Methods of Patient Treatment and Rehabilitation

Both groups of patients were given prosthodontic treatment: the control group received conventional prosthodontic treatment based on the average anatomical parameters of the patient with the use of metal ceramic fixed dentures and without taking into account the individual characteristics of the patient, such as centric relation, therapeutic position, individual hinge and orbital axis, occlusal plane, inclination of the central incisors, and bite height.

It should be noted that there are no standard protocols of diagnostic, therapeutic, and rehabilitation measures in patients with edentulism and the need for full-mouth reconstruction.

We have developed a rehabilitation system based on an interdisciplinary approach, used in the course of treatment, and rehabilitation of patients of the study group (2). In the course of implementing this system, we take into account results of physical examination of patients to plan bite correction. These data were obtained using a set of diagnostic methods to assess the condition of various systems of the body (respiratory, central nervous, cardiovascular, and musculoskeletal).

The patients were treated using the following methods:

Sprint therapy

Mounting casts in an articulator

Wax-up of teeth

Installation of long-term temporary crowns

Installation of implants

Fabrication of the final restorations

The follow-up checking of the treatment results was performed with the use of methods of palpation of muscles of the maxillofacial area, condylography and cephalometry, analysis of models, brux checker tool, and occlusiography.

To ensure the stability of the dental range, the methods of selective grinding of dental hard tissues, temporary and permanent splinting, and ceramic restorations in a new therapeutic position were used. Acrylic crown dentures or bridgework were used for temporary restorations.

To implement the treatment plan with interdisciplinary approach, the anatomical and functional characteristics of the dental system were studied, with special attention paid to the assessment of manifestations of muscle pain syndrome, in particular, the severity of pain with palpation associated with the TMJ dysfunction.

Examination of the patients’ anamnesis involved revealing and analysis of major errors in prior prosthetic dentistry in full-mouth reconstruction patients and specifying the causes of complications of prosthodontic treatment. Specialists in related fields (otorhinolaryngologist, neurologist, psychologist, speech therapist, and osteopathic physician, cosmetologist) are consulted.

Results of aesthetic, clinical functional, and instrumental analysis performed in the course of diagnostics using the methods of condylography and cephalometry make it possible to determine the centric relation when the models are mounted into the articulator. To achieve this, Gamma Dental software functionality is used to analyze the occlusion model. The interdisciplinary approach provides for taking into account and timely correcting functional and aesthetic disorders associated with an incorrect bite in patients undergoing full-mouth reconstruction.

In the study group of patients, treatment was performed with permanent ceramic restorations. Fabrication of the dentures was performed with the use of adjustable Gamma articulators, the advantages of which include casts mounting along a customized hinge axis, occlusal plane measurement, and γ rotation evaluation. At the same time, wax modeling with subsequent disconnection makes it possible to obtain high functional and aesthetic results of prosthodontic rehabilitation of patients in need of full-mouth reconstruction ( Fig. 1 ).

Occlusion simulation using Gamma Dental software.