CLINICAL ALGORITHM OF DENTAL REHABILITATION OF PATIENTS WITH PATHOLOGICAL ABRASION OF HARD TISSUES OF TEETH, AGGRAVATED BY DEFECTS OF DENTAL ROWS WITH THE USE OF DENTAL IMPLANTATION

Abstract

Actuality. Pathological changes of the maxillofacial apparatus associated with pathological abrasion of hard tissues of teeth, aggravated by partial loss of teeth, have a special place among dental diseases due to the complexity of the clinical picture, the presence of risk factors for orthopedic treatment with the use of dental implantation and functional rehabilitation of patients. The aim. Improvement of the clinical algorithm of orthopedic rehabilitation of patients with pathological abrasion of teeth, burdened by defects of dental rows with the use of dental implantation and methods of functional rehabilitation assessment. Methods. Under our observation were 34 persons aged from 30 to 59 years, of which 15 men and 19 women with pathological abrasion of the hard tissues of the teeth of the I-II degree, aggravated by defects of the lateral areas of the tooth rows. Dental implantation and orthopedic treatment were performed after traditional sanitation of the oral cavity and professional oral hygiene. The control group included 12 people of the same age group with intact dentitions and physiological forms of bite, who had intact dentitions without clinically diagnosed diseases of periodontal tissues, pathological wear and teeth affected by the carious process. The ISQ Osstell device was used to determine the degree of primary stability of the implant, as well as the degree of osseointegration. Veneers, semi-crowns and jacket crowns were used to restore the anatomical shape of teeth that had undergone pathological wear. The degree of functional rehabilitation of patients after complex orthopedic rehabilitation was evaluated electromyographically. The results. During the first month after the installation of the implant, a decrease in stability was observed in the bone-implant connection, then from the second month, a gradual increase in the stability of the implant begins, which already exceeds the initial one by the sixth month, with maximum values after 12 months, which confirms the presence of the phenomenon of remodeling of bone tissue around implant. According to the results of an electromyographic study, it was established that before the start of treatment, significant statistically significant changes were noted in the determined indicators of the bioelectric activity of the masticatory muscles in patients with pathological abrasion of the hard tissues of the teeth of the I-II degree, burdened by small included defects of the dentition, compared to the control group, then as six months after the end of the treatment, the data indicate a tendency for the electromyographic indicators of patients with pathological abrasion of the hard tissues of the teeth of the I-II degree to approach the indicators of the control group. The value of the «K» coefficient in the examined group of people after the completion of treatment also testifies to the positive dynamics of adaptation to the established orthopedic structures. Conclusions. Pathological abrasion of the hard tissues of the teeth of the I-II degree, burdened by defects of the dentition, is accompanied by significant changes in the bioelectric activity of the masticatory muscles, which proves the functional changes of the masticatory apparatus in conditions of complex clinical pathology. Based on electromyographic indicators, dental implantation, in combination with the restoration of the anatomical shape of affected teeth with orthopedic structures, allows full functional rehabilitation of dental patients with pathological wear of hard tissues of the teeth, burdened by defects of the dentition.