ION RINDASU Proteze Dentare
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DR. ION RINDAŞU Doctor în ştiinţe medicale
Medic primar Şef de lucrări Institutul Medico-Farmaceutic Bucureşti
PROTEZE DENTARE VOLUMUL I
EDITURA MEDICALĂ Bucureşti 1987
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PREFAŢĂ
Lucrarea colegului dr. Rîndaşu Ion, «PROTEZE DENTARE», este o lucrare clasică ce prezintă foarte pe larg, ca un tratat, toate tehnicile cunoscute pe plan mondial privitoare la confecţionarea protezelor dentare.
Dat fiind paleta foarte variată de probleme tratate, interesează în aceeaşi măsură medicii, studenţii în stomatologie, tehnicienii, mai ales pe cei care vor să se perfecţioneze.
Autorul, avînd o experienţă didactică bogată, a reuşit să îmbine armonios caracterul didactic al expunerii cu caracterul monografic al unei lucrări practic exhaustive în acest domeniu.
Lucrarea, nouă ca formă, şi în cea mai mare parte şi în conţinut, reflectă în permanenţă o gindire medicală cu accent deosebii asupra problemelor de profilaxie, foarte mult neglijate în protetica dentară.
In acest context, sint introduse principiile ocluziei funcţionale, prezentîndu-se şi multe tehnici dentare tratate în această viziune. Din acest motiv, lucrarea se adresează în special acelora care doresc să aprofundeze funcţionalitatea aparatului dente-maxilar.
Praf. dr. Lucian Ene
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CUPRINS
Pag.
I. MICROPROTEZELE (PROTEZELE UNIDENTARE) 9
II. PUNŢI DENTARE 153
III. PROTEZA PARŢIALĂ ACRILICĂ 231
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INTRODUCERE Din cele mai vechi timpuri a existat preocuparea pentru restaurarea
morfologică a arcadelor dentare, care în etapa contemporană a dobîndit noi valenţe, prin progresele realizate de ştiinţele exacte (chimie, metalurgie, biologie etc.) şi a gnatologiei clinice în special.
Leziunile coronare, edentaţia parţială sau totală, reprezintă o îmbolnăvire a întregului organism, cu importante repercusiuni îndeosebi asupra aparatului digestiv şi uneori chiar asupra comportamentului neuropsihic.
îmbolnăvirea, cu localizare la nivelul unor elemente ale aparatului dento-maxilar, necesită tratament complex curativ şi profilactic. Astfel, se poate face următoarea analogie: medicul internist prescrie medicamente şi recomandă regimuri dietetice, iar stomatologul confecţionează proteze dentare cu rol curativ pentru restaurarea funcţiilor aparatului dento-maxilar (masticaţia, fonaţia, fizionomia), şi profilactic pentru conservarea troficităţii ţesuturilor pe care le acoperă sau cu care vin in contact. Acţiunea curativă a tratamentelor protetice se apreciază prin restaurarea satisfăcătoare a funcţiilor aparatului dento-maxilar, iar acţiunea profilactică se evidenţiază progresiv, în timp, prin durabilitatea restaurărilor protetice, prin menţinerea troficităţii structurilor cîmpului protetic.
Suferinţa în cadrul leziunilor coronare, edentaţia parţială sau totală poate avea multiple aspecte, în funcţie de: topografia edentaţiei, numărul dinţilor absenţi (afectaţi), vîrstă, sex, profesie, starea s;cială şi de tipul de sistem nervos, medicul stomatolog fiind chemat să rezolve complex şi competent fiecare caz.
Aiulţi pacienţi ni se adresează cu speranţa de a obţine restaurări protetice optime din punct de vedere estetic, pentru zona frontală, şi masticator pentru zona laterală. Complexitatea particularităţilor morfo-clinice ale cîmpului protetic reprezentate de forma, dimensiunea, poziţia (aranjamentul) şi culoarea dinţilor, relaţia dintre arcadele dentare şi caracteristicile specifice materialelor utilizate pentru confecţionarea protezelor aliaje metalice, mase plastice şi mase ceramice) nu sînt întotdeauna favorabile să-i ofere solicitantului rezolvarea pe măsura aşteptărilor.
Frecvent sînt obţinute restaurări protetice satisfăcătoare pentru funcţiile aparatului dento-maxilar, unele din ele se dovedesc a fi efemere, după o perioadă scurtă de timp pacientul se declară foarte nemulţumit, iar consultaţia de specialitate face aceeaşi remarcă.
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Ulterior, datorită acţiunii nocive a protezelor asupra unor structuri ele devin ineficiente, reprezentînd, în final, un insucces terapeutic total.
în asemenea situaţii a fost neglijat aspectul profilactic al tratamentului şi nu s-a cunoscut, sau s-a minimalizat, acţiunea iatrogenă, ceea ce a determinat modificări morfo-patologice profunde unor ţesuturi. După aceste insuccese se impun tratamente complexe în urma cărora să se realizeze proteze corecte, care să dureze o lungă perioadă de timp.
în cadrul Disciplinei de Propedeutică Stomatologică, prin specificul programei analitice, se îmbină în mod armonios activitatea curativă-profilactică cu activitatea didactică, ceea ce are ca rezultat stimularea efectuării de observaţii utile, materializate prin scrierea unui îndreptar care să fie pus la dispoziţia studenţilor, tehnicienilor şi a medicilor stomatologi. în acest îndreptar sînt cuprinse toate tipurile de proteze dentare indicate în rezolvarea optimă a multiplelor aspecte, întîlnite în practica stomatologică din cabinet si laborator.
Astfel sînt prezentate multitudinea operaţiilor tehnice, sînt enumerate multiple particularităţi, necesare realizării corecte a protezelor durabile, de care trebuie să beneficieze fiecare pacient ce se adresează medicului stomatolog în scopul restaurării integrităţii arcadelor dentare.
Conţinutul monografiei este sistematizat în capitole, fiind însoţit de numeroase fotografii şi schiţe, pentru a fi cît mai uşor de înţeles. în toate capitolele sînt cuprinse date de interes egal pentru medicul stomatolog si tehnicianul dentar, ambii răspunzători de calitatea tratamentului protetic. între cei doi specialişti trebuie să existe o colaborare desăvîrşită, însoţită de un limbaj şi ţel comun.
Profesional, m-am format în cadrul Disciplinei de Protetică Dentară şi Propedeutică Stomatologică conduse de prof. Eugen Costa si Prof. Lucian Ene. personalităţi a căror competenţă în domeniu este recunoscută în ţară şi peste hotare. Am colaborat, de asemenea, continuu şi susţinut, cu tehnicieni dentari foarte bine pregătiţi ca I. Perja, Al. Blănaru, Şt. Săndulescu.
întreaga mea formaţie profesională are la bază activitatea practică de medic stomatolog, desfăşurată la fotoliul dentar şi în laboratorul de tehnică dentară, alături de activitatea didactică, care mi-au impus o documentare susţinută.
PARTEA I
MICROPROTEZELE (Protezele unidentare)
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