RU2707433C1 - Method for lower occlusion treatment by prosthetic repair - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to dentistry, and can be used for treating reduced occlusion by prosthesis. AOCO-M apparatus is used to measure compression force of jaws and determine central ratio of jaws. If observing a peak-free version of the dependence of the force values of jaw compression efforts, a percutaneous electric neurostimulation is performed. Thereafter, again measure the jaw compression force with the AOCO-M apparatus. In the process of repeated measurement of the single-peak type of the power curve of jaw compression efforts, prosthetic repair is performed.

EFFECT: method enables simplifying the treatment of the lower occlusion by determining the force parameters of jaw compression and the use of percutaneous electric neurostimulation.

1 cl, 12 dwg, 6 tbl, 2 ex

Description

The invention relates to medicine, namely to dentistry, and is intended for the treatment of patients with masticatory muscular dysfunction.

According to published data, up to 85% of the population suffer from masticatory musculature dysfunction. The basis of violations of muscle functions are changes in contractile processes in the musculature. A violation of the function of the masticatory muscles leads to the development of generalized forms of periodontitis, increased abrasion of hard tooth tissues, complicated by a decrease in the height of the bite and pain dysfunction of the temporomandibular joint.

A wide variety of treatment methods for dental patients with masticatory muscular dysfunction are known. These include drug therapy, manual therapy, acupuncture, orthopedic treatment (prosthetics) and physiotherapy. The proposed method relates to complex treatment, including prosthetics.

To develop effective treatment, patients with various degrees of masticatory muscle damage are pre-diagnosed. A classification of various types of dysfunction has been developed and treatment methods have been developed for each type of disorder.

There are various methods for determining the central jaw ratio in patients with reduced occlusion before the final prosthetics. According to the results of determining the central correlation of the jaws using the AOTsO-M apparatus, patients are divided into three groups according to the type of distribution of the jaw compression efforts (I.Voityatskaya, 2017. Anatomical and physiological substantiation of the volume and tactics of treatment of dental patients with reduced occlusion: thesis -ra. honey of sciences: 01/14/14 - Dentistry: St. Petersburg, SZGMU named after II Mechnikov, 338., pp. 140-142, 187, 209-213). Three types of graphs of the central ratio of the jaws in patients with a reduced occlusion are presented in table 1.

The one-peak version of the dependence of the force indicators of the jaw compression forces characterizes the preserved functional state of the dentition. Treatment of patients with a single-peak schedule option should be carried out according to the one-stage scheme described in the thesis of I.V.

The peakless version of the dependence of the force indicators of the jaw compression forces characterizes the reduced functional state of the dentofacial apparatus and requires the manufacture of a medical mouthguard and treatment on the mouthguard before prosthetics. Only after treatment on the mouth guard is final prosthetics possible.

The two-peak variant of the dependence of the force indicators of the jaw compression forces characterizes a sharply reduced functional state of the dentition and requires a long complex treatment.

Thus, the treatment of patients with the last two options for strength indicators of jaw compression efforts is much more complicated and longer than prosthetics for patients with the first option. The difficulty lies in the additional stage of prosthetics (using therapeutic mouthguards), which can take from several weeks to several months and in some cases in additional treatment by doctors of other specialties (neurologist, osteopath, endocrinologist, etc.)

Long-term studies and the experience of prosthetics of patients showed that in some patients with a peakless version of the force indicators of the jaw compression efforts, the functional state of the dentition can be restored in a simpler way according to a one-stage scheme.

The prototype of the proposed method of treatment can be considered the treatment of patients with a peakless version of the dependence of the strength indicators of the jaw compression efforts, described in the dissertation by I.Voityatskaya (I.V. Voitatskaya, 2017. Anatomical and physiological rationale for the volume and tactics of treatment of dental patients with a reduced bite: dissertation Doctor of Medical Sciences: 01/14/14 - Dentistry: St. Petersburg, North-Western State Medical University named after II Mechnikov, pp. 234-236. Textbook "Functional-physiological method for determining the ratio of the jaws" St. Petersburg Man. 2017, p. 27).

The technical result of the proposed solution is to simplify the treatment of reduced occlusion and increase the effectiveness of treatment.

To achieve the claimed result in the method of treating a reduced occlusion by means of prosthetics, which includes determining the central jaw ratio and measuring the jaw compression force by the AOCO-M apparatus, the treatment procedure is changed before the final prosthesis. If a peakless variant of the dependence of the force indicators of the jaw compression efforts is detected, percutaneous electroneurostimulation is performed, after which the AOZO-M apparatus measures the jaw compression forces again, when a single-peak view of the graph of the force indicators of the jaw compression forces is transferred to prosthetics during repeated measurement.

Replacing the treatment on the mouthguard, including the manufacture of therapeutic mouthguard and multi-day treatment with mouthguard, determining the functionality of the masticatory muscles by one-stage treatment of percutaneous electroneurostimulation significantly simplifies the treatment of dysfunction and speeds up the prosthetics process.

The method is as follows.

Patients with uncompensated forms of manifestations of general somatic pathology before the start of prosthetics go through the stage of functional diagnostics of the central ratio of the jaws using the apparatus AOTsO-M.

At the first doctor’s visit, the dental patient receives alginate impressions from the upper and lower jaws, models are cast, and individual hard plastic spoons are made. A feature of the upper individual spoon is the presence of a support site in the area of the hard palate, located from the incisal papilla to the level of the first molars. On the lower individual spoon, a platform is created on which the AOCO-M strain gauge sensor is located (Figure 1). The lower individual spoon with flipping clasps allows you to "turn off" the periodontal-muscular reflex, which makes it possible to take into account only the morphofunctional state of the masticatory muscles and TMJ elements.

During the second visit to the doctor, the stage of determining the central ratio of the jaws is carried out using the AOCO-M device. At the same time, by sequentially dissociating the bite using pins of various heights, the values of the integrated index of the maximum compression force of the jaws are estimated, the magnitude of the decrease in the interalveolar distance (MAP) and the displacement of the lower jaw in the sagittal and horizontal planes are determined (Figure 2). To do this, a sensor with a measuring pin of minimum height is installed on the supporting platform of the lower individual spoon, which fixes the usual position of the jaws. Then determine the range of measurements in which the study will be conducted. The working range is the range in which the arrow of the device is in the area of the scale. If the arrow goes beyond the range scale, go to the next range by pressing the button of the second or third ranges. During measurements, the height of the pin is progressively increased by 1.0 mm. The readings of the device are entered in the table of the patient examination card (table 2).

From table 2 it is seen that with a progressive change in the height of the pins, the maximum value of the compression force of the jaws of 125 N is determined at a pin height of 9.0 mm.

Analyzing the results of the first series of measurements, which were carried out with a step of 1 mm, select the pin height at which the maximum compression force is recorded. To clarify the found position, it is necessary to repeat a series of measurements. Absolute values may not be repeated when choosing the height of the pin, fixing the maximum value of the compression force of the jaws. At this stage, it is necessary to clarify the compression forces of the jaws when changing the height of the pin in increments of 0.5 mm.

After selecting the pin that fixes the maximum value, repeat the measurements, taking them in increments of 0.5 mm (table 3)

As the pin height increases, the recorded jaw compression forces will increase with their subsequent decrease, or by repeating the maximum value (table 3).

Having determined the height of the pin at which the maximum compression force of the jaws was revealed, a structural relationship between the jaws is fixed using silicone material of class “C” and silicone registers are obtained (Figure 2, 3; 4)

In patients with a peakless version of the force indicators of the jaw compression efforts, various defects in the dentition, increased abrasion of the hard tissues of the teeth, and generalized periodontitis were revealed. For this category of patients, the greatest therapeutic effect was revealed when using percutaneous electroneurostimulation with pulses with a frequency of 15-30 Hz and a current strength of 8-10 mA, for 15 minutes. Thus, after determining the central ratio of the jaws, percutaneous electroneurostimulation is carried out by a pulsed current with a frequency of 15-30 Hz and a current strength of 8-10 mA for 15 minutes, and then the central ratio of the jaws is re-performed using the AOCO-M and choose a treatment algorithm depending on the type of schedule obtained.

EXAMPLES OF TREATMENT.

One-stage treatment regimen.

Preserving capabilities of the masticatory apparatus and safe rehabilitation resource.

Patient P., 44 years old, turned to the Department of Orthopedic Dentistry, North-Western Medical University named after I.I. Mechnikov with complaints of inconvenience when chewing, unsatisfactory aesthetics of the appearance of the face.

Objectively. Lack of 16-, 17-, 18-, 25-, 26-, 27-, 28th teeth on the upper jaw; lack of 31-, 35th teeth on the lower jaw. The bite is orthognathic, the mucous membrane of the oral cavity is pale pink, moist, with no visible pathological changes. Displacement of the incisal line in the usual occlusion to the left by 1.5 mm. When opening the mouth revealed deviation of the lower jaw to the left. The amplitude of the opening of the mouth is normal. Palpation of the chewing muscle on the right causes pain. Pathological noise during movements in the TMJ on the right. According to the clinical index of TMJ dysfunction (M. Helkimo) - mild degree of dysfunction D I (2 points).

Associated diseases, according to the anamnesis: chronic gastritis, osteochondrosis of the cervical spine.

Dental diagnosis with direction: Increased abrasion of hard tooth tissue, generalized form, 3rd degree. Partial tooth loss: defects in the dentition of the upper jaw (Kennedy 1st grade), lower jaw (Kennedy 3rd grade). TMJ dysfunction.

Using the functional physiological method (FFM) with simultaneous recording of an electromyogram (EMG) when determining the interalveolar distance (MAP), a peakless dependence of the jaw compression forces was revealed, a decrease in MAP of 3.0 mm, with a pin height of 9.0 mm. The magnitude of the displacement of the lower jaw in the horizontal plane of 2.0 mm, in the sagittal plane of 0.5 mm (table 4).

From table 4 it follows that when optimizing MAP on a 9 mm pin with the simultaneous use of FFM and electromyography, an increase in the amplitude of bioelectric activity (BEA) of the masticatory muscles on the right and left (from 0.7 and 0.6 mV initially to 1.12 and 1, 16 mV, respectively), the amplitude of the BEA of the temporal muscles also increased (from 1.21 and 1.19 mV initially to 1.35 and 1.32 mV, respectively).

When conducting a chewing test, there is no reaction of neck muscles to a change in MAP. The asymmetry of the amplitudes of the bioelectric activity of the masticatory and temporal muscles was revealed.

The presence of pathological phenomena (PF) was observed in the form of spindles of parafunctions, loss of activity of electrogenesis in the muscles, single non-cyclic bursts of bioelectric activity. The rehabilitation capabilities of the chewing apparatus are preserved.

The diagnosis was made on the basis of the presence of a decrease in MAP, muscle dysfunction, and signs confirming an upper-posterior asymmetric dislocation of the heads of the lower jaw in the articular cavity of the TMJ, and signs reflecting compression of the bilaminar zone.

Diagnosis: Increased abrasion of hard tissues of teeth of the 3rd degree, generalized form, decompensated. Partial tooth loss: defects in the dentition on the upper jaw - Kennedy Grade 1, defects in the dentition in the lower jaw - Kennedy Grade 3. Rehabilitation resource saved. "Reduced bite syndrome", 1st degree of severity.

According to the data of functional stress tests and studies of heart rate variability (HRV), the safe rehabilitation capabilities of the masticatory apparatus and the safe rehabilitation resource were established, which ensures a good rehabilitation potential of the patient. The rehabilitation prognosis of patient P. is good, complete morphofunctional rehabilitation is possible.

The planned duration of treatment and rehabilitation measures is 3 months. Based on the preserved rehabilitation potential, a one-stage treatment regimen was selected.

Preparatory treatment at the physiotherapist. To compensate for muscle dysfunction, transdermal electroneurostimulation was used with the EPB 50.01 Electronics device. Used pulses with a frequency of 15-30 Hz and a current strength of 8-10 mA. During percutaneous electroneurostimulation, a negative electrode was placed on the ear tragus region, and a positive electrode was fixed on the most prominent part of the chewing muscle proper. The procedures were performed daily for 15 minutes. A total of 10 procedures were performed.

Re-determination of the ratio of the jaws using the apparatus "AOCO-M" revealed the presence of a one-peak view of the graph of the compression force of the jaws.

After which prosthetics was carried out.

Dental prosthetics included the application of a ceramic-metal bridge-like denture and a clasp prosthesis to the upper jaw

fixtures; on the lower jaw of ceramic-metal bridges, the duration of treatment was 2 months.

At the stage of adaptation to dentures, a soft silicone mouthguard was used to prevent muscle dysfunction (the duration of mouthguard use was determined according to the EMG of the masticatory muscles). The patient is fully adapted to the dentures. No complaints.

With the help of the treatment and rehabilitation complex, a complete morphofunctional rehabilitation of patient P. was achieved.

The condition of the dentition before and after treatment is shown in Figures 5, 6, 7, 8.

The two-stage treatment regimen.

Rehabilitation opportunities and rehabilitation resources have been reduced.

Patient S., 56 years old, a high school teacher, turned to the Department of Orthopedic Dentistry, North-Western Medical University named after I.I. Mechnikova with complaints: difficulty in chewing, violation of the appearance of the face and condition of the teeth, notes fatigue in the muscles during a conversation, and sometimes feels discomfort in the masticatory muscles, especially after exercise.

Objectively: the absence of the 25-, 26-, 27-, 35-, 46th teeth. Orthognathic bite. Deformation of the occlusal surface of the upper dentition. Teeth 11, 12 are covered with plastic crowns. The amplitude of the opening of the mouth in full, 45 mm. Deviation of the lower jaw when opening the mouth to the right. Palpation is determined by pain in the chewing muscles of the right.

According to the clinical index of TMJ dysfunction (Helkimo) - mild degree of dysfunction D I (3 points).

A history of concomitant diseases is a disease of the thyroid gland of the dentition in the upper jaw — Kennedy grade 3, Kennedy grade 3 in the lower jaw); deformation of the upper dentition. Temporomandibular joint dysfunction.

The functional-physiological method revealed a peakless graph, a decrease in MAP of 3.0 mm, with a pin height of 9.0 mm (table 1). to the right, in the sagittal plane of 1.5 mm.

From the data of table 1 it follows that with an increase in MAP with simultaneous FFM and electromyography, a peakless graph is detected. With a pin height of 9.0 mm, the optimum height. At this separation height, an increase in the amplitude of BEA of chewing muscles on the right and left (from 0.72 mV and 0.41 mV initially to 1.25 mV and 0.67 mV, respectively), the amplitude of BEA of the temporal muscles slightly increased (from 0.18 mV and 0.21 mV initially up to 0.31 mV and 0.50 mV, respectively).

When performing a chewing test, an asymmetry of the amplitudes of BEA of the chewing and temporal muscles at the height of the usual occlusion and during separation was revealed. The neck muscle response to a change in MAP was also determined in the form of an increase in the amplitude of BEA of the sternocleidomastoid muscles on both sides (from 1.25 mV and 1.21 mV initially to 1.42 mV and 1.35 mV, respectively).

Diagnosis: Partial tooth loss; defects in the dentition on the upper jaw (Kennedy 3rd grade), on the lower jaw (Kennedy 3rd grade). Deformation of the dentition. The rehabilitation resource is reduced. “Reduced occlusion syndrome”, 2nd degree of severity.

According to the data of functional stress tests and studies of heart rate variability (HRV), low rehabilitation capabilities of the chewing apparatus and low rehabilitation resource were detected, which reflected a decrease in the rehabilitation potential of patient C. This circumstance made it possible to make a rehabilitation forecast about the possibility of complete morphofunctional rehabilitation using a two-stage treatment regimen. The total duration of treatment and rehabilitation measures was 6 months.

Preparatory treatment was carried out by a physiotherapist. Percutaneous electroneurostimulation was used to compensate for muscle dysfunction. Used pulses with a frequency of 15-30 Hz and a current strength of 8-10 mA. During percutaneous electroneurostimulation, a negative electrode was placed on the ear tragus region, and a positive electrode was fixed on the most prominent part of the chewing muscle proper. The procedures were performed daily for 15 minutes. A total of 10 procedures were performed.

Re-determination of the ratio of the jaws revealed the presence of a peakless graph of the compression force of the jaws.

A decision was made to conduct treatment with a rigid plastic mouthguard.

During this period, a rigid plastic mouthguard was placed on the lower dentition with a separation of 1.5-2 mm from the found optimal MAP. For 1 month, the mouthguards were ground. Throughout the stage, it is necessary to achieve a decrease in the height of the plastic mouthguard to the optimal bilateral contact to the height determined using the FFM.

The proposed methodology of therapeutic measures is aimed at establishing the heads of the lower jaw in an optimal position for comfortable activity of TMJ elements and restoration of electrogenesis of chewing muscles and neck muscles. The criterion for the positive effect of the use of mouthguards was the absence of pathological phenomenology on EMG and the inclusion of neck muscles at rest and at the time of specific tests. Achieving a positive result was an indication for the final orthopedic treatment. At the next stage, prosthetics were performed at the optimal MAP.

Dental prosthetics was performed with optimal MAP: on the upper jaw - a ceramic-metal bridge, on the lower - metal-ceramic bridges.

The duration of treatment was 2 months.

At the stage of adaptation to dentures, soft silicone mouthguards were used to prevent muscle dysfunction. In connection with professional work, prolonged use of soft mouthguards is recommended. The patient fully adapted to the dentures. No complaints. The effectiveness of treatment and rehabilitation measures was determined according to the functional diagnostics.

On EMG of the masticatory muscles, normalization of the amplitude of the BEA of the masticatory muscles at rest and during functioning was revealed. The asymmetry index corresponded to the physiological corridor, pathological phenomenology (PF) was not detected. EMG data after treatment are presented in table 6.

According to computer stabilometry, no dysfunction of the statokinetic system was detected.

When using this treatment and rehabilitation complex, a complete morphofunctional rehabilitation of patient C was achieved. The initial state and result of treatment measures are shown in Figures 9, 10, 11, 12. When using this treatment and rehabilitation complex, a complete morphofunctional rehabilitation of patient C was achieved.

Thus, the proposed solution, after diagnosing the determination of the jaw ratio, among patients with a peakless version of the force indicators of the jaw compression forces, it is possible to identify patients who, after an additional procedure of percutaneous electroneurostimulation, can be assigned to patients with a one-peak version of the force indicators of the jaw compression efforts. This made it possible to significantly simplify and reduce the treatment time for patients with reduced occlusion.

Claims (1)

A method of treating a reduced occlusion by prosthetics, including measuring the jaw compression force with the AOCO-M apparatus and determining the central jaw ratio, characterized in that, when a peakless version of the dependence of the jaw compression force indicators is detected, percutaneous electrical stimulation is performed, after which the AOCO-M force is re-measured compression of the jaws, upon receipt in the process of repeated measurement of a single-peak view of the graph of strength indicators of the forces of compression of the jaws go to the prosthesis IAOD.

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