UNIFIED ALGORITHM OF REHABILITATION OF PATIENTS WITH OCCLUSIONAL DISORDERS OF IATROGENIC GENESIS COMBINED WITH VERTICAL MALOCCLUSION

Abstract

Malocclusion is common dental diseases. According to epidemiological studies, occlusal pathology in the vertical plane is 5-7% among all anomalies. Occlusial problems contribute to the violation of basic body functions such as breathing, speech, chewing, which significantly impairs the quality of life of patients.Orthodontic treatment of adult patients has its own characteristics associated with the presence of concomitant pathology, as well as the inability to correct some pathologies only by orthodontic treatment. In the case of severe occlusion, complicated by tooth loss, a combination of surgical, orthodontic and prosthetic methods can achieve the best results. The key to successful treatment of such patients is a detailed diagnosis and a well-developed rehabilitation plan. Occlusive disorders, especially those that have arisen or been provoked as a result of dental treatment, usually lead to changes in all parts of the dental system and a number of complications. These structural changes usually make it difficult or sometimes impossible to conduct orthodontic treatment without the use of a set of special preparatory measures.
 The aim of our study: to propose a unified algorithm for complex dental rehabilitation of patients with occlusive disorders of iatrogenic origin in combination with vertical malocclusion and to prove its effectiveness.
 During 2019-2020, 55 patients with occlusive disorders of iatrogenic genesis in combination with pathology of occlusion in the vertical plane aged 23 to 47 years (mean age 36.1 ± 5.2 years) were examined, including 32 women and 23 men. Depending on the complaints and clinical manifestations, patients were divided into three groups. The first included 16 people with muscular manifestations, the second - 18 with disorders of the temporomandibular joint (TMJ) manifestations, the third - 21 people who, in addition to manifestations of TMJ and muscles, had primary neuritic disorders. All patients before and 6 months after treatment underwent clinical and laboratory examinations, radiography, electromyography and digital occlusion analysis of T-scan.
 There was a complete disappearance or significant reduction of complaints and symptoms after 6 months of rehabilitation in all 3 groups of patients. The implementation of our complex rehabilitation algorithm has led to the normalization of the bioelectrical activity of the masticatory muscles according to electromyography research, which is one of the most important criteria for the transition to the next stage of treatment and replacement of temporary restorations with permanent ones. Positive dynamics in the position of the TMJ condyles (tested with Computed Tomography) after the use of occlusal splints was observed in all patients and served as a marker for deciding to move to the next stage of dental treatment, including orthodontic correction. Also, occlusal balancing and normalization of the balance of occlusal contacts under the control of digital occlusal analysis T-Scan III was achieved in all patients in the preparatory stage and then monitored and maintained at all subsequent stages of comprehensive rehabilitation.
 Our study showed that the proposed algorithm for comprehensive rehabilitation of patients with iatrogenic occlusive disorders in combination with vertical malocclusion increases the effectiveness of orthodontic treatment of such patients and significantly reduces the duration of treatment in all 3 groups. This sequence of diagnostic and therapeutic measures provides the best opportunities for the patient to achieve maximum functional and aesthetic results.