RU2784792C1 - Method for preventing dysfunction of the muscular-articular complex of the temporomandibular joint in the presence of a removable prosthesis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to prosthetic dentistry, and is intended for use in the diagnosis, prevention of functional disorders of the muscular-articular complex of the temporomandibular joint in the presence of a removable prosthesis in patients with partial and complete loss of teeth. The control of mechanical irritation of the oral mucosa as a result of using the prosthesis and the control of the state of occlusions and the absence of limitation of the functional ability of the prosthesis are carried out. А removable prosthesis is made taking into account the assessment of the functional state of the masticatory muscles by surface electromyography (EMG). In this case, the asymmetry of the amplitude of the biopotential of the right and left sides with the prosthesis should be within the physiological norm from 0 to 20%, the patient is recommended a preventive examination and re-examination after a year. During a re-examination, provided that the prosthesis is in good condition and there are no complaints, the functional state of the chewing muscles is re-evaluated using EMG, first at rest without a prosthesis in the oral cavity, and then an EMG is performed with the prosthesis. When comparing the obtained electromyograms, the presence or absence of changes in the resting amplitude in the form of asymmetry of the right and left sides is taken into account, while the manifestation of asymmetry from 21% to 50% is regarded as an average degree of severity of dysfunction, and the presence of asymmetry of more than 50% - as a high degree of violations. If asymmetry above the physiological norm is present in EMG without a prosthesis in the oral cavity and persists with a prosthesis, an additional examination of the musculo-articular complex of the temporomandibular joint (TMJ) and further treatment according to indications are recommended. When there is no asymmetry above the physiological norm without a prosthesis, but occurs when the prosthesis is inserted into the oral cavity, it is recommended to make a new prosthesis, and if the asymmetry is above 50%, it is necessary to conduct an additional examination of the musculo-articular complex of the temporomandibular joint before making a new removable prosthesis. And when, with the introduction of the prosthesis, the asymmetry is within the physiological norm or decreases, if its values ​​without the prosthesis were above the limits of the physiological norm, it is recommended to continue using this prosthesis with subsequent control after a year.

EFFECT: method, by reducing the risk of occurrence of functional disorders on the part of the muscular-articular complex of the temporomandibular joint, allows to increase the accuracy of diagnosis and prevention of complications when using removable dentures.

1 cl, 3 dwg, 4 ex

Description

SUBSTANCE: invention refers to medicine, namely to orthopedic dentistry, and can be used for diagnosing and preventing functional disorders of the muscular-articular complex of the temporomandibular joint in the presence of a removable prosthesis in patients with partial and complete loss of teeth.

A modern approach to the timing of the use of removable dentures. Complete or partial absence of teeth directly affects the patient's quality of life. The absence of teeth causes a violation up to the final loss of the vital function of the body - chewing food, which affects the process of digestion and the intake of necessary nutrients into the body, and is also often the cause of the development of inflammatory diseases of the gastrointestinal tract.

No less serious are the consequences of the absence of teeth for the social status of patients: articulation and diction disorders affect the communication abilities of the patient, these disorders, coupled with changes in appearance due to loss of teeth and developing atrophy of the masticatory muscles, can cause changes in the psycho-emotional state up to mental disorders. The absence of teeth is also one of the reasons for the development of specific complications in the maxillofacial region, such as dysfunction of the temporomandibular joint and the corresponding pain syndrome.

The principles of treatment of patients with complete secondary adentia involve the simultaneous solution of several problems:

- restoration of sufficient functional ability of the dentoalveolar system;

- prevention of development of pathological processes and complications;

- improving the quality of life of patients;

- elimination of negative psycho-emotional consequences associated with the complete absence of teeth.

(V.A. Khvatova "Clinical Gnathology". Moscow: Medicine Publishing House, 2005, pp. 122-126).

The orthopedic dentist must determine the features of prosthetics, depending on the anatomical, physiological, pathological and hygienic condition of the patient's dental system. When choosing between equally effective types of prostheses, he should be guided by indicators of profitability. Removable dentures are an economical and simple method of restoring tooth loss.

However, it is not uncommon for patients to believe that removable dentures are permanent and do not need to be replaced. They don't realize that dentures only last three to five years. There are factors that help you know when a prosthesis is no longer suitable for use as it can affect facial features, comfort levels and oral health.

We conducted an analysis of the scientific literature on the topic of the study devoted to the reasons or criteria that determine the need to replace removable dentures.

Coral J Yao (Coral J Yao, С.C. "Patient-reported outcome measures of edentulous patients restored with implant-supported removable and fixed prostheses: A systematic review. Clin Oral Implants Res", 2018 Oct;29) pointed to 7 main reasons for the unsuitability of removable dentures, such as:

1. Inconsistency of the basis of the prosthesis with the prosthetic bed.

Partial dentures should fit snugly and comfortably for a long time. But due to bone atrophy, partial dentures start to slip or don't fit as well as they used to. If the patient has to apply special denture pastes during the day or more often, it is necessary to think about replacing the denture.

2. Material wear

The materials that modern dentures are made of are quite durable, but after years of constant use, dentures wear down to the point where they become unattractive from an aesthetic point of view. Over a long period of time, the pink plastic base of the denture loses its natural look, texture and color, resulting in the dentures looking quite artificial compared to the rest of the natural teeth. Excessively worn dentures can also become dirty and cause irritation, infection, odors, and bad taste in the mouth.

3. Change in phonetics

When a partial denture does not fit properly, sound production is also affected. When using full dentures, you can hear a long “C” sound that almost sounds like a whistle. For the patient, this can be an unpleasant factor and affect the quality of life, in these cases the prosthesis must be replaced.

4. Decreased chewing efficiency

If the patient has difficulty chewing their favorite food, this is an indication that the dentures no longer fit. As a result, this can lead to malnutrition, vitamin and mineral deficiencies, and a weakened immune system.

5. Breakage and damage to the prosthesis

In some cases, the reason for replacing the prosthesis may be related to the prosthesis itself, and not to how atrophy of the alveolar process and masticatory muscles occurs over time. Small cracks in the prosthesis or areas of severe damage may indicate an impending fracture. This prosthesis needs to be replaced.

6. Oral infections

The occurrence of infection in the oral cavity is due to the fact that acrylic bases of prostheses, due to their porosity and over time, can be infected with bacterial and fungal microflora, while stomatitis, fungal and bacterial microflora may occur. This condition can be characterized by redness and soreness in the mouth and requires treatment of the oral mucosa and replacement of dentures.

7. Reduction of the lower third of the face.

Incorrectly defined interalveolar height can adversely affect facial features. This can lead to rapid bone atrophy. In addition, bone loss in the jaw, which decreases with age, can lead to a change in the facial proportions of the face, especially its lower third. This can affect the muscles around the mouth, causing them to sag, leading to an older patient.

Many people mistakenly believe that removable dentures last a lifetime. In fact, most dentures last between three and five years. The actual life of dentures depends on a number of individual factors. The shape of the facial muscles, jawbone, and gum tissue in the mouth gradually changes with age, but a prosthesis does not. Dentures are made of a rigid material that cannot adapt to the physical changes that take place in the human body.

An incorrectly selected prosthesis can have very negative consequences. This can lead to faster bone atrophy and negatively affect the ability to eat, chew, bite and speak. In addition, both the prosthesis itself and the material of the prosthesis can wear out over time. Appearance, comfort, and overall health deteriorate the longer a patient delays replacing a denture.

The presence of a large number of publications on the improvement of the clinical and laboratory stages of the manufacture of complete removable dentures, the variety of proposals and methods indicate the difficulty and unresolved problem. Thus, the study of issues related to the modern approach to the timing of the use of submersible removable dentures seems relevant to us. (Kamenev V.V. The duration of the process of washing out the residual monomer // Abstracts of the reports of the II All-Russian Congress of Dentists. M., 1970. - P. 111); (N.G. Abolmasov, N.N. Abolmasov, V.A. Bychkov, A. Al-Khakim. Orthopedic dentistry. M.: MEDpressinform, 2003, pp. 366-371).

When restoring with removable dentures, there are different approaches to assessing the quality of dentures and determining their expiration dates. One of the important criteria for assessing the full functioning of the dentition in the presence of a removable prosthesis is the assessment of the functional state of the masticatory muscles.

We propose to evaluate the effect of the prosthesis on the functional state of the masticatory muscles during the manufacture of a removable prosthesis.

The closest in technical essence and the achieved result is a method for diagnosing the functional state of the muscular-articular complex of the temporomandibular joint in the presence of a removable prosthesis, including control of mechanical irritation of the oral mucosa as a result of using the prosthesis and monitoring the state of occlusions and the absence of limitation of the functional ability of the prosthesis (" National Leadership" edited by Prof. I.Yu. Lebedenko, Prof. S.D. Arutyunov, Prof. A.N. Ryakhovsky, Moscow; GEOTAR-Media Publishing Group, 2016, pp. 406-407).

The disadvantages of this method is the insufficiently high accuracy of diagnosis, which does not allow timely detection of functional disorders of the masticatory muscles, which in turn can lead to dysfunction of the musculo-articular complex of the temporomandibular joint.

The technical result to which the present invention is directed is to increase the accuracy of diagnosis and prevention of complications by reducing the risk of functional disorders from the muscular-articular complex of the temporomandibular joint when using removable prostheses.

The specified technical result is achieved by the fact that in the method for preventing dysfunction of the muscular-articular complex of the temporomandibular joint in the presence of a removable prosthesis, including the control of mechanical irritation of the oral mucosa as a result of using the prosthesis and the control of the state of occlusions and the absence of limitation of the functional ability of the prosthesis, according to the invention, a removable prosthesis is made taking into account the assessment of the functional state of the masticatory muscles by surface electromyography (EMG), while the asymmetry of the amplitude of the biopotential of the right and left sides with the prosthesis should be within the physiological norm from 0 to 20%, the patient is recommended a preventive examination and re-examination after a year; upon re-examination, provided that the prosthesis is in good condition and there are no complaints, the functional state of the masticatory muscles is re-evaluated using EMG, first at rest without a prosthesis in the oral cavity, and then an EMG is performed with a prosthesis, when comparing the obtained electromyograms, the presence or absence of changes is taken into account rest amplitudes in the form of asymmetry of the right and left sides, while the manifestation of asymmetry from 21% to 50% is regarded as an average degree of severity of dysfunction, and the presence of asymmetry of more than 50% - as a high degree of violations, moreover, if asymmetry is above the limits of the physiological norm, it is present at EMG without a prosthesis in the oral cavity, and is preserved in the presence of a prosthesis, an additional examination of the muscular-articular complex of the temporomandibular joint (TMJ) and further treatment according to indications are recommended; when there is no asymmetry above the physiological norm without a prosthesis, but occurs when the prosthesis is inserted into the oral cavity, it is recommended to make a new prosthesis, and if the asymmetry is above 50%, it is necessary to conduct an additional examination of the musculo-articular complex of the temporomandibular joint before making a new removable prosthesis; and when, with the introduction of the prosthesis, the asymmetry is within the physiological norm or decreases, if its values without the prosthesis were above the limits of the physiological norm, it is recommended to continue using this prosthesis with subsequent control after a year.

The temporomandibular joint belongs to the muscular type joints (incongruent), thus, the functional state of the muscular-articular complex is determined by the functional state of the muscles that provide movement in the joint.

Taking into account the pathogenetic substantiation of the treatment and diagnostic algorithm in patients with the syndrome of pain dysfunction of the temporomandibular joint (Lopushanskaya, T.A. Pathogenetic substantiation of the treatment and diagnostic algorithm in patients with the syndrome of pain dysfunction of the temporomandibular joint: thesis ... Dr. med. Sciences: 14.01.14 / Lopushanskaya Tatyana Alekseevna. - Belgorod, 2019. - P. 62-63.) we conducted a study and identification of the physiological norm and severity of the asymmetry of the temporomandibular joint.

In an electromyographic study of masticatory muscles in dental patients, it is necessary to take into account the symmetry of the amplitude of the biopotential of the right and left sides. The presence of asymmetry is a sign of pathological conditions characteristic of functional disorders. However, absolute symmetry is extremely rare. When conducting surface electromyography in 370 dental patients, we found that with asymmetry of the right and left sides from 0 to 20%, most patients (97%) had resting tonic activity - low-amplitude (5-10 μV) unstable activity recorded at rest normal (Fig. 1. Resting tonic activity).

In those cases when the asymmetry ranged from 21% to 50% in most patients (77%), pathological phenomena were detected in the form of short-term single bursts - spontaneous bioelectrical activity recorded at rest with an average frequency of 2-6 per 1 second, due to involuntary activation of motor neurons or myofibrils; associated with a decrease in inhibitory interneuronal influences stomatogenically induced (Fig. 2. Short-term single bursts).

And in 21% of patients, pathological phenomena were detected in the form of bioelectric silence - an isoelectric line, indicating the absence of bioelectric activity of the muscle when examining the neuromotor apparatus in rest mode, reflects the presence of a degenerative process in the neuromotor apparatus (Fig. H. Bioelectric silence), which corresponds to a more severe pathology, and only in 2% of cases there was a low-amplitude resting tonic activity corresponding to the normal functional state of the muscles.

At the same time, in patients with asymmetry exceeding 50%, in 81% of cases, the previously described pathological phenomena were detected in the form of bioelectric silence (Figure 3) and in 19% of cases in the form of short-term single bursts (Figure 2). Thus, we found that as the asymmetry of the biopotential of the right and left sides increases, functional disorders in the masticatory muscles increase.

Based on the foregoing, when analyzing electromyograms, the presence of asymmetry within 20% was regarded by us as a variant of the physiological norm. Asymmetries between 21% and 50% were considered medium asymmetries, while more than 50% were considered high asymmetries. At the same time, the degree of asymmetry correlates with the severity of functional disorders in the masticatory muscles.

A method for preventing dysfunction of the muscular-articular complex of the temporomandibular joint in the presence of a removable prosthesis is carried out as follows:

A removable prosthesis is made taking into account the assessment of the functional state of the masticatory muscles by surface electromyography (EMG), while the asymmetry of the amplitude of the biopotential of the right and left sides with the prosthesis should be within the physiological norm from 0 to 20%. The patient is recommended a preventive examination and re-examination after a year. During a re-examination, provided that the prosthesis, the oral mucosa are in good condition and there are no complaints, the functional state of the masticatory muscles is re-evaluated using EMG, first at rest without a prosthesis in the oral cavity, and then an EMG is performed with the prosthesis. When comparing the obtained EMG, the presence or absence of changes in the amplitude of rest in the form of asymmetry of the right and left sides is taken into account. The manifestation of asymmetry from 21% to 50% is regarded as an average degree of severity of dysfunction, and the presence of asymmetry of more than 50% - as a high degree of impairment. If asymmetry above the physiological norm is present with EMG without a prosthesis in the oral cavity, and persists with a prosthesis, an additional examination of the musculo-articular complex of the temporomandibular joint (TMJ) and further treatment according to indications are recommended; when there is no asymmetry above the physiological norm without a prosthesis, but occurs when the prosthesis is inserted into the oral cavity, it is recommended to make a new prosthesis, and if the asymmetry is above 50%, it is necessary to conduct an additional examination of the musculo-articular complex of the temporomandibular joint before making a new removable prosthesis.

When, with the introduction of the prosthesis, the asymmetry is within the physiological norm or decreases, if its values without the prosthesis were above the limits of the physiological norm, it is recommended to continue using this prosthesis with subsequent control after a year.

The method is illustrated by examples of its specific implementation.

Example 1

Patient N., 48 years old, complained of inconvenience of chewing, absence of teeth. Objectively: a class II dentition defect according to Kennedy's classification (molars and the first premolar on the lower jaw on the right are missing: 45; 46; 47; 48 teeth), which leads to forced unilateral chewing on the left. History of gastritis, hypertension.

Diagnosis: K08.1 - loss of teeth due to accident, extraction or localized periodontitis

Treatment: it is recommended to make a partial removable denture for the lower jaw. Before the introduction of a partial removable denture into the oral cavity, surface electromyography of the masticatory muscles was performed. According to the results of electromyography, an asymmetry in the amplitude of the biopotential of the right and left sides of 37% was revealed. After fitting a partial removable denture and conducting repeated electromyography, asymmetry of the left and right sides of 16% was recorded, which is within the physiological form. Recommendations on the use of the prosthesis are given. Preventive examination and re-examination in a year are recommended.

A year after the use of the prosthesis, a clinical examination was carried out, including control of mechanical irritation of the oral mucosa as a result of using the prosthesis and control of the state of occlusions and the absence of limitation of the functional ability of the prosthesis. There are no complaints. Repeated electromyography of masticatory muscles was performed in the absence and presence of a prosthesis in the oral cavity. In the absence of a prosthesis in the cavity, the asymmetry was 35%, and in the presence of a prosthesis, 14%. It is recommended to continue using the prosthesis and, in the absence of complaints, an examination after a year.

Example 2

Patient C, 46 years old, complained of inconvenience of chewing, lack of teeth. Objectively: a class II dentition defect according to Kennedy's classification (molars and the first premolar on the left upper jaw are missing: 25; 26; 27; 28 teeth), which leads to forced unilateral chewing on the left. She has a history of gastritis, osteochondrosis of the cervical spine.

Diagnosis: K08.1 - loss of teeth due to accident, extraction or localized periodontitis

Treatment: it is recommended to make a partial removable denture for the upper jaw. Before the introduction of a partial removable denture into the oral cavity, surface electromyography of the masticatory muscles was performed. According to the results of electromyography, an asymmetry in the amplitude of the biopotential of the right and left sides of 43% was revealed. After fitting a partial removable denture and conducting repeated electromyography, an asymmetry of the left and right sides of 18% was recorded, which is within the physiological form. Recommendations on the use of the prosthesis are given. Preventive examination and re-examination in a year are recommended.

A year after the use of the prosthesis, a clinical examination was carried out, there were no complaints. The patient notes an exacerbation of osteochondrosis of the cervical spine. Repeated electromyography of masticatory muscles was performed in the absence and presence of a prosthesis in the oral cavity. In the absence of a prosthesis in the cavity, the asymmetry was 52%, and in the presence of a prosthesis, 17%. Thus, the asymmetry of the biopotential of the masticatory muscles is due to the exacerbation of osteochondrosis of the cervical spine. Recommended treatment of cervical osteochondrosis, further use of the prosthesis and, in the absence of complaints, examination after a year. Example 3

Patient M., aged 50, complained of inconvenience of chewing, lack of teeth. Objectively: a class II dentition defect according to Kennedy's classification (molars and the first premolar on the lower jaw on the left are missing: 35; 36; 37; 38 teeth), which leads to forced unilateral chewing on the left. History of gastritis, type II diabetes.

Diagnosis: K08.1 - loss of teeth due to accident, extraction or localized periodontitis

Treatment: it is recommended to make a partial removable denture for the lower jaw. Before the introduction of a partial removable denture into the oral cavity, surface electromyography of the masticatory muscles was performed. According to the results of electromyography, an asymmetry in the amplitude of the biopotential of the right and left sides of 39% was revealed. After fitting a partial removable denture and conducting repeated electromyography, asymmetry of the left and right sides of 20% was recorded, which is within the physiological form. Recommendations on the use of the prosthesis are given. Preventive examination and re-examination in a year are recommended.

A year after the use of the prosthesis, a clinical examination was carried out, there were no complaints. Repeated electromyography of masticatory muscles was performed in the absence and presence of a prosthesis in the oral cavity. In the absence of a prosthesis in the cavity, the asymmetry was 37%, and in the presence of a prosthesis, 51%. Thus, the asymmetry of the biopotential of the masticatory muscles is due to an inferior removable prosthesis. It is recommended to make a new removable prosthesis. Example 4

Patient S., 57 years old, complained of inconvenience of chewing, lack of teeth. Objectively: complete absence of teeth in the upper jaw and a defect in the Kennedy class I dentition in the lower jaw (molars and first premolars in the lower jaw are missing on both sides: 35; 36; 37; 38; 45; 46; 47; 48 teeth). History of gastritis, hypertension.

Diagnosis: K08.1 - loss of teeth due to accident, extraction or localized periodontitis

Treatment: it is recommended to make a complete removable denture for the upper jaw and a partial removable denture for the lower jaw. Before the introduction of removable dentures into the oral cavity, surface electromyography of the masticatory muscles was performed. According to the results of electromyography, an asymmetry in the amplitude of the biopotential of the right and left sides of 27% was revealed. After the fitting of removable dentures and repeated electromyography, asymmetry of the left and right sides of 14% was recorded, which is within the physiological form. Recommendations on the use of prostheses are given. Preventive examination and re-examination in a year are recommended.

A year after the use of the prosthesis, a clinical examination was carried out, there were no complaints. Repeated electromyography of masticatory muscles was performed in the absence and presence of prostheses in the oral cavity. In the absence of a prosthesis in the cavity, the asymmetry was 25%, and in the presence of prostheses, 12%. Thus, the asymmetry of the biopotential of the masticatory muscles without prostheses is due to the absence of antagonistic pairs of teeth that cause functional overload of the masticatory muscles, while the introduction of removable dentures into the oral cavity optimizes occlusal relationships, eliminates muscle overload and reduces the asymmetry of the biopotential of the masticatory muscles to 12%, which is within the limits physiological norm. It is recommended to continue using the prosthesis and, in the absence of complaints, an examination after a year.

Thus, the use of the proposed method for preventing dysfunction of the musculo-articular complex of the temporomandibular joint in the presence of a removable prosthesis makes it possible to improve the accuracy of diagnosis and prevention of complications by reducing the risk of functional disorders of the musculo-articular complex of the temporomandibular joint when using removable dentures.

Claims (1)

A method for preventing dysfunction of the muscular-articular complex of the temporomandibular joint in the presence of a removable prosthesis, including control of mechanical irritation of the oral mucosa as a result of using the prosthesis and monitoring the state of occlusions and the absence of limitation of the functional ability of the prosthesis, characterized in that the removable prosthesis is made taking into account the assessment of the functional the state of the masticatory muscles by surface electromyography (EMG), while the asymmetry of the amplitude of the biopotential of the right and left sides with the prosthesis should be within the physiological norm from 0 to 20%, the patient is recommended a preventive examination and re-examination after a year; upon re-examination, provided that the prosthesis is in good condition and there are no complaints, the functional state of the masticatory muscles is re-evaluated using EMG, first at rest without a prosthesis in the oral cavity, and then an EMG is performed with a prosthesis, when comparing the obtained electromyograms, the presence or absence of changes is taken into account rest amplitudes in the form of asymmetry of the right and left sides, while the manifestation of asymmetry from 21% to 50% is regarded as an average degree of severity of dysfunction, and the presence of asymmetry of more than 50% - as a high degree of violations, moreover, if asymmetry is above the limits of the physiological norm, it is present at EMG without a prosthesis in the oral cavity and is preserved in the presence of a prosthesis, an additional examination of the muscular-articular complex of the temporomandibular joint (TMJ) and further treatment according to indications are recommended; when there is no asymmetry above the physiological norm without a prosthesis, but occurs when the prosthesis is inserted into the oral cavity, it is recommended to make a new prosthesis, and with asymmetry above 50%, it is necessary to conduct an additional examination of the musculo-articular complex of the temporomandibular joint before making a new removable prosthesis; and when, with the introduction of the prosthesis, the asymmetry is within the physiological norm or decreases, if its values without the prosthesis were above the physiological norm, it is recommended to continue using this prosthesis with subsequent control after a year.

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