METHOD FOR COMPLEX TREATMENT OF ADULT PATIENTS WITH NARROWING OF UPPER JAW Russian patent published in 2020 - IPC A61C7/00 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to orthodontics. Inter-root and inter-coronary measurements are taken before the beginning of treatment in the upper jaw model, which is an upper jaw digital model superimposed by an intraoral scanning of the dentition, and a computer tomography. That is followed by surgical preparation of an upper jaw enlargement: maxillary compact osteotomy of the upper jaw including two parasagittal cuts converging under the anterior nasal spine, osteotomy of bilge-alveolar ridges, anterior and medial walls of the maxillary sinus. Fragments formed after the osteotomy are mobilized. After osteotomy and wound closure, a distraction apparatus with an end-to-end maxillary fixation type is placed in the patient. On the fifth postoperative day, the distraction apparatus first activation is performed at 1.25 mm. Apparatus is activated twice day in 0.25 mm to achieve the desired enlargement result with 0.5 mm overcompensation. Then the screw of the device is fixed to avoid its spontaneous twisting. That is followed by an intermediate diagnosis, computed tomography and digital diagnostic and diagnostic models assessing the quality of the surgical intervention. Measurements are the same as those performed before the beginning of the treatment: the value of the upper jaw enlargement is determined on the dental crowns in millimetres: ΔX - expansion of crowns of teeth in millimetres, ΔY - expansion by teeth roots in millimetres. CAI is considered to be a crown-apical index using the formula CAI = ΔX/ΔY. In the CAI ≠ 1, the tooth displacement pattern is determined as being inclined-translational. In this case, the change in the dental implantation is calculated by calculating the difference in the angles formed by the longitudinal axis of the tooth and the perpendicular lowered on the occlusal plane from the apex of the root before the expansion and after the expansion of the upper jaw. Thereafter, the obtained values are compared between the same teeth of the left and right dentition. If observing differences between them, asymmetry of teeth movement is determined with upper jaw widening. Distraction apparatus is removed, waiting for recurrences and a surgical correction procedure is repeated taking into account the obtained data as a result of repeated diagnostic examination. If CAI = 1, the dental transfer pattern is determined as a result of maxillary expansion. Then, a fixed lock arc orthodontic appliance is installed. After 5–6 months of treatment on a lock arc orthodontic apparatus after switching to steel or titanium-molybdenum arcs, the distraction apparatus is removed and the orthodontic treatment is continued.

EFFECT: method enables reducing the risk of recurrence and side effects with maxillary expansion in adult patients, providing mobility of upper jaw fragments at the stage of surgical preparation for expansion, comparing the expansion of dentures, assessing changes in dental implants, an inclined component of teeth movement under the action of a distraction apparatus, symmetry of expansion of the upper jaw and a result of expansion of the upper jaw after the activation of the distraction apparatus.

1 cl, 13 dwg, 2 ex