Реабилитация пациентов с полной вторичной адентией и суставной дисфункцией височно-нижнечелюстного сустава
Научно-практический журнал Институт Стоматологии №2 (111), июнь 2026
стр. 43-45
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Аннотация
Реабилитация пациентов с полной вторичной адентией, осложнённой дисфункцией ВНЧС, ограничена погрешностями традиционных методик из-за податливости десны и невозможности оценки кинематики мыщелков. Цель — сравнительная оценка цифрового протокола (аксиография, КЛКТ, интраоральное сканирование) в зависимости от статуса ВНЧС. В контрольную группу (без дисфункции) вошли 40 пациентов (67,4±5,8 года), в основную (с дисфункцией ВНЧС) — 79 пациентов (68,1±6,2 года). После сканирования и изготовления стереолитографических протезов с винтовой фиксацией выполнены КЛКТ и аксиография, данные совмещены в виртуальной среде с определением оптимального положения нижней челюсти, затем проведена имплантация с немедленной нагрузкой. У пациентов основной группы исходно зафиксированы асимметрия сагиттального суставного пути (p=0,021) и больший угол Беннета (p=0,018). Частота послеоперационных окклюзионных коррекций во второй группе — 12,7%, против 4,9% в первой (p=0,042). Адаптация к конструкциям во второй группе длиннее на 9,4±1,8 дня и коррелирует с тяжестью дисбаланса ВНЧС (r=0,74; p<0,01). Заключение: интеграция аксиографии в цифровой протокол эффективна независимо от статуса ВНЧС, но дисфункция требует персонализации окклюзионных настроек и удлиняет адаптацию.
Аннотация (англ)
Rehabilitation of patients with complete secondary edentia complicated by TMJ dysfunction is limited by the inaccuracies of traditional methods due to gingival compliance and the inability to assess condylar kinematics. The objective of this study was to comparatively evaluate a digital protocol (axiography, CBCT, and intraoral scanning) depending on TMJ status. The control group (without dysfunction) included 40 patients (67.4±5.8 years old), while the study group (with TMJ dysfunction) included 79 patients (68.1±6.2 years old). After scanning and fabrication of stereolithographic prostheses with screw retention, CBCT and axiography were performed. The data were combined in a virtual environment to determine the optimal position of the mandible, followed by implantation with immediate loading. In patients of the main group, asymmetry of the sagittal articular path (p=0.021) and a larger Bennett angle (p=0.018) were initially recorded. The frequency of postoperative occlusal corrections in the second group was 12.7% versus 4.9% in the first (p=0.042). Adaptation to the structures in the second group lasted 9.4±1.8 days longer and correlated with the severity of TMJ imbalance (r=0.74; p<0.01). Conclusion: the integration of axiography into the digital protocol is effective regardless of the TMJ status, but dysfunction requires personalization of occlusal settings and prolongs the adaptation.
Ключевые Слова
аксиография, хирургические навигационные шаблоны, полная вторичная адентия, дентальная имплантация, немедленная нагрузка.
Ключевые Слова (англ)
axiography, surgical navigation templates, complete secondary edentia, dental implantation, immediate loading.
Список литературы
1. Дегтярев Н.Е., Мураев А.А., Казарян Г.Г., Мухаметшин Р.Ф., Иванов С.С. Цифровое планирование дентальной имплантации с применением аксиографии у пациента с нефиксированным прикусом // Клиническая стоматология. - 2025. - 28 (1). - С. 78-83.
2. Чхиквадзе Т.В., Рощин Е.М., Бекреев В.В. Сравнительный анализ применения виртуальных и механических артикуляторов в функциональной диагностике // Вестник Российского университета дружбы народов. Серия: Медицина. - 2020. - 24 (1). - С. 38-51.
3. Alqahtani F. et al. Advanced additive manufacturing in implant dentistry: 3D printing technologies, printable materials, current applications and future requirements // Int J. Implant Dent. - 2024. - 42. - e00356.
4. Andrade C.A.S., Mahrouseh N., von der Lippe E., Baravelli C.M., Eikemo T.A., Spijker J., Varga O. Trends and inequalities in age-standardized prevalence rate of edentulism among members of European Union between 1990 and 2021 // BMC Oral Health. - 2025. - 26 (1). - P. 49.
5. Atwood D.A. Reduction of residual ridges: a major oral disease entity // J. Prosthet Dent. - 1971. - 26 (3). - P. 266-279.
6. Auduc C., Douillard T., Nicolas E., El Osta N. Fully Digital Workflow in Full-Arch Implant Rehabilitation: A Descriptive Methodological Review // Prosthesis. - 2025. - 7(4). - P. 85.
7. D'Arienzo L.F., Casucci A., Manneh P. et al. Digital workflow in complete dentures: A narrative review // J. Osseointegration. - 2020. - 12 (4). - P. 139-145.
8. de Sousa Ervolino I.C., Goiato M.C., de Moraes Melo Neto C.L., de Caxias F.P., da Silva E.V.F., Túrcio K.H.L, Dos Santos D.M. Clinical reproducibility of different centric relation recording techniques in edentulous individuals: An observational cross-sectional study // J. Prosthodont. - 2023. - 32 (6). - P. 497-504.
9. Hüe O. Condylar paths during protrusion in edentulous patients: analysis with electronic axiography // J Prosthodont. - 2011. - 20 (4). - P. 294-298.
10. Joda T., Zarone F., Ferrari M. The complete digital workflow in fixed prosthodontics: a systematic review // BMC Oral Health. - 2017. - 17 (1). - P. 124.
11. Li J., Sommer C., Wang H.L., Lepidi L., Joda T., Mendonca G. Creating a virtual patient for completely edentulous computer-aided implant surgery: A dental technique // J. Prosthet Dent. - 2021. - 125 (4). - P. 564-568.
12. Liu Y., Gong M., Tao B., Wu Y., Chen X. Computer-assisted preoperative planning system with an automated registration method in prosthesis-driven oral implantology // Int J. Comput Assist Radiol Surg. - 2024. - № 19. - P. 469-480.
13. Oktay E.A., Karaca N. Digital record of complete edentulous arches: Current status and limitations // Selcuk Dental Journal. - 2023. - 10(3). - P. 613-618.
14. Shetty G., Shetty M. Evaluation and Comparison of Conventional Techniques with the Advanced Axiographic Technique in Recording Condylar Guidance // World J. Dent. -2023. - 14 (12). - P. 1075-1083.
15. Utz K.H., Lückerath W., Schwarting P., Noethlichs W., Büttner R., Grüner M., Fuß E., Stark H. Is There «A Best» Centric Relation Record? Centric Relation Records, Condyle Positions, and Their Practical Significance // Int J. Prosthodont. - 2023. - 36 (3). - P. 262-272.
16. Vemulapalli A., Mandapati S.R., Kotha A., Rudraraju H., Aryal S. Prevalence of complete edentulism among US adults 65 years and older: A Behavioral Risk Factor Surveillance System study from 2012 through 2020 // J. Am Dent Assoc. - 2024. - 155 (5). - P. 399-408.
17. Zailai A., Aldwyyan N.F., Alsaedy M.H., Alasiri A., Alharbi R.K., Alothman A.R., Metwaly A.S. Clinical Effectiveness and Accuracy of Fully Digital Workflows Versus Conventional Methods in Implant-Supported Restorations: A Systematic Review and Meta-Analysis // Cureus. - 2026. - 18 (2). - e102864.
18. Zheng H., Shi L., Lu H., Liu Z., Yu M., Wang Y., Wang H. Influence of edentulism on the structure and function of temporomandibular joint // Heliyon. - 2023. - 9 (10). - e20307.
REFERENCES:
1. Degtyarev N.E., Muraev A.A., Kazaryan G.G., Mukhametshin R.F., Ivanov S.S. Tsifrovoe planirovanie dental’noy implantatsii s primeneniem aksiografii u patsienta s nefiksirovannym prikusom // Klinicheskaya stomatologiya. - 2025. - 28 (1). - S. 78-83.
2. Chkhikvadze T.V., Roschin E.M., Bekreev V.V. Sravnitel’nyy analiz primeneniya virtual’nykh i mekhanicheskikh artikulyatorov v funktsional’noy diagnostike // Vestnik Rossiyskogo universiteta druzhby narodov. Seriya: Meditsina. - 2020. - 24 (1). - S. 38-51.
3. Alqahtani F. et al. Advanced additive manufacturing in implant dentistry: 3D printing technologies, printable materials, current applications and future requirements // Int J. Implant Dent. - 2024. - 42. - e00356.
4. Andrade C.A.S., Mahrouseh N., von der Lippe E., Baravelli C.M., Eikemo T.A., Spijker J., Varga O. Trends and inequalities in age-standardized prevalence rate of edentulism among members of European Union between 1990 and 2021 // BMC Oral Health. - 2025. - 26 (1). - P. 49.
5. Atwood DA. Reduction of residual ridges: a major oral disease entity // J Prosthet Dent. - 1971. - 26(3). - P. 266-279.
6. Auduc C., Douillard T., Nicolas E., El Osta N. Fully Digital Workflow in Full-Arch Implant Rehabilitation: A Descriptive Methodological Review // Prosthesis. - 2025. - 7(4). - P. 85.
7. D'Arienzo L.F., Casucci A., Manneh P. et al. Digital workflow in complete dentures: A narrative review // J. Osseointegration. - 2020. - 12 (4). - P. 139-145.
8. de Sousa Ervolino I.C., Goiato M.C., de Moraes Melo Neto C.L., de Caxias F.P., da Silva E.V.F., Túrcio K.H.L, Dos Santos D.M. Clinical reproducibility of different centric relation recording techniques in edentulous individuals: An observational cross-sectional study // J. Prosthodont. - 2023. - 32 (6). - P. 497-504.
9. Hüe O. Condylar paths during protrusion in edentulous patients: analysis with electronic axiography // J Prosthodont. - 2011. - 20 (4). - P. 294-298.
10. Joda T., Zarone F., Ferrari M. The complete digital workflow in fixed prosthodontics: a systematic review // BMC Oral Health. - 2017. - 17 (1). - P. 124.
11. Li J., Sommer C., Wang H.L., Lepidi L., Joda T., Mendonca G. Creating a virtual patient for completely edentulous computer-aided implant surgery: A dental technique // J. Prosthet Dent. - 2021. - 125 (4). - P. 564-568.
12. Liu Y., Gong M., Tao B., Wu Y., Chen X. Computer-assisted preoperative planning system with an automated registration method in prosthesis-driven oral implantology // Int J. Comput Assist Radiol Surg. - 2024. - № 19. - P. 469-480.
13. Oktay E.A., Karaca N. Digital record of complete edentulous arches: Current status and limitations // Selcuk Dental Journal. - 2023. - 10(3). - P. 613-618.
14. Shetty G., Shetty M. Evaluation and Comparison of Conventional Techniques with the Advanced Axiographic Technique in Recording Condylar Guidance // World J. Dent. -2023. - 14 (12). - P. 1075-1083.
15. Utz K.H., Lückerath W., Schwarting P., Noethlichs W., Büttner R., Grüner M., Fuß E., Stark H. Is There «A Best» Centric Relation Record? Centric Relation Records, Condyle Positions, and Their Practical Significance // Int J. Prosthodont. - 2023. - 36 (3). - P. 262-272.
16. Vemulapalli A., Mandapati S.R., Kotha A., Rudraraju H., Aryal S. Prevalence of complete edentulism among US adults 65 years and older: A Behavioral Risk Factor Surveillance System study from 2012 through 2020 // J. Am Dent Assoc. - 2024. - 155 (5). - P. 399-408.
17. Zailai A., Aldwyyan N.F., Alsaedy M.H., Alasiri A., Alharbi R.K., Alothman A.R., Metwaly A.S. Clinical Effectiveness and Accuracy of Fully Digital Workflows Versus Conventional Methods in Implant-Supported Restorations: A Systematic Review and Meta-Analysis // Cureus. - 2026. - 18 (2). - e102864.
18. Zheng H., Shi L., Lu H., Liu Z., Yu M., Wang Y., Wang H. Influence of edentulism on the structure and function of temporomandibular joint // Heliyon. - 2023. - 9 (10). - e20307.
2. Чхиквадзе Т.В., Рощин Е.М., Бекреев В.В. Сравнительный анализ применения виртуальных и механических артикуляторов в функциональной диагностике // Вестник Российского университета дружбы народов. Серия: Медицина. - 2020. - 24 (1). - С. 38-51.
3. Alqahtani F. et al. Advanced additive manufacturing in implant dentistry: 3D printing technologies, printable materials, current applications and future requirements // Int J. Implant Dent. - 2024. - 42. - e00356.
4. Andrade C.A.S., Mahrouseh N., von der Lippe E., Baravelli C.M., Eikemo T.A., Spijker J., Varga O. Trends and inequalities in age-standardized prevalence rate of edentulism among members of European Union between 1990 and 2021 // BMC Oral Health. - 2025. - 26 (1). - P. 49.
5. Atwood D.A. Reduction of residual ridges: a major oral disease entity // J. Prosthet Dent. - 1971. - 26 (3). - P. 266-279.
6. Auduc C., Douillard T., Nicolas E., El Osta N. Fully Digital Workflow in Full-Arch Implant Rehabilitation: A Descriptive Methodological Review // Prosthesis. - 2025. - 7(4). - P. 85.
7. D'Arienzo L.F., Casucci A., Manneh P. et al. Digital workflow in complete dentures: A narrative review // J. Osseointegration. - 2020. - 12 (4). - P. 139-145.
8. de Sousa Ervolino I.C., Goiato M.C., de Moraes Melo Neto C.L., de Caxias F.P., da Silva E.V.F., Túrcio K.H.L, Dos Santos D.M. Clinical reproducibility of different centric relation recording techniques in edentulous individuals: An observational cross-sectional study // J. Prosthodont. - 2023. - 32 (6). - P. 497-504.
9. Hüe O. Condylar paths during protrusion in edentulous patients: analysis with electronic axiography // J Prosthodont. - 2011. - 20 (4). - P. 294-298.
10. Joda T., Zarone F., Ferrari M. The complete digital workflow in fixed prosthodontics: a systematic review // BMC Oral Health. - 2017. - 17 (1). - P. 124.
11. Li J., Sommer C., Wang H.L., Lepidi L., Joda T., Mendonca G. Creating a virtual patient for completely edentulous computer-aided implant surgery: A dental technique // J. Prosthet Dent. - 2021. - 125 (4). - P. 564-568.
12. Liu Y., Gong M., Tao B., Wu Y., Chen X. Computer-assisted preoperative planning system with an automated registration method in prosthesis-driven oral implantology // Int J. Comput Assist Radiol Surg. - 2024. - № 19. - P. 469-480.
13. Oktay E.A., Karaca N. Digital record of complete edentulous arches: Current status and limitations // Selcuk Dental Journal. - 2023. - 10(3). - P. 613-618.
14. Shetty G., Shetty M. Evaluation and Comparison of Conventional Techniques with the Advanced Axiographic Technique in Recording Condylar Guidance // World J. Dent. -2023. - 14 (12). - P. 1075-1083.
15. Utz K.H., Lückerath W., Schwarting P., Noethlichs W., Büttner R., Grüner M., Fuß E., Stark H. Is There «A Best» Centric Relation Record? Centric Relation Records, Condyle Positions, and Their Practical Significance // Int J. Prosthodont. - 2023. - 36 (3). - P. 262-272.
16. Vemulapalli A., Mandapati S.R., Kotha A., Rudraraju H., Aryal S. Prevalence of complete edentulism among US adults 65 years and older: A Behavioral Risk Factor Surveillance System study from 2012 through 2020 // J. Am Dent Assoc. - 2024. - 155 (5). - P. 399-408.
17. Zailai A., Aldwyyan N.F., Alsaedy M.H., Alasiri A., Alharbi R.K., Alothman A.R., Metwaly A.S. Clinical Effectiveness and Accuracy of Fully Digital Workflows Versus Conventional Methods in Implant-Supported Restorations: A Systematic Review and Meta-Analysis // Cureus. - 2026. - 18 (2). - e102864.
18. Zheng H., Shi L., Lu H., Liu Z., Yu M., Wang Y., Wang H. Influence of edentulism on the structure and function of temporomandibular joint // Heliyon. - 2023. - 9 (10). - e20307.
REFERENCES:
1. Degtyarev N.E., Muraev A.A., Kazaryan G.G., Mukhametshin R.F., Ivanov S.S. Tsifrovoe planirovanie dental’noy implantatsii s primeneniem aksiografii u patsienta s nefiksirovannym prikusom // Klinicheskaya stomatologiya. - 2025. - 28 (1). - S. 78-83.
2. Chkhikvadze T.V., Roschin E.M., Bekreev V.V. Sravnitel’nyy analiz primeneniya virtual’nykh i mekhanicheskikh artikulyatorov v funktsional’noy diagnostike // Vestnik Rossiyskogo universiteta druzhby narodov. Seriya: Meditsina. - 2020. - 24 (1). - S. 38-51.
3. Alqahtani F. et al. Advanced additive manufacturing in implant dentistry: 3D printing technologies, printable materials, current applications and future requirements // Int J. Implant Dent. - 2024. - 42. - e00356.
4. Andrade C.A.S., Mahrouseh N., von der Lippe E., Baravelli C.M., Eikemo T.A., Spijker J., Varga O. Trends and inequalities in age-standardized prevalence rate of edentulism among members of European Union between 1990 and 2021 // BMC Oral Health. - 2025. - 26 (1). - P. 49.
5. Atwood DA. Reduction of residual ridges: a major oral disease entity // J Prosthet Dent. - 1971. - 26(3). - P. 266-279.
6. Auduc C., Douillard T., Nicolas E., El Osta N. Fully Digital Workflow in Full-Arch Implant Rehabilitation: A Descriptive Methodological Review // Prosthesis. - 2025. - 7(4). - P. 85.
7. D'Arienzo L.F., Casucci A., Manneh P. et al. Digital workflow in complete dentures: A narrative review // J. Osseointegration. - 2020. - 12 (4). - P. 139-145.
8. de Sousa Ervolino I.C., Goiato M.C., de Moraes Melo Neto C.L., de Caxias F.P., da Silva E.V.F., Túrcio K.H.L, Dos Santos D.M. Clinical reproducibility of different centric relation recording techniques in edentulous individuals: An observational cross-sectional study // J. Prosthodont. - 2023. - 32 (6). - P. 497-504.
9. Hüe O. Condylar paths during protrusion in edentulous patients: analysis with electronic axiography // J Prosthodont. - 2011. - 20 (4). - P. 294-298.
10. Joda T., Zarone F., Ferrari M. The complete digital workflow in fixed prosthodontics: a systematic review // BMC Oral Health. - 2017. - 17 (1). - P. 124.
11. Li J., Sommer C., Wang H.L., Lepidi L., Joda T., Mendonca G. Creating a virtual patient for completely edentulous computer-aided implant surgery: A dental technique // J. Prosthet Dent. - 2021. - 125 (4). - P. 564-568.
12. Liu Y., Gong M., Tao B., Wu Y., Chen X. Computer-assisted preoperative planning system with an automated registration method in prosthesis-driven oral implantology // Int J. Comput Assist Radiol Surg. - 2024. - № 19. - P. 469-480.
13. Oktay E.A., Karaca N. Digital record of complete edentulous arches: Current status and limitations // Selcuk Dental Journal. - 2023. - 10(3). - P. 613-618.
14. Shetty G., Shetty M. Evaluation and Comparison of Conventional Techniques with the Advanced Axiographic Technique in Recording Condylar Guidance // World J. Dent. -2023. - 14 (12). - P. 1075-1083.
15. Utz K.H., Lückerath W., Schwarting P., Noethlichs W., Büttner R., Grüner M., Fuß E., Stark H. Is There «A Best» Centric Relation Record? Centric Relation Records, Condyle Positions, and Their Practical Significance // Int J. Prosthodont. - 2023. - 36 (3). - P. 262-272.
16. Vemulapalli A., Mandapati S.R., Kotha A., Rudraraju H., Aryal S. Prevalence of complete edentulism among US adults 65 years and older: A Behavioral Risk Factor Surveillance System study from 2012 through 2020 // J. Am Dent Assoc. - 2024. - 155 (5). - P. 399-408.
17. Zailai A., Aldwyyan N.F., Alsaedy M.H., Alasiri A., Alharbi R.K., Alothman A.R., Metwaly A.S. Clinical Effectiveness and Accuracy of Fully Digital Workflows Versus Conventional Methods in Implant-Supported Restorations: A Systematic Review and Meta-Analysis // Cureus. - 2026. - 18 (2). - e102864.
18. Zheng H., Shi L., Lu H., Liu Z., Yu M., Wang Y., Wang H. Influence of edentulism on the structure and function of temporomandibular joint // Heliyon. - 2023. - 9 (10). - e20307.
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