STRUCTURAL AND IATROGENIC DETERMINANTS OF FUNCTIONAL DISORGANIZATION IN TEMPOROMANDIBULAR DISORDERS: A PROGNOSTIC MODEL FOR PERSONALIZED REHABILITATION

Abstract

To determine the pre-rehabilitation morpho-functional profile of patients with temporomandibular disorders (TMD) and to establish independent risk factors for structural changes of the temporomandibular joints (TMJ) for personalized planning of prosthetic rehabilitation. Methods. A crosssectional study of 145 patients with verified TMD (DC/ TMD) was conducted, divided into three groups: I (n=52) – myogenic component, II (n=47) – arthrogenic component, III (n=46) – occlusal-functional component. The control group consisted of 30 practically healthy individuals. A comprehensive clinical and instrumental examination was applied (Kennedy–Applegate classification, TWES 2.0, computer occlusography T-Scan, surface electromyography, cone-beam computed tomography of the TMJ). Multivariate logistic regression analysis was used to determine independent predictors of structural changes of the TMJ. Scientific novelty. Based on a comprehensive clinical and instrumental examination of 145 patients with different clinical components of TMD, quantitative predictors of degenerative changes of the TMJ were identified. It has been proven that the greatest independent contribution to structural remodeling of the joints is made by a decrease in occlusal height >2 mm (OR=2.50; p=0.018), belonging to the arthrogenic group (OR=2.48; p=0.016), and severe pathological tooth wear (OR=1.99; p=0.049). For the first time, the protective role of vital teeth has been demonstrated – an increase in their number by every 5 units reduces the odds of degenerative changes of the TMJ by 24 % (OR=0.76; p=0.015). An original system of pre-rehabilitation stratification by factors D (morphological disintegration), V (biological potential of teeth), S (type of support), O (occlusal stability), E (neuromuscular asymmetry) has been substantiated and implemented, which allows individualizing the tactics of prosthetic rehabilitation depending on the severity of functional disorganization. Conclusions. The arthrogenic component of TMD is associated with the most pronounced morpho-functional disorganization and structural remodeling of the TMJ. The leading modifiable risk factors are loss of vertical occlusal support and severe tooth wear, which substantiates the need for their priority correction. The proposed stratification system by factors D, V, S, O, E allows individualizing the tactics of prosthetic rehabilitation