There are a lot of diseases in dentistry that can not only cause a lot of discomfort, but also significantly worsen appearance. One of these pathologies is adentia.

The disease is characterized by the absence of teeth; depending on the form, this may be partial or complete loss. Only a specialist can diagnose the form of the disorder. In this case, an examination, palpation examination, orthopantomography and targeted intraoral radiography are carried out.

When treating adentia, rational treatment is most often carried out using complete and partial and, or.

Adentia, in which complete congenital loss of teeth is observed, is quite rare; a partial form of pathology develops a little more often. Against this background, a change in human social behavior and psychological disadaptation occurs.

Classification of missing teeth

In dentistry, a distinction is made between primary, that is, congenital, and secondary, otherwise acquired, adentia. It depends on the time and reasons why the disease occurred. In addition, there is edentia of permanent and temporary teeth.

True congenital pathology is diagnosed if a tooth germ is missing. At the same time, a complex form of the disease is characterized by a delay in and fusion of adjacent crowns.

Adentia comes in the following forms:

1. Extremely rare in patients primary a form of disorder that is a consequence of developmental disorders even at the embryonic stage. In this case, the fetus may partially or completely lack dental buds.
2. Secondary the form of the disease is typical for people in old age and is a consequence of tooth decay due to disease or mechanical trauma.
3. Complete missing teeth is a fairly rare occurrence, but if installation is required on both jaws, then specialists often remove all remaining teeth.
4. The most common form is partial adentia, it is observed in all children during the period of change of milk teeth and in adults in case of neglect of hygiene rules oral cavity. And also in the absence of prevention and timely treatment.

The diagnosis of partial or complete adentia depends on the number of missing teeth. In this case, the latter is characterized by complete loss, and with partial loss, individual or group loss of up to 10 teeth. If the volume is over 10, then a multiple form is diagnosed. When up to 15 teeth fall out on one jaw, a partial secondary form of the disease is noted.

In medicine, secondary partial adentia also has several classes:

• the first is characterized by the presence of a bilateral end defect;
• in the second, a unilateral terminal defect is observed;
• with the third, there is a unilateral included defect;
• the fourth class is diagnosed in the case of a frontal included defect, which is characterized by the absence of front teeth.

Often classes and subclasses are combined. In addition to the above classes, asymmetric and symmetric tooth loss is noted.

Causes and provoking factors

It is very difficult to name the exact cause of the development of the disease, since the disease has not been fully studied to date. There is a version that the onset of pathology begins during the period of fetal formation; in fact, at this moment, the formation of tooth roots and disruption of the development of the ectodermal layer occur.

There are cases when adentia appears against the background of intrauterine diseases endocrine system and by hereditary factor.

The secondary form of the disease occurs much more often, and it can manifest itself in several ways. According to statistics, tooth loss can be caused by:

• development and lack of treatment;
• untimely or complete absence treatment of other diseases responsible for the destruction of the dentition (most often And);
• pathologies that contribute to the general deterioration of a person’s condition and reorganization of the body’s work;
• often the reason is age factor, despite the fact that by the age of 60 many people have many health problems, including dental problems;
• most common mechanical factor, so tooth loss can be caused by a strong blow;
• and of course plays an important role hereditary factor.

Features of symptoms depending on the form

Diagnosing the development of an anomaly on your own is quite simple, since tooth loss is simply impossible not to notice. In addition to the visual characteristic picture, wrinkles in the oral cavity, as well as gaps between them, may also be noted.

If teeth fall out in front, then later the cheek and upper lip may recede. Also, the development of pathology can cause serious problems with speech.

In general, each form of adentia has its own symptoms, so the following clinical picture is noted:

1. At partial form, several teeth are missing, chewing is impaired, and discomfort, problems with speech, problems with biting and chewing food, and active splashing of saliva is noted.
2. At full form of the disease, all teeth are missing. At the same time, a change in the shape of the face is observed, a whole network of wrinkles appears around the mouth, and a change in speech is also noted. Thinning of the bone tissue also occurs and the patient has to give up solid food, and this leads to a lack of vitamins in the body.
3. Currently, dentists also highlight relative complete edentia, with which some teeth remain in their places, but are subject to complete removal due to severe damage to the general row.
4. Full primary the form is characterized by disruption of the mucous membrane. On at full form disease, even the rudiments of teeth are not visible. If some teeth erupt, then between them there are signs large gaps. Often a symptom of this form is the formation of an uncut tooth hidden in the jawbone or covered by the gum.
5. Secondary manifested by loss, both partial and complete. In this case, a change in the facial skeleton is observed, problems appear when chewing and biting food. The secondary form is accompanied by deterioration of diction. If partial adentia is observed, then the remaining teeth begin to shift, bone tissue is depleted, and discomfort appears when eating too cold or hot food.

Diagnostic criteria

Edentia is a fairly serious problem and only specialists can diagnose this pathology using modern methods. Therapists, surgeons, orthopedists, implantologists, orthodontists and periodontists.

Diagnosis requires anamnesis, examination by a specialist, palpation examination and comparison of dental and chronological age.

If there is a local defect at a time when the period for eruption has already passed, specialists resort to targeted intraoral radiography.

If a multiple or complete form is suspected, orthopantomography is performed. Also, if necessary, the patient undergoes computed tomography temporomandibular joint or x-ray.

Modern dental practice

In order to cure a partial form of adentia, specialists use and.

Prosthetics is the main method of dentition correction. This method is used if one tooth is missing. If there is a loss of several, then the procedure is much more difficult. In this case, one or another orthopedic design is used.

The prosthetic method is also used in cases of complete absence of teeth. In this case, both fixed and removable prosthetic models are also used. If the first option is used, then immediately before the procedure installation is required, which will serve as a kind of support.

Removable plastic plates are used for complete secondary edentia. This correction method is often used for people from the older age group. age group. The use of plates is quite convenient, because they can be removed and cleaned. Prosthetics can also be performed for children from the age of four, but this can provoke disturbances in the development of bone tissue.

In some cases there may be some difficulties. For example, if there are disturbances in the development of bone tissue, the fixation for the prosthesis will be insufficient. In addition, some patients experience allergic reaction on materials used during prosthetics. In such cases, modern is used.

In case of edentulous deuces, braces are initially installed to form a place for the implant

Currently, there are several different methods:

1. Classic two-stage implantation is a method that is used for partial and complete tooth loss. The procedure is possible even if teeth have been missing for a long time. In this case, it may be necessary to build up bone tissue, restore it over several months, and then perform temporary implantation. Only after the implants have taken root is a permanent structure installed. This method has been around for quite some time.
   If mobile or damaged teeth are observed, then apply. But this procedure This is not possible in all cases; a month-long course of treatment may be required before it.
2. Express implantation involves the use of a whole range of technologies to restore teeth. In this case, implants are used. Often used this method with complete adentia. Since it is possible to install the implant at an angle, this makes it possible to bypass atrophied areas of bone tissue and secure the structure as reliably as possible. But, despite the low level of trauma, a permanent implant cannot be installed immediately; first, temporary bridge for 2 or 3 years and only after that permanent, which is reliable and aesthetically pleasing.
3. Despite the fact that it is inferior to previous methods, it has its advantages. This option is used to removable design attached more securely. In this case, thin and small one-sided implants are used, the fixation of which occurs by puncture of tissue, the level of trauma in this case is minimal. Over time, dentures sag, so their service life does not exceed 10 years.

Preventive actions

To avoid the development of adentia in children, first of all, it is necessary to create favorable conditions at the embryonic stage. In addition, it is important to ensure that the deadlines are not extended. To identify pathology early stage It is necessary to visit the dentist at least once every six months.

To avoid the development of a secondary form of the disorder, constant examination by a specialist and compliance with all hygiene standards are also required. In case of partial loss of teeth, prosthetics are necessary; this measure will stop further tooth loss.

Adentia refers to diseases of the oral cavity and implies partial or complete absence of teeth.

Adentia, depending on the cause, can be primary or secondary.

Primary adentia is congenital. Its reason is the absence of tooth buds, which is most often a manifestation of anhidrotic ectodermal dysplasia. Also symptoms of this disease are changes in the skin (lack of hair, early aging of the skin) and mucous membranes (pallor, dryness).

In some cases, it is not possible to establish the cause of primary adentia. It is assumed that the resorption of the tooth germ can occur under the influence of a number of toxic influences or be a consequence of the inflammatory process. Possibly play a role hereditary causes and a number of endocrine pathologies.

Secondary adentia is more common. This adentia appears due to partial or complete loss of teeth or tooth buds. There can be many reasons: most often these are injuries or a consequence of advanced caries.

Depending on the number of missing teeth, adentia can be complete or partial. Complete edentia is the complete absence of teeth. More often it is primary.

Edentia Clinic

Depending on whether the adentia is complete or partial, the clinical manifestations also appear.

Complete edentia leads to serious deformation of the facial skeleton. As a result, speech disorders appear: slurred pronunciation of sounds. A person cannot chew and bite food fully. In turn, malnutrition occurs, which leads to a number of gastrointestinal diseases. Also, complete edentia leads to dysfunction of the temporomandibular joint. Against the background of complete edentia, a person’s mental status is disrupted. Edentia in children leads to disruption of their social adaptation and contributes to the development of mental disorders.

Primary complete adentia in children is a very rare and severe disease in which the rudiments of teeth are absent. The cause of this type of adentia is intrauterine development disorders.

The clinical picture, in the absence of timely treatment, is extremely severe and is associated with pronounced changes in the facial skeleton.

Secondary complete edentia is the loss of all teeth that were originally present. More often, secondary complete adentia occurs due to dental diseases: caries, periodontitis, and also after surgical removal of teeth (for oncology, for example) or as a consequence of injuries.

Secondary partial adentia has the same causes as primary. When this adentia is complicated by abrasion of the hard tissues of the teeth, hyperesthesia appears. At the beginning of the process, a sore throat appears when exposed to chemical irritants. When the process is pronounced, there is pain when closing the teeth, exposure to thermal, chemical irritants, and mechanical influences.

Diagnostics

Diagnosis is not difficult. The clinic is enough. To confirm some types of edentia, an x-ray examination is necessary.

Treatment of adentia

Primary complete adentia in children is treated with prosthetics, which must be carried out starting from 3-4 years of age. These children need dynamic observation specialist, because there is a significant risk of impaired jaw growth in the child as a result of the pressure of the prosthesis.

In case of secondary complete adentia in adults, prosthetics are carried out using removable plate dentures.

When using the method of fixed prosthetics with complete edentia, it is necessary to carry out preliminary dental implantation.

Complications of prosthetics:

Violation of normal fixation of the prosthesis due to jaw atrophy;

Allergic reactions to denture materials;

Development of the inflammatory process;

Development of bedsores, etc.

Treatment of secondary partial adentia, complicated by hyperesthesia, includes tooth depulpation.

When treating secondary adentia, it is necessary to eliminate the causative factor, i.e. disease or pathological process leading to adentia.

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Adentia is perhaps the most unexpected and at the same time unpleasant dental disease. Most people are not even aware of the existence of this disease, but some have had to deal with it personal experience. What is this disease, what are the symptoms and how is this disease treated? Many questions arise, each of which has detailed answers.

The complete or partial absence of teeth is called adentia. This symptom occurs equally often in both children and adults. The etiology of the disease is different for everyone, so the symptoms are also different. Sometimes the patient is diagnosed with only partial dentition.

Often adentia affects only baby teeth. It should be borne in mind that the disease is not always congenital. Improper oral hygiene and the presence of other unfavorable factors may provoke acquired symptoms.

To avoid unpleasant manifestations in yourself and your loved ones, it is better to be fully prepared and study the disease in more detail.

Depending on the form of the disease, certain changes in the jaw can be observed.

This is the most unpleasant variety. Patients with this diagnosis experience the greatest changes. This is definitely a facial deformity. In this case, the cheeks are sunken, the skin on them has a stretched, withered appearance. Observed premature aging facial skin. Speech almost always suffers, especially with congenital edentia.

An aggravating factor is difficult meals. The patient cannot eat fully, because chewing and biting off solid food is almost impossible. As a result, there is a general weakening of the immune system and the entire body as a whole. In this case, it is also difficult to avoid the development of chronic diseases of the digestive system.

A significantly similar defect affects psychological condition person. Along with adentia, patients often acquire numerous complexes and withdraw into themselves.

Sometimes one of the jaws or parts thereof develops without any abnormalities. Then edentia is considered partial. The external manifestations of the disease directly depend on the number of missing teeth. The pathology also generally leads to facial deformation, speech and eating disorders. Patients with partial dentition often suffer from malocclusion, crossbite or deep bite.

Along with partial absence of teeth, dentists can identify various displacements, shortening or narrowing of one of the jaws. Temporomandibular joint also suffers pathological changes. Due to the minimum chewing load, the muscles of the mouth weaken and bone tissue thins.

The absence of one or more teeth practically does not cause any inconvenience to a person, but the body suffers inevitable negative changes. This:

• displacement of the entire dentition;
• disturbance of intestinal motility;
• load on gastrointestinal tract;
• mineralization of tooth enamel slows down;
• protein metabolism suffers.

All these factors inevitably lead to the development of pathologies more serious than the absence of a pair of teeth.

Diagnostic methods

The correct diagnosis can only be established by a specialist after a clinical examination and a series of studies. To examine children who, due to their age, do not yet have teeth, the dentist uses exclusively tactile methods. The baby's gums are palpated for the presence of baby tooth buds. As a rule, an experienced doctor can feel them from a very early age.

In more ambiguous situations, the orthodontist recommends that the child undergo an X-ray examination of the jaw. Panoramic shot will give a complete picture of the disease. Here you can examine in detail the structure of the root system of the tooth and the features of jaw development. The alveolar process is also visible on the x-ray.

Features of diagnosing secondary (acquired) adentia

In the secondary form of the disease, examination is not much different from diagnosis birth defect jaw development. Often a series is added to the show laboratory research to determine the cause of tooth loss. Sometimes this is caused by complex chronic diseases that interfere with prosthetics. Without prosthetics, it is impossible to achieve the expected treatment results. Contraindications may include:

• benign and malignant neoplasms in organism;
• diseases of the mucous membranes;
• the presence of an inflammatory process in the blood;
• remnants of tooth roots under the mucous membranes.

To begin treatment, it is necessary to remove all obstacles, otherwise complications may occur.

Causes of the disease

It is difficult to identify the main cause of congenital absence of teeth and their loss in adulthood. Scientists have proven that the hereditary factor plays a significant role in the formation of pathology. For example, underdevelopment of teeth during the prenatal period.

There is also such a pathology as embryogenesis of dental tissues, which does not allow the jaw and dentition to form normally. The absence of lateral incisors and molars is called phylogenetic reduction.

Caries, damage to tooth enamel, inflammatory processes in the oral cavity, and pulpitis can also lead to complete or partial loss of teeth. Therefore, at the slightest uncharacteristic manifestations in the oral cavity, it is better to immediately contact an orthodontist for qualified advice. Any delays in dental health are almost always fraught with consequences.

Types of edentia

Primary (congenital) complete edentia

The pathology is extremely rare and is considered complex among specialists. genetic disease. In this case, the rudiments of teeth are completely absent. The pathology is accompanied by other physical manifestations. The facial oval of a child with congenital edentia differs significantly in appearance from the face healthy baby. Bottom part the face is reduced, the alveolar processes of the jaw are not fully formed, which is easily visualized. The mucous membranes of such children have a pale appearance and are dry. The patient can eat only soft or liquid foods. Due to the defect, speech does not develop.

Most children with primary edentulous syndrome suffer from a lack of scalp hair, eyebrows and eyelashes. The fontanel of such a baby tightens slowly, and may not narrow at all. Nail plates either absent or excessively brittle and soft. Therefore, we can say that congenital adentia is a complex of complex genetic defects that are formed during a woman’s pregnancy.

Congenital partial dentition

It has slightly different symptoms and milder consequences. Occurs during the eruption of baby teeth. Some teeth, despite everything, simply do not grow. The rudiments are not detected by palpation and x-ray examination.

As a result, gaps form between the teeth, which will inevitably lead to displacement of the entire row. If there are a large number of missing teeth, underdevelopment of the jaw is diagnosed. With a mixed bite, when the first teeth fall out and permanent teeth grow in their place, many empty spaces form in the oral cavity. There is a risk of loosening of the supporting teeth and disruption of the protective enamel layer, which leads to many complications. For example, jaw deformation or the appearance of a crossbite.

Acquired complete edentia

There is a complete absence of teeth on both jaws. They can be either milk or permanent. There is a concept of secondary childhood adentia, when teeth grow normally, but eventually fall out for some reason.

Common causes of the acquired form of the disease may be:

• dropping out;
• removal due to caries, which cannot be treated;
• periodontitis;
• deletion by surgical reasons, for example, oncology.

Over time, the alveolar processes atrophy, lower jaw fits tightly to the nose. The main symptom of the initial stage of secondary adentia is the abrasion of tooth tissue. Because of this, the patient feels unpleasant feelings with a tight jaw closure.

Secondary partial

The most common type of pathology. Most people in at different ages encountered her. This may be tooth extraction due to caries or inflammation in the gums. In this case, the alveolar processes continue to function normally. Displacement occurs rarely and depends on the time that has passed since the removal of adjacent teeth.

It rarely happens that during a mixed dentition, a row shift occurs. Then there is not enough space for the permanent tooth to grow. Therefore, parents should pay attention to delayed eruption and, if necessary, visit a pediatric dentist with their baby.

Treatment of the disease

It is prescribed depending on the type of adentia and other indicators identified during the examination. Most often used:

• prosthetics with crowns or inlays;
• use of implants;
• installation of bridges;
• introduction of removable or fixed prosthesis.

Prosthetics are performed equally often, both with the use of removable and fixed dentures. The first option is more suitable for children. The jaw continues to undergo age-related changes in the future fixed prosthesis may become deformed or move, which is extremely undesirable.

All prostheses, regardless of the material of manufacture, are made on the basis of an impression made in advance. This is required so that it fits perfectly to the patient’s jaw and does not cause discomfort.

Many parents refuse to give their children prosthetics. This is a wrong perception. Even temporary removable dentures are able to restore the aesthetics of the dentition. The child can eat well and develop chewing function.

With acquired partial adentia, dentists decide on artistic restoration. This method allows you to restore the integrity of the dentition with with minimal effort. For this purpose, ceramics and photo composites are used. Depending on the selected material, the service life of the prosthesis is determined.

Implants will help to properly distribute the load on the dentition. This is their advantage over bridges. Installation features make them the most in a safe way treatment in relation to adjacent teeth.

At what age should treatment begin?

​Orthodontists recommend starting prosthetics for complete congenital edentia from the age of three. Just at this age, the baby’s body has become much stronger, and the disease can be diagnosed most accurately. The dentist should Special attention pay attention to the shape of the prosthesis, since a poorly chosen one can provoke a delay in the development of the jaw.

It is necessary to make a responsible choice dental clinic for the treatment of adentia. Only clinics with good diagnostic equipment can provide their patients with truly high-quality care. In the treatment of this defect, it is extremely important to establish the cause of tooth loss. This may be a consequence of serious oncological diseases, which urgently require the intervention of specialists in other fields.

You should not skimp on prosthetic material. Their service life directly depends on this. Although the installation process is painless due to the use of anesthetics, it is still not the most pleasant. Especially for children.

Adentia is complex and very unpleasant disease. But it’s not hopeless. Each patient can count on a positive treatment outcome if they visit the clinic in a timely manner. The treatment can hardly be called cheap, however, the result will help solve not only physiological, but also psychological problems. After visiting the clinic, a person who previously suffered from complete or partial absence of teeth will soon be able to return to everyday life.

Thanks to a wide selection of treatment methods, any patient will find the best way to get rid of this problem.

MINISTRY OF HEALTH OF THE REPUBLIC OF BELARUS

BELARUSIAN STATE MEDICAL UNIVERSITY

DEPARTMENT OF ORTHOPEDIC DENTISTRY

ORTHOPEDIC DENTISTRY. PROSTHETICS WITH REMOVABLE PLATE AND BUGEL DENTURES

Approved by the Ministry of Education of the Republic of Belarus as teaching aid for students of the specialty "Dentistry"

institutions providing higher education

2nd edition

Edited by S. A. Naumovich

Minsk BSMU 2009

UDC 616.314–089.29–633 (075.8) BBK 56.6 i 73

Authors: S. A. Naumovich (chapter 1); S. V. Ivashenko (chapter 2); V. N. Ralo (chapter 1); V. I. Sinitsyn (chapter 1); V. G. Shishov (chapter 2); Yu. I. Kotsyura (chapter 3); P. N. Moiseichik (chapter 3); G.V. Volozhin (chapter 3); A. M. Matveev (chapter 3); O. I. Tsvirko (chapter 3); S. N. Parkhamovich (chapter 2); A. P. Dmitrochenko (chapter 3)

REVIEWERS: head. department otorhinolaryngology, ophthalmology and dentistry of the Grodno State medical university, dr med. sciences, prof. O. G. Khorov; Dean of the Faculty of Dentistry, Head department therapeutic dentistry Belarusian medical academy postgraduate education, Dr. med. sciences, prof. I. K. Lutskaya

Orthopedic dentistry. Prosthetics with removable plate and clasp prostheses O-70: textbook. allowance / S. A. Naumovich [etc.]; edited by S. A. Naumovi-

cha. – 2nd ed. – Minsk: BSMU, 2009. – 212 p. ISBN 978–985–528–002–7.

The publication provides classifications, indications and contraindications for the manufacture of partial removable plate and clasp dentures. Information is given about new technologies and structural materials, new modern methods for manufacturing clasp dentures. The first edition was published in 2007.

Intended for 3rd to 5th year students of the Faculty of Dentistry.

Chapter 1 Prosthetics of partial secondary edentia with removable

plate prostheses

Partial secondary adentia. classification

Partial tooth loss is not a disease, but one of the forms of damage to the dental system, i.e. pathological condition, occurring as a result of a disease - caries, periodontal disease, etc. Therefore, it can be a diagnosis.

A pathological condition caused by a violation of the continuity of the dentition, i.e., the absence of teeth in the dental system, is called partial secondary edentia or a defect in the dentition. The reasons may be:

1. Disorders that occur during the formation of the dental system:

– primary partial adentia caused by missing teeth;

– improper development of tooth buds (impacted teeth).

2. Disorders caused by the loss of teeth in the formed dental system, resulting from:

– development of complicated caries;

– development of periodontal diseases;

– surgical interventions on the jaws for osteomelitis, neoplasms;

– injuries of teeth and jaws of various etiologies.

According to N.V. Sirgichev (1983), N.M. Rozhno (1989), M.D. Korol (1991), the number of people who need to restore the functional unity of their dentition after the age of 56 years reaches 96%, and , 48.34% (±2.5%) of them - in partial removable plate prosthetics (PRP).

The variety of variants of dental arch defects necessitated their systematization, which in most cases was carried out according to anatomical and topographical characteristics.

Thus, E. Kennedy (1942) divides dentition defects into four classes:

I class - bilateral end defect; Class II - unilateral terminal defect;

Class III - included defect in the area of ​​chewing teeth; Class IV - a defect in the frontal area of ​​the dentition.

If there are several defects in the dentition belonging to different classes, the dental arch is assigned to a smaller class (O. Applegate, 1954).

V. Yu. Kurlyandsky (1965) divides dentition defects into 3 groups:

– 1st - single or multiple defects of the dentition (dentitions) while maintaining the distal supports;

– 2nd - single or multiple defects of the dentition (dentition) with the loss of one or both distal supports;

– 3rd - intact dentition, single or multiple defects in them against the background of damage to periodontal tissue.

E.I. Gavrilov (1966) proposed to distinguish the following types of dentition defects:

– end (one- and two-sided);

– included (side - one-, two-sided, anterior);

– combined;

– jaws with single preserved teeth.

K. Eichner (1962) classifies dentition defects according to a slightly different principle. He proceeds from the position put forward by G. Steinhardt (1951),

where the existence of four protective zones that maintain its height is stated in a normal bite. Specified zones formed by premolars and molars. When all teeth are present, the dental arches have four protective zones - two on each side of the jaw. Depending on the number of preserved zones, all dentitions are divided into three groups. The first (A) includes dentitions that have antagonists in all four protective zones; in the second (B) - dentitions that have partially lost their protective zones; in the third (B) - dentition without antagonists.

It should be noted that any classification facilitates the study of the clinic of partial tooth loss; maintaining documentation promotes mutual understanding between doctors and at the same time does not allow accurately determining the prosthetic plan, since the choice of prosthetic design depends not only on the location of the defect, but also on the condition of the crowns, and also the supporting apparatus of the remaining teeth, on their position in relation to the occlusal plane, the type of bite, the structural features of the edentulous alveolar process, the age of the patient, etc.

DISORDERS ARISING IN THE DENTAL SYSTEM DURING PARTIAL SECONDARY EDENTIA

After the loss of teeth in the dentition, the nature of the interdependence of form and function changes. Clinical picture it depends:

– from the time that has passed since the loss of teeth;

– number of lost teeth;

– location of teeth in the dentition;

– the role of teeth in chewing;

– type of relationship of dentition;

– condition of the periodontium and hard tissues of the remaining teeth;

– on the age and general condition of the patient’s body.

The leading symptoms in the clinic of partial tooth loss are:

1) violations of the continuity of the dentition;

2) functional dissociation - the disintegration of the dentition into independently acting groups of teeth and the appearance in connection with this of three links:

– functioning center;

– traumatic node;

– non-functioning link, or atrophic block;

3) functional overload of the periodontium of the remaining teeth;

4) secondary deformations of the occlusal surface of the dentition;

5) violations:

– functions of chewing and speech;

– functions of masticatory and facial muscles;

– activity of the temporomandibular joints;

– aesthetic standards.

Depending on the type of changes occurring in the dentition after tooth loss, the following three degrees of severity of the lesions are distinguished:

Compensated state- is caused by a defect in the dentition that does not affect the shape and structure of the dentition and periodontium.

Subcompensated state- occurs as a result of intrasystemic restructuring in the dentition and periodontium: the crowns of the teeth tilt towards the defect, gaps appear between the teeth, the teeth opposite the defect shift in the vertical direction, and the periodontium is also rearranged.

Decompensated state- occurs in cases where intrasystemic restructuring is complemented by inflammatory phenomena in the periodontium, its destruction, when gingival and bone pockets appear.

Sub- and decompensated states occur with reactive insufficiency of the body, when the masticatory apparatus ceases to form the system and begins to destroy it, resulting in a state of functional pathology and, as a result, disorders adaptive mechanisms, which is clinically manifested by intrasystemic restructuring in the dental system.

V. Yu. Milekevich (1964) in experiments using radioactive Ca45 proved that the disturbance of Ca metabolism in the dissociated dental system is of a generalized nature and does not depend on which jaw the teeth were removed from, that this disturbance precedes clinical and radiological changes and increases according to as destructive manifestations develop and that the restructuring of bone tissue occurs according to the type of osteoporosis (the atrophic process is accompanied by the replacement of sections of tissue with cellular fibrous connective tissue). Moreover, with the onset of the period of sclerosis of bone tissue, the pathological process begins to progress and as a result, a “struggle” arises between the process of tissue adaptation to the new conditions that have arisen and function. The dentofacial system, in which the integrity of the dentition is compromised, should be considered as a system with a risk factor. All this necessitates the use of orthopedic treatment for the loss of even one tooth.

Resorption of residual alveolar ridge in edentulous patients is a chronic, progressive, irreversible process that aggravates general state. The rate of resorption of the alveolar process depends on the type of structure

bone tissue. According to the results x-ray examination, bone tissue can be:

– dense (characterized by a fine-mesh bone structure, thick trabeculae, dense cortical plate; tissue of this type slowly atrophies);

– spongy (the structure of the bone tissue is large-cell, the cortical plate is less clearly visible);

– without cortical layer(the bone beams are thin, along the edge of the alveolar process there are thin needle-like trabeculae; tissue of this type quickly atrophies).

Resorption occurs most intensively in the first 6 months after tooth extraction; the degree of its expression in the area of ​​the alveolar ridge is practically unlimited in volume and time.

Alveolar processes are very high (more than 1.5 cm), high (up to 1.5 cm), medium height(up to 1 cm), low (up to 0.5 cm), very low (less than 0.5 cm). The smaller the height of the alveolar ridge, the more unfavorable conditions arise when the prosthesis performs the function of transmitting vertical load and stabilizing it due to the insufficient size of the alveolar ridge, since in these cases the support area and resistance to horizontal displacement are small.

The shape of the alveolar ridges is: semi-oval, trapezoidal, dome-shaped, wedge-shaped, comb-shaped, flat. Surface character

And the shape of the alveolar ridge should ensure uniform distribution of chewing pressure over the mucosa covering it and at the same time allow easy application and removal of the prosthesis.

TISSUE OF PROSTHETIC FIELD

When examining the mucous membrane of the toothless areas of the alveolar process, information is obtained about its thickness, degree of compliance, pain sensitivity necessary to determine the area of ​​the prosthetic bed.

According to M. Spreng (cited by A.I. Evdokimov, 1974), in the upper jaw, the compliance of the mucous membrane when a ball is immersed in it under a pressure of 200 g varies from 0.6 to 1.5 mm. In the lower jaw, the compliance amplitude is 0.2–0.6 mm. Accordingly, M. Spreng classifies the compliance of the mucous membrane as follows: up to 0.4 mm - small; up to 0.9 mm - average; above 0.9 mm - large.

Lynd (cited by E.I. Gavrilov, 1984), taking into account the degree of pliability of the mucous membrane on the hard palate, distinguishes the following four zones:

1. The area of ​​the sagittal suture is a medial (middle) fibrous zone that does not have a submucosal layer; its pliability is negligible.

2. The alveolar process is a peripheral fibrous zone, almost without a submucosal layer.

3. The area of ​​​​the transverse palatal folds is covered with a mucous membrane that has average degree pliability.

4. The posterior third of the hard palate - has a submucosal layer, rich in mucous glands and containing some adipose tissue: it has the greatest degree of pliability.

As shown by the results of histological and topographic studies (filling of blood vessels) conducted by V. S. Zolotko (1963, 1965), the degree of pliability of the mucous membrane covering various areas of the alveolar processes and part hard palate, is directly proportional to the density of the vascular fields, the density of which increases (towards line A). It is the vessels, thanks to the ability to quickly empty (due to the formation of anastomoses with the maxillary cavity, with the nasal cavity, with deep layers of bone tissue) and fill again with blood, that can create conditions for reducing the volume of tissue. Areas of the mucous membrane of the hard palate with extensive vascular fields, which therefore have, as it were, spring, shock-absorbing properties, are called buffer zones.

C. Suplee (cited by A.I. Evdokimov, 1974) pays main attention to the condition of the mucous membrane of the prosthetic bed and, depending on this, divides it into four classes:

1. Slightly pliable, dense mucosa with natural folds quite distant from the apex of the alveolar process (frenum of the lips, tongue, buccal cords). This mucous membrane covers the well-defined alveolar processes and provides a convenient support for the prosthesis. She visits healthy people normosthenic constitution.

2. Dense, thinned, atrophied mucosa, covering the alveolar processes and palate with a thin layer. The attachment points of its natural folds are located closer to the top of the alveolar process. Such mucous membrane is less convenient for support removable denture. It occurs in people of asthenic constitution, more often in old or elderly people.

3. Loose mucous membrane covering the alveolar processes and the posterior third of the hard palate, often the low alveolar process. Such mucous membrane occurs in diseases of periodontal tissue. Patients in these cases require preliminary treatment - dehydration therapy.

4. The mucous membrane, the movable cords of which are located longitudinally and are easily displaced with slight pressure from the impression mass. This is the mucosa of the atrophied alveolar process with a more protruding soft ridge. Prosthetics in similar cases possible only after special training. This type mucous membranes occur in different common diseases from the outside of cardio-vascular system, for endocrine and other diseases.

The condition of the alveolar processes, palate and the mucous membrane covering them must be taken into account when making prosthetics, since the base of the prosthesis should be placed on tissues that are equally pliable when pressure is applied to them. The decision to make prosthetic restorations for partial secondary edentia is based on the theory that the remaining teeth used for clasps preserve the alveolar bone. At the same time, occlusion

force and muscle activity on the working side increase, and neuromuscular control over the movements of the lower jaw increases. This is explained by the proprioceptive properties of the periodontal ligament of the remaining supporting teeth. In addition, ESPPs are well fixed and stabilized, and are also able to fix the initial bite height.

In the process of diagnosing the disease and planning treatment, as well as further observation The patient must take into account the following parameters of the periodontium of the supporting teeth:

– amount of bone tissue;

– tooth mobility;

– pocket depth;

– width of attached gum;

– the degree of inflammation of surrounding tissues.

The prognosis for the functioning of the ESPP depends on the condition of the periodontium of the supporting teeth.

Examination of patients.

Problems of prosthetics for partial secondary edentia

The production of the ESPP should be preceded by a thorough examination of patients aimed at identifying the etiology, pathogenesis, and clinical picture of the disease. This allows you to make a correct diagnosis and outline the complex therapeutic measures to restore the integrity and functions of the dental system.

For an appointment with a dentist, the patient must come with outpatient card, where his passport details are indicated. The doctor, based on the results of the examination of the condition of the hard and soft tissues of the oral cavity, as well as the topography of the dentition defect, can recommend the patient prosthetics.

		Table 1
Determination of indications for the use of orthopedic structures
	with partial secondary adentia
	Survey
		Results Evaluation Criteria
1. Subjective:	Interview	Complaints that concern the patient in connection with the disease
a) complaints;		vaniyam. The degree of effectiveness of previously carried out
b) medical history		nogo therapeutic, orthopedic treatment;
		past illnesses (Botkin's disease,
		TBC, etc.), allergy status
2. Objective:	Visual	Manifestation of signs of disease on the face, clothes
a) physical examination;	studying	caught by the absence of teeth, character and sti-
		stump of mouth opening, TMJ condition.
		Changes in the oral mucosa.
		Topography of the defect.
		Changes in the dentition.
		Height of clinical crowns of abutment teeth.

Partially secondary adentia is a common disease that occurs in 65% of the world's population - tooth loss.

This affects the functionality of the jaw, which can cause problems with the gastrointestinal tract.

Also, this is reflected in the appearance - a person develops complexes, and atrophy of the facial muscles may develop. Adentia occurs in both adults and children.

Classification

Adentia is divided into two types:

1. Partial secondary adentia. If 1 to 3 teeth are missing in the upper and lower jaw.
2. Full. If more than 80% of the teeth in the oral cavity are missing.

Even if one or two teeth are missing in the upper or lower jaw, neighboring teeth begin to shift.

This negatively affects their main function - chewing food.

With edentia, the bone tissue of the teeth begins to rapidly deplete, as the remaining teeth are subjected to a colossal load.

Partial congenital adentia occurs when more than 10 teeth are missing in the jaw. In 70% of cases, the lateral incisors of the upper jaw are the first to be lost; neighboring teeth immediately begin to shift in their place, so biting off hard food brings discomfort.

If the disease progresses and tooth loss continues, this means that the process has taken on a multiple form. In this case, if measures are not taken to eliminate and treat the cause, the disease can lead to the loss of all dental units.

Partially secondary adentia is a serious stage of pathology, in which the absence of 5 to 15 dental units in one jaw is diagnosed.

Symptoms of edentia

General symptoms of any type of adentia boil down to the complete or partial absence of teeth in the oral cavity. This is the main sign of the disease. However, there are also indirect signs edentulous:

1. Recession of the soft tissues of the face may be observed, which is characterized by a violation of the symmetry of the facial part.
2. May form around the mouth a large number of wrinkles
3. With the loss of more than 50% of the teeth in the oral cavity, atrophy of the facial muscles is observed.
4. Drooping of the corners of the mouth.
5. Changing the shape of the face.

Missing tooth in one row

Partial secondary adentia can also be accompanied by the formation of an incorrect, deep bite. The teeth begin to actively shift in the area of ​​the formed voids, due to which the dentoalveolar processes of healthy teeth lengthen.

Diagnostics

Diagnosing this disease is quite simple.

A dentist can visually assess the picture, name the number of teeth that are missing in both jaws, and, accordingly, determine the type of adentia.

If there is a suspicion of edentia, then diagnosis should include an x-ray of the oral cavity.

In the image, the doctor will be able to see all the nuances that interest him, especially if we're talking about about childhood edentia. It is important to note the presence of the rudiments of permanent teeth and their condition.

When diagnosing, panoramic radiography of the upper and lower jaw will be effective. A panoramic photograph will allow you to determine the structure of the teeth, the condition of the bone tissue of healthy teeth and the alveolar process.

Diagnostics must be carried out qualified specialist, taking into account the following factors:

1. The presence of roots that have not been previously removed and at the time of the study they are under the mucous membrane. This pathology dangerous inflammatory processes, so you need to get rid of such roots as soon as possible.
2. Presence of exostoses.
3. Inflammatory or infectious processes flowing in the oral cavity;
4. Damage to the mucous membrane by tumors.

Partial absence of teeth

If one of the above factors has been detected, you must first eliminate it, and then proceed to diagnostic procedures edentia and disease treatment.

Diagnosis of edentia allows you to immediately see the severity of the disease and take measures that will prevent the oral cavity from losing its functionality.

Causes

One of the main causes of adentia is the abnormal development of the ectodermal germ layer, which is the basis for the formation of tooth primordia.

Disruptions of the endocrine system and poor heredity are two more common factors in the development of primary type adentia.

Partial secondary adentia can develop in a person for the following reasons:

1. Caries. If caries are not treated at an early stage, it can lead to tooth loss over time.
2. Various oral diseases, which affect the gums, mucous membrane and are not cured in time. For example, periodontitis or periodontal disease can cause edentia.
3. Diseases internal organs , weakened immunity, which negatively affects the activity of the endocrine system.
4. Age. The likelihood of tooth loss progresses with age. However, nowadays young people are also seeking help in treating adentia.
5. Rough mechanical impact on teeth. This is one of the most common and serious reasons. This includes mechanical cleaning performed by a non-professional specialist, frequent teeth whitening chemical compounds, injury to the jaw and gums.
6. Incorrect removal of baby teeth, due to which the permanent tooth germ is injured, and it begins to develop abnormally.
7. Hereditary factor.

There are many reasons for the development of adentia, and most of them are indirect.

That is, a person may not notice any abnormalities in the oral cavity for a long period of time, however, at this time it turns out Negative influence on teeth, which in the future may lead to their partial complete loss.

Gum disease and bone depletion can occur due to improper brushing of teeth. If food particles constantly accumulate and plaque forms on the teeth, this can lead to gingivitis. In the absence of treatment, mechanical cleaning and fluoridation, all this will also lead to tooth loss. Therefore, it is important to always maintain oral hygiene and not neglect preventive visits to the dentist.

Not everyone knows that there is such a pathology as. Read the article about the causes of this disease.

We'll tell you what a periodontist treats and how a doctor's examination is carried out.

Treatment of adentia

The most effective treatment for the disease today is orthopedic treatment.

The treatment method is determined by the attending physician based on diagnostic studies, depending on the number of missing teeth in the oral cavity.

Treatment of primary adentia involves the installation of a pre-orthodontic trainer, and the patient himself is registered at the dispensary.

If adentia has been detected in a child, it is important to give the opportunity permanent teeth to erupt correctly and eliminate the risk of any jaw defects.

Dentures for edentulous patients are the only option for restoring missing teeth, and the following methods are used for this purpose:

1. Prosthetics using metal-ceramic crowns and dental inlays.
2. Using an adhesive bridge.
3. Installation of an implant in places where voids have formed.

Treatment must begin with restoration of the basic function of the oral cavity (chewing food). This is necessary in order to prevent the development of any complications and pathological processes which may occur after implantation against the background of an unprepared oral cavity. Only after all diseases and inflammations have been eliminated, and the basic function of the oral cavity has been restored, can we proceed to prosthetics.

Installation of dentures

It starts with installing a metal pin in bone tissue, after which it is installed on the pin artificial tooth. The dentist selects a color and material that will be identical to the natural shade of tooth enamel.

Prosthetics is effective method treatment, however, is expensive. The entire process can take several weeks.

Consequences of edentia

Adentia is one of the most complex and serious dental diseases.

Difficulties arise in terms of treatment, and edentia also negatively affects the quality of life.

Complete edentia can cause speech impairment; it may be difficult to pronounce some sounds, and speech becomes unintelligible.

Difficulties also manifest themselves in biting and chewing solid food, so almost all food has to be consumed in liquid form. Poorly digested pieces of food can cause disruption of the gastrointestinal tract, and a deficiency appears in the body useful elements and minerals, which also negatively affects overall health.

If more than 75% of teeth are missing in the oral cavity, there is a dysfunction of the temporomandibular joint, which can lead to its inflammation.

We must not lose sight of psychological factor. The absence of teeth does not look aesthetically pleasing and brings a lot of discomfort, which can create an imbalance psychological nature. This can lead to low self-esteem, depression and nervous disorders.

Modern implantation methods make it possible to restore all lost teeth without any disruption to the functionality of the oral cavity. If you start treating adentia at an early stage, you can achieve effective results.

Disease prevention

Specific measures that would prevent adentia in both adults and children have not yet been developed. However, to maintain oral health, you should adhere to the following recommendations:

1. Carry out regularly hygiene procedures oral cavity, and do it correctly (use a soft brush to move from bottom to top (lower jaw) and top to bottom ( upper jaw), in order to eliminate all food particles between the teeth. Then move in a circular motion over the entire surface of the oral cavity and finally clean the tongue);
2. During pregnancy, eat foods rich in calcium and potassium. This is necessary both for the woman herself and for the baby.
3. Regular visits to the dentist to identify any diseases and perform hygienic cleaning of the oral cavity. If there is a loss of at least one tooth unit, it is recommended to short time install an implant to prevent development possible deviations oral cavity.

Partially secondary adentia is a serious pathology that requires diagnosis and timely treatment through the installation of implants. Regular visits to the dentist and compliance with all hygienic measures will reduce the risk of developing edentia.

Lack of treatment can lead not only to impaired functionality, but also to inflammation of the joints, asymmetry of facial tissues, and deviations in the psychological state.

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