part of the prosthesis is held on the remaining teeth using telescopic crowns, dental gingival clamps, multi-link and support-retaining clasps. The incisor block, sometimes including the canines, is made removable so that in the postoperative period the tongue can be pulled out to avoid dislocation asphyxia. In the front part of the prosthesis there is a collapsible chin protrusion for the formation of soft tissues of the lower lip and chin. It is attached to the prosthesis using cold-curing plastic only after the sutures are removed.

Replacement prosthesis for the chin region of the lower

jaws (with telescopic fixation system).

Direct prosthetics after resection of half of the lower jaw (according to I.M. Oksman). The fixing part of the prosthesis is held on the remaining teeth using multi-clasp fixation. If the height of the clinical crowns of the supporting teeth is small, they are covered with crowns with retention points. An inclined plane (removable or fixed) is located on the vestibular side of the teeth on the healthy part of the jaw, and keeps the jaw fragment from moving. The lower edge of the prosthesis should have a rounded shape, the outer surface of the replacement part of the prosthesis should be convex, the inner surface should be concave with sublingual ridges for free placement of the tongue.

Direct prosthetics during resection of half of the lower jaw with the ascending branch and articular head (according to Z.Ya. Shur).

A hinge with a plastic rod with a rounded end is attached to the distal end of the replacement prosthesis, which makes up the body of the jaw. The jaw branch is created on the operating table by layering gutta-percha or cold-curing plastic on the rod. With its help, if necessary, you can adjust the boundaries of the prosthesis.

Prosthetics after complete resection of the lower jaw (according to I.M. Oksman).

The replacement prosthesis is made with hyoid protrusions for better fixation, hooking loops, spring bushings or magnets.

After resection of the jaw, the wound is sutured, an aluminum wire splint with hooks is applied to the teeth of the upper jaw, a resection prosthesis is inserted and held in place with rubber rings. After 2-3 weeks, the rings are removed and if the fixation by the formed scars is insufficient, then intermaxillary fixation is used using springs or magnets.

Resection of the jaws is carried out for various neoplasms. Prostheses designed to replace lost tissues and organs, restore impaired functions (chewing, swallowing, speech, breathing), and form a bed (prosthetic field) for a permanent prosthesis are called replacing dentures. Prostheses made during jaw resection are called post-resection. Distinguish immediate post-resection prosthetics And delayed prosthetics. At immediate post-resection prosthetics a replacement prosthesis is made before surgery and put on immediately after surgery (on the operating table), but no later than 24 hours (immediate prostheses). Delayed prosthetics divided into early or immediate prosthetics, which is carried out shortly after surgery during the wound healing period, that is, in the first two weeks, and late or distant prosthetics, no earlier than in 1.5-2 months.

Prosthetics in the treatment of acquired defects of the lower jaw.

In the lower jaw, there are resections of the alveolar process, the chin of the lower jaw with loss of bone continuity, economical resection of half of the lower jaw while maintaining the continuity of its body, resection of half of the jaw with disarticulation and its complete removal.

1. defects and deformations during correct fusion of fragments of the lower jaw. In these cases, a defect in the dentition and alveolar part may be observed.

lower jaw, which sometimes extends to the basal part of the jaw. In addition, the defect can be combined with cicatricial changes in the surrounding soft tissues;

3. defects and deformations of the lower jaw during fusion of fragments using a bone graft;

4. defects and deformations in unfused fragments of the lower jaw after traumatic injuries;

5. defects of the lower jaw after resection of its individual sections;

6. defects after complete removal of the lower jaw.

Direct prosthetics after resection of the chin of the lower jaw (according to I.M. Oksman) indicated for a small defect and in the presence of a sufficient number of stable teeth for clasp fixation.

Replacement prosthesis for the chin region of the lower

jaws (with telescopic fixation system).

N
direct prosthetics after resection of half of the lower jaw (according to I.M. Oksman). The fixing part of the prosthesis is held on the remaining teeth using multi-clasp fixation. If the height of the clinical crowns of the supporting teeth is small, they are covered with crowns with retention points. An inclined plane (removable or fixed) is located on the vestibular side of the teeth on the healthy part of the jaw, and keeps the jaw fragment from moving. The lower edge of the prosthesis should have a rounded shape, the outer surface of the replacement part of the prosthesis should be convex, the inner surface should be concave with sublingual ridges for free placement of the tongue.

N
direct prosthetics for resection of half of the lower jaw with the ascending branch and articular head (according to Z.Ya. Shur).

Protesis after complete resection of the lower jaw (according to I.M. Oksman).

The replacement denture is made with hyoid protrusions for better fixation, hooking loops, spring bushings or magnets.

Resection of the jaws is carried out for various neoplasms. Prostheses designed to replace lost tissues and organs, restore impaired functions (chewing, swallowing, speech, breathing), and form a bed (prosthetic field) for a permanent prosthesis are called replacing dentures. Prostheses made during jaw resection are called post-resection. Distinguish immediate post-resection prosthetics And delayed prosthetics. At immediate post-resection prosthetics a replacement prosthesis is made before surgery and put on immediately after surgery (on the operating table), but no later than 24 hours (immediate prostheses). Delayed prosthetics divided into early or immediate prosthetics, which is carried out shortly after surgery during the wound healing period, that is, in the first two weeks, and late or distant prosthetics, no earlier than in 1.5-2 months.

Prosthetics in the treatment of acquired defects of the lower jaw.

1. defects and deformations during correct fusion of fragments of the lower jaw. In these cases, a defect in the dentition and alveolar part may be observed.

lower jaw, which sometimes extends to the basal part of the jaw. In addition, the defect can be combined with cicatricial changes in the surrounding soft tissues;

3. defects and deformations of the lower jaw during fusion of fragments using a bone graft;

4. defects and deformations in unfused fragments of the lower jaw after traumatic injuries;

5. defects of the lower jaw after resection of its individual sections;

6. defects after complete removal of the lower jaw.

Direct prosthetics after resection of the chin of the lower jaw (according to I.M. Oksman) indicated for a small defect and in the presence of a sufficient number of stable teeth for clasp fixation.

Replacement prosthesis for the chin region of the lower

jaws (with telescopic fixation system).

N
direct prosthetics for resection of half of the lower jaw with the ascending branch and articular head (according to Z.Ya. Shur).

Protesis after complete resection of the lower jaw (according to I.M. Oksman).

The replacement denture is made with hyoid protrusions for better fixation, hooking loops, spring bushings or magnets.

Prosthetics after complete resection of the lower jaw.

Prosthetics after complete resection of the lower jaw (according to I.M. Oksman).

The replacement denture is made with hyoid protrusions for better fixation, hooking loops, spring bushings or magnets.

Acquired defects may result from inflammatory processes(osteomyelitis), specific infection(syphilis, tuberculosis), necrosis of the palate due to the erroneous administration of a solution with the properties of a protoplasmic poison (alcohol, formaldehyde, hydrogen peroxide, etc.), surgical intervention regarding malignant or benign tumors, previous uranostaphyloplasty, as well as injuries: gunshot, household, sports. A defect in the hard palate can also occur as a result of its irritation by a suction prosthesis, causing the appearance of a hematoma followed by inflammation of the mucous membrane, periosteum and bone with its sequestration.

Significant functional impairments occur - speech distortion, changes in breathing; inflammation of the mucous membrane (rhinitis) is frequent, the act of swallowing is significantly impaired, and various mental disorders.

Acquired defects differ from congenital ones not only in origin, but also in the fact that they do not have strict localization or any specific outline; they depend on geometric shape wounding projectile; Various scars are observed along the edge of the defect. In the upper jaw, a distinction is made between resection of the alveolar process, unilateral and bilateral resection of the body of the upper jaw.

Classification of palate defects that occur after gunshot wounds inflammatory diseases and oncological operations, E.A. Kolesnikova.

By localization– defects of the anterior, posterior sections and the area of the border of the hard and soft palate; single and double sided.

According to the condition of the alveolar process and the location of the defect in it:

1) without a defect of the alveolar process;

2) with a process defect (through or non-through);

3) with a process defect in the anterior section;

4) with a process defect in the lateral section.

Depending on the safety of the supporting teeth in the upper jaw:

1) defects in the presence of teeth (on one side; on both sides; in different sections 1-2 teeth);

2) defects in complete absence teeth.

According to the condition of the surrounding tissues:

1) without scar changes in soft tissues near the defect;

2) with cicatricial changes (of the mucous membrane of the palate, with defects in the soft tissues of the perioral area).

By defect size:

1) small (up to 1 cm);

2) medium (from 1 to 2 cm);

3) large (from 2 cm or more).

By form:

1) oval;

2) rounded;

3) undefined defects.

Classification of acquired defects of the upper jaw (according to L.V. Gorbaneva, with additions by B.K. Kostur and V.A. Minyaeva). According to this classification, acquired defects of the upper jaw are divided into 7 classes:

1. defects of the alveolar part without penetration into the maxillary sinus;

2. defects of the alveolar part with penetration into the maxillary sinus;

3. defects of the bony palate: anterior, middle, lateral sections that do not extend to the alveolar part of the jaw;

4. defects of the bony palate involving the lateral part of the alveolar part

the jaw on one side, with the capture of the alveolar part on both sides, with the capture of the anterior section of the jaw;

5. defects of the bone palate and soft palate or only the soft palate;

6. defect formed after resection of the right or left upper jaw;

7. defect formed after resection of both upper jaws.

The class of defect determines the type of prosthetics.

In the presence of acquired defects of the upper jaw and defects of the dentition without violation of sealing oral cavity(1st class) replacement dentoalveolar prostheses are manufactured. If the defect of the upper jaw and the defect of the dentition penetrates into the maxillary sinus or nasal cavity (classes 2 and 4 of defects), then the replacement prosthesis also plays the role of an obturating device, separating the oral cavity from the maxillary sinus or nasal cavity. In cases where there are no defects in the dentition, but only defects in the upper jaw (class 3 and 5), prosthetic obturators are made to separate the oral cavity from the nasal cavity and maxillary sinus. Prostheses made in connection with resection of the upper jaw (one or both) - class 6 and 7 defects are called resection prostheses.