CURRENT TRENDS IN BONE AUGMENTATION DURING DENTAL IMPLANTATION IN PATIENTS WITH PARODONTAL PATHOLOGY AND JAW BONE ATROPHY (LITERATURE REVIEW)
Authors: Kinash Yu.O. , Kinash L.V. 
Published: March 2021

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.

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.

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.

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.

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.

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.

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.

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.