RU2675979C1 - Method of orthodontic treatment of children with mesial occlusion before and during period of second dentition - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, namely dentistry, and can be used to treat patients with mesial occlusion in combination with reverse incisive occlusion/de-occlusion, palatine occlusion (one- and two-sided), narrowing and shortening of the upper jaw arch before and during second dentition. Orthodontic treatment of children with mesial occlusion is performed before and during a second dentition using a facial mask and a fixed apparatus for treating mesial occlusion containing palatal screw, lateral and anterior beams, and a three-dimensional Bertoni screw with three independent rails is used as a screw. Occlusive patches made of plastic are fixed on the side beams, two hooks on each side are welded with two hooks on each side for elastic rods connecting the apparatus for the treatment of mesial occlusion with the Petit face mask. Install the device to the patient, carry out the activation of the three-dimensional screw for 14 days, after the end of the activation, use a face mask with a wearing mode: at least 12 hours a day and apply for 4 months until the full or partial elimination of the vertical and sagittal slits. Then, a third type of Frankel appliance is made and installed for use at night and during the day for 2–3 hours daily to maintain the result obtained during the retention period, and the apparatus for the treatment of mesial occlusion and facial mask is removed.EFFECT: method allows for the integrated treatment of dental anomalies in patients at the stage of occlusion of temporary teeth and early tooth replacement.3 cl, 8 dwg

Description

The invention relates to medicine, namely to dentistry, specifically to methods for treating dentofacial anomalies, and can be used to treat patients with mesial occlusion in combination with reverse incisal occlusion / disocclusion, palatine occlusion (single and bilateral), narrowing and shortening of the dentition upper jaw before and during the change of teeth.

Known device Postnikova M.A. for the treatment of mesial occlusion in combination with retention of permanent teeth and a lack of space in the dentition, including palatine screw, side beams, rings or crowns for 4th and 6th teeth, in addition, a three-dimensional Burtoni screw with three independent teeth was used as a screw guides and an additional front beam is installed to extend the upper incisors mesially, and on the 4th and 6th teeth there are orthodontic crowns welded to the beams by laser welding to separate the bite in the frontal section. The front beam can be temporarily fixed to the maxillary incisors on the Orgco blugloo light-curing filling material (patent for PM No. 92323, CL. A61C 7/00, published on March 20, 2010) ..

The known device can eliminate dental alveolar mesial occlusion in combination with retention of permanent teeth and a lack of space in the dentition, but was not used to treat the gnatic form of mesial occlusion.

There is also a method of treating class III occlusion abnormalities using traction extraoral traction and a fixed apparatus for rapid palatine expansion. The extra-traction force exerted on the teeth acts on the teeth or equipment resting on the teeth by means of elastic traction (see "Biomechanics and Aesthetics in Clinical Orthodontics", Ravindra Nanda, 2009, Moscow, MED press-Inform, pp. 277-285, Fig. 13-3, 13-4, 13-7, 13-15). Extraoral components of the extraoral traction consist of a face mask that transmits force inside the mouth, which is a modified facial arc. Hooks are made in the premolar region to fix the elastic rings to the horizontal part of the face mask.

The known method is indicated for the treatment of patients with normal sizes of the lower jaw, but is not effective enough in the treatment of patients with a gnatic form of mesial occlusion.

Closest to the claimed invention (prototype) is a method of treating mesial occlusion in patients 6-12 years old using a face mask and apparatus for treating mesial occlusion containing a palatine screw, side beams, rings or crowns on the 4th and 6th teeth, moreover, a three-dimensional Burtoni screw with three independent guides was used as a screw, and an additional beam was installed to extend the frontal part of the teeth, and orthodontic crowns soldered to the beams were installed on the 4th and 6th teeth of the upper jaw by welding, while laser welding is applied to these crowns with two hooks on each side for elastic rods connecting the apparatus for treating mesial occlusion with the Ormco face mask, they are installed to the patient and used until the vertical and sagittal gaps are completely or partially removed, after which remove the Burtoni screw and all the beams and guides from the oral cavity, then the patient uses crowns with hooks and elastic rods and a face mask until the mesial occlusion, vertical and sagittal gaps, devices neniya feedback dizokklyuzii the cutting, whereupon the apparatus is manufactured or Persina Andresen-Goyplya apparatus for wearing a retention period, and apparatus for treatment of the mesial and occlusal face mask is removed (RF Patent №2546403). The disadvantages of this method are the impossibility of its use in patients during the period of occlusion of temporary teeth or at the stage of early tooth changes (age up to 6 years), the absence of a splint effect, orthodontic (dentoalveolar) expansion of the upper dentition. The objective of the invention is to remedy these disadvantages.

The problem is solved by the proposed method of orthodontic treatment of children with mesial occlusion before and during tooth change using a face mask and a non-removable device for the treatment of mesial occlusion containing palatine screw, side and front beams, and a three-dimensional Burtoni screw with three independent guides is used as a screw and in addition, a front beam is installed to extend the frontal part of the teeth, and orthodontic plates made of plastic are fixed on the side beams, while in The above-mentioned pads are welded at their ends with two hooks on each side for elastic rods connecting the apparatus for treating mesial occlusion with the Petit face mask, install the device to the patient, activate the three-dimensional screw for 14 days, after the end of activation, use the face mask with the wear mode: do not less than 12 hours a day and used for 4 months to completely or partially eliminate the vertical and sagittal fissures, then a third type of functional Franklin apparatus is manufactured and installed for use I told them at night and day - for 2-3 hours daily to maintain the result in the retention period, and the device for the treatment of mesial occlusion and facial mask is removed. The front beam can be temporarily fixed to the palatal surface of the milk incisors of the upper jaw on a composite material of light or chemical curing.

The orthodontic device includes two occlusal pads (mouth guards) in the lateral sections, a frontal beam (guide) for the protraction of the incisors, and a three-sided screw. The device is fixed.

Hooks are mounted in the occlusal mouthguards for applying the face mask.

The proposed method for orthodontic treatment of children with mesial occlusion before and during the period of tooth change is illustrated by photographs, where in FIG. 1 shows a fixed orthodontic apparatus mounted on the upper dentition: a general view from the occlusal surface, FIG. 2 is a radiograph of a patient, front view, in FIG. 3 is a radiograph of a patient in lateral projection with an apparatus installed, FIG. 4 - front view of the patient, in FIG. 5 is a profile of the patient’s face, in FIG. 6 is a front view of the patient’s teeth, FIG. 7 - side section, right view, in FIG. 8 - lateral section, left view.

Fixed orthodontic apparatus includes two occlusal plastic pads (mouthguards) 1, one guide frontal beam 2, connected by ends with a tripartite screw 3 Burtoni. The occlusal mouthguards are made of acrylic plastic 3 mm thick, the guide beam is made of round steel wire (0.4-0.6 mm). In the occlusal mouthguards, metal hooks 4 for the face mask are welded with the ends. In the central part of the sky there is a tripartite screw to which all the above components of the device are attached.

The device effectively performs orthopedic expansion of the upper jaw in the region of the median palatine suture (controlled one- or two-sided), and the presence of a frontal beam guide allows simultaneous lengthening of the anterior segment of the dentition, thereby correcting the dentition in the sagittal and transverse directions. In addition, occlusal pads (mouthguards) act as a splint, eliminating the mismatch between the central ratio and central occlusion, thereby providing a functional (neuromuscular) effect.

The anterior beam may be temporarily fixed to the palatal surface of the maxillary incisors on a composite material of light or chemical cure.

The device for the treatment of mesial occlusion, reverse incisal occlusion / disocclusion, shortening, and narrowing of the dentition of the upper jaw in children under 6 years old includes a tripartite Burtoni screw, front beam, side beams, occlusal mouth guards, mouth guards, and three independent guides. Two hooks are welded into the occlusal mouthguards on both sides for attaching elastic rings connecting the device to the face mask.

The orthodontic unit is convenient to fix. And since it is non-removable, the constant effect on the dentofacial system under the supervision of an orthodontist makes it possible to reliably predict the result of treatment, and also significantly reduces the duration of treatment. The device can be used in the treatment of patients during the period of occlusion of temporary teeth or at the stage of early tooth change. The device is effective in the treatment of mesial occlusion, including accompanied by reverse incisal occlusion / disocclusion, palatine occlusion, anomalies in the shape and size of the dentition. This device allows you to effectively implement the first stage of orthodontic treatment (early treatment).

The proposed method for orthodontic treatment of mesial occlusion in children before and during the change of teeth is used as follows. Patients with a gnatic form of mesial occlusion and reverse incisor disocclusion in combination with narrowing and shortening of the upper dentition are equipped with the proposed device, the main element of which is a three-sided Burtoni screw 3 with three independent guides. Occlusive mouthguards 1 are fixed on temporary molars and fangs using glass ionomer cement or double-cured cement. To extend the teeth of the anterior part and lengthen the upper dentition, beam 2 was used. Depending on the type of narrowing of the upper dentition, uniform or non-uniform activation of the screw can be used. The screw is activated using a special key (not shown in the photographs). As a result of treatment, orthopedic expansion and lengthening of the upper dentition, mesial displacement of the upper incisors occurs. To create a constant pressure of the beam 2 on the upper incisors and correct the reverse incisal occlusion / disocclusion, the front beam can be fixed to the palatal surfaces of the incisors with a composite material of light or chemical curing. At the level of temporary canines, two hooks 4 are mounted in the occlusal mouth guards from the vestibular surface to allow the use of a face mask.

Clinical example.

Patient M, 6 years old, came to the orthodontics department with complaints of difficulty biting food, protruding chin (according to the parents). Mesial occlusion in the mother is determined.

Results of clinical examination methods:

- the configuration of the face is not changed (Fig. 4),

- profile: convex (Fig. 5),

- position of the upper lip: sinks

- position of the lower lip: protrudes

Conclusions made: Cephalometry results:

- lower pro-macrognathia (Fig. 2, 3)

- upper retrognathia (Fig. 3)

Diagnosis:

Bilateral palatine occlusion

Reverse incisive disocclusion

Narrowing of the upper dentition

Shortening of the anterior segment of the upper dentition (Fig. 6-8).

The treatment was carried out using the orthodontic apparatus described above. Trilateral screw activation was performed daily for 14 days (this activation period was sufficient to correct palatin occlusion). After the activation of the screw for expansion was completed, a face mask (Petit) with the wearing regimen was included in the treatment protocol: at least 12 hours a day. Face mask (Petit) is applied as the most effective in this case. At the same time, the face mask acts on the lower jaw, the acting force presses the lower jaw back, preventing its growth. After 1.5 months from the start of treatment, the central incisors of the upper jaw established themselves in the correct ratio with the incisors of the lower jaw. The presence of diastema on the upper jaw was confirmed, confirming the opening of the median palatine suture. The device was in the oral cavity for 4 months for retention relative to the obtained width of the dentition and the possibility of using a facial mask. Positive changes were achieved in the maxillofacial complex (based on the analysis of situational TRH of the head in the lateral projection). After removing the device, the patient was made a functional Frenkl apparatus of the third type for use at night and during the day for 2-3 hours to maintain the result. The Franklin apparatus is most convenient for treating children under 6 years old. The proposed method of orthodontic treatment is especially recommended for therapeutic purposes for children during the period of active growth (up to 6 years). The presence of occlusal plates (kapp) allows you to set the lower jaw in a central ratio by eliminating functional or dentoalveolar obstructions. The method allows for the comprehensive treatment of dentofacial anomalies in patients at the stage of early tooth change, allowing you to effectively carry out the first stage of orthodontic treatment. A quick adaptation to the apparatus of poorly cooperating patients has been confirmed. Plastic mouthguards can be adjusted in thickness by sawing with a mill or welding using self-hardening plastic, which allows the use of the proposed device in children under 6 years of age with sagittal and transverse occlusion anomalies and disorders in the temporomandibular joint. As a result of treatment using the proposed method, orthopedic expansion of the upper jaw and lengthening of the upper dentition, mesial movement of the upper incisors anteriorly occurs. Orthopedic expansion of the upper jaw (opening of the median palatine suture) causes the mobilization of the sutures surrounding the upper jaw, then allowing the upper jaw to be effectively protected using a face mask. Occlusive linings (mouthguards) can eliminate the mismatch between the central occlusion and the central ratio, acting as a splint. The use of the apparatus at the stage of occlusion of temporary teeth allows early correction of existing skeletal disorders in the sagittal and transverse planes. The presence of occlusal plates (kapp) allows you to set the lower jaw in a central ratio by eliminating functional or dentoalveolar obstructions. Occlusive pads can be performed both without fingerprints and with fingerprints of antagonist teeth, depending on the clinical situation, which expands the functionality of the proposed method in comparison with the known ones. Occlusal pads can be adjusted during treatment, thereby changing the position of the lower jaw in accordance with the objectives of the treatment. Due to the presence of pads (kapp), the device can be used in cases of TMJ disorders in children. The possibility of positioning the lower jaw allows you to apply the proposed method for the treatment of occlusion anomalies in the transverse region - transverse incisal occlusion / disocclusion of any genesis and form (dentoalveolar, gnatic, articular, muscular). In poorly cooperating patients, rapid adaptation to the device occurs. Using the apparatus, an orthopedic expansion is performed (true disclosure of the median palatine suture and periandibular sutures: cheek-maxillary, sphenoid-maxillary sutures, the impact on which is limited in children and adolescents), which ensures effective skeletal protraction of the upper jaw when applying the facial mask. The use of the proposed apparatus allows for the comprehensive treatment of dentofacial anomalies in patients at the stage of occlusion of temporary teeth and early tooth changes, that is, in children before and during tooth changes.

Claims (3)

1. A method of orthodontic treatment of children with mesial occlusion before and during tooth change using a face mask and a non-removable device for the treatment of mesial occlusion containing palatine screw, side and front beams, and a three-dimensional Burtoni screw with three independent guides is used as a screw, characterized the fact that occlusal plates made of plastic are fixed on the side beams, while two hooks on each side are welded into the said plates for their elastic rods connecting the device to I treat mesial occlusion with a Petit face mask, install the device for the patient, activate the three-dimensional screw for 14 days, after the end of the activation, use the face mask with the wear mode: at least 12 hours a day and apply for 4 months until the vertical and sagittal fissures, then they make and install a functional Frenkl apparatus of the third type for use at night and during the day for 2-3 hours daily to maintain the result in retention period, and apparatus for treatment of the mesial and occlusal face mask is removed. 2. The method according to p. 1, characterized in that the front beam is temporarily fixed to the palatal surface of the milk incisors of the upper jaw on a composite material of light or chemical curing. 3. The method according to p. 1, characterized in that the occlusal lining is made with imprints of teeth-antagonists.

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