A method of treating upper retrognathia in childhood and device for its implementation

 

(57) Abstract:

The invention relates to medicine, namely to dentistry. The essence of the proposal lies in the intersection of the vertical buttresses of the upper jaw, followed by a gradual movement of the upper dentition under the action of the screw rod. During the operation, boron without incision of the mucous membrane cross on the upper jaw nosolobnogo and zygomatic buttresses, the connection of the upper jaw with the pterygopalatine processes share osteotomes, the distraction of the upper dentition perform using duclottni mouthguards apparatus and a screw rod. For retention of therapeutic result for 10-12 months apply maxillary removable mouthguards apparatus and chin parse with extraoral elastic thrust on the lower jaw. The method reduces the invasiveness of the treatment. 2 c.p. f-crystals, 5 Il.

The invention relates to dentistry, namely the rehabilitation of maxillofacial surgery and orthopedics.

Severe functional and cosmetic impairment in patients with upper retrognathia make them uncommunicative and withdrawn, forming a further secondary neurotic disorders [1].

Rehabilitation of patients with ganeti conducted with this purpose operations and the complexity of the orthodontic correction at the second stage of treatment limit the possibility of treatment of such patients and make it almost impossible for him to exercise in children. 't find a proper solution to the problem of keeping the achieved therapeutic result, resulting in a rate of recurrence of the deformity varies from 10 to 80% [1,4].

In the proposed U. T. Tairov [5] the method of "closed total osteotomy of the upper jaw under endotracheal anesthesia perform incision of the mucous membrane of the frenulum of upper lip length 12-15 mm, skeletonize the front sections of the bottom of the nasal cavity and the maxillary bone in the pear-shaped holes. Make a vertical incision of the mucous membrane length 10 mm parallel kuloiliobra ridge and semilunar incision length 12-15 mm in the external part of the boundary of the hard and soft palate. Through these incisions provide / tunnelling and perepilivat wire saw of the upper jaw on each side. Osteotomes with two constraints intersect at the base of the columella. From palatal incision separates the tuberosity of the maxilla from the pterygoid processes using osteotome. In the zygomatic bone are introduced shorter spokes Kirchner for fixing the upper dentition in orthognathic ratio.

The operation is impossible without a proper surgeon training and special tools.

Prececisely and viability soft, as well as bone tissues. Moving fragment of the upper jaw with anterior dentition to achieve orthognathic ratio causes it to freeze almost no contact between the bone wound surfaces. This fact significantly complicates the process of consolidation of the jaw fragments.

Hold the upper dentition in displaced anteriorly position U. T. Tairov spent within 1.5-2 months extraoral device with a support for the upper body and torso.

The bulkiness and complexity of the design makes use of such a device in adult patients and excludes its use in children.

The aim of the study was to develop low-impact and effective method of removing the upper retrognathia and device for its implementation in patients in childhood.

The essence of the proposed method of treatment of patients in childhood is to conduct intermittent osteotomy crossing boron only vertical buttresses on line fracture Faure 1, and the subsequent gradual movement of the upper anterior dentition using the developed device.

JV is Elasti without incision of the mucous membrane of thin fissure Burr pierce soft tissue transition fold over the top of the root of the canine and cross nosolobnogo buttress 5 mm above the bottom of the nasal passage. The length of the osteotomy line from the edge of the pear-shaped holes in a lateral direction is 10 mm, Pierce the soft tissue above the apex of the second premolar and cross scholoarly crest in the posterior direction to a length of 10 mm, the Upper jaw is separated from the pterygopalatine branches osteotomes that pasalaqua injected between these anatomical structures at a depth of 5 mm (Fig. 1).

The distraction of the upper dentition is carried out after intermittent osteotomy after 7-10 days, when post-traumatic reconstruction of bone tissue enhances the inflammatory process in the damage zone [6].

Moving the upper anterior dentition by using the tooth-naddesnevyh trays, made of basic plastic "Ftoraks" by hot polymerization. In mouthguard in advance enter the elements of the orthodontic device. The proposed device includes 4 metal coil, 2 brackets with screw thread, 2 tubes with hooks and 2 nuts (Fig. 2). The metal coil is composed of a body (A) length 5.0 mm, with a diameter of 2.0 mm and two round shoulders (B) with a diameter of 5.0 mm, a thickness of 0.5 mm Metal coils are vestibular sides to a depth of 2 mm in the upper mouthguard eticheskoi wire with a diameter of 1,8 mm One end has a loop-like bend to capture the speaker body coil, the other end is cut a screw thread with a pitch of 0.3 mm at a length of 12.0 mm Metal tube (G) with a length of 8.0 mm and an inner diameter of 2.0 mm has one end soldered hook wire diameter of 1.2 mm

Tube with clothes hook on the bracket and is secured by a nut (E). Then the brackets are connected mouthguard, prepisovanie on the upper and lower dentitions (Fig. 3). When this loop-like bend in the bracket fixed on the protruding part of the upper coil, and a hook with a tube over the protruding coil on the bottom of the Kappa. Using nuts tighten sliding the clips tube until the patient's feelings of pressure on the upper teeth. Horizontally directed force created by the apparatus by means of a screw thrust, ensures the retention of mouthguards on dental rows and eliminates the need for additional fixation.

Activating apparatus is conducted daily by turning the nut one-half turn of the thread, which corresponds to 0.15 mm When retroposition upper jaw within 5-8 mm orthognathic ratio dentitions of patients achieved within 30-45 days.

For retention lichenological slingshot the head cap and extraoral elastic thrust on the lower jaw. The duration of the retention period is 10-12 months.

The use of the present invention helps to reduce the invasiveness of surgical intervention, with little blood loss, and to achieve movement of the upper anterior dentition without resorting to complete its separation from the body of the maxilla.

The results of the observations confirm the effectiveness of the proposed remedy the upper retrognathia and suggest the possibility of carrying out such treatment in childhood (Fig. 4, 5).

Sources of information

1. Bezrukov C. M. Clinic, diagnostics and treatment of congenital deformities of the Central zone of the facial skeleton: author. dis.Dr. med. Sciences. -M., 1981.-30 C.

2. Gunko Century. And. Modern principles of diagnosis and treatment of patients with concomitant deformities. // Modern principles of reconstructive surgery of the face and neck in the rehabilitation of patients with congenital and acquired pathology / Tr. Crid. - M., 1987. , 13.-C. 169-171.

3. Kalamkarov H. A. , Rabuchin N. A., Bezrukov C. M. Deformation of the facial skull.- M.: Medicine, 1981. - 239 S.

4. Nedeljkovica and retrognathia. // Kuban scientific medical journal. - 1993. -N 1. - S. 16-18.

5. Tairov U. T. Methods of treatment of patients with upper retrognathia after injury by applying dosed extraoral distraction device. // Dentistry. - 1987. - T. 66, N 1.-S. 33 - 35.

6. Vodolatsky M. P., Christoforo Y. D. Treatment of dentofacial deformities pupils formed with a bite. Method recommendations. - Stavropol, 1987. - 12C.

1. A method of treating upper retrognathia in childhood, consisting in the gradual move toward the front of the upper dentition after surgery, characterized by the intersection of the upper jaw nosolobnogo, zygomatic buttresses, faulty connection of the upper jaw with the pterygopalatine processes, putting in 7 - 10 days after surgery, plastic periodontal apparatus, the daily movement of the upper dentition 0.15 mm, achievement orthognathic ratio dentitions after 30 - 45 days, the retention of therapeutic result for 10 - 12 months removable Kappa-type boxer bus in combination with a chin sling, the head cap and extraoral elastic thrust on the lower jaw.

2. Device for the treatment of upper retrognathia in children who are four metal coil, placed in the side sections of the trays, two brackets with a screw thread, two nuts and two metal tubes, each of which is soldered on the hook for fixing for the protruding part of the lower coil, and each tube is made with dressing on the bracket and the fixing nut, and each bracket has at one end a looped bend to commit for the protruding part of the upper coil.

 

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