RU2784289C1 - Method for objective and subjective quantitative rating of the quality of orthodontic treatment - Google Patents

Abstract

FIELD: dentistry.

SUBSTANCE: invention relates to the field of dentistry, namely, to orthodontics, and is intended for use when rating the quality of orthodontic treatment of maxillofacial anomalies (MFA). A clinical examination of the patient is performed before and after orthodontic treatment. 3D cephalometry data are obtained from cone-beam computerised tomography (CBCT) of the skull before and after treatment. The facial aesthetics, occlusion anomalies in the sagittal, vertical, and transversal directions, and bite characteristics are evaluated. To obtain a subjective rating of the quality of orthodontic treatment, the patients complete the developed questionnaires before and after orthodontic treatment. An objective rating is given by the doctor completing a table indicating the quantitative characteristics of the degree of development of MFA before and after the patient undergoes orthodontic treatment. The analysis of the data from the questionnaires provides an estimated degree of satisfaction of the patient with the quality of orthodontic treatment. The summarised data of objective and subjective ratings is used to make a conclusion about the quality of orthodontic treatment.

EFFECT: due to the quantitative rating of the results of orthodontic treatment and qualitative rating of the degree of satisfaction of patients with the result of orthodontic treatment, the method provides a possibility of estimating the quality of orthodontic treatment, raising the effectiveness of MFA diagnosis and the quality of orthodontic treatment.

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Description

This method relates to the field of dentistry, namely to orthodontics, and is intended to assess the quality of orthodontic treatment of dento-maxillofacial anomalies (DA).

There are various ways of qualitative and quantitative assessment of dentofacial anomalies. They come down to determining the localization of disorders (classification by P. Simon, 1919; V.Yu. Betelman, 1956; D.A. Kalvelis, 1957; V.Yu. Kurlyandsky, 1957; L.V. Ilyina-Markosyan in 1967, H. A. Kalamkarova, 1972; L. S. Persina, 1989; World Health Organization (WHO) in the modification of MGMSU named after A. I. Evdokimov, 1990, PSPbGMU named after academician I.P. Pavlov, 1993), a description of the causes of their occurrence (the etiopathogenetic classification of Kantorovich, 1932), consider the functional state of the dentoalveolar system (Katz 1933), symptoms (Angl's classification, 1889) and quantitative expression of the degree of violations of facial aesthetics, occlusion, morphology and function in various dento-maxillofacial anomalies (the system for the quantitative assessment of dento-maxillofacial anomalies, 2011 "Classification of dentoalveolar anomalies. The system for the quantitative assessment of dentoalveolar anomalies". Fadeev R.A., Ispravnikova A.N., N-L Publishing House, St. Petersburg, 2011. - S. 5-18, 19-32). These methods are classifications of dentoalveolar anomalies and actually reflect the violations identified by the orthodontist.

A known method for quantifying dentoalveolar anomalies, developed by the American Society of Orthodontists - anthropometric scoring system (The ABOM odel Grading System). A system of criteria for the completion of orthodontic treatment based on the assessment of diagnostic models and orthopantomograms is proposed. Measurement of diagnostic models is carried out according to the following ABO parameters:

- alignment of the crowns of the anterior teeth in the vestibulo-oral direction;

- alignment of the crowns of the lateral teeth in the vestibulo-oral direction;

- alignment of the marginal ridges of the lateral teeth in the vertical direction;

- buccal-lingual inclination of the lateral teeth;

- occlusal contacts in the lateral sections;

- occlusal relations in the lateral sections;

- interproximal contacts;

- sagittal fissure.

Using this method of quantitative assessment of the result of orthodontic treatment, it is possible to draw an objective conclusion about the quality of the treatment performed on the basis of measurements of diagnostic models and radiographs, taking into account the criteria of the norm. [The American Board of Orthodontics Grading System for Dental Casts and Panoramic Radiographs. -2012].

The method has a number of disadvantages:

- the degree of severity of signs of anomalies of the dentoalveolar complex before and after orthodontic treatment is not taken into account;

- cephalometric indicators of dentoalveolar anomalies are not analyzed;

- when quantifying the result of orthodontic treatment, the subjective assessment of patients by the quality of treatment is not taken into account. Closest to the proposed one is a method for assessing the quality of orthodontic treatment by comparing the severity of signs of AF before the start of orthodontic treatment and at its completion (Fadeev R.A., Ispravnikova A.N. - RU 2 441 591 C1 IPC A61B 6/14 A61C 19/ 04 2012). By changing the severity of the anomaly, one can judge the effectiveness of the treatment. The function of the masticatory-speech apparatus is assessed, the aesthetics of the face and smile, articulation and occlusion relationships, bite anomalies in the sagittal, vertical and transversal directions, the condition of the periodontal tissues and hard tissues of the teeth, the duration of orthodontic treatment, as well as the condition of the temporomandibular-maxillary joint (TMJ) in patients who have completed orthodontic treatment. The authors proposed an algorithm for the doctor to fill in tables structured in three blocks: assessing the quality of the results of orthodontic treatment, assessing the process of orthodontic treatment, assessing the maintenance of medical records, as a result of which a conclusion is made about the quality of the orthodontic treatment. These techniques allow you to objectively assess the quality of the orthodontic treatment.

The disadvantages of the method are:

- the use of profile teleroentgenograms in a two-dimensional volume, which reduces the accuracy of constructing anthropometric points for obtaining cephalometric measurements;

- assessment of the severity of dentoalveolar anomalies without taking into account the indicators for calculating the control and diagnostic models of the jaws of patients;

- the lack of a subjective assessment of the degree of satisfaction with orthodontic treatment by patients in the analysis of the quality of orthodontic treatment.

The proposed method makes it possible to objectively assess the quality of the orthodontic treatment performed by comparing the severity of signs of AF before the start of orthodontic treatment and after its completion, and also, based on the subjective assessment of patients, to determine how much the implemented treatment plan satisfied their complaints.

The technical result of the method for quantitative objective and subjective assessment of the quality of orthodontic treatment is to increase the efficiency of diagnosing AP and the quality of orthodontic treatment.

The technical result is achieved by the fact that in the method of quantitative objective and subjective assessment of the quality of orthodontic treatment by comparing the indicators of the degree of development of dental anomalies before and after treatment, a conclusion is made about the effectiveness of orthodontic treatment in the form of a percentage. At the same time, based on the results of a survey of patients before and after orthodontic treatment, their degree of satisfaction in the scoring is revealed.

The method is carried out as follows:

Conduct a clinical examination of the patient before and after orthodontic treatment. 3D cephalometry data are obtained by CBCT of the skull and TMJ, control and diagnostic models of the jaws before and after treatment.

The main cephalometric and anthropometric indicators have been selected for the quantitative assessment of AF in three planes (sagittal, vertical, transversal planes):

1. Aesthetic (Up Lip to E-Pin - the position of the upper lip, ∠gl-sn-pg - the angle of the convexity of the facial profile, ∠FH - N' - Pg' - the depth of the face, N-ANS / ANS-Gn - the proportionality of the upper and lower face height).

2. Morphological (∠ANB - ratio of the bases of the upper and lower jaws, the number of Wits-assessment of the disproportion in the development of the apical bases of the upper and lower jaws, Overjet-sagittal fissure, ∠Betta - the ratio of the jaws, skeletal class, ∠A-Pog-I - the severity of protrusion / retrusion of the upper incisors, ∠A-Pog-i - severity of protrusion / retrusion of the lower incisors, ∠ILS / NL - inclination of the upper incisors to the base of the skull, ∠ILi / ML - inclination of the lower incisors to the plane of the lower jaw, ∠SN / MP - inclination lower jaw to the base of the skull, ∠NaBa-PtGn - (FacialAxis-facial angle), ∠ANS-Xi-Pm - the height of the lower third of the face, Me-Me' (N-SNA-ME) - the degree of displacement of the chin from the center line).

3. Occlusal (anthropometric) - the ratio of the dentition (the value of the distal or mesial displacement of the median fissure of the lower first molar from the mesial buccal tubercle of the upper first molar; the contact point of the lower canine and the first premolar relative to the tearing tubercle of the upper canine; sagittal gap between the cutting edges of the lower incisors and the palatal surface of the upper incisors), the size of the incisal overlap, the displacement of the inter-incisor lines, the narrowing of the upper and lower dentition (the distance between the premolars and molars according to Pona's points), the lack of space.

For each indicator, the limits of values corresponding to three degrees are determined. The indicator is assigned 1, 2 or 3 degrees depending on the severity of the deviation from the norm: 1 degree - mild form, 2 degree - medium form, 3 degree - severe form. The doctor enters the numerical values of the indicators and their degree in the table to compare the degree of change in the estimated parameters before and after orthodontic treatment (Table 1). If the value of the parameter corresponds to normal, then "0" is entered in the table cell. To calculate the quantitative assessment, the degrees are equated to points (1 degree \u003d 1 point). The scores obtained according to the indicators before treatment are summed up among themselves and taken as 100%, and the scores after treatment. Then a proportion is drawn up and a mathematical calculation is made:

The sum of all points before treatment - 100%

The sum of all scores after treatment is x,

where x is a numerical indicator of the quantitative assessment of the AFA, which is interpreted as follows:

up to 25% - significant improvement;

26-45% - greatly improved;

46-65% - moderately improved;

66-85% - minimally improved;

86% or more - not improved or worsened.

Thus, the percentage after treatment determines how much the condition of the patient's dentoalveolar system has improved, initially taken as 100%.

To obtain a subjective assessment of the quality of orthodontic treatment, patients are asked to complete questionnaires before and after orthodontic treatment. The questionnaire consists of 31 questions grouped into 3 blocks: block 1 - physical condition, block 2 - psychological state, block 3 - social sphere. The questions are aimed at identifying the severity of complaints in patients before treatment, the dynamics of their changes in the course of treatment and the degree of satisfaction with the result after treatment. Evaluation is carried out on a 4-point system. At the same time, the numbers next to each indicator indicate the quantitative assessment of the identified violations. The digital value "O" means the absence of violations for this indicator, the digital value "4" means the presence of the most pronounced changes in this indicator (Table 2).

The quantitative assessment of the received answers is carried out by summing up the scores for each of the three blocks. To determine the degree of patient satisfaction with the quality of orthodontic care, the score before treatment is taken as 100%, then a proportion and a mathematical calculation are made with the score after treatment:

The sum of all points before treatment - 100%

The sum of all scores after treatment is x,

where x is a numerical indicator of the patient's subjective assessment, which is interpreted as follows:

up to 25% - significant improvement;

26-45% - greatly improved;

46-65% - moderately improved;

66-85% - minimally improved;

86% or more - not improved or worsened. Thus, the percentage after treatment determines the degree of patient satisfaction with the quality of orthodontic treatment.

This method allows, based on the severity of certain signs, to understand the etiology and pathogenesis of ASA, on the basis of this - to choose the tactics of treatment, and by changing the severity of symptoms after treatment - to objectively judge its effectiveness.

The use of this method of quantitative objective and subjective assessment of the quality of orthodontic treatment allows you to objectively evaluate the effectiveness of orthodontic treatment, and also, based on the subjective assessment of the patient, determine how much the implemented treatment plan satisfied the main complaints of the patient.

The implementation of the method is shown by specific clinical examples.

Example 1

Patient L., age at the time of treatment 43 years.

Complaints of malocclusion, crunching in the area of the temporomandibular joint.

Fig.1. The dentition of the patient L. before treatment: (a - right projection, b - anterior projection, c - left projection).

Fig.2. Fitting of the elastocorrector in the oral cavity (a - anterior projection).

Fig.3. Fixation of a functional non-removable telescopic device for the extension of the lower jaw (a - right projection, b - anterior projection, c - left projection).

Fig.4. Fixation of the bracket system (a - right projection, b - anterior projection, c - left projection).

Fig. Fig. 5. The dentition of patient L. after completion of orthodontic treatment: (a - right projection, b - anterior projection, c - left projection).

Based on the clinical examination and cone-beam computed tomography of the skull and TMJ, the diagnosis was made: inferior retrognathia, distal occlusion of the posterior teeth, deep sagittal incisal disocclusion (sagittal gap 6 mm), narrowing, deformity of the dentoalveolar arches, absence of teeth 1.5, 1.6, 2.5, 2.6 , 3.5, 4.6, 4.7 due to removal, fixed prosthetics supported by teeth 1.7,1.4, 2.4, 2.7, thin gingival phenotype, crunching, TMJ clicking, TMJ dysfunction (Figure 1).

According to the CBCT of the skull and TMJ, as well as the anthropometry of plaster models of the jaws, a quantitative assessment of the patient's AF before treatment was carried out, which is presented in the table (Table 3)

Table 3: Quantitative assessment of the AFA of patient L. before treatment.

Based on the doctor's quantitative assessment of the AF, it can be concluded that patient L. is indicated for orthodontic treatment in order to expand the dentition, normalize the position of the lower jaw, the ratio of the dentition in the sagittal, transversal and vertical planes, the position and inclination of the teeth. After orthodontic rehabilitation, the patient was recommended rational prosthetics.

To identify the main complaints and expectations from orthodontic treatment, patient L. was asked to fill out a questionnaire, the data of which are presented in the table (Table 4).

Based on the results of the questionnaire before treatment, it turned out that the main complaints of patient L. are reflected in blocks 1 and 2. The patient experiences pain in the TMJ area when opening her mouth, she is also concerned about the profile of her face, smile, crowded position of her teeth.

Summing up the doctor's quantitative assessment and the patient's subjective assessment, 2 orthodontic treatment plans were proposed: 1 - combined orthodontic-surgical treatment with bone-reconstructive surgery, 2 - dentoalveolar compensation with normalization of the position of the lower jaw. The patient refused combined treatment, thus, it was decided to perform dentoalveolar compensation using a functional non-removable telescopic device for lower jaw advancement and a bracket system.

At the 1st stage of orthodontic treatment, elastocorrection therapy was performed to relieve the pain syndrome of TMJ dysfunction and normalize the movements of the lower jaw (Figure 2). After 6 months, the FNTA apparatus was installed to normalize the position of the lower jaw. Given the presence of defects in the dentition, soldered orthodontic crowns, palatal and lingual wire arches soldered to the crowns were used to stabilize the teeth (Figure 3). 4 months after the installation of a functional non-removable telescopic apparatus (FNTA), the Damon Q bracket system was fixed on the lower dentition, brackets with low torque on the incisors were selected to prevent tooth protrusion. On the next visit (after 1 month), the bracket system was fixed on the upper dentition (Figure 4). After 11 months of using the device, the FNTA was removed and intermaxillary elastic traction was prescribed to stabilize the occlusal contacts in the lateral sections. The total duration of treatment was 17 months.

After orthodontic treatment, the patient underwent a re-quantification of AF according to the CBCT of the skull and TMJ, anthropometry of plaster models of the jaws (Table 5).

Proportion and calculation of the quantitative assessment of the AFA:

Before treatment - 33 points, after treatment -11 points.

33-100%

11th

X= 33.3% - greatly improved

The effectiveness of the treatment carried out is interpreted by the wording "significantly improved".

After treatment, patient L. was asked to fill out the questionnaire again to obtain a subjective assessment of the quality of orthodontic treatment (Table 6).

The proportion and mathematical calculation of the data on the questionnaire: Before treatment -35 points, after treatment - 3 points.

35 - 100%

3rd

X=8.6% - significant improvement

As a result of the treatment, the position of the lower jaw was normalized, the position of the teeth was normalized, the height of the lower third of the face was corrected, and the profile of the patient's face was improved. The data of subjective assessment after questioning the patient also confirm the effectiveness of the treatment (Fig. 5).

Example 2

Patient M., age at the time of treatment - 36 years. Complaints about malocclusion.

Fig.6. Dentitions for patients, before treatment: (a - right projection, b - anterior projection, c - left projection, d - occlusal projection of the upper dentition, e - occlusal projection of the lower dentition).

Fig.7. Fixation of a functional non-removable telescopic device for the extension of the lower jaw (a - right projection, b - anterior projection, c - left projection, d - occlusal projection of the upper dentition, e - occlusal projection of the lower dentition).

Fig.8. Fixation of the bracket system (a - right projection, b - anterior projection, c - left projection).

Fig.9. Dentitions for patients after completion of orthodontic treatment: (a - right projection, b - anterior projection, c - left projection, d - occlusal projection of the upper dentition, e - occlusal projection of the lower dentition).

Based on clinical examination and data on cone-beam computed tomography of the skull and TMJ, the diagnosis was made: inferior retrognathia, distal occlusion of the posterior teeth, deep sagittal incisal occlusion. lingual occlusion of the posterior teeth, bruxism, generalized tooth wear (Figure 1).

A quantitative assessment of the AF of patient M. was carried out (Table 7).

Based on the doctor's quantitative assessment of AF, it can be concluded that orthodontic treatment is indicated for patient M. in order to expand the dentition, normalize the position of the lower jaw, and occlusal ratios in the sagittal, vertical and transversal planes.

To determine the subjective assessment, patient M. was asked to fill out a questionnaire before treatment (Table 8).

Based on the results of the questionnaire before treatment, it turned out that the main complaints of patient M. are reflected in blocks 1 and 2. The patient has difficulty chewing, fear of losing teeth without orthodontic intervention, which indicates a high motivation for treatment. On the aesthetic side, the patient is concerned about the profile of the face, the position of the teeth and chin.

Summing up the doctor's quantitative assessment and the patient's subjective assessment, orthodontic treatment was proposed using a functional fixed telescopic apparatus to advance and normalize the position of the lower jaw and a bracket system.

At the 1st stage of treatment, FNTA was installed to advance the lower jaw (Figure 7). After 5 months of treatment, a vestibular self-ligating bracket was fixed - Damon Clear on the anterior group of teeth of the upper jaw, Damon Q on the lateral group of teeth of the upper jaw and the lower dentition (Fig. 8). After 8 months of use, the FNTA was removed and intermaxillary elastic traction was prescribed to correct occlusal contacts. The total duration of treatment was 15 months.

A quantitative assessment of the AF of the patient M. after treatment was carried out (Table 9).

Proportion and calculation of the quantitative assessment of the AFA:

Before treatment - 32 points, after treatment - 5 points.

32-100%

5th

X=15.6% - significant improvement

The effectiveness of the treatment is interpreted by the wording "significant improvement".

After treatment, patient M. was asked to fill out the questionnaire again to obtain a subjective assessment of the quality of orthodontic treatment (Table 10).

Proportion and mathematical calculation of survey data:

Before treatment - 31 points, after treatment - 6 points.

31-100%

6th

X=19.3% - significant improvement

As a result of the treatment, an optimal expansion of the dentition was achieved, the position of the lower jaw and occlusal relationships were normalized, and the profile of the face was improved. The patient was recommended further restoration of the worn surfaces of the teeth (Fig.9).

The advantages of the proposed method:

- a detailed approach to the diagnosis of AF;

- the ability to assess the severity of each parameter of the AF in three directions;

- the ability to assess the degree of change in each parameter of the AF during and after treatment;

- interpretation of the result of treatment as a percentage;

- a detailed definition of the main complaints of patients, their level of motivation and expectations from treatment, as well as the degree of satisfaction with the result of treatment.

Claims (3)

1. A method for quantitative objective and subjective assessment of the quality of orthodontic treatment consists in conducting a clinical examination of the patient before and after orthodontic treatment, obtaining data from cone-beam computed tomography (CBCT) of the skull, control and diagnostic models of the jaws before and after treatment, evaluating aesthetics faces, anomalies of occlusion in the sagittal, vertical and transversal directions, occlusal ratios, for a quantitative objective assessment of dentoalveolar anomalies (ZNA), cephalometric and anthropometric indicators are selected in three planes: sagittal, vertical and transversal; aesthetic, morphological and occlusal indicators are determined, for each indicator one of three degrees is determined depending on the severity of the deviation from the norm, while degree 1 corresponds to a mild form, degree 2 - to an average form and degree 3 - to a severe form, the obtained numerical values of the indicators are up to orthodontic treatment and their degree, the doctor enters in table 1, after orthodontic treatment, the doctor re-receives the same indicators and also enters in table 1, each received quantitative assessment of the degree is equated to 1 point, if the parameter value is normal, then in the corresponding cell of table 1 enter " 0”, the scores obtained by the indicators before treatment are summed up among themselves and taken as 100%, the scores obtained by the indicators after treatment are also summed up among themselves and taken as X, make up a proportion and carry out a mathematical calculation, determining the value of X, which is an objective numerical indicator of the quantitative assessment of the AF, to obtain subjective assessment of the quality of orthodontic treatment, the patient before and after orthodontic treatment fills in table 2, which presents 31 questions grouped into 3 blocks, with block 1 - physical condition, block 2 - psychological state, block 3 - social sphere, the assessment is carried out in 4 -point system, depending on the frequency of detected violations, indicating a quantitative assessment in numbers next to each indicator; the scores obtained by indicators before treatment are summed up among themselves and taken as 100%, the scores obtained by indicators after treatment are also summed up among themselves and taken as X, make up a proportion and carry out a mathematical calculation, determining the value of X, which is a subjective numerical indicator of quantitative ZFA estimates obtained by an objective numerical indicator and a subjective numerical indicator are interpreted separately, while: at a value of X up to 25%, a significant improvement in the state of the patient's dentoalveolar system is determined; at X equal to 26-45% - greatly improved; at X equal to 46-65% - moderately improved; at X equal to 66-85% - minimally improved; with X equal to 86% or more - not improved or worsened. 2. The method according to p. 1, characterized in that the objective cephalometric and anthropometric numerical indicators before and after treatment are determined in accordance with tables 3, 5 or 7, 9. 3. The method according to p. 1, characterized in that for a subjective assessment of the quality of orthodontic treatment, questionnaires are filled out before and after treatment in accordance with tables 4, 6 or 8, 10.

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