Functional interaction of chewing muscles in children with dentoalveolar system anomalies

Relevance. The focus of modern dental treatment not only on the elimination of aesthetic, but also functional disorders requires an understanding of the functional conjugation of the chewing muscles, the possibility of interprognosis of parameters. Objective. Assess the functional relationship between the tone of the chewing muscles proper and the bioelectric activity of the temporal and sublingual muscle groups in children with anomalies of the dentoalveolar system. Materials and Methods. The study involved 36 patients of Childrens Clinical Dental Clinic No. 2 of Voronezh, aged 6 to 12 years, who had not previously received orthodontic treatment and had distal occlusion anomalies. Evaluation of the bioelectric activity of temporal and sublingual muscles was carried out using surface electromyography on the Electromyograph Dental apparatus (Taganrog, Russia), the Chewing General sample. Evaluation of the tone of the chewing muscles proper was carried out using the Mioton-3C device in a state of physiological rest of the lower jaw. Statistical processing was carried out using Microsoft Excel, version 7.0 and the statistical programs SPSS Statistics 21 and STATISTICA 7. Results and Discussion. Correlation analysis revealed the presence of 4 weak positive, 2 weak negative, 14 moderate positive, 3 moderate negative, and 1 noticeable positive correlation between the tone of the right chewing muscle proper and the parameters of the bioelectric activity of the right and left temporal and sublingual muscles. Correlation analysis revealed the presence of 5 weak positive, 7 weak negative, 9 moderate negative correlations between the tone of the left chewing muscle proper and the parameters of bioelectric activity of the right and left temporal and sublingual muscles. Conclusion. A greater effect of the tone of the right chewing muscle on the bioelectric activity of temporal and sublingual muscles was found compared to the tone of the left chewing muscle itself. 27 equations have been derived that can be used as predictive models for calculating the tone of right and left chewing muscles proper depending on the indicators of bioelectric activity of temporal and sublingual muscles.

RELATIONSHIP BETWEEN CLASS I-II MALOCCLUSIONS AND UPPER RESPIRATORY TRACT DISEASES

In recent years, there has been an increase in the prevalence of dental anomalies among children, and sagittal occlusion anomalies range from 33 to 67% of them. Quite high prevalence of distal occlusion causes morphological changes in the structure of the dentition that lead not only to functional impairment in the dentofacial system, but also in the entire oropharyngeal area. This forces scientists to search for new methods for the diagnosis and differential diagnosis of the conditions. The purpose of this study is to determine and compare anatomical dimensions (anteroposterior size and volume) of the upper respiratory tract in patients with occlusion pathology class I and II on the basis of cone-beam computed tomography. We measured the width of the upper, lower part of the pharynx according to the McNamara method, and the volume on 46 tomograms of patients with dentoalveolar anomalies aged from 8 to 29 years, who were divided into two groups according to the ANB angle into classes I and II. The patients of the group I had the average volume of 10.1 ± 1.27 cm3. According to the McNamara method, the width of the upper pharynx was 17.41 ± 0.44 mm, and width of the lower pharynx was 10.1 ± 0.73 mm. The patients of group 2 showed that the average value of the airpassageways volume was 9.3 ± 0.71 cm3. There was a statistically significant difference in the reduction of the width of the upper pharynx (р˂0, 05). Decrease in the width of the lower respiratory tract in the 1st and 2nd groups in the patients aged 15-29 years may be associated with changes in the cervical spine, resulting from postural disorders of the locomotive apparatus, which increases with age and affects the severity of the dental anomaly and the narrowing of the airways in the lower part.

Abstract 1122‐000031: Reasons Thrombectomy Candidates Become Ineligible After Transfer for Treatment in a Hub‐And‐Spoke Telestroke Model

Introduction : The care of emergent large vessel occlusion (ELVO) stroke patients has been revolutionized by endovascular thrombectomy (EVT). Given its robust efficacy, it is crucial to optimize delivery to eligible patients. Within hub‐and‐spoke hospital system models, some patients first present to distant spoke hospitals and require transfer to hub hospitals for EVT. We sought to understand reasons EVT candidates become ineligible after transfer for treatment. Methods : Consecutive EVT candidates presenting to 25 spokes from 2018 to 2020 with pre‐transfer CTA‐defined ELVO and Alberta Stroke Program Early CT Score ≥6 were identified from a prospectively maintained database. Outcomes of interest included hub EVT, reasons for EVT ineligibility, and 90‐day functional independence (modified Rankin Scale, mRS ≤2). Results : 258 patients were identified with median age 70 years (IQR 60–81) and 50% female. 44% underwent EVT upon hub arrival, of which 87% achieved Thrombolysis in Cerebral Infarction 2b‐3 reperfusion. Compared to EVT‐eligible patients, ineligible patients were older (73 vs 68 years, p = 0.04), had lower NIH Stroke Scale (NIHSS, 10 vs 16, p<0.0001), longer LKW‐hub arrival time (8.4 vs 4.6 hours, p<0.0001), and received less IV alteplase (32% vs 45%, p = 0.04). The clinical reasons cited for becoming EVT ineligible upon hub arrival included large established infarct (49%), mild symptoms (33%), recanalization (6%), distal occlusion location (5%), subocclusive lesion (3%), and goals of care (3%). Becoming EVT ineligible independently reduced the odds of 90‐day functional independence (aOR = 0.26, 95%CI = 0.12,0.56; p = 0.001), even when controlling for age, NIHSS, and LKW‐hub arrival time. Conclusions : Approaches to increase EVT eligibility among ELVO transfers may improve long term outcomes. A primary reason for becoming EVT ineligible is infarct growth. Future studies should explore triaging patients directly to EVT‐capable hubs when feasible, improving inter‐hospital transfer times, supporting ischemic penumbra before EVT, and developing novel neuroprotective agents.

Algorithm of diagnosis and treatment of patients with distal occlusion in the period of replacement bite

The purpose of the work is to establish the degree of influence of various modifiers on the course of chronic generalized periodontitis. We examined 83 periodontal patients. During the examination, in addition to the obligatory volume, data on somatic burden and dependence on smoking were included with the determination of the number of cigarettes smoked per day. Bleeding of the gums was determined in the area of all teeth. To determine the rate of progression of periodontitis on the basis of orthopantomogram data, an indirect indicator was calculated — the decrease in the alveolar bone in relation to the patient's age. It was established by the research that the modeling of periodontitis, with an identical hygienic state of the oral cavity of patients, is affected by concomitant somatic pathology, especially diabetes mellitus, making the course of periodontitis worse; and also a bad habit — smoking, which contributes to more pronounced vascular changes in the periodontium in patients with clinical manifestations of periodontitis. Recommendations are given to take into account the concomitant pathology of internal organs and the degree of dependence of patients on tobacco smoking when planning periodontal treatment, in order to correct these risk factors and motivate the patient to cooperate with a doctor.

Algorithm of diagnosis and treatment of patients with distal occlusion in the period of replacement bite

The article is devoted to treatment methods of young patients with class II malocclusion suffering from temporomandibular joint (TMJ) dysfunction. The authors proposed the improved treatment plan for the studied patients, which implies three stages: the first is a comprehensive functional analysis of the dental-maxillofacial system using digital technologies, the second one is the design, milling, manufacturing of occlusal overlays that allow to control occlusal plane slope and the last one is overlays luting and subsequent treatment with the help of aligners in order to normalize the relationship of the upper and lower teeth in three perpendicular planes with of retrusion control achieving. The described treatment method is disclosed in a clinical example.

PROSTHETIC TREATMENT OF PATIENTS WITH DISTAL OCCLUSION USING A DEPROGRAMMER (CLINICAL CASE)

Introduction. An actual problem of modern dentistry is the anomalies of the position of the lower jaw. The share of these diseases in the structure of requests for dental care can reach up to 27%. The most common pathology is distal occlusion, which accounts for 25 to 37% of all occlusion abnormalities. The aim of this work was to describe and demonstrate on a clinical example the method of orthopedic treatment of patients with distal occlusion proposed by the authors. Material and methods of research. The paper presents a new method of orthopedic treatment of patients with distal occlusion using a deprogrammer of the original design. Orthopedic treatment of patients was carried out on the basis of a multidisciplinary clinic of Postnikov in the city of Samara. Using the method proposed by the authors, orthopaedic treatment was performed in 36 patients with distal occlusion. For clarity, the article considers an original clinical case of treatment of a patient with distal occlusion, who was made a deprogrammer of the author's design, with a detailed analysis of each stage of diagnosis and orthopedic treatment. To confirm the effectiveness of the proposed technique, a CT scan of the patient's temporomandibular joint was performed before and after orthopedic treatment. As a result of the treatment, the patient has a decrease in the hypertonicity of the masticatory muscles, which made it possible to position the lower jaw in the position of the central ratio, which is confirmed by CT data. Conclusion. The use of a deprogrammer-mouthguard, the proposed design allows for deprogramming of the masticatory muscles and correctly determining the central ratio of the jaws, and can be used in the treatment of patients with distal occlusion.

APPLICATION OF THE TWIN-FORSE DEVICE IN COMBINATION WITH A BRACKET SYSTEM FOR THE CORRECTION OF DISTAL OCCLUSION IN ADULT PATIENTS

The aim of the study was to analyze the effectiveness of treatment of patients using the Twin-Forse apparatus in adulthood. A case of a 25-year-old patient was treated with a retroposition of the lower jaw, distal occlusion of the posterior teeth, sagittal incisal disocclusion, deep incisal disocclusion, narrowing of the deformation of the dental alveolar arches, protrusion of the upper and lower incisors, crowded position of the lower teeth. Fixed orthodontic appliances of the Damon Q system (Ormco, USA) were used. Half a year after the fixation of the bracket system, a Twin-Forse apparatus (Ortho Organizers Inc., USA) was installed. After half a year of wearing, the device was removed, the patient was assigned to wear intermaxillary elastics to achieve maximum fissure-tubercular contacts. It has been found that the use of the Twin-Forse device in adult patients helps to achieve optimal functional and aesthetic results.

Treatment of deep overbite in mixed dentition: a clinical case report

Relevance. Deep overbite is one of the most frequent malocclusions in children and teenagers of different ages. Distal occlusion with a deep overbite is the most common (59.6-67.6% according to the literature) in early mixed dentition. Most Russian and international authors state in their research that the severity of malocclusion increases with age. The treatment of the pathology in children is relevant due to deterioration of the deep overbite with age, worsening of functional disorders.Materials and methods. The study analyses the treatment results of a child with a deep bite using the authors’ technique.Results. The study demonstrated the advantages of the authors’ technique. The treatment allowed achieving normal dentoalveolar heights in the posterior mandible on molar and premolar eruption, establishing the correct relationship between the upper and lower dental arches that promoted harmonious development of the child’s maxillofacial area. The treatment regulated the length and width of the upper dental arch and corrected its form. The active intrusion of the lower incisors and extrusion of the lower posterior teeth were observed during the treatment. The curve of Spee was restored, and an increased overlap reduced. Occlusal contacts of posterior teeth improved, and deep overbite decreased. The technique is easy to use and allows curing 9-12-year-old children in a short period (7-10 months).Conclusions. The suggested technique treats deep overbite as well as creates conditions for the further harmonious development of the maxillofacial area. Thus, it can be recommended for the treatment in early mixed dentition.