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UDK 616.314.26-07
SPECIAL FEATURES OF THE APPLICATION OF OCCLUSIOGRAPHY AS THE CONTEMPORARY STOMATOLOGICAL METHOD Shylenko D.R., Belikova N.I.
Ukrainian medical stomatological academy Poltava
In the article there were presented some special features of the application of occlusiography. There were carried out clinical experiments, confirming a reliable decrease of the areas of contact points and near-contact zones of the first order, on occlusiogramme, obtained in patients locating in the position of lying, at 19,42% -for the patients with the sharply increased contact area, at 27,9% - in patients with the moderate increase in the occlusion contacts, and at 33,34% - in patients the area of contact points of them it corresponds to age class.
Key words: occlusiography, stomatological method.
Introduction
Mastication is a physiological act, which ensures crushing food, moistening with its saliva and formation of food lump. It has an effect on the process of digestion in other divisions of the digestive tract, changing their secretory and motor functions.
One of the methods of investigation of functional state of masticatory apparatus it is masticatiogra-phy - record of the motions of lower jaw during the mastication. The report of physiological mastication is characterized by the presence of 5 phases: 1 phase - phase of rest; 2 phase - introduction of food into the cavity of mouth; 3 phases- tentative mastication or initial masticatory function, it corresponds to the process of the approval of the mechanical properties of food and to its initial splitting; 4 phases - basic or true phase of mastication, it is characterized by the correct alternation of the masticatory waves, on masticatiogramme, amplitude and duration of which is determined by the value of the portion of food and by its consistency; 5 phase -formation of food lump on masticatiogramme, take the form of undulating curve with the gradual decrease of wave amplitude. [6]
The functional system of mastication is formed for each masticatory period.
The act of the physiological shutting of mouth consists of three phases [8]: the phase of physiological rest; the motion of closing the lower jaw, which are characterized by the graduated reductions of muscles of those raising lower jaw; and the phase of the joining of the jaws, where the mandibular teeth enter into the contact by the teeth of upper jaw.
Impulses from the receptors of the cavity of mouth generally by the fibers of trigeminal nerve are transferred to the sensory nuclei of the medulla oblongata, nucleus of visual mound, and from there into the cerebral cortex. From the truncus cerebri and visual mound the collaterals will move away to reticular formation. In the regulation of mastication the engine nuclei of the medulla oblongata, red nucleus, black substance, subcortical nuclei and cerebral cortex participate. The totality of the controlling mastication neurons of different divisions of the brain is called the center of mastication. Impulses from it on the motive fibers of trigeminal nerve come to the masticatory muscles. They accomplish motions of the lower jaw up & down, for-
ward and backward and to the side. Muscles of language, cheeks and lips move food to it became wet in the cavity of mouth; they will give and retain food between masticatory surfaces of teeth. In the coordination of mastication the impulses from the receptors of masticatory muscles and teeth play large role. [4]
Such variety of the physiological mechanisms of those when part in the act of mastication, which they are not often taken into consideration by the practicing doctors stomatologists, with the calculation of the factors of occlusion and especially mechanisms of those forming occlusal figure puts sharply a question about the need of conducting the whole series of studies of the reasons for the errors dedicated to development appearing in the stages of functional diagnostics of dentomaxille system. [9, 13]
The effect of a change of the occlusion contacts in the dependence on the position of the body of a patient was for the first time presented by Anderson and Myers [1] in 49 annual meeting IADR (International association of dental research) in Chicago, Illinois, in 1971. However, up to now it did not find proper reflection in domestic and foreign studies.
The purpose of our study was the search for the acceptable model reflecting the change of the occlusal figure in the dependence on the position of the body of patient.
Object and the methods of the studies
One of the closest ones in the technical level and the attainable result the method of the study of occlusion contacts is the method proposed by Ryak-hovsky A.N. [12]. Method provides for the creation of the occlusion contacts of dental prostheses, that uses occlusiogramme obtained in the cavity of mouth, on which is formed on the gypsum model the plane, at which contact points perpendicular axes of tooth lie.
To deficiencies in this method of occlusiogramme can be related: the absence of the possibility of the control of the height of the interocclusion space of near-contact zones, the complexity of the reference area of contact itself, the appearance of inaccuracies with the transfer of contacts from occlusiogramme to the gypsum, the need for using during the construction of the contacts of articulator and as consequence the need of conducting the whole series of occlusion tests for its tuning.
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The second method of the analysis of occlusion contacts was proposed by Shemonaev V. I. and et al. [15]. According to this method for the development of occlusion contacts preliminarily is obtained in the cavity of mouth occlusiogramme of the contact points of teeth. As the material for registering the occlusion contacts "wax basic - 02" (TY 64-2211-77, joint-stock company "CTOMa" Ukraine, Kharkov), is taken color and optical properties of which give possibility of obtaining the precise calibration of the thickness of plate with the changes in accordance with the occlusion surfaces and obtaining color characteristics with the variety of thicknesses on the obtained imprint of the relief of the occlusion surfaces of the antagonizing teeth.
Then, there obtained the scanning image of occlusiogramme in the regime RGB by means of the placement of occlusiogramme into the photometer. Conducting the comparative digital analysis of the obtained scanning image of the surface of joining and preliminarily prepared standards of the material, used for obtaining occlusiogramme with a thickness of from 0 to 0.75 mm, with the step of the measurement of AZ =0.25 mm, makes it possible to reveal the characteristic points of occlusion contacts and area of the near-contact zones of each pair of the antagonizing teeth.
To deficiencies in the method of V. I. Shemonaev can be related the complexity of applying the procedure, the need of preparing the wax standards of material for determining concrete RGB of the characteristics of the layer of material; the absence of the possibility of the preliminary estimation of the state of contacts and near-contact zones according to occlusiogramme, without the application of a photometer.
The third, and in our opinion the most informative and simple in the application method, is the method of determining the occlusion contacts from the means of three-layered wax plate, proposed by D.R. Shylenko [16], since it makes it possible not only to judge the form, area and localization of occlusion contacts, but also gives the possibility to determine rapidly the prevailing diagram of the layout of occlusion contacts, to estimate the area of near-contact zones, with a height of the interocclusion space of from 0,25 to 0,75 mm, to make conclusions about the coefficient of wear of "working" mounds.
The results of studies and their discussion
Employing this procedure we have inspected the state of occlusion at the position lying on the spin and sitting in 50 patients with the physiological bite at the age of 22-25 years with CFE<3.
At the analysis of occlusiogramme from the patients obtained in the position of sitting was revealed the predominance of near-contact zone by the height of 0.25mm in 21 (42%) patients, the pre-
dominance of near-contact zone with the height of 0.5mm in 17 (34%) patients, the predominance of near-contact zone with the height of 0.75mm in 12 (24%) patients. Diagram "a cusp-marginal crest" is the prevailing diagram of the layout of occlusion points in 15 (30%), diagram "cusp-fosse" - in 22 (44%), diagram "a crest-apex-fossa" - in 13 (26%) [17]. A sharp increase in the area of occlusion contacts was revealed in 5 (10%) patients, moderate in 19 (38%) patients, contact area corresponding to age class was revealed in 26 (52%) [10, 11, 14], on the basis what we isolated three groups of a study. To the first group, we related patients with a sharp increase in the area of occlusion contacts, to the second - with that moderate; patients with the area of occlusion contacts to the corresponding age class were referred to the group №3- of control one.
The analysis of occlusiogramme obtained in patients of those locating in the position lying made possible to reveal the prevailing diagram of the layout of occlusion points only in 3 (6%) patients.
Also on occlusiogramme obtained in the patients of those locating in the position of lying was marked sharp reduction in the contact area and near-contact points of the first and second orders. So in the first group the predominance of near-contact zone with the height of 0.25mm was revealed in 1 (20%) patients, the predominance of near-contact zone the height of 0.5mm in 2 (40%) patients, the predominance of near-contact zone with the height of 0.75mm in 2 (40%) patients.
In the second group the predominance of near-contact zone with the height of 0.25mm was revealed in 5 (26,3%) patients, the predominance of near-contact zone the height of 0,5mm in 8 (42,1%) patients, the predominance of near-contact zone with the height of 0.75mm in 6 (31,6%) patients.
In the control group the predominance of near-contact zone with the height of 0.25mm was revealed in 9 (34,6%) patients, the predominance of near-contact zone the height of 0.5mm in 10 (38,5%) patients, the predominance of near-contact zone with the height of 0.75mm in 7 (26,9%) patients.
Sharp reduction of the area of contact points was revealed in all three groups. So in the group №1 contact area decreased on the average of 19,42%, in the group of № 2 at 27,9%, in the control group -at 33,34%.
Thus, reliable reduction in the contact area and near-contact zones of the first order [7] makes possible for us to speak about the inexpediency of application for evaluating the state of the contacts of occlusiogramme of those obtained in the position lying.
Sitting position Lying position
the predominance of near-contact zone by height, (%) contact area, (mm)/middle contact area in the group (mm) the predominance of near-contact zone by height, (%) contact area, (mm)/ middle contact area in the group (mm)
0,25mm 0,5mm 0,75mm 0,25mm 0,5mm 0,75mm
Group №1 (>8,2мм) 60 20 20 10,3 (±0,4) 20 40 40 8,3 (±0,42)
Group №2 (4,28,1мм) 47,4 31,6 21,0 6,1 (±0,35) 26,3 42,1 31,6 4,4 (±0,47)
Group №3 (control room) (<4,1мм) 65,4 23,0 11,6 3,9 (±0,15) 34,6 38,5 26,9 2,6 (±0,12)
Conclusions
The activity of the neuromuscular mechanisms, which support the position of lower jaw in the state of physiological rest depends on the position of body in the space. Any change in the positions of body will affect the activity and sensitivity of propri-orreceptive afferent components and alpha- gamma of the efferent components of reflector system which they support lower jaw in the state of its physiological rest [2].
Reliable reduction in the contact area and near-contact zones of the first order, absence of the possibility to establish with the analysis of occlusi-ogramme, obtained in the patients locating in the position of lying, the prevailing diagram of the layout of occlusion points in 94% of patients, and also the results of investigation of the number of the foreign authors [3, 5] confirm this thesis.
Contemporary stomatological interventions provide the fulfillment of stomatological manipulations when patient it is located in the position lying. The equipment of surgeries with D-Tec lamps and the application of stomatological engines with the absence of alternative to them light source makes impossible the reception of patient in the position sitting. However, the results of the present investigation place under a question the expediency of use in the work the data about the contacts of those obtained with the aid of occlusiogramme of conducted out in the position lying on the spin.
Perspectives for further studies
It is necessary to conduct number of the clinical and laboratory investigations, which will make possible to form the theoretical base, which makes it possible to formulate the theoretical base the results of the present investigation.
Literature:
1. Anderson, J.R., and Myers, G.E.: Nature of Contacts in Centric Occlusion in 32 Adults, / Dent Res 50:7, 1971.
2. Ballard, C.F.: Considerations of the Physiological Background of Mandibular Posture and Movement, Dent Pract 6: 80, 1955.
3. Houk, J., and Henneman, E.: Feedback Control of Movement and Posture, in Mountcastle, V.B., (ed) : Medical Physiology, 12th ed, St. Louis: C.V. Mosby Co., 1968, pp 1681-1696.
4. Hufschmidt, H.J., and Spuler, H.: Mono-and Polysynaptic Reflexes of the Trigeminal Muscles in Human Beings, / Neurol Neuro-surg Psychiatry 25: 332, 1962.
5. Kawamura, Y.: Neurophysiology Background of Occlusion, Periodontics 5: 175, 1967.
6. Shore, N.A.: Physiology of the Stoma-tognathic System, in Occlusal Equilibration and Temporomandibular Joint Dysfunction, Philadelphia: J.B. Lippincott Co., 1989, chap 4.
7. Shylenko D.R. Design procedure of the area contact and closecontact zones of adhesive bridgelike constructions. //World of medicine and biology.-2008.-№1 - C.80-84
8. Sicher, H.: Positions and Movements of the Mandible, J ADA 48: 620, 1954.
9. Воронин В.Ф., Шестаков B.T. Основные направления системных исследований на современном этапе развития отечественной стоматологии //Стоматология. — 2000. — Т. 79, № 6. — С. 55-58.
10. Максимова О.П. Окклюзионное редактирование реставрированных зубов. Клиническая стоматология, 2002, № 1. — C. 22-24.
11. Неспрядько В.П., Жегулович З.Е., Захарова А.Е. Нарушение окклюзионных взаимоотношений при повреждении первых моляров// Современная стоматология. - №1. - 2008. - С.23-27
12. Ряховский А.Н. Способ создания окклюзионных контактов зубных протезов. - Патент №2160069, МПК 7 А 61 С 13/00, заявл. 1999.01.19, опубл. 2000.12.10
13. Хватова В.А. Диагностика и лечение нарушений функциональной окклюзии. — Н. Новгород, 1996. — C. 14-15.
14. Хватова В.А. Диагностика и лечение нарушений функциональной окклюзии. Нижний Новгород, 1996. — C. 2123, 45.
15. Шемонаев В. И. Способ определения окклюзионных контактов антагонирующих зубов. - Патент Российской Федерации RU2286114 опубл. 2005.03.15
16. Шиленко Д.Р. Cnoci6 визначення оклюзшних взаемин.-Декларацшний патент на корисну модель № 29584 Укра-Уни, МПК А61С13/00. / Заявка №2007 13342, заявлено 30.11.2007.
17. Шиллинбург Г., Уилсон Э., Моррисон Дж. Восковое моделирование окклюзионных поверхностей зубов // Перевод Е. Ханина. М.: 2004 С.15-21.
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BiCHHK Украгнсъког жедичног стоматологгчног акадежШ
Реферат
НЕКОТОРЫЕ АСПЕКТЫ ПРИМЕНЕНИЯ ОККЛЮЗИОГРАФИИ КАКСОВРЕМЕННОГО СТОМАТОЛОГИЧЕСКОГО МЕТОДА. ШиленкоД.Р., Беликова Н.И.
Ключевые слова: окклюзиография, стоматологический метод.
В статье изложены некоторые особенности применения оккпюзиографии. Проведены клинические исследования, подтверждающие достоверное снижение площади контактных пунктов и околоконтактных зон первого порядка, на окклюзиограммах, полученных у пациентов, находящихся в положении лежа, на 19,42% - для пациентов с резко увеличенной площадью контактов, на 27,9% - у пациентов с умеренным увеличением оккпюзионных контактов, и на 33,34% у пациентов площадь контактных пунктов у которых соответствует возрастной группе.
Реферат
ДЕЯК1 АСПЕКТИ ЗАСТОСУВАННЯ ОКЛЮЗЮГРАФ11ЯК СУЧАСНОГО СТОМАТОЛОГ1ЧНОГО МЕТОДА. ШиленкоД.Р., Белкова Н.1.
Ключов1 слова: оклюзюграф1я, стоматолопчний метод
У статп викладеш деяга особливосл застосування оклюзюграфп. Проведено кл1шчн1 дослщження, що пщтверджують достов1рне зниження площ1 контактних пунклв \ навколоконтактних зон першого порядку, на окклюзюграммах, отриманих у пащснлв, що перебувають у положены лежачи, на 19,42% - для пащенлв з р1зко збгпьшеною площею контаклв, на 27,9% - у пащенлв з помн рним збгпьшенням оклюзмних контакте, \ на 33,34% у пац1ент1в площа контактних пунклв уяких вщповщас вковм груп1.
УДК 616.314.18.-002.2/4-092
РОЛЬ 1МУННИХ КЛ1ТИН ТКАНИН ПАР0Д0НТУ В ПАТ0ГЕНЕ31 ХР0Н1ЧН0Г0 ГЕНЕРАЛ130ВАН0Г0 ПАР0Д0НТИТУ Шинкевич B.I.
Вищий державний навчальний заклад Украши "Украшська медична стоматолопчна академ1я", м. Полтава
Сучасний pieenb наукових досягненъ дозволяе ввважати хрончний пародонтит iMyHoonocepedno-ваним захворюванням. I хоча перевага лiмфoцитiв серед клтин тфшътрату in locus morbi при хрончних формах nаpoдoнтитiв була доведенана доситъ давно, власн резулътати до^дження вперше на Укран продемонстрували його субпопуляцшний склад. 1мунн клтини, що тфыът-руютъ ясна при хрончному генер^зованому nаpoдoнтитi представлешт: визpiваючими анти-ген-презентуючими дендритними клтинами, CD3+ Т-клтинами, CD4+ Т-хелперами/регуляторами, CD8+ цитотоксичними/ефекторними лiмфoцитами, yS+ внyтpieni-тeлiалъними лiмфoцитами i CD20+ В-клтинами. Kiлъкicнi та ятсн характеристики цих клтини дозволяютъ оцтити гх внесок в патогенез пародонтиту.
Ключов1 слова: хроычний генерал1зований пародонтит, ¡мунопатогенез, ¡муны кл1тини.
Сучасний р1вень наукових досягнень дозволяе
ввважати хронннии пародонтит 1муноопосеред-кованим захворюванням. Велика ктькють дослн джень присвячена розкриттю ураження тканин пародонта як результата комбшованого впливу мкрооргаызмв \ захистних процеав власних тканин макрооргаызму, нав1ть переважанню у деструкци останых [10].
Деструкц1я тканин пародонта, викликана мк-рооргаызмами, опосередкована прямими \ не-прямими уыверсальними мехаызмами. Прямий негативний вплив чинять бактери та Тх продукти: ензими (колагеназа, палуронщаза, хондро1тина-за, кисла фосфатаза), ендотоксини та метаболн ти (бутират, пропюнат, пол1амши амоыю, суль-фоваы компаунди). Бактери та Тхы компоненти: пептидоглканги, тейхосва кислота, ф1мбри, зов-ышы мембраны протеТни, капсула та л1пополь сахариди стимулюють розвиток ¡мунних реакцм макрооргаызму, здатних викликати важку тка-ниннудеструкц1ю.
Важливе питання складас дослщження кттин, що реал^ують локальы ¡мунн1 реакцм при хронн чних запальних захворюваннях тканин пародонта. Тому метою дослщження було встановлення ктьюсних та якюних характеристик основних
1мунних кл1тин-представник1в адаптивного 1мун1-тету, що знаходяться безпосередньо у м1сц1 ураження при хроннному генерал^ованому пародонтит! (ХГП) для з'ясування Тх внеску в де-струкцю пародонту.
Метер1али та методи дослщження. П1д спосте-реженням знаходилися пац1енти вком 41- 60 ро-к1в з хроннним генерал^ованим пародонтитом (п=30). До групи пор1вняння були обраы особи, вр1вноважеы за вком та статтю, з ¡нтактним па-родонтом (п=6). Мюцевий статус тканин порож-нини рота з'ясовували при кпшнному стомато-лопчному дослщженнг
У дослщження включали оаб з необтяженим алерголопчним анамнезом; без хроннних сис-темних захворювань кров1, шлунково-кишкового тракту, сполучноТ тканини; без цукрового дебету та системних серцево-судинних захворювань, що пщтверджувалося кпшнним, бюхЫчним аналЬами кров1 з визначенням показниюв гемо-глобшу, його середньоТ концентраций та серед-нього вмюту гемоглобшу в еритроцит1; гематок-р1ту; еритроцит1в, Тх середнього об'сму; лейкоците, тромбоцит^, нейтрофтв, еозинофтв, ба-зофтв, л1мфоцит1в, моноцитв; м1жнародне ста-ндартизоване стввщношення; креатини; загаль-
