*Volodymyr I. Sarapuk
Improved method of complete removable laminar dentures manufacturing for the prosthodontic treatment of patients with completely absent dentition
Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
A device for the formation of a prosthetic plane of the upper jaw check-bite in the course of the prosthodontic treatment of the patients with completely absent dentition was developed in order to improve the formation of the prosthetic plane during complete removable laminar dentures manufacturing.
The objective was achieved by the fact that the bite plate of the device was made in the form of U-shaped supporting ruler with a fork-like extension on both sides and with a pocket in the central part. The bite plates for the frontal and chewing parts of the upper jaw check-bite were inserted into the pocket. The bite plates were made removable, the frontal plate was T-shaped, and the chewing one was fork-like with rounded forks. The device was additionally equipped with a movable ruler to record strict parallel alignment in relation to the Camper and inter-pupillary lines. The supporting ruler was equipped with two vertical columns of square shape with symmetric millimeter scales, along which the vertical movements of the movable ruler were conducted and its parallel alignment was recorded in relation to the supporting ruler. The movable ruler was additionally equipped with a leveling device fixed in its central part to position the patient’s head relative to the horizon line.
The use of bite plates for the frontal and chewing parts of the upper jaw check-bite and the provision of structural elements in the form of the supporting and movable rulers with the possibility of moving the movable ruler on the vertical columns of the supporting ruler provide a fast, comfortable, precise and uniform formation of the prosthetic plane of the upper jaw check-bite parallel to the Camper and inter-pupillary lines in the prosthodontic treatment of the patients with completely absent dentition.
One of the main directions of modern dentistry development is an increase in the effectiveness of the prosthodontic treatment of dental patients, including the ones with completely absent dentition (1, 2). However, neither preventive measures nor the development of new materials, nor the improvement of existing methods and approaches to the treatment have reduced the percentage of the population requiring primary or repeated prosthodontic treatment (3, 4). All this permits the search for new methods of improving the technology of complete removable laminar dentures (CRLD) manufacturing (5, 6). Designing dentitions in CRLD, the prosthetic plane is the main reference point. The correct determination of the prosthetic plane placement affects CRLD fixation and their stabilization in the oral cavity. Generally, the prosthetic plane is defined by a method that involves its formation on check-bites along the Camper and inter-pupillary lines. The correctness of the prosthetic plane along the Camper and inter-pupillary lines is most often controlled by Larin’s apparatus (7) or by students’ rulers (8). However, the accuracy is lacking when using students’ rulers to determine the prosthetic plane, since it is impossible to put the ruler accurately on the nasal line through the volumetric and prominent facial shape, and the inspection is performed alternately on each side. Parallel alignment is assessed visually which does not guarantee the parallel alignment of the prosthetic plane in relation to the Camper and inter-pupillary lines (9). The method of the prosthetic plane determination on the tomographic image of edentulous jaws is also known. This method involves the formation of a prosthetic plane of the upper check-bite parallel to the Camper and inter-pupillary lines using students’ rulers, adjusting the lower check-bite to the upper one, applying of an X-ray contrast medium, obtaining computed tomography scans of edentulous jaws, contacting of the formed surface of the check-bite (10). This method has several disadvantages: a) the accuracy of the Camper line location can only be determined after obtaining computed tomography scans allowing for mistakes at the early stage and requiring to be repeated; b) the using of such expensive method repeatedly exposes patients to additional radiation and takes a long time (11). The method of the prosthetic plane formation using a laser parallelometer is also known. It involves the projection of a prosthetic plane on a check-bite of the upper jaw parallel to the Camper line, the beam of the immobile fixed to the holder laser module providing lines is guided to the base of wing of nose or along the nasal line and thus the Camper line is formed, and the beam of the mobile module is directed to the previously obtained height of the check-bite and the projection of the prosthetic plane in the frontal area is determined on it (9). The disadvantages of this method lie in the fact that its use involves the presence of a laser parallelometer by which the projection of the laser lines is marked on the check-bite of the upper jaw with a dental spatula, the check-bite is cut off to the level of the laser lines and, thus, imperfections are possible since the prosthetic plane is formed visually (11).
The objective of the research was to improve the method of formation of the prosthetic plane of the upper jaw check-bite during CRLD manufacturing in the course of the prosthodontic treatment of the patients with completely absent dentition.
Material and methods
In order to achieve the objective, we have developed a device for the formation of a prosthetic plane of the upper jaw check-bite in the course of the prosthodontic treatment of the patients with completely absent dentition (12).
The device for the formation of a prosthetic plane of the upper jaw check-bite in the course of the prosthodontic treatment of the patients with completely absent dentition (fig. 1-4) consists of:
1 – the supporting part,
2 – the pocket in the central part of the supporting ruler,
3 – the bite plate for the frontal part of the upper jaw check-bite,
4 – the bite plate for the chewing part of the upper jaw check-bite,
5 – a movable ruler to record strict parallel alignment in relation to the Camper and inter-pupillary lines,
6 – two square columns which are fixed and perpendicular on the fork-like extensions of the supporting ruler,
7 – symmetrical millimeter scales drawn on the square columns,
8 – two openings in a movable ruler similar to those of the square columns,
9 – two extension-projections of square openings,
10 – two round openings with the internal thread on the external walls of the extension-projections,
11 – two screws twisted into the round openings of the extension-projections to fix the parallel alignment,
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