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USING DIGITAL TECHNOLOGIES REHABILITATION OF PATIENTS WITH PRIMARY
ADENTIA
No mu odo a R. Z.
Tashken S a e Medical Uni e si y
Depa men o Hospi al O hopedic Den is y
In oduc ion. In ecen yea sортодонтическом, he numbe o pa ien s wi h missing pe manen ee h
a o hodon ic appoin men s has inc easedствием. The equency o absence o udimen s o ee h,
acco ding o a ious au ho s, anges om 2% o 16.5%. The leading posi ion is occupied by aden ia
o he la e al inciso s o he uppe jaw. The complexi y o he p oblem is caused by an inc ease in he
le el o aes he ic equi emen s on he pa o pa ien s, especially in he si ua ion o a lack- цитаo
bone olume in he al eola idge. T ea men o such pa ien s equi es a comp ehensi e app oach wi h
in e disciplina y supe ision and he use o digi al echnologies.
Ma e ials and me hods.The clinical s udy was conduc ed on he basiso he P esiDen Den al
Clinic(Cheboksa y) in he pe iod om 2018 o 2023. The o al numbe o pa ien s was 24 people ( emale)
aged 16 o 34 yea s. Pa ien s we e di ided in o wo g oups (n=12). Pa ien s o he i s g oup we e eplaced
wi h missing ee h using he adi ional me hod o den al implan a ion wi hou he use o digi al
echnologies, and pa ien s o he second g oup we e eplaced wi h he use o digi al echnologies. The
condi ion o he gingi a in he a ea o he den i ion de ec was assessed: he deg ee o se e i y o he
phenomenon o s ipling, he densi y o he gingi al ma gin o s uc u al ma e ials, he acuum s abili y
o capilla ies acco ding o Kulazhenko, he bleeding index acco ding o Mulleman-Cowell. The SPSS
13.0 so wa e package was used o s a is ical p ocessing o he ob ained esul s.
Resul s and discussion.The i s s age o ea men includedo hodon ic ea men , ins alla ion o b aces
and canine- dis aliza- ion. Some pa ien s we e i ed wi h o hodon ic mini-sc ews in he sub-zygoma ic
zone o dis alize he la e al segmen s o he uppe den i ion. A e c ea ing gaps o u u e la e al inciso s,
a su gical empla e was made and den al implan s we e ins alled. Fou mon hs a e implan a ion, he
b aces sys em was emo ed and empo a y c owns we e ins alled on he implan s, and six mon hs la e ,
digi alme al- ee o hopedic s uc u es we e ins alled using CAD/CAM echnology. We ha e no iden i ied
any cases o implan loss. The basis o an algo i hm o managing pa ien s wi h aden ia o he la e al inciso s o
he uppe jaw was de eloped.
Conclusions.The use o compu e p og ams o планиplanningрования den al implan a ion and
na iga ion su ge y makes i possible o ins all den al implan s mos accu a ely, and o p oduce digi al me al- ee
o hopedic s uc u es using compu e modeling and manu ac u ing echnology. Thus, he isk o
complica ions is educed and e ec i e unc ional ea men is achie ed.- циональное and aes he ic
s a e o he den oal eola sys em in pa ien s wi h p ima y aden ia.
Key wo ds:p ima y aden ia,o hodon ic ea men , su gical empla e, den al implan s, digi al
planning, in ao al scanning, CAD/CAM echnology.
P ima y aden ia e e s o one o he mos se e e o ms o den al anomalies [7]. T ea men o pa ien s in he
absence o udimen s o ee h equi es a se ious indi idual app oach and ком- complex ea men [7, 8, 9, 10,
11]. The mos common is bila e al aden ia o he la e al inciso s o he uppe jaw. The p e alence o
p ima y aden ia o pe manen ee h in child en a ies om 2% o 16.5% in he popula ion [7]. Today,
pa ien s pay g ea a en ion o he aes he ic componen o den al ea men чения. Choosing an e ec i e
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ea men me hod incase o iola ion o he in eg i y o he den i ion is a di icul ask o a p ac icing den is .
In e disciplina y in e ac ion o specialis s in den al p ac ice has expanded he possibili ies- o ea ing
pa ien s wi h p ima y aden ia [1,8, 11]. To accu a ely ans e he su gical in e en ion plan and ins all den al-
ныхimplan s, a compu e - gene a ed su gical empla e is used, which is a link be ween cone-beam
compu ed omog aphy (CBCT), he ea men plan and he su gical ope a ion. Cu en ly, den is s a e ying
o c ea e a na u al e ec o "- g owing" he c own on he den al implan om he gum. Mode n
implan ology uses bio-compa ible ma e ials and digi al echnologies, so he designs a e ul a-
p e c i s e [ 1 , 4 , 5 , 6 , 1 0 , 11 ] . M o d e n C A D / C A M ( C o m p u e - aided design and
Compu e -aided manu ac u ing) echnology is he p oduc ion o den u e ames, c owns o implan s
and enee s using compu e modeling and milling рованияon so wa e – con olled machines [7].
Imp o emen o h ee-dimensional scanning echniques, as well as compu e modeling and
manu ac u ing echnologies, inc eases he accu acy o aes he ic pa ame e s o c owns on den al
implan s, and acili a es he c ea ion o so-called c owns. "in isible" es o a ions. A success ul aes he ic
esul o p os he ics implies "unob usi e- " es o a ion, i s ha monious combina ion wi h adjacen ee h
and so issues. In по- ecen yea s, den is s and den al echnicians ha e paid g ea a en ion o he " whi e
aes he ic "and" pink aes he ic " pa ame e s [14]. A c own p epa ed in compliance wi h all p o ocols will
no ha e an aes he ic esul i he adjacen gum shows signs o an in lamma o y p ocess. Den is s
o en ind i di icul o achie e an ideal "pink aes he ic" o so issues adjacen o he abu men su ace
[14]. O g ea impo ance is he a achmen o he gum, which is esponsible o a kind o in ec ious
"sa e y" o he unde lying bone. To mee hese demands, i is necessa y o de elop a comp ehensi e
app oach o pa ien ca e wi h in e disciplina y cu a ion and he use o digi al echnologies.
The aim o he s udy
was o imp o e
he e ec i eness-
o ea men o pa ien s wi h p ima y
aden ia using digi al planning, хирур- гическихsu gical empla es, in ao al scanning, CAD / CAM
modeling o me al- ee sc ew- ixing c owns on den al implan s.
Ma e ials and me hods o esea ch.The p esen s udy was based on a clinical analysis o he esul s
o obse a ion o pa ien s o pe manen ee h a heP esiDen Den al Clinic(Cheboksa y) in he pe iod om
2018 o 2023. The o al numbe o pa ien s was 24 people ( emale) aged 16 o 34 yea s. The i s s age o
pa ien supe ision consis ed in de e mining he ini ial le el o o al hygiene and eaching indi idual o al
hygiene wi h manda o y use o i iga ion echnologies. Then p o essional o al hygiene was pe o med
(ul asonic- тразвуковой scaling, ul a ine polishing (Ai Flow echnology), polishing wi h
ab asi epads, medical ea men , oxygena ion). All pa ien s we e mo i a ed omoni o - he hyenic
s a e o he mou h a home using plaque indica o s.The implan a ion me hod was used in all pa ien swi h
p e ious o hodon ic ea men wi h b aces las ing om one o wo yea s. All pa ien s we e di ided in o
wo g oups (n=12) by andom sampling. Pa ien s o he i s g oup unde wen eplacemen o missing
ee h using den al- implan a ion acco ding o he adi ional me hod wi hou he use o digi al
echnologies. Pa ien s o he second g oup unde wen den al implan a ion by means o p eope a i e
digi al planning, using a su gical empla e, in ao al scanning, CAD / CAM modeling o me al- ee
c owns o sc ew ixa ion on den al implan s.P os he ics o all pa ien s we e pe o med using compu e
simula ion echnology. P os he ics o pa ien s we e pe o med using me al- ee s uc u es o P oce a
echnology. All c owns on den al implan s we e made o zi conium dioxide, sc ew ixa ion wi h
suppo on implan s o de ed om he p oduc ion cen e so Nobel P oce a (Sweden, Go ebo g; USA,
New Yo k).). The algo i hm was used as a basisde eloped in he Depa men o Clinical and
Expe imen alImplan ology o he Cen al Resea ch Ins i u e o Den is y and Maxillo acial Su ge y.To assess
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he condi ion o he gum in he a ea o den i ion de ec s, he ollowing indica o s we e used: he deg ee o
se e i y o he s ipling phenomenonстиплинга,ность he densi y o he gingi al ma gin o s uc u al
ma e ials, he acuum s abili y o capilla ies acco ding o Kulazhenko, and he Mulle - Man -Cowell
bleeding index.S a is ical in o ma ion The esul s o he s udy we e p ocessed using he s a is ical
so wa e package SPSS 13.0: compa ison o sample dis ibu ions wi h no mal (Kolmogo o -Smi no
es ), Pea son andSpea man co ela ion analysis ( o ank alues). Wi h нор- a no mal dis ibu ion o
alues in he s udy g oups, he a i hme ic mean alues (M), s anda d e o s (m).
Resul s and hei discussion.I is known ha he posi ion o he ee h changes o e ime and equi es
co ec ion o eplacemen o den u es. The p oduc ion o a su gical empla e p o ides an accu a e
ans e o he in e ac i e plan o hesu gical si eс and allows you o accu a ely ins all den al implan s. The
ideal posi ion o he den al implan is a leas 1.5 mm om he oo o he adjacen oo h. The minimum
allowable- dis ance o implan placemen be ween he cen al inciso s and canines is 5.5 mm. In h ee
pa ien s (25%) o he i s g oup, insu icien mesiodis alco ical dis ance was obse ed in he
pos ope a i e, which equi ed epea ed o hodon ic ea men направлен- aimed a inc easing he
dis ance be ween adjacen ee h. The du a ion o ea men was inc eased o one yea . In he second
g oup, only one pa ien was co ela ed wi h he con ac su aces o c owns on den al implan s.When
assessing he gum condi ion, i u ned ou ha he phenomenon o s ipling was p onounced in se en
pa ien s o he i s g oup (58%) and in ele en pa ien s o he second g oup (91%, p>0.05). Isola ed-cases o
ocal loss o he s ipling phenomenon bo h obse ed g oups o pa ien s we e associa ed wi h bac e ial-
associa ed in lamma ion- o h e m a g i n a l a n d a l e o l a desna-ны. The cause o
in lamma ion in hese cases was insu icien a en ion o he hygienic ca e o he o al ca i y in he
home.When e alua ing he ma ginal i o he gum o he s uc u al ma e ials, i was ound ha i was
igh in i e pa ien s (41%) o he i s g oup and en pa ien s (83%, p<0.01) o he second g oup. In h ee
pa ien s o he i s g oup, he gingi al cu showed no signs o in lamma ion, bu i s u go was educed
wi hou signs o in lamma ion. In ou pa ien s o his g oup, he dec ease in he igh ness o he i was
due o bac e ial-ассо- associa ed in lamma ion. The Mulleman-Co-well index in hese pa ien s was equal o
2.41±0.05 poin s. In one pa ien o he second g oup, a dec ease in u go was de ec ed in he absence
воспале- o in lamma ion, in he second pa ien , looseness o he i was due o in lamma ion. The
Mulleman-Co-well index in his pa ien was 2.4 poin s.The Kulazhenko capilla y esis ance sco e showed
no signi ican di e ences in pa ien s o bo h g oups and was 42.3±8.1 s in pa ien s o he i s g oup
and 48.1±7.4 s in pa ien s o he second g oup (p>0.05).In all cases o de ec ion o bac e ial-associa ed
in lamma ion o so issues su ounding he implan , pe iodon al in e en ions we e equi ed o
elimina e den al plaque, including subgingi al, с приме-plaque, wi h he use o an isep ic and an i-
in lamma o y d ugs.
As an illus a ion, we p esen a clinical case.
Pa ien N., 20 yea s old, wen o he clinic complaining o aes he ic dissa is ac ion due o he lack o
uppe la e al inciso s. Objec i e examina ion e ealed acial symme y, clea isible skin, no enla ged
submandibula lymph nodes. In he o al ca i y: es ibule o medium dep h,
su icien a ea o ke a inized gums, a achmen o he enules o he lips and ongue wi hou
pa hological changes. The e a e no la e al inciso s o he uppe jaw. The gums in he a ea o all ee h a e
pale pink, wi h a p onounced phenomenon o s ipling. Good le el o o al hygiene. Diagnosis:
congeni al bila e al aden ia o he la e al inciso s o he uppe jaw.The pa ien was supe ised using an
algo i hm o examina ion and ea men . A he i s s age o cu a ion, a decision was made o pe o m o hodon ic
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co ec ion using a ixed edgewise echnique. A he second s age o cu a ion, den al implan s we e
ins alled in he a ea o ee h 1.2, 2.2, 4.5. When assessing he gum condi ion, a loose i was ound in
he a ea o he den al implan 1.2 o he oo h, which equi ed pe iodon al ea men .A he hi d s age
o cu a ion, he pa ien was i ed wi h digi al me al- ee o hopedic s uc u es using CAD/CAM echnology.
Conclusions. Ou s udy showed ha despi e he di e en indica o s in he condi ion o bone and so
issues, he ins alled s uc u es pe o med chewing and aes he ic unc ions in pa ien s o bo h
obse ed g oups. The changes in he posi ion o he ee h and he condi ion o so issues ha we de ec ed du ing
he obse a ion o pa ien s ce ainly equi ed co ec ion; howe e , no cases o implan loss we e de ec ed.The
use o compu e p og ams o planning den al implan a ion and na iga ion su ge y makes i possible o
ins all den al implan s in he mos accu a e way, and o p oduce digi al me al- ee o hopedic s uc u es
using CAD/CAM echnology. This makes i possible o educe he isk o complica ions and achie e
an e ec i e unc ional and aes he ic s a e o he maxilla y sys em in pa ien s wi h p ima y aden ia. The
algo i hm- o he s udy and ea men o pa ien s wi h congeni al aden ia p esen s a s ep-by-s ep p edic able
app oach o pa ien s. Cu en ly, ehabili a ion па- o pa ien s wi h congeni al oo h loss is a p edic able
me hod o ea men wi h he inclusion o digi al- echnologies in o hodon ic, su gical, o hopedic, and
he apeu ic ea men .
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