RU2840238C1 - Method for planning orthodontic treatment of patients with narrowing of upper jaw - Google Patents

Abstract

FIELD: medical science.

SUBSTANCE: invention refers to medicine, namely to dentistry, and can be used for a method of orthodontic treatment planning in the patients with upper jaw contraction wherein at the first stage the patient is interviewed to detect dentition complaints and nasal breathing. Second stage involves cone-beam computed tomography. Determining the width in the region of the side walls of the nasal cavity, the width in the region of the alveolar crest of the upper jaw at the level of the apex of buccal roots of the molars, the width in the region of the apex of palatine roots of the first molars, for this purpose, the PRAr point is marked on the image, located in the region of the apex of palatine roots of the first molars on the right, the width in the region of bifurcation of the roots of the upper first molars, width is determined in area of most protruding point of lower edge of alveolar process of upper jaw, determining width in region of vestibular surface of tooth crown, width is measured within an apex of mesiobuccal cusps of a first molar of an upper jaw. Third stage involves estimating a stage of the median palatine suture formation by analysing the CBCT imaging data in a frontal projection obtained at the second stage at a segment length. Fourth stage involves estimating a degree of nasal septum curvature in a frontal plane. That is followed by determining a degree of nasal septum curvature in a frontal plane by formula. At the fifth stage, the orthodontic apparatus for maxillary dilatation is selected on the basis of the stage of median palatal suture formed at the third stage and a degree of nasal septum distortion in the frontal plane (SI) determined at the fourth stage.

EFFECT: method provides accurate diagnosis when planning treatment, high accuracy of height correction and formation of dentofacial system in children, due to taking into account changes at skeletal level in several areas, measurement of curvature of nasal septum.

2 cl, 10 dwg, 2 ex

Description

The invention relates to medicine and is intended for selecting a device for expanding the upper jaw when planning orthodontic treatment for patients with narrowing of the upper jaw.

Orthodontic expansion of the jaws is a frequently used method of treating dentoalveolar anomalies. Most often, expansion is necessary in the case of a narrowed or transversely underdeveloped upper jaw. Transverse underdevelopment of the upper jaw causes a disruption of the chewing function due to the incorrect relationship of the lateral antagonist teeth, which disrupts the function of breathing, speech and changes the appearance of a person (abstract of Galiullin M.V. Diagnostics and treatment of dentoalveolar anomalies with a narrowed frontal section of the upper jaw // Perm. - 2008. - 23P. - 2008).

Narrowing of the upper jaw is a pressing problem and requires treatment, since untreated narrowing leads to severe dysfunction of the temporomandibular joint and periodontal disease. Narrowing of the upper jaw can be corrected using orthodontic or surgical rapid expansion of the upper jaw. In this case, the role of modern radiation research methods for diagnostics and at all stages of treatment is great (Al D.A.K., Ulyanovskaya S.A., Bazhenov D.V. Features of the use of modern radiation methods in the diagnosis and treatment of narrowing of the upper jaw // Modern problems of morphology. - 2020. - P.15-17).

To treat narrowing of the upper jaw, devices for expansion and extension of the upper jaw are used, which are selected based on a photograph of the patient's face and dentition, 3D scanning of the dentition, cephalometry, orthopantomography and cone beam computed tomography (CBCT) (A., Nasimov E. E., Abudkadyrova N. B. A case of treating narrowing of the upper jaw using a modified device for expansion and extension of the upper jaw // Conferences Tashkent State Dental Institute. - 2022. - P. 35-36.).

It is also known that narrowing of the upper jaw negatively affects the formation of the nasal septum and often causes its curvature (Babakhanov G. et al. Narrowing of the upper jaw and nasal cavity //Central Asian Journal of Pediatrics. - 2019. - Vol. 2. - No. 1. -P. 159-165). At the same time, expansion of the upper jaw is also known to influence the treatment of curvature of the nasal septum (Gokce G. et al. Efficiency evaluation of rapid maxillary expansion treatment on nasal septal deviation using tortuosity ratio from cone-beam computer tomography images //Computer methods and programs in biomedicine. - 2020. - Vol. 188.-P. 105260).

From (Losev F.F. et al. Algorithms for orthodontic treatment of patients with narrowing of the upper jaw based on the stages of formation of the median palatine suture. - 2022) a method of orthodontic treatment of patients with narrowing and deformation of the upper jaw during the permanent bite is known based on the analysis of cone beam computed tomography data, in which orthodontic treatment was carried out using palatal expanders with tooth-mounted and intraosseous fixation. All patients underwent radiographic examinations (cone beam computed tomography) before and after the expansion of the upper jaw. According to the proposed cephalometric analysis, an assessment was made of the degree of narrowing of the upper jaw, the inclination of the lateral group of teeth, and the degree of the stage of formation of the median palatine suture: External width of the upper jaw: EBW - a line running parallel to the lower border of the cone beam computed tomography image at the level of the hard palate; BAB is a line passing at the level of the buccal alveolar ridge; EWr, EWl are the line of the width of the external alveolar arch passing along the surface between the closest points along the equator of the crowns of the lateral group of teeth; PFr, PFl are the line of the width of the external alveolar arch passing at the level between the deepest points of the longitudinal fissures of the lateral teeth. Inner width of the upper jaw: HPI is the width of the hard palate; ArAl is the width between the apices of the palatine roots of the lateral teeth; РАВ is a line passing at the level of the palatine alveolar ridge; PWr, PWl are the line of the width of the internal alveolar arch passing along the most pronounced area of the palatal surface of the lateral group of teeth; BFr, BFl are the vertical axis of the tooth passing through the area of the bifurcation of the roots and the deepest points of the longitudinal fissures of the lateral teeth. Based on the obtained measurements, a method for treating the upper jaw was selected.

The disadvantage of this method is that it measures the parameters of the width of the upper jaw only at the level of the molars, the selected parameters do not include the nasal area and do not take into account changes in the width of the pyriform aperture, the nasal cavity, and this analysis does not consider the parameters of the curvature of the nasal septum, which in turn affects the improvement of nasal breathing and helps in choosing the type of fixation of the future orthodontic device.

Thus, the objective of the proposed method is to develop a method for planning orthodontic treatment for patients with narrowing of the upper jaw, which would eliminate the shortcomings of the current level of technology and ensure obtaining a complete clinical picture before and after treatment, which helps to achieve the best and predictable treatment results.

The technical result of the claimed method is high diagnostic accuracy in treatment planning and high accuracy of growth correction and formation of the dentofacial system in children, due to, among other things, taking into account changes at the skeletal level in several areas (upper jaw, nasal cavity), measuring the curvature of the nasal septum, which in turn ensures high diagnostic accuracy and treatment planning and has a positive and accurate effect on the growth and formation of the dentofacial system in children.

The technical result is achieved in that the method for planning orthodontic treatment of patients with narrowing of the upper jaw contains five stages, in which, at the first stage, the patient is interviewed to identify complaints about the location of the teeth, nasal breathing, then, at the second stage, cone beam computed tomography (CBCT) is performed to obtain CBCT image data in the frontal projection, after which, at the third stage, the stage of formation of the median palatine suture is assessed using the analysis of the CBCT image data in the frontal projection obtained at the second stage, while at the beginning the width in the area of the lateral walls of the nasal cavity is determined, for which purpose the LrWNC point located in the most protruding area of the lateral wall of the nasal cavity on the right is marked on the image, then the LlWNC point located in the most protruding area of the lateral wall of the nasal cavity on the left is marked, the LrWNC- LlWNC segment is drawn from the LrWNC point to the LlWNC point, after which the LrWNC- LlWNC segment is measured, then the width in the area of the bottom of the nasal cavity is determined, for which purpose point NFr is marked on the image, located on the inner lower surface of the bottom of the nasal cavity on the right, then point NFl is marked, located on the inner lower surface of the bottom of the nasal cavity on the left, a segment NFr - NFl is drawn from point NFr to point NFl and the segment NFr - NFl is measured, then the width in the area of the alveolar ridge of the upper jaw at the level of the apex of the buccal roots of the molars is determined for which purpose point LLMBr is marked on the image, located in the area of the alveolar ridge of the upper jaw at the level of the apex of the buccal roots of the molars on the right; then mark the LLMBl point located in the area of the alveolar ridge of the upper jaw at the level of the apex of the buccal roots of the molars on the left, draw a segment LLMBr - LLMBl from the LLMBr point to the LLMBl point and measure the segment LLMBr - LLMBl, then determine the width in the area of the apex of the palatine roots of the first molars, for which mark the PRAr point in the image located in the area of the apex of the palatine roots of the first molars on the right, then mark the PRAl point located in the area of the apex of the palatine roots of the first molars on the left, draw a segment PRAr - PRAl from the PRAr point to the PRAl point and measure the segment PRAr - PRAl, then determine the width in the area of the bifurcation of the roots of the upper first molars, for which mark the FUr point in the image located at the level of the bifurcation of the roots of the upper first molars on the right; then mark the point FUl, located at the level of the bifurcation of the roots of the upper first molars on the left, draw a segment FUr - FUl from point FUr to point FUl and measure the segment FUr - FUl, then determine the width in the area of the most protruding point of the lower edge of the alveolar process of the upper jaw, for which the most protruding point BACr of the lower edge of the alveolar process of the upper jaw on the right is marked in the image, then mark the most protruding point BACl of the lower edge of the alveolar process of the upper jaw on the left, draw a segment BACr - BACl from point BACr to point BACl and measure the segment BACr - BACl, then determine the width in the area of the vestibular surface of the crown of the tooth, located at the level of the equator, for which the most protruding point EWr in the area of the vestibular surface of the crown of the tooth on the right is marked in the image, then mark the most protruding point EWl in the area of the vestibular surface crowns of the tooth on the left, draw a segment EWr - EWl from point EWr to point EWl and measure the segment EWr -Ewl, then determine the width in the area of the apex of the mesio-buccal cusps of the first molar of the upper jaw, for which point AMCr is marked on the image, located in the area of the apex of the mesio-buccal cusp of the first molar of the upper jaw on the right; then point AMCl is marked, located in the area of the apex of the mesio-buccal cusp of the first molar of the upper jaw on the left, draw a segment AMCr - AMCl from point AMCr to point AMCl and measure the segment AMCr - AMCl. In this case, if stage B of the formation of the median palatine suture is established. In this case, if the lengths formation of the median palatine suture. Then, at the fourth stage, an assessment is made of the degree of curvature of the nasal septum in the frontal plane, for which point 1 is marked in the Crista Galli region on the image in the frontal plane, then point 2 is marked in the most protruding part of the middle third of the nasal septum, point 3 at the level of the anterior nasal spine, then points 1 and 2 are connected by segment 1-2, and then points 2 and 3 are connected by segment 1-3, after which segments 1-2, 2-3 are measured, then points 1 and 3 are connected by segment 1-3, and segment 1-3 is measured, then the degree of curvature of the nasal septum in the frontal plane is determined by the formula:

SI = L _1-2-3 / L _1-3 , where: SI is the degree of curvature of the nasal septum in the frontal plane, where:

L _1-2-3 - the actual length of the nasal septum in the frontal plane, determined by the sum of segments 1-2, 2-3,

L _1-3 - the length of the normal to the nasal septum in the frontal plane, determined by the segment 1-3.

At the fifth stage, based on the stage of formation of the median palatine suture established at the third stage and the degree of curvature of the nasal septum in the frontal plane (SI) determined at the fourth stage, an orthodontic device is selected for expanding the upper jaw.

In this case, if the stage of formation of the median palatine suture is B, and the degree of curvature of the nasal septum in the frontal plane (SI) ≤ 100%, an orthodontic appliance with a tooth-type fixation is selected, and if the stage of formation of the median palatine suture is C, and the degree of curvature of the nasal septum in the frontal plane (SI) ≥ 100%, an orthodontic appliance with a hybrid type of fixation is selected.

An option is possible in which, at the third stage, after determining the width in the area of the apex of the mesio-buccal cusps of the first molar of the upper jaw, the width in the area of the apex of the roots of the deciduous canines of the upper jaw is first determined, for which a point located on the apex of the root of the deciduous canine of the upper jaw on the right is marked in the image, then a point located on the apex of the root of the deciduous canine of the upper jaw on the left is marked, a segment RATMCr - RATMCl is drawn from the point RATMCr to the point RATMCl and the segment RATMCr - RATMCl is measured, and then the width in the area of the apex of the cusps of the deciduous canines of the upper jaw is determined, for which a point located on the apex of the cusp of the deciduous canine of the upper jaw on the right is marked in the image, then a point located on the apex of the cusp of the deciduous canine of the upper jaw on the left is marked, a segment TCTMCr - TCTMCl is drawn from the point TCTMCr to the point TCTMCl and the segment is measured TCTMCr - TCTMCl. In this case, if the lengths of the segments , then stage B of the formation of the median palatine suture is established, and if

median palatine suture.

The method may also include a further stage, which consists of treatment planning and selection of the device fixation type based on CBCT studies of the selected morphometric parameters before and after treatment. Depending on the skeletal age of the patient, the stage of maturation of the median palatine suture, the presence of primary supporting teeth, as well as the degree of narrowing of the upper jaw and the presence of mouth breathing in the anamnesis, devices with a tooth-based or hybrid type of fixation were manufactured. After taking impressions, 3D modeling, coordination and manufacturing of the orthodontic device were performed in a dental laboratory. The design of the device with support on the teeth consisted of a Hyrex 10-12 mm expansion screw from Forestadent, processes extending from it, fixed on temporary molars 5.5 and 6.5 using rings and processes on canines 5.3 and 6.3 to provide additional support. The device with cortical support is identical in design, but in addition to the listed elements, it includes abutments that fit tightly to the mucous membrane and are soldered to the base of the Hyrax screw. 3D modeling was performed, an orthodontic device and a template were obtained, which allows for more accurate installation of temporary orthodontic mini-implants. The device is activated for 21-28 days with a fast or slow activation mode, then the device is kept in the oral cavity from 4 to 6 months to stabilize the result.

All measurements in the stated method can be performed either using software on a computer or manually using a ruler and marker.

Brief description of the drawings

Fig. 1. Determination of width parameters according to the claimed method before treatment in the first clinical Example.

Fig. 2. Determination of the degree of curvature of the nasal septum in the frontal plane before treatment in the first clinical example.

Fig. 3. Determination of width parameters according to the claimed method after treatment in the first clinical example.

Fig. 4. Determination of the degree of curvature of the nasal septum in the frontal plane after treatment in the first clinical example.

Fig. 5. Determination of width parameters according to the claimed method before treatment in the second clinical Example.

Fig. 6. Determination of the width parameters in the area of the root apices of the deciduous canines and in the area of the tubercle apices of the deciduous canines of the upper jaw according to the claimed method before treatment in the second clinical Example.

Fig. 7. Determination of the degree of curvature of the nasal septum in the frontal plane before treatment in the second clinical example.

Fig. 8. Determination of width parameters according to the claimed method after treatment in the second clinical Example.

Fig. 9. Determination of the width parameters in the area of the apices of the roots of the deciduous canines and in the area of the apices of the tubercles of the deciduous canines of the upper jaw according to the claimed method after treatment in the second clinical Example.

Fig. 10. Determination of the degree of curvature of the nasal septum in the frontal plane after treatment in the second clinical example.

Implementation of the invention

The following clinical examples are presented as examples of the implementation of the claimed method: Example 1 P., 14 years old, and Example 2 Patient K., 8 years old.

Example 1

Patient P., 14 years old, complains of uneven teeth and nasal breathing; had not previously been treated by an orthodontist.

First, the stage of formation of the median palatine suture was assessed using computed tomography data in the axial (frontal) projection before treatment (Fig. 1):

- LrWNC- LlWNC = 26.00 mm - width in the area of the lateral walls of the nasal cavity;

- NFr - NFl = 15.20 mm - width in the area of the bottom of the lower nasal passages;

- LLMBr - LLMBl = 57.61 mm - width in the area of the alveolar ridge of the upper jaw at the level of the apex of the buccal roots of the molars;

- PRAr - PRAl = 30.80 mm - width in the area of the apex of the palatal roots of the first molars;

- FUr - FUl = 42.42 mm - width in the bifurcation area of the roots of the upper first molars;

- BACr - BACl = 56.41 mm - width in the area of the most protruding point of the lower edge of the alveolar process of the upper jaw;

- EWr - EWl = 55.22 mm - width in the area of the vestibular surface of the tooth crown, located at the level of the equator;

- AMCr - AMCl = 52.80 mm - width in the area of the apex of the mesial-buccal cusps of the first molar of the upper jaw.

The parameters of the width in the area of the root apices and tubercles of the upper jaw milk canines were not determined due to adentia 53.63.

Thus, stage C of the formation of the median palatine suture was established.

Next, we assessed the degree of curvature of the nasal septum in the frontal plane (Fig. 2), in which SI = L _1-2-3 / L _1-3 = 44.1 mm / 41.6 mm = 1.06 = 106%.

Taking into account stage C and SI = 1.06 = 106%, an orthodontic appliance with a hybrid type of fixation was selected, consisting of four rigid processes fixed to teeth 55,65 using orthodontic rings, abutments that fit tightly to the mucous membrane, soldered to the base of the Hyrax screw.

After 21-28 days of wearing the selected orthodontic appliance with a hybrid type of fixation, a repeat CBCT study was conducted, which confirmed the correctness of planning orthodontic treatment for patients with narrowing of the upper jaw and the achievement of high diagnostic accuracy in treatment planning and high accuracy of growth correction and the formation of the dentofacial system in children.

As a result of the assessment (Fig. 3,4 respectively) of the planned orthodontic narrowing of the upper jaw in the treatment:

- LrWNC - LlWNC = 31.37 mm - width in the area of the lateral walls of the nasal cavity;

- NFr - NFl = 15.62 mm - width in the area of the bottom of the lower nasal passages;

- LLMBr - LLMBl = 56.99 mm - width in the area of the alveolar ridge of the upper jaw at the level of the apex of the buccal roots of the molars;

- PRAr - PRAl = 41.19 mm - width in the area of the apex of the palatal roots of the first molars;

- FUr - FUl = 48.83 mm - width in the bifurcation area of the roots of the upper first molars;

- BACr - BACl = 61.08 mm - width in the area of the most protruding point of the lower edge of the alveolar process of the upper jaw;

-EWr - EWl = 63.09 mm - width in the area of the vestibular surface of the tooth crown, located at the level of the equator;

- AMCr - AMCl = 61.59 mm - width in the area of the apex of the mesial-buccal cusps of the first molar of the upper jaw;

- the degree of curvature of the nasal septum in the frontal plane SI = 26.08 mm/26.35 mm = 0.989=98.9%.

Example 2

Patient K., 8 years old, came with complaints of uneven teeth, nasal breathing, had not been treated by an orthodontist before.

First, the stage of formation of the median palatine suture was assessed using computed tomography data in the axial (frontal) projection before treatment (Fig. 5,6):

- LrWNC - LlWNC = 27.20 mm - width in the area of the lateral walls of the nasal cavity;

- NFr - NFl = 16.10 mm - width in the area of the bottom of the lower nasal passages;

- LLMBr - LLMBl = 58.00 mm - width in the area of the alveolar ridge of the upper jaw at the level of the apex of the buccal roots of the molars;

- PRAr - PRAl = 28.00 mm - width in the area of the apex of the palatal roots of the first molars;

- FUr - FUl = 41.23 mm - width in the bifurcation area of the roots of the upper first molars;

- BACr - BACl = 54.40 mm - width in the area of the most protruding point of the lower edge of the alveolar process of the upper jaw;

-EWr - EWl = 54.81 mm - width in the area of the vestibular surface of the tooth crown, located at the level of the equator;

- AMCr - AMCl = 52.00 mm - width in the area of the apex of the mesial-buccal cusps of the first molar of the upper jaw;

- RATMCr - RATMCl = 31.60 mm - width in the area of the apexes (peaks) of the roots of the deciduous canines of the upper jaw;

- TCTMCr - TCTMCl = 32.40 mm - width in the area of the apexes (peaks) of the tubercles of the milk canines of the upper jaw.

Thus, stage B of the formation of the median palatine suture was established.

Next, an assessment was made of the degree of curvature of the nasal septum in the frontal plane (Fig. 7), in which SI = L _1-2-3 / L _1-3 = 39.9 mm / 39.6 mm = 1.01 = 101%.

Taking into account stage B and SI=1.01=101%, an orthodontic device with a tooth-type fixation was selected, consisting of a Hyrex 10-12 mm expansion screw from Forestadent, branches extending from it, fixed on temporary molars 5.5 and 6.5 with the help of rings and branches on canines 5.3 and 6.3 to provide additional support.

After 21-28 days of wearing the selected orthodontic appliance with a tooth-type fixation, a repeat CBCT study was conducted, which confirmed the correctness of planning orthodontic treatment for patients with narrowing of the upper jaw and the achievement of high diagnostic accuracy in treatment planning and high accuracy of growth correction and the formation of the dentofacial system in children.

As a result of the assessment (Fig. 8-10 respectively) of the planned orthodontic narrowing of the upper jaw in the treatment:

- LrWNC - LlWNC = 30.00 mm - width in the area of the lateral walls of the nasal cavity;

- NFr - NFl = 17.20 mm - width in the area of the bottom of the lower nasal passages;

- LLMBr - LLMBl = 60.30 mm - width in the area of the alveolar ridge of the upper jaw at the level of the apex of the buccal roots of the molars;

- PRAr - PRAl = 32.90 mm - width in the area of the apex of the palatal roots of the first molars;

- FUr - FUl = 42.60 mm - width in the bifurcation area of the roots of the upper first molars;

- BACr - BACl = 56.60 mm - width in the area of the most protruding point of the lower edge of the alveolar process of the maxilla;

- EWr - EWl = 57.50 mm - width in the area of the vestibular surface of the tooth crown, located at the level of the equator;

- AMCr - AMCl = 56.10 mm - width in the area of the apex of the mesial-buccal cusps of the first molar of the upper jaw;

- RATMCr - RATMCl = 31.60 mm - width in the area of the apices of the roots of the deciduous canines of the upper jaw;

- TCTMCr - TCTMCl = 36.10 mm - width in the area of the apex of the tubercles of the deciduous canines of the upper jaw;

- the degree of curvature of the nasal septum in the frontal plane SI = 38.90 mm mm/39.90 mm = 0.97 = 97%.

Claims (6)

A method for planning orthodontic treatment for patients with a narrowed upper jaw, in which, at the first stage, the patient is interviewed to identify complaints about the location of the teeth, nasal breathing, then, at the second stage, cone beam computed tomography (CBCT) is performed to obtain CBCT image data in the frontal projection, first, the width in the area of the lateral walls of the nasal cavity is determined, for which purpose, point LrWNC is marked on the image, located in the most protruding area of the lateral wall of the nasal cavity on the right, then point LlWNC is marked, located in the most protruding area of the lateral wall of the nasal cavity on the left, a segment LrWNC-LlWNC is drawn from point LrWNC to point LlWNC, after which the segment LrWNC- LlWNC is measured, then the width in the area of the floor of the nasal cavity is determined, for which point NFr is marked on the image, located on the inner lower surface of the floor of the nasal cavity on the right, then point NFl is marked, located on the inner lower surface of the floor of the nasal cavity on the left, a segment is drawn NFr - NFl from point NFr to point NFl and measure the segment NFr - NFl, then determine the width in the area of the alveolar ridge of the upper jaw at the level of the apex of the buccal roots of the molars, for which point LLMBr is marked on the image, located in the area of the alveolar ridge of the upper jaw at the level of the apex of the buccal roots of the molars on the right; then mark the LLMBl point located in the area of the alveolar ridge of the upper jaw at the level of the apex of the buccal roots of the molars on the left, draw a segment LLMBr - LLMBl from the LLMBr point to the LLMBl point and measure the segment LLMBr - LLMBl, then determine the width in the area of the apex of the palatine roots of the first molars, for which mark the PRAr point in the image, located in the area of the apex of the palatine roots of the first molars on the right, then mark the PRAl point located in the area of the apex of the palatine roots of the first molars on the left, draw a segment PRAr - PRAl from the PRAr point to the PRAl point and measure the segment PRAr - PRAl, then determine the width in the area of the bifurcation of the roots of the upper first molars, for which mark the FUr point in the image, located at the level of the bifurcation of the roots of the upper first molars on the right; then mark the point FUl, located at the level of the bifurcation of the roots of the upper first molars on the left, draw a segment FUr - FUl from point FUr to point FUl and measure the segment FUr - FUl, then determine the width in the area of the most protruding point of the lower edge of the alveolar process of the upper jaw, for which the most protruding point BACr of the lower edge of the alveolar process of the upper jaw on the right is marked in the image, then mark the most protruding point BACl of the lower edge of the alveolar process of the upper jaw on the left, draw a segment BACr - BACl from point BACr to point BACl and measure the segment BACr - BACl, then determine the width in the area of the vestibular surface of the crown of the tooth, located at the level of the equator, for which the most protruding point EWr in the area of the vestibular surface of the crown of the tooth on the right is marked in the image, then mark the most protruding point EWl in the area of the vestibular surface crowns of the tooth on the left, draw a segment EWr - EWL from point EWr to point EWl and measure the segment EWr -Ewl, then determine the width in the area of the apex of the mesio-buccal cusps of the first molar of the upper jaw, for which point AMCr is marked on the image, located in the area of the apex of the mesio-buccal cusp of the first molar of the upper jaw on the right; then mark the AMCl point located in the area of the apex of the mesiobuccal cusp of the first maxillary molar on the left, draw a segment AMCr - AMCl from the AMCr point to the AMCl point and measure the segment AMCr - AMCl, after which, at the third stage, an assessment is made of the stage of formation of the median palatal suture using the analysis of the CBCT image data in the frontal projection obtained at the second stage with the length of the segments LrWNC - LlWNC equal to or greater than 27 mm, NFr - NFl equal to or greater than 16 mm, LLMBr - LLMBl equal to or greater than 58 mm, PRAr - PRAl less than or equal to 30 mm, FUr - FUl less than or equal to 42, BACr - BACl less than or equal to 55 mm, EWr - EWl less than or equal to 55 mm, and AMCr - AMCl less than or equal to 52 mm, then set stage B of the formation of the median palatine suture, with the length of the segments LrWNC - LlWNC less than 27 mm, NFr - NFl less than 16 mm, LLMBr - LLMBl less than 58 mm, PRAr - PRAl more than 30 mm, FUr - Ful more than 42 mm, BACr -BACl more than 55 mm, EWr - EWl more than 55 mm and AMCr - AMCl more than 52 mm, then stage C of the formation of the median palatine suture is established, then at the fourth stage an assessment is made of the degree of curvature of the nasal septum in the frontal plane, for which point 1 is marked in the Crista Galli area on the image in the frontal plane, then point 2 is marked in the most protruding part of the middle third of the nasal septum, point 3 at the level of the anterior nasal spine, then points 1 and 2 are connected by segment 1-2, and then points 2 and 3 are connected by segment 1-3, after which the segments are measured 1-2, 2-3, then connect points 1 and 3 with segment 1-3, and measure segment 1-3, then determine the degree of curvature of the nasal septum in the frontal plane using the formula: SI=L1-2-3 / L1-3, where SI is the degree of curvature of the nasal septum in the frontal plane, where: L1-2-3 - the actual length of the nasal septum in the frontal plane, determined by the sum of segments 1-2, 2-3, L1-3 - the length of the normal to the nasal septum in the frontal plane, determined by the segment 1-3, at the fifth stage, based on the stage of formation of the median palatine suture established at the third stage and the degree of curvature of the nasal septum in the frontal plane (SI) determined at the fourth stage, an orthodontic appliance is selected for expanding the upper jaw, wherein if the stage of formation of the median palatine suture is B, and the degree of curvature of the nasal septum in the frontal plane (SI) is less than or equal to 100%, an orthodontic appliance with a tooth-type fixation is selected, and if the stage of formation of the median palatine suture is C, and the degree of curvature of the nasal septum in the frontal plane (SI) is greater than or equal to 100%, an orthodontic appliance with a hybrid type of fixation is selected. 2. The method according to claim 1, wherein at the third stage, after determining the width in the region of the apex of the mesio-buccal cusps of the first molar of the upper jaw, the width in the region of the apex of the roots of the deciduous canines of the upper jaw is first determined, for which purpose a point located on the apex of the root of the deciduous canine of the upper jaw on the right is marked on the image, then a point located on the apex of the root of the deciduous canine of the upper jaw on the left is marked, a segment RATMCr - RATMC1 is drawn from the point RATMCr to the point RATMC1 and the segment RATMCr - RATMC1 is measured, and then the width in the region of the apex of the cusps of the deciduous canines of the upper jaw is determined, for which purpose a point located on the apex of the cusp of the deciduous canine of the upper jaw on the right is marked on the image, then a point located on the apex of the cusp of the deciduous canine of the upper jaw on the left is marked, a segment TCTMCr - TCTMCl is drawn from the point TCTMCr to the point TCTMCl and the segment TCTMCr - TCTMCl is measured, with the length of the segments LrWNC - LlWNC equal to or greater than 27 mm, NFr - NFl equal to or greater than 16 mm, LLMBr - LLMBl equal to or greater than 58 mm, PRAr - PRAl less than or equal to 30 mm, FUr - FUl less than or equal to 42 mm, BACr - BACl less than or equal to 55 mm, EWr - EWl less than or equal to 55 mm, AMCr - AMCl less than or equal to 52 mm, RATMCr - RATMCl equal to or greater than 31 mm, and TCTMCr - TCTMCl more than 32 mm, then stage B of the formation of the median palatal suture is established, and if the length of the segments LrWNC - LlWNC is less than 27 mm, NFr - NFl less than 16 mm, LLMBr - LLMBl is less than 58 mm, PRAr - PRAl is more than 30 mm, FUr - Ful is more than 42 mm, BACr - BACl is more than 55 mm, EWr - EWl is more than 55 mm, AMCr - AMCl is more than 52 mm, RATMCr - RATMCl is less than or equal to 31 mm and TCTMCr - TCTMCl is less than or equal to 32 mm, then stage C of the formation of the median palatal suture is established.