RU2561293C1 - Method for detecting abnormal tooth position and selecting therapeutic approach - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: teeth misalignment is one of the most common dentofacial anomalies. Dental panoramic X-ray images are formed and scanned for the purpose of more careful calculation. The electronic images are sent to a personal computer, wherein Gimp graphics editor is used to perform all the calculations. Abnormal positions of the upper and lower teeth in the sagittal plane are detected by an inside angle facing a midline of a dental arch and formed by a Frankfurter plane crossing a long axis of the tooth. Abnormal positions of the upper and lower teeth in the vertical plane are shown by an angle formed by three points, i.e.: a root apex point of single-rooted teeth or a mid-point of root apexes of multi-rooted teeth, a lower end point of a maxillary arch on the right for the teeth of the 1^st and 4^th segments and on the left for the teeth of the 2nd and 3rd segments and a lower end point of an eye socket on the right for the teeth of the 1^st and 4^th segments and on the left for the teeth of the 2nd and 3rd segments. The derived data are compared to the norm, and if observing a tooth inclination in the sagittal plane by 14.9±3.8° or less as compared to the normal value, and in the vertical plane by 2.65±0.67° or less; a therapeutic approach using braces is preferred; if the tooth inclination is from 14.9±3.8 to 20.9±3.8° in the sagittal plane, and from 2.65±0.67 to 4.14±0.94° in the vertical plane, the therapeutic approach is suggested to be based on micro implants; the tooth inclination of 20.9±3.8° or more in the sagittal plane and of 4.14±0.94° or more in the vertical plane as compared to the norm implies the therapeutic approach comprising the combined use of braces and micro implants.

EFFECT: method enables detecting sagittal and vertical teeth repositioning as a part of the orthodontic care, increasing the diagnostic accuracy and the appropriateness of the therapeutic approach preferred.

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Description

The invention relates to medicine, namely to dentistry and orthodontics, and can be used in the diagnosis and treatment of tooth position anomalies in the sagittal and vertical planes in orthodontic treatment and orthodontic preparation for prosthetics.

Improper tooth position is one of the most common anomalies of the dentition. According to G.K. Spatar (1984), it occurs in 25-30% of the examined and in 38.7 ± 2.6% of adults seeking orthodontic care. Moreover, this anomaly in 40-60% of cases is combined with other anomalies in the shape and ratio of the dentition [1].

According to the WHO classification (1997), all tooth position anomalies are considered with respect to three mutually perpendicular planes. In the transversal plane, these anomalies include the labiochemal (vestibular) and oral (palatine or lingual) position of the teeth, in the sagittal plane - mesial and distal tilt, in the vertical plane - infra- and supraposition. These abnormalities occur with the early removal of both milk and permanent teeth, with the incorrect position of the rudiments or the wrong position of other teeth [3].

The position of the teeth in the sagittal plane is determined in relation to the center line of the dentition. If the crown of the tooth is inclined to the center line, then they speak of the mesial inclination of the tooth, if from it, then this is the distal inclination [1, 3].

The position of the teeth in the vertical direction is determined with respect to the occlusal plane. If the cutting edge or tubercles of the tooth are located above the occlusal plane; they talk about supraocclusion, if they fall below it - about infraocclusion. Supra- or infraocclusion is observed with abnormalities of the dental and alveolar arches in the vertical direction (for example, with deep and open bites) [4, 5].

X-ray methods for diagnosing tooth anomalies include orthopantomography, head tele-radiography, and computed tomography. There are two approaches to determining the inclination of teeth according to the results of an orthopantomogram. The first is the determination of the inclination of teeth relative to other teeth. However, it must be borne in mind that the teeth change their position and inclination during orthodontic treatment. In addition, these teeth themselves may have an undiagnosed deviation from the normal axis of inclination. The second is the determination of the inclination of the teeth relative to the midline of the face, which on the orthopantomogram usually coincides with the line drawn through the nasal spine and the deepest point of the chin protrusion. However, this approach can be applied only in the absence of jaw asymmetry [4, 6, 7].

The position of teeth can be most accurately determined by computed tomography (CT) data, however, a patient receiving a CT scan receives high doses of radiation, so it is impossible to refer a patient to this study repeatedly [2, 8].

A known method for the diagnosis of anomalies of the dentofacial system, which includes determining the Spee curve, which is investigated on models of the jaws. The Spee curve connects the cutting edge of the central incisor and the distal tubercles of the second molar [9, 10].

However, the known method has insufficient accuracy, since the accuracy of the occlusion ratio, revealed by studying the models in the articulator, changes rapidly during the skeletal growth of adolescent patients, in addition, the position of the teeth and the ratio of the jaws change significantly during treatment. Another disadvantage of this method is its complexity and duration [11, 12].

A known method for the diagnosis of anomalies of the dentofacial system (RF, No. 2360604, January 24, 2008, IPC АВВ 6/00), including the study of a teleretgenogram of the head in lateral projection, on which the area of the tongue and the area of the space free of the tongue are determined.

A disadvantage of the known method is the impossibility of determining the inclination of the teeth to the plane of the upper and lower jaws when analyzing the teleradiogram of the head in a lateral projection, since in this picture there is a layering of the right and left halves of the skull and it is difficult to determine the particular tooth or group of teeth that is of interest.

A known method for identifying dentition anomalies and a device for its implementation (RF, No. 2134557, 07/22/1998, IPC ⁶ A61C 7/00, A61C 11/00). A known method is to study the models of the jaws, install them in the usual occlusion and then determine the pattern of deviations of the position of the teeth.

The disadvantage of this method is the low diagnostic accuracy.

None of the above diagnostic methods allows you to choose the tactics of subsequent treatment.

For the prototype of the invention, a method for diagnosing anomalies of the dentition, an orthopantomogram and analysis of the image of the upper and lower jaws (RF patent No. 2444292, IPC A61B 6/14, publ. From 10.03.2012) was selected.

The known method is as follows. Receive and analyze the lateral and contoured teleradiographs of the head, jaw models, contoured and profile photographs of the patient's face. Evaluate the malfunction of the masticatory-speech apparatus, the close position of the teeth, their retention and adentia. Identified signs of dentoalveolar anomaly (RFA) are assigned the first, second or third degree of severity: before treatment and after. The data are tabulated. In the vertical columns of the table the directions (sagittal, vertical and transversal) are presented, and in the horizontal - signs of AFA (morphological, occlusal, aesthetic and functional). In the second part of the table in vertical columns presents such characteristics as the close position of the teeth, their retention and adentia, in horizontal - their possible degrees of severity. The known method is intended to assess the effectiveness of the treatment.

The disadvantage of this method is the inability to determine the position of the teeth or any particular tooth in the sagittal and vertical plane, which at the initial stage (before the start of treatment) does not allow to obtain objective data on anomalies of the dentofacial system and choose the appropriate treatment tactics, and, due to the lack of initial objective data also does not allow to objectively evaluate the results of orthodontic treatment.

The objective of the invention is to provide the ability to determine changes in the position of the teeth in the sagittal and vertical planes during orthodontic treatment, improving the accuracy of diagnosis and increasing the accuracy of the choice of treatment tactics, as well as simplifying the method.

The problem is solved in that the method for detecting anomalies in the position of the teeth, including conducting an orthopantomogram and analyzing the image of the upper and lower jaws, anomalies in the position of the teeth of the upper and lower jaws in the sagittal plane is determined by the internal angle facing the middle line of the dentition, which is formed when the intersection of the Frankfurt horizontal and the longitudinal axis of the tooth, the anomalies in the position of the teeth of the upper and lower jaws in the vertical plane are determined by the angle formed by by me points: the apex point of the root of single-rooted teeth or the middle between the apex of the roots of multi-rooted teeth, the point of the lower edge of the zygomatic arch on the right for teeth of 1 and 4 segments and the left for teeth of 2 and 3 segments and the point of the lower edge of the orbit on the right for teeth of 1 and 4 segments and left for teeth of segments 2 and 3, the obtained data are compared with the norm and if the tooth angle in the sagittal plane deviates from the norm by 14.9 ± 3.8 ° or less, and in the vertical plane by 2.65 ± 0.67 ° or less, the treatment tactics using the bracket system when rejected and the angle of inclination of the tooth in the sagittal plane above 14.9 ± 3.8 to 20.9 ± 3.8 °, and in the vertical plane above 2.65 ± 0.67 to 4.14 ± 0.94 °, treatment tactics using microimplants are chosen, when the angle of inclination of the tooth in the sagittal plane from the norm is 20.9 ± 3.8 ° and more, and in the vertical plane 4.14 ± 0.94 ° and more, the treatment tactics in the form of the combined use of the bracket system and microimplants is chosen.

The present invention meets the criteria of "novelty" and "inventive step", since in the process of conducting patent information research, no sources of scientific, technical and patent information were found discrediting the novelty of the proposed invention, as well as technical solutions containing essential features of the proposed method.

The proposed method is illustrated in graphic material.

Figure 1 shows a method for determining anomalies of the dentition in the sagittal plane.

In figure 2. depicts a method for determining anomalies of the dentition of the vertical plane.

Figure 3 presents the orthopantogram after treatment

When diagnosing anomalies of the dentition of the upper and lower jaw in the sagittal plane (Fig. 1), the internal angle 1 is determined, which is formed when the Frankfurt horizontal 2 and the longitudinal axis of tooth 3 intersect, the dentition facing the midline 4.

To determine the position of the teeth of the upper and lower jaw in the vertical plane (figure 2) shows the angle 5 formed by three points: point 6 of the tops of the roots of single-rooted teeth 6 or the middle between the tops of the roots of multi-rooted teeth, point 7 of the lower edge of the zygomatic arch on the right for teeth 1 and 4 segments and point 8 on the left for teeth 2 and 3 segments and point 9 of the lower edge of the orbit on the right for teeth 1 and 4 segments and point 10 on the left for teeth 2 and 3 segments.

The present invention allows to obtain the following technical effect.

The selection of new guidelines in determining the anomalies of the position of the teeth of the upper and lower jaws in the sagittal and vertical planes, namely:

- in the sagittal plane along the inner corner facing the midline of the dentition, which is formed when the Frankfurt horizontal and the longitudinal axis of the tooth intersect;

- in the vertical plane along the angle formed by three points: the point of the tops of the roots of single-rooted teeth or the middle between the tops of the roots of multi-rooted teeth, the point of the lower edge of the zygomatic arch on the right for teeth 1 and 4 segments and on the left for teeth 2 and 3 segments, the point of the lower edge of the orbit on the right for teeth 1 and 4 segments and left for teeth 2 and 3 segments;

- determination of the norm of the angle of deviation

allow you to objectively determine the anomalies in the location of the teeth based on constant bone supports, which do not depend on the age of the patient. This allows you to increase the accuracy of diagnosis up to 95%. The obtained norms provide guidelines for choosing the tactics of orthodontic treatment even in the most difficult clinical cases.

Using the proposed method for the diagnosis of anomalies of the dentition or anomalies of the position of individual teeth accompanied in the vertical and sagittal planes and the choice of tactics for treating patients showed high efficiency when using it.

Orthopantomography is the most common way to study the dentition. The proposed method is simple and does not take much time, in addition, allows you to use it for orthodontic purposes.

To confirm the positive effect of the proposed method, studies were conducted on the basis of the Department of Orthopedic Dentistry and Orthodontics SBEI HPE NizhGMA Russian Ministry of Health. We studied 116 patients aged 18 to 58 years with various anomalies of the dentition. After the treatment of the revealed anomalies, a control x-ray examination was performed, which showed the absence of anomalies in the position of the teeth in the vertical and sagittal planes.

During descriptive statistics, the maximum, minimum, and average values of each parameter measured on orthopantomograms were calculated. In addition, tolerances from mean values were determined. Such calculations were performed for the control group (i.e., persons having an orthognathic bite) and for the group of patients with anomalies of the dentition. For the control group, we examined 50 orthopantomograms of people with intact dentitions aged 18 to 35 years (25 men and 25 women), on which the angle of inclination of all teeth was determined in two planes - sagittal and vertical.

Table 1 shows the results of descriptive statistics of measurements of orthopantomograms of the control group in the sagittal plane. All values are presented in degrees.

Table 1 Results of descriptive statistics of measurements of orthopantomograms of the control group in the sagittal plane average minimum maximum Standard deviation tooth 1.7 98.3 85.0 110.0 7.0 tooth 1.6 92.2 86.0 100.0 4.2 tooth 1.5 92.8 85.0 104.0 5.2 tooth 1.4 90.4 84.0 98.0 3.7 tooth 1.3 91.2 85.0 95.0 2.4 tooth 1.2 94.1 85.0 102.0 5.1 tooth 1.1 91.4 86.0 97.0 2.9 tooth 2.1 88.5 84.0 94.0 2.6 tooth 2.2 90.1 83.0 97.0 4.3 tooth 2.3 89.0 84.0 94.0 2.9 tooth 2.4 89.3 85.0 96.0 3.1 tooth 2.5 92.1 85.0 101.0 3.8 tooth 2.6 92.2 86.0 102.0 5.0 tooth 2.7 98.7 88.0 106.0 5.6 tooth 4.7 116.5 110.0 124.0 4.7 tooth 4.6 112.9 101.0 120.0 5.6 tooth 4.5 104.8 96.0 120.0 5.5 tooth 4.4 101.0 89.0 109.0 5.5 tooth 4.3 98.1 90.0 108.0 5.4 tooth 4.2 90.7 80.0 98.0 4.8 tooth 4.1 90.1 80.0 96.0 4.0 tooth 3.1 92.5 86.0 103.0 4.8 tooth 3.2 92.7 82.0 100.0 5.4 tooth 3.3 97.2 88.0 111.0 6.9 tooth 3.4 98.8 92.0 111.0 5.8 tooth 3.5 103.7 94.0 123.0 6.9 tooth 3.6 109.0 91.0 120.0 7.1 tooth 3.7 113.2 94.0 124.0 7.7

When analyzing the results of descriptive statistics of measurements of orthopantomograms in the sagittal plane, it is noteworthy that all parameters increase from the incisors to the molars both on the upper jaw and on the lower jaw. An exception was the lateral incisors.

Table 2 shows the results of descriptive statistics of measurements of orthopantomograms of the control group in the vertical plane. All values are presented in degrees.

table 2 The results of descriptive statistics of measurements of orthopantomograms of the control group in the vertical plane average minimum maximum Standard deviation tooth 1.7 30.8 23.0 40.0 4.3 tooth 1.6 28.3 22.0 33.0 3.5 tooth 1.5 25.3 19.0 31.0 4.2 tooth 1.4 23.2 17.0 30.0 4.0 tooth 1.3 18.0 12.0 26.0 4.5 tooth 1.2 20.4 14.0 28.0 3.8 tooth 1.1 17.9 13.0 25.0 3.6 tooth 2.1 18.1 13.0 25.0 3.3 tooth 2.2 21.5 16.0 29.0 3.4 tooth 2.3 20.3 15.0 26.0 3.5 tooth 2.4 24.7 20.0 30.0 2.9 tooth 2.5 27.0 20.0 36.0 3.8 tooth 2.6 30.8 23.0 40.0 4.2 tooth 2.7 34.2 25.0 50.0 5.4 tooth 4.7 66.5 55.0 78.0 6.9 tooth 4.6 60.0 50.0 72.0 5.5 tooth 4.5 54.0 43.0 64.0 5.7 tooth 4.4 49.1 40.0 58.0 5.2 tooth 4.3 47.0 40.0 55.0 4.5 tooth 4.2 40.9 34.0 50.0 5.0 tooth 4.1 38.2 33.0 48.0 4.7 tooth 3.1 38.9 33.0 46.0 4.0 tooth 3.2 41.8 35.0 48.0 3.8 tooth 3.3 47.6 40.0 54.0 4.2 tooth 3.4 50.1 42.0 57.0 4.3 tooth 3.5 54.5 45.0 63.0 4.8 tooth 3.6 61.4 52.0 71.0 5.2 tooth 3.7 69.4 58.0 79.0 5.5

When analyzing the results of descriptive statistics of measurements of orthopantomograms in the vertical plane, it is noteworthy that all parameters increase from the incisors to the molars both on the upper jaw and on the lower jaw. The exception was fangs. And also, these parameters on the upper jaw for the teeth on the right (1 segment) have lower values than the parameters for the teeth on the left (2 segment). The greatest variability of the dental arch and large values of the standard deviation are observed in the lower jaw.

Thus, an analysis of the results of descriptive measurement statistics on orthopantomograms showed that all values increased from the central incisor to the molars in the upper and lower jaws in both the sagittal and vertical planes. On the upper jaw, these values in the vertical plane for the teeth on the left had larger values than on the right. On the lower jaw, the angle of inclination of the teeth in the sagittal plane for the teeth on the right was greater than for the teeth on the left.

As a result, normal values of the position of the teeth in the sagittal and vertical planes were obtained, which were used in planning and conducting orthodontic treatment of dentoalveolar anomalies.

The proposed method is as follows.

Orthopantomograms are obtained, which, for the purpose of more accurate calculations, are scanned, after which the electronic version is transferred to a personal computer, where all calculations are performed in the Gimp graphics editor. Measurements of the position of the teeth in the vertical and sagittal planes are carried out in degrees.

The determination of the position of the teeth in the sagittal plane is carried out according to the inner corner facing the midline of the dentition, formed at the intersection relative to the Frankfurt horizontal and the longitudinal axis of the tooth. To determine it, note the lowest points of the right and left orbits (ord and ors) and connect them with a straight line. Then a rotary axis of the tooth is drawn, which passes through the center of rotation (the middle between the apex of the root and the process of the alveolar bone) and the middle of the cutting edge or chewing surface.

The center of rotation of the tooth is chosen as a guide when determining the position of the teeth in the sagittal plane, since this point does not depend on the possible anomalies of the position in other planes, and also eliminate measurement inaccuracies associated with the deviation of the tips of the roots of the teeth. Then the rotated axis of the tooth is extended to the Frankfurt horizontal and measure the angle facing the midline. These measurements are carried out in the area of all teeth of the upper and lower jaws.

The determination of the position of the teeth in a vertical plane is carried out relative to the zygomatic arches and eye sockets.

Find the lowest points of the right and left orbits and the zygomatic arch on the right and left, on which the most protruding points are determined. In the vertical plane, it is determined by the angle formed by the three points of the apex of the root of single-rooted teeth or the middle between the tops of the roots of multi-rooted teeth, the point of the lower edge of the zygomatic arch on the right for the teeth of the first and fourth segments and on the left for the teeth of the second and third segments and the point of the lower edge of the orbit on the right for the teeth the first and fourth segments and left for the teeth of the second and third segments. The obtained data is compared with the norm and when the tooth angle in the sagittal plane deviates from the norm by 14.9 ± 3.8 ° or less, and in the vertical plane by 2.65 ± 0.67 ° or less, treatment tactics using the bracket system are chosen, if the tooth angle is deviated to the sagittal plane from the norm from 14.9 ± 3.8 to 20.9 ± 3.8 °, and in the vertical plane from 2.65 ± 0.67 to 4.14 ± 0.94 °, treatment tactics using microimplants are chosen, when the angle of inclination of the tooth in the sagittal plane from the norm is 20.9 ± 3.8 ° and more and in the vertical plane by 4.14 ± 0.94 ° and more he longer treatment strategy is selected in a combined use of braces and microimplants.

The treatment tactics are selected as follows: if the tooth angle in the sagittal plane deviates by 14.9 ° ± 3.8 ° degrees or less at a rate of 9.8 °, in a vertical plane 2.65 ° ± 0.67 ° or less at a rate of 8.8 ° for treatment anomalies of the dentoalveolar system as a treatment tactic, choose the bracket system, with a deviation of the angle of inclination of the tooth in the sagittal plane from 14.9 ° 3.8 ° to 20.9 ° 3.8 ° degrees with a norm of 9.8 °, in the vertical plane from 2.65 ° ± 0.67 ° to 4.14 ° ± 0.94 ° degrees at a rate of 8.8 ° for orthodontic treatment of anomalies, microia treatment is chosen with implants, with a deviation of the angle of inclination of the tooth in the sagittal plane by 20.9 ° ± 3.8 ° degrees and more at a rate of 9.8 °, and in a vertical plane at 4.14 ° ± 0.94 ⁰ degrees or more at a rate of 8.8 °, choose complex treatment in the form combination of braces and microimplants.

Examples of specific performance are given in the form of extracts from the medical history.

Example No. 1

Patient N., 52 years old, complained of missing teeth. He was referred by an orthopedic dentist for the purpose of orthodontic preparation for prosthetics. From the anamnesis it was found out that tooth 3.6 was removed more than five years ago due to complications of caries, earlier orthodontic treatment was not carried out.

During a clinical examination: the face is of the mesocephalic type, a direct profile, nasolabial folds are expressed, the chin fold is smoothed.

Examination of the oral cavity: the mucous membrane is pale pink, moderately moist, with no visible pathological elements. Dental formula:

When assessing the ratio of dentitions in the position of central occlusion, a neutral ratio of fangs was revealed (Engle's 1st class). The incisors of the upper jaw overlap the incisors of the lower jaw by 1/2 the height of the crown; the cutting-tubercular contact is preserved. The middle line of the dentition of the lower jaw is shifted to the right by 1 mm. There is a close position of the front teeth of the lower jaw, diastema of the upper jaw, mesial inclination 4.7.

The study of the orthopantomogram showed that the tooth tilt 4.7 in the sagittal plane is 130 ° (norm 116.5 ± 4.7), the deviation from the norm when compared with the control group tables was 8.8 °, so a decision was made to treat this anomaly with a microimplant.

Based on a comprehensive examination of the patient, the diagnosis was made:

partial loss of teeth of the upper and lower jaws, deformation of the dentition, anomalies in the position of individual teeth.

Orthodontic treatment plan:

1. Normalization of the position of the tooth 4.7;

2. To prosthetize the upper and lower jaw;

3. Stabilization of the achieved results (retention period).

The treatment was carried out using a microimplant (AbsoAnchor SH13-10), metal tiger brackets with hooks that were fixed on the buccal and lingual surfaces of the tooth 4.7 and elastic traction (elastic chain).

The patient came in every three weeks. Activation consisted of a change in the elastic chain, which was superimposed from the braces from the buccal and lingual surfaces of the tooth 4.7 to the microimplant installed in the retro-molar region. The treatment period for this patient was 24 weeks. The study of the orthopantomogram after treatment showed that the angle of inclination of the tooth 4.7 in the sagittal plane is 130 °, which is normal when compared with the tables of the control group.

After the active treatment period ended, a removable retention kappa was placed on the lower dentition. The mode of use of the device involved the constant wearing of it for 6 months and then only in the evening and at night.

Example No. 2

Patient M., 42 years old, complained of missing teeth. He was referred by an orthopedic dentist for the purpose of orthodontic preparation for prosthetics. From the anamnesis, it was found out that tooth 3.6 and 3.7 were removed about two years ago, dental implants were installed in the same period, but the patient did not appear for prosthetics, previously no orthodontic treatment was performed.

Clinical examination: the face is of the mesocephalic type, convex profile, nasolabial and chin folds are moderate.

Examination of the oral cavity: the mucous membrane is pale pink, moderately moist, with no visible pathological elements. Dental formula:

When assessing the ratio of dentitions in the position of central occlusion, a neutral ratio of fangs on the right (1st grade of Engle) and a ratio of fangs on the left according to 2nd grade of Engle were revealed. The incisors of the upper jaw overlap the incisors of the lower jaw at the crown height Vi, the cutting-tubercular contact is preserved. The middle line of the dentition of the upper jaw is shifted to the left by 2 mm. A close position of the front teeth of the lower jaw, diastema and tremors of the upper jaw, a mesial inclination of 3.7, supraposition 1.6, 1.5, 2.6 are noted.

The study of the orthopantomogram showed that the angle of inclination of the tooth 1.6 in the vertical plane is 35 ° (norm 28.3 ± 3.5 °), the deviation from the norm when compared with the tables of the control group was 3.2 °, the angle of inclination of the tooth was 1.5-32 ° (norm 25.3 ± 4.2 °) , deviation from the norm 2.5 °, the angle of inclination of the tooth 2.6-39 ° (norm 30.8 ± 4.2 °), deviation from the norm 4 °, so it was decided to treat this anomaly with the help of the bracket system.

Based on a comprehensive examination of the patient, the diagnosis was made: partial loss of teeth of the upper and lower jaws, deformation of the dentition, anomalies in the shape of the dental arches and anomalies in the position of individual teeth.

Orthodontic treatment plan:

1. Normalization of the position of the teeth 1.6, 1.5, 2.6

2. Normalization of the shape of the dentition of the upper and lower jaws;

3. Correction of the position of the midline of the dentition;

4. Prosthetics of the upper and lower jaw;

5. Stabilization of the achieved results (retention period).

The treatment was carried out with fixed orthodontic appliances (bracket system, direct arc technique), using the standard metal bracket system (Russia), 018 groove. The patient came to activate the bracket system once a month. The duration of leveling the angle of inclination of the teeth 1.6, 1.5, 2.6 lasted for 32 weeks.

In the first phase of leveling, arcs of a nickel-titanium alloy of round (0.014) and square sections (0.016 * 0.016) were used.

In the 2nd phase, the correction of the torque was carried out using a steel arc of 0.016 * 0.022 and the normalization of the Spee occlusal curve. The midline displacement between the central incisors was corrected using intraoral oblique intermaxillary elastic

In the 3rd phase, the final correction of the torque was carried out using a steel arc of 0.017 * 0.025. The final vertical correction was carried out by a steel arch 0.017 * 0.025 and vertical intermaxillary traction (table 3).

Table 3 Orthodontic Arc Change Sequence Upper jaw Lower jaw Orthodontic arch Use time Orthodontic arch Use time Nitanium 0.014 1.5 months Nitanium 0.014 2 months Nitanium 0.016 * 0.016 2.5 months Nitanium 0.016 * 0.016 2.5 months Chromium 0.016 * 0.022 4 months Chromium 0.016 * 0.022 4 months Chromium 0.017 * 0.025 5 months Chromium 0.017 * 0.025 5 months Active period 12.5 months Active period 13.5 months

On the orthopantomogram after the leveling stage, the position of all the teeth was normal. The angle of inclination of tooth 1.6 was 28.1 ° (norm 28.3 ± 3.5 °), tooth 1.5–25.6 ° (norm 25.3 ± 4.2 °), tooth 2.6–33.1 ° (norm 30.8 ± 4.2 °).

Example No. 3

Patient E., 42 years old, complained of incorrect tooth position. From the anamnesis it was found out that teeth 3.6 and 4.6 were removed more than ten years ago, earlier orthodontic treatment was not carried out.

Clinical examination: dolichocephalic type face, convex profile, nasolabial folds smoothed, chin fold is moderate.

Examination of the oral cavity: the mucous membrane is pale pink, moderately moist, with no visible pathological elements. Dental formula:

When assessing the ratio of dentitions in the position of central occlusion, a neutral ratio of canines to the right and left was revealed according to Engle's 2 class. The incisors of the upper jaw overlap the incisors of the lower jaw by 1/2 the height of the crown; the cutting-tubercular contact is preserved. The middle line of the dentition of the lower jaw is shifted to the right by 2 mm. There is a diastema and tremors of the lower jaw, a mesial inclination of 3.7, 4.7.

The study of the orthopantomogram showed that the angle of inclination of the tooth 3.7 in the sagittal plane is 125.5 ° (norm 113 ± 7.7 °), the deviation from the norm when compared with the tables of the control group was 4.8 °, the angle of inclination of the tooth was 4.7-132 ° (norm 116.5 ± 4.7 °) , the deviation from the norm is 10.8 °, so it was decided to treat this anomaly with the help of the bracket system.

Based on a comprehensive examination of the patient, the diagnosis was made: partial loss of teeth of the upper and lower jaws, deformation of the dentition, distal bite, complicated by anomalies in the shape of the dental arches and anomalies in the position of individual teeth.

Orthodontic treatment plan:

1. Normalization of the position of the teeth 3.6, 4.6

2. Normalization of the shape of the dentition of the upper and lower jaws;

3. Correction of the position of the midline of the dentition;

4. Prosthetics of the upper and lower jaw;

5. Stabilization of the achieved results (retention period).

The treatment was carried out using fixed orthodontic equipment (Damon system of self-ligating braces, 022 groove). The duration of leveling the angle of inclination of the teeth 1.6, 1.5, 2.6 lasted for 29 weeks.

Treatment was carried out

In the first phase of leveling, arcs of a nickel-titanium alloy with the addition of round copper (0.014) and rectangular cross-section (0.014 × 0.025 and 0.018 × 0.025) were used, and the position of teeth 3.6.4.6 was leveled using nitinol springs.

In the second phase, the correction of the torque was carried out using a steel arc of 0.016 × 0.025 and the normalization of the Schlee occlusal curve.

In the 3rd phase, the final correction of the torque was carried out using a steel arc of 0.019 × 0.025 in the upper jaw and 0.016 × 0.025 in the lower jaw. The final vertical correction was carried out by the above-mentioned wire arches and vertical intermaxillary traction (table 4).

Table 4 Orthodontic Arc Change Sequence Upper jaw Lower jaw Orthodontic arch Use time Orthodontic arch Use time CuNiTi 0.014 2.5 months CuNiTi 0.014 2 months CuNiTi 0.014x0.025 2.0 months CuNiTi 0.014 × 0.025 2.0 months CuNiTi 0.018x0.025 3 months CuNiTi 0.018 × 0.025 2.5 months SS 0.016x0.025 2 months SS 0.016 × 0.025 2 months SS 0.019x0.025 3 months SS 0.016 × 0.025 3 months Active period 12.5 months Active period 11.5 months The use of other devices and materials: finishing elastics - 2 weeks.

On the orthopantomogram after the leveling stage, the position of the teeth 3.7, 4.7 was normal. The angle of inclination of tooth 3.6 was 119.4 ° (norm 113 ± 7.7 °), tooth 4.7-117.8 ° (norm 116.5 ± 4.7 °).

List of references

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Claims (1)

A method for diagnosing tooth position anomalies and choosing treatment tactics, including orthopantomograms, analyzing the image of the upper and lower jaws and selecting treatment tactics, characterized in that the anomalies in the position of the teeth of the upper and lower jaws in the sagittal plane are determined by the internal angle facing the midline dentition, which is formed at the intersection of the Frankfurt horizontal and the longitudinal axis of the tooth, anomalies in the position of the teeth of the upper and lower jaws in the vertical plane of the definition divide by the angle formed by three points: the root tip of the single-root teeth or the middle between the root tips of the multi-root teeth, the lower edge of the zygomatic arch on the right for teeth 1 and 4 segments and the left for teeth 2 and 3 segments and the lower edge of the orbit on the right for teeth 1 and 4 segments and on the left for teeth of 2 and 3 segments, compare the obtained data with the norm and if the tooth angle in the sagittal plane deviates from the norm by 14.9 ± 3.8 ° or less, and in the vertical plane by 2.65 ± 0.67 ° or less, choose treatment tactics with application with a brace system, if the tooth angle in the sagittal plane deviates above 14.9 ± 3.8 to 20.9 ± 3.8 °, and in the vertical plane above 2.65 ± 0.67 to 4.14 ± 0.94 °, treatment tactics using microimplants are chosen, when the tooth angle in the sagittal deviates planes from the norm at 20.9 ± 3.8 ° and more, and in the vertical plane at 4.14 ± 0.94 ° and more, treatment tactics in the form of the combined use of the bracket system and microimplants are chosen.

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