Specific Aspects of Orthopedic Rehabilitation of Occlusal Disorders in Dental Arch Reconstruction Using Tooth- and Implant-Supported Fixed Prostheses

The problem of rational choice and scope of dental interventions remains complex and relevant both for patients with natural dentition and for cases of dental arch reconstruction using implants. This study addresses the optimization of diagnostic and therapeutic approaches in patients with occlusal disorders resulting from inadequate dental treatment. The findings contribute directly to improving the quality of dental care, particularly in the fabrication of fixed prostheses. Aim. To develop an algorithm of therapeutic measures aimed at normalizing occlusal relationships of the dental arches and restoring the functional integrity of the stomatognathic system by enhancing the effectiveness of orthopedic treatment in patients with tooth- and implant-supported fixed prostheses. Materials and Methods. A comprehensive examination of 94 patients aged 18 to 60 years was conducted following various dental restorations, based on their clinical complaints. The diagnostic protocol included a full range of clinical and supplementary methods: patient questionnaires, oral examination, and intraoral occlusiography; radiological methods (orthopantomography, intraoral periapical radiography, and 3D cone-beam computed tomography); additional instrumental methods (computerized occlusal analysis using T-Scan III, electromyography of the masticatory muscles, and diagnostic model analysis in an articulator); and statistical methods. Results. The study revealed new possibilities for functional and physiological rehabilitation of patients by establishing muscular-occlusal balance during dental arch reconstruction with tooth- and implant-supported fixed prostheses. An algorithm for integrating fixed orthopedic restorations was developed through evaluation of occlusal correction using the T-Scan system and optimal selection of articulating paper. Conclusions. A physiological correlation between the specificity of occlusal relationships and the functional state of the masticatory muscles has been demonstrated. A concept of occlusal physiology describing the interaction of different functional tooth groups at the moment of normal maximal intercuspation has been formulated. The presence of hypercontacts, which are not subjectively perceived by patients, leads to disturbances in occlusal-muscular balance, as confirmed by changes in computerized occlusiography and surface electromyography indices. In cases of complete occlusal reconstruction and traditional correction with articulating paper, a 100% incidence of physiological disruption in the biodynamic parameters of occlusal-muscular interaction was observed. The possibility of restoring these parameters to physiological norm through sequential occlusal correction using the synchronization function of the T-Scan and BioPAK-EMG systems has been demonstrated.