In the dissertation, the results of radiological research are presented, in the process of which has been solved a number of scientific tasks, which allowed to achieve the goal - to increase the effectiveness of diagnosis and planning of orthodontic treatment of patients with anomalies with the ratio of dental arches and teeth position by developing an optimal radiation study algorithm using a cone-ray study. Computer tomography, television genography, orthopantomography.
The basis of the dissertation is an analysis of the results of the primary and secondary radiation examination of 1460 patients with anomalies of the ratio of dental arches and the position of the teeth that were surveyed from 2016 to 2019 at the Medical Center of UKRINMED Group LLC - the base of the Department of Radiology of the National University of Health. I'm named after P. L. Shupik.
The survey is executed on a cone-ray computer tomography of Planmeca Promax 3D. 1460 surveyed patients were divided into article: Men - 600 (41.1%) and women - 860 (58.9%); By age: from 6 to 18 years - 560 (38.3%), from 18 to 44 years - 900 (61.7%) and the number of signs of basic and concomitant pathologies.
The frequency of anomalies of the ratio of dental arches and the position of the teeth in patients on the basis of analysis of data orthopantomograms, television genograms, conical-ray computer tomography are determined; Analysis of the effectiveness of orthopantomograms, television genograms in direct and side projections, a tapered-ray computer tomogram with anomalies of the ratio of dental arches and teeth position; The correlation links between the age, the article and the risk of repeated treatment of the patient with anomalies of the ratio of dental arches and the position of the teeth are determined. 560 (38.3%) by patients aged 6 to 18 and 900 (61.7%) of patients aged 18-44 with a primary appeal performed orthopantomography and television genography. In the secondary examination, patients performed a CPT. The statistical and radiation features of patients have been analyzed that the number of patients with related pathologies was 478 (32.7%) in the age group of 6 to 18 years and 815 (90.5%) in a group of 18 to 44 years. These patients under our algorithm are recommended for adjustment of an orthodontic treatment plan in order to eliminate the signs of concomitant pathology. 82 (5.6%) and 85 (5.8%) Patients of the relevant age groups is recommended for further planning of orthodontic treatment.
Statistically proved the effectiveness of orthopantomography, television-radiation, conical-ray computer tomography in patients with anomalies of the ratio of dental arches and the position of the teeth by analyzing diagnostic accuracy, sensitivity and specificity in age groups 6 - 18, 18 - 44 years with a combination of signs of basic and concomitant pathology. .
The diagnostic model for the forecast of the secondary appeal of patients with a mathematical method of choosing an optimal diagnostic methodology is developed. The risk of secondary appeal at a maximum probability of 88% (with the sense above - the model predicts secondary appeal) is determined. In defined PR-coefficient of 0.79 - the research of OPTP and TRG is recommended; In terms of 0.85, the recommendation is to conduct a CPT in both age groups.
The purpose of the next stage of the dissertation research was to determine the radiation predictors that affect the repeated radiological examination of patients with abnormalities of the ratio of dental arches and the position of the teeth. In order to build a prognostic model as a result of the analysis were identified predictors of impact, which were statistically significant: groups - the number of signs of the main diagnosis, groups - the number of signs of comorbidities, retention, tooth rotation. The relationship between these indicators and the reversal index using a logit model was studied. The study of the above effects allowed us to build a diagnostic model to predict the risk of additional patient treatment after the initial diagnostic examination. The model is characterized by statistically significant coefficient estimates and high for biostatistical studies ROC Curve Area: 0.82. Interpretation of statistical characteristics of the method is similar to the above. In this case, the Cutoff Probability Point is the probability of no re-appeal, which separates the cases where re-appeal from those where it is not expected by the model. This means that if the model's estimated probability of re-treatment is less than 12%, this case should be classified as high risk. In terms of re-appeal risk, this value corresponds to a marginal probability of 88% (if the value is higher - the model predicts re-appeal).
