DEVELOPMENT AND CLINICAL EVALUATION OF AN ORTHODONTIC TREATMENT METHOD FOR DISTAL OCCLUSION USING DIGITALLY FABRICATED POSITIONING OCCLUSAL OVERLAYS

Relevance. In adult patients with distal occlusion, correction of sagittal relationships is often performed against the background of a functionally unfavorable position of the mandible. Objective. To develop a method of orthodontic treatment of distal occlusion using digital positioning occlusal pads and evaluate its clinical effectiveness. Materials and methods. The prospective before–after study included 30 patients aged 21-43 years (29.4 ± 5.9 years) with distal occlusion. After a comprehensive diagnosis, the therapeutic position of the lower jaw was determined, an intraoral scan was performed, individual pads were modeled in Exocad, and treatment with aligners was performed. Clinical manifestations of TMJ dysfunction, parameters of articular spaces according to CBCT data, electromyographic parameters, sagittal fissure, depth of incisor overlap, occlusal relationships and structural stability were evaluated. The differences at p < 0.05 were considered statistically significant. Results. The frequency of TMJ discomfort decreased from 80.0 to 13.3%, the pain intensity decreased from 4.8 ± 1.6 to 0.9 ±0.7 points, and the EMG asymmetry coefficient decreased from 24.7 ±6.8 to 8.9 ±3.4% (p < 0.001). The posterior articular space increased from 1.8 ±0.5 to 3.0 ± 0.4 mm, and the proportion of patients with central articular heads increased from 16.7% to 86.7%. The sagittal fissure decreased from 7.4 ±1.5 to 2.1 ±0.6 mm, the incisor overlap depth decreased from 5.8 ±1.4 to 2.4 ±0.7 mm; molar class I was achieved in 90.0% of patients. Of the 60 pads, 2 chips and 3 cases of debonding were registered. Conclusion. The proposed method provided a significant improvement in occlusal and functional parameters with a low incidence of technical complications. The limitations of the study are the absence of a control group and a short follow-up period.