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WO2025116783A1 - Procédé de restauration de la hauteur individuelle de synaraxie (variantes) - Google Patents

Procédé de restauration de la hauteur individuelle de synaraxie (variantes) Download PDF

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Publication number
WO2025116783A1
WO2025116783A1 PCT/RU2024/050303 RU2024050303W WO2025116783A1 WO 2025116783 A1 WO2025116783 A1 WO 2025116783A1 RU 2024050303 W RU2024050303 W RU 2024050303W WO 2025116783 A1 WO2025116783 A1 WO 2025116783A1
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Prior art keywords
patient
lower jaw
angle
sna
intermaxillary
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English (en)
Russian (ru)
Inventor
Евгений Михайлович РОЩИН
Николай Отарович ДОРЕЛЬ
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Priority claimed from RU2023131114A external-priority patent/RU2836077C1/ru
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Publication of WO2025116783A1 publication Critical patent/WO2025116783A1/fr
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/103—Measuring devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C7/00—Orthodontics, i.e. obtaining or maintaining the desired position of teeth, e.g. by straightening, evening, regulating, separating, or by correcting malocclusions
    • A61C7/36—Devices acting between upper and lower teeth
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H30/00—ICT specially adapted for the handling or processing of medical images
    • G16H30/40—ICT specially adapted for the handling or processing of medical images for processing medical images, e.g. editing

Definitions

  • the invention relates to dental medicine, in particular, it considers a combined method for diagnosing various types of dental occlusion disorders that lead to changes in the parameters and asymmetries of a person's face.
  • a method for combined analysis of dental arch destruction, disorders of the location and relationship of the upper and lower jaws and the influence of these components on the configuration of the face is considered.
  • the bite decreases (the lower third of the face decreases), which leads to a decrease in the height of the face.
  • the dental arches and temporomandibular joints are components of the dental system, which experience increased load during functioning (chewing, biting off food). With unsatisfactory dynamic observation, the dental arches can be destroyed and deformed, leading to overload of the joints. Disturbances of the dental arches in turn can lead to the development of facial asymmetries, that is, the listed components are in mutual connection with each other, as shown in Fig. 1
  • Violations of the aesthetic parameters of the face for the patient are the fundamental reason for the restoration of the dental arches. That is, the aesthetic parameters of the face must be taken into account in the calculations for the reconstruction of the dental arches.
  • RU2354300 describes a method for determining the bite height in individuals with dentoalveolar anomalies and deformations of the maxillofacial region, in which the nosological form of the dentoalveolar anomaly and/or deformation of the maxillofacial region is determined, the parameters characterizing the functional state of the patient's masticatory apparatus in the position of the dental arches in occlusion are assessed by tomographic examination of the temporomandibular joint (TMJ) area in the position of the dental arches in central occlusion, and the optimal bite height.
  • TMJ temporomandibular joint
  • RU2753798 discloses a method for treating patients with generalized decompensated pathological abrasion of teeth of grades II-III, according to which the height of the lower third of the face is measured in a state of relative physiological rest and in a state of habitual occlusion with the calculation of the height of the lower third of the face, the interalveolar height is restored under radiological control of the temporomandibular joints.
  • RU2445043 describes a method for correcting TMJ dysfunctions identified by early diagnostics, in accordance with which anthropometry of the face to determine the displacement of the lower jaw and the change in the height of the lower third of the face, determine the displacement of the lower jaw in the sagittal, transverse and distal directions, conduct orthopantomography and determine the size of the joint spaces.
  • Set the lower jaw in a neutral position in central occlusion make a mouthguard with bite pads to fix the lower jaw in this position.
  • Repeat occlusography in central occlusion together with the mouthguard determine the difference in the initial and blocking contacts and, if the contact is ahead, perform selective grinding.
  • the elimination of dysfunction is judged by the patient's subjective sensations, anthropometric data and maintaining the lower jaw in a position without displacement in the sagittal and transverse planes.
  • CN109069097 describes a method for processing three-dimensional data for dentistry, comprising the steps of: obtaining scan data generated by a dental scanner, data on facial bones including tooth shapes measured using computed tomography or magnetic resonance imaging;
  • US1 1030741 discloses a method for processing three-dimensional dental data, comprising:
  • US5951498 describes a method for cephalometric analysis of soft tissues for aesthetic correction of facial imbalance in a patient, comprising: performing a cephalometric analysis of soft tissues comprising the steps of:
  • a primary facial frame is formed, corresponding to the individual proportions of a human face and consisting of a lower base, which is a horizontal line tangent to a point on the lower edge of the lower jaw, an upper base in the form of a horizontal line tangent to the highest point on the skull, and lateral borders in the form of vertical lines passing tangent to the most protruding points on the zygomatic bone and perpendicular to the lines of the upper and lower bases, then using computed tomography, an image of a face in a frontal position is obtained and the resulting image is aligned in size with a photograph or scan of a person's face by matching the location points along the outer border of the right eye and the outer border of the left eye, the most protruding point on the edge of the nose and the lowest point
  • the disadvantage of this method is that the fundamental principle is the use of aesthetic analysis based on points on the outer surface of the patient's face, and not on the structure of the bone system, the points on which do not change their position. Disclosure of invention
  • the present invention is aimed at achieving a technical result consisting of increasing the accuracy of bite restoration individually for the patient by using calculations based on anthropometric points on bone structures that do not depend on the number of teeth in a person.
  • the specified technical result for the first variant is achieved in that the method for restoring an individual bite height taking into account facial proportions is characterized by the fact that in the frontal position of the patient's face, an image of the patient's temporomandibular region and his frontal profile is obtained, according to the image of the temporomandibular region, the presence of displacements of the temporomandibular joint heads in the joint space and their direction relative to the centered position are established, in which the distance from the surface of the joint head in the anterior and posterior sections is equal to 2-3 mm, and in the upper section 3-4 mm, according to the same image, the patient's bite height is determined and the deviation in angle from the angle of the normalized bite height according to Recketts, equal to 45 ⁇ 2 ° and measured according to anthropometric points on the bone structures of the lower and upper jaws according to the value of the intermaxillary angle SNA-Xi-Pm, or according to deviations from the ratio between the width of the lateral and central incisor equal to
  • prosthetic structures are first modeled for installation on the patient's dental arches or implants, ensuring the elimination of the displacement of the joint heads of the lower jaw by half of the detected displacements, and fixed on the dental arches of the patient's lower jaw for adaptation of the patient's lower jaw, and after the end of the adaptation period lasting at least three months, based on a repeated digital image model, prosthetic structures are modeled that ensure the final elimination of the displacement of the joint heads of the lower jaw, and fixed on the dental arches of the patient's lower jaw for adaptation of the patient's lower jaw to the new bite height.
  • the specified technical result for the second variant is achieved by the fact that the method for restoring the individual bite height taking into account facial proportions is characterized by the fact that in the frontal position of the patient's face, an image of the patient's temporomandibular region and his frontal profile is obtained, according to the image of the temporomandibular region, the absence of displacements of the temporomandibular joint heads in the joint space relative to the centered position is established, in which the distance from the surface of the joint head in the anterior and posterior sections is equal to 2-3 mm, and in the upper section 3-4 mm, according to the same image, the patient's bite height is determined and the deviation in angle from the angle of the normalized bite height is established no Recketts, equal to 45 ⁇ 2° and measured by anthropometric points on the bone structures of the lower and upper jaws by the value of the intermaxillary angle SNA-Xi-Pm, or by deviations from the ratio between the width of the lateral and central incisor equal to 1: 1.6
  • the specified technical result for the third variant is achieved by the fact that the method for restoring an individual bite height taking into account facial proportions is characterized by the fact that in the frontal position of the patient's face, an image of the patient's temporomandibular region and his frontal profile is obtained, the floor of which determines the proportions of the face in the vertical direction and when establishing the deviations of the lower part in the area from the lower part of the nose to the lower point of the chin by its height from the height of the middle part of the face in the area from the lower part of the nose to the eyebrows, the deviation of the current angular value of the face profile Gl-Sn-Pog from the angular value of the face profile equal to 165-175 ° is determined, then the patient's bite height is determined and the deviation in angle from the angle of the normalized bite height according to Recketts is established, equal to 45 ⁇ 2 ° and measured by anthropometric points on the bone structures of the lower and of the upper jaw by the value of the intermaxillary
  • the intermaxillary angle SNA-Xi-Pm is considered to be the angle between two lines emanating from a common point, which is the geometric center of the Xi branches of the lower jaw, one of which is directed to the forward-protruding point SNA of the nasal bone, and the other is directed to the point Pm on the anterior contour of the chin, located in the middle between the anterior point Rod of the chin protrusion in medial section when the head is oriented along the Frankfurt horizontal and the subspinal point B, located posteriorly on the anterior contour of the apical base of the lower jaw.
  • the angular value of the GI-Sn-Pog facial profile is understood to be the angle formed by two lines emanating from the common point Sn, located at the transition of the nasal septum to the upper lip, one of which is directed towards the forehead and passes through the most protruding point GI on the soft tissue contour of the forehead, and the other is directed along the chin and passes through the most protruding point of the Rod on the soft tissue contour of the chin.
  • the specified features are essential and are interconnected with the formation of a stable set of essential features sufficient to obtain the required technical result.
  • Fig. 1 the general algorithm of interrelations of three types of studies
  • Fig. 2 the color coding of the distances of the joint head from the walls of the joint space is shown
  • Fig. 3 the normalized distances from the joint head to the walls of the joint space
  • Fig. 4 the diagram of the intermaxillary angle according to Ricketts
  • Fig. 5 the Gl-Sn-Pog facial profile angle is shown
  • Fig. 6 the diagram of facial proportions by the height of the face from the front
  • Fig. 7 the ratios between the width and height of the face are shown, normalized equal to 1:1,618
  • Fig. 1 the general algorithm of interrelations of three types of studies
  • Fig. 2 the color coding of the distances of the joint head from the walls of the joint space
  • Fig. 3 the normalized distances from the joint head to the walls of the joint space
  • Fig. 4 the diagram of the intermaxillary angle according to Ricketts
  • Fig. 5 the G
  • Fig. 8 the block diagram of the algorithm for implementing the method according to the first embodiment
  • Fig. 9 the block diagram of the algorithms for implementing the method according to the second embodiment and the extended algorithm for implementing the method according to the first embodiment
  • Fig. 10 the block diagram of the algorithm for implementing the method according to the third embodiment
  • Fig. 11 an example of an image of the temporomandibular joint from one side of the head with a demonstration of the distances from the head of the joint to the walls of the joint space
  • Fig. 12 the same as in Fig. 10, view from the other side of the head
  • Fig. 13 diagram of the intermaxillary angle according to Ricketts for the joints in Figs. 11 and 12
  • Fig. 13 diagram of the intermaxillary angle according to Ricketts for the joints in Figs. 11 and 12
  • Fig. 13 diagram of the intermaxillary angle according to Ricketts for the joints in Figs. 11 and 12
  • Fig. 13 diagram of the inter
  • a new method which, when conducting diagnostics and prescribing treatment, takes into account the use of the necessary combined calculations: analysis of the position of the temporomandibular joints, the structure of the dental arches, aesthetic anthropometric parameters of the face, since these are interconnected structures.
  • the claimed method is based on the following premises.
  • the SdiMatriX Studio software is used to analyze the position of the articular heads. This program is used to scan the area of the articular space and interpret the main parameters of the position of the head of the mandible joint in color gradation in terms of indicating the distances from the surface of the head to the walls of the articular space (Fig. 2). Within the color gradation, green is the normal range, blue shows that the thickness/distance is more than 3 mm, yellow is the thickness of the articular space of 1-2 mm, and red shows that the thickness is less than 1 mm.
  • the gradation of the color coding of the articular space is based on known data, according to which the distance from the surface of the head of the joint to the walls of the articular space in the anterior, upper and posterior sections should be 2-3 mm (Fig. 3).
  • the intermaxillary angle SNA-Xi-Pm is considered to be the angle between two lines emanating from a common point, which is the geometric center of the Xi branches of the lower jaw, one of which is directed to the forward-protruding point SNA of the nasal bone, and the other is directed to the point Pm on the anterior contour of the chin, located in the middle between the anterior point Rod of the mental protrusion in medial section when the head is oriented along the Frankfurt horizontal and the subspinal point B, located posteriorly on the anterior contour of the apical basis of the lower jaw.
  • the third necessary component included in the combined calculation is the analysis of facial proportions. It is necessary to consider not only the proportions of the height and width of the face, but also the angle of the facial profile (Fig. 5 and 6). Since when the height of closure decreases, not only the height of the face changes, but also the lower jaw may shift, which will lead to a change in the facial profile.
  • the angular values of the facial profile indicate the correct positioning of the lower jaw, taking into account aesthetic parameters. Normally, this angle is 165-175 degrees.
  • the angular value of the facial profile Gl-Sn-Pog is understood as the angle formed by two lines emanating from the common point Sn, located at the junction of the nasal septum and the upper lip, one of which is directed toward the forehead and passes through the most protruding point GI on the soft tissue contour of the forehead, and the other is directed along the chin and passes through the most protruding point Rod on the soft tissue contour of the chin.
  • the vertical component of the face can be divided into 3 approximately equal segments in height for analyzing the proportion of the face.
  • the lower section in the theory of facial proportion in the vertical direction is located from the lower part of the nose to the lower point of the chin along its height
  • the middle section is located from the lower part of the nose to the eyebrows.
  • the lower segment changes. Therefore, for restoration taking into account the aesthetic proportions according to the face scan data, it is possible to take the upper and middle segments as a basis.
  • the "golden proportion" algorithm is also applicable (Fig. 7).
  • the ratio between the width and height of the face should correspond to 1: 1.618.
  • the method for restoring individual bite height taking into account facial proportions according to the first variant consists in the fact that:
  • the patient's bite height is determined and the deviation in angle from the angle of the normalized bite height according to Recketts, equal to 45 ⁇ 2° and measured according to anthropometric points on the bone structures of the lower and upper jaws according to the value of the intermaxillary angle SNA-Xi-Pm (Fig. 13), or according to deviations from the ratio between the width of the lateral and central incisor equal to 1:1.618, and the ratio between the width of the lateral incisor and canine equal to 1:0.618, in which the central incisor is 60% wider than the lateral incisor and 60% wider than the part of the canine visible from the front, is established;
  • the lower jaw is shifted by the established deviation and in the direction of this deviation to the line SNAA-Pm_intermaxillary angle SNA-Xi-Pm, at the position of which the intermaxillary angle is equal to 45 ⁇ 2°;
  • prosthetic structures are modeled for installation on the patient's dental arches or implants, ensuring the preservation of the new bite height by changing the position of the lower jaw relative to the upper jaw, and they are fixed on the dental arches of the patient's lower jaw to adapt the patient's lower jaw to the new bite height.
  • the analysis of the joint arrangement is fundamental. That is, the initial task is to correct the position of the joint heads in the joint space. It provides for the presence of displacements of the lower jaw. If the joints are in an uncentered position, this can lead to their overload and the progression of various diseases. Analysis of the bite height - this factor indicates the wear or destruction of the dental arches.
  • the normal parameters for the joint arrangement and the normal parameters for calculating the bite height are used.
  • the joint space is normally 2-3 mm in the anterior and posterior sections, and 3-4 mm in the upper section. This allows you to adjust the position in accordance with the bite height.
  • the bite height according to Recketts is 45 ⁇ 2° (from 43° to 47°). Thus, the correction of the bite height allows you to select the optimal aesthetic parameters of the face. In most cases, secondary correction is not required.
  • the sequence of actions in cases where visible facial asymmetries consists of analyzing facial proportions with clearly visible signs of aesthetic disturbances, performing an aesthetic calculation to restore the symmetry of facial parameters, after which an analysis of the bite (the height of the closure of the dental arches) is carried out taking into account the restored aesthetic proportions, and then an analysis of the location of the joints of the lower jaw is carried out.
  • the analysis of facial proportions comes to the fundamental level.
  • an image of the patient's temporomandibular region and his profile is obtained front view, by which the proportions of the face in the vertical direction are determined.
  • the presence of deviations of the lower part of the face in the area from the lower part of the nose to the lower point of the chin by its height from the height of the middle part of the face in the area from the lower part of the nose to the eyebrows or from the height of the upper part of the face is established.
  • the deviation of the current angular value of the face profile Gl-Sn-Pog from the angular value of the face profile equal to 165-175° is determined.
  • the patient's bite height is determined using the methods described in relation to the previously considered method, and the deviation value is established.
  • the image of the temporomandibular region using the image of the temporomandibular region, the presence of displacements of the temporomandibular joint heads in the joint space and their direction relative to the centered position are established, in which the distance from the surface of the joint head in the anterior and posterior sections is 2-3 mm, and in the upper section 3-4 mm.
  • the lower jaw is shifted by the established deviation and in the direction of this deviation to the line with the SNA-Pm points of the intermaxillary angle SNA-Xi-Pm, at the position of which the intermaxillary angle is 45 ⁇ 2°.
  • prosthetic structures are modeled for installation on the patient's dental arches or implants, ensuring the preservation of the new bite height by changing the position of the lower jaw relative to the upper jaw, and they are fixed on the dental arches of the patient's lower jaw to adapt the patient's lower jaw to the new bite height.
  • prosthetic structures are first modeled on the basis of the digital image model for installation on the patient's dental arches or implants that ensure the elimination of the displacement of the joint heads of the lower jaw by half of the detected displacements, and they are fixed on the dental arches of the patient's lower jaw to adapt the patient's lower jaw, and after the end of the adaptation period lasting at least three months, prosthetic structures are modeled on the basis of a repeated digital image model that ensure the final elimination of the displacement of the joint heads of the lower jaw, and they are fixed on the dental arches of the patient's lower jaw to adapt the patient's lower jaw to the new bite height.
  • Example. Patient B. has a decrease in the bite height within 5 mm.
  • a one-time increase can lead to severe discomfort, and the patient may not adapt to the new height.
  • the increase in the bite height is done in stages, on average, in 2 corrections.
  • the first stage is an increase in the bite by 2.5 mm, an analysis of facial features, while the proportions may not be restored to normal during the first correction.
  • the second correction with an increase and taking into account the aesthetic parameters. It is also possible that the absence of displacements of the temporomandibular joint heads in the joint space relative to the centered position is established based on the image of the temporomandibular region.
  • the patient's bite height is determined and, if deviations are established, the lower jaw is shifted to the SNA-Pm line of the intermaxillary angle SNA-Xi- Pm, at the position of which the intermaxillary angle is equal to 45 ⁇ 2°.
  • the current angular value of the face profile Gl-Sn-Pog is determined for the subsequent correction of the lower jaw displacement to the angular value of the face profile equal to 165-175°, and a digital pictorial model of the lower jaw is obtained at the normalized position of the joint head in the joint space and in relation to the normalized intermaxillary angle and angular value of the face profile.
  • prosthetic structures are modeled for installation on the patient's dental arches or implants, ensuring the preservation of the new bite height by changing the position of the lower jaw relative to the upper jaw, and they are fixed on the dental arches of the patient's lower jaw to adapt the patient's lower jaw to the new bite height.
  • the main calculations for the bite height, joint position and aesthetic parameters of the face are made using the SDiMatriX studio software.
  • the jaw scans digital jaw models
  • These digital models in a new ratio are exported to the equipment that models future structures on the dental arches or implants.
  • the structures are fixed on the dental arches and the patient adapts to the new bite height.
  • the average adaptation time is about 3 months.
  • a repeated face scan is made for anthropometric calculations and a CT scan is done to calculate the bite height and joint position. All this data is analyzed again in the SDiMatriX program.

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Abstract

L'invention se rapporte au domaine de la stomatologie. L'invention concerne un procédé de restauration de la hauteur individuelle de synaraxie en tenant compte des proportions faciales, lequel consiste, dans une position face au visage du patient, à obtenir une image de la région temporo-mandibulaire du patient et de son profil de face, établir en fonction de l'image de la région temporo-mandibulaire la présence de décalages des têtes d'articulations temporo-mandibulaires de la fente articulaire et leur orientation par rapport à une position centrée. En fonction de cette même image, on détermine la hauteur de la synaraxie du patient et on définit un écart d'angle à angle de la hauteur normée de la synaraxie selon Recketts. On effectue ensuite un décalage de la mâchoire inférieure selon l'écart déterminé et dans la direction de cet écart sur la ligne SNA-Pm de l'angle inter-mandibulaire SNA-Xi-Pm. On détermine ensuite la valeur angulaire courante du profil du visage Gl-Sn-Pog en vue de la correction ultérieure du décalage de la mâchoire inférieure, et on obtient un modèle d'image numérique de la mâchoire inférieure dans la position normée de la tête de l'articulation dans la fente articulaire et par rapport à l'angle inter-mandibulaire normé et la valeur angulaire du profil du visage.
PCT/RU2024/050303 2023-11-28 2024-11-26 Procédé de restauration de la hauteur individuelle de synaraxie (variantes) Pending WO2025116783A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
RU2023131114 2023-11-28
RU2023131114A RU2836077C1 (ru) 2023-11-28 Способ восстановления индивидуальной высоты прикуса с учетом лицевых пропорций (варианты)

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Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2008128700A1 (fr) * 2007-04-18 2008-10-30 Materialise Dental N.V. Création assistée par ordinateur d'un agencement dentaire particularisé à l'aide d'une analyse faciale
US10143536B2 (en) * 2012-10-31 2018-12-04 Ormco Corporation Computational device for an orthodontic appliance for generating an aesthetic smile
RU2713149C1 (ru) * 2019-02-05 2020-02-03 Николай Отарович Дорель Способ определения первоначальных пропорций лица человека для восстановления деформаций зубных рядов и способ диагностики нарушений конфигурации лица человека при стоматологических работах
RU2760086C1 (ru) * 2021-05-06 2021-11-22 Лосев Владимир Федорович Способ диагностики аномалии высоты прикуса для выбора тактики ортопедического лечения

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2008128700A1 (fr) * 2007-04-18 2008-10-30 Materialise Dental N.V. Création assistée par ordinateur d'un agencement dentaire particularisé à l'aide d'une analyse faciale
US10143536B2 (en) * 2012-10-31 2018-12-04 Ormco Corporation Computational device for an orthodontic appliance for generating an aesthetic smile
RU2713149C1 (ru) * 2019-02-05 2020-02-03 Николай Отарович Дорель Способ определения первоначальных пропорций лица человека для восстановления деформаций зубных рядов и способ диагностики нарушений конфигурации лица человека при стоматологических работах
RU2760086C1 (ru) * 2021-05-06 2021-11-22 Лосев Владимир Федорович Способ диагностики аномалии высоты прикуса для выбора тактики ортопедического лечения

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