RU2760294C1 - Device for the treatment of patients with incomplete facial growth, mesial ratio of the dentition caused by upper micro-, retrognation and forced position of the lower jaw - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, namely to devices for the treatment of patients with incomplete facial growth, mesial ratio of the dentition. The device includes a base for the upper jaw with a Y-shaped cut, starting at the level of the distal surface of the canines and ending at the center of the posterior border of the base. The anterior and lateral sectors of the base are connected to each other by an orthodontic triple screw. The base is made with one-shoulder round retaining clasps on the first molars. The base additionally contains occlusal platforms for premolars and molars, which overlap the lateral teeth of the upper jaw, end on their vestibular surface and have point contacts with the lateral teeth of the lower jaw. A lip bumper located in the area of ​​the front teeth is connected to the base.EFFECT: possibility of increasing the size of the upper jaw in the sagittal and transversal directions and stimulating its growth while excluding the previously formed forced position of the lower jaw.1 cl, 7 dwg

Description

The invention relates to medicine, namely to dentistry and orthodontics, and is intended for the treatment of patients with incomplete facial growth, mesial ratio of the dentition caused by underdevelopment of the upper jaw (upper micrognathia) or the posterior position of the upper jaw in the skull (upper retrognathia) or a combination of these reasons , as well as the forced position of the lower jaw.

The prevalence of dentoalveolar anomalies, according to various sources, ranges from 75% to 95.3%. The mesial ratio of the dentition accounts for from 8% to 16.9% (Gioeva Yu.A., Persin L.S.Mesial ratio of the dentition (clinical picture, diagnosis, treatment). - Moscow: Medicine, 2008; Gioeva Yu. A., Topolnitskiy O.Z., Alimova A.V. Analysis of the harmony of the face of patients with mesial occlusion of the third degree depending on the type of growth of the facial skeleton // Collection of reports and materials of the VI International scientific-practical conference "Innovations in the branches of the national economy, as a factor in solving the socio-economic problems of our time. ”- Moscow, 2016. - pp. 143-152).

The following forms of this pathology are distinguished:

- skeletal anomalies, characterized by a change in the size of the jaws, their location in the skull;

- tooth-alveolar anomalies, characterized by a change in the ratio of the dentition of the upper and lower jaws;

- combined forms of anomalies (Myagkova N.V. Gnatic forms of mesial occlusion: improving methods of diagnosis and treatment of patients of different ages. - Abstract of the thesis for the degree of Doctor of Medical Sciences. - Yekaterinburg, 2017. - 47s; Fadeev R.A., Prozorova N.V., Fadeeva M.R., Li P.V., Litovchenko Yu.P. An alternative approach to the treatment of skeletal forms of mesial ratio of dentition in patients with a completed type of facial growth // Institute of Dentistry. - 2018. - No. 4 (81). - S. 44-47).

Among the skeletal forms of the mesial ratio of the dentition are distinguished

forms caused by the underdevelopment of the upper jaw (upper micrognathia), the posterior position of the upper jaw in the skull (upper retrognathia), an increase in the size of the lower jaw (lower macrognathia), the anterior position of the lower jaw in the skull (lower prognathia), as well as various combinations of the above reasons.

A number of researchers distinguish functional anomalies characterized by the habitual, forced forward displacement of the lower jaw with the formation of class III anomalies. These violations are also referred to skeletal anomalies, in particular, to the lower prognathia with the possibility of displacement of the lower jaw back (Fadeeva M.R., Prozorova N.V., Fadeev R.A., Novikov N.V., Vladimirov V.S. Analysis of the face profile in patients with mesial ratio of dentition // Zh-al "Institute of Dentistry" No. 4 (89) - 2020. - P. 30-31). In addition, improper eruption of teeth with the formation of a cross-ratio of the dentition in the lateral region leads to a displacement of the lower jaw to the side, which, in turn, leads to displacement of the heads of the lower jaw and asymmetric growth of the lower jaw.

The closest analogue of the proposed device is Schwarz's single-jaw lamellar apparatus, which is a base plate on the upper or lower jaw, a clasp for fixation in the area of the lateral teeth, a retraction arch in the area of the anterior teeth and a screw for expanding the dentition (Trezubov V.N., Shcherbakov A. S., Fadeev R.A. "Orthodontics. Second edition. Moscow," Medical book. - 2005 - S. 99-100; K.G. Isaakson, J.D. Muir, R.T. Reed "Removable orthodontic appliances". Moscow, "MEDpress-inform. - 2012 - pp. 100-101).

The disadvantage is the limitation of the correction of occlusion pathology by the transversal direction, the impossibility of lengthening the dental alveolar arch in the anterior region and stimulating the growth of the upper jaw, changing the forced position of the lower jaw.

The task is to develop an orthodontic appliance with the elimination of the listed disadvantages for the correction of the mesial ratio of the dentition caused by the upper micro- and / or retrognathia in combination with the forced position of the lower jaw in patients with incomplete facial growth.

The task is achieved by the fact that in the device for the treatment of patients with incomplete facial growth, mesial ratio of the dentition caused by the upper micro- and / or retrognation and forced position of the lower jaw, including the basis for the upper jaw with a Y-shaped cut starting at the level of the distal the surface of the canines and ending in the center of the posterior border of the base, the anterior and lateral sectors of which are interconnected by an orthodontic triple screw, with one-shoulder round retaining clasps on the first molars, the base additionally contains occlusal platforms on the premolars and molars, which overlap the lateral teeth of the upper jaw, end with their vestibular surfaces and have point contacts with the lateral teeth of the lower jaw, as well as a labial bumper connected to it, located in the region of the anterior teeth.

FIG. 1 shows a general view of the device: a - top view, b - side view.

The apparatus consists of a base for the upper jaw 1 with a Y-shaped cut 2, starting at the level of the distal surface of the canines and ending in the center of the posterior border of the base, the anterior 3 and lateral 4 sectors of the base are interconnected by an orthodontic triple screw 5; round one-shoulder retaining clasps on the first molars 6; occlusal areas on premolars and molars 7, which overlap the occlusal surface, end on the vestibular surface and have point contacts with the lateral teeth of the lower jaw 8; lip bumper 9 located in the area of the front teeth.

The occlusal platforms serve to separate the dentition of the upper and lower jaw, and their modeling with point contacts with the lateral teeth of the lower jaw eliminates the previously formed forced position of the lower jaw, leads to relaxation of the muscles that are in an asymmetric tonic state and helps to find the correct position of the lower jaw. Unscrewing the triple screw allows to increase the size of the upper jaw in the sagittal and transversal directions, as well as to stimulate its growth. The lip bumper allows you to move the upper lip forward and eliminate its pressure on the alveolar part of the upper jaw, which also promotes the growth of the upper jaw in the sagittal direction.

Clinical and laboratory stages of the manufacture of this device imply taking impressions from the upper and lower jaw, casting plaster models of the jaws, making a bite template for the upper jaw with occlusal ridges in the area of the posterior teeth, determining the central position of the lower jaw with a separation of 0.5 mm in the area of the posterior teeth , plastering the models into an occluder or articulator, modeling the apparatus with the introduction of a screw, clasps and a lip bumper into the wax composition of the apparatus, transferring the wax composition into plastic, grinding and polishing the apparatus, applying the apparatus to the patient's upper jaw.

It is recommended to activate the screw from 1 time in three days to 1 time in 7 days, depending on the patient's age. At the age of 5-8 years - 1 time in three days, at the age of 9-11 years - 1 time in 5 days, at the age of 11-14 years - 1 time in 7 days. Such modes of screw activation are associated with bone density at different age periods.

After reaching normal overlap with the upper incisors of the lower ones (the upper incisors should overlap the lower ones by 1/3 of the height of the crown of the tooth, and the sagittal inter-incisal distance should be 2-2.5 mm), the occlusal linings are first ground in the molar region to obtain their contact due to tooth-alveolar lengthening ... After obtaining contact in the molar area, the occlusal onlays are ground in the area of the premolars, also achieving their contact due to the dentoalveolar lengthening.

The use of this apparatus is illustrated by a clinical example.

Patient A., 7 years old, complained of malocclusion, reverse incisor overlap. After a clinical examination, analysis of the diagnostic models of the jaws, a computed tomogram and a profile teleroentgenogram, the diagnosis was made: mesial ratio of the dentition, upper micrognathia, lower prognathia with the possibility of displacement of the lower jaw back, forced position of the lower jaw.

For the purpose of treatment, the patient underwent the proposed apparatus and recommendations were given for activating the screw 1 time in three days.

FIG. Figures 2-7 show the results of treatment 1 year after its initiation.

FIG. 2 - photograph of the dentition of patient A. before the start of treatment (front projection).

FIG. 3 - photograph of the dentition of patient A. 1 year after the start of treatment (front projection).

FIG. 4 - photograph of the dentition of patient A. 1 year after the start of treatment (right projection).

FIG. 5 - photograph of the dentition of patient A. 1 year after the start of treatment (left projection).

Fig. 6 is a profile teleradiograph of patient A. before treatment.

FIG. 7 - profile teleradiograph of patient A. after treatment.

Thus, the use of the proposed apparatus for the treatment of patients with incomplete facial growth, mesial ratio of the dentition caused by the upper micro-retrognosis and the forced position of the lower jaw allows to achieve good results in a short period of time.

Claims (1)

A device for the treatment of patients with incomplete facial growth, mesial ratio of the dentition caused by upper micro- and / or retrognation and forced position of the lower jaw, including a base for the upper jaw with a Y-shaped cut, starting at the level of the distal surface of the canines and ending at the center of the posterior the boundaries of the base, the anterior and lateral sectors of which are interconnected by an orthodontic triple screw, with one-shoulder round retaining clasps on the first molars, characterized in that the base additionally contains occlusal platforms for the premolars and molars, which overlap the lateral teeth of the upper jaw, end on their vestibular surface and have point contacts with the lateral teeth of the lower jaw, as well as a labial bumper connected to it, located in the region of the anterior teeth.

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