RU2723133C1 - Orthodontic apparatus - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to orthodontic dentistry, and is intended for use in treating mesial occlusion. Orthodontic apparatus is used, which is a tray provided with a possibility of partial coating of the upper dental arch and having a right and left occlusive patches combined in the front part of the tray and connected in the rear part by means of a back web. Tray is made rigid from plastic, in the front part of the tray there is a tongue trap directed downwards and reaching the height of the lower surface to the level of the necks of the lower frontal teeth from the lingual side, in addition, the tray is provided with a palatal recess extending from the tongue trap to the back web, and open from the vestibular side corresponding to the location of the superior frontal teeth from the canine to the canine, and the tongue trap is configured to form a sagittal gap between the vestibular surface of the tongue trap and the lingual surfaces of the inferior frontal teeth.

EFFECT: use of the orthodontic apparatus enables providing high clinical effectiveness in mesial occlusion, restraining growth of the lower jaw, eliminating protrusion and three lower frontal teeth, eliminating tongue parafunction and normalizing swallowing.

6 cl, 8 dwg, 3 ex

Description

FIELD OF THE INVENTION

The invention relates to medicine, namely to orthodontic dentistry, and is intended, in particular, for the treatment of mesial occlusion that occurred when the lower jaw was displaced mesially into the usual occlusion, to inhibit the growth of the lower jaw, eliminate protrusion and three lower frontal teeth, to eliminate tongue parafunction normalization of swallowing.

State of the art

A known orthodontic apparatus (RU 182370 U1, publ. 08/15/2018) containing an elastic double-jaw mouthguard, the contacting surfaces of the jaws of the upper and lower jaws are interconnected, and the surfaces of the mouthguards are made in the form of flexible plates, with the possibility of touching the vestibular surface, protruding from the dentition of defective teeth, and spaced 1-2 mm from the surfaces of healthy teeth.

The famous Franklin orthodontic apparatus (http://orto-info.ru/sistemyi-vyiravnivaniya-zubov/lechebno-profilakticheskie-apparatyi/frenkelya.html © Orthodontist Magazine) is a removable device that fixes both jaws: upper and lower. Its basis is a complex skeleton of metal, buccal shields and labial pelots - devices for abduction of the lower lip in order to redistribute the functional load from one row to another. The closure of the lips while stimulating the tone of the circular muscle of the mouth. For the manufacture of the anatomical framework there is a medical wire of high strength, up to 1 mm in diameter, which is formed in the form of three special arcs: palatine, lingual and vestibular. Sometimes a lingual arch is included. The arcs themselves are connected to the plates, their ends are fixed in the middle of the shields during the manufacturing process. Fixation of fangs and incisors for constant pressure and inhibiting the growth of the jaw is carried out by special loops. Pelots and shields can be plastic or metal. In the type 3 Franklin orthodontic device, labial pelots are fixed in the region of the upper lip. The vestibular arch exerts pressure on the incisors of the lower jaw, and palatine on the dentition of the upper. Also, the occlusal-type pads are fixed on the arches in the lateral areas. During installation, it is ensured that the pelots exert pressure on the alveolar ridge, and the plates are at a small distance from it.

The Persian orthodontic apparatus for normalizing distal occlusion is known (http://orto-info.ru/sistemyi-vyiravnivaniya-zubov/individualno-izgotovlennyie-apparatyi/ko okklyuzii-persina.html © Journal Orthodont), which refers to combined devices, t .to. it contains both elements of passive correction of the bite, and active. The device is a plate located on a hard sky, to which an arc-shaped piece of wire is attached. In the area of the frontal teeth, the arc bends, forming a spiral from half loops. Thus, when the patient closes the jaw, the wire element promotes the extension of the lower jaw and stimulates its active growth. In addition, the device can be used to treat mesial occlusion. In this case, the apparatus is a monoblock construction located on two jaws. A feature of this device is the presence in the occlusal overlays of the prints of the masticatory surfaces of the lateral teeth of the upper jaw. This helps to fix its position in the device. There are no such prints on the lower jaw, as a result of which the lower jaw has the ability to move in the distal direction. The device aligns the dentition due to the redistribution of the natural functional load from the muscles of the jaw, lips and cheeks.

The type 3 Franklin apparatus and the Persian apparatus for correcting mesial occlusion are quite complicated, while both devices use a vestibular arch, when activated by a doctor, a distalizing effect on the lower jaw occurs, while the vestibular arch serves as a pelot for the lower lip, not allowing it to shift the lower lip the jaw distally.

The technical problem solved by the claimed invention is to simplify the design of the orthodontic apparatus while ensuring high treatment efficiency, based on the use of new principles of the apparatus.

Disclosure of the invention

This technical problem is solved due to the fact that the single-jaw apparatus, which is an acrylic plastic mouthguard, is equipped with a trap for the tongue, which, when swallowed, provides total isolation of the tongue from the lower frontal teeth and directs the tongue to the hard palate in the region of a large palatine incision.

In this case, the kappa is an orthodontic device made of hard acrylic plastic, with fixation on the upper jaw, with six upper front teeth from right to left canine open, free from plastic from the vestibular side. Lateral teeth from 4 premolars to the last molars, and in the milk and removable bite, from milk canines to the 5th milk or 6th permanent molar, are closed with plastic from the vestibular side 1 ± 0.1 mm above the neck of the teeth. Accordingly, in the right and left side portions, the kappa forms occlusal overlays on the chewing surface of the lateral antagonist teeth. In addition, there are two main elements: a large palatine notch and a trap for the tongue, which are described in detail below.

The trap is made protruding downward and reaching the lower boundary to the level of the necks of the lower anterior teeth. The shape of the trap is such that when fixing the apparatus, there is a sagittal gap between the vestibular surface of the trap for the tongue and the lingual surfaces of the lower anterior teeth. At the same time, another necessary condition for solving a technical problem, working in conjunction with the presence of a trap for the tongue, is the implementation of a large palatine incision. In this case, the open sky in a large palatine notch located above the trap for the tongue serves as a reliable reference point and determines where, in which direction the tongue needs to be moved to stop during swallowing movement. The trap for the tongue, for its part, prevents the incorrect position of the tongue, eliminates its pressure on the lower teeth. A large palatine incision is made as large as possible, that is, as much as possible, from the point of view of maintaining the strength and rigidity of the apparatus. In addition, another necessary condition for solving the technical problem posed is the presence of weakly expressed, smoothed prints of the lower posterior teeth on the lateral occlusal surfaces of the mouthguard. This provides the convenience of closing the lower lateral teeth with the mouthguard and sliding of the lower teeth on the plastic when moving the lower jaw distally after the doctor has removed the retention points.

The tongue trap has the following form. In the front part of the apparatus base, the line of the lower edge of the tongue trap from the left to the right canine in the projection onto the frontal plane forms an arc, convex down to the lower frontal teeth, while the lower border of the tongue trap is located at the level of the necks of the lower incisors from the lingual side when closed mouth: lower posterior teeth in contact with occlusal lining. In projection onto the sagial plane, the tongue trap has a bulge in the direction of the anterior teeth and a concavity in the tongue. The thickness of the trap varies between 3-6 mm depending on the situation: for example, how far it is planned to move the lower jaw distally. Due to this thickness of the trap for the tongue, it is possible to make corrections with an interval of 1-2 weeks, that is, remove the plastic from which the trap for the tongue is made, as the lower jaw, lower teeth move distally and contacts, retention points between the tongue trap appear and lower frontal teeth. Since such contacts will prevent further displacement of the lower jaw by the distal, lingual inclination of the teeth during their protrusion, they must be removed by periodically grinding the plastic from the vestibular surface of the tongue trap using carbon paper (carbon paper) to visualize the contact. The implementation of the apparatus entirely from plastic also significantly affects the solution of the technical problem posed, since most energetically, with the maximum effect, the tongue will be repelled from the smooth surface of the tongue trap made of plastic and its own sky in the region of a large palatine incision., Unlike analogues known from the prior art, which use wire insulation for the tongue, about which the tongue is injured and reflexively repelled less vigorously.

The technical result achieved by using the invention is to simplify the device due to the use of a single jaw apparatus for treatment, while ensuring high efficiency of treatment of mesial occlusion, restraining the growth of the lower jaw, eliminating protrusion and three lower front teeth, eliminating tongue parafunction and normalizing swallowing due to that the apparatus uses correctly directed muscles of the maxillofacial region to achieve a therapeutic result, creates conditions in the mouth for the normal function of the tongue when swallowing. At the same time, unlike the mentioned analogues, the device is not removed during meals, due to which the effectiveness of treatment is further increased.

The achievement of the technical result is due to the following reasons.

One of the main causes of mesial occlusion with the usual shift of the lower jaw forward is the incorrect position and work of the tongue when swallowing. When swallowing, the tongue abuts against the lower frontal teeth, which can lead to protrusion, displacement of the lower jaw into the usual mesial occlusion, and also stimulate the growth of the lower jaw. When the lower frontal teeth lean forward, for example, as a result of pressure on the tongue when they are not swallowed correctly, they seem to switch to a larger radius of the dental arch while maintaining their transverse dimensions, and gaps are formed between the teeth - three.

In the claimed apparatus, the correction of mesial occlusion is due to the fact that the complete isolation of the tongue from the lower frontal teeth with the help of a tongue trap leads to a change in the biodynamic balance between the muscles of the tongue and the circular muscle of the mouth in favor of the circular muscle of the mouth, including in favor of the muscles of the lower lips. Thus, while wearing the apparatus, the lower lip puts pressure on the lower frontal teeth in the lingual direction and on the lower jaw itself in the distal direction constantly, especially actively at the time of swallowing. It does not require activation of the device by the doctor, as provided for in the known analogues, when the doctor activates the vestibular arch in the lower frontal teeth.

In the claimed apparatus due to the proposed design creates a constant pressure of the lower lip on the lower front teeth in the lingual direction, pressure on the lower jaw itself in the distal direction, and with the teeth closed, the tongue does not put pressure on the lower front teeth, the lower jaw in the mesial direction, and on the contrary, resting in a trap for the tongue and / or in the hard palate, opened due to the presence of a large palatine notch, at the time of each swallowing movement pushes away from them and distally displaces the lower jaw, with which the tongue is connected anatomically and physiologically. This is because the upper jaw and the orthodontic apparatus fixed on it are conditionally “motionless”, form a single whole with the facial skeleton of the skull, and the lower jaw is “mobile” relative to the upper jaw. In addition, when using the invention, the work of the tongue when swallowing is normalized: a large palatine notch, the absence of extra wire elements, a large free space for the tongue allow the patient to accurately navigate where the tongue should move when swallowing, what the tongue rests against, namely, the tongue moves into the direction of free space, above the trap for the tongue, to the large palatine notch, to the open mucous membrane of the hard palate, which the tip of the tongue abuts against when swallowing. To some extent, such swallowing, in addition to the effects described above, also stimulates the growth of the upper jaw and the formation of a dome of the hard palate. Thus, as a result of treatment with this device, protrusion and three lower frontal teeth, if any, are eliminated, and the lower jaw moves distally from the usual mesial occlusion to the central ratio. The effectiveness of the claimed orthodontic apparatus is manifested in a combination of a trap for the tongue and a large palatine incision with good fixation of the apparatus. This is a kappa on the upper jaw with shallow, smooth prints of the lower lateral teeth for the convenience of closing the jaws - closing the lower dentition with the mouthguard. The device can be made non-removable by fixing it on dental cement.

An analysis of the prior art to identify solutions having features matching the distinguishing features of the claimed invention showed the following.

In the prior art orthodontic device for treating the symptoms of snoring and sleep apnea syndrome (RU 154582 U1, 2015), there is a platform for the tip of the tongue on the upper mouth guard behind the incisors. However, the known device is not intended for the treatment of the above pathologies for which the claimed invention is intended, namely: for the treatment of mesial occlusion, for restraining the growth of the lower jaw, for eliminating protrusion and three lower frontal teeth, for eliminating the parafunction of the tongue, for normalizing swallowing. The known orthodontic device (RU 154582) shifts the lower jaw down and forward, and the tip of the tongue anteriorly upward, thereby increasing the posterior air space, in addition, the device allows the lower jaw to be displaced to the edge contact of the front teeth while maintaining the contacts of the posterior teeth due to bite occlusal sites ("water pads"). A platform for the tip of the tongue is needed to normalize the position of the tip of the tongue during sleep, due to which the size of the upper respiratory tract increases and the position of the tongue is normalized, which helps to eliminate the clinical manifestations of snoring and night apnea. When the device is worn during sleep, both posterolanguage and posterolateral airspace increase. In the claimed device, the design is made so that it moves the lower jaw back and up, and in the device according to RU 154582 the lower jaw is moved down and forward, that is, the properties that exhibit this feature in the known device do not coincide with the properties that exhibit a similar feature in the claimed invention.

A bite correction plate is also known for use during night sleep (CN 209032682U, 2019) and is made in the form of a base, lip septum and septum for the tongue, with the lip septum located on the outer edge of the plate base and pointing up and down, and the septum for the tongue is located along the inner front of the base of the plate, curved and protrudes up and down relative to the basis. In this device, the septum for the tongue works like a normal limiter for the tongue and is not intended to exclude the impact of the tongue on the lower front teeth, since it does not reach the necks of the lower teeth in height.

Thus, the signs “platform for the tip of the tongue” (RU 154582), “partition for the tongue” (CN 209032682), known from the prior art, have a different shape and do not affect the technical result indicated by the applicant, which is achieved using the claimed invention.

Brief Description of the Drawings

The invention is illustrated by drawings, which depict:

in FIG. 1 is a general top view of the orthodontic apparatus (mouthguard);

in FIG. 2 - the same side view; figure 3 is the same, front view

in FIG. 4 ÷ 8 - photo of the orthodontic apparatus in different angles.

In the drawings, the positions indicated:

1 - a large palatine cut;

2 - rear jumper;

3 - trap for the tongue;

4 - prints of the upper posterior teeth;

5 - occlusal pads;

6 - front lintel with imprints of the upper front teeth; The implementation of the invention

The orthodontic unit is designed to be installed on the upper dentition and is made of acrylic plastic, while it is possible to perform both completely from plastic and from plastic with reinforcement with metal elements embedded in the mouthguard base.

The orthodontic apparatus contains a mouthguard made with a large palatine notch 1 — a portion of the mouthguard where the plastic is completely removed (opening, slot in the mouthguard). Large palatine notch 1 is made 2 mm above the necks of the teeth of the upper jaw.

Kappa is made open from the vestibular side, corresponding to the location of the upper anterior teeth and closed at the location of the posterior teeth from the fourth premolars to the last molars, and in the milk and replaceable bite, from milk canines to the 5th milk or 6th permanent molar, from the vestibular sides by 1 ± 0.1 mm above the position of the necks of the teeth. Thus, the occlusal lining 5, i.e. the right and left parts of the mouthguard are made covering the upper lateral teeth from the vestibular side and with deep imprints of the four upper teeth to ensure fixation of the mouthguard on the upper jaw of the patient. In addition, the occlusal pads 5 on the front lintel 6 have imprints of the upper front teeth, and on the outside, on the surface of contact with the lower teeth, shallow prints of the lower lateral teeth for the convenience of closing the jaws, i.e. ensuring closure of the lower dentition with the mouth guard.

The right and left parts of the occlusal lining 5 are connected in the area of 6 or 7 teeth by means of a rear lintel 2 made of plastic bounding the palatine notch 1, which reaches the trap 3 with the front edge.

Kappa is equipped with a trap 3 for the tongue located in the front of the kappa and made of plastic in one piece with the front of the kappa, the trap 3 for the tongue in height is made protruding downward and reaching the necks of the lower incisors on the lingual side. The tongue trap 3 is configured to form a sagittal gap between the vestibular surface of the tongue trap 3 and the lingual surfaces of the lower anterior teeth.

In the front part of the apparatus base behind the upper canines, the line of the lower edge of the trap 3 from the left to the right canine in the projection onto the frontal plane forms an arc, in particular, an ellipse arc (or other curve), convex down to the lower frontal teeth. The lower boundary of trap 3 is projected onto the necks of the lower incisors from the lingual side, i.e. located at the level of the neck of the lower incisors with a gradual decrease in height to the right and left ends of the trap 3 for the tongue. In the projection onto the sagittal plane, the tongue trap 3 has a bulge towards the front teeth, smoothly turning into a concavity from the tongue, so that the tongue is as if isolated from the lower teeth by a part of the bulge. The thickness of the trap 3 for the tongue is 4–6 mm at the incision site along the sagittal plane.

Installation and principle of operation of the tray. Kappa is fixed on the upper jaw, when fitting the device, it is necessary to ensure a sagittal gap between the tongue trap 3 and the lingual surfaces of the lower frontal teeth: the lower jaw should be able to move back (distally), and the lower teeth should be bent lingually during protrusion. On the occlusal pads 5 are recesses that provide multiple contacts with the lower lateral teeth. During treatment, the doctor periodically makes corrections to the apparatus, removing the contacts of the lower frontal teeth with the tongue trap 3 to create a permanent sagittal gap between the tongue trap 3 on the vestibular side and the lower frontal teeth on their lingual side.

In addition, the doctor periodically grinds the retention points on the occlusal lining 5 in places of contact with the lower lateral teeth.

The frequency of correction is usually 1 time in 2 weeks. In addition, correction, elimination of retention points on occlusal patches from the side of the imprints of the lower teeth is also done about 1 time in 2 weeks, which is necessary, since these retention points prevent the lower jaw from moving back (distally) to the correct position of the central ratio of the joint heads.

Examples of therapeutic use of devices

Example 1. Artyom N., 7 years old, the child's parents complained of protruding lower frontal teeth. The child can put the upper and lower frontal teeth back to back, but he is so uncomfortable. During swallowing, the tongue rests on the lower front teeth.

The patient was diagnosed with mesial displacement of the lower jaw into habitual occlusion. Reverse incisal overlap in the anterior portion of the dentition. Slight narrowing of the upper dentition. Parafunction of the tongue.

The patient was made an orthodontic apparatus - a mouthguard with a screw for expansion, a palatine notch and a trap for the tongue. After a month and a half of treatment with an installed orthodontic apparatus and performing exercises for proper swallowing, a normal incisive overlap was obtained in the front area of the dentition. After another two months of expansion of the upper dentition, it began to correspond in width, or transversally, to the lower dentition. Swallowing normalized, the tongue during swallowing movement without an apparatus no longer rested on the front teeth.

The patient was withdrawn from active treatment, monitored with examinations once every 1.5 months, the kappa was left as a retention apparatus, it was recommended to tighten the screw once every two weeks so that the kappa did not restrain the growth of the jaw, continue to perform exercises for proper swallowing in the apparatus and without alternating once a day.

Thus, as a result of treatment, the usual mesial occlusion is eliminated, the lower jaw is displaced distally to the central ratio, swallowing normalized, which must be continued to be fixed by performing exercises.

Example 2. Patient Marina O., 38 years old, was referred by an orthopedic dentist to eliminate protrusion, three lower front teeth, and reverse incisal overlap.

The patient showed a neutral bite, tongue parafunction (during swallowing, the tongue rests on the lower teeth), protrusion and three lower front teeth, reverse incisal overlap, as well as slight crowding and retrusion of the upper front teeth.

A kappa with a large palatine neckline, a trap for the tongue and traction springs under the upper incisors was made for the patient.

As a result of 4 months of treatment, the reverse bite in the anterior portion of the dentition was eliminated, trems in the lower anterior teeth were significantly closed, protrusion of the lower incisors and retrusion and crowding of the upper incisors were eliminated. There was a normalization of swallowing, decreased parafunction of the tongue.

Example 3. Twin brothers Egor and Nikita L., 10 years old, mesial occlusion, vertical disocclusion of 1 mm and 2 mm, the shift of cosmetic centers of the lower dentition to the left. Parafunction of the tongue. Skeletal deformity.

The tactics of treatment was to lengthen and expand the upper dentition and restrain the growth of the lower jaw and lengthen the lower dentition.

Patients were made mouthguards for the upper jaw with a palatine notch, a trap for the tongue and a screw for expansion, recommended exercises for proper swallowing with the installed orthodontic apparatus. Subsequently, similar apparatuses were used with a tongue trap and palatine incision, but with a different screw arrangement: for sectoral advancement of the upper front teeth from the canine to the canine, the traction springs under the upper incisors, etc. All devices had a tongue trap. At the age of 13, the brothers began rapid skeletal growth. At this stage, the following result was obtained in both patients: a direct bite, cosmetic centers coincide, swallowing normalized.

Thus, a kappa with a trap for the tongue and a palatine notch inhibits the growth of the lower jaw due to the blockage of the tongue with its stimulating effect on the lower jaw when it rests on the lower front teeth at the time of the pharynx.

Depending on the objectives of the treatment, the claimed orthodontic apparatus, a mouthguard with a trap for the tongue and a large palatine incision can be used in combination with various additional fixing, active and other elements, such as:

- orthodontic screw for expansion or sectoral;

- piston screws for individual teeth or traction springs;

- with braces on the front teeth of the upper jaw

- with braces on the lower dentition for fixing the rods according to class 3 (kappa is made with hooks in plastic from the vestibular side in the area of premolars or molars);

- pelots under the upper lip or intraoral;

- vestibular arch, round or button-shaped clasps, Adams clasps;

- with the mask of Delyar, welded into the plastic from the vestibular side in the area of the first premolar hooks.

The device can be made non-fixed by fixing it on dental cement.

The device can be used to treat children in a shift and permanent bite and for the treatment of adults.

Claims (6)

1. The orthodontic apparatus, which is a mouthguard, made with the possibility of partial covering of the upper dental arch and having a right and left occlusal lining, combined in the front of the mouthguard and connected in the rear through the rear bridge, characterized in that the mouthguard is made of rigid plastic, in the front part of the mouthguard, a tongue trap is made, directed downward and in height reaching the lower surface to the level of the necks of the lower frontal teeth on the lingual side, in addition, the mouthguard is made with a palatine notch extending from the tongue trap to the posterior bridge and open from the vestibular side corresponding to the location of the upper anterior teeth from canine to canine, and the trap for the tongue is configured to form a sagittal gap between the vestibular surface of the trap for the tongue and the lingual surfaces of the lower anterior teeth. 2. The orthodontic apparatus according to claim 1, characterized in that the tray is made of plastic reinforced with metal elements. 3. The orthodontic apparatus according to claim 1, characterized in that the occlusal lining is made with imprints of the upper front teeth on the front of the mouthguard, and the imprints of the lower lateral teeth are made on its outer side. 4. The orthodontic apparatus according to claim 1, characterized in that the kappa is made with the possibility of closing the upper posterior teeth from the fourth premolar to the last molars, and in the milk and removable bite - from milk canines to the 5th milk or 6th permanent molar, on the vestibular side, 1 ± 0.1 mm above the position of the necks of the teeth. 5. The orthodontic apparatus according to any one of paragraphs. 1-4, characterized in that the trap for the tongue, the line of its lower edge in the projection onto the frontal plane in the area from the left canine to the right canine is made in the form of an arc, convex down to the lower frontal teeth with a gradual increase in height in the direction from the periphery to the central part of the mouthguard, and in the projection onto the sagittal plane, the tongue trap is made with a bulge facing the lower frontal teeth and with concavity on the tongue side at a variable thickness in the section along the sagittal plane in the range from 3 ± 0.2 mm to 6 mm ± 0.3 mm. 6. The orthodontic apparatus according to claim 1, characterized in that the rear jumper is located between 6 or between 7 molars.

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