CONCEPTUAL FEATURES OF OCCLUSAL BALANCE IN THE DEVELOPMENT AND PATHOLOGY OF LOCALIZED AND GENERALIZED DISEASES OF PARODONTAL TISSUES IN PATIENTS WITH PARTIAL TOOTH LOSS DURING ORTHOPEDIC REHABILITATION BOTH ON THE NATURAL TEETH AND THOSE ON DENTAL IMPLANT
Authors: Kinash Yu.O. , Kinash L.V. 
Published: September 2022

The biomechanical component is an important aspect of orthopedic rehabilitation in the case of parodontal tissue pathology, which involves the most accurate reproduction of not only the shape of the tooth but also the location (functional axis) and the relationships of occlusal surfaces. At the same time, it is important to understand that the functional axis of the tooth and the areas of occlusal contacts are very dynamic and depend on the strength and character of masticatory movements. Therefore, the force vectors on the tooth axis continuously change in the articulation cycle, which helps to change the force of the occlusal interaction of the dentitions and the direction on the periodontium itself and the bone tissue of the jaws.

Aim: To explain the importance of restoration of functional occlusal relationships in patients with localized and generalized diseases of parodontal tissues, on the example of partial tooth loss with rational orthopedic rehabilitation on natural teeth and dental implants.

Materials and methods. Clinical examination of patients with localized and generalized parodontal tissue diseases. Orthopantomography – for visualization of the general state of the dentofacial system. In complicated cases, computer tomography with 3D replication was used to make a diagnosis and choose a treatment method. Adjustable articulators have been configured for individual functions together with CAD/CAM technology for the production of rational orthopedic restorations.

Study results and discussion. 10 patients after orthopedic treatment (13 orthopedic restorations on their natural abutment teeth and dental implants) were admitted to the Dental Medical Center of Danylo Halytsky Lviv National Medical University with complaints of difficult mastication, increased mobility of orthopedic restorations, and halitosis. During clinical examination and taking history, it was found that all patients with parodontal tissue pathology underwent local orthopedic treatment on their natural abutment teeth consisting of 3 bridgework (23% (p<0.05)) and 4 single (31% (p<0.05)) orthopedic restorations and 9 dental implants, which corresponded to 3 bridgework (23% (p<0.05)) and 3 single (23% (p<0.05)) orthopedic restorations, which were used from 6 to 12 months. The signs of disocclusion and overloading were found on the laterotrusion side when checking the static and dynamic occlusion according to the concepts of group management and canine protection. As a result of orthopedic rehabilitation in a virtual articulator adjusted for individual function, functional occlusion was normalized, pathological dental mobility, signs of peri-implantitis, and inflammatory processes of the supporting teeth were eliminated for 10 patients (13 orthopedic restorations) with localized and generalized diseases of parodontal tissues and partial loss of teeth. After 12 months, control clinical examination with additional examination methods of patients with parodontal tissue pathology corresponded to the stabilization of the pathological process both on their natural abutment teeth and on dental implants with normative osseointegration.

Conclusion. Therefore, the shape and size of restored functional occlusal relationships in adjustable articulators configured for individual function using modern CAD/CAM technologies ensure the balancing of force vectors on teeth and dental implants in parodontal tissue pathology.

Directions for future research. Unfortunately, modern technologies are not available to all patients and medical institutions of health care of Ukraine due to their high cost. Consequently, a significant number of orthopedic restorations are manufactured in commercial technical laboratories or manually by dental technicians in municipal health care facilities. Therefore, scientific publications must be aimed at attracting and implementing modern technologies in health care educational institutions for further scientific and practical development.