What is a tooth stump. Various options for the restoration of the tooth stump with a composite material of chemical curing "DentaKor. Stage. Preparation of the tooth stump

Inflammation of the salivary gland can occur in any age group and bring many inconveniences and complications to the patient.

Salivary glandular organs, their functions

The photo shows where the salivary glands in humans are located.

In the oral cavity and beyond, there are a large number of glands that produce a special secret - saliva. The largest of them are paired salivary glands: submandibular, sublingual and parotid. Smaller ones are represented by the buccal glands, lingual, labial, etc.

The parotid salivary gland is located behind the jaw, in front of the ear. The facial nerve, which is responsible for the facial muscles and a large artery with veins, passes through its tissue. The duct, through which the secret from the glands enters the oral cavity, opens on the inner surface of the cheek in the region of the upper large molars.

The sublingual gland, according to its name, is located under the lingual muscle. It feeds on blood through the lingual arteries.

The submandibular salivary gland is located within the boundaries of the submandibular triangle. A small section of the upper edge is located near the parotid.

Functions of the salivary glands

Influence the perception of the taste of the food consumed.
They have an important effect on articulation.
Enzymes (amylase, peroxidase and others) are necessary to start the process of digestion of food already in the oral cavity. Then the food with them enters the stomach.
Production of a special secret that contains mucin, enzymes, lysozyme, immunoglobulin A:

Mucin, in turn, envelops the food, so the formed food lump easily passes the esophagus.
Lysozyme has an antibacterial effect, thanks to which it protects the surface of the teeth from the formation of caries and demineralization.
Immunoglobulin A (secretory protein) performs a local protective function, destroying bacteria and viruses.

Causes of the disease

Inflammation of the salivary gland, or otherwise - sialadenitis, implies the development of inflammatory processes in the thickness of this organ. Sialadenitis downstream can be acute and chronic.

The main causes of inflammatory processes in the organs that produce saliva:

Symptoms of the disease

Common clinical signs of inflammation of the salivary glands include: sudden sharp pain at the site of the affected gland, which becomes more intense during eating; dry mouth due to impaired saliva production; swelling and roughness of the surface of the glandular organ.

Symptoms of inflammation of the parotid gland

Acute onset of the disease with fever, weakness, headache.
Later, manifestations of acute damage to the tissue of the organ join: swelling of the parotid region, soreness when pressing on the swelling and on the tragus of the ear, the color of the skin over the enlarged gland does not change.
Feeling of dryness in the mouth, pain when opening the mouth.
Important diagnostic features: bilateral lesion and Mursu's symptom (inflammatory ridge around the orifice of the excretory duct at the level of 1-2 molars of the upper jaw).
Contact with a patient with parotitis.
Sometimes the process spreads to neighboring structures, complicated by pancreatitis, orchitis (inflammation of the glandular structures of the testicles), adnexitis (ovarian damage), which can lead to a decrease in reproductive function, up to infertility.

With inflammation of the sublingual gland (sublingitis), in addition to intoxication and general symptoms, there is an unpleasant aftertaste in the mouth, pain when chewing food, a feeling of an inflammatory roller under the tongue. Submandibulitis, or inflammation of the submandibular gland, has similar manifestations. Diagnostic criterion - an increase in the neck on the side of the lesion.

Symptoms of non-specific inflammation

With nonspecific inflammation, the symptoms directly depend on the stage and type of inflammation:

With serous sialadenitis there is pain and swelling of the salivary gland, a feeling of dryness in the mouth, elevation of the earlobe. The pain syndrome intensifies during meals, after the reflex production of salivary fluid at the sight of food. The body temperature is normal or slightly elevated, the color of the skin over the gland is not changed. When pressing on the excretory duct, the discharge is insignificant or absent altogether.
In case of purulent sialadenitis the pain is sharp, which can disturb sleep. There is difficulty in opening the mouth, pus is released from the duct. The body temperature rises intensively (more than 38 C). The tissue of the organ itself is dense, the skin above it is shiny and acquires a bright red color. Edema can spread to the lower jaw, temporal region and cheek.
Gangrenous sialadenitis manifested by skin necrosis, rapid course, severe intoxication. Such a pathological condition can lead to the spread of infection and the development of a septic condition (massive entry of bacteria, toxins and decay products into the bloodstream).

Elderly people may develop isolated inflammation of the salivary duct, or sialodochitis. Manifested in excessive salivation during eating and talking, angular stomatitis (jamming in the corners of the mouth).

Diagnosis of the disease

If the above symptoms are found, it is necessary to contact an infectious disease specialist or a surgeon in order to find out the cause of the disease.

To diagnose inflammation of the salivary glands in a child and an adult, the doctor conducts a survey, a general examination of the patient, prescribes a general blood test (to determine the nature of the inflammation), in some cases, an ultrasound examination, contrast sialography is performed.

Treatment tactics

Treatment of inflammation of the parotid salivary glands (with parotitis) consists in prescribing a sparing diet, bed rest for 5-7 days, taking antiviral drugs, frequent rinsing of the mouth and dry heat on the affected area. At high temperature - antipyretic drugs (paracetamol, ibuprofen).

General approaches in the treatment of diseases of the salivary glands:

The appointment of drugs that enhance the production of saliva (a solution of pilocarpine or potassium iodide).
Careful oral hygiene. Teeth should be brushed not only in the morning and evening, but also after each meal.
Take crushed, soft and not coarse food, so as not to injure the inflamed ducts and the inner lining of the oral cavity.
Give up smoking and alcohol.
Physiotherapeutic treatment has a good effect: UHF, dry warm bandages on the diseased gland, semi-alcohol compresses.
With microbial infections of the salivary glands, the use of antibacterial and anti-inflammatory drugs (penicillins, cephalosporins, etc.) is indicated.
In the event of purulent or gangrenous sialoadenitis, first of all, surgical intervention is performed by excising the affected tissue of the organ, draining the wound to drain the pus and administering local antibiotics. After the operation, infusion therapy is performed using saline and colloidal solutions.

In the treatment of inflammation of the salivary glands at home, you can use a variety of antiseptic solutions for rinsing the mouth (furatsilin, rotokan chamomile, saline). To reduce pain, it is recommended to gently self-massage in the area of edema, or with alcohol.

It is important to remember that inflammatory processes in the salivary glands and their consequences can greatly complicate the patient's life, contribute to the development of caries and diseases of the gastrointestinal tract.

The human body is a "complex device" that is assembled from interconnected "parts". The salivary glands are one of the most important parts in the function of digestion. But many do not represent the importance of this component in the body.

The salivary gland (glandulae saliariae) is an external secretion gland that produces a liquid substance called saliva. And you can also say that these glands are an organ.

Classification of the salivary glands

To classify in the following areas:

Size: big and small
By the type of saliva secreted: serous (protein), mucous and mixed.

Serous(protein) contains a large amount of protein, the mucosa contains the main amount of viscous mucus and minerals, and the mixed one contains both proteins and minerals in equal proportions.

The minor salivary glands include glands that are located throughout the oral cavity. They make up the bulk of the total number of glands. P separated on the:

Their function is to keep the mouth from drying out between meals. The lesser lingual glands are in turn divided into glands at the root of the tongue and glands at the tip of the tongue. By structure, they belong to the tubular alveolar glands. The glands of the tip of the tongue secrete a protein-mixed secret, and a group of the rest, including the glands of the root of the tongue, secrete a mucous-protein saliva.

Major salivary glands

Quantity There are 3 pairs of large glands that produce saliva:

Parotid
Submandibular
Sublingual

Within 24 hours, these glands secrete a small amount of saliva, but when food enters the mouth, the amount greatly increases.

parotid glands

The parotid glands secrete protein saliva. These glands are composed of a large number of lobules. In the constituent lobules, a number of departments:

Secretory (alvioli, acini).
Exhibition channels.
Salivary striated tubes.

The epithelium of the secretory section consists of 2 different types of cells, serocytes and myoepitheliocytes. Serocytes are shaped like a cone. Myoepitheliocytes serve as baskets for acini. In their cytoplasm there are filaments, this contributes to the reduction and release of saliva.

The submandibular glands composition saliva are mixed. Their departments for secretion production are of two types: protein-mucous and protein. Protein acini are composed in the same way as in the parotid glands. Insert sections have a short length. The cells of the striated ducts perform a function similar to insulin.

sublingual glands

The sublingual glands produce a mucous-protein secret, in which mucoids predominate. Exhibition and striated ducts in these glands are poorly developed. In the sublingual glands, there are three types of salivary sections: albuminous, mucous, and mixed. The main part is made up of mixed end sections.

Where are the salivary glands

All of these glands are located in the oral cavity. Small glands are located near the location of the mucous membrane of the tongue, palate, lips and cheeks. Large glands are located in the layers of the floor of the tongue, under the jaw and in the parotid layer. The parotid gland is located behind the maxillary fossa, the submandibular glands are located in the submandibular triangle, and the submandibular salivary gland is located on the maxillohyoid muscle.

Functions of the salivary glands

Action these glands is very important:

Wetting and liquefaction of food.
Enhancement of taste.
Chewing food.
Teeth protection.
Cleansing the oral cavity.

It's all done by the salivary glands.

Numerous substances that make up the glands have a beneficial effect on digestion. The action of enzymes acts within 30 minutes after food enters the mouth. Although the food is in the mouth for a fraction of a minute, it is there that the digestive process begins. Complete breakdown occurs in the stomach due to the production of gastric juice.

The main job of the salivary glands is the production of saliva.

This is a transparent slightly viscous substance that consists of 99.5% water, the remaining 0.5% is:

Saliva contains a large number of different microbes but over time people have become susceptible to many of them. And many bacteria are still not adapted to the body, saliva helps in their neutralization. Therefore, it is imperative to observe hygiene, as many microbes mutate and form serious infections.

Functions of saliva

The functions of saliva are divided into 2 types:

Digestive.
Not digestive.

To digestive functions can include:

Enzymatic.
Formation of a bolus of food.
Temperature regulation.

Enzymatic breaks down certain substances such as complex carbohydrates. They help the stomach to digest food. The formation of a food bolus provides a softer swallow without damaging the tissues of the pharynx. The thermostat function cools or heats food up to 36°.

To not digestive features include:

Moisturizing, which does not allow dry mouth to prevail.
Bactericidal helps the body in disinfection.
Participation in mineral enrichment of teeth also protects tooth enamel from damage.

The study of these glands was first conducted by Academician Pavlov. At the end of the 19th century, he conducted an experiment on a dog. Cutting the places where the glands are located, he brought them out. Within 24 hours, pure saliva was collected in the container. This helped to obtain a complete chemical composition, as well as to recognize all the functions and properties salivary glands.

Diseases of the salivary glands

Diseases of the salivary glands develop very rarely. This can happen from blows to the face, from severe bruises to the ears and throat. There can also be one defect in these jelly - this is their absence in the oral cavity.

sialadenitis

Sialoadenitis can occur in the most common cases. Sialadenitis can be:

viral (popularly mumps) - arises from epidemics viral parotitis.
bacterial - affects the glands through infection through the lymph and blood. It occurs with poor hygiene, with complications after operations on the abdominal organs, with stone disease, if the canal is blocked.
serous sialadenitis, it is characterized by dryness in the oral cavity, the earlobe is raised, the pain increases when chewing.
purulent sialadenitis - instead of saliva, it can stand out pus, edema extends to the scales, cheeks, jaw. On palpation, the gland is painful and dense.
gangrenous sialoadenitis - proceeds violently, necrosis of the tissues of the oral cavity occurs, and the dead parts of the gland are released. The disease is fatal without proper treatment.
chronic sialadenitis is divided into 3 types:

interstitial leads to a lesion in 85% of parotid diseases;
parenchymal in 99% women are ill, the parotid glands are also affected;
sialodochitis affects only the ducts, occurs more often in the elderly.

Exacerbation can begin abruptly. As a rule, this is the beginning of autumn and the beginning of spring. The exacerbation begins with dry mouth, the gland increases in size.

It is necessary to pay attention to the fact that each type of sialadenitis is treated in different ways, therefore, if any signs appear, you should urgently contact your doctor, and not self-medicate.

Diagnostics and prevention

Usually, the treatment includes food that increases salivation, the appointment falls on antibiotics, rinsing and massage of the glands. For prevention, you need to monitor hygiene. Treat teeth in time, with any infection, you need to rinse your throat, teeth and mouth.

In the mucous membrane of various parts of the oral cavity a large number of small salivary glands are laid. According to the nature of the secret that they secrete into the oral cavity, the salivary glands are divided into mucous, protein and mixed. In addition, there are three pairs of large salivary glands - parotid, submandibular and sublingual. The secret of all small and large salivary glands, which enters the oral cavity, is saliva.

In the oral cavity it is not a pure secretion of salivary glands, but a biological fluid, often called oral fluid. It includes not only the products of the salivary glands, but also microorganisms, desquamated epithelial cells, food residues, leukocytes, etc.

The main properties of saliva:
1. It acts as a lubricant for oral tissues and organs, moistens food and facilitates swallowing.
2. Digestive enzymes found in saliva are involved in the digestion of food.
3. The cleansing role of saliva consists in the constant mechanical and chemical cleansing of the oral cavity from food debris, microflora, detritus, etc.
4. The protective function of saliva is to protect the organs of the oral cavity from environmental factors.
5. Due to the mineralizing function of saliva, the mineralization of teeth is carried out, the "maturation" of the enamel after their eruption, the optimal composition of the enamel is maintained.

parotid glands. These are the largest of all salivary glands. They are located subcutaneously and lie in the parotid-masticatory region on the branch of the lower jaw, in the masticatory muscle and the maxillary fossa. Saliva from the parotid glands enters the oral cavity through the stenon duct, which opens on the mucous membrane of the cheek opposite the upper second large molar.

Submandibular glands. In size, they are the average of all three glands, about the size of a walnut. These glands lie in the submandibular cellular space of the floor of the mouth under the maxillohyoid muscles. The excretory duct of the submandibular gland - the submandibular, or warton, duct - runs along the inner surface of the sublingual gland and opens on the sublingual papilla on its own or together with the duct of the sublingual gland.

sublingual glands. The sublingual gland is 2-3 times smaller than the submandibular gland. It is located under the mucous membrane of the floor of the mouth in the region of the sublingual folds above the maxillohyoid muscle. Numerous short ducts of the gland - small sublingual ducts - open along the sublingual fold. In addition to small ducts, sometimes there is a large sublingual duct. It passes along the inner surface of the gland and, either independently or by connecting with the duct of the submandibular gland, opens on the sublingual papilla.

Gone are the days when the restoration of a very badly damaged tooth, from which only one root remained, was a very serious and sometimes insoluble problem, which led to the complete loss of the tooth. Modern technologies that have appeared recently make it possible to save teeth that have undergone very strong destruction by restoring them.

Restoration of the stump of the tooth is done in two ways. One of them is the use of a pin cast stump inlay or onlay. Inlays are used when the tooth is partially preserved and it is possible to insert the inlay into the cavity. Currently, their use is limited, since they do not create the effect of depreciation, and this can lead to destruction of the roots of the teeth. Onlays are used to protect teeth from further decay.

Another method is the direct restoration of the tooth using anchor pins and composite materials. It is used in cases where it is necessary to restore the entire tooth as a whole. It also allows you to change the position of the teeth. In this case, it is necessary that the tooth root be of sufficient length, with good patency and have walls that are not destroyed by the carious process.

Recently, direct restoration of the tooth stump using composite materials has been widely used. Materials used for restoring the core of a tooth can be cured chemically, by exposure to light, or by dual curing. Dentists successfully use composite materials to restore the stump of teeth. They have a large selection of shades, good performance, a large margin of safety and the ability to achieve high aesthetic performance. In the case of restoration of large cavities, the best result is achieved with the use of glass ionomer cements, which are used both as a base material and in combination with other composite materials.

Glass ionomer cements have low toxicity, high strength, and excellent aesthetic characteristics. A wide range of available glass ionomer cements makes it possible to solve a wide range of problems in the field of practical dentistry, take into account the properties of other materials used, as well as the various material possibilities of patients. The use of light composites allows modeling the restoration before the onset of hardening. The absence of active chemical additives makes it possible to give them the necessary aesthetics and to give resistance to discoloration.

Do not rush and certainly remove problem teeth and tooth roots. Seek advice from the specialists of the private dental clinic "Apollonia", who have extensive experience and high qualifications. It is possible that the teeth are subject to restoration. The cost of restoring the stump of the tooth can be found on the website of the clinic in

Questions to control knowledge on the topic of the lesson

1. Etiology of complete destruction of the tooth crown. Clinical variants of the gingival part of the roots.

2. Classification of pin structures.

3. Requirements for the root of the tooth.

4. Indications for the choice of pin construction depending on the clinical condition of the gingival part of the root.

Complete destruction of the crown of the tooth. Etiology.

Complete destruction of the crown of the tooth the vast majority occurs as a result of caries, less often with trauma. The development of secondary caries due to insufficient and clinically unreasonable treatment of the cavity during the initial visit, the use of low-quality material leads to spalling

and fractures of the crowns of the teeth, pathological abrasion, dysplasia and hereditary disorders of the development of the teeth lead to a significant or complete loss of the crown.

Complete defects of the crown part of the forelock include destruction with an index of destruction of the occlusal surface of the tooth (IROPZ)> 0.7. In these cases, the remains of the crown part of the tooth protrude 2-3 mm above the gum level. With such destruction, the neurovascular bundle of the pulp, as a rule, is completely necrotic, periapical processes are determined. With hypoplasia

and pathological abrasion, with the most significant loss of hard tissues, the vital activity of the pulp can be preserved, in addition, there may be no pathological processes in the periapical tissues. Complete defects of the crown part of the tooth include:

1. the presence of the gingival part of the tooth crown, protruding above the level of the gingival margin at a distance of up to 3 mm;

2. the presence of hard tissues of the tooth at the level of the gingival margin;

3. destruction of hard tissues of the tooth below the level of the gingival margin up to a quarter of the length of the root (with greater destruction, removal of the tooth root is indicated).

The destruction of the crown of the tooth leads to morphological changes in the dentition: adjacent teeth tilt (converge), the opposing tooth is displaced towards the defect. The absence of the crown part of several teeth, especially adjacent ones, can lead to deformation of the dentition, bite, dysfunction of the masticatory muscles and TMJ.

Types of orthopedic pin structures.

A pin tooth is a fixed prosthesis that completely replaces the crown of the tooth and is fixed in the root canal with a pin.

They are distinguished depending on their purpose, design, manufacturing method and the material from which they are made. Pin designs that serve only to replace the crowns of natural teeth are called restorative.

By design, pin teeth are divided into monolithic and combined.

According to the manufacturing method - cast and soldered.

According to the material from which they are made - into metal, plastic, porcelain and lined.

Metallic and non-metallic parts of a pin tooth can be connected with cement (Davis, Duval crown), solder (pin tooth according to Akhmetov), directly (plastic pin teeth). In some designs of pin teeth, the veneer in the form of a porcelain facet is connected to a metal protective plate by means of crampons or other devices.

L.V. Ilyina-Markosyan divides pin teeth depending on the principle of strengthening them at the root.

In some cases, the pin tooth adjoins with its crown part or root protective plate to the outer surface of the prepared root (plastic pin teeth), in others, the protruding part of the tooth root is covered with a ring (Richmond pin tooth), in the third, the fixing part of the pin tooth adjoins not only to the outer surface of the root, but also to the inner walls of the mouth of the canal (pin tooth according to Ilyina-Markosyan).

one . Pin designs, in which the root part is only

in contact with the stump of the tooth:

a) plastic pin tooth; b) standard pin designs (Logan, Davis, Duval, Bonville, Forster, Style); c) brazed pin tooth.

The disadvantage of these structures is the access of the oral fluid to the root canal due to the lack of tightness.

2. Pin teeth, in the manufacture of which the mouth of the root canal is hermetically closed with a tab:

a) according to Ilyina-Markosyan; b) according to Citrine;

c) pin stump tab.

3. Pin designs that hermetically close the stump of the tooth not only with a root plate, but also with an additional ring or half ring:

a) according to Richmond;

b) according to Katz; c) according to Akhmetov.

Classification of modern pin structures:

1. Pin structures used for emergency care, both for temporary and permanent restoration of the crown part of the tooth (plastic pin tooth, Shiraka pin tooth, etc.).

2. Universal, individually manufactured one-piece cast pin structures (stump pin crown according to Kopeikin, stump pin tooth, composite stump pin tabs).

3. Industrially manufactured pins and stump inlays ( RADIXANKER, CYTCO, MOOSER, IKADENT, C-POST, etc.)

4. Composite stump inlays reinforced with polymer fibers

("Ribbond" and others)

5. Pin structures for the treatment of root fractures (a cast stump pin insert with an intra-stump channel and a threaded pin by E.A. Bragina et al., intra-root pins and an apical titanium insert by Griban A.M. et al.)

6. Transdental pins (endodonto-endoosseous implants) and parapulpal pins.

By design, pin teeth are distinguished:

1. According to Logan - a monolithic porcelain tooth connected directly to the pin.

2. According to Richmond - root protection with a ring as a support.

3. According to V.N. Kopeikin - a stamped steel cap as a root protector and a pin fitted along the root canal.

4. According to L. V. Ilyina-Markosyan - the supporting part in the form of a cast insert (shock absorber).

5. According to A.A. Akhmedov - a metal crown with a plastic lining and a pin.

6. According to A.Ya. Katsu - root protector and half ring.

7. According to N.A. The beam-pin tooth consists of a metal semi-cap with an open vestibular surface, an elastic pin and a plastic lining.

8. According to ORTON - one-piece cast with a support tab.

9. According to Davis - composite, consisting of a separate porcelain crown and pin, which are connected with cement.

10. Field. Shargorodsky - the root protective plate is modeled on a wax model after fitting the ring and pin along the root canal. Root protection is not stamped, it is cast together with a pin and a ring.

11. According to Duvel - diatoric porcelain teeth, in which pins with a special washer are attached.

12. According to V.N. Scab - a metal ring, a pin and a ground standard tooth made of plastic;

13. According to 3.P. Shirakoy - fitted standard plastic tooth and pin. The mouths of the root canal are used to form the retainer tab. The pin with the tooth is welded with quick-hardening plastic

3 question.

Indications for the choice of designs of pin teeth

determined based on the following clinical situations:

1. the degree of preservation of the supragingival part of the tooth crown and the level of destruction of root tissues in relation to the gingival margin;

2. group affiliation of the roots of the teeth - single or multi-rooted teeth;

3. the nature of the occlusal relationship - bite.

Choice of pin tooth design depends on the size of the preserved supragingival part of the tooth root, the type of bite and other conditions. So, with a deep bite, only solid cast pin teeth with plastic or ceramic facing can be used to restore the front teeth. In cases where part of the front teeth protrudes above the gum for 1-2 mm (type I), pin teeth according to Richmond, Katz, Shargorodsky, Akhmedov are shown,Ilyina-Markosyan,Davis, Logan, orstump pin tab according to Kopeikin,and in the group of lateral teeth - only a stump pin crown according to Kopeikin or a stump pin tooth. With type II roots, pin teeth can be used alongIlyina-Markosyan,Citrine, Orton, Logan, Davis, Kopeikin, plastic pin tooth.

With III and IV types of roots, a stump pin tab according to Kopeikin is shown, in addition, the restoration of the crown part of such teeth can be done using anchor pins, followed by coating with solid crowns.

Indications for the use of pin structures:

1. Pin teeth are used to restore the crown part of the tooth with its complete absence or significant destruction ( index of destruction of the occlusal surface of the tooth 0.8 or more).

2. As a support for a bridge prosthesis.

3. Pin structures in combination with other elements for

4. For reinforcing pulpless teeth.

5. Pins for replanted teeth.

Contraindications to the use of pin structures:

1. Unstopped pathological changes in the periapical tissues.

2. Root canal obstruction.

3. Short roots with thinned walls.

4. Atrophy of the bone tissue of the alveolar process at the root by 3/4 or more.

5. Destruction of the root by more than 1/4 of its length.

6. A defect in any of the root walls equal to or greater than 1/4 of the root size.

AT blocks that unite a large group of teeth, as well as for clamp fixation, it is not recommended to use roots with significant cystic changes in the periapical tissues, even if they have been successfully treated.

While maintaining the supragingival part of the tooth crown, protruding above the gingival margin, it is possible to use all types of pin teeth. In cases of destruction of this part of the crowns and the location of the root tissues at the level of the gums, pin teeth designs according to Kopeikin or cast structures can be used. The same constructions are shown in the destruction of root tissues subgingivally.

An important indicator of pin structures is the ratio of the length of the pin and the vertical size of the crown part. The length of the pin inserted into

root canal, corresponds to half or more of the length of the root and cannot be less than the vertical size of the restored coronal part.

For pins, use standard clasps, orthodontic wire of various diameters, corresponding to the diameter of the root canal. The shape of the pin is rectangular, oval.

The choice of pin design depends on the condition of the root and the qualifications of the doctor. The main attachment between the root and the extra-root part of such a prosthesis is a pin, which transfers pressure to the root walls, therefore there are

general clinical and technical rules for the root of the tooth:

The root must stand above the gum or be on the same level with it (this requirement is relative, since in other cases a different design should be chosen);

the root must be stable in the hole;

in the area of the root apex there should be no inflammatory changes in periodontal tissues;

the walls of the root must be of sufficient thickness and must not be affected by caries or other pathological process;

the root canal must be passable for a length not less than the height of the crown;

the root canal cannot be curved for two thirds of its length, counting from the enamel-cement joint;

the circular ligament of the tooth should not be damaged;

the root canal should be obturated with filling material not less than one third of the apical foramen.

Requirements for the roots of teeth that serve as a support for pin structures:

1. The root canal must be well passable for a length equal to the length of the pin.

2. The periapical part of the root canal should be well sealed and the apical periodontium should be free from signs of acute or chronic inflammation ( granuloma, cystogranuloma, cyst, etc.). In the presence of near-apical changes, if they are not extensive, in the absence of fistulas and good filling of the root apex, prosthetics with a pin tooth are acceptable. With significant damage to the periodontal apex of the root, prosthetics with a pin tooth can be carried out after root resection, if a sufficient length of the root remains.

3. The root must be longer than the height of the future crown.

4. The walls must be of sufficient thickness (at least 2 mm) to withstand the chewing pressure transmitted through the pin, and

speaking

affected

caries.

5. The root stump must be open. If it is covered by the gum, then a gingivectomy is performed.

6. The root must be stable.

Based on the clinical state of the supraalveolar part, 4 types of roots can be distinguished, which can be used as a support in the restoration of the crown part of the teeth (F.N. Tsukanova, 1986):

Type I - roots with a preserved supragingival part (2 mm or more);

Type II - roots at the level of the gums with the preservation of the walls;

Type III - roots, the edges of which are hidden under the gum;

IV type - roots with the destruction of the bifurcation.

The absence of conditions is a contraindication for the manufacture of pin structures. The nature of the bite should be taken into account, i.e. with a deep bite, preliminary orthodontic treatment is necessary, and if there are defects in the lateral sections of the dentition, their replacement. It is also necessary to take into account the anatomical, topographic and age features of the root canal.

^ LDS. Complete absence (destruction) of the tooth crown

	1. Pin teeth, in	2. Pin teeth,	3. Pin teeth,
Types of pin	which root		hermetically
structures	part is in contact with	in which the mouth	covering the stump
	tooth stump (Logan,	root canal	teeth not only
		closes with a tab	root
		(according to Citrine,	plate, but
		Ilyina-Markosyan)	ring (according to
			Richmond, Akhmetov)

^ Requirements,
presented	should be on	the tooth is on	should speak
	gum level and be	gum level and	above the gum by 1.5-2
	sealed up to	sealed up to	mm and be
	tops	tops	sealed up to
			tops
Indications	Complete destruction
	top teeth crowns
for use
pin
structures
	deep bite,
Contraindications	length mismatch
	root crown

Characteristics of various types of pin structures. Pin tooth with Richmond ring. Currently

is used extremely rarely. This design consists of a ring, a root protective plate and a pin. It can be made if the coronal part protrudes 2-3 mm above the gum. The circumference of the root is measured with a thin wire or a centimeter. According to this length, a ring is made of 900 gold alloy, 0.25-0.28 mm thick, 4-4.5 mm high, to which a plate is soldered to obtain a cap. After fitting the cap on the root, a hole is made in the plate, through which a gold-platinum alloy pin is fitted, an impression is taken, a model is obtained, on which the pin is connected to the cap with gold solder, and it is again applied to the stump. Complete impressions are taken from the dentition of both jaws, the models are plastered in an occluder. The future metal bed for the facet is modeled from wax, it is cast and soldered with a cap. Then they grind and attach a porcelain facet to the cap and metal stock or make a plastic lining. After that, the pin tooth is fitted and reinforced with cement.

Due to the complexity of manufacturing a brazed cap, a design with a stamped steel cap - a Richmond pin tooth in the MMSI modification - has become widespread. The protective cap is the main advantage of the Richmond pin tooth design: the ring provides reliable protection of the part of the root protruding above the gum from saliva, caries development and cementation.

Positive traits:

- the possibility of using with thin walls of the tooth root, strengthens them with a ring;

- the cap prevents the ingress of saliva and de-cementing of the pin structure;

- can be used as a support for a bridge prosthesis.

Negative qualities:

Translucence of metal in the area of the neck of the tooth, plastic quickly changes color.

Stages of manufacturing a pin tooth according to Richmond: 1. - preparation of the root;

2. - obtaining the dimensions of the root circle;

3. - fitting of the ring and pin;

4. - obtaining an impression with a ring and a pin and making a model;

5. - fitting mouthguard with a pin;

6. - taking impressions and casting a model with a kappa;

7. - production of a crown;

8. - fixation of the prosthesis in the oral cavity.

The tooth is prepared so that the root protrudes 1.5 mm above the gum level. To measure the circumference of the root, a loop of wire with a diameter of 0.4 mm (bindrat) is used, removing the loop from the root, it is cut, the wire is straightened and a strip of the desired length and width is cut along its length from a gold plate (900 samples). With the help of round-nose pliers, a ring is made from the strip, the edges of which are set end-to-end, soldered with 750 samples solder and fitted to the root. The edges are contoured along the neck of the tooth and advanced under the gum by 0.5 mm. To obtain a kappa, a gold plate and a gold pin are soldered to the ring. Then impressions are taken and models with mouthguards are cast. They are plastered in an occluder and a crown of the design chosen by the doctor is made.

Pin tooth according to Akhmedov. The root of the tooth is prepared in compliance with the rules for processing the tooth under a full metal crown. The stump of the tooth serves as a support for a snug fit of the edge of the crown and must necessarily protrude above the gum level. After fitting the metal crown, the oral wall of the crown is perforated with a drill according to the projection of the root canal, a previously fitted pin made of stainless wire is inserted through the hole into the root canal. Get an impression with a pin and determine the color of the plastic. A model is obtained in the laboratory, a pin is soldered to the crown, and a window is cut out on its vestibular surface. After facing, a crown is fitted with a pin in the mouth.

Stages of manufacturing a pin tooth according to A.A. Akhmedov.

This design is especially convenient when the gingival part of the crown is preserved.

1. tooth crown preparation

2. taking impressions of both dentitions

3. production of a stamped crown;

4. fitting of the pin and crown in the clinic;

5. obtaining an impression and determining the color of the future plastic cladding;

6. soldering in the laboratory of the tooth and pin, the manufacture of the veneer;

7. grinding, polishing;

8. the finished tooth with a pin is fitted in the oral cavity and fixed with cement.