ORTHOPEDIC TREATMENT OF PERIODONTAL DISEASES WITH PARTIAL ABSENCE OF TEETH USING CLASP PROSTHESES

Комлев С.С.

Кандидат медицинских наук,

ГБОУ ВПО Самарский Государственный Медицинский Университет Минздрава России

ОРТОПЕДИЧЕСКОЕ ЛЕЧЕНИЕ ЗАБОЛЕВАНИЙ ПАРОДОНТА С ИСПОЛЬЗОВАНИЕМ БЮГЕЛЬНЫХ ПРОТЕЗОВ ПРИ ЧАСТИЧНОМ ОТСУТСТВИИ ЗУБОВ

Аннотация

Клиническим проявлением генерализованного пародонтита является подвижность зубов, смещение в вестибулярном направлении и появлении множественных дефектов зубных рядов, при этом в большинстве случаев развивается травматическая окклюзия, особенно ярко проявляющаяся, когда пародонтит осложнен концевыми дефектами зубных рядов, так как вся жевательная нагрузка падает на фронтальные зубы. В статье описано использование бюгельных протезов для шинирования зубов, имеющих II-III степень подвижности с одновременным восстановлением концевых дефектов зубных рядов с целью профилактики травмы пародонта фронтальных зубов и создание благоприятных условий для лечения заболеваний пародонта. Ключевые слова: бюгельный протез, заболевание пародонта, частичное отсутствие зубов.

Komlev S. S.

Candidate of Medical Sciences,

Samara State Medical University

ORTHOPEDIC TREATMENT OF PERIODONTAL DISEASES WITH PARTIAL ABSENCE OF TEETH USING CLASP PROSTHESES

Abstract

Clinical symptom of generalized periodontitis is tooth mobility, displacement in vestibular direction and emergence of multiple dentition deformities. In most cases traumatic occlusion is developed, especially well shown when periodontitis is complicated with free-end defects of dentitions since all the chewing load falls on frontal teeth. The article describes the use of clasp prostheses for splinting teeth with II-III degree of mobility with simultaneous reduction free-end defects of dentitions to prevent periodontal injury of frontal teeth and create favorable conditions for treatment of periodontal diseases. Keywords: clasp prosthesis, periodontal disease, partial absence of teeth. Periodontal diseases are multifactorial lesions. The main reasons of it’s development are violations microbiocenosis of oral cavity and periodontal tissue hemodynamics. Inflammation of periodontal tissue often develops in case of violation of the immune system or local defense mechanisms of the oral cavity [1]. The efficiency of treatment of periodontal diseases can be achieved only with integrated approach, which is based on a clear definition of the basic pathogenetic mechanisms of disease, and includes therapeutic, surgical, physiotherapeutic and orthopedic methods. Also includes immunotropic impact, methods directed to improving the level of vital activity as a whole, psycho-emotional state, improving social conditions of vita activity, treatment of intercurrent somatic diseases, conducing development of periodontal diseases [2]. The orthopedic treatment of periodontitis is primarily aimed at fixation of motile teeth and redistribution load on teeth with periodontal lesions or or mucous membrane of prosthesis bed. The most important point is elimination of traumatic overload of periodontal tissues [3]. The main orthopedic methods of treatment periodontal diseases are selective lapping, temporary splinting, use of permanent splinting devices, different orthopedic constructions. Correctly chosen and conducted orthopedic treatment aimed not only to restore the defects of the dentition, but also to reach reliable stabilization of the remaining teeth, promotes normalization of occlusal loads, periodontal trothic, strengthening of reparative processes in its tissues [4]. However, there is a number of complications of orthopedic treatment of periodontal diseases. When carrying out the retrospective analysis first of all development of the fast-progressing periodontitis should be noted which is led to reduction of time of effective use of splinting devices and prostheses. Defects of crowns, breakages of splinting devices and prostheses, change of interocclusal space due to promotion of teeth and atrophy of bone tissue, specific for periodontal diseases, deterioration of esthetic features of orthopedic constructions, chewing malfunction, etc. belong to other complications. One of the major reasons for the development of complications while conducting orthopedic treatment of patients with periodontitis is bad biocompatibility of materials, used for splinting and orthopedic constructions. As a result, intolerance of splinting devices and prostheses arise. Nowadays, this problem is rather acute in view of the intensive introduction of new materials and their combinations in orthopedic dentistry. While conducting orthopedic treatment of periodontal diseases special attention should be paid to injuring of bearing teeth while preparation. Most often burn of pulp and periodontal tissues is observed, that can lead to the activation of inflammatory reactions, edema, exudation, formation of infiltrates i.e. aggravation of inflammatory lesions of periodontal tissues. Despite the urgency of the problem - the emergence of complications while conducting orthopedic treatment of patients with periodontal diseases, many aspects remain unclear, although it’s solution is extremely important for everyday dental practice. Clinical symptom of generalized periodontitis is tooth mobility, displacement in vestibular direction and emergence of multiple dentition deformities. In most cases traumatic occlusion is developed, especially well shown when periodontitis is complicated with free-end defects of dentitions since all the chewing load falls on frontal teeth. The traditional solution of this problem is using partial removable splinting constructions of prostheses for restoring free-end defects of dentitions, not enough considering the degree of mobility of bearing teeth and functional state of periodontal tissues. Modern technologies allow to conduct splining of mobile teeth with simultaneous reduction of certain types of small bounded defect during the therapeutic reception as well as sufficient strength, high esthetic design of construction with help of combination of photopolymer composites, plastic or fiberglass frames. However, using of proposed tire frames with II-III degree of mobility of frontal teeth, complicated with free-end defects of dentitions can lead to the destruction of these constructions and complication of traumatic occlusion. The aim of study was the use of clasp prostheses for splinting teeth with II-III degree of mobility with simultaneous reduction free-end defects of dentitions, prevention of front teeth periodontal tissues and create favorable conditions for treatment of periodontal diseases. At the Chair of Orthopedic Dentistry SamSMU we observed 36 patients with generalized periodontitis II-III degree of severity with free-end defects of dentitions. While conducting treatment of patients we used the following scheme: therapeutic treatment, including sanitation of teeth, removing supragingival and subgingival dental plaque, conducting drug anti-inflammatory therapy, physiotherapeutic impact;  surgical treatment, including extracting teeth with III-IV degree of mobility,  complicated with suppuration as well as teeth on X-ray of which bone tissue resorption was greater than 2/3 the length of the root; selective lapping; orthopedic correction of occlusal relationships of dentitions; rational prosthetics with compulsory use of splinting orthopedic apparats. Elective lapping of teeth taking into account the need of creating space for their movement, reducing the compression of periodontal vessels, removal of factors violating blood circulation and tissue trothics. To restore the unity and uniform distribution of chewing pressure of patients with generalized periodontitis complicated with free-end defects of dentitions we used clasp prostheses of different design, in some clinical situations prostheses with clasps for splinting frontal teeth were used. The use of such clasps helps to reduce pressure of occlusal loads, save physiological mobility of teeth and promotes the regenerative processes in the periodontal tissues of bearing teeth. Splinting of mobile teeth with free-end defects of dentitions is actual, especially during treatment of generalized periodontitis. During treatment we evaluated clinical status and condition of periodontal tissues before and after treatment, and in 6, 12, 18 months on basis of objective indicators: PMA index – papillary-marginal-alveolar, Kr – bleeding, bone tissue loss, a PC – the depth of the periodontal pocket, GN – suppuration, tooth mobility and Schiller – Pisarev test (SP). In addition, we determined the quality of splinting. The diagnosis was made according to the taxonomy of periodontal diseases proposed by N.F. Danilevsky (1994). Statistical processing of the results was performed on a personal computer with help of integrated software package Microsoft Excel. During initial examination all patients had weak hyperemia with cyanotic tinge, slight friability of gums, suppuration from periodontal pockets, a large number of supragingival and subgingival dental plaque, loss of bone tissue is 6,1 ± 0,1 points, tooth mobility 2,2 ± 0,11 points. A significant decrease of PMA performance was determined: before treatment 6,2 ± 1,2%, the dynamics of indicators (54,1 ± 2,4%), p <0.01; SP - before treatment 2,3 ± 0,05 points, the dynamics of index (1,5 ± 0,05 points) p <0.01; KR before treatment 2,6 ± 0,17 points, the dynamics of index (2,56 ± 0,09 points), p <0.01; PC before treatment 5,0 ± 0,2 mm, after treatment with 4,01 ± 0,1 mm; GN before treatment 2,02 ± 0,5 points, 0 points after treatment. Analysis of long-term results showed that the inflammatory reaction in periodontal tissues had not renewed, suppuration from periodontal pockets were not observed. That indicates a stable remission of periodontal tissues. Clasps of clasp prosthesis fix mobile teeth, chewing pressure is evenly distributed on all the bearing teeth. Vestibular clasp of clasp prosthesis splints all mobile teeth and prevents their displacement in the vestibular direction that creates favorable conditions for stabilization of periodontal inflammation and reduce the time for treatment of periodontitis. Thus, our experience of treating 36 patients using clasp prostheses various design, and in some clinical cases with clasps for splinting frontal mobile teeth, makes it possible not only to save mobile teeth, but also to recover the lost one. This causes an increase of the reserve possibilities of periodontal tissues, prevention of traumatic occlusal and increase chewing efficiency.

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