[The characteristics of the design and use of metal ceramic dentures in patients with maxillodental anomalies and dentition deformities].
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Biomedical subjects
Publications and source records attributed to Kh A Kalamkarov.
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A total of 868 patients aged 25 to 68 with various types of occlusion and dentition defects were examined. 212 (24.4%) patients presented with a shortened interalveolar distance (height of occlusion). Abnormal abrasion of hard dental tissues, dentition defects in the lateral sections of dental arches, abnormal occlusion (deep or prognathic), reduced tolerance of periodontal tissues, and dysfunction of the masticatory muscles (bruxism) were found to be the pathogenetic factors leading to the development of this condition. Dysfunction of the masticatory muscles was detected in 41.5% of patients with shortened interalveolar distance and dysfunction of the temporomandibular joint in 9.9%; moreover, in many of them traumatic occlusion and disorders in the regional circulation in the periodontium of teeth exposed to overexercise were observed. Orthodontic treatment of patients with shortened interalveolar distance was carried out in two stages: the first stage consisted in functional and adaptation restructuring of the maxillodental system by repair of the height of occlusion and normalization of the mandibular position on a plastic cup which the patients wore for 3 months, and then the second stage ensued, at which they were fitted with dentures. Good results were attained in 95.7% patients.
A total of 416 patients aged 40 to 60 suffering from abnormal teeth abrasion were fitted with cermet dentures. Orthodontic treatment was preceded by therapeutic and surgical preparation of the teeth and periodontium and by functional and adaptation rearrangement of the maxillodental system, if indicated. Remote results were assessed after 2 to 12 years. Due to such preparation good results were attained in 95.9% patients. Complications were observed in only 4.1%: exacerbation of periodontitis, ceramic facing chipping off, insertion of abutment teeth, and functional overload of the periodontium.
A total of 4864 patients (2810 women and 2054 men) aged 16 to 64 with maxillofacial abnormalities and 3686 patients (2283 women and 1403 men) aged 18 to 64 with dentition defects were examined. 2624 patients aged 19 to 62 were admitted for orthodontic treatment. Experiments on 96 dogs were carried out. Pathologic changes in the periodontal tissue were detected in 3765 (77.4%) patients with maxillofacial abnormalities and in 2918 (78.8%) with dentition defects. The author considers that two major factors contribute to the pathogenesis of functional overstrain of the periodontium: change of occlusion loading of the teeth and reduced tolerance of periodontal tissues. Good results were attained in 92.7% of patients with functional overloading of the periodontium. Dog experiments demonstrated that overexercise of teeth may lead to changes in the periodontium, which are similar to tissue restructuring in orthodontic interventions. If the periodontium is weakened, an exacerbation of periodontitis develops. After stopping of functional overstrain--repair processes in the periodontal tissues of young animals, including repair of bone tissue take place.
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Time course of morphologic changes in periodontal tissue was studied in 42 miniature pigs with experimental bruxism. An inflammation has developed in the marginal periodontium. At first the inflammatory infiltrate was situated under the epithelial fixation to the tooth involving destruction of the epithelial fixation and formation of pockets, inflammatory infiltrate, and granulation tissue, these destructive changes involving the lower sections of the periodontium. Signs of resorption were detectable in the dental alveolus osseous wall, cement, and dentin. The changes in the periodontal tissue described above appear to result from a complex of factors developing in experimental animals with simulated bruxism.
A total of 426 patients, 215 female and 211 male ones, aged 40 to 65, were treated for abnormal abrasion of the teeth; 52 of these developed temporomandibular joint dysfunction. Orthodontic and physiotherapeutic methods were added to the complex of therapeutic measures for this patient population. Orthodontic treatment was aimed at normalization of the occlusion height (interalveolar space) and mandibular status and was carried out with a plastic cup attached to the denture for a period of up to 6 months. This was followed by rational prosthetics. Good late results were achieved in 48 patients (92.2 percent) with temporomandibular joint dysfunction. Four patients developed recurrences of such dysfunction in various periods after the treatment.
The authors emphasize the knowledge of the psychologic characteristics of an old man to make good contacts with him. They give recommendations on the physician's behavioral patterns with elderly patients at all stages of orthodontic treatment and point out the relationship between the personality features of the physician and his ability to psychologically influence the patients.
Two cases of allergic responses to "dentistry gold" are reported. The condition was confirmed in epicutaneous tests with 2 different gold--containing substances. Removal of the dentures was the cure for these patients. Dentures fabricated using other materials (silver-palladium alloy, plastics) did not cause adverse effects in these patients.
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A complex of implanted dentures was manufactured with a corundum ceramic compound "Kador" made in the USSR. The technique of implantation is described. The authors used a double-staged technique of implantation immediately after the frontal teeth loss or in the late periods in unilateral or bilateral unrestricted end defects of dentition. Within the 1.5-year follow-up 35 of the 36 implants were functionally reliable.
A ten-years' experience with metalloceramic dentures is analyzed. Orthopedic treatment was performed in patients with different forms of dentomaxillary pathology. Possible sources of construction and fixation errors and complications are exposed, and their prevention described.
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