RU2811894C1 - Method for monitoring results of treatment of abnormal occlusion - Google Patents

Abstract

FIELD: dentistry.

SUBSTANCE: invention can be used to monitor the results of treatment of abnormal occlusion. At the first visit, and then during the treatment period every 2-4 months, two fixed symmetrical points on the left and right - zygion and one point on the midline of the face - nasion and three moving points are applied to the patient's face 3-4 times: two on the right and on the left - gonion and one - pogonion. From a constant position of the patient and his head from a distance of 100 cm, the patient's face is photographed at the moment the mouth is open to the maximum extent. When the moving pogonion point is shifted to the midline of the face - to the nasion point or to the midline, as well as the gonion points are shifted to the zygion and nasion points until they are symmetrically positioned relative to the midline of the face, taking into account the presence of physiological asymmetry of the face, the treatment of occlusion shall be deemed satisfactory.

EFFECT: ability to control the results of treatment of abnormal occlusion through the use of the stated guidelines.

1 cl, 4 dwg, 25 ex

Description

The present invention relates to the field of medicine, namely dentistry, and can be used in orthodontics to monitor the results of treatment of abnormal bite.

An abnormal bite may be accompanied by a violation of the position of the teeth, the shape and size of the dental arches and their relationship, the structure and functions of the temporomandibular joints, the symmetry and proportionality of the middle and lower parts of the face, and the movements of the lower jaw. It is believed that the nature of the movements of the lower jaw may indicate the functional state of the temporomandibular joints and depends on the occlusal relationships of the teeth.

To monitor the results of restoring occlusion and missing teeth with dental prosthetics, studying the movements of the lower jaw and the functional state of the temporomandibular joints, a model of an electronic multifunctional complex with software is known [Paramonov E.A., Tolchenov A.A., Zubov D.V. Model of a complex for diagnosing the functions of the temporomandibular joint // Priority directions for the development of science and technology: reports of the X All-Russian scientific and technical. conf. - Tula: Publishing House "Innovative Technologies", 2001. - p. 104-105]. The model is a frame stand on which 4 digital video cameras are mounted, aimed at the patient’s head. The authors use cameras that record at 100 frames per second. Video cameras are connected to a communicator, which is connected to a computer that processes video and stores data. The authors created a program that allows tracking an object in real time, and developed a model for constructing three-dimensional movement trajectories.

Flaws:

• Significant duration of the study (from 40 minutes to 2 hours)

• Expensive special equipment that is not available for use in the daily practice of an orthodontist.

To monitor the state of the bite and the quality of dental prosthetics, methods and devices for recording movements of the lower jaw are known [Patent No. 2276972 C2 Russian Federation, IPC A61C 19/045. Method for recording movements of the lower jaw: No. 2004116832/14: application. 06/04/2004: publ. 05.27.2006 / G.V. Bolshakov, I.K. Batrak, E.I. Rubtsov; applicant State Educational Institution of Higher Professional Education "Moscow State Medical and Dental University of the Ministry of Health of the Russian Federation"]. The device is fixed on the patient's head, the articular and incisal paths, sagittal shift and transversal movements are recorded, then the data on the movements of the lower jaw are analyzed and used in modeling dentures.

Flaws:

• The use of complex devices fixed on the head causes inconvenience for adult patients and is practically impossible for use in children.

• Gnathosensors are connected to an electrical network, which makes parents wary and complicates the use of the method in children.

• The complexity of the method makes it difficult to widely use it in practical dentistry.

To analyze the dynamics of changes in distances between reference points on the patient’s face during movements of the lower jaw in women and men with orthognathic occlusion, the use of an automated image processing system was proposed, consisting of a television installation combined with a personal computer and software with which data is entered [Kalivradzhiyan E.S., Mutafyan M.I., Korneva A.K., Leshcheva E.A. Non-contact method for computer assessment of the state of movements of the lower jaw // Dentistry. - 1995. - No. 6. - With. 63-68.]. Marks are applied to the patient's face through a plastic template in the area of projection of the nasal (nasion) and chin (gnation) points. Then two tests are carried out and the coordinates of the movement of the chin point (gnation) in relation to the nasal point (nasion) are recorded. During the first test, the subject, from a state of central occlusion, opens and closes his mouth twice with maximum amplitude, then makes lateral movements of the lower jaw with maximum amplitude. The second test involves chewing and swallowing a standard food item. Each test ends with a 15-second pause, during which the coordinates of the points corresponding to the state of physiological rest are recorded. As a result of data processing, the trajectories of movement of the support points of the lower jaw during the first test are obtained, and the total movements of the head that occur when the patient’s head is not rigidly fixed are studied.

Flaws:

• The method provides for correction of the dynamic relationship in the frontal plane of only two anthropometric points: the chin (gnation) and the nasal (nasion).

• The graph obtained as a result of the study has a complex shape, which makes it difficult to evaluate.

• When applying reference marks to the skin of the face with a marker through a plastic template with holes of a certain diameter, it is difficult to obtain clearly contoured points, especially in active and emotional children.

• In cases where it is necessary to conduct functional tests with chewing a test portion of a standard food product and then swallowing it, parents, especially of young children, may be wary and not give consent.

There is a known method, accepted as the closest analogue, used to control the treatment of abnormal bite - a functional test according to Ilina-Markosyan and Kibkalo [Khoroshilkina F.Ya. Manual of Orthodontics 1999, pp. 90-91]. The displacement of the lower jaw is diagnosed in four positions: 1 - at rest, 2 - with the teeth closed (habitual occlusion), 3 - with the mouth wide open, 4 - when the lower jaw is placed in the position of central occlusion. In this case, each position of the lower jaw is compared relative to each other and the direction of displacement of the lower jaw relative to the midline of the face is determined.

Disadvantages of analogues:

• The doctor identifies the result of a clinical functional test visually, evaluates it subjectively and describes it in any form in the “Medical record of the dental patient”, thus the method is unreliable.

• There is no possibility of documenting the characteristics of the movements of the patient’s lower jaw, quantitative characteristics and comparative analysis of changes possible during orthodontic treatment of an abnormal bite; objective control of treatment, duration of procedures for monitoring results, labor costs - time of bite correction are not provided.

Tasks:

• Increasing the reliability and information content of detecting displacement of the movements of the lower jaw in case of abnormal occlusion.

• Reducing the time for monitoring treatment results over time, minimizing the use of the functions of the patient’s head and oral cavity to fix the elements of the diagnostic device.

• Reducing the doctor’s labor costs when diagnosing an abnormal bite by 5-7 times.

• Ensuring availability of monitoring the progress of treatment.

A method for monitoring the results of treatment of abnormal bite, which consists in the fact that at the first visit and 3-4 times every 2-4 months, two fixed symmetrical points are applied to the patient’s face on the left and right - zygion, on the right and left - gonion and one - pogonion and from a constant position of the patient and his head from a distance of 100 cm, photograph the patient’s face at the moment of the maximum open mouth until the movable pogonion point gradually shifts to the midline of the face - to the nasion point or to the midline, as well as the displacement of the gonion points to the zygion and nasion points to their symmetrical position relative to the midline of the face, taking into account the presence of physiological asymmetry of the face, and occlusion treatment is defined as satisfactory.

The technical result of the proposed method is to increase the reliability and information content of the control of movements of the lower jaw in case of an abnormal bite due to the use of additional zygomatic (zygion) and angular (gonion) points on the left and right relative to the midline of the face; reducing the time the patient participates in monitoring treatment over time, eliminating the use of the head and oral cavity to fix the elements of the diagnostic device, since bulky elements of the diagnostic devices are not fixed, and functional tests using foreign bodies are excluded. The method significantly reduces the doctor’s labor costs when diagnosing an abnormal bite, eliminates the use of expensive devices and is available for use in any outpatient department.

The method is carried out as follows.

Anthropometric points are taken as a basis: two fixed symmetrical points - zygion and one point on the midline of the face - nasion and three moving points: two - on the right and left points - gonion (gonion) and one - pogonion (pogonion) .

The patient is seated in a dental chair, the back and headrest of which are set vertically, perpendicular to the seat. Marks are applied to the anthropometric points on the patient's face: nasal nasion, two (right, left) zygomatic zygions, chin pogonion and two (right, left) angular gonions. From a distance of 100 cm, at the same level with the patient’s head, a camera is installed on a stationary tripod and the patient’s face is photographed at the moment the mouth is maximally open. The resulting photographs are printed.

Monitoring the displacement of points during treatment is repeated 3-4 times every 2-4 months. Based on identified deviations from the norm, the doctor monitors the result obtained and specifies the continuation of treatment until the maximum achievement of the norm - elimination of the malocclusion. Subject to a gradual displacement of the moving pogonion point to the midline of the face - to the nasion point or to the midline, as well as displacement of the gonion points to the zygion and nasion points until their symmetrical position relative to the midline of the face, taking into account the presence of physiological asymmetry of the face, treatment of occlusion is determined as satisfactory.

The method was tested on 29 patients, including 18 women and girls and 11 men and boys with an abnormal bite before treatment, during treatment every 2-4 months and after treatment, respectively, in periods of mixed and permanent dentition.

Example 1 (photo 1 and photo 2)

For a better understanding of the method, the application contains photographs of the patient, photo 1 - before treatment of the bite, photo 2 - after treatment, where item 1 - zygion points, item 2 - nasion, item 3 - gonion, item 4 - pogonion, p. 5 - midline of the face.

Patient A., 9 years old. He complained about the unsightly position of the teeth in the upper and lower jaws. Conducted a comprehensive primary dental examination of the patient. A preliminary clinical diagnosis was formulated: distal bite, deep bite, crossbite, narrowing of the upper dentition, abnormal position of the teeth.

On the first visit, the points were marked: 1 - zygion, 2 - nasion, 3 - gonion, 4 - pogonion, 5 - midline of the face. At a distance of 100 cm, at the same level with the patient’s head, a camera was installed on a stationary tripod and a photograph of the patient’s face was taken at the moment the mouth was maximally open. The resulting photograph of the face was printed.

A treatment plan was drawn up.

Treatment monitoring using the proposed method was repeated during treatment 3 times with an interval of 2 months.

Based on identified deviations from the norm, the obtained result was monitored and the continuation of treatment was specified until the maximum achievement of the norm - elimination of the malocclusion.

Provided that the moving point pogonion 4 is shifted to the midline of the face 5 and to the point nasion, as well as the points gonion 3 are displaced to their symmetrical position relative to the midline of the face 5 and the points zygion and nasion, taking into account the presence of physiological asymmetry of the face, the treatment of the bite was determined to be satisfactory.

Example 2 (photo 3 and photo 4)

Patient V., 7 years old, was referred to an orthodontist by a pediatric dentist. Based on the dental examination of the patient, a preliminary clinical diagnosis was formulated: crossbite, narrowing of the upper dentition, abnormal position of the teeth.

On the first visit, the points were marked: 6 - zygion, 7 - nasion, 8 - gonion, 9 - pogonion, 10 - midline of the face.

At a distance of 100 cm, at the same level with the patient’s head, a camera was installed on a stationary tripod and, after applying dots on the face, a photograph of the patient’s face was taken at the moment the mouth was maximally open. The resulting photograph of the face was printed.

Treatment monitoring using the proposed method was repeated during treatment 4 times with an interval of 4 months.

Based on identified deviations from the norm, the obtained result was monitored and the continuation of treatment was specified until the maximum achievement of the norm - elimination of the malocclusion.

Subject to the displacement of the moving point pogonion 9 to the midline of the face 10 and to the point 7 nasion, as well as the displacement of the points gonion 8 to their symmetrical position relative to the midline of the face 5 and the points zygion and nasion, taking into account the presence of physiological asymmetry of the face, the result of bite treatment was determined as satisfactory .

Claims (1)

A method for monitoring the results of treatment of abnormal occlusion, which consists in the fact that at the first visit and 3-4 times every 2-4 months, two fixed symmetrical points on the left and right - zygion, one point on the midline of the face - nasion, and three moving points: on the right and left - the gonion, and one - the pogonion, after which the patient’s face is photographed from a distance of 100 cm at the moment the mouth is maximally open; treatment of occlusion is defined as satisfactory if the pogonion is displaced to the midline of the face or to the nasion point, the gonion points are displaced to the zygion and nasion points to their symmetrical position relative to the midline of the face.