RU2774017C1 - Actuator for mouth opening mechanotherapy device - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to dentistry, and is intended for use in procedures for restoring the kinematics of lower jaw movements. After collecting an anamnesis and making a diagnosis for the patient, the specialist prescribes a mouth opening mechanotherapy using a mouth opening mechanotherapy device containing an occlusal fork for opening the mouth. At the same time, the body is made in the form of a part, in which the support frame is made concave inward, while on the sides of the body there is a guide longitudinal vertical canvas for the lower occlusal fork of the lower jaw, in the upper part of the support frame the upper occlusal fork of the upper jaw is attached, made with the possibility of sagittal movement.

EFFECT: method, due to the use of the principles of biomechanics of the dentoalveolar system, the TMJD and the masticatory muscle group, allows to increase the efficiency and efficiency of restoring the correct kinematics of the movements of the lower jaw.

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Description

The invention relates to medicine, namely to dentistry, and is intended for carrying out procedures for restoring the kinematics of lower jaw movements by using the principles of biomechanics of the dentoalveolar system, temporomandibular joint (TMJ) and masticatory muscle group. This device can be used to treat diseases associated with limited mouth opening and stiffness in the TMJ. In addition, the device is applicable as part of a complex algorithm for the treatment of TMJ diseases according to ICD-10: TMJ pain dysfunction syndrome (Kosten's Syndrome) (K 07.6), internal disorders (K 07.61), recurrent dislocation and subluxation of the TMJ (K 07.62), osteoarthrosis (M 19.OX, M 15.VX), ankylosis (K 07.64). Also, the device is used at the stages of rehabilitation in the pre- and post-operative period of congenital and acquired anomalies (K 10.81, K 10.82), at the stages of functional rehabilitation after achieving osseointegration in the fracture treatment algorithm (S 02.62). In addition, according to indications after surgical treatment, it is used at the stages of functional rehabilitation of diagnoses K 07.56, D 16.40, D 16.41. Also, the device is applicable in cases of rehabilitation of the kinematics of movements of the lower jaw as part of the algorithm for treating patients with muscle diseases (M 61.VX, M 62.VX), myofascial pain (K 07.63), contracture - TMJ stiffness, which is not classified in other headings (K 07.64). In addition to all this, the device is recommended as an auxiliary device as part of the author's treatment algorithms: “Alg_DrobyshevShipika diagnostic and treatment algorithm for TMJ diseases in patients with malocclusion .02076881.01018-01 99 01) and “Results of using platelet-rich blood plasma enriched with growth factors in the treatment of diseases TMJ-PRGF-DSM". Also, the device can be used in the postoperative period of functional rehabilitation of patients based on the approaches described in the patent - "Method for minimally invasive surgical treatment of internal disorders of the temporomandibular joint using arthrocentesis with arthrolavage" (2576787(13) C1) [MPK A61C19/00]. Moreover, the device is mandatory in the protocol of complex rehabilitation of patients after TMJ arthroplasty with both partial endoprostheses of the articular cavity and complete prostheses of the head of the condylar process and articular fossa. Also, the device has positively proven itself in the treatment of patients with spastic hypertonicity of the masticatory muscles of various origins and the elimination of muscular dystonia. In addition, mechanotherapy with this device is recommended for patients at the stages of orthodontic treatment using elastic intermaxillary traction to prevent contractures and limit the kinematics of articular elements. Moreover, the effectiveness of the device has been proven in all cases to restore the amount of mouth opening after orthognathic operations and operations for resection of the coronoid process.

Also, mechanotherapy with the indicated device according to the protocol for combining sagittal and vertical movements of the lower jaw is recommended with the simultaneous use of physiotherapy (ultraphonophoresis, electrophoresis, diadynamic currents, transcutaneous electrical nerve stimulation, etc.), which contributes to the formation of the correct remodeling vector of the articular elements of the TMJ and the formation of physiological bioelectrical activity of masticatory muscles .

The prior art is known PASSIVE TRANSLATOR LOWER JAW [US5846212 (A), publ. 12/08/1998], characterized in that it includes, in order to achieve omnidirectional movement of the patient's lower jaw, a plate for moving the upper jaw, with a mouthpiece attached to it, necessary for temporary fixation of the dentition of the patient's upper jaw. In this case, the movement control plate is inserted between the movement plates of the upper and lower jaws. The guide slots of the respective plates, which may be straight or curved, are positioned at 90 degrees to allow relative omnidirectional translational positioning and movement of the translation plates for subsequent selective omnidirectional therapeutic or diagnostic positioning. The movement drive is supported by one of the translation plates and has a mechanical interaction with the translation plates of the upper and lower jaw and serves to provide protrusive, retrusive and lateral movement of the mandible and mouthpiece for the corresponding omnidirectional protruding, retrusive and lateral therapeutic movement of the patient's mandible or for diagnostic positioning and movements of the lower jaw.

The disadvantages of analog are:

- this technical solution during the mechanotherapy of opening the mouth does not realize the possibility of reproducing the sagittal translational movement of the lower jaw forward with the implementation of the translational movement of the head of the condylar process of the lower jaw;

- the design of this solution is inconvenient and cumbersome;

- the degree of opening of the mouth is not regulated.

Also from the prior art APPARATUS FOR MECHANOTHERAPY FOR DYSFUNCTIONAL SYNDROMES, ARTHROSIS AND ANKYLOSIS OF THE TEMPOROMANDIAN JOINTS [RU 2440063 C1, publ. 01/20/2012], characterized in that it includes a cylindrical body equipped with a spring connected by a cable to a handle and rods located perpendicular to the axis of the body and the spring. The rods are installed with the possibility of moving along the slot coaxial with the body in the reciprocating and perpendicular direction, enclosed in a casing and their ends are rigidly connected to the impression tray on the lower jaw. On the screw-nut of the body, a pair of rods also perpendicular to the spoon on the upper jaw is fixed, which are provided with hinges at the ends to allow the spoon to tilt by 10-15°.

The disadvantages of this analogue are:

- the inherent design features of this technical solution during operation do not allow to reproduce and, accordingly, correct the correct mechanics and kinematics of the mouth opening.

The closest in technical essence are the SIMULATOR FOR POSTOPERATIVE OPENING OF THE MOUTH FOR THE TEMPOROMANDIAN JOINT [CN 213373519 (U), publ. 06/08/2021], characterized in that it contains a plate for opening the mouth and a connecting rod, while one side of the plate for opening the mouth is connected to the connecting rod. Fixed connection, both sides of the connecting rod are slidably connected to the support rod, the upper surface of the connecting rod is threaded to the rotating rod. The middle part is rigidly connected to the middle rod, the top of the rotating rod is movably connected to the U-rod, and one side of the U-rod is rigidly connected to the base plate, so the bottom surface of the U-rod is movably connected to the movable rod through the bottom plate and one side a movable rod that is movably connected to the inner plate through a connecting shaft. The surface is movably connected to the outer tube, the upper surface of the outer tube is movably clamped to the rod through the fixing tube, and the upper surface of the clamping rod is fixed.

The main technical problem of the prototype is that in this technical solution, the mouth opening training is performed without taking into account the mechanics and kinematics of the mouth opening, namely, the mouth opening is not performed along the correct physiological curve. Also, this device does not implement the sagittal translational movement of the lower jaw forward with the implementation of the translational movement of the head of the condylar process of the lower jaw.

The objective of the invention is to eliminate the disadvantages of the prototype.

The technical result of the invention is to increase the efficiency and speed of restoring the correct kinematics of the movements of the lower jaw.

The specified technical result is achieved due to the fact that the actuator for the device for mechanotherapy of opening the mouth, containing an occlusive fork for opening the mouth, characterized in that the body is made in the form of a part in which the support frame is made concave inward, while on the sides of the body there is a longitudinal guide a vertical canvas for the lower occlusal fork of the lower jaw; in the upper part of the support frame, the upper occlusal fork of the upper jaw is attached, made with the possibility of sagittal movement.

In particular, the side projection of the support frame is in the form of a Posselt curve.

In particular, the lower occlusal fork of the lower jaw is kinematically connected to the body.

In particular, the lower occlusal fork of the lower jaw has a retention arcuate strip in the form of a semi-ellipse in the form of a side.

In particular, the lower and upper occlusal forks of the upper and lower jaws have perforations.

In particular, the fixation of the lower occlusal fork of the lower jaw is made with the possibility of rotation, the amplitude of which lies in the range from 3 to 7 degrees.

In particular, the upper occlusal fork of the upper jaw is made with the possibility of sagittal movement within 10 mm.

In particular, the housing on the opposite side relative to the support frame is made of an elongated shape, while on the sides the elongated part is sequentially connected by means of hinged joints to the graduated power frame of the main lever and the main lever itself for the lower occlusal fork of the lower jaw.

In particular, seven perforations were made on the upper occlusal fork of the upper jaw, and four holes on the lower one.

Brief description of the drawings

In FIG. 1 shows a general view of the mouth opening mechanotherapy device.

In FIG. 2 shows a general view of the occlusal fork.

In FIG. 3 shows a rear view of the device.

The figures indicate: 1 - device body, 2 - finger stop of the sagittal piston, 3 - sagittal piston, 4 - support platform of the finger stop, 5 - stabilization finger stop, 6 - support trigger, 7 - body of the main Posselt mechanism, 8 - support frame Posselt guide, 9 - Posselt guide canvas, 10 - hinges, 11 - main lever, 12 - graduated power frame of the main lever, 13 - spikes, 14 - lower occlusal fork for the lower jaw, 15 - upper occlusal fork for the upper jaw, 16 - perforations, 17 - arcuate retention strips, 18 - graduated holes, 19 - locking cylinder.

Implementation of the invention

The mouth opening mechanotherapy device is made from the articulation of two mating parts 1 by bolted connections through mounting holes. In the front part of the device there is a finger stop of the sagittal piston 2 mounted on the sagittal piston 3 by means of the support platform of the finger stop 4. In the lower front of the device behind the support platform of the finger stop 4 there is a stabilization finger stop 5. Opposite the stabilization finger stop 5 from below, closer to the front of the device there is a support trigger 6, behind which the body 7 is located, in which the support frame 8 is made curved, while in the middle part along the sides along the body 7, the canvases of the Posselt guide 9 are made. at the other end of which there is a hinge 10 for graduated power frames of the main arm 12, which, on the other hand, are fixed with spikes 13 in the side canvases of the Posselt guide 9 and have a kinematic connection with the lower occlusal fork for the lower jaw 14. In the front of the device, there is an upper occlusal fork for the upper jaw and 15, which is a response to the lower occlusal fork for the lower jaw 14. In this case, the lower 14 and upper 15 occlusal forks for the jaws are made in the form of symmetrical arcuate parts. The occlusal forks of the upper and lower jaws 14, 15 have perforations 16, and in the front part of the lower occlusal fork for the lower jaw there is a retention arcuate strip 17. In addition, graduated holes 18 are located on each graduated power frame of the main lever, into which the locking cylinder is inserted. 19.

The mouth opening mechanotherapy device is used as follows.

Initially, after collecting an anamnesis and making a diagnosis for the patient, the specialist prescribes mechanotherapy for opening the mouth using a device for mechanotherapy for opening the mouth according to the 777/555 protocol, which includes two phases:

Phase 1 is performed according to the "7-7-7" protocol for three weeks, is aimed at restoring the vertical mobility of the TMJ joint and includes: seven vertical stretching movements activated by pressing the patient's leading hand on the main lever 11, lasting seven seconds, performed seven once a day. In total, such a cycle takes less than ten minutes a day. The minimum expected results of treatment are 1.5-2 mm per week of increasing the size of the mouth opening.

Phase No. 2 is performed according to the "5-5-5" protocol for three weeks, is carried out immediately after the movements are performed according to the "7-7-7" protocol, is aimed at restoring the kinematics of the sagittal mobility of the lower jaw within the angle of the specified sagittal-articular path and includes into itself: five movements activated by pressing the finger stop of the sagittal piston 2 with the main hand of the patient while fixing the device with the other hand using the stabilization finger stop 5 or the support trigger 6, depending on the comfort of the grip. At the same time, phase No. 2 can be extended if necessary, in agreement with the attending physician or specialist without restrictions.

In addition, before using the device, it is necessary to retain the impression material or similar material used to individually modify the support bed of the occlusal surface of the fork. To do this, perforations 16 are made in the lower and upper occlusal forks for jaws 14.15: seven on the upper fork, and four on the lower fork.

In general, to use the device according to the prescribed treatment plan, the patient takes the device and positions the hands as described above for each of the phases. After the patient, opening his mouth, places the dentition of the upper jaw on the upper occlusal fork for the upper jaw 15, and the lower jaw leads behind the lower occlusal fork for the lower jaw 14 and places the dentition of the lower jaw on it. At the same time, the lower occlusal fork for the lower jaw has a retention arcuate strip 17 in the form of a semi-ellipse according to the type of side, which rises above the plane of the fork by 1.2 mm. This constructive solution is necessary for the possibility of modifying the occlusal fork with silicone or hybrid material according to the morphology of the occlusal surface of the lower jaw and the dentition. Such a constructive solution allows the lower jaw to be displaced sagittally forward relative to the upper one according to the trajectory of the sagittal articular path within the limits of maintaining the angle of the sagittal articular path of about 33-35 degrees (physiological norm according to Gizi) and the possibility of adaptation within 5-7 degrees due to the rotational mechanism of fixing the lower occlusal fork 14 along the individual inclination of the occlusal plane, which ultimately has a positive effect on the remodeling of the intraarticular disc and its posterior pole, the restoration of the tone of the lateral pterygoid muscles and the formation of the shape of the head of the condylar process of the lower jaw, as well as the restoration of optimal kinematic movements within the physiological volume.

When performing stretching movements using the device, the lower occlusal fork for the lower jaw 14 with the lower jaw located on it is kinematically connected to the body 7 and moves along the trajectory of the Posselt figure, given by the outline of the Posselt guide 9 of the support frame 8 of the corresponding radius. At the same time, the fixation of the lower occlusal fork of the lower jaw is structurally modeled with the possibility of rotation from three to seven degrees to level the inclination of the occlusal plane of the lower jaw dentition and ensure uniform distribution of the load over the entire trajectory of the active phase of mouth opening. And the upper occlusal fork of the upper jaw is made with the possibility of longitudinal (sagittal) movement within 10 mm, which corresponds to the maximum possible physiological protrusion movement of the lower jaw. Also, for a controlled process of stretching exercises, on each graduated power frame of the main lever there are four graduated holes 18, into which the locking cylinder 19 is inserted. Installing the locking cylinder 19 in the corresponding holes sets the necessary degree of restriction of movement of the lower occlusal fork of the lower jaw 14, which allows you to protect the patient from receiving traumatic effects.

Thus, the use of the studied technical solution makes it possible to increase the efficiency and efficiency of restoring the correct kinematics of the movements of the lower jaw.

An example of achieving a technical result:

Patient M, 45 years old, complained of pain in the lower jaw on the left, radiating to the temple and aggravated by movement of the lower jaw, as well as restriction of mouth opening, a feeling of heaviness and stiffness in the masticatory muscles.

Anamnesis: for several years there were clicks when opening the mouth on the left. Two months before going to the clinic, with a wide opening of the mouth, there was a sharp pain in the region of the temporomandibular joint on the left and limitation of mouth opening.

Clinical examination:

On external examination: the configuration of the face is changed by reducing the height of the lower third of the face.

When examining the oral cavity: the mucous membrane is pale pink, moderately moistened. There is a partial secondary absence of teeth and the presence of orthopedic structures.

During palpation of the masticatory muscles, moderate pain is noted in the region of the masticatory and temporal muscles and severe pain at the projection points of the lateral pterygoid muscles. Articular noises were not determined, mouth opening was limited to 25 mm, mandibular flexion to the left was noted. The level of pain on the visual analog scale of pain (VAS) - 8 POINTS.

Additional examination methods

Magnetic resonance imaging:

arthrosis of the right TMJ of 1-2 degrees, partial ventro-lateral dislocation of the articular disc with reposition, low degree joint hypomobility, fibrosis of the bilaminar structure;

arthrosis of the left temporomandibular joint of the 2nd degree, synovitis, complete ventral dislocation of the articular disc without reposition, low degree of joint hypomobility, pronounced signs of functional overload of the lateral pterygoid muscles.

Surface electromyography before treatment: a pronounced asymmetry in the distribution of bioelectrical activity between the temporal and masticatory muscles on the right and left, revealed hypertonicity of the masticatory muscles - IMPACT = 2932 μV (according to the study criteria, the normal values of the IMPACT index do not exceed 1500 μV).

Diagnosis: deforming osteoarthritis of the temporomandibular joint on the right and left, internal disorders of the temporomandibular joint on the right and left, synovitis of the temporomandibular joint on the left, hypertonicity of the masticatory muscles, muscular dystonia.

Comprehensive treatment plan:

1. Production of an occlusion-stabilizing apparatus in the position of the central ratio of the jaws (“Algorithm for the diagnosis and treatment of TMJ diseases in patients with malocclusion”, copyright certificate of the electronic resource No. 19989 2014).

2. Carrying out minimally invasive surgical techniques for the treatment of TMJ diseases with the introduction of hyaluronic acid and blood plasma enriched with growth factors (“Method for minimally invasive surgical treatment of internal disorders of the temporomandibular joint using arthrocentesis with arthrolavage” RF Patent No. 2576787 2016).

3. Introduction of the neuroprotein preparation into the masticatory muscles according to the EMG scheme.

4. Mouth opening mechanotherapy with a device for mouth opening mechanotherapy – “OpenWide” device.

5. Stabilization of the constructive occlusion in the position of the central ratio of the jaws by the method of rational prosthetics.

6. Dynamic observation.

In view of the difficult financial situation, according to the patient, as well as the presence of concomitant pathology of the gastrointestinal tract and fears about surgical procedures and injections, the patient refused the first three stages of treatment. It was proposed to conduct a course of mechanotherapy using a patented device to restore the size of the mouth opening and the function of eating. Additionally, Voltaren gel was prescribed in the TMJ area on the right and left 2 times a day for 7 days locally. At the same time, mechanotherapy with the help of the claimed device was recommended according to the protocol "777/555". On the 14th day after the start of the cycle of mechanotherapy with the claimed device, a positive trend was noted due to an increase in the amplitude of mouth opening by 40% relative to the baseline (before treatment - 25mm, after treatment - 35mm), leveling of pain by 50%. On palpation of the masticatory, temporal and lateral pterygoid muscles, pain is noted, opening the mouth more than 3 cm is accompanied by discomfort and pain mainly in the masticatory and lateral pterygoid muscles. Conducted control surface electromyography of masticatory muscles. According to the results of the examination: there was a slight asymmetry in the distribution of bioelectrical activity between the temporal and masticatory muscles on the right and left. The total bioelectrical activity of the masticatory muscles 14 days after the application of mechanotherapy with the help of the claimed device decreased by 8% relative to the data obtained before treatment (IMPACT=2932 μV). At the same time, the hypertonicity of the masticatory muscles was preserved (IMPACT=2693 μV). 42 days after the passage of two phases of the mechanotherapy cycle according to the 777/555 protocol, the patient noted a significant decrease in pain, a feeling of stiffness in the muscles, an increase in the amplitude of mouth opening up to 41 mm, which fits into the boundaries of the physiological norm. The increase in the mouth opening value, at the maximum value of the physiological norm of 45 mm, was 36% (55% of the norm before treatment and 91% after mechanotherapy). At the same time, a decrease in the total amplitude of the bioelectrical activity of the masticatory muscles was noted based on the IMPACT index during compression in occlusion by 52%. The increase in the protrusion movement of the lower jaw relative to the maximum value of the physiological norm of 10 mm (100%) ranged from 70% to 93% relative to the maximum norm. The severity of pain when opening the mouth and movements of the lower jaw according to VAS decreased by 50% of the initial value. Thus, the use of the device is effective as part of the complex treatment algorithm.

In addition, to confirm the claimed technical result and evaluate the effectiveness of the mouth opening mechanotherapy device according to the protocol "777/555", 23 patients were examined with a total duration of six weeks.

Criteria for inclusion in the study:

1) men and women from 21 to 55 years of age;

2) patients with TMJ diseases.

Criteria for exclusion from the study:

1) patients who could not or did not want to make all the necessary visits to the doctor;

2) pregnant women or women who were planning a pregnancy during this study or women who are lactating.

Study Exclusion Criteria: Patients who cannot complete all stages of the study or refuse to continue participation in the study are excluded from the study, including:

1) patients who refuse to perform any diagnostic procedures, if there is no possibility of replacing them with other methods in accordance with the study protocol;

2) patients in whom contraindications to any type of examination are revealed in the course of the study, in the absence of such at the stage of preliminary selection.

As a selection criterion for the study group, the coincidence of the triad of signs was taken:

1) the presence of pain syndrome;

2) restriction of mouth opening;

3) internal disorders of the TMJ according to MRI (ICD-10C K07.6).

All patients recorded the amplitude of mouth opening and the nature of the movements of the lower jaw and recorded the difference between studies and normal values. With the maximum opening of the mouth, the distance between the cutting edges of the upper and lower incisors (normally from 40 to 50 mm), the amplitude of the anterior movement of the lower jaw (protrusion) is normally about 10 mm. At the same time, the amplitude of active mouth opening (in mm), protrusion movements of the lower jaw (in mm) relative to the values of the physiological norm, the presence and localization of pain sensations during the performance of the main types of movements of the lower jaw according to VAS from 0 to 10, where 0 is the absence of pain, were documented. , and 10 - unbearable pain.

The values of the main parameters of all patients at the time of treatment were as follows:

The average value of the mouth opening (in mm) was 35.4 mm, sigma S - 4.79, the error of the mean (m) parameter - 0.1. The mean value of the pain assessment parameter at the maximum opening of the mouth on a 10-point visual analogue scale (VAS) was 7.22 points, sigma S - 1.62, the error of the mean (m) parameter - 0.34. The maximum possible average (m) protrusion movement of the lower jaw forward (protrusion) was 7.78 mm, sigma S - 1.59, the error of the average (m) parameter - 0.33.

After evaluating the results of using the proposed device according to the protocol "777/555" for six weeks, the following results were obtained: the size of the mouth opening increased by 23.5% (8.3 mm), the decrease in the severity of pain during the maximum opening of the mouth according to VAS by 61% (4.4 points), an increase in the maximum possible protrusion displacement of the lower jaw forward by 19.7%.

Claims (9)

1. An actuator for mechanotherapy of opening the mouth, containing an occlusal fork for opening the mouth, characterized in that the body is made in the form of a part in which the support frame is made concave inwards, while on the sides of the body there is a guide longitudinal vertical canvas for the lower occlusal fork of the lower jaw , in the upper part of the support frame, the upper occlusal fork of the upper jaw is attached, made with the possibility of sagittal movement. 2. The mechanism according to claim 1, characterized in that the side projection of the support frame is made in the form of a Posselt curve. 3. The mechanism according to claim 1, characterized in that the lower occlusal fork of the lower jaw is kinematically connected to the body. 4. The mechanism according to claim 1, characterized in that the lower occlusal fork of the lower jaw has a retention arcuate strip in the form of a semi-ellipse in the form of a side. 5. The mechanism according to claim 1, characterized in that the lower and upper occlusal forks of the upper and lower jaws have perforations. 6. The mechanism according to claim 1, characterized in that the fixation of the lower occlusal fork of the lower jaw is made with the possibility of rotation, the amplitude of which lies in the range from 3 to 7 degrees. 7. The mechanism according to claim 1, characterized in that the upper occlusal fork of the upper jaw is made with the possibility of sagittal movement within 10 mm. 8. The mechanism according to claim 3, characterized in that the body on the opposite side relative to the support frame is made of an elongated shape, while on the sides the elongated part is sequentially connected by means of hinged joints to the graduated power frame of the main lever and the main lever itself for the lower occlusal fork of the lower jaw . 9. The mechanism according to claim 5, characterized in that seven perforations are made on the upper occlusal fork of the upper jaw, and four holes on the lower.

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