Ponomarenko V. Clinical and pathogenetic features of implantation treatment of secondary edentulism in patients of senile age

The thesis provides the solution of a relevant issue of modern medicine, namely, increasing the efficiency of treatment of patients with complete secondary anodontia of the mandible with non-removable implant-supported structures. The main achievement of the research is as follows: on the basis of clinical, laboratory studies and mathematical modeling of the stress-strain state of the system, a complete non-removable lamellar prosthesis – dental implant for the mandible – treatment of complete secondary anodontia of the lower jaw in elderly and senile patients has been improved and substantiated with non-removable orthopedic construction on implants. The method of determining the state of supporting tissues in prosthetics of complete secondary anodontia of the mandible with a non-removable prosthesis using implants in elderly and senile patients has been developed (Patent for utility model No. 117449). Indications and contraindications to the proposed method of treatment for elderly and senile patients with complete secondary anodontia have been improved. Prognosis and prophylaxis of complications during prosthetics and using non-removable dentures on implants in elderly and senile patients have been confirmed on the basis of the developed mathematical model and clinical and laboratory examination of patients. The immediate and long-term results of treatment in patients with complete secondary anodontia have been traced; the analysis of the results was carried out, which made it possible to conduct orthopedic treatment in disintegration of one of the distal implants. The orthopedic protocol for treatment of elderly patients with toothless lower jaws has been improved on the basis of clinical and laboratory parameters of individual links in homeostasis of the oral cavity and the developed mathematical model at four and three implants, taking into account the compliance of the mucous membrane and using the amortization abutments. The individual links in the pathogenesis of complications that may arise in prosthetics with orthopedic constructions in elderly and senile patients on implants have been studied. Based on the results of electromyography, mastication efficacy and clinical evaluation of tissues of the prosthetic bed, high efficiency of the developed treatment has been proved, especially in case of disintegration of one distal implant. As a result of the research, the expediency of using amortization abutments in highlycompliant mucous membrane has been proved, and especially with disintegration of one of distal implants. The results of the study will help to successfully address the issues of planning and treatment for patients with secondary anodontia using endosseus implants. Examination and dynamic observation of elderly patients in need of orthopedic treatment have been conducted, including clinical and instrumental methods of study before and after endosseus implantation in the immediate and long-term follow-up periods, which enabled us to develop a set of prophylactic measures to prevent complications in the tissues of the prosthetic bed, to clarify the indications for the proposed method of treatment. The clinical and laboratory examination of thirty two elderly patients with complete secondary anodontia of the mandible and the conducted implantation rehabilitation (delivering four implants, direct prosthetics with a temporary non-removable structure and its replacement with a permanent non-removable structure) revealed that due to the application of the developed treatment, disintegration of implants was not observed during the observation period. The developed treatment with the use of amortization abutments in highly compliant mucous membrane and disintegration of one of distal implants was achieved due to the mathematical justification of the possibility to reduce the functional load on implants and, correspondingly, the bone tissue, with a decrease in the possibility of implant disintegration. Fixation and stabilization of prostheses, as well as the restored chewing function satisfied all patients under examination.