Bioreactor i. y. of maycoba and f. j. khoroshilkina for the treatment of distal deep bite

 

(57) Abstract:

The invention relates to medicine and can be used in dentistry for the treatment of distal deep bite. Biorefractory for the treatment of distal deep bite contains the basis hooded on the incisors of the lower calucci, sphenopalatine clasp, the locking hooks and power elements, however, he has two premaxillary springs, lower arms which are fixed in the hood, shoulders and the upper - retracement the space for the incisors of the upper jaw, the power elements mounted on the base. 3 Il.

The invention relates to medicine and can be used in dentistry for the treatment of distal deep bite with proposition cutters and vestibulodynia canines of the upper jaw.

Currently distal deep bite is one of the main problems of orthodontics, as is quite often (up to 23) and refers to the number of subcluster-facial anomalies, prone to frequent relapses. He appears to 13.6 preschool and school children, which is 31.3 of the total number of malocclusion. Dysfunction subcluster-facial system observed in 69 patients with this anomaly and their percentage increases from Irina, 1987). The clinical picture distal deep bite has typical characteristics: characteristic vestibular deviation upper front teeth with tremani or without, the presence of sagittal slits between the incisors. The gnashing of teeth is usually a deep cutting overlap. Often the canines of the upper jaw are vestibulopathy. Facial characteristics specified malocclusion is also characterized by impaired the overall aesthetics of the face due to its convexity, often shortened lower part of the face, upper teeth are positioned on the lower lip, which turned forward, her lips are not closed. This anomaly bite causes the center of gravity of the head is often in antirealism position relative to the line connecting the center of the shoulder-shoulder Arti - in the course of circulation, hips, knees and feet, which is absent in normal development the kitty facial Department of the skull and musculoskeletal system. Such change in position leads to impaired posture. Load increases attributable to the neck muscles. Such patients often have scoliosis. This creates conditions for constrained development of the thorax and lung function. Distal deep bite has a negative impact on respiratory function. Boobsthe reduction of the nasal cavities, and breach of pneumatization pneumatic sinuses of the skull.

It is known that the upper respiratory tract, pneumatization the bones of the skull and light form from a functional point of view a whole. Violation of such functional integrity is characterized as a weakness of the lungs and is called sensorinformatie. While in the body accumulate oxidation products, including carbon dioxide. When x-ray examination of patients with distal deep bite there is a violation of architectonics pulmonary pattern: diffuse enhancement, enrichment and localized depletion. This is due to peribronchial-perivascular infiltration and manifestations of emphysema that a number of patients further confirmed by the decrease in lung-heart ratio. In children older than 12 years of change is expressed most clearly. In some cases, such violations in accordance with these clinical observations can be regarded as a manifestation of chronic pneumonia (Guide to orthodontics/edited by Professor F. J. Khoroshilkina. M. Medicine, 1982).

Treatment of distal deep bite includes:

achieving neutral ratio dentitions;

the elimination of proposition cutters and vestibuloplasty fangs and the so-called "posterior rotation of the mandible";

normalization functions subcluster-facial system;

improving facial aesthetics.

In orthodontic practice for the treatment of said pathology applied vestibular plates (Karitza, James, Nuala, Kraus, Songer and others), propulsor (Moleman), maxillary plate with Nakonechny platform and an inclined plane to the incisors of the lower jaw, activators (Antezana Couple, Thatta, Klammt, Harold Woodside and others), bionator (Balters, Janson, Khoroshilkina of Makarevich), the shapers of the bite (Bimler), open elastic activators (Klamt and others), cybernator (SATA), kineton (Stockfish), regulators function (Frenkel).

Currently, much attention is paid to the search for new structures of orthodontic appliances, which synthesized the best quality mechanical and functional treatment methods subcluster-facial anomalies. Typically, in such devices use the power of elastic deformation of orthodontic wire, which produce structural elements.

The known device for the treatment of distal occlusion consists of a base with overlays on the lateral teeth of the upper jaw, the hood on the upper and lower front teeth and abneget to the incisors of the upper jaw. In the middle of the crown of fangs her bend down, bend the hooks, after which the ends of the arc are sent back and at the level of the anterior third of the crowns 1st permanent molars up; at the ends of the arc bend the wire loop, moving the brackets, made of wire with a diameter of 0.8 mm, separated from the vestibular surface 4's, 5's and 6's teeth in the upper jaw of 2.0 mm, the ends of the brackets is fixed to the plastic base between 3-mi and 4-mi teeth, and behind 6 teeth. 1st permanent molars of the lower jaw do "rakoobraznye" spring wire diameter of 0.8 mm with hooks, bent in the distal direction, densely covering the distal surface of their crowns and perelivayuschiesya on their vestibular surface. Between hooks on the arc and "rakoobraznyh" the springs pull the rubber ring. Due to their reduction in transmit pressure nasobny vestibular arc to the front teeth of the upper jaw, retrose which is accelerated. When this occurs unimpeded sliding of the wire loops vestibular arc in brackets. You can combine the instrumental treatment with extraction of certain teeth for orthodontic reasons.

Positive as specified ustroystv is accelerated access the public slide on the brackets, available in the lateral parts of the apparatus. However, the drawback is the lack of opportunities to actively reach dentoalveolar shortening in the area of the incisors of the upper jaw, because after palatal deviation depth cutting overlap increases, which exacerbates the already existing deep bite; the design of the device does not provide elements to correct vestibuloplasty canines of the upper jaw, which is often Strachowice symptom when the distal deep bite; if the angles of inclination of the incisors of the upper jaw to the ground plane of the upper jaw small, i.e. there is a significant proposition, when applying elastic traction is not excluded slippage vestibular arc on the vestibular surfaces of the incisors of the upper jaw towards deshevym papilla, what causes them injury.

Known orthodontic device for the treatment of distal occlusion of the dentition has a plastic sphenopalatine basis on the upper jaw, sphenopalatine wire (diameter 1.0 mm) clasp, clasps Adams on the teeth and vestibular wire arc wears it with vinyl chloride tube, extends into the U-shaped bends in the teeth area. The listed items used in other oppuritele with wax pattern with occlusive rollers, provides active wire element. He is a symmetrical arcuate wire (diameter 0.8 mm) design, sostayashego 2 one and a half coils of the spirals, curved in the vertical plane and located in the region of the teeth from the lingual side. Spiral moving in a straight stretch of curvilinear structures passing through the equator of the crowns of the lower posterior teeth from the lingual side. Straight arched structures are moving in 6 Polymetal, curved in the vertical plane to form the lingual surfaces of the lower anterior teeth. The beginning of the curved loops corresponds to the distal surface of the lower canines, the value of the loop width equal to mesiodistal size of the tooth, the upper edge of the loop 10 15aboutcurved backwards, acts over the cutting edges of the lower frontalini teeth. The free ends of arched structures are fixed (warialda) in the distal to the plastic base. The apparatus has Hubnik plastic bandage, fixed wire through the branches in a plastic base with two sides between the canine and premolar.

An advantage of the apparatus is the ability to transfer the load from the lower dentition on marinamichael balance between language and circular muscle of the mouth.

The disadvantage of this apparatus is the uniform load distribution on the front and side areas of the dentition, while in the treatment itself deep bite it is necessary to increase the chewing pressure or artificially created therapeutic pressure on the front teeth and weaken it to the side teeth. This is due to the fact that in the treatment of deep bite goal of orthodontic treatment is to achieve dentoalveolar shortening in the field of incisors in both jaws and on the contrary, dentoalveolar extension in the posterior teeth on both jaws. In addition, the design has elements to correct vestibuloplasty canines of the upper jaw. It is known that the fastest and the most beneficial therapeutic effect in the treatment of sagittal malocclusion, which is distal to the occlusion can be achieved by applying duclottni, i.e. block devices. Such design allows to stably fix the lower jaw in a position of constructive occlusion, which is very important during the whole period of treatment. Said apparatus is odnochastny design that does not provide this requirement.

The objective of the invention is azpeitia canines of the upper jaw, which allows you to achieve a neutral value dentitions, retroneu upper incisors, dentoalveolar shortening of the upper incisors, change the horizontal growth of the facial skeleton on the vertical, eliminating vestibuloplasty canines of the upper jaw prolonged action of springs apparatus, the growth of the apical basis of both jaws in the transverse plane, functional and aesthetic optimum in subcluster-facial area.

The essence of biorefractory of Mitsuba I. Y. and Khoroshilkina F. I for the treatment of distal deep bite is that it has an upper and lower part of the base is made of acrylic plastic, interconnected by lines occlusion without occlusal overlays on the lateral teeth, and the maxillary part consists of the right and left segments connected by a metal clasp to make the structure more comfortable without loss of rigidity and has a vestibular retraction arc for incisors of the upper jaw with two loops and two springs, two springs double rod with hooks for clico-upper jaw and actually two hooks for fixing the elastic thrust; and the lower part of the base and is described in the hood, the top of the shoulders in the retraction space for the incisors of the upper jaw, not connected with the segments of the maxillary part of the basis and actually two hooks for fixing the elastic traction.

Thus, the device is made of acrylic plastic and has an upper and lower part of the base which are interconnected along the line of occlusion without occlusal overlays on the lateral teeth, their spatial relationship is provided by the so-called constructive occlusion defined previously using the wax pattern on the upper jaw with occlusal wax plates on the lateral teeth. The maxillary part of the base of the apparatus consists of right and left segments connected by a palatal wire (cross-section 1 x 2 mm) ferrule to make the structure more comfortable without loss of rigidity. In the maxillary part of the basis fixed: vestibular wire (diameter of 0.6 or 0.8 mm depending on the degree of protrusion of the incisors of the upper jaw and the period of development subcluster-facial system) retraction arc, located on the vestibular surfaces of the teeth above the equator and having two single-turn loops, curved horizon is the interdental space of the teeth. Next arc is located on the distal surfaces of the teeth, bent up at an angle 90aboutand turns into spring, consisting of two dvuhvalkovyh spirals diameter 5.0 mm, curved anteriorly in the vertical plane. The height of the individual springs and due to the topography of the transition folds of the mucous membrane of the oral cavity. Anterior shoulders springs are moved through an arc, ensuring its stable fixation, bend angle 90aboutin nebem direction, are placed in the interproximal areas of the teeth and fixed (warialda) in the right and left segment of the maxillary part of the basis of the apparatus. With palatal side of the maxillary segments part of the basis of the apparatus in the region of the teeth are wire (diameter 0.6 mm) spring in the form of two dvuhvalkovyh spirals, curved in the horizontal plane. The diameter of the spirals of 3.5 mm One shoulder springs welded to the base unit, the other goes to the vestibular poverhnosti teeth through the spaces between the teeth. On the vestibular surfaces of the teeth of the upper jaw, the shoulder is a round-shaped retaining clamp and the distal edge of these teeth ends with a hook, curved downward in a vertical plane. The hook is for the PI is from the interdental space of the teeth, facing shoulders wire (diameter 0.8 mm) hooks, curved at an angle of 90aboutin the horizontal plane back, rising up above the gingival margin of the teeth and actually ending the round hooks (diameter 4.0 mm), curved in the vertical plane. The gap between the plane of the hooks of the vestibular surfaces of the teeth and the mucous membrane of the alveolar process of the maxilla is 2.0 to 3.0 mm Hooks are used for fixing the elastic traction.

The mandibular part of the basis of bioreactor has wire hooks, technical details of which corresponds to that for similar hooks of the maxillary part of the basis of the apparatus, except that the hooks of the mandibular part of the basis curve in a vertical plane down. In front there is a plastic hood on the incisors of the lower jaw, which covers them for 1/3 of the height of the crowns. In the vestibular space in the area of the teeth with a gap from the surface 2,0 3,0 mm, are vertically arranged premaxillary wire (diameter 0.8 mm) retraction spring in the form of two one and a half coils coils with a diameter of 4,5 5,0 mm Lower arms of the springs are welded into the hood of the mandibular part of the basis operationa Playground is connected only with the hood of the mandibular part of the basis of the apparatus by means of these springs. The vector force of the spring is directed in the vertical plane.

The positive effect associated with the use of the apparatus, is achieved due to the fact that:

the apparatus can be used around the clock, with the exception of meal times;

formed neutral ratio of teeth in occlusion;

retraction space for the incisors of the upper jaw allows you to actively influence them in a vertical plane and quickly achieve dentoalveolar shortening in the frontal section of the upper dental arch;

vertically arranged premaxillary retraction of the spring acting on the upper incisors in the vertical plane, creating a force vector of the action in the upward direction, and the vector of reaction forces in the downward direction, which changes the horizontal growth of the bones of the facial Department of the skull on the vertical due to the rotation of the lower jaw back;

by means of springs is eliminated vestibuloplasty canines of the upper jaw;

by means of springs vestibular retraction of the arc is eliminated proposition incisors of the upper jaw, and the technical parameters of the springs allow you to get orthodontic force corresponding to the second degree of strength by A. M. Schwarz;

primerally and location system of springs and hooks, located in the vestibular space of the oral cavity creates an artificial barrier between the teeth and the alveolar processes of the jaws with one hand and cheeks with the other hand that promotes the growth of apical basis of both jaws in the transverse plane;

morphological changes in subcluster-facial system that occurs under the action of the apparatus, contribute to the formation of new functions that, in General, creates a functional and aesthetic optimum in subcluster-facial area.

In Fig. 1 depicts bioreactor, view of the maxillary part of the basis of Fig. 2 is a view of the mandibular part of the basis of Fig.3 is the same, side view. The drawings are given the following designations: 1 vestibular retraction arc, 2 retractive space, 3 loop vestibular retraction arc 4 premaxillary retraction spring, 5 "open" shaped spring double rod with hook, 6 "closed" club-shaped spring vestibular retraction arc, 7 sphenopalatine clasp, 8 hook maxillary part of the base 9 of the maxillary part of the base apparatus 10 of the lower part of the base system, 11 hook mandibular part of the basis of the apparatus 12, the hood on the incisors of the lower jaw, 13 hook "accrediting deep bite is used as follows. After application of the apparatus on the upper jaw when closing the mouth of the patient is forced to raise the lower jaw forward, because its neutral position relative to the upper jaw, i.e. the constructive occlusion was defined previously using the wax pattern on the upper jaw with occlusal wax plates on the lateral teeth. While the incisors of the lower jaw fall between the hood and the basis of the mandibular part of the apparatus. The actual healing period is divided into 2 stages. At the 1st stage the aim of orthodontic treatment is the elimination of vestibulopathy permanent canines in the upper jaw. With this purpose, activate the "open" shaped spring double rod with hook (Fig.1-3, item 5). Due to the action of force by the elastic deformation of the springs occurs distal movement of teeth. For amplification and prolongation of the action of these springs can be put elastic traction between the hooks (Fig.3, item 8, 13). It must be emphasized that in the case of bioreactor in combination with the extraction of certain teeth for orthodontic reasons after the removal of teeth of the second upper permanent premolars ( teeth) can be moved forward due to physiological mesial migration. To prevent e is nuclear biological chemical (NBC retraction of the arc, curved at an angle of 90aboutin the horizontal plane in nebem direction, and tight approximal anterior surface of the teeth (Fig.1, 3, item 6), locking of the latter.

After elimination of vestibulopathy canines of the upper jaw proceed to the 2nd stage of treatment. The aim of orthodontic treatment at this stage is to fix the proposition incisors of the upper jaw with the simultaneous achievement of dentoalveolar shortening in these teeth. To do this, remove the plastic (prints the cutting edges of the incisors of the upper jaw) with the plane of the retraction of the pad in contact with the incisors of the upper jaw, and Polish it. Then activate the "closed" club-shaped spring vestibular retraction of the arc (Fig. 1, 3, item 6). As a result of activation of arc pressure on the vestibular surface of the incisors of the upper jaw, whose cutting edges slide freely upon retraction of the platform and moved distally. To ensure the prolongation of action of the springs and strengthen it, impose elastic traction between the hooks of the maxillary part of the basis of the apparatus (Fig.1, 3, item 8) and loops vestibular retraction of the arc (Fig. 1, 3, item 3). If the angles cont aatest slipping vestibular retraction arc up, i.e. deshevym papilla of these teeth, which leads to injury of the latter, it is necessary to impose elastic traction between the hooks of the mandibular part of the basis of the apparatus (Fig. 2, 3, item 11) and loops vestibular retraction of the arc (Fig.1, 3, item 3).

It is known that distal deviation crowns of incisors of the upper jaw contributes not only to eliminate the proposition of these teeth, but also increases the depth of the cutting floor. Thus, at the 2nd stage of treatment necessary to achieve dentoalveolar shortening in the field of these teeth. To do this, activate the premaxillary retraction spring (Fig. 1, 2, 3, position 4), hence causing the pressure force on the incisors of the upper jaw, aimed in the vertical plane. This force is transmitted to said teeth through retraction of the site (Fig.1, 3, position 2). This load causes dentoalveolar shortening in the area of the incisors of the upper jaw. The absence of the pressure force on the teeth in the lateral parts of the dental arches thanks razobscheniyu occlusion and absence of barriers to vertical movement (occlusal pads on the lateral teeth are missing) contributes to the extension of the lateral teeth towards each other, i.e. proschool feature of the apparatus is the ability to simultaneously affect the frontal group of teeth in two planes: sagittal and vertical. This significantly reduces the time of orthodontic treatment. In the traditional structures of orthodontic appliances influencing these teeth wired or only in one plane or in two, but not simultaneous, and sequential. In addition, the presence of the permanent force of the action, upward, and reaction forces directed downward, and their localization in the anterior dental arches leads to the "back rotation of the mandible. It helps to change the horizontal growth of the facial skeleton with distal deep bite on the vertical, which is desirable in the treatment specified malocclusion.

In biorefractory of Mitsuba I. Y. and Khoroshilkina F. I. for the treatment of distal deep bite combines the positive qualities of mechanical (potential and kinetic energy of springs and elastic rings) and functional (constructive occlusion; the location of the springs and hooks in the vestibular space in the form of a protective screen, which promotes the growth of apical basis of both jaws in the transverse plane) treatments subcluster-facial anomalies. You can combine the instrumental treatment with extraction of certain teeth on orthodontic the national and aesthetic optimum in subcluster-facial area.

The device was tested in a clinical setting in 7 patients: 3 patients treated in Regional children's dental clinic, Krasnodar and 4 patients in the clinic of the Department of orthodontics FSD vnpo "Dentistry" the USSR Ministry of health.

P R I m m e R. Patient J. 10 years and 4 months. (history N 81), appealed to the orthodontic clinic with complaints of violation of the functions of mastication, speech, and cosmetic deformity of the face. As a result of comprehensive examination (clinical and laboratory includes study of diagnostic models of the jaws, orthopantogram, side alertthingy head) diagnosis: distal, deep bite. The anomaly of the position of individual teeth: proposition teeth, vestibuloplasty teeth. Violation of the functions of chewing, swallowing and speech. Violation total facial aesthetics by reducing its lower third.

Treatment plan:

elimination of vestibulopathy teeth,

the elimination of proposition teeth.

the achievement of dentoalveolar shortening in the area of the teeth,

the achievement of dentoalveolar extension in the posterior teeth of the upper and lower jaws,

achieving neutral ratio of dentition in the sagittal plane,

achieving morphofunctional is both exhibitions jaws, cast diagnostic models and working models for making bioreactor. This visit is defined constructive occlusion. Jaw set in a neutral ratio in the sagittal plane with vertical separation in the lateral parts of the dental arches on 3,5 4,0 mm

October 23, 1987 prepisovan bioreactor. Recommended use of the apparatus the first 7 days no more than 5 hours a day.

October 30, 1987 at the control examination determined that the patient has mastered bioreactor. Activate the spring teeth to their distal movement and recommended: to apply elastic traction between the springs and hooks the maxillary part of the basis of the device and use the device at least 10 to 12 hours a day.

The patient visited the clinic 1 time in 30 days.

January 18, 1988 at the next control examination showed that the teeth are moved distally. Produced training retraction of the pad to the distal movement of the incisors of the upper jaw, activated spring vestibular retraction arc imposed elastic pull on loops vestibular retraction of the arc and the hooks of the upper and lower jaw part of the basis of the apparatus. Produced activation Michel clinic 1 time in 30 days.

may 27, 1988 at the control examination showed that the proposition teeth fixed. Commit cutting edges of the incisors of the upper jaw protecrion, activated premaxillary retraction spring. Recommended further use of the device at least 10 to 12 hours per day. In subsequent follow-up visits were made correction apparatus and activating premaxillary retraction springs.

September 13, 1988 at the control examination showed improvement in overall facial aesthetics. Removed the casts of both jaws, cast a diagnostic model of the jaws. In their study found that the ratio of dentition neutral. Between lateral teeth have pictureshorney contact. The incisors of the upper jaw overlap antagonists 1/3 the height of their crowns. The length of the anterior segment of the dental arch was 15,60 mm Sagittal gap between the incisors of the upper and lower jaw 2,00 mm Study side teleroentgenogram head obtained after the treatment apparatus, allowed to establish that the dentoalveolar height of the upper first permanent molars ( SpP) increased by 2.10 mm; lower first permanent molars ( Medo) increased by 1,90 mm Dentoalveolar visol 0.90 mm. The angle of inclination of the incisors of the upper jaw to the ground plane of the upper jaw ( SpP) increased by 4,70about. Were studied the angular sizes of the facial Department of the skull: SNA, SNB, ANB, NGoGn, NGoAr; the ratio of the linear dimensions: it is found that after the treatment, the position of the upper jaw relative to the plane of the anterior skull base (angle SNA) has not changed. The lower jaw is moved forward (SNB angle increased to 3.89about). Normalized relative positions of the jaws relative to each other in anteroposterior direction (angle ANB before treatment 7,63aboutafter treatment of 3.75about). Achieved posterior rotation of the mandible (angle NGoGn more angle NGoAr on 9,65about). The percentage of rear total height of the face to the front total height of the face () has changed from 67,14 to 61,68% indicating a vertical type growth of the facial Department of the skull. This is confirmed by the decrease in the values of top front elevation of the face to the front lower the height of the face () 0,19 (before treatment 0,86, after treatment of 0.67). Instrumental treatment is over.

September 3, 1991, the patient called on a control check to verify the long-term results of treatment. The patient's age 14 years 3 months. Klinicheskaya; the alignment of the upper and lower jaw is not broken; the ratio of the dentition neutral; depth cutting overlap within normal limits.

The findings testify to the effectiveness of orthodontic treatment.

Bioreactor for the treatment of distal deep bite, containing the basis hooded on the incisors of the lower jaw, sphenopalatine clasp, the locking hooks and power elements, characterized in that it has two premaxillary springs, lower arms which are fixed in the hood, and upper shoulders in the retraction space for the incisors of the upper jaw, the power elements mounted on the base and made in the form of vestibular retraction arc, retraction of the platform, premaxillary retraction springs associated with retraction platform, open-shaped spring with a double thrust with hook and closed clavate spring vestibular retraction of the arc, during this retraction space is connected with the upper shoulders premaxillary retraction springs, and a closed club-shaped spring with its ends fixed in the maxillary part of the basis.

 

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