CC BY
4THE ADVANTAGE OF INTEGUMENTARY PROSTHESES IN THE TREATMENT OF PATHOLOGICAL ABRASION OF HARD DENTAL TISSUES
Panahov N.,
Doktor of Medical Sciences. Professor Azerbaycan Tibb Univtrsiteti, Ortopedik stomatologiya kafedrasi
Baku Azerbaycan Arkhmammadova G., Azerbaijan Medical University, Department of Orthopedic DentistryAssistent
Baku, Azerbaijan Aliyev T.
Doctor of Philosophy in Medicine,assistant Department of Pediatric Dentistry Azerbaijan Medical University, Baku, Azerbaijan https://doi.org/10.5281/zenodo.7327000
Abstract
According to the results of the examination of 19 patients with pathological abrasion of teeth, complicated by partial loss of teeth, the degree of functional pathology of the dentoalveolar apparatus was established, and the features of orthopedic treatment of patients with this pathology were determined.
Keywords: covering prosthesis, fixation elements, pathological abrasion of hard dental tissues, dentition defects.
Orthopedic treatment of pathological tooth abrasion is complex. A special group consists of patients with pathological abrasion of hard tissues of the teeth, complicated by defects in the dentition of various lengths and localizations. According to various authors, the prevalence of this pathological condition ranges from 26% to 92% [1, 2, 3]. Difficulties in the rehabilitation of patients with this pathology are determined by a certain combination of morphofunctional disorders caused by occlusal changes, dysfunctional disorders, aesthetic deficiencies, etc. [4, 5]. The above factors determine the need for an individual approach to the preparation of a treatment plan [6, 7]. Taking this into account, the purpose of our work was to determine the possibilities of increasing the level of orthopedic treatment of patients with pathological abrasion of hard dental tissues, complicated by defects in the dentition by clinical testing of the one-stage prosthetics technique. Objects and Methods To determine the features of the use of orthopedic constructions in patients with pathological abrasion of hard dental tissues, we formed a clinical group of 19 patients with pathological abrasion of hard tissues of teeth of II-III severity and the presence of included and end defects in the anterior and lateral areas. The control group consisted of 20 people with intact dentition. Patients were examined according to a certain scheme: anamnesis, examination of the face and oral cavity, study of plaster models, radiography of teeth and jaws, electromyographic studies of masticatory muscles (if necessary, MRI study). Before prosthetics, patients with this pathology were subject to appropriate therapeutic, surgical and orthopedic training. Results of the study Clinical symptoms in the vast majority of patients were accompanied by persistent violations of aesthetic standards, partial absence of teeth, chewing dysfunction, trauma to the soft tissues of the
oral cavity, discomfort in the temporomandibular joint and muscles, etc. An objective examination revealed a decrease in the height of the bite, asymmetry of the face due to the shortening of the lower third, the severity of the chin and nasolabial skin folds. The existing teeth had a characteristic crater-like shape in the lateral sections of the jaws, in the anterior - refined, usurized edges; in some patients, the crown parts of the teeth are erased almost to the level of the gums, in 13 people a horizontal form of pathological abrasion is determined, in 4 - vertical, and only in 2 - mixed. Palpation in 3 patients was determined by an increased tone of the masticatory muscles with their slight soreness. 2 people complained of pain in the TMJ, especially when chewing solid food. The group was also characterized by symptoms of underbite. Attention was drawn to the signs of chronic inflammation of the mucous membrane, especially in the case of the defeat of the pathological process of erasing the entire crown part of the tooth. This group is characterized by the presence of traumatic lesions of the alveolar processes in the areas of missing antagonist teeth (2 people) and on the lateral surface of the tongue (1 person). To study the degree of functional disorders and their further dynamics, patients of the clinical and control groups underwent a series of electromyographic studies. The qualitative characteristics of the analyzed electromyograms of the clinical group before treatment indicated various degrees of a decrease in the clarity of the structure of the records, which is associated with a profound change in the rhythm of the masticatory muscles. The duration of the phase of bioelectrical rest did not correspond to the duration of excitation of the masticatory muscles. An uneven inclusion of motor units in the contraction process was observed. During the performance of the functional test "arbitrary chewing", the side of chewing was
clearly defined, indicating the imperfection of the neuro-regulatory mechanisms of the act of chewing. Morphofunctional changes in the masticatory apparatus of the patients of the clinical group also affected all quantitative indicators of the electrical activity of the masticatory muscles. The amplitude of biopotentials is significantly reduced against the background of an increase in the frequency of their oscillations.
Significant changes occur in the duration of excitatory and inhibitory processes. All this affects the indicator of their ratio - the coefficient "K" (1.10-1.20 in the norm, 2.12-2.27 in pathology). The clinical picture, typical for the selected category of patients, is illustrated by an extract from the medical history of a patient who asked for help at the clinic of orthopedic dentistry with complaints of chewing dysfunction due to loss of teeth and a change in their anatomical shape, an aesthetic defect, discomfort in the masticatory muscles.
Objectively, there was a decrease in the lower third of the face, the severity of nasolabial and chin folds. In the oral cavity, there is a pathological abrasion of the hard tissues of the teeth of II-III degrees, a terminal defect in the dentition in the lower jaw, a decrease in the height of the bite.
Functional and aesthetic rehabilitation consists in the creation of areal fixation of integumentary prostheses built with full-type borders. In this case, the use of intradental attachments, telescopic crowns, support-retaining clasps, etc. is considered optimal as additional fixation elements. Orthopedic treatment of pathological abrasion of hard dental tissues is determined by the clinical state of oral tissues and in each case depends on morphofunctional changes that characterize the severity of the pathological process.
The generalized sequence and content of the clinical and laboratory stages are reflected in the corresponding scheme.
- I visit: taking full anatomical impressions for the manufacture of control models, their analysis, drawing up a treatment plan.
- II visit: preparation of abutment teeth for intradental attachments or other retention elements. Removal of complete anatomical prints from both jaws (they are obtained using elastomeric materials in one-and two-stage methods). In the dental laboratory, wax constructions of attachments are modeled.
- III visit: fixation of the cast patricians on the abutment teeth and removal of functional impressions using individual spoons. Determination of central occlusion using wax bite rollers.
- IV visit: check of the wax construction of the integumentary prosthesis.
- 5th visit: fabrication of matrix elements from rigid-elastic cold polymerization plastic and imposition of a finished orthopedic structure. Possible specific changes in the phasing and dependence on the clinical conditions in each case should be indicated.
The functional state of the masticatory apparatus is characterized by constant positive dynamics and, after some time, it makes it possible to assess the first signs of the formation of a new functional level, which should be confirmed by qualitative and quantitative analyzes of the electromyogram of the patients under study.
An indicative absence of bioelectrical activity in the masticatory muscles in a state of relative rest of the lower jaw. Volitional contraction is distinguished by the inclusion of many mobile units and the same abrupt transition from an active state to calmness. Voluntary chewing has the form of clearly marked vigils of activity and rest. In separate records it is already possible to reveal the fact of alternation of the sides of chewing in certain periods, which indicates the stable nature of changes in the mechanism of regulation of the act of chewing towards its normalization. A clear trend towards normalization of the act of chewing is demonstrated by the approach of the quantitative characteristics of the act of chewing in these patients to the level of the control group. The results obtained make it possible to unambiguously assert the effectiveness of the used method for the treatment of pathological abrasion of teeth, the essence of which is the use of a removable cover denture as a rehabilitation structure.
Conclusions:
1 A cover prosthesis made according to the proposed method can significantly reduce the orthopedic rehabilitation of patients with this pathology.
2 High hygiene and reliable fixation provide an accelerated period of adaptation to prostheses.
References:
1. Beda V.I. Nekotorye aspekty jetiologii i pato-geneza zubocheljustnoj sistemy pri snizhenii vysoty prikusa / V.I. Beda // Ukrainskij stomatologicheskij al'manah. - 2001. - № 6. - S. 56-58.
2. Dvornik V.N. Rasprostranennost' patolog-icheskogo stiranija zubov (obzor literatury) / V.N. Dvornik // Aktual'nye problemy ortopedicheskoj sto-matologii i ortodontii: materialy Vseukr. nauk. konf. -Poltava, 2000. Vyp. 2. - S. 4-5.
3. Kalamkarov H.A. Ortopedicheskoe lechenie patologicheskoj stiraemosti tverdyh tkanej / H.A. Kalamkarov. - M.: Med. inform. agentstvo, 2004. -184 c.
4. Levko V.P. Kliniko-jeksperimental'noe obosno-vanie povyshenija jeffektivnosti processov adaptacii pri lechenii s#emnymi vidami zubnyh protezov v ran-nie sroki: avtoref. dis. na poluchenie nauch. stepeni kand. med. nauk: spec.14.01.22 «Stomatologija». - K., 1999. - 16 s.
5. Bassi F. Overdenture therapy and worst-case scenarios: alternative management strategies / F. Bassi // Int. J. Prosthodont. - 2007. - Vol. 20, № 4. - P. 350353.
