Improving the rehabilitation of patients requiring a full-mouth reconstruction: an interdisciplinary approach
Background: In order to increase the effectiveness of the orthopedic treatment of patients with dentition defects, a comprehensive assessment of the functioning of the dentofacial system, in particular, the clinical diagnosis and correction of existing temporomandibular joint (TMJ) pathology, should be performed. Aims: The present paper was aimed at improvement of the effectiveness of orthopedic rehabilitation of patients after full-mouth reconstruction, based on the individual anatomical, functional, and clinical characteristics of TMJ. Materials and methods: A prospective non-randomized single-center examination and treatment of 216 patients (age 44.3 ± 15.2 years, 126 men and 90 women) with partial or complete absence of teeth or deformations of the dentition after previous incorrect orthopedic treatment were carried out. Patients were divided into two groups. The first group (n = 109) included people whose treatment was delivered through standard orthodontic procedures. The second group (n = 117) covered patients, in the treatment of which the proposed interdisciplinary approach to orthodontic rehabilitation was applied, taking into account the individual anatomical and functional characteristics of the dentoalveolar system. Results: In 1-3 years after the treatment start, among the second group of patients, significantly lower indicators of the visual-analogue scale for assessing pain intensity (by 27.5-46.0%), lower frequency of TMJ clicking (in 1.9-4, 5 times), and less painful chewing (8.2-11.2 times) were registered. Besides, according to condylography results, among the participants of the second group, a higher frequency of positive improvements in the TMJ condition (5.4-5.8 times) was noted. In conformity with the Global Aesthetic Improvement Scale (GAIS), patients from this group estimated the aesthetic results after treatment and rehabilitation better than others (self-assessment results increased by 24.1-27.4%). Conclusions: The study revealed high clinical effectiveness of applying an interdisciplinary approach to orthopedic rehabilitation of patients who experienced a full-mouth reconstruction. Thus, comprehensive diagnostics should be carried out with the involvement of multi-profile specialists to achieve better results when planning treatment and rehabilitation measures