Український стоматологічний альманах (Mar 2017)
MODERN METHODS OF DIAGNOSIS AND TREATMENT IN PATIENTS WITH DENTITION DEFECTS COMPLICATED OF DISORDERS OF THE TEMPOROMANDIBULAR JOINT
Abstract
The aim of research is to increase the efficiency of diagnosis in patients with dentition defects, complicated with disorders of the temporomandibular joint. Materials and Methods. 60 patients with dentition defects, teeth deformations and disorders of the temporomandibular joint were examined; condition and location of dentition defects, degree of the teeth mobility, degree of the alveolar bone atrophy, state of hard tissue of teeth were studied. The diagnostic analysis of models was by radiographic techniques and condilography and 3D scanner 3SHAPE. "Survey map" was developed, which is divided into such topics: history of the periodontal treatment, the endodontic treatment, the orthodontic treatment, the orthopedic treatment and the analysis of vertical, sagittal and transversal movements of the mandible. Results. During the examination lateral dental defects were found in 46 patients and defects in the frontal area were found in14 patients there were also combined defects. Due to our "Survey map" we revealed that endodontic history knew only 55% of patients, but details about the treatment knew only 36.7%. About periodontal treatment in general included 70%, but about more detailed inspection was only 28.3%. About preorthodontic treatment was 33.3% and young patients in details was only 21.7%.The largest percentage amounted the information about the orthopedic treatment was 83.3%, and in details aware the features about the previous orthopedic treatment was 61.7% of patients. We should note that the smallest part of patients knew about the state and previous diseases of the temporomandibular joint, this percentage was 16.7%. However, the exact data could indicate only 13.3% of patients. Studying the state of the TMJ and the masticatory muscles we take into account vertical movements of the mandible: maximum opening and S - like shift, pain; in the sagittal mandible movements are they limited or unlimited; in the transversal are they symmetry and blocked or not blocked. We have found the following clinical features during the examination of the temporomandibular joint according to the proposed map: in 53.3% of patients occurs occasionally stiffness and limitation of the mandible movements in the night; in 8.3% of patients presents crunch; 36.7% of patients S-like lowers jaw; 35.0% of patients has sagittal movements limitations of the mandible, 31.7% suffer from transversal movement restrictions and 26.7% of patients feel pain during the palpation of the TMJ. Our results indicate for a lack of attention during the examination of patients with dentition defects that are combined with teeth deformations and disorders of the temporomandibular joint and therefore occlusal relationship. One can suggest the algorithm for our patients with such disorders, including the examination of models in 3D scanner 3SHAPE, usage the equalizer and production of the temporary structures to fill dentition defects, stabilize the joint heads of the mandible on the base of the condylography for a period from 2 to 6 months. After stabilization of the TMJ the permanent modern design of aesthetic metal-based or zirconium dioxide constructions were made. Conclusions: So, it was found that detailed examination and diagnosis of patients, particularly the pre-history of the treatment will objectively assess the state of dentition and plan complex treatment. However, only from 13.3% to 61.7% of patients know in details about the preliminary stages and methods of dental treatment. Our results indicate for a lack of attention during the examination of patients with dentition defects that are combined with teeth deformations and disorders of the temporomandibular joint and therefore occlusal relationship. Beside, in 53.3% of patients occurs occasionally stiffness and limitation of the mandible movements in the night; in 8.3% of patients presents crunch; 36.7% of patients S-like lowers jaw; 35.0% of patients has sagittal movements limitations of the mandible, 31.7% suffer from transversal movement restrictions. Based on the results one suggest the algorithm of treatment, which includes the study of models in 3D scanner 3SHAPE, the use of temporary structures, kappa and modern aesthetic prosthetics.
