CRITERIA FOR THE EVALUATION AND ESTIMATION OF IATROGENIC PROSTHETIC FACTORS – SEMIOLOGY AND SYMPTOMATOLOGY

• Main Authors: G. LUCA, Nicoleta Dimcevici-POESINA, S. POPA
• Format: Article
• Language: English
• Published: Academy of Romanian Scientists 2013-12-01
• Series: International Journal of Medical Dentistry
• Subjects: tolerated malocclusions; iatrogenic prosthetic factors; pathological abrasion; pathological dental mobility; dental fractures
• Online Access: http://www.ijmd.ro/articole/335_48_pdf_IJMD%204-2013%20tipo.pdf

Introduction: The principles lying at the basis of a balanced dental occlusion cannot be analyzed separately, but only if considering the teeth (and, implicitly, dental occlusion) as integrated into the masticatory system, which includes the masticatory muscles, the temporo-mandibu‑ lary joint and the maxillary bones. Scope: The scope of the present study was to correlate and establish the interde‑ pendence between the morpholgically-incorrect prosthetic works and the tissular and functional damages suffered by the neighbouring structures, as a result of some incor‑ rectly-made prosthetic works. Also, the study aims at iden‑ tifying the factors and limits responsible for a prolongued maintenance of such irreversible pathological modificati‑ ons within an asymptomatic zone for the patient. Materials and method: The working hypothesis of the present inves‑ tigation started from the analysis of the various objective signs, versus the morphology of the incorrectly performed prosthetic works. The study, initiated as early as 2009, in a private stomatological clinics (DentEstet, Bucuresti), includes a number of 500 patients (250 women and 250 men), selected among the patients having addressed the stomatological office from various reasons (not always related to the prosthetic pathology of the cases here under investigation). Included in the study have been only the patients with fixed prosthetic works associated with one or several of the previously described objective signs, potentially induced by the iatrogeneicity of the prosthetic works. Results: The pathological effects of the iatrogenic works here under analysis, upon both the antagonistic and prosthetic support teeth, may be clinically identified during a minute examination performed prior to produ‑ cing irreversible final effects (abrasions, fractures, dental mobility, etc.). Such noxious effects of the iatrogenic pros‑ thetic works appear as a false masticatory comfort and as a common functional occlusion, tolerated by the patient, even if not in a perfect equilibrium with all components of the dento-maxillary apparatus. Discussion: The present study involved clinical examination and interpretation of the signs induced by iatrogenic prosthetic works. The main contribution to such signs was brought by the abrased antagonistic teeth, which is actually the first symptom in most of the cases. The causes leading to the occurrence of these clincal pathological signs are represented by an incorrect realization of the occlusal morphology (from the part of the dental technician) and by the absence of a pro‑ fessional occlusal equilibrium. The trophic chain of these iatrogenies assumes several stages, starting from the pre‑ paration of the prosthetic dies (the occlusal space), to the impression technique and materials, patterns’ mounting in the articulator (which prevents a complete simulation of the mandibular movements inside the masticatory system), ending with the final modelling of the prosthetic work. Conclusions: Realization of prosthetic works in full, active colaboration with the dental technician and for each case in part, along with a minute analysis of the works made in the oral cavity, may eliminate several of the conditions favourizing the manifestation of some undesired destruc‑ tive factors. Checking of the occlusion at regular time inter‑ vals, as periodical stomatological controls, should become customary for any stomatologist.