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Department of orthopfedic stomatology with implantology PATHOLOGICAL EROSION OF TEETH HARD TISSUES. SECONDARY DEFORMATIONS OF DENTAL ROWS. CLINICS. – PowerPoint PPT presentation

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Title: Department of orthopfedic stomatology with implantology


1
Department 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.

4
Ethiology
  • 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.

8
Classification 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. ? ??????????? ?? ????????????? ????????
  • ????????????
  • ????????????????.
  • 4. ? ??????????? ?? ????????? ????????????????
    ???????
  • ? ???????? ?????
  • ? ?????????????.

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.

13
Clinic 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.

17
Patient T., 49 years. Generalized horizontal
form of erosion of teeth hard tissues.
18
Patient 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.
20
Hypertrophy of alveolar process on upper jaw
21
Patient 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.

24
Patient A., 68 years. Vertical form of erosion
of teeth hard tissues.
25
Patient 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.

27
Patient S., 59 years. Going down bite
28
Functional 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.

29
ORTHOPAEDIC 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.

32
Orthopaedic 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.

36
A disconnector of bite in the frontal area of
upper jaw
37
A 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.

40
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41
Orthopaedic 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).

42
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SECONDARY 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.

52
Orthopaedic 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.

56
Thank you for attention!
57
CLINICAL 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.
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