RU2710679C1 - Chewing muscle deprogramming device - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to dentistry, and is intended for use in determining a central ratio of jaws. Deprogrammer represents a tray, the kappa is equipped with a plastic pad in the frontal group of teeth, which is located at angle of 45° or 90° relative to cutting edge of central cutters, wherein selection of angle depends on distalization of lower jaw head: with pronounced distalization device is made with inclination of pad surface 45°, at less pronounced – 90°, and thickness of patch is selected based on normalizing anterior morphological height of occlusion, taking into account that closing and movement of lower jaw is only on lower front cutters, for separation in chewing group of teeth, which is necessary for muscular deprogramming with subsequent finding of central ratio of jaws. Presented deprogrammer can be made on both upper and lower jaws.EFFECT: use of the device allows de-shaping chewing muscles, normalizing the position of the TMJ and the lower face height, and improving comfort for the patient during treatment.1 cl, 8 dwg, 1 ex

Description

The invention relates to medicine, namely to dentistry, and is intended to determine the central ratio of the jaws.

A device for deprogramming masticatory muscles using a Jig-Lucia-type deprogrammer is known in the art. This is a standard partial bite mouth guard that fits in the front of the dentition and prevents lateral teeth from closing. The action of the mouthguard should last for 30 minutes in combination with protrusive and retrusive movements of the lower jaw [Tamazyan NG, Radyshevskaya TN, Starikova IV, Bobrov DS Comparative characteristics of the masticatory muscle deprogramming methods // Colloquium-journal. 2019.Vol. 2. No. 3 (27). S. 37].

The disadvantage of this device is the need for accurate selection of a standard bite mouth guard for uncoupling the chewing group of teeth, since excessive separation of the teeth leads to displacement of the heads of the temporomandibular joint, and the inability to register the central ratio of the jaws.

Cois's deprogrammer is also known. The device is a palatine plate on the upper jaw made of acrylic plastic with a retention arch. In the region of the incisal papilla there is a flat protrusion of about 3 mm in height and 6 mm in width. For the manufacture of Coyce's deprogrammer, a gypsum model is made from alginate impressions of the upper and lower jaw. According to the model, the vestibular arch (wire) of the future design is made, which will further control the stability of the acrylic base inside the patient's oral cavity. The basis has the shape of a horseshoe, turned by special high-precision tools so as to have a small platform for the central lower incisors. Further, while taking, the Cois Deprogrammer is trying on in the patient's oral cavity. A check is made of the reliability of stabilization of the apparatus, the coincidence of the points of influence with the provided points in the treatment plan. The device is tested using articulation paper. After the test, the deprogrammer most often goes back for revision in order to remove excess material from the palatal surface, which interferes with the patient's normal articulation. Also, the contact with the lower incisors is further narrowed, turning it practically into the point of contact of the platform with the middle of the line of one of them. [The purpose of the Cois deprogrammer and the subtleties of its application [Electronic resource] / Electron, Zh. - Magazine Orthodontist. - access to log: http://orto-info.ru/ortodonticheskoe-lechenie/podgotovitelnyiy-period/deprogrammatora-koysa.html]

This deprogrammer has several disadvantages:

1. Volumetric design, which creates inconvenience for the patient during use.

2. The complexity of manufacturing.

3. Used exclusively on the upper jaw.

4. The time of use of the device, which also creates discomfort for the patient. So, one patient is shown 6-8 hours of wear during the day, others - around the clock with the possibility of removal only for oral hygiene and eating.

The objective of the invention is to remedy these disadvantages.

The problem is solved by the proposed design of the deprogrammer, which is a mouthguard with an individual plastic pad installed at an angle of 45 ° or 90 °.

The deprogrammer can be made both on the upper and lower jaw and used at night.

The technical result is an accurate determination of the central ratio of the jaws.

The essence of the device is illustrated by drawings, which depict: in FIG. 1 is a view of a device with a plastic pad at an angle of 90 °;

in FIG. 2 is a view of the device with a plastic pad at an angle of 45 °;

in FIG. 3 - layout of the deprogrammer with a plastic pad at an angle of 90 °;

in FIG. 4 is a layout diagram of a deprogrammer with a plastic overlay at an angle of 45 °.

In FIG. 5a is a photograph of the lower part of the face of patient A. before treatment, FIG. 5c is a photograph of the dentition in the closed position before treatment; FIG. 5c is a photo of patient A, with open dentition before treatment, in FIG. 6 and 7 are computed tomograms of patient A. before and after deprogramming, FIG. 8a, 8b and 8c, respectively - photo of the lower part of the face of patient A. after applying the deprogrammer, photograph of the dentition in the closed position after application of the deprogrammer, photo of patient A, with open dentition after treatment.

A device for deprogramming the masticatory muscles (deprogrammer) (Fig. 1-4) is a mouthguard 2 with a plastic pad 1 in the region of the frontal group of teeth 3, which is located at an angle α (45 or 90 °) relative to the cutting edge of the central incisors. The proposed deprogrammer is made as follows.

Silicone impressions are removed from the upper and lower jaw, a gypsum model is made for making mouth guards for teeth of the upper or lower jaw with a thickness of 0.5 to 0.75 mm using a vacuum formatter. Next, a plastic patch is applied to the mouthguard in the area of the frontal group of teeth, which is located at an angle of 45 or 90 ° relative to the cutting edge of the central lower incisors. The choice of angle depends on the distalization of the heads of the lower jaw: with pronounced distalization, the deprogrammer is manufactured with an inclined plane of 45 °, with a less pronounced one - 90 °. The thickness of the lining is selected based on the normalization of the anterior morphological height of the bite, taking into account that the closure and movement of the lower jaw were only on the lower front incisors. This separation in the area of the chewing group of teeth is necessary for muscle deprogramming, followed by finding the central ratio of the jaws.

The patient wears a deprogrammer for a week at night.

Clinical example. Patient A., 35 years old. (Fig. 5 a, b, c). The patient complained of unsatisfactory aesthetics and the failure of previously made orthopedic constructions. There were also complaints of pain when opening the mouth in the area of the articular heads of the lower jaw, for clicks in the TMJ when opening the mouth. Before starting treatment using a deprogrammer, the patient underwent a preliminary examination. The photographic protocol was carried out. Received impressions from the upper and lower jaws. The patient was referred for radiography. Computed tomography of the jaw and TMJ was performed. Computed tomography revealed a pronounced distalization of the heads of the lower jaw (Fig. 6).

Diagnosed with: K08.1 Partial absence of teeth in the upper jaw Kennedy grade 3. Decreased height of the lower face. Distal position of the lower jaw. K07.6 Syndrome of pain dysfunction of the temporomandibular joint.

A treatment plan has been drawn up:

1. The manufacture of the deprogrammer;

2. Conversion of the deprogrammer to the bus;

3. Dental prosthetics.

Making a deprogrammer. The deprogrammer is made on the lower jaw. In the absence of frontal teeth on the lower jaw, the deprogrammer is made on the teeth of the upper jaw. Silicone impressions are removed from the lower jaw, a gypsum model is made for making mouth guards for teeth of the lower jaw with a thickness of 0.5 mm or more using a vacuum formatter. On the mouthguard 1 in the region of the front teeth, a plastic lining 2 is applied with a thickness of 2.5 mm in the region of the frontal group of teeth, at an angle of 90 ° (Fig. 1) relative to the cutting edge of the central lower incisors. The plastic overlay is located at an angle of 90 °, taking into account unexpressed distalization, and with strong distalization, a deprogrammer is made with a plastic overlay located at an angle of 45 ° (Fig. 2) relative to the cutting edge of the central incisors. The thickness of the lining is selected from the calculation of normalizing the anterior morphological height of the bite, taking into account that the jaw closure and movement are only on the lower front incisors, for separation in the chewing group of teeth, which is necessary for muscle deprogramming, followed by finding the central ratio of the jaws.

The patient is advised to wear a mouthguard overnight for a week. The next examination of the patient was carried out in a week. The stability of occlusion was checked, with repeated closure of the central lower incisors with articulation paper 8 microns thick, an imprint remains on the plastic overlay.

Then the deprogrammer was converted into a tire by layering plastic in the area of the chewing group of teeth. The patient wore a tire for 30 days. A repeated examination of computed tomography was performed in order to identify the position of the TMJ elements. Positive dynamics was noted, the anterior position of the heads of the lower jaw relative to past computed tomography of the TMJ was observed (Fig. 7). There are no complaints about clicks and pain when opening the mouth. Dentures were performed (Fig. 8 a, b, c).

Thus, the proposed deprogrammer allows you to deprogram the masticatory muscles, normalize the position of the TMJ heads and lower face height, increase patient comfort during treatment, simplify the manufacture of the deprogrammer and its transformation into a splint, accurately determine the central ratio of the jaws. In addition, the proposed deprogrammer can be made both on the upper and lower jaw, which expands its functionality.

Claims (1)

A device for deprogramming the masticatory muscles containing a mouthguard that is placed in the front of the dentition and prevents the closure of the posterior teeth, characterized in that the mouthguard is provided with a plastic patch in the region of the frontal group of teeth, which is located at an angle of 45 ° or 90 ° relative to the cutting edge of the central incisors , the choice of angle depends on the distalization of the heads of the lower jaw: with pronounced distalization, the device is manufactured with a slope of the lining plane of 45 °, with a less pronounced one - 90 °, and laths selected based morphological normalization front height occlusion given to closing and movement of the lower jaw was only on the lower anterior incisors, to isolate a posterior region of the teeth, the need for muscle deprogrammatsii followed by finding the ratio of the central jaw.

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