Justification of approaches to comprehensive orthopedic treatment of patients with wedge-shaped tooth defects accompanied by dentin hypersensitivity

Background. Given the multifactorial etiology and the variety of manifestations of non-carious dental lesions, which, in addition to the visible loss of hard dental tissues, are accompanied by hypersensitivity, there is a need for a comprehensive approach involving both therapeutic and orthopedic measures. The treatment of patients with non-carious lesions, particularly wedge-shaped defects, includes several approaches: direct and indirect restoration of defects, treatment of hypersensitivity, and occlusion optimization. The choice of orthopedic treatment method is determined by clinical manifestations, particularly the degree of damage and clinical complications. The development and justification for the use of modern indirect restorations are relevant as their technology involves minimal preparation of the enamel and dentin when replacing hard tissue defects of non-carious origin. The aim of the study: to improve approaches to orthopedic treatment of patients with wedge-shaped defects of hard dental tissues accompanied by hypersensitivity. Materials and methods. We observed 34 individuals aged 30 to 44, including 16 men and 18 women, with deep cervical and coronal wedge-shaped tooth defects accompanied by hypersensitivity. The control group consisted of 11 age-matched people with intact dental arches and physiological occlusion who had no clinically diagnosed periodontal diseases or carious and non-carious lesions. The search was conducted using standard methodologies. To objectively assess the degree of hard dental tissue sensitivity at different stages of the study, the tooth hypersensitivity intensity index (THII) was used. To determine the degree of non-carious lesions and the optimal depth of preparation, the dentometry method was used with the multifunctional dental device EndoEst-3D. To restore the anatomical shape of teeth with wedge-shaped defects accompanied by dentin hypersensitivity, vestibular partial crowns and metal-free jacket crowns were applied. Orthopedic treatment was carried out after traditional oral sanitation and comprehensive professional oral hygiene. Results. The results of the dentometric study indicate significant differences in the distance from the prepared surface to the pulp chamber of vital teeth between the groups at the measurement points (p < 0.05). In particular, in individuals from clinical group I, as a result of deep total tooth preparation required by the crown fabrication technique, the thickness of the dentin above the pulp in the points of the incisal edges of canines, incisors, and the buccal cusp of premolars (1.91 ± 0.05 mm) differed significantly from the measurements in clinical group II (p < 0.05), which increases the risk of reactive changes and complications in the pulp. After preparation for the vestibular partial crowns, a significantly greater layer of dentin remains over the pulp at the measurement points compared to jacket crowns, where deep total preparation of the tooth coronal part is required (2.47 ± 0.06 mm versus 1.91 ± 0.05 mm, respectively, p < 0.05). The dentin reaction to deep total preparation is significant, as confirmed by the reliably different values when comparing the THII in the first (2.39 ± 0.03 points) and second clinical groups (1.83 ± 0.04 points) (p < 0.05). Tooth sensitivity in the second clinical group after treatment was 0.27 ± 0.08 points, showing significant differences compared to pre-treatment values and approaching the control group. This indicates a positive outcome of the proposed treatment for patients with non-carious hard tissue lesions (wedge-shaped defects) accompanied by hypersensitivity (p < 0.05). Follow-up examinations at 6 months showed that the THII remained stable and did not significantly differ from that recorded immediately after treatment. Conclusions. A comprehensive analysis of the examination and treatment results in clinical groups I and II allowed to conclude that orthopedic treatment of individuals with deep cervical and crown wedge-shaped defects complicated by hypersensitivity should be conducted by replacing the hard tissue defects with vestibular partial crowns. This method requires significantly less reduction of hard tissues and helps avoid complications in the pulp while providing aesthetic outcomes and eliminating increased tooth sensitivity.