RU2658159C1 - Method for improving the quality of treatment for patients with mesial occlusion in combination with complete absence of teeth on the upper jaw - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to dentistry, and is intended to improve the quality of diagnosis and treatment of patients with mesial occlusion in combination with complete absence of teeth on the upper jaw and the definition of interalveolar height. Conduct orthopantomography and teleradiography of the patient's head in a lateral projection, based on the obtained data, the angular and linear parameters and interalveolar height using the Dolphin-Imaging program. Taking into account the obtained data, diagnostic models are produced and their anthropometric analysis is performed, the installation of the Ormco bracket system, USA, on the teeth for intrusion and retraction of the mandibular incisors and elimination of the diastema and three for a period of 6 months. Perform a subsequent installation of a non-removable flex-retainer on the teeth 3.3, 3.2, 3.1, 4.1, 4.2, taking impressions from two jaws, making models with bite rolls, fitting wax template of a complete removable prosthesis to the upper jaw, setting the teeth, conducting cephalometric analysis in the Dolphin-Imaging program to evaluate the results of treatment.

EFFECT: method allows to reduce the number of visits to the orthodontist, to exclude the subjectivity of the evaluation of interalveolar height and to increase its accuracy, to improve the quality of treatment.

1 cl, 2 tbl, 12 dwg, 1 ex

Description

The invention relates to medicine, namely to dentistry, and is intended to improve the quality of diagnosis and treatment of patients with mesial occlusion in combination with a complete absence of teeth in the upper jaw and determining the interalveolar height.

The quality of treatment of such patients largely depends on the accuracy of determining the interalveolar height.

The anthropometric method for determining the interalveolar height is known, based on data on the proportionality of individual parts of the face according to the principle of the "golden" section or the "golden" division (division in the extreme and middle ratios).

For example, using the Geringer compass, which automatically determines the point of the "golden" section. The device consists of two compasses. They are connected so that the legs of the large compass are divided in the extreme and middle respects. Only on one leg is a larger segment located closer to the hinge, and the second is further away from it. No matter what distance is measured by this compass, the middle leg always divides it in extreme and middle respects. If you ask a patient who has front teeth to open his mouth wide and put the extreme leg of the compass on the tip of the nose, and the second on the chin tubercle, then the distance thus obtained will be divided by the middle leg in the extreme and middle respects. A large value will correspond to the distance between the indicated points, but already with closed teeth or bite rollers.

The Wodsworth-Wait method (Wodswort-Wait) is based on the equality of the distances from the middle of the pupils to the line of closure of the lips and from the base of the septum of the nose to the lower part of the chin (Orthopedic Dentistry: A Guide for Doctors, Studios of Universities and Medical Schools / N.G. Abolmasov , N.N. Abolmasov, V.A., Bychkov, A. Al-Hakim. Medpress-inform, 2002, 427-429 p.).

The disadvantages of the method: use only for the classic profile of the face, high subjectivity of the method, inaccuracy of measurement.

Also known is the anatomical and physiological method for determining the interalveolar height. It is based on the concept of the relative physiological rest of the lower jaw and data on the anatomical structure of the tissues surrounding the oral gap. The patient is introduced into a short conversation, in order to distract attention, at the end of the conversation, the lower jaw is set to a physiological rest position, which is characterized by the presence of a gap between the points of Subnasale and Gnation. A distance of 2-3 mm is noted on the wax pattern (Orthopedic Dentistry: Textbook / Betelman A.I .; Medicine, Moscow, 1965, 182 pp.).

The disadvantages of the method: the magnitude of the physiological rest of the lower jaw is individual for each patient, and in this method, an average value of 2-3 mm is used. Active patient collaboration and a high level of communication are needed. Difficulty in using the method for tremor of the masticatory muscles and other concomitant diseases.

There is also a method of measuring the interalveolar height using a device for determining the central ratio of the jaws, containing maxillary and mandibular plastic bases, maxillary and mandibular support surfaces, strain gauges fixed to the mandibular support plate, in which a rod and a stop are inserted, which the rod is freely mounted on the upper part and interacts with the maxillary support plate, and the rod interacts with the mandibular support plate. Measurement of the interalveolar height is carried out using a device in the form of an expander that reproduces the movements of the lower jaw, with the transfer to the device of all angles of the movements of the lower jaw and fixation in a central ratio. With the help of the screw, the planes are extended and the lower jaw returns to its original position, there is a uniform effect on all muscles. And the movement of the spoon in the grooves returns the inner articular disc to the usual anteroposterior position (RF Patent for IZ No. 2103947).

The disadvantages of this method: the need for cooperation of the patient, the complexity of the measurements, the need for an apparatus, the inability to use the apparatus in patients with increased emetic reflex.

The objective of the invention is to eliminate these disadvantages and increase the efficiency of diagnosis and orthodontic treatment of patients with mesial occlusion in combination with a complete absence of teeth in the upper jaw by improving the quality of diagnosis and reducing treatment time.

A method for improving the quality of treatment for patients with mesial occlusion in combination with a complete absence of teeth in the upper jaw contains sequential radiological research methods: orthopantomography and teleretgenography of the patient’s head in lateral projection, measurement of angular and linear parameters and interalveolar height using the Dolphin-Imaging program, production of diagnostic models and their anthropometric analysis, installation of a bracket system (Ormco, USA) on teeth for intrusion and retrusion of lower jaw incisors and lips injuries of the diastema and three for a period of 6 months, the subsequent installation of a fixed flex-retainer on the teeth 3.3, 3.2, 3.1, 4.1, 4.2, removal of impressions from two jaws, production of models with bite rollers, fitting a wax template of a full removable denture on the upper jaw, setting teeth, performing cephalometric analysis in the Dolphin-Imaging program to evaluate treatment results.

The method is illustrated by illustrations, where in FIG. 1 is an orthopantomogram of a patient; FIG. 2 is a tele-radiograph of the patient’s head in a lateral projection; FIG. 3 shows the results of measuring angular and linear parameters using the Dolphin-Imaging computer program; FIG. 4 - installation of a bracket system (Ormco, USA) on existing teeth of the lower jaw, front, right and left views, in FIG. 5 - installation of a fixed flex-retainer on the lingual surface of the teeth 3.3, 3.2, 3.1, 4.1, 4.2 of the lower jaw, FIG. 6 - the position of the teeth of the lower jaw after the end of orthodontic treatment, FIG. 7 - prints from the upper and lower jaws, in FIG. 8 is a wax pattern with bite rollers, FIG. 9 - fitting the finished wax template of a complete removable denture to the upper jaw, determining the structural bite, in FIG. 10 is a cephalometric analysis in Dolphin-Imaging, FIG. 11 is a fixed complete removable denture in the oral cavity, front and side views, in FIG. 12 - a complete removable denture on the upper jaw.

A method for improving the quality of treatment for patients with mesial occlusion in combination with a complete absence of teeth in the upper jaw and determining the interalveolar height using the Dolphin Imaging program is carried out in the following sequence:

1) Carrying out orthopantomography and teleretgenography of the head in a lateral projection (Fig. 1 and 2)

2) Measurement of angular and linear parameters using the Dolphin-Imaging program (Fig. 3)

3) Installing the bracket system on existing teeth (Fig. 4)

4) Completion of orthodontic treatment (Fig. 6), removal of the bracket system, installation of a fixed flex-retainer (Fig. 5)

5) Preparing the patient for rational removable prosthetics

6) Production of a complete removable denture on the upper jaw (Figs. 7, 8, 9)

7) Cephalometric analysis of the patient’s dentition to determine the interalveolar height, normalization of the lower third of the face (Fig. 10)

8) The delivery of a complete removable denture to the upper jaw (Fig. 11-12).

Clinical example.

Patient A., 64 years old (Figs. 1-4). Diagnosis: Mesial occlusion of a dentoalveolar form, diastema and trema in the area of the teeth of the lower jaw, 1-1.5 mm in combination with a complete absence of teeth on the upper jaw. The patient uses a full removable denture on the upper jaw for 10 years. Complaints about dropping the prosthesis when biting off food due to malocclusion, the presence of pain in the TMJ (Temporomandibular joint). During wearing, the prosthesis broke 3 times as a result of uneven abrasion of plastic teeth due to an incorrectly chosen interalveolar height.

Treatment:

Carrying out orthopantomography (determined the absence of teeth on the upper jaw and a partial absence on the lower jaw) and teleretgenography of the head in a lateral projection (Fig. 1-3). The changes in the patient's angular and linear parameters were determined using the Dolphin-Imaging program.

The parameter values are placed in table 1.

A decrease in the SNA angle indicates micrognathia of the upper jaw, a decrease in the Anterior Face Height parameter indicates a decrease in the total front height of the face, an increased L1 Protrusion parameter indicates an increase in the angle between the axis of the central incisors of the lower jaw and the base of the lower jaw.

Diagnostic plaster models were made and anthropometric analysis was performed using the available methods. The dentoalveolar form of mesial occlusion was diagnosed.

We installed a bracket system (Ormco, USA) (Fig. 4) on teeth 3.3, 3.2, 3.1, 4.1, 4.2 for intrusion and retrusion of the mandibular incisors (posterior to the tongue) and elimination of diastema and three (spaces between teeth 1-1.5 mm ) The treatment period was 6 months.

This completed the orthodontic treatment and began the retention period (Fig. 6).

In the retention period, a flex-retainer was installed (FIG. 5) on teeth 3.3, 3.2, 3.1, 4.1, 4.2 (to stabilize the result).

The impressions were removed from two jaws (Fig. 7), models with bite wax rollers were made (Fig. 8).

We prepared a ready-made wax template for a complete denture on the upper jaw (Fig. 9), determined the structural bite, and set the teeth (Fig. 12).

Cephalometric analysis was performed in the Dolphin-Imaging program, the parameters of the interalveolar height were determined (Fig. 10). The results are summarized in table 2.

As can be seen from the table, as a result of treatment, the interalveolar height of the Lower Face Height and the position of the jaws relative to each other and the cutter angle improved. A complete removable denture was fixed in the patient’s oral cavity (Fig. 11). The patient notes an improvement in the function of biting, chewing, aesthetics, there is no pain in the TMJ (Temporomandibular joint).

The proposed method for improving the quality of treatment for patients with mesial occlusion in combination with a complete absence of teeth in the upper jaw can reduce the number of visits to the orthodontist, exclude the subjectivity of evaluating the determination of the interalveolar height and increase its accuracy, improve the quality of treatment. This is achieved by measuring the interalveolar height using the Dolphin-Imaging program, without the active cooperation of the patient; it is possible to take measurements in patients with any profile of the face; laborious manipulations by the orthodontist and orthopedist are not required to measure the interalveolar height.

Claims (1)

A method for treating patients with mesial occlusion in combination with a complete absence of teeth in the upper jaw, comprising sequential orthopantomography and tele-radiography of the patient’s head in lateral projection, based on which angular and linear parameters and interalveolar height are measured using the Dolphin-Imaging program, taking into account which make diagnostic models and conduct their anthropometric analysis, install the Ormco bracket system, USA, on the teeth for intrusion and retrusion of the mandible incisors and eliminate asthma and three for a period of 6 months, the subsequent installation of a fixed flex-retainer on the teeth 3.3, 3.2, 3.1, 4.1, 4.2, imprinting from two jaws, making models with bite rollers, fitting a wax template of a full removable denture on the upper jaw, staging performing cephalometric analysis in Dolphin-Imaging to evaluate treatment results.

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