Partial Tooth Loss Research Articles

RESTORATION OF ALVEOLAR DEFECTS USING ALLOGENIC BONE BLOCKS

Dental manipulation is often associated with the placement of implants in patients with partial or complete tooth loss. Before implants are placed, the dental surgeon is most often faced with a bone deficit in the alveolar ridge area. With any technique, the main disadvantage of autologous bone extraction is the additional trauma to the patient. Reducing the invasiveness of the surgical steps is particularly relevant in elderly patients with comorbidities [1, 2, 3]. In this article, the authors propose to use bone blocks of allogenic origin when restoring defects of the alveolar ridge of the jaw bones.

МОРФОФУНКЦИОНАЛЬНАЯ ХАРАКТЕРИСТИКА И ОСОБЕННОСТИ ВТОРИЧНЫХ ДЕФОРМАЦИЙ ЗУБНЫХ РЯДОВ В РАЗЛИЧНЫЕ ВОЗРАСТНЫЕ ПЕРИОДЫ

Introduction. Currently, there is no consensus in the literature about the incidence of secondary deformities of the dentitions and their age characteristics. Thus, the question of the prevalence and features of secondary dentoalveolar deformities and anomalies of the dental arches in different age groups is relevant. Aim of the research. To study the prevalence, nature, features of secondary dentoalveolar deformities and anomalies of the dentition in different age groups. Materials and methods. For our study, we selected patients of different age groups who consulted the orthopedic dentistry clinic of the FSBEI HE Novosibirsk State Medical University of the Ministry of Health of Russia, as well as the 2–5 year students of the Faculty of Dentistry. Group 1 — 150 students aged 18–27 years, group 2 — 130 patients aged 30–45 years, group 3 — 140 patients aged 46–60 years. Results. In group 1, 150 second-fifth year students of the Faculty of Dentistry of the Novosibirsk State Medical University, aged 18–27 years, were examined. In 13 of them, the teeth were intact. Signs of secondary dentition deformities in patients of the first group were observed in 63 (42%) students. In group 2, 130 patients aged 30 to 45 years were examined, in 5 patients the dentitions were intact. Signs of secondary deformities of dentitions in the examined group 2 were observed in 71 (56%) patients. In group 3, 140 patients aged 46 to 60 years were examined, 18 of them had intact dentitions. In 122 of them, partial loss of teeth was observed. Signs of secondary deformities of the dentition in the examined group 3 were observed in 55 people (40%). Conclusion. The study shows that secondary dentition deformities can be observed both with preserved dentition in cases of multiple carious lesions of the occlusal surfaces of the teeth, anatomically incorrect restoration of the occlusal surfaces of the crowns of chewing teeth, or their contact surfaces after filling, and with partial loss of teeth in all age groups.

Методика оценки точности установки зубных имплантатов с применением цифровых технологий

The aim of the research. To develop a method for evaluation of dental implant placement accuracy using surgical navigation templates created with application of digital technologies. Material and methods. The clinical study enrolled 11 patients (5 male and 6 female) with partial tooth loss. Prosthetic treatment of the patients was performed using 15 implants manufactured by the additive method and installed using navigational surgical templates. In a computer program that we developed (certificate of state registration of computer program No. 2021665044, 17.09.2021), images of the planned position of the implants were superimposed over images of the actually installed implants with subsequent measurement of linear deviations in the area of the apical and the coronal portions of the implants as well as angular deviations between the long axes of the implants. Results. The mean angular deviation in the sagittal plane between the planned position of the implants and the ones installed in the oral cavity was 4.453 ± 2.554°. Mean linear deviation was 1.713 ± 0.7506 mm in the apical portion of the implant and 1.499 ± 0.9248 mm in the coronal portion. Conclusion. During this study, deviations were found in the position of implants after surgery, which indicates the existence of certain errors in the method of using navigational surgical templates. The computer program we have proposed makes it possible to evaluate the accuracy of dental implant placement by measuring linear and angular deviations between their planned and actual position aft er surgery.

Digital study of interocclusal contact points in patients with partial tooth loss in case of immediate and nearest implantation prosthetics

The main purpose of this study was to study the qualitative and quantitative characteristics of occlusal ratios of dentitions in patients with partial loss of teeth replaced by preliminary direct or proximal dental implantsprostheses to prevent complications on the masticatory muscles and the temporomandibular joint. The article presents a detailed analysis of the interocclusal relations of dentitions in patients with partial tooth loss before and after prosthetics, including an assessment of the interocclusal contact points, their multiplicity, uniformity and strength of masticatory pressure, the presence of premature contacts, the trajectory of the overall direction of occlusal load, occlusal balance between the left and the right sides of dentition. The assessment of interocclusal relationships in the control and main groups was carried out using an available, simple, and unbiased digital device "T-Scan III" (Tekscan, USA).

Additive manufacturing of PLA to mimic the thrust force of mandibular bone during drilling

Edentulism is a condition that results in the partial or total loss of teeth. It may lead to problems during chewing and be a cause of self-isolation and low self-esteem. Edentulism can be resolved both with removable prostheses (dentures) and fixed implants, with the latter being more efficient. The installation of a fixed implant involves a real surgical operation in which the jaw/mandibular bone is drilled through a special drill. One of the main cautions the surgeon must have during the operation is not to sever the nerves during the drilling. Given the composition of the bone is different in each person, the drilling thrust force is variable and controlling its movement can sometimes be complicated. Therefore, being able to test the operation on a dummy may reduce the number of errors. Additive manufacturing with its high degree of customization and ability to produce objects with almost no geometrical limitations could provide the required features to realize the dummy. In this work, the drilling properties of samples made in PLA through Fused Filament Fabrication (FFF) were studied. The samples were designed to mimic the composition of the bone. Specifically, a thin, hard, and denser outer layer and a 25% internal filling were adopted. The samples were drilled with a dental drill properly connected to a collaborative robot.

A case of treatment denture and implant-assisted removable partial denture in a patient with collapsed occlusion caused by partial loss of posterior and anterior teeth

A case of treatment denture and implant-assisted removable partial denture in a patient with collapsed occlusion caused by partial loss of posterior and anterior teeth

Патофизиологические аспекты регенерации костной ткани при увеличении ширины тонкого альвеолярного гребня челюстей с применением пьезохирургической техники

One of the main problems that impede dental rehabilitation with the use of dental implants is the limited amount of bone tissue in cases of its pronounced atrophy. According to a number of authors, about 50% of patients need additional osteoplastic operations before or at the stage of dental implantation. Objective. The aim of the paper is to assess the effectiveness of piezosurgical apparatus for splitting the alveolar crest of the jaw in the insertion of dental implants. Materials and methods. Forty adult patients (15 men and 25 women) aged 36 to 49 years who had undergone surgery for partial tooth loss on one and/or both jaws were evaluated. All in all, 48 implants were placed against the narrow alveolar crest of the jaws, which was surgically split using microsaws (Group 1- 11 patients), thin dental drills (Group 2 -15 patients) and piezosurgery apparatus (Group 3, 14 patients). The postoperative follow-up period was 4 to 6 months before the orthopaedic treatment. Results. During crestal splitting, the smallest bone reduction was obtained using piezosurgical technique, which was 0.84±0.22 mm, while with microsaws and dental drills, this figure was slightly higher, 0.93±0.21 mm (p≥0.05) and 1.23±019 mm (p≤0.05), respectively. One of the properties of a piezosurgical instrument is the effect on protein molecules, namely, their denaturation. This reduces the number of postoperative complications. Conclusion. The technique of alveolar crest splitting with a piezosurgical instrument works according to the absolutely natural and unique mechanism of bone healing - the mechanism of fracture repair. This technique uses the local bone resource and avoids or significantly reduces the use of foreign bone grafting materials. There is a tendency to a better rate of restoration of the lost width of the alveolar crest of the jaw when using the piezosurgical apparatus, in contrast to the use of microsaws and dental drills.

Comprehensive study of dental orthopedic morbidity in elderly people and the ways to eliminate it

Relevance. The social profile of senile people has some differences from other age categories of patients. People of the older age group dream of finding harmony with the outside world, preserving the love of the nearest and dearest and relatives and the opportunity to communicate with the opposite sex. Dental health and the resulting quality of life contributes to this in many ways. A smile, laughter, the ability to talk without feeling embarrassed by splashing saliva, bad breath or visible absence of teeth, taking your favorite food together with the nearest and dearest are the main indicators of their life quality dependent on dental health, without which it is impossible to imagine a modern person High prevalence of dental diseases among senile people cause a high need for making various dental prosthetic structures. Studying dental health of this category of citizens can become a promising area of practical healthcare, a comprehensive study of this issue has determined the relevance and purpose of this publication.Materials and methods. The object of the study was senile people, 75-89 years old, who sought dental orthopedic care in municipal healthcare institutions of Cheboksary, the Chuvash Republic. The sample size was 481 people.Results. It was found that the maximum number of patients in the age group of 75-88 years - 188 persons (39.1%) - had complete absence of teeth, the total number of patients with the first, second, third and fourth classes according to the Kennedy classification of dentition defects was 56 persons (11.6%), 143 persons (29.7%), 79 persons (16.4%), 15 persons (3.2%), respectively. The total number of patients with the first Kennedy subclasses (class 1-3) was 135 persons (33.1%), with the second subclasses – 69 persons (16.9%), with the third subclasses - 53 persons (13.0%). The analysis of dental prosthetic structures mounted in elderly patients showed that the total number of orthopedic structures amounted to 4,615 units, among which there were pin structures - 1,328 units (28.8%); the total number of artificial dental crowns was 1,662 units (36.0%); the total number of prosthetic bridges – 620 units (13.4%); removable laminar dentures in partial loss of teeth – 445 units (9.6%); clasp prostheses – 184 units (4.1%); removable laminar dentures in complete loss of teeth – 376 units (8.1%).Conclusions. All types of dental orthopedic diseases are commonly found in patients of senile age, they had all kinds of dental prosthetic structures made. The choice of the dental prosthetic design used in orthopedic dental rehabilitation was determined by the type of dentition defect and met the principles of rational prosthetics.

The Impact of Tooth Retention on Health and Quality of Life in Older Adults

America is aging rapidly, and older adults (age ≥65 y) are retaining more of their natural teeth, a trend expected to continue. Although much is known about the impact of complete tooth loss on overall health and well-being, less is known about the effect of partial tooth loss. We conducted a systematic review to advance our understanding of the impact of retaining ≥20 teeth on health and quality of life (QoL) in older adults using two tooth retention concepts – shortened dental arch (SDA) and functional dentition (FD). We searched seven scientific databases from 1981–2019 for publications on tooth retention and outcomes and impact on health and QoL. Ninety-six studies were included in this review. Most were assessed with low risk of bias (n=74) and of good quality (n=73) using the revised Cochrane Risk of Bias tool and Newcastle-Ottawa Scale. Tooth retention was defined as FD in 82 studies, SDA in 10 studies, and four studies used both. Most were cross-sectional and only seven were from the US. We found an increasing trend among published studies in using FD and SDA to describe natural dentition retention (50 articles in 2015-19 vs one in 1995-99). In general, having <20 teeth was associated with increased likelihood for functional dependence, onset of disability, declines in higher-level functioning, and lower QoL. New information is needed to facilitate clinical decision-making, care-giving, and to help health providers better meet the future oral health needs of an aging US population.

Rehabilitation of maxillary prosthodontics using removable partial denture with extracoronal attachment

Several methods are available for the management of partial tooth loss, namely by using removable partial dentures, fixed den-tures, and implants. Combined dentures can be the treatment of choice when implant or FD are not possible and can be an ade-quate alternative to conventional clasps and RPD. This article is intended to determine the maxillary prosthodontic rehabilita-tion with RPD using an extracoronal attachment. The repair of partially missing teeth is a challenge in treatment planning. The technique followed by the care of the patient is effective in providing optimal care for an individual. The use of the combined RPD and FD makes for more retentive and esthetic, stable and function in the replacement of missing teeth. Long-term suc-cess requires sophisticated laboratory techniques, clinical expertise, and depends on biological factors, especially periodontal conditions.

RESULTS OF CLINICAL AND INSTRUMENTAL STUDY OF DIGITAL OCCLUSION INDICES DURING REGISTRATION OF INTERMAXILLARY INTERCUSPAL POSITION IN PATIENTS WITH UNILATERAL DEFECTS AND INTACT DENTITIONS

Introduction. Determination of the patients’ dentitions ratios is an important in the orthopedic dental treatment of defects of the dentofacial system (DFS).&#x0D; The aim of the study. Performance of the comparative clinical and instrumental analysis of ICP occlusal relationships registration results in groups of patients with intact dentitions and unilateral defects of dentitions.&#x0D; Materials and methods. Examination of 10 patients of both sexes aged 24 to 50 years was conducted. All examined patients were divided into treatment and control groups. The first treatment group of the study included 5 patients with class A2 unilateral defects of dentitions of the DFS according to the Eichner classification. The control group consisted of 5 patients with intact dentitions.&#x0D; Results. As a result of the study conducted it was found that at the stage of transition from ICP to MIC, the OT index in patients of the control group with the use of Futar D registration material was (0,37±0,07) sec, values of the proportion of the occlusal force (COF) on the right were determined in the interval (65,2±7,71) %, on the left they were (34,8±7,71) %, length of the occlusal trajectory (L) was (8,6±2,94) mm.&#x0D; OT index in patients of the treatment group with the use of Futar D registration material during the transition from ICP to MIC made up (0,37±0,07) sec, values of the proportion of the occlusal force (COF) on the right were determined in the interval (32,4±6,22) %, on the left they were (67,6±6,22) % (p&lt;0,05), length of occlusal displacement trajectory (L) increased to (12,6±2,88) mm (p≥0,05).&#x0D; Conclusions:&#x0D; &#x0D; An important feature of physiologically coordinated functioning of the dentofacial system of patients is the uniform occlusion of dentition with simultaneous contact of all groups of&#x0D; At the time of static and dynamic occlusion, frequent sliding contacts are observed in the end position of the ICP. As the occlusal pressure increases towards the maximum intercuspation (MIC), the area of the contact surfaces of the teeth increases. Under this condition, an occlusal pressure occurs, causing redistribution of the functional load of the DFS&#x0D; The interval of dental occlusion between the ICP and MIC positions, or delta (∆), which can be determined using Tekscan III digital technology, demonstrates spatio-temporal indices of redistribution of intermaxillary relations. Their values in patients with partial loss of teeth cause a particular&#x0D; With the use of Futar D registration material, clinical and instrumental analysis of digital indices of the transition from ICP to MIC allowed the establishment of the extension of time duration of dental occlusion by 1,2, increase in the length of the occlusal trajectory by 1,5, a significant change in proportional participation of the sides of dentitions (p&lt;0,05) in patients of the treatment group compared to the control&#x0D; &#x0D; Prospects for further research. The conducted instrumental studies demonstrate challenging opportunities to identify individualized features of static and dynamic occlusal balance at clinical registration of intermaxillary position of ICP with the help of various registration materials and techniques.

Association Between Tobacco Smoking, Dental Status and Self-perceived Oral Health in Elderly Adults in Colombia.

Tobacco smoking is responsible for several health problems, including mouth diseases. The aim of the present study was to establish the association between smoking and dental status and self-perceived oral health in a large group of elderly Colombian adults. Analysis of 18,937 survey records of participants aged ≥ 60years old was conducted. Information regarding age, sex, skin color, socioeconomic level, education, marital status, denture use, partial tooth loss or edentulism, Geriatric Oral Health Assessment Index (GOHAI) and tobacco smoking was retrieved from the database. A descriptive analysis and multivariate logistic regression analysis were performed. Half of the participants were edentulous in the maxilla while mandibular teeth were more frequently retained in more than 60% of the participants. After adjusting for sex and age, smoking consistently increased the odds of partial or complete edentulism in the maxilla (OR 1.05; 95% CI 1.02-1.09) and mandible (OR 1.04; 95% CI 1.00-1.08). Nonetheless, the increase in the odds in the mandible was not statistically significant. The habit of smoking was associated with increased tooth loss that in the long-term may result in poor oral health affecting the quality of life of elderly people.

FEATURES OF MANUFACTURE OF ADVANCED PROVISIONAL BRIDGE-BASED PROSTHESES

Abstract. The relevance of the topic is related to the need to improve methods of preparation of dentitions for orthopedic treatment, taking into account the defects of dentitions in patients with reduced occlusion height, taking into account the condition of the masticatory muscles and temporary use of plastic dentures, which provide gradual lifting of occlusion to normalize the masticatory group muscles and reorganization of myostatic reflexes.&#x0D; The aim of the research. Improving the effectiveness of preparation for orthopedic treatment of patients with partial tooth loss, with reduced occlusion height, by improving the design of a temporary bridge-based prosthesis.&#x0D; Materials and methods of research. We examined, treated and conducted clinical observation of 93 patients, who were divided into three groups according to the height of the reduction in occlusion, to achieve this goal and solve problems during the dissertation. Group 1 consisted of 32 patients with included dentition defects with reduced occlusion height up to 2 mm (n=32), group 2 - patients with included dentition defects with reduced occlusion height up to 2-4 mm (n=31), group 3 - these are patients with included dentition defects with reduced occlusion height up to 4-6 mm (n=30). All patients of the main groups belonged to the second and third age groups according to the WHO, aged 35-55 years. The control group (n=30) are young people who belonged to the 1st age group according to the WHO with intact dentition, without concomitant somatic and dental pathology, were admitted in one visit. Also, 123 fiberglass-reinforced plastic prostheses were made.&#x0D; Research results. When drawing up a plan for orthopedic treatment of patients with reduced occlusion height, we took into account possible complications, which are characterized by chipping of the facing material, pathological changes in the temporomandibular joint and masticatory muscle group. We have improved the method of manufacturing non-removable temporary plastic orthopedic constructions by reinforcing with fiberglass tapes and beams, to prevent them and gradually raise the bite.&#x0D; Expanded data on the dynamics of changes in myostatic reflexes and the effectiveness of the use of fixed orthopedic constructions, depending on the pathological process, the timing of adaptation of the masticatory muscle group to orthopedic constructions, according to the degree of reduction in occlusion height. The absence of complaints of breakage and other technical defects of the proposed temporary orthopedic constructions in 100% of cases, successfully allows to use it in the clinic of orthopedic dentistry.&#x0D; A new method of preparing patients for permanent orthopedic treatment by combined reinforcement of temporary non-removable bridge constructions with fiberglass tapes and beams is proposed, which differ in that after preliminary modeling of the frame of the bridge constructions, the technology of double reinforcement, model two support platforms with a step-like transition between them, in which fiberglass tapes and beams are fitted with dental tweezers, after which they are polymerized by the generally accepted method with a photopolymer lamp. Complete the modeling of the constructions and polymerize the prosthesis in the pneumopolymerizer with subsequent grinding and polymerize the prosthesis.&#x0D; Conclusion. The results of the research revealed the high efficiency of the improved method of manufacturing non-removable makeshift plastic of orthopedic constructions.

CURRENT TRENDS IN BONE AUGMENTATION DURING DENTAL IMPLANTATION IN PATIENTS WITH PARODONTAL PATHOLOGY AND JAW BONE ATROPHY (LITERATURE REVIEW)

Today, despite the progress made in dental implantology, the problem of rehabilitation of patients with significant bone atrophy in parodontal diseases has not been fully studied.&#x0D; The study aims to review the current views of various authors on the aetiology and treatment of parodontal diseases, which caused multiple tooth loss and bone atrophy in patients with occlusal pathology, based on the literature sources of scientific and medical information.&#x0D; Object and methods of study. Analytical study of scientific and medical literature on the treatment of multiple and partial tooth loss in patients with parodontal diseases in bone atrophy with impaired jaw relationships and orthopaedic rehabilitation using dental implantation and methods of bone augmentation of the mandible and maxilla.&#x0D; The use of implants in orthopaedic treatment expands the possibilities of using fixed prostheses, satisfying patients functionally and aesthetically. In case when the preservation of teeth becomes impossible or impractical to ensure proper treatment of the patient, they can be removed and replaced with dentures on dental implants.&#x0D; According to Misch C. [6], the masticatory load, which is exerted on the bone tissue of the jaws by an implant, increases the density of the bone structure. When teeth are lost due to parodontitis, there is atrophy of the alveolar ridge and a change in the structure of bone tissue, which is characterized by an increase in the porosity of the cancellous bone [4;5;7]. Sufficient bone volume and density in the area of the planned implantation are the main and important parameters for achieving normalized primary implant stabilization [11]. Partial and complete loss of teeth, as well as parodontal diseases, are always accompanied by the bone tissue of alveolar bone tissue of varying severity [1;4;5;13]. Signs of parodontal diseases in dentition defects are always more pronounced than in intact dental arch. The disease progresses rapidly, the dentition is destroyed if appropriate occlusal therapy is not performed [13;14]. Systemic factors and comorbidities in patients also play a significant role in reducing the bone volume of the jaws.&#x0D; The relationship between decreased bone density and age-related hormonal changes in women, as well as at the gender level, has been studied. Thus, women have changes in bone architecture and less dense arrangement of trabeculae in the jawbones than men [15].Bone tissue has a distinguishing feature – loss of multiple teeth or parodontal diseases lead to a redistribution of functional load, which causes its resorption [7;20]. In this regard, tooth extraction inevitably leads to a decrease in bone volume. The success of dental implantation on the maxilla became partially possible due to the introduction of sinus lifting with the use of osteoplastic materials [12;20;21]. According to some scientists[21], the autogenous bone graft is the gold standard in regenerative processes due to its osteoinductive, osteoconductive, and osteointegration properties, which are necessary for the restoration of lost bone tissue.&#x0D; The use of dentin in human teeth as an autograft was first described in a clinical case report in 2003 [23]. In recent experiments, these materials have proven to be a real alternative to the bone graft. Thanks to the work of a group of researchers [23;24], significant efforts were made in the basic and clinical study to find the best bone graft material for osseointegration of implants in the maxillary sinus. The autogenous dentin graft (AutoBT; Korea Tooth Bank, Seoul, Korea) was first developed in 2008, and several clinical studies have praised the use of AutoBT in the sinus compared to other grafts.&#x0D; Given the current development of advanced technologies in dental implantation, dentists use navigation templates in their practice, which are made using CAD CAM technology to improve the quality of care for patients who have indications for dental implantation. New diagnostic approaches allow us to virtually plan, simplify, and speed up surgery, to ensure accuracy. Thanks to this technology, dentists optimize the location of dental implants, taking into account the difficult conditions specific to patients with parodontal pathology.

ASSESSMENT OF THE OCCLUSAL RELATIONS NATURE AT THE STAGES OF ORTHOPEDIC REHABILITATION OF PERSONS WITH PERIODONTAL TISSUE DISEASES COMPLICATED BY DENTITION DEFECTS

Resume. According to epidemiological studies, there is still an increased prevalence of periodontal disease among the population of different regions of the world, with increasing intensity and aggressiveness. Long-term chronic generalized lesions of recurrent and progressive inflammatory-dystrophic process lead to the destruction of alveolar processes, pathological mobility of teeth, tooth loss and dentofacial dysfunctions. One of the most characteristic symptoms of generalized periodontitis is the presence of traumatic occlusion. Depending on the degree of pathological changes in periodontal tissues, the size and topography of dentition defects, the replacement of dentition pathologies should be planned by splint-type orthopedic structures and computerized analysis of occlusal relationships with T-Scan III system.&#x0D; The aim of the study is to improve the effectiveness of orthopedic treatment of periodontal diseases complicated by defects of the dentition with the control of occlusal relationships with a computerized T-Scan III system.&#x0D; Materials and methods. We have examined 87 persons aged between 30 and 69 years with generalized periodontitis of I – III severity, complicated by partial loss of teeth of different sizes and topography, and a control group of the same age in 10 patients with intact dentition and physiological forms of occlusion without clinically diagnosed periodontal diseases.&#x0D; Computerized analysis of occlusion indices was performed by the T-Scan III system. We have investigated the stereotype of functional loads according to the following quantitative and qualitative indicators: the index of asymmetry of force between the parts (%); time of occurrence of the maximum amount of dental contacts (sec); time of disclusion (sec); the presence of premature occlusal contacts on the natural teeth and orthopedic constructions, and the presence of changes in the direction of the trajectory of the total vector of occlusal load. &#x0D; Orthopedic rehabilitation of patients in the case of periodontal diseases of the I-II degree of severity and the presence of small defects of the dentition, we conducted by splint-type orthopedic structures, dental implants, and artificial crowns of our own design with discrete occlusal loading (Licence for Effective Model No 143278, Ukraine, MPK А61С 13/007, u 2019 11487: Artificial Crown with Support on a Dental Implant).&#x0D; Patients with periodontal diseases of the II – III severity, complicated by defects of dentitions with different size and topography, the dental prosthetics has been performed by traditional removable and combined orthopedic splint-type constructions, and removable splint-type dentures of their own design: "Removable Prosthesis of Splint Type" (Licence for Effective Model No 130980 Ukraine, IPC (2006.01) А61С 13/007, u 2018 03039, 10.01.2019). &#x0D; Computerized analysis of occlusion indicators for the patients of I and II clinical groups and the III control group has been performed before and after orthopedic treatment by T-Scan III system.&#x0D; Results of the research. The results of investigation for functional occlusion have demonstrated that the index of relative strength asymmetry between the sides of the dentition in patients with generalized periodontitis complicated by dentition defects increased significantly and led to nonphysiological redistribution of loads compared with indices obtained in patients from control group due to the lack of correspondence for occlusal contacts. These indices are equal to 16.7 ± 3.8% in patients of I group and 18.9 ± 4.8% in group II compared to the similar control indicators – 4.7 ± 1.01%, respectively (p≤0.01). It should be noted that these indicators have differed from the control group indicators according to the severity of the pathological process. Rational prosthetics with removable and non-removable orthopedic structures, including on the base of dental implants, helps to optimize occlusal relations.&#x0D; Conclusions. Occlusographic studies performed in patients with generalized periodontitis having different severity and complicated by partial tooth loss have showed increased index of relative strength asymmetry between the sides of chewing, the presence of premature contacts and incorrect location of the trajectory of the total occlusal load vector.&#x0D; The dynamics of pathological changes in occlusion indices corresponds to the degree of generalized periodontitis, which indicates the necessity of opportune replacement of dentition defects, taking into account the occlusal relations.&#x0D; Rational prosthetics helps to optimize occlusal relations.

Tooth Loss, Denture Use, and Cognitive Impairment in Chinese Older Adults: A Community Cohort Study.

Evidence regarding the associations of tooth loss and denture use with incident cognitive impairment is inconclusive in older adults, and few prospective studies have examined the potential interaction between tooth loss and denture use in these specific populations. Data were assessed from 17 079 cognitively normal older adults aged ≥65 years, participating in the Chinese Longitudinal Healthy Longevity Survey. The outcome of interest was cognitive impairment (assessed by the Chinese version of Mini-Mental State Examination). The number of natural teeth and status of denture use were collected by a structural questionnaire. A total of 6456 cases of cognitive impairment were recorded during 88 627 person-years of follow-up. We found that compared with participants with 20+ teeth, those with 10-19, 1-9, and 0 teeth had increased risks of incident cognitive impairment (p-trend < .001). Participants without dentures also had a higher risk of incident cognitive impairment, compared with those who wore dentures. Effect modification by denture use was observed (p-interaction = .010). Specifically, among those without dentures, the adjusted hazard ratio (95% confidence interval) for participants with 10-19, 1-9, and 0 teeth were 1.19 (1.08, 1.30), 1.28 (1.17, 1.39), and 1.28 (1.16, 1.41), respectively, as compared to those with 20+ teeth. In contrary, among denture users, detrimental effect was only observed among those with 0 teeth (hazard ratio 1.14, 95% confidence interval: 1.16, 1.41). In Chinese older adults, maintaining 20+ teeth is important for cognitive health; denture use would attenuate the detrimental effects of tooth loss, especially for partial tooth loss, on cognitive impairment.

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

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.

CLINICAL AND RENTGENOLOGICAL CHARACTERISTICS OF LOW INVASIVE TECHNIQUE OF DENTAL IMPLANT PLACEMENT IN LATERAL PARTS OF MANDIBLE IN BONE TISSUE DEFICIENCY

Today, minimally invasive dental implant placement techniques along with immediate or early dentition restoration by dentures are widely used and well represented in the scientific literature. The issue of using minimally invasive techniques under bone tissue deficiency is especially relevant in dentistry. Among the approaches in solving this problem, and in particular in the lateral mandibular parts of, there is the bicortical placement of one-stage small diameter implants bypassing the mandibular canal. However, we have not found reliable data on clinical studies of this technique. The aim of this study was to investigate the clinical and radiological stability of thin one-stage implants fixed bicortically by applying minimally invasive technique in the lateral parts of the mandible under bone tissue deficiency. 47 patients with partial or complete loss of teeth in the lower jaw having no severe somatic pathology was examined and included into the study. The first (main) group included 25 patients with severe bone tissue deficiency in the lateral regions, who were subjected to the placement of 146 implants using the minimally invasive implant placement technique we adapted by bicortical placement of small-diameter non-separable implants bypassing the inferior alveolar nerve using a surgical template. The second group (control) consisted of 22 patients with unexpressed atrophy of the lateral parts of the mandible, who received 70 implants placed by the standard one-stage implantation technique. In addition to the generally accepted clinical methods, we determined the hygiene index, the Schiller-Pisarev test and carried out orthopantomographic studies. The results obtained have shown that the minimally invasive technique of dental implant placement is characterized by less complicated and more favourable course of the postoperative period, no pain syndrome, minimal post-traumatic reaction of the soft tissues of the face and oral mucosa, as well as no postoperative inflammatory complications. Orthopaedic treatment using minimally invasive method of dental implant placement for bone tissue deficiency using one-stage small-diameter implants in the lateral parts of the lower jaw created good conditions for personal hygiene. The average level of vertical resorption of peri-implant bone tissue in the first year of functioning was 0.763 ± 0.001 mm, and for two years it did not exceed 0.837 ± 0.001 mm, which corresponds to the generally accepted criteria for effectiveness.

ORTHOPEDIC RESTORATION OF PARTIAL TOOTH LOSS AND WAYS OF ITS IMPROVEMENT

The increase in the prevalence and intensity of dental diseases in modern conditions, such as caries and its complications, non-carious lesions and pathological abrasion of dental hard tissues and periodontal diseases, leads to partial tooth loss and persistent pathological morpho-functional changes of the dentoalveolar system.&#x0D; Partial tooth loss is accompanied by changes in almost all areas of the dentoalveolar system and leads to a number of complications, including deformations of the dentition. At the same time, changes in the neuromuscular system, dysfunction of the temporomandibular joints (TMJ), aesthetic, phonetic and functional disorders are often involved in clinical symptoms. Pathological morphological changes significantly complicate orthopedic treatment, and often make it impossible without the use of a set of special preparatory measures.&#x0D; To restore the integrity of the dentition and the functional efficiency of the masticatory apparatus, various designs of dentures are used, which are divided into fixed and removable according to the terms of fixation, and their choice is determined by the list of indications and contraindications for manufacturing.&#x0D; It is known that non-removable structures are much more widely used as compared to removable prostheses, as they have a number of advantages: restoration of masticatory efficiency by 95-100%, high aesthetics and accuracy, good fixation and quick adaptation to them. The main condition of orthopedic treatment with bridges is the presence of defects limited by teeth. They are used in case of a defect of the dentition, which consists in the loss of no more than 3 lateral teeth and 4 teeth in the frontal jaw.&#x0D; The sizes of dental bridges do not go beyond the dentition and they transfer the masticatory load to the jawbone through the periodontium, i.e., naturally. Because of this, they are considered more physiological than other prostheses. Bridge prostheses virtually do not disrupt the speech, temperature, tactile and taste sensitivity.&#x0D; Orthopedic treatment of dentition defects is also carried out with the help of removable structures, which include removable bridges, arches and partial laminar dentures. The advantage of removable dentures is their high hygiene, but the problems include proper fixation, long-term adaptation, aesthetic requirements and full recovery of masticatory efficiency.&#x0D; The aim of the research is to improve the quality of orthopedic care for patients with defects of the dentition with the help of bugel prostheses on clasps by introducing an original method of their manufacture.&#x0D; Material and methods of experimental studies. We made 138 solid bugel prostheses (84 – the upper jaw, and 54 – the lower jaw), 48 bridge prostheses (39 metal-ceramic, 9 with photopolymer facing). We observed 95 patients aged from 23 to 74 years (52 men, 53 women) during the period of 5 years. In all patients, the defects of the dentition were replaced with solid bugel prostheses on the clasps, according to our original method:&#x0D; Upon receipt of the impression for the metal-ceramic non-removable structure with a clasp, the previously made temporary plastic crowns were fixed on the prepared teeth, and then the impression was obtained with the impression spoon together with the temporary crowns and removed from the oral cavity. The working model was cast on the obtained imprint.&#x0D; The proposed method makes it possible to simultaneously obtain an impression on the basis of which a working model is made for the manufacture of both fixed and removable parts of the orthopedic structure, which avoids the repetition of clinical and technical stages of prostheses manufacture, reduce their number, improve the accuracy of connecting removable and non-removable structures, and saves materials and time for doctor and patient.

Association of periodontitis and cognitive impairment: A systematic review and meta‐analysis

AbstractBackgroundEmerging evidence suggests link between poor periodontal status and cognitive impairment. This review systematically assessed longitudinal evidence on the association of periodontitis and tooth loss with cognition.MethodsComprehensive literature search for studies examining effect of periodontitis on cognition was conducted on two electronic databases, Medline and Scopus. Longitudinal studies having periodontitis or its surrogate measure (tooth loss) as exposure and cognition as outcome were included. Meta‐analysis was conducted on RevMAN‐5 software. Primary random effects model analyzing the effect of periodontitis (all measures) on cognition was generated. Secondary analyses included models based on periodontal specific measures 1 and tooth loss. Quality assessment of included studies was conducted.ResultsOut of 97 studies, 16 were included in the systematic review. Meta‐analysis included 9 studies. In preliminary results, primary model showed significant association between periodontitis and cognitive impairment (OR=1.22, 95%CI:1.01–1.49, p=0.04). In secondary analyses, neither periodontitis (based on specific measures) nor tooth loss was associated with cognitive impairment. However, further stratification of tooth loss found significant association between partial tooth loss and cognitive impairment (OR=1.53, 95%CI:1.03–2.29, p=0.04). The overall quality of evidence was low.ConclusionPeriodontitis appears to contribute to overall risk of cognitive impairment. This association may be driven by specific aspects of periodontitis such as severity, chronicity and corresponding tooth count. However, firm conclusions cannot be drawn due to overall low quality of evidence and lack of coherent methodology among studies (e.g. variability across periodontal and cognitive assessments). Well‐designed longitudinal studies with larger sample size and including comprehensive and standardized assessment of both periodontal and cognitive status are warranted.