RU2664594C2 - Method of dental anomalies diagnostics and treatment quality increasing - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, in particular to orthodontic dentistry, and can be used for diagnostic models computer analysis for biometric diagnostics, in particular for the computer analysis of cephalometric dental radiographs in order to improve the quality of diagnosis and treatment. Secondary points are plotted to teleroentgenogram, along which the values of 37 parameters are determined. These parameters are compared with the norm and for those indicators that have deviations from the norm, they establish diagnosis and prescribe treatment. After treatment course, new TRH is made and points are also plotted there and 37 parameters are determined. By their values, they form the opinion and the terms of treatment.EFFECT: method allows to increase the accuracy of diagnosis and the quality of dentoalveolar anomalies treatment, to take into account the patients individual characteristics.1 cl, 4 dwg, 1 ex, 1 tbl

Description

The invention relates to medicine, in particular to orthodontic dentistry, and can be used for computer analysis of diagnostic models in biometric diagnostics, in particular, for computer analysis of cephalometric images in order to improve the quality of diagnosis and treatment.

A known graphic method for determining the shape of dental arches and the location of teeth in the coordinate system [Diagnosis and functional treatment of dentofacial anomalies / Khoroshilkina F.Ya., Frenkel R., Demner L.M., Falk F., Malygin Yu.M., Frenkel K. (Joint Edition of the USSR-GDR). - M .: Medicine, 1987. - S. 218-219; Yu.K. Petrova. A method for determining the size of dental arches in the transverse and sagittal directions. // Information leaflet of VNPO "Dentistry" of the Ministry of Health of the USSR, 1990. Registration 10-11 / 80] on the sizes obtained on the models of the jaws of patients at various examination times (before treatment, after its completion and when checking long-term results), by means of a graphical image of the form dental arch, as well as the shape, which should be normal. For this purpose, a coordinate system is plotted on graph paper, where the ordinate axis is the midline of the corresponding jaws (RR '), the abscissa axis for the upper dental arch is the line drawn through the midpoint of the incisal papilla (PP'), perpendicular to the RR 'line, for the lower dental arcs - a line drawn through the Pont point on a distally located molar (MM '). On the ordinate axis, dimensions reflecting the sagittal arrangement of the teeth are laid aside, on the abscissa axis, dimensions reflecting their transversal arrangement. The perpendiculars to the ordinates and abscissas are restored from the points, the intersections of which correspond to the location of the measured point of each upper and lower tooth. The resulting points are connected by lines. The image of the forms of dental arches that existed before treatment, during treatment and after treatment is transferred to a transparent pearl film and compared along the reference lines in order to detect changes in the location of the teeth.

Disadvantages:

1. conventional designation of the location of the teeth in the coordinate system, which leads to the complexity and subjectivity of the semantic perception of deviations of the dental arch;

2. determining the location of individual teeth in the coordinate system is quite laborious; the method does not provide a quantitative assessment of violations of the dental arch, i.e. unreliable.

There is also a method of determining and planning the direction and magnitude of the movement of teeth during orthodontic treatment, including measuring the transverse dimensions of the front teeth of the upper jaw on a gypsum diagnostic model, building a normal dentition and comparing it with the patient’s dentition with planning the direction and magnitude of the movement of each tooth, in which diagnostic lines are applied to the gypsum diagnostic model of the upper jaw: a line along the mid-sagittal suture R, transverse mid-papillary iju MRI and / or transverse line P; base points O and / or O 'and points on the surface of teeth B; the MRI line is drawn through the center of the incisal papilla perpendicular to the R line, the base point O is marked at the intersection of the indicated lines, the P line is drawn through the palatine fossa perpendicular to the R line and the base point O 'is applied to the P line in the middle of the distance between the palatine fossae, projected onto the gypsum diagnostic model of the lower jaw: diagnostic lines: Rн, МРТн and / or Рн, base points He and / or О 'n, apply points on the surface of teeth Вн, measure the width of four incisors of the upper jaw, find their sum and get the parameter “sum of width incisors ", the base point O or O 'for the upper jaw, He or O' n, is selected based on its stable position during the entire orthodontic treatment and reconstruction of the jaw, gypsum models of the jaws are placed on a horizontal surface, orienting them in an orthocrest in the coordinate system, the X axis is perpendicular to the Y axis, so that for the upper jaw, the R line coincides with the Y axis, and the P line or the MRI line coincides with the X axis, and for the lower jaw the Rn line coincides with the Y axis, and the Pn line or the MRI line coincides with the X axis parallel to the x-axis below the gypsum model place the ruler, photograph the models of the upper and / or lower jaw with the ruler with a digital camera mounted on a tripod, electronic photographs of the models are inserted into the computer in BMP format with a resolution of at least 800 × 800 pixels, to obtain a digital photograph of the gypsum models, they are processed using of a computer program, the image of the digital model of the upper and / or lower jaw is displayed, using the image of the ruler in the photo, the digital image is scaled and calibrated, marked and edited the position of the selected stable base points and points of teeth B and / or Bn is obtained on the obtained digital model of the upper and / or lower jaw, the distance model from the stable base point to the point B and / or Bn of each tooth is entered digitally, a program based on these data builds a diagram of the real arch of the patient’s dentition, then the parameter “Sum of widths of incisors” is entered into the program, according to which the program builds a diagram of one of the four options for normoduces: option 1 “Sum of width of incisors” - 26.0-28.0 mm, option 2 - 28.1-30.0 mm, option 3 - 30.1-32.0 mm, option 4 - 32.1 -34.0 mm, virtually compare the normodig scheme and the patient’s real arc, and the comparison takes place on the selected stable base point and points B and / or Bn on the tooth surface, which are located on the patient’s real arc diagram and the normodug scheme in identical areas, and the diagrams are displayed on the computer screen in the form of arcs of different colors, as a result of the comparison, an image of the position of point B and / or Bn of each tooth of the real arc is compared with the normative position with the direction of movement Z of the real tooth as well as the magnitude of the planned movement until the norm is reached, the results are saved in the form of a table and diagram, additionally identify the zone of arcs with the greatest discrepancy, the zone of correspondence, boundary zones and activate the orthodontic arc system by setting stoppers in the places of correspondence of the patient’s arc scheme and normal arc scheme or release active sections of the orthodontic arc system in the mismatch zone, in the volume of which the movement of the teeth is planned. Apply points B and / or Bn on the surface of the teeth on gypsum models and mark the same points on their digital image in a computer: for molars - in the region of the apex of the mesial buccal tubercle, for premolars - in the region of the buccal tubercle, for fangs - in the region of the top of the tear tubercle, for incisors - in the center of the vestibular edge of the cutting surface. Photographing is carried out with a digital camera with a resolution of at least 12 mg / pixels, the ruler has millimeter divisions and a length of at least 10 cm (RF patent for IZ No. 2538620, class A61B 5/103).

The disadvantage of this method is the need to manufacture gypsum diagnostic models, which complicates the diagnosis and reduces its accuracy.

Closest to the claimed invention (prototype) is a method for the diagnosis of dentofacial anomalies using the program "DOLPHIN-IMAGING". Known methods for the analysis of teleradiographs by authors such as Gwartz, Bjork, Ricketts, which take into account a different number of parameters (Bjork - 27; Gwartz - 19; Ricketts 14) (LS Persin: Orthodontics. Modern methods for the diagnosis of dentofacial anomalies , 2007, Moscow, S. 136-150).

Disadvantages: - lack of information

- there is no objective assessment of aesthetic changes during treatment

The objective of the invention is to improve the accuracy and quality of diagnosis and treatment of dentofacial anomalies.

The essence of the invention lies in the fact that in addition to those points that are used for the diagnosis of Gwartz, Bjork, Ricketts, in the Dolphin Imagin program, the following diagnostic points are additionally applied to the teleradiogram, according to their anatomical location:

Porion - the highest point on the contour of the external auditory canal

Orbitale - the lowest point of the lower edge of the orbit

RT Point - the intersection of the lower boundary of the circular opening and the posterior wall of the pterygo-maxillary fissure

Sella - midpoint of the Turkish saddle

Nasion - a point on the anteroposterior margin of the nasolabial suture in the mid-sagittal plane

Basion - the lowest point of the clivus, corresponding to the front edge of the large occipital foramen

S.T. Glabella - the most anterior point of the frontal bone

Pronasale - the most prominent anterior point of the tip of the nose

Subnasale - the junction of the nasal septum and upper lip

A-Point - the anterior point of the apical basis of the upper jaw, located at the deepest point of transition from the anterior nasal spine to the alveolar process

B-Point - the anterior point of the apical basis of the lower jaw, located at the place of greatest depth of the curve at the border of the body of the lower jaw and the alveolar part

Pogonion is the most anterior point of the chin.

Gnation - the intersection of the anterior and inferior contours of the chin

Mention - the most prominent point of the lower contour of the chin

Gonion - the point of the angle of the lower jaw at the point of intersection with the bisector of the angle formed by tangents along the lower edge of the body and the posterior edge of the branch of the lower jaw

Articulare - located on the posterior-upper edge of the lower jaw branch, in the place of contact of this edge with the temporal bone

Condylon - the most protruding point on the posterior contour of the head of the lower jaw

ANS (spina nasalis anterior) - anterior nasal spine

PNS (spina nasalis posterior) - posterior nasal spine

U6 Occlusal - top of the mesial-buccal tuber of the first molar of the upper jaw

L6 Occlusal - apex of the mesial-buccal tuber of the first molar of the upper jaw

U6 Distal - the distal surface of the upper first molar

U6 Mesial - mesial surface of the upper first molar

L6 Distal - the distal surface of the lower first molar

L6 Mesial - mesial surface of the lower first molar

L1 Tip - the top of the lower central incisor

L1 Root - apex of the root of the lower central incisor

U1 Tip - top of the upper central incisor

U1 Root - apex of the root of the upper central incisor

As a result, a list of the angular and linear parameters calculated for these points is obtained, which make it possible to make the most accurate diagnosis and prescribe an appropriate treatment plan.

According to the proposed method, a total of 37 parameters are studied, among which the following are not included in the known methods:

FH-SN ° - angle formed by the Frankfurt horizontal and the anterior section of the base of the skull

SN-NPog ° - the angle formed by the anterior section of the base of the skull to the line NPog

Na-Go-Me ° - lower mandibular angle

ANS-PNS - base of the upper jaw

Go-Pg - base length of the lower jaw

Na-Me - Front Total Face Height

Na-ANS - upper front face height

ANS-Me - lower front face height

N-ANS / ANS-Me - balance of face proportions

S-Go - total posterior height of the face

Occ. Plane to SN ° - angle formed by the occlusal plane and the anterior section of the base of the skull

U1-NA ° - the angle formed by the axis of the upper central incisor and the line NA

L1-В ° - the angle formed by the axis of the lower central incisor to the line NB

U1-PP ° - the angle formed by the axis of the upper central incisor and the plane of the base of the upper jaw

U6-PP - perpendicular from the mesial buccal tuber of the first molar of the upper jaw to the base of the upper jaw

L6-MP - perpendicular from the mesial buccal tuber of the first molar of the lower jaw to the base of the lower jaw

The presence of these parameters can significantly improve the quality of diagnosis, prescribe a treatment plan that is most appropriate for the existing dentofacial anomaly, objectively evaluate the results after the end of orthodontic treatment.

Clinical example.

Patient R., 19 years old. He complained of difficulty biting food, the inability to fully chew, improper sound pronunciation, aesthetic disorders (chin protrusion, altered profile).

Diagnosis: mesial occlusion, gnathic form, reverse incisal disocclusion, reverse sagittal fissure 15 mm, vertical fissure 10 mm, crowded teeth position in the anterior part of the lower jaw, II degree, tooth cake position 4.3, tooth adentia 4.6, tooth closure only in areas 1.7, 4.7 , 4.8 and 2.7, 3.7, 3.8.

Clinical examination, orthopantomography, and teleretgenography with decoding of TRH of the head in lateral projection in the Dolphin Imaging program (USA) were performed. The following diagnostic points are applied to the x-ray according to their anatomical location and a graphic image of changes in the parameters of the dentofacial system in patient R. is obtained (Fig. 1):

Porion (Po) - the highest point on the contour of the external auditory canal

Orbitale (Or) - the lowest point of the lower edge of the orbit

RT Point - the intersection of the lower boundary of the circular opening and the posterior wall of the pterygo-maxillary fissure

Sella (Se) - midpoint of the Turkish saddle

Nasion (N) - point on the anteroposterior margin of the nasolabial suture in the mid-sagittal plane

Basion (Ba) - the lowest point of the clivus, corresponding to the front edge of the large occipital foramen

S.T. Glabella - the most anterior point of the frontal bone

Pronasale - the most prominent anterior point of the tip of the nose

Subnasale - the junction of the nasal septum and upper lip

A-Point (A) - the anterior point of the apical basis of the upper jaw, located at the deepest point of transition from the anterior nasal spine to the alveolar process

B-Point (B) - the anterior point of the apical basis of the lower jaw, located at the place of greatest depth of the curve at the border of the body of the lower jaw and the alveolar part

Pogonion (Pog) - the most anterior point of the chin protrusion

Gnation (Gn) - the intersection of the front and lower contours of the chin

Mention (Me) - the most prominent point of the lower contour of the chin

Gonion (Go) - the point of the angle of the lower jaw at the point of intersection with the bisector of the angle formed by tangents along the lower edge of the body and the posterior edge of the lower jaw branch

Articulare (Ar) - located on the posterior-upper edge of the lower jaw branch, in the place of contact of this edge with the temporal bone

Condylon (C) - the most protruding point on the posterior contour of the head of the lower jaw

Spina nasalis anterior (ANS) - anterior nasal spine

Spina nasalis posterior (PNS) - posterior nasal spine

U6 Occlusal - top of the mesial-buccal tuber of the first molar of the upper jaw

L6 Occlusal - apex of the mesial-buccal tuber of the first molar of the upper jaw

U6 Distal - the distal surface of the upper first molar

U6 Mesial - mesial surface of the upper first molar

L6 Distal - the distal surface of the lower first molar

L6 Mesial - mesial surface of the lower first molar

L1 Tip - the top of the lower central incisor

L1 Root - apex of the root of the lower central incisor

U1 Tip - top of the upper central incisor

U1 Root - the apex of the root of the upper central incisor.

Based on the set points, we determine the values of 37 parameters, compare the individual values of the parameters of patient R. with the norm.

Indications are tabulated.

We identify deviations of the parameters from the norm (Fig. 1). Given the parameters that have deviations from the norm, we make a diagnosis and draw up a treatment plan. Based on the studied parameters, the diagnosis was made: mesial occlusion and a complex orthodontic and surgical treatment was prescribed. The treatment included the fixation of Damon vestibular metal braces (Ormco, USA) on the teeth of the upper and lower jaws using the composite material Blu-Gloo (USA). A full-length steel arc of 0.14 CuNiTi was installed. After 2 months, the arc changes to 0.16 CuNiTi. After another 3 months, the arc changes to 0.18 CuNiTi. Six months after fixing the bracket system, the patient underwent two operations at the Department of Maxillofacial Surgery and Dentistry at the SamGMU Clinics Clinic at the Department of Maxillofacial Surgery: bilateral sagittal osteotomy in the lower jaw and Le Fort I osteotomy in the upper jaw. One month after the operation, they performed TRG and OPTG, changed the arc to 0.16 × 0.25 CuNiTi. Decrypted TRG in the program Dolphin Imaging (Fig. 2), received a result close to normal.

At the end of the course of treatment, repeated x-ray studies are performed (Fig. 3). Again, 37 parameters are studied and compared with the initial values. They evaluate the dynamics of changes in the indicators and, based on this, make a forecast about the duration of treatment and, in the event of normalization of the change in parameters, make a conclusion about the results of treatment.

The invention improves the accuracy of diagnosis and the quality of treatment of dentofacial anomalies, taking into account the individual characteristics of the patients. The present invention allows to demonstrate to patients a graphic overlay of changes in the parameters of the dentition on the face profile before and after orthodontic treatment (Fig. 4)

If the diagnostics of this maxillofacial anomaly used the previously known methods for the diagnosis of TRH in the lateral projection (Bjork; Gwartz; Ricketts), then the necessary morphological parameters of the dentofacial system (Occ. Plane to SN; N-ANS / ANS-Me ; L6-MP), allowing to give exact dimensions for surgical interventions on the upper and lower jaws (osteotomy).

Claims (32)

A method for evaluating dentoalveolar anomalies, including teleroentgenography with decoding of TRG of the head in lateral projection in the Dolphin Imaging program (USA), after which the following diagnostic points are applied to the image, according to their anatomical location: Porion (Po) - the highest point on the contour of the external auditory canal, Orbitale (Or) - the lowest point of the lower edge of the orbit, PT Point - the intersection of the lower boundary of the circular opening and the posterior wall of the pterygo-maxillary fissure, Sella (Se) - the midpoint of the Turkish saddle, Nasion (N) - a point on the anteroposterior margin of the nasolabial suture in the mid-sagittal plane, Basion (Ba) - the lowest point of the clivus, corresponding to the front edge of the large occipital foramen, S.T. Glabella is the most anterior point of the frontal bone, Pronasale is the most prominent anterior point of the tip of the nose, Subnasale - the junction of the nasal septum and upper lip, A-Point (A) - the anterior point of the apical basis of the upper jaw, located at the deepest point of transition from the anterior nasal spine to the alveolar process, B-Point (B) - the anterior point of the apical basis of the lower jaw, located at the place of greatest depth of the curve at the border of the body of the lower jaw and the alveolar part, Pogonion (Pog) - the most front point of the chin protrusion, Gnation (Gn) - the intersection of the front and lower contours of the chin, Mention (Me) - the most prominent point of the lower contour of the chin, Gonion (Go) - the point of the angle of the lower jaw at the point of intersection with the bisector of the angle formed by the tangents along the lower edge of the body and the posterior edge of the lower jaw branch, Articulare (Ar) - located on the posterior upper edge of the lower jaw branch, at the point of contact of this edge with the temporal bone, Condylon (C) - the most protruding point on the posterior contour of the head of the lower jaw, Spina nasalis anterior (ANS) - anterior nasal spine, Spina nasalis posterior (PNS) - posterior nasal spine, U6 Occlusal - top of the mesial-buccal tuber of the first molar of the upper jaw, L6 Occlusal - top of the mesial-buccal tuber of the first molar of the upper jaw, U6 Distal - the distal surface of the upper first molar, U6 Mesial - mesial surface of the upper first molar, L6 Distal - the distal surface of the lower first molar, L6 Mesial - mesial surface of the lower first molar, L1 Tip - top of the lower central incisor, L1 Root - the top of the root of the lower central incisor, U1 Tip - top of the upper central incisor, U1 Root - the top of the root of the upper central incisor, values of 37 parameters are determined from the set points: SNA (°), SNB (°), ANB (°), FMA (MP-FH) (°), FH-SN (°), Facial Plane to SN (SN-NPog) ( °), Saddle / Sella Angle (SN-Ar) (°), Lower Gonial Angle (Na-Go-Me) (°), Facial Axis-Ricketts (NaBa-PtGn) (°), Gonial / Jaw Angle (Ar- Go-Me) (°), Wits Appraisal (mm), Anterior Cranial Base (SN) (mm), Maxillary length (ANS-PNS) (mm), Go-Pg (mm), Pog-NB (mm), Anterior Face Height (NaMe) (mm), Upper Face Height (N-ANS ') (mm), Lower Face Height (ANS-Me) (mm), Lower Face Height (ANS-Me) (mm), UAFH / LAFH Ratio (N-ANS / ANS-Me) (%), Posterior Face Height (SGo) (mm), PA Face Height (S-Go / N-Me) (%), Ramus Height (Ar-Go) (mm), Articular Angle (°), U1-SN (°), IMPA (L1-MP) (°), Interincisal Angle (U1-L1) (°), Occ Plane to SN (°), L1 Protrusion (L1-APo) ( mm), U6-PT Vertical (mm), L1-MP (LADH) (mm), U6-PP (UPDH) (mm), L6-MP (LPDH) (mm), Overbite (mm), Overjet (mm) , U1-NA (°), L1-NB (°), U1-Palatal Pla ne (°), based on a comparison of the individual values of the patient’s parameters with the norm, the presence of their deviations is determined, taking into account which treatment is carried out, at the end of which these parameters are re-evaluated compared to their initial values, on the basis of which a conclusion is drawn on the effectiveness of the treatment.

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