Method for diagnosis of demineralization of the enamel of permanent teeth

 

The invention relates to medicine and can be used in electromedical diagnostics initial stage of demineralization of the enamel of permanent teeth with fixed orthodontic appliances. According to the method determines the level of functional resistance of hard tissues of teeth to caries, diagnose the demineralization of the enamel of permanent teeth with braces on the value of the current passing through the hard tissues of the tooth. The finer points chosen on the vestibular surface of the tooth at the cervical area point 1, near the cutting edge of the tooth point 2 and the lateral edge of the bracket point 3. After a month diagnose the initial stage of demineralization: the teeth of the upper jaw with a medium level of resistance at the current point 1 from 0.05 to 0.07 µa at 2 - from 0.02 to 0.04 μa, at the point 3 is from 0.02 to 0.04 μa, and low resistance when current at point 1 is from 0.18 to 0.22 μa, at the point 2 from 0,071 to 0,089 µa, at point 3 is from 0.12 to 0.16 μa; for the teeth of the lower jaw with a medium level of resistance when current at point 1 from 0,113 up to 0.127 μa, at the point 2 from 0,047 to 0,053 µa, at point 3 from 0,065 to 0.12 μa, and low resistance when current at point 1 from 0.17 to 0.25 μa, at the point 2 from 0.1 to 0.12 μa, at the point 3 from 0.17 to 0,the roadways orthodontic apparatus by detecting pre-clinical manifestations of demineralization of hard tooth tissues taking into account the functional resistance of hard tissues of teeth to decay. 1 Il.

The invention relates to medicine, namely to electromedical diagnostics, and can be used to diagnose the initial stage of demineralization of the enamel of permanent teeth that are fixed orthodontic appliances.

A known method for the diagnosis of caries, according to which areas with impaired permeability of enamel paint 2% solution of methylene blue (axamit L. A. Diagnostics of early demineralization of enamel staining method / Results clinical and experimental research, M., 1973, S. 4-5).

Identified as a result of a patent search is a known method for the diagnosis of demineralization of the hard tissues of the permanent teeth used in dentistry. The disadvantage of this method is that it does not give quantitative characteristics of the carious process. Furthermore, the method does not allow you to diagnose preclinical manifestations of demineralization of hard tissues of teeth, as he diagnoses the demineralization of enamel when the demineralization process has already moved in the clinical stage: determined visually, and on the morphological level occurred Gnostics focal demineralization of hard tissues of permanent teeth, in accordance with which the control point measured current passing through the hard tissues of the tooth, and its value diagnose the presence of demineralization. Identified the electrometric method of diagnosis, provides a quantitative assessment of the degree of demineralization (Electrometric initial diagnosis, pissarevo, recurrent caries and other hard tissue lesions of teeth with complete mineralization of enamel / guidelines, the Ministry of health of the RSFSR, Omsk, 1988, S. 10).

It is known that orthodontic treatment is a factor contributing to the demineralization of tooth tissues. Already at the initial stages of treatment conditions for the emergence of initial caries on the border “bracket-enamel”. However, visually and clinically changes in the enamel of the tooth under the bracket and on the border are not detected for a long time, and in most cases, irregularities in the enamel of the tooth in the form of chalky spots detect visually after removing the bracket. The lack of opportunity prompt diagnosis and clinical manifestations of demineralization of hard tissues of teeth that have orthodontic apparatus, causes serious carious changes in hard dental tissues due to the lack St. the agnostics focal demineralization of hard tissues of permanent teeth used in dentistry. The disadvantage of this method is that the method diagnoses the demineralization of enamel when the demineralization process has already moved in the clinical stage: determined visually or when outside enamel is not broken, but inside the hard tissues of the tooth has a large cavity. In the used method for the diagnosis of the scale reference values of current passing through the hard tissues of the tooth at the point, do not allow to diagnose the condition of hard tissue of teeth, which has the bracket, as shown above, changes in the enamel of the tooth under the bracket and on the border visually and is clinically determined. Furthermore, the method does not allow to diagnose the condition of the tissues of teeth for orthodontic treatment because of the uncertainty in the choice of the control points, as in this case there are no visually defined for the study area demineralization of hard tissues of teeth and a large tooth surface is occupied by the bracket. In addition, it is known that patients with low levels of resistance to caries process of demineralization of hard tooth tissues develops more actively than in patients with medium and high levels of resistance. In known from the accounts of the functional resistance of teeth to dental caries, what is important in orthodontic treatment, when there are no visually defined for the study area demineralization of hard tissues of teeth.

Thus, the known method electrometric diagnosis of focal demineralization of hard tissues of permanent teeth closest to the proposed method, when the implementation does not allow to achieve the technical result consists in the possibility of diagnostics of hard tissues of a tooth with a pre-installed fixed orthodontic apparatus, by identifying preclinical manifestations of demineralization of hard tooth tissues taking into account the functional resistance of hard tissues of teeth to decay.

The present invention solves the task of creating a method for the diagnosis of demineralization of the enamel of permanent teeth, which allows to achieve the technical result consists in the possibility of diagnostics of hard tissues of a tooth with a pre-installed fixed orthodontic apparatus, by identifying preclinical manifestations of demineralization of hard tooth tissues taking into account the functional resistance of hard tissues of teeth to decay.

The essence invented the eye in a controlled point measure amperage, through hard tissues of the tooth, and its value diagnose the presence of demineralization previously for each patient to determine the level of functional resistance of hard tissues of teeth to caries, and then diagnose the demineralization of the enamel of permanent teeth with the installed bracket for this controlled choose on the vestibular surface of the tooth of the first and second points located on the continuation of the vertical axis of symmetry of the bracket: the first point is between “pricesnews” edge of the bracket and gingival sulcus (point 1), the second point is between the edge of the bracket and the cutting edge of the tooth (point 2), and the third point is chosen on the horizontal line of symmetry of the bracket laterally with respect to the edge of the bracket (point 3), one month after installing the bracket in controlled points measure the current passing through the hard tissues of the tooth, the measurement results diagnose the presence of an initial stage of demineralization of teeth of the upper jaw, if for patients with a medium level of resistance of hard tissues of teeth to caries the magnitude of the current is at point 1 from 0.05 to 0.07 µa at 2 - from 0.02 to 0.04 μa, at the point 3 is from 0.02 to 0.04 µa, and for patients with low p-level is - the t 0,071 to 0,089 µa, at point 3 is from 0.12 to 0.16 μa, and the teeth of the lower jaw having an initial stage of demineralization diagnosed if patients with a medium level of resistance of hard tissues of teeth to caries the magnitude of the current is at point 1 from 0,113 up to 0.127 μa, at the point 2 from 0,047 to 0,053 µa, at point 3 from 0,065 up to 0.12 μa, and for patients with a low level of resistance of hard tissues of teeth to caries the magnitude of the current is at point 1 from 0.17 to 0.25 µa, at point 2, from 0.1 to 0.12 μa, at the point 3 from 0.17 to 0.19 µa.

The technical result is achieved in the following way. Conducted by the authors of the invention the analysis of the processes occurring in the solid tissues of the permanent tooth after installing orthodontic appliances - bracket showed that orthodontic treatment is a factor contributing to the demineralization of tooth tissues. Already at the initial stages of treatment conditions for the emergence of sites of initial caries on the border “bracket-enamel”. Fixed orthodontic apparatus, being a foreign body in the mouth, stimulates the function of salivation that is simultaneously inhibiting risk factor in the development of caries. In addition, a bracket mounted on the surface of the enamel of the tooth p is again the enamel of the tooth is subjected to shrinkage, that entails the formation of zones of tension and compression of the enamel prisms. This increases the likelihood of development around the bracket structural damage and the appearance of microcracks, which reduces the density of the hard tissues of the tooth. In addition, as a result of this change in terms of diffusion and osmosis in solid tissues, which leads to slowing down of metabolic processes in the enamel, and therefore provokes demineralization of hard tooth tissues and, as a consequence, the decrease of the density of the tissues of the tooth. Because the end result of the processes occurring in the solid tissues of the permanent tooth with orthodontic apparatus is to reduce the density of hard tissues, it was possible to diagnose the condition of hard tissues such teeth is to use the principle laid down in the electrometric method of monitoring the status of hard tooth tissues: in a controlled point measure the current passing through the hard tissues of the tooth, and its value diagnose the presence of demineralization.

When orthodontic treatment equipment, as a rule, fixed on a long-term period (12 months and more). Since the condition of hard tissues of teeth mounted on a bracket, especially on the and is the choice of the control points. In the proposed method, the selection of points allows to take into account the existence of risk areas and the most frequently affected areas of the vestibular surfaces of the teeth around the base of the braces, which, in turn, allows to obtain reliable information about the condition of the tissues of the whole tooth. The finer points chosen on the vestibular surface of the tooth, as it has a bracket and it is this surface of the tooth is exposed to adverse effects from its installation. Due to the fact that the first point is chosen between “pricesnews” edge of the bracket and gingival sulcus (point 1), you can control the cervical area of the tooth. Selecting a second point between the edge of the bracket and the cutting edge of the tooth (point 2) enables control of this area of the enamel of the vestibular surface of the tooth. Selecting a third point on the horizontal line of symmetry of the bracket laterally with respect to the edge of the bracket (point 3) provides control over the middle area of the enamel of the tooth. Due to the fact that the first and second points is chosen on the continuation of the vertical axis of symmetry of the bracket, it is possible to obtain information about the status of the hard tissues of both halves of the tooth in the vertical axis of symmetry of the break is x points divides the tooth with the installed bracket for three control areas: cervical, the average and the area in the immediate vicinity of the cutting edge of the tooth. Point 1 indicates the most dangerous area for the occurrence of initial caries - cervical. Point 2 characterizes the area where the pronounced self-cleaning (the equator of the tooth), the surface is smooth and uniform characteristic of the organic film pelicula. Point 3 refers to the average area of the tooth, where the conditions for the formation of carious processes are averaged in nature compared to the two previous controlled areas of the vestibular surface of tooth enamel. As a result, the choice of the control points, the proposed method allows to obtain reliable integrative information about the condition of the teeth, that enables diagnostics of hard tissues of a tooth with a pre-installed fixed orthodontic equipment.

The timing of monitoring the status of hard tooth tissues: one month after installing the bracket in controlled points measure the current passing through the hard tissues of the tooth is the result of statistical data resulting from research, and is the best.

Due to the fact that the results of measurements diagnose the presence starting with the t current through hard tissues of the tooth, take into account that the teeth of the upper and lower jaws are in the mouth in different physiological conditions. As previously for each patient determine the functional resistance of hard tissues of teeth to tooth decay, take into account the peculiarities of the patient's body, as in patients with a low level of resistance to caries process of demineralization of hard tooth tissues develops more actively than in patients with moderate levels of resistance. Thus diagnose the presence of an initial stage of demineralization of teeth of the upper jaw, if for patients with a medium level of resistance of hard tissues of teeth to caries the magnitude of the current is at point 1 from 0.05 to 0.07 µa at 2 - from 0.02 to 0.04 μa, at the point 3 is from 0.02 to 0.04 μa, and for patients with a low level of resistance of hard tissues of teeth to caries the magnitude of the current is at point 1 from 0.18 to 0.22 μa, at the point 2 from 0,071 to 0,089 µa, point 3 - from 0.12 to 0.16 μa. For the teeth of the lower jaw having an initial stage of demineralization diagnosed if patients with a medium level of resistance of hard tissues of teeth to caries the magnitude of the current is at point 1 from 0,113 up to 0.127 μa, at the point 2 - 0.0 is to decay the value of the current is at point 1 from 0.17 to 0.25 µa, at point 2, from 0.1 to 0.12 μa, at the point 3 from 0.17 to 0.19 µa.

The timing of monitoring the status of hard tooth tissues, diagnosis of the presence of the initial stage of demineralization separately for the teeth of the upper and lower jaws, a preliminary determination of the level of functional resistance of hard tissues of teeth to caries, set intervals test values of current, used for diagnostics, in conjunction with the choice of the control points provide a diagnostic of the state of the hard tissues of the tooth with a pre-installed fixed orthodontic apparatus, by identifying preclinical manifestations of demineralization of hard tooth tissues taking into account the functional resistance of hard tissues of teeth to decay.

Intervals test values of current used for the diagnosis obtained by practice in the result set of data.

Thus, the present invention is a method for the diagnosis of demineralization of the enamel of permanent teeth if the implementation provides the achievement of the technical result consists in the possibility of diagnostics of hard tissues of a tooth with a pre-installed fixed orthodontic instruments is sistently of hard tissues of teeth to decay.

The drawing explains the implementation of the method. It depicts the tooth 1 has mounted on the bracket 2, and the location of the controlled point on the surface of tooth enamel.

Method for diagnosis of demineralization of the enamel of permanent teeth, perform the following way. Previously for each patient to determine the level of functional resistance of hard tissues of teeth to caries, and then diagnose the demineralization of the enamel of permanent teeth with the installed bracket. To do this in a controlled point measure the current passing through the hard tissues of the tooth. Previously as a controlled pick on the vestibular surface of the tooth of the first and second points located on the continuation of the vertical axis of symmetry of the bracket: the first point is between “pricesnews” edge of the bracket and gingival sulcus (point 1), the second point is between the edge of the bracket and the cutting edge of the tooth (point 2), and the third point is chosen on the horizontal line of symmetry of the bracket laterally with respect to the edge of the bracket (point 3). One month after installation bracket for controlled points measure the current passing through the hard tissues of the tooth. According to the measurement results diagnose the presence of the initial phase of deminers to decay the value of the current is at point 1 from 0.05 to 0.07 µa, point 2 - from 0.02 to 0.04 μa, at the point 3 is from 0.02 to 0.04 μa, and for patients with a low level of resistance of hard tissues of teeth to caries the magnitude of the current is at point 1 from 0.18 to 0.22 μa, at the point 2 from 0,071 to 0,089 µa, at point 3 is from 0.12 to 0.16 μa. For the teeth of the lower jaw having an initial stage of demineralization diagnosed if patients with a medium level of resistance of hard tissues of teeth to caries the magnitude of the current is at point 1 from 0,113 up to 0.127 μa, at the point 2 from 0,047 to 0,053 µa, at point 3 from 0,065 up to 0.12 μa, and for patients with a low level of resistance of hard tissues of teeth to caries the magnitude of the current is at point 1 from 0.17 to 0.25 μa, at the point 2 from 0.1 to 0.12 µa, at point 3 from 0.17 to 0.19 µa.

Control points were selected, retreating from the edge of the bracket on 1 - 2 mm.

Studies were performed on vestibulares surface of each tooth of the upper and lower jaws, with strengthened metal braces.

Exposure time: agent before gluing similar and equal to 15 seconds. For gluing locking devices used orthodontic composite “Brackfix” (Voko). The fixation of the support rings was performed using glass ionomers cement “Agua Meron” (Voko).

For discovermag points was performed control measurements of current, through hard tooth tissues in controlled points. The original measurements were zero.

As a measuring device used device “steel 2333” made in the state register of measuring instruments.

Before measuring the patient's dental arch with fixed, non-removable equipment removed all elastic elements, metal ligatures, was removed from the slots of the orthodontic archwire. The patient was carefully rinsed her mouth with water. Then brushes for low-speed handpiece with elongated bristles gently remove soft plaque around the base of the braces. Spent the retraction of the soft tissues of the lips and cheeks, was set saliva ejector. Areas of the dental arch isolated from saliva and dried by a stream of air. In the mouth put the passive electrode. The tip of the active electrode was dipped in a drop of electrolyte (10% solution of calcium chloride). Then the active electrode was applied to the controlled point. Skipped through it a current of 100 µa. The value of the current strength was diagnosed with the presence of the initial stage of demineralization of the enamel of permanent teeth.

The dimension of the measurement results of the MCA.

Example 1. Patient P., aged 15.

Diagnosis: Neutral occlusion, kuchenne p what about the TER-test.

After receiving diagnostic models of jaws panoramic snapshot of dentition, examine the photos of the face, in full face and profile, was conducted with the help of the device “steel-2333” electrometric study of the vestibular surfaces of the teeth in the control points selected in accordance with the claimed method.

According to the device, the conductivity of the vestibular surfaces of the teeth in all the surveyed points was equal to zero. Then there was carried out the procedure of fixation of fixed orthodontic appliances (braces) on the teeth of both jaws.

When you re-inspection after 1 month again electrometric study of the vestibular surfaces of the teeth showed an increased conductivity data for all monitored points. Indicators on the teeth of the upper jaw: point 1 - 0,19; point 2 - 0,08; point 3 - 0,14.

Indicators on the teeth of the lower jaw meet: point 1 - 0,2; point 2 - 111; point 3 - 0,18.

Consequently, it is possible to state with certainty the fact that began the process of demineralization of the enamel on the periphery of the bracket, more expressed in points 1, i.e. closer to the cervical area of the tooth. In order to prevent the development of clinically detectable Demin the teeth enamel.

Example 2. Patient K., aged 13.

Complaints about unsightly view of the location of the teeth and the desire to correct the anomaly.

Diagnosis: Distal occlusion, deep blocking bite, retrose Central incisors of the upper jaw protrusion of the lateral incisors of the upper jaw, kuchenne the position of the incisors of the lower jaw, polurethane 35 of the tooth. When determining the level of functional resistance of hard tissues was detected average level.

Treatment plan: the normalization of the position of the teeth on both jaws with fixed orthodontic appliances - braces. The treatment plan did not provide for removal of any teeth.

When conducting preliminary electrometric studies of the vestibular surfaces of the teeth was not observed phenomena conductivity on any tooth in controlled measurement points.

Later, 1 month after fixing the braces when you re-inspection was conducted electrometric study. According to the readings, the conductivity values of the teeth of the upper jaw in our proposed measurement points were as follows: point 1 - 0,06; point 2 - 0,025; point 3 - 0,03. Indicators on the teeth of the lower jaw meet: point 1 - amount of 0.118; point 2 - 0,05; point 3 - 0,08 I demineralization of the enamel around the foot braces. To prevent complications were prescribed course of preventive measures, which should be in the process of using orthodontic appliances.

Claims

Method for diagnosis of demineralization of the enamel of permanent teeth, which consists in the fact that in controlled points measure the current passing through the hard tissues of the tooth, and its value diagnose the presence of demineralization, wherein the pre for each patient to determine the level of functional resistance of hard tissues of teeth to caries, install on permanent tooth braces, as controlled pick on the vestibular surface of the tooth of the first and second points located on the continuation of the vertical axis of symmetry of the bracket: point 1 - between “pricesnews” edge of the bracket and gingival sulcus, point 2 - between the edge of the bracket and the cutting edge of the tooth, point 3 - select a horizontal line of symmetry of the bracket laterally with respect to the edge of the bracket, and the diagnosis of demineralization of enamel carried out one month after installing the bracket, thus diagnose the presence of an initial stage of demineralization of teeth of the upper jaw, if € in point 1 of 0.05 - 0.07 μa, at the point 2 0,02 - 0,04 µa, at point 3 0,02 - 0,04 MCA, and for patients with a low level of resistance of hard tissues of teeth to caries the magnitude of the current is at point 1 0,18 - 0,22 µa, at point 2 0,071 - 0,089 MCA, in point 3 of 0.12 - 0.16 μa, and diagnose the presence of an initial stage of demineralization of teeth of the lower jaw, if for patients with a medium level of resistance of hard tissues of teeth to caries the magnitude of the current is at point 1 0,113 - to 0.127 µa, in point 2 0,047 - 0,053 µa, at point 3 0,065 - 0,12 MCA, and for patients with a low level of resistance of hard tissues of teeth to caries the magnitude of the current is at point 1 0,17 - 0,25 µa, at point 2 0,1 - 0,12 µa, at point 3 0,17 - 0,19 µa.



 

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EFFECT: enhanced effectiveness in reducing the number of recidivation cases.

2 dwg, 1 tbl

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