Удосконалення методики реставрації контактних поверхонь бічних зубів

Abstract

Відновлення повноцінної форми та функціональних можливостей бічних зубів до цього часу залишається досить складною проблемою. У наукових публікаціях вказується, що особливі складності виникають під час реставрації апроксимальних поверхонь. Формування анатомічного контуру із правильними контактними співвідношеннями між сусідніми зубами дозволяє запобігти застряганню їжі між зубами та допомагає стабілізувати зуби у міцному контакті один з одним. Мета даної роботи – удосконалення технології відновлення контактних поверхонь бічних зубів. Завдяки запропонованому алгоритму відновлення контактних поверхонь бічних зубів, на нашу думку, можна досягти більш високого естетичного і функціонального результату, а також запобігти виникненню ускладнень. Насамперед, адекватне відтворення контактного пункту, інтерпроксимального простору та амбразур визначає необхідний простір для нормального обсягу ясеневого сосочку, запобігає застряганню їжі між зубами та допомагає стабілізувати зуби у міцному контакті один з одним. Це є надзвичайно важливим для нормального функціонування міжзубного сосочка та профілактики пошкодження глибоких структур пародонту із втратою кісткової тканини та епітеліального прикріплення; Restoring the complete form and functionality of lateral teeth is quite a challenge to this date. In scientific publications, it is remarked that special difficulties arise during the restoration of approximal surfaces. Incorrect restoration of coronal tooth provokes inflammation and injury of interdental papilla, and increases the risk of more severe inflammation in parodontium. Considerable experience in restoring contact surfaces of lateral teeth with different accessories and modern filling materials has already been accumulated. However, recent studies indicate a sufficiently large number of low-quality restorations of teeth. The author of this article refers to the development of optimization techniques of restoring lateral teeth, proposing his own algorithm. The aim of this work is improving the techniques of restoring adjoining surfaces of lateral teeth. Materials and methods. We observed 103 patients with caries of approximal surface in 117 first and second molars of the upper and lower jaws. These patients underwent direct composite restoration via our proposed methods. Clinical evaluation of restorations was carried out immediately after treatment, in 6 and 12 months, according to the criteria of United States Public Health Service Ryge Criteria for Direct Clinical Evaluation of Restoration (USPHS Ryge) with the obligatory account of periodontal status and contact point. Research results. If restoration of two adjoining surfaces is necessary, it is initially recommended to conduct restoration of distally located tooth. After preparation of cavity, we conduct insulation of operational field with rubber dam which is installed on all lateral teeth in the working side. In the event of significant destruction of coronal tooth before installing the matrix we conducted restoration of transition angles between oral and vestibular surfaces into the adjoining face. The next step of treatment is to establish and fixate the matrix that must protect the gingival margin from filling material and contamination of cervical cavity class II with gingival liquid. In our opinion, preference should be given to contour matrix, shape and height of which is determined by the anatomical features of teeth. In the cervical area, the matrix is adapted by means of a wedge that is inserted from the vestibular or oral interdental space, depending on preservation and density of walls. In our work we use wooden wedges of different sizes that are less traumatic, absorb moisture and have the ability to expand. After that, acid etching of enamel (for 30 seconds) and dentin (for 15 seconds) is conducted, and acid is washed away with water current (not less than for 30 seconds). After complete drying, the adhesive preparation of cavity is carried out. The next stage is application of a portion of liquid composite up to 1 mm on the entire height of the inner matrix surface, followed by activation of matrix to the side of the tooth and polymerization of filling material. In order to improve the mechanical properties of the tooth-restoration complex in significant destruction of the tooth, reinforcement of the sidewall at the equator level is additionally carried out using the fiberglass tape Poliglas ESTA. Later on, the cavity is filled with traditional layered techniques and polymerization of composite material of normal or high density. After removal of sectional matrix using forceps and removing rubber dam (interdental wedge remains in place), additional polymerization is carried out, culminating in the final modeling of occlusal surface. After that, density of contact point, smoothness of the adjoining surface and contact face transitions into oral and vestibular ones are checked using floss. Correction of restoration is performed using burrs and strips, the latter are recommended to be cut longitudinally in half in order to prevent the disruption of the contact point. At the final stage, grinding and polishing with restoration discs, polishing cups and heads of different abrasiveness are carried out, after which the finishing light-striking is to be performed. According to the results of re-examination, in 6 and 12 months it can be concluded that restoration, carried out using the proposed method, meets the functional and aesthetic requirements and does not need corrections. In all cases high rates of marginal fit and satisfactory condition of interdental papilla are identified; no cleavage of tooth walls, no filling loss, secondary caries and hypersensitivity are detected. Thus, thanks to the proposed algorithm for restoration of adjoining surfaces of lateral teeth, in our opinion, one can achieve higher aesthetic and functional outcome and prevent complications. Firstly, adequate reproduction of contact point, interproximal space and embrasures determines the necessary space for the normal amount of gingival papilla, prevents food sticking between the teeth and helps to stabilize teeth in firm contact with each other. It is extremely important for normal functioning of interdental papilla and prevention of damage to deep structures of parodontium in the loss of bone tissue and epithelial attachment.