TACTICS OF THE DENTIST DURING ORTHOPEDIC TREATMENT WITH DIFFERENT PROSTHESIS DESIGNS IN NON-STANDARD CLINICAL SITUATIONS

In the clinic of prosthetic dentistry, when choosing different prosthesis designs, it is mandatory to take into account the condition of the prosthetic bed elements, namely: the presence, number and location of teeth, characteristics of the mucous membrane, and the bone foundation. In some patients, symmetrical bone formations (torus) along the inner surface of the mandible of various shapes and sizes with or without a pronounced undercutes are observed. These alveolar tori do not cause harm to patients, are painless, and patients receive information about their existence when they visit a doctor for a professional examination, the need for dental treatment or oral prosthetics. They do not interfere with the manufacture of fixed structures. The presence of exostoses is a contraindication to prosthetics with removable dentures and requires special surgical training. The quality of denture manufacturing for such patients depends on the condition of the prosthetic bed tissues, the method of taking an impression, the quality of impression and base materials, laboratory stages of dental work, experience in using removable structures, the patient's psychological state, his or her characteristic features and many other factors. The use of removable dentures is complicated due to the occurrence of traumatic denture stomatitis and requires repeated correction of the base. Correction of the dentures to eliminate areas of increased pressure is performed on the day of denture placement, as well as repeatedly during follow-up visits. Particular attention is paid to areas of the denture bed with exostoses under the thin layer of the mucous membrane, the borders of the dentures, and occlusal contacts. The aim of the study was to determine the tactics of a dentist in non-standard clinical situations in the presence of bone formations that change the configuration of the jaws. The tasks included a comprehensive examination of patients, determination of indications for special preparation for prosthetics and justification of the choice of orthopedic treatment method, including prosthetics supported by dental implants. In the course of our work, we analyzed orthopantomograms, computed tomography of jaws with existing bone formations and unfavorable clinical conditions for prosthetics, studied diagnostic models, and performed parallelemetry. In cases where patients have numerous bone formations, it is necessary to align the shape of the alveolar ridge with significant bone removal, which further accelerates the processes of atrophy, complicates or makes prosthetics impossible. In this regard, the dentist's tactics should be flexible in choosing and justifying the method of orthopedic treatment of patients with alveolar torus and exostoses. Cooperation of dentists, orthopedists, surgeons and oncologists should be mandatory.