The dissertation presents a new approach for complex treatment and rehabilitation of dental patients, considering clinical and laboratory argumentation of differentiated choice among various methods of therapeutic, prosthetic and surgical iatrogenic interventions due to the prognostic assessment of patient-oriented criteria.
As a result of the dissertation research the significance of relative risk levels regarding biological and biomechanical complications development under the conditions of providing classical dental manipulations was statistically substantiated and stratified. Approaches and mechanisms for optimization of such were presented by implementation of minimally invasive interventions and choice of rehabilitation options based on the specific conditions of each individual clinical situation. According to the obtained data, complex prognostic models for the minimally invasive treatment protocols effectiveness were structured, taking into account not only the components of biological and biomechanical prognosis, but also the financial feasibility of the interventions by recalculation the potential summed amount of labor intensity units upon the established levels of complications’ relative risk.
Algorithms for the implementation of digital diagnostic methods with the aim of objectifying and optimizing the amount of directed hard tissues reduction during the prosthetic treatment of dental patients with selection of different types of fixed prosthetic restorations were proposed.
During the statistical analysis of the data it was noted that the minimization of hard dental tissues reduction during the implementation of mini-invasive preparation protocols was characterized by a non-linear decrease regarding the relative risk of complications in cases of porcelain fused to metal restorations to the level of RR = 2,181 (95% CI: 1,834-2,654, p = 0,0443), in the cases of all-ceramic restorations to the level of RR = 1,425 (95% CI: 1,357-2,431, p = 0,0812), in the cases of all-zirconium restorations to the level of RR = 1,583 (95% CI: 1,361-2,499, p = 0, 0714), in the cases of all-ceramic veneers to the level of RR = 0,585 (95% CI: 0,436-0,735, p = 0,231), in the cases of partial ceramic crowns to the level of RR = 0,775 (95% CI: 0,595-1,011, p = 0,120)
The set of clinical, economical and prognostic criteria for the choice of dental implantation method as a subspecies of minimally invasive patient-oriented treatment option among patients with burdened periodontal status was systematized. Also, algorithm of adjuvant antibiotic therapy during the course of periodontal treatment was structured, while considering possibilities for providing in-detail analysis of antibiotic sensitivity
Systematization and processing of the obtained numerical results allowed to state the fact of statistically confirmed increase of relative risk for loss of periodontally compromised teeth under conditions of initial periodontal status parameters deterioration, among which role of periodontal pockets depth (p = 0,05), level of surrounding bone tissue (p = 0,05) and the level of connective tissue attachment (p = 0.05) in the perspective of 1-year, 3-year and 5-year monitoring periods respectively were statistically approved.
It was proved that supportive periodontal therapy with a multiplicity of 3-4 times per year associated with changes of Δ OHIP-14 in the range of 14,56 ± 8,22 conventional units, based on which an additional period of function could reach 8,55 ± 4,28 years for periodontally-compromised, but stabilized tooth under conditions of maximum efficiency of provided iatrogenic interventions. Such outcome is critical in terms of the potential prospect for replacement of periodontally compromised teeth with prosthetic restoration supported by dental implants, which in turn are characterized by an additional period functioning in terms of the quality of life of patients depending on changes of dental status at the level of 14,42 ± 9,04 additional years after 1 year of monitoring, 10,64 ± 8,59 additional years after 3 years of monitoring, and 8,96 ± 6,93 additional years after 5 years of monitoring.
