Обоснование применения навигационных шаблонов при установке дентальных имплантатов

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Акрамов, С., & Олимов, А. (2020). Обоснование применения навигационных шаблонов при установке дентальных имплантатов. in Library, 20(3), 238–245. извлечено от https://inlibrary.uz/index.php/archive/article/view/14290
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Аннотация

В  данной  статье  благодаря  разработке  новых  систем  имплантатов  и  методик  реконструктивных  операций  при атрофии альвеолярной костной ткани челюстей появилась возможность применения метода дентальной имплантации для замещения ортопедическими конструкциями дефектов зубных рядов любой локализации.   Протезирование на имплантатах способствует достижению основной цели - полному восстановлению жевательной функции у пациентов с частичным или полным  отсутствием  зубов,  улучшению  качества  жизни  пациента  как  в  физиологическом,  так  и  в  социально-психологическом аспектах.

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Sanjar A. Akramov

Azimjon B. Olimov

Tashkent State Dental Institute

JUSTIFICATION OF THE STUDY TO DEVELOP A SYSTEM OF PREDICTING OUTCOMES OF DENTAL

IMPLANTS


http://dx.doi.org/10.26739/2181-0966-2020-3-18

ABSTRACT

In this article, thanks to the development of new implant systems and methods of reconstructive operations for atrophy of

the alveolar bone tissue of the jaws, it is possible to use the method of dental implantation to replace dental defects of any localization
with orthopedic structures. Prosthetics on implants helps to achieve the main goal - complete restoration of masticatory function in
patients with partial or complete absence of teeth, improving the quality of life of the patient both in physiological and socio-
psychological aspects.

Key words

: occlusal relationships, prosthetics, diagnostic template, radiopaque template, orthopedic design, ZD-modeling.

Акрамов Санжар Акбарович

Олимов Азимжон Бахромович

Ташкентский государственный стоматологический институт

ОБОСНОВАНИЕ ПРИМЕНЕНИЯ НАВИГАЦИОННЫХ ШАБЛОНОВ ПРИ УСТАНОВКЕ ДЕНТАЛЬНЫХ

ИМПЛАНТАТОВ

АННОТАЦИЯ

В данной статье благодаря разработке новых систем имплантатов и методик реконструктивных операций при

атрофии альвеолярной костной ткани челюстей появилась возможность применения метода дентальной имплантации для
замещения ортопедическими конструкциями дефектов зубных рядов любой локализации. Протезирование на имплантатах
способствует достижению основной цели - полному восстановлению жевательной функции у пациентов с частичным или
полным отсутствием зубов, улучшению качества жизни пациента как в физиологическом, так и в социально-
психологическом аспектах.

Ключевые слова:

окклюзионные взаимоотношения, протезирования, диагностических шаблон, рентгеноконтрастный

шаблон, ортопедический конструкция, ЗД-моделирования.

Aкрамов Санжар Aкбарович

Олимов Aзимжон Бахромович

Тошкент Давлат Стоматология Институти

ДЕНТAЛ ИМПЛAНТЛAРНИ ЎРНAТИШДA НAВИГAЦИОН ШАБЛОНЛАРНИ ҚЎЛЛAШНИ AСОСЛAСШ

AННОТАЦИЯ

Ушбу мақолада, янги имплант тизимлари ва қайта тишловчи операция усуллари ривожланиши, жағларнинг

алвеоляр суяк тўқимаси атрофиясида, тиш қатори нуқсонларида ҳар қандай жойлашувида уларни ортопедик тизилмалар
билан то`лдириш учун реконструктив тиш имплантация усулларини қо`ллаш имкониятини пайдо қилади. Имплантларда
протезлашнинг асосий мақсади - беморларда тишларнинг қисман ёки тўлиқ чайнаш функциясини тўлиқ тиклаш, беморнинг
физиологик ва ижтимоий-психологик жиҳатдан ҳаёт тарзини яхшилашга ёрдам беради.

Калит сўзлар:

окклузив муносабатлар, протезлаш, диагностика шаблон, рентгено-контраст шаблон, ортопедик

конструксия, 3Д-модилирофка.


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The purpose of this work is on the ground of the result of

the analysis and generalization of information contained in
domestic and foreign special literature to provide a theoretical
basis for researches on the development of the system for dental
implantation outcomes prognostication and to determine its
informative value and effectiveness on the basis of the principles
of evidence-based medicine.

This review article presents an analysis of the results of

experimental, clinical and laboratory studies in the preparation
and conduct of dental implantation, in the process of monitoring
patients in the postoperative period, during prosthetics and the
use of orthopedic structures based on dental implants. This is an
important theoretical basis for the development of the unified
system to prognosticate the outcomes of dental implantation that
will contribute to the reduction in the number of complications,
increase in the terms of implants functioning and consequently
improvement of dental care quality.

At the present stage, the method of dental implantation has

taken its rightful place among other dental interventions and
plays a leading role in the system of comprehensive
rehabilitation of patients with dental defects [1, 2, 3]. Revived in
the middle of the XX century, it is experiencing rapid
development due to its knowledge intensity and integrative
potential. Improvement of implants and methods of their
placement is carried out in various directions in order to improve
their quality and eliminate the shortcomings identified during
clinical operation [4, 5]. This process involves the most modern
achievements of scientific and technological progress in
metallurgy, chemistry, physics, materials science, biology and
toxicology [6, 7].

The above facts confirm that dental implantation continues

to be actively implemented in the daily practice of maxillofacial
surgeons and dental surgeons, which underlines the relevance of
this publication.

The purpose of the work is to provide a theoretical

justification for research on the development of a system for
predicting the outcomes of dental implantation based on the
analysis and generalization of data from domestic and foreign
specialized literature.

Escalation of traditional orthopedic treatment often leads to

an undesirable result – failure of restorations and loss of teeth. In
this situation, an important role is played by unjustified
endodontic intervention – "preventive" depulpation of teeth used
for supporting orthopedic structures. At the same time, implants
that provide a reliable support can become an alternative to
prosthetics with a limited prognosis. In addition, there is
currently some progress in the implementation of complex and
productive techniques to optimize the position of implants and
achieve not only adequate functional, but also cosmetic results
[8, 9, 10]. The vast majority of special sources of information are
devoted to the surgical technique of implant placement [11, 12,
13], the characteristics of bone tissue and the requirements for
the alveolar process, the jaw bone during these operations and
contain, mainly, data from radiation research methods, the
results of pathomorphological, less often – biochemical
characteristics of osteointegration processes [14, 15, 16].

The long-term success of implantation depends on both

medical factors (correct selection of patients, ensuring stable
primary fixation of the implant) and design factors (optimal
material, production technology, chemical activity of the implant
surface, its macrostructure) [17]. Despite the high results of
dental implantation, there are currently a number of unresolved

issues related to their rejection. In this regard, predicting the
results of dental implantation at the present stage is very relevant.

It is known that for optimal osseointegration, the dental

implant should:have clinical stability, function for at least 5
years, do not damage the adjacent tissues; do not cause negative
symptoms and sensations in the patient, satisfy the patient both
in functional and aesthetic aspects.

At the same time, there are a number of conditions that

depend not only on the quality of implants and the technique of
their placement, but also directly on the state of the patient's
div, including the presence of somatic diseases [18, 19]. The
level of dental implantology at the present stage, unfortunately,
is limited to a very narrow range of indications for this type of
rehabilitation of dental patients. In this regard, the desire of many
patients to have fixed orthopedic structures or to improve the
fixation of removable ones with implants very often does not
coincide with the capabilities of the method. Taking data on
successful treatment of 80-90% of patients, it should be
remembered that this indicator was calculated in relation to
persons who did not have contraindications to the use of the
dental implantation method. In the same situations, when the
number of contraindications decreases and the range of
indications expands, the percentage of positive results inevitably
decreases. Recent studies show that the use of intraosseous
implants in clinical practice does not always give a stable and
guaranteed result [20, 21].

A detailed analysis of the literature indicates that failures

when using the method, unfortunately, are very common and
occur more often than they are usually said, and even more so to
take them into account when evaluating the results of treatment
[22, 23]. To determine the correct approaches and provide
optimal conditions for the healing, adaptation and functioning of
artificial support in the oral cavity, it is necessary to synthesize
modern knowledge in the field of anatomy, morphology, biology
and physiology of the tissues surrounding the implant. In
addition, it is of great importance to correctly determine the
indications and contraindications for dental implantation, and
with strict and adequate consideration of the patient's somatic
health.

In most basic manuals and monographs [24, 25, 26], the

absolute contraindications to dental implantation include
conditions such as: pathology of the immune system and
leukocyte dysfunction; diseases requiring periodic use of
steroids; diseases of the bone system (congenital osteopathy,
osteonecrosis, dysplasia); disorders in the blood clotting system;
neoplasms that need chemotherapy; uncontrolled endocrine
diseases and diabetes; disorders of the Central and peripheral
nervous system (schizophrenia, paranoia, dementia, psychosis,
neurosis, alcohol or drug addiction); specific-infectious diseases
(syphilis, tuberculosis, actinomycosis, HIV infection). The list of
relative contraindications includes poor oral hygiene; foci of
chronic odontogenic infection; local inflammatory processes;
abnormal bite; diseases of the temporomandibular joint;
bruxism; diseases of the oral mucosa, especially facultative and
obligate precancers.

However, the sources of special information contain

information that even the strictest compliance with the existing
system of indications and contraindications for dental
implantation surgery, surgical techniques for placing implants
(with high qualifications of a maxillofacial surgeon or a dental
surgeon) does not make it possible to overcome complications,
the number of which, according to various authors, varies from
3 to 10% [27, 28, 29]. In social terms, implantation is


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contraindicated for patients who are careless about their health,
as well as for people who abuse coffee, which violates the ratio
of calcium and phosphorus in the blood and their absorption by
bone tissue [30].

Many specialists in the field of dental implantation offer

their own criteria for evaluating the results of this type of
rehabilitation of patients with partial secondary adentia, which
are very different, and in some cases situations and
contradictory. Differences may be related to differences in the
registration of osteointegration parameters in the jaw-dental
implant system, differences in the tactics of patient selection and
examination schemes. Many publications indicate the following
range of clinical diagnostic parameters for recording and
evaluating the results of dental implantation. First, these are
parameters that are reflected in the patient's outpatient card:
General dental status data; risk factors that may affect the final
outcome of rehabilitation in the future (including General dental,
aesthetic, and biomechanical factors); prognosis categories -
good or satisfactory (these categories should always be made
known to the patient). If dental implantation was performed for
extended clinical indications, then it should be reflected what
was done to improve the effectiveness of this method, measures
(dental implantation for periodontal diseases, bone and soft
tissue deficiency in the desired area) and ways to address these
issues, as well as the doctor's assessment of risk factors for a
particular patient. Secondly, during the healing period, it is
necessary to register measures aimed at preventing the
occurrence of inflammatory processes in the tissues surrounding
the implant or performing timely radical surgical intervention in
the event of a pathological process. Third, upon completion of a
healing period is required register values colombianitos marginal
bone loss: after defunctioning period valid values range from 1.5
to 2.4 mm with no symptoms of inflammation of the soft tissue
close to the implant, as well as in the presence of dense gingival
cuff around osseointegrated artificial support. Fourth, criteria for
long-term treatment outcomes are needed.

According to M. D. Perova (2001), after 3 years, the

positive result of intra-bone dental implantation is at least 92%,
the increase in the loss of bone structures for 3 years does not
exceed 0.3 mm [31]. However, it should be emphasized that
neither domestic nor foreign sources and annals of specialized
literature have data on a single standard for evaluating and
predicting the results of dental implantation.

Despite the fact that the world practice of dental

implantation over the past 60 years of development has proved
its worth, some maxillofacial surgeons treat this method of
rehabilitation of dental patients with great doubt. There are a
number of good reasons for this, the main one being implant
rejection. We often hear unsatisfactory reviews from both
patients and colleagues who believe that dental implantation is a
thankless task, implants are unreliable and it is hopeless to do
this. Kozlov (1999) point out that currently dental implantation
is an object of increased attention not only because it is quickly
and widely implemented in clinical practice [27], but also
because when using this method, complications arise, usually of
a destructive nature and leading to loss of bone volume in the
dentoalveolar region, which immediately negatively affects the
General health of the patient and his social adaptation in society
[32]. The condition of the patient's bone tissue is determined not
only by local factors, but also by the level of his somatic health.
This condition must be taken into account when selecting
patients, determining indications for implantation, and
predicting the results of surgery.

It is known that changes that develop as a result of primary

and secondary osteoporosis due to endocrine pathology occur in
all parts of the skeleton, including in the bone tissue of the jaws
[33]. Violation of bone remodeling affects the intensity of
periodontal tissue damage in generalized periodontitis [34, 35],
contributes to the occurrence and progression of the carious
process [36]. Bone density can vary significantly in different
anatomical areas and even differ in the same area. Data on the
state of bone tissue in the area of planned implant placement is
of exceptional importance when drawing up a treatment plan.
The percentage of complications and negative outcomes is
higher when implants are placed in bone with very low
(insufficient initial stability) or high density. The minimal
thickness of the cortical plastic and the low density of the spongy
bone can make it difficult to initially stabilize the implant and
cast doubt on the likelihood of its osseointegration.

According to some authors, adequate contact between the

implant surface and the surrounding bone tissue can be achieved
even in osteoporosis [37]. However, the very fact of providing
osseointegrative contact in this condition is not a guarantee of
the effective functioning of the implant [38], since even the
physiological load on the bone with this type of architectonics
often causes a "breakdown" of its vital processes and
functioning, pathological restructuring and resorption occur
[39].

To ensure an adequate process of osseointegration and

obtain a good "adhesion" between the implant and the bone
tissue, a sufficient amount and good quality of bone is necessary.
And this option can be considered almost ideal, since in such a
situation, as a rule, the patient is practically healthy. However,
the reality is far from ideal. In practice, it turns out that patients
who apply for this type of specialized care are older people who
have a certain number of somatic diseases or deviations from the
norm:

endocrine

discorellations,

metabolic

disorders,

cardiovascular pathology, etc.a Larger percentage of them are
women whose hormonal background naturally changes with age
[40].

Regional osteoporosis of the jaws is observed in women

aged 40-50 years, that is, at the age corresponding to the
beginning of menopause, when the third type of bone (medium-
density bone tissue) is more often detected, characterized by the
fact that the preparation of the latter during surgery is performed
with less effort. This type of architectonics is defined in almost
60% of women of this age [41].

With age-related "shutdown" of ovarian function, 60-80%

of women may have various clinical manifestations of an
estrogen-deficient condition, the so-called functional disorders,
one of which is menopausal osteoporosis. In the structure of
osteoporosis, it is 85% [42]. According to who experts, the
incidence of osteoporosis ranks third in the world after
cardiovascular disease pathology and diabetes [43]. This disease
belongs to the group of heterogeneous, characterized by
progressive loss of bone tissue that begins after natural or
surgical menopause. These phenomena in the div entail
specific approaches to all medical manipulations, including
dental implantation [44].

An urgent problem in achieving long-term and stable

results of dental patients ' rehabilitation using implants is the lack
of knowledge and experience in planning treatment and
monitoring patients who have passed it. The sources of
complications of any surgical intervention can be both the
characteristics of the patient's div, its behavior, and the
specifics and technologies of performing medical manipulations.


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In this case, it is almost always not so much about the natural
connections between the phenomena, but about the degree of risk
of developing a particular type of complications. However, to
date, there is no information in the sources of specialized
literature about the existence or development of a system for
predicting the results of dental implantation that takes into
account all factors in the aggregate.

Conclusion.

The presented material, including the analysis

of the results of experimental and clinical laboratory studies
during the preparation and conduct of dental implantation,
during the monitoring of patients in the postoperative period and
during the operation of implants, provides a theoretical basis for
the development of a unified system for predicting the outcomes
of dental implantation, which will help reduce the number of
complications and improve the quality of dental care for patients.

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