Ozhohan R. Clinical justification of the modified methods of diagnosis and treatment at patients with dentition defects combined with function of disorders of the TMJ

At this dissertation we have proposed and clinically substantiated an algorithm of examination and treatment patients with dentition defects, complicated with dental deformations and TMJ disorders. This algorithm is based on the analysis of occlusal relations, application of the individual approach to each patient, the usage of modern articulation system (condylography) and 3D digital technologies, application of the proposed by us individual tire caps and orthopedic rehabilitation with modern fixed aesthetic non-removable dentures at the final stage of our complex treatment. The proposed design of the tire-cap is designed digitally. The method of its manufacture allows us to individualize its thickness depending on the condition and position of the articular heads of the TMJ and localization of dentition defects in the distal or frontal areas, on one or both sides of the dentition, carrying out its gradual raising of bite height and achieving high aesthetic results of orthopedic treatment at the same time. We have examined and treated 160 patients among whom we have indicated 110 patients with TMJ disorders complicated with the manifestations of joint dysfunction. We have found that at patients of 2nd and 3rd groups with TMJ dysfunction the most typical complaints before treatment were: pain at the area of TMJ, which was indicated at 91.7% of patients, long-term disease was indicated at 79.2% of patients, pain during mandible movements - 72.5%, pain during wide mouth opening was observed in 77.5%, feeling of tightness and pain in the area of masticatory muscles was observed in 68.3% of patients. Objective inspection before treatment has established in 53.3% periodic stiffness and restriction of the mandible movements in the evening; 36.7% of patients had S-shaped lowering of the mandible; 35.0% of patients had limited sagittal movements of the lower jaw; 31.7% had blocked transverse lower jaw movements. After 6 and 12 month of the proposed complex treatment, we have established that indicators of vertical, protrusion and sagittal movements of the articular heads at patients of 3rd group became significantly better than before treatment and from the indicators at patients of 2nd group who received conventional treatment. During the analysis of transverse movements of the mandible at patients of 3rd after the usage of the proposed tire-cap we have admitted the significantly increasing of all these parameters (p <0,05) and in next 6 and 12 months after permanent orthopedic treatment we can note stabilization and improvement of these indicators in comparison with previous terms and with indicators of patients at 2nd group. Moreover, there is a significant improvement of the periodontitis indices: RI, PMA, Silness-Loe and RVI, the results of which indicate the advantages of the proposed by us algorithm over conventional methods of treatment. Key words: dentition defects, functional disorders of the temporomandibular joint, tire-cap, condylography, 3D scanner. Branch – medicine.