УМК Стоматология 5.10.21.Ru.en

Non-profit educational institution
Educational-scientific-production complex
"International University of Kyrgyzstan"
Quality Management System
Educational-methodical complex of the discipline "dentistry"
PLO "General Medicine" (for foreign citizens) (5 years) ISM IUK
International University of Kyrgyzstan

International School of Medicine
Department of "Special clinical disciplines"
"APPROVED"
Vice-rector for educational and administrative work
prof. Musa kyzy Alina
______________________
"__" ____________ 2021
EDUCATIONAL-METHODOLOGICAL COMPLEX OF DISCIPLINE
"Dentistry"
main educational program
in the specialty General Medicine (for foreign citizens)
graduate qualification: general practitioner
Bishkek 2021
1
Table of contents
1. The work program of the academic discipline ..........................................................................................5
1.1. Explanatory note ..............................................................................................................................5
1.2. Recommended educational technologies ...........................................................................................7
1.3. The scope of the discipline and types of educational work ................................................................8
1.4. Discipline structure ............................................................................................................................1
1.4.1. Thematic plan for the study of the discipline (by semester)........................................................1
1.4.2. Organization of students' independent work ...............................................................................1
1.4.3. Evaluative Assessment Tools ......................................................................................................3
1.4.4. Course policy and assessment criteria .........................................................................................6
1.4.5. Educational-methodical and informational support of the discipline ..........................................7
1.4.6. Logistics of the discipline............................................................................................................8
1.4.7. Student research work .................................................................................................................8
2. Teaching materials ....................................................................................................................................9
2.1. Lecture notes ......................................................................................................................................9
2.2. Development of practical / seminar / laboratory classes ................................................................125
3. Methodical recommendations for students............................................................................................141
3.1. Methodical recommendations for students on the study of the discipline .....................................142
3.2. Methodical recommendations for the implementation of practical / seminars, laboratory work. ..143
3.3. Methodical recommendations for the implementation of independent work. ................................143
3.4. Methodological instructions for the implementation of abstracts, reports, essays .........................144
3.5. Methodical instructions for preparation for the final certification. ................................................145
3.6. Methodical recommendations for the student's research work.......................................................145
4. Glossary.................................................................................................................................................147
5. Reference materials and applications ....................................................................................................150
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International University of Kyrgyzstan

International School of Medicine
Department of "Special clinical disciplines"
"APPROVED"
Vice-rector for educational and administrative work
prof. Musa kyzy Alina
________________________
"__" ____________ 20__
THE WORKING PROGRAM OF THE DISCIPLINE
"STOMATOLOGY"
main educational program

in the specialty General Medicine (for foreign citizens)
graduate qualification: general practitioner
Full-time education
Well 4
Semester 8
Credit / Exam (semester) 8
Total Curriculum Credits 4
Total curriculum hours 144
Work program developer: Reviewed and approved at a meeting of the

Imankulov A.M. department "Special clinical disciplines"
Minutes No. ______ dated "____" ________
2021.
Head of the Department,
Ph.D., Aitikeev A. U.
__________________(signature)
Bishkek 2021
3
The work program for the discipline "Otorhinolaryngology" has been developed in
accordance with the requirements of the State Educational Standard of Higher
Professional Education in the specialty 560001 General Medicine.
Work program agreed with the educational and methodological sector of ISM,
EMD
Chief specialist of EMD ______________ ___________________
(Full name) (signature)
"____" _________ 20__
Work program agreed with the head of the main educational program in the
direction / specialty 560001 General Medicine (for foreign citizens)
Head of the PLO ________________________ ___________________
"____" _________ 20__
External review given by ___________________________________________

_________________________________________________________________
(place of work, position, academic degree, academic title, full name)
"____" _________ 20__ (review attached)
Work program agreed with the department of monitoring and quality of the UNPK
"MUK"
Director of DMaQ ___________________ ___________________
"____" _________ 20__
4
1. The work program of the academic discipline

1.1. Explanatory note
● Mission of ISM MUK - training of competent specialists in the field of
medicine, corresponding to international standards and traditions of medical ethics,
ready for continuous professional growth using modern achievements of science and
practice, to solve public health problems.
− Annotation of the academic discipline
Dentistry is a discipline dealing with the study of teeth, their structure and
functioning, their diseases, methods of their prevention and treatment, as well as
diseases of the oral cavity, jaws and border areas of the face and neck.
− The purpose and objectives of the discipline
provide the student with knowledge and skills in dentistry with
taking into account further education and preparation for professional activity in the
specialty (LD).
Discipline objectives:
1) teaching students the basic anatomical and physiological features of the
maxillofacial region, which affect the occurrence, development, course, diagnosis,
prevention and treatment of dental diseases;
2) mastering the basic practical skills necessary for the examination of dental
patients;
3) teaching students the basics of etiology, pathogenesis, clinical manifestations,
diagnosis and differential diagnosis of major dental diseases, their complications and
terminal conditions;
4) study of emergency conditions in dentistry and training in the provision of care;
5) identification of links between dental diseases and environmental factors, bad
habits;
6) recognition of hidden, long-standing foci of chronic infection of the oral cavity
for the prevention of common diseases;
7) teaching students the classification of major dental diseases;
8) teaching students the relationships between pathological processes that occur in
the maxillofacial region and in other organs and systems.
Place of discipline in the structure of OOP (prerequisites, postrequisites)
The discipline "Dentistry" is studied and belongs to the cycle
professional disciplines of the educational standard of higher professional medical
education in the specialty (LD). The content of the discipline "Dentistry" is based
on the content of such previous disciplines as:
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− Histology
− Oral hygiene
− Normal anatomy
− Pathological anatomy
− Normal physiology
− Pathological physiology
Competencies of students, formed as a result of mastering the discipline, the

planned results of mastering the discipline -
A graduate in the specialty "General Medicine" with the assignment of the
qualification of a specialist "General Physician" in accordance with the State
Educational Standard of Higher Professional Education and General Education and
the tasks of professional activity, must have the following professional
competencies:
Code Content of competence
SLK-3 Able to analyze medical information based on the principles of
evidence-based medicine
IR-4 Willingness to work with information from various sources
PC-6 Ability to apply up-to-date information on public health indicators
at the healthcare facility level
and additional professional competencies:

The planned results of mastering the educational discipline "Dentistry" are
determined by the competencies acquired by the student, ie. his ability to apply
knowledge, skills and personal qualities in accordance with the goals of the
educational program and the tasks of professional activity:
After mastering the discipline "Dentistry" the student:
will know:
● structure and equipment dental departments of medical organizations; sanitary
and hygienic
● requirements for the organization of dental treatment-and-prophylactic
institutions;
● duties and rights of a doctor in the provision of dental and emergency medical
care;
● professional ethics and deontological aspects treatment-and-prophylactic
work of a dentist
● principles and methods of outpatient treatment of dental diseases;
● classification, etiology, pathogenesis of pulp and periodontal diseases;
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● etiological factors leading to the development of diseases of the pulp and

periodontal disease;
● methods of examination, diagnosis, prevention and therapeutic treatment of
patients with pulp and periodontal diseases;
● methods of endodontic treatment of patients with pulp and periodontal
diseases;
● causes of complications in therapeutic practice in the treatment of patients
with pulp and periodontal diseases and methods of their prevention;
will be able to:
● conduct a dental examination of the patient and draw up a medical history
● write down the dental formula of permanent and temporary teeth in accordance
with the international designation system
● determine the state of hard tissues of teeth
● determine the prevalence and intensity of dental diseases in the group surveyed
● determine the hygienic state of the oral cavity using indices;
● carry out an individual selection of oral hygiene products for the patient,
depending on the age and condition of the oral cavity
● perform various methods of brushing teeth on phantoms
● teach teeth cleaning methods to children and adults
● carry out controlled brushing of teeth
● carry out diagnostics and differential diagnostics of the initial forms of caries and
non-carious lesions;
1.2. Recommended educational technologies

For the development of students of the educational discipline "Dentistry", the
acquisition of knowledge and the formation of professional competencies, the
following educational technologies are used:
● lecture-electronic presentation,
● problem lecture,
● lesson-conference,
● training,
● brainstorm,
● small group method,
● participation in scientific and practical conferences, congresses, symposia,
● student research work,
● written analytical work
● preparation and defense of abstracts,
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● distance educational technologies.
1.3. The scope of the discipline and types of educational work

According to the Total
8th sem.
curriculum 2017 in hours in credits
Total labor intensity 72 72 2
Classroom work 36 36 1
Lectures 18 18 0.5
Practical lessons 18 18 0.5
Seminars
Laboratory works
Independent work 36 36 1
CPC 18 18 0.5
SRSP 18 18 0.5
Final control type offset
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1.4. Discipline structure
1.4.1. Thematic plan for the study of the discipline (by semester)
Auditory lessons
Student independent
methods and methods
Forms of current and

laboratory works
No. Name
practical lessons
midterm control
classroom work
Total hours on
sections and topics
technologies,
performance
competence
educational
of teaching
disciplines
academic
seminars
(lectures and practical exercises)
Formed
lectures
SRSP
work
Used
Module 1 T
1 Caries, examination 2 2 4 2 2 SLK-3, LV / PL NS,
methods, etiology, ZK, R
classification, diagnosis, IK-4,
treatment methods. PK-6
2 Etiology, pathogenesis of 2 2 4 2 2 SLK-3, LV / PL NS,

inflammation ZK, R
pulp of the tooth. IK-4,
Classification of diseases PK-6
of the pulp. Methods for
the diagnosis of
inflammation of the pulp of
the tooth.
1
3 Etiology, pathogenesis of 2 2 4 2 2 SLK-3, LV / PL NS

periapical tissue ZK, R ZS
inflammation. IK-4,
Classification of PK-6
periodontitis diseases.
Diagnostic methods for
periodontitis
4 Orthopedics, introduction 2 2 4 2 2 LV / PL NS,
to orthopedics, ZK, R ZS
classification of SLK-3,
prostheses, diagnostics in IK-4,
orthopedics, goals and PK-6
objectives
5 Types of orthopedic 2 2 4 2 2 SLK-3, LV / PL NS,
structures, indications of ZK, R
contraindications, IK-4,
selection criteria, metal- PK-6
ceramic crowns
Module 2 T
6 Preparation methods for 2 2 4 2 2 SLK-3, LV / PL NS,
crowns, preparation ZK, R
features, impression IK-4,
taking, classification, PK-6
methods for making
crowns
7 Surgical dentistry, 2 2 4 2 2 SLK-3, LV / PL NS,
introduction, basic terms, ZK, R
manipulations. IK-4,
Classification of diseases PK-6
2
eig Tooth extraction operation, 2 2 4 2 2 LV / PL NS,

ht indications and ZK, R
contraindications. Tooth SLK-3,
extraction techniques. IK-4,
Suture methods PK-6
nin Periodontics section 2 2 4 2 2 SLK-3, LV / PL NS,

e introduction. Periodontal ZK, R
structure, physiology of IK-4,
periodontal tissues, their PK-6
diseases and classification
Total hours 18 18 36 18 18
by discipline:
Abbreviation for designations of educational technologies, methods and methods of teaching:traditional lecture (L), lecture-
visualization (LP), problem lecture (LP), lecture-press conference (LPK), lesson-conference (LC), training (T), debate (D),
brainstorming (MSH) , master class (MC), "round table" (CC), activation of creative activity (ATD), regulated discussion (RD),
discussion of the forum type (F), business and role-playing educational game (CI, RI), small group method (MG), classes using
simulators, simulators (TP), computer simulation (CS), analysis of clinical cases (CS), preparation and protection of medical
history (IB), use of computer training programs (COP), interactive atlases (IA), attending medical conferences, consultations (VC),
participation in scientific and practical conferences (NPK), congresses, symposia (Sim), educational and research work of a student
(UIRS), conducting subject Olympiads (O),preparation of written analytical works (AR), preparation and defense of abstracts (P),
design technology (PT), excursions (E), distance educational technologies (DOT).
Reduction of forms of current and midterm monitoring of academic performance: T - testing, Pr - assessment of the development
of practical skills (abilities), ЗС - solving situational problems, КР - control work, КЗ - control task, IB - writing and protecting a
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case history, CL - writing and protecting a curatorial sheet, R - writing and defense of the abstract, C - interview on control
questions, D - preparation of a report, etc.
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1.4.2. Organization of students' independent work
N The topic of the SRS task Recommended Timing

o. student's literature surrende
independent work: r
(week
number)
1. Caries, examination Abstract, 1
methods, etiology, presentation Borovskiy E.V.
classification, Therapeutic dentistry:
diagnosis, treatment textbook
methods.
Yu.M. Maksimovsky,
L.N. Maksimovskaya,
L.Yu. Orekhova.
Therapeutic dentistry. :
Textbook for students of
dental faculties
2. Etiology, Abstract, Oral Medicine 2
pathogenesis of presentation 1st Edition
inflammation Exam Preparatory
pulp of the tooth. Manual for
Classification of Undergraduates,
pulp diseases. V.A. Kozhokeeva, K.B.
Methods for Kuttubaeva, S.M.
diagnosing Ergeshov
inflammation Pulpitis: clinic,
pulp of the tooth. diagnostics, treatment .:
Study guide
3. Etiology, Abstract, L.N. Maksimovskaya, 3
pathogenesis of presentation P.I. Roshchin.
inflammation Medicines in dentistry:
periapical tissues. Endodontics
Classification of Oral Medicine
periodontitis 1st Edition
diseases. Exam Preparatory
Methods for the Manual for
diagnosis of Undergraduates
periodontitis.
4. Orthopedics, Abstract, Functional Occlusion 4
introduction to presentation 1st Edition
orthopedics,
1
classification of From TMJ to Smile

prostheses, Design
diagnostics in Author: Peter Dawson
orthopedics, goals Orthopedic dentistry
and objectives. Lebedenko.
Abolmasov orthopedic
dentistry.
5 Types of orthopedic Abstract, Functional Occlusion 5
structures, presentation 1st Edition
indications of From TMJ to Smile
contraindications, Design
selection criteria, Author: Peter Dawson
metal-ceramic Orthopedic dentistry
crowns. Lebedenko.
Abolmasov orthopedic
dentistry
6 Preparation methods Abstract, Clinical Problem Solving 6
for crowns, presentation in Prosthodontics
preparation features, 1st Edition
impression taking, Author: David Bartlett
classification, Functional Occlusion
methods for making 1st Edition
crowns. From TMJ to Smile
Design
Author: Peter Dawson
7 Surgical dentistry, Abstract, Clinical Review of Oral 7
introduction, basic presentation and Maxillofacial Surgery
terms, 2nd Edition
manipulations. A Case-based Approach
Classification of Author: Shahrokh
diseases. Bagheri
8 Tooth extraction Abstract, Clinical Review of Oral 8
operation, presentation and Maxillofacial Surgery
indications and 2nd Edition
contraindications. A Case-based Approach
Tooth extraction Author: Shahrokh
techniques. Suture Bagheri
methods ...
9 Periodontics section Abstract, Periodontics: Prep 9
introduction. presentation Manual for
Periodontal Undergraduates
structure, 1st Edition
2
physiology of Authors: Vivek Bains

periodontal tissues, Vivek Gupta Jyoti Bansal
their diseases and : GEOTAR-Media. - 2002
classification - 328p.
1.4.3. Evaluative Assessment Tools

Current and milestone (modular) control
Current control of students' knowledge may represent:

- oral questioning;
- checking the completion of written homework;
- checking abstracts, essays, reports.
Topics of essays (essays, reports)
1. Tooth pulp. Histological structure, main functions.

2.Dentin of the tooth. Histological structure, chemical composition, physiological
properties.
3. Tooth enamel. Histological structure, chemical composition, physical and
physiological properties.
4. Topographic and anatomical features of the structure of the tooth cavity.
5. Physiology of the oral cavity. Mechanical, chemical, enzymatic processing of
food in the mouth. Oral reflexes.
6. Periodontium. The structure of tissues and functions of the periodontium.
7. Saliva as a biological environment of the oral cavity. Chemical composition,
changes under the influencevarious factors, role
saliva in the maturation of the enamel after the eruption of the tooth.
8. Periodontium, histological structure. Blood supply, innervation, physiological
properties, basic functions.
9. Anaphylactic shock.
10. Organization of dental care in the republic. The structure of dental health care
institutions.
11. Rights and obligations of a dentist. Deontology in dentistry.
12. Ergonomics in dentistry.
13. Occupational hazards of a dentist.
14. Anesthesia in therapeutic dentistry. Indications, methods of carrying out.
15. Prevention of HIV infection, viral hepatitis.
16. The microflora of the oral cavity in health and disease.
17. Defense mechanisms of the oral cavity. Nonspecific and specific protection
factors.
eighteen.Organization of equipment dental office...Dental equipment...
3
19. Types of dental instruments.

20. Organization doctor's work- dentist at therapeutic reception... Medical history,
registration and reporting
documentation. Quantitative and qualitative indicators of the department's work.
21. Percussion, palpation, thermometry, tooth mobility, electrodontodiagnostics,
radiography, probing.
22. Mineralization, demineralization, remineralization of enamel, factors.
23. X-ray diagnostics. Differential diagnosis, EDI.
24. Medical records, meaning.
25. Sterilization of dental instruments.
26. Dental instruments. Caring for him and types of sterilization.
27. Methods of examination of the patient.
28. Anatomy of the teeth. Dental tissue histology.
29. Classification of filling materials. Basic requirements for them.
30. Cements, chemical composition, physical properties, indications to use...
Features of the cooking technique and
filling.
31. Glass ionomercements. Composition, properties, indications for use.
32. Amalgams, chemical composition. Chemical properties, indications to
use.Peculiarities cooking techniques
and filling.
33. The use of composite materials for filling cavities. Classification, composition,
indications.
34. Light-cured composite filling materials. Indications, filling technique.
35. Composite filling materials of chemical curing. Indications, filling technique.
36. Stages of restoration (filling) of teeth with composite materials.
37. Adhesive system IV-V generation. Primer, adhesive Indications, method of
application.
Frontier (modular) control may represent:

- testing by section (computer);
Sample test tasks for midterm (modular) control

1. Hypoplasia of dental hard tissues is:
1) an endemic disease caused by fluoride intoxication with excess content
its in drinking water
2) a developmental defect, consisting in the underdevelopment of the tooth or its
tissues
3) fusion, fusion and bifurcation of teeth
4) violation of enamel formation, expressed by a systemic violation of the
structure
mineralization of deciduous and permanent teeth
4
5) the progressive loss of tooth tissue (enamel and dentin) is not enough identified
etiology
2. Fluorosis is:
it in drinking water. 2) a developmental defect, consisting in the
underdevelopment of the tooth or its tissues
structure
mineralization of dairy and permanent teeth
etiology
3. Tooth erosion is:
tissues
structure and
etiology
4. Imperfect amelogenesis is:
tissues
structure and
etiology
5. Anomaly of tooth development is:
tissues
etiology
5
5) violation of enamel formation, expressed by a systemic violation of

structuresNS
6. The age at which physiological abrasion is limited to the enamel:
1) under 25
2) under 30
3) under 35
4) under 40
5) under 50
Final control
Final control at the end of the study of an academic discipline, it is carried out in the
form of a test, which is set on the basis of the results of midterm (modular) control
in the discipline.
1.4.4. Course policy and assessment criteria

The control of students' knowledge is carried out according to the point-rating
system in accordance with the standard "Regulations on the modular point-rating
system for assessing the knowledge of students at the NOU UNPK" International
University of Kyrgyzstan ".
The discipline "Dentistry" includes 2 modules, toEach module is rated on a 100 point
system:
Maximum score -100, of which:
- attendance - 20 points;
- current control - 40 points (20 points - for classroom work, 20 points - for
independent work),
- midterm control (delivery of the module) - 40 points.
The results of the 2 modules are added up and the average score is displayed.
Scoring Policy Module 1 Module 2
Attendance 20 points 20 points
Classroom work (activity in discussions, 20 points 20 points
during oral questioning, working with a
glossary, etc.)
Independent work: essay, report 20 points 20 points
Total by module (testing) 40 credits 40 credits
Total by discipline: More than 60 points
Offset
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Final control in the form of offset is carried out based on the results of attendance,
current and midterm (modular) control.
Final control form - offset.
To assess the student's progress, the following scale of correspondence between
grades and points is used:
Scale of correspondence of grades and points

Maximum Intervals
score "Unsatisfactory" "satisfactorily" "OK" "Great"
twenty 0-11 12-15 16-17 18-20
40 0-23 24-30 31-35 36-40
60 0-35 36-45 46-53 54-60
100 0-59 60-75 76-89 90-100
1.4.5. Educational-methodical and informational support of the discipline

List of sources and literature:
Main literature
Borovskiy E.V. Therapeutic dentistry: textbook.
Yu.M. Maksimovsky, L.N. Maksimovskaya, L.Yu. Orekhova. Therapeutic
dentistry.: A textbook for students of dental faculties
Afanasyev V.V., Barer G.M., Ibragimov T.I. Stomatology. Recording and
Maintaining Medical History: A Practical Guide
Abolmasov N.N. orthopedic dentistry
Clinical Review of Oral and Maxillofacial Surgery2nd Edition A Case-based
Approach
Author: Shahrokh Bagheri
Periodontics: Prep Manual for Undergraduates
1st Edition
Authors: Vivek Bains Vivek Gupta Jyoti Bansal
L.N. Maksimovskaya,
P.I. Roshchin.
Medicines in dentistry: Endodontics
Oral Medicine
1st Edition
Exam Preparatory Manual for Undergraduates
7
The list of resources of the information and telecommunication network

"Internet" necessary for mastering the discipline:
- www.kyrlibnet.kg...
- www.iprbookshop.ru...
- www.consilium-medicum.com...
- www.medportal.ru...
- www.studmedlib.ru...
1.4.6. Logistics of the discipline

When teaching students, she applies modern methods and forms of education using
the latest information technologies, electronic educational resources and other
information systems necessary for the successful implementation of educational,
scientific and medical activities.
The classrooms of the course are equipped with modern and innovative facilities to
provide quality education to students. The lecture halls are equipped with computers,
video projectors and sound systems, allowing lectures to be conducted at a high
professional level. There is also portable equipment for teaching staff in the form of
laptops and projectors for convenient presentation of educational material in
electronic format
1.4.7. Student research work

SRWS in the discipline "Dentistry" is aimed at solving the following problems:
− development of skills of perception and analysis of professional information;
− developing and improving the ability to make decisions and implement them;
− development and improvement of creative abilities in the independent study
of professional problems.
To solve the first problem, students are invited to read and meaningful analysis of
scientific monographs and articles on various public health issues contained in the
list of resources of the information and telecommunications network "Internet":
https://www.euro.who.int/en/health-topics/Health-systems/public-health-
services/public-health-services
https://www.cdcfoundation.org/what-public-health
https://www.researchgate.net/journal/Public-Health-Monograph-0079-7596
https://www.journals.elsevier.com/public-health
The results of work with scientific monographs and articles are discussed in practical
classes.
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To develop and improve the communication skills of students, special training

sessions are organized in the form of work in small groups, "brainstorming",
discussions, presentations, or, in preparation for which, students are assigned in
advance into groups defending a particular point of view on the problem under
discussion.
2. Teaching materials
Educational and methodological materials (UMM), as methodological support of the
discipline, are presented in the form of lecture texts, seminar developments, practical
classes, both in print and in electronic form.
2.1. Lecture notes
Topic 1. Carious lesions of teeth

1. Purpose of the lecture:
study the anatomy of teeth, histological structure, physiological features, as well as
study carious lesions of the teeth, their classification, diagnosis and modern methods
of treating carious lesions.
2. Issues under consideration:
● Tooth Anatomy
● terms and definitions of dentistry
● goals and objectives of dentistry in the treatment of caries
● research methods
● diagnostics
● treatment methods
3. Educational technologies
- Lecture with multimedia visualization.
- Problem lecture.
4. Basic and additional literature:
1. Borovskiy E.V. Therapeutic dentistry: textbook.
2. Yu.M. Maksimovsky, L.N. Maksimovskaya, L.Yu. Orekhova. Therapeutic
3. Afanasyev V.V., Barer G.M., Ibragimov T.I. Stomatology. Recording and
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Topic number 1 Carious lesions of teeth
Caries (lat. caries decay) - a complex, slowly flowing pathological process that
occurs in hard tissues toothand developing as a result of the complex impact of
adverse external and internal factors. At the initial stage of development, caries is
characterized by focaldemineralization inorganic part enamels and the destruction
of its organic matrix... This ultimately leads todestruction hard tooth tissues with the
formation of a cavity in dentine, and in the absence of treatment - to the occurrence
of inflammatory complications from pulp and periodontium...
Epidemiology
Caries is the most common human disease (over 93% of people). In childhood, it
ranks first among chronic diseases and occurs 5-8 times more often than the disease,
which ranks second in prevalence -bronchial asthma... According to different
authors, from 80 to 90% of children with milkbite, about 80% of adolescents have
carious cavities at the time of graduation, and 95-98% of adults have filled teeth.
Statistics show that in the equatorial regions (Africa, Asia) caries is less common
than in the circumpolar regions (Scandinavia, North America). In developing
countries, there is also a higher incidence of tooth decay.
Etiology
Currently, the occurrence of dental caries is associated with local changes pH on the
surface of the tooth under dental plaque due to fermentation (glycolysis)
carbohydratescarried out microorganisms, and the formation of organic acids...
Acid-forming streptococci (Streptococcus mutans, Str. sanguis, Str. mitis, Str.
salivarius), which are characterized by anaerobicfermentation and some
lactobacillus...
When considering the mechanisms of the occurrence of dental caries, attention is
drawn to the variety of various factors, the interaction of which determines the
emergence of a focus of demineralization: microorganisms of the oral cavity, the
nature of nutrition (amount of carbohydrates), diet, the amount and quality of
salivation (remineralizing potential of saliva, buffer properties, nonspecific and
specific saliva protection factors), shifts in the functional state of the body, the
amount fluorineentering the body, the influence of the environment, etc. However,
10
the main factors for the occurrence of caries are as follows: caries susceptibility of
the tooth surface, cariogenic bacteria, fermentable carbohydrates and time.
Although tooth enamel is the hardest tissue of the human body (hardness 5 ... 6 by
Mohs scale, which roughly corresponds to feldspar), hydroxyapatites of enamel
prisms are too sensitive to an increase in acidity, which gives rise to the onset of
their destruction already at pH 4.5.
Determining factors that affect the intensity of caries development:
● the presence of a large amount of carbohydrates in the diet, in particular,
sucrose - the main component of edible sugar, which is under the action of enzymes
saliva easily forms glucose as a substrate for anaerobic glycolysis... Regular removal
of plaque counteracts the development of caries (therefore, you need to brush your
teeth);
● saturation of tooth enamel with fluoride ions (F>). Fluorapatites, which are
formed as a result of the replacement of OH> -groups and hydroxyapatites of the
enamel with fluorine ions, are resistant to the destructive effect of acidic equivalents
of saliva. The most effective anti-carious effect of fluorides is observed when they
are found in the body during the development of teeth and their mineralization. By
recommendationsworld health organization, fluoridation drinking water to a
concentration of 1 mg F> / ml leads to a decrease in the incidence of caries in the
population by 30-50%
Cariogenic situation
A cariogenic situation is a condition of the oral cavity that forms many factors and
determines the propensity for the disease. They reveal a tendency to illness by
examining the oral cavity and performing a series of tests (staining the enamel,
determining plaque, traces of bacteria, resistance of hard tissues to acids). With the
help of tests, the dentist determines the degree of susceptibility of hard tissues: high,
medium or low resistance to caries.
There are general and local causes of caries. Local factors include factors that are
located and act in the oral cavity. General - the condition and diseases of the body,
other causes of dental caries.
Caries susceptibility of the tooth surface
Tooth enamel- the hardest tissue in the human body. It is 96% mineral,
mainlyhydroxyapatites, which are very susceptible to acids, therefore, the
destruction of enamel begins already at a pH of 4.5. Caries susceptibility of the tooth
surface depends on many factors:
11
● on the properties of the anatomical surface of the tooth: in natural crevices

and in the spaces between teeth there are favorable conditions for long-term fixation
of dental plaque;
● from the saturation of the tooth enamel fluorine: the resulting fluorapatites
more resistant to acids;
● from oral hygiene (from use toothpastes, gels, rinses): timely removal of
dental plaque prevents further development of caries;
● from dietary factors: soft, carbohydrate-rich foods contribute to the formation
of plaque. The amount of vitamins and minerals also affects the general condition of
the body and especially saliva;
● on the quality and quantity of saliva: a small amount of viscous saliva
promotes the attachment of bacteria to the "pellicle" and the formation of dental
plaque. The buffering properties of saliva (which neutralize acids) and the amount
ofimmunoglobulins and other protective factors in saliva
● from a genetic factor;
● from the general condition of the body.
Recent research data show that stress experienced by the mother during the period
of time can play an important role in the development of dental caries in a child.
pregnancy... This conclusion was made by a research group fromWashington
University Seattle as a result of the analysis of data from 716 children and their
mothers under the National Health and Nutrition Examination Program (1988-
1994)[eleven]...
Cariogenic bacteria
In the oral cavity, many bacteria, but in the process of plaque formation and
subsequent enamel demineralization, mainly acid-forming streptococci
(Streptococcus mutans, Streptococcus viridans, Str. sanguis, Str. mitis, Str.
salivarius), which are characterized by anaerobic fermentation and lactobacillus
(Lactobacillus).
Within a few minutes after taking carbohydrates, especially sucrose, there is a
decrease in pH from 6 to 4. In dental plaque, except lactic acid, which is directly
formed during the fermentation of carbohydrates, are found formic, oil, propionic
and other organic acid...
Anti-caries flora
Recently it was discovered that in addition to bacteria, the vital activity of which
destroys tooth enamel, there are bacteria that counteract this process. Robert Burne
and Marcelle Nascimento fromUF College found streptococcus A12 in plaque, a
12
previously unknown strain that helps neutralize acids in the oral cavity by
metabolizing arginine
Fermentable carbohydrates
It is the acids formed during the fermentation of carbohydrates that lead to the
destruction of the surface of the tooth enamel. The presence and activity of
fermentation in the plaque depends on the quantity and quality of available
carbohydrates. Most intensefermentation sucrose, less intense - glucose and
fructose... Mannit, sorbitol and xylitol also penetrate into dental plaque, however,
due to the low activity of the enzyme that converts them into fructose, they are not
dangerous. Starchbeing polysaccharide, in its pure form is not karyogenic, since its
molecules do not penetrate into dental plaque. However, food processing can destroy
the molecular structure of starch and increase its cariogenicity.
Time
The frequency with which a tooth is exposed to cariogenic acid influences the
likelihood of tooth decay. After every meal that contains sugar, microorganisms
begin to produce acids that destroy tooth enamel. Over time, these acids are
neutralized by the buffering properties of saliva and partially demineralized enamel.
After each period of exposure to acids on the tooth enamel, the inorganic mineral
components of the tooth enamel dissolve and can remain dissolved for 2 hours. If
carbohydrates are taken periodically throughout the day, then the pH will be low for
a long time, the buffering properties of saliva do not have time to restore the pH, and
there is a possibility of irreversible destruction of the enamel surface.
As shown earlier, the speed of the carious process depends on many factors, the
process that has begun may slow down if fluoride is used, but on average, caries of
the contact surfaces in permanent teeth progresses slowly and the cavity can form
within 4 years. Since the root of the tooth is covered with softer tissue -cement, root
caries develops 2.5 times faster than in the enamel area.
If the oral hygiene is extremely unsatisfactory and the diet is rich in sugar, tooth
decay can develop literally a few months after a tooth erupts.
Classification of caries by WHO
In classification WHO (10th revision) caries is allocated in a separate heading.

● Caries of enamel (including "chalk stain").
● Dentin caries.
● Caries of cement.
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● Suspended caries.
● Odontoplasia.
● Another.
● Unspecified.
Process depth classification
For the practitioner, the topographic classification is more convenient and

acceptable:
● A) Uncomplicated (simple) caries.
○ Caries stage of the spot (carious spot).
At this stage, the tooth enamel changes color due to the formation of a chalky spot
on it. At the same time, the surface remains smooth, since the enamel is still only in
the initial stage of destruction. At this point, it is important to prevent further
development of the disease. In the early stages, it is easier, cheaper, and painless to
cure tooth decay. In the first stage, tooth treatment begins with a stain removal
procedure. Then enamel remineralization is carried out, that is, the application of
special preparations (for example, sodium fluoride and calcium gluconate solutions)
to the tooth neck. It is also possible to use such a method as infiltration-impregnation.
Superficial caries.
At the next stage, the untreated chalk stain becomes rough due to the
demineralization of the enamel. In this case, the enamel-dentin junction is not
affected. The tooth in this place hurts from hot, cold food, and also becomes sensitive
to sweet and sour (possibly painless). Treatment of this stage of cervical caries will
consist in grinding the area of the tooth affected by caries. Then, by analogy with
the treatment of the previous stage, remineralizing therapy is performed. (But if
caries is localized in fissures or on contact surfaces (these areas are susceptible to
caries, since there are good conditions for fixing food, and they are difficult to
cleanse), then remotherapy will be useless, so you can prepare the affected area
"according to all the rules." and seal).
Medium caries.
At the third stage, caries begins to penetrate deeper. The enamel-dentin junction is
affected. Serious damage to the tooth becomes clearly visible. Pain sensations
become more frequent, intense and prolonged. Treatment of medium caries consists
in removing the damaged part of the tooth, treating it with medications and installing
a filling.
Deep caries.
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When damage to an untreated tooth reaches the peri-pulpal dentin, the stage of deep
caries begins. The treatment procedure consists in removing the damaged part of the
tooth, treating it with medications, introducing remineralizing drugs and installing a
filling. In the absence of treatment for this disease, further destruction of dentin and
damage to the pulp (nerve) of the tooth occurs -pulpitis and, as its further outcome,
periodontitis...
B) Complicated caries (pulpitis, periodontitis).
This classification takes into account the depth of the process, which is important
for choosing a treatment method.
Caries in the spot stage, superficial caries, medium caries with small defects are not
visible on radiograph... It is very important to differentiate caries from other
diseases:
caries in the spot stage must be differentiated from such non-carious lesions, how
hypoplasia and fluorosis;
common between these diseases: the presence of spots, indications of eom
(electrodontometry) is normal, no subjective discomfort. Differences: caries, unlike
these two diseases, can be stained with special dyes, fluorosis and hypoplasia also
occur before teething, and caries after; caries occurs in caries-susceptible areas, and
they are in atypical (caries-resistant) places;
superficial caries must be distinguished from such non-carious diseases, how wedge-
shaped defects and erosion of hard tissue...
Classification by the severity of the process
Clinical observations have established that the severity and speed of the carious
process determine the methods and tactics of treatment. Based on their results, T.V.
Vinogradova proposed a classification of caries according to the severity and
prevalence of the carious process:
compensated form. In this form, the average intensity of caries is less than the
average intensity for this age group. The process is slow, the existing carious cavities
are lined with hard pigmented dentin (chronic caries);
subcompensated form. The average intensity of caries is equal to the average for this
age group;
decompensated form, or "acute caries". The average caries intensity is much higher
than the average for this age group. With this form, the carious process is intense,
15
there are multiple carious cavities that are filled with soft dentin. The extreme form
of acute caries is the so-called "systemic damage" of teeth by caries, in which there
is damage to all or almost all of the teeth in the areanecks...
Localization classification
The American scientist Black proposed a classification of carious cavities by

localization:
● Class I: lesion of cavities in the area of fissures and natural depressions of the
teeth;
● Class II: lesion of cavities located on the contact surfaces of small and large
molars;
● Class III: damage to the cavities located on the contact surfaces of the incisors
and canines without involving the incisal edge;
● IV class: damage to the cavities located on the contact surfaces of the incisors
and canines with the involvement of the incisal edge and corners;
● V class: lesion of cavities located in the region of the necks of all groups of
teeth;
● Class VI (highlighted later): damage to cavities of atypical localization: the
cutting edges of the anterior teeth and the cusps of the chewing teeth.
Classification by the origin of the process
There are the following types of dental caries:

● primary caries;
● secondary (recurrent) caries - caries of previously filled teeth.
Duration classification
In the textbook "Dentistry" edited by V. Kozlov, the following division of the types
of caries is also proposed:
● fast flowing;
● slow flowing;
● stabilized.
Clinical picture
Spot stage
Demineralization begins with the loss of the natural gloss of the enamel and the
appearance of matte, white, light brown and dark brown spots. The appearance of
16
this zone is a consequence of the loss of mineral substances by the tooth tissues, in
particularcalcium salts, which leads to a violation of the structure of the enamel.
A white carious spot, depending on the severity of the process, can have two
development paths:
● a white carious spot (progressive demineralization) later turns into superficial
caries due to a violation of the integrity of the surface layer;
● the process slows down, stabilizes, and due to the penetration of organic dyes,
the enamel changes color. It should be understood that the stabilization is temporary
and sooner or later a tissue defect will appear at the site of the pigmented spot.
Caries in the spot stage is usually asymptomatic; very rarely, in the acute course of
the process (white spot), sensitivity to chemical and thermal stimuli may occur.
However, the carious stain stains wellmethylene blue... For this reason, it is this
substance that is used for diagnostic purposes.
Superficial caries (caries superficialis)
Superficial caries occurs in the place of a white or pigmented spot as a result of

destructive changes in the enamel of the tooth. It is characterized by the occurrence
of short-term pain from cold and from chemical irritants -sweet, salty, sour... When
examining the tooth, a defect (cavity) is found. With superficial caries, the defect is
within the enamel.
Medium caries (caries media)
It develops as a consequence of the superficial. With average caries, dentin is

involved in the pathological process.
Deep caries (caries profunda)
With deep caries, there are significant changes in dentin, which causes complaints.
Patients indicate short-term pains from mechanical, chemical and thermal stimuli,
which disappear after their elimination.
Examination reveals a deep carious cavity filled with softened dentin. Probing the
bottom of the cavity is painful. Due to the fact that dentin is more susceptible to
carious processes, the cavity in dentin is usually more extensive than the enamel
entrance.
In some cases, symptoms may appear pulpitis: aching pain in the tooth after removal
of the irritant.
Diagnostics
17
With deep forms of caries, it is usually not difficult. The use of a dental mirror and
probe makes it easy to find and diagnose cavities. Cavities localized on the
"proximal" (touching) cavities of the teeth (class II according to Black) constitute a
certain complexity. In such cases, thermal diagnostics (cold) andradiograph teeth.
The X-ray also helps diagnose “caries in the stage of stains", In which the integrity
of the enamel is not compromised and the probe is not delayed. Diagnosis of caries
in the stain stage can also be carried out by staining the tooth surface with a
solutionmethylene blue or caries detector (includes magentapink) (the changed areas
are colored) - using this method you can differentiate caries in the stage of stains
from hypoplasia and fluorosis... You can also dry the surface of the tooth - in this
case, the carious surface loses its shine, but this sign is more difficult to distinguish,
therefore it is less reliable than a test with methylene blue.
To find and diagnose "latent" and initial caries, you can use "transluminescence" -
shining through the tooth from the opposite side with a strong light source, such as
dental photopolymerizer...
remineralizing therapy
Demineralization of caries in the stain stage is reversible when remineralizing

therapy... For this, applications of a 10% solution are carried out within 10
days.calcium gluconate, 1-3% solutionremodents"(A product that is obtained from
natural raw materials) and fluorine-containing preparations (sodium fluoride2-4%).
The most effective procedure for this procedure is carried out in the doctor's chair:
first, the tooth is cleaned from plaque andpellicles, then the chalky spot is treated
with a weak acid solution (for example, 40% citric acid) for 1 minute, after which it
is washed with water and a solution of 10% is applied calcium gluconate or calcium
hydrochloride by using applications or electrophoresiswithin 15 minutes with the
addition of fresh solution every five minutes. For non-pigmented white spots, the
prognosis is favorable, provided hygiene is optimizedoral cavity...
Filling a carious cavity
Treatment of superficial, medium and deep caries is carried out dissection (removal
of the affected tissue) followed by replacement, filling carious cavity.
Stages of carious cavity processing:
1. definition occlusal points;
2. anesthesia tooth[eighteen] (application, infiltration, conduction, anesthesia);
3. cleaning a tooth from food plaque with a brush and paste or dental
sandblasting (Air flow and etc.);
18
4. imposition of an isolating system according to the situation (cofferdam,

OptiDam and etc.);
5. preparation of a carious cavity drill... Removing the overhanging edges of the
enamel,necrectomy (complete removal of the softened infected dentin), forming a
cavity for better fixation fillings... Depending on the usedfilling material, method
adhesionetc., there are different methods of cavity formation. In case of deep caries,
the bottom area is prepared manually by dental "excavators"To exclude perforation
(opening) pulp, or a drill at low speeds;
6. antiseptic (drug) treatment of the carious cavity is carried out using a 2%
aqueous solution chlorhexidine or a gel based on it, also some conditioning gels are
already included antiseptics;
7. in the case of a deep carious cavity, a medicated pads or gaskets from glass
ionomer cements;
8. depending on the type of material introduced, the carious cavity is treated with
primer, adhesive... When using a 4th and 5th generation adhesive, enamel and dentin
are first conditioned with 20% or 37%phosphoric acid... 6, 7 and 8 generations of
adhesive systems are self-etching;
9. applying dental adhesive;
10. filling of a carious cavity seal or tab from composite materials, metal
compositions (amalgams) or ceramics... In the case of composite and ceramic
materials, it is possible to restore the color of the tooth;
11. grinding of occlusal contacts, polishing of fillings.
When pulpitis have to do depulpation (nerve removal) of a tooth.
Early treatment of caries with filling allows you to keep the tooth healthy longer,
since you have to dissect (destroy) a smaller part of it. With severely decayed teeth,
it is necessary to installcrown...
Caries treatment without drilling and filling
Similar techniques are under research and development. So, doctors from the French
National Institute of Health and Medical Research (INSERM) in 2010 discovered a
method of treating a patient with dental caries without surgery. Melanocyte
stimulating hormones, introduced into the carious cavity or applied nearby, stimulate
the cells of the tooth tissue to multiply and heal damage. Experiments on mice have
shown that teeth are restored within a month [source not specified 278 days]...
Caries treatment during pregnancy
Traditionally, it is considered that dental treatment under anesthesia in pregnant

women is dangerous due to possible complications for the fetus. However, recent
19
studies show the opposite results. So, according toAmerican Dental Association,
researchers from several groups agreed that local anesthesia and dental treatment
during pregnancy are safe for the fetus
Another prospective study published in August in the Journal of the American
Dental Association also confirms that the use of local anesthesia during pregnancy
does not harm the fetus. During the work, 210 pregnant women were monitored,
who received dental treatment (53% in the first trimester) using local anesthesia.
Their data were compared with data from a control group of 794 women who had
not been exposed to any teratogens during pregnancy. The results of the study did
not show any difference in the incidence of complications of pregnancy and
miscarriage between the two groups, and there was also no difference in terms of
delivery and fetal weight. Most often, dental treatment included: endodontic
treatment (43%), tooth extraction (31%), tooth restoration (21%).
The safety of X-ray examination for the treatment of teeth in pregnant women is
confirmed by another independent study conducted in Helsinki... In the course of the
work, it was shown that even the use of such protective devices as a lead apron for
the mother is not justified, since the radiation dose is very small and does not cause
complications in the fetus.
Prophylaxis
Based on modern ideas about the occurrence of caries teeth, its prevention should be
carried out in two directions:
● elimination of a cariogenic situation in the oral cavity;
● increased caries resistance of tooth tissues.
The main measures prevention caries are
● regular oral care;
● decrease in consumption Sahara;
● usage fluorinated toothpastes;
● adherence to the correct technology brushing teeth;
● Flossing before or after brushing your teeth
● use of solutions 0.1-0.2% chlorhexidine for daily mouthwash or chlorhexidine
toothpastes;
● use mouthwash;
● use xylitol at least 3 times a day after meals in the form of xylitol chewing
[23]
gum ;
● preventive examination at dentist at least once every six months.
20
Improving the body, maintaining good oral hygiene, eliminating dentoalveolar

deformities (crowded teeth), as well as special events:
● sealing of fissures and blind pits;
● diet correction;
Sealing fissures and blind pits
Sealing (sealing) of fissures and blind pits with special flowable polymers
(composites based on methacrylate,polyurethane) allows you to protect the most
likely places of caries formation (fissures) and reduces the growth of caries by up to
90%.
Diet correction
One of the main risk factors for the development of caries is the presence of sugars
in the diet. A promising direction of prevention is limiting carbohydrates in the diet
of children and replacingSahara non-cariogenic products (sorbitol, xylitol) in infant
formula and confectionery... Milk and some varieties cheesealso contribute to the
remineralization of enamel. Usagechewing gum (especially with xylitol) also has a
positive role. First, chewing gum removes food debris and, in part, plaque from the
fissures of the teeth; secondly, the act of chewing leads to the release of a large
amount of saliva, and the active components that make up some chewing gums
(calcium lactate or pyrophosphate and tripolyphospha]), improves remineralization
of the enamel surface and reduces the formation of supragingival calculus
For the prevention of caries V. K. Leontiev the "culture of carbohydrate
consumption" was proposed
1. do not use sweet as the last meal when eating;
2. do not eat sweets between meals;
3. do not eat sweets at night;
4. if you violate these rules, you should brush your teeth, chew sugar-free gum,
or eat hard vegetables or fruits that cleanse your mouth.
Sour and sweet drinks are best drunk through straw... Sucking is also
harmfullollipopscontaining sugar.
In 2020, scientists have established benefits for the fight against caries of traditional
Sichuan pickled cucumbers... Of these,strain bacteria Lactobacillus plantarum K41,
which has shown a strong inhibitory effect against the formation of biofilms the main
carious bacterium Streptococcus mutans
Oral hygiene
21
Oral hygiene plays an important role in the prevention of diseases such as tooth
decay, gingivitis, periodontitis... Timely removal of plaque not only stops the carious
process, but also leads to a curegingivitis (cm. teeth cleaning methods).
Fluoridation
Fluorine has a very pronounced anti-carious effect, which is explained by the

substitution hydroxyl group (OH-) hydroxyapatite enamel on fluorine(F-). Some
authors cite evidence that fluorine also inhibits acid-forming bacteria. The most
pronounced effect is observed with its optimal intake into the body during the period
of development, mineralization and subsequent maturation of teeth, that is, in
childhood. The most radical and effective method is water fluoridation (up to a
concentration of 1 mg / l), which leads to a decrease in caries by 30-50%[31]...
WHO[32]recommended to carry out fluoridation of water in all countries. Although
it must be borne in mind that a high amount of fluoride (more than 1 mg / l) can lead
tofluorosis...
Along with the introduction of fluoride inside, local applications of fluorine with 1-
2% fluoride are also used. sodium or fluoride tin, application of fluorinated varnishes
(fluoride varnish).
Animal research conducted in 1991 year by the National Toxicology Program,
argued that fluoride increases the risk of osteosarcomasin male rats. In the same year,
scientists at the National Cancer Institute found an increase in cases of the disease
in men under 20 living in areas where water fluoridation occurs. V2001 yearElise
Bassin (Harvard School of Dental Medicine) conducted a study on the incidence of
osteosarcoma among children under 20 years of age. Among boys who drank water
with fluoride content from 30 to 90% of the Center for Desease Control and
Prevention standards, the risk of osteosarcoma was 5 times higher than that of the
control group who drank non-fluoridated water. At a fluoridation level of 100% and
above, this indicator increased up to 7 times. The greatest relationship between these
factors was observed in boys aged 6 to 8 years. This study was pressured by her
research advisor, Chester Douglass (publisher of the company-sponsored
fluoridation journalColgatemanufacturer of fluoride toothpastes) was not published
until 2005 year
Fluoridation of water in Russia is protected by Yu. A. Rakhmanin (academician
RANS, ISA, RAVN, MAI, Corresponding Member RAMS) and A.P. Maslyukov
(academician RAVN).
22
Topic 2. Pulpitis
1. Purpose and objectives:

to study the inflammation of the pulp of the tooth, the peculiarities of the course of
the disease, methods of examination and treatment

− Etiology
− Classification
− Pathogenesis
− Clinic
− Diagnostics
− Treatment
1. Therapeutic dentistry, E. V. Borovskiy and sov., Moscow., 1998;

2. Dentistry, N. N. Bazhanov, "Medicine", Moscow, 1990
3. L.N. Maksimovskaya,
4. P.I. Roshchin.
5. Medicines in dentistry: Endodontics
Pulpitis - inflammation internal tissues tooth (pulp). The pulp is located inside the
canal and contains the nerve, vessels, cells of the connective tissue and provides
nutrition to the hard tissues of the tooth from the inside. Pulpitis develops when an
infection enters the tooth, most often as a result of a long-term currentcaries...
Common manifestations are increased tooth sensitivity to temperature, throbbing
pain, in rare cases, asymptomatic course is possible. Depending on the duration of
the course, it can be acute and chronic.
In the absence of treatment, pulpitis can lead not only to tooth loss, but also to the
transition of the inflammatory process on the tissues of the jaw and sepsis(mainly in
people with severely reduced immunity), so it needs to be treated. Currently,
methods have been developed that allow to treat pulpitis without completely
23
destroying the pulp, that is, preserving the viability of the nerve and feeding vessels
(methods of vital amputation)
Etiology
Pulp inflammation is always caused by infection in the pulp chamber. This can
happen in two ways: intradentally (through the crown of the tooth) and retrograde
(through the apical (located at the apex of the tooth) orifice). Most often, pulpitis is
a complicationcaries... Sometimes it can be the result of incorrect actions of the
doctor (grinding a tooth under orthopedic structures, poor qualityfilling materials,
surgical interventions on the periodontium, exposure to chemicals). Cases of
retrograde pulpitis (that is, infection throughapical foramen tooth
There are three main groups of factors causing pulpitis:

1. Physical factors:
○ overheating of the pulp, for example, when preparing a tooth for a crown or
preparing a carious cavity without cooling;
○ opening of the tooth cavity when preparing a carious cavity;
○ traumatic fracture of the tooth crown with opening of the pulp chamber;
○ denticles and petrification - are slowly deposited in the tissues of the pulp, can
irritate its nerve endings, squeeze blood vessels, disrupt microcirculation, cause
edema, discomfort, which facilitates the occurrence of pulpitis from the action of
other factors;
○ pronounced pathological abrasion of teeth, in the presence of concomitant
diseases (diabetes mellitus, osteoporosis - they slow down the deposition of tertiary
(compensatory) dentin, which leads to the opening of the pulp chamber.
2. Chemical factors are always iatrogenic (due to the actions of the doctor):
○ non-compliance with the exposure of the etching gel, which is necessary for
the adhesion of most composite materials and some glass ionomer cements;
○ poor quality (incomplete) rinsing of the etching gel;
○ the use of strong antiseptics for drug treatment of the formed cavity in the
treatment of caries;
○ toxic effect of filling material.
3. Biological factors - direct infection of the pulp chamber:
○ as a complication of the carious process (including with recurrent caries
developing under the filling);
24
○ the penetration of microbes from the carious cavity through the dentinal
tubules after preparation, when taking an impression under pressure (a very rare
way);
○ retrograde pulpitis - the ingress of microbes through the apical foramen in
osteomyelitis, sepsis, through the lateral branches of the root canal, after curettage
of deep periodontal pockets.
Classification
MMOMA classification (1989)
1. acute pulpitis:
1. focal purulent
2. diffuse purulent
2. chronic pulpitis
1. fibrous
2. gangrenous
3. hypertrophic
3. exacerbation of chronic pulpitis
1. exacerbation of chronic fibrous pulpitis
2. exacerbation of chronic gangrenous pulpitis
4. condition after partial or complete removal of the pulp.
ICD-10 classification - used for diagnosis in most dental clinics in the world. The
correspondence to the shape of the pulpitis according to the MMSI is indicated in
brackets.
● K04 - diseases of the pulp and periapical tissues
● K04.0 pulpitis
● K04.00 - initial (pulp hyperemia) (according to MMOMA deep caries)
● K04.01 - acute (according to MMSI, acute focal pulpitis)
● K04.02 - purulent (pulp abscess) (acute diffuse according to MMSI)
● K04.03 chronic (according to MMSI - chronic fibrous pulpitis)
● K04.04 chron. ulcerative pulpitis (according to MMSI - chronic gangrenous
pulpitis)
● K04.05 - pulp polyp (according to MMSI - chronic hypertrophic pulpitis)
● K04.08 - other specified pulpitis
● K04.09 - Unspecified pulpitis
● K04.1 pulp necrosis (pulp gangrene)
25
● K04.2 pulp degeneration (denticles, pulp petrification)

● K04.3 improper TV formation. tissues in the pulp (secondary or irregulatory
dentin)
Pathogenesis
Pulpitis are classified as acute and chronic. Acute pulpitis is understood as a
condition when the infection has penetrated into the pulp with a closed pulp chamber
(through a thin wall of a tooth destroyed by caries). Acute pulpitis initially has a
focal character and proceeds as serous inflammation (serous pulpitis), then
appearspurulent exudate(purulent pulpitis). In this case, very severe pains appear
due to the accumulation of purulent exudate in a closed pulp chamber. Chronic
pulpitis is most often the outcome of an acute one.
Chronic pulpitis is divided into fibrous, hypertrophic and gangrenous. The main
form of chronic pulpitis is fibrous pulpitis, in which fibrous connective tissue grows.
With hypertrophic pulpitis occurshypertrophicproliferation of pulp tissue through an
open carious cavity. With gangrenous pulpitis, tissue decay is found in the coronal
pulp. In the root pulp is foundgranulation tissue...
Acute pulpitis
Acute focal
The inflammation is in the projection of the horn of the pulp. This stage lasts about
2 days. The causative tooth is very sensitive to thermal stimuli (mainly to cold), and
the pain intensifies and continues after the removal of the stimulus (in contrast
tocaries). Percussion (tapping) of the tooth is insensitive or insensitive
(unlikeperiodontitis).
Acute diffuse
The main signs of acute diffuse pulpitis are strong, radiating (spreading) along the
branches trigeminal nervepains that get worse at night. The pains are intermittent.
Quite often, patients note pains of a different nature in the temporal region.
Chronic pulpitis
Chronic inflammation of the neurovascular bundle of the tooth, contributing to

functional and structural changes.[eight]
26
Chronic fibrous pulpitis
Fibrous pulpitis often occurs asymptomatically or with mild discomfort.
Chronic hypertrophic (proliferative) pulpitis
With hypertrophic pulpitis, a hypertrophied fibrous polyp is found in the carious

cavity.
Chronic purulent pulpitis
Purulent pulpitis can occur with significant pain, while the tooth is sensitive to hot,
and cold soothes the pain.
Focal pulpitis
The presence of a carious cavity filled with softened dentin. The walls and bottom
of the cavity are dense. Probing sharply painful at the bottom of the cavity closer to
the horn of the pulp. The tooth cavity is closed. On X-ray, the carious cavity is close
to the tooth cavity. Vertical percussion is painless. EDI - 15-20 μA
Acute diffuse
A similar pain is characteristic of an acute attack. The carious cavity is deep, with a
large amount of softened dentin. Probing painful throughout the bottom. Vertical
percussion is painful. On the roentgenogram - the carious cavity communicates with
the tooth cavity. There are no changes in the periodontium. EOD - 20-35 μA.
Chronic
Fibrous
The cavity can be either closed or open. Probing is painful. Slowly increasing pain
from hot or cold is inherent. Percussion is also painless. EDI - 20-40 μA
Gangrenous
The cavity is open. Increasing pain under the influence of heat. With percussion,
slight pain is possible, EDI - 40-80 μA
27
Treatment
Serous pulpitis is considered reversible with proper treatment (Ca-containing
medicinal pads for fillings, antibiotic dressings, etc.), which is aimed at alkalizing
the tooth cavity, with the subsequent formation of secondary dentin. The indications
for this (biological) method of treatment are young age (up to 30 years), the absence
of chronic diseases and sufficient caries resistance (resistance of tooth tissues to the
carious process). Partial removal of the pulp (pulp amputation) is also possible, but
it is now rarely used, mainly in milk teeth and teeth with an unformed apex (up to
two years after the eruption of the tooth).
In the treatment of acute purulent and chronic pulpitis, mechanical and drug
treatment is performed root canal systems (depulpation - "removal of the nerve")
and filling (airtight obturation) channel... This type of treatment is divided into
devital and vital extirpation.
Devital extirpation
In this method, there is a complete destruction of the pulp of the tooth. Removal of
the neurovascular bundle is carried out in 2 visits. After anesthesia, a message is
created with the cavity of the tooth (pulp chamber) and a devitalizing paste is applied
(popularly referred to as "arsenic", But in fact it is almost never used, but is replaced
by a paste based on paraformaldehyde and anesthetic, it can be left on for a week,
and its toxicity is much lower).
Vital amputation
It allows you to preserve the viability of the nerves and vessels that feed the tooth,
which ensures normal trophism of the tooth tissues and prevents the development of
periapical complications. Studies by a number of authors have shown that after vital
amputation, the root pulp retains its viability, producing secondary dentin.
Removal of the neurovascular bundle and its obturation is carried out under
anesthesia in one visit in the absence of pronounced inflammation, passing into the
periodontium. In case of spread of inflammation beyond the root system, a medicinal
substance is left in the canal (for antiseptics and relieving inflammation). During the
treatment, it is necessary to take at least two images: the first one - before the start
of treatment, to assess the length and structure of the canals; the second - after, to
assess the quality of the filling of the canals. A pulped tooth subsequently needs
28
reinforcement (fixation of a fiberglass, titanium, silver, etc.) and (or) crown

coverage, as indicated.
Effects
After depulpation, the tooth becomes "dead" (its blood supply is cut off). Since
complete sterilization of such a tooth is impossible, bacteria that are protected from
immunity and antibiotics can develop in it. Hypothetically, they can cause an
infection in the body if the immune system is seriously weakened, for example, in
the treatment of cancer.
Complications
Chronic pulpitis without proper treatment, with inadequate treatment of the root
canal system, with leaking obturation of the canal or leaking tooth restoration (seal,
tab, onlay, crown) can go to periodontitis...
Prophylaxis
The main task is to prevent the onset and development of diseases at the earliest
stages.
Types of prevention of pulpitis:
1. Primary: Includes a number of activities that are quite cheap and simple
(drawing up a diet, individual and professional care and selection of hygiene
products, the use of fluorine drugs), the regular implementation of which will several
times reduce the risks of pulpitis spread.
2. Secondary: It is used in cases where the disease has already arisen and is
aimed at preventing complications (for example, treatment of caries as prevention
of pulpitis and periodontitis).
Topic 3. Etiology, pathogenesis of inflammation

periapical tissues.
Classification of periodontitis diseases.
Methods for the diagnosis of periodontitis.

learn the definition of periodontitis, diagnosis, examination methods, treatment and
prevention
29

− Etiology
− Classification
− Pathogenesis
− Clinic
− Diagnostics
− Treatment
4. P.I. Roshchin.
Periodontitis is an inflammatory process that affects the periodontal tissue and

spreads to the adjacent bone structures. The periodontium is a connective tissue
formation that fills the periodontal gap. On the one hand, the periodontium is limited
by the cement of the tooth root, and on the other, by the inner compact plate of the
alveoli.
The width of the periodontal gap on the lower jaw is slightly smaller (0.15-0.22 mm)
than on the upper (0.20-0.25 mm).
The width of the periodontal gap of the teeth is different in its individual areas. It
expands in the peri-apical region and at the apex of the interalveolar septum, and
narrows in the middle third of the root. Average values of periodontal thickness
change with the development and function of the tooth, as well as with age. In a
tooth formed, but not yet erupted, the periodontal width is 0.05-0.1 mm. With the
loss of antagonists, the periodontal gap decreases to 0.1-0.15 mm.
In connection with the pathological process, it changes. With an increased load on
the tooth, periodontal thickening and changes in the bone structure of the hole occur,
which often leads to an expansion of the periodontal gap. Hyperplasia of the cement
- hypercementosis - also changes its contours and size.
The periodontium begins to develop simultaneously with the root of the tooth shortly
before its eruption. Its development occurs due to the mesenchymal cells of the outer
layer of the dental sac, which surrounds the tooth germ.
30
The formed periodontium consists of bundles of collagen fibers, in between which

there are layers of loose connective tissue with separate elastic fibers. Vessels and
nerves pass through this tissue. Among the bundles of collagen fibers, the so-called
oxytalan fibers are found, which, in their chemical structure, occupy an intermediate
position between collagen and elastic ones (V.V. Gemonov, 1982). Reticular fibers
are located between collagen bundles, repeating their course. The connective tissue
cells of periodontitis are diverse. Here you can find cementoblasts, osteoblasts,
osteoclasts, fibroblasts, plasma cells, macrophages, mast cells. A feature of the
connective tissue of the periodontium is the accumulation of epithelial cells in it,
which are the remnants of the tooth-forming epithelium. For the first time these
clusters were described by Malasse in 1885. In the works of N.A. Astakhova (1908)
it was proved that these cells are the remnants of the epithelium of the dental organ,
which were preserved after its resorption. With the inflammatory process in the
periodontium, the cells are activated and show a tendency to multiply.
The periodontium performs various functions, one of which is a barrier that protects
the jaw bone tissue from the penetration of harmful agents (microorganisms, toxins,
medicinal substances).
The fixing function of the periodontium is provided by the circular ligament,
interalveolar and apical fibers. The ligamentous apparatus ensures the physiological
mobility of the tooth.
The shock-absorbing function of the periodontium is performed by collagen,
reticular and elastic fibers, as well as blood and lymph vessels. It is known that the
periodontium contains 60% of tissue fluid, not counting the large amount of lymph
and blood that are in the vessels. Therefore, the pressure experienced at the moment
of their closing and chewing food is distributed along all the walls of the periodontal
fissure.
The plastic function is provided by cementoblasts, which form secondary cement,
and osteoblasts, which are involved in the formation of bone tissue.
An important function of the periodontium is trophic. The nutrition of the cementum
of the tooth and the compact plate of the alveoli is carried out due to the significantly
developed network of blood vessels and nerves.
A.I. Rybakov (1970) also distinguishes the reflexogenic function of the

periodontium. In his opinion, the receptors send signals to the chewing muscles,
which regulates the strength of the chewing pressure on the teeth. Sensory function
is due to the rich innervation of the periodontium.
CLASSIFICATION. In the classification schemes of periodontal diseases there are

more similarities than discrepancies (P.P. Lvov, 1938; E.M. Gofung, 1946; S.A.
Vayndrukh, 1962; E.V. Levitskaya et al., 1973; G.D. . Ovrutsky, 1984; Hattyasy,
31
1955; Sobkowiak, 1979). The differences concern only details that are not of
fundamental importance. The most widespread classification of G.I. Lukomsky
(1955), including the following forms of the disease: 1. Acute periodontitis:
a) serous (limited and diffuse), b) purulent (limited and diffuse).

2. Chronic periodontitis:
a) granulating, b) granulomatous, c) fibrous.
3. Chronic periodontitis in the acute stage.
In my opinion, acute periodontitis is mainly of drug-toxic and traumatic origin.
Trauma occurs with fractures or dislocations of the teeth, during their treatment,
when the instrument is carried out beyond the apex of the root, when correcting the
inclination of teeth with dentoalveolar deformities (I.B. Tril, 1995). Acute purulent
periodontitis can develop in acute osteomyelitis and odontogenic sinusitis, when
intact teeth (one or more) are involved in the inflammatory process. In the
overwhelming majority of cases, we observed not acute periodontitis, but an
exacerbation of its chronic course.
Depending on the localization of the pathological process in the periodontium, apical
(apical) periodontitis is distinguished, in which inflammation develops between the
apex of the tooth root and the wall of the alveoli; marginal (marginal) - inflammation
begins from the edge of the gums. Marginal periodontitis is not subject to surgical
treatment and we will not dwell on it. Distinguish between diffuse periodontitis.
In the chronic course of periodontitis, we distinguish two active forms: granulating
and granulomatous. The fibrous form of chronic periodontitis is cicatricial
replacement of the periodontium, the outcome of an acute inflammatory process in
the scar. On the roentgenogram in these cases, the periodontal gap in the affected
tooth is somewhat widened, in some places its narrowing is determined. If the
periodontium has undergone ossification as a result of inflammation, then the
display of the periodontal gap on the radiograph may be absent. The increased
formation of new layers of cement at the root of the tooth causes hypercementosis
(AM Solntsev, AA Timofeev, 1989).
In terms of prevalence, periodontitis is limited or diffuse. Apical granulomatous
periodontitis, depending on the localization of the granuloma, can be strictly apical,
apicolateral and lateral. The granuloma of multi-rooted teeth can be located between
the roots, that is, form interroot granulomatous periodontitis. Localization of the
granuloma is due to the site of infection from the root canal of the tooth into
periodontitis. Penetration of infection through the central apical foramen causes
apical periodontitis. The development of apicolateral granulomas is due to the
simultaneous exit of infection through the main apical foramen and its deltoid
branch. The emergence of lateral granulomas is a consequence of the predominant
32
entry of infection into the periodontium through one of the branches of the root
canal.
ETIOLOGY AND PATHOGENESIS. Periodontitis in the overwhelming majority
of cases is of infectious origin and occurs under the influence of nonspecific
pathogens, most often staphylococci, acting alone or in combination with another
microflora. A feature of this infectious process is the lack of immunity and even a
decrease in the body's resistance to re-introduction of the pathogen. In the
pathogenesis of periodontitis, great importance is attached to the allergic
restructuring of the reactivity of the periodontium, which occurs under the influence
of sensitization by microorganisms, toxins and products of pulp decomposition (BC
Ivanov, 1984). In recent years, much attention in the pathogenesis of the disease has
been paid to anaerobic streptococci and bacteroids, which were found during
bacteriological examination of root canals and granulomas (A.I. Marchenko et al.,
1984).
The infection penetrates into the periodontium through the root canal, the bottom of
the gingival pocket, by hematogenous and lymphogenous routes, by continuation. It
should be noted that the hematogenous and lymphogenous pathways of the onset of
periodontitis have not been convincingly proven. We observed periodontitis and
retrograde pulpitis in periodontitis, osteomyelitis, that is, in those cases when the
periodontium, and subsequently the pulp, were involved in inflammation, which
spread along the length, possibly with the participation of blood and lymph vessels.
Microorganisms enter the dental pulp tissue through the carious cavity. If these
microorganisms are devoid of pathogenic properties, then their first contact with the
pulp tissues may not be accompanied by the development of a pronounced
inflammatory reaction. However, the penetration of the waste products of
microorganisms through the lymphatic vessel system into the regional lymph nodes
with their subsequent fixation by immunocompetent cells already at this stage of the
development of the pathological process may be accompanied by the production of
antibodies and sensitization of the body. A new entry of the same non-pathogenic
microbes into the pulp tissue of a sensitized organism may be accompanied by the
development of allergic inflammation. In some cases, the penetration of
microorganisms is preceded by the occurrence of sensitization of the organism to the
identical microflora of some other infectious focus, and the very first introduction of
microbes into the dental pulp may be accompanied by the development of allergic
inflammation.
CLINIC. In acute serous periodontitis, aching, mild pains in the tooth appear,
aggravated by biting. Pain usually does not radiate and patients correctly indicate
the localization of the affected tooth. With prolonged pressure on the tooth (closing
the jaws), the pain subsides somewhat. No soft tissue swelling. Regional lymph
nodes increase slightly, slightly painful. There is little tooth mobility and positive
33
vertical percussion. In acute serous periodontitis, there are no changes on the

roentgenogram, but if there is an exacerbation of chronic periodontitis, then on the
roentgenogram we see the previous pathological changes. There are no general
changes in acute serous periodontitis, and a blood test also does not give reliable
deviations from the norm.
With the transition of serous inflammation to a purulent form of periodontitis, the
intensity of pain increases. They become sharp, pulsating, radiating along the
branches of the trigeminal nerve. Strengthened in a horizontal position, during
physical exertion, when exposed to heat. Sharp pains occur with any touch of the
tooth, which becomes mobile. The patient notes that the tooth seems to "grow". The
patient's mouth is half-open, because he cannot close his teeth due to pain when
touching a sick tooth. The mucous membrane of the alveolar process is hyperemic,
edematous, painful within the causative tooth, and can sometimes be infiltrated.
Edema of the soft tissues of the maxillofacial region appears. Regional lymph nodes
are enlarged, painful. The general condition suffers due to sleep and eating disorders,
weakness may appear, malaise, fever and other symptoms of intoxication. The blood
tests showed leukocytosis, stab shift to the left, accelerated ESR. On the
roentgenogram with purulent periodontitis, there are no changes - the periodontal
gap is not changed, the destruction of bone tissue is not detected. Only in some cases,
on the 3-5th day from the onset of the development of the disease, an indistinctness
of the compact plate of the alveoli may appear.
Acute periodontitis must be differentiated from acute pulpitis. With pulpitis, pain is
acute, paroxysmal, more often at night, tooth percussion is less painful, there are no
inflammatory changes in the peri-maxillary soft tissues. Helps in carrying out
differential diagnostics electroodontometry. Differences between acute periostitis,
osteomyelitis and acute periodontitis will be discussed further in the relevant
sections.
Treatment of acute periodontitis consists in creating an outflow of exudate from the
periapical region, which leads to a subsidence of acute inflammation. You can
prescribe symptomatic treatment, physiotherapeutic procedures (rinsing, UHF in an
athermal dose).
Depending on the nature of the course of chronic periodontitis, pathomorphological
changes in the bone surrounding the apex of the tooth root, granulating,
granulomatous and fibrous periodontitis are distinguished. Granulating periodontitis
is an active form of inflammation characterized by frequent exacerbations. Patients
complain of recurring pain in the area of the affected tooth. There may be no pain.
It is clear from the anamnesis that this tooth has been bothering the patient for a long
time. At first, the pain is paroxysmal, aggravated by biting and swelling of the gums.
With the expiration of purulent contents through the fistula, the pain subsides.
34
Objectively, on the alveolar process of the jaw, in the area of the affected tooth, it is
usually possible to detect a fistulous passage with purulent discharge. The
localization of fistulas is different. Most often, they open in the projection area of
the apex of the tooth root from the vestibular side. This is because the outer wall of
the alveoli is thinner. Around the mouth of the fistulous tract, there is often an
overgrowth of bleeding pink granulations. Instead of a fistula, in some cases, a scar
can be found, which indicates that the functioning fistula has closed. With
granulating periodontitis, fistulous passages can open on the skin, the localization of
which is quite typical and depends on the location of the causative teeth. Cutaneous
fistulas can be localized in the corner of the eye (the reason is the upper canine), in
the buccal region (in the upper part - from the first upper molar, less often -
premolars), in the chin (from the lower incisors and canine). We did not observe
fistulas on the neck with granulating periodontitis.
35
The mucous membrane of the gums in the area of the affected tooth is edematous,
hyperemic and pasty. This type of periodontitis is characterized by the symptom of
"vasoparesis". It consists in the fact that when pressing on the mucous membrane of
the gums with a button-like instrument or the blunt side of the tweezers, its blanching
is noted, which is slowly replaced by persistent hyperemia (G.I. Lukomsky, 195E).
This is due to the fact that the decay products in the focus of inflammation cause
persistent paresis of the vasomotor nerves, which leads to disturbances in vascular
tone, congestion and swelling of the gum area. A painful infiltration is felt in the
projection of the root apex.
X-ray examination plays an important role in the diagnosis of periodontitis. On the

radiograph in the bone at the apex of the tooth root, a site of bone tissue resorption
with uneven and indistinct contours is distinguished. In some cases, partial
resorption of the tooth root is found. The destruction of bone tissue sometimes
extends to the alveoli of adjacent teeth. Granulating periodontitis of multi-rooted
teeth leads to resorption of the inter-root bone septum. In this case, on the
roentgenogram, the roots of the teeth are visible against the background of the area
of osteolysis of the bone tissue, which does not have clear boundaries.
Granulating periodontitis is distinguished by the originality of the
pathomorphological picture. When examining an extracted tooth, in some areas of
the root, fragments of granulation tissue of a dark red color are visible, the surface
of the root is rough. Microscopically, the growth of granulation tissue is detected at
various stages of its maturation. Resorption of bone tissue and hard tissues of the
tooth root is observed.
Granulating periodontitis is the most typical and formidable focus of odontogenic

infection, from which microorganisms and their waste products enter the body,
causing its sensitization. (Yu.I. Vernadsky, 1985; A.A.Timofeev, 1985, 1988; T.D.
Zabolotny et al., 1989). Due to the occurrence, in this form of periodontitis, a
resorptive process in the alveolar bone, toxic products of inflammation are absorbed
into the blood to a greater extent than in other forms of it. Intoxication decreases
after an exacerbation of the process, as a result of which a fistula occurs, through
which purulent contents are separated. Closing the fistula after a short time often
again leads to an exacerbation of the inflammatory process and increased
intoxication. Granulating periodontitis in the clinical course is extremely dynamic,
36
Granulomatous periodontitis is characterized by the formation of granulation tissue

and the surrounding connective tissue (fibrous) capsule. The fibrous capsule is a kind
of protective barrier on the way to the penetration of microbes, toxins and decay
products into the body. Granulomatous periodontitis is asymptomatic for a long
time. There is a relatively stable balance between the activity of microflora and the
body's resistance. In some patients, granulation tissue, destroying the bone
(especially in the upper jaw), spreads under the periosteum. Subperiosteal
granuloma occurs. In the projection of the apex of the tooth root, the granuloma can
be palpated in the form of a clearly delimited dense, slightly painful formation with
a smooth surface.
With granulomatous periodontitis, using X-ray examination at the apex of the tooth
root, it is possible to detect a focus of destruction of bone tissue, which has a rounded
shape and fuzzy smooth edges. We distinguish between apical, apicolateral, lateral
and interroot granulomas. Apical granuloma is localized strictly at the apex of the
tooth root, lateral - on the side of the tooth root, apicolateral - on the side of the apex
of the tooth root. The tops of the roots of the teeth facing the granuloma are often
resorbed. In multi-rooted teeth, the granuloma can be located in the place of the
deltoid branching of the root canal - interroot granuloma
The clinical and radiological picture of simple granulomas is no different from

epithelial ones. Epithelial granulomas are often filled with inflammatory exudate and
fatty detritus, they can merge, forming cystogranulomas, and then cysts.
According to E.V. Borovsky et al. (1973), the diameter of the granuloma usually
does not exceed 0.5 cm, and the size of the cystogranuloma ranges from 0.5-0.8 cm.
Microscopic examination can reveal that the dental granuloma in appearance
resembles a spherical or oval sac. It is surrounded by a dense shell with a smooth
surface and one edge can be tightly soldered to the root of the tooth. Distinguish
between simple, complex and cystic granulomas. A simple granuloma consists of
maturing granulation tissue, which is delimited at the periphery by a fibrous capsule.
In a complex granuloma, an overgrowth of epithelial cords can be found. With
vacuolar dystrophy and disintegration of epithelial cells in the central parts of the
granuloma, a cavity is gradually formed, lined with the epithelium of the cystic
granuloma.
37
We have observed patients with granulomas for many years. A granuloma localized
near the outer plate of the jaw (more often in the region of the buccal roots of the
upper molars) can cause destruction of the thin bone wall and grow under the
periosteum, forming a subperiosteal granuloma. In this case, in the projection of the
tops of the roots, a hemispherical formation with clear boundaries, a smooth surface,
dense, slightly painful on palpation, covered with an unchanged mucous membrane
is determined. The high pressure of the contents in the granuloma determines its
density, which often simulates the presence of a tumor. On the roentgenogram, the
subperiosteal granuloma does not differ from the usual ones.
Fibrous periodontitis develops as an outcome of an acute inflammatory process in

the scar. Macroscopically, the periodontium is thickened, dense, there is an
overgrowth of fibrous tissue. With fibrous periodontitis, there is an increased
(excessive) formation of cement at the root of the tooth, which causes
hypercementosis. There are no clinical symptoms in this form of the disease. The
diagnosis is made on the basis of radiography - expansion or narrowing of the
periodontal gap, its uneven outlines, its ossification is possible (there is no gap) -
hypercementosis is detected. The bone plate of the alveoli is often sclerosed,
thickened (due to the scar).
If fibrous periodontitis is found in properly sealed roots of teeth, then there is no

need to carry out any measures related to its treatment. In another case - an untreated
or incorrectly treated tooth - conservative treatment is required according to the
methods generally accepted in therapeutic dentistry.
Errors can occur with an incorrect assessment of radiographs, when, as a result of an

unsuccessful projection, a mental or incisal opening is superimposed on the apex of
the tooth root, which is taken for the presence of a granuloma or cyst in the patient.
With the pneumatic type of the maxillary sinus, the latter can be radiographically
superimposed on the projection of the apex of the tooth root and also taken for a
cyst. The diagnosis is clarified after repeated radiographs with a slightly altered
projection. In the absence of peri-root granulomas or cysts, the periodontal gap of
the projected teeth on the X-ray photograph is unchanged, and the teeth are intact.
38
In fundamental guidelines on dentistry and in the periodical literature, there is no

information about pathomorphological changes in the gums in this disease. It was
revealed that in patients with chronic periodontitis, the duration of which is
measured from 1 month to 1 year, microscopic examination in the surface layers of
the multilayered squamous epithelium of the gums showed focal oxyphilia and
picrinophilia of cells. This indicates the beginning dystrophic changes in the
epithelium. In some areas of the mucous membrane, epithelial cells with symptoms
of vacuolar dystrophy are found. Vacuolated cells for the most part do not contain
nuclei, are enlarged, deformed, merge in places with each other, forming sections of
the mucous membrane with hydropic transformation of the epithelium. There are
surface defects of the epithelium - erosion (Fig. 5.1.6), made by necrotic detritus or
fibrous exudate with colonies of microbes. Erosions are delimited by dystrophic
altered epithelium (vacuolated or stained oxyphilically) or epithelium with pyknotic
nuclei, and in some places completely necrotic.
In patients with chronic periodontitis lasting more than 1 year, microscopic

examination determines the same changes as in patients of the previous group. These
changes are complemented by defects in the mucous membrane in the form of ulcers,
the bottom of which is granulation tissue, and the lateral surfaces are delimited by
the altered epithelium.
Around the ulcers, the so-called inflammatory growths of the epithelium were
observed, which are the result of pathological regeneration. Against the background
of inflammatory lymphohistiocytic infiltration and proliferation of granulation
tissue, the epithelial cords grew rather deeply into the subepithelial tissues of the
gums. Fresh ulcers were filled with necrotic detritus or fibrinous exudate with
microbial colonies. Near the ulcers in the thickness of the epithelial cover,
microcysts can be found (Fig. 5.1.8), often multi-chambered. Discomplexation of
the epithelium was noted under them, and subepithelial growth of granulation tissue,
on the sides they were delimited by compacted stratified epithelium. We believe that
morphogenetically, cysts arise from the fusion of dead vacuolated epithelial cells.
39
Chronic periodontitis, both granulating and granulomatous, periodically worsens,

and granulating much more often. Clinical signs of exacerbation of both forms are
quite the same. Initially, there is pain in the area of the tooth, aggravated by biting.
Quite quickly, the intensity of pain increases, it radiates along the branches of the
trigeminal nerve. In the future, the pain can spread to the temporal region, ear, eye,
back of the head. Even a light touch to the tooth intensifies it, and chewing food
becomes impossible. If the molars of the lower jaw are affected, it becomes difficult
to open the mouth. Further spread of the inflammatory process causes contracture of
the lower jaw. Often in these cases, there is pain when swallowing. Already on the
1st day of exacerbation, patients have an increase in body temperature, weakness
occurs, sleep is disturbed, some of them get chills. On the 2nd day, the swelling of
the soft tissues around the pathological focus is expressed quite clearly, the regional
lymph nodes are enlarged and painful.
When examining the oral cavity, hyperemia and edema of the mucous membrane of
the alveolar process in the area of the diseased tooth are noticeable. Its coronal part
is partially or completely destroyed, positive percussion is observed. In one third of
patients, we observed positive percussion of the adjacent tooth. Tooth mobility, as a
rule, was absent, only in 20% of patients it was clearly expressed. X-ray
examination, in the exacerbation stage, did not reveal any differences in comparison
with the "cold period".
Laboratory blood counts changed. The number of leukocytes increased to 8-11 * 109
/ l. In the blood formula, an increase in the number of neutrophilic granulocytes
(neutrophilia) was observed due to segmented (70-72%) and stab (8-10%)
leukocytes. In these patients, we have repeatedly noted an increase in ESR up to 12-
16 mm / h, and in 15% - more than 20 mm / h. We failed to reveal a significant
increase in microbial sensitization of the body in patients with chronic periodontitis.
Parameters of phagocytic activity of peripheral blood leukocytes were within the
normal range. In patients with concomitant diseases (diabetes mellitus,
thyrotoxicosis, malignant tumors, etc.), phagocytosis indicators were reduced.
40
As a result of microscopic examination, carried out during an exacerbation of the

serous stage of periodontitis, edema and hyperemia of the periodontium, expansion
of its vessels, and their plethora were revealed. In some areas, it was impregnated
with serous exudate. With the progression of serous inflammation, the process
passed into a purulent stage. When examining the extracted tooth in a thickened and
full-blooded periodontium, yellow foci were found - abscesses. In the case of
purulent fusion of the periodontium, only some of its fragments remained on the
surface of the tooth root, and the main part of the root was covered with purulent
exudate. Microscopic examination in the thickness of the periodontium against the
background of pronounced hyperemia revealed focal or diffuse leukocytic
infiltrates, single or multiple microabscesses. Acute inflammatory process in the
periodontium was accompanied by changes in bone tissue. According to the research
of V.V. Panikarovsky (1982), at this stage of the development of the disease,
moderate resorption of the bone wall of the dental alveoli and cement of the tooth
root is observed.
AP Grokholsky (1994) proposes to divide all the errors of conservative treatment of
periodontitis and associated complications into the following groups: perforation of
the bottom of the tooth cavity or the walls of the root canal: formation of a ledge in
the root canal, preventing its correct filling; breaking off the instrument in the root
canal; development of emphysema; periodontal irritation with potent drugs;
incomplete filling of the canal; aggravation of the removal of filling material; deep
removal of the pin; statement on the radiograph of the wrong diagnosis; violation of
the correct implementation of treatment methods for periodontitis.
E. Kaufman et. al. (1984) described the occurrence of subcutaneous emphysema in
patients in the maxillofacial region after mechanical treatment of the canal with wall
perforation, treatment of the tooth canal with hydrogen peroxide.
A frequent complication of the conservative treatment of periodontitis of the lower
premolars and molars is the penetration of the filling material into the mandibular
canal. This complication leads to the development of post-traumatic neuritis of the
mandibular nerve. The diagnosis is confirmed by x-ray or computed tomography.
The prognosis is unfavorable, because physiotherapy and anti-inflammatory
treatments, most often, do not give a positive effect. Removal of a foreign body
(filling mass) is not always a fairly simple surgical intervention. It should be
performed only when it leads to recurrence of inflammation, persistent pain,
progression of neuritis symptoms.
It is possible to push the filling material under the mucous membrane of the
maxillary sinus or under the periosteum of the alveolar process of the upper and
lower jaw. The penetration of the filling mass under the mucous membrane or
through it into the maxillary sinus can lead to the development of sinusitis, and under
the periosteum - to the occurrence of an abscess.
41
According to A.P. Grokholsky (1994), long-term results are the main criterion in
assessing the methods of conservative treatment of periodontitis. (In terms of 3 to 6
years), obtained on the basis of clinical and radiological studies. 3 months after high-
quality filling of the root canals, partial restoration of bone tissue in the peri-apical
region is observed, after 6 months - significant restoration of bone tissue, and after
12 months - its complete restoration. Long-term results of treatment in terms of 3 to
7 years indicate the presence of favorable treatment outcomes in 80-90% of cases.
Features of the course of periodontitis in children, according to N.M. Chuprynina
(1985), the following:
• in milk and unformed permanent teeth, periodontitis often occurs with a closed
tooth cavity and with a shallow carious cavity;
• in milk teeth, the granulating form of chronic periodontitis prevails, while
pathological resorption of the roots of these teeth is often observed;
• the granulating form of periodontitis in young children is accompanied by the
formation of a fistula on the gums more often than in adolescents and adults;
• quite often, with all forms of periodontitis, bone rarefaction is observed in the area
of root bifurcation, which is more significant than the apex of the roots;
• necrosis of the pulp and death of the growth zone in chronic periodontitis of
unformed teeth lead to the cessation of root formation;
• the granulating process at the root of the milk tooth, spreading to the follicle of the
corresponding permanent tooth, can disrupt its development;
• in multi-rooted teeth, different roots may have different forms of chronic
inflammation;
• granulating form more often than in adults, it can be accompanied by chronic
lymphadenitis, and sometimes periosteal reaction.
In the elderly, the clinical course of each form of periodontitis has its own
characteristics, which must be taken into account when diagnosing the disease and
choosing a treatment method. First of all, acute periodontitis is very rare in the
elderly. We observed acute periodontitis in young people due to trauma of a very
diverse nature (household, sports, etc.), while in elderly people, the so-called
traumatic periodontitis is, as a rule, a chronic form. In other words, traumatic chronic
periodontitis is characterized by a chronic course from the very beginning of its
onset. This feature of the course of periodontitis in old people is explained by the
fact that it occurs due to the action of a constant traumatic factor, and not, as in young
people, a one-time trauma.
42
Acute forms of odontogenic periodontitis in old people are practically not observed,
although an exacerbation resembling a picture of acute periodontitis is a fairly
frequent phenomenon. And if chronic periodontitis can be asymptomatic for years
in people of all age groups, then in the stage of exacerbation, its course has some
difference, depending on the age of the patients. So, in old people, the exacerbation
of chronic periodontitis is less pronounced. This also applies to the pain reaction,
and edema of the surrounding soft tissues, and the general condition of the body.
Much less frequently than in young people, regional lymphadenitis and
adenophlegmon occur. Usually, even with the rapid course of periodontitis, only the
formation of a subperiosteal abscess occurs along the transitional fold near the
causative tooth. After opening the abscess (independently or with the help of a
doctor), fistulas often remain with purulent discharge. Fistulas occur, as a rule, from
the vestibular side of the alveolar process in the projection of the tooth root. Only
with a disease of the lateral incisors, first premolars and molars of the upper jaw,
sometimes fistulas can occur in the palate. The localization of the fistula does not
depend on age, but in older people with reduced regenerative capabilities of the
body, long-standing fistulas rarely close. They can exist for years, and therefore the
exacerbation of periodontitis may not occur for a number of years. With a long-term
illness, pus can flow through the periodontal fissure, in these cases, the fistula is
found in the periodontal pocket. The indicated localization of fistulas, the absence
of lush granulations in the circumference of their mouths, scanty purulent discharge
from them, long-term functioning without a tendency to close the fistulous tract is
characteristic of periodontitis,
Some features of the radiographic image in the elderly should be noted. So, with
fibrous periodontitis on the roentgenogram, the periodontal gap may not be widened,
but narrowed to the limit or may not be detected at all. Sometimes the root of the
tooth on the roentgenogram looks thickened, as with hypercementosis. In
granulomatous periodontitis, the bone tissue at the edges of the granuloma more
intensively than in the neighboring areas, delays X-rays and therefore looks
sclerosed on the X-ray. Moreover, the areas of the bone facing the granuloma and
constituting its outer border have clear, even edges. And the outer sections of the
sclerosed bone sections have uneven, fuzzy edges. Similar changes in the bone in
the circumference of the focus can be observed on the roentgenogram and with
granulating periodontitis.
43
TREATMENT. When periodontitis is complicated by serous periostitis, manifested

in soft tissue edema, some authors recommend dissecting the mucous membrane and
periosteum along the transitional fold at the causal tooth to relieve the tension of the
inflamed tissues and create an outflow of serous exudate (E.V. Borovsky et al., 1973;
Ya. M. Biberman, 1985). I think that it is not advisable to carry out such cuts.
Clinical observations show that in most patients, the inflammatory phenomena
subside if it is possible to create an outflow. In cases where it is not possible to drain
the abscess through the root canal due to its obstruction, it is necessary to resort to
tooth extraction.
In the literature, there are several opinions about the attitude to antibacterial
treatment of patients with exacerbated chronic periodontitis. So, according to Yu.I.
Vernadsky (1970), A.I. Evdokimova (1972), N.A. Gruzdeva (1978), V.P.
Pochivilina (1984), when this disease occurs, antibiotics should be used. A.G.
Shargorodsky (1976, 1985), V.A. Dunaevsky (1979), GA. Vasiliev, T.G. Robustova
(1981), Ya.M. Biberman (1985) believe that in the treatment of patients with
exacerbated chronic periodontitis, antibacterial drugs can be omitted.
Due to the lack of a unified view of this issue, we began to study it. The patients
were divided into 2 groups depending on the medication being carried out. Patients
of the 1st group were prescribed antibiotics, in the 2nd they were not used. The
results of the examination of patients in both groups showed that on the third day of
surgical treatment, the clinical symptoms of the disease subside and the laboratory
parameters normalize in all patients, regardless of the ongoing drug therapy (AA
Timofeev, 1982). Consequently, the removal of the causative tooth in patients with
exacerbated chronic periodontitis is a fairly effective therapeutic measure.
Antibacterial drugs should be prescribed only to patients with concomitant diseases
and weakened persons with severe symptoms of intoxication, if there is any doubt
about the favorable outcome of the disease. On an outpatient basis, it is advisable to
use antibiotics such as ampicillin, oxacillin 0.5 g 4 times a day. It is recommended
to prescribe a therapy that includes the use of pain relievers: amidopyrine, analgin,
phenacitin 0.25-0.5 g 2-3 times a day, symptomatic treatment.
To stop the inflammatory process, it is advisable to prescribe warm (40-42 ° C) baths
with a solution of potassium permanganate 1: 3000 or 1-2% sodium bicarbonate
solution, a decoction of medicinal herbs (10-15 minutes 6-8 times a day). It is
necessary to act with an UHF electric field in an athermal dose, apply microwave
therapy, fluctuating, ultrasound. With severe pain syndrome, it is necessary to
prescribe darsonvalization, diadynamic therapy, sinusoidal modulated currents.
The methods of treating chronic periodontitis in the "cold period" are very diverse.
Conservative treatment is quite fully developed and widely covered in numerous
literary sources. Surgical treatment of this disease can be divided into the following
types: tooth extraction, root apex resection, tooth replantation, hemisection and
amputation of the roots of premolars and molars, coronary-radicular separation.
44
Root apex resection, apicoectomy, or, rather, granulemectomy (this operation can be
performed while preserving the root apex), aims to eliminate a chronic pathological
focus in the bone, while preserving the tooth.
More often, the operation is performed on single-rooted teeth of the upper and lower
jaws, less often on small and large molars. This is explained, on the one hand, by the
cosmetic value of the anterior teeth, and, on the other hand, by the convenience of
performing this operation and the possibility of thorough filling of the root canals.
Malmstrom M. et. al. (1982) tested the effectiveness of retrograde (before surgery)
and direct (before surgery) filling of teeth canals in 154 patients. It was noted that
the restoration of bone tissue in the area of operation occurs faster after direct filling
of root canals during tooth resection. My observations fully confirm the authors'
research on the inexpediency of retrograde filling.
B.D. Kabakov, A.S. Ivanov (1978) indicate a high (91.6%) positive effect of the
resection of the apex of the roots of small and large molars. We have not seen such
success in our practice. However, in some cases, we have observed a positive effect.
Failures after root apex resection are most often caused not by errors in the technique
of the operation, but by errors in determining the indications and contraindications
to the mentioned surgery. The indications for the operation are: fracture of the upper
third of the root; curvature of the root apex, which interferes with the administration
of apical therapy; fracture of the instrument in the root canal; lack of success from
apothecary therapy; excessive introduction of filling material and its spread under
the periosteum; subperiosteal granulomas; peri-root cysts, in the cavity of which the
tops of the roots of the teeth are located.
Contraindications to the operation are: periodontitis, acute and exacerbated chronic
periodontitis, tooth mobility; exposure of the anatomical neck of the tooth;
involvement in the pathological process of more than one third of the apex of the
tooth with cysts; apicolateral and lateral granulomas; discoloration of the tooth root;
the absence of a part of the anterior wall of the alveoli; old age of the patient.
45
Operation method: under local anesthesia, a trapezoidal or semi-oval incision of the

mucous membrane and periosteum to the bone is made. The base of the incision
faces the transitional fold. The size of the flap at the edges should exceed the "bone
window", which will be formed when removing the granuloma or cyst by 0.5-1.0
cm. The flap is exfoliated with a raspatory from the alveolar edge to the transitional
fold. If during the detachment of the flap, a "bone window" is found, then it is
expanded with bone clippers to the peripheral borders of the pathological focus so
that a "funnel-shaped" cavity is formed. If there is no "bone window", then it is
formed with the help of a chisel and a hammer in the projection of the pathological
focus. The granuloma (cyst) is removed with a smoothing iron or a bone spoon and
the root apex of the causative tooth is freed. A fissure bur is used to remove (resect)
the apex of the root and the cyst membrane located behind it or the remnants of the
granuloma. We do not use retrograde root filling, because Amalgam residues enter
the cavity, forming fistulas, and also onto the blood clot, delaying (inhibiting) the
healing of the bone wound. The causal tooth should be filled (up to its apex) before
surgery. The quality of the filling must be checked with an X-ray before the
operation. In case of poor-quality filling of the root of the tooth, it is impossible to
operate on the patient, because a relapse is possible. If there is a fistula on the gum,
then it should be excised and the wound sutured. The mucoperiosteal flap is placed
in place. If necessary, it is mobilized by dissecting the periosteum with a horizontal
incision. The flap is sutured with catgut. Care should be taken when resecting the
root apex,
Tooth replantation is understood as the transplantation of an extracted tooth into its
own alveolus. Dental replantation is indicated in case of unsuccessful conservative
treatment of chronic periodontitis. Contraindications to this type of surgical
treatment are the same as to resection of the root apex. But during replantation, they
are specified immediately after the extraction of the tooth from the hole. In addition
to the previously listed contraindications, the absence of non-mineralized cement on
the tooth root and the appearance on it of round or oval, yellow areas, devoid of soft
tissue pink cover, as well as diseases that inhibit the processes of bone tissue
regeneration, should be added. Replantation of a tooth is carried out when it is
dislocated.
46
The essence of this operation is that after tooth extraction with minimal trauma, it is
immersed in a warm (37 ° C) isotonic sodium chloride solution with the addition of
antibiotics. The replantable tooth cannot be stored in formalin and alcohol. The well
is cleaned of granulations, washed with a solution of antibiotics. Under aseptic
conditions, mechanical cleaning of the root canals and carious cavity of the tooth is
performed, they are sealed with phosphate cement or fast-hardening plastic. Then
the apex of the root is resected, the root stump is expanded and deepened with a
boron within the cement border and filled with amalgam or plastic, after which it is
inserted into the hole. Single-rooted teeth are fixed for two weeks with a quick-
hardening plastic or metal splint. Multi-rooted teeth may not need to be fixed. For
the entire period of immobilization of the tooth, strict hygienic care for the oral
cavity and a gentle diet are prescribed. Even with an impeccable operation technique,
the roots of the replanted tooth, on average, dissolve after 8-10 years, the tooth
becomes mobile and has to be removed. Even so, this interference is justified. The
most significant periods of replantable teeth are observed during the transplantation
of an accidentally dislocated or accidentally removed healthy tooth (according to our
data, more than 10 years).
There are 3 types of fusion of the transplanted tooth with the alveoli: periodontal -
occurs when the periosteum of the alveoli and the remnants of the periodontium on
the roots of the tooth are completely preserved; periodontal fibrous - with partial
preservation of the periosteum of the alveoli and the remnants of the periodontium
at the root of the tooth; osteoid - with complete removal of the periosteum of the
alveoli and the periodontium of the tooth root. The prognosis of the viability of the
replanted tooth is the most favorable for periodontal disease and the least for the
osteoid type of engraftment. The replanted tooth, according to our observations, can
function for 10 years or more.
BC Moroz (1969) proposed to transplant a tooth from a corpse to a patient -
orthotopic allotransplantation. However, due to the complexity of material
collection, the operation was not used in clinical practice.
The surgical methods used for the treatment of chronic periodontitis include
hemisection, root amputation, coronary-radicular separation.
Hemisection means the removal of the root together with the adjacent coronal part
of the tooth. Amputation means removing the entire root while preserving the crown
of the tooth.
47
The indications for these surgical interventions are: the presence of bone pockets in
the area of one of the roots of the premolar or molar; cervical caries of one of the
roots; fracture of the tooth root, vertical split of the tooth; the presence of inter-root
granulomas, rarefaction of the apex of the interalveolar septum after perforation of
the bottom of the pulp chamber during tooth treatment; cases when a tooth is used
as a support (under a bridge) and when an X-ray image shows a significant bone loss
at one of its roots, as well as the impossibility of performing a root apex resection.
Carrying out amputation of the tooth root can hardly be considered advisable, since
food accumulates under the remaining part of it, which causes chronic inflammation
of the soft tissues.
Contraindications for hemisection and root amputation include: a significant defect
in the bone tissue of the hole; the case when the tooth does not represent functional
and cosmetic value; the presence of accrete roots, as well as acute inflammation of
the oral mucosa and impassable root canals of the teeth to be preserved.
Hemisection and amputation of the tooth root is carried out in two ways - with
exfoliation of the muco-periosteal flap and without its exfoliation. The technique for
carrying out these surgical interventions is simple and described in sufficient detail
in the literature. Therefore, we do not consider it necessary to dwell on its
presentation. It should only be recalled that after these operations, with the existing
mobility of the remaining fragment, it is necessary to splinter it with orthodontic
splints or splints made of composite materials. Literature data (V.P. Poltavsky, 1976;
V.P. Pochivalin, 1984, and others) indicate a high efficiency (in 90-100% of
patients) of such surgical interventions in the treatment of patients with chronic
periodontitis.
Under coronary-radicular separation, it is necessary to understand the dissection of
the tooth into two parts (used in the treatment of molars of the lower jaw) in the
bifurcation area, followed by careful smoothing of the overhanging edges, curettage
of the inter-root pathological pocket and covering each of the root segments with a
crown.
The indications for the operation are: the presence of small inter-root granulomas,
perforation of the bottom of the pulp chamber with rarefaction of the apex of the
inter-root septum. The operation is contraindicated in pathological processes in the
area of the interroot septum, the elimination of which can lead to exposure of more
than 1/3 of the length of the roots.
After performing the surgical intervention, a protective bandage is applied to the
area of the formed pathological pocket and the tooth fragments are fixed with a
splint, strengthening it by the adjacent teeth.
48
In cases where the above methods of surgical treatment do not give a positive effect,
they resort to tooth extraction surgery.
Surgical treatment of periodontitis in elderly people includes one type of surgery -
tooth extraction. Replantation of the tooth and resection of the apex of its root in the
elderly are inapplicable and even contraindicated.
I would like to briefly dwell on the operation, which is not directly related to chronic
periodontitis, but is performed on the alveolar process of the jaw and associated with
the previously described.
Compactosteotomy is an operation aimed at reducing the resistance of the compact
bone substance before the upcoming movement of an abnormally located individual
tooth or a group of teeth.
The indication is deformation of the dentition, in which orthodontic treatment is
ineffective: implantation of teeth, their rotations and movements. A contraindication
is considered to be diseases that inhibit the regeneration processes (rickets,
osteodysplasia, diabetes mellitus, etc.).
Preparation for the operation consists in sanitation of the oral cavity. The technique
of intervention is as follows: cutting out a muco-periosteal (trapezoidal flap;
perforation of the compact layer of the jaw in the form of a "comb", the teeth of
which enter between the moved teeth (interalveolar osteotomy), and the base is
located above this group of teeth (performed with the vestibular and palatine or
lingual sides); wound suturing; fixation and instrumental movement of teeth.
Tooth autotransplantation - transplanting it into another alveolus, is rarely used.
When a dystopic tooth is introduced into the edentulous areas of the alveolar process,
it is necessary to create a hole for the tooth to be moved with the help of a bur, and
after the transplantation of the latter, fix it with a splint, which is held for at least two
weeks. When performing compactosteotomy or autologous transplantation, care
must be taken to avoid opening the floor of the maxillary sinus or nasal cavity. When
moving or osteotomy over the tops of the teeth, the pulp should be removed,
followed by filling of the root canals according to generally accepted methods.
Topic 4. Introduction to Prosthetic Dentistry

To master the general provisions and tasks of orthopedic dentistry, the main
nosological forms of diseases found in orthopedic dentistry.
49

● a brief history of the development of prosthetic dentistry
● main forms of diseases
● pathogenesis
● defect classification
● clinic
● pathological abrasion
- Problem lecture.
4. Literature:
1. Orthopedic dentistry, Abolmasov N.G., Abolmasov N.N.

2. Therapeutic dentistry Borovsky
3. Orthopedic dentistry Lebedenko, Artyusov
4. Orthopedic dentistry Trezubov, Shcherbakov
The term "orthopedics" was proposed in 1741 by N. Andry (Andry, 1658-1742),

who first named the specialty that deals with the study, prevention and treatment of
persistent deformities of the human body. This term, which successfully defines the
essence and scope of the activity of this discipline, is composed of the Greek words:
"orthos" (direct, correct, fair) and "paideuo" (to educate, educate, train, grow).
The tasks of orthopedics first included the prevention and elimination of skeletal
curvatures. For a long time, the attention of patients and doctors was attracted by
deformities of the limbs and spine, which were associated not only with a decrease
in working capacity, but also with a change in the psyche of patients.
The founder of scientific orthopedics, the Frenchman N. Andri, in 1741 published
the work "L'orthopedie", that is, "Orthopedics, or the art of preventing and correcting
deformities of the body in children."
Prophylaxis and treatment in orthopedics has developed in three directions:
functional, prosthetic and operative. Orthopedic practice has shown that lasting
results are provided by the mutual influence of form and function (combined,
functional and surgical treatment). Orthopedics has become an independent
scientific discipline as a result of the development of special methods, both in
research and diagnosis, and in treatment. Bloodless and surgical methods have been
50
developed for treatment in orthopedics. Their purpose is to restore normal form,

statics and function.
In the field of the dental system and the maxillofacial skeleton, the same tasks are
faced by orthopedic dentistry. Thus, the latter is an independent part of general
orthopedics and a section of general dentistry.
Orthopedic dentistry, having emerged on the basis of dental prosthetics, has passed
a long and difficult path of development. At the same time, not only the methods of
prosthetics were improved and the area of their application expanded, but also there
was a struggle with narrow practicality. Initially, the tasks of dental prosthetics were
to replace existing defects in the dentition. The process of the formation of defects
and deformations of the dentoalveolar system essentially dropped out of the doctor's
field of vision. Only over time, a preventive direction emerged, which is
characteristic of orthopedic dentistry of our time.
Proceeding from preventive tasks, orthopedic dentistry is currently actively studying
the causes of anomalies, defects, deformations and dysfunctions of the organs of the
dentition.
Since the reasons that caused a particular disease are not always known, it is
important to start studying the pathology at its early stages and apply treatment as
soon as possible aimed at stopping the disease. This method of studying various
diseases of the dentoalveolar system prevents the appearance of severe, neglected
deformities.
The brilliant work of Russian scientists (I.M.Sechenov, S.P. Botkin, I.P. Pavlov,
K.A. Bykov) influenced not only general medicine, but also orthopedic dentistry.
This helped to abandon the localistic concepts that once dominated dental
prosthetics. Currently, orthopedic dentists consider the body in its unity, and the
processes occurring in the oral cavity are explained by the influence of factors of
both external and internal environment.
The maxillofacial apparatus is an extremely complex system that is daily disturbed
throughout a person's life by a number of local and general disease processes. Often,
she is also exposed to gross injuries in the domestic and military environment. All
these changes and damage to the morphological structure of the masticatory
apparatus entail disturbances in its complex functional functions.
Prosthetic dentistry is based on achievements:
51
● fundamental sciences, in particular physics and chemistry, and disciplines

such as materials science, strength of materials, metallurgy, macromolecular
chemistry, technology of metals, plastics, ceramics. Knowledge of the theory of
cutting, casting, stamping, broaching and forging is essential;
● general medical sciences: development of the theory of diagnosis, physiology
and pathological physiology of the body, clinical manifestations of diseases and an
integrated approach to the treatment of the body with the simultaneous development
of preventive measures;
● biology with a constantly developing section "Man and Environment";
● pharmacology and its section "Pharmacokinetics";
● section of medical science - orthopedics - with its foundations in the treatment
of diseases of the musculoskeletal system of the human body.
Thus, in the modern view, orthopedic dentistry is a field of clinical medicine that
studies the etiology and pathogenesis of diseases, anomalies, deformations and
injuries of teeth, jaws and other organs of the oral cavity and maxillofacial region,
and develops methods for their diagnosis, treatment and prevention.
It consists of general and private courses.
The general course is propaedeutic, that is, preparatory. The private course consists
of three main sections: Dental Prosthetics, Orthodontics and Oral and Maxillofacial
Orthopedics.
The propedeutic course of prosthetic dentistry includes a brief anatomical and
physiological outline of the masticatory apparatus, issues of biomechanics,
occlusion and articulation, general and special methods of patient examination
(diagnosis), assessment of the signs of the disease obtained during this
(symptomatology or semiotics), clinical materials science, as well as laboratory
techniques ( the method of manufacturing prostheses and various orthopedic
devices).
Dental prosthetics is engaged in diagnostics, clinical practice, prevention and
elimination of defects in teeth and dentition resulting from any pathology.
Throughout a person's life, there is a loss of enamel and dentine as a result of their
abrasion. This natural process begins as soon as the teeth erupt and begin to perform
their function. Its severity depends on the type of teeth closing, the hardness of the
enamel and dentin, the magnitude of the chewing pressure and the properties of the
food consumed.
52
Natural erasure of enamel occurs in two planes - horizontal and vertical. Abrasion
in the horizontal plane is observed along the incisor edge of the incisors, tubercles
of the canines, premolars and molars. The associated decrease in the height of the
crowns of the teeth should be considered as an adaptive response of the body. The
fact is that the vascular system and other tissues of the periodontium and
temporomandibular joint change with age. However, the decrease in the
functionality of these organs is compensated by a decrease in the size of the external
lever of the tooth and the flat shape of the occlusal surface.
Vertical abrasion is in particular understood as the abrasion of the contact surfaces

of the tooth, as a result of which the interdental contact points turn over time into
contact pads. The disappearance of interdental contacts does not occur due to the
medial displacement of the teeth. At the same time, the dental arch remains
continuous, but the length of its contact surfaces of the tooth, as a result of which
the interdental contact points turn over time into contact pads. The disappearance of
interdental contacts occurs due to the medial displacement of the teeth. At the same
time, the dental arch remains continuous, but its length decreases. The
transformation of contact points into contact pads should be regarded as an adaptive
phenomenon. It is known that with age-related atrophy of the alveolar process, there
is a subsidence (retraction) of the gums and interdental papilla. This should lead to
the formation of triangular spaces between the teeth. However, their occurrence is
prevented by the appearance of the contact area and the medial shift of the teeth.
In some people, natural functional abrasion is slowed down or absent. This could be
explained by the use of soft food, a deep bite that impedes the lateral movement of
the lower jaw, weakness of the chewing muscles. However, there are patients who
have a normal bite and they eat a wide variety of food, and the abrasion is so poorly
expressed that at the age of 40, the tubercles of the molars and premolars remain
almost unchanged. The reasons for this are unknown, but it is believed that this
phenomenon is associated with tooth mobility caused by congenital or acquired
functional periodontal deficiency. Often these patients suffer from periodontitis.
In addition to natural, there is also an increased abrasion of enamel and dentin. It is

characterized by a rapid flow and significant loss of enamel and dentin. Increased
abrasion of teeth occurs in 4% of people aged 25 to 30 years and in 35% to 40 to 50
years.
Increased abrasion violates the anatomical shape of the teeth: the tubercles
disappear, the cutting edges of the incisors, the height of the crowns decreases. With
53
a direct bite, the cutting edges and chewing surface of all teeth are erased, with a
deep bite - the labial surfaces of the lower and palatal - the upper apron of the teeth.
Increased abrasion, having arisen once, steadily grows, it deepens in places where
dentin is exposed, and lingers somewhat where enamel is preserved. As a result, the
erasure facets have the appearance of smoothly polished cups or crater-shaped
recesses, the edges of which are bounded by sharp enamel projections. Formation:
crater-like facets due to unequal hardness of enamel and dentin. The latter is softer
and therefore wears off faster.
Etiology.
Increased abrasion of teeth is polyetiological. The causes of the pathological process

are:
I. Functional insufficiency of dental hard tissues due to their morphological

inferiority:
1) hereditary (Stenson-Capdepon syndrome);
2) congenital (a consequence of impaired amelo- and dentinogenesis in diseases of

the mother and child);
3) acquired (a consequence of neurodystrophic processes, disorders of the function

of the circulatory system and the endocrine apparatus, metabolic disorders of various
etiologies.
Functional overload of teeth with acquired as a result of neurodystrophic processes,

disorders of the function of the circulatory system and the endocrine apparatus,
metabolic disorders of various etiologies).
II. Functional overload of teeth with:
1) partial loss of teeth (decrease in the number of antagonizing pairs of teeth, mixed
function, etc.);
2) parafunction (bruxism, food-free chewing, etc.);
3) hypertonicity of the masticatory muscles of central origin and associated with the
profession (vibration, physical stress);
4) chronic dental trauma (including bad habits).
54
III. Occupational hazards acid and alkaline necrosis, dustiness, hydrochloric acid
intake for achilia.
Some of the reasons listed can cause generalized abrasion, and some - only local
damage. For example, with congenital insufficiency of enamel and dentin, a
generalized form of increased abrasion should be expected, while with functional
overload, only the teeth that maintain the interalveolar height are involved in the
process.
Pathogenesis.
With pathological abrasion of the hard tissues of the teeth, various morphological
and functional disorders in the dentoalveolar system are observed: hyperesthesia of
hard tissues of the teeth, deformation of the dentition, shortening of the interalveolar
distance and the lower third of the face, the function of the masticatory muscles, pain
dysfunction of the temporomandibular joints. Dysfunction of the masticatory
muscles is manifested by pain during their contraction. Their bioelectric activity
increases, and it is also noted in the phase of physiological rest, asynchronous
contractions appear, regional blood circulation in the periodontium is disrupted.
These symptoms are observed mainly with a pronounced pathological abrasion of

the hard tissues of the teeth and only with a decompensated form, when there is a
shortening of the lower third of the face. In patients with a compensated form of
abrasion, accompanied by hypertrophy of the alveolar process of the jaws, there are
no such disorders. With vertical deformities of the dentition, a decrease in the
interalveolar distance and bruxism, dysfunctions of the masticatory muscles and the
temporomandibular joint are observed much more often and are more pronounced.
This is due to the blockage of sagittal and transverse movements of the lower jaw.
Our data indicate that three factors play an important role in the pathogenesis of
dysfunctions of the masticatory muscles and temporomandibular joints: a decrease
in the height of the bite and shortening of the lower third of the face, blocking of
movements of the lower jaw, its lateral and distal displacement.
In the pathogenesis of shortening the interalveolar distance, an important role is

played by: 1) pathological abrasion of hard tissues of teeth (generalized,
decompensated form),
2) extensive defects of the dentition in the lateral regions (areas of the premolars and
molars),
55
3) malocclusion (deep, prognathic),
4) a decrease in the tolerance of the tissues of the marginal periodontium (with

periodontitis, diseases of the central nervous and cardiovascular systems,
gastrointestinal tract, endocrine regulation disorders, collagenosachydr.), 5)
dysfunction of the masticatory muscles (primarily bruxism). Painful dysfunction of
the temporomandibular joint is not observed in all patients with pathological
abrasion of teeth and not in all its forms [20, 21, 23].
There is a close relationship between the presence of pathological abrasion of the

teeth and a decrease in the height of the bite, dysfunction of the masticatory muscles
and the temporomandibular joint. Dysfunction of the temporomandibular joint with
pathological abrasion of hard dental tissues is observed in 9.4% of cases.
Consequently, dysfunction of the masticatory muscles and pain dysfunction of the

temporomandibular joint are not present in all such patients. Considering this, we
distinguish two forms of this pathology: without impairment and with impaired
function of the masticatory muscles. The first one can be considered as
uncomplicated, the second - as complicated.
A clear relationship was also revealed between dysfunction of the masticatory

muscles and pain dysfunction of the temporomandibular joint in this pathology. In
the pathogenesis of dysfunction of this joint, an important role is played by a
decrease in the height of the bite and the lower third of the face, the presence of
premature contacts (supracontacts) and blocking of sagittal and transverse
movements of the lower jaw, lateral and distal displacement of the jaw, parafunction
of the masticatory muscles (bruxism). The interaction of these factors is individual
in each case. It was found that only a decrease in the height of the bite in combination
with a decrease in the lower third of the face does not always lead to painful
dysfunction of the temporomandibular joint. This testifies, on the one hand, to the
great compensatory capabilities of this joint, on the other, to the fact that
Stages of pathological abrasion of teeth:
I degree - abrasion of the enamel of the cutting edges of the incisors and canines and
the upper part of the masticatory tubercles of premolars and molars. Abrasion occurs
within the enamel of the teeth and partially dentin.
56
II degree - complete erasure of the masticatory tubercles with exposure of dentin

tissue. Abrasion occurs within the main dentin mass without the formation of a
cavity.
III degree - reduction as a result of erasure of the height of the crown of the tooth to
2/3 of the normal size. Erasure of tooth tissues occurs within the replacement dentin
with translucence of the tooth cavity.
IV degree - erasure to the level of the tooth neck. The entire crown of the tooth is
erased.
-Horizontal
-Vertical
-Faceted
-Patterned
-Stepped
-Cellular
-Mixed
Clinic.
Increased abrasion can be limited and spilled. Limited or localized increased

abrasion captures only individual teeth or groups of teeth, not spreading along the
entire arch. It is most often observed on the front teeth, but the process can also
spread to premolars and molars. In the generalized (diffuse) form, increased abrasion
is noted throughout the entire dental arch.
Depending on the compensatory-adaptive response of the dentition, three clinical

forms of increased abrasion of the hard tissues of the teeth should be distinguished:
uncompensated, compensated and subcompensated. These forms occur both with
generalized wear and tear, and with localized. Localized uncompensated increased
abrasion is characterized by a decrease in the height of the crowns of individual teeth
and the appearance of a gap between them (open bite). The interalveolar height and
the height of the face are preserved due to the unwashed teeth.
57
Localized compensated wear also causes a decrease in the height of the crowns of
individual teeth. At the same time, worn teeth retain contact with antagonists due to
hypertrophy of the alveolar part (vacate hypertrophy) in this zone, which leads to
dentoalveolar lengthening. The interalveolar height and face height remain
unchanged.
Generalized uncompensated increased abrasion of hard tissues of the teeth leads to

a decrease in the height of the crowns of the teeth, which is accompanied by a
decrease in the interalveolar height and the height of the face. The lower jaw
approaches the upper, possibly distal displacement.
Generalized compensated increased abrasion of hard tissues of teeth is manifested

by a decrease in the vertical dimensions of the crowns of all teeth, a decrease in
interalveolar height, and the height of the lower third of the face does not change.
The reduction in crowns is compensated by the growth of the alveolar process.
The facial skeleton in patients with this form of abrasion is characterized by:
1) a decrease in the vertical dimensions of all teeth;
2) the absence of changes in the position of the lower jaw and the preservation of
the vertical dimensions of the face;
3) deformation of the occlusal surface and a decrease in the depth of the incisal
overlap;
4) dentoalveolar lengthening in the area of all teeth;
5) a decrease in the interalveolar height;
6) shortening the length of the dental arches;
7) an increase in the length of the base of the lower jaw;
8) a decrease in the length of the roots of the anterior teeth and the first premolars.
The generalized subcompensated form of increased tooth wear is a consequence of

insufficiently pronounced dentoalveolar lengthening, which does not fully
compensate for the loss of hard dental tissues, which contributes to a moderate
decrease in the vertical dimensions of the lower third of the face and the approach
of the lower jaw to the upper one.
58
Increased abrasion can be combined with the loss of part of the teeth,
pathology of the masticatory muscles and temporomandibular joints. The clinical

picture becomes even more complex.
The treatment of patients with abnormal tooth wear presents significant difficulties.
This is due to the fact that the pathogenesis of the disease has not been finally
clarified. In this regard, conservative methods of pathogenetic therapy have not been
developed that would stop the process of erasing hard dental tissues. For the
treatment of pathological abrasion of teeth, two methods have been proposed -
medication and orthopedic. Drug treatment is aimed mainly at eliminating
hyperesthesia of hard tissues and is effective only in the initial stages of the
pathological process.
It involves rubbing in fluorinated pastes. Clinical observations show that such

treatment of hard tissue hyperesthesia is effective in many, but not all, patients. As
for the loss (erasure) of the hard tissues of the teeth, then with drug treatment it does
not stop, but continues to progress with varying intensity. Therefore, orthopedic is
the main method of treating tooth abrasion and its complications.
When planning orthopedic treatment, one should take into account the clinical type
of pathological tooth wear (horizontal, vertical, localized, generalized, compensated,
uncompensated), the depth of the lesion (I, II and III degree of wear), the presence
of complications (dysfunction of the chewing muscles and temporomandibular joint)
... The principles of planning and carrying out orthopedic treatment in the presence
of temporomandibular joint dysfunction and in its absence differ significantly.
Orthopedic treatment of pathological abrasion of teeth, not complicated by

dysfunction of the temporomandibular joint In the absence of signs of dysfunction
of the temporomandibular joint, orthopedic treatment is shorter and much easier than
in the presence of such a complication.
In case of pathological abrasion of hard tooth tissues of the 1st degree (up to 1/3 of
the crown length), treatment depends on the clinical type of abrasion, the patient's
age and the functional state of the masticatory muscles. In patients with generalized
abrasion of teeth without dysfunction of the masticatory muscles (uncomplicated
form), treatment consists in rational prosthetics with one-stage restoration of the bite
height without prior restructuring of the myotatic reflexes of the masticatory
muscles.
59
The main goals of prosthetics for pathological abrasion of hard dental tissues are:
1) restoration of aesthetic norms;
2) ensuring multiple uniform contact throughout the dentition;
3) restoration of the bite height;
4) prevention of recurrence of a declining bite;
5) prevention of functional periodontal overload;
6) maintaining the normal position of the lower jaw.
To achieve these goals, both fixed (crowns, bridges) and removable clasp prostheses
with occlusal overlays can be used. It is inappropriate to use stamped crowns and
brazed bridges, since crowns, especially gold crowns, are rubbed over the occlusal
surface, and bridges often break at adhesions.
Over time, the plastic wears out, which leads to a decrease in the interalveolar
distance with all its complications. Fixed dentures should be solid and made of
materials that are not subject to increased abrasion. These primarily include metal
and porcelain. You can also use high-strength plastic (isosit).
Porcelain-fused-to-metal prostheses (crowns and bridges) fulfill these requirements.

They restore aesthetic norms in the best way. In contrast to acrylic resin, porcelain
does not wear out, and therefore the restored bite height is maintained for a long
time. This in turn prevents distal displacement of the mandible.
However, when using metal-ceramic prostheses in patients with pathological

abrasion of the hard tissues of the teeth, more often than usual, there is a spalling of
the ceramic veneer and a functional traumatic overload of the periodontium of the
abutment teeth. To prevent these complications, we recommend using metal-ceramic
prostheses only in the area of anterior teeth and premolars, and for the area of molars,
if they are not visible when talking and smiling, it is better to make one-piece metal
crowns.
It should be borne in mind that in the area of the anterior teeth the occlusal load is
significantly less than in the area of the second premolars and molars, therefore, the
risk of porcelain spalling is less. In addition, in the manufacture of solid metal
crowns on molars, instead of metal-ceramic, much less hard tissues of abutment teeth
60
are ground, which in turn reduces the risk of pulp overheating and the occurrence of
traumatic pulpitis.
In the manufacture of bridges in the field of antagonists, it is necessary to use such

metal alloys that have sufficient hardness and can withstand increased occlusal
pressure for a long time. Forged gold alloy crowns are not recommended. The
sequence of prosthetics is also of some importance. It is advisable to first compensate
for defects in the dentition in the area of premolars and molars with one-piece
bridges or clasp prostheses with occlusal metal onlays, to stabilize the bite height,
and then to make metal-ceramic crowns or bridges in the area of the anterior teeth.
This significantly reduces the risk of chipping of the porcelain. To avoid functional
traumatic overload of the periodontium and the introduction of abutment teeth, it is
important to correctly draw up a plan of orthopedic treatment and choose a rational
design of prostheses. Of great importance for the prevention of recurrence of the
shortening of the interalveolar distance after the installation of prostheses are the
choice of their design and the sequence of prosthetics.
When choosing a design, it is necessary to take into account the size and topography
of dentition defects, as well as the condition of the tissues of the marginal
periodontium. In patients with intact periodontal disease or periodontitis of mild and
moderate severity in the presence of small (1-2 teeth) included defects in the
dentition, one-piece bridges can be used in the lateral sections. To achieve multiple
contact, single crowns can be additionally fabricated.
For mild to moderate periodontitis, the number of abutment teeth should be

increased. In severe periodontitis, bridges are contraindicated. In these cases, it is
advisable to use splinting clasp prostheses. In the presence of large (3 teeth or more)
included defects in the dentition, it is advisable to use clasp prostheses with occlusal
overlays. They are also shown for terminal defects of the dentition (class I and II
according to Kennedy).
Clasp prostheses transfer part of the occlusal load to the mucous membrane of the
alveolar process of the jaw. Thus, the periodontium of the abutment teeth is relieved
and their loosening and penetration into the alveolar process is prevented. The
gingivomuscular reflex, which was mentioned above, also helps to prevent the
functional overload of the periodontium, the introduction of abutment teeth and the
recurrence of the shortening of the interalveolar distance (declining bite) when using
clasp prostheses.
61
Topic 5. Preparation for different types of crowns

To master the main types of orthopedic structures, to study methods of preparation
for metal-ceramic and ceramic crowns
1. Know the tools needed to prepare teeth for artificial crowns.

2. Know the stages and principles of preparation of various groups of teeth for
artificial crowns.
3. Know the auxiliary materials required for fixed prosthetics (impression
materials, waxes, etc.).
4. To be able to prepare a tooth for various types of artificial crowns (stamped,
plastic, one-piece, one-piece with veneer).
5. To be able to restore the stump of the prepared tooth with wax.
6. Be able to wax the intermediate part of the bridge.

− classification of orthopedic structures
− indications and contraindications
− preparation technique for different types of crowns
− aesthetic aspects of structures
− functional features of crowns
- Problem lecture.
4. Basic and additional literature to the topic:
1. Shcherbakov A.S., Gavrilov E.N., Trezubov V.N., Zhulev E.N. Orthopedic

dentistry. St. Petersburg, IKF "Foliant", 1995.
2. Kopeikin V.N., Guide to Prosthetic Dentistry. M., "Medicine", 1993.
62
3. Zhulev E.N. Materials science in orthopedic dentistry. Nizhny Novgorod,

"NGMA", 2000.
4. Kopeikin V.N., Demner L.M.Dental technology. M., "Triad-X", 1998.
Many defects and lesions of hard tooth tissues cannot be restored (restored) with the
help of filling materials. To recreate the anatomical shape of the teeth and replace
the defects in the dentition, it is necessary to use fixed orthopedic structures. It
follows from this that knowledge of the basics of preparing teeth for artificial crowns
is necessary and relevant in modern conditions.
An artificial crown is a fixed prosthesis that restores the anatomical shape and
function of the tooth and prevents its further destruction.
In 1984, I. Yu. Milikevich proposed to use the index, which he called IROPZ (index
of destruction of the occlusal surface of the tooth), to select the method of restoration
of the crown part of the tooth. The entire area of the occlusal surface of the tooth is
taken as a unit. The fracture index (surface area of the cavity or filling) is calculated
from one (the entire occlusal surface). When the IROPZ is equal to 0.55-0.6 or more,
that is, when the surface is destroyed by more than 55%, the use of inlays is shown
in order to prevent further destruction. With an index of 0.6-0.8, the use of artificial
crowns is shown, when the index is greater than 0.8, the manufacture of pin
structures is shown.
Types of artificial crowns.
There are various classifications of artificial crowns:
1. Depending on the function being performed.
artificial crowns
restorative fixing
63
temporary permanent
2.
By design:
artificial crowns
full jacket equatorial cult crowns telescopic

with pin
3.
Depending on the material:
artificial crowns
metal non-metallic combined

(from noble and non- (plastic, porcelain) (metal lined with plastic,
noble alloys) porcelain and other
materials)
4.
Depending on the manufacturing method:
artificial crowns
64
stamped cast made by method

polymerization
Requirements for artificial crowns:
1. Should restore the anatomical shape of the tooth.

2. Should restore the volume of the natural tooth crown (height and width).
3. Ensure the correct relationship with adjacent teeth and antagonists, and
therefore the continuity of the dental arch and its functional unity.
4. The edge of the artificial crown should fit snugly around the neck of the tooth.
5. The edge of the crown should be immersed in the tooth gingival sulcus by ½
of its depth (up to a maximum of 0.2 mm).
6. An artificial crown should not overestimate the interalveolar height (there
should be no premature contacts).
7. An artificial crown must meet aesthetic requirements.
Odontopreparation for artificial crowns.
During the preparation of teeth, the doctor has the following tasks:
● create a tooth shape that would satisfy all the requirements for the chosen
design of artificial crowns, taking into account the removal of the minimum amount
of hard tissue;
● perform grinding without injuring adjacent teeth, marginal periodontium,
without destroying or injuring the pulp of the tooth.
● prepare in such a way that the patient experiences as little discomfort as
possible.
The volume of hard tooth tissues to be ground off depends on the wall thickness of
the chosen artificial crown:
● stamped crown (steel) - 0.2-0.22 mm.

● for a stamped crown (gold) - 0.22-0.25 mm
● for a solid metal crown - 0.3-0.5 mm
● for a combined metal-plastic and metal-ceramic crown - 1.3-1.5 mm.
For odontopreparation of teeth for artificial crowns, shaped heads of various shapes
and separation discs are used (Fig. 1, 2).
65
Rice. 1. Separation of teeth with a disc.
Rice. 2. Separation of teeth with a pike bur.
Scheme of the indicative basis of actions when preparing teeth for stamped crowns.
action components funds criteria

actions self-control
1 2 3
1. Clinical Probe, mirror, The degree of destruction of the

evaluation of the tweezers, X-ray. crown of the tooth, the presence
tooth. of fillings, the degree of severity
of the equator, the ratio with
antagonists and adjacent teeth,
assessment of the radiograph, the
state of the periodontal tissues,
periodontal tissue, the degree of
tooth mobility.
66
2. Preparation for Probe, mirror, dental Effectiveness of anesthesia,

separation. unit, mechanical reliable isolation of soft tissues
handpieces - straight from cutting tools. The separation
and contra-angle, disc is installed above the contact
turbine handpiece, point parallel to the long axis of
single-sided diamond- the tooth, the doctor's hand is
coated separation fixed on the jaw.
discs, fissure burs,
spike.
3. Separation. It is Also. The appearance of a visible gap

carried out at low between the teeth, the walls are
speeds, without smooth, parallel to each other,
strong pressure of polished to the neck of the tooth,
the cutting tool on there are no overhanging edges in
the tooth. the cervical region from the
contact sides.
4. Dissection of the The same, cylindrical Grinding of the edges of the tooth
oral, vestibular, heads, separation disc. in the places of transition of the
occlusal surfaces labial and oral surfaces into
and incisal edges, contact surfaces, the tooth
grinding the acquires a shape close to a
equator of the tooth. cylinder, the diameter of which
does not exceed the diameter of
the neck of the tooth, the
anatomical shape of the occlusal
surface and the incisal edge is
preserved, but reduced by the
thickness of the artificial crown.
67
5. Finishing of the Probe, mirror, turbine The stump of the tooth is

tooth stump. and mechanical smoothly ground, its diameter
handpieces, burs: does not exceed the diameter of
fissure, flame-shaped, the neck of the tooth, it resembles
pike-shaped with a cylinder in shape.
diamond coating.
For odontopreparation of teeth for solid metal and combined crowns, it is

recommended to form a ledge.
A ledge is a platform that bears a load and prevents the crown from sinking under
the gum and injuring the periodontal joint.
The choice of the ledge shape depends on the shape, size, inclination, topography of
the tooth and the state of the tissues of its coronal part. The shoulder width ranges
from 0.5 to 1 mm. An uneven shoulder width is allowed in cases where there is a
narrowing of the side surfaces and there are no favorable conditions for creating a
shoulder with a width of 1 mm. The ledge can be straight (Fig. 3, b), with a notch
(Fig. 3, c), with a beveled edge (Fig. 3, d), with a top (Fig. 3, e) or beveled (Fig. 3, f
).
Rice. 3. Variants of the formation of the gingival part of the tooth stump.
In the cervical region of the teeth of the anterior group and premolars at the level of
the gums, a width of 0.3-0.5 mm (up to 0.8 mm) is created.
It is not necessary to create a ledge (Fig. 3, a):
● on the second premolars, molars,

● in the presence of gum recession or a narrow tooth neck,
● on the contact and oral surfaces of the teeth.
68
Scheme of the indicative basis for the preparation of teeth for artificial crowns made
of plastic.
action components funds criteria

actions self-control
1 2 3
1.Separation. Probe, mirror, turbine The preparation and the adjacent

The hard tissues of handpieces, straight tooth are completely separated,
the tooth are ground and contra-angle the probe is used to check the
off by at least 1 mm mechanical presence of overhanging edges,
so that a shoulder handpieces, fissure, the walls are even, smooth. The
0.6-0.8 mm wide is peak and flame-shaped contact surfaces converge with
formed in the diamond heads, the formation of a barely
cervical region - in separation discs. pronounced cone (slope no more
the teeth of the than 3-5о).
frontal group, 0.5
mm - in the lower
premolars.
2. Preparation of the Mirror, turbine and On the occlusal surface, the

occlusal surface mechanical tubercles are preserved, the
(incisal edge) to a handpieces, burs, shape of the incisal edge is
thickness of 1.0-1.5- grinding wheels preserved, but decreases by the
2.0 mm. (diamond). thickness of the artificial crown
(1-1.5 mm).
3. Dissection of the Probe, mirror, tips, The walls are smooth, even,
vestibular and oral diamond heads there are no overhanging edges.
surfaces. Hard (cylindrical, conical, The ledge is at the level of the
fabrics are sanded to end, marking). gums or slightly below.
a thickness of up to 1
mm, a shoulder is
formed.
69
4. Final preparation. Probe, mirror, wax The stump of the tooth is

plate or carbon paper, smoothly ground, the transitions
tips, burs: end, from the vestibular surface to
cylindrical diamond the oral and sharp edges on the
heads. occlusal surface are rounded, the
stump of the tooth has the shape
of a barely expressed truncated
cone.
Scheme of the OOD "Preparation of teeth for solid metal and combined artificial
crowns."
action components means of action criteria

self-control
1 2 3
1. Separation. The Probe, mirror, dental The walls are smooth, even,
contact surfaces are handpieces, separation converging at an angle of 5-
prepared on a cone at discs, shaped diamond 7o. The ridge is created
an angle of no more heads. partially, follows the contours
than 5-7o. Grinding up of the gingival papilla.
to 1 mm of hard tooth
tissues with the
formation of a ledge.
70
2. Dissection of the Probe, mirror, dental The equator is ground on the

oral, vestibular, handpieces, marking vestibular and oral surfaces.
chewing surfaces burs, cone-shaped, The walls are ground to the
(incisal edge). Marking flame-shaped, spike- depth of the marking groove.
grooves are applied for shaped and other burs. The occlusal surface is ground
uniform grinding. The for solid crowns - by 0.3-0.5
ledge is formed at the mm, for combined crowns: for
level of the gums, then the central incisors of the
it is immersed under the upper jaw - by 1.0-1.2 mm, for
gum to a depth equal to the lateral incisors of the
half the depth of the upper jaw - by 0.8-1, 0 mm, in
periodontal sulcus or the canines and premolars of
periodontal pocket. the upper and lower jaw - by
1.2-1.4 mm, in the molars of
the upper and lower jaw - by
1.3-1.5 mm. The ledge is
formed circular or vestibular.
The absence or symbol of a
ledge on the incisors of the
lower jaw and the last molars
is allowed.
3. Obtaining a control Impression tray, Quality control of tooth

model of the dentition impression material. preparation, correction of
with prepared teeth. imperfections.
71
4. Finishing. Probe, mirror, tips, All surfaces are smooth, the

shaped diamond anatomical structure of the
heads. tooth is preserved, but the
tooth is reduced in size by the
thickness of the artificial
crown. The transitions from
one surface to another are
smooth. The ledge is formed,
its width is from 06 to 1.0 mm.
The walls of the tooth stump
converge within 3-5 ° (up to
10 °). The shape of the tooth
stump is a truncated cone.
Rice. 4. Preparation of a tooth for a one-piece or combined artificial crown.
The main (structural) materials are called the materials from which dentures,
apparatus, and fillings are made.
The main dental materials include:
1. metals and their alloys;

2. ceramics (dental porcelain and sitalls);
3. polymers (base, facing, elastic, fast-hardening plastics);
4. filling (restoration) materials (composite materials, cements, amalgams, etc.).
Auxiliary materials are used at various stages of prosthesis manufacturing:
72
1. 6.
impression; insulating;
2. modeling; 7. low-melting alloys;
3. molding; 8. solder;
4. abrasive; 9. fluxes;
5. polishing; 10. whitened.
Clinical Materials - Materials used in a clinical dental appointment:
1. impression materials;
2. filling materials;
3. waxes and wax compositions.
More than 500 alloys are used in dentistry. International standards (ISO, 1989)
divide all metal alloys into the following groups:
1. Alloys of noble metals.
Alloys of noble metals

containing 20-30% of
Alloys of noble metals gold, platinum or other
based on gold precious metals.
gold;
gold-palladium;
silver-palladium.
2.
Base metal alloys:

1. chromium-nickel (stainless) steel;
2. cobalt chromium alloy;
3. nickel-chromium alloy;
4. cobalt-chromium-molybdenum alloy;
5. titanium alloys.
73
3. Alloys for metal-ceramic structures.

1. with a high gold content (at least 75%);
2. with a high content of precious metals (gold and platinum or gold and
palladium - not less than 75%);
3. palladium-based (at least 50%);
4. based on base metals
● cobalt (+ chromium - at least 25%, + molybdenum - at least 2%),
● nickel (+ chromium - at least 11%, + molybdenum - at least 2%).
In addition, there are the following classifications of alloys used in prosthetic

dentistry:
alloys,
used in orthopedic dentistry
by appointment by the number of by the by melting by

alloy physical point processing
components nature of the technology
alloy
components
● ● ● ● ●
for removable two-component mechanical fusible; heat
prosthetics; (Argident 3: Au- mixture; ● refract treatment;
● for cermet Pt); ● solid ory; ● therm
prostheses; ● three- solution; o-
● for metal- component ● chemi mechanical;
polymer (Rebar 3: Au- cal ● chemi
prostheses; Pd-Ag); compounds. cal-thermal.
● for solid ● multicom
metal structures; ponent (Viron-
● for stamped 99).
crowns.
74
Topic 6. Methods of preparation for crowns, preparation features, taking

impressions, classification, methods of making crowns.

indications and contraindications
clinical laboratory stages of crown manufacturing
preparation steps
taking casts
1. Markov B.P., Lebedenko I.Yu., Yerichev V.V. A guide to practical exercises

in prosthetic dentistry. Part 1. - M .: GOU VUNMTs MZ RF, 2001 .-- 662 p.
2. 2. Markov B.P., Lebedenko I.Yu., Erichev V.V. A guide to practical exercises

in prosthetic dentistry. Part 2 - M .: GOU VUNMTs MZ RF, 2001 .-- 235s.
3. 3. Orthopedic dentistry: Textbook for students stomatologich. fac. honey.

universities. / Ed. V.N. Kopeikina, M.Z. Mirgazizov. - 2nd ed. add. - M .: Medicine,
2001 .-- 621 p.
4. 4. Trezubov V.N., Shteyngart M.Z., Mishnev L.M. Prosthetic Dentistry:

Applied Materials Science: Textbook for honey. universities. - SPb .: SpetsLit, 2001
.-- 480 p.
5. 5.Trezubov V.N., Shcherbakov A.S., Mishnev L.M. Prosthetic Dentistry:

Propedeutics and the Basics of a Private Course: A Textbook for Med. universities.
- SPb .: SpetsLit, 2001 .-- 480 p.
6. 6.Guide to Prosthetic Dentistry. / Ed. V.N. Kopeikin. - M .: Triada-X, 1998 .-

- 495 p.
75
The most common prostheses used to restore a decayed tooth crown are full artificial
crowns. Due to the fact that they have a different design and are intended for
different purposes, they are systematized according to certain criteria:
1. By design or by the size and method of covering the tooth:

● complete, that is, covering all surfaces of the tooth;
● equatorial, that is, reaching the equator of the tooth;
● crowns with a pin;
● telescopic crowns;
● fenestrated or fenster crowns.
By manufacturing method:
● stamped;
● cast;
● brazed (seam) - now they are practically not used.
3. Depending on the material:
● metal (gold alloys, stainless steel, cobalt-chromium alloys (KHS), silver-
palladium, titanium);
● non-metallic (plastic, porcelain);
● combined, that is, lined with plastic, porcelain or other ceramic masses (metal-
plastic and cermet).
4. By appointment:
● restorative;
● supporting (in bridges or other types of prostheses);
● fixing (for holding drugs, orthodontic or maxillofacial appliances);
● splinting;
● temporary and permanent.
Clinical rationale for orthopedic treatment with stamped crowns
1. An unconditional indication for the use of artificial crowns is significant tooth

decay due to caries, its complications or other reasons that cannot be eliminated by
filling or inlay.
2. For covering the teeth that support the clasps, especially if you need to change
their clinical shape.
3. For fixation during treatment with bridges, i.e. abutment crowns.
4. Pathological abrasion.
5. Shape anomalies.
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6. For fixing various orthodontic or maxillofacial appliances.

7. For splinting in case of periodontal diseases and fractures of the jaws.
Contraindications:
1. Covering intact teeth with crowns, if this is not caused by the design features
of the dentures.
2. Untreated foci of chronic inflammation in the region of the marginal or apical
periodontium.
3. Pathological mobility (III degree according to Entin).
4. General grave health condition.
Clinical and laboratory stages of the manufacture of stamped crowns. Preparation of

teeth in the manufacture of stamped crowns. Requirements for a properly prepared
tooth for a stamped crown
1. 1st clinical stage - examination, diagnosis, choice of treatment method,

psychotherapeutic preparation of the patient, premedication (if necessary), tooth
preparation, impression taking.
2. 1st laboratory stage - Obtaining demountable plaster models of jaws. Making
wax bases with bite rolls (if necessary).
3. 2nd clinical stage - determination of the central ratio of the jaws.
4. 2nd laboratory stage - production of a stamped crown.
5. 3rd clinical stage - quality control of the manufactured crown (fit) in the oral
cavity.
6. 3rd laboratory stage - grinding and polishing of the artificial crown.
7. 4th clinical stage - cementation of the crown.
1st clinical stage After examining the oral cavity, making a diagnosis, the doctor
should issue an order, carry out anesthesia, since odontopreparation is accompanied
by significant trauma to dental tissues. Preparing a tooth for a stamped crown
consists in giving it a certain shape, most often resembling a cylinder and providing
a free overlay of a crown, the edge of which, entering the gingival groove, should
tightly cover the neck of the tooth. The position of the patient and the doctor during
odontopreparation When grinding, a certain sequence should be observed. It is most
advisable to start with the preparation of the contact surfaces. A thin one-sided
separation disc is inserted into the straight handpiece, with the abrasive surface
facing the mesial or distal tooth surface. The disc is mounted above the contact point
parallel to the tooth axis. Processing is carried out intermittently at minimum speed,
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without strong pressure of the cutting tool on the tooth in order to avoid disk
jamming and soft tissue injury. With short-term touches, hard tissues are removed
from the tooth until a visible gap appears between the teeth. Keeping the disk parallel
to the long axis of the tooth, grind the contact surface until the cutting tool touches
the neck of the tooth. Excessive removal of tooth tissue with a ledge should be
feared. It is also possible to use a fine fissure bur (diamond or carbide) on a turbine
unit. Mechanical preliminary separation is possible in very tight teeth. For this, a
loop of ligature bronze-aluminum wire is applied around the interdental contact, the
ends of which are twisted until light pressure is felt on the teeth. After a day, the
teeth move away from each other, and the resulting gap makes it easy to prepare the
contact surface with a separation disc. Grinding of the contact surfaces is considered
complete if all overhanging edges in the cervical region have been removed from
the contact sides. The accuracy of the preparation is controlled by a probe. The
smoothness of its movement under the gum indicates a flat surface. The ground
surfaces should be parallel to the long axis of the tooth. For a novice doctor, it is
difficult to determine the parallelism of the sides of the tooth, therefore, the shape
of not a cylinder, but a truncated cone with the apex facing the antagonist teeth, may
be recommended. The contact walls of the tooth will converge to each other, but
their inclination should be barely noticeable (1-3 °). The thickness of the hard tissue
layer removed from the contact surfaces will be minimal at the neck and more
significant at the equator, chewing or cutting surface of the tooth. Grinding of the
vestibular and oral surfaces is carried out approximately according to the same rules.
The thickness of the removed tissue layer depends on the severity of the equator,
anatomical shape, size and position of the crown in the dentition. First, the most
prominent parts of the tooth in the equator are removed with large heads. And then
the vestibular and oral surfaces are aligned with diamond, cylindrical or wheel-
shaped heads, achieving a smooth transition between them, without sharp edges: In
the front teeth, the labial surface can be ground with a separation disc. Having given
the patient's head a more horizontal position, the separation disc is placed parallel to
the long axis of the crown and the necessary tissue layer is gradually removed with
intermittent movements. Particular attention should be paid when processing the
pre-gingival ridge. To prevent injury to the gingival margin, when grinding the pre-
gingival ridge, a conical or reverse-truncated diamond head is used. Preparation
control is carried out visually or using an angled probe. After grinding the lateral
walls of the anterior teeth, the cylindrical shape is obtained only in the cervical
region. In other areas, the anatomical shape inherent in the tooth is preserved. The
oral surface of the anterior teeth is ground down to the thickness of the stamped
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crown. The preparation of the side walls is finished by grinding the edges of the
tooth at the transition points of the labial and oral surfaces to the contact surfaces.
The smoothness of the transition should correspond to the curvature of the cervical
part of the tooth in the corresponding areas. When grinding the occlusal surface or
incisal edge, it is necessary to maintain their inherent anatomical shape. To do this,
in premolars and molars, a layer of hard tissue is alternately removed in the area of
tubercles and fissures, and the incisor and canines are ground off the incisal edge
and, additionally, the vestibular and oral sides. The control of the amount of
removed fabrics is carried out using carbon paper folded in 16 layers. This
corresponds approximately to a crown thickness of 0.25-0.3 mm. When placed
between the prepared tooth and the antagonists, it stains the areas of the chewing
surfaces that are not sufficiently disconnected from each other when the dentition is
closed. Grinding is carried out until the carbon paper easily passes between the teeth.
Abrasion of the hard tissues of the chewing surfaces of molars and premolars leads
to separation from the antagonists. In the anterior teeth, separation from the
antagonists in the central occlusion position is achieved only with direct or
orthognathic bites with minimal overlap. With a deeper overlap, the separation can
be achieved by grinding the palatal surface from the tubercles to the incisal edge of
the upper anterior teeth, as well as the labial surface and the incisal edge of the lower
anterior teeth. the upper teeth and from the lingual side of the lower teeth, as well as
the transition of the chewing surface to the lateral ones. Otherwise, the volume of
the artificial ladybug will be too large, and she will protrude from the dentition.
When preparing a tooth for a crown, one should pay attention to its position in the
dentition. For example, when turning along the axis, you can correct the position of
the tooth by grinding the most protruding areas - mesio-vestibular and oral-distal.
1. refusal of the patient due to fear of pain - it is necessary to find contact and
give anesthesia, if there are no contraindications.
● Anesthesia involves more careful adherence to the preparation regimen due to
the danger of pulp overheating;
damage to the soft tissues of the cheek, tongue, especially when working with
separation discs (more often the gums and tongue are cut).
● Prevention: hand rest in any position, mirror protection, special metal

protection
● If soft tissues are injured, you must immediately stop the drill and carefully
remove the cutting tool from the oral cavity. The wound must be pressed with a
79
sterile napkin and the patient must be given surgical care.

● Injury to the soft tissues of the oral cavity is rarely complete without mental
trauma to the patient and the doctor. In the future, after the injury, the doctor will
need maximum efforts to convince the patient of the overall favorable outcome of
orthopedic treatment;
grinding during separation not to the neck of the tooth, but higher, penetrating into
the thickness of dentin
● Prevention: the separation disc should be directed strictly along the

longitudinal axis of the prepared tooth and during rotation it is necessary to press it
more tightly against the wall of the prepared tooth;
4. insufficient removal of hard tooth tissues from the occlusal surface - when
fitting the crown, there will be an increase in the interalveolar height;
5. insufficient removal of tooth tissues from the vestibular, lingual or approximal
(contact) surfaces - the manufactured crown will not tightly cover the clinical neck
and food debris will get in, the gingival edge will be injured;
6. pulp burn
● compliance with the preparation rules, taking into account the safety zones
according to Abolmasov
7. fainting, collapse.
Prevention of complications:
1. Psychological preparation of patients.

2. The operation of preparing teeth with live pulp should be performed under
anesthesia, and in some cases with the use of anesthesia.
3. The tool should be highly abrasive, well centered.
4. It is necessary to protect the soft tissues.
5. The drill should be turned on after the tip is inserted into the oral cavity and
the hand holding it is securely fixed. It is necessary to remove the cutting tool only
after the drill has completely stopped.
6. Compliance with the rules for the preparation of teeth.
Taking casts. Characterization of alginate impression materials.After preparing the

tooth for a metal stamped crown, it is necessary to take an impression that gives an
accurate impression of the prepared tooth. Impressions are taken from both jaws.
Usually, an impression is taken with alginate masses, their use allows you to get a
fairly accurate impression, but requires certain skills. You can also use gypsum
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(extremely rarely), double impressions taken with the help of silicone, polysulfide,
polyester masses are especially accurate. When taking an impression, you must
follow the correct sequence of actions.
1. Selection of an impression tray.

● To obtain anatomical impressions, use special metal or plastic spoons for the
upper and lower jaw. The spoon consists of a body and a handle. In the body of the
upper spoon, there is a bed for the imprint of the teeth or alveolar processes, the bed
for the imprint of the palatine fornix and the outer board. The lower spoon differs
from the upper one in that instead of the bed for the imprint of the palatine fornix, it
has a notch for the tongue, limited by the inner rim. The sides of the tray are used to
hold the impression material, and the handle helps to properly fix the tray in the oral
cavity. The impression trays come in a variety of shapes and sizes. If elastic masses
are used for the impression, then the spoon must be perforated.
Preparing the impression material and placing it on a spoon.

Introduction of a spoon with a mass into the oral cavity.
Forming the edges of the print.
+
Removing the impression from the oral cavity. Requirements for the anatomical
impression:
1. The anatomical impression should provide a distinct impression of the
mucous membrane to the transitional fold and the remaining teeth.
2. The edges of the print should be smooth, rounded, but not thick.
Provisional crowns The prepared tooth becomes sensitive to thermal, chemical and
infectious irritants. To avoid this, the tooth should be covered with a temporary
crown or a celluloid cap.Method: before preparation, impressions are taken from the
teeth with an alginate material, into which a self-polymerizing (cold polymerization)
plastic is applied, and after processing the teeth is introduced into the oral cavity
until final hardening. Then the provisional crown is processed. It is strengthened on
the tooth immediately after preparation with temporary cement. 1st laboratory stage
Impressions from the alginate mass are immersed in a solution of potassium
permanganate for 5 minutes. Plaster prints are glued together with boiling wax,
immersed in cold water for 5-10 minutes, and plaster models are cast. In order to fix
them in the position of the central occlusion in the occluder, wax bases with bite
rollers are used. On plaster models along the boundaries outlined with a chemical
pencil, templates or bases are made from dental wax. In the area of dentition defects,
rollers are installed, the width of which in the lateral sections is not more than 1-1.2
cm, and in the area of the front teeth - 0.6-0.8 cm, the height of the rollers in the
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lateral sections is 1-2 mm above the chewing surface natural teeth, and in front of
their occlusal plane should be located at the level of the cutting edges. Obtaining a
plaster model. The impression taken out of the water is shaken off, put on a table
with a spoon upwards so that all the remaining water is glass, and proceeds to stir
the plaster, adhering to the rules. Pour as much water into the rubber cup as needed
to saturate the plaster. This is roughly one part water for two parts gypsum. Gypsum
is poured into the water in small portions until there is no free water on top. Only
after that, the gypsum is vigorously stirred with a special spatula so that a
homogeneous thick mass without lumps is obtained. A model cast from too liquid
gypsum will be brittle, since the gypsum will bind only the amount of water that is
required according to the chemical formula, the rest of the water will evaporate, and
the model will become porous, loose. Excessively thick gypsum will not give an
accurate impression, since it will not display the relief of the mucous membrane
(when taking an impression) or all the indentations in the impression (when
receiving a model). In such gypsum, pores can turn out, since air bubbles will not
have time to escape through its thickness before it hardens. It is necessary to strictly
observe the rules for storing gypsum, arising from its properties described above. It
is necessary to protect the gypsum from moisture and contamination. Gypsum is
stored in thick paper bags or in resealable barrels in a dry place. Before use, it is
recommended to sift the gypsum through a sieve in order to remove lumps and
incidental impurities.To better fill all the depressions in the impression and to
eliminate air bubbles, it is recommended to pour the gypsum in small portions onto
the protruding parts of the impression and shake it at the same time. There are special
vibrators for this purpose, but good results can be achieved without a vibrator by
tapping the impression spoon against the edge of the rubber cup. The impression is
filled with plaster of paris slightly above its edges; a little plaster is poured on a table
covered with oilcloth and, turning the print over with a spoon up, put it on the plaster
in a horizontal position. Model height must be 1, 5-2cm at its thinnest part. Smooth
the edges of the model with a spatula and wait until the plaster has completely
hardened. Separation of the model from the plaster impression. When the plaster has
hardened, the impression tray is removed with light blows with a hammer or spatula.
The finished model is trimmed, giving it more accurate contours, while trying to
keep all its anatomical details intact. The lower model does not have a recess on the
lingual side so as not to weaken it. Any damage, such as a fracture of the model,
breakage of the alveolar ridge, scratches in the area of the working part, etc., make
the model unsuitable for further work. In some cases, it is permissible to stick a
broken off plaster tooth or part of it. The broken tooth must be precisely attached to
the model and reinforced with cement or waterproof glue (celluloid solution in
acetone). 2nd clinical stage To compare the models in the occluder, it is necessary
in the clinic to determine the central occlusion or the central ratio of the jaws.
Depending on the presence of antagonizing pairs of teeth and their location, the
establishment of the dentition in the central occlusion is carried out differently. With
the existing teeth antagonists, the height of the bite is fixed by natural teeth. Is a
fixed bite, anatomical and physiological norm for a given patient. In case of non-
82
fixed bite, wax templates are fitted in the oral cavity and the mesiodistal position of
the lower jaw is fixed in such a way that the bite height obtained using the occlusal
rollers is 2-4 mm less than the height of relative physiological rest. Determination
of the central ratio of the jaws. According to the degree of difficulty in determining
the central ratio of the jaws, four groups of defects in the dentition are distinguished:
When making 1-2 crowns, the central occlusion is determined by its signs, guided
by which the models are put into the occluder, that is, they are most often dealing
with the 1st group. drawn up in the central occlusion, fixed in the articulator. Having
received an idea of the nature of the closure of the dentition and the ratio of the jaws,
they proceed directly to the manufacture of the prosthesis. 2nd laboratory stage
Methods of stamping metal crowns. Plaster models, fixed in the articulator, examine
and check the degree of separation of the prepared tooth from the antagonists. With
an eye scalpel, plaster is removed, which violates the clarity of the contours of the
neck of the tooth. Engraving is done carefully to avoid damaging the cervical part
of the tooth. With inaccurate removal of excess gypsum, its perimeter shrinks or
expands. You cannot deepen the gingival groove, just mark its precise contours. If
the interdental spaces are not wiped out by the impression material and are filled
with plaster, it is carefully removed with a fine file or an eye scalpel. The contours
of the gingival margin should be clearly defined along the entire perimeter of the
tooth neck. With a sharpened chemical pencil, outline the clinical neck of the tooth.
The resulting line serves as a guideline for determining the length and width of the
crown edge, as well as the degree of its immersion in the gingival groove. The
anatomical shape of the artificial crown is restored with a special modeling wax and
a modeling spatula. Cut the wax with the sharp edge of the spatula, rounded - to melt
it on the fire of a burner To obtain the first layer, boiling wax is poured onto the
stump of a plaster tooth, holding the model with the base up, the tip of a spatula with
boiling wax is applied to the surface of the tooth from the neck to the cutting edge
or chewing surface, preventing the molten wax from getting into the neck area and
maintaining the accuracy of its contours. By layering molten wax on the surface of
a plaster tooth, an increase in volume is achieved, which is necessary to restore the
anatomical shape. To obtain an imprint of antagonist teeth on the simulated tooth,
their occlusal surface is lubricated with a thin layer of oil, petroleum jelly, or simply
moistened with water. Having received the imprint of the antagonists on warm wax,
they proceed to modeling the artificial crown. The wax is cooled and the excess is
scraped off. The volume of the modeled tooth is reduced by the thickness of the
stamped crown metal - 0.25-0.3 mm. The relief of the occlusal surface is modeled
taking into account the age characteristics of natural teeth. After modeling, the wax
surface should be smooth. All surfaces in contact with the antagonists are separated
by the thickness of the metal. The modeled tooth is cut out from the plaster model.
The crown part of the tooth in the direction of the longitudinal axis should continue
approximately to the height of two more crowns. The thickness of the so-called root
part of the plaster die must exactly match the cross-sectional profile in the neck area,
a violation will lead to the manufacture of an artificial crown with an inaccurate
entrance hole. The marking of a plaster die is carried out in several ways: The relief
83
of the chewing surface is modeled taking into account the age characteristics of
natural teeth. After modeling, the wax surface should be smooth. All surfaces in
contact with the antagonists are separated by the thickness of the metal. The modeled
tooth is cut out from the plaster model. The crown part of the tooth in the direction
of the longitudinal axis should continue approximately to the height of two more
crowns. The thickness of the so-called root part of the plaster die must exactly match
the cross-sectional profile in the neck area, a violation will lead to the manufacture
of an artificial crown with an inaccurate entrance hole. The marking of a plaster die
is carried out in several ways: The relief of the chewing surface is modeled taking
into account the age characteristics of natural teeth. After modeling, the wax surface
should be smooth. All surfaces in contact with the antagonists are separated by the
thickness of the metal. The modeled tooth is cut out from the plaster model. The
crown part of the tooth in the direction of the longitudinal axis should continue
part of the plaster die must exactly correspond to the cross-sectional profile in the
neck area, a violation will lead to the manufacture of an artificial crown with an
inaccurate entrance hole. in contact with antagonists, they are separated by the
thickness of the metal. The modeled tooth is cut out from the plaster model. The
crown part of the tooth in the direction of the longitudinal axis should continue
part of the plaster die must exactly match the cross-sectional profile in the neck area,
a violation will lead to the manufacture of an artificial crown with an inaccurate
entrance hole. The marking of a plaster die is carried out in several ways: in contact
with antagonists, they are separated by the thickness of the metal. The modeled tooth
is cut out from the plaster model. The crown part of the tooth in the direction of the
longitudinal axis should continue approximately to the height of two more crowns.
The thickness of the so-called root part of the plaster die must exactly match the
cross-sectional profile in the neck area, a violation will lead to the manufacture of
an artificial crown with an inaccurate entrance hole. The marking of a plaster die is
carried out in several ways:
1. stepping back about 1 mm from the line of the clinical neck of the tooth,
indicated with a chemical pencil, a groove 0.5 mm deep is made parallel to it. - it
serves as a guide for determining the length of the edge of the metal crown.
2. first mark the second line with a chemical pencil, located at a distance of 1
mm from the first, and then engrave the groove, stepping back from the second line
by another 1 mm. Advantage - preliminary shortening of the crown along the groove
allows you to subsequently clarify its length along the second line drawn with a
chemical pencil. The pre-built headroom significantly reduces the likelihood of
over-shortening the crown and thus ensures the highest precision in the fabrication
of the prosthesis.
84
With a spatula, remove excess gypsum in the entire cervical part and give it a cross-
sectional profile equal to the neck contour. Metal stamps are prepared using gypsum
stamps. To obtain an exact copy of a gypsum stamp from the metal, it is soaked in
water or in a solution of office glue. Liquid gypsum is poured into a rubber ring with
a diameter of 3-4 cm and a height of 4-5 cm. The wet gypsum stamp is preliminarily
coated with a thin layer of gypsum, removed and re-immersed in it, and then
completely placed in liquid gypsum so that the stamp is located strictly vertically
and is located in the very center of the rubber ring. This makes it easier to remove
the plaster die from the mold and maintains its accuracy. The hardened plaster block
is pushed out of the rubber ring, give the block the shape of a rectangle and make
wedge-shaped longitudinal grooves with a depth of 3-4 mm on two opposite sides,
leaving a layer up to the plaster die of at least 3-5 mm. The longitudinal grooves
should be oriented to the plaster die so that the fracture line passes exactly through
its middle. To split the plaster mold, it is placed on the palm of the left hand, and the
blade of a plaster knife is inserted into a longitudinal wedge-shaped groove. If the
fracture line is misaligned, it may be difficult to remove the plaster die from the
mold. In this case, on the half of the mold where the gypsum stamp remains, an
additional wedge-shaped groove is made strictly in the direction of the stamp and
the remaining part of the gypsum block is split along it. After releasing the plaster
die, all parts of the plaster mold are folded, placing in a rubber ring and pouring into
it a molten low-melting alloy, melted in a special spoon on the flame of a gas or
alcohol burner at a temperature of 65-95 ° C. In our country, they use the Melott
alloy: tin, lead, bismuth (5: 3: 8), the melting point is 65 ° C. For each tooth, 2 stamps
are cast: the first is used for final stamping, the second for preliminary. Defects
appearing on the surface of the stamp are removed with a file carefully in the area
of the neck. Excess metal on the chewing surface is removed with burs or circles
without disturbing its relief. In this form, a metal stamp is ready for stamping a
crown. In the manufacture of several crowns, the following technique is used: liquid
gypsum is poured into a manufactured metal frame 5-6 cm wide, 2 cm high and 15-
20 cm long, into which the previously prepared teeth are lowered in a horizontal
position at half their thickness and at a distance of 1 cm from each other After the
gypsum has hardened, "locks" are made at both ends of the block in the form of
recesses and immersed in cold water for soaking, then the second half of the mold
is cast. After the gypsum of the second half has hardened, they are separated from
each other with light hammer blows and the plaster teeth are removed. Then both
halves of the mold are connected, the inlet of each plaster tooth is slightly widened
and the mold is filled with a molten low-melting alloy. For preliminary stamping, a
metal stamp under No. 2 is used. For the manufacture of stainless steel crowns,
standard sleeves of various diameters and thicknesses are used (0.20-0, 28 mm)
manufactured by industry. For stamping crowns made of gold or platinum alloy,
disks with a diameter of 23-30 mm and a thickness of 0.25-0.28 mm are used. .If
there are no sleeves of a suitable diameter and they are larger than the diameter of a
metal tooth, then they are pulled through the "Samson" or "Sharp" apparatus. In the
same way, sleeves are obtained from discs (gold, platinum). this hole of the matrix
85
and is pulled with a punch. Transferring the sleeve from one hole to another, they
achieve the required diameter so that the sleeve is put on a metal stamp with some
effort. Repeated pulling of the sleeve through the holes leads to a change in the
structure of the metal and its properties, therefore, to restore the previous structure
of the metal and its properties, the sleeve must be subjected to heat treatment after
pulling and during operation. the sleeve is calcined in an oven or in the flame of a
soldering apparatus to a temperature of 1100 ° C (straw-yellow color) and quickly
cooled in water or in air. This achieves the fixation of the most stable structure of
the steel sleeve, the so-called austenitic, which is a solid solution of carbon in iron.
For an anvil, a lead base and hammers are used: copper - for steel, horn - for an alloy
of gold. An approximate shape is first given on the anvil. Putting the sleeve on a
stamp made of low-melting alloy No. 2, it is upholstered with a hammer, bringing it
closer to the shape of the stamp; hammer blows should be directed to the most
convex sections of the sleeve, driving them towards the neck of the tooth. You can
create a bed in a lead block and hammer the stamp into the sleeve with a hammer
until the first imprints of the chewing surface or the incisal edge of the tooth appear
at the bottom of the sleeve. If the advance of the sleeve meets an obstacle from the
side of the protrusion on the stamp near the neck of the tooth, then the sleeve is
removed and trimmed. Instead of lead, a low-melting alloy is used to form the
occlusal surface, pouring it into a mold, as shown. With hammer blows, the sleeve
is given an approximate shape of the future crown, achieving a tighter fit to the entire
surface of the metal stamp. A metal stamp of a tooth with a pre-stamped crown put
on it is wrapped with a linen cloth or thick paper (to prevent the ingress of moldin
between the crown and the stamp) and after placing it strictly in the center with the
chewing surface down with hammer blows or pressing in a special press, hammer it
into the mass. press and abruptly release, while the cylinder, entering the base,
strikes the pin-peak, and the molding or rubber acts as a counter-stamp, evenly
transmitting pressure in all directions and contributing to a tight fit of the crown to
the surface of the metal stamp. the surface of the crown, then they are broken with
a hammer, the crown is removed from the stamp by melting it, holding the crown
with tweezers. This concludes the laboratory stage. Single crowns are bleached,
boiled, wiped before being sent to the clinic; if the crown is intended for anchoring
a bridge, then it is not bleached due to the danger of thinning. These crowns are
whitened after the final fabrication of the bridge, so that in the case of external
stamping, the stamp is the tooth we have prepared from a fusible alloy, and the
counter stamp is a mold or unvulcanized rubber. The combined stamping method
combines elements of external and internal stamping - it is not used, The method of
combined stamping of crowns. The method of making a metal stamp was borrowed
from the outer stamping, and a metal counter stamp from the inner stamping. It is
also called punching according to the MMOM method (Moscow Medical Dental
Institute). The device consists of a steel cuvette, the inner surfaces of which are
tapered and have two protrusions in the middle line, facilitating the splitting of the
counter-stamp. The metal stamp of the tooth is prepared in exactly the same way as
for the outer stamping. After that, the surface of the metal stamp is wrapped with
86
one layer of adhesive plaster, leaving the occlusal surface or incisal edge free. This
corresponds to the thickness of the metal crown. To do this, you can grease the
surface of the stamp with oil and sprinkle with talcum. Installing the holder with a
stamp in the center of the cuvette, pour a molten fusible alloy into it, after which the
cuvette is set upside down on the stand, remove the cotton wool from the hole in the
bottom of the cuvette and insert a pestle into the hole, the counter-stamp is removed
with hammer blows. The splitting of the counter-stamp and the release of the metal
stamp from it is carried out using a chisel or a plaster knife, which are inserted into
the resulting recess on the lateral surface of the stamp. When using a rod with
triangular teeth, the counter-stamp is split at the moment of its release from the
cuvette. The adhesive plaster is removed from the surface of the metal tooth, a pre-
stamped crown is put on, and, having installed in the recess of the counter-stamp,
the latter is inserted into the cuvette with light tapping with a hammer so that it
returns to its previous position. you can use the pestle with the hollow side. After
that, stamping is carried out by blows of a hammer on the stamp and pestle. The
stamp with the crown is freed from the counter-stamp in the manner described
above, that is, by knocking out the counter-stamp, melting it and releasing the crown.
grinding and polishing the crown. The crown, tested in the patient's oral cavity, is
again transferred to the dental laboratory for bleaching, grinding and polishing. In
the process of manufacturing dentures, metal parts are heat treated, which increases
and accelerates their chemical interaction with atmospheric oxygen. As a result of
this effect, an oxide film (scale) is formed on the metal surface, which impairs the
appearance of the metal, complicating the processes of processing, grinding and
polishing the surface. Removal of the oxide film from the entire surface of metal
parts is carried out using chill. As bleaching, aqueous solutions of many acids
(hydrochloric, sulfuric, nitric, etc.) and their mixtures are used. To whiten prostheses
made of gold and silver-palladium alloys, a 40% aqueous solution of hydrochloric
acid is used. The product is heated red-hot, and then dipped into a vessel with
hydrochloric acid solution and closed with a lid. After 1-2 minutes, the product is
removed from the solution and washed in running water. All work with hydrochloric
acid should be carried out in a fume hood, since its vapors have a harmful effect on
the mucous membrane of the respiratory tract. Do not allow it to come into contact
with clothing, skin or tools. After stamping crowns made of gold alloys in molds
made of low-melting metals, their particles remain on the crowns in the form of
plaque, which is removed by immersing the crown in hydrochloric acid for 2-3
minutes. Then it is thoroughly washed with water and wiped off. As chill for
processing crowns made of stainless steel, a mixture is used, most often consisting
of 6 parts of nitric acid, 47 parts of hydrochloric acid, 47 parts of water. In this
solution, steel products are boiled for 1-2 minutes. To avoid damage to the crown,
it is necessary to strictly observe the whitening regime. 3rd clinical stage. Checking
the quality of the stamped crown and the requirements for it. The quality of the
stamped crown made in the laboratory is carefully checked in the oral cavity. on a
prepared natural tooth, which is greatly facilitated by a preliminary assessment of
the artificial crown on a plaster stamp. The smooth, even surface of the crown
87
indicates the high quality of the stamped prosthesis. Folds and dents on the metal
surface, poor coverage of the plaster die neck with the edge of the crown indicate
the poor quality of the stamping. The gap between the edge of the crown and the
plaster die will result in poor retention of the crown. Several crowns, Due to poor
quality stamping, easily removable from the plaster die, it is easy to confuse in the
oral cavity before checking. Checking the length of the crown. On a plaster die, the
edge of the crown should overlap the line of the clinical tooth neck to a minimum,
that is, by 0.3-0.5 mm. The issue is resolved individually according to clinical
indications:
● if the edge of the crown overlaps the clinical neck line more than is required
for the patient, the crown is carefully shortened with a silicon carbide stone or shaped
head.
● the crown, which turned out to be obviously short on the plaster die and the
prepared tooth, must be reworked.
The finished crown should have an anatomical shape with a well-defined equator to
match the tooth. The cutting edge and chewing surface are carefully stamped, their
relief corresponds to the patient's age. Checking the stamped crown on the prepared
tooth in the oral cavity. The artificial stamped crown is removed from the plaster
stamp, washed with hydrogen peroxide, disinfected with alcohol and placed on the
abutment tooth. If the crown is not applied, the quality of the tooth preparation must
be checked. The stump of a ground tooth, which is widened in comparison with the
perimeter of the neck, can interfere, requiring additional grinding of hard tooth
tissues and bringing the stump to the required shape. A narrow crown does not fit
over a properly prepared natural tooth due to:
1. inaccurate impression;
2. sloppy engraving of the neck of the tooth on a plaster working model;
3. narrowing the neck of a gypsum die or removing part of a low-melting alloy
when processing a metal die.
Regardless of the reason, the crown is sent to the dental laboratory for re-stamping.
1. moves along the natural tooth prepared for it;

2. when the crown is fully applied, it is minimally immersed in the periodontal
sulcus.
The immersion depth is checked with an angled probe, feeling the edge of the crown
under the gum along the entire perimeter of the neck of the tooth. Carefully examine
the position of the edge of the crown in the area of the interdental gingival papillae.
Excessive immersion of the crown in this area is caused by:
88
1. inconvenience when engraving the neck of the tooth on a plaster model;

2. shortening of a metal crown on a metal or plaster die due to the sharp bend of
the edge of the crown in this place.
Chronic inflammation of the interdental papillae is a common reaction of the

marginal periodontium to crown lengthening. The depth of the crown margin under
the gum is checked on the impression. Having inserted the crown into the
impression, the degree of immersion of its edge into the gingival pocket along the
entire perimeter of the tooth neck is determined. It will correspond to the width of
the cervical part of the crown protruding above the gum print.After specifying the
length of the crown, it is necessary to check the tightness of the coverage of the neck
of the natural tooth. A wide crown will be poorly fixed, and a slightly narrowed one
may not completely superimpose, which will manifest itself in the occurrence of
premature occlusal contact, which prevents the closure of the dentition. Restoring
the anatomical shape of the prosthetic tooth involves maintaining the continuity of
the dental arch by recreating the interdental contact points. Artificial crown, not
having tight contacts with adjacent teeth is considered inferior. Only in patients with
sparsely located teeth in the form of a diastema or three, such a position of the
artificial crown in relation to the adjacent teeth can be considered appropriate. In
most patients, an artificial crown should have close contact with the adjacent teeth.
The crown is a fixed prosthesis that restores the shape of the tooth and prevents its
further decay. It is also a foreign body, having a harmful effect on the tissues of the
marginal periodontium. The harmful effect of the crown, like any other prosthesis,
can be exacerbated by non-compliance with the manufacturing rules. Only in
patients with sparsely located teeth in the form of a diastema or three, such a position
of the artificial crown in relation to the adjacent teeth can be considered appropriate.
In most patients, an artificial crown should have close contact with the adjacent
teeth. The crown is a fixed prosthesis that restores the shape of the tooth and prevents
its further decay. It is also a foreign body, having a harmful effect on the tissues of
the marginal periodontium. The harmful effect of the crown, like any other
prosthesis, can be exacerbated by non-compliance with the manufacturing rules.
Only in patients with sparsely located teeth in the form of a diastema or three, such
a position of the artificial crown in relation to the adjacent teeth can be considered
appropriate. In most patients, an artificial crown should have close contact with
adjacent teeth. The crown is a fixed prosthesis that restores the shape of the tooth
and prevents its further decay. It is also a foreign body, having a harmful effect on
the tissues of the marginal periodontium. The harmful effect of the crown, like any
other prosthesis, can be exacerbated by non-compliance with the manufacturing
rules. restoring the shape of the tooth and preventing its further destruction. It is also
a foreign body, having a harmful effect on the tissues of the marginal periodontium.
The harmful effect of the crown, like any other prosthesis, can be exacerbated by
non-compliance with the manufacturing rules. restoring the shape of the tooth and
preventing its further destruction. It is also a foreign body, having a harmful effect
89
on the tissues of the marginal periodontium. The harmful effect of the crown, like
any other prosthesis, can be exacerbated by non-compliance with the manufacturing
rules.
1. Anatomical shape characteristic of this tooth. Correctly modeled cusps and
equator provide a normal relationship with the teeth of the opposite jaw and adjacent
ones. Crown Equator:
● creates interdental contacts that protect the interdental papilla;
● protects the vestibular and oral edges of the gums from food damage. One of
the main conditions for the existence of the dental arch is its continuity, restored by
interdental contacts.
2. Dense coverage of the neck of the tooth with immersion in the gingival pocket
by no more than 0.3-0.5 mm. A crown wider than the neck of the tooth irritates and
pushes the gum back, causing its atrophy - there is a gap between such a crown and
the tooth, which is initially filled with cement, but later saliva dissolves it and food
penetrates into the resulting gap, the decomposition products of which cause
necrosis of the tooth tissues, this is favored by a violation of the integrity enamel
during preparation. Deep immersion of the crown under the gum injures the marginal
periodontium.
3. An artificial crown should not increase the interalveolar height.If not, then
with central occlusion, the entire force of the contracting muscles falls only on the
tooth covered with a crown and its antagonists. Such occlusion will be traumatic,
manifesting itself in the form of pain in the tooth when it bites into its mobility.
4. When modeling the cusps of the chewing teeth, age characteristics should be
taken into account. In young people, the tubercles are well pronounced, in the
elderly, on the contrary, due to physiological wear, they are poorly represented and
for this reason the lateral movements of the lower jaw become smoother.
Fitting the crown The crown is placed on the tooth without much effort, gradually
bringing it to the gingival margin. With a tight coverage of the crown edge of the
neck of the tooth and compliance with the edge of the gum, it is advanced into the
gingival groove. After the probe, the depth of the crown edges is checked: in the
case of deep penetration into the pocket, corrections are made. The edges of the
crown cannot be bent wider than the neck of the tooth - the crown is re-stamped. A
narrow crown should not be shortened - this can make it inappropriate to the neck
of the tooth.It is also necessary to make sure that there are no premature contacts
with lateral occlusions, for which the patient is asked to move the lower jaw to the
right and left while maintaining the contact of the teeth - the crown should not
90
interfere with the occlusal relationship during the movements of the lower jaw ...
The identification of possible premature contacts is based on the nature of the
occlusion of the posterior teeth prior to prosthetics.If the artificial crown breaks the
usual occlusion, it should be corrected or redone. Avoid the appearance of premature
contacts also in case of anterior occlusion. 3rd laboratory stage The crown is ground
with an elastic wheel, then a polishing paste is applied to a hard brush or felt (fixed
in a grinder), depending on the material of which the crown is made, and polishing
is completed with a soft thread brush "Fluff". The following are used as polishing
masses: iron oxide, or crocus (PerOz), Chromium oxide is a fine-grained green
powder. Pastes are widespread,
Composition, Rough Average Thin
%
Chromium 81 76 74
oxide
Silikogel 2 2 1.8
Stearin ten ten ten
Split fat 5 5 5
Oleic acid - - 2
Bicarbonate - - 0.2
soda
Kerosene 2 2 2
4th clinical stage Before fixation, the crown is thoroughly treated with hydrogen
peroxide, degreased with alcohol and dried. The abutment tooth is covered with
cotton swabs and subjected to medication: it is cleaned of plaque, washed with
antiseptics, disinfected with alcohol, dried with ether or warm air. Liquid cement is
kneaded on a sterile glass plate. The rules for preparing the cement and its
consistency depend on the brand and the goal that needs to be achieved when
strengthening the crown. The prepared cement is applied to the crown with a spatula,
91
filling it by about two-thirds. The inner walls are coated to the edge of the crown.
Narrow incisor crowns are filled with a trowel. The crown is placed on the tooth,
making sure that the cotton swabs do not fall under the edge of the crown. After the
cemented crown has been placed, the occlusal relationship for central occlusion
should be checked immediately. If the crown is in close contact with the antagonist
teeth, the patient is asked to keep the teeth closed for 10-15 minutes until the cement
hardens. When using restorative crowns, it is necessary to control their position on
the tooth. To do this, in the final phase of application, approximately 3-4 mm from
the edge of the crown to the gum, the patient is asked to close the teeth. When fixing
the stamped crown, one should not immediately check the nature of occlusal
contacts in lateral occlusions. This can cause a displacement of the crown and a
violation of the occlusion. Only after the cement has completely hardened is it
necessary to verify the accuracy of the restoration of the occlusal relationship. The
remains of the cement are carefully removed from the surface of the crown and
adjacent teeth. It is especially necessary to carefully remove the cement filling the
interdental space, the movement of the instrument should be directed from the gum
to the incisal edge or occlusal surface. Avoid using too much force that can cause
the crown to move. The remains of cement on the surface of the polished crown can
be easily removed with a cotton swab soaked in a liquid of phosphate-cement, only
after that it is necessary to rinse the mouth with a soda solution or a solution of
potassium permanganate. After removing the remains of cement, the patient is
advised not to eat for 1-2 hours until the fixing material has completely hardened.
Cements for permanent fixation of fixed dentures; Avoid using too much force that
can cause the crown to move. The remains of cement on the surface of the polished
crown can be easily removed with a cotton swab soaked in a liquid of phosphate-
cement, only after that it is necessary to rinse the mouth with a soda solution or a
solution of potassium permanganate. After removing the remains of cement, the
patient is advised not to eat for 1-2 hours until the fixing material has completely
hardened. Cements for permanent fixation of fixed dentures; Avoid using too much
force that can cause the crown to move. The remains of cement on the surface of the
polished crown can be easily removed with a cotton swab soaked in a liquid of
phosphate-cement, only after that it is necessary to rinse the mouth with a soda
solution or a solution of potassium permanganate. After removing the remains of
cement, the patient is advised not to eat for 1-2 hours until the fixing material has
completely hardened. Cements for permanent fixation of fixed dentures;
1. Zinc-phosphate cements: Unifas, Adgezor (Czech Republic), Phosphacap,
Poscal (Germany), Septocell (France).
2. Polycarboxylate cements: Carboco, Aqualox (Germany), Selfast (France).
3. Glass ionomer cement: "Meron", "Aqua Meron". KemPhil Superior, Base
Line (Germany), Ionocell (France), Fuji ionomer (Japan).
4. Polymer cements: "Resiment" (France), "Bifix", "Dualcement", "Vario-link",
"F-21" (Germany), etc.
92
5. Light and chemically cured cements: "Bifix", "Avanto" (Germany).
Materials for temporary fixation of artificial crowns
1. Materials based on zinc oxide and eugenol (guaiacol): "Dentol", "Temporo-

M", "Zinoment" (Germany), etc.
2. Cement with calcium superhydroxide: Provicol (Germany).
Topic 7. Surgical dentistry, introduction, basic terms, manipulations.

to study the features of the anatomy of the maxillofacial region for anesthesia, to
know the classification of anesthetics used in dentistry. As well as mastering various
methods of anesthesia for surgical procedures.

− anesthetics used in dentistry
− drugs prolonging the effect of anesthetics
− tools
− methods of pain relief
− innervation of teeth and jaw
- Problem lecture.
4. Basic and additional literature on the topic:
1. Surgical dentistry head. edited by T.P. Osokin. Editors L.V. Levushkina, M.G.
Fomina, N.V. Kirsanov. Art editors S.L. Andreev, T.S. Tikhomirov. Technical
editor at NA. Birkin. Proofreader A.F. Matveychuk
2. Clinical Review of Oral and Maxillofacial Surgery 2nd EditionA Case-based

Approach Author: Shahrokh Bagheri
ANESTHETICS USED FOR LOCAL ANESTHESIA
Cocaine is an anesthetic that ushered in the era of modern local pain relief. However,
it is toxic and is currently practically not used in dental practice. Dikain is a white
crystalline powder, readily soluble in water and alcohol. Its solutions are sterilized
93
by boiling. This is a strong local anesthetic used for surface anesthesia (tissue is
lubricated with a 0.25-2% solution). For adults, the highest single dose of dicaine is
0.09 g (3 ml of a 3% solution).
Pyromecaine is an anesthetic for surface anesthesia, which is not inferior in

efficiency to dicaine. The drug is used in the form of a 1 - 2% solution, 5%
pyromecaine ointment, 5% pyromecaine ointment with methyluracil and 3%
pyromecaine ointment with methyluracil and collagen (pyrometkol), applying it to
the surface of the tissue. The maximum single dose of pyromecaine is 1 g of
Novocaine. White crystalline powder, readily soluble in water and alcohol. Its
aqueous solution is sterilized by boiling for 30 minutes. The anesthetic is low-toxic,
has a wide range of therapeutic action. It is used in infiltration, conduction
anesthesia. Applied novocaine in the form of 0.25-0.5% solution for infiltration, 1-
2% solution for conduction and infiltration anesthesia of the tissues of the alveolar
process. Infiltration anesthesia in soft tissues occurs very quickly.
The highest single dose when injected into the muscle is 0.1 g. For infiltration
anesthesia, the following higher doses are established: when using a 0.25% solution
of novocaine - no more than 500 ml (1.25 g) at the beginning of the operation, then
throughout each hour operations - no more than 1000 ml (2.5 g); when using 0.5%
solution
- respectively 150 ml (0.75 g) and 400 ml (2 g). In clinical practice, with conduction
anesthesia, no more than 100 ml of a 1% solution and 30 ml of a 2% solution are
used.
In order to slow down the absorption of novocaine into the blood (to prevent possible
toxic effects) and increase the duration of its action, 0.1% adrenaline hydrochloride
solution is added to the anesthetic solution in a ratio of 1: 100,000 (1 ml of adrenaline
per 100 ml of novocaine). The duration of action of anesthesia with novocaine does
not exceed 30 minutes. In the focus of inflammation
the use of novocaine does not give a pronounced analgesic effect.
In case of intoxication, dizziness, weakness, nausea, pale skin, sweating, agitation,
tachycardia, lowering blood pressure, respiratory failure up to apnea, convulsions
may appear. Sometimes pulmonary edema may develop. With the development of
an allergic reaction, there may also be skin rashes, itching, dermatitis, Quincke's
edema, bronchospasm phenomena (see p. 86). Trimecaine (mezocaine) is a white
crystalline powder, readily soluble in water and alcohol. The solutions are sterilized
by boiling at 100 ° C for 30 minutes. Trimecaine has a good analgesic effect in the
focus of inflammation, in the area of keloid scars and in the presence of granulation
tissue. Exceeds novocaine in the speed of the onset of anesthesia 2 times, in the
severity of the analgesic effect - 2-2.5 times, in the duration of anesthesia - 3 times.
Its toxicity is low. Combines well with adrenaline. Allergic reactions are rare. It is
of little use for application anesthesia. Apply 0.25-2% solutions for infiltration
anesthesia and 1-2% solutions for conduction anesthesia.
94
When using a 0.25% solution of trimecaine, up to 800 ml, 0.5% - up to 400 ml, 1%
- up to 100 ml and 2% - up to 20 ml of anesthetic are administered. Lidocaine
(xycaine, xylocaine) is a white crystalline powder, highly soluble in water and
alcohol. For anesthesia, lidocaine hydrochloride is used. It is a strong anesthetic,
causes a deeper and more prolonged anesthesia than novocaine (up to 3-5 hours),
surpassing its analgesic effect by 2-3 times * Provides a good efficacy of anesthesia
in inflamed tissues. Allergic reactions are extremely rare. The toxicity of lidocaine
depends on the concentration of the solution: its 0.5% solution does not differ in
toxicity from novocaine, 1-2% solutions are 1.4-1.5 times more toxic than
novocaine. Contraindicated in cardiovascular failure, atrioventricular block II-III
degree, liver and kidney disease. For infiltration anesthesia during surgical
interventions on soft tissues, 0.25% and 0.5% solutions are used, and for conduction
anesthesia (and infiltration during operations on the alveolar ridge, other areas of the
upper and lower jaws) - 1-2% solutions. For application anesthesia, 1-2% aerosol of
lidocaine is used. Maximum doses of anesthetic: 0.15% solution - 1000 ml, 0.5% -
500 ml, 1-2% - no more than 50 ml. Bupivacaine (marcaine, carbostezin) is 6 times
more potent than novocaine in terms of its analgesic effect, but 7 times more toxic.
More effective than lidocaine. Anesthesia occurs in 4-10 minutes, reaching a
maximum in 15-35 minutes. The duration of anesthesia is 12-13 hours. In surgical
practice, 0.25%, 0.5% and 0.75% solutions are used. The maximum dose is 175 mg.
Articaine (ultracaine D-S, ultracaine D-S forte) is a local anesthetic of the amide
group, is available in cylindrical ampoules of 1.7 ml and in vials of 20 ml in the form
of a 4% solution. Less toxic than lidocaine, and only IV2 times higher than that of
novocaine. However, the analgesic effect of articaine is 5 times higher than that of
novocaine. The anesthetic has a high degree of protein binding and low fat solubility,
which is the basis for its choice in pregnant women (the least toxic to the fetus).
Ultracaine D-S contains adrenaline at a dilution of 1: 200,000, and ultracaine D-S
forte - 1: 100,000. The very low concentration of adrenaline in ultracaine D-S
determines its safety in persons with concomitant cardiovascular diseases, as well as
in pregnant women. Anesthesia occurs within 1-3 minutes after injection into the
tissue. The duration of action is 45-75 minutes. Contraindicated in paroxysmal
tachycardia, tachyarrhythmias, glaucoma.
95
DRUGS THAT LONGER THE EFFECT OF LOCAL ANESTHETICS

Vasoconstrictor drugs, slowing down the absorption of local anesthetic, reduce its
toxic effect. In addition, the severity and duration of pain relief increases, and the
amount of anesthetic administered can be reduced.
Adrenaline is a hormone of the adrenal medulla. It is produced in the form of a 0.1%
solution of epinephrine hydrochloride. The solution must not be heated. Epinephrine
affects a - and 0-adrenergic receptors. It narrows the vessels of the abdominal organs,
skin and mucous membranes, increases blood pressure. The effect of adrenaline on
cardiac activity is complex: it intensifies and speeds up the heart contractions, but,
reflexively exciting the center of the vagus, due to an increase in blood pressure, it
can slow down cardiac activity and contribute to the occurrence of cardiac
arrhythmias. Adrenaline expands the muscles of the bronchi, coronary vessels of the
heart, increases blood sugar. It is used as a local vasoconstrictor, adding to local
anesthetics to prolong the action and reduce their absorption. Adrenaline should be
added to the anesthetic solution with a tuberculin syringe, dosing in milliliters. It is
rational to add 1 ml of adrenaline per 100 ml of anesthetic solution, that is, in a ratio
of 1: 100,000 hormone of the posterior lobe of the pituitary gland).
STORAGE ANALYSIS SOLUTIONS
It is allowed to prepare solutions of novocaine and trimecaine for 3 days. If solutions

are stored for more than 3 days, they should be reapplied.
sterilize. In the case of using an anesthetic solution from an ampoule, it must be
carefully treated with alcohol and opened, holding it with a sterile napkin. The
needle through which the anesthetic was taken from the ampoule must be replaced
before anesthesia is administered. Vials with anesthetic for reusable collection of the
drug are treated with alcohol, and the inserted needle is closed with a sterile napkin.
The end of the rubber stopper of the cylindrical ampoule (carpule) with the
anesthetic is treated with alcohol before being fixed in the injector, after which a
disposable double-ended needle is inserted.
Store local anesthetics separately from other medicines. Failure to comply with this
rule can lead to the accidental introduction of other solutions into the tissue, which
is fraught with serious complications.
Color To prevent errors associated with the introduction of other liquids instead of
novocaine, I. G. Lukomsky in 1940 proposed a color test.
Into two clean tubes labeled 2 and
96
4 ml, pour 2 ml of a light pink solution of potassium permanganate (1:10 000). Then,
2 ml of the test solution is poured into one of the test tubes from a vial or syringe.
After 1-2 minutes, the solution of potassium permanganate from novocaine acquires
an orange or straw-yellow color. If the color of the solution has not changed, then
this indicates the presence in the vial or syringe of another substance, not novocaine.
TOOLS
In practical work, syringes of various designs (glass, plastic, glass

and metal) and containers (1, 2, 5, 10 and 20 ml). The combination syringe for 2 and
5 ml is more convenient to use. For infiltration anesthesia use needles about 3 cm
long and 0.5-0.7 mm in diameter, for conduction anesthesia - 4-8 cm long and 0.7-1
mm in diameter. The needles have a pointed end, beveled at an angle of about 45 °.
The bevel section has a concave or flat profile. It is necessary to monitor the patency
and condition of its end section.
Recently, disposable syringes and injection needles have become more common.
The most convenient among them are the injector of the carpule with anesthetic (1.7-
2 ml) and disposable double-ended needles (Fig. 6). Disposable double-ended
needles are less traumatic when working with an injector and an anesthetic cartridge
(the injection is less painful).
The use of the injector and the carpool allows ensuring the integrity of the latter,
their quick and convenient replacement, and the impossibility of returning the
anesthetic from the tissues to the carpula.
Sterilization When sterilizing syringes, needles, dishes for anesthetic solutions, they
are thoroughly washed so that there are no traces of blood on them, then they are
kept in a Biolot solution (5 g of Biolot per 1 ml of water) or in a 3% solution of
hydrogen peroxide with 0 , 5% solution of synthetic detergents ("Progress", "Astra,"
Lotos "," Trias-A "), washed again with water and boiled for 45 minutes in distilled
water. The syringes are boiled disassembled by immersing them in cold water, after
wrapping the glass parts with gauze. The needles are boiled with a mandrin.
Sterilization of needles and syringes in a dry heat sterilizer is possible.
NON-INJECTION ANALYSIS
Anesthesia with cooling. When tissues are cooled, the excitability of nerve receptors
decreases, and when frozen, the transmission of a nerve (pain) impulse stops.
Chlorethyl is used for pain relief.
97
Chlo r e t l is produced in 30 ml glass ampoules with a capillary tube closed with a

rubber cap. When chloroethyl evaporates, the temperature drops to -35 ° C. This
causes tissue cooling at a shallow depth with a loss of pain sensitivity lasting no
more than 3 minutes.
While carrying out anesthesia, the ampoule with chloroethyl should be kept at a
distance of about 30 cm from the operating field so that the liquid has time to
evaporate. An indicator of sufficient cooling is the appearance of a white coating in
the form of snow on the skin. With prolonged cooling, tissue necrosis is possible.
Chlorethyl is a powerful narcotic drug, therefore it is necessary to prevent the
inhalation of the evaporating vapors of chloroethyl by the sick. Anesthesia with
cooling can be used when opening the superficially located abscesses of the peri-
maxillary tissues.
Application anesthesia. This method of anesthesia can be used to numb the oral
mucosa. In this case, 0.5-2% solutions of dicaine are used. A small swab is
impregnated with an anesthetic and smeared with it on the mucous membrane, or for
3-5 seconds, keep it on the tissues. The analgesic effect of dicaine appears in 1-3
minutes, its duration is 20-40 minutes.
Application anesthesia can be performed with 1-2% pyromecaine solution, 1-2%,
less often 5% lidocaine solution, as well as its 10% aerosol.
Application anesthesia is used for interventions on the mucous membrane, to
anesthetize the injection site of the needle when
performing injection anesthesia in the mouth, with puncture of the maxillary sinus
or surgery on it.
INJECTION ANALYSIS
For infiltration anesthesia during operations on the soft tissues of the face and in the
oral cavity, 0.25-1% solutions, novocaine are used, and for interventions on the
alveolar ridge or in the area of the jaw body
98
- 1-2% solutions of novocaine, trimecaine and lidocaine. For conduction anesthesia

use 1-2% solutions of these anesthetics. The temperature of the anesthetic should be
close to the body temperature of the person. Its introduction rate is small. The
injection should not be unexpected for the patient. Conducting infiltration
anesthesia, the needle is immersed in soft tissues to a depth of 1-2 mm and 0.3-0.5
ml of anesthetic solution is injected. An anesthetic depot (nodule) is formed. Slowly
advancing the needle through the already infiltrated tissue, an anesthetic solution is
injected in an area slightly exceeding the size of the operating field. It is possible to
infiltrate tissue by removing the needle and re-inserting it at the border of the nodule.
If it is necessary to anesthetize not only superficial, but also deeply located tissues,
the needle is gradually immersed in them, all the time releasing the anesthetic.
With conduction anesthesia, the anesthetic is injected not into the tissue of the
operating field, but at some distance from it - into the area of the nerve that conducts
pain impulses from the intervention zone. Anesthetic solution can be administered
endoneurally and perineurally. With the endoneural method, the anesthetic is
injected directly into the nerve trunk, with the perineural method, which is used most
often, in the immediate vicinity of it. In this case, the anesthetic gradually permeates
the nerve fibers.
Intraligamentary anesthesia is a type of infiltration anesthesia, when a local
anesthetic is injected directly into the periodontium of a tooth under some pressure
to overcome tissue resistance. An anesthetic solution, injected under high pressure,
spreads into the cancellous substance and bone marrow spaces of the bone, into the
pulp of the tooth, and with low pressure - towards the gums and periosteum. The
injectors used make it possible to develop a strong dosed pressure using a reducer,
to control the amount of anesthetic injected. However, it is quite possible to use
standard syringes such as "Record" and domestic thin needles with a diameter of 0.4
ml. Before anesthesia, the gingival groove and the crown of the tooth are treated
with an antiseptic. The needle is inserted into the gingival groove at an angle of 30
° to the central axis of the tooth. The bevel of the needle is directed towards the root
surface. The needle is advanced into the periodontium to a depth of 1-3 mm. For
anesthesia of single-rooted teeth, 0.2 ml of anesthetic is enough, multi-rooted - 0.4-
0.6 ml - trimecaine, lidocaine, xylosthesin, ultracaine, etc. Anesthesia occurs in 15-
45 seconds, its duration is 1-3 minutes, if administered
anesthetic without adrenaline, and 30-45 minutes if adrenaline is added to the
anesthetic.
INERVATION OF TEETH AND JAWS
99
The organs of the oral cavity receive innervation from the motor, sensory, autonomic
(sympathetic and parasympathetic) nerves. The sensory nerves that innervate the
skin of the face, soft tissues and organs of the oral cavity, jaw include the trigeminal,
glossopharyngeal, vagus nerves and branches extending from the cervical plexus
(large ear nerve and small occipital). In the area of the face along the branches of the
trigeminal nerve are located
5 autonomic nerve nodes: 1) ciliary (gangl. Ciliare), 2) roof

pubic (gangl. pterigopalatinum), 3) ear (gangl. oticum), 4) submandibular (gangl.
submandibulare), 5) sublingual (gangl. sublinguale). The ciliary node is connected
with the first branch of the trigeminal nerve, with the second - the pterygopalatine,
with the third - the ear, submandibular and sublingual nerve nodes. Sympathetic
nerves to the tissues and organs of the face go from the upper cervical sympathetic
node.
The trigeminal nerve (n. Trigeminus) is mixed. It contains motor, sensory and
parasympathetic secretory nerve fibers. The organs of the oral cavity receive sensory
innervation mainly from the trigeminal nerve (Fig. 7). Three branches extend from
the trigeminal node: 1) the orbital, 2) the maxillary and 3) the mandibular nerves.
The orbital nerve (n. Ophtalmicus) is sensitive, does not participate in the
innervation of the jaws and tissues of the oral cavity.
The maxillary nerve (n. Maxillaris) is sensitive, leaves the cranial cavity through a
round hole (foramen rotundum) into the pterygopalatine fossa (fossa
pterigopalatina), where it gives off a number of branches (Fig. 8).
The infraorbital nerve (n. Infraorbitalis) is a continuation of the maxillary nerve and
gets its name after the departure from the last zygomatic and pterygopalatine nerves.
From the pterygopalatine fossa, through the lower orbital fissure, it enters the orbit,
where it lies in the infraorbital sulcus (sulcus infraorbitalis) and through the
infraorbital fossa (foramen infraorbitalis) leaves the orbit, dividing into terminal
branches that form a small crow's feet (pes anserinus minor). The latter branches out
in the area of the skin and mucous membrane of the upper lip, lower eyelid,
infraorbital region, wing of the nose and the cutaneous part of the nasal septum.
In the pterygopalatine fossa, the posterior upper alveolar branches (rami alveolares
superiores posteriores) depart from the infraorbital nerve in
an amount from 4 to 8. A smaller part of them does not enter the thickness of the
bone tissue and spreads down the outer surface of the tubercle towards the alveolar
process. End up
Rice. 7. The structure of the trigeminal nerve (scheme
100
J - trigeminal node; 2 - the orbital nerve; 3 - the maxillary nerve; 4 - mandibular

nerve; 5 - the bottom of the IV ventricle; 6 - lingual nerve; 7 - motor fibers
innervating the chewing muscles.
56
Rice. 8. Maxillary nerve.

1 - posterior upper lune branches; 2 - zygomatic nerve; 3 - the maxillary nerve; 4 -
the nerve of the pterygoid canal; 5 - the orbital nerve; 6 - trigeminal nerve; 7 -
mandibular nerve; 8 - drum string; 9 - ear node; 10 - connecting branches of the
pterygoid-palatine node with the maxillary nerve; 11 - chewing nerve; 12 - lower
alveolar nerve; 13 - lingual nerve; fourteen
- pterygoid-palatine node; 15 - infraorbital nerve; 16 - anterior upper lune branches.
101
they are in the periosteum of the upper jaw, adjacent to the alveolar process, the
mucous membrane of the cheeks and gums from the vestibular side at the level of
large and small molars. Most of the posterior upper alveolar branches through the
foramina alveolaris posteriora penetrate into the canalis alveolaris, from which they
exit to the outer surface of the upper jaw and enter its bony tubules. These nerves
innervate the tubercle of the upper jaw, the mucous membrane of the maxillary sinus,
the upper large molars, the mucous membrane and the periosteum of the alveolar
process within these teeth. The posterior upper alveolar branches take part in the
formation of the posterior part of the upper dental plexus.
In the pterygopalatine fossa, less often in the posterior part of the infraorbital sulcus,
the middle superior alveolar branch departs from the infraorbital nerve
(ramus alveolaris superior medius). Sometimes the latter is represented by two
stems. It passes through the thickness of the anterior wall of the upper jaw and
branches into the alveolar process. This branch takes part in the formation of the
middle section of the upper dental plexus, has anastomoses with the anterior and
posterior upper alveolar branches, innervates the upper small molars, the mucous
membrane of the alveolar process and the gums from the vestibular side in the area
of these teeth.
In the anterior part of the infraorbital canal, the anterior superior alveolar branches
(rami alveolares superiores anteriores) - 1-3 stems depart from the infraorbital nerve.
These branches can, however, branch off from the infraorbital nerve along the entire
length of the infraorbital canal or sulcus, at the level of the infraorbital foramen and
even after the main trunk leaves it. The trunks of the anterior alveolar nerve can exit
in one canal (infraorbital)
with the infraorbital nerve or located in a separate bone canal. Passing through the
thickness of the anterior wall of the upper jaw medial to the middle upper alveolar
branch, the anterior upper
+
the alveolar branches take part in the formation of the anterior part of the upper
dental plexus. They innervate the incisors and canines, the mucous membrane and
periosteum of the alveolar process and the mucous membrane of the gums from the
vestibular side in the area of these teeth. From the anterior superior alveolar
branches, the nasal branch departs to the mucous membrane of the anterior fundus
of the nose, which anastomoses with the nasopalatine nerve.
102
The posterior, middle and anterior upper alveolar branches, passing through the
thickness of the walls of the upper jaw, anastomosing with each other, form the upper
dental plexus - plexus dentalis superior. It anastomoses with the same plexus of the
other side. The plexus is located in the thickness of the alveolar process of the upper
jaw along its entire length above the tops of the roots of the teeth, as well as in the
upper parts of it in the immediate vicinity of the mucous membrane of the maxillary
sinus.
A number of branches extend from the upper dental plexus:

a) dental branches (rami dentales), going to the pulp of the teeth;
b) periodontal and gingival branches (rami periodontales et rami gingivales), which
innervate the periodontium of teeth and gum tissue;
c) interalveolar branches, going to the interalveolar partitions, from where branches
depart to the periodontium of the teeth and the periosteum of the jaw;
d) to the mucous membrane and bony walls of the maxillary sinus.
Topic 8. Tooth extraction operation, indications and contraindications.
Tooth extraction techniques. Suture methods

to study the techniques of tooth extraction, periostomy, to know the features of the
maxillofacial region during the operation of tooth extraction

− indications and contraindications for the removal of permanent teeth
− NSpreparation for tooth extraction
− tooth extraction technique
− complications of tooth extraction
− prevention of complications
- Problem lecture.
103

Tooth extraction operation
The operation of tooth extraction includes a number of successively performed

techniques, as a result of which, after the forcible separation of tissues, a tooth or a
tooth root is extracted from the hole.
Indications for tooth extraction.
The most common indication for tooth extraction is the need to sanitize the oral
cavity in the presence of chronic periodontitis in the acute stage, when it is
impossible to eliminate the inflammatory focus at the apex of the tooth. Multi-rooted
teeth, which are the cause of odontogenic osteomyelitis, are also removed. The
dentist can remove teeth when fitting a removable denture, but there must be strict
indications for this.
So, the indications for tooth extraction are the following situations and groups of
diseases:
1. Acute stage of odontogenic osteomyelitis (this is an emergency).
2. Odontogenic purulent periostitis, phlegmon, peri-maxillary abscesses,

lymphadenitis, sinusitis in the acute stage.
3. Exacerbation of chronic periodontitis with ineffectual conservative treatment,

obstruction of root canals, pronounced tooth mobility, pronounced purulent
inflammation in the periodontium.
4. Roots of teeth, if they cannot be used for prosthetics.
5. A tooth located in the area of the fracture of the alveolar process is removed, since
it interferes with the reposition of fragments or is a conductor of infection.
104
6. Removed ratified teeth, complicated by the development of cysts, pain, purulent

inflammation, etc.
7. A tooth is removed, which causes permanent trauma to the tongue and oral
mucosa, if this cannot be removed by grinding or prosthetics.
8. III-IV degree of tooth mobility with periodontal disease.
9. Radical removal of tumors.
10. Lower macrognathia (in children, the rudiments of 8 | 8 teeth are removed to
delay the growth of the lower jaw).
11. In orthodontic treatment of malocclusion to free up space for moving teeth.
12. The Popov-Gedon phenomenon.
13. Supernumerary and dystopic teeth.
Contraindications to tooth extraction.
There are a number of conditions in which tooth extraction is contraindicated.

Contraindications to tooth extraction are divided into absolute and relative, general
and local. Extraction of teeth is absolutely contraindicated in case of diseases of the
cardiovascular system in the stage of decompensation, myocardial infarction, blood
diseases with impaired coagulation system. Relative contraindications are acute viral
respiratory diseases, some diseases of the nervous system (psychosis, epilepsy),
hypertension, coronary heart disease. In such cases, it is necessary to stabilize the
patient's condition, and only then carry out the extraction of the tooth.
The absolute local contraindications include the presence of a hemangioma in the

area of the tooth, a malignant tumor. Relative local contraindications are angina,
acute stomatitis, gingivitis.
With an exacerbation of a number of diseases and physiological conditions, the

operation of tooth extraction must be postponed until such conditions subside or the
onset of remission in the clinic. These conditions include:
• Cardiovascular diseases during the crisis: hypertension, angina pectoris,

myocardial infarction (in the first 6 months), endocarditis, arrhythmias, etc.
• Acute renal failure.
105
• Acute infectious hepatitis.
• Acute leukemia, agranulocytosis.
• Hemorrhagic diathesis.
• Mental illness during an exacerbation.
• Acute circulatory disorders (fainting, collapse, shock).
• Acute infections.
• Acute anaerobic and aerobic infection.
• Acute radiation sickness.
• I, II, IX months of pregnancy due to the risk of miscarriage and premature birth.
• Menstruation.
• Stomatitis.
• Radiation therapy for cancer.
Preparation of the operating field
In order to reduce bacterial contamination, remove food debris, prevent the ingress
of dental plaque into the socket of the removed tooth, the following measures are
taken:
remove dental deposits from the removed and adjacent teeth,
+
suggest the patient to rinse the mouth with an antiseptic solution: 100-150 ml of
potassium permanganate solution 1: 1000, furacilin 1: 5000.
Tooth Extraction Tools
To remove teeth, various types of forceps are used, the design of which takes into
account the anatomical features of the structure of a certain group of teeth (Fig. 109,
A, B). To remove teeth with a destroyed crown (roots), both forceps with narrow
converging cheeks and elevators are used.
106
Rice. 109. Instruments for tooth extraction: A - forceps for removing teeth of the
upper jaw, B - forceps for removing teeth of the lower jaw, C - elevators for
removing roots of teeth
Extraction of teeth with forceps
The tooth extraction operation includes a number of preparatory and main stages.
Preparatory stages:
1. Giving the patient a position convenient for the operation of tooth extraction.
2. Selection of the optimal instrument (forceps) for the extraction of the target tooth.
3. Detachment of the gums from the

extracted tooth using a narrow raspatory, an elevator.
Rice. 110. Applying forceps: A - correct (the axis of the cheeks coincides with the
axis of the tooth), B - incorrect (the axis of the cheeks of the forceps does not
coincide with the axis of the tooth)
The main stages of the tooth extraction operation:
1. Application of forceps. Having opened the forceps, they are placed on the crown
of the tooth to be extracted so that the axis of the cheeks coincides with the axis of
the tooth (Fig. 110).
2. Advancement of forceps. After application, the forceps are advanced under the
detached gum to the tooth neck, which provides the necessary conditions for good
fixation of the forceps (Fig. 111). When removing a tooth with a destroyed crown,
the cheeks of the forceps are moved under the gum along the alveolar edge of the
jaw to a depth of 4-5 mm to prevent fracture (breaking off) of the crown and secure
fixation of the forceps during dislocation and extraction of the tooth from the hole.
107
Rice. 111. Advancement of forceps during tooth extraction: A - with a preserved

crown, B - with a destroyed crown
3. Fixation of forceps. After making sure that after the forceps advance, the axis of
the cheeks coincides with the axis of the tooth, grasp the handles of the forceps with
all fingers of the hand and squeeze them with such force that the forceps and the
tooth make up a single system. If the force of compression of the tooth with forceps
turns out to be insufficient, then during the next technique - dislocation of the tooth
- slipping of the forceps is possible. If the tooth is compressed too much with forceps,
a fracture (breaking off) of the crown is possible.
4. Tooth dislocation (luxatio). Dislocation of the tooth aims to destroy the
periodontal fibers that hold the tooth, to push the walls of the alveoli and thereby
prepare the necessary conditions for the extraction of the tooth. Dislocation is carried
out by pendulum-like and rotational movements (Fig. 112). Rotational movements
used for dislocation of single-rooted

teeth of the upper and lower jaw.
Rice. 112. Biomechanism of dislocation of the teeth of the upper jaw with forceps:
A, B - with pendulum-like dislocating movements, the tooth-forceps system act
alternately as a lever of the first and second kind, C - during rotational dislocation
movements, the tooth-forceps system acts as a gate
Dislocation of multi-rooted teeth on the upper jaw is carried out with pendulum
movements in the buccal-palatal direction. During the dislocation of multi-rooted
teeth on the lower jaw, pendulum movements with the handles of the forceps are
108
carried out they alternately go down

and up (Fig. 113).
Rice. 113. Biomechanism of dislocation of a multi-rooted tooth of the lower jaw: A
- the tooth-forceps system acts as a lever of the second kind, B - as a lever of the first
kind
During the dislocation of the upper jaw tooth, especially during the period of
mastering the technique of this operation, it is advisable to fix the alveolar process
with the fingers of the left hand, and when removing the lower teeth - the lower jaw
(Fig. 114). This technique allows you to measure the magnitude of the effort applied
by the doctor and thereby prevents the occurrence of complications such as a fracture
of the alveolar process of the upper jaw, dislocation of the lower jaw.
Rice. 114. Fixation with the left hand of the alveolar process of the upper jaw (A) of
the lower jaw (B) during tooth extraction
109
5. Extraction of the tooth from the socket. After complete separation of the tooth
from the surrounding tissues, it is removed by a rotational or "eversion" movement.
Extraction of teeth and roots of teeth with an elevator
There are three types of elevators: straight,

angular, bayonet (Fig. 109, B). The method of their application is based on the use
of the principle of leverage. So, when the root is removed, the pointed working part
of the straight elevator is forcefully introduced into the periodontal fissure and it is
pushed into the depth by reciprocating rotational movements. The elevator, acting
like a wedge, expands the periodontal gap, breaks the fibers of the periodontium
(Fig. 115). After the introduction of the end of the elevator by 0.4-0.6 cm, it acts as
a lever of the first kind with a fulcrum in the region of the edge of the alveoli. In this
case, the force transmitted to the end of the elevator causes the extrusion
(dislocation) of the tooth root from the alveolus.
Rice. 115. Biomechanism of tooth root extraction with a straight elevator: the
elevator is used as a wedge (A) and as a lever of the first kind (B)
Similarly, a straight elevator is

used when removing third molars, acting as a lever of the first kind with a fulcrum
in the area of the apex of the interdental septum (Fig. 116).
Rice. 116. Biomechanism of removal of the upper (A) and lower third molars (B) by
a straight elevator
110
To remove the roots of the lower

molars and incompletely erupted third molars, side elevators and a bayonet-shaped
Lecluse elevator are used (Fig. 117).
Rice. 117. Biomechanism of tooth root extraction with a lateral elevator (A) and
lower third molar with a bayonet-shaped Lecluse elevator (B)
First, one of the roots of the tooth is removed with forceps or a straight elevator,
after which a lateral elevator is inserted into its hole and the second root is pushed
out (dislocated) by rotating the handle.
The tools recommended for the removal of individual groups of teeth with a
preserved and destroyed crown (roots) are shown in Fig. 118-121.
After tooth extraction, the entrance to the hole is covered with a gauze "ball", which
is held by the patient for 10-15 minutes. 3-4 hours after tooth extraction, the patient
is allowed (recommended) to irrigate, rinse the mouth with a warm antiseptic
solution, decoction of herbs (St. John's wort, celandine, etc.) every 50-60 minutes.
111
Rice. 118. Instruments recommended for the extraction of upper jaw teeth with
preserved coronal part
Rice. 119. Instruments recommended for the extraction of teeth of the upper jaw
with a destroyed coronal part (roots)
112
Rice. 120. Instruments recommended for the extraction of teeth of the lower jaw
with preserved coronal part
Rice. 120. Continuation

+
113
Rice. 121. Instruments recommended for the extraction of teeth of the lower jaw
with a destroyed coronal part (roots)
Topic 9. Periodontology introduction to the section. Periodontal structure,

physiology of periodontal tissues, their diseases and classification
2. Goals and objectives:

− acquisition of theoretical knowledge in the field of periodontology
− study of modern aspects of the etiology and pathogenesis of periodontal
diseases
− study of the features of examination of patients with periodontal diseases;
− mastering the basics of diagnosis and treatment of periodontal diseases
− familiarization with complications in the treatment of periodontal diseases
and with methods for their elimination
− study of the procedure for processing medical documentation in the
management of patients at a periodontal appointment
114
− the formation of practical skills necessary for the independent work of a

periodontist in an ambulatory-prophylactic institution to show the population of
periodontal care in compliance with the basic requirements of medical ethics and
deontological principles
− study of the system of objective criteria for assessing the effectiveness and
safety of modern methods of treating periodontal diseases
− the formation of practical skills for the independent search and application of
knowledge on the treatment of periodontal diseases, the use of international systems
and databases for this purpose, allowing to receive and introduce into clinical
practice modern information in the field of periodontology
− formation of students' skills in collegial management of patients with
periodontal pathology. Determination of the need to attract specialists from related
specialties and the amount of necessary intervention;

− structure and function of the periodontium
− classification of periodontal diseases
− methods of periodontal research
− etiology and pathogenesis of periodontal disease
− treatment methods
1. Artyushkevich A.S., Trofimova E.K., Latysheva S.V. Clinical

Periodontology: A Practical Guide.- Minsk: Urajay, 2002.- 303 p.
2. Bezrukova I.V. Rapidly progressive periodontitis: Etiology, clinic, treatment:
Author's abstract. dis. ... Dr. med. nauk.- M., 2001.- 40 p.
3. A.I. Grudyanov Periodontics. Selected lectures.- Moscow: JSC
"Stomatology", 1997.- 32 p.
4. Ivanov VS Periodontal diseases, - 3rd ed., Revised. and additional - M .:
Medical Information Agency, 1998. - 296 p.
5. Kankanyan A.P., Leontiev V.K. Periodontal Diseases: New Approaches in
Etiology, Pathogenesis, Diagnosis, Prevention and Treatment /.- Er .: Tigran Mets,
1998.-360 p.
115
6. Kurakina N.V., Kutepova T.F. Periodontal diseases .- M .: Medical book,

N.Novgorod: Publishing house of NGMA, 2000.-162 p.
7. Modina T.N. Pathogenetic criteria for the diagnosis and treatment of various
forms of rapidly progressive periodontitis: Author's abstract. dis. ... Dr. med. nauk.-
M., 2002.- 43 p.
8. Sivovol S.I. Clinical aspects of periodontology. - 2nd ed., Rev. and additional
- M .: Ed. "Triada-X", 2001. - 166 p.
The periodontium includes a complex of tissues that have a genetic and functional
commonality: periodontium, alveolar bone, gum with periosteum. Some authors
include in the periodontal complex and tooth tissue (cement, for example). But in
this case, the meaning of the word (para - about iodontos - tooth) changes. Thus, the
concept of "periodontium" is an artificially isolated structural element of the
masticatory system (periodontal tissues), by which N.K. Loginova [1995] suggests
understanding the interaction of various elements (teeth, jaw bones,
temporomandibular joints, chewing muscles, tongue , salivary glands), aimed at
achieving the final result - the formation of a food lump suitable for swallowing.
When reading this section in the literature, you may come across such terms (see
"Appendix 1 - Glossary of modern terms for characterizing the state of periodontal
disease in health and disease" - report of the WHO scientific group No. 621, Geneva,
1980), as:
1. alveolar ridge - the crown edge of the alveolar process, ending close to the
contours of the enamel-cement border;
2. connective tissue attachment - fibers of the connective tissue of the gums and
periodontal ligament, growing into the cement of the root;
3. periodontal junction - a bridge between the gum tissue and the part of the tooth
that is covered by the gum;
4. gum - the epithelial-connective tissue surrounding the tooth and the alveolar
ridge attached to them and extending to the mucogingival junction (i.e., to the
clinically distinguishable line between the gum and the alveolar ridge mucosa);
5. gingival margin - the line of the gingival tissue, which is the junction of the
gingival epithelium and the epithelium of the groove;
6. gingival groove (gingival gap) - a small groove between the tooth and most
of the gums, located between the epithelial attachment (the biological mechanism of
attachment of epithelial cells of the connective epithelium to the surface of the
tooth), i.e. the lower part of the groove and the edge of the gums. This is an
anatomical concept;
7. clinical gingival groove - the space that is created by the introduction of a
probe between a healthy or slightly inflamed gum and the surface of the tooth. It is
always deeper than the anatomical groove;
116
8. interdental papilla - part of the gum tissue protruding above the crown, filling
the space between the contact surfaces of the tooth, both from the labial (buccal) and
lingual (palatal) sides.
We will get acquainted with the terms for characterizing diseases (diseases) of the
periodontium as we further elaborate on this problem. Periodontal functions:
1. barrier function, which is provided by:
● the ability of the gum epithelium to keratinization (with periodontal disease,
this function is impaired);
● a large number and features of the direction of bundles of collagen fibers;
● turgor of the gums;
● the state of mucopolysaccharides of connective tissue formations of the
periodontium;
● structural features of the gingival groove;
● the antibacterial function of saliva due to the presence in it of such biologically
active substances as lysozyme, inhibin, etc .;
2. trophic function is provided by a wide network of capillaries and nerve
endings;
3. function of reflex regulation of chewing pressure - irritation of numerous
nerve endings is transmitted through a wide variety of reflex highways;
4. plastic function consists in the constant reconstruction of tissues lost in the
course of physiological or pathological processes (osteoblasts, fibroblasts, etc.);
5. the shock-absorbing function is provided by the presence of collagen, elastic
fibers of the periodontium and the fluid contained in the vessels and tissues.
A great contribution to the development of the problem of periodontal diseases was
made by such domestic scientists as: A. I. Evdokimov, E. E. Platonov, N. F.
Danilevsky, G. D. Ovrutsky, G. N. Vishnyak, T. F. Vinogradova, T. I. Lemetskaya,
E. V. Borovsky, V. S. Ivanov , M. M. Tsarinsky, T. V. Nikitina, A. P. Bezrukova,
L. A. Dmitrieva, A. I. Grudyanov, A. P. Kankanyan, V. K. Leontiev and others.
At the Department of Therapeutic Dentistry of the Smolensk State Medical
Academy, the following worked and are working on this problem: L. M. Tsepov, V.
G. Morozov, E. V. Petrova, N. S. Levchenkova, S. N. Lozbenev, A. I. Nikolaev, L.
B. Turgeneva, A. P. Khromchenkov, E. N. Zhazhkov, N. N. Usoltseva. They
defended dissertations, prepared and published monographs, reference manuals,
guidelines, developments, letters, received patents for inventions.
There is a lot of data on the systematization and classification of periodontal
diseases. The systematization of diseases in general and periodontal diseases in
particular provides for the assignment of certain nosological forms of pathology to
the main (typical) pathological processes - inflammation, dystrophy, tumors and
tumor-like lesions. As for the classifications, some of them are of historical interest,
some are set out in textbooks on therapeutic dentistry. It is necessary to dwell in
117
more detail on the domestic classification adopted in November 1983 by the 16th
Plenum of the Board of VNOS in Yerevan. This classification is still used in Russia.
This classification provides for the allocation of inflammatory (gingivitis,
periodontitis), dystrophic (periodontal disease), idiopathic and tumor (tumor-like) in
their morphological and clinical essence of periodontal lesions.
1. Gingivitis is an inflammation of the gums caused by the unfavorable effect of
general and local factors and proceeding without violating the integrity of the
gingival attachment. Forms: catarrhal, hypertrophic (more correctly, hyperplastic),
ulcerative. Current: acute, chronic, aggravated, remission. Prevalence: localized,
generalized. : light, medium, heavy.
2. Periodontitis is an inflammation of the periodontal tissues, characterized by
progressive destruction of the periodontium and bone. As can be seen from the
definition given by the authors of the classification to this type of pathology, for
some reason an indication of the cause of its occurrence "dropped out" from it. Only
a characteristic of the pathological process is given. Course: acute, chronic,
exacerbated (including abscess), remission. Prevalence: localized, generalized.
Severity: light, medium, severe.
3. Periodontal disease is a periodontal dystrophic lesion. Here, as you can see,
there is generally no reference to the cause of the onset of the disease, and its
characteristics (except for indicating the morphological essence of the process).
Course: chronic, remission. Prevalence: generalized (it was easier to indicate this,
giving the definition of the disease). Severity: mild. , medium, heavy.
4. Idiopathic periodontal diseases with progressive lysis of periodontal tissues
(Papillon-Lefebvre syndrome, histiocytosis X, akatalasia, neutropenia,
agammaglobulinemia, uncompensated diabetes mellitus). We share the point of
view of TI Lemetskaya about the inexpediency of introducing the concept of
"idiopathic diseases", since this removes responsibility from the dentist for
clarifying the general disease that caused periodontolysis. The term "idiopathic"
implies an unclear etiology. And here not everything agrees with the logic, since the
etiology, for example, of diabetes mellitus is known.
5. Periodontomas are tumor and tumor-like processes in the periodontium.
Thus, the main categories used by the authors of this classification when
systematizing periodontal diseases were: the clinical form of the disease, indicating
the morphological nature of the lesion, its prevalence, severity and staging in this
form. At the same time, there is no consistency in its compilation: with a more than
detailed presentation of data concerning many aspects of gingivitis, the characteristic
of group 5 (periodontal disease) states the well-known fact that "periodontomas" are
tumor and tumor-like processes in the periodontium.
This classification, unfortunately, does not provide for any other forms of
periodontal pathology (for example, rapidly progressive periodontitis, other
118
"aggressive" manifestations), nor complications of periodontal diseases, nor their

outcome, nor their prognosis, nor the possibility of combined lesions.
From the point of view of formal logic, the main task of classification is to
systematize the accumulated knowledge by drawing up a more or less strict system
of subordinate concepts (classes). The classification is based on logical rules for
dividing the volume of concepts and ordered distribution, combining objects into
classes based on their similarities and differences [Tarasov K.E et al., 1989]. The
natural classification of diseases contributes to a more adequate recognition of
diseases, because without it, it is impossible to logically correct and differentiate in
the diagnosis of diseases.
A correctly drawn up classification must satisfy a number of requirements related to
the division of concepts.
1. Division into classes should be carried out on a single basis (attribute). Failure
to adhere to a single basis makes the division confusing and cross-cutting, thus, the
entire classification is also erroneous.
2. The division must always be proportionate. This means that the sum of all
division members must completely exhaust the entire scope of its class (generic
concept). Otherwise, the division turns out to be incorrect - either too wide or too
narrow
3. Members of the division of the same row must be mutually exclusive.
Consequently, each of the objects included in this class can be attributed only to one
of the division members and in no case to several members of this series at once (as,
for example, it was done for periodontitis in groups 2 and 4 of the specified
classification).
4. The division basis must be a sign indicating a significant difference between
the division members.
In the classification of periodontal diseases, such signs should be the features of the
etiology, pathogenesis, localization of the pathological process, some clinical
features of the disease, i.e. signs characterizing the essence and specifics of the
nosological form. Features of the course, the presence of complications, etc. can also
be such essential signs. It seems completely natural that the end members of the
division in the classification of periodontal diseases should be separate nosological
forms known to modern clinical medicine.
It should be recalled that nosological signs for denoting diseases are diverse, and
their meanings are determined extremely loosely. The above-mentioned authors of
the monograph (Tarasov K.E. et al., 1989) "Logic and semiotics of diagnosis" offer
the following designations:
1. +
2. The pathological process is the inner essence and course of the disease.
119
3. Disease is an external manifestation of a pathological process.

4. Disease - detection of the onset of disease phenomena and the fact of the
existence of a disease in a given person,
5. Nosological unit (nosological form) - the designation of a disease, according
to the existing nomenclature and classification of diseases, which must be updated
every 10 years.
The features of examination of patients with periodontal diseases are influenced by
the following:
1. difficulty in identifying the cause of the disease and its pathogenesis,
2. periodontal disease is a collective term that unites a large group of periodontal
lesions, different in etiology and pathogenesis,
3. close connection of periodontal diseases with pathology of internal organs and
body systems
4. a dentist at an outpatient appointment is very limited in time,
5. the need to interact with orthopedists, surgeons, orthodontists, internists,
6. long-term, steadily progressive nature of periodontal diseases,
7. the need to use a large number of different index indicators and other
additional research methods.
Diagnostics of any disease is a very complex system of interweaving of all logical
methods and types of inferences. There has long been an opinion that, they say, the
diagnosis of periodontal disease is not difficult. This common statement is based on
the fact that "everything is visible here", everything is available for research and
there is no need, as internists do, to carefully examine patients.
Diagnostics is always an algorithm, the effectiveness of which depends on the
quality of information, both initial and secondary, coming in the form of feedback,
i.e., the diagnostic process. The first requirement for the algorithm is the clarity of
the structure. The first structural unit of the diagnostic algorithm is the patient's
complaints. The latter are objectified using the second informational unit of the
diagnostic algorithm - anamnesis. Examination is the first check of the diagnosis
version (Old doctors said: "Woe to the doctor who examines the patient at the very
beginning of the disease"). Verification of the diagnosis is a paraclinical study, and
here half, if not all of the success depends on a clear examination plan. The plan is
based on two points: to know what to look for, to have, what to look for [Artamonov
R., 1995]. Clinical diagnosis is the pinnacle of diagnostics. At this stage, a detailed
diagnosis of a specific clinical case is formulated according to the modern
nomenclature and classification of diseases. Therefore, a clinical diagnosis is a
complete characteristic of a clinical case that meets the current level of medical
science.
The traditional approach to the diagnosis of periodontal disease is to assess the
condition of the gums, the level of decreased attachment of the periodontal ligament
120
to the root of the tooth, the presence of supra- and subgingival dental deposits, the
level of resorption of the alveolar process according to the radiograph.
Diagnosis of periodontal disease, as a rule, is still carried out on the basis of
anamnesis and examination. Most of the periodontal indices proposed for assessing
the state of the periodontium are not standardized, therefore, the opinion of a number
of authors about them is different, but in practice, dentists show a reasonable
restrained attitude towards them. In addition, the assessment of the hygienic state of
the oral cavity and the severity of an already developed pathological process helps
little to diagnostics.+
The purpose of the diagnostic process is not to detect a disease in general, but to
identify a very specific disease. The doctor judges the disease on the basis of its
symptoms, thinks in nosological categories.
The diagnostic process includes 3 sections:

1. technical, covering knowledge, medical diagnostic technique, specific
research techniques;
2. semiotic - the study of the diagnostic value of symptoms and syndromes of
the disease;
3. logical - a study of the characteristics of medical thinking.
Symptom is a sign of a pathological condition or disease, a unit of nosology, one of
the elements of morpho-functional changes in the body.
Syndrome is a specific combination of several internally interrelated symptoms, a
set of symptoms united by a single pathogenesis.
The methodology of diagnosis includes the problems of epistemology, logic,
semiotics, semantics, focused on the specifics of medical diagnosis. In a semiotic
sense, diagnostics is a process of designating a disease based on knowledge of its
signs and finding these signs in a patient on the basis of the existing classification
and nomenclature of diseases.
The diagnosis of a disease is the most essential part of the doctrine of diagnosis and
is the basis for documenting diseases in medical practice. In constructing a diagnosis,
the leading is the nosological principle, according to which the diagnosis should:
● contain the name of a specific disease as provided for by the current
nomenclature;
● include not only the designation of its essence (reflected in the name of the
nosological form, for example, "periodontitis");
● indicate, if possible, the nature of the disease (the etiological component of
the diagnosis), the pathogenesis of the main manifestations or complications (the
121
pathogenetic component of the diagnosis), the pathological expression (the

morphological component of the diagnosis), the nature and degree of disturbances
in the activity of individual physiological systems (the functional component of the
diagnosis).
In most cases, periodontal disease is closely associated with various and multifaceted
pathology of internal organs and systems, so patients need a comprehensive
examination, both clinical and laboratory. Therefore, they apply:
1. Laboratory studies, which may be required both to establish and confirm the
diagnosis, and to determine the prognosis and control of the course of the disease
and the effectiveness of treatment. These studies are usually carried out for disorders
of hematopoiesis, infections, tumors, allergic conditions and immunopathies. The
material for laboratory research can be various biological fluids: blood (whole,
plasma, leukocytes and erythrocytes), saliva, oral fluid, cheap fluid, as well as tissues
(gums, granulation tissue) obtained by excision, scraping, puncture, etc. ...
2. Allergic tests are important in assessing the patient's condition. Application
techniques are used more often. The results are taken into account after 10-20
minutes (immediate type reactions), 24, 48 and 72 hours (delayed type reactions).
3. Biochemical studies make it possible to assess the collagenolytic activity of
the gingival fluid, the intensity of bone tissue breakdown, blood glucose, etc.
4. Immunological studies include determining the number of lymphocytes and
the functional activity of the links of the immune system. For a dentist, it is important
to choose an adequate research method, an understanding of the fundamental
essence, the ability to correctly interpret the results of immunological studies, and to
make corrections on their basis in therapeutic measures.
5. Periodontal indices, which are subdivided into reversible (PMA, Russell,
etc.), based on such signs as inflammation, bleeding, tooth mobility, reflecting the
dynamics of the pathological process and the effectiveness of treatment, and
irreversible (complex) - the X-ray index , index of gingival atrophy, index Ketchke,
Ramfjord, allowing to obtain data on the resorption of bone tissue of the alveolar
process.
6. X-ray of teeth, alveolar bone, jaws is the main method of X-ray examination,
the most important way to assess the condition of bone tissue in case of periodontitis,
periodontal disease, idiopathic periodontal diseases. To characterize pathological
changes in the analysis of an X-ray, take into account: the expansion of the
periodontal gap, osteoporosis of the interalveolar septum (in which there is a
decrease in the number of bone beams per unit volume), destruction of the cortical
plate of the alveoli, vertical and horizontal resorption of the alveolar 'process.
Within the framework of this lecture, it is not possible to present all the research
methods used in periodontology. It should be noted that most objective methods
characterize only one of the links in the pathogenesis of periodontal disease. A
122
simple, formal combination (or summation) of the external manifestations of the

disease cannot lead to the correct diagnosis.
A practical dentist in a mass outpatient appointment needs a set of diagnostic tests.
In the scheme below (see the table) of additional research methods, those that make
up the minimum that help the doctor in any conditions to navigate for the correct
diagnosis are marked in bold. The left half of the table (column) shows the main
signs of periodontal disease, and the right half - the methods for their identification
and assessment. Methods that can be used in any dental setting are highlighted in
bold in the table.
Details of the features of clinical and laboratory diagnostics of periodontal diseases
can be found in the reference manual prepared by the staff of the Department of
Therapeutic Dentistry of the SSMA and published by typographic method in 1995,
as well as in the book "Diagnosis and Treatment of Periodontal Diseases" (Moscow,
MEDpressinform, 2002). In conclusion, a few words about periodontal sounding
systems offered by various foreign companies and their place in the diagnosis of
periodontal diseases. Of course, this device based on digital technologies saves
research time, ensures the accuracy of the results obtained, and ensures that the
patient understands his disease. But it requires special training of personnel and costs
the hospital several thousand dollars.
Table. Additional research methods for periodontal diseases
Symptoms of Detection and assessment methods

periodontal disease
1. Chronic
inflammation of the 1.
gums, suppuration Schiller-Pisarev test
from periodontal 2. Investigation of the parameters of a cheap liquid
pockets (DC)
3. Benzidine test
4. Bacteriological examination of the contents of
periodontal pockets (PC)
5. Gingival and PC thermometry
6. Study of water fractions in the oral fluid (OR)
123
2. The presence of
periodontal pockets 1.
PC Depth Measurement
2. X-ray of alveolar processes and teeth with filling
of the PC with contrast agents
3. Supra- and
subgingival dental 1.
deposits Staining "dental" plaque
4. Resorption of bone
tissue of the alveolar 1.
bone Dental radiography
2. Panoramic X-ray
3. Orthopantomography
4. Densitometric analysis of radiographs
5. Echoosteometry
6. Determination of concentration in blood of
alkaline phosphatase, calcium ions, citric acid,
hydroxyproline
5. Mobility of teeth,
violation of occlusion 1.
Determination of the degree of tooth mobility
2. Revealing premature teeth contacts using
occludograms
3. Revealing the functional overload of teeth by the
analysis of odontoparodontograms
6. Disturbances in the
periodontal 1.
microvasculature, Biomicroscopy (vital microscopy) of the gums
changes in tissue 2. Rheoparodontography
metabolism 3. Photoplethysmography
4. Kulazhenko test
5. Rotger's test
6. Determination of tissue oxygen balance
124
7. Changes in local
immunological 1.
reactivity and Determination of protective factors (lysozyme,
resistance of immunoglobulins, etc.)
periodontal tissues 2. Exfoliative cytology
3. Yasinovsky test
4. Test Kavetsky-Bazarnova
5. McClure-Aldrich test
8. Hyperesthesia of the
necks of the teeth 1.
Samples with mechanical, thermal and chemical irritants
9. Changes from other

organs and systems 1.
Clinical analysis of blood, urine
2. Biochemical blood test for glucose
3. Consultations and examination by an
endocrinologist, rheumatologist, gastroenterologist,
allergist, immunologist
4. Consultation with a dentist-surgeon, dentist-
orthopedist
2.2. Development of practical / seminar / laboratory classes
Topic 1. Carious lesions of teeth

1. Purpose of the lesson:
study the anatomy of teeth, histological structure, physiological features, as well as
study carious lesions of the teeth, their classification, diagnosis and modern methods
of treating carious lesions.

● tooth anatomy
● terms and definitions of dentistry
● goals and objectives of dentistry in the treatment of caries
125
● research methods
● diagnostics
● treatment methods
- Problem lecture.

4. Borovskiy E.V. Therapeutic dentistry: textbook.
5. Yu.M. Maksimovsky, L.N. Maksimovskaya, L.Yu. Orekhova. Therapeutic
6. Afanasyev V.V., Barer G.M., Ibragimov T.I. Stomatology. Recording and
5. Basic concepts that must be mastered by students in the process of studying

the topic:
● cariogenicity
● hygiene index
● carious lesions
● Black classification
6. Questions for the lesson:

1. The purpose of the dental examination at the preventive dental appointment.
Equipping and organizing a workplace for a dental examination. Dental examination
methods
2. Interviewing the patient, assessing the general condition
3. External examination of the maxillofacial area
4. Study of the functions of the maxillofacial area
5. Methods of objective examination of the oral cavity. The sequence of objective
examination of the oral cavity organs. Rules for the use of tools.
6. Examination of the soft tissues of the oral cavity.
7. Study of the bite.
8. Examination of teeth. Dental formula recording rules.
7. Questions for self-control:

1. Objectives and methods for assessing the incidence. Features of the epidemiology
of dental caries. Units of measurement in assessing morbidity (person, tooth, tooth
surface, carious focus).
126
2. Prevalence of dental caries.

3. The incidence of dental caries: a) clinical registration of levels of caries D1-D4
(according to Axelsson); b) epidemiological method using the ICDAS II index; c)
determination of the epidemiological level of the intensity of dental caries and caries
of dental surfaces according to WHO (KPUZ, KPUZ, KPUZ + KPUZ; KPUP,
KPUP, KPUP + KPUZ); significant caries index SiC.
4. Dynamics of the intensity of caries: the concept of growth, reduction.
5. Assessment of the activity of dental caries: the form of activity of dental caries
(according to TF Vinogradova), PEC.
6. Assessment of the level of dental care (USP).
8. Venue
room 702, Department of "Clinical disciplines",
Eastern Medical Campus, Bishkek, st. April 7, 6
Topic 2. Pulpitis

to study the inflammation of the pulp of the tooth, the peculiarities of the course of
the disease, methods of examination and treatment

− Etiology
− Classification
− Pathogenesis
− Clinic
− Diagnostics
− Treatment

9. P.I. Roshchin.
127

the topic:
1. pulpitis
2. apex
3. radio-pole section
4. apex locator

1. Clinical and morphological signs of inflammation.
2. Basic and additional methods of examination of a dental patient.
3. Classification of pulp diseases according to ICD-10.
4. Differences in the structure of the coronal and root pulp.
5. Microorganisms that cause inflammation of the dental pulp.
1. Methods for examining the oral cavity.
2. Etiology of pulpitis.
3. Pulpitis pathogenesis.
4. Clinical picture of dentin caries (deep carious cavities).
8. Venue
Topic 3. Etiology, pathogenesis of inflammation
periapical tissues.
Classification of periodontitis diseases.
Methods for the diagnosis of periodontitis.

learn the definition of periodontitis, diagnosis, examination methods, treatment and
prevention

− Etiology
128
− Classification
− Pathogenesis
− Clinic
− Diagnostics
− Treatment

9. P.I. Roshchin.

the topic:
• Histological structure of the periodontium.
• Inflammation, etiology, pathogenesis.
• Methods of examination of a dental patient.
• Methods of treatment of root canals.
• Filling materials.

• The structure and functions of the periodontium.
• Clinical and morphological signs of inflammation.
• Examination methods used to diagnose periodontitis.
• Methods of treatment of root canals.

• Causes of periodontitis.
• Basic research methods required for the diagnosis of forms of chronic periodontitis.
129
• Additional research methods required for differential diagnosis of forms of chronic

periodontitis.
8. Venue
Topic 4. Introduction to orthopedic. dentistry

To master the general provisions and tasks of orthopedic dentistry, the main
nosological forms of diseases found in orthopedic dentistry.

● a brief history of the development of prosthetic dentistry
● main forms of diseases
● pathogenesis
● defect classification
● clinic
● pathological abrasion
- Problem lecture.
4. Literature:
● Orthopedi
c dentistry, Abolmasov N.G., Abolmasov N.N.
● Therapeutic dentistry Borovsky
● Orthopedic dentistry Lebedenko, Artyusov
● Orthopedic dentistry Trezubov, Shcherbakov

the topic:
● Department of Prosthetic Dentistry.
130
● Dental laboratory.
● Dental technician workplace.
● Equipment and tools for the manufacture of dentures.
● Dentures. Types of dentures: removable and non-removable.
● Materials for the manufacture of dentures: constructional and auxiliary.

● Content, goals, objectives, sections of orthopedic dentistry.
● The main structural units that make up the department of orthopedic dentistry
of the polyclinic
● The main production facilities that are part of the structure of the dental
laboratory. Sanitary and hygienic standards, which they must comply with.
● Organization of a dental technician's workplace.
● The concept of "denture". Types of dentures.
● Classification of materials for the manufacture of dentures
● What questions does the general section of prosthetic dentistry study?
● What equipment should be equipped with a dental technician's workplace?
● What types of dentures are fixed?
● What types of dentures are used to replace dental hard tissue defects?
● What types of dentures are used to replace dentition defects?
● What devices and instruments are used to make dentures?
● What materials belong to the groups of structural and auxiliary ones?
8. Venue
Topic 5. Preparation for different types of crowns

To master the main types of orthopedic structures, to study methods of preparation
for metal-ceramic and ceramic crowns
● Know the tools needed to prepare teeth for artificial crowns.

● Know the stages and principles of preparation of various groups of teeth for
artificial crowns.
131
● Know the auxiliary materials required for fixed prosthetics (impression

materials, waxes, etc.).
● To be able to prepare a tooth for various types of artificial crowns (stamped,
plastic, one-piece, one-piece with veneer).
● To be able to restore the stump of the prepared tooth with wax.
● Be able to wax the intermediate part of a bridge

− classification of orthopedic structures
− indications and contraindications
− preparation technique for different types of crowns
− aesthetic aspects of structures
− functional features of crowns
−
- Problem lecture.
● Shcherbakov A.S., Gavrilov E.N., Trezubov V.N., Zhulev E.N. Orthopedic

dentistry. St. Petersburg, IKF "Foliant", 1995.
● Kopeikin V.N., Guide to Prosthetic Dentistry. M., "Medicine", 1993.
● Zhulev E.N. Materials science in orthopedic dentistry. Nizhny Novgorod,
"NGMA", 2000.
● Kopeikin V.N., Demner L.M.Dental technology. M., "Triad-X", 1998.

the topic:
● The concept of "bridge".
● Indications for use.
● Structural elements of bridges. Types of bridges: according to the number of
supporting elements, according to the manufacturing technique (stamped-brazed
bridge, solid bridge), according to the materials for production (all-metal, plastic,
porcelain, combined).
● Cantilever prosthesis. Laboratory technology for the manufacture of a
stamped-brazed bridge. Supporting elements. Laboratory technology for the
manufacture of stamped metal crowns.
132
● Forms of the intermediate part (tangent, flush, saddle). Modeling the

intermediate part.
● Modeling materials.
● The concept of "bridge". Indications for the use of bridges.
● Components of bridges. Types of supporting parts of bridges.
● Types of bridges (according to the number of supporting elements, according
to materials, according to laboratory technology).
● Clinical and laboratory stages of manufacturing a stamped-brazed bridge
prosthesis.
● The sequence of stages in the manufacture of supporting elements of a
stamped brazed bridge.
● Types of the intermediate part of the bridge (by design, by material, by shape).
● Basic rules for modeling the intermediate part.
● Requirements to be met by the materials used to model the intermediate part.
● In what clinical cases is the manufacture of bridges contraindicated?
● What types of prostheses are bridges according to the method of transmission
of masticatory pressure?
● How can the supporting elements of a bridge be represented?
● What is the main difference between a stamped-brazed bridge and a one-piece
bridge?
● What is a cantilever prosthesis?
● What are the indications for its use?
● In what sequence are the laboratory steps carried out in the manufacture of a
stamped-brazed bridge prosthesis?
● What is the indication for the fabrication of the intermediate part of the bridge
of the tangent, wash forms?
● What techniques are used during the middle part modeling phase?
8. Venue
133
Topic 6. Methods of preparation for crowns, preparation features, taking

impressions, classification, methods of making crowns.

● indications and contraindications
● clinical laboratory stages of crown manufacturing
● preparation steps
● taking casts
● Markov B.P., Lebedenko I.Yu., Yerichev V.V. A guide to practical exercises

in prosthetic dentistry. Part 1. - M .: GOU VUNMTs MZ RF, 2001 .-- 662 p.
● Markov B.P., Lebedenko I.Yu., Yerichev V.V. A guide to practical exercises
in prosthetic dentistry. Part 2 - M .: GOU VUNMTs MZ RF, 2001 .-- 235s.
● Prosthetic dentistry: A textbook for students stomatologich. fac. honey.
universities. / Ed. V.N. Kopeikina, M.Z. Mirgazizov. - 2nd ed. add. - M .: Medicine,
2001 .-- 621 p.
● Trezubov V.N., Steingart M.Z., Mishnev L.M. Prosthetic Dentistry: Applied
Materials Science: Textbook for honey. universities. - SPb .: SpetsLit, 2001 .-- 480
p.
● Trezubov V.N., Shcherbakov A.S., Mishnev L.M. Prosthetic Dentistry:
Propedeutics and the Basics of a Private Course: A Textbook for Med. universities.
- SPb .: SpetsLit, 2001 .-- 480 p.
● Guide to Prosthetic Dentistry. / Ed. V.N. Kopeikin. - M .: Triada-X, 1998 .--
495 p.

the topic:
● The concept of "impression". Types of impressions.
● Materials for obtaining impressions. Requirements they must meet.
134
● Classification of impression materials.

● Composition and properties of zinc oxide eugenol (zinc oxide guaiacol)
impression materials. Indications for use.
● Composition and properties of elastic alginate materials. Indications for use.
● Composition and properties of silicone elastomeric materials. Indications for
use.
● Thermoplastic impression materials: composition, properties, application.

● Supporting materials. The concept of "impression"
● Types of impressions: working and auxiliary, anatomical and functional, one-
phase and two-phase. The concept of "impression materials". Classification of
impression materials
● Requirements to be met by impression materials. Properties of impression
materials: plasticity, impression efficiency, elasticity, deformation capacity,
strength, thermal stability, volumetric and linear shrinkage.
● The concept of "syneresis". Hard impression materials (gypsum, zinc oxide
eugenol, zinc oxide guaiacol)
● Elastic impression materials (alginate, silicone, polysulfide, polyester).
Thermoplastic impression materials.
● What is the chemical reaction underlying the structuring process of zinc oxide
eugenol (zinc oxide guaiacol) impression materials?
● For what purpose are fillers (talc, kaolin, chalk) introduced into the
composition of zinc oxide eugenol (zinc oxide guaiacol) impression materials?
● How is the base of alginate impression materials represented?
● What substance is added to the composition of alginate materials in order to
convert a soluble sodium alginate gel into an insoluble calcium alginate gel?
● What masses belong to the group of elastic rubber-like impression materials?
What properties are they characterized by?
● What groups are silicone impression materials divided into depending on the
mechanism of the vulcanization reaction?
● What is the reaction underlying the vulcanization (structuring) of K-silicone
impression materials? What is this reaction accompanied by?
● What substance is the catalyst for the polymerization reaction of A-silicone
impression materials?
135
8. Venue
Topic 7. Surgical dentistry, introduction, basic terms, manipulations.

to study the features of the anatomy of the maxillofacial region for anesthesia, to
know the classification of anesthetics used in dentistry. As well as mastering various
methods of anesthesia for surgical procedures.

− anesthetics used in dentistry
− drugs prolonging the effect of anesthetics
− tools
− methods of pain relief
− innervation of teeth and jaw
- Problem lecture.


the topic:
● Collection of complaints. Medical history. Anamnesis of life. Local status.
Inspection, palpation, percussion.
● Special equipment, apparatus and instruments for examining dental patients
and performing operations in the maxillofacial area.
136
● Investigation of the function of motor and sensory nerves. Examination of the

salivary glands, temporomandibular joint, regional lymph nodes of the face and
neck.
● Radiological: radiography, panoramic radiography, magnetic nuclear
resonance and computed tomography. Endoscopic examinations.

● Clinical and pharmacological characteristics of local anesthetic drugs used in
dentistry. The use of vasoconstrictors for local anesthesia (indications,
contraindications).
● Types of local anesthesia. Local anesthesia: choice of anesthetic, use of a
vasoconstrictor, mechanism of anesthesia.
● Potentiated local anesthesia. Combined pain relief.
● Innervation of the upper jaw. Methods for local anesthesia. Infiltration

anesthesia.
● Anesthesia of the upper posterior alveolar branches on the tubercle of the
upper jaw.
● Anesthesia of the upper anterior alveolar branches.
● Palatine nerve pain relief - at the foramen magnum. Pain relief of the
nasopalatine nerve.
● Anesthesia of the 2nd branch of the trigeminal nerve at the circular opening
(pterygopalatine anesthesia).
8. Venue
Topic 8. Tooth extraction operation, indications and contraindications.
Tooth extraction techniques. Suture methods

to study the techniques of tooth extraction, periostomy, to know the features of the
maxillofacial region during the operation of tooth extraction
137

− indications and contraindications for the removal of permanent teeth
− preparation for tooth extraction
− tooth extraction technique
− complications of tooth extraction
− prevention of complications
- Problem lecture.


the topic:
● Local complications: damage to nerves and blood vessels, muscles, infection,
post-injection jaw joint. The clinical picture. Diagnostics.
● Measures aimed at preventing the development of complications. Dentist
tactics.
● Common complications: fainting, collapse, anaphylactic shock, allergic
reactions.
● Providing emergency care. Prevention of complications.

● Types and methods of pain relief. Nasopharyngeal, endotracheal, intravenous
anesthesia.
● Indications and contraindications for general anesthesia.
● Features of intubation anesthesia during operations in the maxillofacial
region.
● Complications with general anesthesia. Resuscitation in dental practice.
138

● Instrumentation, surgical access, taking into account the structure of the skin,
the location of nerves, large vessels, chewing and facial muscles. Types of seams.
● Features of operations in the oral cavity.
● Patient preparation.
● Surgical field processing.
● Preparing the surgeon's hands.
8. Venue
Topic 9. Periodontology introduction to the section. Periodontal structure,

physiology of periodontal tissues, their diseases and classification
2. Goals and objectives:

− acquisition of theoretical knowledge in the field of periodontology
− study of modern aspects of the etiology and pathogenesis of periodontal
diseases
− study of the features of examination of patients with periodontal diseases;
− mastering the basics of diagnosis and treatment of periodontal diseases
− familiarization with complications in the treatment of periodontal diseases
and with methods for their elimination
− study of the procedure for processing medical documentation in the
management of patients at a periodontal appointment
− the formation of practical skills necessary for the independent work of a
periodontist in an outpatient-prophylactic institution to provide the population with
periodontal care in compliance with the basic requirements of medical ethics and
deontological principles
− study of the system of objective criteria for assessing the effectiveness and
safety of modern methods of treating periodontal diseases
− the formation of practical skills for the independent search and application of
knowledge on the treatment of periodontal diseases, the use of international systems
and databases for this purpose, allowing to receive and introduce into clinical
practice modern information in the field of periodontology
− formation of students' skills in collegial management of patients with
periodontal pathology. Determination of the need to attract specialists from related
specialties and the amount of necessary intervention;
139

− structure and function of the periodontium
− classification of periodontal diseases
− methods of periodontal research
− etiology and pathogenesis of periodontal disease
− treatment methods
9. Artyushkevich A.S., Trofimova E.K., Latysheva S.V. Clinical

Periodontology: A Practical Guide.- Minsk: Urajay, 2002.- 303 p.
10. Bezrukova I.V. Rapidly progressive periodontitis: Etiology, clinic, treatment:
Author's abstract. dis. ... Dr. med. nauk.- M., 2001.- 40 p.
11. A.I. Grudyanov Periodontics. Selected lectures.- Moscow: JSC
"Stomatology", 1997.- 32 p.
12. Ivanov VS Periodontal diseases, - 3rd ed., Revised. and additional - M .:
Medical Information Agency, 1998. - 296 p.
13. Kankanyan A.P., Leontiev V.K. Periodontal Diseases: New Approaches in
Etiology, Pathogenesis, Diagnosis, Prevention and Treatment /.- Er .: Tigran Mets,
1998.-360 p.
14. Kurakina N.V., Kutepova T.F. Periodontal diseases .- M .: Medical book,
N.Novgorod: Publishing house of NGMA, 2000.-162 p.
15. Modina T.N. Pathogenetic criteria for the diagnosis and treatment of various
forms of rapidly progressive periodontitis: Author's abstract. dis. ... Dr. med. nauk.-
M., 2002.- 43 p.
16. Sivovol S.I. Clinical aspects of periodontology. - 2nd ed., Rev. and additional
- M .: Ed. "Triada-X", 2001. - 166 p.

the topic:
● Anatomical and histological features of the structure of the mucous membrane

of the gums, periodontal tissue, root cement and alveolar bone.
● Gingival junction, physiology of the gingival groove, gingival fluid.
140
● Periodontal functions.
● Age-related periodontal changes.
● X-ray characteristics of the periodontium are normal

● acquisition of theoretical knowledge in the field of periodontology;
● study of modern aspects of the etiology and pathogenesis of periodontal
diseases;
● study of the features of examination of patients with periodontal diseases;
● mastering the basics of diagnosis and treatment of periodontal diseases;
● familiarization with complications in the treatment of periodontal diseases
and with methods for their elimination;
● familiarization with the principles of organization and operation of the clinic
of periodontology;

● What are the distinctive structural features of the oral epithelium, groove
epithelium and attachment epithelium?
● How is the blood supply and innervation of the periodontal tissues carried
out?
● How is the periodontal barrier function carried out? What are the factors of
local protection?
● What is the ratio of the height of the apex of the interalveolar septum and the
enamel-cement junction in people 18 and 50 years old without periodontal
pathology?
8. Venue
3. Methodical recommendations for students
141
3.1. Methodical recommendations for students on the study of the discipline

The study of the theoretical part of the disciplines is designed not only to deepen and
consolidate the knowledge gained in the classroom, but also to promote the
development of students' creative skills, initiative and organize their time.
The material outlined in the lectures must be regularly worked out and supplemented
with information from other sources of literature, presented not only in the discipline
program, but also in periodicals.
When studying the discipline, you must first read the recommended literature for
each topic and make a short synopsis of the main provisions, terms, information that
require memorization and are fundamental in this topic for mastering the subsequent
topics of the course. To expand knowledge of the discipline, it is recommended to
use Internet resources; conduct searches in various systems and use materials from
sites recommended by the teacher.
Each student maintains a workbook, the design of which must meet the
requirements, the main of which are as follows:
− on the title page indicate the subject, course, group, surname, name,
patronymic of the student;
− each work is numbered in accordance with the guidelines, indicate the date of
the work;
− completely write down the name of the work, the purpose and principle of the
method, briefly characterize the progress of the task and the object of research;
− if necessary, provide a graphic image; the results of the assignments are
presented in the form of graphic images with obligatory signatures to them, as well
as tables or described verbally;
− at the end of each work, a conclusion or conclusion is made, which are
discussed when summing up the results of the lesson.
All primary entries must be made in a notebook in the course of completing tasks.
To check the academic activity and the quality of the student's work, the teacher
periodically checks the workbook.
The material outlined in the lectures must be regularly worked out and supplemented
with information from other sources of literature, presented not only in the discipline
program, but also in periodicals.
When studying the discipline, you must first read the recommended literature for
each topic and make a short synopsis of the main provisions, terms, information that
require memorization and are fundamental in this topic for mastering the subsequent
topics of the course. To expand knowledge of the discipline, it is recommended to
use Internet resources; conduct searches in various systems and use materials from
sites recommended by the teacher.
142
3.2. Methodical recommendations for the implementation of practical /

seminars, laboratory work.
Practical lessonsare held after the lectures, and are of an explanatory, generalizing
and reinforcing nature. They can be held not only in the classroom, but also outside
the educational institution.
In the course of practical training, students perceive and comprehend new
educational material. The practice sessions are systematic, regularly following each
lecture or two or three lectures.
Practical lessons are carried out according to the schedule of the educational process
and independent work of students in disciplines.
When preparing for practical exercises, it is necessary to study in advance the
methodological recommendations for its implementation. Pay attention to the
purpose of the lesson, to the main questions for preparing for the lesson, to the
content of the topic of the lesson.
Before each practical lesson, the student studies the plan of the seminar with a list
of topics and questions, a list of references and homework based on the material
presented to the seminar. The student is recommended the following scheme of
preparation for the seminar:
1. work out the lecture notes;
2. read the basic and additional literature recommended for the studied section;
3. answer the questions of the plan of the seminar;
4. study the topic and select literature for writing essays, reports, etc.;
3.3. Methodical recommendations for the implementation of independent

work.
When studying the discipline "Dentistry»The following types of students'
independent work are applied:
− study of theoretical material based on lecture notes and recommended teaching
aids, educational literature, reference sources;
− independent study of some theoretical issues that were not considered in the
lectures, with the writing of abstracts, preparation of presentations;
Students are offered for reading and meaningful analysis of monographs and
scientific articles on public health problems. The results of working with texts are
discussed in practical lessons.
To develop the skills of independent work, students complete tasks, independently
referring to educational, reference and scientific-methodological literature.
Checking the fulfillment of tasks is carried out both in practical classes with the help
of oral presentations of students and their collective discussion, and with the help of
written independent work.
143
Section 1.4.2 contains topics for self-study of theoretical material, assignment

for each topic, deadline for work, educational literature.
Section 1.4.3. the topics for writing the abstract are indicated.
Section 2.2. assignments, tasks and exercises are given for each topic of the course.
A list of literature required for self-preparation is provided.
Independent work contributes to the development of such necessary skills in the
student as the choice and solution of the task, the collection and analytical analysis
of published data, the ability to highlight the main thing and make a well-founded
conclusion.
3.4. Methodological instructions for the implementation of abstracts, reports,

essays
abstract - a summary in writing of the content of the scientific work on the topic
provided. This is an independent research work, where the student reveals the
essence of the problem under study with elements of analysis on the topic of the
abstract.
Provides various points of view, as well as his own views on the problems of the
topic of the abstract. The content of the abstract should be logical, the presentation
of the material should be worn
problematic and thematic in nature.
Requirements for abstract design:
The volume of the abstract can range from 9-10 printed pages.
Main sections: table of contents (plan), introduction, main content, conclusion, list
of references.
The abstract text should contain the following sections:
- title page indicating: the name of the university, the department, the topic of the
abstract, the author's full name and the teacher's full name
− introduction, relevance of the topic.
− main section.
− conclusion (analysis of literary search results); conclusions.
− the list of literary sources must have at least 10 bibliographic titles, including
network resources.
The text part of the abstract is drawn up on a sheet of the following format:
− top indent - 2 cm; left indent - 3 cm; indent on the right - 1.5 cm; bottom
margin - 2.5 cm;
− text font: Times New Roman, font height - 14, space - 1.5;
− page numbering - at the bottom of the sheet. There is no number on the first
page.
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The essay must be completed correctly in compliance with the culture of

presentation. There must be references to the literature used, including periodicals
for the last 5 years.
Abstract evaluation criteria:
− Relevance of the research topic;
− correspondence of the content to the topic;
− depth of elaboration of the material;
− the correctness and completeness of the development of the questions posed;
− the significance of the conclusions for further practical activities;
− the correctness and completeness of the use of literature;
− compliance of the abstract design with the standard;
− the quality of the message and answers to questions when defending the
abstract.
3.5. Methodical instructions for preparation for the final certification.

Final certification in the form of a credit for the discipline "Dentistry»Is
carried out according to the results of attending classes, current and midterm
(modular) control.
In this regard, for the successful passing of the final control, it is
recommended to attend all classes and actively participate in classroom studies and
the student's independent work.
All modules are carried out according to a modular schedule. The tests
themselves have three sections: exam, module and training regimen. The exam and
the module are available on schedule, the training mode is available on the electronic
educational platformwww.test.edu.kgwhere students can practice solving tests
online.
On the electronic educational platform www.test.edu.kg methodological
materials are also posted. Each student has his own ID number and password to enter
this platform. The student has the ability to log into the system both from a computer,
from a tablet and from a phone, select a discipline and, for each topic of the chosen
discipline, view the necessary training materials, lecture notes (in PPT or PDF
format), and complete a test task (MCQ).
3.6. Methodical recommendations for the student's research work.

The purpose of the research work is to develop the intellectual abilities of students
by studying the algorithm of scientific research and gaining initial experience in the
implementation of a research project on the educational material of the chosen
specialty.
The main tasks and results of the implementation of scientific research work are:
145
- mastering scientific methods of cognition and deepening the theoretical knowledge

of students in the specialty;
- mastering modern methods of scientific research;
- development of students' practical skills of independent search for scientific and
technical information, conducting theoretical and / or experimental work;
- the acquisition by students of the ability to analyze the results of research,
formulate conclusions and recommendations;
- development of students' ability for independent, creative, vigorous activity in
continuous renewal and enrichment of scientific baggage.
When performing NIRS, you must learn the following basic steps:
− independent search for information on a given topic;
− selection of essential information necessary for full coverage of the problem
under study, separation of this information from secondary (within the framework
of this topic);
− analysis and synthesis of knowledge and research on the problem;
− generalization and classification of information on research problems;
− logical and consistent disclosure of the topic;
− generalization of psychological knowledge on the problem and the
formulation of conclusions from the literary review of the material;
− stylistically correct design of a scientific thought of an abstract type;
− competent design of scientific abstract text;
− correct design of scientific work.
146
4. Glossary
An adhesive prosthesis is a prosthesis that is attached to the abutment teeth without

prior turning with special dental materials. It is used most often as a temporary
construction.
Adhesives are special binders that enhance or provide adhesion. Most often they are
high density liquids or gels. Used to fix the final veneer to enamel, dentine.
Adhesion is an indicator of the adhesion of surfaces of dissimilar materials.
Direct adhesion - elimination of small defects in teeth using a light-cured filling
material. It is used for the restoration of small chips, to eliminate wedge-shaped
defects in the area of the necks of the teeth and the spaces between the teeth.
Indirect adhesion is a special method of dental restoration using ceramics, which are
attached to the surface of enamel, dentin, and metal. Striking examples are veneers
and lumineers.
Allergy - acute intolerance to certain substances, including drugs. It is manifested
by poor health and a painful state of the human body.
Allergic test - an analysis to identify substances that cause an allergic reaction in a
person and a painful state of the body.
Alveolitis is an inflammatory process that occurs in the alveolus (hole) after tooth
extraction.
Alveoloplasia is a surgical intervention aimed at the formation of the alveolar ridge
with its atrophy, or with defects that occur after osteomelitis, removal of a tumor,
and various injuries.
Biocompatibility - the individual tolerance of the organism to the introduction of
foreign materials, or the ability of a foreign material not to interfere with the
recovery processes in tissues.
Lower jaw block is a complete or local limitation of the sensitivity of the jaw.
Atypical facial pain is a pain syndrome characterized by throbbing or dull pain.
The bracket system is a permanently worn fixed orthodontic construction aimed at
correcting the occlusion. Consists of braces that are attached to each tooth, and an
arch that connects them together into a single system. The archwire also allows the
orthodontist to move the teeth in the desired direction using additional system
elements.
Bruxism is uncontrolled clenching of the jaws and grinding of teeth. Most often it
manifests itself at night during sleep, in rare cases during the day. It is characterized
by abrasion of teeth and enamel on the chewing surface. The disease is treated with
the participation of a dentist and a neurologist.
Clasp prosthesis is a complete removable prosthesis, consisting of artificial teeth and
its fastening elements on existing teeth. In this design, a graceful metal arch is used,
which ensures easy adaptation to the prosthesis.
Hemisection is the removal of one of the roots of a tooth, sometimes together with
the coronal part of the tooth.
147
Dental hygienist is a specialist with secondary or higher education who specializes

in professional oral hygiene and teaching patients to care for teeth, gums, braces,
implants, removable and fixed dentures.
The hygienic index (GI) is a numerical indicator that characterizes the hygienic state
of the patient's oral cavity at the moment.
Gingivitis is an inflammation of the soft tissues of the gums without involvement of
bone tissue in the inflammatory process. Spills over into periodontitis if not treated.
Gingivectomy is an operation in the treatment of periodontal disease, which is the
excision of the edge of the gum when it grows.
Tooth hypersensitivity is a pronounced pain reaction of various kinds of stimuli:
temperature, chemical or mechanical.
Diagnosis - determination of the type and complexity of the disease based on the
patient's story and complaints, the result of the examination, the study of the
necessary tests, images and examinations.
The Florida Probe Diagnostic System is a computer technology developed in the
USA. It is intended for obtaining and demonstrating to patients with the help of a
monitor objective results of examining the state of the tissues surrounding the tooth.
Diastema is the gap between the central teeth.
Fissure Sealing - This procedure is often referred to as “fissure sealing”. This is a
medical procedure in which a special filling material is inserted into the fissures
(dental grooves). The goal is to prevent the occurrence of a carious process. It is
widely used for the prevention of dental caries in children.
Protective metal crown - an onlay that is installed on a severely damaged or decayed
milk tooth. It is used when it is impossible to restore a tooth with a filling material.
Tartar is a calcareous formation on the surface of the teeth. It is mainly located in
the cervical region of the teeth, since the excretory ducts of the large salivary glands
are located there.
Inlay (inlay) - a small tab, which is used to eliminate the defect of the coronal part
of the tooth. It is made of ceramics or composite materials individually in shape and
color.
Excision of the "hood", in another way "pericoronorite". Excision of the area of the
mucous membrane above the tooth.
Caries is a common disease of the hard tissues of the tooth, which is caused by the
action of bacteria and harmful microorganisms. As a result of caries, anatomical,
functional and aesthetic defects appear in the teeth in the form of cavities.
Caries in children under two years of age - in another way, "bottle caries". This is a
lesion of the surface of the front teeth. The most common cause of occurrence is
non-observance of the correct diet for the child.
Carisolv (carisolv) - technology of caries treatment without the use of a drill. It
consists in treating the surface with a special compound and subsequent filling of
the defect.
Kinetic tooth preparation is one of the methods for eliminating caries in children. It
is used for small lesions of hard tissues, or for the treatment of fissures. The principle
148
of operation is to apply a special powder under pressure to the tooth, which gently
acts on hard tissues.
A cyst is a non-tumor formation with a cavity that is filled with cystic fluid. Most
often it develops as a result of chronic inflammation around the apex of the tooth
root.
Flap surgery is a surgical procedure to remove inflamed tissue deep under the gum
or calculus.
Non-carious lesions of teeth - pathological abrasion of teeth, malformations of hard
tissues of teeth and root surface. They arise as a result of heavy loads, endocrine
diseases, disturbances in the position of adjacent teeth, as a result of long-term use
of hard toothbrushes and poor-quality dental care. Manifested in the form of defects
on the teeth and high sensitivity to chemical and temperature influences.
Intolerance to base plastics is a complication after the placement of removable
dentures, accompanied by unpleasant sensations in the gum area. It manifests itself
in the form of: burning, pain, inflammation of the mucous membrane at the point of
contact with a removable denture, gag reflex.
Implant failure - rejection of a metal rod by the tissues of the oral cavity, which is
accompanied by an inflammatory process of soft or bone tissues.
Osteomyelitis is an inflammation of the jaw bone tissue.
Operation - tissue dissection, excision or stitching.
Operative periodontics is a set of surgical methods that allow local or complete
restoration of the gum bone tissue and form its correct and beautiful contour.
Orthodontics is a large branch of dentistry that specializes in the prevention,
diagnosis and treatment of dentoalveolar deformities and malocclusion.
Filling polishing - removal of roughness and overhanging edges of the filling
material from the tooth using special tools.
Full bracket system - a bracket system that connects all the teeth of the upper and
lower jaws.
A complete removable denture is a denture consisting of artificial teeth located on a
plate made of plastic to match the color of the gums. It is used in the complete
absence of teeth in the upper or lower jaws.
Conduction anesthesia is a modern method of pain relief, in which an anesthetic is
supplied to the nerve fiber of the branches of the trigeminal nerve and blocks it. The
advantage is that pain sensitivity is turned off over a large area of the jaw and
adjacent soft tissues.
149
5. Reference materials and applications

Application
Annotation of the discipline "Dentistry"
Discipline name Dentistry
The amount of discipline in 2 credits (72 hours)
credits
Semester and year of study 8 semester, 4 course
Place of discipline in the Discipline "Dentistry" is included in the number
curriculum of clinical disciplines
SLK-3, IK-4, PK-6
Pre and post discipline The content of the discipline "Dentistry»Is based
requisites on the content of such preceding disciplines as:
− Histology
− Hygiene oral cavity
− Normal anatomy
− Pathological anatomy
− Normal physiology
− Pathological physiology
Goals and objectives of the The purpose of the discipline:

discipline − Formation of students' knowledge,
skills and abilities necessary for a future doctor
to work in the healthcare sector; systems that
ensure the preservation, strengthening and
restoration of public health; organization of
preventive and therapeutic and diagnostic
services; trends in the development of global
health care.
− Training of a doctor with general and
special competencies that contribute to his social
mobility and stability in the labor market,
readiness for postgraduate training with the
subsequent implementation of professional
medical practice in the chosen field.
− Developing students' purposefulness,
organization, hard work, responsibility,
150
communication, tolerance, improving the

general culture.
Discipline objectives:
− To help students acquire knowledge
based on the ability to independently study and
analyze indicators that characterize the health
status of various age-sex, social, professional
and other groups of the population, measures to
preserve, strengthen and restore health;
− Form theoretical foundations and
practical skills
− Master provision of dental care.
Requirements for the results will be famousb
of mastering the discipline − Able to analyze medical information
based on the principles of evidence-based
medicine
− Willingness to work with information
from various sources
− Ability to apply up-to-date information on
health indicators
Monitoring form − Assessment of the development of

practical skills, abilities (Ex.).
− Writing and defending an abstract (report,
essay).
Midterm control form Testing (computer) - 2 Modules
Final control form Offset
Basic literature 1. Clinical Problem Solving in
Prosthodontics1st Edition Author: David
Bartlett Functional Occlusion1st Edition From
TMJ to SmileDesignAuthor: Peter Dawson
2. Oral Medicine 1st Edition
Exam Preparatory Manual for Undergraduates
3. V.A. Kozhokeeva, K.B. Kuttubaeva, S.M
4. ... Ergeshov Pulpit: clinic, diagnosis,
treatment .: Study guide
5. Periodontics: Prep Manual for
Undergraduates1st EditionAuthors: Vivek Bains
Vivek Gupta Jyoti Bansal
151

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International University of Kyrgyzstan

EDUCATIONAL-METHODOLOGICAL COMPLEX OF DISCIPLINE

graduate qualification: general practitioner

International University of Kyrgyzstan

THE WORKING PROGRAM OF THE DISCIPLINE

main educational program

Work program developer: Reviewed and approved at a meeting of the

External review given by ___________________________________________

1. The work program of the academic discipline

Competencies of students, formed as a result of mastering the discipline, the

and additional professional competencies:

● etiological factors leading to the development of diseases of the pulp and

1.2. Recommended educational technologies

● distance educational technologies.

1.3. The scope of the discipline and types of educational work

1.4. Discipline structure

methods and methods

Forms of current and

2 Etiology, pathogenesis of 2 2 4 2 2 SLK-3, LV / PL NS,

3 Etiology, pathogenesis of 2 2 4 2 2 SLK-3, LV / PL NS

eig Tooth extraction operation, 2 2 4 2 2 LV / PL NS,

nin Periodontics section 2 2 4 2 2 SLK-3, LV / PL NS,

1.4.2. Organization of students' independent work

N The topic of the SRS task Recommended Timing

classification of From TMJ to Smile

physiology of Authors: Vivek Bains

1.4.3. Evaluative Assessment Tools

Current control of students' knowledge may represent:

Topics of essays (essays, reports)

1. Tooth pulp. Histological structure, main functions.

19. Types of dental instruments.

Frontier (modular) control may represent:

Sample test tasks for midterm (modular) control

5) violation of enamel formation, expressed by a systemic violation of

1.4.4. Course policy and assessment criteria

Scale of correspondence of grades and points

1.4.5. Educational-methodical and informational support of the discipline

The list of resources of the information and telecommunication network

1.4.6. Logistics of the discipline

1.4.7. Student research work

To develop and improve the communication skills of students, special training

2.1. Lecture notes

Topic 1. Carious lesions of teeth

Topic number 1 Carious lesions of teeth

Caries susceptibility of the tooth surface

● on the properties of the anatomical surface of the tooth: in natural crevices

Classification of caries by WHO

In classification WHO (10th revision) caries is allocated in a separate heading.

For the practitioner, the topographic classification is more convenient and

The American scientist Black proposed a classification of carious cavities by

There are the following types of dental caries:

Superficial caries (caries superficialis)

Superficial caries occurs in the place of a white or pigmented spot as a result of

Medium caries (caries media)

It develops as a consequence of the superficial. With average caries, dentin is

Deep caries (caries profunda)

Demineralization of caries in the stain stage is reversible when remineralizing

Filling a carious cavity

4. imposition of an isolating system according to the situation (cofferdam,

Caries treatment without drilling and filling

Caries treatment during pregnancy

Traditionally, it is considered that dental treatment under anesthesia in pregnant

Improving the body, maintaining good oral hygiene, eliminating dentoalveolar