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Архивы формирование десны | White Crown
Формирование десневого контура — один из важнейших этапов в протезировании на имплантатах.
Именно от десны зависит как будет выглядеть ваша коронка на имплантате, насколько она будет неотличима от собственного зуба, насколько она будет физиологична и комфортна.
Итак, когда установленные имплантаты интегрировались и пациент приходит на протезирование, то область имплантации представляет собой ровный участок десны с выступающими формирователями.
Если выкрутить формирователи десны, то увидим просто «дырки» в десне с имплантатами в глубине.
Протезирование постоянными коронками в условиях несформированной десны не даст нужного результата. Очень часто коронки в таких случаях выглядят как будто шляпки грибов на ножке. То есть широкая верхняя часть коронки на уровне жевательной поверхности и значительно зауженная часть коронки в придесневой области. Или же изготавливают коронки с нависающими над десной краями и поднутрениями, потому что другими способами установить коронку на имплантат нет возможности из-за плотности и объема десны. Все это дает лишь кратковременный положительный эффект и радость от новых зубов сменяется разочарованием, так как нависающие края коронки плохо поддаются очищению, появляется запах и воспаление десны. Из-за длительного раздражения десна проседает, дополнительно усугубляя ситуацию. Естественно страдает и внешний вид.
Все это грозит более серьезным осложнением – периимплантитом!
Чтобы избежать множества проблем при протезировании на имплантатах нужно правильно сформировать десну.
Формирование десны проводится временными коронками на протяжении как минимум 3-х месяцев. О временных коронках можно почитать здесь…….
При всем при этом, несмотря на название, временные коронки — уже полноценные зубы и анатомически и функционально, но благодаря материалу, из которого они изготовлены (пластик или композит) возможна корректировка по форме, для достижения нужного профиля десны.
Таких корректировок может быть несколько, в зависимости от достигаемого результата и проводятся они примерно раз в месяц.
Какой должна быть десна в области коронок на имплантатах?
Между коронкой и естественным зубом, а также между коронками на имплантах должны быть сформированы межзубные сосочки, как и у естественных зубов.
Только в этом случае мы не получим «черных треугольников» между коронками и коронки на имплантах будут выглядеть максимально естественно.
Еще одно требование при формировании десны — достаточный объем десны должен быть не только со стороны зуба или соседней коронки, а также со стороны щеки или неба!!! То есть по всему периметру имплантата!!!
Пример формирования десны в области установленного имплантата 46.
Фиксация временной коронки во всех случаях только винтовая, никакого цемента! Коронка от уровня десны должна плавно уходить к имплантату. Во время фиксации временной коронки происходит отдавливание и смещение десны. Данная процедура проводится под местной анестезией, чтобы избежать неприятных ощущений. Временная коронка постепенно, иногда в течение 5-10 минут накручивается на имплантат, более быстрая и агрессивная фиксация коронки может привести к значительной ишемии и некрозу десны. Поэтому – никакой спешки!
Фиксированная постоянная коронка должна максимально соответствовать восстанавливаемому зубу как функционально, так и эстетически!
В случае, если фиксация постоянной коронки будет проводится на цемент, то по сформированному контуру десны изготавливается индивидуальный абатмент и на него в последующем фиксируется коронка.
Абатмент в этой ситуации выглядит как зуб, который обточили под коронку.
Формирование десны в случае изготовления мостовидного протеза с опорой на имплантаты, также имеет свои особенности. Так как существует промежуточная нависающая часть, то необходимо создать такой профиль десны и такую форму промежуточной части (фасетки), чтобы в этой области максимально физиологично поддерживалась гигиена. Что это значит? Так как промежуточной части и как следствие возможность попадания под эту часть остатков пищи нам не избежать, то нужно этот участок сделать доступным для гигиены и самоочищения.
Промежуточная (нависающая) часть не должна иметь навесы и поднутрения, она не должна сидеть на десне как седло, а быть выпуклой и абсолютно гладкой. Если в этом участке и застрянет остаток пищи, то гладкие и выпуклые поверхности позволят без проблем произвести очистку этой поверхности.
Такой подход используется при протезировании как бокового, так и фронтального участков.
Промежуточная часть так же может быть модифицирована на этапе временных коронок пока не будет достигнута оптимальная форма этого участка.
Все эти манипуляции с десной проводит врач ортопед. Однако создать достаточный объем десны над имплантатом – это задача хирурга. Именно хирург имплантолог должен, учитывая биотип десны и планируемую конструкцию будущего протеза, произвести правильную установку имплантата. Если мягких тканей над интегрированным имплантатом недостаточно, то никакой ортопед не сможет создать оптимальный десневой контур. Пластические операции по наращиванию десны зачастую малоэффективны или результат не длительный.
Продемонстрированные выше примеры — это лишь частные случаи. Каждый человек уникален и требует индивидуального подхода! Однако этап временного протезирования и формирования десневого контура обязателен для всех.
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