Features of the algorithm for managing patients with metabolic syndrome during prosthetics with fixed structures supported by dental implants

Abstract

Inflammatory-destructive manifestations after dental implantation are the most common cause of their loss. Changes in the organs and tissues of the mouth in individuals with metabolic syndrome (MS) are characterized by a long-term chronic course, with deterioration of the hygienic condition, against the background of pathological changes in the periodontium, with disturbances in microcirculation and bone condition. It is also important that the insufficient awareness of doctors of various specialties about the pathogenetic relationship of the somatic and dental pathologies, with the unconductivity of their actions in the treatment of such patients. The aim of the study: Development of an algorithm for managing patients with metabolic syndrome of varying severity during prosthetics with fixed structures supported by dental implants.
Materials and methods.
The study involved 255 patients aged 35 to 65 years. The first group included 95 patients with overweight (pre-obesity) and grade I obesity and two additional criteria of MS, against the background of normal tissue sensitivity to insulin. The second group included 72 patients with grade I or II obesity and additional MS criteria, including arterial hypertension and/or type 2 diabetes mellitus. The comparison group included 88 patients without MS. All patients underwent delayed dental implantation. The periodontal status, jaw bone condition, and gum microcirculation were assessed.
Results.
The index assessment of the periodontal condition showed that in individuals with MS in the study groups, regardless of age, 100% of the patients had periodontal complex tissue pathology of varying severity. A tendency toward a decrease in bone mineral density was determined, with a predominance of bone type 3 and 4. Changes in microcirculation in periodontal tissues during the inflammatory-destructive process are more pronounced, especially in the second group of individuals, which is manifested by a decrease in the level of tissue blood flow to 20.9%, the intensity of tissue blood flow to 46% and vasomotor activity to 33.6%, as a consequence, a decrease in active and passive regulatory mechanisms. The patients were treated according to the algorithm we proposed. The “survival” of dental implants was 100% for the comparison group, 99% for the first group, and 96% for the second group.
Conclusions.
The developed algorithm for the complex preparation of persons with metabolic syndrome during orthopedic treatment of end defects with non -removable constructions on dental implants allows you to achieve stability according to the studied indicators with the predominance of a compensated state, which will ensure a high percentage of osteointegration of DI, and will further achieve the maximum success of the dentisting of the persons from end defects on the background of MS.