EVALUATION OF THE SUCCESS OF DIRECT AND INDIRECT RESTORATIONS IN THE REPLACEMENT OF DEFECTS OF HARD TISSUES OF CHEWING TEETH WITH DIFFERENT DEGREES OF THEIR DESTRUCTION

Abstract

Treatment of dental caries has changed significantly in recent years. Early detection and diagnosis of caries based on clinical indicators and assessment of risk factors is effective. Several studies have shown that approximately 60% of procedures performed in dental offices are restoration of carious cavities or replacement of old restorations. The correct choice of material and technique can be considered as key factors that affect the success or failure of the restoration. Undoubtedly, the question always arises before the clinician: when to apply a seal, inlay or crown, what criteria should be used in order to differentiate the indications before their manufacture. Goal. To systematically evaluate the cumulative survival and success rates of direct and indirect restorations for defects of hard dental tissues with different degrees of their destruction after a 3-year period of use, to analyze the main complications that arose during their use and to determine factors that can affect the clinical result of restorations. Research material and methods. We performed a retrospective analysis of the quality of direct composite and indirect restorations (inlays and crowns) of vital and endodontically treated lateral teeth in 298 patients (423 restorations) aged 25 to 60 years with varying degrees of destruction of their occlusal surface, who applied to the Department of Stomatology of the Shupyk National Healthcare University of Ukraine. The restorations were carried out at the KNP "Dentistry" in Kyiv and at the Department of Dentistry of the P.L. Shupyk National Health Service of Ukraine at least three years ago. Exclusion criteria from the study group, in addition to age restrictions, were dysfunctional TMJ changes, severe general somatic pathology, and manifestations of bruxism. and severe periodontal pathology. The clinical quality of direct and indirect restorations was assessed using visual-instrumental control and according to the recommendations of the revised FDI criteria for the evaluation of direct and indirect dental restorations (2023). The presence of inflammatory changes in the periodontal tissues was determined using the periodontal index (PI), the presence of plaque – using the OHI-S index (Green-Vermillion, 1964), the gingival sulcus bleeding index (SVI) was determined according to the Miihlemann and Son method. The results. Factors affecting the strength of restored teeth include the type of cavity, the amount of tooth tissue lost, the technique used for filling and indirect restorations, and the composition of the materials used. Cavities of the second class are most prone to fractures due to the frequent loss of a large volume of tooth tissue. In addition, depulped chewing teeth with direct composite restorations were more prone to fractures (25.9%) due to loss of dentine elasticity, dehydration, and deep cavities. Evaluation of the quality of restorations of the chewing group of teeth with direct and indirect restorations showed that the level of oral hygiene was significantly correlated with their quality. Conclusions. Currently, there is no single unified protocol regarding the choice of methods of restoration of hard tissues of chewing teeth. The choice between the direct and indirect method of restoration of the teeth of the chewing group is determined not only by objective factors, but also depends significantly on the patient's preferences and the dentist's skills, financial capabilities, etc. Therefore, the problem of choosing a method of treatment of defects of hard tissues of the teeth remains relevant and requires careful study.