RU2657195C1 - Method of diagnosing the musculoskeletal system in planning and conducting dental treatment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to diagnostics in dentistry, and can be used before and/or during dental surgery. For this purpose, anamnesis, dental examination, osteopathic examination with detection of abnormalities in the cranio-mandibular system with compressed and relaxed jaws, determination of the physiological position of the mandible after miorelaxation are performed. Then optical topography of the spine is carried out in 3 positions: jaws in relaxed state, jaws are closed and the jaws are closed with the location between the teeth of the bite pattern, first between the posterior teeth on both sides, then between the front teeth. Scans the feet in the patient's standing position with the help of the DIOS Pedoscan scanner in 3 positions: jaws in a relaxed state, jaws are closed and the jaws are closed with the location between the teeth of the bite pattern, first between the posterior teeth on the right, then between the posterior teeth on the left, then between the front teeth. When abnormalities are detected in cranio-mandibular system, therapy is performed, including osteopathic correction, muscle relaxation, therapeutic physical training, acupuncture and physiotherapy, as well as perform the removal of impressions and make an occlusal cap for positioning and centering the lower jaw. After this, the above sequence of actions is repeated, with the optical topography of the spine and the scanning of the feet in the patient's standing position using the DIERS Pedoscan scanner in 3 positions: jaws in a relaxed state, jaws closed without occlusal jaws and jaws closed with occlusal cap. Then dental treatment is performed to create stable interdental contacts that hold the lower jaw in a new position. Once every 6 months, the results of treatment are monitored.

EFFECT: method provides diagnosis of abnormalities in cranio-mandibular system, which allows further effective dental treatment by achieving, due to subsequent correction of the revealed disorders, the physiological position of the mandible.

3 cl, 25 dwg, 1 ex

Description

The invention relates to medicine, namely to methods for diagnosing the musculoskeletal system in general and the cranio-mandibular system in particular, and allows you to take into account the influence of the condition of the spine on the result of dental treatment.

The following technical solutions are known from the prior art.

A known method for visualizing the temporomandibular joint (RF patent No. 2269932, published 02.20.2006), in which an ultrasound scan of the TMJ is performed, which allows visualizing the TMJ trajectory in real time, and also eliminating the radiation load on the patient and medical staff.

In the method for diagnosing hip joint dysfunction, an instrumental assessment of the values of the static and functional misalignment of the pelvis is used using the method of computer optical topography (COMOT), which allows registering minor deviations that are visually undetectable (RF patent No. 232,446, published 05/20/2008).

In the article by Sarnadsky et al. “Screening diagnostics of spinal deformity using computer optical topography using functional tests” (Izvestiya TRTU. Thematic issue. Medical information systems. "Materials of a scientific and technical conference - Medical information systems - MIS-2000". - Taganrog : TRTU, 2000. - No. 4 (18). - P. 74-78) provides information on the KOMOT method, which allows remote and non-contact determination of the surface shape of the patient’s trunk in three planes: frontal, horizontal and sagittal, p In order to increase the efficiency of screening, various functional tests were developed.

The closest analogue to the patented solution is a method for assessing the functional state of the musculoskeletal system, in which computer posture of the patient’s posture is performed in a calm state and under load, then the distance ratios between the selected reference points are compared, based on which the functional state of the musculoskeletal system is evaluated (patent RF №2265395, published 10.12.2005).

The use of optical topography for the diagnosis of posture and spine in the planning and implementation of dental treatment is an urgent topic in medicine.

The need for such a diagnosis in dentistry is justified by the mutual influence of occlusion (jaw position) and other structures of the musculoskeletal system.

Optical Topography (OCT) is a relatively new diagnostic method. In 1996, permission was received by the MHFR for its use. Since 2002, the method has been used in mass examinations of children in Togliatti.

The method is used for screening diagnostics of orthopedic pathology directly in kindergartens and schools. The method is informative, intuitive, easy to do.

To date, two types of computer topographers manufactured by the Novosibirsk company Metos and DIERS Formetric made in Germany are used.

Provides highly accurate determination of the relief of the surface of the body.

The examination is completely harmless to the health of patients and staff, shown to children from 4 years of age. It does not carry X-ray loads. The minimum time for diagnosis. The method is based on the moire topography method. Only the luminous flux from two sources is used: the projector of the strips and the illuminator of the reflective markers mounted on the anatomical landmarks of the body surface of the subject. The camcorder transfers the image to a computer.

The only system that allows dynamic diagnostics of the spine, in contrast to static MPT, CT and X-ray diagnostics.

The obtained data after analyzing the topographic parameters describe the deviation of the apex of kyphosis, the presence of hyperlordosis, the localization of the arc of scoliatic or kyphotic curvature, the degree of deviation and rotation of the vertebrae, expressed in degrees, the asymmetry of the shoulders, the inclination and skew of the pelvis. As a result of computer processing, a graphic topographic image of the body is constructed in several projections, a conclusion is issued indicating the type of posture disturbance, and in the presence of scoliosis with an indication of the degree of deformation, according to the classification of V.D. Chalkin (1965).

The method has wide application possibilities - from basic diagnostics of diseases of the musculoskeletal system to rehabilitation and sports medicine. The method has never been used in dentistry for planning and conducting dental treatment.

Today, with the development of an interdisciplinary approach in medicine, an integrated approach to treatment, prevention and preservation of treatment results is developing. The connection between posture disturbance and the formation of a pathological bite in children, violation of the position of the cervical vertebrae and TMJ diseases, as well as the influence of muscle imbalance on the occurrence of relapses of dental treatment, the emergence of neurological complications after dental treatment have been scientifically proven.

Currently, there is an urgent need to develop protocols for a comprehensive examination of patients with disorders in the dentofacial area and the musculoskeletal system, in order to improve the quality and effectiveness of treatment, to ensure the timely involvement of specialists from other areas (neurologists, ENT doctors, orthopedists, pediatricians and osteopaths), prevent the development of complications, save the result of treatment.

The technical result of the method is as follows:

- improving the quality and effectiveness of dental treatment (without correcting disorders of the musculoskeletal system, in particular, the cranio-mandibular system, and obtaining muscle balance, it is impossible to determine the physiological position of the lower jaw necessary for therapeutic, orthopedic, orthodontic and gnatological treatment);

- reducing the time of treatment, as the impact of the muscles and the position of the pelvic bones, the position of the spine, leg length, foot deformation will delay the time to achieve the result

- providing analysis during treatment of the effect of the new position of the lower jaw on the spine and posture as a whole, conducting the necessary number of tests and tests to determine the optimal position of the jaw;

- reducing the risk of complications and decompensations from other organs and systems;

- accounting and analysis of the patient's condition in the functional unity of all structures, considering the position of the jaw bones as an inseparable part of the supporting motor system.

The specified technical result is achieved due to the following sequence of diagnostic steps:

1. Dental diagnosis in the analysis of the relationship between cranio-mandibular dysfunction (CMD) and the condition of the spine:

a) Medical history

b) Dental examination

- conditions and position of teeth

- shapes and sizes of dental arches

- the ratio of the dentition

- analysis of habitual occlusion

- analysis of muscle dysfunctions

palpation of the masticatory muscles

- palpation of the temporomandibular joint

- visual analysis of the movement of the lower jaw

- diagnosis of TMJ by existing methods of hardware diagnostics (dental computed tomography, radiological, functional)

- Dental instrumental examination (OPTG, TRG, analysis of jaw models, digital photos);

2. Osteopathic examination with detection of disorders in the craniomandibular system (KMC), caused by occlusion, with tight and relaxed jaws

- test of four lines

- analysis of leg length

- foot rotator test

- standing bending test

- - sitting bending test

- oculomotor test

- analysis of the state of the atlanto-occipital articulation (СОС1)

- diagnosis of the upper cervical spine (C2C3)

- manual diagnosis of the presence of pathological patterns in the skull

- manual diagnosis of the presence of cranial suture dysfunctions

3. Determination of the physiological position of the lower jaw after muscle relaxation, which can be done in two ways:

- Apparatus "Miostim" (according to the program: deprogramming and myocentric)

- The method of osteopathic correction.

4. Production of a silicone register of the physiological position of the lower jaw with subsequent testing and manufacturing of an occlusal splint

5. Biometric examination of the spine by optical topography in 3 positions:

- jaw relaxed

- jaws closed

- the jaw is closed and there is a silicone bite pattern between the teeth

We analyze the following parameters of the state of the spine:

- deviation of the peak of kyphosis,

- the presence of hyperlordosis,

- localization of the arc of scoliotic or kyphotic curvature;

- analysis of the lateral deviation and rotation of the vertebrae, expressed in degrees;

- analysis of the position of the pelvis: tilt and skew

As a result of computer processing, a graphic topographic image of the body surface of the subject is constructed in several projections, a conclusion is issued indicating the type of posture disturbance, and in the presence of scoliosis, indicating the degree of deformation, according to the classification of V.D. Chalkin).

The examination takes place in the following position

a) jaw relaxed;

b) the jaw is closed;

c) a bite pattern between the posterior molars on both sides;

6. Additional diagnostics of foot pathology using the DIERS Pedoscan scanner (https://www.youtube.com/watcri?v=5rngUiQRMEw&sns=em) in the standing position of the patient

Analyze:

- pressure stop

- asymmetry in the distribution of stop pressure,

- rotation of the legs,

- movement of the center of gravity of the body,

- dynamic equilibrium.

The examination takes place in the following position

a) jaw relaxed;

b) the jaw is closed;

c) a silicone bite pattern between the lateral teeth on both sides (right and left);

Conducting complex therapy:

1. Osteopathic correction is performed.

2. Muscle relaxation (osteopathic, medication, hardware “Miostim”).

3. Imprinting and making an orthotic (occlusal mouthpiece) for positioning and centering the lower jaw.

4. The purpose of the complex of physiotherapy exercises and myogymnastics.

5. Acupuncture and physiotherapy. Intermediate diagnosis 1 time in 10 days.

1. Inspection of the dentist.

2. Correction of orthotics.

3. Osteopathic examination.

Monitoring of treatment after 40 days.

Examination of the spine by optical topography and scanning of the feet in the patient's standing position:

1) In a relaxed state.

2) Occlusion without orthotics (the jaws are closed without an occlusal mouthpiece)

3) Occlusion with orthotics (jaw closed with occlusal mouth)

With a consistently good result achieved with the new position of the lower jaw, it is recommended to carry out dental treatment (orthodontic or reconstructive prosthetics, with the aim of creating stable interdental contacts holding the lower jaw in a new position)

Monitoring of the results of treatment is carried out once every 6 months, includes an examination of 3 specialists: dentist, osteopath and orthopedic examination using the method of optical topography.

As a result of using this technique, the dentist:

1) in addition to dental treatment, carries out the rehabilitation of the entire musculoskeletal structure, supporting the general health of the patient;

2) avoids mistakes in determining the central position of the lower jaw, achieving a harmonious position and interaction of the cranio-mandibular structures and structures of the entire spine as a whole, including the cervical spine, which in turn is the prevention of the development of neurological disorders, which often occur after dental interventions.

A correctly defined position of the lower jaw will allow the dentist to avoid relapses of the disease, complications in the form of a violation of the TMJ function, chipping of the crowns, periodontal overload, changing the position of the teeth after the orthodontic treatment, and breaking of the retainers.

The quality of the treatment is improved, which affects the satisfaction and absence of complaints from the patient.

Further, the solution is illustrated by reference to the figures, which show the following:

FIG. 1 - “sensors” of the postural system.

FIG. 2 - postural patterns.

FIG. 3 - postural patterns.

FIG. 4 - postural patterns.

FIG. 5 - postural signs of craniomandibular dysfunction.

FIG. 6 - clinical picture with distal occlusion.

FIG. 7 - the effect of ascending and descending dysfunction on posture.

FIG. 8 is an illustration of the connection between organs using the hyoid bone as an example.

FIG. 9 is an illustration of the relationship between the organs using the example of the spheno-basilar symphysis (SBS).

FIG. 10 - anatomical trains.

FIG. 11 - test 4 lines.

FIG. 12-25 - illustrations for clinical examples.

Below is a summary of studies of the relationship between the function of the maxillary joint (TMJ) and the musculoskeletal system.

There is a close relationship between the position of the body with the structure and function of the TMJ. John Martin Littlejohn showed the connection between the symphysis of the lower jaw and the pubic symphysis through the line of gravity. He also showed the presence of functional triangles in the body, creating a relationship between the TMJ and other body structures. There are also functional connections with the sickle of the brain, the cerebellum, the muscles of the neck and the spine.

Robert Samoyan created a model to demonstrate the integration of TMJ in an upright position. Dalaer claims that intracranial structures serve to transmit a balance of forces between the weight of the facial skull and the compensatory tone of the muscles of the neck. The TMJ function and the occlusal patterns of the upper and lower jaw depend on this balance. An incorrect posture must be corrected, only in this case a successful and long-term treatment result can be achieved.

A posture with a curved pelvis and unequal leg length can have such an effect on occlusion that it will be detected by electromyographic methods.

Bahnemann believes that most cases of jaw anomalies are associated with vertebral syndrome, which he calls the maxillary vertebral syndrome.

According to Schottl and Bruich, based on studies by Haberfelner, Bannemann, Rocabado and Trynfels, the following relationships can be found:

- distal occlusion and anteflexia of the head (70% of cases according to Rocabado);

- TMJ and occipital-atlanto-axial joints and cross bite;

- an open bite and a curved pelvis;

- head and neck position and speech.

- mouth breathing, open bite and digestive tract disorders;

- motor function of the tongue and impaired skeletal muscle tone;

- temporomandibular joint and hyoid bone;

- communication of the ocular, auricular, occlusal planes.

In FIG. Figure 1 shows the "sensors" of the postural system, where it is seen, for example, that the occlusal plane and the plane of the foot are similar, and both the arch of the upper jaw and the arch of the feet are also similar. This picture shows that if there are changes in one “sensor”, then there will be a problem in similar “sensors”.

In FIG. Figure 2 shows the Hull and Wernham postural patterns:

- normal line of gravity. The line of gravity goes from the axis of the tooth-like process of the 2 cervical vertebra through the cape of the sacrum, the middle of the hip joint and the knee joint to the heel-cuboid joint,

- the line of gravity consists of a combination of forces that hold the body in an upright position,

- chest and abdominal pressure are normal.

The skull is aligned along the pelvic line, and the shoulder girdle along the pelvic girdle.

The front line runs from the tip of the collar to the pubic fusion. It runs parallel to the line of gravity and perpendicular to the pubic line, resulting from stresses in the chest and abdomen

Breast and abdominal pressure are normal.

In FIG. 3 shows the postural patterns:

- forward displaced line of gravity,

- tendency to femoral hernia, inguinal hernia, prolapse of internal organs, inflammation of the bladder.

The influence of triangles: if there is a distortion of the pelvis, then there will also be a change in the occlusal plane.

In FIG. 4 shows the postural patterns:

- the line of gravity is tilted back,

- general weakening,

- tendency to constipation,

- a tendency to hemorrhoids, prolapse of the rectum.

In FIG. 5 shows the postural signs of cranio-mandibular dysfunction:

- an abnormal ratio of teeth with neutral occlusion - grade 1,

- distal occlusion - grade 2,

- medial occlusion - grade 3.

Easily noticeable signs can be different raising of the eyebrows, curvature of the head, one-sidedly raised clavicles.

1. In the case of distal occlusion, the line of gravity, especially in the head, cervical thoracic zone, the head is shifted forward, lordosis of the lumbar spine, a change in the position of the vertebrae of the lumbar spine.

2. In the case of medial occlusion, the line of gravity in the head, cervical thoracic region and shoulders, the head is shifted back, the cervical and lumbar spine in extension.

3. In all cases, the restriction of mobility of the hyoid bone.

4. Latent scoliosis occurs.

5. Pelvic imbalance.

6. In the case of a cross bite, asymmetry of the face and scoliosis.

7. In the case of an open bite, axial dysfunction of the atlas.

Thus, cranio-mandibular dysfunction will always be associated with a person’s posture.

There is a close relationship between the occipital-cervical zone, neck muscle tone and TMJ function. The head in the joint occupies a position that guarantees the best occlusion of the teeth.

Bannemann could almost always demonstrate a change in the position of the spine in the wrong position of the lower jaw.

It is important to stabilize the masticatory muscles to stabilize the head before dental treatment. In the case of prognathy, with an abnormal position of the body, the bite is too open, a lower position of the atlas is found in 30% of cases. The presumptive cause is frequent inflammation of the nasopharyngeal region, due to the close location of the atlas, and this location of the atlas can also damage the vertebral arteries (feeding the cerebellum and brain stem) of the lining of the brain and spinal cord, spinal cord, medulla oblongata, hyoid nerve, superior cervical ganglion and vagus nerve .

In FIG. 6 shows the clinical picture with distal occlusion.

The consequences:

- impaired speech and swallowing,

- violation of the movement of the tongue,

- dizziness,

- headache,

- neuro-vegetative symptoms.

In FIG. Figure 7 shows the effects of ascending and descending dysfunction.

Barra Vertical Alignment Test:

1. Ascending dysfunction (pelvis tilted to the side), short leg, lower back pain, dysfunction of the foot, knee, hip joint or pelvis.

2. Downward dysfunction (deviation towards the head, neck) neck pain, dysfunction of the clavicle, shoulder, lower jaw, old cranio-cervical trauma, eye and vision disorders.

3. Dysfunction ascending and descending (head and neck in one direction, the pelvis in the opposite).

4. Compensatory condition. Any intervention is associated with a risk of decompensation.

5. Unilateral hypertonicity (head, upper body and pelvis deviate in the same direction), disorders of the central nervous system or vestibular apparatus.

Occlusion and cervical spine:

It should be noted that

- those who deal with occlusal problems always evaluate the cervical spine,

- the ratio of the upper and lower jaws is always associated with the static neck,

- the occlusal plane (the plane in which the occlusal contacts of the teeth of the upper and lower jaws are located) parallel to the C2C3 plane (the plane in which the articular surfaces of the 2 and 3 cervical vertebrae pass),

- Violation of occlusion is always accompanied by changes in the cervical spine.

When exiting the skull, the dura mater is attached to the large occipital foramen and C2C3 and then sags with the pouch and attaches to the second sacral vertebra. The dura mater combines the entire complex of the skull and spinal column into a single whole. Therefore, when twisting the spine and the dura mater, as if the dentists did not try to determine the correct position of the lower jaw, while the cervical vertebrae will be in a state of twisting or tilting, i.e. will not stand symmetrically and correctly in their row, it will be impossible to achieve the correct position of the head and lower jaw.

If we consider a person from the point of view of various theories, then from the point of view of the joint theory of the facet of the teeth interact with each other as articular surfaces. Fangs determine the position and freedom of movement of the lower jaw, and the position of the articular process of the lower jaw in the temporomandibular joint determines changes in the atlanto-occipital joint. If there is no fanging or fangs are dystopian, then problems in the cervical spine are predicted. With a change in the position of the bone structures, the muscles also change their state and structure, and without working with the muscles, the bone structures cannot independently return to their normal position.

Dysfunction of the cervical vertebrae affects the TMJ through the cervical fascia or hyoid bone. Breathing through the mouth, according to Lawrence and Razuk, causes the extension of the head to create the best passage through the mouth.

The shortening of the neck muscles resulting from the extension of the head causes its adaptive protrusion to maintain a horizontal look. The result is hypertension of the occipital muscles and muscles of the back of the neck.

The combination of the inclination of the head, neck, and shoulder girdle also leads to the displacement of the lower jaw back and down due to the tension of the hyoid muscles. This causes compression of the condylar process in the articular cavity of the ANS and an increase in the tone of the masticatory muscles. Lateral bending with contralateral rotation of the head causes a shift in the lower jaw, resembling a congenital torticollis.

Dynamic signs of cranio-mandibular dysfunction:

- restriction of rotation of the head from the side of the raised shoulder blade,

- the atlas and the axial vertebra are usually in the position of rotation directed to the side occupying the lower position of the scapula,

- lateral redistribution of weight leads to instability of the lower limb.

Any changes in the position of the lower jaw lead to a change in the position of the head on the spine. The articular process of the TMJ and the condyles of the atlantooccipital joint are congruent.

In FIG. Figure 8 shows the relationship between organs using the hyoid bone as an example.

Hyoid bone dysfunction can occur as a result of disorders in the TMJ and induce NPI through myofascial networks. However, it can also participate in the development of NPI. Changes in one triangle will always cause compensatory changes in another.

Dura mater.

- leaves the skull through the large occipital foramen,

- attached to the 2nd and 3rd cervical vertebra,

- hangs with a bag,

- attached to the 2 sacral vertebra.

The base of the skull, which the orthodontist takes as a reference point in calculating the TWG, is movable.

The mobility of the bones of the skull is carried out under the influence of the movement of neuroglia. The rhythm of a healthy person is 6-8 movements per minute, with a decrease in rhythm, vitality decreases (vitality of the body). The rhythm depends on the position of the tongue and occlusion.

Children with reduced vitality suck their fingers, stimulating a cruciform suture in the sky and starting the movement of the cerebrospinal fluid.

In FIG. 9 shows the spheno-basilar symphysis (SBS).

- the connection of the occipital and sphenoid bones,

- the occipital bone controls the temporal bone,

- the temporal bone affects the extension of the lower jaw forward,

- The sphenoid bone acts on the upper jaw.

It is important to normalize the work of SBS immediately after the birth of the baby.

In FIG. 10 shows anatomical trains. The essence of anatomical trains is that whatever tasks each individual muscle performs, it is functionally integrated and works inside the fascial web.

These layers and lines follow the interweaving of the connective tissues of the human body, forming meridians - myofascia.

Any tension, tension, fixation, compensation, as well as most motor acts can be distributed along these lines.

One has only to recognize the existence of these myofascial meridians and understand the relationship between them, they can easily be used to assess the patient's condition and treatment.

From an aesthetic point of view, understanding these trains will make it possible to even more subtly feel the three-dimensionality of musculoskeletal anatomy and evaluate models of compensation and stress distribution in the body as a whole.

From a clinical point of view, this leads us to get a clear idea of how painful phenomena in one part can be associated with an absolutely non-disturbing zone, located far from the problem zone.

The anatomical train scheme can be used to understand the holistic picture of relationships in the patient’s body. This is a fascial theory.

The musculoskeletal concept is based on the idea that the muscles attach to the bones and offer a musculoskeletal concept, a mechanistic model of movement. Leopold Buquet proposed a theory of muscle chains based on the synergistic work and functional connection of individual muscles with each other. Synergies, muscle chains behave like one muscle:

Dental: maxillary, temporal, aponeurosis, occipital, back, front of the thigh, foot.

Often cramps in the calf muscles are associated not with varicose veins, but with hypertonicity of the temporal muscle.

Myofunctional adaptation on the example of premature contact of the first molar on the left.

- twisting SBS,

- turn inside the temporal bone,

- tension of the fascia of the pharynx, mediastinum, diaphragm,

- a change in the position of the sacrum,

- back position of the left ilium,

- flat feet on the left.

Causes of cranio-mandibular dysfunctions:

- primary (congenital, traumatic, tooth extraction, opening the mouth too wide),

- secondary (skull bones dysfunctions, muscle dysfunctions, malocclusion, bad habits, nasal breathing dysfunction, dysfunction of the upper cervical and atlanto-occipital joints, poor posture, pelvic dysfunction, sacrum, leg length, psychological and emotional facts, neurological disorders, lack of vitamins and minerals, hormonal disorders).

Diagnostics includes the steps of:

- history taking,

- visual assessment

- palpation,

- examination of the oral cavity,

- orthodontic diagnostics (analysis of diagnostic models of the jaws, OPTG, TRG in direct and lateral projection, digital photos),

- instrumental examination of the TMJ (computed tomography, MRI, electromyography of the masticatory muscles, kinesiography of the movements of the lower jaw),

- diagnostics of the spine, posture, feet in statics and dynamics by optical topography and stabilometry.

Anamnesis collection includes:

- the initial onset of symptoms,

- dental or orthodontic surgery,

- family history

- violation of the structures of the lower jaw and joint,

- pain in the TMJ,

- cramps of chewing muscles,

- pain when opening the mouth.

TMJ limitation:

- Restriction on waking up indicates night grinding of teeth.

- If after clicking the mouth you can open further it is a disk problem.

- Sounds in the joint, loud clicks, audible at a distance are social problems. Quiet, perceived only by the patient often arise along with pain and functional disorders:

- creaking, grinding,

- violation in the muscles - pain,

- impaired speech and swallowing,

- auditory symptoms,

- disorders in the immune system,

- triggering factors (orthodontic surgery),

- headache,

- radiating pain of the back of the neck,

- static and dynamic disturbances in the spine.

In FIG. 11 is an illustration of a “4 line test”.

The lines connecting the symmetrical points must be parallel. If asymmetry is visible with the naked eye, accordingly, a violation of occlusion is also visible. In dental questionnaires, there are already questions about knee joints, etc.

The following are clinical examples that demonstrate the results of the diagnosis of the musculoskeletal system when planning and conducting dental treatment according to the proposed method.

Example No. 1.

Patient G., 8 years old.

Complaints: difficulty in teething in the upper jaw, slight crowding of the teeth in the lower jaw, malocclusion.

Anamnesis of the disease: Orthodontic treatment has not been carried out before;

Anamnesis of life: pregnancy without complications, birth trauma, mixed feeding, impaired swallowing, difficulty in nasal breathing, incorrect orientation of the head and body in space.

Objective examination data:

1. general examination: the body is developed proportionally, the shape of the fingers, the condition of the skin and mucous membranes, the condition of the hair and nails - normal, impaired posture;

2. dental examination:

- facial signs: the face is symmetrical and proportional, the displacement of the chin relative to the midline of the face, the supramental fold is expressed, the retrognatic profile of the lips according to Ricketts, the profile is convex,

- a small vestibule of the oral cavity, a removable bite I phase, teeth 1.2-2.2 in the teething stage, there is a delay in the eruption of the central incisors in the upper jaw, distal occlusion, narrowing of the dentition, anterior position and parafunction of the tongue.

3. osteopathic examination with the identification of disorders in the cranio-mandibular system with tight and relaxed jaws

4. determination of the physiological position of the lower jaw by muscle relaxation

Additional research data:

- study of control and diagnostic models: in the transversal plane, the narrowing of the upper and lower jaw at the points of Pont, Engle class II, the discrepancy between the mesiodistal sizes of the teeth,

- X-ray methods - orthopantomogram, lateral tele-roentgenogram (TRG), direct tele-roentgenogram,

- additional clinical methods:

- Photometry of direct and side photographs of the face according to Schwartz,

- functional research methods: computer optical topography, stabilometry, podometry in 3 positions:

1. jaws in a relaxed state: deviation from the central line in the region of the VII cervical vertebra - 3 mm, pelvic distortion - 20 mm, pelvic twisting - 3 degrees, scoliosis angle - 10 degrees,

2. jaws closed: deviation from the center line in the region of the VII cervical vertebra - 6 mm, pelvic distortion - 3 mm, pelvic twisting - 7 degrees, scoliosis angle - 10 degrees,

3. the jaw is closed with the location between the teeth of the bite template, at the beginning between the posterior teeth on both sides, then between the front teeth: deviation from the center line in the region of the VII cervical vertebra - 3 mm, misalignment of the pelvis - 18 mm, twisting of the pelvis - 3 degrees, scoliosis angle - 10 degrees,

- scan of the feet in the patient position while standing with the DIERS Pedoscan scanner in 3 positions:

1. relaxed jaws: weight distribution on the right leg

2. jaws closed: weight distribution on the right leg

3. the jaw is closed with the location between the teeth of the bite template, at the beginning between the back teeth on both sides, then between the front teeth: weight distribution on the right leg

DIAGNOSIS:

I. The underlying disease:

- Morphological disorders:

- closure of the dentition - distal occlusion

- closure of the dentition in the vertical direction - vertical incisive disocclusion, due to undercutting of the incisors on the upper jaw

- Anomalies in the shape of the dentition - in the sagittal direction - a shortened dentition in the upper and lower jaw; transversally, symmetrically narrowed upper and lower dentition

- Anomalies of individual teeth - teething delay 1.2-2.2;

- soft tissue abnormalities - abnormal attachment of the frenulum of the lower lip, tongue parafunction

- TMJ dysfunction - violation of the position of the jaw in the TMJ of an ascending nature, due to a violation of the position of the bones of the pelvis and spine

Etiological factor

- Functional disorders: infantile swallowing, impaired nasal breathing

- Aesthetic disorders - violation of the shape of the face in profile, violation of the position of the head in space

Concomitant diseases - scoliosis of the II degree

TREATMENT PLAN:

- therapy, including osteopathic correction: normalization of the position of the pelvic bones, cervical spine, position of the tongue and hyoid bone, muscle relaxation, a set of physiotherapy exercises, acupuncture and physiotherapy

- The appointment of a myofunctional trainer (occlusal cap) to correct the position of the lower jaw in the TMJ, to normalize swallowing and breathing with the wearing mode: at least 1.5 hours of daily wear + night for 1 year with follow-up examinations once every 6 months

- Osteopathic support for orthodontic treatment: osteopathic examinations once every 6 months

- Orthopedic consultation on the manufacture of orthopedic insoles

- Retention period: orthodontic and osteopathic examinations 1 time in 6 months

DIARY OF TREATMENT

After the osteopathic correction, an orthodontist was examined, diagnosed by computer optical topography, stabilometry and podometry:

- functional research methods: computer optical topography, stabilometry, podometry in 3 positions:

1. jaw in a relaxed state: deviation from the center line in the region of the VII cervical vertebra - 6 mm, pelvic distortion - 7 mm, pelvic twisting - 3 degrees, scoliosis angle - 2 degrees

2. the jaw is closed: a deviation from the center line in the region of the VII cervical vertebra is 5 mm, the pelvic skew is 8 mm, the pelvic twist is 7 degrees, the scoliosis angle is 2 degrees

3. the jaw is closed with the location between the teeth of the bite template, at the beginning between the rear teeth on both sides, then between the front teeth: deviation from the center line in the region of the VII cervical vertebra - 6 mm, pelvic distortion - 7 mm, pelvic twisting - 3 degrees, scoliosis angle - 5 degrees

- scan of the feet in the patient position while standing with the DIERS Pedoscan scanner in 3 positions:

1. jaw relaxed: weight distribution on both legs

2. jaws closed: weight distribution on both legs

3. the jaws are closed with the location between the teeth of the bite template, at the beginning between the rear teeth on both sides, then between the front teeth: weight distribution on both legs

Findings:

- A posture with a curved pelvis and unequal leg length can have such an effect on occlusion that it will make it impossible to correct occlusion.

- In a compensatory state, any therapeutic intervention is associated with a risk of decompensation.

- The wrong posture should be corrected, only in this case a successful and long-term treatment result can be achieved.

- When conducting an orthodontic diagnosis, it is necessary to include in the examination protocol the analysis of posture and spine in order to timely identify factors affecting the results of treatment, prevention of complications and obtain a stable result in the future.

- When conducting a patient examination before orthodontic treatment, a comprehensive examination of patients with the participation of specialists is necessary:

orthopedists and neurologists with the aim of early detection of violations of the formation of bone muscle skeleton in growing patients during skeletal growth.

- When reconstructing the bite and determining the position of the lower jaw in adult patients, it is necessary to take into account the musculoskeletal balance of the body and deviation from the anatomical norm as a factor causing disturbances in the TMJ.

Claims (3)

1. A method for diagnosing and correcting disorders of the cranio-mandibular system when planning and / or conducting dental treatment, characterized in that an anamnesis is sequentially collected; dental examination; osteopathic examination with the identification of disorders in the cranio-mandibular system with tight and relaxed jaws; determination of the physiological position of the lower jaw after muscle relaxation; optical topography of the spine in 3 positions: the jaw is relaxed, the jaw is closed and the jaw is closed with the location between the teeth of the bite template, first between the back teeth on both sides, then between the front teeth; scanning of the feet in the patient position with the DIERS Pedoscan scanner in 3 positions: the jaw is relaxed, the jaw is closed and the jaw is closed between the teeth of the bite template, first between the back teeth on the right, then between the back teeth on the left, then between the front teeth ; and if violations in the cranio-mandibular system are detected, therapy is carried out, including osteopathic correction, muscle relaxation, physical therapy, acupuncture and physiotherapy, as well as imprinting and making an occlusal mouthpiece for positioning and centering the lower jaw; after that, the aforementioned sequence of actions is repeated, with optical topography of the spine and scanning of the feet in the patient standing with the DIERS Pedoscan scanner carried out in 3 positions: the jaw is relaxed, the jaw is closed without an occlusal mouth, and the jaw is closed with an occlusal mouth, with subsequent dental treatment to create stable interdental contacts holding the lower jaw in a new position; at the same time, once every 6 months they monitor the results of treatment. 2. The method according to p. 1, characterized in that the dental examination includes taking impressions and anthropometric measurement of gypsum models of the jaws, conducting an orthopantogram, a teleretgenogram of the skull in frontal and lateral projections, a cephalometric analysis of the obtained images, analysis of digital photographs of the patient’s face, performed in full face and profile, analysis of digital photographs of the oral cavity, additionally examine the maxillary joint through examination, palpation and visual analysis of movements in this soup tave through dental computed tomography of the joint and axiography. 3. The method according to p. 1, characterized in that muscle relaxation to determine the physiological position of the lower jaw is carried out by means of an apparatus or osteopathic correction.

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