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PERIODONTOLOGICAL STATUS OF PATIENTS WITH DENTOMAXIMAL ANOMALIES BEFORE ORTHODONTIC TREATMENT

Gum recession is a pathological condition of periodontal tissues, which is manifested by apical displacement of the gingival margin, which has a multifactorial genesis. Patients with this pathology are concerned about aesthetic disorders. Many researchers note the high prevalence of this pathology. Gum recession is observed in all age groups from 45-85%. A special place among the factors contributing to the development of gum recession is occupied by anatomical and physiological features: the biotype of the gums, the volume and bone loss of the alveolar process of the jaw. The need for orthodontic correction has increased in recent years, as the prevalence of dento-maxillofacial anomalies among the adult population is 30-55%. Despite the variety of diagnostic measures that are carried out, the assessment of the periodontal status of patients with occlusal anomalies remains relevant, as it directly affects the quality of the result of orthodontic treatment. 
Purpose and objectives are to analyze the periodontal status of patients with various types of maxillofacial anomalies to improve the effectiveness of diagnosis and planning of orthodontic treatment. 
Materials and methods of research. As part of the study, 240 patients ((27.3%) and women (72.7%) of young age from 15 to 44 years old) with dento-jaw anomalies were examined, who sought orthodontic aid in the children's dental department of the "University Clinical Dental Polyclinic" Uzhhorod National University. Assessment of periodontal status was carried out on the basis of clinical diagnostic methods examination, determination of hygiene indices, measurement of the depth of gum recession and periodontal (periodontal) pockets (Miller (1985), assessment of bleeding (Muhllemann, (1971). Determination of gum biotype was carried out using a set of colored probes Colorvue Biotype Probe (Hu-Friedy, USA), which allows noninvasive classification of biotype into thin, medium, thick and extremely thick. 
Results of the research. It was found that in patients with dento-maxillofacial anomalies, the thin biotype of the gums is most common (60.3% of cases), the average biotype in 37.7% of cases, and the thick biotype in 2% of cases. 
According to the results of the analysis of the gum biotype in various types of dento-jaw anomalies, it was found that patients with a distal bite have a thin gum biotype in 27% of cases, an average biotype in 18% of cases. The patients with a mesial bite have the biotype values which were distributed as follows: 12.5% thin and 5.8% medium; in open bite 11.3% thin and 10.0% medium and in 2% cases thick gum biotype. The patients with a deep bite have the thin biotype which was found in 7% of patients, the average in 1.3%; in case of crossbite thin and medium biotype met with the same frequency in 2.5% of cases. 
Examination of patients with various types of bite anomalies showed that gum recessions of the 1st class (Miller's classification) are found much more often in 57% of cases, and mainly in incisors of the lower and upper jaw (40% of cases), in premolars of both jaws in 17% of cases. The patients with a distal bite of the 1st class of gum recession was 25% and with a mesial bite 15%, and the patients with open, deep and crossbites had the same frequency 4%. We diagnosed gingival recession of the 2nd class only in the region of the incisors of the lower jaw in 10% of cases: in distal bite in 5% of cases, in mesial bite in 3%, open bite in 2%. Grade 3 gum recession was not detected in the patients of the studied groups. In the area of the teeth of both jaws of patients with a distal bite, gingival recession of the 4th class was diagnosed in 32% of cases, and in the area of incisors and premolars in 16% of cases, respectively. According to the study, the majority of patients (58.3%) with dento-jaw anomalies did not have an inflammatory process in the periodontal tissues. All degrees of chronic generalized periodontitis (GGP) were found only in patients with a distal bite, a mild degree was noted in 13% of cases, an average degree in 6.7%, severe in 5% of cases. Mild CPH was detected in patients with mesial bite – in 8.3% of cases, with open bite – in 1.6% of cases, with deep bite – in 1.7%, with crossbite – in 0.8%. CPH of moderate degree was diagnosed in 2.5% of cases in patients with deep bite, in 1.7% of cases with crossbite. 
Conclusion. The patients with maxillofacial anomalies which biotype was determined in the area of the incisors of the lower jaw and it was found that 60.3% of the examined had a thin gum biotype, 37.6% had an average gum biotype, and 2% had a thick gum biotype. Data from our study show that bite anomalies are most often combined with a thin biotype and very rarely with a thick one. The patients of all studied groups with a thin and medium biotype had recession of the gums in the area of the teeth of the upper and lower jaw before the treatment of dento-jaw anomalies. The 1st class of gum recession in the area of the incisors was detected in 40% of cases; the 1st class of recession in the area of premolars 17%; the 2nd class of gum recession in the area of incisors 10%, with 4th class of gum recession localized in incisors and premolars, met with the same frequency in 16% of cases.