THE CHOICE OF THE METHOD OF RESTORATION OF DAMAGE TO THE HARD TISSUES OF THE VITAL TEETH OF THE LATERAL AREA DEPENDING ON THE LOCATION, VOLUME, OCCLUSAL LOAD AND DEPTH OF THE DAMAGE

Abstract

Introduction. Preparation of the cavity of the teeth of the lateral area is often associated with a decrease in the fracture strength of the teeth. Choosing the right restoration design and cavity preparation is complex because it involves esthetic, biomechanical, and anatomical considerations. Preventing resistance to the destruction of a tooth with a large loss of hard tissues due to the preparation of a carious cavity is a significant problem. The selected material can be composite or ceramic. Advanced composite materials have excellent characteristics and broad application prospects and are in great demand in recent years. Among the options available, ceramic restorations can be an alternative material for lateral teeth with significant loss of tooth structure. Compared to composite restorations, they have superior esthetics, chemical strength, biocompatibility, and resistance to compression and wear. Other factors to consider are the type of restorative technique (i.e., direct, semidirect, or indirect), the amount and quality of residual tooth structure, mechanical forces on the residual structure, presence of defects, and parameters for extending the preparation to the esthetic zone. Goal. To evaluate the resistance to destruction and compare the quality of self-made direct and indirect restorations of hard tissues of living teeth of the lateral area in the dynamics of use depending on the location of the defect, occlusal load, volume of the defect and depth of the lesion according to the LOV/DD systematization. On the basis of the obtained data, propose optimal methods of restoring damage to the hard tissues of the vital lateral teeth. Research material and methods. Replacement of tooth tissue defects was performed in 98 patients (129 vital teeth). Depending on the location of the defect, the occlusion load, the volume of the defect and the depth of the lesion according to the LOV/DD systematization. Depending on the method of treatment, the groups were further divided into subgroups A – replacement of the defect was performed by direct nanohybrid composite restoration (Dentsplay Spectra nv), B – restoration of lateral teeth was performed by an indirect method using CAD/CAM technology using ceramic CAD-blocks based on IPS lithium disilicate e.max CAD, Ivoclar Vivadent, C – the prepared cavities were filled with nanohybrid material, the teeth were prepared and full ceramic lithium disilicate crowns were made using the CAD/CAM method. The clinical quality of direct and indirect restorations was evaluated 1 week after the installation of the restoration and in the long term (12, 24, 36 months) using visual-instrumental control according to the recommendations of the revised FDI criteria for the evaluation of direct and indirect dental restorations (2023). The level of success of restorations was calculated by dividing the scores into sufficient (scores 1–3) and insufficient (scores 4 and 5). The results. In the 1st group, modern nanohybrid composites are not inferior in quality to indirect ceramic restorations in all periods of observation. In the II group, the effectiveness of using direct and indirect restorations depended on the depth of dentin damage. With moderate damage to the dentin with a cavity depth within the middle third of the dentin, direct and indirect restorations showed the same effectiveness. At the same time, with deep damage to the dentin, indirect restorations proved to be more reliable. In the III group, the use of direct restorations turned out to be completely ineffective after 36 months with negative results in 66.7% of patients. At the same time, the strength of teeth restored with a ceramic inlay was the same as that of normal intact teeth. When using indirect restorations, slightly better indicators were obtained during the manufacture of inlays, which can be explained by the maximum preservation of hard tooth tissues in the case of their manufacture. Conclusions. The choice between direct and indirect dental restorations is chosen individually for each patient and depends on several factors, including the condition of the tooth, extent of damage, aesthetic requirements, functional needs and longevity of use.