DYNAMIC CHANGES IN INDICATORS OF COMPUTERISED OCCLUSION ANALYSIS IN PATIENTS WITH OCCLUSAL DISORDERS RESULTED FROM IMPROPER DENTAL PROCEDURES
Authors: Nespryadko V.P. , Volovar O.S. , Tereshchuk O.H. , Shinchukovskyi I.A. , Etnis L.O. 
Published: May 2023

Introduction: The time of adaptation of the patient's maxillofacial apparatus to reconstructive manipulations is a crucial issue in prosthodontics. The sequence of actions and diagnostic measures used in the preparatory stages for prosthetics is still remaining unclear. Our research aimed to predict the duration of treatment and occlusal correction needed in combination with repositioning of the lower jaw.

Materials and methods: 134 patients were included in the study. T-Scan computerized analysis of occlusion was used before the treatment, immediately after the denture placemen, and in 3 and 6 months following the treatment. Patients were divided into three groups: the clinical group I of 60 patients (44.8%) had direct and indirect orthopaedic appliances of small and medium length; the group II of 40 patients (29.9%) received prosthetic correction with removable and fixed dentures, was divided into two subgroups. The 1 subgroup of the group II included 23 patients (17.2%), who had total preliminary prosthetic correction with fixed ceramic dentures with pronounced architecture of the occlusal surface. The 2 subgroup of the group II involved 17 patients (12.7%), who had total preliminary prosthetic correction with removable and fixed ceramic dentures with pronounced architecture of the occlusal surface in the lateral areas. The group III of 34 patients (25.4%) was similar to those in the I and II groups, but had a common somatic pathology underlying the development of neurotic symptoms.

Symptomatic manifestations of functional disorders of the maxillofacial apparatus were characteristic for each group. The group I had muscular symptoms (including pain), noises made by the TMJ, a feeling of discomfort during long conversations and chewing. The group II had symptoms similar to those in the group I as well as pain in the TMJ region and difficulty with mouth opening. The group III had neurotic symptoms such as radiating pain along the branches of the trigeminal nerve and the presence of trigger points as well as the symptoms experiences by the groups I and II.

The treatment involved the doctors from related fields of medicine; the verification of occlusal contacts was carried out across all the stages of the procedure of denture placement using a T-Scan computerized analysis of occlusion.

Results: The results demonstrate the normalization of closing and opening times in all three study groups immediately after denture placement and with a gradual improvement over the first 6 months that is due to adaptation processes in the dento-maxillofacial apparatus. The balance between left and right sides has also been restored. These results have been confirmed clinically, and in particular, by the reduction or complete absence of symptoms in the patients of all clinical groups.

The worst dynamic changes were found in the patients of the group III. The closing time increased to 0.5-0.7 ms, the opening time decreased by 0.3 ms, the balance of the right and left sides was 40%-60%. These results can be attributed to the history of neurogenic pathology.

Conclusions: The highest percentage of successful treatment outcomes was achieved in patients of the clinical group II. From a prognostic standpoint, diagnosis and making a treatment plan should be based on the analysis of occlusion correction using the T-Scan that allows prosthodontists to achieve a functional optimum in the future.