I (pericardium; Greek peri around + kardia heart; obsolete synonym pericardial sac) tissue membrane surrounding the heart, aorta, pulmonary trunk, mouth of the vena cava and pulmonary veins. There are fibrous P. (pericardium fibrosum), covering ... ... Medical encyclopedia
CONNECTIONS- LIGAMENTS, ligamenta (from the Latin ligo I knit), a term used in the normal anatomy of the ligaments of humans and higher vertebrates primarily to designate dense connective tissue cords, plates, etc., complementing and reinforcing one or... ...
BLADDER- BLADDER. Contents: I. Phylogeny and ontogeny............119 II. Anatomy...................120 III. Histology...................127 IV. Methodology for researching M. n.......130 V. Pathology...................132 VI. Operations on M. p... Great Medical Encyclopedia
LITHOTOMY- (lithotomia), an operation performed for stone disease Bladder and consists of opening the bladder and removing stones from it. K. is one of the oldest operations, which was mentioned 6 centuries BC. e. in medical... ... Great Medical Encyclopedia
OTITIS- (from Greek ous, otos ear), inflammation of the ear; because anatomically the ear is divided into the outer ear ( Auricle, outdoor ear canal), average ( Eustachian tube, tympanic cavity) and internal (labyrinth), then otitis externa, mediae and... are distinguished. Great Medical Encyclopedia
Toothache- occurs as a result of damage to dental or surrounding tooth tissues, with neuralgia trigeminal nerve, as well as for a number common diseases. Most often it accompanies dental caries and its complications (Pulpitis, periodontitis, periostitis). For… … Medical encyclopedia
Pulpitis- Should not be confused with Bulbit Pulpitis ICD 10 K04.004.0 ICD 9 522.0522.0 DiseasesDB ... Wikipedia
KECAPCHOE SECTION- (sectio caesarea), operation of removing the fetus from the uterus through an incision abdominal wall. The concept of "K" With." expanded after the introduction in 1896 by Duhrssen of the kolpohysterotomia ant. method, which he called “vaginal Caesarean... ... Great Medical Encyclopedia
Amyloid of the Eye- EYE AMYLOID, Pat. process in which rum is deposited in the tissues of the eye amyloid substance(see Amyloid degeneration). This process is exclusively local in nature. They are subjected to it, ch. arr., conjunctiva in all its parts and cartilage of the upper and... ... Great Medical Encyclopedia
CHEST CAVITY- (cavum pectoris), enclosed in the chest, the walls of the cavity, lined with intrathoracic fascia (fascia endothoracica), limit it in front, from the sides and from behind. Below, the chest cavity is separated from abdominal cavity a diaphragm protruding into it in the form of... ... Great Medical Encyclopedia
GROIN AREA- (regio inguinalis) is located in the lower abdomen and represents a right triangle, the sides to which are the lower Poupart’s ligament, the upper part of the lineae interspinarig sup., inside the line running along the outer edge of the m. recti. Within these limits... ... Great Medical Encyclopedia
THEORY OF BUFFER ZONES
The study of the morphology of the tissues of the prosthetic bed and their reactions allowed E.I. Gavrilov to create a theory of buffer zones, which includes the following provisions:
1. The pliability of the mucous membrane of the prosthetic bed is explained by the ability of the vessels to change the volume of the bloodstream.
2. Buffer zones on upper jaw located between the base of the alveolar process and the middle zone corresponding to the palatal suture. These buffer zones project onto dense vascular fields hard palate.
3. Thanks to a dense network of anastomoses between the vessels of the mucous membrane of the hard palate and nose vascular bed The prosthetic bed can quickly change its volume under the influence of the prosthesis, acting as if it were a hydraulic shock absorber. 4. The base of a complete removable denture, regardless of the functional impression technique, makes microexcursions under the influence of a pulse wave.
5. The provision on buffer zones allows us to reveal the mechanism for distributing the chewing pressure of the prosthesis between the alveolar process and the hard palate.
6. Taking into account the shock-absorbing properties of the mucous membrane of the buffer zones, the advantage of a compression impression over an impression without pressure has been proven.
7. The pathogenesis of functional and structural changes in the tissues of the prosthetic bed is also based on the vascular factor, i.e. disruption of the blood supply to the mucous membrane of the prosthetic bed as a result of side effect prosthesis (Fig. 17).
Rice. 17, Scheme of buffer zones (according to Gavrilov)
The compliance of the mucous membrane lining the prosthetic bed is measured using point compliance, which occurs when pressing on the mucous membrane with a thin rod of the device.
Depending on the general condition man and his constitution by professor Kalinina 4 were allocated type of mucous membranes:
1. Dense mucous membrane, which distributes chewing pressure well. As a rule, such a mucous membrane is observed in almost healthy people normosthenic physique, regardless of age. Alveolar process atrophy is moderate.
2. Thin mucous membrane, which occurs, as a rule, in asthenics with varying degrees of atrophy of the alveolar processes. Occurs in older people with significant or complete atrophy alveolar processes.
3. Loose, pliable mucous membrane. Occurs in hypersthenics, in patients with general somatic diseases ( diabetes, cardiovascular diseases, etc.).
4. Mobile mucous membrane. Occurs in patients with periodontal diseases, observed with atrophy of the alveolar process and underlying bone as a result of increased pressure of the removable denture, i.e. in patients who have previously been fitted with removable dentures with pressure on the mucous membrane.
There are mobile and immobile mucous membranes. Mobile mucous membrane covers the cheeks, lips, floor of the mouth. She has a loose underside slime layer connective tissue and easily folds. When the surrounding muscles contract, this mucous membrane is displaced. Its degree of mobility varies widely (from large to insignificant).
motionless the mucous membrane is devoid of a submucosal layer and lies on the periosteum, separated from it by a thin layer of fibrous connective tissue. Its typical locations are the alveolar processes, the area of the sagittal suture and the palatine ridge. Only under the pressure of the prosthesis is the compliance of the immobile mucous membrane towards the bone revealed. This compliance is determined by the presence of vessels in the thickness of the connecting layer.
The transitional fold is the fornix, which is formed between the mobile and immobile mucous membrane. On the upper jaw, a transitional fold is formed during the transition of the mucous membrane from the vestibular surface of the alveolar process to the upper lip and cheek, and in distal section- into the mucous membrane of the pterygomaxillary fold. On the lower jaw, on the vestibular side, it is located at the place of transition of the mucous membrane of the alveolar part to the lower lip, cheek, and on the lingual side - at the place of transition of the mucous membrane of the alveolar part to the floor of the oral cavity.
The neutral zone is located on the border of the transitional fold and the fixed mucous membrane (Fig. 18)
Rice. 18. Scheme of the location of the fixed mucous membrane (a), neutral zone (b) and transitional fold (c)
QUESTION 14 The concept of “prosthetic bed”, “prosthetic field”
The prosthetic bed is all the tissues and organs of the oral cavity that have direct contact with the prosthesis.
The prosthetic field is all tissues, organs and systems of the body that have direct and indirect contact with the prosthesis. This is a broader concept that includes the concept of a prosthetic bed. For partial removable dentures, the prosthetic bed is:
The mucous membrane of the hard palate, alveolar part, as well as the cheeks, lips and tongue, which have direct contact with the prosthesis constantly or sometimes.
Abutment teeth
Chewing surface antagonist teeth. For fixed dentures (inlays, crowns), the bed is: The wound surface of the crown; Walls of the cavity for the inlay; The mucous membrane of the gingival pocket; Chewing surface of antagonist teeth. The prosthetic field, in addition to the above, are: 1. the mucous membrane of the gastrointestinal tract, since the work of the gastrointestinal tract depends on the quality of food processing in the oral cavity, that is, the better the food is processed, the less the load on the gastrointestinal tract and vice versa;
2. temporomandibular joint and masticatory muscles;
3. the patient’s psyche, since the prosthesis has an effect on the psyche.
QUESTION 15 Facial muscles, their functions
Facial muscles, starting on the surface of the bone or from the underlying fascia and ending in the skin, are capable, when contracted, of causing expressive movements of the facial skin (facial expressions) and reflecting the state of mind (joy, sadness, fear). They are also involved in articulate speech and the act of chewing!
Majority facial muscles concentrated around the mouth opening and palpebral fissure. Their muscle bundles have a circular or radial course. The circular muscles act as sphincters, and the radially located muscles act as dilators. Human facial muscles due to the high differentiation of the central nervous system, in particular With the existence of a second signaling system are the most advanced. The participation of facial muscles in the act of chewing is to capture food and hold it in the mouth while chewing. These muscles play a special role in the act of sucking when taking liquid food.
Highest value V orthopedic dentistry have muscles surrounding the opening of the mouth. In a child, they affect the growth of the jaws and the formation of the bite, and in an adult, they change the facial expression with partial or complete loss of teeth. Knowledge of the functions of these muscles helps to correctly plan treatment, for example, using myogymnastics, or design prostheses taking into account facial expressions. This muscle group includes:
1) orbicularis oris muscle (orbicularis oris);
2) the muscle that lowers the angle of the mouth (t.
3) muscle that lowers the lower lip (m.
4) mental muscle (t. teshanz);
5) buccal muscle (t. buccal muscle);
6) muscle that lifts the upper lip (t.
7) zygomaticus minor muscle (t.
8) zygomaticus major muscle (t. g!§otap "siz ta]og);
9) muscle that lifts the angle of the mouth (t.
10) muscle of laughter (i.e. drowning).
Materials for filmed prints, their classification, indications for application and properties. Medical-technical
requirements for sending materials
At our department, we consider all materials from the perspective of three groups: 1. Basic or structural materials. 1, Auxiliary materials, 3. Impression or impression materials.
Classification
It is very difficult to classify impression materials. You can select
the following groups:
1) impression materials that harden in the oral cavity (zincoxy-
eugenol masses, gypsum);
2) impression materials that acquire elasticity after polymerization (alganate, silicone, thiokol materials),
3) thermoplastic masses, which, like the masses of the first group, harden in the oral cavity. Distinctive property them is that they become plastic when heated (wall, thermomass MST-2: 3, stomoplast, orthocor, dentofol, xantigen, etc.). As these materials cool, they become hard, exhibiting reversibility.
Classification by I.M. Oksman (according to physical condition material after hardening):
Crystallizing materials (gypsum, Repin, Dentol)
2. Thermoplastic (Stene, Acrodent, Orthocor, Stomoplast, Dentafol)
3. Elastic:
e Alginate (Stomalgic)
« Silicone (Sielast 03, 05, 21, 22, 69) (Elastic).
* Thiokol (Tiodent)
Indications to the use of gzttisk materials
1, for obtaining impressions in the manufacture of removable dentures with partial loss of teeth and complete absence of teeth.
2, for obtaining impressions in the manufacture of supported clasp
Prosthetics
3. .to obtain impressions in the presence of convergence and divergence of teeth.
4. to obtain impressions in the manufacture of fixed dentures:
a) crowns
b) pin teeth
c) tabs
d) bridges various designs.
6. in the manufacture of splints and prosthetic splints for orthopedic treatment
periodontal disease.
7. in the manufacture of complex maxillofacial prostheses, obturators.
8. for relining and correcting removable dentures in a laboratory manner.
9. for making two-layer bases (with soft lining)
10. when repairing removable dentures
Currently, the industry produces textile masses of various chemical compositions and properties. Each of them has its own positive and negative qualities, allowing it to be used in certain cases. It should be said that there is no universal mass suitable for all types of impressions. Therefore, the doctor must have a large assortment of impression materials at his disposal in order to choose the one that best suits the tasks.
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healthy mucous membrane has a pale pink color in the gum area and pink in other areas. If there are various pathological processes the color of the mucous membrane changes, its configuration is disrupted, and various elements of damage appear on it. Hyperemic areas indicate inflammation, which is usually accompanied by tissue swelling. Sharp hyperemia is characteristic of acute inflammation, a bluish tint is characteristic of chronic inflammation. If certain deviations in the color and structure of the mucous membrane are detected, it is necessary, through a survey, to establish the time of appearance of these changes, what sensations they are accompanied by, and determine the tactics for further examination, not forgetting about oncological alertness. For example, areas of increased keratinization can develop into a focus of neoplasm.
Elements of damage to the mucous membrane. Examination of the mucous membrane should be based on a correct assessment of local and general etiopathogenetic factors, since they can act not only independently, but also in combination. For example, the causes of symptoms such as hyperemia, bleeding, swelling and burning of the mucous membrane of the prosthetic bed may be: 1) mechanical injury; 2) disturbance of heat exchange of the mucous membrane due to poor thermal conductivity of a plastic prosthesis; 3) toxic-chemical effects of plastic ingredients; 4) allergic reaction to plastic; 5) changes in the mucous membrane with some systemic diseases(vitaminosis, endocrine diseases, gastrointestinal tract); 6) mycoses.
The following elements of damage to the mucous membrane are found: erosion - surface defect; aphthae - small round areas of ulceration of the epithelium of a yellow-gray color with a bright red inflammatory rim; ulcers - a defect of the mucous membrane and underlying tissue with uneven, undermined edges and covered gray coating bottom; hyperkeratosis - excessive keratinization with a decrease in the desquamation process. It is necessary to use all outpatient and laboratory methods to identify the cause of the lesion ( colds, contact with an infectious patient, gastrointestinal disease, etc.). Very probable causes should not be excluded - trauma to this area by a sharp edge of a tooth, a tilted or displaced tooth, a poor-quality prosthesis, electrochemical damage to tissues as a result of the use (in the manufacture of prostheses) of different metal alloys with different electrolytic potentials (stainless steel and gold). It must be remembered that the traumatic areas may be located at a distance from the injured area of the tongue or cheek due to the displacement of tissues or the tongue during conversation or eating. During the examination, the patient is asked to open and close his mouth, move his tongue - this will help clarify the traumatic area.
Traumatic injuries - ulcers - must be differentiated from cancerous and tuberculous ulcerations, syphilitic ulcers.
Long-term trauma can lead to hypertrophy of the mucous membrane. Are formed benign tumors: fibroma - a tumor of fibrous connective tissue, papilloma - a tumor developing from squamous epithelium and protruding above its surface; papillomatosis - the formation of multiple papillomas.
When identifying petechial (petechiae is a spot on the mucous membrane with a diameter of up to 2 mm, formed as a result of capillary hemorrhage) rashes on the mucous membrane of the soft and hard palate, even if the patient uses a removable denture, it is first necessary to exclude a blood disease. Thus, with thrombocytopenic purpura (Werlhof's disease), areas of hemorrhage (hemorrhages) appear on the mucous membrane in the form of pinpoint bright red spots, sometimes purple, cherry-blue or brown-yellow in color.
You should remember about chemical and electrochemical damage to the mucous membrane, as well as possible allergic reaction to the base material.
Having assumed one or another form of the disease, it is necessary to carry out additional laboratory research(blood analysis, cytological examination fingerprint smears, bacteriological, immunological studies) or refer the patient to a dentist or surgeon, dermatovenerologist. It should also be remembered that the discrepancy between the clinical (presumptive) and cytological diagnoses serves as an indication not only for re-examination, but also for expanding research methods.
Establishing the nature of lesions of the oral mucosa, the reasons that caused or maintained this lesion, is important for choosing a treatment method and the material from which dentures and appliances must be made. It has now been proven that when chronic diseases oral mucosa (red lichen planus, leukoplakia, leukokeratosis) orthopedic measures occupy a leading place in complex therapy.
An increase in the size of the papillae, the appearance of bleeding gums, a bluish tint or sharp hyperemia indicate the presence of subgingival calculus, irritation of the gingival margin by the edge of an artificial crown, filling, removable denture, the absence of interdental contacts and injury to the mucous membrane by food lumps. These symptoms may occur when various types gingivitis, periodontitis (Fig. 44). The presence of fistula tracts and scar changes on the gums confirms the presence of an inflammatory process in the periodontium (Fig. 45). Painful areas, swelling (bulging), and sometimes fistulous tracts with purulent discharge may form on the gums, as well as along the transitional fold. They arise as a result of inflammatory (acute or chronic) processes in the periodontium.
On the mucous membrane of the cheek and tongue, you can sometimes notice tooth marks and areas of hemorrhage from biting the mucous membrane during chewing. These phenomena arise as a result of tissue edema, which in turn develops in diseases of the gastrointestinal tract. Traces from biting the tongue and cheeks can be detected when the occlusal height decreases, violations of the occlusal relationships of individual teeth; finally they can appear during epileptic seizure, dyskinesia (a disorder of coordinated motor acts, consisting of impaired spatial coordination of movements) of the tongue with damage to the nervous system.
The degree of hydration of the mucous membrane is also subject to assessment. Dry mucous membrane (xerostomia) is caused by hyposecretion salivary glands, which occurs as a result of diseases of the parotid and sublingual glands; noted in diabetes, candidiasis. If you complain of dry mouth, it is necessary to palpate these glands and determine the quantity and quality of saliva. Normally, a few drops of clear secretion are released from the ducts.
Topographic and anatomical features of the structure of the mucous membrane of the prosthetic bed. Great importance When examining a patient in need of orthopedic treatment, it is necessary to study the topographic and anatomical features of the structure of the mucous membrane of the prosthetic bed. This is of particular importance when choosing impression materials, using removable denture structures, and dispensary observation of people using dentures (assessing the quality of treatment).
Rice. 46. Oral mucosa.
a - upper frenulum; lips; b - buccal-gingival fold; c - transverse palatal folds; g - seam of the sky; d - blind fossa; e - pterygomaxillary fold; g - palatine tonsil; z - pharynx; and - language; j - lower buccal-gingival fold.
Rice. 47. Scheme of the location of the mucous membrane of the alveolar process.
a - actively mobile; b - passively mobile; c - immobile mucosa; d - transitional fold; d - valve zone.
In the vestibule of the mouth, both the upper and lower jaws have frenulums of the upper lip and lower lip (Fig. 46). As a rule, the frenulum ends on the mucous membrane of the alveolar process, not reaching the gingival margin by 5-8 mm. The other end connects to the aponeurosis of the orbicularis oris muscle. Sometimes the frenulum reaches the level of the gingival margin, attaching to the gingival papilla between the central incisors. Such an abnormal attachment, as a rule, leads to the formation of a gap between the central incisors - a diastema, and over time to retraction of the gingival margin of these teeth. V
On the vestibular side in the area of the premolars on both the upper and lower jaws on the right and left there are lateral buccal-gingival folds.
Inspect and determine the boundaries of the frenulum and folds by moving the lip, and then the cheek forward and upward with the mouth half open.
With the loss of teeth, the place of attachment of the frenulum and folds does not change, but due to atrophy of the alveolar process, it seems to approach its center. When examining the vestibule of the mouth, it is necessary to determine the boundaries of the transition of the fixed mucous membrane into the mobile one, and in the latter - the boundary of the transition of the passively mobile mucous membrane into the actively mobile one.
Passively mobile mucous membrane - a section of the mucosa that has a pronounced submucosal layer, due to which it can move in different directions when applied external force(one should not confuse the concepts of “mobile” and “pliable”. The mucous membrane is always pliable, but the degree of compliance is very different, but the pliable mucous membrane is not always mobile). The zone of passively mobile mucous membrane on the vestibular side in orthopedics is called the neutral zone (Fig. 47).
Actively mobile mucous membrane is a section of the mucosa that covers the muscles and moves when the latter contract.
The place of transition of the actively mobile mucous membrane of the alveolar process into the same mucous membrane of the cheek is called the transitional fold. It is the upper (for the upper jaw) and lower (for the lower jaw) border of the arch of the vestibule of the mouth.
The vault of the oral vestibule has a variable volume in length and, as a rule, is narrow in the anterior region and widens in the distal direction. Both the volume of the arch and its vertical size decrease when the mouth opens, since the contracting muscles of the cheek or lip seem to be pressed against the alveolar process.
Accepted in orthopedic dentistry special term"valve zone". It extends from the transition point of the fixed mucous membrane to the actively mobile one on the cheek.
To determine the boundaries of different areas of the mucous membrane, palpation and inspection are used. During the examination, by retracting the lip and then the cheek, the examinee is asked to slowly open and close his mouth and strain individual muscle groups. To determine the boundaries of the transitional fold on the oral side on the lower jaw, they are asked to move the tongue. These tests are described in detail in Chapter 7. Behind the tubercle of the upper jaw, a pterygomandibular fold is identified, running from the pterygoid hook to the buccal protrusion (ridge) on the lower jaw. The fold is well defined when the mouth is opened wide. Sometimes a small mucous fold runs from the tubercle in the distal direction to the pterygomandibular fold. The latter, like all of the above, must be taken into account both when taking an impression and when determining the boundaries of a removable denture: the denture must have recesses that exactly correspond to the volume of the folds.
In the vestibule of the mouth, on the mucous membrane of the cheek at the level of the crown of the second upper molar, there is excretory duct parotid gland, having the shape of a rounded elevation.
From the oral side, all areas of the hard and soft palate are subject to inspection and examination. The condition (severity, position, color, pain) of the incisive papilla (papilla incisiva), transverse palatine folds (plicae palatinae transversae), palatal suture (raphe palati) and the presence of the palatine ridge (torus palatinus) are determined. U different persons they can be significantly or, conversely, weakly expressed or completely unnoticeable, but this is not a pathology. At the same time, the height of the vault of the palate is determined, which depends on the vertical size of the alveolar process (this value varies depending on the presence or absence of teeth, the cause of tooth loss) and the development of the entire jaw. Thus, with a narrow upper jaw, the vault of the palate is almost always high, while with a brachycephalic shape of the skull and a wide face, it is flat.
At the border of the hard and soft palate, on the sides of the median palatal suture, there are palatine blind fossae, which serve as a guide in determining the boundaries of removable dentures.
Rice. 48. “Dangling” alveolar ridge according to Supplee.
Along the line of location of these pits, the normally pale pink mucous membrane of the hard palate passes into the mucous membrane of the soft palate, which has a pinkish-red color. The mucous membrane of the hard palate is covered with stratified squamous keratinizing epithelium and is tightly connected to the periosteum almost throughout its entire length (alveolar process, palatine suture and small areas to the right and left of it). In these areas, the mucous membrane is stubborn and immobile. In areas in the anterior part of the hard palate in the submucosal layer there is a small amount of adipose tissue, which determines its vertical compliance (compression during palpation, compression from a hard object). The palatal folds and incisive papilla can also move horizontally.
In the posterior third of the palate at the level of the second or third molar there are large and small openings through which neurovascular bundles, directed anteriorly, with a well-defined submucosal layer. In the area from the base of the alveolar process to the area of the palatal folds and the median suture, the mucous membrane is very pliable.
Taking into account the structure of the submucosal layer, the following zones are distinguished in the immobile or limitedly mobile mucous membrane, based on varying degrees of compliance: the region of the alveolar process, the region of the median suture, the region of the transverse palatal folds and incisive papilla, the region of the middle and posterior thirds of the palate.
Changes observed after tooth extraction mainly affect bone tissue, but can also be observed in the mucous membrane; in the center of the alveolar process it loosens, has an irregular configuration, longitudinal folds appear, zones of inflammation and increased sensitivity, as well as areas of mobile mucosa - a “dangling” alveolar ridge (Fig. 48).
These changes occur due to poor oral hygiene, poorly manufactured prosthesis, as a result of resorption bone tissue and replacing it with connective tissue during periodontitis.
In the lower jaw, in the oral cavity itself, the frenulum of the tongue, the floor of the mouth, the retroalveolar region and the mandibular tubercle are examined. The mucous membrane lining the floor of the mouth passes from the tongue, and then into the mucous membrane of the body and the alveolar part of the jaw. Several folds form here. The frenulum of the tongue is a vertical fold of mucous membrane that runs from the lower surface of the tongue to the floor of the mouth and connects to the oral surface of the gums. The fold is clearly visible when the tongue moves. The frenulum may be short and limit the movement of the tongue, causing tongue-tiedness. If the fold is attached close to the gingival margin of the incisors, gum retraction may occur. After removal of the incisors, due to bone tissue atrophy, the fold seems to move to the center of the alveolar part of the body. On the sides of the frenulum, the ducts of the submandibular and sublingual salivary glands open, from which distally there is an elevation (ridge) formed by the duct and the body of the gland.
A feature of the mucous membrane of the floor of the mouth is the presence of a well-developed submucosal layer with loose connective and adipose tissue and underlying muscles: mylohyoid and chin hypohyoid. This explains the high mobility of tissues during tongue movements. The retroalveolar region is limited by the posterior edge of the mylohyoid muscle, posteriorly by the anterior palatine arch, on the sides by the root of the tongue and the inner surface of the lower jaw. This area is important because it is where there is no muscle layer. Its absence determines the need to use this area for fixation of a removable denture. Mandibular tubercle is a formation of mucous membrane in the center of the alveolar part, immediately behind the wisdom tooth. TO distal end The tubercle is attached to the pterygomaxillary fold, so this zone seems to rise upward when the mouth opens wide.
The mucous mandibular tubercle has various shapes and volumes, can be mobile and is always pliable.
Orthopedic dentistry
Edited by Corresponding Member of the Russian Academy of Medical Sciences, Professor V.N. Kopeikin, Professor M.Z. Mirgazizov
THEORY OF BUFFER ZONES
The study of the morphology of the tissues of the prosthetic bed and their reactions allowed E.I. Gavrilov to create a theory of buffer zones, which includes the following provisions:
1. The pliability of the mucous membrane of the prosthetic bed is explained by the ability of the vessels to change the volume of the bloodstream.
2. Buffer zones on the upper jaw are located between the base of the alveolar process and the middle zone corresponding to the palatal suture. These buffer zones project onto the dense vascular fields of the hard palate.
3. Thanks to the dense network of anastomoses between the vessels of the mucous membrane of the hard palate and the nose, the vascular bed of the prosthetic bed can quickly change its volume under the influence of the prosthesis, being, as it were, a hydraulic shock absorber. 4. The base of a complete removable denture, regardless of the functional impression technique, makes microexcursions under the influence of a pulse wave.
5. The provision on buffer zones allows us to reveal the mechanism for distributing the chewing pressure of the prosthesis between the alveolar process and the hard palate.
6. Taking into account the shock-absorbing properties of the mucous membrane of the buffer zones, the advantage of a compression impression over an impression without pressure has been proven.
7. The pathogenesis of functional and structural changes in the tissues of the prosthetic bed is also based on the vascular factor, i.e. disruption of the blood supply to the mucous membrane of the prosthetic bed as a result of a side effect of the prosthesis (Fig. 17).
Rice. 17, Scheme of buffer zones (according to Gavrilov)
The compliance of the mucous membrane lining the prosthetic bed is measured using point compliance, which occurs when pressing on the mucous membrane with a thin rod of the device.
Depending on the general condition of a person and his constitution, the professor Kalinina 4 were allocated type of mucous membranes:
1. Dense mucous membrane, which distributes chewing pressure well. As a rule, such a mucous membrane is observed in practically healthy people of normosthenic physique, regardless of age. Alveolar process atrophy is moderate.
2. Thin mucous membrane, which occurs, as a rule, in asthenics with varying degrees of atrophy of the alveolar processes. Occurs in older people with significant or complete atrophy of the alveolar processes.
3. Loose, pliable mucous membrane. It occurs in hypersthenics and in patients with general somatic diseases (diabetes mellitus, cardiovascular diseases, etc.).
4. Mobile mucous membrane. Occurs in patients with periodontal diseases, observed with atrophy of the alveolar process and underlying bone as a result of increased pressure of the removable denture, i.e. in patients who have previously been fitted with removable dentures with pressure on the mucous membrane.
There are mobile and immobile mucous membranes. Mobile mucous membrane covers the cheeks, lips, floor of the mouth. It has a loose submucosal layer of connective tissue and easily folds. When the surrounding muscles contract, this mucous membrane is displaced. Its degree of mobility varies widely (from large to insignificant).
motionless the mucous membrane is devoid of a submucosal layer and lies on the periosteum, separated from it by a thin layer of fibrous connective tissue. Its typical locations are the alveolar processes, the area of the sagittal suture and the palatine ridge. Only under the pressure of the prosthesis is the compliance of the immobile mucous membrane towards the bone revealed. This compliance is determined by the presence of vessels in the thickness of the connecting layer.
The transitional fold is the fornix, which is formed between the mobile and immobile mucous membrane. On the upper jaw, a transitional fold is formed when the mucous membrane passes from the vestibular surface of the alveolar process to the upper lip and cheek, and in the distal part - into the mucous membrane of the pterygomaxillary fold. On the lower jaw, on the vestibular side, it is located at the place of transition of the mucous membrane of the alveolar part to the lower lip, cheek, and on the lingual side - at the place of transition of the mucous membrane of the alveolar part to the floor of the oral cavity.
The neutral zone is located on the border of the transitional fold and the fixed mucous membrane (Fig. 18)
Rice. 18. Scheme of the location of the fixed mucous membrane (a), neutral zone (b) and transitional fold (c)
QUESTION 14 The concept of “prosthetic bed”, “prosthetic field”
The prosthetic bed is all the tissues and organs of the oral cavity that have direct contact with the prosthesis.
The prosthetic field is all tissues, organs and systems of the body that have direct and indirect contact with the prosthesis. This is a broader concept that includes the concept of a prosthetic bed. For partial removable dentures, the prosthetic bed is:
The mucous membrane of the hard palate, alveolar part, as well as the cheeks, lips and tongue, which have direct contact with the prosthesis constantly or sometimes.
Abutment teeth
Chewing surface of antagonist teeth. For fixed dentures (inlays, crowns), the bed is: The wound surface of the crown; Walls of the cavity for the inlay; The mucous membrane of the gingival pocket; Chewing surface of antagonist teeth. The prosthetic field, in addition to the above, are: 1. the mucous membrane of the gastrointestinal tract, since the work of the gastrointestinal tract depends on the quality of food processing in the oral cavity, that is, the better the food is processed, the less the load on the gastrointestinal tract and vice versa;
2. temporomandibular joint and masticatory muscles;
3. the patient’s psyche, since the prosthesis has an effect on the psyche.
QUESTION 15 Facial muscles, their functions
Facial muscles, starting on the surface of the bone or from the underlying fascia and ending in the skin, are capable, when contracted, of causing expressive movements of the facial skin (facial expressions) and reflecting the state of mind (joy, sadness, fear). They are also involved in articulate speech and the act of chewing!
Most of the facial muscles are concentrated around the mouth and palpebral fissure. Their muscle bundles have a circular or radial course. The circular muscles act as sphincters, and the radially located muscles act as dilators. Human facial muscles due to the high differentiation of the central nervous system, in particular With the existence of a second signaling system are the most advanced. The participation of facial muscles in the act of chewing is to capture food and hold it in the mouth while chewing. These muscles play a special role in the act of sucking when taking liquid food.
The muscles surrounding the opening of the mouth are of greatest importance in orthopedic dentistry. In a child, they affect the growth of the jaws and the formation of the bite, and in an adult, they change the facial expression with partial or complete loss of teeth. Knowledge of the functions of these muscles helps to correctly plan treatment, for example, using myogymnastics, or design prostheses taking into account facial expressions. This muscle group includes:
1) orbicularis oris muscle (orbicularis oris);
2) the muscle that lowers the angle of the mouth (t.
3) muscle that lowers the lower lip (m.
4) mental muscle (t. teshanz);
5) buccal muscle (t. buccal muscle);
6) muscle that lifts the upper lip (t.
7) zygomaticus minor muscle (t.
8) zygomaticus major muscle (t. g!§otap "siz ta]og);
9) muscle that lifts the angle of the mouth (t.
10) muscle of laughter (i.e. drowning).
Materials for filmed prints, their classification, indications for application and properties. Medical-technical
requirements for sending materials
At our department, we consider all materials from the perspective of three groups: 1. Basic or structural materials. 1, Auxiliary materials, 3. Impression or impression materials.
Classification
It is very difficult to classify impression materials. You can select
the following groups:
1) impression materials that harden in the oral cavity (zincoxy-
eugenol masses, gypsum);
2) impression materials that acquire elasticity after polymerization (alganate, silicone, thiokol materials),
3) thermoplastic masses, which, like the masses of the first group, harden in the oral cavity. Their distinctive property is that they become plastic when heated (wall, thermomass MST-2: 3, Stomoplast, Orthocor, Dentofol, Xantigen, etc.). As these materials cool, they become hard, exhibiting reversibility.
Classification by I.M. Oksman (according to the physical state of the material after hardening):
Crystallizing materials (gypsum, Repin, Dentol)
2. Thermoplastic (Stene, Acrodent, Orthocor, Stomoplast, Dentafol)
3. Elastic:
e Alginate (Stomalgic)
« Silicone (Sielast 03, 05, 21, 22, 69) (Elastic).
* Thiokol (Tiodent)
Indications to the use of gzttisk materials
1, for obtaining impressions in the manufacture of removable dentures with partial loss of teeth and complete absence of teeth.
2, for obtaining impressions in the manufacture of supported clasp
Prosthetics
3. .to obtain impressions in the presence of convergence and divergence of teeth.
4. to obtain impressions in the manufacture of fixed dentures:
a) crowns
b) pin teeth
c) tabs
d) bridges of various designs.
6. in the manufacture of splints and prosthetic splints for orthopedic treatment
periodontal disease.
7. in the manufacture of complex maxillofacial prostheses, obturators.
8. for relining and correcting removable dentures in a laboratory manner.
9. for making two-layer bases (with soft lining)
10. when repairing removable dentures
Currently, the industry produces textile masses of various chemical compositions and properties. Each of them has its own positive and negative qualities, allowing it to be used in certain cases. It should be said that there is no universal mass suitable for all types of impressions. Therefore, the doctor must have a large assortment of impression materials at his disposal in order to choose the one that best suits the tasks.
Source: infopedia.su
The gums are the most vulnerable part oral cavity. Unpleasant smell from the mouth, bleeding while brushing teeth are direct signs of periodontal disease, which are subsequently complicated by loosening and loss of teeth. Gum problems can bother a person at any age, and each of them requires specific treatment. Let's take a closer look at ways to combat periodontal pathologies and the symptoms of the most common types of gum diseases.
Functions
To understand the functions of periodontal tissue, you must first consider what the gums look like. The main role of the periodontium is to protect the oral cavity from negative influences.
The main functions of the gums include:
- plastic – regular renewal and restoration of gum tissue;
- trophic – regulation of reflex pressure due to the presence of many nerve endings in the gum tissue;
- protective – achieved due to the special structure of the periodontium and the presence of keratinized epithelium on it;
- shock-absorbing - the gums reduce the load on the jaw bones when chewing food and prevent damage to the alveolar processes.
Structure
The gum consists of several main parts, each of which is worth considering separately:
- free edge;
- alveolar area;
- transition fold,
- gingival sulcus.
A person can see all these departments independently using a mirror. The alveolar part of the gum is especially clearly distinguished, since it is the largest. Only a dentist can examine the condition of the gingival sulcus in detail using special instruments.
Free edge
It is located near the base of the tooth (or the cervical part of the crown). This tissue is considered mobile. The marginal region has no connection with the jaw bones and tooth roots. In appearance, the free edge looks like a triangle and occupies a width of about 1.5 mm.
Alveolar area
The alveolar margin is considered immobile and has a strong connection with the roots of the elements and the alveolar bone. This area is clearly visible in the mirror, as it occupies almost the entire periodontal area. The width of the attached gum area is up to 9 mm. Its surface is covered with multilayer epithelium, which protects gum cells from negative external influences.
If the alveolar edge lags behind the tooth, periodontitis develops. The size of the gum pocket is more than 3 mm. Gradually, food particles and bacterial plaque enter the resulting pockets, causing infectious complications in the oral cavity. Large periodontal pockets cause the development of periodontal disease and loss of dentition.
Gingival sulcus
The area is located between the edge of the gum and the elements of the dentition. Usually its width is up to 0.7 mm, less often up to 2 mm. When periodontal inflammation occurs, serum exudate enters the gingival grooves, causing the appearance of stone on the teeth. This condition requires dental care, since it is not possible to cope with cervical tartar on your own.
Transitional fold
The gum ends with a transitional fold. There is a loose submucosal layer at the site. Due to the transitional fold, a smooth transition to the moving areas of the mucous membranes of the mouth (lips, cheeks) is ensured. The epithelium of this area is renewed 6 times faster than other areas of the oral mucosa.
Diseases
One of the most commonly observed gum diseases is periodontitis. 70% of the planet's inhabitants encounter pathology every year, and every year it becomes more common. Advanced forms of the disorder lead to loosening of the teeth and their falling out of the socket. In place of destroyed periodontal fibers, voids appear, which dentists call periodontal pockets.
Causes of gum problems include:
- bruxism;
- metabolic disorder;
- malfunction of the immune system;
- bite defects;
- poor oral care.
The main signs of pathology: bad breath. Discharge of purulent masses when pressing on the gums, blood while brushing teeth, increased pain symptoms during meals, exposure of the neck of the teeth.
In children, exacerbation of signs of periodontitis is observed during teething or when changing milk bite permanent. The cause of the disorder in this case is insufficient oral care.
Another gum pathology that has a non-infectious etiology is periodontal disease. It develops due to the gradual reduction of jaw bone tissue. In case of violation appearance gum remains unchanged.
The main signs of periodontal disease:
- discomfort while eating and when brushing teeth;
- increased reaction of teeth to temperature stimuli.
Among the causes of pathology, one should highlight: hormonal imbalance, smoking, lack of microelements in the body, violation metabolic processes in organism. The risk group for the disease includes women suffering from polycystic ovary syndrome.
Periodontitis is another serious dental disorder that develops against the background of pulpitis and advanced forms of caries. In rare cases, infection occurs against the background of sinusitis, osteomyelitis, and otitis.
Characteristic signs of periodontitis:
- aching pain;
- inflammation of the submandibular lymph nodes;
- purulent discharge from the mouth;
- spread of pain to the temporal region;
- temperature increase.
2 weeks after the first signs appear, periodontitis becomes chronic and difficult to treat.
Epulis is a tumor on the tissues of the parenchyma, characterized by its small size and red tint. Gum disease is asymptomatic if the neoplasm is benign. Cancer tumor gradually increases in size and is accompanied by a number of symptoms:
- swelling;
- destruction of the root canals of the tooth;
- the formation of ulcers and erosions in the oral cavity.
Epulis appears as a result of bite defects, the formation of tartar on the enamel, or an incorrectly installed orthodontic system.
Acute or chronic inflammation In dentistry, gum disease is called gingivitis. Treatment of the pathology is quite easy if its cause and provoking factors are correctly identified. In a difficult-to-treat form, gingivitis occurs in people with metabolic problems and thyroid gland. In this case it is required individual approach when drawing up a treatment regimen.
Other causes of gum health problems include:
- disturbances in the gastrointestinal tract;
- weakened immunity;
- tuberculosis;
- eruption of baby teeth in children or wisdom teeth in adults;
- lack of vitamin C in the body;
- diabetes.
The chronic form of gingivitis is asymptomatic. The only symptom of the disorder is periodontal hyperplasia. Often, overgrown tissue completely covers the crown of the tooth. The acute form of gingivitis is accompanied by pain in the affected area, swelling and bleeding.
Fighting gum pathologies
The first step in gum treatment is an examination of the oral cavity by a dentist. After this, the specialist begins to sanitize the carious lesions and remove plaque on the enamel using ultrasound. These measures are necessary to prevent re-exacerbation of dental disorders.
By removing tartar, it is possible to prevent a number of problems - periodontitis, gingivitis. After the stone is removed, the teeth are polished to reduce the risk of bacterial plaque forming on their surfaces. Enamel polishing is postponed to another date when acute course gingivitis or periodontitis. Carious lesions are sanitized and filled with composite material. Teeth that are not amenable to therapeutic treatment are removed.
Drug therapy
Used to combat gum disease pharmacological agents. They can reduce the intensity of the symptoms of disorders, but do not affect their cause. Typically, medications used to combat the symptoms of gum disease are applied topically. In rare cases, dentists prescribe pills to patients.
To reduce gum pain, potent medications are prescribed - Ketanov, Tempalgin. You are allowed to drink more than 3 tablets per day. Maximum time taking painkillers – 3 days.
To relieve discomfort, ointments and gels are used - Kamistad, Cholisal. The products are characterized complex action: they reduce swelling of the soft tissues of the mouth, minimize the severity of inflammatory processes and promote the regeneration of damaged mucous membranes. Ointments are allowed to be used no more than 6 times a day for 1-2 weeks.
To prevent complications of infectious gum diseases, use antiseptic solutions for mouth rinse – Chlorhexidine, Miramistin, hydrogen peroxide
In rare cases (with fever and extensive inflammation), patients are recommended to take antibiotics: Metronidazole, Erythromycin, Ampicillin. Mouth rinsing is not performed only after tooth extraction, because this interferes with the formation of a protective clot in the socket.
Selection of suitable pastes
Therapy of dental diseases is necessarily complemented by competent daily hygiene procedures. The composition of a toothpaste intended for gum care should include: herbal ingredients with anti-inflammatory effects (sage, chamomile, calendula, oak bark); antimicrobial substances that have a detrimental effect on gram-positive and gram-negative microorganisms (triclosan, copolymer), regenerating substances ( vegetable oils, vitamin E).
Medicinal pastes are not intended for regular use, as they can upset the balance of oral microflora. Products containing antibacterial components can be used for no longer than 3 weeks.
The brush that is used during the treatment of gum pathologies should have soft bristles and a surface for cleaning the gums. This will avoid severe bleeding of periodontal tissues during hygiene procedures. After completing the course of therapy, it is recommended to change the brush.
Traditional medicine
Herbs and other natural ingredients relieve signs of dental problems no worse than medications, but they need to be used at the initial stages of the problem. Facilities alternative medicine can also be used in cases where it is not possible to urgently consult a dentist or for the prevention of dental disorders.
You can cope with inflammation at home by:
- Soda solution with added sea salt. They need to rinse their mouth 4-6 times a day. To prepare the product, you need to dissolve 1 tsp. each dry ingredient in 200 ml of warm water.
- Applications with aloe or kalanchoe. The leaf of the plant is crushed to a paste and applied to the problem area of the oral cavity for 15-20 minutes.
- Lotions based on tincture of propolis, cloves or mint. A small cotton swab is moistened in liquid and applied to the gum for 10 minutes 3 times a day.
Gum diseases are easy to cure in the initial stages of development and difficult to eliminate when they become chronic. Preventive rules will help prevent gingivitis, periodontitis, periodontal disease and gumboil, including good nutrition and daily brushing of teeth using a standard kit and floss, complete gum care.
