Etiology, pathogenesis, clinical picture, diagnosis, prevention and treatment of anomalies of individual teeth, color, structure of hard tissues h. Correcting malocclusion
IN clinical practice There are a wide variety of abnormal forms of dentition: narrowing of dentition (acute-angled, saddle-shaped, V-shaped, trapezoidal, generally narrowed and other forms), expansion of dentition, lengthening of dentition, shortening of dentition, dentoalveolar shortening or dentoalveolar elongation. Altered forms of dentition are usually observed with various malocclusions. Therefore, we will talk about the various reasons for the development of one or another form of dentition in the appropriate sections. In this section, it is advisable to outline the variations in the shape of the dentition of the permanent dentition.
The chewing apparatus has gone through a long evolutionary path of development from cartilaginous fish to humans. Evolutionary development The masticatory apparatus, having gone through the struggle of contradictions of differentiation and reduction, reached its greatest perfection in primates. If at the long stage of development of vertebrates from cartilaginous fish to hominids, the differentiation of the masticatory apparatus seems to come to the fore, then in the history of the development of hominids, as well as in the history of man himself, the reduction of the masticatory apparatus comes to the fore.
Hominids had a large canine and diastom. The reduction of the canine is probably associated with the loss of the function of defense and attack and the transfer of this function to the hand. At the same time, the anterior part of the dental system was significantly reduced. Consequently, the size of the incisors and canines decreases first. Next comes the turn of reduction chewing teeth, while the role of the key tooth passes from the second molar to the first. At the same time, the reduction of premolars occurs. This process is already noticeable in Sinanthropus. The Neanderthal man already had pronounced signs of reduction of all teeth.
Further reduction of teeth is characterized by an increase in cases of congenital absence of third molars, a decrease
teeth, increasing the degree of reduction of the tubercles. In recent millennia, the reduction of the upper lateral incisor has increased (a sharp decrease in size up to its complete absence).
F. Weidenreich believes that one of the reasons for the increasing process of reduction is general changes skulls associated with brain evolution.
It is currently believed that changes in the structure of food and the increasingly developing “laziness” of the masticatory apparatus are one of the most important reasons for the reduction of both teeth and, especially, alveolar processes.
Among the reasons that caused a later wave of changes in the human dental system, the rapid spread of caries should be noted. There are studies stating that caries more often affects people with large teeth and individuals with a more differentiated tooth structure (L.MLomiashvili, 1993). Probably, a rapid reduction in the size and simplification of the structure of human teeth can be considered a protective reaction in relation to caries (A.A. Zu6ov, 1968).
Differentiation processes under the influence of an increasingly complex function have led to the development of the most complex masticatory apparatus in humans (an incongruent temporomandibular joint, a developed articular tubercle, occlusal curves, highly differentiated chewing surfaces of the teeth). At the same time, the interaction of the processes of differentiation and reduction led man to the possession of the most vulnerable masticatory apparatus.
The literature describes in sufficient detail the structure of the normal dentition. The main pathological conditions are no less fully represented. However, the complex interweaving of internal and external factors, which determine the development of the masticatory apparatus, leads to the formation of transitional variants that cannot be attributed to the norm and which, reaching a certain degree, must be defined as pathological.
The upper incisors are located in the jaw in a slightly curved arc, sometimes almost in a straight line. Due to the frequent discrepancy between the sizes of the upper incisors and the sizes alveolar process they are often crowded together. Anthropologists call this phenomenon crowding. There may be different forms of crowding of the upper incisors. Most often, the central incisors are displaced in the vestibular direction, and the lateral incisors in the palatal direction, but it can also be the other way around. Often a reduction dentition in the area of the incisors is formed due to
the gates of the latter around an axis. The reduction of the anterior part of the upper dentition quite often occurs due to the reduction of the lateral incisors (from a decrease in size and change in the shape of the crown to the complete absence of rudiments).
In the row of upper incisors, a phenomenon of the opposite order is observed, namely, the presence of additional (supernumerary) teeth, most often the supernumerary tooth is located between the central incisors. It was called mesiodens. Supernumerary teeth are considered an atavism. The opposite phenomenon to crowding also occurs - gaps between teeth (diastemas and trema). The most important is the diastema between the central incisors, associated with excessive development of connective tissue in this area.
The upper canines, as a rule, are not subject to significant reduction. These are stable, well-developed teeth. Cases of supernumerary canines have been reported, but much less frequently in incisors. The canine usually protrudes somewhat in the vestibular direction. It is sometimes called an angular tooth, as it is located in the area of the angle of the alveolar process. Quite often, the upper canine teeth erupt abnormally or become fractured. This is not least due to the order of its eruption (it is, as it were, forced to “wedge” between the lateral incisor and the first premolar). Sometimes the opposite phenomenon is observed - a diastema between the canine and the first premolar.
The upper premolars are located on the rounded segment of the alveolar process arch upper jaw. Crowding of premolars may manifest itself in a shift of one of them in the palatal direction. As a rule, there are no spaces between premolars. In the area of the upper premolars, both differentiation processes are observed (massiveness and angularity of the vestibular tubercles, pronounced ridges and grooves, the formation of additional tubercles) and reduction processes (smoothing of the crown relief, a decrease in its size, a decrease in the intertubercular groove). Sometimes the reduction is expressed in the absence of the second premolar. The second premolar, as a tooth more susceptible to reduction, often has one root and one canal, while the first premolar has a more pronounced tendency to differentiate roots. The opposite process may also occur - hierodontia (third premolar).
With a normal ellisiform shape of the alveolar process, the upper molars are located along the arch. When paraboloid-
In the new and V-shaped alveolar process, they are located almost in a straight line. The upper molars in the alveolar process are arranged in a fan-shape, because their crowns are inclined towards the vestibular side. The most stable (key) tooth is the first molar, the most variable is the third molar. The most differentiated crown of the first molar has an additional Carabelli cusp. The third molar can be reduced to a bicuspid and single-tubercular form, and the number of roots often decreases (the medial and distal roots often merge, sometimes all three roots merge). In the row of upper molars, hypodontia (the third molar is missing) is often observed. The third molar is often impacted or abnormally positioned. This is due to lack of space on the alveolar ridge. Less commonly, hyperodontia (fourth molar) is observed in the row of upper molars. This is due to the presence of three premolars in the distant ancestors of humans and monkeys, one of which was transformed into a molar. Sometimes this molar can grow onto the distal surface of the third molars, forming an additional cusp.
The lower incisors, as a rule, are located on the alveolar process with a convex arc outward. They often have a crowded position with varying rotation around their axis. The reduction of the lower incisors is insignificant, and therefore hypodontia is extremely rare. Also rare is a supernumerary lower incisor between the central incisors. Diastsma occurs between the incisors, although much less frequently than on the upper jaw.
The lower canines, like the upper ones, protrude somewhat in the vestibular direction. A canine is a tooth that is little susceptible to reduction. The lower canine is very often located abnormally (usually displaced in the vestibular direction). Between the lower canine and the first premolar, a trema is often observed, which is due to the patterns of phylogenesis of the masticatory apparatus (for example, in predators, the upper canine enters this gap when the dentitions are closed). Edentia or, conversely, a supernumerary lower canine, as a rule, is not observed.
The first lower premolar is usually poorly differentiated and has a very small lingual cusp. It is slightly susceptible to reduction. The second lower premolar is differentiated. It belongs to the type of variable teeth, i.e. subject to reduction. This interaction of differentiation and reduction causes the lower second premolar to be
similar to the first premolar, and maybe, with a high degree of differentiation, resemble a molar. Thus, the shape of premolars varies widely: from canine-like to molar-like. If for the second premolar a canine-like shape is a sign of its high degree of reduction, then for the first premolar such a shape is not an indicator of reduction; on the contrary, such similarity to the neighboring class indicates insufficient differentiation. True types reductions are found only among variable teeth. The significant difference in the shape of the lower premolars can be explained by the weak delineation of the morphogenetic field in this area and the overlapping fields of other classes of teeth (canines and molars). The lower premolars are often crowded, although there may be space between the first premolar and the canine. Adentia occurs in the second premolar.
Lower molars modern man are located approximately in a straight line, although the third molar can occupy a different position up to its location in the branch of the jaw. The vertical axes of the lower molars are inclined towards the lingual side. The most stable in this series is the first molar. The roots of the first molars never fuse; the distal root sometimes has two canals. The roots of the second molars are straight, long, and sometimes fused. The third lower molar is the most variable tooth, its crown can have from 6 to 2 tubercles, the roots are short and curved. Edentia of the lower third molar is observed more often than the upper one. This tooth is often impacted. Presence of a fourth molar on lower jaw happens more often than on the top. Gaps (tremes) between the lower molars are observed very rarely.
Molars tend to move forward during life. This is very clearly seen in the example of the elephant’s dental system. In his lower jaw, a larger molar is replaced as it wears out by another, moving forward as if from an ascending branch. An elephant has a total of 6 sets of teeth. Since there are no other teeth in front of these two teeth, there is no obstacle to this forward movement. U close relative elephant - rock hyrax - there is a wide gap between the incisors and pre-carpal teeth. Another close relative, the manatee, has no incisors at all. Consequently, in this whole group of animals there is no obstacle to the manifestation of the tendency of the teeth to move forward.
In carnivores, there is a diastema between the canine and premolar teeth. Rodents and lagomorphs lack fangs, therefore, there is also a large gap between the incisors and molars. Diastema is also characteristic of anthropoids, prehominids and hominids. In modern humans, the anterior region has sharply shrunk jaw bones, there is no diastema, and the tendency for the molars to move forward has been preserved, so quite often one has to observe the phenomenon of crowding - crowded position of the teeth, especially in the frontal sector.
In clinical practice, there are a wide variety of abnormal forms of dentition: narrowing of the dentition (acute-angled, saddle-shaped, V-shaped, trapezoidal, generally narrowed and other forms), expansion of the dentition, lengthening of the dentition, shortening of the dentition, dentoalveolar shortening or dentoalveolar elongation. Altered forms of dentition are usually observed with various malocclusions. Therefore, we will talk about the various reasons for the development of one or another form of dentition in the appropriate sections. In this section, it is advisable to outline the variations in the shape of the dentition of the permanent dentition.
The chewing apparatus has gone through a long evolutionary path of development from cartilaginous fish to humans. The evolutionary development of the masticatory apparatus, having gone through the struggle of contradictions of differentiation and reduction, reached its greatest perfection in primates. If at the long stage of development of vertebrates from cartilaginous fish to hominids, the differentiation of the masticatory apparatus seems to come to the fore, then in the history of the development of hominids, as well as in the history of man himself, the reduction of the masticatory apparatus comes to the fore.
Hominids had a large canine and diastom. The reduction of the canine is probably associated with the loss of the function of defense and attack and the transfer of this function to the hand. At the same time, the anterior part of the dental system was significantly reduced. Consequently, the size of the incisors and canines decreases first. Next comes the reduction of the chewing teeth, with the role of the key tooth moving from the second molar to the first. At the same time, the reduction of premolars occurs. This process is already noticeable in Sinanthropus. The Neanderthal man already had pronounced signs of reduction of all teeth.
Further reduction of teeth is characterized by an increase in cases of congenital absence of third molars, reduction of teeth, and an increase in the degree of reduction of the tubercles. In recent millennia, the reduction of the upper lateral incisor has increased (a sharp decrease in size up to its complete absence).
F. Weidenreich considers general changes in the skull associated with the evolution of the brain to be one of the reasons for the increasing process of reduction.
It is currently believed that changes in the structure of food and the increasingly developing “laziness” of the masticatory apparatus are one of the most important reasons for the reduction of both teeth and, especially, alveolar processes.
Among the reasons that caused a later wave of changes in the human dental system, the rapid spread of caries should be noted. There are studies stating that caries more often affects people with large teeth and individuals with a more differentiated tooth structure (L.MLomiashvili, 1993). Probably, a rapid reduction in the size and simplification of the structure of human teeth can be considered a protective reaction in relation to caries (A.A. Zu6ov, 1968).
Differentiation processes under the influence of an increasingly complex function have led to the development of the most complex masticatory apparatus in humans (an incongruent temporomandibular joint, a developed articular tubercle, occlusal curves, highly differentiated chewing surfaces of the teeth). At the same time, the interaction of the processes of differentiation and reduction led man to the possession of the most vulnerable masticatory apparatus.
The literature describes in sufficient detail the structure of the normal dentition. The main pathological conditions are no less fully represented. However, the complex interweaving of internal and external factors that determine the development of the masticatory apparatus leads to the formation of transitional variants that cannot be attributed to the norm and which, reaching a certain degree, must be defined as pathological.
The upper incisors are located in the jaw in a slightly curved arc, sometimes almost in a straight line. Due to the frequent discrepancy between the size of the upper incisors and the size of the alveolar process, they are often crowded. Aptropologists call this phenomenon crowding. There may be different forms of crowding of the upper incisors. Most often, the central incisors are displaced in the vestibular direction, and the lateral incisors in the palatal direction, but it can also be the other way around. Often, a reduction in the dentition in the area of the incisors is formed due to the rotation of the latter around an axis. The reduction of the anterior part of the upper dentition quite often occurs due to the reduction of the lateral incisors (from a decrease in size and change in the shape of the crown to the complete absence of rudiments).
In the row of upper incisors, a phenomenon of the opposite order is observed, namely, the presence of additional (supernumerary) teeth, most often the supernumerary tooth is located between the central incisors. It was called mesiodens. Supernumerary teeth are considered an atavism. The opposite phenomenon to crowding also occurs - gaps between teeth (diastemas and trema). The most important is the diastema between the central incisors, associated with excessive development of connective tissue in this area.
The upper canines, as a rule, are not subject to significant reduction. These are stable, well-developed teeth. Cases of supernumerary canines have been reported, but much less frequently in incisors. The canine usually protrudes somewhat in the vestibular direction. It is sometimes called an angular tooth, as it is located in the area of the angle of the alveolar process. Quite often, the upper canine teeth erupt abnormally or become damaged. This is not least due to the order of its eruption (it is, as it were, forced to “wedge” between the lateral incisor and the first premolar). Sometimes the opposite phenomenon is observed - a diastema between the canine and the first premolar.
The upper premolars are located on the rounded segment of the arch of the alveolar process of the upper jaw. Crowding of premolars can manifest itself in a shift of one of them in the palatal direction. As a rule, there are no spaces between premolars. In the area of the upper premolars, both differentiation processes are observed (massiveness and angularity of the vestibular tubercles, pronounced ridges and grooves, the formation of additional tubercles) and reduction processes (smoothing of the crown relief, a decrease in its size, a decrease in the intertubercular groove). Sometimes the reduction is expressed in the absence of the second premolar. The second premolar, as a tooth more susceptible to reduction, often has one root and one canal, while the first premolar has a more pronounced tendency to differentiate roots. The opposite process may also occur - gynerodontia (third premolar).
With a normal ellipsoidal shape of the alveolar process, the upper molars are located along the arch. With a paraboloid and V-shaped alveolar process, they are located almost in a straight line. The upper molars in the alveolar process are arranged in a fan-shape, because their crowns are inclined towards the vestibular side. The most stable (key) tooth is the first molar, the most variable is the third molar. The most differentiated crown of the first molar has an additional Carabelli cusp. The third molar can be reduced to a bicuspid and single-tubercular form, and the number of roots often decreases (the medial and distal roots often merge, sometimes all three roots merge). In the row of upper molars, hypodontia (the third molar is missing) is often observed. The third molar is often impacted or abnormally positioned. This is due to lack of space on the alveolar ridge. Less commonly, hyperodontia (fourth molar) is observed in the row of upper molars. This is due to the presence of three premolars in the distant ancestors of humans and monkeys, one of which was transformed into a molar. Sometimes this molar can grow onto the distal surface of the third molars, forming an additional cusp.
The lower incisors, as a rule, are located on the alveolar process with a convex arc outward. They often have a crowded position with varying rotation around their axis. The reduction of the lower incisors is insignificant, and therefore hypodontia is extremely rare. Also rare is a supernumerary lower incisor between the central incisors. Diastsma occurs between the incisors, although much less frequently than on the upper jaw.
The lower canines, like the upper ones, protrude somewhat in the vestibular direction. A canine is a tooth that is little susceptible to reduction. The lower canine is very often located abnormally (usually displaced in the vestibular direction). Between the lower canine and the first premolar, a trema is often observed, which is due to the patterns of phylogenesis of the masticatory apparatus (for example, in predators, the upper canine enters this gap when the dentitions are closed). Edentia or, conversely, a supernumerary lower canine, as a rule, is not observed.
The first lower premolar is usually poorly differentiated and has a very small lingual cusp. It is slightly susceptible to reduction. The second lower premolar is differentiated. It belongs to the type of variable teeth, i.e. subject to reduction. This interaction of differentiation and reduction results in the fact that the lower second premolar can be similar to the first premolar, and can, with a high degree of differentiation, resemble a molar. Thus, the shape of premolars varies widely: from canine-like to molar-like. If for the second premolar a fang-like shape is a sign of its high degree of reduction, then for the first premolar such a shape is not an indicator of reduction; on the contrary, such similarity to the neighboring class indicates insufficient differentiation. True types of reduction are found only among variable teeth. The significant difference in the shape of the lower premolars can be explained by the weak delineation of the morphogenetic field in this area and the overlapping of fields of other classes of teeth (canines and molars). The lower premolars are often crowded, although there may be space between the first premolar and the canine. Adentia occurs in the second premolar.
The lower molars in modern humans are located approximately in a straight line, although the third molar can occupy a different position, up to its location in the jaw branch. The vertical axes of the lower molars are inclined towards the lingual side. The most stable in this series is the first molar. The roots of the first molars never fuse; the distal root sometimes has two canals. The roots of the second molars are straight, long, and sometimes fused. The third lower molar is the most variable tooth, its crown can have from 6 to 2 tubercles, the roots are short and curved. Edentia of the lower third molar is observed more often than the upper one. This tooth is often impacted. The presence of a fourth molar in the lower jaw is more common than in the upper jaw. Gaps (three spaces) between the lower molars are observed very rarely.
Molars tend to move forward during life. This is very clearly seen in the example of the elephant’s dental system. In his lower jaw, a larger molar is replaced as it wears out by another, moving forward as if from an ascending branch. An elephant has a total of 6 sets of teeth. Since there are no other teeth in front of these two teeth, there is no obstacle to this forward movement. A close relative of the elephant, the rock hyrax, has a wide gap between the incisors and precarpal teeth. Another close relative, the manatee, has no incisors at all. Consequently, in this whole group of animals there is no obstacle to the manifestation of the tendency of the teeth to move forward.
In carnivores, there is a diastema between the canine and premolar teeth. Rodents and lagomorphs lack fangs, therefore, there is also a large gap between the incisors and molars. Diastema is also characteristic of anthropoids, prehominids and hominids. In modern humans, the anterior section of the jaw bones has sharply decreased, the diastema is absent, and the tendency for the molars to move forward has been preserved, so quite often we observe the phenomenon of crowding - crowded position of the teeth, especially in the frontal sector.
a) Abnormal position of individual teeth
1. Labiobuccal teething
2. palatoglossus teething
3. mesial teething
4. distal teething
5. low position (infraocclusion)
6. high position (supraocclusion)
7. rotation of the tooth around the longitudinal axis (tortoanomaly)
8. transposition
9. dystopia
b) Tremas and diastemas between teeth
c) Close position of teeth (crowding)
a) Vestibular deviation of teeth
An anomaly of the dentition, which is a displacement of one or more teeth of the dentition outward - towards the lips.
In this case, as a rule, the incisors are displaced.
The main causes of vestibular deviation of teeth:
Delay in the replacement of primary teeth by permanent ones
Lack of space in the dentition
Incorrect location of the tooth germ
Nasal breathing problems in a child
Treatment involves moving misaligned teeth in the desired direction and holding them in the correct position using orthodontic appliances.
Oral inclination of teeth
An anomaly of the dentition, which is characterized by an inward displacement of one or more teeth - towards the tongue or palate.
The main causes of oral tilting of teeth:
Prolonged replacement of milk teeth with molars
Premature removal of baby teeth
Narrowing of the dentition
Incorrect location of permanent tooth buds
Supernumerary teeth in the dentition
Shortened frenulum of the tongue
Some bad habits of a child
Treatment involves opening the bite and moving the teeth in the vestibular direction using orthodontic appliances.
Supraposition- this is the displacement of the tooth in the vertical direction when the tooth is above the occlusal curve.
Reasons: absence of antagonist teeth in the upper jaw, incomplete eruption of teeth in the upper jaw, excessive growth of the alveolar process in the lower jaw and its underdevelopment in the upper jaw. Diagnosed by examining the mouth. The degree of displacement is set relative to the occlusal plane. The most informative method is teleradiography.
Treatment: Increase in dentoalveolar height as a result of bone building. This is achieved by creating traction that transfers the load through the periodontium to bone structures. Hooks, bracket systems, Angle arch.
Infraposition- displacement of the tooth in the vertical direction when the tooth is below the occlusal curve.
Causes: absence of an antagonist tooth in the lower jaw, incomplete teething in the lower jaw, excessive growth of the alveolar process in the upper jaw and its underdevelopment in the lower jaw.
Treatment: involves reducing the dentoalveolar height. This is done using plates with occlusal pads or bite pads. Andresen-Goipl monoblock, positioner.
Tortoanomaly- rotation of the tooth along the vertical axis. The rotation of the tooth can be of varying degrees: from a few degrees to 90° and even up to 180°, when the tooth is turned with the palatal side, for example, in the vestibular direction.
Reasons: insufficient space in the dentition, not correct position tooth germ, presence of supernumerary teeth, macrodentia. Diagnosed by examining the oral cavity. The size of the space in the dentition and the degree of tooth rotation are clarified by measuring on models. The relative position of the roots of the tortoanomalous tooth and adjacent teeth is determined on an orthopantomogram.
Treatment: involves the creation of a pair of forces directed in the directions opposite to the rotation of the tooth. Of the non-removable devices, the Engle device is most often used in combination with a ring on a moving tooth, a rubber or ligature traction. Best results achieved with the help of braces.
Transposition- mutual change in the location of teeth in the dentition, for example, a canine in place of a premolar, and a premolar in place of a canine.
Causes: atypical formation of tooth buds. A phenomenon close to transposition is when the tooth buds are displaced mutually as a result of insufficient space or due to provoking factors (supernumerary teeth, odontogenic neoplasms, etc.). In this case, an incomplete change in the relative position of the teeth occurs during eruption, expressed to varying degrees in the area of the roots and crowns.
Diagnosis is based on data clinical picture, x-ray examination and study of jaw models
Treatment: The choice of treatment method - surgical (removal of individual teeth) or orthodontic - depends on the degree of their displacement and inclination of the roots. It is advisable to remove teeth that have erupted outside the dentition and are rotated around an axis. Orthopedic treatment involves changing the shape of tooth crowns through prosthetics.
b) Gaps between teeth (diastemas and trema)
An abnormality of the dentition, which is characterized by the presence of spaces between the front incisors (diastema) or other teeth in the dentition (trema)
The cause of diastema can be:
Low attachment of the frenulum of the upper lip
The presence of a wide, dense bone septum between the edentulous central incisors
Anomalies in the shape and size of teeth
Presence of supernumerary teeth
Incorrect placement of anterior teeth
Early loss of one of them.
The cause of three may be:
Edentia
Some anomalies in the shape and size of teeth
Some abnormalities in the position of teeth
Displacement of teeth.
Treatment of this anomaly can be purely orthodontic or complex ( surgery with further hardware treatment). Tremes: plates with retraction arches, arm-shaped springs, trainers. Diastemas: Elastic traction on crowns, arches or bars. Plates with arm-shaped springs. Bracket systems.
c) Crowded teeth
An anomaly of the dentition, which is characterized by a close arrangement of teeth relative to each other, accompanied by rotation of individual teeth around their longitudinal axis and overlap of adjacent teeth with each other due to lack of space in the dentition.
The reason for such an anomaly in the dentition, as a rule, is the insufficient development of the alveolar process or the basal part of the jaw, and sometimes the relatively large size of the teeth, due to which some teeth cannot be placed in the correct position.
Treatment consists of making room for all teeth and then correctly positioning the teeth using orthodontic appliances and, if necessary, surgery.
56.Anomalies in the shape of the dentition. Etiology, clinical picture, pathogenesis, principles of orthodontic correction.
Abnormal forms of dentition are distinguished into the following types:
1) V-shaped, when the dentition is narrowed in the lateral sections, the central and sometimes lateral incisors are rotated around the longitudinal axis and the anterior section protrudes;
2) trapezoidal, when the dentition in the lateral sections is narrowed, and the anterior one is flattened;
3) a generally narrowed dentition, when both the anterior and lateral teeth located closer to the median plane than should be normal;
4) saddle shape, when the narrowing is most pronounced in the area of the second premolar and first molar;
5) asymmetrical shape, when the location of the lateral teeth to the median plane of one and the other side is different.
5) short frenulum of the tongue
57.Anomalies in the size of the dentition. Etiology, clinical picture, pathogenesis, principles of orthodontic correction.
Anomalies in the size of the dentition in the transversal plane:
Narrowed dentition. Narrowed dentition is characterized by a change in their shape due to a decrease in the distance between the median plane and the teeth located laterally from it. The narrowing of the upper dentition is determined in relation to the mid-sagittal suture, the lower - in relation to the median plane of the face and jaw.
The main etiological factors for narrowing the dentition are:
1) difficult nasal breathing, predominant breathing through the mouth;
2) sucking thumb, several fingers or foreign objects;
3) dysfunction of swallowing and speech;
4) parafunctions of facial and masticatory muscles and tongue muscles.
5) short frenulum of the tongue
6) sluggish chewing or chewing food on one side does not have a stimulating effect on the growth of the jaw bones
7) premature loss of temporary teeth, especially molars, significantly reduces chewing pressure, which is one of the main factors stimulating the physiological and proportional development of the jaw bones, which also causes their narrowing
8) general diseases of the body - rickets, dyspepsia, infectious and other diseases that affect metabolism, weaken the body and can cause narrowing of the dentition.
The narrowing of the dentition can be unilateral or bilateral, symmetrical or asymmetrical, on one or both jaws, without a violation of the closure of the dentition and with a violation. There are narrowing of the dentition with protrusion of the front teeth, crowded position, rotation of some teeth around the longitudinal axis, partial or complete retention of individual teeth.
Diagnosis is made based on clinical and x-ray examination, as well as studying control and diagnostic models of jaws. The width of the dentition in the area of premolars and molars is determined by the Pon method and the width of the apical base using snagina. Comparison of the obtained data with the individual norm allows us to determine the severity of the dentition and choose a rational method of treatment.
Treatment consists of expanding the dentition and their apical base, determining possible options placing individual teeth in the correct position.
Depending on the age of the patient, various orthodontic appliances are used. During the period of temporary occlusion, these are mainly positioners, functional Frenkel regulators; in mixed dentition - expansion plates with a screw or spring; in permanent dentition - arch devices with a bracket system. With a significant narrowing of the dentition, as a rule, some teeth are removed (usually the first premolars). At an older age, it is possible to use compactosteotomy and open the palatal suture.
Expanded dentition. Expanded dentitions are characterized by an increase in the distance between the median plane and the teeth located laterally from it. Expansion of the dentition is less common than narrowing.
The main etiological factors of expanded dentition and their apical basis are the following: abnormal formation of dental follicles, bad habits, parafunction of the muscles of the maxillofacial area, delayed physiological change of teeth, macrognathia, tumors, macroglossia.
Extended dental arch It can be a unilateral violation, bilateral, symmetrical, asymmetrical, on one jaw, on both jaws, without a violation of the closure of the dentition or with a violation.
During the period of temporary occlusion, vestibular plates, positioners, functional Frenkel regulators can be used (on the side of the dento-alveolar expansion, the side shield should be adjacent to the teeth and the alveolar process), Mühlemann propulsor, etc.; during the period of mixed dentition, along with those listed, it is recommended to use mouth guards with an unscrewed screw; during the period of permanent occlusion - mainly non-removable arc devices. Depending on the cause of this pathology, if necessary, connect surgical methods treatment.
2.1.Violation of formation And teething: absence of teeth and their rudiments (edentia), formation of supernumerary teeth.
2.2. Dental retention.
2.3. Violation of the distance between teeth (diastema, trema).
2.4. Uneven development of the alveolar process, underdevelopment or excessive growth.
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2.5. Narrowing or expansion of the dentition.
2.6. Abnormal position of several teeth.
3. Anomalies of dental relationshipsrows. An anomaly in the development of one or both dentitions creates a certain type of relationship between the dentitions of the upper and lower jaws:
1) excessive development of both jaws;
2) excessive development of the upper jaw;
3) excessive development of the lower jaw;
4) underdevelopment of both jaws;
5) underdevelopment of the upper jaw;
6) underdevelopment of the lower jaw;
7) open bite;
8) deep incisal overlap.
By Kalvelis classification distinguish anomalies of individual teeth, dentition and bite. Among the anomalies in the shape of the dentition, the author identifies a narrowed dentition, saddle-shaped compressed, V-shaped
different shapes, quadrangular shape, asymmetrical.
Malocclusions are considered in relation to three planes:
1) in the sagittal plane - prognathia, progeny;
2) in the transversal plane:
a) generally narrowed dentition;
b) discrepancy between the width of the teeth
rows - violation of the ratio
dentition on both sides and
violation of the ratio on one
side (oblique or cross
bite); c) dysfunction
breathing;
3) in the vertical plane:
a) deep bite - overlapping
or combined with pro-
gnathia (roof-shaped); b) from
closed bite - true (rahi
tic) or traumatic (from
finger sucking).
By classification by H.A. Kalamka-rowa(1972) among dental anomalies There are anomalies in the development of teeth, jaw bones and combined anomalies.
Dental abnormalities can form
to be carried out at all stages of their development
from the beginning of the formation of tooth primordia
until they are completely erupted and
location in the dentition.
To anomalies of dental development from
there are quantity anomalies,
shape, size, position,
violation of the timing of eruption,
tooth structures.
To anomalies in the number of teeth
include edentia and supercomp
lectical teeth.
Adentia (hypodontia) occurs as a result of the absence of a tooth germ. Edentia of several teeth (partial) or all teeth (complete) is possible. The most common cases are partial edentia of the lateral incisors of the upper jaw and second premolars.
Adentia leads to delayed growth and development of the jaw bones, deformation of the dentition and disruption of their closure. The most pronounced anomalies are formed with complete edentia.
Supernumerary teeth (hyper-odontia) occur in the presence of extra (supernumerary) tooth germs, disrupt the process of eruption of complete teeth, which changes the shape of the dentition and the type of their closure.
The location of the supernumerary tooth germ between the roots of the central incisors leads to the formation of a diastema (gap between the central incisors). The crowns of supernumerary teeth may have abnormal shape and size.
Anomalies in the shape and size of teeth include changes in the shape of the crown. These are ugly teeth that have an awl-shaped, barrel-shaped or wedge-shaped shape, as well as the teeth of Hutchinson, Fournier, Tourneur, which are found in certain diseases. Anomalies in the shape of teeth change the shape and integrity of the dentition.
Abnormal sizes include teeth whose mesiodistal dimensions are larger (macrodentia) or smaller (microdentia) than normal.
With macrodentia (giant teeth), the size of the teeth may be 4-5 mm larger than the normal size. In this case, the shape of the tooth crown is disrupted and fusion of the incisor roots is observed. The presence of giant teeth leads to disruption of the cosmetics, integrity, shape of the dentition and their closure, disruption of the function of chewing and speech.
Microdentia leads to a discrepancy between the size of teeth and alveolar processes. As a result, trema appear (gaps between the lateral teeth), a violation of the relationship of the dentition and their closure.
For a clearer and more complete diagnosis of anomalies of teeth, dentition, jaws and bite A.A. Ani-kienko and L.I. Kamysheva (1969) developed the basic provisions that formed the basis for the classification of dentoalveolar anomalies of the Department of Orthodontics and Pediatric Prosthetics of the Moscow State Medical University.
Classification of anomalies of teeth and jaws of the Department of Orthodontics and Children's Prosthetics of Moscow State Medical University (1990)
/. Anomalies of teeth.
1.1. Anomalies of tooth shape.
1.2. Anomalies in the structure of hard dental tissues.
1.3. Abnormalities in tooth color.
1.4. Anomalies in tooth size (height, width, thickness).
1.4.1. Macrodentia.
1.4.2. Microdentia.
1.5. Anomalies in the number of teeth.
1.5.1. Hyperodontia (in the presence of supernumerary teeth).
1.5.2. Hypodontia (dental edentia - complete or partial).
1.6. Anomalies of teething.
1.6.1. Early eruption.
1.6.2. Delayed eruption (retention). 1.7. Anomalies in the position of teeth (in one, two, three directions).
1.7.1. Vestibular.
1.7.2. Oral.
1.7.3. Mesial.
1.7.4. Distal.
1.7.5. Supraposition.
1.7.6. Infraposition.
1.7.7. Rotation along the axis (tortoano-malia).
1.7.8. Transposition.
2. Anomalies of the dentition.
2.1. Violation of form.
2.2. Violation of size.
2.2.1. In the transversal direction (narrowing, widening).
2.2.2. In the sagittal direction (lengthening, shortening).
2.3. Violation of the sequence of teeth.
2.4. Violation of the symmetry of the position of the teeth.
2.5. Loss of contact between adjacent teeth (crowded or sparse position).
3. Anomalies of the jaws and their individual
anatomical parts.
3.1. Violation of form.
3.2. Violation of size.
3.2.1. In the sagittal direction (lengthening, shortening).
3.2.2. In the transversal direction (narrowing, widening).
3.2.3. In the vertical direction (increase, decrease in height).
3.2.4. Combined in two and three directions.
3.3. Violation of the mutual position of parts of the jaws.
3.4. Violation of the position of the jaw bones.
I. Sagittal anomalies of occlusion. Distal occlusion (di-stocclusion) dentition is diagnosed when their closure in the lateral areas is disturbed, namely: the upper dentition is shifted forward relative to the lower one or the lower dentition is displaced
back in relation to the top; closure of the lateral group of teeth according to Angle’s II class. Mesial occlusion (mesioocclusion) dentition - a violation of their closure in the lateral sections, namely: the upper dentition is shifted back in relation to the lower one or the lower dentition is shifted forward in relation to the upper one; closure of the lateral group of teeth III Angle's class. Violation of the closure of the dentition in the anterior area - sagittal incisal disocclusion. When moving the incisors of the upper jaw forward or lower back, disocclusion of the frontal group of teeth, for example, disocclusion as a result of protrusion of the upper incisors or retrusion of the lower incisors.
II. Vertical anomalies approx.
inclusions. Vertical incisal
disocclusion - the so-called
open bite, at which from
there is no closure of the anterior groups
py teeth. Deep incisal disc
exclusion - the so-called deep
bite, when the upper incisors
cover the bottom ones of the same name
teeth without closing them. Deep
incisal occlusion - upper incisions
tsy overlap those of the same name
lower teeth more than y g high
you crowns; closure of incisors with
stored.
III. Transversal anomalies
occlusion. Cross Occlusion:
1) vestibulocclusion - displacement of the lower or upper dentition towards the cheek; 2) palatino-occlusion - displacement of the upper dentition to the palatal side; 3) lin-occlusion- displacement of the lower dentition towards the tongue.
L.S. Persii (1990) proposed a classification of anomalies of occlusion of the dentition, which is based on a principle reflecting the dependence of anomalies of closure of the dentition in the sagittal, vertical, transversal planes on the type of closure.
1. Anomalies of occlusion of the dentition.
1.1. In the side area.
1.1.1. Along the sagittal plane - distal (disto) occlusion, mesial (mesio) occlusion.
1.1.2. Vertically - disocclusion.
1.1.3. According to the transversal - cross occlusion, vestibular occlusion, palatine occlusion, linguoocclusion.
1.2. In the frontal area.
1.2.1. According to the sagittal - sagittal incisal disocclusion, reverse incisal occlusion, reverse incisal disocclusion.
1.2.2.Vertical - vertical incisal disocclusion, direct incisal occlusion, deep incisal occlusion, deep incisal disocclusion.
1.2.3. Along the transversal - anterior transversal occlusion, anterior transversal disocclusion.
2. Anomalies of occlusion of pairs of antagonist teeth.
2.1. By sagittal.
2.2. Vertical.
2.3. By transversal.
13.4. Etiology of dental anomalies
13.4.1. Endogenous causes
Genetic factors. The child inherits from his parents the structural features of the dental system and face - the size and shape of the teeth, the size of the jaws, the characteristics of the muscles, the function and structure of soft tissues, as well as their patterns
formations (Graber). A child can inherit all parameters from one parent, but it is possible, for example, that the size and shape of his teeth will be like his mother’s, and the size and shape of his jaws will be like his father’s, which can cause a violation of the relationship between the sizes of teeth and jaws (for example, large teeth with narrow jaws will lead to a lack of space in the dentition).
Hereditary diseases (developmental defects) cause a sharp disturbance in the structure of the facial skeleton. This group of diseases includes congenital clefts of the upper lip, alveolar process, hard and soft palate, Shershevsky's disease, Crouzon's disease, dysostosis, one of the leading symptoms of which is congenital underdevelopment of the jaw bones (unilateral or bilateral), Van der Woude syndromes (a combination of cleft palate and fistulas lower lip), Franceschetti, Goldenhar, Robin. Studies have shown that between a third and half of children with a cleft palate experience familial transmission of the defect.
Heavy system congenital diseases may also be accompanied by malformations of the teeth and jaws.
Hereditary diseases are developmental disorders of tooth enamel (imperfect amelogenesis), dentin (dentinogenesis imperfecta), and a developmental disorder of enamel and dentin known as Stenton-Capdepont syndrome. Anomalies in the size of the jaws (macro- and micrognathia), as well as their position in the skull (prognathia, retrognathia), are also inherited.
Anomalies of the teeth and jaws of a genetic nature entail disturbances in the closure of the dentition, in particular a violation of the closure along the sagittal. By inheritance
a type of violation of the vertical closure of the dentition can be transmitted (vertical incisal disocclusion, vertical incisal deep disocclusion and occlusion), piastema, low attachment frenulum of the upper lip, short frenulum of the tongue, lower lip, small vestibule of the oral cavity, as well as edentia. There is a certain relationship between anomalies of the oral cavity and the dental system. Thus, a low-attached frenulum of the upper lip can cause a diastema, and due to a short frenulum of the tongue, the development of the lower jaw in the anterior region is delayed and speech articulation is impaired. A small vestibule of the oral cavity and a short frenulum of the lower lip lead to exposure of the necks of the lower incisors and the development of periodontitis.
Endocrine factors. Very important in the development of a growing child has endocrine system, it significantly influences the formation of the dental system.
Endocrine glands begin to function in the early stages intrauterine development child, therefore, a violation of their functions can cause congenital anomalies of the dental system. Gland dysfunction internal secretion possible after birth. Deviations in the functioning of various endocrine glands cause corresponding deviations in the development of the dental system.
With hypothyroidism - decreased function of the thyroid gland - there is a delay in the development of the dental system, and there is a discrepancy between the stage of development of teeth, jaw bones and the age of the child. Clinically, there is a delay in the eruption of milk teeth; the replacement of milk teeth with permanent ones occurs 2-3 years later. Observed
multiple enamel hypoplasia; the roots of permanent teeth also form much later. The development of the jaws is delayed (osteoporosis), and their deformation occurs. Adentia, an atypical shape of the crowns of the teeth and a decrease in their size are noted.
With hyperthyroidism - increased function of the thyroid gland - there is a retraction of the middle and lower thirds of the face, which is associated with a delay in the growth of the jaws in the sagittal direction. Along with changes in the morphological structure of the teeth, dentition and jaws, the function of the masticatory, temporal and tongue muscles is disrupted, which together leads to disruption of the closure of the dentition, more early teething teeth.
With hyperfunction of the parathyroid glands, the contractile reaction of the muscles, in particular the masticatory and temporal muscles, increases.
As a result of calcium metabolism disturbances, deformation of the jaw bones and the formation of deep occlusion occur. In addition, resorption of the interalveolar septa and thinning of the cortical layer of the jaw and other skeletal bones are noted.
Due to hypofunction of the adrenal cortex, the timing of teething and the replacement of baby teeth is disrupted.
In patients with congenital androgenital syndrome, accelerated growth osteochondral zones of the facial skeleton. This is manifested in the development of the base of the skull and lower jaw in the sagittal direction.
Cerebrohypophyseal dwarfism is accompanied by disproportionate development of the entire skeleton, including the skull. The brain skull is quite developed, while facial skeleton even in an adult it resembles a child’s. This is due to a decrease in the sella turcica, shortening of the middle part of the face, upper
Etiology, pathogenesis, clinical picture, diagnosis, prevention and treatment of anomalies of individual teeth, color, structure of hard dental tissues, quantity (edentia, supernumerary teeth)
The abundance of classifications complicates communication between doctors, interferes with the study of literature and the use of the experience of various orthodontic clinics. It is more convenient to use the classification of D.A. Kalvelis without taking into account some details essentially related to the description of the clinics.
Clinical and morphological classification of Kalvelis dentofacial anomalies. YES. Kalvelis believes that the classification should be based on morphological changes relating to teeth, dentition and the entire occlusion as a whole, taking into account the etiology and significance of their deviations for function and aesthetics.
I. Anomalies of individual teeth
1.Anomalies in the number of teeth:
a) adentia - partial and complete (hypodentia);
b) supernumerary teeth (hyperdontia).
2.Anomalies in the size and shape of teeth:
a) giant teeth (excessively large);
b) spike-shaped teeth;
c) ugly shape;
d) teeth of Hutchinson, Fournier, Turner.
3.Anomalies in the structure of hard dental tissues: hypoplasia of dental tissues, hyperplasia.
4. Disorders of the teething process:
a) premature teething due to:
1) diseases (rickets and other serious diseases);
2) premature removal of baby teeth;
3) incorrect position of the tooth germ (dental retention and persistent milk teeth as rows;
b) discrepancy between the width of the upper and lower dental arches:
1) violation of the relationships of the lateral teeth on both sides;
2) violation of the relationships of the teeth on one side (oblique or crossbite);
c) respiratory dysfunction.
3. Vertical anomalies:
a) deep bite:
1) overlapping suggestive symptom);
4) supernumerary teeth;
5) abnormal tooth development (follicular cysts);
b) delayed teething.
II. Anomalies of the dentition
1. Violation of the formation of dentition:
a) abnormal position of individual teeth:
1) labiobuccal eruption;
2) palatoglossal eruption;
3) medial eruption;
4) distal eruption;
5) low position (infraocclusion);
6) high position (supraocclusion);
7) rotation of the tooth around the longitudinal axis (tortoanomaly);
8) transposition;
9) spaces between teeth (diastema);
10) close position of teeth (crowding);
b) dystopia upper canines.
2. Anomalies in the shape of the dentition:
a) narrowed dentition;
b) saddle-shaped compressed dentition;
c) V-shaped dentition;
d) quadrangular dentition;
d) asymmetrical.
III. Malocclusions
1. Sagittal anomalies:
a) prognathia;
b) progeny;
1) false;
2) true.
2. Transversal anomalies:
a) general narrowed teeth;
2) combined with prognathia (roof-shaped);
b) open bite:
1) true (rachitic);
2) traumatic (from finger sucking).
The procedure for making a diagnosis and drawing up a treatment plan .
Based on the generalization of patient examination data, a diagnosis is formed and a treatment plan is selected.
The diagnosis is formed in the following sequence:
1. Malocclusions: cross, deep, open - with or without displacement of the lower jaw (the Angle class can be indicated in brackets) and, if possible, etiology.
2. Additional anomalies (narrowing of the dentition, incorrect position of the teeth, etc.).
3. Morphological deviations from soft tissues (tongue, lips, cheeks, frenulum).
4. Defects of teeth and dentition, associated disorders and their etiology.
5. Dysfunction (if possible, etiology and pathogenesis, including bad habits).
6.Aesthetic violations.
Anomalies of individual teeth
There are anomalies in color, shape, size, structure of hard tissues, number and position of teeth.
Abnormalities in tooth color are rare. Depulpated teeth or teeth with pulp necrosis may be discolored. These problems are dealt with by dentists who specialize in restorations in combination with teeth whitening and aesthetic prosthetics.
Anomaly in the number of teeth expressed in increased or decreased quantities. Normally, a primary bite has 20 teeth, a permanent bite has 28-32. Currently, the dental system tends to be reduced, or rather, to be further improved and adapted to the new functional needs of modern man. In this regard, there is a disappearance of the upper lateral incisor, all wisdom teeth - upper and lower, and some authors talk about the reduction of small molars.
Among anomalies in the structure of hard dental tissues distinguish between hyperplasia and hypoplasia. The first is expressed in the presence of a sharply limited formation covered with enamel on the neck of the tooth or on the cementum of the root. These so-called enamel drops represent hypertrophy of dentin, covered on all sides with enamel.
Hypoplasiausually manifests itself in the symmetrical arrangement of dental tissue defects not only on teeth of the same name (incisors and first molars), but also on identical areas of the surface of the crowns. Examination of teeth from the point of view of their histological structure has not only local, but also general clinical significance, since it gives an idea of the general condition of the whole organism. Thus, hypoplasia indicates a violation of mineral metabolism and decalcification bone skeleton in childhood. If the central incisors are affected by hypoplasia, then this gives the right to talk about the process of decalcification in the first year of the child’s life. If all teeth, with the exception of wisdom teeth, bear traces of hypoplasia, then this indicates the continuation of the process until a later age. Anomalies in the structure of hard dental tissues also include fluorosis. It is a type of hypoplastic dental lesion, most often caused by an increase in the amount of fluoride in drinking water. These anomalies are not subject to orthodontic treatment.
The transitional stages of reduction of these teeth are expressed in the spiky shape of the lateral incisors and the altered morphology of wisdom teeth. All this, of course, is not a pathology, but the result of phylogenetic development.
We will pay special attention to consideration adentia and retention . A decrease in the number of teeth can also be the result of pathological changes in the dental follicle in the jaw, such an anomaly is considered by many to be true edentulism as opposed to false, that is, delayed eruption or retention. Both retention and edentia can be partial or complete (the latter is rare). Retention usually affects the upper canines, second premolars and wisdom teeth. Impaction of primary teeth is very rare. With retention of several permanent teeth, rudimentary clavicles, non-healing of the fontanel and cranial sutures are sometimes found in these patients - this anomaly is called Disostosis cranialis. Most often, the follicles of the lateral incisors of the upper jaw are absent, then the second and first premolars and wisdom teeth. When permanent teeth are edentulous, the resorption of the roots of baby teeth is delayed and they persist for a long time, remaining stable. These teeth are removed only according to strict indications.
The causes of adentia may be a violation of mineral metabolism in the prenatal period and after the birth of a child due to diseases of the pregnant mother and diseases of early childhood, dysfunction of the endocrine glands (encephalopathy), heredity, impaired development of the ectoderm, osteomyelitis of the jaws, leading to the death of tooth germs. Dental impaction, like edentia, is definitively diagnosed using radiographs. Impacted teeth may be fully or insufficiently formed and tilted toward the distal or mesial side.
Supernumerary teeth more often observed in the permanent dentition, less often in the milk dentition; more often on the upper (incisors, molars, premolars, canines) than on the lower (premolars, incisors, canines) jaw. Supernumerary teeth can be normally developed or have an abnormal shape (subulate). They can stand in the dental arch or outside it (vestibular, oral). Sometimes they are located between the upper central incisors, disrupting the correct position of the incisors and other teeth. With a significant jaw size, a supernumerary tooth may not affect the shape of the dental arch; With a small jaw, anomalies in the position of individual teeth occur.
Retained supernumeraries teeth may be accidentally discovered during X-ray examination.
The etiology of supernumerary teeth is not yet clear and there are many theories on this issue.
Shape anomaliesmost often touch their chewing or cutting surface. These anomalies occur in the lateral incisors and wisdom teeth. The upper lateral incisors are often subulate and other irregular in shape.
There are teeth with altered crown sizes - overdeveloped or underdeveloped (macrodentia and microdentia).
Macrodentia, or giant teeth, occurs as a result of the fusion of the follicles of two teeth or the follicle of a complete and supernumerary tooth, sometimes as a result of endocrinopathy. There are known cases with the lateral incisors of the upper jaw, sometimes canines, premolars and molars.
Disturbances in the formation of dentition.
Violations in the formation of dentition come down to two types: wrong the placement of individual teeth or groups of teeth and anomalies in the shape of the dentition, when the entire dentition is deformed and differs sharply from the typical appearance.
Abnormal positions of individual teeth. If the displacement of individual teeth is determined in three mutually perpendicular directions, then it is not difficult to identify six main types of displacement - horizontal (four) and vertical (two). In addition to these basic displacements, the tooth may be rotated around a vertical axis (tortoanomaly). There is also a so-called transposition, when the teeth change places. And the last abnormal form of teeth position is dystopia of the upper canines, which in essence is not new form displacement, however, highlight it in separate group advisable for purely practical reasons, since it relates to frequently occurring anomalies.
Labial-buccal teething, that is, the tooth is located outside the dentition, or palatine-lingual, when the tooth is located inside. The reason, as a rule, is a lack of space in the dentition or an eruption disorder. The vestibular position of the tooth usually causes noticeable disturbance appearance. Palatal (lingual) eruption most often occurs in incisors, canines and premolars.
With the labial-buccal position of the teeth, the function is not particularly impaired, and aesthetic disturbances mainly predominate. In the palatoglossus position, especially the upper frontal teeth, the chewing movements of the lower jaw are disrupted and the tongue is injured.
Children with supernumerary teeth. The frequency of examination by a dentist is once a year, by an orthodontist - once a year. obstetrician-gynecologist - weekly up to 1 month, pediatrician, orthodontist - weekly up to 2 months, 3 times a year up to 14 years.
The main attention should be paid to the presence of erupted supernumerary teeth of irregular shape or functional disorders in the dentofacial area.
The main ways of recovery: removal of erupted supernumerary teeth that have an irregular shape. At the age of 11 to 14 years, the solution to the problem of preserving a supernumerary tooth located in the dental arch and having the correct crown shape and removing a complete tooth located outside the dental arch. Removal of supernumerary impacted teeth with their superficial location. Changing the location of an impacted supernumerary tooth by moving the complete teeth using orthodontic appliances and removing the tooth after it has erupted. Reitz therapy.
Children with an abnormal shape of the central incisors, the presence of fused complete and supernumerary teeth, with large enamel drops. Examination by a dentist (once a year) and an orthodontist.
The main attention should be paid to the violation of the size and shape of the upper central teeth(giant teeth, teeth with cusps, enamel drops, merged with supernumerary teeth), location of teeth.
When the hard and soft palates are not fused, anomalies of individual teeth are widespread .
When isolated Non-union of the hard and soft palate (partial and complete) examination by a dental surgeon (once a year before surgery and once every 6 months in 2 years after it), an orthodontist (from 2.5 years to 12 years), a dental therapist (once every 6 months), an otorhinolaryngologist (one once every 6 months), speech therapist.
In case of complete non-union of the upper lip, alveolar process, hard and soft palate (unilateral and bilateral), the frequency of examination by a dental surgeon before and after surgery is once every 6 months, by an orthodontist - 2 times a year before transfer to a clinic for adults, by a dental therapist - once every 6 months, by an otorhinolaryngol - once every 6 months, by a speech therapist - from 8 months to 7 years - once a year, after surgery systematically until speech is fully established, by a pediatrician - once every 6 months, by an orthopedist - once every year.
The main attention should be paid to:
1) bite, with a bilateral cleft - on the size and position of the incisive bone;
2) condition of the nasopharynx;
3) growth of the bases of the jaws, the degree of underdevelopment of the upper jaw in the sagittal, transversal and vertical directions;
4) congenital absence rudiments of individual teeth in the upper jaw (lateral incisor in the area of nonunion, second premolars, third molars), anomalies in the position of the anterior and lateral teeth, the degree of carious tooth destruction, displacement of individual teeth towards the defect, the number of supernumerary teeth in the area of the alveolar process defect, shortening of the frenulum tongue, poor posture.
Main ways of recovery:
Orthodontic treatment from birth to 3 months (correction of the shape of the upper jaw, plastic surgery of a shortened frenulum of the tongue up to 3 months, plastic surgery of the upper lip at 3-4 months, veloplasty of the upper jaw at 2 months). Orthodontic treatment according to the McNeil method - stimulating the growth of the upper jaw along the edges of nonunion for up to 6 years. The second stage of the Schweckendieck operation is palate plastic surgery at the age of six. Orthodontic treatment, dentofacial prosthetics before transferring the patient to a clinic for adults (especially in the prepubertal period). Removal of supernumerary teeth and individual permanent teeth for orthodontic indications. A speech therapist, together with a physical therapy specialist and a pediatrician, trains external breathing and puts oral exhalation until 4.5-5 years, and then puts pronunciation individual sounds speech. Systematic sanitation of the oral cavity, pharynx, nasopharynx before palate plastic surgery. Normalization of posture. Treatment by a dental surgeon for excessive growth of the lower jaw.
Observation and treatment are carried out until the patient is transferred to a clinic for adults (cosmetic correction of the lip and skin-cartilaginous part of the nose at 16-18 years old).
Anomaly of development of individual teeth - a very common pathology that causes a whole series problems. According to the literature, such pathology occurs in 12-22% of cases among all dentofacial teeth.anomalies and deformations.
Anomalies in the development of individual teeth occurin the following classifications:
Classification non-carious lesions teeth (Stewart, Prescott, 1976):
1. Anomalies in the number of teeth:
a) hyperdontia;
b) hypodontia.
2. Anomalies in tooth size:
a) microdentia or macrodentia;
b) merger;
V) fusion.
3. Anomalies in tooth shape.
4. Anomalies of enamel structure:
A) imperfect amelogenesis;
b) enamel hypoplasia associated with the action of external factors;
V) local enamel hypoplasia;
G) hypocalcification enamels.
5. Anomalies of dentin structure:
A) dentinogenesis imperfecta;
b) dentin dysplasia;
6. V) regionalodontodysplasia. Anomalies in cement structure.
7. Abnormalities in tooth color.
Classification of non-carious lesions of hard dental tissues (T. F. Vinogradova, 1978):
1. Anomalies caused by external factors:
A) systemic enamel hypoplasia;
b) aplasia of the enamel of primary teeth premature babies;
V) local enamel hypoplasia as a result of trauma;
G) fluorosis;
d) "tetracycline teeth."
2. Anomalies that are hereditary and caused by imperfections in the structure of hard dental tissues:
A) imperfect amelogenesis;
b) dentinogenesis imperfecta;
V) Stainton-Capdepont syndrome.
3. Anomalies in the number, size and shape of teeth,genetically determined by heredity:
Type - autosomal dominant.
4. Anomalies of structure and malformations of tissues teeth that arise as a result of systemic pathology in the child's body:
A) Hutchinson's teeth for hereditary syphilis;
b) "amber "teeth with osteogenesis imperfecta;
V) gray-blue and brown teeth with hemolytic syndrome.
Abnormalities in tooth color
The color of a tooth depends mainly on the colorenamel, and it is enamel that is the tissue that transmits it normally. The color of teeth varies greatly among different people, as it is a hereditary trait. This is evidenced by the gama shades of artificial teeth, which we focus on when making dentures.
There are cases of hereditary transmission of suchteeth colors, like blue and pink enamel, in identical twins.
It is necessary to differentiate the innate color of teethand acquired. The latter can be predetermined by the impregnation of hard dental tissues by anycoloring solution. Yes, when filling roots channels resorcinol-formalin paste tooth subsequently acquires a pink color (Fig. 7.1),and when silvered - dark gray. Change meetscolor of dental hard tissues as a result of consumptionmedications such as tetracycline (lemon to dark brown). Currently this drugThey are not used in the pharmacopoeia, but others may appear. Only a correctly collected anamnesiscan help make a differentialdiagnostics. The color of teeth changes as a resultnot only endogenous, but also exogenous effects: smoking, consumption of food dyes, the effects of lead onindustrial enterprises. These color changes are mainly superficial - in the form of plaque.
Treatment consists of:
1 refillingcanals and tooth, and then bleaching chemical solutions
2 whitening intact teeth with ultraviolet beam (quartz).
The most commonly used treatment is orthopedic treatment, that is, dental prosthetics.
Anomalies in the structure of hard dental tissues
Tooth tissues have different origins: e codermal (enamel) and mesodermal (dentin, pulp, cement).
The process of tooth development consists of the following stages:
1 tooth laying;
2 formation of the crown part of the tooth;
3 loss of mineral components of enamel;
3 formation and loss of mineral components of root dentin;
4 tooth eruption;
5 formation of dentin and root cement;
6 root resorption (for temporary teeth);
7 final formation of enamel under the influence of saliva.
All of the above processes occur with the participation life support systems that are supporteddental pulp, periodontium and saliva.
Anomalies in the structure and development of the tooth can be the result of hereditary and acquired structural defectsprimary tissue (ectoderm and mesoderm), from which form enamel, dentin, cement, as well asmay occur as a result of a disruption of the mechanismformation of enamel and dentin of the tooth crown, dentinand root cement, mechanism teething tooth and root resorption, the mechanism of tooth ripening after teething . In addition, structural anomalies and malformations of the tooth can arise and develop as patterns in the pathogenesis of systemic pathology - hereditary, congenital and acquired (Fig. 7.2).
Anomalies in the structure and development of teeth can be classifiedfor T. F. Vinogradova, 1987.
Anomalies in the structure of dental tissues that are transmittedhereditary, caused by structural imperfectionstissues that form enamel and dentin (the appearancehereditary diseases and syndromes are caused byas a rule, hereditarily fixed changes genetic code, so-called mutations). Latestmay be caused by external factorsenvironment (ionizing radiation, etc.),and those arising under the influence of internal conditionsin a cell or in the body as a whole):
- Stainton-Capdepont syndrome (hereditary disorderstructure of enamel and dentin; type of inheritance autosomal dominant);
- amelogenesis imperfecta hypoplastic type;
- inheritance is recessive, linked to the Y chromosome, and autosomal dominant;
- dentinogenesis imperfecta of the hypoplastic type, recessive inheritance.
Anomalies in the number, size and shape of teethcaused by hereditary transmission. Type of imitationisolated pathology autosomal dominant.
Structural anomalies and malformations of dental tissues that arise as patterns of pathogenesissystemic pathology in the child’s body - hereditary , innate and acquired: " amber " teeth with imperfect amelogenesis ; Hutchinson's teeth congenital syphilis; gray, gray-blue, brownteeth with hemolytic syndrome and hemolyticjaundices of various types tiologies: adentia, hypodentia and spiny teeth with ectodermal dysplasia, microdentia with pituitary nanism (Fig. 7.3).
Anomalies of structure and malformations of tissues teeth, which are caused by the influence of external factors:
- fluorosis;
- "tetracycline teeth;
- systemic nonspecific hypoplasia of temporary tissuesand permanent teeth;
- partial or complete aplasia of the enamel of primary teethin children born premature, etc.;
- focal hypoplasia, which is caused by trauma, "chapped enamel (when breathing through the mouth);
- inflammatory processes;
- tumors, cysts, etc.
Rice. 7.1. The pink color of the 11th tooth is due to
filling root canals resorcinol-
formaldehyde paste.
Rice. 7.2. Aplasia of tooth 37 enamel.
Rice. 7.3. Imperfect amelo- and dentinogenesis, open bite, narrowing of the upper jaw.
Hyperplasia manifests itself in the presence of the neckor root cement sharply limited education, which is covered with enamel (so-called enamel drops). Hypoplasia is characterized by symmetrical locations of dental tissue defects not only onteeth of the same name, but also in the same areascrown surfaces. Hypoplasia indicates a violation of mineral metabolism and discalcification bone skeleton in childhood. Damage to hypoplasiacentral incisors gives the right to speak about the process of discalcification in the first year of lifechild, and if all teeth - about continuing the process to a later age.
Fluorosis is a type of hypoplasticdamage to teeth caused by fluoride content in drinking water(over 1.2 mg per liter). In this case, there arisesdecalcification of enamel, which manifests itself in the formationspots Fluorosis differs from caries in that fluorous the spot is lighter than carious.
Fluorosis is localized spots predominantlyon chewing mounds, and carious ones - in fissures and approximal surfaces.
Fluorose spots are located symmetrically. Novik I.O. distinguishes 3 degrees of tooth damage by spotted enamel (fluorosis):
- papery white and lightly pigmented small spotsenamel (mild form of fluoride intoxication);
- spotting occupies more than half of the surface of the crown (moderate degree of intoxication);
- spotting affects the entire tooth and is combined withenamel erosions. Most often this causes damageall teeth (severe formfluoride toxicosis, which is often combined with other pathological factors - rickets, infantile tetany,tuberculosis and other infectious diseases).
Anomalies in tooth shape
The most common cause of tooth shape abnormalities isthere is a pathology in the development of their rudiments. Distinguishanomalies in the shape of the crown parts of teeth and roots.
Anomalies in the shape of crowns may concern bothmorphological features of the chewing and cutting surfaces of the teeth, as well as the size of the crown.
These include:
- awl-shaped teeth, Hutchinson's teeth, ugly teeth - of uncertain shape, for example: "tooth in tooth" (dens in dentis);
- microdentia;
- macrodentia (that is, large or giant teeth);
When carried out a perfect differential diagnosisit is necessary to determine the number of teeth. As a rule, abnormal (subulate) shapes arecompleteteeth. But there are times whencomplete incisors have a tenon shape. This concernsmainly upper lateral and lowerincisors. There are forms of atypia and central upper incisors.
Treatment of the above pathology is carried outorthopedic methods, restoration of correctanatomical shape of teeth using cosmeticscrowns or therapeutic - using restorations with composite materials.
A special anomaly of dental development is represented byso-called teeth that have become angry or fused(Fig. 7.4).
Rice. 7.4. Fused teeth.
The first mentions of teeth that were angry are foundin the "Guide to the treatment of dental diseases",which was translated into Russian under the editorship ofProfessor Gruboe and issued in 1898 in Kharkov.The section on dental anomalies was written by a famous professorfrom Munich by Stranfield.
A. Sternfield distinguishes:
- teeth that have grown together;
- teeth that were angry;
- double teeth.
Howthe author notes that fusion concerns onlyroots of teeth, when cement forms a commonmembrane around the roots of two adjacent teeth. Underfusion should be understood as the organic combination of dentintwo adjacent teeth. The merger can spreadon both teeth as a whole or on crowns. In the formation of double teeth, the author provides for the presencecompleterudiments (inside one dental sac, not one, but two rudiments develop,which then merges completely or partially).
Wedl believes that double teeth are formed as a result of the fact that instead of one normal tooth germ, two are formed. And the difference in fusion and fusion is that with fusioncombination occurs with the help of cementthe end of the process of tooth formation, and upon fusion- during the formation of adjacent teeth. As notedauthor, only molars can be fusedusing cement. When teeth merge, notesA. Sternfild, the dentinal mass of one tooth passesinto the dentin mass of another. On top of such dentin mass in the area of the root part a generalcement capsule, and in the coronal part -general enamel shell. The merger boundary is markedmore or less pronounced furrow. Mergermay occur along the entire length of the teeth and is calledfull. In a partial merger, they merge ormolars, or crowns. Dental pulp cavitywho were angry, maybe common (single), separate and split (that is, forked nearroot or crown part). So chino m, pulp fusion cavities are not the main thing characteristic feature fusion of teeth.
The literature contains data on the merger of complete teeth with supernumerary ones. Some authors deny this, which indicates a difference of thoughts.
Teeth that were angry can be like permanent ones,so do baby teeth. Mainly subject to mergerfrontal group of teeth, namely: permanent central and lateral incisors with supernumerary teeth, milklateral incisors with primary canines (usually teeth,which were angry are the baby teeth). That's why inDuring the milk period of occlusion, teeth that have become angry do not disrupt the formation of dentition and bite. Dairyteeth that were angry are sometimes removed ifthey linger in the dentition. And most importantlyin this case, remove them in a timely manner!
Until recently permanent teeth who were angryusually removed. But such a solution to the issue is inappropriate. The most rational in aestheticregarding optionorthodontic treatment dental arches is the preservation of the frontal teeth, including the canines (the so-called “aesthetic six”), since there are no similar ones in the dentition.
Based on clinical, radiological and histological Research by S.I. Doroshenko (1991) identifies four types of dental fusion:
1 type - layering or building onto a complete set toothcomplete parts in the form spines or mounds;
2 type - fusion of only the crown part of the teeth;
3 type - fusion of tooth roots;
4 type - fusion of teeth along the entire length.
The author proposed an original methodtreatment of this dental anomaly, which consists of hemisections the less complete part of the tooth and providing the part that remains with the required shape of the complete tooth.
Various methods have been developed hemisections, depending on the nature of the fusion, its length, the age of the patient and orthodontictreatment for closure formed diastemas and three:
1) a method of treating teeth that were angry, with individualpulp cavities;
2) a way to treat teeth that were angry with only one pulp cavities;
3) a more gentle way to treat angry teeth, using a ledge-like hemisection;
4) way orthopedic treatment teeth that were angry.
Anomalies in the number of teeth
The normal number of teeth in a person is considered to be 32 teeth in the permanent and 20 teeth in the baby period.
Edentia or absence of teeth (Fig. 7.5)
Rice. 7.5. Multiple edentia (patient 17 years old).
Adentia is distinguished:
1) primary (that is, congenital absence of rudiments);
2) secondary - acquired (lack of rudiments as a result oftheir destruction as a result of temperatureinfluence or radiation influence, injury. Butsecondary adentia associated with tooth extraction , it is inappropriate to include here.
In addition, adentia is distinguished:
1) partial, when individual teeth are missing (from 1 to 3);
2) numerical (from 4 and more);
3) complete.
Complete absence of teeth is quite rare.In our clinic over the past 20 years we have encounteredonly 3 such cases (two of them had one impacted tooth).
Partial edentia is very common.This phenomenon, as noted by Kalvelis D. A. (1964), is explained by a physiological reduction in the number of teeth.On the path of reduction are the upper lateral incisorsand wisdom teeth - from changing shape (subulate) totheir complete disappearance. Easy partial formedentulism is the absence of one of the upper lateral incisors. Even in the absence of two lateralincisors, the aesthetic defect becomes more noticeable. If the absence of lateral incisors causesdistances between teeth, then numerical adentia - defects dentition with the following deformation occlusal relationships, as well as occlusion in general, requires complex special interventions. Becauseconsider numerical congenital missing teethas a phenomenon of phylogenetic reduction is impossible. IN In these cases we should talk about a general systemicdisease - the so-called e syndrome whodermal dysplasia.
Absence of wisdom teeth, special complications from the side of the dentofacial does not call the device. But their presence on one of the jaws can lead to relapses or complications dentofacial anomalies (if appropriate) when they teething Considering the above, some authors believeIt is advisable to remove tooth germs in a timely manner wisdom.
The goal of treatment for different cases edentulousthere must be restoration of the integrity of the dentition andwhile obtaining positive cosmetic effect. In other words - to ensure functional and cosmetic usefulness dentofacial apparatus.
Treatment methods for adentia:
1. Orthopedic (prosthetic).
2. Combined in complexorthodontic(hardware) and surgical methods.
Purely orthopedic method, renewaldentition defects, removable and non-removableDentures are not entirely complete.Advantage should be given to the combined one, that is,complex treatment.
First of all, necessary previous preparation of the oral cavity for prosthetics:
- e endodontic preparation, which consists of depulpation permanent temporary teeth in the absence ofroot resorption. This allows timelyeliminate unwanted pulp diseases asresorption organand thereby extendpresence of temporary teeth in the dentition,which is especially important with numerous edentiapermanent teeth. Such teeth, as studies have shownemployees of our department, you canuse a more rational design for support of dentures;
- orthodonticpreparation is about properarrangement of teeth in the dentition usingorthodontic devices.
In the absence of lateral teeth (one or two), diastemas or trema appear. Fangs shiftin place of the lateral incisors. Previous preparation consists of hardware relocation canines - distal, central incisors - medial(i.e. summary of diastemas) in order to create spacefor artificial lateral incisors. Orthodontic appliances can be used to move teethboth removable and non-removable. Often, gaps in teethrow with edentulous lateral incisors, on the contrary, are closed by moving the fangs in their place. In such cases, for aesthetic purposes, canines are restored in the shape of missing teeth using composites or covered with aesthetic crowns (plastic, combined). Large defects compensated with removable dentures.
Surgical preparation is especially important whennumerical and complete edentia and consists of transpositionteeth or their implantation. Numerical and partialadentia is classified as an ectodermal pathology.With numerical and complete edentia, there is a deviation on the side other organs. Yes, people with edentia have underdevelopedhair (fluff, or absent altogether), less sweat glands or theycompletely absent. As a result, severe dryness appears. skin(roughness,cracks, etc.). Thermal and watermetabolism in the body, which leads to complications, especially during the hot season and during physicalloads Overheating the body can causeshock and more severe consequences.
With edentia, inferiority is noted not onlydental tissue, but also bone. Weakened or such important biological stimulation is missinggrowth asteethingteeth. As a result, the alveolar processes are underdeveloped. Application of removableprostheses, especially those of irrational design, are complicated by circumstances and bone tissue atrophyprogresses. Alveolar processes are not adaptedto a similar method of transmitting chewingloads. Attempts at widespread useimplantations are still ineffective, which is due with bone deficiency. Future,obviously remains with the transplantation of rudiments andsearching for new treatment methods.
There are reports of successful carrying out transplantation of tooth buds, which was carried outG. Yu. Dranovsky from Makhachkala (Dagestan).Transplantation of primordia (altotransplantation) spent inexperiment on 331 dogs (puppies and adultsanimals), and then on patients (in 14 of them there waspositive result).
The technique was that the donor(cadaver "a) they took the rudiments and preserved them; wasthe so-called “bank” was created.
After implanted these rudiments into the bone of the recipient. Transplantation of primordia can be carried out:
1) intraorally (it has its disadvantages, under conduction anesthesia, infectionwounds, longer healing period);
2) extraorally (under general anesthesia , but faster, it only leaves a scar on the face, which is unprofitable with cosmetic point vision, especially in girls).
The operation is as follows: peel offtrapezoidalforms of mucoperiosteal flap,expose bone tissue. Then they cook it into bonesa corresponding bed for the allograft, that is, the rudiments;the wound is stitched up.
Supernumerary teeth ( hyperodontia )
In a certain world period (Eocene) dentalA number of a large number of mammals, including the ancestor of man, consisted of 44 teeth. Appearance in humansin the permanent occlusion period beyond 32 teeth,as noted by A. Sternfeld (1898), D. A. Kalvelis(1964) should be seen as an obvious returnto the past (that is, the phenomenon of atavism). Moreoversupernumerary teeth appear mainly in places where mammals used to have a large number of themquantity. Indeed, quite often we meetan increase in the number of teeth in the incisor area andpremolar(third incisors, third or even quarterspremolars) (Fig. 7.6).
Thus, about increasing the number of teethcan be said in cases where in dairythere are over 20 teeth in the occlusion, and in the permanent- over 32 teeth:
Busch distinguishes 3 types of supernumerary teeth:
1) awl-shaped with a conical crown and the sameroot;
2) lumpy teeth with a lumpy crown and crowscat-likesinking of its surface (they are also calledpremolar-liketeeth);
3) supernumerary teeth, similar in shape to complete.
Kollman distinguishes 2 types of supernumerary dental formations:
- supernumerary teeth appear simultaneously withpermanent;
- teeth develop slowly one after another. Authorexplains this phenomenon by the fact that budding "extra" rudiments ("enamel processes") fromthe dental plate can occur both horizontally , and vertically.
Rice. 7.6. Spike-shaped supernumerary tooth.
Supernumerary teeth not only disrupt the correctnessconstruction of dental incisors, but can disruptand processteethingteeth.Teethingsupernumerary teeth are associated with extremejaw growth, which, in turn, can causeemergencedentofacialdeformation. Most often, supernumerary teeth erupt between the central ones.incisors or in their place.
The treatment is that such teeth are usually, deleted. But sometimes supernumeraryteeth that resemble complete ones in shape are kept, while damaged and incorrectly positionedcomplete ones are removed. After removing supernumerariesteeth are often neededorthodontic(hardware) treatment for the purpose of correct locationteeth.
Anomalies teething teeth
Impacted teeth
Delayteethingteeth are calledretention. Occursretentionboth permanent and milk teeth. But baby teethretainedare very rare. More oftenretainedthere arepermanent teeth are usually in the following arrangement: canines, second premolar, wisdom teeth, central incisors, lateral incisors. Canine teeth are delayed as a result of insufficient jaw growth; the second premolar is often delayed due to the fact thatthe second temporary molar was removed prematurely; then the permanent first premolar moves mediallyto the first molar.
Impacted teeth can cause incorrectthe position of adjacent teeth, their inclination and the formation of the distance between the teeth. Reasonretentionthinkgeneral disease of the endocrine glands , the process may be genetically determined. For todayreasonsretentionteeth are considered early removal of baby teeth, insufficient chewing,do not use solid food - crackers, non-frictioncarrots, apples and more.
Retention May be partial(lack of oneor several teeth) and full -(when there are noall teeth). Atretentionpermanent teeth sometimesX-ray shows rudimentary clavicles, non-fusion of the crown and cranial sutures - this The anomaly was named by the authors - syndrome Andorsson-Pekker). We watched completeretentionteeth in a 15-year-old patient withpituitarydwarfism caused by dysfunction of the anteriorpituitary particles. Patient of dwarf stature(disproportionate dwarf), underdeveloped limbs, osteochondrosis of the joints and more. On the upper jawthere is not a single tooth, and one is erupting on the bottom onefrom incisors with a large inclination towards the alveolar process.On a plain radiograph, thicker bonesThere are almost all teeth germs of an ugly shape. Teeth crowns at the stage of mineralization. The crowns of the teeth seem to be “eaten away”, with areas of resorption in the form of varnish, whichresemble melted snow. The alveolar ridges are rounded and wide, the palate is deformed.
Moreover, the reasonretentionmay be: curvature of the tops of the roots; injury; cysts; discrepancy between the sizes of crowns and jaws.
Diagnoseretentionby radiographs.Impacted teeth can be fully formed or unformed and located withdifferent degrees of inclination.
F. Ya. Khoroshilkina with co-authors ( 1977, 1982) proposed to separate the violation teething individual teeth into 3 degrees retention :
1degree - called idiopathic (conditional)retentionteeth and is characterized by slowdevelopment of the tooth germ compared withsymmetrical;
2degree -retentionteeth due to their inclinationlongitudinal axes in relation to tooth that is in front, 15°, lack of space, underdevelopment of dentalarcs, etc.
3degree - standretention, characterized by bookmarktooth not in its directionproduction.
V. P. Nespryadko (1985) identifies 3 clinical forms of pathology teething :
1) temporaryretention
2) half retention
3) rackretentionpermanent teeth.
The main criterion for this division was the timingteethingpermanent teeth, degree of formation their roots, as well as the mechanismteethingpermanent teeth that were retained earlier.
The choice of treatment method depends on the degreeand typeretention. Teeth that stand straight after extractioncompleteand baby teeth, decorticationbone tissue, can be "set"into the dentition. If the tooth cannot be removed, then if there is space in the dentition, a transplant can be done, but such a tooth is not durable. Original treatment methodretainedteeth were proposed by V.P. Nespryadko. The essence of the method isas follows: under conduction anesthesia,corner (trapezoidal) section of softtissue to the bone and peel offmucosupraceousflap. Using a bur or chisel, removelayer of bone and expose the crownimpactedtooth The crown is exposed towards the equator and a thin burdelete bone tissue, which was adjacent to him.To the exposed part of the crownimpactedtooth select extended metal crown(from earlierprepared), which should fit onto the tooth without excesseffort, but fit tightly enoughand perform overcombalveolar processno less than 5-6 mm Ifimpactedthe tooth is directed towards the opposite row, it is desirable that the extended crown collides with the antagonistspalatal surface like an inclined plane. If necessary, position correctionimpactedhooks are soldered to the tooth crown and anecessaryorthodonticapparatus. The author believesthat the extended crown promotes transmission toretentionsfunctional pressure tooth, which isthe most populousstimulantteething. There are otherssurgical treatment methodsretentionteeth: decortication, exposure of the coronal part of the tooth with the following packing; decortication - release fromcoronal bone tissueimpactedtooth, throwing a metal loop (ligature) aroundanatomical neck with the following removal of freethe end of the ligature into the oral cavity. But significanttheir disadvantage is that they are all too traumatic andcause complications: wound infection, rupture of the loop (requires repeated intervention), losscystictissue, development of scar tissue of the mucous membrane and bone.
In recent years, they have become widespread more gentle treatment methods forretention. So I. E. Androsova (1977) for the purpose of stimulationregrowthteeth suggested usingKhonsurid. V.V. Galenko (1986) - pulsed electrical stimulation and eelectrophoresiswith adrenalinein an area of teeth that have not erupted.
Positive results with treatmentretardedteeth were obtained using new methodstreatments suggested by staffDepartment of Orthodontics and Orthopedic PropaedeuticsdentistryNMU(vibration influence usingultraphonophoresis lidazifromHosurid, vacuum therapy).
It is worth dwelling on such an important issue.When to deleteimpactedtooth and whether to remove itit at all, if there is no hope forproduction? In this regard, an interesting publication isthe British (Tgaseu S, Lee R.T. 1985), who clearly showed thatretainedteeth can be "aggressive", that is, cause destruction of the roots of neighboringteeth, sometimes with tightening of the pulp.
A significant issue is the availability of space in the dentition foreruption of retainedtooth At the same time, it is important complex treatment which includes hardware treatment, stimulation methodsand tooth extractions according to indications.
There are prematureteethingteeth and delayed (i.e.retention).
Experts have observed cases oftemporary teeth that erupt in newborns.In these cases, as a rule, the teeth are removed,to ensure normal feeding of the child.
Teethingteeth is one ofmorphophysiologicalsigns of organism development. Children with the highest indicators of physical development havemore prematureteethingteeth. It has been found that most teeth erupt in girls.earlier than boys.
Thus, the processteethingteethinfluenced by a number of diverse factors: local and general, endogenous and exogenous.
Occupies a special placeretentionteeth as a resultincorrect placement (atypical position).Cases described in the literatureteethingteeth into the nasal cavity, maxillary sinus and even into the eye socket (A.I. Marchenko, in 1962).
