"Improving the methods of prevention and treatment of distal bite in children
with impaired lip closing function"
Dissertation for obtaining the degree of Doctor of Philosophy in the field of
knowledge 022 "Health care", specialty 221 "Dentistry".
National University of Health Care of Ukraine named after P.L. Shupyka of the
Ministry of Health of Ukraine, Kyiv, 2023.
In the dissertation, a clinical and laboratory solution to the current issue of
modern clinical dentistry was carried out - increasing the effectiveness of orthodontic
treatment of early variable distal occlusion with impaired lip closing function by
substantiating, developing and implementing the proposed treatment and prevention
scheme using a self-developed myofunctional orthodontic equipment.
The scientific novelty of the work consists in the studied features of clinical,
anthropometric and functional indicators of the maxillofacial system and functional
indicators of breathing in children with a distal occlusion with impaired lip closing
function in the period of early variable bite, which will make it possible to
comprehensively approach the choice of treatment method.
During the examination of 86 children aged 6-9 years with a distal bite and a
violation of the function of closing the lips, 40.6% and 59.4% of them were diagnosed
with a mixed type of breathing. The patients were divided into two main groups: the
1st group included children with an oral type of breathing (47 people), and the 2nd
group included children with a mixed type of breathing (39 people).
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According to the chosen method of orthodontic treatment, the experimental
groups were further divided into 2 subgroups. Subgroup 1 of both groups included
children who were treated according to the proposed method, and subgroup 2 -
according to the standard method. The control group consisted of 15 children of a
similar age without orthodontic pathology and a violation of the function of closing the
lips with a physiological type of breathing.
To increase the efficiency of patient treatment, the proposed method of using
removable mechanically acting orthodontic equipment, a complex of myogymastic
exercises, and a self-developed myofunctional vestibular plate of LykhotaMykhailovska (utility model patent No. 152016) is scientifically substantiated. The
complex of myogymnastics proposed by the author for children with a distal bite with
disorders of the function of closing the lips, which includes exercises aimed at
normalizing the function of the maxillofacial system as a whole. The standard method
of treatment included the use of Myobrace myofunctional devices and a complex of
myogymnastic exercises.
According to the results of the analysis of the obtained results, a number of
extremely important facts were established, and a number of important factors that
influence the formation of the distal bite in children 6-9 years old were determined.
The ENT examination of children showed adenotonsillar hypertrophy in 62.8%,
narrowing of the nasal passages in 22.1% and curvature of the nasal septum in 20.9%
of people, hypertrophy of the lower nasal concha in 15.1%.
In all children with oral breathing, a constantly open mouth was observed,
tongue sticking between the teeth - in 10.6%, hyperactivity of the chin muscle - in
14.9%, infantile swallowing - in 36.2% of people. 78.9% of patients of the 1st group
and 63.8% of children of the 2nd group showed significant impairment of the function
of the orbicularis oris muscle.
Index assessment (GI - 1.98 ± 0.33 and 1.2 ± 0.22; РМА - 40.2 ± 0.19 % and
26.4 ± 0.19 % (р≤0.05); SBI - 12.11 ± 0.02 and 10.25 ± 0.04; PI - 2.3 ± 0.12 and
0.98+0.4, respectively, in the 1st and 2nd groups) confirmed the presence of moderate
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gingivitis in children degree without violating the integrity of the tooth epithelial
attachment.
