Modern approaches to rehabilitation of patients using removable laminar dentures

The demand for dental orthopedic assistance in Russia makes more than 60% of the number of examined patients. With this, a share of use of removable dentures for rehabilitation of patients with partial or complete absence of teeth makes 40.2% of all types of prosthetics. Removable prosthetics remains an actual treatment option for patients with partial or complete absence of dentitions, along with use of non-removable structures including those with support on dental implants. Improvement of approaches to manufacture and design of dentures led to a considerable increase in the variants of combinations of materials and methods of their manufacture, and there appeared a possibility to optimize denture structures due to the ability to compensate for atrophic processes of the bone tissue. All this permits an orthopedist to achieve satisfactory results in treatment with use of removable dentures. In the given literature review, modern views on the variants of orthopedic rehabilitation of patients with use of removable laminar dentures are presented including their technological, functional, operational, phonetic, chewing peculiarities, and information on modern materials for manufacture of dentures is given. Based on the literature data, it can be concluded that despite active development of the technological component of the manufacture of removable dentures, the basic principles of their design, methods of evaluation of the effectiveness and comfort of use have not undergone significant changes. However, there are a significant number of factors whose influence on the success of orthopedic rehabilitation with removable dentures has not been fully studied. For example, orthopedic dentists often do not analyze the volume of atrophy of the bone tissue of the jaws and design the basis of a dental prosthesis without taking these parameters into account. Another important issue that remains not considered is taking into account the design and architectonics of the resulting prosthesis and its effect on the speed and direction of respiratory flows in the oral cavity. All this creates a technological window that allows, due to compliance with the physiological requirements of the factors described above, to significantly increase the functional properties of the denture, to facilitate the patients habituation to the prosthesis by reducing the adaptation period. The research conducted in this area of knowledge will permit to obtain both new scientific data and develop a number of practical recommendations aimed at improvement of the quality of orthopedic rehabilitation using removable dentures made of various materials.

Opioid use in Older Orthopedic Rehabilitation Inpatients: A Retrospective Study

Background: While there is much evidence about pain management for orthopedic patients in the immediate perioperative setting, little is known about how opioids are used during inpatient rehabilitation in the days and weeks that follow, particularly in older adults. A safe upper limit of 50 oral morphine equivalents (OME) is frequently cited in guidelines. This study’s objective is to characterize the use of opioids in an older adult population undergoing orthopedic rehabilitation. Methods: This is a retrospective observational study of adults aged ≥50 years old admitted for orthopedic rehabilitation between November 2019 and June 2021 at an academic rehabilitation hospital in Toronto, Canada. Acute care admissions preceding rehabilitation were for either a surgical or non-surgical orthopedic indication. Participants were divided into opioid-naïve individuals who received opioids, opioid-naïve individuals who did not receive opioids, and pre-existing chronic users of opioids. Demographic, clinical, and medication administration data were collected through the electronic health record and manual chart review. Average daily opioid dose for the first seven days of each stay was characterized using OME. Linear regression was used to assess for variables independently associated with opioid dose. Results: A total of 643 patients undergoing orthopedic rehabilitation were included: 125 (19.4%) involved chronic opioid users, 416 (64.7%) were opioid-naïve patients who received opioids, and 102 (15.9%) were opioid-naïve patients who did not receive opioids, with median age respectively of 72, 79, and 83. Median daily OME over the first week for chronic users was 30.3 and for opioid-naïve users was 6.9. Opioid dose was significantly positively associated with reported pain as defined by day 3 pain score and knee replacement; it was inversely associated with admission for a non-surgical indication and age. Conclusions: Opioids are frequently but heterogeneously used in older adults undergoing orthopedic rehabilitation. Median OME use in this cohort of older adults was substantially lower than the 50 OME threshold suggested in guidelines. Dedicated guidance for opioid use is warranted for this unique patient population.

SUBSTANTIATION OF THE EFFECTIVENESS OF A COMPREHENSIVE ALGORITHM OF ORTHOPEDIC REHABILITATION FOR THE PREVENTION OF PATHOLOGY OF THE ORAL MUCOSA

Актуальность : известно, что съемные ортопедические конструкции зубных протезов на протяжении долгого времени являются сложными раздражителями слизистой оболочки полости рта (СОПР). Грамотное выполнение технологических этапов изготовления, своевременная коррекция, рекомендации по профессиональной и индивидуальной гигиене полости рта и самих зубных протезов не всегда гарантируют отсутствие микробной колонизации на поверхности базисов условно-патогенными и патогенными представителями и воспалительной реакции со стороны тканей протезного ложа. При выборе базисного материала в качестве замещающей и восстанавливающей конструкции и при ортопедическом лечении в целом перед врачом-стоматологом встает вопрос о профилактике осложнений дисбиотического и воспалительного характера. Целью настоящего исследования является изучение влияния базисного материала съемных ортопедических конструкций на состояние тканей протезного ложа и доказательство эффективности предложенного авторами комплексного метода профилактики дисбиоза полости рта, влияющего на успех всего протезирования и качество стоматологического здоровья. Методика исследования: в клинике ортопедической стоматологии пациенты, нуждающиеся в съемном протезировании, были сформированы на 3 равноценные группы исследования, каждой из которых был предложен определенный алгоритм лечебно - профилактических мероприятий. Для решения поставленной задачи на предмет эффективности авторской методики далее использовали методику макрогистохимической реакции, что позволило оценить состояние слизистой оболочки под базисами съёмных протезов из акрилового полимера через сутки, 7 и 14 дней наложения съемного зубного протеза, также изучали количественный и качественный состав микробиоциноза слизистой оболочки полости рта. Результаты исследования: результаты клинико-микробиологического исследования слизистой оболочки протезного ложа указывают на целесообразность применения предложенной авторами методики ортопедической реабилитации для профилактики дисбиоза полости рта. Заключение : исследования, направленные на изучение данных проблем, особенно важны для повышения эффективности ортопедической реабилитации для снижения стоматологических осложнений у пациентов воспалительного и дисбиотического характера Relevance: it is known that removable orthopedic structures of dentures for a long time are complex irritants of the oral mucosa (SOPR). Competent implementation of the technological stages of manufacturing, timely correction, recommendations for professional and individual hygiene of the oral cavity and the dentures themselves do not always guarantee the absence of microbial colonization on the surface of the bases by conditionally pathogenic and pathogenic representatives and an inflammatory reaction from the tissues of the prosthetic bed. When choosing a basic material as a replacement and restoring structure and during orthopedic treatment in general, the dentist faces the question of preventing complications of a dysbiotic and inflammatory nature. The purpose of this study is to study the influence of the basic material of removable orthopedic structures on the state of the prosthetic bed tissues and to prove the effectiveness of the complex method of prevention of oral dysbiosis proposed by the authors, which affects the success of all prosthetics and the quality of dental health. Research methodology: in the clinic of orthopedic dentistry, patients in need of removable prosthetics were formed into 3 equivalent study groups, each of which was offered a certain algorithm of therapeutic and preventive measures. To solve the problem for the effectiveness of the author's technique, the method of macrohistochemical reaction was further used, which made it possible to assess the state of the mucous membrane under the bases of removable dentures made of acrylic polymer after a day, 7 and 14 days of applying a removable denture, and the quantitative and qualitative composition of microbiocinosis of the oral mucosa was also studied. Results of the study : the results of clinical and microbiological examination of the mucous membrane of the prosthetic bed indicate the expediency of using the method of orthopedic rehabilitation proposed by the authors for the prevention of oral dysbiosis. Conclusion: studies aimed at studying these problems are especially important for improving the effectiveness of orthopedic rehabilitation to reduce dental complications in patients of an inflammatory and dysbiotic nature

Clinical Evaluation of Prosthetics Results for Patients with Dentition Defects with Various Dental Bridges Designs

The article presents the study results of clinical effectiveness of orthopedic rehabilitation for patients with dentition defects with different designs of implant-supported dental bridges. The work describes and analyzes complications that occurred during the operation of dental bridges and identifies the optimal design with the most predictable prognosis. The purpose of the study was to evaluate the results of prosthetics in patients with dentition defects with various implant-supported dental bridge designs in different observation terms. Materials and methods. For the clinical investigation we selected 90 patients with dentition free-end defects, who were divided into three groups, 30 patients in each group. Group I patients had dental bridges with cobalt-chromium alloy, faced with feldspar ceramic made, patients of II group – prosthetic constructions on the basis of zirconium dioxide with feldspar ceramic coating, patients of III group – zirconium dioxide framework with following press-ceramic coating. Oral hygiene index OHI-S and Leus comprehensive periodontal index, compliance of the fabricated dental bridges with clinical requirements, and the most common complications that occurred during the use of these fixed prostheses were evaluated for all patients. Results. After 36 months, we found that the highest mean value of OHI-S index was in patients of group I, specifically 1.24±0.19 points. Significantly (p<0.05) lower this index was in patients of group II – 0.64±0.09 points. Minimal OHI-S index was found in group III patients, being at 0.43±0.04 points, it was significantly (p<0.05) different from indicators of group I and group II patients. The mean values of comprehensive periodontal index also differed significantly (p<0.05) in all groups, their indices ranged between 1.24±0.21 points, 0.35±0.03 points and 0.24±0.02 points, respectively. Group II patients' orthopedic constructions turned out to be the most effective, with 96.7% of the prostheses having no malfunctions after 3 years of use. The only violation that occurred in this group was full fracture of intermediate part of one dental bridge. The number of dental bridges that functioned without complications in groups I and III during the same term was 70.0% and 90.0%, respectively. Among the complications, the most frequently observed were chipping of the aesthetic coating of the prosthesis, integrity and retention violations of the dental bridges in different terms. The worst hygienic and comprehensive periodontal indexes were recorded in patients with metal-ceramic dental bridges. Conclusion. The use of zirconium dioxide frameworks and veneered feldspar ceramics provides the most reliable functioning of fixed implant-supported dental bridges and the minimum number of complications in the observation period of 36 months

Determination of occlusal connections in patients with congenital cleft lip and palate before and after their orthopedic rehabilitation

The aim of this study was to define and analyze the reproducibility of occlusal relationships according to the results of occlusogram in jaw closure using quantitative analysis of occlusion in adult patients with congenital cleft lip and palate before and after their prosthesis with different versions of dentures and types of their constructive features. Materials and methods. The study was conducted on 37 patients with congenital cleft lip and palate, 11 (29.73 %) of whom had right-sided clefts, 11 (29.73 %) – left-sided and 15 (40.54 %) – bilateral. The number of occlusal contact points was measured for all patients before the treatment and after the orthopaedic rehabilitation. Research results. Significant differences were found between the number of occlusal contact points before (unusually small number) and after orthopaedic treatment (significant increase), regardless of the type of cleft (p<0.001). Such conditions in the oral cavity significantly complicate the tactics of orthopaedic rehabilitation, which affects the need to find more complex options for combinations of fixed and removable orthopaedic structures. Conclusion. Based on the conditions and objectives of this study, the application of the basic principles of a multidisciplinary approach determine the possibility of rehabilitation of such patients by orthopedic methods by making different versions of orthopedic structures. Adequate and high-quality prosthesis for defects and deformations of the teeth rows and occlusion in patients with CCLP leads to improved occlusal relationships and increase in the number of occlusal contact points.

Efficacy of wrist robot-aided orthopedic rehabilitation: a randomized controlled trial

Background In recent years, many studies focused on the use of robotic devices for both the assessment and the neuro-motor reeducation of upper limb in subjects after stroke, spinal cord injuries or affected by neurological disorders. Contrarily, it is still hard to find examples of robot-aided assessment and rehabilitation after traumatic injuries in the orthopedic field. However, those benefits related to the use of robotic devices are expected also in orthopedic functional reeducation. Methods After a wrist injury occurred at their workplace, wrist functionality of twenty-three subjects was evaluated through a robot-based assessment and clinical measures (Patient Rated Wrist Evaluation, Jebsen-Taylor and Jamar Test), before and after a 3-week long rehabilitative treatment. Subjects were randomized in two groups: while the control group (n = 13) underwent a traditional rehabilitative protocol, the experimental group (n = 10) was treated replacing traditional exercises with robot-aided ones. Results Functionality, assessed through the function subscale of PRWE scale, improved in both groups (experimental p = 0.016; control p < 0.001) and was comparable between groups, both pre (U = 45.5, p = 0.355) and post (U = 47, p = 0.597) treatment. Additionally, even though groups’ performance during the robotic assessment was comparable before the treatment (U = 36, p = 0.077), after rehabilitation the experimental group presented better results than the control one (U = 26, p = 0.015). Conclusions This work can be considered a starting point for introducing the use of robotic devices in the orthopedic field. The robot-aided rehabilitative treatment was effective and comparable to the traditional one. Preserving efficacy and safety conditions, a systematic use of these devices could lead to decrease human therapists’ effort, increase repeatability and accuracy of assessments, and promote subject’s engagement and voluntary participation. Trial Registration ClinicalTrial.gov ID: NCT04739644. Registered on February 4, 2021—Retrospectively registered, https://www.clinicaltrials.gov/ct2/show/study/NCT04739644.

Fabrication and Use of a Customized Provisional Composite Abutment in Dental Practice

Introduction. Reducing the time of implant integration and the period of prosthetics is an important task of dentistry since this leads to improved quality of life and successful rehabilitation of the patient. Therefore, currently, there is an intensely increased interest in immediate or early loading of the implant, when certain parameters of primary implant stability in the bone tissue are achieved. Materials and Methods. The materials used to perform the procedure for placement of a customized provisional composite abutment were a provisional prefabricated abutment with a retention grip for the composite; aluminum oxide powder with a particle size of 27 μm for better adhesion of the composite, with which the retention grip of the provisional abutment is coated; 3M Single Bond Universal light-curing adhesive applied to the provisional abutment; and Filtek Bulk Fill 3M composite including a low-viscosity radiopaque nanocomponent and ytterbium trifluoride filler with a particle size of 0.01–3.5 nm. Methods used in this study were as follows: fabrication technique using the Cervico system for a customized provisional composite abutment; sandblasting of the provisional abutment using the apparatus RONDOFLEX (KERR); light polymerization of low-viscosity composite using Demi Ultra Kerr lamp (luminous flux power not less than 1100 mW/cm2); and radiographic control of the abutment fit in the implant. Results. The surgical and orthopedic treatment of 20 patients was performed using this technique. The control group consisted of 11 patients with similar pathology, in whose surgery the fabrication of a provisional prosthesis was used. As a result, it was possible to form a gingival profile, in comparison with the control group, to accelerate mucogingival and bone integration, as well as to quickly carry out orthopedic rehabilitation of the patient. The average value of the time required for the final formation of soft tissues for prosthetics in patients in the experimental group was significantly lower than those in the comparison group ( p = 0.007 and p = 0.028 , respectively). In most clinical cases, there is no need for surgery on soft tissues, which eliminates the possibility of additional traumas. Conclusions. The use of a promising technology for the fabrication of a crown on the implant and a customized provisional composite abutment significantly reduced the period of orthopedic rehabilitation of the patient. Immediate implantation with a customized provisional composite abutment completely forms the gingival profile, reduces the risk of microbial contamination in the area of bone formation, minimizes soft tissue ischemia, and accelerates the processes of mucogingival and bone integration around the implant.

Systematic Team-Approach Rehabilitation After Knee Fracture Surgery Is Associated With Better Functional Outcomes

Purpose In Western developed countries, patients commonly receive rehabilitation after orthopedic surgery to improve functional dysfunction. In China, however, rehabilitation is widely neglected. An appropriate perioperative rehabilitation model for early orthopedic rehabilitation is urgently needed in China. We evaluated the outcomes of perioperative rehabilitation patterns and promoted the functional recovery of orthopedic patients in China. Methods 668 patients from 9 centers who underwent internal fixation surgery because of knee joint fracture were assigned to 2 groups: 1) control group: received the standard postoperative treatments, or 2) trial group: received perioperative rehabilitation in team-based approach. The visual analog scale (VAS), Hospital for Special Surgery (HSS) knee and Berg Balance Scale (BBS) scores were assessed 12 and 24 weeks postoperatively. Results The VAS scores at 12 and 24 weeks postoperative showed that the trial group had significantly less pain than control group (P < 0.001). Compared to the control group, the trial group had significantly better HSS knee scores at 12 weeks (P < 0.05) and significantly better BBS scores at both 12 and 24 weeks postoperative (P < 0.05). Conclusions Compared to common postoperative treatments, patients with systematic team-approach rehabilitation had better functional outcomes and pain relief after knee fracture surgery.