RESUMEN
This case report involved the development of a rehabilitation system for patient with edentulism and an algorithm for diagnostic and therapeutic measures to be planned based on the patient's individual anatomical and physiological features. The results of treatment and rehabilitation made it possible to achieve the optimal distribution of loads on the dentition. It was shown that it is necessary to analyze casts in an articulator to reproduce a three-dimensional model of mandibular movements taking into account the individual features of the patient to obtain a satisfactory assessment and treatment planning of patients with edentulism requiring full mouth reconstruction. This case confirms that the developed algorithm is anatomically and pathogenetically justified, as it considers all changes and interrelationships of structures of the dentition.
RESUMEN
OBJECTIVES: Planning, adequate preparation, and further prosthodontic management are the most important steps in the treatment of this population of patients with dental and mandibular anomalies. The purpose of the article is the improvement of safety and clinical effectiveness of prosthodontic rehabilitation of patients after full-mouth reconstruction. MATERIALS AND METHODS: A single-center open prospective nonrandomized study, examination, and treatment of 198 patients with partial or total absence of teeth were performed. Higher safety and clinical effectiveness of the treatment were found in the patients of the main group who showed a significant reduction in the rate of complications relative to the comparison group. In the main group, the number of aesthetic defects and cases of repeated prosthetics decreased in comparison with the corresponding occurrence rate of such cases in patient groups. RESULTS: It showed statistically significantly reduction in the rates of occurrence of the complications when using the proposed algorithm: the rate of inflammation of the marginal periodontium and peri-implant tissues in the main group was 2.9 times less frequent and loosening of the supporting implants was 3.9 times less frequent. The rate of polymer chipping or abrasion in the area of the incisal edge or masticatory surface was two times lower in the main group of patients, short crowns were found 1.9 times less often, sores in the area of the dental pontic in the main group were 1.8 times less frequent than in the comparison group, and no fractures of bridgework were found in the main group. The frequency of neuralgic facial pain in the patients of the main group was 5.2 times less than in the comparison group, complaints about pain in the temporomandibular joint area were 8.4 times less frequent, increased abrasion of antagonist teeth was 3.9 times less frequent, and phonetics disorders were 8.4 times less frequent.The effectiveness of the algorithm developed by us is also confirmed by the fact that the number of aesthetic defects and cases of the need for repeated prosthetic treatment was reduced in comparison with the corresponding frequency of such cases in groups of patients where standard approaches to prosthetics were applied. In particular, aesthetic defects found in the main group of patients were 2.5 times less frequent than in the comparison group, and repeated prosthetics was performed 2.7 times less frequently. CONCLUSION: Application of the developed comprehensive approach to planning of prosthodontic rehabilitation provides for significant reduction in the frequency of complications and aesthetic defects, as well as cases of repeated need for prosthetics.
RESUMEN
OBJECTIVE: The aim of this study is to improve the safety and efficiency of prosthodontic treatment of patients with dental defects. It is necessary to perform a comprehensive assessment of the dentofacial system disorders, including the analysis of the features of pain manifestations. This study also supports to improve the efficiency of prosthodontic rehabilitation of patients with complete dental reconstruction on the basis of an assessment of the severity of orofacial pain manifestations. MATERIALS AND METHODS: The study was a single-site prospective open nonrandomized study with the examination and treatment of 452 patients (age = 44.3 ± 15.2 years, including 282 men and 170 women) with partial or total edentulism. The patients were divided into two groups: group 1 (control) of 218 patients treated with a standard prosthodontic approach and group 2 (study) of 234 patients treated which the proposed interdisciplinary approach to prosthodontic rehabilitation. RESULTS: The study establishes higher safety and clinical efficiency of the proposed interdisciplinary approach. The patients undergoing full-mouth reconstruction with the use of the interdisciplinary approach demonstrated statistically significant decrease in the rate of pain in muscles of the maxillofacial area on palpation, pain, and spasms in the neck area, statistically significantly less frequent pains in the temporomandibular joint (TMJ) during chewing, pain during opening and closing the mouth. CONCLUSION: The application of the developed comprehensive approach to prosthodontic rehabilitation planning makes it possible to improve essentially the results of treatment at the expense of reduction of pain manifestations in the area of maxillofacial muscles and pain sensations associated with functioning of the TMJ.
RESUMEN
Purpose: To compare the aspect of the reproduction accuracy in studied methods of determination of the (CR) of jaws using the digital research methods. The methods used were bilateral manipulation by P.E. Dawson, frontal deprogrammer, leaf gauge, and intraoral device for recording of Gothic arch angle. Methods: To determine the reproduction accuracy of the centric relation of jaws, we examined 5 patients with intact dentition in a prosthetic dentistry clinic (first class in Angle's system). For each method, 20 registrations of the centric jaw relation were carried out by one operator. The breaks between definitions were 30 minutes. A total of 400 CR recording operations were carried out (400 records of CR). In order to study the reproducibility of CR determination methods, 200 recorded mandible positions were analyzed by means of an analog-to-digital method (a macro kit Canon 650D, Canon 60 mm macro IS USM f2.8, Canon macro ring MR-14 EX and the computer program Adobe Photoshop) to assess the first occlusal contact obtained in the CR of jaws, while the other 200 were analyzed by means of a digital method (the computer program Avantis for 3D modeling, Prime as a laboratory 3D scanner (DOF), and Trios as an intraoral scanner (3Shape)) to assess the spatial position of the mandible in the CR. Statistical analysis was carried out using STATISTICA-10. In all statistical analysis procedures, the critical significance level p was assumed to be 0.05. Results: In the study of the data by means of the computer program Avanti 3D, the reproducibility of the mandible position in the CR reached 0.119 ± 0.012 mm for frontal deprogrammer, 0.225 ± 0.028, p ≤ 0.05 for bilateral manipulation by Dawson P.E., 0.207 ± 0.02, p ≤ 0.05 for leaf gauge, and 0.120 ± 0,013, p ≤ 0.05 using an intraoral device for recording the Gothic arch angle. The analog-to-digital method showed an identical tendency for reproduction of the mandible position. Conclusions: The digital analysis we made using the Avantis 3D program showed, with high confidence, that the maximum reproducibility of the CR position was reached by using our own design frontal deprogrammer and the device for recording Gothic arch angle.