Клінічна ефективність лікування пацієнтів з функціональними розладами скронево-нижньощелепного суглоба із застосуванням запропонованих методів

Abstract

Aim. The main purpose of our research is to improve the efficiency of diagnosis and treatment at patients with dentition defects and functional disorders of the temporomandibular joint with a help of individual tire and special patient approaches.Materials and methods. During the examination of patients with dental defects and functional disorders of the temporomandibular we examined the condition and the localization of dentition defects, analyzed diagnostic models and used radiographic methods such as orthopantomography and 3D tomography, as well as 3D condylography. At this stage of study we have examined 120 patients aged from 25 to 65 years. According to the clinical features and methods of treatment, patients were divided into the following groups:– patients with defects of dental rows, dention defects and functional disorders of the TMJ, examined and treated by conventional methods (group 1, 60 people).– patients with dention defects and functional disorders of the TMJ, examined and treated with the proposed methods using the articulation system, 3D scanner 3SHAPE and individual tire (group 2, 60 people). We have proposed a special method of manufacturing an individual tire for patients with functional disorders of the temporomandibular joint. Our complex treatment of the temporomandibular joint dysfunction hasn’t performed quickly, it includes occlusal ratios and selective grinding of occlusal surfaces, conducting of a condylography and application of an Aqualizer for 3-4 weeks which finally leads to production of temporary esthetic dentures.Results. After the proposed treatment that lasts 6 months, we found a significant reduction of patients with pain of the TMJ, that contains in 1 group 15 patients and in 2 group – 4 patients. However, it should be noted that these patients had significantly lower intensity and duration of joint pain than before treatment. The intensity of pain during lower jaw movements at patients of both groups after treatment decreased, however, the number of patients was 12 at first group but the level before treatment contains 43 people (72.5 %). At the second group, the number of patients with joint pain during movements of the mandible before treatment was 44 and after six months it was significantly reduced to 4 patients. The number of patients with wide-open mouth pain at the first group decreased from 45 (77.5 %) to 11 and at the 2-nd group from 48 patients to 5 patients. It should be noted that all indicators were better in 2 group. Hence, as you can see it indicates the high efficiency of the proposed treatment and proposed by us individual tire design.Conclusions. 1. Our individual tire design allows us to individualize it’s thickness depending on the condition and position of joint heads, furthermore localization of the dentition defect on both sides of the dental row, as well as to carry out gradual lifting of a bite and achieve great esthetic result at the lateral area.2. The proposed step-by-step treatment at patients with functional disorders of the TMJ involves the analysis of occlusal ratios with obligatory usage of Aqualizer for 3– 4 weeks. The next stage of treatment include the manufacture of temporary fixed structuresk, and the usage of the proposed functional individual tire for 3–6 months. The next stage include permanent aesthetic non-removable dentures (metaloplastic, metal-ceramics or zirconium dentures) and finally relaxation elastic tire for 3–6 months as a prevention of the dysfunction syndrome.3. After 6 months of the proposed treatment we found a significant decrease at the number of patients with pain of the TMJ that was 4 patients, compared with the group of patients who received conventional treatment – 15 patients. The number of patients with wide open mouth pain in 1group decreased from 45 to 11, and in 2 group from 48 patients to 5 patients. Clicks and crunches during wide-opening at the TMJ before treatment were detected in 1 group at 21 patients and in 2 group at 18. After 6 months of treatment these symptoms were detected at 9 patients in 1 group, and at 3 patients in 2 group, who achieved proposed by us treatment.Key words: dysfunction of the temporomandibular joint, dentition defects, individual tire, condylography, temporary and permanent dentures.