Dental rehabilitation of total adentia at pensioners of the Ministry of defense and contingent attached to military medical organizations


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Abstract

Legal, economic and clinical aspects of treatment of military personnel, retired military personnel, as well as the attached contingent in the conditions of hospitals of the Ministry of defense are presented. The study is based on the results of studying the number of dental implants installed in patients from 2014 to 2019 based on the medical records and outpatient records of a dental patient in two specialized departments of multidisciplinary hospitals of the Ministry of defense of the Russian Federation. Primary medical records were studied, data on the sex and age of patients, the presence (absence) of opportunistic diseases used implant system, the installation of dental implants and their amount and frequency of soft tissue and osteoplastic operations (to increase the volume of the bone and soft tissues of the alveolar bone (part) jaws) and the Protocol of the temporary and permanent prosthesis. Based on the analysis, we describe the current possibilities of medical and diagnostic work and present various types of orthopedic structures on dental implants for the dental rehabilitation of the above-mentioned contingents with complete adentia of the jaws (including in cases where absolute indications require the removal of all teeth due to foci of chronic odontogenic infection or periodontitis). The methods of treatment of patients in cases of combination of adentia with varying degrees of atrophy of the alveolar processes (parts) of the jaws are analyzed in detail. Clinical examples of dental rehabilitation are shown both with and without the use of methods for increasing the volume of jaw bone tissue, using various modern protocols for fixing orthopedic structures on zygomatic and root dental implants, and the frequency of their use in military medical organizations of the Ministry of defense of the Russian Federation during the reporting period. Based on the presented results, it is shown that the military medical organizations of the Ministry of defense of the Russian Federation have a full range of opportunities to provide comprehensive dental care to patients with complete secondary adentia, even in the presence of extreme bone atrophy of the jaws.

About the authors

M. I. Muzikin

Military Medical Academy. S. M. Kirov

Author for correspondence.
Email: vmeda-nio@mil.ru
Russian Federation, Saint Petersburg

G. A. Grebnev

Military Medical Academy. S. M. Kirov

Email: vmeda-nio@mil.ru
Russian Federation, Saint Petersburg

A. K. Iordanishvili

Military Medical Academy. S. M. Kirov

Email: vmeda-nio@mil.ru
Russian Federation, Saint Petersburg

S. V. Tereshchuk

The Main Military Clinical Hospital. acad. N.N. Burdenko

Email: vmeda-nio@mil.ru
Russian Federation, Moscow

M. V. Melnikov

Military Medical Academy. S. M. Kirov

Email: vmeda-nio@mil.ru
Russian Federation, Saint Petersburg

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2. Fig. 1. The number of dental implants installed in specialized departments of military medical organizations of the Ministry of Defense of the Russian Federation

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3. Fig. 2. The number of augmentation operations performed separately or together with dental implantation in specialized departments of military medical organizations of the RF Ministry of Defense

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4. Fig. 3. The number and distribution of manufactured removable orthopedic structures

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5. Fig. 4. Stage of dental rehabilitation of patient G., 64 years old, including the installation of 2 one-stage mini-implants and fixation of previously made removable acrylic prostheses: a - view in the oral cavity after tooth extraction and installation of mini-implants; b - the fixation of the prostheses was carried out immediately after the operation

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6. Fig. 5. Progressive loss of soft tissues in the area of the ball abutment in patient L., 57 years old: a, b - production of a removable prosthetic construction on ball abutments in 2014; c, d - control examination and replacement of silicone matrices in 2017, there is a decrease in the volume of the mucous membrane in the peri-implant zone; e, f - control examination and replacement of silicone matrices in 2019, progression of a decrease in the volume of the mucous membrane in the peri-implant area

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7. Fig. 6. The number of manufactured fixed orthopedic structures for 6 and more dental implants

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8. Fig. 7. Restoration of the dentition of the upper jaw using a fixed orthopedic structure of patient M., 63 years old: a - the initial clinical picture in the oral cavity; b - temporary orthopedic construction made by the "silicone key" method on the day of surgery; c - clinical picture in the oral cavity after fixation of permanent abutments; d - the appearance of the final design of cermet in the oral cavity; e - the patient's smile after the completion of dental rehabilitation

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9. Fig. 8. Stages of dental rehabilitation using dental implants and bone grafting in the upper jaw and dental implantation without bone grafting in the lower jaw of patient G., 69 years old: a - the initial clinical picture in the oral cavity; b - a section of a computed tomogram before the start of treatment; c - installation of a temporary conditionally removable acrylic prosthesis on the upper jaw; d - the smile of a patient with temporary acrylic dentures on the upper and lower jaw; e - conditionally removable metal-ceramic prostheses of both jaws on screw fixation; f - fixation of restorations in the oral cavity, completion of dental rehabilitation

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10. Fig. 9. Frequency of performing implantation techniques in conditions of bone tissue deficiency using dental and zygomatic implants without using augmentation techniques

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11. Fig. 10. Dental rehabilitation using the protocol on 4 dental implants in patient J., 49 years old: a - the initial clinical picture in the oral cavity; b - clinical picture in the oral cavity after removal of all removable structures; c - temporary conditionally removable acrylic prosthesis was installed according to the method of immediate loading; d - the smile of a patient with temporary acrylic dentures on the upper and lower jaw; e - the type of mucous membrane in the oral cavity at the control examination one year after the operation; e - a section of a computed tomogram one year after the operation

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12. Fig. 11. The sequence of dental rehabilitation of patient M., 68 years old, from the start of treatment to the installation of the final orthopedic structure: a - the initial clinical picture in the oral cavity; b - a section of a computed tomogram before the start of treatment; c - relocation of a removable prosthesis in the oral cavity, transferring it to a conditionally removable one; d - temporary orthopedic structures on the upper and lower jaw; e, f - the stage of fixing permanent conditionally removable acrylic prostheses on the bar; g, h, i - the final result of the treatment; k - slice to the control computed tomogram 2 years after the completion of treatment

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13. Fig. 12. Time intervals for the installation of the final orthopedic construction during staged bone grafting (a) and during dental rehabilitation using zygomatic implants (b)

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14. Fig. 13. Dental rehabilitation of patient H., 58 years old, using zygomatic implants: a, b, c - sections of a computed tomogram before the start of treatment; d, e, f - sections of a computed tomogram after treatment; g - fixation of the conditionally removable prosthesis in the oral cavity 24 hours after the operation; h - type of orthopedic construction in the oral cavity; and, k - control examination 2 years after completion of treatment

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Copyright (c) 2020 Muzikin M.I., Grebnev G.A., Iordanishvili A.K., Tereshchuk S.V., Melnikov M.V.

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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