The thesis presents the rationale and new solution to the relevant objective of modern dentistry is to increase the effectiveness of treatment of dentognathic deformations accompanied by phonetic disorders through a multidisciplinary approach to the development and use of a complex of diagnostic and therapeutic measures based on definition and refinement of etiopathogenetic connections of the dentognatic deformations with impaired sound pronunciation.
During examination of 462 children, age 6-12 years old in schools of Kyiv anomalies and deformations of the dentognatic apparatus was found in 83.3%. The abnormality of sound pronunciation was defined in 66.2%, in combination with occlusion pathologies – in 96.1%.
In the development of a complex of diagnostic and therapeutic measures, an examination of the ENT organs, muscular structures of the articulatory apparatus, orthodontic and phonetic diagnostics of 155 children, age 3-12 years old was conducted. Comprehensive otolaryngological, orthodontic treatment and speech therapy correction were carried out.
Clinical dental examination and treatment using removable (Schwarz`, Andresen-Haupl`s, Brückl-Reeykhenbakh`, Flis-Filonenko) and fixed (Mark Rosa) devices for 10-12 months, followed by a retention period were performed for 82 patients, age 6-12 years old with dentognathic deformations and phonetic disorders.
Anthropometric measurements were performed using the 3Shape Viewer computer program on scanned models of the jaws with determining the length of the anterior portions of the dentition using the Mirgazizov method and transversal dimensions using the Moorrees method. Cephalometric studies carried out by the Schwarz method using the computer program RadiocefStudio2, the superimposition of the cephalogram was carried out. The results of anthropometric measurements and the analysis of cephalogram showed positive changes in comparison with the initial clinical picture at the end of treatment, which is evidence of its effectiveness.
Cone-beam computed tomography of the skull to determine the volume of the respiratory tract was performed using a Gendex tomograph by iCAT CB-500. The obtained data were processed in the SIMPlant graphic dental program with the construction of multiplanar, panoramic and 3D reconstructions. Proven an increase in the volume of the upper respiratory tract by 53.8 ± 4.2% after the expansion of the upper jaw at the tooth-alveolar level which led to a change in the position of the tongue with its dislocation to the hard palate; thus improving the results of orthodontic treatment and correcting the sound pronunciation.
Attention was focused on the education of kinetic and kinesthetic praxis. Patients in addition to speech therapy classes used vestibular plates Dr. Hinz and removable devices with a bead, non-removable Bluegrass appliances, proposed devices for eliminating and preventing harmful language habits and training the muscular structures of the articulation apparatus (declarative patent of Ukraine #126393 from June 11, 2018).
A set of diagnostic and therapeutic measures for patients with dentognatic deformations, accompanied by phonetic disorders, consisting of motivational, diagnostic and therapeutic units were proposed. Motivational unit provided for the formation of a positive result of orthodontic and speech therapy treatment; creating an atmosphere of emotional comfort between an orthodontist, a speech therapist, a child and his parents; planning of personality-oriented treatment and remedial education. Diagnostic – establishing the type of dentognatic deformations, determining the state of formation of the phonetic side of speech, determining the state of the upper respiratory tract. Therapeutic - orthodontic treatment, depending on the type of deformations, the patient's age, the degree of formation of the dentognatic apparatus, the etiology of phonetic correction with obligatory and correctional tasks; otolaryngological conservative and/or surgical treatment of adenoiditis and tonsillitis; control of the level of oral hygiene, therapeutic treatment of pathologies of hard dental tissues, inflammatory processes of periodontal tissues and oral mucosa. This allowed the implementation of a comprehensive multi-vector treatment of maxillary deformations accompanied by phonetic disorders.
Evaluation of the effectiveness of the proposed therapeutic-dental complex of dentognathic deformations accompanied by phonetic disorders based on a multidisciplinary approach showed the need to determine the state of nasopharyngeal and palatine tonsils and proved the effectiveness of orthodontic treatment with speech therapy correction. Noted an improved electromyography, anthropometric measurements of scanned models of the jaws, cephalometry in 86.6% of patients
Key words: children, dentognathic anomalies and deformations, phonetic disorders, diagnosis, treatment, multidisciplinary approach.
