Complete Adentia Research Articles

COMPARISON OF DIGITAL AND CLASSICAL PROTOCOLS IN THE TREATMENT OF PATIENTS WITH COMPLETE MAXILLARY ADENTITY USING THE "ALL ON FOUR" TECHNIQUE: A 3-YEAR FOLLOW-UP

Today there is a problem of significant prevalence of complete adentia. A modern solution to this problem is implantation followed by prosthetics. However, modern prosthetics is currently impossible without adequate implantation. One of the most predicted methods of implantation in patients with complete edentia is the "All on four" method, which includes the installation of 4 implants at specific angles in the alveolar process. The purpose of this study was to compare digital and traditional protocols in the treatment of patients with complete maxillary adentia using the "All on four" technique during a 3-year follow-up period according to the following parameters: implant survival during a 3-year follow-up period; alveolar ridge height in the implant sites at the end of a 3-year follow-up period; assessment of patient satisfaction with the treatment at the end of a 3-year follow-up period (aesthetic and functional components). Research methods. 70 patients with complete maxillary edentulousness who were treated using the "All on four" technique participated in the study. The total number of implants was 280 units. Implant survival during the 3-year follow-up period was determined at the end of the study by the number of retained implant units. The height of the alveolar ridge in the implant sites was determined at 36 months after the final prosthetics using CBCT data in Planmeca Romexis® software. The patient's satisfaction with the treatment was assessed at 36 months after the final prosthetics on a scale from 0 to 10 points, where 0 meant extreme dissatisfaction with the result, and 10 meant complete satisfaction. The scientific novelty lies in the comparison of the traditional and digital protocols from both the clinician and patient perspectives. The study was also long, with follow-ups conducted over 3 years. Conclusions. When using the digital protocol, a higher percentage of implant survival was observed at the end of the 3-year follow-up. Patients' assessment of the results of treatment using computer-assisted planning is higher than the assessment of the results of treatment by patients who underwent rehabilitation according to the traditional protocol. Taking into account the results of the study, we recommend the use of a digital protocol in the rehabilitation of patients with complete maxillary edentulousness using the All on Four technique.

ORTHOPEDIC REHABILITATION OF DEFECTS IN THE DENTITION OF THE JAWS OF CLASSES I AND II ACCORDING TO KENNEDY

According to WHO, the highest prevalence of partial adentiais observed at the age of 37 to 46 years, while 12.8% of the adult population of this age has complete adentia. Restoring the integrity of the dentition helps to improve the function of chewing, aesthetics and speech, as well as the quality of life of patients. In Kennedy grades I and II, treatment is most often carried out with the manufacture of partial removable dentures.

The effectiveness of dental implantation in patients with type II diabetes mellitus

The issue of the safety of dental implants in patients with diabetes mellitus, despite the increase in the number of orthopedic corrections of partial or complete adentia with their use, remains open [1].
 In such a situation, the most urgent question is the development of new, safe and less traumatic methods of dental implantation, which would expand the indications for prosthetics on implants for this category of persons and improve the quality of life of such patients through full-fledged correction of chewing function.
 The purpose of the study was to investigate the effectiveness and safety of the method of orthopedic rehabilitation proposed by the authors using implants in patients with type II diabetes mellitus.
 Material and methods. As part of the study, 68 patients were treated, who were divided into three groups: the main group (patients with DM operated without the formation of muco-periosteal flaps according to the protocol developed by us) — 34 patients (50 %); control group 1 (patients with DM operated according to the traditional protocol with the formation of muco-periosteal flaps) — 16 patients (24 %); control group 2 patients without diabetes, operated without formation of muco-periosteal flaps according to the protocol developed by us) — 18 patients (26 %).
 The effectiveness of dental implantation was evaluated after 2 years. Such indicators as the survival rate of dental implants and the level of bone resorption (according to the results of intraoral radiography were used as criteria. In addition, bone density was studied on the Hounsfield scale (HU).
 Results. It was found that in patients of the main group and control group 2, survival rates were 98.70 % and 98.72 %, respectively, in patients of control group 1, the survival rate of dental implants was 89.48 %, which is also comparable with literature data on dental implantation in patients with diabetes mellitus [2, 8, 9]. Possibly greater effectiveness in the main group and control group 2 is associated with a new method of dental implantation (RF Patent No. 2794843 dated 25.04.2023) [7] and the use of a collapsible navigational surgical template (Patent RU No. 2796749 dated 29.05.2023) [6], which allowed the main group and the control group to fix individual trajectories of articulation of the mandible (which further allowed to avoid incorrect orthopedic rehabilitation, which could lead to uneven or excessive load on dental implants), to avoid reduction of the alveolar ridge, to plan in advance the exact position of dental implants, and also eliminated the need for the formation of muco-periosteal flaps and further suturing.
 Conclusion. The use of the technique developed by us (RF patent No. 2794843 dated 25.04.2023) allows us to increase the effectiveness of treatment of patients with type II diabetes mellitus and bring it closer to the results of practically healthy people (according to retrospective observation for two years).

The need for orthopedic dental services for the elderly population of Kazakhstan

<b>Objective</b>: To determine the orthopedic dental status of the elderly population of Kazakhstan using clinical and diagnostic determinants.<br /> <b>Methods:</b> The dental status of 708 patients from three institutions in Almaty, Kazakhstan, was recorded using WHO dental questionnaires. The patients were divided into groups according to their age and sex, and modern statistical methods were used to process the data. Through the construction of tables and graphs, calculation of relative values, and assessment of the reliability of the differences in the data, we determined if there were any differences between the groups.<br /> <b>Results: </b>The study revealed that most patients who needed orthopedic dental care were 60 years of age and older. The older the age of patients with registered diagnoses of partial and complete adentia, the greater the need for removable prosthetics. The most common type of orthopedic treatment required for these patients was removable dentures. Analysis of the quantitative relationship between the need for orthopedic dental care and patients’ gender revealed the following patterns: the critical value of Chi-square at the significance level p≤0.0001 was 23.95, the exact Fisher criterion was 0.0000 (p=0.0000), and the calculated Cramer’s V criterion and the conjugacy coefficient showed the relationship between the variables were at the levels of 0.17 and 0.18, respectively.<br /> <b>Conclusions:</b> Owing to the aging population in Kazakhstan, and indeed the world, the problem of medical adaptation and social rehabilitation of older age groups is pertinent, and our findings argue that the introduction of geriatric dental services in Kazakhstan is warranted.

Variants of the typical variability of alveolar arches in different craniotypes

Background. The implementation of the principles of evidence-based medicine in applied and fundamental research consists in the precision of morphometric measurements in determining the types, dimensions and spatial location of the facial and cerebral parts of the skull. Published scientific data on the variability of morphometric parameters of the alveolar arches are contradictory and heterogeneous due to the lack of definition of interdependencies with gender, age characteristics and individual features of the skull.Goal. Investigation of the regularities between morphometric values and forms of the alveolar arches of the upper jaw in mesocrane, brachycrane and dolichocrane types of the skull.Materials and methods. Morphometry was performed on 93 preparations of skulls with lower jaws of both sexes of the first and second periods of adulthood with physiological types of bite and the shapes of the alveolar arches of the upper jaw were established. Taking into account the value of the transverse-longitudinal index, the skulls of mesocrane (n=54; 58.1%), brachycrane (n=23; 24.7%) and dolichocrane (n=16; 17.2%) types were identified. The length, width, depth and diagonal of the alveolar arches were studied as morphometric parameters.Results. The minimum and maximum limits of fluctuations of values, average statistical indicators, coefficients of variation are determined. The variability of the parameters of the alveolar arches of the upper jaw depending on the shape of the facial skull and gender characteristics was established. It is proved that the smallest values of the depth of the alveolar arch of the upper jaw are noted in brachycranes, the largest – in dolichocrans, while the smallest dimensions of the length, width of the alveolar arch of the upper jaw are determined in dolichocrans, and the largest – in brachycranes, while the smallest diagonal values of the alveolar arch of the upper jaw are revealed in mesocrans.Conclusions. The shape of the alveolar arches in the mesocrane type of skull has a proportional arcuate shape, in brachycrania − an arcuate «wide and short» shape, in dolichocrania − an arcuate «narrow and long» shape. The obtained new data on the variant variability of the alveolar arches should be used when planning treatment tactics for patients with complete adentia.

Clinical and epidemiological characteristics of the frequency and structure of edentulism in elderly and senile people of the Republic of Sakha (Yakutia)

Aim. Based on the results of the study of the frequency and structure of complete loss of teeth in the upper and lower jaws, to determine the need of elderly and senile people in prosthetics with complete removable orthopedic structures. Materials and methods. A dental examination was carried out in 5,791 people aged 60 to 93 years. At the same time, on the recommendation of WHO, a key age group of 65-74 years was formed. The study took into account the topography of the absence of teeth, gender, age, the presence and evaluation of previously manufactured complete removable dentures and the need for prosthetics. Results. A high prevalence of complete loss of teeth on the upper and lower jaws was found in the examined age groups of elderly and senile age. The largest proportion of complete loss of teeth of the upper and lower jaws was revealed in the age group of 75-84 years. At the same time, in elderly people, complete adentia is detected mainly in women, since men occupy a quarter of the gender ratio. Meanwhile, taking into account the indications for reprosthetics and the absence of prostheses with complete loss of teeth, the need for the manufacture of orthopedic structures in the form of complete removable prostheses in the surveyed population is determined. Conclusions. The obtained results dictate the need to improve orthopedic rehabilitation of patients with complete loss of teeth in the upper and lower jaws, taking into account the data obtained on the structure and frequency of complete loss of teeth in elderly and senile people.

Forming the maxillary palatal relief on the outer palatal surface of the complete removable dentures

Prosthodontic treatment of secondary complete adentia in the upper jaw with completely removable plate prothesis consists in reflecting the palatal relief on the outer surface of the upper jaw prosthesis basis. Preparation of CRPP for SCA is an arrangement of known clinical and laboratory stages.
 During the prosthodontic treatment of SCA with maxillary CRPP, the following sequence was performed at the clinical and laboratory stages for the purpose of reflection of the palatal relief on the outer side of the maxillary prosthetic bases, the 2nd and 4th laboratory stages have been improved. So that:
 Replacing the wax with plastic in the composition of complete removable dentures. 4,5,6,7,8 figures of our work refer to this stage. At this stage: Figure 8-reflection of the relief of a part of the hard palate in the base plate wax added to the trial denture of a maxillary complete removable platen prosthesis. Figure 9-reflection of the relief of a part of the hard palate in the denture wax added to the trial denture of a maxillary complete removable platen prosthesis.
 The present study shows that the complete removable upper plate prosthesis (CRPP) is more functional in the prosthetic treatment of secondary complete adentia (SCA). By using CRPP on the upper jaw, unnatural disturbances in the relief of the palatine region are eliminated. It will be useful for improving other clinical and laboratory stages of preparation of maxillary CRPP.

ANALYSIS OF INTERCONNECTION PROBLEMS DATA INDICATORS OF THE PATIENT'S QUALITY OF LIFE WITH MANUFACTURING PRINCIPLES OF REMOVABLE DENTURES

Assessing the quality of patient's life can become a crucial criterion when evaluating the effectiveness of disease treatment, as well as when comparing the efficiency of various programs: conservative and surgical treatment, various types of drug therapy, rehabilitation regimens, etc. In recent years, increasing attention has been paid to health, particularly dental, associated with the study of the life quality indicators.
 The purpose of our study was to analyze the relationship between patient's quality of life indicators and the organization of the patient's dental rehabilitation with removable denture structures and the treatment of partial and complete adentia.
 The study included 56 patients who sought dental care for partial or complete adentia. One of the conditions for forming the selective statistical population was its homogeneity in terms of age and gender composition, as well as general somatic status. When analyzing the data on the life quality of patients with partial and complete adentia, we used the SF-36 questionnaire (The Short Form-36) as a basis, comparing the data both before and after prosthetic treatment to evaluate its effectiveness. Moreover, we took into account both objective and subjective factors that could affect the life quality of patients during prosthetic treatment.
 The results of quality of life indicators in patients with partial adentia (PA-1 group) and complete adentia (CA-2 group) considering gender and age before and after treatment with partial removable and complete removable dentures, were determined applying the SF-36 questionnaire in compared groups.
 Thus, analyzing the overall picture, it is possible to note a statistically significant (Р<0.05) decrease in quality of life indicators on all scales in patients with complete adentia (CA) compared to the group of patients with partial adentia (PA).
 The evaluation of quality of life indicators has an extremely important clinical and prognostic value when making diagnosis, selecting prosthetic treatment method, and evaluating the long-term prosthetic outcomes.
 These data should be taken into account in the practical activities of prosthetic dentists, to prevent common conflicts arising due to the inconsistency of patients' expectations with the predicted results of treatment and the results of rehabilitation measures.

Use of surgical templates in the daily practice of the oral surgeon

BACKGROUND: Three-dimensional (3D) technology allows for the creation of individual surgical templates. This is a special construction, providing precise placement of dental implants in the jaw tissue. Templates are divided by the type of fixation into bone pins and screws and dental and gingival pins. The surgical template is made by 3D printing from a special resin. The technology allows the computer modeling to be transferred precisely to the patients jaw. The optimal angle for implant insertion and free overlapping of the template, which has holes for positioning and cooling the mucosa, is important to consider. The goals of template making are the correct positioning of the implant and the accuracy of placement, which affects the success of further prosthetics. The template is the link between surgery and prosthetics. Proper positioning of the implants increases the accuracy of the orthopedic prosthesis.
 AIM: The study was aimed to compare the standard implantation protocol and implant placement using a 3D-printed surgical template.
 METHODS: Comparative assessment of two groups of patients was conducted. Group 1 was implanted using a surgical template, whereas Group 2 was implanted according to the standard technique, without a template. In total, 35 patients with partial adentia and 10 patients with complete adentia were examined. The effectiveness of surgical templates during the placement of dental implants and the risks of complications were assessed.
 RESULTS: In Group 1, where surgical templates were used, a 40% decrease in the duration of surgery, a 90% reduction in the gingival incision area, and accurate positioning of the construct were observed. Postoperative complications such as pain, swelling, bleeding, and numbness developed less frequently by 70%. Group 2 was implanted according to the standard technique; however, the implant deviation from the planned position was observed in 35% of patients. The effectiveness of surgical templates lies in the accuracy of implant positioning and denture fabrication and reduction of complications.
 CONCLUSIONS: The use of surgical templates is indicated in complicated clinical cases, critical bone atrophy, and for avoiding damage to anatomically important areas. The planning of the surgical template is simultaneous with the placement of the implant and with consideration of the subsequent prosthetic construction, since the accuracy of positioning affects the accuracy of the prosthetic construction. The use of advanced technologies increases the effectiveness of dental implantation.

Analytical review of graphic methods for the study of dental arches in clinical orthodontics

The analysis of textbook and modern literature sources devoted to the graphic construction of human dental arches was carried out in order to select the optimal research methods, taking into account the individual characteristics of the craniofacial morphology. The features of the construction of dental arches according to the Hawley method are presented and the possibilities of using this technique only for some types of dental arches are shown. Information is given on the amendments to the calculations of the radius of the Hawley circle, taking into account the geometric laws of the circle. Attention is paid to the shape of the dental arch of the milky period of the bite and the possibility of using the Schwartz method in children only with optimal occlusive ratios without signs of anomalies of the dentition-jaw system is noted. Amendments to the A. Schwartz method are presented, taking into account the size of the teeth and the size of the diastem component. The method for determining the size of the dental arches by the parameters of diagnostic triangles and the dental pentagon is shown. Methods of graphic construction of predicted forms of arcs with their anomalies, as well as with defects of long length, including complete adentia, are presented. This analysis can be useful to orthopedic dentists and orthodontists when choosing methods of prosthetic and orthodontic treatment.

THE INFLUENCE OF PHONETIC ADAPTATION ON THE QUALITY OF LIFE OF PATIENTS WITH ADENTIA

Abstract. Regardless of the reason for the extraction of teeth, complications of caries, severe periodontitis or traumatic extraction, the result is always the same - the formation of a defect in the dentition, requiring its replacement. Situations when it is necessary to replace an included defect with the absence of one tooth have long been included in daily dental practice and do not cause discussions, however, situations when it is necessary to fill in the entire dentition require a lot of clinical experience and training. Given the fact that such rehabilitation cannot exclude a financial factor, removable dentures still remain, although not ideal, but a rather relevant method of treating complete adentia. The term "adaptation" (from Latin adaptation - adaptation) - within the framework of orthopedic dentistry means the patient's getting used to the use of prostheses. Any replacement prostheses in the oral cavity at first are perceived as a foreign body being an irritant. The time of adaptation to the prosthesis depends on many factors: the design of the prosthesis, the quality of fixation, the nature of the transfer of pressure on the mucous membrane, the psycho-emotional lability of the patient, the duration of the use of the prosthesis. Over the past few decades, the main vector of development of dental treatment has been aimed at improving the aesthetics and functional features of the dentoalveolar system of patients. This fact is confirmed by the standard complaints of patients. In total dental rehabilitation, as a rule, the phonetic adaptation of patients to orthopedic structures with various types of fixations at the stage of prosthesis manufacturing is not taken into account either by dentists or dental technicians. Situations when diction and phonetics are not restored after the treatment are quite rare in everyday practice, but the ways of adaptation of patients to new orthopedic structures are not predictable both in clinical course and in terms of timing.

Perspectives for the use of probiotics in the treatment of peri-implantitis. Literature reviewe

The use of dental implants for the treatment of partial and complete adentia is increasing every year. Following this, despite the improvement in the quality of dental services, the percentage of complications also increases. One of the most common complications in implant treatment is peri-implantitis. The microorganisms causing this process are in the biofilm on the surface of the implant, which complicates the treatment and reduces the effectiveness of antimicrobials. One of the principles of modern medicine is prevention, which opens up new prospects for the use of probiotics.

IMPLEMENTATION OF NEUROMUSCULAR DENTISTRY PRINCIPLES IN REHABILITATION OF PATIENTS WITH COMPLETE ADENTIA

According to World Health Organization about 15% of the world’s adult population suffer from complete adentia, with a steady growth in the number of patients affecting not only the elderly which is accounted for by an increase in life expectancy, yet also among people in their working age. Apart from disturbed chewing and speech functions, complete adentia leads to altered anatomical and topographic proportions of the face and facial skeleton, progressive atrophy and osteoporosis of the jaws, masticatory and mimic muscle atrophy, as well as to dysfunction affecting these muscles and temporomandibular joints. Due to lack of proper nutrition, changed exterior, issues in interaction with others, this group of patients develop a whole set of psychosomatic reactions finally causing social withdrawal. Rehabilitation of patients with complete loss of teeth is an urgent issue. However, the effectiveness of prosthetic treatment depends not only on the denture manufacturing technology, but on the quality of functioning involving the maxillofacial organs in combination with the respective orthopedic appliances. Whereas precise and reliable assessment of the maxillofacial neuromuscular balance enables to predict immediate and long-term outcomes of orthopedic treatment. Employing the principles of neuromuscular dentistry allows us to assess reliably the changes in the reflex mechanisms of muscular apparatus. This was carried out throughout all the stages of prosthetic treatment in patients with complete adentia with intraosseous implants with fixed bridges and conditionally removable denture.

EFFECTIVENESS OF DENTAL IMPLANTATION WITH IMMEDIATE LOADING WHEN REPLACING FRONTAL DENTITION DEFECTS

Dental implantation, viewed as an independent research-based method used to treat patients with partial and complete adentia, has a special place among the major dental specialties. There are surgical algorithms and established methods for using dental implants available. The classical two-stage implantation protocol with delayed loading is considered the most reliable and predictable, featuring the lowest complication rate. The increased interest in direct dental implantation with immediate loading can be accounted for by psycho-emotional factors, accelerated implant osseointegration, better functional and aesthetic results, prevention of alveolar process bone atrophy, as well as reduced volume of surgical and orthopedic interventions. The stability of dental implants after direct implantation and immediate loading has been found to match the stability of implants after employing a two-stage technique. The primary stability of dental implants installed directly into the hole of the removed tooth on the anterior mandible is due to a small volume of spongy substance at a significantly thick cortical layer, possible installation of an implant with a length exceeding the length of the tooth root, the availability of a proper keratinized gum zone, as well as the removal from occlusion temporary structures on implants.

USE OF OSTEOPLASTIC MATERIALS TO RESTORE BONE DEFECTS FOLLOWING THE SURGICAL TREATMENT

In recent years, the number of dental surgical operations has been growing rapidly worldwide, and clinicians are facing pressing issue to select and apply osteoplastic materials, which would promote rapid repair of jaw bone defects and relieve symptoms during the post-operative period. With the advancements in the field of dentoalveolar reconstruction, it is of great importance to develop the material for bone restoration, which by its properties would be identical to autologous bone. The aim of this study is to analyze the effectiveness of osteoplastic materials used for the augmentation following sinus lift, tooth socket preservation, osteosynthesis of mandibular fractures and extraction of impacted third molars. 280 people aged from 18 to 55 with partial or complete adentia and atrophy of the alveolar arch of the jaws, with chronic periapical infection, chronic generalized periodontitis, fractures and impacted third molars were examined at the Department of Surgical Dentistry and Maxillofacial Surgery of the Chernivtsi Regional Clinical Hospital. All patients were planned to undergo prosthodontic treatment assisted by dental implants. The study has demonstrated that the patients of subgroups B of all groups of the study, where the augmentation of bone defects was performed using a combination of osteoplastic material «Colapan-L» containing multipotent mesenchymal stem cells of adipose tissue and platelet-rich plasma presented alleviating clinical symptoms including pain, collateral oedema, hyperaemia of the oral mucosa and better bone regeneration at the site of surgery, compared with subgroups A, where the augmentation was performed with osteoplastic material «Colapan-L», and sub-groups B, whose healing followed by blood clot forming. The use of osteoplastic materials containing multipotent mesenchymal stem cells of adipose tissue during dental operations improves the regenerative and reparative properties of bone tissue, facilitates the postoperative period and reduces the duration of inpatient treatment period.

METHODS OF DEPROGRAMMING THE MASTICATORY MUSCLES: LITERATURE REVIEW

Deprogramming of masticatory group muscles is an integral step in determining and fixing the centric jaw relation in the diagnosis and treatment of patients with orthopedic and orthodontic pathology of the maxillary system. The review presents the main methods for determining the centric jaw ratio using deprogramming of masticatory muscles, as well as indications for the use of these methods. In complete adentia, the most acceptable are the method of non-forced control of the mandibular movements, the Dawson method, the Schiler method, the method of recording the Gothic angle, transcutaneous electroneurostimulation. The above-listed methods can be used in partial adentia as well, and in the presence of all teeth in the oral cavity. In the pathology of the temporomandibular joint, deprogramming methods using the Lucia jig, a leaf gauge, Sliding Guide, as well as the method of recording the Gothic angle will also perform a diagnostic function. With the help of these methods, it is possible to change the design of long-wearing deprogrammers and medical devices. The most universal of these methods are the method of electronic recording of the Gothic arch and transcutaneous electroneurostimulation.

ЭКСПЕРИМЕНТАЛЬНО-МАТЕМАТИЧЕСКОЕ ОБОСНОВАНИЕ ПРИМЕНЕНИЯ ЦИФРОВЫХ ТЕХНОЛОГИЙ ДЛЯ РЕГИСТРАЦИИ ПОЛОЖЕНИЯ НИЖНЕЙ ЧЕЛЮСТИ ПРИ ТОТАЛЬНОМ ПРОТЕЗИРОВАНИИ С ИСПОЛЬЗОВАНИЕМ ДЕНТАЛЬНЫХ ИМПЛАНТАТОВ

Subject. When prosthetics of toothless jaws are performed, the physiological position of the lower jaw must be determined before the final structures are made. In some cases, the use of temporary prostheses for several weeks may be useful to check for a new occlusion in a centric relationship. When the correct ratio is achieved, it is difficult to transfer them from the preliminary prostheses to the final ones. This article presents a case and a technique used to communicate information about the position of the lower jaw using a digital workflow.
 To determine the optimal position of the lower jaw, a computer tomogram of the temporomandibular joint was used to mathematically measure the correct position of the head of the lower jaw.
 Purpose. To describe a technique designed to transfer the inter-occlusal relations of the upper and lower jaws, using digital technologies in the prosthetics of full adentia using dental implants.
 Methodology. On the example of a clinical case of rehabilitation of a patient, total removal of failed teeth was performed, followed by prosthetics of complete adentia with the installation of six implants on the upper and lower jaws. After the completion of the integration period, a cone-beam computed tomography was performed with the capture of the temporomandibular joint, and a scan of plaster models with installed gum shapers was performed. The obtained data were compared in a specialized program for mathematical calculation of the optimal position of the lower jaw. This information was used to produce registration templates for the manufacture of fixed structures supported by implants in the resulting central jaw ratio.
 Results. A digital protocol for determining the central ratio of the jaws allowed us to transfer the information obtained in a virtual model of the temporomandibular joint to a permanent restoration based on implants.
 Conclusion. The approach described in this article predictably conveys information about the optimal position of the lower jaw during prosthetics and allows you to perform the final restoration on implants with optimal occlusal ratios, based on a mathematical calculation performed in specialized programs.

Синдром возрастной полости рта как компонент гериатрического статуса

According to the literature, there is a high prevalence of the syndrome of senile asthenia (frailty) among the elderly. This condition is associated with a number of physical, functional and biochemical changes in the body. The interrelationships of the senile mouth with the malnutrition syndrome are known, the associations with other geriatric syndromes are insufficiently studied. At the same time, early diagnosis of conditions and diseases as the risk factors for the development of senile mouth is very important. The aim of the study: To study the role of the senile mouth in the formation of geriatric status. Materials and methods: In total, 570 elderly and senile people were included in the study (58 persons without adentia, 512 persons with adentia. The age of the patients ranged from 65 to 84 years. The groups of patients without adentia and with adentia were comparable in age and sex composition. Results: The study showed that the senile mouth is associated with the loss of 11 or more teeth in any variant of adentia, and with a smaller number of lost teeth – with the 1st and 4th classes of adentia according to E. Kennedy, while the ethiological causes of adentia do not have a significance in increasing the risk for developing of senile mouth. Cardiovascular pathology, type 2 diabetes mellitus and diseases of the musculoskeletal system increase the risk of developing the progression of the senile mouth. The senile mouth is associated with such geriatric syndromes as the syndrome of malnutrition and the risk of its development, dina/ sarcopenia, falls syndrome, depression, cognitive disorders and uncorrected sensory deficits. Conclusion: Senile mouth take place in the processes of formation of geriatric status in elderly patients. It is necessary to investigate the state of the dentition according to E. Kennedy. The patients with complete adentia, as well as with grades 1, 4 of adentia and its mixed forms are the groups of increased risk of frailty. It is also advisable to conduct a comprehensive geriatric assessment with targeted correction of the identified geriatric syndromes in people with senile mouth before and after dental intervention.

EFFICIENCY OF THE COMBINATION BASED ON BONE AUGMENTATION MATERIALS AND MULTIPOTENT MESENCHYMAL STROMAL CELLS OF ADIPOSE TISSUE IN PATIENTS OF STUDY GROUPS BEFORE DENTAL IMPLANTATION

In recent decades, the most common method of treating partial or complete adentia is the use of dental implants. Often, due to insufficient jaw bone volume due to atrophy in the are of the removed teeth, it is impossible to perform intraosseous implantation. In order to eliminate the defi cit of bone tissue before the installation of dental implants, surgical interventions are required. Examination and treatment with dental implants were performed on 140 patients who had previously undergone surgery and used bone augmentation materials and their combinations with multipotent mesenchymal stromal cells of adipose tissue to increase the volume of jaw bone tissue. 3 months after the installation of dental implants in patients of group I, in which the restoration of the volume of bone tissue of the jaws was performed using bone augmentation material «Colapan–L», and in persons of group II, where augmentation was used a combination of drug «Colapan–L», multipotent mesenchymal stromal cells of adipose tissue and platelet-rich plasma, the values of the OHI–S index corresponded to the data before treatment, p>0.05, and were equal to each other, p2>0.05. In the control group III, the values of this index increased 1.4 times relative to baseline, p <0.05, and were signifi cantly higher than in patients of groups I and II, p1<0.01. After 3 months of observation, a decrease in the PMA index data relative to baseline values was determined: 1.2 times in group I, p, p1 <0.01, and 1.1 times in group II, p <0.05, p1, p2<0,01. At the same time, in patients of group III the values of this parameter increased and were 1.3 times higher than the reference values, p <0.01. After 6 months of studies in patients of groups I and III, the values of the SchillerPisarev test were higher than the initial data, p<0.05, and were equal to each other, p1>0.05. In patients of group II, the values of this parameter were equal to the initial data, p>0.05, and were probably lower data in persons of groups I and III, p1, p2<0.01. It was found that in patients in whom a combination based on multipotent mesenchymal stromal cells of adipose tissue, the drug «Colapan–L» and platelet- enriched blood plasma was used to fi ll bone defects, peri-implant tissues were completely restored after dental implants. The effectiveness of our proposed osteoplastic combination in patients of the study groups was confi rmed by the positive dynamics of the values of the hygienic index OHI-S, periodontal index PMA and Schiller- Pisarev test during the observation.

A METHOD FOR MODELING ARTIFICIAL DENTURES IN PATIENTS WITH ADENTIA BASED ON INDIVIDUALSIZES OF ALVEOLAR ARCHES AND CONSTITUTION TYPE

87 persons of older age groups with complete adentia underwent somatometric (anthropometric) as well as biometric measurements with cast models of the toothless jaws. The linear and index somatometric parameters, and linear and index parameters for the upper jaw alveolar arches, were calculated. Alveolar arches were classified in view of the total sum of the diagonal dimensions (macro-, micro- and normodiagonal type), the arch index (brachy-, dolicho- and mesoarch type). Modelling the projected shape of the dental arch was based on the parameters of length (the sum of the alveolar arches diagonals multiplied by the 1.06 coefficient), width (the product of the width of the alveolar arches by a coefficient of 1.16). The depth of the dental arch frontal segment was calculated as the product of the diagonal by the incisor-canine angle sine, which in case of mesotrusion arches is 0.42 (angle value — 25°), for protrusion arches — 0.5 (angle value — 30°), for retrusion arches — 0.34 (angle value — 20°). Given the regularities of the circle geometry, the frontal segment dimensions served to determine the radius of the circle where the front teeth sat. The graphical method developed to construct the forecasted upper dental arch shape, based on the balance of the alveolar and dental arches major parameters, allows forecasting the optimal shape and size of the artificial dental arch, achieving a balanced relationship between the shapes of the teeth and the alveolar arches, as well as constructing a balanced articulatory relationship while achieving optimal functional and aesthetic results.