RU2436539C1 - Method of orthodontic treatment of impacted tooth - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention relates to medicine and is intended for treatment of patients with delayed eruption of permanent teeth. Orthopedic wire is preliminarily bent in form of loop. Part of impacted tooth crown is exposed, to which ends of loop from orthopedic wire, bent according to the shape of exposed crown, are fixed. Loop is tied up to orthodontic arch of standard bracket-system. Orthopedic wire is removed, when impacted tooth erupts outside on 1/3 of crown length. Further treatment is carried out in accordance with standard methods. ^ EFFECT: method makes it possible to prevent recurrence of follicular cyst, tooth loss, install deeply-lying impacted tooth into dentition, simplify method of pulling out impacted tooth. ^ 1 dwg, 1 ex

Description

The invention relates to medicine, namely to dentistry, and can be used to treat patients with delayed eruption of permanent teeth (retention), i.e. the tooth did not erupt within two years after the onset of normal eruption. According to the literature, retention occurs in 4-18% of patients visiting a dental clinic (abstract of the dissertation by Ph.D. Yu.G. Khudoroshkova, Omsk, 2007).

Retention of individual teeth can be a cause of difficulty biting off food, infantile swallowing, pathological oral breathing, a bad habit of laying the tongue in a dentition defect. The absence of separate anterior teeth as a result of retention in the dentition and the abnormal position of adjacent teeth leads to an ugly smile and psychological discomfort. Retained teeth are the cause of various dentition and jaw diseases, they can act as a foreign body, causing damage to neighboring organs, due to spontaneous eruption, cause the resorption of roots of adjacent permanent teeth or their abnormal eruption. Resorption of the retained tooth is possible, as a result of which it fuses with the alveolar bone, causing neuralgia and the formation of cysts. Causes of teething delays are:

- endocrine disorders;

- supernumerary teeth;

- atypical tooth structure;

- delay in changing the temporary tooth;

- underdevelopment of the alveolar process;

- cysts, usually follicular, which are diagnosed in 51.1% of cases of odontogenic cysts (V.A. Zelensky, F.S. Mukhoramov. "Pediatric surgical dentistry and maxillofacial surgery." Textbook for universities, Moscow, 2008) . It is with follicular cysts that a retained tooth can lie most deeply in the jaw.

In the absence of appropriate treatment for the follicular cyst, the causative tooth does not erupt, the cyst can suppurate, an increase in its size in the future can lead to a pathological fracture, asymmetries of development, because growth zones on the jaws may be involved in the process (N. A. Rabukhina, P. A. Arzhantsev. “X-ray diagnostics in dentistry”. Moscow, 2003).

Therapeutic measures are carried out in two stages:

- Surgical - exposure of part of the crown of an uncut tooth;

- orthodontic - pulling a tooth and installing it in the dentition.

There is a method of orthodontic treatment of retained teeth (B.Nikolov, 1985), in which orthodontic removable plates with periodic relocation are used, which act as an irritant and contribute to the eruption of the retained tooth.

The disadvantage of this method is that pressure on the alveolar process can cause a relapse of the follicular cyst and aggravate the patient's condition.

There is also a method of orthodontic treatment of retained teeth (G.A.Sekletov, 2006), in which the entire crown of the retained tooth is exposed, a cast is taken from the exposed crown, an orthodontic crown with a hook for traction is made, which is fixed with phosphate cement to the completely exposed tooth crown, after which the retarded tooth is pulled out according to the standard method.

The disadvantage of this method is that it is complex and time-consuming, traumatic at the surgical stage of treatment, because requires significant exposure of the crown of the retained tooth to fix the crown.

There is also a known method of orthodontic treatment of retained teeth (Yu.G. Khudoroshkov, 2008), adopted as a prototype, in which the crown of the retained tooth is exposed, a mold is taken from the half-cut tooth and an individual bracket is made, which is fixed to the retained tooth, and then it is pulled along standard technique.

The disadvantage of this method is that it is not applicable for stretching the retention (not cut) of the teeth from follicular cysts, because the depth of such teeth is large, which does not allow to take a cast from them.

The technical result of the claimed technical solution is: prevention of recurrence of the follicular cyst, tooth loss, the establishment of a deep-seated retained tooth in the dentition, simplification of the method of stretching an uncut tooth.

The specified technical result is achieved by the fact that in the method of orthodontic treatment of the retained tooth, in which the crown of the retained tooth is exposed, an individual bracket is fixed on the retained tooth, the retained tooth is pulled by fixing it to the orthodontic arch of a standard bracket system, according to the invention, the orthopedic loop is preliminarily bent wire, expose part of the crown of the retained tooth, to which the ends of the loop of the orthopedic wire are fixed, bent in shape naked part of the crown and the loop to tie orthodontic archwire standard braces, waiting to be cut out impacted tooth 1/3 bit length, after which the orthopedic wire is removed and then treatment is carried out by standard methods.

The inventive method is as follows (see drawing): the orthodontic wire is preliminarily bent in the form of a loop, after the surgical stage of exposing part of the crown of the retented tooth 1, the ends 2 of orthopedic wire of round cross section made of stainless steel 20X18H9T, previously curved in shape of the exposed part of the crown, are fixed, used in orthopedic dentistry for fixing partial removable laminar dentures in the oral cavity (V.N.Trezubov. Orthopedic dentistry. Applied material Conducting. Textbook for medical schools. ”SPb .: Special literature, 1999, p.61). It can easily be curved in the shape of the exposed part of the tooth crown for optimal fixation to it. The choice of the length of the fixed wire is dictated by the depth of the retained (uncut) tooth. The ends 2 of the orthodontic wire are fixed to the tooth, for example, on glass ionomer cement 3 Vitremer of triple chemical curing, which is used in practice as a filling material for the treatment of caries (S.T.Sokhov. "Medicines and filling materials used to treat dental caries." Textbook. - Moscow. ANMI: 2001, p. 155-156). Vitremer glass ionomer cement has high adhesive properties, releases fluoride ions into the weakly mineralized enamel of the retained tooth. A positive property of this material is that it has hydrophilic properties, in contrast to other known fixing materials (composites, etc.), and the medium around the exposed, deep-lying crown is “wet”. The low solubility of this glass ionomer cement, which is close to zero, is also taken into account. The loop 4 of a previously bent in the form of a loop orthopedic wire facing the oral cavity is fixed to a standard orthodontic arch 5 using the direct arc technique (bracket system). They wait until the retarded tooth cuts out 1/3 of the crown length, after which the orthopedic wire is removed and then the treatment is carried out according to the standard method by gluing a standard bracket or hook, or button, to the erupted crown.

An example of a specific application of the proposed method

Patient A., born in 1993, on October 6, 2009, turned to the Department of Pediatric Dentistry with complaints of darkening of the crown and mobility of 22 teeth, the absence of 23 teeth.

Anamnesis: 22 tooth mobility appeared 3 months. back.

Objectively: crown 22 is changed in color, mobility is 1 degree. Crown 23 is missing. On the orthopantomogram in the alveolar part of the frontal section of the upper jaw, the tooth 23 is determined to the left, the crown is facing the root of the tooth 22, the root of the tooth 23 is formed. Root 22 is resorbed, the shell of the follicular cyst from 23 tooth half.

Diagnosis: Follicular cyst of the upper jaw from 23 teeth. Retention 23 teeth. Pathological resorption of the root of the 22 tooth.

Treatment: under the sol.Septanesti 1.8 ml infiltration anesthesia, 22 teeth were removed. Cystotomy performed. Partially exposed crown 23 of the retained tooth. On October 8, 2009 - no complaints. On the exposed part of the crown of the 23 tooth, Vitremer glass ionomer cement is fixed with a previously bent in the form of a loop orthodontic wire, which is tied to a standard bracket system. On March 5, 2010 - no complaints. The eruption of the crown 23 of the tooth is more than half. Pre-curved loop-shaped orthopedic wire removed. Instead of an orthopedic wire loop, a bracket for 23 teeth was fixed according to the standard method for its further correct installation in the dentition.

The inventive method allows you to save a deep-seated retarded tooth, prevents the development of such complications associated with non-dentition, such as:

- relapse of the follicular cyst;

- damage to neighboring organs;

- abnormal teething of adjacent teeth;

- neuralgia;

- the formation of cysts;

- difficulty biting off food;

- violation of aesthetics;

- psychological discomfort.

The inventive method is easy to use and does not require significant costs. Exposing a portion of the crown of a retention tooth is less traumatic for the patient. The inventive method can be applicable for stretching uncracked teeth with a follicular cyst, when the retained tooth lies deep in the thickness of the jaw.

Claims (1)

A method of orthodontic treatment of a retained tooth, in which the crown of the retained tooth is exposed, an individual bracket is fixed on the retained tooth, the retained tooth is pulled by fixing it to the orthodontic arch of a standard bracket system, characterized in that the orthopedic wire is pre-bent in a loop, and a portion of the crown of the retained is exposed tooth, to which the ends of the loop of orthopedic wire are fixed, curved in the shape of the exposed part of the crown, and the loop is tied to the orthodontic If the standard bracket system is used, they wait until the retarded tooth cuts out 1/3 of the crown length, after which the orthopedic wire is removed and further treatment is carried out according to the standard method.

Images