The thesis provides theoretical generalization and new solution-date scientific and practical problems of modern dentistry - improve current methods of diagnosis, use of new treatments and prevention of relapse in patients with open bite using proprietary developed orthodontic appliances.
The purpose of the dissertation is to increase the efficiency of treatment patients with open bite, in particular, to reduce the frequency of relapses, by improving clinical and radiological diagnosis, choosing the optimal age for orthodontic treatment and the use of various designs of retention appliances.
In a mass survey of 1452 children aged 6 to 17 years in schools in Kyiv, dental anomalies were found in 1094 people - in 75.3% of cases. In particular, open bite is 2.3% of all surveyed, in the structure of dentition anomalies - 3.1%, and according to 1764 patients' referrals dental medical center NMU O.O. Bogomolets is 5.5%.
We received 73 patients with open bite from 8 to 12 years of age who applied for orthodontic help at the Bogomolets Dental medical center. Taking into account the clinical picture and etiological factors, patients were divided into groups and subgroups according to the parameters of the inclining of the teeth (protrusion or retrusion) and the type of face growth.
For the analysis of cephalograms were used parameters that objectively characterize the vertical aspect ratio of the facial skull.
According to cephalograms, the skeletal component of the open bite was diagnosed in 78%. The vertical direction of the growth of the facial skeleton was observed in 70% of the subjects, which had a prognostic value for choosing.
Developed an algorithm for conducting differential diagnostics of different form of open bite.
In order to improve the treatment effectiveness, the designs of orthodontic devices for the treatment of open bite (patents of Ukraine to the utility model No. 115089 dated July 23, 2017 and No. 117888 dated July 10, 2017), have been developed, which allow for targeted implementation and effective movement of teeth in a vertical plane.
The use of our orthodontic appliances for the treatment of open bite gave a positive result in 43 (81.1%) out of 53 patients, of which 31 (77.5%) out of 40 patients with vertical type of growth and 12 (92.3%) out of 13 patients with horizontal type of growth.
To performed an ACOVA was significant association of the treatment period with the treatment method, type of growth and age of the patient was revealed, the determination parameter R2adjusted = 0.7 at p <0.001. The analysis showed that the treatment period for patients in the main group is reduced (p <0.001) by 6.5 months (95% СI 5.1 months-7.9 months) relative to the comparison group. This is evidence of the effectiveness of open bite treatment offered by our appliances. In addition, it has been found that in patients with a vertical type of growth, the terms of treatment on average by 5.8 months (95% СІ 4.4 months-7.2 months) are longer (p <0.001) than in children with a horizontal type growth.
The method of constructing multifactor logistic regression models was used to evaluate the treatment effectiveness. The analysis revealed 3 significant risk factors: the design of the orthodontic appliances, age, and lower jaw angle (∠N-Go-Me). It was established that the risk of failure to achieve the treatment effect by the index of the size of the vertical gap is reduced (p = 0.04) with the use of the proposed orthodontic appliance, OR = 0.18 (95% СI 0.04 - 0.92) relative to the comparison group (for standartization for the age and ∠N-Go-Me index also increased the risk of failure to achieve the treatment effect (p = 0.005), OR = 2.3 (95% СІ 1.3 - 4.1) for each year of the patient's age (according to standartization by treatment and indicator ∠N-Go-Me).
Established that after the end of orthodontic treatment there is no complete normalization of the functional activity of mimic and chewing muscles, which may be the cause of relapse and requires a sufficiently prolonged period for its recovery. New designs of retention orthodontic devices (Patents of Ukraine for Utility Model No. 117886 dated July 10, 2017 and No. 117887 dated July 10, 2017) have allowed to improve the efficiency of the retention period.
With the help of mechano-mathematical modeling, the mechanism of action of the developed orthodontic devices used to stabilize the results of open bite treatment was analyzed.
Key words: children, open bite, diagnostic, orthodontic treatment, retention.
