Особливості заміщення дефектів зубних рядів у осіб із захворюваннями тканин пародонта різного ступеня тяжкості

Abstract

Resume. The high prevalence of periodontal disease causes the urgency of finding ways to improve methods of diagnosis, treatment and prevention of complications of this disease. The complex clinical picture requires a differentiated approach to the choice of orthopedic rehabilitation of such patients taking into account the patient's age, degree of pathological changes and activity of the pathological process with mandatory immobilization of movable teeth by different types of splints and splint dentures. Depending on the degree of pathological changes in periodontal tissues, the size and topography of dentition defects and the severity of destructive-resorptive processes in the alveolar bone, the replacement of dentition defects should be planned using dental implants and splinttype dentures. The aim of the study. Improving the effectiveness of orthopedic treatment of periodontal diseases, burdened by defects of the dentition through the differentiated use of dental implants and splinting structures. Materials and methods. A comprehensive clinical and laboratory examination of 237 patients with clinically diagnosed periodontitis I–III degree, burdened by partial loss of teeth. From the specified contingent of persons we carried out orthopedic treatment of 98 patients aged from 30 to 69 years with periodontal diseases of various severity, aggravated by defects of dentitions of various size and localization. Cone-beam computed tomography was used for objective quantitative and qualitative assessment of periodontal tissue and bone tissue of the edentulous jaw in individuals with various clinical forms of periodontal disease, to determine the relative densitometric density of bone tissue, when planning dental implantation and for control its results. The localization of supracontacts was determined by occlusion. Diagnosis and elimination of traumatic occlusion were performed according to Jenkelson and Schuller [3]. Evaluation of the stability of dental implants was performed by frequency – resonance analysis of the stability of dental implants using the Osstell ISQ device. Results. According to the results of examination of 237 people and the division of patients into three age groups, the clinical features of the pathological process in the age aspect were established. The results of computed tomography of the dental apparatus of the subjects showed that periodontal disease in the age aspect in the dynamics is accompanied by the severity of destructive-resorptive processes in the alveolar bone, which are manifested in a decrease in the relative densitometric density of bone marrow and bone loss. Orthopedic rehabilitation of this contingent of persons was performed with the use of biologically indifferent structural materials and splinting orthopedic structures, including splinting of abutment teeth, removable prosthetics and dental implantation, as well as accompanying physiotherapy of prostheses. In the case of periodontitis of I–II degree with sufficient volume and density of bone tissue in the area of the dentition defect, high clinical efficacy was shown by the use of dental implantation in the case of gradual loading of the dental implant using a superstructure of own development. In the presence of medium and large defects of the dentition on the background of periodontitis II–III severity in the presence of significant pathological mobility of abutment teeth and insufficient volume and density of bone tissue in the area of the defect sufficient clinical effectiveness showed the use of removable dentures own design. Conclusions. Periodontal diseases in the age aspect in the dynamics are accompanied by pronounced destructive-resorptive processes in the alveolar bone, which are manifested by a decrease in the relative densitometric density of bone tissue and progressive loss of height of the alveolar process. Timely application of dental implantation due to the dosed gradual occlusal load on the alveolar bone helps to preserve the structure of the alveolar bone and the height of the alveolar process. In the presence of medium and large defects of the dentition on the background of periodontitis II–III severity in the presence of significant pathological mobility of abutment teeth and insufficient volume and density of bone tissue in the area of the dentition defect, the use of removable dentures of splinttype design is shown. To prevent complications of prosthetics and prolong the use of orthopedic structures, it is advisable to use photodynamic maintenance therapy. Key words: periodontal tissue disease, dentition defect, dental implantation, splint-type denture.