RU207849U1 - A device for biometric measurements of the narrowing of the upper and lower jaws, taking into account the height of the fornix of the hard palate in children and adolescents with connective tissue dysplasia - Google Patents

Abstract

The utility model relates to medicine, namely to dentistry, and can be used to determine the narrowing of the upper and lower jaws taking into account the height of the fornix of the hard palate in patients with occlusion anomalies and deformities of the dentition, in particular, associated with connective tissue dysplasia. A device for measuring the narrowing of the upper and lower jaws, taking into account the height of the fornix of the hard palate at various degrees of severity of connective tissue dysplasia, including a measuring device for determining linear dimensions with a specified accuracy (for example, a vernier caliper), containing a bar with a scale and a ruler of a depth gauge 8, on which are installed measuring stationary 1 and movable 2 jaws, made in the form of a truncated plate with a shaped edge and with the possibility of a tight fit and fixing on them by means of a screw connection of removable intraoral pads 5, 6, made in the form of a triangular plate with an end part at the apex, and movable 2 jaw equipped with a digital readout device (display) 9, and the end part of the overlays 5, 6 contains the upper 11 and lower 15 needle-shaped edges, oriented along the vertical axis. The use of this utility model contributes to the conduct of quick and accurate biometric measurements of the narrowing of the upper and lower jaws, taking into account the height of the fornix of the hard palate at various degrees of connective tissue dysplasia, the timely adoption of complex therapeutic and prophylactic actions to restore changes in the upper and lower dentition and dentoalveolar anomalies without performing complex clinical and diagnostic activities. 5 dwg, 4 tbl

Description

The utility model relates to medicine, namely to dentistry, and can be used to determine narrowing of the upper and lower jaws taking into account the height of the fornix of the hard palate in patients with occlusion anomalies and deformities of the dentition, in particular, associated with connective tissue dysplasia.

A method for measuring the height of the hard palate is known from the scientific literature (see the Guide to Orthodontics / Edited by F.Ya. 120), in which the proportional interdependence of the sizes of dental arches and their proportional basis for orthognathic occlusion according to N. Howes is determined. The data he received was confirmed by N.G. Snagina. At the same time, in the transverse direction, the width of the apical basis is measured on the upper jaw between the deepest points of the canine fossae, on the lower jaw - retreating 8 mm downward from the intersection of the horizontal line connecting the necks of the lower canines and the first premolars, and the vertical line passing through their apex interdental papilla. Normally, the width of the apical base of the upper jaw is 44% of the sum of the mediodistal dimensions of the 12 permanent teeth (incisors, canines, premolars and first permanent molars) of each jaw. Narrowing of the dentition is usually accompanied by a narrowing of the apical base.

In the known solution, when measuring the dimensions of dental arches and their proportional basis in orthognathic occlusion, anatomical and topographic landmarks of the upper and lower jaws are complex in technique, which significantly increases the complexity of work on its implementation, incl. due to the numerous mandatory sequential steps, it is also not suitable for measuring maxillary constriction in children with connective tissue dysplasia.

A device is known for optimizing the position of the molar of the lower jaw (see RU No. 153077, class A61C 7/00, publ. 06/27/2015), containing a lock made in the form of a perforated button, a partial orthodontic nitinol arch having a bend of not more than 90 degrees, and an opening spring, wherein the lock is soldered to the orthodontic ring, where the partial orthodontic nitinol arch connecting the lock and the perforated button has an additional semicircular bend, where the opening spring is fixed on the arch.

Using the known device, the position of the mandibular molar is measured, however, the device does not allow determining the parameters of the dentition of the mandible, for example, the narrowing of the dentition, which is characteristic of deformity in children with connective tissue dysplasia.

A device for distal movement of the first molars of the upper jaw with simultaneous stabilization of the position of the second molars of the upper jaw in the treatment of distal occlusion of II class I subclass according to Angle (see RU No. 176904, class A61C 7/002, publ. 01.02.2018) contains orthodontic crowns, installed on the second premolars and second molars of the upper jaw, connected to each other by a wire clasp, where the wire beams located on the palatine and vestibular surfaces of the orthodontic crowns of the second molars of the upper jaw have elastic chains fixed to the locks of the braces of the first molars and wire processes located on the vestibular surface orthodontic crowns of the second molars of the upper jaw, and buttons of the first molars and wire processes located on the palatal surface of the orthodontic crowns of the second molars of the upper jaw and a bracket system fixed to the first molars of the upper jaw, excluding the second premolars.

The known device has a complex design and technological difficulties to prevent the movement of the second molars mesially and to ensure the distalization of the first molars of the upper jaw with distal occlusion of II class 1 subclass according to Angle, in addition, it is not suitable for measuring the narrowing of the upper jaw in children with connective tissue dysplasia.

The device for measuring the height of the vault of the hard palate (patent RU No. 177476 class A61B 5/107, publ. 02/26/2018) contains a measuring rod made in the form of a ruler with a scale vertically located on the edge of the handle, while frictionally mounted on the rod of the ruler support control bar.

The known solutions make it possible to determine the height of the fornix of the hard palate in children with connective tissue dysplasia, however, it is impossible to assess the narrowing of the upper and lower jaws depending on the height of the fornix of the hard palate at various degrees of severity of dysplasia.

The problem to be solved by the claimed solution is expressed in the creation of a universal device for measuring the narrowing of the upper and lower jaws in children and adolescents, taking into account the height of the fornix of the hard palate at various degrees of severity of connective tissue dysplasia.

The technical effect obtained when solving the problem is expressed in the possibility of simultaneous measurement of the narrowing of the dentition of the upper and lower jaws within the framework of one procedure, performed under outpatient conditions of dental procedures.

To solve the problem, a device for measuring the narrowing of the upper and lower jaw, taking into account the height of the fornix of the hard palate of children and adolescents with various degrees of severity of connective tissue dysplasia, including a measuring device for determining linear dimensions with a specified accuracy, containing a bar with a scale and a depth gauge ruler, on which measuring stationary and movable jaws are installed, made in the form of a truncated plate with a shaped edge and with the possibility of a tight fit and fixing on them by means of a screw connection of removable intraoral pads made in the form of a triangular plate with an end part at the top, moreover, the movable jaw is equipped with a digital display device counting indications, the end part of the overlays contains the upper and lower needle-like edges, oriented along the vertical axis.

Comparative analysis of the features of the claimed solution with known features indicates the compliance of the declared solution with the "novelty" criterion.

The set of features of the utility model provides a solution to the stated technical problem, namely, the creation of a simple device that allows a direct assessment of the narrowing of the upper and lower jaws in the oral cavity, taking into account the height of the fornix of the hard palate in children and adolescents with dentoalveolar anomalies, in particular, associated with connective dysplasia. fabrics.

It is known that connective tissue dysplasia (CTD) is a genetically determined disorder of its development, characterized by defects in its basic substance and fibers. Currently, among the main causes of DST, there are changes in the rates of synthesis and assembly of collagen and elastin, the synthesis of immature collagen, a violation of the structure of collagen and elastin fibers due to their insufficient cross-linking. This indicates that in DST, connective tissue defects in their manifestations are very diverse. At the morphogenetic level, the organs and tissues of the oral cavity are of connective tissue origin. At the same time, in children and adolescents, local phenotypic signs from the hard palate, anomalies of occlusion and deformation of the dentition, displacement of the inter-incisal lines of the upper and lower jaws in relation to the midline of the face, diastema, anomalies of attachment of the frenum of the tongue and lips, TMJ dysfunction, multiple caries are revealed teeth, periodontal disease, pathological abrasion of teeth, inclination of the anterior portion of the occlusal plane in relation to the interpupillary line, but also other organs and systems.

The degree of CTD is determined, as a rule, by the method of T. Milkovska-Dmitrova and A. Karkashev (1985) (see table 1): mild (I degree) is diagnosed in the presence of two main signs; medium (II degree) - with 3 major and 2-3 minor or 3-4 major and 1-2 minor; severe (III degree) is defined in the presence of 5 main and 3 minor signs.

Determination of the severity of CTD in each specific child is calculated by the sum of the points. At the first (mild) severity of CTD (variant of the norm), the sum of points should not exceed 12, and at the average - 23. At severe severity, it is 24 or more points. In this case, the height of the vault of the hard palate can be determined by means of measurements using a known device for measuring the height of the vault of the hard palate (see Table 2, RU No. 177476, cl. A61B 5/107, publ. 02/26/2018).

A device for measuring the narrowing of the upper and lower jaws taking into account the height of the fornix of the hard palate at various degrees of severity of connective tissue dysplasia is illustrated by the figures, where figure 1 shows a general assembly diagram of the device in a disassembled state (front view); figure 2 is a general assembly diagram of the device in a disassembled state (rear view); figure 3 is a general view of the assembled device; figure 4 - removable intraoral pads of the device (A - front view; B - reverse side); Figure 5 is an isometric view of the removable intraoral overlays of the device.

The claimed device is based on a standard measuring device for determining the linear dimensions of parts with a specified accuracy (reading device), for example, a digital caliper type (see https://aziada.ru/blog/electronny-shtangentsirkul-electronic-digital-caliper-instrykcia -na-russkom), while stationary 1 and movable 2 jaws for measuring external dimensions are made in the form of a truncated plate, on which two through holes 3, 4 are selected. removable intraoral pads for fixed 5 and movable 6 measuring jaws. And in the hole 4, a thread is cut for attaching the linings by means of a screw 7. In addition, a probe-depth gauge 8 is used for measurements (see Figs. 1, 2).

The measurement results are projected onto the display 9 (with a digital version of the reading device), which is aligned with the movable jaw 2, or fixed on the scale of the measuring ruler 10 of the device by means of the screw 14 (see Fig. 3).

The pads 5, 6 are made of tool steel in the form of a triangular plate, on the top of which bifurcated needle-shaped end parts 11 and 15 are made, moreover, the edges of the needles (upper and lower) are directed in different directions along the vertical axis and coincide with the measuring surface of the patch. The upper end portions 11 are intended for measurements on the upper jaw, the lower 15 - on the lower jaw. At the same time, on the reverse side of the plates, recesses are selected for a tight and even fit of the linings 5, 6 on the measuring jaws 1, 2. For this, figured protrusions 12 are made on the plates for subsequent landing in the oval holes 3 of the jaws and through holes 13 are selected for the passage of the screw fasteners (see Fig. 4).

To assemble the device, strips 5, 6 are sequentially installed on the edges 1, 2 by fitting the protrusions 12 onto the fixing holes 3 and fastening with screws 7. This ensures a strict coincidence of the measuring surfaces of the edges of the needle-shaped end parts 11, 15 and the strips 5, 6.

The device is used as follows.

Removable working parts are sterilized by known methods, for example in an autoclave. Further, the device is assembled for use by placing the overlays 5, 6 on the edges 1, 2.

The assembled device, holding by the measuring ruler, is introduced into the cavity of the patient's open mouth, for which purpose, the needle-shaped end parts 11, 15 of the intraoral pads 5, 6 are fixed at the measuring points, after which the obtained values are recorded. For example, on the upper jaw, the measuring points are located in the middle of the longitudinal fissures of the first premolars and the anterior intersection of the longitudinal and transverse fissures of the first molars of the upper jaw. Then, if necessary, begin to measure the constrictions in the lower jaw, for which purpose, the lower edges of the end parts 15 are fixed at the measuring points, which are located at the distal point of the first premolar, in contact with the second premolar (the point between the premolars), and the midpoint on the vestibular surface or the distal-buccal cusp of the first molar, where these measuring points, according to Pona, are used for permanent occlusion.

To obtain objective data, the standard Pona method is used to determine the width of the dentition in children, while the presence of a relationship between the sum of the mesiodistal dimensions of the upper incisors and the width of the dentition in the region of the first premolars and molars is established. The Pona index characterizes the width of the dentition. As you know, this index determines the relationship between the sum of the mesiodistal dimensions of the upper incisors and the width of the dentition in the area of the first premolars and molars, which are expressed by the premolar and molar indices: 80 and 64. This relationship is reflected in the following formulas:

The measuring points on the upper jaw are: the middle of the longitudinal fissures of the first premolars and the anterior intersection of the longitudinal and transverse fissures of the first molars. Further, the interpretation of the obtained data of the narrowing of the upper jaw is carried out, depending on the parameters of the height of the fornix of the hard palate at various degrees of severity of connective tissue dysplasia. In this case, the measuring points on the lower jaw are: the distal point of the first premolar in contact with the second premolar (the point between the premolars), and the midpoint on the vestibular surface or the distal-buccal cusp of the first molar. Further, the interpretation of the obtained data of the narrowing of the lower jaw is carried out, depending on the parameters of the height of the fornix of the hard palate at various degrees of severity of connective tissue dysplasia.

Thus, the doctor can easily determine the measuring points. At the same time, according to the data obtained, the degree of narrowing of the upper and lower jaws is diagnosed depending on the height of the fornix of the hard palate at various degrees of severity of connective tissue dysplasia.

The indications of the device are data for the subsequent determination of the narrowing of the upper and lower jaws, taking into account the height of the fornix of the hard palate in children with varying degrees of severity of CTD (see tables 3, 4).

In addition, by means of the claimed device, the narrowing of the upper and lower jaws is determined taking into account the height of the fornix of the hard palate, for example, on plaster control and diagnostic models of the upper and lower jaws with various degrees of severity of connective tissue dysplasia. At the same time, a device is additionally used to measure the height of the arch of the hard palate (patent RU No. 177476 (class A61B 5/107, publ. 02.26.2018), for which on a plaster model according to Pont's points on premolars in the middle of the intertubercular fissure and molars of the upper jaw at the point of the anterior depression of the intertubercular fissure, a reference control bar of the known device is applied, creating a horizontal initial point, advance the measuring ruler all the way (to the deepest (highest) point of the fornix of the hard palate), after which the obtained value is recorded.

Next, measurements are carried out using the claimed device for measuring the narrowing of the upper jaw, taking into account the height of the fornix of the hard palate at various degrees of severity of connective tissue dysplasia, where the needle-shaped upper end parts 11 are set at the measuring points, which are located in the middle of the longitudinal fissures of the first premolars and the anterior point of intersection of the longitudinal and transverse fissures of the first molars of the upper jaw, after which the obtained values are recorded.

To measure the narrowing of the lower jaw, taking into account the height of the fornix of the hard palate at various degrees of severity of connective tissue dysplasia, where the lower needle-shaped end parts 15 are set at measuring points that are located at the distal point of the first premolar in contact with the second premolar (the point between the premolars) and the middle a point on the vestibular surface or the distal-buccal tubercle of the first molar, after which the obtained values are recorded.

Thus, on the basis of the obtained measurement results, the narrowing of the upper and lower jaws is determined.

Experimental studies have established that with a mild degree of DST, taking into account the height of the fornix of the hard palate, the narrowing of the upper jaw at the measuring points of the premolars and molars reaches -2.57 and -2.16 mm, the average - -2.9 and -2.57 mm, heavy - -6.69 and -6.58 mm, respectively, on the lower jaw it reaches at the measuring points of the premolars and molars up to -2.23 and -3.57 mm, medium - -3.29 and -6.25 mm, heavy - -7.68 and -8.84 mm.

In contrast to the known solutions, the claimed device has the following advantages:

simplicity of design and reliability in use;

reduced patient visits to the doctor;

measurement of the narrowing of the dentition of the upper and lower jaws within the framework of one procedure, which helps to reduce the time spent on the patient's appointment, incl. by quickly diagnosing and drawing up a plan for comprehensive medical and social rehabilitation of school-age children with DST;

the ability to control the measurement by the doctor, carried out by the claimed device, which ensures the simplicity and accuracy of the measurement work;

the possibility of convenient movement of the measuring edges of the device allows the most accurate installation of the device on the measuring points of the first premolars and the anterior point of intersection of the longitudinal and transverse fissures of the first molars of the upper jaw, as well as at the measuring points located at the distal point of the first premolar in contact with the second premolar (the point between the premolars ), and the midpoint on the vestibular surface or the distal-buccal tubercle of the first molar of the lower jaw;

Practical approbation confirms the effectiveness and versatility of the device for biometric measurements in outpatient settings of dental practices and plaster models of the upper and lower jaws, based mainly on the ease of use and accuracy of measurements.

In addition, the use of the device when detecting local (organs and tissues of the oral cavity) phenotypic signs of connective tissue dysplasia contributes to a more rapid adoption of complex therapeutic and prophylactic actions to restore the narrowing of the upper and lower jaws and dentoalveolar anomalies without complex clinical diagnostic measures.

Table 1

A point scale for assessing the significance of phenotypic signs of CTD

by T. Milkovska-Dmitrova and A. Karkashova (1985)

Sign Points Sign Points Epicantus 2 Flat chest 2 Hypertelorism of the eyes 1 Dilated capillaries of the skin of the back, face 2 Vision pathology 4 Funnel-shaped deformity of the sternum 6 Blue sclera 1 Slight depression on the sternum 2 Wide nose 1 Kyphosis 4 Saddle nose 2 Scoliosis 4 Protruding ears 2 Asthenic physique 1 Adherent lobes 1 Clinodactyly of little fingers 1 Asymmetry of the nasal septum 2 Easy occurrence of hematomas 3 Scars on the skin 3 Hernia 3 High sky 3 Weakness of the abdominal muscles 3 Pallor of the skin 2 Transverse striation of the feet 3 Increased elasticity of the skin 3 Flat feet 3 Leather as "suede" 2 Corns 2 Soft skin 2 Incomplete syndactyly of 1 and 2 toes 2 Pronounced venous pattern 3 Sandal gap 2 Skin wrinkling 2 Hallux valgus 3 Dark spots 1 Hollow foot 3 Keel chest 5 Joint hypermobility 4

table 2

Indicators of deformation of the hard palate in children with varying degrees of severity of connective tissue dysplasia

Morphological parameters DST severity Easy (up to 12 points) Average (up to 23 points) Severe (over 24 points) The height of the vault of the hard palate according to the device for measuring the height of the vault of the hard palate up to 1.8+0.02 cm From 1.9 + 0.04
up to 2.7 + 0.3 * cm From 2.8 + 0.03
up to 3.2 + 0.02 ** cm

Note: Р * - reliability of differences in DST of mild and moderate degrees and severity; Р ** - reliability of differences in DST of moderate and severe severity.

Table 3

Clinical characteristics of the narrowing of the upper jaw depending on the severity of connective tissue dysplasia (mm)

Indicators of narrowing of the upper jaw Mild degree
(depth of the height of the vault of the hard palate up to 18.0 + 0.02 mm) Medium degree
(the depth of the height of the arch of the hard palate from 19.0 + 0.04
up to 27.0 + 0.3 mm) Severe degree
(the depth of the height of the arch of the hard palate from 28.0 + 0.03
up to 32.0 + 0.02 mm) 1 degree premolar 1 degree molar Grade 2 premolar Grade 2 molar Grade 3 premolar Grade 3 molar Minimum values -9.87 + 0.46 -10 + 0.47 -12.2 + 0.36 -14 + 0.18 -9.5 + 0.59 -17.12 + 0.74 Maximum values +5.51 + 0.38 +7.69 + 0.40 +3.53 + 0.11 +6.13 + 0.15 -5.24 + 0.53 -3.37 + 0.82 Average values -2.57 + 0.13 -2.16 + 0.15 -2.90 + 0.17
* -2.57 + 0.24
* -6.69 + 0.47
** -6.58 + 0.43
**

Note: Р * - reliability of differences in the narrowing of the upper jaw in case of mild and moderate CTD; Р ** - reliability of differences in the narrowing of the upper jaw with CTD of moderate and severe severity.

Table 4

Clinical characteristics of the narrowing of the lower jaw depending on the severity of connective tissue dysplasia (mm)

Indicators of narrowing of the upper jaw Mild degree
(depth of the height of the vault of the hard palate up to 18.0 + 0.02 mm) Medium degree
(the depth of the height of the arch of the hard palate from 19.0 + 0.04
up to 27.0 + 0.3 mm) Severe degree
(the depth of the height of the arch of the hard palate from 28.0 + 0.03
up to 32.0 + 0.02 mm) 1 degree premolar 1 degree molar Grade 2 premolar Grade 2 molar Grade 3 premolar Grade 3 molar Minimum values -8.12 + 0.44 -10.02 + 0.51 -10.1 + 0.33 -14.1 + 0.21 -13.2 + 0.61 -16.16 + 0.68 Maximum values +1.88 + 0.36 +3.47 + 0.38 +1.79 + 0.14 +1.65 + 0.17 -2.17 + 0.55 -1.53 + 0.77 Average values -2.23 + 0.11 -3.57 + 0.13 -3.29 + 0.16
* -6.25 + 0.26
* -7.68 + 0.44
** -8.84 + 0.48
**

Note: Р * - reliability of differences in the narrowing of the lower jaw in case of mild and moderate CTD; Р ** - reliability of differences in the narrowing of the lower jaw with CTD of moderate and severe severity.

Claims (1)

A device for measuring the narrowing of the upper and lower jaws, taking into account the height of the fornix of the hard palate of children and adolescents with various degrees of severity of connective tissue dysplasia, including a measuring device for determining linear dimensions with a specified accuracy, containing a bar with a scale and a depth gauge ruler, on which the measuring stationary and movable jaws, and the measuring jaws are made with the possibility of a snug fit and fixing on them removable intraoral pads in the form of a plate with an end part at the top, while the movable jaw is equipped with a digital readout device, the end part of the pads contains upper and lower needle-shaped edges oriented along vertical axis.

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