RU2810390C1 - Method of sequential distalization of teeth with mesial displacement of lateral group of teeth - Google Patents

Abstract

FIELD: medicine; dentistry; orthodontics.

SUBSTANCE: invention is intended for use in distalizing a group of teeth and maintaining their desired position. Models of the jaws are obtained. A sketch of an ALF device is made on jaw models, providing a volume of distalization of the lateral group of teeth by more than 3 mm. An ALF device is made with a frame made of wire with a cross-section of 0.8 mm and with active elements made of wire with a cross-section of 0.5–0.7 mm. Then the ALF device is fixed in the oral cavity and activated once every two weeks. The second and first molars are sequentially distalized, thus unloading the anterior section and making it possible to simultaneously open the space in the anterior sector. After achieving the desired amount of distalization, the final correction of the position of the teeth is performed using one or a series of thermoformed aligners.

EFFECT: through the use of a device of a certain design the method makes it possible to increase the effectiveness of treatment, does not complicate oral hygiene, and reduces treatment time.

1 cl, 2 ex

Description

The invention relates to the field of medicine, namely dentistry, orthodontics, i.e. obtaining or maintaining the desired position of teeth, such as straightening, leveling, adjusting, separating, or correcting malocclusions.

For distalization of molars, we propose the following algorithm of actions, such as the use of an ALF device and aligners.

A patient who needs distalization of the lateral group of teeth is fixed with an ALF-device (Advanced Lightwire Functionals) - an orthodontic device consisting of a group of wires welded in a special way with light strength - Elgiloy yellow 14" 022 0.559 mm. This device is based on the principles of cranial osteopathy and eliminates bite pathology at the level of its cause - a violation of the natural position of the cranial bones of the skull.

The second and first molars are sequentially distalized, thus unloading the anterior section and making it possible to simultaneously open the space in the anterior sector, and, consequently, the initial stage of correcting the position of the teeth. After achieving the desired amount of distalization, the final correction of the position of the teeth is carried out using one or a series of thermoformed aligners.

There are known methods for distalizing teeth using removable palatal plates with a screw, miniscrews and a brace system (full or partial), aligners.

The widely used Schwartz apparatus with a sectoral cut and a screw for distalization of the lateral group of teeth is known. This device is removable and ensures the maintenance of satisfactory oral hygiene, which is a plus. It has a number of disadvantages, such as: patient cooperation is required (the device is removable); effective in mixed dentition, voluminous, which makes it difficult to get used to, causes hypersalivation, unusual position of the tongue, and distorts speech.

There are known examples of distalization of molars using bracket systems (full and partial) and miniscrews [patent RU 2740248 C1 “Method of distalization of molars and premolars”, patent holder V.N. Tishchenko]; [patent RU 2561892 C1 “Method for distalization of the lateral group of teeth of the upper jaw”, patent holders Popov S.A., Kosheleva Yu.V.], [patent: RU 134423 U1 “Device for distal movement of permanent molars”, patent holders: Vasilyeva M.B. ., Kosyreva T.F.]; [patent RU 2641000 C1 “Method of moving teeth in patients with distal occlusion”, patent holder A.A. Dikova]; [patent RU 2181574 C1 “Orthodontic apparatus for distalization of teeth with terminal defects of the dentition”, patent holders S.V. Chernenko, N.N. Soboleva]; [patent RU 2144335 C1 “Orthodontic device”, patent holder Alimova M.Ya.]. This group of non-removable effective devices, which do not require the cooperation of patients directly during distalization of teeth, has a number of disadvantages: difficulty in oral hygiene, incompatibility of miniscrews with the patient’s bone tissue, their frequent loss, traumatization of the mucous membrane, loss of support (in the absence of combination with skeletal support), distal deviation of the molars, which prevails over the corpus movement of the tooth when using NITI opening springs, significantly increases the cost of treatment.

Aligners, as an alternative to the bracket system, are also often used for leveling and distalization of teeth; they have all the same advantages as removable plates, but unlike them, they are less voluminous, getting used to them is much faster, but they also require the cooperation of patients and their strength is not enough to ensure complete distalization of teeth, especially with terminal defects. The effective use of aligners for distalization of molars by 2-3 mm is known.

As a prototype, we chose a frame-spring device for sagittal-transversal movements of individual teeth or their groups, described in the monograph by P.D. Mailyan. [Patent RU2375010C2].

The device is a structure with springs and palatal supports. For corpus movement of teeth, lingual and/or buccal springs are added, sealed between the supporting frames of the lateral teeth. This device is described in combination with non-removable arch equipment to solve further tooth correction in the mesiodistal direction.

The disadvantage of this prototype is the lack of achieving normalization of the position of individual teeth and the use of additional fixed equipment for this, which creates risks of demineralization of teeth, complicates oral hygiene, is traumatic, and is not aesthetically pleasing.

The problem to which the invention is aimed is the need to develop a method that is devoid of the above disadvantages.

The technical result consists in increasing the efficiency of treatment, replacing fixed arc equipment with removable aligners, and reducing treatment time. This is achieved by first installing an ALF device on the patient, then using thermoformed aligners for the final leveling of the teeth.

To manufacture an ALF apparatus, it is necessary to obtain 2 high-quality models of jaws made of supergypsum for manufacturing and fitting. A sketch of the future design is drawn with a pencil. Using a straight tip with a ball-shaped bur of the smallest diameter, we make holes in the area of the interdental papillae between the 1st and 2nd molars, as well as 1st molars and 2nd premolars for subsequent fixation of the elements of the apparatus on the model.

We use wire with a cross-section of 0.5-0.7 mm for active elements; 0.8 mm for the apparatus frame. We bend the necessary elements and perform soldering. Attachments (special fastenings-locks on the teeth) made of light-curing composite material fix the ALF device in the oral cavity. Depending on the form of the attachment, the device can be fixed in the oral cavity so that either the device is non-removable (only the doctor at the appointment will remove it for activation), or removable - the patient can remove it while eating to perform oral hygiene.

In parallel with the distalization of teeth, it is possible to correct the shape and opening of other parts of the dental arch, in contrast to the isolated use of aligners. Plus, the volume of distalization using the ALF device can be 3 mm or more. On aligners, the maximum allowable volume of distalization is 2-3 mm. Sandra Tai's guide to working with clear aligners talks about the timing of distalization. A result of 2 mm is achieved in 40 weeks.

After distalization on the ALF, which allows the molar to be moved by 4 mm in 13 weeks, a system of aligners or one thermoformable aligner is connected for final leveling of the dentition or for further distalization after creating the end support.

Devices in the oral cavity are practically invisible to strangers either when talking or smiling - the aesthetics of the face and smile do not suffer, which is comfortable for the patient.

Clinical examples

Example 1.

Patient S. applied to the dental clinic of Omsk State Medical University with complaints about uneven teeth and a lack of desire to install braces.

No orthodontic treatment had been performed before.

The diagnostics showed the need to distalize the 1st segment by 4 mm, which cannot be done with aligners without an end support.

Patient before treatment: narrowing of the upper dentition, vestibular position of tooth 1.2, mesial displacement 1.3, 1.4, 1.5, 1.6, 1.7 by 4 mm.

The ALF device was manufactured. Fixed in the oral cavity using photopolymer locks. Activation periods: 1 time every 2 weeks. After 3 months, tooth 1.7 by 4 mm was distalized. At the same time, the anterior sector opened and the position of tooth 1.2 improved. The symmetry of the arrangement of teeth 1.7-2.7, 1.6-2.6 has been restored.

Next, the patient undergoes treatment with aligners.

Example 2.

Patient A. applied to the dental clinic of Omsk State Medical University with complaints of dysfunction of the temporomandibular joint, crowding of teeth in the anterior segment of the upper dentition. She expressed a desire for treatment without braces.

No orthodontic treatment had been performed before.

The diagnostics showed the need for distalization of the 1st segment by 4.5 mm.

Patient before treatment: narrowing of the upper dentition, vestibular position, rotation along the axis of the tooth 1.2, distal displacement 1.1, mesial displacement 1.3, 1.4, 1.5, 1.6, 1.7.

First stage: ALF device is manufactured. Fixed in the oral cavity using photopolymer locks. Activation periods are once every 2 weeks.

After 1 month, tooth 1.7 by 2 mm was distalized. After 2 months, tooth 1.7 was distalized by 4.4 mm, tooth 1.6 by 2 mm. At the same time, the anterior sector opened and the position of tooth 1.2 improved. Distalization of teeth 1.4, 1.5 and final alignment of teeth is carried out using aligners.

Thus, this method of sequential distalization of teeth with mesial displacement of the lateral group of teeth, including preliminary installation of an ALF device, distalization of molars, characterized in that the distalization distance is chosen by more than 3 mm, while simultaneously adjusting the width in other parts of the dentition, with the final leveling of teeth using a given number of thermoformed aligners, solves the problem we set: it provides the possibility of reducing treatment time, less inconvenience when wearing, faster adaptation, a high level of hygiene and aesthetics and, importantly, a distalization volume of 3 mm or more and efficiency in distalization of teeth even in the presence of terminal defects.

Claims (1)

A method for sequential distalization of teeth with mesial displacement of the lateral group of teeth, including making jaw models, making a sketch of an ALF device on the jaw models, providing a volume of distalization of the lateral group of teeth by more than 3 mm, and making an ALF device with a wire frame with a cross-section of 0.8 mm and with active elements made of wire with a cross-section of 0.5-0.7 mm, then the ALF device is fixed in the oral cavity and activated once every two weeks, after distalization of the lateral group of teeth, and thermoformed aligners are used for final leveling of the dentition.