Evaluation of occlusal ratios and masticatory function in patients with maxillary fractures by digital analysis system
DOI:
https://doi.org/10.11603/2311-9624.2021.3.12460Keywords:
Le Fort, maxillary fractures, Tscan, occlusiography, buttressAbstract
Comminuted maxillary fractures in the area of vertical buttresses complicate the process of reduction and fixation, create preconditions for the development of deep functional disorders in the early and late post-traumatic period. Their restoration with the titanium miniplates is the main treatment task of this category of patients.
The aim of the study – to investigate occlusal relationships and determine their changes in patients with maxillary fractures, depending on the applied method of reconstruction of vertical buttresses using digital analysis of occlusion.
Materials and Methods. The study involved 18 patients with multiple midface fractures (15 men and 3 women). Average age 43.8±10.8 g. Analysis of occlusion performed in groups with linear fractures (Gr1, n=6), with bone defects in the area of vertical buttresses (Gr2, n=5) and with restored buttresses using bone autografts (Gr3, n=7). The analysis was carried out using the apparatus and software "T-Scan" company "Tekscan" (Tekscan, Inc., S. Boston, MA, USA). The time of occlusion, disocclusion, and the index of occlusion asymmetry were investigated.
Results and Discussion. Median values of occlusion time, disocclusion, asymmetry index Gr1- (0.17 (0.12 ÷ 0.25), 0.18 (0.15 ÷ 0.19), 12.2 % (8 % ÷ 29.1 %)); Gr2 - (0.29 (0.18 ÷ 0.37), 0.13 (0.12 ÷ 0.20), 28.4 % (16.8 % ÷ 36.8 %)); Gr3 - (0.22 (0.21 ÷ 0.38), 0.11 (0.08 ÷ 0.22), 23.2 % (15.4 % ÷ 29.7 %)) respectively. There was a tendency to increase the occlusion time by 24 %, disocclusion time by 16 % and the degree of asymmetry by 17 % in patients with mandibular fractures accompanied by detachment or cutting of the masticatory muscles and in patients with coronal approach accompanied by exposure of the temporal muscles for the treatment of midface bones fractures.
Conclusions. 1. Factors contributing to worsening functional changes are fractures of the maxilla with defects in the area of vertical buttresses (asymmetry index growth by an average of 13.6 % and occlusion time by 0.1 s), also, trauma of masticatory muscles during the surgical approach. 2. Replacement of vertical buttresses defects with bone autografts improves the restoration of masticatory function in comparison with patients where miniplates were used to fix the fragments at the site of defects, as an independent surgical solution (the mean time of occlusion in this category of patients was 25 % less, and the asymmetry index was less by 19 %).
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