Title: Department of orthopfedic stomatology with implantology
1Department of orthopfedic stomatology
with implantology
PATHOLOGICAL EROSION OF TEETH
HARD TISSUES.SECONDARY DEFORMATIONS OF DENTAL
ROWS. CLINICS. ETHIOLOGY. PATHOGENESIS.
ORTHOPEDIC TREATMENT PRINCIPLES
2- Erosion of teeth frequent process, observed
for people of all ages. It can be both
physiological and pathological phenomenon. - Physiological erosion has an adapting character,
preventing the functional overload of teeth and
conditioned by it pathological changes in
paradontum tissues. It is the slowly current
compensated process, directed on the improvement
of mastication function, conditioning for slow
motion of lower jaw and smooth sliding of dental
rows in the different phases of articulation.
Physiological erosion of teeth is observed both
in a suckling bite and in a permanent bite.
3- Pathological erosion is a transient process, it
is accompanied by changes in a tooth and
periodontal tissues, and also by parafunction
masseters and TMJ. - The pathological erosion of teeth - it is the
state of enhanceable erosion, when in short space
teeth lose the anatomic form, atypical blivets
appear on them surrounded the sharp edges of the
saved enamel. - Mutual relations in dental rows are changing
bite goes down and dental rows can not perceive
the functional loading without the further damage
of hard tissues.
4Ethiology
-
- Reasons of pathological erosion development
- endogenous
- exogenous.
- The endogenous factors inherited inclination,
metabolic disturbance, neurodistrophical and
endocrine violations which are accompanied the
inferior structure of enamel and dentine,
diseases of gastroenteric highway. One of reasons
of pathological erosion development is bruxism. - Operating of hemadens on the process of
forming, growth and calcination of tooth tissues.
Pathological erosion is observed both at the
enhanceable and at lowered function of thyroid,
and also at other endocrine diseases.
5-
- From exogenous reasons of pathological erosion
of teeth a most value has the appearance of bite,
professional harmfulness and functional overload
of teeth. - Harmful professional and domestic habits.
Holding in teeth nails, needles, cannon-bits,
having a snack of filaments (there are aniline
dyes and silver fir acid in filaments).
6- Acid necrosis of teeth
- It is observed at workers of chemical
industry, which deal with hydrochloric, nitric
and other acids. Hit of acids on teeth with the
stream of respirable air, cause the
decalcification of enamel foremost foreteeth with
subsequent by its erosion. - In one of London schools (Bartlet and al., 1998)
the stomatological inspection of schoolboys was
conducted. As a result of examination is found
out 57 inspected signs of pathological erosion.
Authors bind the reason in great numbers of
aerated drinks.
7- Types of bite
- and functional overload of teeth
- It is set that at a direct bite erosion of hard
tissues of teeth arises up considerably quick,
than at other kinds. In particular case notedly
at the loss of far teeth, when remaining teeth
carry the megascopic, not characteristic by its
loading it is not only bitten off by them but
also chew food. Thus there is (horizontal) a
typeform of erosion of all of teeth which are in
occlusion and diminishing of interalveolar
height.
8Classification of pathological erosion
-
- A. L. Grozovskiy (1946) set the following forms
of pathological erosion - horizontal- is erosion of all masticatory and
cuttings surfaces at a continuous dental row - vertical- is erosion of palatal surface of upper
jaw teeth and vestibular surface of lower jaw
teeth - mixed - pathological erosion develops both in
horizontal and vertical planes. -
- The form of pathological erosion, in
opinion of author, depends on the type of bite
and anatomic-physiological features of TMJ. In
the case of advantage of joint motions, that
depends on the form of joint, the vertical form
of erosion develops more frequent, at that time
when the horizontal form of erosion is caused by
mainly sliding motions.
9- V.U. Kurlyandskiy (1962) talks about the
limited and generalized forms of pathological
erosion of teeth hard tissues. - At the limited form, when a direct traumatic
knot appears, growth of alveolar process is
marked on the height of erosion of teeth. Direct
traumatic knots arise up and in the case of
uneven erosion of teeth. Then they are located in
the area of teeth which detain erosion.
10- M.G.BUSHAN (1979) on a degree and depth of
defeat - selects erosion
- physiological (within bounds of enamel)
- transitional (within bounds of enamel and
dentine) - pathological (within bounds of dentine).
- Author estimates erosion
- 1) depending on the defeat depth
- to 1/3 length of crown
- from 1/3 to 2/3 length of crown
- from 2/3 length of crown to gum.
- 2) depending on the defeat plane
- horizontal
- vertical
- mixed.
- 3) depending on the process extent
- limited
- generalized.
- 4) depending on a change the
sensitiveness of dentine
11- 3. ? ??????????? ?? ????????????? ????????
- ????????????
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12-
- V.N.Trezubov, A.S. Scherbakov,
- L.M. Mishnev (2001) select three clinical
forms of pathological erosion depending on the
compensatory-adapting reaction of masticatory
system - 1) uncompensated
- 2) compensated
- 3) subcompensated.
- Among all of the transferred classifications of
pathological erosion, classification of - M. G. Bushan is most acceptable, fully
determining clinical displays character of teeth
hard tissues pathological erosion.
13Clinic of teeth hard tissues pathological
erosion
-
- The anatomic form of tooth crowns part is
violated and together with it masticatory
pressure changes on cuttings and masticatory
surfaces, and also on paradontium and elements of
TMJ. Origin of specific form of erosion
localization of teeth hard tissues at
ortognatic, direct or deep bites depends on the
individual structure of TMJ, incisor covering,
occlusive curve and direction of force of
masticatory musculature action. - All of these elements in a complex determine
character and degree of motions of lower jaw
freedom.
14- The horizontal form of pathological erosion of
teeth hard tissues is more frequent than all
observed at a direct bite and can be generalized
or limited (horizontal erosion at a direct bite
is related to absence of the incisor covering and
weak expressed of arthral hillocks). - The characteristic sign of horizontal
pathological erosion is shortening of crowns,
education on-the-spot closing of teeth of
fasings uzurs, cells. Often, in particular case
II and III degrees, there is an enhanceable
sensitiveness of dentine.
15- Giperestezy on a clinical flow is divided into
three degrees (Y.A. Fedorov, 1981) - I degree - tooth tissues react on a temperature
irritant (cold, warm) the threshold of
electro-excitability presents 5-8 mcA. - II degree - tooth tissues react on temperature
and chemical irritants (sweet, sour and
suchlike) threshold of electro-excitability of
dentine is 3-5 mc?. - III degree - tooth tissues react on all of types
of irritants the threshold of electro-excitabilit
y arrives at 1,5-3,5 mc?.
16-
- For the horizontal form of teeth elimination
characterizes by hypercementosis and
insignificant atrophy of alveolar sprout, and for
a vertical and mixed form are expansions of
periodontal crack and atrophy of dental
teethridges edges. - There are two forms of generalized elimination
of teeth - compensated and decompensated - (Gavrilov A.I., 1978).
- The first form is characterized by elimination
of teeth is compensated growth of alveolar
sprouts of jaws (vacant hypertrophy). The height
of lower third of face does not go down. - At the second form growth of alveolar sprouts
is not expressed or poorly expressed. As a result
of it the height of lower third of fase diminish - The decline of occlusial height mainly depends
on a depth or degree of elimination of teeth,
type of bite, size and topography.
17Patient T., 49 years. Generalized horizontal
form of erosion of teeth hard tissues.
18Patient N., 53 years. Generalized horizontal form
of erosion teeth hard tissues.
19 Patient M., 60 years. Generalized form of
pathological erosion of teeth hard tissues on a
lower jaw.
20Hypertrophy of alveolar process on upper jaw
21Patient T., 62 years. Hypertrophy of alveolar
process on lower jaw.
22- The limited form can be observed both at intact
dental rows and at partial defects in them. At
intact dental rows the limited erosion is
compensated due to the vacant hypertrophy of
alveolar process of jaw area, it is not decline
from occlusal height. - Deep incisor covering and expressed slopes of
arthral tubercles at a blackout supraocclusion
determine predominance of vertical joint motions
above horizontal, and also considerable
limitation of scope of l lower jaw lateral
motions. This explains sharp erosion of lateral
teeth and most frequent development of the
limited vertical and rarer mixed form of erosion
of foreteeth.
23-
- The mixed form of pathological erosion of teeth
characterises orthognatic bite. At orthognatic
bite the origin of one or another form of erosion
of foreteeth depends more frequent than all on
the degree of the incisor covering. The mixed
form is observed mainly at the expressed frontal
covering and characterized intensive erosion of
cheek casps of masticatory teeth on upper jaw. - There is individualization of occlusial
curves forms in the initial stages of teeth
erosion. Pathological erosion can be even or
unevenly expressed on one or both jaws, on front
or lateral areas, and also in the separate groups
of teeth. - At erosion of teeth of the I degree (to 1/3
crowns length) the decline of height is expressed
insignificantly, and facial signs or barely
visible, or absent.
24Patient A., 68 years. Vertical form of erosion
of teeth hard tissues.
25Patient T., 56 years. Mixed form of pathological
erosion of teeth hard tissues.
26- Heavy forms of teeth erosion (II and III
degrees), when crowns considerably or wholly
effaced them, are accompanied the large decline
of interalveolar height (going down bite). - It causes the change of topographical
correlations of TMJ elements. An arthral head is
displaced upwards and distal. The elements of
joint are overloaded. Some time they get along at
such loading. But decompensation which is
expressed in disfunction of joint with certain
pathological complex of simptoms comes at certain
unfavorable terms, that in special literature
named variously. Most widespread is a term
Kostens syndrome, described by author early at
1934. Terms are known also as syndrome of
pathological occlusion, occlusal-articulational
dysfunctional syndrome.
27Patient S., 59 years. Going down bite
28Functional and morphological violations at
pathological erosion of teeth hard tissues
- 1. Loss of teeth anatomic form.
- 2. Tone of masseters diminishes, there are their
asynchronous reductions. - 3. Duration of mastication lengthens process.
- 4. Efficiency of masticatory function goes down.
- 5. Neuro-muscle violations develop.
- 6. The mucous membrane of cavity is often
injured. - 7. The sensitiveness of teeth is increased to the
action of various irritants. - 8. Interalveolar height diminishes, the lower
department of face shortens. - 9. Correlations of TMJ elements change.
- 10. Occlusal-articulation dysfunctional syndrome
develops in a number of cases.
29ORTHOPAEDIC TREATMENT OF TEETH PATHOLOGICAL
EROSION
- The orthopaedic rehabilitation of patients with
pathological erosion of teeth hard tissues
foresees the decision of many tasks, conditioned
the clinical features of disease. - It is necessary to take to them
- On possibility, removal of reason which caused
pathology. - Stop or deceleration of enhanceable erosion
process. - Renewal of necessary bite height and warning of
decline of bite relapse. - Renewal of teeth anatomic form.
- Removal of the cosmetic failing.
- Taking to the minimum the amount of teeth, which
subject preparing. - Maintainance of lower jaw normal position.
30-
- Before planning of orthopaedic treatment it is
necessary to take into account the clinical
variety of teeth pathological erosion
(horizontal, vertical, non-communicative,
generalized, compensated, uncompensated), depth
of damage - (I, II, III degrees of erosion), presence of
complications.
31- For patients with generalized erosion of teeth
without violation of functions of masseters
(uncomplicated form) conduct rational prosthetics
with simultaneous renewal of height of bite
without previous alteration of myotatic reflexes
of the masticatory system. - For achievement of these aims it is possible to
apply both unremovable (crowns, bridge prosthetic
appliances) and removable BRD prosthetic
appliances with occlusal protective straps. - Most authors consider inefficient application
of the pressed crowns and soldered bridge
prosthetic appliances, because crowns, in
particular case gold, are worn through on a
masticatory surface, and bridge prosthetic
appliances of break are in the areas of joint.
32Orthopaedic treatment of pathological
elimination of teeth II - III degrees with
violation of masticatory muscles function
-
- Treatment is conducted in two stages the first
stage is disjoining of bite and alteration of
miotatic reflexes of the masticatory system,
second is dental prosthetics with the use of
rational dentures. A two-stage treatment is shown
also at pathological elimination of hard fabrics
of teeth II and III degrees, to complicated
violation of masticatory muscles function.
33- For renewal of height of bite, normalization of
position of lower jaw and alteration of myotatic
reflexes of masseters we can also use plastic
splint. More frequent than it lay on a lower
dental row, but it is possible to apply and on
upper jaw. With this purpose it is possible to
use removable prosthetic appliances which are
used by a patient. The use of different dental
and dent-alveolar splint possible. Term of using
kappa 3-6 months. -
- Application of tooth and dentogingival tires
pursues such aims - Normalization of interalveolar distance
- Relaksaciya of masseters
- Occlusal and neuromuscular stabilizing
- Replicon of arthral head and disk of TMJ
- Removal of functional overload of teeth,
retaining height of bite.
34- Tasks of orthopaedic treatment on the stage of
rational prosthetics - fixing of new height and achievement of even
plural contact all over dental row. It is
possible to apply both removable and unremovable
constructions of prosthetic appliances depending
on a size and topography of dental rows defects
and state of parodontic tissues.
35- Offered on our department method of treatment
consists in the disconnector of bite in a frontal
area by plastic kappa or tire and in alteration
of reflexes of the masticatory system on the
first stage. Second - foresees fixing of the new
got height of bite and renewal of anatomic form
of teeth taking into account aesthetically
beautiful requirements.
36A disconnector of bite in the frontal area of
upper jaw
37A disconnector of bite in the frontal area of
lower jaw
38-
- After making and fixing of disjoining
construction of prosthetic appliance to all of
patients the oscillation massage of areas of
person was appointed on either side of upper jaws
and lower jaws for the acceleration of
morpho-functional alteration of the masticatory
system. Application of oscillation massage allows
almost in 2 times to shorten the term of setup
time through 1,5 -2 month to begin the next stage
of orthopaedic rehabilitation of patients.
39- On the stage of rational prostetics, except for
a necessity to fix the got height of bite, it is
needed to take into account aesthetically
beautiful requirements to the constructions.
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41Orthopaedic treatment of noncommunicative
pathological erosion of teeth
-
- At the noncommunicative form of PS in front
group of teeth and intact dental rows lay on
plastic splint for temporal bridge prosthetic
appliance and increase the height of bite on
1-3?? depending on the degree of erosion. Must
use splint of patient a few months. There is
alteration of alveolar process in this period. In
the area of the effaced teeth which the height of
bite is restored on, and there are processes of
alteration of bone fabric in a lateral area
(dent-alveolar
lengthening).
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46SECONDARY DEFORMATIONS
-
- One of symptoms of partial loss of teeth are
deformations of dental rows which are often
accompanied the change of occlusal mutual
relations. At normal occlusion the form of dental
arcs, their mutual relations, at different
positions of lower jaw provides a valuable
function, and also stability to loadings, which
arise up during mastication, swallowing and talk. - The most frequent reason of the second
deformations of dental rows is a partial loss of
teeth. To the loss of teeth bring a caries over
with his complications, operations of
maxillufacial area, trauma and wound.
47- A row over of theories which explain the
mechanism of origin of the second deformations at
a partial edentia is brought in literature. - The articulatory equilibrium theory (after
Godon), is built on that the dental system is
single whole stable existence of this system it
is possible in that case, when continuity of
dental rows is stored. Thus every separate tooth
is under act of the reserved chain of forces,
which not only retain teeth in the same position
but also save dental rows. Interrelation between
the teeth of one jaw and depicts the antagonists
of Godon as a parallelogram of forces which
????????????? articulatory equilibrium. At the
loss of teeth these forces conduce to inclination
of nearby with a defect teeth, and raising
antagonists.
48- There is description of various forms of
dental-jaw deformations in literature. - So, Gavrilov (1968) described forms of the
second moving of teeth, which meets more
frequent - vertical moving of overhead and lower teeth which
lost antagonists (one-sided, two-sided, meeting). - distal or medial moving.
- inclination in a tongue or cheek side.
- turn about vertical axis.
- combined moving (for example, fan-shaped location
of foreteeth at the diseases of tissues of
paradontium).
49- V.A.Ponomareva (1964) selects two forms of
teeth vertical moving - The first form is characterized by advancement
of teeth with the increase of alveolar process
without denudation of root cement. - The second form is characterized by advancement
of tooth, which is characterized denudation of
root cement without the increase of alveolar
process.
50- A rehabilitation of patients with dental-jaw
deformations is a difficult enough complex of
medical measures of orthodontic and orthopaedic
character the eventual stage of which is
prosthetics. - For this purpose it is recommended to use
different methods - 1. Therapeutic (method of hard tissues
regrinding). - 2. Orthopaedic.
- 3. Surgical.
- 4. Apparatus (method of desocclusion).
- 5. Apparatus-surgical.
51- Therapeutic method
-
- With the purpose of conditioning for
?????????????? considerable regrinding of
masticatory surface is offered. - For determination of degree of regrinding study
diagnostic models, and also X-ray pictures. At
small displacement it is sometimes enough to
conduct regrinding within the limits of enamel
with subsequent remineralising therapy. There is
a necessity of devitalization of the pulled out
teeth and making of artificial crowns at
considerable regrinding.
52Orthopaedic method of treatment
- At convergence of the ????????? located
supporting tooth and absence of vertical change
of teeth-antagonists apply bridge prosthetic
appliances of ordinary construction, with massive
regrinding teeth. - For the compensation of defects of dental rows
which was complicated axial inclination of
supporting teeth (Z.Y.Schur) offered the
demountable constructions of bridge prosthetic
appliances and worked above their improvement. - At convergation teeth we also use unremovable
prosthetic appliances on equator crowns, the
sparing preparing of supporting teeth is the same
arrived at.
53- Apparatus method
- For the removal of deformations of occlusal
plane caused the second moving of teeth, except
for regrinding teeth apply moving of the pulled
out teeth (apparatus method of treatment of
dental-jaw deformations). - Essence of apparatus method consists in
application of plane prosthetic appliances with
high teeth or ??????????? grounds by which
lengthenings natural teeth get the large
functional loading, what other teeth. As a result
of the functional loading of their supporting
vehicle there is alteration of alveolar process.
It results in shortening of lengthenings teeth
and smoothing in one or another degree of
occlusial surface of dental rows. - For reduction of terms of orthodontics treatment
we can use - 1. Vacuum-therapy method.
- 2. Ultrasound.
- 3. Vibratory massage.
54- Surgical method of treatment
- To the exodontia with the purpose of correction
of deformations of occlusal plane, as to the most
radical method, come running then, when other
methods are unsuccessful or contra-indicated. - Testimonies to the exodontia
- Pathological mobility of teeth because of
diseases of tissues of paradontium (III-IV of
item). - Unfavorable correlation of crown of the tooth and
his root. - A presence of chronic inflammatory hearths is in
a paradontium. - Sharply expressed vertical moving of teeth, when
them regrinding goes beyond the scopes of crown
of the tooth. - Inclination of teeth toward the defect of dental
row at which neither orthopaedic nor other
interferences do not give the desired result. - Sear and yellow leaf of patient.
- Chronic diseases of the cardio-vascular and
nervous system, which do not allow to apply other
methods of treatment.
55- Apparatus method
- Treatment with the help of this method consists
from the leadthrough of partial ?????????????????
or decortication and application of medical
vehicle for dezocclusion. - From V.P.Nespryad'ko data as a result of bone
trauma proliferative inflammation develops on
periphery of area of ??????????, a compact layer
loses an usual structure, demineralising, that
facilitates moving of teeth in future.
56Thank you for attention!
57CLINICAL FORMS
- 1. Abrasion - is elimination, caused by objects
from outside (smoking tubes, pips etc. up to a
tooth brush). The form of elimination depends
upon irritant. - 2. Erosion arises up as a result of chemical
irritants action. More often external, but can
be and internal (for example, at the promoted
acidity). Form smooth hearths of defeats
without clear scopes on any tooth surface. - 3. Atricya arises up because of surplus contacts
of teeth-antagonists. Often meets at bruxism. - 4. Abrakcya arises up as a result of functional
overload. Can have a form of enamel cracks.