CLINICAL JUSTIFICATION OF THE EFFICIENCY OF USING IMPROVED METHODS OF DETERMINING AND FIXING OCCLUSAL RELATIONSHIPS IN PATIENTS WITH PARTIAL EDENTULOUS
Authors: Kovalyshyn A. Y. , Dmytryshyn T. M. 
Published: January 2025

Determining the optimal occlusal relationships according to the anatomical and functional features of the maxillofacial system (MFS) and subsequent adaptation till physiological functions are restored is an actual task during prosthetic treatment of patient with partial edentulous with help of fixed and removable partial denture (FPD, RPD).
Purpose: to establish the effectiveness of the proposed methods of determining and fixing of the occlusal relationships based on the study of clinical indicators in patients who simultaneously use FPD and RPD for prosthetic therapy.
Material  and  Methods. Our study included 120 patients aged 55-70 years with partial edentulous without endocrine and systemic disorders, acute forms of periodontal tissues diseases and good level of individual oral hygiene who came to the Department  of  Stomatology  of  Postgraduate  Education of Ivano-Frankivsk National Medical University for prosthetic treatment. Prosthetic treatment was carried out with FPD, RPD using the proposed methods of forming occlusal relationships (group 1) and generally accepted methods (group 2). Each study group was divided into two subgroups: a – patients without occlusal disorders, and b – patients with occlusal disorders and vertical occlusion dimension (VOD) loss. The examination of each person included the collection of anamnesis and complaints, general dental examination, the determination of the Russell periodontal index (PI), the assessment of occlusal relationships and the condition of the temporomandibular joint (TMJ) according to "Hamburg protocol".
Results and conclusions. The analysis of patient’s complaints and anamnesis, the data of the objective dental examination, and assessment of the periodontal tissue condition established the effectiveness of the proposed methods of determining and fixing occlusal relationships in patients with partial edentulous simultaneously treated with  FPD and RPD.
In addition, 23.3% more people of the 2a subgroup felt tension and fatigue of the masticatory muscles a week after treatment than in 1a subgroup, and 36.7% more - in the 2b subgroup than in 1b after a year of FPD and RPD use (p< 0,05). There were significantly more patients with signs of eccentric supraocclusion in the 2a subgroup a year after prosthetic treatment than in 1a (30±0.09% (9) and 3.3±0.03% (1)), and with signs of centric supraocclusion in the 2b subgroup - 36.7±0.09% (11), against 10±0.06% (6) in 1b (p <0.05).  
         Also, there was observed a positive effect of proposed method of determining and fixing of the occlusal relationships during prosthetic treatment on TMJ  a year after prosthetic treatment with FPD and RPD. There were 16.7% and 13.3% fewer people in 1a and 1b subgroups with one positive symptom of  the “Hamburg protocol” and 6.7% and 40% fewer persons with two positive symptoms, compared to the data received before treatment. There was an increase by 13.3% of number of patients with one positive symptom according to “Hamburg protocol” in the 2a subgroup and by 10% of persons with two symptoms. It was determined a decrease of patients with two positive symptoms according to “Hamburg protocol” in 2b subgroup by 10% after one year.
An improvement of periodontal tissues condition of abutment teeth was evaluated by PI assessment after a year of observation of patients. It was established that the average value of PI in subgroup 1b was significantly lower by 57.6% than in subgroup 2b, and it was lower in subgroup 1a  by 39.3% than in patients of subgroup 2a (р<0,05).