RU2719920C1 - Method of orthopaedic treatment of patients with distal occlusion - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to dentistry, and is intended for use in orthopaedic treatment of patients with distal occlusion by using deprogramming chewing muscles. Patient is examined by questioning, face and mouth examination, CT of temporomandibular joint and its analysis. Computer tomography of the temporomandibular joint is diagnosed and the doctor decides on which jaw the deprogrammer will be made in relation to the clinical case: upper or lower. Alginate diagnostic impressions are then obtained from the upper and lower jaws and a deprogramming agent is made thereon, which is a tray, on which in the area of the front teeth a plastic pad is applied in the frontal group of teeth at angle of 90° relative to the cutting edge of the central lower incisors with undeveloped distalisation, and in pronounced distalisation, a deprogrammer is made with a plastic pad placed at angle of 45° relative to the cutting edge of the central incisor teeth. Thickness of the lining is selected based on the normalization of anterior morphological height of the occlusion with allowance for the fact that the jaw closure and movement were only on the lower front incisors, since this dissection within chewing group of teeth is necessary for muscular deprogramming with subsequent finding of central ratio of jaws. Manufactured deprogramming agent is recommended for a patient to be put on for the night for a week, after which the stability of occlusion is checked with reusable closing of the central lower incisors with articulation paper with thickness of 8 mcm: on the plastic pad there must be an imprint, then the deprogrammer is transferred into the splint by layering the plastic within the chewing group of teeth, inspection is carried out and in missing areas in the chewing department is added plastic, is carried out correction of canines and incisions, manufactured tire is recommended to be worn for up to one month depending on degree of neglect of the disease and on what volume of muscular memory needs to be "reinstalled". That is followed by a repeated complex examination: the CT position on the computed tomography, wherein complete deprogramming of the patient is achieved at the moment, when test parameters and results of patient's questioning about quality of life without carrying device coincide with results of studies, then denture is replaced.

EFFECT: method allows de-shaping chewing muscles, normalizing the position of the temporomandibular joint head and lower face height, providing higher comfort for the patient during treatment, simplifying the deprogramming procedure and its conversion into a tire, and determining the central ratio of the jaws.

1 cl, 5 dwg, 1 ex

Description

The invention relates to medicine, namely to dentistry, and is intended for orthopedic treatment of patients with distal occlusion using masticatory muscle deprogramming.

Distal tooth abrasion, absence or loss of teeth, deformation of the dentition, as well as incorrect previous prosthetics or orthodontic treatment can distally move the lower jaw distally. The lateral pterygoid muscles at the moment of tight closure of the dentition in the final phase of the movement of the lower jaw lead it to a new position, which is called forced (adapted). Over time, the muscles "remember" a new position. [Lisitsyna, A.Yu. The effectiveness of using individual mouthguards for muscle deprogramming [Electronic resource] / A.Yu. Lisitsyna // Actual problems of modern medicine and pharmacy - 2017: Sat. materials LXXI Int. scientific-practical conf. students and young scientists, Minsk, April 17-19. 2017 / under the editorship of A.V. Sikorsky, O.K. Doronina. - Minsk: BSMU, 2017. - S. 1041-1044.].

By deprogramming the masticatory muscles, one can “erase” the pathologically developed muscle memory and set the jaw in the correct position.

A known method of deprogramming of masticatory muscles using a deprogrammer type Jig-Lucia (jig). This is a standard partial bite mouth guard that fits in the front of the dentition and prevents lateral teeth from closing. The action of the mouthguard should last for 30 minutes in combination with protruding and retrusive movements of the lower jaw [Tamazyan NG, Radyshevskaya TN, Starikova IV, Bobrov DS Comparative characteristics of masticatory muscle deprogramming methods // Colloquium-journal. 2019.Vol. 2. No. 3 (27). S. 37].

The disadvantages of this method is the error in the process of selecting a standard mouthguard (jig). In addition, when using Jig-Lucia, it is not possible to plan the height of the bite in advance.

Also, to deprogram the masticatory muscles, you can use the Cois deprogrammer. The device is a palatine plate on the upper jaw made of acrylic plastic with a retention arch. In the region of the incisal papilla there is a flat protrusion of about 3 mm in height and 6 mm in width. For the manufacture of Coyce's deprogrammer, a plaster model is made from alginate impressions of the upper and lower jaw. According to the model, the vestibular arch (wire) of the future design is made, which will further control the stability of the acrylic base inside the patient's oral cavity. The basis has the shape of a horseshoe, turned by special high-precision tools so as to have a small platform for the central lower incisors. Further, while taking, the Cois Deprogrammer is trying on in the patient's oral cavity. A check is made of the reliability of stabilization of the apparatus, the coincidence of the points of influence with the provided points in the treatment plan. The device is tested using articulation paper. After the test, the deprogrammer most often goes back for revision in order to remove excess material from the palatal surface, which interferes with the patient's normal articulation. Also, the contact with the lower incisors is further narrowed, turning it practically into the point of contact of the platform with the middle of the line of one of them. [The purpose of the Cois deprogrammer and the subtleties of its application [Electronic resource] / Electron. journal - Magazine Orthodontist. - access mode to log: http://orto-info.ru/ortodonticheskoe-lechenie/podgotovitelnyiy-period/deprogrammatora-koysa.html]

This deprogrammer has several disadvantages:

1. Volumetric design, which creates inconvenience for the patient during use.

2. With false production.

3. Used exclusively on the upper jaw.

4. The time of use of the device, which also creates discomfort for the patient. So, one patient is shown 6-8 hours of wear during the day, others - around the clock with the possibility of removal only for oral hygiene and eating.

The objective of the invention is to remedy these disadvantages.

The problem is solved by the proposed method of orthopedic treatment of patients with distal occlusion, which involves the use of a special device - a deprogrammer. The deprogrammer is a mouthguard with a plastic overlay in the area of the frontal group of teeth, which is located at an angle of 45 and 90 ° degrees relative to the cutting edge of the central incisors. The choice depends on the distalization of the heads of the lower jaw. With severe distalization, the deprogrammer is manufactured with an inclined plane of 45 °, with less pronounced - 90 °.

The proposed method of orthopedic treatment of patients with distal occlusion using a special device - deprogrammer is as follows.

1. A patient is examined by questioning, examining the face and oral cavity and using additional diagnostic methods necessary for making a diagnosis and choosing the optimal treatment plan: photos of the patient’s dentition, computed tomography (CT) of the TMJ, functional-manual analysis. On computed tomography of the TMJ, an analysis and selection of a deprogrammer is carried out. Deprogrammers with an inclined plane of 45 and 90 ° relative to the cutting edge of the central lower incisors are considered. The choice depends on the distalization of the heads of the lower jaw. With severe distalization, a deprogrammer with an inclined plane of 45 ° is used, with less pronounced - 90 °. Decide on which jaw the deprogrammer will be made with respect to the clinical case: upper or lower. A deprogrammer cannot be made in the area of missing teeth. Then receive alginate diagnostic prints from the upper and lower jaw. They analyze indicators and identify pathologies.

2. If distal occlusion is detected, the doctor discusses the treatment plan with the patient and proceeds to the next steps.

3. The manufacture of the deprogrammer. Silicone impressions are removed from the upper and lower jaw, a gypsum model is made for making mouth guards for teeth of the upper or lower jaw with a thickness of 0.5 to 0.75 mm using a vacuum formatter. Next, a plastic patch is applied to the mouthguard in the area of the frontal group of teeth, which is located at an angle of 45 or 90 ° relative to the cutting edge of the central lower incisors. The angle of the lining depends on the distalization of the heads of the temporomandibular joint. With severe distalization, a deprogrammer with an inclined plane of 45 °, with a less pronounced 90 °. The thickness of the lining is selected based on the normalization of the anterior morphological height of the bite, taking into account that the closure and movement of the lower jaw were only on the lower front incisors. This separation in the area of the chewing group of teeth is necessary for muscle deprogramming, followed by finding the central ratio of the jaws. It is necessary to advise the patient to wear a mouthguard overnight for a week.

4. The next examination of the patient in a week. A check is made on the stability of occlusion, with repeated closure of the central lower incisors with articulation paper of 8 microns, a fingerprint should remain on the plastic plate.

5. Transfer of the deprogrammer to the tire by layering plastic in the area of the chewing group of teeth. A check is carried out and plastic is added to the missing areas in the chewing department, and correction of fang and incisal leads is carried out. The duration of treatment with a tire for about a month, it depends on the degree of neglect of the disease and on how much muscle memory you need to "reinstall". Complete deprogramming of the patient is achieved at the moment when the test indicators and the results of a patient survey on the quality of life without wearing the device coincide with the research results.

6. It is necessary to interview the patient about the sensations. A second comprehensive examination is being carried out: checking the position of the TMJ on computed tomography, electromyography, functional and manual analysis. Analysis of indicators.

7. Dental prosthetics.

The invention is illustrated by graphic materials and photographs, where in FIG. 1a is a view of a device for deprogramming chewing muscles with a plastic pad at an angle of 90 °; on figb - view of the device with a plastic plate at an angle of 45 °, in fig. 2a, b, c - dentitions of patient A, 35 years old, before treatment, in FIG. 3 is the result of computed tomography prior to treatment; FIG. 4 is the result of computed tomography one month after the start of treatment; FIG. 5a, b, c - dentition of patient A, 35 years old - the result of treatment.

The invention is illustrated by a clinical example.

Clinical example.

Patient A., 35 years old. (Fig. 2a, b, c). The patient complained of unsatisfactory aesthetics and the failure of previously made orthopedic constructions. There were also complaints of pain when opening the mouth in the region of the articular heads of the lower jaw, for clicks in the TMJ when opening the mouth. Before starting treatment using a deprogrammer, the patient underwent a preliminary examination. Photoprotocol was carried out (Fig. 2a, b, c). Received impressions from the upper and lower jaws. The patient was referred for radiography. Computed tomography of the jaw and TMJ was performed. Computed tomography revealed a pronounced distalization of the heads of the lower jaw (Fig. 3).

Diagnosed with K08.1 Partial absence of teeth on the upper jaw Kennedy Grade 3. Lowering the height of the lower face. Distal position of the lower jaw. K07.6 Syndrome of pain dysfunction of the temporomandibular joint.

A treatment plan has been drawn up:

1. The manufacture of the deprogrammer;

2. Conversion of the deprogrammer to the bus;

3. Dental prosthetics.

Making a deprogrammer. Deprogrammer is made on the lower jaw. In the absence of frontal teeth on the lower jaw, the deprogrammer is made on the teeth of the upper jaw. Silicone impressions are removed from the lower jaw, a gypsum model is made for making mouth guards for teeth of the lower jaw with a thickness of 0.5 mm or more using a vacuum formatter. A plastic pad 2.5 mm thick was applied to the mouthguard in the region of the front teeth in the region of the frontal group of teeth, at an angle of 90 ° (Fig. 1a) relative to the cutting edge of the central lower incisors. The plastic overlay is located at an angle of 90 ° taking into account unexpressed distalization, with strong distalization a deprogrammer is made with a plastic overlay located at an angle of 45 ° (Fig. 1b) relative to the cutting edge of the central incisors. The patient is advised to wear a mouthguard overnight for a week. The next examination of the patient in a week. The stability of occlusion was checked, with repeated closure of the central lower incisors with articulation paper 8 microns thick, an imprint remains on the plastic plate.

The deprogrammer was converted to a tire by layering plastics in the chewing group of teeth. The patient wore a tire for 30 days. A repeated examination of computed tomography was performed in order to identify the position of the elements of the TMJ. Positive dynamics was noted, the anterior position of the heads of the lower jaw relative to past computed tomography of the TMJ was observed (Fig. 4). There are no complaints about clicks and pain when opening the mouth. Dentures were performed (Fig. 5a, b, c).

The proposed method for orthopedic treatment of patients with distal occlusion allows deprogramming of the masticatory muscles, normalizing the position of the TMJ heads and lower face height, increasing patient comfort during treatment, simplifying the manufacture of the deprogrammer and its transformation into a splint, and precisely determining the central ratio of the jaws. In addition, the proposed method of treatment using a deprogrammer can be used on both the upper and lower jaw, which expands its functionality.

Claims (1)

A method of orthopedic treatment of patients with distal occlusion, comprising examining a patient by questioning, examining the face and oral cavity, computed tomography of the TMJ and analyzing it, characterized in that the computed tomography of the TMJ is diagnosed and the doctor decides which jaw the deprogrammer will be made with respect to the clinical case : upper or lower, then receive alginate diagnostic impressions from the upper and lower jaws and make a deprogrammer based on them, which is a mouthguard on which in The front teeth are coated with a plastic patch in the area of the frontal group of teeth at an angle of 90 ° relative to the cutting edge of the central lower incisors with unexpressed distalization, and with pronounced distalization, a deprogrammer is made with a plastic pad located at an angle of 45 ° relative to the cutting edge of the central incisors, and the thickness of the pad is selected based on the normalization of the anterior morphological height of the bite, taking into account that the closure and movement of the lower jaw were only on the lower front incisors , since this disconnection in the chewing group of teeth is necessary for muscle deprogramming, followed by finding the central ratio of the jaws, then the manufactured deprogrammer is recommended to put the patient on overnight for a week, after which the stability of occlusion is checked when the central lower incisors are repeatedly closed with articulating paper 8 thick micron: a fingerprint should remain on the plastic overlay, then the deprogrammer is transferred to the bus by layering the plastic in the w of the tooth group, the check is carried out and plastic is added to the missing areas in the masticatory section, the fang and incisor leads are corrected, the manufactured tire is recommended to be worn by the patient for up to one month, depending on the degree of neglect of the disease and on how much muscle memory needs to be “reinstalled”, then a second comprehensive examination is carried out: checking the position of the TMJ on computed tomography, while the patient is completely deprogrammed at the time when the test indicators the results of the patient survey on the quality of life without wearing the device coincide with the results of research, then spend prosthetic dentition.

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