Methods of prosthetic dentistry

Physiological and morphological basis of prosthodontics

Successful prosthodontic treatment is impossible without a foundation in the normal physiology and histology of the maxillofacial region. The doctor works daily with a unified functional system that includes mastication, swallowing, speech production, and salivation. Understanding the biomechanics of the masticatory muscles and the kinematics of the temporomandibular joint forms the basis of gnathology and occlusion diagnostics.

Any intervention that alters the shape of the dental arches or the hard palate inevitably affects articulation and the act of swallowing. Furthermore, when preparing for prosthetics, it is important to consider the hydrodynamic theory of dentinal pain in order to correctly interpret the patient's complaints and select adequate pain management methods.

From a morphological perspective, a prosthodontist must have a detailed understanding of the structure of the prosthetic bed mucosa. It is subdivided into masticatory, lining, and specialized mucosa. It is precisely these histological nuances that dictate the choice of the optimal design and material for the future prosthesis.

Conservative treatment methods for internal TMJ disorders

Therapy for joint pathologies requires a multidisciplinary approach involving prosthodontists, orthodontists, and maxillofacial surgeons. At initial stages, non-surgical techniques demonstrate high efficacy:

• Prosthodontic and orthodontic measures. These include bite correction and rational dental prosthetics to restore normal occlusion.
• Appliance-based treatment. The use of therapeutic splints, occlusal guards, and trainers.
• Medication support. When synovitis develops, nonsteroidal anti-inflammatory drugs (diclofenac sodium, nimesulide) and complex homeopathic remedies (Traumeel S, Zeel T) are prescribed.
• Physiotherapy and rehabilitation. After acute inflammation subsides, physical therapy procedures and a course of myotherapy are indicated.

Specific methods are used for complications. For example, masticatory muscle spasms are relieved by transcutaneous electrical nerve stimulation (TENS), and in cases of recurrent disc displacement with transient joint locking, blocks of the motor branches of the trigeminal nerve are used. Even if the disc cannot be reduced due to adhesions or changes in its shape (as confirmed by MRI), adequate conservative therapy reliably relieves pain, eliminates synovitis, and improves joint function.

Prosthodontic tactics in TMJ osteoarthritis

Osteoarthritis is accompanied by pronounced changes in the joint elements: the anterosuperior surface of the condyle flattens, may acquire a club-like shape, and osteophytes frequently form in the anterior region.

The basic treatment principle is the elimination of the etiological factor. Most often, degenerative changes are triggered by microtraumas due to the loss of posterior teeth and occlusal disruption. Therefore, rational prosthodontics becomes the primary and most important step.

Additionally, the following are used:

1. Pharmacotherapy (NSAIDs, steroids, chondroprotectors) to control pain and stimulate cartilage repair.
2. Physiotherapy (magnetotherapy, ultraphonophoresis with hydrocortisone) to reduce inflammation.
3. Rheumatologist consultation, if other joints are involved.

In cases of severely impaired jaw function against the background of deforming arthrosis, surgical intervention is indicated: disc plasty and remodeling of the mandibular condyle with the removal of deformed areas.

Minimally invasive joint surgery

If conservative methods of prosthodontics yield no results, the patient is referred to the inpatient department for minimally invasive surgeries.

• TMJ lavage. The procedure is performed under local anesthesia. The doctor punctures the upper compartment of the joint and irrigates it with special solutions. This allows for expanding the joint space, breaking down adhesions, and cleansing the cavity of fibrous strands and inflammatory byproducts. The main goal of lavage is to create anatomical and physiological conditions for the articular disc to return to its correct position.
• Arthroscopy. Used for the majority of internal joint disorders as the next stage of treatment if non-invasive and puncture techniques prove ineffective.

Class and exam questions

What else to study on this topic

• Hydrodynamic Theory of Dentin Pain and Pulp Innervation
• Histological structure of the enamel-dentin junction and odontoblasts
• Facial embryogenesis and mechanisms of congenital cleft formation
• TMJ pain dysfunction syndrome and its classification according to ICD-DA
• Diagnostics of sialadenitis and Sjögren's syndrome in an outpatient setting

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.