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Change in the Dominant Side of Chewing As a Serious Factor for Adjusting the Prophylaxis Strategy for Implant-Supported Fixed De

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Change in the Dominant Side of Chewing As a Serious Factor for Adjusting the Prophylaxis Strategy for Implant-Supported Fixed De Published online: 2020-08-20 THIEME 54 OriginalChange inArticle the Dominant Side of Chewing Zekiy et al. Change in the Dominant Side of Chewing as a Serious Factor for Adjusting the Prophylaxis Strategy for Implant-Supported Fixed Dental Prosthesis of Bounded Lateral Defects Angelina O. Zekiy1 Evgenii A. Bogatov2 Igor A. Voronov3 Martiros S. Sarkisyan3 Ernest Llaka3 1Department of Prosthetic Dentistry, I.M. Sechenov First Moscow Address for correspondence Angelina O. Zekiy, Doctor of Sciences State Medical University, Moscow, Russian Federation (Medicine), Department of Prosthetic Dentistry, I.M. Sechenov First 2Department of Prosthetic Dentistry, Institute of Dentistry named Moscow State Medical University, Trubetskaya Street, 8, Bd. 2, 119991, after E.V. Borovsky, I.M. Sechenov First Moscow State Medical Moscow, Russian Federation (e-mail: [email protected]). University (Sechenov University), Moscow, Russia 3Department of Prosthetic Dentistry, PFUR Medical Institute, RUDN University, Moscow, Russia Eur J Dent:2021;5:54–62 Abstract Objective The main purpose of this article is to study the effect of a change in the dominant side of chewing after prosthetics with fixed structures on implants on the main indicators of osseointegration, adaptation to dentures, and the clinical dental status of patients. Materials and Methods In a clinical trial, an analysis was made of the adapta- tion of 64 patients to intraosseous implant-supported fixed dentures and 56 appar- ently healthy volunteers. The examination complex included determination of the functionally dominant side of chewing, gnathodynamometry and electromyog- raphy indicators of masticatory muscles, and radiological osseointegration crite- ria. The overall treatment outcomes were evaluated using a visual analogue scale and an objective medical questionnaire, “Prognosis of Adaptation to Orthopedic Structures.” Results Patients were divided into two subgroups: with a change in the dominant side of chewing after completion of orthopaedic treatment (40 cases) and without a change in the dominant side of chewing (24 cases). In the second subgroup of patients, Keywords in contrast to the first subgroup, relatively better indicators of gnathodynamometer ► dental implantation and electromyography were observed. So, in the first group, gnathodynamometry ► osseointegration indicators on the dominant side were 255.7 N and in the second group 225 N after 9 to ► peri-implantitis 12 months. Electromyography indices amounted to (198.5 μV s) to (166.3 μV s) after ► partial loss of teeth 9 to 12 months. Bone density remained at the required level, and overall treatment ► chewing function outcomes were higher. Namely, the compact plate of the alveolar ridge was preserved, ► gnathodynamometry and the condition of the bone tissue around the implants testified to stable osseointe- ► electromyography gration. The participation of surface masticatory muscles in adaptation of patients ► visual analogue scale to intraosseous implant-supported fixed orthopaedic structures and the necessity ► adaptation to and importance of changing the dominant chewing side for the general outcomes of dentures orthopaedic treatment have been discussed. DOI https://doi.org/ © 2020. European Journal of Dentistry. 10.1055/s-0040-1715551 This is an open access article published by Thieme under the terms of the Creative ISSN 1305-7456. Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) Thieme Medical and Scientific Publishers Pvt. Ltd., A-12, 2nd Floor, Sector 2, Noida-201301 UP, India Change in the Dominant Side of Chewing Zekiy et al. 55 Conclusions It has been established that a change in the functionally dominant chew- ing side is accompanied by relatively unstable indicators of chewing function, which is combined with increased loads on the installed prostheses during 3 to 6 months of adaptation. This must be taken into account when planning an individual patient adap- tation complex for dental orthopaedic structures. Introduction Chewing is one of the most important elements of the diges- tive function; it is characterized by complicated motor-sen- Dental implantation is currently one of the dynamically sory activity, which consists of rhythmic motor acts aimed at developing fields of clinical dentistry. The manufacturing of size reduction, food grinding, and moisturizing, which should intraosseous (dental) implant-supported fixed orthopaedic lead to the formation of a bolus that can be swallowed.24,25 structures for the restoration of bounded dentition defects The functional significance of occlusal disorders for the claims to be the “gold standard” in modern orthopaedic den- masticatory system has been extensively studied, primarily tistry. Up to 2 million implants are installed annually in the because of the idea that they may have an undesirable effect world; the positive results of such prosthetics are summarized on the dentofacial system.26 Various electrophysiological and 1-3 in several large retrospective studies. video-fixing techniques have been proposed for the dynamic It should be noted that the effectiveness (~95–96%) of den- study of the chewing function.27-29 tal implantation is evaluated mainly based on the preserved The restoration of occlusal surfaces, by definition, is osseointegration, the integrity of the mounted structure, and accompanied by the restructuring of the chewing link of 4-6 7 questionnaires for quality of life. Thus, Jang et al showed the dentition. In general, addiction to dentures can take on the example of a large sample of patients (n = 6385) exam- from several weeks to 3 to 4 months; afterward, a stable ined from 2000 to 2009 that the cumulative survival rate of type of chewing is usually formed, and the situation in the titanium dental implants was 96.3%. oral cavity stabilizes, usually no less than for 3 to 5 years.30 Naturally, osseointegration, which ensures the forma- When restoring lost teeth with intraosseous implant- tion of a strong bond between the implant and the recipi- supported dentures, a functioning area of the chewing appa- ent’s osseous tissue, is the basis for the reconstruction of ratus appears with new loads that extend directly to the the three-dimensional (3D) dentin architectonics; therefore, osseous tissue, bypassing the reflex areas of periodontal it is recognized as the main indicator of the success of den- tissue. This is inevitably accompanied by intensification of tal implantation in the dynamics of the use of orthopaedic osteolysis processes, which in turn can exacerbate overload 8-10 structures. Recently, various modifications of implant of supporting teeth. In case of a change in the position of surface that lead to the nanorelief formation have been used the lower jaw and the height of the lower third of the face, to accelerate the formation and enhance the bond strength new conditions are created for the activity of the masticatory 11-14 between the bone and implants. muscles and the temporomandibular joint.31 New occlusal Since currently the quality of the implants and the tech- relationships change the perception and transfer of chewing nique of their installation have reached the optimum level, late pressure on the underlying tissues, as a result, the nature of complications, reducing the time limits of functioning of pros- the chewing movements of the lower jaw changes. Often this theses and implants, remain the only serious problem. Their may even require a change in the dominant chewing side.32 causes are mainly associated with microtraumas during the The dentition defects arising because of tooth extraction orthopaedic structure functioning (inaccurate calculation of and their deformation lead to the formation of persistent biomechanics plays a role here) and the impact of pathogenic habitual occlusion, sometimes not coinciding with the microflora (microbial associations that colonize tissues and predominant side of chewing. This creates an adverse 15-17 surfaces nearby the implant and in its internal interface). effect on the dentofacial system, which leads to complica- They negatively affect osseointegration; as a result, it is pre- tions.33 In dental practice, there are many cases confirm- cisely its insufficiency that dominates among the causes of ing changes in the chewing surface of teeth and dentitions 2,18,19 unsatisfactory outcomes of this prosthetic option. on the dominant side of chewing and the need to study it In connection with the above, it seems relevant to con- when prosthetics are on dental implants.34 There is a lack sider the influence of such factors that, outside the action of stability information on the predominant dominant side of the infectious-inflammatory ones, can impose a negative of chewing in the norm and in the absence of teeth and effect on the stability of dental implants. The clinical task is to other pathological conditions. The nature of the occur- achieve almost complete immobility of the “tissue-implant” rence of a change in the dominant side of chewing and its bond in the shortest possible time limits and to provide no stability after the completion of orthopaedic treatment traumatic effects and chewing overloads during operation of with the use of designs based on dental implants has not 20-23 fixed orthopaedic structures. been studied.35
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