Treatment Of Distal Occlusion Research Articles

Abstract WP42: Real-world Utilization Of Advanced Imaging Based Patient Selection For Thrombectomy

Introduction: Multiple clinical trials support an extended treatment window for thrombectomy for large vessel occlusions (LVO) and the treatment of distal occlusions, leading to increased numbers of patients requiring advanced imaging during acute stroke evaluation. Across hospital systems, there is great variation in advanced imaging protocols for acute stroke patients. The goal of this study is to provide a descriptive analysis of the real-world practices in facilities across the United States. Methods: Acute stroke consultations seen by TeleSpecialists, LLC physicians in the emergency department in 227 facilities (27 states) from July 1, 2021 to December 31, 2021 were extracted from the TeleCare TM database. The encounters were reviewed for age, ethnicity, stroke risk factors, last known normal (LKN), arrival time, thrombolytics candidate, door to needle (DTN) time, advanced imaging, LVO, if Neurointerventionalist (NIR) accepted case, premorbid modified Rankin Score (p-mRS), and NIHSS score. Comparison of baseline characteristics and time benchmarks between advanced imaging group (computed tomography angiography (CTA) with optional CT perfusion (CTP)) vs no advanced imaging group (CT only) was performed. Analysis of the location of the occlusion and of the specific vessels being accepted for intervention was performed. Results: There were 29,187 acute stroke consultations seen with 12,641 (43.3%) receiving advanced imaging. The median DTN time for advanced imaging group was 44 minutes (33, 59) vs 41 minutes (30.5, 54) with no advanced imaging group, p = 0.158. There was a higher NIHSS score and lower p-mRS in the advanced imaging group. Analysis of patients with LVO showed lower DTN times, higher NIHSS scores, lower p-mRS, and shorter LKN to arrival times in the patients accepted for thrombectomy. Majority of cases accepted for thrombectomy were left M1 (31.4%) or right M1 (26.6%) occlusions. A significantly lower percentage of patients accepted for intervention had left M2 (10%) and right M2 (6%) occlusions. Conclusion: Advanced imaging in a large real-world data set of acute stroke patients did not significantly delay DTN times. The ability to maintain DTN times is likely related to thrombolytics being prioritized and a parallel process.

PECULIARITIES OF USING ORTHODONTIC ACTIVATORS FOR DISTAL BITE AND APPLICATION OF RETENTION APPARATUS TO RETAIN RESULTS

Relevance. Distal occlusion is accompanied by certain morphological, functional, and aesthetic changes, in which there are disorders of external respiration, speech disorders, dysfunction of chewing, and swallowing. Today the problem of treatment of occlusion anomalies is not completely solved. The presence of errors and complications in the treatment of distal occlusion, the presence of recurrence of the disease in the form of a double occlusion, which necessitates repeated, and often unsuccessful treatment, indicates that the problem is still far from its final solution.
 Objective: to investigate the effectiveness of the use of orthodontic activators for the treatment of distal occlusion and retention devices to maintain the results of treatment.
 Materials and methods. 126 children aged 9-12 years with distal occlusion are divided into 2 groups. Group I (n=63) – children with distal occlusion and physiological type of respiration; Group II (n=63) – children with distal occlusion and pathological (oral) type of breathing. Conducted clinical, myographic, and anthropometric studies. All patients were treated by wearing a removable functional two-jaw orthodontic activator for at least 16 hours a day, with mandatory use during sleep, for 6 months. In addition to this hardware method of treatment, preventive measures were prescribed: myogymnastic and breathing exercises. The correction of the orthodontic activator was performed once a month. A control electromyographic study to determine the effectiveness of treatment was performed 3 months after the start of treatment (selectively, in some patients - also in the sixth month of treatment). Nylon floss, to keep the teeth in the achieved position.
 Results. The study of the designs of retention devices and comparison of their effectiveness showed that after active orthodontic treatment the most effective retention can be achieved by using a retainer made of flex wire and nylon thread impregnated with liquid photopolymer. The most optimal way to fix the fixed retention apparatus was as follows: complete completion of the active period of treatment; control of fissure-tubercle contact; professional teeth cleaning; conducting X-ray control to identify the position of the roots of the teeth; production of gypsum models and their fixation in the occluder; detection of contact points of the frontal group of teeth; detection of the location of the retainer in the oral cavity; making a retainer indirectly; fixation of the retention apparatus in the oral cavity. Our proposed method of manufacturing and fixing non-removable retainers with the use of nylon thread allows us to achieve reliable long-term retention of the achieved positive results after active orthodontic treatment.
 Analysis of the study data of children aged 9-12 years with distal occlusion and pathological (oral) type of respiration compared with the control group showed an increase in all measured EMG parameters for the temporalis muscles (in the range of 16-31.1±3.12%) and reduction - for the actual masticatory and circular muscles of the mouth (in the range of 17.0-29.8±3.09% and 16.8-35.9%, respectively). The total deviation of the values of the obtained indicators from the normative ranges from 16.0 to 35.9 ±2.56%. These abnormalities can be seen as a manifestation of the formation of a pathological muscle reaction, accompanied by negative changes in the appearance of the patient.
 The design of a removable functionally acting two maxillary orthodontic activators for simultaneous treatment of distal occlusion and dysfunction of masticatory and facial muscles in children with physiological and pathological types of respiration has been developed. It consists of a monoblock and a vestibular plate, monolithically connected to each other.
 Conclusions. In patients with distal occlusion, treatment with a removable functional two-jaw orthodontic activator helps to restore myodynamic balance in the dental system, resulting in improved patient facial expression, self-esteem, and quality of life. Wearing non-removable retainers with the use of nylon thread allows us to achieve reliable long-term retention of the achieved positive results after active orthodontic treatment.

DISTAL OCCLUSION AND DENTAL CROWDING: TREATMENT STRATEGY

Dental anomalies are the leading ones among dental diseases in the period of mixed (79,96%) and permanent (84,33%) dentition. According to the results of our studies, frequency of distal occlusion (up to 40%) and dental crowding (up to 65%) are the largest in structure of orthodontic pathology.
 The aim of the study is to analyze and summarize knowledge about ways of enhancement of treatment and prophylaxis efficiency in patients with distal occlusion and dental crowding.
 Genetic predisposition, early childhood diseases (including upper respiratory tract infections), children's bad habits, pathological state of teeth (adentia, impaction, micro-, macrodentia), micro-, macrognathia, functional disorders of maxillofacial area contribute a high percentage in structure of "risk factors" which lead to formation of distal occlusion with dental crowding. For each particular patient distal occlusion, complicated by dental crowding, is formed under the influence of combination of several "risk factors", where the first place belongs to disturbances of dental area: breathing, closing of lips, swallowing, chewing, speech.
 Today it is well known that the first step in correction of distal occlusion of dentitions is to evaluate the patient's potential growth. Treatment in the period of mixed dentition is important with relation to protection of palate from trauma by mandibular incisors with a large sagittal gap, prophylaxis of dysfunction of temporomandibular joint, psychological rehabilitation of children during speech formation, as well as to improve the prognosis of treatment in older age. The best period of treatment is a peak of growth and development. Growth is the most important factor in planning treatment of distal occlusion, since dramatic changes in correction are related to growth rather than teeth movement. Orthodontists forbear from recommendations for teeth extraction in growing patients, as they believe that it leads to worsening of face profile and does not allow to achieve optimal relationships of jaw and occlusion.
 In adult patients, complete conservative correction of distal occlusion is possible only in the absence of skeletal disorders. Combined method, namely combination of orthodontic treatment and orthognathic surgery, is an alternative for adults treatment.
 Adequate individual approach to orthodontic treatment in patients with distal occlusion complicated by dental crowding is based on a comprehensive clinical examination, scientific analysis and results interpretation of additional examination methods. Full functional occlusion is possible if all elements of dentition: occlusion, periodontal tissues, temporomandibular joints, muscles and nervous system, are considered. Stable results and positive prognosis are provided by normalization of physiological state of masticatory and mimic muscles.

Treatment of distal occlusion in children

The article presents data from domestic and foreign authors about the etiology, clinical manifestations and treatment of distal bite in children. The necessity and expediency of using the myofunctional apparatus Miobrace (MRC, Australia) is substantiated. The clinical case of using the myofunctional trainer MioBrace in the treatment of distal bite is considered in detail.

ЭФФЕКТИВНОСТЬ ОРТОДОНТИЧЕСКОГО ЛЕЧЕНИЯ ДИСТАЛЬНОГО ПРИКУСА У ДЕТЕЙ 7 ЛЕТ

Background. This scientific article shows the results of the use of removable orthodontic appliances in children with distal bite and a violation of nasal breathing. Distal bite is the most common anomaly of the dental system today. The most favorable period for the correction of the distal bite is an early interchangeable bite. The prevalence of distal occlusion increases with increasing patient age. There are a large number of orthodontic appliances for the treatment of distal bite. However, the question of the relationship between the effectiveness of the orthodontic apparatus and the severity of the distal occlusion remains relevant.
 Objectives ― to evaluate and compare the effectiveness of the use of removable orthodontic appliances in the treatment of distal occlusion in children 7 years old with a violation of nasal breathing.
 Methods. On orthodontic treatment were patients with a sagittal gap from 0 to 8 mm. A comparative description of the use of removable laminar devices, removable double-jaw apparatus Myobrace and functional trainers T4K was carried out. The examination included a clinical examination, an analysis of control and diagnostic models of the jaws, and an analysis of lateral projection of X-ray diffraction patterns.
 Results. In the treatment of distal occlusion, the sagittal slit is corrected. For the correction of the sagittal slit 0―2 mm, the use of removable plate apparatus with an inclined plane is most effective. The best dynamics of the correction of the sagittal slit 3―5 mm occurred in patients using the functional train Myobreis. The sagittal slit 6―8 mm is corrected in two stages using the T4K trainer.
 Conclusion. It was noted that in patients with distal occlusion, the effectiveness of the use of orthodontic appliances depends on the size of the sagittal slit before the start of treatment.

EXPERIENCE TREATMENT OF DISTAL OCCLUSION WITH IMPAIRED FUNCTION OF MASTICATORY AND FACIAL MUSCLES BY REMOVABLE FUNCTIONAL MAXILLARY ORTHODONTIC ACTIVATOR

Currently existing removable orthodontic appliances do not allow to provide the simultaneous treatment of distal occlusion and functional impairments of it. Thus aim of our research was to design and implement into practice the removable maxillary orthodontic activator which is able to treat the distal occlusion, control the tone of masticatory and facial muscles and restore the nasal breathing at the same time.

Treatment of distal occlusion in children

The aim of the study was to investigate the prevalence of distal occlusion in children of Karaganda region and improvement of orthodonontic appliances treatment methods. Complex dental examination of 1500 children of rural districts of the Karaganda region was carried out. Dental examination showed that 88% of children had dental and facial anomalies. Distal occlusion occured in 42% of children. There is a high prevalence of distal occlusion in pediatric population of Karaganda region rural districts. The use of original orthodontic appliance allowed reducing treatment time by SD=0.5 months and meet the aesthetic requirements of the patients.

Stability of results and function of the masticatory system in patients treated with the Herren type of activator.

Forty-nine individuals, aged 15–24 years, who had been out of retention for 3–8 years after treatment of distal occlusion with the Herren type of activator were examined for stability of the treatment results and the function of the masticatory system. The examination comprised measurements on dental casts of the overjet, overbite, molar relation and length, widths and relative space of the dental arches. Facial morphology was analysed from profile cephalograms and the function of the masticatory system by means of a questionnaire and a clinical examination. The treatment had brought about a substantial reduction of the overjet that was essentially stable after retention. The long-term effect on the overbite was slight. After retention, a partial relapse in the molar relation improvement achieved during active treatment occurred in the majority of subjects. The changes in upper arch widths were within the limits for normal growth. There were no marked changes in lower arch widths but the width between the lower canines tended to decrease. The dental arch lengths decreased and the crowding increased in both arches after retention. The morphology of the face at the follow-up examination was within normal limits except for a total facial retrognathism. The treatment had generally not brought about a lasting proclination of the lower incisors. The lip profile was also normal. The prevalence of symptoms and signs of mandibular dysfunction was in agreement with that found in random samples of untreated individuals. The prevalence of a large distance between the retruded contact and intercuspal positions of the mandible was high, however, indicating a functionally less statisfactory occlusion in part of the sample.

Stability of results and function of the masticatory system in patients treated with the Herren type of activator

Forty-nine individuals, aged 15–24 years, who had been out of retention for 3–8 years after treatment of distal occlusion with the Herren type of activator were examined for stability of the treatment results and the function of the masticatory system. The examination comprised measurements on dental casts of the overjet, overbite, molar relation and length, widths and relative space of the dental arches. Facial morphology was analysed from profile cephalograms and the function of the masticatory system by means of a questionnaire and a clinical examination. The treatment had brought about a substantial reduction of the overjet that was essentially stable after retention. The long-term effect on the overbite was slight. After retention, a partial relapse in the molar relation improvement achieved during active treatment occured in the majority of subjects. The changes in upper arch widths were within the limits for normal growth. There were no marked changes in lower arch widths but the width between the lower canines tended to decrease. The dental arch lengths decreased and the crowding increased in both arches after retention. The morphology of the face at the follow-up examination was within normal limits except for a total facial retrognathism. The treatment had generally not brought about a lasting proclination of the lower incisors. The lip profile was also normal. The prevalence of symptoms and signs of mandibular dysfunction was in agreement with that found in random samples of untreated individuals. The prevalence of a large distance between the retruded contact and intercuspal positions of the mandible was high, however, indicating a functionally less statisfactory occlusion in part of the sample.