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2940 East European Scientific Journal #2(66), 2021 UDC: 616.31-073.759:616.716 ГРНТИ: 76.29.55
Yarova S.P.
Doctor of medicine professor of the department of dentistry №2, Donetsk National Medical University, Ukraine
Turchenenko S.O. assistant of the department of dentistry №2, Donetsk National Medical University, Ukraine
Yarov Yu.Yu. Doctor of philosophy, associate professor of the department of dentistry №2, Donetsk National Medical University, Ukraine
Reva O.P.
student of the department of dentistry, Donetsk National Medical University, Ukraine
THE USE OF THE DIGITAL OCCLUSIOGRAPHY IN DIAGNOSTICS AND TREATMENT OF
MAXILLOFACIAL PATHOLOGY
Ярова С.П.
Доктор медецини, Професорка кафедри стоматологИ №2, Донецький нацгональний медичний унгверситет, Украгна
Турчененко С.О. асистент кафедри стоматологи №2, Донецький нацгональний медичний унгверситет, Украша
Яров Ю.Ю.
Доктор фглософгг, доцент кафедри стоматологИ №2, Донецький нацгональний медичний унгверситет, Украгна
Рева О.П.
студентка стоматологгчного факультету, Донецький нацгональний медичний унгверситет, Украгна
ЗАСТОСУВАННЯ ЦИФРОВО1 ОКЛЮЗЮГРАФП В Д1АГНОСТИЦ1 ТА Л1КУВАНН1
ЩЕЛЕПНО-ЛИЦЬОВО1 ПАТОЛОГП
Introduction. Research into the dental occlusal disorders is an important component in the complex functional analysis of the maxillofacial apparatus.
Aim of the study was to research the role of static and dynamic parameters of occlusion in various pathological conditions of the maxillofacial system, which were reflected by the results of digital occlusiogram.
Materials and methods. The review of scientific works is conducted in that the presented results of occlusion parameters were determined with the T-Scan device, which measures and analyzes the clenching force of teeth using ultrathin sensors. T-Scan technology is designed to carry out a dynamical determination of the occlusion on all treatment stages, and is the only quantitative method of the occlusion analysis to be used in practice.
Review and discussion. During the restoration of dental defects with orthopedic structures, the T-Scan system provides precision occlusal diagnostics, allowing to stabilize the maxillofacial system by providing adequate frontal guides, reaching the maximum intercuspidation, and removing obstacles. Proposed strategy of prevention of occlusive defects is based on the identification and elimination of risk factors, which serve as criteria for choosing the volume of treatment and preventive measures. Occlusal injury is the most common complication that accompanies generalized periodontitis. The use of the T-Scan computer system has made it possible to establish that pathological occlusion can accelerate the progression of the existing inflammatory process. During restoration with composite materials, precise modeling and functional verification of occlusal contacts in statics and in dynamics is required. With the help of the T-Scan device, not only the presence or absence of occlusal contacts can be investigated, but also the magnitude of the load distribution for each tooth, the exact localization of the supercontact in the central occlusion and at different movements of the mandible can be determined. The introduction of the T-Scan device gave the opportunity to follow changes in occlusion during orthodontic treatment and to make the appropriate correction at the final stages and in the retention period. The criteria for TMJ dysfunction were discovered, namely: limited opening, deviations of the mandible movement, deviation or interruption of the opening.
—— East European Scientific Journal #2(66), 2021 41
Conclusions. The performed studies revealed significant changes in occlusion relations in patients with defects in dentition, dental anomalies, dysfunction of the temporomandibular joint, periodontal tissue pathology, indicating the feasibility and necessity of using this method for the diagnosis and to determine the effectiveness of the treatment of the respective pathological conditions.
Резюме. Вступ. Дослщження оклюзшних порушень зубних р.вдв е важливим компонентом у комплексному функцюнальному аналiзi стану зубо-щелепного апарату. Метою дослiдження стало вивчення питання про роль статичних та динашчних параметрiв оклюзiï при рiзних патологiчних станах зубо-щелепно1' системи, яш вiдображають результати цифровоï оклюзiографiï.
Матер1ал i методи досл1дження. Визначення параметрiв оклюзiï проводили на апаратi T-Scan Ill, який визначае та аналiзуе силу стискання зубiв, використовуючи ультратонш датчики. Технологiя T-Scan III призначена для проведения динамiчного визначення оклюзи на всiх етапах лiкування зубiв i е единим кшьшсним методом аналiзу оклюзiï, що застосовуеться на практищ.
Результати. При вiдновленнi дефекпв зубних рядiв незнiмними та зшмними ортопедичними конструкцiями система T-scan III забезпечуе прецизiйну окклюзiйну дiагностику, що дозволяе стабшзувати щелепно-лицеву систему, забезпечити адекватш фронтальнi направляючi, досягти максимального мiжбугоркового положення, усунути перепони. За ввдсутносл своечасного вiдновлення дефектiв зубних рядiв, розвиваеться ускладнення у виглядi зубощелепних деформацiй та порушень оклюзшних сшвввдношень. Надважливою залишаеться проблема ортопедичного лiкування пацiентiв з повною втратою зубiв. Розроблена стратегiя профiлактики оклюзшних порушень, яка грунтуеться на виявленш та усуненнi факторiв ризишв розвитку, яш служать критерiями вибору обсяпв л^вально-профiлактичних заходiв. Оклюзiйна травма е найб№ш поширеним ускладненням, що супроводжуе генералiзований пародонтит. Застосування комп'ютерного комплексу T-scan III дало змогу встановити, що патологiчне оклюзiйне навантаження може прискорити прогресування iснуючого запального процесу. Тому проведення оклюзiйного монггорингу в таких випадках е обов'язковим у повсякденнiй практицi. При реставрацп композитними матерiалали необхвдне точне моделювания i функцiональна перевiрка оклюзiйних контакпв в статицi i в динамщг За допомогою апарату T-scan III дослщжена не тiльки наявнiсть чи вiдсутнiсть оклюзiйних контактiв, але i величина розподшу навантаження на кожний зуб, визначена точна локалiзацiя суперконтакта в центральнш оклюзiï та при рiзних рухах нижиьо1' щелепи. Одним з основних критерив оцiнки якосл ортодонтичного лiкування е оклюзiйний контроль. Впроваджения апарату T-scan III дало можливють прослiдкувати змiни оклюзiï в процес лiкувания i провести вщповвдну корекцiю на завершальних етапах та в ретенцшному перiодi.
Сучасний рiвень комп'ютерних технологiй дають можливiсть глибокого розумшня ролi оклюзiï в патологи скронево-нижньощелепного суглоба (СНЩС). Виявлено критерп дисфункцiï СНЩС, а саме: обмежене розмикання, вiдхиления руху нижиьо1' щелепи, змщення або перепона при розмиканш та деяш iншi, яш використовуються для дiагностики стану суглоба. Контроль зворотноьо1' реакцiï на певне оклюзшне втручаиия, дае можливiсть впливати на результати л^вання. Висновок. Проведенi дослвдження виявили значнi змiни оклюзiйних сшввщношень у пацiентiв з частковими та повними дефектами зубних рядiв, зубощелепними аномалiями, дисфункцiею скронево-нижиьо-щелепного суглобу, патолопею тканин пародонта, що вказуе на дошльшсть та необхiднiсть використання цього методу для дiагностики вiдповiдних патолопчних стаиiв. Важливим також е використання функцюнальних методiв для визначення ефективносп проведеного лiкуваиия та контролем його стаб№ностг Key words: digital occlusiography, maxillofacial pathology. Ключовi слова: цифрова оклюзюграфiя, щелепно-лицева патологiя.
Introduction. Research into the dental occlusive disorders is an important component in the complex functional analysis of the condition of the maxillofacial apparatus. On the one hand, occlusive relations have a significant impact on the development and progress of dental diseases (non-carious and periodontal pathology), on the other hand, an appropriate treatment (orthopedic, orthodontic) has a significant influence on occlusion. Due to changes in the dynamic and statistical parameters of occlusion during the treatment process, all components of the maxillofacial system are affected. Satisfactory closing of dental rows, i.e. the adjustment of the static parameters, can be achived with the change of position, simulating a new shape of occlusive surface. However, analyzing only the static parameters of occlusion is not a complete objective method of assessing the quality of treatment. It is necessary to analyze the occlusion in the dynamics from the first contact to the position of maximum intercuspidation. It
is known that finctional imbalance of occlusion imposes greater requirements for the adaptive capacity of the neuro-muscular apparatus [1, 2, 3]. It should be noted that the restoration of physiological occlusion has always been given considerable attention as one of the stages of dental rehabilitation. Formation of physiological occlusion is the basis for the uniform distribution of functional loads in the presence of a sufficient number of properly placed occlusal contacts and adequate interposition of the components of the temporomandibular joint. Creation of optimal occlusal-articulational relation of teeth requires a comprehensive study of the parameters of dynamic occlusion. The final structural compatibility during different movements of the mandible can be checked only in the mouth. [4, 5]. All of the above suggests the relevance of this problem and the feasibility and perspectivity of its further study taking into account
42 East European Scientific Journal #2(66), 2021 new technological possibilities and originality of approaches.
The aim was to study of scientific works about research the role of static and dynamic parameters of occlusion in various pathological conditions of the maxillofacial system, namely: the dental defects, dentomaxillary anomalies, neuromuscular pathology, pathology of the temporomandibular joints, periodontal disease, as well as the dynamics of the rehabilitation period on the basis of the analysis of literary data, which were reflected by the results of digital occlusogram.
Materials and methods. The review of scientific works is conducted in that the presented results of occlusion parameters were determined with the T-Scan device, which measures and analyzes the clenching force of teeth using ultrathin sensors. T-Scan technology is designed to carry out a dynamical determination of the occlusion on all treatment stages, and is the only quantitative method of the occlusion analysis to be used in practice. Diagnostics with the T-Scan device is very simple and painless. To determine the occlusion effort, the patient needs to bite an individual plate - an ultrathin sensor. At this time, all micromovements of teeth are displayed on the computer monitor. The technology provides quantitative data on force and time of dental compression. Data is provided with two- and three-dimensional active charts, which help you quickly and accurately recognize the problem points needed for the further formation of ideally balanced occlusion. The use of the T-Scan device in conjunction with the myograph allows to determine the relationship between the muscle electrical potentials and the occlusal relations of the teeth.
Review and discussion. One of the topical problems of modern dentistry is the qualitative diagnosis of the state of occlusal relations at the stages of planning the orthopedic construction, the clinical-laboratory stage and in the long-term observation perspective. New occlusive relations between artificial teeth can change the character of chewing movements, create unusual conditions, cause functional changes of chewing muscles and temporomandibular joint [6]. Therefore, the study of the parameters of occlusion, which allows quantitative determination of the degree of its malfunction and to further control the rehabilitation of patients after treatment, is appropriate and promising. It has been established that after receiving non-removable dentures, despite the carefulness and accuracy of checking and correction of occlusion relations on the day of fitting and fixing orthopedic constructions, in the nearest future patients complain of pain in the chewing muscles, difficulties in clenching teeth, etc. This led to the idea of examining the state of occlusive relations during the period of adaptation to non-removable dentures. The results of the study showed that since premature contacts do not disappear in most cases, it is necessary to provide care to patients during the adaptation to non-removable prosthetics (period of 1 month) [7, 8, 9]. The study of the features of occlusal relations of dentition in patients with non-removable metal-ceramic bridges was conducted. It was proven that the average number of
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occlusive contacts is directly related to the continuity of the dentition and the term for the manufacture of orthopedic constructions [10]. The introduction of prosthetic technology with the use of dental implants has opened new possibilities for the rehabilitation of patients with partial teeth loss [11]. In order to increase the effectiveness of non-removable prosthetics on dental implants with minor defects in dentition caused by loss of 1-2 teeth, a clinical and instrumental algorithm for diagnosis and stabilization of occlusion relations was proposed. This allowed to achieve the harmonization of clinical indicators of static and dynamic occlusion with complete absence of signs of occlusal dysfunction [12]. The obtained results on the character of functional-occlusal management in patients with group referral function depending on age, justify the repetition of the form of occlusal surfaces of individual teeth and dentitions, which reflect the natural state of the masticatory apparatus in the corresponding age. The use of T-Scan III allows to visually and objectively investigate dynamic occlusions, compare the results obtained, analyze the recorded graphic images both in statics and in dynamics. Research of occlusion of patients in different age groups showed that restoration of lost teeth with dental implants should be performed without changing the relations in the lateral parts of the tooth row, so that the restored fragment does not change the morpho-functional interrelations of the dentition within the field of occlusion characteristic to this age [13]. Among the methods for restoring the impaired integrity of dentitions, the problem is the choice of the method of treatment of lateral teeth associated with the high chewing load that falls on this area. An effective option for orthopedic treatment can be ceramic inlays and veneers. It has been proven that an important stage in the preparation of oral cavity is the optimization of occlusion. The T-Scan III system provides precision occlusion diagnostics, which allows to stabilize the maxillofacial system, provide adequate frontal guides, achieve maximum intercuspidal position, eliminate obstacles [14, 15].
Significant prevalence of caries, its complications and pathology of periodontal tissues contribute to an increase in partial loss of teeth among not only elderly, but also in young and middle aged people. Dentition defects cause the overload of teeth that preserve the bite height. In the absence of their timely replacement with dentures, complications develop in the form of maxillofacial deformations and defects of occlusion relations. The research of the effect of partial teeth loss on the functional parameters of occlusion, complicated by maxillofacial deformations, showed an increase in the asymmetry index of relative strength between the sides, as well as the presence of premature contacts and the wrong placement of the trajectory of the total vector of occlusion load. It was shown that the dynamics of changes in occlusal indexes occurs in accordance with the age of the dentition defects and the degree of development of maxillofacial deformations, and is increasing in dynamics. The revealed patterns indicate the need for timely replacement of defects in dentition with regard to occlusal relations [16].
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The problem of orthopedic treatment of patients with complete loss of teeth is extremely important today. In this case, special attention should be paid to the complete absence of teeth on one of the jaws. In such situation, the construction of only one complete removable denture is carried out taking into account the opposite dentition, which can be both intact and with partial defects, replaced by non-removable or partially removable dentures. In such cases it is very difficult to create a balanced occlusion. In order to improve the adaptation to a complete removable prosthesis, occlusive contacts were corrected using T-Scan III. The elimination of occlusive deformations allowed for successful adaptation in 51.3% of cases [17, 18]. It is known that the main task of a complete reconstruction of dentition is the creation of dynamic neuromuscular (functional-physiological) occlusion. New occlusive relations between artificial teeth can change the character of chewing movements, create unusual conditions, cause functional changes of chewing muscles and temporomandibular joint. Objectively assessment of the state of all major components of the tooth-jaw system is possible through modern diagnostic computer technology. Physiological interconnection between the specific occlusal relations and the functional state of the masticatory muscles was proved. A graphic confirmation of occlusive-muscular imbalance was found in the presence of supercontacts, which were subjectively non-registered by the patient. In addition, it has been shown that in complete occlusion reconstruction and traditional correction using articulatory paper, in 100% of cases, physiology disturbances of biodynamic indices of occlusion and muscular interaction were established. The possibility of their restoration to the level of physiological norm with the consistent correction of occlusion using the synchronization function of occlusio- and myography devices was proven [19]. Due to the reorganization approach in the establishment of indicators of occlusion, a strategy for the prevention of occlusive malfunctioms has been developed, based on the identification and elimination of their risks factors, taking into account the degrees of occlusion disorders, which serve as criteria for choosing the volume of treatment and prevention measures [20].
Occlusal injury is the most common complication that accompanies generalized periodontitis, especially in the early stages of the disease. It can be damagin to patients with healthy periodontium, lead to the destruction of composite restorations, breakage in orthopedic structures, and the destabilization of various types of removable prostheses, especially those that are used with complicated maxillofacial pathology in patients with generalized periodontitis. That is why the diagnostics of occlusive relations is an integral part of the treatment of this disease. The performed comparison of the methods of detection of occlusive disorders in patients with generalized periodontitis on the basis of the use of articulation paper and hardwarecomputer complex T-Scan III, which made it possible to talk about the necessity of mandatory involvement of objective methods in everyday practice [21]. It is known that pathological occlusion can accelerate the progression of the existing inflammatory process. One
East European Scientific Journal #2(66), 2021 43 of the problems of diagonomics of occlusion relations in patients with periodontal tissue diseases is the mobility of teeth, which prevents supracontacts from being evaluated due to significant deviation from the axis of the tooth. The standard procedure with the use of articulatory paper is impossible and ineffective prior to the splinting. Using the T-Scan III system, supracontacts were evaluated in patients with generalized periodontitis, taking into account the time of closure of dental antagonists. In analyzing the results, it was determined that teeth that first come in contact have the highest degree of mobility compared with other teeth. This justifies expediency of control of these parameters [22].
Nowadays, widely used restoration technologies are performed directly in the patient's mouth, using various composites of the last generations. However, the high quality aesthetic composite material on its own can't provide functional quality of restoration. Precise modeling and functional verification of occlusal contacts in statics and in dynamics are neccessary. The modern development of computer technologies allows for timely and rational correction of occlusion after direct restoration with the help of the T-Scan III device, which investigates not only the presence or absence of occlusive contacts, but also the magnitude of the load distribution for each tooth, to determine the exact localization of supercontact in the central occlusion and various movements of the mandible. It was established that the correction of occlusion in the mouth in the process of direct composite restoration is lacking, faults in the formation of the contact surface of the teeth are created, which leads to defects of the restoration and to the pathological "usual" occlusion. Therefore, high functional quality of restoration can be provided only under timely and qualitative control of occlusion with the use of modern methods of occlusion determination. Composite restorations of frontal teeth with veneers are variants of aesthetic treatment with minimal invasive preparation of hard tooth tissues. The T-Scan III computer analysis system provides reliable data on the pressure, strength and time of occlusal contacts. Such control is necessary for high quality and timely correction of restorations in order to minimize the significant occlusion load on adhesive structures in which bonding should be preceded by corrections of occlusive relationships [23].
One of the main criteria for evaluating the quality of orthodontic treatment is occlusion control. The introduction of the T-Scan III device opened new opportunities that allow to track the changes in occlusion during the treatment process and make the appropriate correction at the final stages and in the retention period [24]. Crossbite in children is often accompanied by asymmetry of the face and causes rebuilding of the tooth-jaw system at the level of the dentition and the alveolar proccess. The analysis of occlusograms for children with crossbite before orthodontic treatment showed that in all cases there were signs of malocclusion: displacement of the vector of strength, unbalanced occlusal load between the left and right sides of the teeth rows, and the presence of supracontacts. The complex of measures for correction
44 East European Scientific Journal #2(66), 2021 of the revealed malfunctions allowed to achieve effective results of early orthodontic treatment [25]. Premolars have a physiological feature of "splitting up" the occlusive loads. This was confirmed with the help of the T-Scan III system, namely: in the process of forming a plural intercuspidal contact there is a wavelike change in the said function of premolars. «Splitting axis» is a line that crosses the palate between premolars, with its points of occlusal contact placed on it, during the interaction of which takes place the coordination of neuromuscular activity [26]. Therefore, it is important to understand the occlusive changes that occur in the event of loss of these teeth. Thanks to the use of the computer system it was proved that when the premolars are lost, there is a decrease in the symmetry and synergy indices, the imbalance in the occlusion component, which leads to a new non-physiological model of the stomatognatic system [27].
The modern level of computer technologies provides an opportunity for a deeper understanding of the role of occlusion in the pathology of the temporomandibular joint (TMJ). It is known that a number of characteristics that describe the movement of the mandible indicate some TMJ dysfunction, such as limited opening, deviations in the mandible, dislocation or interruption of the opening, and some others that are used to diagnose joint conditions. Therefore, there is a possibility that by normalizing the TMJ function and controlling the reciprocal response to certain occlusive intervention, the outcome of treatment can be affected [28]. The main factor in the total rehabilitation of patients with signs of dysfunction of the temporomandibular joint is a stable functional outcome. The key is the correction of the microocclusion under the control of the modern computer system T-Scan III, as well as the monitoring of occlusion during the entire rehabilitation period. Due to restoring the harmony of the interaction of teeth, muscles and joints, the tooth-jaw system works effectively without recurrence of dysfunction in clinical situations. [29, 30].
Conclusions. The performed studies based on the use of the modern computer technology of occlusion monotiring T-Scan Ill revealed significant changes in occlusion relations in patients with partial and complete defects in dentition, dental anomalies, dysfunction of the temporomandibular joint, periodontal tissue pathology, indicating the feasibility and necessity of using this method for the diagnosis of the respective pathological conditions. It is also important to use functional methods to determine the effectiveness of the treatment and control its stability.
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Address for correspondence: Yarova Svitlana, 0506204307
Donetsk National Medical University address: Mashonobudivnikov Boulevard, 39, Kramatorsk, 84404
The work is a fragment of the research initiative of the Department of Stomatology №2 "To develop supportive treatment of patients after dental implantation, depending on the level of oral hygiene". State registration number 0117U005532. Source of funding: own funds.
