RU2834144C1 - Method of correcting 2nd class of angle closure using aligners with buttons - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to dentistry, and is intended for use in Angle class 2 correction. Method involves collecting anamnesis at the first stage, inspecting the patient’s oral cavity for diagnosis and planning of further treatment. At the second stage, a dental arch is photographed, then an X-ray examination of the dental rows is carried out, and then dental arch impressions are taken. At the third stage, the obtained dental arch data are loaded into the doctor’s personal office to create a digital SET UP model of the patient’s dental arch. At the fourth stage, the digital SET UP model is used to perform successive movement of teeth and occlusion correction. At the fifth stage, a set of aligners is made by thermoforming a medical biopolymer on stereolithographic models of dental arches with planned movements of teeth. At the sixth stage, on the set of aligners made at the fifth stage, buttons from biocompatible plastic are attached, on the upper jaw the first button between 12th and 13th teeth and the second button between 22nd and 23rd teeth from the vestibular side, or a first button opposite tooth 13 and a second button opposite tooth 23 on the vestibular side, or a first button between 13 and 14 teeth and a second button between 23 and 24 teeth on the vestibular side, on the lower jaw a third button opposite tooth 35 and a fourth button opposite tooth 45 on the vestibular side, or third button opposite tooth 36 and fourth button opposite tooth 46 from vestibular side, or third button opposite tooth 37 and fourth button opposite tooth 47 from vestibular side, elastic traction with working force from 1 to 130 g in sagittal direction of lower jaw is fixed between buttons of upper and lower jaws. First button is attached to the fourth button, and the second button is attached to the third button. On the first week of wearing the aligners, elastic rods with a working force of up to 70 g are installed to adapt the temporomandibular joint to the teeth movements planned at the fifth stage. On the second week, the elastic rods are replaced with elastic rods with a working force of 70 g to 130 g. On the third week, the elastic rods are replaced with elastic rods with a working force of up to 70 g. At the fourth week, the elastic rods are replaced with elastic rods with a working force of 70 g to 130 g. After the fourth week, the patient is examined to assess the movement of the teeth of the lower jaw and to correct the working force of the elastic rods. If the teeth of the lower jaw are displaced by 1-1.5 mm, elastic rods are installed with a working force of 70 g to 130 g for 4 weeks and the patient is examined to assess the movement of the teeth once every four weeks before the end of treatment, which is determined by the achievement of the teeth movement planned at the fifth stage, and if the teeth of the lower jaw are displaced by less than 1 mm, elastic rods are installed with a working force of up to 70 g for four weeks, after which the patient is examined to assess the movement of the teeth and if the lower jaw displacement is fixed by 0.5-1 mm, elastic rods are installed with working force from 70 g to 130 g for 4 weeks and the patient is examined to assess the movement of the teeth once every four weeks before the end of the treatment, which is determined by the achievement of the planned teeth movement at the fifth stage.

EFFECT: method enables for controlled, in the process of treatment, exposure of a group of teeth to change 2nd class of Angle closure without the need to attach orthodontic buttons to the surface of the teeth.

4 cl, 8 dwg

Description

Mesioocclusion (Mesial bite) - mesial bite is a pathology characterized by a violation of the closure of the dental arches, which determines the anterior position of the lower teeth in relation to the upper ones (Features of the treatment of adults with mesioocclusion, with the parallel development of dentoalveolar deformation Scientific review. Galinsky V.S. Medical sciences. - 2017. - No. 3 - P. 15-17).

A method for treating patients with mesial occlusion is known, in which a chin implant is installed and fixed to the bone tissue with four screws, a mucoperiosteal flap is placed on top, and the wound is closed with interrupted sutures in such a way that the hooks of the chin implant remain outside in parallel on both sides for further fixation of the rubber traction on them: the second end of the hooks is fixed to the installed rings on the sixth molars of the upper jaw on both sides (Yeshiev D.A., Yeshiev A.M. Use of a chin implant in the correction of class III occlusion according to Angle // International Journal of Applied and Fundamental Research. - 2020. - No. 7. - P. 35-39).

This method cannot be used when treating with aligners.

It requires the installation of a large amount of additional equipment on the teeth.

A method for treating patients with mesial occlusion using bracket systems is known, in which a photo protocol and CT are carried out, on the basis of which the movement of the jaws along the axis to the norm is planned (Khasanov A.I., Rakhmanov Sh.A., Abduvaliev A.A. Preparation and planning for orthognathia of patients with jaw deformation of the 3rd class according to Angle // Conferences. - 2023. - No. 2-3 (91-92). - P. 43-49).

This method cannot be used when treating with aligners.

It requires the installation of a large amount of additional equipment on the teeth.

For orthodontic correction of the bite, aligners with lingual buttons are used, onto which elastic traction is put to apply forces between the buttons necessary to correct the position of the teeth (Postnikov M.A. et al. Method of orthodontic treatment of patients with distal occlusion. - 2018 and Gezalova N., Mironova E. Treatment of the distal relationship of the dentition using a system of orthodontic aligners // Digital dentistry. - 2018. - Vol. 8. - No. 1. - Pp. 61-67).

A method for treating Class III mesioocclusion according to Angle is known using clear aligners with metal buttons for elastic support installed on them, in which, when installing the first clear aligners, rectangular retainers were installed on the posterior teeth, and rectangular ones with gingival bevels were installed on the lower anterior teeth to ensure maximum retention of the aligners. In addition, posterior anchorages ensured adequate anchorage and control of distal inclination of the molars and premolars, while retainers on the lower canines and upper first molars prevented adverse effects of movements when using Class III intermaxillary elastics. An interproximal reduction (IPR) between the lower incisors of 2 mm was planned (Fig. 4). After extraction of the third molar, composite attachments and metal buttons for elastic support were installed. Orthodontic elastics and clear aligners were delivered to the patient. The patient wore the aligners correctly for 22 hours per day with class III elastics secured to the upper first molars and lower canines. After 12 months of treatment, the patient showed improvement in class III malocclusion, positive anterior overbite, resolution of posterior crossbite, and improved alignment of the upper and lower teeth (Inchingolo A. D. et al. Treatment of class III malocclusion and anterior crossbite with aligners: a case report // Medicina. - 2022. - Vol. 58. - No. 5. - P. 603).

This method requires the installation of additional equipment on the tooth surface.

From Wang Q. et al. Biomechanical analysis of effective mandibular en-masse retraction using Class II elastics with a clear aligner: a finite element study // Progress in Orthodontics. - 2022. - Vol. 23. - No. 1. - P. 23 a method for shifting and distributing the load on the lower jaw dentition is known at different positions of elastic materials of class II according to Angle during mass retraction in therapy with transparent aligners.

This method does not take into account the dynamics during treatment with aligners.

The objective is to develop a method for eliminating the shortcomings of known methods of correction of the 2nd class of occlusion according to Angle using aligners with buttons.

The technical result of the claimed method is the possibility of a controlled effect on a group of teeth during the treatment process to change the 2nd class of occlusion according to Angle without the need to attach orthodontic buttons to the surface of the teeth.

The technical result is achieved by collecting anamnesis, examining the patient's oral cavity in the first stage to establish a diagnosis and plan further treatment. In the second stage, a photo protocol of the dental arches is carried out, then an X-ray examination of the dental arches is carried out and then impressions of the dental arches are obtained. In the third stage, the obtained data on the dental arches are loaded into the doctor's personal account to create a digital SET UP model of the patient's dental arches. In the fourth stage, sequential movement of teeth and correction of the bite are carried out on the digital SET UP model. In the fifth stage, a set of aligners is manufactured by thermoforming a medical biopolymer on stereolithographic models of the dental arches with the planned tooth movements. At the sixth stage, buttons made of biocompatible plastic are attached to the set of aligners manufactured at the fifth stage: on the upper jaw, the first button between the 12th and 13th teeth and the second button between the 22nd and 23rd teeth on the vestibular side, or the first button opposite the 13th tooth and the second button opposite the 23rd tooth on the vestibular side, or the first button between the 13th and 14th teeth and the second button between the 23rd and 24th teeth on the vestibular side; on the lower jaw, the third button opposite the 35th tooth and the fourth button opposite the 45th tooth on the vestibular side, or the third button opposite the 36th tooth and the fourth button opposite the 46th tooth on the vestibular side, or the third button opposite the 37th tooth and the fourth button opposite the 47th tooth on the vestibular side. An elastic traction with a working force of 1 to 130 g is fixed between the buttons of the upper and lower jaws. in the sagittal direction of the lower jaw, with the first button attached to the fourth button, and the second button attached to the third button. In this case, during the first week of wearing the aligners, elastic tractions with a working force of up to 70 g are installed to adapt the temporomandibular joint to the tooth movements planned at the fifth stage. During the second week, the elastic tractions are replaced with elastic tractions with a working force of 70 g to 130 g. During the third week, the elastic tractions are replaced with elastic tractions with a working force of up to 70 g. During the fourth week, the elastic tractions are replaced with elastic tractions with a working force of 70 g to 130 g. After the fourth week, the patient is examined to assess the movement of the teeth of the lower jaw and adjust the working force of the elastic tractions. In this case, if the displacement of the teeth of the lower jaw occurred by 1-1.5 mm, elastic tractions with a working force of 70 g to 130 g are installed for 4 weeks and the patient is examined to assess the movement of the teeth once every four weeks until the end of the treatment, which is determined by achieving the movement of the teeth planned at the fifth stage. If the displacement of the teeth of the lower jaw occurred by less than 1 mm, elastic tractions with a working force of up to 70 g are installed for four weeks, after which the patient is examined to assess the movement of the teeth, and if the displacement of the teeth of the lower jaw is recorded by 0.5-1 mm, elastic tractions with a working force of 70 g to 130 g are installed for 4 weeks and the patient is examined to assess the movement of the teeth once every four weeks until the end of the treatment, which is determined by achieving the movement of the teeth planned at the fifth stage. The technical result is also achieved in a particular case by the fact that at the fifth stage, holes with a diameter of 1.0 mm are made in the aligners in the area of button installation, into which the buttons are installed using internal (in relation to the patient) fixators. The technical result is also achieved in a particular case by the fact that the internal (in relation to the patient) fixators are made in the form of rivets. The technical result is also achieved in a particular case by the fact that at the fifth stage, liquid UV-curable glue is applied to the aligners from the outer (in relation to the patient) side from the vestibular side using a syringe tube and the buttons are pressed, then UV-curable glue is exposed to the surface of the aligners for 10 seconds using a UV lamp, which after hardening fixes the buttons.

Brief description of the drawings.

Fig. 1 shows a button made of biocompatible plastic with a flat base in the form of a circle/disk for attachment to the aligner using UV glue.

Fig. 2 shows a button made of biocompatible plastic for mechanical fastening with a rivet to the aligner.

Fig. 3 shows the stage before the biocompatible plastic button is installed on the aligner using liquid UV-curable adhesive.

Fig. 4 shows the stage after the installation of a button made of biocompatible plastic on the aligner using liquid UV-curable adhesive.

Fig. 5 shows the stage before the biocompatible plastic button is fixed to the aligner with a rivet.

Fig. 6 shows the stage after fixing the button made of biocompatible plastic to the aligner with a rivet.

Fig. 7 shows the stage of fixing a button made of biocompatible plastic to the aligner.

Fig. 8 shows the stage of fixing a button made of biocompatible plastic to the aligner. The claimed method is carried out as follows.

At the first stage, anamnesis is collected, the patient’s oral cavity is examined to make a diagnosis and plan further treatment.

At the second stage, a photo protocol of the dental rows is carried out, then an X-ray examination of the dental rows is carried out and then impressions of the dental rows are obtained.

At the third stage, the obtained data on the dental arches are uploaded to the doctor’s personal account, for example, the EUROKAPPA doctor’s personal account, to create a digital SET UP model of the patient’s dental arches.

At the fourth stage, the digital SET UP model is used to consistently move teeth and correct the bite.

At the fifth stage, a set of aligners is manufactured by thermoforming a medical biopolymer on stereolithographic models of dental arches with planned movements.

At the sixth stage, buttons made of biocompatible plastic are attached to the set of aligners manufactured at the fifth stage: on the upper jaw, the first button between the 12th and 13th teeth and the second button between the 22nd and 23rd teeth on the vestibular side, or the first button opposite the 13th tooth and the second button opposite the 23rd tooth on the vestibular side, or the first button between the 13th and 14th teeth and the second button between the 23rd and 24th teeth on the vestibular side; on the lower jaw, the third button opposite the 35th tooth and the fourth button opposite the 45th tooth on the vestibular side, or the third button opposite the 36th tooth and the fourth button opposite the 46th tooth on the vestibular side, or the third button opposite the 37th tooth and the fourth button opposite the 47th tooth on the vestibular side. Between the buttons of the upper and lower jaws, an elastic traction with a force of 1 to 130 g is fixed, for example, from Ormco https://ormco.ru/market/elastic/rod/ in the sagittal direction of the lower jaw, while the first button is attached to the fourth button, and the second button is attached to the third button.

In this case, during the first week of wearing the aligners, elastic tractions up to 70 g are installed, which ensures smooth adaptation of the TMJ to the planned movement. During the second week, the elastic tractions are replaced with more rigid ones from 70 g to 130 g. During the third week, the elastic tractions are again replaced with less rigid ones - up to 70 g. During the fourth week, the elastic tractions are again replaced with a pressure range from 70 g to 130 g. After the fourth week, the patient goes to his/her attending physician for a routine examination.

The main goal of this technique is to assess the volume of movement of the lower jaw and select the necessary working force of elastics depending on the patient’s biological limits.

In the first case: If the displacement of the lower jaw (lower jaw teeth) has occurred by 1-1.5 mm, the patient continues to wear elastic traction in the range from 70 g to 130 g for the next 4 weeks. Then follows a control examination, if the positive dynamics of the lower jaw advancement is also maintained, the strength of the elastic traction remains unchanged. Control examinations to assess the movement once every 4 weeks are maintained until the end of treatment, which is determined by the planned advancement of the lower jaw, taking into account the biological limits of the patient's TMJ.

In the second case: If the jaw (lower jaw teeth) displacement is less than 1 mm, the patient switches to wearing elastics in the range of up to 70 g for the next 4 weeks.

If the follow-up examination shows positive dynamics of extension from 0.5 mm to 1 mm, the patient switches to stronger elastic traction (from 70 g to 130 g) until the next follow-up examination. If the positive dynamics persist, then all treatment follows the stages described in the first case.

It is also possible to adjust the treatment if the patient does not show any positive dynamics in the advancement of the lower jaw. In this case, additional diagnostic manipulations should be carried out, such as CBCT of the TMJ to determine the correctness of the treatment plan drawn up at the first stage, taking into account the biological capabilities of the patient's TMJ, for example, the presence of blocking occlusal contacts of the dental arches.

When implementing the method, it is also possible that at the sixth stage, holes with a diameter of 1.0 mm are made in the aligner in the area of button installation, into which buttons are installed using internal fasteners in the form of rivets relative to the patient.

When implementing the method, it is also possible that at the sixth stage, liquid UV-curable glue is applied to the aligners from the outer side of the aligner with respect to the patient from the vestibular side using a syringe-tube and the buttons are pressed, then UV-curable glue is exposed to the surface of the aligner using a UV lamp for 10 seconds, which after hardening fixes the buttons. Examples of implementing the claimed method.

As part of the study of the claimed method, treatment and correction evaluation of the 2nd class of closure according to Angle were carried out using aligners with buttons in 14 patients using the claimed method.

The first five stages of the planned method were the same for all 14 patients.

At the sixth stage, the biocompatible plastic buttons were attached in different ways (taking into account the results at the first five stages of treatment):

- In 3 patients, at the sixth stage, buttons made of biocompatible plastic were attached to the upper jaw, the first button between the 12th and 13th teeth and the second button between the 22nd and 23rd teeth on the vestibular side, on the lower jaw, the third button opposite the 35th tooth and the fourth button opposite the 45th tooth on the vestibular side,

- In 7 patients, at the sixth stage, buttons made of biocompatible plastic were attached to the upper jaw: the first button opposite the 13th tooth and the second button opposite the 23rd tooth on the vestibular side; on the lower jaw, the third button opposite the 36th tooth and the fourth button opposite the 46th tooth on the vestibular side,

- For 4 patients, buttons made of biocompatible plastic were attached to the upper jaw; the first button was attached to the upper jaw between the 13th and 14th teeth and the second button between the 23rd and 24th teeth on the vestibular side; on the lower jaw, the third button was opposite the 37th tooth and the fourth button was opposite the 47th tooth on the vestibular side.

Then, in the first week, all 14 patients were fitted with elastic tractions with a working force of 50 g, in the second week, the elastic tractions were replaced with elastic tractions with a working force of 100 g, in the third week, the elastic tractions were replaced with elastic tractions with a working force of 60 g, and in the fourth week, the elastic tractions were replaced with elastic tractions with a working force of 100 g.

After the fourth week, the patients were examined to assess the movement of the lower jaw teeth and adjust the working force of the elastic tractions. Eight patients with a 1-1.5 mm movement of the lower jaw teeth were given elastic tractions with a working force of 125 g for 4 weeks and the patient was examined to assess the movement of the teeth once every four weeks until the end of the treatment, i.e. until the planned tooth movement at the fifth stage was achieved.

In six patients, in whom the displacement of the lower jaw teeth occurred by less than 1 mm, elastic tractions with a working force of 60 g were installed for four weeks, after which the displacement of the lower jaw teeth by 0.5-1 mm was recorded and elastic tractions with a working force of 125 g were installed for 4 weeks and the patient was examined to assess the movement of the teeth once every four weeks until the end of treatment, i.e. until the planned tooth movement at the fifth stage was achieved.

Evaluations of the treatments performed on 14 patients using the stated method showed that all patients achieved correction of the 2nd class of occlusion according to Angle using aligners with buttons in all 14 patients, which confirmed the possibility of a controlled effect on a group of teeth during treatment to change the 2nd class of occlusion according to Angle without the need to attach orthodontic buttons to the surface of the teeth. Also, patients noted the absence of discomfort during treatment, and the doctors who performed the treatment noted improved hygiene of the surface of the patients' teeth (mineral formations were not detected on the surface of the teeth, which is usually the case when buttons are installed on the surface of the teeth).

Claims (4)

1. A method for correcting class 2 occlusion according to Angle using aligners with buttons, characterized in that at the first stage anamnesis is collected, the patient's oral cavity is examined to establish a diagnosis and plan further treatment, at the second stage a photo protocol of the dentition is carried out, then an X-ray examination of the dentition is carried out and then impressions of the dentition are obtained, at the third stage the obtained data of the dentition are uploaded to the doctor's personal account to create a digital SET UP model of the patient's dentition, at the fourth stage sequential movement of teeth and correction of the bite are carried out on the digital SET UP model, at the fifth stage a set of aligners is manufactured by thermoforming a medical biopolymer on stereolithographic models of the dentition with the planned tooth movements, at the sixth stage buttons made of biocompatible plastic are attached to the set of aligners manufactured at the fifth stage, the first button on the upper jaw between the 12th and 13th teeth and the second button between the 22nd and 23rd teeth with a vestibular sides, or the first button opposite the 13th tooth and the second button opposite the 23rd tooth from the vestibular side, or the first button between the 13th and 14th teeth and the second button between the 23rd and 24th teeth from the vestibular side, on the lower jaw the third button opposite the 35th tooth and the fourth button opposite the 45th tooth from the vestibular side, or the third button opposite the 36th tooth and the fourth button opposite the 46th tooth from the vestibular side, or the third button opposite the 37th tooth and the fourth button opposite the 47th tooth from the vestibular side, between the buttons of the upper and lower jaws an elastic traction with a working force of 1 to 130 g is fixed in the sagittal direction of the lower jaw, while the first button is attached to the fourth button, and the second button is attached to the third button, while in the first week of wearing the aligners, elastic tractions with a working force of up to 70 g are installed for adaptation temporomandibular joint to the tooth movements planned at the fifth stage, in the second week the elastic tractions are replaced with elastic tractions with a working force of 70 g to 130 g, in the third week the elastic tractions are replaced with elastic tractions with a working force of up to 70 g, in the fourth week the elastic tractions are replaced with elastic tractions with a working force of 70 g to 130 g, after the fourth week the patient is examined to assess the movement of the teeth of the lower jaw and adjust the working force of the elastic tractions, while if the displacement of the teeth of the lower jaw occurred by 1-1.5 mm, elastic tractions with a working force of 70 g to 130 g are installed for 4 weeks and the patient is examined to assess the movement of the teeth once every four weeks until the end of the treatment, which is determined by achieving the tooth movement planned at the fifth stage, and if the displacement of the teeth of the lower jaw occurred by less than 1 mm, elastic tractions with a working force of up to 70 g for four weeks, after which the patient is examined to assess the movement of the teeth, and if a displacement of the teeth of the lower jaw by 0.5-1 mm is recorded, elastic tractions with a working force of 70 g to 130 g are installed for 4 weeks and the patient is examined to assess the movement of the teeth once every four weeks until the end of treatment, which is determined by the achievement of the movement of the teeth planned in the fifth stage. 2. The method according to item 1, wherein at the fifth stage, holes with a diameter of 1.0 mm are made in the aligners in the area where the button is installed, into which the buttons are installed using internal fasteners relative to the patient. 3. The method according to item 2, wherein the fasteners internal to the patient are made in the form of rivets. 4. The method according to item 1, in which, at the fifth stage, liquid UV-curable glue is applied to the aligners on the outer side of the aligners with respect to the patient on the vestibular side using a syringe tube and the buttons are pressed, then the UV-curable glue is exposed to the surface of the aligners using a UV lamp for 10 seconds, which, after hardening, fixes the buttons.