CORRECTION OF MALOCCLUSION WITHOUT THE USE OF FIXED
EQUIPMENT
Ganeev
A. N., MD Averyanov, S. V., PhD Gulyaeva O. A., PhD Djumeev R.M., PhD Dubova
O.M.
Bashkir state
medical University, Russia
Abstract: the article
is devoted to the study of the effectiveness of treatment of crowding of teeth
with myofunctional disorders in patients of different age groups using the
system lastposition, Myobrace
Keywords:
dentofacial anomalies, orthodontic correction, fixed orthodontic appliances,
Myobrace
The relevance of an alternative method of orthodontic correction without
braces using selected individually according to the size of bestpositioned
obvious. Problems such as resorption of roots, decalcification of tooth enamel,
recession of the gingival margin, gingivitis and other complications arising
from the treatment of fixed equipment is, unfortunately, well known to
orthodontists. On the other hand, chronic mouth breathing, reverse swallowing,
as well as harmful myprivacy often lead to a narrowing of the dental arches and
make the results of orthodontic treatment unstable.
As you know, difficult nasal breathing leads to disruption of the
functioning of the body and can cause disorders, mental and physical
development. General weakness, pallor, decreased resistance to infection is a
clinical feature of persons with adenoid growths in the nasopharynx
complicating nasal breathing [1]. Mouth breathing leads to disruption of facial
muscles, the circular muscles of the mouth, tongue and to the development of
dentoalveolar anomalies. Violations balance observed between buccal,
masticatory, temporal and hyoid muscles. Biodynamically balance can be
disturbed between the circular muscle of the mouth, chin, and muscles of the
floor of the mouth. At infringement of function of respiration, the activity of
the circular muscle of the mouth several times higher compared to the norm, and
its endurance is significantly reduced.
Functional failure of the circular muscles may be causing the increase
of the length of the upper dentition, thus acquiring a V-shape, and contribute
to the formation of distal occlusion [2].
In the distal position of the mandible, often observed in children with
impaired nasal breathing also changed and the position of the lower lip in
contact with palatal surface of upper incisors, it contributes to their
vestibular displacement that is outwardly manifested in the form, characterized
by deep folds supramentalise [2].
Special attention should be paid to the position of the tongue during
mouth breathing. Language, being a strong muscular body, affects the formation
of the arched palate of the upper jaw: the condition of the muscles of the
tongue is interconnected with the sagittal dimensions of the upper dentition, anterior
segment long, apical basis and long of the dentition. When mouth breathing, the
child lays the tongue between the dental arches, which contributes to a
protrusion of the upper incisors. This state of language on the background of
mouth breathing can also lead to the formation or anterior open bite[3].
Further pressure strained cheek muscles, occurs in a child when breathing
through the mouth, contributes to narrowing of the dental arches.
An important role in the emergence of the dentofacial anomalies plays
the functional state of muscles involved in the act of swallowing [1]. From
birth to the eruption of primary teeth children have the infantile type of
swallowing. The swallowing function undertaken by a specific group of muscles,
undergoing a restructuring in later stages of a child's development when they
begin to erupt first teeth. If the infantile type of swallowing persists after
the complete eruption of primary teeth, the tip of the tongue of the child at
every swallowing motion, slips between the teeth and the result begins to
prevail, the function of the chin muscles. As a result, these children
experience dental alveolar shortening of the mandible in the anterior region,
protrusion of the upper front incisors and dentoalveolar elongation of the
upper jaw in lateral areas.
For dentofacial anomalies caused by myofunctional disorders
characterized by a narrowing of the dental arches aggravated by the absence in
the modern system of power required for jaw bones load. According to research
by V. P. Okushko, out of 100 children, with addictions and dysfunctions, 80%
have a narrowing of dental arches, which in approximately 50% of children is
complicated by the distal position of the mandible. A high percentage of such
violations caused the emergence of a new development system silicone
lastposition "using the myobrace system" (Myobrace)
with built-in extending the framework for the correction of crowding in
patients with narrowing of dental arches, arising on a background of
myofunctional disorders. Sets of series, Myobrace
combine, thus, the properties of myofunctional trainers and orthodontic
widening effect of the arc. For the indication can be replacement of
non-removable orthodontic techniques in the permanent dentition.
Size bestpositioned is chosen individually for each patient by measuring
mesiodistal sizes of the four upper incisors. The width of these cutters are
summed and then, in accordance with the special table is selected the right
size [3]. Two-layer design, Myobrace allows you to combine the comfort of a
flexible silicone that forms the outer layer with the efficiency of the elastic
inner skeleton that stimulate the growth and expansion of the dental arches.
The distal ends of the device provide a good support for the second molars. The
effect of dental alignment is achieved through a built-in frame, acting on the
principle of the orthodontic arch, as well as individual cells for the teeth in
the front group. In addition, positioners, Libras possess all the structural
features characteristic of myofunctional trainers: "tongue" training
for correct position of the tongue, adverse bumpers, limit language, special
thickenings in the area of molars, providing decompression of the temporomandibular
joint. Trainer, Libras, as well as other devices of the family myofunctional
trainers, has openings for gradual adjustment type of respiration [3].
Indications for use of the system, Myobrace:
crowding in the anterior region, narrowing dentition, open bite, class II Engel
(the I-th and II-th subclass) deep bite, the I-th class of Engel in the
background crowding, dentoalveolar forms of class III harmful myofunctional
habits and dysfunction, correction of the position of the lower jaw.
Contraindications for treatment system: a distinct third class (skeletal
form), the inability of free nasal breathing (you must receive confirmation
from the otorhinolaryngologist about the functionality of the breath).
The aim of our study was to determine the effectiveness of the treatment
of crowding of teeth with myofunctional disorders and difficulty nasal
breathing in patients of different age groups using the system, Myobrace.
System Myobrace is used for the correction of clinical cases in which
the dentofacial anomalies was due to the narrowing of the dentition and,
consequently, overcrowding. Patients underwent diagnosis and calculation
models, as well as tests on nasal breathing. In connection with the failure of
nasal breathing one of the patients was additionally treated at the
otorhinolaryngologist. Before you can assign a system Libras, we determined the
tone of the circular muscles of the mouth, which is indicators of strength,
speed and muscle endurance. The functional status of the dentition was
determined with the test exercises. Selecting as the main indicator of the
endurance of the circular muscle, which is measured by the retention time of
the apparatus, it is possible to intensify the healing process, individually
dosing the load.[4] Improving endurance of muscle fibers, we positively impact on the strength and speed of muscle
contractions. To this end, the patient in the first phase of treatment is
offered during the months gradually increase the time of use, Myobrace,
bringing it in total to 2 hours a day.
Recommended mode of increasing the load: three times a day for three
approach starting with the maximum for the patient retention time, Myobrace,
each time you should increase it by 1-2 minutes.
The first inspection is recommended after 2 weeks, the second in a
month. In the next step the patient for about six months is Myobrace
two hours a day and sleeps with a machine at night.[5] a Subsequent follow-up
visits the most revealing after 3 and 6 months. With good dynamics of the
adjustment process after 4-6 months the patient is selected individually the
size of Myobrace, which he continues to wear 5-6 months, and several
months after treatment - in as a retentive apparatus.
The use of the apparatus, Libras in the early mixed dentition
(6-8years), allows to stimulate the development of Airways, maxillary sinuses
and due to the cessation of proliferation of the adenoid tissue to normalize
the development of bronchopulmonary system of the growing child in just 6-8
months, which also contributes to the normal growth of the jaw bones [6]. In
addition, patients with flattening of the hard palate resulting from the use of
the trainer, Myobrace in the early mixed dentition we observed the
normalization of the shape of the nasal septum. During the second period of the
mixed occlusion this effect is no longer observed, so such a correction should
be carried out as early as possible.
Conclusion: in children with dysfunction of breath, not having
pathology in the size and structure of the respiratory tract, the use of the
system, Myobrace allows you to restore nasal breathing, and normalize
the functions of the respiratory system. Therefore, orthodontic treatment
should start at an early age. In the process of orthodontic treatment using
positioners, Myobrace in children in the mixed dentition restored form of
the alveolar processes and dentition, the lower jaw is moved forward relative
to the base of the skull and the alveolar bone, as well as by normalizing the
ratio of the elements and growth of the temporomandibular joint articular
process is removed with a sagittal slit[5]. We consider it appropriate
application of myofunctional apparatus system, Myobrace
also in the permanent dentition for the treatment of minor anomalies on the
background of myofunctional disorders. In such patients, the trainers of the
system, Myobrace is an alternative to non-removable orthodontic
equipment.
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