A COMPREHENSIVE APPROACH TO THE TREATMENT OF PATIENTS WITH ALVEOLAR RIDGE ATROPHY IN PARODONTAL DISEASES: FROM THE USE OF BONE AUGMENTATION TO THE RESTORATION OF FUNCTIONAL OCCLUSION

Abstract

The rate of atrophy is significantly lower with the included dentition defects than with the final ones, as the teeth that limit the newly formed defect are natural constraints for bone resorption. However, the comprised dentition defects are not able to prevent the pathological process in the inflammatory-destructive process and generalized diseases in parodontal tissues, which in the future will affect the choice of prosthetic restoration and patient’s aesthetic appearance. Therefore, in the complex treatment of parodontal diseases, functional occlusion plays a remarkable role, which is achieved by rational prosthetics with prosthetic restoration made in articulators customized for individual function by CAD/CAM technology to eliminate traumatic interference and evenly distribute the masticatory load on the dentition and parodontal tissues.
 The aim of the study is to increase the therapeutic efficacy for patients with alveolar ridge atrophy in generalized parodontal diseases due to the inflammatory-destructive process from the use of bone augmentation followed by prosthetic rehabilitation of such patients and the development of a treatment approach.
 Materials and methods: Preliminary examination of patients was carried out according to the generally accepted methods of subjective and objective examination. Spot-film radiography, computed tomography, diagnostics were performed in an individually adjusted articulator, orthopantomogram, Vita Easyshade Advance 4.0 device.
 A digital database has been created in Microsoft Excel for the calculations. Statistical processing of the results was performed by the "Statistica 6.0" software.
 The canine guide on the laterotrusion side causes the distal-buccal surface of the lower canine of the working side to slide along the palatal slope of the upper canine of the working side. According to the table, among 25 patients of female patients 15 patients dominate in the gender assessment of the results, including 11 patients who underwent a comprehensive treatment of parodontal diseases with apical complications from the use of bone augmentation, which estimated 73.3% (p<0.05). The other 4 patients, which estimated 26.7% (p<0.05) of the total number of female patients were treated without the use of bone augmentation. In the treatment of male patients, the distribution was as follows: 7 patients, which estimated 70% (p<0.05) of the total number of male patients, underwent comprehensive treatment of parodontal disease with bone augmentation, 3 patients (30% (p<0.05)) underwent comprehensive treatment of parodontal diseases without the use of bone augmentation. Therefore, there were 25 patients with generalized parodontal disease with apical complications, 18 patients (72% (p <0.05)) of all patients without gender distribution received comprehensive treatment with bone augmentation, 7 patients (28% (p<0.05)) without regard to gender, comprehensive treatment was performed without the use of bone augmentation.
 Destructive processes in generalized parodontal diseases with apical complications cause bone defects that have to be replaced to rebuild the implant site and areas of restoration. The directed or nondirectional bone augmentation was used for this purpose. However, the directed bone augmentation with bioresorbable membranes is not sufficient at considerable bone defects. A strong skeleton is required for this purpose, which will provide additional mechanical support to counteract the load from the upper tissues and external factors, increase the regenerative potential, be able to save the bone from resorption; it will not be resorbed by itself and will form the necessary pattern of the alveolar process. At the same time, the masticatory load on the parodontal tissues normalizes due to the restoration of the anatomical relief of the occlusal relations, which will ensure the durability of prosthetic restoration made by CAD/CAM technology and comfortable use.