Диференційований підхід до ортодонтичного лікування дітей із зубощелепними аномаліями, обтяженими дефектами зубних рядів

Abstract

Summary. Modern protocols on providing orthodontic care of children with anomalies and secondary dento-maxillaire deformities include the use of functional- guiding and mechanically-operated orthodontic equipment based on specific clinical indications. At the same time, the issues of orthodontic treatment of dento-maxillaire anomalies complicated by dentition defects still remain controversial, as the vast majority of functionally-guiding and mechanically-operated orthodontic equipment does not provide simultaneous replacement of dentition defect, whereas methods of pediatric prosthetics are often limited by the use of claspless removable laminar prostheses. Their functional efficiency is low due to insufficient fixation and the need for periodic replacement due to the growth of jaws in accordance with the age and physiological development of a child’s body. The use of traditional fixed bridge prostheses during the period of jaws growth is unacceptable, whereas the manufacture of split bridge prostheses with an intermediate part in the form of sliding elements, movably interconnected, as well as cantilever bridges, is limited by dentition due to the removal of only one tooth. Orthodontic appliances that meet these requirements, should be used to replace dentition defects, combined with dento-maxillaire anomalies in each period of formation of the dento-maxillaire system, which determines the relevance of our research. Goal. To increase the effectiveness of comprehensive treatment of children with dento-maxillaire anomalies, complicated by dentition defects of the frontal area with the use of a prosthetic appliance of our own design. Materials and methods. To achieve this goal, we examined 115 children aged from 5 to 17 years with dentition defects of the frontal area, who applied to the Department of Orthopedic Dentistry and Orthodontics, Kyiv Medical University. Of these, orthodontic treatment was performed in 64 patients with the use of removable and non-removable orthodontic appliances, including a prosthesis appliance of our own design: «Prosthesis appliance for upper jaw expansion » Ukrainian patent for a utility model № 145538 dated 28.12.2020, which is fixed using orthodontic bands and temporary fixation cement on the second temporary molars. The appliance has a plastic base with a screw, with which, if necessary, it is possible to influence the growth of the jaw. It also has artificial teeth in the frontal area, which are connected to the base, and do not inhibit the growth of the frontal segment of the upper jaw. Results. According to the results of the research it is determined that for each period of formation of the dento-maxillaire system with dento-maxillaire anomalies complicated by dentition defects it is reasonable to apply a personalized approach when conducting psycho-emotional preparation for treatment, oral cavity sanation, placing on myogymnastic exercises and appropriate orthodontic treatment combined with pediatric prosthetics. Traditional removable and non-removable orthodontic appliances as well as appliances of our own design were used to treat this group of people. According to the results of the treatment, the use of a fixed orthodontic appliance of our own design in children of young and middle age, which restores the function of biting food, allows to replace the dentition defect and meet the aesthetic requirements of patients, as well as to conduct continuous orthodontic treatment due to impossibility to remove the appliance. Indications for the use of this prosthesis appliance is the absence of 1 to 4 front teeth with the possibility of correcting the transversal size of the jaws. Our proposed prosthesis appliance meets the requirements and is easy for patients to use. Conclusions. Indications for the use of the prosthesis appliance of our own design is the absence of 1 to 4 front teeth with the possibility of correcting of the transversal size of the jaws. The use of a non-removable prosthesis appliance of our own design in children of young and middle age, which restores the function of biting food, allows to replace the dentition defect, meet the aesthetic requirements of patients, and to conduct continuous orthodontic treatment. Key words: dento-maxillaire anomalies, dentition defect, orthodontic treatment, orthodontic appliances, prosthesis appliance.