An interdisciplinary approach to evaluation of the results of dental implantation and prosthetic treatment

Abstract

Аim of the present study is to set up a procedure for interdisciplinary interaction in complicated orthopaedic cases with the analysis of causes of complications after dental implantation and prosthetic treatment. Material and Methods. Digital panoramic radiography (J.Morita Veraviewepocs), cone-beam computed tomography (J.Morita Accuitomo 100), results of MELISA (Memory Lymphocyte Immuno-Stimulation Assay)-tests from InVitaLab (Neuss Germany), histological examination of bone tissue in sections, painted hematoxylin-eosin for I. Van Gieson (x 250/400), metallographic examination of the implant from the ВТ-6 (Ti-6AI-4V) alloy on oblique samples in scanning microscope Epiquant (х250). Results and Discussion. According to clinical studies of biocompatibility of dental materials, the most difficult for diagnosis and treatment are adverse reactions of patients in the form of allergies or intoxication against the background of the so-called "somaticized state", related to the use of dental prostheses. Typical "manifestations of psychosomatic disorders in the oral cavity" include chronic pain or occlusal discomfort, burning mouth syndrome, atypical odontangiography, phantom bite syndrome, senestopathy, and halitophobia. Specialists, distant from the problems of psychosomatic medicine, point out suspected diseases and non-specified conditions (Z.03.89), person with feared health complaint in whom no diagnosis is made (Z.71.1) conditions of unclear etiology (K29.7, K59 .9, D50.9, E03.2, F48.0/ G90.8) or unspecified (K29.9, T78.8 / T88.7). According to the European Academy of Allergy and Clinical Immunology data, the resources for diagnosing hypersensitivity reactions to metals (most often IV type) are still limited, and incidence of allergy upon the use of the titanium alloy Ti-4Al-6V, is one of the causes for the failure of dental implantation. In most patients, elimination of "incompatible" dentures yields a long-lasting positive result. However, in some patients, replacement of fillings, repeated endodontic treatment or even tooth extraction only exacerbate psychosocial distress. Patient H. (43 years old) suddenly felt significantly worse 7 years ago after prosthetic treatment for a partial loss of teeth on the upper and lower jaw (K08.432) . Complaints of malaise increased after completion of subsequent dental restorative treatment with use of dental implants. The dental and periodontal tissues status, orthopantomography and computed tomography data, as well as complete contact osteogenesis of the alveolar bone adjacent to the dental implant, without signs of fibrotisation and cellular inflammatory reaction on histological sections, as well as the absence of relief cracks, fractures, or other signs of destruction on oblique slices of the implant from the alloy ВT-6 (Ti-6AI-4V), did not confirm the hypothesis of postosteointegrational failure of dental implantation and prosthetics. In the process of differential diagnosis with the assistance of specialists of various medical specialties, taking into account the positive reaction to salt / compounds of titanium cadmium, weakly positive - nickel and iron, according to the results of the MELISA test, the clinical diagnosis: main condition-somatoform disorder (F45.2) after accomplished dental prosthetics (Z98.8); other condition-allergy, unspecified (Т78.40) - was clarified. Conclusions. Experience of interdisciplinary collaboration in the process of differential diagnostics and treatment of psychosomatic and allergic disorders and other adverse reactions related to dental practice, is the key element of evidence base for the founding of adapted medical guidelines and unified clinical protocols. Complications in the patient H. occurred due to insufficiently careful analysis of her history of life and disease during arrangement of prosthetic treatment, which should be considered a medical error. In the further treatment of patient H., an individual selection of materials for prosthetics, control of the applicability of dentures, and exact adherence of the patient to all medical orders are necessary.

Keywords

• dental implantation, allergy to metals, somatoform disorder