Malynovskyi V. Prevention of occlusive disorders in prosthetic treatment of generalized periodontitis

In the first stage of the study, based on the results of a survey of 237 patients with varying degrees of severity of generalized periodontitis, 37-62 years of age, who received prosthetic treatment in the period from 1 to 3 years, unsatisfactory results were established in 43.0 ± 3.2% of patients. Ineffective treatment led to a decrease in the quality of life to unsatisfactory in 31.6 ± 3.0% of cases. Subsequently, in the second stage of the work, according to the results of comparative clinical and radiological evaluation of periodontal tissues in 128 patients with generalized periodontitis I-II degree of severity, age 35-55 years, it was established that the course of the disease in the background of acceptable occlusive imbalance is almost not differed from the periodontal status of patients, in cases of established occlusion equilibrium (p < 0.05), whereas for patients with diagnosed occlusive imbalance, a significantly worse result was obtained. The presence of occlusive imbalance in patients with generalized periodontitis was characterized by increased activity of tartrate-resistant acid phosphatase (TRAP) in serum and increased concentration of β-CrossLaps in urine (p < 0.05), indicating an increase in resorptive processes in the bone tissue. At the same time, the level of bone formation markers such as osteocalcin and bone alkaline phosphatase (BAR) in serum as well as the concentration of C-terminal procollagen type I (CICP) in blood plasma in patients with generalized periodontitis with diagnosed occlusive imbalance decreased in comparison with cases where the occlusive equilibrium was diagnosed (p <0.05). The occlusal imbalance leads to changes in microbiota of periodontal tissues that consist in reducing the intensity of colonization of periodontal protective microorganisms and increasing the number of colonies conditionally pathogenic microorganisms (p < 0.05). According clinical testing among 60 patients, optimization of the preparation of supporting teeth under non-removable casted splints in patients with generalized periodontitis allowed to achieve a more significant improvement in the state of periodontal tissues in the remote term after orthopedic treatment based on the results of an index assessment (p < 0.05), according to the X-ray examination, according to which the index of osteoporosis activity decreased to 7.18 ± 0.14 points versus 7.60 ± 0.16 points – for comparison group (p < 0.05), as well as according to the results of computerized occlusion diagnosis, which allowed to register the preservation of occlusion equilibrium in 90.0 ± 5.5% of patients in the main group and only in 66.7 ± 8.6% – in the group of comparison (p < 0.05).