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11ORTHOPEDIC MEASURES IN THE TREATMENT OF GENERALIZED PERIODONTITIS
Arkhmammadova G.,
Azerbaijan Medical University, Department of Orthopedic Dentistry, Assistant
Baku, Azerbaijan Aliyev T.,
Doctor of Philosophy in Medicine, assistant Department of Pediatric Dentistry Azerbaijan Medical University, Guseynova G. Azerbaijan Medical University, Department of Therapeutic Dentistry Assistant
Baku, Azerbaijan DOI: 10.5281/zenodo.7347305
ABSTRACT
Treatment of generalized periodontitis is complex; Achieving a positive result of medical and surgical treatment is impossible without the elimination of traumatic occlusion and functional overload of the periodontium. For this purpose, measures are taken to normalize occlusion and stabilize mobile teeth.
Keywords: generalized periodontitis, traumatic occlusion, temporary splinting, permanent splinting.
In modern dentistry, periodontitis uses three main types of orthopedic intervention - selective grinding, splinting and prosthetics. Depending on the clinical picture and the type of occlusal disorders, the combination and sequence of prescribing these methods may be different [1,2]. It has been proven that selective grinding of supracontacts at the initial stage of periodontitis can slow down the progression of atrophy [3,4]. In the presence of a pronounced degree of resorption, splinting is necessary. It allows to reduce periodontal overload due to the redistribution of stress from an individual tooth to a group of teeth and thereby eliminate traumatic occlusion, normalize the direction of the load, and prevent secondary tooth displacement [5]. The opinions of clinicians agree that temporary splinting is recommended at the initial stages of treatment. According to the duration of wearing, such constructions can be conditionally divided into short-term and long-term temporary (or conditionally permanent). The term for applying tires of the first type is from several days to one month; the second type - from one to several months, and sometimes years. The main requirements for splints are strength and reliable fixation of mobile teeth, the absence of negative effects, the possibility of unhindered hygienic and medical manipulations [6]. Temporary tires are installed for the entire period of active treatment until remission occurs, when it will be possible to install a permanent splinting prosthesis. The function of such structures is to eliminate the traumatic impact of pathological mobility, which leads to hemodynamic disturbances in the periodontium [6,7].
Tires help to increase the effectiveness of patho-genetic and symptomatic therapy; improving periodon-tal trophism, contribute to the weakening of the activity of the inflammatory process [5]. The decision on the need and method of splinting is made on the basis of an assessment of tooth mobility and bone tissue atrophy. If the destruction does not exceed 1/4 of the root length, splinting is not considered necessary [3]. With atrophy within half the height of the socket and mobility of the
first degree, it is necessary to eliminate mainly the horizontal component of masticatory pressure [8]; when resorption reaches 2/3 of the root length; it is necessary to level both the vertical and horizontal components [8.9]. It is recommended to choose the type of splint based on the clinical conditions [7.8]. There is no consensus on the priority of using removable or non-removable structures; the choice is based on the reserve forces of the periodontium and the degree of its functional insufficiency [9.10]. Teeth with functional insufficiency are recommended to be combined with teeth that have retained the periodontal endurance reserve [3.7.].
It is desirable that the coefficients of teeth with reserve forces are 1-2 times higher than the sum of the coefficients of teeth without such, and the sum of the coefficients of the teeth included in the block corresponds to the sum of the antagonist coefficients [7.8].
The length of the tire determines the prevalence of the pathological process. A specific type of stabilization can be provided by using various designs of removable and non-removable splints [11.12]. In modern practice, splints are divided into those that do not require tooth preparation (removable structures); with partial preparation of one or more surfaces (fiberglass and frame tapes, flex-arc, cable-stayed, insert splints); splints with total tooth preparation (a block of crowns, a splinting bridge) [13]. Crown and bridge structures with a solid frame remain the most widely used method of permanent splinting today; they are recommended in cases of generalized periodontitis of the 1st-2nd degree, including those with included defects, or multiple lesions of the teeth with caries, as well as severe deformities of the dentition [13]. The disadvantage of these designs is the need for significant preparation of the supporting teeth, in most cases with preliminary depulpation, [14]. The previously existing numerous options for fixed splints with partial preparation of the surface of the teeth, manufactured on the basis of stamped-soldered technology - ring, semi-ring, crown-
beam, semi-crown, - do not apply today. to. have a number of significant design flaws and poor aesthetics.
Modern designs that do not require total preparation are various options for adhesive splints.
The widespread introduction of adhesive technologies has led to the use of light-cured composites and fiber materials (fiberglass, Kevlar) for splinting, as well as milled insert and beam splints based on zirconium dioxide. As recommendations on the use of adhesives, the presence of a single dentition with the absence of diastemas and three in the absence of violations of the enamel structure in the supporting teeth is called.
Indications include long-term temporary splinting, as well as direct prosthetics in case of removal of single anterior teeth using their natural crown or replacement of the defect with a composite or a tooth from a set. The clinical effectiveness of the use of adhesive splints made of non-metallic reinforcement and light-curing composites is recognized by many experts [15], but there is no consensus on the timing of their use. A number of authors characterize this type of tires negatively and classify them as temporary. In particular, A.I. Grudyanov points to "unreasonably extended use of expensive temporary structures made of composite materials reinforced with synthetic fibers"[3] .
Belousov N.N. considers it expedient to use adhesive tapes as temporary splints only for mild forms of periodontitis that do not require surgical intervention and subsequent hard splinting [14]. According to some authors, the "temporary nature" of adhesive splints is explained both by a short fixation period (usually within one year) and by the creation of unfavorable hygiene conditions for splinted teeth, which can aggravate periodontitis.
Conclusions
In the analyzed literature sources, data on the path-ogenesis of traumatic occlusion in generalized perio-dontitis are widely presented. There is information about various methods for assessing occlusal contacts, including modern hardware-digital diagnostic methods that allow an objective assessment of the distribution of functional load in the dentition. The revealed information regarding splinting structures has a different age, many tire modifications mentioned are outdated and are not used at the present time. There is practically no data in the literature on modern designs of removable splints intended for permanent and long-term temporary use, and on the use of modern technologies in immediate prosthetics.
In most studies, various modifications of direct fabricated fiber adhesive structures are mentioned as a method of long-term temporary splinting. Also, little information was found about the algorithms for the preparatory stage of orthopedic treatment, protocols for the use of temporary splinting structures and immediate prostheses in the complex treatment of generalized per-iodontitis.
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