Shtepa V. O. Optimization of occlusal correction measures based on postural reflexes. – Qualifying scientific work on the manuscript. Thesis for the degree of Doctor of Philosophy in the field 22 – Medical Care, in specialty 221 – Stomatology. – State Institution "Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine", Dnipro, 2020. According to the results of the survey of 300 persons aged 25-44 years, it was established a significant prevalence of occlusive disorders in the form of the functional overload focuses and premature interdental contacts. Comprehensive analysis of occlusion by parameters of the state of the centric and eccentric occlusion, the sequence of formation of the vector of maximum occlusion load, the balance of occlusion and the time of closing and opening of dentitions allowed to define the presence of occlusive disorders in 14.0% of persons with intact dentitions, in 35.0% – in the presence of direct restorations of occlusive surfaces and in 44.0 % – in the restoration of dentitions with non-removable dentures of small sizes. At the same time, 100% of patients had occlusive disorders and asymptomatic course.
As a result of studying the ratio of occlusive and postural balances among 30 people under the age of 45, on a par with men and women, with intact dentitions, orthognatic bite, which had no clinically expressed signs of occlusive imbalance, it was established that the position of the head affects the distribution of occlusive contacts (p < 0.05). For different positions of the head primary interdental contact was significantly different (p < 0.05).
According to the results of computer-based stabilometry among 60 people aged 25 to 44 years, it was found that patients who, according to computer analysis diagnosed an occlusive imbalance exceeding 40%-60%, registered worse indicators of body stability in space (p<0.05). Between the indicators of occlusion balance and the results of the stabilometric study was set direct, average strength, dependence (r=0.41, p<0.05). Correlation rate was more pronounced in detected occlusion disorders (r=0.48, p<0.05) than in patients with normal occlusion contacts (r=0.34, p<0.05).
It was examined 270 patients, equally men and women, under 45 years of age, who had defects of crowns of teeth and dentitions, restored with fixed casted dentures, including combined ones. According to the results of clinical study, supplemented with computer diagnostics, in 67.4 % of patients, the restoration of the occlusal balance was confirmed. In these cases as a result of prosthetic treatment the data of computer stabilometry revealed a statistically significant decrease in the mean results of the deviation of the body from the centre of its mass (р ˂ 0.05). The sensitivity of the postural test was 64.3 ± 2.3 %. The specificity of this test for occlusal diagnostics was 83.0 ± 5.2 %. According to the calculations of the prognostic value of the test, the absence of its changes indicated that the occlusion imbalance was more likely than its dynamics as a proof of the occlusal balance. The accuracy of the postural test on the quality of the occlusal correction was 70.4 ± 2.8%. The relatively low values of the reproducibility index (59.4 ± 3.0%) indicated that, against the background of the high accuracy of the averaged result, the postural test data may vary significantly in different clinical situations.
As a clinical trial, it was performed prosthetic treatment of 30 patients under 45 years of age, equally men and women, who had defects of crowns of teeth and dentitions and occlusive imbalance, which exceeded 60% - 40% according to the computer diagnostics.
In the process of prosthetics of these patients, reduction of computer stabilometry indices was established. One-time occlusal correction with the splints did not improve the postural balance significantly (p > 0.05). However, the values of the stabilometric indices, which were obtained in the long term of observation after dental prosthetics, indicated the restructuring of postural reflexes due to the normalization of occlusion (р ˂ 0.05).
So, the obtained results allow us to recommend a postural test for clinical use as a control of the success of occlusal correction, in particular for fixed dental prosthetics in young people.
