Brodetska L. Multidisciplinary approach to the treatment of patients with impacted teeth

This thesis is devoted to the relevant problem of multidisciplinary approach to the treatment of patients with impacted teeth and a lack of room in dentition. The review of scientific literature made is evident of the necessity to develop objective criteria of differential diagnostics of spatial arrangement of an impacted tooth and making optimal conditions for its eruption. The development of the therapeutic measures’ complex for patients with IT depending on the occlusion period involving profound study of clinical-roentgenological characteristics of IT and cellular-molecular mechanisms of IT eruption as well as mechanical- mathematical substantiation of IT migration peculiarities at various stages using individual compilation of elastic tractions is still up-to-date these days if to take into account the complicated and multicomponent cascade of changes which occur in dental-maxillary system in case of dental eruption impairment. The goal of this work is to enhance the effectiveness of orthodontic treatment of IT having not enough room in dentition applying a multidisciplinary rationale of diagnostic-therapeutic modes based on the analysis of molecular mechanisms of osseous remodeling impairment of dental eruption processes; determination of IT spatial location and differential application of orthodontic efforts depending upon the type of bite and IT displacement stage. Investigation assignment: 1. To make analysis of the prevalence and structure of IT accompanied by insufficient room in dental arch in case of mixed and permanent occlusion. 2. To identify clinical-radiological features of IT in mixed and permanent periods of occlusion for further design of a diagnostic algorithm based on the major assessment criteria. 3. To evaluate changes of osseous remodeling in patients within the area of impacted tooth through the study of RANKL/RANK/OPG signaling method. 4. To study NF-κB-signaling state as an apoptosis trigger of osseous tissue in the area of impacted tooth. 5. To determine the volume and the way of orthodontic forces application to IT having not enough room in dentition depending on its group identity, the stage of dental derivation on the basis of mechanical-mathematical modeling of a deformed solid body. 6. To devise and evaluate the efficacy of the suggested differentiated multidisciplinary complex of diagnostic-therapeutic techniques depending on the clinical–radiological peculiarities of IT, occlusion period and dental extrusion stage. The study was carried out following the latest principles of bioethics and evidentiary medicine in accordance with the guidelines of adequate clinical practice and particular significance to confidentiality demands. Overall, 109 patients with IT participated in the research resulting from the lack of room in dentition in mixed and permanent occlusion. The patients were carried out a clinical-radiological study in mixed occlusion (n=62) to define spatial position of IT and orthodontic treatment using removable appliances followed by the therapeutic dental support.