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FACIAL CHANGES DUE TO TOOTH LOSS
Ziloliddin Tursunaliev
Assistant of the Department of Therapeutic and Surgical Dentistry, CAMU
The physiological equilibrium of the masticatory apparatus, as the stability of the
form and function of the dentoalveolar system, masticatory muscles, and soft tissues,
is under the constant influence of morphological, physiological, constitutional,
endocrine, socio-economic impacts of the environment. Pathological changes
occurring in the formed occlusion due to defects in the dental arches are characterized
by a disruption of the interrelation between form and function. It has been revealed that
in distally unrestricted defects, this system is qualitatively altered, which is confirmed
by a disturbance in the metabolism of calcium salts, which is generalized and directly
dependent on the time elapsed since tooth loss and the nature of functional changes.
The loss of posterior teeth in the absence of antagonists leads not only to
deformations of the dental arches but also to occlusal deformations, one type of which
is occlusal deformation with a posterior shift of the mandible. One of the forms of a
collapsing bite arises.
The causes of a collapsing bite include various pathologies of the masticatory
apparatus. These are increased abrasion of hard dental tissues, early loss of posterior
teeth in the absence of opposing teeth, functional overload of individual teeth or groups
of teeth in periodontal diseases, irrational prosthetics, the formation of defects in the
dental arches, systemic periodontal diseases, etc.
The clinical picture depends on the form of occlusal deformation. In the initial
stage, the signs of a collapsing bite are weakly expressed, and the rare complaints of
patients are explained by the fact that the pathological process is in its initial stage, and
significant morpho functional changes have not yet occurred. As the disease further
develops, patients complain of difficulty chewing food. Upon external examination, a
noticeable decrease in the height of the lower third of the face and pronounced
nasolabial and chin folds are noted. Upon examination of the oral cavity, the depth of
the incisal overbite depends on the type of the initial natural occlusion. Partial or
complete blocking of lateral movements of the mandible and deformations of the dental
and alveolar arches may be observed. The height of the gap between the dental arches
in the anterior region in the state of relative rest of the mandible varies within a wide
range. Compared to patients suffering from the initial stage of a collapsing bite, a
certain increase in the gap is noted – from 2 to 12 mm. The developed stage of a
collapsing bite is characterized by the localization of the pathological process within
the dental arches and its transition to the temporomandibular joint. Patients complain
of pain when opening and closing the mouth, chewing, clicking in the joint, fatigue of
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the masticatory muscles, stuffiness or noise in the ears, and difficulty chewing food.
However, the external signs at this stage are more pronounced than in the initial stage.
Myo arthropathic dysfunctional syndrome develops [2].
In the process of the progressive decrease in the height of the lower third of the
face, the articular heads can come into supporting contact with the deepest, posterior
extracapsular part of the articular fossa, where the Glaserian fissure is located. This
area is a thin bony septum separating the temporomandibular joint from the organs of
hearing. The articular head compresses the Eustachian tube, creating conditions for the
appearance of symptoms such as noise in the ears, a feeling of stuffiness in the ears,
and hearing loss. The distal displacement of the articular head and its pressure on the
chorda tympani nerve can cause a burning sensation of the tongue and a decrease in
taste sensitivity. In addition to these symptoms, some patients with a collapsing bite
may experience a feeling of pressure in the ears when chewing, tenderness of the
auricle, pain upon pressure on the tragus of the ear, a popping sound in the ears when
swallowing, and dryness of the oral mucosa.
With further development of the process, degenerative changes in the disc and
capsule of the temporomandibular joint may be observed. The developed stage of a
collapsing bite with the mandibular head displaced upward and backward is
characterized by the fact that, due to the pull of the masticatory muscles with resilient
periodontium of the anterior teeth, a deep incisal overbite is initially formed, and then
a deep bite. A deep bite can turn into a deep traumatic bite.
Given the serious functional and morphological changes observed in this form of
occlusal deformation, a specific treatment strategy for this group of patients has been
developed at the Department of Prosthetic Dentistry.
The treatment of patients with defects in the dental arches complicated by a
collapsing bite with a distal shift of the mandible is complex, labor-intensive, and
lengthy, requiring high qualifications from the prosthodontist. Interaction with other
specialists, most often orthodontists, is necessary for the preparatory stage and
combined treatment methods, paying particular attention to functional disorders in the
dentoalveolar system. Treatment should aim to eliminate all existing pathology. In
cases where the deep bite has not turned into a traumatic bite, it is necessary to shift
the mandible to its previous position, i.e., forward and downward. This shift
simultaneously restores the height of the lower third of the face. This can be achieved
by using a maxillary plate with an inclined plane. Depending on the degree of
mandibular displacement, this preliminary orthodontic treatment can be carried out in
one or two stages. Thanks to this stage, a reduction in subjective symptoms is achieved
first, followed by the complete disappearance of the patient's complaints. To
consolidate the achieved result, and also to ensure the subsidence of the pathological
process, patients are recommended to wear the plate for another 4-6 weeks [1, 4].
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After preliminary preparation of the patient, the fabrication of permanent
prostheses is started according to the indications, taking into account the established
individual height of the lower third of the face.
In cases where there is a reflected traumatic node in the area of the upper anterior
teeth, it is advisable to combine a plate with an inclined plane with a vestibular arch
wire to return them to their previous position. Subsequent prosthetic treatment should
include splinting these teeth.
This sequence of treatment for patients with a complicated form of partial
edentulism – occlusal deformation with the mandible shifted upward and backward –
allows for the creation of the best conditions for the dentoalveolar system: eliminating
overload of the temporomandibular joints, compression of nerve endings and related
disorders, restoring the integrity of the dental arches, articulation, and chewing
function.
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Nigmatov R.N., Nigmatova I.M., Kadyrov Z.M., Kholmirzaev R.A. Differentiated
Approach to Speech Correction in Children with Open Bite. // Stomatologiya:
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2.
Nigmatova I.M., Nigmatov R.N., Nodirkhonova M.O., Mavlyanova M.A.
Treatment of Vertical Anomalies Using the LM-Activator in Children with Speech
Function Disorders during the Mixed Dentition Period. // Stomatologiya: Scientific
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3.
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Aligners Prior to Prosthetics in Secondary Deformations of the Dentition in
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U.M. The Frequency of Crossbite Occurrence in Children with Mixed Dentition
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Sokolova N.D., Kalinnikova L.V. (Ed.). Children with Disabilities: Problems and
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