No abstract

Relevance. Treatment of the temporo-mandibular joint (TMJ) dysfunctions still stays an urgent issue of modern stomatology. Its significance is predisposed for its high incidence and annual increase in patients’ referrals as well as diversity of it clinical manifestations, complexity of diagnosis and treatment, variability of clinical pattern, which requires a multi-disciplinary approach. According to Ukrainian and foreign authors, the TMJ pathologies take up the third place after caries and parodontal diseases, being diagnosed in 20 % of children and almost 87 % of adults. The share of patients with the TMJ dysfunction increases every year. The 79 % are represented with the intra-capsular disorders of the temporo-mandibular joints. The study was necessitated by the fact that there is still no single agreement in the treatment methods and definite treatment protocols regarding the intracapsular TMJ disorders. Objectives: analysis of efficiency of the TMJ intracapsular disorders patients’ treatment using the pathogenetically rationalized conservative and mini-invasive surgical methods. Methods and materials. The study includes the data of 38 patients with complaints of the TMJ region pain and the TMJ dysfunction. All patients were examined according to the common protocol. According to the disorder stage, the patients were administered either the conservative treatment course using the treatment tray on the mandible or maxilla, with the subsequent orthopedic or prosthetic treatment, or the splint therapy with subsequent surgical intervention. Results. Having analyzed the dynamical pattern of the treatment outcomes within the study, it has been detected that the surgical injection correction of the TMJ disorders was effective in all examined patients. To provide for the long-term steady treatment outcome the prosthetic-orthopedic rehabilitation measures were indicated, aimed at preserving the correct occlusion relation. Conclusion. The method of hyaluronic acid preparations injection into the TMJ cavity as a stage of the TMJ dysfunction therapy has proven its effectiveness in all the examined patients. In order to achieve the long-term steady result, the patients were recommended prosthetic-orthopedic rehabilitation for producing and supporting the occlusion relation.

The aim: To detect the main problems regarding available high-quality stomatological service in Ukraine and define their main solutions. Materials and methods: The authors used general scientific methods of synthesis, generalization, scientific data interpreting, systemic approach method, medical statistic method, and analysis of the activity of state and private institutions dealing with stomatological service in Ukraine. The paper is based on the materials of a representative selective study of Ukrainian households, held by the State Committee of Statistics of Ukraine to study people’s self-estimation of their health and the availability of certain medical services. Results: Most citizens of Ukraine (60-80%) are treated in the state/public healthcare sector. Though, during the last century, a decrease in dental visits per citizen in the state and public institutions has been noted, as well as a decrease of all medical service types’ volume, offered in the mentioned institutions. In Ukraine the observed trends are represented as the decrease in the network institutions number, insufficient budgeting of state/public medical institutions, prevailing commercial characteristics of stomatological service and people’s low income, which leads to decreased affordability, and quality of medical service, thus negatively affecting people’s health. Conclusions: The fundamental studies of the quality assessment show that the medical service requires strong structure, process quality, and result quality. The quality of medical service organization is extremely important and it should be maintained high on all levels of management and treatment processes, regarding the conditions of medical process and resources of medical organizations. Medical service should be patient-centered. To solve the problem, the entire state system of quality management is required in Ukraine.

The prevalence of dysfunction of the temporomandibular joint (TMJ), especially in people aged 18-65 years, reached 95-98% among all dental applications. The course of the pathology is usually hidden, with periodic recurrences, and has a long nature, which is accompanied by a decrease in overall quality of life. Treatment of this pathology of the TMJ is a set of complex therapeutic, orthopedic and psychological measures. The literature describes many ways to treat TMJ dysfunction, and one of the modern ones is the use of occlusal splints, which enables to change the position of the mandible, diagnose and eliminate musculoskeletal dysfunction of the TMJ. The aim of the study was to determine the effectiveness of treatment of musculoskeletal dysfunction of the TMJ with occlusal splints according to axiography. Material and methods. 274 patients aged 18 to 65 years were diagnosed with temporomandibular joint (TMJ) pain syndrome before and after treatment.Results. All patients with signs of TMJ dysfunction before treatment had a violation of the trajectory of the mandible (deviation – 68.7%, dyslexia – 31.3%). When opening and closing the mouth, asymmetrical shifts of the lower jaw to the sides of more than 2 mm (deviation from the midline – more than 2 mm) were observed. After treatment with occlusal splints there was an improvement in the trajectory of opening and closing the mouth: the number of patients with a violation of the trajectory decreased by 89.1%, and the displacement of the mandible during opening and closing the mouth in 92.4% of patients decreased on average to 0, 9 mm. When analyzing the movements of the mandible in the sagittal plane in 79 % of cases, deviations of the trajectory of the mandible were detected. After treatment with occlusive muscle relaxation splints, elimination of violations of the trajectory of the mandible in the transverse plane was noted in 93.4% of cases, reduction of displacement to 0.9 mm in 78.1% of patients. Сonclusions. The trajectory of the mandible in the sagittal plane improved in 80.1% of patients, normalization of the position of the mandible relative to the neuromuscular trajectory was achieved in 93.4% of clinical cases. According to the analysis of parameters, such treatment should be considered effective.

The prevalence of dysfunction of the temporomandibular joint, especially in people aged 18-60 years, reached 95-98 % among all dental applications. The course of the pathology is usually hidden, with periodic recurrences and has a long nature, which is accompanied by a decrease in overall quality of life. Treatment of this pathology of the temporomandibular joint is a set of complex therapeutic, orthopedic and psychological measures. The literature describes many ways to treat temporomandibular joint dysfunction, one of the modem ones is the use of occlusal splints, which allow to change the position of the mandible, diagnose and eliminate musculoskeletal dysfunction of the temporomandibular joint. The aim of the study was to determine the effectiveness of treatment of musculoskeletal dysfunction of the temporomandibular joint with occlusal splints according to axiography. 274 patients aged 18 to 65 years were diagnosed with temporomandibular joint pain syndrome before and after treatment. All patients with signs of temporomandibular joint dysfunction before treatment had a violation of the trajectory of the mandible (deviation is 68.7 %, dyslexia is 31.3 %). When opening and closing the mouth, asymmetrical shifts of the lower jaw to the sides of more than 2 mm (deviation from the midline is more than 2 mm) were observed. After treatment with occlusal splints there was an improvement in the trajectory of opening and closing the mouth: the number of patients with a violation of the trajectory decreased by 89.1 %, and the displacement of the mandible during opening and closing the mouth in 92.4 % of patients decreased on average to 0.9 mm. When analyzing the movements of the mandible in the sagittal plane in 79 % of cases, deviations of the trajectory of the mandible were detected. After treatment with occlusive muscle relaxation splints, elimination of violations of the trajectory of the mandible in the transverse plane was noted in 93.4 % of cases, reduction of displacement to 0.9 mm in 78.1 % of patients. The trajectory of the mandible in the sagittal plane improved in 80.1 % of patients, normalization of the position of the mandible relative to the neuromuscular trajectory was achieved in 93.4 % of clinical cases. According to the analysis of parameters, such treatment should be considered effective. Keywords: musculoskeletal dysfunction, temporomandibular joint, clinical dysfunction index, axiography, sagittal articular pathway angle, sagittal incisor pathway angle, Bennett’s angle (movement), duration.