RU2444292C1 - Method of objective estimation of orthodontic treatment results - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to orthodontology and is intended for estimation of orthodontic treatment results. Lateral, frontal teleradiographs (TRG) of head, orthopantomogram (OPTG), profile and frontal photographs of patient's face, models of jaws, their analysis in sagittal, vertical and transversal directions are obtained. Disorders of masticatory-vocal apparatus, close positioning of teeth, their retention and adentia are estimated. In accordance with data of diagnostic table 1 determined is degree of expression of each sign of dentoalveolar-facial abnormality (DAA) - first, second or third - before beginning ortghodontic treatment and after its completion. Treatment efficiency is determined comparing degree of expression of DAA signs before and after treatment.

EFFECT: method makes it possible to estimate efficiency of orthodontic treatment by degree of expression of DAA signs before and after treatment.

26 dwg, 13 tbl, 3 ex

Description

A method for objectively evaluating the results of orthodontic treatment relates to the field of dentistry, in particular to orthodontics. The method allows to objectively assess the quality of the conducted orthodontic treatment by comparing the severity of signs of RFA before the start of orthodontic treatment and upon its completion. By changing the severity, one can judge the effectiveness of the treatment.

There are six keys of occlusion according to L.Andrews (1872) [2], which should be sought when achieving orthodontic treatment. The first key is the correct focal contact between the first permanent molars of the upper and lower jaws with the correct inclination of the longitudinal axes of these teeth to the occlusal plane; the second key is the correct angulation in degrees (mesiodistal inclination) of all teeth; the third key is the correct torc (vestibular inclination of the roots); the fourth key - teeth located in the dentition should not be rotated along the axis; fifth key - the presence of tight contacts between the teeth of each dentition without diastema and three; the sixth key - the concavity of the Spee curve should not exceed 2 mm. The disadvantage of this method for evaluating occlusion is that it allows you to evaluate only the ratio of the dentition, does not take into account the clinical situation before treatment, allowing you to only correlate the result of treatment with the keys to optimal occlusion.

Closest to the method of an objective assessment of the results of orthodontic treatment is the method of applying lateral TRH according to A.Björk, Swartz M.L. (overlays at the base of the skull, overlays of the upper jaw, overlays of the lower jaw) [1]. The imposition of lateral TRH before and after treatment allows us to trace skeletal and dental changes that occurred during the period of orthodontic treatment. But the overlay method does not allow to characterize these changes quantitatively, to answer the question to what extent the changes have occurred.

The objective of the method of objective assessment of the results of orthodontic treatment is to characterize the degree of change in the severity of signs of RFA as a result of the treatment.

To accomplish the task, a method is proposed for evaluating the results of orthodontic treatment by assigning signs of AFA degrees of severity before treatment and after and then comparing them.

To explain the operation of the method of objective assessment of the results of orthodontic treatment, Table 1 is proposed (see Fig. 1), which presents the parameters, guided by which, the signs of RFA are assigned the first, second or third degree: before treatment and after. The vertical columns of the table show directions (sagittal, vertical and transversal), while the horizontal columns show signs of CFA (morphological, occlusal, aesthetic and functional. In the second part of the table, vertical columns show such characteristics as the position of the teeth, their retention and adentia, in horizontal - their possible degrees of severity.

A method for objectively evaluating the results of orthodontic treatment works as follows: they receive and analyze lateral and bezel-shaped TRH, jaw models, face-shaped and profile photographs of the patient’s face, assess malfunctions of the masticatory-speech apparatus, close position of the teeth, their retention and adentia before and after treatment treatment. Analysis of lateral TRG is carried out according to the methodology of Fadeev R.A., Kuzakova A.V., 2009 [1]. In accordance with the data in Table 1, each feature is assigned a first, second, or third degree of severity. Based on the results of comparing the severity of signs of RFA before and after treatment, a conclusion is drawn on the effectiveness of the treatment.

To illustrate the work with this method, we provide several extracts from medical records.

Patient B., 26 years old (Fig. 2 a-c). He went to the clinic with complaints about the close position of the teeth of the upper and lower jaws.

Figure 2. Photographs of the face of patient B., 26 years old, before treatment: a) a face photograph of the face; b) a face photo with a smile; c) profile photo of the face.

When examining the oral cavity revealed a close position of the front teeth of the upper and lower jaws, corresponding to the 2nd degree on the upper and 3rd degree on the lower, the mesial ratio of the dentition corresponding to the 1st degree, cross occlusion in the lateral departments of the 2nd degree, displacement of the interdental line, open bite in the anterior 1 st degree, narrowing of the dentition of the upper jaw (Fig. 3, 4 a-d).

Figure 3. OPTG of patient B., 26 years old, before treatment

Figure 4. Photos of the dentitions of patient B., 26 years old, before treatment: a) dentitions in the right projection; b) dentitions in a direct projection; c) dentitions in the left projection; g) the upper dentition in a direct projection; g) the lower dentition in a direct projection.

Analysis of lateral TRH confirmed that the anomaly is concentrated mainly at the level of the dentition (Fig. 5). The study of lateral TRG, OPTG, photographs and models of the patient's jaws showed that morphological abnormalities corresponded to the 1st degree in the sagittal and 2nd degrees in the vertical direction. Aesthetic disorders were characterized as 1st degree in the sagittal and vertical directions (Tables 2, 3).

Figure 5. Copy of lateral TRH of patient B., 26 years old, before treatment.

The results of a quantitative assessment of RFA of patient B., 26 years old, before treatment: morphology, occlusion, aesthetics, function.

Table 2. Direction Morphology Occlusion Aesthetics Function Sagittal one one one Vertical 2 one one Transversal one 2

The results of a quantitative assessment of RFA of patient B., 26 years old, before treatment: close tooth position, retention, adentia.

Table 3. 1st 2nd 3rd power power power Close tooth position + Retention Adentia

Considering the revealed nature of the anomaly, a treatment method was proposed with the removal of two lower premolars. However, meeting the wishes of the patient, and also taking into account the fact that the lower incisors were in the correct position, an agreed treatment plan was chosen without removing the contact surfaces of the teeth of the lower jaw. The treatment was carried out using a fixed arch apparatus and Derichsweiler apparatus and consisted in expanding the upper dentition, as well as in correcting the shape of the dentition of the upper and lower jaws with the subsequent creation of multiple occlusal contacts.

Below are photographs of the patient at the stages of treatment and in the retention period, the results of a quantitative assessment of RFA after completion of treatment (Fig.6-11, table. 4, 5).

6. Derichsweiler apparatus, fixed on the teeth of patient B., 26 years old.

7. Photos of the dentitions of patient B., 26 years old, at the stage of orthodontic treatment: a) dentitions in the right projection; b) dentitions in a direct projection; c) dentitions in the left projection; g) the upper dentition in a direct projection; g) the lower dentition in a direct projection.

Fig. 8. Photos of patient B., 26 years old, in the retention period of treatment: a) dentitions in the right projection; b) dentitions in a direct projection; c) dentitions in the left projection; g) the upper dentition in a direct projection; g) the lower dentition in a direct projection.

Fig.9. OPTG of patient B., 26 years old, in the retention period of treatment.

Figure 10. Copy of lateral TRH of patient B., 26 years old, after completion of treatment.

11. Photographs of the face of patient B., aged 26, after completion of treatment: a) a face photograph of the face; b) a face photo with a smile; c) profile photo of the face.

The results of a quantitative assessment of RFA of patient B., 26 years old, after completion of treatment: morphology, occlusion, aesthetics, function.

Table 4. Direction Morphology Occlusion Aesthetics Function Sagittal one N N Vertical 2 N N Transversal N N

The results of a quantitative assessment of RFA of patient B., 26 years old, after completion of treatment: close tooth position, retention, adentia.

Table 5. 1st 2nd 3rd power power power Close position + teeth Retention Adentia

From a comparative analysis of the diagnostic tables, it can be seen that there was an improvement in the aesthetics, occlusion and close position of the teeth, which allows us to conclude the effectiveness of the orthodontic treatment. However, along with the improvement of many indicators, the degree of close position was replaced by the first, which confirms the proposed method of treatment with the removal of the lower premolar.

Patient P., 23 years old. Appealed to the clinic with complaints of poor facial aesthetics (Fig 12 a-b). On examination, tooth loss was detected 46, during the previous orthodontic treatment, 24 and 24 teeth were also removed, the distal ratio of the dentition, deep incisal overlap (Fig.13a-d).

Fig. 12. Photographs of the face of patient P., 23 years old, before treatment: a) a face photograph of the face; b) a face photo with a smile; c) profile photo of the face.

Fig.13. Photos of the dentitions of patient P., 23 years old, before treatment: a) dentitions in the right projection; b) dentitions in a direct projection; c) dentitions in the left projection; g) the upper dentition in a direct projection; g) the lower dentition in a direct projection.

Analysis of lateral TRG, OPTG, photographs, models of the patient's jaws showed that there is lower retro- and micrognathia, posterior position of the chin, protrusion of the lower incisors (Fig. 14). Morphological abnormalities corresponded to the 3rd degree in the sagittal and vertical directions, occlusion was characterized by the 2nd degree in the sagittal and 1st degrees in the vertical, aesthetic disorders were characterized by the 1st degree in the sagittal and vertical directions (see Tables 6, 7) .

Fig.14. Copy of lateral TRH of patient P., 23 years old, before treatment.

The results of a quantitative assessment of RFA of patient P., 23 years old, before treatment: morphology, occlusion, aesthetics, function.

Table 6. Direction Morphology Occlusion Aesthetics Function Sagittal 3 2 one Vertical 3 one one Transversal one N

The results of a quantitative assessment of RFA of patient P., 23 years old, before treatment: close tooth position, retention, adentia.

Table 7. 1st degree 2nd degree 3rd degree Close tooth position + Retention Adentia

Taking into account the data obtained and the patient’s desire to improve the face profile, an apparatus-surgical treatment method was chosen. 44 tooth was removed, the shape of the dentition was corrected. The second, surgical, stage was the operation of the osteotomy of the lower jaw with the movement of its fragment forward. At the final stage of orthodontic treatment, multiple occlusal contacts were created (Figs. 15-19, Tables 8, 9).

Fig.15. Photos of the dentitions of patient P., 23 years old, before the operation of the osteotomy of the lower jaw: a) dentitions in the right projection; b) dentitions in a direct projection; c) dentitions in the left projection; g) the upper dentition in a direct projection; g) the lower dentition in a direct projection.

Fig.16. Correlation of dentitions in the postoperative period of patient P., 23 years old (surgeon - Z. D.N. of the Russian Federation, prof. Soloviev MM): a) dentitions in the right projection; b) dentitions in a direct projection.

Fig.17. Photographs of the face of patient P., 23 years old, in the postoperative period: a) a face photograph of the face; b) a face photo with a smile; c) profile photo of the face.

The results of a quantitative assessment of RFA of patient P., 23 years old, after treatment: morphology, occlusion, aesthetics, function.

Table 8. Direction Morphology Occlusion Aesthetics Function Sagittal one one 2 for mesial dentition ratio Vertical 2 N one Transversal N

The results of a quantitative assessment of RFA of patient P., 23 years old, after treatment: close tooth position, retention, adentia.

Table 9. 1st 2nd 3rd power power power Close tooth position Retention Adentia

Fig. 18. Photos of the dentitions of patient P., 23 years old, after completion of treatment: a) dentitions in the right projection; b) dentitions in a direct projection; c) dentitions in the left projection.

Fig.19. Copy of lateral TRH patient P., 23 years old, after completion of treatment.

A comparative analysis of the diagnostic tables shows that there have been changes in the severity of morphological, occlusal and aesthetic signs, the severity of the close position of the teeth in the direction of the norm, which allows us to conclude that the effectiveness of orthodontic treatment.

Patient P., 21 years old. I turned to the clinic with complaints of chin protrusion, the posterior position of the upper lip, facial asymmetry (Fig. 20 a, b).

Fig.20. Photos of patient P., 21 years old, before treatment: a) face photo of the face; b) profile photo of the face.

When examining the dentition, their mesial cross ratio in the anterior and lateral regions, an open bite was determined. The separation of the dentition in both vertical and sagittal directions was 5 mm. There was also a close position of the front teeth of the upper and lower jaws, the absence of the first upper premolar on the right and left, as well as the right lower lateral incisor and premolar (Fig.21 a, b).

Fig.21. The ratio of the dentition of patient P., 21 years old, before treatment: a) dentition in the right projection; b) dentitions in a direct projection.

Despite the previously conducted therapeutic measures, by adulthood, the anomaly has become more pronounced. A thorough clinical and radiological examination, the study of digital photographs of the dentition, as well as the analysis of the profile TRG allowed us to make the following diagnosis: upper micrognathia, lower macro- and prognathia, anterior position of the chin of the lower jaw, close position of the teeth in the front of the upper and lower jaw, loss 14, 24, 41 and 44 teeth (Fig. 22). Table 10, 11 presents the results of a quantitative assessment of RFA of patient P., 21 years old, before treatment.

Fig.22. Copy of lateral TRH of patient P., 21 years old, before treatment.

The results of a quantitative assessment of RFA of patient P., 21 years old, before treatment: morphology, occlusion, aesthetics, function.

Table 10. Direction Morphology Occlusion Aesthetics Function Sagittal 3 3 3 Vertical 2 2 3 Transversal one 2 one

The results of a quantitative assessment of RFA of patient P., 21 years old, before treatment: close tooth position, retention, adentia.

Table 11. 1st degree 2nd degree 3rd degree Close tooth position + Retention Adentia

Based on the diagnosis, a treatment plan was drawn up, according to which the first stage was planned reconstructive surgery on the upper jaw and genioplasty. The second stage was planned orthodontic treatment aimed at correcting the shape of the dentition of the upper and lower jaws. The next, third, stage was intended to perform an osteotomy of the lower jaw and, finally, an orthodontic treatment was intended as the final “chord”, the aim of which was to create multiple occlusal contacts of the dentition (Figs. 23-26, Tables 12, 13).

Fig.23. The ratio of the dentition of patient P., 21 years old, after surgery of the osteotomy of the lower jaw: a) dentition in the left projection; b) dentitions in a direct projection.

Fig.24. OPTG patient P., 21 years old, in the postoperative period.

Fig.25. Copy of lateral TRH of patient P., 21 years old, after completion of treatment.

Fig.26. Photograph of patient P.'s face, 21 years old, after completion of treatment.

The results of a quantitative assessment of RFA of patient P., 21 years old, after completion of treatment: morphology, occlusion, aesthetics, function.

Table 12. Direction Morphology Occlusion Aesthetics Function Sagittal 2 3 N Vertical 2 one N Transversal N one one

The results of a quantitative assessment of RFA of patient P., 21 years old, after completion of treatment: close tooth position, retention, adentia.

Table 13. 1st 2nd 3rd power power power Close tooth position Retention Adentia

From a comparative analysis of the diagnostic tables, it can be seen that there was an improvement in the morphology, occlusion, facial aesthetics, and the close position of the teeth, which makes it possible to evaluate the effectiveness of orthodontic treatment.

Thus, the proposed method for an objective assessment of the results of orthodontic treatment, guided by a comparison of the severity of signs of AF in the sagittal, vertical and transverse directions before and after treatment, objectively assess its effectiveness.

Information sources

1. Fadeev R.A., Kuzakova A.V. Clinical cephalometry. - A manual on the diagnosis of orthodontics. - SPb .: LLC "MEDI publishing house", 2009. - 64 p., P. 47-53.

2. Khoroshilkina F.Ya. Orthodontics. Defects in teeth, dentitions, malocclusion, morphofunctional disorders in the maxillofacial region and their complex treatment. - M .: Medical Information Agency LLC, 2006. - 544 p., Pp. 190-192.

Claims (1)

A method for objectively evaluating the results of orthodontic treatment, including obtaining lateral, beveled tele-roentgenograms (TRG) of the head, orthopantomograms (OPG), profile and face-shaped photographs of the patient's face, jaw models, analyzing them in the sagittal, vertical and transverse directions, assessing dysfunctions of the masticatory-speech apparatus , the close position of the teeth, their retention and adentia, characterized in that each symptom of dentofacial facial anomalies (CCA) is assigned a first, second or third degree of expression before and after ZCHA treatment and after its completion and to draw conclusions about the effectiveness of orthodontic treatment.

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