ShINYROVANIE In STOMATOLOGY — an immobilization of jaws at their changes, and also at diseases of a parodont by means of special devices (tires) from metal, plastic or improvised material.
Distinguish a temporary (transport) and constant (medical) immobilization. The temporary immobilization is carried out in the way on -
lozheniye of bandages or alloyed binding of teeth, a constant — hl. obr. nazubny wire tires, more rare zubonadesnevy and nadesnevy tires.
The temporary immobilization at fractures of jaws consisting in fixing of fragments aims to reduce pain and traumatization of soft tissues keen edges of the injured bones, at extensive damages of a mandible with the considerable shift of fragments it eliminates danger of asphyxia. The temporary immobilization does not provide steady fixing of fragments in the correct situation therefore its use is admissible only for transportation of the patient in the next specialized to lay down. establishment. The temporary immobilization proceeding more than 1 — 2 days, especially in the presence of sharply displaced or mobile fragments complicates the subsequent reposition and can promote an union of fragments in the wrong situation.
The easiest way of a temporary immobilization at changes of a mandible — its fixing to unimpaired upper by circular bandaging through the head (under a mandible enclose the plate wrapped by cotton wool and a gauze) or imposing of a mitella (see fig. 5 to St. Desmurgy, volume 7, Art. 163). Standard bandages are more convenient: the soft tire sling made of cloth Wild orange — Urbanskoy, withheld on the head by means of the rubber strips strengthened on a rag of fabric; the rigid tire - pra-shcha, having a basic head hat, to a cut sling fastens by means of rubber strips (see fig. 9 to St. Dental equipment, t. 24, Art. 280).
At fractures of an upper jaw the temporary immobilization is carried out by means of make-shifts, napr, a wooden level or a ruler, to-ruyu brought under teeth and tied up for the ends to the circular bandage applied a calvaria (fig. 1). In nek-ry cases
of Fig. 1. A temporary immobilization of fragments of an upper jaw by means of a wooden level.
at insignificant injury of an upper jaw and unimpaired lower with the remained dentition, the temporary immobilization is reached by imposing of the tire sling. Standard metal it is upper
the maxillary tire used for a transport immobilization, consists of the tire spoon inserted into an oral cavity with the side cores located outside on both sides of an upper jaw.
Fig. 2. A temporary immobilization of fragments of an upper jaw by means of the standard maxillary metal tire spoon: and — the tire spoon with extraoral cores: — the patient with the imposed tire *
Cores serve for fastening of the tire by means of rubber strips to a basic head hat (fig. 2). At splinting its intra oral part is covered wadded and gauze laying.
Alloyed binding of teeth (an alloyed bandage) for the purpose of a temporary immobilization is shown in the presence of not less than two steady teeth on each of fragments. Teeth connect on one jaw (one-maxillary binding) or on both, and then connect (intermaxillary binding). Fixing of fragments by imposing of an alloyed bandage is admissible for the term of no more than 3 — 4 days because of danger of shaking of teeth. The technique of alloyed binding of teeth is simple; such bandage smears to be imposed in any medical establishment. Under local anesthesia carry out reposition of fragments. Then a bronzoalyuminiyevy wire 0,2 — 0,5 mm thick, 6 — 8 cm long carry out by means of a mouse-tooth forceps to an interdental interval, cover two next teeth in necks, remove the end of a wire outside, connect both ends and twist clockwise. Such ligatures impose on both sides from a change and connect among themselves, reaching a fastening of fragments. The ends of ligatures turn in so that they did not injure a mucous membrane of an oral cavity. The way offered Ivy is more convenient (R. N of Ivy). The piece of a wire 6 — 8 cm long is bent in half in the form of a hairpin and twisted so that the small loop (fig. 3) was formed. The ends of a wire enter between the teeth planned for fixing and, having wound with them around a neck of two next teeth, bring to their outer surface, drag through a loop and connect among themselves, twisting clockwise. In need of intermaxillary binding alloyed bandages naklady-
howl on teeth antagonists and connect the piece of a wire passed through loops of ligatures.
The constant immobilization is applied generally at changes of a mandible. For this purpose use the tires manufactured nonlaboratory and laboratory in the ways. Simpler produce by a nonlaboratory method, hl. obr. nazubny wire tires and tires from quick-hardening plastic; in the laboratory way (in special dental laboratories) — difficult tires on the prints removed from jaws of the patient. Difficult tires quite often represent the re-poniruyushchy and immobilizing devices.
Splintage at changes of a mandible is generally made by means of nazubny wire tires. The method is offered in 1915 by S. S. Tigershted. Before imposing of nazubny tires fragments of a jaw reponirut under conduction anesthesia. Wire tires produce manually, modeling them in size and a form of a tooth arch of the victim and depending on localization of a change, its character, existence of teeth on fragments of jaws. For this purpose use an aluminum wire diameter apprx. 2 mm; the tire is tied to teeth alloyed bandages from a bronzoalyuminiyevy wire.
Fig. 3. Alloyed binding of teeth according to Ivy at fractures of jaws: and — the piece of the bronzoalyuminiyevy wire folded double is entered into an interdental interval: — a type of the tied ligature; in — a ligature on teeth of the patient; — intermaxillary binding (alloyed bandages are applied teeth antagonists and are fastened among themselves).
The one-maxillary slick tire (smooth bracket) is applied at linear changes of a mandible, easily reducible, located within dentition, in the presence of not less than 2 — 3 steady teeth on each fragment (fig. 4, and, c). At small defects in dentition impose the tire with a steam-softening bend (fig. 4, d). In cases when big fragment is displaced
the DOGROSE 439
towards a change, use the tire with the inclined plane (fig. 4, e).
In most cases at changes of a mandible use the tire with zatsepny loops (fig. 4, e).
Fig. 4. A constant immobilization at changes of a mandible with use of nazubny wire tires: and, in —
an immobilization by means of a smooth bracket (and — the smooth bracket is imposed on a mandible; — fixing of a smooth bracket an alloyed wire; in — a type of a mandible with the imposed smooth bracket after its fixing); — an immobilization by means of the bracket having a steam-softening bend; about — splintage by a bracket with the inclined plane at the shift of big fragment of a bone towards a change; e — intermaxillary fixing by means of the wire tire with the hooked loops (brackets are fastened among themselves by rubber rings).
Zatsepny loops on the tire bend so that they corresponded to outside buccal or lip camber of tooth, but not an interdental space. Having tied zatsepny tires to teeth, top and bottom jaws connect rubber rings, creating draft in a certain direction for providing reposition of fragments and recovery of the correct bite (intermaxillary fixing). There are advanced tires with zatsepny loops. So, in A. I. Stepanov's modification before its fixing on a jaw put on ready hooks a slick tire; G. A. Vasilyev developed the standard nazubny tape tire with zatsepny hooks, to-ruyu fix on a jaw an alloyed wire.
Zubonadesnevy and gingival tires apply at changes of a mandible with toothless fragments, defects of a bone tissue, at localization of a change out of dentition. They are made of plastic by laboratory methods. Weber's tire representing the plate reminding a removable orthopedic prosthesis belongs to this type of tires. At localization of a change behind dentition use Weber's tire with the inclined plane, edges are prevented by the shift of big fragment towards a change. The tire of Port serves for an immobilization of fragments in the absence of teeth on both jaws. It consists of two plates — for a top and bottom jaw, welded among themselves; in front department of the tire there is an opening for meal.
Tires from quick-hardening plastic apply to an immobilization of fragments at a fracture of jaws of various localization. This type of tires is shown at fractures of jaws in combination with radiation injuries. Fixing of tires to teeth is carried out by means of kapron thread or a bronzoalyuminiyevy wire. At defect of dentition in the field of a change the immobilization of fragments can be made by means of a cap (see) from quick-hardening plastic, made in the form of a bridge-like prosthesis.
One-maxillary and intermaxillary fixing can be carried out by means of the cap-type tires, to-rye stamp from one piece of sheet metal for each tooth or for several teeth in the form of a kappa.
At impossibility of an immobilization by means of tires, napr, at the excessive shift of fragments, defects of a bone tissue, existence of toothless fragments, and also in need of earlier recovery of function of a jaw apply operational methods of treatment with use of extraoral methods of fixing and various ways of an osteosynthesis (see Jaws).
Splintage at diseases of a parodont — association of group of teeth in the uniform block for the purpose of an immobilization of mobile teeth and distribution of chewing pressure upon the remained teeth.
Temporary splintage of teeth is carried out at an exacerbation of a disease, operative measures, after movement of teeth at use of op mod of optical techniques of treatment (see). Constant tires use how to lay down. devices for an immobilization of teeth for long time.
Tires can be removable and fixed, and on extent — integral (for all jaw) and partial (for group of teeth). Fixed tires provide long and strong fixing, are convenient, meet the cosmetic requirements, however a lack of this type of tires is need of preparation of teeth. From removable tires byu-gelny shiniruyushchy prostheses most reliably eliminate funk-tsionny overloads of a parodont. The tire prosthesis represents a metal framework, one of basic elements to-rogo is the connecting arch (clasp). The arch can be wide or narrow, in some cases have the form of a frame. In a framework of a prosthesis there are fixing and unloading devices in the form of the holding and basic holding clasps (see Dentures) various design — kogtevidny, ring-shaped, continuous mnogozvenyevy, with occlusal slips (tsvetn. the tab., Art. 368, fig. 1 — 4). As a rule, in a prosthesis there are false teeth filling defects of dentitions. Bibliography: Gavrilov E. I. and Oakham and N And, M. Orthopedic stomatology, page 402, M., 1978; 3 and at with and e in V. I., etc. Surgical stomatology, page 348, M., 1981; The Guide to orthopedic stomatology, under the editorship of A. I. Evdokimov, M., 1974; The Guide to surgical stomatology, under the editorship of A. I. Evdokimov, M., 1972. V. I. Zausayev, A. I. Matveeva.