RU2692447C1 - Method for treating distal occlusion in children caused by mandibular retrognathia, and device for its implementation - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: group of inventions relates to medicine, specifically orthodontics, and is intended for use in correcting distal occlusion, preventing sleep apnea. Impressions of the upper and lower dentures are taken; a silicone bite registry is made in the position of the lower jaw corresponding to the central ratio of the jaws. Individual device is made. Device is fixed and fixed. Its installation is performed so that central incisors of lower jaw are located between plates of retaining block. It is recommended to wear the device daily for not less than 3 hours during the day and throughout the night. In 1.5 months, correct jaw position is controlled. After the correction stage termination, the retentional phase is switched to night use of the device. When the sagittal slit is reduced to 2 mm, the posterior plate of the device is ground and placed so that the central incisors of the lower jaw are located in front of the front plate of the holding block. It is recommended to wear the device daily for not less than 3 hours during the day and throughout the night. In 1.5 months, correct jaw position is controlled. Device for method implementation consists of smooth plastic bus made individually. Tire covers and tightly adjoins part of hard palate and maxillary teeth. Tire does not contain imprints of masticatory surfaces of antagonist teeth and covers teeth of upper jaw by 1.5 mm above cutting edges of crowns of anterior teeth group and by 4 mm lateral teeth, in the anterior tire from the palatine side a holding block is arranged, made in the form of two parallel plates of a semicircular shape with thickness of 1 mm, perpendicular to the occlusal plane, distance between plates is equal to thickness of lower central cutters, height of plates is equal to value of bite lifting for its correction. Use of the invention allows providing forward and stabilization of the lower jaw with correction of the distal occlusion, correction of the position of the lower jaw in the temporomandibular joint dysfunction.EFFECT: inventions allow increasing efficiency of orthodontic treatment of distal occlusion, without injuring teeth and soft tissues; reduced total length of treatment, reduced frequency of check-up visits to an orthodontist; as well as prevent sleep apnea.3 cl, 7 dwg, 1 ex

Description

The group of inventions relates to medicine, namely orthodontics, and can be used to correct the distal bite, prevent sleep apnea.

Distal bite is the most common anomaly of the dentofacial system today. Patients with a distal bite have a reduced height of the lower third of the face, a convex profile, a beveled chin (in the form of a “bird profile”), curvature of the teeth, and dysfunction of the temporomandibular joint. Violation of the closure of the teeth leads to a violation of the function of chewing and reduce the quality of life. Genetic predisposition, artificial feeding, the presence of bad habits: prolonged use of the nipples, thumb sucking, biting the lower lip, difficulty in nasal breathing, inactive chewing - all this contributes to the underdevelopment of the lower jaw and its displacement back, which in turn leads to a distal bite. In addition, the distal bite leads to the fact that at night the jaw occupies the usual back position, the muscles relax, and there is a big risk of blocking the airways. Such respiratory arrest occurs from 1 to 10 times per night. Chronic apnea (respiratory arrest) leads to oxygen deficiency and diseases of the cardiovascular system.

Currently, the distal bite is treated with the use of various devices and devices, both manufactured industrially and individually. The term of treatment with the use of existing devices from 9 months to 2 years. The method of treatment depends on the device, which is planned to be used for the correction of the distal bite.

Methods of treatment using individually manufactured devices include, as a rule, taking jaw prints, making bite registration in a central lower jaw ratio, making a device, fitting and fixing the device in the patient's mouth. Removable devices, with the exception of functional devices, are recommended to be worn 24 hours a day throughout the entire period of correction, excluding the time for eating and brushing teeth.

There is a method of treating the distal occlusion using the Clarke apparatus (William J. Clark. Orthodontic treatment with paired blocks. Orthodontic treatment with paired blocks. Moscow "MEDpress Inform" 2007), including the removal of interocclusal wax prints of the upper and lower dentition, obtaining a silicone bite in position the mandible corresponding to the central ratio of the jaws, the manufacture of individual devices, fitting and fixing the device. The treatment of paired blocks includes two stages. At the first stage, apparatuses with paired blocks are used to correct the anteroposterior ratio and vertical size. Next is the correction of paired blocks, 1 time in 2-4 weeks. The second stage is retention. The purpose of the retention phase is to maintain the achieved relationship of the incisors until the buccal occlusion segment is completely formed. The maxillary device is modified, supplemented by a retaining sponge in the anterior region, allowing to hold the position of the lower incisors. The duration of treatment of the active phase is on average 6–9 months for complete correction of the distal occlusion and the sagittal fissure that holds the phase - 3–6 months. to complete the eruption of molars, the formation of occlusion and to stimulate the eruption of premolars by correcting blocks. The goal is to keep the lower jaw in the correct position set during the active phase until the buccal occlusion is formed. Retention for 9 months, while wearing the device during the day is reduced after stabilization. On average, treatment time is 18 months, including the retention period. Using this method allows to achieve occlusion only in the position of the protrusion of the lower jaw, prevents closure of the dentition in the distal occlusion familiar to the patient, eliminates unfavorable tubercle contacts, removes the block of the lower jaw in the distal functional position.

However, this method has the following disadvantages:

- for the implementation of this method requires the use of only a specific device, which is a two-maxillary and occupies a significant volume in the oral cavity;

-the removal of the lower jaw is performed in one step, that if there is a significant displacement of the lower jaw to the posterior before the treatment, it can cause discomfort in the masticatory muscles and in the temporomandibular joint;

-the use of the method requires monthly monitoring by an orthodontist;

- to obtain a complete correction of the distal occlusion, the device must be worn 24 hours a day throughout the entire correction period, excluding the time for eating and brushing teeth, which in pediatric patients requires additional control and cooperation from parents. The duration of treatment is an average of 1.5 years.

This method is selected as a prototype.

There are a lot of devices that are used to treat distal bite.

A device known as a puller (pusher) Muhleman (NV Golovko Orthodontic Apparatus: study guide. Poltava, 2002. p. 40.), which belongs to the functionally active vestibule-oral, two-jaw apparatus. In the region of the upper jaw, the boundaries are similar to the vestibular plate, and in the region of the mandible, to the activator. Both parts are connected by plastic, which is located between the tooth rows in the frontal area. The propulsor keeps the lower jaw in the extended position (to the neutral ratio of the first permanent molars) and separates the bite in the region of the posterior teeth. The upper and lower boundaries are located in the highest and lowest parts of the transition folds. The posterior margins end at the distal surface of the second dairy or first permanent molars. The plate concerns only the cutting edges and the lower part of the vestibular surface of the upper incisors to be tilted in the palatal direction. From the rest of the teeth and alveolar parts (processes), the plate should be kept at a distance of the required expansion (no more than 2.5 mm). On the lower part of the apparatus there is a process, made of plastic, to hold the lower jaw, turned to the lingual side of the lower incisors.

The disadvantage of this apparatus is its massiveness: the boundaries of the apparatus at the transitional fold of the mucous membrane, the part holding the lower jaw, occupies a large volume in the mouth of the patient. In addition, this device with an occlusal surface covers only incisors.

There are standard devices made by the factory conveyor method, the effectiveness of which is reduced due to the lack of reliable and convenient fixation. Also, this type of apparatus makes it difficult to open the mouth or makes it impossible to wear the device, which is uncomfortable for children. In addition, this type of apparatus requires constant monitoring by the parents for tight closing of the child’s lips for 2-3 hours during the daytime and during sleep at night. This type of device includes a myofunctional trainer (Belousov, Yu.N. Myobrays treatment of myofunctional disorders / Yu.N. Belousov, M.I. Emelyanov // Medical science and education of the Urals. -2008. -№1. –C .1-10-102.), Which is manufactured industrially and refers to the standard functional apparatus for the treatment of bite. This device consists of a two-layer structure that combines the advantages of a soft, flexible silicone that forms the outer layer and a rigid inner layer that forms an elastic framework that stimulates the growth and expansion of the patient's dental arch. Due to the high elasticity, a leveling effect is achieved. The device allows you to clearly fix the lower jaw in the anterior position due to recesses under the front teeth.

The disadvantages of using this device are that to keep it you need to keep your mouth closed, the circular muscle of the mouth must be tense, and at night the device requires control from another person. In addition, this device has only one position for the lower jaw and is not suitable for patients with a significant displacement of the lower jaw back due to the impossibility of a single-stage displacement of the lower jaw to the anterior position. Also, since this unit is standard, it does not fit all patients without exception and requires additional correction in height and length.

Known cap for the treatment of parafunctions of the chewing muscles (Patent RU 2154440, 2000), used, including, at the distal displacement of the lower jaw, made of hard plastic, having imprints of antagonistic teeth on the occlusal surface, inclined peloty in the area of the upper frontal teeth. Kapu is worn by a doctor for 2 to 8 months. The disadvantages of the device are the presence of teeth imprints of antagonists, which limit the functional movements of the lower jaw, thus, not allowing the muscles to adapt to the desired position of the lower jaw.

The task of the claimed group of inventions is the improvement of the method and the development of a device for the treatment of distal bite due to retrognacy of the lower jaw.

The technical result is an increase in the effectiveness of orthodontic treatment of the distal occlusion, while not injuring the teeth and soft tissues, without causing marked discomfort in patients, especially children; reliable and convenient fixation; reduction of the total duration of treatment, reduction of the correction and retention stages, and reduction in the frequency of follow-up visits to the orthodontist; careful removal of the mandible from the usual posterior position and depogramacii the muscles of the temporomandibular joint; elimination of bump contacts; sleep apnea prevention.

The technical result is achieved by the fact that in the method of treating distal occlusion in children, caused by retrognosis of the lower jaw, comprising two stages - correctional and retention, taking impressions of the upper and lower dentition, obtaining a silicone bite registration in the lower jaw, corresponding to the central jaw ratio, manufacturing individual device, fitting and fixing the device, make the proposed device and install it so that the central incisors are lower her jaw placed between the plates of the holding unit, recommend wearing the device on a daily basis for at least 3 hours a day and throughout the night, after 1.5 months to achieve proper control of the relative position of the jaws.

It is preferable to achieve the reduction of the sagittal slit up to 2 mm according to the proposed method, to grind the back plate of the device, to install it so that the central incisors of the lower jaw are located in front of the front plate of the retaining block, continue to wear the device daily for at least 3 hours during the daytime and throughout the night After 1.5 months, the achievement of the correct mutual position of the jaws is monitored.

In the device for the implementation of the method of treatment of distal occlusion in children, caused by retrognosis of the lower jaw, made of plastic, made individually, contains a tire covering a part of the hard palate and all the teeth of the upper jaw, tight to them, the tire is made smooth without imprints of the chewing surfaces of teeth antagonists covering the teeth of the upper jaw 1.5 mm above the cutting edges of the crowns of the anterior teeth and 4 mm lateral teeth, in the anterior section of the splint on the palatine side is a retaining a block made in the form of two parallel plates of a semicircular shape with a thickness of 1 mm perpendicular to the occlusal plane, the distance between the plates is equal to the thickness of the lower central incisors, the height of the plates is equal to the magnification of the bite to correct it.

The principle of operation of the proposed method and device is illustrated by the attached graphic materials, where

Figure 1 - drawing (a) and photo (b) of the tire (top view);

Figure 2 - drawing of the sagittal projection of the tire at the distal displacement of the lower jaw (in section along the midline of the face);

Figure 3 - photographs of the dentition of a patient with a distal bite (a) for treatment and (b) after 2 months;

Figure 4 is a photograph of the dentition using a splint covering all the teeth of the upper jaw 1.5 mm above the cutting edges of the crowns (a - before the treatment; b - after 2 months);

 5 is a photograph of a tire installed in the patient’s mouth (top view of the device);

6 is a photograph of bite registration;

Fig.7 - TRG in lateral projection: (a) - before treatment, (b) - after treatment.

A device for implementing a method for treating distal occlusion in children, caused by retrognacy of the lower jaw, consists of an individually made, tight-fitting smooth tire without imprints of the chewing surfaces of antagonist teeth (Fig. 1-2, item 1). The tire is made of plastic and covers part of the upper palate and all the teeth of the upper jaw 1.5 mm above the cutting edges of the crowns of the anterior group of teeth with an increase of up to 4 mm on the lateral teeth (Figure 4). In the anterior section of the splint, a holding block is designed on the palatine side for inserting the central incisors of the lower jaw. The block consists of two parallel plates (Fig. 1-2 pos. 2,3) of a semicircular shape, perpendicular to the occlusal plane. The distance between the plates is equal to the thickness of the lower central incisors, the height of the plates is equal to the size of the bite raising for its correction. Plate thickness - 1 mm. To ensure the desired location of the central incisors of the lower jaw between the retaining plates, calculate the place of attachment of the plates to the palatal surface of the tire according to the bite pattern.

The method is as follows. Remove prints of the upper and lower jaws. Silicone bite registration is obtained in the position of the mandible corresponding to the central ratio of the jaws. Working models plaster in the articulator in the position of the central ratio. Make the proposed device from plastic. The patient is fixed the device in the mouth, checked by a direct method (in the mouth) for the absence of supercontacts. The position of the lower jaw is set between the plates (in front of the back plate). The patient is recommended to wear the device every day for at least 3 hours during the daytime and throughout the night, and after 1.5 months they monitor the achievement of the correct mutual position. After the end of the corrective stage, they enter the retention phase - night application of the device.

If there is an initial sagittal slit of more than 4 mm, in order to reduce it to 2 mm, the back plate of the device is ground and installed, so that the central incisors of the lower jaw are located in front of the front plate of the retention block, and after 1.5 months the correct mutual position of the jaws is monitored .

An example of the use of a group of inventions.

Patient Ts., 11 years old, was admitted for orthodontic treatment.

Complaints (according to mom): do not like the profile, the lower jaw is shifted back. There is a bad habit: lip disconnection, laying the lower lip under the upper teeth.

A history of the patient's mother: 2 years behind orthodontic treatment. 1 year orthodontic treatment using a removable laminar apparatus with an inclined plane. Dynamics was not observed. Trainer could not wear due to the fact that the device is massive, it is impossible to close his mouth with him. My daughter could not control the position of the lips, which made wearing the trainer ineffective. At night, the trainer was on the pillow. After that, we were treated with a removable plate, the success was very unstable. The record at school was hard to control, it suffered. As such, we did not observe an improvement in bite. The orthodontic trainer during fitting failed to fix in the oral cavity due to a large sagittal slit.

Objectively: the profile is convex, the lips are not closed, the submental groove is expressed. 2 class Angle, sagittal slit 8 mm. Protrusion of the central incisors of the upper jaw, retrusion of the central incisors of the lower jaw.

First visit: consultation, anamnesis, objective examination, lateral projection X-ray analysis, orthopantomogram. The removal of 2 x impressions on the upper and lower jaws, registers the bite in the position of the lower jaw, corresponding to the position of the central ratio of the jaws (Fig.6).

Laboratory stage:

Design and wax modeling of the device on plaster models of the jaws: an individual tight-fitting smooth tire without imprints of the chewing surfaces of the antagonist teeth, covering a part of the hard palate and the central group of teeth of the upper jaw by 1.5 mm, in the anterior region of the lateral teeth 4 mm, in the anterior section with palatal side designed retention block. The location of the block is dictated by the position of the lower central incisors in the position of the central jaw relation. The block is made in the form of two parallel plates of a semicircular shape with a thickness of 1 mm, perpendicular to the occlusal plane, at a distance equal to the thickness of the central incisors of the mandible, the distance was 2 mm. The height of the plates is equal to the height of the bite raising 4 mm - the front step, 3 mm - the rear step.

Second visit: fitting and fixing the device in the oral cavity. Photo protocol (Fig. 4a). Recommendations are given (closure at 1 step, i.e. the position of the central incisors of the mandible between the plates).

Third visit: activation of the apparatus (grinding in the area of teething teeth). Photo protocol (Fig. 4b). Sanding back plate. Recommendations are given (closure at 2 steps, i.e. the position of the central incisors of the lower jaw in front of the anterior plate).

For 2 months, the patient's profile improved. The sagittal gap has decreased from 8 mm to 4 mm. The fangs and the first molars rose from 2 in 1 class of Angle, which corresponds to the goals of orthodontic treatment. Improved position of the canine (tooth 2.3) (Figure 3).

During the 4 months of treatment with this device, a consistently good result was obtained: the distal occlusion was eliminated, the closure of the molars in grade 1, the lower teeth noticeably stepped forward. Improved appearance.

On the TRG in the lateral projection after orthodontic treatment, an increase in the angle of the mandible (extension of the mandible forward), improvement of the profile, increase in the lumen of the upper respiratory tract, reduction of protrusion of the maxillary incisors can be seen.

Using the group of inventions, 6 patients aged from 7 to 32 years were treated. Patients in the replaceable bite (5 patients), the device was used as a treatment to correct the distal percussion. The sagittal cleft was initially 3-10 mm. In all patients, grade 2 was adjusted to grade 1, the sagittal slit was completely eliminated. The patient, 32 years old, was given the device as a retention apparatus after the bracket system. As a result of treatment using the bracket system, class 2 was not corrected (the patient refused to wear intermaxillary elastic cravings. As well as non-removable correctors. After using the device, class 2 was corrected to 1. Strong interdental contacts were obtained.

The use of the proposed group of inventions increases the effectiveness of orthodontic treatment of the distal bite, allows to achieve the desired effect in a short period of 3-4 months. The gradual two-stage extension of the lower jaw to the pre-calibrated exact position of the central jaws ratio promotes careful removal of the lower jaw from the usual posterior position and depograation of the temporomandibular joint muscles due to the absence of antagonist-contacting teeth on the splint, the absence of tubercle-shaped contacts, without injuring the teeth and soft tissue without causing marked discomfort in patients.

The use of the invention allows to ensure the advancement and stabilization of the lower jaw when correcting the distal bite, correcting the position of the lower jaw with dysfunction of the temporomandibular joint. The device according to the invention can be used as a medical device for stabilizing the lower jaw in the correct position, as a retention device on the upper dentition after orthodontic treatment in order to prevent recurrence, and also as a prophylactic device in order to prevent apnea during sleep, due to the block in the anterior part of the device, which stably fixes the anterior position of the lower jaw, which prevents the soft tissue from sticking.

Claims (3)

1. A method of treating distal bite in children, caused by retrognetization of the lower jaw, which includes two stages - correctional and retention, taking impressions of the upper and lower dentition, obtaining a silicone bite registration in the position of the lower jaw, corresponding to the central ratio of the jaws, making an individual device, fitting and fixing the device, characterized in that the device is manufactured according to claim 3., make its installation so that the central incisors of the lower jaw are located between Lastin holding block, and wear the device on a daily basis for at least 3 hours a day and throughout the night, after 1.5 months to achieve proper control of the relative position of the jaws. 2. The method according to p. 1, characterized in that upon reaching the reduction of the sagittal slit to 2 mm, the back plate of the device made according to claim 3 is ground and its installation, so that the central incisors of the lower jaw are located in front of the front plate of the holding block, and they wear the device every day for at least 3 hours during the daytime and throughout the whole night; after 1.5 months they monitor the achievement of the correct mutual position of the jaws. 3. A device for implementing the method of treating distal occlusion in children, caused by retrognacy of the lower jaw, made of plastic, made individually, containing a tire covering a part of the hard palate and all the teeth of the upper jaw, tight to them, characterized in that they make a smooth tire without imprints of the chewing surfaces of antagonist teeth, covering the teeth of the upper jaw 1.5 mm above the cutting edges of the crowns of the anterior group of teeth and 4 mm lateral teeth in the anterior section of the tire on the palate side put holding unit arranged in the form of two parallel plates semicircular shape of 1 mm in thickness, perpendicular to the occlusal plane, the distance between the plates is equal to the thickness of the lower central incisor, the height equal to the lifting plates occlusion for its correction.

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