Assessment of the state of microhemodynamics in the supporting tissues during prosthetics with the use of implants on the lower jaw with complete absence of teeth

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Authors

  • F.F. Losev 1, PhD in Medical Sciences, full professor, director
    ORCID: 0000-0002-9448-9614
  • E.K. Krechina 1, PhD in Medical Sciences, full professor of the Functional diagnostics Department
    ORCID: 0000-0003-2936-0707
  • M.M. Kayugin 1, PhD candidate at the Department of functional diagnostics
  • 1 Central research institute of dental and maxillofacial surgery, 119021, Moscow, Russia

Abstract

Purpose of work — study of microhemodynamics in the mucous membrane of the alveolar ridge during removable prosthetics with the use of implants.
Materials and methods.
A clinical and functional study of the state of microhemodynamics in supporting tissues was carried out in 60 people aged 50 to 65 years (55.5±2.5, 31 men and 29 women) with a diagnosis of complete loss of teeth (K08.1) in the lower jaw in orthopedic treatment based on dental implants, which were divided into 2 groups: I group (29 people) — using removable structures with fixation using a lock (locator type), II group (31 people) — removable dentures with fixation on telescopic crowns. To study the state of microcirculation in the mucous membrane of the alveolar ridge, the method of laser Doppler flowmetry (LDF) was used using a LAKK-M device (Lazma, Russia). At the same time, the index of microcirculation (M), which characterizes the level of tissue blood flow, was assessed; parameter σ, which determines the fluctuations in the flow of erythrocytes and the shunting index (PS) of the blood flow.
Results.
According to LDF data, it was found that the level of microcirculation in the mucous membrane of the alveolar ridge in response to functional load after fixation of a removable prosthesis with locators (I group) and telescopic crowns (II group) is accompanied by an increase in the level of blood flow (M) and its activity (σ) by 37 and 66%, respectively, and 2.2—2.4 times more, respectively, which indicated the development of hyperemia in the microvasculature and persists up to 3 and 6 months, respectively.
Conclusion.
In orthopedic treatment based on implants in the mucous membrane of the alveolar ridge, microhemodynamics normalization occurs 3—6 months after prosthetics, depending on the design of the supporting elements.

Key words:

microcirculation, removable dentures, implants, telescopic crowns, locators

For Citation

[1]
Losev F.F., Krechina E.K., Kayugin M.M. Assessment of the state of microhemodynamics in the supporting tissues during prosthetics with the use of implants on the lower jaw with complete absence of teeth. Clinical Dentistry (Russia).  2021; 24 (2): 24—28

Introduction

Rehabilitation of patients after complete loss of teeth is one of the urgent problems of modern orthopedic dentistry. The increase in the life expectancy of people, the rejuvenation of the group of persons with complete loss of teeth led to an increase in the requirements for the quality of removable dentures, their aesthetic and functional properties, for the improvement and individualization of removable dentures with complete loss of teeth [1, 2]. A number of works have been devoted to improving the function of complete removable dentures [3—6].

In recent years, in the clinic of orthopedic dentistry, intraosseous implants are increasingly used as supports for dental prostheses [7]. The success of orthopedic treatment depends on a number of factors, and the main ones are careful, correctly carried out diagnostics and drawing up an adequate treatment plan, rational orthopedic treatment [8].

A clinical study of the results of prosthetics has shown that the above factors may not be enough. In this regard, it is of interest to use functional research methods in supporting tissues to predict the results of orthopedic treatment [9—11]. There are known data on the violation of microhemodynamics in the supporting tissues with partial and complete loss of teeth [12—16].

However, an objective assessment of the functional state of the supporting tissues with complete loss of teeth in the lower jaw remains relevant for predicting the immediate and long-term results of orthopedic treatment, since the available information is insufficient.

Objective — study of microhemodynamics in the mucous membrane of the alveolar ridge during removable prosthetics with the use of implants.

Materials and methods

To achieve this goal, a clinical and functional study of the state of supporting tissues was carried out in 60 people aged 50 to 65 years (average age 55.5±2.5 years), 31 men and 29 women, with a diagnosis of complete loss of teeth (K08.1) on the lower jaw during orthopedic treatment based on dental implants, which were divided into 2 groups: group I (29 people, 15 men and 14 women, mean age 56±2.6 years) — using removable structures with fixation using a lock (locator type); group II (31 people, 16 men and 15 women, mean age 57±2.7 years) — in which orthopedic treatment was carried out with the manufacture of removable dentures with fixation on telescopic crowns. The groups were matched for age and sex.

Inclusion criteria: complete loss of teeth in the lower jaw (K08.1), degree of atrophy of the alveolar ridge type II according to the classification of I.M. Oksman, the absence of teeth from 1 to 3 years, the absence of sub- and decompensated general somatic pathology, allergic reactions, cardiovascular pathologies and diseases of the oral mucosa.

Exclusion criteria: partial loss of teeth in the lower jaw, diseases of the cardiovascular system, oral mucosa, or somatic diseases in the stage of decompensation.

Diagnostics of the state of supporting tissues was carried out on the basis of clinical, radiological and functional data.

All patients had complete removable plate prostheses in the upper jaw.

Implantation was carried out using intraosseous implants from Astra Tech (Sweden). Orthopedic treatment was carried out according to the generally accepted method.

To study the state of microcirculation in the mucous membrane of the alveolar ridge, the method of laser Doppler flowmetry (LDF) was used using a LAKK-M device (Lazma, Russia). LDF was performed according to the standard technique, by imposing a sensor in the area of the transitional fold at three points (the frontal region and the area of the chewing teeth of the lower jaw). The state of microcirculation was assessed by the index of microcirculation (M), which characterizes the level of tissue blood flow, the parameter σ, which determines the fluctuations in the flow of erythrocytes. According to the wavelet analysis of LDF-grams, the shunting index (PS) of blood flow was determined.

Results

According to LDF data, before prosthetics in the mucous membrane of the alveolar ridge of the lower jaw, it was found that the level of M blood flow was reduced by 30.8%, which indicated a decrease in tissue perfusion with blood. The activity of blood flow σ was also less than the norm by 37.2%, which indicated a decrease in the level of microcirculation in the mucous membrane of the alveolar ridge.

After fixation of the removable prosthesis in group I, the level of blood flow in the mucous membrane of the alveolar ridge increased by 36.7%, its intensity increased by 2.2 times, which characterized an increase in blood flow in the supporting tissues and was associated with the development of hyperemia (see Table, Fig. 1, 2). The resulting tendency intensified after 2 weeks, which was indicative of increased hyperemia. After 1 month, the blood flow level decreased by 26.4%, remaining higher than the initial values, which indicated the persistence of obstructed blood flow in the microvasculature and venous stasis. After 3 months, the level of blood flow and its intensity decreased, which characterized the tendency for a decrease in hyperemia in the microcirculation system. After 6 months, the indices of microhemodynamics were higher than the initial values, which persisted after 12 months and characterized an improvement in blood circulation in the microvasculature.

After fixation of the removable prosthesis in group II, an increase in the level of blood flow by 66% and its intensity by 2.4 times was also noted, which characterized the development of hyperemia more pronounced in comparison with group I due to functional load (see Table, Fig. 1, 2). After 1 and 3 months, all indicators had a tendency to consistently decrease, and hyperemia was stopped 6 months after fixation of the removable denture. 12 months after prosthetics, the blood flow level was restored (M>26%, σ>5.9%), which was higher than the initial values and indicated an improvement in blood circulation due to the functioning of the prosthetic structure.

According to the data of wavelet analysis of LDF-grams, before prosthetics, the shunting index (PS) exceeded normal values by 1.5—1.8 times, which characterized the prevalence of shunting blood flow over the nutritive one in the mucous membrane of the alveolar ridge and was associated with a lack of functional load. After fixation of the prosthesis in group I, PS tended to increase, which further (after 1 month) increased to an even greater extent and was associated with the development of hyperemia in response to functional load, decreased after 3 months, which characterized an improvement in the functioning of microcirculation, and remained after 6 and 12 months (see Table, Fig. 3).

In group II, after fixation of the construction, PS increased, which characterized an increase in shunting blood flow due to the development of hyperemia in the microvasculature, which intensified after 2 weeks, 1 and 3 months. After 6 months, the PS decreased to normal values, which persisted after 12 months.

Conclusion

In case of orthopedic treatment based on implants in the mucous membrane of the alveolar ridge, depending on the design of the supporting elements, the normalization of microhemodynamics occurs 3—6 months after prosthetics.

Dynamics of microcirculation parameters in the mucous membrane of the alveolar ridge after implant-supported prosthetics
Term I group II group
M, perf. units σ, perf. units PS M, perf. units σ, perf. units PS
Before prosthetics 13.84±1.64 1.57±0.40 1.50±0.15 15.86±0.12 1.30±0.31 1.84±0.05
After fixing the prosthesis 18.93±0.34* 3.46±2.22 1.54±0.19 25.63±1.98 3.14±0.01* 1.95±0.02
In 2 weeks 18.00±1.84 3.05±0.17 2.00±0.20* 23.50±2.48 3.63±0.33 2.50±0.10*
After 1 month 13.93±1.25* 3.35±0.59 2.20±0.10 19.22±0.01 3.40±0.05 2.70±0.20
In 3 months 15.00±1.30 2.99±0.19 1.98±0.18 15.24±0.05 2.23±0.09* 2.50±0.30
In 6 months 17.26±1.28 2.83±0.39 1.60±0.12 15.98±0.12 1.38±0.04* 1.90±0.25*
After 12 months 18.35±2.12 2.50±0.67 1.20±0.15* 19.07±0.18 2.20±0.07* 1.30±0.02*
Intact periodontium 20.00±1.20 2.51±0.60 1.03±0.18 20.00±1.20 2.51±0.60 1.03±0.18
* — compared with the previous period, the differences are statistically significant (p<0,05)
Fig. 1. Microcirculation index (M) in the mucous membrane of the alveolar ridge in patients with complete loss of teeth of the lower jaw after implant prosthetics (I group — locking prostheses, II group — prostheses on telescopic crowns)
Fig. 2. Blood flow intensity (σ) in the dynamics of observation in the mucous membrane of the alveolar ridge in patients with complete loss of teeth in the lower jaw after prosthetics using implants (I group — locking prostheses, II group — prostheses on telescopic crowns)
Fig. 3. Shunting index (PS) in the dynamics of observation in the mucous membrane of the alveolar ridge in patients with complete loss of teeth in the lower jaw after prosthetics with the use of implants (I group — locking prostheses, II group — prostheses on telescopic crowns)

References

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Received

March 30, 2021

Accepted

May 7, 2021

Published on

June 1, 2021