14 апреля 2016г.
Introduction. Topical task of modern orthopedic treatment of patients by removable structures is to increase the functional efficiency of prostheses and prevention of atrophic changes supporting tissues prosthetic bed [4].
The forces of chewing pressure is a measure of performance that can be used to link the anatomical form and function to assess the effectiveness of prostheses to restore chewing and provide reference data for research on biomechanics [5]. In addition, knowledge of the maximum performance of chewing pressure helps to formulate the ideal treatment plan for the masticatory muscles [2, 3]. The definition of chewing pressure - an important criterion for research of the functional state of dental system for violations of occlusion, neuromuscular syndrome, restoring the dentition with removable and fixed structures, treatment with implants [1, 7, 9, 10].
The aim of this study was to improve the method for evaluating chewing pressure on the stages of orthopedic treatment due to clinical use of a special device.
Materials and methods. To improve the method for evaluating chewing pressure used a special device "BNV-02" - is a mechanical method of recording chewing pressure between the teeth-antagonists in different parts of the dentition with the evaluation redistribution chewing load in the early and late periods (ISO 10139-2). For the generalized analysis of the received results was calculated the average value and its average error, also was applied the index analysis of chewing pressure indicators for each of the groups of defects of the dentition. Clinical application of the developed device was performed in 57 patients who were made dentures, and who needs the correction of denture base [5, 6]. The first measurement was performed to manufacture orthopedic construction, the second in the early (immediately after the manufacture of the prosthesis) and distant (30-45 days) during the treatment period.
Results. Treatment of 21 patients with edentulous by prostheses in the early period allowed for chewing pressure in the range 2,83 ± 0,14 ÷ 3,57 ± 0,27 kg, which differ depending on the area of the dentition. Later, in the long term, increased chewing pressure, especially in the left side portions.
It should be noted that the effect of increasing the chewing pressure that was recorded in this group of patients, accompanied by its uniform distribution on the side portions of the dentition (in the early period immediately after the manufacture of the prosthesis, performance of chewing pressure in the right and left side portions were respectively 1,25 ± 0,05ed and 1,20 ± 0,05ed, and in the long term (30-45 days after the manufacture of the prosthesis) - 1,29 ± 0,06 and 1,30 ± 0,04ed that achieved through preferential increase of chewing pressure LBU ( p <0.05).
The analysis of results of treatment of 16 patients with edentulous one of jaws identified (Table 1), that in the case using the prostheses in early period on upper jaw provides chewing pressure within (3,32 ± 0,30 ÷ 4,31 ± 0,59) kg, and the lower - (4,29 ± 0,58 ÷ 5,07 ± 0,92) kg. After a period of adaptation, that is in the long term achieved a slight increase of the chewing pressure (p> 0.05) and the proportional distribution of the chewing pressure due of its significant relative increase in the LBU (p <0.05).
Treatment of 20 patients with partially edentulous by removable dentures at different stages of treatment and taking into account the localization of defects of the dentition defined chewing pressure (Table 1). In the early period on the lower jaw the level of chewing pressure was (4,39 ± 0,18 ÷ 5,62 ± 0,35) kg, and at the upper - (4,59 ± 0,22 ÷ 5,98 ± 0,38) kg (p> 0.05). The standardized index distribution of chewing pressure in the early period in the PBU of the mandible was 1,27 ± 0,04ed, LBU - 1,26 ± 0,05ed; there was a significant increase in this index in the long term in the LBU to 1,33 ± 0,01ed (p <0.001). Analysis of patterns of redistribution of chewing pressure revealed its proportionality at the expense of significant relative increase in the LBU (p <0.001).
Analysis of absolute indicators of chewing pressure and its growth in the long term using of removable structures reveals that along the chewing pressure s growth performance (Pict. 1) in a number of cases detected "alignment" of indicators of chewing pressure on symmetrical dentition parts.
Conclusions. Thus, it is clear that improving the evaluation method of chewing pressure is an important task of the modern orthopedic treatment of patients with removable structures, thereby increasing the functional efficiency of prostheses along with the prevention of atrophic changes of the supporting tissues of prosthetic bed. Restore chewing function and resumption of lost forms of particular sections of the dentition in the application of removable strucrures requires taking into account the forces and laws of redistribution of chewing pressure in the symmetric parts during the planning and construction of the basis borders, as well as in earlier and later periods of the use of prostheses. To achieve this goal was used a special device "BNV-02" - a mechanical recorder of chewing pressure between the teeth-antagonists in different parts of the dentition, which allows you to individualize treatment policy for recovery of chewing function. In the process, it was revealed that orthopedic treatment by removable dentures of dentition defects in various localization provides an increase of chewing pressure with its uniform distribution on the symmetric parts regardless of the extent and location of generated through dentition defect. To evaluate the uniformity of the distribution of chewing pressure on different parts of the dentition was proposed standardized symmetry index, which reflects the emerging under the influence of compensatory adaptation effects.
Prospects of job in this thread obvious, since further researchs of chewing pressure will provide its response in relation to the constitutionally - biological (sex, age, diet), clinical factors (prescription of defect, state of the prosthetic field), as well as to obtain data about the coordinate chewing features pressure on areas of the dentition.
Keywords : chewing impression, removable structures, the chewing function.
Список литературы
1.
Без’язична Н.В. Порівняльна оцінка сили жувального
тиску при ортопедичному лікуванні
знімними зубними протезами залежно від матеріалу м’якої
підкладки // Український журнал клінічної та лабораторної медицини,
2007. Т. 2. № 4. С. 52-54.
2.
Без’язична Н.В. Сила жувального тиску на етапах ортопедичного лікування знімними конструкціями зубних протезів // Медицина і..., 2007. № 3/4. С. 47-49.
3.
Безъязычная Н.В. Жевательное давление на этапах ортопедического лечения съёмными протезами: способы и результаты клинического изучения // Медицина
и ... . № 2(13), 2007.
С.27-30.
4. Гнатодинамометрия. Определение жевательной активности // URL: http://meduniver.com/Medical/stomatologia/256.html (дата обращения: 27.04.2015).
5.
Голік В.П., Без'язична Н.В., Томілін
В.Г. Спосіб виготовлення м'якої підкладки акрилового базису знімних протезів. Пат. 24836, Україна, МПК (2006) А61С13/00. Опубл. 10.07.2007. Бюл.№10.
6.
Голік В.П., Без'язична Н.В., Шкляр С.П. Спосіб оцінки якості матеріалу для м'яких
підкладок базису знімних протезів. Деклараційний патент на
корисну модель. Пат. 14743, Україна, МПК А61В 10/00, А61С 13/007. Опубл. 15.05.2006. Промислова власність, 2006. № 05.
7.
Жевательное давление // URL: http://ortostom.net/content/zhevatelnoe-davlenie (дата обращения: 27.04.2015).
8.
Коробко В. Т. Исследование жевательного давления под базисом пластиночного протеза на верхней челюсти: автореф. дис.. ... канд.мед.наук: 14.00.21. 1966. 18 с.
9.
Рожко М.М., Михайленко Т.М., Онищенко В.С. Довідник з ортопедичної стоматології // Київ, 2004. 290 с.
10. Токаревич И.В.,
Наумович Ю.
Я. Современные
методики
оценки
функции
жевания
// Современная стоматология, 2009. №3-4. 32 с.
