IROPZ in dentistry: what is it, definition, classification according to Milikievich

Orthopedic dentistry - the field of dentistry, which allows diagnosing, treating and preventing anomalies, destruction and deformation of the organs responsible for chewing, breathing, the formation of voice and speech. Its primary purpose is the restoration of dental defects, jaw bones and soft tissues of the face by means of all kinds of structures.

In this, a fundamental role is played by the assessment of the condition of the tooth - IROPZ.

What is IROPS?

The root cause of the violation of the integrity of the tooth remains caries. In the course of the pathological process, the hard tissues of the teeth are damaged, their shape is deformed, provoking a failure of speech and chewing functions, the appearance of external defects.

The effectiveness of actions restoring a damaged tooth is due to a number of factors:

• the degree of damage to the coronal region, which is under the influence of the carious process;
• timely access to a dentist;
• correct diagnostics, professionalism and experience of specialists, as well as characteristics of the components involved and technological methods.

Before reconstructing the anatomical shape and functions of the dental tissue, individual preparation is required for each individual case.

For example, Black's operative effect on hard tooth tissues consists in removing the enamel left without dentin, and in the shortening of the tubercle, damaged by more than 2/3 of the interval from the median fissures to its top. Such an action will postpone a possible fracture of the tooth crown to a later period.

When crossing the contact surface with the chewing one, it is important to try to protect the area of ​​resistance according to Black, providing some stability to the teeth upon completion of the restoration and excluding the fracture of the filling due to the load during chewing.

In the course of calculating the damage factor of the zone occlusions of chewing teeth with malfunctions of groups 1-2 and the selection of a prosthetic model, it is recommended to use the index of destruction of the occlusal surface of the teeth (IROPZ), developed in 1984. scientist Milikevich V. NS.

Its use guarantees a relatively high precision of experiments. Nevertheless, the method is very painstaking, it takes a lot of time to organize it due to the large number of its stages (taking an impression, selecting and creating a model, calculating the area and calculating the index). Recently, computer technologies have been actively used in calculating the index.

Direct methods of establishing the IROPZ index are mainly reflected in practical health care. These include: the visual value of IROPZ and its calculation according to the anatomical indications of the occlusion surface. They are often used by specialists in the selection of options and methods of reconstruction.

IROPZ in dentistry is defined as the ratio of the "cavity - filling" area to the chewing tooth surface. It can be calculated by taking the total area of ​​the occlusion of the tooth as a unit.

With the introduction of the latest techniques and materials, the chances of reconstructing the crown zone of the tooth in orthopedic dentistry have significantly expanded, and its functional significance has increased.

The selection of a tooth restoration method is influenced by:

• the existence and position of antagonists;
• degree of bite;
• oral hygiene.

Teeth are restored either by filling or by prosthetics (using a tab, artificial crowns, designs with a pin), using the IROPZ index.

Based on the classification of IROPZ, it is possible to consider the main stages of damage to the hard dental membranes:

• 1 degree - from 0.2 to 0.4 - filling is applied;
• Grade 2 - IROPZ ranges from 0.5 to 0.6 (the defect of the occlusion area is more than 50%), in order to prevent subsequent destruction, the method should be applied tabs;
• Grade 3 - index in the range of 0.6 - 0.8 (damage exceeds 60%) - filling with involvement is recommended artificial crowns;
• 4 degree - the index value is higher than 0.8 (destruction of the occlusion zone over 80%) - manufactured pin models and crowns.

In all these cases, as well as in order to exclude the curvature of the dentition (with adjacent teeth with fillings that recreate more than half of the chewing zone), prosthetics are recommended.

Clinical Evaluation Study of the Restoration

The clinical study of treatment outcome involves the use of a variety of assessment criteria. Modern experts are trying to develop a holistic approach to checking the quality of dental restoration operations.

The most important features of a high-quality dental service with the use of an aesthetic restoration include: the qualifications of a doctor, esthetics that recreate the shape and color of the tooth, restoration of chewing function, a long period of operation of the restoration - up to 8 years.

The system of clinical criteria uses the methodicality of rating scales, any of which expresses the clinical need and the level of reversal in fact. Within the framework of a common feature, any discrepancy is indicated by an individual letter, and the subsequent tactics of the doctor depend on the assessment code.

The first step is the analysis of the reconstruction carried out. Then the recorded state should be concretized using a more detailed assessment. The impracticability of restoration actions implies the need to replace it with another option, and the level of damage is determined by a specialist by the need for emergency intervention.

When restoring, it is important to take into account the patient's age, the configuration and condition of the antagonists, the position and abrasion of adjacent teeth.

The service life of the restorations and their effectiveness is due to the professional experience of the orthodontist, mastering the pros and cons of the technology used and the analysis of a separate clinical sign in relation to the entire constructions.

The quality of dental restoration can be assessed by individual indicators:

• marginal fit;
• tooth anatomy;
• position of the restored surface and contact point;
• the presence of deficiencies (breakages, cracks, chips);
• color, color variety along the edge of restoration;
• reaction to restoration actions pulp;
• repeated caries.

Optimal marginal fit assumes the absence of imperfections along the entire perimeter of the restoration or small gaps that do not destroy hard dental tissues in any way. It is influenced by the nature of the prepared surface, the quality of bonding, the stage of hardening and polymerization of heliomaterials.

To assess the result of the restoration, its contour is also examined. In the part of the neck of the tooth, damage to the gingival papilla is provoked by an underestimated contour, therefore, in practice, it is preferable to use convex matrices and retraction threads.

A separate place is allocated in the work of the orthodontist and the contact point. It has been noted that if it is properly installed, the floss will hardly be able to break through between the teeth.

Occlusal dental loads, reconstructed composite, suggest the development of stress in both tension and compression. The maximum stress occurs on the edge of the restoration and on the surface of the enamel-composite, therefore wear also usually occurs on the edge.

As a consequence of stress, cracks form under the surface, provoking the appearance of cracks. They, in turn, cause the development and occurrence of secondary caries, color metamorphosis, spalling.

Based on the results of IROPZ, research and experiments, with a high-quality restoration, the formation of materials with a reduced intensity of tensile and shear stress is predicted. This reduces the pulling force that causes subsurface cracking.

Restoration of the anatomy and function of the tooth is considered the primary task of the orthodontist during restoration. Aesthetic dental treatment is central to enhancing the patient's sense of well-being, emotional stability, perception of others and in relationships with them.

Correctly organized restorative dental treatment significantly affects the psychology and quality of life of patients.