Stomatologist № 2 (37) – 2020, pp. 20-31                                                                                                                            SCIENTIFIC PUBLICATION

New approaches in the complex treatment of dentoalveolar abnormalities in combination with temporomandibular joint dysfunction

Yu.L. Denisovaa, S.P. Rubnikovichb, I.N. Baradinac, A.S. Grishchenkovd

aMD, PhD, DMSci, Professor, Belarusian State Medical University, Minsk, Belarus
bMD, PhD, DMSci, Professor, Belarusian Medical Academy of Postgraduate Education, Minsk, Belarus
cMD, PhD, Associate Professor, Belarusian Medical Academy of Postgraduate Education, Minsk, Belarus
dMD, PhD, Belarusian Medical Academy of Postgraduate Education, Minsk, Belarus

https://doi.org/10.32993/stomatologist.2020.2(37).9

ABSTRACT
The aim of the study is to determine the efficiency of complex treatment of dentoalveolar abnormalities in combination with temporomandibular joint dysfunction using orthodontic, orthopedic and therapeutic treatment.
Objects and methods. The object of the study was 34 patients with skeletal asymmetry and dysfunction of the temporomandibular joint. The patients were divided into 2 groups. In the first group (15 patients), traditional combined orthodontic treatment and splint therapy were performed. In 19 patients of the second group, the proposed combined complex treatment (orthodontic, orthopedic, and therapeutic) was used with the use of digital diagnostic methods for analyzing the TMJ, occlusal plane, and masticatory muscles. The effectiveness of the integrated approach in the treatment of skeletal asymmetry and temporomandibular joint dysfunction was evaluated using clinical data (extra-oral and intra-oral aesthetic and functional parameters) and instrumental methods, including analysis of t-scan occlusal contacts, myography and conebeam computed tomography (CBCT).
Results and discussion. Indicators of objective tests of patients of the first group significantly differed from the second group, which indicated the absence of multiple fissuretubercle contacts between antagonist teeth and stable occlusion, as well as the preservation of increased muscle tone in the maxillofacial region throughout the entire period of observation (3 years). In long-term follow-up, pain dysfunction was observed in 7 (47%) patients of the first group. All patients of the second group had good efficiency of treatment for 6 keys of Andrews occlusion.
Conclusion. For the treatment of patients with skeletal asymmetry and dysfunction of the temporomandibular joint, a new complex of interdisciplinary treatment measures has been developed and clinically justified, including orthodontic treatment, digital planning, orthopedic and therapeutic treatment, which surpasses traditional methods of treatment in its effectiveness and allows significantly improving the functional and aesthetic state of the dental system, as well as reducing the risk of complications.

Keywords: skeletal asymmetry, temporomandibular joint dysfunction, orthodontic treatment, splint therapy

References

  1. Dedova L.N., Rubnikovich S.P., Denisova Ju.L., Kandrukevich O.V., Solomevich A.S., Rosenik N.I. Rasprostranennost’ stomatologicheskih zabolevanij v Respublike Belarus’ [The prevalence of dental diseases in the Republic of Belarus]. Stomatologija. Jestetika. Innovacii – Dentistry. Aesthetics. Innovation. 2017, no. 2, pp. 193–202.
  2. Rubnikovich S.P., Baradina I.N., Serdjuchenko N.S., Denisova Ju.L., Borodin D.M., Grishhenkov A.S. Diagnostika zabolevanij visochnonizhnecheljustnogo sustava [Diagnosis of diseases of the temporomandibular joint]. Minsk: Belaruskaja navuka, 2019. 189 p.
  3. Denisova Ju.L. Primenenie vakuum-UFO-terapii v kompleksnom lechenii pacientov s hronicheskim periodontitom v sochetanii s zubocheljustnymi deformacijami [The use of vacuum UV-therapy in the complex treatment of patients with chronic periodontitis in combination with dentofacial deformities]. Medicinskij zhurnal – Medical journal. 2012, no. 3 (41), pp. 46–49.
  4. Denisova Ju.L., Dedova L.N. Costojanie al’veoljarnoj kostnoj tkani pacientov s hronicheskim generalizovannym periodontitom (parodontitom) v sochetanii s zubocheljustnymi deformacijami [The condition of the alveolar bone tissue of patients with chronic generalized periodontitis (periodontitis) in combination with dentofacial deformities]. Parodontologija – Periodontology. 2012, vol. 17, no. 2 (63), pp. 41–44.
  5. Denisova Ju.L., Bazylev N.B., Rubnikovich S.P., Fomin N.A. Lazernye spekl-tehnologii v stomatologii. diagnostika naprjazhenij i deformacij tverdyh biotkanej, ortodonticheskih i ortopedicheskih konstrukcij [Speckle laser technology in dentistry. diagnostics of stresses and deformations of solid biological tissues, orthodontic and orthopedic structures]. Inzhenerno-fizicheskij zhurnal – Physics Engineering Journal. 2013, vol. 86, no. 4, pp. 882–893.
  6. Denisova Ju.L. Al’veoljarnyj indeks (AI) – novyj metod rentgenosteometrii v periodontologicheskoj praktike [Alveolar index (AI) – a new method of x-ray steometry in periodontological practice]. Stomatolog. Minsk – Stomatologist. Minsk. 2012, no. 3 (6), pp. 24–28.
  7. Rubnikovich S.P., Bazylev N.B., Lavinskaja E.I., Naumovich S.A., Fomin N.A. Lazernoe zondirovanie biotkanej metodami dinamicheskoj spekl-fotografii v kvazireal’nom vremeni [Laser probing of biological tissues using dynamic speckle photography in quasi-real time ]. Doklady Nacional’noj akademii nauk Belarusi. – Reports of the National Academy of NAS of Belarus. 2003, vol. 47, no. 4, 46 p.
  8. Rubnikovich S.P., Baradina I.N., Denisova Ju.L. Prognoz i lechenie pacientov s disfunkciej visochno-nizhnecheljustnyh sustavov [Prognosis and treatment of patients with temporomandibular joint dysfunction]. Voennaja medicina – Military medicine. 2015, no. 1 (34), pp. 47–52.
  9. Rubnikovich S.P. Primenenie cifrovoj dinamicheskoj spekl-anemometrii v diagnostiki poverhnostnogo krovotoka tkanej rotovoj polosti [The use of digital dynamic speckle anemometry in the diagnosis of surface blood flow in the tissues of the oral cavity]. Stomatologicheskij zhurnal – Dental Journal. 2007, no. 3, 26 p.
  10. Rubnikovich S.P. Lazerno-opticheskaja diagnostika boleznej periodonta i obosnovanie metodov ih lechenija [Laser-optical diagnosis of periodontal diseases and the rationale for their treatment]. Stomatolog. Minsk – Stomatologist. Minsk. 2012, no. 1 (4), pp. 15–19.
  11. Fomin N.A., Rubnikovich S.P., Bazylev N.B. Analiz naprjazhenno-deformacionnogo sostojanija kornja zuba, vosstanovlennogo litoj kul’tevoj shtiftovoj vkladkoj metodom cifrovoj spekl-fotografii [Analysis of the stress-strain state of a tooth root restored by a cast stump pin insert by the method of digital speckle photography]. Sovremennaja stomatologija – Modern dentistry. 2001, no. 3, 50 p.
  12. Bazulev N., Fomin N., Lavinskaya E., Mizukaki T., Takayama K., Hirano T., Nakagawa A., Rubnikovich S., Fuentes C., Martemianov S., Saulnier J.-B., Tuhault J.-L. Laser monitor for soft and hard biotissue analysis using dynamic speckle photography. Laser Physics, 2003, vol. 13, no. 5, pp. 786–795.
  13. Rubnikovich S.P. Primenenie cifrovoj dinamicheskoj spekl-anemometrii v diagnostiki poverhnostnogo krovotoka tkanej rotovoj polosti [The use of digital dynamic speckle anemometry in the diagnosis of surface blood flow in the tissues of the oral cavity]. Stomatologicheskij zhurnal.– Dental Journal. 2007, no. 3, pp. 26.
  14. Fomin N., Hirano T., Bazylev N., Rubnikovich S., Lavinskaya E., Mizukaki T., Nakagawa A., Takayama K. Quasi-Real Time Bio-Tissues Monitoring using Dynamic Laser Speckle Photography. Journal of Visualization, 2003, vol. 6, no. 4, pp. 371–380.
  15. Rubnikovich S.P., Baradina I.N., Denisova Ju.L., Borodin D.M. Diagnosticheskie meroprijatija pri bruksizme v sochetanii s disfunkciej visochno-nizhnecheljustnyh sustavov i stiraemost’ju zubov [Diagnostic measures for bruxism in combination with temporomandibular joint dysfunction and tooth abrasion]. Stomatolog. Minsk – Stomatologist. Minsk. 2018, vol. 29, no. 2, pp. 52–61.
  16. Rubnikovich S.P., Baradina I.N., Denisova Ju.L., Borodin D.M. Lechebnye meroprijatija, sodejstvujushhie vosstanovitel’nym processam zubocheljustnoj sisteme u pacientov s bruksizmom [Therapeutic measures that promote restoration of the dentition in patients with bruxism]. Stomatologija. Jestetika. Innovacii – Dentistry Aesthetics. Innovation. 2018, vol. 1, no. 3, pp. 306–316.
  17. Rubnikovich S.P., Borodin D.M., Denisova Ju.L., Baradina I.N. Osobennosti diagnosticheskih meroprijatij pacientov s disfunkciej visochnonizhnecheljustnyh sustavov i priznakami bruksizma [Features of diagnostic measures for patients with temporomandibular joint dysfunction and signs of bruxism]. Bulletin Kubanskij nauchnyj medicinskij vestnik – Kuban Scientific Medical. 2018, vol. 25, no. 5, pp. 77–82.

Correspondence to:  E-mail: denisova_yul@mail.ru