ROC - Curs 3

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Curs de ET - Reabilitare orala complexa

Transcript of ROC - Curs 3

  • CURSS ET_Roc

    SPttROTEttAttA TOTAL AR[VttlnDEFINITIE.TERMINOLOIE

    Dettitie: SupraOrOteca repre2ttt Lliproce(u tt resmurttre protttmoiltt a edenta:iCi SubtOtalc sau tctale,caractcttzPn conicloarca ltteiprozc mtaI,carc Pe:a lllucozaitt Prelttt lttcaswi corespEtoare dIIcrrcst s Pl ilor.Dhiii FeSt CCSpeCtiV inpltttclc)SuilLati,Cizolail orc :l Cu SiStemc cu cse,mattct1 3telescOTe,ie solidatl prsistcme spcialo(btte Cu ce),c015brd astl apttahi protetic,m sPrin,0meltmere si o stabilittte superiolci proteze totale cOnventionale.

    In cazul supraprcltezarilor pc d=lil nattali so ttldicpsiFca cu precttderc arttdchilor deesOase,L tilnP ce corotteic stmt ainPo cPIttgivat hacest1,bral de rCZiStenal dhtelui devine mai mare dectt ccl dert,conscdu-l mai multtp pe ttcad.L acest sens,nece ttnte ttebtte cvalutt catcrLttc,uat corcct cndodOilttc apoI Pttepttat11dGrca suprapro6szttI.

    Terminologieg in licra a do spccial e cxistmai lnlti termeGodcesc spraPrcFtezttea:

    21l Ei:1ltta c313 uttli"11iif`,g7

    `

    19,iS

    '7'OSttcs, 1erama gennan:l;^ac

    " siF;

    11litttattarancezI `,prOtt ttIzl'

    `

    .

    7?J ey deShcste O protezlnobili2abiltt care prclzttlttt o cxtensicmetalictt sau polimerictt peste supraiele=LCiZttc/091e tte diniilor restanii.

    r"`

    Z SOIn.1ctt O prOteztt ctte se Tr pC!CSuti mOi si dtte(Os,rttdcistt dti rest)

    tt"J Jg`

    Z r Js CStC aouit unui sistem de capcpril0,cOpele sccundo.rld incluse 2protcz.PcdoscnILrca acesili tlp dcPrOteZC,literatta anglclsaxOnloloscstc F

    '7fic on,/Jr2,cea gerritan

    de hibridPrOiese(protCZtt httrid,i CettiP^ g ?s'F

    Prczen,pe ttCadc a lor dti reSt1,,pennitC prOteticittluhi stt aleagtt unadin urlarcle varittte terapcuttcci

    /, (pmtc 10t);/r7(cu eiemente cOttcte si proteza pah aCrilictt sscheletcu elcmcnte obisnuite de menthCre,sprtsi stttiliztte):/ Z

    `(Cu 31Cmcnte cGcte 51 protett schelGttttt cu

    iementc sPCCiale de mcnterC,SprtL si stabilize):

    "

    `

    tt ,7f/ ?1FfF77 =duptt cxtractia Ordinii10r restan,dtt ace,anltt au valottc protctic;

    1

  • SQ?rrZrgForF7F,.Pella usura aceasgere ast einisc o sttie de pOsc, si anumci z tt r7 F`eStedicattt h:e caile m care

    cxisttt din,rcs,SttnOsi,cu o distiutic uttittrmtt pe allcada de,cu unrapotti coroan=rttdttcvorabil si ctte,1ma cxameolor parttcicc,arattt cacestia sltti penttu a supona sttctti suplimentttc.

    s7=F,Zestc indicattt in edettatiile termotenne,1edentalil10 1ateralG illtttsc(cu numtt lllarc dc dinli ttSCn1,unOOri in regimeaontaltt dl cOnsiderente ttzloolluce sau in cazluor rezori avansate ale crcsteicdec).

    SCZ Se pune :n cdeiltaiile sutotale alc unui lnaxllar, cusuport dentoparod6nttt1 51 lnucoosos deiCitar,cu retelitivitttti rcdusecttrora h seoplm pe arcada attagonist,dttti namrdi sall restatrtti prOtctEcc ttxe sau palmo1lizabilc.

    EFZ ttl, Cste indicatn locul suraprOtezttii la pacicntii

    COOrera si Cu igie ickor.

    CLASIFICAREA TIPUttLOR DE SUPRAPROTEZARE TOTALAA.n ttLnctt de sstructttrib de sP att Sttpraprotezttrtil.s,~ar P=72.stt9p~f,F7..ctte de sistettele utiliz&e tt supFaprottezare:.rpr,Z77,care ttilLeaztt dinti Sali resttri radicultte,trtta!i

    coreci endodontic.Rcsttrile radttcllitte pote pr:.ttr/(dill alnalgam stt dmateriale cottnpozitc)m portiunca coron

    a canalelor;.

    `

    `r(prevlcu rilrot1attdicular)cimenittc re

    ditttc.

    2 sfpTrz : sJf , , J3n, S` ,apliCatc Pe di,Sape rcsi radiculo%atc endodolittc.Sistelelo lpeciale poii: .sfarOr

    ,s,sF777?"77tt./sr

    "rFO/r.

    c.nctie de perioatta ttn carc se realizeaztt suprapolzarea: Sf FgZrg rttc F,cttactcr provizof(oOteztt PaFtial amOvibil,

    ransfolnattt lil proteztt otaltt aplicattt PcstC ultiltti t_11ti restalltil.s,y,zJ"iF,.

    SUPRAPROTEZAREA TOTALA ALIOVIBILA FE DttRTI RESTANTISAUPE RESTURI RADILARE

  • ,/ JELE SPR4PREEAf Pf DiV RISittN=,

    AR41/T//~/CELff PR%RCON,FENTONAZFSupraprotezarca pe dulil nattrali prczttlttt o scrie dc avalltc, atat pcnttu

    cOnttrttil paciell1lui,cat si rCilttu lcdici.?At l F ?r

    J,, prin stul1rea

    ctionaltt a osullli alvcol[de la nivclul ultilnilor dttlti10r rcstlti.2.Crf0

    'PrrEr,prilll lltcntherCa unOr zone

    retelltive nalrale ale cresici alveolare,lnep1l dlri10r prezcniilAr:In protezarea paltt COnentiOnal,dtii rcstttti prevzuti cll

    m10aCe specitte de retentte,211n.preuncu retentivitttca vers8mlui vestttultt alcrcstei de la acosi nivcl,reprezttlttt ictori ilmpoltttli Care sc Opun tendinic10r dcdesprindcrc a prOtczci,desi lipsestc suc9iunCa tttern.Sitlla,a cttC prczilhsdintii rcstanti gupati unttatcrttl pc ttcad,sau prezcr.ti nulnai in zOna frontal,cstenevorailtt pen:ru o buncnitterC a protezei pale pe c ,aceasta[andtcndhta dc a SC dCSprttde duplinia crosetelor.

    In astfel de siiiSupraezttea tpc dmti rCttanti,pm rcttLttea1lputttIii corollttC si ObiincrCa unci 2nciidcllttglinalc Optilllc,crcaztt condi!iivorabile de lnen!inere,prllcrcsterea a succittii imterne a picsci protetice.

    .'rlF lmci ttpraprttcztti tc cttc multimblmttt:it)COmpativ tt ccl

    uncl proteze totale convenllOnalc.I)atorittt prczcntei dinil10r, acest sPrttm SCrealttcaztt pe o supramai ltare,cstc llixt,dcnlopodontal,cat si mucOSOS,CeCa Ce as19fos1tie tti a prespStlli10r ttsticttorhnchl2nttegului cttIlp protttic.In phis,stttnulca nttLCOnaltt a Osului alveolar conttiblliela scttdcrca rei de aoo9i rczorbticCOnscrvttduipalnettii dimcnsionali pe operioadtt mai mdehngattt dc timp_

    .S/sT71FZ rOeste lllultbunit,COll_pttaiv cua unei proteze tottlc conventiOnttle,dttorittt prczcn!ci dti10r rcstansi a proceseiorlor alveolarc(mai ttnale si mtti late), Carc constittie rctentivti nattralestIPlilllclltare,ce se opun tcndIIIJ;elOr dc dcstabllizare a piosci prOtetice.

    .ftt_g/ sFfz prm pttsttarea proprceptoriloIParodolltali diil rarOdOntiul dmltllclr restall)Care controlcaz,prin intcrincdiul ullormccanisme cottplcxc,GXCrCitarca nlnc=ilor eseniialC ab sistelu:ui stOm0 atiasticalia,Zi01lolllia,natta,egiutilia,nctia de alcnlcIc.

    .Cfr7r7JJ0,77F?Oy77 /17Ff,'0la pacicll,i supraprotcza,,colparaiv cucci ploz3[oal alllovibil cttn1=olldaliPFz(lCiOr dli resialtt pccad, a ligaine.ltelor parcldontale si a proprioccPtOrilor dc la acest nivcl, carercprczitttvcrigi alc ttedbackli senzorial.Stailitatea lttai buntt a suprapro(czei siansJnitca rielor lasticai si dltoParOd011101 u ttllttai ttucoOsos),21buntcStC SCnSibilitatca tactiltt si pcrforinallta nCurO-11lusctllar,pacielll11dcapabil scxercite fortc laStiCatoril lnai lllari si cu un cOnttol illat prccts al acestoraln plus,lnargEli:c protczei de la nivelul dinii10r rcsl11,191lu necesittt cxtilnderea lor

  • panin d1le de sac si deci, nu vor provoca leziuni de decubit si discOpacie:lui

    b.PttsrF? 27'fO f IjnittttilC delltoparodolltalc rcstIltc au sivaloarectiOnoclLal,prin calitatea proprioccplci si a liicmorici ocluzttc.

    La subiecttl dentat, proprioceplia eStC asittrat dc receptorii anali inligainelltele dciltoParodontale, lnuschi, tendoalle, os alveol, TI, deterin1ndpOZi:iilC mandci in timpul cxcrcitincili10r.Rcttexul ocluzal aparc o dcuettP,ia d1,i10r Si SC ala origttlca rela,il10r lilandibulocraliiellc.

    La cdentl total, rolul pFO_iDrioccptorilor estc prclllat de cxtcrocertOriiprczenti la niVeld ilucoasei,ctte rcttizcaztt o perceptie ttult ttai redus.

    Lle11loria oclllaltt cste reprczcntattt de engalna lliscrilor mandibulare,constituittt pc baza1lbrlliattilor culcsci transinisc dc propriclccptorii parodontali.Prezetta sttucrttor proPrioceptc Pttodoltttc va co)aiin supraprotczttc,laObtinCrea unor pozilii interinaxiltte lnai sige si lllai stabile.

    .S? r sr's

    lr.Pttsca ttlor dli rCSiti Sub prOtczG ttcec fav lle asua sccrettd dC10r sde,rcc ii podttali dmroldttecti tt stilllllttea rettexlui salivar,prh rcglarea tttubi si allplittdhiiiniscarilor lnandiblllrc.

    CrcfFcre l,fO sttrJ PttZarJJLa om, onolia ttfe un roldeoscde impot in iiiterttCa lui ttn socicttte,illd considcraonctiC psiosocial.Tuibttrile zionolnice ctte ap la edenta subtotal sunt deosebit degave si de cvidette,attt pentrtl pacie,cat si pclltu allul s,d deteiinmatede lnodiicttea scliclnei cclrporale illdividualc.tsticl, naginca pe cttc necttedivid sio creeaztt dcspre she,dcve inutt dittritt de ilnagca propriei in

    =fi,

    ceca ce deterinttltt apttitia de tu]bri si nlpri gencratotte de nevrozc si psozc.La acestc dczechilibre coltribuie si77sFF s?J r, ctte CStedu mai nOciv,cu cat scctoltll abscnt,al,sc antt ia nivci11l cavitji Orale,sector dc lclcalizalc a aictivittttii si ZOntt dc colaborare cll sclncnii.

    P?:Fc.fZ/ tt rssullt icgac ipui dc pliczI

    >pactt dintii rcsttnli,dC Obiccioali,sult pttsttatt Ca atarc pc arcad,citrcbuie stt sc arlilttnizcze rcrct(dill pCt de vedcrc al ct31orii si al lloorlogici)cudii arciali ai prOic_7ei parttaIC lpfcu ac rcaliza daritt il10dittcIorcromttice ale dintilor natwali produsc in dmpl in plus,migarea dtilor restanti,consccutiv cdelltattci Sau parodolltopatici creazproblcme 211 pozitionttea corecttt a

    dinilor ionli artittcittliDactt diltii ICStanli Sunt utilizati ca Staipi llltro supraprotczare,toatc accstc

    inconvcnicntc sunt indcpate,nctia ttZiOnolllictt ihd rettcuttt lotalitate. :Redilcttsicnarea ccrcct8 ct[ui inirior Jci,L rclac de OCiuzie

    ccntric)(Carc la cdentatul subiotal estc lnicsora!prin riCrdCrca cclntactclor dentodentare dill zona lateral)eStC inal lisor de rcalizat pritttro sllpraproczare, dccatpro protczare par=alCOnvcll,iOnal.

  • >Funclia ttZiononlic,rettcutpr:Bo protczare ptttialtt alllclvibil,poate iaiciaitt de vi_711li21ea0,oi10r sa seilor proteoc dtt EOnao,pl oG ttl]sc ttntalttpltt in cazul unci surraproteziri pe dinti restttllti.

    > Prczcllta vcrsan1lui vcstibular al ,cii Protcticc, 2 zona ontal, poateoca aspeconomEc ai blEei stpeoe,at L cl Foteztti p

    =c,cat

    si h cazul supraprOtezttii pe din=reStan._3~.R fr77:FgjChiar dac,in tiinOul viclll,individul pierde cll llsurinitt dinii datOritunOr

    cauze ce:in de lipsa de igientt oral,neglcnta privttd prczeea la c6nttoaleleperiodicc Prottlactice,acceptea unor exttaci dentarecstive,etc,picrdoreallltililor dli restattli pOate detenntta instt un 5oc cmOi101lal plltellic,cOnstittlttd oadcvalatauIIItt pshologic.

    ECFienta ClhiCtt a artttat ccei mailr.ulti pacietl,unsiin aceastct,bie,prilltt dorillia de a pttstta necondironat acesti d1,Chiar dactt ei nu mai prezlllovaloarc protctic, rcspingalld sOltttia tCrapcuactt ac Protczarc total alnOvibilCOI1 l.DC accea,ptts ca pe ttcatt a untt dhtirezittah,(Chi,i acopde o prottztt total),va dttinua acest sttess psaillologic,va permite O adtttare maiuSO,i Va pregati pacielltll ttn tilnp,Porlttu solutia tOtal alloOvilDiltt conveniOnal.

    6.Str,Z `

    STFSen,rrCS7

    FPAlputtea corondittctt rapo]l cofoalltt clinic

    rdttc,vOttca rttdacii micsord astttl braei Si Crescd bra1rczistcntei dtCluicttc se colnpolttt ca o pie dea(lI.Ftttele maStiCatoriivor avea astfcl, o dttcc:ie predOininalit ver[ical,in axul rttdttcir.ii si vor disPtteaC011Onentele llociveorizolltale,l de torsiune,asa nttnitelo,. rrr".

    .Dintii uttliZati ca stttpi 2o suprOprotczFc au 0J,/ vrbr_z,prevenhddttca c1 91 prokd astttl smcttrire de sprttmsubiacente ale cttnpubi protcticde ttrtt excCSiVe ctte ar accclera rezofbttaalvelar:la acest ettct prottlactic cOncur,i stabilitatta si rctcntta mai bttltt asuprapliczci colPativ cu Pleza ioal ainOviiltt cOttvCll01lal, P1transiniterca l_11iibrini a sOlicitttrilor la nivclul osului alvcolar.

    8. Duptt supraprotczarc, f7frr,i7 si 2n specialf

    `

    :`rfz7/.9,Incidenl lezithtiilor dc dccubit este iilai rcdusl cazui supraprotezarii,

    decttt in cazul protezttril Govcntionale. l ali ava 81 sttrayOteztti esic aceia c,dac12dc rttd ilc

    pttstrate 2si picrdc cu tiinpul valoarea protctic ei OStC cxtrasl, nu estc nccesarrelacerealicgaltt a piogei protcticc,ci n1ai colpletarca ci cu latcrial acrilic PcalttCOZal,:lttca,41:corcspunztor dill=c:ui exttas.

    .O supraproteztt par!ialtt patc i u,Gr trattsnat :I]proteztt totilcdiat,avand avantttclc Suniltte accstcia

  • 2.Rcptta::ile unci supraprotczc iGttilC Sunt inai u,or de reaLzat sicOstisiittarc dccat ceic alenci Protczc schlctizate

    2.DEZ47'143ESPR4PRIZ4fP]D_Tf R3SiDczatttele s.praprotczttrii sttt relttiv pu:e,COiV Cu ttult101C

    avttltttc ale acestei solutii tCrapcutice.f.Pr

    "'Prrz 7f2'`7?,

    ''

    , cOliipttativ cucel al unei protcze tcltale convettlionale,dcottccC ilpllGInanopcrc clinicc si

    tchologice suplttnenre:endodonticc,pttodolltale,prepri radiculare laorioasc,real32rea do suprasttllGi lnetalicc tuIIlatc.

    2.Srrz Fff",?` gF

    `

    sas'

    Far

    dectt protczele mlc,deoece,avand un sPrttitl si O stttilitatt crcsc,penttitpaciellhi stt dcoltee maStiCttorii mtt mtti.

    g. Sl70Z S 77FfF l'0s f ,tt O, dCctt protezeic

    tOtale convcnttonale,deoarccc PreZisisteme specialc de mcn=ncre si Stttil e.JSj J ST9P

    Z S`V

    rcr, g P4farJ'l,rc O.Mttorea raciCntl10r cu indica:li de Supraproteztte slmt persoalle

    vArstnice, cll abili ZiCe fcdusc, cu igielltt oraltt dcttcitar i dc acecasusccPtibilitttca la catti cstc mult ttMli crcsGut.In scopul prevcnilii lczilttlilorcaoase,ca si a illlokLttvirii podoli:iului ttnti10r restti sttnt necesFe sategii dcconsiliere nutrttional,respcctca mui prottain Sustut dc fgientt oral, aphca:iitopicc dc ttuor si un protocol strict al conoGlor Pcriodicc bianuale ale pacion1lui.

    _3~.AZda srOZrFf,Stt F"r2"FFc _rattrg,ceea ce,pentru pacicnt ttnsealnn 11ti lnhe viziic la cabttct,i[pellttumedic,lnai lttult tilnp alocat pclltlIinalizarea ttatttnellllui.

    F.IjC4IIL3ENEMZFttJ SPPR A:AFJ D SZ Sr,cFz r"PrFa Sau,suntdictte la pacientii

    cu:pu!ini d11:i restlti pC arcad;abrazre sccr:allolnalii congcnitale asocia ctl anodontii:anttmalii de crestcrei dezvoltttc ale maxilarc10r,cu dccaltte sagitale si

    attsversa[olarJ,co n3 pcrmicao oolCCttC(li=glcaltt ottcirgttalic

    .

    in prcze,lin.ttOritttea protcticioilor sttt adeptii cOnccptului conscttator,(dcconscrvarc a s:IucttFilor tislllc aic GPdui protctic:d,rCSttti radicularc,parodolu, OS alveolar), cclr. cantta,posibilitalea dc a ittenille unli dedillti Peoadvederca supraprotezttrii csic luat in collsiderafe,Ori dc catc Gcxisttt o ittdicatic de CXttaco.

    In concluzie,supraprotczCa Pc dinii rCSt1:i cstC indicati[a doutt catcgor:im:de pacienti:

    .PfF7 J,FJ:J frgrff17.S,r/

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  • Pr grF"F , O/frf, J7?r

    i:l/`

    3 f fF:Df641RE SPR4PRIEZAlfENrC PU]DfRJS PJR(]DH

    l.In functtc de vttrsa crottologttctt a pacielu sulDraprotczttea pc dlilti restti cstCdiCa T

    F, dGtt s,1`/

    ] darPrf/r 7r 1 stt sPrGFsF 7ff7,rz"sy?r7:

    .sII.praprotezaFCa PC dillti restallti cSte ttdic P ',

    Z7ftt -7f2S sl la care secpeazproblclllc dc adaptaic psiliosomatictt la o protezare totaltt alllovibiltt Gonventiclnal

    2.hflcttc aC Starea gettera pacietti:.suprOprotezttca pe dlli reStanii reprCZlnttt o saq` fZar

    P Or "y ,/ s 0rFtt F?F.

    b.SupraIIttezttea pe dinrcttanti este i.nttcPFsJ rj,"zF?faJ,f?F,d00arecc:

    reduce nuuledttte10r deame: rac31tttlC tt a e si Celeserle si deZttSe a picsei

    plotetice,comparattv cll o prOtezalc scllcletizat;lnbunttt!cstC Stabilftatea protezci,colttparattv ctl proteza total

    conventional.6.In fuctte de localttzarca Enaxttarandibular2 edetttatictt suboatte:.suprttrotezttea pe din:i reSta esdiC rf],fr77? ,

    dcoece sprattta de spr prOtetic este dettcitrctetttivh!e oSOasc alccallipului protetic sunt adesea destthtate dttoritt rezolbtiCi alveoltte si 2oonscc,o prOtezo1 ldibulartt nu va avea condilii Optunc dc mcnlerC,Sprttin si stabilittte

    .sttraprotezttca pe dli reSt ulC ttJ ?FF r(dOtt in

    situaiiilc Clillicc,1olattv rc cu rezorbtti avlSate,caFc zollCIClcollale dcSprttin nll maio valoarc pro(cttctt optipcntm a asira condi:ii]C de menttnere,sprttin 91 stabilitate ulicl protcze tcltale acrillcc

    4.I co dC rttl,itteg:fea pao Itt si ax c Pfa eatt dittrilor resta,SurFattroteZarea este ittdicattt in urarcle situatti cl:ice:

    .cxistentaui7F,s J`

    F',Cc nu ortt colldttiipcu o prOeza xtt sal[,artta1 2101ribil, da0 1l L]111llli hsLIttccnt,distributiC:1lCfavora1lo pc arcadtt si valclrii proteticc scttzltltc a lor ;penttu ctt iliacese siala:li supoltl dcntoparodontal este dcttcar, cste dc prci)rat ca supoli L,COOSOS SOo:i13o(oreSiC Cdcate hc,ronlllittC,Cll dirccriC Ottzo31ta15,cTlrczorbiie redus,olttt l.alat1dc adallcilnc lnedie,cti tOrus paiatin absent,cu zoncbiostatice dc sprttin binc rcprezctttatc,cu iliucoasdc acopcriro grOasrmadcrcllttt dc oscu rczilient1li11lite norlmalc)

  • .sittatiile clicc cG Prcz: 7FF rF Fr POJF I,Cu Oartt 11lobilillc ttadul I I, dar care ll

    fCZittttt sclllc dC imSuttcielltaparodoah mttor:

    .sitta,1le Cllce care prezt r/ff"Fi7(igati

    oroal,cxtttzai stt Ggrcsai),CC mOdittctt pttamcttii dcnsicnall ai spaliubiprotcttc Potcntial,OCurandu-l partial Sau in totalitate.

    5 ln ttnctie de sittatiaiCcAttPtturo edettiat parttialtins/subotal:

    .supraprotezttca cste indicattt F og rfrZ,Prgr7Sr?1' j rrttZJJ tt F]2o OttveOttC,datoria re2fbttei dVC01cstte ctte a desat retetttilFitttile nttwalc ale callYulul protettc.

    inctie de sittuatia Clictt existtetttt re maxilarill antagoist,suprao(=area eSte inttica

    .iillc Clittcc caractcrizatc prrl/ 2 zf,0

    7FrpFfrsa/s767 Jlo?: F7POFZ/J sc~Ftt Pr/

    z(diniii rest,ind aCOpCritt cu microprottzecorottc do 2nveli);

    ?7Js

    "3r

    `

    /PZr OrAin astl de cazwi,dintii rcstanti landibulaFiSnutrte masticttorii mtti

    crestei edontttc alttgoniste,voriz`d apttitia Shdrolului de itterrelttie Si

    ondollelldibulocI11t.sittatiilC Clmicc caractcrizttc prin F r fJrrztt F

    l' 771'7fF

    7, `F,2 ?`77'` PZ `7F

    :LIFASf.Im accst caz1clc masticaIII suPlEllinttclsmise maxilttui,pot avea drept conseciil:destabilizarea protezei de pecpul prOtctic,acca ci si apttitia sinttOmlilui colnbinat a lui Kelly.

    CollPlicattib al1ilc polri eFi:att praim attputtrea conartt a d]orrcstttti si realizarea tttci sllpraprotezari de dp ovcrlay, cttc, prin disiributtcaunifoa ibrielor inasticatorii asllpra crestei,va reduce paternttl picrderttor OsOasealveolare

    .supraprotezttlea pottic tt considerattt s" /IPr' in

    siillatiilc clillLiCC in carc s//.9_ )FFs:JbrF`Ff ttOXl"

    ~Jfr

    r r=z",Prg77r

    .2.hC IIILE SIPR4PR07Z43C4ZUL R4NOR CDttESfTR C4PRA

    Sllpraprotczarca pc dinti reSta CSiC:Ildicattt in urntoarcle sitllatii C:iniccilaictiule ccnsenitaie ii?`cg r,`,FFSf,,.,

    gT/ /r se indicutilizarca uitinilor dinti prCZellli ltrO supraprGtczarci

    pe illaxllar,11l prognatisl:11anibular:

  • pe mttdibul,in.micrctta=ile mttdibultte.In alttbele sitta,scOpul suprayotcii cstte de a prevli acccarea

    decalttului Sagitalilsvcrsal dhe cclc doulnaxilttc..7017r/l,Cu puttni dmti preze,pc arCad,supraprotczarOa

    rttreZttto lndica=c de CICCric penim festattarca nttc,nalsi estctictt a sis1uluistQlatoDacoa]a sc insoteste Si dC tticsorea dinsittnii verticale deocluzic,alllputrile corOnare nu lnai sunt nccesare,supraprotcza aplicandu_se dcctPcste acesica

    79 PF/7r? "` ttg JP:[Cr,77r,77gi7Z

    7,2.In 2gectiitte doie:.? r_tt ttF?Z7 7^Z77, ,Chitt dactt acestia sunt in

    numttr mare pe ttcad.Attcthnea sc hs6tcttte de rcttl,maelttii mandibu10-crelle cxtraposturalcxcelltricc, cu lllic9orttea selIIlittcativtt a dnensiuniivelticale de oclie si cli tulri ttzionolnicc aselnantttoare edontatllui total.

    Dcottfcce,o rcconstimttc rrOtCttcxtt cste dttosebi(L clificih,cori chttrinosibil,sttraprotczalca repre2htsoluiia optim.in aceste sittaii, dintiineccsprepi mhilie de deretelltivttarc(Fig.2)3,4).

    Dactt abrazia sa prodtls ttn tilnp)nu este ncccsrtt nici dGvitalizttea(lti10r,calnerelc pulptte,illd obttrate prttl depuneri de dclltintt sccundde reactic.

    . frs,SFr"FttJ?,cttc nuremit recOnstii prOteticc ttxe sau lmclbilizabilcl

    ?crJ'

    777,bs,c1110dilici derli,

    voluin si culoafe ale dintilor din zona ttontal,illcIF_lsiv a Ficil101ilor l. 7 zr

    "c 7.SOS

    1, PttF/2,s ^ Srr

    _1,/F,de ctiologie:_srirfrttr accidellte dc lunc,sPortive,1utcFc,plgi finpuscate:

    F'SF7lgir ctuptt extilparea ullor 1lnori dc inGzostrttcttrtt sau dcplzIscu bucal, cc sc pOt lsoli dC pierderi OsOasc ilnportlic, cc nccesitrecollsttuJOtettce cuiieze De multe tti,L astl de siiua,u se poaterealiza o prolozare tota] prin inctode convcnticlnelG. Solulia Ortilntt csiesuprarrotcZttCa pc dintii rcSt

    ',SCICCtati cu tttC'C Ca dmti Stttpi.Daci arcada cstcasiloic, sc indictt Pstrarca intc:ittii COrOttare a di10rr a sc prcPabollttri radiclare

    RAttDgP4)ROrrZ(RPF DrS34Ca orico lcrapic Pro:elictt si sllprap^oezala are liini[ si conttldicariile ei.

    In general,accstc conttaindicatii Sunt rclativ p,nC si tin dc starea generaltt si locala pacicnt111111.

    1oaittdic21itte getterafe si rcprczolltalc defa aiCtiuni generaleave,:livalidante,i casccttzalltc:b.attctii Cardiovascularc scvcrC:

  • . c.aic=utti lnctabollce si endrine severe;d.attcttltti alc 5istelluJ ros cal(boala e )2.Coiiralttdttcatitte locatte:.gIr,7zJ,dttOrittt impositttii pacicnlui de a o

    rcaliza sau reizului dc a colabora cu lnedic11.ri?fFr7J7fr

    fsusceptttilitate crcscuttt la cii dentttc,Cu cvOlutli farid PrO:eSiVe:dinti cu IIacttri coronoradicule verticalcldinti Cu rttdttcini cttG,ce llll potatali corect endodonticidinti ctl tlatalente endodontice iattogcne,carc au produs pcrfOr.trca

    lnecanictt a rttdttciloilor si/sau ttactca acelor de canalidinti cu ittaci ofizontale situatc subggival,dinco10 dc 1/2 apical;dinti Cll distttc,i corOnttc stbgingi7ale:di!i pluriradiculi cu lezitti dcrca,c gadlil II si III;dinti CC Preznoene de rezotic radiculm..OttFroJJ: ParoJ:attcluni pttOdOttale,cu evoLtii rttid progIIesivo;dinti Cu ttobilittte de gadul III,cu ilnplantare osoastt rattculsub 12

    apicLdettcte osoasc si de pmoiCare nu pot tt corecttte prin procedee

    ciligicalc.

    10