Молодежный инновационный вестникМолодежный инновационный вестник2415-7805Федеральное государственное бюджетное образовательное учреждение высшего образования "Воронежский государственный медицинский университет имени Н.Н. Бурденко" Министерства здравоохранения Российской Федерации6327UnclassifiedPROSTHETICS ON IMPLANTS IN AN AESTHETICALLY SIGNIFICANT AREARyabikinaDarya Alexandrovnadasharyabikina9@gmail.comhttps://orcid.org/0000-0003-2938-82751405202110S14194220402202114022021Copyright © 2021, Молодежный инновационный вестник2021<p>At the moment in the development of dentistry, the restoration of anterior teeth is of great importance, since they affect the function, anatomy and aesthetics of the dentition. This research paper presents an algorithm for prosthetics on single implants in an aesthetically significant area. The aesthetically significant area is the area that is visible with a wide smile. Replacement of a tooth in the anterior region depends on white (restoration itself) and pink (adjacent gingiva) aesthetics. This article describes the results of the research using both theoretical (work with educational and scientific literature) and empirical (conversation) methods. The object of the study was middle-aged people with loss of anterior teeth. Issues such as the expediency of using aesthetic materials in an aesthetically significant area - metal-free ceramics (zirconium dioxide and lithium disilicate) and various types of fixation; choice of treatment tactics depending on the biotype of the patient's gums. Attention is paid to the assessment of the placement of the implant and the choice of the abutment, the importance of adhering to all clinical stages in a certain sequence and the installation of a provisional prosthesis to form the correct contour of the eruption and the gingival margin. Prosthetics on implants have high durability, excellent aesthetic and functional results.</p>implant1abutment2gingival biotype3eruption contour4crown5metal-free ceramics6cement-retained7.имплантат1абатмент2биотип десны3контур прорезывания4коронка5безметалловая керамика6цементная фиксация7.<p>Relevance.<br />Currently, the problem of the loss of front teeth is quite acute. Partial absence of teeth is a fairly common disease, and in terms of prevalence it stands along with caries and periodontal diseases. About 75% of the population suffer from the diagnosis Loss of teeth due to an accident, extraction or localized periodontitis (Kopeikin V.N., Mirgazizov M.Z., 2001). The causes of tooth loss are caries, periodontal disease, and trauma. Violation of the integrity of the dentition leads to a deterioration in chewing, a decrease in digestive function, leads to impaired speech and aesthetic parameters. Loss of teeth is an irreversible disease; only orthopedic treatment can help.<br />Aesthetically significant zone-zone, visible with a wide smile. With a single loss of teeth in this area, there are several options for solving the problem. The most optimal solution is implant prosthetics. With this variant of orthopedic treatment, the lost anatomy, function, aesthetics, and speech are restored. Due to the use of aesthetic materials, namely metal-free constructions - an abutment and a crown, for example, from zirconium oxide, highly aesthetic prosthetic results can be obtained. Obviously, the result of the implantation will depend on many factors, for example, on the position of the implant, the thickness of the bone in the implantation zone, the biotype of the gum and the contour of the eruption. This explains the urgency of this problem. After all, prosthetics on implants in an aesthetically significant area is the work of two doctors: an implant surgeon and an orthopedist.<br />The aim of the study was to increase the efficiency of orthopedic treatment of included dentition defects using dental implantation of intraosseous implants in the anterior group of teeth.<br />Materials and methods.<br />The set goal of the work required a set of research methods: theoretical (work with educational and scientific literature), empirical (conversation), radiological, clinical. The study was carried out on the basis of the Department of Faculty Dentistry of V.G. N.N. Burdenko for 6 months. Different types of crowns, abutments and fixation methods were studied. It should be noted that during the restoration of teeth in the anterior part of the jaw, there is a possibility of chipping. The same probability remains with prosthetics on implants, it depends on many factors (bite, prevailing food in the diet, etc.) and can be low, medium or high. For patients with a high risk of chipping, it is inappropriate to install all-ceramic crowns, they are not strong enough. Therefore, it is preferable for such patients to use metal-ceramic crowns on a titanium abutment, which are stronger. For persons with a medium and low probability of chipping, the placement of all-ceramic crowns on ceramic abutments is recommended - this practically guarantees high aesthetics. Also, aesthetics and strength depend on the types of fixation. There is screw and cement fixation. The screw fixation is more durable, but less aesthetically pleasing, it is used when there is access to the screw from the oral side. Cement fixation is more aesthetic, but inferior in strength to screw fixation; it is used when access is from the vestibular side or the side of the incisal edge. Also, if we talk about aesthetics, then we must not forget about the gum biotype. The biological width is the width of the band of epithelial and connective tissue attachment, and the periodontal complex is the biological width and the periodontal sulcus. Patients with thin and thick gum biotype were studied. With a thick biotype, the gum is denser, more elastic, and has shallow papillae. Due to its thickness, it blocks the metallic color of the parts, promoting aesthetics. The thin biotype of the gum is characterized by high gingival papillae, it is easy to injure, when probing the gingival groove, the probe shines through the soft tissues. This type of gum shows through the metal parts of the denture without contributing to aesthetics. This means that all-ceramic crowns and ceramic abutments should be used in patients with thin gum biotype. Our research also showed that in case of orthopedic treatment on implants, it is necessary to use temporary crowns. As well as restoring aesthetics and function, this also forms the gingival margin. The physician should strive for a uniform transition of the crown into the gingival margin, without sacrificing functional properties. An important concept in this topic is the eruption contour. This transition from the round prosthetic part of the implant to the individual contour of the artificial crown at the level of the gingival margin is formed using the abutment. Placement of the abutment is preceded by the insertion of a gingiva former with a circular cross-section, which contributes to the correct formation of the gingival bed. The abutment creates a smooth transition between the crown and soft tissue, supports the gingiva and improves its appearance.The best result is prosthetics with an individual abutment, as it can reduce the deviation between the axis of the implant and the crown. The placement of a temporary crown allows you to maintain the optimal shape of the soft tissues and simulate the correct contour of the eruption. When it is installed, transient ischemia of soft tissues is observed, their shape stabilizes within a month. Then a permanent crown with a permanent intragingival contour is made.<br />Results.<br />Implant prosthetics is suitable for many people, but this procedure also has contraindications. The use of all-ceramic crowns, ceramic abutments and cement-retained restorations provides a better aesthetic result in patients than the use of metal-ceramic crowns, titanium abutments and screw-retained ones. It is also easier to achieve aesthetics in patients with thick gums than with thin ones. It is especially important for prosthetics on implants to observe all stages in a certain sequence, this contributes to the correct formation of the gingival margin and the contour of the eruption.<br />Discussion.<br />The use of prosthetics on implants with included defects in the dentition gives a high degree of functionality, good aesthetics and durability. However, like all medical operations, implantation has contraindications and disadvantages. Absolute contraindications include oncology, viral infections and general diseases that affect regeneration and healing; to relative - age up to 18 years, pregnancy, etc. Cons of implantation - long healing, risk of infection and inflammation after surgery, high cost.<br />Conclusion.<br />Prosthetics in an aesthetically significant area is a rather difficult problem, since the doctor needs to achieve aesthetic and functional results. The most modern solution to the problem is prosthetics on implants. For prosthetics in the frontal zone, it is more expedient to use metal-free ceramics and cement fixation, which provide high aesthetics; it is also necessary to take into account the biotype of the patient's gum. All stages of the implantation itself and the management of the patient after it should be carefully observed. The use of implants gives high functional and aesthetic indicators, but also has its drawbacks: there are contraindications, risks of the postoperative period, long healing and a rather high cost.</p>[1. Протезирование с опорой на имплантаты. Планирование от результата / Штефан Вольфарт;пер. А.Островский/ Санкт-Петербург ООО «Азбука стоматолога», - 2016.- С.-44-50,59-69,74,91-98,204-213.][2. Ортопедическое лечение с опорой на дентальные имплантаты / Карл Е.Миш; пер. с англ. - М. : Рид Элсивер/ 2010. – С.-370-414.][3. Зубная имплантация.Новый уровень протезирования / И.Суднев,И.Михайлов,Е.Гольдштейн / СПб.: ООО «МЕDИ издательство», - 2007. - С.-12-13.]