RU2375010C2 - Orthodontic devices and methods - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions relates to orthodontic devices and methods and can be used in correction of dental-alveolar arch of form of upper jaw and stimulation of growth and filling of defects of missing jaw tissues. Wire frame is installed on first segment of teeth and fastening elements, which are connected via lingual arch or lingual and vestibular load-bearing elements. As alternative, fastening elements can be fixed on lateral teeth segments, i.e. wire frame. Wire frame encompasses lateral segments and is connected with two plates. Plates are located on both sides of median palatine suture and are connected to each other via loadbearing palatine element of wire frame. Fastening elements of lateral teeth segments and plate or plates are connected via springs. Edges of jaw defects can become irritated, transferring oscillatory movement to plate. Space can be freed for newly formed tissues by periodic correction of plate working surface. Alveolar arch form is corrected by fitting of orthodontic device in mouth cavity, its periodical removal, activation and influence on teeth of translational and rotating forces.

EFFECT: process of correcting form of alveolar process and dental arch becomes more intensive.

15 cl, 4 ex, 17 dwg

Description

Field of Invention

The invention relates to medicine, and in particular to orthodontics. More specifically, the invention can be used to correct the shape of the dentoalveolar arch both in the direction of increase and decrease, to correct the shape of the upper jaw, namely the dental, aleveolar and basal arches, to stimulate the growth and closure of defects of missing jaw tissues, in particular palatine cleft and lack of alveolar bone, and to correct the shape of the dentoalveolar arch in the lingual and vestibular directions.

State of the art

As early as 1880, Continuous JACKSON constructed an apparatus containing the vestibular and lingual arches connected by bridges in the region of the posterior teeth (see CONSUMMATE OCCLUSION, Robert Murray Ricketts, 1996, Fig. 2-2).

Also known is a device made in the form of lingual and vestibular springs acting on the front teeth and fastened to connecting fastening elements from the frames to the individual lateral teeth of the lingual arch (see US patent No. 1142467, 06/08/1915).

The above devices provide correction of teeth in the anterior region, but due to the rigid attachment of the arches to the frames of the posterior teeth, they are characterized by limited possibilities of transverse movement of the latter.

Non-removable orthodontic appliances are also known, containing arcs fixed in locks rigidly fixed on the teeth. These devices allow translational-rotational effects on the teeth to provide correction of the shape of the dental arch and the position of individual teeth (see PCT application WO No. 048868 A2, A61C 7/14, 02.06.2005).

The above arc devices do not stimulate the intensive growth of the alveolar ridge and correction of the shape of the dentoalveolar arch, as a result of which they require long-term treatment.

In addition, when moving the teeth, the surface of the alveolar ridge, facing the root of the tooth, in places of compression of the walls of the bone marrow cavities is periodically subjected to intensive resorption.

Closest to the claimed versions of the devices in their technical essence is an orthodontic device for correcting dental arches (see the patent of the Republic of Armenia No. 512. A 61C 7/00, 1999). The apparatus contains fastening elements connected through the lingual and vestibular arcs with activation nodes, which are made in the form of frames covering the lateral segments of the teeth. The latter are formed from wire parts located near the necks of the teeth on the lingual side and scattered along the height of the teeth on the vestibular side, connected by jumpers through the interdental spaces.

The apparatus and its design provide for the corpuscular movement of teeth: lateral teeth with translational-rotational influences on them, and frontal teeth with the efforts of the vestibular and lingual arches of the incisors dispersed along the height. Since the apparatus is removable, it is possible to periodically restore the decreasing forces of the frameworks and arcs by removing the apparatus and activating its elements.

Practical use of the apparatus allows to obtain corpuscular movement of teeth and an increase in the transveral dimensions of the alveolar process with an intensity of 0.3-0.4 mm per month. However, this device has limited capabilities in the implementation of sagittal-transverse movements of the teeth and is virtually deprived of the possibility of stimulating the growth of the alveolar process in case of narrowing of the jaw in the lingual direction. In addition, the design of the apparatus does not provide a stable dispersion of arcs along the height of the incisors, as a result of which the intensity of treatment is reduced in view of the need for frequent correction of arcs.

The device, known as the Derichsweiler’s fixed orthodontic device for accelerated rupture of the palatine suture, is a maxillary plastic base with a screw and metal fittings, the free ends of which are rigidly connected to rings or crowns in the region of the posterior teeth (see F. Khoroshilkina, Malygin Yu.M. Fundamentals of design and manufacturing technology of orthodontic appliances. - M .: Medicine, 1977, p. 97, Fig. 35). The design of the apparatus ensures the stability of the installation in the oral cavity, however, being non-removable, it contributes to the development of inflammatory diseases of the mucous membrane.

Also known is an orthodontic apparatus for accelerated rupture of the palatine suture, containing a fixed support part in the form of rings or crowns rigidly connected to the lateral segments of the teeth and connected to each other through vestibular arches.

The apparatus has fixation units made in the form of vertically arranged tubes soldered on a lingual surface, and a removable part, which is a plastic base with a screw and metal fittings, the free ends of which are bent and installed in vertically arranged tubes (see F. Khoroshilkina. , Malygin Yu.M. Fundamentals of design and manufacturing technology of orthodontic appliances. - M .: Medicine, 1977, p. 98, Fig. 36).

However, the above apparatus is not convenient enough to use. Its removal and installation in the oral cavity are possible only with the direct participation of a doctor, namely the orthodontist.

Another well-known apparatus for accelerated rupture of the palatine suture (RA patent No. 511. MKI5 A61C 7/36, 1999), which compares favorably with analogues in that, being removable, provides conditions for the most simplified removal and installation of the apparatus and at the same time ensures the stability of the apparatus. The device consists of removable and non-removable parts. The fixed part is an orthodontic ring on the posterior teeth, interconnected by vestibular arches with fixation nodes. The removable part contains plates with vestibular arches located on both sides of the median palatine suture, and a power element in the form of soldered springs connecting the base plates.

The previously noted design was selected as a prototype for the variants of the proposed devices for correcting the upper jaw. Prototype designs, like analogues, do not provide effective correction of the configuration (geometry) of the arch of the sky, simultaneous body movement of the teeth and correction of their axial position. In addition, the designs do not provide correction of the shape of the dentoalveolar arch in the anterior region.

A known method of closing the palatine cleft of the upper jaw by lowering the palatine processes, by the action of the nasal plate on the palatine processes of the upper jaw in the oral direction. The method is carried out by an obturator consisting of a periodontal and nasal plates with loops for elastic traction. The obturator is effective during the period of active growth of children up to 7-8 years. The known method and obturator provide reduction and rapprochement of the palatine processes, but they are not intended to correct the shape of the dental arch (see ed. St. USSR 848020. MKI 7 A61C 7/00, 07/23/1981).

There is also known a method of stimulating the growth of tissues of the upper jaw by irritation of the edges of the palatine cleft. The method is carried out using the Mac-Nile apparatus, consisting of a maxillary plate with fastening elements and pelots fixed to the plate through staples, irritating edges of defects (see Khoroshilkina F.Yu., Malagin Yu.M. Design Basics and Orthodontic Appliance Manufacturing Technology. -M.: Medicine, 1977, p. 98, Fig. 36).

There is also a method of simultaneously closing and irritating the edges of the cleft palatine plate in combination with correcting the shape of the dental arch. The method is carried out using an obturator apparatus (see. P. Mayilyan. New means of orthodontic treatment. Kolomna, Moscow Region, p. 58). This development is selected as a prototype for the claimed group of inventions.

The device consists of removable and non-removable parts. Fixed parts are orthodontic rings, rigidly fixed to the lateral teeth and connected by vestibular arches with fixation nodes. The removable part is the basis of the apparatus, made in the form of plates adjacent to the base of the lateral teeth from the lingual side with closed vestibular-lingual arcs and correction nodes for engagement with the fixed part. The lingual arch is fixed to the plates through the orthodontic springs. The basis of the apparatus through closed vestibulolingual arches is fixed on the fixation nodes of the fixed part of the apparatus.

The above apparatuses are designed to cover the surface of the defect with a plate and, when worn for a long time due to irritation of the edges of the cleft, help to reduce its size. A significant advantage of the device is that it also provides correction of the shape of the dental arch.

However, the above-mentioned obturators and the methods based on which they function do not provide intensive stimulation of the growth and filling of defects of missing jaw tissues.

Initially, correction of the position of the teeth was achieved by translational actions on them of the active parts of removable orthodontic appliances, which was carried out by periodically removing the apparatus, restoring its diminishing effects and fitting in the oral cavity.

At the beginning of the twentieth century. Mershon and Crozat have developed devices that allow translational effects on both the lateral and frontal teeth from their lingual surface simultaneously (see. Orthodontics Handbook. Chisinau, 1990, p. 180, fig. 27 and p. 188, fig. 28). At about the same time, Ainsworth constructed a device that allows translational effects to be simultaneously applied to the lateral and frontal surfaces of the lateral and frontal teeth (see Kolesov, “Dentistry for Children, Moscow, 1970, Fig. 106).

Currently, in practice, advanced removable translational-impact devices — Crozat-Ricketts and Wilson (see, respectively, “CONSUMMATE OCCLUSION” R. Ricketts, 1996, FIGS. 2-7 and “ENHANCED ORTHODONTICS” R. Wilson, W. Wilson, are widely used in practice. p. 55).

The above apparatuses that implement the method of periodic activation and impact on the teeth by translational efforts, can achieve correction of the position of the teeth and the shape of the dental arch. However, the expansion and lengthening of the dentition as described above leads to a literal (vestibular) inclination of the teeth, that is, their body movement is not ensured.

In 1886, Engle, the founder of modern fixed orthodontic equipment, designed a translational action apparatus that was fixedly fixed on the vestibular surface of the teeth. In 1916, he was the first to propose a method of exposure to translational-rotational forces, which is carried out by a non-removable arc apparatus, providing corpuscular movements of teeth. Subsequently, Engle, having improved the design of a fixed orthodontic apparatus for translational-rotational action on the teeth, performed it in the form of arcs fixed in locks rigidly fixed to the teeth. The method and apparatuses developed by Engle made it possible to achieve body movement of the teeth and correct the shape of the dental arch (see "CONSUMMATE OCCLUSION", R. Ricketts, 1996, Figs. 2-5B and 2-6A).

However, with pronounced deformations of the dentoalveolar arch, the achievement of corpuscular movement of teeth in the vestibular lingual direction by the action of translational-rotational forces on them with non-removable arc devices is possible only after preliminary correction of the geometry of the dental arch and alignment of the teeth.

As a rule, the indicated preliminary correction is carried out by fixed or removable translational devices installed in the oral cavity at the initial stages of treatment. This means that the process of correcting the dentoalveolar arch is multi-stage, and translational-rotational effects on the teeth with non-removable arc devices are carried out at later stages of orthodontic treatment.

As you know, the movement of teeth in the alveolar bone is possible due to the coordinated processes of resorption (resorption) and regeneration (apposition) of the alveolar bone. In this case, the surface of the alveolar ridge, facing the root of the tooth, in places of compression and extension of the walls of the bone marrow cavities is periodically subjected to resorption and apposition, respectively.

The use of large forces in fixed arc devices can lead to resorption of not only the alveolar bone, but also the roots of the teeth, so in practice small efforts are most often used. Summarizing the foregoing, it can be stated that non-removable arc devices do not provide intensive correction of the shape of the alveolar process and require long-term treatment.

To eliminate the phased treatment with severe deformations of the dentoalveolar arch, removable designs of orthodontic appliances were proposed that provide translational and rotational forces on the teeth. Apparatuses of this design are wire frames on the segments of the dentition, scattered along the height of the teeth, interconnected by orthodontic arches and / or springs (see patent for the invention of the Republic of Armenia No. 512. MKI A61C 7/00, 1999 and applications for inventions Republic of Armenia No. 20050147, 20050148, 20050149. MKI A61C 7/00, 2005). The above-described devices were used in a manner typical of removable devices: periodic removal of the device, restoration of diminishing forces and its fitting.

This method of treatment with these devices compares favorably with the known ones in that with significant deformations of the dentoalveolar arch, it is possible to exclude a multi-stage treatment and achieve a translational-rotational effect on all teeth in the right direction. Although when using the devices, the forces applied to the crowns of individual teeth (50-150 g), generally accepted in orthodontics, were applied, in reality, the moments of rotation force on the tops of their roots were several times higher than the similar values provided by other translational-rotational devices. This is ensured by the fact that the wire fastening frames with elements distributed over the height of the tooth crowns allow for a rotational action, providing the largest possible shoulder of the applied forces and contributing to an increase in the torque force on the tooth roots. The above property allows you to move the axis of rotation of the teeth towards the apex of the roots and, as a result, create zones of extension and compression of the alveolar bone from the oral and vestibular surfaces of the roots of the teeth. Depending on the axial position of the teeth during their movement, the magnitude, sequence and combination of applied translational and rotational forces on them are regulated. The use of devices in the foregoing way provides a corpuscular movement of teeth, combined with the growth of the alveolar process, with an intensity of up to 0.3-0.4 mm / month. However, the prolonged exposure to the details of the fastening elements of wire frames located in the interdental space has an expelling effect on the teeth from the hole, which leads to the mobility of individual teeth.

Summary

The task of the claimed group of inventions is the creation of apparatus designs that can intensify the process of correcting the shape of the alveolar process and the dental arch.

The task, according to the first embodiment of the device, is solved by the fact that the device containing fasteners connected through lingual and vestibular wire power units and made in the form of wire frames covering the lateral segments of teeth formed from teeth located on the necks on one side and distributed installed along the height of the tooth with another lingual and vestibular parts connected by jumpers, according to the invention, is equipped with a wire frame mounted on the front segment uboalveolyarnoy arc, and the connection of fastening elements carried by the wire frame of the front segment of the lingual and / or vestibular springs.

The task, according to the second variant of the apparatus, is solved by the fact that the known apparatus containing fasteners connected through a lingual arch with activation nodes and made in the form of wire frames covering the lateral segments of the teeth and formed from lingual and vestibular parts located at the necks of the teeth with according to the invention it is equipped with a wire frame mounted on the front segment of the tooth veolyarnoy arc and associated lingual arc directly and / or through the spring, and the fastening element or elements are further connected to the lingual arch springs.

The task, according to the third embodiment of the apparatus, is solved by the fact that the apparatus containing fasteners connected through a lingual arch with activation nodes and made in the form of wire frames covering the lateral segments of the teeth and formed from lingual and vestibular parts located at the necks of the teeth with one according to the invention, equipped with a wire frame mounted in the frontal segment of the dentoalveolar arc and is connected with the lingual arch directly and / or through the springs, and the fastening element or elements are connected to the wire frame of the front segment and additionally to the lingual arch by the springs.

The essence of all variants of the proposed group of inventions is the fact that the details of the wire frames scattered along the height of the teeth are located on the side of the movement of the teeth.

The essence of all variants of the proposed group of inventions is that the wire frame is made of components mounted on a separate tooth and / or group of teeth of a segment connected by lingual and / or vestibular springs.

The objective of the group of inventions is to create an apparatus with increased functionality to correct the shape of the upper jaw, namely the dentoalveolar and basal arches.

According to the first embodiment, the task of the apparatus is solved by the fact that in the known technical solution containing fastening elements on the lateral segments of the dentition and two plates connected to them located on both sides of the median palatine suture, connected through a wire palatine force element, according to the invention, fasteners are made in the form of wire frames covering the lateral segments of the teeth, and the plates are connected to the fasteners through springs.

According to a second embodiment of the apparatus for correcting the upper jaw, the problem is solved in that in a known technical solution comprising fasteners on the lateral segments of the dentition and two plates connected to them located on both sides of the median palatine suture connected through a wire palatine force element , according to the invention, the design is equipped with fasteners on the front segment, the fasteners are made in the form of wire frames covering the tooth segments, plates connected to the fastening elements on the side segments through the springs, and the fastening elements on the front teeth are connected to the palatal wire power element through the springs.

According to a third embodiment of the apparatus for correcting the upper jaw, the problem is solved in that in a known technical solution comprising fastening elements on the lateral segments of the dentition and two plates connected to them located on both sides of the median palatine suture connected through a wire palatine force element , according to the invention, the design is equipped with fasteners on the front segment, the fasteners are made in the form of wire frames covering the tooth segments, and the sides and e wheel mounting elements are interconnected and the plates through the palatal arch by means of springs.

The objective of the proposed method is the intensification of stimulation of growth and filling of defects in the missing tissues of the jaw.

The problem is solved in that in the known method, which includes closing the defect surface with a plate and irritating its edges, according to the proposed method, oscillatory movements are reported to the plate and, periodically adjusting its working surface, free up space for newly formed tissues.

The task of the claimed apparatus is to create a design that provides intensification of stimulation of growth and filling defects of missing tissues. The problem is solved in that in comparison with the known technical solution containing fastening elements on the posterior teeth, palatine plate or plates covering the missing defect tissue and lingual arch connected to the springs and fasteners and the plate or plates, according to the proposed device, fastening elements made in the form of wire frames with parts, grasping the necks of the lateral teeth from the vestibular and lingual sides, and connecting jumpers located in the interdental space, and also in inter-tubercular fissures in the sagittal and / or transverse directions.

This design allows the periodical activation of the ligaments located in the intercuspid fissures of the ligaments in the frontal direction to achieve vibrational movements of the plate. In addition, the design allows dental alveolar movements in both sagittal and transverse directions.

The objective of the other proposed method is to intensify the correction of the shape of the alveolar ridge and increase the usability of the apparatus. The problem is solved in that, in comparison with the known method of correcting the shape of the dentoalveolar arch, including periodic removal, activation and fitting of the device and the impact on the teeth with translational and rotational forces, according to the invention, the forces developed by the device are repeatedly removed in the intervals between periodic activations and act on them by the forces of chewing muscles.

Brief Description of the Drawings

The invention is illustrated graphic materials.

In figures 1, 2, 3, respectively, the first, second and third versions of the apparatus for correcting the shape of the alveolar arch are shown.

Figure 4 shows a variant of the apparatus for correcting the shape of the dentoalveolar arch, where the wire frame divides the components located on two groups of teeth of the lateral segment, and connected to each other through lingual and vestibular springs.

Figure 5 shows the first variant of the orthodontic apparatus for correcting the shape of the upper jaw.

Figure 6 shows a cross section of the apparatus according to the first embodiment

7 shows a second embodiment of the apparatus for correcting the shape of the upper jaw.

On Fig. The third embodiment of the apparatus for correcting the shape of the upper jaw is shown.

In Fig.9. An apparatus with a palatal plate is shown to stimulate the growth of missing jaw tissues.

Figure 10 shows a variation of the apparatus of Figure 9 with a palatine plate and an alveolar plate with artificial teeth.

11-12 depict zones of compression and stretching of the alveolar ridge, formed under the influence of a wire frame with elements dispersed along the height of the tooth with details in accordance with the presented method of correcting the shape of the alveolar arch.

Figure 13 shows the zones of compression and extension of the alveolar ridge when removing the forces developed by the apparatus and the partial return of the tooth to its original position in accordance with the presented method of correcting the shape of the dentoalveolar arch.

On Fig-15 depict alternating changes in the zones of compression and tension under the influence of the forces of the masticatory muscles in accordance with the presented method of correcting the shape of the dentoalveolar arch.

On Fig-17 shows a model of the jaw of patients before and after orthodontic treatment according to the following examples of a specific implementation of the method of correcting the shape of the dentoalveolar arch.

Detailed description

CORRECTION OF THE DENTAL ARVAL ARC FORM

As shown in FIG. 1, the apparatus for correcting the shape of the alveolar arch, according to the first embodiment, comprises fastening elements (1) made in the form of wire frames wrapping around the lateral segments of the teeth, and a wire frame (2) mounted on the front segment of the teeth, which is connected with the fastening elements (1) through lingual (3) and / or vestibular (4) springs.

As shown in FIG. 2, the apparatus for correcting the shape of the alveolar arch, according to the second embodiment, comprises fastening elements (11) made in the form of wire frames surrounding the lateral segments of the teeth and wire frame (12) mounted on the front tooth segment. The latter is connected directly (13) and / or through springs (14) with a lingual arch (15), the free ends of which are fixed to the fastening elements (11). The lingual arch (15) is equipped with activation units (16) and is additionally connected to one or both fastening elements (11) through springs (17). A variation of the described options and, in particular, the second version of the apparatus (see Figure 4) may be a sectional design of the wire frame. In this case, it is made of components mounted on a separate tooth and / or group of teeth (8) of the segment, interconnected by lingual (9) and vestibular (10) springs.

The apparatus for correcting the shape of the dental alveolar arch, according to the third embodiment, contains fastening elements (21) made in the form of wire frames surrounding the lateral tooth segments and a wire frame (22) mounted on the front tooth segment. The latter through the springs (23) is connected to the lingual arch (24), the free ends of which are fixed to the fastening elements (21). The lingual arch (24) is equipped with activation units (25) and is additionally connected to one or both fastening elements (21) by springs (26). The wire frame (22) on the front segment, in turn, is connected to the element or fastening elements (21) by a spring or springs (27).

A characteristic feature of all the options is that the wire frames are made of lingual and vestibular parts located near the necks of the teeth on one side and scattered along the height of the tooth on the other, connected by jumpers in the interdental space. At the same time, the lingual (see Fig. 3) and vestibular (see Figs. 1, 2, 4) parts of the wire frames scattered along the height of the teeth are located on the side of the tooth movement, i.e. in the first case, the apparatus is intended to narrow, and in the second - to expand the dentoalveolar arch.

The apparatus for correcting the shape of the dentoalveolar arch, according to the first embodiment, is used as follows. By fitting the apparatus in the oral cavity, the patient is taught how to handle it. The device is activated every 15-20 days. By activating the lingual (3) and vestibular (4) springs in the sagittal and / or transverse directions during combination and alternation (according to clinical indications) with rotation around the longitudinal axis of the wire frames of the fastening elements (1) and the transverse wire frames of the front segment (2), a correction is achieved forms of the dentoalveolar arch.

The apparatus for correcting the shape of the dentoalveolar arch, according to the second embodiment, is used as follows. By fitting the apparatus in the oral cavity, the patient is taught how to handle it. The device is activated every 15-20 days. The activation of the lingual arch (15), its activation nodes (16) and the springs (17) and (14) installed respectively between the lingual arch (15) and the frames (11) and (12) in the sagittal and / or transverse directions, as well as when combined and alternating (according to clinical indications) with the rotation of the wire frames of the fastening elements (11) and the frontal segment (12) around the longitudinal axis, a correction of the shape of the dentoalveolar arch is achieved.

The apparatus for correcting the shape of the dentoalveolar arch, according to the third embodiment, is used as follows. By fitting the apparatus in the oral cavity, the patient is taught how to handle it. The device is activated every 15-20 days. By activating the lingual arch (24), its activation nodes (25) and the springs (26) and (23) installed respectively between the lingual arch (24) and the frames (21) and (22) in the sagittal and / or transverse directions when combined and alternating (according to clinical indications) with rotation of the wireframes of the fastening elements (21) and the frontal segment (22) around the longitudinal axis, correction of the shape of the dentoalveolar arch is achieved.

Example: a 27-year-old patient came to the clinic with complaints of a cosmetic defect. Objectively: distal deep bite (malocclusion 2-1 class according to (Engl), narrowing of both dentoalveolar arches, incorrect position and crowding of teeth in the anterior segment.

Two devices were made and fitted in the patient’s oral cavity: the device for the upper dentition according to the first embodiment of the apparatus, and the lower dentition according to the second embodiment of the apparatus.

Activation of the lingual (3) and vestibular (4) springs and frameworks (1) and (2) on the upper jaw and the activation of the elements (6) of the lingual arch (5) and the springs (7) and (4) installed between the arch (5) and frames (1) and (2) on the lower jaw, the correction of the shape of the dentoalveolar arches was achieved. 3.5 months after the start of treatment, measurements of the transverse dimensions of the dentoalveolar arch in the region of 4 teeth showed an increase in the upper jaw by 5 mm and the lower by 6.5 mm. The position of the teeth was significantly normalized, there were three between the teeth, which in the next month was used to correct their position. Alveolar arch growth was also achieved in the lateral parts of the lower jaw. The closure of the teeth after 6 months returned to normal. The device is removed after 3 months of the retention period.

Example: A 19-year-old patient came to the clinic with complaints of a cosmetic defect and facial asymmetry after an orthodontic treatment. Objectively: asymmetry of the face, the left side prevails in size over the right. A biometric study of jaw models showed an excess of the transverse dimensions of the left side of the dental arch (from the middle palatine suture) by 3-5 mm. Forced compensatory displacement of the lower jaw to the left. Wilson's occlusal plane tilts from right to left.

Devices for the upper and lower dentitions according to the third embodiment of the apparatus for correcting the shape of the dentoalveolar process are manufactured and stocked to the patient.

The first 2 months of unilateral activation of the elements (25) of the arc (24) and springs (23) and (26), as well as the frame (21), an increase in the right side of both jaws was achieved. At the same time, Wilson's occlusal curve was corrected — dentoalveolar shortening of the right lower jaw segment. By activating the springs (23) and (26) and the frame (22) at the 3rd month of treatment, tooth-alveolar movement of the frontal segment of both jaws to the right was achieved. During the 4th month, the devices did not activate. At the 5th and 6th months, by activating the arc (25), springs (23) and (26) and the frame (21), a tooth-alveolar displacement of both left lateral jaw segments in the lingual direction was achieved.

The asymmetry of the face decreased significantly after 6 months of treatment. The devices were removed after 3 months of the retention period.

The practical use of the proposed device options for correcting the shape of the alveolar arch has shown that they allow:

- to provide dentoalveolar movements of the frontal segment in the sagittal-transversal directions;

- to achieve uniform and / or uneven expansion and narrowing of the dentition;

- ensure the sequence of dental alveolar movements - of the lateral or frontal segments in different directions;

- to intensify sagittal-transverse movements of both individual and simultaneously several segments of the dentition.

Upper Jaw Correction

In clinical practice, underdevelopment and deformation of the upper jaw are often encountered, the causes of which can be a violation of mineral metabolism (rickets, dyspepsia) in early childhood, infectious and chronic diseases, impaired swallowing, breathing and speech, early loss of temporary or permanent teeth, chewing parafunction and facial muscles.

With a significant narrowing of the dental, alveolar and basal arches, which is most often found with severe forms of rickets, the dome of the sky usually has a double bottom.

It is well known that bone tissue is a viscoelastic medium, the elasticity of which increases significantly with its growth.

Considering the above, the apparatuses are designed in such a way that when correcting the convex parts of the arch of the palate, the action of the plates on them is combined with the opening of the middle palatine suture and the growth of the dentoalveolar process. That is, above and below the convex parts of the arch of the sky, a zone of growth of bone tissues (a zone with increased elastic properties of bone tissue) was created. The impact of the plates on the convex parts of the arch of the palate and the presence of two zones with increased elastic properties of bone tissue can significantly improve the efficiency of correcting the shape of the dome of the sky.

As shown in FIGS. 5 and 6, the apparatus for correcting the shape of the upper jaw, according to the first embodiment, comprises fastening elements (31) made in the form of wire frames wrapping around the lateral tooth segments. Plates (33) are attached to the orthodontic springs (32) welded to the fastening elements (31). The plates (33) are located on both sides of the median palatine suture, on the bulges of the arch of the sky (see Figure 6), and are interconnected by a wire palatine force element (34), made, in particular, in the form of soldered springs.

As shown in Fig.7, the apparatus for correcting the shape of the upper jaw, according to the second embodiment, contains fastening elements respectively on the lateral (41) and incisor (42) segments of the dentition, which are made in the form of wire frames covering the teeth of the corresponding segments. Plates (44) are attached to the orthodontic springs (43) welded to the fastening elements of the lateral segments (41), which are located on both sides of the median palatine suture, on the bulges of the arch of the sky. The plates (44) are interconnected by a wire palatine power element (45), which is connected through an orthodontic spring (46) to the fastening element on the cutting segment (42). As shown in Fig. 8, the apparatus for correcting the shape of the upper jaw, according to the third embodiment, comprises fastening elements (51) and (52) respectively on the lateral and incisive segments of the dentition, which are made in the form of girth teeth of the corresponding segments, wire frames. The palatine arch (54) is fixed to the orthodontic springs (53) welded to the fastening elements (51) and (52), to which plates (56) are attached through the orthodontic springs (55). The plates (56) are located on both sides of the median palatine suture, on the bulges of the arch of the sky, and are interconnected, in particular, by two wire palatine force elements (57).

According to clinical indications in the third embodiment of the apparatus, wire frames for segments of the dentition can be made of components installed on separate and / or groups of teeth connected by lingual and / or vestibular springs.

In all versions of the apparatus, the fastening elements are made in the form of wire frames, which are formed from teeth located at the neck on one side and dispersed lingual and / or vestibular parts mounted on the other, connected by jumpers in the interdental space. In this case, the dispersed components of the wire frames are located on the side of the movement of an individual tooth or group of teeth.

The apparatus for correcting the shape of the upper jaw, according to the first embodiment, is used as follows. By fitting the apparatus in the oral cavity, the patient is taught how to handle it. The device is activated every 10-14 days. By activating the palatal force element (34) installed between the plates (33) and the springs (32) connecting the plates (33) with the fastening elements on the lateral segments (31), bone growth of the middle palatine suture and alveolar bone is achieved.

The apparatus for correcting the shape of the upper jaw, according to the second embodiment, is used as follows. By fitting the apparatus in the oral cavity, the patient is taught how to handle it. The device is activated every 10-14 days. By activating the palatal force element (45) installed between the plates (44) and the springs (43), respectively installed between the plates (44) and the fastening elements on the side segments (41), and the power element (45) and the fastening element on the incisal segment (42) ), bone growth of the median palatine suture and alveolar process in the sagittal and transverse directions is achieved.

The apparatus for correcting the shape of the upper jaw, according to the third embodiment, is used as follows. By fitting the apparatus in the oral cavity, the patient is taught how to handle it. The device is activated every 10-14 days. Activation in the sagittal and transverse directions of the springs (57) installed between the plates (56), the springs (55) installed between the plates (56) and the palatine arch (54), the springs (53) connecting the fasteners (51) and (52 ) with the palatine arch (54), as well as the palatine arch (54), bone growth of the median palatine suture and alveolar process is achieved.

The presence of growth zones above and below the convex parts of the arch of the sky (with a double bottom of the dome of the sky) and the impact on them of the palatine plates (1) allows you to purposefully correct the shape of the sky (see Fig.6).

According to clinical indications, the second and third variants of the device can be used in the treatment of malocclusion.

Example

A patient aged 14 complained of a cosmetic defect. Objectively: violation of nasal breathing, narrowing of the upper dentition, cross bite, in-depth double bottom of the arch. The first version of the orthodontic apparatus for correcting the shape of the upper jaw was made and stocked. The patient received the necessary recommendations for using the device. After 3 months, an increase in the transversal dimensions of the alveolar ridge in the region of the fourth teeth by 9 mm and in the region of the sixth by 5 mm was achieved. The ratio of dentition returned to normal. The shape of the sky dome (its geometry) has been corrected. The depth of the arch of the palate in the area of sixth teeth decreased by 3 mm. After 3 months of the retention period, the device was removed. Moreover, during the retention period, the device was used for 1.5 months around the clock and 1.5 months - only at night.

STIMULATION OF GROWTH OF MISSING JAW TISSUES

It is well known that bone tissue has significant regenerative abilities. With injuries at the sites of fractures and bruises, bone tissue acquires plastic properties (ability to regenerate) and the formation of immature tissues (bone callus). Based on the foregoing, we were tasked to develop a treatment method and apparatus that periodically microtraumatize the edges of the defect stimulates intensive tissue growth.

As shown in FIGS. 9 and 10, the apparatus for stimulating the growth of missing jaw tissues consists of fastening elements (61) and (62) in the form of wire frames on the lateral and frontal segments of the teeth. Elements (61) of fastening the lateral teeth on the chewing surface are provided with jumpers (63) and (64) located respectively in the interdental space and in the inter-tubercular fissures in the sagittal and / or transverse directions. The fastening elements (61) and (62) are connected via an orthodontic spring (65) to a lingual arch (66). The lingual arch (66), in turn, is connected through the springs (67) and (68) to the palatine plate (69) and the alveolar plate (70), respectively. If the tissue of the alveolar bone is defective, the injuring plate (70) is provided with artificial teeth (71), as shown in FIG. 10.

The apparatus for stimulating the growth of missing tissues is used as follows.

By periodically activating the jumpers (64) of the fastening elements (61) located in the frontal direction on the chewing surface of the teeth, conditions are created for the action of the chewing muscles (when the teeth are closed) on the apparatus. As a result of this, plates (69), (70) are driven into oscillatory movements, and, as a result, microtrauma of the surface of the missing tissues and the ends of the cleft defects of the alveolar ridge occurs. Every 20-25 days, correction of the working surfaces of the plates (69), (70) frees up space for newly formed tissues. By activating the springs (65) and the lingual arch (66), correction of the dentoalveolar arch is achieved.

Microtrauma of the ends of the missing tissues, as well as the release of space for newly formed tissues contribute to the intensive growth and filling of jaw defects.

The method and apparatus can be used to eliminate defects in the missing tissues of the alveolar process of both the upper and lower jaws. The method can also be performed on another device, where the oscillatory movements are provided by a separate functional unit that is built into the device and provides low-frequency oscillations.

Example

A patient, 11 years old, came to the clinic with complaints of a cosmetic defect and difficulty chewing. Objectively: anomaly of occlusion of the 3rd class according to Engle, sagittal-transversal decrease in the size of the upper jaw. Cleft of the hard palate 2 × 2 cm in size, postoperative scars on the hard palate and upper lip (uranoplastics and chyeloplastics). Low location of the dome of the sky. An apparatus was manufactured and installed according to the embodiment depicted in FIG. 9. Every 20-25 days, arcs (66) and springs (67) were activated in the sagittal and transverse directions and at the same time, jumpers (64) on the chewing surface of the fastening elements (61) for the anterior teeth in the frontal direction were also activated.

By activating the springs (65) and the lingual arch (66), correction of the dentoalveolar arch in the sagittal-transverse direction is achieved. By activating the jumpers (64) on the fastening elements (61) in the frontal direction, a regime was provided for injuring and irritating the surface of the ends and missing tissues of the cleft palate. In addition, in the process of uneven activation of the springs (67), the sky was raised and formed. 5 months after the start of treatment, the ratio of dentition returned to normal. 7 months after the start of treatment, the cleft completely closed. The edges of soft tissues are freshened and stitches are laid. As a result of treatment, an increase in the transversal and sagittal sizes of the dentoalveolar process in the region of the first premolar by 9 mm, and in the region of the median palatine suture from sixth to first teeth, by 6 mm was also achieved. After 4 months of the retention period, the device is removed.

CORRECTION OF THE DENTAL ARVAL ARC FORM

As you know, periodontal is a viscoelastic medium. Tissues of the alveolar ridge (more precisely, periodontal) tolerate vertical loads relatively well and much worse horizontal loads. When applying translational and rotational forces to the tooth crown, depending on their size and points of application, the axis of rotation of the teeth can be located outside the tooth crowns within the crowns (see Fig. 11), as well as the roots of the teeth (see Fig. 12).

As a result of the impact on the teeth by translational and rotational forces, the alveoli is squeezed by the roots of the teeth in the horizontal direction, which leads to its elastic deformation and movement of the tooth. Periodic removal of the device leads to a partial return of the tooth to its original position (see Fig.13). Changes in the direction of translational-rotational forces that occur during the act of chewing, contribute to an intensive alternating change in the zones of compression and tension of the periodontium (Fig.14 and 15). Repeated removal of translational and rotational efforts between periodic activations of the apparatus on the teeth, combined with an intensive alternating change in the zones of compression and extension of the periodontium during chewing, stimulate the intensive growth of bone tissue of the alveolar process. In addition, frequent removal of the apparatus or its active elements reduces the buoyant effects of the parts of the fastening elements on the teeth from the hole, increase the efforts of the masticatory muscles on individual teeth during chewing, and, as a result, prevent the mobility of individual teeth.

The effectiveness of the treatment of the proposed method was monitored by measuring the transverse dimensions of the dental arch and alveolar bone in patients. The distances between the vertices of the cheek tubercles of 4 teeth and the mesial-buccal 6 teeth, as well as the points located below these tubercles by 10 mm, were measured. Studies have shown that there is an increase in the size of the dental arch and alveolar process of both jaws with an intensity of 2 mm / month. Moving teeth of similar intensity with other methods of translational-rotational impact on the teeth (due to lack of bone tissue of the alveoli) would lead to exposure of the roots of the teeth.

With a small height of the crowns of milk and permanent teeth and their unexpressed equator, the method was carried out by modifications of devices with combined parts of fastening elements. Embodiments of the indicated fastening elements may be non-removable parts in the form of attachment points directly glued to individual teeth or fixed on the orthodontic rings, on which wire frame frames of the tooth rows are fixed to the dental arches with the most simplified removal and installation process. The removal of tensile forces on the teeth is performed by removing the device or its active elements from the oral cavity.

Examples

A 18-year-old patient came to the clinic with complaints of a cosmetic defect. Objectively: deep bite, narrowing of both dentoalveolar arches, crowding and rotation of incisors of both jaws. Devices for correcting the shape of the dentoalveolar arches are made and prepared for the patient. The first activation of the apparatus was carried out 3 days after their fitting. Subsequent activation was carried out every 20-25 days. The patient was recommended to remove the device at least once a day during meals. 3 months after the start of treatment, an increase in the alveolar ridge in the area of 4 teeth in the upper jaw by 5 mm and in the lower jaw by 6 mm was achieved. The ratio of the dentition and the position of the teeth returned to normal. To consolidate the results of treatment, it is recommended that the device be worn continuously for 1.5 months and removed during meals, and then 2-month night wearing of the device. Control examinations were carried out every month, and 4 months after the end of the retention period, the examination showed stable results of orthodontic treatment (see Fig. 16).

A 21-year-old patient came to the clinic with complaints of a cosmetic defect. Objectively: deep bite, narrowing of both dentoalveolar arches, crowding and rotation of incisors of both jaws, protrusion of the upper central incisors. Devices for correcting the shape of the dentoalveolar arches are made and stocked to the patient.

The first activation of the apparatus was carried out 3 days after their fitting. Subsequent activation was carried out every 20-25 days. The patient was recommended to remove the device at least once a day during meals. 4 months after the start of treatment, an increase in the alveolar ridge in the region of 4 teeth was achieved - by 6 mm in the upper jaw and by 7 mm in the lower jaw. The ratio of the dentition and the position of the teeth returned to normal. To consolidate the results of treatment, it is recommended that the device be worn continuously for 2 months and removed only during meals. And then - 2-month night wearing the device. Control examinations were carried out every month, and 3 months after the end of the retention period, the examination showed stable results of orthodontic treatment (see Fig. 17).

The method has also been successfully applied in the treatment of periodontal disease. Although the foregoing is a complete description of a preferred embodiment of the present invention, various alternatives, modifications and equivalents may be used. Therefore, the scope of the presented invention should not be determined by reference to the above description, but by reference to the attached claims along with their full scope of equivalents. Any trait, whether preferable or not, can be combined with any other trait, whether preferable or not. The appended claims should not be interpreted as including the restrictions “means plus function” or “step plus function” unless such a limitation is explicitly quoted in this paragraph using the phrase “means for” or “step for”.

Claims (15)

1. Apparatus for correcting the shape of the dentoalveolar arch, containing fastening elements connected through lingual and / or vestibular wire power units, made in the form of wire frames that are located around the lateral tooth segments, formed from teeth located on the necks of the teeth on one side and spread out along the tooth with other lingual and vestibular parts connected by jumpers, characterized in that it is equipped with a wire frame mounted on the frontal segment of the dentoalveolar arch, and the connection of the fastening elements is carried out through the wire frame of the front segment. 2. The apparatus according to claim 1, characterized in that the lingual or vestibular parts of the wire frames scattered along the height of the teeth are located on the side of the movement of the teeth. 3. The apparatus according to claim 1, characterized in that the frame is made of component parts mounted on a separate tooth and / or group of teeth, connected with each other by lingual and / or vestibular springs. 4. Apparatus for correcting the shape of the dentoalveolar arch, containing fasteners connected through a lingual arch with activation nodes, made in the form of wire frames surrounding the lateral tooth segments, formed from teeth located on the necks of the teeth on one side and distributed along the height of the tooth on the other, lingual and vestibular parts connected by jumpers, characterized in that it is equipped with a wire frame mounted on the frontal segment of the dentoalveolar arch, the frame is connected to the lingua Flax arc directly and / or through the spring, and the element or fastening elements are further connected to the lingual arch springs. 5. The apparatus according to claim 4, characterized in that the lingual or vestibular parts of the wire frames dispersed along the height of the teeth are located on the side of the movement of the teeth. 6. The apparatus according to claim 4, characterized in that the wire frame is made of components mounted on a separate tooth and / or group of teeth of a segment connected by lingual and / or vestibular springs. 7. Apparatus for correcting the shape of the dentoalveolar arch, containing fasteners connected through a lingual arch to activation nodes, made in the form of wire frames, covering the lateral segments of the teeth, formed from the teeth located at the necks on one side and distributed along the height of the teeth on the other lingual and vestibular parts connected by jumpers, characterized in that it is equipped with a wire frame mounted on the frontal segment of the dentoalveolar arch, which is connected with the ling cial arc through the spring, and the fastening element or elements are connected to the wire frame and the front segment further lingual arch springs. 8. The apparatus according to claim 7, characterized in that the lingual or vestibular parts of the wire frames dispersed along the height of the teeth are located on the side of the movement of the teeth. 9. The apparatus according to claim 7, characterized in that the wire frame is made of component segments mounted on separate and / or group of teeth, connected by lingual and / or vestibular springs. 10. Apparatus for correcting the shape of the upper jaw, containing fastening elements on the lateral segments of the dentition and two connected to them, located on both sides of the median palatine suture plate, connected through a wire palatine force element, characterized in that the fastening elements are made in the form of grasping lateral tooth segments of wire frames, plates are located on the deformed parts of the arch of the sky (only on the convex parts of the arch of the sky), connected to the fastening elements through the springs. 11. Apparatus for correcting the shape of the upper jaw, containing fastening elements on the lateral segments of the dentition and connected to them located on both sides of the median palatine suture two plates connected through a wire palatine force element, characterized in that it is equipped with fastening elements on the front segment, fasteners are made in the form of wire frames covering teeth segments, plates are connected to fasteners on lateral segments through springs, and fasteners on front teeth are connected inens with wire palatine force element through springs. 12. Apparatus for correcting the shape of the upper jaw, containing fastening elements on the lateral segments of the dentition and connected to them located on both sides of the median palatine suture two plates connected through a wire palatine force element, characterized in that it is equipped with fastening elements on the front segment, fasteners are made in the form of wire frames covering teeth segments and are connected to each other and to the plates by the palatine arch through the springs. 13. A method of stimulating the growth of missing tissues of the defects of the jaw by closing the defect surface with a plate and irritating its edges, characterized in that the plate is given oscillatory movements and, periodically adjusting its working surface, free up space for newly formed tissues. 14. Apparatus for stimulating the growth of missing tissues of the defects of the jaw, containing fastening elements on the posterior teeth, covering the missing tissue of the defect plate or plates and a lingual arch connected through a spring to the fastening elements and the plate or plates, characterized in that the fastening elements are made in the form of wire frames with the parts surrounding the necks of the lateral teeth from the vestibular and lingual sides and the jumpers connecting them, while the jumpers are located in the interdental space, as well as between Ugrs fissures in sagittal and / or transverse direction. 15. A method of correcting the shape of the dentoalveolar arch by periodic removal, activation and fitting of the apparatus and the action of translational and rotational forces on the teeth, characterized in that in the intervals between periodic activations the forces developed by the apparatus are repeatedly removed by the chewing muscles.

Images