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УДК 616.31
Musayev Emin Ruzi
Doctor of Philosophy in Medicine, Associate Professor Azerbaijan Medical University,Department of Orthopedic Dentistry
Baku, Azerbaijan Babayeva Narin Nazim
Azerbaijan Medical University,Department of Orthopedic Dentistry assistent
Baku, Azerbaijan
LONG-TERM RESULTS OF COMPLEX TREATMENT USING CLASP PROSTHESES IN PATIENTS OF VARIOUS AGE GROUPS WITH PERIODONTAL PATHOLOGY.
Мусаев Эмин Рузи оглы
Доктор философии в области медицины.Доцент Aзербайджанский медицинский университет, Кафедра ортопедической стоматологии, г.Баку, Азербайджан
Бабаева Нарын Назим кызы Aзербайджанский медицинский университет, Кафедра ортопедической стоматологии,ассистент
г.Баку,Азербайджан
ОТДАЛЕННЫЕ РЕЗУЛЬТАТЫ КОМПЛЕКСНОГО ЛЕЧЕНИЯ С ИСПОЛЬЗОВАНИЕМ БЮГЕЛЬНЫХ ПРОТЕЗОВ У ПАЦИЕНТОВ РАЗЛИЧНЫХ ВОЗРАСТНЫХ ГРУПП С
ПАТОЛОГИЕЙ ПАРОДОНТА.
Abstract
The presented clinical and experimental study confirms the improvement in the quality of orthopedic treatment of patients of the older age group with intact periodontal disease using labial spherical attachment of the clasp prosthesis and an increase in the number of abutment teeth in the examined patients. The use of biomechan-ical computer research data for planning the design of a combined clasp prosthesis and calculating the number of abutment teeth makes it possible to normalize occlusal pressure and functional load on the roots, periodontium and alveolar ridge. All these factors together lead to the normalization of the functional state of the masticatory apparatus and allow us to recommend the developed method for practical application in practical public health.
Аннотация
Представленное клинико-экспериментальное исследование подтверждает повышение качества ортопедического лечения пациентов старшей возрастной группы с интактным пародонтом при применении лабиального сферического крепления бюгельного протеза и увеличения количества опорных зубов у обследованных. Использование данных биомеханических компьютерных исследований для планирования конструкции комбинированного бюгельного протеза и расчета количества опорных зубов позволяет нормализовать окклюзионное давление и функциональную нагрузку на корни, пародонт и альвеолярный гре-
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бень. Все эти факторы в комплексе в целом приводят к нормализации функционального состояния жевательного аппарата и позволяют рекомендовать разработанный метод к практическому применению в практическом здравоохранении.
Keywords: clasp prosthesis, generalized periodontitis, tooth mobility, stress-strain state.
Ключевые слова: бюгельный протез, генерализованный пародонтит, расшатанность зубов, напряженно деформационное состояние.
Periodontal disease, according to many classics of the scientific dentistry and modern scientists [2,4,5,6] are absolute contraindication to the use of partial removable plate clasp-retained prostheses for restoring end defects dentition I and II classes according to Kennedy. In the same time implant technologies are not always applicable according to the most for a variety of reasons, from the general health of the patient to moral and ethical beliefs or the material aspect.
The only possible recovery method functional usefulness of the dentition in this case is the manufacture of clasp prostheses [7,8].
In the last decade, for their attachment to abutment teeth various designs of attachments are actively used and lock fasteners [9], displacing clasp fixation in a number of indicators: aesthetics, prosthesis fastening strength, hygienic indicators. At the same time, various designs of lock fasteners do not equally transfer the load from the secondary part of the combined prosthesis on periodontal abutment teeth [10]. Overwhelming majority locks rigidly fixes the prosthesis on the teeth, transferring the load to the periodontium directly through the elements of the fastening structure or by means of interlock. This factor is a prerequisite for limiting the use of these systems in periodontal pathology or age destruction of bone tissue. In this case, it is advisable to use labile fixation systems that allow you to keep the clasp prosthesis on the abutment teeth, but the occlusal pressure at the same time distributed mainly on the edentulous areas of the alveolar process [1.3]. The variant modified by us possesses such properties. fastening VKS-SG
The purpose of this work is to determine the effectiveness the use of modified lock fastenings of clasp prostheses in patients of different age groups depending on the condition periodontium and the number of abutment teeth. Materials and research methods. In the course of our work examination and further orthopedic treatment 82 patients of different age groups:
4 people (4.9%) - aged 20 to 39 years;
47 people (57.3%) - aged 40 to 59;
31 people (37.8%) are over 60 years old.
In the younger age group, out of 4 examined, there were 3 women and 1 male, in the middle group the overwhelming majority were also women (34 women and 13 men), and in the oldest of 31 people, 12 were men. The standard examination protocol included: collection anamnesis, external examination and examination of the oral cavity, assessment of GI indices (according to Loe, Silnes; 1963) and the Green-Vermillion
Oral Hygiene Index. Everyone Patients underwent panoramic X-ray examination.
Several patients (11 people) who had significant the discrepancy between the data of panoramic x-ray and objective condition of the periodontium, a 3-D x-ray was performed study. Condition of the temporo-mandibular joints (TMJ) All patients were examined before treatment and in the long term (after 18-24 months).
All patients had terminal defects of the dentition of medium length in the lateral sections dentition (I or II classes according to Kennedy), in 7 people (8.5%), while included defects were also localized in the anterior region. In each age group of patients, depending on the condition periodontium was divided into two subgroups: with intact periodontium (IP) and patients with generalized periodontitis (GP) 2-3 severity.
Of the 4 people in the age group of 20-39 years, HP was noted in 3 examined (75%); in the group of 4059 years old - in 29 (61.7%) out of 47; in a group older than 60 years - in 23 (74.1%) of 31 patients.
Teeth limiting the defect and adjacent to them in patients with HP had 1-2 degree of mobility, at the time of the examination poor hygiene. In 36 of 55 patients (65.4%), the index oral hygiene Green- ermillion was OH1-S=1.2-1.8; at 19 patients (34.6%) it was even more: OH1-S = 1.9-2.3. In 27 patients without signs of inflammation in the periodontium, higher oral hygiene, and Green's Oral Hygiene Index- Vermillion OH1-S was 0.2-0.5. At the same time, women of average groups aged 53- 9 years and the older group on radiographs there is destruction of bone tissue, which is expressed in the presence of single foci of osteoporosis of moderate intensity. Among men we noted this process only in the older age group (after 60 years) in 4 people.
Patients with GP were diagnosed radiologically resorption of bone tissue by 1/3-1/2 the length of the roots of the teeth, multiple areas of osteoporosis. On CT scans taken on 9 patients who had a discrepancy in the degree of pathological mobility of teeth and the level of bone tissue on a panoramic digital X-ray, a significant loss of bone tissue was noted on vestibular and proximal surfaces of the alveolar process (for 3/4 of the length of the root) with preservation of the palatal or lingual surface one tissue of the alveolar process almost in full.
Axiographically, 73 (89%) of 82 examined patients had TMJ dysfunction at an early stage, without clinical manifestations.
9 patients (11%) were diagnosed with clinical signs of arthrosis of the TMJ (click or crunch in the joint, pain dysfunction). The decrease in mobility in one of the joints amounted to 28% horizontal and up to 17% vertical component. Almost always it was the joint
of the working side when unilateral end defect. If the defects were located on both sides of the dentition, then a more pronounced dysfunction of the TMJ was noted on the side where the teeth were removed later. EPA test also confirmed the discrepancy between movements in the right and left TMJ and decrease in the range of motion on the working side.
All patients with terminal defects of the dentition were comprehensive therapeutic training, including periodontal and endodontic interventions, and made combined designs of dentures, consisting of ceramic-metal primary design with hinged lock fastening, and a clasp prosthesis with thermoplastic matrices in in accordance with our recommendations based on biome-chanical computer research of flat limbs elemental models [12]. During prosthetics, 55 (67%) patients of all age groups, patients with GP, or patients of older age groups with intact periodontium, more the number of teeth (at least three on the side of the defect). Dentures were performed according to the protocol.
The remaining 27 patients (33%), regardless of age and periodontal conditions, combined dental pros-theses with a minimum number of supporting teeth (two from the side defect) due to pre-existing clinical conditions (intact abutment teeth, previously manufactured expensive dentures and categorical refusal of the patient to change the design, etc.)
Repeated examinations were carried out after 1824 months after treatment for signs characterizing the state of the TMJ and periodontal: depth of the periodontal pocket, mobility of the supporting teeth, x-ray data on the volume of bone tissue alveolar process, ax-iographic indicators.
Results of the study and their discussion. In 49 patients, the main groups (89%) who systematically (1 time in 6 months) received a course professional oral hygiene and stimulation therapy, a good state of oral hygiene was noted (OH1-S=0.2-0.5; GI=0- 0.2), and clinical and radiological stabilization of the bone alveolar tissue. Axiographically fixed normalization and synchronism of mobility in the right and left TMJ parallelism of lines in an expanded diagram illustrating spatial movements.
The EPA test also confirms the increased movement of the head right joint from 0-0.3 mm to 1.2-2.0 mm (Fig. 4, pos. 3) and from 0.6-0.9 mm to 2.0- 3.0 mm (Fig. 4, pos. 4) with the same amplitude of movement of the lower jaws.
None of the examined patients showed any impairment fixation of non-removable structures of dentures, the depth of the tooth gum pockets in the area of the abutment teeth is not enlarged, signs inflammation of the marginal periodontium is absent.
In 6 (10.9%) out of 55 subjects of the main group who ignored hygienic prevention, an unsatisfactory condition was noted oral hygiene (OH1-S = 1.9-2.4), GI = 1.3-1.7, indicating gingivitis of moderate severity, progressing radiologically visible destruction of the bone tissue of the alveolar process. Depth periodontal pocket increased by an average of 1.2±0.4 mm. Noted an increase in pathological mobility of supporting teeth in constructions by 1 degree and an axiographic study
in these patients confirmed a minimal improvement in the functional state of the TMJ (by 12-15%).
In the control group, which consisted of 27 subjects who combined dentures were made with minimal number of supporting teeth, only 5 (18.5%) patients never in 2 years did not undergo a preventive course of maintenance therapy. Whereas, that the vast majority (22 out of 27 surveyed, which is 81.4%), were observed by a periodontist, received a professional hygienic care for the state of the oral cavity and took a course stabilizing therapy, all patients of this group had unsatisfactory condition of the periodontium: an increase in the depth pathological tooth-gingival pocket by 1.8-3.0 mm; indicators indices were OH1-S=1.8-2.3; GI=1.4-1.8. In patients not who underwent a prophylactic course, respectively, OH1-S = 2.6-2.8; GI=2.5-2.8; periodontal pocket increased by 3.5-4.0 mm. On the Panoramic x-rays show a decrease in alveolar ridge by 2.54 mm, an increase in the number, size and intensity foci of osteoporosis. All patients in the control group had pathological mobility of supporting teeth together with crowns. Axiographic analysis and EPA test showed no improvement in functional state of the TMJ compared with the original.
Findings. Presented clinical-experimental the study confirms the improvement in the quality of orthopedic treatment of patients with GP and patients of the older age group (> 60 years) with intact periodontium when using a labile spherical fixing the clasp prosthesis and increasing the number of supporting teeth in 68.5±2.6% of the examined. Use of biomechanical data computer research for planning design of the combined clasp prosthesis and calculation of the number of supporting teeth allows normalize occlusal functional load on the roots, periodontium and alveolar ridge. All these factors in the complex contribute to the normalization functional state of the masticatory apparatus as a whole and allow recommend the developed method for use in practical healthcare.
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Shahmuradov Rauf Rafael, Mammadova Gunay Fahraddin, Gromov Oleg Vladislavovich
THE EXPEDIENCY OF USING THE TREATMENT-AND-PROPHYLACTIC COMPLEX OF ORAL HYGIENE AT THE STAGES OF PROSTHETICS WITH NON-REMOVABLE ORTHOPEDIC
STRUCTURES.
Шахмурадов Рауф Рафаель, Маммадова Гунай Фахраддин, Громов Олег Владиславович
ЦЕЛЕСОБРАЗНОСТЬ ИСПОЛЬЗОВАНИЯ ЛЕЧЕБНО-ПРОФИЛАКТИЧЕСКОГО КОМПЛЕКСА ГИГИЕНЫ ПОЛОСТИ РТА НА ЭТАПАХ ПРОТЕЗИРОВАНИЯ НЕСЪЕМНЫМИ ОРТОПЕДИЧЕСКИМИ КОНСТРУКЦИЯМИ.
Abstract
Patients who used the recommendations of an orthopedist on the 4th day showed a complete absence ofpain, bleeding edema and hyperemia. times faster, the hygiene indicator stably remained in the "good" interval, while in the control group the state of hygiene worsened somewhat and the "satisfactory" hygiene interval returned.
Аннотация.
У пациентов использовавших рекомендации врача ортопеда на 4 сутки отмечалось полное отсутствие болевых ощущений,кровоточивости отека и гиперимии.Контрольный осмотр через три месяца показал, что у пациентов, обученных гигиеническому режиму и использовавших зубную пасту «Сенсадин» и опласкиватель, состояние краевого пародонта нормализовалось в два раза быстрее, показатель гигиены стабильно оставался в интервале «хороший», тогда как в контрольной группе состояние гигиены несколько ухудшилось и вернулось интервал «удовлетворительная» гигиена.
Key words: periodontium, fixed orthopedic structures, individual oral hygiene, Sensadin therapeutic and prophylactic agents, LISTERINE® rinse
Ключевые слова: пародонт,несъемные ортопедические конструкции, индивидуальная гигиена полости рта, лечебно-профилактические средства «Сенсадин»,ополаскиватель LISTERINE®
Как показала практика при частичном отсутствии зубов предпочтение отдается несъемным мо-стовидным конструкциям [6]. Однако процесс изготовления несъемных ортопедических конструкций имеет свои особенности от которых будут зависеть сохранение жизнеспособности пульпы, состояние тканей пародонта, ретенция и фиксация протеза, срок службы, а главное - его эстетический вид [5].
Одной из особенностей препарирования твердых тканей зуба под несъемные ортопедические конструкции является создание пришеечного уступа, особенно при протезировании передней
группы зубов. [3]. Уступ должен обеспечивать плавный переход искусственной коронки к корню зуба и предупреждать травмирование края слизистой оболочки и междесенного сосочка [1]. Однако чрезмерное сошлифование твердых тканей с созданием излишней конусности боковых стенок приводит к травмированию пульпы и краевого паро-донта, что в будущем ухудшает фиксацию готового протеза.
Причиной травмы может стать процедура ретракции десен. Ретракция десен представляет собой процедуру расширения зубодесневой бороздки и
