RU2761715C1 - Method for orthodontic treatment of edentulism - Google Patents

Abstract

FIELD: dentistry.

SUBSTANCE: invention relates to medicine, namely, to dentistry, and is intended for comprehensive treatment, including orthodontic treatment. Proposed is a method for orthodontic treatment of dental edentulism, including visual examination of the patient, collection of complaints, medical history, examination of the oral cavity, examination and exclusion of decay cavities, analysis of panoramic images, impressions from the upper and lower jaws, casting of plaster models, and dental edentulism treatment planning. Impressions are made using Vonflex A silicone, and edentulism treatment planning is conducted by 3-D modelling of plaster casts, while determining the percentage of deviations of teeth from the standard position and planning the process of changing the position of teeth and the time of wearing aligners according to the formula Ta=4.5×Cd+Cm, wherein Ta is the time of wearing aligners, Cm is the coefficient of missing teeth, Cd is the coefficient of deformation, wherein the coefficient of deformation is determined at a deviation of the position of the tooth from the norm up to 10% as 1.1, at a deviation up to 20% as 1.5, at a deviation up to 40% as 3.3, above as 4, the coefficient of missing teeth in the absence of two or more teeth between the teeth, corrected by calculation, is set as 0.65, in the absence of one tooth, set as 0, the guard wall thickness is increased by 25% every 7 days for 21 days, then pontics in the form of missing teeth are installed in the guards, after the end of treatment, casts are made again and plaster models are manufactured, compared by 3D modelling, and the error of reconstruction of the position of the teeth is determined to manufacture prosthetics.

EFFECT: invention provides an increase in the effectiveness of the treatment of edentulism by predicting the duration of treatment and preparing the oral cavity for installation of prosthetics.

1 cl, 4 dwg

Description

The invention relates to medicine, namely to dentistry, and is intended for complex treatment, including orthodontic. The method can be used in orthodontics and prosthetic dentistry.

One of the urgent problems of modern dentistry is dentoalveolar anomalies. Adentia is a common pathology in dentistry, which is characterized by the absence of partial teeth. Lack of teeth is not only an aesthetic problem, but also a reason for the deterioration of human health.

In this regard, the interest of researchers in identifying risk factors and developing effective methods of treating the disease is not weakening.

Adentia can be congenital and acquired. Congenital dentoalveolar anomalies are the cause of the most complex forms and varieties of the clinical picture for orthodontic and orthopedic treatment, requiring complex intervention.

Adentia is a disease characterized by partial or complete absence of teeth in the oral cavity, leading to the formation of an incorrect bite, impaired pronunciation of sounds, and a violation of biting and chewing food. Partial or complete loss of teeth can significantly reduce the quality of life, and health problems arise. With edentulousness, the likelihood of passive displacement of other teeth also increases, so it is necessary to provide space for teeth that are just about to erupt. If there is a shortage of free space in the dentition, orthodontic treatment is necessary before prosthetics.

A known method of treating patients with congenital adentia of permanent teeth using basal implants "Biomed" (patent RU2638286, published on 12.12.2017 bul. 35), containing the use of orthodontic, surgical, orthopedic treatment methods, and orthodontic treatment is carried out in children over 14 years old and carried out using a bracket system in the following sequence: fixation of Damon vestibular metal brackets (Ormco, USA) on the teeth of the upper and lower jaws using Blu-Gloo composite material (USA), installation of a full-size steel arch 0.14 CuNiTi, after 2 months the arch is changed to 0.16 CuNiTi, after 3 months change of the arc to 0.18 CuNiTi, after 3 months change of the arc to 0.14⋅0.25 CuNiTi of age, the braces are removed and two surgeries are performed: removal of temporary teeth and subsequent implantation in the area of the extracted teeth with a bone thickness in the apical region of at least 3 mm, then a surgical stage is carried out, which consists in the use of dental implants in combination with orthodontic treatment in the following sequence: incision and provision of prompt access to the alveolar process; creation of a bone bed; implant placement; closure of the operating wound, the specified surgical treatment is performed in several stages: anesthesia; preparation of the implant bed is carried out without incision of the gums, after anesthesia, a screw implant is screwed into the prepared hole through a small puncture, a Biomed basal implant is used as an implant, the implant is installed in such a way that there is at least 1 mm of bone tissue around, then the final implant installation is carried out; removal of the installation tool; and X-ray control, 3 days after implantation, prosthetics are performed with crowns or bridges, after which a retention period follows, during which the fixed retainer is fixed on the teeth of the lower jaw and the removable retention device is delivered to the dentition of the upper jaw, and the retention device is not applied to the elements of the orthopedic structure is fixed.

The disadvantage of this technical solution is that the treatment requires a long time of wearing the bracket system, which creates inconvenience for the patient, there is discomfort, pain, a certain diet, difficulty in brushing teeth. During the entire period of treatment, a defect is observed at the site of the missing teeth - the toothless area remains open, the patients develop a complex - a decrease in self-esteem. Also, the disadvantage of this method is age restrictions, namely, the beginning of treatment from the age of 14.

The closest to the claimed technical solution is the description of a single-jaw elastomer for correcting the position of the teeth within one dentition, made in the form of a mouthguard with segments of varying rigidity, characterized in that the supporting areas with orthognathic position of the teeth are formed of silicone elastomer with Shore SH70 rigidity, and areas with dystopic teeth are formed from a silicone elastomer with Shore stiffness SH50 (patent RU2365355, published on August 27, 2009, bullet 24).

The disadvantage of this technical solution is that the method provides for a less targeted, without the possibility of adjustments, the effect of elastic forces on the teeth, the position of which is rigidity, which complicates the production process of the corrective mouthguard.

The objective of the invention is to eliminate these disadvantages by developing an effective orthodontic method for the treatment of teeth adentia.

The technical result is an increase in the efficiency of edentulous treatment by predicting the timing of treatment and preparing the oral cavity for prosthetics.

To achieve the claimed technical result, the functional ability of the dentition is restored.

A method of orthodontic treatment of edentulous teeth is proposed, which includes a visual examination of the patient, collection of complaints, anamnesis, examination of the oral cavity, examination and exclusion of carious cavities, analysis of panoramic images, taking impressions from the upper and lower jaws, casting plaster models and planning the treatment of edentulous teeth.

The difference is that impressions are taken using Vonflex A-silicone, and the planning of edentulous treatment is carried out by 3-D modeling of plaster casts, while determining the percentage of deviation of the teeth from their standard position and planning the process of changing the position of the teeth and the time of wearing aligners according to the formula

Te = 4.5 × Kd + Ko, where

Te is the time of wearing aligners,

Kо is the coefficient of the absence of teeth,

Kd - coefficient of deformation,

where the coefficient of deformation is determined when the position of the tooth deviates from the norm up to 10% - 1.1, deviation up to 20% - 1.5, deviation up to 40% - 3.3, over - 4, the coefficient of missing teeth in the absence of two or more teeth between teeth, which are corrected calculated, set - 0.65, in the absence of one tooth - 0, every 7 days for 21 days, the wall thickness of the mouth guard is increased by 25%, pontiques are installed in the mouth guards in the form of missing teeth, after the end of treatment, impressions are taken again and plaster models are made which are compared by 3-D modeling and determine the error in restoring the position of the teeth for the manufacture of prostheses.

The essence of the proposed method is shown in figure 1, figure 2, figure 3, figure 4, where figure 1 shows a model of the patient's jaw before treatment, figure 2 - visualization of aligners, figure 3 - plaster model at the stage preparation for prosthetics, figure 4 - the manufacture of a prosthesis. A description of the implementation of the invention is given below.

The patient is examined by interviewing, examining the face and mouth, photographing the patient, using additional diagnostic methods necessary for making a diagnosis and for forming a comprehensive treatment plan: OPTG (orthopantomography), TRG (teleradiography), CBCT (cone-beam computed tomography).

Then, when establishing the diagnosis of edentulous teeth and making a decision on treatment, impressions are taken with Wonflex A-silicone from the upper and lower jaws. The use of Wonflex A-silicone is most preferable, because it more accurately reflects the relief of the structures of the oral cavity.

In addition, supportive gum therapy is prescribed. To eliminate inflammation in the oral cavity, Viscid is used for rinsing 2 times a day after brushing teeth, a bath with decoctions of oak bark, chamomile flowers, sage 3-4 times a day, applications on the affected areas with sea buckthorn oil 2-3 times a day for 10 15 minutes, applications to the affected areas with an oil solution of retinol (vitamin A) 2-3 times a day for 10-15 minutes.

Subsequently, gypsum models are cast on the basis of the impressions;

- 3D scanning of models is carried out using plaster models of the jaws, a virtual treatment plan is drawn up, a kind of video film of the movement of teeth in space in accordance with a treatment plan drawn up by an orthodontist. The percentage of deviation of the teeth from their standard position is determined and the value of Kd is determined. Strain ratio values have been determined based on practical experience and patient observation.

The process of changing the position of the teeth is calculated step by step by the technician, determining the optimal path of movement of the teeth in such a way that all the teeth ultimately line up in an even dentition. The search for the optimal movement of teeth to create an even dentition is carried out on the model, by moving a group of teeth, using computer calculations, which increases the clarity and accuracy of calculations. Every 7 days for 21 days, the wall thickness of the mouth guard is increased by 25%. The teeth are forcibly aligned.

Next, the time required to wear aligners is determined using the formula

Te = 4.5 × Kd + Ko, where

Te is the time of wearing aligners,

Kо is the coefficient of the absence of teeth,

Kd - coefficient of deformation.

The formula and method are used for partial adentia. After the diagnosis of partial adentia has been established, the patient must be psychologically adjusted to the treatment process. As a rule, the question of the duration of treatment, the need for gum treatment and the time of wearing aligners are of interest. The psychological attitude plays an important role, the patient must be adjusted for a certain period of time during which he will undergo treatment. In addition, visiting a doctor too often for check-ups significantly reduces interest in treatment. Predicting the timing allows you to set a relaxed schedule for inspections.

The emotional and psychological attitude of the patient makes it possible to increase the effectiveness of edentulous treatment by predicting the timing of treatment and then preparing the oral cavity for prosthetics.

The process of treatment with aligners is less painful and comfortable for the patient, in contrast to the use of braces. The duration of wearing is negotiated at the beginning of treatment and the patient is psychologically adjusted for a certain period of time.

In addition, the correct planning of the period of time for edentulous treatment can reduce the likelihood of gingival atrophy (gradual reduction of the periodontal tissues), which also increases the effectiveness of treatment. The bone tissue should receive a chewing load. Pontiques in the form of missing teeth are installed in the trays. Thus, the effectiveness of edentulous treatment is increased.

The number of movements in a setup depends on how far to move a tooth and (or) a group of teeth to achieve the desired result, i.e. depends on the coefficient of deformation. All data on the clinical case are contained in electronic form, which allows access to information and visualization at any time. After agreeing with the patient about the details of the treatment plan, the doctor discusses the treatment plan with the patient.

- if necessary, according to indications, remove wisdom teeth, carry out caries treatment;

- a set of mouth guards is cast in the laboratory and sent to the doctor;

- the orthodontist puts the mouthguard in the oral cavity, if necessary fixes the activators on the teeth, teaches the patient how to wear the aligners;

- a patient - a child - wears one mouthguard for a week, and an adult - for two weeks, then changes to the next one, thereby there is a step-by-step movement of the teeth, normalizing the position of the tooth (s) in the patient's mouth.

The extreme aligner in the series has the form of the correct position of the teeth (standard). After the end of the treatment, we remove the activators from the surface of the tooth enamel by polishing;

As the alignment of the position of the teeth is achieved and the required space in the dentition is obtained, we take impressions with Wonflex A-silicone and make a partial removable denture with artificial teeth on clasps.

In order to prevent caries, we recommend the local use of the innovative remineralizing drug "RemarsGel", oral administration of the courses "Kaltsinov", vitamins "Pikovit".

To eliminate inflammation in the oral cavity, we use Viscid - a new rinse agent 2 times a day after brushing teeth, a bath with decoctions of oak bark, chamomile flowers, sage 3-4 times a day, applications on the affected areas with sea buckthorn oil 2-3 times a day for 10-15 minutes, applications to the affected areas with an oil solution of retinol (vitamin A) 2-3 times a day for 10-15 minutes.

The method differs in that aligners are an alternative to braces, elastopositioners. Manufacturing of a simpler and lighter apparatus does not require frequent repeated visits to the doctor, the apparatus is comfortable to use, elimination of premature contacts, shortening the time of orthodontic treatment, increasing its effectiveness and stability of the result. It is also important that age-related indications have been expanded: the beginning of treatment during the period of mixed bite. Orthodontic treatment is carried out using removable systems - aligners and partial removable dentures. A significant advantage is the aesthetic component, namely the imitation of the presence of all teeth by staining the vestibular surface of the aligner in the area of missing teeth in the color of the patient's enamel.

The method of orthodontic treatment of edentulous teeth (an example of clinical treatment is given) is illustrated in FIG. 1, which shows the model of the jaws of the patient M. before treatment, FIG. 2 depicts the aligner step used for the tooth movement process; FIG. 3, which presents a diagnostic model - the final result of the movement of teeth on aligners; Fig. 4 is a plaster model with a partial removable denture with artificial 1.2, 2.2 teeth.

A specific example of the use of this method of orthodontic treatment of edentulous teeth.

Patient M., 11 years old, complained of an ugly smile, the presence of gaps between the teeth, impaired pronunciation of sounds and biting off food. The patient smiled without opening her mouth. When communicating with others, the patient experienced self-doubt.

Anamnesis: she did not seek orthodontic help before.

Objectively: impaired closure of teeth in the anterior region, partial primary adentia of 1.2, 2.2 teeth, oral position of 1.1, 2.1 teeth, mesial displacement of 1.3, 2.3 teeth, vestibular 4.2, 4.1, 3.1, secondary adentia 8.4.

OPTG: Replaceable bite. The degree of formation of the roots of erupted teeth and primordia corresponds to age, partial primary adentia of 1.2, 2.2 teeth, oral position of 1.1, 2.1 teeth, mesial displacement of 1.3, 2.3 teeth, vestibular 4.2, 4.1, 3.1 secondary adentia 8.4.

Dental formula

After carrying out diagnostic studies, on the basis of clinical examination data, according to anthropometric measurements of jaw models, using an additional research method - OPTG, the patient was diagnosed with mixed bite, cross occlusion, partial primary adentia of 1.2, 2.2 teeth, oral position 1.1, 2.1 teeth, mesial displacement 1.3, 2.3 teeth, vestibular 4.2, 4.1, 3.1 teeth. The percentage of deformation (deviation from the normal position) was 10%.

Purpose of treatment: to expand the upper dentition, create space for teeth 1.2, 2.2 teeth (edentulous), eliminate the reverse incisor overlap, correct the occlusion of the dentition

Treatment plan:

1) orthodontic correction of the position of the teeth, creating space for missing teeth using aligners;

2) the imposition of a partial removable denture on the upper jaw with artificial 1.2, 2.2 teeth.

To prevent a cariogenic situation during orthodontic treatment, prophylactic procedures.

Orthodontic treatment progress:

Impressions were taken from the upper and lower jaws with Wonflex A-silicone, models of the jaws were cast.

3D scanning of the models was carried out, a virtual treatment plan was drawn up, in accordance with the treatment plan drawn up by an orthodontist.

The technician calculates the process of changing the position of the teeth step by step, determines the optimal path of movement of the teeth in such a way that all the teeth as a result line up in an even dentition. The search for the optimal movement of the teeth to create an even dentition is carried out on the model using computer calculations.

The estimated period of wearing the aligners was: 5 months.

A virtual setup of orthodontic treatment on aligners was created, the treatment plan was discussed and agreed with the patient.

The doctor places an order to the laboratory.

A set of mouth guards is cast in the laboratory and sent to the doctor.

The orthodontist fits the mouthguard in the oral cavity, the patient is given recommendations on how to care for the device, instructions for wearing aligners. The patient wears one mouthguard 22 hours a day, excluding meals and brushing the teeth and apparatus for a week, then changes to the next one to move the teeth step by step until a place in the dentition for 1.2, 2.2 teeth is formed and the correct position of the teeth in the patient's mouth is normalized. An important advantage is the possibility of installing pontiques in the trays in the form of missing teeth, painted in the color of the enamel. The duration of treatment with aligners is on average 4.5 months, the number of aligners on the upper jaw is 18 pcs., On the lower jaw - 9 pcs.

After achieving the stated goals, a partial removable denture was made for the upper jaw in order to close the cosmetic defect.

Upon reaching the required place in the dentition, impressions were taken with Wonflex A-silicone and a partial removable denture with artificial 1.2, 2.2 teeth was made. The patient was given recommendations for the care of the prosthesis, according to the rules of nutrition. The prosthesis is recommended to be worn around the clock, removed for hygiene procedures.

In order to prevent caries, we recommend the local use of the innovative remineralizing drug "RemarsGel", oral administration of the courses "Kaltsinov", vitamins "Pikovit".

To eliminate inflammation in the oral cavity, we use Viscid for rinsing 2 times a day after brushing our teeth, baths with decoctions of oak bark, chamomile flowers, sage 3-4 times a day, applications on the affected areas with sea buckthorn oil 2-3 times a day for 10 15 minutes, applications to the affected areas with an oil solution of retinol (vitamin A) 2-3 times a day for 10-15 minutes.

In dynamics - control over the eruption of third molars.

The use of the claimed orthodontic device has reduced the number of refusals in the treatment of the above anomalies and significantly reduced the number of complications inherent in the already known devices.

Claims (6)

A method of orthodontic treatment of edentulous teeth, including visual examination of the patient, collection of complaints, anamnesis, examination of the oral cavity, examination and exclusion of carious cavities, analysis of panoramic images, taking impressions from the upper and lower jaws, casting plaster models and planning the treatment of edentulous teeth, differing in that, that impressions are taken using Vonflex A-silicone, and the planning of edentulous treatment is carried out by 3-D modeling of plaster casts, while determining the percentage of deviation of the teeth from their standard position and planning the process of changing the position of the teeth and the time of wearing aligners according to the formula Te = 4.5 × Kd + Ko, where Te is the time of wearing aligners, Kо is the coefficient of the absence of teeth, Kd - coefficient of deformation, where the coefficient of deformation is determined when the position of the tooth deviates from the norm up to 10% - 1.1, deviation up to 20% - 1.5, deviation up to 40% - 3.3, over - 4, the coefficient of missing teeth in the absence of two or more teeth between teeth that are corrected, set - 0.65, in the absence of one tooth - 0, every 7 days for 21 days, increase the wall thickness of the mouth guard by 25%, then install pontic in the form of missing teeth in the mouth guard, after the end of treatment, impressions are taken again and plaster models are made, which are compared by 3-D modeling and determine the error in restoring the position of the teeth for the manufacture of prostheses.

Images