Actual problems in dentistry Actual problems in dentistry Проблемы стоматологии 2077-7566 2412-9461 46787 10.18481/2077-7566-21-17-3-108-113 ОРТОПЕДИЧЕСКАЯ СТОМАТОЛОГИЯ ORTHOPEDIC DENTISTRY ОРТОПЕДИЧЕСКАЯ СТОМАТОЛОГИЯ EXPERIMENTAL AND MATHEMATICAL JUSTIFICATION OF THE APPLICATION DIGITAL TECHNOLOGIES FOR RECORDING THE POSITION OF THE LOWER JAW DURING TOTAL PROSTHETICS USING DENTAL IMPLANTS ЭКСПЕРИМЕНТАЛЬНО-МАТЕМАТИЧЕСКОЕ ОБОСНОВАНИЕ ПРИМЕНЕНИЯ ЦИФРОВЫХ ТЕХНОЛОГИЙ ДЛЯ РЕГИСТРАЦИИ ПОЛОЖЕНИЯ НИЖНЕЙ ЧЕЛЮСТИ ПРИ ТОТАЛЬНОМ ПРОТЕЗИРОВАНИИ С ИСПОЛЬЗОВАНИЕМ ДЕНТАЛЬНЫХ ИМПЛАНТАТОВ Мельников Юрий Андреевич Melnikov Yuri A. yuramelnikov69@gmail.com Жолудев Сергей Егорович Zholudev Sergey Egorovich zholudev_se@mail.ru

доктор медицинских наук;

doctor of medical sciences;

 Заикин Дмитрий Александрович Zaikin Dmitry Aleksandrovich dmitri@3dlab.clinic АНО «Объединение «Стоматология», филиал № 6 Екатеринбург Россия АНО «Объединение «Стоматология», филиал № 6 Екатеринбург Russian Federation Уральский государственный медицинский университет Ural State Medical University ООО "СОЮЗ-ПЕЧАТЬ" 3DLAB Екатеринбург Россия LLC "SOYUZ-PRINT" 3DLAB Ekaterinburg Russian Federation 17 3 108 113 05 11 2021 https://dental-press.ru/en/nauka/article/46787/view

Предмет. При протезировании беззубых челюстей физиологическое положение нижней челюсти должно быть определено до изготовления окончательных конструкций. В некоторых случаях использование временных протезов в течение нескольких недель может быть полезно для проверки новой окклюзии в центрическом отношении. При достижении правильных межокклюзонных отношений их трудно перенести с предварительных протезов на конечные. В этой статье представлен клинический случай и методика передачи информации о положении нижней челюсти с помощью цифрового рабочего процесса. Для определения оптимального положения нижней челюсти была использована компьютерная томограмма височно-нижнечелюстного сустава для математического измерения правильного положения головки нижней челюсти. Цель. Описать методику, предназначенную для передачи межокклюзонных отношений верхней и нижней челюстей с использованием цифровых технологий, при протезировании полной адентии при помощи дентальных имплантатов. Методология. Проведено тотальное удаление несостоятельных зубов с последующим протезированием полной адентии с установкой шести имплантатов на верхней и нижней челюстях. После завершения периода интеграции проведена конусно-лучевая компьютерная томография с захватом височно-нижнечелюстного сустава, сканирование гипсовых моделей с установленными формирователями десны. Полученные данные были сопоставлены в специализированной программе для математического расчета оптимального положения нижней челюсти. Эта информация использовалась при изготовлении регистрационных шаблонов для создания несъемных конструкций с опорой на имплантаты в полученном центральном соотношении челюстей. Результаты. Цифровой протокол определения центрального соотношения челюстей позволил перенести информацию, полученную в виртуальной модели височно-нижнечелюстного сустава, в несъемную реставрацию с опорой на имплантаты. Заключение. Подход, описанный в настоящей статье, предсказуемо передает информацию об оптимальном положении нижней челюсти при протезировании и позволяет выполнить окончательную реставрацию на имплантатах с оптимальными окклюзионными отношениями, основываясь на математическом расчете, выполненном в специализированных программах.

Subject. When prosthetics of toothless jaws are performed, the physiological position of the lower jaw must be determined before the final structures are made. In some cases, the use of temporary prostheses for several weeks may be useful to check for a new occlusion in a centric relationship. When the correct ratio is achieved, it is difficult to transfer them from the preliminary prostheses to the final ones. This article presents a case and a technique used to communicate information about the position of the lower jaw using a digital workflow. To determine the optimal position of the lower jaw, a computer tomogram of the temporomandibular joint was used to mathematically measure the correct position of the head of the lower jaw. Purpose. To describe a technique designed to transfer the inter-occlusal relations of the upper and lower jaws, using digital technologies in the prosthetics of full adentia using dental implants. Methodology. On the example of a clinical case of rehabilitation of a patient, total removal of failed teeth was performed, followed by prosthetics of complete adentia with the installation of six implants on the upper and lower jaws. After the completion of the integration period, a cone-beam computed tomography was performed with the capture of the temporomandibular joint, and a scan of plaster models with installed gum shapers was performed. The obtained data were compared in a specialized program for mathematical calculation of the optimal position of the lower jaw. This information was used to produce registration templates for the manufacture of fixed structures supported by implants in the resulting central jaw ratio. Results. A digital protocol for determining the central ratio of the jaws allowed us to transfer the information obtained in a virtual model of the temporomandibular joint to a permanent restoration based on implants. Conclusion. The approach described in this article predictably conveys information about the optimal position of the lower jaw during prosthetics and allows you to perform the final restoration on implants with optimal occlusal ratios, based on a mathematical calculation performed in specialized programs.

 дентальная имплантация навигационная хирургия височно-нижнечелюстной сустав полная адентия немедленная нагрузка центральное соотношение челюстей dental implantation guided surgery temporomandibular joint full edentulous immediate loading central jaw ratio

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