Clinical Justification of the Proposed Methods of Permanent Prosthetics for Patients With Defects of Hard Tissues and Dental Row
Year: 2025
Type: article
Abstract: Background. The issue of aesthetic requirements for prosthetic structures, especially in the frontal area, is currently relevant for patients. Modern structural materials such as zirconium dioxide and pressable ceramics are widely used in patients with hard tissue defects and dentition defects. However, it is necessary to develop clear indications for the use of constructions based on pressable ceramics, zirconium dioxide, an individual approach to patients, taking into account the state of the periodontium of the teeth and the state of soft tissues, especially the gums, marginal periodontium and interdental papillae. The purpose of the work is to develop criteria and indications and to clinically substantiate the proposed methods of aesthetic orthopedic treatment with metal-free aesthetic constructions of dental prostheses. Мaterial and methods. An objective examination of patients was conducted, who were divided into the following clinical groups: 1 patients with aesthetic defects of the hard tissues of the teeth, who were treated with commonly accepted methods of manufacturing constructions based on zirconium dioxide during orthopedic treatment (15 patients), 2 patients with aesthetic defects of the hard tissues of the teeth, who underwent examination and orthopedic treatment with metal-free structures according to the proposed methods based on zirconium dioxide (15 patients) , 3 – patients with aesthetic defects of the hard tissues of the teeth, who were treated with conventional metal-ceramic structures during orthopedic treatment (30 patients). Observation periods: before treatment, 3, 6 and 12 months after treatment. The condition of the hard tissues of the teeth were studied: condition of periodontal tissues, color of tooth stump, type of bite, analysis of diagnostic models, the state of oral hygiene using the indices of Sillness-Low, PMA, bleeding gums PBI. In order to evaluate metal-free restorations, clinical evaluation methods according to the USPHS (Ryge) criteria and statistical survey methods were applied. Results and discussion. The production of the proposed structures of artificial crowns from zirconium dioxide or pressable ceramic consists in taking into account the state of the interdental space in the area of the connection of adjacent crowns or at the contacts "artificial crown artificial crown", "artificial crown tooth". At the same time, the preparation of the contact surfaces of the adjacent teeth, which will be joined by crowns, is carried out in a differentiated manner, namely, the contact surfaces of the adjacent teeth are prepared to the minimum thickness of the material, and the edge of the crown should deepen under the gums by 0.1-0.2 mm. The shape of the interdental contact of the crowns is individually modeled and repeats the shape of the interdental space while preserving the space for the gingival papilla. During the clinical evaluation of the proposed artificial crown structures based on the USPHS Ryge criteria, we established that in patients of groups 1 and 2, the marginal adaptation criterion "A" was 100.0%. However, in patients of group 3 with metal-ceramic structures, the "A" indicator was 90.0%. Sensitivity after orthopedic treatment was absent in all patients of groups 1 and 2 (100.0%), and the color correspondence and transparency according to criterion A in these patients was also 100.0%. It was clinically established that the patients of groups 1 and 2 have a marginal periodontal condition without an inflammatory process, gums are pale pink in color, and the gums do not bleed. The indicators of RVI and Sillness-Low indices in patients of group 2 practically remain at the same level after prosthetics, and it was established that they significantly worsened to (0.58±0.05) and (0.56±0.08) points in patients of group 3 after 12 months. Conclusions. The technique proposed by us consists in the fact that the preparation of hard tooth tissues for artificial crowns is carried out differently, depending on the area and depth of the interdental space, and the modeling of the crowns is carried out individually, taking into account the depth and space for the formation of the interdental papilla. In order to preserve the gingival margin and the gingival papilla between the teeth, we suggested leaving a minimal space in the interdental space of the connected crowns to prevent chronic traumatization and the development of the inflammatory process in the tissues of the interdental papilla. During the clinical evaluation of the proposed artificial crown constructions based on the USPHS Ryge criteria, we obtained the best results: (100.0%) in the 2nd group of patients who were made artificial crowns based on zirconium dioxide according to the proposed method, and who received criterion A according to all comprehensive indicators of the assessment of orthopedic treatment. In 10.0% of patients of group 3, a color discrepancy was detected in the cervical region according to criterion B. In patients of group 2, who underwent orthopedic treatment with non-removable structures based on zirconium dioxide according to the proposed method, indicators of RVI and Sillness-Low indices after 12 months remain at the level after prosthetics, however, they reliably worsen during this period in patients of group 3.
Source: Ukrainian Dental Almanac
Authors: P.Z. Ozhohan, М.Z. Ozhohan-Shumilova
Institution: Ivano-Frankivsk National Medical University
Language: English
Subfield: Orthodontics
Field: Dentistry
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4408953270