RU2818138C1 - Method of dynamic observation of changes in defects of oral mucosa by optical impression - Google Patents

Abstract

FIELD: medicine; dentistry.

SUBSTABCE: method relates to medicine, namely dentistry, and can be used for dynamic monitoring of changes in defects of the oral mucosa by optical impression. A number of scans of the elements of the lesion of the mucous membrane of the oral cavity and the red border of the lips with surrounding anatomical formations are carried out. After that, the data is saved and conservative treatment is prescribed. After the end of treatment, a repeat scan of the affected area is performed and scans are superimposed on each other with measurement of changes in the boundaries of the defect, mm.

EFFECT: method provides an atraumatic determination of the lesion area of the oral mucosa and the red border of the lips, as well as the ability to monitor changes in the area of defects, changes in their location due to the use of an intraoral scanner.

1 cl, 3 dwg, 1 tbl, 1 ex

Description

The invention relates to medicine, in particular to dentistry, and can be used in oncology for neoplasms of the oral mucosa.

There are no full-fledged analogues of the developed method for measuring changes in defects in the oral mucosa; there are methods that perform a similar function: measuring the approximate surface area of the affected area.

1) Method for determining the area of damage to the mucous membrane of the oral cavity and the red border of the lips using silicone impression materials (RF Patent No. 2404703 dated October 27, 2010 “Method for determining the area of damage to the mucous membrane of the oral cavity and the red border of the lips using silicone impression materials” (Nuriyeva N.S.)) - the area of the lesion is determined by outlining the defects with a chemical pencil and applying silicone impression material to them with further measurement of the defect using graph paper. Disadvantages: depends on the operator’s skills, inaccuracy, complexity of execution, duration of the procedure.

2) A device for determining the area of inflammatory changes in the oral mucosa (RF Patent No. 160599 dated March 27, 2016 “Device for determining the area of inflammatory changes in the oral mucosa” (R.V. Komolov))

The device consists of a palette cut to the shape of half of the dentition and a control and measuring plate. The palette is made of dense polymer transparent film, has fields for writing, has fields for writing, and is divided into central and peripheral measuring sectors using perforated longitudinal arc-shaped lines. The control and measuring plate is a cover for the palette, consisting of a transparent and scale-coordinate part, interconnected along the entire perimeter, except for the outer edge.

The disadvantage of this method is the need for a measuring device in the clinic, as well as low accuracy when working with defects of complex configuration.

Unlike previously described methods, the invention will allow dynamic monitoring of changes in the area of the defect in the oral mucosa, changes in the configuration and location of the affected area, which will allow assessing the effectiveness of conservative treatment, as well as the need for surgical intervention.

The method is based on the need to dynamically monitor lesions of the oral mucosa to exclude the possibility of their malignancy, as well as to objectively assess the effectiveness of the treatment.

This problem is solved by the fact that the method uses a sequence of actions to measure changes in the area of lesions in the oral mucosa. To carry out the method, a three-dimensional impression of the oral cavity is obtained using an intraoral scanner (a device used in planning and implementing orthopedic and surgical treatment of diseases of the oral cavity). It should be noted that the presence of a scanner in the clinic conducting the measurement is not required; the file can be obtained from a third party, but it must meet the following requirements. When working with a scanner that has a color scanning function (the resulting file format is .ply), no additional manipulations are required. For a scanner with a black-and-white surface display (received file format, stl), the defect is outlined with a chemical pencil to improve visualization. Requirements for the surface being examined: the size of the defect should not be less than 1*1 mm; in lesions with mild hyperemia and hyperkeratinization, they should be pre-painted with an indicator to improve visualization of the boundaries. A digital impression for working with the affected area must reflect not only the defect, but also the surrounding tissues (when working with the gum, palate, transitional fold, it is necessary to capture retention points, such as teeth, palatal folds; when working with flat surfaces - cheeks, lips - must be involved in at least 5 mm of surrounding tissue). The number of patient visits to the clinic (hospital, dispensary) for dynamic observation is at least 2. After treatment (the time period for dynamic tracking is determined for each disease individually, in accordance with Clinical Guidelines for the treatment of the disease being studied), the patient is invited for a repeat scan. The resulting files are loaded into a standard program for working with scans of the oral cavity used in dental laboratories (EXOCAD), where they are superimposed on each other with a change in the transparency of the control impression, after which the change in the size and configuration of the defect in mm from the edge of the original defect is assessed to the edge of the defect on the control scan and a decision is made on further treatment tactics.

Requirements for implementing the method: availability in the clinic of a computer with an installed operating system, the ability to obtain a digital impression of the patient’s oral cavity.

Unlike indirect analogues, the method allows you to objectively assess changes in the area of damage to the oral mucosa in square millimeters, requires minimal time and does not depend on the operator’s skill. In the proposed method of dynamic monitoring of changes in defects of the oral mucosa using an optical impression, digital technologies are used for the first time.

Clinical case of application of the technique.

Patient, 32 years old, complains of a feeling of tightness and roughness of the mucous membrane of the cheek on the right, which has been bothering him for about 2 weeks.

Objectively: on the mucous membrane in the projection of the roots of teeth 4.6, 4.7 and the transitional fold there is a chalky-colored plaque with clear boundaries. The element rises slightly above the level of the mucous membrane, on an unchanged base. Has a rough surface. The size of the defect is 15*20 mm. During luminescence examination, there is a low-intensity glow with a yellowish tint with a transition to violet. Oral hygiene index 0.9. Teeth 4.6, 4.7 - fillings without breaking the marginal seal, percussion, thermal diagnostics are painless.

Life history: Denies general somatic diseases, allergic reactions, bad habits. Notes periodic sore throat and sore throat, associates it with work (teacher), regularly sucks cough drops (up to 5 pieces per day).

Diagnosis: verrucous leukoplakia.

Treatment:

An intraoral scan was performed to assess the dynamics after conservative treatment was prescribed (Fig. 1.)

• It is recommended to consult a therapist about a sore throat and avoid sucking on lozenges.

• A soft toothbrush and hypoallergenic toothpaste are prescribed.

• A diet that excludes irritating foods: sour, spicy, hot.

• Antiseptic treatment of the defect area - chlorhexidine 0.05% twice a day - 1 week.

• Applying vitamins A and E topically to the lesion at night - 1 week.

• A follow-up examination after 1 week is recommended.

Second visit in 1 week. No complaints.

Objectively: on the mucous membrane in the projection of the roots of teeth 4.6, 4.7 there is a chalky-colored plaque with clear boundaries. The element rises slightly above the level of the mucous membrane, on an unchanged base. Has a rough surface. The size of the defect is 8*2 mm. During luminescence examination, there is a low-intensity glow with a yellowish tint with a transition to violet. A repeat intraoral scan was performed (Fig. 2).

By comparing scans in the standard EXOCAD program (Fig. 3), we can conclude that the size of the defect decreased by 7 mm in the horizontal direction and 18 mm. According to the table presented in the Clinical Guidelines for the Treatment of Leukoplakia (Table 1), this outcome is a sign of stabilization of the process, which eliminates the need for surgical treatment, allowing the patient to remain under observation with a follow-up examination once every six months.

Brief description of drawings:

Fig 1. Scan of the mucous membrane at the initial appointment.

Fig 2. Scan of the mucous membrane after 1 week of conservative treatment.

Fig 3. Overlay of scans with changing image density in the standard program.

Table 1. Clinical recommendations (treatment protocols) for the diagnosis of leukoplakia. Patient management tactics depending on the outcome of conservative treatment.

Claims (1)

A method for dynamic monitoring of changes in defects of the oral mucosa using an optical impression, characterized in that a series of scans of lesions of the oral mucosa and the red border of the lips with surrounding anatomical formations are carried out, after which the data is saved, conservative treatment is prescribed, after which a second treatment is carried out scanning the affected area and superimposing the scans on each other with measuring changes in the boundaries of the defect, mm; The results obtained are correlated with clinical recommendations to determine further treatment tactics.