RU212978U1 - Device for functional and mechanical correction of underdevelopment of the upper and lower jaws - Google Patents

Abstract

The utility model relates to medicine, namely to dentistry, and can be used in orthodontics in the treatment of children with underdevelopment of the upper and lower jaws. A device for functional and mechanical correction of underdevelopment of the upper and lower jaws is proposed, which includes in its design a palatal plate-basis with cuts in the sagittal and transverse directions, screws for expanding and lengthening the dentition, clasps, springs and supporting semi-arches for moving the first permanent molars and the first premolars in the distal direction, with two upper and two lower biting, parallel to each other platforms-steps, made integral with the base, symmetrically relative to the longitudinal line of the cut, interconnected by two inclined rigid plates. The device allows to provide a comprehensive functional and mechanical therapeutic and prophylactic effect during the period of active growth of the dentoalveolar region, to normalize the shape and size of the dentoalveolar arches and the position of permanent teeth in the sagittal, vertical and transversal directions, to provide conditions for the formation of a physiological, functionally complete permanent occlusion, to reduce terms of orthodontic treatment. The provided structural elements in the dynamics of treatment allow for timely correction of treatment tactics. At the same time, the device, due to the combined effect on functional and mechanical defects of the upper and lower jaws, makes it possible to obtain stable, functionally complete rehabilitation results in growing patients with underdevelopment of the upper and lower jaws.

Description

The utility model relates to medicine, namely to dentistry, and can be used in orthodontics in the treatment of children with underdevelopment of the upper and lower jaws.

Underdevelopment of the upper and lower jaws is accompanied by anomalies in the position of the teeth, dentition and occlusion in the sagittal, transversal and vertical directions, forced displacement of the lower jaw due to incorrect occlusal contacts, myofunctional and aesthetic disorders.

Rehabilitation of patients with underdevelopment of the upper and lower jaws, concomitant dentoalveolar anomalies and functional disorders in the period of permanent occlusion is long, involves the use of complex and expensive removable and non-removable orthodontic devices, myogymnastics, often includes traumatic surgical (orthognathic surgery) interventions, and the result is not always stable [Orthodontics. National leadership. In 2 vols. T. 1. Diagnosis of dentoalveolar anomalies / ed. L.S. Persina. - Moscow: GEOTAR-Media, 2020. - 304 p.: ill. - (Series "National Guidelines"). - DOI: 10.33029/9704-5408-4-1-ONRD-2020-1-304; Orthodontics. National leadership. In 2 vols. T. 2. Treatment of dentoalveolar anomalies / ed. L. S. Persina. - Moscow: GEOTAR-Media, 2020. - 376 p.: ill. - (Series "National Guidelines"). - DOI:10.33029/9704-5409-l-2-ONRD-2020-l-376; Kleinrock Maria. Functional disorders of the motor part of the chewing apparatus. - Lviv, "GalDent", 2015. - 256 p. ].

In this regard, it is of interest to eliminate the underdevelopment of the upper and lower jaws, dental anomalies and functional disorders even in the period of active growth of the facial skeleton and the change of temporary teeth to permanent ones [Khoroshilkina F.Ya. Orthodontics. - Publishing house "Medical Information Agency", 2010. - 592 p. ill. https://www.mmbook.ru/catalog/stomatologija/ortodontija/104789-detail; Mitchell Laura. An Introduction to Orthodontics. - Oxford University Press, 2013. www.oxfordtextbooks.co.uk/orc/mitchell4e; https://dentald.ru/magazin/pro duct/osnovy-ortodontii-laura-mitchell].

To eliminate the underdevelopment of the upper jaw in the period of mixed dentition, a type III Frenkel function regulator is used. The device is double-jawed, has a frame structure, contains labial pads, buccal shields, occlusal linings, palatine clasp, anterior palatine arch, lingual arch, vestibular arch. The labial pads and buccal shields are located on the threshold of the oral cavity, move the lips and cheeks away from the dentition. Occlusal lining separates the dentition. The palatine clasp connects the right and left buccal shields. The anterior palatine arch pushes the upper incisors, the vestibular arch deflects the lower incisors in the lingual direction [Khoroshilkina F.Ya., Frenkel R., Demner L.M., Falk F., Malygin Yu.M. Diagnosis and functional treatment of dentofacial anomalies. - M.: Medicine, 1987. -303 p. ]

To eliminate the underdevelopment of the lower jaw, regulators of the Frenkel function of the I-type and II-type are used. These devices are double-jawed, have a frame structure, contain labial pads and buccal shields, a palatine clasp, and a lingual arch. The labial pads and buccal shields are located on the threshold of the oral cavity, move the lips and cheeks away from the dentition. The palatine clasp connects the right and left buccal shields. The lingual arch rests on the gum and prevents the mandible from moving distally. The design of the I-type Frenkel function regulator has a vestibular arch that deflects the upper incisors in a lingual direction. In the design of the Frenkel II-type function regulator, there are vestibular and anterior palatine arches simultaneously to align the position of the upper incisors [Khoroshilkina F.Ya., Frenkel R., Demner L.M., Falk F., Malygin Yu.M. Diagnosis and functional treatment of dentofacial anomalies. - M.: Medicine, 1987. - 303 p. ].

To stimulate the growth of the lower jaw, a two-jaw activator (monoblock) of Andresen-Heupl (1936), an activator (open) of Klammt (1955) is also used [Guide to orthodontics // Ed. F.Ya. Khoroshilkina. - M.: Medicine, 1999. - 650 p. ] and other two-jaw devices of a monoblock or frame design [Orthodontics. National leadership. In 2 vols. T. 2. Treatment of dentoalveolar anomalies / ed. L.S. Persina. - Moscow: GEOTAR-Media, 2020. - 376 p.: ill. - (Series "National Guidelines"). - DOI: 10.33029/9704-5409-1-2-ONRD-2020-1-376]. Once in the mouth, the Andresen-Häupl activator holds the underdeveloped mandible in an advanced, constructive bite position to achieve the desired mandibular growth effect.

All double-maxillary individual devices are made on plaster models of the jaws, compared in the position of constructive occlusion, the method of determining which corresponds to the type of anomaly of occlusion in the patient. So, for the manufacture of a two-jaw apparatus for a patient with underdevelopment of the upper jaw, when determining a constructive bite, they ask to displace the lower jaw as much as possible in the distal direction and receive imprints of antagonist teeth on the bite ridges. And for the manufacture of a two-jaw apparatus, when eliminating underdevelopment of the lower jaw, a constructive bite is determined using a wax basis with bite rollers, the patient is asked to push the lower jaw to the physiological ratio of the first permanent molars (according to Angle's 1st class) and bite the pre-softened wax rollers. Then the plaster models of the jaws are compared in the position of a constructive bite according to the impressions of the teeth on the wax rollers, fixed with plaster in the occluder and the necessary orthodontic device is made.

Known modifications of the Andresen-Heupl activator [Khoroshilkina F.Ya., Malygin Yu.M. Fundamentals of design and manufacturing technology of orthodontic appliances. - M.: Medicine. -1977. - 264 pages; Khoroshilkina F.Ya., Persin L.S. Orthodontics: Treatment of dentofacial anomalies with modern orthodontic appliances, clinical and technical stages of their manufacture. - M.: Ortodent-INFO - Book. 1. - 1999. - 212 p., Book. 2. - 1999. - 269 S.], when the design, based on the treatment plan, includes screws, a vestibular arch, springs.

Disadvantages of double jaw orthodontic devices:

bulkiness of double-maxillary orthodontic devices - with limited opening of the mouth, they are difficult, sometimes impossible to enter into the oral cavity;

violation of the configuration of the face - the buccal shields and lip pads of the Frenkel function regulators occupy the vestibule of the oral cavity, move the cheeks and lips away from the dentoalveolar arches and thereby change the appearance, causing discomfort and aesthetic dissatisfaction;

all double-maxillary orthodontic devices disrupt chewing, and the Andresen-Heupl activator excludes the possibility of both chewing and speech functions, which does not contribute to the training of these basic functions of the dentoalveolar system;

discomfort, fatigue in the muscles occur due to the fact that the double-jaw orthodontic devices constantly hold the lower jaw in the position of a constructive bite, limiting any of its movements, except for minor movements during swallowing and speech;

the risk of injury to the gingival mucosa, pain in the area of the abutment teeth due to unintentional displacement of the device during sleep, when the position of the lower jaw cannot be consciously controlled;

prolongation of the treatment time with double jaw orthodontic devices due to the fact that they are recommended to be used at a limited time of the day, only at night, which reduces the effectiveness of their impact;

Single-jaw devices are known. They consist of a plate for the upper or lower jaw with clamp fixation. If it is necessary to expand the dentition, the base is sawn in accordance with the direction of the median line of the dentition and a screw is used to expand the dentition. If it is necessary to move a group of teeth, the base is sawn into segments and special screws are used to move individual teeth or a group of teeth. To move individual teeth, protracting, "hand-shaped" or coiled springs are used. Vestibular arches are used to tilt the anterior teeth. Teeth are moved in the vestibular direction with the help of a lingual arch, anterior palatine arch, protracting springs, a rigid or springy inclined plane. To separate the dentition, a bite pad or occlusal pads are used. Thus, certain elements of single-jaw removable orthodontic devices solve individual tasks of the planned treatment [Isaakson K.G. Removable orthodontic appliances K.G. Isaacson, J.D. Muir, R.T. Reed; per. from English. - M.: MEDpress-inform, 2012. - 144 p.: ill.:].

Disadvantages of single jaw orthodontic appliances:

limited use - single-jaw devices solve separate problems, which excludes the simultaneous functional and mechanical correction of underdevelopment of the upper and lower jaws;

an increase in the cost due to the need to repeatedly change devices during treatment to consistently eliminate dentoalveolar anomalies, increase the number of visits.

Tasks:

to develop a device that is less bulky, in comparison with previously known two-jaw orthodontic devices, capable of performing simultaneous functional and mechanical correction of underdevelopment of the upper and lower jaws;

to develop a device that improves the configuration of the face when using it, which does not cause discomfort and aesthetic dissatisfaction with constant round-the-clock use;

to develop a device that does not exclude the full performance of the functions of chewing, swallowing and speech with constant round-the-clock use, which will allow for constant training of these basic functions of the dentoalveolar system;

minimize the sensations of muscle fatigue and discomfort during the period of getting used to the device, thereby reducing the period of adaptation to the device;

minimize the risk of injury to the oral mucosa and supporting teeth by achieving the effect of adhesion, fixation and stabilization of the device in a short time;

reduction of treatment time and increase in its effectiveness due to the fact that with constant round-the-clock use, the period of adaptation to the device is reduced, the effect of adhesion, fixation and stabilization of the device is ensured in a short time, underdevelopment of both the upper and lower jaws is simultaneously eliminated with one device.

To solve the tasks set, a device is intended for functional and mechanical correction of underdevelopment of the upper and lower jaws, which consists in the fact that it contains a palatine basis plate having cuts in the sagittal and transverse directions, and in the sagittal direction - in the projection of the median palatine suture, and in transversal - at the level of the second premolars, perpendicular to the first cut; at the same time, to expand the dentition, a screw is installed in the base at the level of the center of the longitudinal axis of the crown part of the anatomically normal position of the first premolars, and to lengthen the lateral segments of the dentition, screws are installed in the base also at the level of the center of the longitudinal axis of the crown part of the anatomically normal position of the second premolars on the left and on the right, parallel to the conditional lines passing through the fissures of premolars and molars, at a distance of 3-5 mm from the necks of the teeth, congruent to the gum; to increase the distance between the lateral incisor and the first permanent molar to the distance necessary to accommodate the permanent canines, the first premolars and the second premolars, they are installed from the distal surface of the lateral incisor and the mesial approximal surface of the first permanent molar along a one-arm clasp made of orthodontic wire with a diameter of 0.9-1 .0 mm; to displace the first premolar in the distal direction, a spring with a curl is installed in the basis, with the condition of touching its working part in the cervical region of the tooth from the side of the proximal surface; in the basis, the ends of the semi-arc made of orthodontic wire with a diameter of 1.0 mm are rigidly fixed as a support: the semi-arc is located tangentially to the distal surface of the first permanent molar, and the ends of the semi-arc and the spring with a curl are connected by an elastic rod; the base fits snugly against the palatine surface of the incisors and canines, at the same time with the base, symmetrically with respect to the longitudinal line of the cut, two upper and lower bite bits are made, parallel to each other, step platforms, the upper and lower platforms are rigidly connected to each other by inclined plates at an angle of 120-125 °, while the upper areas have a size of 2-3 mm, and the lower ones correspond to the length of the sagittal fissure between the patient's upper and lower incisors.

Technical result:

the palatal plate-basis 1 of the device rests on the mucous membrane of the upper jaw, tightly adhering to the palatal surface of 10 incisors and canines, the clasps 6 provide a secure fixation of the device, including during the functions of chewing, swallowing and speech;

unscrewing the screw 4, installed in the base perpendicular to the cutting line along the median seam 2, stimulates expansion, and unwinding the screws 5 installed in the base perpendicular to the transverse cut lines 3, elongates the upper dentition, activates the springs 7 with a curl and elastic traction 9 based on the semi-arches 8 - distalization of the first premolars and creation of a place for independent eruption of permanent canines and second premolars in the dentition;

the position of the lower jaw in a constructive bite, set to eliminate deep occlusion, is provided by the upper platforms-steps 11, to stimulate the growth of the lower jaw and eliminate distal occlusion - inclined plates 12 and lower platforms-steps 13, while the patient masters the given position of the lower jaw gradually, having the ability to regularly relieve muscle tension by moving the lower jaw to a position of physiological rest, which contributes to the functional correction of underdevelopment of the lower jaw;

the device is removable, easily removed for oral hygiene, cleaned and installed on the jaw by the patient on their own, providing ease of use, simplicity, comfort.

The device allows

provide a comprehensive functional and mechanical therapeutic and prophylactic effect in the period of active growth of the dentofacial region due to the presence of a combination of the structural elements indicated in the formula;

normalize the shape and size of the dentoalveolar arches and the position of permanent teeth in the sagittal, vertical and transverse directions, provide conditions for the formation of a physiological, functionally complete permanent occlusion;

increase efficiency, reduce the time of orthodontic treatment by 30-40% by reducing the period of getting used to the use of the device by 25-35%, the possibility of wearing it around the clock, the simultaneous effect on functional and mechanical defects and the intended structural elements (cuts, screws, clasps, a spring with a curl , bite pads connected by inclined plates) in the dynamics of treatment allow for timely correction of treatment tactics. At the same time, the device, due to the combination of functional characteristics and the inclusion of additional functions in the design at the same time: the combined effect on functional and mechanical defects of the upper and lower jaws is less cumbersome, allows you to obtain stable, functionally complete rehabilitation results in growing patients with underdevelopment of the upper and lower jaws.

For better understanding, the device is shown schematically in Fig. 1 - general view, Fig. 2 - view in sagittal section, where 1 - palatal plate, which is sawn in the direction of the median palatine suture 2 and sawn in the transverse direction 3 - perpendicular to the median palatine suture. Opposite the first premolars along the midline 2, a screw 4 is installed to expand the dentition of the upper jaw, opposite the second premolars along line 3, one screw 5 is installed on each side to lengthen the lateral segments of the upper dentition. Clasps 6 and one spring 7 of orthodontic wire with a diameter of 0.6 mm with a springy curl and hook and one half-arc 8 of orthodontic wire with a diameter of 1.0 mm are rigidly fixed in the plate on each side. On each side, between the spring hook 7 and the semi-arc hook 8, an elastic rod 9 is installed (an elastic ring is an elastic "chain"). To the palatal surface of the incisors and canines 10, the palatal plate-basis 1 fits snugly, along with the base symmetrically with respect to the longitudinal line of the cut, on each side, parallel to each other, the upper biting 11 and lower biting 13 platform-steps are made, connected at an angle of 120-125 ° with inclined rigid plates 12.

The device is used as follows.

The palatal plate-basis 1 fits snugly against the palatal surface of 10 incisors and canines. The device is fixed on the teeth of the upper jaw using clasps 6. The upper biting pads 11 are in contact with the cutting edges of the lower incisors and the tubercles of the lower canines. The inclined plates 12 assist in holding the mandible in the constructive occlusion position, limiting displacement in the distal direction. When trying to open the mouth wide and displace the lower jaw in the distal direction, the cutting edges of the lower incisors and tubercles of the canines touch the surface of the lower bite pads 13 and the patient returns the lower jaw to the position of the given constructive bite.

In the adaptation period lasting 10-14 days, myogymnastics can be additionally prescribed to train the muscles that protrude the lower jaw. The patient observes nasal breathing, proper performance of swallowing and speech functions, closes the lips completely and correctly, removes the oral hygiene device in the morning and evening, rinses the mouth and rinses the device after eating.

To expand the upper dentition relative to the median palatal suture 2, screw 4 is unscrewed by 1/4 turn once a week until the individual normal width of the upper dentition is reached. The screw in the base must be installed parallel to the occlusal plane and perpendicular to the median palatal suture. When the screw is untwisted, forces are generated in opposite directions and pressure is exerted on the inner surfaces of the posterior teeth. There is an expansion of the upper dentition, the growth of the upper jaw in the transversal direction is stimulated.

To lengthen the lateral segments of the upper dentition relative to the transverse direction 3, the screws 5 are unscrewed by 1/4 turn every 2-3 days, the screws in the base should be installed in the direction of the imaginary line passing through the longitudinal fissures of the lateral teeth.

For distal movement of the first premolars, the curls of springs 7 are untwisted with orthodontic forceps and the working part of the spring is moved to close contact with the mesial approximal surface of the first premolars. To move the first premolars, an elastic rod 9 is used, which is attached with a little effort to the hooks on the spring 7 and the elastic semi-arc 8. The orthodontist determines the strength of the elastic. The direction of the rod should be in the direction of the occlusal surface of the lateral teeth. During the initial impact of the elastic, the tooth moves in a given direction, the distance between the points of application of the force decreases and, as a result, the force of the elastic decreases. At each visit, the doctor controls/corrects the position of the spring on the movable tooth and the supporting semi-arc, the direction of action of the elastic, the distance between the movable teeth, which achieves controlled distalization of the first premolar and first molar, selects the force, and until the next visit, the patient replaces the elastic traction independently.

Under conditions of constant functional and mechanical impact, the upper dentition expands and lengthens to the individual norm, and anomalies in the position of the teeth are eliminated. Creating a sufficient length of the lateral segments of the dentition provides space in the dentition for the eruption of the second premolars and canines. Dentoalveolar growth in the lateral sections of the lower dentition leads to normalization of the curvature of the occlusal plane and lengthening of the lower dentition, elimination of deep incisal occlusion/disocclusion.

Restoration of the myodynamic balance of the muscles (lips, cheeks and tongue) surrounding the dento-alveolar arches, and the muscles that move the lower jaw, provides conditions for synchronous growth of the upper and lower jaws, elimination of their underdevelopment in the sagittal, transversal and vertical directions, which ensures the stability of the result treatment.

The device has been tested on 32 patients for 5 years

Example 1

A 9-year-old patient turned to the orthodontist with complaints of malocclusion and ugly position of the front teeth. On examination, the configuration of the face was changed, the profile of the face was convex, the chin was "beveled" back, the lips were closed incorrectly, the lower lip was everted, the height of the lower face was reduced, the cutting edges of the upper incisors rested on the lower lip. In the oral cavity - the mucous membrane of the vestibule of the oral cavity is pale pink, moderately moistened, the frenulum of the upper lip is attached along the midline to the base of the interdental papilla. The bite is changeable.

Dental formula:

The ratio of the first permanent molars according to the second class of Angle. The upper dental arch is shortened in the lateral sections. In the dentition, there is not enough space for the eruption of premolars. The upper incisors are inclined in the vestibular direction. The lower dental arch is shortened, has a trapezoidal shape, the bend of the occlusal plane exceeds 2.0 mm. Between the cutting edges of the upper and lower incisors at the time of occlusion, the sagittal gap is 4.0 mm long. The cutting edges of the lower incisors are in contact with the mucous membrane in the anterior palate. On diagnostic models, the upper dental arch is symmetrically narrowed by 3.0 mm, the lower dental arch is shortened by 2.5 mm. On the orthopantomogram, there are rudiments of permanent canines, second permanent molars and premolars. On the lateral teleroentgenogram of the head, a decrease in the Se-N-B angle by 3° and an increase in the ANB angle by 3° indicate inferior micrognathia.

The diagnosis was formulated: Distal occlusion, lower micrognathia, deep incisal disocclusion, narrowing and shortening of the lateral segments of the upper dentition, vestibular inclination of the upper incisors, shortening of the anterior section of the lower dentition, difficult eruption of permanent lateral teeth.

A treatment plan has been drawn up:

Expansion of the upper dentition, lengthening of the lateral segments by distalization of the upper first premolars and first permanent molars. Stimulation of the growth of the lower jaw, elimination of distal occlusion, deep incisal disocclusion. Myogymnastics for the normalization of the closing of the lips, the normalization of breathing, swallowing, speech.

The treatment plan was agreed upon with the parents and the child, voluntary consent was issued for orthodontic treatment and for the use of personal data for use in research work.

At the first visit, casts were obtained with an alginate mass, control-diagnostic and working plaster models of the jaws were cast.

An order has been issued. The work was transferred to the dental laboratory. With a dental technician, the design features of an orthodontic apparatus - a device for functional and mechanical correction of underdevelopment of the upper and lower jaws - were clarified. Basis - palatine plate 1 sawn in sagittal 2 and transversal 3 directions. In the sagittal direction, the basis is sawn in the projection of the median palatine suture and screw 4 is installed in the basis at the level of the center of the longitudinal axis of the coronal part of the anatomically normal position of the first premolars. In the transverse direction, the basis is sawn at the level of the second premolars perpendicular to the first cut, screws 5 are installed in the basis at a distance of 3 mm from the necks of the teeth, congruent to the gum. To increase the distance between the lateral incisor and the first permanent molar to the distance required for the placement of permanent canines, the first premolars and second premolars are installed from the distal surface of the lateral incisor and the mesial proximal surface of the first permanent molar along a one-arm clasp 6 made of orthodontic wire with a diameter of 0.9 mm . To displace the first premolar in the distal direction, a spring 7 with a curl is installed in the basis, with the condition of touching its working part in the cervical region of the tooth from the proximal surface in close proximity to the palatal surface; in the base, as a support, the ends of the semi-arc 8 made of orthodontic wire with a diameter of 1.0 mm are rigidly fixed. The semi-arc is located tangentially to the distal surface of the first permanent molar, and the ends of the semi-arc and the spring with a curl are connected by an elastic rod 9; the basis fits snugly to the palatal surface of 10 incisors and canines; together with the base 1, symmetrically with respect to the longitudinal line of the cut 2, two upper bite pads-steps 11 and two lower bite pads-steps 13 are made parallel to each other, connected at an angle of 120° with inclined plates 12, while the upper pads 11 have a size of 2 .0 mm, and the lower 13 correspond to the length of the sagittal fissure (4.0 mm) between the patient's upper and lower incisors.

2nd visit: after 10 days, the patient is invited to an appointment for fitting an orthodontic device. It was found that the clasp fixation is sufficient to fix the device. The patient and his parents are trained in the rules of using an orthodontic device, myogymnastics to normalize lip closure, the rules of oral hygiene and the device. It is recommended to use the device constantly in the daytime and at night, to train nasal breathing, closing lips, correct pronunciation of sound phonemes, and take soft food. Observe oral hygiene and the device, clean the device at least three times a day. The patient was invited for a follow-up examination after 3 weeks.

3rd visit: the patient had no complaints. Examination of the face, oral cavity and device was carried out. The patient gradually mastered the position of the lower jaw in the constructive occlusion and the closing of the lips, which led to an improvement in the configuration of the face, and learned to take soft food in the presence of a device in the mouth. Recommendations are given to unwind the screw for expansion and the screws for lengthening the upper dentition by 1/4 turn every week, continue to perform myogymnastics to normalize the closing of the lips for 10-15 minutes at least 3-4 times during the day. The patient was invited for a follow-up appointment after 2 months.

4th visit: a survey, examination were conducted, a cast and a model of the upper jaw were obtained. The measurements showed the expansion of the upper dental arch by 1.0 mm, the lengthening of the lateral segments by 2.0 mm. The activation of springs for distalization of teeth 1.4 and 2.4 was performed, the ends of the springs with a curl and semi-arcs are connected by elastic traction. It is recommended to change the elastic band weekly, continue to loosen the screws weekly by 1/4 turn, perform myogymnastics and control the complete, correct closing of the lips. The patient was invited for an appointment in 2 months. He was referred for another orthopantomography.

5th visit: carried out, interview and inspection. The treatment is going well. The patient closes his lips freely. A repeated orthopantomogram revealed an increase in space for the eruption of permanent canines and second premolars into the dentition. The patient and parents are satisfied with the result of the treatment. It is recommended to continue treatment. Invited for an appointment in 2 months.

6th visit: no complaints, a survey and examination were carried out. The lips are closed completely, correctly, without tension. The shape and dimensions of the upper dental arch are normalized, permanent canines erupt, lower first premolars, lower second temporary molars are mobile. The ratio of the first permanent molars is normal. Within 7 months, distal occlusion, deep incisal occlusion were eliminated, conditions were created for normal eruption of permanent teeth. The patient is recommended to continue observation until the change of temporary teeth to permanent ones is completed.

7th visit: The patient came after six months. There are no complaints, a survey and inspection were carried out. Lips are closed completely, freely. Permanent teeth erupted in the dentition. The ratio of the permanent canines and the first permanent molars is fissure-tubercular, the overlap of the incisors is 1/3 of the height of their crowns. On the orthopantomogram, the roots of permanent canines, premolars and second molars are in the apexogenesis stage. Treatment completed successfully. A retention apparatus is not required. Dispensary observation is recommended until the formation of a permanent occlusion is completed. Inspection after six months revealed 100% elimination of functional and mechanical disorders.

Example 2

A 10-year-old patient addressed an orthodontist with complaints of malocclusion and an ugly position of the front teeth. On examination, the configuration of the face was changed, the profile of the face was convex, the chin was “beveled” back, the lips were not closed correctly, the lower lip was turned inside out, the height of the lower part of the face was reduced, the cutting edges of the upper incisors rested on the lower lip. In the oral cavity - the mucous membrane of the vestibule of the oral cavity is pale pink, moderately moistened, the frenulum of the upper lip is attached along the midline to the base of the interdental papilla. The bite is changeable.

Dental formula:

The ratio of the first permanent molars according to the second class of Angle. The upper dental arch is shortened in the lateral sections. In the dentition, there is not enough space for the eruption of the upper permanent canines and second premolars. The upper incisors are inclined in the vestibular direction. Between the cutting edges of the upper and lower incisors, the sagittal gap is a distance of 5.0 mm. The cutting edges of the lower incisors are in contact with the mucous membrane of the palate. On diagnostic models, the upper dental arch is symmetrically narrowed by 3.5 mm, the lateral segments are shortened by 3.0 mm. On the orthopantomogram, the rudiments of permanent teeth are present. On the lateral teleroentgenogram of the head, a decrease in the Se-N-B angle by 3° and an increase in the ANB angle by 3° indicated lower micrognathia.

The diagnosis was formulated: Distal occlusion, lower micrognathia, deep incisal disocclusion, narrowing of the upper dentition, shortening of the lateral segments, vestibular inclination of the upper incisors, shortening of the anterior section of the lower dentition, difficult eruption of permanent teeth.

A treatment plan has been drawn up:

Extension of the upper dentition, lengthening of the lateral segments of the upper dentition by distalization of the first premolars and first permanent molars. Stimulation of the growth of the lower jaw, elimination of distal occlusion, deep incisal disocclusion. Myogymnastics to normalize lip closure.

The treatment plan was agreed upon with the parents and the child, voluntary consent was issued for orthodontic treatment and for the use of personal data for use in research work.

At the first visit, casts were obtained with an alginate mass, control-diagnostic and working plaster models of the jaws were cast.

A similar design of an orthodontic appliance is proposed - a device for functional and mechanical correction of underdevelopment of the upper and lower jaws (see example 1). In basis 1, from the distal surface of the lateral incisor and the mesial approximal surface of the first permanent molar, a one-arm clasp 6 made of orthodontic wire with a diameter of 1.0 mm is installed. The basis is sawn in sagittal 2 and transvesal 3 directions, screw 4 is installed for expansion and screws 5 for lengthening the dentition. To move the first premolars in the distal direction, springs with a curl 7 are installed, half-arches 8 made of orthodontic wire with a diameter of 1.0 mm are used as a support. The upper 11 and lower 13 biting, parallel to each other platforms-steps, are interconnected by a rigid inclined plate 12 at an angle of 125°, while the upper platform 11 has a size of 3.0 mm, and the lower 13 corresponds to the length of the sagittal fissure (5.0 mm) between the upper and lower incisors of the patient.

An order has been issued. The work was transferred to the dental laboratory.

2nd visit: after 12 days, the patient is invited to an appointment for fitting an orthodontic device. The patient and his parents are trained in the rules of oral hygiene and care of the orthodontic device. It is recommended to use the device constantly in the daytime and at night, to control the complete, correct closing of the lips and the pronunciation of sound phonemes, to take soft food. The patient was invited for a follow-up examination in 2 weeks.

3rd visit: the patient had no complaints, the face, oral cavity and device were examined. The patient gradually mastered the position of the lower jaw in the constructive occlusion to stimulate growth, learned to eat with the device in the oral cavity, tries to breathe through the nose, and controls the closing of the lips. The patient and parents are satisfied with the improvement in facial configuration. Recommendations were given to unwind the screw for expansion by 1/4 turn weekly and unscrew the screws by 1/4 turn twice a week to lengthen the upper dentition, to continue monitoring the correct speech, closing of the lips, and nasal breathing. The patient was invited for a follow-up appointment after 2.0 months.

4th visit: a survey, examination were conducted, a cast and a model of the upper jaw were obtained. The measurements showed the expansion of the upper dental arch by 1.0 mm, the lengthening of the lateral segments by 3.0 mm. The activation of springs for distalization of teeth 1.4 and 2.4 was performed, the ends of the springs with a curl and semi-arcs are connected by elastic traction. It is recommended to change the elastic band weekly, continue to loosen the screws weekly by 1/4 turn, perform myogymnastics and control the complete, correct closing of the lips. The patient is invited to an appointment in 1.5 months. He was referred for another orthopantomography.

5th visit: Questioning and examination showed that the treatment is going well. Facial shape has improved. The patient closes his lips with slight tension. The patient and parents are satisfied with the results of treatment. It is recommended to continue treatment. Invited for an appointment in 2.5 months.

6th visit: no complaints, a survey and examination were carried out. Lips are closed completely, correctly. The shape and dimensions of the upper dental arch are normalized, the canines and premolars erupt. The ratio of the first permanent molars is normal. Eliminates deep incisal occlusion. A repeated orthopantomogram revealed an increase in space for the rudiments of permanent teeth. The patient is advised to continue observation until the eruption of permanent canines, premolars and second molars is complete. Check-up in 2 months.

7th visit: no complaints, a survey and examination were carried out. Lips are closed completely, freely. The permanent teeth erupt into an arch. The ratio of the permanent canines and the first permanent molars is fissure-tubercular, the overlap of the incisors is 1/3 of the height of their crowns. On the orthopantomogram, the roots of permanent canines, premolars and second molars are in the apexogenesis stage. The treatment was carried out successfully for 8 months. A retention apparatus is not required. Dispensary observation is recommended until the formation of a permanent occlusion is completed. Inspection after six months revealed 100% elimination of functional and mechanical disorders.

Claims (1)

A device for functional and mechanical correction of underdevelopment of the upper and lower jaws, consisting in the fact that it contains a palatal plate-basis having cuts in the sagittal and transverse directions, and in the sagittal direction - in the projection of the median palatine suture, and in the transversal direction - at the level of the second premolars perpendicular to the first cut; at the same time, to expand the dentition, a screw is installed in the base at the level of the center of the longitudinal axis of the crown part of the anatomically normal position of the first premolars, and to lengthen the lateral segments of the dentition, screws are installed in the base also at the level of the center of the longitudinal axis of the crown part of the anatomically normal position of the second premolars on the left and right , parallel to the conditional lines passing through the fissures of premolars and molars, at a distance of 3-5 mm from the necks of the teeth, congruent to the gum; to increase the distance between the lateral incisor and the first permanent molar to the distance required for the placement of permanent canines, the first premolars and second premolars are installed from the distal surface of the lateral incisor and the mesial proximal surface of the first permanent molar along a one-arm clasp made of orthodontic wire with a diameter of 0.9-1, 0 mm; to displace the first premolar in the distal direction, a spring with a curl is installed in the basis, with the condition of touching it with the working part in the cervical region of the tooth from the side of the proximal surface; in the basis, the ends of the semi-arc made of orthodontic wire with a diameter of 1.0 mm are rigidly fixed as a support: the semi-arc is located tangentially to the distal surface of the first permanent molar, and the ends of the semi-arc and the spring with a curl are connected by an elastic rod; the basis fits snugly to the palatal surface of the incisors and canines; along with the base, symmetrically with respect to the longitudinal line of the saw cut, two upper and two lower bite bits are made, parallel to each other, step platforms, interconnected by inclined rigid plates at an angle of 120-125 °, while the upper platforms have a size of 2-3 mm, and the lower ones correspond to the length of the sagittal fissure between the upper and lower incisors of the patient.

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