USING DIGITAL TECHNOLOGIES REHABILITATION OF PATIENTS WITH PRIMARY ADENTIA

ISSN: 2582-4686 SJIF 2021-3.261,SJIF 20222.889, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-11 821 USING DIGITAL TECHNOLOGIES REHABILITATION OF PATIENTS WITH PRIMARY ADENTIA Normurodova R. Z. Tashkent State Medical University Department of Hospital Orthopedic Dentistry Introduction. In recent yearsортодонтическом, the number of patients with missing permanent teeth at orthodontic appointments has increasedствием. The frequency of absence of rudiments of teeth, according to various authors, ranges from 2% to 16.5%. The leading position is occupied by adentia of the lateral incisors of the upper jaw. The complexity of the problem is caused by an increase in the level of aesthetic requirements on the part of patients, especially in the situation of a lackцитаof bone volume in the alveolar ridge. Treatment of such patients requires a comprehensive approach with interdisciplinary supervision and the use of digital technologies. Materials and methods.The clinical study was conducted on the basisof the PresiDent Dental Clinic(Cheboksary) in the period from 2018 to 2023. The total number of patients was 24 people (female) aged 16 to 34 years. Patients were divided into two groups (n=12). Patients of the first group were replaced with missing teeth using the traditional method of dental implantation without the use of digital technologies, and patients of the second group were replaced with the use of digital technologies. The condition of the gingiva in the area of the dentition defect was assessed: the degree of severity of the phenomenon ofstipling, the density of the gingival margin to structural materials, the vacuum stability of capillaries according to Kulazhenko, the bleeding index according to Mulleman-Cowell. The SPSS 13.0 software package was used for statistical processing of the obtained results. Results and discussion.The first stage of treatment includedorthodontic treatment, installation of braces and caninedistaliza-tion. Some patients were fitted with orthodontic mini-screws in the sub-zygomatic zone to distalize the lateral segments of the upper dentition. After creating gaps for future lateral incisors, a surgical template was made and dental implants were installed. Four months after implantation, the braces system was removed and temporary crowns were installed on the implants, and six months later, digitalmetal-free orthopedic structures were installed using CAD/CAM technology. We have not identified any cases of implant loss. The basis of an algorithm for managing patients with adentia of the lateral incisors of the upper jaw was developed. Conclusions.The use of computer programs forпланиplanningрования dental implantation and navigation surgery makes it possible to install dental implants most accurately, and to produce digital metal-free orthopedic structures using computer modeling and manufacturing technology. Thus, the risk of complications is reduced and effective functional treatment is achieved.- циональное and aesthetic state of the dentoalveolar system in patients with primary adentia. Key words:primary adentia,orthodontic treatment, surgical template, dental implants, digital planning, intraoral scanning, CAD/CAM technology. Primary adentia refers to one of the most severe forms of dental anomalies [7]. Treatment of patients in the absence of rudiments of teeth requires a serious individual approach and комcomplex treatment [7, 8, 9, 10, 11]. The most common is bilateral adentia of the lateral incisors of the upper jaw. The prevalence of primary adentia of permanent teeth in children varies from 2% to 16.5% in the population [7]. Today, patients pay great attention to the aesthetic component of dentaltreatmentчения. Choosing an effective ISSN: 2582-4686 SJIF 2021-3.261,SJIF 20222.889, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-11 822 treatment method incase of violation of the integrity of the dentition is a difficulttask for a practicing dentist. Interdisciplinary interaction of specialists in dental practice has expanded the possibilitiesof treating patients with primary adentia [1,8, 11]. To accurately transfer the surgical intervention plan and install dentalныхimplants, a computer - generated surgical template is used, which is a link between cone-beam computed tomography (CBCT), the treatment plan and the surgical operation. Currently, dentists are trying to create a natural effect of"- growing" the crown on the dental implant from the gum. Modern implantology uses bio-compatible materials and digital technologies, so the designs are ultrap r e c i s e [ 1 , 4 , 5 , 6 , 1 0 , 11 ] . M o d e r n C A D / C A M ( C o m p u t e r - aided design and Computer-aided manufacturing) technology is the production of denture frames, crowns for implants andveneers using computer modeling and milling рованияon software – controlled machines [7]. Improvement of three-dimensional scanning techniques, as well as computer modeling and manufacturing technologies, increases the accuracy of aesthetic parameters of crowns on dental implants, and facilitates the creation of so-called crowns. "invisible" restorations. A successful aesthetic result of prosthetics implies "unobtrusive- "restoration, its harmonious combination with adjacent teeth and soft tissues. In поrecent years, dentists and dental technicians have paid great attention to the " white aesthetic "and" pink aesthetic " parameters [14]. A crown prepared in compliance with all protocols will not have an aesthetic result if the adjacent gum shows signs of an inflammatory process. Dentists often find it difficult to achieve an ideal "pink aesthetic" of softtissues adjacent to the abutment surface [14]. Of great importance is the attachment of the gum, which is responsible for a kind of infectious "safety" of the underlying bone. To meet these demands, it is necessary to develop a comprehensive approach to patient care with interdisciplinary curation and the use of digital technologies. The aim of the study was to improve the effectivenessof treatment of patients with primary adentia using digital planning, хирургическихsurgical templates, intraoral scanning, CAD / CAM modeling of metal-free screw-fixing crowns on dental implants. Materials and methods of research.The present study was based on a clinical analysis of the results of observation of patients of permanent teeth at thePresiDent Dental Clinic(Cheboksary) in the period from 2018 to 2023. The total number of patients was 24 people (female) aged 16 to 34 years. The first stage of patient supervision consisted in determining the initial level of oral hygiene and teaching individual oral hygiene with mandatory use of irrigation technologies. Then professional oral hygiene was performed (ultrasonicтразвуковой scaling, ultrafine polishing (Air Flow technology), polishing with abrasivepads, medical treatment, oxygenation). All patients were motivated tomonitorthe hyenic state of the mouth at home using plaque indicators.The implantation method was used in all patientswith previous orthodontic treatment with braces lasting from one to two years. All patients were divided into two groups (n=12) by random sampling. Patients of the first group underwent replacement of missing teeth using dentalimplantation according to the traditional method without the use of digital technologies. Patients of the second group underwent dental implantation by means of preoperative digital planning, using a surgical template, intraoral scanning, CAD / CAM modeling of metal-free crowns of screw fixation on dental implants.Prosthetics of all patients were performed using computer simulation technology. Prosthetics of patients were performed using metal-free structures of Procera technology. All crowns on dental implants were made of zirconium dioxide, screw fixation with support on implants ordered from the production centersof Nobel Procera (Sweden, Goteborg; USA, New York).). The algorithm was used as a basisdeveloped in the Department of Clinical and ExperimentalImplantology of the Central Research Institute of Dentistry and Maxillofacial Surgery.To assess ISSN: 2582-4686 SJIF 2021-3.261,SJIF 20222.889, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-11 823 the condition of the gum in the area of dentition defects, the following indicators were used: the degree of severity of the stipling phenomenonстиплинга,ностьthe density of the gingival margin to structural materials, the vacuum stability of capillaries according to Kulazhenko, and the MulletMan -Cowell bleeding index.Statistical information The results ofthe study were processed using the statistical software package SPSS 13.0: comparison of sample distributions with normal (Kolmogorov-Smirnov test), Pearson andSpearman correlation analysis (for rank values). With норa normal distribution of values in the study groups, the arithmetic mean values (M), standard errors (m). Results and their discussion.It is known that the position of the teeth changes over time and requires correction or replacement of dentures. The production of a surgical template provides an accurate transfer of the interactive planto thesurgical siteс and allows you to accurately install dental implants. The ideal position of the dental implant is at least 1.5 mm from the root of the adjacent tooth. The minimum allowabledistance for implant placement between the central incisors and canines is 5.5 mm. In three patients (25%) of the first group, insufficient mesiodistalcortical distance was observed in the postoperative, which required repeated orthodontic treatment направленaimed at increasing the distance between adjacent teeth. The duration of treatment was increased to one year. In the second group, only one patient was correlated with the contact surfaces of crowns on dental implants.When assessing the gum condition, it turned out that the phenomenon of stipling was pronounced in seven patients of the first group (58%) and in eleven patients of the second group (91%, p>0.05). Isolated-cases of focal loss of the stipling phenomenon both observed groups of patients were associated with bacterialassociated inflammationo f t h e m a r g i n a l a n d a l v e o l a r desna-ны. The cause of inflammation in these cases was insufficient attention to the hygienic care of the oral cavity in the home.When evaluating the marginal fit of the gum to the structural materials, it was found that it was tight in five patients (41%) of the first group and ten patients (83%, p<0.01) of the second group. In three patients of the first group, the gingival cuff showed no signs of inflammation, but its turgor was reduced without signs of inflammation. In four patients of this group, the decrease in the tightness of the fit was due to bacterial-ассоassociated inflammation. The Mulleman-Co-well index in these patients was equal to 2.41±0.05 points. In one patient of the second group, a decrease in turgor was detected in the absence воспалеofinflammation, in the second patient, looseness of the fitwas due to inflammation. The Mulleman-Co-well index in this patient was 2.4 points.The Kulazhenko capillary resistance score showed no significant differences in patients of both groups and was 42.3±8.1 s in patients of the first group and 48.1±7.4 s in patients of the second group (p>0.05).In all cases of detection of bacterial-associated inflammation of soft tissues surrounding the implant, periodontal interventions were required to eliminate dental plaque, including subgingival, с приме-plaque, with the use of antiseptic and antiinflammatory drugs. As an illustration, we present a clinical case. Patient N., 20 years old, went to the clinic complaining of aesthetic dissatisfaction due to the lack of upper lateral incisors. Objective examination revealed facial symmetry, clear visible skin, no enlarged submandibular lymph nodes. In the oral cavity: vestibule of medium depth, sufficient area of keratinized gums, attachment of the frenules of the lips and tongue without pathological changes. There are no lateral incisors of the upper jaw. The gums in the area of all teeth are pale pink, with a pronounced phenomenon of stipling. Good level of oral hygiene. Diagnosis: congenital bilateral adentia of the lateral incisors of the upper jaw.The patient was supervised using an algorithm of examination and treatment. At the first stage of curation, a decision was made to perform orthodontic ISSN: 2582-4686 SJIF 2021-3.261,SJIF 20222.889, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-11 824 correction using a fixed edgewise technique. At the second stage of curation, dental implants were installed in the area of teeth 1.2, 2.2, 4.5. When assessing the gum condition, a loose fit was found in the area of the dental implant 1.2 of the tooth, which required periodontal treatment.At the third stage of curation, the patient was fitted with digital metal-free orthopedic structures using CAD/CAM technology. Conclusions. Our study showed that despite the different indicators in the condition of bone and soft tissues, the installed structures performed chewing and aesthetic functions in patients of both observed groups. The changes in the position of the teeth and the condition of soft tissues that we detected during the observation of patients certainly required correction; however, no cases of implant loss were detected.The use of computer programs for planning dental implantation and navigation surgery makes it possible to install dental implants in the most accurate way, and to produce digital metal-free orthopedic structures using CAD/CAM technology. This makes it possible to reduce the risk of complications and achieve an effective functional and aesthetic state of the maxillary system in patients with primary adentia. The algorithmfor the study and treatment of patients with congenital adentia presents a step-by-step predictable approach to patients. Currently, rehabilitation паof patients with congenital tooth loss is a predictable method of treatment with the inclusion of digital-technologies in orthodontic, surgical, orthopedic, and therapeutic treatment. REFERENCES 1. 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